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R Turner-Warwick

Publications and source records attributed to R Turner-Warwick.

At least 19 recordsLinked to original sources
PubMed1990

The construction and reconstruction of the vagina with the colocecum.

Absence of the vagina is a distressing problem. In this study, we present the results for 13 patients treated by vaginal replacement using an isolated colocecal segment. There were no important surgical complications, and none of the patients had stenosis of the neovagina. At the time of this report, seven patients had regular and satisfactory intercourse, and none of the remaining patients thought that they were incapable. It is concluded that the colocecal segment provides an acceptable substitute for the vagina and that this procedure is appropriate for the more complex instances of congential and acquired vaginal atresia.

Anastomosis, Surgical↗
PubMed1989

Prevention of complications resulting from pelvic fracture urethral injuries--and from their surgical management.

Times have changed, and urology is not what it was: it is no longer possible for any urologist to be an in-depth expert in more than one or two of its many expanding subspecialist fields--such as pediatric, oncology, reconstruction and functional restoration, stone surgery, gynecourology, neuropathic urinary tract dysfunction, transplantation, fertility, and andrology, etc. Although some techniques for the resolution of urethral strictures, such as dilatation and internal urethrotomy, can be regarded as general urologic procedures, the problems involved in definitive urethral reconstruction should never be underestimated. The potentially complicated nature of a pelvic fracture urethral injury is entirely apparent. It is particularly important to appreciate that an apparently short subprostatic stricture cannot be reliably identified preoperatively as 'simple' and consequently appropriate for a simple perineal approach repair; any surgical failure to resolve a urethral distraction defect inevitably complicates it and may even preclude a subsequent anastomotic retrievoplasty. Thus, surgeons with a general urologic training who do not have both a special additional and ongoing experience of reconstructive procedures and a particular aptitude for the problems involved must be advised that "having a go" is not in the best interests of their patients. The prevention of complications is the essence of good surgery and is essentially a personal matter because many contrarily conceived procedures work quite satisfactorily in the hands of others: consequently, many of the views expressed in this communication are essentially personal, and references to personal publications are made to substantiate statements. However, no one is more conscious than I am of the contributions of friends and colleagues across the world who are interested in the most intriguing field of functional reconstruction, and I am also particularly grateful to the many who have most generously referred their patients and thus created the series on which this article is based.

Female↗
PubMed1984

Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation.

A technique is described for recording the electromyographic activity of striated muscle in the urethral sphincter. Using a concentric needle electrode and an oscilloscope with a delay line and trigger, individual motor units were isolated and measured. To validate the method as a means of detecting pathology, the results are presented of analysis of the motor units of a group of patients with disturbances of micturition, known to have either cauda equina lesions or pelvic nerve injury. These results are compared with those from a group of controls. In the control group 93% of the motor units were less than 6 ms in duration and 2.0 mv in amplitude. Of motor units recorded from patients with cauda equina or pelvic nerve injury 59% exceeded the control ranges for amplitude or duration. It is concluded that quantitative analysis of individual motor units may be a helpful technique in the investigation of patients with disorders of micturition.

Adult↗
PubMed1983

Non-obstructive detrusor failure. A urodynamic, electromyographic, neurohistochemical and autonomic study.

Twenty-eight patients presenting with persistent loss of the voiding reflex have been evaluated. Those with cauda equina lesions or pelvic nerve injury were distinguished from a group with idiopathic detrusor failure by their abnormal urethral behaviour during filling, and by urethral sphincter electromyography (EMG). Bladder muscle biopsies revealed the presence of presumptive cholinergic fibres in all three groups, indistinguishable in quantity and distribution from normal controls. The implications of these findings for the diagnosis and management of these patients is discussed.

Adult↗
PubMed1979

The intravenous urodynamogram.

Modifications to the intravenous urogram are described. It is suggested that the time has come to rationalise the standard procedure. If an evaluation of the lower urinary tract is required, the voiding films may be modified to provide an intranvenous urodynamogram. If an evaluation of the upper urinary tract is directed at a specific question, then the number of spot-films can often be reduced.

Adult↗
PubMed1979

Observations upon techniques for reconstruction of the urethral meatus, the hypospadiac glans deformity and the penile urethra.

Many minimal defects of the terminal urethra may be left untreated; others may be considerably improved by a simple one-stage extension to a terminal position by one of the many one-stage "flap-strip" procedures. Patients with a marked ventriflexed glans are much better treated by the "kippered-glans" procedure; undertaken as a two-stage procedure, the functional and the cosmetic results of this procedure are extremely good and reliable. The results of one-stage procedures reflect the experience and the judgement of the surgeon but they tend to be less perfect and furthermore there is always an element of "double or quits" inasmuch as complications may require revision procedures. Thus a minor surgical dilemma arises because both the cosmetic and the functional results of a two-stage "kippered-glans" procedure for severe hypospadiac deformities tend to be better than those achieved for minor deformities by one-stage flap-strip or glans-flap procedures.

Humans↗
PubMed1978

Results of prolonged bladder distension as treatment for detrusor instability.

Forty-six patients with urinary symptoms associated with unstable (uninhibitable) detrusor contractions have been treated by a total of 58 bladder distensions; 43 of these were fully re-evaluated urodynamically thereafter and none showed conversion from unstable to stable detrusor behaviour. Four patients with unstable bladders were symptomatically improved but 5 patients reported symptomatic deterioration. We have concluded that while over-distension may sometimes improve a patient's symptoms, it did not result in the abolition of detrusor contractions or the reversal of unstable detrusor behaviour.

Adolescent↗
PubMed1977

A personal view of the immediate management of pelvic fracture urethral injuries.

1. The best treatment for all but the most severe urethral injuries associated with pelvic fractures must surely be suprapubic catheter drainage without local exploration. 2. The free drainage of exudates from an injured urethra is be obstructed by the larger sizes of standard-shaft indwelling catheter; the use of a standard shaft catheter in an injured urethra requires careful consideration in relation to the individual problem and should not be a routine; however, a fenestrated catheter may have some positive advantages. 3. The results of treating the less severe fracture-dislocation injuries by suprapubic catheter are sufficiently good to make any attempt at immediate local readjustment of incomplete dislocations inadvisable for all but those with a special experience of the surgery of the traumatized urethra. 4. If abdominopelvic exploration has to be undertaken for non-urologic indications, the repositioning of a dislocated bladder base by the aligned sling-suture technique is a relatively simple procedure which can be swiftly and reliably accomplished by an emergency surgeon. 5. The treatment of a urethral injury, even if severely dislocated, is not in itself a matter of immediate urgency once suprapubic catheter drainage has been established; however, exploration for continued bleeding may be. If bleeding is controlled by local tamponade there may be considerable advantage in postponing definitive resolution of a massive urethral dislocation for a week or so because the patient is usually fitter and the procedure is less likely to be complicated by serious hemorrhage. When a particular urethral injury is considered suitable for a delayed primary repositioning, the patient may be fit enough to transfer to the care of a urologic department with special experience of these problems.

Child↗
PubMed1976

The use of the omental pedicle graft in urinary tract reconstruction-.

The omentum is unique in that it is the only body tissue specifically developed for the resolution of infected process; it also regains its suppleness once healing has taken place. The characteristics are not shared by the periureteral and perivesical tissues so that a properly mobilized pedicle graft is valuable adjunct to be more difficult repairs and reconstructions of the urinary tract.

Female↗
PubMed1976

Complex traumatic posterior urethral strictures.

A distinction between simple and complex posterior urethral strictures is proposed. The development of a complex stricture, requiring an extensive transpubic repair, must be regarded as a less than admirable result of the initial treatment, even if it is occasionally inevitable. However, it is particularly important that our endeavors to improve the end result of the relatively rare severe urethral injuries should not result in over-management of the relatively minor injuries, since this could increase the stricture potential of many. Therefore, we must keep our over-all concepts of the initial management of urethral injuries under careful review. Posterior urethroplasty should be regarded as a specialist procedure. It can be made to appear beguilingly simple but it cannot be recommended for occasional or general use. Even the relatively simple free patch graft technique is inadvisable for use in the sphincter area for surgeons who do not have considerable experience of it in the relatively forgiving bulbourethral area. The results of repair of posterior urethral strictures, even the complex ones, by anastomotic procedures can be excellent but real competence depends upon a particular aptitude of the surgeon for the minutiae of reconstructive techniques, appropriate training in a specializing department, a real ongoing numerical experience and special instrumentation with facilities for detailed urodynamic evaluation of this sphincter active area of the urethra.

Abdominal Injuries↗
PubMed1975

The use of the omental pedicle graft in urinary tract reconstruction.

The omentum is unique in that it is the only body tissue specifically developed for the resolution of infected process; it also regains its suppleness once healing has taken place. These characteristics are not shared by the peri-ureteral and per-vesical tissues so that a properly mobilized pedicle graft is a valuable adjunct to the more difficult repairs and reconstructions of the urinary tract.

Aortic Diseases↗