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Biomedical subjects

E Milroy

Publications and source records attributed to E Milroy.

At least 19 recordsLinked to original sources
PubMed1998

[Stents in therapy of urethral strictures].

The human urethra seems remarkably tolerant of foreign material within its lumen. Providing that a stricture has been adequately cut by means of urethrotomy, or dilated with bougies, the majority of urethras will tolerate both permanent and temporary stents with few problems. Temporary stents have the obvious advantage over permanent stents that no foreign material is left in the urethra but before these can be recommended it is essential that more clinical experience is gained and that long term results up to ten years after removal of the stent are published. Great care is also needed in the use of any sort of permanent device, either the Urolume stent, or varieties of the Strecker such as the Memotherm device. These should not be used in children and should be probably be avoided in young adults. The majority of strictures in this age group are in any case treated more easily by single stage urethroplasty procedures. The use of permanent epithelial covering stents should be limited to the bulbo-membranous urethra, with the possible exception of carefully selected sphincters strictures used in combination with an artificial urinary sphincter. Better results will be obtained by using these stents in strictures with a short history before multiple urethrotomies and dilatations have been carried out and before extensive urethral and periurethral fibrosis has occurred. This means that urethral rupture strictures are unsuitable, and in any case these are simple to deal with be means of stricture excision and primary end to end anastomosis of the urethra particularly when the stricture is in the bulbar urethra. Care must also be taken in using these devices in post-urethroplasty strictures if extensive periurethral fibrosis exists, although it has to be admitted that these stents may be very successful in some of these patients. The difficulty at the present time is our inability to define exactly which traumatic stricture or post-urethroplasty stricture will succeed and which will fail. Metal urethral stents should not be used for the first treatment of a urethral stricture. Depending on the aetiology, the site and the length of the stricture there is always a 40-50% chance that the stricture may be cured by means of a simple urethrotomy or dilatation and this should always be tried at least once before resorting to urethral stenting. There is no doubt that permanent urethral stents have an important role to play in the treatment of recurrent urethral strictures. Careful patient selection is essential in order to achieve the best results and we need more long term results before the final role of these devices in the treatment of urethral strictures can be determined. Temporary stenting of the urethra with non-epithelial covering stents is a simpler and safer treatment but at this point in time we cannot be sure how effective this treatment is and for which patients it is most successful. Long term results must be awaited before the place of these temporary devices can be defined.

Adolescent↗
PubMed1996

Long-term results of urolume urethral stent for recurrent urethral strictures.

PURPOSE: We present the long-term results of the first 50 patients treated with a new urethral stent (UroLume) developed in 1985 for recurrent bulbomembranous urethral strictures. MATERIALS AND METHODS: All stents were inserted with the patient under general anesthesia using a standard endoscopic delivery system. Of the patients 27 were followed for 5 years or longer, 5 for 4 years and 18 for shorter periods due to death, illness or other factors. RESULTS: Mean (plus or minus standard deviation) maximum flow rate at last following was 19.7 ml. per second (+/- 6.9), and 93% of the patients were satisfied with the stent. In 8 patients (16%) narrowing developed within the lumen of the stent and in the remaining 84% the stent achieved its purpose of maintaining a good urethral lumen. In 9 patients stricture recurred outside the stent because of inaccurate positioning. All of these complications were satisfactorily treated by an additional overlapping stent. Failures occurred particularly in patients with a long stricture history and extensive periurethral fibrosis. CONCLUSIONS: These results indicate that at 4 to 6 years promising early results with the UroLume stent for urethral strictures are maintained with a low late failure rate. This device is not suitable for all strictures and cases with extensive periurethral fibrosis should be avoided but it remains a useful and successful treatment option for many recurrent bulbomembranous urethral strictures.

Adult↗
PubMed1994

A modified prostatic UroLume Wallstent for healthy patients with symptomatic benign prostatic hyperplasia: a European Multicenter Study.

OBJECTIVES: This European multicenter study was aimed to assess the clinical reliability of a modified prostatic UroLume Wallstent (American Medical System, Minnetonka, MN) in the treatment of 135 healthy patients with symptomatic benign prostatic hyperplasia. METHODS: Ninety-one patients who were obstructed but still voiding spontaneously and 44 patients who had an indwelling catheter were treated by placement of a modified stent. RESULTS: A significant improvement in mean peak flow rates and residual urine volumes was maintained throughout follow-up. Both obstructive and irritative voiding symptoms were significantly improved after placement of the stent, although a greater amelioration was seen in obstructive symptoms. The rate of patients reporting erections increased after stent insertion. Eighty percent of sexually active patients reported the maintenance of antegrade ejaculation postoperatively. A greater than 80% epithelialization of the stent was seen in 28 patients (100%) examined at the 18-month follow-up. Long-term complications were seen in 51 patients (38%). Twenty-one of these patients had the stent removed due to intractable detrusor instability, stent encrustation, stent migration, or persistence of obstruction due to prominent median lobe, understenting, or severe hyperplasia of the epithelium of the prostatic urethra. In 6 of them another stent was reimplanted while the others were treated surgically. CONCLUSIONS: Although this modified stent was abandoned due to an unacceptable rate of complications, this study demonstrates that bladder outlet obstruction in healthy patients with benign prostatic hyperplasia can be successfully relieved by the placement of a UroLume Wallstent.

Aged↗
PubMed1993

The UroLume stent in the management of benign prostatic hyperplasia.

There were 54 patients entered into this study of the UroLume permanent prostatic stent, most of whom were unfit for conventional prostatic surgery. The stents were inserted with the patient under local or regional anesthesia. Of the patients 34 presented in acute retention, 12 had chronic retention, 4 had severe and worsening symptoms, and 4 had symptoms and urodynamic evidence of obstruction occurring in the presence of Parkinson's disease. Following stent insertion 50 patients were able to void satisfactorily, while the remaining 4 presented with chronic retention and detrusor failure. The 40 patients who had no or minimal remaining symptoms were satisfied with the stent. Most patients experienced frequency and urgency of micturition for 1 to 3 months, which resolved in all but 9 patients with persistent severe detrusor instability. Symptom scores decreased to 6.5 (total) at 1 year for nonretention patients and 6.0 for retention patients. Stents were covered with epithelium within 6 to 9 months. However, when the stent was positioned with any part of the proximal end within the bladder or when the stent could not be epithelialized incrustation occurred (14 cases, all of which were asymptomatic). No serious urosepsis was noted in any patient in this study. Six stents were removed endoscopically without difficulty or damage to the urethra at up to 18 months. The implications of these findings to the potential role of the UroLume stent in the management of a wider range of patients with prostatic obstruction are discussed.

Aged↗
PubMed1993

Treatment of sphincter strictures using permanent UroLume stent.

The success of the permanent UroLume urethral stent in the treatment of recurrent bulbar urethral strictures led to its use in cases of recurrent strictures in the sphincter active membranous urethra. Among 6 patients treated 3 traumatic strictures have recurred despite the urethral stent but 3 post-prostatectomy strictures have been treated successfully in conjunction with an artificial sphincter to restore continence.

Adult↗
PubMed1990

Clinical overview of prazosin in the treatment of prostatic obstruction.

Prazosin is well known to most physicians as an effective antihypertensive medication, but its therapeutic value in many cases of benign prostatic hyperplasia (BPH) may be unfamiliar to many. Prostate problems are among the most common medical conditions facing older men, with BPH appearing in more than 50% of men over the age of 50 years and in 90% of those over 80 years of age. About 10% of men over the age of 40 undergo surgery for the condition. Research in the past 15 years has revealed that smooth muscle contractions in the enlarged prostate are controlled by stimulation of the alpha 1-receptors in the tissue. This discovery has provided the rationale for administering drugs to block the stimulation of the alpha 1-receptors to relieve the obstructive and irritative symptoms of BPH. Prazosin was an early candidate for such medication because of its highly selective alpha 1-blockade and its well-documented safety record. Early clinical trials yielded convincing evidence of prazosin's effectiveness in reducing BPH symptoms, and the number of patients treated with prazosin for BPH now numbers in the several hundreds. In these trials, prazosin administered in doses from 1 mg to as high as 9 mg a day relieved obstructive and irritative symptoms, as well as improved flow rates and decreased urethral pressure. Overall, between 60 and 70% of treated patients can be expected to enjoy real benefits from prazosin therapy.

Aged↗
PubMed1986

Autotransplantation of human parathyroid glands.

Six patients with primary hyperparathyroidism have had glands autotransplanted into their forearm or deltoid region immediately after presumed total parathyroidectomy. Five hyperplastic glands were transplanted; two patients are normocalcaemic, two are hypercalcaemic and one is hypocalcaemic. The one normal transplanted gland did not show any evidence of function. We conclude that immediate transplantation of parathyroid tissue following total parathyroidectomy may not be the procedure of choice.

Adult↗
PubMed1984

Parathyroid venous sampling and ultrasonography in primary hyperparathyroidism due to multigland disease.

The results of pre-operative venous sampling and ultrasonography in 20 patients with primary hyperparathyroidism, who were shown histologically to have multigland disease, were reviewed. Ultrasonography (15 patients) demonstrated abnormal parathyroid tissue in 46% (seven patients), but correctly predicted only 33% of the involvement or non-involvement of individual glands. The main deficiency was the high number of false negatives. Parathyroid venous sampling (19 patients) showed elevated levels of parathyroid hormone in 18 (94.7%), but overall the sites of normal and abnormal glands were predicted in 56 of 76 sites (73.6%). The investigation was misleading in one patient (5.2%), in that no abnormal glands were predicted. The sampling maps of the above 19 patients were randomly mixed with those of 100 consecutive patients, whose disease was due to a single adenoma. All but one of the multigland disease cases were identified correctly but six of the single adenoma patients were predicted as having two glands involved, and were therefore thought to be multigland. The usefulness of, and difficulties in, diagnosing multigland disease in primary hyperparathyroidism are discussed.

Adenoma↗
PubMed1978

An experimental approach to the optimum oestrogen dosage in prostatic carcinoma.

The action of diethylstilboestrol on the androgen response mechanism of the human prostate has been examined. A simple in vitro test system that assesses effects on hormone uptake, receptor binding and translocation to the nucleus has been employed. The test has also been modified to study the effect of diethylstilboestrol on the activity of 5 alpha-reductase, the enzyme responsible for the conversion of testosterone to 5 alpha-dihydrotestosterone. These results are discussed in relation to the dosage of diethylstilboestrol for treatment of carcinoma of the prostate.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗