Search PubMed⌕ Search

Biomedical subjects

G S Gerber

Publications and source records attributed to G S Gerber.

At least 37 records · Page 2Linked to original sources
PubMed2000

Internet and postal survey of endourologic practice patterns among American urologists.

PURPOSE: We determine endourological practice patterns among American urologists for the management of distal ureteral calculi, ureteropelvic junction obstruction, staghorn calculi and the use of ureteral stents with extracorporeal shock wave lithotripsy (ESWLdagger). MATERIALS AND METHODS: Surveys were mailed by the United States postal service to 1,000 American urologists selected randomly from the American Urological Association membership roster. The same survey was sent via the Internet to 3,065 American urologists with an electronic mail address listed in the roster. RESULTS: Responses were received from 1,029 urologists (postal 601, Internet 428). Ureteroscopy was the preferred treatment for all distal ureteral calculi less than or equal to 10 mm. Acucisedouble dagger endopyelotomy was the most frequently selected therapy for adults with ureteropelvic junction obstruction (50.3%, 514 of 1,022). Open pyeloplasty was recommended by a significantly greater percentage of urologists in practice longer than 15 years compared with the remaining survey respondents (166 of 485, 34.2% versus 92 of 427, 21.5%). For patients with renal pelvic stones 10, 15 or 20 mm. who are treated with ESWL routine stent placement was preferred by 25.3% (259 of 1,022), 57.1% (584 of 1,022) and 87.1% (888 of 1, 019) of urologists, respectively. Percutaneous nephrolithotomy was preferred for patients with staghorn calculi by 80.5% (828 of 1,028) of survey respondents. CONCLUSIONS: Most urologists follow the American Urological Association practice guidelines for patients with distal ureteral calculi and staghorn stones. There is a significant difference of opinion regarding the use of stents with ESWL. No clear consensus has been reached concerning the management of adults with ureteropelvic junction obstruction. These data may be useful in designing physician education programs and/or future investigations to help define standard treatment practices for urological diseases.

Adult↗
PubMed2000

Role of transurethral biopsy sampling of the prostate to diagnose prostate cancer in men undergoing surgical intervention for benign prostatic hyperplasia.

PURPOSE: Newer minimally invasive surgical procedures are being used to treat men with significant benign prostatic hyperplasia (BPH). These modalities do not allow retrieval of prostate tissue for histologic review. The goal of our study was to assess the value of transurethral biopsies in detecting prostate cancer in men who would undergo surgical intervention for BPH. MATERIALS AND METHODS: Between September 1997 and January 1999, 422 men undergoing transurethral resection of the prostate (TURP) had transurethral biopsies obtained before completing the TURP. Pathology reports as well as prostate-specific antigen (PSA) results were reviewed and analyzed to determine when cancer was present. RESULTS: Pathological examination revealed that cancer was found in 53 men (12.5%). The transurethral biopsies detected cancer in 32 of 53 (60.4%). No cancers were found in the transurethral biopsy specimen only. Of the 21 cancers missed by transurethral biopsy, 7 were stage T1b. PSA level >10 ng/mL increased the likelihood of finding cancer. CONCLUSIONS: Transurethral biopsy sampling is unreliable for detecting prostate cancer in men with clinically significant BPH. Significant cancers are missed if transurethral biopsies are used to determine the presence of carcinoma before minimally invasive surgical therapy for BPH.

Adult↗
PubMed2000

Management of entrapped ureteral stone baskets.

Entrapped stone baskets can occur and can lead to significant ureteral injury and long-term morbidity. We describe two patients in whom semirigid ureteroscopy was used to facilitate safe removal of impacted baskets from the ureter.

Adult↗
PubMed1999

Benign adenomatous multicystic kidney tumor (Perlmann's tumor) and renal cortical carcinoma with adenomatous multicystic features: 12 cases.

OBJECTIVES: To re-examine clear cell cystic lesions of the kidney and to assess their potential clinicopathologic significance, as the long-forgotten diagnosis of benign adenomatous multicystic kidney tumor (Perlmann's tumor) has not been cited in the literature in more than 35 years. METHODS: We identified 12 patients between 1959 and 1996 who underwent a radical nephrectomy at our institution and were diagnosed with either adenomatous multicystic clear cell kidney tumor (n = 4) or with renal cell carcinoma (RCC) associated with features of adenomatous clear cell multicystic kidney tumors (n = 8). All diagnoses were reviewed histologically by a single pathologist. RESULTS: Nine of 1 2 patients had Stage T2NOMO disease, and 3 patients had Stage T1 NOMO disease. There were 8 men and 4 women. The average age at the time of surgery was 60.5 years (range 25 to 74). Six patients are still alive with a mean follow-up of 4.7 years (range 1.5 to 16.3) and have no evidence of recurrent disease. Of the 6 patients who died, mean survival time was 8.8 years (range 0 to 15.7). One patient died in the perioperative period, and the other 5 patients died of other causes, unrelated to their kidney tumor. CONCLUSIONS: Adenomatous clear cell multicystic kidney disease may represent a histologically distinct benign neoplasm, and its presence in association with RCC may confer a more favorable prognosis. Its distinction from usual solid hemorrhagic or focally necrotic RCC is important.

Adult↗
PubMed1999

Phytotherapeutic agents in the treatment of lower urinary tract symptoms: a demographic analysis of awareness and use at the University of Chicago.

OBJECTIVES: To assess awareness and use of phytotherapeutic agents in treating lower urinary tract symptoms (LUTS). METHODS: A survey was conducted of 1280 patients presenting to the University of Chicago Hospitals urology clinic. The questions pertained to age, race, educational level, and use of prescription and nonprescription medications for urinary symptoms. RESULTS: Of 1264 patients filling out the surveys correctly, the 51 to 60-year-old age range demonstrated the greatest percentage of use of these agents. Whites were nearly twice as likely as their African American counterparts to use medicinal botanicals. Men with college or graduate school degrees were 1.5 times as likely to use medicinal botanicals in treating LUTS. More than 50% of men using phytotherapeutic drugs were also taking prescription medications for the urinary symptoms. CONCLUSIONS: There is significant use of phytotherapeutic agents in men with LUTS, although there is variability in their use between patient groups. American physicians need some understanding of these agents to best advise and treat their patients.

Adult↗
PubMed1999

Performing flexible ureteroscopy through a cystoscopy introducer sheath.

Performing flexible ureteroscopy through a cystoscope sheath positioned with its tip near the orifice of the ureter prevents buckling of the ureteroscope and decreases the friction against the ureteroscope. This results in more precise translation of the surgeon's movements to the tip of the instrument and facilitates the procedure.

Cystoscopes↗
PubMed1999

The use of hyperbaric oxygen in urology.

PURPOSE: We review the use of hyperbaric oxygen therapy in urology, and present the mechanisms of hyperoxia action in whole body hyperbaric chamber treatments, patient outcomes and patient selection criteria. MATERIALS AND METHODS: The literature on hyperbaric oxygen use in urology was reviewed. RESULTS: Hyperbaric oxygen is a treatment alternative for patients with an underlying ischemic process unresponsive to conventional therapy. Specific factors which may influence patient selection of hyperbaric oxygen include cancer and absolute contraindications of active viral disease, intercurrent pneumothorax and treatment with doxorubicin or cisplatin. This technique is particularly useful in the treatment of intractable hemorrhagic cystitis secondary to pelvic radiation therapy. Further investigation of the efficacy of hyperbaric oxygen is warranted for patients with necrotizing fasciitis (Fournier's gangrene), posttraumatic ischemic injury and/or impaired wound healing. CONCLUSIONS: Hyperbaric oxygen is a therapeutic alternative which complements the surgical and medical options for select patients.

Costs and Cost Analysis↗
PubMed1999

Holmium: YAG laser endoureterotomy in the treatment of ureteroenteric strictures following orthotopic urinary diversion.

The management of ureteroenteric strictures in patients who have undergone urinary diversion can be challenging. In those patients with an orthotopic neobladder, anastomotic ureteral strictures can be treated endoscopically using a retrograde or antegrade approach. The availability of small (7.5F) flexible ureteroscopes, as well as the use of the Holmium laser has facilitated the ability to precisely incise the stricture under direct endoscopic visualization (endoureterotomy). We describe our technique for laser endoureterotomy in patients with ureteroenteric strictures following orthotopic urinary diversion.

Aged↗
PubMed1999

Endourologic treatment of renal pelvic and ureteral transitional cell carcinoma.

Endoscopic treatment of patients with upper urinary tract transitional cell carcinoma is recommended in those with tumor in a solitary kidney, bilateral disease, renal dysfunction, and significant intercurrent illness that precludes a major abdominal surgical procedure. Endoscopic management also may be appropriate in selected patients with small, low-grade lesions in the presence of a normal contralateral kidney. Almost all ureteral tumors and some renal collecting system lesions can be managed using rigid and/or flexible ureteroscopy, which is associated with less bleeding and more rapid recovery than a percutaneous approach. However, larger renal malignancies can be managed effectively using percutaneous resection. Six patients with upper tract transitional cell carcinoma underwent endoscopic resection. The antegrade and retrograde surgical techniques are described. With follow-up up to 23 months, local recurrence in two patients was managed successfully by repeat endoscopic resection. No patient has experienced disease progression or developed metastases.

Aged↗
PubMed1999

Combination therapy in the treatment of patients with staghorn calculi.

The treatment of patients with staghorn calculi remains a challenging problem. Combination therapy using percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy has been recommended as the best option for most patients. Using this technique, 10 (83%) of 12 renal units with partial or complete staghorn calculi were rendered stone-free, with no significant septic episodes or serious complications. Blood transfusion was necessary in three patients. "Sandwich" therapy using initial percutaneous debulking followed by extracorporeal shock wave lithotripsy and/or "second-look" nephroscopy offers patients a high likelihood of achieving a stone-free state while avoiding the morbidity and lengthy recovery associated with open surgery.

Combined Modality Therapy↗
PubMed1998

Saw palmetto (Serenoa repens) in men with lower urinary tract symptoms: effects on urodynamic parameters and voiding symptoms.

OBJECTIVES: To assess the effects of saw palmetto on voiding symptoms and urodynamic parameters in men with lower urinary tract symptoms (LUTS) presumed secondary to benign prostatic hyperplasia (BPH). METHODS: Fifty men with previously untreated LUTS and a minimum International Prostate Symptom Score (IPSS) of 10 or greater were treated with a commercially available form of saw palmetto (160 mg twice per day) for 6 months. The initial evaluation included measurement of peak urinary flow rate, postvoid residual urine volume, pressure-flow study, and serum prostate-specific antigen (PSA) level. Patients completed an IPSS, serum PSA was determined, and flow rate was measured every 2 months during the course of the study. A urodynamic evaluation was repeated at the completion of the 6-month trial. RESULTS: The mean IPSS (+/-SD) improved from 19.5+/-5.5 to 12.5+/-7.0 (P <0.001) among the 46 men who completed the study. Significant improvement in the symptom score was noted after treatment with saw palmetto for 2 months. An improvement in symptom score of 50% or greater after treatment with saw palmetto for 2, 4, and 6 months was noted in 21% (10 of 48), 30% (14 of 47), and 46% (21 of 46) of patients, respectively. There was no significant change in peak urinary flow rate, postvoid residual urine volume, or detrusor pressure at peak flow among patients completing the study. No significant change in mean serum PSA level was noted. CONCLUSIONS: Saw palmetto is a well-tolerated agent that may significantly improve lower urinary tract symptoms in men with BPH. However, we were unable to demonstrate any significant improvement in objective measures of bladder outlet obstruction. Placebo-controlled trials of saw palmetto are needed to evaluate the true effectiveness of this compound.

Aged↗
PubMed1998

Evaluation of changes in prostate specific antigen in clinically localized prostate cancer managed without initial therapy.

PURPOSE: We define changes in prostate specific antigen (PSA) measurements with time in 49 men 71.9 +/- 7.0 years old (mean plus or minus standard deviation) with clinically localized prostate cancer who remain untreated. MATERIALS AND METHODS: We retrospectively analyzed PSA changes in prostate cancer patients managed by watchful waiting. In all patients a minimum of 3 PSA levels were measured at intervals of at least 6 months after malignancy was diagnosed. The rate of change in serum PSA level with time (PSA velocity) was determined using an exponential, log linear model. RESULTS: In 49 patients treated conservatively mean initial PSA level plus or minus standard deviation was 12.3 +/- 11.1 ng./ml. and mean PSA followup during which no therapy for prostate cancer was introduced was 32.1 +/- 13.2 months. PSA levels decreased during the observation period in 11 of the 49 patients (22%) and median PSA doubling time in the remaining 38 was 55.7 months (range 15.1 to 994.5). There was no significant correlation between age at diagnosis, Gleason sum, initial PSA level or clinical stage and PSA velocity. The short-term rate of change in PSA during the first 9 months after prostate cancer was diagnosed correlated poorly with overall PSA velocity. The short-term rate of PSA change was greater than the overall rate of change in 14 of 37 patients (38%). CONCLUSIONS: There is significant variability in the rate of change of PSA with time in men with clinically localized prostate cancer who remain untreated. The usefulness of serial PSA measurements in the management of watchful waiting is unclear. Changes in PSA may not be helpful or appropriate in determining the need for therapy after a period of observation.

Aged↗
PubMed1998

Benign prostatic hyperplasia in older men.

Urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) may adversely affect quality of life in many older men. Evaluation of patients with BPH should be focused on excluding complicating factors such as urinary tract infection, renal dysfunction, and malignancy. Watchful waiting is an appropriate option for men in whom such complicating conditions have been excluded. For those men who elect to be treated, therapy using alpha blockers (terazosin, doxazosin) or 5-alpha reductase inhibitors (finasteride) should be offered initially. Surgical treatment is generally reserved for patients who do not have a sufficient response to medical therapy and those with absolute indications for intervention, such as complete retention, recurrent infection or hematuria, renal insufficiency, and bladder stones.

5-alpha Reductase Inhibitors↗
PubMed1998

Use of novel urodynamic parameters, detrusor contraction duration and detrusor contraction index, in men with lower urinary tract symptoms.

The aim of this study was to correlate the results of the urodynamic measures, detrusor contraction duration (DCD) and detrusor contraction index (DCI), with voiding symptoms in untreated men with lower urinary tract symptoms (LUTS) and in men treated with doxazosin. Ninety-one men with untreated LUTS underwent urodynamic evaluation. DCD (duration of detrusor contraction in seconds), DCI (interval, in seconds, that urine is passed divided by the total duration of the bladder contraction), and standard urodynamic measures of obstruction were determined. The urodynamic findings were correlated with the severity of voiding symptoms as assessed by the International Prostate Symptom Score (I-PSS). Fifty of these men were treated subsequently with 4 mg of doxazosin for 3 months and then underwent repeat urodynamic evaluation, in which changes in symptom score and urodynamic results were analyzed. DCD was the only urodynamic measure that correlated significantly with the I-PSS results in untreated patients. Although DCD, detrusor pressure at maximum flow, and the Abrams-Griffiths number decreased in men treated with doxazosin, only DCI and symptom score improved significantly after treatment for 3 months. No urodynamic parameter was useful in predicting the likelihood of a favorable response to treatment with doxazosin. DCD and DCI may be useful urodynamic measures in untreated men with LUTS and in those treated with doxazosin. Further study of these parameters is warranted.

Adrenergic alpha-Antagonists↗