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PubMed1987

Role of the pelvic nerve in the dynamics of micturition in the decerebrate dog as determined by suprapubic endoscopical and urodynamic evaluation.

The role of the pelvic nerves on the dynamics of micturition was evaluated in 13 decerebrate dogs, four male and nine female, by direct observation of bladder movement, by suprapubic cystoscopic observation of urethral behavior, and by pressure flow EMG studies. Experiments were performed before and after unilateral pelvic nerve transection. In control conditions and after unilateral pelvic nerve transection, the bladder neck was not tightly closed during the collecting phase, the membranous portion of the urethra opened and closed spasmodically during the emptying phase, and reflex micturition developed. Direct observation showed that after unilateral pelvic nerve transection, the ipsilateral bladder did not contract. A pressure flow EMG study showed that unilateral pelvic nerve transection produced a significant increase in threshold volume, threshold pressure, bladder compliance and residual volume, and a significant decrease in contraction pressure and flow rate. The present study shows that unilateral pelvic nerve transection has no demonstrable effect on urethral function, but has effects on bladder function during the collecting and emptying phases and that bladder innervation is unilateral in the dog.

Animals↗

PubMed1987

Treatment of ulcer and nonulcer interstitial cystitis with sodium pentosanpolysulfate: a multicenter trial.

The effect of sodium pentosanpolysulfate (Elmiron) in the treatment of interstitial cystitis was observed in an open controlled multicenter trial. We studied 87 patients with symptoms for more than 2 years at 17 centers in Finland and Sweden. Patient selection was based on the typical chronic symptomatology but the material subsequently was stratified according to objective cystoscopic findings. The medication (400 mg. daily in 2 oral doses) was discontinued after 6 months. The response was evaluated every 4 weeks during treatment and every 3 months thereafter. Most patients responded favorably, many with diminution of pain within only 4 weeks from the start of treatment. The frequency of micturition decreased significantly and the mean volume per void per 24 hours increased in the patients without bladder ulceration but such changes were not found in the patients with ulcer. The bladder capacity was smaller in the ulcer group. In these patients the pre-treatment intensity of pain was somewhat greater than in those without bladder ulcer but the pain was alleviated in both groups and this effect was stable at the 3-month followup. The differences in responses in the 2 groups indicate a probable fundamental difference between ulcerative and nonulcerative interstitial cystitis. Side effects of the drug were few, slight and transient. Therefore, the study indicates that a significant number of patients with interstitial cystitis can be expected to benefit from treatment with sodium pentosanpolysulfate.

Adult↗

PubMed1987

Monitoring endoscopic treatment of superficial bladder carcinoma by postoperative urinary cytology.

Transurethral resection was the only modality of treatment in 39 patients with long-standing, recurrent, superficial bladder carcinoma. Postoperative urinary cytology was performed within 3 days of each endoscopy. Tumor recurrence was defined by the presence of a positive biopsy or visible papillary tumors on followup cystoscopic examination. Tumor recurred in 38 patients (97.4 per cent) and 1 patient (2.6 per cent) has remained free of disease 74 months following transient positive postoperative cytology. Among the 38 recurrences 15 (39.5 per cent) were positive, 3 (7.9 per cent) suspicious and 20 (52.6 per cent) negative at the postoperative cytological examination. The interval to recurrence did not differ significantly among the 3 groups. The failure of a negative postoperative cytology study to predict a durable response to treatment by transurethral resection reflects the polychronotopic nature of superficial bladder tumors in this select patient population and suggests the need for adjuvant therapy.

Carcinoma, Transitional Cell↗

PubMed1987

Inactivation of bladder tumor cells and enzymes by methylene blue plus light.

Using a cystoscopic light source and methylene blue as the sensitizing dye, photoactivation was examined in two types of experiments. In the first, the in vitro study destruction of two enzymes (glucose-6-phosphate dehydrogenase and lactic dehydrogenase) was examined in suspensions of whole and homogenized tumor cells from a transplantable bladder tumor. In the second or in vivo study rats were used to demonstrate that tumor cell suspensions treated with methylene blue plus light, when inoculated into susceptible rats, failed to "take" and produce new tumors. These experiments suggest a possible therapeutic use in treatment of human bladder tumors, though further study would be required.

Animals↗

PubMed1987

The treatment of 100 consecutive patients with ureteral calculi in a British stone center.

Of all ureteral calculi 20 per cent will require removal. The use of extracorporeal shock wave lithotripsy has changed dramatically the treatment of ureteral stones requiring intervention. We reviewed 111 procedures for 108 stones in 100 consecutive patients. Primary techniques included extracorporeal shock wave lithotripsy after retrograde manipulation (63 cases), percutaneous nephrolithotomy alone (1) and after retrograde manipulation (3), ureteroscopic removal (29), cystoscopic removal (2) and open ureterolithotomy (2). These techniques and the results are discussed. Of the patients 11 required a secondary procedure, including extracorporeal shock wave lithotripsy in 3, ureterorenoscopy for failed extracorporeal shock wave lithotripsy in 2, an open operation for complications of ureterorenoscopy in 2 and correction of associated stricture in 2. All patients ultimately were free of stones. Our experience with in situ extracorporeal shock wave lithotripsy is described. An open operation was done only when less invasive forms of treatment failed or electively to correct an associated anatomical abnormality.

Adult↗

PubMed1986

Serum lymphocyte adherence inhibition test in bladder cancer patients.

In 29 patients with a history of bladder cancer cystoscopic determination of tumor status was correlated with the results of a serum modified capillary tube lymphocyte adherence inhibition test. With donor lymphocytes from 3 healthy volunteers as indicator cells, patient sera were added to a butanol extract of the T-24 tissue-cultured bladder carcinoma cell line. Lymphocyte adherence inhibition of more than 15 per cent was selected as positive. Mean values for 17 cases positive for tumor were 26.6 +/- 14.1 per cent compared to 10.0 +/- 6.8 per cent for 18 cases negative for tumor. False positive and false negative values at this cutoff averaged 19 and 14 per cent, respectively, and there was no significant difference in the individual results of the 3 donor leukocytes. Serial examinations of 6 patients had lymphocyte adherence inhibition values consistent with the changes in tumor status. These results suggest that the serum lymphocyte adherence inhibition test correlates well with clinical tumor status and, therefore, may serve as a useful tumor marker in patients with bladder cancer.

Adult↗

PubMed1986

Bacillus Calmette-Guerin for superficial transitional cell carcinoma of the bladder.

Pasteur strain bacillus Calmette-Guerin was used to treat superficial transitional cell carcinoma of the bladder in 28 patients. Patients selected for treatment had an incomplete resection, positive selected site biopsies and/or post-resection positive cytology findings. Complete response required negative histology and cytology findings at cystoscopic followup 4 to 8 weeks after completion of treatment. Of the patients 20 (71 per cent) demonstrated a complete response, including all 6 with carcinoma in situ. Results converted to negative in 16 of 17 patients with positive urine cytology findings and 4 with positive prostatic urethral biopsies. Of the responders 8 had received prior treatment with thiotepa. The treatment regimen of 120 mg. Pasteur strain bacillus Calmette-Guerin weekly for 6 weeks was well tolerated. It was necessary to limit the number of treatments to 5 because of local irritative effects in only 3 patients. No chronic bladder disability has been noted during followup of 3 to 30 months. This experience supports the efficacy of bacillus Calmette-Guerin as a cost-effective, well tolerated treatment modality for patients with superficial transitional cell carcinoma of the bladder.

Aged↗

PubMed1985

A new technique for the transurethral or percutaneous removal of renal stones.

This new technique uses a cystoscopically placed torque guide wire and catheters to deliver a stone basket to the renal calix containing the stone. Under fluoroscopic control the basket, placed through a 9F catheter, is used to dislodge and capture the stone. The stone-containing basket and catheter then are removed transurethrally or percutaneously. This procedure was used to remove small caliceal stones in 3 patients undergoing ureteral stone manipulation, and it facilitated the percutaneous removal of a larger stone in the upper pole infundibulum in 1 patient.

Adult↗

PubMed1985

The manifestation and management of late urological complications in renal transplant recipients: use of the urological armamentarium.

The incidence of urological complications in renal transplant patients is well documented. The majority of these complications occur in the early postoperative period; late occurrences (more than 3 months) are much less common. We have had experience with 7 patients who presented with late complications 3 months to 7 years after transplantation: ureteral obstruction occurred in 4 patients, ureteral disruption or laceration in 2 and neurogenic bladder with hydronephrosis in 1. Management of these patients has been varied and has included cystoscopic stent placement, Boari flap, ureteropyelostomy, ureteroneocystostomy, bladder augmentation and urinary undiversion. Grafts have been salvaged in 6 of 7 patients. Transplant patients who present with late urological complications can be challenging. However, the potential for intervention and graft salvage is excellent.

Female↗

PubMed1985

Retrograde nephrostomy and percutaneous calculus removal in 30 patients.

We used a new technique, retrograde nephrostomy, to provide intrarenal access for percutaneous calculus removal in 30 consecutive patients. Under fluoroscopic control, we maneuvered cystoscopically a 5F and 9F coaxial catheter pair over a guide wire into the calix selected for nephrostomy. Then, a sheathed 20 to 21 gauge needle was passed through the 9F catheter into the flank to create the nephrostomy. Eight patients were given general and 22 intravenous sedation and local anesthesia for nephrostomy placement and calculus removal. Retrograde nephrostomy and subsequent calculus removal were completed successfully in 90 and 83 per cent of the 30 patients, respectively. There were 6 complications and 3 failures among the first few patients due to inferior equipment and inexperience with the technique. Over-all, we found that retrograde nephrostomy provided reliable, precise intrarenal access and we believe that it could become an alternative technique to aid in percutaneous calculus removal procedures.

Adult↗

PubMed1985

Vinblastine and methotrexate for advanced bladder cancer.

Fifty-seven patients with advanced measurable urothelial tract cancer, 52 of whom had an adequate trial, were treated weekly with 3 to 4 mg. per m.2 vinblastine and 30 to 40 mg. per m.2 methotrexate. Of 3 patients with unidimensional parameters 2 showed improvement lasting 16 and 27 months, which was documented by serial cystoscopic examinations. An additional 2 patients had measurable disease that could have been encompassed in a preoperative radiotherapy field. Both patients are free of disease at more than 12 and 14 months, respectively. Of the 47 patients with bidimensionally measurable parameters 19 (40 per cent) achieved a complete or partial remission lasting a median of 8 months, with a range of 1 to 24 months. Of 25 patients with intra-abdominal or pelvic disease 7 achieved a complete or partial remission and 5 also had a minor remission. Of note, 18 of 38 patients who had received no prior chemotherapy achieved a remission versus 1 of 9 who had been treated previously (p equals 0.06). Responders frequently obtained another remission with subsequent chemotherapy (4 of 9 versus 0 of 16, p equals 0.03). Responders lived 14 months versus 8 months for nonresponders (p equals 0.02). Four responders had brain metastases compared to none of 28 nonresponders. The combination of vinblastine and methotrexate is a well tolerated, effective outpatient regimen for patients with urothelial tract cancers.

Adult↗

PubMed1985

The new Baumrucker resectoscope.

The discontinuation of the Baumrucker resectoscope by American Cystoscope Makers, Inc. (after 20 years of popularity) was owing to its complicated and expensive covered spring mechanism, and frequent repairs. A simple spring device is described, which is different from any resectoscope action on the market today. It is simple and inexpensive to attach, and has been free of breakdown or repairs. The tip of the loop is within the sheath during insertion. Above all, it restores an effective finger-controlled resectoscope to the urological market.

Humans↗

PubMed1984

The value of urinary fibrin/fibrinogen degradation products as tumor markers in urothelial carcinoma.

Urinary fibrin/fibrinogen degradation products as biological tumor markers in urothelial carcinoma have been studied and compared to urinary cytology. In 93 per cent of the patients with urothelial carcinoma urinary fibrin/fibrinogen degradation product levels were elevated significantly. There was excellent correlation when the urinary cytology and urinary fibrin/fibrinogen degradation product results were compared together to cystoscopic findings.

Carcinoma, Transitional Cell↗

PubMed1984

Laser in the treatment of localized prostatic carcinoma.

Laser treatment associated with transurethral resection of the prostate is a new and promising approach for curative treatment of stages T1 and T2 prostatic cancer. The neodymium-YAG laser beam can be conducted down a flexible quartz fiber cable, which permits its use through a cystoscope. The laser provides an area of tissue destruction to a depth of 4 to 6 mm. Followup in 16 patients revealed no serious complications and the functional results have been good. Currently, 15 patients have no sign of disease, while treatment failed in 1 with stage T3 cancer. The value of laser treatment is confined to the control of local disease.

Adenocarcinoma↗

PubMed1984

Ultrasound diagnosis of small asymptomatic bladder carcinoma in patients referred for gynecological scan.

We report on 4 patients with bladder cancer detected during pelvic ultrasound for gynecological indications without urinary symptoms. Only 1 of the 4 patients had hematuria. All 4 patients were treated by cystoscopic excisional biopsy and no further operation was required. We stress that the bladder often is forgotten during pelvic ultrasound and that sonography is a sensitive, noninvasive tool to examine the bladder.

Adult↗

PubMed1984

Resident research, part-time.

During residency training, research must be cost-effective in these times of constraint. Its value lies in helping the resident critically analyse each clinical problem and understand the basic physiopathologic processes, in adding new skills, in preparing the resident for an academic career, in improving abilities in writing and speaking, and in providing the satisfaction of accomplishment. The principal limitations on a full year in research are inadequate funds for support and the unwillingness of residents to take that much time out of their clinical training. Alternatives are for the resident to take 1 or 2 afternoons each week during clinical training to work on an ongoing project in an established laboratory or, preferably, to formulate an original project and carry it out under supervision in the departmental laboratory, or in the cystoscopic, operating or outpatient facilities. To do this requires an interested, available preceptor, a stimulating idea (preferably the resident's), a limited experimental design, regular time free from clinical duties, and enough funding and help. Opportunities exist in most programs but enthusiasm and direction is required to realize them. Since a declining number of physicians are applying to the National Institutes of Health, it is important that students and residents become stimulated to enter fields of research. But such stimulation requires support.

Attitude↗

PubMed1983

The reversibility of catheter-associated polypoid cystitis.

Cystoscopic and histologic evidence of polypoid cystitis was recorded in 20 hospitalized patients with indwelling urethral catheters followed by cystoscopy, biopsies and repeated urine samples before and after catheter removal. The majority of the lesions were located in the posterior wall or dome. The lesions disappeared after removal of the catheter in 13 of the 15 patients followed for up to 28 weeks despite persistent bacteriuria. Polypoid cystitis still remained 28 weeks after catheter removal in 1 patient. The lesion is important as a differential diagnosis to bladder tumor. The importance of adequate biopsies is emphasized.

Aged↗

PubMed1983

In vivo urothelial surface histology by microscopic chromocystoscopy.

Microscopic chromocystoscopy is a new in vivo procedure that we have developed to aid in the detection and treatment of bladder tumors. Intravesical ionic dye chromocystoscopy was introduced by our group to permit cystoscopic viewing with ordinary light of selectively stained malignant urothelial surfaces by the cationic dye, methylene blue. With the recent availability of the Hamou hysteroscope, a microscopic endoscope, we have combined intravesical ionic dye chromocystoscopy with microscopic cystoscopy to give in vivo urothelial surface histology, with resolution of cytological detail. We herein describe our new method and preliminary results with this procedure, which we have designated in vivo urothelial surface histology by microscopic chromocystoscopy.

Cystitis↗