ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15903.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Measurement of ureteric function has hitherto involved the use of invasive techniques. A non‐invasive, radioisotope method of imaging and displaying individual ureteric boluses has been described, a refinement of which is used in this department. Each “spindle” displayed using this technique theoretically represents an individual ureteric bolus of urine, but the technique has never been validated in the normal ureter in either the experimental model or man.A porcine model was set up to allow simultaneous measurement of ureteric bolus transmission using the radioisotope (compressed image) method and by the accepted techniques of electromyography (EMG) and urine drop counting. The timing of each urinary bolus, as recorded by the different modalities, was then compared.The results from 11 studies showed a significant correlation between the radioisotope and EMG methods (mean r= 1.00,P=0.0003). There was a constant relationship between the part of the radioisotopic image representing the rear end of the bolus and the EMG complex (mean time difference = 5.32 ± 1.067s), thus defining that part of the image representing the peristaltic contraction wave. There was a variable relationship between the EMG and the part of the image representing the leading edge of the bolus (mean time difference = 13.36 ± 5.23s), emphasising that bolus length is variable, being dependent on bolus volume.The radioisotope “spindle” concurs with EMG activity in the porcine ureter. The compressed image technique is thus validated as a non‐invasive method of demonstrating ureteric

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15904.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—A new method for discriminating between the urine of potential calcium stone formers and healthy persons has been proposed, based on determination of the calcium binding capacity of urine (CBC) by titration of early morning urine with a calcium chloride solution. For this purpose a new PVC matrix calcium ion selectrode for measuring calcium ion concentration in whole urine was used. The selectrode has a disposable membrane which can easily be prepared and replaced in the laboratory. Plots of the calcium ion concentration versus the concentration of total added calcium were linear up to a point where precipitation of calcium salts commenced. The slopes of these titration lines were used as criteria for discrimination. Statistical evaluation showed good separation between the urine of healthy and stone forming donors. A 2‐samplettest with unequal variances gave mean values of 0.31 for healthy urine (13 samples) and 0.64 for stone forming urine (26 samples). Individual 99% confidence intervals were 0.21‐0.40 for the controls and 0.54‐0.73 for the patients respectively. D iscriminant analysis showed that from a group of treated patients with low DI (13 samples), 3 were classified as stone formers and 10 were non‐formers. Thus there was good correlation with the clinical situation and with the previously propose

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15905.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—We have studied the inhibitory effects ofDesmodium styracifolium‐triterpenoid(Ds‐t) (extracted fromDesmodium styracifolium (Osbeck) Merr, a herbal medicine) on the formation of calcium oxalate renal stones induced experimentally by ethylene glycol (EG) and 1α(OH)D3(1αD3) in rats.The incidence of urinary stone formation was 81% in the control group, which received EG and 1αD3, and 29% in the Ds‐t group, which received EG and 1αD3supplemented by Ds‐t. The serum calcium (Ca) concentration in the Ds‐t group was significantly elevated and urinary Ca excretion was markedly reduced. Urinary excretion of citrate (Cit), a factor that prevents stone formation, was significantly increased in the Ds‐t group. Excretion of urinary phosphorus (P), which was elevated to a significantly greater extent in the controls than in the Ds‐t group, was increased in both groups. The increase in urine volume in the Ds‐t group was significantly greater than in the control group. The 24‐h creatinine clearance rate (Ccr) was significantly lower in the controls. These findings suggest that Ds‐t inhibits the formation of Ca oxalate stones in rat kidneys by increasing the output of urine, decreasing the excretion of calcium and increasing the urinary excretion of citrate.Ds‐t may be useful in preventing the recurrence of urinary Ca oxalate sto

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15906.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—The role of retrograde ureterography in the management of pelviureteric junction (PUJ) obstruction remains controversial and it has recently been reiterated that visualisation of the entire ureter on the affected side is mandatory owing to the high incidence of other ureteric abnormalities. In a review of 119 consecutive adult pyeloplasties carried out over a 9‐year period, only 2 ureteric abnormalities were found in association with PUJ obstruction (duplex ureter/3‐cm proximal stricture). Other anatomical abnormalities included aberrant vessels, fascial bands and renal anomalies. Most secondary abnormalities were undiagnosed prior to surgery and all were easily dealt with per‐oper

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15907.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—A total of 49 retrograde balloon dilatations for pelviureteric junction (PUJ) obstruction were carried out on 43 pelviureteric junctions in 42 patients from 1986 to 1991. The majority (34/ 43) were performed as primary treatment for PUJ obstruction, with 9 patients having a history of previous open pyeloplasty. Follow‐up ranged from 3 months to 4 years (mean 18 months). Clinical improvement, as assessed by absence of symptoms, was seen in 34 cases (80%). There was either no change or an improvement in renographic findings (t1/2 time and/or split function) in 40 patients (93%). Of the 9 patients who were undergoing secondary treatment, 5 showed clinical improvement and 8 showed no change or renographic improvement. Nine patients required 12 further procedures, of which 5 were interval nephrectomy.Balloon pyelolysis is a simple procedure with good results over a 4‐year follow‐up period. It is less effective for the treatment of secondary pelviureteric junction obstruction. It has a low morbidity and no mortality, involves a short hospital stay and allows an immediate return to full activity. It is therefore an attractive alternative to open pyeloplasty as first‐line treatment for PUJ ob

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15908.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—This study was designed to investigate non‐invasively human ureteric function between individuals and with increasing diuresis, using the radioisotope compressed image technique.Five normal males underwent fast frame renography with ureteric spindle imaging in dehydrated and hydrated states, urine production being measured in each individual for each scan.Urine flow rates and renographic parameters demonstrated that each ureter carried more urine in the hydrated state. The velocity at which individual boluses passed down the ureter was constant for each ureter and did not change with diuresis.The ureteric peristaltic rate showed wide individual variation between ureters in the same subject, but fell within what is becoming accepted as the “normal range” of<4 urine boluses per minute.Some ureters accommodated an increase in urine flow by an increased peristaltic frequency, some showed no change and others showed a decreased frequency. In those ureters in which there was no change, or a decrease in perstaltic frequency with diuresis, the increased urine flow must have been handled by increases in bolus volume. Thus increases in ureteric urine flow in man are accommodated by changes in both peristaltic frequencyandbolus size.The results are discussed in relation to previous studies which used invasive tec

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15909.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—We have completed a 19‐year audit of all patients referred to the urodynamic/ continence unit since its inception in 1972 and their subsequent clinical management; a total of 20,437 patients were referred, increasing from 51 in the first year to 1564 in 1990. Although the annual number of referrals has remained constant for the last 8 years, the need for more complex urodynamic assessment such as video‐cystourethrography has increased from 5% (56/1164) in 1981 to 25% (385/1564) in 1990. The number of out‐patient attendances to medical, physiotherapy and continence clinics has also increased over that period. We conclude that the number of referrals represents increasing recognition of the value of urodynamic assessment. Accurate diagnosis leads to more effective treatment, whether surgical, medical or conservative. Some methods of diagnosis are complex and suitable only for a tertiary referral

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15910.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Factors involved in monitoring bladder neck mobility were studied by means of vaginal ultrasonography. Thirty‐three continent, 28 incontinent and 39 patients who had undergone surgery for incontinence were examined in the supine and sitting positions during rest, the Valsalva manoeuvre and withholding urine.Bladder neck mobility can be described as a semicircular movement with the tip of the symphysis pubis as the centre and a line from the tip to the bladder neck as the radius (BS). Movement can be measured by 2 independent factors: BS distance and size of the angle between the BS line and the midline of the symphysis, at rest, during the Valsalva manoeuvre and withholding urine.The continent controls were characterised by a 90° angle at rest, a long BS (2.4 cm) and a fixed bladder neck. The incontinent patients had a shorter BS (2.1 cm), angles at rest of approximately 100°—the angle increased with the grade of incontinence—and a mobile bladder neck.If 2 of the 3 criteria (angle at rest ≥ 95°, BS ≤ 2.3 cm and mobility ≥ 20°) are regarded as diagnostic of incontinence, diagnostic sensitivity was 84% and specificity 82%.In the surgical group, patients who failed to respond to treatment had a shorter BS, larger angles and greater bladder neck mobility than their successfully tre

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15911.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Summary—Five patients with an ileal conduit and 5 with an ileo‐caecal bladder substitute have been studied metabolically. All had undergone cystectomy for infiltrating carcinoma and they formed 2 homogeneous groups in terms of age and follow‐up.Function in both groups was within normal limits but closer examination of patients with an ileo‐caecal bladder revealed mild functional damage as shown by reduced creatinine secretion, a lower level of bicarbonate and lower urinary acid valency secretion.It was concluded that the ileal conduit is more satisfactory from a metabolic point of view than the ileo‐caecal bladder, which requires closer follow‐up and treatment with bicarbonates i

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15912.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY