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Biomedical subjects

J L Lockhart

Publications and source records attributed to J L Lockhart.

At least 37 records · Page 2Linked to original sources
PubMed1993

The gastroileoileal pouch: an alternative continent urinary reservoir for patients with short bowel, acidosis and/or extensive pelvic radiation.

We report on 6 patients who underwent a new type of continent urinary diversion: the gastroileoileal reservoir. These are a select group of patients who presented with the short bowel syndrome, acidosis, borderline diarrhea and/or severe pelvic radiation, which precluded the use of terminal ileum and the ileocecal segment. Considering these factors, and based on the different functional properties of the stomach as well as the need for a large reservoir, a segment of stomach and proximal ileum was used to construct the reservoir. Four patients have been followed for at least 6 months, with the longest followup being 12 months. Temporary dysphagia requiring hydrogen blockers developed in 1 patient. Results indicate excellent function of the continent urinary system, lack of metabolic complications, absent diarrhea and excellent patient tolerance. This procedure could be a useful alternative in some difficult clinical situations when continent urinary diversion is desirable.

Acidosis↗
PubMed1993

Periurethral polytetrafluoroethylene paste injection in incontinent female subjects: surgical indications and improved surgical technique.

We present the results with 2 techniques for periurethral polytetrafluoroethylene (Polytef) injection in 21 female subjects with type III stress urinary incontinence. The standard technique included the use of a stainless steel needle for injection, paste "sopping" and a Wolff, Storz or Lewy syringe as an injecting element. Postoperatively, no catheters were left indwelling and all patients were encouraged to urinate following recovery from the anesthesia. The modified technique included the use of a 14F angio-catheter for injection of the paste, paste heating and a Lewy syringe or Mentor gun as injector. Postoperatively, all patients were left with an indwelling suprapubic catheter for 3 to 5 days. A total of 27 injections was performed, including 9 with the standard technique and the last consecutive 18 with the modified technique. Average followup has been 11.4 months. Cure, improvement and no change rates from the preoperative condition were 11%, 22% and 67% with the standard technique and 39%, 17% and 44% with the modified technique, respectively. In the latter group 3 patients had received pelvic radiotherapy as definitive treatment for pelvic malignancies. The overall failure rate in patients with a stable detrusor was 42% compared to 75% in the group with bladder instability and low compliance. Advantages of the modified technique include avoidance in the formation of intraoperative and postoperative fistulas, and easier handling and injection of the heated paste to achieve urethral compression. Improved short-term results with the modified technique indicate that a larger group of patients and long-term followup are essential requirements to determine the true efficacy of this technical modification. Based on these preliminary results, we now prefer the modified technique to the standard technique in the management of type III stress urinary incontinence.

Adolescent↗
PubMed1992

Long-term followup with the use of lyophilized dura mater for abdominal wall closure in children: report of 3 cases.

We report our experience with 3 children treated during infancy by abdominal wall reconstruction using lyophilized dura mater. Followup has been 36, 46 and 96 months postoperatively and they demonstrated adequate abdominal wall healing. One child has mild muscular diastasis, while 1 has completely healed. In 1 child a small defect developed in the repair, which was closed at a secondary procedure. Wound infection, dehiscence or herniation did not occur. There has been no evidence of Creutzfeldt-Jakob disease, which has been reported when allogenic dura was not obtained from registered tissue banks. Our experience with dura mater suggests that the material may be a useful adjunct in the repair and closure of complex abdominal defects.

Abdominal Muscles↗
PubMed1991

Ileal segment for ureteral substitution or for improvement of ureteral function.

A total of 29 patients received an ileal segment interposition between the upper and lower urinary tract for partial or total ureteral substitution, or for ileal wrapping around a massively dilated, aperistaltic ureter. Indications for an operation included the presence of an extensively diseased or short ureter and an aperistaltic megaureter that had failed previous reconstructive attempts. Nine patients (group 1) underwent an ileal sleeve procedure in an attempt to increase the ureteral peristaltic activity and facilitate drainage. Among these patients 7 (78%) had a stable upper tract radiologically and normal serum creatinine (less than 1.6 mg./100 ml.), while 2 (22%) had deterioration of the renal function. Ten patients (group 2) had undergone a myriad of reconstructions that failed and then underwent complete ureteral substitution with ileum. Among them, renal function (as evidenced by excretory urography and serum creatinine) is stable in 7 (70%) and deteriorated in 3 (30%). In 10 patients (group 3) the ureters were partially replaced by ileum in addition to a bladder augmentation procedure. Of these patients 8 (80%) have stable renal function and 2 (20%) had renal failure. Over-all, 7 patients have different degrees of renal failure; among them 2 (6.9%) are on dialysis and 2 (6.9%) have received a transplanted kidney. In groups 2 and 3 the results with an antireflux operation indicated that among 6 ureteroileal reimplantations 5 (83%) were successful, among 12 intravesical intestinal nipples 6 (50%) failed to prevent reflux and there was no case of obstruction, while among 4 ileocecal intussusceptions 2 (50%) were successful and 2 failed. Mucous secretion produced temporary ureteral obstruction in 1 ureter (3.4%), which resolved without surgical intervention. Some of the aforementioned procedures were done in the past and in some situations a different reconstructive technique would be considered presently. The surgical complexity and magnitude of the procedures justify their performance only in difficult clinical situations as an alternative to urinary diversion or renal autotransplantation.

Adolescent↗
PubMed1991

Results, complications and surgical indications of the Florida pouch.

One hundred and seven patients underwent continent urinary diversion using an extended, detubularized right colonic segment as the urinary reservoir and the distal part of the ileum as a continent catheterized efferent system. This reservoir allows the accommodation of a large volume of urine; urodynamics in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 milliliters (an average of 747 milliliters). The reservoir maximal volume and pressure remains unchanged in six patients studied urodynamically three to four years postoperatively. Maximal reservoir pressures ranged between 10 and 58 centimeters of H2O (an average of 35 centimeters). Of 201 ureterocolonic reimplantations, four ureters were initially reimplanted using a modified Le Duc procedure, 26 ureters were subsequently managed using the Goodwin transcolonic approach and 165 reimplantations were done with a direct (nontunneled) mucosa to mucosal anastomosis. The over-all success rates with each of the three techniques (absence of reflux and obstruction) have been 75.0, 84.7 and 87.4 per cent, respectively. However, the incidence of obstruction was 13.3 per cent for the tunneled and 4.2 per cent for the non-tunneled reimplantations. Six megaureters underwent imbrication and direct reimplantation, and three of these became obstructed. One patient died of pulmonary embolism. Medical and surgical complications markedly predominated in the group who underwent simultaneous cystectomies, and in this group, the over-all complication rate was comparable with that for previously reported series with ileal conduits. The double row plication of the distal part of the ileum and ileocecal valve allows easy catheterization every four to six hours and 105 patients (97.2 per cent) remained continent between catheterizations. The stoma is covered using a small gauze, cap or sterile adhesive strip. This protects clothing from mucus production by the stoma and an occasional episode of urinary dribbling. Seven patients required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.

Adolescent↗
PubMed1990

A continent colonic urinary reservoir: the Florida pouch.

A total of 92 patients underwent continent urinary diversion with an extended, detubularized right colonic segment as the urinary reservoir and the distal ileum as a continent catheterizable efferent system. In this series 65 patients were followed for 6 to 46 months (average 17 months). Our reservoir allows the accommodation of a large volume of urine; urodynamic studies in 28 patients demonstrated a maximum reservoir capacity varying between 550 and 1,200 cc (average 747 cc). Maximal reservoir pressures ranged from 10 to 58 cm. water (average 35 cm. water). Of the 127 ureterocolonic reimplantations 4 ureters were initially reimplanted with a modified Le Duc procedure, 26 ureters were managed subsequently with the Goodwin transcolonic approach and 91 reimplantations were done with a direct (nontunneled) mucosa-to-mucosa anastomosis. The overall success rates with each of the 3 techniques (absence of reflux and obstruction) were 75, 88.6 and 90.1%, respectively. Six megaureters underwent imbrication and direct reimplantation, and 3 of these (50%) became obstructed. Two converted ileal conduits were opened at the antimesenteric edge and were patched to the reservoir while the ureteroileal anastomosis was left undisturbed. One patient (1.5%) died of pulmonary embolism. Medical and surgical complications occurred only in the group who underwent simultaneous cystectomy and the over-all rate of complication was comparable to previous series with ileal conduits. The double row plication of the distal ileum and ileocecal valve allows for easy catheterization every 4 to 6 hours and 63 patients (97%) remain continent between catheterization. Four patients (6%) required reoperation for correction of incontinence or other complications. Our satisfactory experience with these patients makes this technique an excellent approach to achieving continent urinary diversion.

Colon↗
PubMed1990

Combined cystourethropexy for the treatment of type 3 and complicated female urinary incontinence.

We treated 37 women with type 3 stress urinary incontinence or with an associated complicating factor, such as morbid obesity, a large or proximal diverticulum or a urethrovaginal fistula, via combined transvaginal cystourethropexy. All women with type 3 stress incontinence had failed a previous anti-incontinence operation. Patients in both groups underwent suprapubic needle suspension and an additional bladder neck support procedure. Among 33 patients who underwent preoperative urodynamic studies 30 had stable bladders (90%), while 3 had low pressure detrusor instability (10%). The success rate in achieving continence, including cured and improved patients, was 94.6% with a followup of 3 to 72 months. Four patients (10%) required temporary intermittent catheterization for 3 to 4 weeks but none presented with long-term voiding dysfunction. The added bladder neck support improved our results in these complicated female incontinence cases compared to the standard suprapubic needle suspension procedures alone. The combined procedure currently is our method of choice for treatment of type 3 and other complicated cases of female urinary incontinence.

Adolescent↗
PubMed1988

Periurethral polytetrafluoroethylene injection following urethral reconstruction in female patients with urinary incontinence.

We present our results with periurethral polytetrafluoroethylene (Polytef) injection after urethral reconstruction in 20 female patients with urinary incontinence. These patients have failed previous urethral reconstructive procedures to cure incontinence, including Young-Dees-Leadbetter bladder neck reconstruction, transvaginal urethroplasty, transvaginal urethral plication and vesical flap urethroplasty. Of the patients 4 also underwent a bladder augmentation procedure. After polytetrafluorethylene injection 10 patients (50 per cent) were cured of the incontinence, 2 (10 per cent) had marked improvement from the preoperative condition, 5 (25 per cent) had definite improvement but still wear pads for protection and 3 (15 per cent) had no change from the preoperative condition. Bladder pressure recordings did not demonstrate a difference in results among patients with detrusor stability or instability. Periurethral polytetrafluoroethylene injection remains a valuable procedure in the management of persistent incontinence after bladder neck and urethral reconstruction.

Adult↗
PubMed1987

Palliative treatment of obstructing stone during pregnancy.

We present a twenty-three-year-old obese female with a twenty-four-week gestation pregnancy, a left ureteral stone, and urosepsis. She was treated conservatively with intravenous antibiotics and an indwelling Double J Cook catheter until the postpartum period. This represents a satisfactory alternative to nephrostomy drainage or surgical or percutaneous stone removal during pregnancy.

Adult↗
PubMed1987

Remodeled right colon: an alternative urinary reservoir.

A total of 11 patients underwent bladder substitution or continent supravesical diversion with a remodeled right colonic segment as a urinary reservoir. Of the patients 1 woman and 2 men had bladder substitution: in 2 the bladder neck and urethra were preserved, and in 1 man radical cystoprostatectomy with preservation of the distal sphincteric mechanism was performed. All 3 patients currently are continent. In the 8 diversion patients an anti-incontinence mechanism was reconstructed with a segment of plicated ileum sutured to the abdominal wall. Six patients are completely dry between catheterizations every 4 to 6 hours, 1 man requires more frequent catheterizations, and the woman has refused self-catheterization and wears an external appliance. There were 18 ureterointestinal reimplantations performed successfully for upper tract protection, and 1 ureterocolonic reimplantation became partially obstructed and required percutaneous dilation. Reflux did not occur. This remodeled right colonic segment, reconstructed with interruption of the intestinal circular fibers, allows for storage of large urine volumes at reasonable pressures and it is a suitable alternative bladder substitution procedure. Plicated ileum has allowed for easy catheterization and it has been an adequate anti-incontinence mechanism when associated with this colonic reservoir.

Adult↗
PubMed1987

Malignant vesical tumors following spinal cord injury.

We present 11 male patients with spinal cord injury and neurogenic bladder disease in whom malignant vesical tumors developed. The incidence of these tumors in our spinal cord injury unit was 2.3 per cent. We investigated retrospectively the clinical, endoscopic and radiographic diagnoses, and analyzed the treatment. The most common presenting symptoms were recurrent urinary infections, hematuria and stone disease. Two patients presented with abdominal symptomatology (a large abdominopelvic mass and peritonitis). Endoscopic evaluation was nonspecific in 8 patients (72 per cent). Squamous cell carcinoma was present in 9 patients (81 per cent). One patient had pure transitional cell carcinoma, and 1 had mixed squamous and transitional cell cancer. Cytology was of no value in these patients. The presence of local invasion and bulky disease suggests that ultrasonography or computerized tomography of the abdomen and pelvis should be included during followup. Radical cystoprostatectomy with pelvic lymphadenectomy is the recommended therapy for localized disease. The presence of active or recurrent urethral disease in 55 per cent of the patients indicated that urethrectomy also should be performed.

Adult↗
PubMed1987

Antireflux ureteroileal reimplantation: an alternative for urinary diversion.

Direct antireflux ureteroileal reimplantation with a short (2 to 2.5 cm.) intraintestinal ureteral segment was used in 14 patients with 26 ureters reimplanted into the ileum as part of a bladder augmentation procedure, substitution cystoplasty or continent supravesical diversion. Our incidence of reflux was 3.8 per cent (1 ureter), while ureteroileal obstruction occurred in 11.4 per cent (3 ureters). The over-all short-term technical success (maximum 18 months) with this operation was 84.8 per cent. These encouraging results make antireflux ureteroileal reimplantation an attractive alternative for its use in urinary tract reconstruction with ileal reservoirs.

Adolescent↗
PubMed1986

Female urinary incontinence: preoperative selection, surgical complications and results.

A total of 98 women with stress urinary incontinence underwent surgical repair via 3 different techniques: 38 patients underwent a Burch colposuspension (group 1), 25 underwent a Stamey procedure (group 2) and 35 had a modified Pereyra operation (group 3). The main indication for an operation was clinically unacceptable incontinence, and urodynamic studies were done on all patients with associated stress and urge incontinence or who underwent reoperation. Subtracted bladder pressure recording was an important preoperative screening tool, since patients with high pressure instability did worse surgically than those with a stable bladder or low pressure instability. In patients with detrusor stability similar results were achieved for initial surgery and reoperations. Among the patients with a stable bladder with and without a previous anti-incontinence operation the over-all results were better in groups 1 and 3 than in group 2. Complications were of lesser magnitude in groups 2 and 3 than in group 1.

Adult↗
PubMed1986

Sphincterotomy failure in neurogenic bladder disease.

Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.

Adult↗
PubMed1986

The antireflux ureteroileal reimplantation in children and adults.

We report on 6 patients with 11 ureters who underwent antireflux ureteroileal reimplantation as part of various reconstructive procedures. A success rate of 82 per cent (9 ureters) was obtained. Our preliminary report shows that the ureteroileal reimplantation represents a satisfactory alternative for urinary diversion and undiversion or a vesical augmentation procedure with the small bowel.

Adolescent↗
PubMed1986

Augmentation cystoplasty in the management of neurogenic bladder disease and urinary incontinence.

Vesical augmentation procedures were performed on 15 patients for neurogenic bladder disease and urinary incontinence. Enterocystoplasty with ileum, cecum and sigmoid was used associated with different operations to prevent upper tract deterioration or urinary incontinence. The small bowel stored larger amounts of urine at a lower maximal detrusor pressure at capacity than the large bowel. All ureterointestinal and ureterovesical reimplantations were successful, including 5 ureteroileal with the Camey procedure. The 2 failures, characterized by persistent urinary incontinence, included a male patient who refused intermittent catheterization and a girl with persistent hypersecretion of mucus and recurrent urinary tract infections.

Adolescent↗