A modified papaverine test and the use of venous constriction in erectile dysfunction.

A simple technique employing a penoscrotal tourniquet in the investigation and management of impotence due to venous leakage is described. Fifteen patients were investigated using a constriction band and intracorporeal injection of papaverine. Colour doppler ultrasound studies demonstrated that the tourniquet abolished venous leakage in 11 cases and there was a close correlation between clinical and ultrasonographic findings. Most of the patients with venogenic impotence found the device to be of therapeutic benefit. The technique is simple and provides reliable clinical information about the likely cause of erectile failure and is an effective and acceptable aid to treatment in correctly selected cases.

A feminizing adrenocortical carcinoma presenting with gynaecomastia.

A case is presented in which gynaecomastia was the sole initial presenting symptom of a feminizing adrenocortical carcinoma. This rare pathological lesion is discussed.

Testicular denervation. A new surgical procedure for intractable testicular pain.

Chronic testicular pain has many different aetiologies. Identification and treatment of an underlying problem resolve the issue in most cases. However, a proportion of patients with chronic testicular pain have no demonstrable aetiological factor and pose a difficult treatment problem. All of these patients are initially treated by non-surgical measures. Various operations advocated in the literature for non-responders include epididymectomy, scrotal orchiectomy and inguinal orchiectomy, all of which have a significant failure rate. We describe a hitherto unreported operative procedure in a series of 4 patients, with immediate and lasting relief of their pain.

The current status of embolization in renal cell carcinoma--a survey of local and national practice.

The current role of renal embolization in carcinoma of the kidney is uncertain. In order to assess surgeons' opinion of its usefulness a questionnaire was circulated to all general urologists practising in Britain and Ireland. Also, a series of cases in which the technique was employed (n = 35) was reviewed and compared with a similar group who were not embolized (n = 40). There was a 71% response to the survey. The principal findings were that all but five urologists believe that embolization should not be used routinely in the management of renal cell carcinoma. Thirty-five per cent stated that they felt it has a role in management of symptoms in metastatic or inoperable tumours. The review of both series of patients in our unit shows that embolization (using 95% ethanol infused via a balloon occlusion catheter) did not reduce peroperative blood loss and did significantly increase hospital stay. There were no deaths in this series, and morbidity was confined to 'post-embolization syndrome' in 16 cases. We believe that in those cases where embolization is indicated, alcohol infusion via a balloon occlusion catheter is a safe and efficient method.

Case report: limey urine.

A case is described of multiple tiny bladder stones giving rise to unusual ultrasound and plain radiograph appearances of a calcified sediment within the bladder.

Percutaneous drainage in emphysematous pyelonephritis--an alternative to major surgery.

Emphysematous pyelonephritis is a rare, life-threatening infection of the kidney associated with the production of gas, usually found in diabetic patients. Experience of this condition reported in the literature suggests that vigorous medical treatment and early nephrectomy are advisable. We report a case in which percutaneous renal drainage combined with medical therapy produced not only complete recovery of the patient, but also preservation of renal function on the affected side.

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.

Distigmine bromide and post-prostatectomy voiding.

Distigmine bromide (Ubretid) is a long-acting anticholinesterase which is thought to improve detrusor function, restoring normal voiding patterns which may have been disturbed by autonomic overactivity, particularly after surgery. Ninety-three patients entered a double-blind study of the effect of distigmine bromide versus placebo on voiding after prostatectomy. The results demonstrated that there was a trend towards improvement but no statistically significant increase in post-operative flow rates, in reduction in bladder volume, and in the incidence of re-catheterisation in the patients treated with distigmine bromide.

Bladder outflow obstruction treated with phenoxybenzamine.

Sixty-one male patients with urodynamically proven outflow obstruction took part in a study of phenoxybenzamine (PBZ), the initial phase of which was double-blind (41 patients). The double-blind phase of the trial showed an overall symptomatic improvement in the PBZ patients. The symptoms of slow stream and hesitancy were significantly improved. The urethral pressure profile features of prostatic plateau height and prostatic plateau area were significantly decreased in the PBZ group. Dizziness was the commonest side effect of PBZ but was well tolerated by most patients. This study shows that PBZ has an effect on bladder outflow obstruction by reducing pressure in the proximal urethra and that the drug has a place in the management of patients with symptoms attributable to such obstruction, especially where operative treatment has to be delayed.

A controlled trial of single dose intravesical adriamycin in superficial bladder tumours.

Sixty patients with recurrent superficial bladder tumours (Ta or T1) entered an open controlled trial of single dose Adriamycin. After transurethral resection of tumor recurrences, patients were alternately allocated to the control group or to the Adriamycin group, who received an instillation of 50 mg of Adriamycin in 50 ml of saline for 30 min. Six months later all patients were readmitted for endoscopy. In the Adriamycin group significantly more patients showed a decrease in the number of recurrent papillomas (72%) than in the control group (39%). This study shows that the use of adjuvant chemotherapy in the form of single dose Adriamycin is effective in reducing tumour recurrence.

Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus.

Gastrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphagia for carcinoma of the oesophagus. More recently, total parenteral nutrition has proved to be efficient and safe, offering an alternative to gastrostomy feeding. Twenty-four patients were randomly selected into two groups to compare the efficacy of total parenteral nutrition and gastrostomy feeding with respect to nitrogen balance and weight gain. Total parenteral nutrition was found to be superior to gastrostomy feeding in achieving an earlier positive nitrogen balance and greater weight gain during a 4-week period. However, gastrostomy feeding is still preferred as it is cheap, simple and safe, and allows patients to be active, mobile and self dependent. Total parenteral nutrition is reserved for those patients in whom an earlier operation is advisable.

Bladder outflow obstruction treated with phenoxybenzamine.

Sixty-one male patients took part in a study of phenoxybenzamine (PBZ), the initial phase of which was double-blind (41 patients). All patients had urodynamically proven outflow obstruction. The double-blind phase of the trial showed an overall symptomatic improvement in the PBZ patients. The symptoms of slow stream and hesitancy were significantly improved. The urethral pressure profile features of prostatic plateau height and prostatic plateau area were significantly decreased in the PBZ group. Dizziness was the most common side effect of PBZ but was well tolerated by most patients. This study shows that PBZ has an effect on bladder outflow obstruction by reducing pressure in the proximal urethra and that the drug is suitable for the treatment of patients with symptoms attributable to obstruction.

Congenital hepatic fibrosis: the long-term prognosis.

The long-term prognosis in congenital hepatic fibrosis has been assessed in 30 patients, 13 treated at Newcastle and 17 from other British centres. Twenty-four patients had been followed-up for more than five years from diagnosis. Shunt operations, performed in 18 patients, were successful in controlling haemorrhage with a low mortality (1/18), low incidence of recurrent haemorrhage (3/18) and portal-systemic encephalopathy (3/18) but with a higher incidence of postoperative jaundice (7/18). About a third of the survivors had some evidence of hepatic dysfunction but none had chronic portal systemic encephalopathy. Intelligence quotient was close to normal but educational achievement and job status were low. Serum albumin fell after shunt surgery and a few patients developed ascites: anaemia and hypersplenism however, were corrected by surgery. Blood ammonia is raised in survivors with congenital hepatic fibrosis and rises further after a normal meal; further observations are needed on cerebral function after several decades of survival.