UROLINK: a model for working together in a changing world.
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Developing Countries↗
Biomedical subjects
N W Harrison
Publications and source records attributed to N W Harrison.
The 2-year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy vs transurethral resection of the prostate.
OBJECTIVE: To assess the 2-year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy of the prostate (IRFT) vs transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Patients with lower urinary tract symptoms (LUTS) and urodynamic evidence of bladder outlet obstruction (BOO) were randomized to undergo IRFT or TURP and were followed up using the International Prostate Symptom Score (IPSS) and urodynamic assessment for 2 years. RESULTS: At 2 years there was a clinically relevant reduction in the IPSS in the IRFT (20 to 9) and TURP groups (22 to 4). There was also a statistically significant reduction in the detrusor pressure at maximum urinary flow in both groups, but the reduction in the IRFT group was probably not sufficient to explain the observed symptomatic improvements solely from a reduction in BOO. CONCLUSION: IRFT can produce a sustained improvement in LUTS for at least 2 years. However, such improvements are unlikely to be entirely the result of a reduction in BOO. The effects of radiofrequency energy may, at least partly, be independent of any thermal effect and depend instead on neuromodulation of lower urinary tract nerves.
Catheter Ablation↗
Is transurethral resection of the prostate safe and effective in the over 80-year-old?
OBJECTIVE: To assess the safety and effectiveness of transurethral resection of the prostate (TURP) in patients over 80 years old. PATIENTS AND METHODS: The records of all patients over 80 years old undergoing TURP at one institution over a 3.5-year period were studied retrospectively. RESULTS: 31% of patients underwent TURP for symptoms and 68% for urinary retention. The early complication rate was 41%. The late complication rate was 22%. There were no deaths within 30 days of surgery. Of all patients, 80% were satisfied with the outcome of their operation. Of all patients with retention, 80% were able to void with small residual volumes by 6 weeks after operation. CONCLUSIONS: Although TURP in the over 80-year-old male is associated with significant morbidity, it is an effective treatment for urinary symptoms or retention. The majority of patients are able to void afterwards and are satisfied with the outcome of their surgery.
Aged↗
Evaluation of fine-needle aspiration cytology for renal masses.
OBJECTIVE: To evaluate the accuracy and use of fine-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (< 5 cm) tumours, are being discovered more frequently. PATIENTS AND METHODS: Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42-88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (< 5 cm and >/= 5 cm). Patients were followed up to the determination of a final diagnosis on tissue histology, after nephrectomy where possible. RESULTS: Thirty-six patients had histologically confirmed carcinoma at nephrectomy, and nine had presumed carcinoma (four unfit for surgery, five with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insufficient sample in eight cases (16%). The sensitivity was 89% for large (>/= 5 cm) solid masses, 64% for small (< 5 cm) solid masses and 50% for complex cysts. CONCLUSION: FNA does not contribute to the diagnosis of malignancy in large (> 5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (< 5 cm) masses and complex cysts, FNA can occasionally confirm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.
Adult↗
Interstitial radiofrequency therapy of the prostate in the management of acute urinary retention.
OBJECTIVE: To evaluate in a prospective study the efficacy of interstitial radiofrequency therapy (IRFT) of the prostate in relieving acute urinary retention in patients with benign prostatic hyperplasia. PATIENTS AND METHODS: Twenty-seven patients presenting in acute urinary retention who failed at least one trial of voiding one week after presentation were treated with IRFT of the prostate. During the 6-month follow-up, the International Prostate Symptom Score (IPSS), urinary flow rate, post-void residual volume (PVR) and serum creatinine were determined and changes in erectile and ejaculatory functions recorded. The treatment was considered successful if the patient resumed normal voiding, without compromising renal function and without troublesome lower urinary tract symptoms necessitating further treatment. RESULTS: Of the 26 evaluable patients, 77% resumed normal voiding. At 6 months after treatment, the mean (SD) IPSS had decreased from 15.0 (8.3) to 8 (5.4), the PVR from 950 (203) to 88 (60) mL and the maximum flow rate was 10.5 (4.36) mL/s. CONCLUSION: IRFT of the prostate is a safe and effective treatment, at least in the short-term, for relieving acute urinary retention in patients with benign prostatic hyperplasia. The longer term follow-up is continuing.
Acute Disease↗
Transballoon cystometry: a new technique to assess detrusor function after urinary retention.
OBJECTIVE: To validate a new urodynamic technique to assess detrusor function in patients presenting with acute urinary retention, using the balloon channel of their Foley catheter (transballoon cystometry), and to use the technique to assess patients presenting in acute retention. PATIENTS AND METHODS: The technique of transballoon cystometry is described and validated in vitro using a specially constructed water manometer, and in vivo on five patients who had a suprapubic catheter in addition to the urethral Foley catheter. Fifty-two patients presenting in acute retention underwent transballoon cystometry one week after catheterization; they were divided according to their clinical presentation into uncomplicated acute retention (41 patients) and acute-on-chronic retention (11 patients). The results from transballoon cystometry were compared between these groups. RESULTS: The pressure recorded through the balloon channel was equal to that recorded through the lumen of the catheter, both in vitro and in vivo. Patients with acute-on-chronic retention had a larger volume at first sensation, a larger maximum cystometric capacity, higher end-filling pressure and lower maximum detrusor pressure during isometric contraction than patients in uncomplicated retention. CONCLUSION: Transballoon cystometry is accurate and easy to perform. The clinical distinction between uncomplicated acute retention and acute-on-chronic retention was supported by the urodynamic data. This test could be used before surgery to identify patients with detrusor failure.
Acute Disease↗
Radiofrequency heat-treatment to the prostate for bladder outlet obstruction associated with benign prostatic hyperplasia: a 4-year outcome study.
OBJECTIVES: To evaluate the long-term effect on symptom relief and voiding performance of prostatic radiofrequency thermal treatment for bladder outlet obstruction (BOO) associated with benign prostatic enlargement (BPE). PATIENTS AND METHODS: During 1991-1994, 151 patients (mean age 76 years, range 49-91) with symptomatic BOO associated with BPE (i.e. reduced urinary flow rate and persistent residual urine) but with no clinical evidence of carcinoma of the prostate, were treated using the Thermex II (Direx, Israel) intraurethral radiofrequency (RF) prostatic thermal treatment system. This treatment rates the intraurethral temperature to 48 degrees C for 3 h in a single session under local anaesthesia. The patients were followed using symptom scores and uroflowmetry for 24-48 months after treatment. RESULTS: At 1 year, 70% had a good outcome, but by 3 years this had fallen to 40% and at 4 years to 22%. An increase in mean urinary flow rate, from 9 to 12 mL/s, was sustained throughout the follow-up. There was a reduction in mean residual urine from 83 to 51 mL at 6 months, but this increased to 70 mL by 3 years (not significant). The voiding pressure, which declined at 6-12 months, increased again to near pre-treatment values at 1-2 years. CONCLUSIONS: In patients with symptomatic BPE, prostatic thermal treatment with RF relieves symptoms in 60% for at least 2-3 years. In selected cases it is a useful form of management, as it can be performed as a day-case with minimal risk. Changes in standard objective variables were small but statistically significant for at least one year. The study highlights the importance of waiting for late results from clinical trials.
Aged↗
A prospective randomized trial of interstitial radiofrequency therapy versus transurethral resection for the treatment of benign prostatic hyperplasia.
OBJECTIVE: To carry out a prospective randomized trial comparing interstitial radiofrequency therapy (IRFT) with transurethral resection of the prostate (TURP) in the treatment of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia. PATIENTS AND METHODS: The change in detrusor pressure at maximum flow (PdetQmax) was chosen as the primary measure of outcome but the symptom score, Qmax and residual volume were also measured. Patients with urodynamic evidence of BOO were randomized to receive IRFT (n = 25) or TURP (n = 25); the urodynamics were repeated 6 months after treatment. RESULTS: There was a statistically significant reduction in PdetQmax at 6 months for TURP (P < 0.001) and IRFT (P < 0.01) although the change seen in the latter group was probably not clinically relevant. Nevertheless, a clinically relevant reduction in symptom score occurred in both groups. Both techniques were associated with a low morbidity. CONCLUSION: IRFT is a cheap and safe technique which may be useful in the treatment of lower urinary tract symptoms in certain groups of patients in whom symptomatic improvement is a priority rather than objective outcome. The underlying mechanism for this symptomatic improvement is at present unclear.
Aged↗
Sutureless membranous urethroplasty.
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Anastomosis, Surgical↗
Interstitial radiofrequency therapy of the prostate: results of a pilot study.
PURPOSE: We assessed the feasibility of using interstitial radiofrequency therapy for benign prostatic hyperplasia (BPH) in 50 patients. MATERIALS AND METHODS: Therapy was given using a standard diathermy unit as the radiofrequency generator and a disposable needle electrode. The main outcome measure was improvement in symptoms assessed by symptom scores. RESULTS: Patients with bothersome symptoms or acute retention showed clinically significant improvements in symptom score, while those with chronic retention did not. There were no serious complications. CONCLUSIONS: Interstitial radiofrequency therapy may be effective for symptomatic BPH. Further studies with long-term objective data are under way to assess its role in the management of BPH.
Aged↗
Urethral anaesthesia with topical bupivacaine. A role for a longer-acting agent.
OBJECTIVE: To assess the efficacy and toxicity of bupivacaine as a topical urethral anaesthetic. PATIENTS AND METHODS: This prospective two-part study comprised a pilot study of 10 men (mean age 73 years, range 39-86), to determine the toxicology, pharmocokinetics and suitable preparation of bupivacaine gel, and a study of 40 men (mean age 76 years, range 59-92) to compare the efficacy of bupivacaine with lignocaine gel. All patients were undergoing treatment for benign prostatic hyperplasia by transurethral radiofrequency heating using the Direx Thermex II system. RESULTS: There were no major adverse events. Bupivacaine provided good topical anaesthesia with a mean duration of 141 min, compared with 29 min for lignocaine. Serum samples taken from patients showed that the drug was absorbed slowly, and with a dose of 50 mg there was a wide margin between serum drug concentrations and toxic levels. CONCLUSION: Bupivacaine is safe and effective as a topical anaesthetic agent in the urethra in circumstances where prolonged duration of action is desirable. For lower urinary tract procedures 20-22 mL of anaesthetic gel is required, giving 2-3 h of analgesia/anaesthesia with no significant toxicity or adverse effect. The application of longer-acting anaesthetic agents need not be only during surgical intervention, but might usefully be extended post-operatively to provide early management of pain.
Administration, Topical↗
Ethical issues in the developing world.
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Circumcision, Female↗
The Prostakath stent: four years' experience.
The Prostakath stent is recommended as an option in the treatment of acute urinary retention in the patient at high risk from a transurethral resection of the prostate. In 57 of 64 patients with acute retention, voiding was re-established. A stent-related problem developed in 16 patients and further treatment was usually required. Patients with satisfactorily functioning stents have been followed up for 12.0 +/- 9.9 months. The most frequent complication was displacement of the stent. Infection and stone formation were uncommon. Our results do not support the use of the Prostakath in patients with symptoms of outflow obstruction or chronic retention.
Acute Disease↗
The measurement of the main PGE metabolite, 13,14-dihydro-15-keto prostaglandin E by radioimmunoassay using methyl oxime stabilization.
The measurement of 13,14-dihydro-15-keto prostaglandin E2 [PGEM] is complicated by the artefactual formation of compounds of the corresponding A series which are reactive towards protein. Existing methods of assay depend on the deliberate dehydration to the 'A' form followed by cyclization in alkaline solution to a bicyclic derivative which is stable and can be measured by radioimmunoassay. We report an alternative approach using methyl oximation of the 9- and 15-keto groups which confer stability on the molecule. This derivatization is simple and does not involve an active intermediate such as those of the PGA series. The antiserum for radioimmunoassay is raised against the methyl oxime form. The label is the methyl oxime of PGEM coupled to a tripeptide Pro-gly-tyr through the nitrogen in the proline ring. This is a linkage distinct from that used to raise the antiserum and thus is not preferentially recognized over the endogenous analyte; this results in a high sensitivity assay. The results correlated well with those from the bicyclic assay when both assays were used to measure the same samples of peripheral blood from women receiving a sustained release PGE pessary for ripening the cervix. The technique provides a rapid and reliable method for determining prostaglandin E metabolites.
Alprostadil↗
Surgical training in developing countries.
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Developing Countries↗
Irrigation or no irrigation after transurethral prostatectomy?
Urologists remain divided as to the need for routine irrigation following transurethral prostatectomy (TURP). This randomised prospective study compared a policy of irrigation with that of no irrigation in a consecutive group of 200 patients undergoing TURP. In the irrigation group, a mean of 15 litres of irrigating fluid was used in each patient and one-third of patients required at least one bladder washout. In the no irrigation group, although two-thirds of the patients required at least one bladder washout, only one-third required more than one washout. No significant difference in blood loss, electrolyte balance, infection rate or recovery was seen in the 2 groups. This study led to a local change in practice, converting from a policy of routine irrigation to one of no irrigation.
Humans↗
Re: BAUS UROLINK.
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Developing Countries↗
Autologous transfusion.
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Blood Transfusion, Autologous↗