ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07334.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07335.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo describe the technique and report our experience of laparoscopic nephrectomy.Patients and methodsBetween August 1992 and December 1993, 106 patients underwent laparoscopic nephrectomy at the Mansoura Urology and Nephrology Center.Results Of the 106 patients, laparoscopic nephrectomy was performed successfully in 97 cases. Conversion to an open procedure was necessary in the remainingnine patients.ConclusionFor a selected group of patients, laparoscopicnephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and return to work is rapid.

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07336.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the results and cost implications of laparoscopic nephrectomy.Patients and methodsTen patients underwent attempted laparoscopic nephrectomy and nephro‐ureterectomy. The cost of the laparoscopic procedures was estimated to allow comparison with that of open surgery.ResultsTwo patients required conversion to an open procedure, one for a colonic tear, the other for irretrievable loss of pneumoperitoneum. The median operating time for successful cases was 3 h (range 2.5‐4). The mean morphine equivalent of analgesia delivered per patient was 18 mg (range 10–28). There was no mortality. Post‐operative complications consisted of one case of prolonged ileus and another of chest infection. The median hospital stay of successful cases was 5 days (range 4–17), and the mean time to return to normal activity was 4 weeks (range 3–6). The cost of the procedure using re‐usable instruments was approximately £2000, comprising £100 for equipment, £900 theatre costs and £1000 for hospital stay. Using disposable equipment adds up to £900 to the cost. In comparison an open nephrectomy typically costs around £2300.ConclusionLaparoscopic nephrectomy is associated with lower analgesia requirements, shorter hospital stay and quicker return to work than equivalent open procedures. The cost, particularly when performed with re‐usable instruments, is not prohibitive being comparable with that of open nephrectomy. With further experience it should become part of the armamentarium o

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07337.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes.Patients and methodsOne hundred consecutive patients underwent laparoscopy for 128 impalpable testes. They ranged in age from 2.7 to 19.3 years (median 10.8). Histological examination was performed on 39 testicular biopsies, nine primarily orchidectomized testes and 13 tissue samples from the end of blind‐ending vessels and vasa deferentia. Any additional diagnoses to that of impalpable testes were recorded.ResultsThere were no complications associated with laparoscopy and the procedure clarified the situation in all patients. In 50% of patients either blind‐ending cord structures above the internal inguinal ring or intra‐abdominal testes were identified; in the remainder, cord structures could be seen passing through the ring, indicating an intracanalicular testis. The impalpable testis was absent in 77% of patients with a contralateral scrotal testis. A seminoma was found in one 18.6‐year‐old patient with bilateral cryptorchid‐ism. No intratubular germ cell neoplasia (carcinomain situ) was found. Germ cell hypoplasia or aplasia was demonstrated in 95% of patients with testicular parenchyma. Additional diagnoses were made in 49% of patients with bilaterally undescended testes (one or both of which were impalpable).ConclusionWe recommend laparoscopy as a safe procedure which leads to a diagnosis in patients with impalpable testes; the advent of laparoscopic procedures makes definitive treatment possible in about 50% of such patients. Open procedures will be indicated only to ascertain the quality and treatment of intracanalic

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07338.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo measure the ionized Ca2+in urine from normal subjects and patients with urinary tract stones.Patients and methodsUrine samples were obtained from 37 normal subjects and 52 stone‐formers. Ca2+was measured using plastic dip‐cast ion‐selective electrodes; total Ca and other variables were measured by standard analytical techniques.ResultsThe ionized Ca2+and the total Ca were greater in stone‐formers' urine although the difference was more significant with the Ca2+data, especially at a standardized pH. Absolute values of the Ca2+were dependent on the type of reference electrode used. The Ca2+was a function of urine pH; lower values were recorded as pH increased. Measured values of the Ca2+did not correlate well with calculated values using a standard computer program.ConclusionsMeasurement of the Ca2+in spot urine samples at a standard pH provides a more discriminative test than total Ca for the presence of urinary tract stones. The pH dependence of the Ca2+may have important consequences in the formation of urinary tract stones. The poor correlation between measured and computed values of Ca2+emphasizes the importance of accurate measurement of this v

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07339.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectivesTo assess the accuracy and reproducibility of methods used to measure glomerular filtration rate (GFR) in clinical practice.Patients and methodsSimultaneous clearances of iohexol,99mTc‐diethylene‐triamine‐penta‐acetic acid (DTPA), 24 h renal creatinine clearance and creatinine clearance estimated from a serum sample only, were obtained in 31 patients. Accuracy was calculated relative to iohexol clearance. The reproducibility of each method was determined by repeat measurements in the same individuals: three99mTc‐DTPA clearances in 21 patients; three 24 h creatinine clearance estimations in 12 patients; and three serum creatinine clearance estimations in 21 patients.ResultsThe mean differences between99mTc‐DTPA clearance, 24 h renal creatinine clearance and estimated creatinine clearance compared with the reference method were 0.2 mL/min, 21.6 mL/min and 0.6 mL/min, respectively.99mTc‐DTPA clearance had fairly tight 95% limits of agreement (12.2 mL/min) compared with 35.4 mL/min for 24 h creatinine clearance and 25.8 mL/min for estimated creatinine clearance. The reproducibility for each method was 5.4%, 24.3% and 6.1%, respectively.ConclusionSingle‐injection99mTc‐DTPA clearance provides an accurate and reproducible method of GFR measurement that is suitable for objective monitoring of renal function. Twenty‐four hour creatinine clearance is neither sufficiently accurate nor reproducible for this purpose. Creatinine clearance estimation from a serum sample without urine collection may be preferable to the more traditional 24

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07340.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation.Patients and methodsA total of 5361 patients, who represented 89% of all those undergoing prostatic procedures in four health regions (Mersey, Wessex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collected on a pre‐coded data collection form which was completed during the hospital stay by the principal operator. Patient identification occurred at the time of surgery.ResultsImportant findings included: (i) both older men and those of higher social class were more likely to undergo prostatectomy with fewer symptoms; (ii) men who waited longer for surgery had worse symptoms by the time of their operation; (iii) there were unexplained differences in routine pre‐ and post‐operative investigation and treatment. Half the men had their flow rate or residual urine measured as part of their pre‐operative assessment. About half the men received prophylactic antibiotics; (iv) when large groups were analysed, a consistent proportion of men throughout the study (12%) were undergoing the operation for a second time. The clinical course of men having a repeat operation differed in many ways from those having a first time procedure; (v) the larger proportion of men (62%) had surgery for strong indications as opposed to symptoms alone; (vi) although most operations were performed by consultants, emergency admissions, though symptomatically more severe and sicker, were more likely to be operated on by trainee surgeons; (vii) significant variation in mean pre‐operative symptom severity and bother scores were seen between surgeons.ConclusionThe clinical management of prostatectomy has been defined in a large and representative UK sample. In some circumstances consistent variations have been identified. It is not yet clear whether these variations influence outcome. These data can be used by surgeons wishing to compare their own patient management with that descr

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07341.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo determine whether histological analysis of six multiple random biopsies of the gland or analysis of only one biopsy provides a good estimate of the different components of the hyperplastic gland compared with the results obtained from tissue specimens {reference values).Materials and methodsThe various components of prostate tissue obtained from 30 men undergoing suprapu‐bic adenomectomy were investigated. The histological analysis was performed on multiple tissue specimens reflecting adenoma (reference values) and on one and six biopsies performed at random on the enucleated material of the hyperplastic gland. Immunohisto chemistry using anti‐actin as a label of smooth muscle and specific histological staining coupled with computer‐assisted quantitative morphometric analysis was used to ascertain the histological composition of the prostate.ResultsThe mean (±SD) area densities obtained from tissue specimens were 34.1 ±5%, 32.4 ± 6.9%, 17.6 ±4.5% and 15.9 ±5.5% of smooth muscular and fibrous tissue, and epithelium and glandular lumen, respectively. The mean ratio of stromal to epithelial hyperplasia averaged 4.05 ± 1.73. Both one and six biopsies gave a good estimate of fibrous tissue and glandular epithelium, but the percentage of smooth muscle was overestimated and the percentage of glandular lumen was underestimated. There was a significant relation between the prostate area densities of glandular epithelium (r=‐0.41, P<0.05), the percentage area density of prostate smooth muscle (r=0.43, P<0.05), and the weight of enucleated adenoma. No correlation was found with prostate‐specific antigen (PSA).ConclusionIt seems feasible to propose medical treatment of benign prostatic hyperplasia (BPH) based on the histological composition of the prostate gland. One biopsy, reflecting in good proportions the nature of the adenoma, would be used to provide insight into the pathogenesis and

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07342.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

ObjectiveTo assess the efficacy of the new, second generation UroLume (American Medical Systems) prostatic stent.Patients and methodsForty‐seven men with symptomatic and objective evidence of bladder outflow obstruction who were fit for a transurethral resection accepted, as an alternative, the insertion of a new prostatic stent which shortens less than its predecessor.ResultsIt was possible to insert the stent into 44 of the 47 men. All patients voided spontaneously following stent insertion. Thirty‐three patients had their stent inserted either as a day case or with an overnight stay. Six patients were lost to follow‐up and two died. Of the remaining 36 patients 22 have now been followed for 2 years, with a mean obstructive score of 1.6 (range 0–12), a mean irritative score of 2.5 (range 0–10) and a mean peak flow of 16.8 mL/s (range 3–31). Fourteen stents had to be removed; in the majority of cases this was because of stent migration or the development of epithelial hyperplasia within the lumen of the stent.ConclusionBecause of the development of epithelial hyperplasia and stent migration in approximately one‐third of men in this study, a third generation stent has now been developed. Before permanently implanted stents can be recommended for widespread use, the efficacy of new stents should be assessed in specialist units with large numbers of patients and adequate facilities

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1995.tb07343.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY