摘要:

Stents to relieve bladder outflow obstruction were first developed as an alternative to a long‐term indwelling urethral catheter (Fabian, 1980). With improved technology and methods of insertion the indications for the use of stents in the male urethra have increase

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15869.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Infections following cystoscopy are rare and often asymptomatic (Richards and Bastable, 1977; Manson, 1988; Clark and Higgs, 1990). However, outbreaks may occur if instruments are either poorly decontaminated or have been previously damaged. Many urologists now perform flexible fibreoptic cystoscopy on an out‐patient basis. In such endoscopy units, infection control measures must include the prevention of transmission of blood borne infections such as hepatitis B virus (HBV) and human immunodeficiency virus (HIV) due to the risk of blood contamination of urine and should be implemented in all cases regardless of patient risk factors (UK Health Departments, 1990). In hospitals that classify patients into low and high risk groups, medical staff may fail to recognise a number of significant risk factors (Parryet al., 1991). Though to date there have been only 2 reports of viral (HBV) transmission following endoscopy (both gastrointestinal) (Birnieet al., 1983; Gorse and Messner, 1991), the potential risk for cross‐infection remains. Thus the appropriate decontamination of fibreoptic endoscopes continues to be an extremely important is

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15870.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12‐lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right‐sided and left‐sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s.It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo‐analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oxymeter to be perfectly reliable for raising the alarm when depression of respiration and vaso‐vagal reacti

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15871.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryExtracorporeal shock wave lithotripsy (ESWL) is widely used to treat urinary calculi. With increasing numbers of ESWL, more patients prone to infectious complications will be treated. However, little is known about the infectious risks of ESWL. To provide a basis for the rational use of antimicrobial prophylaxis, we studied the incidence of bacteraemia during ESWL. A total of 23 patients with urinary calculi were treated. Blood cultures (4–7 per patient) were taken before, during and immediately after ESWL, adding up to a total of 154 cultures. In 22 of these patients no bacteraemia was detected. In 1 patient small numbers of 2 different micro‐organisms were found in 2 blood samples only. This finding, and the circumstances of blood collection, suggested contamination rather than bacteraemia. It was concluded that the risk of bacteraemia during ESWL is very

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15872.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe value of tumour ploidy status as a prognostic indicator in renal carcinoma is disputed. In this retrospective study the DNA content of 90 primary and 10 secondary renal cell carcinomas was measured using flow cytometry. Data on recurrence and survival were available in all cases. Tumours were staged according to the TNM system and histological grade was based on nuclear morphology. Formalin‐fixed, paraffin‐embedded material was processed using standard techniques. Multiple samples were examined in 19 cases. Of the primary tumours, 52 were diploid, 24 were aneuploid and 6 were tetraploid; 8 patients had uninterpretable histograms. Ploidy of the secondary tumours was similar to that of their respective primaries. Aneuploidy correlated with higher grade but not with TNM category and, although associated with an increased risk of death, did not provide independent prognostic information. Heterogeneity of ploidy was found in 6 of the 19 cases where more than 1 sample was assessed. It was concluded that tumour DNA content in renal carcinoma is weakly linked to outcome, is subject to sample error and does not provide accurate prognostic information as a single independent varia

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15873.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryMedium‐term results are presented for the periurethral injection of Teflon in the treatment of stress urinary incontinence. Follow‐up data were obtained on 36 women by means of case note review and the completion of a postal questionnaire. Mean follow‐up was 5.1 years. Subjective results showed 12 patients to be dry or much improved while the remaining 24 patients did not obtain significant benefit from the procedure. Repeat injections in 12 women resulted in only 3 obtaining useful improvement, while a subgroup of patients who had undergone previous procedures showed a better response. No significant complications were observed. Periurethral Teflon injection is a minor surgical procedure which can produce worthwhile improvement, although an initially good result may not be sustained with longer follow‐up. This method may be advocated as treatment for poor risk patients who are unsuitable for surgery, particularly when previous attempts at formal surgical correction have been unsuc

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15874.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryCystitis cystica, a common urothelial pathology whose aetiology, morphology and clinical significance are poorly understood, affects the human urinary bladder and trigone in both sexes. We have studied the fine structure of urothelial cysts in 11 patients diagnosed cystoscopically as suffering from cystitis cystica. Several abnormal features were observed in the adjacent urothelium, including large intracellular vacuoles (4 patients), Brunn's nest (5), lymphocyte infiltration (10) and generally disorganised urothelial architecture (10). Squamous metaplasia was observed in one case.The wall of each cyst consisted of a 2–3 layered epithelium with either tall columnar or flattened cells lining the fluid‐filled lumen. Both types of lining cell possessed short microvilli, while the columnar type also contained numerous membrane‐bound, electron dense secretory granules in the apical cytoplasm. Rough endoplasmic reticulum, mitochondria and Golgi membranes were plentiful in the surface cells. Junctional complexes joined adjacent lining cells. The deeper cells contained relatively fewer organelles, while a basal lamina separated the cyst wall from the underlying connective t

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15875.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe majority of primary bladder neoplasms are known to arise within the mucosa around the ureteric orifices and bladder base. This may be due to the mucosa in this area being more susceptible to carcinogens than other areas of the bladder. Deficiency in the nucleotide salvage pathway enzyme thymidine kinase (TK), and especially its TK 1 isozyme, has been shown to predispose cell lines to increased mutagenesis. Total TK and TK 1 activities were measured in mucosal samples taken adjacent to the ureteric orifices and dome in 32 normal bladders and both total TK and TK 1 were shown to be significantly decreased in the mucosa adjacent to the ureteric orifices.This may explain why primary bladder neoplasms occur more commonly in this site.

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15876.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA community study to determine the prevalence and natural history of benign prostatic hyperplasia (BPH) in a typical Scottish community has been undertaken in men from 40 to 79 years of age. From 2497 eligible men, 1627 (65%) agreed to take part and after screening by symptom score and urinary flow rate 561 were offered a full investigation including transrectal ultrasonography; 492 (87.7%) attended and 415 were found to have BPH, which was defined as a prostate ≥ 20 g. Following urological consultation, 3 groups of patients with BPH were recognised: those requiring no therapy (39.5%), those in whom therapy options were considered (50.5%) and those where operation was advised (10%). Seventeen patients with prostatic carcinoma were found, 4 of whom were treated by radical prostatectomy. A total of 67 operations for BPH resulted from the study in patients not previously referred to our urological unit, the majority of whom had not consulted their GP for symptoms of prostatism. This represents a serious challenge to British urolog

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15877.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryProstate cancer is currently the most commonly diagnosed cancer among males in the United States. As technology improves and the search for this enigmatic condition intensifies, we are detecting greater numbers of non‐palpable tumours. These tumours are generally treated aggressively, given the uncertainty of their behaviour, but this approach may be over‐zealous for small volume disease. The likelihood of detecting any cancer volume can be derived from Bayes' theorem of conditional probability. A laboratory model using coloured clay was created to contrast tumour volumes of 2.5, 5 and 20% (n=75). Six random systematic biopsies were then taken from each model in a blind fashion; 36% of the 2.5%, 44% of the 5% and all of the 20% models had at least 1 positive biopsy. Twenty‐two of the 25 models representing 20% tumour had 3 or more biopsy cores positive. These data suggest that low volume disease with low biological potential will be found by random biopsy as the mathematical probability predicts. The high incidence of occult prostate cancer in the older population makes this a worrying observation. Also, and perhaps more important, there is a direct correlation between the volume of disease and the number of positive biopsies. This correlation is easily seen in both models and may allow for an estimation of tumour volume. This ability to estimate tumour volume may be a useful clinical tool that helps to guide therapy and assess prog

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1993.tb15878.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY