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Christopher Gonzalez - One of the best experts on this subject based on the ideXlab platform.
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Urethral Reconstruction in Patients with Neurogenic Bladder Dysfunction
Current Bladder Dysfunction Reports, 2010Co-Authors: Jessica T. Casey, Christopher GonzalezAbstract:Prolonged urethral catheterization can lead to significant urethral defects, including strictures, diverticula, erosions, and fistulas. Although it is a potentially challenging procedure, urethral reconstruction can allow patients with Neurogenic Bladder Dysfunction to continue clean intermittent catheterization, improve or maintain their cosmetic appearance, and improve sexual function. There is a paucity of literature focusing specifically on urethral reconstruction in patients with Neurogenic Bladder Dysfunction, with most studies involving small, heterogeneous populations. This article reviews published outcomes of urethral reconstruction and comments on the technical aspects of repair in patients with Neurogenic Bladder Dysfunction.
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Urethral Reconstruction in Patients With Neurogenic Bladder Dysfunction
The Journal of urology, 2008Co-Authors: Jessica T. Casey, Bradley A. Erickson, Neema Navai, Lee C. Zhao, Joshua J. Meeks, Christopher GonzalezAbstract:Purpose: There is limited literature examining urethral reconstruction in patients with Neurogenic Bladder Dysfunction. We describe our experience of urethral reconstruction in men with concurrent Neurogenic Bladder.Materials and Methods: A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with Neurogenic Bladder Dysfunction. Patient characteristics including the etiology of Neurogenic Bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated.Results: A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates dif...
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Safety and efficacy of percutaneous nephrolithotomy in patients with Neurogenic Bladder Dysfunction
Urology, 2004Co-Authors: Jonathan N. Rubenstein, Christopher Gonzalez, Lynn W. Blunt, J. Quentin Clemens, Robert B. NadlerAbstract:Abstract Objectives To review our experience performing percutaneous nephrolithotomy (PNL) on patients with Neurogenic Bladder Dysfunction with special attention paid to the risks of surgical complications and stone recurrence. Patients with Neurogenic Bladder Dysfunction with or without urinary diversion are at increased risk of urolithiasis, surgical complications, and recurrent stone disease. Methods We retrospectively reviewed the 23 patients with Neurogenic Bladder Dysfunction who underwent PNL at our institution. Neurologic lesions included spina bifida, traumatic spinal cord injury, exstrophy/epispadias, neonatal meningitis, stroke, and spine chondrosarcoma. Bladder management included ileal conduit (n = 8), intermittent catheterization (n = 7), indwelling catheter (n = 7), and ureterosigmoidostomy (n = 1). Results We performed 100 procedures on 47 renal units (17 bilateral, 7 with recurrent stones). Urinary tract infection/colonization was seen in 21 of 23 patients, most of whom had more than one organism. The stone-free rate was 96%. Six patients required three or more procedures, each had a complete staghorn calculus. In an average of 36 months of follow-up, 10 patients (46%) had recurrent stone disease requiring intervention, and 5 patients (23%) underwent repeat PNL. The stone composition analysis revealed mainly infection-related stones. Conclusions PNL in patients with Neurogenic voiding Dysfunction is safe and effective, with outcomes comparable to that of patients without such lesions. The complication rate is small but statistically significant. It is important to obtain adequate urine cultures, because renal pelvis and Bladder culture data may differ and affect the outcome. Risk factors for recurrent stone disease include a high spinal cord lesion, indwelling urinary catheter, and ureterosigmoidostomy.
Barry A. Kogan - One of the best experts on this subject based on the ideXlab platform.
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Neurogenic Bladder Dysfunction due to myelomeningocele neonatal versus childhood treatment
The Journal of Urology, 1997Co-Authors: Laurence S. Baskin, Barry A. KoganAbstract:AbstractPurpose: We sought to determine whether the neonatal institution of treatment of Neurogenic Bladder Dysfunction in myelomeningocele patients at high risk of urinary tract deterioration improves renal and Bladder outcome.Materials and Methods: We reviewed the records of patients with Bladder Dysfunction believed to be at high risk for renal deterioration based on urodynamic studies. All patients were treated with clean intermittent catheterization. We compared rates of urinary infection, hydronephrosis, reflux, continence and surgical intervention in 46 patients in whom treatment was started in year 1 of life and 52 treated after age 4 years.Results: Renal outcome was similar in both groups with persistent hydronephrosis in 6 of 46 patients (13%) and 7 of 52 (14%), respectively. However, significantly fewer Bladder augmentation procedures were required in patients started on treatment during year 1 of life (5 of 46, 11% versus 14 of 52, 27%, p <0.05).Conclusions: In addition to any psychological be...
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Neurogenic Bladder Dysfunction due to myelomeningocele: neonatal versus childhood treatment.
The Journal of urology, 1997Co-Authors: Laurence S. Baskin, Barry A. KoganAbstract:AbstractPurpose: We sought to determine whether the neonatal institution of treatment of Neurogenic Bladder Dysfunction in myelomeningocele patients at high risk of urinary tract deterioration improves renal and Bladder outcome.Materials and Methods: We reviewed the records of patients with Bladder Dysfunction believed to be at high risk for renal deterioration based on urodynamic studies. All patients were treated with clean intermittent catheterization. We compared rates of urinary infection, hydronephrosis, reflux, continence and surgical intervention in 46 patients in whom treatment was started in year 1 of life and 52 treated after age 4 years.Results: Renal outcome was similar in both groups with persistent hydronephrosis in 6 of 46 patients (13%) and 7 of 52 (14%), respectively. However, significantly fewer Bladder augmentation procedures were required in patients started on treatment during year 1 of life (5 of 46, 11% versus 14 of 52, 27%, p
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Follow-up in Children with Neurogenic Bladder Dysfunction
Pediatric Neurogenic Bladder Dysfunction, 1Co-Authors: Erim Erdem, Laurence S. Baskin, Barry A. KoganAbstract:Children with Neurogenic Bladder Dysfunction can have a multitude of urological problems. These problems can be divided into four main categories, and therapy as well as follow-up should address them. These categories are as follows: (a) preservation of the upper urinary tract; (b) prevention of UTIs and reduction of their morbidity; (c) achieving continence at the appropriate age; and (d) providing adequate sexual function. Furthermore, taking all of the above into account, overall quality of life should be preserved.
Jessica T. Casey - One of the best experts on this subject based on the ideXlab platform.
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Urethral Reconstruction in Patients with Neurogenic Bladder Dysfunction
Current Bladder Dysfunction Reports, 2010Co-Authors: Jessica T. Casey, Christopher GonzalezAbstract:Prolonged urethral catheterization can lead to significant urethral defects, including strictures, diverticula, erosions, and fistulas. Although it is a potentially challenging procedure, urethral reconstruction can allow patients with Neurogenic Bladder Dysfunction to continue clean intermittent catheterization, improve or maintain their cosmetic appearance, and improve sexual function. There is a paucity of literature focusing specifically on urethral reconstruction in patients with Neurogenic Bladder Dysfunction, with most studies involving small, heterogeneous populations. This article reviews published outcomes of urethral reconstruction and comments on the technical aspects of repair in patients with Neurogenic Bladder Dysfunction.
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Urethral Reconstruction in Patients With Neurogenic Bladder Dysfunction
The Journal of urology, 2008Co-Authors: Jessica T. Casey, Bradley A. Erickson, Neema Navai, Lee C. Zhao, Joshua J. Meeks, Christopher GonzalezAbstract:Purpose: There is limited literature examining urethral reconstruction in patients with Neurogenic Bladder Dysfunction. We describe our experience of urethral reconstruction in men with concurrent Neurogenic Bladder.Materials and Methods: A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with Neurogenic Bladder Dysfunction. Patient characteristics including the etiology of Neurogenic Bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated.Results: A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates dif...
Ahmad Elbadawi - One of the best experts on this subject based on the ideXlab platform.
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structural basis of Neurogenic Bladder Dysfunction iii intrinsic detrusor innervation
The Journal of Urology, 2003Co-Authors: Axel Haferkamp, Joachim Dorsam, Neil M Resnick, Subbarao V Yalla, Ahmad ElbadawiAbstract:ABSTRACTPurpose: We studied the ultrastructure of intrinsic detrusor innervation in long-standing Neurogenic Bladder Dysfunction in the human.Materials and Methods: Endoscopic or open detrusor biopsies were obtained from 15 female and 31 male patients 7 to 96 years old who had hyperreflexic Neurogenic Bladder Dysfunction for less than 1 to 43 years. Of the patients 9 had meningomyelocele, 25 had spinal cord injury and 12 had a brain disorder. Changes in intrinsic detrusor nerves were evaluated by electron microscopy qualitatively and quantitatively according to predefined criteria.Results: Axonal degeneration was observed in 44 of the 45 biopsies with discernible intrinsic nerves. Structurally normal axons were 5½ or 4 times more common in brain disorder than meningomyelocele or spinal cord injury group biopsies (median 33%, 6%, 8%, respectively). Axonal regeneration, not encountered in nonneuropathic Dysfunctional detrusors, was observed in restricted distribution in most biopsies (76%) and was independe...
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structural basis of Neurogenic Bladder Dysfunction ii myogenic basis of detrusor hyperreflexia
The Journal of Urology, 2003Co-Authors: Axel Haferkamp, Joachim Dorsam, Neil M Resnick, Subbarao V Yalla, Ahmad ElbadawiAbstract:ABSTRACTPurpose: We describe the ultrastructure of detrusor smooth muscle in long-standing Neurogenic Bladder Dysfunction in the human.Materials and Methods: Detrusor biopsies were obtained from (15 female and 31 male) patients 7 to 96 years old with Neurogenic Bladder Dysfunction for less than 1 to 43 years. Of the patients 9 had meningomyelocele, 25 spinal cord injury and 12 brain disorder. Urodynamically, all patients had detrusor hyperreflexia (Neurogenic detrusor overactivity) in addition to Bladder outlet obstruction in 4, impaired detrusor contractility in 19, decreased Bladder compliance in 4, and detrusor-sphincter dyssynergia in 24. Ultrastructural changes in detrusor, including those associated with detrusor overactivity, impaired detrusor contractility and Bladder outlet obstruction, were evaluated qualitatively and quantitatively.Results: Intermediate junctions of muscle cells were absent or reduced in 45 biopsies, which instead had dominant intimate cell appositions with much narrower juncti...
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Structural Basis of Neurogenic Bladder Dysfunction. I. Methods of Prospective Ultrastructural Study and Overview of the Findings
The Journal of urology, 2003Co-Authors: Ahmad Elbadawi, Neil M Resnick, Joachim Dorsam, Subbarao V Yalla, Axel HaferkampAbstract:ABSTRACTPurpose: We standardize procedures for ultrastructural study of detrusor smooth muscle and intrinsic nerves in Neurogenic Bladder Dysfunction in the human, and present an overview of the findings.Materials and Methods: The study included 18 female and 33 male patients 7 to 96 years old. They had Neurogenic Bladder Dysfunction with hyperreflexia for less than 1 to 43 years, resulting from upper motoneuron lesions (spinal cord injury 25, brain disorder 17) or combined upper and lower motoneuron deficit (meningomyelocele 9). Endoscopic or open Bladder biopsies were processed for ultrastructural study of detrusor smooth muscle and intrinsic neural elements. Qualitative morphologic criteria of muscle cell arrangement, degeneration and cell-cell contacts, as well as those of degeneration and regeneration of intrinsic neural elements are defined.Results: Five biopsies from the brain disorder group had insufficient smooth muscle and were excluded from study. The remaining 46 biopsies were evaluated by ele...
Bradley A. Erickson - One of the best experts on this subject based on the ideXlab platform.
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Urethral Reconstruction in Patients With Neurogenic Bladder Dysfunction
The Journal of urology, 2008Co-Authors: Jessica T. Casey, Bradley A. Erickson, Neema Navai, Lee C. Zhao, Joshua J. Meeks, Christopher GonzalezAbstract:Purpose: There is limited literature examining urethral reconstruction in patients with Neurogenic Bladder Dysfunction. We describe our experience of urethral reconstruction in men with concurrent Neurogenic Bladder.Materials and Methods: A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with Neurogenic Bladder Dysfunction. Patient characteristics including the etiology of Neurogenic Bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated.Results: A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates dif...
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Is Nasogastric Tube Drainage Required After Reconstructive Surgery for Neurogenic Bladder Dysfunction
Urology, 2007Co-Authors: Bradley A. Erickson, Ryan P. Dorin, J. Quentin ClemensAbstract:Objectives To determine whether the routine use of nasogastric tubes (NGTs) after bowel surgery for Neurogenic Bladder Dysfunction improves outcomes. Methods We retrospectively evaluated 54 consecutive patients (30 women, 24 men) with Neurogenic Bladder who underwent Bladder reconstruction or replacement with bowel segments by one surgeon from December 2000 to August 2005. The first 32 [NGT(+)] had NGTs placed during the procedure, whereas the subsequent 22 [NGT(−)] did not. We compared short-term postoperative outcomes between groups. Results Patient age ranged from 17 to 74 years (mean, 42.6 years). Procedures included augmentation cystoplasty with or without creation of catheterizable stoma (31), ileovesicostomy (13), and ileal conduit (9). Mean age or mean operative time did not differ between the NGT(+) and NGT(−) groups. The NGT(−) patients experienced less time to oral intake (3.1 versus 4.4 days, P Conclusions Routine use of NGTs in patients undergoing Bladder reconstruction or replacement for Neurogenic Bladder Dysfunction seems to confer no benefit. The omission of NGTs in this population is possible without increasing overall morbidity. These findings parallel those previously reported in neurologically intact patients undergoing urinary diversion.