Showing papers in "BJUI in 1969"

The urethral pressure profile.

Abstract: SUMMARY Continuous pressure profiles would seem to include all possible advantages over other methods of urethral assessment. The method applies equally to electro-stimulation testing and to the evaluation of stricture. A wide range of variations and refinements to the method may be suggested, for instance, the profile catheter should preferably be withdrawn at a known steady rate, and this could perhaps be achieved by a mechanical device. It might also be useful if subsequent profiles could be superimposed on the initial trace to allow of a more accurate comparison between sequential examinations. Perfectly adequate results may however be obtained with the simple apparatus described above.

The single ectopic ureter

Abstract: Objectives To correlate renal function with the site of the ectopic orifice in patients with a single ectopic ureter and to evaluate the role of ureteric reimplantation in the preservation of renal function. Patients and methods Forty-four patients (41 female, age 1.5 months to 20 years) with a single ectopic ureter have been managed in our institution in the last 21 years. The classical symptom of continuous wetting with intermittent normal micturition was reported in most of the female patients. The investigative evaluation included intravenous urography (IVU), cysto-urethroscopy, vaginoscopy with retrograde ureteric catheterization, micturating cysto-urethrography (MCU) and ultrasonography. Diuretic renography was carried out in four patients after it became available in 1992. Renal function was assessed in relation to urinary tract anomalies and with outcome after ureteric re-implantation. Results Thirty-eight patients (two males) had a unilateral ectopic ureter; the ectopic orifice was vaginal in 12, vestibular in 11, urethral in nine, at the bladder neck in two, the seminal vesicle in one and undetermined in three. Twenty-one patients had renal and/or ureteric abnormalities, with reflux detected on MCU in three ureters. Associated anomalies included hypospadias (two, one female), skeletal anomalies (two), anorectal malformations (three), cryptorchidism (two), and unilateral cystic ovary (one). Two patients had preoperative hypertension. In 15 patients, renal function was considered sufficient to justify ureteric reimplantation, 14 of whom regained continence. One girl had suprapubic leakage from the bladder and died during secondary nephroureterectomy. Another girl had persistent incontinence; she was found to have contralateral duplex ureters with a vestibular ectopic orifice and was cured after upper polar hemi-nephroureterectomy. IVU and renography carried out in two patients each within 4 weeks of surgery showed a moderate improvement in renal function. Eight patients reported for follow-up after ureteric reimplantation (mean duration 11 months); none had hypertension or urinary infection. Twenty-three patients with rudimentary kidneys underwent nephroureterectomy. Histopathological examination of the excised kidneys showed moderate to severe dysplasia with chronic pyelonephritis. Six patients (one male) had bilateral single ectopic ureters, with normal renal function in the five females. Unilateral reimplantation in the boy resolved the symptoms; one girl died before surgery and the other four underwent bilateral ureteric reimplantation, after which one was dry for up to 3 h while the other three were incontinent, one of whom subsequently underwent urinary diversion. Conclusions There was no clear correlation of renal function with the site of the ectopic ureteric orifice, as most of the patients with a vaginal ectopic ureter had sufficient renal function to justify renal preservation. Ureteric reimplantation preserved renal function, although the improvement after surgery was determined by the degree of renal dysplasia.

Growth studies of calcium oxalate in the presence of various ions and compounds.

Abstract: SUMMARY The well-known techniques of modification of crystal habit and composition or inhibition (prevention or slowing down) of crystal growth by addition of foreign substances to the crystallising solution have been successfully applied to the crystallisation of calcium oxalate. Several ions, notably A13+, many dyestuffs, including thosepermitted as colouring matter in foods, and some compounds of therapeutic value are particularly effective. It is hoped that some of these may prove to be of use in the control of the formation of calcium oxalate renal calculi.

Renal pelvic carcinoma in a Swedish district with abuse of a phenacetin-containing drug.

Abstract: SUMMARY A series of epithelial renal pelvic tumours diagnosed between the years 1960 and 1968 is reported from a county hospital in Sweden. Ten, possibly 12, of the 15 patients had been abusers of phenacetin-containing drugs, and nine of them came from a factory whose workers were known for heavy analgesic consumption. Two abusers had also developed a urinary bladder carcinoma. All the patients but two were males, which accords with the epidemiology of analgesic abuse in this particular area. The present study supplies further circumstantial evidence for a carcinogenic effect caused by phenacetin-containing drugs.

A study of human bladder detrusor muscle.

Abstract: SUMMARY A study of the pharmacology of the smooth muscle from the vault of the human bladder is reported. Human detrusor muscle shows maintained tonic contraction in vitro. Acetylcholine provokes powerful contraction which is blocked by atropine and potentiated by physostigmine. Other cholinergic substances have a similar action. Phenylephrine has a motor action, while the other adrenergic monamines are all inhibitory in action. Nicotine in the presence of physostigmine has a motor action which is blocked by hexamethonium. 5–hydroxytryptamine is motor to the preparation and its action is not blocked by morphine, atropine or hexamethonium. Histamine has a motor effect. Pitressin and morphine are without effect.

Post-operative recto-prostatic fistula1

Abstract: SUMMARY Post-operative fistulas between the rectum and prostatic cavity are discussed. Various serological factors are considered. A new exposure dividing the anal canal and rectum is described as an alternative to Kraske's post-rectal approach.

Congenital valves and diverticula of the anterior urethra.

Abstract: SUMMARY This report summarises the clinical findings and treatment of 17 examples of congenital anterior urethral valves and diverticula. Eight of the patients were under 2 years of age at the time of presentation, many of them had well-marked urinary obstruction although it was seldom as severe as that seen in posterior urethral valves, and very much more satisfactory results attended surgical treatment. The diagnosis should be suspected in children with lower urinary tract obstruction and a palpable ventral penile swelling, and should be established by a voiding cysto-urethrogram which visualises the entire urethra. The diagnosis may be confirmed by endoscopy when a sharp valvular ridge should be easily seen. An anterior urethral valve or diverticulum may be missed on a retrograde urethrogram. Surgical excision by a one- or two-stage urethroplasty was the usual method of treatment. AEtiological series have been discussed.

Composition of urinary calculi by x‐ray diffraction. collected data from various localities

Abstract: SUMMARY An X-ray diffraction study of the composition of upper tract urinary stones from 3 centres in Great Britain shows that the calcium oxalates and the calcium phosphates are the most abundant and frequently occurring crystalline constituents, and that the most common varieties of stones are those composed of pure calcium oxalate and calcium oxalate+calcium phosphate. The relative proportions of these types, however, vary in the different areas. Infection stones consisting of struvite + calcium phosphate are the next important type in the collections from Bristol and Dundee, but there are few of these stones in the collection from the Royal Navy. In a small collection of lower urinary tract calculi from Dundee, stones composed of calcium oxalate + calcium phosphate again predominate, but they are exceeded by infection stones if the different varieties of these are grouped together. Whereas a few composition types dominate the collections of upper urinary tract calculi, there are many more combinations of constituents found in the collection of lower tract stones.

Urological complications of rectal surgery1

Abstract: SUMMARY Pressure and flow measurements during micturition have been employed in the investigation of bladder dysfunction after major rectal surgery. Parasympathetic denervation of the bladder is shown to be the principal aeetiological factor. It occurred in 21 per cent, of males and 29 per cent, of females after excision of the rectum for carcinoma. Denervation did not occur after anterior resection for carcinoma or rectal excision for inflammatory disease and in these patients recovery of bladder function was rapid. Urethral obstruction and distortion of the bladder neck are not important factors in the causation of post-operative urinary retention after pelvic surgery.

Spontaneous recanalisation of the divided vas deferens

Abstract: In 7 healthy adult males subjected to bilateral vasectomy spontaneous recanalisation of the divided vas deferens occurred. The vasa had been either resected and tied (3 Group I) or cut and tied (4 Group II). The operation was considered a failure if the wife became pregnant (3 men) or if sperm continued to be found in the ejaculate for longer than the 3-5 months usually considered necessary to empty the vesicles (4). In all 7 men reexplorations were performed and vas segments were removed from each side. Histological examination found recanalisation of 1 vas in each man: 3 on the right 3 on the left and 1 for which location was not certain. A striking difference in the appearances of the Group I and Group II cases was the larger amount and greater density of scar tissue in the Group I cases. Recanalisation of the vas might occur if the 2 cut ends are allowed to come into contact. If leakage of seminal fluid or local accumulation of tissue fluid occurs 1 or both cut ends of the vas will become surrounded by a sperm granuloma. Histological examination suggested this phenomenon occurred in all Group II cases. In Group I in which the interval between operations was longer (10-18 months as opposed to 3-9 months) the specimens suggest that the granulomata have healed and formed scar tissue.

Communicating cysts and diverticula of the renal pelvis.

Abstract: SUMMARY Sixteen cases of communicating cyst of the renal calyx are described. A new technique for surgical treatment of the condition is described.

Electronic techniques for the control of adult urinary incontinence

Abstract: SUMMARY Twenty-one patients with urinary incontinence were treated with portable electronic stimulators, the stimulus being delivered by a vaginal pessary, a rectal plug or an implantable device. Details are given of the degree of success achieved with each device. The results have proved sufficiently encouraging to warrant extension of the trials. It is suggested that the implantable device should not be regarded as the primary treatment, owing to the danger of electronic failure or lead migration. The investigations used to assess the suitability of patients for the various devices are described.