Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combinationu / Nefrolitectomía percutánea tubeless con posibilidad de reexploración: la combinación perfecta

Objectives: To evaluate an alternative approach to tubeless surgery that allows a second per- cutaneous procedure using the same nephrostomy tract. Methods: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephros- tomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. Results: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. Conclusion: We present a safe and simple modification of tubeless percutaneous nephrolitho- tomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.(AU)

Objetivos: Evaluar una sencilla modificación de la nefrolitectomía percutánea tubeless que permita un segundo procedimiento endoscópico utilizando el mismo trayecto percutáneo. Métodos: Veinte pacientes fueron sometidos a nefrolitectomía percutánea en decúbito supino modificado entre septiembre de 2012 y mayo de 2013 en nuestro centro. Los criterios de inclusión para el estudio fueron: ausencia de infección urinaria, punción única y tiempo opera- torio menor de 2 h. Al finalizar el procedimiento se instaló una rienda de sutura en el extremo del catéter ureteral, quedando exteriorizada a través del trayecto de nefrostomía para su recuperación en caso de necesidad. Se realizó tomografía computarizada o radiografía simple a todos los pacientes el primer día postoperatorio. Si el paciente estaba «libre de cálculos¼, el catéter ureteral fue retirado junto con la sonda Foley. En caso de litiasis residual se realizó un segundo procedimiento percutáneo, utilizando el mismo trayecto inicial, exteriorizando el catéter ureteral a través del trayecto de la nefrostomía. En todos los pacientes se objetivaron las complicaciones postoperatorias, la estadía hospitalaria y la presencia de litiasis residual, además de la caída del hematocrito y la creatinina. Resultados: Trece pacientes cumplieron los criterios de inclusión. No hubo complicaciones may- ores relacionadas con la colocación del catéter ureteral y su exteriorización. Dos pacientes requirieron una segunda intervención percutánea, lograda con éxito mediante el uso del catéter ureteral reexteriorizado. Conclusión: Se presenta una modificación segura y sencilla de la nefrolitectomía percutánea tubeless sin renunciar a la posibilidad de recuperar el trayecto de nefrostomía original.(AU)

Embolización de riñón poliquístico: una alternativa menos invasiva a la nefrectomía pre-trasplante / Embolization of polycystic kidney: a less invasive alternative to pretransplant nephrectomy

La embolización arterial de riñón poliquístico, en candidatos a trasplante renal, es una técnica recientemente descrita que pudiese servir como alternativa a la nefrectomía a objeto de generar el espacio suficiente para el injerto. Materiales y Métodos: Presentamos el caso de un paciente varón de 57 años con enfermedad renal crónica secundario a enfermedad renal poliquística familiar autosómica dominante en hemodiálisis. Los riñones ocupaban completamente el abdomen y pelvis. Se le realizó embolización del riñón derecho y se controló con Tomografía Axial Computada de abdomen y pelvis sin contraste cada 3 meses. Resultados: El procedimiento se realizó sin complicaciones, salvo el intenso dolor lumbar posterior al procedimiento que requirió altas dosis de analgesia endovenosa. Se logró una disminución del volumen renal de un 46 por ciento en 6 meses, creando así espacio suficiente para el alojamiento del injerto renal. A los 9 meses se realizó el trasplante, evolucionando con adecuada función del injerto. Conclusión: La embolización arterial renal es una técnica efectiva, poco invasiva y con baja morbilidad, la cual puede ser utilizada para la disminución del volumen renal, en pacientes con riñones poliquísticos, a objeto de crear suficiente espacio para un trasplante renal...

Renal arterial embolization of polycystic kidneys in renal transplant candidates has been recently described as an alternative to nephrectomy for generating enough space for the renal graft. Materials and Methods: We present the case of a 57 year old male patient, with chronic renal failure in hemodialysis, secondary to autosomal dominant polycystic kidney disease. The cystic kidneys completely occupied the abdomen and pelvis leaving no space for a renal transplant. Right renal arterial embolization was performed. The patient was followed up with unenhanced computed tomography every 3 months. Results: Right renal embolization was performed without complications, except the severe low back pain, which required high doses of intravenous analgesia. Renal volume decreased by 46 percent in 6 months, making enough space for the renal graft. Nine months after embolization, renal transplant was carried out on the right iliac fossa with no complications and with immediate graft function. Conclusion: Renal arterial embolization is an effective, less invasive and safer technique that can be used to reduce renal volume and make enough space for a renal transplant...

Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination.

OBJECTIVES: To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract. METHODS: Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. RESULTS: Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. CONCLUSION: We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.

Resultados perioperatorios de la nefrectomía parcial abierta versus laparoscópica. Experiencia del Hospital Militar de Santiago / Perioperative outcomes of open versus laparoscopic partial nephrectomy. Experience the Military Hospital of Santiago

INTRODUCCIÓN: La nefrectomía parcial laparoscópica (NPL), es una cirugía ampliamente aceptada para lesiones sólidas delriñón y representa una alternativa a la nefrectomía abierta (NPA). El objetivo del trabajo es realizar un análisis comparativo de los resultados perioperatorios y las complicaciones entre ambas técnicas en tumores renales órgano-con nados menores de 7 cm (T1). PACIENTES Y MÉTODOS: Estudio descriptivo comparativo. Se revisaron 74 pacientes entre 2000 y 2013; 25 NPLy 49 NPA. Se analizó: tiempo de isquemia, variación de hematocrito y creatinina, necesidad de reintervención, porcentaje decomplicaciones y transfusión y la presencia de bordes quirúrgicos comprometidos por neoplasia. RESULTADOS: La variaciónde hematocrito preoperatorio menos postoperatorio fue 7.2 puntos (p<0.05). Según tipo de cirugía, 6.3 puntos para NPAvs 9.04 para NPL (p=0.07). La variación de creatinina post-pre según tipo de cirugía, fue NPA: 0.29 vs NPL: 0.09 (p= 0.22). El tiempo de isquemia promedio fue de 20.0 minutos; 18.4 minutos vs 22.3 minutos para NPA y NPL, respectivamente (p=0.26).La tasa de complicaciones fue 20% vs 6,12% para NPL y NPA, respectivamente (p=0.069). De los pacientes sometidos aNPL, 4 presentaron sangrado: 1 hemoperitoneo (4%), 2 hematoma retroperitoneal (8%) y 1 sangrado de lecho operatorio(4%). Además, 1 paciente presentó un pneumotórax. De los pacientes sometidos a NPA, 1 presentó una sepsis de focourinario (2%), 1 sangrado de lecho operatorio (2%) y 1 un hematoma autolimitado (2%). Respecto al resultado oncológico inmediato, 10.96% de las intervenciones tuvo márgenes positivos, 12% vs 10.2% para NPL vs NPA respectivamente. Estadiferencia no alcanzó significancia estadística (p=0.68)...

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) is a widely accepted surgery for solid lesions of the kidney and isan alternative to open nephrectomy (NPA). The objective of this work is to perform a comparative analysis of perioperative outcomes and complications between the two techniques in organ-con ned renal tumors less than 7 cm (T1).PATIENTS AND METHODS: A comparative descriptive study. 74 patients between operated between 2000 and 2013 werereviewed; 25 NPL and 49 NPA. We analyzed ischemia time, creatinine and hematocrit variation, need for reoperation,complications and transfusion rate and the presence of surgical margins involved by neoplasia. RESULTS: The preoperative minus postoperative hematocrit variation was 7.2 points (p <0.05). According to type of surgery, 6.3 points for NPA vs 9.04for NPL (p = 0.07). The change in creatinine by type of surgery was NPA: 0.29 vs NPL : 0.09 (p = 0.22). The mean ischemiatime was 20.0 minutes; 18.4 minutes vs 22.3 minutes for NPA and NPL, respectively (p = 0.26). The complication rate was 20% vs 6.12% for NPL and NPA, respectively (p = 0.069). Of patients undergoing LPN, 4 had bleeding: 1 hemoperitoneum(4%), 2 retroperitoneal hematoma (8%) and 1-surgical-bed bleeding (4%). In addition, 1 patient presented a pneumothorax.In patients undergoing NPA: 1 had urinary sepsis (2%), 1 surgical-bed bleeding (2%) and 1 self-limited hematoma (2%).Regarding the immediate oncological outcome, 10.96% of the interventions had positive margins 12% vs 10.2% for NPL vsNPA respectively. This diference did not reach statistical significance (p = 0.68)...

Litotricia extracorpórea versus ureterolitectomía endoscópica para el manejo de litiasis de uréter distal. Costos asociados. Experiencia del Hospital Militar de Santiago / Extracorporeal shock wave lithotripsy versus endoscopic ureterolithectomy for management of distal ureteral stones. Associated costs. Experience the Military Hospital of Santiago

INTRODUCCIÓN: La ureterolitiasis distal (UD) es una patología prevalente. Su tratamiento quirúrgico es con litotricia extracorpórea(LEC) o ureteroscopía (URS), ambas con tasa libre de cálculo (TLC) sobre 90% y mínimas complicaciones. El objetivode este trabajo es comparar la TLC luego de la primera intervención y su costo asociado. Además, comparar el costo totaltratándolos con LEC o URS. PACIENTES Y MÉTODOS: Estudio descriptivo comparativo, que muestra el costo económicode LEC vs URS para tratamiento de UD entre 2009 y 2013. Se incluyeron 107 pacientes; 47 URS y 60 LEC. Se analizaronnúmero de días hospitalizados, necesidad de reintervención y costo total de atención médica. Los costos se ajustaron alvalor actual de la prestación. Se describió la TLC en ambos procedimientos. Se obtuvo el costo total de hospitalizacióny se compararon las variables de interés. RESULTADOS: l tamaño de litiasis fue 8.21mm versus 7.39mm para URS y LEC,respectivamente (p=0.24). Luego de la primera intervención, la TLC fue 97.8% para URS y 80% para LEC (p=0.007). En LEC,12 pacientes requirieron retratamiento elevando la TLC a 95%, (p=0.13). Se instaló catéter JJ en 53.1% y 18.3% para URS yLEC, respectivamente (p<0.001). El costo de honorarios médicos, insumos y derecho a pabellón, es $460.838 para URS y$1.243.075 para LEC. El número de días de hospitalización post procedimiento fue 1.6 y 1.71 días para URS y LEC, respectivamente(p=0.86). En relación con los costos totales, la LEC en promedio, es un 132% más cara respecto a la URS (p<0.001)...

INTRODUCTION: Distal ureterolithiasis (UD) is a common disorder. Its treatment is surgical either with extracorporeal lithotripsy(LEC) or ureteroscopy (URS), both with a stone free (TLC) over 90% and minimal complications. The aim of this studyis to compare the TLC after the rst intervention and its associated cost. Also, compare the total costs of treatment with LECor URS. PATIENTS AND METHODS: A comparative descriptive study, which shows the economic cost of LEC vs UD URS fortreatments performed between 2009 and 2013. 107 patients were included; 47 URS and 60 LEC. Number of hospitalizationdays, reoperation and total cost of care were analyzed. Costs were adjusted to present charges for the same procedures. TLC was described in both proceedings. The total cost of hospitalization was obtained and the variables of interest werecompared. RESULTS: Stone size was 8.21mm versus 7.39mm URS and LEC, respectively (p = 0.24). After the rst intervention,TLC was 97.8% for URS and 80% for LEC (p = 0.007). In LEC, 12 patients required retreatment raising the TLC to 95% (p = 0.13).JJ catheter was installed in 53.1% URS and 18.3% LEC, respectively (p <0.001). The cost of medical supplies, operation roomand physician fees was $460.838 for URS and $1.243.075 for LEC. The number of hospitalization days post procedure was1.6 and 1.71 days for URS and LEC, respectively (p = 0.86). In relation to total costs, LEC is on average, 132% more expensivewhen compared to URS (p <0.001)...

[Single-session extracorporeal shock wave lithotripsy for urinary calculi: factors predicting success after three weeks of follow-up]. / Factores predictivos de éxito tras una sesión única de litotricia extracorpórea de cálculos urinarios a las tres semanas de seguimiento.

INTRODUCTION: The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center. MATERIAL AND METHODS: The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses. RESULTS: The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis. CONCLUSIONS: Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.

[Prepatency, parasitemia and histological lesions in mice infected with two Trypanosoma cruzi populations isolated in Chile]. / Concordancia de lesiones histológicas en ratones infectados por dos poblaciones de Trypanosoma cruzi de Chile.

BACKGROUND: The great variability in the clinical presentation of Chagas disease may depend in part in the genetic variability of Trypanosoma cruzi populations. AIM: To compare prepatent period, parasitemia, mortality and histological lesions in mice infected with two populations of Trypanosoma cruzi isolated in Chile. MATERIAL AND METHODS: Two Trypanosoma cruzi populations, isolated from Chilean Triatomides and genetically characterized by kinetoplast restriction fragment DNA profiles, were compared. Two groups of 40 Balb/c mice were studied. Each mouse was inoculated with 10(4) trypomastigotes, of the V-121 and sp COMB 2 Trypanosoma cruzi populations. The prepatent period, parasitemia, mortality and histopathological lesions, at different evolutionary stages of infection were registered during 32 days. RESULTS: Prepatency and mortality were similar in both groups of mice. However, parasitemia was significantly greater in mice inoculated with V-121 than those inoculated with sp COMB 2. Amastigote pseudocysts and inflammation were present only in skeletal muscle and myocardium in both groups of mice. The intensity of tissue involvement was associated to the level of parasitemia, therefore it was greater in mice inoculated with V-121 population. CONCLUSIONS: V-121 population of Trypanosoma cruzi caused a greater parasitemia than COMB 2, in inoculated mice.

Concordancia de lesiones histológicas en ratones infectados por dos poblaciones de Trypanosoma cruzi de Chile / Prepatency, parasitemia and histological lesions in mice infected with two Trypanosoma cruzi populations isolated in Chile

Background:The great variability in the clinical presentation of Chagas disease may depend in part in the genetic variability of Trypanosoma cruzi populations. Aim: To compare prepatent period, parasitemia, mortality and histological lesions in mice infected with two populations of Trypanosoma cruzi isolated in Chile. Material and methods: Two Trypanosoma cruzi populations, isolated from Chilean Triatomides and genetically characterized by kinetoplast restriction fragment DNA profiles, were compared. Two groups of 40 Balb/c mice were studied. Each mouse was inoculated with 104 trypomastigotes, of the V-121 and sp COMB 2 Trypanosoma cruzi populations. The prepatent period, parasitemia, mortality and histopathological lesions, at different evolutionary stages of infection were registered during 32 days. Results: Prepatency and mortality were similar in both groups of mice. However, parasitemia was significantly greater in mice inoculated with V-121 than those inoculated with sp COMB 2. Amastigote pseudocysts and inflammation were present only in skeletal muscle and myocardium in both groups of mice. The intensity of tissue involvement was associated to the level of parasitemia, therefore it was greater in mice inoculated with V-121 population. Conclusions: V-121 population of Trypanosoma cruzi caused a greater parasitemia than COMB 2, in inoculated mice.

Experiencia en prostatectomía radical laparoscópica / Experience in laparoscopic radical prostatectomy

La prostatectomía radical laparoscópica (PRL) es una nueva técnica quirúrgica que surge como alternativaa la prostatectomía radical abierta con el fin de reducir su morbilidad. Presentamos nuestra experienciainicial en PRL.Revisión retrospectiva de 17 pacientes operados entre marzo 2002 y agosto 2003 por PRL, por cáncer depróstata localizado, en 3 centros hospitalarios. Nueve pacientes fueron operados por vía transperitonealy 8 por vía extraperitoneal, sin conservación de bandeletas. Dos pacientes fueron sometidos alinfadenectomía íleo obturatriz. PSA preoperatorio promedio fue 9,5 ng/ml (rango 5,5-16,8).El tiempo operatorio promedio fue 5,1 h (rango 2,5-7), la mediana de sangrado estimado fue 500 cc(rango 100-2000 cc), con 2 transfusiones. Hubo 3 conversiones, una por tiempo prolongado de cirugía,otra por lesión de arteria epigástrica con hemorragia profusa y otra por imposibilidad de encontrar elcuello vesical. Hubo 3 complicaciones intraoperatorias resueltas por vía laparoscópica, lesión de arteriaepigástrica, perforación de vejiga, lesión de recto. La mediana de hospitalización fue 5 días (rango 4-19).La mediana de tiempo de catéter vesical fue de 6 días (rango 4 a 24). Hubo una fístula urinaria. Laetapificación patológica fue T2a (12 porciento), T2b (70 porciento), T3a (18 porciento), con 1 margen positivo en un pacienteT3a. La mediana de seguimiento fue de 3 meses (rango 1-15), con una sobrevida libre de tumor a 3 mesesde 95 porciento. Una continencia nocturna de 100 porciento y una continencia diurna de 85 porciento sin paños y de 15 porciento usando un paño.La prostatectomía radical laparoscópica es una técnica factible de realizar, que requiere una larga curvade aprendizaje para reducir los prolongados tiempos operatorios y la morbilidad perioperatoria. Se requierede un buen material laparoscópico y de un equipo quirúrgico afiatado y motivado (cirujanos,anestesista, arsenalera y personal de pabellón) para lograr resultados comparables a la técnica abierta.

Diferencias de resultados quirúrgicos de trasplantes renales según lugar de procuramiento / Differences in surgical results of renal transplants according to place of harvesting

Es frecuente durante el procuramiento de riñones en donante cadáver dejar el mejor riñón para el hospital de origen (riñón casa) y la otra unidad para el pool nacional. Es así que la mayoría de los riñones derechos, por tener una vena más corta, o riñones con más de una arteria o una vena, o la sospecha de lesión de uréter van al pool nacional, lo que por lo general implica una mayor dificultad técnica en el momento del trasplante. El objetivo de este trabajo es comparar las complicaciones quirúrgicas de los riñones trasplantados de riñones casa versus los del pool nacional. De los 212 trasplantes realizados 185 (87,2 por ciento) provienen de trasplante cadáver. 97 riñones (62,4 por ciento) proviene del pool nacional y 88 (47,6 por ciento) de las unidades casa. El promedio de isquemia fría en riñones pool fue de 21,9 horas versus 19,1 de los riñones casa y el isquemia caliente 40,9 minutos versus 41,7 minutos respectivamente. Se presentaron 3 complicaciones vasculares en los riñones casa versus 5 en los de riñones pool. En cuanto a las complicaciones urológicas 10 fueron de riñones casa versus 7 de riñones pool. La mayoría de los pacientes que se trasplantaban en el Hospital del Salvador son de donantes cadáver. Aunque no existe una diferencia significativa en cuanto al tiempo operatorio reflejado en los tiempos de isquemia caliente, si existe una mayor proporción de complicaciones vasculares de los riñones provenientes del pool nacional versus los casa (6 versus 3). En cuanto a las complicaciones urológicas se observa una mayor tasa en los provenientes de las unidades casa (10 casa versus 7 pool). La principal complicación que presentan los riñones provenientes del pool nacional son de origen vascular.

Tratamiento del cáncer vesical superficial con BCG intravesical con dósis intermedia (27-60 mg) / Treatment of superficial bladder cancer with intravesical BCG with intermediate doses

La historia natural del cáncer vesical superficial se caracteriza por una alta tasa de recidiva, de hasta un 70 porciento y una progresión de un 30 porciento. La terapia intravesical con BCG ha utilizado dósis altas, mayores de 100 mg, con buenos resultados pero con una alta incidencia de efectos colaterales y dósis bajas (0,5-2 mg) con escasos resultados en disminuir la recurrencia y progresión. Este trabajo analiza en forma prospectiva los resultados de la terapia intravesical con dósis intermedias, 27 a 60 mg y evalúa sus resultados y efectos adversos.

[Laparoscopic cholecystectomy and percutaneous echo-guided cholecystostomy. Their applications in acute cholecystitis]. / Colecistectomia laparoscopica e colecistostomia percutanea ecoguidata. Applicazioni nella colecistite acuta.

Laparoscopic cholecystectomy is nowadays proposed as elective treatment in acute cholecystitis; the advantages obtained with this method are comparable with those of laparoscopic cholecystectomy outside inflammatory complications. Moreover in emergency we have the advantage of better diagnostic definition and less surgical trauma. When acute cholecystitis affects high risk patients from the anesthesiologic view percutaneous US-assisted cholecystostomy is considered more valuable than the medical conservative treatment. Drainage of gallbladder is followed from a dramatic clinical improvement with more time for a laparoscopic cholecystectomy or for a percutaneous lithotripsy or eventually for the simple withdrawal of the catheter.

Electromagnetic shock-wave lithotripsy of gallbladder calculi. Multicentered preliminary report on experience with 276 patients.

The Lithostar Working Group reports on the first 276 patients who underwent lithotripsy of biliary calculi by means of an electromagnetic Lithotriptor (Lithostar Plus from Siemens). Some 66% (183/276) and 27% (75/276) of the patients had solitary and two or three stones, respectively while 7% (18/276) had more than three gallbladder calculi. Calcified calculi were found in 11% of the patients. On an average the patients were treated in 1.6 (range 1.4-2.15) sessions; with the exception of one user the maximal energy (setting 9) was applied. The upper limit of shock waves per session was 1500-6000 (x = 2189 +/- 1058). 17% and 48% of the patients were free from calculi after 3 and 6 months, respectively. During the follow-up period 14% of the patients complained of severe biliary pain and 1.5% suffered from pancreatitis, which was controlled by conservative treatment. In three out of five patients with a transitory cholestatic jaundice endoscopic papillotomy was necessary. Four patients underwent an elective cholecystectomy. Considering the selection of the patients, the results obtained are comparable with those found in other studies.

Experimental study on the action of diltiazem on detrusor muscle and clinical evaluation in patients with detrusor hyperactivity.

Diltiazem added to the medium before administration of the agonist, caused a concentration-dependent antagonism of potassium chloride-induced contractions in strips of rat detrusor and human detrusor. When added at the time of peak potassium chloride-induced increase in muscle tone, the drug lowered the tone gradually and concentration-dependently. Diltiazem also depressed carbachol-induced contractions. In patients with disturbances of micturition due to detrusor hyperactivity, oral diltiazem (Angizem) treatment for 10 days significantly increased bladder capacity, lowered bladder pressure and maximum detrusor pressure and raised the threshold of the second sensation of micturition. In addition, diltiazem significantly reduced frequency of diurnal and nocturnal micturition and number of episodes of incontinence. Diltiazem appears to be an effective detrusor muscle relaxant and may be useful for the treatment of disturbances of micturition due to detrusor hyperactivity.