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Biomedical subjects

G E Leach

Publications and source records attributed to G E Leach.

At least 73 records · Page 4Linked to original sources

Symptom analysis of patients undergoing modified Pereyra bladder neck suspension for stress urinary incontinence. Pre- and postoperative findings.

The results of a physician-directed follow-up of 145 women undergoing the modified Pereyra bladder neck suspension from March 1980 to February 1986 are presented. Median follow-up was 3.5 years (2.0-7.7); 70 percent of patients had follow-up between three and four years postoperatively. All patients had preoperative demonstration of stress incontinence as well as urodynamic evaluation. Fifty-one percent of patients reported no stress incontinence and 76 percent reported that their sense of urinary control was better, or much better at the time of follow-up. Improvement was seen in all grades of stress incontinence. Age, weight, parity, and history of prior anti-incontinence surgery had no significant impact on success rates. Although preoperative urgency symptoms were more common among failure (28% vs 15%), this association was not statistically significant. However, persistent or de novo urgency symptoms postoperatively were highly associated with postoperative incontinence (p less than 0.005). The onset of recurrent incontinence was experienced more than two years postoperatively in 23 percent of the incontinent group.

Female↗

Surgical treatment of concomitant urethral diverticulum and stress incontinence.

Urinary incontinence is frequently associated with a urethral diverticulum in female patients. Preoperative evaluation including a thorough history and physical examination, voiding cystourethrogram, urethroscopy, and urodynamic studies can diagnose both the urethral diverticulum and any concomitant bladder-urethral dysfunction. Preoperative recognition of stress urinary incontinence or patients at risk for this problem postoperatively permits effective treatment with concomitant transvaginal bladder neck suspension and urethral diverticulectomy.

Diverticulum↗

Postprostatectomy incontinence. Pathophysiology, evaluation, and management.

Given the prevalence of bladder dysfunction (i.e., poor compliance or detrusor instability) as a cause of postprostatectomy incontinence, urodynamic studies are essential in the evaluation of such patients. Appropriate management strategies based on the findings of a pertinent history and physical examination, appropriate radiologic studies, and urodynamics optimize the opportunity for successful treatment. Because bladder dysfunction frequently accompanies sphincter insufficiency, bladder dysfunction must be diagnosed and treated effectively before implantation of an artificial urinary sphincter.

Humans↗

Complications of bladder neck suspension procedures.

Typical genuine stress urinary incontinence is the result of an anatomic defect, with most procedures designed to restore the support of the proximal urethra and bladder neck. Complications associated with these procedures have been presented to help facilitate an understanding of their etiology and prevention. Careful attention to patient selection, history and physical examination, and surgical detail can prevent most of these complications.

Female↗

Bladder leiomyoma.

We herein present a case of leiomyoma of the urinary bladder discovered during evaluation for stress urinary incontinence. The histologic findings of this benign tumor and its urologic implications are reviewed.

Adult↗

Urodynamic findings in interstitial cystitis.

The urodynamic findings in 41 women with proven interstitial cystitis were reviewed. All subjects had pain during bladder filling with sensory instability and limited functional capacity. Despite an average symptom duration of 5.7 years, all women had normal bladder wall compliance during cystometry. Fourteen of 41 women had additional significant urodynamic findings.

Adult↗

Transurethral incision of the prostate: a preoperative and postoperative analysis of symptoms and urodynamic findings.

The efficacy of transurethral incision of the prostate was evaluated prospectively in 26 men with urodynamic evidence of outlet obstruction secondary to small prostate glands (estimated size less than 30 gm). All men completed preoperative and postoperative symptom questionnaires and extensive urodynamic testing with a median postoperative followup of 16.25 months. There was a significant improvement in subjective symptom analysis and objective urodynamic parameters (peak and mean uroflow rates, maximal detrusor pressure at peak flow, volume at first urge and post-void residual volume) as a result of transurethral incision of the prostate with minimal postoperative morbidity. Antegrade ejaculation was preserved in 55% of the men with normal preoperative ejaculation. Based on subjective and objective criteria, transurethral incision of the prostate is an effective treatment option for selected men with outlet obstruction.

Aged↗

Bone fixation technique for transvaginal needle suspension.

The transvaginal needle suspension procedure coupled with the bone fixation technique provides excellent restoration of continence without causing outflow obstruction. The surgical procedure is precise, with a significant decrease in postoperative pain and discomfort when the pubic tubercle is utilized as the fixation point for the suspension sutures.

Female↗

Bone fixation technique for transvaginal needle suspension.

Bone fixation of the suprapubic suspension sutures has been used in conjunction with transvaginal needle suspension in 115 women with genuine stress urinary incontinence over the last two years with excellent results being obtained. Utilizing the pubic tubercle as the fixation point for the suspension sutures (rather than the anterior abdominal wall) has decreased postoperative discomfort and obviated the need for any synthetic material.

Evaluation Studies as Topic↗

Mechanism of continence after modified Pereyra bladder neck suspension. Prospective urodynamic study.

Twenty females with genuine stress urinary incontinence who underwent modified Pereyra bladder neck suspension were urodynamically studied pre- and postoperatively in an attempt to determine the mechanism by which continence was restored. Detailed analysis demonstrated no significant change comparing the pre- and postoperative cystometry findings, uroflow parameters, maximal voiding pressure, urethral resistance, maximal urethral closure pressure, or functional urethral length. The only significant change identified as a result of the surgical procedure was an alteration of proximal urethral pressure transmission during stress from negative to positive gradients. It is concluded that the modified Pereyra bladder neck suspension restores continence by restoring proper urethral support with restoration of positive pressure transmission to the proximal urethra without causing outflow obstruction, changing functional length, or altering maximal urethral closure pressure.

Adult↗