PubMed Health⌕ Search

Biomedical subjects

R C Feneley

Publications and source records attributed to R C Feneley.

At least 19 recordsLinked to original sources
PubMed1992

Haemospermia.

Haemospermia is a frightening symptom. Many cases are of benign aetiology but 5 to 10% will have underlying malignancy. Many younger patients require only routine clinical examination, urine analysis and reassurance, but patients aged over 40 years, those with persistent haemospermia, or those with associated haematuria require urological investigation. Imaging of the prostate and seminal vesicles with transrectal ultrasound is of particular value in the investigation of these patients.

Blood↗
PubMed1992

Ureteric stone management using a second generation lithotriptor.

A series of 209 consecutive patients with ureteric calculi underwent 296 extracorporeal shock wave lithotripsy treatments on the Siemens Lithostar over a 25-month period; 123 stones were upper ureteric, 30 mid-ureteric and 56 lower ureteric; 46.9% were right-sided stones, 53.6% were left-sided and 0.5% (1 patient) were bilateral. On referral, 60 patients had stents and 15 had nephrostomies for obstruction. All treatments were performed without anaesthesia except for 9 patients in whom stent insertion or ureteroscopic manipulations were attempted concomitant to ESWL. The average number of treatments was 1.42, with 27.5% of patients requiring more than 1 treatment. The average number of shocks per treatment was 3995 and the average hospital stay was 1.79 days. Complete clearance of the stone was achieved in 82% of upper ureteric stones, 89% of mid-ureteric and 80% of lower ureteric stones. The facility for X-ray localisation of stones allows a high proportion of ureteric calculi to be treated successfully by ESWL, including the more taxing middle and lower ureteric calculi.

Adolescent↗
PubMed1992

Extracorporeal shock wave lithotripsy for renal calculi in children.

Fifteen children (8 male and 7 female) with an age range of 18 months to 15 years were treated with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Two children had a history of metabolic stone disease and 1 child had previously undergone open stone surgery. Four children were treated with a ureteric stent in place and 1 nephrostomy was inserted before treatment. All children were treated under general anaesthesia and all of the stones treated were confined to the kidney and ranged in size from 5 mm to a complete staghorn. The number of treatments ranged from 1 to 6 and generator voltage ranged from 16 to 19 kV with a maximum number of 30,000 shocks to a complete staghorn. Complications were minimal, with 3 children presenting with colic, 1 child requiring a stent and none requiring a nephrostomy after treatment. The overall stone clearance rate at 3 months was 65%. ESWL provides an effective treatment for selected calculi in children. In the short term, complications are minimal but the long-term effects on children need to be monitored.

Adolescent↗
PubMed1992

Urological audit: the role for an aggressive approach to high grade superficial bladder tumours.

A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.

Adult↗
PubMed1992

A departmental audit of patients with bladder cancer.

In keeping with the recent demands of the Department of Health for medical audit in clinical practice, an audit was undertaken of the management of bladder cancer patients in a large department of urology having three consultants with varied approaches of management. This study revealed interesting controversial areas for further scrutiny. For example, the poor prognosis of grade 3 T1 tumours with and without associated carcinoma-in-situ (CIS) and the speed of progression to invasive disease have indicated that a change to a more aggressive approach to the management of these tumours is necessary. High recurrence rates at the site of the original tumour (60%) and the presence of CIS also indicate the need for expert and thorough initial tumour assessment. The delays in diagnosis and treatment lend further support to the need for a 'haematuria clinic' to minimise such delays, which may influence prognosis. To reduce the occurrence of systematic errors in the recording, follow-up and surveillance of patients with bladder cancer, a protocol is suggested for a structured approach to optimise results, particularly in the poor prognostic categories.

Adult↗
PubMed1979

The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients.

There were 152 patients with prostatism investigated by inflow cystometry and pressure flow analysis of micturition before and after elective prostatectomy. Many symptoms attributed to obstruction were found to be owing to bladder instability, which was demonstrated in 60 per cent of the patients. The symptomatic improvement postoperatively was accompanied by a decrease in the incidence of instability to 25 per cent. The repeat urodynamic studies and symptom analysis demonstrated a surgical success rate of 88 per cent.

Aged↗
PubMed1979

Urinary incontinence: prevalence and needs.

The prevalence of recognised urinary incontinence in a community was found to be 1%; the prevalence of unrecognised incontinence was 3.3% in men and 8% in women in a group practice of 7000 patients. The approach to investigation and management of urinary incontinence in a urodynamic unit and the staffing of this unit are described.

Adolescent↗
PubMed1979

The influence of prostatic anatomy on the differing results of prostatectomy according to the surgical approach.

An anatomical study of cadaver prostates has demonstrated that, in all cases, adenomatous tissue lies inferior to the verumontanum. The proportion of tissue distal to the verumontanum varies from less than 10 to 50%. In a series of 100 patients the post-operative urodynamic studies showed that in the tansurethral resection group the mean urethral length was longer, the flow rate lower and the residual urine higher than in the retropubic prostatectomy group. It is suggested that prostatectomy by the transurethral route is less complete due to residual sub-verumontanal prostatic tissue. However, it is likely that by restricting resection to supra-verumontanal tissue many patients are spared post-operative stress incontinence.

Aged↗
PubMed1978

Transfer of adoptive immunity by intra-arterial injection of tumor-immune pig lymph node cells: treatment of recurrent urinary bladder carcinoma after radical radiotherapy.

Twenty-four patients with invasive transitional cell carcinoma of the urinary bladder, recurrent after radiotherapy, were treated by intra-arterial infusion of tumor-immune pig lymph node cells. In 11 patients there was a remission of the disease process, and 3 patients remain alive and free of disease in excess of one year after treatment.

Aged↗
PubMed1978

Adoptive immunotherapy and radiotherapy in the treatment of urinary bladder cancer.

Thirty-one patients with invasive transitional cell carcinoma of the urinary bladder were treated either by infusion of tumour immune pig mesenteric lymph node cells into the tumour blood supply, followed 6 weeks later by 5500 rad, or by radiotherapy alone. The patients were paired prior to treatment, using 4 criteria: age (nearest decade), sex, clinical stage (T3 or T4) and histological grade (average or high). The first patient in each pair then received combined treatment and the second radiotherapy alone. Administration of pig cells before radiotherapy offered no advantage to the patient in terms of the incidence of remission or the length of survival after treatment.

Animals↗
PubMed1978

Idiopathic bladder instability treated by biofeedback.

Biofeedback training has been used to treat 27 female patients suffering from symptoms associated with detrusor instability Re-education to auditory and visual stimuli took place during 4 to 8 one-hour sessions at weekly intervals. Using subjective and objective methods of assessment 81% of the patients were improved following treatment.

Adolescent↗
PubMed1977

Renography as a prognostic index of urinary tract problems in childhood.

Many radiological methods are used in investigating urinary tract problems in children, and some are poorly tolerated. The simplest and most acceptable technique is isotope renography. Its value has been assessed in predicting the outcome of urinary tract problems in 91 children over the age of 2 years presenting consecutively over a period of 3 months. The results of initial assessment by renography and radiography have been compared with the final clinical assessment 7 years later. 35 patients were identified as being "at risk" and all of these had abnormal renograms and radiograms. Normal renographys was found unexpectedly in some patients with severe reflux but with a good final result. It is concluded that renography can be used to screen children with urinary tract infection, thereby excluding the less acceptable radiological investigations unless the renogram is abnormal.

Child, Preschool↗
PubMed1976

Excretion urography in the investigation of prostatism.

The excretion urogram and urodynamic studies of 201 patients presenting with prostatism were reviewed. The urographic features of trabeculation and diverticula were found to be associated with bladder instability as shown on inflow cystometry but not to be associated with outflow obstruction as shown by the pressure-flow analysis of micturition. The bladder shadow on the preliminary film and the bladder size on the post-evacuation film were associated with the measured residual urine and with outflow obstruction. The basal prostatic filling defect was also associated with outflow obstruction.

Aged↗