Search PubMed⌕ Search

Biomedical subjects

H R Hadley

Publications and source records attributed to H R Hadley.

36 records · Page 2Linked to original sources
PubMed1987

Female urethral obstruction after Marshall-Marchetti-Krantz operation.

During the last 5 years 13 neurologically normal women were seen with urodynamically proved urethral obstruction after a Marshall-Marchetti-Krantz operation. These obstructed patients were treated by a simple transvaginal procedure consisting of complete urethrolysis followed by a needle urethrovesical resuspension procedure. Postoperatively, 12 patients experienced complete disappearance of the presenting symptoms, return to a normal voiding pattern and decreased residuals of urine to less than 50 cc. The remaining patient, although urodynamically unobstructed, had to remain on intermittent catheterization. The pathophysiology, diagnosis and treatment of this iatrogenic type of female urethral obstruction are discussed.

Female↗
PubMed1985

Urethral replacement using ileum with an intussuscepted ileal valve for continence.

Numerous techniques for replacing the urethra have been previously described, but attempts to provide continence have rarely been satisfactory. Urethral replacement using ileum with an ileal intussuscepted valve for continence has been successfully performed in ten female dogs. Eight of them were available for a 1 to 6-month followup. This neo-urethra has provided good continence and can be easily catheterized. The clinical usefulness of this technique in the treatment of total urethral loss in humans needs to be further explored.

Animals↗
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

Transvaginal needle bladder neck suspension.

Like the transabdominal bladder neck suspension, the aim of the transvaginal needle suspension of the bladder neck is to suspend the bladder neck and urethra in a fixed retropubic position. Because the transvaginal technique does not require the splitting of the abdominal wall fascia, postoperative discomfort and convalescence may be lessened. Different techniques of transvaginal needle bladder neck suspension, including suspension of the bladder neck with a fascial sling, are discussed in detail.

Fasciotomy↗
PubMed1985

Genitourinary fistulae. Vaginal approach for repair of vesicovaginal fistulae.

Controversy still remains concerning the timing of repair, the type of approach, and the technical guidelines most likely to prevent recurrence of both radiated and nonradiated vesicovaginal fistulae. The authors advocate the transvaginal approach because it avoids a cystotomy and involves minimal blood loss and consequently is followed by less postoperative discomfort and a shorter hospital stay. Included in this discussion are the techniques and results of the transvaginal approach for simple vesicovaginal fistulae as well as for complex cases and radiation fistulae.

Catheters, Indwelling↗
PubMed1985

The pathophysiology of stress incontinence.

The factors contributing to stress incontinence of urine are reviewed and categorized with respect to their effects on coaptation and compression of the urethra. Intrinsic urethral dysfunction and poor anatomic support are discussed from both a functional and a pathophysiologic approach.

Estrogens↗
PubMed1984

[Treatment of urinary stress incontinence by transvaginal suspension of the bladder neck. Peyreyra-Raz technic].

Results are reported of the use of the technique of suspension of paravaginal tissue from either side of the neck of the bladder to treat female stress incontinence. Conducted almost exclusively through the vaginal route, an inversed incision in U allows dissection of the total retropubic space and pre-urethral bladder neck adhesions from any previous surgery, and the passage of a solidly implanted non-absorbable thread from one side of the suprapubic incision involving skin and subcutaneous tissue is made down to the aponeurosis alone. A special long needle is then passed from above downwards from the lateral extremity of the suprapubic incision to the vaginal incision and the two ends of the non-absorbable thread clamped. One of the advantages of the retropubic dissection is the guidance of this needle without the risk of perforation of the bladder or urethra. The ends of the thread are brought from the vaginal incision to the lateral angles of the hypogastric wound and tied together or over a small square of Teflon. The tension of the thread is such that it will just allow ascension of the posterior lip of the neck. This ascension, as well as the absence of any vesico-urethral perforation, and the permeability of the ureteral meatuses is verified by endoscopy. The very wide safety margin inherent in this procedure is shown by the 96% of perfect results in patients not previously operated upon, and the 94% of successes in those operated upon previously on one or several occasions without practically any complications. These findings suggest that this technique should occupy a place of choice in the treatment of urinary stress incontinence in women.

Female↗
PubMed1984

[Vaginal approach to non-irradiated vesicovaginal fistula].

We herein report our experience in the transvaginal repair of 30 consecutive cases of non-radiated Vesicovaginal Fistulae. The new principles applied include: early surgery as soon as the fistula is recognized, no excision of the fistulous tract to avoid retraction and bleeding of the margins as well as to provide protection of the ureteric orifices, closure of the intact fistula in two layers, rotation and advancement of the vaginal flap to cover the fistula avoiding overlapping of suture lines, and finally assurance of adequate bladder decompression with both a suprapubic tube and an urethral catheter. In the followup period of 6 to 72 months, we experienced a 94% success rate at primary repair with only two failures which are now dry after subsequent trans-vaginal closure. In spite of size, location or proximity to the ureteric orifices, the vaginal approach has proved to be amenable in all cases with minimal discomfort for the patient, a shorter hospital stay and equal or even better results than the more extensive abdominal approach.

Female↗