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Biomedical subjects

S D Boyd

Publications and source records attributed to S D Boyd.

At least 73 records · Page 4Linked to original sources
PubMed1989

[The Kock continent urinary diversion].

The continent ileal reservoir as conceived by Kock produces a low-pressure, high-capacity reservoir with continent and nonrefluxing valves constructed from ileum. From August 1982 through March 1988, 531 patients underwent continent urinary diversion via a Kock reservoir at our institution. Of these, 39 males had a Kock bladder substitution, while the rest underwent cutaneous Kock diversion. Early complications occurred in 16% of all patients, and there was an operative mortality rate of 1.9%. Surgical modifications of nipple fixation, which are discussed in detail in this paper, help to reduce late complications to less than 10%. Patient satisfaction with both procedures remains excellent.

Adolescent↗
PubMed1988

Role of urethral reconstruction and artificial sphincter in complicated salvage radical prostatectomy.

Patients undergoing radical prostatectomy following failed definitive radiation therapy for adenocarcinoma of the prostate run a substantial risk of refractory bladder neck contractures and urinary incontinence developing. A combined reconstructive technique utilizing a urethral pull-through procedure and implantation of an artificial urinary sphincter to treat these complications is described. When a patient can truly be cured by radical prostatectomy, this relatively straightforward reconstruction can salvage what otherwise would be considered a surgical failure.

Adenocarcinoma↗
PubMed1988

Two-stage technique for implantation of inflatable penile prosthesis in pelvic cancer surgery.

A two-stage technique for implantation of an inflatable penile prosthesis has been developed for patients undergoing radical pelvic cancer surgery. Over the past five years, this method has been utilized in 147 men undergoing radical cystectomies or prostatectomies. The technique involves implanting the reservoir and pump of the prosthesis at the time of the radical cancer operation when the lateral neurovascular bundles of erection are being sacrificed. The reservoir and pump are permanently connected, and the cylinder tubings from the pump are temporarily connected and placed in the subcutaneous tissue overlying the pubis. During a second procedure, usually six to twelve weeks later, the cylinders are implanted infrapubically and connected to the easily located pump tubing. The advantages are several. (1) The pump and reservoir are easily implanted during the pelvic surgery while importantly not adding significantly to the operative time or morbidity of the primary procedure. (2) The reservoir is easily positioned in the pelvis. (3) The scrotum with its contained pump already will be healed when the entire prosthesis is connected, bypassing the initial scrotal pain and edema. (4) Psychologically the patients feel relieved that their erectile dysfunction is being treated immediately. This two-stage technique appears to maximize the gain of early and easy implantation while minimizing the potential problems of concomitant surgery.

Humans↗
PubMed1988

The hemi-Kock augmentation ileocystoplasty: a low pressure anti-refluxing system.

Experiences with various methods of using intestinal segments for bladder augmentation and urinary undiversion, as well as with clinical applications of the Kock continent ileostomy for urinary diversion have led us to develop the hemi-Kock augmentation ileocystoplasty for selected patients requiring a nonrefluxing bladder augmentation. In 6 of 7 patients this bladder augmentation technique fulfilled the requirement for a low pressure nonrefluxing reservoir. Renal function has been preserved and electrolyte problems have not occurred. Nocturnal incontinence has been eliminated. Although 2 of 7 patients required surgical revision patient acceptance has been excellent. Prerequisites to implementing this approach are appropriate patient selection and familiarity with the surgical principles of the continent ileal reservoir.

Adult↗
PubMed1988

Treatment of unusual Kock pouch urinary calculi with extracorporeal shock wave lithotripsy.

Since the establishment of extracorporeal shock wave lithotripsy for the treatment of upper urinary tract calculi, further potential applications have been explored. We report the successful use of extracorporeal shock wave lithotripsy for the treatment of obstructive calculi on staples within the afferent nipple of a Kock pouch ureteroileal urinary diversion.

Adult↗
PubMed1988

A comparative study of perioperative complications with Kock pouch urinary diversion in highly irradiated versus nonirradiated patients.

To define the nature and risk of complications associated with Kock pouch urinary diversion after high dose radiation (more than 4,500 rad), we analyzed the clinical course of 44 irradiated patients and a comparable group of 42 selected retrospectively from the nonirradiated patient cohort. Of the 42 patients in the irradiated group 18 had received 4,500 to 5,700 rad and 24 had received 6,000 to 8,700 rad. With standard statistical methods we found no difference between the irradiated and control groups when compared for age, sex ratio, followup interval, surgical procedure, operative time or estimated blood loss. There were 2 operative mortalities in the irradiated and 1 in the control groups. In the immediate postoperative period there was no difference between the irradiated and control groups when compared for hospital stay, incidence of urine leak or fascial dehiscence. The irradiated group had 8 urine leaks (20 per cent) and 3 patients (7.5 per cent) required surgical repair. The control group had 5 urine leaks and 1 patient (2.3 per cent) required repair. Diarrhea severe enough to require further hospitalization or medication was significantly more frequent in the irradiated group (18 versus 2 per cent) but the postoperative stay was not significantly different (13 versus 11 days). We conclude that Kock pouch urinary diversion may be performed safely in highly irradiated patients.

Combined Modality Therapy↗
PubMed1988

Continent urinary diversion. A 5 1/2 year experience.

From August 1982 through March 1988, 531 patients have undergone continent urinary diversion using an ileal reservoir constructed according to the method of Kock. For the past year, the Division of Urology at the USC School of Medicine in Los Angeles has used the principle of Kock reservoir construction for primary lower urinary tract reconstruction after cystectomy in 39 highly selected male patients by means of a ureteroileal urethrostomy. Early complications occurred in 86 of 531 patients (16.2%), resulting in an operative mortality rate of 1.9% (ten of 531). The early complication rate was 16.5% in patients undergoing single stage cystectomy and Kock pouch construction and 15.2% among patients undergoing Kock pouch conversion. Late complications have been analyzed in a group of 489 patients who have undergone Kock cutaneous diversion. The complications unique to continent urinary diversion, their incidence, and the effect of technical modifications in reducing the number of late complications are discussed. Since the time of the last modification, in July 1985, the overall incidence of late complication has dropped to 22%. Based on this ongoing experience, the authors conclude that: 1) the continent ileal reservoir as conceived by Kock remains the best internal reservoir for bladder replacement in terms of volume, accommodation with the lowest internal pressures compared with other alternative reservoir construction, 2) the intussuscepted ileal nipple valve mechanism is a reproducible, highly effective mechanism that prevents reflux in 95% of patients and produces excellent continence, 3) our enthusiasm remains tempered by the need for reoperation in approximately 10-15% of patients, usually due to a pinhole fistula or false passage at the base of the efferent nipple valve mechanism, 4) electrolyte abnormalities rarely occur and gastrointestinal dysfunction is unusual in the absence of radiation, and 5) continent urinary diversion is a viable long-term concept that provides a real alternative in terms of quality of life and self-image for the patient undergoing urinary diversion.

Adolescent↗
PubMed1988

Complications of the Kock pouch.

Over the past 41/2 years, 395 consecutive Kock pouch procedures have been performed by the urology faculty at the University of Southern California School of Medicine as an alternative to conventional cutaneous urinary diversion. This article reviews the early and late complications experienced in the 386 patients surviving the operation and describes in detail modifications in surgical technique designed to reduce the complication rate and the subsequent need for re-operation. We remain convinced that construction from ileum of a low-pressure, high-capacity internal reservoir with continent and nonrefluxing valves as originally described by Kock remains the ultimate technique for patients requiring permanent urinary diversion or for those requiring conversion from a pre-existing form of diversion.

Adolescent↗
PubMed1987

Quality of life survey of urinary diversion patients: comparison of ileal conduits versus continent Kock ileal reservoirs.

There has been a recent marked increase in interest in continent urinary diversions. While considerable time has been spent on the technical aspects of these diversions the psychological impact has not yet been fully explored. We describe an extensive survey that was conducted among 100 consecutive adults (87 respondents) who had undergone urinary diversion via an ileal conduit and 100 consecutive adults (85 respondents) in whom a continent Kock ileal reservoir was created during the last 3 to 5 years at our university by the same surgeons. The Kock pouch patients were stratified further into 63 with primary diversion and 22 who underwent conversion from previous conduit diversions. The survey consisted of a questionnaire that included a social and sexual survey, the Beck Depressive Inventory, the Profile of Mood States and a physical impact study. The results revealed that all patients surveyed generally were satisfied with the diversions and they had adapted reasonably socially, physically and psychologically. The key to adaptation seemed to be a detailed, realistic preoperative education about the type of diversion used. Patients with ileal conduit diversions had the lowest expectations of the form of diversion as defined by the preoperative awareness of the need to wear an external ostomy appliance with its associated inconveniences and change in the external body image. Postoperatively, ileal conduit patients also had the poorest self images as defined by a decrease in sexual desire and in all forms of physical contact (sexual and nonsexual). The subset of patients who underwent conversion from conduit diversions to Kock pouches, however, were statistically the most satisfied, and they were the most physically and sexually active. We conclude that the Kock continent urostomy offers an important alternative to noncontinent forms of diversion.

Adaptation, Psychological↗
PubMed1987

Continuing experience with the continent ileal reservoir (Kock pouch) as an alternative to cutaneous urinary diversion: an update after 250 cases.

The continent ileal reservoir as conceived by Kock produces a low pressure, high capacity reservoir with continent and nonrefluxing valves constructed from ileum. From August 1982 through August 1985, 250 patients underwent this type of surgery at our institution. Of these patients 171 underwent simultaneous radical cystectomy for cancer, 60 had had a previous urinary diversion of another type and 19 had a neurogenic bladder. Our experience represents a series of expected complications and ongoing modification to the surgical technique. A total of 42 patients (16 per cent) suffered early complication resulting in an operative mortality rate of 2 per cent (5 of 250). One or more late complications necessitating 85 revisions occurred in 77 patients (31 per cent). The end result has been an overwhelming success tempered only by the need for reoperation. It is believed that the surgical modifications described will decrease further the incidence of late complications. The basic surgical premise as conceived by Kock remains a low pressure, high capacity reservoir with continent and nonrefluxing valves that can be constructed from ileum. The concept is sound and offers a genuine alternative to the patient who requires cutaneous urinary diversion.

Adolescent↗
PubMed1987

Management of late complications of the Kock pouch form of urinary diversion.

Urinary diversion via the continent ileal reservoir has been performed at our institution since 1982. During a 3-year period 250 patients have sought this procedure as an alternative to other forms of cutaneous urinary diversion. We analyzed our data in terms of late complications resulting directly from the operation or from this form of urinary diversion. In this context 77 of the 245 patients who survived the operation have suffered 1 or more late complications, requiring 85 reoperations. The late complications mainly have involved problems with continence or ease of catheterization and they were detected within 6 months. We report our experience and describe the technical aspects of treatment.

Adolescent↗
PubMed1987

An update on the Kock pouch for continent urinary diversion.

The authors continue to feel, based on a 4 1/2 year clinical experience in more than 400 patients, that the Kock continent urostomy offers an important alternative to noncontinent forms of diversion. Not only can it provide an improved body image, but the Kock pouch can also help to salvage, both physically and emotionally, those patients with unsatisfactory results from conduit diversion.

Adolescent↗
PubMed1986

[The Kock continent ileal urinary reservoir: surgical technic and clinical results].

From July 1985 through January 1986, 43 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception and fixation of the nipple valves to prevent reflux and to ensure continence. A strip of PGA mesh serves as a collar to fix the afferent-efferent limb to the pouch once the intussusception technique has been accomplished. The use of a narrow Marlex strip allows fixation to the abdominal wall both lateral and medial to the stoma site (insert). This strip is important in preventing a parastomal hernia and helps fix the continence valve mechanism to the posterior abdominal wall. Previous urinary diversion was by ureterosigmoidostomy in 2 patients, standard ileal conduit in 8 and chronic dialysis after nephrectomy of solitary kidney and cystectomy in 1. A total of 32 patients underwent simultaneous anterior exenteration or radical cystectomy for pelvic malignancy. There were 4 postoperative deaths and early complications occurred in one patient. Late complications occurred in only 3 patients: they required reoperation and revision of the continence valve mechanism. The end result in 39 of 43 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electolytes have remained normal in all patients. X-ray of the Kock pouch have shown no evidence of reflux, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir. During the same time, 21 patients out of 278 patients who underwent creation of a Kock continent ileal urinary reservoir since August 1982, underwent revision of Kock pouch. Two of those required subsequent reoperation and revision of the continence valve mechanism. The end result in all patients has been an overwhelming success.

Adult↗