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Biomedical subjects

G E Leach

Publications and source records attributed to G E Leach.

107 records · Page 6Linked to original sources
PubMed1985

Transvaginal closure of the bladder neck and placement of a suprapubic catheter for destroyed urethra after long-term indwelling catheterization.

We report on 6 women with continuous urinary incontinence as a late complication of an indwelling urethral catheter for neurogenic bladder. Pressure necrosis by the balloon resulted in progressive destruction of the entire urethra, with subsequent incontinence despite the catheter. Surgical attempts at bladder neck closure to correct the incontinence generally have been unsuccessful. Instead of supravesical urinary diversion, we performed transvaginal closure of the bladder neck and percutaneous placement of a permanent suprapubic tube cystostomy. All 6 patients remained dry after closure and none has shown upper urinary tract deterioration at followup for as long as 5 years.

Adult↗
PubMed1985

Delayed diagnosis of voiding dysfunction: occult spinal dysraphism.

The recognition of spinal dysraphism as a potential cause of voiding dysfunction is of the utmost importance if appropriate treatment and followup are to be initiated. We present 2 women with prolonged voiding dysfunction who had spinal dysraphism, intradural lipoma and related urodynamic abnormalities. The importance of initial symptom recognition, physical examination, urodynamic evaluation, appropriate treatment and periodic re-examination to detect progressive neurological impairment is emphasized.

Adult↗
PubMed1984

Modified Pereyra bladder neck suspension after previously failed anti-incontinence surgery. Surgical technique and results with long-term follow-up.

Fifty-four female patients with persistent or recurrent stress urinary incontinence who underwent between 1 and 9 previously unsuccessful operative procedures were treated with transvaginal mobilization of the urethra and anterior vaginal wall with subsequent modified Pereyra bladder neck suspension. The important points of this technique are reviewed. With minimum follow-up of twenty-four months, a 94 per cent cure rate was achieved with minimal morbidity in this difficult group of patients.

Adult↗
PubMed1983

Augmentation cystoplasty in the treatment of neurogenic bladder dysfunction.

We report on the role of augmentation cystoplasty in the treatment of 18 patients with neurogenic bladder dysfunction and associated symptoms of severe urinary urgency, frequency and urinary incontinence. All patients failed to obtain any symptomatic improvement with a variety of treatments, including intermittent self-catheterization and pharmacologic manipulation. Preoperative evaluation helped segregate the patients into 3 groups: 1) those with extremely poor bladder wall compliance, 2) those with severe detrusor hyperreflexia and 3) those with a combined problem of poor bladder wall compliance and hyperreflexia. Bladder augmentation involved cecocystoplasty in 15 cases and ileocystoplasty in 3. In 5 patients an artificial urinary sphincter cuff was placed in an attempt to improve continence. Followup ranging from 12 to 120 months (mean 38 months) was available in 17 patients. An excellent surgical result was obtained in 82 per cent of the patients who became asymptomatic and continent after augmentation cystoplasty. Augmentation cystoplasty is a therapeutic modality that should be considered a viable treatment option in selected patients with neurogenic bladder dysfunction.

Adolescent↗
PubMed1983

Obstructing urethral valve in a woman: a case report.

We report on a woman with a urethral valve causing obstruction, hyperreflexia, vesicoureteral reflux and retention. The diagnosis of urethral valves in female subjects rests on endoscopy and radiographic studies. Transurethral resection of the valve is effective treatment. The literature is discussed briefly.

Aged↗
PubMed1982

Urodynamic manifestations of cerebellar ataxia.

The urodynamic findings in 15 patients with voiding dysfunction associated with various forms of the ataxia syndrome were reviewed. Urodynamic studies helped segregate the patients into 3 groups: group 1-detrusor hyperreflexia, group 2-normal bladder contractility and group 3-acontractile bladder. Pelvic floor electromyography demonstrated either coordinated or uncoordinated vesicosphincteric function. Although the neurologic findings associated with the ataxia syndrome have been studied extensively the urodynamic findings have not yet been recorded. We emphasize the importance of urodynamic evaluation in the treatment of patients with ataxia and voiding dysfunction.

Cerebellar Ataxia↗
PubMed1982

Radiotherapy for prostatic carcinoma: post-irradiation prostatic biopsy and recurrence patterns with long-term followup.

From 1968 through 1975, 159 patients with stages A, B and C adenocarcinoma of the prostate were treated with supervoltage radiation therapy. A median dose of 7,200 rad was given. The influence upon survival of grade, stage and a positive biopsy result after irradiation is analyzed. Over-all survival is a patently imprecise test of local treatment because patients die of intercurrent disease and are alive with metastases for significant intervals. The classification of survival with no evidence of recurrent disease excluded those patients dying of intercurrent disease. Therefore, the rate of survival free of disease always will be greater than the over-all survival rate in these patients, and a certain percentage of the patients without evidence of cancer will harbor subclinical disease. The 5 and 10-year survival rates free of disease were 80 and 69 per cent, respectively, in 51 patients with stages A and B cancer, and 66 and 47 per cent, respectively, in 108 with stage C disease. The 5 and 10-year over-all survival rates were 72 and 56 per cent, respectively, in the former and 68 and 39 per cent, respectively, in the latter patients. Survival free of disease and death of prostatic carcinoma were influenced adversely by advancing grade and stage (p less than 0.05), while over-all survival was influenced adversely by grade (p equals 0.02) but not by stage (p greater than 0.05). A positive biopsy result after irradiation did not predict survival free of disease, over-all survival or death of prostatic cancer in patients followed for 10 years (p greater than 0.05).

Adenocarcinoma↗
PubMed1981

Giant vesical calculi in the female.

We herein report a case of giant vesical calculi in the female bladder. To the best of our knowledge, these calculi represent the largest group of vesical calculi ever removed from the female bladder. The etiologic factors that contribute to bladder calculus formation in the female are discussed.

Aged↗
PubMed1980

Partial nephrectomy: Mayo Clinic experience 1957--1977.

Three hundred and six partial nephrectomies were performed at Mayo Clinic between 1957 and 1977. Operative and postoperative risks were analyzed according to the indication for surgery, type of partial nephrectomy performed, and other factors. The results demonstrate that partial nephrectomy performed by modern techniques is safe, with acceptable operative time, operative blood loss, and postoperative hospital stay. Complications encountered also were investigated. One death occurred, 8 delayed nephrectomies were required, in 2 patients delayed renal hemorrhage developed, 10 had urinary fistulas or urinomas, and in 16 patients wound infections developed. Study of the techniques used in those cases with postoperative complications suggests several approaches to reduce still further the morbidity of partial nephrectomy.

Adolescent↗