Renal adenocarcinoma metastasizing to contralateral renal pelvis.

Ureteric metastases from renal adenocarcinoma are uncommon and occur predominantly in the residual ipsilateral ureteric stump. We report on a patient with renal adenocarcinoma metastasizing to the contralateral renal pelvis and the clinical problems involved.

Bladder dysfunction following anterior resection for carcinoma of the rectum.

A retrospective study was made of 190 patients who had anterior resections of the rectum for carcinoma at Concord Hospital between 1971 and 1981. Urinary tract infection occurred in 25 percent of patients. Bladder dysfunction occurred in 22 percent of patients, and was more frequent in those in whom the tumor was less than 10 cm from the anal verge. The patients were compared with 122 patients who had undergone abdominoperineal excisions of the rectum for carcinoma. Although the overall incidence of bladder dysfunction was the same in both groups, there was a significantly higher incidence of permanent bladder dysfunction in patients undergoing abdominoperineal excision (P = 0.00034).

Investigation and treatment of renal calculi.

We have investigated and treated 176 patients who were suffering from renal calculi. The stones contained calcium in 87% of patients, predominantly urate in 11%, and rarely contained magnesium ammonium phosphate or cystine. Of the patients with calcium stones, hypercalciuria was present in 75% and was identified in 57% by the measurement of the 24-hour urinary calcium excretion, and in a further 18% by a standardization calcium "fast-and-load" test. Nine patients were found to have primary hyperparathyroidism and were treated surgically. A further 21% were suspected to have normocalcaemic hyperparathyroidism, and metabolic studies are being developed to clarify this. The treatment of hypercalciuria included a low-calcium diet, and various combinations of a thiazide diuretic, phosphate supplements and sodium cellulose phosphate. Hypercalciuria was controlled in all compliant patients, and only two developed further stones. Hyperuricosuria was rarely the sole metabolic abnormality in patients with calcium stones, though this might reflect the referral pattern of the Unit. Uric acid stones were frequently, but not invariably, associated with hyperuricosuria and acid urine, and even large uric acid calculi dissolved with a combined therapy of high fluid intake, allopurinol and an alkalinizing agent. Surgical treatment was rarely required in these patients. A stone in the renal pelvis of one patient was removed percutaneously and did not require ultrasonic fragmentation. Modern methods of investigation and treatment have greatly improved the outlook for patients with recurrent renal calculi.

Hypernephroma treated by nephrectomy, excision of tumour, and autotransplantation.

A patient developed a hypernephroma in his only fuctioning kidney. This was treated by nephrectomy, bench surgery which involved excision of the tumour and repair of the kidney, and autotransplantation. The patient remains well with good renal function, and no recurrent or metastatic disease.

The value of prophylactic antibiotics in transurethral prostatic resection: a controlled trial, with observations on the origin of postoperative infection.

Prophylactic antibiotics significantly decrease the incidence of urinary tract infection following endoscopic prostate resection. They are ineffective in reducing the incidence of postoperative fevers, or in reducing the frequency of positive blood cultures during or after operation. A majority of prostate glands harbour colonies of potentially pathogenic organisms, and these are the commonest source of infection of the urinary tract following release by prostatic surgery.

Use of prophylactic antibiotics in urethral instrumentation.

A prospective study of 210 patients undergoing urethral instrumentation is presented. The patients were divided into 2 groups, receiving either amoxicillin or cephalexin. The postoperative incidence of infection and complications was compared to a control group of 110 patients receiving no antibacterial agent. Routine prophylactic antibiotics are recommended for patients undergoing urethral instrumentation. If the urine is infected at the time of instrumentation antibiotic therapy should be used according to the sensitivity studies.