Acute abdomen--remember spontaneous perforation of the urinary bladder.

Spontaneous perforation of the urinary bladder is a rare clinical condition presenting as an acute abdomen. It should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumour in the bladder. Disproportionately elevated serum urea and creatinine should raise the index of suspicion. A case of spontaneous perforation of the bladder, five years following successful treatment of a bladder tumour by radiotherapy, is reported.

An unusual renal tumour.

Primary renal lymphoma is a rare disease. The basis for diagnosis of this entity has been described and its existence is widely accepted. Localized deposition of amyloid is also a rare phenomenon. A case of primary lymphoma with localized amyloid deposition is reported here.

Painful bladder disease: clinical and pathoanatomical differences in 115 patients.

The diagnostic criteria for interstitial cystitis considered as a subgroup of painful bladder disease (that is sensory bladder disease and chronic abacterial cystitis) are not well established. Some urologists rely on symptoms, while others rely on cystoscopic appearance or pathological findings. Among 115 patients with painful bladder disease we compared symptoms, and cystoscopic and urodynamic findings in those with and without detrusor mastocytosis (28 or more mast cells per mm.2) and attempted to elucidate possible differences between the groups. We chose the pathological anatomical criterion of detrusor mastocytosis to be diagnostic for interstitial cystitis. A total of 43 patients had detrusor mastocytosis and other pathological anatomical signs of interstitial cystitis, and 72 had no mastocytosis but the pathological diagnoses of chronic unspecific cystitis, fibrosis of the bladder, detrusor myopathy, intestinal metaplasia and normal findings. When the 2 groups of patients were compared we found no differences in regard to symptoms (pain, dysuria, frequency, nocturia and urgency), frequency of allergy and hysterectomy, duration of symptoms, petechial bleeding during cystoscopy with bladder distension and cystometric findings. The patients with mastocytosis differed from those without mastocytosis in that they were older, and had a higher frequency of hematuria, a higher frequency of a red, scarred and richly vascularized bladder at cystoscopy before distension, and a smaller cystoscopic bladder capacity. We conclude that by dividing patients with painful bladder into 2 groups according to the mast cell counts in the detrusor, certain differences in the clinical findings in the groups can be ruled out. However, in individual patients one cannot note with certainty to which pathological anatomical group the patient belongs, since great overlapping between the groups exists. Whether only patients with detrusor mastocytosis have interstitial cystitis depends on definitions and still remains an open question.

A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease.

Painful bladder disease, sensory bladder disease, chronic abacterial cystitis and interstitial cystitis are ill-defined conditions of unknown etiology and pathogenesis, and, therefore, they are without any rational therapy. Pathogenetic theories concerning defects in the epithelium and/or mucous surface coat (including glycosaminoglycans) of the bladder, and theories concerning immunological disturbances predominate. Sodium pentosanpolysulfate (Elmiron) acts by substituting a defective glycosaminoglycan layer and inhibits complement reactions in inflammatory processes. We compared sodium pentosanpolysulfate versus placebo in a prospective double-blind, clinically controlled multicenter trial of 115 patients with painful bladder disease. Two protocols were used. Protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2), and protocol B included 72 patients with a painful bladder and unspecific histological findings. The patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months. Before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies. The results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts. A significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found. We conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease.

Blood loss in prostatic resection after relief of acute retention of urine by prolonged catheter drainage.

Blood loss in transurethral resection of the prostate was measured in 31 patients and a comparison made between 12 who had required prolonged preoperative bladder drainage by indwelling urethral catheter and 19 who had not been catheterised. There was no difference in blood loss per gram weight of prostatic tissue resected per minute operating time between the two groups.

The diagnosis and management of benign fibrous ureteric polyps.

The diagnosis and management of benign fibrous ureteric polyps are discussed. A pre-operative diagnosis is suggested by a long history of loin pain or haematuria, both, in a younger patient with the radiological findings of ureteric obstruction or a radiolucent ureteric filling defect. The diagnosis is confirmed at operation by opening the ureter and exposing characteristic fronds of polyps arising from a common base. It is suggested that management should be conservative local excision and not nephroureterectomy, as previously practised.

The effect of frusemide used for post-prostatectomy irrigation on total body potassium.

The effects of 2 techniques of bladder irrigation on total body potassium have been compared. The results show that a net decrease was associated with both methods. This was marginally greater (0.1 greater than P greater than 0.05) in the group which underwent a forced diuresis using frusemide with a fluid load. This group received some potassium supplements without which it is possible that the decrease would have been greater. It is concluded that this regime cannot be overtly criticised for its potential loss of potassium.

Use of an elemental diet for long-term nutritional support in Crohn's disease.

An elemental diet was used for long-term (up to 360 days) nutritional support in eight patients with Crohn's diesease. They had lost 30% (range 18-37%) of their weight in health. A whole-body monitor was used to measure total body potassium as an index of the lean tissue mass. Three preoperative patients who has been unable to maintain their weight on a normal diet were able to restore 10% per month of their lost lean tissue once they were established on an elemental diet. In five patients who had had a successful resection of their bowel lesion the postoperative rate of restoration of the lean tissue mass while taking an elemental diet was 18.5% per month, while in two control postoperative patients on a normal diet it was 19% per month.