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Biomedical subjects

W B Waters

Publications and source records attributed to W B Waters.

At least 37 records · Page 2Linked to original sources
PubMed1989

Ureteral replacement using ileum in compromised renal function.

Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.

Animals↗
PubMed1987

The Kock pouch: initial experience and complications.

The modified Kock continent internal reservoir procedure has been performed on 15 patients at our medical center since December 1984: 13 underwent simultaneous anterior exenteration for pelvic malignancy, 1 had conversion from an ileal conduit and 1 underwent cystectomy for refractory interstitial cystitis. There was no operative mortality. There were 3 early complications: a urinary leak from the pouch in 2 patients that required re-exploration to close the defect, and an enteric-Kock pouch fistula in 1 that required resection of the small bowel fistula and repair of the pouch defect. All 3 patients are doing well. The late complication in 3 cases was urinary incontinence of the efferent nipple valve with difficulty in catheterization of the stoma. Two patients have undergone revision with a new efferent nipple valve added on to the pouch and creation of a new stoma. One patient is completely dry and continent, 1 has tolerable intermittent leakage and refuses a further operation, and 1 is awaiting revision. Although the initial experience is small, we are encouraged by these results and believe that this procedure is an alternative form of urinary diversion for the properly selected patient.

Adult↗
PubMed1986

Computerized tomography scan in the preoperative staging of renal cell carcinoma.

Forty-two patients with renal cell carcinoma were evaluated with computerized tomography (CT) followed by surgical exploration, extirpative surgery, or autopsy to determine the accuracy of the CT scan in assessing the extension of the disease. There was an overall accuracy of 95 percent (40/42 patients). The two staging errors were misinterpretation of renal vein involvement and liver invasion. The CT scan is an accurate preoperative indicator of the diagnosis, state, and extension of renal cell carcinoma. Other radiologic studies (arteriography and inferior venacavography) should be used as complementary studies in selective patients.

Carcinoma, Renal Cell↗
PubMed1985

Normal excretory urography in patients with primary kidney neoplasms.

The records of 65 consecutive patients discharged from the hospital with a diagnosis of primary parenchymal neoplasm of the kidney were reviewed. Four of the 65 patients had neoplasms which were not detected by excretory urography. The 4 undetected lesions included 3 renal cell carcinomas and 1 oncocytoma. All of these lesions projected from the anterior or posterior surface of the kidney, and all 4 were clearly demonstrated by computed tomography. Normal findings on an excretory urogram do not completely exclude a neoplasm of the kidney. When there is strong clinical suspicion of a renal neoplasm, computed tomography should be the initial examination or should be done even if the urogram has shown normal findings.

Adenoma↗
PubMed1985

Urinary undiversion using the existing ileal loop and distal right ureter.

Urinary undiversion is an accepted technique in a highly selective patient population. We reconstructed the urinary tract in six female mongrel dogs. A 15 cm. segment of ileum was isolated, both ends were closed and bowel continuity re-established. The proximal two-thirds of each ureter were anastomosed to the proximal end of the ileal segment. The distal one-third right ureteral segment, in continuity with the bladder, was anastomosed end-to-side to the distal ileal segment. Information from the intravenous pyelograms, renal function tests, electrolytes and pathological studies showed normal upper tracts without dilatation or obstruction, preservation of renal function and normal electrolytes except for mild hyperchloremia in all 6 animals. There was chronic pyelonephritis in one animal and mild focal renal inflammation in two animals. The uretero-ileal anastomoses were patent and the ureters were not dilated. The interposed ileum functions well as a conduit and does not become a reservoir over time. We believe incorporating ileum into the urinary tract in this technique of undiversion is a safe and effective clinical alternative in selected patients.

Animals↗
PubMed1982

Ultrasonic scanning during operation for renal calculi.

Real-time B-mode ultrasound scanning was used during operations for nephrolithiasis. Scanning was done before pyelotomy or nephrotomy to confirm the presence of calculi. For stones in an intrarenal position, requiring an incision through renal parenchyma for extraction, ultrasound permitted guidance for an exploratory needle to localize the calculi precisely. Once the needle tip was in the proximity of the stone a nephrotomy incision was made along the needle track. This procedure enabled the use of relatively small nephrotomy incisions and reduced search time and tissue manipulation. After calculi were extracted ultrasonography was used to make certain that all stone fragments were removed. Ultrasound was considered helpful in 15 of 16 operations.

Adult↗
PubMed1982

Complications of retroperitoneal lymphadenectomy in the management of nonseminomatous tumors of the testis.

Retroperitoneal lymphadenectomy is the definitive operation for the accurate pathologic staging and treatment of Stage A, B1 and B2 nonseminomatous germ cell tumors of the testis. A review of 33 patients who underwent thoracoabdominal lymphadenectomy during a three year period yielded evidence of four minor complications and one major complication that resulted in the only operative death. The thoracoabdominal approach is preferred and allows one to palpate the ipsilateral thoracic cavity for unsuspected pulmonary metastasis to perform with greater ease bilateral dissection that includes a left suprahilar dissection, to use an extraperitoneal approach in patients without bulky abdominal disease--Stage B3 and C--and can be performed safely and with minimal morbidity and mortality by the well trained urologic surgeon.

Adolescent↗
PubMed1981

Urodynamic localization of isolated bladder neck obstruction in men: studies with micturitional vesicourethral static pressure profile.

Micturitional vesicourethral static pressure profile, a method of recording the static (lateral) component of voiding pressure in the successive urethral segments contiguous with the bladder, has allowed us to establish directly the site and degree of bladder outlet obstruction in 16 men. The diagnosis of isolated bladder neck obstruction was confirmed with greater confidence by using this technique with a 10F trilumen catheter in conjunction with uroflowmetry and radiologic studies. Repeat studies with a 5F single lumen catheter have suggested that the obstructions recognized with the 10F catheter ware not entirely artifactual. Our experience with this technique in several men with non-neurogenic bladder neck obstruction indicates the importance of including this study in the urodynamic armamentarium.

Adult↗
PubMed1981

Urodynamic evaluation of prostatic enlargements with micturitional vesicourethral static pressure profiles.

We studied 58 men with prostatism, who were between 58 and 75 years old, with micturitional vesicourethral static pressure profiles. The study consisted of recording static (lateral) pressures of successive segments of the posterior urethra during voiding, with synchronous monitoring of the vesical pressure activity. An abnormal pressure decrease across the supramontane urethra was considered to be a functional compromise to the prostatic urethra. The studies indicated that the degree of prostatic urethral obstruction was not related to the clinical and endoscopic assessment of prostatic enlargement. Three major patterns emerged from our studies: 1) moderate to severe prostatic enlargement with severe obstruction, 2) moderate to severe prostatic enlargement with minimal or no obstruction and 3) minimal prostatic enlargement with severe obstruction. Also, a good correlation became apparent between micturitional vesicourethral static pressure profilometry and uroflowmetry.

Aged↗
PubMed1981

Results of inferior vena cava resection for renal cell carcinoma.

A total of 24 patients with renal cell carcinoma involving the inferior vena cava underwent thoracoabdominal radical nephrectomy with removal of tumor thrombus by an open or closed technique. The tumor extended in the inferior vena cava to the level of the renal or lower hepatic veins in 18 patients and it reached the level of the diaphragm or right atrium in 6. Of the 24 patients 3 with preoperative findings minimally suggestive of disseminated disease were shown later to have metastases in the questionable areas, 3 with disease at the level of the diaphragm had incomplete resections, 4 had metastases to regional lymph nodes and 1 had questionable preoperative findings and lymph node metastases. Only 13 of the 24 patients (54 per cent) did not have either disseminated or residual tumor postoperatively. The mean survival duration of this subgroup (20 months) was comparable to that of the group as a whole (21 months). However, 4 patients from this subgroup are free of disease, with a mean followup of 30 months. There was 1 postoperative death. Morbidity, including renal failure, intraoperative hypotension and sepsis, was common. The results in this series suggest that the prognosis for patients with renal cell carcinoma and inferior vena cava involvement is guarded.

Adenocarcinoma↗
PubMed1981

Segmental replacement of the ureter using tapered and nontapered ileum.

We attempted to reduce the absorptive surface area and maintain the natural antireflux mechanism of the distal ureter by using ileum as an interposed segment rather than a total ureteral substitute in six dogs. In each dog we compared the physiologic effects of a longitudinally tapered ileal segment versus a simple nontapered segment. Information from the intravenous pyelogram, renal function tests, and the pressure flow studies showed preservation of renal function and parenchyma, no secondary dilation of the upper tracts, continued peristaltic activity, no evidence of obstruction or stone formation secondary to mucus production, no early pyelographic abnormalities, and no differences in pressure flow characteristics between the tapered and nontapered segments. We believe that incorporating ileum into the urinary tract to bridge a ureteral defect is a safe and effective clinical alternative.

Animals↗
PubMed1979

Management of infected polycystic kidneys.

We report 5 cases of severe uncontrolled infection of polycystic kidneys. Retrograde pyelography antedated infection in 2 of the patients. Difficulty in establishing the diagnosis was demonstrated in all cases. Each patient was treated initially with antibiotics but definitive therapy required an operation in 4 cases.

Adult↗
PubMed1979

Operative versus non-operative management of patients with staghorn calculi and neurogenic bladder.

During the last 5 years 22 patients have been treated at our hospital for staghorn calculi and neurogenic bladder. In 17 patients an operation was done soon after discovery of the calculi, while 5 patients were followed non-operatively. The latter 5 patients had a rapid downhill course marked by sepsis and renal function deterioration and an operation was necessary in 4 of the 5 cases. Injudicious non-operative therapy only prolongs the relentless effects of staghorn calculi in patients with spinal cord pathology.

Adult↗
PubMed1979

Sexual impotence: the overlooked complication of a second renal transplant.

The incidence of sexual impotence in 20 men who have received at least 2 kidney transplants was 65% compared to 10% after the first transplant. The importance was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotence to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Adult↗
PubMed1978

Sexual impotence: the overlooked complication of a second renal transplant.

THE INCIDENCE OF SEXUAL IMPOTENCE IN 20 MEN WHO HAVE RECEIVED AT LEAST 2 KIDNEY TRANSPLANTS WAS 65 PER CENT COMPARED TO 10 PER CENT AFTER THE FIRST TRANSPLANT. The impotence was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotance to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Adult↗