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Biomedical subjects

G E Leach

Publications and source records attributed to G E Leach.

At least 37 records · Page 2Linked to original sources
PubMed1997

[The variability of the leakage pressure threshold due to exertion "the Valsalva Leak Point Pressure" as a function of the filling volume of the bladder].

OBJECTIVE: To determine the influence of the bladder filling volume on the Valsalva Leak Point Pressure (VLPP) in patients investigated for urinary stress incontinence. PATIENTS AND METHODS: 50 patients investigated for urinary stress incontinence were included in this prospective study. Evaluation consisted of clinical examination, urodynamic examination with simultaneous fluoroscopic assessment and cystoscopy. VLPP was measured while standing every 100 cc during filling until the cystomanometric bladder capacity. RESULTS: We observed a significant reduction of VLPP as a function of bladder filling volume. The VLPP measured at 200 cc constituted the reference value in view of its sensitivity and specificity for the diagnosis of type III urinary stress incontinence (Blaivas' classification). CONCLUSION: Measurement of VLPP must be standardized and interpreted as a function of bladder filling volume.

Adult↗
PubMed1996

Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men.

PURPOSE: We reviewed the urodynamic findings and treatment outcomes of a large series of men with primary bladder neck obstruction. MATERIALS AND METHODS: A retrospective review was done of the presenting symptoms and urodynamic findings of 36 men with primary bladder neck obstruction. Outcomes after treatment with alpha-blockers, transurethral incision of the bladder neck and prostate, or no long-term therapy were determined by chart review and patient survey in the majority of cases. RESULTS: Mean age of the men was 41 years. Patients had significant lower urinary tract symptoms, decreased peak urinary flow rates, elevated post-void residual, markedly elevated peak voiding pressures and poor funneling of the bladder neck during voiding. Although most patients initially chose alpha-blocker therapy, only 30% of those beginning alpha-blockers continued them long term, usually due to inadequate symptomatic improvement. A total of 18 men underwent transurethral incision, which resulted in significant improvements in symptom scores, peak urinary flow rates, post-void residual and peak voiding pressures. Patients reported a mean 87% overall improvement in symptoms after transurethral incision. CONCLUSIONS: Video urodynamics facilitate diagnosis of primary bladder neck obstruction. Transurethral incision is the most effective therapy for primary bladder neck obstruction.

Adrenergic alpha-Antagonists↗
PubMed1996

Post-prostatectomy incontinence: urodynamic findings and treatment outcomes.

PURPOSE: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocation multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. RESULTS: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p<0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. CONCLUSIONS: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.

Aged↗
PubMed1996

Local anesthesia for urologic procedures.

The ability to perform a variety of urologic procedures (urethrotomy, prostate surgery, penile prosthesis insertion, and bladder neck suspension) under local anesthesia in an outpatient setting is a significant advance in patient care. The surgical techniques are described that will allow the urologist to incorporate these procedures into practice.

Anesthesia, Local↗
PubMed1996

Postprostatectomy incontinence.

Post-prostatectomy incontinence is a devastating complication that is frustrating for the patient and the surgeon. Bladder dysfunction with or without sphincteric incompetence is the main cause for post-prostatectomy incontinence. Treatment based on the urodynamic evaluation is effective in restoring continence and improving the patient's quality of life.

Humans↗
PubMed1996

Percutaneous bladder neck suspension.

The early results after PBNS are extremely encouraging. The procedure is easy to learn, is performed rapidly on an outpatient basis under local anesthesia if desired, and has minimal postoperative morbidity. Continued objective follow up is critical to define the long-term efficacy of this promising technique.

Female↗
PubMed1996

Needle suspension procedures: past, present, and future.

This article reviews the history, evolution, and future of transvaginal needle suspension procedures for stress urinary incontinence. Although numerous technical modifications to the original Pereyra transvaginal needle suspension procedure have been described, the true success rates of these procedures are difficult to ascertain. In general, outcomes reported in the literature are variable, and few long-term studies exist. Only the results of well-designed, prospective, and long-term studies will determine whether recent advances in patient selection and continuing technical modifications will improve the outcome of bladder neck suspension procedures.

Female↗
PubMed1996

Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management.

PURPOSE: The recent literature on intrinsic sphincteric deficiency is reviewed. MATERIALS AND METHODS: We performed an extensive literature search related to the diagnosis, management and treatment of intrinsic sphincteric deficiency. RESULTS: Stress urinary incontinence results from insufficient urethral resistance and/or support during increases in intra-abdominal pressure. Since treatment of stress urinary incontinence is closely related to the mechanism of urinary leakage, recognition of intrinsic sphincteric deficiency is of the utmost importance in its evaluation. Furthermore, to date there is no consensus on the treatment of intrinsic sphincteric deficiency and various procedures may be considered. CONCLUSIONS: The pathophysiology of urinary incontinence in female patients is still controversial. Intrinsic sphincteric deficiency is best recognized by history and clinical examination in conjunction with documentation of severe stress urinary incontinence, a fixed urethra and a low Valsalva leak point pressure. The pubo-vaginal sling procedure still represents the most widely accepted treatment to correct intrinsic sphincteric deficiency.

Female↗
PubMed1995

Quality-of-life outcomes in men treated for localized prostate cancer.

OBJECTIVE: To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer. DESIGN: A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients. SETTING: A large managed care population in California. SUBJECTS: A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60). MAIN OUTCOME MEASURES: General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel. RESULTS: No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low. CONCLUSIONS: Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer.

Adenocarcinoma↗
PubMed1995

Non-operative management of the urinary tract in spinal cord injury.

Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catheterization supplemented with anticholinergic agents. Sixty-four spinal cord injured patients, treated with intermittent catheterization and anticholinergic therapy, were evaluated for long-term efficacy in maintaining upper tract status and preservation or improvement in continence. Complications of therapy were also evaluated. Therapy was based upon initial urodynamic evaluation followed by limited subsequent evaluation of the urinary tract. Mean follow-up was 54 months. Only 1 patient developed hydronephrosis. Fifty-nine patients either became continent or experienced improved continence on therapy. Eight patients required surgical procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6). The most common complication of therapy was urinary tract infection. Thirty-nine infections occurred in 23 patients, 16 of which were febrile. Fifteen patients were non-compliant with treatment recommendations. The only factor related to therapeutic complications which reached statistical significance was non-compliance with therapy. The combined use of intermittent catheterization and anticholinergic agents provides an effective means to prevent hydronephrosis and establish continence in chronic spinal injury.

Adolescent↗
PubMed1995

Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients.

PURPOSE: We attempt to determine the long-term success rate of the modified Pereyra bladder neck suspension, identify preoperative factors predictive of long-term outcome, and investigate the influence of method and length of followup on reported continence status after modified Pereyra bladder neck suspension. MATERIALS AND METHODS: The charts of 177 patients who underwent modified Pereyra bladder neck suspension at our institution more than 5 years ago were reviewed. An attempt was made to contact all patients either by mail or telephone to complete a patient survey questionnaire. RESULTS: Of 177 patients 125 (71%) completed the patient survey with a mean followup of 9.8 years. At survey followup 20% of the patients reported no incontinence of any type and 51% reported stress urinary incontinence with or without urge incontinence. Of the patients 71% reported significant improvement in the incontinence and 73% were satisfied with the results of the procedure. No accurate preoperative predictors of long-term outcome were identified. The method and length of followup had significant impact on reported continence status after modified Pereyra bladder neck suspension. CONCLUSIONS: This long-term study using outcomes analysis reveals a high rate of recurrent stress incontinence after modified Pereyra bladder neck suspension. However, most patients maintain significant subjective improvement and remain satisfied with the results of the operation.

Female↗
PubMed1995

Fluorescein angiography of the bladder: technique and relevance to bladder cancer and interstitial cystitis patients.

PURPOSE: Fluorescein angiography has been used in the study of bleeding vessels, neovascularity, tumors and ischemic tissues in a variety of disorders. This pilot study was designed to evaluate the feasibility, safety and relevance of this interesting technology for the evaluation of bladder wall vessels in patients with interstitial cystitis and bladder cancer. MATERIALS AND METHODS: Five patients with National Institutes of Health defined interstitial cystitis symptoms and 10 with bladder cancer were studied during cytoscopy while they were under general anesthesia. A yellow-green barrier filter (520 nm.) was placed over the cystoscope eyepiece and a blue exciter filter (465 nm.) was attached to the light source. Patients received a 5 ml. bolus of 10% fluorescein intravenously. RESULTS: After hydrodistension, glomerulations in interstitial cystitis patients were more prominent with fluorescein angiography and occurred in the venule phase. Areas of papillary transitional cell tumor and carcinoma in situ developed a brilliant yellow-green fluorescence. Adjacent normal urothelium was nonfluorescent and provided a contrasting dark background facilitating the detection of all lesions. No allergic reaction or other adverse effect related to the fluorescein injection was observed. CONCLUSIONS: These unique observations in a limited number of patients suggest that fluorescein angiography of the bladder is a safe and simple procedure. This preliminary report underscores the relevance of fluorescein angiography in the detection of bladder tumor and offers a new approach to the evaluation of bladder wall vessels in interstitial cystitis patients.

Arterioles↗
PubMed1995

Dimethyl sulfoxide does not trigger urine histamine release in interstitial cystitis.

OBJECTIVES: Dimethyl sulfoxide (DMSO), an agent that provides symptomatic relief in patients with interstitial cystitis (IC) works via an unknown mechanism. We investigated whether DMSO acts as a chemical stimulant of mast cell degranulation. METHODS: A radioimmunoassay (RIA) specific for histamine was used to test this hypothesis. Twelve women with strictly diagnosed IC were treated with intravesical instillations of DMSO. Treatments were repeated at varying intervals, and each patient received three to six treatments. Urine histamine levels were measured before and after each intravesical instillation of DMSO. Dilutional effects of DMSO were corrected for by conversion of urine histamine concentration to urine histamine:creatinine ratio. RESULTS: The RIA was unaffected by the addition of DMSO to urine. No consistent change in the urine histamine:creatinine ratio following DMSO instillation was found. Trend analysis revealed no trend in the histamine:creatinine ratio with time. CONCLUSIONS: The relief of symptoms reported in 50% to 77% of patients treated with intravesical DMSO is not related to detectable mast cell release of histamine. Other mechanisms of action must be investigated to explain the beneficial effect of this agent.

Administration, Topical↗
PubMed1995

Local anesthesia for laser prostatectomy.

The technique of visual laser-assisted prostatectomy (VLAP) with a noncontact right-angle delivery system (Urolase) under local anesthesia is described. The advantages of local anesthesia include the facilitation of early patient discharge (2-3 hours after the procedure), avoidance of the risks of spinal and general anesthesia in high-risk patients, and, potentially, the enabling of VLAP as an outpatient office procedure. This technique was employed in 52 men with symptomatic benign prostatic hyperplasia (BPH) as an outpatient procedure without significant morbidity. The mean AUA Symptom Scores and uroflow measures all improved significantly with 1-year follow-up. Outpatient VLAP under local anesthesia is a promising treatment alternative for men with BPH.

Aged↗
PubMed1995

How potent is potent before nerve sparing radical retropubic prostatectomy?

PURPOSE: We objectively evaluated potency before nerve sparing radical retropubic prostatectomy. MATERIALS AND METHODS: A total of 45 consecutive potent, neurologically normal and sexually active candidates 47 to 70 years old (mean age 62) completed a detailed questionnaire (separate from their partner), and underwent penile biothesiometry, RigiScan* testing for 3 nights, and duplex Doppler scanning of the cavernous arteries before and after prostaglandin E1 injection. RESULTS: Of the patients 8 noted moderate and the remainder normal erections on the questionnaire. RigiScan testing and penile biothesiometry correlated poorly with potency status. Duplex scanning demonstrated excellent peak velocities in 93% of the patients. CONCLUSIONS: This well studied prospective series underscores the importance of careful objective assessment of potent surgical candidates, and underlines a strong correlation between preoperative potency status and duplex Doppler scanning.

Aged↗
PubMed1995

Surgical treatment of intrinsic urethral dysfunction: injectables (fat).

Injection of autologous fat has been used for many years to correct cosmetic surgical defects. More recently, autologous fat injection has been applied to the treatment of urinary incontinence. The background and technique of periurethral fat injection are described in this article. The technique is safe, and preliminary results are encouraging in women with intrinsic sphincter deficiency. Long term follow-up and comparative trials will determine the ultimate utility of periurethral fat injection for the treatment of women with intrinsic sphincter deficiency.

Adipose Tissue↗