Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Artigo em Inglês | MEDLINE | ID: mdl-32265404

RESUMO

OBJECTIVES: This study aimed to evaluate successful use of a midstream urine collection device in women with lower urinary tract symptoms and to assess specimen contamination. METHODS: Nonpregnant women 18 years or older without use of antibiotics in the last 4 weeks were recruited. After using the midstream urine collection device to obtain a specimen in a private restroom, a paired specimen was obtained by transurethral catheterization. Patients completed preference questionnaires. Culture organisms and microscopic urinalysis of paired specimens (device vs catheterized) were compared using the McNemar χ test. Bivariate analysis was performed. RESULTS: Successful use was demonstrated in 54 (77%) of 70. Reasons for failure included inadequate specimen volume and improper device use. Older median age (50 vs 72 years, P = 0.0003) and history of diabetes (7% vs 27%, P = 0.037) were associated with failed use. Organisms were discordant in 21 (41%) of 51 paired urine culture specimens. The device detected 7 (88%) of 8 uropathogens. There were no detectable differences in microscopic urinalysis. CONCLUSIONS: The midstream urine collection device could increase comfort, and many patients prefer it to transurethral catheterization. With proper patient selection and instructions for use, this device could increase satisfaction. Further studies are needed to assess contamination rates with this device.

2.
Urology ; 132: 37-42, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310773

RESUMO

OBJECTIVES: To examine the safety and effectiveness of placing ureteral stents in an office-based setting vs in the operating room (OR). METHODS: A retrospective chart review was performed to examine outcomes, specifically complication rate, unanticipated hospitalizations, and stent failures, when patients received JJ stents in the clinic procedure suite, using local analgesia and/or nitrous oxide gas analgesia, compared to patients who had ureteral stents placed in the OR, typically with general anesthesia. Additionally, multivariable analysis was performed to determine predictors of complications. RESULTS: Around 565 procedures were performed in the clinic and 179 were performed in the OR. The complication rate for the clinic group was 4.1%, compared to 7.8% in the OR group. Unplanned admissions to the hospital occurred after 3.0% of clinic procedures and 9.5% of OR procedures. Stent placements failed in 1.1% of clinic procedures and 0.56% of OR procedures. Clinic procedure time was 10 minutes vs 12 minutes in the OR (P <0.01). Clinic vs OR setting was not predictive of complications (P = 0.99). We did not identify factors that impacted complication rate in ureteral stent placement in the clinic vs OR setting. Notably, the procedure time for a clinic stent placement was significantly shorter than the OR stent placement. CONCLUSIONS: This study demonstrates excellent outcomes with a novel approach to a standard procedure, with shorter procedure time and no difference in complication rates.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos não Entorpecentes , Sedação Consciente/métodos , Óxido Nitroso , Salas Cirúrgicas , Stents , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto Jovem
3.
Proc (Bayl Univ Med Cent) ; 32(2): 196-198, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31191126

RESUMO

Over 500,000 men in America have a vasectomy annually; 2% to 6% of these individuals later elect to have a vasectomy reversal. Vasovasostomies are typically performed using a single- or double-layer closure, with no demonstrated difference between the two in terms of success rates. In 2005, Ho et al described a microscopic technique in which three full-thickness sutures are used and the anastomosis is reinforced with fibrin glue. At our institution, a similar technique has been used for >10 years. To describe our experience, a retrospective chart review was undertaken. Patient demographic information and operative characteristics were analyzed. In each case, fibrin glue was circumferentially applied to reinforce the anastomosis. The overall patency rate was 88.4%, and rates comparing individuals who had their vasectomy reversal within 10 years of vasectomy reached statistical significance with an odds ratio of 2.91 (P = 0.048). Median operative time was 94 minutes. Other demographic variables analyzed did not have a correlation with patency. In conclusion, our technique provides acceptable patency rates, especially with obstructive intervals of 10 years or less, while likely resulting in cost savings given the decreased operating room time and suture used.

4.
J Am Coll Surg ; 228(4): 482-490, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885474

RESUMO

BACKGROUND: Frailty is an emerging risk factor for surgical outcomes; however, its application across large populations is not well defined. We hypothesized that frailty affects postoperative outcomes in a large health care system. STUDY DESIGN: Frailty was prospectively measured in elective surgery patients (January 2016 to June 2017) in a health care system (4 hospitals/901 beds). Frailty classifications-low (0), intermediate (1 to 2), high (3 to 5)-were assigned based on the modified Hopkins score. Operations were classified as inpatient (IP) vs outpatient (OP). Outcomes measured (30-day) included major morbidity, discharge location, emergency department (ED) visit, readmission, length of stay (LOS), mortality, and direct-cost/patient. RESULTS: There were 14,530 elective surgery patients (68.1% outpatient, 31.9% inpatient) preoperatively assessed (cardiothoracic 4%, colorectal 4%, general 29%, oral maxillofacial 2%, otolaryngology 8%, plastic surgery 13%, podiatry 6%, surgical oncology 5%, transplant 3%, urology 24%, vascular 2%). High frailty was found in 3.4% of patients (5.3% IP, 2.5% OP). Incidence of major morbidity, readmission, and mortality correlated with frailty classification in all patients (p < 0.05). In the IP cohort, length of stay in days (low 1.6, intermediate 2.3, high 4.1, p < 0.0001) and discharge to facility increased with frailty (p < 0.05). In the OP cohort, ED visits increased with frailty (p < 0.05). Frailty was associated with increased direct-cost in the IP cohort (low, $7,045; intermediate, $7,995; high, $8,599; p < 0.05). CONCLUSIONS: Frailty affects morbidity, mortality, and health care resource use in both IP and OP operations. Additionally, IP cost increased with frailty. The broad applicability of frailty (across surgical specialties) represents an opportunity for risk stratification and patient optimization across a large health care system.

5.
Urology ; 126: 49-53, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654140

RESUMO

OBJECTIVE: To further analyze calcium tartrate tetrahydrate stones after a recent case report described this novel stone. Prior to this, there was only one previously reported occurrence of this stone in a human. This unusual stone composition is not tested for routinely. True prevalence and possible causes of this stone are unknown. MATERIALS/METHODS: During the previous case report, micro-CT and Fourier-transform infrared spectroscopy were used to identify a calcium tartrate tetrahydrate stone. This information was applied to urinary stones with previously unidentified compositions in the Mayo Metals laboratory database between 2010 and March 2018. Two additional stones were identified at our institution. Three patients had medical records available for analysis. RESULTS: Between 2010 and March 2018, 35 calcium tartrate stones in 25 patients were identified in the Mayo database as well as 2 at our institution (37 stones in 27 patients). Thirty stones were pure calcium tartrate with the remainder having elements of more common stones. The average age was 46.3 (±14.7) with a slightly higher incidence in females (17 vs 10). Of the 3 medical records investigated, all 3 were males (average age 48.7), and each reported consumption of an energy supplement (Spark) routinely. CONCLUSION: The true prevalence of this relatively unknown stone remains unclear and additional investigation is warranted. We believe all stone laboratories should have access to the IR spectra for calcium tartrate tetrahydrate. Attention should be paid to possible causes of this stone, particularly with relation to oral supplements, to aid with future prevention and treatment.


Assuntos
Tartaratos/análise , Cálculos Urinários/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectroscopia de Infravermelho com Transformada de Fourier , Adulto Jovem
6.
Transl Androl Urol ; 7(6): 931-934, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30505730

RESUMO

Background: Each year in the US, approximately 500,000 men choose to undergo a vasectomy for permanent sterilization. Despite being a very common procedure, studies reporting demographic data and characteristics that motivate men to choose a vasectomy are somewhat limited. With this analysis, the primary objective was to determine if a difference existed between the ages and number of children among men choosing to have a vasectomy at urology practices in urban (Austin, TX = City A, population 947,890) and rural (Temple, TX = City B, population 76,277) settings. A secondary objective was to establish if there was a trend in these variables over time. Methods: After IRB approval was obtained from each institution, a retrospective chart review was undertaken to identify men who had undergone a vasectomy at each facility from 2011-2017. Demographic data was recorded. Statistical analysis was done using student's t-test and linear regression. Results: The mean age at time of vasectomy in City A was 37.41 years versus 36.18 in City B (P<0.001). Men in City A underwent vasectomy after a mean of 1.96 children as opposed to a mean of 2.60 children in City B (P<0.001). There was no statistically significant trend in average age or number of children over time. Conclusions: Men in an urban setting underwent vasectomy at an older age and with fewer children when compared to a rural practice environment. While studies evaluating demographics of men undergoing vasectomy have previously been performed, our results are unique in terms of a direct comparison between different population concentrations.

7.
Proc (Bayl Univ Med Cent) ; 31(2): 165-167, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29706808

RESUMO

Semen from asymptomatic men who are being evaluated as male partners in interfile couples have been reported to contain a variety of bacteria. Longitudinal studies of the variation of these bacteria over time and their resistance patterns have not been commonly reported. At our institution, residues from semen samples are routinely evaluated for bacteria, including antibiotic sensitivity profiles. We set out to profile the changes in semen bacteria and antibiotic resistance at our institution over time. A total of 72 semen isolates were examined for type of bacteria and sensitivity to a panel of antibiotics. The results were divided into two separate 5-year intervals (the first beginning in 2006, the second in 2011) and compared. The majority of bacteria were skin flora, with Streptococcus and Staphylococcus being the most prevalent. The resistance data for these two pathogens showed minimal statistically significant difference between the two time periods, although the Staphylococcus species did show a trend toward increasing resistance, suggesting that antibiotics currently used in sperm cell preparations may need to be varied.

8.
Investig Clin Urol ; 59(3): 177-181, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29744474

RESUMO

Purpose: Cryopreservation of sperm from human semen has been available since the 1950s. The actual utilization of available cryopreservation technology has been infrequently reported. We set out to examine the utilization and outcomes of cryopreserved sperm cells based on the indication for storage. Materials and Methods: A dataset was developed from retrospective review. The purposes for cryopreservation, eventual utilization, and outcomes of use for insemination were recorded. The types of utilization were accumulated as proportions for different purposes. The timing for use of samples for insemination procedures was evaluated using survival statistics. The frequency of patients arranging to destroy samples was also reported. Results: From September 1988 through March 2015, 1442 samples were cryopreserved. Samples were cryopreserved for four primary purposes: infertility treatments focused on intrauterine insemination (IUI) or in vitro fertilization/intracellular injection (IVF/ICSI), for fertility preservation related to cancer treatment, or prior to military deployment. Total utilization rates were 19.3%. Samples cryopreserved for IUI were more likely to be used (64.3%), while samples cryopreserved as backup for IVF/ICSI were more likely to be destroyed (29.8%). Pregnancy rates varied based on the indication and ART used. Pregnancies per cycle were 35% for IVF/ICSI and were 10% for IUI. Conclusions: Cryopreservation of sperm is a valuable and underutilized resource, particularly amongst male cancer patients. This technology can facilitate infertility treatments based on a variety of indications, including deployment-a patient cohort unique to our dataset.


Assuntos
Criopreservação/estatística & dados numéricos , Preservação da Fertilidade/estatística & dados numéricos , Infertilidade/terapia , Militares/estatística & dados numéricos , Neoplasias/terapia , Espermatócitos , Feminino , Humanos , Inseminação Artificial/estatística & dados numéricos , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Estados Unidos
9.
J Urol ; 199(1): 229-236, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28709886

RESUMO

PURPOSE: We evaluated the therapeutic success rate, changes in quality of life and safety of sacral neuromodulation 5 years after InterStim™ implantation. Included in study were subjects with bothersome symptoms of overactive bladder, including urinary urge incontinence and/or urgency-frequency, in whom at least 1 anticholinergic medication failed and 1 medication had not been tried. MATERIALS AND METHODS: Therapeutic success was defined as a urinary urge incontinence or urgency-frequency response of 50% or greater improvement in average leaks or voids per day, or return to normal voiding, defined as fewer than 8 voids per day. Quality of life was evaluated by ICIQ-OABqol (International Consultation on Incontinence Modular Questionnaire). Safety was evaluated through adverse events. RESULTS: Of the 340 subjects who completed the test stimulation 272 had an implant, of whom 91% were female. Mean age was 57 years. At baseline 202 subjects with urinary urge incontinence had a mean ± SD of 3.1 ± 2.7 leaks per day and 189 with urgency-frequency had a mean of 12.6 ± 4.5 voids per day. The 5-year therapeutic success rate was 67% (95% CI 60-74) using modified completers analysis and 82% (95% CI 76-88) using completers analysis. Subjects with urinary urge incontinence had a mean reduction from baseline of 2.0 ± 2.2 leaks per day and subjects with urgency-frequency had a mean reduction of 5.4 ± 4.3 voids per day (each completers analysis p <0.0001). Subjects showed improvement in all ICIQ-OABqol measures (p <0.0001). The most common device related adverse events were an undesirable change in stimulation in 60 of the 272 subjects (22%), implant site pain in 40 (15%) and therapeutic product ineffectiveness in 36 (13%). CONCLUSIONS: This multicenter study shows that sacral neuromodulation had sustained efficacy and quality of life improvements, and an acceptable safety profile through 5 years in subjects with overactive bladder.


Assuntos
Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiopatologia , Dor Pós-Operatória/epidemiologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária de Urgência/terapia , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia
10.
J Endourol Case Rep ; 3(1): 192-195, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29279874

RESUMO

Background: Calcium tartrate tetrahydrate has been reported as the main mineral in urinary stones in rats that have significant tartrate in their diet, but in humans, there has been only one mention of calcium tartrate stones in the form of bladder stone, and that case was in Africa. Case Presentation: Patient is a 34-year-old Caucasian male who presented with typical symptoms of nephrolithiasis. CT abd/pelvis (renal stone protocol) revealed a 2 cm nonobstructing stone of the right renal pelvis. Patient underwent an uncomplicated right percutaneous nephrolithotomy and was noted to be stone free after surgery. Stone analysis was difficult with regard to determining composition, but was finally identified as calcium tartrate tetrahydrate. Conclusion: This was an unusual case, as this is the first recorded case of a calcium tartrate tetrahydrate outside of Africa. This type of stone had only been mainly described in rat models with dl-bitartrate in their diet. Our patient was an otherwise healthy, relatively muscular individual with no obvious source for this stone other than a vitamin and amino acid supplement that he takes regularly that contains l-carnitine (as tartrate) and choline (as bitartrate and citrate). The prevalence of this stone type is presently unknown, as stone analysis laboratories have not had the ability to recognize it. Although a connection between the supplement and stone formation is conjecture at this time, we believe this necessitates further investigation.

11.
Can Urol Assoc J ; 11(7): E311-E314, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28761594

RESUMO

INTRODUCTION: We sought to provide a technical update on the use of a prostate morcellator device (PMD) to manage organized blood clots of the bladder following laser prostatectomy. METHODS: Herein, we describe our experience in using the Wolf Piranha morcellator in managing organized bladder blood clots supplemented with a retrospective chart review of the patients in whom this procedure was performed. RESULTS: Six patients, all male with a mean age of 75 ± 8.9 years, had organized bladder clots following either holmium laser enucleation or photoselective vaporization of the prostate managed with a PMD. Clots were recognized based on hematuria or urinary retention a median of 3.5 days following the aforementioned procedures. Initial management was attempted with more conservative measures, including a three-way Foley catheter, followed by cystoscopy with an Ellik evacuator, or a glass Tommey syringe. Morcellation times were a mean of 10.2 ± 6.15 minutes (range 2-18). This technique was able to manage clots that were an average of 173.3 ± 115.9 cc in size. The procedure was well-tolerated. No patients experienced intraoperative or morcellator-related complications. CONCLUSIONS: Benign prostatic hypertrophy frequently requires surgical endoscopic management and can be complicated by hematuria and bladder blood clot formation. When these clots become organized, this can lead to urinary retention and the required management, evacuation, may be difficult. The use of a Wolf Piranha PMD is a safe, well-tolerated, and effective in evacuating organized blood clots of the bladder.

12.
J Endourol ; 31(9): 847-850, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28637364

RESUMO

OBJECTIVES: To compare perioperative outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RSP) for benign prostatic hypertrophy (BPH). METHODS: Patient demographics and perioperative outcomes were compared between 600 patients undergoing HoLEP and 32 patients undergoing RSP at two separate academic institutions between 2008 and 2015. RESULTS: Patients undergoing HoLEP and RSP had comparable ages (71 vs 71, p = 0.96) and baseline American Urological Association Symptom Scores (20 vs 24, p = 0.21). There was no difference in mean specimen weight (96 g vs 110 g, p = 0.15). Mean operative time was reduced in the HoLEP cohort (103 minutes vs 274 minutes, p < 0.001). Patients undergoing HoLEP had lesser decreases in hemoglobin, decreased transfusions rates, shorter hospital stays, and decreased mean duration of catheterization. There was no difference in the rate of complications Clavien grade 3 or greater (p = 0.33). CONCLUSIONS: HoLEP and RSP are both efficacious treatments for large gland BPH. In expert hands, HoLEP appears to have a favorable perioperative profile. Further studies are necessary to compare long-term efficacy, cost, and learning curve influences, especially as minimally invasive approaches become more widespread.


Assuntos
Terapia a Laser/métodos , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Anemia/epidemiologia , Anemia/metabolismo , Anemia/terapia , Transfusão de Sangue/estatística & dados numéricos , Hemoglobinas/metabolismo , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Próstata/patologia , Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/estatística & dados numéricos
13.
Curr Urol Rep ; 17(11): 82, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27665577

RESUMO

BACKGROUND: The urinary catheter is an ancient device for urinary drainage in patients. Placement of a urethral catheter is a common medical procedure that may have led to morbidity and mortality. Urethral catheterization is commonly performed by a nurse. Difficult catheter placement generates urology consultation. Difficult catheterization with a vision-guided urinary catheter may provide expedited and successful catheter placement by nursing personnel. METHODS: A PubMed.gov and Ovid Medline search for articles on history of urinary catheter, difficult urinary catheterization, iatrogenic urethral injury, iatrogenic urethral injury and CAUTI, management of iatrogenic urethral injury, and techniques for urinary catheter placement was performed. RESULTS: The history of urinary catheters is reviewed. Technical advances in the last century are discussed. Indications for catheter placement are included. Outcomes and cost of complications of urinary catheters are discussed relative to present practice quality standards. Review of difficult urinary catheterization management algorithms developed with urological catheter improvements during the last decade is analyzed. Educational and technological advances to improve outcomes of urinary catheter use are addressed. CONCLUSIONS: Provider attention to issues of urinary catheterization is enhanced by education and additional skills for catheterization. Physician and nurse providers can use current technology with preparation to improve the catheterization care of patients.


Assuntos
Doença Iatrogênica/prevenção & controle , Uretra/lesões , Doenças Uretrais , Cateterismo Urinário/normas , Cateteres Urinários , Humanos , Doenças Uretrais/diagnóstico , Doenças Uretrais/etiologia , Doenças Uretrais/prevenção & controle
14.
Urology ; 94: 57-63, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27131966

RESUMO

OBJECTIVE: To evaluate the therapeutic success rate, and changes in quality of life (QOL) and safety in subjects using sacral neuromodulation (InterStim System) at 36 months. Subjects with bothersome symptoms of overactive bladder (OAB) including urinary urge incontinence (UI) and/or urgency frequency (UF), who had failed at least 1 anticholinergic medication, and had at least 1 untried medication were included. METHODS: Subjects with successful test stimulation received an InterStim implant. Therapeutic success and quality of life through 36 months was evaluated in implanted subjects with data at baseline and follow-up. Safety was evaluated using reported adverse events. RESULTS: A total of 340 subjects received test stimulation resulting in 272 implanted subjects. Demographics include 91% female, mean age of 57 years, and baseline symptom severity of 3.1 ± 2.7 leaks/day (UI) and 12.6 ± 4.5 voids/day (UF). The analysis showed an OAB therapeutic success rate of 83% (95% confidence interval: 78%-88%). UI subjects had a mean reduction from baseline of 2.3 ± 2.3 leaks/day whereas UF subjects had a mean reduction of 5.3 ± 4.0 voids/day (both P < .0001). Statistically significant improvements were observed in all measures of the International Consultation on Incontinence Modular Questionnaire-OABqol (all P < .0001). Eighty percent of subjects reported improvements in their urinary symptom interference. Device-related adverse events occurred in 47% (127/272) of subjects post-implant; 91% were resolved at the time of this analysis. CONCLUSION: The 36-month follow-up data from the multicenter study demonstrate sustained safety, effectiveness, and improved QOL in subjects implanted with InterStim, without requiring failure of all medications.


Assuntos
Terapia por Estimulação Elétrica , Neuroestimuladores Implantáveis , Bexiga Urinária Hiperativa/terapia , Feminino , Seguimentos , Humanos , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária de Urgência/terapia
15.
Neurourol Urodyn ; 35(2): 246-51, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25546568

RESUMO

AIMS: This prospective, multicenter post-approval study evaluated the success rate of sacral neuromodulation (SNM) with the InterStim® System at 12-months. Subjects with bothersome symptoms of overactive bladder (OAB) including urinary urge incontinence (UI) or urgency-frequency (UF), who failed at least one anticholinergic medication and had at least one not tried were included. METHODS: Subjects with successful test stimulation received an SNM implant. Therapeutic success (≥50% improvement in average leaks/day or voids/day or a return to normal voiding frequency [<8 voids/day]) and quality of life through 12 months were evaluated for implanted subjects. RESULTS: Of the 340 subjects that went through test stimulation, 272 were implanted with SNM. Of these, 91% were female, mean age was 57, UI subjects had 3.1 ± 2.7 leaks/day, UF subjects had 12.6 ± 4.5 voids/day. The analysis which includes all implanted subjects with diary data at baseline and 12 months showed an OAB therapeutic success rate of 85% at 12 months. UI subjects had a mean reduction of 2.2 ± 2.7 leaks/day; UF subjects had a mean reduction of 5.1 ± 4.1 voids/day (both P < 0.0001). Subjects showed significant improvement from baseline in all measures of ICIQ-OABqol (all P < 0.0001). 80% of subjects reported improved changes in their urinary symptom interference at 12 months. Device-related adverse events occurred in 16% (56/340) of subjects during test stimulation and 30% (82/272) of subjects post-implant. CONCLUSIONS: This multicenter study shows SNM is safe and effective and results in improved outcomes through 12 months in subjects with OAB symptoms, without requiring failure of all medications.


Assuntos
Qualidade de Vida , Sacro , Estimulação da Medula Espinal/métodos , Bexiga Urinária Hiperativa/terapia , Bexiga Urinária/inervação , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses Neurais , Estudos Prospectivos , Recuperação de Função Fisiológica , Estimulação da Medula Espinal/efeitos adversos , Estimulação da Medula Espinal/instrumentação , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/diagnóstico , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/psicologia , Urodinâmica
16.
Neurourol Urodyn ; 34(3): 224-30, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24415559

RESUMO

AIMS: This prospective, randomized, multicenter trial evaluated the 6-month success rate of sacral neuromodulation (SNM) with InterStim® Therapy versus standard medical therapy (SMT) for overactive bladder (OAB). METHODS: Enrolled subjects discontinued OAB medications prior to and during baseline data collection and were randomized 1:1 to SNM or SMT. Subjects had bothersome symptoms of overactive bladder (OAB) including urinary urge incontinence (≥2 leaks/72 hr) and/or urgency-frequency (≥8 voids/day). Subjects failed at least one anticholinergic medication, and had at least one medication not yet attempted. The primary objective was to compare OAB therapeutic success rate at 6 months between SNM and SMT. RESULTS: Overall, 147 subjects were randomized (70 to SNM and 77 to SMT); 93% were female and mean age was 58. The primary intent to treat analysis showed OAB therapeutic success was significantly greater in the SNM group (61%) than the SMT group (42%; P = 0.02). In the as treated analysis, OAB therapeutic success was 76% for SNM and 49% for SMT (P = 0.002). The SNM group showed significant improvements in quality of life versus the SMT group (all P < 0.001) and 86% of SNM subjects reported improved or greatly improved urinary symptom interference score at 6 months, compared to 44% for SMT subjects. The device-related adverse event rate was 30.5% and the medication-related adverse event rate was 27.3%. CONCLUSIONS: This study demonstrates superior objective and subjective success of SNM compared to SMT. SNM is shown to be a safe and effective treatment for OAB patients with mild to moderate symptoms. Neurourol. Urodynam. 34:224-230, 2015. © 2014 Wiley Periodicals, Inc.


Assuntos
Plexo Lombossacral , Estimulação da Medula Espinal , Bexiga Urinária Hiperativa/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo
17.
Int Urogynecol J ; 24(2): 349-51, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22588141

RESUMO

Computed tomography (CT)-guided lead placement for sacral neuromodulation was used in a patient with arthritis and narrow S3 foramina. Bilateral S3 foramina were localized and guide needles were placed with CT guidance. Lead placement was further modified by placement of a tined, quadripolar lead through a dilated S3 tract without initial somatosensory testing. The lead was then interrogated to assess placement and to differentiate superiority of response between two leads. The patient has had greater than 50 % improvement in urinary symptoms by voiding diary. Using CT guidance, satisfactory localization of bilateral S3 foramina may be achieved where prior attempts with conventional fluoroscopy have failed.


Assuntos
Artrite/terapia , Terapia por Estimulação Elétrica/métodos , Sacro/diagnóstico por imagem , Sacro/inervação , Tomografia Computadorizada por Raios X/métodos , Incontinência Urinária de Urgência/terapia , Idoso , Eletrodos , Feminino , Humanos , Resultado do Tratamento
18.
Female Pelvic Med Reconstr Surg ; 16(6): 358-61, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22453622

RESUMO

OBJECTIVE: : To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI). STUDY DESIGN: : The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial. Patients with concomitant pelvic organ prolapse surgeries were not included in this analysis. RESULTS: : Sixty-seven patients underwent TVT, whereas 69 had TOT procedures. In the TVT group, 30 patients (42%) were unable to void immediately postoperatively compared with 11 patients (16%) in the TOT group (P = 0.0003). The mean (SD) age and BMI of patients who failed or passed voiding trials was 58.6 (12.0) years and 28.0 (4.9) kg/m or 53.5 (12.3) years and 29.8 (5.7) kg/m, respectively. Of 38 patients who did not pass a voiding trial on the day of the procedure, 31 (82%) passed on postoperative day 1, and all patients had passed a voiding trial by postoperative day 11. The mean (SD) BMI for 7 patients who did not pass voiding trial by postoperative day 1 was 28.3 (5.2) kg/m. CONCLUSIONS: : Women with higher BMIs were more likely to pass voiding trials after midurethral sling procedures. Patients who had TOT placement had greater success passing a postprocedure voiding trial than did patients who had TVT placement.

20.
Urology ; 73(4): 748-9, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19118872

RESUMO

We report a case of traumatic Foley catheter placement and manipulation that resulted in a large, symptomatic, vena cava air embolism confirmed on computed tomography. To the best of our knowledge, our report represents the first case of a large, symptomatic, vena cava air embolism as a direct result of Foley catheter trauma. The included computed tomography images are unique in that they simultaneously show an improperly positioned Foley catheter and a large vena cava air embolism.


Assuntos
Cateterismo/efeitos adversos , Cateterismo/instrumentação , Embolia Aérea/etiologia , Veia Cava Inferior/lesões , Humanos , Masculino , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA