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Biomedical subjects

R J Millard

Publications and source records attributed to R J Millard.

At least 19 recordsLinked to original sources
PubMed2000

Autoradiographic localization of tachykinin and calcitonin gene-related peptide receptors in adult urinary bladder.

PURPOSE: In bladder, sensory afferent nerve fibers contain the "sensory neuropeptides" substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP), which interact with tachykinin NK-1 and NK-2 receptors and CGRP receptors, respectively. The purpose of this study was to examine the autoradiographic distribution of these three receptor types in the human bladder, to determine whether the anatomic location of the receptors was consistent with their known functional roles. MATERIALS AND METHODS: Specimens of urinary bladder from 9 patients (58-74 years) were obtained at cystectomy. Frozen sections of dome were labeled with [125I]-Bolton-Hunter [Sar9,Met(O2)11]-SP (NK-1 receptors), [125I]-[Lys5,Tyr(I2)7,MeLeu9,Nle10]-NKA(4-10) (NK-2 receptors) and [125I]-rat CGRP-I. Binding sites were visualized using emulsion autoradiography. RESULTS: NK-1 receptors were found over the endothelium of arterial blood vessels within the detrusor muscle and lamina propria, and over small vessels in the subepithelium. NK-2 receptors were seen over the detrusor muscle and very sparsely over blood vessels, whereas CGRP receptors were expressed densely over the smooth muscle layer of arteries and arterioles, and weakly over collecting venules. NK-1 and CGRP receptors were not observed over the detrusor muscle. CONCLUSIONS: Although the afferent nerves contain all three peptides, not all cell types express receptors for each peptide. The general distribution of receptors is in good agreement with the location of nerves, and with the known actions of SP and CGRP as vasodilator agents, and of NKA (but not SP or CGRP) in contracting the detrusor muscle.

Aged↗
PubMed1998

Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-"BPH" study.

Despite the lack of evidence in the literature for close relationships between lower urinary tract symptoms and bladder outlet obstruction, the majority of urologists rely on symptomatology when selecting patients for prostatic surgery. We investigated the relationships between a wide range of lower urinary tract symptoms from the ICSmale questionnaire and the results of urodynamic pressure and flow studies. We evaluated 933 patients with lower urinary tract symptoms suggestive for bladder outlet obstruction from 12 countries who participated in the ICS-"BPH" study with the ICSmale questionnaire and urodynamic pressure and flow studies. Spearman rank correlation coefficients were obtained between symptoms and measures of bladder outlet obstruction. There was little or no correlation between a wide range of symptoms and the results of free uroflowmetry and pressure and flow studies. From symptoms alone, it is not possible to diagnose bladder outlet obstruction. Pressure and flow studies and symptom profiles measure different aspects of the clinical condition that should be viewed separately in the evaluation and treatment decision of the patient presenting with lower urinary tract symptoms.

Humans↗
PubMed1996

Urinary urge incontinence: randomised crossover trials of penthienate versus placebo and propantheline.

OBJECTIVE: To compare the efficacy of penthienate with that of propantheline and placebo for treatment of primary idiopathic detrusor instability. DESIGN: Two prospective, randomised, crossover trials (double-blind for penthienate versus placebo and non-blinded for penthienate versus propantheline). SETTING: Urology Clinic of Prince Henry Hospital, Sydney, NSW (an outpatient clinic of a tertiary referral hospital), in 1993-1994. PARTICIPANTS: Neurologically intact patients with urodynamically proven detrusor instability, urgency and urge incontinence, but no stress incontinence (20 participated in the penthienate/placebo trial and 23 in the penthienate/propanthelin trial). OUTCOME MEASURES: Cystometrography results before and after treatment; frequency and volumes of urine voided in weeks 1 and 4 of treatment; and patient scores for degree of continence, side effects, efficacy and acceptability of treatment. INTERVENTIONS: Penthienate (5 mg), propantheline (15 mg) or placebo (all three times a day) for 4 weeks. RESULTS: Penthienate produced significantly greater improvements than placebo in frequency (daytime, P = 0.002; and night-time, P = 0.02), incontinence scores (P = 0.002) and amplitude of unstable detrusor contractions, when present (P = 0.01), and significantly increased diurnal and nocturnal bladder capacity, both on cystometrography (P = 0.003) and by voiding-diary records (P < 0.001). It also increased residual urine volume over the baseline level, but not significantly. Side effects, especially dry mouth, were common with penthienate, and one patient developed urinary retention. Penthienate was significantly better than propantheline in improving cystometric capacity (P = 0.03), and reducing the amplitude of unstable detrusor contractions (P = 0.01), and was perceived as more effective by patients for frequency, nocturia and incontinence. CONCLUSIONS: Penthienate (5 mg three times a day) was objectively and subjectively significantly better than both placebo and propantheline (15 mg three times a day) for treatment of primary idiopathic detrusor instability.

Adult↗
PubMed1996

A study of the efficacy and safety of transurethral needle ablation (TUNA) treatment for benign prostatic hyperplasia.

The objective of this early phase III study was to determine the efficacy and safety of transurethral needle ablation (TUNA) in patients presenting in acute urinary retention due to benign prostatic hyperplasia (BPH). Between September 1993 and August 1994, 20 patients of mean age 68.8 years were entered into a two-center study and treated with TUNA after presenting in acute urinary retention and having failed at least one trial of voiding. A mean of 5.4 lesions at shield temperatures of 54.6 degrees C were produced. Patients were reviewed at 1, 3, 6, and 12 months (mean, 6.2 months). In 17 of 20 patients, voiding was reestablished in a mean of 2.6 days. Three patients required TURP for persistent retention, and 2 patients had delayed TURP for bothersome symptoms. Two voiders died later of unrelated causes. Five patients were lost to follow-up at 6 months but were voiding when last reviewed. Symptom scores decreased from a mean of 19.0 (range 4-35) to 8.25 (range 1-20) at 12 months (p = 0.06). Mean peak flow rate was 11.4 ml/sec (range 6.6-16.8) at 12 months (p = 0.001). Mean prostatic volume at baseline was 65.8 cc and decreased to 56 cc at 12 months (p = 0.111). The treatment was well tolerated by all patients, and side effects were mild, including urinary tract infection and epididymo-orchitis. This study demonstrates the safety and effectiveness of TUNA procedure in patients with urinary retention due to benign prostatic hypertrophy.

Aged↗
PubMed1996

Early clinical experience with continent urinary diversion.

BACKGROUND: Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Five-year experience with continent diversion is reported. METHODS: Between 1989 and 1994, 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff-type procedure. All have now been followed up for at least 12 months. RESULTS: The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300-1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re-operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications. CONCLUSIONS: From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is optimal.

Acidosis↗
PubMed1994

The accuracy of portable ultrasound scanning in the measurement of residual urine volume.

The accuracy of 2 successive models of a portable (2.5 kg.) ultrasound unit in determining residual urine volumes in 100 patients was assessed. Ultrasound measurements were compared to post-scan bladder volumes obtained by catheterization and fluoroscopic screening in the same patients. The first ultrasound unit (group 1, 50 patients) showed correlation with residual volumes of 0.86 (R2 = 0.73) and a mean difference from the true residual volume of 41 ml. (95% confidence interval 26 to 55 ml.). The second ultrasound unit (group 2, 50 patients) showed correlation with residual volumes of 0.97 (R2 = 0.94) and a mean difference from the true residual volume of 24 ml. (95% confidence interval 17 to 31 ml.). The differences in volumes were significantly lower with scanner 2 (t = 2.02, p = 0.047). The mean difference between catheter volume estimate and true bladder volume was 25 ml. (95% confidence interval 16 to 34 ml.). The accuracy of the BladderScan BVI 2500+ scanner is as good as catheter estimations of true residual volume and is sufficient to recommend its use as an alternative to catheterization for the determination of residual urine volume.

Adolescent↗
PubMed1994

Controlled trial evaluation of a General Practitioner education package on incontinence: use of a mailed questionnaire.

OBJECTIVE: To evaluate whether an education package will significantly improve General Practitioners' knowledge of the aetiology, diagnosis and treatment of incontinence. SUBJECTS AND METHODS: Of the 510 General Practitioners contacted 124 returned a 27 item questionnaire (q1). The doctors were randomized into a test group (n = 80) who received an education package and a control group (n = 44) who did not. Follow-up questionnaires (q2) were sent to those in the test group at 6 weeks and to those in the control group at 4 weeks post-randomization. The answers to 18 of the 27 questions were found in the education package and the remaining nine were not. The test group was asked to rate the usefulness of the package. RESULTS: There was a mean increase in scores for the two questionnaires of 5.2 in the test group compared with 0.4 in the control group. The average increase in scores in the test group was highly significant compared with that in the control group (P < 0.001). The results remained significant when the non-responders were included. The change in scores in the test group was significant only for those 18 questions with answers contained in the education package. There was no significant improvement between the two groups for the change in scores for the nine questions not answered in the education package (P = 0.74). General Practitioners gave the package a mean rating of 4.2/5 and it was still being used more than 6 weeks after delivery by at least 31 of 49 General Practitioners. CONCLUSIONS: For the General Practitioners who expressed an interest in receiving an education package on incontinence, and who answered the questionnaires, there was an improvement in the knowledge of incontinence directly attributable to the package.

Attitude of Health Personnel↗
PubMed1992

The management of invasive transitional cell carcinoma of the bladder. Results of definitive and preoperative radiation therapy in 390 patients treated at the Prince of Wales Hospital, Sydney, Australia.

The treatment results for invasive transitional cell carcinoma (TCC) of the bladder were assessed in a series of 390 patients referred to the Department of Radiation Oncology at the Prince of Wales Hospital, Sydney, Australia, during the period 1977 to 1988. These patients were managed by one of two strategies: cystectomy (87 patients) and radiation therapy (303 patients). Actuarial survival rates (death from any cause) were determined and comparisons were made using log-rank tests and Cox regression analyses. The mean follow-up time was 7.6 years. Independent prognostic factors for shorter survival were: the presence of a ureteric obstruction (P less than 0.001), increasing clinical stage (P less than 0.001), increasing patient age (P = 0.003), and earlier year of presentation (P = 0.008). Comparison of the two strategies indicated no significant difference in overall survival after adjusting for imbalances in prognostic factors (P = 0.007 unadjusted; P = 0.29 adjusted). The slightly longer survival of 46 patients from 1983 onward who received primary systemic chemotherapy (compared with 149 patients not given chemotherapy) was not statistically significant (P = 0.12 unadjusted; P = 0.56 adjusted for prognostic factors). The 5-year actuarial rates of severe complications were 8.0% after cystectomy and 5.3% after radiation therapy. In 303 patients treated by definitive radiation therapy, the 5-year actuarial rate of freedom from bladder failure for all clinical tumor stages was 44% (Tx, 67%; T1, 45%; T2, 56%; T3, 39%; and T4, 39%). These results suggest that definitive radiation therapy is a viable alternative to radical cystectomy for patients with invasive TCC of the bladder.

Adult↗
PubMed1989

The accuracy of a catheterized residual urine.

Residual urine is important in the evaluation of the urological patient. The gold standard to obtain this information is a catheterized specimen. We examined the accuracy of a catheterized value to ascertain whether the bladder was emptied completely. After the bladder was catheterized 10 ml. radiocontrast material were instilled into the bladder to allow radiographic documentation of complete evacuation. We found that 26 per cent of 515 patients evaluated had residual urine after routine attempts were made to evacuate the bladder fully. We conclude that a single residual urine estimate may be inaccurate and one should not always base therapeutic decisions upon any single such measurement.

Adult↗
PubMed1989

Management of incontinence: a urological approach.

This article reviews a urologist's approach to urinary incontinence with particular reference to incontinence in men. Many of the general remarks apply equally to men and women and in choosing to refer your patient to a urologist for further management of incontinence, the decision should seldom be based solely on the sex or age of the patient but on concomitant urological symptoms.

Female↗
PubMed1988

Management of refractory detrusor instability by transvesical phenol injection.

The results of transvesical phenol injection into the paravesical nerve plexuses are reported in 40 consecutive patients. A 58% success rate was achieved in the treatment of refractory detrusor instability and 73% success was seen in detrusor hyper-reflexia in 11 patients with multiple sclerosis. Urinary retention occurred in 8%. Troublesome complications were seen in 2 patients who had had previous pelvic radiotherapy, which should be regarded as an absolute contraindication to the procedure.

Adult↗
PubMed1986

Predictors of long term outcome following a bladder re-training programme.

A total of fifty-three female patients suffering from urinary urgency and urge incontinence completed a bladder re-training programme which comprised behavioural and biofeedback treatment components. The psychological status of patients prior to treatment and at eighteen-month follow-up was compared. The role of clinical and psychological factors was examined in relation to treatment outcome (immediately following treatment and at eighteen-month follow-up). Compared to pre-treatment, patients at the eighteen-month follow-up were experiencing fewer psychological symptoms and were more internal with respect to their locus of control, irrespective of urological response to the programme. Poor treatment compliance predicted a poor treatment response both in the short- and long-term. Excessive worrying about, and preoccupation with, the urinary symptoms, previous surgery, and chronic urinary symptoms were all good predictors of a poor treatment response in the long term.

Adolescent↗
PubMed1984

The clinical significance of bladder speed.

By calculation of a notional maximum possible flow rate (Qm) from the pressure-flow parameters of clinical urodynamic studies, a variable is obtained which relates to the speed of shortening of the muscle fibres and hence to detrusor contractility. Bladder outlet obstruction causes a reduction in detrusor contractility. After the satisfactory relief of outflow obstruction, the clinical results are related to the degree of recovery of detrusor contractility.

Adolescent↗