Referral patterns and diagnoses in women attending a urodynamic unit.
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Adolescent↗
Biomedical subjects
P Abrams
Publications and source records attributed to P Abrams.
Stamey-Martius procedure for severe genuine stress incontinence.
There are few options now available to treat patients with severe genuine stress incontinence caused by urethral failure. These patients usually have a low maximum urethral closure pressure (less than 20 cm of water) and anterior vaginal wall scarring caused by previous surgery. In 32 such patients we used the Martius fat pad insertion procedure, in addition to the Stamey procedure, and achieved a 91% symptomatic success rate over a mean 13-month follow-up period. Because of its simplicity, reliability and low morbidity, we recommend this procedure in this difficult group of patients before performing a sling procedure or insertion of an artificial urinary sphincter.
Adipose Tissue↗
Personal computers and urological research.
The value of a computer in urological research depends not only upon an appropriate and informed choice of hardware, but also the purchase of software programs which will facilitate input, manipulation and transfer of relevant data. Acquaintance with the Data Protection Act is essential, as is registration as a data user in most cases.
Computer Literacy↗
Urological audit: the role for an aggressive approach to high grade superficial bladder tumours.
A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.
Adult↗
Surgical treatment and complications of urinary incontinence.
Numerous surgical approaches to the management of incontinence, particularly genuine stress incontinence, have been reported. No single operation is a panacea for the condition, and many factors must be taken into account before deciding which procedure is best tailored to an individual's needs. The procedures vary in their results, morbidity, and associated complications. Awareness of these previous complications encourages their avoidance and permits better management should they occur.
Female↗
Pilot study of screening for prostate cancer in general practice.
The success of a screening programme for cancer depends on the sensitivity of the tests used and on the proportion of the target population that comes forward for screening. To assess the value of digital rectal screening and prostate-specific antigen (PSA) measurement as screening measures, the 814 men in a city general practice aged between 55 and 70 were recruited in one of five different ways. Men with a palpably suspicious prostate or a serum PSA greater than 4 ng/ml were referred for transrectal ultrasonography and, if indicated, biopsy. 472 men (58%) were screened; of these 68 underwent transrectal ultrasonography and 29 biopsy. In 7 the biopsy specimen showed carcinoma. Serum PSA was better than digital examination as a screening test--all men with prostate cancer had raised concentrations of serum PSA, whereas only 1 had a palpably abnormal prostate. All 7 had localised disease, and 5 underwent radical prostatectomy. The best methods of patient recruitment were to send an appointment for screening and to "tag" the patient's notes.
Aged↗
Urodynamic morbidity and dysuria prophylaxis.
A group of 324 patients received prophylactic treatment with either sodium bicarbonate, potassium citrate or a glucose placebo following urodynamic studies. Urine was screened for infection both before and after testing and the incidence of dysuria assessed by postal questionnaire; 63% of patients experienced some degree of dysuria and this was severe and prolonged in 6.3%, the majority of whom were male. Neither sodium bicarbonate nor potassium citrate was any more effective in preventing dysuria than placebo. The presence of severe prolonged dysuria was not associated with a urinary tract infection or with any particular urodynamic diagnosis.
Bacteriuria↗
Indoramin in the treatment of prostatic bladder outflow obstruction.
A series of 40 patients took part in a double-blind, placebo-controlled trial of indoramin in prostatic bladder outflow obstruction. Patients were assessed clinically and urodynamically before and after 4 weeks' treatment. Significant improvement was seen in nocturia, volume voided, flow rates and residual urine. The drug was well tolerated, although 7 patients on treatment and 7 on placebo noted side effects. These results suggest that indoramin may be a useful agent in the symptomatic management of bladder outflow obstruction.
Double-Blind Method↗
Para-urethral collagen implantation for female stress incontinence.
A series of 25 women with genuine stress incontinence were treated by para-urethral injection of glutaraldehyde cross-linked collagen. The technique was simple and associated with few complications. Follow-up at 3 months revealed 20 patients (80%) to have been symptomatically improved or cured. An increase in urethral closure pressure together with a decrease in urine flow rate and increase in detrusor pressure was found post-operatively. The success rate was significantly higher (90%) in patients who had undergone previous surgery for urinary incontinence when compared with those who had had no previous surgery (73%).
Adult↗
Limiting similarity and the form of the competition coefficient.
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Animals↗
Clinical experience with Tc-99m labeled (N2S2) anti-melanoma antibody fragments and single photon emission computed tomography.
We evaluated the imaging capability of murine Tc-99m-labeled antimelanoma Fab fragments in 12 patients with clinical stage II and III melanoma. Tc-99m-NRX118.7 antimelanoma Fab fragment, 10.0 to 27.2 mCi (370-1, 006 MBq), was injected IV 30 min after irrelevant nonspecific intact antibody and 5 min after intact specific antibody were given. In all patients, whole-body scans and spot views were obtained. Single photon emission computed tomography (SPECT) was additionally performed in eight of the patients. The procedure was well tolerated, and 31 of 38 known foci of melanoma were detected (sensitivity, 82%). SPECT aided in detecting and better localizing lesions in the head, neck, and chest. The specificity of the technique was satisfactory when interpretation was performed with a knowledge of normal sites of accretion and excretion of technetium-99m activity such as the kidneys and gut. In several instances, lesions were discovered by means of the antibody scan before detection by other methods, and in two instances, the lack of visualization on antibody scan of a palpable mass correctly indicated that no melanoma was present in the mass. Scan results in three patients led to alterations in patient care; including preventing aggressive surgical and nonsurgical treatments. Although these data are encouraging, evaluation in additional patients will be essential to determine the clinical utility of this antibody scan in the management of patients with melanoma.
Adult↗
Artificial urinary sphincters.
The use of artificial sphincters for the treatment of urinary incontinence has evolved steadily over the last few decades. Currently available designs are suitable for implantation in male and female patients of all age-groups. This article describes the clinical implications of artificial urinary sphincters in the treatment of incontinent patients.
Female↗