Biomedical subjects

M E Mayo

Publications and source records attributed to M E Mayo.

At least 19 recordsLinked to original sources

PubMed2000

Urodynamic evaluation and long-term results of the orthotopic gastric neobladder in men.

PURPOSE: Orthotopic neobladders are most commonly formed from colon and/or small bowel segments. However, after excellent results were reported in children, we constructed gastric neobladders in select men who had undergone cystectomy. Although gastric neobladders in adults have been reported to have decreased capacity, to our knowledge neither long-term followup nor urodynamic parameters have been reported in these patients. MATERIALS AND METHODS: Gastric neobladder was performed in 8 patients following cystectomy for malignancy in 7 and undiversion in 1. Average followup was 43 months and all patients underwent urodynamic evaluations an average of 9.1 months after surgery. Patients also completed an incontinence questionnaire. The gastric neobladder group was compared to a similar group of patients who underwent neobladder construction from either small bowel (Kock/Hautmann/Studer) or ileocecal segments (Mainz). RESULTS: The gastric neobladder group had significantly reduced mean bladder capacity compared to the ileal or ileocecal neobladder group (309 versus 551 cc, respectively, t = 0.001), while compliance was similarly decreased (27 versus 59 cc/cm. H2O, respectively, t = 0.04). Incontinence rates were greater in the gastric neobladder group (63%) compared to the ileal or ileocecal neobladder group (8% to 23%, t = 0.02). Complication rates were comparable. Revision or removal was required in 3 (38%) patients for severe incontinence, intractable dysuria and ureterogastric anastomotic stricture, respectively. CONCLUSIONS: Adult gastric neobladders as currently constructed are associated with poor urodynamic parameters and high incontinence rates. Routine use of gastric neobladders in adults is not recommended. They may be appropriate, especially as composites, in select cases such as renal failure or inadequate bowel length. The reasons for success in some patients and not in others are unknown.

Adult↗

PubMed1999

Continence and urodynamic parameters of continent urinary reservoirs: comparison of gastric, ileal, ileocolic, right colon, and sigmoid segments.

OBJECTIVES: To compare the urodynamic parameters and continence rates among five different continent urinary reservoirs. METHODS: Continent urinary reservoirs were constructed in 40 patients with an average age of 60 years (range 23 to 81). Twenty-three had orthotopic neobladders ("neobladders"), and in 17 the reservoirs exited by way of an abdominal wall stoma as "stomal urinary reservoirs." In the neobladders, the detubularized segment was ileum (Hautmann) in 5, ileocecal (Mainz) in 8, sigmoid in 4, and gastric in 6. In the stomal urinary reservoirs, the segment was ileocecal in 11 (Mainz) and right colon in 6 (Indiana). Urodynamic studies were performed at a mean of 9.1 months. RESULTS: Stomal urinary reservoirs had the best continence rates (Indiana pouch 100%, Mainz pouch 91%). Neobladder continence rates were as follows: Hautmann, 80%; Mainz, 75%; sigmoid, 50%; and gastric, 33%. Day and night incontinence rates were nearly identical. Compared with the other pouches, gastric and sigmoid reconstructions had the smallest capacity, were the least compliant, and were the most contractile. CONCLUSIONS: Stomal urinary reservoirs using ileocecal valve and right colon, with or without an overlying patch of ileum, provide similar excellent results. Continence approached 100% in compliant patients without the need for revision. Patients with neobladders were less continent, although those with ileal or ileocecal configurations still had very good continence rates. Neobladders of sigmoid or stomach can be used when necessary, but with greater incontinence rates. This poorer continence can be explained by the decreased capacity, decreased compliance, and a tendency toward high pressure spikes despite detubularization.

Adult↗

PubMed1999

Endourological treatment of ureteroenteric strictures: efficacy of Acucise endoureterotomy.

PURPOSE: The Acucise endoureterotomy balloon catheter has proved to be a safe and effective alternative to open surgery for the management of ureteropelvic junction obstruction and benign ureteral stricture disease. The established management of ureteroenteric strictures following urinary diversion is open surgical revision. There are few reports evaluating the efficacy of Acucise endoureterotomy in patients with ureteroenteric strictures. MATERIALS AND METHODS: The Acucise cutting balloon catheter was used to treat 9 patients with 12 ureteroenteric strictures 2 cm. or less in length. Median time from diversion to stricture was 48 months (range 13 to 192). Success was defined as resolution of symptoms and radiographic confirmation of patency. RESULTS: Recurrence of malignancy accounted for failure in 1 patient with bilateral strictures. Of the remaining 10 benign strictures 7 (70%) required open revision or serial stent changes. The remaining 3 strictures in 2 patients have remained patent at 30 and 18 months of followup for a success rate of 30%. There were no perioperative or operative complications. Mean followup was 9 months after Acucise treatment before intervention was necessary. CONCLUSIONS: Acucise endoureterotomy for ureteroenteric strictures following urinary diversion is a low morbidity procedure. Although the success rate is only 30%, Acucise endoureterotomy offers an alternative to immediate open surgical revision.

Adult↗

PubMed1998

Few patients with "chronic prostatitis" have significant bladder outlet obstruction.

OBJECTIVES: A high prevalence of significant bladder outlet obstruction has been reported among men diagnosed as having "chronic prostatitis." To evaluate the possibility that case selection may determine this high prevalence, we compared findings in patients referred directly to our Urodynamic Unit with that of patients evaluated in our Prostatitis Clinic. METHODS: The videourodynamics records of 201 men aged 18 to 50 years who presented to the Urodynamic Unit with any lower tract symptoms (irritative and/or obstructive with or without pain) were compared with the findings in 123 Prostatitis Clinic patients. The latter were evaluated for obstruction with flow rates and, if abnormal, by retrograde urethrograms and videourodynamics. RESULTS: Only 37 (18%) of 201 patients referred to the Urodynamic Unit had pain as a significant symptom and might have been diagnosed as having chronic prostatitis. Of these 37 patients, 4 (11%) had definite obstruction, 6 (16%) were equivocal, 6 (16%) were hypocontractile, 1 (3%) had pseudodyssynergia, and 7 (19%) had normal findings. The remainder had abnormalities of bladder filling (hypersensitivity in 11 [30%] and detrusor instability in 2 [5%]). Fewer of the 123 patients with prostatitis had obstruction (definite in 2 [1.6%] and equivocal in 1 [0.8%]) (P = 0.03), 2 (1.6%) had hypocontractile detrusors, and 2 had urethral strictures. CONCLUSIONS: Patients referred to the Urodynamic Unit with lower urinary tract symptoms and pain rarely have bladder outlet obstruction. However, they are significantly more likely to have bladder outlet obstruction than patients referred to the Prostatitis Clinic who can be screened for obstruction by history, flow rate, postvoid residual, and retrograde urethrogram.

Adolescent↗

PubMed1997

Morbidity of dysfunctional voiding syndrome.

OBJECTIVES: External sphincter dyssynergia in the absence of an identifiable causative neurologic lesion (dysfunctional voiding, Hinman-Allen syndrome, non-neurogenic neurogenic bladder) has been known to cause significant morbidity. To determine the outcomes in this syndrome, we conducted a retrospective study of 37 patients referred for urodynamic studies and subsequently diagnosed with dysfunctional voiding. METHODS: After diagnosis, follow-up was conducted through chart review and telephone calls to the primary physicians or the patients. RESULTS: Follow-up was possible in 27 patients (17 female, 10 male; mean follow-up 49 months, range 4 to 192). The average age at diagnosis was 12 years. Eleven patients developed significant or ongoing morbidity. Ten of these 11 patients underwent 17 operations. Eight patients were cured through medication, behavioral modification, intermittent catheterization, and/or other nonoperative treatments. The remaining 8 patients did not experience significant morbidity but did not have resolution of their symptoms as of their last medical evaluation, and most were lost to follow-up. CONCLUSIONS: Dysfunctional voiding resulted in severe morbidity in 11 (40%) of 27 study patients. Eight patients (30%) were cured using nonoperative, conservative treatments, and 8 (30%) had unresolved symptoms within the follow-up period. Urodynamic studies are essential in the diagnosis of the syndrome but cannot be used to consistently predict outcome.

Adolescent↗

PubMed1996

Interstitial cystitis in children.

PURPOSE: Interstitial cystitis has been rarely reported in children. We present our experience with 16 children in whom clinical symptomatology and cystoscopic findings were consistent with the diagnosis of interstitial cystitis. MATERIALS AND METHODS: We retrospectively reviewed the charts of 20 children referred for chronic sensory urgency, frequency and bladder pain who underwent cystoscopy and hydrodistension. Four patients were excluded from study because of infection identified at cystoscopy or lack of cystoscopic changes with hydro-distension. RESULTS: Patient age at onset of first symptoms ranged from 2 to 11 years (median 4.5) and age at diagnosis ranged from 3 to 16 years (mean 8.2). Of the 16 children 14 (88%) presented with symptoms of urinary frequency and sensory urgency, and in 13 (81%) lower abdominal pain was relieved by voiding. None of the children had motor urgency. Urodynamic evaluation in 8 cases revealed early bladder sensation with no evidence of involuntary bladder contractions. Diffuse glomerulations and terminal hematuria were demonstrated in all patients after hydro-distension. Followup was available for 14 patients. Relief of symptoms occurred after hydro-distension in all children except 1. Seven children (50%) required repeat hydro-distension. CONCLUSIONS: Children with symptoms of bladder pain, urinary frequency and sensory urgency have bladder changes on cystoscopy consistent with interstitial cystitis. Although rare, this condition is recognizable and it should not be confused with dysfunctional voiding in which complaints are secondary to involuntary bladder contractions.

Adolescent↗

PubMed1995

External urethral sphincterotomy: long-term follow-up.

UNLABELLED: We retrospectively reviewed the charts of 37 male spinal cord injury patients who underwent sphincterotomy from 1986-1993 to evaluate the long-term results of this procedure. Patients were selected for the operation based on urodynamic criteria and all had some detrusor activity or were able to void by Valsalva's maneuver. There were 26 cervical injuries and 11 thoracic injuries. The operation was judged a failure if the following were present postoperatively: the presence of large post void residual volumes associated with urinary tract infections, autonomic dysreflexia symptoms associated with bladder overdistension or high voiding pressures, and/or progressive upper tract deterioration due to persistent vesicoureteral reflux or poor bladder emptying. Eighteen' operations were failures and 19 operations were successful. Causes for sphincterotomy failure included recurrent detrusor sphincter dyssynergy (6), detrusor hypocontractility (6), bladder neck contracture (3), stricture at the external sphincter (1), incomplete sphincterotomy (1), and unknown etiology (1). The reoperation rate was 32%. The mean follow-up time was 49 months for the failure group (range 2-81) and 26 months (range 2-54) for the successes. The longer mean follow-up period in the former group suggests that the number of failures increased with time. There was no predictor of failure among any of the following parameters: age at operation, level of injury, previous bladder neck/sphincter operations, preoperative maximum detrusor contraction pressures, or rise time to maximum pressure. IN CONCLUSION: (1) the external urethral sphincterotomy, even in appropriately selected patients, can have a high failure rate over time, and (2) we could not identify any variables to predict an unsuccessful operation using our present selection criteria.

Adult↗

PubMed1995

Incontinence after radical prostatectomy: detrusor or sphincter causes.

PURPOSE: Prospective studies have shown a high prevalence of decreased compliance immediately after radical prostatectomy, which may be a temporary phenomenon in men in whom incontinence persists for more than 1 year. We examined the video urodynamic records of 74 consecutive men referred to our urodynamic laboratory with incontinence as the predominant symptom following radical prostatectomy to evaluate voiding parameters and bladder function. MATERIALS AND METHODS: The urodynamic assessment was made an average of 3.8 years postoperatively. All men presented with persistent post-prostatectomy incontinence, and 64 underwent radical retropubic and 10 radical perineal prostatectomy. RESULTS: A total of 42 men (57%) had sphincter weakness alone, 29 (39%) had detrusor instability and/or decreased compliance combined with sphincter weakness and only 3 (4%) had detrusor instability alone. Of 29 men with a combination of factors 8 had decreased compliance, with 3 also having detrusor instability. Anastomotic strictures occurred in 24% of the patients. A total of 31 patients voided by straining without demonstrable detrusor contraction (42% overall). CONCLUSIONS: Decreased compliance is an infrequent finding after radical prostatectomy. Detrusor abnormalities in general are rarely the sole cause of incontinence, with sphincter weakness being present in the majority of patients.

Aged↗

PubMed1995

Lower urinary changes over time in suprasacral spinal cord injury.

This paper reviews 179 patients (23 females and 156 males) with suprasacral spinal cord injury (SCI) who underwent videourodynamic evaluation to compare maximum detrusor pressure, compliance, and trabeculation with methods of bladder management, years post-injury, and age. The patients were divided into four groups based on mode of bladder management: clean intermittent catheterization (CIC), indwelling catheter (IND), external collector (EC), and voiding (V). Maximum pressure decreased significantly with increasing age for those using EC (P < 0.01) and CIC (P < 0.05). Maximum pressure also decreased significantly with years post-injury for patients on EC (P < 0.01) and was highest the first decade after injury and progressively decreased through the fifth decade. Post-hoc tests indicated more severe trabeculation in patients in the EC group than in either the CIC or IND groups. Age and trabeculation did not correlate in those on EC. We conclude that patients with long-standing suprasacral SCI using EC are more likely to have lower detrusor pressures than are those with less chronic SCI. This finding may reflect the effects of age as well as reduced survival in those using EC with chronically elevated detrusor pressure.

Adolescent↗

PubMed1994

Catheter modification for transrenal temporary total ureteral obstruction: the "occlusive" nephroureteral catheter.

When temporary diversion of urine is desired and a simple nephrostomy catheter is insufficient or passage of a ureteral stent cannot be achieved, a standard 8 or 10 F nephroureteral catheter can be modified to provide a single nephrostomy drainage catheter with an occluded ureteral segment that provides total diversion of urine. The "occlusive" nephroureteral catheter is exchangeable over a guide wire as necessary. When healing of the ureteral or bladder process has occurred, the catheter is removable, allowing restoration of normal urine flow.

Adult↗

PubMed1994

Long-term urodynamic follow up in pediatric spinal cord injury.

Less than 5% of all spinal cord injuries occur in children under 16 years of age. We have followed up 40 children with spinal cord injury at our medical center. The patients have an average age at presentation of 9.0 years (range newborn to 17 years) and have a mean follow up of 46.1 months (range 1 to 240 months). Twenty-two patients have cervical injuries, 13 thoracic and five have lumbar injuries. Bladder management in this group includes 11 patients with reflex voiding and 29 patients combining anticholinergic medication with intermittent catheterization. Twenty-eight patients have a follow up for more than 1 year. Review of the video urodynamics in this group has shown good function and preservation of the urinary tract in 25 of 28 patients. Treatment failures can be attributed to noncompliance with recommended voiding regimens. Upper tract surveillance using intravenous pyelogram or renal ultrasound has shown preservation of the upper tracts in all patients with anatomically normal lower tracts. We recommend aggressive follow up in this group of patients with yearly renal ultrasound and video urodynamics every 1-2 years to monitor urinary tract function.

Adolescent↗

PubMed1993

Fate of upper urinary tracts in patients with indwelling catheters after spinal cord injury.

Several modes of urinary tract drainage exist for the spinal cord-injured (SCI) patient, but the use of an indwelling catheter is discouraged. We retrospectively reviewed the charts of our traumatic SCI patients followed twenty years or more since initial injury to compare urinary tract preservation and the incidence of urologic complications in patients with neurogenic bladders voiding spontaneously with those using long-term indwelling catheters. Eighty-one patients with long-term injuries were identified; 73 of them fit the study criteria. Forty-one patients voided spontaneously having a balanced bladder or performing intermittent catheterization or have undergone sphincterotomy or vesicostomy, and 32 had indwelling suprapubic or Foley catheters. Renal function measured by creatinine clearance was similar in both groups: 81.3 +/- 20.2 mL/min for spontaneous voiders and 83.7 +/- 24.9 mL/min for catheterized patients. Review of urinary tract imaging and incidence of complications in both groups was very comparable, with the exception that the catheterized group had a higher prevalence of scarring and calicectasis on radiologic imaging of the upper urinary tracts which was statistically significant. Of the remaining population, in 6 of 81 patients, bladder cancer developed, and they underwent radical cystectomy and urinary diversion and 2 had proximal diversion alone. Of the 6 patients with bladder cancer, 2 were spontaneous voiders with transitional cell carcinoma (TCC) developing. Three of the 6 patients had indwelling catheters: in 1 patient TCC developed, in 1 adenocarcinoma, and in 1 squamous cell carcinoma. In 1 patient TCC developed in a defunctionalized bladder after ileal conduit formation. Based on this study, we can conclude that in select groups of SCI patients, the choice of an indwelling catheter may be made if other methods fail, provided patients undergo regular upper urinary tract imaging and cystoscopy.

Adult↗

PubMed1993

Bladder neck closure with continent augmentation or suprapubic catheter in patients with neurogenic bladders.

Twenty-four patients, with various combinations of non-healing decubitus ulcers, urethral fistulae, incontinence, and penile skin breakdown were candidates for proximal urinary diversion, having failed intermittent, external, and indwelling catheterization combined with pharmacologic therapy. Seventeen patients underwent bladder neck closure, including seven with multiple sclerosis and ten with spinal cord injury, and because they were unable or unwilling to do catheterization, had their urine diverted by suprapubic catheter. Seven patients, including four with spinal cord injury, underwent bladder neck closure and continent augmentation with formation of a catheterizable cutaneous stoma on the anterior abdominal wall, using right colon and right colon/ileum configurations. When ureteral reflux and obstruction are absent, the patient's bladder was used which spared the added risk of ureteral implantation and possible ureteral stricture while increasing total bladder capacity. In a select group of patients with intractable incontinence, perineal and penile skin breakdown, or urethral fistulae, bladder neck closure and urinary diversion by suprapubic catheter or continent augmentation has proven to be a reliable and effective alternative to an ileal conduit.

Catheterization↗

PubMed1992

Lower urinary tract dysfunction in multiple sclerosis.

Previous investigators have shown that in multiple sclerosis failure to empty the bladder was secondary to detrusor-distal sphincter dyssynergia or areflexia. However, our urodynamic evaluation of 46 female and 43 male patients with multiple sclerosis revealed that 63 percent of patients failed to empty their bladders because of a hypocontractile detrusor, and only 6 percent had areflexia. Detrusor-distal sphincter dyssynergia (6%) and bladder neck obstruction (6%) were present in only 12 percent of patients. Hyperreflexia was common (78%) and was associated with hypocontractility in 63 percent of patients. Urgency incontinence was significantly more common in females and voiding difficulty significantly more common in males. Sensation was also reduced in 74 percent of female and 77 percent of male patients. In conclusion, failure to empty the bladder in multiple sclerosis is most commonly associated with hypocontractility, and the combination of hyperreflexia and hypocontractility produces the symptoms of urgency and incomplete emptying.

Adult↗

PubMed1992

Lower urinary tract dysfunction in cerebral palsy.

The urodynamic findings in 33 patients with cerebral palsy referred with lower urinary tract symptoms were reviewed. Difficulty urinating was the predominant symptom in approximately half of the patients and half of these also had hyperreflexia and urgency when full. Three patients had varying degrees of retention and the remaining 14 had difficulty initiating a urinary stream. The other half had urgency incontinence as a major presenting symptom and this was associated in nearly all cases with hyperreflexia. There were 10 adults: 5 with difficulty urinating and 5 with urgency. The more serious manifestations, such as retention, were found only in the adults, suggesting that difficulty urinating may progress in adult life. Classical detrusor-sphincter dyssynergia with bladder wall changes was seen only once, and the cause of difficulty urinating in the other patients seemed to be due to a lack of voluntary control over and the hypertonus of the pelvic floor.

Adolescent↗

PubMed1991

Intraoperative cardiovascular collapse secondary to latex allergy.

An apparent allergic reaction has been noted in children undergoing open urological surgery. This condition is characterized by precipitous hypotension, tachycardia and upper body flushing, and it often causes termination of the procedure. Latex allergy has been identified as the possible inciting event. Contact of latex rubber gloves with intra-abdominal structures (handling bowel) appears to be the most dramatic trigger mechanism for this reaction. We report on 10 patients with latex allergy, 6 of whom have myelomeningocele, who have undergone reconstructive surgery. Severe anaphylactic shock developed intraoperatively in 5 patients and during a barium enema performed with a latex catheter in 1 patient. These 6 patients had previous allergic reactions to latex material, which was not detected preoperatively. In the remaining 4 patients latex allergy was diagnosed preoperatively. A total of 6 patients agreed to a skin prick test to liquid latex. Three patients reacted with a wheal size greater than or equal to a histamine control at a dilution of 1:1,000 and 3 patients at 1:100. In contrast, none of the 5 normal controls reacted to any of the concentrations including full strength latex. A history of exposure to latex products (balloons, surgical gloves, catheters, condoms and so forth) with allergic reactions should heighten surgeon awareness of a potentially severe intraoperative reaction. Furthermore, a skin prick test may be used to screen high risk patients such as those with myelomeningocele. A protocol involving preoperative corticosteroid and antihistamine therapy is recommended.

Adolescent↗

PubMed1990

Reduction in human bladder wall compliance following decentralization.

The urodynamic records of patients who presented with voiding symptoms and/or incontinence, and who had areflexia after conal-cauda equina injury (33) or a radical pelvic operation (31) were examined. In contrast to reported experimental and clinical evidence, we found a higher prevalence of decreased compliance in the patients who had undergone a radical pelvic operation than in those who had sustained conal-cauda equina injury.

Adolescent↗

PubMed1990

Urodynamic studies in children who wet.

The value of urodynamic evaluation was assessed in children with diurnal and/or nocturnal enuresis without overt obstruction or neuropathy. The hypothesis that children with bladder instability and dysfunctional voiding represent 2 separate populations was also examined. A simplified urodynamic method was used to evaluate 191 children and they were divided into 3 groups: 64 had normal bladders which were stable during filling and voiding was co-ordinated and complete; 97 had unstable bladders but voiding was normal and co-ordinated; 30 had dyssynergic voiding and an increased volume of residual urine. The urodynamic evaluations were helpful in distinguishing the large number of children with normal findings in whom the problem was motivational. The children with unstable bladders had a physiological abnormality due to delayed maturation and in these cases anticholinergic and musculotrophic agents were usually helpful. The dysfunctional voiders had serious behavioural problems, were difficult to treat, and often required a multidisciplinary approach. These data indicate that there are indeed 2 distinct groups: 1 with instability alone and 1 with dysfunctional voiding with or without instability. Although infection and/or reflux are common in the former, the more devastating urinary tract changes, particularly heavy trabeculation and elongation of the bladder, occur in the latter group.

Child↗