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Biomedical subjects

R C Feneley

Publications and source records attributed to R C Feneley.

At least 37 records · Page 2Linked to original sources
PubMed1992

Ureteric stone management using a second generation lithotriptor.

A series of 209 consecutive patients with ureteric calculi underwent 296 extracorporeal shock wave lithotripsy treatments on the Siemens Lithostar over a 25-month period; 123 stones were upper ureteric, 30 mid-ureteric and 56 lower ureteric; 46.9% were right-sided stones, 53.6% were left-sided and 0.5% (1 patient) were bilateral. On referral, 60 patients had stents and 15 had nephrostomies for obstruction. All treatments were performed without anaesthesia except for 9 patients in whom stent insertion or ureteroscopic manipulations were attempted concomitant to ESWL. The average number of treatments was 1.42, with 27.5% of patients requiring more than 1 treatment. The average number of shocks per treatment was 3995 and the average hospital stay was 1.79 days. Complete clearance of the stone was achieved in 82% of upper ureteric stones, 89% of mid-ureteric and 80% of lower ureteric stones. The facility for X-ray localisation of stones allows a high proportion of ureteric calculi to be treated successfully by ESWL, including the more taxing middle and lower ureteric calculi.

Adolescent↗
PubMed1992

Extracorporeal shock wave lithotripsy for renal calculi in children.

Fifteen children (8 male and 7 female) with an age range of 18 months to 15 years were treated with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Two children had a history of metabolic stone disease and 1 child had previously undergone open stone surgery. Four children were treated with a ureteric stent in place and 1 nephrostomy was inserted before treatment. All children were treated under general anaesthesia and all of the stones treated were confined to the kidney and ranged in size from 5 mm to a complete staghorn. The number of treatments ranged from 1 to 6 and generator voltage ranged from 16 to 19 kV with a maximum number of 30,000 shocks to a complete staghorn. Complications were minimal, with 3 children presenting with colic, 1 child requiring a stent and none requiring a nephrostomy after treatment. The overall stone clearance rate at 3 months was 65%. ESWL provides an effective treatment for selected calculi in children. In the short term, complications are minimal but the long-term effects on children need to be monitored.

Adolescent↗
PubMed1992

Urological audit: the role for an aggressive approach to high grade superficial bladder tumours.

A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.

Adult↗
PubMed1992

A departmental audit of patients with bladder cancer.

In keeping with the recent demands of the Department of Health for medical audit in clinical practice, an audit was undertaken of the management of bladder cancer patients in a large department of urology having three consultants with varied approaches of management. This study revealed interesting controversial areas for further scrutiny. For example, the poor prognosis of grade 3 T1 tumours with and without associated carcinoma-in-situ (CIS) and the speed of progression to invasive disease have indicated that a change to a more aggressive approach to the management of these tumours is necessary. High recurrence rates at the site of the original tumour (60%) and the presence of CIS also indicate the need for expert and thorough initial tumour assessment. The delays in diagnosis and treatment lend further support to the need for a 'haematuria clinic' to minimise such delays, which may influence prognosis. To reduce the occurrence of systematic errors in the recording, follow-up and surveillance of patients with bladder cancer, a protocol is suggested for a structured approach to optimise results, particularly in the poor prognostic categories.

Adult↗
PubMed1991

Mobile versus fixed site lithotripsy.

The efficacy of a mobile Dornier HM4 lithotriptor, was compared with that of a fixed site Siemens Lithostar. A total of 115 calculi in 98 patients were treated, 55 on the mobile Dornier and 60 on the Lithostar. The groups were similar except for stone size, the mean of the Lithostar group being 11 mm compared with 7.7 mm in the Dornier group. Fragmentation rates were not significantly different, 88% and 75% on the mobile and fixed site machines, respectively and, at 3 months follow-up 66% and 46% were stone free or with fragments of less than 2 mm. There were no serious complications, and the incidence of mild complications was similar in the two groups. We conclude that the mobile Dornier HM4 is an effective lithotriptor and can offer several advantages over fixed site machines.

Female↗
PubMed1989

Urethral closure in management of urinary incontinence.

Urethral closure with suprapubic catheterization has been used in 50 patients with urethral destruction due to an indwelling catheter. Thirty-seven of the patients were dry after the initial operation. Long-term complications were seen in 33 patients. Those that did occur were not life threatening. This relatively minor procedure offers a good alternative to formal diversion in this group of severely disabled patients.

Adult↗
PubMed1988

Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy?

A randomised, prospective trial comparing transurethral prostatectomy with conservative management was carried out in 38 men with proven bladder outflow obstruction. Patients were assessed urodynamically before treatment and 6 months later. All 21 patients who had a prostatectomy showed a significant improvement in peak flow rate, voiding pressures and residual urine volume, but only 71% were symptomatically better. Of the 17 patients treated conservatively, 56% noted an improvement in their symptoms, although their peak flow rates and residual urine volume were virtually unchanged. Following prostatectomy, the incidence of detrusor instability fell by 78%, whereas in the conservatively treated group the reduction was only 50%. Patients who had done well or badly after treatment were analysed as separate subgroups. The single feature which distinguished between these two groups was the high incidence of reversion to bladder stability in those who had a good symptomatic response to treatment.

Aged↗
PubMed1987

Enuresis at 25.

Explore the source record for details and available documents.

Adult↗
PubMed1986

Identification of the poor risk patient with "prostatism" and detrusor failure.

Twenty-five patients with "prostatism" and chronic retention of urine have been followed up for 4 years to determine the natural history of the disorder and results of elective treatment. Twenty-one patients with low pressure during bladder filling maintained normal upper tracts and renal function; they were subdivided by micturition pressure into two groups which differed significantly in terms of both total bladder capacity and variance of capacity. Patients with good voiding pressures had a very satisfactory outcome following surgery, with almost complete relief of symptoms, but patients with poor voiding pressures obtained a poor symptomatic and urodynamic result from repeated surgical procedures. Four patients declined operation and the subsequent course of the disorder is described. Four patients had painless retention associated with high pressure bladder filling, hydronephrosis and uraemia. Operation was successful in reversing these potentially terminal complications. None of the 25 patients developed acute retention. Men with "prostatism" do not constitute a homogeneous population. Identification of specific patient groups enables an accurate prediction of the consequences of both conservative and operative management.

Adult↗
PubMed1985

Treatment of bladder carcinoma with tumor-immune pig lymph node cells. Phase I study.

A total of 77 patients with invasive TCC of the urinary bladder each received a single arterial injection of tumor-immune pig lymph node cells (LNC), into the tumor blood supply. The patients were divided into 4 groups: those receiving pig LNC as the only treatment (16 patients); those who received pig LNC on relapse (judged by EUA cystoscopy and biopsy) following radical radiotherapy, 5,500 cGy (34 patients); those who received pig LNC followed after an interval of six weeks by radiotherapy, 4,000 cGy (10 patients); as in Group 3 but with the dose of radiotherapy increased to 5,500 cGy (17 patients). Complete remission was characterized by complete disappearance of the tumor (for a varying time) following treatment. Partial remission was defined as: a reduction in the level of symptoms and a decrease in tumor size on EUA and/or cystoscopy. There were 1 complete and 3 partial remissions among the patients in Group 1, 5 complete and 7 partial in Group 2, 6 complete and 2 partial in Group 3, and 8 complete and 1 partial in Group 4. Of the 20 patients showing complete remission, 7 lived for more than five years after treatment.

Animals↗
PubMed1984

Acute urinary retention--a urodynamic assessment.

Thirty male patients with acute urinary retention were studied by standard urodynamic techniques on admission to hospital. Ten individuals also underwent cystography and sequential urodynamic testing over 96 h. Twenty-three per cent of patients did not require subsequent prostatectomy. Inability to initiate a voiding contraction during cystometry at the time of admission was associated with a prolonged duration of retention and a greater retained volume. The internal urethral meatus is closed in retention, and release of the retention results in an increase in profile length and maximum urethral closure pressure and a decrease in maximum urethral pressure. Free catheter drainage was associated with a reduction in bladder capacity and the appearance of detrusor instability.

Acute Disease↗