The Journal of urology
-
The Journal of urology · Dec 1992
Randomized Controlled Trial Clinical TrialEffects of acute bolus and chronic continuous intrathecal baclofen on genitourinary dysfunction due to spinal cord pathology.
A prospective, blinded study was done to examine the effects of acute bolus and chronic continuous intrathecal baclofen on genitourinary function in 10 patients with severe spasticity due to spinal cord pathology. Genitourinary function was assessed by symptom questionnaires and urodynamic studies performed after a bolus dose of baclofen and 6 to 12 months after continuous intrathecal baclofen. Results were compared to placebo for acute bolus testing or to pre-continuous intrathecal baclofen values. ⋯ Whereas bladder capacity, compliance, sensation and voiding pressures were not different after continuous intrathecal baclofen, when a mean of all patients was compiled, a 72% increase in capacity and 16% improvement in compliance were observed in subjects without cervical spinal cord pathology. Detrusor-sphincter dyssynergia was abolished in 40% of the patients. Continuous intrathecal baclofen may represent a novel approach to the management of patients with a neurogenic bladder who have decreased bladder compliance and detrusor hyperreflexia not controlled by oral medications.
-
A total of 11 male neonates with hydronephrosis and a large bladder in utero had the megacystis-megaureter association. Prenatal ultrasound findings included bilateral hydroureteronephrosis; a large, smooth, thin-walled bladder, and normal volume of amniotic fluid. ⋯ The prenatal diagnosis of the megacystis-megaureter association can be suspected with reasonable accuracy. Prompt postnatal continuous antibiotic prophylaxis and uroradiological confirmation allow for nonemergency management of this condition with excellent results.
-
The Journal of urology · Sep 1992
Review Case ReportsFemale fertility following extracorporeal shock wave lithotripsy of distal ureteral calculi.
This study was prompted by a spontaneous abortion in a 21-year-old woman following extracorporeal shock wave lithotripsy (ESWL ) of a distal ureteral calculus. To our knowledge, it is the first clinical retrospective study on the possible adverse effects of ESWL to the female reproductive tract. We analyzed treatment data and radiation exposure of 84 women in the reproductive period, and surveyed the patients by questionnaire, to which 67 (79.8%) responded. ⋯ Overall 7 children with no malformations or chromosomal anomalies were born to 6 patients. Miscarriages were noted in 3 patients (4.5%) but they occurred at least 1 year after ESWL. Our data suggest that ESWL of lower ureteral calculi is a safe and effective procedure, and does not affect female fertility or lead to increased teratogenic risk.
-
The Journal of urology · Aug 1992
Comparative StudyUltrasound for detecting Schistosoma haematobium urinary tract complications: comparison with radiographic procedures.
Chronic infection with Schistosoma haematobium primarily causes urinary tract complications. These lesions are often silent or ignored and not detected until irreversible changes have occurred. However, early chemotherapy can prevent progression and usually reverse all but the more severe abnormalities. ⋯ Ultrasound was as sensitive as an IVP in detecting bladder masses, hydronephrosis and renal stones. It detected hydroureter less frequently (sensitivity 62.5%) than an IVP but visualized this lesion and hydronephrosis in some patients with nonfunctioning kidneys. Ultrasound demonstrated bladder stones as well as an x-ray but it detected bladder wall calcification with less sensitivity (65%) and was much less sensitive (12.5%) for detecting ureteral stones.
-
The Journal of urology · Aug 1992
Radiographic evaluation of adult patients with blunt renal trauma.
Recent reports in the literature suggest that radiographic evaluation of the normotensive blunt trauma patient with microscopic hematuria is no longer necessary. Several facilities, however, including ours, continue to perform excretory urography (IVP) routinely in this setting. To evaluate further whether this practice is indicated, we retrospectively reviewed the records of 317 adults who presented to our facility between May 1986 and December 1989 after blunt trauma with resultant microscopic hematuria but no shock. ⋯ No significant urological injury was identified. Thus, no injury would have been missed if a policy of observation had been followed in these patients. Our data support other reports in the literature that radiographic staging is not necessary in the adult blunt trauma patient with microscopic hematuria but no shock.