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Jerry G Blaivas

Publications and source records attributed to Jerry G Blaivas.

At least 19 recordsLinked to original sources
PubMed2007

The urgency perception score: validation and test-retest.

PURPOSE: We validate a grading system for urinary urgency. MATERIALS AND METHODS: A total of 225 subjects participated in a validation study of a fixed format question that examined the reasons why an individual usually voids. The response comprised 5 graded categories. The written questionnaire was completed by the subject twice in 3 to 14 days, during which there was no change in symptoms. Subjects included asymptomatic normal volunteers and consecutive patients with lower urinary tract symptoms without urinary urgency and those with overactive bladder with or without other lower urinary tract symptoms. Content validity was established by an expert panel. Discriminant validity was assessed by examining the frequency of responses in the various categories across the 3 groups (chi-square test) and by comparing average scores in each of the 3 groups using 1-way ANOVA, followed by LSD post hoc tests. Test-retest reliability was assessed using the intraclass correlation coefficient and kappa coefficient. RESULTS: A total of 83 normal subjects, 62 patients with lower urinary tract symptoms and 80 patients with overactive bladder were included in the study. Median age was 71 years (range 21 to 97). For test-retest reliability the intraclass correlation coefficient (0.86) and kappa coefficient (0.68) indicated a good level of agreement (p <0.001). The overactive bladder group achieved a significantly higher score than the normal and lower urinary tract symptoms groups (mean +/- SD 2.5 +/- 0.99 vs 1.6 +/- 0.93 and 1.8 +/- 0.93, respectively, each p <0.001). CONCLUSIONS: The urgency perception score appears to be a valid and reliable means of grading urinary urgency. We believe that this method of grading urgency will prove to be more clinically useful than the simple yes/no characterization of urgency as a sudden compelling desire to void and it will be a useful item for questionnaires and diary keeping.

Adult↗
PubMed2006

The pathophysiology of lower urinary tract symptoms after brachytherapy for prostate cancer.

OBJECTIVES: To determine the spectrum of pathophysiology underlying the lower urinary tract symptoms (LUTS) persisting for > or = 6 months after brachytherapy for localized prostate cancer. PATIENTS AND METHODS: A database of men from two practice settings was searched for men who developed LUTS persisting for > or = 6 months after completing brachytherapy for localized prostate cancer. Patients were evaluated with a structured history and physical examination, International Prostate Symptom Score (IPSS), 24-h voiding diary, noninvasive free-flow uroflowmetry, postvoid residual urine volume (PVR), cystoscopy and a video-urodynamic study. Specific data collected included symptoms, elapsed time since brachytherapy, Gleason score, IPSS, total number of voids/24 h, maximum voided volume, cystoscopic findings, and urodynamics findings (PVR, maximum urinary flow rate, Schaefer obstruction grade, Watts factor, incidence of detrusor overactivity (DO) urethral obstruction and low bladder compliance). These data were compared with those from a previous study of men with LUTS who did not have prostate cancer. RESULTS: The study included 47 men (aged 54-88 years); the median (range) interval between brachytherapy and evaluation was 1.5 (0.5-13) years. Thirty-seven men complained of overactive bladder symptoms (79%), and 31 of incontinence (71%), 21 of obstructive symptoms (44%), and persistent dysuria in 12 (26%). Comparison of urodynamic findings in men with unselected causes of LUTS vs LUTS due to brachytherapy revealed the following comparisons: DO in 252 of 541 (47%) unselected vs 28 of 33 (85%) brachytherapy, (P < 0.001); and urethral obstruction in 374 of 541 (69%) unselected vs 24 of 33 (73%) brachytherapy (P = 0.85). CONCLUSION: The pathophysiology and severity of persistent LUTS in men after brachytherapy differs from that of men with LUTS in the general population. Men after brachytherapy have a much higher incidence of DO, prostatic and urethral strictures and prostatic urethral stones.

Aged↗
PubMed2005

What to do?

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Humans↗
PubMed2005

Long-term followup of augmentation enterocystoplasty and continent diversion in patients with benign disease.

PURPOSE: We evaluated long-term outcomes in patients undergoing augmentation enterocystoplasty (AC) (with or without an abdominal stoma) or continent urinary diversion in patients with benign urological disorders. MATERIALS AND METHODS: This was a retrospective study of 76 consecutive adults who underwent AC (with or without an abdominal stoma) or continent urinary diversion because of benign urological conditions. The outcomes assessed were a patient satisfaction questionnaire, continence status, catheterization status, bladder capacity, bladder compliance, detrusor instability, maximum detrusor pressure, upper tract status, significant postoperative morbidity, need for reoperation, persistent diarrhea and vitamin B12 deficiency. RESULTS: The 76 patients (18 men and 58 women) were 19 to 80 years old (mean age 49). Followup was 1 to 19 years (mean 8.9). Preoperative diagnoses were neurogenic bladder in 41 patients, refractory detrusor overactivity in 9, interstitial cystitis in 7, end stage bladder disease in 7, radiation cystitis in 3, exstrophy in 3, postoperative urethral obstruction in 3 and low bladder compliance in 3. A total of 50 patients underwent simple AC, 15 underwent AC with an abdominal stoma and 11 underwent continent supravesical diversion. Of the 71 evaluable patients 49 (69%) considered themselves cured, 14 (20%) considered themselves improved and 8 (11%) considered treatment to have failed. All 7 patients with interstitial cystitis had failed treatment. Mean bladder capacity increased from 166 to 572 ml and mean maximum detrusor pressure decreased from 53 to 14 cm H2O. Serum creatinine improved or remained normal in all patients. Five patients experienced persistent diarrhea requiring intermittent antispasmodics but none had vitamin B12 deficiency, pernicious anemia or malabsorption syndrome. Long-term complications were stomal stenosis or incontinence in 11 of 26 patients (42%) with stomas, de novo bladder and renal stones in 2 of 71 (3%) and 1 of 71 (1%), respectively, and recurrent bladder stones in 6%. Small bowel obstruction occurred in 5 of 71 patients (7%), requiring surgical exploration in 4 (6%). CONCLUSIONS: AC and urinary diversion provide a safe and effective long-term therapy in patients with refractory neurogenic bladder but stomal problems in patients with continent diversion continue to be a source of complications.

Adult↗
PubMed2004

Development and validation of a new treatment outcome score for men with LUTS.

AIMS: To develop, validate, and test elements of a new outcome score for men with lower urinary tract symptoms (LUTS). METHODS: Elements of well-established questions from the International Prostate Symptom Score (IPSS) assessment were combined with both established noninvasive objective determinants of voiding function including maximum uroflow (Qmax), postvoid residual urine volume (PVR), total number voids, maximum voided volume (MVV) as well as a subjective patient assessment parameter, to create a new LUTS treatment outcome instrument which we have termed the "LUTS outcome score" (LOS). The LOS is comprised of eight items; each assigned a score of 0, 1, or 2. Thus, the score ranges from 0 (best) to 16 (worst). Patients were divided into surgical/non- surgical (pharmacologic or behavior modification) treatment groups. Content validity and cutoff values for cure/improve/fail were established by an expert panel. Criterion validity was established by comparison to the IPSS. Internal reliability analysis was performed to obtain information about the relationships between individual items in the scale. Individual LOS items were correlated with the subjective outcome score. We also calculated the correlations between the LOS, IPSS, subjective post-treatment response, and age. Internal consistency, based on the average inter-item correlation was calculated using Cronbach's alpha statistic. Associations between continuous variables were examined by calculating the Pearson correlation coefficient, and between ordinal variables, using Spearman's rho. Test-retest analysis was recorded to determine reproducibility of the patient subjective outcome score. Seventy-seven men who underwent treatment for LUTS for at least 6 months participated in the study. All completed a detailed pretreatment and post-treatment clinical evaluation consisting of history/physical, questionnaire, voiding diary, urinalysis, Q, PVR, and videourodynamic study. Subjective responses of cured/improved/failed status following treatment were assessed by independent investigators. RESULTS: A high level of internal consistency was observed among the LOS symptom questions, Cronbach's alpha = 0.81 for the total cohort. The LOS correlated directly and significantly with the patient's subjective post-treatment response (r = 0.75, P < 0.001), age (r = 0.27, P = 0.02), and with the total IPSS (r = 0.62, P < 0.001). The IPSS also correlated directly and significantly with the patient's subjective post-treatment response (r = 0.48, P < 0.001) but did not correlate with the patient's age (r = 0.10, P = 0.41). When the subjective parameter for post-treatment response was subtracted from the LOS, the resulting correlation (r = 0.52, P < 0.001) approximated that obtained using the IPSS. CONCLUSIONS: The LOS is valid and internally consistent. Unlike the IPSS, it combines subjective, semisubjective, and objective parameters. Because of the objective components, it diminishes the possibility of overestimating cure and underestimating improvement relying only on patient's symptoms. Further, we believe it will prove to be useful for post hoc analysis in patients who have not had pre-treatment assessment.

Aged↗
PubMed2004

Pad test by mail for home evaluation of urinary incontinence.

AIMS: To present a simple, cost-effective, and convenient method of home pad test using the mail system and evaluating change in pad weight over time. MATERIALS AND METHODS: A series of nine kinds of commonly available commercial brands of urinary incontinence pads ranging from thin liners less than 10 g in dry weight to large diapers weighing over 100 g each were assembled. Two or three of each variety were individually weighed on an OHAUS LS2000 Portable Standard scale accurate to +/- 1 g. The pads were then wet uniformly with 20 cc of saline, placed individually in sealable plastic bags, sealed, and reweighed. Random groups of three pads were mailed by standard 1st class mail to the Urocenter of New York. The sealed pads were reweighed at 8 and 14 days from the original wetting. Concurrently, ten incontinence pads soiled with urine were similarly examined to confirm that there would be no detectable difference between urine and saline for the purpose of the study. In the second part of the study, 20 pads of the same type (13 inch-long pads with absorbent gel) were divided into 4 groups of 5 pads; each group was uniformly wet with 5, 10, 20, or 50 g of saline. These pads were mailed and reweighed at 7 and 14 days from the initial wetting. RESULTS: Twenty-four pads were used in the first part of the study. The dry weights of 22/24 (92%) of the pads were within 2 g of the average weight for their brand. At the first reweighing, 22 pads (92%) weighed within 2 g of their initial wet weights (Fig. 1). Only two pads on day 8 differed substantially from their initial weights: one pad appeared to have lost 4 g and another one 9 g. On day 14, 23/24 pads remained within 1 g of their day 8 weight and 1 differed by 2 g, and the total weight of the 24 pads on day 14 was only 4 g different from their initial weight (P = 0.71, Fig. 1). The soiled pads exhibited weight changes that were indistinguishable from the saline pads. The average cost of mailing the pads by 1st class mail was $4 and the average length of time in the mail was 5 days +/- 1 day. In the second part of the study, 18/20 pads had lost less than 1 g at 1 week, and at 2 weeks, 19/20 had lost less than 2 g when compared to their initial weights (Fig. 2). One pad had lost 3 g. Pads in the low volume groups (5 and 10 g) lost an average of 1.4 and 1.2 g, respectively, while pads in the high volume groups (20, 50 g) lost an average of 1.8 and 2 g at 2 weeks. CONCLUSIONS: Dry pads of any single brand have a relatively standard weight that varies insignificantly between pads. Up to 2 weeks of delay in the weighing of individually sealed pads does not significantly affect the clinical measurement of weight at a variety of low (5 g) or high (50 g) volumes of simulated incontinence. Home pad test using the mail system is a feasible, inexpensive, and clinically accurate method of evaluating incontinence. Patients can be instructed in techniques for home pad test, allowing for greater compliance, and convenience for both physicians and patients.

Humans↗
PubMed2004

Tort reform.

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Liability, Legal↗
PubMed2004

Cybermedics.

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Cybernetics↗
PubMed2004

Ghost unwriting.

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Authorship↗
PubMed2004

Peer review.

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Peer Review↗
PubMed2004

Urethral reconstruction after erosion of slings in women.

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent peer review literature and provide expert opinion about the diagnosis and treatment of sling erosions. RECENT FINDINGS: The incidence of sling erosion depends partly on the composition of the sling. Synthetic slings, particularly those made of woven polyester and other tightly woven material erode 15 times more often than autologous, allograft and zenograft slings. The presenting symptoms for all types of sling erosions include urinary retention, urge and mixed incontinence, but synthetic sling erosions often present with additional symptoms, including vaginal discharge, vaginal pain/pressure, suprapubic pain, and recurrent urinary tract infection. The diagnosis is made by cystoscopy. For synthetic sling erosions, it is generally agreed that the entire sling and as much foreign material (bone anchors, screws and sutures) as possible should be removed and the urethra repaired. For non-synthetic sling erosions, incision or partial excision of the sling and urethral closure suffices. The success rate for urethral repair ranges from 89 to 100%, but unless an anti-incontinence procedure is performed concomitantly, the likelihood of postoperative incontinence ranges from 44 to 83%. When synchronous anti-incontinence surgery was performed the anatomical success rate was 96% and the continence rate 87%. SUMMARY: Erosions of urinary slings are rare, but synthetic slings erode 15 times more often than non-synthetic slings. The anatomical success rate is very high after a single operation, but unless a concomitant anti-incontinence operation is performed, the likelihood of postoperative sphincteric incontinence is very high.

Female↗
PubMed2004

Periurethral masses: etiology and diagnosis in a large series of women.

OBJECTIVE: To describe the differential diagnosis of periurethral masses in a consecutive series extracted from a single tertiary urogynecologic practice database. METHODS: A patient database of a private urology and urogynecology practice with 1,950 women was searched for patients who were found to have a periurethral mass during the accrual dates of 1994 to 2002, and these records were reviewed for diagnostic testing and results. All women provided a history, completed a questionnaire, and underwent physical examination, voiding diary, cystoscopy, and videourodynamic testing; selected patients then underwent additional imaging. RESULTS: Seventy-nine (4%) patients aged 41.2 +/- 14 years were identified. Of these, 72 (91%) had been referred for evaluation of persistent irritative lower urinary tract symptoms or incontinence. Seven patients (9%) had been referred specifically because of a periurethral mass. Sixty-six patients (84%; 95% confidence interval [CI] 73%, 91%) had urethral diverticula, of which 4 (6%; 95% CI 2%, 14.8%) contained malignancies. Six patients (7%; 95% CI 3%, 15%) had vaginal cysts histologically identified as fibromuscular tissue, 4 (5%; 95% CI 1%, 12%) had leiomyomata, and 2 (2.5%; 95% CI 0.03%, 8.8%) had ectopic ureteroceles. Two patients had vaginal squamous cell carcinomas (2.5%; 95% CI 0.03%, 8.8%), and 1 had an infected granuloma. Masses were palpable in 42 patients (53.8%; 95% CI 42%, 64%) and in 37 patients either were encountered at surgery (n = 5) or were urethral diverticula diagnosed by voiding cystourethrogram (n = 32). CONCLUSION: Periurethral masses were encountered in less than 4% of our patient sample. Most masses were urethral diverticula; however, the differential diagnosis included leiomyoma, vaginal cysts, and malignancy. Masses were generally either palpable or seen at imaging studies performed during evaluation of lower urinary tract symptoms.

Adolescent↗
PubMed2004

Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck.

PURPOSE: We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). MATERIALS AND METHODS: A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. RESULTS: Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six patients considered themselves cured of lower urinary tract symptoms and 1 was improved. In 1 patient the obstruction site was not clear. One patient had mild stress incontinence under rare circumstances not severe enough to require protective pads. The average change in flow was 6 +/- 10 vs 30 +/- 17 ml per second (p <0.03). The average change in voided volume was 194 +/- 170 vs 416 +/- 206 ml per second (p <0.06). Average change in post-void residual urine was 680 +/- 445 vs 173 +/- 366 ml (p <0.05). CONCLUSIONS: PBNO is an exceedingly rare condition, which is easily treatable when properly diagnosed by VUDS. The presentation of patients in urinary retention in middle age suggests that PBNO may be more common in less apparent forms than has previously been recognized.

Adult↗