Biomedical subjects
D Rickards
Publications and source records attributed to D Rickards.
Inguinal bladder hernia associated with vesico-ureteric reflux.
The urinary bladder is frequently found as a component of inguinal herniae. This report describes a case of 'bladder hernia' associated with vesico-ureteric reflux. The current methods of investigation and subsequent treatment for this condition are reviewed along with the possible underlying cause of vesico-ureteric reflux in this case.
Does residual urine predispose to urinary tract infection?
The relationship between the presence of post-micturition residual urine and urinary tract infection is unclear. We have performed a retrospective analysis of 342 studies on bladder emptying and compared the incidence of bacterial infection and pyuria in patients with residual urinary volumes of more or less than 100 ml. In patients with a residual volume > 100 ml 49/219 studies showed evidence of pyuria and 28/198 studies of patients whose residual urine was less than 100 ml showed evidence of infection. In cases where the residuals were > 100 ml 33/123 had evidence of pyuria and 19/109 infection. There was no significant increase in the rate of infection in patients with large residual urinary volumes, suggesting that there is no definite correlation between post-micturition residues and urinary tract infection.
Multiple prostatic abscesses presenting with urethral discharge.
Prostatic abscess has become less common, is now usually related to urinary tract infection, and is a rare cause of urethral discharge. The case is described of a man with prostatic abscesses caused by Staphylococcus aureus possibly related to recent skin abrasions. Transrectal ultrasound was used to make the diagnosis and to facilitate repeated drainage with a successful outcome.
Stricture disease: radiology of urethral stents.
Self-expanding metal stents are emerging as an effective alternative treatment in the management of urethral obstruction. The radiologic studies of 33 men with anterior urethral strictures (subprostatic, n = 11; bulbar, n = 22) that had recurred despite repeated optical urethrotomy and dilation were reported. In all patients, the stricture was successfully treated with stent insertion. Urethrography performed 1 month later in 19 patients showed an irregular intrastent lumen of varying degrees due to a hyperplastic urothelial reaction confirmed at endoscopy the same day. Available follow-up urethrograms in seven patients at 3 months showed that the hyperplasia was settling, and by 6 months, the intrastent lumen was smooth and of good caliber. Urethrography revealed postoperative structures in 14 patients. Strictures seen at 1 month (n = 6) were due to initial stent misplacement and were treated with the insertion of a second stent. Strictures seen 3 months after insertion (n = 4) occurred within the stent lumen and were considered to be significant at endoscopy in only one patient. Strictures that developed 6-12 months after stent insertion (n = 4) were not within the stent and were considered to represent genuine new strictures.
Voiding dysfunction due to neurosyphilis.
Three patients with neurosyphilis presenting with urinary frequency, incontinence and voiding dysfunction were investigated. Unlike the previously reported finding of areflexia in tabes dorsalis, all 3 had hypocompliant detrusor hyper-reflexia with detrusor-sphincter dyssynergia and post-micturition residual urine. One patient also had bladder neck dyssynergia treated by bladder neck incision. The other 2 patients were initially managed by intermittent catheterisation but 1 ultimately underwent urinary diversion. The clinical relevance of these findings and the treatment of this condition are discussed.
Permanently implanted urethral stent for prostatic obstruction in the unfit patient. Preliminary report.
We describe the use of a new urethral stent implanted into 12 patients with prostatic outflow obstruction. All were in a high risk group for surgery and 11 were treated successfully, with a follow-up of 1 to 11 months (median 9). The majority of patients were satisfied with the procedure, which provided a quick, safe and effective alternative to conventional surgical treatment. The stent, woven from fine stainless steel in the form of a tubular mesh, was inserted via a delivery device using combined ultrasound and endoscopic control under local anaesthesia. The procedure was well tolerated, the stent becoming covered with epithelium by 6 to 8 months following insertion, yet allowing easy removal within the first 4 to 6 weeks should the need arise. This technique provides a useful alternative to conventional surgical treatment in the high risk patient.
What is the clinical significance of urethroprostatic reflux as a radiological finding during videocystourethrography in neurologically normal patients?
The video records of 264 males referred for videocystometry were reviewed retrospectively for evidence of urethroprostatic reflux. This was found in 11% of the cases with three distinct patterns; during bladder filling (27%); during voiding (50%), and during the 'stop test' (23%). All cases with filling reflux were unstable. Reflux at the time of the stop test was usually associated with prostatic or bladder neck obstruction. Voiding reflux occurred in a similar group of patients but there was often a clinical history of the previous surgical relief of obstruction or documented urinary infections. Recognition of this sign suggests the transmission of high pressures to the prostatic urethra and contrary to previous work is uncommonly associated with a history of lower urinary tract pain in cases where it may otherwise go unexplained.
The ultrasound cystodynamogram--a new radiological technique.
Voiding dysfunction may be assessed using the intravenous urodynamogram (IVUD) or combined with pressure studies in the videocystometrogram (VCMG). However, VCMG requires bladder catheterization and voiding in public which often leads to inhibition of sphincter relaxation. For this reason the urinary flow rate measurement performed in private is more representative of the true voiding pattern. The ultrasound cystodynamogram (USCD) evaluates the bladder capacity, mean and maximum flow rates, flow pattern and post-micturition residual. The diagnostic capability of USCD was studied in 116 consecutive cases 46 of whom had also had VCMG. Comparison of the data obtained using both techniques revealed no significant difference. USCD has proved to be accurate, safe and reproducible and is of particular value in patient follow-up.
The radiological investigation of urinary tract infections in childhood.
Children with urinary tract infection require imaging of the entire urinary tract to search for a correctable underlying cause and to find those with or at risk of renal parenchymal damage. In this paper, we discuss the causes of urinary tract infection and assess the merits of each imaging technique. A diagnostic algorithm is proposed.
Imaging the prostate.
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Contemporary flow meters: an assessment of their accuracy and reliability.
The accuracy, reliability and cost effectiveness of 5 currently marketed flow meters have been assessed. The mechanics of each meter is briefly described in relation to its accuracy and robustness. The merits and faults of the meters are discussed and the important features of flow measurements that need to be taken into account when making diagnostic interpretations are emphasised.
Asymptomatic bladder neck incompetence in nulliparous females.
This study investigated 29 nulliparous women using the technique of transvaginal ultrasound to assess whether their bladder necks were open or closed at rest. The patients comprised 2 groups: 4 reported occasional episodes of stress incontinence, all of whom had closed bladder necks; the remaining 25 patients were totally asymptomatic. Overall a 21% incidence of an open bladder neck was recorded. It is likely that the true incidence of open bladder necks in young nulliparous women is higher than this, since none of these patients had troublesome stress incontinence. Since women with open bladder necks are more likely to develop stress incontinence if the integrity of the distal sphincter mechanism is compromised by neural damage, antenatal recognition of this problem should provide a contraindication to traumatic vaginal delivery and may in the future reduce the incidence of symptomatic stress incontinence in the population.
Renal angiomyolipoma: a comparison of 5 cases diagnosed by CT scan.
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Percutaneous interventional uroradiology.
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CT muscle scanning in the evaluation of patients with spinal muscular atrophy (SMA).
One hundred patients with spinal muscular atrophy (SMA) were assessed by CT scanning using a standardised technique. The spectrum of CT abnormality occurring in SMA was observed and by overall analysis the patients were divided into 4 groups. While the CT appearances of these groups correlated well with clinical assessment of severity of disease, the disease process was usually much more widespread than clinical examination suggested. CT abnormality was first observed in the leg and gluteal muscles, progressing to the posterior spinal, thigh, shoulder girdle and sternomastoid muscles. Hypertrophy of sartorius and gracilis was observed in a significant number of patients. Fascial planes were preserved in involved muscles in over half of the patients, even in late-stage disease. Asymmetrical muscle involvement was seen with increasing frequency as the disease process increased in extent as evaluated by CT scanning. There was no discernible difference in the CT appearances in those patients who clinically had limb-girdle, facioscapulohumeral or scapuloperoneal distribution of weakness.
A double-blind study comparing the efficiency, tolerance and renal effects of iopromide and iopamidol.
A randomized double-blind, group comparative study was carried out to investigate the diagnostic efficiency and side-effect profiles, with particular reference to renal tolerance, of iopamidol and a newer non-ionic contrast medium iopromide, when used in excretory urography. The trial demonstrated that, in a population of 137 patients undergoing excretory urography and being investigated from baseline up to 2 weeks after the administration of the contrast medium, there were no significant adverse effects on the indicators currently thought to reflect renal function. The efficiency of the two contrast agents proved to be very similar and the radiographic quality of opacification was adequate in nearly every case.
A technique for the removal of retained balloon bladder catheters.
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