Clinical experience with the saphena loop arteriovenous fistula on the thigh.

The increasing number of patients on regular dialysis treatment (RDT) for many years produces a number of problems, one of which is the vascular access procedure. When the internal subcutaneous fistula cannot be used either as the first procedure or after some years of treatment, alternative methods are necessary. We present here clinical experience with the saphenous vein arteriovenous fistula placed on the upper thigh in 8 patients. The function was insufficient with a flow rate of about 125 ml/min and the complication rate was very high with development of 5 haematomas, 1 thrombosis and 1 case of severe oedema. Far more serious, however, the recording of 2 fatal external bleeding episodes. According to the literature, clinical experience with this procedure is very limited in other centres. From our experience we would not recommend this procedure and from the 2 fatal bleeding episodes we would question the placement of any fistula on the upper thigh unless absolutely necessary.

Transurethral resection of very large prostates. A retrospective study.

Twenty-one patients with benign prostatic hypertrophy (BPH), and a weight of transurethrally resected tissue exceeding 80 g (Group 1), were compared to a control group of 30 patients with a weight of resected tissue less than 80 g (Group 2) with regard to the peri- and postoperative course and the symptomatic and urodynamic results of surgery. All patients were followed 12 months postoperatively. In both groups more than 90% of the patients were satisfied with the results of the operation. However, the obstructive symptoms were better relieved than the irritative symptoms. The group who had large resections performed had a longer operating time and a greater perioperative blood loss than the group of minor resections. No differences were found with regard to other peri- or postoperative complications or subjective results. Transurethral resection is safe and efficient in treating BPH, also with very large prostates.

[Neurogenic bladder disturbances]. / Neurogene blaereforstyrrelser.

Knowledge of the neurophysiology of bladder control is growing, as better diagnostic methods are developed and because clinical interest in the field is greater and treatments are better. It is problematic that the symptoms are very few and do not provide much information about the lesions in the nervous system. We describe the bladder symptoms in most neurological diseases, and the neurophysiology of normal voiding is described. A strategy for handling neurological bladder symptoms is outlined.

Bladder neuropathy in lumbar disc disease.

Disturbances of bladder, function often occur in cases of sciatica due to intervertebral disc lesions, although other clinical signs of sacral root compression are absent. In 32 patients, operated upon because of lumbar disc diseases without cauda equina syndrome, micturition symptoms were registered, and bladder function was investigated. Intravesical pressure/volume relations (water cystometry) and simultaneous intravesical pressure/urinary flow relations (urodynamic examination) were recorded preoperatively together with anal sphincter surface EMG. In almost half of the patients cystometry revealed bladder hyposensibility (late first sensation), and a quarter voided mainly by straining (detrusor paresis). These findings were unrelated to the neurosurgical pathology. Pronounced micturition symptoms or abnormal preoperative urodynamic examinations indicated evaluation two months after lumbar disc operation. Two-thirds tended towards recovery, one third remained unchanged.

Recurrency after optical internal urethrotomy. A comparative study of long-term and short-term catheter treatment.

The rate of recurrence after internal urethrotomy a.m. Sachse was studied in a prospective, consecutive, randomized series of 43 patients using short-term (1 day) and long-term (14 days) postoperative catheter treatment. No significant difference was found between the two groups according to voiding interview, flowmetry and retrograde urethrography.

Internal urethrotomy with the Sachse urethrotome.

30 patients with urethral strictures treated with internal urethrotomy with the Sachse urethrotome were followed from 2-25 months postoperatively. Reexamination included retrograde urethrography and flow studies. One half of the patients were fully satisfied, one fourth reasonably so, whereas the remaining patients were dissatisfied. Urethrography and flow study revealed a considerably higher rate of recurrence than the clinical results.

Total cystectomy and cutaneous uretero-ileostomy following supervoltage radiotherapy for bladder carcinoma.

Cutaneous uretero-ileostomy was performed on 59 patients previously given irradiation at a dose of 6000 rads as a curative treatment. In 47 patients the urinary diversion was combined with total cystectomy. The indication for operation was residual tumour and/or subjective symptoms. It is concluded that radical surgery following super-voltage radiotherapy is possible, but implies a high lethality and severe complications. The prognosis is especially poor in patients who at the time of surgery have invasive malignant tumours. In our opinion, the operation should be done only if necessitated by severe subjective symptoms and not on the sole indication of residual tumour.

Control for recurrences of urinary bladder tumours by transabdominal ultrasonic scanning.

By transabdominal ultrasonic scanning of the filled bladder it is possible to examine the surface of the bladder urothelium in the outpatient clinic. In a "blind" study of 129 patients controlled for recurrences of urinary bladder tumours the results of dynamic transabdominal ultrasonography were compared with the results of cystoscopy. The ultrasound could identify the recurrences of 5 mm or above in size significantly. Below 5 mm in dimension, when positioned in the dome of the bladder or at severe trabeculation the ultrasonic scanning lead to a misdiagnosis. No invasive recurrences were overlooked by ultrasonography. We will advocate that transabdominal ultrasonic scanning replace routine cystoscopy in low-risk patients with superficial bladder tumours of the Ta category and a low grade after the primary transurethral treatment and no or few recurrences of the same Ta category at the first control cystoscopy. On the other hand we will recommend to continue cystoscopy of patients with frequently recurring urinary bladder tumours, the high grade Ta tumours, carcinoma in situ because of the risk of invasive growth, and patients with primary invasive tumours including those with the superficial invasion (category T1).