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H N Whitfield

Publications and source records attributed to H N Whitfield.

At least 19 recordsLinked to original sources
PubMed2006

Is there a role for the intravenous urogram in the 21st century?

Over the last two decades, there have been major advances in methods of medical imaging that have brought great benefits to patients both for diagnosis and for treatment. There has been an increasing tendency for some of these new imaging modalities to be dependent on highly sophisticated technology. The belief has developed amongst doctors who use these techniques that newer is necessarily better. Just as patients (and some doctors) now often believe that anything done with a laser represents the best that can be offered, so there is a tendency to demand that newer techniques in imaging should always be offered as the preferred option. In urological practice that philosophy is questionable.

Colic↗
PubMed2000

A model to quantify encrustation on ureteric stents, urethral catheters and polymers intended for urological use.

OBJECTIVE: To validate an encrustation model and to quantify encrustation on currently used urological devices and polymers intended for urological use. Materials and methods An encrustation model was validated: (i) to measure the amount of calcium leaching from the glass model and from the polymer used; (ii) to determine whether the use of a single-source or pooled urine produced similar results; (iii) to determine in vitro encrustation; and (iv) to compare the results of in vivo implantation of the same materials into the bladders of rodents with the in vitro results. A test polymer (a ureteric stent, a urethral catheter or a biomaterial) and a control silicone polymer were housed separately but received human urine from the same reservoir and under the same conditions (pH 6.0 and 37 degrees C) for 5 days. The amount of calcium encrustation on each polymer was measured using atomic absorption spectroscopy. Each experiment was repeated at least four times and the results expressed as an encrustation index, defined as the ratio of encrustation of the test and reference polymers. RESULTS: The amount of calcium leaching from the glass model and polymers tested was insignificant. The use of a single-source or pooled urine gave the same results in the encrustation model. The in vitro results correlated with in vivo implantation of disks into the bladders of rats. Among the commonly used ureteric stents tested, the Cook C-Flex ureteric stents encrusted least. Hydrogel-coated ureteric stents encrusted more than uncoated stents. The Bard polytetrafluoroethylene short-term urethral catheter encrusted more than the Bard hydrogel-coated long-term catheter. A plasma-activated surface modification of a synthetic biomaterial with hyaluronic acid encrusted less than silicone, a long-term biomaterial widely regarded as the 'gold standard'. CONCLUSION: This validated encrustation model is the first to quantify encrustation on currently available ureteric stents and urethral catheters. A novel coating for a biomaterial was identified using the encrustation model, and which encrusted less than silicone.

Animals↗
PubMed2000

Urinary encrustation of alloplastic materials.

Currently, all alloplastic materials placed within the urinary tract are susceptible to encrustation, and devices made from these biomaterials are prone to the associated complications. Encrustation is affected by such surface properties as roughness and irregularity, hydrophobicity and wetability, charge, polymer chemistry, and coatings. The composition of the surface may also influence reactivity at the interface. A raised urinary pH as a result of infection with urease-producing bacteria is an important mechanism of encrustation, but encrustation can take place in the absence of infection. Individual variations in the risk of encrustation have been identified. Better device designs are required, as are better models for examining biomaterials and biofilm formation. With a coordinated multidisciplinary approach and adequate resources, we may solve the problem of encrustation, which has such an adverse effect on patient quality of life and on healthcare costs.

Coated Materials, Biocompatible↗
PubMed1999

The physicochemical basis of urinary catheter encrustation.

OBJECTIVES: To determine the relationship between urinary pH and Ca2+ solubility in urine samples from patients who experienced either frequent ('blockers') or infrequent ('nonblockers') catheter blockage by crystalline deposits of divalent cation salts. MATERIALS AND METHODS: Fresh urine samples from 'blockers' and 'nonblockers' were collected and the ionic calcium concentration ([Ca2+ ]) measured using a Ca2+-selective electrode whilst the urinary pH was increased in 0.25 increments between 4.75 and 9.00. The pH at which crystallization occurred (nucleation) was determined and crystal composition analysed. RESULTS: The mean (sd) voided urinary pH of catheter 'blockers' was significantly more alkaline than that from 'nonblockers', at 7.63 (0.64) and 5.97 (0.80), respectively (P=0. 001). The nucleation pH of catheter 'blockers' was significantly more acid than in 'nonblockers', at 7.43 (0.73) and 6.45 (0.65), respectively (P=0.005). Urine from 'blockers' had significantly more Ca phosphate and Mg ammonium phosphate crystals. 'Blockers' were further divided into two subsets with and without urease-based urinary tract infection; both showed a decrease in the nucleation pH. CONCLUSION: In the urine from 'nonblockers' there is a wide safety margin between voided and nucleation pHs; this margin was less in the urine from 'blockers'. This reduction in the safety margin arises partly because the voided pH in those with a urinary tract infection is more alkaline. However, the decrease in the nucleation pH also suggests that a fundamental property of urine is altered, which reduces Ca2+ solubility at more neutral pH values. The long-term goal is to increase the nucleation pH of catheter 'blockers' and increase the margin of safety.

Calcium↗
PubMed1997

A prospective, randomized, double-blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy.

OBJECTIVE: To determine the optimum duration for the retention of 2% lignocaine gel intraurethrally as an anaesthetic for flexible cystoscopy in men. PATIENTS AND METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted in two parts. Initially, the importance of duration was determined, i.e. whether pain relief was significantly improved when lignocaine gel was instilled for longer than is currently practised. As pain relief was improved by retaining the lignocaine gel for longer, the optimum time was determined in a second trial. Initially, 90 patients were divided into four groups receiving 20 mL of 2% lignocaine gel or plain lubricating gel for 5 or 25 min. Subsequently, 60 men were divided into two groups receiving 20 ml of 2% lignocaine gel for 15 or 25 min. The patients' discomfort was recorded using a 4-point descriptive pain scale and a 100 mm non-graphical visual analogue scale. RESULTS: In the first study, those patients receiving lignocaine gel for 25 min experienced significantly less pain than the other three groups. In the second, lignocaine gel in the urethra for 15 min provided the same level of pain relief as lignocaine for 25 min. CONCLUSION: Pain during flexible cystoscopy can be significantly reduced when 20 mL of 2% lignocaine gel is left in the urethra for 15 min; lignocaine gel would be more effective when left for longer than is currently practised.

Analgesia↗
PubMed1996

Low-angle X-ray scattering signatures of urinary calculi.

This is the first reported use of low-angle X-ray scattering for the investigation of urinary calculi. Low-angle X-ray scattering (LAXS) measures the diffraction of a broad spectrum of X-rays at a single angle and uses a conventional diagnostic X-ray beam, and could thus be developed for use in vivo. A total of 45 calculi were investigated using this technique. Calcium oxalate stones showed a bimodal signature with peaks of almost even photon energies. Signatures for the other stone types were less well-defined. The results are discussed in more detail below. Our preliminary results show that the technique is capable of distinguishing between calcium oxalate stones and other stone types in vitro. Further work is in progress to correlate the results of this technique with objective parameters of stone hardness.

Humans↗