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Biomedical subjects

Wendy W Leng

Publications and source records attributed to Wendy W Leng.

8 recordsLinked to original sources
PubMed2006

Sacral nerve stimulation for the overactive bladder.

Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.

Electric Stimulation Therapy↗
PubMed2005

Treatment of postoperative voiding dysfunction following incontinence surgery.

Persistent postoperative voiding dysfunction is a known complication following female stress incontinence surgery. Although many variations on surgical technique exist, the most common cause remains attributable to hypersuspension of the urethra. The diagnosis of postoperative voiding dysfunction in this setting can be challenging due to the lack of standardized criteria and varied clinical presentation. Furthermore, patients can present with a wide spectrum of symptomatology, not merely incomplete bladder emptying or outright retention. The symptoms of urethral hypersuspension can range from purely bladder storage symptoms on one hand (frequency, urgency, or urge incontinence), to the more commonly recognized bladder emptying dysfunction on the other hand (incomplete emptying or frank urinary retention). Although most cases of mild postoperative voiding dysfunction appear to resolve with expectant management, a subset of patients clearly benefit from a sling incision or formal urethrolysis. This leads to prompt improvement or resolution of their postoperative bladder symptoms. The timing of surgery must be determined by the clinician's judgment. However, experience would suggest that postoperative bladder symptoms that persist beyond 4 weeks rarely resolve spontaneously. Within the literature, there has been a paradigm shift toward earlier intervention. Indeed, there are some data to suggest that delayed time to urethrolysis can lead to irreversible bladder dysfunction.

Female↗
PubMed2005

How sacral nerve stimulation neuromodulation works.

The authors believe that the principles underlying the multiple possible SNS mechanisms of action can be summarized as somatic afferent inhibition of sensory processing in the spinal cord. Regardless of whether the lower urinary tract dysfunction involves storage versus emptying abnormalities, the pudendal afferent signaling serves as a common crossroads in the neurologic wiring of the system. Not only can pudendal afferent input turn on voiding reflexes by sup-pressing the guarding reflex pathways, pudendal afferent input to the sacral spinal cord also can turn off supraspinally mediated hyperactive voiding by blocking ascending sensory pathway inputs. For these reasons, SNS can take advantage of the complex neurologic pathways described and offer successful treatment for a seemingly disparate group of lower urinary tract pathologies. SNS is a urologic technique that has proved safe and minimally invasive, and it holds great promise for many patients who have lower urinary tract dysfunction.

Afferent Pathways↗
PubMed2004

Delayed treatment of bladder outlet obstruction after sling surgery: association with irreversible bladder dysfunction.

PURPOSE: Our urethrolysis cohort demonstrated an unusual delay time to surgical treatment of bladder outlet obstruction. We determined whether urethrolysis outcomes, ie persistent bladder symptoms, were associated with time between sling and urethrolysis surgeries. MATERIALS AND METHODS: Retrospective analysis of all patients who underwent urethrolysis for post-sling voiding dysfunction between June 1997 and June 2002 was performed. We excluded from study 6 patients with a known history of overactive bladder symptoms, neurogenic bladder dysfunction and use of anticholinergic pharmacotherapy before stress incontinence surgery. The remaining 15 patients were stratified into 2 outcomes groups based upon the absence or presence of post-urethrolysis bladder storage symptoms. Patients (7) in group 1 have no current bladder symptoms. Patients (8) in group 2 still require anticholinergic drug therapy for significant bladder symptoms of frequency and urgency. Data collected for the 2 groups included mean age, existence of urinary retention before urethrolysis, mean time to urethrolysis in months, urethrolysis outcome based upon subjective bladder symptoms and followup duration. For comparison of mean age between groups the standard t test was used. Fisher's exact test was used to compare frequency of urinary retention before urethrolysis between groups. Lastly the Mann-Whitney U test was conducted to compare time to urethrolysis between groups. All statistical analyses were conducted using the SPSS software package (SPSS, Inc., Chicago, Illinois). RESULTS: There was no statistically significant difference between the groups with respect to age or frequency of urinary retention before urethrolysis. Time to urethrolysis for the whole cohort ranged from 2 to 66 months. Mean followup after urethrolysis was 17.3 +/- 22.9 months. Comparison of mean time between incontinence and urethrolysis surgeries between group 1 (9.0 +/- 10.1 months) and group 2 (31.25 +/- 21.9 months) demonstrated a statistically significant difference (p = 0.01). CONCLUSIONS: This urethrolysis population demonstrated an unusual delay time to surgical treatment of bladder outlet obstruction. We categorized the cohort according to absence or presence of persistent bladder storage symptoms, and found a strong association between persistent bladder symptoms and greater delay to urethrolysis.

Aged↗
PubMed2004

Recognition and treatment of bladder outlet obstruction after sling surgery.

At the University of Pittsburgh School of Medicine, our experience with urethrolysis over the past several years offered a unique opportunity to assess outcomes after delayed time to urethrolysis. We observed a highly suggestive association between prolonged time to urethrolysis and a greater likelihood of persistent bladder dysfunction. If this observation is corroborated by other studies, it would be prudent to lower our threshold of clinical suspicion to detect bladder outlet obstruction. Videourodynamics testing can be invaluable for making the distinction between outlet obstruction versus de novo urge incontinence. Here, we briefly review the literature on urethrolysis and present the urethrolysis technique utilized at our institution. The article concludes with several challenging and controversial clinical judgment questions asked ofDr Leng by Dr Chancellor.

Journal Article↗
PubMed2003

Obstructive uropathy induced bladder dysfunction can be reversible: bladder compliance measures before and after treatment.

PURPOSE: We demonstrated that abnormal bladder compliance in the setting of obstructive uropathy can be improved by relief of bladder outlet obstruction. MATERIALS AND METHODS: A cohort of 9 men with nonneurogenic lower urinary tract symptoms and videourodynamics proven bladder outlet obstruction were identified prospectively from a university urology practice. Study exclusion criteria ensured absence of active urinary infection, hematuria and neurourological pathology. Testing specifically focused on assessment of the bladder compliance curve, and a compliance value was calculated (ml./cm. H2O). Treatment intervention consisted of transurethral incisions or resection of the prostate in 8 cases and transurethral balloon dilation of a urethral stricture in 1. Followup videourodynamics testing was performed 1 month after treatment to confirm relief of outlet obstruction and reassess bladder compliance. RESULTS: Mean patient age was 75.2 +/- 6.16 years. Pretreatment mean bladder compliance +/- SE was 3.06 +/- 0.45 ml./cm. H2O. At 1 month after treatment videourodynamics testing confirmed relief of obstruction in the cohort. Posttreatment mean bladder compliance +/- SE was 13.53 +/- 0.45 ml./cm. H2O. Nonparametric paired t test analysis determined that the difference between pretreatment and posttreatment bladder compliance was statistically significant at p = 0.0117. CONCLUSIONS: This pilot study suggests that relief of obstructive uropathy even in elderly patients with long-standing lower urinary tract symptoms, can significantly improve bladder compliance.

Aged↗
PubMedDate not supplied

The relationship between overactive bladder and sexual activity in women.

PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by > or = 60% of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25% of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.

Adult↗