Contractile actions of imidazoline alpha-adrenoceptor agonists and effects of noncompetitive alpha1-adrenoceptor antagonists in human vas deferens.

The contractile actions of imidazoline alpha-adrenoceptor agonists were investigated in human vas deferens longitudinal and circular muscle. The effects of phenoxybenzamine were studied in comparison to dibenamine and SZL-49 (4-amino-6,7-dimethoxy-2-quinazolinyl-4-(2-bicyclo[2,2,2]octa-2,5-dienylcarbonyl-2-piperazine), an alkylating prazosin analogue that discriminates between alpha(1H)- and alpha(1L)-adrenoceptor subtypes. The imidazoline alpha-adrenoceptor agonist, A-61603 (N-[5-(4,5-dihydro-1H-imidazol-2yl)-2-hydroxy-5,6,7,8-tetrahydronaphthalen-1-yl]methanesulfonamide hydrobromide), was a potent agonist (pD(2); longitudinal muscle 6.9, circular muscle 6.4) and cirazoline a partial agonist (pD(2); longitudinal muscle 6.1, circular muscle 5.1). Oxymetazoline was less effective, indanidine and clonidine were ineffective. SZL-49 produced a differential inhibition of contractions evoked by A-61603 in circular (alpha(1H)) compared to longitudinal (alpha(1L)) muscle and phenoxybenzamine had the opposite effect. Dibenamine inhibited the contractions comparably in both muscle types and analyses of its partial alkylation of receptors yielded identical estimates of equilibrium dissociation constant (pK(d)) for A-61603 in longitudinal (5.82) and circular (5.84) muscle. Receptor occupancy-response relationships revealed that whilst the muscle types are not different in receptor reserves for A-61603, contraction to the potent imidazoline is more efficiently coupled in longitudinal than in circular muscle. This underlies the markedly different responsiveness of the muscle types to cirazoline or oxymetazoline (alpha-adrenoceptor agonists with lower efficacies relative to A-61603). The differential inhibitory actions of phenoxybenzamine and SZL-49 are discussed.

Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial.

OBJECTIVE: To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment. PATIENTS AND METHODS: The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later. They were randomly assigned to receive 1 h of microwave hyperthermia or a sham treatment. Of the 96 patients, 93 were assessed at 3 months and 62 at 6 months after treatment. RESULTS: There was no statistically significant difference in the objective measures of BOO between the treated and control groups of patients. There was an improvement of approximately 40% in all the subjective measures, but there was no significant difference between the treated and control groups. CONCLUSION: Microwave hyperthermia, within the parameters defined in this trial, resulted in no significant difference from sham treatment in subjective or objective outcome.

Localized amyloidosis of the genito-urinary tract.

Localized amyloidosis of the uro-genital tract is uncommon. It often simulates a neoplastic process. We describe our experience with three cases of localized amyloid of the bladder and one each of the ureter, prostate and corpora spongiosa.

Does flexible cystoscopy miss more tumours than rod-lens examination?

The first blind, prospective, randomised comparison of flexible cystoscopy with rod-lens cystoscopy was carried out on 53 consecutive volunteers with bladder tumours or haematuria. Three patients' recurrences were missed on flexible cystoscopy and 3 others on rod-lens examination. It was expected that the 9% rate of missed tumours would lessen with increased experience of flexible cystoscopy, as 2 of them occurred in the first 12 examinations and all of the lesions missed were < 5 mm in diameter. Rod-lens cystoscopy, the accuracy of which appears to have been measured for the first time, was no more sensitive.

Radical external beam radiotherapy for localised carcinoma of the prostate using a hypofractionation technique.

The survival of 232 patients with apparently localized carcinoma of the prostate is reported, who were treated between October 1964 and October 1984 by a radical course of external beam radiotherapy using a hypofractionation technique. Assessment was made in a retrospective analysis, noting influence of age, stage of disease at presentation, initial histology, dose of radiotherapy given and any subsequent treatment required, recorded up to October 1986. From this it will be seen that the development of a six fraction regime, given over a period of three weeks leads to comparable results to other reported series, whether assessed as a local response or by survival curves, and to the economical use of scarce resources, but even more important, is less wearing for patients than daily fractionation, with early and late morbidity being within acceptable limits.

Carcinoma of prostate treated by radical external beam radiotherapy using hypofractionation. Twenty-two years' experience (1962-1984).

The survival of 209 patients with apparently localized carcinoma of the prostate treated by radical external beam radiotherapy is reported, noting the influence of age, stage of the disease at presentation, initial histology, previous surgery, and dose of radiotherapy given. From this it is seen that the development of a six-fraction regimen given over a period of three weeks leads to excellent results whether assessed as a local response or by survival curves and to the economical use of scarce resources, but, even more important, is less wearing for patients than conventional daily fractionation and with no major early or late morbidity recorded up to October 1986.

Stony testicle: case of calcific granulomatous orchitis.

A thirty-three-year-old man presented with a hard testicular mass considered preoperatively to be a malignant testicular tumor. Frozen section revealed calcific granulomatous orchitis, which does not appear to have been previously described in man. Granulomatous orchitis is an important differential diagnosis of testicular lesions. The hard nature of this particular lesion contributed to the preoperative diagnosis of malignancy.

Isolated ileal loop augmentation of existing ileal conduit.

A new method of stomal revision in an existing ileal conduit is described. Two cases are reported in which the procedure was a success. It is suggested that ileal loop augmentation of an existing ileal loop may serve, in selected cases, as a useful alternative to complete conduit reconstruction.

The management of transitional cell carcinoma in the prostate.

Transitional cell carcinoma of the prostate is a rare tumour. A review of 318 patients with carcinoma of the prostate presenting to this hospital in the 5 years between April 1974 and April 1979 revealed 7 patients with transitional cell carcinoma arising within the prostate. Two of these had previously been treated for a transitional cell carcinoma of the bladder. These prostatic tumours are usually poorly differentiated and carry a poor prognosis. Early radical surgery, however, achieved a good result in one of our patients. Other forms of treatment were ineffective and a review of the literature revealed that this was also the experience of others. We suggest that cystoprostatectomy should be considered as an early form of treatment.

Single dose intravesical thiotepa as an adjuvant to cystodiathermy in the treatment of transitional cell bladder carcinoma.

Tumour cell implantation may be a factor in the aetiology of recurrent well-differentiated superficial bladder tumours. A prospective trial is reported in which single dose intravesical thiotepa was administered to a group of randomly selected patients immediately after cystodiathermy. A control group of patients was treated by cystodiathermy alone and tumour recurrence in the 2 groups was compared. Significantly fewer patients in the thiotepa-treated group developed recurrent tumour and there was also a significantly reduced incidence of pure vault recurrence in this group. The beneficial effects of adjuvant thiotepa were apparent after 1 treatment. In this series of patients no benefit resulted from the continued use of adjuvant thiotepa once a patient developed a recurrent tumor.

Long-term survival after urinary diversion. A reappraisal of ureterosigmoidostomy.

Long-term survival occurs following both ureterosigmoid and ileal diversions. Both manoeuvres carry a significant complication rate but where patients have good rectal continence, ureterosigmoid diversion offers the advantage of appliance free life. Success depends on initial good renal function and successful implantation of the ureters into bowel avoiding both reflux and stenosis. Where there is a likelihood of long survival as in such conditions as ectopia vesicae, this technique will provide very satisfactory management and three patients surviving more than a total of 100 years illustrate this approach.