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Biomedical subjects

G D Webster

Publications and source records attributed to G D Webster.

At least 37 records · Page 2Linked to original sources
PubMed1996

Kock versus right colon continent urinary diversion: comparison of outcome and reoperation rate.

OBJECTIVES: To compare one surgeon's sequential experience with two types of continent cutaneous diversion; namely, the Kock pouch (KP) and the right colon pouch (RCP). METHODS: Outcomes for the final 30 KP patients seen during the period 1989 to 1992 and the initial 30 RCP patients seen between 1992 and 1995 were analyzed retrospectively. Patients differed in median age (KP 52.5, RCP 63.5 years), in number in whom malignancy was the reason for diversion (KP 18, RCP 25), and median follow-up period (KP 50, RCP 16 months). RESULTS: No intraoperative complications or perioperative deaths occurred. Immediate postoperative complications were mild and self-limited in both groups, with the exception of 1 RCP patient who developed life-threatening hemorrhage from a ruptured splenic artery aneurysm. KP patients had a statistically higher (P < 0.05) surgical revision requirement (16 patients, 26 revisions) than RCP patients (4 patients, 4 revisions). The majority of KP revisions were for efferent limb problems. Of the 14 KP patients not requiring revision, 4 have mild incontinence not warranting surgery. Three renal units showed new mild hydronephrosis (2 KP, 1 RCP) and are being observed. Prolonged diarrhea was present in 1 patient in each group, and vitamin B12 supplementation was required in 1 KP and 2 RCP patients. CONCLUSIONS: The markedly higher rate of surgical revision with the Kock pouch has led to our change in practice in favor of the right colon pouch for continent cutaneous urinary diversion.

Colon↗
PubMed1996

Bladder outlet obstruction in women.

While voiding dysfunction is relatively common in women, true bladder outlet obstruction is a rare condition and may be present in a misleading manner. To make an accurate diagnosis and tailor appropriate treatment, urodynamic investigation is required. However, even sophisticated urodynamic studies have limitations in predicting obstruction as a complication of anti-incontinence surgery and response to ureterolysis.

Female↗
PubMed1996

Endoscopic management of the obliterated anastomosis following radical prostatectomy.

PURPOSE: We evaluated an endoscopic technique to treat the challenging problem of an obliterated anastomosis following radical prostatectomy. MATERIALS AND METHODS: Four men with a mean 2.25 cm. obliterative defect underwent visual internal urethrotomy along a sternal guide wire passed under direct antegrade and retrograde vision. Men then performed self-dilation according to an increasing interval protocol. RESULTS: All 4 men maintained anastomotic patency for a mean followup of 12.5 months and 1 no longer requires self-calibration. There were no complications of this procedure. CONCLUSIONS: Endoscopic management coupled with self-dilation offers a safe, minimally invasive option for difficult, long obliterative anastomotic defects following radical prostatectomy.

Aged↗
PubMed1995

Impotence following pelvic fracture urethral injury: incidence, aetiology and management.

OBJECTIVE: To evaluate the potency status of patients undergoing delayed perineal repair following a pelvic fracture urethral injury to determine the incidence and aetiology of impotence. PATIENTS AND METHODS: Long-term potency (> 6 months post-operatively) was subjectively evaluated in 92 patients and correlated with their pre-operative and intra-operative findings. The management of their impotence was aso reviewed. Thirty original pelvic radiographs were assessed independently to determine if the pattern of bony injury was associated with the development of impotence. RESULTS: Fifty-seven patients (62%) remained impotent in the long term with a median follow-up of 48 months (range 12-128) and the operation did not render any potent patient impotent. Self-injection with vasoactive agents was successful in 24 of 27 (89%), suggesting a neurogenic aetiology in the majority. Bilateral pubic rami fracture was also associated with a high incidence of impotence. CONCLUSION: Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the symphysis pubis is the most likely cause of impotence in this injury.

Adolescent↗
PubMed1995

Detrusor instability.

Detrusor instability is a common cause of urgency and urge incontinence in neurologically normal patients. It is defined as an involuntary phasic detrusor contraction of any pressure associated with symptoms of urge or leakage while the patient is attempting to inhibit micturition. The etiology is unknown but it has been associated with congenital causes, aging, stress incontinence, and bladder outlet obstruction. Diagnosis relies on a urologic history and physical examination, a voiding diary, and a urodynamic evaluation. Treatment is primarily pharmacologic and behavioral, with surgical options being reserved for selected patients.

Humans↗
PubMed1994

Performance of four computer-based diagnostic systems.

BACKGROUND: Computer-based diagnostic systems are available commercially, but there has been limited evaluation of their performance. We assessed the diagnostic capabilities of four internal medicine diagnostic systems: Dxplain, Iliad, Meditel, and QMR. METHODS: Ten expert clinicians created a set of 105 diagnostically challenging clinical case summaries involving actual patients. Clinical data were entered into each program with the vocabulary provided by the program's developer. Each of the systems produced a ranked list of possible diagnoses for each patient, as did the group of experts. We calculated scores on several performance measures for each computer program. RESULTS: No single computer program scored better than the others on all performance measures. Among all cases and all programs, the proportion of correct diagnoses ranged from 0.52 to 0.71, and the mean proportion of relevant diagnoses ranged from 0.19 to 0.37. On average, less than half the diagnoses on the experts' original list of reasonable diagnoses were suggested by any of the programs. However, each program suggested an average of approximately two additional diagnoses per case that the experts found relevant but had not originally considered. CONCLUSIONS: The results provide a profile of the strengths and limitations of these computer programs. The programs should be used by physicians who can identify and use the relevant information and ignore the irrelevant information that can be produced.

Analysis of Variance↗
PubMed1994

Synchronous management of anastomotic contracture and stress urinary incontinence following radical prostatectomy.

Of 77 patients presenting for artificial urinary sphincter implantation due to incontinence following radical prostatectomy 26 had a significant associated urethrovesical anastomotic contracture. Synchronous endoscopic contracture incision with electrocautery and implantation of an artificial urinary sphincter (AMS800) were performed in all cases. A total of 25 patients void with a good subjective flow, with an average followup of 32 months. In 1 patient symptomatic stenosis recurred 6 months after incision and reincision was successful at the time of sphincter revision. No infection or erosion developed and 24 patients are socially continent (0 to 1 thin pad per day). During this time 5 patients underwent 8 revisions of the artificial sphincter. Synchronous contracture incision with electrocautery and artificial urinary sphincter implantation are safe and provide satisfying results in patients with complex post-prostatectomy incontinence.

Anastomosis, Surgical↗
PubMed1993

Urological dysfunction in patients with diastematomyelia.

Little information exists concerning voiding dysfunction associated with diastematomyelia (splitting of the spinal cord). We present 27 patients 4 days to 62 years old (mean 13 years) who underwent neurosurgical intervention for treatment of this disorder. Of these patients 14 had urological evaluation, with 11 having undergone video urodynamics. Nine patients had minimal urological manifestations. No patient had a urodynamically proved hostile bladder nor evidence of upper urinary tract deterioration. In our experience, patients with a spinal cord fixation syndrome resulting from diastematomyelia not associated with a meningomyelocele appear to have a relatively benign course in terms of the urological manifestations. However, due to the lack of reports concerning the urological findings in this occult dysraphic state, we still suggest upper and lower urinary tract evaluation and followup.

Adolescent↗
PubMed1992

Management of type III stress urinary incontinence using artificial urinary sphincter.

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.

Adult↗
PubMed1992

Anomalies associated with myelodysplasia.

The records of 181 patients with myelodysplasia were reviewed. The prevalence of associated genitourinary anomalies as well as cardiac, facial, anal, and tethered cord were determined. The prevalence of congenital malformations associated with myelodysplasia were less in this series than in previous reports.

Abnormalities, Multiple↗
PubMed1992

Complications of enterocystoplasty.

Bladder reconstruction, either by augmentation or substitution enterocystoplasty, is a safe alternative to supravesical urinary diversion providing careful attention to preoperative selection, surgical technique, and postoperative review is observed. However, under the most optimal conditions an untoward outcome may occur. We reviewed our series of 100 intestinocystoplasties to categorize the types of complications encountered, and to identify preoperative risk factors that could potentially develop into an unfavorable sequela. Twenty-seven patients required either early or late surgical intervention, while 30 were managed nonoperatively. In our review we identified two groups, those with myelodysplasia and those with a solitary functioning kidney, who are at a higher risk for an unfavorable outcome to develop.

Adult↗
PubMed1992

The value of urodynamic studies in infants less than 1 year old with congenital spinal dysraphism.

The role and timing of urodynamic studies in infants with congenital spinal dysraphism are controversial. We reviewed 64 consecutive infants with a mean followup of 28 months who underwent video urodynamic study when they were less than 1 year old (50 of the 64 patients were less than 3 months old). A previously reported video urodynamic "hostility score" from 0 (best) to 10 (worst) was given to each study and compared with the outcome of the upper urinary tract and subsequent urodynamic studies. A larger fraction of these children with high hostility scores (5 or greater) had upper tract deterioration (39%) compared to those with low hostility scores (9%). Moreover, 6 of 14 patients in the low hostility group who underwent repeat video urodynamic studies after age 1 year had high hostility lower urinary tracts. We conclude that urodynamic studies during and after the first year of life are useful in the appropriate urological evaluation and management of infants with spinal dysraphism.

Female↗
PubMed1992

Successful outcome of artificial urinary sphincters in men with post-prostatectomy urinary incontinence despite adverse implantation features.

A total of 75 men with post-prostatectomy urinary incontinence underwent artificial urinary sphincter implantation with a mean followup of 3.7 years. Average patient age at implantation was 67 years, with 30 men being 70 years old or older. In only 15 men (20%) was there no adverse implantation feature, while the remainder had adverse features, such as detrusor hyperactivity (44), bladder neck or urethral stricture disease (27), previous radiation therapy (11) and metastatic prostate cancer (11). Although men with ideal implantation characteristics, men with normal detrusors and men who underwent prostatectomy for benign disease had slightly better outcome in terms of urinary continence, in general each group of men with and without adverse features had satisfactory urinary continence. Other than men with a benign prostate, who fared better, each group of men with and without adverse features had equal need for device revisions. In conclusion, men with post-prostatectomy urinary incontinence should not be excluded from consideration for artificial urinary sphincter implantation based on the failure to meet ideal implantation criteria provided such adverse features are recognized and appropriately addressed.

Aged↗
PubMed1992

Management of the bladder outlet in patients requiring enterocystoplasty.

We reviewed 30 patients who required augmentation enterocystoplasty and a procedure to modify the bladder outlet for the treatment of intractable incontinence. Of the 30 patients 16 were treated with simultaneous cystoplasty and an outlet procedure, 6 initially underwent an outlet procedure followed by cystoplasty and in 8 cystoplasty was performed first with a subsequent operation to modify the bladder outlet. Continence was achieved in 29 patients. The current methods for evaluation of the bladder and its outlet are reviewed, focusing on the predictive value of preoperative testing to determine which patients require cystoplasty and an outlet modifying procedure.

Adolescent↗
PubMed1992

The hemi-Kock ileocystoplasty: a versatile procedure in reconstructive urology.

The hemi-Kock system, constructed from approximately 40 cm. of terminal ileum, comprises a detubularized and remodeled ileal plate with a stapled ileoileal intussusception to form a 1-way valve. This system has been applied to reconstruct 30 varied cases in which the intussuscepted valve was used either for reflux prevention or as a continent stoma. The patients included 11 with intractable urinary incontinence and a devastated bladder outlet in whom the hemi-Kock pouch was anastomosed to the bladder after the bladder neck had been surgically closed, with the afferent limb of the nipple valve being routed through the abdominal wall as a continent stoma. In 9 patients who had previously undergone supravesical diversion, undiversion was accomplished with this system to augment the bladder, with the antireflux nipple being anastomosed to the prior ileal loop or ureters. In 5 patients in whom intractable bladder hyperactivity had led to devastated upper tracts with markedly dilated ureters this system was used for bladder augmentation, with the ureters being reimplanted into the afferent limb of the hemi-Kock system to prevent reflux. The final patients were those in whom the hemi-Kock pouch was converted into a complete reservoir and used for orthotopic bladder replacement. The hemi-Kock system proved to be successful in each of these roles. It created a capacious low pressure reservoir, protected the upper tracts from reflux and improved those that were previously dilated, and it proved to be a reliable continent stoma when applied to that use. The versatility of the hemi-Kock system in its application to a variety of reconstructive endeavors recommends it for use.

Adolescent↗