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Biomedical subjects

A R Stone

Publications and source records attributed to A R Stone.

At least 55 records · Page 3Linked to original sources
PubMed1990

Neobladders: clinical management and considerations for patients receiving chemotherapy.

Continent catheterizable urinary reservoirs and orthotopic bladder substitutes are complex surgical endeavors. The goal is preservation of renal function, reliable continence, and storage intervals acceptable to the patient. The construction requires familiarity with bowel segments and may increase operative time for radical cystoprostatectomy by 30% to 50%. Patients with continent reservoirs have improved body image, work habits, and sexual and interpersonal relationships. Experience with patients with dysfunctional neurogenic bladders previously converted to Bricker urostomies now undiverted to continent reservoirs indicates an overall increase in physical activity and self-satisfaction. These patients are tolerant of reoperations to maintain independence from wet urostomies. Undoubtedly, the expectations of bladder cancer patients will differ from those of young adults with neurogenic bladder, but we have found that when all options are presented patients will seek out therapy that least alters their body image. Therefore, patient selection becomes an important factor in determining the success of continent reservoirs. Patients must have the dexterity and motivation to catheterize the urinary reservoir, irrigate for mucus and, in cases of orthotopic bladder replacement to urethra, accept the need for artificial sphincter placement in 30% to 40% of cases. Management of the neo-bladders requires additional consideration of several practical and theoretic points for both the surgeon and medical oncologist: 1. Patients with diffuse carcinoma in situ or transitional cell carcinoma at the bladder neck or prostatic urethra should undergo simultaneous urethrectomy excluding orthotopic bladder replacement. 2. Ten percent to 40% of patients undergoing radical cystoprostatectomy for transitional cell cancer will have concomitant underdiagnosed adenocarcinoma of the prostate; patient prognosis will remain defined by the stage and grade of the bladder cancer. 3. Patients may have a tendency toward dehydration because of increased loss of free water through bowel transit. 4. Absorption of chloride, ammonium, and hydrogen ions may cause hyperchloremic acidosis, especially in face of imparied renal function. 5. Because of the potential for drug absorption across reservoir mucosa, patients receiving chemotherapy may require Foley catheterization with irrigation in addition to intravenous hydration. 6. Creatinine clearance is unsuitable for studying the renal function of reservoir patients because urine passes through the intestinal segment where creatinine is absorbed; glomerular filtration is better estimated by nuclear scanning with the reservoir emptied. 7. Most reservoirs will remain colonized with bacteria. 8. Antibiotic prophylaxis for the patient with temporary impairment of immune function during chemotherapy may be necessary. 9. Mucus may entrap bacteria serving as a host defense; its production may diminish with time from construction. All patients should be capable of performing reservoir irrigations to manage mucus obstruction.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Agents↗
PubMed1989

The clinical application of aspiration deoxyribonucleic acid flow cytometry to neurologically impaired men entering an electroejaculation program.

For the neurologically impaired patient electroejaculation with a rectal probe can furnish sperm for artificial insemination. However, documentation of pregnancies in this patient group has been limited. Deoxyribonucleic acid flow cytometry has been shown to be a reproducible quantitative method with which to evaluate spermatogenesis. We assessed the ability of deoxyribonucleic acid flow cytometry on testicular aspirates to predict the quality of sperm production in 13 men undergoing electroejaculation. Semen analysis was performed on antegrade and retrograde specimens. Deoxyribonucleic acid histograms from testicular aspirates were evaluated for the relative proportions of haploid, diploid and tetraploid cells. These ratios were compared to the means reported for our own series of 25 patients who at vasovasostomy had sperm intraoperatively and to the similar figures from a group of 10 accident victims. Five patients had normal testicular ploidy compartments defined as within 2 standard deviations from control means. Of the 5 patients 4 had normal sperm counts and motilities (30 per cent or greater). Two patients have contributed sperm for artificial insemination; 1 has resulted in pregnancy. Three patients had moderately abnormal (2 to 4 standard deviations) testicular ploidy classes. These patients had adequate sperm counts but low motilities (5 per cent or less). Of the 5 patients with markedly abnormal (greater than 4 standard deviations) histograms 4 remained azoospermic despite repeated attempts at electroejaculation. Our data support the use of deoxyribonucleic acid flow cytometry on testicular aspirates as a predictor of which patients might succeed and those who are unlikely to succeed in an electroejaculation program.

Adult↗
PubMed1989

The split-cuff ureteral nipple reimplantation technique: reliable reflux prevention from bowel segments.

The split-cuff nipple ureteral implantation technique is described in 18 patients undergoing lower urinary tract reconstruction or supravesical diversion. This technique provides a simple and reliable antireflux mechanism into large and small bowel segments. No reflux or upper tract deterioration was seen initially, and only 1 case of mild reflux has occurred after 30 months of followup.

Follow-Up Studies↗
PubMed1989

Treatment and complications of Fournier's gangrene.

Ten patients with Fournier's gangrene were seen over an 11-month period; 3 had indwelling urethral catheters, 3 had preceding perineal infection and 6 had a history of alcohol abuse. An average of 2.1 operations was required per patient and the average hospital stay was 41 days. The mortality rate was 20%; 7 patients developed acute renal failure and 5 developed adult respiratory distress syndrome. Early treatment of these complications should help to reduce the mortality of this disease.

Acute Kidney Injury↗
PubMed1987

Carcinoma associated with augmentation cystoplasty.

Three patients with augmentation ileocystoplasties developed carcinoma at the ileovesical junction 7, 22 and 24 years after surgery. All were originally reconstructed for genitourinary tuberculosis and all had developed huge capacity ileal segments with large residual urines, associated with recurrent urinary tract infection. With the current trend for using small bowel for both augmentation and substitution cystoplasty, balanced voiding must be achieved and maintained, and long-term follow-up is mandatory.

Adenocarcinoma↗
PubMed1986

Radical prostatectomy: anatomical predictors of success or failure.

A total of 143 patients underwent radical prostatectomy. Surgical specimens were evaluated with respect to local extent of disease, Gleason grade of the primary and relative nuclear roundness of the surgical specimen. The probability of disease control in the total population was 88 per cent at 5 years. Only 8 per cent of the patients who had disease confined to the specimen failed compared to 14 per cent of those who demonstrated extension outside of the surgical margins. The incidence of failure increased as a function of seminal vesicle involvement. Seminal vesicle involvement was greatest among patients with a Gleason grade greater than 7. Postoperative radiation did not offer any apparent advantage in patients with positive margins.

Adenocarcinoma↗
PubMed1986

The urological evaluation and management of patients with myelodysplasia.

The urological evaluation and results of management of 183 myelodysplastic patients are presented. Our management protocol stresses upper tract and infection status surveillance during the early childhood years, and a clean intermittent catheterisation programme with pharmacological manipulation of detrusor and sphincter function as the optimal later management. Continence failures are few and are manageable by sphincter prosthetic surgery or bladder augmentation. Urodynamic results are valuable in children with difficult incontinence or poor upper tracts. The intermittent catheterisation programme reduces the incidence of symptomatic urinary infections in these patients, but the incidence of asymptomatic bacteriuria is high. The adverse results of supravesical diversion in myelodysplastic children rarely justify its use.

Child, Preschool↗
PubMed1986

Ileocaecocystoplasty in urinary tract reconstruction in children.

Ten children have undergone lower urinary tract reconstruction by ileocaecocystoplasty. Four patients had previously been diverted and the other six were reconstructed because of intractable incontinence or deteriorating renal function. Continence was primarily achieved in eight patients and renal function improved or remained stable in all 10. Reflux was prevented by a plicated ileocaecal valve in five of eight patients. Continued pharmacological manipulation, intermittent self catheterisation and secondary surgical intervention were frequently necessary in these patients who required careful counselling and follow-up.

Adolescent↗
PubMed1984

Urethrovaginal fistula: a review of the surgical management.

Urethrovaginal fistulas may occur after external or surgical trauma and result commonly in urinary incontinence. Various repair procedures have been suggested. However, it appears that the Martius operation with labial fat pad interposition between the repaired urethra and vagina is as satisfactory as any.

Adolescent↗
PubMed1983

Bladder training--3 years on.

Fifty-six patients with the "urge syndrome" were reviewed between 1 and 5 years after in-patient treatment by bladder training. There was an overall initial cure/improvement rate of 85%. The best long-term results were obtained in those with objectively stable bladders before treatment. Forty-three per cent of patients with reduced detrusor compliance and idiopathic instability relapsed after initial improvement. Those with primary instability or with associated degenerative disease responded poorly to treatment.

Adolescent↗
PubMed1983

Preliminary results of AS 791/792 artificial sphincter for urinary incontinence.

Twenty-seven patients with incontinence have been treated by implantation of the AS 791 or 792 artificial sphincter over the past 24 months. All but four were incontinent as a result of myelodysplasia or prostatic ablation: 22 are currently completely continent, 2 await activation and 3 have failed. There has been only one mechanical failure, though 3 patients have required the insertion of a higher pressure reservoir to resolve stress incontinence, reflecting our conservative approach to the initial choice of reservoir.

Adolescent↗
PubMed1983

Optical urethrotomy--a 3-year experience.

One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.

Adolescent↗
PubMed1982

The results of reflux prevention in adults with reflux nephropathy.

Twenty adult patients with varying degrees of reflux nephropathy and renal impairment were selected for anti-reflux surgery. Following reflux prevention, those patients with symptoms related to recurrent urinary tract infection were greatly improved. However, in those patients with impaired and deteriorating renal function, surgery only occasionally influences this progression. These patients all had significant proteinuria both pre- and post-operatively. Proteinuria appears to be a more significant prognostic indication of renal deterioration than the degree of reflux or reflux nephropathy.

Adolescent↗
PubMed1982

Assessment for and results of urinary undiversion.

Twenty-five patients with surface diversions have been assessed for undiversion over the past 3 years. Fourteen of these have been reconstructed of which half are in the more difficult myelodysplastic group. In 7 patients renal deterioration or renal failure was the indication for undiversion. The critical factors for success are good urethral mechanism function and adequate ureteric function. All but one are subjectively pleased, and all but one have stable renal function and are continent. Infection, especially Pseudomonas, must be eliminated and careful follow-up is mandatory.

Adult↗
PubMed1982

The bone scan as a tumour marker in prostatic carcinoma.

The technetium methylene diphosphate bone scan was elevated in 100 consecutive new patients presenting with carcinoma of the prostate. 48% of the patients has a positive bone scan at the initial diagnosis. The scan was more helpful than the skeletal X-ray in the diagnosis of bone metastases: 23% of the X-ray-negative patients were scan-positive. Serial bone scans were more sensitive than either X-rays or serum acid phosphatase in following the progress of the disease. It is concluded that the bone scan in patients with prostatic carcinoma can be used as a reliable tumour marker, especially for monitoring the course of metastases.

Bone and Bones↗