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K F Parsons

Publications and source records attributed to K F Parsons.

At least 37 records · Page 2Linked to original sources
PubMed1996

The role of an advanced thermotherapy device in prostatic voiding dysfunction.

OBJECTIVES: To investigate the efficacy of an advanced transurethral thermotherapy (TUMT) device (T3, Urologix) using urodynamic analysis in addition to the standard evaluation protocol in patients with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Fifty men with symptomatic BPH were assessed using the AUA symptom score, uroflowmetry and ultrasonography (to determine prostatic volume and residual urinary volume) before and 6 weeks, 3, 6 and 12 months after thermotherapy. TUMT was delivered using a focused microwave energy system for 1 h in each patient, treated on an out-patient basis. Video pressure flow studies with advanced urodynamic analysis were also performed before and 3 months after treatment. RESULTS: The mean AUA symptom score decreased by 63%, the mean peak flow rate increased by 64% and the post-void residual volume decreased by 30% 3 months after treatment; this improvement was maintained at one year after treatment. Advanced urodynamic analysis showed that 52% of the patients had a decreased severity of obstruction. Furthermore, the efficiency of detrusor contraction improved in 86% of the patients. The improvement in the symptom score, flow rate and residual urine was significantly better in patients with marginal obstruction than in patients with unequivocal obstruction. CONCLUSION: Urodynamic analysis can predict the treatment outcome of TUMT and the results of thermotherapy are significantly better in patients with marginal prostatic bladder outflow obstruction.

Aged↗
PubMed1996

Quantification of voiding dysfunction in patients awaiting transurethral prostatectomy.

PURPOSE: We investigated the role of advanced urodynamic analysis in the diagnostic evaluation for transurethral resection of the prostate. MATERIALS AND METHODS: A total of 62 consecutive patients awaiting transurethral resection of the prostate with the American Urological Association symptom score of more than 12, peak flow rate less than 13 ml. per second and significant residual urine underwent routine video pressureflow studies with advanced urodynamic analysis to quantify outflow function. Postoperative outcome was assessed at 3 months by symptom scores, uroflowmetry and ultrasonography (residual urine). RESULTS: The parameters used in the diagnostic evaluation for transurethral resection of the prostate did not correlate with urodynamic diagnosis of unequivocal obstruction. Weak detrusor contractility (without significant obstruction) accounted for voiding dysfunction in 50% of the patients. The results of transurethral resection of the prostate were significantly better in patients with unequivocal compared to equivocal obstruction. Furthermore, patients with unequivocal obstruction but weak detrusor contractility had a significantly poorer treatment outcome. CONCLUSIONS: Advanced urodynamic analysis in the diagnostic evaluation of patients with symptomatic benign prostatic hyperplasia can predict treatment outcome and, therefore, allows the urologist to choose the most appropriate therapeutic option for individuals.

Aged↗
PubMed1995

Vesical urothelium proliferation in spinal cord injured persons: an immunohistochemical study of PCNA and MIB.1 labelling.

Urinary tract infection occurs more commonly, is more virulent and proves more difficult to eradicate in spinal cord injury persons than in the neurologically intact. In order to find out the peculiarities of the neuropathic bladder which make it vulnerable to recurrent cystitis, we studied the proliferation status of the urothelium in spinal cord injured persons. Eleven consecutive, unselected male spinal cord injury patients (aged 18-73 years) were included in the study. Those with, or undergoing treatment for acute urinary tract infection were excluded. All patients underwent cystoscopy and cold cup bladder biopsy from the trigone and bladder dome. Immunocytochemical analysis was performed using defined, commercially available antibodies for PCNA (PCNA 10, DAKO) and MIB-1 (raised against recombinant DNA defined segment of Ki-67 antigen DAKO) streptavidin/biotin and alkaline phosphatase immunocytochemistry (for MIB-1 with microwave-enhanced antigen retrieval) were used to demonstrate the presence of cell cycling-associated nuclear proteins. Foci of lymphocytic aggregations present in the sections served as in-section controls for antigen preservation. Ten patients showed labelling of 20-70% of cells for PCNA in basal cell layers of dome lining. Higher urothelial layers showed a variable, but generally reduced degree of labelling. Of these 10 patients, three showed complete absence of MIB-1 activity in the basal and other layers of dome urothelium and two demonstrated only a very occasional positive nucleus. MIB-1 labelling was < 5% in four others and it was between 5% and 10% in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Comparative pathology of dome and trigone of urinary bladder mucosa in paraplegics and tetraplegics.

Paraplegic/tetraplegic individuals are prone to develop chronic urinary tract infection, urinary calculi and bladder outlet obstruction, and have a 16 to 28 times higher risk for squamous cell bladder cancer. The preferable method of monitoring those patients who are at high risk of developing vesical neoplasia has been an annual check-up inclusive of cystoscopy and cold cup bladder biopsy of all suspicious areas as well as predetermined random sites. It may be desirable to take a biopsy from one site (when there is no suspicious lesion) with a flexible cystoscope while the patient is sitting in the wheelchair itself in the outpatient clinic instead of multiple biopsies from the done, trigone and both lateral walls of the urinary bladder taken in the operation theatre set-up using a rigid cystoscope with the patient positioned in lithotomy. Before adopting such a cost-saving and more convenient procedure routinely, we evaluated whether any significant additional histopathological findings are obtained by taking bladder biopsies from the dome and the trigone of the urinary bladder instead of just one, be it dome or trigone in the absence of any visible urothelial lesion in the bladder. In forty consecutive tetraplegic/paraplegic patients who did not have any cystoscopically distinguishable urothelial neoplastic lesion such as papilloma, cold cup biopsies of the dome and the trigone were taken randomly before carrying out any diagnostic or therapeutic procedure, eg electrohydraulic lithotripsy of vesical calculi. All the biopsy specimens were evaluated by a pathologist who was unaware of the clinical details and not involved with the primary diagnosis. In 15 cases, significant additional histopathological finding(s) were recorded in the trigone biopsy which were not seen in the dome biopsy (follicular cystitis: n = 4; squamous metaplasia: n = 4; extensive squamous metaplasia with focal atypia: n = 1; limited focal atypia: n = 1; extensive glandular metaplasia: n = 1; intestinal metaplasia and possibly follicular cystitis: n = 1; and follicular cystitis and intestinal metaplasia: n = 1; mild atypia: n = 1; extensive calcification of epithelial denudation: n = 1). Histopathology of dome biopsies revealed significant additional histopathological finding(s) in nine cases (follicular cystitis: n = 2; squamous metaplasia: n = 2; intestinal metaplasia: n = 1; squamous metaplasia and adenomatoid metaplasia and mild atypia: n = 1; features of interstitial cystitis: n = 1; mild dysplasia: n = 1; mild crypt hyperplasia of urothelium with mild atypia: n = 1). Thus in twenty cases (50%), significant additional findings were obtained by taking cold cup random biopsy of the dome as well as the trigone in the absence of any visible morphological changes. Although single site biopsy may be less traumatic, more convenient to the patient as well as to the staff, and cost saving, in the spinal cord injury patients with neuropathic bladder, it may not be diagnostically adequate even in those patients who do not have any cystoscopically distinguishable lesion in the urinary bladder.

Adult↗
PubMed1990

Urodynamic evaluation of lower urinary tract function in relation to total hysterectomy.

Although many women relate the onset of urinary symptoms to the operation of simple hysterectomy, many also have symptoms prior to surgery. Prospective study is therefore the most valid method of objective analysis of the effects of this operation upon micturition. To determine whether total hysterectomy is associated with increased postoperative vesicourethral abnormality, the incidences of urinary symptoms and urodynamic abnormality were assessed pre and postoperatively in 36 women undergoing hysterectomy. Preoperative symptoms were present in 58.3%, although urodynamically proven dysfunction was found in only 38.9%. After hysterectomy, 75% of women were symptomatic with a further 30.6% developing a urodynamic abnormality. The operation of total (simple) hysterectomy is associated with a significant increase in the subjective and objective incidence of vesicourethral dysfunction.

Adult↗
PubMed1990

Bladder dysfunction after simple hysterectomy: urodynamic and neurological evaluation.

Many women presenting with symptoms of bladder dysfunction relate their onset to the operation of simple hysterectomy. This study reviews the urodynamic findings in 126 women who had a simple hysterectomy, of whom 25 also had sacral reflex latencies measured. The results show that 47.0% had detrusor instability, 36.7% had urethral obstruction, and 24.8% stress incontinence. These findings are statistically significant when compared to controls. 80% of the women who underwent measurement of sacral reflex latencies had evidence of nerve conduction abnormality.

Female↗
PubMed1990

Urodynamic evaluation prior to total hysterectomy: indications and incidence of abnormality.

Although it is recognized that total hysterectomy may be associated with subsequent urinary symptoms, many women are symptomatic prior to operation. However, only objective rather than subjective analysis can provide an accurate assessment of the preoperative state of the lower urinary tract. This study determined the incidence of preoperative, urodynamically-proven, vesicourethral dysfunction in women undergoing total hysterectomy. The incidence of urinary symptoms in 30 women awaiting hysterectomy was assessed and compared with the urodynamic findings. Sixteen (53%) of these patients had preoperative urinary symptoms, although bladder dysfunction was present in only 8 (27%). The presence of marked urinary symptoms in women awaiting hysterectomy warrants preoperative urodynamic investigation to identify any underlying bladder dysfunction.

Adult↗
PubMed1989

The effects of simple hysterectomy on vesicourethral function.

Many women who present with symptoms of bladder dysfunction relate the onset to the operation of simple hysterectomy. A group of 42 women undergoing simple hysterectomy was studied prospectively. Urinary symptoms, urodynamic findings and sacral reflex latencies (SRLs) were assessed pre- and post-operatively. After hysterectomy the incidence of urinary symptoms increased from 58.3 to 75.0%. Vesicourethral dysfunction was altered in 30.6% of patients, 72.7% of whom had evidence of pelvic neuropathy as detected by SRLs. The results show that simple hysterectomy is associated with a significant incidence of post-operative vesicourethral dysfunction and that there is an identifiable neurological abnormality incurred at operation which is pertinent to the subsequent disordered voiding.

Adult↗
PubMed1988

Chronic urinary retention--a sensory problem?

Factors which predispose some men with benign prostatic hyperplasia to chronic urinary retention whilst others develop acute retention are not understood. In order to assess whether there is an occult neuropathy associated with chronic retention, neurophysiological measurements were used to test the integrity of the lower urinary tract nerve supply. A series of 22 male patients with chronic urinary retention secondary to prostatic hyperplasia underwent sacral reflex latency measurement; 73% demonstrated a sensory suprasacral abnormality with intact spinal reflex arcs. These results suggest that although the sacral reflex pathways are intact, there is a sensory/proprioceptive abnormality in the higher neurological centres which may be an adaptive mechanism to the presence of bladder outflow obstruction.

Adult↗
PubMed1988

The use of sacral reflex latencies in detrusor bladder neck dyssynergia.

Detrusor bladder neck dyssynergia (DBND) is a well recognised cause of bladder outflow obstruction, especially in the younger man. The cause is unknown, and the aim of this study was to determine if any neurological dysfunction is associated with this condition. Twenty-five males with proven DBND had sacral reflex latency studies performed. The conduction latencies indicate that the underlying cause is unrelated to any demonstrable neuropathy. Sacral reflex latencies are not helpful in the investigation of DBND.

Adult↗
PubMed1988

Bulbocavernosus reflex latency in the investigation of diabetic impotence.

Impotence in males is a well recognised complication of diabetes mellitus, commonly held to be due to an autonomic neuropathy. The aim of this study was to determine the incidence of periphero-conus neuropathy in diabetic impotence. Nineteen diabetic males seeking treatment for loss of potency had bulbocavernosus reflex latency (BCRL) and sacral reflex latencies (SRLs) performed. The conduction studies indicated that impotence in these cases was associated with peripheral neuropathy in 21% of patients and that BCRL and SRLs are sensitive and useful diagnostic tests.

Adult↗
PubMed1986

Urinary retention in men after total hip arthroplasty.

A prospective study of sixty-four men was conducted before they underwent a total hip arthroplasty to try to identify the factors that are predictive of postoperative urinary retention. Although neither the urological history nor the physical examination provided information that was helpful in accurately identifying the patients who were at risk, those whose peak urinary flow rate was less than seventeen milliliters per second did have a statistically significant likelihood of the development of urinary retention. A system of management that we hope will reduce the incidence of this complication is proposed.

Adult↗
PubMed1985

The management of upper urinary tract calculi in spinal cord damaged patients.

The management of upper urinary tract calculi in 49 patients in the Mersey Regional Spinal Injuries Centre was reviewed retrospectively. Morbidity in nine patients was increased by either delay in operative intervention (5 cases) or inadequate follow up evaluation (4 cases). Earlier active treatment using modern endourological techniques and lithotripter technology is encouraged. A clinical algorithm incorporating these new techniques is shown.

Female↗