Nifedipine, a calcium channel blocker, was tested for its in vivo effect on the ureter and kidney... more Nifedipine, a calcium channel blocker, was tested for its in vivo effect on the ureter and kidney during acute obstruction. There was no discernible effect on peristalsis but glomerular filtration rate was improved. Thus, nifedipine would not be expected to decrease renal colic from obstruction.
Introduction: Macroplastique (MPQ) is a urethral bulking agent (UBA) used in the treatment of str... more Introduction: Macroplastique (MPQ) is a urethral bulking agent (UBA) used in the treatment of stress urinary incontinence (SUI) in women with intrinsic sphincter deficiency (ISD). UBA of various materials have been studied as early as the 1930s. MPQ has been shown to have a good safety profile with no carcinogenic effects. It is constructed of a silicone elastomer with a large diameter of 140 ųm suspended in a lower molecular weight gel. The elastomer has a rough configuration that interlock. These are unique properties of the material that do not allow for migration once implanted under the mucosa of the urethra [1]. The durability of MPQ has been shown in patients who were successful at one year and followed up to 2 years in a previous study. They maintained high success rate and demonstrated up to a 67% dry rate but even higher improvement rates of incontinence in the short term, 75% [1, 2]. The purpose of this study is to evaluate the safety and efficacy of MPQ in women with SUI...
Periurethral collagen injections have been used to treat female urinary incontinence secondary to... more Periurethral collagen injections have been used to treat female urinary incontinence secondary to intrinsic sphincteric deficiency (ISD). As an alternative, a transurethral submucosal collagen injection was used in 33 consecutive women suffering from stress incontinence secondary to ISD at Tulane University Medical Center. Prior to the procedure, careful clinical examination with a videofluorourodynamic study was performed for each case. The procedure was carried out under local anesthesia assisted with monitored anesthesia care (MAC). The collagen was injected transurethrally by the long collagen needle (C. R. Bard). In the first 11 cases the average cumulative collagen injected per patient was 6.1 ml, whereas in the last 22 cases the average was 3.5 ml. As a result of the injection 16 patients were dry (48.5%) and 11 were improved (33.3%), with an overall success rate of 81.8%. The injection failed in 6 patients (18.1%). The mean follow-up was 18.8 months, with a range of 2-33 months. In the successful group there was a significant decrease in pretreatment frequency, from an average of 8 to 4.9 (P = 0.005) and in nocturia from an average of 2.14 to 0.76 (P = 0.001). Also, there was a significant decrease in the number of pads, from an average of 3.7 to 1.1 (P = 0.001). The stress leak-point pressure showed a significant increase, from an average of 68.1 to 93.5 cm H2O (P = 0.03). There was no relation between grade of incontinence and the success of the injection. Two cases suffered from temporary urinary retention. This study revealed that the transurethral submucosal collagen injection is an effective method for treating cases of intrinsic sphincteric deficiency. The volume of collagen required to produce the seal effect is small and it may decrease the reinjection rate. As experience is gained, the procedure time is typically 15 minutes. This makes it a reliable, cost-effective and well-controlled method. However, it has a learning curve and the cystoscope instruments require minor adaptation for its use.
... Carl Klutke has acted as unpaid investigator and paid speaker for Mentor and Boston Scientifi... more ... Carl Klutke has acted as unpaid investigator and paid speaker for Mentor and Boston Scientific. He has also received a fee as a speaker for Ethicon. David Staskin is an inventor for American Medical Systems. REFERENCES. ...
The 2 components of detrusor compliance were analyzed in 32 children with myelomeningocele and co... more The 2 components of detrusor compliance were analyzed in 32 children with myelomeningocele and compared to compliance in 15 age-matched controls with nonneuropathic enuresis. In myelomeningocele initial compliance was variable, whereas terminal compliance was relatively constant. Low terminal compliance corresponded with vesicoureteral reflux, deterioration of upper tract morphology and diminished renal function.
Failure to impregnate, after successful vasovasostomy, has been attributed to immunologic, testic... more Failure to impregnate, after successful vasovasostomy, has been attributed to immunologic, testicular, and epididymal factors. To study the effect of vasectomy on human vas innervation and vesicoelastic properties. Vas rings were obtained from 8 healthy males during vasectomy as controls and compared to those of 3 vasovasostomy patients. The active and passive properties were determined and the cumulative blocking effects of phenoxybenzamine, propranolol, atropine and tetrodotoxin were studied. There was significantly higher rigidity in the vasovasostomy group as compared to the control group but there were similar active forces between the two groups up to 100-120% of stretch. In the control group, phenoxybenzamine blocked 33.3%, propranolol blocked 15.8%, and atropine blocked 36.5% but tetrodotoxin had no further effect. In the vasovasostomy group, phenoxybenzamine blocked 33.3% (similar to control), propranolol blocked 2%, atropine blocked 11.7% and tetrodotoxin blocked 37.1%. In vasovasostomy group there was increased rigidity without reduction of the active force. There were also decreased cholinergic and possible existence of nonadrenergic noncholinergic neurotransmitters.
Nifedipine, a calcium channel blocker, was tested for its in vivo effect on the ureter and kidney... more Nifedipine, a calcium channel blocker, was tested for its in vivo effect on the ureter and kidney during acute obstruction. There was no discernible effect on peristalsis but glomerular filtration rate was improved. Thus, nifedipine would not be expected to decrease renal colic from obstruction.
Introduction: Macroplastique (MPQ) is a urethral bulking agent (UBA) used in the treatment of str... more Introduction: Macroplastique (MPQ) is a urethral bulking agent (UBA) used in the treatment of stress urinary incontinence (SUI) in women with intrinsic sphincter deficiency (ISD). UBA of various materials have been studied as early as the 1930s. MPQ has been shown to have a good safety profile with no carcinogenic effects. It is constructed of a silicone elastomer with a large diameter of 140 ųm suspended in a lower molecular weight gel. The elastomer has a rough configuration that interlock. These are unique properties of the material that do not allow for migration once implanted under the mucosa of the urethra [1]. The durability of MPQ has been shown in patients who were successful at one year and followed up to 2 years in a previous study. They maintained high success rate and demonstrated up to a 67% dry rate but even higher improvement rates of incontinence in the short term, 75% [1, 2]. The purpose of this study is to evaluate the safety and efficacy of MPQ in women with SUI...
Periurethral collagen injections have been used to treat female urinary incontinence secondary to... more Periurethral collagen injections have been used to treat female urinary incontinence secondary to intrinsic sphincteric deficiency (ISD). As an alternative, a transurethral submucosal collagen injection was used in 33 consecutive women suffering from stress incontinence secondary to ISD at Tulane University Medical Center. Prior to the procedure, careful clinical examination with a videofluorourodynamic study was performed for each case. The procedure was carried out under local anesthesia assisted with monitored anesthesia care (MAC). The collagen was injected transurethrally by the long collagen needle (C. R. Bard). In the first 11 cases the average cumulative collagen injected per patient was 6.1 ml, whereas in the last 22 cases the average was 3.5 ml. As a result of the injection 16 patients were dry (48.5%) and 11 were improved (33.3%), with an overall success rate of 81.8%. The injection failed in 6 patients (18.1%). The mean follow-up was 18.8 months, with a range of 2-33 months. In the successful group there was a significant decrease in pretreatment frequency, from an average of 8 to 4.9 (P = 0.005) and in nocturia from an average of 2.14 to 0.76 (P = 0.001). Also, there was a significant decrease in the number of pads, from an average of 3.7 to 1.1 (P = 0.001). The stress leak-point pressure showed a significant increase, from an average of 68.1 to 93.5 cm H2O (P = 0.03). There was no relation between grade of incontinence and the success of the injection. Two cases suffered from temporary urinary retention. This study revealed that the transurethral submucosal collagen injection is an effective method for treating cases of intrinsic sphincteric deficiency. The volume of collagen required to produce the seal effect is small and it may decrease the reinjection rate. As experience is gained, the procedure time is typically 15 minutes. This makes it a reliable, cost-effective and well-controlled method. However, it has a learning curve and the cystoscope instruments require minor adaptation for its use.
... Carl Klutke has acted as unpaid investigator and paid speaker for Mentor and Boston Scientifi... more ... Carl Klutke has acted as unpaid investigator and paid speaker for Mentor and Boston Scientific. He has also received a fee as a speaker for Ethicon. David Staskin is an inventor for American Medical Systems. REFERENCES. ...
The 2 components of detrusor compliance were analyzed in 32 children with myelomeningocele and co... more The 2 components of detrusor compliance were analyzed in 32 children with myelomeningocele and compared to compliance in 15 age-matched controls with nonneuropathic enuresis. In myelomeningocele initial compliance was variable, whereas terminal compliance was relatively constant. Low terminal compliance corresponded with vesicoureteral reflux, deterioration of upper tract morphology and diminished renal function.
Failure to impregnate, after successful vasovasostomy, has been attributed to immunologic, testic... more Failure to impregnate, after successful vasovasostomy, has been attributed to immunologic, testicular, and epididymal factors. To study the effect of vasectomy on human vas innervation and vesicoelastic properties. Vas rings were obtained from 8 healthy males during vasectomy as controls and compared to those of 3 vasovasostomy patients. The active and passive properties were determined and the cumulative blocking effects of phenoxybenzamine, propranolol, atropine and tetrodotoxin were studied. There was significantly higher rigidity in the vasovasostomy group as compared to the control group but there were similar active forces between the two groups up to 100-120% of stretch. In the control group, phenoxybenzamine blocked 33.3%, propranolol blocked 15.8%, and atropine blocked 36.5% but tetrodotoxin had no further effect. In the vasovasostomy group, phenoxybenzamine blocked 33.3% (similar to control), propranolol blocked 2%, atropine blocked 11.7% and tetrodotoxin blocked 37.1%. In vasovasostomy group there was increased rigidity without reduction of the active force. There were also decreased cholinergic and possible existence of nonadrenergic noncholinergic neurotransmitters.
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