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At least 1,189 records · Page 66Linked to original sources
PubMed1996

Interstitial cystitis--an update.

Interstitial cystitis is a rare chronic debilitating condition predominantly affecting middle-aged women. The diagnosis, made from the combination of symptoms, cystoscopic findings and bladder biopsies, is often delayed because GPs are often unaware of the condition. The precise aetiology remains obscure and it is clear that there is much research that needs to be undertaken to shed any light on the various current aetiological theories. There is a wide assortment of therapies already available and many more currently under trial. Until there is further progress in the pathogenesis of IC, it seems unlikely that non-operative treatment will consist of anything but palliation. The only potential cures currently available are cystectomy and urinary diversion or surgical replacement of the bladder by enterocystoplasty.

Cystitis, Interstitial↗
PubMed1996

Detrusor myopathy: an accurate predictor of bladder hypocompliance and contracture in interstitial cystitis.

OBJECTIVE: To determine whether any histological characteristics within the detrusor in cases of early interstitial cystitis (IC) predict the subsequent development of severe symptoms due to bladder contracture. PATIENTS AND METHODS: The detrusor muscle component of bladder biopsies from 21 patients with IC was examined in sections stained with haematoxylin and eosin. Videocystometrography was performed at least 2 months after the biopsy and the patients were then followed up clinically for at least 3 years. RESULTS: The detrusor appeared normal in 13 patients; in eight there was evidence of detrusor myopathy. Patients with biopsies confirming detrusor myopathy were significantly more likely to have hypocompliant bladders than those with normal detrusor muscle histology (P < 0.02). Over the following 3 years, six of the eight patients with detrusor myopathy developed progressively severe symptoms and required subtotal cystectomy and enterocystoplasty. None of the 13 patients without detrusor myopathy required bladder substitution. CONCLUSION: In IC, detrusor myopathy is associated with bladder hypocompliance. Patients with detrusor myopathy appear to have more severe disease and are more likely to progress to bladder contracture requiring substitution enterocystoplasty.

Contracture↗
PubMed1996

Bladder replacement by ileocystoplasty: the final treatment for interstitial cystitis.

OBJECTIVE: To develop and improve the technique of bladder replacement with ileum in patients with interstitial cystitis. PATIENTS AND METHODS: A consecutive series of 27 patients (23 women and four men, median age 61 years, range 40-79) with chronic severe interstitial cystitis refractory to conservative therapies underwent cystectomy and bladder replacement using an ileal pouch. The relief of pain was assessed over a median follow-up of 30 months (range 2-48). RESULTS: Pain relief was complete in all patients and the median neo-bladder capacity was 520 mL (range 350-700). Only four patients required intermittent self-catheterization to drain post-micturition residual urine. Bladder calculi formed in two patients and were removed successfully at cystoscopy. CONCLUSION: Bladder replacement with ileum in the form of the Kock pouch is an effective surgical treatment for intractable interstitial cystitis.

Adult↗
PubMed1997

Diagnosis and management of high-pressure peristaltic contractions in cystoplasties.

OBJECTIVE: To define the aetiology of and therapeutic strategy for high-pressure peristaltic contractions within colo- and caecocystoplasties associated with symptoms of frequency, urgency and urge incontinence. PATIENTS AND METHODS: In a series of over 150 subtotal supratrigonal colo- and caeco-cystoplasties, nine patients were identified with such symptoms. These patients underwent videocystometrography (VCMG) confirming the presence of phasic peristaltic contractions of > 35 cmH2O. RESULTS: In three cases, there was urodynamic evidence of outlet obstruction and symptoms resolved when the obstruction was surgically relieved. In the other six cases, high-pressure peristaltic contractions were present without bladder outlet obstruction. The symptoms did not respond to anticholinergic medication. Three of the six patients had tolerable symptoms which did not warrant further intervention. The other three cases had disabling urge incontinence and underwent ileal patch cystoplasty. The symptoms resolved in all three cases, although later recurred in one patient, probably due to incomplete division of the taenia coli during ileal patch cystoplasty. CONCLUSION: It appears that colonic smooth muscle can develop high-pressure contractions in response to neobladder outlet obstruction. Relieving the obstruction ameliorates symptoms associated with these contractions and reduces the magnitude of the peristaltic waves. Symptoms related to high-pressure peristaltic contractions without neobladder outlet obstruction do not respond to anticholinergic medication but can be successfully treated by ileal patch cystoplasty.

Adult↗
PubMed1998

Excision of residual masses of metastatic germ cell tumours after chemotherapy: the role of extraperitoneal surgical approaches.

OBJECTIVE: To evaluate the efficacy and safety of extraperitoneal surgical approaches for the removal of residual masses of metastatic germ cell tumours in men after chemotherapy. PATIENTS AND METHODS: A series of 75 men (median age 32 years) with metastatic germ cell tumours of testicular (n = 63) or extragonadal (n = 12) origin, who had been treated with an intensive course of platinum-based chemotherapy, were found to have residual tumour masses. Extraperitoneal surgical approaches were used on 80 occasions to excise these masses. A thoraco-abdominal extraperitoneal approach (n = 71) was used for large masses and those with intrathoracic metastases while smaller retroperitoneal masses were removed through 12th rib (n = 5) or Rutherford-Morrison (n = 4) extraperitoneal approaches. RESULTS: Complete macroscopic clearance of residual masses within the thorax and retroperitoneum was achieved in all cases. The median blood loss was 0.8 L and the median in-patient stay was 7 days. Complications included chest infection in four cases. Two patients died about 4 weeks after surgery, one from septic pericarditis and another after an epileptic fit secondary to brain metastases. Eleven patients have developed tumour recurrence, five of whom have died from disseminated disease. Hence the survival rate and disease-free survival rate are 91% and 83%, respectively, with a median follow-up of 22 months. CONCLUSIONS: The thoraco-abdominal extraperitoneal surgical approach for retroperitoneal lymph node dissection after chemotherapy for testicular cancer is safe and has some advantages over anterior approaches, allowing synchronous removal of intrathoracic disease, improved access to nodes above and behind the renal vessels and more rapid post-operative recovery.

Adolescent↗
PubMed2003

Squamous cell carcinoma antigen: a role in the early identification of nodal metastases in men with squamous cell carcinoma of the penis.

OBJECTIVE: To evaluate whether serum squamous cell carcinoma antigen (SCCAg) measurements may be of use in identifying nodal metastases in patients with SCC of the penis after treating the primary tumour. PATIENTS AND METHODS: The levels of SCCAg were analysed in 11 men with penile SCC between 1994 and 2001. RESULTS: An elevated SCCAg level had a sensitivity of 57% (95% confidence interval, CI, 18-90%) and a specificity of 100% (CI 40-100%) for nodal metastases. Levels of SCCAg increased exponentially in patients who developed nodal metastases after treatment of the primary tumour, and were elevated before clinical or radiological evidence of nodal disease. CONCLUSION: Either the absolute level or the rate of rise of SCCAg may be a useful tool with which to follow patients after excision of the primary tumour. It may be more sensitive than computed tomography and magnetic resonance imaging in detecting recurrence, but further evaluation is needed.

Antigens, Neoplasm↗
PubMed1999

Plateletpheresis efficiency: a comparison of the spectra LRS and AMICUS separators.

BACKGROUND: Optimizing the yields of plateletpheresis by increasing collection efficiencies may provide several benefits: to patients, by increasing the dose in single-donor platelet (SDP) units; to the collection center, by increasing the percentage of components that may be split into double units; and/or to the donor, by reducing the duration of donation. STUDY DESIGN AND METHODS: A prospective, randomized study was undertaken to compare the efficiency of platelet collection in paired donations by 21 donors on two cell separators (Spectra LRS, version [v] 5.1; and AMICUS, v2.37). The order of donation was randomly assigned; donations were performed at least 2 weeks apart. A fixed blood volume (4000 mL) was processed by utilizing standard protocols. Findings were confirmed in a retrospective, matched study that compared the two separators by using fixed collection times (90 min). RESULTS: The AMICUS and Spectra LRS separators consistently produced white cell-reduced (<1 x 10(6) white cells) components. The AMICUS harvested 32 percent more platelets on average (median, 4.9 x 10(11); range, 1.5-8.7 x 10(11)) than the Spectra LRS (median, 3.7 x 10(11); range, 2.1-7.7 x 10(11)) (p = 0.03), with mean times of 71.5 and 66.0 minutes (p = 0.03), respectively, to process 4000 mL. Mild donor reactions tended to be more common on the AMICUS separator, which used significantly more ACD (median 482 mL vs. 389 mL; p<0.0001) than on the Spectra LRS. CONCLUSIONS: The AMICUS separator harvested more platelets per unit of blood volume processed than the Spectra LRS. Possible benefits include increased dose in each single-donor unit, increased double-unit harvests, and/or shorter donation time.

Cell Separation↗