PubMed Health⌕ Search

Biomedical subjects

T E McDermott

Publications and source records attributed to T E McDermott.

At least 19 recordsLinked to original sources
PubMed1998

Epididymectomy in the management of intrascrotal disease: a critical reappraisal.

OBJECTIVE: To assess the outcome of epididymectomy as a method of treating epididymal pathology. PATIENTS AND METHODS: Forty-one patients who underwent epididymectomy between 1990 and 1995 were analysed retrospectively; their clinical records were reviewed and their satisfaction with the outcome and relief of symptoms assessed using a questionnaire and/or telephone interview. RESULTS: Twenty-nine patients with pain were subdivided into three categories depending on the indication for epididymectomy, i.e. post-vasectomy epididymal engorgement (eight patients), complex cystic disease (11) or 'chronic epididymitis' (10). The outcome was satisfactory in 27 of the 29 patients. The best results were obtained in the group who underwent epididymectomy after vasectomy, where seven of eight improved after the procedure. Those with chronic epididymitis had the least favourable outcome, with only seven reporting any improvement in symptoms. CONCLUSIONS: Epididymectomy has a valuable role in the management of epididymal pathology in appropriately selected patients.

Cysts↗
PubMed1998

The role of orchiectomy in the management of postpubertal cryptorchidism.

PURPOSE: Owing to the risk of future malignancy, many postpubertal male subjects presenting with unilateral cryptorchidism undergo orchiectomy rather than orchiopexy. We examined the incidence of spermatogenesis and carcinogenesis in whole orchiectomy specimens removed from postpubertal cryptorchid male subjects. We review the concept that orchiectomy is justifiable in these patients. MATERIALS AND METHODS: A total of 52 patients with postpubertal cryptorchidism (unilateral in 48, bilateral in 4) were retrospectively analyzed from 1984. Patient age ranged from 15 to 66 years (mean 26). Six patients presented with primary infertility (unilateral in 3, bilateral in 3). The undescended testicles were palpable in 32 cases (62%). All patients underwent unilateral orchiectomy and whole specimens were examined histologically. RESULTS: Histology showed normal spermatogenesis in only 1 orchiectomy specimen, while 15 had maturation arrest, 6 testicular agenesis and 30 seminiferous tubular atrophy and/or Sertoli-cell-only syndrome with no spermatogenesis. The location of the undescended testis was the superficial inguinal pouch in 32 cases, inguinal canal in 6 and inside the deep ring in 8. Absent spermatogenesis was significantly associated with a high level of maldescent and with increasing age. Two patients (4%) had carcinoma in situ of the testicle. Torsion of an undescended testicle occurred in 1 patient (2%). CONCLUSIONS: This analysis of cryptorchid testes in postpubertal male subjects confirms that the majority cannot contribute to fertility, have significant malignant potential and may undergo torsion. Therefore, orchiectomy remains the treatment of choice for the majority of postpubertal male subjects presenting with unilateral cryptorchidism.

Adolescent↗
PubMed1997

Prognostic factors in squamous cell carcinoma of the penis and implications for management.

OBJECTIVE: To determine the clinical and pathological features, methods and outcome of management in squamous cell carcinoma of the penis (SCCP). PATIENTS AND METHODS: A retrospective study was carried out of 42 patients (mean age 63 years, range 28-86) with a histological diagnosis of SCCP. The disease stage, grade, treatment of primary tumour, lymph node disease and survival were recorded; the mean follow-up was 4 years (range 1.5-25). RESULTS: The disease stage was T1 in 24 patients (57%), T2 in 14 (33%), T3 in three (7%) and T4 in one (2%); the tumour grade was well differentiated in 20 (47%), moderately differentiated in 14 (33%) and poorly differentiated in three (7%). Eight patients had histologically confirmed inguinal node disease at presentation, six of whom underwent lymph node dissection, while two underwent radiotherapy. Five patients developed inguinal node disease during follow-up (mean 10 months, range 4-21). Three of these patients were irradiated and two underwent lymph node dissection. Six patients (14%) had local recurrence, five of whom were managed surgically. One patient developed a local recurrence 11 years after initial surgery. Seven patients died from their disease (17%); four died within 2 years, being patients with high-stage and/or high-grade disease. CONCLUSIONS: Modern management should include a standard staging classification and treatment protocols to maximize survival.

Adult↗
PubMed1997

Double pigtail ureteric stent versus percutaneous nephrostomy: effects on stone transit and ureteric motility.

OBJECTIVES AND METHODS: The effects of double pigtail ureteric catheters (JJS) and percutaneous nephrostomies (PN) on ureteric motility and artificial stone transit was assessed in 12 dogs. Each animal underwent bilateral nephrostomies and an artificial stone insertion into each upper ureter (n = 20). A 4-Fr JJS was inserted on one side (group 1) while a PN was left on the contralateral side (group 2). In 4 stone-only 'control' ureters (group 3), the PN was sealed after 72 h. Stone passage was assessed by plain x-rays. Pelvic and ureteric motility was assessed prior to stone insertion and again at 2 weeks. RESULTS: In group 1, only 1 of 8 stones (12.5%) passed completely. Four reached the midureter, 3 remained static. Six of 8 stones (75%) in group 2 passed completely. Two stones remained in the distal ureter. All 4 stones (100%) in group 3 passed by day 3 postoperatively. At laparotomy the J-stented ureters were dilated and both pelvic and ureteric contractions were diminished. Ureteric diameter was normal on the PN side. The ureters contracted with normal amplitude, but diminished rate of contraction above the stones in the ureters with residual calculi (n = 2), and in the 6 ureters from which spontaneous stone passage had occurred. A similar pattern was found in the 4 group 3 ureters. CONCLUSIONS: Double J stents are associated with ureteric dilatation, diminished peristalsis and impaired stone passage. APN preserves ureteric peristalsis and facilitates stone passage. In the initial phase, raised hydrostatic pressure appears to the most important factor determining stone passage.

Animals↗
PubMed1996

Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment.

OBJECTIVES: To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy. PATIENTS AND METHODS: The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease-free and overall survival of the patients. RESULTS: The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease-free and overall survival than had those with symptomatic tumours (P < 0.05). CONCLUSIONS: The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies the follow-up.

Carcinoma, Renal Cell↗
PubMed1995

Is there a role for in vivo methylene blue staining in the prediction of bladder tumour recurrence?

OBJECTIVE: To assess the role of in vivo staining with intravesical methylene blue in predicting tumour recurrence. PATIENTS AND METHODS: Thirty-nine patients (27 men and 12 women, age range 43-75 years) newly diagnosed with bladder tumours were prospectively studied and followed for a minimum of 2 years. Potential biopsy sites were identified by staining intravesically with a 1% methylene blue solution and compared with random biopsy sites. RESULTS: Biopsy directed by methylene blue staining detected carcinoma in situ more often than random biopsy. Rates of recurrence were similar in both stained and unstained groups. CONCLUSION: Methylene blue staining does not add significantly to the management of patients presenting with bladder tumours.

Adult↗
PubMed1995

'Firm' versus 'soft' double pigtail ureteric stents: a randomised blind comparative trial.

It is generally considered that 'firm' double pigtail ureteric catheters, while easier to insert and less prone to migration, may cause more patient discomfort than the 'softer' variety of stent. Objective support for these perceptions is however lacking. The aim of this study was to compare firm and soft stents regarding their ease of insertion, positional stability, biocompatibility and patient tolerance. 155 patients were randomised to receive 'firm' (polyurethane, n = 78) or 'soft' (Sof-Flex, n = 77) stents. Ease and mode of insertion was recorded at time of initial placement. Positional stability, degree of bladder inflammation, stent encrustation and patient tolerance were recorded at the time of removal. Patient tolerance was assessed by symptom score in double-blind fashion. Results showed no significant difference in ease of insertion, positional stability, degree of bladder inflammation or stent encrustation between the two groups. There was a significantly higher incidence of dysuria, renal and suprapubic pain in the firm stent group. There was no significant difference in the incidence of urgency, frequency, nocturia or haematuria. Normal activity and return to work were reported in 67 and 45% of patients with soft and firm stents, respectively. The data indicates that patient tolerance appears to be related to the softness of the stent material.

Biocompatible Materials↗
PubMed1993

Haemospermia: how to proceed?

Haemospermia is an alarming symptom but does it signify serious disease and how should it be investigated? A retrospective review of 44 men showed no evidence of malignancy and infection as the commonest cause. Standard investigation with midstream specimen of urine, intravenous pyelogram and cystoscopy is unhelpful. Microscopy and culture of a first stream specimen of urine or expressed prostatic secretions is the investigation of choice. Cystoscopy should be reserved for patients with recurrent haemospermia.

Adult↗
PubMed1993

Is retrograde ureterography indicated in pelviureteric junction obstruction?

The role of retrograde ureterography in the management of pelviureteric junction (PUJ) obstruction remains controversial and it has recently been reiterated that visualisation of the entire ureter on the affected side is mandatory owing to the high incidence of other ureteric abnormalities. In a review of 119 consecutive adult pyeloplasties carried out over a 9-year period, only 2 ureteric abnormalities were found in association with PUJ obstruction (duplex ureter/3-cm proximal stricture). Other anatomical abnormalities included aberrant vessels, fascial bands and renal anomalies. Most secondary abnormalities were undiagnosed prior to surgery and all were easily dealt with per-operatively.

Adolescent↗
PubMed1993

European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate.

A prospective randomised trial was undertaken in nine European Hospitals to test antibiotic prophylaxis for men undergoing transurethral resection of the prostate. Of the men with no significant growth (< 10(4) cfu ml-1) in their preoperative urine, 247 received a single 1 gram dose of ceftazidime with the induction of anaesthesia, 256 received 1 g daily from the time of induction of anaesthesia until removal of the urethral catheter (but < or = 5 days) and 261 received no prophylaxis. Of evaluable patients 83 (33.9%), 45 (18.7%) and 29 (11.6%) of the no-prophylaxis, single-dose and multidose groups, respectively, developed urinary tract infection in the immediate post-operative period. There were significantly fewer febrile episodes and fewer prescriptions for alternative antibiotics in teh ceftazidime-treated groups. For men developed peri-operative septicaemia and all were in the no-prophylaxis group. We conclude that patients, even those with culture-negative urine pre-operatively, benefit from antibiotic prophylaxis and that antibiotic prophylaxis should be considered for all men undergoing prostatic surgery as a routine procedure.

Aged↗
PubMed1992

Treatment strategy for piezoelectric shock wave lithotripsy of upper ureteral calculi.

In situ piezoelectric lithotripsy monotherapy for upper ureteral stones is an attractive option because it can be conducted on an outpatient basis. Difficulty in calculus localization with ultrasound is the limiting factor. We reviewed our experience with 99 patients treated for upper ureteral calculi with the EDAP LT.01 lithotriptor. For stones above the lower renal border we achieved a 53% stone-free rate compared to 25% for calculi below the lower renal border. In situ piezoelectric lithotripsy of upper ureteral calculi may be considered for stones above the lower renal border.

Adolescent↗
PubMed1991

Spontaneous recovery of renal function after resection of contralateral hypernephroma.

We report a case of nonfunction of an anatomically normal kidney associated with a contralateral hypernephroma. X-ray and radionuclide imaging suggested a disturbance of the contralateral renal blood flow at the microvascular level. Normal function resumed after tumor resection. The implications for management are discussed.

Carcinoma, Renal Cell↗
PubMed1990

Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy.

Insertion of a double pigtail stent is known to cause ureteric dilatation. We analysed the effect of an indwelling double pigtail stent on the success rate of calculus extraction by second ureteroscopy when the initial ureteroscopy fails. Over a 12-month period, a first ureteroscopy failed in 42 patients; 30 were then treated by ureteroscopy combined with a ureteric stent and 12 were treated without a ureteric stent. The group with an indwelling stent had a successful second ureteroscopy or spontaneously passed the calculus in 24 cases (84%) compared with 5 unstented cases (45%). Ureterolithotomy was necessary in 2 patients with a stent and 3 with no stent. It was concluded that following failed ureteroscopic manipulation of calculi, insertion of a double pigtail stent was associated with a higher subsequent success rate for removal of stone by ureteroscopy and a consequent lower rate of ureterolithotomy.

Adult↗
PubMed1989

Extracorporeal shockwave lithotripsy using ultrasonic imaging: urologists' experience.

The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography. A total of 406 calculi (359 renal and 47 ureteric) in 317 patients were treated. Analgesia or sedation was not routinely used and 59% of all treatments were performed as outpatient procedures. The clearance rate of renal calculi smaller than 1 cm was 81%, while that of calculi larger than 3 cm was 80% (mean clearance 77.5%). Lithotripsy of ureteric calculi following retrograde manipulation to a renal site resulted in 94.4% clearance compared with 39% for those treated at a ureteric site; 93% of 684 lithotripsy treatments were either painless or caused only mild pain. Our experience with imaging and treating urinary calculi with the EDAP LT.01 lithotripter has been excellent. Patients are treated effectively and inexpensively as out-patients without analgesia or sedation.

Adolescent↗
PubMed1984

The use of urodynamic studies to assess the effect of pharmacological agents with particular references to alpha-adrenergic blockade.

A method of studying the effect of drugs on the lower urinary tract is described, using cord-injured patients with detrusor hyperreflexia. In this study 19 patients received intravenous phentolamine. This alpha-adrenergic blockade produced a significant reduction in the maximum voiding detrusor pressure, voided volumes and peak flow rates with no reduction of outflow tract obstruction.

Humans↗
PubMed1980

Transurethral ureterolithotomy.

The technique of transurethral ureterolithotomy for calculi impacted in the intramural ureter is described. Follow-up date on a group of 30 patients treated by this method are presented. Vesicoureteric reflux was found to occur in almost 50% of cases. The presence of reflux was not found to cause symptoms, infection or renal destruction. Therefore transurethral ureterolithotomy is recommended for the removal of intramural ureteric stones not suitable for basket extraction.

Adult↗