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A J Schaeffer

Publications and source records attributed to A J Schaeffer.

At least 19 recordsLinked to original sources
PubMed2000

Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction.

PURPOSE: The role of bacteria in the chronic pelvic pain syndrome (nonbacterial prostatitis and prostatodynia) is controversial and difficult to assess because the bacterial flora of the prostate is not well defined. Polymerase chain reaction (PCR) is a highly sensitive molecular method of bacterial detection. It confirms the sterility of tissue with a high level of confidence and detects small numbers of microbial agents that may represent pathogens. We performed PCR to determine bacterial colonization of the prostate in presumably healthy men and in those undergoing simple or radical prostatectomy. MATERIALS AND METHODS: We analyzed 28 prostate samples from 18 organ donors from whom prostate tissue was obtained under sterile surgical conditions at organ withdrawal, 14 sterile surgical prostate specimens from 7 patients undergoing radical prostatectomy for prostate cancer who previously underwent transrectal biopsy and 6 sterile surgical specimens from 2 men who underwent simple prostatectomy for benign prostatic hyperplasia (BPH), including 1 with an indwelling catheter for several weeks. For PCR we used 2 sets of primers to detect bacterial 16S rRNA gene sequences. Normal prostate tissue seeded in vitro with known numbers of Escherichia coli was used to assess the sensitivity of PCR. RESULTS: Only 3 of the 28 organ donor samples had histological signs of minimal inflammation and all other samples appeared to be normal without evidence of inflammatory reaction. All of these samples were PCR negative. Of several PCR control reactions the mixture of prostate tissue seeded with known numbers of E. coli demonstrated the high sensitivity of the assay, allowing the detection of as few as 6 bacteria in the presence of 25 mg. of prostate tissue. A focal and heterogeneous distribution of inflammation and infection was noted in the 14 radical prostatectomy specimens. In the prostate cancer and BPH groups there was a strong association of inflammation with positive PCR findings. Of 11 samples 3 without but all 9 with inflammation were PCR positive. CONCLUSIONS: PCR is a highly sensitive method for detecting bacteria in the prostate. In our study negative PCR reactions in the prostate tissue of apparently healthy men made the presence of normal bacterial flora in the prostate extremely unlikely. The presence of bacteria and/or inflammation in radical prostatectomy specimens was found to be a localized process. Concordance between inflammation and positive PCR results in simple and radical prostatectomy specimens suggests that bacteria may frequently have a role in histologically inflammatory prostatitis.

Adolescent↗
PubMed1999

Questionnaire based results of the bulbourethral sling procedure.

PURPOSE: The success rate of the bulbourethral sling procedure to treat post-radical prostatectomy incontinence has been reported in a previous chart review analysis. We present further evaluation of the procedure using postoperative mailed questionnaires. MATERIALS AND METHODS: Between October 1994 and October 1997, 66 men underwent the bulbourethral sling procedure at our hospital. Postoperatively all patients with indwelling bolsters were mailed questionnaires to assess continence status, discomfort and voiding patterns. RESULTS: Of the 66 patients 4 required bolster removal for infection (2), erosion (1) or pain (1), and 1 died. These patients were not assessed further. Questionnaire data were obtained from the remaining 61 patients. At a median followup of 9.6 months (mean 11.9, range 3 to 30) 25 patients (41%) reported complete cure of incontinence, 32 (53%) required no pad for protection and 52 (85%) required 2 pads or less. Persistent perineal numbness or discomfort was present in 32 patients (52%). Of 12 patients who received adjuvant radiation therapy only 1 (8%) was cured. CONCLUSIONS: The short-term success rate following the bulbourethral sling procedure is high but persistent perineal discomfort is common. Adjuvant radiation predisposes to treatment failure.

Aged↗
PubMed1999

Urodynamic analysis of the bulbourethral sling procedure.

PURPOSE: The bulbourethral sling procedure is successful in correcting incontinence following radical prostatectomy. However, the mechanism of action of the sling is not intuitively clear. We analyze the results of urodynamic testing on a cohort of men who underwent the bulbourethral sling procedure. MATERIALS AND METHODS: Between October 1994 and October 1997, 66 men underwent the bulbourethral sling procedure at our hospital. All but 1 patient underwent preoperative video urodynamic testing. Intraoperative urethral pressure profilometry and abdominal leak point pressure measurements were performed. Additionally, all patients were invited to undergo followup video urodynamic testing. Results were correlated with current continence status. RESULTS: Preoperatively all patients demonstrated intrinsic sphincter deficiency. Following sling placement postoperative Valsalva leak point pressure values were significantly increased but maximum resting urethral pressures were unchanged. Preoperative and postoperative Abrams-Griffiths nomograms were not consistent with postoperative bladder outlet obstruction. Postoperative voiding pressures were consistently less than corresponding Valsalva leak point pressures. CONCLUSIONS: Patients undergoing video urodynamic testing following the bulbourethral sling procedure demonstrated unobstructed voiding patterns, despite significant increases in Valsalva leak point pressures.

Humans↗
PubMed1999

Prostatitis: US perspective.

The diagnosis and management of prostatitis syndromes is a challenge to the clinician. Careful history and examination of the prostate fluid and quantitative segmented bacteriologic cultures will lead to proper categorization into the recognized forms of the prostatitis syndrome. Antimicrobial therapy is effective in the majority of men with acute and chronic bacterial prostatitis (CBP). Fluoroquinolone agents appear to have an increasingly important role in this regard, although a randomized, prospective, double-blind study is still lacking. Alpha-1-selective blocking agents may relieve symptomatology of chronic pelvis pain syndrome (CPPS). Other non-prostatic sources of voiding symptoms should be sought and ruled out, especially malignancy or inflammatory disorders.

Adolescent↗
PubMed1999

Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA).

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of two specific types of urinary tract infections (UTIs): uncomplicated, acute, symptomatic bacterial cystitis and acute pyelonephritis in women. The guideline does not contain recommendations for asymptomatic bacteriuria, complicated UTIs, Foley catheter-associated infections, UTIs in men or children, or prostatitis. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent women. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members represented experts in adult infectious diseases and urology. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendation and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council, the sponsor and supporter of the guideline. The American Urologic Association and the European Society of Clinical Microbiology and Infectious Diseases have endorsed it. An executive summary and tables highlight the major recommendations. Performance measures are described to aid in monitoring compliance with the guideline. The guideline will be listed on the IDSA home page at http://www.idsociety.org It will be evaluated for updating in 2 years.

Acute Disease↗
PubMed1999

Roles of glycoproteins and oligosaccharides found in human vaginal fluid in bacterial adherence.

Adherence of type 1-piliated Escherichia coli to carbohydrate structures of vaginal mucosa plays a major role in the pathogenesis of ascending urinary tract infections in women. Colonization of the vaginal introitus is influenced by interactions between pathogens, vaginal fluid, and vaginal epithelium. In this study, the type and amount of carbohydrates and glycoproteins present in vaginal fluid were determined. Free and protein-bound oligosaccharides in vaginal fluid specimens were analyzed by fluorophore-assisted carbohydrate electrophoresis (FACE) and high-pressure liquid chromatography (HPLC). Two-dimensional electrophoretic separations of vaginal fluid glycoproteins were performed together with bacterial overlay assays. The results of FACE showed that the majority of the oligosaccharides are in the free state and the bound oligosaccharides are undetectable. HPLC analysis of free sugars revealed glucose as the major sugar (3.3 +/- 0.3 mM), and the concentrations of mannose and glucosamine were 0.065 +/- 0.04 and 0.02 +/- 0.001 mM, respectively. Radiolabeled E. coli bound three vaginal fluid glycoproteins with the following molecular masses and pIs: 82 kDa and pI 5.5, 55 kDa and pI 4.5, and 55 kDa and pI 6.5. The binding was inhibited by mannose and by deglycosylation of the proteins prior to the overlay assay. One of these putative receptors was identified to be the heavy chain of secretory IgA (S-IgA). These data suggest that the free mannose in the fluid is less than that required to affect E. coli-epithelial cell binding interactions and that S-IgA may bind E. coli in the vaginal introitus.

Adult↗
PubMed1999

Efficacy and safety of self-start therapy in women with recurrent urinary tract infections.

PURPOSE: We evaluated the efficacy of self-start therapy in women with recurrent urinary tract infections. MATERIALS AND METHODS: Women with recurrent urinary tract infections received a dip slide urine culture kit and 6 tablets of norfloxacin (400 mg.). At each symptomatic urinary tract infection episode the patient performed a culture and initiated therapy. The culture was returned and the patient was resupplied with another kit and norfloxacin. Patients were seen 5 to 9 days and 4 to 6 weeks after therapy to assess treatment outcome. RESULTS: A total of 34 women were enrolled in the study and were evaluable for treatment outcomes. Six women followed for 74 months were asymptomatic and 9 followed for 103 months had no infections. A total of 28 women followed for 355 months had 84 symptomatic episodes and 25 had 67 urinary tract infections. Patients had symptomatic episodes at a rate of 2.8 per patient-year (range 0 to 9) and infections at a rate of 2.3 per patient-year (range 0 to 9). The greatest risk of symptoms of infection or infection occurred in the first 3 months and among patients with a higher rate of infection before entering the study. Of the 84 symptomatic episodes 78 (92%) responded clinically. Of 78 cultured episodes 11 (14%) were negative. The remaining 67 cultured documented infections were cured microbiologically 5 to 7 days after therapy. No adverse effects occurred. The annual cost unaccompanied by a symptomatic episode was $86 and $259 if symptomatic episodes occurred. CONCLUSIONS: Intermittent self-start therapy is effective, safe and economical in women with recurrent urinary tract infections.

Adult↗
PubMed1998

Angiosarcoma of the bladder: a review.

OBJECTIVES: To present a new case of angiosarcoma of the bladder, review 9 other previously reported cases, and discuss the unique features of our case with regard to presentation, treatment, and clinical course of patients with this exceedingly rare tumor. The utility of multimodality therapy is emphasized. METHODS: We report the latest case of angiosarcoma of the bladder. We also reviewed the world literature (MEDLINE) and discovered 9 previously reported cases of angiosarcoma of the bladder. Presentation, treatment, and clinical course were analyzed. RESULTS: Of the 10 cases, 2 were considered to have arisen from a preexisting bladder hemangioma. Two patients had a history of prior gynecologic malignancies treated with external beam radiotherapy, with subsequent sarcoma formation within the past treatment field. Two other patients presented with skin lesions that predated the discovery of bladder lesions. Only 4 patients presented with primary bladder lesions and no preexisting disease or previous carcinogenic exposure (except for tobacco use). Hematuria was a universal presentation, and treatment was widely variant. Of the 10 patients, 8 died during a period of follow-up of 23 months. Five patients died of tumor-related causes. Mean survival of these 5 was 10.6 months. The 2 most recent patients (including ours) were alive and tumor free at 8 and 32 months, respectively. Both of these patients underwent multimodality oncologic approaches as part of their treatment regimen. CONCLUSIONS: Angiosarcoma of the bladder is exceedingly rare and usually fatal. Prognosis is poorer than that of angiosarcomas in more traditional sites. Regional lymph nodes are typically spared, but local recurrence with eventual distant metastasis is the rule. Optimal therapy has not been determined, but it most likely should involve a multimodal approach combining radical surgery with chemotherapy and radiotherapy.

Hemangiosarcoma↗
PubMed1998

Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women.

The problem with recurrent urinary tract infections in women is enormous and contributes significantly to national health care costs. As the role of office urology and the external "cost-effective" pressures placed on the practicing urologist have heightened, a consistent, logical approach towards diagnosis and management of urinary tract infection becomes essential. This article briefly discusses the cause and pathophysiology behind recurrent urinary tract infections in women. A practical discussion of proper evaluation and treatment options will also be provided in hopes of offering the clinician a simple, stepwise approach to this sometimes difficult condition.

Algorithms↗
PubMed1998

Prostatitis: US perspective.

The diagnosis and management of prostatitis syndromes is a challenge to the clinician. Careful history and examination of the prostate fluid and quantitative segmented bacteriologic cultures will lead to proper categorization into the recognized forms of the prostatitis syndrome. Antimicrobial therapy is effective in the majority of men with acute and chronic bacterial prostatitis (CBP). Fluoroquinolone agents appear to have an increasingly important role in this regard, although a randomized, prospective, double-blind study is still lacking. Alpha-1-selective blocking agents may relieve symptomatology of chronic pelvis pain syndrome (CPPS). Other non-prostatic sources of voiding symptoms should be sought and ruled out, especially malignancy or inflammatory disorders.

Acute Disease↗
PubMed1998

The male bulbourethral sling procedure for post-radical prostatectomy incontinence.

PURPOSE: We evaluate the efficacy of the male bulbourethral sling procedure in the treatment of post-radical prostatectomy urinary incontinence. MATERIALS AND METHODS: We reviewed the records of 64 consecutive men with severe post-prostatectomy incontinence who underwent the male bulbourethral sling procedure at Northwestern Memorial Hospital and Stanford University Hospital. Preoperatively 50% of the patients were completely incontinent (diapers, clamps or condom catheter), and the remainder required a mean of 4.7 pads per day. Data were collected by chart review, patient interviews at followup appointments and telephone interviews. Median followup was 18.1 months (mean 22.4, range 6.5 to 53.8). RESULTS: Following a single sling procedure 36 patients (56%) became dry, and 5 (8%) were significantly improved. In 17 patients 23 retightening procedures were performed, which decreased the median followup to 16 months and increased the success rate to 75% (67% cured, 8% improved). The revision, erosion and infection rates were 27, 6 and 3%, respectively. CONCLUSIONS: The male bulbourethral sling procedure is effective treatment for post-radical prostatectomy urinary incontinence. Patients who had received adjuvant radiation therapy demonstrated a lower continence rate than those who had not. Further followup is needed to assess long-term efficacy.

Aged↗
PubMed1998

Long-term results of the Stamey bladder neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure.

PURPOSE: We performed followup of a cohort of women who underwent the Stamey endoscopic needle suspension (group 1) or the Marshall-Marchetti-Krantz vesicourethropexy (group 2) between 1975 and 1983. MATERIALS AND METHODS: Telephone interviews were performed to assess current continence status and time to failure. Risk factors for recurrence of incontinence were correlated with long-term results. RESULTS: Long-term data were obtained for 32 of 41 women (78%) in group 1 and 36 of 54 (67%) in group 2. Range of followup was 9.4 to 19.9 years (median 15.0, mean 15.2) in group 1 and 13.2 to 21.9 (median 16.8, mean 17.0) in group 2. Of group 1 patients 44% remained dry compared to 33% of group 2 patients. Persistent local side effects were reported by 9% of group 1 and 0% of group 2. Urinary urgency was present in 70% of group 1 patients and 23% of group 2. There was no relationship between long-term operative success and age at surgery, degree of preoperative incontinence, parity, obesity, prior incontinence surgery or prior hysterectomy for either procedure. CONCLUSIONS: The Stamey and the Marshall-Marchetti-Krantz procedures yield high initial cure rates with progressive, parallel declines in continence status with time.

Adult↗
PubMed1997

Do infectious agents cause interstitial cystitis?

The possibility that infectious agents play a role in the etiology of interstitial cystitis (IC) has been investigated for a number of years. Early studies were directed toward attempts to cultivate bacteria and fungi on routine culture media and microscopic examinations of urine or bladder tissue specimens for the presence of microorganisms. In more recent years, this approach has been expanded to include sophisticated culture techniques to search for the presence of fastidious and unusual organisms that would not be detected by routine culture methods. Similarly, the presence of viruses has been sought by incubating specimens from interstitial cystitis patients in mammalian cell cultures to detect cytopathic effects. None of these approaches has provided convincing evidence that micro-organisms or viruses are associated with IC. The latest attempts to search for the presence of bacteria have made use of the polymerase chain reaction (PCR) to amplify bacterial 16S rRNA genes that would be present if bacteria were present in bladder tissue or urine of IC patients. This approach allows bacteria to be detected and even identified without culture. However, the results from the great majority of bladder biopsy samples analyzed by these molecular techniques have been negative. PCR strategies have also been used to search for the presence of certain viruses in IC specimens, again without success. At this time, the results from laboratory culture, light and electron microscopy, and various molecular strategies to detect micro-organisms and viruses in IC specimens all argue against an infectious etiology for IC.

Bacteria↗