SEARCH · Search PubMed

Results for “MORBIDITY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,423 records · Page 79Linked to original sources

PubMed2004

Health service utilization for perceived postpartum morbidity among poor women living in Karachi.

To explore traditional beliefs and practices, to assess puerperal morbidity, and to understand care-seeking behaviors, a qualitative and quantitative study was conducted in low socio-economic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews were conducted in July and August 2000. 525 Muslim women, who were 6-8 weeks post-partum, were then interviewed at home. Maternal care was relatively good-more than three-quarters of recent mothers sought antenatal care and more than half (267/525) delivered in a hospital or maternity home. Counseling to attend post-partum clinics among facility deliveries was 16% (43/267), of which only 26% (11/43) attended. Practices during the delivery and puerperium, such as massaging the vaginal walls with mustard oil during labor to facilitate delivery and inserting vaginal or rectal herbal pessaries to facilitate 'shrinkage of the uterus' and/or 'strengthening of the backbone', were pervasive. The core symptoms that are clinically significant during the puerperium are heavy vaginal bleeding and high fever, since they are potentially fatal symptoms if appropriate and timely care is not sought. About half of the study women (53.3%) reported at least one illness symptom, high fever (21.1%), heavy vaginal bleeding (13.9%), and foul smelling vaginal discharge (9.6%). Women did not know the underlying biologic cause of their perceived post-partum morbidity; weakness was frequently mentioned. Women sought care initially from close relatives or traditional healers and if they continued to suffer from their morbidity they finally approached a trained health care (allopathic) provider. The high prevalence of perceived post-partum morbidity illustrates the demand for post-partum community-based health care programs. We suggest promoting maternal health education that encourages women to seek appropriate and timely care by accessing public or private health services.

Adult↗

PubMed2006

Morbidity and efficacy of genitofemoral nerve grafts with radical retropubic prostatectomy.

OBJECTIVES: To review our experience with genitofemoral nerve grafting after radical prostatectomy, to determine both morbidity and efficacy. METHODS: We identified patients who underwent genitofemoral nerve grafting between 2001 and 2003 at our hospital. Morbidity was recorded prospectively in the charts, and a validated questionnaire (International Index of Erectile Function, IIEF-5) was used to determine erectile function. RESULTS: Twenty-seven patients received 32 genitofemoral nerve grafts. Five patients (19%) received bilateral grafts. In 3, a single nerve was harvested for a bilateral graft. Mean graft length was 5 cm, and mean follow-up was 14 months. Two patients (7%) reported persistent, minor numbness or tingling of the ipsilateral thigh or hemiscrotum. No other morbidity was noted. Overall, 56% of the patients were able to sustain an erection with enough firmness for penetration at the time of follow-up. Of those patients who reported no preoperative erectile dysfunction, 69% were able to have sexual intercourse. CONCLUSIONS: Harvesting and interposition of genitofemoral nerve grafts in the neurovascular bundle adds very minimal morbidity to radical prostatectomy. The results reported in our patients are at least comparable to those achieved with sural nerve grafting. Whether these results are a consequence of an effective unilateral nerve-sparing dissection or the nerve grafting itself is uncertain.

Aged↗

PubMed1999

Work and pregnancy: the role of fatigue and the "second shift" on antenatal morbidity.

OBJECTIVE: This study was undertaken to evaluate factors at home and work associated with antenatal morbidity (emergency department visits and hospitalizations) among employed pregnant women. STUDY DESIGN: This prospective study of 213 women included 3 antenatal interviews at about 16, 24, and 30 weeks' gestation with questions on health history, lifestyle, housework, working conditions, and emergency department visits and hospitalizations. Work scores and home scores were formulated from each interview. Fatigue was defined as being very tired or extremely tired at the end of a typical workday. The risk of antenatal morbidity was modeled by means of logistic regression; results are presented as adjusted odds ratios with 95% confidence intervals. RESULTS: The risk of antenatal morbidity, which was greatest during the second trimester, was increased by stress (adjusted odds ratio, 2.45; 95% confidence interval, 1.32-4.57), fatigue (adjusted odds ratio, 3.77; 95% confidence interval, 1.98-7.18), work plus home score (adjusted odds ratio, 1.55; 95% confidence interval, 1.22-1.97), and the interaction of fatigue and work plus home score (adjusted odds ratio, 4.61; 95% confidence interval, 2.02-10.50). CONCLUSIONS: These findings suggest that maternal fatigue contributes significantly to antenatal morbidity.

Adult↗

PubMed2001

Preoperative chemotherapy for lung cancer does not increase surgical morbidity.

BACKGROUND: Preoperative chemotherapy (C+S) for non-small cell lung cancer (NSCLC) has increased in an attempt to improve survival. Patients receiving C+S potentially may have an increase in postoperative morbidity and mortality compared with surgery alone (S). We reviewed our experience with C+S and S in a tertiary referral center. METHODS: Three hundred eighty consecutive patients underwent lobectomy or greater resection for NSCLC between August 1, 1996, and April 30, 1999: 335 patients (259 S; 76 C+S) were analyzed; 45 additional patients were excluded for prior NSCLC, other chemotherapy for other malignancy, or radiation. We compared morbidity and mortality overall, and by subset analysis (clinical stage, pathological stage, procedure, and by protocol use) for both C+S and S patients. RESULTS: Demographics, comorbidities, and spirometry were similar. We noted no significant difference in overall or subset mortality or morbidity including pneumonia, acute respiratory distress syndrome, reintubation, tracheostomy, wound complications, or length of hospitalization. CONCLUSIONS: C+S did not significantly affect morbidity or mortality overall, based on clinical stage, postoperative stage, or extent of resection. The potential for enhanced survival in resectable NSCLC justifies continued study of C+S.

Aged↗

PubMed1983

Intraaortic balloon pump morbidity: a comparative analysis of risk factors between percutaneous and surgical techniques.

We reviewed our concurrent experience with percutaneous insertion versus surgical placement of the intraaortic balloon pump over a two-year period both to compare morbidity and to provide guidelines for the choice of method in particular patient groups and clinical settings. The effects on morbidity of sex, age, emergency placement, coexisting peripheral vascular disease, and duration of counterpulsation were determined. Sex was a highly significant factor, with low complication rates (3/29 or 10.3%) for percutaneous insertion in men and an inordinately high morbidity (12/17 or 70.6%) in women (Fisher exact test: p = 4.611 X 10(-5)). This difference may be due to the smaller size of the femoral artery in women. We conclude that percutaneous insertion is the preferred technique for most men but that direct exposure of the femoral artery should be employed in women. Given the serious morbidity encountered with each technique, there is no justification to broaden the indications for intraaortic balloon counterpulsation.

Assisted Circulation↗

PubMed1998

Increased risk and decreased morbidity of coronary artery bypass grafting between 1986 and 1994.

BACKGROUND: The collective impact of advances in medical, surgical, and anesthetic care on the characteristics and outcomes of patients who undergo coronary artery bypass grafting was assessed. METHODS: We compared the demographic and clinical characteristics, preoperative risk factors, morbidity, and mortality of two groups of patients who underwent coronary artery bypass grafting in isolation or in combination with other procedures between July 1, 1986, and June 30,1988 (group 1, n = 5,051), and between January 1, 1993, and March 31, 1994 (group 2, n = 2,793). The patients were stratified according to their preoperative risk level. Outcome measures consisted of changes in preoperative risk categories; hospital mortality rates; overall and risk-adjusted major cardiac, neurologic, pulmonary, renal, and septic morbidity rates; and intensive care unit length of stay. RESULTS: Changes in the distribution of risk categories, from a median of 2 to 4 on a 9-point scale (p < 0.001), indicated that patients in group 2 were at significantly higher risk than those in group 1. The risk-adjusted mortality rate did not change (2.8% to 2.9%; p = 0.15), but the risk-adjusted morbidity rate decreased significantly (14.5% to 8.8%; p < 0.001). CONCLUSIONS: At our institution, patients who undergo coronary artery bypass grafting are now at greater preoperative risk at the time of hospital admission. However, their morbidity rate is significantly lower and their mortality rate is unchanged, results that we attribute to the collective impact of changes in our medical and surgical procedures.

Aged↗

PubMedDate not supplied

Psychiatric morbidity following motor vehicle accidents: a review of methodological issues.

Motor vehicle accidents (MVAs), even those of a nonserious nature, appear to increase the risk of severe psychiatric morbidity in survivors. The present review examines the evidence indicating the levels of psychiatric morbidity in MVA survivors. Although no consistent profile has emerged, the most commonly reported symptoms are depression, anxiety, irritability, driving phobia, anger, sleep disturbances, and headache, with rates of posttraumatic stress disorder (PTSD) across studies of 0% to 100%. Variability in the type and severity of psychiatric outcomes may be due, in part, to methodological inadequacies in many studies, particularly the use of biased population samples, inclusion of subjects exposed to varied types of accidents, an absence of a clear definition of PTSD, a reliance on clinical judgment rather than the use of objective psychometric measures, the failure to include ratings of injury severity, and the absence of assessments for past exposure to traumatic events or preexisting posttraumatic reactions. The most important concern relates to the use of nonrepresentative samples, usually patients referred for medicolegal assessment in whom issues of compensation are of central importance. Gender and age differences distinguish the compensation group from the general population of MVA survivors, who therefore may also differ in the vulnerability to posttraumatic morbidity. It is argued that more systematic research on unselected subject samples is critical to establish epidemiological data on the true nature and extent of psychiatric morbidity following MVAs.

Accidents, Traffic↗

PubMed1991

Anthropometric measurements in a newborn population in west Africa: a reliable and simple tool for the identification of infants at risk for early postnatal morbidity.

The predictive value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in a cohort of 490 neonates born in Yaoundé, Cameroon. Mid-arm circumference (MAC), head circumference, weight, and length were measured within 6 hours of birth, and the gestational age, individual MAC/head circumference ratio, and individual ponderal index were calculated. A detailed questionnaire on gestational medical history was also obtained from the mothers. All infants were then closely monitored during the first 72 hours after delivery for the appearance of symptoms requiring medical intervention and treated accordingly. Low birth weight (LBW) was observed in 37.75%, prematurity in 25.5%, and small size for gestational age in 14.1% of the neonates. Gestational medical problems were reported by 44.3% of the mothers; malaria was the most frequent. Early postnatal morbidity was observed in 26% of the infants; infection (53%), respiratory distress (26%), hypoglycemia (26%), and convulsions (11.7%) accounted for most of the problems. The MAC correlated best of all variables with birth weight (r = 0.91); a value of less than or equal to 9.5 cm had a 93% sensitivity and a 90.5% specificity in the prediction of LBW. An MAC cutoff value of less than or equal to 9.5 cm was also the best of all variables in the prediction of early postnatal morbidity, and 85.2% sensitivity and 74.3% specificity were achieved. We conclude that in developing countries, where scales are not always available and the overburdened maternity wards cannot allow for medical surveillance of every infant, the MAC can be used in the estimation of birth weight. Moreover, an appropriately calculated cutoff value of MAC may serve as a reliable indicator of LBW and of infants at risk for early postnatal morbidity.

Anthropometry↗

PubMed1995

Maternal and neonatal morbidity associated with in vitro fertilization.

OBJECTIVE: The purpose of this case-control study was to examine the maternal and neonatal morbidities associated with in vitro fertilization (IVF) in a single large teaching hospital. It was hypothesized that IVF mothers would have more perinatal complications and IVF infants would have higher mortality and morbidity rates than non-IVF control subjects. METHODS: One hundred forty-three gestations resulting from 101 IVF pregnancies, which included singletons (n = 62), twins (n = 72), and triplets (n = 9), were compared with equal numbers of non-IVF control subjects. Each pregnancy was matched by maternal age, race, insurance type, neonatal gender, order of gestation, order in delivery, and date of delivery (+/- 6 months). Among the 143 matched gestations, six IVF and seven control infants died, leaving 137 IVF and 136 control neonates for comparison. RESULTS: The IVF mothers had more pregnancy-induced hypertension (21% vs 4%), premature labor (44% vs 22%), labor induction (25% vs 1%), and preterm delivery (37% vs 21%). The IVF infant survivors had a lower mean (+/- SD) birth weight (2623 +/- 857 gm vs 3006 +/- 797 gm), more frequent occurrence of low birth weight (42% vs 27%), and shorter gestations (37 +/- 4 vs 38 +/- 3 weeks). The IVF infants had longer hospitalizations, more days of oxygen therapy, more days of continuous positive airway pressure, and increased prevalence of respiratory distress syndrome, patent ductus arteriosus, and sepsis. CONCLUSIONS: Couples who undergo IVF appear to be at increased risk of having low birth weight and preterm infants, and multiple gestations account for most of the neonatal morbidities. Both the mothers who conceive multiple gestations by means of IVF and their neonates are at an increased risk of having multiple morbidities.

Adult↗

PubMed2003

Gender-related differences in morbidity and mortality during combined valve and coronary surgery.

BACKGROUND: Gender-related differences in morbidity and mortality are well described for coronary artery bypass grafting but are not well understood for combined valve and bypass surgery. METHODS: We reviewed retrospectively the morbidity and mortality of 1570 consecutive patients who underwent combined valve and bypass procedures at the Toronto General Hospital between January 1990 and October 2000. RESULTS: There were 1073 men (68%) and 497 women (32%). The mean ages (+/- 1 SD) of women and men were 69 +/- 9 and 68 +/- 9 years, respectively (P =.02). Of the 1570 total patients, 973 patients (62%) underwent aortic valve and coronary bypass surgery, 481 patients (31%) had mitral valve and coronary bypass operations, and 116 (7%) patients had double or triple valve and coronary bypass operations. Preoperative hypertension (P =.002), diabetes (P =.001), and atrial fibrillation (P =.001) were seen more frequently in women. Body surface area was significantly lower in women (P =.0001). At presentation, more women were in congestive heart failure (69% vs 58%, P =.001) and in New York Heart Association functional class III or IV (25% vs 19%, P =.001). Although there was no difference in the number of women with three or more diseased vessels (32% vs 38%), only 35% of women received three or more grafts compared with 44% of men (P =.001). The use of left internal thoracic grafts, although uncommon in the whole study population (36%), was less common in women than in men (26% vs 41%, P =.001). Multivariable logistic analyses for morbidity and mortality showed female gender to be an independent risk factor. Mitral valve replacement, age, left ventricular dysfunction, New York Heart Association classes III and IV, and association of tricuspid valve disease, diabetes, peripheral vascular disease, and preoperative renal failure were found to be independent risk factors for mortality. CONCLUSION: Female gender is an independent risk factor for combined morbidity and mortality during and after combined valve and coronary bypass surgery. As with isolated coronary artery bypass grafting, women undergoing combined procedures have more premorbid conditions, are more often in heart failure, had an equal incidence of triple vessel disease but received fewer grafts than men, and, therefore, were more frequently incompletely revascularized.

Aged↗

PubMed1996

Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial.

INTRODUCTION: We undertook a prospective, randomized, controlled clinical trial to evaluate morbidity outcomes and safety of a modified anesthetic technique to provide shorter sedation and early extubation (1 to 6 hours) than those of the conventional anesthetic protocol used for prolonged sedation and extubation (12 to 22 hours) in patients after coronary artery bypass grafting. METHODS: One hundred twenty patients undergoing elective coronary artery bypass grafting were prospectively assigned randomly to either an early extubation group (n = 60; 15 micrograms.kg-1 fentanyl and 2 to 6 mg.kg-1.hour-1 propofol and isoflurane) or to a conventional extubation group (n = 60; 50 micrograms.kg-1 fentanyl and 0.1 mg.kg-1 midazolam and isoflurane). Cardiac morbidity (postoperative myocardial ischemia, postoperative myocardial infarction, and perioperative sympathoadrenal stress response), respiratory morbidity (postextubation apnea, alveolar-arterial oxygen gradient, pulmonary shunting, oxygen consumption, atelectasis, and reintubation), hemodynamic values and vasoactive medication requirements, intraoperative awareness, postoperative cognitive function, 30 day mortality, and intensive care unit and hospital lengths of stay were compared between the two groups. RESULTS: Fifty-one of the 60 patients in each group (85%) were extubated within the defined time period. Postoperative extubation time and intensive care unit and hospital lengths of stay were significantly shorter in the early group. At 48 hours after operation, there were no significant differences between the two groups in myocardial ischemia incidences, ischemia burdens, or creatine kinase isoenzyme MB levels. Four patients in the conventional group, but not in the early group, had postoperative myocardial infaction. The extubation anesthetics used were effective in suppressing the perioperative plasma catecholamine stress response in both groups. Postextubation apnea characteristics were similar between the groups. Intrapulmonary shunt fraction improved significantly in the early group at 4 hours after extubation. The incidences and degree of atelectasis did not differ significantly between the two groups. The incidences of treated postoperative complications were comparable between the two groups, but three patients in the conventional group died as a result of stroke or postoperative myocardial infarction. CONCLUSION: Early extubation after coronary artery bypass grafting is safe and does not increase perioperative morbidity. There is an improvement in postextubation intrapulmonary shunt fraction and a reduction in intensive care unit and hospital lengths of stay.

Aged↗

PubMed1999

Atheroembolic renal disease: effect on morbidity and survival after revascularization for atherosclerotic renal artery stenosis.

PURPOSE: Atheroembolic renal disease is increasingly found in older patients with general atherosclerosis. We evaluated the impact of atheroembolic renal disease on morbidity and survival after surgical revascularization for atherosclerotic renal artery stenosis. MATERIALS AND METHODS: The study group comprised 44 patients who underwent surgical revascularization for atherosclerotic renal artery stenosis and concomitant intraoperative renal biopsy. Renal biopsy specimens were reviewed by a pathologist and evaluated for the presence or absence of atheroemboli, and the presence and severity of arteriolar nephrosclerosis. Postoperative patient data were reviewed to evaluate survival, and the incidence of renal and systemic morbid events. Patients were followed for 1 to 14.5 years (median 6.2) after surgical revascularization. RESULTS: Atheroembolic renal disease was identified in the intraoperative biopsy specimen in 16 patients (36%, group 1) and was absent in 28 (64%, group 2), termed groups 1 and 2. Atheroembolic renal disease correlated significantly with decreased patient survival. The 5-year survival in groups 1 and 2 was 54 and 85%, respectively (p = 0.011). Similarly the incidence of systemic atherosclerotic complications was significantly higher in group 1 than group 2 (86 versus 58%, p <0.05). In addition, renal or renovascular complications developed in more group 1 than group 2 patients (p = 0.07). There was no significant association between the presence or severity of arteriolar nephrosclerosis and postoperative survival or morbid events. CONCLUSIONS: Our results indicate that atheroembolic renal disease is associated with decreased survival and an increased incidence of atherosclerotic morbid events after surgical revascularization for atherosclerotic renal artery stenosis. This information may be useful for therapeutic decision making in patients with atherosclerotic renal artery stenosis.

Embolism, Cholesterol↗

PubMed2003

The impact of co-morbid disease on cancer control and survival following radical cystectomy.

PURPOSE: We clarified the impact of concurrent medical disease on tumor control and survival following radical cystectomy. MATERIALS AND METHODS: A total of 106 consecutive patients with clinically localized (cT2 or less) disease underwent radical cystectomy at the University of Michigan between 1997 and 1998. The Charlson Index, a validated risk adjustment index, was used to assess preoperative co-morbidity. The 3 primary end points were pathological stage, disease specific survival and overall survival. Logistic regression models were used to determine the relationship between Charlson Index and pathological stage, while Cox regression models were used for the 2 survival end points. RESULTS: Of our study population 24% had a Charlson Index score of 2 or greater. Myocardial infarction, nonurothelial solid malignancies and cerebrovascular disease were the most common co-morbid conditions at 14%, 12% and 10%, respectively. On bivariate analysis the Charlson Index was significantly associated with decreased disease specific (p = 0.049) and overall (p = 0.016) survival. In a multivariate model the index was independently associated with decreased cancer specific survival (p = 0.049) and increased risk of extravesical disease (p = 0.033). CONCLUSIONS: We demonstrated an association between co-morbid illness and adverse pathological and survival outcome following radical cystectomy. This finding underscores the value of assessing overall health before recommending and proceeding with surgery. Moreover, our results emphasize the need to adjust for co-morbidity when comparing outcomes following radical cystectomy.

Aged↗

PubMed1991

The frequency and morbidity of local tumor recurrence after definitive radiotherapy for stage C prostate cancer.

Radiotherapy is reported to provide good control of locally advanced prostate cancer. However, few long-term studies have assessed the morbidity related to local tumor recurrence in patients treated with radiotherapy alone (without hormonal manipulation). To determine the frequency and severity of morbidity related to local recurrence we reviewed the course of all patients with clinical stage C prostate cancer treated at our institution between 1966 and 1979 with bilateral pelvic lymph node dissection, radioactive gold seed implantation and external beam irradiation therapy to the prostate. Of the 121 patients 60% died and the 40% still alive at the time of review were followed for a mean of 8.1 years (range 3.3 to 14.8 years). Over-all, 64 patients (53%) had local recurrence, which was defined as a clinical event causing signs or symptoms and was proved by biopsy. On an actuarial basis the risk of local recurrence was 43 +/- 10% (mean +/- 2 standard errors) at 5 years and 74 +/- 11% at 10 years. Any symptomatic episode requiring active intervention or causing morbidity was denoted an adverse event. There were 162 adverse events among the 73 patients (2.2 adverse events per patient): 69% of these were severe (requiring surgical intervention) and 55% were chronic (more than 3 months in duration). The most common cause of an adverse event was bladder outlet obstruction requiring transurethral resection of the prostate (44 patients); 16 patients (13%) became incontinent. Hydronephrosis developed in 24 patients (20%). Local recurrence after definitive radiotherapy for our patients with stage C prostate cancer was common and was associated with serious morbidity, frequently requiring surgical intervention. Radiotherapy alone may not be sufficient to provide long-term local control of stage C prostate cancer.

Adult↗

PubMed2001

Vaginal preparation with povidone iodine and postcesarean infectious morbidity: a randomized controlled trial.

OBJECTIVE: To determine whether vaginal preparation with povidone iodine before cesarean decreased the incidence of postpartum infectious morbidity. METHODS: Participants were randomly assigned to vaginal preparation with povidone iodine (n = 247) or no preparation (n = 251). Postpartum infectious morbidity included fever, defined as temperature of 38C or greater after the day of surgery; endometritis, defined as fever with abdominal or uterine tenderness and initiation of intravenous antibiotics; and wound separation, defined as disruption of the abdominal incision that required wound care. We calculated overall rates of postpartum infectious morbidity, relative risks (RR), and 95% confidence intervals (CI) for the effect of vaginal preparation. As designed and reported, the trial had at least 80% power to detect a 10% or greater absolute difference in rates of overall infectious morbidity, fever, and endometritis (two-tailed, alpha = 0.05). RESULTS: There was no difference between groups in maternal age, parity, race, education, prior cesarean, type of anesthesia, labor before current cesarean, number of vaginal examinations during labor, internal monitoring, prophylactic antibiotic use, gestational age at delivery, or payment status. Excluding 68 women with chorioamnionitis, incidence of postoperative fever was 19.3%, endometritis 7.2%, and wound separation 7.0%. Vaginal preparation with povidone iodine before cesarean had no effect on risk for fever (RR 1.1, 95% CI 0.8, 1.6), endometritis (RR 1.6, 95% CI 0.8, 3.1), or wound separation (RR 0.6, 95% CI 0.3, 1.3). CONCLUSION: Vaginal preparation with povidone iodine before cesarean had no effect on the incidence of fever, endometritis, or wound infection.

Adult↗

PubMed2003

Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: a prospective comparison of two seed implant methods-preplanning and intraoperative planning.

OBJECTIVES: To compare morbidity between two currently used iodine-125 seed implantation techniques for the treatment of localized prostate cancer. METHODS: Iodine-125 brachytherapy was used in 300 consecutive men with localized prostate cancer. Two seed implant techniques were used: preplanning, using preloaded needles, and intraoperative planning, using a Mick applicator. A comparison was made between the groups for urinary morbidity. The International Prostate Symptom Score was assessed prospectively among all patients. Computed tomography-based implant quality parameters were correlated with lower urinary system morbidity. RESULTS: The median follow-up was 30 months. In both treatment groups, the International Prostate Symptom Score increased significantly for about 9 to 12 months and returned to baseline thereafter. The International Prostate Symptom Scores reached a higher level and remained at a higher level for a longer period in the intraoperative group. Although the differences were statistically significant, they were of mild clinical importance. Overall, the incidence of acute retention and the need for surgery was very low in both groups (2% and 1%, respectively). No differences were noted between the two groups. Significantly better computed tomography-based implant dosimetry parameters were noted with the intraoperative method. A positive correlation (P < 0.001) was found between the dosimetry parameters and symptom severity. CONCLUSIONS: This prospective study reports the first large-scale comparison of urologic outcomes after two different seed implant techniques. Both were associated with very low urinary retention rates or other grade 3 or greater urologic morbidity. Almost all men had worse urinary symptoms for the first 6 to 9 months, regardless of the seed implant technique used. Patients treated with the intraoperative method demonstrated toxicity for a longer duration. Because of the much better gland isodose coverage and greater doses delivered in the intraoperative seed implantation, we favor this method.

Adenocarcinoma↗

PubMed1997

Morbidity of dysfunctional voiding syndrome.

OBJECTIVES: External sphincter dyssynergia in the absence of an identifiable causative neurologic lesion (dysfunctional voiding, Hinman-Allen syndrome, non-neurogenic neurogenic bladder) has been known to cause significant morbidity. To determine the outcomes in this syndrome, we conducted a retrospective study of 37 patients referred for urodynamic studies and subsequently diagnosed with dysfunctional voiding. METHODS: After diagnosis, follow-up was conducted through chart review and telephone calls to the primary physicians or the patients. RESULTS: Follow-up was possible in 27 patients (17 female, 10 male; mean follow-up 49 months, range 4 to 192). The average age at diagnosis was 12 years. Eleven patients developed significant or ongoing morbidity. Ten of these 11 patients underwent 17 operations. Eight patients were cured through medication, behavioral modification, intermittent catheterization, and/or other nonoperative treatments. The remaining 8 patients did not experience significant morbidity but did not have resolution of their symptoms as of their last medical evaluation, and most were lost to follow-up. CONCLUSIONS: Dysfunctional voiding resulted in severe morbidity in 11 (40%) of 27 study patients. Eight patients (30%) were cured using nonoperative, conservative treatments, and 8 (30%) had unresolved symptoms within the follow-up period. Urodynamic studies are essential in the diagnosis of the syndrome but cannot be used to consistently predict outcome.

Adolescent↗

PubMed1999

Contemporary incidence of morbidity related to vesicoureteral reflux.

OBJECTIVES: The association among vesicoureteral reflux (VUR), renal scarring, and reflux nephropathy is well established. Screening programs for children who present with urinary tract infection (UTI) and their siblings, along with medical and surgical management, have been promoted by pediatric medical and urologic specialists in Buffalo and the surrounding community for more than two decades. Has this comprehensive and costly effort resulted in a decrease in VUR-related morbidity and should it be continued? METHODS: The records of all active patients who presented from 1982 through 1997 to this region's single pediatric nephrology referral center were reviewed. One hundred twenty-two children and adolescents (73 boys, 49 girls) were identified with hypertension (HTN), renal insufficiency (RI), and end-stage renal disease (ESRD) requiring dialysis or transplantation. RESULTS: There were 70 patients (57%) with HTN, 19 (16%) with RI, and 33 (27%) with ESRD. Reflux nephropathy was the underlying cause in 6 patients (5%)-3 with HTN and 3 with ESRD. The etiologies of morbidity in the remaining patients were medical renal disease, 61 (50%); idiopathic, 17 (14%); obstructive uropathy, 14 (11%); primary congenital renal hypoplasia, 12 (10%); and vascular, 12 (10%). Of the 6 patients with VUR-related morbidity, 4 were boys (3 with ESRD, 1 with HTN) and 2 were girls (with HTN). Five children presented in the 1980s and 1 in the 1990s. Only 1 patient had a history of UTI, and she presented early in the series in 1982 at 5 years of age. Ages of presentation were infancy (2 boys), early childhood (1 boy, 1 girl), and adolescence (1 boy, 1 girl). Reasons for presentation were failure to thrive (n = 2), voiding dysfunction without UTI (n = 1), muscle cramps (n = 1), UTI (n = 1), and HTN (n = 1). Reflux grade ranged from I to V, but 4 patients had grade III or less. CONCLUSIONS: Awareness of VUR-related morbidity has led to more widespread diagnosis and treatment, which appears to have resulted in a dramatic decrease in the numbers of affected patients in this community. The diagnosis and treatment of VUR has altered the epidemiology of HTN and renal failure in children and young adults.

Adolescent↗