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Biomedical subjects

A G Timoney

Publications and source records attributed to A G Timoney.

At least 37 records · Page 2Linked to original sources
PubMed2000

A prospective randomized trial comparing transurethral resection of the prostate and laser therapy in men with chronic urinary retention: The CLasP study.

PURPOSE: We assessed the effectiveness of laser therapy versus transurethral prostatic resection in men with symptomatic chronic urinary retention secondary to benign prostatic enlargement. MATERIALS AND METHODS: This trial was multicenter, pragmatic and randomized. Analysis was done by intent to treat. Laser therapy involved neodymium:YAG noncontact visual prostate ablation, while transurethral prostatic resection was performed by standard electroresection. Patients were included in our study if they reported moderate to severe lower urinary tract symptoms with an International Prostate Symptom Score (I-PSS) of 8 or more, benign prostatic enlargement and a persistent post-void residual urine volume of more than 300 ml. Followup was 7.5 months. Primary outcome measures included the I-PSS, I-PSS quality of life score, maximum urinary flow and post-void residual urine volume. Secondary outcome measures included treatment failure, complications, hospital stay and catheterization time. RESULTS: A total of 82 patients agreed to be randomized to receive laser therapy (38) or transurethral prostatic resection (44). There were significant improvements in all primary outcomes in each group from randomization to followup. Transurethral prostatic resection was significantly better than laser therapy for I-PSS and maximum urinary flow values (p = 0.035 and 0.029, respectively) but there were no differences in post-void residual urine volume and I-PSS quality of life score between the groups. We noted significantly more treatment failures with laser therapy than resection (8 versus 0, p = 0.0014), although only 3 patients required resection after laser therapy because of persistent symptoms. In addition, hospital stay after resection was 2-fold that after laser therapy (ratio of geometric means 2.01, 95% confidence interval 1.54 to 2.61, p <0.0001). However, time to catheter removal was 9 times longer in the laser therapy group (p <0. 0001). Complication rates were significantly higher for transurethral prostatic resection (chi-square 5.05, 1 df, p = 0.025). CONCLUSIONS: Transurethral prostatic resection is more effective than laser ablation in men with chronic urinary retention in terms of symptom score, maximum urinary flow and failure. However, men who underwent resection had significantly more treatment complications and were hospitalized longer than those who received laser therapy. This finding implies that laser ablation therapy may have a role in patients at higher risk who are willing to accept a lower level of effectiveness in exchange for decreased complication rates and hospital stay.

Humans↗
PubMed1999

Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones.

OBJECTIVE: To report our experience of using flexible ureterorenoscopy for upper urinary tract stones. PATIENTS AND METHODS: Thirty-seven patients (13 females, 24 males, mean age 48 years, range 10-76) with upper urinary tract stones not responding to other treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragments. RESULTS: Twenty-three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ureteric stones, 14 were rendered stone-free at the end of the procedure and 14 of the 22 patients with kidney stones were treated successfully; 80% of the lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no major complications. CONCLUSION: Flexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be reserved for such cases.

Adolescent↗
PubMed1999

A computer-assisted training/monitoring system for TURP structure and design.

A generic framework for a computer-assisted system for both soft tissue endoscopic surgery and surgical training is being researched and developed. The concept demonstrator is a specific system for transurethral prostatic resection (TURP). The main novelty of the research is that it is not confined to an in vitro trainer system. An in vivo monitoring version of the system, for use in the operating theater, is also being researched. This paper presents the framework's structure and design using the United Modeling Language. It also discusses and justifies the underlying information technologies chosen to implement this approach. Object-oriented concepts and well-proven mathematical tools have been adopted as the foundation of this research and development. The rationale for having chosen such tools is presented. The objectives are to arrive at a system which is modular, general, and reusable.

Computer Simulation↗
PubMed1993

The use of ultrasound in automated prostatectomy.

A new way of applying transurethral ultrasound scanning in the common surgical procedure of the transurethral resection of the prostate is described. The scanning is incorporated as part of a robotic procedure for surgery, so that the overall time spent in an operation can be further shortened, and a safe and accurate operation can be achieved. The prostate dimensions obtained pre-operatively by the transrectal method and those obtained operatively are compared. A robotic system, which was developed specifically to remove prostatic adenoma automatically, is discussed. The system, called a motorized frame, is briefly described, together with its predecessor, a manual frame, in relation to ultrasound measurements. Sizing of the prostate pre-operatively using transrectal ultrasound methods is discussed, using both the manual and the motorized frame. The shortcomings of transrectal ultrasound for use in a robotic procedure are highlighted.

Humans↗
PubMed1993

Management of the neuropathic bladder by suprapubic catheterisation.

Forty out-patients with neuropathic bladders managed by suprapubic catheterisation have been reviewed. Management included anticholinergic therapy and daily clamping of the catheter to maintain a compliant bladder of good capacity. Twenty-three females and 17 males (mean age 45 years) were studied. Failed intermittent catheterisation and the replacement of long-term urethral catheters were the main indications for suprapubic catheterisation. Catheter-related problems were common, with only 5 patients reporting none. Acceptance by patients was high (84%). No evidence could be found of accelerated renal deterioration in patients followed up for more than 2 years. A policy for the management of suprapubic catheters is recommended.

Adult↗
PubMed1993

Laparoscopic varicocele ligation.

A laparoscopic varicocele ligation was performed in 49 men with a clinically proven varicocele. Patients were treated predominantly on a day case or overnight basis with minimal post-operative morbidity. Identification of the testicular artery was aided by a laparoscopic Doppler probe in the majority of patients and preserved in 39 cases. The varicocele persisted in 7 patients, 4 of whom have subsequently had an inguinal exploration confirming a missed testicular vein as the source. In all 7 patients the artery was identified without the use of the Doppler probe, this being suggestive of misidentification of the vessels at laparoscopy. The complications included 4 wound infections, 1 scrotal haematoma and 1 vasal injury which necessitated an open vasovasostomy. Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling a rapid return to normal activity. The success rate can be improved by accurate identification of the testicular vessels with the use of a laparoscopic Doppler probe.

Adolescent↗
PubMed1992

Correlation of bacteriological flora of the urethra, glans and perineum with organisms causing urinary tract infection in the spinal injured male patient.

Positive urine cultures are common and often asymptomatic in the male spinal injured patient performing self clean intermittent catheterisation. It is possible that the positive urine cultures result from contamination from the colonised urethra at the time of catheterisation. This contamination could result in true infection of the bladder urine or yield false positive results, explaining the frequently seen asymptomatic cases. In a prospective study positive urine cultures were found on 58 occasions (74%) in 10 asymptomatic patients studied. In 19% of screenings, with positive urine cultures, an identical organism was cultured from the catheter specimen of urine, the perineum and the urethra. The flora of the anterior urethra is strongly correlated to that of the perineum (37.1%), as well as that of the bladder (52.6%). In 4 patients a correlation also existed between the urethra and fingers, and the perineum and fingers. This was associated with an increased incidence of positive urine culture in these patients. Suprapubic aspirates of urine before and after catheterisation cultured the same organisms. However, quantitative culture revealed colony counts that approached a 10-fold increase following catheterisation in one patient. This suggests that catheterisation is at least partially responsible for ascending infection in this group of patients. Catheter specimens were found to be a good representation of the bladder urine, with an 87.5% correlation.

Adult↗
PubMed1992

Measurement of surgical diathermy current during trans-urethral resection of the prostate gland.

A system is described that has been developed to measure the surgical diathermy current passing through the patient during each cut of a trans-urethral resection of the prostate gland (TURP), with 1.5% glycine solution as irrigant. The immediate aim was to distinguish capsular tissue of the male prostate gland from the hyperplastic adenomatous tissue within it. The ultimate aim was to prevent resection into the surgical capsule which can easily result in excessive blood loss and absorption of irrigant. The system was used in a conventional theatre setting with a commercial diathermy system (Eschmann TD 411-S) of known output characteristics. Measurements were made in 12 patients during resection with a standard loop, involving typically 75 cuts in each patient (60 in adenoma and 15 in capsule). In 8 of these patients this was followed by roller ball placement on typically 10 sites each of capsule or residual adenoma at very low diathermy settings. The results showed great variability both between patients, and between different cuts in the same patient, with no consistent difference between tissues identified under direct vision as adenoma and surgical capsule. Physical reasons are suggested for the observed variability, and it is concluded that it is not possible to use this technique to guide tissue resection in the prostate.

Electrocoagulation↗
PubMed1991

The development of a surgeon robot for prostatectomies.

The removal of prostatic tissue through transurethral resection of the prostate (TURP) is an operation that can require considerable skill from a surgeon as well as being a lengthy procedure. The potential for using robotic techniques was investigated in a preliminary feasibility study using a standard six axis 'Puma' robot. This led to the construction of a manually operated 'safety frame' which has been shown to be effective through clinical trials on 30 patients. A special-purpose robot, based on the design of the manual frame, has now been constructed. Some of the safety issues are discussed which make this procedure an ideal candidate for a robotic device.

Equipment Design↗
PubMed1990

Urological outcome in female patients with spinal cord injury: the effectiveness of intermittent catheterisation.

A review of 52 female patients with spinal cord injury is presented. Twenty five of 38 patients seen within 3 months of their injury were discharged on a clean intermittent catheterisation regime. Of the 14 patients seen at an interval of 3 months or greater after the injury, only 3 practised clean intermittent catheterisation but 8 had a long-term indwelling urethral catheter as the method of management. At 49 months median follow-up, only 14 (50%) continue on the programme of intermittent catheterisation and 9 (32%) are dry. This lack of success was due to incontinence, despite drug therapy in 17 patients. Recurrent symptomatic urinary tract infection occurred in 10 (36%). Thirteen of the 14 patients (92%) on long-term indwelling urethral catheter developed complications. Five patients voided normally. Automatic bladder emptying was employed in only 2 patients but was associated with the development of a non-functioning kidney in 1 and severe incontinence in another. Upper tract changes occurred in 7 patients (13%) including 3 on indwelling catheter drainage and 2 on intermittent catheterisation. Four patients have had implantation of the Brindley intradural sacral anterior root stimulator because of recurrent symptomatic urinary tract infections and incontinence in all 4. Post-operatively the incidence of infection has been reduced. Improvement in the degree of incontinence is related to the completion of posterior root section. Those patients who have no alternative to long-term catheter drainage are managed by the suprapubic route to avoid urethral incompetence. This is combined with catheter clamping for 2 hours daily to maintain bladder capacity and anti-cholinergic therapy to reduce detrusor contractility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Permanent external striated sphincter stents in patients with spinal injuries.

Nine patients with complete quadriplegia underwent external striated sphincter stenting with the Wallstent in place of an external striated sphincterotomy. Although suprapubic catheters were placed to provide an outlet should problems develop with the stent, they were successfully removed within 6 weeks in all but 1 patient. Complete bladder emptying with reduced voiding pressures was achieved, together with a significant reduction in the duration of hyper-reflexic contractions. Epithelialisation of the stent was almost complete within 3 months and intermittent catheterisation or endoscopy (and resection) is possible through the stent. Although this is a preliminary report of this new technique, it is hoped that sphincter stenting will provide a rapid, safe and effective method of treating high pressure hyper-reflexia and detrusor sphincter dyssynergia in quadriplegic patients.

Adult↗
PubMed1990

The Angelchik antireflux device: a 5-year experience.

A total of 44 patients had an Angelchik antireflux prosthesis inserted over a 5-year period. Of these, 41 were available for review and were assessed by interview using a modified Visick grading. Of the 23 patients followed up for a minimum of 3 years 74% had an excellent or satisfactory outcome; 92% of patients with symptoms of reflux obtained relief, but less than 50% of those patients presenting with dysphagia had a satisfactory outcome. The incidence of mild postoperative dysphagia increased the longer the period of follow-up. The main cause of a Visick 3 or 4 result was prosthesis migration. We have modified our technique of insertion to reduce these complications, and in a more recent series have achieved a Visick Grade 1 or 2 in up to 92% of patients. We conclude that dysphagia is a relative contraindication to the insertion of the Angelchik prosthesis. Our recent results encourage the use of the prosthesis provided steps are taken to reduce the incidence of migration and pericapsular fibrous tissue formation.

Adult↗
PubMed1989

The "plain film" bladder shadow in outflow obstruction: as accurate a discriminant of residual urine as ultrasound.

The height, width and area of the bladder shadow on post-micturition plain abdominal radiography was compared with the residual urine obtained at endoscopy from 58 men presenting with pure bladder outflow obstruction. Each parameter of the bladder shadow correlated significantly with the residual urine in patients in whom this shadow was visible. Post-micturition plain abdominal radiography is considerably cheaper than ultrasound and appears to be equally effective in the determination of residual urine. Its use as the sole imaging technique in the routine management of bladder outflow obstruction is recommended.

Aged↗
PubMed1989

Histamine and duodenal ulceration in renal transplant recipients.

Six of 25 renal transplant recipients had a duodenal ulcer at endoscopy. Histamine concentration and the activity of histamine methyltransferase, the degrading enzyme of histamine, were measured in gastric mucosal biopsies obtained at endoscopy and compared with patients with duodenal ulcer but not undergoing transplant and with patients with an apparently normal stomach and duodenum. Histamine concentrations in the corpus (no ulcer, median: 151 nmol/g; DU, median: 122 nmol/g) and in the antrum (no ulcer, median: 118 nmol/g; with DU, median: 113 nmol/g) of renal transplant patients, irrespective of ulcer diagnosis, and in patients with a chronic duodenal ulcer (median corpus histamine: 137 nmol/g and median antral histamine: 126 nmol/g) were not different from one another but significantly lower than the corresponding values in normal subjects (median corpus histamine: 241 nmol/g, p less than 0.01, and median antral histamine: 178 nmol/g, p less than 0.05). Histamine concentration in the corpus was significantly higher than in the antrum in all three groups of patients (p less than 0.05). There were no significant differences in histamine methyltransferase activity in any of the groups studied. Mucosal histamine and histamine methyltransferase activity were significantly correlated in the corpus (p less than 0.05) and antrum (p less than 0.02). Plasma concentration of histamine after transplant was higher in the patients who subsequently were discovered to have a duodenal ulcer (p less than 0.05). The occurrence of ulcer after transplantation was not related to the serum creatinine level. The uniform depletion of gastric histamine and increase in circulatory histamine after renal transplantation may be a factor in the pathogenesis of duodenal ulcer disease in this clinical situation.

Adult↗
PubMed1988

Microbiological look at urodynamic studies.

Urine samples were cultured for aerobic, fastidious, and anaerobic bacteria in 88 patients (66 F, 22 M) before and after standard urodynamic investigations. 37 of 42 women with detrusor instability, and 14 of 17 women with stress incontinence, had evidence of bacteriuria with aerobic or fastidious bacteria before investigation, as did 6 of 13 men with bladder outflow obstruction. 8 men (36%) acquired bacteriuria with aerobic bacteria after investigation, compared with 10 women (15%). Recalcitrant, irritative urinary symptoms in women may be caused by an underlying infection, the urodynamic changes being secondary. In men who have urodynamic studies, antibiotic prophylaxis should be considered.

Bacteriological Techniques↗
PubMed1988

Response of the benign hypertrophied prostate to treatment with an LHRH analogue.

Twenty patients with outflow tract obstruction secondary to benign prostatic hypertrophy were treated with an LHRH analogue, buserelin, for up to 6 months. Despite maintaining castrate levels of testosterone and achieving a significant reduction in tissue levels of dihydrotestosterone, no significant improvement was seen in flow rate or residual volume.

Buserelin↗
PubMed1988

Partial nephrectomy: an option in calculus disease?

Thirty-seven patients treated by partial nephrectomy for calculus disease between 1971 and 1986 were reviewed retrospectively. Of the 25 patients available for analysis, 20% developed immediate surgical complications, 20% had residual post-operative stone and 33% developed true ipsilateral stone recurrence during the period of follow-up. Our results from partial nephrectomy for calculus disease are compared with the results of treatment by percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy. It was concluded that partial nephrectomy should be reserved for situations where stone disease is associated with anatomical abnormalities which cannot be treated by the newer modalities of stone management.

Humans↗