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Biomedical subjects

D M Barrett

Publications and source records attributed to D M Barrett.

At least 91 records · Page 5Linked to original sources
PubMed1987

Cystometric properties of ileum and right colon after bladder augmentation, substitution or replacement.

Cystometric studies were performed on 38 patients who had undergone augmentation, substitution or replacement enterocystoplasty. These studies were done to determine the choice of bowel segment to augment or replace the detrusor and the shape in which the bowel segment should be reconstructed. Eleven patients underwent tubular and 10 detubularized right colon cystoplasty, while 10 underwent tubular (Camey bladder) and 7 detubularized ileocystoplasty. Compliance curves were normal in nearly all patients except those who underwent tubular ileocystoplasty. Cystoplasty contractions were more common with tubular cystoplasty. These contractions appeared at a lower bladder capacity and were higher in amplitude in tubular cystoplasty patients. Detubularizing the bowel for bladder reconstruction appears to create a better low pressure capacitor with better compliance and fewer high pressure cystoplasty contractions.

Adolescent↗
PubMed1987

The model AS 800 artificial urinary sphincter: Mayo Clinic experience.

The model AS 800 artificial urinary sphincter was implanted in 100 male and 9 female patients between 7 and 89 years old. Postoperative followup was 1 to 32 months. The indication for implantation was total urinary incontinence in 86 patients (78.9 per cent), stress incontinence in 22 (21.2 per cent) and urgency incontinence in 1 (0.9 per cent). Of the patients 97 (89 per cent) underwent implantation for the first time, 7 (6.4 per cent) had a previous artificial urinary sphincter model replaced by the AS 800 device and 5 (4.6 per cent) underwent reimplantation of a previous model. The cuff was placed around the bladder neck in all 9 female patients, whereas in the male patients the cuff was implanted around the bladder neck in 20 and around the bulbous urethra in 80. Thirty-one patients (28.4 per cent), 29 of whom were continent at night, were practicing nocturnal deactivation of the device. Complete post-activation continence was achieved in 91 patients (83.5 per cent), some leakage occurred in 10 (9.2 per cent) and 8 (7.3 per cent) remained incontinent. A total of 23 patients required 1 or more revisions, the most common indications for the first revision being loss of cuff compression (9), tubing kink (3), cuff erosion (3) and infection (2). At the time of this report 89 patients (81.7 per cent) were continent, 9 (8.3 per cent) still had some leakage, 3 (2.8 per cent) were incontinent, 5 (4.6 per cent) were awaiting reimplantation and 3 (2.8 per cent) had died of unrelated causes.

Adolescent↗
PubMed1987

Perioperative and postoperative complications from bilateral pelvic lymphadenectomy and radical retropubic prostatectomy.

The complications experienced by 692 consecutive patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy from 1978 through 1984 were analyzed. Four patients (0.6 per cent) died in the perioperative or early postoperative period. Pulmonary embolus developed in 19 patients (2.7 per cent) and severe to total urinary incontinence occurred in 34 (5 per cent). Our large series suggests that radical retropubic prostatectomy with staging bilateral pelvic lymphadenectomy can be performed in a safe manner with minimal postoperative morbidity.

Adenocarcinoma↗
PubMed1987

Giant leiomyoma of the prostate.

Giant leiomyoma of the prostate is a rare lesion. We document a case in a 61-year-old man who presented with urinary obstructive symptoms. He had undergone transurethral resection twice before he was seen at our institution, where suprapubic prostatectomy was performed. At follow-up 18 months postoperatively, no evidence of recurrent disease was found and his voiding pattern was normal.

Humans↗
PubMed1986

Bladder replacement with use of a detubularized right colonic segment: preliminary report of a new technique.

Dissatisfaction with the long-term results of cutaneous urinary diversion and a demand for a more socially acceptable solution have prompted the development of procedures that allow continent urinary diversion. Creation of an internal reservoir from reconstructed bowel segments, which is anastomosed to the patient's urethra and allows continence and urination through the urethra, is a particularly attractive option. We describe a technique that is relatively easy to perform and that incorporates a detubularized right colonic segment. The advantages of this procedure are discussed.

Aged↗
PubMed1985

Long-term results with the Jonas malleable penile prosthesis.

Long-term assessment (mean followup 30 months) of patient-partner satisfaction and device reliability was done in 100 patients who had undergone implantation of a Jonas malleable penile prosthesis. Evaluation included an extensive questionnaire and radiographs of the prosthesis. The long-term satisfaction rate was 84 per cent and 2 patients had wire fractures. A life-table analysis was performed with the data from 78 patients who had completed the questionnaire and who had a radiograph of the original implanted device. The probability of having a device without mechanical failure at 23.6 months was estimated to be 96.1 per cent. Thereafter, no additional mechanical failures occurred in units followed up to a maximum of 44 months.

Actuarial Analysis↗
PubMed1985

Percutaneous removal of kidney stones: review of 1,000 cases.

We report the results of 1,000 consecutive patients who underwent percutaneous removal of renal and ureteral stones. Removal was successful for 98.3 per cent of the targeted renal stones and 88.2 per cent of the ureteral stones. Complications, evolution and technique are discussed. Percutaneous techniques are an effective way to handle the majority of renal calculi and these techniques will continue to be important as shock wave lithotripsy becomes more widespread in the United States.

Blood Transfusion↗
PubMed1985

Stented versus nonstented ureteroileal anastomoses: is there a difference with regard to leak and stricture?

We reviewed the clinical histories of 362 patients (711 renal units) who had undergone ileal conduit diversion. Stents were used in 126 patients (247 renal units) and were not used in 236 (464 renal units). The stented group was divided further into 95 patients (186 renal units) with silicone single J stents and 31 (61 renal units) with some other type of stent. The over-all incidence of urine leakage was 1.7 per cent (6 of 362 patients). The over-all incidence of stricture was 3.9 per cent (11 without and 3 with stents). No leak occurred among the 126 patients in whom a stent was used. None of the 95 patients in whom silicone single J stents were used had stricture. If stents are to be used, we recommend silicone single J stents because of their satisfactory performance to date.

Female↗
PubMed1985

Recurrent or persistent urinary incontinence in patients with the artificial urinary sphincter: diagnostic considerations and management.

Clinical experience in the selection of patients for implantation of the artificial urinary sphincter and the surgical techniques for sphincter implantation indicate a need to provide suitable guidelines for patient followup and the management of post-implantation urinary incontinence. Two types of post-implantation incontinence are recognized: 1) immediate post-activation incontinence and 2) delayed or recurrent incontinence. The potential causes, and the diagnostic and management techniques are dependent on not only an understanding of device function but also on the use of already available clinical tools. Physical examination, inflate-deflate roentgenograms of the device, cystoscopy and retrograde urethrography each has an important role in determining the cause and, therefore, the appropriate remedy for the restoration of urinary control. Causes that result in loss of urinary control after implantation include improper operation of the device by the patient, detrusor hyperreflexia, occlusive cuff erosion, improper cuff sizing and device malfunction. Proper recognition of the precise cause of post-implantation incontinence and workable guidelines for management will provide for effective assurance that urinary control can be restored successfully.

Equipment Failure↗
PubMed1985

The artificial urinary sphincter: experience with the AS 800 pump-control assembly for single-stage primary deactivation and activation--a preliminary report.

The introduction of a new pump-control assembly mechanism for the artificial urinary sphincter has eliminated the need for two-stage surgical procedures in patients with urinary incontinence and has provided the option of deactivation or activation both at the time of implantation and at a later time, in accordance with the clinical judgment of the surgeon. Individualization of treatment on the basis of the patient's clinical condition is a considerable advance in the management of urinary incontinence because it allows broader applications in the use of the artificial sphincter.

Adult↗
PubMed1985

Use of the artificial urinary sphincter in the management of severe incontinence in females.

AS 792 and AS 800 sphincters were implanted in 31 female patients with incontinence due to various causes including neurologic dysfunction, recurrent stress incontinence, spinal cord trauma and pelvic trauma. Continued continence has been achieved in 21 of these patients. Erosions required removal of the device in the ten other patients. The AS 800 model has significant modifications that allow activation and deactivation without additional operative procedures. Satisfactory continence can be achieved in properly selected patients. The integrity of the vesicovaginal surgical plane is the key to success. Patients with multiple operations are the most difficult to manage and delayed activation is mandatory. Intermittent catheterization can be safely done and mechanical reliability is good.

Adolescent↗
PubMed1984

Inflatable penile prosthesis. New device design and patient-partner satisfaction.

The three most significant factors in achieving patient-partner satisfaction with a penile prosthetic device are selection of the patients, realistic expectations of both the patient and the partner, and reliability of the device. Exchange of information between the clinical observers and the design engineers can significantly enhance the reliability of the device.

Erectile Dysfunction↗
PubMed1984

Incontinence, intermittent self-catheterization and the artificial genitourinary sphincter.

Although the artificial genitourinary sphincter is ideally suited for incontinent patients who can empty the bladder completely, we have observed 22 patients with artificial sphincters who also perform intermittent self-catheterization to augment bladder emptying. No cuff erosions have occurred to date, with 11 patients on intermittent catheterization for more than 30 months. In patients who will require intermittent self-catheterization after sphincter implantation the cuff should be placed around the bladder neck. We believe that patients with sphincteric incontinence and decreased bladder contractility resulting in excessive residual urine volume are reasonable candidates for use of the artificial sphincter with intermittent self-catheterization.

Adolescent↗
PubMed1983

Acute panautonomic neuropathy.

Two patients with acute panautonomic neuropathy had severe impairment of sympathetic and parasympathetic function of acute onset. Autonomic tests suggesting a postganglionic lesion and direct evidence of loss of unmyelinated and small myelinated fibers on nerve biopsy were found in Patient 1. There was a selective loss of small myelinated and unmyelinated nerve fibers; C potential was absent in the in vitro compound action potential; dopamine-beta-hydroxylase activity was unmeasurable. No definite abnormalities were found on the nerve biopsy of Patient 2. The acute panautonomic neuropathies appear to comprise a spectrum of somatic and autonomic involvement.

Acute Disease↗