Controversial cases in endourology.
Explore the source record for details and available documents.
Calcium Oxalate↗
Biomedical subjects
M Monga
Publications and source records attributed to M Monga.
An abnormal screening ultrasound: concordance with a tertiary obstetrical ultrasound unit.
OBJECTIVE: To determine concordance of ultrasound diagnosis in referrals to a tertiary obstetrical ultrasound unit (TOU) for suspected abnormalities. STUDY DESIGN: Consecutive referrals for "abnormal outside ultrasound" during a 6-month period were compared with the TOU ultrasound diagnosis. Concordance of diagnosis was compared on the basis of organ system involved and referral for single or multiple suspected abnormalities. Chi(2) analysis was used; p < 0.05 was considered significant. RESULTS: Of 104 consecutive referrals reviewed, 42 (40.4%) had no abnormality documented at the TOU. Of the 62 abnormal ultrasound scans at the TOU, 78.3% were concordant. Concordance based on organ system involvement was central nervous system, 30.3%; cardiothoracic, 66.7%; gastrointestinal, 63.6%; genitourinary, 50%. Referrals for a single suspected anomaly were statistically no more likely to have a normal TOU ultrasound scan (40.4%) than those referred for multiple suspected anomalies (36.4%, p > 0.05). CONCLUSIONS: Most referrals to a tertiary center for "abnormal outside ultrasound" will be diagnosed with an abnormality.
Congenital Abnormalities↗
Oral therapy for Peyronie's disease.
Peyronie's disease (PD) remains a therapeutic dilemma for the urologist. Despite a myriad of medical therapies proposed for PD there have been limited advances in oral medical treatment. Several new approaches are presented which hold promise of success, although a definitive medical therapy for PD has yet to be established. Since early stage disease is reputed to respond better than well-established plaques, an early trial of inexpensive, safe and well-tolerated oral therapy is often initially recommended. This review discusses the historical aspects as well as contemporary oral medical therapy for PD. With advances in the molecular biology of inflammation and wound healing, the management and understanding of this frustrating disease will no doubt improve.
4-Aminobenzoic Acid↗
Developmental therapeutics program at the NCI: molecular target and drug discovery process.
As the drug discovery and developmental arm of the National Cancer Institute (NCI), the Developmental Therapeutics Program (DTP) plans, conducts and facilitates development of therapeutic agents for cancer and AIDS. DTP's goal is to turn 'molecules into medicine for the public health'. Areas of support by DTP are discovery, development and pathways to development for the intramural and the extramural community. The Developmental Therapeutics Program (DTP) operates a repository of synthetic and pure natural products, which are evaluated as potential anticancer agents. The repository derives from a historical database of greater than 600 000 compounds, which have been supplied to DTP from a variety of sources worldwide. The in vitro anti-cancer drug cell line screen established at DTP is unique in several respects. It has changed the NCI emphasis from a compound-oriented drug discovery effort to a disease-panel oriented exercise, emphasized human tumor cells derived from solid tumors, developed a high volume screening method that can adapt to processing of numerous chemical agents or natural source-derived extracts, that has minimized the use of animals, and saved on the amount of material required for the initial screening. The hollow fiber assay created at the DTP has demonstrated the ability to provide quantitative initial indices of in vivo drug efficacy, with minimum expenditures of time and materials and is currently being utilized as the initial in vivo experience for agents found to have reproducible activity in the in vitroanticancer drug screen. Drugs showing activity with unique mechanisms of actions are being further developed for treatment of hematopoietic neoplasms, prominent examples being flavopiridol, UCN-01 and depsipeptide among others.
Animals↗
Ureteral stenting after ureteroscopy for distal ureteral calculi: a multi-institutional prospective randomized controlled study assessing pain, outcomes and complications.
PURPOSE: We compare postoperative pain, stone-free rates and complications after ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. MATERIALS AND METHODS: A total of 113 patients with distal ureteral calculi amenable to ureteroscopic treatment were prospectively randomized into stented (53) and unstented (60) groups. Stones were managed with semirigid ureteroscopes with or without distal ureteral dilation and/or intracorporeal lithotripsy. Preoperative and postoperative pain questionnaires were obtained from each patient. Patients with stents had them removed 3 to 10 days postoperatively. Radiographic followup was performed postoperatively to assess stone-free rates and evidence of obstruction. RESULTS: Six patients randomized to the unstented group were withdrawn from the study after significant intraoperative ureteral trauma was recognized, including 3 ureteral perforations, that required ureteral stent placement, leaving 53 with stents and 54 without for analysis. Patients with stents had statistically significantly more postoperative flank pain (p = 0.005), bladder pain (p <0.001), urinary symptoms (p = 0.002), overall pain (p <0.001) and total narcotic use (p <0.001) compared to the unstented group. Intraoperative ureteral dilation or intracorporeal lithotripsy did not statistically significantly affect postoperative pain or narcotic use in either group (p >0.05 in all cases). Overall mean stone size in our study was 6.6 mm. There were 4 (7.4%) patients without stents who required postoperative readmission to the hospital secondary to flank pain. All patients (85%) who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture on followup imaging (mean followup plus or minus standard deviation 1.8 +/- 1.5 months), and the stone-free rate was 99.1%. CONCLUSIONS: Uncomplicated ureteroscopy for distal ureteral calculi with or without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent. Patients without stents had significantly less pain, fewer urinary symptoms and decreased narcotic use postoperatively.
Humans↗
Seizure disorders in pregnancy.
Epilepsy is the presence of two or more seizures in the absence of an identifiable cause for the seizures; that is, no intracranial or metabolic abnormality. Epilepsy affects approximately 1% of the US population, which represents an estimated 1.1 million women of reproductive age. The management of women with epilepsy during pregnancy is the focus of this article.
Abnormalities, Drug-Induced↗
Urinary transforming growth factor-beta1 levels correlate with bladder outlet obstruction.
BACKGROUND: Urinary transforming growth factor-beta1 (TGF-beta1) levels have been shown to correlate with elevated intrapelvic pressure associated with ureteropelvic junction obstruction. Other studies have evaluated urinary TGF-beta1 levels in prostate cancer. This study tests the hypothesis that urinary TGF-beta1 levels might correlate with objective measures of bladder outlet obstruction (BOO). METHODS: Twenty-three men (age: 46-85 years) with lower urinary tract symptoms underwent urodynamic studies consisting of non-invasive uroflowmetry, cystometrogram and voiding pressure flow studies. Patients were classified as obstructed (n = 17) or not obstructed (n = 6) based on Abrams-Griffith nomograms. Urinary TGF-beta1 was extracted from an aliquot of urine obtained at the time of bladder catheterization for urodynamic studies. Urinary TGF-beta1 levels were then determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: There was a strong correlation between urinary TGF-beta1 levels and the presence of obstruction by Abrams-Griffith nomogram criteria (P = 0.025). Urinary TGF-beta1 levels were significantly higher in men with obstruction (0.039 +/- 0.011 pg/mL) than in men without obstruction (0.029 +/- 0.009 pg/mL; P = 0.036). CONCLUSION: Urinary TGF-beta1 levels correlate with objective measures of BOO. Further study is needed to test the utility of urinary TGF-beta1 as a non-invasive diagnostic tool for BOO.
Aged↗
Correlation of external and internal monitoring of uterine activity in a cohort of term patients.
External tocodynamometry (ET) and intrauterine pressure monitoring (IUPC) are commonly used to assess uterine contractile activity. It is believed that ET does not accurately document contraction amplitude. However, no direct comparison of ET and IUPC has been published in term patients. Our objective was to determine the correlation between frequency, duration, and amplitude as measured by ET and IUPC. Twenty patients between 36 and 41 weeks' gestation were enrolled during active spontaneous labor. Uterine contractions were recorded simultaneously by ET and IUPC for 2 hours. ET and IUPC data were compared using the Spearman correlation coefficient and the Wilcoxon signed-rank test. The median body mass index (BMI) of the patient population was 31.8 kg/m2 (range 22.2 to 42.3). There was good correlation of contraction frequency measured by ET and IUPC (r = 0.75, p = 0.001), but poor correlation of both contraction amplitude (r = 0.26) and duration (r = 0.27). ET and IUPC assessment of uterine contractile activity, specifically contraction amplitude and duration, do not appear to correlate in a population of moderately obese patients. This suggests that ET should not exclusively be relied upon in this population to assess uterine contractile activity during labor.
Adolescent↗
Characterization of ultrastructural and metabolic abnormalities in semen from men with spinal cord injury.
BACKGROUND: In men with spinal cord injury (SCI), fertility is impaired because of a combination of ejaculatory dysfunction and poor semen quality. We hypothesized that ultrastructural and metabolic abnormalities of sperm could be an underlying factor in infertility in these men. METHODS: To investigate mechanisms contributing to the abnormal sperm parameters, we analyzed seminal constituents and sperm ultrastructure in ejaculates from 7 men with SCI and compared them with 5 control subjects. Sperm adenosine triphosphate (ATP) content was measured using a firefly luciferase bioluminescent assay kit, and ultrastructure was evaluated by electron microscopy. Seminal oxidative stress (8-iso-prostaglandin F-2alpha [8-iso-PGF2alpha]) and transforming growth factor-beta1 (TGF-beta1) levels were measured by specific enzyme-linked immunoabsorbent assay kits. RESULTS: Semen samples from men with SCI showed azoospermia (3) and severe asthenospermia (2; motility 0-5%). A majority (65%) of sperm from asthenospermic samples showed degenerative changes and significant axonemal defects. Incubation of normal sperm with SCI seminal plasma induced a concentration-dependent decrease in sperm motility (43%) accompanied by a significant drop in intracellular ATP content (33%). Semen samples from men with SCI exhibited levels of 8-iso-PGF2alpha 3.5-fold higher than those from controls and levels of TGF-beta1 that were 10% higher than those from controls. CONCLUSION: Our results suggest that seminal constituents of men with SCI are detrimental to sperm movement and that ultrastructural degenerative changes may contribute to the impaired sperm motility and viability seen in these patients. These preliminary results must be confirmed in larger patient populations and longitudinal studies.
Adult↗
Intravesical ethanol as quantitative measure of bladder hyperpermeability.
BACKGROUND AND PURPOSE: Bladder surface hyperpermeability may be a factor in the etiology of interstitial cystitis (IC). We evaluated the intravesical instillation of ethanol as a quantitative measure of bladder hyperpermeability in an experimental model in male New Zealand White rabbits. MATERIALS AND METHODS: In two study groups (N = 4 each), the glycosaminoglycan (GAG) layer on the bladder surface was disrupted via a 10-minute exposure to 10% protamine sulfate (PS). The study groups then underwent bladder instillation of 10% (group 1) and 20% (group 2) ethanol. The control groups underwent bladder instillation of either 10% (N = 2) or 20% ethanol (N = 2) without exposure to PS. Ten minutes after ethanol instillation, venous blood was sampled, and the ethanol concentration was determined by mass spectrometry. Study group animals were sacrificed after blood sampling. Control animals were sacrificed at 2 weeks and 4 weeks for histologic examination of the bladder. RESULTS: The blood alcohol concentration was 0 in the control animals exposed to 10% or 20% ethanol, 14.5+/-2.2 ng/dL in the 10% ethanol study group, and 25.6+/-3.6 ng/dL in the 20% ethanol study group. Histologic examination of bladder tissue revealed no ethanol-induced abnormalities in the control animals. CONCLUSION: Intravesical instillation of 10% and 20% ethanol is a safe and reliable quantitative measure of bladder hyperpermeability in an animal model. Clinical trials are ongoing to evaluate the utility of the intravesical ethanol test for diagnosing IC and monitoring the response to therapy.
Animals↗
Ureteral access for upper urinary tract disease: the access sheath.
Ureteral access with the flexible ureteroscope remains a challenge for the urologist. The routine use of a newly developed, site-specific ureteral access sheath facilitates entry into the ureter for fragmentation and basket extraction of ureteral and renal calculi. The step-by-step technique of ureteral access with the Access Sheath is described.
Equipment Design↗
Endoscopic extraction of an ejaculatory duct calculus to treat obstructive azoospermia.
Calculous obstruction of an ejaculatory duct is an uncommon cause of azoospermia or low-volume oligospermia in the infertile man. We report the case of a 32-year-old man with azoospermia, low ejaculate volume, and transrectal ultrosonography (TRUS) findings of bilateral seminal vesicle distention. On cystoscopy for planned transurethral resection of the ejaculatory ducts, a calculus obstructing the right ejaculatory duct at the verumontanum was discovered and removed. Three months later, semen analysis showed improvements in volume, sperm concentration, and sperm motility. An ejaculatory duct calculus should be included in the differential diagnosis of obstructive azoospermia or low-volume oligospermia. Magnetic resonance imaging or TRUS may be advisable to identify ductal calculi.
Adult↗
Third year medical student attitudes toward learning urology.
PURPOSE: We studied certain research questions, including the learning environments in which third year medical students perceive that they acquire urological knowledge and skills, and whether medical students interested in urology as a career have different perceived learning needs than those interested in other specialties. MATERIALS AND METHODS: A survey instrument was pilot tested and revised. The instrument elicited student perceptions of how they best learned urological diagnosis and skills. Student attitudes toward the third year urology rotation and career motivation toward urology were assessed. Consecutive students were surveyed after completing the third year urology rotation. RESULTS: Most students perceived that they learned to manage most urological problems by seeing patients in outpatient clinics and they learned to perform physical examination and urinalysis interpretation by seeing patients. The overall usefulness of various learning environments was highest for seeing patients in clinic, followed by resident teaching, following inpatients, independent reading, watching open surgery, formal conferences, watching endoscopic surgery and routine menial work. Students interested in urology as a career choice were equally motivated by seeing patients in clinic, the subject matter and seeing surgery. CONCLUSIONS: Third year medical students perceive that the most important urological learning environment is outpatient evaluation of patients. The urological learning needs of third year medical students are not different in those interested and not interested in urology as a career.
Attitude↗
Betamethasone alteration of the one-hour glucose challenge test in pregnancy.
OBJECTIVE: To determine if betamethasone administration alters the one-hour (50-g) glucose challenge test (GCT) and, if so, to determine the duration of this effect. STUDY DESIGN: Pregnant women with singleton gestations eligible to receive antenatal betamethasone (24-34 weeks) with no evidence of infection, diabetes mellitus, hepatic or pancreatic disease, betamimetic therapy or prolonged steroid use were invited to participate. Betamethasone (12 mg) was administered intramuscularly upon admission and repeated in 24 hours. After an 8-hour fast, a 50-g GCT was administered 24 hours (day 1) and 72 hours (day 3) after the second betamethasone injection. Plasma glucose samples were drawn one hour after the glucose challenge. Statistical analysis utilized the McNemar exact test. RESULTS: Seven patients, all with normal GCTs 7-10 days outside the study period, were enrolled. Six had abnormal GCT results on day 1 (P = .03). Three had abnormal results on day 3. CONCLUSION: Betamethasone administration results in abnormal one-hour GCTs in pregnant women.
Adult↗
Obliterated urethra: holmium:yttrium-aluminum-garnet cut-to-light with urolume stenting.
Antegrade-retrograde urethrotomy, or the cut-to-light procedure, performed for obliterated urethra is associated with a high rate of recurrence of urethra] stricture. With the goal of reducing the stricture recurrence rate, we performed a modified cut-to-light procedure using a holmium:yttrium-aluminum-garnet laser and UroLume stenting in a 76-year-old man with urethral obliteration.
Aged↗
Interstitial laser therapy for benign prostatic hyperplasia in the anticoagulated patient.
PURPOSE: Interstitial laser therapy (ILT) was performed without discontinuing warfarin anticoagulation therapy in eight patients (mean international normalized ratio 2.8 +/- 0.8) with benign prostatic hyperplasia. Three patients were in urinary retention and had failed voiding trials. Five had severe symptoms (mean American Urological Association symptom score 22 +/- 7) and had failed medical therapy. MATERIALS AND METHODS: Interstitial laser therapy was performed using the Indigo model 830e LaserOptic Treatment System with the patient under local anesthesia. Mean operative time was 25 minutes and mean total laser energy was 6,785 J. RESULTS: After surgery, spontaneous voiding was achieved by 7 of the 8 patients at 1 week and by all 8 patients at 3 weeks. At 3-month follow-up, mean American Urological Association symptom score was 13 +/- 5, and mean peak urinary flow rate had increased to 12.2 +/- 3.2 mL/s from 8.8 mL/s (excluding retention) before surgery. Interstitial diode laser therapy appears to be a safe and effective technique for treatment of benign prostatic hyperplasia in the fully anticoagulated patient.
Aged↗
Inverted papilloma as a cause of high-grade ureteral obstruction.
Inverted papilloma of the urinary tract is a rare benign lesion. We report, to our knowledge, the first case of high-grade ureteral obstruction caused by an inverted papilloma with coexistent carcinomatous elements. Our patient was referred for evaluation of painless, gross hematuria. Imaging studies demonstrated a left proximal ureteral filling defect causing severe left-sided hydroureteronephrosis. Ureteroscopy demonstrated a 1-cm papillary lesion on the medial aspect of the proximal ureteral wall. Pathologic examination documented a lesion with elements of inverted papilloma and a small focus of well-differentiated transitional cell carcinoma. We discuss the management and significance of this rare urothelial lesion.
Aged↗
Risk factors for symptomatic uterine rupture during a trial of labor: the 1990s.
The purpose of this study is to identify pregnancy and labor factors that place women at increased risk for symptomatic uterine rupture during trial of labor following cesarean section. The study population consisted of 16 women with uterine rupture after a trial of labor who were compared with 32 women without uterine rupture after a trial of labor. Using a case-control study design with a 1:2 match, we examined risk factors that might be associated with an increased risk of uterine rupture. Cases were more likely to have an induction of labor with the use of oxytocin and/or amniotomy (56 vs. 34%) and more likely to undergo augmentation with oxytocin (25 vs. 19%) in comparison with controls. In addition, cases were more likely to be given oxytocin (for either induction or augmentation) (75 vs. 50%) and cervical ripening agents (31 vs. 9%) versus controls. Neonates born after uterine rupture had a higher rate of significant acidosis (pH < 7.0, 57 vs. 0%, p = 0.0002) and lower Apgar scores. There was a significantly higher risk of maternal infection (36 vs. 3%, p = 0.003), transfusion (13 vs. 0%, p = 0.03), and longer length of stay in patients with uterine rupture. There is a trend for increased use of augmentation and induction agents to be associated with uterine rupture. Serious maternal and fetal morbidities are increased following uterine rupture.
Acidosis↗