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Biomedical subjects

M I Frazer

Publications and source records attributed to M I Frazer.

18 recordsLinked to original sources
PubMed2001

The tension-free vaginal tape procedure in women with previous failed stress incontinence surgery.

PURPOSE: The tension-free vaginal tape procedure is an increasingly popular choice for treating female urinary stress incontinence. This ongoing, prospective, open label study presents the results of tension-free vaginal tape surgery at 1 year in women who have previously undergone unsuccessful stress incontinence surgery. MATERIALS AND METHODS: A total of 67 women with previous failed surgery for stress urinary incontinence underwent the tension-free vaginal tape procedure. Treatment outcome was categorized as cure, significant improvement or failure based on cystometry findings and urinary pad loss results at 3 months of followup, and on subjective questioning at 3 months and 1 year of followup. RESULTS: At 12 months 54 women (81%) were cured, 4 (6%) were significantly improved and 9 (13%) were no better. No serious morbidity was noted after the procedure. CONCLUSIONS: The tension-free vaginal tape procedure provides the prospect of a success rate similar to that of a conventional sling procedure in patients with previous failed surgery. It has a low rate of operative complications and postoperative morbidity.

Adult↗
PubMed1993

Choroid plexus cysts in the fetal brain.

Choroid plexus cysts may be detected in the fetal choroid plexus on routine second trimester ultrasound scanning. The presence of these cysts is associated with trisomy 18 (Edward syndrome) in 3.47% of cases and with trisomy 21 (Down syndrome) in 0.46% of cases. The cysts themselves almost always disappear by 23 weeks and are thought to be a normal developmental variant. The world literature experience would indicate that the size of the choroid plexus cyst and the presence of bilateral cysts has no bearing on the magnitude of risk of chromosomal abnormality; 76% of babies with trisomy 18 also have other dysmorphic features which may be detectable by ultrasound. It is strongly advised that genetic counselling be undertaken and amniocentesis be considered when choroid plexus cysts are identified in the fetus.

Adult↗
PubMed1991

Hysterectomy revisited.

This paper summarizes the results obtained in 279 vaginal hysterectomies performed in the 5 years 1985-1989 in the public and private practices of a single gynaecologist. It is suggested that it is feasible and safe to perform a hysterectomy vaginally in preference to the abdominal route in the majority of women, even in the absence of uterine descent. It is essential that registrars in training continue to be thoroughly versed in the techniques of vaginal surgery if such techniques are not to be forgotten.

Adult↗
PubMed1990

Do women with idiopathic sensory urgency have early interstitial cystitis?

Interstitial cystitis is rarely considered as a cause of urinary symptoms in referrals to gynaecology clinics. Recent concepts in the diagnosis of this condition mean that it is emerging as a much more common entity, with both early and late forms of the disease being described. Mast cell density in the detrusor muscle has been reported to be useful as a disease marker to substantiate the diagnosis of interstitial cystitis where no classical diagnostic features exist. We assessed mast cell counts in bladder biopsies from 27 women with idiopathic sensory urgency and 10 control patients about to undergo a colposuspension procedure for pure genuine stress incontinence; 30% of the study group had a clear increase in the detrusor muscle mast cell population (detrusor mastocytosis). No control patient showed such an increase. Early interstitial cystitis should be considered as a possible cause of lower urinary tract symptoms in patients with apparently idiopathic sensory urgency.

Adult↗
PubMed1990

Abdominoperineal urethral suspension: a report of 20 cases.

Twenty patients adjudged to require surgical management of genuine stress incontinence underwent the abdomino-perineal urethral suspension procedure between May, 1989 and February, 1990. Short-term subjective follow-up revealed a 94% cure and improved rate in 19 patients in whom the operation was completed. There was a striking absence of postoperative voiding morbidity. We believe this somewhat neglected procedure is worthy of further objective study and comparison with the more popular methods of surgical management of genuine stress incontinence.

Adult↗
PubMed1989

Trigonal sensitivity testing in women.

Tests of the integrity of bladder sensation are a poorly understood and often neglected part of urodynamic investigations. The electrical techniques that have been described to test sensation involve the use of costly and complex equipment; electrical current also is not the natural stimulator of bladder nerves. Trigonal sensitivity testing held promise as a simple, effective and inexpensive test of bladder sensation. We evaluated a modified version of this technique in 89 women: 78 had urodynamically proved lower urinary tract dysfunction and 11 were control patients. The technique proved to be of no value in distinguishing among various urodynamic diagnoses. In particular, patients with detrusor instability or bladder hypersensitivity showed no characteristic patterns on trigonal sensitivity testing. Sensitivity values correlated neither with the first sensation to void nor the cystometric bladder capacity during urodynamic testing. It does not appear to contribute any clinically useful information in the evaluation of lower urinary tract dysfunction in women.

Adult↗
PubMed1989

The severity of urinary incontinence in women. Comparison of subjective and objective tests.

The subjective assessment of urine loss in 84 incontinent women was quantified by using a 10-cm visual analogue scale. These results were compared with the results of a 2-h pad weighing test. We found no relationship between a patient's subjective impression of the severity of her incontinence and the corresponding objective assessment by a 2-h pad weighing test.

Female↗
PubMed1989

Transvaginal ultrasound in the assessment of bladder volumes in women. Preliminary report.

Transvaginal linear array ultrasound is described as a method of measuring bladder volumes in the range 2 to 175 ml, overcoming the limitations of abdominal ultrasound at these smaller (though clinically important) volumes. The mean error over the range 10 to 175 ml was 23%. Statistical analysis of preliminary data obtained by this technique shows that bladder volume in ml can be calculated by the formula: Volume = 5.9 x (height x depth) - 14.6 ml (95% confidence limits = +/- 37 ml)

Female↗
PubMed1989

The accuracy of measurement of residual urine in women by urethral catheterisation.

Two potential sources of error in the measurement of residual urine volumes in women were quantified. These were (i) whether a diuresis is operating at the time of measurement, and (ii) the time between voiding and residual urine volume collection. A regime is suggested for the accurate measurement of residual urine in women by urethral catheterisation.

Diuresis↗
PubMed1989

Maximum and average urine flow rates in normal male and female populations--the Liverpool nomograms.

The study of voiding in men and women has been handicapped by the lack of a normal reference range covering urinary flow rates over a wide range of voided volumes. Normal volunteers (331 males and 249 females) were studied. Each voided once into a calibrated Dantec Urodyn 1000 mictiograph. On a second occasion 282 men and 46 women voided. The maximum and average urine flow rates of the first voids in both sexes were compared with the respective voided volumes. Nomogram charts, in centile form, for both the maximum and average urine flow rates were constructed using statistical transformations of the data. Males showed a significant decline in both urinary flow rates with age, although there was no statistically significant variation in either urine flow rate with respect to first versus repeated voiding. Females showed no statistically significant variation in either urine flow rate with respect to age, parity or first versus repeated voiding. The maximum and average urine flow rates in both sexes showed an equally strong relationship to voided volume. No artificial restriction of voided volume, e.g. minimum 200 ml, appeared appropriate. These nomograms offer reference ranges for both maximum and average urinary flow rates in both sexes covering a wide range of voided volumes (15-600 ml).

Adolescent↗
PubMed1989

Is the investigation of most stress incontinence really necessary?

The case histories of 494 women referred to a urodynamic clinic with the symptom of stress incontinence were studied. None had undergone previous incontinence surgery. In only 12 patients was stress incontinence the sole symptom. In the remainder, symptoms suggestive of detrusor instability were present in 417, of a voiding disorder in 261 and of an inflammatory disorder in 166. The sign of stress incontinence was present in only 168 patients and was not a reliable guide to the diagnosis of genuine stress incontinence. Urodynamic studies were necessary in 488 patients in order to obtain an accurate diagnosis.

Evaluation Studies as Topic↗
PubMed1989

Assessing the effectiveness of different urinary catheters in emptying the bladder: an application of transvaginal ultrasound.

The effectiveness of different types of urinary catheters in completely draining the bladder has not been tested. Transvaginal ultrasound, which is able to measure bladder volumes in women from 2 to 175 ml, provides a means of measuring any fluid volume remaining in the bladder following catheter drainage. Using transvaginal ultrasound, the post-catheterisation bladder volumes were measured in 26 female patients; 14 underwent urethral catheterisation using either a 14F short plastic female catheter or a Foley catheter of the same size (balloon not inflated); 12 had an indwelling 12F suprapublic catheter following bladder neck surgery. The mean post-catheterisation bladder volumes after using the short plastic female and Foley catheters were less than 1 ml and 77 ml respectively. A short plastic catheter should be used in women to collect the residual urine volume by urethral catheterisation. A Foley catheter is relatively ineffective in this task. A 12F suprapubic catheter was found to drain the bladder relatively well. The mean post-catheterisation bladder volume was 35 ml. Prior to removing a suprapubic catheter post-operatively, it is recommended that the residual urine volume (measured using the suprapubic catheter) be checked by measuring the post-catheterisation bladder volume (using either a short plastic catheter or transvaginal ultrasound).

Drainage↗
PubMed1988

Diuretic response to fluid load in women with urinary incontinence: optimum duration of pad test.

The pattern of bladder filling in response to a 1-litre fluid load was assessed in 20 women with urinary incontinence. The period between 60 and 120 min after the fluid load was identified as best for pad testing because of consistently high bladder volumes and filling rates. A 2-h pad test is recommended as achieving effective and reproducible test conditions for the quantification of urine loss.

Adult↗