Biomedical subjects
Publications and source records attributed to M H Ashken.
We report a case of renal cell carcinoma that showed extensive osteosarcomatous differentiation and simulated a staghorn calculus clinically and radiologically. The literature on osteosarcomatous differentiation in renal cell carcinoma is reviewed.
We describe the effect of ranitidine in reducing mucus in urine in 8 patients with enterocystoplasty and present a simple technique for measuring the concentration of mucus in urine. After a 10-day course of ranitidine (300 mg daily in divided doses) the concentration of mucus had fallen significantly from an initial level of 1.38 +/- 0.18 to 0.39 +/- 0.04 mg/ml.
Clam enterocystoplasty has been used successfully in the treatment of refractory urge incontinence. We report 31 patients who underwent ileocystoplasty between 1982 and 1989. The majority of patients were pleased with the outcome of the operation. The main post-operative complication was voiding dysfunction due to relative bladder outflow obstruction. Urinary tract infection and mucus production were significant long-term problems.
We describe the use of the urethral Wallstent in 71 patients with urethral strictures. The stainless steel stent is self expanding when released from its endoscopic introducer. The results over a 3-year period have been good with only mild discomfort and slight urethral leakage for up to 3 months. Migration, infection and encrustation have not been a problem and serial endoscopic review shows healing to be variable but complete in up to 12 months. It is considered that this simple endoscopic technique offers a simple, safe and effective alternative to multiple dilatations, urethrotomies and urethroplasty procedures in patients with bulbar urethral strictures.
Medium-term results are reported in 100 patients who had a Stamey operation for genuine stress incontinence. The results were good in 72, improved in 8 and 20 were failures when assessed clinically and with pad tests. Most of the failures occurred in the first post-operative year. A repeat Stamey operation was easy and the results have been good in 7 of the 8 cases. Bladder outflow obstruction, urinary infection and wound sepsis were not a problem.
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Sixty female patients with clinically demonstrable stress incontinence of urine have had a Stamey operation during the last 3 years. The results have been good in curing stress incontinence, whilst the majority of the failures have been in patients with severe detrusor instability or a chronic cough. There have been few post-operative complications and urodynamic studies have shown improved cough urethral profiles and no evidence of bladder outflow obstruction. The Stamey procedure can be recommended as the initial operation for surgically curable incontinence. Mild bladder instability is not a contraindication to the operation and it is also useful in elderly, unfit or obese patients.
Otis urethrotomy is an empirical procedure when used in the treatment of recurrent urinary tract infection and the urethral syndrome. Sixty-four female patients were randomised into two treatment groups. One group had cystoscopy alone and the other cystoscopy and Otis urethrotomy. The patients were assessed pre-operatively and at 6 weeks after surgery both symptomatically and by urodynamic testing. There was no significant difference in the results obtained in the two groups. We conclude that Otis urethrotomy has no advantage in the routine treatment of patients with lower urinary tract symptoms.
Distigmine bromide (Ubretid) is a long-acting anticholinesterase which is thought to improve detrusor function, restoring normal voiding patterns which may have been disturbed by autonomic overactivity, particularly after surgery. Ninety-three patients entered a double-blind study of the effect of distigmine bromide versus placebo on voiding after prostatectomy. The results demonstrated that there was a trend towards improvement but no statistically significant increase in post-operative flow rates, in reduction in bladder volume, and in the incidence of re-catheterisation in the patients treated with distigmine bromide.
Blood loss during operation was measured in 106 patients undergoing transurethral resection of the prostate, using a colorimetric technique. The total blood loss was related to the length of operation and the weight of prostate resected. There was no relationship between blood pressure and the blood loss during operation. However there was a significant reduction in blood loss if the patient received a regional rather than a general anaesthetic. Blood loss was lower in those patients undergoing prostatectomy for carcinomatous disease.
Sixty patients with recurrent superficial bladder tumours (Ta or T1) entered an open controlled trial of single dose Adriamycin. After transurethral resection of tumor recurrences, patients were alternately allocated to the control group or to the Adriamycin group, who received an instillation of 50 mg of Adriamycin in 50 ml of saline for 30 min. Six months later all patients were readmitted for endoscopy. In the Adriamycin group significantly more patients showed a decrease in the number of recurrent papillomas (72%) than in the control group (39%). This study shows that the use of adjuvant chemotherapy in the form of single dose Adriamycin is effective in reducing tumour recurrence.
Verrucous carcinoma of the penis or 'Buschke-Löwenstein' tumour is a rare lesion. The condition may be mistaken for condyloma acuminatum or epidermoid carcinoma of the penis which carries a worse prognosis. The verrucous carcinoma once completely excised rarely recurs. All reports of recurrence were thought to be due to inadequate excision. Three cases of this tumour have presented to our department within the last 9 months and their presentation and clinical management will be outlined in this paper.
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One hundred and nine male patients took part in a randomized trial of elective suprapubic or urethral catheterization in retention of urine. The self-retaining trocar suprapubic catheter proved safe and reliable in trained hands and its use was associated with a low incidence of side effects. The suprapubic catheter when used to allow continuous flow resection appeared to lead to decreased blood loss and reduced resection time. No decrease in urinary infection rate over the period of hospital stay was noted in the suprapubic group. The suprapubic catheter was more comfortable than the urethral and also allowed a trial of voiding prior to removal. Use of the suprapubic catheter was not associated with an increased hospital stay.