ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00071.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00052.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine the clinical applicability of ultrasound‐guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall.Materials and methods The detrusor structure in 22 biopsies, 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis. In addition, several specimens from each of three bladders were evaluated, also ‘blindly’, for ultrastructural diagnosis of the detrusor in an independent current study of voiding dysfunction in geriatric patients.Results There were no differences in intercellular distances and cell:nucleus ratios between transabdominal and transurethral biopsies in eight of the 11 patients. Furthermore, ultrasound‐guided transabdominal biopsies were as representative of the detrusor as were transurethral biopsies.Conclusion The transabdominal approach is recommended as an easy, relatively inexpensive and efficient method of obtaining biopsies of the detrusor for study of its structure in voiding dysfunction. On the other hand, the observations and diagnoses made by ‘blind’ qualitative study of several specimens from the same bladder were identical. This, together with the similarity of detrusor structure in the transabdominal and transurethral biopsies, strongly supports the idea that such structure is relatively uniform throughout the

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09893.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To describe the technique for and urodynamic changes during therapeutic instillations of intravesical capsaicin in patients with detrusor hyper‐reflexia.Patients and methods Ninety intravesicalinstillationsof capsaicin were performed as a therapeutic procedure in 30 patients; 21 patients had various causes of non‐traumatic spinal cord disease, five patients were very severely neurologically impaired and were bed‐bound with an indwelling catheter, and four were neurologically normal. Simultaneous cystometry was performed in 25 patients during the instillation of capsaicin; 100 mL of 1 or 2 mmol/L capsaicin in 30% ethanol/saline was instilled into the bladder for 30 min and two patients received 30% ethanol/saline only. The last 56 capsaicin treatments were preceded by the instillation of 40 mL of 2% lignocaine for 20 min. Detrusor hyper‐reflexia was decreased and urinary continence improved for 3–6 months after a single instillation; the instillation was then repeated. Two patients who received only ethanol/saline showed no clinical or urodynamic improvement.Results The treatment was not abandoned in any patient due to discomfort and there were no short‐ or medium‐term complications. All patients with spinal cord disease and phasic detrusor hyper‐reflexia had similar, frequent and repetitive detrusor contractions during the instillation of capsaicin. These acute reactive contractions did not occur in the neurologically normal patients. Similarly, the instillation of intravesical lignocaine only caused no phasic detrusor contractions. Intravesical lignocaine instillation before capsaicin markedly reduced and sometimes abolished the detrusor overactivity and lessened the discomfort for the patients. The instillation of lignocaine before capsaicin did not alter the benefit from each instillation of intravesical capsaicin.Conclusion A method has been developed for administering capsaicin intravesically which diminishes discomfort for the patient and in the short‐and medium‐term is free of complications. The study also provides functional evidence of the role of capsaicin‐sensitive afferents in phasic detrusor hyper‐

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09844.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To examine the alterations in the electrical properties of bladder smooth muscle in rats with diabetes mellitus (DM) induced by streptozotocin.Materials and methods The study comprised 34 control rats and 20 with DM induced experimentally by injection with streptozotocin. At 10–15 weeks after the induction of DM, control and treated rats were killed, the bladder removed and the electrical responses of membranes from the detrusor smooth muscle recorded using intracellular microelectrodes.Results The resting membrane potential of the smooth muscle remained unaltered by DM but the frequency of spontaneous spike discharges sensitive to nicardipine was decreased. Transmural nerve stimulation elicited a purinergic excitatory junction potential (EJP) in muscles from both types of rat, but the threshold intensity of stimulation required to evoke an EJP was higher in muscle from the diabetic rat. Furthermore, EJPs large enough to trigger a nicardipine‐sensitive spike potential could be elicited easily in muscles from the control rat, but not in muscles from diabetic rats. Stimulation of muscarinic receptors with exogenous acetylcholine (ACh) caused greater depolarization in muscle from diabetic rats. Stimulation of purinergic receptors with α,β‐methylene ATP caused a similar depolarization in both groups of rats. Application of potassium‐free solution or ouabain depolarized the membrane by about 9 mV or 5 mV, respectively, in muscles from both groups of rat. Removal of potassium‐free solution produced an ouabain‐sensitive transient hyperpolarization which was larger in muscle from control rats, indicating that the potency of the Na‐K pump was weakened in rats with DM.Conclusion In the detrusor smooth muscle of rats with DM, there were fewer spontaneous spike discharges, supersensitivity of post‐junctional muscarinic receptors, reduced potency of the post‐junctional Na‐K pump and a decrease in the release of neurotransmitter, possibly due to the impairme

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00045.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome.Patients, subjects and methods Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of ‘bother’ that symptoms were causing. Eighty‐five women with clinical symptoms attending for urodynamic assessment and 20 women with nonewere asked to self‐complete the questionnaire. The instrument's validity was assessed by interviewing patients and measuring levels of missing data, comparing symptom scores between clinical and non‐clinical populations and comparison with frequency/volume charts and data from pad tests. The instrument's reliability was assessed by measuring both internal consistency and stability, using a 2‐week test‐retest analysis.Results The questionnaire was completed by the patients with a mean of only 2% of items missing; most questions were easily understood. Construct validity was good, with the instrument easily differentiating clinical and non‐clinical populations. Criterion validity, as tested against frequency/volume charts and pad‐test data, was acceptable, with Kappa coefficients of 0.29–0.79 for frequency/volume data and Spearman rank correlations of 0.50–0.97 and 0.31–0.67 for frequency/volume and pad‐test data, respectively. The reliability of the instrument was good; a Cronbach's alpha of 0.78 indicated that the symptom questions had high internal consistency, while stability was excellent, with 78% of symptoms and problems answered identically on two occasions, and Spearman rank correlations of 0.86 and 0.90, respectively.Conclusion The instrument has good psychometric validity and reliability. The stability demonstrated at baseline and the ability to differentiate clearly between community and clinical populations suggest that it should be ideal for measuring changes following therapeutic intervention. The addition of life‐impact items and a ‘bother’ factor may provide the opportunity to identify those women who wish treatment for their symptoms; this

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00186.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To assess the variability of free‐flow studies in men presenting with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to determine the sensitivity, specificity and predictive values of consecutive measurements of maximum flow rate for the presence of bladder outlet obstruction (BOO) at several threshold values.Patients and methods The value of multiple free‐flow studies was assessed in 165 men presenting with LUTS suggestive of BPO. Each patient was requested to void four times into a uroflowmeter and the voided volume and post‐void residual urine volume (PVR) were also measured. The variability of the maximum flow rate (Qmax ), voided volume and PVR between consecutive voids was assessed. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various thresholds of Qmaxfor the presence of BOO were calculated for each consecutive void.Results The mean Qmaxon void 1 was 10.2 mL/s and the mean maximum value for Qmaxbetween voids 1 and 2 was 12.5 mL/s. For voids 1, 2 and 3, the mean maximum Qmaxwas 13.9 mL/s and for voids 1 to 4 it was 15.2 mL/s. There were no significant changes in PVR among any of these voids. There was a statistically significant, although small, decrease in voided volume between voids 1 to 3 and voids 1 to 4. The specificity and PPV of Qmaxfor BOO increased with each subsequent void, such that using a threshold value for Qmaxof 10 mL/s on the fourth void, the specificity and PPV for BOO were 96% and 93%, respectively.Conclusions There was a significant increase in Qmaxwith each successive void when men with LUTS suggestive of BPO performed multiple free‐flow measurements and consequently, single free‐flow measurements substantially underestimated the maximum Qmaxthat these patients achieved. The specificity and PPV of Qmaxfor BOO can be improved considerably by performing multiple free‐flow studies and by carefully selecting an appropriate threshold value (although whether pressure‐flow studies are unnecessary will depend on what level of specificity and PPV is deemed acceptable in clinical practice). These findings should be considered if free‐flow studies are to be used as the basis for deciding the clinical management of men with LUTS and may be particularly useful for urologists with limited facilities

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00097.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To develop a method of determining the characteristics of epirubicin resistance and to study the reversal of such resistance in the intravesical treatment of superficial bladder cancer, using sensitive and resistant derivatives of a bladder cancer cell linein vitro.Materials and methods Epirubicin fluorescence and flow cytometry were used to measure the intracellular levels of epirubicin in both sensitive and resistant live cultured bladder tumour cells, with and without different doses of the resistance‐reversing agent verapamil.Results There was a reliable, highly significant and consistent difference in intracellular epirubicin concentration between the resistant and sensitive bladder tumour cells. In addition, it was possible to substantially reverse the features of resistant cell subline with additional verapamil.Conclusion Application of this assay to clinical specimens should allow better targeting of epirubicin intravesical chemotherapy and avoid the premature termination of such treatment in patients whose tumours remain sensitive to this agent. Furthermore, the addition of verapamil to intravesical epirubicin may permit effective treatment of those patients whose tumours have inherent or acquired resistance to e

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09038.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate the use of confocal microscopy in the study of resistance to epirubicin and to determine the effect of temperature, viability and a resistance‐reversing agent on the intracellular distribution of this drug in sensitive and resistant derivatives of a superficial bladder cancer cell line.Materials and methods Viable and non‐viable adherent cells were incubated in epirubicin solutions under various conditions. After incubation, the distribution of intracellular epirubicin fluorescence was visualized using confocal microscopy and a ×50 water‐immersion lens.Results There was a striking and consistent difference between resistant and sensitive cells in the intracellular distribution of the drug. In addition to having greater overall levels of epirubicin fluorescence, sensitive cells accumulated epirubicin predominantly in the nucleus. Epirubicin fluorescence in resistant cells was cytoplasmic and granular in appearance. When incubated at 0°C, both cell lines showed no nuclear uptake and thus resembled resistant cells at 37°C. However, dead cells rapidly acquired brightly fluorescent nuclei. The resistance‐reversing agent verapamil appeared to cause reversion of the resistant to the sensitive phenotype.Conclusion Confocal microscopy allows epirubicin‐sensitive and resistant cultured tumour cells to be differentiated reliably and provides information about the mechanisms of action of, and resistance to, epirubicin. Applying this technique to clinical specimens should enable patients who have the resistant phenotype to be detected and the efficacy of intravesical resistance‐reversing agents to be e

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.09539.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To establish a hospital based shared‐care clinic to investigate and manage benign prostatic hyperplasia (BPH) with general practitioners (GPs).Patients and methods During one year, 330 patients referred with suspected prostatic obstruction were investigated in an outreach clinic in a rural cottage hospital by urology department nurses according to a protocol. After this, they were referred directly back to their GPs with recommendations for their management or seen in the urologist's clinic. A questionnaire was completed by the GPs to assess their satisfaction with and attitudes to the clinic.Results One‐third of the patients were referred directly back to their GP, a third were seen routinely and a third seen urgently in the urologist's clinic, usually because a prostate‐specific antigen assay indicated the possibility of latent prostatic cancer. A survey confirmed that GP support for the clinic was unanimous whilst patients were reassured by the thoroughness and sensitivity of the clinic's nursing staff.Conclusion The clinic reduced the workload of the GPs and urologists whilst providing a speedy and comprehensive assessment of patients presenting with suspected prostati

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.00810.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY