Management of vesical dysfunction in multiple sclerosis.

Using urodynamic testing, vesical dysfunction in patients with multiple sclerosis can be classified and basic therapeutic principles outlined. Satisfactory voiding patterns can be achieved in most patients with multiple sclerosis without surgical procedures. Flexibility and willingness to change programs as the disease process changes make possible reasonably satisfactory results.

Anterior bladder tube in radical retropubic prostatectomy.

Six patients with a minimum of ten months' follow-up have undergone reconstruction of the urethra by anterior bladder tube after radical retropubic prostatectomy; 4 void well and are continent, 1 is incontinent, and 1 has severe stricture.

Urodynamics studies in benign prostatic hypertrophy.

A study of patients with benign prostatic hypertrophy indicates that flow rates may well be useful in evaluating the degree of obstruction and the results of therapy. Electromyography and cytometry studies, while demonstrating certain tendencies in benign prostatic hypertrophy, do not give statistically significant data for evaluation and prognostication either by themselves or when correlated with radiographic changes and flow rates.

Posterior urethral valves.

Twenty cases of posterior urethral valves are reviewed with the presentation of several illustrative cases. Review of the current literature regarding managment of patients is discussed.

Psychiatric treatment of erectile dysfunction in urology outpatient clinic.

This study examined the feasibility of establishing a satellite psychiatry service in a urology outpatient clinic for the express purpose of engaging men with inhibited sexual excitement in psychiatric treatment. This approach appeared to be more successful as judged by complete referrals and symptom remission than referral to a psychiatry clinic.

Anterior bladder tube for continence in neurogenic bladder. Experimental study.

Experimental studies designed to evaluate the anterior bladder tube as a method of maintaining continence in the neurologically deprived bladded achieved a 50 to 60 per cent success rate. This success rate is not sufficient to warrant its clinical use.

Sandwich radiotherapy (3,000 and 4,500 rads) around radical retropubic prostatectomy for stage C prostatic carcinoma.

Supervoltage external radiotherapy has been sandwiched around radical retropubic prostatectomy as a potentially curative procedure for Stage C or D1 adenocarcinoma of the prostate. Preoperatively, 3,000 rads were delivered to the pelvis and prostate by approximately 18 by 20 cm. AP-PA opposing ports over a three-week period. After three weeks' rest, radical retropubic prostatectomy was done. After three weeks' postoperative recovery, additional radiotherapy was delivered as follows: 2,000 rads to the pelvis and prostatic fossa by AP-PA opposing ports, plus 2,500 rads to the prostatic fossa alone by 360 degree rotation, plus 4,500 rads to the abdominal periaortic-caval lymph node area. Fifteen cases have been followed for up to five and one-half years to date without serious complications of the therapy and without demonstrable recurrent or residual tumor in the pelvis.

Intermittent catheterization in children.

Many children with myelodysplasia are ideal candidates for intermittent nonsterile urethral catheterization to manage urinary incontinence. This method of urinary management becomes no permanent commitment and is preferred by patients and parents to supravesical diversion when successful.

Female urinary tract fistulas.

Urinary tract fistulas in women are an uncommon complication of a variety of surgical procedures. However, such fistulas lead to significant patient and physician distress, and have important medicolegal implications. Successful repair of urinary tract fistulas requires careful preoperative evaluation and adherence to basic surgical principles. A variety of approaches and techniques may be used, and the choice of procedure is less important than achieving adequate resection of fibrosis with watertight, tension-free closure of well vascularized tissues in layers. Interposition grafts of omentum, muscle, peritoneum and labial fat may be used in recurrent, complicated or radiated fistulas, and add significantly to the rate of success. Overall, successful repair of urinary tract fistulas can be achieved in the majority of cases.

Progress and problems in screening for carcinoma of the prostate.

Carcinoma of the prostate is the second most common cause of cancer-related deaths in American men. This is due, in part, to the low percentage of cases that are diagnosed when the tumor is still curable. To improve early detection, routine screening has been performed using one or a combination of tests that included open prostate biopsy, serum acid phosphatase, the digital rectal exam, and transrectal sonography. These studies have been critically reviewed and the problems associated with prostate cancer screening have been discussed. No study has proven that routine screening reduces the mortality from prostate cancer. Furthermore, the positive predictive value and the sensitivity of each of these tests are too low for any of them to be useful for screening at the present time. To determine the value of screening, new studies are needed which should include a control group and an assessment of the disadvantages of screening as well as the potential benefits. Based on published reports, however, routine screening for prostate cancer using any test should be considered investigational at the present time.

Comparison of the incidence of bladder hyperreflexia in patients with benign prostatic hypertrophy and age-matched female controls.

Detrusor hyperreflexia long has been recognized as a condition associated with certain neurological disorders (that is multiple sclerosis, cerebrovascular accidents, spinal cord injuries and parkinsonism). Bladder outlet obstruction (primarily benign prostatic hypertrophy) recently has been added to the list. Hyperreflexia associated with bladder outlet obstruction does not always resolve with relief of the obstruction. Our study of age-matched female controls indicates that there is a baseline rate of hyperreflexia associated with the aging process alone. This baseline hyperreflexia probably explains persistent symptoms in men with hyperreflexia following relief of the obstruction.

Early detection of prostate cancer by routine screening.

In an attempt to detect prostate cancer when the disease was still localized, a free screening clinic was established for men over the age of 45 years. Digital rectal examinations were performed for 811 men. Prostate biopsy was recommended to 43 in whom abnormalities were found by digital rectal examination; only 38 complied. Prostate cancer was detected in 11 men. The patients with cancer ranged in age from 60 to 79 years, with the highest incidence of cancer in the group aged 70 to 79 years. The overall incidence in men between 51 and 80 years old was 1.7%. Staging evaluation revealed that none of the patients with prostate cancer had metastases to the bone or elevated serum acid phosphatase levels. Five men (45%) were found by clinical or pathological methods to have stage B disease. Two others (18%) showed radiographic evidence of lymph node metastases (stage D1). The cost of detecting each cancerous prostate tumor was approximately +6,300. Routine screening can be a cost-effective method for diagnosing prostate cancer in patients with less extensive disease. The ability of early detection to prolong survival of patients with this disease will require further investigation.

Use of sexual history to differentiate organic from psychogenic impotence.

The use of sexual symptomatology to differentiate psychogenic from organogenic impotence was studied. All patients were independently classified based on the evaluation of a minimum of one night of nocturnal penile tumescence recording, a sleep lab technician's rating of penile turgidity of erections, Doppler determination of penile blood flow, determination of serum prolactin and testosterone levels. Three aspects of symptomatology significantly discriminated the criterion groups. The single best predictor was the presence or absence of early morning erections as reported by the patient.