Biomedical subjects

D R Bodner

Publications and source records attributed to D R Bodner.

31 records · Page 2Linked to original sources

PubMed1990

Application of office ultrasound in the management of the spinal cord injury patient.

The effectiveness of office ultrasonography of the bladder and kidneys to provide routine urological followup was assessed in the outpatient spinal cord injury clinic. A total of 86 asymptomatic spinal cord injury patients underwent office ultrasonography of the kidneys and bladder as part of the routine urological followup. There were 106 ultrasound scans performed. Of the patients 68 had a blinded excretory urogram for comparison, including 20 who underwent additional studies (computerized tomography scans of the abdomen and pelvis, and/or radiologist-performed ultrasound examinations of the kidneys and bladder). All 18 patients who underwent office ultrasound but not excretory urography each underwent computerized tomography scans of the abdomen and pelvis and/or radiologist-performed ultrasound examinations of the kidneys and bladder. Office ultrasound detected 5 of 6 kidney stones, 6 of 6 hydronephrotic kidneys, 5 of 7 renal masses (4 of 6 cysts and 1 of 1 renal tumor), 3 of 3 bladder stones and 3 of 3 bladder diverticula. Subtle changes of chronic renal infection noted on excretory urography in 4 patients were not detected on corresponding ultrasound scans but voiding cystourethrograms revealed no reflux, and comparison to prior studies confirmed that these renal units were stable. Outpatient ultrasonography performed by the urologist proved to be a cost-effective and sensitive screening examination for urological disorders in the spinal cord injury population. The technique is easily learned, well tolerated and indicated when further urological evaluation is required.

Cost-Benefit Analysis↗

PubMed1989

Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence.

Beginning October 1985, 111 men agreed to enter a prospective study of the side effects of low dose papaverine/phentolamine therapy. A total of 46 men dropped out, 30 during the initial phase. The percentage of men with painless nodules almost consistently doubled from one followup examination to the next: 8 per cent at 1 month, 17 per cent at 3 months, 32 per cent at 6 months and 57 per cent at 12 months. The average injection frequency of those with nodules was 2 1/2 times higher than those without nodules. Of the men 41 per cent required an increased dose of medications during followup, and 40 per cent of 50 men had at least 1 abnormality of liver function, most of these involving mild to moderate elevations of alkaline phosphatase and lactic dehydrogenase. Priapism was not encountered during self-injection but it did occur twice in 329 physician-administered injections. Careful regular monitoring of patients should continue as some patients enter the second year of treatment.

Adult↗

PubMed1989

The effect of verapamil on the treatment of detrusor hyperreflexia in the spinal cord injured population.

Verapamil, a calcium channel blocker, was tested alone and in combination with oxybutynin chloride for its clinical effectiveness in the treatment of detrusor hyperreflexia in a spinal cord injured population. Fourteen patients with detrusor hyperreflexia were included. All patients were treated with oxybutynin chloride alone and with the combination of oxybutynin chloride and verapamil. Six of the patients were also studied on no medication and verapamil alone. Cystometric and clinical comparisons were made with each change in drug dosage. Verapamil 240SL, when used alone, produced a delay in the first detrusor contraction as compared to no medication in 5 of the 6 patients but clinical improvement was insignificant. Clinical improvement with tolerable side effects was noted in 13 of the 14 patients treated with the combination of oxybutynin chloride and verapamil over oxybutynin alone. Our early experience with verapamil suggests that it may be a valuable adjunct in the treatment of detrusor hyperreflexia.

Adult↗

PubMed1989

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence.

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

Erectile Dysfunction↗

PubMed1988

Alternative method of nerve-sparing when performing radical retropubic prostatectomy.

An alternative method of preserving the pelvic parasympathetic nerve plexus and potency when performing a radical retropubic prostatectomy is described. The prostate is removed in an antegrade manner as opposed to the classic retrograde approach with a current potency rate of 60 percent. The advantages of this technique are ease of defining the lateral vascular pedicles and late transection of the dorsal vein complex to minimize bleeding early in the procedure.

Erectile Dysfunction↗

PubMed1988

Injection therapy for impotence.

Injection of vasoactive drugs is an effective form of treatment for selected patients with impotence from virtually all causes. The two most commonly employed drugs in the United States are either papaverine alone or various combinations of papaverine and phentolamine. Patients with organic and mixed impotence are best suited for injection treatment, but selected patients with psychogenic impotence also benefit from therapy. After the patient is selected for injection therapy, he undergoes a series of trial injections in the physician's office. The incidence of priapism will be minimized if the initially administered doses are low and the patient is titrated to an appropriate dose level. Uncontrolled trials have revealed that injection treatment produces a satisfactory erection in 65 to 100 per cent of patients for a follow-up period of as long as 2 years with minimal side effects, but the dropout rate is high. If priapism does occur, it almost always responds readily to treatment with aspiration, low doses of an alpha-adrenergic agent, or both. The other common side effects are bruising or ecchymosis and nodule formation at the injection site. This latter complication has not been noted to cause significant abnormal penile curavature necessitating cessation of the program.

Clinical Trials as Topic↗

PubMed1988

The urethral syndrome.

The urethral syndrome remains a diagnosis of exclusion. The obvious difficulty is the lack of overall significance of this problem: patients with urethral syndrome do not die of their disease. More serious causes of urinary frequency, dysuria, and suprapubic discomfort must be excluded. A combination of a careful history, physical examination, inspection of the urine, urine culture, urine cytology, and cystourethroscopy with biopsy will make the diagnosis. One's personal bias about the etiology will often direct the evaluation. Selective usage of suppressive antibiotics along with reassurance and careful follow-up will prove effective in treating these patients. With greater understanding of lower urinary tract infections and the neurologic innervation of the bladder and urethra, it would seem appropriate for us to continue to develop a better understanding of the urethral syndrome, its etiology, and a more effective treatment rationale. A systematic approach must be maintained in the evaluation of these patients so that an appropriate treatment can be devised.

Diagnosis, Differential↗

PubMed1987

Acquired infundibular stenosis.

Acquired infundibular stenosis is an unusual complication resulting in pancalyceal obstruction. We have cared for 6 patients with acquired infundibular stenosis not associated with tuberculosis. All patients had urinary diversion with ileal conduits for a minimum of eleven years and documented ileal-ureteral reflux and chronic urinary tract infections. The clinical, radiographic, and pathologic characteristics of this syndrome are described and therapeutic guidelines suggested.

Adult↗

PubMed1987

The application of intracavernous injection of vasoactive medications for erection in men with spinal cord injury.

Obtaining and sustaining an erection that is firm enough and adequate for vaginal penetration and satisfactory completion of intercourse are common problems for the male spinal cord injury patient. Intracavernous injection of vasoactive substances offers a new treatment option but it must be approached with caution in this population. During the last year we placed 20 spinal cord injury men (16 paraplegics and 4 quadriplegics) on self-injection of papaverine alone or with phentolamine. Of the patients 19 were able to obtain an erection adequate for penetration. The patient who did not obtain an adequate erection had anomalous penile venous drainage. Six episodes of priapism occurred in 3 patients: 1 had a surgical shunt placed elsewhere before he entered our program, and 2 were treated with aspiration of the corpora and injection of epinephrine. All 3 patients subsequently have been able to obtain satisfactory erections with use of lower doses of papaverine alone.

Adult↗

PubMed1986

Ileal and jejunal conduit urinary diversion.

The indications for urinary diversion have changed in recent years, and it is most often required in association with radical surgery for pelvic malignancies. Many patient with lower urinary tract dysfunction can be managed satisfactorily without diversion by use of intermittent catheterization, administration of specific pharmacologic agents, and, when necessary, implantation of artificial sphincters. For patients who require urinary diversion, the ureteroileal conduit remains the standard by which other methods should be judged. If satisfactory results are to be obtained, it is clear that meticulous attention to indications, operative technique, and careful follow-up are essential. As many of these patients have other disabilities, the management of the urinary tract must be integrated with other aspects of patient care. The introduction of the colonic conduit and recently the continent types of urinary diversion represent a search for the ideal method that has yet to be achieved.

Adenocarcinoma↗

PubMed1986

Primary transitional cell carcinoma of the prostate.

Two cases of the rare primary paramalpighien tumors of prostate, arising from the prostate gland canals lined with paramalpighien epithelium, are described and their poor prognosis due to rapid local and metastatic spread emphasized.

Aged↗

PubMed1985

Impotence: evaluation and treatment.

Impotence is a multifaceted problem. Complex neurologic pathways intermingle to control specific vascular changes in a tightly controlled hormonal milieu. Although great progress has been made in understanding the mechanism of erection, further studies are needed. Careful history and physical examination along with appropriate laboratory tests and noninvasive penile vascular studies are important in differentiating organic from psychogenic impotence. Understanding the etiology of impotence permits a more logical and effective treatment plan. The advent of the semirigid and inflatable penile prostheses has provided a simple and effective treatment for patients with organic impotence for whom there were no treatment options available in the past. The continued improvement in the design of the prostheses and the simplicity with which they can be implanted have revolutionized the treatment of impotence. With newer prosthetic devices being developed, the penile prosthesis will continue to improve the quality of life for impotent patients.

Angiography↗

PubMed1985

Primary transitional cell carcinoma of the prostate.

Transitional cell carcinoma of the prostate is an unusual finding usually associated with transitional cell carcinoma of the bladder. We recently treated two patients with transitional cell carcinoma of the prostate without evidence of bladder involvement. Their histories are reviewed and the literature pertinent to this entity is discussed.

Aged↗