Search PubMed⌕ Search

Biomedical subjects

G S Gerber

Publications and source records attributed to G S Gerber.

At least 55 records · Page 3Linked to original sources
PubMed1997

Serum creatinine measurements in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia.

OBJECTIVES: To determine the usefulness of routine serum creatinine measurements in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) and to correlate these findings with patient age, symptom severity, and comorbid diseases. METHODS: We analyzed serum creatinine measurements in 246 consecutive men presenting for evaluation of voiding symptoms and BPH. Multiple logistic regression analysis was used to determine whether the International Prostate Symptom Score (IPSS), quality-of-life measure from the IPSS, patient age, or a history of diabetes mellitus or hypertension predicted abnormal creatinine levels. RESULTS: An elevated serum creatinine level was noted in 11% (26 of 245) of evaluable patients. Only a history of diabetes or hypertension predicted the presence of renal insufficiency. Among men with no history of comorbid disease, increasing age was significantly associated with the finding of an abnormal creatinine. Neither the overall symptom score nor the quality-of-life measure was significantly associated with the likelihood of detectable renal dysfunction. CONCLUSIONS: Medical renal disease secondary to diabetes or hypertension appears to be the most likely cause of elevated serum creatinine measurements in men with BPH and renal insufficiency. We were unable to identify subgroups of patients in whom the risk of renal dysfunction is sufficiently low to avoid routine serum creatinine measurements.

Adult↗
PubMed1997

Doxazosin in men with lower urinary tract symptoms: urodynamic evaluation at 15 months.

OBJECTIVES: To assess the results of doxazosin treatment in men with lower urinary tract symptoms (LUTS) treated for 15 months and to correlate symptomatic changes with alterations in urodynamic measures. METHODS: After an initial 3-month treatment period with doxazosin 4 mg/day, 50 men with LUTS were given the choice of continued treatment with this agent or other therapeutic options. All patients were evaluated by International Prostate Symptom Score (IPSS) questionnaires and urodynamic evaluation initially and after 3 months of treatment. Patients were followed for an additional 12 months and those who continued doxazosin treatment underwent repeat urodynamic testing. RESULTS: Among the original 50 patients, 24 men (48%) continued doxazosin treatment for 15 months, 18 men (36%) discontinued therapy, and 8 men (16%) were either dead or lost to follow-up or had been diagnosed and treated for prostate cancer. Comparison of values at 3 and 15 months of follow-up (9.4 versus 13.4, P = 0.03) showed significant worsening of voiding symptoms, as assessed by the IPSS, in the 24 men still receiving doxazosin. This deterioration of subjective results with doxazosin occurred despite continued improvements in peak urinary flow rate (Qmax), detrusor pressure at peak flow (PdetQmax), and objective measures of obstruction (Abrams-Griffiths number) from 3 to 15 months of follow-up. CONCLUSIONS: Relief of voiding symptoms in men with LUTS treated with doxazosin over prolonged intervals of 15 months does not correlate well with changes in urodynamic measures.

Adrenergic alpha-Antagonists↗
PubMed1997

Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy.

PURPOSE: There is no clear evidence that intraurethral lidocaine jelly decreases pain and/or makes rigid cystoscopy more tolerable for patients. Since lidocaine jelly is significantly more expensive than plain lubricant, we attempted to assess the true benefit of this agent. MATERIALS AND METHODS: We performed a randomized, prospective, double-blind study to compare the anesthetic effects of intraurethral 2% lidocaine jelly versus plain lubricant in patients undergoing rigid cystoscopy. Unlike previous studies, we ensured adequate urethral filling by using 30 cc of each agent and we waited 20 minutes after instillation of the agent before performing cystoscopy to allow adequate absorption. Cystoscopy was performed using a 17 to 21F rigid instrument. A total of 189 patients was entered into the study but 10 were excluded from analysis due to incomplete questionnaires. A 10-point scale (1-least to 10-most painful) was used to measure pain perception. RESULTS: In men pain perception was significantly decreased when lidocaine jelly was used (mean plus or minus standard error 3.00 +/- 0.21 versus 4.36 +/- 0.37 points, p = 0.002). In women there was no observed difference in pain perception when lidocaine jelly or plain lubricant was used (3.21 +/- 0.38 versus 3.11 +/- 0.30 points, p = 0.823). Patient race, performance of a related procedure, cystoscope size or history of cystoscopy did not significantly affect reported pain scores. There was a slight decrease in pain perception with increasing age (-0.23 +/- 0.10 points per decade, p = 0.021). The level of patient anxiety before cystoscopy was also significantly associated with pain perception (p < 0.001). CONCLUSIONS: Lidocaine jelly offers no advantage over plain lubricant in regard to pain control during rigid cystoscopy in women. However, when used in adequate amounts and allowed to dwell in the urethra for 20 minutes before cystoscopy, lidocaine jelly can significantly decrease pain in men.

Adult↗
PubMed1997

Endoscopic management of ureteral strictures.

PURPOSE: We investigated and defined the role of endourological methods in the treatment of patients with ureteral stricture. MATERIALS AND METHODS: A literature search was performed of the MEDLINE data base from 1978 through August 1996 concerning endoscopic treatment of patients with ureteral strictures. Additional articles from before 1978 were also selectively included. RESULTS: Many endourological methods are available to treat patients with ureteral strictures. Ureteral dilation via an antegrade or retrograde approach may be accomplished in most cases with varying rates of success depending on stricture etiology, location and length. Endoscopic ureterotomy may also lead to long-term patency in select cases and appears to be superior to dilation alone in patients with anastomotic ureteral strictures. However, no randomized studies comparing endourological methods in the treatment of ureteral stricture disease were found. CONCLUSIONS: Significant advances in technique and technology have led to an improved ability to treat ureteral strictures without the need for open surgery in many patients.

Endoscopy↗
PubMed1997

Transurethral vaporization of the prostate in the treatment of bladder outlet obstruction at two university hospitals.

Transurethral vaporization of the prostate (TVAP) is a new technique for the surgical treatment of men with benign prostatic hyperplasia (BPH). The primary advantage of TVAP appears to be shortened hospitalization and less bleeding than is associated with transurethral resection of the prostate (TURP). Since February 1995, 66 consecutive men with bladder outlet obstruction (47 with persistent voiding symptoms and 19 in complete urinary retention) secondary to prostatic disease underwent TVAP at two university hospitals. TVAP was utilized in all patients regardless of prostate size. The mean length of follow-up was 3.2 months. All 19 men in complete retention were able to void adequately following surgery with a mean postvoid residual volume of 18cc and a mean International Prostate Symptom Score (I-PSS) of 7.5. In the remaining patients, the I-PSS decreased from a mean of 19.6 to 8.4. Pre- and postoperative peak urinary flow rate data were available in 17 men and increased from 9 to 18 cc/s. Limited transurethral resection of prostatic tissue at the completion of TVAP was necessary to adequately relieve bladder outlet obstruction in 18% (12/66) of patients. Hospitalization of < 24 h was needed in 68% (45/66) patients. The urinary catheter was removed within 1 day of surgery in 68% (45/66) of men as well. Seven patients required catheter replacement postoperatively due to difficulty voiding (five men) or bleeding (two men). No patient required blood transfusion. TVAP is effective in relieving bladder outlet obstruction in men with and without urinary retention. The majority of patients require brief or no hospitalization and are able to void adequately within 24 h of surgery. TVAP appears to be less effective in men with large prostate glands, and limited TURP is more frequently needed in these cases. The long-term results of TVAP will require further study.

Aged↗
PubMed1997

Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis.

OBJECTIVE: We investigated the disease-specific and metastasis-free survival rates in men with locally advanced (clinical stage T3) prostate cancer who were treated surgically. METHODS: A retrospective, multi-institutional pooled analysis of the results of surgical treatment in 345 men with clinical stage T3 disease was performed. Survival curves were generated using the Kaplan-Meier method. RESULTS: Among 298 evaluable patients, pelvic lymphadenectomy alone was performed in 56 men (19%), while 242 men (81%) underwent node dissection and radical prostatectomy. In total, 122 of 298 patients (41%) had nodal metastases and/or seminal vesicle tumor spread. Pathologically organ-confined disease was noted in 27 men (9%). The actuarial 10-year disease-specific and metastasis-free survival rates for all patients managed surgically were 57 and 32%, respectively. For patients with well, moderately and poorly differentiated tumors, cancer-specific survival rates at 10 years were 73, 67 and 29%, respectively. CONCLUSIONS: A large number of men with clinical stage T3 prostate cancer have advanced disease and are unlikely to achieve improved long-term survival with surgery alone. Although there may be a role for radical prostatectomy in selected patients with low to intermediate grade tumors, such treatment appears unlikely to result in long-term survival in men with high grade disease. A prospective study is necessary to determine the optimal treatment approach in men with locally advanced prostate cancer.

Adult↗
PubMed1997

Ambulatory urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin.

We investigate the results of ambulatory urodynamic evaluation of men with lower urinary tract symptoms (LUTS) believed secondary to benign prostatic hyperplasia (BPH) treated with doxazosin and compare these results to conventional urodynamic study. Ten men with previously untreated LUTS underwent conventional urodynamic evaluation, which was repeated after treatment with doxazosin (4 mg daily) for 3 months. All patients continued on doxazosin and subsequently underwent ambulatory urodynamic evaluation. All men completed an International Prostate Symptom Score (I-PSS) questionnaire with a decrease in score from a mean of 20.4 initially to 8.7 after treatment with doxazosin for 3 months. The mean maximum urinary flow rate increased from 11.9 to 15.3 cc/s and the mean detrusor pressure at peak flow decreased from 99 to 82 cm H2O. The mean duration of ambulatory study was 5 h and 8 minutes (mean 6 voiding cycles). The mean ambulatory voiding pressure in the ten patients treated with doxazosin was 75 cm H2O. Ambulatory urodynamic monitoring is well tolerated by most men with LUTS. Intravesical voiding pressures remain in the obstructed range in most men treated with doxazosin despite marked improvement in urinary symptoms. Ambulatory urodynamic evaluation demonstrates that these elevated detrusor pressures are present during routine daily activities. The long-term effect of increased voiding pressures on urinary tract function is unclear.

Adrenergic alpha-Antagonists↗
PubMed1996

Results of radical prostatectomy in men with clinically localized prostate cancer.

OBJECTIVE: To assess the results of radical prostatectomy in men with early prostate cancer. DESIGN: Retrospective, nonrandomized, multi-institutional pooled analysis. SETTING: Eight university medical centers in the United States and Europe. PATIENTS: A total of 2758 men with stage Tl and T2 prostatic cancer. MAIN OUTCOME MEASURES: Disease-specific and metastasis-free survival rates. RESULTS: Tumor grade was the most important preoperative factor in determining outcome. Disease-specific survival 10 years following surgery and associated 95% confidence intervals were 94% (range, 87%-98%), 80% (range, 74%-85%), and 77% (range, 65%-86%) for those men with grade 1, 2, and 3 tumors, respectively. Metastasis-free survival at 10 years was 87% (range, 78%-92%), 68% (range, 62%-73%), and 52% (range, 38%-64%) for patients with grade 1, 2, and 3 cancers, respectively. CONCLUSIONS: Radical prostatectomy leads to high 10-year disease-specific survival rates in men with all tumor grades. However, caution is needed in comparing these results with similar studies of alternative treatment strategies, such as watchful waiting, due to the inherent potential biases in uncontrolled trials. Nevertheless, these results offer the best currently available estimates of 10-year outcome of radical prostatectomy in men with clinically localized prostate cancer and may be useful in counseling patients with early malignancy.

Europe↗
PubMed1996

An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin.

OBJECTIVES: To assess the urodynamic changes in men with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction treated with doxazosin and to correlate these changes with voiding symptoms. METHODS: Fifty patients with LUTS were treated with doxazosin at a dose of 4 mg/day for 3 months. All men were initially evaluated by International Prostate Symptom Score (I-PSS) questionnaires, measurements of urinary flow rate, and complex urodynamic study. Those patients completing the 3-month study underwent repeat testing. RESULTS: Forty-four (88%) men underwent initial and follow-up urodynamic evaluation. The mean I-PSS improved from 20.6 to 10.5 (P < 0.001), mean peak urinary flow rate increased for 11.7 to 13.2 cc/s (P = 0.20), mean detrusor pressure at peak flow decreased from 9 3.6 to 83.0 cm H20 (P = 0.15), and mean cystometric bladder capacity increased from 266 to 304 cc (P = 0.07). Using the Abrams-Griffiths nomogram and number, more than 58% of patients remained obstructed after treatment with doxazosin for 3 months. Men with and without objective evidence of bladder outlet obstruction at the outset of the study had similar improvement in voiding symptoms. Most patients elected to continue treatment with doxazosin at the completion of the study (41/44, 93%). CONCLUSIONS: The majority of patients had objective evidence of persistent bladder outlet obstruction after treatment with doxazosin for 3 months despite significant benefit. The results of complex urodynamic evaluation did not predict treatment response in men with LUTS suggestive of bladder outlet obstruction. Urodynamic study does not appear to be helpful in the evaluation of patients with uncomplicated LUTS prior to treatment with doxazosin.

Adrenergic alpha-Antagonists↗
PubMed1996

Treatment of prostate cancer using external beam radiotherapy after laparoscopic pelvic lymph node dissection.

OBJECTIVES: To evaluate the results of prostatic irradiation in men with clinically localized prostate cancer and no laparoscopic evidence of nodal metastases compared with a cohort of patients who received radiation therapy with no prior surgical staging. PATIENTS AND METHODS: Thirty-one men with clinically localized prostate cancer and no evidence of pelvic nodal metastases after laparoscopic pelvic lymph node dissection received external beam radiation therapy to the prostate (65-70 Gy). The mean and median prostate specific antigen (PSA) levels in these men before treatment were 41.6 ng/mL and 28.0 ng/mL, respectively, and the mean Gleason sum was 6.1 (range 3-7). During the same interval, a group of 42 consecutive men with clinically localized prostate cancer were treated by external beam radiation therapy with no laparoscopic staging of the pelvic nodes. Treatment failure was defined by the development of bone metastases or a rising PSA level at least 6 months after the completion of radiotherapy. RESULTS: Radiation therapy was generally well tolerated after laparoscopy and no patient required hospitalization or surgery for side-effects related to the treatment. The median duration of follow-up in the 31 men who underwent laparoscopy was 21.5 months. The probability of treatment failure in this group was 41.8% and 56.3% with 24 and 30 months follow-up, respectively. When controlling for pre-treatment PSA level, grade and stage, there was no significant difference in the treatment failure rate between the groups treated with and without laparoscopic staging. CONCLUSIONS: These results suggest that there is no difference in treatment outcome with laparoscopic pelvic lymphadenectomy before external beam radiation therapy in high-risk patients who have significant pre-treatment elevations of PSA level.

Aged↗
PubMed1995

Lasers in the treatment of benign prostatic hyperplasia.

Laser treatment of men with BPH remains in its infancy. To date, a large number of techniques and devices have been developed and investigated to varying degrees. Each laser system that is utilized in a unique fashion must be evaluated individually, since tissue effects may vary significantly with minor changes in technique or technology. Overall, it appears that the majority of men treated by laser prostatectomy experience objective and subjective improvement with short-term follow-up. In most cases, further direct comparisons with TURP with longer follow-up are needed to assess adequately the relative efficacy and morbidity of laser therapy. Although early results are promising and technologic advances are likely to improve further the results seen with laser treatment of men with BPH, it may be premature to relegate TURP to the history books.

Humans↗
PubMed1995

Combined laparoscopic and transurethral neodymium: yttrium-aluminum-garnet laser treatment of invasive bladder cancer.

OBJECTIVES: The feasibility and efficacy of combined cystoscopic and laparoscopic neodymium: yttrium-aluminum-garnet (Nd:YAG) laser coagulation of invasive bladder cancer were investigated. METHODS: Five patients with extensive Stage T2-T3a bladder cancer who were not candidates for radical cystectomy were treated by Nd:YAG laser irradiation. All patients also underwent transperitoneal laparoscopic mobilization of the intestine away from the bladder with continuous monitoring of the laser treatment. In 2 cases, laser therapy of the serosal surface of the bladder at the site of tumor was also administered. RESULTS: The procedure was completed without complications in all 5 patients. A mean of 58,607 joules (J) of energy was delivered transurethrally with an additional 8000 to 10,000 J utilized via laparoscopy in 2 cases. Local disease recurrence was noted within 1 to 4 months in 4 of the 5 patients. Distant metastases were detected within 1 to 9 months postoperatively in 3 of 5 patients. No perioperative bowel or bladder perforation occurred. CONCLUSIONS: The use of laparoscopy allows for the safe delivery of large amounts of laser energy to the bladder. However, in this small group of patients with extensive bladder tumors, effective palliation of local disease could not be reliably achieved. Further study is necessary to determine whether treatment modifications or selection of patients with less extensive tumors will lead to better results with combined laparoscopic and cystoscopic laser therapy.

Aged↗
PubMed1995

Ureteroscopic endopyelotomy in an ectopic kidney.

A patient with an ectopic, pelvic kidney with congenital ureteropelvic junction obstruction was treated by retrograde, ureteroscopic endopyelotomy without percutaneous access. Preoperative ureteral stent placement and angiography facilitated the procedure. The patient had an uneventful recovery with improved drainage from the involved collecting system demonstrated by renal scintigraphy 6 months postoperatively. Ureteroscopic endopyelotomy avoids the need for percutaneous access, which may be difficult in patients with ectopic, malrotated kidneys and appears particularly well suited to the treatment of ureteropelvic junction obstruction in such cases.

Female↗
PubMed1995

Applicability of Iceland spar as a stone model standard for lithotripsy devices.

The identification of a universal stone model standard would enable reproducible fragmentation data useful for the design, evaluation, and comparison of various lithotripsy devices. The clinical benefits of such a stone model include the elucidation of setting parameters that would optimize fragmentation strategies. Iceland spar is a pure form of calcite (CaCO3) that was subjected to experimental disintegration by electrohydraulic lithotripsy and extracorporeal shockwave lithotripsy. Iceland spar was fragmented with both lithotripsy methods in a reproducible fashion. The degree of fragmentation was directly related to alterations in either power or shock frequency. Iceland spar is radiopaque, inexpensive, easily obtained, homogenous in composition, and sizable. Iceland spar meets a variety of stone model criteria, warranting its continued investigation as a potential stone model standard.

Calcium Carbonate↗
PubMed1995

Treatment of ureteropelvic junction obstruction by endopyelotomy.

Endoscopically controlled incision of the ureteropelvic junction (UPJ) (endopyelotomy) has become an accepted form of treatment for both primary and secondary obstruction. The procedure may be performed using either an antegrade, percutaneous technique or via a retrograde approach. Success rates range from 61 to 86% in large series, which is slightly inferior to results of open pyeloplasty. However, the length of hospitalization and recovery period are significantly lessened with an endoscopic approach, and it appears that endopyelotomy should be the initial procedure of choice for most adults with UPJ obstruction.

Adult↗