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Biomedical subjects

A C Diokno

Publications and source records attributed to A C Diokno.

At least 19 recordsLinked to original sources
PubMed1992

The management of injuries to the urethra, bladder or vagina encountered during difficult placement of the artificial urinary sphincter in the female patient.

Between 1977 and 1989, an artificial urinary sphincter was implanted in 57 female patients. In 6 patients inadvertent intraoperative injuries to pelvic organs occurred, 5 of whom had a history of an average 2.8 previous operations for incontinence (range 2 to 4). The remaining patient was a 16-year-old girl with primary internal sphincter incompetence. All 6 patients presented with total incontinence. Intraoperative injury included 4 women who sustained vaginal perforations, while 1 had an anterior bladder perforation and in 1 the urethra was entered. Mechanisms of injury were sharp perforation of structures adherent to the pubis and blunt tears of distorted urethrovaginal tissues. Primary closures of the urethra, bladder and vaginal defects followed by insertion of the artificial urinary sphincter were accomplished successfully. Postoperative management included vaginal antiseptic packs, appropriate antibiotics and delayed sphincter activation. Of the 6 patients 5 remained dry after initial placement with a mean followup of 32 months (range 7 to 77). The remaining patient required replacement with a higher pressure balloon and a smaller cuff, which resulted in complete continence.

Adolescent↗
PubMed1992

Epidemiology of bladder emptying symptoms in elderly men.

We provide estimates of the prevalence, incidence and remission of difficult bladder emptying symptoms (prostatism) among noninstitutionalized men 60 years old and older living in a community in the United States. The prevalence of 1 or more symptoms of prostatism (hesitancy, straining, weak stream, intermittency or use of a catheter) among men who never had prostatic surgery is 35%. The annual incidence rates during years 1 and 2 of followup were 16.4% and 16.1%, respectively. Remission of symptoms of prostatism also was observed. Of the respondents with severe symptoms at baseline 22.9% were asymptomatic 1 year later. The prevalence of prostatic surgery in this population was 20%. The annual incidence rates during years 1 and 2 of followup were 2.6% and 3.3%, respectively. Urological and nonurological correlates of prostatism are identified. The irritative bladder symptoms are all significantly associated with moderate to severe bladder emptying symptoms (p < 0.0005). Nonurological conditions that also are associated with moderate to severe symptoms of prostatism include use of sedatives or tranquilizers, arthritis, poor health status and transient ischemic attacks. These observations are the initial step in documenting and understanding the various symptoms of prostatism, and its application in clinical practice.

Follow-Up Studies↗
PubMed1991

Relationship between use of diuretics and continence status in the elderly.

Although diuretics have been implicated as a cause of urinary incontinence, no evidence has been presented prior to this report to confirm such a relationship. Our epidemiologic survey of 1,956 respondents sixty years of age and older in Washtenaw County, Michigan, revealed 24.6 percent of men and 36.9 percent of women were current users of a diuretic medication. Comparisons between users and non-users of diuretics and continence and incontinence status revealed no significant difference in the prevalence of incontinence in either gender. However, when male respondents who had cystometric examinations were analyzed, it was found that diuretic users who have uninhibited detrusor contractions (UDC) had a significantly higher prevalence of urinary incontinence (85.7%) when compared with non-users with UDC (25%) (p = 0.009). Among men who did not have UDC, use or non-use of diuretics showed a similar relationship but did not reach statistical significance (p = 0.085). There were too few female respondents with UDC to make meaningful analysis in this group.

Aged↗
PubMed1991

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Aged↗
PubMed1990

Urodynamic tests for female geriatric urinary incontinence.

Most urodynamic tests currently in use in the evaluation of female urinary incontinence have not been applied to a community-based sample to determine their specificity. In this study of a random sample of noninstitutionalized elderly, 258 self-reported continent and 198 self-reported incontinent women sixty years and older, who participated in a household survey, underwent a clinic evaluation (history, physical examination, and urinalysis); of these 67 continent and 100 incontinent female respondents underwent urodynamic testing. The uroflowmetry, cystometry, and supine static urethral pressure profilometry (UPP) findings did not differ significantly between continent and incontinent subjects (whether based on a self-report or a clinician's diagnosis of urinary continence status). Standing static and dynamic UPP and lateral cystography showed significant differences between self-reported continent and incontinent respondents. The provocative stress test significantly distinguishes continence from incontinence, and stress incontinence from other types. The sensitivity of the provocative stress test was 39.5 percent, whereas its specificity is 98.5 percent. Urodynamic testing including uroflow study, static UPP, and lateral cystography should not be used as a screening test but rather selectively as a confirmatory test, and to determine the therapeutic approach, and to assess the outcome of therapy.

Aged↗
PubMed1990

Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults.

In this study, patterns of urinary incontinence, its severity and types were studied by three sequential data collections at annual intervals. The data are from a panel survey of a probability sample of 1,956 noninstitutionalized persons aged 60 and over residing in Washtenaw County, Michigan, who were interviewed in their homes about urine loss. Based on these self-reports, the prevalence of urinary incontinence was 18.9% in men and 37.7% in women. One-year incidence rates of about 20% among women and about 10% among men were found. One-year remission rates were about 12% for women and about 30% for men. When becoming incontinent, respondents were most likely to develop mild incontinence. Those who changed their severity level were most likely to progress from mild to moderate.

Aged↗
PubMed1990

Sexual function in the elderly.

Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.

Aged↗
PubMed1979

Review of neurogenic bladder in multiple sclerosis.

Neurologic involvement of the urinary bladder and urethral sphincter in multiple sclerosis has been known for some time. Thirty-one patients with a proved diagnosis of multiple sclerosis were evaluated urologically for symptoms of urinary incontinence, retention, or urinary tract infection. On initial presentation, 27 (74 per cent) were found to have neurogenic bladders of which 23 (85 per cent) were of the uninhibited type. Electromyography of the periurethral striated muscle revealed vesicosphincter incoordination in 9 of the 19 patients studied. Approximately one-half of the patients with uninhibited bladders had uncoordinated sphincters. Modalities of treatment are discussed.

Adult↗
PubMed1979

Testicular tumor in male pseudohermaphrodite with X/XY chromosomal mosaicism.

A case of testicular tumor in an intersex patient is presented. Knowledge of the potential of gonadal malignancy is important in the management of disorders of sexual differentiation. These patients, in whom the fields of oncology, embryology, endocrinology, and genetics intersect, provide a fruitful ground for clinical investigation.

Adult↗
PubMed1979

Self-catheterization for decompensated bladder: a review of 100 cases.

The non-neurogenic decompensated bladder is a poorly defined entity. In an attempt to elucidate this condition 100 consecutive patients with non-neurogenic decompensated bladders were studied, etiology was sought and treatment with intermittent self-catheterization was done. Of the patients 34 per cent were able to resume voiding. Bacteriuria and pyuria were decreased from 90 to 18 per cent. Complications were few and over-all acceptance was excellent. A definition of non-neurogenic decompensated bladder was established.

Adolescent↗
PubMed1979

Intermittent catheterization in children less than 6 years old.

Neurogenic bladder dysfunction often requires treatment early in life. Intermittent catheterization is an accepted means of treatment in older children and adults but its use in young children and infants has been limited because of fear of urethral injury. The results of managing 42 patients less than 6 years old by intermittent catheterization are presented. Excellent results were achieved even in small infants.

Child, Preschool↗
PubMed1979

Enuresis: principles of management and result of treatment.

We studied 115 consecutive cases of primary enuresis. Excretory urography, urodynamic testing and endoscopy are needed only in children with enuresis and concomitant urinary infection. A detailed urologic history was the most important factor in deciding upon a treatment program. Children with diurnal and nocturnal enuresis or nocturnal enuresis and daytime urgency and frequency of urination are started on anticholinergic medication. Girls with enuresis and urinary infection also are started on anticholinergic medication. Significant improvement occurs in up to 90% of the patients. Children with only nocturnal enuresis and no other symptoms are started on imipramine with a 70% improvement rate.

Adolescent↗
PubMed1979

Neurogenic bladder dysfunction.

The combined use of cystometry and perineal electromyography permits the physician to detect abnormalities in the synchronization of bladder contraction and urinary sphincter relaxation. With each pattern of neurogenic bladder disease, the coordination between bladder and sphincter determines whether urinary tract problems will develop. Treatment is tailored to specific bladder and sphincter defects.

Humans↗
PubMed1978

Urodynamic evaluation of female stress urinary incontenence.

To understand further the urodynamics of female stress urinary incontinence 6 patients with this condition were studied before and after anterior vesicopexy. The evaluation included uroflowmetry, cystometry, urethral pressure profilometry, anatomical urethral length measurement with the subject in the supine and standing positions, demonstration fo stress incontinence and cystourethroscopy. These procedures, except cystometry and cystourethroscopy, were repeated 7 days and 4 to 6 weeks postoperatively in most patients. All patients had short preoperative functional urethral lengths and standing anatomical lengths and all were lengthened after the anterior vesicopexy. The urinary flow rate demonstrated decreased peak and average flow rates 1 week postoperatively but complete recovery 4 to 6 weeks later. We believe that this study reaffirms the importance of urethral length in the pathophysiology of female stress urinary incontinence and, by demonstrating decreased flow rates in the immediate postoperative period, draws attention to the need for careful observation of voiding after catheter removal to avoid bladder decompensation. The marked improvement observed in the 4 to 6-week postoperative period reveals that anterior vesicopexy does not obstruct the urethra since no tissue posterior to the urethra is used. These urodynamic studies have proved to be valuable adjuncts in the evaluation of female stress incontinence.

Adult↗
PubMed1977

Bladder dysfunction after radical abdominal hysterectomy.

Bladder dysfunction is a common occurrence following radical hysterectomy. We studied bladder function prospectively in 10 patients before and after radical hysterectomy. Results suggest that the hypertonic phase observed immediately postoperatively is the result of an increase in myogenic tonicity of the detrusor muscle secondary to the trauma of operation and prolonged catheter drainage. The inability of patients to urinate effectively is due to partial detrusor denervation. Combined cystometry and electromyography confirmed the presence of normal sphincter function and the absence of detrusor sphincter dyssynergia. Prevention of postoperative bladder atony includes a careful preoperative urologic evaluation, including cystometry. Postoperative bladder care should emphasize the prevention of overdistention. Inability to empty the bladder after operation may be managed effectively by intermittent self-catheterization, Urecholine, or prolonged catheter drainage. Patients should be evaluated periodically to uncover delayed bladder decompensation.

Bethanechol Compounds↗
PubMed1977

Action of oral and parenteral bethanechol on decompensated bladder.

A double blind balanced Latin-square study was conducted on 20 adult patients with decompensated bladders to determine the relative effectiveness of oral and parenteral bethanechol chloride (Urecholine) on the stretch response of bladder muscle. Detrusor reaction was measured by modified cystometry. Five mg. of subcutaneous bethanechol chloride produced a significant increase in intravesical pressure which was more rapid in onset, of larger magnitude, and of shorter duration than oral doses of 100 and 200 mg.

Administration, Oral↗