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Biomedical subjects

C K Payne

Publications and source records attributed to C K Payne.

9 recordsLinked to original sources
PubMed2000

Behavioral therapy for overactive bladder.

What is behavioral therapy? On the one hand there is no consensus in the literature as to the definition of the treatment or the optimal mode of delivery. On the other hand, it is possibly the "best" single treatment for urinary incontinence when viewed from a risk:benefit analysis. There is general agreement that within this framework wide variations exist in intensity of treatment, expertise required to deliver the treatment, and the subsequent cost of therapy. A definition of behavioral therapy should include at least the following techniques: first, education and explanation of normal lower urinary tract function; second, micturition charts and diaries; and finally, timed voiding/bladder training regimens. All of the behavioral methods are demonstrably effective, with improvement rates in incontinence episodes uniformly in excess of 50%. Our challenge is to define the critical parts of behavioral therapy and develop algorithms that can be delivered to the incontinent population in the most cost-effective manner.

Behavior Therapy↗
PubMed1999

A transvaginal sling procedure with bone anchor fixation.

Urethral sling procedures have become increasingly popular in the treatment of female stress incontinence. Until recently, the use of this procedure in the urologic community has been limited by technical difficulties and complications (e.g., urinary retention, urethral injury, urge frequency). Many modifications of the original sling procedure recently have been described to decrease surgical morbidity. This article describes a minimally invasive sling procedure performed completely through the vagina, with the aid of bone anchor fixation. The potential advantages of this operation include a rapid return to full activity and normal voiding. It should be noted that neither the long-term safety nor the efficacy has been established.

Bone Screws↗
PubMed1998

Epidemiology, pathophysiology, and evaluation of urinary incontinence and overactive bladder.

OBJECTIVES: To present an overview of current knowledge regarding the epidemiology, pathophysiology, and evaluation of urinary incontinence (UI) with a focus on the problem of the overactive bladder. METHODS: The most recent data on the epidemiology of UI are presented. The literature on the pathophysiology of urinary urge incontinence (UUI) is reviewed, and key concepts related to patient evaluation are summarized. RESULTS: The prevalence of UI depends on the population being surveyed. The overactive bladder constitutes a substantial percentage of the overall problem, ranging from > 50% of incontinent men to only 10% to 15% of incontinent younger women. Few data are available on the incidence of the disorder or on racial/ethnic trends. Overactive bladder or urge incontinence is called detrusor hyperreflexia when a neurologic cause is known and detrusor instability when there is no neurologic abnormality. Although the pathophysiology of idiopathic instability is not well understood, some evidence suggests that this condition may result from subclinical neurologic disease or primary smooth muscle disease. Most patients with UUI can be adequately evaluated with a history, physical examination, determination of postvoid residual volume, and urinalysis. When neurologic disease or other complicating factors are present, or if initial treatment fails, sophisticated urodynamic testing is appropriate. CONCLUSIONS: Urinary incontinence is prevalent in all strata of the population, although it affects women and the elderly disproportionately. With the exception of cases in which a neurologic lesion can be demonstrated, the etiology of UUI remains elusive. A thorough history, physical examination, determination of postvoid residual, and urinalysis will be adequate to classify and treat the majority of patients.

Female↗
PubMed1998

Biofeedback for community-dwelling individuals with urinary incontinence.

OBJECTIVES: To review the role of biofeedback in the management of community-dwelling individuals with urge urinary incontinence (UUI), and to present a practical approach to patient evaluation and treatment selection. METHODS: In view of a lack of objective published information, perspectives on the use of biofeedback in UUI are derived from extrapolation of studies in patients with stress incontinence as well as from the author's personal experience. RESULTS: Through the use of careful baseline evaluations, appropriate exercise and biofeedback treatment for UUI can be selected for specific patients. Office-based biofeedback is preferred for patients who have no or minimal ability to isolate and contract the levator muscles at baseline. Such individuals cannot be expected to exercise effectively without instruction but can be converted to home-based treatment once responses have been achieved. Patients with weak contractions but appropriate muscle isolation are appropriate candidates for Kegel exercises; biofeedback has not been conclusively demonstrated to be superior to exercise therapy alone in this group. Vaginal cones or simple home biofeedback units may be useful adjuncts in these cases. Patients who have good muscle isolation and strong pelvic contractions at baseline generally have more severe bladder dysfunction and require aggressive treatment aimed at the detrusor. Instruction in "quick flicks" may assist in inhibiting urgency, and motivated patients may be offered vaginal cones. CONCLUSIONS: Pelvic floor muscle dysfunction is an important but often-overlooked component of UUI. The algorithm presented here can assist in tailoring exercise and biofeedback therapy to the individual patient. However, more research is needed to help stratify patients according to the degree of detrusor dysfunction and status of pelvic floor muscles before intervention.

Algorithms↗
PubMed1994

Genitourinary problems in the elderly patient.

Dramatic advances across several fronts have provided a marked improvement in the quality of life for the elderly urologic patient. Radical surgery for cancer is much safer than in the past, and our focus is on preservation of function or complete functional reconstruction. In other areas we strive to continue to deliver excellent treatment while minimizing patient morbidity. This is seen most dramatically in the treatment of urinary stone disease. Ongoing work in patients with BPH promises to provide similar benefits to this population in the coming years. At the same time, we must remember that our abundance of therapeutic options imposes a responsibility to individualize treatment so as to best serve each patient.

Aged↗
PubMed1993

Gastrocystoplasty without opening the stomach.

We describe a modification of gastrocystoplasty using the GIA stapler to harvest the segment for augmentation without opening the stomach. This simplification reduces operative time and blood loss without introducing complication specific to it and has been successfully used in our first 5 patients.

Adolescent↗
PubMed1989

Contributions of a supportive work environment to parents' well-being and orientation to work.

Examined the joint and unique contributions of informal social support in the workplace and formal, family-responsive benefits and policies provided by employers to the job-related attitudes and personal well-being of employed parents with a young child. Eighty married men, 169 married women, and 72 single women with a preschool child completed a survey concerning social support from co-workers and supervisor, utilization of family-responsive benefits and policies, readiness to leave the employer for additional benefits, job satisfaction, organizational commitment, role strain, and health symptoms. Among the findings: (a) Fathers and mothers expressed equal levels of job satisfaction and organizational commitment, but mothers reported more role strain and health symptoms; (b) nearly 48% of married women's organizational commitment was accounted for by measures of support in the workplace; (c) informal social support at work was significantly more important to men's well-being than that of women; and (d) formal, family-responsive policies appeared more consequential for the prediction of women's role strain, perhaps because of women's greater responsibility for adjusting work life to meet the demands of family roles.

Absenteeism↗