Renal function in men with lower urinary tract symptoms at first presentation to urology out-patient department.

AIM: Current national guidelines state that it is mandatory to perform an estimation of renal function in all males with lower urinary tract symptoms (LUTS). As national audit evidence suggests this is not general practice, we have carried out a study to assess the value of routine testing of renal function in this group. PATIENTS AND METHODS: Serum creatinine or urea was measured in 213 consecutive men presenting to the urology out-patient department with lower urinary tract symptoms. Risk factors for renal dysfunction such as large post-void residual volume, proteinuria, microscopic haematuria, diabetes mellitus and cardiovascular disease were noted. RESULTS: Twelve of 213 patients had abnormal results. One 90-year-old had a raised serum urea but was found to have a normal creatinine level. Ten of the remaining 11 patients would have had their renal dysfunction predicted by history, examination or bedside tests. CONCLUSIONS: Routine measurement of creatinine or urea in men presenting with LUTS with no other risk factors could be considered purely a health screening test. It is suggested that it should no longer be considered as mandatory, in this situation, but used only if specifically indicated. A urine flow rate would be a more useful test in reaching a diagnosis and planning treatment.

Transurethral resection of the prostate in the anticoagulated patient.

OBJECTIVE: To assess the safety of transurethral prostatectomy (TURP) in patients on long-term full anticoagulation. PATIENTS AND METHODS: Twelve TURPs were performed on 11 patients with urinary retention or severe symptoms from prostatic obstruction who also required anticoagulation for a history of life-threatening thromboembolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 days before surgery; on admission a day later, full intravenous heparinization was commenced. Heparin was stopped 4 h before TURP and re-commenced with an initial bolus in the recovery room, and warfarin re-started that evening. RESULTS: The mean weight of prostate resected was 23 g and the mean peri-operative decrease in haemoglobin was 1.6 g/dL. Only one patient required a transfusion of 3 units, but the activated partial thromboplastin time (APTT) had risen to >4. The mean pre- and post-operative APTT were 1.7 and 2.64, respectively, and the mean total length of hospital stay 6.7 days. Three patients were re-admitted for secondary haemorrhage at 8, 9 and 28 days after TURP, but all resolved with catheterization for 24 h only. There were no other major complications or thrombo-embolic phenomena. CONCLUSION: TURP can be conducted safely in this high-risk group of patients with a regimen that allows a brief but controlled interruption to their full anticoagulation. This protects from the risks of thromboembolic incidents with no major increase in haemorrhage or hospital stay.

Biochemical and haematological indicators of excessive alcohol consumption.

Discriminant function analysis was used to determine the optimum combination of haematological and biochemical tests which gave the best discrimination between hospital patients with high and low alcohol intakes. We studied 265 patients with alcohol-related disease, 133 gastroenterology outpatients drinking less than 20 g of alcohol per day, and 104 patients with a variety of non-alcoholic liver disease. Values of mean cell volume (MCV), serum bilirubin, aspartate transaminase, serum alkaline phosphatase (AP) and gamma glutamyl transferase (gamma GT), serum albumin, serum globulin, and uric acid were determined in each patient. The best discrimination between the three groups of patients was provided by a combination of mean corpuscular volume, log10 gamma GT, and log10 serum alkaline phosphatase. In women, 92% of the high alcohol group, 100% of the low alcohol group, and 87% of the non-alcoholic liver disease were correctly allocated by the discriminant analysis. The corresponding figures for the men were 80%, 100%, and 71%. Thus, over 80% of patients with excessive alcohol intake were correctly allocated by the use of three simple laboratory tests.

Sex-related differences in the haematological effects of excessive alcohol consumption.

Mean corpuscular volume (MCV) was measured at presentation in 320 hospital patients with a history of excessive alcohol consumption. The MCV of the 94 women thought to be actively drinking more than 80 g/day of alcohol was 101.3 fl compared with 96.7 fl in their male counterparts. Alcohol consumption, age, smoking habits, prevalence of inadequate diet, or serum and red cell folate levels did not differ significantly between men and women. It is suggested that MCV is a better indicator of excessive alcohol consumption in women than in men, and that women are more susceptible to the haematological toxicity of alcohol.