ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15554.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A series of 66 children with unilateral renal disease and normal total renal function were reviewed with the aim of determining whether clinically detectable compensatory hypertrophy indicated severe contralateral renal impairment. The proportion of total renal function that was contributed by each kidney was determined using isotope renography (99mTc‐DTPA for 46 children,99mTc‐DMSA for 20). Kidney length was measured from plain abdominal radiographs or intravenous urograms and hypertrophy was expressed as the renal size index (RSI). Of 37 kidneys with a RSI greater than 2 standard deviations from the mean, 36 had less than 15% of total function in the contralateral diseased kidney. Kidneys with less than 10 or 15% of total renal function could be selected with 97 or 80% sensitivity and 84 or 97% specificity, respectively, using the same RSI selection

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15555.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—Patients with stab wounds and haematuria were selected for surgical exploration if they had signs of severe blood loss, an associated intra‐abdominal laceration or major abnormality on the intravenous urogram (IVU). Patients without these signs were selected for non‐operative management, consisting of bed rest, an intravenous antibiotic for 24 h and regular observation. Of 95 patients, 60 (63%) were selected for non‐operative management (Group 1) and 35 (37%) were selected for primary surgical exploration (Group 2).At surgery in Group 2, a major renal injury and/or associated intra‐abdominal laceration was found in 31 patients. Thus a probably unnecessary operation was performed in only 4 patients (4% of the whole group of 95 patients). Renal complications occurred in 12 of the 60 patients (20%) in Group 1 and consisted mainly of secondary haemorrhage caused by an arteriovenous fistula (AVF) or pseudo‐aneurysm. Management of the renal complications included segmental artery embolisation in 6, nephrectomy in 2, heminephrectomy in 1, open surgical ligation of an AVF in 1 and spontaneous resolution in 2 patients. The mean period of hospitalisation was significantly shorter in Group 1 (6.1 days) than in Group 2 patients (9.9 days).Comparing the Group 1 patients who developed renal complications with those who did not, we would recommend more aggressive selection for surgery of those patients exhibiting clinical signs of shock, a fall in haemoglobin during observation, a palpable abdominal mass, a haemothorax and/or pneumothorax ipsilateral to the renal injury, and IVU signs of extravasation, non‐function, delayed excretion or hydroureteronephrosis due to blood clots. An alternative management strategy would be to perform renal angiography before surgical exploration, with segmental artery embolisation as definitive treatment of the

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15556.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—We report our experience with pulsed dye laser lithotripsy in the treatment of 100 ureteric stones in 95 patients over a 14‐month period from July 1989 to September 1990.The overall rate of successful stone fragmentation was 97%. There was a low incidence of minorcomplications–mild haematuria, ureteric colic and urinary tract infection; ureteric perforation occurred in only 3 patients, all of whom were successfully treated conservatively.Pulsed dye laser lithotripsy is a safe and effective mode of treatment for ureteric stones. Currentindications for laser fragmentation of stones are ureteric stones, impacted pelviureteric junction stones and Steinst

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15557.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A total of 36 subtrigonal phenol injections were performed on 29 patients with detrusor instability. Long‐term follow‐up (mean 13.7 months) showed a subjective response rate of only 14%, and objectively there was no significant change in any urodynamic parameter in the group as a whole. There was, however, a significant improvement in cystometric capacity and volume at first contraction, in those under 55 years of age. One patient developed a vesicovaginal fistula following repeat injections. This suggests that subtrigonal phenol injections have little place in the treatment of detrusor instability, especially in the over 55s, and repeat injections should be abandoned because of the risk of major complica

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15558.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A study was carried out on 112 patients who had undergone a clam procedure. Followup extended from 15 months to 8 years. The efficacy of the operation in achieving and maintaining continence in patients with instability and hyper‐reflexia was confirmed (93% in the neuropathic group, 91% in the congenital instability group and 78% in the idiopathic group).Complications were common and included inability to void (requiring self‐catheterisation), haematuria, mucus production and recurrent urinary tract infection. Complete bacteriological data were obtained on 80 patients; 30% were infected pre‐operatively (all but 4 in the neuropathic group) but 66% had bacteriuria at the time of assessment after surgery. Subjectively, 17 patients (24%) who “never” got infected had bacteriuria, as did 29 (63%) of those who were “occasionally” infected. Objectively, 84% of patients on intermittent self‐catheterisation (ISC) had positive cultures, but even in those voiding spontaneously bacteriuria was present in 60%.Careful follow‐up of these patients is mandatory and a more rigorous approach to eradication of infection and subsequent prophylaxis

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15559.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A series of 52 patients with squamous cell carcinoma of the urinary bladder were studied over a 6‐year period. They constituted 27% of all bladder tumours. The male: female ratio was 12: 1; 62% of the patients were below the age of 50 years (mean 47) and 31% had a previous history of urinary bilharziasis. Associated stigmata ofSchistosoma haematobium, as sandy patches, were detected in 69% of patients. Fourteen had bilharzial ureteric strictures as seen on intravenous urography and most of the tumours occurred in the region of the trigone; 60% had T3 NO MO tumours at presentation. Eighteen patients received radical radiotherapy and 16 patients under the age of 55 years underwent radical cystectomy with diversion of urine to an isolated rectum. The 5‐year survival rate in the radical cystectomy group was 75%. Other modalities of treatment and their results are disc

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15560.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—An increased long‐term morbidity rate after transurethral compared with open prostatectomy has recently been claimed on the basis of retrospective studies of operations done up to 20 years ago. These studies have led to a demand for a prospective trial. Most reports show that peri‐operative mortality following prostatectomy is virtually confined to unfit men over 80 years old. Before agreeing to participate in a trial we examined our operative mortality in this group of patients. Between 1981 and 1987, 123 octogenarians underwent transurethral prostatectomy: 64 operations were elective and 59 were performed for retention. There were 2 operative deaths (1.6%), both from gram‐negative septicaemia despite prophylactic antibiotics. There were no additional deaths in the first 12 months following surgery. Few of these patients would have been considered fit to undergo an open prostatectomy. Any proposed randomised trial would have to exclude such high risk patients until it can be shown that open prostatectomy is equal

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15561.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A self‐administered patient questionnaire was developed to assess the severity of key symptoms before and after transurethral prostatectomy (TURP). This questionnaire was validated by comparison with a standard assessment performed by the doctor. Complete data were obtained on 39 men studied before and 3 months after prostatectomy.Close associations were found between the scores resulting from the assessments performed by the patient and those carried out by the doctor. These associations were found for individual scores and for aggregate scores for obstructive and irritative symptoms before and after operation.Symptom scores after operation were significantly related to the patients' overall assessment of whether the operation had been a success–a low score being associated with a satisfactory outcome. It is suggested that self‐administered symptom questionnaires can give a reliable picture of the outcome of prostatectomy and might be useful in developing audit

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15562.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients.The prostatic urethra is measured either by abdominal/transrectal ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 21 coils were correctly positioned at the first attempt using this new method–a success rate equivalent to that of ultrasound‐guided inse

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15563.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY