Morbidity and the impact on daily activities associated with catheter drainage after acute urinary retention.

OBJECTIVE: To evaluate the effect on quality of life of being discharged home with a catheter before definitive treatment in patients with acute urinary retention (AUR). PATIENTS AND METHODS: Patients attending the emergency department with AUR were assessed and discharged home with a catheter if they fulfilled predetermined criteria. They were admitted to the day-care unit for urological assessment and completed a disease-specific quality-of-life questionnaire. RESULTS: Of 101 patients presenting to the emergency department in AUR, 84 were sent home after catheterization (83%); 78 (93%) patients completed the questionnaire. The major side-effects reported were urinary leak (46%), mild haematuria (44%), urgency (42%), pain around the penis (42%), painful erection (31%) and catheter blockage (26%). Only 12% of patients felt having a catheter was very inconvenient and 93% would find it acceptable to have a catheter in future. CONCLUSION: A significant minority of patients discharged home with a catheter had side-effects related to their catheter but were not greatly inconvenienced, and their capacity to carry out normal daily activities was not impaired. The immediate discharge of patients in AUR and planned treatment will enable better use of inpatient urology resources.

Long-term evaluation of the Gittes procedure for urinary stress incontinence.

PURPOSE: We evaluate the long-term outcome of the Gittes procedure for urinary stress incontinence. MATERIALS AND METHODS: A total of 87 women with proved genuine stress incontinence were treated with the Gittes procedure. The same urologist performed 95 consecutive operations during an 8-year period. Patients were evaluated by a postal questionnaire. RESULTS: Of the patients 52 (60%) (55 operations) responded to the questionnaire. Mean and median followup were 53 and 46 months, respectively (range 24 to 103). Twelve patients (23.1%) reported complete absence of postoperative urinary incontinence and were considered cured, 14 (26.9%) were significantly improved and a total of 30 (57.7%) benefited from the operation. The short-term results were initially encouraging but by 2 years only 20 patients were completely continent (38.5% cured). Of the 40 patients who were not cured 32 (80.0%) experienced incontinence within 2 years postoperatively. There were 26 who had complained of frequency and/or urgency preoperatively. There was a statistically significant subjective failure rate in this group (p = 0.007). CONCLUSIONS: The Gittes procedure is simple and has minimal complications. Although it provides continence in the early weeks and months following surgery, the long-term cure rate is disappointing, with most failures occurring within 2 years of surgery. Preoperative irritative symptoms, even when multichannel cystometry did not reveal instability, were associated with a poor subjective outcome. Our results suggest that the Gittes procedure is not satisfactory for the management of genuine stress incontinence in women.

Multifocal renal cell carcinoma in sibs from a chromosome 9 linked (TSC1) tuberous sclerosis family.

Multifocal renal cell carcinomas (RCCs), together with angiomyolipomas (AMLs) and renal cysts, were identified in early adult life in two sisters with tuberous sclerosis (TSC). They were members of a multigenerational tuberous sclerosis family showing strong evidence for a mutant TSC causing gene on chromosome 9 (TSC1). Previous reports of multifocal RCC in young patients with TSC suggest that constitutional mutations at the TSC loci may predispose to RCC. In the rat a germline mutation affecting the TSC2 gene is associated with transmission of multifocal RCC as an autosomal dominant trait. However, the cases reported here are the first to suggest a similar role for the TSC1 gene in renal cell carcinogenesis.

Early diagnosis of cytomegalovirus infection in renal transplant and dialysis patients by DNA-DNA hybridisation assay.

One hundred forty-eight urine specimens were collected from 47 renal transplant and dialysis patients and screened for the detection of cytomegalovirus (CMV). Diagnosis of CMV infection was suggested in 17 out of 47 patients (36.2%) by more than one of the five methods used. DNA hybridisation assay (DNA HA) using 32P-labelled probe detected CMV DNA in 15 (31.9%) of 47 patients, whereas virus isolation on conventional tube cell cultures (CTC), immunofluorescence incorporating monoclonal antibodies on centrifugation vial cultures (IF), complement fixation test (CFT), and electron microscopy (EM) yielded positive results in only nine (19.2%), 12 (25.2%), 11 (23.4%), and one (2.1%) of 47 patients, respectively. The significance of these results obtained by DNA HA lies not only in the apparent increase in number of patients diagnosed, but also in both early and rapid detection of CMV DNA. More importantly, the DNA HA is highly specific in that it correlates accurately with clinical and laboratory data characteristic of CMV disease. In respect of clinically manifest CMV disease, the specificity of DNA HA, CTC, IF, CFT, and EM was 87.5, 43.7, 56.3, 43.7, and 6.3%, respectively. These advantages of DNA HA make it the test of choice for early diagnosis of CMV infections in immunosuppressed patients.

Skin necrosis: a complication of alcohol infarction of a hypernephroma.

A case of skin infarction after transcatheter ablation of a hypernephroma using alcohol is described. Possible avenues for migration are discussed.

High serum prolactin associated with poor prognosis in carcinoma of the prostate.

Seventy patients with carcinoma of the prostate have had regular estimations of serum prolactin levels during a 10-month period, and were followed up for a further 6 months. Of 21 patients who recorded at least one high serum prolactin, 10 (48%) died during these 16 months, while of 50 with normal prolactin, only 2 (4%) died. Ten (21%) of the 47 patients on oestrogen or anti-androgen therapy died, and 9 of these had a high prolactin. This contrasts with 2 (14%) deaths of 14 who had had either bilateral orchiectomy or radiotherapy to the prostate. One of the 2 who died had a high prolactin. It is concluded that an elevated serum prolactin in treated carcinoma of the prostate is associated with progression of the disease and a poor prognosis.

The surgical management of bilharzial strictures of the ureter.

Twenty-one ureteric strictures due to bilharzia have been treated surgically in 13 patients. Two required nephrectomy; 19 had direct ureteric reimplantation into the dome of the bladder after excision of the strictured segment of ureter. A simple technique of reimplantation into the dome of the bladder is described and early results have justified its further use.

Internal urethrotomy using Sachse knife for managing urethral strictures.

Urethral strictures secondary to trauma have been a frequent cause of obstruction in the male population residing in Saudi Arabia. This study of 59 patients presenting with urethral strictures covers a two-year period. Patients were asked to return for the initial follow-up one month after treatment and were asked about the force of their urine stream. They returned again after six months for a urethrogram; finally yearly follow-ups were commenced.

Renal tuberculosis in a multi-racial community.

There were 44 new cases of renal tuberculosis at the Waikato Hospital, 1961-1975. Thirty-three patients were Maoris or Polynesians and 10 Europeans. Most patients were adults. Culture of the urine and intravenous urography were the most useful diagnostic tests. The patients were treated with antituberculous chemotherapy. Seventeen had surgical procedures including 10 nephrectomies. In all there was one death. Factors concerned with prevention in high risk groups are discussed.

Prolonged curarisation in the presence of renal impairment.

Prolonged curarisation in the presence of renal failure occurred in six cases where pancuronium was used, and one case where alcuronium was used. The cases are presented with a brief review of the literature. Pancuronium must be used with great caution if postoperative reversal problems are to be avoided. Greater use of adjuvants will reduce requirements and may eliminate the problems encountered in renal failure.

Pre-operative balloon occlusion of the renal artery for radical nephrectomy.

Six of 8 patients with renal tumours were successfully catheterised pre-operatively and the renal artery occluded by a Swan Ganz balloon tipped arterial catheter. At subsequent radical nephrectomy early ligation of the renal vein was readily accomplished and there was noticeable decrease in vascularity and engorgement of the kidney and its tumour.

A shortage of kidneys for transplant in New Zealand.

There is a shortage of donor kidneys for transplantation in New Zealand. As a successful transplant is generally accepted to be superior to long-term haemodialysis as a treatment for chronic renal failure, efforts must be made to increase the supply of donor organs. Transplant centres in New Zealand are probably supplying near their maximum possible number of cadaver donors and it is not enough. The number of donors available could be greatly increased if peripheral hospitals took a more active part in donor supply. A further increase in the number of transplants in New Zealand each year would be expected if live related donor transplants were to become more common.

Peptic ulceration, gastric secretion, and renal transplantation.

Fifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication. In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations. Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.

The humoral responses of haemodialysis patients to antigen challenge.

Twenty-four patients on regular haemodialysis had repeated serum samples tested for lymphocyte cytotoxicity and for factors which inhibit the mixed lymphocyte culture (MLC). It was found that serum with a high urea content did not increase the incidence of inhibition of MLC. In 16 patients on haemodialysis there was inhibition of MLC by autologous serum and the same combinations of lymphocytes were inhibited in repeated tests. The serum from 10 of these patients was also cytotoxic for lymphocytes. Serum from 12 patients was not cytotoxic but 6 of these caused inhibition MLC. It is suggested that inhibition of MLC may be produced by factors which are not specific for HLA. Serum from patients who previously rejected kidney transplants or who had pregnancies or multiple blood transfusions showed increased cytotoxicity, but these factors did not increase the frequency of serum inhibition of MLC. The significance of serum inhibitory factors and cytotoxic antibodies in the early clinical course of 12 cadaver transplants is discussed.