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M A Ghoneim

Publications and source records attributed to M A Ghoneim.

At least 37 records · Page 2Linked to original sources
PubMed2001

Synchronous twin-pulse technique to improve efficacy of SWL: preliminary results of an experimental study.

BACKGROUND AND PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for the majority of renal and ureteral stones. The Dornier HM3 lithotripter has good results but with some limitations and complications. A number of second- and third-generation machines have been developed employing different energy sources, focusing devices, and coupling media. These devices overcome some of the limitations and lessen the complications but at the expense of the success rate. Use of the consecutive double-pulse technique (as in the MFL 5000) and of combined under-table and over-table modules consecutively (as in the Siemens Lithostar Plus) improves the efficacy of fragmentation. The aim of this study was to study the effects of the use of synchronous twin pulses generated by under-table and over-table identical shockwave reflectors for stone fragmentation. MATERIALS AND METHODS: We designed a lithotripter with two identical shockwave generators and identical reflectors (twin heads). One reflector was under the table and fixed, while the second reflector was over the table and hangs on a C-arm so that the angle between the axes of the two reflectors could be changed. The second focal points (F2) of the two reflectors lay in the same position. A lucent lightweight acrylic water tank with one side sealed by a silicon rubber membrane was fixed to the SWL table so that the membrane coupled with the water cushions of both reflectors. The tank was filled with degassed water and the targeted material was fixed on a holder and immersed in the water so as to be at F2. Comparison of the use of one shockwave source and two shockwave sources simultaneously was done relative to: (1) cavitation effect on aluminum foil; (2) quality of disintegration, shape of the focal zone, and ideal position of F2 using ceramic blocks; and (3) disintegrative efficacy using dental bone cement. RESULTS: The cavitation effect became more localized with the use of two reflectors. Also, the volume and rate of stone disintegration increased with the use of the two reflectors, with production of fine (<2-mm) fragments. The focal zone became smaller and conical with no propagation of shockwaves beyond F2. These results were more evident if the angle between the axes of the reflectors was 90 degrees. CONCLUSION: This new technique of SWL may improve the efficacy of treatment of urinary tract stones. It also may be less harmful to the renal tissues, but animal experiments must be carried out to prove this.

Equipment Design↗
PubMed2001

Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years' follow-up.

BACKGROUND: Schistosomiasis is a major health problem in some areas of the world. Schistosomal-specific nephropathy is a well-known occurrence and eventually leads to end-stage renal failure. Patients with schistosomal infection were considered to be suitable recipients for renal transplantation. However, the long-term impact of schistosomiasis on kidney transplantation is not yet been reported. METHODS: The long-term impact of schistosomiasis on patient and graft outcomes was studied by comparing two groups of subjects from a total of 243 patients. Group I consisted of cases with schistosomal infections and group II consisted of schistosoma-free controls. Schistosomiasis was documented in group I by identifying schistosoma eggs in urine, stool or rectal mucosal biopsy. Also intra-operative biopsies from bladder mucosa of the graft recipients and from the lower end of the ureter of living donors were obtained to search for schistosoma eggs. RESULTS: Sixty-three cases of schistosomiasis were diagnosed in both recipients and donors, 65 cases in recipients only, and eight cases in donors only. Infected recipients and donors with active lesions were treated at least 1 month before transplantation by combined antischistosomal drugs (praziquantel and oxamniquine). The 243 patients (136 schistosoma-infected cases and 107 controls) were followed regularly for a period of 10 years after transplantation. We found that there was no significant difference in the incidence of acute and chronic rejection between the groups; however, higher cyclosporin doses were needed for the infected group with subsequent higher incidence of both acute and chronic cyclosporin nephrotoxicity. Moreover, the schistosomal group had a significantly higher incidence of urinary tract infection and urological complications with no evidence of schistosomal re-infection. CONCLUSIONS: Despite a higher incidence of schistosoma-related complications after renal transplantation, schistosomal infection is not a major risk factor for transplantation. Therefore, infected patients can be considered as suitable recipients if they have been properly treated before transplantation.

Adult↗
PubMed2001

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part I: when statistics fail.

PURPOSE: We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction. MATERIALS AND METHODS: Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study. RESULTS: Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade. CONCLUSIONS: Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

Adult↗
PubMed2001

The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part II: the potential usefulness of artificial neural networks.

PURPOSE: The International Prostate Symptom Score (I-PSS) is used exclusively for evaluating patients with a prostate condition and following various treatment modalities. As previously demonstrated, there is poor or no correlation of bladder outlet obstruction diagnosed by pressure flow study with the symptoms projected by the I-PSS. Thus, we applied an artificial neural network model to assess patients with lower urinary tract symptoms. MATERIALS AND METHODS: Data on 460 patients enrolled in part 1 of our study were entered into a multilayer feed forward, back propagation network. RESULTS: In the training set of 305 patients the model predicted obstruction in 94% with 94% sensitivity and 68% specificity. In the test set of 155 patients it predicted obstruction in 87% with 87% sensitivity and 44% specificity. CONCLUSIONS: The accuracy of the model for diagnosing obstruction based on the I-PSS is acceptable, considering that statistical models failed to demonstrate a correlation of symptoms with objective obstruction.

Adult↗
PubMed2001

A simple assay and histochemical localization of transglutaminase activity using a derivative of green fluorescent protein as substrate.

Histidine-tagged green fluorescent protein (His(6)-Xpress-GFP), a widely used fluorescent probe, was found to be a good substrate for transglutaminase, an enzyme that catalyzes covalent crosslinking of proteins. GFP alone did not serve as a substrate but its derivative His(6)-Xpress-GFP was readily crosslinked through the Gln and Lys residues present in the short N-terminal extension (His(6)-Xpress). His(6)-Xpress-GFP was sensitive enough to detect the transglutaminase activity in guinea pig liver homogenates. The fluorescent substrate could also be used for activity staining of transglutaminase on histological tissue sections, and such applications revealed a surprisingly wide distribution of transglutaminase in the body, especially in the extracellular matrices of various tissues, suggesting an important role for transglutaminase in maintaining the integrity of the extracellular matrix and connective tissues by crosslinking its constituent proteins.(J Histochem Cytochem 49:247-258, 2001)

Amino Acid Sequence↗
PubMed2001

Coadministration of ketoconazole and cyclosporine for kidney transplant recipients: long-term follow-up and study of metabolic consequences.

In a prospective randomized study including 100 kidney transplant recipients, we previously reported on the safety and financial benefits of the coadministration of ketoconazole (keto) to cyclosporine (CsA)-treated kidney transplant recipients. In this study, we report on the long-term follow-up of these patients and their control group, as well as possible metabolic consequences of this drug combination. Evaluation of 51 keto-treated patients and their control group (49 patients) included graft function, lipogram, fasting blood glucose, liver function tests, serum calcium, phosphorus, and radiological and histopathologic assessments. Follow-up of these patients for 54 months showed that the CsA dose reduction was 72.9% at 12 months, decreased to 69.3% at the last follow-up. We also found that the mean keto dose required for CsA dose reduction decreased to 82.8 +/- 24.1 mg/d compared with the starting dose (100 mg/d). Diagnosis of acute rejection episodes was similar in both groups. However, in the control group, rejection episodes were more recurrent, with poorer response to treatment. Acute CsA nephrotoxicity was more common in the keto group, but this was encountered more at keto induction and was rapidly reversed on further reduction of CsA doses. Chronic graft dysfunction was statistically significantly less in the keto group during the first year. However, by the end of the study, the difference was not statistically significant. In this study, hepatotoxicity was similar in the two groups. On studying the metabolic consequences, we found that serum cholesterol, low-density lipoprotein, and triglyceride levels were lower in the keto group. Bone mineral contents in both groups were less than the mean values for age- and sex-matched healthy controls. From this study, we conclude that long-term use of low-dose keto in CsA-treated kidney transplant recipients is safe and cost-saving and may induce better graft function. Bone mineral contents, vitamin D blood levels, and lipid profiles are not affected by long-term keto coadministration in CsA-treated kidney transplant recipients.

Adult↗
PubMed2001

Urological complications after living-donor renal transplantation.

OBJECTIVE: To determine the incidence and management of urological complications after 1200 consecutive live-donor renal transplantations, all of which were carried out in one centre; the possible risk factors and the effect on patient and graft survival were also assessed. PATIENTS AND METHODS: Data were retrieved from an electronic database; the incidence of urological complications was determined, and correlated with relevant risk factors by univariate and multivariate analysis. The effect on patient and graft survival was assessed using Kaplan-Meier statistics. RESULTS: There were 100 complications in 96 patients (8%); urinary leaks occurred in 37, ureteric strictures in 23 and lymphoceles causing ureteric obstruction in 17. Percutaneous needle biopsy was complicated by haematuria and clot anuria in six patients. Late complications included 11 cases of stones, four of bladder malignancy and two of haemorrhagic cystitis. There was evidence that the age of the recipients (< 10 years), method of establishing urinary continuity (uretero-ureteric anastomosis) and a high dose of steroids had an independent positive effect on the incidence of urological complications. However, their development did not influence graft or patient survival. CONCLUSION: When there is meticulous attention to the technical details, renal transplantation should incur few urological complications. Early intervention with percutaneous drainage reduces morbidity and the likelihood loss of graft function. Proper and prompt management should not affect the graft and/or the patient's survival.

Adolescent↗
PubMed2001

Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients.

PURPOSE: We report functional results of the orthotopic ileal neobladder using a serous-lined extramural tunnel as an antireflux procedure. MATERIAL AND METHODS: One-stage radical cystectomy and orthotopic ileal W-shaped neobladder creation were performed in 353 male and 97 female patients for invasive bladder cancer. The ureters were reimplanted using a serous-lined extramural tunnel for reflux prevention. Of the patients 344 were evaluable at a mean followup plus or minus standard deviation of 38 +/- 25 months. Evaluation included clinical and radiographic studies to determine functional and oncological outcomes. RESULTS: Four patients (0.8%) died in the hospital. Early complications in 42 patients (9%) were treated conservatively but 3 women underwent vaginal repair of a pouch-vaginal fistula. During the observation period there were 90 oncological failures, of which 3 were isolated urethral recurrence. Late complications included pouch stones in 10 cases, outflow obstruction in 11, mucous retention in 2, adhesive bowel obstruction in 3 and hypercontinence in 9 females. The incidence of daytime and nighttime continence was 93.3% and 80%, respectively. The upper tracts remain unchanged or improved in 96.2% of the reimplanted renal units, while reflux was observed in 3%. CONCLUSIONS: The serous-lined extramural tunnel has proved its efficiency and durability as an antireflux technique.

Adult↗
PubMed2001

Bilharzial related, organ confined, muscle invasive bladder cancer: prognostic value of apoptosis markers, proliferation markers, p53, E-cadherin, epidermal growth factor receptor and c-erbB-2.

PURPOSE: We investigated the association of the apoptosis related proteins Bcl-2, Bcl-x, Bax and Bak, p53, the adhesion molecule E-cadherin, the receptor proteins epidermal growth factor receptor and c-erbB-2, and the proliferation markers proliferating cell nuclear antigen and Ki-67 with the clinical outcome of bilharzial related transitional cell carcinoma and squamous cell carcinoma. MATERIALS AND METHODS: Cystectomy specimens from 109 patients with organ confined, muscle invasive stage, pT2pN0M0, bilharziall positive bladder cancer were examined, including 60 with squamous cell carcinoma and 49 with transitional cell carcinoma. Immunohistochemical results were correlated with tumor progression. RESULTS: In squamous cell carcinoma but not in transitional cell carcinoma the loss of epidermal growth factor receptor, Bax and Bak was significantly associated with higher histological grade (p = 0.02, 0.006 and 0.01, respectively). On univariate analysis patients with transitional cell carcinoma had a poorer prognosis than those with squamous cell carcinoma. p53 Over expression and the loss of Bak positivity were associated with shortened progression-free survival in transitional cell carcinoma (p = 0.006 and 0.04, respectively), and squamous cell carcinoma (p = 0.00001 and 0.04, respectively). In squamous cell carcinoma high tumor grade (p = 0.02) and in transitional cell carcinoma high labeling indexes for MIB-1, Bcl-x expression and c-erbB-2 positivity (p = 0.03, 0.02 and 0.04, respectively) were associated with a poorer prognosis. On multivariate analysis p53 emerged as a significant prognostic factor for each condition. Additional independent prognostic factors were proliferating cell nuclear antigen for squamous cell carcinoma, and MIB-1, Bcl-x and Bax for transitional cell carcinoma. CONCLUSIONS: Bilharzial related transitional cell carcinoma and squamous cell carcinoma of the bladder differ in interims of protein expression and prognosis. Independent prognostic factors were p53, MIB-1, Bcl-x, and Bax in the former disease, and p53 and proliferating cell nuclear antigen in the latter disease.

Adult↗
PubMed2001

Effects of selective autonomic and pudendal denervation on the urethral function and development of retention in female dogs.

PURPOSE: This trial is an experimental approach to the possible causes of continence and voiding problems after urethra sparing radical cystectomy and orthotopic bladder substitution in women. MATERIALS AND METHODS: Between January 1996 and January 1999 we included 24 mongrel female dogs in this 4-phase study of 6 dogs each. The effects of autonomic denervation of the urethra (phase 1) and urethral transection just distal to the bladder neck (phase 2) on the urethral pressure profile were recorded. In phase 3 the effects of autonomic denervation, urethral transection and pharmacological manipulation of the denervated transected urethra on the urethral pressure profile were studied in succession. In phase 4 the effects of pudendal nerve transection and pharmacological blockade were recorded. In the 12 phases 2 and 3 dogs the transected urethra was re-anastomosed to the bladder neck. Acute experiments were repeated after 2 and 6 months, urethrocystoscopy was done and post-void residual urine was estimated. Two of the latter dogs were sacrificed 6 months after the acute experiment and the urethras were histopathologically examined. RESULTS: Autonomic denervation resulted in a 46% to 48% decrease in mean maximal pressure in the proximal urethra in phases 1 and 3 (p <0.001) with no significant effect on the distal urethra. Urethral transection in phase 2 did not affect the urethral pressure profile. Phentolamine injection after urethral denervation and transection in phase 3 produced a further reduction of 11.3% and 46.3% in mean resting pressure in the proximal and distal urethra, respectively, while succinyl choline produced a 38.1% further decrease in the distal urethra. Unilateral and bilateral pudendal denervation reduced pressure in the distal urethra significantly but not in the proximal urethra. When phentolamine was given thereafter, a further decrease of 38% and 2.4% resulted in resting pressure values in the proximal and distal urethra, respectively. The change in distal urethral pressure was marginally significant after succinyl choline injection (p = 0.05). Results were reproducible after 2 and 6 months. The proximal urethra remained patent with no post-void residual urine after autonomic denervation. There was no significant urethral fibrosis after realignment of the transected urethra in the 2 sacrificed phases 2 and 3 dogs. CONCLUSIONS: From this study we concluded that autonomic denervation reduced pressure in the proximal urethra by less than 50%. Continuity of the urethra with the bladder is not necessary for proper urethral function. After autonomic denervation the proximal urethra remained patent with no subsequent fibrosis. In addition, no post-void residual urine was noted. Bilateral pudendal denervation did not completely block activity of the distal urethra. The nonneuromuscular components had a small role in the creation of urethral closure function.

Animals↗
PubMed2001

Live-donor renal transplantation at the Urology & Nephrology Center of Mansoura: 1976-1998.

Based on more than 1,200 living donor transplants performed at the Urology & Nephrology Center at Mansoura University between 1976-1998, we report: 1. The overall graft survival rate was 75.8% and 51.9% at 5 and 10 years, respectively, with a projected half-life of 10.7 years. 2. Three factors acted as independent variables that significantly influenced graft survival: the number of HLA mismatches, the number of acute rejection episodes and the presence of posttransplant hypertension. a. Grafts with 2 or fewer HLA-A, -B and -DR mismatches had a significantly better survival rate. b. The incidence and the number of early acute rejection episodes had a significant negative impact on graft survival. c. A significant reduction in graft survival was associated with hypertension uncontrolled by or newly developed after transplantation. 3. Bilharziasis had no impact on the outcome. 4. Despite improvements in tissue matching and immunosuppression, an important proportion of grafts is still lost following living-donor kidney transplantation. 5. Efforts must be directed to identify better regimens, which can provide adequate immunosuppression and minimal nephrotoxicity.

Academic Medical Centers↗
PubMed2000

A magnetic device for increasing the urethral resistance to flow: an experimental study in female dogs.

OBJECTIVE: To test a new magnetic device for increasing the urethral resistance to flow in a dog model, and thus provide a potential mechanical device for the treatment of incontinence in women. MATERIALS AND METHODS: The study comprised 12 female mongrel dogs; three dogs were used to study the effect on urethral resistance of inserting a vaginal magnet (control experiment) and five were assessed in a urodynamic study. With the animals under general anaesthesia, the bladder and the urethra were exposed by a low midline incision. One magnet, embedded in a silicon layer, was placed on the anterior side of the urethra 3 cm distal to the bladder neck and fixed with a few sutures. To increase the urethral resistance as required, a second magnet was inserted into the vagina and the device activated. Urethral pressure profiles and leak-point pressures were recorded in the anaesthetized animals under resting conditions and after the urethra was compressed between the magnets. Recordings were also made after pharmacological blockade of the urethral musculature. In four additional dogs, chronic experiments were conducted to evaluate the effect of continuous compression of the urethra and the vaginal wall for 14 days. RESULTS: Urethral compression between the magnets resulted in a doubling of the maximal pressure in the proximal urethra and in a threefold increase of the leak-point pressure. After pharmacological denervation of the urethra the differences between the control pressures and those after activating the device were even greater, although not significantly so. After 2 weeks of continuous compression of the vaginal wall and the urethra between the magnets there was no detectable tissue damage. CONCLUSION: These results suggest that the magnetic device can efficiently increase urethral pressure and that prolonged compression caused no apparent damage to the urethra or vagina. It may therefore be a useful potential method of providing urinary continence in women.

Animals↗
PubMed2000

Paediatric lower urinary tract rhabdomyosarcoma: a single-centre experience of 30 patients.

OBJECTIVE: To retrospectively analyse the long-term outcome of children with bladder and/or prostate rhabdomyosarcoma who were diagnosed at the authors' institution over the last 17 years. PATIENTS AND METHODS: The study comprised 30 children (26 boys and four girls, mean age 5 years, range 15 days to 15 years); 23 had stage III and seven had stage II disease. The initial biopsy showed an embryonal variant in 27 and round-cell sarcoma in three patients. All patients received eight weekly doses of vincristine, actinomycin D and cyclophosphamide (VAC). Subsequent treatment depended upon the response to chemotherapy. RESULTS: Fourteen patients had a complete or partial response to chemotherapy (> 50% reduction in tumour size); they were maintained on VAC chemotherapy for 2 years. Twelve patients in this group survived with no evidence of disease for 7 months to 10 years. Additional therapies were used in three patients, i.e. radical cystectomy in one and external irradiation in two. Sixteen patients had a minimal response to chemotherapy; in six, radical cystectomy was feasible and was followed by one year of chemotherapy. All patients were free of disease for 4-11 years. Radiotherapy was given to the remaining 10 patients; thereafter radical cystectomy became feasible in five while partial cystectomy was possible in three. Only three of these 10 patients survived for 4-11 years. CONCLUSION: The tumour response to initial chemotherapy can be used to stratify patients into two risk-groups, i.e. low-risk patients with a complete or partial response in whom the bladder could be salvaged, and high-risk patients with a minimal response, in whom intensive treatment should be pursued, with no attempt at bladder salvage.

Adolescent↗
PubMed2000

Correlation between central zone perfusion defects on gadolinium-enhanced MRI and intraprostatic temperatures during transurethral microwave thermotherapy.

BACKGROUND AND PURPOSE: The likelihood of success of thermoablation of prostatic hyperplasia depends on delivering an optimal thermal dose, but data on the temperatures achieved with these methods are few. We sought to develop a noninvasive method for monitoring intraprostatic heat distribution. PATIENTS AND METHODS: Thirteen patients ranging from 50 to 76 (mean 61.3+/-8.1) years were enrolled in this study, all of whom had evidence of obstruction by uroflowmetry and pressure-flow studies. The mean total volume of the gland was 40.3+/-13.1 cc, while the mean adenoma volume was 20.4+/-10.1 cc, as estimated by preoperative transrectal ultrasonography. All the patients were treated with the Urologix Targis device for at least 45 minutes. Continuous temperature mapping was performed during the therapy using spatially dispersed thermosensors at 16 prostatic sites. The patients were evaluated 5 to 12 days postoperatively with MRI of the prostate utilizing a pelvic phased-array coil at 1.5 T. RESULTS: Postprocedure MRI demonstrated a mean perfusion defect of 28.1+/-2.1% and 63.6+/-34% of the total gland and transition zone volumes, respectively. The mean anteroposterior (AP) and transverse diameters of the perfusion defects, as measured on the MRI images, were 29.2+/-5.2 mm and 32.7+/-5.9 mm, respectively. The maximum mean peak temperatures were 66.8+/-13 degrees C and were recorded at 4 mm from the urethra. No temperatures higher than 45 degrees C were recorded beyond 15 mm on either side of the urethra in the AP direction and beyond 16 mm on either side of the urethra in the transverse diameter. This perfusion defect was persistent for 27.7+/-5.2 mm in the superoinferior diameter, which is equivalent to the length of the antenna (28 mm). CONCLUSION: Perfusion defect diameters as measured by postprocedure MRI accurately represent the prostatic tissues exposed to temperatures of > or =45 degrees C for 45 minutes or more. So, MRI provides an accurate, noninvasive method for screening the effective heat pattern generated in the prostate during transurethral microwave thermotherapy.

Aged↗
PubMed2000

Comparison of genetic changes in schistosome-related transitional and squamous bladder cancers using comparative genomic hybridization.

The development of bladder tumors has been associated with a number of causative agents, including schistosomiasis. Schistosome-related cancers show different clinical and pathological features compared with non-schistosome-related bladder cancers, occurring in younger patients, and being predominantly of squamous cell type. This study addresses the difference between squamous and transitional tumor types in the presence of schistosome infection as a measure of the relationship between tumor genotype and phenotype. We have used comparative genomic hybridization to analyze primary muscleinvasive schistosome-related bladder tumors in 54 patients. Twenty-six of these tumors were squamous cell carcinomas; the remaining 28 were of transitional cell type. On average, transitional cell tumors showed 1.8 times the number of chromosomal aberrations as squamous cell tumors (14.4 versus 8.2, P: < 0.001). For both groups combined, the most prevalent genetic alterations were losses of 8p and 18q, and gains of 8q. Transitional cell cancers also showed frequent losses involving 5q, 9p, 10q, 11p and 11q, and gains at 1q and 17q. Loss of 11p was significantly more frequent in TCC than in SCC tumors (50 versus 4%, P: = 0.01). Squamous cell cancers showed more frequent losses of 17p and 18p than transitional tumors, which was clearly significant given the overall reduced frequency of changes in squamous cancers (P: = 0.001 and P: = 0.03, respectively). These data show that different histologic subgroups of bladder tumors are characterized by distinct patterns of chromosomal alterations. The genetic changes found in the transitional cell group are similar to those reported in non-schistosome-related transitional cell tumors, but differ from tumors exhibiting squamous differentiation.

Animals↗
PubMed2000

Nocturnal enuresis in men with an orthotopic ileal reservoir: urodynamic evaluation.

PURPOSE: We evaluated the urodynamic features of enuretic and continent patients with an orthotopic neobladder. MATERIALS AND METHODS: Included in our study were 100 men with an orthotopic hemi-Kock or W neobladder and a minimum followup of 1 year. Of the patients 50 were completely continent day and night, and 50 had enuresis without evidence of an underlying organic etiology, such as stones, reflux or urethral stricture. RESULTS: Univariate analysis showed significantly higher pressure and a larger volume of post-void residual urine in the men with enuresis. In addition, maximum urethral pressure, maximum flow and compliance were decreased in the enuretic group compared to the continent group. Multivariate analysis revealed that post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions are the most critical parameters affecting nocturnal continence. CONCLUSIONS: The cystometric parameters significantly associated with nocturnal enuresis in patients with an orthotopic reservoir are post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions. Urethral pressure and flow parameters did not sustain significance on multivariate analysis.

Enuresis↗
PubMed2000

A predictive model of survival after radical cystectomy for carcinoma of the bladder.

OBJECTIVE: To evaluate the effect of patient and tumour characteristics on the disease-free survival after radical cystectomy for infiltrating bladder cancer, and to use these to help in constructing a meaningful prognostic index. METHODS: The disease-free survival was initially evaluated in 1026 patients (the reference series, 1969-1990). A multivariate analysis showed that the tumour P stage, grade and nodal involvement were the only factors which had an independent and significant association with survival. The computed regression coefficients were then used to classify patients into one of four risk categories and the results then validated by applying the model to a prospective test series (1991-1995). RESULTS: The 5-year disease-free survival of both groups was similar. When the results for the risk categories of the reference series were compared with those of the test series, there was no significant difference. CONCLUSION: This comprehensive prognostic model for the results of radical cystectomy was validated and verified in a prospective group of patients. Adjuvant therapies are indicated for patients with a high risk score.

Adult↗