[Blood loss and irrigation fluid during transurethral resection of the prostate (TURP)].
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Blood Loss, Surgical↗
Biomedical subjects
J Miskowiak
Publications and source records attributed to J Miskowiak.
[Circumcision by the method of Lucas].
Circumcision a.m. Lucas is described and the results are given in 85 boys with a median age of four years (range, 2-14 years). The postoperative period was uncomplicated in 79% of the cases. The most frequent complication was bleeding (8%), but reoperation was only needed in one case. Haematomas were registered in 4% of the boys. Glans was free or nearly free in 89% of the cases. Only 12% of the families were dissatisfied with the length of the remaining prepuce: the Muslim parents found the prepuce too long (8%), the Danish parents found that too much of the prepuce had been removed (4%). Circumcision a.m. Lucas gives uniform results, is without major complications, and can be performed on medical as well as ritual indications.
Adolescent↗
[Follow-up of patients after splenectomy at a local hospital].
We have studied the records of 79 patients splenectomised between 1965-1995 and questioned the 39 patients still alive regarding pneumococcal immunisation and measures against infections. Fifty percent of patients operated before 1978 had still not been immunised. Twenty-four percent of the patients operated after 1978 were neither immunised at the hospital nor recommended this, and 10% had still not been immunised in 1995. Eight percent of the patients did not know that they had lost their spleen. Eighty-three percent of the patients had not been informed about measures against infection. Only 17% had penicillin available at home. We recommend that besides pneumococcal immunisation, special splenectomy cards and antibiotic prescription, splenectomised patients should be given written guidelines about dealing with infections and recommendations that pneumococcal antibody levels be controlled five years after the primary immunisation. Extraordinarily, hospitals should also inform previously splenectomised patients.
Adult↗
Conventional or Li vasectomy: a questionnaire study.
OBJECTIVE: To compare pain, discomfort, complications and convalescence during and after vasectomy performed conventionally or using the Li 'no-scalpel' method. PATIENTS AND METHODS: Between March 1993 and May 1995, 256 men were vasectomized at two city hospitals in Copenhagen; half of the patients underwent the conventional technique at one hospital and the remaining half the Li method at the other. The two groups were matched for the time at which they underwent surgery and therefore for the duration of follow-up. A questionnaire was sent to all patients, in which they scored pain and discomfort using a 10 cm visual analogue scale (VAS). The reproducibility of measurements was tested on 10 patients who had answered the same questions 1.5-2 years earlier. RESULTS: Men vasectomized using the Li method experienced less pain at rest after the first week (P = 0.05) and less use of analgesics (P < 0.001), had fewer infections (P = 0.0015) and contacts with their physician (P = 0.0078) than those conventionally vasectomized. There were no significant differences between the groups for pain and discomfort during surgery and in the first week after vasectomy, frequency of bleeding, haematoma, oedema, granuloma, pain at activity, absence from work, vasectomy failure by sperm analysis, sexual activity and satisfaction with the cosmetic result (all P > 0.05). CONCLUSION: Vasectomy using the Li method reduced post-operative pain, the use of analgesics, the frequency of infections and contacts with a physician when compared with the conventional procedure.
Adult↗
Percutaneous sclerotherapy of hydronephrosis in a non-functioning kidney.
A 27-year-old woman was admitted with an abdominal mass in the right hypochondrium. Ultrasound, intravenous urography and scintigraphy revealed a giant non-functioning hydronephrosis. Because she refused surgery, a percutaneous aspiration with instillation of doxycycline was performed. One year thereafter, the patient was still without recurrence of any symptoms or hydronephrosis.
Adult↗
[Blood loss during transurethral resection of the prostate].
Measurement of the perioperative blood loss during transurethral resection of the prostate was performed using the modern HemoCue photometer in 100 men. The measurement lasts only 5-10 minutes. The median weight of the removed prostate was 28 grams and the operating time 60 minutes. The median blood loss was 393 ml (range 8-1843 ml) and was positively correlated to operating time, change in the peroperative blood pressure, volume of the irrigating fluid and the drop in the postoperative serum sodium. Perioperative measurements of the blood loss draw the surgeons' attention to the haemostasis, provide an objective measure of the most important factor for morbidity during TURP and allow a rational policy for blood transfusion. It is an advantage to place this measurement in the hands of professionals, i.e. laboratory technicians, who are trained to quality-secure the measurement and preserve the photometer.
Aged↗
[Results of radiotherapy of ureteral obstruction in invasive bladder cancer].
Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. Drainage improved in only 20% of kidneys and the diverting catheter could be withdrawn permanently in only one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). This raises doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle invasive bladder cancer.
Aged↗
[Semirigid and flexible uretero-nephroscopy].
Thirty-seven ureteronephroscopies with the modern ureteroscope were attempted in 30 patients (median age of 60 years) because of radiographic filling defects, tumours, stenoses, stones, broken double "J" stent, unilateral haematuria and surveillance. Only one ureteronephroscopy (3%) could not be performed. The radiographic filling defects represented tumour (ten), stones (three) and a torn-off papilla (one). The ureteric stenoses could be classified as congenital (one), secondary to a vascular graft (1), tumour (1) or inflammation (two). In nine patients the stones were removed, and in four fragmented and the fragments passed during the next two to four weeks while treated with a stent. One ureteric tumour and two pelvis/calyx tumours were coagulated. One broken stent was removed, and one displaced nefrostomy catheter was caught in the calyx and pulled into the pelvis. There were three cases with transient fever, all in patients with infected nefrostomies. The modern ureteronephroscopy is a valuable method with only few complications.
Adult↗
Expression and characterization of preproVIP derived peptides in the human male urogenital tract.
Expression of the gene sequence encoding vasoactive intestinal polypeptide (VIP) leads to the synthesis of a 170 amino acid precursor molecule which can be processed to five fragments: preproVIP 22-79, peptide histidine methionine (PHM), or peptide histidine valine (PHV), preproVIP 111-122, VIP and preproVIP 156-170. Using region specific radioimmunoassays and antisera against the functional domains of the VIP precursor in combination with immunocytochemistry and chromatography, the localization, distribution and identity of the preproVIP derived peptides within the human male urogenital tract were investigated. Postmortem as well as fresh tissue specimens were used. All the preproVIP derived peptides were expressed and could be demonstrated in nerve fibres throughout the urogenital tract in close relation to the epithelial lining and in vascular as well as non-vascular smooth muscle. The VIP-related peptide containing fibres were most abundant in the prostate parenchyma and the seminal vesicle. Using double immunostaining, co-localization of the various preproVIP derived peptides could be evidenced. The fact that all preproVIP derived peptides are present in the urogenital tract, should be taken into consideration when the regulatory aspects of neuropeptides in physiological and pathophysiological functions are discussed.
Adult↗
Results of radiotherapy on ureteric obstruction in muscle-invasive bladder cancer.
OBJECTIVE: To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer. PATIENTS AND METHODS: Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. RESULTS: Drainage improved in 20% of kidneys and the diverting catheter was withdrawn permanently in one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). CONCLUSION: The results of this study raise doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle-invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle-invasive bladder cancer.
Adenocarcinoma↗
[Epididymitis, testicular torsion and color Doppler].
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Child↗
[Vasectomy using the Li method].
The no-scalpel vasectomy is described and evaluated. Nineteen out of 21 consecutive patients could be operated with this technique. The median operating time was 16 minutes, range 9-50 minutes. There were no complications and the scar was barely visible after ten days. The median score for pain was 0.4 cm (range 0.0-5.0 cm) and for discomfort 0.7 cm (range 0.0-5.0 cm) on a 10 cm long visual analogue scale. The method is minimally invasive and well-tolerated by the patients. When some routine is gained the operating time is short.
Adult↗
Hormonal treatment of obstructed kidneys in patients with prostatic cancer.
A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal therapy alone survived for a median of 26 months (range 1-111), while the patients who also needed diversion survived for a median of 13 months (range 1-28). The median time spent at home was 24 months (0-102) and 10 months (0-23) respectively, presumably reflecting the worse general condition of the patients who required diversion.
Aged↗
[Treatment of superficial bladder tumors with intravesical BCG].
Thirty three patients with carcinoma in situ (CIS) or/and numerous recurrences of superficial bladder tumor were treated with intravesical BCG after transurethral resection. 63% of patients with CIS were free of recurrence after two years, two underwent cystectomy and one died because of progression. Patients with Ta and concomitant CIS responded well to BCG, while the patient with T1 tumor and CIS was free from recurrence for 15 months. Dysplasia of grade II disappeared after BCG. 62% of patients with Ta tumor were without recurrence after one year, but after two years 86% of the patients had recurrences. Patients with T1 tumor were free from recurrence for eight months, after which 25% had progression. The side effects of BCG were transient: urinary frequency in 48%, malaise in 39%, dysuria in 36%, haematuria, bladder pain and fever in 24%. 15% of the patients required isoniazid treatment. It is concluded that intravesical BCG is beneficial in CIS and superficial bladder tumors.
Administration, Intravesical↗
Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration.
A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.
Adolescent↗
Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials.
Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy.
Adult↗
Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis.
In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantageous in diagnosing acute urinary-tract obstruction, and transurethral incision is useful in the acute treatment of ureterocele.
Aged↗