ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05967.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Early experience of extracorporeal shock wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 145 patients underwent 185 treatments for 189 stones. Treatments were performed with either intravenous sedation and analgesia (90%) or general anaesthesia (10%). There were 123 renal calculi, 44 ureteric calculi and 22 staghorn calculi. Stone fragmentation was achieved with 1724 ± 1035 shocks at 19 kv. The immediate stone fragmentation rate was 90% and the 3‐month clearance rate 88%. Secondary treatments were required in 19% of patients and additional procedures in 17%. A comparison between stone size and the number of shock waves required to achieve stone fragmentation revealed a linear relationship. The Lithostar is a very effective second generation lithotriptor which can be used for renal, staghorn and ureteric calculiin situ, without manipula

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05968.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A review has been made of the indications, technical problems, complications and results of 31 allograft nephrectomies in 29 patients; 12 patients died between 15 days and 1 month after graft nephrectomy, which was undertaken within 6 months of transplantation.Gross local and general complications occurred in 7 patients who survived graft nephrectomy. The procedure is recommended when graft failure occurs within 6 months of transplatation provided it is associated with systemic signs of severe rejection or sepsis, or if it occurs in cases where continuation of immunosuppressants is life‐threaten

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05969.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—Intermittent hydronephrosis is notoriously difficult to diagnose but, once confirmed, requires surgery. In contrast, congenital megacalicosis is accepted as a non‐obstructive cause of upper urinary tract dilatation for which surgery is inappropriate. Experience with 2 cases and a review of the literature suggest that occasionally the clinical features and radiographic findings in the 2 conditions may overlap, leading to misdiagnosis. Attention to the combination of clinical features and radiography, together with the use of radionuclide techniques and acute pain studies, may help to distinguish between these conditi

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05970.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A group of 184 consecutive patients requiring surgery for ureteric stones was studied over a 4‐year period. The success rate for primary endoscopic management was 90.3%; 12 patients required ureterolithotomy for failed endoscopic manoeuvres and complications occurred in 5.5%. Optimum methods of treatment for ureteric stones according to size and location are sugges

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05971.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A series of 35 patients, with unilateral hydronephrosis complicating bilharzial stricture of either the upper or the middle third of the ureter, was divided into 2 groups. Group A, comprising 21 patients, was treated by resection anastomosis. Group B, comprising 14 patients, was treated by other reparative procedures without resection of the stricture. The results of the surgical correction, assessed clinically and radiologically, showed that significantly better results were achieved with resection anastomosis than with the other procedure

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05972.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—We report 40 patients seen over a 15‐year period with a histological diagnosis of adenocarcinoma of the bladder; 18 patients had primary adenocarcinoma of the bladder, arising either from the urachus or from glandular metaplasia of the urothelium, and the other 22 had secondary lesions representing invasion from adjacent structures, notably prostate, colon and ovary. In this latter group symptoms related to the primary lesion were variable. The distinction between primary and secondary neoplasm is an important one and was rarely made on the basis of endoscopic or clinical findings alone. Urachal tumours were more common in females, whereas primary and secondary vesical adenocarcinomas were more common in males. The urachal tumours also occurred in a younger age group. Most of the adenocarcinomas, urachal or primary, were already advanced at the time of diagnosis. All tumours were palpable bimanually after resection and were at least T2 or T3. In the urachal carcinomas the results of partial cystectomy were disappointing because of the high rate of local recurrence and death from metastases. Primary non‐urachal vesical adenocarcinoma carried an even poorer prognosis if non‐radical surgery was carried out. The mean survival was 13 months. Radiotherapy was not effective in urachal and primary adenocarcinomas as these tumours are generally radioresistant. The treatment of secondary adenocarcinoma was governed by the primary site of the tumour. Radical surgery combined with chemotherapy and radiotherapy appeared to give the longest survival in the colonic tumours. Patients with prostatic cancer had a poorer survival rate than those with the same stage tumour but without bladder involvement, with renal failure secondary to obstructive uropathy being the commonest cause o

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05973.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—We present a series of 13 patients with diffuse carcinomain situ(CIS) of the bladder who failed an initial induction course of intravesical therapy with Mitomycin C, thiotepa, doxorubicin or Bacillus Calmette Guérin (BCG). Cystectomy, although indicated, was, for various reasons, not performed after the first failure of intravesical therapy and all patients were subsequently treated topically with the same or different agents. Of the 7 patients treated with 2 induction courses, 6 showed a complete response during a follow‐up period of 24 to 42 months. Although 1 patient initially responded completely, he developed invasive transitional cell carcinoma (TCC) Grade IV 30 months later. Among the 3 patients who underwent 3 induction courses, 2 had a complete response at 42 and 60 months of follow‐up and 1 developed TCC Grade IV with muscle invasion 18 months later. Two of the 3 patients treated with 4 induction courses are free of disease at 48 and 57 months; the third developed low grade, low stage TCC. This experience suggests that the majority of patients with CIS who fail initial treatment usually respond to further treatment with the same or a different drug. The question as to whether a second course of intravesical therapy, subsequent to failure of the first course, should be given before cystectomy requires further investi

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05974.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—The case histories of 494 women referred to a urodynamic clinic with the symptom of stress incontinence were studied. None had undergone previous incontinence surgery. In only 12 patients was stress incontinence the sole symptom. In the remainder, symptoms suggestive of detrusor instability were present in 417, of a voiding disorder in 261 and of an inflammatory disorder in 166. The sign of stress incontinence was present in only 168 patients and was not a reliable guide to the diagnosis of genuine stress incontinence. Urodynamic studies were necessary in 488 patients in order to obtain an accurate diagnosi

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05975.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Summary—A group of 28 patients with neurogenic bladder dysfunction and low bladder compliance was studied using medium fill cystometry (CMG) and ambulatory monitoring (AM) during natural bladder filling. The aims of the study were to compare the 2 techniques and to determine if ambulatory monitoring might be useful in predicting upper tract dilatation.AM demonstrated significantly lower end filling pressures compared with CMG. Phasic detrusor contractions were found more commonly during AM and the frequency of phasic detrusor contractions during AM was associated significantly with poor compliance identified during CMG.Patients with upper tract dilatation had significantly greater residual urine volumes, higher pressure rises during CMG and higher frequencies of phasic detrusor contractions compared with those patients with normal upper tracts.The high pressures seen at the end of a medium fill CMG were not found during AM and therefore are unlikely to be the underlying explanation of upper tract dilatation in such patient

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1989.tb05976.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY