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Biomedical subjects

Hunter Wessells

Publications and source records attributed to Hunter Wessells.

29 records · Page 2Linked to original sources
PubMed2003

A national survey of urinary and health related quality of life outcomes in men with an artificial urinary sphincter for post-radical prostatectomy incontinence.

PURPOSE: We determine health related quality of life and urinary outcomes of men undergoing implantation of an artificial urinary sphincter for post-radical prostatectomy incontinence. MATERIALS AND METHODS: Through a data base provided by American Medical Systems, we mailed the UCLA Prostate Cancer Index to men who underwent artificial urinary sphincter implantation during 6-month intervals in 1995 in 1999, providing 5 and 2-year followup data, respectively. RESULTS: Of the anonymous questionnaires 36% were returned from the 1995 cohort and 45% from the 1999 cohort. Age adjusted mean scores for the 8 health related quality of life domains were comparable in both groups. Urinary function and bother scores were worse in the 1995 cohort compared to the 1999 group (40 and 48 versus 53 and 58, respectively, p <0.001), with pad use of 97% and 83% respectively. Revision rates were 16% at 2 years and 28% at 5 years after implantation. CONCLUSIONS: Our national survey revealed that despite significant differences in urinary function and bother, men 2 and 5 years after artificial urinary sphincter implantation had similar general health related quality of life. The continence outcomes differed from most single institution studies in that men after sphincter implantation reported a high degree of urinary dysfunction and bother. Artificial urinary sphincter implantation may significantly improve scores in urinary function but continued pad use is to be expected.

Aged↗
PubMed2003

Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the incidence and resolution of sexual adverse experiences (AEs) in men with benign prostatic hyperplasia treated with finasteride 5 mg compared with placebo. METHODS: The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year, randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men, aged 45 to 78 years, with symptomatic benign prostatic hyperplasia, enlarged prostates, and no evidence of prostate cancer. Patients completed a questionnaire at screening regarding their history of sexual dysfunction. During treatment, spontaneously self-reported sexual AEs were recorded. RESULTS: At screening, 46% of patients in each treatment group reported some history of sexual dysfunction. During year 1 of the study, 15% of finasteride-treated patients and 7% of placebo-treated patients had sexual AEs that were considered drug related by the investigator (P <0.001). During years 2 to 4, no between-group difference was noted in the incidence of new sexual AEs (7% in each group). The drug-related sexual AE profile for finasteride was similar for men with or without a history of sexual dysfunction. Sexual AEs resolved while continuing therapy in 12% of finasteride patients and 19% of placebo patients. Only 4% of finasteride and 2% of placebo patients discontinued the study because of sexual AEs. In men who discontinued with a sexual AE, 50% and 41% experienced resolution of their sexual AE after discontinuing finasteride or placebo therapy, respectively. CONCLUSIONS: Compared with placebo, men treated with finasteride experienced new drug-related sexual AEs with an increased incidence only during the first year of therapy.

Aged↗
PubMed2003

Renal injury and operative management in the United States: results of a population-based study.

BACKGROUND: To evaluate the extent to which nonoperative renal trauma management has been adopted, we determined the incidence of renal injury and the rate of operative management across the United States. METHODS: International Classification of Diseases, Ninth Revision diagnosis and procedure codes identified patients with renal injuries in an 18-state administrative database representing 62% of the U.S. population. RESULTS: Of 523,870 patients hospitalized for trauma in 1997 or 1998, 6,231 (1.2%) had renal injuries (4.89 per 100,000 population). Sixty-four percent of patients with injuries that were classified had contusions/hematomas, 26.3% had lacerations, 5.3% had parenchymal disruption, and 4% had vascular injuries. Eleven percent of renal trauma patients required surgical management of their kidney injuries, of whom 61%, or 7% of patients with renal injuries overall, underwent nephrectomy. Injury Severity Score, mechanism, and renal injury severity were independent predictors of nephrectomy. CONCLUSION: The nephrectomy rate in community and academic centers reflects renal and global injury severity. Prospective trials are indicated to determine whether, in the traumatized patient with severe kidney injury, renal preservation could lead to improved outcomes compared with nephrectomy.

Adolescent↗
PubMed2003

MT-II induces penile erection via brain and spinal mechanisms.

alpha-Melanocyte-stimulating hormone induces penile erection via melanocortin (MC) receptors in areas surrounding the third ventricle, but spinal and peripheral mechanisms have not been demonstrated. We used pharmacological strategies to localize the site of the proerectile action of the melanocortin receptor agonist MT-II. We administered MT-II intracerebroventribularly (i.c.v.), intrathecally (i.th.), and intravenously (i.v.) and scored penile erection and yawning for 90 min in awake male rats. In some animals i.c.v. or i.th. SHU-9119 was injected 10 minutes before i.c.v. and i.th. MT-II to confirm the MC receptor action of the agonist and to distinguish spinal from supraspinal effects. To exclude a site of action in the penis, we recorded intracorporal pressure responses to intracavernosal injection of MT-II in the anesthetized rat. MT-II induced penile erections in a dose-dependent fashion, with optimal response at 1 microg for both i.c.v. and i.th. routes. Supraspinal MT-II-induced erections were completely suppressed by 1 microg SHU-9119 i.c.v. Yawning was observed with i.c.v. and i.v. MT-II, whereas spinal injection did not produce this behavior. SHU-9119 blocked the erectile responses to i.th. MT-II when injected i.th. but not i.c.v. Intracavernosal MT-II neither increased intracorporal pressure nor augmented neurostimulated erectile responses. The lumbosacral spinal cord contains MC receptors that can initiate penile erection independent of higher centers. We confirmed the supraspinal proerectile action of MT-II. These results provide insight into the central melanocortinergic pathways that mediate penile erection and may allow for more efficacious melanotropin-based therapy for erectile dysfunction.

Animals↗
PubMed2002

A technique of bladder neck closure combining prostatectomy and intestinal interposition for unsalvageable urethral disease.

PURPOSE: We describe a technique of bladder neck detachment and augmented closure incorporating total prostatectomy and urinary diversion in men with complex bladder and urethral pathology due to fistula, radiation and neurogenic dysfunction. MATERIALS AND METHODS: We retrospectively reviewed the records of 5 men 38 to 61 years old who presented with unsalvageable urethral pathology, including prostate cancer in 2. All 5 patients underwent radical prostatectomy and augmented bladder neck closure with creation of a continent catheterizable stoma in 4 and chimney diversion in 1. RESULTS: Bladder neck closure was performed with interposition of an ileocecal patch in 4 cases and sigmoid colon in 1. At a mean followup of 6 months no fistula, recanalization or urinoma developed. Delayed complications included stomal stenosis, stomal incontinence requiring collagen injection and rupture of the augmented bladder in 1 case each. The 2 men with prostate cancer had undetectable prostate specific antigen. CONCLUSIONS: Prostatectomy facilitated mobilization of the bladder neck away from the urethral pathology and interposition of an intestinal segment at the bladder neck allowed healing. In addition to cases of complicated urethrovesical pathology, this technique may have applications in salvage prostatectomy after pelvic irradiation for carcinoma.

Adult↗
PubMed2002

Efficacy and safety of sildenafil citrate (Viagra) in black and Hispanic American men.

The objective of this study was to assess the efficacy and safety of sildenafil citrate (Viagra) in black American and Hispanic American men with erectile dysfunction (ED) of broad-spectrum etiology. A total of 246 black American and 197 Hispanic American men were randomized to sildenafil (50 mg, adjustable to 25 mg or 100 mg, depending on efficacy and tolerability; n = 124 and n = 99, respectively) or matching placebo (n = 122 and n = 98, respectively). After 6 weeks, patients were given the option of switching to the other blinded treatment for the following 6 weeks. The 12 weeks of double-blind treatment were followed by 12 weeks of open-label extension. Despite differences in prevalence of hypertension, diabetes mellitus, hyperlipidemia, and use of concomitant antihypertensive agents between the 2 study groups, sildenafil was efficacious and well tolerated. After 6 weeks, scores for questions 3 and 4 from the International Index of Erectile Function (IIEF) were significantly higher among sildenafil-treated black and Hispanic patients than in placebo-treated patients. In addition, compared with placebo, a significantly larger proportion of sildenafil patients reported improved erections and improved ability to have sexual intercourse. When efficacy results were stratified by ED severity or number of risk factors, scores for IIEF questions 3 and 4 were lower in men with severe ED versus mild-to-moderate ED. Similarly, the percentage of patients reporting improved erections decreased with ED severity and number of risk factors. The proportion of patients switching to the other treatment after 6 weeks was significantly higher in the placebo group (71% to 85%) than in the sildenafil group (27% to 28%). The most common adverse events included headache and vasodilation, which were mild to moderate in nature and were comparable between groups. These data demonstrate that despite differences in prevalence rates of comorbidities, efficacy and safety of sildenafil is maintained across different ethnic groups.

Adult↗
PubMed2002

Ventral onlay graft techniques for urethroplasty.

Techniques of anterior urethroplasty have evolved over the last 40 years due to advances in tissue transfer techniques and the changing etiology of urethral stricture. The use of free grafts has come full circle from full thickness skin grafts to the current popularity of buccal mucosa grafts. Grafts fell out of favor due to poor results with full thickness skin grafts and the more widespread use of pedicle flaps. Although controversy still exists as to the appropriate use of flaps versus grafts, the evidence does not demonstrate an advantage in outcomes: overall success rates for grafts and flaps are similar (84.3 and 85.9% respectively). Nevertheless, grafting techniques are now considered first line therapy for the majority of strictures that cannot be excised and reanastomosed.

Humans↗
PubMed2002

The long-term effect of specific type II 5alpha-reductase inhibition with finasteride on bone mineral density in men: results of a 4-year placebo controlled trial.

PURPOSE: We determine the effect of long-term suppression of dihydrotestosterone with finasteride, a specific type II 5alpha-reductase inhibitor, on bone mineral density. MATERIALS AND METHODS: As part of a large (3,040 cases) 4-year, double-blind, placebo controlled trial designed to assess the long-term effects of finasteride in men with benign prostatic hyperplasia, 157 men 46 to 76 years old who were randomized to receive either 5 mg. finasteride or placebo underwent dual energy x-ray absorptiometry of the lumbar spine at baseline and at years 2, 3 and 4. RESULTS: Of 117 patients who had a baseline measurement and at least 1 additional measurement during the study baseline mean plus or minus standard deviation bone mineral density values were 1.12 +/- 0.17 gm./cm.2 in the finasteride group (63) and 1.10 +/- 0.17 gm./cm.2 in the placebo group (54). After 4 years bone mineral density was not different between treatment groups (finasteride 1.14 +/- 0.17 gm./cm.2 and placebo 1.13 +/- 0.18 gm./cm.2). Similar results were obtained for the 33 finasteride and 25 placebo treated patients who completed the study with year 4 bone mineral density measurements. CONCLUSIONS: These data demonstrate that long-term inhibition of type II 5alpha-reductase with finasteride does not adversely affect bone mineral density.

5-alpha Reductase Inhibitors↗