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Biomedical subjects

R A Appell

Publications and source records attributed to R A Appell.

At least 73 records · Page 4Linked to original sources
PubMed1994

Multicenter trial in North America of UroLume urinary sphincter prosthesis.

We investigated the effectiveness and associated complications of treatment with an endoluminal urethral sphincter prosthesis in 153 spinal cord injury men (mean age 36 years, range 16 to 74 years) with urodynamically diagnosed detrusor-external sphincter dyssynergia. These patients were prospectively treated with a urethral sphincter stent at 15 centers in North America. Followup ranged from 2 to 33 months. Voiding pressures averaged 76 +/- 28, 42 +/- 21, 44 +/- 38, 35 +/- 18 and 32 +/- 20 cm. water, respectively, before prosthesis insertion in 153 patients and at 3 months in 123, 6 months in 114, 12 months in 98 and 24 months in 22. A significant decrease in voiding pressure was noted in the 22 patients at 24 months compared with matched preoperative data (80 +/- 25 cm. water, p = 0.03). The residual urine decreased from 181 +/- 154 ml. before insertion to 82 +/- 93 ml. at 24 months (p = 0.01). Maximum cystometric capacity remained constant, with a mean of 195 +/- 158 ml. before insertion to 248 +/- 122 ml. at 24 months (p = 0.17). No significant differences were apparent after 24 months of followup in any of the urodynamic parameters between 44 patients with and 109 without previous external sphincterotomy. Hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth and soft tissue erosion did not occur. No deleterious effects were observed on renal or erectile function. Of the patients 43 (28.1%) required 2 prostheses to bridge the external sphincter completely. Stent removal was required in 10 patients. Seven explantations were required for prosthesis migration, 1 for pain and urethral edema, 1 for inability to maintain a condom catheter, and 1 for nonepithelialization and secondary bladder neck obstruction. A total of 13 patients (8.5%) required a subsequent operation for bladder neck obstruction. Therefore, the sphincter prosthesis is an attractive modality for the treatment of external sphincter dyssynergia in patients with and without previous external sphincterotomy because of its ease of deployment and minimal associated morbidity.

Adolescent↗
PubMed1994

Pathogenesis and medical management of benign prostatic hyperplasia.

This is simultaneously an exciting and confusing time for those caring for patients with BPH. For years we thought we had the answer, TURP, but costs and complications have opened this area for further study in alternative methods for the management of BPH. The pathogenesis and the maintenance of BPH is poorly understood and the natural history of BPH has not been well characterized. The bothersome level of symptoms to individual patients varies widely as well as the expectations of patients to the outcome of treatment. Satisfaction and cure are not necessarily identical, especially in patients with BPH, in which there seems to be great variability in the clinical course. Perhaps, in the future, this will be able to be related to the equally variable histological picture of BPH. There are problems in designing appropriate clinical trials for the evaluation of new treatments for BPH to take into account these variabilities in patient cases and histology (Table 9). The proper evaluation of new approaches to the management of patients with BPH takes years to complete, and physicians must resist the temptation to rush into any new treatment without reasonable caution for proven safety and efficacy when compared with existing modalities of treatment.

Adrenergic alpha-Antagonists↗
PubMed1994

Collagen injection therapy for urinary incontinence.

The goal of treatment in patients with ISD is to allow for coaptation of the urethral mucosa without obstruction. Urodynamically this means that the pressure necessary to open the urethra (leak point pressure) is increased but no appreciable change occurs in the closure pressure of the urethra. Periurethral injections have the potential to accomplish this need. Contigen appears efficacious and safe in the properly chosen patient. The cross-linking of the bovine collagen has enhanced the durability of the substance when injected and reduced the potential to produce local immune-type reactions. None of the patients in the multicenter trial (many of whom have been followed for more than 5 years) have had an adverse event related to immunogenicity. The technical aspects of the actual injection process are easily learned, and no special equipment is needed. More important than technique is patient selection. The best results are attained in those patients who do not have detrusor problems, have an adequate bladder capacity, and have minimal anatomic abnormality (urethral hypermobility). Because injection of Contigen can usually be done with local anesthesia alone, a significant number of patients who are not acceptable candidates for open surgical procedures (slings and artificial sphincters) may benefit from this treatment. It is anticipated that Contigen will be a valuable adjunct in the management of both adult and pediatric incontinence problems.

Biocompatible Materials↗
PubMed1992

Evaluation of urinary incontinence in the elderly.

Urinary incontinence affects millions of elderly American men and women. This paper reviews the causes of urinary incontinence and the evaluation that can be easily accomplished as an outpatient with minimal expense and morbidity.

Aged↗
PubMed1991

Urinary incontinence. Not a 'normal' part of aging.

Urinary incontinence is a common problem that affects millions of elderly men and women and their caregivers. Evaluation of incontinence is easy and inexpensive and does not require hospitalization. A basic evaluation consists of history taking (including a review of drug use), physical examination, and appropriate laboratory testing. Urodynamic evaluation may also be necessary. Treatment may consist of behavior modification techniques (eg, Kegel exercises, biofeedback, bladder retraining), use of a mechanical device or pharmacologic agent, or surgery. Should medical and surgical methods fail, alternatives are available to ensure patients' well-being and comfort.

Aged↗
PubMed1989

The use of the Magnetip double-J ureteral stent in urological practice.

The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.

Adult↗
PubMed1982

Experience with a laterally based vaginal flap approach for urethral diverticulum.

We found 15 cases of urethral diverticula in female patients who were evaluated for recurrent urinary tract infection. A voiding cystourethrogram was the most useful investigative technique. All cases were managed by a vaginal approach, using a laterally based flap incision. There were no complications with this easily learned technique, which makes full exposure of the diverticulum easy and covers the urethral defect with intact vaginal wall. Using this technique we have had no delayed healing, fistula formation or incontinence. A history of gonorrhea may have an etiologic role in acquired diverticula.

Adult↗
PubMed1981

Effect of experimental bilateral cryptorchidism on in vitro metabolism of progesterone by rat testis.

Changes in the in vitro capacity to convert progesterone (4-pregnen-3,20-dione) to its metabolites were studied in testes of experimentally cryptorchid adult rats for varying lengths of time. Cryptorchidism resulted in a decrease in testicular, seminal vesicle, and prostatic weights, implying suppression of in vivo androgen production and this decrease was confirmed in vitro. Cryptorchidism decreased the conversion of androgen from progesterone and increased the formation of 20 alpha-dihydroprogesterone (20 alpha-dihydroxy-4-pregnen-3-one). This indicated that enzyme activity for androgen analysis synthesis from a progesterone substrate in the rat testis was heat-sensitive and suggested 20 alpha-dihydroprogesterone may have an important role as the primary steroid produced in experimental cryptorchidism.

20-alpha-Dihydroprogesterone↗