Intrarenal access: effects on renal function and morphology

This study describes the effect of the 4 most commonly used methods of intrarenal access on renal function and morphology in the dog at 48 h. The extended sinus approach was associated with no functional or parenchymal loss; the radial paravascular approach was followed by a 20% decrease in function and no significant parenchymal loss; the anatrophic intersegmental nephrotomy caused a 30% functional decrease with a significant parenchymal loss; the bivalve nephrotomy was associated with a 50% loss of function and considerable parenchymal loss and distortion.

The treatment of patients with urinary incontinence after prostatectomy

Seventy-seven patients were treated for incontinence after prostatectomy for benign prostatic hypertrophy. Forty-six patients had detrusor instability and 28 had stable bladders. No cause for the incontinence was found in 3 patients. The majority of the group had sphincter damage (74%). Conservative treatment other than drugs was all that was required in 22 patients, but drugs such as Eskornade, imipramine or emepronium were used in a further 19. Some symptomatic improvement occurred in 53% of these 19 patients. Surgery was required in 38 cases (relief of obstruction endoscopically in 11, insertion of prosthetic devices in 27). Endoscopic treatment rarely effected a cure, but the results with prostheses were satisfactory, a cure or improvement occurring in 65% of the patients, with a low complication rate.

Pituitary ablation in the relief of pain in advanced prostatic carcinoma

Fifty-five patients with diffuse pain due to bone metastases from prostate carcinoma were treated by pituitary ablation (53 with intrasellar Yttrium 90 and 2 with intrapituitary alcohol instillation). The provisional criteria of the British Prostate Group were used to assess results. Post-operatively, 44 patients (80%) were significantly free of pain and 12 of them were completely pain-free. In only 11 cases (20%) was there no relief of pain. Of the 39 patients who required narcotics before ablation, only 12 required them post-operatively. Pituitary ablation with Yttrium 90 has an important place in the relief of pain in advanced carcinoma of the prostate, although survival is not increased.

Improved techniques in radionuclide imaging of prostatic lymph nodes

Further improvements have been made in the technique of human prostatic lymphoscintigraphy, allowing better anatomical localisation of the areas of uptake of activity. A single median injection into the capsule of 99mTc labelled antimony sulphide colloid has been found to give as good imaging as 2 injections on either side of the midline. By placing markers on the umbilicus, pubic symphysis and both anterior superior iliac spines, a "pelvic grid" can be superimposed on the antero-posterior view. Further help with accurate localisation may be attained by taking 3 views; antero-posterior, postero-anterior and lateral, in 9 instances, prostatic injection was performed without any sedation or anaesthesia. The resulting scintigrams were indistinguishable in quality from those of anaesthetised patients.

The evaluation of 68 patients with post-prostatectomy incontinence

Sixty-eight patients with incontinence following prostatectomy for benign prostatic hypertrophy were studied. Detrusor instability was present in 45 patients, most commonly associated with sphincter damage (28 patients), but alone in 11, and with residual obstruction in 6 patients. Sphincter damage was the cause of incontinence in 47 patients (alone in 18, with detrusor instability in 28, and with residual obstruction in 3). Some patients who complained of a combination of frequency, nocturia and urgency before prostatectomy were later found to have detrusor instability, but post-operatively no association between symptoms and pathology was noted. It is suggested that the need for surgery should be definitely established in patients who present with equivocal symptoms. All patients with a combination of frequency, nocturia and urgency should have a urodynamic assessment before prostatectomy.

Intravenous inosine for ischaemic renal surgery

The use of the intravenously administered nucleotide inosine is described for the protection of function in the human kidney undergoing ischaemic renal surgery. The treatment of 7 patients is described. The simplicity of the technique is emphasised.

Long-term follow-up in patients with superficial bladder tumours treated with intravesical Epodyl

Sixty-four patients with multiple, superficial papillary bladder tumours which had ceased to be controlled by endoscopic resection and diathermy were treated before July 1972 with intravesical Epodyl instillations. Of these, 19 had developed no further recurrences; 20 patients were free of tumour to one year, but later developed recurrences. Twenty-four patients were never entirely free of tumour after starting Epodyl and one patient became free of recurrences 2 years after starting Epodyl. Only the patients whose histology showed no invasion of the lamina propria responded to treatment. The overall 5-year survival rate was 66%, with a disease-free interval of 61% at one year and 25% at 5 years. Failure to clear the bladder of tumour after 12 months' treatment, or worsening of biopsy stage from PIS to Pla or Plb while on treatment, were associated with a high risk of dying of invasive tumour and in future should be used as immediate indications for radical treatment.

A new approach to the correction of the penile deformity in Peyronie's disease

Nesbit's operation was performed on 23 of 160 patients with Peyronie's disease seen between January 1975 and July 1978. Details of the preoperative treatment and operative technique are provided. Normal sexual intercourse was resumed by 20 of the 23 patients and none had a significant residual deformity. It is suggested that Nesbit's operation is the procedure of choice in patients who do not respond to conservative treatment.

Human prostatic lymphoscintigraphy. A preliminary report

A simple method for demonstrating prostatic lymphatic drainage by transrectal injection of 99mTc labelled antimony sulphide colloid into the prostatic capsule has been developed. This technique may be readily applied in clinical practice with obvious potential in the assessment and follow-up of patients with carcinoma of the prostate.

Idications for testicular biopsy or exploration in azoospermia

Investigation of 311 azoospermic males has shown that the combination of estimation of testicular size and plasma FSH allows the spermatogenic function of the testes to be accurately assessed by non-invasive methods. Patients with small testes and grossly elevated levels of plasma FSH have absent, or grossly impaired spermatogenesis, and do not require surgical exploration. They should be advised with regard to adoption or artificial insemination. Patients with large testes (5 cm) or an FSH level which is not grossly elevated require operation and should undergo a surgical exploration and the possible correction of an obstructive lesion. A testicular biopsy is essential if no obstructive lesion is found as the histology of these patients may show a spermatogenic arrest.

Serial bone scanning: the assessment of treatment response in carcinoma of the prostate

Serial bone scans and radiographic surveys were performed in 167 patients with histologically proven carcinoma of the prostate: 435 scans and surveys were performed. Nineteen of 99 patients with negative findings on diagnosis have become positive on follow-up. Forty-nine patients had positive findings on presentation; 8 have regressed on follow-up and 26 have progressed; 15 have remained unchanged. This is a sensitive method of follow-up in patients with carcinoma of prostate. Changes occurred in bone scans and skeletal surveys before any alteration in serum acid or alkaline phosphatases, symptoms of metastases or change in prostatic size in the majority of cases. The documentation of progression from MO to M1 disease presents no problems. However, problems in quantitation may arise in patients presenting with M1 disease.