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Biomedical subjects

C J Bennett

Publications and source records attributed to C J Bennett.

At least 19 recordsLinked to original sources
PubMed1995

The nonrefluxing ileal conduit: a new form of urinary diversion.

PURPOSE: We describe a variation of the ileal conduit that includes a nonrefluxing nipple valve designed to protect the upper urinary tracts. MATERIALS AND METHODS: A total of 13 patients underwent urinary diversion with the nonrefluxing ileal conduit. The nonrefluxing nipple valve is created by intussuscepting the ileum into the conduit. RESULTS: Followup ranged from 3 to 35 months. No patient demonstrated radiographic deterioration of the upper tracts or a clinically significant increase in serum creatinine level during followup. CONCLUSIONS: The nonrefluxing ileal conduit appears to be a viable treatment option in select patients with neurogenic bladder dysfunction.

Adult↗
PubMed1995

Fluorourodynamic and clinical evaluation in males following construction of a Kock ileal-urethral reservoir.

OBJECTIVES: Since 1986, we have offered the option of lower urinary tract reconstruction with the Kock ileal-urethral reservoir in selected male patients requiring diversion. This study provides insight into the functional characteristics of the Kock ileal-urethral reservoir and its effect on continence. METHODS: Twenty-four of the initial 225 male patients undergoing this procedure at our institution were evaluated by fluorourodynamics within 2 years of neobladder construction. Information regarding continence was also obtained by means of a patient interview and questionnaire. RESULTS: The average resting neobladder pressure was 8.5 cm H2O (range, 0 to 18). Reservoir capacity averaged 741 cc (range, 225 to 1400). Afferent nipple failure with bilateral grade II vesicoureteral reflux was noted in 1 patient (4%). Unsatisfactory daytime continence was seen in 2 patients (8%). Unsatisfactory nighttime continence was seen in 6 patients (25%). Patient satisfaction was high with an average rating of 8.6 on a scale of 1 to 10. CONCLUSIONS: Fluorourdynamic data demonstrate a low-pressure, high-capacity reservoir with a low incidence of reflux. The rate of continence is acceptable and patient satisfaction is excellent. The Kock ilealurethral reservoir is an excellent alternative to standard diversion for the male patient undergoing cystectomy.

Adult↗
PubMed1995

Differences in urinary tract infections in male and female spinal cord injury patients on intermittent catheterization.

Intermittent catheterization has gained wide acceptance for use in hospitalized patients following spinal cord injury. Most studies evaluating this procedure, however, look only at the infection rate in the male SCI population. In this study the rate and type of infection encountered in the male and female SCI population were evaluated in an inpatient hospital environment. Fifty four patients who were undergoing intermittent catheterization with the MMG/O'Neil catheter system were evaluated. All patients were similar with regard to level of injury and bladder management. There were 45 males and nine females in our study group (n = 45). A total of 10,945 catheterizations were performed with 75 infections indentified. The overall infection rate was 0.68% or one infection for every 146 catheterizations. Of the 45 males there were 58 infections of which 11 (18%) were E. coli. This contrasts with the female population (9) in which there were 17 infections with nine (53%) being E. coli. While a variety of infecting organisms were present in males, females were colonized with either E. coli, enterococcus or Klebsiella. While hospital based intermittent catheterization would appear to be associated with an acceptable low incidence of urinary tract infections (0.68%), infected females have a higher incidence of E. coli (53%) compared to the male population (18%). This study also demonstrated that female patients had a significantly higher infection rate than males (nine females with 17 infections compared to 45 males with 58 infections over the same time period). The higher incidence of urinary tract infections in females with E. coli perhaps is related to the proximity of bowel/stool contamination.

Adult↗
PubMed1995

Management of sphincter dyssynergia using the sphincter stent prosthesis in chronically catheterized SCI men.

This effort represents a subset analysis of the long-term Multicenter North American Trial of the UroLume sphincter stent prosthesis to determine the effect of the sphincter stent prosthesis in SCI men afflicted with detrusor-external sphincter dyssynergia (DESD) and chronically managed with an indwelling urinary catheter. Forty-one of 153 male patients in this study were evaluated urodynamically before and after placement of the sphincter stent prosthesis. Of the 41 patients, 34 (81 percent) suffered cervical-level injury while 10 patients (25 percent) had been treated previously with external sphincterotomy. Forty patients (98 percent) were troubled with recurrent urinary tract infections (UTI), with a mean of 4.6 +/- 3 episodes of UTI per year. Seven patients (17 percent) demonstrated hydronephrosis prior to stent placement. Follow-up ranged from six to 44 months. Voiding pressures decreased from a mean of 77 +/- 23 cmH2O preoperatively to 35 +/- 18 cmH2O at 12 months (n = 34) and 33 +/- 20 cmH2O at 24 months (n = 22) after stent insertion (p = 0.001). Post-void residual urinary volume decreased from 202 +/- 187 ml preinsertion to 64 +/- 69 ml at 24 months (p = 0.001) postinsertion. Maximum cystometric capacity remained constant at 201 +/- 144 ml preinsertion to 203 +/- 79 ml at 24 months (p = 0.75) postinsertion. No significant changes in any of the urodynamic parameters occurred after 24 months of follow-up between patients with (n = 10) and without (n = 31) previous external sphincterotomy. Neither hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth, stent encrustation or stone formation, nor soft tissue erosion occurred in any patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Comparison of bladder management complication outcomes in female spinal cord injury patients.

A total of 70 female spinal cord injury patients was retrospectively analyzed for outcomes of long-term bladder management. Three groups were defined: 1) 23 patients on intermittent catheterization, 2) 25 treated by reflex voiding and incontinence padding, and 3) 22 with an indwelling catheter. Mean years of using the specific bladder management technique were 8.5 +/- 4.7, 15.8 +/- 7.3 and 16.7 +/- 9.0 for the 3 groups, respectively. All patients were evaluated for long-term complications. There were 4 major complications (17%) in the intermittent catheterization group, 10 (40%) in the padding group and 58 (greater than 200%) in the indwelling catheter group. The aggregate difference in complication rates among the 3 group was highly significant (p < 0.00001). Of comparable long-term patients (11 to 23 years) there were no major complications among 6 on intermittent catheterization, 8 among 14 who use padding and 21 among 9 with an indwelling catheter. The differences among the groups remained significant (p < 0.00001). Additional analyses showed highly significant differences between the catheter group and the other 2 groups (intermittent catheterization p = 0.0009 and padding p = 0.0005), and a difference that approached significance between the intermittent catheterization and padding groups (p = 0.085). The results strongly support intermittent catheterization as the optimal management of female patients following spinal cord injury given that other factors, in particular independent hand function or the need for appropriate assistance, are considered.

Catheters, Indwelling↗
PubMed1991

An unusual complication of high dose infusion computerized tomography in a patient with a continent diversion.

We describe a myelodysplastic woman with a Kock continent ileal reservoir who suffered parastomal herniation of the pouch following high dose infusion computerized tomography. Prophylactic indwelling catheterization in patients with continent diversion undergoing procedures that induce significant diuresis or involve prolonged distension of the reservoir is probably indicated.

Adult↗
PubMed1991

Electroejaculation following retroperitoneal lymphadenectomy.

Transrectal electroejaculation was performed in 24 men who were anejaculatory from retroperitoneal lymphadenectomy. Of the men 23 had undergone retroperitoneal lymphadenectomy because of testis cancer. Seminal emission was achieved in all patients. In 21 patients greater than 10 x 10(6) progressively motile sperm with normal morphology were obtained. The average sperm count and motilities obtained were 289 x 10(6) and 18%, respectively, for the antegrade fractions, and 2,051 x 10(6) and 13%, respectively, for the retrograde fractions. Of the 3 azoospermic failures 2 had chemotherapy-induced testicular damage and 1 had carcinoma in situ of the remaining testis. A total of 19 couples underwent artificial insemination with electroejaculated sperm. There were 7 pregnancies achieved in 74 insemination cycles (36.8% of the couples conceived for a 9% cycle fecundity). Routine semen parameters could not predict which couples would be successful in achieving pregnancy. There were 2 first trimester spontaneous abortions. Five healthy children have been born. Electroejaculation is an excellent treatment for anejaculation that persists following retroperitoneal lymph node dissection.

Adult↗
PubMed1990

Combined electroejaculation and in vitro fertilization in the evaluation and treatment of anejaculatory infertility.

Seven couples underwent combined electroejaculation and in vitro fertilization for anejaculatory infertility after a failed regimen of electroejaculation and intrauterine insemination. Two pregnancies resulted, one proceeding to a term vaginal delivery and one ending in a 6-week spontaneous abortion. Poor sperm binding and no fertilization were seen in two of the couples. Fertilization of the oocytes but no subsequent pregnancy were seen in the other three couples. Combined in vitro fertilization and gamete intrafallopian transfer was performed in four of the couples. The combination of electroejaculation and in vitro fertilization offers the opportunity to evaluate the female pelvis, observe the sperm-oocyte interaction, and achieve a pregnancy in couples with anejaculatory infertility.

Adult↗
PubMed1990

Nifedipine pretreatment for autonomic dysreflexia during electroejaculation.

Ten spinal-cord-injured males who exhibited autonomic dysreflexia during electroejaculation were given sublingual calcium channel blocker nifedipine pretreatment to prevent this complication. Nifedipine was successful in decreasing peak systolic, diastolic, and mean blood pressures during the procedure. The use of nifedipine resulted in fewer aborted trials and allowed higher energy delivery during the procedure.

Administration, Sublingual↗
PubMed1989

Predictors of success in electroejaculation of spinal cord injured men.

Rectal probe electroejaculation was attempted in 48 spinal cord injury men and greater than 10 million sperm were obtained in 71%. Patient age and interval since injury had no effect on outcome. The best performance was seen in thoracic paraplegics and in those using intermittent catheterization for bladder management. Indwelling urethral catheters and high pressure reflex voiding had a negative impact on electroejaculation results.

Adult↗
PubMed1989

The significance of empathy in current hospital based practice.

This paper examines empathy as a practice component that is particularly significant in its relationship to self-determination in the discharge process in acute hospital settings. Empathy is also emphasized as an essential ingredient to a psychosocial assessment that leads to accurate problem formulation and preciseness in planning. Current theories on empathy are discussed in a literature review, while pertinent practice issues are presented in several case vignettes. Theory and practice confirm that empathic skills can develop on both sentient and cognitive levels over time. This development is enhanced by supervision that utilizes the worker's capacity for self-awareness.

Adult↗