Biomedical subjects
Publications and source records attributed to J G Gow.
Since 1970 short course regimes of chemotherapy have been adopted for the treatment of 87 patients suffering from genitourinary tuberculosis. The response to chemotherapy, the effect of surgery, the importance of hypertension and the relapse rate have been studied. It is concluded that all cases of genitourinary tuberculosis will respond to a short intensive course of chemotherapy, which need not be given for longer than 6 months.
Fifty-nine patients who had undergone augmentation cystoplasty were studied over a period of 18 years. The indications for the operation were a tuberculous contracted bladder in 51, interstitial cystitis in 7 and carcinoma in 1. The ileum was used in one patient, the colon in 16 and the caecum in 42. The results did not seem to be influenced by the segment of bowel and the long-term results of using the colon as bladder substitute were similar to those achieved by using the caecum. An excellent result has been achieved in 78% of the 49 surviving patients. Operative mortality was 5.1% (3 patients). Contraindications include progressive severe renal failure, enuresis and a history of previous psychiatric disturbance.
Genitourinary tuberculosis should be managed on an outpatient basis, patients being seen once a week. The treatment of choice is a short-course regimen comprising 2 months of either three or fours drugs - streptomycin, rifampicin, isoniazid, and pyrazinamide - followed by isoniazid and rifampicin three times a week for either 2 or 4 months, depending on the severity of the lesion. Patients should be followed-up, normally for one year, and be told to report to their doctors if they have any recurrence of urinary symptoms. However, if they have renal calcification they should be followed-up as for any other case of calcification and seen annually for at least 10 years. Surgery still has an important part to play in the present management. Radical surgery, nearly always nephrectomy or epididymectomy, should be carried out when there are destructive lesions. Reconstructive surgery, mainly the the repair of strictures at the lower end of the ureter and bladder augmentation for a small fibrotic bladder, is frequently required. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy. There is no reason now why all patients should not be able to return to a normal efficient life - free from all association with the disease - not later than 4 months after the start of treatment.
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The authors have treated 106 patients with bladder carcinoma. Results are reported here.
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The results of caecocystoplasty for tuberculous bladder contracture in 30 patients over a 15-year period are presented. The operative mortality was 3.3%. Poor renal function was not a contraindication to surgery. The results indicate that caecocystoplasty provided relief of symptoms in over 90% of patients. Renal function was preserved and associated obstructive uropathy was usually relieved. Efficient cystoplasty emptying was observed in 80% of patients if detrusor resection was kept to the minimum consistent with a wide caecovesical anastomosis.
Azoospermia in the presence of a normally functioning testis and a normal vasogram has been thought to be due to an obstruction in the epididymis between the body and the head. However, bypass operations have been singularly unsuccessful except when there was evidence of past inflammation causing fibrosis of the body and tail of the epididymis. Two substances, glycerylphosphorylcholine and carnitine, which are known to be secreted by the epididymis, were investigated. The results of this preliminary study suggest that they may play a part in the management of patients presenting with azoospermia.
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In the past year 20 new cases of genitourinary tuberculosis were referred for treatment at Wrightington Hospital. Many of these patients had waited a long time between diagnosis and referral and the start of effective treatment. We suggest that a new short course of chemotherapy should be used, and surgery undertaken during the first three months of treatment, but after the patient has had at least four weeks' drug treatment. After chemotherapy follow-up may be reduced to two years. Genitourinary tuberculosis remains a serious disease and should be managed by a urologist.
The problem in the treatment of genitourinary tuberculosis was to find a new regimen of chemotherapy that was shorter in time but equally effective as the traditional 2-year method, using streptomycin, isoniazid and para-aminoslicylate. A short course of treatment using rifampin, isoniazid and ethambutol was then devised, the method depending on the severity of the disease using the Semb classification. This short course of chemotherapy was combined with an early operation in advanced or extensive disease in the urinary tract. The regimen is as satisfactory as the traditional method and a followup of 2 years is all that is necessary.
25 years' experience of the open surgical management of the lower ureteric stricture is reviewed. An extravesical anti-reflux tunnel procedure has been found to be simple and effective. There is still a place for the Boari procedure or psoas hitch, particularly in the management of a long stricture of when gross thickening of the ureter makes the formation of a tunnel of effective length impracticable.
Latex, hydrophilic polymer-coated latex and PVC balloon indwelling urethral catheters were compared in respect of the urinary tract infections arising in association with their use in male patients. The polymer (Hydron) coating conferred no benefit over uncoated latex which in turn was indistinguishable from PVC. No significant differences in the spectra of infecting organismns were observed between the 3 catheter types.
Forty-three patients were treated with cephazolin sodium, a parenteral cephalosporin antibiotic for 45 episodes of urinary tract infection complicated by a variety of underlying conditions. In 42 episodes, there was a satisfactory clinical response, and in 37 episodes this was associated with elimination of the bacterial pathogen from the urine. In 21 out of 31 patients available for examination 3 months later, the urine was still free of bacteria. A relatively prolonged plasma half-life and high urinary concentrations of the drug permit successful treatment of urinary tract infections with injections given only twice daily.
1. Calcification in renal tuberculosis is not warranting a healing process, but may be a clinical manifestation of the disease. 2. Calcification presenting at least one year after the start of treatment should be considered differently from calcification first seen on presentation, and s,ould be treated in the same way as renal calculi. In view of the high incidence of associated active renal tuberculosis, calcification present when first seen should be removed, preferably with partial excision if the lesion is amenable to this form of treatment, but if it is not removed, patients should be followed up indefinitely, as complications can occur at any time. 3. Extra-renal calcification is more common in patients suffering from genito-urinary tuberculosis who present with renal calcification. 4. The incidence of renal calcification in patients suffering from renal tuberculosis is increasing. This could either be due to the host, the pathogenic organism, or possibly the treatment. As the host and treatment have not changed, it would suggest some alteration in the character of the organism.