Showing papers in "Scandinavian Journal of Urology and Nephrology in 1978"

Bladder Function in Healthy Elderly Males

Abstract: Bladder function was studied in 20 healthy elderly male volunteers using cystometry, uroflowmetry and voiding cystourethrography. Two persons were excluded from the study as neurological examination had shown evidence of organic neurological disease, and one person did not complete the study. 53% of the remaining 17 persons had detrusor hyperreflexia. Urinary flow rates were reduced and maximal intravesical pressures elevated in the persons studied, although they claimed to have a normal voiding pattern. No correlation was found between the reduction of urinary flow rate respectively increase in maximal intravesical pressure and the presence of detrusor hyperreflexia. The high incidence of detrusor reflex disturbances thus suggests that incipient infravesical obstruction in old age and possible subclinical impairment of the central nervous control of the micturition reflex are major etiological factors in detrusor hyperreflexia.

Grading of human renal adenocarcinoma.

Abstract: One hundred and thirty-eight adenocarcinomas of human kidney were assessed histologically with special reference to the tumor malignancy as indicated by the 5-year survival of the patients. Four different grading systems were used; the classification based on the histologic type of tumor growth, the grading of malignancy according to Arner et al., the grading based on the nuclear structure of carcinoma cells and finally a combined grading system based on the nuclear structure and the demarcation of the tumor from the surround tissue. The histologic type of growth was observed to be an inappropriate basis for grading of renal carcinoma. The grading system of Arner et al. was an appropriate method of malignancy grading despite its somewhat low reproducibility. The grading system based on the nuclear structure of the tumor cells was an accurate measure of the intrinsic malignancy of renal carcinoma and gave an excellent correlation between tumor grade and the 5-year survival rate of the patients. The combined grading system was an equally accurate method in estimating the 5-year prognosis of ranal carcinomas and indicated that the poor demarcation of the tumor from the surroundings in an unfavorable prognostic sign.

Determination of glomerular filtration rate in advanced renal insufficiency.

Abstract: The glomerular filtration rate (GFR) has been determined in 17 patients with advanced renal insufficiency (GFR<15 ml/min) by different clearance techniques using creatinine, inulin and 51Cr-EDTA as filtration markers. With renal inulin clearance as reference method for GFR, endogenous renal creatinine clearance overestimated GFR by an average of 30%. Renal clearance of 51Cr-EDTA and inulin were closely correlated and thus 51Cr-EDTA is a suitable GFR marker even at low filtration rates. However, it was found that the plasma clearance of 51Cr-EDTA overestimated the GFR often by more than 100% in the range 2.6-11.2 ml/min. Renal clearance measured during 24 h was lower than 4 h renal clearance with the patient well hydrated and resting in bed. It is concluded that the precise measurement of low glomerular filtration rates requires the use of renal clearance techniques. Four-hour 51Cr-EDTA renal clearance is a suitable method for measuring and following the development of renal function in advanced renal insu...

The Effects of Long-Term Treatment with Norephedrine on Stress Incontinence and Urethral Closure Pressure Profile

Abstract: Twenty-five women with stress incontinence of urine were given an α-adrenoceptor stimulating agent (norephedrine) and a placebo during respective 14-day periods according to a double-blind cross-over schedule. The results were classified as the patient's own assessment of therapeutic effect and as change in urethral closure pressure profile measured by a microtransducer catheter. Norephedrine had a significant therapeutic effect on the symptom stress incontinence and produced significant increase in maximum urethral pressure and maximum urethral closure pressure in the lithotomy and the erect position. Reduction of incontinence was associated with increase in maximum urethral closure pressure. The sum therapeutic effect was of moderate degree.

Are Doctors Able to Assess Prostatic Size

Abstract: The between-observer variation was evaluated through three independent estimates of preoperative prostatic weight in each of 40 patients. Error in the estimates was of considerable magnitude irrespective of size of prostates. Experienced urologists did not attain a more reliable estimate than unexperienced doctors. Only about 2/3 of estimates were correct within a range of ±25 g. However, there was a statistically significant correlation between estimated and actual operative prostatic weight.

A simple photometric method for determination of blood loss during transurethral surgery.

Abstract: A new method for determining blood loss during transurethral operations is presented. Its basic principle is photometry of blood concentrations in haemolysed irrigating fluid. At test study was run on 50 patients who underwent transurethral prostatic resection because of hyperplasia. The photometer was of a type commonly used for routine determination of a haemoglobin concentration in blood. The apparatus for the test is therefore readily available. The test is simple to perform and gives highly reliable results within a few minutes. In seven cases double sampling was done. Since the results within each pair of samples were practically identical, double sampling was considered superfluous for the rest of the case series. Visual estimation of blood loss during transurethral operations seems to be customary in most urologic units in Sweden. We found this method to be unreliable, with underestimates of about 100% in several cases.

The effects of norephedrine and bethanechol on the human urethral closure pressure profile.

Abstract: In twelve women with urinary stress incontinence simultaneous measurements were made of the intravesical and intra-urethral pressures, including the urethral closure pressure profile (UCPP), before and after oral administration of norephedrine or subcutaneous injection of bethanechol. The investigations were carried out at various bladder volumes in the supine position and at bladder volume 300 ml in erect position. Irrespective of bladder volume or body position, norephedrine caused a statistically significant rise in maximum urethral pressure (MUP) and in maximum urethral closure pressure (MUCP). The intravesical pressure was not affected. After intravenous injection of phentolamine, MUP and MUCP fell to levels below the original readings, but here too the intravesical pressure was unaffected. Injection of bethanechol was followed by significant increase in the intravesical pressure, irrespective of bladder volume or body position. There were no consistent changes in the intra-urethral pressure. As a co...

Rupture of the penis.

Abstract: A case of acute penile rupture in a 32-year-old man is reported. The treatment was non-surgical. The symptoms subsided and sexual function was restored to normal within 8 weeks. The aetiology, pathology and symptomatology of penile rupture and the therapeutic possibilities are briefly surveyed. Language: en

Serum hormone levels in benign prostatic hyperplasia.

Abstract: The peripheral serum levels of FSH, LH, testosterone and total estrone (sum of free + conjugated estrone, mainly estrone sulphate) were determined in 20 patients with benign prostatic hyperplasia (BPH) aged 59-79 years and in 49 healthy men aged 58-79 years. There were no significant differences in the levels of FSH, LH and testosterone. The level of total estrone was significantly higher in the BPH group (p<0.05). The results are in accordance with our previous study on the urinary estrogen excretion in BPH and give additional support to the hypotheses concerning a role of the estrogens in the etiology of BPH.

The margin to incontinence after three types of operation for stress incontinence.

Abstract: Three of the most widely used operations for stress incontinence--urethropexy ad modum Marshall-Marchetti-Krantz, pubococcygeal repair according to Ingelman-Sundberg and the Zoedler sling operation--were studied concerning urodynamic results Simultaneous urethrocystometry with recording of the urethral pressure profile was used to quantify postoperative continence The urethral pressure profile at rest, the transmission of pressure from abdomen to urethra and the efficiency of the smooth muscle in the urethral wall and its supporting tissues in a dynamic situation were compared with preoperative findings Equally good results were obtained with the Marshall-Marchetti-Krantz and the Ingelman-Sundberg operation, which improved pressure transmission

The effect of alpha-adrenergic stimulation in stress incontinence.

Abstract: The urethra is innervated by adrenergic fibres and its smooth muscle is equipped mainly with alpha-adrenoreceptors. Norephedrine chloride, which is an alpha-stimulating agent, has been proposed as therapy for stress incontinence, since it was shown to increase the maximum urethral pressure at rest. For further study of the effect of norephedrine chloride on the urethal closure pressure at rest and in a dynamic situation, we examined ten severely stress-incontinent women before and after three weeks of treatment with this agent (100 mg by mouth twice daily). The urethral closure pressure at rest, between coughs of varied strength and at the precise moment of stress were recorded. The margin to leakage, the tone of the urethral wall and the transmission of pressure from abdomen to urethra were also among the estimated factors. No improvement was found in any of these respects. Alpha stimulation in this form therefore seems ineffective in severe stress incontinence and is not an alternative to surgical treat...

A new solution for initial perfusion of transplant kidneys.

Abstract: There is good evidence that blood should be removed from kidneys as completely as possible before they are transplanted. Rabbit kidneys, either freshly isolated or after one hour of warm ischaemia, were perfused with a solution of osmolality 400 mOsm/kg which contained high concentrations of Mg++ (72 mEq) and glucose (167 mM). The rate and completeness of blood removal were measured by collecting effluent fractions until 100 ml had been perfused, and then assaying the haemoglobin in each effluent fraction and the residual haemoglobin in the kidney. A pressure of 60 mmHg was found to be sufficient for effective perfusion. The addition of 5% dextran 40 (Rheomacrodex) to the perfusate greatly improved the completeness of blood removal from kidneys subjected to one hour of warm ischaemia. Rabbit kidneys washed out with this solution functioned excellently after transplantation.

Secondary Hyperparathyroidism Combined with Uremia and Giant Cell Containing Tumor of the Cervical Spine

Abstract: A 47-year-old woman with chronic pyelonephritis since 1950 was prepared for hemodialysis or kidney transplantation. Investigation disclosed secondary hyperparathyroidism and an osteolytic lesion in C VII and Th I causing a subluxation. There were minor neurological symptoms and apparent risk of luxation of the cervical spine with resulting injury to the spinal cord. Operation was performed with total parathyroidectomy and excision of the bone tumor, followed by fixation of the cervical spine with bone graft. There were no major complications during the postoperative period and the patient was mobilized four months after the operation.

The use of dimethyl-sulfoxide (DMSO) in the treatment of interstitial cystitis.

Abstract: Dimethyl-sulfoxide (DMSO) was used in 17 patients with interstitial cystitis. The diagnosis was made on the basis of clinical and laboratory findings and the characteristic picture with Hunner ulcera. The majority of the patients had responded poorly to other forms of conservative treatment. Subjective symptoms were controlled in 2/3 of the cases but repeated treatment was needed and 5 patients did not respond to the therapy. The DMSO treatment is an alternative worth to try and has in some cases a dramatic and lasting effect.

Treatment of Prostatic Carcinoma with Cyproterone Acetate

Abstract: Sixteen patients with prostatic carcinoma were treated with 200 mg of Cyproterone acetate daily. No other kind of hormonal treatment was administered. Increasing skeletal metastases were observed in 6 patients. whereas significant reduction of metastases took place in 2 patients. Objective relief of stranguria was observed only in 3 patients. The amount of residual urine increased in 3 patients and was reduced in 5. In about one third of the patients, the prostate gland became smaller and softer. The acidic phosphatases decreased from pathological to normal values in 7 patients. There were no observed hepatic, renal or haemotological side-effects. However, serious cardio-vascular complications occurred in 6 patients, while arterial hypertension developed in 4. It is suggested that Cyproterone acetate cannot be recommended as the only kind of hormonal treatment of prostatic cancer.

Electrolyte distrubances after jejunal conduit urinary diversion.

Abstract: The use of jejunum in conduit urinary diversion may lead to electrolyte disturbances, characterized by hyponatremia, hypochloremia, hyperkalemia, acidosis, and azotemia, and a clinical picture of nausea, vomiting, dehydration, anorexia, and lethargy. Four out of six patients deviated with a jejunal loop developed this syndrome, the cause of which is discussed. It is concluded that the use of jejunum in urinary diversion should be avoided.

Isolated FSH deficiency in a male. A case report.

Abstract: This report describes the case of a 26-year-old man investigated because of infertility. The patient appeared healthy with normal sexual activity, physical appearance and karyotype. Repeated semen analyses showed a marked oligozoospermia. A testicular biopsy specimen revealed arrested spermatogenesis and normal Leydig cells. Hormone analyses were normal except for a markedly reduced serum FSH level. Only a few such cases have been previously reported.

Renal allograft rupture.

Abstract: In the present material of 448 consecutive renal transplants the incidence of allograft rupture was 3.6%. Among 389 first transplants there were two ruptures in the living donor group (126 patients...

Treatment of urgency by instillation of emepronium bromide in the urinary bladder.

Abstract: The possibility of a purely local action of intravesically instilled emepronium bromide (Cetiprin®) was investigated. Subjective reports and simultaneous urethrocystometry were used to assess such effect. In order to ascertain the purely local nature of effect, the serum was analyzed for freely circulating emepronium ion at increasing intravesical concentrations. No adverse effects were found at the highest dosage (100 mg in 100 ml saline solution), and the concentrations in serum were very low or were not detectable. The seemingly promising influence on micturition frequency and urge prompted a double-blind study of 20 patients with chronic urgency. In ten of them 100 mg emepronium bromide in 100 ml saline solution was instilled intravesically, while the other ten received only the same volume of saline solution. The symptoms were relieved in eight of the ten patients given emepronium bromide. The observation time was one week. The therapeutic possibilities were further evaluated in 24 women with frequen...

Ultrastructural characteristics of human renal cell carcinoma in relation to the light microscopic grading.

Abstract: Twenty-two consecutive cases of renal adenocarcinoma were graded histologically according to the nuclear structure of the tumor cells. The ultrastructural characteristics of these tumors were then evaluated and the findings were compared with the results of the nuclear grading. No ultrastructural characteristic was found which would have been specific for either Grade I, II, III or IV carcinomas. There was no ultrastructural features that could have been used as a basis for malignancy grading. The results show that electron microscopy has nothing to add to the nuclear grading system of renal adenocarcinoma and the value of this grading system is to be emphasized.

Thrombus formation in the artificial kidney. Platelet and fibrin(ogen) content of experimental thrombi detected by radioisotope technique.

Abstract: In vitro studies in a “mini-Kiil” dialyser showed that, in spite of presumably adequate heparinization (2.5 IU/ml plasma), 51Cr-labelled platelets and 125I-labelled fibrin(ogen) deposited on membranes and blood lines, when freshly drawn human blood was dialyzed for 30 min. Platelet retention dominated, with a Cr/I ratio 3 times that of blood. Increasing the heparin concentration led to a reduction both of 51Cr- and 125I-activity, with a slight fall in the Cr/I ratio. Heparin was unable to prevent platelet retention in the dialyser, but the platelet aggregating effect of heparin was shown to be of minor importance compared to its anticoagulant activity and effect on thrombin induced platelet aggregation. Platelet retention by the blood lines exceeded that of the dialyser, in spite of a much smaller surface area. Differences in thrombogenicity between cuprophane and silicone rubber as well as different flow characteristics in the two situations were probably contributory. When heparinized tubing was used, t...

Autonomic receptor functions of the human ureter: an in vitro study.

Abstract: The autonomic receptor functions of ureteral smooth muscle were studied in vitro on strips of human ureter obtained at surgery. A dose-dependent, reproducible, contraction response to 5-hydroxytryptamine (Serotonin, 5-HT) was demonstrated. This response could be blocked by methysergide. Responses to acetylcholine and to drugs stimulating adrenergic receptor functions were also found, but they were weak and inconsistent. This suggests that contraction of ureteral smooth muscle is mediated through receptors which are sensitive to 5-hydroxytryptamine.

Renal transplantation in polycystic kidney disease.

Abstract: Thirty-one renal transplantations were performed in 25 patients with end-stage polycystic disease of the kidneys. Of the 14 recipients transplanted with both polycystic kidneys in situ and followed for at least 6 months, 10 had a previous history of urinary tract infection. Four of these 14 recipients had relapsing urinary tract infection after transplantation, the other 10 have been at risk on immunosuppressive therapy for a total of 152 months and have had no trouble that could be attributed to the presence of the polycystic kidneys. Despite the potentiality of polycystic kidneys to be a source of post-transplant infection when left in situ, a good outcome of renal transplatation could be achieved without preparative bilateral nephrectomy. The one-year patient and graft survivals are comparable to those obtained in our total transplantation series and renal transplantation is considered to be an acceptable therapy in polycystic disease.

Degree and course of skeletal demineralization in patients with chronic renal insufficiency

Abstract: To Study the degree and course of skeletal demineralization in patients with chronic renal failure gamma-ray bone densitometry of the radius was performed (1) in a cross-sectional study of 88 uremic patients and (2) in a longitudinal study over 13.5 months in 26 of these patients. The results were compared to measurements of bone mineral content/width (BMC/W) in 191 normal adults. Furthermore to evaluate the importance of calcium-metabolic changes in skeletal demineralization of uremic patients measurements of serum ionized calcium (Ca++), phosphate, alkaline phosphatase, immunoreactive parathyroid hormone (i-PTH), intestinal calcium absorption, skeletal X-ray and 99mTechnetium-polyphosphate bone scintigraphy were performed in the majority of the patients. An accelerated bone loss (mean 3.1% per year) was demonstrated in uremic patients together with a significant reduction in BMC/W. The duration of uremia was correlated with the BMC/W values, whereas dialysis treatment as such did not affect BMC/W. The m...

Double vas deferens and epididymis associated with ipsilateral renal agenesis simulating ectopic ureter opening into the seminal vesicle.

Abstract: A 26-year-old man presented clinical, radiographic and, at operation, macroscopic signs of an ectopic opening of the left ureter into the seminal vesicle and agenesis of the left kidney. However, histological examination of the surgical specimen revealed that the supposed ureter was actually a vas deferens, and the structure removed from the renal site showed a histological composition like that the epididymis. The anomaly observed was thus a retroperitoneal duplication of the vas deferens and epididymis and failure of development of the ipsilateral kidney and ureter.

Refluxing Ureteral Stump

Abstract: Two cases are presented of reflux into a residual ureter causing recurrent urinary tract infection. A voiding cysto-urethrogram should be included in the investigative routines when nephrectomy for unilateral chronic pyelonephritis is planned. If severe reflux is seen, the entire ureter should be removed along with the kidney.

Effects of terbutaline and isoproterenol on hyperkalemia in nephrectomized rabbits.

Abstract: Terbutaline, an adrenergic beta2-receptor-stimulating substance, resembled isoproterenol in its hypokalemic effect on rabbits made hyperkalemic by nephrectomy three days prior to the experiments. Both agents lowered the serum potassium values. The duration of the terbutaline effect was longer and had less influence on the cardiovascular system than had isoproterenol.

Comparison of radiological measurement and actual size of ureteral calculi.

Abstract: 100 ureteral calculi were measured on X-ray films and directly on the stone after passage or removal. The largest diameters were compared. The size of the stone was radiologically overestimated for 59 stones, correct for 26 and underestimated for 15. 73 of the stones were radiologically measured within +/-25% of the actual size.