Showing papers in "BJUI in 1978"

Risk factors in calcium stone disease of the urinary tract.

Abstract: The concept that calcium stone formation may be explained on the basis of a number of risk factors is developed. The main risk factors involved are shown to be calcium, oxalate, pH, acid mucopolysaccharides and uric acid. A method is described for calculating and combining the individual risk factors into a measure of the "relative probability" of forming stones (PSF). PSF values are generally lower in normal subjects than in stone-formers. Amongst the normals, PSF values are lower in children and women than in men. Recurrent stone-formers have the highest PSF values and these correlate well with the severity of the diseases as defined by the stone episode rate of the patient. Single stone-formers have PSF values intermediate between those of normal men and those of recurrent stone-formers.

Diuresis Renography in Equivocal Urinary Tract Obstruction

Abstract: A trial of the value of diuresis renography in equivocal upper urinary tract obstruction is presented Fifty-two patients were examined by standard renography and renography under a diuretic provocation The results indicate that the technique is of considerable value in making the vital distinction between dilatation on the excretion urogram due to atonicity and that caused by a genuine obstruction A quantitative index of the response to diuresis reflecting the degree of impedance to flow is described--the Diuresis Excretion Index Diuresis renography is recommended in the evaluation of the patient with equivocal urinary tract obstruction

A Placebo-controlled Double-blind Study of the Effect of Phenoxybenzamine in Benign Prostatic Obstruction

Abstract: A double-blind placebo-controlled study of phenoxybenzamine for the symptomatic treatment of benign prostatic obstruction is reported. Statistically significant evidence of an improvement in both the peak and mean flow-rates was found. Both diurnal and nocturnal frequency were significantly diminished. Residual urine was unaffected, and the possible reasons for this are discussed. Urethral pressure recordings confirmed the reduction in the closure pressure in the prostatic segment of the urethra. It was concluded that there was good evidence that the treatment is effective.

The Testes After Torsion

Abstract: Summary— In torsion of the testis a large proportion of testes saved by surgery develop secondary atrophy. External manual reduction may be used as a first treatment, but surgical fixation is mandatory before the patient leaves the hospital. Prophylactic fixation of the contralateral testis should always be performed as 30% of the patients will otherwise develop symptoms. The preventive operation causes no discomfort to the patient and no harm to the testis. The fertility of the torsion patients is reduced. Patients treated for unilateral testicular torsion seem to have bilateral testicular abnormality resulting in decreased spermatogenesis.

The long-term follow-up of surgically treated vesicoureteric reflux.

Abstract: We have followed up 83% of a series of 166 patients with vesicoureteric reflux who were treated surgically more than 10 years ago. We found an incidence of hypertension of 12.8%. The need for careful follow-up of the blood pressure of patients with reflux nephropathy is stressed.

A Critical Evaluation of the Results of Transurethral Resection of the Prostate

Abstract: In a review of 1057 consecutive prostatectomies of which 95% were performed transurethrally, carcinoma was present in 11.8%. There were 10 deaths within a month of operation (0.9%), 9 of these patients having been exceptionally old and unfit. The rate of complications and the end results appear to justify using transurethral resection as the method of choice for prostatectomy whenever it is feasible.

An objective assessment of the unstable bladder of psychosomatic origin.

Abstract: Summary— An objective assessment of 40 female patients with an unstable bladder was made. An organic or structural cause had previously been eliminated. In all patients an emotive or psychogenic origin for their urinary symptoms was discovered. The diagnosis of detrusor instability was confirmed by cystometry and bladder drill retraining was employed for 3 months. Cystometric investigation was then repeated and the patient was reassessed from the symptomatic point of view. The cure rate was 82.5%.

Radical cystectomy for carcinoma of the bladder.

Abstract: Summary— A personal series of 50 radical cystectomies has been reviewed to decide whether it is a justifiable operation and, if so, when it should be performed. In spite of the fact that radical cystectomy had a higher operative mortality than simple cystectomy and was sometimes followed by lymphoedema, in patients with invaded iliac lymph nodes it was followed by a 25% 5-year survival. It appears, therefore, to be a justifiable procedure. It is recommended that simple cystectomy should be performed for patients with papillomatosis, carcinoma in situ, and as a salvage procedure after radiotherapy has failed, and that radical cystectomy should be reserved for elective cases of invasive vesical tumours, and for those patients who are found at exploration to have obvious metastatic deposits in the iliac lymph nodes.

Functional Obstruction of the Ureter and Renal Pelvis. A Histological and Electron Microscopic Study

Abstract: Histological, histochemical and electron microscopic techniques have been used to compare dilated and normal calibre segments of ureter and renal pelvis in cases of idiopathic hydronephrosis and primary obstructive megaureter. In both conditions a marked increase in collagen and elastic tissue occurs in the wall of the distended segment and this infiltration extends throughout the proximal dilated ureter and renal pelvis. Evidence is presented to show that in the dilated segment, smooth muscle cells are directly involved in the synthesis of connective tissue elements. These findings support the view that the primary anomaly in idiopathic hydronephrosis and primary obstructive megaureter can be attributed to a malfunction of smooth muscle cells in the ureter and renal pelvis. However, the possibility remains that the changes in smooth muscle are secondary and have been induced by obstruction and distension caused in these pathological conditions by unknown aetiological factors.

Idiopathic Bladder Instability Treated by Biofeedback

Abstract: Biofeedback training has been used to treat 27 female patients suffering from symptoms associated with detrusor instability Re-education to auditory and visual stimuli took place during 4 to 8 one-hour sessions at weekly intervals. Using subjective and objective methods of assessment 81% of the patients were improved following treatment.

Biofeedback in the treatment of detrusor instability.

Abstract: Summary— Detrusor instability has remained resistant to conventional forms of treatment. An attempt to use biofeedback methods in its management is described. Six female patients with symptoms of frequency, urgency and urge incontinence due to detrusor instability were conditioned to auditory and visual stimuli for 6 to 81 h sessions. They were assessed clinically and urodynamically. The results are presented as well as detailed case studies of 3 patients. Subjectively, 3 were cured, 2 improved and 1 remained the same; objectively, 3 were cured, 1 improved and 2 remained the same. No significant side effects were encountered.

The site of recurrence of non-infiltrating bladder tumours.

Abstract: Summary— A study of 56 cases of non-infiltrating bladder tumour showed a striking difference in the distribution within the bladder of the primary and the recurrent tumours. More than three-quarters of the primary tumours were confined to a restricted area near a ureteric orifice whereas only one-fifth of recurrent tumours were found in this site. By far the commonest site for recurrent tumours was the postero-superior wall of the bladder. Forty-five recurrent tumours formed in the air bubble region, a site in which no primary tumour was found in the whole series. The postero-superior wall of the bladder is subject to mild trauma and abrasion by the tip of an endoscope and the air bubble region is the recipient of hot gas produced by the diathermy. These gas bubbles may also convey detached tumour cells to the recipient site. Local trauma may encourage tumour formation either by producing a raw surface which allows implantation of tumour cells, or possibly also by reducing local resistance to the primary carcinogenic factor.

The distinction between obstructive uropathy and nephropathy by radioisotope transit times.

Abstract: Summary— Deconvolution analysis of different regions of interest on gamma camera renography enables obstructive lesions causing impairment of nephron function to be distinguished from obstructive lesions in which parenchymal function is unimpaired. Quantitation of isotope transit time through the parenchyma is a reliable method of diagnosing upper urinary tract obstruction.

The Incidence and Consequences of Damage to the Parasympathetic Nerve Supply to the Bladder after Abdominoperineal Resection of the Rectum for Carcinoma

Abstract: Fifty-one patients undergoing abdominoperineal resection of the rectum for carcinoma were studied with regard to bladder function after surgery. Fifty-nine per cent had motor denervation of the bladder due to tumour or operative damage to the pelvic parasympathetic nerves and this produced symptoms of incomplete bladder emptying requiring treatment in 90% of this group. The factors affecting the incidence of nerve damage were discussed. The long-term effect of parasympathetic nerve damage was investigated and the management is discussed.

Bone scanning and plasma phosphatases in carcinoma of the prostate.

Abstract: Summary— Bone scanning with 99mTc-Sn-HEDP, radiographic skeletal survey and determination of plasma acid and alkaline phosphatase values were carried out in a consecutive series of 90 untreated patients with carcinoma of the prostate. 99mTc-Sn-HEDP provided satisfactory bone imaging and was convenient in use. The addition of bone scanning to radiographic survey increases the detection rate of skeletal metatases by 16%. Radiography increases the accuracy of bone scanning by identifying false positive scans due to benign disease and false negative scans when there are diffuse symmetrical bony metastases. The plasma phosphatases alone are less accurate staging tests. The acid phosphatase data support the validity of scan positive—X-ray negative findings. Bone scan abnormalities due to secondary deposits usually precede elevation of plasma alkaline phosphatase.

The management of indwelling catheters.

Abstract: Summary— Eighteen geriatric patients with indwelling catheters were observed for a total of 393 weekly urine specimens. The effects of a 1 week course of antibiotics/chemotherapeutic agent followed by urinary antiseptics for 6 weeks, and also of regular bladder washouts, were noted. All urine specimens were infected except 24% during antibiotic treatment and 9% during antiseptics and 6% after washouts. Only washouts reduced the extent of catheter blockage. There was little difference in the time in situbetween silastic and latex Foley catheters—only 31% of silastic remaining for longer than 4 weeks. Bard-Roberts catheters were the least satisfactory. Catheter leakage was not affected by urinary pH. Further developments in long-term catheter management are needed.

Apha-Adrenergic Agents in Urinary Disorders of the Proximal Urethra Part I. Sphincteric Incontinence

Abstract: Phenylpropanolamine, an alpha receptor stimulant, was found effective in 11 of 13 female and 6 of 7 male patients with sphincteric incontinence. In all the male patients except 1, the incontinence has followed prostatectomy. Side effects occurred in only 1 patient. As a rule, the benficial response depended on the therapy being continued. The results are consistent with the distribution of alpha receptors and their effect in the proximal urethra.

The effect of pelvic nerve stimulation and some drugs on the urethra and bladder of the dog.

Abstract: Pelvic nerve stimulation caused an increase in pressure in both the urethra and bladder of anaesthetised dogs. The increases were only partially blocked by intravenous injection of atropine and were not significantly reduced by phentolamine, propranolol or methysergide. Quinidine produced some reduction in the bladder but not the urethral response. Hexamethonium reduced but did not abolish the responses to pelvic nerve stimulation. Close arterial injection of acetylcholine and 5-hydroxytryptamine increased the bladder and urethral pressures; noradrenaline produced a biphasic increase in urethral pressure but had no effect on the bladder; ATP increased bladder pressure but the response of the urethra was variable. The results indicate that some fibres in the pelvic nerve to the urethra as well as to the bladder are atropine resistant and suggest that transmission does not involve 5-hydroxytryptamine or noradrenaline and probably not ATP. The significance for treatment of detrusor dysfunction is discussed.

A New Urinary Test for Stone “Activity”

Abstract: Summary— Rapid evaporation of urine to osmolarity 1200 results in a high incidence of envelope Wedellite and calcium phosphate crystals. The Wedellite crystals closely resemble those seen in untreated urine samples of stone formers. The incidence of crystalluria produced by these tests is higher in the stone formers than in the normal subjects, reduced by thiazides and increased by cellulose phosphate; combined thiazide and cellulose phosphate therapy was most effective in reducing crystalluria. Simple calcium and oxalate concentration products were calculated and did not correlate well with incidence of calcium oxalate crystalluria. Although the product is important, inhibitors of crystal formation must be equally important. It is postulated, but not proven, that the evaporation tests may indicate normal subjects at risk to stone formation when exposed to chronic dehydration and whether a stone former is still metabolically active.

Results of prolonged bladder distension as treatment for detrusor instability.

Abstract: Forty-six patients with urinary symptoms associated with unstable (uninhibitable) detrusor contractions have been treated by a total of 58 bladder distensions; 43 of these were fully re-evaluated urodynamically thereafter and none showed conversion from unstable to stable detrusor behaviour. Four patients with unstable bladders were symptomatically improved but 5 patients reported symptomatic deterioration. We have concluded that while over-distension may sometimes improve a patient's symptoms, it did not result in the abolition of detrusor contractions or the reversal of unstable detrusor behaviour.

Reflex urethral instability.

Abstract: Summary— Eleven patients with incontinence and large post-voiding residual urine volumes have been studied with a urodynamic technique. Results indicate that reflex urethral relaxation was responsible for urinary incontinence. A probably relationship of this syndrome to bladder overdistension is suggested by ancillary evidence.

The influence of refined carbohydrate on urinary calcium excretion.

Abstract: Summary— In the course of study of the influence of varying the amount of refined carbohydrate (sugar and sugar products) in an otherwise standardised diet in 18 normal subjects it was evident that the analysis of 24-h urine collections failed to show the profound diurnal variation in urinary electrolyte excretion and, in particular in this instance, calcium excretion. The analysis of individually voided specimens showed some normal subjects to have spontaneously high peaks of urinary calcium concentration throughout the day even whilst on a diet with low refined carbohydrate content. Increase in the refined carbohydrate content of the otherwise standardised diet caused significant increase in the number of urines with a calcium concentration above 9 mmol/l. Refined carbohydrate, a common constituent in Western diets, can therefore influence urinary electorlyte excretion in such a way that there may be an increased risk of over-saturation with calcium oxalate.

The Measurement and Interpretation of Urethral Pressures Obtained by the Method of Brown and Wickham

Abstract: Summary— The most significant error in routine measurement of urethral pressure by the Brown-Wickham method is caused by the slow response of the system to increasing pressure Errors due to viscous pressure losses in the measuring catheter and to variable orientation of the catheter sideholes are not normally important The distensibility of the urethra may be estimated from the variation of the measured pressure with infusion flow rate in the range above 2 ml/min In highly distensible urethras the pressure actually measured is similar to the true pressure in the undistended urethra, but in less distensible urethras this is not so Substantial leakage, at a flow rate of 2 ml/min or more, begins to occur when the intravesical pressure is approximately equal to the maximum pressure in the undistended urethra Therefore, in highly distensible urethras the maximum measured pressure is a satisfactory guide to the intravesical pressure needed for substantial leakage In less distensible urethras, however, substantial leakage may occur when the intravesical pressure is perhaps 25 cm H2O below the maximum pressure measured in the urethra Leakage at very low flow rates may be possible through some urethras when the intravesical pressure is very low indeed The urethral closure pressure profile, as ordinarily measured, is not a reliable guide to the possibility of such leakage With care, the method of Brown and Wickham gives satisfactory measurements of the urethral closure pressure profile However, the maximum profile pressure exceeds, sometimes by a considerable amount, the bladder pressure needed to cause leakage

Urethral Injury and Fractured Pelvis

Abstract: Summary— In 333 consecutive cases of fractures of th pelvis admitted as emergencies to one hospital 53% were in males, of whom 34 had suspicious clinical signs of urethral or vesical injury. In 15 patients catheterisation was performed uneventfully and in no case did this make the injury worse; in 8 an attempt at primary realignment was performed, resulting in 4 cases without any stricture, and 2 who needed annual dilatation only. In 4 additional cases associated laceration of teh bladder was repaired which one had no stricture and 2 needed infrequent dilatations. In a further 41 cases a catherter was used and led to no strictures. Among 67 males with post-tramatic urethral injures caused by pelvic fracture the best results were seen when the 2 ends were urethral injuries caused by pelvic fracture the best entirely, and in 17 others it led to an easy urethroplasty. Difficult strictures occurred in servere injuries with uncorrected displacement of the soft parts. Where feasible, early surgical repair appears to give the best chance of minimislng the severity of subsequent urethral stricture.

Obstructive Azoospermia: Respiratory Function Tests, Electron Microscopy and the Results of Surgery

Abstract: Forty-five patients have been treated surgically for obstructive azoospermia. Fifteen underwent reversal of vasectomy and 40% of the wives became pregnant. Thirty had epididymovasostomy, and in only 2 (6.5%) did the sperm count become normal, although a few poorly motile sperms appeared in the ejaculate in a further 4 patients. Congenital abnormalities of the vasa in 7 cases and post-inflammatory blocks in 4 cases were examples of obstructive azoospermia due to well defined causes. However, in half of the patients (15 cases) the cause was obscure although it was associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). The results of pulmonary function tests in 30 cases, and electron microscopic studies of cilia from epididymes (10 cases) and bronchial mucosa (2 cases) indicated that the basic abnormality might be malfunction of the microtubules which appeared to be ultrastructurally normal in most cases. One case appeared to be associated with dietary deficiency, and correction of diet coincided with a successful result of surgery.

The role of bone scanning in the assessment of prostatic carcinoma.

Abstract: Summary— Fifty new cases of carcinoma of the prostate were assessed prior to treatment to determine the incidence of bony metastases. The radioisotope bone scan was the most sensitive method of detecting metastases and of localising them. It was twice as accurate as the serum acid phosphatase estimation. Skeletal X-rays were the least accurate method. Forty-six per cent of patients had abnormal bone scans at presentation. The histological grade of the tumour correlated well with the bone scan. The higher the grade, the more likely was the bone scan to be abnormal. There is need for greater accuracy in detecting metastases, and the bone marrow acid phosphatase estimation, either alone or in conjunction with the bone scan, may provide this accuracy.

Surgical management of impotence using the inflatable penile prosthesis: experience with 103 patients.

Abstract: The inflatable hydraulic penile prosthesis has been implanted in 103 patients with both organic and psychogenic impotence. The 4 failures in this series resulted from infection. Mechanical problems occurred in 27 patients, but with additional implant experience, these have been significantly induced. All mechanical complications are correctable through secondary and tertiary surgical procedures. Ninety-eight of 99 patients with a normally functioning prosthetic device had satisfactory intercourse without significant difficulty. The inflatable penile prosthesis has improved to be a highly satisfactory method of treating male impotence.

Diagnostic Catheterisation and Bacteriuria in Women with Urinary Incontinence

Abstract: Summary— The risk of single catheterisation in females with urinary incontinence and/or genital prolapse was studied in patients referred for urodynamic examination. Two hundred and eighty-six single catheterisations were performed followed by a mid-stream specimen 1 week later, and in 31 of these the initial specimen contained more than 105bacteria. Following catheterisation bacteriuria occurred in 5 (2%) of the patients with initially sterile urine. The phenomenon of “asymptomatic bacteriuria”, “transient significant bacteriuria” and “bladder defence mechanism” is discussed. The risk of introducing urinary tract infection in urodynamic studies is low.

Controlled clinical trial of arginine for infertile men with oligozoospermia.

Abstract: Summary— 64 infertile men with oligozoospermia took part in a double blind cross-over trial. Each patient received matching capsules of a placebo and arginine for periods of 12 weeks. There was no difference in the conception rates of the wives or changes in the quality of the semen during each period of treatment.

Serial Bone Scanning: The Assessment of Treatment Response in Carcinoma of the Prostate

Abstract: Summary— Serial bone scans and radiographic surveys were performed in 167 patients with histologically proven carcinoma of the prostate: 435 scans and surveys were performed. Nineteen of 99 patients with negative findings on diagnosis have become positive on follow-up. Forty-nine patients had positive findings on presentation; 8 have regressed on follow-up and 26 have progressed; 15 have remained unchanged. This is a sensitive method of follow-up in patients with carcinoma of prostate. Changes occurred in bone scans and skeletal surveys before any alteration in serum acid or alkaline phosphatases, symptoms of metastases or change in prostatic size in the majority of cases. The documentation of progression from MO to M1 disease presents no problems. However, problems in quantitation may arise in patients presenting with M1 disease.