Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation.

The long-term results of simple high-pressure balloon dilation in the treatment of ureteropelvic junction obstruction (UPJO) and ureteral strictures were evaluated. A total of 77 consecutive patients were treated: 40 had UPJO and 37 ureteral strictures. The etiology of the obstruction included congenital UPJO, previous stones, sequelae of endoscopic and open surgery, radiotherapy, and urinary tract reconstruction. A retrograde ureteroscopic approach was used. Evaluation included clinical and radiographic examinations and renal scintigraphy with diuretic wash-out. The procedure was repeated in 21 cases. The median follow-up was 29 months. The procedure was considered successful if it left the patient asymptomatic and with improved renographic function and drainage. The overall success rate was 70%. The best results were obtained in strictures secondary to stones, with a success rate of 94%, and in strictures secondary to reconstructive and ureteroscopic surgery, with a success rate of 91%. In congenital UPJO, the results were less encouraging: in patients with a symptom debut after the age of 18 years, balloon dilation was successful in 57% of cases; in patients with symptom debut before the age of 18 years, success was achieved in only 25% of cases. There were no major complications. It was concluded that simple high-pressure balloon dilation is a safe and reasonably effective technique for the management of most ureteral strictures and congenital UPJO with symptom debut in adult life. Balloon dilation seems to have no place in the treatment of primary congenital UPJO in children.

Invasive, high grade transitional cell carcinoma of the bladder treated with transurethral resection. A survival analysis focusing on TUR as monotherapy.

Two hundred and fifteen consecutive patients admitted to our department between 1978 and 1988 were included in a retrospective study. Entrance criteria were transitional cell carcinoma of the bladder T1-4, Grade III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TUR). Patients were followed with cystoscopies. Recurrent tumours were treated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (> 10), adjuvant therapy was recommended. The patients were retrospectively allocated to three different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Table I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectively. In the analysis, most emphasis was put on Group 1. For stages T1-4 in this group, the median survivals was 67, 19, 9 and 2 months, respectively. Differences were statistically significant (p < 0.05). T1 tumour stage seemed to predict a reduced risk of progression compared with the higher tumour stages (p = 0.05, Fisher's test). There was a tendency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radical TUR does not seem to offer the same cure rates as radical cystectomy. However, in a selected group of patients with a troublesome medical history, or for patients wishing minimal risk treatment, TUR might be a reasonable treatment modality.

Peyronie curvature treated by plication of the penile fasciae.

OBJECTIVE: To evaluate the results of plication of the penile fascia in patients with penile curvature secondary to Peyronie's disease. PATIENTS AND METHODS: Twenty-eight men with Peyronie curvature underwent plication of the penile fascia. Before operation, the deviation of the penis was so severe (median 60 degrees) in 24 men that they were unable to perform sexual intercourse. Follow-up was based on hospital records, one postal questionnaire sent to all patients and a clinical evaluation of the men in the out-patient clinic. RESULTS: After an uncomplicated operation and a median follow-up of 34 months, 20 of the 28 men were able to perform sexual intercourse and 23 were satisfied with the result of the operation. The most frequent reasons for dissatisfaction with the outcome of the operation were insufficient straightening, pain from sutures and uncharacteristic pain related to the penis and/or scrotum. CONCLUSION: The technique is simple to perform and the method gives functional and cosmetic results equal to those of more invasive procedures. The provision of adequate information to patients before the operation is important to ensure their satisfaction with the outcome.

[Breast reduction surgery. County of Velje--a 12-year follow-up study]. / Mammareduktionsplastik. Vejle Amt--en 12 års opgørelse.

A questionnaire investigation of 299 women treated operatively over a 12-year period for breast hypertrophy in four general surgical units is presented. Different surgical techniques were used, and in one of the departments one plastic surgeon performed the operations. The results of the different techniques were compared. All techniques gave good physical relief. Pers & Bretteville-Jensen's technique proved to be better in maintaining the sensitivity of the nipple, but a higher incidence of complications occurred. With McKissock's, Strömbeck's and Bames-Ragnell's techniques all scars end up looking like an anchor. These methods are preferred by most women, in spite of a higher risk of losing the sensitivity of the nipple. Significantly more women who had undergone reduction mammaplasty with the Pers & Bretteville-Jensen technique, which ends up with a horizontal scar across the breast, regretted the operation. The cosmetic results were very important for the patients, and a more uniform treatment of the patients might be preferred.

[The course after ileo-cystoplasty in patients with interstitial cystitis]. / Forløbet efter ileocystoplastik hos patienter med cystitis interstitialis.

The results of ileocystoplasty in nine patients with interstitial cystitis were evaluated. In addition to the information obtained from the hospital records, all patients answered a postal questionnaire. No serious complications occurred. Mean follow-up was 95 months (75-125 months). Seven patients were continent, of whom three were practising clean intermittent self-catheterization (CIS). One patient remained stress and urge incontinent in spite of CIS. After an uncomplicated operation one patient died seven years later from unknown causes. Six patients were very satisfied and two fairly satisfied with the outcome of the operation. All would accept a new operation if necessary.

Long-term follow-up after clam ileocystoplasty. Complications and results including some quality-of-life parameters for 32 patients treated for neuropathic and nonneuropathic bladder disease.

The results of clam ileocystoplasty in 32 patients were evaluated. Nineteen patients had a neuropathic (group N) and 13 a nonneuropathic disease (group NN). Mean follow-up was 75 months; 62 months for group N and 95 months for group NN. Mean age was 38 years. Postoperative complications and some quality-of-life parameters including continence, and the need for clean intermittent self-catheterization and an artificial sphincter were assessed. The mean pre-/postoperative bladder volumes were for group N and NN 173/364 ml and 171/246 ml, respectively. Eighty percent of the patient were satisfied with the operation and would undergo a new operation if necessary. The remainder had some expectations that were unfulfilled.

[Vesicovaginal fistulas with special reference to therapeutic possibilities and time]. / Vesikovaginale fistler specielt med henblik på behandlingsmuligheder og -tidspunkt.

We report our own results of minimally invasive treatment in eight women with vesicovaginal fistula after gynecologic surgery. Minimally invasive or non-operative measures include fulguration of the fistula area and bladder drainage. In addition to our own results, the paper gives a review of the treatment of vesicovaginal fistulae. With respect to the literature we compare and discuss the possible procedures, surgical as opposed to conservative of minimally invasive. We also focus on the results of non-delay in the treatment of vesicovaginal fistulae. The results of non-delay and minimally invasive therapy are interesting, and it seems that these possibilities could be offered to some patients prior to or instead of surgery.

[Duodenal cancer--illustrated by 5 cases, with special consideration to symptomatology, diagnosis and treatment]. / Cancer duodeni--belyst ved fem sygehistorier, specielt med henblik på symptomatologi, diagnostik og behandling.

Over a period of 30 months we have seen five patients with duodenal cancer (four adenocarcinomas and one carcinoid-tumour). All patients are presented with a brief history of vague and non-specific symptoms. Diagnosis was established by endoscopy and biopsies. In one case, a Whipple's procedure was performed, and the patient is without evidence of tumour recurrence eight months later. Three patients could only be offered palliative surgery, of these, one is still alive two years after the operation, one (the patient with a carcinoid tumour) died three months postoperatively, and the third has only just recently been operated. The fifth patient died ten days after the diagnosis was confirmed, without any specific treatment. The different diagnostic methods available as well as the treatment and prognosis of duodenal cancer are discussed. We conclude that: 1) despite improved diagnostic procedures, the diagnosis of duodenal cancer is still difficult and delayed due to vague and non-specific symptoms, 2) the diagnostic procedure is endoscopy and biopsy. 3) the treatment is surgery and 4) the prognosis is poor in the majority of patients.