ABSTRACTS -Twelfth Annual Meeting

Saturday, April 12, 1997
New Orleans, Louisiana

A New Apparatus for Microsurgical Skin-Flap
and Free-Graft Tubularization

David S. Schulsinger*, Philip S. Li and Mark Golden
The James Buchanan Brady Foundation, Department of Urology,
The New York Hospital- Cornell Medical Center, New York, New York

Hypospadjas is a well-recognized urologic congenital anomaly, occurring in 1 of 300 newborn boys. Occasionally, the prologist is confronted with the situation of deficient genital skin due to prior operation or a high degree of urethral abnormality. In such instances, free extragenital nonhair-bearing skin grafts and buccal mucosa grafts have gained popularity. Despite many different types of surgical repairs or the use of various autologous grafts, urethrocutaneous fistulas are a persistent problem in hypospadias repair, with an incidence of up to 30%. Microsurgery is advantageous because it avoids large needle trauma, allows more precise apposition and identifies exact needle placement to tissue. These features may decrease the incidence of urethrocutaneous fistula and stricture. We developed a new method of microsurgical hypospadias reconstruction (MHR) with the use of a specially designed graft tubularization apparatus (GTA). This device prepares a rectangular tissue into a tubular graft. The 4 independently rotating arms of the GTA eliminates the need for temporary stay sutures, stabilizes the tissue for debridement, simplifies tubular reconstruction, allows tailoring of the tubularized tissue to the desiied diameter and minimizes tissue damage and complications. We discuss our method of microsurgical hypospadias reconstruction using the GTA and review our experimental results.

Continuous Ambulatory Urodynamic Monitoring in
Neobladder Patient

Kiyoki Okada*, Toshio Yoshida and Hajime Ishida
Department of Urology, Nihon University School of Medicine, Tokyo, Japan

Conventional urodynamic study did not clarify the mechanism of urinary leakage in patients with ileal neobladder following radical cystectomy for bladder cancer. Especially unknown was the cause of nocturnal incontinence which occurred in some patients despite an achievement of complete continence during daytime. Patients were examined to analyze the data of urodynamics obtained throughout a day using continuous ambulatory monitoring system. SYNETICS MEDICAL: MICRODIGITAPPER URO was used to measure vesical pressure, urethral pressure, abdominal pressure and urinary leakage. We performed urethral Kock pouch in 60 patients over the last 8 years. Among them, 9 male patients were selected in this study. The age ranged from 55 to 65 years old with a mean of 58. Four normal males were included for ambulatory monitoring as a control In the normal male, vesical pressure showed highest in sitting position, next in standing, lowest during sleep. Urethral pressure revealed highest in standing position, next in sitting, and lowest during sleep. In cases of urethral Kock pouch, the patterns of postural changes were almost the same as in normal ones. Vesical pressure was highest in sitting position, whereas urethral pressure showed highest in standing. Most of them felt it was easier to urinate in a sitting position than in standing one. They urinated with the aid of abdominal pressure. Vesical pressure rose remarkably in sitting position when straining. However, urethral pressure showed higher in standing position than in sitting. When the patient fell asleep, urethral pressure went down much more than vesical pressure. As the vesical pressure rose, nocturnal incontinence appeared. This phenomena was not seen in normal cases or prostatectomy patients. Thus, we estimated that the cause of nocturnal incontinence in urethral Kock pouch patient was due to the lower urethral pressure and higher vesical pressure during sleep.

Automated Analysis of Urinary Sediment: A Clinical Application

Hiroshi Okada*, M.D., Masato Fujisaiva, M.D.,
Soichi Arakaiva, M.D. and Sadao Kaynidono, M.D.,
Kobe University School of Medicihe, Kobe, Japan

Urinalysis is a perfect non-invasive examination and it is still the most basic test for urogenital diseases. This test has usually been done by direct observation of a centrifuged urinary sediment under high power microscope, and it takes at least 1 min. for each specimen including time for centrifugation. A newly developed automated urinary sediment analyser UF- 100, which uses flowcytometric technology to differtiate components in the urine without centrifugation, can make a full report of the concentration of RBCs, WBCs, epithelial cells, casts, and bacteria in the urine within 15 seconds. The results made by UF-100 were compatible to those made by experienced technicians.

Conventional Versus Telemetric Monitoring Of Urodyniamic Parameters In Nonhuman Primates: A Comparative Study

Mike W Aertker*, Mostafa Sakr, and Gainal M. Ghoniem
Tulane Regional Primate Research Center, Covington, LA

Our ongoing telemetric studies with nonhuman primates have demonstrated that telemetry can be successfully used to acquire urodynamic data. However, primates must be under anesthesia in order to form urodynamic procedures and to obtain calibration data for the telemetry implants. An investigation the effect of performing studies while under anesthesia as well as a comparison of telemetric to coventional data is warranted. Conventional urodynamic procedures were done under sedation with Ketamine HCI (10 mg/kg body weight) or Tiletamine HCl/Zolazepam HCl (10 mg/kg body weight) using conventional fluid filled catheters conected to transducers mounted on a Grass polygraph. The transducers were calibrated before each study. Telemetry data was also acquired at the same time by placing an antenna under the animal and aquiring the data on a nearby computerized data acquisition system. Direct comparisons of conventional telemetric data were made by capturing the analog output from the amplifiers on the polygraph (conventional data) and also acquiring them on the data acquisition system. Direct comparison of telemetric and conventional data proved to correlate extremely well for bladder contractions with an average r = 0.96. Comparison of conventionally acquired rectal pressure to metric abdominal pressure yielded strong correlation with an average r = 0.82. This high degree of elation validates using conventional means to obtain calibration data for the telemetric implants. Significant differences were found for studies under sedation and data collected telemetrically from awake animals. Bladder capacity, pressure at capacity, and maximum detrusor pressure were all found to be significantly higher in sedated animals and are summarized in the following table: Parameter Conventional Telemetric p-value Bladder capacity (ml) 105.2 78.1 49.9+ 37.5 0.0016 Pressure at capacity (cm H20) 7.6+2.7 3.2 * 2.1 0.0001 Max detrusor pressure (cm H20) 28.4 7.8 47.5+24.1 0.0310 From this we can conclude that significant differences found between conventional urodynamic studies and telemetric data acquired from awake animals must be due to the effect of sedation on the animal. Direct comparisons of conventional to telemetric data indicate high correlation between the two which would further suggest that differences were due to the effects of sedation and not difference in measuring technique.

Ultrasonic Spectrum Analysis for Improved Evaluation
of Suspicious Prostate Tissue and Biopsy Guidance

Ernest J. Feleppa*, William R. Fair, Tian Liu, Neil Fleshner, Andrew Kalisz and Victor Reuter
Riverside Research Institute, New York, New York

We have been successfully applying spectrum analysis of ultrasonic echo signals to tissue typing in the eye, liver, kidney, skin, breast, and other organs. These studies were aimed at detection or diagnosis of disease or at monitoring treated tissue. The success of these studies is due to the utilization of echo signal information by spectrum analysis that is discarded in conventional ultrasonic imaging and is based on the quantitative relationship between the parameters computed by spectrum analysis and the structural properties of tissue. Recently, we applied our spectrum analysis methods to tissue typing in the prostate with initial emphasis on identifying suspicious regions in order to improve the efficacy of biopsy placement. These studies have led to very encouraging results. ROC curve analyses comparing the tissue typing accuracy of ultrasonic spectrum analysis to that of conventional ultrasonic imaging show a 79% area for spectrum analysis versus a 60% area for conventional ultrasonic imaging. Tissue type images based on spectrum analysis clearly show suspicious regions warranting biopsy. These studies are supported part by NIH Grant CA-53561.

New Methods for Evaluating Bladder Compliance

Douglas F. Milam*, Vanderbilt University Medical Center

Measurements of bladder compliance and storage pressure is important in patients with spinal cord injury and other neurologic diseases. These patients may transmit high pressure to the upper urinary tract leading to loss of renal function, recurrent urinary tract infections, etc. Conventional pressure volume cystometry often produces confusing results. In addition to measuring the elastic properties of the bladder that test also is influenced by detrusor hyperreflexia. Often a patient will experience an involuntary bladder contraction at a point significantly less than the anatomic bladder capacity. That contraction may be sustained throughout the study or may decay during the course of filling. This produces a [pressure volume curve which is non-linear. It is difficult to separate the component of increased storage pressure due to the elastic properties of the bladder from that due to involuntary bladder contraction. In 20 patients with spinal cord injury or sever bladder involvement from multiple sclerosis we have compared conventional pressure volume determinations with numerical integration of the pressure volume curve. We find that evaluation using numerical integration of the pressure volume curve is less affected by artifactual involuntary bladder contraction. This study suggests that integration of the pressure volume curve may play an important role in the evaluation of patients with decreased bladder elasticity.

Evaluation of Bladder Elasticity

Margot S. Damaser* ,
Hines VA Hospital and Loyola University of Chicago, Chicago, Illinois

It is currently thought that detrusor pressures exceeding 30-40 cm H2O indicate a risk of reflux, which could lead to kidney damage. However, the urinary bladder is a viscoelastic organ, so detrusor pressure is a function of the filling rate during cystometry. In general, the higher the filling rate, the higher the pressures. We have developed a method of measuring detrusor bladder pressure in subjects conducting intermittent catheterization by connecting a pressure gauge to the catheter. Thus, detrusor pressure can be estimated without the influence of filling rate.

The Effect of Magnetic Fields on Sperm Motility

Aaron Bush*, Irving Garlovsky, Yuliy Kirko, Aleksandr Galperin, Irving M. Bush
The Center for the Study of Genito-Urinary Diseases, Ltd., West Dundee, Illinois

In 1995-96 magnetic fields supplied by 500-750 gauss magnets were shown to effect the locomotion 0 of single-cell organisms (paramecium and euglena but not amoeba orproteus!) and to alter the growth of Siha tumor cells grown in tissue flasks. No experiments to date have shown the specific effect on magnetic/electromagnetic fields (EMF on human cells. Suggestions that "power lines" and other common household appliance affect the incidence of human cancer; that an EMF field changes the pH of cells in tissue culture and can decrease the rate of migraine headaches has yet to be validated. Experiments: ejaculated semen specimens were tested in magnetic fields obtained by 500 gauss rod magnets at less than 30 minutes; 30 minutes to 2 hours, 2-6 hours, 6-12 hours, and 24 hours after ejaculation. Each specimen was placed ion 2 equal microscopes at the spine time. All specimens were evaluated twice at 100x 450x as to count, motility, WBC's and straight line motion and recorded with a black and white television camera on 8mm tape. An additional 100 specimens were split into 2 portions first 1/ 3 and subsequent 2/3 of the ejaculation and tested in a similar manner. The magnets were standardized at the manufacturer and retested in our laboratory with 2 separate gauss meters. Results: 1. Magnetic fields generally caused: a) an increase in the motility of human sperm; b) activated mobile sperm (20%); c) enhance semen liquefaction and unclumping. 2. Seemingly non-mobile sperm can be activated but active enhance sperm have a shorter motility time. Conclusion: Whether magnetic fields can be used to increase or decrease fertility is at present no known, however the use of magnetic fields may become a standard technique to evaluate semen samples in the clinical laboratory.

Microwave Balloon Catheter for BPH

Steven Price , Raymond S. Kasevich, Stuart M. Selikowitz
John R. LaCourseand Ralph Meyer 'Invatrortics Corporation,
-' Veterans Administration Medical Center,
-Department of Electrical and Computer Engineering
-University of New Hampshire C.R. Bard, Inc.

A Foley catheter containing a maximum 1.2 min diameter microwave antenna for BPH hyperthermia application has been successfully tested for microwave energy transmission and power deposition patterns in phantom load materials representative of prostate dielectric properties(1) The active portion of the microwave antenna is 4 to 6 cm and located 1 cm proximal to the inflation balloon. The antenna was required to provide heating of a portion of the prostate in the temperature range of 43 to 46 degrees Centigrade. The heated volume of the prostate in this temperature range was required to be at least 16 mm in diameter and 60 mm in length. The antenna design goals were achieved by the selection of the microwave antenna from U.S. Patent No. 4,776,086 by Raymond S. Kasevich, This design provides a. well-defined and smooth power deposition pattern over its active length and may easily be designed for lengths longer than conventional antennas used for similar applications. The well-defined heating pattern without current leakage back along the feed transmission line is achieved with a patented choke design. The antenna design may include a fiber optic transmission line for temperature feedback control. The fiber optics are integral to the antenna design.

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