摘要:

Objective To assess the outcome of surgery for urethral failure.Patients and methods Patients undergoing lower urinary tract reconstruction are recorded prospectively by protocol. Thirty‐four are presented whose urethra had failed as a conduit; in 23 the urethra was incontinent and in 11 it was spastic causing chronic retention. The incontinent patients had failed a variety of reconstructions, in five including insertion of an artificial sphincter. Those with chronic retention were unable to self‐catheterize the urethra.Results A continent supra‐pubic diversion using the Mitrofanoff principle was performed. In two patients a new technique was used in which a detrusor tube formed the continent conduit. Ninety‐four per cent of patients were continent. Two patients voided to completion, the remainder emptied by self‐catheterization. Five minor revisions were required to allow easy catheterization. There was one death. The complication rate was 17%.Conclusion This type of reconstruction is preferable to the formation of an ileal conduit in this difficult group of

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07456.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objectives Prostate specific antigen (PSA) measurement has become increasingly popular as a screening test for prostatic adenocarcinoma. Although this is a sensitive, organ‐specific assay, use as a screening tool is hampered by the lack of a clearly defined normal range in older men, frequent elevation of PSA levels by benign processes, and the availability of two different assays, one polyclonal and the other monoclonal, which produce very different values. This study was designed to evaluate the distribution of PSA levels by the Yang and corresponding Hybritech values in patients from the general population.Subjects and methods A total of 478 volunteers over 40 years of age underwent serum PSA determination by the Yang polyclonal radioimmunoassay and digital rectal examination. The PSA levels were stratified and the patient distribution analysed.Results In 69% of patients, PSA levels were ≤ 2.5 ng/ml (proposed normal range for the Yang polyclonal assay). In 89% of patients, PSA levels were ≤ 7.3 ng/ml by the polyclonal assay which corresponds approximately to the proposed normal range of 0–4.0 ng/ml by the Hybritech monoclonal assay. Nine per cent of patients fell between 7.4 and 18.4 ng/ml by the polyclonal assay (4.1–10 ng/ml by the monoclonal assay) and 2% had polyclonal PSA levels>18.4 ng/ml (>10 ng/ml by the monoclonal assay). Cancer detection rates (influenced by the percentage of patients undergoing biopsy) were 0.3% in patients with polyclonal PSA levels ≤ 2.5 ng/ml, 1.2% in patients ≤ 7.3 ng/ml, 20.9% between 7.4 and 18.4 ng/ml, and 50% of those>18.4 ng/ml; the overall cancer detection rate was 3.8%.Conclusions These data support the use of higher PSA levels as a criterion for further evaluation in screening for prostate cancer and establish the frequency distribution of PSA in a screening population when the Yang

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07457.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To evaluate transrectal ultrasonography (TRUS) with a 7 mHz rotating probe as a staging procedure in 33 patients with localized prostatic carcinoma.Patients and methods The ultrasound scans were compared to histopathological whole‐mount step sections of the surgical specimens. Twenty‐five of the patients had tumours with pathological stage T3 (pT3) and eight had tumours with stage pT2 giving a prevalence of extracapsular growth of 0.76.Results The overall sensitivity, specificity, positive and negative predictive values for detection of extracapsular tumour growth by TRUS of prostatic cancer were found to be 0.68, 0.63, 0.85 and 0.38, respectively. Six tumours showed solely microscopic foci of extracapsular tumour growth.Conclusion This technique gives a high percentage of both understaging (32%) and overstaging (37%) and therefore TRUS is an unreliable tool in the staging protocol prior to radical prostatect

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07458.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To study the effect of transrectal ultrasonography (TRUS) including digital rectal examination (DRE) of the prostate on serum prostate specific antigen (PSA).Patients and methods In a diagnostic centre for general practitioners serum PSA was determined in patients before, immediately after, and one week after TRUS including DRE. In a small group of patients PSA was determined at various times after DRE and TRUS.Results The PSA levels showed a statistically significant rise of 20% immediately after DRE and TRUS. After 7 days the PSA levels had returned to their initial levels. This decrease appeared to occur within the first 24 h.Conclusion When applying the diagnostic triad PSA, DRE and TRUS blood samples for PSA should preferably be taken before DRE and TRUS. If blood samples are taken afterwards, it is safe to do so after seven days.

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07459.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To investigate the cause of erectile dysfunction after nerve‐sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B).Patients and methods Erectile function was evaluated in 20 patients, mean age 65 years (range 44–74), both pre‐operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessedResults Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury.Conclusion We conclude that post‐prostatectomy impotence is multifactorial but vascular injury plays a substanti

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07460.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To diagnose xanthogranulomatous pyelonephritis (XGP) in childhood pre‐operatively.Patients and methods Eleven cases of XGP presenting to Birmingham Children's Hospital over a 10‐year‐period are reported. Nine (82%) were diagnosed pre‐operatively on the clinical and radiological findings.Results The characteristic clinical findings were urinary tract infection (9 cases), palpable renal mass (8 cases) and anaemia (8 cases). The most common radiological findings were enlarged kidney (9 cases), renal calculi (7 cases) and non‐functioning kidney (6 cases). Renal ultrasound typically demonstrated a central echoic area (6 cases) and multiple hypoechoic areas in the parenchyma (7 cases). A computed tomography (CT) scan was performed in three cases. This showed characteristic multiple, low attenuation, unenhanced areas within the parenchyma with extension of the inflammatory process into peri‐nephric fat (two cases). Ten cases (91%) were of the diffuse type. There was extension into the peri‐nephric fat in eight cases (73%). Three cases (27%) were associated with congenital urological abnormalities. Nephrectomy was performed in 10 cases and a partial nephrectomy in one.Conclusion XGP is uncommon in childhood but should always be considered in the differential diagnosis of renal masses, especially in the presence of anaemia. Nephrectomy usually results in a p

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07461.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objectives To ascertain the necessity for the use of nephrostomies and ureteric stents after paediatric pyeloplasties.Patients and methods Seventy children with a pelviureteric junction obstruction underwent a dismembered pyeloplasty between March 1983 and March 1991 at The Bristol Royal Hospital for Sick Children. A nephrostomy and stent were not used routinely except for the first few months of the survey. Indications for their use were: surgery on a single kidney, an inflamed renal pelvis or a revision pyeloplasty. Urinary catheters were only used for those patients with proven or suspected vesicoureteric reflux.Results Thirteen patients had a nephrostomy and stent inserted (Group 1) of whom three patients (23%) developed complications. Fifty‐seven patients had only a wound drain inserted (Group 2) of whom nine (16%) developed complications. The hospital stay of 12.1 days for patients in Group 1 was significantly longer than the 5.4 days for Group 2 (P value<0.05). Long‐term radiological and/or radio‐isotopic follow‐up showed improvement in function and/or drainage in 95% of both groups.Conclusions These findings support the concept that paediatric pyeloplasties can be safely performed at any age without the insertion of a nephrostomy tube or stent and that hospital stay is therefore significantly

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07462.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective To determine whether there are two distinct types of congenital obstruction of the proximal urethra.Patients and methods Three boys with a congenital bulbar urethral narrowing (Cobb's collar) were examined. Recent papers on congenital obstructive posterior urethral membrane (COPUM) were reviewed.Results The more proximal lesion is a membranous obstruction which is able to prolapse as far as the bulbar urethra, but has paramedian folds that attach along the posterior wall of the urethra to the verumon‐tanum, and is due to persistence of an embryological attachment between the distal verumontanum and the anterior wall of the posterior urethra. The more distal narrowing is not always obstructive and is primarily a bulbar urethral membrane, is independent of the verumontanum and external sphincter, and may represent a persistence of part of the urogenital membrane.Conclusions There are two distinct types of congenital obstruction of the proximal urethra, with the association to the verumontanum being the distinguishing featur

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07463.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07464.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1994.tb07465.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY