Khat chewing and bladder neck dysfunction. A randomized controlled trial of alpha 1-adrenergic blockade

OBJECTIVE

To assess whether the effect of chewing khat leaves (Catha edulis) on the urodynamics of healthy males is altered by the selective alpha 1-adrenergic blocking agent indoramin in a prospective randomized double-blind controlled trial.

SUBJECTS AND METHODS

The urodynamics of 11 healthy males were studied before and during a khat chewing session preceded by indoramin or placebo.

RESULTS

Khat chewing produced a fall in average and maximum urine flow rate. This effect was inhibited by indoramin.

CONCLUSIONS

The urinary side-effects of khat chewing are probably mediated through stimulation of alpha 1-adrenergic receptors.

Sham versus transurethral microwave thermotherapy in patients with symptoms of benign prostatic bladder outflow obstruction

Transurethral microwave thermotherapy (TUMT) is a single-session, minimally invasive outpatient treatment for patients with symptoms of benign prostatic bladder outflow obstruction. We designed a prospective randomised trial to identify any placebo response. Patients with a Madsen symptom score over 8 for at least 6 months were eligible for study. Two measurements of urinary flow less than 15 mL/s and a residual urine of under 350 mL were also required for entry. Patients with renal dysfunction, upper urinary tract disease, co-existing bladder disease, and malignant prostatic change were excluded. 43 patients were studied: 21 were randomised to receive a sham treatment and 22 to thermotherapy. Sham treatments were done with the urethral applicator in situ. 40 patients were available for evaluation at 3 months. 2 patients had delayed follow-up and 1 patient randomised to TUMT has undergone transurethral resection. The thermotherapy group showed a 70% decrease (from 14.5 to 4.3) in the mean Madsen score, a 53% increase in flow-rate (8.5 to 13.0 mL/s), and 92% decrease in residual urine volume (147 to 12 mL). No significant change was seen in these mean indices in the sham group. There was no difference in the main complication of transient haematuria between the two groups. However, there was a 22% frequency of acute retention in the TUMT group. The results show little significant placebo component to the subjective and objective improvement that occurs in patients who have received TUMT.

Endometriosis of the ureter

Five patients with ureteric endometriosis are described. Extensive pre-operative investigation failed to reveal the aetiology of the unilateral upper urinary tract obstruction seen in all of these patients. Due to the dense fibrosis that invariably accompanies ureteric endometriosis, early surgical excision of the ureteric stricture permits effective resolution of upper tract dilatation and improved renal salvage.

Fournier's gangrene of the scrotum following day case vasectomy

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Spontaneous rupture of renal artery aneurysm

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Biofilms, bacteria and bladder catheters. A clinical study

Biofilms were present on 16 of 33 urethral catheters examined. In 11 cases the catheter carried a different microbial flora from that of the bladder urine. The length of time the catheter was in situ did not influence biofilm formation, and all types of materials tested supported biofilm growth. Biofilms were seen on 2 of the 7 catheters where prophylactic antibiotics had been used.

Plasma lignocaine levels during transurethral prostatectomy

It has been reported that transurethral absorption of lignocaine may cause systemic toxicity when associated with mucosal damage within the urethra. We measured the serum levels of lignocaine in 30 patients after the transurethral administration of 400 mg lignocaine gel just before transurethral prostatectomy. In 11 patients additional lignocaine was given as part of the anaesthetic induction (Group A). In 19 patients no additional lignocaine was given (Group B). Two patients in Group A and three patients in Group B also underwent Otis urethrotomy. The mean peak plasma lignocaine concentration as measured by sequential venous samples was 1424 ng/ml in Group A and 72 ng/ml in Group B. We conclude that 400 mg lignocaine gel applied endourethrally before transurethral resection of the prostate results in plasma concentrations well below the toxic levels.

Irrigation and acute ureteric dilatation--as for ureteroscopy

The effects of irrigation with sterile and infected saline after acute ureteric dilatation by graded Teflon dilators were evaluated renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F, and 100 ml of sterile or infected saline were then introduced from a height of 60 cm under gravity. One week after irrigation and dilatation the ipsilateral kidney was either functioning less than 10% or there was an obstructive nephropathy. Histology at 3 months suggested that extravasation of infected irrigating fluid was the most likely cause of ureteric stricture formation.

The effects of double J stents on renal pelvic dynamics in the pig

Intra-pelvic pressure and peristaltic activity were measured before and during diuresis in 26 minipigs, immediately, one week and three weeks following ureteric intubation with 5 and 6F polyethylene double J stents. Changes in these dynamic parameters were seen which indicate that these stents caused renal outflow obstruction. The severity of this obstruction appears dependent upon the size of the catheter and the temporal length of intubation. This study indicates that double J stents provide sub-optimal drainage of the renal pelvis and damaged ureter.

Suprapubic endoscopy: a percutaneous approach

We have assessed whether suprapubic endoscopic surgery can be helpful in situations where transurethral access is inadequate, difficult or likely to be associated with urethral damage and have applied a modified version of the well known techniques for creating and dilating a track for percutaneous renal access to the bladder. This method has been used in a series of clinical cases and in certain experimental studies. Assessment of the techniques has allowed their modification and the development of a specially designed access cannula--the St Peter's Hospital cannula.

Acute ureteric dilatation for ureteroscopy. An experimental study

The effects of three methods of acute ureteric dilatation (by graded Teflon dilators, low and high pressure balloon dilators) were evaluated radiologically, renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F. All three methods caused upper urinary tract dilatation and an obstructive nephropathy which had not resolved 96 h after dilatation. Histology at 24 h showed destruction of the transitional epithelium, with inflammation throughout the ureteric wall. Four weeks after dilatation the ureter was still dilated and urothelial nests were seen in the lamina propria and in the muscle coats. There was no evidence of ischaemic necrosis or ureteric stricture formation. The implications of these findings for clinical practice are discussed.

Urothelial reaction to ureteric intubation. A clinical study

Urothelial biopsies from ureters intubated with silicone (11) and other polymer (13) double J stents revealed features of mucous metaplasia in 12/24 cases. These changes were associated with encrustation of the stents and occurred principally in stone-forming patients.

Extracorporeal shock wave lithotripsy. Is sessional access worthwhile?

One hundred and fifty-three patients with renal stones referred to one teaching hospital have received extracorporeal shock wave lithotripsy (ESWL) treatment as a result of a monthly sessional arrangement organised with a neighbouring lithotripter unit. The results of treatment, assessed 3 months after lithotripsy, showed results comparable with those from any lithotripter centre. Sessional access for lithotripsy may provide a satisfactory way of increasing the number of patients who are treated with lithotripsy by reducing the demand for beds at the hospitals where a lithotripter is sited.

Tissue effects of an ultrasonic scalpel for clinical surgical use

The effects of a new ultrasonic scalpel were studied in laboratory animals. Tissue heat conduction from the tip of the ultrasonic blade was measured. Tissue damage was assessed by light microscopy of histochemically stained sections. The ultrasonic scalpel incised nonfibrous tissue effectively, with minimal heat conduction, and the incisions healed with no evidence of fibrosis nor of tissue destruction.

The effects of extracorporeal shock wave lithotripsy on urological prostheses and endoprostheses

The combination of ESWL and Endourology (EU) enables a wider range of stones to be treated without open surgery than either modality alone. EU frequently involves the maintenance of a plastic prosthesis in or near the area of maximal shock wave concentration during ESWL. Prostheses subjected to a standard test treatment by ESWL and others removed from patients after ESWL were examined visually, microscopically and biochemically by electron microscopy (SEM) and X-ray emission spectroscopy (XES) to investigate the effects of ESWL on the prosthesis itself. Foley catheter balloons leaked. Previously smooth surfaces were disrupted and possibly toxic additives may be released. Care should be taken in selecting indwelling EU prostheses if ESWL treatment is likely to follow.

Ureterorenal endoscopy: which instrument, what cost?

This report describes the design, availability, repair facilities and costs of rigid ureteroscopes. Clinical factors affecting design are detailed. A classification is given. A new test of flow dynamics is described. Short operating ureteroscopes with a stable or integral telescope system appear to be superior to other types, especially as they may be used for antegrade ureteroscopy.

Serum parathyroid hormone levels in the hypercalcaemia of urological malignant disease

Serum parathyroid hormone (PTH) levels have been measured in 8 patients with hypercalcaemia associated with urological malignancy: 3 renal cell carcinomas, 2 adenocarcinomas of prostate, 2 transitional cell carcinomas of bladder and one transitional cell carcinoma of kidney. Five (63%) of these 8 patients had bone metastases. PTH was detectable in the serum of all 8 hypercalcaemic patients, but in only 2 cases was the PTH level above the normal range, and in one of these a coincidental parathyroid adenoma was found to be responsible for the hypercalcaemia. It appears that these tumours can produce a hormone-like substance with biological effects similar to PTH.

An experimental study of hydrophilic plastics for urological use

Hydrophilic graft copolymers of polyethylene vinyl acetate (PEVA) were extruded into tubular form. These materials increase both external and internal diameters by 60% on contact with water. The tubes were used as ureteric stents in an experimental study and were superior to silicone stents of the same calibre in the limitation of urinary extravasation. Histological, cytotoxic and electron microscopic studies showed that PEVA is a biocompatible material suitable for clinical use in urology.

A double-blind controlled trial of a new alpha-1 blocking drug in the treatment of bladder outflow obstruction

Thirty-one patients with urodynamically proven bladder outflow obstruction were treated with Alfuzosin in a 3-month, double-blind, placebo-controlled study. The irritative symptoms of bladder outflow obstruction were improved significantly in the treatment group, according to both objective and subjective evaluation. There was no objective evidence of a reduction in outflow resistance or obstruction in either group.

The effects of double J stenting on unobstructed ureters. An experimental and clinical study

Upper tract pressure flow studies in four clinically unobstructed ureters with double J stents in situ indicated that urinary flow occurred mainly around the stent and that there was significant vesicorenal pressure transmission. This study examined the dynamics of ureteric urinary flow and morphological effects consequent upon stenting a ureter in vivo. In a porcine model, ureteric intubation caused a rise in intrapelvic pressures, hydroureter, vesicorenal reflux and generalised thickening of the ureteric wall with characteristic histological changes in the urothelium. These findings suggest that double J stents may compromise urinary drainage when ureteric obstruction is not present, urging caution in their use in the damaged, unobstructed upper urinary tract.

Hydrophilic graft copolymers: a new concept in urological surgery

Hydrophilic graft copolymers are derived from hydrophobic polymers which have been copolymerized and then grafted by radiation initiation so that they become hydrophilic. Tubes of such material expand in diameter by 60% when wet and become slippery. The first medical applications of these materials are described: they have been used as an access conduit for percutaneous renal surgery and endoscopic access to the ureter.

Bilateral pelviureteric junction obstruction: the case for endoscopic management

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A comparison of bipolar and monopolar diathermy probes in experimental animals

The effects of monopolar and bipolar diathermy were studied in laboratory animals. The power required to coagulate transected vessels in air was established and the effect of immersion in saline and water during electrocoagulation was investigated. Tissue heat conduction from each type of probe was measured and compared. Tissue damage was assessed by light microscopy of histochemically stained sections. The bipolar system operated at a lower power output (13 W) with less heat conduction, and was unaffected by the surrounding medium.

Percutaneous pyelolysis: indications, complications and results

The results of percutaneous pyelolysis in 28 patients are presented. There were 18 successful and 10 unsuccessful cases. The indications for the procedure are defined in the light of this analysis.

Multiple congenital defects of the urinary tract

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