ABSTRACT
Infection stones in the urinary tract are always associated with infection with a urease-producing, urea-splitting organism. The most common of these organisms are easy to culture and identify and can be treated early either with an appropriate antibiotic or with an anti-urease agent. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producing organisms which are difficult to grow; their presence and effects frequently go undetected and untreated. Other organisms, as yet unknown, may also be involved in the same process. We report the first series of 8 patients with recurrent infection-type stones likely to have been caused by a "hard to grow" organism. Five patients never had a positive culture; in 2 patients 1 of 10 urine cultures grew a coagulase-negative Staphylococcus and in 1 patient the same organism was grown from a stone but never in the urine. The clinical course of all of these patients was significantly improved after blind treatment with antibiotics and in one case with an anti-urease agent.
Subject(s)
Ureaplasma Infections/microbiology , Ureaplasma urealyticum/isolation & purification , Urinary Calculi/microbiology , Urinary Tract Infections/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Humans , Male , Middle Aged , Recurrence , Ureaplasma Infections/drug therapy , Ureaplasma Infections/urine , Urinary Calculi/chemistry , Urinary Calculi/urine , Urinary Tract Infections/urineABSTRACT
The cases of 57 patients who underwent implantation of a Kaufman prosthesis for urinary incontinence at this center are reviewed. All except one of the patients were incontinent following prostatic surgery. Although many of the patients required revision or adjustments after the initial implantation, 55 percent of the cases eventually had a satisfactory outcome. Patients rendered incontinent after retropubic prostatectomy had a higher success rate with the Kaufman prosthesis than patients after other types of prostatectomy. This simple and relatively inexpensive device can still play a useful role in the treatment of patients with mild and moderate stress incontinence following prostatectomy.
Subject(s)
Urinary Incontinence/prevention & control , Urinary Sphincter, Artificial , Aged , Costs and Cost Analysis , Equipment Design , Equipment Failure , Humans , Male , Middle Aged , Prostatectomy/adverse effects , Urinary Incontinence/etiology , Urinary Sphincter, Artificial/economicsABSTRACT
Although the concept of prostate liquefaction had been proposed by Wickham 15 years ago, its clinical application has been delayed by various technical problems. The authors report on the investigative procedures that have been undertaken to design and develop the ELSA (Endoscopic Liquidiser and Surgical Aspirator) prototype which has been utilized in the clinical setting with promising results.
Subject(s)
Laparoscopes , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Aged , Animals , Equipment Design , Flow Cytometry , Humans , Laser Therapy , Liver , Male , Middle Aged , Particle Size , Prostatectomy/instrumentation , Suction , SwineABSTRACT
The patient selection criteria in a clinical trial of an alpha-blocker for the treatment of benign prostatic hypertrophy were such that 85% of the patients on the waiting lists of 4 hospitals had to be excluded. The value of such a trial is discussed. Trial protocols should be designed to allow the enrollment of patients truly representative of the patients for which the treatment is intended.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Prostate/drug effects , Prostatic Hyperplasia/drug therapy , Aged , Clinical Protocols/standards , Double-Blind Method , Humans , London , Male , Outcome Assessment, Health Care , Placebos , Prostatic Hyperplasia/diagnosis , Severity of Illness Index , Waiting ListsABSTRACT
The results following 94 trans-trigonal phenol injections in 60 patients over a 5-year period are analysed. In only 1 patient was there a lasting effect. The others all required alternative treatment for bladder instability, hyper-reflexia or hypersensitivity. Older patients with normal bladder compliance and patients with a neuropathic aetiology had slightly better results but also failed to derive lasting benefit. The complications associated with the treatment and the general anaesthetic outweigh the transient benefits of this technique.