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Biomedical subjects

L W Bowen

Publications and source records attributed to L W Bowen.

14 recordsLinked to original sources
PubMed1990

The prognostic significance of augmentation of urethral closure pressure and functional length.

Sixty-one women with genuine stress incontinence undergoing preoperative and postoperative multichannel urodynamic investigation were tested with augmenting urethral closure pressure profiles during contraction of the pelvic floor muscles to assess voluntary control of the urethral "sphincter." Increases of 20% or more above resting functional length and closure pressure were selected as indicators of augmentation. The presence or absence of augmentation of functional urethral length and/or closure pressure during pelvic floor contraction allowed for the grouping of these patients into six subgroups which were compared for urinary symptoms, prior anti-incontinence procedures and the presence of low urethral pressure, detrusor instability and genuine stress incontinence both pre- and postoperatively. Evaluation of the patient's ability to augment functional length and closure pressure did not affect surgical success nor did its presence or absence correspond to the presence of a low pressure urethra, detrusor instability, or specific urinary symptoms. Evaluation of augmentation of functional length and closure pressure was therefore felt to be of no prognostic value during the performance of multichannel urodynamic testing in incontinent females.

Adult↗
PubMed1989

Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study.

A retrospective comparison was made of the urodynamic parameters of urethral sphincteric function of 21 women with failure of modified Burch retropubic urethropexy and 21 matched control subjects in whom operation was successful. The match criteria included multiple risk factors that contributed to the failure of antiincontinence surgery. The preoperative resting urethral closure pressure and urethral functional length were significantly lower in the study (failure) group than in the control (success) group. These parameters of intrinsic urethral function improved only in the control (success) group after operation. Further study showed that 17 of the 21 patients (81%) in the control (success) group had preoperative closure pressure greater than 20 cm H2O, whereas only five of the 21 patients (24%) in the study (failure) group had initial closure pressure higher than this value. Identification of a low-pressure urethra by preoperative urethral profilometry suggests a greatly increased risk for operative failure.

Adult↗
PubMed1989

Voiding dysfunction.

Voiding dysfunction in women results from either a failure of the bladder to contract appropriately or a failure of the urethra or bladder neck to relax during attempts at micturition. Complaints of urinary frequency and urgency most often accompany voiding dysfunction. Associated symptoms, which are not always present, include postvoid fullness, poor flow, hesitancy, and complete urinary retention. Obstructive uroflowmetry and elevated residual urine are suggestive screening tests; however, complete multichannel urodynamic evaluation is necessary to arrive at a specific diagnosis. Once a diagnosis has been made, therapy will be directed at either increasing vesical contractility or reducing bladder outlet obstruction. Acute urinary retention should be dealt with initially by bladder decompression via catheterization. Regardless of the cause of the voiding dysfunction, if further therapy is unsuccessful, clean intermittent self-catheterization may prove to be the best alternative. This can ensure maintenance of relatively low intravesical pressure and residual urine, thus reducing the risk of urinary infection.

Diagnosis, Differential↗
PubMed1989

Cryosurgery versus dilation and massage for the treatment of recurrent urethral syndrome.

One year after the initiation of a prospective, randomized, crossover trial comparing dilation and massage to urethral cryosurgery utilizing a specially designed urethral cryoprobe, our results show that cryosurgery was more effective in the treatment of recurrent urethral syndrome in women. Ninety-one percent of patients first treated with cryosurgery were successful in achieving relief from their symptoms whereas only 33% of the women initially treated with dilation and massage were successful (P = .005). In addition, cryosurgery was more successful in treating women when they crossed over after failing the other therapy (75% vs. 0%). In total, 21 of 24 patients (87.6%) were treated successfully with one of the two modalities. Nineteen of the 22 patients (86.4%) in this select group treated with cryosurgery during the trial were successful, whereas only 5 of 15 (33.3%) treated with dilation and massage were successful (P = .001).

Cryosurgery↗
PubMed1988

The effect of retropubic urethropexy on detrusor stability.

A group of 86 women with genuine stress incontinence who underwent retropubic urethropexy were evaluated with both pre- and postoperative urodynamics. Twenty of these 86 women (23.3%) also had unstable detrusors preoperatively. Eleven of these 20 women (55%) had stable detrusors after retropubic urethropexy. Five of the 66 patients (7.6%) who had stable detrusors preoperatively were found to have unstable detrusors on postoperative urethrocystometry. The overall cure rate for women with detrusor instability and genuine stress incontinence was only 30%. Analysis of symptoms, previous anti-incontinence procedures, age, parity, and cystometric parameters revealed no differences between those women who had stable detrusors after retropubic urethropexy and those who remained unstable. Similarly, patients whose bladders became unstable after retropubic urethropexy could not be distinguished from those who remained stable. Patients undergoing retropubic urethropexy should understand the possibility that the operation may cause urinary incontinence due to detrusor instability even if it cures their genuine stress incontinence, and that if they have both genuine stress incontinence and detrusor instability, their chances for an operative cure of both conditions are low.

Adult↗
PubMed1988

Hysterectomy and prior incontinence surgery as risk factors for failed retropubic cystourethropexy.

The effects of prior hysterectomy and incontinence surgery were evaluated retrospectively in 86 women undergoing modified Burch cystourethropexy. These women were evaluated before and three months after surgery with multichannel urodynamic testing. Forty percent of the 50 women with prior incontinence surgery remained incontinent after the cystourethropexy even though 94% of them had undergone anatomic correction. This result was not statistically different from the 28% failure rate in patients without prior incontinence surgery. Forty-two percent of the 62 women who had previously undergone hysterectomy failed cystourethropexy despite anatomic correction in 95%. This finding was significantly different from the 17% failure rate in women without prior hysterectomy (P less than .025). This retrospective analysis suggests that prior hysterectomy may place women at increased risk of continued incontinence following cystourethropexy despite anatomic correction of urethrovesical junction descent. Contrary to the results of other investigators, women with prior incontinence surgery in this study were not found to be at significantly greater risk of incontinence after cystourethropexy.

Female↗
PubMed1987

Cryotherapy for the treatment of proximal urethral condyloma acuminatum.

Between March and November 1985 we treated 89 female patients with condyloma acuminatum of the lower genital tract. All patients were evaluated with colposcopy, urethroscopy and anoscopy. Carbon dioxide laser vaporization was used to treat condylomata in the cervix, vagina, vulva, anus and distal urethra. Urethral involvement by condylomata was found in 31 patients (35 per cent). Eight patients had biopsy proved proximal urethral condylomata (9 per cent). Cryotherapy was used to treat these lesions. Six patients required only 1 treatment, while 2 required 2 treatments to cure the proximal urethral condylomata.

Adult↗
PubMed1987

The low pressure urethra as a factor in failed retropubic urethropexy.

Eighty-six patients with preoperative and postoperative urodynamic studies who underwent modified Burch colposuspensions were divided into two groups, one with a urethral closure pressure of 20 cm H2O or lower, and one with a pressure over 20 cm H2O. The two groups were comparable except for a difference in age (53.3 versus 46.6 years; P less than .01). There were significant differences between the two groups in both preoperative and postoperative functional lengths and closure pressures (P less than .01). The low-urethral-pressure group had a 54% failure rate, compared with 18% in the group with urethral closure pressures above 20 cm H2O (P less than .0005). Low urethral pressure was found to be a significant independent risk factor for patients under the age of 50, but not independent of age in women over 50 years old. Patients under the age of 50 who have urethral closure pressures of 20 cm H2O or lower are at high risk of surgical failure when undergoing a modified Burch colposuspension (P less than .0002). These patients should not be considered appropriate candidates for this procedure.

Adult↗
PubMed1986

Uninhibited urethral relaxation: an unusual cause of incontinence.

Uninhibited urethral relaxation appears to be a clinically distinct cause of urinary incontinence. It was found in 11 of 534 incontinent women who had multichannel urodynamic evaluation, and in 2 of these it was the sole cause of incontinence. This diagnosis should only be made after careful scrutiny has ruled out a low pressure detrusor contraction, cough, valsalva, or heel bounce as the cause of the urethral relaxation. Because the majority of patients had a voiding mechanism that included a detrusor contraction, it is unlikely that uninhibited urethral relaxation represents a variant of detrusor instability in patients unable to generate a detrusor contraction. It most likely reflects an exaggeration of urethral instability due to relaxation of the smooth and/or striated urethral musculature.

Humans↗
PubMed1986

Evaluation of male consorts of women with genital human papilloma virus infection.

Ninety male partners of women with genital condylomata were evaluated for evidence of condylomata by visual examination of the genitalia with the colposcope, urethroscopy, and biopsy. Fifty-three men (59%) were found initially to have condylomata and nine other cases were found on reevaluation for a total prevalence of 69%. Thorough evaluation with the use of acetic acid, magnification and liberal use of biopsy is stressed. Urethroscopy may not be a necessary part of the routine screening evaluation.

Adult↗
PubMed1986

Maternal-fetal pH difference and fetal scalp pH as predictors of neonatal outcome.

The purpose of this study was to determine if interpretation of fetal scalp pH values would be enhanced by concurrent measurement of maternal venous pH. The last fetal capillary pH obtained before delivery was compared with simultaneous maternal-fetal pH difference as predictors of neonatal outcome assessed by five-minute Apgar scores. Fetal scalp pH and maternal-fetal pH difference were significantly correlated with r = -0.72 (P less than .0001). The acidotic fetuses born to acidotic mothers had low maternal-fetal pH differences, and all were nondepressed at birth. A 33% reduction in false negatives was found using maternal-fetal pH difference instead of scalp pH alone. Errors in interpretation of fetal scalp pH can be reduced by the use of maternal-fetal pH difference.

Apgar Score↗
PubMed1985

Use of a large Foley catheter balloon to control postpartum hemorrhage resulting from a low placental implantation. A report of two cases.

In two cases postpartum hemorrhage resulted from placental implantation in the noncontractile cervical segment of the uterus. The hemorrhage was controlled successfully by inflating a large Foley catheter balloon with 60 ml of saline inside the cervical canal. The tamponade was the only therapy necessary. In some cases this technique may be useful in slowing the bleeding while stabilizing the patient and preparing for definitive treatment.

Adult↗