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J W Fowler

Publications and source records attributed to J W Fowler.

At least 19 recordsLinked to original sources
PubMed1995

Radical radiotherapy for localized adenocarcinoma of the prostate. A report of 191 cases.

OBJECTIVE: To assess the results of radiotherapy in the treatment of localized prostate cancer. End points for assessment were survival, local control, development of metastases, and the toxicity of therapy. MATERIALS AND METHODS: The case notes of 191 patients who were treated with radical radiotherapy between 1982 and 1992 were reviewed. The pathology of 130 patients was reviewed by a single pathologist. A multivariate analysis was performed to identify significant prognostic factors with regard to survival and relapse. RESULTS: One-hundred and eighty-two patients were assessable. The minimum length of follow-up was one year (median = 40 months). The actuarial cause-specific 5 and 10 year survival rates were 63% and 35% respectively. Local progression occurred in 41% of patients with 37% developing metastases. Multivariate statistical analysis demonstrated that T stage and Gleason Score were significant predictors for survival. Late complications were usually mild, with only 4% developing serious bladder toxicity. CONCLUSION: Radical radiotherapy has a role in the curative treatment of prostate cancer. Survival is significantly related to T stage at the time of presentation, and to the Gleason Score of the tumour. Survival in this series was not as good as the best surgical series, but it is still not clear which patients should receive radiotherapy and which surgery as their primary management.

Actuarial Analysis↗
PubMed1994

Laparoscopic pelvic lymphadenectomy--early results.

OBJECTIVE: To report our initial experience and early results of laparoscopic pelvic lymphadenectomy (LPL). PATIENTS AND METHODS: Between May 1991 and April 1992, 10 patients with genitourinary malignancy (eight prostate, one bladder carcinoma, one penile melanoma) underwent LPL. Following biopsy, initial staging was carried out using computed tomography (CT), a bone scan and the prostate specific antigen level (prostate cancer). Six patients underwent unilateral laparoscopic dissection, three patients bilateral dissection and one patient required conversion to an open procedure. Operative times ranged from 2 to 3 h, and the number of lymph nodes removed ranged from three to nine (median five). RESULTS: Three patients had their staging altered following LPL (one patient was upstaged and two patients were downstaged), with significant therapeutic implications. Two patients suffered thromboembolic complications while undergoing definitive therapy soon after LPL. CONCLUSION: Our early results suggest that LPL is valuable in identifying suitable patients for radical therapy as well as excluding patients with lymph node involvement, thereby reducing morbidity.

Aged↗
PubMed1993

Suppurative epididymo-orchitis in young "high risk" patients--a new problem?

During a 4-year period we have treated 3 young patients with severe epididymo-orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of "high risk" activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV-positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure. Investigations for atypical pathogens should be performed when young patients present with refractory epididymo-orchitis. These patients should also be counselled with regard to HIV testing.

AIDS-Related Opportunistic Infections↗
PubMed1989

Management of localised prostatic carcinoma.

Localised carcinoma of the prostate may be amenable to radical curative therapy. Staging pelvic lymphadenectomy is controversial but is the only means of demonstrating lymph node spread accurately. Five patients in a group of 16 who presented apparently with localised prostatic carcinoma, and who had negative bone scan and CT scan, were shown at operation to have metastatic carcinoma involving their lymph nodes; 3 of 8 patients with high grade tumours were free of lymph node metastases. Without staging lymphadenectomy, these patients may have been inappropriately treated.

Humans↗
PubMed1988

Videourodynamic assessment of the Stamey procedure for stress incontinence.

Fifty-three patients underwent the Stamey procedure after stress incontinence was demonstrated by videourodynamic assessment. It was possible to repeat this assessment in 45 patients post-operatively; 58% were shown to be continent and in 20% the leakage was less. Failed operations were unrelated to age, weight, parity, degree of bladder neck descent or previous pelvic surgery. Coexisting detrusor instability was not a contraindication to surgery. Delayed voiding was common immediately after surgery but voiding problems were not encountered once micturition had been re-established. Although a significant objective failure rate was demonstrated, the Stamey procedure has many advantages and it can be recommended as first-line treatment in cases of stress incontinence.

Adult↗
PubMed1987

Peritoneal flap ureteropexy for idiopathic retroperitoneal fibrosis.

Eight patients had 13 ureters treated by peritoneal flap ureteropexy. There were no significant post-operative complications. Eleven ureters were functioning normally after an average follow-up of 28 months. The operation is suggested as a method of choice where omental wrapping is not possible.

Aged↗
PubMed1986

Diagnosis and treatment of posterior urethral injury.

The initial investigation and diagnosis in 28 patients with posterior urethral trauma are presented. Twenty-five patients underwent either primary realignment for complete rupture or cystostomy alone for partial rupture. The results of their management are reported.

Adolescent↗
PubMed1986

Results of surgery following radical radiotherapy for invasive bladder cancer.

Five hundred and ninety-one of 889 patients with T1 to T4 transitional cell carcinoma of the bladder had persistent or recurrent cancer after radical radiotherapy. Durable local control was significantly poorer for patients with grade 1 or T4 cancer before radiotherapy. Three hundred and twenty-two patients received additional surgical treatment: 211 were endoscopically managed and 111 had secondary cystectomy. The survival of patients with residual or recurrent cancer after radiotherapy was significantly improved by secondary local treatment (P less than 0.0001). A comparison was made between endoscopic treatment and cystectomy after radiotherapy. Patients having secondary cystectomy were younger (mean age 60.0 years) than those managed endoscopically (66.8 years). The 5-year actuarial survival rate (from the date of radiotherapy) for patients who had endoscopic treatment was 47.1% compared with 62.5% for those who had cystectomy (P = 0.16). After both treatments survival was significantly correlated with the T category of the tumour before radiotherapy. Local tumour control was better after cystectomy; 85.6% of patients were locally tumour-free at the end of follow-up compared with 44.5% of those managed endoscopically. There was no overall difference in the subsequent risk of metastases between the two forms of surgery. However, seven of 12 patients managed endoscopically prior to secondary cystectomy died of their cancer. Five of these patients died from metastases even though they were locally disease-free. There was a significantly increased risk of metastases in patients managed endoscopically who were not locally disease-free after treatment (P = 0.0003). Caution is advised in persisting with endoscopic treatment after radiotherapy if local control is not readily achieved.

Aged↗
PubMed1985

Urethral dysplasia and bladder cancer in cystectomy specimens.

Sixty-five patients had a cystectomy for a solitary bladder tumour (28) or multifocal lesions (37). The histological extent of the disease within the bladder was correlated with mucosal abnormalities within the urethra. The presence of multifocal or solitary bladder disease was not an accurate predictor of the presence or absence of urethral dysplasia. Details of mortality and morbidity associated with one-stage cysto-urethrectomy are presented and it is concluded that irrespective of whether the bladder contains a solitary or multifocal tumour, complete cysto-urethrectomy should be considered as the treatment of choice whenever cystectomy for attempted cure is indicated.

Adult↗
PubMed1985

The control of male stress incontinence by implantable prostheses.

Twenty-six patients were treated by implantable prostheses in a 10-year period, 22 by primary Kaufman III and four by primary Rosen. Sixteen of 22 patients having the Kaufman III procedure were cured or markedly improved over a follow-up period of 6 months to 10 years. The Rosen prosthesis, whilst simple to install and making the patient continent, eventually produced urethral fistulae in all cases. The Kaufman III prosthesis appears to be the procedure of choice in uncomplicated male stress incontinence.

Adult↗
PubMed1984

Histopathological review of transitional cell carcinoma of the upper urinary tract.

A histopathological review of 30 patients with transitional cell carcinoma (TCC) of the upper urinary tract showed that 21 patients had dysplastic epithelium adjacent to the tumour, irrespective of the degree of invasion; 20 patients had multifocal disease with some degree of dysplasia or carcinoma elsewhere. It is concluded that radical surgery should be performed whenever possible, even in the superficial low grade tumour.

Adult↗
PubMed1982

The effects of radiotherapy on the integrity of the ureteroileal segment following cystectomy.

Thirty-nine patients treated by cystectomy and ileal loop diversion for carcinoma of bladder were divided into 3 groups: A. cystectomy alone, B. cystectomy combined with pre-operative irradiation, C. Salvage cystectomy following radical radiotherapy. The post-operative complications and subsequent function of the ureteroileal segment of the urinary diversion were compared in the 3 groups. Those having primary cystectomy had the fewest complications and best long-term function, whilst those having surgery within 12 months of radical radiotherapy had the highest incidence of ureteroileal obstruction. The possible aetiology is discussed.

Female↗