[Female urethral diverticulum]. / Urethradivertikkel hos kvinner.

Female urethral diverticulum is a rare condition. The reported incidence varies from 1.4-5%, depending on the population studied. The correct diagnosis is often delayed because of unspecific symptoms from the patients' lower urogenital tract. The classic triad of female urethral diverticulum is dribbling of purulent matter, dyspareunia and dysuria. The majority of patients have a palpable mass located on the anterior vaginal wall. The presentation and management of 11 women with urethral diverticulum who where admitted to the Surgical Department of the Central Hospital in Akershus during the period 1.1. 1975 to 1.4. 1996 is reviewed. Investigations included vaginal examination, urethrocystoscopy, urography and urethrography with a double balloon catheter. A palpable mass was found in all 11 patients. The urethrography was positive in eight out of ten patients. Diverticulectomy was performed on nine patients. In follow-up interviews from three months to 21 years after treatment, one patient was found to suffer from incontinence after surgery, two patients noticed recurrence of some symptoms, and six patients were completely relieved of their complaints.

A bladder cancer multi-institutional experience with total cystectomy for muscle-invasive bladder cancer.

BACKGROUND: The role of total cystectomy was to be assessed in the curative treatment of muscle-invasive bladder cancer. METHODS: Two hundred and fifty-three patients with T2-T4a transitional cell carcinoma of the urinary bladder were referred to precystectomy radiation therapy (46 Gy, 66 patients; 20 Gy, 187 patients). These patients represented approximately 20% of all patients developing muscle-invasive bladder cancer in Southern Norway from 1980-1990. The clinical T categorization was generally based on palpability and extent of the palpable bladder tumor assessed by the referring urologist. Twenty-six patients (10%) did not have total cystectomy, most often due to peroperatively demonstrated locoregional inoperability. Two or three cycles of cisplatin-based combination chemotherapy were given to 68 patients. RESULTS: For the 227 patients who underwent cystectomy, the cancer-specific 5-year survival rate was 58% (T2 [104 patients], 63%; greater than or equal to T3 [123 patients], 54%) (P = 0.022). The comparable figure for patients with histologically proven regional lymph node metastases was 22%. The 97 stage-reduced cases (less than or equal to pT1) survived significantly longer than the 130 patients without stage reduction (74% versus 46%) (P < 0.0001). Neoadjuvant chemotherapy was correlated with a more favorable survival in patients with greater than or equal to T3 tumors but did not seem to influence survival of patients with T2 bladder cancer. CONCLUSIONS: In a multicenter setting, prognostically relevant T categorization of operable muscle-infiltrating bladder cancer can be based on the palpability of the primary tumor. Approximately 50% of favorably selected patients with operable T2-T4 bladder cancer survived for at least 5 years independent of whether the operation was done at a large uro-oncologic unit or a smaller urologic section. In this retrospective review, chemotherapy seemed to improve the survival in patients with deeply infiltrating (greater than or equal to T3) bladder cancer but appeared to represent an overtreatment in patients with T2 tumors.

Clinical significance of DNA ploidy and S-phase fraction and their relation to p53 protein, c-erbB-2 protein and HCG in operable muscle-invasive bladder cancer.

DNA ploidy and S-phase fraction (SPF), determined by flow cytometry were studied in 118 patients with muscle-invasive transitional cell carcinoma (TCC) of the urinary bladder, scheduled for cystectomy after pre-operative radiotherapy (20 Gy/1 week) with or without systemic cisplatin-based neo-adjuvant chemotherapy. The correlation between these parameters and immunohistochemically demonstrated p53, c-erbB-2 and HCG was also investigated. There were 16 DNA diploid and 102 DNA non-diploid tumours. DNA ploidy was not related to the T (all 118 patients) or pN (58 patients) category, occurrence of stage reduction or cancer-related 5 years survival. Patients with high SPF tumours tended, however, to have a better prognosis than those with low SPF TCC reaching the level of significance (P < 0.05) for those patients who had high SPF tumours and received neo-adjuvant chemotherapy. Fifty-one of the tumours were p53 positive. p53 positive tumours were significantly more often found in TCC with low SPFs than in those with high SPFs. Respectively 12 and 9% of the tumours were HCG and c-erbB-2 positive, without correlation to DNA ploidy or SPF. We conclude that DNA ploidy does not represent a prognostic parameter in muscle-invasive operable bladder carcinomas. A high SPF, determined by FCM, may be helpful to identify patients with chemotherapy-sensitive TCC of the urinary bladder.

[Reconstructive surge of blunt renal trauma]. / Konserverende kirurgi ved stumpt nyretraume.

The most usual causes of blunt renal injuries are motor vehicle accidents, falls and participation in contact sports. Severe injuries are rare and a conservative approach in the treatment of such injuries is advocated by most authors. In this article we present a patient who suffered a major injury to the right kidney which was treated successfully by reconstructive surgery. We discuss the diagnosis of renal injuries, indications for surgery and surgical technique.

Pre-cystectomy chemotherapy in patients with muscle infiltrating bladder carcinoma. A multicentre feasibility study.

Fourteen patients with muscle infiltrating bladder cancer in whom total cystectomy was planned, received 3 cycles of cis-platinum (70 mg/m2 Day 1) and Methotrexate (40 mg/m2 Day 1) with 3-week intervals before pelvic radiotherapy (20 Gy). Thirteen patients underwent cystectomy whereas the remaining patient finally was found to be inoperable. The subjective toxicity (nausea, vomiting, decrease of performance status), the hematological side effects and the nephrotoxicity of this pre-cystectomy treatment were acceptable. In particular, the treatment did not increase the per- and postoperative complication rate as long as patients were selected who were good risk candidates for major surgery. Stage reduction (P less than T) was seen in 9 of 13 patients. Combination therapy with cis-platinum/methotrexate and short term pelvic radiotherapy is feasible as adjuvant pre-cystectomy treatment in patients with muscle infiltrating bladder cancer. The possible therapeutic superiority of this adjuvant treatment has to be shown in randomized trials.

A new method with fiberoptic transducers used for simultaneous recording of intravesical and urethral pressure during physiological filling and voiding phases.

A new technique using fiberoptic transducers for simultaneous registration of intravesical and urethral pressures during the physiological filling and voiding phases is described. The method, which is simple, exact and stable, was used on several patients with different urological problems. The study shows that the measurement technique and the fiberoptic transducer system are suited for clinical use.

An unusual complication of lithotripsy.

The case described illustrates a most unusual course of events due to a perforation in the wall of the bladder during transurethral lithotripsy. Irrigation fluid forced its way retroperitoneally to the mediastinum. The differential diagnostic problems encountered are discussed.

Diagnosis of hyperparathyroidism in patients with urolithiasis using measurement of serum immunoreactive parathyroid hormone and serum calcium.

Serum immunoreactive PTH (iPTH) was measured in 74 patients with urolithiasis and correlated to the corresponding serum calcium values. Serum iPTH was measured using a rooster antibovine iPTH antiserum which crossreacted with the human hormone within the 44-68 amino acid residue region. Sixty-six of these patients had normal serum iPTH and calcium concentrations. Their calcium values varied from 2.2 mmol/l to 2.6 mmol/l and their serum iPTH concentrations were less than 0.6 micrograms/l. The remaining 8 patients with urolithiasis were judged to have primary hyperparathyroidism because of an abnormal iPTH/calcium relationship. These patients had serum calcium concentrations varying from 2.6 mmol/l to 3.4 mmol/l and iPTH concentrations between 0.35 micrograms/l and 3.03 micrograms/l. The diagnosis was verified histologically in 7 patients after operation. In the last patient iPTH was reduced from 1.01 micrograms/l to 0.21 micrograms/l after surgery, and serum calcium changed from 2.6 mmol/l to 2.2 mmol/l. The combined evaluation of serum iPTH and calcium may improve the diagnosis for hyperparathyroidism and was in our series helpful in making a correct diagnosis in 2 out of 7 patients who had histologically verified disease. In addition, iPTH measurements are valuable to rule out hyperparathyroidism as the cause of hypercalcaemia.

Sigmoidocystoplasty in adults with enuresis.

Sigmoidocystoplasty was performed upon 13 adult patients with enuresis to increase the small bladder capacity. Eleven patients were in the follow-up study. The mean observation time was 29.5 months with a range from 13 to 66 months. Ninety per cent of the patients were satisfied with the result.

Pelvic fractures.

Stabilization of unstable pelvic fracture is warranted to relieve pain and to reduce bleeding. A trapezoid frame external fixation is suggested for reduction and retention of such fractures. Some controversy exists concerning the sources of bleeding and the measures for control. On the one hand, bleeding arises from fractures of the cancellous bone. On the other hand, blood vessels may be torn by the fracture. Massive bleeding is common which requires a good blood bank service. The complications of pelvic fracture consist bleeding, nervous and urological injuries.

Management of renal and ureteric injuries, and retroperitoneal haematoma.

Retroperitoneal injuries form a special subgroup of abdominal trauma. Injuries of kidney and ureter as well as methods of management of retroperitoneal haematoma are discussed in this chapter. High-dose infusion urography is recommended in renal injuries. Angiography may give valuable additional information. A retroperitoneal haematoma in the upper part of th abdomen may mask serious injuries of other retroperitoneal organs, pancreas, duodenum or main vessels. A midline approach is recommended for exploration and treatment of these injuries.

The influence of pregnancy and contraceptive pills upon oxygen consumption during phagocytosis by human leukocytes.

Oxygen consumption during phagocytosis by leukocytes was examined in pregnant women and women taking the contraceptive pill. In pregnancy, oxygen consumption during phagocytosis was increased, while oral contraception produced a decrease.

PIP: Oxygen consumption during phagocytosis by leukocytes was measured in 21 pregnant women, in a number of women on oral contraception (OC) use, and in 6 healthy controls. Oxygen consumption was measured with a polarographically technique which reflected the total phagocytic capacity of leukocytes. Oxygen consumption was found to be higher in pregnant women than in controls, thus causing increased protection against infection for both mother and fetus. Such result is in agreement with a previous observation. Oxygen consumption was reduced in women on OC, indicating that OC has an inhibitory effect upon phagocytosis; this result is not in agreement with previous observations.

Oxygen consumption during phagocytosis by leucocytes in renal transplant patients.

Oxygen consumption during phagocytosis by leucocytes in renal transplant patients and in normal persons was studied. A significant decrease in oxygen consumption was observed in patients receiving immunosuppressive treatment. This may partly explain the increased susceptibility to infections in these patients.

Total replacement of the ureter with a segment of ileum. A follow-up study.

Total replacement of the ureter with a segment of ileum was performed on seven patients. Five of them were followed up for a mean of 20 months. The results of the operation were good. Serum electrolyte imbalance occurred postoperatively in one case.

Sigmoidocystoplasty: a follow-up study.

Sigmoidocystoplasty was performed in 62 patients. 36 were followed up. The mean observation period was 68 months, ranging from 6 to 318 months. In 18 patients the results were considered as good, 11 were improved after the operation and in 6 cases the situation was unchanged. The importance of normal urine outflow and postoperative urine cultures is emphasized.