Carcinoma of the urinary bladder in Jamaica

Seven cases of benign papilloma and 25 cases of carcinoma of the urinary bladder seen in the University College Hospital of the West Indies between 1953 and 1960 are reviewed. Benign papilloma of the urinary bladder is relatively uncommon in Jamaica. A high incidence of squamous cell carcinoma situated away from the base of the bladder, and often associated with stricture of the urethra is noted. Early diagnosis of these lesions should be possible with consequent improvement in the length of survival after radical surgery. The use of a rectal bladder (with a perineal colostomy) is suggested as a substitute for the excised bladder. In hospital practice, this operation has certain advantages over either the use of the intact rectum as a receptacle for the urine or of an isolated ileal loop as a urinary conduit

Pathology and treatment of urethral structure and its complications in Jamaica

The pathology and treatment of 66 severe or complicated strictures of the urethra are reviewed. There is little evidence from this series that lymphogranuloma venereum is an important cause of urethral stricture and its complications. The importance of avoiding the formation of false passages with bougies is emphasized. Fistulous tracks fall into definite patterns. A study of these in association with the urethrograms will allow pre-operative assessment of the extent of the lesions, and therefore of the extent of resection likely to be required. The suggestion is made that when unilateral hydronephrosis is present, obstruction at the lower end of the affected ureter is sometimes the result of infection which spread from the prostate gland or which was initiated by the passage of a bougie outside the urethra posterior to the base of the bladder. Patients with long-standing cystitis in association with stricture of the urethra may develop a carcinoma which is usually squamous celled and situated away from the base of the bladder. Impassable strictures and those complicated by fistula and abscess formation are best treated by excision and anastomosis in one stage when short and situated in the bulbo-membranous urethra, and by two-stage excision and reconstruction when long, multiple or in the penile urethra. (Summary)

Urethral stricture and its complications

The pathology and treatment of severe urethral stricture in 66 patients treated in the University College Hospital of the West Indies have been described. Excisional surgery has been followed by: immediate end-to-end anastomosis of the urethra, reconstruction of the urethra as a second stage, permanent diversion of the urine by perineal urethrostomy when possible. Although this type of surgery is time-consuming it provides great relief to the patient and even greater relief to the attending surgeon (AU)

Some problems of cystometry

Cystometry is performed to evaluate deranged bladder function. In paraplegics the results are not always consistent with their clinical progress, nor have the results of treatment based on such tests always been satisfactory. The methods used involve a catheter in the urethra connected to a water manometer or a pressure recording device (Band 1956). At the same time filling of the bladder is artificially carried out by running in saline through the same catheter. This introduces several possible errors, and to avoid some of these, Comarr has used the normal excretion of the kidneys to fill the bladder (Comarr 1959) whilst von Garrelts uses a fine polythene tube in the urethra, instead of a catheter (von Garrelts 1956). Preliminary experiments have been made to record the pressure changes via a suprapubic polythene tube, avoiding a urethral catheter altogether. In this way a record of detrusor function unaffected by abnormal reflexes initiated at the level of the sphincters can be obtained (AU)

Complications of urethral stricture

Sixty-six patients with urethral stricture treated by excisional surgery have been described. Complications involving the urethra and peri-urethral tissues, the renal tract proximal to the stricture, and the rest of the body have been studied. The operative methods employed have been briefly described. The indications for excisional surgery have been discussed, and may be summarised as follows: (1) No fistulae present - (a) Strictures found to be impassable after two separate and gentle attempts at bouginage under anaesthesia. (b) Strictures for which dilatations at frequent intervals are necessary, and which are accompanied by persistenta urethral discharge or perineal induration and tenderness. (2) Fistulae present - (a) Penile strictures should be excised and the urethra reconstructed in two stages. (b) Bulbous or membranous strictures with fistulae arising at or below the level of the membranous urethra may be treated by one stage excision and anastomosis, with temporary diversion of the urine. (c) Strictures in bulbous or membranous urethra with fistulae arising from above the perineal membrane, must be treated by extensive resection of diseased tissue with reconstruction of the urethra in two stages. (d) Single fistula, urethral diverticulum, or fistulae without associated stricture formation, may be treated by excision of diseased tissue and external urethrostomy. (e) The very severe lesions and those patients whose age, kidney function or state of nutrition precludes major surgery should be treated by some form of permanent diversion of the urine (AU)

Hands

One hundred and sixty cases of sepsis and trauma seen in the first six months of the Hand Clinic of the University College Hospital of the West Indies have been described. The details of techniques which have been found to contribute to success include the use of a tournique on the arm and regional local anaesthesia. Methods of skin cover for finger-tip injuries are discussed. Reasons are given for performing primary tendon suture on all cut flexor tendons. An incision turning down the pulp as a flap has been used for those severe terminal pulp infestions complicated by osteomyelitis of the phalanx. Finally, some good results from early penicillin irrigation of tendon sheath infections are recorded. (AU)

Skeletal tuberculosis in Jamaica

One hundred and six cases of skeletal tuberculosis seen in the University College Hospital of the West Indies have been reviewed: The disease often has an acute onset, but if this is survived, the progress is remarkably slow and the prognosis is good. Treatment is therefore primarily conservative, operation being employed only for stabilisation, correction of deformity, or drainage of abscesses. However, direct attack on the diseased vertebral body has been done in paraplegics, with remarkably satisfactory results. Advanced disease of the hip joint may also be treated by curretage of the lesion itself, combined with corrective osteotomy. The importance of early diagnosis has been emphasized. Deformity and disability can be prevented by starting treatment early in the course of the disease. (Summary)