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Biomedical subjects

A R Stone

Publications and source records attributed to A R Stone.

At least 37 records · Page 2Linked to original sources
PubMed1994

The vaginal wall sling: a compressive suspension procedure for recurrent incontinence in elderly patients.

OBJECTIVE: To determine the efficacy of the vaginal wall sling in the management of recurrent stress urinary incontinence (SUI) in an elderly female population. METHOD: Eighteen elderly female patients (average age 68.4 years) with recurrent stress urinary incontinence were studied with a thorough evaluation including video-urodynamics. Thirteen patients were diagnosed with type III SUI and 5 patients had type II SUI: A description of the technique, first described by Raz, is provided. RESULTS: Follow-up ranged from six to forty-two months (average 18 months). All patients are completely dry and express satisfaction with their outcome. Seventeen of 18 patients (94%) are voiding spontaneously. One patient at twelve months' postoperation requires clean intermittent catheterization. CONCLUSION: Many elderly female patients with recurrent stress urinary incontinence have intrinsic urethral sphincteric incompetence as well as recurrent hypermobility that often classifies them as type II SUI: The vaginal wall sling addresses both problems and is a safe, simple, and effective procedure in the management of recurrent incontinence in elderly female patients.

Aged↗
PubMed1994

Is sphincterotomy the best management of the spinal cord injured bladder?

Transurethral incision of the external urinary sphincter with condom catheter drainage has long been used in the management of the male quadriplegic or high thoracic level paraplegic with neurogenic bladder. The decrease in outlet resistance is believed to lower the high intravesical pressures associated with detrusor-sphincter dyssynergia and obviate the need for an indwelling catheter, with its associated infectious complications. We reviewed 16 consecutive cases of sphincterotomy performed at our institution during the last 8 years to determine the long-term success rate and outcome of this mode of bladder management. Of the patients 13 are cervical level quadriplegics and 3 are thoracic level paraplegics who were unable to perform self-catheterization. Preoperative urodynamics most commonly demonstrated detrusor external sphincter dyssynergia, moderate to severe hyperreflexia and decreased compliance. Followup ranged from 3 months to 8 years (median 39 months). Only 8 of 16 patients still manage the bladder with a condom catheter, while 8 have an indwelling suprapubic cystostomy tube. Only 1 patient followed for more than 4 years postoperatively still uses condom catheter drainage. The most common reason for conversion to suprapubic drainage was difficulty with the external appliance but other reasons included desire for increased independence, high post-void residual volumes and renal deterioration. We conclude that sphincterotomy is generally effective in decreasing outlet resistance and improving voiding efficiency initially but that careful patient selection and close long-term followup are necessary to guarantee long-term success.

Adult↗
PubMed1993

Fatal perforation of augmentation cystoplasty in an adult.

This is a case report of a fatal spontaneous perforation of an augmentation enterocystoplasty in a twenty-nine-year-old T12 paraplegic, thirteen months post augmentation and placement of artificial urinary sphincter. A review of the literature involving 41 episodes in 31 patients is provided with a discussion concerning presentation, etiology, and management.

Adolescent↗
PubMed1993

The changing urodynamic pattern in infants with myelomeningocele.

A total of 43 infants with spina bifida was evaluated with a standard simplified urodynamic technique to determine whether bladder behavior altered with development and the optimal timing for urodynamic testing. Using urodynamic evaluation plus renal ultrasound and voiding cystourethrography the patients were divided into 2 groups: 1) those with a favorable prognosis and 2) those with an unfavorable prognosis. Only 55% of the initial urodynamic studies were predictive of future clinical course. The patients who worsened generally did so in the first 6 months of life. Of the patients initially believed to have an unfavorable prognosis 86% improved or stabilized with therapy. Urodynamic testing appears to be an important adjunct at 6-month intervals in infancy and early childhood as bladder behavior continues to evolve.

Follow-Up Studies↗
PubMed1992

Tamm-Horsfall protein as a marker in interstitial cystitis.

It has been suggested that immunohistochemical staining for Tamm-Horsfall protein in bladder epithelium may be a marker for interstitial cystitis. Of bladder biopsies from 14 interstitial cystitis patients only 3 demonstrated positive staining for Tamm-Horsfall protein within the mucosa, whereas 2 of 11 control biopsies showed positive Tamm-Horsfall protein results. In addition, staining in 4 ureteral specimens from interstitial cystitis patients and 4 controls was negative in all cases. An effort to detect this protein in enterocystoplasty specimens also showed a negative pattern. Our study does not confirm the Tamm-Horsfall protein as permeating either the bladder epithelium in interstitial cystitis or bowel mucosa in enterocystoplasty. This finding does not necessarily mean that these surfaces are not permeable to substances of smaller molecular size, nor does it define whether this is of importance in the etiology of interstitial cystitis. However, it does suggest that this technique does not allow detection of a marker for the disease.

Adult↗
PubMed1992

The hemodynamics of vacuum constriction erections: assessment by color Doppler ultrasound.

Duplex ultrasound with pulsed Doppler and color flow sonography were used to image the penis and conduct blood flow velocity studies in 5 patients. Cavernous body cross sectional area, cavernous artery diameters and peak systolic velocities were measured in the flaccid shaft, after transient exposure to negative pressure in a vacuum constriction device, and with a vacuum constriction device band applied to the tumescent shaft. We found that exposure to vacuum transiently increased central cavernous arterial blood flow velocities compared to baseline values in all patients. After a trial of a vacuum constriction device and application of the constricting band cavernous body cross sectional areas doubled. Despite increased cavernous arterial diameters in 4 of 5 patients and increased blood flow in all patients after vacuum-induced tumescence alone, we could not visualize arterial inflow in the penile shaft once the constricting band was in place. Color Doppler ultrasound can detect cavernous artery systolic flow as low as 2 to 9 cm. per second. Our data suggest that the erectile state maintained distal to the vacuum constriction device band is low flow and relatively ischemic.

Aged↗
PubMed1992

Lymphocyte function in patients with interstitial cystitis.

To determine whether there is a primary immunological disorder involved in the etiology of interstitial cystitis, we compared the in vitro function of peripheral blood lymphocytes from 10 patients with interstitial cystitis to those from 10 healthy female controls. The lymphocytes were isolated and incubated in either cell culture medium alone, cell culture medium supplemented with the mitogen phytohemagglutinin or cell culture medium with autologous sterile filtered urine, the latter to detect any immunogenic potential of urine in this disease. We studied the relative proliferation of the phenotypes CD2, CD4, CD8, CD19, CD14 and CD56 by immunofluorescence and flow cytometry. To detect activation of T lymphocytes we also studied expression of HLA-Dr and interleukin-2 receptors. There was no difference in the rate of proliferation of the various lymphocyte phenotypes between the 2 groups in any of the culture media. Similarly, there was no difference between the 2 groups in the degree of lymphocytic activation after incubation. Furthermore, incubation in the presence of autologous urine caused no increase in activation above that seen in control cultures. We also assessed the production of the lymphokines interleukin-1, interleukin-2 and interferon-gamma in the supernatant fluid of the cell cultures. There was no difference in the production of these immunoregulatory cytokines between the control and patient groups, and again urine did not act as a mitogen in either group. We conclude from this study that there is no primary immunological disorder evident in patients with interstitial cystitis, and that the urine does not act as a stimulant to the immune system. This finding casts severe doubt on any theory suggesting that interstitial cystitis is an autoimmune disease or that urine contains an autoantigen causing the disease.

Adult↗
PubMed1991

Cellular immunity in interstitial cystitis.

It has been suggested that interstitial cystitis is an autoimmune disease. The evidence for this hypothesis, based on studies of humoral immune factors, has been contradictory. We assessed the immune response in interstitial cystitis by evaluating lymphocyte populations in the peripheral blood and bladder tissue of interstitial cystitis patients. The lymphocyte phenotypes in peripheral blood were entirely normal, including the CD4 (cluster designation nomenclature) and CD8 subsets, and the CD4:CD8 ratio. Bladder lamina propria showed a predominance of CD4 over CD8 lymphocytes in interstitial and other forms of cystitis. Bladder epithelium showed a similar pattern in bacterial or mechanical cystitis but specimens from patients with interstitial cystitis had a predominance of CD8 cells. The findings of normal lymphocyte populations in the peripheral blood are not supportive of an autoimmune mechanism in the disease. The findings in bladder tissue show that the urothelium is not involved in the inflammatory reaction, as is the lamina propria, and they would suggest, therefore, that the initiating factor does not originate from the bladder lumen. The CD8 predominance in the urothelium along with a CD4 predominance in the lamina propria may form a characteristic pattern for the diagnosis of interstitial cystitis and merits further study.

Adult↗
PubMed1991

Can histological assessment predict the outcome in interstitial cystitis?

In a retrospective study we compared the outcome of 39 patients with interstitial cystitis to the histological findings at initial diagnostic bladder biopsy. The degree of inflammation and fibrosis and the mast cell counts were assessed on each biopsy. The prognostic relevance of the clinical features of age, duration of symptoms, frequency, nocturia, pain and bladder capacity was assessed. The study showed no statistical correlation between the severity of histological findings at diagnosis and the eventual outcome of the disease. Over 50% of patients with severe histological abnormalities responded to conservative treatment. Although the majority of patients with mild pathological changes responded to conservative treatment, some did require surgical intervention. The clinical features of pain, nocturia and bladder capacity showed significant differences between the 2 patient groups. However, the former 2 features are subject to many variables and the latter probably has too wide a range to be useful as a prognostic indicator. Only the response of patients to conservative treatment will indicate those who are not being helped and who may eventually require surgical treatment.

Cell Count↗
PubMed1991

Treatment of voiding complaints and incontinence in painful bladder syndrome.

The treatment of voiding complaints and incontinence in painful bladder syndrome requires careful attention to detail. As the exact nature of these conditions is unknown, no single modality is effective, and multiple treatments may be required. A sympathetic and supportive physician is necessary in all these cases.

Humans↗
PubMed1990

Recurrent interstitial cystitis following cystoplasty: fact or fiction?

The severity of symptoms in interstitial cystitis may necessitate surgical treatment in approximately 10% of the patients. Substitution cystoplasty provides satisfactory results in most of these cases, while avoiding the need for urinary diversion. It has been suggested that interstitial cystitis may affect the bowel segment used in this form of operation. We studied bowel segments removed from cystoplasties in 5 patients with interstitial cystitis and compared these to bowel used for lower urinary reconstruction for other disorders in 6 patients. All segments showed varying degrees of inflammation, fibrosis and mastocytosis but there was no difference between the 2 groups for these features. We conclude that inflammation and fibrosis is the usual reaction of bowel to exposure to urine, and they do not represent a specific spread of interstitial cystitis in those patients. However, this reaction does mimic the histological appearance of interstitial cystitis in the bladder and may suggest a model for this disease.

Adult↗