ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16202.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryTwenty‐four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth.ESWL is a safe and successful non‐invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitor

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16203.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThis experimental study was designed to investigate the responses of renal function to elevated intravesical pressure. Ten male New Zealand type rabbits were used. A supravesical ureterocutaneous urinary diversion was performed in all rabbits to disconnect bladder and kidneys and to ensure a free urine flow. Two parameters of renal function were measured simultaneously: urine output by simple collection and glomerular filtration rate (GFR) by total plasma clearance of51Cr‐EDTA. Measurements were performed initially with the bladder empty and then with intravesical pressure 60 cm H2O. A significant decrease in urine output and in GFR was observed in all rabbits when the bladder was overdistended. Urine output returned to the initial levels after relief of the increased intravesical pressure. The results suggest that for these responses a vesicorenal reflex activated by the elevated intravesical pressure is responsibl

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16204.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThirty‐six urinary stones were studied by computed tomography and bone densitometry in order to find a correlation between the chemical composition of the stones and the densitometric data.In vitro, the more common cases of lithiasis can be divided into 3 main groups: uric acid, cystine and the calcium salts,e.g.calcium oxalate monohydrate, calcium oxalate dihydrate and calcium phosphate. Struvite stones fall between the second and third groups. Computed tomography and bone densitometry can differentiate between the groups, provided that the value of the “stone mineral or calcium content” is correlated with the true calculated volume of the stone (resulting in the specific stone density) instead of the projection area (resulting in the area density). This is only possiblein vitro.Thein vivoapplication of these technologies in the treatment of stones of unknown composition could provide important information, but major restrictive factors pose difficulties. Further clinical studies are necessary, especially to define the role of bone densito

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16205.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA model capable of comparing the effects of bacterial virulence factors on renal scarringin vivohas been developed using the female piglet. By creating, at open surgery, unilateral vesicoureteric reflux (VUR) and quantifying scarring both by uptake of an isotope bound to functioning renal parenchyma and by planimetry of the surface area scarred, the effects of 2 organisms, a P‐fimbriateEscherichia coliand anE. coliK 1 have been compared. The P‐fimbriateE. coliwas shown to express P‐fimbriae in freshly voided urine, was more hydrophobic and produced smaller scars. This indicates that neither the hydrophobicity nor P‐fimbriation of the organism causing urinary tract infection (UTI) is of prime importance for the development of renal scars and is evidence against the “big bang” theory for the development of renal scars.Studies on the association of UTI with VUR showed that infection with bothE. coliunder study led to VUR on the side contralateral to the side undergoing surgery. It seems likely that a nonspecific effect of UTI, such as bladder oedema, is responsible for this acquired VUR.An effect of the 2 bacteria under study on the lower urinary tract was observed in that infection with the P‐fimbriateE. coliallowed the retention of an intravesical wax plug, whereas infection withE. coliK1 did not. Epidemiological data have shown that the majority of upper urinary tract infections in children are associated with UTI by P‐fimbriate organisms. Such an association may be explained in part by an effect of P‐fimbriate bacteria on lower urinary tract function rather than an effect on the up

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16206.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryIn an experimental study of female piglets with surgically created unilateral vesicoureteric reflux,Escherichia coliwere inoculated into the bladder and, at later sacrifice, bacterial culture was undertaken of renal parenchyma from the refluxing and non‐refluxing kidneys. Positive cultures of the sameE. coliwere obtained from 33% of refluxing kidneys with pyelonephritic renal scars, 23% of refluxing kidneys without scars and 21% of non‐refluxing kidneys. Although other aspects of the experiments confirmed that a combination of urinary infection, vesicoureteric reflux and intra‐renal reflux is a necessary precondition for renal scarring, these findings indicate that reflux plays a role in the pathogenesis of renal scarring over and above a means whereby pathogens gain access from the lower urinary tract to the renal substance. Possible mechanisms are disc

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16207.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummarySeventeen kidneys removed from patients with renal carcinoma were submitted to exvivoultrasonography and then to serial pathological examination in an attempt to detect secondary tumours in apparently normal tissue.Ex vivoultrasonography failed to reveal further tumours, but 2 lesions measuring 5 and 8 mm were found on pathological examination. These preliminary data suggest that intra‐operative ultrasonography may be of little value in detecting secondary tumours in conservative surgery for renal carcinom

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16208.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryTwenty females with pure stress urinary incontinence (Group A) were studied clinically and urodynamically together with 20 stress incontinent women with idiopathic detrusor instability (Group B) and 20 controls (Group C). Forty females with the idiopathic urge syndrome, 20 with detrusor instability (motor urgency. Group D) and 20 with stable bladders (sensory urgency, Group E) were also investigated. Detrusor contractility, assessed on the basis of strength and velocity parameters derived from pressure flow data, was increased in the unstable groups. In particular, the maximum mechanical power (per unit of bladder wall surface area) generated by the contracting detrusor during voiding was higher in the unstable patients, this was also the case when estimating maximum bladder contraction velocity.No significant difference in these parameters was found in the patients with sensory urgency when compared with the controls and with the women with stress urinary incontinence, nor was there any significant difference between patients with motor urgency and the stress incontinent patients with detrusor instability.The enhanced contractile capability could be explained in the unstable stress incontinent group by a reduced threshold of stretch receptors in the urethral walls. If this were the case, urine running through the urethra at the beginning of voiding would be able to activate a urethrovesical reflex which may augment micturition contractions.In the group with the idiopathic urge syndrome one could speculate that sensory and motor urgency are due to the same neurological disorder (i.e.possibly a reduction in a tonic inhibitory or modulatory device) that would affect detrusor mechanics at different levels of the nervous system, resulting in different contractile capabilities.

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16209.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe effect of intravesical oxybutynin hydrochloride on detrusor behaviour was studied in 15 patients with urinary incontinence due to detrusor hyper‐reflexia by ambulatory bladder monitoring. Twelve patients had a reduction in the frequency and amplitude of hyper‐reflexic contractions and incontinence episodes following oxybutynin administration. Intravesical oxybutynin may have a role in the management of patients on intermittent self‐catheterisation with detrusor hyper‐reflexia who cannot tolerate the side effects of anticholinergic agents, including oxy

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16210.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryEncrusted cystitis is a rare condition characterised by the formation of calcified plaques adherent to or embedded in the bladder mucosa. Although chronic infection with urea‐splitting organisms is a prerequisite, other factors seem to play an important role in its development.We report our experience of 4 such cases in which encrusted cystitis presented with various symptoms, produced different pathological abnormalities and was treated by different means in each patien

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb16211.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY