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Biomedical subjects

M L de Kock

Publications and source records attributed to M L de Kock.

At least 19 recordsLinked to original sources
PubMed1997

Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison.

PURPOSE: We compared the efficacy of dilation versus internal urethrotomy as initial outpatient treatment for male urethral stricture disease. MATERIALS AND METHODS: A total of 210 men with proved urethral strictures was randomized to undergo filiform dilation (106) or optical internal urethrotomy (104) with local anesthesia on an outpatient basis. RESULTS: Life table survival analysis showed no significant difference between the 2 treatments with regard to stricture recurrence. Hazard function analysis showed that the risk of stricture recurrence was greatest at 6 months, whereas the risk of failure after 12 months was slight. The recurrence rate at 12 months was approximately 40% for strictures shorter than 2 cm. and 80% for those longer than 4 cm., whereas the recurrence rate for strictures 2 to 4 cm. long increased from approximately 50% at 12 months to approximately 75% at 48 months. Cox regression analysis showed that for each 1 cm. increase in length of the stricture the risk of recurrence was increased by 1.22 (95% confidence interval 1.05 to 1.43). CONCLUSIONS: There is no significant difference in efficacy between dilation and internal urethrotomy as initial treatment for strictures. Both methods become less effective with increasing stricture length. We recommend dilation or internal urethrotomy for strictures shorter than 2 cm., primary urethroplasty for those longer than 4 cm. and a trial of dilation or urethrotomy for those 2 to 4 cm. long.

Adolescent↗
PubMed1997

Outpatient treatment for male urethral strictures--dilatation versus internal urethrotomy.

Male patients with proven urethral strictures (total 210) were prospectively randomised to undergo either dilatation (106 patients) or internal urethrotomy (104 patients) as an outpatient procedure under local anaesthesia. The incidence of complications or failure during the performance of the procedure did not differ significantly between the two treatment groups. Complications or failure in performing urethral dilatation were significantly more common in patients who presented with retention or complications compared with symptoms only, and in those with a positive compared with negative urine cultures. Complications or failure in performing internal urethrotomy were significantly more common in patients with a positive than with a negative urine culture, and long (> 2 cm) rather than short (< 2 cm) strictures, whereas the difference approached significance for patients with multiple rather than single strictures (P = 0.06). Failure alone in the performance of internal urethrotomy was significantly more common in patients with trauma compared with urethritis as aetiology, and in those without previous stricture treatment. With a mean follow-up of 15 months the cumulative percentage of recurrent urethral strictures did not differ significantly between the two treatment groups. We conclude that urethral dilatation and optical internal urethrotomy under local anaesthesia are equally successful as initial outpatient treatment. With regard to successful performance of the procedure itself, multiple, longer (> 2 cm), post-traumatic, and previously untreated strictures are better managed with dilatation, whereas patients with complications or retention are better managed with internal urethrotomy. A positive urine culture is associated with a higher complication and failure rate in the performance of both procedures.

Adolescent↗
PubMed1994

Epidemiology of urethral stricture at Tygerberg Hospital.

Over a 12-month period, 120 consecutive male patients with confirmed urethral stricture were prospectively studied with regard to the epidemiology of the disease. Specific urethritis is the main aetiological factor (45%) and internal and external trauma account for an alarming 38.3% of cases. The prevalence is highest among 40-50-year-old coloured men who have had little schooling, multiple sexual partners and who have a low annual income. The incidence can be reduced by upliftment of moral and educational standards of the local population, and by emphasising the potential dangers of catheterisation and instrumentation of medical personnel.

Adolescent↗
PubMed1993

Genito-urinary tuberculosis--experience with 52 urology inpatients.

The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0.74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scortal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.

Adolescent↗
PubMed1991

Prostate carcinoma--the value of T stage and grade in predicting metastases and prognosis. A cost-effective approach to clinical staging.

In order to evaluate the initial T stage and tumour grade as predictors of metastatic disease and prognosis in adenocarcinoma of the prostate, 963 patients were reviewed. Of the patients, 41% presented with metastatic disease. Stage T4 tumours were associated with a consistently poor prognosis, and 70% of such patients had demonstrable distant metastases. No patient with TOf local disease had metastases or died of prostate cancer during follow-up. The incidence of metastases was also low in stages T1 and T2. High tumour grade correlated strongly with more advanced disease. Using this information a more cost-effective approach to the staging of prostate carcinoma is proposed.

Adenocarcinoma↗
PubMed1990

[Intravesical BCG as a treatment for superficial and in situ transitional cell carcinoma of the bladder].

Intravesical BCG is already established as effective therapy in the management of superficial bladder cancer. However, varying results have been obtained with different BCG strains; these are ascribed to variations in their immunogenicity. The locally available BCG strain which contains approximately 1.2 x 10(9) colony-forming units per 120 mg was used for intravesical instillation in 27 patients with recurrent superficial transitional cancer of the bladder. Ten of the 13 patients who received BCG prophylactically to reduce or stop recurrencies completed therapy and 7 (70%) were in remission after 1 or 2 courses with a mean follow-up of 2 years. Fourteen patients received BCG therapeutically for in situ carcinoma. Thirteen of these patients completed therapy and 9 (69%) responded favourably after 1 or 2 courses of BCG for a mean follow-up period of 23 months. Adverse effects of the treatment were mild and well tolerated except in a patient who received radiotherapy. Although 21 patients experienced irritable bladder symptoms only 1 discontinued treatment as a direct result. The only other patient in whom treatment had to be stopped, developed severe polyarthritis after 3 instillations. A statistically significant reduction in the number of recurrences (P less than 0.001) was experienced by the patients who received BCG prophylactically. Although this is a very limited study, the locally available BCG strain exhibited therapeutic activity. It is cost-effective and warrants further study.

Administration, Topical↗
PubMed1990

A true hermaphrodite with some unusual features.

A fifteen-month-old boy with ambiguous external genitalia was found to have a 46XX karyotype, an ovotestis in the right labioscrotal fold, and an absent left gonad. He also had a rudimentary uterus and fallopian tubes and a blind-ending vagina lined with squamous epithelium. These features are compared with those more commonly found in true hermaphroditism.

Disorders of Sex Development↗
PubMed1989

Guidelines for the treatment of urethral strictures.

Over a period of 12 years 467 patients with urethral stricture were treated surgically at Tygerberg Hospital. The following surgical guidelines were developed: visual cold-knife urethrotomy should be the first line of treatment; urethroplasty is indicated when urethrotomy fails or is unfeasible; the urethroplasty of choice should be a single-stage operation; and staged procedures should be reserved for complicated cases.

Adolescent↗
PubMed1988

Percutaneous nephrolithotomy. Experience with renal and proximal ureteral calculi at Tygerberg Hospital.

Percutaneous nephrolithotomy (PCN) enables the urologist to remove upper urinary tract stones through a percutaneous nephrostomy tract. The principal advantages of PCN are the low morbidity, shortened hospital stay and rapid recovery. Percutaneous puncture failed in 5 (11%) of the first 44 patients with upper tract urolithiasis treated by PCN at Tygerberg Hospital. In 35 patients (80%) PCN cleared the kidney of stones but in 4 patients (9%) all stone fragments were not removed during the procedure. If the puncture and dilatation was successful, then 90% of patients were stone-free after PCN. Complications were minimal except for a diabetic who died of septicaemia. PCN is an alternative to open renal surgery in the management of most upper urinary tract stones. The technique is readily mastered by any urologist experienced in endoscopic surgery.

Adolescent↗
PubMed1987

Malignant fibrous histiocytoma of the spermatic cord. A case report.

A case of malignant fibrous histiocytoma of the spermatic cord treated by primary local excision, followed 5 days later by radical inguinal orchidectomy and hemi-scrotectomy is reported. At 30 months' follow-up the patient is free from local recurrence.

Genital Neoplasms, Male↗
PubMed1986

Extra-adrenal phaeochromocytoma. A case report.

A case of hypertension in a young woman caused by an extra-adrenal phaeochromocytoma (EAP) situated in the hilum of the left kidney is reported. Surgical removal of the EAP resulted in control of the patient's hypertension without further drug treatment. The clinical features, diagnostic work-up and management of EAP are briefly discussed.

Adult↗
PubMed1983

Stab wounds associated with hematuria--a review of 67 cases.

The clinical records of 67 patients who underwent surgical exploration for stab wounds associated with hematuria were reviewed in an attempt to evaluate the need for mandatory operation and to define criteria for possible nonoperative of such cases. Minor renal injuries without associated intra-abdominal lacerations were found in 61 per cent of the patients. Delayed renal hemorrhage occurred in 15 per cent of the patients despite early exploration, suture and drainage of the kidney, and antibiotic prophylaxis. Of 7 nephrectomies 5 were performed for secondary hemorrhage. Postoperative pulmonary complications arose in 28 per cent of the patients. A policy of mandatory operation on all patients with stab wounds and hematuria led to apparently needless surgery in 61 per cent of the patients in this series. Retrospective analysis revealed that the rate of probably unnecessary operations could have been reduced to 24 per cent by selecting for operation only those patients with signs of severe hemorrhage, associated intra-abdominal injury or major extravasation of contrast material on excretory urography.

Adolescent↗
PubMed1982

The suprapubic approach in the surgical treatment of female stress incontinence.

Stress incontinence in women is a frequent and humiliating complaint, the aetiology and pathogenesis of which are not always apparent. Routine investigation followed by standard vaginal or abdominal surgical procedures will cure most uncomplicated cases. However, in complicated cases a more sophisticated pre-operative evaluation and a more versatile surgical approach are indicated in order to restore the changed anatomy and function.

Adolescent↗