摘要:

Summary—The ever increasing amount of laparoscopic instrumentation and the lack of any objective comparison make choosing the most appropriate equipment a difficult task for the urological neo‐laparoscopist. All major manufacturers of laparoscopic equipment were invited to submit as much of their equipment as possible for inspection. A selection of ports, hand instruments, haemostatic devices and imaging systems was then tested in a laboratory and clinical setting. Costings are provided for evaluated ports, hand instruments and imaging systems. Vessels with a diameter greater than 7 mm, such as renal artery and vein, should be secured with a linear stapler‐cutter. The optics of the Olympus 0TV‐S4, CLV‐10 light source, Olympus light cable and A5254A telescope are superior to the other imaging systems tested. Laparoscopic equipment is diverse in specification, performance and cost. Due consideration must be given to these factors when purchasing equipment to avoid disappointment and wastage of resources, particularly with regard to disposable instruments and imagin

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06445.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim‐sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discus

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06446.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Ten of 42 patients with cystinuria admitted for extracorporeal shock wave lithotripsy (ESWL) treatment had ureterolithiasis. Of these, 3 had bilateral stones, 2 had only 1 functioning kidney, and 2 had stones in both the kidney and ureter on the same side. Only 1 patient was on medical treatment at the time of referral. After initiation of medical treatment for cystinuria, 2 patients were discharged without further intervention, 1 was discharged after placement of a ureteric stent and 10 were treated with ESWL. After an average of 1.5 ESWL treatment sessions per ureter, 8 patients became stone‐free and in the remaining 2, ureteroscopy was required to complete the treatment. Problems associated with the ESWL treatment of cystine stones are discussed. It was concluded that ESWL is the treatment of choice for ureterolithiasis in patients with cystinuria because it is effective and is the least invasive procedure even in patients with cystinu

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06447.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—We have developed a ureteric stent with features designed to facilitate active expulsion of ureteric stone fragments. Its unique characteristics include a helix‐like ridge along a thin central core; the superior edge of the ridge is bevelled caudally and the inferior is concave. The ridge's outer edge is smooth and hydrophilic. As the stent is moved in relation to the ureteric wall (owing to respiratory motion and/or peristalsis), stone fragments will slip over the superior edge of the helical ridge. Once past this edge, they cannot migrate in a cephalad direction; they will pass down the helical trough or be ratcheted by the repetitive bevel and emerge through the ureteric orifice. To evaluate the effectiveness of the design it was compared with a conventional, smooth‐surfaced double‐pigtail stent in anex vivoporcine model. A single artificial stone fragment (3×2×2 mm, 4×3×2 or 5.5×3×2 mm) was placed in the proximal ureter and the stent was moved up and down (56 studies with each type of stent). The helically ridged stent required a mean of 79 excursions (standard deviation 60, range 8–291). In contrast, the conventional stent was unable to move any stone fragments‐even after more tha

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06448.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Twenty‐one patients underwent endoscopic subureteric injection of Polytef paste for the correction of secondary vesicoureteric reflux (VUR) in transplanted kidneys. Ureteroneocystotomy was performed in renal transplants using an extravesical technique in 19 patients and the Leadbetter‐Politano technique in 2 cases. Success was achieved in only 6 patients, including the 2 ureters reimplanted according to the Leadbetter‐Politano technique. No significant complication relating to the technique was observed. Despite the low success rate (30%), endoscopic treatment of VUR in transplanted kidneys is justified as a first attempt in view of the morbidity of VUR and the difficulties of repeated surgical reimplantation in this pop

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06449.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Uretero‐ileal stenosis is a recognised complication of ileal conduit urinary diversion. Two patients are described in whom a combination of fibreoptic conduitoscopy with standard endoscopic “biliary” sphincterotomy was used to treat anastomotic strictures. The technique of endoscopic transurostomy diathermy anastomotomy allowed the salvage of 3 renal units without the need for laparotomy or long‐term indwelling ureter

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06450.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—The phenomenon of urethral instability has been poorly defined and its significance is disputed. The aim of this study was to investigate the prevalence and significance of urethral instability in a group of women with idiopathic detrusor instability. Urethral instability was defined as a spontaneous fall in maximum urethral pressure of one‐third or more, in the absence of detrusor activity, over a 2‐min period. Urethral instability occurred in 42% of patients with detrusor instability and was strongly associated with the sequence of relaxation of the urethra prior to unprovoked detrusor contraction. Women with detrusor instability and a stable urethra exhibited primary contraction of the detrusor. The symptom of stress incontinence was more common in women with urethral instability.Women with detrusor instability may be subdivided into 2 groups on the basis of urethral instability, the presence of which suggests a primary dysfunction of the urethra. Such patients may derive more benefit from treatment with an alpha adrenoceptor agonist in addition to (or instead of) standard anticholinergic th

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06451.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—In a cross‐sectional study, 85% of 3114 women responded to a questionnaire on urinary incontinence and a history of abdominal, gynaecological and urological surgery. In 1987 the prevalence of urinary incontinence was 17%; 63% had undergone surgery, mainly gynaecological, and almost one‐third of the respondents had had more than one operation. Bivariate and multivariate analysis showed stress urinary incontinence to be associated with previous exposure to su

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06452.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Urinary frequency is a common complaint in the elderly and can be due to many different causes. To clarify the aetiology of frequency, patient‐maintained frequency‐volume charts were evaluated as a diagnostic tool. We studied 215 patients who complained of frequency. They were divided into 2 groups based on age: 85 were over 65 years of age (elderly group) and 130 were less than 64 years old (adult group). Compared with the adults, elderly patients had a smaller urinary volume during waking hours and a larger volume during sleeping hours, with more frequent episodes of voiding and a smaller volume voided during the latter period. Analysis of the cause of frequency led to the patients being subdivided into 6 diagnostic categories. Among elderly patients, nocturnal polyuria (37%) and an unstable bladder (34%) were frequent causes. In adult patients an unstable bladder (28%) and polyuria due to excessive fluid intake (23%) were most common. As a result of our findings, 108 patients were advised not to be concerned about their micturition and/or restriction of fluid intake. Seventy‐six patients (35%) required anticholinergic medication. Frequency‐volume charts, together with a detailed medical history, provide useful information on the diagnosis and treatment of

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06453.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—We report the changes in the pattern of diuresis in 20 women (average age 71 years) with increased nocturnal diuresis who were treated with 20 ng desmopressin (Minirin). Before treatment, antidiuretic hormone levels were measured every 4 h over a 24‐h period and 75% of the levels were found to be beneath the lowest detectable limit (<0.4 pmol/l).Nocturnal diuresis decreased by 355 ± 208 ml and in 8 cases the decrease exceeded 400 ml. Diurnal diuresis, on the other hand, increased by 226 ± 331 ml. Side effects were mild and occurred in only 2

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb06454.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY