Flavoxate treatment of micturition disorders accompanying benign prostatic hypertrophy: a double-blind placebo-controlled multicenter investigation.

To investigate the effect of flavoxate (Urispadol) treatment on patients with symptomatic benign prostatic hypertrophy (BPH), with the main weight on the irritative symptoms, a randomized, double-blind, parallel-group, placebo-controlled and multicenter investigation was carried out. Seventy patients entered the study, 37 were allocated to flavoxate treatment on a daily dose of 1,200 mg (400 mg t.i.d.) for 12 weeks, and 33 patients were allocated to placebo treatment. In spite of a sufficient power, the study did not discriminate the two treatment groups in a statistically significant way (p > 0.05), when considering the main endpoints: the irritative symptom score and the global patient evaluation. Conservative treatment of micturition disorders accompanying BPH with flavoxate in doses of 1,200 mg/day cannot be recommended for clinical use.

A retrospective evaluation of 691 ureteroscopies: indications, procedures, success rate and complications.

In the period of 1983-1990, a total of 691 ureteroscopies were performed in 480 patients. The main indications for ureteroscopy were stones, stenoses or making a diagnosis. In one third of the cases, pathology was suspected in the renal pelvis or at the ureteropelvic junction, in one third in the distal third of the ureter, and in the remaining cases, in either the upper or the middle part of the ureter. The most frequent ureteroscopic procedures were diagnostic examination or surveillance and procedures involving treatment of stones. In the 1st attempt, the ureteroscope was introduced to the suspected pathology in 79.9% of all cases, and the main objective was achieved in 76.6%. The success of stone manipulation has increased from 74% in the 1st to 92% in the last part of the period. More than half the procedures involving a ureteral stenosis were not completed satisfactorily. The location of suspected pathology did not influence the results. Complications occurred in 23% of the ureteroscopies, and the relative number of major complications decreased continuously. We conclude that ureteroscopy is appropriate at any location of pathology and that efforts must be made to minimize both major and minor complications.

Painful caliceal calculi. The treatment of small nonobstructing caliceal calculi in patients with symptoms.

From 1984 to 1989 35 patients presented with uncharacteristic flank pain or recurrent urinary tract infections and small nonobstructing caliceal calculi. Thirty patients were treated; 13 with percutaneous stone extraction, 8 with extracorporeal shock wave lithotripsy, 3 with ureteroscopic stone manipulation and 2 by open surgery. Stone removal was successful in 39 patients and they were all relieved of their symptoms (86%). Stone size was decreased in 2 patients who felt a marked alleviation. Where the stone remained unaffected the symptoms persisted unabated. These observations suggest that small caliceal stones can cause pain. The results of treatment are such that it is justifiable to treat a small caliceal stone in patient suffering from flank pain of no other known cause.

Treatment of recurrent urethral stricture by internal urethrotomy and intermittent self-catheterization: a controlled study of a new therapy.

A controlled study of the effect of treatment of recurrent urethral stricture by internal urethrotomy followed by clean intermittent self-catheterization for 3 months is reported. There were 28 men (median age 70 years, range 18 to 75) allocated to internal urethrotomy and clean intermittent self-catheterization for 3 months (treatment group) and 33 (median age 76 years, range 36 to 87) were randomized to undergo internal urethrotomy only (observation group). The groups were comparable in terms of patient age, etiology of the primary stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate (p less than 0.01). After termination of the treatment all patients from both groups were evaluated by uroflowmetry 2, 4, 6 and 12 months later, and a new recurrence was defined as a maximum flow rate of less than 10 ml. per second (micturition volume greater than 100 ml.) and a characteristic flow curve. From the treatment group 23 patients could be assessed: 2 had discontinued clean intermittent self-catheterization due to urethral hemorrhage, 2 died during the observation period and 1 was lost to followup. From the observation group 28 patients were assessable: 3 died during the observation period and 1 was lost to followup. Treatment results were not significantly different (p less than 0.01). Of the patients in the treatment and observation groups 78% and 82%, respectively, had a new stricture. The median interval for this to occur was 4 months for both groups. Since no patient had clinical signs of stricture during clean intermittent self-catheterization, we conclude that for the treatment of recurrent urethral stricture clean intermittent self-catheterization following internal urethrotomy should be continued for a long duration, possibly permanently.

Evaluation of outpatient assessment after transurethral prostatectomy.

The need for a three-month visit at the outpatient clinic for assessment including uroflowmetry was retrospectively evaluated in 78 patients who underwent transurethral resection for benign prostatic hypertrophy during 1986. One patient died before discharge and six were lost to follow-up. Eleven patients requested appointments earlier than three months, and 10 of these needed further treatment; four were operated on and six were treated with drugs. The remaining 60 patients attended as arranged. Thirty-nine were discharged, but 21 required further treatment. Eleven were operated on, four were given drugs, one had an external catheter because of incontinence, and five needed further visits to the outpatient clinic for other reasons. It was not possible to predict the necessity for follow-up from preoperative symptoms, cystitis, maximum urinary flow (ml/s), blood loss during operation, or length of stay in hospital after operation. We conclude that 35% (95% c.l. 23-48%) of the arranged outpatient visits three months after transurethral resection for benign prostatic hypertrophy are necessary and that the need is not predictable.

Treatment of symptomatic metastatic prostatic cancer with cyproterone acetate versus orchiectomy: a prospective randomized trial.

During a 2-year period, 37 patients with symptomatic metastatic prostatic cancer were included in a prospective randomized phase-III trial. Nineteen patients were randomized to subcapsular orchiectomy, and 18 to cyproterone acetate (CPA) treatment with a dose of 50 mg b.i.d. The median age of the patients was 74 years (range 48-88 years), with no differences between the treatment groups. At 3, 6, and 12 months after initiation of the therapy and then every 6 months, patients were clinically and biochemically examined, and isotope scans and X-rays were performed. All patients were followed until death. Relief from symptoms was found following 3 months of treatment in 70.6% (95% confidence limits = 44.0-89.7%) of the patients treated with CPA, and in 83.3% (95% confidence limits = 58.6-96.4%) of the orchiectomized patients. The median time to relapse was 9 months in the CPA group, and 11 months in the orchiectomy group (p greater than 0.05). The median survival time was 13 months, with no differences between the groups. The treatment of advanced prostatic cancer with CPA is found to be a valuable alternative to orchiectomy.

Antiandrogenic treatment of benign prostatic hyperplasia: a placebo controlled trial.

In a randomized triple-blind multicentre study, injections with the anti-androgenic agent oxendolone were compared with placebo in the treatment of benign prostatic hyperplasia. Thirty patients were treated with weekly injections of oxendolone 200 mg during a 3 months' period, and 30 patients were allocated to placebo treatment. During oxendolone treatment the maximum urinary flow rate increased statistically significantly (from 6.8 ml/s to 8.2 ml/s). However compared to placebo, the oxendolone effect was statistically insignificant. A slight but statistically significant improvement of the symptoms "sensation of retention", "urgency" and "frequency", was observed following oxendolone treatment, but an almost identical effect was seen in the placebo group. Following either treatment no change was observed in the residual urine volumes, in prostatic volume as measured by transrectal ultrasonotomography, or in any other therapeutic parameters. Conservative treatment of benign prostatic hyperplasia with the antiandrogen oxendolone in a dose of 200 mg a week cannot be recommended for clinical use.

Primary tumors of the renal pelvis: evaluation of clinical and pathological features in a consecutive series of 10 years.

We operated on 36 patients for primary carcinoma of the renal pelvis between 1975 and 1984. The patients were evaluated for etiological factors, symptoms, diagnostic modalities, treatment, histological type and grade of dedifferentiation, presence of invasion, abnormalities in the urothelium adjacent to the tumor, abnormalities in the epithelium of the collecting tubules and patient survival. No etiological factors were found. The main symptom was hematuria. Diagnosis was made by excretory urography with tomography. Urine cytology examination was of no help in the diagnosis. The survival was high in patients with low grade tumors, tumors without invasion and tumors without coexisting atypia in the adjacent urothelium but it was poor in those with high grade tumors, tumors with invasion and tumors with atypia of the adjacent urothelium.

Stereological estimates of nuclear volume in the course of primary tumors of the renal pelvis.

The aim of this retrospective study was to provide quantitative data which make grading of primary tumors of the renal pelvis objective and reproducible by stereological estimation of nuclear volume using the principle of estimation of the mean volume of particles of arbitrary shape. The study includes 35 kidney specimens with primary transitional cell tumor of the renal pelvis. After standard fixation, embedding, sectioning and hematoxylin-eosin staining, an unbiased estimate of the mean volume of nuclei sampled with a change proportional to volume: (formula; see text) was calculated. Here 1(0) is the length of the intercept through a test point hitting a nucleus measured in a random direction. The mean nuclear volumes of the tumors are spread over a wide range, from 159 microns 3 to 1.555 microns 3. Ten of 11 patients with nuclear volume above 800 microns 3 died of the disease while only 8 of 24 patients with a mean nuclear volume below 800 microns 3 died of the disease. This simple and fast estimate of mean nuclear volume seems to provide objective data with a high prognostic value.

Intravesical pressure changes during bladder drainage in patients with acute urinary retention.

Using a transurethral approach intravesical pressure and blood pressure were recorded in 10 males with acute urinary retention during either continuous or fractionated drainage. Upon evacuation of the initial 100 cm3 urine the intravesical pressure declined to approximately 50% of the initial value in both groups relieving pain in all patients. Blood pressure was significantly lowered following the procedure, but clinical manifestations were absent. One patient demonstrated hematuria, but treatment was not necessary. The study renders no support for previous recommendations of fractionated outlet of urine in this condition.

Renal function following aneurysmectomy of the abdominal aorta.

Postoperative renal function was evaluated in 90 patients operated on for abdominal aortic aneurysms. Forty-four patients were operated on acutely because of impending or actual rupture of the aneurysm. Forty-six patients were operated on electively. The overall mortality rate was 23.7% with a post-operative mortality of 7.8%. Postoperative renal function was evaluated by measurements of the s-creatinine. Impaired renal function was found postoperatively in 45% of the surviving patients. Forty percent of the patients operated on electively had postoperative renal impairment compared with 52% of the patients operated on acutely. The postoperative mortality rate in patients with impaired renal function was 32.4% compared with 8.7% in patients with unchanged renal function. No significant relation between postoperative renal impairment and administration of aminoglycosides, duration of the operation or clamping time of the aorta was found. We found a significant relationship between postoperative renal impairment and episodes of hypotension (p less than 0.01) and the volume of blood transfusions needed (p less than 0.001).

Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study.

In a prospective randomized double-blind study of 141 patients referred for reconstructive vascular surgery on the abdominal aorta and the lower extremities, placebo was compared to antibiotic prophylaxis. The prophylaxis group received three doses of a combination of methicillin, 2 g and netilmicin, 200 mg. Antibiotic prophylaxis reduced postoperative wound infections as compared to placebo, i.e. 4/69 (5.8%) vs. 12/72, (16.7%) respectively (P = 0.04). No graft infections occurred. Two cases of postoperative septicaemia were seen in the placebo group, none in the antibiotic group. Among different procedures aortic-femoral bypass operations showed the highest wound infection rates. The two treatment groups were comparable with regard to all other postoperative complications registered, including nephro- and ototoxicity. The antibiotic regimen was considered safe, but had only marginal value as prophylaxis in vascular reconstructive surgery on the abdominal aorta and the lower extremities.

Concentrations of mecillinam and ampicillin determined in serum and renal tissue: a single-dose pharmacokinetic study in patients undergoing nephrectomy.

A study was carried out to determine serum and renal tissue concentrations of antibiotics after a single intravenous injection of 1.0 g ampicillin plus 0.4 g mecillinam, given up to 4 hours before surgery, in 13 patients with normal or near normal kidney function who were undergoing nephrectomy. Both antibiotics showed higher tissue concentrations than the corresponding serum levels. The mean kidney:serum ratio was 2.4 for ampicillin and 1.4 for mecillinam. Serum half-lives were calculated to be 57 minutes for ampicillin and 52 minutes for mecillinam. Corresponding elimination half-lives in the kidney were 45 minutes and 44 minutes, respectively.

Prophylactic antibiotics in amputation of the lower extremity for ischemia. A placebo-controlled, randomized trial of cefoxitin.

Of 152 patients who were scheduled for an amputation for ischemia, seventy-seven were randomly assigned to perioperative prophylaxis with cefoxitin (Mefoxin) and seventy-five patients, to injections of a placebo. The patients were followed for twenty-one days or, in the case of wound complications, to the end of treatment. An infected wound occurred in 38.7 per cent of the patients in the placebo group and 16.9 per cent of those in the antibiotic group (p less than 0.005). Clostridial infection occurred in eight patients in the placebo group and in none in the antibiotic group (p = 0.003). Three of the patients with clostridial infection died of gas gangrene. A multivariate analysis showed that the absence of antibiotic prophylaxis increased the risk of infection by a factor of 3.3 (p = 0.004) and increased the need for reamputation by a factor of 4.5 (p = 0.003). We concluded that amputation patients should have prophylaxis with a broad-spectrum antibiotic given perioperatively.

Ischemic colitis complicating reconstruction of the abdominal aorta.

A review of 23 patients with ischemic colitis after surgical treatment of the abdominal aorta disclosed a pathogenetic heterogeneous finding. Ligation of the inferior mesenteric artery, abolished collateral blood supply or nonocclusive low flow state, or both, was a common feature. An incidence of 0.5 per cent was revealed for full-thickness necrosis. The mortality was 70 per cent since diagnosis was made first since perforation and peritonitis had occurred. On the basis of these findings vital prophylactic measures and diagnostic possibilities are discussed herein.

Urethral cancer in females. A case history.

A case of female urethral cancer with late diagnosis on account of concomitant complaints is presented. When persistent urethral symptoms or localized pain are found the diagnostic procedure should include urethrocystoscopy .