M P David

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (171)280.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Thirty-nine men with sexual disturbances in middle-age (52-68 years) were included in this study. Semen samples were obtained by masturbation and were analysed for its composition Serum was prepared and analysed for FSH, LH, prolactin and testosterone. Results were compared with the values obtained in a recent study by the authors on a young fertile group (Homonnai et al. - 1980). Hormonal evaluation revealed a significant increase in FSH, LH, and prolactin concentrations, Testosterone levels were not different in the two groups (old v:s young). Nevertheless, accessory gland functions were depressed, semen volume decreased by 30% and fructose secretion by the seminal vesicle was diminished significantly. The average sperm concentration and morphology were not different than in young group but their quality in terms of motility and vitality was depressed. Sperm production by the tests was decreased by 30% compared to the young control group. Increased serum prolactin levels and elevated estrogen activity may be responsible for the sexual disturbances known in older men.
    Andrologia 01/2009; 14(2):164-70. · 1.75 Impact Factor
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    ABSTRACT: Clinical observations suggest that betamethasone reduces maternal perception of fetal movements and short term variability, but that this dose not occur after treatment with dexamethasone. To compare the effect of betamethasone and dexamethasone on fetal biophysical parameters. In a randomized, prospective, double blind study, 20 courses of betamethasone and 20 courses of dexamethasone were given in random sequence to patients with imminent preterm labor. During the first 32h after initiation of treatment, fetal movements were counted by the mothers and recorded by ultrasound, and a nonstress test was performed. Betamethasone induced a significant decrease in fetal movements as perceived by the mother and observed by ultrasound. Fetal breathing movements also decreased. Dexamethasone did not change fetal body movements. Neither drug changed the short term variability. Unlike betamethasone, dexamethasone does not induce a decrease in fetal movements. Dexamethasone might, therefore, be preferred for enhancement of lung maturation in imminent preterm labor.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 08/2001; 97(1):50-2. · 1.84 Impact Factor
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    ABSTRACT: The present study was undertaken to evaluate the efficacy of Stamey bladder neck suspension in preventing post-perative stress urinary incontinence in clinically continent women undergoing surgery for genitourinary prolapse. Thirty clinically continent women with severe genitourinary prolapse were found to have a positive stress test with re-positioning of the prolapse. They all had significant urethrovesical junction hypermobility. In addition to the genitourinary prolapse repair, these patients underwent a prophylactic Stamey procedure to prevent the possible development of post-operative stress urinary incontinence. The mean duration of follow-up was 8+/-4.5 months (range, 3-19 months). Seven (23.30%) patients developed overt post-operative stress urinary incontinence that was confirmed urodynamically. Eleven (36.7%) other patients denied stress incontinence; however, post-operative urodynamics demonstrated sphincteric incontinence. Post-operative complications were uncommon and minor. In conclusion, continent patients with a positive stress test demonstrated on re-positioning of the prolapse during pre-operative urodynamic evaluation are considered to be at high risk of developing post-operative stress urinary incontinence. In these patients, an additional, effective anti-incontinence procedure should be considered during surgical correction of genitourinary prolapse. The Stamey procedure, although simple and safe, does not appear to be the optimal solution to this clinical problem.
    Neurourology and Urodynamics 02/2000; 19(6):671-6. · 2.67 Impact Factor
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    ABSTRACT: To examine the prevalence and characteristics of voiding difficulties in women. Two hundred six consecutive female patients who attended a urogynecology clinic were recruited. Patients were interviewed regarding the presence and severity of symptoms that would suggest voiding difficulties (ie, hesitancy, straining to void, weak or prolonged stream, intermittent stream, double voiding, incomplete emptying, reduction, and positional changes to start or complete voiding). Urodynamic evidence of voiding difficulty was considered as a peak flow rate less than 12 mL/s (voided volume greater than 100 mL), or residual urine volume greater than 150 mL, on two or more readings. Residual urinary volume, flow patterns, and pressure-flow parameters were analyzed and compared between symptomatic and asymptomatic patients who had urodynamic parameters of voiding difficulties. One hundred twenty-seven (61.7%) women reported having voiding difficulty symptoms; 79 others (38.3%) were free of such symptoms. Urodynamic diagnosis of voiding difficulty was made in 40 women (19.4% of the study population): 27 in the symptomatic group and 13 in the asymptomatic group (21.2% and 16.5%, respectively). Only 1 patient had voiding difficulty due to bladder outlet obstruction. All other cases of low flow rate were due to impaired detrusor contractility. Objective evidence of voiding difficulty may be found in both symptomatic and asymptomatic patients and is usually due to impaired detrusor contractility. The clinical significance of the abnormal flow parameters in asymptomatic patients is unclear.
    Urology 09/1999; 54(2):268-72. · 2.42 Impact Factor
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    ABSTRACT: Anal incontinence in young women may be the result of injury to the pelvic floor during vaginal delivery. This study was conducted to evaluate the relationship between obstetric risk factors and the prevalence of anal incontinence 3 months and 1 year after delivery. Three hundred consecutive women who delivered in the obstetric ward of the Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, were prospectively interviewed 3 months postpartum with regard to the symptom of anal incontinence. Patients with anal incontinence that started after delivery were questioned about the type, frequency, and severity of the problem, concomitant stress urinary incontinence (SUI), previous colorectal assessment, and wish for further evaluation and treatment. Obstetric data were collected from the women's medical charts. Symptomatic patients were followed-up 1 year postpartum. Anal incontinence was reported by 21 patients: 19 were incontinent to gas, whereas only 2 patients were incontinent to solid feces (6.3% and 0.7% of the study population, respectively). Five patients (24% of the anal-incontinent patients) also had concomitant SUI. The length of the first and second stages of labor, operative vaginal delivery, and episiotomy were found to be associated (P < 0.05) with the development of anal incontinence at 3 months postpartum. At I year postpartum all patients with combined anal incontinence and SUI had persistent symptoms. The major obstetric risk factors for postpartum anal incontinence are prolonged first and second stages of labor, operative vaginal delivery, and the use of episiotomy.
    Scandinavian Journal of Gastroenterology 03/1999; 34(3):315-8. · 2.16 Impact Factor
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    ABSTRACT: The study was conducted to assess the prevalence of stress urinary incontinence in premenopausal nulliparae, primiparae, and grand multiparae, and to examine possible obstetric risk factors. Three hundred consecutive nulliparae, primiparae, and grand multiparae, 20 to 43 years of age, were interviewed during the third postpartum day of their consequent delivery about the symptom of stress urinary incontinence. Women were asked whether they had experienced stress urinary incontinence before, during, or after previous pregnancies and how troubled they were by their incontinence. Details of general and gynecologic history, parity, mode of previous deliveries, and birth weights were sought. Main outcome measures included prevalence of pregnancy-related and (persistent) nonpregnancy-related stress urinary incontinence. Prevalence of persistent stress urinary incontinence was significantly higher in grand multiparae compared with nulliparae (21% vs. 5%, respectively; P = 0.0008). Prevalence of persistent stress urinary incontinence among grand multiparae who had been delivered of at least one baby weighing more than 4,000 g was significantly higher than in those who did not (29.4% vs. 16.7%, respectively). The birth weight of the first newborn and operative vaginal delivery were not found to be associated with increased risk of stress urinary incontinence. Grand multiparity was found to be associated with an increased risk of developing persistent stress urinary incontinence during reproductive ages. The delivery of at least one baby weighing more than 4,000 g seems to be a predominant factor. Neurourol. Urodynam. 18:419-425, 1999.
    Neurourology and Urodynamics 02/1999; 18(5):419-25. · 2.67 Impact Factor
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    ABSTRACT: The present study prospectively surveyed the prevalence of anal incontinence among 283 consecutive female patients attending a urogynecologic outpatient clinic in a maternity hospital. Data concerning bowel habits, laxative use, previous anorectal surgery, and the presence, severity, and frequency of anal incontinence were collected by interviewing the patients. Anal incontinence was reported by 83 women, representing 29% of the study population. Of those reporting anal incontinence, 30% (9% of the study population) were incontinent to solid feces, 22% (6%) to liquid feces, and 48% (14%) to gas. Age distribution demonstrates progressive rise and a high prevalence of anal incontinence in patients older than 60 years. A significant higher rate of vacuum deliveries was found among patients with anal incontinence, compared with continent patients (9.6% vs. 2.5%; P = 0.01). Increased prevalence of anal incontinence was also found among patients with past history of hemorrhoidectomy and those with urodynamic diagnosis of combined genuine stress incontinence and detrusor instability/sensory urgency. In conclusion, in patients attending a urogynecologic clinic, anal incontinence is a frequent, although rarely volunteered, symptom.
    Neurourology and Urodynamics 02/1999; 18(3):199-204. · 2.67 Impact Factor
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    ABSTRACT: The present study was undertaken to evaluate the efficacy of Kelly plication in preventing postoperative urinary stress incontinence in clinically continent patients undergoing surgery for genitourinary prolapse. Thirty clinically continent patients with grade-3 genitourinary prolapse were found to have a positive stress test with repositioning of the prolapse during preoperative urodynamic evaluation. In addition to the genitourinary prolapse repair, these patients underwent a Kelly plication as a preventive measure against possible development of postoperative urinary stress incontinence. Postoperative follow-up included a detailed urogynecologic questionnaire, pelvic examination, urine culture, Q-tip cotton swab test, and a full urodynamic evaluation. The mean duration of follow-up was 25.5 +/- 14.1 months. Fifteen (50%) patients developed subjective and objective postoperative stress incontinence. Eleven (37%) patients developed objective postoperative stress incontinence (proven by urodynamic evaluation) with no subjective complaints of stress incontinence. Prophylactic Kelly plication as performed by the method described does not appear to be effective in preventing postoperative urinary stress incontinence in clinically continent patients who undergo surgery for genitourinary prolapse.
    Neurourology and Urodynamics 02/1999; 18(3):193-7; discussion 197-8. · 2.67 Impact Factor
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    ABSTRACT: The study prospectively evaluated the relationship between sexual dysfunction and urodynamic diagnoses in 100 consecutive female patients referred for urogynecologic evaluation. Sexual function was evaluated by a detailed questionnaire that addressed four phases of the sexual cycle: desire, arousal, orgasm and satisfaction. Each phase of the sexual cycle was assessed separately using a score of 1-4. Total sexual function (TSF) score was calculated by combining the scores of the four examined parameters (range 4-16). Analysis revealed statistically significant (P < 0.05) lower TSF scores in patients with detrusor instability (DI) than in those with genuine stress incontinence, sensory urge or mixed urodynamic diagnoses (8.65 +/- 4 versus 12.22 + 3.6, 10.25 +/- 4.1 and 11.47 +/- 4.1, respectively). Three per cent of the elderly women (>60 years) compared to 29% of the younger women (< or = 60 years) reported urinary incontinence during sexual activity. Sexual function should therefore be routinely evaluated in women presenting with urinary symptoms.
    International Urogynecology Journal 01/1999; 10(5):325-8. · 2.17 Impact Factor
  • Journal of The American Association of Gynecologic Laparoscopists - J AMER ASSOC GYNECOL LAPAROSC. 01/1999; 6(3).
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    ABSTRACT: Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy. A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy. Early detection of interstitial pregnancy may facilitate conservative medical treatment.
    The Journal of reproductive medicine 09/1998; 43(8):719-22. · 0.75 Impact Factor
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    ABSTRACT: In a prospective, randomised, double-blind, placebo-controlled study 40 women with sensory urgency or detrusor instability randomly received either magnesium hydroxide (group A) or placebo (group B). Pre- and post-treatment symptoms, frequency-volume charts and cystometry results were compared. Eleven of 20 patients receiving magnesium (55%) reported a subjective improvement of their urinary symptoms, compared with five patients taking placebo (20%). In both study groups there was no statistically significant difference in pre- and post-treatment urodynamic parameters in those reporting symptomatic improvement. Magnesium was well tolerated by patients in group A, and no side effects were reported. These results suggest that magnesium hydroxide may be beneficial for detrusor instability or sensory urgency in women.
    British Journal of Obstetrics and Gynaecology 07/1998; 105(6):667-9.
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    ABSTRACT: This study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. In group 1 (30 patients, early administration), the epidural catheter was sited and the first epidural injection of 0.25% bupivacaine administered at a cervical dilatation of <4 cm; group 2 (30 patients, late administration) received the epidural catheter and first epidural injection of 0.25% bupivacaine at a cervical dilatation of >or=4 cm. The progression and outcome of labor were compared between the two groups. There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.
    International Journal of Obstetric Anesthesia 07/1998; 7(3):161-4. · 1.80 Impact Factor
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    ABSTRACT: The study was conducted to compare the neonatal and maternal outcome of breech infants delivered vaginally at term with those delivered by cesarean section. All singleton term breech deliveries between January 1, 1992 and December 31, 1994 were reviewed (n = 496). Criteria for eligibility for vaginal trial of labor included: frank or complete breech presentation, estimated fetal weight of 2000-3800 g, no hyperextension of the fetal head and no history of uterine scar (group A, n = 283). Patients who did not fulfill these criteria, or had an abnormal pelvimetry, were delivered by cesarean section without a trial of labor (group B, n = 213). In group A, 226 patients (80%) delivered vaginally, and 57 (20%) patients underwent a cesarean section; 70% of the nulliparae and 89% of the multiparae delivered vaginally. No differences were observed between the groups in gestational week, number of nulliparae, pregnancy complications, and rates of epidural analgesia. However, maternal age and birth weight were significantly higher in group B. No maternal or perinatal mortality occurred. The incidences of 5-min Apgar score <7, birth trauma, neonatal complications, and neonatal intensive care unit admissions were similar between the groups and in the nulliparae and multiparae of each group. Maternal morbidity was significantly lower in patients who delivered vaginally. We conclude that a trial of labor in breech presentation based on appropriate selective criteria, and an active policy of labor management performed by experienced physicians, will facilitate safe delivery in most nulliparae and multiparae.
    American Journal of Perinatology 02/1998; 15(2):97-101. · 1.57 Impact Factor
  • A Groutz, D Pauzner, M P David
    Harefuah 12/1997; 133(9):393-6.
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    ABSTRACT: We prospectively evaluated 29 patients with early postabortion or postpartum bleeding, suspected of having possible retained trophoblastic tissue by transvaginal sonography and transvaginal sonohysterography. All patients received methyl-ergometrine maleate (Sandoz) and amoxicillin and clavulinic acid (Pharmascope) orally for 5 days and were then reevaluated. Ten patients (34.5%) had a normal uterine cavity on both transvaginal sonography and sonohysterography. Nineteen patients (65.5%) were suspected of having residual trophoblastic tissue by transvaginal sonography. Of these, five (26%) showed normal uterine cavity by sonohysterography. One patient (8.3%) reported heavy bleeding with clots after the conservative treatment. Repeated examination revealed normal uterine cavity. The remaining patients underwent curettage, and histopathologic examination revealed trophoblastic tissue. Transvaginal sonohysterography is more accurate than transvaginal sonography for diagnosing residual trophoblastic tissue in patients with postpartum and postabortion bleeding. Its use may eliminate unnecessary curettage procedures.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 05/1997; 16(4):257-61. · 1.40 Impact Factor
  • A Groutz, Y Wolf, M P David
    Harefuah 05/1997; 132(8):578-81.
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    ABSTRACT: Malignant melanoma is the second most common vulvar malignancy. The superficial inguinal lymph nodes are the main site of metastases. Endometrial metastasis of vulvar malignant melanoma has not been previously reported. Vulvar malignant melanoma was diagnosed in a 60-year-old, postmenopausal woman. Immunohistochemical stains were positive for vimentin and S-100 protein and negative for HMB-45. Six months following vulvectomy, right inguinal lymphadenectomy and immunotherapy, curettage was performed due to postmenopausal bleeding. Histologic and immunohistochemical examinations revealed metastatic malignant melanoma with the same staining reactivity as the primary vulvar neoplasm had. Hysterectomy and bilateral salpingo-oophorectomy was performed, disclosing invasion of the endometrium and the inner two thirds of the myometrium. Only 10 other cases of endometrial metastases from malignant melanoma have been previously reported. All those cases involved a primary tumor occurring in the trunk and extremities. This is presumably the first report on endometrial and myometrial metastases from vulvar malignant melanoma.
    The Journal of reproductive medicine 05/1997; 42(4):244-6. · 0.75 Impact Factor
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    ABSTRACT: There has been growing concern about the number of multiple gestations resulting from assisted reproductive technologies. For in-vitro fertilization (IVF), there are guidelines concerning the number of embryos to be transferred. In oocyte donation, however, there is a paucity of studies addressing this issue and common practice is extrapolated from standard IVF procedures. This may not be correct since endometrial receptivity has been shown to be altered in oocyte donation. Thus the purpose of this study was to assess the optimal number of embryos to be transferred in oocyte donation. The study population included 254 patients with ovarian failure who underwent a total of 601 embryo transfers in a single shared oocyte donation programme. Pregnancy rates (PRs), multiple pregnancies, triplet pregnancy rates, and implantation rates were evaluated according to the number of embryos transferred. A significant linear increase in PRs was noted with the increasing number of embryos transferred up to five (11.1% for one embryo, 36.7% for five embryos). Multiple pregnancies increased significantly from 15.8% for two embryos transferred, to 44.4% for five embryos. The rate of triplet pregnancies also increased from 2.7% for three embryos transferred, to 8.3% for five embryos. Optimization of the number of embryos to be transferred is discussed.
    Human Reproduction 05/1997; 12(4):699-702. · 4.67 Impact Factor
  • Fertility and Sterility 01/1997; 68. · 4.17 Impact Factor

Publication Stats

1k Citations
280.07 Total Impact Points


  • 1981–2009
    • Tel Aviv University
      • Department of Obstetrics and Gynecology
      Tell Afif, Tel Aviv, Israel
  • 1999–2000
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1982–2000
    • Tel Aviv Sourasky Medical Center
      • Obstetrics Gynecology
      Tel Aviv, Tel Aviv, Israel
  • 1989–1994
    • Assaf Harofeh Medical Center
      Ayun Kara, Central District, Israel
  • 1993
    • University of Southern California
      Los Angeles, California, United States