[Surgical management of impotence].
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Adult↗
Biomedical subjects
O Lukkarinen
Publications and source records attributed to O Lukkarinen.
Nephrogenic adenoma of the bladder.
Nephrogenic adenoma is a rare, benign lesion of the bladder, occurring as a metaplastic response of urothelium to chronic infection or trauma. The symptoms are non-specific, being merely those of chronic cystitis. Endoscopically, the lesion can be mistaken easily for a low grade, low stage transitional cell carcinoma. The treatment consist of long-term, low-dose antibiotic therapy, transurethral resection and fulguration of the tumour.
Adult↗
[Management of urinary incontinence by an internal prosthesis].
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Adult↗
Immunoscintigraphic evaluation of lymph node involvement in prostatic carcinoma.
Five patients who were candidates for radical prostatectomy were investigated. One milligram of diethylene triamine pentaacetic acid derivatives of purified F(ab')2 fragments of monoclonal antibodies against prostatic acid phosphatase, labeled with 99mTc, were bilaterally injected into the periprostatic space. The amount of radioactivity injected varied between 3 and 7 mCi. Imaging took place dynamically for the first hour following injection, then at 6 and 24 hr. In one patient, lymph node metastases were detected in the left paraaortic, iliac, and obturator lymph nodes by this technique. The lesions incorporating radioactivity were confirmed to be metastases of prostatic cancer following staging pelvic lymphadenectomy. Immunolabeling electron microscopy studies revealed internalized antibody in prostatic cancer cells. In the four other patients, radioimaging did not show any lymph node metastases, and this negative finding was confirmed at surgery. These early data indicate the possibility of preoperative staging of prostatic cancer using radiolabeled derivatives of monoclonal antibodies raised against prostatic acid phosphatase and injected into the periprostatic area.
Acid Phosphatase↗
Intravesical prostaglandin F2 for promoting bladder emptying after surgery for female stress incontinence.
Prostaglandin F2 alpha 10 mg was administered intravesically in a double-blind placebo-controlled study to promote micturition in cases of urinary retention after operative treatment of urinary stress incontinence in women. Fifteen of 18 patients (83%) succeeded in voiding after treatment with prostaglandin F2 alpha, but the placebo was ineffective in all 18 patients (P less than 0.001). Although the effect of prostaglandin F2 alpha on bladder muscle contraction was short-lived, it seemed to enhance the restoration of bladder motor function with no serious side effects, and thus to be clinically useful in the treatment of post-operative urinary retention.
Administration, Intravesical↗
Effect of distension on function and nervous ultrastructure in the canine urinary bladder.
Canine bladders were distended for 4 h at 100 cm H2O to study the effects of distension on bladder function and structure. A micturition study was performed before overstretching, immediately after distension and 5 days after it. Bladder function was impaired immediately after distension, compliance and residual urine were increased and the maximum pressure during voiding decreased. The function returned to normal after 5 days. Overstretching caused diffuse or focal submucosal haemorrhages, only rarely fibrosis or necrosis of bladder wall. Electron microscopic changes of the bladder peripheral nerves were slight, the consistent finding being oedema in areas of outer mesoaxons and between cytoplasmic processes of Schwann cells. This change was sometimes accompanied by a rupture of the surrounding basement membrane. Axonal lysis was observed in one case. It is concluded that these anatomical changes, although found at the moment of functional recovery, may be linked to impaired conductivity of nerves in the bladder wall causing, at least partly, its impaired function. This may further decrease bladder instability and after urinary retention cause prolonged micturition problems. Functional recovery occurs, however, quite rapidly in healthy bladders.
Animals↗
A controlled, double-blind, cross-over study of terodiline in motor urge incontinence.
In a placebo-controlled, randomized, double-blind, cross-over study, terodiline (50 mg/d) was compared with emepronium (600 mg/d) in 20 patients with motor urge incontinence. Evaluation of clinical efficacy was based on changes in micturition pattern, flow measurements, residual urine, cystometry and patient preferences, and safety on adverse reactions, blood chemistry, urine examinations and ECG. The number of voluntary micturitions decreased from a mean of 21.5 per 48 h on placebo by 1.6 on terodiline and 2.8 on emepronium. Involuntary micturitions decreased from 3.6 per 48 h by 1.3 on both treatments (p less than 0.05). The maximal flow rate decreased from a mean of 24.5 ml/sec to 19.6 ml/sec on emepronium and increased to 25.4 ml/sec on terodiline. Residual urine decreased from a mean of 54 ml to 49 ml on terodiline and increased to 60 ml on emepronium. Volume at first desire to void in the supine position increased on emepronium by 44 ml (p less than 0.05) and on terodiline by 3 ml, on the upright position by 11 ml and 18 ml, respectively. Bladder capacity increased in the supine position on emepronium by 32 ml and decreased on terodiline by 8 ml, in the upright position increased by 9 ml and 5 ml, respectively. The bladder pressure at first desire to void in the supine position increased on emepronium by 2 cmH2O, and decreased on terodiline by 2 cmH2O. The intravesical pressure at strong desire to void decreased on emepronium by 6 cmH2O and on terodiline by 7 cmH2O, in the upright position by 2 cmH2O and 1 cmH2O, respectively. 39% of the patients preferred terodiline, 39% emepronium and 22% placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The treatment of incomplete bladder emptying in females by bladder neck incision.
Thirty females suffering from incomplete bladder emptying underwent bladder neck incision. All patients had undergone some form of therapy earlier without success. The bladder neck incision was often an alternative to repeated catheterizations or an indwelling catheter. In 7 patients (23%) the result was excellent, 12 other patients (40%) benefited from the operation. The role of this operation and possible complications is discussed.
Adult↗
Concentrations of androgens in human benign prostatic hypertrophic tissues incubated for up to three days.
Twenty-one samples of surgically removed benign prostatic hypertrophy (BPH) were brought to the laboratory either in an insulated container (ambient temperature) or on ice. They were cleaned and roughly minced at room temperature. In 18 cases, samples of up to 1 g were kept at various temperatures (4 degrees C, c. 20 degrees C, and 37 degrees C) for up to 77 h; some were taken for storage (-70 degrees C) at the beginning and others at various times within this period. In three cases, portions of tissue were incubated in liquid medium in the absence and presence of testosterone. The concentrations of six androgens (testosterone, 5 alpha-dihydrotestosterone (5 alpha-DHT), 5 alpha-androstane-3 alpha, 17 beta-diol, androstenedione, 5 alpha-androstanedione, and androsterone) were measured by radioimmunoassays. The results indicated that in conditions resembling those after death, the BPH tissue content of 5 alpha-DHT falls to a variable degree, while concentrations of 5 alpha-androstane-3 alpha, 17 beta-diol, 5 alpha-androstanedione, and androsterone increase. After 2 to 3 days, the 5 alpha-DHT concentrations remained greater than those reported previously from this laboratory (and others) in normal prostate tissue removed at autopsy.
Aged↗
Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by a small benign prostate? A randomized urodynamic study.
Transurethral electroresection of the prostate (TURP) was compared with bladder neck incision (BNI) in the treatment of 24 patients with urinary obstruction caused by a small benign prostate. An evaluation of the urodynamic findings and subjective symptoms was undertaken before the operation and 6 months afterwards. Thirteen patients underwent TURP and 11 BNI. All patients except one in the BNI group subjectively considered the result good. The urodynamic evaluation showed that the detrusor pressure at maximum flow rate decreased more in the TURP group than in the BNI group and the urethral pressure profile was shorter after the operation. The maximum flow rates after the operation were similar in both groups. Retrograde ejaculation developed in 62% of the patients after TURP but none after BNI. BNI is recommended for men under 60 years with minimal prostatic hypertrophy and with an active sexual life.
Aged↗
Postoperative urinary retention. I. Incidence and predisposing factors.
198 (3.8% comprising 4.7% of the males and 2.9% of the females) out of 5220 surgical patients developed total urinary retention postoperatively. The frequency of this condition increased with age and was highest after thoracotomies and endoprosthetic surgery of the hip joints. Voiding history was abnormal in 80% of the patients affected. Subclinical obstructive bladder dysfunction, over-distension of the bladder during the operation and in the recovery room after the operation, sympathomimetic and anticholinergic medication during or after anaesthesia, and an inability to stand or sit after surgery were common causes of retention. Premedication, type of anaesthesia, nature of the liquids given and postoperative analgetics seemed not to affect the incidence of retention. Postoperative urinary retention is an underestimated and mostly avoidable complication. Every patient should be asked for a urinary history before an elective operation. Infravesical obstruction should be relieved before any other elective surgical procedures are undertaken. In cases of emergency surgery prophylactic catheterization to prevent postoperative retention is recommended for patients with obstructive symptoms.
Adolescent↗
Postoperative urinary retention. II. Micturition problems after the first catheterization.
198 out of 5220 surgical patients were catheterized because of unexpected postoperative urinary retention. In 39% of cases micturition succeeded after the first catheterization of the overdistended bladder, but 61% (58% of the males and 66% of the females) developed more copolicated voided problems. The volume of fluids given intravenously during anaesthesia, the volume of primary urinary retention and increasing age were predisposing factors for prolonged micturition difficulties. Hospitalization was protracted because of postoperative urinary retention in 21 patients, and for 20 males prostatic surgery was necessary to relieve persistent retention.
Adolescent↗
Screening for carcinoma of the prostate. Rectal examination, and enzymatic and radioimmunologic measurements of serum acid phosphatase compared.
Veterans (n = 771, 54-76 years of age) from the Second World War, who attended a rehabilitation program arranged by the state between the years 1979 and 1983, were screened for prostatic cancer by rectal examination of the prostate and by measurement of serum prostate-specific acid phosphatase (PAP) concentration and enzyme activity (total and tartrate-labile). Nine cases with prostatic cancer confirmed by needle biopsy were found. Serum PAP concentrations were elevated in five of the nine cancer patients and rectal examination was positive in six of them, whereas the serum PAP concentration was elevated and rectal examination was positive simultaneously only in two patients. Serum PAP concentrations were elevated in 25 patients without prostatic cancer, and rectal palpation of the prostate resulted in 21 false-positive findings. The enzyme activity of serum acid phosphatase was not elevated in any of the nine patients diagnosed as having prostatic cancer. The predictive value of a positive finding in serum PAP concentration (16.7%) or rectal palpation of the prostate (22.2%) in this unselected, asymptomatic population was similar and low. Both tests together gave additive information.
Acid Phosphatase↗
Immunoreactive prostatic acid phosphatase in prostatic cancer: diagnosis and followup of patients.
We compared the measurements of serum acid phosphatase activity to those obtained by radioimmunoassay of prostatic acid phosphatase in the sera of 126 untreated prostatic cancer patients. The catalytic activity of prostatic acid phosphatase was elevated in 32 per cent of the patients and the serum concentration of prostatic acid phosphatase was elevated in 66 per cent. Of these 126 patients 16 had stage T0-2M0N0-x disease, and enzyme activity and prostatic acid phosphatase concentration were increased in 0 and 38 per cent, respectively, in this group. Of the 110 patients with proved extracapsular cancer the corresponding figures were 36 and 70 per cent, respectively. We followed 109 of these 126 patients for 1 or more years after orchiectomy. A salient finding was that return of elevated serum prostatic acid phosphatase concentration to the health-associated reference interval within 7 days following castration indicated no progression of the disease at 1 year irrespective of the initial staging. The same was not detected by the measurement of catalytic activity of serum acid phosphatase. Our findings substantiate data showing that the measurement of circulating prostatic acid phosphatase is achieved better by immunological techniques than by measurements of catalytic activity of the enzyme. A novel aspect is the usefulness of immunological prostatic acid phosphatase measurements in evaluation of the prognosis of patients with metastatic prostatic carcinoma following ablative endocrine treatment.
Acid Phosphatase↗
Immunoreactive prostate-specific acid phosphatase in prostatic cancer.
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Acid Phosphatase↗
Ligation of the left spermatic vein in the treatment of male infertility.
During a 5 year period 26 selected infertile men underwent surgical correction of varicocele. They were followed up for at least 1 year after surgery. Significant improvement was detected in sperm count and motility (%) of semen analysis after ligation of the internal spermatic vein. Eight of the wives became pregnant after operation. The correction of varicocele by ligation of the internal spermatic vein is an accepted treatment for male infertility.
Adult↗
Androgen concentrations in epithelial and stromal cell nuclei of human benign prostatic hypertrophic tissues.
Prostate tissues removed from patients with benign prostatic hypertrophy were separated into epithelial and stromal components and nuclei purified from these. The concentrations of testosterone, 5 alpha-dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, 4-androstene-3,17-dione, 5 alpha-androstanedione and androsterone in pooled preparations of the purified nuclei were determined by radioimmunoassays after the purification of solvent steroid extracts by Lipidex-5000 column chromatography. The most abundant androgen measured was 5 alpha-dihydrotestosterone and it was significantly (P less than 0.05) more concentrated in the stromal nuclei than in the epithelial nuclei. The mean concentration of androsterone was also significantly (P less than 0.05) greater in the stromal nuclei whereas that of testosterone was equal in the two nuclear types. The concentrations of 5 alpha-androstane-3 alpha,17 beta-diol, 4-androstene-3,17-dione and 5 alpha-androstanedione were below the sensitivity limits of the assays in the majority of cases, but the results indicated that when detectable the first two were more concentrated in the stromal than the epithelial nuclei. The results emphasize the importance of the prostatic stroma in androgen metabolism, and the relative concentrations of 5 alpha-dihydrotestosterone and testosterone indicated identical 5 alpha-reductase activities in the nuclei in comparison with respective whole cell epithelial and stromal preparations. 5 alpha-Dihydrotestosterone concentrations were clearly higher than the nuclear androgen receptor levels previously reported from this laboratory.
Androgens↗