ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00051.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate and compare changes in pulmonary function after retroperitoneoscopic and open surgery.Patients and methods From June 1994 to October 1995, 11 patients (five men and six women, mean age 44.7 years, range 29–69) underwent retroperitoneoscopic procedures (Group 1) and 11 patients (eight men and three women, mean age 57.5 years, range 22–73) underwent flank‐incision procedures (Group 2). The surgery comprised eight adrenalectomies and one each of nephroureterectomy, nephrectomy and pyelolithotomy in Group 1, and five adrenalectomies, four nephroureterectomies, one ureterolithotomy and one excision of a retroperitoneal tumour in Group 2. Pulmonary function tests (PFTs) were performed before and 3 days after surgery; the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), forced expiratory volume at 25% (FEV25% ), FEV1 /FVC, vital capacity (VC), total lung capacity (TLC), residual lung volume (RV) and functional residual capacity (FRC) were compared between the groups. The post‐operative changes in the PFTs were assessed using a pairedt‐test and the degree of change in both groups compared using the Mann–WhitneyU‐test. Other factors possibly influencing PFT were analysed using multiple regression.Results Pulmonary function was impaired in both groups on the third day after surgery. In Group 2, the FVC, FEV1 , FEV25% , VC and TLC had declined significantly (allP<0.05) from the pre‐operative value. In Group 1, only the FVC and VC decreased significantly (P<0.05). Post‐operative pulmonary complications occurred in two patients in Group 2 but in none of those in Group 1, showing that pulmonary function was generally less affected in Group 1 than in Group 2.Conclusion Although pulmonary function was impaired 3 days after surgery in both groups, retroperitoneoscopic surgery, by eliminating a large flank incision, caused less post‐operative

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02572.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To examine adrenal invasion by renal cell carcinoma (RCC), particularly by adrenal micrometastasis, to determine whether adrenalectomy should be performed during radical nephrectomy.Patients and methods From 1987 to 1994, 129 patients with RCC (90 men and 39 women, mean age 61.4 years, range 22–81) underwent radical nephrectomy with associated adrenalectomy because they had risk factors for adrenal invasion (tumour size>5 cm, or tumour of the superior pole). Pathological examinations were carried out systematically and records of these examinations reviewed. The tumour size was recorded and the frequency of invasion calculated.Results There were 10 cases where the gland was invaded; one was a synchronous contralateral metastasis and nine (7%) were ipsilateral invasions of which two were tumours in the superior pole that invaded the gland by direct extension and the other seven invaded the gland by distant metastasis, six being micrometastatic (4.7%). A single micrometastasis was found in two cases (1.5%). There was no adrenal invasion by tumours of5 cm) sho

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02633.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objectives To study the changes in renal resistive index (RI) and renal function with time during different grades of partial unilateral ureteric obstruction, and to determine the correlation between the ultrasonographic and renographic findings.Materials and methods Ten dogs underwent right partial ureteric obstruction; grade 1 (mild) obstruction was applied in five dogs (group A) and grade 3 (moderate and severe) obstruction in the other five (group B). All dogs were assessed using excretory urography, diuretic renography with the calculation of half‐time drainage (Tn) and bilateral renal Doppler ultrasonography before the experiment began, after one week of obstruction, and every 2 weeks during 8 weeks of obstruction.Results In both groups, after the induction of right ureteric obstruction, there was a progressive decrease of effective renal plasma flow (ERPF) and a progressive increase of the RI of the right kidney at the end of the first and second weeks of obstruction, with an almost stable value thereafter. The decrease of ERPF and the increase of RI in the right kidney were correlated with the degree of obstruction. There was also a dramatic increase of Tnof the right kidney that correlated with the degree of obstruction. Concomitantly, there was a significant compensatory increase of ERPF and a significant decrease of the RI of the left kidney in both groups. The compensatory increase in ERPF limited the loss in total ERPF in both groups. The contribution of obstructed kidney to the total ERPF was significantly reduced in both groups. At the end of the eighth week, taking all kidneys together, there was a statistically significant negative correlation between the ERPF and RI, and between ERPF and Tn, and a positive correlation between Tnand RI.Conclusions Unilateral partial ureteric obstruction increased the RI and Tnand decreased the ERPF of the corresponding kidney, together with a decrease of RI and an increase in ERPF of the contralateral kidney. The more severe the obstruction, the greater the increase in RI and Tnand the decrease in ERPF. After the obstruction stabilized, RI and Tnwere positively c

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02244.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To assess the efficacy of the pulsed holmium:YAG laser for the fragmentation of ureteric stones.Patients and methods One hundred patients (72 males and 28 females, age range 14 months–85 years) underwent 114 ureteroscopic procedures using either a 7.2 F semi‐rigid or 9.5 F flexible ureteroscope. A holmium:YAG laser (Sunrise Technologies, Fremont, Ca, USA) was used for laser lithotripsy at a maximum energy of 1.0 J/pulse at 5 Hz. Most of the stones (46%) were located in the upper third of the ureter. The mean size of the stones was 9×8 mm and the mean duration of the procedure was 73 min (including anaesthesia) with a mean hospital stay of 2.7 days.Results All the stones were accessed successfully using miniaturized endoscopes either retrogradely or antegradely. The holmium laser effectively fragmented all types of stones. Total clearance of all stones fragments was achieved in 87% of cases, with the best results obtained for stones in the lower third of the ureter (96%). The complications attributed directly to the laser included three strictures and three perforations of the ureteric wall.Conclusion The holmium:YAG laser was effective in fragmenting ureteric stones irrespective of their hardness. However, it has the potential to damage the ureteric wall and must

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00105.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To study the morphology and function of the upper urinary tract over the long‐term in dogs with an enterocystoplasty and a refluxing or anti‐refluxing uretero‐intestinal anastomosis.Materials and methods Subtotal cystectomy and ‘cup’ ileocystoplasty were performed in 13 dogs. The right ureter was implanted into the cystoplasty with a refluxing technique in seven and with an anti‐reflux procedure in six dogs. The le ft renal unit acted as an intact control in 11 dogs, while in two the intramural part of the left ureter was incised to produce reflux. Thus, of the 26 renal units, nine had a refluxing junction (anastomosis), six were anti‐refluxing and 11 served as intact controls. Total and separate glomerular filtration rates (GFRs) were measured pre‐operatively and regularly thereafter, and cystometry, urography and ascending enterocystography were performed. At necropsy, urine was obtained for culture from the cystoplasty and renal pelves, and both kidneys were examined histologically.Results The cystometric pressure was low in 12 of the 13 dogs; urography showed no obstruction. The fall in separate GFR did not differ significantly among the groups (with and without reflux protection, and control units). Reflux was detected in three of nine renal units with refluxing anastomosis and in three of 11 control units. Bacteriuria was found in the cystoplasty in all dogs; the incidence in the upper urinary tract was seven of eight renal units with a refluxing anastomosis, one in five of those with an anti‐refluxing anastomosis and three of nine control units. Pyelonephritis was found in none of the control kidneys, in six of nine kidneys with a refluxing and in two of six with an anti‐refluxing anastomosis; it was less severe in the latter.Conclusion Refluxing ureteric implantation in a low‐pressure enterocystoplasty was commonly associated with bacteriuria in the upper urinary tract and with pyelonephritis. Thus, anti‐reflux implantation was beneficial for ren

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02376.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objectives To: (i) describe the sociodemographic characteristics of women undergoing surgery for stress incontinence in the UK and the ways in which they differ from women of a similar age in the general population; (ii) the severity and impact of their symptoms and their expectations of surgery and; (iii) their general state of health.Patients and methods A prospective cohort study was carried out on 442 women undergoing surgery for stress incontinence in 18 hospitals in the North Thames region between January 1993 and June 1994. Sociodemographic factors, stress incontinence severity, symptom impact scores, and general health status were measured.Results Women undergoing surgery for stress incontinence were similar to their peers in the general population apart from being more likely to have smoked (61.4 against 51.1%), to have subsequently given up (39.5 and 25.3%) and to be of higher parity (≥4; 19.7 and 12.0%). Most women (81.6%) reported moderate to very severe stress incontinence. The impact of symptoms was correlated positively with severity (P<0.001) after accounting for its positive correlation with mental health status (P<0.005), socioeconomic status (P<0.05) and its negative correlation with age (P<0.02). Many women also suffered from other urinary symptoms including urgency (76%) and frequency (42.3%). Apart from their urinary problems, women were in good health (77% reported no or only mild coexistent conditions). However, a very high proportion (34.2%) had previously undergone a hysterectomy.Conclusions These results suggest that women undergoing stress incontinence surgery are remarkably similar to their peers, apart from their primary condition. The effect that stress incontinence has on women's lives depends not only on the severity of the problem but also on other factors. The high rate of previous hysterectomy warrants furt

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02607.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To compare estimates of bladder volume obtained by conventional real‐time ultrasonography with those obtained from magnetic resonance imaging (MRI) by the Cavalieri method of unbiased stereology.Subjects and methods The study comprised nine subjects (four men and five women, mean age 23 years, range 18–34) with no history of bladder disease. Before micturition, each volunteer underwent ultrasonography, immediately followed by MRI. The volunteers then voided, the true voided volume of urine was measured and the imaging protocols were repeated in the same order after micturition. The bladder volume was estimated from ultrasonography using the formula; volume=0.7 (L×TS×AP), (where L is the maximum supero‐inferior diameter, AP the maximum anteroposterior diameter and TS the maximum transverse diameter) and from MRI using the Cavalieri method. For each imaging modality, the volume of urine voided was estimated as the difference in the volume estimate before and after micturition.Results The mean percentage coefficient of variation for the estimates of bladder volume by ultrasonography was 2.17 before and 4.43 after micturition. There was no significant difference in the replicate estimates of each bladder diameter by ultrasonography before and after micturition (P=0.98). The MRI method consistently underestimated the voided volume; the mean discrepancy between the estimated voided volume and the true voided volume was 7.7 mL and –67.7 mL for the ultrasonographic and MRI estimates, respectively, which are significantly different (P=0.02) when assessed using a multifactor ANOVA. Further analysis using multiple‐range tests showed a significant difference between the voided volume estimated by MRI and the corresponding true voided volume. There was no difference between the voided volume estimated by ultrasonography and the corresponding true volume.Conclusion Ultrasonographic estimates of voided volume were more reliable than the those obtained using the MRI method. This is possibly due to a delay between micturition and the acquisition of MR images after micturition, which allowed the bladder to partly refill with urine. The empirical approach using measurements from ultrasonograms provides a fast and reliable technique; ultrasonography remains the recommended imaging modality for estima

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02398.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine whether any histological characteristics within the detrusor in cases of early interstitial cystitis (IC) predict the subsequent development of severe symptoms due to bladder contracture.Patients and methods The detrusor muscle component of bladder biopsies from 21 patients with IC was examined in sections stained with haematoxylin and eosin. Videocystometrography was performed at least 2 months after the biopsy and the patients were then followed up clinically for at least 3 years.Results The detrusor appeared normal in 13 patients; in eight there was evidence of detrusor myopathy. Patients with biopsies confirming detrusor myopathy were significantly more likely to have hypocompliant bladders than those with normal detrusor muscle histology (P<0.02). Over the following 3 years, six of the eight patients with detrusor myopathy developed progressively severe symptoms and required subtotal cystectomy and enterocystoplasty. None of the 13 patients without detrusor myopathy required bladder substitution.Conclusion In IC, detrusor myopathy is associated with bladder hypocompliance. Patients with detrusor myopathy appear to have more severe disease and are more likely to progress to bladder contracture requiring substitution enterocyst

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02599.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine the prevalence of human papillomavirus (HPV) DNA types 6, 11 and 16 in histological sections of human bladder cancer.Materials and methods Fifty‐five formalin‐fixed, paraffin‐embedded bladder tumour specimens were analysed for the presence of HPV infection using Southern blotting DNA hybridization and radiolabelled probes for HPV DNA types 6/11 and 16.Results Despite the detection of HPV DNA type 6, 11 and 16 in positive control samples and the successful detection of HPV DNA in anogenital cancer using the same technique, no HPV DNA was found in any of the bladder tumour specimens examined.Conclusions Using a technique with proven efficacy in the detection of HPV DNA from histological specimens, no HPV DNA was present in any of the bladder tumours examined. This finding is in agreement with most recently published studies suggesting that HPV has no significant role in the development of human b

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.25810.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY