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Biomedical subjects

R S Kirby

Publications and source records attributed to R S Kirby.

At least 19 recordsLinked to original sources
PubMed1992

The clinical assessment of benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male and the second most common cause of surgical intervention in men older than 60 years of age. Unfortunately, many men currently undergo prostatectomy without rigorous evaluation of their condition in terms of either transition zone hyperplasia or the extent to which this is causing bladder outflow obstruction. METHODS: In this review, the importance of symptoms and symptom scoring systems associated with bladder outflow obstruction due to BPH were considered as well as the use of prostate specific antigen (PBS), uroflowometry, and abdominal and transrectal ultrasound studies in addition to magnetic resonance imaging (MRI). CONCLUSION: Patients undergoing surgical or non-surgical treatment for BPH should be studied by means of a formal symptom score, as well as repeated uroflowometry and abdominal ultrasound. PSA determination should also be made and those patients with values above 4 mg/ml should undergo transrectal ultrasound study and biopsy. Patients with values greater than 10 mg/ml should be considered for systematic biopsy whatever this reveals. MRI, with or without the new endorectal coil, is a promising tool for evaluation of the prostate, but more in a research than routine clinical context.

Antigens, Neoplasm↗
PubMed1992

Management of colovesical fistulae associated with pelvic malignancy.

Thirteen patients with malignant colovesical fistulae are presented. The underlying pathology was cancer of the colon (seven cases), bladder (four cases) and cervix (two cases). The series demonstrates that wide surgical excision may be needed to achieve tumour clearance and that this may necessitate pelvic exenteration. Three patients who underwent inadequate tumour excision developed recurrence in the bladder, two with a fatal outcome. Wide excision of the bladder may be performed without urinary diversion by subtotal cystectomy and a reconstructive procedure. Substitution cystoplasty was performed on two patients at the time of tumour excision. Urinary tract involvement by such tumours is often extensive and optimal results may be achieved with a multidisciplinary approach.

Aged↗
PubMed1992

Oat cell carcinoma of urinary bladder.

Oat cell carcinoma of the urinary bladder is extremely uncommon. There have been 52 reported cases in world literature to date. On light microscopic, histochemical, and ultrastructural grounds, these tumors are similar to oat cell carcinoma of the bronchus and other extrapulmonary oat cell carcinomas. Furthermore, they may be grouped together as a clinical entity characterized by an aggressive clinical course with early and extensive metastases, and partial remission with certain chemotherapeutic agents. We report a case of primary small cell carcinoma of the urinary bladder in a forty-two-year-old man and review previous reports with similar histology. The importance of establishing this diagnosis and the optimum forms of therapy are discussed.

Adult↗
PubMed1992

Use of the ASI titanium stent in the management of bladder outflow obstruction due to benign prostatic hyperplasia.

An expandable titanium intraprostatic stent was inserted into 30 patients with infravesical obstruction due to benign prostatic hyperplasia (BPH). All of the men were considered unsuitable for transurethral resection of the prostate as a result of comorbid conditions. In 25 patients effective micturition was reestablished with this technique. In 21 of these men, who have been followed for longer than 1 year, the mean maximum flow rate at 1 year was 10.8 ml. per second and the mean residual urine was 56 ml. Although urinary tract infections occurred subsequent to stent insertion in 10 individuals, these resolved after appropriate antibiotic treatment and no stents have had to be removed for this reason. Followup cystoscopy or examination by electron microscopy of those stents that have been removed has shown partial epithelialization of the stent surface in a proportion of patients, and a minor degree of incrustation occurred in 1 case. We conclude that an expandable intraprostatic titanium stent is an acceptable alternative to transurethral resection of the prostate or long-term catheterization in this particular group of high risk patients.

Aged↗
PubMed1992

Eosinophilic prostatitis and prostatic specific antigen.

Eosinophilic prostatitis is a rare form of abacterial prostatitis with uncertain aetiology. Its clinical presentation, like other types of abacterial prostatitis, commonly mimics carcinoma of the prostate. Transrectal ultrasound may be helpful in the diagnosis of prostatitis but histological confirmation is necessary. Prostatic specific antigen has been widely used in the diagnosis and follow-up of patients with prostatic carcinoma. High levels of this antigen (greater than 30 micrograms/l) have been claimed to be highly specific for prostate cancer, although lesser elevations may also occur in patients with large benign prostate glands and in bacterial prostatitis. We report 3 patients with histologically proven eosinophilic prostatitis and high levels of prostatic specific antigen. This diagnosis may closely mimic carcinoma of the prostate and must be excluded by histological examination of biopsy material before treatment for presumed prostate carcinoma is initiated.

Antigens, Neoplasm↗
PubMed1992

Cystectomy and substitution enterocystoplasty: alternative primary treatment for T2/3 bladder cancer.

The optimal treatment for invasive bladder cancer remains controversial. Although external beam radiotherapy is able to eradicate the disease in a number of patients, the difficulty is selecting those who will respond. Those who do develop a local recurrence will require a salvage cystectomy combined with urinary diversion. The results of performing cystectomy and bladder reconstruction as a primary procedure are presented and the concept of combining this with chemotherapy as an alternative strategy for the management of bladder cancer is discussed.

Adenocarcinoma↗
PubMed1992

Encrustation of intraprostatic stents--a comparative study.

Metallic stents have been used in the management of prostatic disease in patients unfit for surgery. A variety of stents have become available but the optimum design and metal of construction has not yet been defined. This study examined one of the potential complications of stent insertion by demonstrating that they are susceptible to encrustation. Using an in vitro model it compares the ability of the different materials used in their construction to resist this encrustation. Titanium appears less able to resist deposition than the other metals examined. The long-term complication of encrustation may inhibit the use of some of these stents.

Calcium Phosphates↗
PubMed1992

Sphincter electromyography in patients after radical prostatectomy and cystoprostatectomy.

Urethral sphincter weakness may occur after major pelvic surgery and urinary incontinence, either temporary or permanent, may result. In order to determine whether the cavernous nerves described by Donker and Walsh carry fibres to the distal urethral sphincter as well as those supplying the corporal bodies, we have studied prospectively the sphincter electromyography in 2 groups of 10 patients: (1) those who had undergone nerve-sparing radical prostatectomy for prostatic carcinoma and (2) those who has undergone radical cystoprostatectomy for bladder carcinoma. This study group was compared with a control group of normal individuals. The results showed significant differences in duration of motor units between the control group and prostatectomy group and between the control group and cystectomy group but no significant difference between the 2 operated groups. There was no significant difference in amplitude of the motor units, the sacral reflex latencies or the pudendal somatosensory evoked potentials between all 3 groups. It was therefore concluded that division of the cavernous nerve of Walsh does not compromise distal urethral sphincter function. Furthermore, radical transabdominal lower urinary tract surgery may induce significant electromyographic changes in the external sphincter which may not be clinically evident. This may potentially affect continence later if second-stage urinary reconstructive surgery is undertaken.

Aged↗
PubMed1992

Endometriosis of the ureter.

Five patients with ureteric endometriosis are described. Extensive pre-operative investigation failed to reveal the aetiology of the unilateral upper urinary tract obstruction seen in all of these patients. Due to the dense fibrosis that invariably accompanies ureteric endometriosis, early surgical excision of the ureteric stricture permits effective resolution of upper tract dilatation and improved renal salvage.

Adult↗
PubMed1992

Finasteride in the treatment of benign prostatic hyperplasia. A urodynamic evaluation.

A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia (BPH) were treated in a double-blind, placebo-controlled study with finasteride (Proscar, MK-906), a 5-alpha reductase inhibitor, 5 mg or 10 mg/day or placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study. In treated patients dihydrotestosterone declined by over 60%, remaining unchanged with placebo. Symptom scores fell significantly in all 3 groups. Mean maximum flow rates fell slightly in placebo-treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group. After 1 year's treatment, the reduction in symptom score and increase in flow rate were well maintained; the mean prostate volume was reduced by 14% and prostatic specific antigen declined by 28%. It was concluded that finasteride shows some efficacy in the treatment of BPH, with minimal toxicity, but 12 months of therapy or longer may be necessary to achieve maximal effect.

Aged↗
PubMed1992

Prostate specific antigen and bone scan correlation in the staging and monitoring of patients with prostatic cancer.

The ability of serum prostate specific antigen (PSA) to predict bone metastases at initial presentation was determined in 146 patients, and in 66 patients during a 3-year period; 14.7% of patients with bone metastases at presentation had a PSA value less than 20 ng/ml. All patients who subsequently developed bone metastases had a PSA greater than 20 ng/ml and the rise in PSA often antedated the detection of bone metastases. Bone scans are still necessary in the initial staging but following diagnosis and treatment can be replaced by serum PSA measurement in monitoring patients with prostatic cancer.

Biomarkers, Tumor↗
PubMed1992

Surgical reinforcement of gender identity in adolescent intersex patients.

The presentation of phenotypic gender ambiguity at the time of adolescence is uncommon. Surgical reinforcement of gender, or reassignment is often complex and multistage. We present 2 cases of children who developed secondary sexual characteristics contrary to their chromosome status who, because of their late presentation, required significant surgical intervention to reinforce the gender assigned to them. We review some of the surgical techniques involved.

Adolescent↗
PubMed1991

Detubularisation in cystoplasty: clinical review.

Cystoplasty using a detubularised bowel segment is preferable to using a tubularised length of intestine. This has been shown experimentally to result in a reduction in the contractility of the neobladder, although contractions are not completely abolished. Incontinence, especially nocturnal, may still be a problem. Assessment of renal function has shown a marked incidence of upper tract dysfunction despite detubularisation. All patients remain at risk of upper tract obstruction following cystoplasty. Because bowel contraction waves are brought on by distension, it may be possible either to postpone or to prevent the onset of contractions by avoiding an excessive build-up of bladder volume. Clean intermittent self-catheterisation is an efficient means of emptying the bladder, although sphincter rebalancing may also be required.

Adult↗