bluuebunny/crossref_metadata_2025 huggingface dataset:
Autologous Renal Transplantation with Direct Pyelocystostomy in the Treatment of Recurrent Renal Calculi
Authors: PETTERSSON S. , BRYNGER H. , HENRIKSSON Ch. , NILSON A. E. , RANCH T.
Published: November 2008

Summary— Six male patients with severe recurrent urinary calculus disease underwent renal autotransplantation with direct pyelocystostomy to allow spontaneous passage of stones. The only serious complication was an early renal vascular thrombosis with graft loss in one patient who had been operated on three times before with ipsilateral partial resections for nephrolithiasis. The other five patients did well (observation time 4–34 months). Their renal function has remained unchanged.

Autotransplantation with direct pyelocystostomy should be considered in patients with multiple recurrent stones of the upper urinary tract, especially when some degree of obstruction has developed or when other predisposing anomalies prevail.
The Effect of Oral Acetohydroxamic Acid on Urinary Saturation in Stone‐forming Spinal Cord Patients
Authors: BURR R. G. , NUSEIBEH I.
Published: November 2008

Summary— Chronic urinary infection is thought to be a major factor in the causation of urinary calculi in paraplegic patients. Acetohydroxamic acid is reported to be effective in some patients for the management of this type of stone disease, but there have been no studies of urinary saturation levels during therapy with this drug.

In this study 10 patients received oral acetohydroxamic acid for seven days. Marked lowering of urinary pH and ammonium levels were observed, but decreases in urinary saturation were small. The administration of acetohydroxamic acid resulted in increased urinary excretion of magnesium and phosphate, effects that have not previously been reported.
Inverted Papilloma of the Upper Urinary Tract
Authors: WATTERS G. , GRANT A. , WILEY S. , KNEALE K. , MITTERDORFER A.
Published: November 2008

Summary— The authors describe a case of inverted papilloma of the renal pelvis. This case is compared with the 11 cases of inverted papilloma of the upper urinary tract previously described.
Isolated Ileal Loop Augmentation of Existing Ileal Conduit
Authors: KIRBY R. S. , BULTITUDE M. I. , LLOYD‐DAVIES R. W.
Published: November 2008

Summary— A new method of stomal revision in an existing ileal conduit is described. Two cases are reported in which the procedure was a success. It is suggested that ileal loop augmentation of an existing ileal loop may serve, in selected cases, as a useful alternative to complete conduit reconstruction.
Changes in the Mucosa of Colon Conduits with Particular Reference to the Risk of Malignant Change
Authors: MOORCRAFT J. , DuBOULAY C. E. H. , ISAACSON P. , ATWELL J. D.
Published: November 2008

Summary— Intestinal suction biopsies were obtaineid in 15 infants and children with cutaneous colo‐ureterostomies. The patients were subdivided into groups according to the length of time the conduit had been established, i.e. less than 5 years, 5 to 10 years, 10 to 15 years and over 15 years. The histological changes found were chronic inflammation with a dense infiltration of plasma cells and eosinophils. The changes were progressive and correlated with the length of time the conduit had been established. As persistent chronic inflammation is a precursor of malignancy, it seems likely that there is a risk of malignant change in these conduits. Regular follow‐up of such patients is recommended and should include flexible fibreoptic endoscopy of the conduit.
The Incidence and Significance of Vaginal Metaplasia of the Bladder Trigone in Adult Women
Authors: LONG E. D. , SHEPHERD R. T.
Published: November 2008

Summary— One hundred and six bladders were removed at autopsy from adult women dying of diseases unrelated to the urinary tract. A fixative solution had been introduced into the bladder as soon as possible after death. The naked‐eye appearances were recorded before and after application of Lugol's iodine solution and the trigones then submitted to histological examination. Vaginal metaplasia of the trigone was present in the majority (72%) of bladders, a similar incidence being found in both pre‐menopausal and post‐menopausal age groups. Histological evidence of chronic inflammation was found significantly more frequently in bladders showing vaginal metaplasia and it is suggested that vaginal metaplasia is not a consequence of chronic inflammation but that its surface characteristics may predispose to chronic infection. Its purported hormonal aetiology does not explain all observed features. Prominent venous channels within the tunica propria around the urethral orifice were a constant feature in all bladders studied. Two of the 76 bladders showing vaginal metaplasia also displayed atypical hyperplasia of this squamous epithelium, a previously unrecorded observation. The possible implications of such atypical hyperplasia are briefly discussed.
Distigmine Bromide and Post‐Prostatectomy Voiding
Authors: SHAH P. J. R. , ABRAMS P. H. , CHOA R. G. , ASHKEN M. H. , GACHES C. G. C. , GREEN N. A. , WILES ANN
Published: November 2008

Summary— Distigmine bromide (Ubretid) is a long‐acting anticholinesterase which is thought to improve detrusor function, restoring normal voiding patterns which may have been disturbed by autonomic overactivity, particularly after surgery.

Ninety‐three patients entered a double‐blind study of the effect of distigmine bromide versus placebo on voiding after prostatectomy. The results demonstrated that there was a trend towards improvement but no statistically significant increase in post‐operative flow rates, in reduction in bladder volume, and in the incidence of re‐catheterisation in the patients treated with distigmine bromide.
Vasoplasty: Flap Operation
Authors: SINGH H. , SHARMA BHARTI
Published: November 2008

Summary— Vasoplasty was performed in 40 cases by the flap technique; the patency rate was 79% and the pregnancy rate 34%. The method produced acceptable results almost as good as those achieved by microsurgery but without the need for expensive apparatus and long training.
Placebo—the Drug of Choice in Female Motor Urge Incontinence?
Authors: MEYHOFF H. H. , GERSTENBERG T. C. , NORDLING J.
Published: November 2008

Summary— In a randomised double‐blind cross‐over trial of 19 females with motor urge incontinence but without bladder suspension defect, the effects of 14 days' treatment with emepronium bromide 200 mg qid, flavoxate chloride 200 mg qid or placebo qid were compared by means of micturition charts, the patients' drug preferences and evaluation of side effects.

Placebo was the only drug giving rise to a statistically significant decrease in the frequency of voidings, incontinence and nocturia. Forty‐seven per cent of the patients preferred placebo and side effects were less frequent during treatment with this medication. No differences could be demonstrated between the effects of emepronium bromide and flavoxate chloride.

Perhaps detrusor instability is not always the main reason for the voiding dysfunction in these patients, in whom the effect of placebo was equal or superior to the effect of “active drugs” and superior to no treatment at all.
Blood Concentration of Lignocaine after Application of 2% Lignocaine Gel in the Urethra
Authors: AXELSSON K. , JOZWIAK H. , LINGÅRDH G. , SCHONEBECK J. , WIDMAN B.
Published: November 2008

Summary— In 35 patients undergoing topical anaesthesia with lignocaine (lidocaine) get (2% Xylocaine gel) the concentration of lignocaine base was measured in repeated venous blood samples. Twenty patients (group I) were given 20 ml of 2% lignocaine gel (400 mg lignocaine) and 5 patients (group II) received 40 ml (800 mg lignocaine) endourethrally. These 2 groups of patients underwent either dilatation of the urethra or urethrocystoscopy. Ten patients (group Ill), undergoing transurethral resection of the prostate or a bladder tumour, were given 20 ml of gel (400 mg lignocaine) plus spinal anaesthesia with 2 ml of 5% lignocaine (100 mg lignocaine) with 7.5% glucose (Xylocaine “heavy”).

The mean peak blood concentrations of lignocaine in these 3 groups were 0.06, 0.15 and 0.36 μg/ml respectively. Patients undergoing urethral dilatation had significantly higher blood concentrations than cystoscopy patients. The blood concentrations in group III were not higher than the expected value when spinal anaesthesia and lignocaine gel were given simultaneously. There was no statistically significant difference in the blood concentration between patients undergoing different types of transurethral resection (prostate and cancer of the bladder).

Lignocaine applied endourethrally gives an extremely low blood concentration which is far below the level which can cause general toxic symptoms.
Fluphenazine/Nortriptyline in the Irritable Bladder Syndrome. A Double‐blind Placebo Controlled Study
Authors: Martin M. R. , Schiff A. A.
Published: November 2008

Summary— A double‐blind, placebo controlled, randomised order crossover study was carried out on the effect of Motival (0.5 mg fluphenazine with 10 mg nortriptyline) 3 times daily on the bladder function and psychiatric morbidity of 13 women without evidence of infection, complaining of recurrent dysuria and frequency. Bladder function was assessed symptomatically and by ambulatory urodynamics, and patients completed the General Health Questionnaire, a validated instrument for the detection of psychiatric disturbance.

Correction of the urodynamic abnormalities was associated with Motival treatment in 5 of the 8 patients with unstable bladders, compared with none of 7 patients receiving placebo (P < 0.02). Motival was also associated with a greater frequency of symptomatic improvement. Only 2 patients were classified as psychiatrically disturbed, suggesting that the therapeutic effect of Motival is not related to its psychotropic properties.
Removal of Retained Urinary Catheters
Authors: Chin P. L. , Singh R. K. , Athey G.
Published: November 2008

Summary— In a 1‐year register, retained urinary catheters were encountered on 23 occasions. ln vitro tests showed that 2 ml of ether or chloroform injected through the inflation channel of catheter balloons caused disruption within a few seconds but liquid paraffin took over 20 min, leaving an unacceptable amount of debris. A new method of removal using diagnostic ultrasound to identify the balloon of the retained catheter is described, together with suggestions for removal of retained catheters occurring under different circumstances.
The Meatal Problem with TUR Prostate: the Value of Post ‐ operative Self ‐ dilatation
Authors: Walton J. K. , Wright W. L. , Robinson R. G. , Nacey J. N.
Published: November 2008

Summary— In a preliminary retrospective study, we found that 37% of patients about to undergo a transurethral resection of the prostate had an external meatus too small to admit a 26 F resectoscope sheath.

In a prospective study, a formal meatotomy was compared with an Otis urethrotomy for patients with narrow meatus. This study was stopped because 71% of cases having a meatotomy developed strictures compared with 29% having an internal urethrotomy.

In a further study of 59 patients, regular self ‐ dilatation of the meatus with a plastic spigot was compared with internal urethrotomy of the meatus alone. Seven per cent of cases having self ‐ dilatation developed strictures compared with 34% having internal urethrotomy.

It was concluded that in those patients with a narrow external meatus meatotomy should not be carried out, but self ‐ dilatation following internal urethrotomy greatly reduces the incidence of meatal strictures.
Radioimmunoassay for Prostatic Acid Phosphatase in Early Prostatic Carcinoma
Authors: Samuell C. T. , Morgans B. T. , O'Donoghue E. P. N.
Published: November 2008

Summary— A radioimmunoassay procedure has been used to measure prostatic acid phosphatase in the serum of 46 patients with intracapsular carcinoma of the prostate. The results obtained did not differ significantly from those obtained in a control group of similar size. It is concluded that the radioimmunoassay procedure for measurement of prostatic acid phosphatase has no advantage over enzyme activity measurements for the detection of early prostatic carcinoma.
Urinary Tract Undiversion
Authors: Sheehan S. J. , Duff F. , Guiney E. J. , Kelly D. G. , Smith J.
Published: November 2008

Summary—
Nine children underwent urinary diversion for lower urinary tract obstruction and were followed for periods of 2.5 to 15 years (median 10 years). Eight had cutaneous ureterostomies and the ninth had an ileal conduit. Undiversion was performed because of the return of normal function, the possibility of renal transplantation and ileal conduit stomal obstruction.

The patients have been followed for periods ranging from 6 months to 9 years (median 2.5 years) after undiversion. To date, eight have moderate to good renal function. The remaining child has progressive renal failure. Eight are continent and one has mild stress incontinence.
Microvascular Surgical Orchiopexy in the Treatment of High‐lying Undescended Testes
Authors: Garibyan H. , Hazebroek F. W. J. , Schulkes J. A. R. , Molenaar J. C. , Dabhoiwala N. F.
Published: November 2008

Summary—
Extensive laboratory experiments in animals have led us to believe that autotransplantation of the testis in the human is feasible. To date, nine of our patients (aged 4–13 years) with undescended intra‐abdominal testes have undergone autotransplantation. Using a microvascular surgical technique to anastornose the testicular vessels to the inferior epigastric vessels, it has been possible to place the testis in a scrotal position in every case. No postoperative complications have been noted. Follow‐up varied from 9 to 18 months and no atrophy of the testis was observed in this period. Doppler investigations on all of the transplanted testes continue to demonstrate good arterial flow. The aim of surgery on the undescended testis is not only to increase the chances of fertility and to diminish the possibility of malignant transformation but also, more importantly perhaps, to prevent possible abnormal psychosexual development in the child.
The Natural History of Ureteric Bilharzia
Authors: NAUDE J. H.
Published: November 2008

Summary— A prospective study of apparent obstruction of the ureter by Bilharzia was undertaken.

Over a 2‐year period, 130 patients with active Bilharzia and 58 patients with inactive or chronic Bilharzia, all of whom had apparently obstructive lesions of the ureter, were studied.

Ureteric lesions were examined for true mechanical obstruction by post‐micturition erect radiography, erect diuresis renography and, in selected cases, by perfusion pressure flow studies.

Of the 130 patients with active Bilharzia, 32 ureters were found to be mechanically obstructed and in each case the obstruction resolved with anti‐bilharzial medication.

Of the 58 patients with chronic or inactive lesions, only 5 ureters were found to be truly obstructed and required surgery.

It is concluded that surgery is unnecessary for ureters obstructed by active Bilharzia within 2 months of starting treatment because the obstruction will resolve in most patients. In the so‐called chronic bilharzial stricture, obstruction is more apparent than real and thorough investigation will save many patients from unnecessary surgery.
Urological Problems Following Treatment of Carcinoma of the Cervix
Authors: JONES C. R. , WOODHOUSE C. R. J. , HENDRY W. F.
Published: November 2008

Summary— One thousand one hundred and sixty‐one cases of carcinoma of the cervix presenting over a 20‐year period to 1982 were considered: 326 (28%) of these women developed urological problems, of whom 82 (7%) had major complications. Fistula formation occurred in 46 cases (4%), and was associated with active malignant disease in 33. Significant progressive ureteric obstruction occurred in 15 patients, 11 of whom had active malignancy. Overall, 35 (43%) of 82 patients with major urological problems had no evidence of active disease.

Urinary diversion by ileal conduit proved to be a relatively simple and effective way of dealing with the serious problems, especially for patients with fistula formation and progressive ureteric obstruction, 67% and 73% of whom, respectively, underwent this procedure. More complex reconstructive surgery proved successful in a small number of selected patients, in whom there was no evidence of active tumour. Attempts to compromise with less definitive or over‐ambitious procedures resulted in further complications and prolonged hospitalisation.
A 15‐Year Follow‐up of 406 Consecutive Spinal Cord Injuries
Authors: WEBB D.R. , FITZPATRICK J. M. , O'FLYNN J. D.
Published: November 2008

Summary— 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.
Stamey Endoscopic Bladder Neck Suspension for Stress Incontinence
Authors: ASHKEN M. HANDLEY , ABRAMS P. H. , LAWRENCE W. T.
Published: November 2008

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.
Choosing the Right Intravesical Chemotherapeutic Agent. Results of an In vitro Monolayer Cell Culture Assay
Authors: WHELAN P. , FLYNN C. , RAMSDEN C.
Published: November 2008

Summary— The use of a monolayer cell culture technique is described. Twenty‐four superficial bladder tumours have been tested against Thiotepa, Adriamycin and Mitomycin C. Cultures were set up in parallel for a clonogenic assay after the method of Salmon. In the monolayer all 24 tumours grew; 21 showed a greater than 50% inhibition to Mitomycin, 13 to Adriamycin and 6 to Thiotepa. In the clonogenic assays, only 12 grew satisfactorily. It is concluded that this monolayer assay gives a reasonable prediction of the sensitivities of the commonly used intravesical agents.
Intravesical Methotrexate in the Treatment of Superficial Bladder Cancer
Authors: SMITH G. , THEODOROU C. , FIELD G. , HARGREAVE T. B. , CHISHOLM G. D.
Published: November 2008

Summary— Thirty patients with superficial bladder cancer (Tis, Ta, TI) difficult to control by endoscopic means were given a total of 49 courses of methotrexate at fortnightly intervals. Four concentrations were investigated. In 14 courses this was the sole treatment and in the remainder the methotrexate was given as prophylaxis. Toxicity was not a problem but in both groups, although there was some evidence of anti‐tumour activity, there were high recurrence rates and intravesical methotrexate cannot be recommended.
Carcinoma of the Prostate of Ductal Origin
Authors: LEMBERGER R. J. , BISHOP M. C. , BATES C. P. , BLUNDELL WENDY , ANSELL I. D.
Published: November 2008

Summary— Thirty‐nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate‐specific antigen in all ductal carcinomas.
Urethral Stricture Following Cardiac Surgery: a Prospective Study
Authors: FERRIE B. G. , SETHIA B. , McLEOD M. , GRAY C. , KIRK D.
Published: November 2008

Summary— A prospective study was undertaken to assess the incidence of urethral stricture in 105 men undergoing coronary artery by‐pass grafting. A pre‐operative urological history was taken and peak urine flow rates measured before surgery, and 1 week and between 6 and 8 weeks after operation. All patients were catheterised in theatre with a standard type and size of urethral catheter and details recorded of the by‐pass time and the degree of hypothermia. Postoperative urological problems such as urethral discharge and haematuria were noted. In addition, 100 patients completed a postal questionnaire about urinary symptoms between 4 and 12 months after surgery. The overall incidence of urethral stricture was 2%.
Urodynamic Evaluation of Bladder Neck Obstruction in Chronic Prostatitis
Authors: MURNAGHAN G. F. , MILLARD R. J.
Published: November 2008

Summary— Urodynamic assessment was performed in 50 patients with symptoms which supported a diagnosis of chronic prostatitis and commonly suggested outflow obstruction. Twenty‐three patients had bladder instability with an equal incidence with or without obstruction; this was demonstrated in 30 patients and was localised to the bladder neck in 24 and to the prostate in 6. A sensory problem presented on urodynamic testing in 26 patients (52% of the entire series), with a lower incidence (43%) in the obstructed group.

Posterior urethritis was found in 28 (78%) of 36 patients subjected to cystourethroscopy. Endoscopic findings were suggestive of obstruction in 20 (95%) of 21 patients with urodynamic evidence of outflow obstruction and the sites of obstruction generally corresponded. The studies have provided urodynamic evidence that bladder neck obstruction could be a significant though not a predominant factor in the aetiology of the clinical syndrome of chronic prostatitis.
Selection of Patients For Implantation of the Brantley Scott Artificial Urinary Sphincter
Authors: MUNDY A. R. , STEPHENSON T. P.
Published: November 2008

Summary— The Brantley Scott artificial urinary sphincter (AUS) is a safe, effective and relatively trouble‐free device for the control of sphincter weakness incontinence. Suitable patients should have no other urodynamic dysfunction or have had such a dysfunction corrected or controlled.

Patients with post‐prostatectomy incontinence pose no problems in selection, although as a group they are the most prone to develop complications.

Pure stress incontinence does not warrant implantation of an AUS except in very rare instances.

In neuropathic dysfunction the AUS is one of several treatment options for the correction of incontinence and is most effectively used as such.

In all patients, thorough pre‐operative videourodynamic evaluation is essential to get the best results and therefore to justify the infective and mechanical risks and the expense of the device.
Maldescended Testes and Fertility: a Review of 68 Cases
Authors: HARGREAVE T. B. , ELTON R. A. , WEBB JENNIFER A. , BUSUTTIL A. , CHISHOLM G. D.
Published: November 2008

Summary— We report an analysis of 68 of 1112 couples who attended an infertility clinic where the man had past or present evidence of testis maldescent. The age at orchiopexy for these 68 men was later than would be expected, taking into account surgical practice in Scotland for the relevant time period and this supports the view that late orchiopexy is a risk factor for subsequent infertility. There was no evidence that antisperm antibodies are responsible for the damage to spermatogenesis in unilateral cases; however, measurement of the serum hormones showed elevations of LH and FSH which cannot be entirely explained as secondary to the damaged spermatogenesis. There was weak but nevertheless significant evidence that testis maldescent may be a poor prognostic factor as far as subsequent fertility is concerned and that this is independent of the length of time the couple have been trying and the man's motile sperm density. In two men there was intra‐abdominal undescent and both were found to have testis tumours; we would reemphasise that abdominal exploration is mandatory in such cases.
Germinal Aplasia: How it May Mimic Obstructive Azoospermia
Authors: JEQUIER ANNE M. , ANSELL I. D. , BULLIMORE N. J.
Published: November 2008

Summary— Six patients with azoospermia due to germinal aplasia are described. It is demonstrated that germinal aplasia may be mistakenly diagnosed as azoospermia due to ductal obstruction.
Aetiological Factors in the Production of Obstructive Azoospermia
Authors: JEQUIER ANNE M. , HOLMES S. C.
Published: November 2008

Summary— From a group of 749 infertile men, 102 (13.6%) were found to have obstructive azoospermia. An attempt is made to ascribe an aetiology to these obstructive lesions. In more than half of these patients, no cause for their obstructive lesion could be elicited. Only five gave a past history of gonorrhoea, and genital tract infection related to only eight patients. The disorder now most frequently associated with obstructive azoospermia is chronic respiratory disease. It is suggested that the aetiology of obstructive azoospermia has changed in recent years.
Clinicopathological Features of Retroperitoneal Tumours
Authors: PARKINSON M. CONSTANCE , CHABREL C. M.
Published: November 2008

Summary— The clinicopathological features of 49 neoplasms in the retroperitoneum, but not arising directly from a major retroperitoneal organ, are described. Abdominal pain and a mass, urinary tract symptoms and evidence of pressure on venous channels or nerves were common modes of presentation. In 6 cases the neoplasms were found incidentally and in 4 patients removal of the retroperitoneal mass was an elective procedure during the treatment of metastatic testicular germ cell tumour. Histopathological diagnosis revealed 4 major tumour types: germ cell neoplasms, non‐germ cell metastatic carcinoma, soft tissue sarcoma and lymphoma. The differential diagnoses are discussed. A knowledge of the neoplasms to be expected in this site may indicate which pre‐operative investigations should be undertaken.
Scanning Electron Microscopy of Human Bladder Mucosa in Acute and Chronic Urinary Tract Infection
Authors: ELLIOTT T. S. J. , SLACK R. C. B. , BISHOP M. C.
Published: November 2008

Summary— The morphological response of the bladder surface to acute and chronic urinary tract infection (UTI) was investigated using both scanning and transmission electron microscopy of bladder biopsies taken during routine cystoscopy. Acute bacterial infection only minimally altered bladder epithelium, whereas in chronic infections the surface layers showed gross changes which included loss of the outer layers of epithelial cells and alteration of the bladder contour. In addition, more erythrocytes and polymorphonucleocytes were present in chronic infection. In both acute and chronic urinary infection, bacteria were confined to a limited number of sites on the bladder surface and appeared to be arranged in microcolonies, but more bacteria were attached to bladder surfaces in chronic than in acute UTI. These findings were confirmed by studying epithelial cells shed from patients with proven urinary infections.

A few patients who had been treated with antibiotics before cystoscopy and biopsy were also studied. These antibiotics included cephalosporins which had been previously shown to produce bacterial morphological variations in vitro. Some of these changes were subsequently observed in the biopsies and the results suggest mechanisms whereby bacteria involved in urinary tract infection can survive exposure to antibiotics.
Sexual Function in Prostatic Cancer Patients Treated with Radiotherapy, Orchiectomy or Oestrogens
Authors: BERGMAN B. , DAMBER J.‐E. , LITTBRAND B. , SJÖGREN K. , TOMIĆ R.
Published: November 2008

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.
Allopurinol Treatment of Renal Calcium Stone Disease
Authors: FELLSTRÖM B. , BACKMAN U. , DANIELSON B. G. , HOLMGREN K. , JOHANSSON G. , LINDSJÖ M. , LJUNGHALL S. , WIKSTRÖM B.
Published: November 2008

Summary— Thirty‐one calcium stone patients were treated with 300 mg allopurinol daily during a mean follow‐up period of 2 years. They were also given advice on diet and fluid intake. The effects on the recurrence rate of stones were compared with the effects on the recurrence rate in 43 calcium stone patients who were given similar advice on diet and fluid intake but were not treated with allopurinol. In both groups there was a reduction in the recurrence rate but no difference between patients treated with allopurinol and the control group. Some patients with only hyperuricosuria prior to treatment seemed to benefit from allopurinol treatment, whereas those with hypercalciuria continued to form stones with the same frequency. Allopurinol treatment in calcium stone disease appears less effective than treatment with thiazides, magnesium hydroxide or orthophosphate.
Selection of Operative Procedure for Circumcaval Ureter (Type I): A Rational Approach
Authors: KUMAR SANTOSH , BHANDARI M.
Published: November 2008

Summary— The surgical treatment of circumcaval ureter (type I) should eliminate the ureteric obstruction which is of variable causation. At operation, the aetiology of the obstruction can be determined by inspection of the extent of ureteric dilatation, perfusion‐pressure study and calibration of the lumen. Using this approach, the cause of the obstruction was found to be non‐stenotic intrinsic obstruction of the retrocaval segment in two cases of type I circumcaval ureter. In these patients, resection of the obstructing segment and uretero‐ureterostomy were carried out. The third patient had pelviureteric junction stenosis which was treated by dismembered pyeloplasty after ureteric relocation.
Survey of Antibiotic Prophylaxis in British Urological Practice
Authors: WILSON N. I. L. , LEWI H. J. E.
Published: November 2008

Summary— Guidelines for the use of prophylactic antibiotics to cover operative procedures on the urinary tract have been suggested, but the extent to which these have been adopted into routine practice has not been assessed.

This survery documents the use of prophylactic antibiotics in urological surgery in Britain. It demonstrates that awareness of the potential role of antibiotic prophylaxis is increasing. Most urologists now adopt a selective approach in the use of prophylactic agents.
Biochemical Studies in Paraplegic Renal Stone Patients: 2. Urinary Excretion of Citrate, Inorganic Pyrophosphate, Silicate and Urate
Authors: BURR R. G. , NUSEIBEH I. , ABIAKA C. D.
Published: November 2008

Summary— The urinary excretions of citrate, inorganic orthophosphate and pyrophosphate, silicate and urate were measured in 17 paraplegic patients with renal calculous disease associated with urinary infection, in 16 paraplegics with no history of urinary calculus and in 14 healthy control subjects.

The paraplegics excreted less citrate, orthophosphate and pyrophosphate than the control subjects. The stone‐formers excreted more urate than the paraplegics without stone disease, but less than the control subjects. There were significant positive correlations between urinary orthophosphate and pyrophosphate and between urinary silicate and 24‐ h urine volume.

The possible roles of increased urate and diminished excretion of citrate and inorganic pyrophosphate in the aetiology of renal calculosis in paraplegic patients deserve further investigation.
Long‐term Follow‐up, Further Experience with and Modifications of the Transverse Colon Conduit in Urinary Tract Diversion
Authors: SCHMIDT J. D. , BUCHSBAUM H. J. , NACHTSHEIM D. A.
Published: November 2008

Summary— In the past 6 years, an additional 22 patients with extensive pelvic irradiation have had their upper urinary tracts diverted employing the transverse colon conduit. Most procedures were performed with radical cystectomy following high dose radiotherapy in patients with bladder cancer or with pelvic exenteration for recurrent cervical cancer. The operative mortality rate was unchanged at 4%. Upper urinary tracts and renal function have remained stable or improved in 88 and 95% of patients respectively. Although most conduits were constructed with refluxing ureterocolic anastomoses and without stents, the more recent procedures have employed both antireflux submucosal tunnel anastomoses and stents.

Nineteen of 25 patients diverted by this method between 1970 and 1976 have been followed for up to 155 months. All patients with recurrent or persistent malignancy have died (mean survival 44 months). Seven patients (37%) are living and well (mean survival 104 months). Upper urinary tracts remain normal in two‐thirds of those with the longer follow‐up.

Major complications requiring additional surgery continue to occur in one‐third of this highly selected group of patients in whom the transverse colon conduit remains the preferred diversionary technique.
Cis‐platin and Methotrexate in the Treatment of Transitional Cell Carcinoma of the Urinary Tract
Authors: CARMICHAEL J. , CORNBLEET M. A. , MacDOUGALL R. H. , ALLAN S. G. , DUNCAN W. , CHISHOLM G. D. , SMYTH J. F.
Published: November 2008

Summary— Nineteen patients with recurrent or metastatic transitional cell carcinoma of the urinary tract were treated with a 3‐weekly combination of methotrexate 200 mg/m2 as a 24‐h infusion with folinic acid rescue and cis‐platin 100 mg/m2. An objective response rate of 68% was obtained, with 4 patients (21 %) achieving complete remission. Pulmonary disease and lymph node metastases were particularly sensitive to this therapy. The median duration of response was 21 weeks with a median survival of 54 weeks in the responding patients. This regimen warrants further investigation in the treatment of invasive bladder carcinoma.
Evaluation of the Efficacy of Oral Methotrexate in the Prevention of Recurrence of Superficial Bladder Tumours
Authors: MARCH J. L. NOGUEIRA , OJEA A. , FIGUEIREDO L. , JAMARDO D. , DIEZ E. , VILLANUEVA J. PEREZ
Published: November 2008

Summary— Twenty‐four patients with previously untreated TI transitional cell carcinoma of the bladder were treated with oral methotrexate 50 mg weekly for 18 months. Thirteen developed tumour recurrences (recurrence index 11 per 100 patient months at risk) and in one‐third of the patients treatment was stopped because of unwanted side effects. These results are no better than our previous experience with intravesical Adriamycin, thiotepa or cisplatin.
Catheter‐induced Urethritis: a Comparison Between Latex and Silicone Catheters in a Prospective Clinical Trial
Authors: NACEY J. N. , TULLOCH A. G. S. , FERGUSON A. F.
Published: November 2008

Summary— A controlled randomised prospective study has been carried out on 100 male patients to compare the incidence of urethritis following catheterisation with either latex or silicone catheters. All patients underwent elective cardiac surgery and were catheterised for 48 h with antibiotic cover, and were followed up for 6 months post‐operatively. Of those with latex catheters 22% developed urethritis, compared with 2% of those in the silicone catheter group. This difference is statistically significant (P < 0.01). Two of the former patients developed a decreased urinary flow and both had tight anterior urethral strictures.
Classification of Enlarged Prostatic Utricle in Patients with Hypospadias
Authors: IKOMA F. , SHIMA H. , YABUMOTO H.
Published: November 2008

Summary— An enlarged prostatic utricle is often associated with hypospadias. To evaluate the relationship between the incidence of prostatic utricle and the degree of hypospadias, we performed retrograde urethrography and/or micturating cystourethrography on 280 patients with hypospadias. Prostatic utricles were demonstrated in 84 patients (27.5%) and the incidence increased according to the severity of hypospadias. The prostatic utricles were classified into four types from the standpoint of size and location of the opening of the utricle, and a direct relationship was demonstrated between the severity of hypospadias and increasing size of the prostatic utricle.
Ureteric Obstruction Secondary to Appendicular Abscess Treated by Transuretero‐ureterostomy
Authors: HARTY J. I.
Published: November 2008

A patient with a right lower quadrant mass and hydronephrosis is described. At exploration the mass proved to be a chronic appendicular abscess which involved the ureter. The patient was managed by appendicectomy and transureteroureterostomy. The management of ureteric obstruction secondary to appendicular abscess is briefly discussed.
Polyarteritis Nodosa: an Unrecognised Cause of Fournier's Gangrene
Authors: DOWNING R. , BLACK J.
Published: November 2008

A local predisposing cause is frequently identified in Fournier's gangrene, but a systemic aetiology is rare. We therefore present a case of Fournier's gangrene occurring in association with polyarteritis nodosa.
Evaluation of Obstructive Uropathy in Children. 99m Tc‐DTPA Renography Studies under Conditions of Maximal Diuresis
Authors: SUKHAI R. N. , KOOY P. P. M. , WOLFF E. D. , SCHOLTMEIJEF R. J. , HEIJDEN A. J. VAN DER
Published: November 2008

Summary— Renographic studies under standardised conditions of maximal diuresis provoked by hypotonic saline infusion and frusemide were used in 17 patients with dilatation of the upper urinary tract in order to distinguish between obstructed and non‐obstructed urinary tracts. Of the six patients who were obstructed on clinical and X‐ray evidence only three showed an obstructed pattern on the renographic curves after maximal diuresis. After operation these three patients showed improvement in both renographic curve and functional images of the renal parenchyma. A new method of identifying the parenchymal area is described.
Thallium‐Technetium Subtraction Scintigraphy as an Aid to Parathyroid Surgery
Authors: PERCIVAL R. C. , BLAKE G. M. , URWIN G. H. , WILLIAMS J. L. , KANIS J. A.
Published: November 2008

Summary— We describe the application of thallium‐technetium subtraction scintigraphy in nine patients with failed previous parathyroid surgery or with tertiary hyperparathyroidism due to chronic renal failure. The technique successfully located all adenomas, but only 45% of hyperplastic glands. The series included three abnormal glands located retrosternally. The technique appeared to be more useful in patients with primary hyperparathyroidism than in tertiary hyperparathyroidism, possibly related to differences in gland mass. We conclude that this method of scintigraphy is a valuable adjunct to the management of patients with parathyroid disorders, particularly those requiring revision surgery.
A Physiological Approach to the Investigation of Chronic Urinary Retention
Authors: MACHIN D. G. , GARDNER B. P. , WOOLFENDEN K. A. , DESMOND A. D. , PARSONS K. F.
Published: November 2008

Summary— Twenty‐six male patients with chronic urinary retention were investigated by self filling cystometry, followed by fast filling cystometry.

Fast filling cystometry tended to increase the end filling pressure and to indicate a smaller bladder capacity than did self filling cystometry.

Inadequate filling of the bladder may lead to an unrepresentative detrusor voiding contraction and an incorrect diagnosis of detrusor failure.

Fast filling cystometry masks detrusor instability, which may be a factor producing upper tract dilatation and renal impairment.

It is suggested that chronic retention of urine should be investigated by self filling cystometry.
Patterns and Significance of the Sacral Evoked Response (the Urologist's Knee Jerk)
Authors: GALLOWAY N. T. M. , CHISHOLM G. D. , McINNES A.
Published: November 2008

Summary— Neurological examination may fail to demonstrate any abnormality in patients who have neurogenic bladder dysfunction. Standard clinical methods will include full examination of segmental nerves to the level of S1 but will not include the lower sacral segments which control sphincter function. We describe a simple method of measuring the integrity and function of these segments of the cord. The method and the common patterns of response are described. The stimulus is physiological (not supramaximal), the response is measured with surface mounted electrodes at the urethral and anal sphincters and each measurement is the average response after 100 stimuli.
The Undescended Testis in Adult Life
Authors: FORD T. F. , PARKINSON M. CONSTANCE , PRYOR J. P.
Published: November 2008

Summary— The management of the undescended testis in the adult patient presents problems in terms of locating the impalpable gonad, the risk of malignancy and prognosis with regard to fertility. CT scanning has been used to locate four intra‐abdominal testes. The risk of malignancy has been assessed by determining the incidence of carcinoma in situ after orchiectomy or testicular biopsy in 90 patients (112 testes). Carcinoma in situ was found in 4 of 16 abdominal, 3 of 44 inguinal and none of 52 scrotal testes following orchiopexy in childhood. Seventy per cent of undescended testes in adult patients had no evidence of spermatogenesis. This fact, together with the risk of malignancy in those testes in which germ cells are present, suggests that orchiectomy should be performed in unilateral cases, Testicular biopsy is essential if an undescended testis is to be preserved for androgenic function.
Malignant Fibrous Histiocytoma Involving the Bladder
Authors: TURNER A. G.
Published: November 2008

Malignant fibrous histiocytoma is a rare tumour (Mackenzie, 1975). It originates in the cells with the potential of forming histiocytes or facultative fibroblasts.
Percutaneous Coagulum Nephroithotripsy: a New Approach
Authors: HASUN R. , RYAN P. C. , WEST A. B. , FITZPATRICK J. M. , MARBERGER M.
Published: November 2008

Summary— Intrarenal scatter of stone fragments during percutaneous nephrolithotripsy is a complication which may predispose to post‐operative pain and further stone formation. The use of a coagulum to prevent such a complication has proved difficult when introduced percutaneously. This experimental study describes a new gelatine (Lithogel®) which is introduced through the nephroscope to coat the renal calculus; it allows easy disintegration of the calculus within the gel, is safe to use and effectively prevents the scatter of fragments into inaccessible calices.
A Strategy for Management of Upper Tract Calculus Disease
Authors: PAYNE S. R. , WEBB D. R. , WICKHAM J. E. A.
Published: November 2008

Summary— Extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and ureterorenoscopy now mean that approximately 98% of all renal and 85% of all ureteric calculi can be treated effectively, without recourse to open operative intervention, in centres possessing the necessary equipment and expertise. Experience with these techniques allows us to propose a strategy for the surgical treatment of upper tract stone disease.
Neurophysiological Measurements in Primary Adult Enuretics
Authors: FIDAS A. , GALLOWAY N. T. M. , McINNES A. , CHISHOLM G. D.
Published: November 2008

Summary— The nerve supply of the lower urinary tract was studied in 25 primary adult enuretics by full urodynamic assessment and neurophysiological measurements. The latter consisted of the measurement of static EMG, sensory thresholds and sacral reflex latencies (SRL). All patients were normal on clinical neurological examination. All neurophysiological measurements were within normal limits in only three patients and the remaining 22 had at least one abnormal response. The commonest abnormality was a high or even absent urethral sensory threshold. These defects in sensory and motor innervation correlated with the clinical dysfunction. It was concluded that this is a valuable method for the detection of nerve defects in the lower urinary tract, especially when the clinical neurological examination is normal.
“Clam” Ileocystoplasty for the Treatment of Refractory Urge Incontinence
Authors: MUNDY A. R. , STEPHENSON T. P.
Published: November 2008

Summary— Forty patients with refractory urge incontinence were treated by “clam” ileocystoplasty. Thirty patients were cured of their symptoms and are voiding spontaneously, six were cured of their symptoms and are on clean intermittent self‐catheterisation and four had their symptoms significantly improved by the operation.

Bladder compliance is usually improved by the operation and detrusor instability is either abolished or reduced to an insignificant level, but voiding dysfunction is a common post‐operative problem and must be identified and treated.
Sphincter Behaviour in Myelomeningocele
Authors: MUNDY A. R. , SHAH P. J. R. , BORZYSKOWSKI M. , SAXTON H. M.
Published: November 2008

Summary— Four hundred and two videourodynamic studies were performed on 207 children with neuropathic vesicourethral dysfunction due to myelomeningocele. The children were divided into three groups (contractile, intermediate and acontractile) according to the urodynamic behaviour of their bladders, and the behaviour of the bladder neck and distal sphincter mechanism was assessed in each group.

The bladder neck may be competent or incompetent in children with contractile bladders but is never obstructive, and is always incompetent in children with either intermediate or acontractile bladders at their usual bladder volumes. The distal sphincter mechanism is nearly always dynamically obstructive (detrusor‐sphincter dyssynergia) in children with contractile bladders but is rarely if ever incompetent, whereas in children with intermediate or acontractile bladders, both (static) distal sphincter obstruction and sphincter weakness incontinence exist to some degree, although the predominance of one of these may mask the existence of the other unless it is specifically looked for or some therapeutic manoeuvre unmasks it.

The main conclusion from this study is that, with the possible exception of those few children with more minor partial cord lesions, dysfunction of one or both sphincter mechanisms is the rule in congenital cord lesions.
A Double‐blind Controlled Trial of a New α‐1 Blocking Drug in the Treatment of Bladder Outflow Obstruction
Authors: RAMSAY J. W. A. , SCOTT G. I. , WHITFIELD H. N.
Published: November 2008

Summary— Thirty‐one patients with urodynamically proven bladder outflow obstruction were treated with Alfuzosin in a 3‐month, double‐blind, placebo‐controlled study. The irritative symptoms of bladder outflow obstruction were improved significantly in the treatment group, according to both objective and subjective evaluation. There was no objective evidence of a reduction in outflow resistance or obstruction in either group.
Oncogenes and Bladder Cancer
Authors: MALONE P. R. , VISVANATHAN K. V. , PONDER B. A. J. , SHEARER R. J. , SUMMERHAYES I. C.
Published: November 2008

Summary— We screened a series of 15 superficial and invasive transitional cell carcinomas of the bladder for transforming activity on the NIH/3T3 transfection assay. In addition, by obtaining tumour DNA and normal lymphocyte DNA from the same patients we looked for evidence of gene amplification or rearrangement of the c‐H‐ras‐I gene by Southern blot analysis.

One patient (with a grade 2 T1 tumour) was shown to have an activated oncogene on the NIH/ 3T3 transfection assay and this was identified as a c‐H‐ras‐I gene. We could find no evidence of gene amplification or rearrangement of this gene in any tumour.

The significance of activation of ras oncogenes in the pathogenesis of human bladder carcinoma is unclear.