摘要:

Summary—The purpose of this study was to evaluate the function of the intestinal segments used to replace the bladder after cystoprostato‐vesiculectomy. The series included 30 patients, 10 of whom underwent clinical, radiological, urodynamic and electromanometric investigations. Seven patients had an ileocaeco‐urethrostomy (ICUS) and 3 had an ileo‐urethrostomy with a reservoir (IR).The results were good in all patients and there was no sign of tumour recurrence. All were completely continent during the day but during the night only those who observed the 2‐h intervals between voiding were continent. The radiological findings for 1 patient showed grade I asymptomatic vesicoureteric reflux. In all cases, periodic pressure waves were observed during electrocystomanometric tests at basal levels, with the IR patients showing waves higher in frequency and lower in amplitude. Prostigmin induced a significant variation in motor activity in IR patients only. The urodynamic tracings showed an almost physiological flow in both groups. Cystomanometry revealed good compliance in both types of new bladders. The height and width of contraction waves during filling was greater in ICUS than in IR patients. Good perineal sphincteric activity was demonstrated by electromyography. Low passive resistance was indicated by the urethral pressure profile.Preliminary analysis of data indicated good functional micturition and renal function in both ICUS and I R patients. Slight differences were found between the two intestinal segments used for bladder re

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05121.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—At the beginning of this century it was realised that peristalsis would cause incontinence if bowel was used for augmentation or substitution of the bladder. Trans‐section of the antimesenteric border and cross‐folding of the intestinal segments (Goodwin's cup‐patch technique) is an efficient means of solving this problem and has been successfully used in the Kock pouch.We anastomosed the ileal low pressure reservoir to the membranous urethra in 22 male patients following radical cystoprostatectomy for bladder cancer. The mean observation time was 16 months (range 3–36). The capacity of the bladder substitute increased with time, the average being 450 ml after 6 months. In the first 4 patients with a short (2–5 cm) intestinal segment between the pouch and the urethra, micturition was prolonged, residual urine varied from 50 to 300 ml and bacteriuria was found. Occasional expulsions of several ml of urine were caused by peristalsis within this short tubular segment. In the following 18 patients, the low pressure reservoir was anastomosed directly to the membranous urethra. Micturition was good, with no notable residual urine, no bacteriuria and no paroxysmal urinary incontinence. However, a safety pad is used by half of the patients because once or twice a week, mainly at night, a few ml of urine may be lost. No significant changes in serum electrolytes, bicarbonate or creatinine were noted. With the three different antireflux techniques used, no obstructive or inflammatory changes in the upper urinary tracts were found, although no long‐term antibiotic prophyla

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05122.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A continent urinary diversion was formed for 16 patients using the Mitrofanoff principle for continence. As originally described, this system used the appendix tunnelled into the bladder to form a continent catheterisable vesicostomy. We have expanded the technique and have used all available narrow tubes as continent conduits (ureter 10 cases, appendix 5, Fallopian tube 1). The urine container was made of large and small intestine and bladder in several combinations. The system has been very satisfactory: 14 patients were continent and able to catheterise; 1 required a revision to achieve continence and 1 awaits revision; 3 patients required revision procedures for strictur

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05123.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Interstitial cystitis (IC) is characterised by recurrent inflammation and destruction of bladder tissue without obvious cause. To determine whether this self‐perpetuating disease is the result of an autoimmune disorder, we studied 26 patients with IC of mean duration 5 years and compared the results with those of a control group of similar age and sex with other urological complaints.We performed a standard autoimmune profile and looked for specific antibodies to normal human bladder in the serum, using an indirect immunofluorescence technique. Deep bladder biopsies were examined by conventional histology and cryostat sections were studied with peroxidase‐conjugated anti‐human antibodies in a search for immunoglobulin deposition within the bladder.Seventeen of 26 patients with IC (65%) and 5 of 14 controls (36%) demonstrated non‐organ‐specific antibodies; 40% of those with IC had anti‐nuclear antibodies; 18 IC patients (75%) and 4 of 10 controls (40%) had anti‐bladder antibodies present in the serum, but 5 healthy volunteers showed no such antibody activity. There was no statistically significant difference between the two groups for either type of antibody (Fisher's exact test). Only 5 of 17 patients with IC (29%) showed immunoglobulin deposition in the bladder epithelium, a similar proportion to controls (38%); 4 of these 5 had circulating anti‐bladder antibodies present in the serum.Although IC patients demonstrated a non‐specific increase in antibody formation, this was not significantly different from a similar group of other urological patients. The lack of specificity makes this immunological response more likely to be a secondary phenomenon associated with inflammatory damage to the bladder rather than the primary c

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05124.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A prospective 2‐phase study was performed on 24 patients with locally advanced transitional cell carcinoma of the urinary bladder to evaluate the toxicity of integrated treatment with Adriamycin 10 mg/m2(group A) or 20 mg/m2(group B) and hyperfractionated, accelerated radiotherapy. Local and systemic toxicity with Adriamycin 10 mg/m2was significantly lower than with 20 mg/m2. Complete tumour remission was achieved in 18 patients (6 of 8 patients in group A and 12 of 16 in group B). In 12 cases the treatment could be stopped after the first ser

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05125.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Forty patients with either metastatic, post‐radiotherapy recurrent, or poor prognosis locally advanced transitional cell carcinoma of the bladder were treated in a new combination chemotherapy programme with methotrexate, vinblastine, mitozantrone and JM8 (carboplatin); 33 patients were assessable for response. There were 9 complete responses (27%), 12 partial responses (36%) and 7 disease stabilisations (21%); 5 patients (15%) had progressive disease. The median duration of complete response has not been reached and is in excess of 9 months (range 4–>18 months). This regimen was without significant toxicity and this is in contrast with M‐VAC, which is thought to be currently the most effective treatment for urothelial

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05126.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Levels of volatile N‐nitrosamines were measured in 10 brands of latex and 2 brands of silicone catheters using high performance liquid chromatography. The cytotoxicity of catheters from identical batches was determined by measuring the inhibitory effect of catheter extracts on the uptake of3H‐labelled thymidine into L‐929 fibroblasts in culture (IC50).The most frequently encountered nitrosamines were N‐nitrosodi‐n‐butylamine and N‐nitrosodiethylamine. Total N‐nitrosamine levels in excess of 100 ng/g were found in 6 of the 16 catheters tested. When compared with the cytotoxicity of the catheters a significant correlation was found, with increasing nitrosamine content being associated with greater cytotoxicity. In view of the reported toxic and carcinogenic effects of these compounds it is suggested that the nitrosamine content of catheters be routinely monitored and safe regulatory

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05127.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—The treatment of prostatic carcinoma with diethylstilboestrol (DES) and ethinyloestradiol (Lynoral) has become less popular since the introduction of new forms of treatment such as antiandrogens, estramustine phosphate and LHRH analogues. One of the reasons for this decline in popularity is the risk of cardiovascular side effects during treatment with oestrogens.In the literature, different dosages of DES and ethinyloestradiol are recommended and different rates of cardiovascular side effects are reported. In a prospective study, 18 patients were treated with ethinyloestradiol 0.05 mg/day. In most cases this lowered the plasma testosterone permanently below castrate level during therapy. Also, because the acid phosphatase returned to normal in almost all patients, this treatment seemed adequate. In 4 patients the treatment was stopped because of side effects, in 3 of these because of cardiovascular complications. The cardiovascular side effect at this dose are considerable (29%) but comparable rates are reported in some studies following placebo treatment of patients with prostatic carcinom

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05128.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A series of 30 female patients underwent total urethral substitution for a variety of conditions, usually urogenital sinus abnormalities or post‐irradiation vesicourethrovaginal fistulae. Five different techniques were used: bladder flap neourethroplasty, neourethroplasty using a urinary tract remnant, vaginal/urogenital sinus neourethroplasty, pedicled labial skin tube neourethroplasty and colonic substitution neourethroplasty with synchronous implantation of an artificial sphincter.Bladder flap neourethroplasty is appropriate if the bladder size is adequate and if the bladder neck is incompetent, but stress incontinence is a common complication which must be anticipated and dealt with proleptically. Vaginal/UG sinus neourethroplasty is preferred if the bladder neck is competent enough to preserve continence. When no other tissue is available, particularly after radiotherapy, a pedicled labial skin tube neourethroplasty gives the best results. Colonic substitution with the implantation of an artificial sphincter is not satisfactory.Any surgically created neourethra should be wrapped with either labial fat pads or omentum and, in the absence of a competent bladder neck, with an artificial sphincter cuff to support the urethra and to prevent it telescoping, and for use as a back‐up if continence is not ade

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05129.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Unknown factors in the seminal plasma of normal semen that affect the motility of spermatozoa have a positive effect on adenosine triphosphatase (ATPase) enzyme activity. In an attempt to produce such an effect, spermine, spermidine and kallikrein were added to the incubation media in which spermatozoal ATPase enzyme activity was determined. These seminal substances increased the triple ATPase enzyme activity of spermatozoa from oligoasthenozoospermic men. We propose that the ATPase enzyme activity of spermatozoa may indicate sperm motility as a biochemical tes

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05130.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY