Massive bilateral angiomyolipomas resulting in respiratory failure.
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Adult↗
Biomedical subjects
S N Venn
Publications and source records attributed to S N Venn.
Outcome of the artificial urinary sphincter in female patients.
PURPOSE: We reviewed the outcome in female patients at our unit in whom an artificial urinary sphincter was inserted. MATERIALS AND METHODS: We reviewed notes on 68 patients and mailed a questionnaire to those without recent followup. RESULTS: Median time since insertion was 12 years. Overall 25 patients (37%) had the original artificial urinary sphincter in situ and were dry at a median followup of 7 years. The artificial urinary sphincter was replaced for loss of function in 12 patients, of whom 11 were dry with the replaced device. The device was removed for erosion or infection in 31 patients, of whom 19 underwent successful replacement or were continent after removal. Overall 55 of 68 patients (81%) were continent. Those with neuropathic bladder dysfunction achieved a continence rate of greater than 90%, although half required sphincter removal initially. When the indication for insertion was stress incontinence, 70% of the patients had the original or a replaced artificial urinary sphincter in situ and 82% were continent. All patients with previous pelvic irradiation had the sphincter removed and urinary diversion was done. CONCLUSIONS: The overall continence rate in female patients after insertion of an artificial urinary sphincter is satisfactory. A satisfactory outcome was achieved in terms of stress incontinence and we would recommend an artificial urinary sphincter after an adequate anti-stress incontinence operation fails. Continence in patients with neuropathic bladder dysfunction is excellent and the artificial urinary sphincter should be considered first line treatment in this group, although the risk of revision surgery is high. Pelvic irradiation is a contraindication to the artificial urinary sphincter in female patients.
Adolescent↗
Augmentation cystoplasty.
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Bacterial Infections↗
'Nerve-sparing' cystectomy in women.
Although the indications for cystectomy other than for cancer are few, it is occasionally necessary for severe interstitial cystitis or hemorrhage due to radiation cystitis. The use of substitution cystoplasty after cystectomy has increased in men in the last decade, and this has resulted in the development of 'nerve-sparing' approach to cystectomy to improve continence and potency. The use of substitution cystoplasty in women after cystectomy has lagged behind that in men because it was considered necessary to remove the entire urethra, making orthotopic substitution impossible. Recently the need to remove the entire urethra has been questioned, with the finding that if the bladder neck is free of tumour, recurrence of disease in the urethra has not so far been found to occur. In addition, it appears possible to substitute on to the urethra without incontinence. This has led to the development of a 'nerve-sparing' technique of cystectomy, and renewed interest in the anatomy of the urethra. This paper reviews the current literature on 'nerve-sparing' cystectomy and describes our technique.
Cystectomy↗
The long-term outcome of artificial urinary sphincters.
PURPOSE: We reviewed the outcome of artificial urinary sphincters inserted more than 10 years ago. MATERIALS AND METHODS: We analyzed the records of 100 patients and mailed a questionnaire to those without recent followup. RESULTS: Overall 84 patients were continent, including 36 with the original artificial urinary sphincter in place who were dry at a median followup of 11 years and 27 in whom the device was successfully replaced due to mechanical failure who were previously continent for a median of 7 years. In 21 patients it was removed due to infection or erosion and reimplantation was successful 3 to 6 months later or they remained dry without another artificial urinary sphincter. Of the male patients with a bulbar and bladder neck sphincter 92% and 84%, respectively, were continent at 10 years as well as 73% of the females. Device survival was 66% at 10 years. Overall 37% of the prostheses were removed due to infection or erosion in the 10-year period with the highest risk in females (56%) and lowest in males with a bulbar sphincter (23%). CONCLUSIONS: The artificial urinary sphincter is effective long-term treatment for incontinence in male patients. In female patients the risk of erosion is high, although overall long-term continence is satisfactory.
Adolescent↗
Pelvic fracture injuries of the female urethra.
OBJECTIVE: To review pelvic fracture urethral injuries in women, generally regarded as rare and thus discussed infrequently. PATIENTS AND METHODS: Twelve patients (age range 7-51 years) with such injuries were reviewed; most had associated injuries, generally more severe than seen in males with urethral injuries. RESULTS: Patients with milder injuries, perhaps damaging just the innervation of the urethra, presented with incontinence; more severe injuries seemed to cause a longitudinal tear in the urethra but again patients presented mainly with incontinence problems. The most severe injuries were associated with complete rupture of the urethra and a distraction defect suggesting an avulsion injury. These problems were difficult to treat both reconstructively and in providing continence. CONCLUSIONS: Pelvic fracture urethral injuries occur in females, but less often than in males. The female urethra seems relatively resistant to injury; differing degrees of severity of pelvic trauma cause different types of urethral injury but in general, a more severe injury is needed to damage it than is necessary in males.
Adolescent↗
Changing practice in anterior urethroplasty.
OBJECTIVE: To describe our experience of penile urethral repair and reconstruction, cataloguing the change in practice from one-stage flap to two-stage free graft procedures for anterior urethroplasty. PATIENTS AND METHODS: Between January 1992 and December 1996, 79 patients underwent anterior urethroplasty. Of the 45 one-stage bulbar patch urethroplasties, 37 (76%) used buccal mucosal free grafts rather than flaps. Of the 34 penile urethroplasties, 26 (82%) (including all of the circumferential reconstructions) were two-stage procedures. RESULTS: Buccal mucosal free grafts were at least as good as local skin flaps for patch urethroplasty and two-stage repairs gave much better results than one-stage repairs for total circumferential reconstruction of the penile urethra. CONCLUSIONS: For a patch urethroplasty of an uncomplicated stricture in the bulbar urethra, buccal mucosal free grafts are now the material of choice. For a patch urethroplasty of an uncomplicated stricture in the penile urethra the Orandi procedure remains the 'gold standard'. For a circumferential repair of the urethra, particularly the penile urethra, a two-stage repair using a free graft gives better results than a one-stage repair using a flap.
Follow-Up Studies↗
Continent urinary diversion using the Mainz-type ureterosigmoidostomy--a valuable salvage procedure.
OBJECTIVES: To review the indications and outcome of patients undergoing a Mainz-type ureterosigmoidostomy. PATIENTS AND METHODS: Fourteen patients who had lost or were about to lose their urethra and sphincter mechanism underwent this operation to provide a continent urinary diversion. Patients had a minimum follow-up of 2 years. RESULTS: There were no significant postoperative complications. Three patients have died from recurrent malignant disease. All patients were continent. CONCLUSION: The Mainz-type ureterosigmoidostomy is a useful technique in situations where orthotopic reconstruction is not possible. Incontinence and reflux do not occur with this detubularized pouch.
Adult↗
Early experience with the use of buccal mucosa for substitution urethroplasty.
OBJECTIVE: To evaluate the early results of anterior urethroplasty using a one-stage free graft with buccal mucosa. PATIENTS AND METHOD: Thirty-nine patients (aged 23-59 years) underwent a one-stage urethroplasty using buccal mucosa, 28 as a patch and 11 as tube grafts. All patients were evaluated by post-operative urethrography at 6 months and were followed using urinary flow rates and symptoms for 2-5 years. RESULT: There was one recurrent stricture (3%) in the group with a patch urethroplasty but five of the 11 patients with tube grafts had a recurrent stricture. CONCLUSION: The early results using buccal mucosa for patch urethroplasty are encouraging. Although the results from tube grafts are poor, they are similar to those from other methods of single-stage urethroplasty.
Adult↗
Urethroplasty for balanitis xerotica obliterans.
OBJECTIVE: To review the results of different methods of urethroplasty for anterior urethral strictures caused by balanitis xerotica obliterans (BXO). PATIENTS AND METHODS: Twenty-eight patients underwent urethroplasty for BXO; 12 had a one-stage pedicled penile skin-flap urethroplasty and 16 excision and a two-stage free-graft urethroplasty using nongenital skin. RESULTS: The treatment failed in all patients undergoing a one-stage pedicle penile skin urethroplasty because the disease recurred with BXO, whereas the treatment failed in only one patient using a two-stage free graft procedure. CONCLUSION: A two-stage free-graft urethroplasty using nongenital skin is recommended for anterior urethral strictures caused by BXO.
Balanitis↗
'Nerve-sparing' cystectomy and substitution cystoplasty in patients of either sex: limitations and techniques.
OBJECTIVES: To determine the limitations of cystectomy and orthotopic substitution cystoplasty in men and women with bladder cancer. PATIENTS AND METHODS: Cystectomy and orthotopic substitution cystoplasty were carried out in 79 patients (mean age 60 years, range 31-74, including eight women) who were followed for a mean of 7 years (range 1-13) to evaluate continence, potency and survival. RESULTS: Overall, 80% of the patients were continent without further treatment and 55% of the men who were potent before surgery remained so afterward. The best results were obtained with retrograde cystectomy in both sexes and are only achievable in women in this way. Continence was achieved more easily in women than in men, although pathological delineation of the tumour preoperatively and technical considerations per-operatively make both the selection and the procedure more demanding in women than in men. CONCLUSIONS: Cystectomy and orthotopic substitution cystoplasty is possible in patients of either sex and should be offered to all patients as an alternative to ileal conduit urinary diversion, unless preoperative assessment suggests that the urethra must be removed with the bladder, which is rare in men and uncommon in women. In such patients, a continent diversion may be the preferred option.
Adult↗
Long-term results of augmentation cystoplasty.
OBJECTIVES: To present the long-term results and complications of augmentation cystoplasty. METHODS: 267 patients underwent augmentation cystoplasty with a minimum follow-up of 3 years. RESULTS: Patients with neuropathic bladders had a 78% continence rate with cystoplasty alone increasing to 90% with the addition of an artificial urinary sphincter. Patients undergoing cystoplasty for detrusor instability had a 93% continence rate. The complications of this procedure include bacteriuria, absorption disorders, stones and the potential risk of malignancy. DISCUSSION: The overall results of continence with augmentation cystoplasty are excellent. Long-term follow-up is required to ensure prompt treatment of the complications.
Adolescent↗
Written information for transurethral resection of the prostate--a national audit.
OBJECTIVES: To assess the use and content of written information relating to transurethral resection of the prostate (TURP). MATERIALS AND METHODS: All 328 full members of the British Association of Urological Surgeons (BAUS) were requested to submit any information sheets or specialized consent forms given to patients about to undergo TURP. They were asked to record when the information was given and whether this was recorded in the notes. The sheets were analysed with reference to a nominally comprehensive list of topics suitable for inclusion in such sheets. RESULTS: One-hundred and eleven replies were received (34%) which represents 44% of urological departments. Of those replying, only 56 used information sheets for TURP. The overall comprehensiveness of the information was surprisingly poor, with 12% omitting to mention retrograde ejaculation and 19% failing to discuss the need for a catheter. CONCLUSION: The written information given to patients about to undergo TURP appears inadequate. There is a need for a nationally accepted information sheet that can be edited locally.
Communication↗
Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial.
OBJECTIVE: To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment. PATIENTS AND METHODS: The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later. They were randomly assigned to receive 1 h of microwave hyperthermia or a sham treatment. Of the 96 patients, 93 were assessed at 3 months and 62 at 6 months after treatment. RESULTS: There was no statistically significant difference in the objective measures of BOO between the treated and control groups of patients. There was an improvement of approximately 40% in all the subjective measures, but there was no significant difference between the treated and control groups. CONCLUSION: Microwave hyperthermia, within the parameters defined in this trial, resulted in no significant difference from sham treatment in subjective or objective outcome.
Aged↗
Heating characteristics of a 434 MHz transurethral system for the treatment of BPH and interstitial thermometry.
A system is described for delivering transurethral hyperthermia to the prostate. The system used a helical coil antennae powered by a 434 MHz generator. The antennae was housed in a disposable 22 Ch Foley catheter with water passed down the centre of the winding of the antennae and returned between the antennae and inner wall of the catheter. The flow rate of the circulating water could be varied. The position of the antennae was adjustable with respect to the balloon, essentially altering the length of the antennae. Urethral wall temperature was measured with a thermocouple passed down a small tube moulded into the outer wall of the catheter. Rectal temperature was measured using thermocouples placed in grooves machined into a custom made perspex rectal applicator. A computer program displayed the temperature and controlled the power to the generator. The SAR around the catheter was measured in a polyacrylamide gel phantom. However this does not take into account the effects blood flow and thermal conduction which may have important clinical implications. In order to investigate the actual temperature within the prostate during treatment, a group of patients underwent intraprostatic thermometry.
Acrylic Resins↗