Renal adenocarcinoma in young adults.

Renal adenocarcinoma is rare in young people. The prognosis of the condition would appear to be better in young people justifying a radical treatment rationale even in cases of advanced disease. This report describes a series of patients under the age of 30 with renal adenocarcinoma and a review of the literature. The possible mechanisms for the apparent improved survival of patients in this age group is discussed.

New intra-ureteral stent for use during reconstructive surgery.

This paper describes a stent which has been specifically designed to facilitate the identification of the ureters during lower urinary tract reconstruction. It has semi-rigid limbs which allow easy ureteric identification and a soft central portion which lies across the trigone without traumatising the ureteric orifices.

Epidural anaesthesia in the management of the painful bladder.

Bladder pain is a difficult symptom to manage. Epidural anaesthesia, which was used in 10 patients with sensory disorders, carries a low morbidity and helps to define those patients with severe bladder pain who might benefit from denervation procedures.

Subtrigonal phenol injection. How safe and effective is it?

A series of 24 patients underwent 27 transtrigonal phenol injections for the treatment of bladder instability. Only 2 of 18 patients with detrusor instability and 2 of 6 with detrusor hyperreflexia continued to derive benefit from the procedure 6 months after it was carried out. Serious complications attributable to phenol were seen in 2 patients in this series and in a further 4 patients referred for complications resulting from this therapy in other centres. These results and a review of the literature lead us to suggest that transvesical phenol injection should not be used except in the hyper-reflexic bladder when no alternative treatment is possible. Particular care should be exercised in patients who have undergone extensive prior surgery or radiotherapy.

Does the Kaufman prosthesis still have a place? Review of thirteen years' experience.

The cases of 57 patients who underwent implantation of a Kaufman prosthesis for urinary incontinence at this center are reviewed. All except one of the patients were incontinent following prostatic surgery. Although many of the patients required revision or adjustments after the initial implantation, 55 percent of the cases eventually had a satisfactory outcome. Patients rendered incontinent after retropubic prostatectomy had a higher success rate with the Kaufman prosthesis than patients after other types of prostatectomy. This simple and relatively inexpensive device can still play a useful role in the treatment of patients with mild and moderate stress incontinence following prostatectomy.

A consumer's guide to commercially available urodynamic equipment.

Eight commercially available urodynamic machines from 6 major manufacturers (Aspen Medical, Dantec, Electro-Medical Supplies (EMS), Uro-gyn, Ormed and Wiest) were assessed for accuracy, construction and user-friendliness. There was less than 10% inaccuracy with regard to fill volume, void rate and pressure measurements. The Wiest 6000 plus system was between 11 and 14% inaccurate during voided volume measurement and other systems were less than 10% inaccurate. User-friendliness was assessed during routine cystometry and is mainly dependent on the software supplied with the equipment. The merits and faults of each urodynamic system with regard to performing a urodynamic investigation, running a urodynamic service and data management are compared with an "ideal" urodynamic system.

Extrarenal adult Wilms tumour: presentation, diagnosis and management.

Adult Wilms tumour is an uncommon entity, with fewer than 200 cases reported in the world literature. Strict criteria for the definition of this tumour have been specified, amongst which was the need for it to be a primary renal neoplasm. We present radiological and histological evidence of this tumour occurring at an extrarenal site, and make the case for relaxation of these criteria to include this eventuality.

Trans-trigonal phenol failed the test of time.

The results following 94 trans-trigonal phenol injections in 60 patients over a 5-year period are analysed. In only 1 patient was there a lasting effect. The others all required alternative treatment for bladder instability, hyper-reflexia or hypersensitivity. Older patients with normal bladder compliance and patients with a neuropathic aetiology had slightly better results but also failed to derive lasting benefit. The complications associated with the treatment and the general anaesthetic outweigh the transient benefits of this technique.

Modified Stamey procedure for bladder neck suspension.

A review of 76 patients who underwent endoscopic bladder neck suspension (EBNS) for stress incontinence is presented. Pre-operative video-urodynamic studies in 71 patients demonstrated stable stress incontinence in 61 (86%). There was a history of previous pelvic surgery in 52 patients (68%). Surgery was performed by trainee urologists in 35 cases (46%). The overall complication rate was 46%, of which 17% were per-operative and did not influence the outcome of surgery. Infection occurred in 16% and necessitated removal of the suture buffers in 9%. Follow-up ranged from 7 to 30 months (mean 18.3). Complete resolution of stress incontinence or a marked improvement in symptoms was seen in 86% of cases. Patients with no history of previous pelvic surgery were all either cured or improved by the procedure. Of the 52 patients who had undergone previous pelvic surgery, 42 (80%) were either cured or improved. All of the 10 failures were in this group. There was no difference between complication or success rates achieved by consultants or urologists in training. It was concluded that EBNS is the treatment of choice in patients with primary stress incontinence and it is an effective procedure in patients who have undergone previous unsuccessful surgery for stress incontinence.

Acupuncture in the treatment of bladder instability.

Twenty patients with lower urinary tract symptoms attributable to bladder instability or sensory urgency were treated with traditional Chinese acupuncture; 77% of patients with idiopathic detrusor instability were symptomatically cured. Urodynamic assessment after treatment showed no consistent changes and instability was abolished in only 1 patient. Bladder capacity rose in those who responded. Acupuncture is safe and free of complications and side effects. In patients with diurnal symptoms associated with idiopathic bladder instability it offers a therapy as effective as other non-invasive treatments.

Is antibiotic prophylaxis necessary for routine urodynamic investigations? A controlled study in 100 patients.

The value of a prophylactic antibiotic before a routine cystometrogram has been assessed in a controlled trial of 100 patients. The infection rate was low and not statistically different in both groups. Subsequent symptoms of dysuria and haematuria had a mechanical aetiology.

How does bladder function change in the early period after surgical alteration in outflow resistance? Preliminary communication.

A decrease in voiding pressures because of decreased outflow resistance has been demonstrated in 8 males, and conversely an increase in voiding pressures because of increased outflow resistance has been demonstrated in 7 females undergoing surgery. These changes occur in the early postoperative period.

The choice of suprapubic continent catheterisable urinary stoma.

Two types of continent urinary diversion are compared. In six patients a Kock pouch was used. Two were completely successful but the other four patients required 10 revision operations between them and only two achieved complete continence. In seven patients a Mitrofanoff operation was done. The results were much better and six achieved complete continence with only three revision operations in two patients. It was concluded that the Kock pouch was more difficult and where possible the Mitrofanoff operation should be used to form a continent suprapubic catheterisable stoma.

Ileal loop diversion in women with incurable stress incontinence.

Eighteen women with incurable stress incontinence underwent ileal loop urinary diversion. Eight patients required surgical revision of their stomas. Another eight patients required the formation of iatrogenic vesicovaginal fistulas but subsequently underwent cystectomy for persistent vesical discharge. Twelve patients with a psychiatric history underwent a total of 29 further operations after diversion compared with a total of six operations for the six patients without a psychiatric history. Urinary diversion is an unsatisfactory solution to the problem of incurable stress incontinence and the relationship between psychiatric disorders and incurable stress incontinence requires further study.

Post-hysterectomy urethral dysfunction: evaluation and management.

A retrospective study of the functional alteration of the urethra following hysterectomy was made in 98 patients. Three groups were identified. Sixty per cent (group A) had stable stress urinary incontinence, 27.8% (group B) had high pressure detrusor instability and 12.2% (group C) had voiding dysfunction. Some of the patients in group A were treated medically and others surgically. Those in group B were treated with oxybutinin and those in group C were treated surgically. The cure rate in group A ranged from 55 to 89%; in group B it was 82% and in group C between 90 and 100%.

Results of treatment of post-prostatectomy incontinence using the Kaufman prosthesis.

The results of inserting 55 Kaufman prostheses into 45 patients with post-prostatectomy incontinence have been reviewed. Twenty-seven patients (60%) were continent and 3 were greatly improved. Ten patients were dry after their first prosthesis, 11 required 'topping up' of the device, and 5 were after the first prosthesis had been replaced. Results improved in the later part of the series. The Kaufman prosthesis is a valuable device in the treatment of post-prostatectomy incontinence.

Teflon injection in stress incontinence.

Forty-six patients, 28 females and 18 males, underwent periurethral or perurethral Teflon injection. The results in females were satisfactory, especially where resting anatomy was normal. Male results were disappointing, no patients with post-prostatectomy stress incontinence being cured.