Vasoactive intestinal polypeptide (VIP)-immunoreactive nerve fibres associated with the striated muscle of the human external urethral sphincter.
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Adolescent↗
Biomedical subjects
J K Light
Publications and source records attributed to J K Light.
Detrusor areflexia in suprasacral spinal cord injuries.
Patients with high thoracic or cervical spinal cord injuries normally have a detrusor contraction during cystometry. Thirteen patients with detrusor areflexia and a high spinal cord lesion underwent neurophysiological evaluation with electromyography of the pelvic floor muscles, lumbosacral-evoked potential to tibial nerve stimulation, the bulbocavernosus reflex and water cystometry. Two groups of patients were identified. Of those patients with initial detrusor areflexia evidence was found for a subclinical second lesion involving the lumbosacral arc, which accounted for the acontractile bladder. In the remaining patients of this group, who had an intact sacral reflux arc, a detrusor contraction developed after a mean of 16.6 months from the date of injury. The second group of patients exhibited initial detrusor hyperreflexia that subsequently converted to areflexia. A reason was found for the alteration in bladder behavior in each case. The possible reasons for differential recovery of the somatic and autonomic nervous systems are discussed together with a rationale for the second subclinical spinal cord lesion. The most predictive neurophysiological test was electromyography of the pelvic floor.
Adolescent↗
Management of urinary incontinence in women with the artificial urinary sphincter.
This study concerns 39 women who underwent implantation of the artificial urinary sphincter for severe, persistent urinary incontinence following surgical correction of the anatomical deformity. The cause of incontinence was poor or absent function of the urethral sphincteric mechanism. The success rate in this series with the artificial urinary sphincter was 92 per cent. The condition of the tissues in the cuff area is crucial for success of the procedure. Some technical considerations of the procedure are discussed.
Adult↗
Enteroplasty to ablate bowel contractions in the reconstructed bladder: a case report.
A technique using a large and small bowel segment to ablate bowel contractions is reported. This procedure resulted in urinary continence and preservation of the upper tracts. The technique may be applied when significant bowel contractions result in urinary incontinence or renal deterioration.
Child↗
Reconstruction of the lower urinary tract: observations on bowel dynamics and the artificial urinary sphincter.
In 14 patients the lower urinary tract was reconstructed using bowel and the artificial urinary sphincter. Of these patients 11 underwent augmentation cystoplasty. The ileocecal segment was used in 4, cecum in 4 and ileum in 3. Total reconstruction of the lower urinary tract was done using the sigmoid colon in 2 patients and an ileocecocolonic segment in 1. Significant bowel contractions were seen in all segments of the large bowel, including the ileocecal segment, which resulted in urinary incontinence in 3 patients with the artificial urinary sphincter and reflux in 3. The ileal cup-patch technique consistently produced low bladder pressures with excellent compliance and an adequate volume. Because of the unpredictable bowel contractions observed in the ileocecal, sigmoid and cecal segments we recommend that augmentation cystoplasty be performed using the cup-patch technique. This procedure will ensure the virtual absence of bowel contractions, and is associated with excellent compliance and capacity.
Adolescent↗
The artificial urinary sphincter in children. Experience with the AS800 series and bowel reconstruction.
Recent reports have shown that the artificial urinary sphincter is a reliable means of achieving urinary continence in both adults and children who have urinary incontinence of various etiologies. Although complications may occur, currently the artificial urinary sphincter is the most efficient means of obtaining urinary continence. The author discusses the features of the device, how to trouble-shoot when problems occur, and the role of the device in patients who have undergone partial or total reconstruction of the bladder with bowel.
Adolescent↗
Experience with inflatable penile prosthesis.
Prosthesis surgery for management of erectile impotence has become an increasingly important aspect of urology. The inflatable penile prosthesis (IPP) provides the impotent patient with a controllable, natural-appearing and physiologically functional penis. Major modifications in the prosthesis and in the surgical implantation technique have been made since its initial introduction. In this article we present a histologic review of the IPP and our ten-year experience with it.
Adult↗
Meningomyelocele: a clinical, urodynamic and neurophysiological evaluation.
A total of 11 children with chronic meningomyeloceles underwent a clinical neurological, urodynamic and neurophysiological evaluation to define further the level and type of lesion present in the lumbosacral spinal area. The neurophysiological evaluation was correlated with detrusor activity. Detrusor hyperreflexia was present in 45 per cent of the patients and functional activity of the somatic sacral reflex arc was demonstrated in 4. Absolute interruption of the somatic sacral reflex arc was found in the remaining patients with detrusor areflexia. All patients had evidence of a lower motor neuron lesion on clinical neurological evaluation, with weak or absent myotatic and musculocutaneous reflexes. Electromyographic evaluation revealed signs of severe partial to complete denervation of the affected muscle groups. However, increased motor unit potentials were observed in 5 patients after coughing and stimulation of the perianal skin. The bulbocavernosus reflex was absent clinically and electrophysiologically in all 6 patients tested. However, this finding did not indicate absolute interruption of the reflex arc, since further temporal and spatial stimuli resulted in an increase in motor unit potentials. Somatosensory cortical evoked potentials were useful in demonstrating an intact afferent input system to the spinal cord and brain area. However, lumbosacral evoked potentials appeared to be the least useful neurophysiological method to demonstrate partial preservation of the input to the spinal cord level. Therefore, detrusor and external urethral sphincter function may be documented on urodynamic and neurophysiological evaluation when the clinical examination has revealed a complete lower motor neuron lesion. The complexity of the lesion caused by the malformation in patients with meningomyelocele is shown.
Adolescent↗
Total reconstruction of the lower urinary tract using bowel and the artificial urinary sphincter.
We report 3 cases in which the lower urinary tract was reconstructed using bowel. In each instance the cuff was placed around the bowel to provide a continence mechanism. The 2 patients in whom the sigmoid colon was used have sporadic diurnal incontinence with nocturnal enuresis. Urodynamic evaluation has shown that this is secondary to high pressures generated within the closed sigmoid loop. The ileocecocolonic segment is preferable for reconstruction of the lower urinary tract, since the pressure developed within the bowel is significantly lower. The use of the artificial urinary sphincter around the bowel extended the versatility of the device.
Adolescent↗
The artificial urinary sphincter in children.
One hundred and thirty-two children underwent implantation of the AS792 artificial urinary sphincter over the past 5 years: 90% had an excellent result following the implantation. Thirty-one patients (24%) required further surgery to correct a malfunction of the device. The device was removed in 5.3% of the patients and the incidence of infection was 3.8%. The artificial urinary sphincter has been shown to be a reliable means of achieving urinary incontinence in children. With attention to patient selection and meticulous surgical technique, a high success rate can be expected.
Adolescent↗
Treatment of urinary incontinence in children: the artificial sphincter versus other methods.
Urinary incontinence in children is a distressing problem that often is magnified during puberty, since the children then realize the full significance of the disorder. Although there are numerous methods of treatment described none offers the reliable combination of a normal body image and total urinary continence. We describe our experience with the AS792 artificial urinary sphincter in treating children with urinary incontinence of varying etiologies and compare it with other described methods.
Adolescent↗
Use of the artificial urinary sphincter in spinal cord injury patients.
A total of 49 patients with neuropathic bladder dysfunction and urinary incontinence underwent implantation of the AS791/792 artificial urinary sphincter. Preoperative urodynamic evaluation allowed the bladder response to be categorized as hyperreflexia, areflexia and low compliance. The over-all success rate in obtaining total urinary continence in these patients was 70 per cent, although the type of bladder present did influence the degree of success. Although urodynamic evaluation is an essential prerequisite for sphincter implantation there were no clear-cut data that allowed an accurate prediction of the postoperative result. The only absolute contraindication to implantation of the artificial urinary sphincter is significant bladder fibrosis. Owing to the success in obtaining total urinary continence in this complicated group of patients, we believe that the artificial urinary sphincter should be considered in carefully selected patients with neuropathic bladder dysfunction secondary to spinal cord injury.
Adolescent↗
Use of the AS792 artificial sphincter following urinary undiversion.
Reconstruction of the urinary tract after diversion has been successful in patients with normal innervation of the lower tracts. However, the possibility of urinary incontinence after such major surgical procedures has dissuaded many surgeons from attempting urinary undiversion in patients in whom the continence status cannot be determined accurately before the operation or who were known to be incontinent before the original diversion. For this reason, the presence of neuropathic bladder dysfunction has been considered a relative contraindication to urinary undiversion unless it can be established preoperatively that the patient will obtain urinary continence. Eight patients are reported who had successful outcome with the use of the AS792 artificial urinary sphincter to control incontinence after urinary undiversion. Because of this successful experience it is now believed that patients with neuropathic bladder dysfunction or anatomically abnormal lower tracts are no longer precluded from urinary undiversion. A variety of methods has been used to reconstruct the urinary tract, including total reconstruction of the bladder and urethra with the sigmoid colon in 1 case. In the latter case the artificial sphincter was placed around the bowel segment to provide continence. The use of the artificial sphincter around a bowel segment offers many possibilities for reconstructive procedures involving bowel in the future.
Adolescent↗
Treatment of the epispadias-exstrophy complex with the AS792 artificial urinary sphincter.
The AS792 artificial urinary sphincter was implanted in 11 incontinent patients with the epispadias-exstrophy complex. To date 10 patients (91 per cent) are totally continent of urine with normal renal function and intact urinary systems. The recent reports concerning success with bladder neck reconstruction in this syndrome are reviewed. Owing to the relatively poor success of this procedure in achieving total urinary continence it is recommended strongly that insertion of the artificial urinary sphincter be the initial anti-incontinence procedure for these patients. The success rate with the artificial sphincter currently is superior to any form of bladder neck reconstruction in patients with the epispadias-exstrophy complex.
Adolescent↗
Complications of the artificial urinary sphincter in pediatric patients.
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Adolescent↗
Bronchopleural fistula management.
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Animals↗
Bethanechol chloride and the traumatic cord bladder.
The effect of bethanechol chloride was evaluated in 28 men with neurogenic bladder disease secondary to traumatic spinal cord damage. Simultaneous measurements of bladder pressure, electromyography of the pelvic floor and flow rate were obtained to evaluate the effect on voiding. The results of these studies revealed that bethanechol chloride failed to improve voiding dysfunction in these patients in either the supine or sitting position. Functional bladder outlet obstruction was aggravated by bethanechol chloride. It was found that the effect of this drug on the bladder was unpredictable, as evidenced by some patients converting from a definite detrusor contraction to a wave type pattern. Bethanechol chloride failed to induce a detrusor contraction in patients with areflexia or wave pattern bladders.
Adult↗
Management of neurogenic impotence with inflatable penile prosthesis.
The inflatable penile prosthesis was used to manage impotence of neurogenic origin secondary to spinal cord injury. The female partners were also interviewed. Analysis of the results indicated that this was an eminently satisfactory method of managing this distressing complication of spinal cord injury. Both men and women indicated satisfaction with the prosthesis. The incidence of complications was the same as in those patients with non-neurogenic impotence. Erosion of the prosthesis due to pressure necrosis of denervated tissue did not occur.
Adult↗