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Biomedical subjects

S L Stanton

Publications and source records attributed to S L Stanton.

At least 55 records · Page 3Linked to original sources
PubMed1996

Urogynaecology.

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Female↗
PubMed1995

Periurethral collagen injections for genuine stress incontinence: a 2-year follow-up.

OBJECTIVE: To assess the short- and medium-term efficacy of periurethral collagen injection in women with urethral sphincter incompetence and to determine if urodynamic variables can elucidate the mechanism of action. PATIENTS AND METHODS: Sixty women (mean age 64 years, range 20-90) with genuine stress incontinence received periurethral collagen injections under local anaesthesia; 55 had undergone previous continence surgery. A total of three injection sessions were allowed. Subjective and urodynamic assessments were obtained at 1, 3, 6, 12 and 24 months after injection to evaluate success and long-term effects of collagen. RESULTS: Subjective success rates were 86% at 3 months, 77% at 12 months and 68% at 24 months. Objective cure rates were 61% at 3 months, 54% at 12 months and 48% at 24 months. Low urethral pressures and decreased bladder neck mobility did not affect the outcome. Collagen injections significantly increased stress maximum urethral closure pressures and functional urethral length; increase in the latter and clinical assessment of bulking at the time of injection appeared to predict medium-term success. There were some minor early complications and none in the medium-term. CONCLUSIONS: Periurethral collagen injections continued to be effective at the 2-year follow-up, although there was a time-dependent decline. In comparison with more complicated procedures used in patients with previous failed continence surgery, periurethral collagen injection is a simple, acceptable, day case procedure which improves the quality of life in physically fit or frail patients, with few complications.

Adult↗
PubMed1995

A follow up of silastic sling for genuine stress incontinence.

OBJECTIVE: To assess the use of silastic sling for genuine stress incontinence. DESIGN: Retrospective descriptive analysis. SETTING: Tertiary referral centre for urogynaecology. SUBJECTS: Eighty-eight women with urodynamically proven genuine stress incontinence, 10 had coexistent detrusor instability. In 74 women, the sling operation was for recurrent incontinence. INTERVENTION: A low Pfannenstiel incision was used and a suburethral tunnel dissected to insert the sling, which was attached under minimal tension with non-absorbable sutures to each ileopectineal ligament. MAIN OUTCOME MEASURES: Clinical and urodynamic data were assessed between two and three months post-surgery; thereafter clinical assessment and pad testing were performed at yearly intervals for five years. RESULTS: The subjective cure at three months was 81% and the objective cure was 69%. There was a fall in success rate with increasing number of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05). Neither age, parity nor menopausal status made a statistical difference to the cure rate. Twenty-three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Post-operatively, 29 women had detrusor instability: 22 women developed detrusor instability de novo and seven had detrusor instability presurgery. Urodynamic findings postsurgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four bladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent. CONCLUSIONS: A silastic sling operation for the treatment of genuine stress incontinence provides a good long term cure, considering that 45% of women had two or more previous failed continence operations. The high prevalence of detrusor instability and voiding difficulties postsurgery should be noted.

Adult↗
PubMed1995

Burch colposuspension: a 10-20 year follow up.

OBJECTIVE: To review the outcome of women who underwent Burch colposuspension 10 to 20 years ago and to assess factors which affect long term success. DESIGN: Longitudinal retrospective study. SETTING: Urogynaecology Unit, St George's Hospital, London. SUBJECTS: One hundred and nine women with genuine stress incontinence. MAIN OUTCOME MEASURES: Survival analysis of subjective and objective cure of stress incontinence. RESULTS: Cure of incontinence following Burch colposuspension is time-dependent, with a decline for 10 to 12 years when a plateau of 69% is reached. Factors adversely affecting cure are previous bladder neck surgery (logrank test P = 0.02), pre-operative weight greater than 80 kg, intra-operative blood loss more than 1000 ml and the development of post-operative detrusor instability. Post-operative complications included de novo detrusor instability (14.7%), long term complaints of voiding difficulty with objective recovery at the final follow up (22%) and recurrent urinary tract infection (4.6%). CONCLUSIONS: Long term follow up after colposuspension is necessary to assess sequelae. We suggest that new continence procedures should be followed up for 5 to 10 years.

Adult↗
PubMed1994

Perineal bladder neck ultrasound: appearances before and after continence surgery.

An objective method of quantifying suture tension during bladder neck elevation for genuine stress incontinence has long been sought. Perineal ultrasonography has been used to measure bladder neck position and excursion in continent and incontinent women. This study used perineal ultrasound findings to determine surgical positioning of the bladder neck and predict outcome. Eighteen asymptomatic controls and 72 women with genuine stress incontinence were studied before and after continence surgery. Perineal ultrasonography was used to plot bladder neck position at rest and on maximum Valsalva maneuver on an x, y co-ordinate system to allow comparison between groups. Logistic regression analysis was then performed to derive an equation for the likelihood of continence. In both pre-and postoperative analysis, the best correlation with continence was achieved with the use of the patient's age and the distance of the bladder neck resting position measured along the x-axis. An equation was derived to give the probability of continence. The equation is easily calculated using a pocket calculator. The distance of the bladder neck along the x-axis is under the direct control of the surgeon, so the patient's age can be put into the equation and the distance along the x-axis most likely to make the patient continent can be calculated. This can be done during surgery to provide an objective method for evaluating suture tension.

Journal Article↗
PubMed1994

Urethral sensitivity in the aetiology of sensory urgency.

OBJECTIVE: To investigate urethral hypersensitivity as a cause of sensory urgency. PATIENTS AND METHODS: Twenty women with sensory urgency and 10 normal controls were enrolled in the study. A urethral conductance catheter was designed comprising three pairs of electrodes. These were accurately located in the urethra using the principle of urethral electrical conductance. The urethral sensory threshold was then measured at three sites along the urethral by applying a stimulatory current across each pair of electrodes in turn. RESULTS: The women with sensory urgency had significantly higher thresholds for urethral stimulation along the whole urethra when compared with the control group. CONCLUSION: Urethral hypersensitivity was not found to be a feature of sensory urgency and in fact the converse was demonstrated. This has not been described before. High sensory thresholds may occur with small fibre peripheral neuropathies. Thus, peripheral neuropathy is potentially a factor in the, as yet unknown, aetiology of sensory urgency.

Adolescent↗
PubMed1994

Sacrocolpopexy: a retrospective study of a clinician's experience.

OBJECTIVE: To assess the factors that may predispose patients to the development of vaginal vault prolapse and enterocele, and to determine the success of sacrocolpopexy in correcting prolapse. DESIGN: A retrospective study of women with vault prolapse undergoing sacrocolpopexy over a 10 year period between 1983 and 1993, with analysis of postoperative complications and success. SETTING: St. George's Hospital in London, a university teaching hospital, and private practice. SUBJECTS: Forty-one women, presenting with symptomatic vault prolapse, who desired preservation of sexual function. INTERVENTIONS: Forty-one patients underwent 43 sacrocolpopexies. Of these, 39 were performed by the senior author. All but four were reviewed in the clinic within the last year. MAIN OUTCOME MEASURES: Pre- and post-operative data and any interim prolapse or incontinence surgery were recorded. Success was assessed subjectively and by clinical examination for recurrence of prolapse, associated post-operative complications, subsequent voiding difficulties, and incidence of incontinence. RESULTS: Failure was defined as a symptomatic enterocele or evidence of a third degree enterocele on examination. The 41 patients were followed for a mean time of 21.2 months. The cure rate of vault prolapse was 88%. The most common complications were stress incontinence, urinary tract infection, and persistent vaginal discharge. Using the unpaired t-test and chi 2 analysis, there was no significant difference between failures or successes in terms of weight, parity, age, previous surgery, pulmonary history, or difficulties with defaecation, although the number of patients studied was small. CONCLUSIONS: Sacrocolpopexy is a successful operation for the correction of prolapse. Complications include the development of genuine stress incontinence, detrusor instability, voiding difficulty, and mesh infection.

Female↗
PubMed1994

Bladder neck mobility and the outcome of surgery for genuine stress urinary incontinence. A logistic regression analysis of lateral bead-chain cystourethrograms.

Bladder neck position, as determined by preoperative and postoperative resting and straining lateral bead-chain cystourethrograms, was analyzed by logistic regression analysis in 94 women undergoing 98 operations for genuine stress incontinence. A total of 384 roentgenograms were analyzed in an attempt to build a model that would predict the likelihood of surgical success in a given patient based on the preoperative films and explain a successful surgical outcome based on the characteristics of the postoperative films. The most important predictors of success were the number of previous incontinence operations, a large distance between the bladder neck and the pubic symphysis at rest, and increased mobility of the bladder neck before surgery. Successful surgery appeared to be related most closely to decreasing mobility of a previously hypermobile bladder neck.

Female↗
PubMed1992

The incidence of genital prolapse after the Burch colposuspension.

OBJECTIVE: Our objective was to determine the incidence of postoperative genital prolapse after the Burch colposuspension and to identify risk factors for the development of subsequent prolapse. STUDY DESIGN: The charts of 131 patients who had a Burch colposuspension performed by the senior author (S.L.S.) between 1977 and 1986 were reviewed at the Urodynamic Unit of St. George's Hospital, London. Emphasis was placed on the degree of genital prolapse on clinical examination and whether further surgery was required to correct the prolapse. RESULTS: Thirty-five patients (26.7%) required a total of 40 operations to correct genital prolapse after colposuspension. At 20 operations, more than one procedure was required to correct combined prolapse. The patient's age, weight, parity, menopausal status, and prior pelvic surgery did not affect the incidence of postoperative prolapse. The only preoperative risk factor identified was the presence of a large cystocele. CONCLUSION: Postoperative genital prolapse is a significant complication of the Burch colposuspension. It is unclear whether this is due to a disruption of the vaginal axis or to an intrinsic weakness of the pelvic floor in these women.

Adult↗
PubMed1992

Perineal video-ultrasonography in the assessment of vaginal prolapse: early observations.

OBJECTIVE: To investigate the efficacy of perineal ultrasonography in the assessment of vaginal prolapse. DESIGN: A prospective descriptive study. SETTING: Urodynamic Unit, St. George's Hospital, London. SUBJECTS: Six women, three of them were awaiting colposuspension and three had had a colposuspension. INTERVENTIONS: Perineal ultrasound scans were performed on women with and without incontinence and prolapse, both before and after continence surgery. Movement of the bladder, urethra, uterus, vaginal vault and enterocele were observed during coughing and the valsalva manoeuvre. MAIN OUTCOME MEASURES: To assess reproducibility, six patients had six different measurements taken of bladder neck and prolapse position and movement relative to the symphysis. The measurements were plotted upon an X-Y co-ordinate axis. Each measurement was repeated three times and one way analysis of variance performed upon the readings. RESULTS: Perineal ultrasonography clearly demonstrated movement of the whole pelvic floor. Minor degrees of both anterior and posterior vaginal wall prolapse could be seen and quantified. An increase in posterior vaginal wall mobility was noted in women after colposuspension. All measurements taken were found to be reproducible. CONCLUSIONS: Perineal ultrasonography is easy to perform and is reproducible. It may improve understanding of why some women develop posterior vaginal wall prolapse after colposuspension and, conversely, why some women develop incontinence following anterior repair for prolapse.

Cough↗
PubMed1992

Measurement of oxybutynin and its N-desethyl metabolite in plasma, and its application to pharmacokinetic studies in young, elderly and frail elderly volunteers.

1. A quantitative h.p.l.c. plasma assay for oxybutynin (OB) and its active metabolite, N-desethyl oxybutynin (DEOB) is described. The method is linear with coefficients of variation ranging between 4 and 11.8% for OB and 4.6-9.1% for DEOB over the typical concentration range measured. Minimum detectable levels were 0.5 and 5 ng/ml for OB and DEOB respectively from a 2 ml sample. 2. Pharmacokinetic parameters were obtained after a single oral dose of OB and after administration two or three times daily to frail elderly and elderly volunteer groups respectively. Single dose results were also compared with data from young healthy volunteers. 3. There was a wide range in peak blood levels and high levels of parent drug were matched by high DEOB metabolite levels. Plasma levels on repeated administration were as would be predicted from the single dose kinetics. 4. Area under the plasma time course curve for DEOB metabolite was less than or equal to 5 than that of the parent drug. 5. A trend of increasing peak plasma levels and bioavailability was observed with increasing age and frailty, with the differences more apparent between the active elderly and frail elderly groups than between the active elderly and young volunteers. 6. Results indicate that for frail elderly patients a lower initial starting dose of 2.5 mg OB given two or three times a day may provide adequate therapeutic blood levels of the drug.

Administration, Oral↗
PubMed1991

Psychological aspects of 211 female patients attending a urodynamic unit.

Psychological aspects of 211 female patients attending a Urodynamic Unit were assessed by means of standardized questionnaires. Patients with genuine stress incontinence (GSI) showed changes comparable to other patients with longstanding physical complaints. Patients with sensory urgency (SU) lacked self esteem and were more anxious than those with GSI. Patients with detrusor instability (DI) were as anxious and lacking in self esteem as patients with sensory urgency and additionally had morbid thoughts and worries and higher scores on the hysteria sub-scale of the Crown-Crisp Experiential Index. Roughly a quarter of all the patients reported that their urinary symptoms rendered life intolerable and they were as anxious, depressed and phobic as psychiatric inpatients.

Adolescent↗