Biomedical subjects
Publications and source records attributed to N W Harrison.
A series of 30 patients with outflow obstruction underwent treatment with prostatic stents. Most had retention of urine and were unfit for conventional surgery. The prostatic stent was readily inserted under local anaesthesia and successfully relieved obstruction in 80% of patients with acute retention. Minor problems were common but there were few major complications.
The diagnosis of non-opaque calculi can be difficult. In 4 patients with protracted symptoms, 2 had renal pelvic filling defects, 1 a possible filling defect and 1 complete obstruction of the ureter at L4. Non-opaque calculi were readily diagnosed by CT scanning. Three patients have successfully undergone surgery (2 open, 1 percutaneous) and 1 awaits percutaneous nephrolithotomy. Of two stones available for analysis, one was composed of uric acid and the other calcium and phosphate. We recommend CT scanning as the investigation of choice for unexplained filling defects in the renal pelvis and ureter or when a non-opaque calculus is suspected.
The results of needle aspiration cytology of solid renal lesions in Brighton from 1977 have been reviewed. Thirty-one lesions were aspirated and of the 21 malignant tumours, cytology accurately diagnosed 19 (90%) when sufficient material was sent for analysis. Of the eight avascular solid renal space-occupying lesions aspirated, cytology gave a correct differentiation (benign versus malignant) in seven (87%). The results compare favourably with those of other published experience. A modification is suggested to the accepted diagnostic pathway.
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3 cases of massive bladder calculus are described and are of interest not only because they are rare, but also because of the remarkably few symptoms they produced.
Phenoxybenzamine, an alpha-adrenergic blocking drug has been evaluated in the treatment of 14 children with neuropathic bladder dysfunction. The majority of children treated showed significant reductions of residual urine and urethral closure pressure. A useful clinical response in terms of improved bladder control was obtained in over half the patients. Children with mild radiological changes in the upper urinary tracts showed radiological improvement but those with marked changes did not improve. The drug is generally well tolerated but side-effects of postural hypotension, lethargy and nausea may occur.
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34 upper urinary tract pressure/flow studies were carried out in 24 children. Obstruction was reliably diagnosed in 8 studies, and excluded in 21. This technique may provide information of clinical value in the patient with upper urinary tract dilatation.
Urodynamic studies have been carried out in 10 boys with the prune belly syndrome. In spite of gross radiological changes the condition is compatible with normal voiding dynamics. Filling cystometrograms show a marked shift to the right. Pressure/flow studies may demonstrate an unbalanced voiding mechanism which can be treated by urethrotomy. Following urethrotomy urethral pressure profiles showed a significant fall, flow rates increased and residual urine volumes were reduced. Urological treatment in the prune belly syndrome should be directed at producing a bladder which empties well: a balanced voiding mechanism. Urodynamic investigations are helpful in achieving this aim. Residual urine determination and flow rates should be used in routine follow-up. Urethrotomy to lower bladder outflow resistance is advocated as one of the first steps in treating the unbalanced voiding mechanism that is often found in the prune belly syndrome.
Ultrasound has been used to assess residual urine in children and found to have considerable advantages over other methods. Using a B-mode scan in the sagittal plane the presence or absence of residual urine can be confidently determined. Quantitative measurements of volume are subject to considerable error but semi-quantitative information in individual cases can be obtained by comparison of records made at subsequent examinations. More accurate quantitative values might be achieved by constructing an individual calibration curve. The advantages of ultrasound for assessing residual urine are that it is simple, quick, harmless and non-invasive. Because of these features the examination can be readily repeated, is suitable for out-patient use and is acceptable to children.
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Explore the source record for details and available documents.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.