A double-blind single dose comparison of intramuscular ketorolac tromethamine and pethidine in the treatment of renal colic.

The efficacy of a single dose of intramuscular ketorolac 10 mg or 90 mg was compared with pethidine 100 mg in a randomized double-blind study in 121 patients reporting at least moderate pain due to renal colic. Pain was assessed before drug administration, and then at 1 hour and 12 hours after the dose. Sedation was also assessed at these times, and additionally at the 12 hour assessment the time of the next analgesic dose was recorded. At 1 hour after dosing, pain scores had decreased in all groups; the largest decrease was seen in the ketorolac 90 mg group. The difference in the decrease was significant between the two ketorolac groups, but the differences between ketorolac and pethidine were not significant. Fewer patients in the ketorolac 90 mg group (17%) required a further dose of analgesic within 10 hours than in either the ketorolac 10 mg group (39%) or the pethidine 100 mg group (47%). The difference between ketorolac 90 mg and pethidine 100 mg was statistically significant. At both assessment times the proportion of patients with no sedation was higher in the two ketorolac groups than in the pethidine group. The overall incidence of adverse events was low with all drugs, notably so for the occurrence of vomiting after ketorolac. The results of the study show that intramuscular ketorolac is efficacious in the treatment of renal colic.

Modified nephroureterectomy: a risk of tumour implantation.

The standard surgical management of patients presenting with transitional cell carcinoma of the upper urinary tract is nephroureterectomy with excision of a cuff of bladder around the ureteric orifice. Recently a modified technique of resecting the lower ureter endoscopically and completing the nephroureterectomy through a single loin incision has been advocated as a safe and simple procedure. We consider that this technique may have a risk of tumour implantation at the site of the resected lower ureter. We report our experience of this operation in five patients, two of whom developed invasive tumour at the site of the ureteric orifice after only a short follow-up.

The use of urodynamic studies to assess the effect of pharmacological agents with particular references to alpha-adrenergic blockade.

A method of studying the effect of drugs on the lower urinary tract is described, using cord-injured patients with detrusor hyperreflexia. In this study 19 patients received intravenous phentolamine. This alpha-adrenergic blockade produced a significant reduction in the maximum voiding detrusor pressure, voided volumes and peak flow rates with no reduction of outflow tract obstruction.

The effect of anteromedian sphincterotomy on penile erections in patients with neuropathic bladder.

In a series of 94 patients with neuropathic bladder undergoing anteromedian urethral sphincterotomy, 20 had no penile erections prior to surgery. In the remaining 74 cases, seven (9 X 5 per cent) had diminished erections postoperatively and three (4 per cent) no erections. It is considered that the risk of this complication is less with anteromedian sphincterotomy than with bilateral 3 and 9 o'clock sphincterotomy.

Long term indwelling urethral catheterisation for congenital neuropathic bladder.

Long term urethral catheterisation remains an important and effective method of achieving dryness and maintaining renal function in children with congenital neuropathic bladders. Those most likely to require an indwelling catheter are girls who are severely disabled because of myelomeningocele. The management of such catheterisation and its consequences, in the light of our experience with a 100 children treated over a 12 year period, is described.

Conservative management of vesicoureteric reflux in the congenital neurogenic bladder.

A series of 31 patients with congenital neurogenic bladder in which vesicoureteric reflux was managed conservatively by methods designed to improve voiding function is reported. Satisfactory results, in terms of the appearance of the upper urinary tracts on IVU, were obtained by indwelling urethral catheter, or by alpha-adrenergic blockade, internal urethrotomy or external urethral sphincterotomy; in the case of the last 3 procedures this was accompanied by diminution or resolution of vesicoureteric reflux. Less satisfactory results were obtained by intermittent self catheterisation and in patients managed in this way a case exists for ureteric reimplantation.

The effect of distigmine bromide on voiding in male paraplegic patients with reflex micturition.

The effect of parenteral and oral distigmine bromide on voiding efficiency in 23 male spinal cord injured patients is described. The parenteral preparation of the drug improved voiding efficiency.

Drug effect on the voiding cystometrogram: a comparison of oral bethanecol and carbachol.

A system for objective assessment of drug activity on voiding parameters is presented. Two groups of spinal cord injured patients with reflex micturition were given bethanecol chloride 50 mg or carbachol 4 mg orally. Carbachol produced a much greater change in recorded voiding parameters.

Ileal conduit urinary diversion: long-term follow-up in adults.

Ninety-six adult patients who had an ileal conduit urinary diversion between 1970 and 1976 were reviewed. Forty-nine of the patients had been followed up for an average period of 6 years. In this group, the upper tracts showed an improvement in 23%, whilst deterioration, which could be attributable to the conduit, occurred in 16%. Late complications included stomal problems in 9 patients, pyelonephritis in 2 and renal calculi in 3. Eight out of 9 patients examined had a reduced glomerular filtration rate as calculated from Tc DTPA clearance.