Long-term suprapubic catheterisation: clinical outcome and satisfaction survey.

We report on the clinical outcome and satisfaction survey of long-term suprapubic catheterisation in patients with neuropathic bladder dysfunction. Between early 1988 and later 1995, 185 suprapubic catheters were inserted under direct cystoscopic vision. Anti-cholinergic therapy was given to all patients with significant detrusor hyper-reflexia; the catheters clamped daily for two hours and changed every six weeks. Ultrasonography and assessment of the serum creatinine were used to assess the upper renal tracts, and the results of the pre- and post-catheter video-cystometrography was used to evaluate bladder morphology, cystometric capacity, maximum detrusor pressure and the presence of vesico-ureteric reflux. There were equivalent numbers of males and females. The follow-up ranges from 3-68 months. Following catheterisation, there was a 50% reduction in the average maximum detrusor pressure, bladder morphology improved in 85% of the cases; the bladder capacity and upper renal tracts remained unchanged. Vesico-ureteric reflux was abolished in 33% of the cases. Complaints were common consisting of recurrent catheter blockage, persistent urinary leakage and recurrent urinary tract infections. There was a 2.7% incidence of small bowel injury with one fatality. However, the general level of satisfaction was high. It is concluded that suprapubic catheterisation is an effective and well tolerated method of management in selected patients with neuropathic bladder dysfunction for whom only major surgery would otherwise provide a solution to incontinence. We are encouraged to find preservation of renal function with maintained bladder volumes and reduced maximum detrusor pressures thus justifying the policy of catheter clamping and anti-cholinergic therapy in the presence of significant detrusor hyper-reflexia. However, even in expert hands this procedure is not without hazards.

Iatrogenic hypospadias--a preventable injury?

Iatrogenic hypospadias is a preventable injury to the ventral male urethra produced by the downward pressure of an indwelling urethral catheter. In spite of avoiding long-term urethral catheterisation, we have acquired 16 patients with this injury in the last 9 years either in our unit or discovered in patients referred to our unit. Although not a life endangering complication, the majority of such patients find the penile appearance so produced unacceptable. We have reconstructed any penis that has more than meatal cleavage in a total of six patients, with good results. The majority of patients have been fully investigated so that an alternative therapy to catheterisation may be provided. Where possible a catheter free state has been achieved. If not, a suprapubic catheter has been inserted. Those not reconstructed were due to reasons of ill health, and in two instances, due to patient choice.

Endoscopic correction of intractable stress incontinence with silicone micro-implants.

OBJECTIVE: To assess the clinical value of silicone micro-implants (Macroplastique, Uroplastique, Bioplastique) in the treatment of intractable genuine stress incontinence. MATERIALS AND METHODS: Between January 1992 and March 1995, 34 patients with failed previous surgery for genuine stress incontinence were treated with transurethral submucosal injection of Macroplastique. RESULTS: The initial success rate was high, 90% at 1 month and 75% at 3 months postoperatively. However, at 2 years of follow-up the success rate fell to 48%. Patient satisfaction was high. CONCLUSION: Macroplastique is a relatively simple and effective day-case procedure for intractable genuine stress incontinence. It may have a place as a last-resort surgery for genuine stress incontinence predominantly due to sphincter incompetence in an unfit patient with failed previous anti-incontinence procedures despite good repositioning of the bladder neck. However, many more patients and a much longer follow-up are needed before any further meaningful statements can be made about the success or failure of this material.

Developments in the ureteroscopes, techniques and accessories associated with laser lithotripsy.

Two stages in the development of the technique of laser lithotripsy are described. In the first series, spanning 1985-1988, three consecutive groups of patients are compared. In the first 100 patients, 11.5-F ureteroscopes were used. Access on first retrograde attempt was successful in 73%; 3% developed strictures; the ureteric perforation rate was 7%; and 12% required nephrostomy drainage. These results contrast with those of the third group in this series, consisting of 200 patients using a miniaturised ureteroscope. Access on the first retrograde attempt was successful in 99%. There were no strictures, no perforations and no requirements for nephrostomy drainage. (The second group of 100 patients using a range of rigid ureteroscopes was intermediate in its complication rate: 2% developed strictures, the ureteric perforation rate was 3%, and 6% required nephrostomy drainage). In the second series, spanning 1989-1990, the procedures were performed by all grades of urologists using miniaturised endoscopes. An in-depth audit was performed and each patient was followed until completely clear of fragments. The stones were successfully accessed on the first attempt in 213 cases (89%). In group A (139 patients, no basket used) 32 renal units (23%) were cleared of stone fragments immediately following the procedure, rising to 78 units (56%) by 3 months and 99 units (71%) beyond 3 months follow-up. Some fragments remained in 40 renal units and were cleared by further ureteroscopy, ESWL or PCNL, with the exception of 1 patient who had small residual fragments despite ESWL for fragments flushed to the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

The fate of G3pT1 bladder cancer.

Poorly differentiated (G3) cancers are known to have a worse prognosis than other superficial bladder tumours. In the period 1976 to 1987, 53 patients with G3pT1 disease were treated by radical radiotherapy with a 5-year survival rate of 64%. Thirteen patients (25%) developed an invasive tumour during the follow-up period. The presence of secondary carcinoma in situ was associated with a poor prognosis. These results are better than those reported for transurethral resection alone and suggest that radiotherapy is the treatment of choice in G3 superficial tumours.

Biotin bioavailability from protein supplements and cereal grains for growing broiler chickens.

A 21d growth bioassay was conducted with broiler chicks to estimate the availability of biotin from canola meal (CM), cereal grains and CM-supplemented cereal diets. A standard biotin response curve was generated with biotin-supplemented diets, using growth rate (g/d) as the dependent variable (X) and biotin intake (micrograms/d) as the independent variable (Y), as follows: Y = 2.28X + 9.76, r = 0.946 (P less than 0.01). Other groups of chicks were fed diets containing CM, soybean meal (SBM), cereal grains or CM + grain as a source of biotin. Results indicated that biotin bioavailability (%) was low in most cereal grains, i.e. wheat 17, triticale 20, barley 21, and sorghum 39; moderate in CM, 66; and high in SBM, 98, and maize, 114. Plasma and liver biotin concentrations in excess of 4000 ng/L and 3000 ng/g, respectively, were indicative of adequate biotin status.

Biotin bioavailability of protein supplements and cereal grains for starting turkey poults.

Biotin bioavailability was estimated in canola meal (CM), various cereal grains, and protein supplements using turkey poults in a growth bioassay study. Following a 10-day pretest period to deplete the biotin reserves of newly hatched poults, triplicate groups (seven poults each) were fed a basal diet without added biotin, or supplemented with graded levels of d-biotin (100, 200, and 400 micrograms/kg) for 21 days. Poult growth (y, g/day) was positively related to biotin intake (x, micrograms/day), as follows: y = 3.05x + 4.32, r = .997 (P less than .01). Similar groups of poults were fed test ingredients: CM, soybean meal (SBM), or soyprotein isolate (SPI) incorporated at levels of 25% into the diet by partial replacement of casein and carbohydrates; other poult groups were given cereal grain (25%) or cereal grain (25%) + CM (25%) included in the SPI-based diet. Use of the regression equation to compute bioavailable biotin gave bioavailability values (in percentages) that were low for triticale (15.9), wheat (17.0), barley (19.2), and sorghum (29.5), moderate for CM (65.4) and SBM (76.8), and high for corn (95.2). The combination of CM and cereal substantially increased the total biotin available for poult growth, with individual biotin contribution being strongly additive for CM plus barley, sorghum, or wheat, but less so in case of CM plus corn or triticale diets. Therefore, CM seems to be a good source of bioavailable biotin for starting poults. Increased levels of bioavailable biotin reduced the incidence of pathological signs (dermatitis, hock disorders, and broken feathers) and also poult mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

The rat as a model for evaluation of biotin bioavailability from feed ingredients for poultry and swine.

Biotin bioavailability from poultry and swine feed ingredients was determined in an experiment involving growing rats (55-60 g body weight, initially), housed individually in stainless steel cages with raised metal floors. The rats were fed a biotin-free diet fortified with egg-white powder for 7 d prior to being put on test. Thereafter, 5 rats were randomly assigned to each of the experimental diets, as follows: a basal egg white-free diet (A) without added biotin, or supplemented with graded levels of d-biotin, i.e., 0.05, 0.10, 0.25, 0.50 and 1.00 microgram/g, and also 12 test diets prepared by incorporating various cereal grains and/or two protein supplements into diet A by partial replacement of casein and carbohydrates. The experimental diets were fed ad libitum for 21 d, and met or exceeded recommended levels for all nutrients except biotin. Results showed significant correlations between pairs of parameters, including plasma biotin vs biotin intake (P less than 0.01), liver biotin vs biotin intake (P less than 0.05) and plasma biotin vs liver biotin (P less than 0.01). The bioavailable biotin from test ingredients was estimated using the derived regression equation, Y = 0.54X + 1.05, (r = 0.85), where X = biotin intake (microgram/d) and Y = plasma biotin (ng/ml). In most cases, these values were greater than the corresponding biotin intakes, indicating that intestinal biotin synthesis and coprophagy might be increasing the supply of bioavailable biotin to the rats. Therefore, the rat might not be a good model animal for routine evaluation of biotin bioavailability from feed ingredients.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of biotin supplementation of a barley-wheat diet on restoration of healthy feet, legs and skin of biotin deficient sows.

Sixteen sows with induced biotin deficiency were divided into groups of four and fed an egg-white-free barley-wheat based diet without added biotin (control) or supplemented with one of three levels of synthetic d-biotin (100, 200 or 400 micrograms kg-1) for two parities in order to determine the optimal level required to reverse symptoms of the deficiency and to evaluate the relationship among dietary biotin levels, stage of recovery and serum biotin concentrations. Biotin supplementation significantly reduced (P less than 0.05) the incidence of lesions (on the foot pads, above the dew claws and on the skin) and also dry skin, but had no effect (P greater than 0.05) on hoof cracks, hair score or hair density. Time after supplementation had significant effects on reversal of most biotin deficiency symptoms. Interactions between biotin supplementation and time after supplementation suggested that these symptoms were reversed more quickly when higher levels of biotin were fed. Serum biotin concentrations of biotin-supplemented sows were increased with time and exceeded 600 ng litre-1 after 0.5, 1.0 and 1.5 months following biotin supplementation of the basal diet with 400, 200 and 100 micrograms kg-1. In contrast, serum biotin concentrations of the control sows remained low and peaked at 411 ng litre-1 after 2.5 months. The data suggested that supplementation of a barley-wheat diet to provide 147 to 217 micrograms available biotin kg-1 might be adequate to restore healthy feet, legs and skin and concurrently maintain high serum biotin concentrations.

Development of a system for clinical evaluation of the biotin status of sows.

Sixteen test gilts were fed an egg white-fortified practical diet and four control gilts an egg white-free diet over a two-parity period in order to monitor changes in the serum biotin levels as induced biotin deficiency progressed. Gilts were individually housed in metal crates with slatted floors. Serum biotin (ng/L) of test animals declined from 1490 (initially) to 610 (month 3), remained stable (months 4-8) and thereafter approached 400, 135 and 30 after months 9, 13 and 15, respectively. Early clinical symptoms, i.e. lesions (on the feet, legs and skin), hoof cracks, hair loss and dry skin, were first observed after six months and became progressively more pronounced with time. After nine months, the induced symptoms resembled those characteristic of biotin deficiency. In contrast, serum biotin remained high in the control animals which did not develop symptoms. The data are interpreted to mean that serum biotin might be used as a sensitive index of biotin deficiency development in sows. On the basis of these observations, a system is proposed for evaluation of the sow's biotin status. Adequate biotin may be indicated by serum biotin level (ng/L) > 700; marginal, > 600 < 700; inadequate, > 400 < 600; and deficient, < 400. Alternatively, several concurrent clinical symptoms (i.e. alopecia, hoof cracks and lesions on the feet, legs and skin) may aid in the diagnosis of inadequate biotin status of sow herds reared under field conditions.

Evaluation of a rapid method for preparation of fatty acid methyl esters for analysis by gas-liquid chromatography.

The major limitation to fatty acid analysis by gas-liquid chromatography is associated with preparation of fatty acid methyl esters (FAME). In the present study, FAME preparations were made from plant oils (corn, olive, sunflower), sunflower oil margarine, lard and various animal tissue fats by a rapid transesterification involving tetramethylammonium hydroxide in methanol, and also by a longer conventional saponification-esterification method. Fats from animal (beef, mutton, pork) adipose tissues were extracted by a simpler modified procedure and also by the Folch method prior to the rapid and the conventional FAME preparations, respectively. FAME analysis on a gas-liquid chromatograph equipped with a Silar 10C glass capillary column indicated similar fatty acid composition of a given fat or oil, whether FAME was prepared by the rapid or the longer conventional method. The data obtained by both methods were very highly correlated for all the fats (r = 0.9895 - 0.9999). However, the rapid method showed a tendency for enhanced recoveries of lower chain fatty acids (e.g. 14:0), and also of unsaturated C18 isomers. Possibly, losses of fatty acids that occurred during the lengthy fat extraction, fatty acid esterification or ether-evaporation FAME concentration steps (conventional method) were minimised by the single transesterification step (rapid method). This rapid transesterification method appears to be an attractive alternative to FAME preparation from a wide variety of different fats for gas-liquid chromatographic analysis.

Effect of starch infusion at the terminal ileum on nitrogen balance and apparent digestibilities of nitrogen and amino acids in pigs fed meat-and-bone and soybean meal diets.

Growing pigs were each surgically fitted with a single T-shaped cannula at the terminal ileum, and fed a cornstarch-based diet made isonitrogenous with meat-and-bone meal (MBM) or soybean meal (SBM). Starch or water was infused through the cannulas and the effects on N balance and apparent digestibilities (AD) of N and amino acids (AA) were studied. The infusion of starch, as contrasted to water, increased (P less than .01) excretion of fecal N and decreased (P less than .05) excretion of total urinary N, including urinary urea N, without affecting the amount of N retained. The increased excretion of fecal AA following starch infusion resulted in lowered (P less than .05) AD (percentage units) of indispensable AA, threonine (8.4), methionine (6.7), valine (6.6) and lysine (5.0); and dispensable AA, tyrosine (6.9) and aspartic acid (5.7). The same pattern of AD decreases was obtained for both protein sources, but in general, the magnitude of these decreases was greater for MBM than for SBM. Large differences (percentage units) were observed between AD of individual AA and that of N (arginine, +11.2 and isoleucine, -5.2, in MBM; arginine, +7.6 and methionine, -7.6, in SBM). Results showed that the route of N excretion and the AD of N and AA, as determined by the fecal analysis method, were influenced by the amount of starch entering the hindgut. It was concluded that AD of individual AA, and not N, should be considered when formulating pig diets; however, because of the dependence of AD values on starch entering the hindgut, AD values (fecal analysis method) may not be reliable measures of AA availabilities.

The utilization of rye by growing chicks as influenced by calcium, vitamin D3, and fat type and level.

Four experiments were conducted with growing chicks to study the effects of feeding rye and wheat diets supplemented with different calcium levels, two types and two levels of fat, and increasing levels of vitamin D3 and to study the interrelationships of these dietary ingredients on chick performance. In Experiment 1, feed conversion efficiency was reduced to a much greater extend (10% vs. 1%) when tallow replaced soybean oil in a rye-based diet containing only .6% calcium compared to a wheat-based diet. When the dietary calcium was increased to 1.1% the replacement of tallow by soybean oil resulted in only a small reduction in feed efficiency for chicks fed either the rye-(3%) or wheat- (1%) based diets. The retention of fat, particularly tallow, was depressed in rye as compared to wheat-fed birds. Fat retention was also influenced by calcium levels. Increasing the dietary calcium from .6 to 1.1% improved tallow (16%) and depressed (7%) soybean oil retention in rye-based diets, whereas in wheat-based diets the retention for both fats was slightly decreased. Experiment 2 showed that the efficiency of utilization of rye diets containing 7.5% tallow was improved by 10% when the level of dietary calcium was increased from .6 to 1.1% while the corresponding improvement in similarly formulated wheat diets was only 1%. The improvement of 2.5% fat, however, was only about 3% for both wheat and rye diets. The results from Experiment 3 showed that in the presence of a large excess of vitamin D3, the depression in the efficiency of utilization of the wheat diet was 13% but was less than 1% for the rye diet. This indicates that rye contains a factor that depresses vitamin D3 absorption. In Experiment 4, when dietary calcium was increased from .80 to 2.00% or when penicillin (200 mg/kg) was added, the improvement in efficiency of feed utilization was greater in chicks fed a rye diet (7%) compared to those fed a wheat diet (1%). The rye diets, however, were always less efficiently utilized than the corresponding wheat diets. Vitamin D supplementation, in contrast, did not affect chick performance. These results show that the performance of chicks fed rye diets is markedly influenced by type and level of dietary fat and the level of dietary calcium.