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Biomedical subjects

R Bruskewitz

Publications and source records attributed to R Bruskewitz.

At least 37 records · Page 2Linked to original sources

Symptom analysis of patients undergoing modified Pereyra bladder neck suspension for stress urinary incontinence. Pre- and postoperative findings.

The results of a physician-directed follow-up of 145 women undergoing the modified Pereyra bladder neck suspension from March 1980 to February 1986 are presented. Median follow-up was 3.5 years (2.0-7.7); 70 percent of patients had follow-up between three and four years postoperatively. All patients had preoperative demonstration of stress incontinence as well as urodynamic evaluation. Fifty-one percent of patients reported no stress incontinence and 76 percent reported that their sense of urinary control was better, or much better at the time of follow-up. Improvement was seen in all grades of stress incontinence. Age, weight, parity, and history of prior anti-incontinence surgery had no significant impact on success rates. Although preoperative urgency symptoms were more common among failure (28% vs 15%), this association was not statistically significant. However, persistent or de novo urgency symptoms postoperatively were highly associated with postoperative incontinence (p less than 0.005). The onset of recurrent incontinence was experienced more than two years postoperatively in 23 percent of the incontinent group.

Female↗

Further study of the increased mortality following transurethral prostatectomy: a chart-based analysis.

Previous studies using large administrative databases found an elevated relative risk of reoperation and death after transurethral resection of the prostate compared to open prostatectomy. To investigate whether differences in case-mix unmeasured by administrative data explained this finding, we reviewed the charts of 485 patients who had undergone prostatectomy (236 open and 249 transurethral) at the Health Science Centre, Winnipeg, Manitoba, Canada between 1974 and 1980. Data from patient histories, physical examinations and laboratory evaluations were abstracted and used to control for case-mix in models comparing the rates of reoperation and mortality after transurethral versus open prostatectomy. Several models were specified. In all models the relative risk of dying after transurethral prostatectomy remained elevated (1.36 to 1.89), as did the risk for reoperation (3.62). A prospective trial is needed to establish the relative safety and effectiveness of transurethral and open prostatectomy.

Aged↗

AMS malleable penile prosthesis.

The American Medical Systems (AMS) malleable penile prosthesis was implanted in 57 patients from January, 1983 to 1985. Fifty-one per cent of the procedures were performed under local anesthesia, and 28 per cent in ambulatory (day) surgery. The prosthesis was evaluated in terms of cosmetic result, patient satisfaction and function, and postoperative complications. Ninety-one per cent of patients were satisfied with their decision to select the malleable prosthesis, and 66 per cent reported no difficulty with concealment. A comparison is made with data available from the alternative Jonas malleable prosthesis.

Adult↗

Predictive value of low maximum flow rate in benign prostatic hyperplasia.

Among 84 patients with prostatism selected for transurethral resection of the prostate, 18 had a maximum flow at spontaneous uroflowmetry less than or equal to 7 ml/sec. Preoperatively there was no significant difference between patients with maximum flow less than or equal to 7 ml/sec (Group 1) and patients with maximum flow greater than 7 ml/sec (Group 2) in age, duration of symptoms, symptom scores, bladder volume, residual urine, and detrusor pressure at maximum flow. Patients in Group 1, however, had significantly lower urethral resistance and bladder volume independent maximum flow than patients in Group 2. Postoperatively, patients with preoperative maximum flow less than or equal to 7 ml/sec improved significantly in symptom scores and urodynamic findings apart from bladder volume and detrusor pressure at maximum flow. There were no significant differences between groups in postoperative symptom scores or urodynamic findings. We conclude that preoperative maximum flow rates less than or equal to 7 ml/sec at spontaneous uroflowmetry were related to high urethral resistance and not detrusor decompensation among patients with prostatism, and that patients with maximum flow rates less than or equal to 7 ml/sec fared as well postoperatively as patients with maximum flow greater than 7 ml/sec.

Aged↗

Long-term clean intermittent self-catheterization in renal transplant recipients.

Eight renal transplant recipients with neurogenic bladders or lower urinary tract dysfunction were managed with clean intermittent self-catheterization after transplantation instead of urinary diversion. A total of 85 treatment months was reviewed. Of the patients 5 continue to do well after 10 to 17 months of intermittent catheterization and 3 suffered immunological graft failures. In selected renal transplant recipients with lower urinary tract dysfunction clean intermittent catheterization is a reasonable alternative to urinary diversion.

Adolescent↗

Impact of an intermittent catheterization program on children with myelomeningocele.

Among 164 children being followed in a myelomeningocele clinic, 85 (52%) are on an intermittent catheterization program (ICP). Among 53 children on ICP for 5 years or more, a high percentage have achieved satisfactory dryness, decreased frequency of urinary tract infection, and improvement in renal status. The potential for improved well-being afforded by ICP is one factor that should be considered in decisions about "active" or "supportive" treatment in newborn infants with myelomeningocele.

Child↗

Evaluation of obstructive uropathy with diuretic renography.

Diuretic renography has been recommended as a useful test to distinguish obstructed from dilated, but not obstructed, urinary systems. Twenty-four diuretic renograms were performed in 20 children, and a good correlation was found with other indicators of obstruction. The sensitivity for identifying obstruction was 83%, with a specificity of 94%. Severe hydroureteronephrosis may blunt or even mask the effect of diuresis on causing emptying of the tracer from the renal pelvis. Some kidneys did not drain well with the patient in a supine position but did empty with a change of position; these kidneys should be regarded as nonobstructed.

Adolescent↗

The relevance of minimum urethral resistance in prostatism.

To determine whether the minimum urethral resistance was useful to identify bladder outlet obstruction in prostatectomy candidates, 46 patients undergoing transurethral resection of the prostate were evaluated by means of detailed symptom analysis, cystoscopy, rectal examination and post-void residual urine determination. In addition, each patient underwent extensive urodynamic testing, the results of which were not made available to the operating urologist as patients were selected for surgery. This prospective, blind evaluation has been completed in 33 and 15 patients 3 and 12 months postoperatively, respectively. A correlation is noted between the minimum urethral resistance, and symptomatology and uroflowmetry but no correlation was identified with prostatic length and the resected prostatic weight. The minimum urethral resistance was not useful in predicting which patients would benefit from transurethral resection of the prostate. It is concluded that symptom analysis generally is a better predictor of the outcome of transurethral resection of the prostate than is minimum urethral resistance.

Adolescent↗

Treatment of urinary incontinence with the artificial sphincter.

From December 1977 to November 1978, 21 American Medical System 742A artificial sphincters were implanted in 19 male and 2 female patients with a variety of etiologies for incontinence, including post-prostatectomy incontinence, female incontinence following unsuccessful bladder neck suspension and myelodysplasia. Urodynamic evaluation before sphincter placement is reviewed. Eight patients (38 per cent) had excellent or improved results, while 5 (24 per cent) remained unchanged and 5 (24 per cent) suffered urethral erosion. Between January and September 1979, 18 patients had placement of the 742B or 742C model of the sphincter. Again a variety of etiologies for incontinence was represented, including 11 patients with postoperative male incontinence (10 after prostatectomy). Over-all, 9 patients (50 per cent) had excellent or improved results, while 6 (33 per cent) suffered urethral erosion. Of the post-prostatectomy group 50 per cent had excellent or improved results, while 50 per cent had erosion. Failures occurred more frequently in women, in patients with recurrent urinary tract infections or neurogenic bladders, and after failure of previous anti-incontinence surgical procedures.

Adolescent↗

Female urethral diverticula: double-balloon catheter study.

A double-balloon catheter was used to evaluate the female urethra in 51 patients. Six different radiographic appearances were identified. Three of the categories are considered variants of normal. One of the categories consisted of eight patients with urethral diverticula. All showed large rounded or lobulated collections of contrast material which were adjacent to the urethra and which persisted on postvoid films. Other abnormalities should be closely correlated with the clinical findings to determine their significance. The diagnosis of urethral diverticulum may be missed, as physical examination and endoscopy can be negative. Therefore, the optimal method for identifying its presence and extent includes both a double-balloon catheter study and a voiding cystourethrogram.

Adult↗

Surgical considerations in treatment of Peyronie disease.

A comparison is made of two groups of patients treated surgically in nonrandomized fashion for Peyronie disease. The first group was treated with excision of the plaque and dermal patch graft; the second with simple incision of the plaque and implantation of penile prostheses. Literature and personal experience comparing the two methods are discussed.

Humans↗

AMS 742 sphincter: UCLA experience.

Between December 1977 and November 1978 artificial sphincters were implanted in 2 female and 19 male patients for the treatment of urinary incontinence. Etiologies for incontinence varied, including post-prostatectomy incontinence, myelodysplasia and female incontinence after unsuccessful bladder neck suspension. Over-all, 38 per cent of the patients were excellent or improved postoperatively, while 24 per cent experienced continuing unabated urinary incontinence and 24 per cent experienced urethral erosion at the site of cuff placement. The device was removed in 14 per cent of the patients when it became infected.

Adolescent↗

Radiographic evaluation of an artificial urinary sphincter (AMS 742).

The American Medical Systems' inflatable anti-incontinence device is a relatively new prosthesis. Its design, function, and proper method of radiographic evaluation in the pre- and postoperative patient are discussed. Complications peculiar to this device are demonstrated.

Humans↗

Urethral pressure profile using microtip catheter in females.

The use of urethral pressure profilometry in the clinical investigation of dysfunction of the female lower urinary tract is discussed. Included is a description of the use of two-channel microtip profilometry in the urethral syndrome, urinary retention, detrusor hyperreflexia, stress incontinence, and normal females. Dual-channel profilometry improves the diagnostic accuracy of urethral profile studies and aids in the understanding of lower urinary tract pathophysiology.

Adult↗

Extravesical ureteroplasty.

The results of extravesical ureteroplasty (Lich-Gregoir technique) for primary extravesical reflux in 62 children with 82 refluxing renal units are evaluated. Postoperative radiograms revealed persistent reflux in 5 (6.1 per cent) and obstruction in 1 (1.2 per cent) of the renal units. Of 7 patients in whom bilateral reflux had been noted previously but who had unilateral reflux at the time of operation, unilateral repair resulted in absence of reflux on the contralateral side in 6. The favorable success rate, low morbidity and median 5-day hospitalization support the use of extravesical ureteroplasty for uncomplicated reflux.

Adolescent↗