Long-term clinical results and quality of life after insertion of a self-expanding flexible endourethral prosthesis

OBJECTIVE

To evaluate the safety and efficacy of the Urolume self-expanding flexible endourethral stent, based on a long-term follow-up, and to determine its role amongst the various modalities of treatment available for the relief of bladder outlet obstruction (BOO) arising from benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

From January 1991 to April 1992, the Urolume wallstent (American Medical Systems, USA) was placed successfully in each of 62 patients (aged 50-89 years) who had significant subjective and objective evidence of BOO. The stent was placed as a daycase procedure under general anaesthesia. Pre-operatively, each patient was assessed fully in an out-patient clinic by symptoms, a flow rate measurement and a rectal examination. Post-operatively, patients were assessed using transrectal ultrasonography, cystoscopy, symptoms and flow rate measurement, and after 5 years, the International Prostate Symptom Score and satisfaction score were obtained.

RESULTS

After 5 years, 27 (39%) patients survived and 10 (14%) died with their Urolume stent intact; 22 (32%) completed the follow-up and five refused or were lost to follow-up. Day and night-time frequencies and flow rates improved continuously. Complete epithelialization occurred in 16 of the 22 patients assessed. Of those in whom the Urolume was removed, 20 are alive and five dead.

CONCLUSION

The effectiveness of the Urolume in improving symptoms and flow rates in patients with BPH was confirmed. However, the high failure rate arose largely from inexperience in selection and deployment. There are no absolute criteria to predict a successful outcome. This study confirms the Urolume as a safe device. Most patients whose symptoms settled in the first year maintained a good flow rate and a significant improvement in symptoms for 5 years; their quality of life at the last follow-up was good.

Malignant mesothelioma of the tunica vaginalis testis diagnosed by aspiration cytology--a case report with review of literature

A case of malignant mesothelioma of the tunica vaginalis testis diagnosed by preoperative cytology of hydrocele fluid is reported. In our view this is only the second case diagnosed by preoperative cytology. The unique feature of this case, the characteristic ultrasound appearance, was recognized and confirmation by aspiration cytology led directly to radical orchiectomy, thus avoiding hydrocelectomy, hemiscrotectomy and possible local recurrence. Aetiopathogenesis and management options of this rare tumour are discussed, with a review of the literature.

Management of major biliary complications after laparoscopic cholecystectomy

OBJECTIVE

A total of 50 major bile duct injuries after laparoscopic cholecystectomy were managed by the Duke University Hepatobiliary Service from 1990-1992. The management of these complex cases is reviewed.

SUMMARY BACKGROUND DATA

Laparoscopic cholecystectomy is the preferred method for removing the gallbladder. Bile duct injury is the most feared complication of the new procedure.

METHODS

Review of videotapes, pathology, and management of the original operations were reviewed retrospectively, and the injuries categorized. Major biliary injury was defined as a recognized disruption of any part of the major extrahepatic biliary system. Biliary leakage was defined as a clinically significant biliary fistula in the absence of major biliary injury, i.e., with an intact extrahepatic biliary system.

RESULTS

Thirty-eight injuries were major biliary ductal injuries and 12 patients had simple biliary leakage. Twenty-four patients had the classic type injury or some variant of the classic injury. A standard treatment approach was developed which consisted of ERCP for diagnosis, preoperative PTC with the placement of stents, CT drainage immediately after the PTC for drainage of biliary ascites, and usually Roux-en-Y hepaticojejunostomy with placement of O-rings for future biliary access if necessary. Major ductal injuries were high in the biliary system involving multiple ducts in 31 of the 38 patients. Re-operation was required in 5 of the 38 patients with particularly complex problems.

CONCLUSIONS

Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach.

Antenatal unilateral hydrocephalus

Fetal ventriculomegaly usually involves both lateral ventricles. If dilatation of the dependent lateral ventricle is seen, it might be assumed that the condition is bilateral and symmetric and that reverberation artifact is obscuring the ventricle nearer to the transducer. However, unilateral hydrocephalus can occur, though rarely and usually as a result of unilateral obstruction of the foramen of Monro. Careful attention to visualization of the obscured hemisphere is emphasized. In the patient described here the condition was associated with frontoethmoidal encephalocele.

Secretin receptors in a new preparation of plasma membranes from intrahepatic biliary epithelium

Secretin is thought to cause choleresis by acting on a receptor expressed by bile duct epithelial cells. In this study, the receptor was characterized using a new preparation of intrahepatic bile duct plasma membranes. Hyperplastic biliary trees were obtained from 3-week bile duct-ligated rats. The biliary trees were homogenized, filtered, and subjected to an aqueous two-phase partition technique to yield highly purified plasma membranes (confirmed by a 14-fold enrichment in gamma-glutamyl transpeptidase activity and a 10-fold enrichment in 125I-secretin binding). 125I-secretin bound saturably with high affinity and in a dose-dependent fashion (Kd = 1.3 +/- 0.1 nM, Bmax = 273 +/- 23 fmole/mg) to purified plasma membranes. The binding characteristics of secretin were most consistent with a single site receptor model. Competitive binding studies indicated that the secretin-related peptides glucagon, peptide histidine isoleucine, gastric inhibitory peptide, and growth hormone releasing factor did not inhibit binding. Vasoactive intestinal peptide (1 microM) reduced maximal binding by 19 +/- 1%. The GTP analogs guanylylimidodiphosphate and guanosine 5'-O-[3-thiotriphosphate] (1 microM) inhibited binding by 16 +/- 2 and 13 +/- 1%, respectively. In conclusion, secretin binds to a specific, high-affinity receptor in intrahepatic bile duct epithelium that is coupled to a G-protein-linked signal transduction system.

Postmenopausal hyperandrogenism of ovarian origin. A clinicopathologic study of four cases

Postmenopausal hyperandrogenism with overt clinical effects is rare and often related to ovarian stromal disorders. We present a clinicopathologic study of 4 cases. The patients (age range 41-75 years; mean 62 years) had evidence of hirsutism or frank virilization. Their serum testosterone was elevated with or without increases in their serum androstenedione and DHEA levels. There were two right-ovarian hilus cell tumors, one associated with left-ovarian stromal hyperplasia and the other with bilateral hyperthecosis and nodular hilus cell hyperplasia. The other tumor was a small corticomedullary stromal luteoma with bilateral hyperthecosis and nodular hilus cell hyperplasia. The fourth patient had bilateral hilus cell hyperplasia with mild cortical-stromal hyperplasia. All these patients had rapid normalization of androgen levels after surgery without recurrence after a 2- to 10-year follow-up.