Current trends in bladder cancer in England and Wales.

PURPOSE: We examined trends in bladder cancer (BC) incidence, mortality and survival in England and Wales during a 30-year period. MATERIALS AND METHODS: Age standardized incidence and mortality rates for BC, cohort incidence ratios, and 1 and 5-year relative survival from BC were calculated, and current trends were assessed. RESULTS: Between 1971 and 1998 the total number of cases of BC increased by 57% from around 7,200 to almost 11,400. Between 1971 and 1998 directly age standardized incidence increased by 16% in males and 37% in females. Directly age standardized mortality decreased by 26% in males and showed little change in females during the same period. Five-year relative survival improved by around 15% points in the 1970s and early 1980s. However, there was less improvement in survival thereafter in that 5-year relative survival for patients diagnosed in 1993 to 1995 was 67% in men and 58% in women. CONCLUSIONS: With an almost 60% increased incidence during the last 3 decades, BC incidence remains much higher in men but has increased more rapidly in women. There have been steady decreases in mortality rates, more marked in men than in women. Unusually, women have a significantly lower survival rate than men. Reasons for these patterns and trends are unclear. The trends in bladder cancer incidence by birth cohort suggest that the relationship with smoking may not be that strong and that other factors may be involved. Further research should focus on reasons for the recent increase in bladder cancer incidence in younger female birth cohorts.

Validation of the ethanol breath test and on-table weighing to measure irrigating fluid absorption during transurethral prostatectomy.

OBJECTIVE: To determine the agreement between on-table weighing and the ethanol breath test in measuring the fluid absorption of patients during transurethral prostatectomy (TURP), and to assess the practicality of on-table weighing in the clinical setting. PATIENTS AND METHODS: The absorption of irrigating fluid by the patient during TURP can lead to adverse sequelae, including cardiac stress. Despite modern techniques irrigant may still be absorbed and therefore methods to detect absorption are important. Most methods are impractical or inaccurate, but the expired ethanol technique and continuous on-table weighing are more promising. TURP was undertaken in 44 men (mean age 71 years) using continuous flow 1.5% glycine/1% ethanol as the irrigating solution. Intraoperative irrigant absorption was calculated by the ethanol breath test, using published formulae. Absorption measured by the weighing machine was calculated as (weight gain + blood loss - fluid given), and blood loss by the Hemocue method. RESULTS: The mean (sd) resected weight was 23 (14) g at a mean resection rate of 0.74 g/min. The mean (range) absorption using the balance was 456 (- 343 to 2486) mL, and using the ethanol breath test was 435 (44-2750) mL, with the mean of the differences being - 17 mL, with a 95% confidence interval (CI) of - 81 to -40, the 95% limits of agreement being - 389 to 356 mL (95% CI - 458 to - 337 and 297 to 418 mL). CONCLUSIONS: Both methods are comparable and measure irrigating fluid absorption to levels of accuracy that are useful clinically. Either method could (and should) be used in routine practice.

Paravesical suture granuloma: a problem following herniorrhaphy.

We discuss the diagnosis and management of a paravesical suture granuloma and review 11 such cases reported in the literature. Granulomas are an unusual complication of surgery, which have been noted to occur from several months to 11 years postoperatively. Of the 11 patients reported on 10 had undergone previous inguinal herniorrhaphy and presented with urinary symptoms and a palpable mass, and 1 had undergone femoral herniorrhaphy. In 7 cases the clinical diagnosis was a malignancy. It is important to consider suture granulomas in the differential diagnosis of a suprapubic mass involving the bladder so that unnecessary major surgery can be avoided.

Long-term results of treating advanced prostatic cancer with the LH-RH analogue Zoladex.

Fifty-six patients with previously untreated advanced prostatic cancer were treated with the LH-RH agonist Zoladex. Patients have been followed for between 24 and 39 months. The response rate and duration of response have been assessed and related to the degree of differentiation of the primary tumor. All of the patients with well-differentiated tumors responded symptomatically, while the comparable figure for patients with poorly differentiated tumors was 67%. The better differentiated tumors tended to respond longer than their poorly differentiated counterparts (18.75 months compared to 15.9 months, respectively). Overall survival was worse in patients having tumors of higher grade and the mean survival after relapse was shorter. The results confirm the unfavorable prognostic significance of poor histological grade in prostatic cancer and indicate that response to treatment, duration of response, and time to death following relapse are also adversely influenced.

The treatment of metastatic prostatic cancer with the slow release LH-RH analogue Zoladex ICI 118630.

The clinical and endocrine response to a depot preparation of the LH-RH analogue ICI 118630 (Zoladex) was assessed in 55 untreated patients with advanced prostatic cancer. Whereas gonadal androgen suppression was achieved in all patients, subjective and objective clinical response occurred in only 69%, indicated by a relief of bone pain, a decrease in the size of the primary tumour and lymph node metastases and improvement in bone scan appearances. A third of these patients, however, subsequently showed progression of their disease. Serious side effects were not encountered in this study. The depot formulation is a simple, safe and convenient method of administering Zoladex and offers an alternative treatment for metastatic prostatic cancer.

Ultrasound assessment of residual urine. A quantitative method.

A method of measuring residual urine volume using ultrasound is described. The volume is computed from serial parallel sections of the bladder. This method is found to be significantly more accurate than previously reported techniques and is quick and easy to perform.

A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease.

A modified technique for performing the Gritti-Stokes amputation is described and the results obtained in 247 cases are presented. The mortality rate was 9.3% and healing occurred in 87% of survivors. Using this modified technique the frequently cited criticisms of non-union of the patella and painful stumps were not found to be major problems. The prosthetic problems of amputation at this level are discussed in relation to recent developments in the design of artificial limbs.