LHRH analogues as primary treatment for urinary retention in patients with prostatic carcinoma.

Thirty-one patients with retention of urine and carcinoma of the prostate were treated with LHRH analogues as primary therapy rather than prostatectomy; 21 patients voided without the need for surgical intervention. Patients presenting in acute retention of urine voided more readily than those presenting in chronic retention, with only 20% requiring surgery. This approach to treatment is safe, efficacious and cost effective.

Outcome in carcinoma in situ of bladder treated with intravesical bacille Calmette-Guérin.

Fifty-three patients with carcinoma in situ of the bladder were treated with Evans strain BCG given intravesically. Complete remission was achieved after either one or two 6-weekly courses in 53% of patients. The median duration of remission was 32 months. Treatment-related bladder symptoms were minor during the first course, more severe during the second. There was no relation between severity of symptoms and likelihood of response. With a median follow-up of 32 months, disease progression has occurred in 10% of complete responders, whereas failure to respond on either cystoscopic, histological or cytological grounds was associated with a 48% progression rate. Although intravesical BCG produces impressive responses in carcinoma in situ of the bladder, managed conservatively the condition remains a dangerous one.

Balloon dilatation of the prostate: technique and early results.

Fourteen men with outflow obstruction were treated by balloon dilatation of the prostatic urethra using 25 and 30 mm balloon catheters. Significant improvement in objective measurement of outflow obstruction was noted in only 2 patients.

Flushing. Long-term side effect of orchiectomy in treatment of prostatic carcinoma.

Orchiectomy is considered a safe and simple procedure, free from serious side effects, in the treatment of prostatic carcinoma. We have found that 76 percent of patients experienced postorchiectomy flushes, and 30 percent believed their symptoms warranted treatment. The flushing started at between one and twelve months (average 2.7 months) postoperatively and lasted an average of thirty months or, in some cases, up to the time of death (average 33 months). No single precipitating factor was found, and no single hormone seemed to be responsible. Special attention was given to the nonflushers to see whether or not it was of prognostic significance, and it appears that the slight elevation in the testosterone level sufficient to prevent flushing may indicate a nontesticular source of androgen. Medroxyprogesterone acetate (Provera), 5 mg twice daily, appeared to be an effective agent for controlling the flushes.

Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.