Showing papers in "BJUI in 1984"

Radical Prostatectomy and Cystoprostatectomy with Preservation of Potency. Results Using a New Nerve-sparing Technique

Abstract: A surgical technique that preserves the branches of the pelvic plexus that innervate the corpora cavernosa was employed during radical retropubic prostatectomy in 64 men and radical cystoprostatectomy in 11 men. In patients undergoing radical retropubic prostatectomy, sexual function returned gradually in the vast majority of patients post-operatively and by 1 year 86% were potent. The age of the patient did not influence post-operative potency but potency did correlate with clinical and pathological stage. Preliminary data suggest that deliberate excision of the neurovascular bundle unilaterally did not adversely affect potency. Of the 11 patients who underwent radical cystoprostatectomy, 82% have erections. Of the 6 patients with sexual partners who have been followed for 1 year, 4 (67%) are potent. These data suggest that erectile function can be preserved in most patients following radical prostatectomy and cystoprostatectomy.

A Prospective Study of Renal Stone Recurrences

Abstract: A simple metabolic investigation was carried out in 54 patients presenting with their first attack of renal stones. In three cases a probable cause for stone formation was found. During the following 8 years 53% of the patients developed recurrences, the risk of which was highest during the first years after the initial attack. Recurrences were more common in males than in females. As a group, patients who were to have recurrences had higher urinary calcium levels but there was a considerable overlap between the two groups. This prospective study confirms the opinion from retrospective evaluation of the natural history of renal stones that recurrences are common. However, they cannot be predicted from standard laboratory findings in individual patients.

Percutaneous Nephrolithotomy: One Stage or Two?

Abstract: Summary— Two hundred and fifty cases of percutaneous nephrolithotomy (PNL) are described. One hundred and fifty cases were treated in two stages, 100 in a single stage. The one-stage method has been shown to be as safe as the two-stage method but should be reserved for those with experience of the technique and who possess adequate instrumentation. PNL has proved to be a preferable option to open stone surgery and a useful alternative to extracorporeal shock wave lithotripsy (ESWL).

Abnormalities of the innervation of the urethral striated sphincter musculature in incontinence.

Abstract: Summary— Perineal nerve and transcutaneous spinal cord stimulation have been used to study 17 patients with idiopathic neurogenic faecal incontinence, 12 of whom also had urinary incontinence. Significant increases in spinal, perineal and pudendal nerve motor latencies were demonstrated in all 17 patients. These results suggest that there is damage to the nerves innervating both the urethral and perianal sphincter musculature in these patients, including those with isolated faecal incontinence. There was evidence of both a distal (perineal nerve) and a proximal (sacral root) component to the damage to the nerve supply of the urethral striated sphincter muscle in half of the patients.

Complications of Vasectomy: Review of 16,000 Patients

Abstract: Sixteen thousand, seven hundred and ninety-six men underwent vasectomy between 1970 and December 1983 and have been reviewed. Post-operative side effects were few and significant complications were reported in 0.9%. Failure to achieve sterility occurred in 72 men, 69 of whom have been analysed. The early recanalisation rate was 0.36%. This rate was not influenced by the operative technique used, but varied markedly between individual surgeons. Experience and care with technique should result in a failure rate of 0.2% or better. There were six cases of late recanalisation in men previously thought sterile by two consecutive azoospermic analyses 4 months after vasectomy.

Percutaneous pyelolysis: indications, complications and results.

Abstract: The results of percutaneous pyelolysis in 28 patients are presented. There were 18 successful and 10 unsuccessful cases. The indications for the procedure are defined in the light of this analysis.

Intraepithelial Lymphocytes in the Normal Epididymis. A Mechanism for Tolerance to Sperm Auto-Antigens?

Abstract: Summary— Using a monoclonal immunoperoxidase technique on frozen tissue sections of normal testis and epididymis, a distinctive distribution of lymphocytes has been identified. Almost all of the intra-epithelial lymphocytes were T cells and the majority of these belonged to the T8+ (“suppressor/cytotoxic”) subset. The distribution contrasted with the predominance of the T4+ (“helper/inducer”) subset in the interstitial tissues and in normal peripheral blood. The predominance of the “suppressor/cytotoxic” subset within the epithelium of the epididymis may exist in order to prevent the development of the immune response to auto-antigens on spermatozoa.

Continent caecal reservoir in urinary diversion.

Abstract: Construction of a continent urinary reservoir was attempted in 18 patients with carcinoma of the bladder. The caecum was used as the reservoir and an intussuscepted ileal nipple was created to provide continence. Fifteen patients are alive and have been observed for 7 to 68 months. The most common complication was malfunction of the nipple valve with urinary leakage and/or difficulty in catheterisation. Revision of the outlet was performed one or more times in 11 cases. The technique of nipple valve construction was successively evolved, with improvement in the functional results. Stricture of one uretero-intestinal anastomosis occurred in three patients. Construction of a continent caecal reservoir is a complex procedure and the problem of a stable, continence-ensuring mechanism in the outlet has not been conclusively solved. The enhanced quality of life offered by a successful continent reservoir nevertheless warrants continued clinical trials in selected patients.

Direct Vision Internal Urethrotamy. A Critical Review of 365 Operations

Abstract: Summary— Internal urethrotomy under direct vision for urethral strictures in the male was employed on 369 occasions in 225 patients during a 4-year period. A retrospective review of results showed an overall cure rate of 77% but the cure rate after each individual operation was less than 50%. Operations for recurrence carried a significantly lower cure rate than initial operations but even after several recurrences there were reasonably good results considering the relatively minor procedure. An active post-operative follow-up employing routine urethroscopy showed significantly better results than mictiographic follow-up. The post-operative period of catheterisation and positive urine culture at the time of follow-up had no significant influence on the results.

Acute urinary retention--a urodynamic assessment.

Abstract: Thirty male patients with acute urinary retention were studied by standard urodynamic techniques on admission to hospital. Ten individuals also underwent cystography and sequential urodynamic testing over 96 h. Twenty-three per cent of patients did not require subsequent prostatectomy. Inability to initiate a voiding contraction during cystometry at the time of admission was associated with a prolonged duration of retention and a greater retained volume. The internal urethral meatus is closed in retention, and release of the retention results in an increase in profile length and maximum urethral closure pressure and a decrease in maximum urethral pressure. Free catheter drainage was associated with a reduction in bladder capacity and the appearance of detrusor instability.

Genitourinary tuberculosis. A study of 1117 cases over a period of 34 years.

Abstract: One thousand one hundred and seventeen patients with genitourinary tuberculosis who were treated over a period of 34 years have been reviewed. During this time various regimens of treatment were used and have been evaluated. Emphasis is placed on the results of the group on short-course chemotherapy which has been in use since 1970 and is now standard practice. This group has been carefully studied, as the chemotherapeutic combinations are important to developing countries. The clinical response, sterilisation of urine, urinary reversion, drug toxicity and the place of surgery in relation to modern chemotherapy have been discussed and assessed. They show that the results of short-course chemotherapy are satisfactory and confirm that there is no need to extend chemotherapy beyond 4 months, except in unusual circumstances.

Treatment of invasive bladder cancer by local resection and high dose methotrexate.

Abstract: Summary— Fifty-seven patients with transitional cell carcinoma of the bladder, categories pT2, pT3a and pT3b, were treated by transurethral resection of the tumour mass (54 cases) or partial cystectomy (3 cases) followed by 8 doses of methotrexate 2 g i.v. every 3 weeks with appropriate Leucovorin rescue. At completion of chemotherapy 6 months after TUR 33/57 patients were tumour-free; 5/57 had new superficial tumours; 13/57 had persistent tumour invading muscle, 3 showed tumour progression and 3 had died from treatment complications. One-year survival was 45/57 (82%);2-year survival was 23/39. Although some patients developed metastases and others have grown new superficial tumours, of those surviving, the bladder was free of the original invasive tumour in 38/45 (84%) at 1 year and in 19/24 (79%) at 2 years. It is concluded that transurethral resection plus high dose methotrexate may offer an effective alternative to radiotherapy or cystectomy for a significant proportion of patients with invasive bladder cancer.

The smooth muscle of rat bladder in the early stages of streptozotocin-induced diabetes.

Abstract: Summary— The morphology of the rat bladder was studied following 8 weeks of streptozotocin-induced diabetes, at which stage distension of the bladder had occurred. Evidence is presented for hypertrophy of the smooth muscle of the bladder wall in experimental diabetes. It is suggested that the morphological changes found in the diabetic rat bladder are associated with polyuria. The results are discussed in relation to clinical studies of bladder dysfunction in diabetes mellitus.

Bladder Inhibition by Penile Electrical Stimulation

Abstract: Transcutaneous electrical stimulation was applied to the penis in 22 patients complaining of frequency, urgency and/or urge incontinence. Detrusor activity was suppressed with this stimulation, causing decreased bladder spasticity and/or increased cystometric capacity in 10 of 22 patients. Clinical success was noted in four patients with a portable stimulator.

Prognostic factors in renal carcinoma. An evaluation of operative findings.

Abstract: Summary— A consecutive series of 257 patients with renal carcinoma treated by radical nephrectomy is presented. The crude 5–year and 10–year survival rates for all patients were 47 and 31% respectively and for patients without distant metastases 62 and 50%. The importance of factors relating to prognosis was investigated with multivariate survival analysis. Metastases, nodal involvement and histological grade were strongly and independently associated with survival, but the influence of venous invasion was less important. When these factors are taken into consideration, direct extension, size and cell type of the tumour or sex and age of the patient give no significant additional prognostic information.

The Artificial Urinary Sphincter in Children

Abstract: Summary— One hundred and thirty-two children underwent implantation of the AS792 artificial urinary sphincter over the past 5 years: 90% had an excellent result following the implantation Thirty-one patients (24%) required further surgery to correct a malfunction of the device The device was removed in 53% of the patients and the incidence of infection was 38% The artificial urinary sphincter has been shown to be a reliable means of achieving urinary incontinence in children With attention to patient selection and meticulous surgical technique, a high success rate can be expected

Long-term follow-up of surgery for urinary incontinence in elderly women.

Abstract: This study reviews the 3- to 5-year follow-up of 35 elderly women treated by colposuspension for incontinence due to urethral sphincter incompetence (genuine stress incontinence). All patients had pre- and post-operative urodynamic studies and were followed up annually by clinical assessment and Urilos test. Thirty-two patients were subjectively cured and 31 objectively cured. Cystocele was corrected by the colposuspension. Rectocele and enterocele were frequently encountered at follow-up and prophylactic closure of the pouch of Douglas or posterior repair were recommended. Although the peak urine flow rate measurements at follow-up were reduced, no patient encountered difficulty in bladder emptying. The low operative and post-operative morbidity rate was due to careful pre-operative medical selection.

A 15-year follow-up of 406 consecutive spinal cord injuries.

Abstract: A follow-up of 406 traumatic spinal cord injuries admitted from 1967 to 1982 is presented. Forty patients died, only two (5% of deaths and 0.5% of the series) from renal complications. Twenty-seven died from pulmonary or cardiovascular causes, complete and cervical lesions being the most significant factors in mortality. Early and continued active urological treatment aimed at the provision of low pressure bladder drainage to protect the upper tract. The management and results are critically discussed.

Use of Alum to Control Intractable Vesical Haemorrhage

Abstract: Eight patients with hitherto uncontrollable vesical bleeding were treated by irrigating the bladder with a 1% solution of alum. The method does not require anaesthesia and bleeding ceased in every case.

Cis‐diamminedichloroplatinum (DDP) as Initial Treatment of lnvasive Bladder Cancer

Abstract: Cis-diamminedichloroplatinum (DDP) was used as the initial treatment in a pilot study of 17 patients with biopsy-proven transitional cell carcinoma of the bladder. No patient had received any previous radiotherapy or chemotherapy. The clinical stages of the tumours were T2 (2 patients), T3 (13) and T4 (2). Before treatment the tumours were assessed by cystoscopy, biopsy, examination under anaesthesia (EUA), computed axial tomography (CT scan) and ultrasound. DDP was given at a dose of 100 mg/m2 intravenously with hydration using mannitol and saline. Each patient received three treatments at 3-weekly intervals. Twelve days after the third treatment, response was assessed by cystoscopy, biopsy, EUA, CT scan and ultrasound. Eleven of the 17 patients had a partial response. Survival was significantly increased in responders compared with non-responders. Seven patients had a low creatine clearance following treatment, 5 had audiograms showing evidence of ototoxicity and 2 developed leucopenia during treatment. This study confirmed the activity of DDP in bladder cancer and showed that it was active in producing a response in the primary tumour in 11 of 17 patients.

The composition of catheter encrustations, including the effects of allopurinol treatment.

Abstract: Summary— The composition of encrustations precipitated on long-term indwelling urethral catheters was analysed using a newly developed wet chemical method that allows determination of small sample volumes. In contrast to earlier studies, the major portion of the encrusted material could be identified; ammonium magnesium phosphate and calcium phosphates (brushite and apatite) were the major components. The effect of allopurinol was also investigated and it was found to decrease significantly the amounts of urate and calcium phosphate but not to lower significantly the total amount of material precipitated on the catheters.

Results of Transvesical Infiltration of the Pelvic Plexuses with Phenol in 116 Patients

Abstract: Summary— One hundred and sixteen patients with detrusor instability, detrusor hyper-reflexia or bladder hypersensitivity who had failed to respond to standard conservative methods of management were treated by transvesical infiltration of the pelvic plexuses with phenol. A satisfactory response was obtained in detrusor hyper-reflexia (82%), in detrusor instability in patients over 55 years of age (69%) and in idiopathic bladder hypersensitivity (68%). The response rate was much less satisfactory in detrusor instability in patients less than 55 years of age (14%) and when there was a definable cause for bladder hypersensitivity (0%).

Nesbit's operation for Peyronie's disease.

Abstract: Summary— Nineteen patients with Peyronie's disease were treated by a modification of Nesbit's operation. The deformity was completely corrected in 18 patients. Potency was restored to 4 of the 6 impotent patients and satisfactory coitus became possible for 15 patients, whereas it had been possible for only 3 before operation.

Dynamics of a continent caecal reservoir for urinary diversion.

Abstract: Motor activity of the caecal reservoir for urine, and of the intussuscepted nipple valve in the ileal outlet, was studied in seven continent and two incontinent patients by means of a catheter equipped with two microtransducers. The basal pressure was low in the reservoir even at large-volume filling. In the continent patients the basal pressure was always higher in the ileal outlet than in the reservoir. No high-pressure zone was present in the outlet in the incontinent patients. Intermittent pressure waves occurred in the reservoir, and they increased in frequency, duration and amplitude with increasing filling. Pressure waves with higher amplitude arose simultaneously in the outlet. Increasing time from construction of the reservoir was accompanied by decreasing amplitude of the pressure waves, indicating adaptation towards the larger functional capacity of the reservoir. The recorded dynamics seemed to reflect the functional state of the reservoir.

Percutaneous sclerotherapy of varicoceles--an alternative to conventional surgical methods.

Abstract: Between May 1981 and October 1982, 259 varicoceles were identified by phlebography. It was possible to occlude 217 with Varicocid using a percutaneous Seldinger catheterisation technique under local anaesthesia. This method is an alternative to standard surgical techniques and has several advantages. It is cheap, it can be carried out on an out-patient basis, it lacks the risks associated with general anaesthesia and there are few complications.

Sexual Function in Prostatic Cancer Patients Treated with Radiotherapy, Orchiectomy or Oestrogens

Abstract: Summary— Sexual function in prostatic carcinoma patients was studied in 12 patients from each of three treatment groups: radiotherapy, orchiectomy and oestrogen treatment. Significant deterioration occurred in all groups. Although erectile potency was preserved in 9 of 12 patients treated with radiotherapy, 7 of these had a marked reduction in the frequency of sexual activity. Men subjected to orchiectomy or oestrogen treatment were seldom capable of having intercourse or of experiencing orgasm. However, oestrogen-treated men continued sexual activity with their partner more often than orchiectomised subjects. Patients receiving oestrogen treatment scored significantly higher for mental depression than those in the other two treatment groups.

Perineal nerve and transcutaneous spinal stimulation: new methods for investigation of the urethral striated sphincter musculature.

Abstract: Summary— The distal motor latencies in the perineal and pudendal nerves were measured in 20 normal subjects using digitally directed pudendal nerve stimulation. The mean pudendal and perineal nerve latencies were 1.9 ms ± 0.2 (SD) and 2.4 ms ± 0.2 (SD) respectively. In a further eight normal subjects transcutaneous spinal stimulation was used to record the motor latency from L1 and L4 stimulation sites to the urethral striated sphincter musculature. The mean spinal nerve terminal latencies from L1 and L4 were 4.9 ms ± 0.3 (SD) and 4.1 ms ± 0.2 (SD) respectively. These techniques can be applied to the investigation of the nerve supply to the urethral striated musculature in stress urinary incontinence and other disorders affecting the innervation of the anterior pelvic floor musculature.

Stamey Endoscopic Bladder Neck Suspension for Stress Incontinence

Abstract: Summary— Sixty female patients with clinically demonstrable stress incontinence of urine have had a Stamey operation during the last 3 years. The results have been good in curing stress incontinence, whilst the majority of the failures have been in patients with severe detrusor instability or a chronic cough. There have been few post-operative complications and urodynamic studies have shown improved cough urethral profiles and no evidence of bladder outflow obstruction. The Stamey procedure can be recommended as the initial operation for surgically curable incontinence. Mild bladder instability is not a contraindication to the operation and it is also useful in elderly, unfit or obese patients.

Effects of high intake of dietary animal protein on mineral metabolism and urinary supersaturation of calcium oxalate in renal stone formers.

Abstract: Summary— The metabolic effects of a high protein diet (HPD) were studied in eight patients with idiopathic recurrent calcium oxalate stones. On the HPD there was a 35% increase in urinary calcium concomitant with increased excretion of cyclic AMP and hydroxyproline. These findings point to an enhanced resorption of bone, possibly secondary to increased renal loss of calcium. The urinary citrate decreased by 25% along with reduced serum standard bicarbonate and urinary pH. The high formation of acid metabolites might also have adverse effects on calcium balance and bone. Urinary oxalate excretion was not affected nor were there any significant changes in the calculated urinary supersaturation of calcium oxalate, if changes in urinary citrate, pH, sulphate, sodium, phosphate and volume were also considered. This study suggests that the possible negative influence on the propensity to form renal stones of a diet rich in animal protein is probably due to reduced urinary inhibitory activity.

Carcinoma of the Prostate with Soft Tissue or Non‐regional Lymphatic Metastases at the Time of Diagnosis: a Review of 47 Cases

Abstract: The clinical course of 47 patients with carcinoma of the prostate who at the time of initial presentation had metastases to soft tissue or non-regional lymph nodes was retrospectively reviewed The response rate to primary hormonal treatment (orchiectomy or oestrogens) and the duration of response were similar to those of 47 other patients presenting with skeletal metastases only The survival of the patients in the study group was not statistically different from that of patients with skeletal metastases only The results suggest that patients presenting initially with metastases to non-regional lymph nodes or soft tissue should be treated by the same therapeutic methods as for disseminated prostatic cancer in general (oestrogens or orchiectomy) Slight or no urinary symptoms at the time of initial presentation in spite of a locally advanced tumour was a common finding; 20% of the patients had normal serum prostatic acid phosphatase despite the presence of disseminated disease Lymph node enlargement in the left supraclavicular fossa was the most common site of non-regional lymphatic spread Elderly males with metastatic carcinoma in this region should be investigated for the possibility of prostatic cancer