Prolonging follow-up intervals for non-invasive bladder tumors: a randomized controlled trial.

Considerable resources are devoted to the follow-up of patients with superficial bladder tumors. Traditionally these patients are evaluated every three months in the first year(s) after the primary resection. In a randomised controlled design we evaluated the consequences of doubling the follow-up intervals for patients with non-invasive bladder tumors (Ta) with none of the following risk factors: concomitant urothelial dysplasia, tumor grade > II, early recurrence. The patients were allocated to one of two follow-up regimens: Regimen I: follow-up every three months for the first two years and every six months in the third year, thereafter once a year. Regimen II: Every six months for the first year and once a year thereafter. At most of the follow-up visits the bladder was examined by transabdominal ultrasound. Cystoscopy was performed in all patients once a year. The data from the 97 patients were evaluable. Three patients in regimen I and 1 patient in regimen II progressed in grade and/or stage in the observed period. No patient died of his tumor disease. There was no difference with regard to recurrence, progression and tumor-related death between the two groups. The total number of follow-up visits in regimen II was reduced by 37.5% (P = 0.0016) compared to regimen I. The number of patients specific follow-up visits with a recurrent tumor present was increased by 65% (P = 0.0475). In the future we will follow this selected group of patients with non-invasive bladder tumors as described.

Management of the non-descended testis: doubtful value of luteinizing-hormone-releasing-hormone (LHRH). A double-blind, placebo-controlled multicentre study.

In a double-blind, placebo-controlled multicentre study, the effect of luteinizing-hormone-releasing-hormone (LHRH) in 141 boys was analysed after 4-week treatment period with 0.4 mg LHRH nasal spray or placebo nasal spray three times daily. Data from 123 boys was analysed, with 62 boys in the treatment group and 61 in the placebo group. Full response i.e. the testis at the bottom of the scrotum on both sides in boys with bilaterally undescended testes, was found in six patients, one of them in the placebo group [Therapeutic gain of LHRH with 95% CI: 8.1% (0.1-16.6%, P = 0.12)]. Only in these boys could surgery be avoided. Considering the number of testes (and not the number of boys) a significant effect was found on at least one testis in 25% of boys with bilaterally undescended testes [Therapeutic gain with 95% CI: 24.0% (13.2-34.8%, P = 0.001)]. In unilateral undescended testes, the LHRH treatment showed no effect (P = 1.00). The inclusion of retractile testes did not affect our results. In our opinion LHRH has a limited place in treatment of the non-descended testis.

Uretero-pelvic stenosis.

In a prospective series of 66 patients with uretero-pelvic stenosis ("genuine hydronephrosis") the clinical data and the results of treatment were registered. We found an estimated incidence per year of 5:100,000 inhabitants. In the age group under 10 years there was a striking majority of boys. Routine antimicrobial prophylaxis was not given; only one patient had clinical urinary tract infection postoperatively, but bacteriuria in the nephrostomy catheter was frequent. Follow-up 12 months after dismembered pyeloplasty with postoperative nephrostomy showed 85% of the patients to be cured, i.e. with no symptoms and with normal drainage from the renal pelvis. In 5% of the cases (3 patients) the result was unsatisfactory. The technique can be recommended in the treatment of ureteropelvic stenosis.

Use of blood in transurethral prostatectomy--routine or selective cross-matching?

In our series of 700 transurethral resections of the prostate 464 patients (66%) received no blood transfusions, while 121 patients (17%) received two or more units of blood. A significant relationship was demonstrated between the size of the prostate and the estimated blood loss, as well as between the presence of a preoperative urethral catheter and the blood loss.

Urinary tract infections in connection with transurethral resection of the prostate.

The study evaluates the incidence and consequences of infectious complications after 700 transurethral resections of the prostate. The patients were treated individually for bacteriuria according to urine cultures. No general antibacterial prophylaxis was used. 376 patients (54%) had negative urine cultures throughout the course and received no antibacterials. Of the 256 patients with an indwelling catheter before surgery only 64 (25%) had negative cultures throughout, as opposed to 312 (70%) out of 444 patients without an indwelling catheter preoperatively. Antibacterial treatment was given to 127 patients (18%) before surgery because of bacteriuria. Positive urine cultures postoperatively indicated antibacterial therapy to 197 patients (28%). Four non-fatal cases of septicemia were recorded. The influence of bacteriuria and indwelling catheters on the postoperative course and on the length of hospital stay is documented. It is concluded that antibiotic prophylaxis may be indicated in patients with a preoperative urethral catheter; other patients should be treated if and when bacteriuria occurs.

[Male sterilization with vasectomy. The effect of the operation on sex life]. / Mandlig sterilisation med vasektomi. Indgrebets indflydelse på det seksuelle samliv.

PIP: 182 of 220 men, 25-54 years of age, who underwent vasectomy, filled out a questionnaire describing how the operation affected their sex life. Nearly all of the men were married and were regularly employed. 86% of those who returned the questionnaire had 2 or 3 children. 99% said that their wives agreed with their decision to undergo vasectomy. 80% chose vasectomy because their wives could not or did not want to use oral contraceptives or other methods, or because they wanted 100% effectiveness. 48 experienced short-term difficulties. 6% reported a decrease in libido or orgasm, and 1% reported a decrease in sexual intercourse after the operation. 86% would recommend the operation to others, 7% would not.^ieng

Vesico-ureteral reflux in non-paediatric patients.

In the period 1968-1975 we treated 55 female and 19 male adolescent or adult patients for vesico-ureteral reflux (v. u. r.) to a total of 116 renal units. The reflux was primary in 69 units, secondary in 20 and or mixed type in 27 units. It was of moderate degree in 50 units, 31 (62%) of which showed radiologic nephropathy. Of the 18 units with gross reflux, 16 (89%) showed nephropathy. Re-implantation of 75 ureters in the bladder ad modum Politano-Leadbetter was followed by cessation of reflux in 66 units (88%), with cure of symptoms and bacteriuria in a corresponding number of patients. Infravesical surgery or antibacterial medication were less effective when used alone. Two patients with severely impaired renal function (serum creatinine greater than 440 mumol/l) failed to improve, despite technically successful surgery. Primary v. u. r. in adolescents and adults has often been present since childhood, and many of these patients show radiologic evidence of nephropathy. Effective antireflux treatment should be given early, in order to prevent progressive renal damage.

Post-irradiation total cystectomy for bladder cancer.

Treatment with radiotherapy (6000 rad) followed by total cystectomy was carried out in 125 patients with T1-T3 bladder cancer, the tumour being poorly differentiated (grade III-IV) in 115 cases. Survival was significantly better, if the irradiation had resulted in complete tumour regression before cystectomy, and if the tumour at the initial examination was of category T1. The relative cumulative survival after 5 years for patients with T1-tumours was 60%, as opposed to 40% for patients with T3-tumours. 4 patients (2.4%) died within 30 days of the cystectomy, but 13 patients (10%) died within 3 years from complications of the treatment regime. 83 patients (66%) experienced non-fatal complications such as infected cavity and urinary or intestinal stenosis. 3 years after the cystectomy 62 patients (50%) were dead from recurrent tumour or from other causes.

Changes in the serum concentrations of sodium, potassium, and free haemoglobin during transurethral resection of the prostate--parts of the TUR-syndrome?

In 133 patients undergoing transurethral resection of the prostate under standardized conditions the concentration of serum sodium decreased, and the concentration of free plasma haemoglobin increased significantly after the operation. Such changes were not found in a control group of 31 patients undergoing cystoscopy or bladder biopsy. The changes in the operated group are believed to be caused by the absorption of water used as irrigating fluid during the resection.