摘要:

SummaryNocturnal enuresis is common. Although its aetiology remains unclear recent evidence increasingly supports the lack of a normal nocturnal increase in ADH leading to nocturnal polyuria exceeding functional bladder capacity. Sleep patterns are probably normal although an arousal disorder might be a factor. Treatment should follow careful evaluation to determine if one is dealing with ‘uncomplicated’ or ‘complicated’ enuresis. Complicated enuresis requires further investigation. ‘Uncomplicated enuresis’ always requires reassurance and patient and parent education. Resource centres such as ERIC can provide information and advice.Active treatment should be tailored to the patients age, motivation and parental wishes. Behavioural modification techniques yield the highest long‐term cure rate but require the most commitment and are rarely successful before the age of 7–8 years. Pharmacotherapy has been revolutionized by DDAVP which gives a response rate of up to 70% relatively free from side‐effects but at the price of a high relapse rate after medication. Imipramine is less expensive than DDAVP but may be fatal in overdose. Anticholinergics should be reserved for those patients with significant diurnal symptoms or those who fail first‐line pharmacotherapy.Overall patients and parents should be reassured by the high sp

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07259.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo examine the effectiveness and complication rate of extracorporeal piezoelectric shock wave lithotripsy (EPL) as monotherapy for the treatment of large renal calculi.Patients and methodsTreatment consisted of semi‐ambulant EPL as monotherapy combined with protective ureteric stenting in 84 patients. Three groups were established according to stone volume (borderline‐stone, partial and complete staghorn). An average of 18 230 shock waves was applied in 3.76 sessions to each patient.ResultsNo major complications were observed but there were minor complications in 33% of patients. Invasive auxiliary methods were necessary in only 12%. After a mean follow‐up of 9 months (n= 72), 54% of patients were stone‐free and in 22% the fragments passed spontaneously. Thus the success rate was 76%.Analysis of the three groups showed no difference in stone status during follow‐up. There was no relation between the outcome of treatment and stone volume. Analysis of the patients who failed to respond to treatment showed that they were treated for longer than the stone‐free group, with significantly fewer sessions per week (0.71 vs 1.28 sessions/week). It appears that higher rates of stone removal can be achieved with more frequent treatment sessions at shorter intervals.ConclusionWe consider semi‐ambulant EPL monotherapy to be a minimally invasive alternative treatment in patients with large renal calculi, including st

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07260.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate the immediate and long‐term results of a radical surgical technique in the treatment of renal tumours with extensive involvement of the inferior vena cava (IVC).Patients and methodsSeven patients with extensive involvement of renal tumours into the IVC were operated upon using a cardiopulmonary by‐pass, hypothermia and cardiac arrest to facilitate surgery. Wide exposure of the IVC in a bloodless field permitted complete removal of all visible tumour in each case. Histological sections confirmed renal cell cancer in six patients and Wilms tumour in a 15‐year‐old girl.Results All patients recovered well from their surgery with no major complications and spent one or two days in the Intensive Treatment Unit and an average of 13 days in hospital after the operation. Of the seven patients, four are alive and well with no obvious disease after an average follow‐up time of 30 months (range 8–54). The other three patients have died from disseminated renal cancer.ConclusionThis procedure provides good local control of the tumour and offers the only hope of cure in patients with this disease. In collaboration with the surgical cardiac team it can be safely carried out with acceptable morbidity an

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07261.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo examine the impact on survival of pulmonary resection in the treatment of renal cell carcinoma that has metastasized to the lung.Patients and methodsFrom June 1986 to July 1991, 19 patients were submitted to synchronous or asynchronous lung metastasectomy. Histological examination confirmed the presence of lung metastases from renal cell carcinoma in 16 cases (six synchronous and 10 asynchronous with a mean disease‐free interval of 23 months). In the other three cases, histological examination revealed tuberculomas, chondroid ham‐artoma and foci of anthracosis.ResultsTo date, among the six patients with synchronous lung métastases, three have died, two are progressing and one has no evident disease after a mean survival of 24 months. Among the 10 patients who underwent surgical resection of metachronous lung metastases, one has died, three are progressing and six have no evident disease (mean survival time, 43 months).ConclusionWhile the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (five out of six patients died or are in progression shortly after metastasectomy), the results after surgery of asynchronous lung metastases are encouraging, although the real efficacy of this treatment is still to be confi

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07262.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo investigate the susceptibility of primary renal cell carcinoma (RCC) and metastatic RCC to lymphokine‐activated killer (LAK) cells using three RCC cell lines derived from the primary and metastatic tumours in a male patient with advanced RCC.Materials and methodsThree RCC cell lines (named HANKS) were derived from a 44‐year‐old man with advanced RCC. HANKS‐Pr, HANKS‐Lu and HANKS‐LN were established from the primary lesion and the metastatic lung and lymph node lesions, respectively. The susceptibility of HANKS cell lines to 18 different LAK cells obtained from either patients with urological cancer or from healthy volunteers was studied. The three groups of LAK cells were divided as follows: (A) LAK cells from RCC patients (n= 6); (B) LAK cells from patients with transitional cell carcinoma (TCC)/prostatic carcinoma (CaP) (n= 4) and (C) healthy volunteers (n= 8). A51Cr‐releasing cytotoxic assay was used to determine susceptibility.ResultsThe mean percentage lysis of the HANKS cell lines to the 18 allogenic LAK cells were 28.1% in HANKS‐Pr, 20.2% in HANKS‐Lu and 10.4% in HANKS‐LN. The susceptibility of HANKS‐LN to LAK cells was significantly lower than that of HANKS‐Pr and HANKS‐Lu in all three groups (P<0.05). In contrast, the susceptibility of HANKS‐Pr was significantly higher than HANKS‐Lu in group A only (P<0.01).ConclusionThis is the first report to describe the different susceptibilities of primary RCC and metastatic RCC derived from the same patient. HANKS‐LN itself might be the least susceptible to LAK cells because it was not related to the source of LAK cells. Furthermore, RCC may affect the cytotoxicity of LAK cells to HANKS‐Pr. These data indicate there are at least two different types of mechanisms leading to the different susceptibil

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07263.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo compare trospium chloride (TCI), a quaternary ammonium derivative with atropine‐like effects and predominantly antispasmodic activity, with oxybutynin (Oxy) in terms of efficacy and adverse effects.Patients and methodsIn a randomized, double‐blind, multicentre trial, 95 patients with spinal cord injuries and detrusor hyper‐reflexia were studied. Treatment consisted of three doses per day over a 2 week period, with either Oxy (5 mg three times daily) or with TCl (20 mg twice daily) with an additional placebo at midday. TheResultswere evaluated with regard to changes inObjective(urodynamic) data and subjective symptoms as well as the incidence/severity of adverse effects.ResultsWith both drugs there was a significant increase in maximum bladder capacity, a significant decrease in maximum voiding detrusor pressure and a significant increase in compliance and residual urine; there were no statistically significant differences between the treatment groups. The percentage of patients who reported severe dryness of the mouth was considerably lower (4%) in those receiving TCl 2times20 mg/day than in those receiving Oxy (23%) 3times5 mg/day. Withdrawal from treatment was also less frequent in those receiving TCl (6%) than in those receiving Oxy (16%).ConclusionTrospium chloride and oxybutynin, judged in terms of Objective urodynamic parameters, are of substantially equal value as parasympathetic antagonists. However, assessment of tolerance in terms of adverse drug effects showed that TCl had certain advan

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07264.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo evaluate the outcome of the Stamey procedure for stress incontinence and to decide if it is an acceptable first‐line option for the treatment of patients.Patients and methodsBetween June 1987 and March 1993 67 women had Stamey bladder neck suspension carried out for the treatment of stress incontinence. In September 1993 all patients received a detailed questionnaire to ascertain their present status.ResultsImmediately after surgery 70% of patients were dry and 15% were much improved. At 6 months 56% of patients were dry and 21% were much improved. More than 1 year following surgery, of 58 patients responding only 31% were dry and 28% were much improved. More than 5 years after surgery only 18% of the 28 women responding were dry. The factors which were significantly associated with failure were obesity (P<0.005) and the number of pads used per day (P<0.05). Previous surgery may also be an important factor.ConclusionThe Stamey vesical neck suspension has a good early success rate but the results in the longer term are not acceptable. This operation should not be used as a first‐line treatment for stress incontinence and should be reserved for specific patient subgro

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07265.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo study the effectiveness of combining DNA ploidy and the blood‐group related membrane antigen Tn as bladder tumour markers which have been individually associated with high tumour grade and poor prognosis. In particular to (i) determine whether use of these two markers would improve tumour detection compared with either alone, particularly of high grade disease and (ii) determine whether intermediate rates of marker expression would occur in bladder cancer patients with no current tumour compared with those with a tumour and a control group with benign prostatic hypertrophy.Patients and methodsA total of 102 patients undergoing cystoscopic monitoring for either benign prostatic hyperplasia (BPH) or for transitional cell carcinoma (TCC) at the Repatriation Hospital and Flinders Medical Centre were included in the study. The patients comprised three study groups, those with BPH (n= 37), with TCC but no tumour present (n=38) and those with TCC and a tumour present at cystoscopy (n= 27). Exfoliated cells obtained from bladder washings at cystoscopy were double‐labelled using a monoclonal antibody to the Tn antigen and a DNA stain, pro‐pidium iodide and examined by flow cytometry.ResultsRates of marker expression in 2 7 patients with tumours were 30% for Tn antigen, 30% for aneuploidy and 48% for either marker. Marker expression was strongly associated with tumour grade, with no expression at grade 1, 38% (3/8) tumours at grade 2 and 90% (9/10) at grade 3. In patients with a history of bladder tumours but no current tumour, rates were intermediate (30%) compared with patients with current transitional cell carcinoma (42%) and control patients (19%).ConclusionThe use of Tn antigen combined with DNA flow cytometry can increase tumour detection, particularly of high grade, aggressive disease. Gradation of expression of these markers across patient groups at increasing risk of a tumour, with intermediate expression in patients with no current tumour, suggests that marker expression may be detecting a pre‐neoplastic stage of the disease, which is not possible with cytology. Given two parallel disease processes for superficial papillary and for high grade disease with invasive potential, the expression of high grade tumour markers in cells from cystoscopically normal bladders may represent a pre‐clinical stage of aggressive disease. The identification of patients at risk of invasive disease using combinations of tumour markers may offer advantages in clinical management, particularly when no tumour is present and therefore no histopatholog‐ical assessm

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07266.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo investigate the relationship between interphase cytogenetics and the grade and stage of bladderCancerin patients with transitional cell carcinomas of the urinary bladder.Patients and methodsBy use ofin situhybridization with chromosome‐specific DNA probes, the copy number of pericentromeric sequences on chromosomes 7, 10, 11, 17, 18, X and Y was detected within interphase nuclei in formalin‐fixed and paraffin‐embedded sections of the routinely processed bladder cancers from 20 patients. The percentage of hyperdi‐ploid cells (three or more spots) was estimated using light microscopy.ResultsThe percentage of hyperdiploid cells for chromosomes 7, 11 and 17 was highly correlated with increasing tumour grade (P<0.01, Spearman rank correlation) or increasing pathological stage (P0.05). As high tumour grade and stage are both indicative of more aggressive tumour behaviour and a worse prognosis, these findings suggest that the percentage of hyperdiploid cells, especially for chromosomes 7,11 and 17, may be highly predictive of bladder tumour aggressiveness.ConclusionThese preliminary results suggest that measurement of numerical chromosome aberrations usingin situhybridization in bladder cancer may offer a new objective and quantitative assay of the biological potential of individual

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07267.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the role ofin vivostaining with intravesical methylene blue in predicting tumour recurrence.Patients and methodsThirty‐nine patients (2 7 men and 12 women, age range 43–75 years) newly diagnosed with bladder tumours were prospectively studied and followed for a minimum of 2 years. Potential biopsy sites were identified by staining intravesically with a 1% methylene blue solution and compared with random biopsy sites.ResultsBiopsy directed by methylene blue staining detected carcinomain situmore often than random biopsy. Rates of recurrence were similar in both stained and unstained groups.Conclusionmethylene blue staining does not add significantly to the management of patients presenting with bladder tumo

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07268.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY