ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15687.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A series of 21 patients with hydronephrosis (mean age 37 years) underwent an Anderson‐Hynes pyeloplasty; a nephrostomy catheter was not used routinely. One patient developed urinary leakage post‐operatively but this ceased following insertion of a ureteric catheter. Assessment was carried out after a mean observation time of 85 months. Clinical examination, laboratory investigations, urography and renography were performed pre‐operatively and at follow‐up. There was no evidence of stones or stenosis in the pelvis. Patients operated upon before the age of 30 years showed improved renal function. All patients had symptoms pre‐operatively but only one had symptoms post‐operatively. It was concluded that the results of surgical intervention in hydronephrosis are excellent, especially in patients aged less

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15688.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A series of 155 patients who underwent nephrectomy for renal carcinoma between 1965 and 1985 at Manchester Royal Infirmary were analysed for survival in relationship to presenting features, surgical staging and histopathology. Univariate and multivariate analyses were carried out. Five‐year survival estimates for stage 1 disease were 81%, for stage 2 disease 65%, for stage 3 disease 39% and for stage 4 disease 6%. An erythrocyte sedimentation rate (ESR) greater than 30 mm/h was associated with worse survival and a history of hypertension was associated with better survival. Renal vein invasion alone was related to worse survival. Perinephric fat invasion was also associated with worse survival and this association in the multivariate analysis was more significant than expected, suggesting that the principles of radical surgery should be observed. The presence of granular cells as opposed to clear cells worsened survival. Patients with papillary tumours had a better survival than those with solid tumo

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15689.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—The effect of peri‐operative blood transfusion on survival after surgery for renal carcinoma was studied in 201 patients. In addition to blood transfusion, several other factors were included in a multivariate analysis. Using Cox's proportional hazards model, transfusion of more than 4 units of blood was found to be an independent prognostic factor in addition to tumour stage, erythrocyte sedimentation rate and macrohaematu

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15690.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—Of 507 consecutive recipients of renal allografts, 45 developed a urological complication. In 39 patients (7.7%) ureteric problems were implicated and these comprised 30 cases of obstruction and 9 cases of ureteric necrosis presenting as urinary leakage.In 7 patients ureteric obstruction resolved following a period of nephrostomy decompression; 10 patients were reconstructed surgically and this was successful in 8, with 2 patients requiring further surgical procedures. Ten patients were successfully treated by percutaneous stenting after dilatation of the stricture. Stenting failed in 4 patients and in 1 patient caused rupture of a calix. All 10 stents have now been removed and there is no recurrence of stricture (follow‐up 32.0 ± 8.6 months). Of the remaining 3 grafts, 2 were removed and the other graft had percutaneous removal of a ureteric calculus.The 1‐year survival rate of allografts in the ureteric complication group was 84.6%; in the recipients without a urological complication it was 81%.It was concluded that an active approach to ureteric problems following renal transplantation results in the rescue of the majority of allo

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15691.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A group of 30 consecutive patients (26 men and 4 women, mean age 51 years), with clinically and radiologically verified cervical spondylosis causing radiculopathy and/or myelopathy, were questioned about voiding symptoms, examined urodynamically and subjected to tests of tibial somatosensory evoked potentials (SEP). Seventeen patients (61%) complained of irritative bladder symptoms and detrusor hyperactivity was demonstrated urodynamically in 13 (46%). Three (11%) experienced difficulty in emptying the bladder, and all of these had a hypotonic detrusor. The bladder was insensitive to cold in 36%, this and SEP abnormalities being more common in the patients with clinically severe myelopathy, whereas detrusor hyperactivity was found equally in all patients. Urodynamic investigation seems to provide additional information on the severity of the disease and is therefore recommended for wider use in these patient

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15692.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A total of 86 consecutive patients who presented to the accident and emergency department with acute urinary retention due to prostatomegaly required catheterisation; 56 received suprapubic catheters and 30 were catheterised urethrally. Both groups were followed up for 3 years.Of the 30 patients catheterised urethrally, 12 (40%) developed urinary tract infections compared with 10 (18%) urinary tract infections in the 56 patients catheterised suprapubically. Five patients (17%) in the urethral group developed urethral strictures with no strictures in the suprapubic group. Two patients catheterised urethrally developed epididymo‐orchitis and 1 developed septicaemia. None of the patients with suprapubic catheters developed these complications. Furthermore, 16 patients catheterised suprapubically underwent successful trial clamping of their catheter, whereas 7 patients required recatheterisation following removal of their urethral catheters.We recommend that the use of suprapubic catheters should become the preferred initial treatment for acute urinary retent

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15693.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—Microendoscopic observation of methylene blue‐stained urothelial surfaces, so‐called microscopic chromocystoscopy (MCC), was undertaken in 65 patients with superficial bladder cancer (Ta and T1) and its effectiveness in detecting concurrent urothelial dysplasia or carcinomain situwas studied. A total of 166 biopsy samples were taken from 75 stained and 91 non‐stained portions. Of 75 methylene blue‐stained areas, 21 were judged to be abnormal (MCC‐positive) by microscopic observation. Fourteen of these 21 MCC‐positive areas (67%) were proven to be abnormal histologically, while 7 of 54 MCC‐negative portions (13%) were histologically abnormal. Only 4 of 91 biopsies (4%) from non‐stained mucosa were proven to have urothelial atypia. In per patient figures, 1 or more concurrent field changes were detected in 15 of 65 cases (23%). MCC contributed to the diagnosis in 10 of

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15694.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted.There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3).A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted.This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning “established” surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be intro

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15695.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A total of 51 patients with locally advanced transitional cell carcinoma of the bladder were entered into a phase II study to evaluate the effect of initial cisplatin (100 mg/m2, Day 2) combined with methotrexate (30 mg/m2. Days 1 and 8) and vinblastine (4 mg/m2, Days 1 and 8). Of 44 evaluable patients, 25 (57%) achieved an objective response of their primary bladder tumour (complete response (CR): 4 patients; partial response (PR): 21 patients); 30 of the 36 patients with micturition disturbances obtained relief. Toxicity was acceptable, but dose modifications due to haematological or renal toxicity were required in 153 of the 690 drug courses. Non‐protocol dose modifications were performed 45 times.The experience gained in this trial emphasises the need for improved co‐operation between urologists, radiologists and clinical oncologists in such multicentre phase II studies. Difficulties were observed in adhering to dose modification rules, assessing pre‐treatment tumour size (due to variation in quality of measure and in timing relative to initial transurethral resection (TUR)) and defining response to chemotherapy (due to failure to perform mandatory investigations at the right time). This study also illustrates that the accepted criteria for assessing response in the primary bladder tumour are difficult to apply in practice and that the results of any study using this indicator lesion require caution in their interpr

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15696.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY