Biomedical subjects
Publications and source records attributed to D M Barrett.
A retrospective analysis of 5 cases of primary leiomyosarcoma of the bladder seen during 1958 through 1978 revealed that segmental resection is curative in selected cases but that more extensive extirpation may be warranted, depending on the stage of the disease. Radiation therapy had no effect on regional disease. Early diagnosis and aggressive surgical therapy are important.
We analyzed 100 patients who underwent implantation of the Jonas penile prosthesis because of impotence, complications, and patient and partner satisfaction. Data were gathered by direct patient contact and mailed questionnaires, and at followup ranging from 4 to 18 months. Complications occurred in 7 patients. Of the 100 patients 90 were satisfied with the results and would choose the same operation again, although 20 claimed to have some difficulty with concealment of the penis. A total of 56 patients underwent implantation of the prosthesis under local anesthesia, which has resulted in diminished patient risk as well as reduced cost and duration of hospitalization.
The records of 34 patients with posterior urethral disruptions secondary to blunt pelvic trauma who were treated with primary realignment were reviewed. Among the 29 evaluable patients there was a 38 per cent incidence of stricture (11 of 29), a 3 per cent incidence of incontinence (1 of 29) and a 15 per cent incidence of impotence (4 of 27). Primary realignment has a low morbidity and an acceptable rate of incontinence, impotence and stricture formation, and is recommended in the treatment of posterior urethral injuries.
The AS791 prosthetic sphincter was implanted in 66 patients with urinary incontinence after radical prostatectomy. Of these patients 49 (74 per cent) were continent 3 months to 4 1/2 years after implantation. Excluding the 22 patients who had had previous pelvic radiation therapy 41 (93 per cent) were continent. Mechanical problems have been few, establishing the reliability of this unique sphincter mechanism.
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We have performed percutaneous extractions of renal pelvic stones in 15 patients with the use of the Wolf percutaneous universal nephroscope. At one session, with the patient under general anesthesia, a percutaneous tract is dilated to 24 F, and the stone is immediately removed. Fifteen stones have been removed successfully by ultrasonic lithotripsy, basket retrieval, use of a forceps, or a combination of these techniques. Average operating time has been 1 hour and the mean hospitalization time 4 days. The advantages of this technique are that a skin incision of only 1 to 2 cm is required to remove the stone, hospital days are fewer than with open procedures, and postoperative morbidity is minimal. In selected situations, this method represents a significant advance over standard open surgical procedures for removal of renal pelvic stones.
The usefulness of bethanechol chloride as a therapeutic adjunct in the treatment of patients with residual urine but no obstruction has been questioned. This study, in which oral bethanechol chloride was compared to a placebo in a randomized, double-blind fashion, does not show a significant short-term effect in female patients with persistent elevation in residual urine. No differences were seen in voided volume, residual volume, percentage residual volume, mean flow rate and intravesical pressure at 100 ml. volume and at maximal capacity when the treatment groups were compared to the group receiving the placebo.
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In 12 children with membranous urethral strictures transpubic urethroplasty has been performed successfully with minimal morbidity and no mortality. Of the 12 patients 8 are completely continent after transpubic urethroplasty, 2 have partial continence and 2 are incontinent. Wedge resection of the pubic symphysis afforded satisfactory exposure to the prostatic urethra, and none of the 12 patients experienced orthopedic instability, abnormal gaits or pelvic girdle pain. In 3 patients there was loss of erectile function after pelvic injury, which reflects the significant risk of impotence after crush injury to the pelvis with rupture of the posterior urethra.
More than 200 patients have undergone combined uroflowmetry and external sphincter electromyography studies in our urodynamic laboratories. Pediatric surface electrocardiographic electrodes placed on the perianal skin were used to monitor skeletal muscle electromyographic activity while the patient voided into a standard load-cell type of uroflowmeter. The findings indicate clearly that 1) flow electromyography is reliable and easy to perform, 2) striated muscle electromyographic activity is reduced during normal voiding, 3) external sphincter dyssynergia is rare in patients without true neurologic disease and 4) many patients, especially women, void by straining, which causes an increase in external sphincter electromyographic activity but, generally, does not impair voiding. Results of this study suggest that sphincter dyssynergia has been overdiagnosed. With the use of the flow electromyography study the behavior of the external striated muscle sphincter during voiding can be demonstrated easily and reliably in most clinical urodynamic evaluations.
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Controversy surrounds the management of multicystic dysplastic kidneys. This report of a renal cell carcinoma originating in a multicystic kidney lends support to elective removal of these kidneys.
The 36 patients who underwent radical retropubic prostatectomy for adenocarcinoma after transurethral resection of the prostate were reviewed to evaluate the difficulty of the radical operation, the rate of morbidity and the survival. In 24 patients (67 per cent) the dissection proved to be routine; 18 patients (50 per cent) had perfect urinary control, whereas 4 were totally incontinent. There appears to be no untoward effect on survival, since all patients remain alive, 22 per cent having had followup for 5 years or more.
Substantiated by the simultaneous comparison with wire and rectal catheter electrodes, disposable surface electrocardiogram electrodes developed for infants have proved to be easy to place, well tolerated and reliable for urodynamic testing in more than 400 clinical urodynamic evaluations.
Urinary retention may develop in the absence of significant organic disease. Patients with psychogenic retention range from those with episodic acute retention to those who have learned to inhibit urination and have retention with a large residual urine volume owing to myotonic detrusor degeneration. A combination of thorough medical, neurologic, psychiatric and urologic evaluation is indicated for all such patients. Management consists of the implementation of bladder training with or without intermittent catheterization, which generally may be accomplished on an outpatient basis.