Recent trends in mortality due to testicular cancer in Ireland: a comparison with England and Wales

In the period 1961-84, the number of deaths in Ireland due to the testis cancer rose by 64%. This was due both to significant male population expansion (25.3%) and to an increased mortality rate. In the 25-34 years age group, one of the groups at highest risk, the mortality rate rose by 123%. In contrast, in England and Wales, although the male population has risen by 8.5% since 1961, the number of deaths has decreased by 17%. This is due to falling mortality rates, for example an 18% decrease in those aged 25-34 years. The highest rate of all occurred in those Irish over 75 years old. The changing Irish trends appear to lag behind those in England and Wales by some decades, and this raises important aetiological considerations.

Superficial bladder tumors (stage pTa, grades 1 and 2): the importance of recurrence pattern following initial resection

We treated 414 new patients with stage pTa, grades 1 and 2 bladder tumors by transurethral resection between 1970 and 1982. All of the patients with grade 3 or previous upper tract tumors, or who had been treated at some stage with intravesical chemotherapy were excluded. Followup for 5 or more years was available in 188 of the patients. There was a low increase in T stage (6 per cent). Of the patients followed for 5 or more years 46 per cent remained free of tumor. Only 16 per cent of the patients had multiple tumors at presentation and 20 per cent had tumors of 10 gm. or more. These factors were associated with a worse prognosis. Patients free of tumor at 3 months had an 80 per cent chance of having no further recurrences and this rate remained the same up to 2 years from the start of the disease. Patients with a recurrence at 3 months were much less likely to remain free of tumor, and had a higher chance of recurrence at every future visit.

Bladder carcinoma in patients 40 years old or less

A total of 50 patients 40 years old or less presented with transitional cell carcinoma of the bladder between 1967 and 1982: 24 were 15 to 30 years old (group 1) and 26 were 31 to 40 years old (group 2). Of the patients 2 (8 per cent) in group 1 and 14 (54 per cent) in group 2 had recurrences. Invasion did not occur in group 1 but it did occur in 3 patients in group 2. Almost two-thirds of each group smoked roughly 20 cigarettes per day. It would appear that bladder carcinoma in patients 30 years old or less has a favorable prognosis but it still should be followed carefully. Disease occurring when the patient is 31 to 40 years old has a much worse prognosis and is no different from that affecting the older age groups.

Percutaneous coagulum nephrolithotripsy: a new approach

Intrarenal scatter of stone fragments during percutaneous nephrolithotripsy is a complication which may predispose to post-operative pain and further stone formation. The use of a coagulum to prevent such a complication has proved difficult when introduced percutaneously. This experimental study describes a new gelatine (Lithogel) which is introduced through the nephroscope to coat the renal calculus; it allows easy disintegration of the calculus within the gel, is safe to use and effectively prevents the scatter of fragments into inaccessible calices.

Percutaneous nephrolithotripsy: a functional and morphological study

Percutaneous removal of renal calculi requires a nephrostomy track, irrigation and lithotripsy. The purpose of this study is to investigate the effects of these procedures on renal function and anatomy. Renal access was obtained through a small left subcostal incision and a 22 Ch nephrostomy track was formed by fine parenchymal puncture and serial dilation in 15 dogs. Three liters of glycine solution were perfused through these tracks. In a further 16 dogs, human calculi were placed transparenchymally in the renal pelvis and disintegrated under vision through the Wolf nephroscope using an ultrasonic probe in 8 and electrohydraulic probe in 8. Assessments were made in all animals at 48 hours or 6 weeks by creatinine clearance, microfil casts, contrast radiography and ex-situ conventional and digital subtraction angiography. There was no significant urinary leakage or bleeding from the nephrostomy track at 48 hours. There was a small track hematoma and at 6 weeks a surface dimple and fine linear parenchymal scar. There was no ureteric or pelvic damage. Microfil casts showed small track defects at 48 hours resolving to a fine scar at 6 weeks. All angiograms were normal. Some IVU's displayed minor track defects at 48 hours but all were normal at 6 weeks. Corrosion casts and subtraction angiography demonstrated no significant vascular defects. Creatinine clearance showed no significant difference between experimental and control sides. Occasionally, intra pelvic scatter of fine calculus fragments was seen at 48 hours but none was detectable at 6 weeks. Transparenchymal nephrostomy, irrigation and nephrolithotripsy caused initial minor anatomical defects that rapidly resolved and were not associated with any loss of renal function.

Bladder neck contracture following prostatectomy

In an 11-year period, 49 patients developed bladder neck contracture after prostatectomy--an incidence of 0.86%. This complication was found to be more common after resection of small fibrous hyperplastic prostates. The best results for treatment of the contracture were obtained after bladder neck incision, which gave a 9% incidence of recurrence; after transurethral resection of the bladder neck contracture the recurrence rate was 46%, and after bladder neck dilatation it rose to 100%.

Simple aid to ureteroscopy

Initial experience with the rigid ureteroscope showed that despite ureteral dilation and guide wire followers, introduction of the ureteroscope can be difficult due to bladder mucosa catching on the instrument. A simple, cheap disposable device using a modified ureteric catheter is presented that overcomes this problem.

Oxybutinin and the prevention of urinary incontinence in spina bifida

A controlled study was performed to determine the effect of oxybutinin on incontinence in spina bifida patients on clean, intermittent self catheterisation. Cure or significant improvement was achieved in 66.6% of the patients. Bladder capacity was increased and filling pressure reduced during treatment.

A canine model for the investigation of human calculus disease

The rapid development of new methods for the treatment of renal calculi requires an animal model to assess the efficacy of stone treatment in vivo. This requires the implantation of human calculi large enough to be easily imaged radiologically. Most previous models have required multiple operative procedures and ureteric obstruction which has confused results. This study demonstrates the one-stage insertion of human calculi into the canine renal pelvis through a nephrostomy which does not affect the collecting system or cause any significant functional or structural damage to the kidney.

Calcium excretion in metastatic prostatic carcinoma

In 64 men with prostatic carcinoma, calcium excretion per litre of glomerular filtrate (Cae) was persistently lower in those with bone secondaries than in those with soft tissue involvement only, despite a normal range of serum calcium in both groups. In three patients who showed an improvement in their bony metastases on bone scan 6 months after starting treatment, the Cae values had increased slightly but still remained in the low range. In a further five who showed no improvement on bone scan, Cae values were lower than before. In patients with prostatic carcinoma, Cae is an indicator of early changes in calcium homeostasis. It may also provide an objective indication of progression of bone secondaries.

Doppler localisation of intrarenal vessels: an experimental study

The use of the Doppler probe to localise the intrarenal vessels was assessed in 15 dogs. This prevented the need for renal artery clamping and radial nephrotomies were placed in silent areas on the renal surface. Functional studies were performed post-operatively at 48 h and 1 month, using creatinine clearance, microfil casts and cast angiography. There was no significant loss of function when three or six radial nephrotomies were made and the Doppler accurately localised sites for nephrotomy between the intrarenal arteries and veins which were undamaged.

A 15-year follow-up of 406 consecutive spinal cord injuries

A follow-up of 406 traumatic spinal cord injuries admitted from 1967 to 1982 is presented. Forty patients died, only two (5% of deaths and 0.5% of the series) from renal complications. Twenty-seven died from pulmonary or cardiovascular causes, complete and cervical lesions being the most significant factors in mortality. Early and continued active urological treatment aimed at the provision of low pressure bladder drainage to protect the upper tract. The management and results are critically discussed.

Flexible cystourethroscopy: advantages and limitations

Much interest has been expressed in flexible cystourethroscopy, which has obvious potential advantages. In this study it was compared to rigid endoscopy in 25 patients. It was found to be a painless procedure, but not as accurate in diagnosing vesical lesions as the rigid endoscope.

Renal accumulation of ammonia: the cause of post-ischaemic functional loss and the "blue line"

The "blue line", a dark discoloration at the corticomedullary junction, is a constant finding after a significant period of renal ischaemia. In this study, it has been shown to be caused by packing of all of the peritubular capillaries at the corticomedullary junction with red blood cells. Five rats and 10 dogs were alkalinised by replacing their drinking water with 2% sodium bicarbonate for 2 weeks pre-operatively, in order to inhibit the glutaminase enzyme system and thereby decrease ammonia accumulation during ischaemia. Five rats and 6 dogs were used as unprotected controls. All animals were subjected to 60 min warm ischaemia. Renal function was significantly protected in the alkalinised rats (P less than 0.002) and dogs (P less than 0.001), with the serum creatinine rising to a maximum of 0.21 +/- 0.03 mmol/l in the alkalinised rats and 0.18 +/- 0.04 mmol/l in the alkalinised dogs. There was no "blue line" in the alkalinised animals. It is suggested that the "blue line" plays a central role in post-ischaemic renal failure. Prevention of ammonia formation by alkalinisation protects against ischaemic renal damage and the formation of the "blue line".

Prognostic factors influencing survival of patients receiving intravesical epodyl

Results from a retrospective analysis of 139 patients with recurrent superficial bladder tumors treated by intravesical epodyl are reviewed. Of patients who had complete clearance of tumor from the bladder 95 per cent became free of disease within 12 months of starting intravesical therapy. No patient who had persistent tumors at 2 years was free of tumor subsequently. The majority of complete responders who suffered recurrences did so within 3 years and 80 per cent of a small series of patients who remained free of tumor after 3 years and then stopped treatment continued to be free of tumor for a further 2 years. Failure to respond within 12 months or early invasion of the submucosa on biopsy (stage P1b tumors) was associated with poor survival. In patients who underwent salvage cystectomy the demonstration that 35 per cent had involved metastatic lymph nodes and 38 per cent had invasion of muscle is a clear indication of the dangers of delaying radical treatment once the patient has failed to respond completely to intravesical therapy.

Inosine in ischaemic renal surgery: long-term follow-up

Inosine, a purine nucleotide, has been used in 33 patients as a method of preventing ischaemic renal damage. The long-term results have been reviewed with a mean follow-up of 28 months. Inosine was administered either intra-arterially or intravenously. Renal function was assessed by serum creatinine, creatinine clearance and divided function renography. Inosine afforded satisfactory protection in ischaemic periods of up to 60 min, particularly if pre-operative function was normal. It was less reliable if pre-operative function was poor or in ischaemic periods greater than 60 min. Inosine is a helpful aid in ischaemic renal surgery.

Hyperoxaluria following glycine irrigation for transurethral prostatectomy

Thirty-four patients were studied following transurethral prostatectomy with glycine irrigation during and soon after the operation. Three cases developed hyponatraemia and this was accompanied by severe hyperoxaluria with raised urinary glycolate. This could be a hazard if urinary volume were allowed to fall.

A study of the effectiveness of inosine in renal transplantation

Kidneys preserved with cold Collins' solution only function satisfactorily if there is no significant preceding period of warm ischaemia. This paper reports an attempt to provide protection to renal function during such a warm ischaemic episode using the nucleotide inosine. In these experiments inosine given intravenously to dogs followed by 15 min of warm renal ischaemia and by either 12 or 24 h of cold preservation with Collins' solution did not protect renal function against the warm ischaemic insult.