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Biomedical subjects

K J Kreder

Publications and source records attributed to K J Kreder.

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

Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence.

OBJECTIVES: Our purpose was (1) to evaluate the efficacy on an intent-to-treat basis of a 3-month course of pelvic floor muscle exercises as first-line therapy for urinary incontinence in consecutive women seen in a tertiary care center with stress, urge, and mixed urinary incontinence and (2) to evaluate whether a specially designed audiotape improves compliance and efficacy of the exercises. STUDY DESIGN: A prospective randomized trial wa conducted with 71 women seen for treatment of urinary incontinence in two tertiary care center referral clinics (in the departments of gynecology and urology). The primary outcome measure was the number of incontinent episodes, as documented with a 3-day voiding diary. Statistical analysis included t tests and Wilcoxon signed-ranks test, as appropriate. A value of p < or = 0.05 was considered significant. RESULTS: Forty-four percent of all enrollees had a > or = 50% improvement in the number of incontinent episodes per day. This increased to 56% of enrolles who completed the treatment course. For all enrollees the mean number of incontinent episodes per day decreased from 2.6 to 1.7 for genuine stress incontinence, from 3.5 to 2.3 for detrusor instability, and from 3.9 to 3.2 for mixed incontinence. For enrollees who completed the 3-month course the mean number of incontinent episodes per day decreased from 2.5 to 1.4 for genuine stress incontinence, from 2.8 to 0.5 for detrusor instability, and from 3.0 to 1.7 for mixed incontinence. Six months after completing the course of exercises approximately one third of all enrollees reported that they continued to note good or excellent improvement and desired no further treatment. There was no difference in outcome measures and no difference in compliance between the women who exercised with the aid of the audiotape and those who exercised according to our usual office routine (p > 0.05). CONCLUSIONS: One third of all participants remained improved to the patient's satisfaction 6 months after completion of a risk-free, inexpensive, simply provided therapy. Our audiotape did not improve our success rate or decrease the dropout rate. In this study the exercises were equally effective for all three urodynamic diagnoses. Inexpensive methods that could be used by primary care providers to improve the success rate of this therapy merits further attention.

Adult↗
PubMed1996

A change in practice: current urologic practice in response to reports concerning vasectomy and prostate cancer.

OBJECTIVE: To examine the practice patterns of urologists performing vasectomy in response to studies reporting an increased risk of prostate cancer in vasectomized men. DESIGN: A mailed survey. SETTING: A university medical institution. PARTICIPANTS: One thousand five hundred randomly selected United States urologists under the age of 65 years. MAIN OUTCOME MEASURE: Urologists reported practice patterns of vasectomy in response to studies showing possible link between vasectomy and prostate cancer. RESULTS: A response rate of 51% (759/1,500) was obtained. Although > 90% state that these studies have had little or no effect upon their practice of vasectomy, 27% screen vasectomized men earlier for prostate cancer, and 20% would be reluctant to recommend a vasectomy to a man with a strong family history of prostate cancer. CONCLUSIONS: Over one fourth of urologists who screen for prostate cancer have altered their screening patterns even though they responded that the studies have not affected their practice patterns.

Health Knowledge, Attitudes, Practice↗
PubMed1996

Laparoscopic urethral sling for treatment of intrinsic sphincter deficiency.

The surgical treatment of intrinsic sphincter deficiency, or Type III genuine stress urinary incontinence, has traditionally been accomplished by sling cystourethropexy, the placement of an artificial urinary sphincter, or periurethral injection. We developed a laparoscopic approach for the performance of a sling cystourethropexy as an alternative to the open approach and herein describe our experience. We have found that a laparoscopic sling cystourethropexy is feasible, but at the present time, we have been unable to demonstrate any significant advantages to the patient in terms of decreased cost or convalescence compared with the open vaginal sling cystourethropexy.

Female↗
PubMed1996

Treatment of stress urinary incontinence in women with urethral hypermobility and intrinsic sphincter deficiency.

PURPOSE: We compared 2 treatment modalities (sling cystourethropexy and periurethral collagen injection) in patients with intrinsic sphincter deficiency alone or with urethral hypermobility (combined stress urinary incontinence). MATERIALS AND METHODS: We retrospectively reviewed a series of 50 consecutive patients treated surgically for intrinsic sphincter deficiency during a 2-year period. All patients were evaluated by history and physical examination to assess urethral hypermobility and urodynamic testing. Intrinsic sphincter deficiency was assessed by abdominal leak point pressure and video urodynamics. Of the 50 patients 28 underwent a pubovaginal sling operation and 22 received a periurethral injection of collagen. RESULTS: Of the patients studied 40% had combined stress urinary incontinence. A pubovaginal sling procedure resulted in a cure rate of 81% in this group, compared to 25% for periurethral injection of collagen. CONCLUSIONS: A subgroup of women exists with combined stress urinary incontinence due to urethral hypermobility and intrinsic sphincter deficiency. When treated with sling cystourethropexy women with combined stress urinary incontinence do as well or better than those with intrinsic sphincter deficiency alone and those treated with periurethral collagen injection do worse.

Adult↗
PubMed1995

Survival of patients with localized prostate cancer treated with percutaneous transperineal placement of radioactive gold seeds: stages A2, B, and C.

Between 1984 and 1991, a total of 177 patients with adenocarcinoma of the prostate were treated with transcutaneous, transperineal radioactive gold seeds. Of these 177 patients, 20 were determined to have pelvic lymph node involvement and were excluded from this review. The remaining 157 patients received a median radioactivity dose of 164 mCi with a median follow-up of 48 months. Cancer-specific survival at 5 years was 100% for stage A2 and B1, 90% for stage B2, and 76% for stage C cancer. Covariates of grade, total radioactivity administered, age of the patient, and number of seeds implanted did not influence disease-free survival in a statistically significant manner. Significant complications were observed in two patients. The survival rates of patients treated with 198Au seed implantation for localized cancer are equivalent or better when compared to historical data of patients treated with 125I implantation, external beam radiotherapy, combination radioactive gold seed implantation and external irradiation, and radical prostatectomy. In addition, these comparable survival rates using interstitial 198Au seeds may be achieved with less morbidity.

Actuarial Analysis↗
PubMed1995

Laparoscopic partial nephrectomy: initial experience and comparison to the open surgical approach.

During an 18-month period, 6 laparoscopic partial nephrectomies were attempted, 4 of which were successful. The surgical technique was modified and improved between cases aided by new laparoscopic instrumentation, such as the argon beam coagulator and the 7.5 MHz. ultrasonic sector scanning system. In a retrospective comparison between laparoscopic and open partial nephrectomy, estimated blood loss was 525 ml. for the former versus 708 ml. for the latter procedure. However, operating time was more than 2 hours longer with the laparoscopic approach. The major advantages of the laparoscopic procedure appear to be a more rapid return to full diet, less postoperative pain and less requirement for parenteral narcotics. Despite the small size of this series and limited followup data, convalescence may be shortened by 4 weeks after laparoscopic partial nephrectomy. Patients with benign diseases of the kidney, especially with a duplicated collecting system, who require partial nephrectomy may be considered candidates for the laparoscopic approach. The advantages to the patient, however, may be offset by the technical demands on the surgeon.

Adult↗
PubMed1995

Urethral reconstruction after pelvic fracture with urethral disruption: the gold standard.

Traumatic injuries with disruption of the posterior urethra frequently occur in patients who sustain pelvic fracture. Several endoscopic and open reconstructive techniques have been proposed for management of such urethral injuries. Treatment objectives include restoration of physiological urethral voiding with preservation of urinary continence and sexual function. This article summarizes the current recommendations for evaluation and treatment of patients with traumatic posterior urethral injuries. The various reconstructive techniques are reviewed and selection criteria and clinical outcomes are evaluated.

Fractures, Bone↗
PubMed1994

Testicular cancer in blacks. A multicenter experience.

BACKGROUND: The rarity of testis tumor in black patients has made the study of a large series difficult. Much of the epidemiologic and clinical information regarding this neoplasm in this population is in dispute, including data on incidence, prognosis, histologic distribution, age and stage at presentation, and side distribution. METHODS: A retrospective review of 66 blacks with testicular tumors from seven military medical centers was performed. RESULTS: Similar results were found for blacks with testis tumor to those of the general testis cancer population regarding prognosis, side distribution, and age of onset for nonseminoma and interstitial tumors. There is a slight increase in the expected number of interstitial tumors in blacks, but the distribution between seminoma and nonseminoma is similar to the general population. The mean age of presentation for seminoma in blacks was younger than that of the general testis cancer population. For testis tumor treated at the same institution, there was an increased delay of diagnosis in blacks compared with whites. The number of new cases of testicular cancer between 1979 and 1991 at one major center was increased for whites but not for blacks. The availability of cisplatin-based combination chemotherapy has resulted in an improved prognosis for blacks, as has already been demonstrated for white populations. CONCLUSIONS: Testis tumor in blacks behaves similarly to testis tumor in the general population except that in blacks there are more interstitial tumors and the mean age of presentation for seminoma is younger. Further, there is an increased delay in diagnosis for blacks compared with whites, but the incidence of this tumor in this population does not appear to be increasing. Cisplatin-based chemotherapy has significantly improved survival in this population.

Adult↗
PubMed1994

Compartment syndrome: an unusual complication of the lithotomy position.

The compartment syndrome is a rare complication of surgery in the lithotomy position, but one that may result in neurovascular damage and permanent disability. Herein, we present a case of bilateral three-compartment syndrome following urethroplasty in the dorsolithotomy position, with review of the literature and discussion of the causes and possible means to prevent this complication.

Adult↗
PubMed1994

Laparoscopic approaches to the treatment of intrinsic urethral weakness (type III stress urinary incontinence).

The treatment of intrinsic urethral weakness (Type III stress urinary incontinence) has traditionally been accomplished by the performance of a sling cystourethropexy or the placement of an artificial urinary sphincter. As experience with operative laparoscopy continues to increase, the possibility of performing these procedures from a laparoscopic approach becomes realistic. We report our experience with the laparoscopic performance of a sling cystourethropexy and placement of an artificial urinary sphincter in the canine model. On the basis of initial results, we believe these techniques are feasible in human subjects.

Animals↗
PubMed1993

Direct vision internal urethrotomy using topical anesthesia.

A consecutive series of 18 patients underwent attempted direct vision internal urethrotomy (DVIU) under topical lidocaine anesthesia. The procedure was completed successfully in 15 of 18 (83%) patients. In these patients 12 of 15 (80%) reported either minimal or no discomfort. Direct vision internal urethrotomy using topical lidocaine anesthesia is a safe and cost effective procedure.

Adult↗
PubMed1993

Randomized clinical trial comparing balloon dilatation to transurethral resection of prostate for benign prostatic hyperplasia.

To evaluate the effectiveness and clinical outcome of patients treated by balloon dilatation of the prostate (BDP) compared with transurethral resection of the prostate (TURP) we performed a prospective, randomized clinical trial. Fifty-one men were randomized to either BDP or TURP. Both groups demonstrated a significant decrease in symptom score from preoperative levels (TURP 13.6 to 6.0 [p < 0.05]; BDP 14.1 to 8.1 [p < 0.01] at 1 year). The TURP group improved peak urinary flows; while, after initial improvement, the balloon group returned to pre-procedure levels. At twelve months 14 of 19 BDP patients (74%) and 14 of 18 TURP patients (78%) considered themselves improved. BDP results in symptomatic improvement; however, the effect may not persist. Objective improvement after BDP does not always occur. The morbidity of BDP is low and compares favourably to that of TURP. Thus BDP does not appear to be as effective as TURP and may offer only temporary relief of symptoms.

Aged↗
PubMed1993

Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies.

We describe the use of lidocaine as a topical anesthetic for 35 patients undergoing random bladder biopsies (bladder mappings) and cold-cup resection of small bladder lesions. Serum lidocaine levels were measured 7 to 10 minutes after instillation of the anesthetic using fluorescent polarization immunoassay. Adequate pain control was noted in 33 of 35 patients (94%), with negligible serum lidocaine levels noted in all 35. One patient had a 2 cm. tumor on the anterior wall of the bladder making resection with topical anesthesia suboptimal and 1 patient required 1 mg. supplemental intravenous midazolam hydrochloride to complete the procedure. We conclude that topical lidocaine is a safe, inexpensive and effective mode of anesthesia for bladder mappings and cold-cup biopsies of small bladder lesions. However, it may be inadequate for lesions large enough to require resection rather than cold-cup biopsy and those at poorly accessible regions of the bladder.

Aged↗
PubMed1993

Ogilvie's syndrome: a potential complication of vaginal surgery.

Ogilvie's syndrome is a well described disorder of the gastrointestinal tract and is characterized by marked dilatation of the distal colon without mechanical obstruction. There are numerous proposed etiologies for this syndrome, which include an association with certain medical conditions, medications and major abdominal surgery. The occurrence of Ogilvie's syndrome, however, is not widely reported following vaginal operations. We present 3 cases in which procedures on the bladder neck performed through the vagina resulted in the development of postoperative Ogilvie's syndrome. Early diagnosis and treatment of this syndrome are important to avoid significant morbidity and mortality.

Aged↗