Urodynamics and laser prostatectomy.

A total of 81 patients with symptomatic bladder-outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) underwent visual laser ablation of the prostate (VLAP) using a right-angled firing neodynium: YAG laser. The mean pre-operative prostatic volume was 48.5 ml. All patients were discharged on the 1st post-operative day with an indwelling catheter. Two patients underwent a transurethral prostatectomy (TURP) after failing a trial without catheter on two occasions. Of the remaining 79 patients, 75 were evaluated 6 months post-operatively. Mean symptom scores (I-PSS) decreased from 20.9 to 5.8, the mean maximal urinary flow rate increased from 7.9 to 16.4 ml/s and the mean residual volume decreased from 88.1 to 15.6 ml. Several different methods of evaluating BOO from pressure-flow measurements were used and all showed improvement. All the above-mentioned parameters showed a highly significant improvement (P < 0.01) at 6 months.

Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis.

OBJECTIVES: To assess whether the synthetic vasopressin analogue desmopressin [1-desamino 8-D-arginine vasopressin] is efficacious and safe in the management of nocturia +/- enuresis in patients with multiple sclerosis. PATIENTS AND METHODS: Twenty-two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency +/- enuresis were entered into the study. A two week placebo run-in, to establish normal voiding patterns, followed by a double-blind, placebo-controlled, cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out. RESULTS: Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia. CONCLUSION: Desmopressin is an efficacious and safe treatment for nocturia +/- enuresis in patients with multiple sclerosis.

A 12-week placebo-controlled double-blind study of prazosin in the treatment of prostatic obstruction due to benign prostatic hyperplasia.

A series of 93 normotensive patients with benign prostatic hyperplasia and maximum urinary flow rates < 15 ml/s, treated at 2 hospital centres using an identical protocol, was randomly assigned to receive a 12-week course of treatment with prazosin or placebo in a double-blind parallel group trial. A total of 75 patients completed the study and were suitable for the final analysis. Prazosin was administered orally in doses of 0.5 mg and then 1 mg twice daily for 4 days and 2 mg twice daily for the remainder of the trial. Patients on treatment with prazosin exhibited a significantly increased maximum urinary flow rate as compared with placebo, with a significant reduction in maximum voiding detrusor pressure. Prazosin therapy did not produce a significant effect on either frequency or standard parameters of detrusor instability. A double-blind overall assessment of drug efficacy and tolerance significantly favoured prazosin therapy. A total of 30 patients receiving prazosin and 28 receiving placebo reported varied adverse effects. Eighteen patients were excluded from the final analysis, 10 being withdrawn because of adverse effects, 7 on treatment with prazosin and 3 in the placebo group. In long-term usage oral prazosin was well tolerated and appeared to improve obstructed voiding in patients with benign prostatic hyperplasia.

Dialysis in patients with upper urinary tract transitional cell carcinoma.

In some patients with primary malignant disease of the kidney the only way of achieving a cure may involve radical surgery. If the tumour is bilateral or involves a solitary kidney, renal failure may be unavoidable. The role of dialysis and transplantation in these patients following "curative" cancer surgery is not clear. A review of the literature and experience with 4 patients who ultimately had bilateral nephrectomies for multiple recurrent upper tract urothelial malignancy is reported. These 4 patients remained free of tumour recurrence on dialysis at 5, 8, 12 and 72 months respectively since commencing dialysis, although 2 have died from unrelated causes. It would seem reasonable to offer dialysis followed by subsequent transplantation in this group of patients after a period of 1 to 2 years has elapsed without any evidence of malignant recurrence.

Villous adenoma in augmentation colocystoplasty: a case report and discussion of the pathogenesis.

Reports of malignant tumors in enterocystoplasties have recently been accumulating. To date no case of benign tumors has been recorded. We present a case of villous adenoma in a sigmoid colocystoplasty. The possible etiological factors and pathogenesis are discussed, and recommendations are made about followup.

The Stamey endoscopic bladder neck suspension in the elderly.

The Stamey procedure was performed on 21 women aged 65 to 81 years; 17 were cured (completely dry) or significantly improved (maximum 1 pad/day). Urethral length was significantly increased by the operation but maximum urethral pressure and maximum flow rate were unchanged. Complications were few.

A double-blind comparative trial of short-term orally administered enoxacin in the prevention of urinary infection after elective transurethral prostatectomy: a clinical and pharmacokinetic study.

A double-blind randomized comparative study was done to investigate the efficacy of enoxacin in the prevention of urinary infection after elective transurethral prostatectomy, as well as its ability to penetrate the prostate. A total of 40 patients received 200 mg. enoxacin and 40 received a placebo, given orally the night before the operation, 2 to 4 hours preoperatively and every 12 hours postoperatively for 36 hours. Urine samples for bacterial culture were obtained within 1 week preoperatively, at operation and at 48 hours, 5 days, and 2 and 6 weeks postoperatively. Samples of the serum and prostate were taken at operation and assayed for enoxacin levels. Of the placebo patients 15 had a urinary infection postoperatively (38 per cent) compared to 3 enoxacin patients (8 per cent) (p less than 0.01). Enoxacin penetrated well into prostatic tissue; the mean levels in tissue and serum were 3.1 +/- 1.8 mg. per kg. (standard deviation) and 1.26 +/- 0.48 mg. per l., respectively, with a mean tissue-to-serum ratio of 2.53 +/- 1.8.

Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy?

A randomised, prospective trial comparing transurethral prostatectomy with conservative management was carried out in 38 men with proven bladder outflow obstruction. Patients were assessed urodynamically before treatment and 6 months later. All 21 patients who had a prostatectomy showed a significant improvement in peak flow rate, voiding pressures and residual urine volume, but only 71% were symptomatically better. Of the 17 patients treated conservatively, 56% noted an improvement in their symptoms, although their peak flow rates and residual urine volume were virtually unchanged. Following prostatectomy, the incidence of detrusor instability fell by 78%, whereas in the conservatively treated group the reduction was only 50%. Patients who had done well or badly after treatment were analysed as separate subgroups. The single feature which distinguished between these two groups was the high incidence of reversion to bladder stability in those who had a good symptomatic response to treatment.

Obstructed voiding in the female.

Bladder outlet obstruction in women is rare. The characteristics and aetiology of the condition in 163 females are discussed and their relation to treatment evaluated.

A double-blind trial of the effect of beta-sitosteryl glucoside (WA184) in the treatment of benign prostatic hyperplasia.

Cholesterol-lowering agents are still used in some countries for the treatment of benign prostatic hyperplasia (BPH). A randomized, double-blind, placebo-controlled urodynamic study, carried out on 53 patients with proven outflow obstruction, has failed to prove that the drug, beta-sitosteryl beta-D-glucoside (WA184), is superior to placebo in the treatment of outflow obstruction due to BPH when administered at a dose of 0.3 mg/day. Possible reasons for this include an insufficient dose and duration of treatment (this drug is known to have a potent effect on cholesterol metabolism in the prostate) and the predominantly stromal pathological changes which characterize BPH and which may be unaffected by such agents.

Cord compression and carcinoma of the prostate: is laminectomy justified?

Metastatic carcinoma of the prostate is a common cause of spinal cord compression. In this review of 37 men who underwent laminectomy for this condition this was the first presentation of previously undiagnosed cancer in 11 (29%). One year after decompression 17 (50%) were alive. Twenty patients (59%) could walk after laminectomy. All but 8 were relieved of pain and bladder function was improved in 13 (38%). Those ambulant before laminectomy (7) and those with occult prostate cancer did particularly well. Poor results were associated with a rapid onset of paraparesis and pre-operative progression to paraplegia. A delay in diagnosis was detrimental to outcome. A high index of suspicion in patients with carcinoma of the prostate is essential so that early diagnosis can be made before paraplegia is established. Carcinoma of the prostate must always be excluded in men with cord compression of unknown aetiology.

Stamey endoscopic bladder neck suspension for stress incontinence.

Sixty female patients with clinically demonstrable stress incontinence of urine have had a Stamey operation during the last 3 years. The results have been good in curing stress incontinence, whilst the majority of the failures have been in patients with severe detrusor instability or a chronic cough. There have been few post-operative complications and urodynamic studies have shown improved cough urethral profiles and no evidence of bladder outflow obstruction. The Stamey procedure can be recommended as the initial operation for surgically curable incontinence. Mild bladder instability is not a contraindication to the operation and it is also useful in elderly, unfit or obese patients.

A controlled trial of otis urethrotomy.

Otis urethrotomy is an empirical procedure when used in the treatment of recurrent urinary tract infection and the urethral syndrome. Sixty-four female patients were randomised into two treatment groups. One group had cystoscopy alone and the other cystoscopy and Otis urethrotomy. The patients were assessed pre-operatively and at 6 weeks after surgery both symptomatically and by urodynamic testing. There was no significant difference in the results obtained in the two groups. We conclude that Otis urethrotomy has no advantage in the routine treatment of patients with lower urinary tract symptoms.