Anne-Charlotte Kinn

Squamous Cell Carcinoma of the Renal Pelvis

Comparisons were made between 15 cases of squamous cell carcinoma of the renal pelvis and 27 cases of transitional cell carcinoma. The frequencies of calculosis and infection of the urinary tract were higher in the squamous cell group. These patients were somewhat older than the patients with transitional cell carcinoma and had a much poorer prognosis. Only five of them survived for a year and only one was still alive after five years. Squamous cell carcinoma generally occurred as a single tumour. The urothelial carcinomas showed the recognized tendency to multiplicity. Cytologic examination of the urine may be helpful in establishing the diagnosis. Monitoring of patients with renal pelvic calculi should include regular cytologic examination of the urine, in the hope that squamous cell tumours of the urinary tract will be detected at an early stage.

Burch Colposuspension for Stress Urinary Incontinence: 5-Year Results in 153 Women

The long-term results of Burch colposuspension for stress urinary incontinence were evaluated in 153 women operated on in 1984-1990. At follow-up 2 months postoperatively, 88% of the women reported continence, 5% were almost continent and the failure rate was 7%. At 24 months the corresponding figures were 86.7 and 7% and 39-102 months (mean 5 years) postoperatively they were 78, 11 and 11%. There were few complications. Follow-up urodynamic investigations showed significant rise of the pressure transmission from bladder to urethra in the cured patients. Reasons for failure are discussed. For patients with low urethral closure pressure, a vaginal sling procedure is preferable to Burch operation. Burch colposuspension is safe and advisable for patients with genuine stress incontinence. Urodynamic evaluation thus should be made preoperatively, but need not to be repeated if the clinical result is good.

Denervation of Periurethral Prostatic Tissue by Transurethral Microwave Thermotherapy

Purpose: To determine whether transurethral microwave thermotherapy (TUMT) affects innervation of the urethra and periurethral prostate. Material and methods: Ten patients with troublesome benign prostatic hyperplasia (BPH) were treated with TUMT 1 week prior to transurethral resection of the prostate (TURP). At surgery, a biopsy was taken for histological examination and for immunohistochemical staining of the non-specific neuromarker protein gene product (PGP) 9.5. Control material consisted of identical biopsies from 10 patients undergoing TURP because of BPH, but not subjected to TUMT prior to surgery. Results: Histological examination revealed well-preserved, non-necrotic tissues in all biopsies. Nerve fibres were completely or almost absent in the smooth muscle layer in all but one of the TUMT cases, whereas all non-TUMT patients exhibited large numbers of nerve fibres in the smooth muscle layer. Conclusions: TUMT does affect innervation of the urethra and periurethral prostatic tissue.

Neurotransmission in activation of the contractile response in the human urinary bladder.

The endogenous contracting transmitter at the neuromuscular junction in strips from human urinary bladder has been investigated using field stimulation and selective antagonists. Atropine in low concentrations was found to inhibit bladder contractions whereas higher concentrations of the drug sometimes had the opposite effects. Indomethacin inhibited, phentolamine enhanced and methysergide had no dose-dependent effect on the field stimulation response. It is proposed that acetylcholine is one of the transmitter substances responsible for the contraction of the human detrusor. Species differences which could be responsible for the alleged atropine-resistance of the bladder are discussed. It is concluded that anticholinergic drugs should be of therapeutic value for treatment of muscular hyperactivity in the human urinary bladder.

Renal Function in Idiopathic Hydronephrosis

In 11 patients who underwent Anderson-Hynes pyeloplasty for unilateral hydronephrosis, renal function was examined with split-clearance technique immediately after the operation and 2-5 years postoperatively. The studies shortly after pyeloplasty showed decreased glomerular filtration rate (GFR) and renal plasma flow (RPF) in most of the hydronephrotic kidneys. GFR improved slightly during the follow-up period, but RPF did not increase. The tubular dysfunction, expressed as moderately increased fractional excretion of electrolytes, showed significant improvement only as regards magnesium. The study indicates that reconstructive surgery is not warranted if the aim is to improve renal function in an asymptomatic patient with normal total GFR. On the other hand, patients with pain caused by the renal obstruction should always be subjected to surgery.

The lazy bladder--appraisal of surgical reduction.

Ten patients with abnormally large bladder capacity and large volumes of residual urine, but without neurologic or obstructive bladder disease, were urodynamically investigated. Detrusor contractility was defective in the male patients as compared with healthy men, but in this respect the women did not differ significantly from controls. After reductive cystoplasty with fundus invagination or detrusor duplication, detrusor efficiency did not improve but there was less residual urine and previous urinary tract infections did not recur. Strict indications for cystoplasty are recommended. The operation should preferably be limited to men with tendency to urinary tract infection or dilatation of the renal pelves. Bladder neck incision should be performed at the same operation.

Sexual function one year after transurethral prostatic resection : Patients' own assessments

One year after transurethral resection of the prostate for benign hyperplasia, 127 men received a questionnaire requesting personal evaluation of sexual function, including erection, ejaculation, libido and satisfaction. Significant postoperative dysfunction was reported in all these respects: 54% of the responders claimed deterioration and half of them blamed the operation. Decline in sexual function had a multifactorial background, including advancing age, morbidity, and changed marital and social conditions. Although other examinations with preoperative and postoperative evaluation report a lower incidence of impotence development, which may be more reliable, it is psychologically interresting that the patients themselves suspect the transurethral resection as the cause of impaired sexuality.

The Effect of Noradrenaline on the Contractile Response of the Urinary Bladder: An in Vitro Study in Man and Cat

In this study, bladder muscle strips from the detrusor of man and cat were used to evaluate the modulating effects of adrenergic agonist and antagonists on the field stimulation induced contractile response. Noradrenaline (NA) inhibited and phentolamine enhanced the contraction in a dose-dependent manner. Propranolol did not influence the field stimulation response. When a study of the combined effect of adrenergic drug influence was performed, the NA-induced inhibition was partly reversed by propranolol but a further increase of the contractile response compared to the control was seen, when phentolamine was added. No species differences were found. The conclusion drawn from these results is, that the inhibiting effect of NA on the contractile response is mediated via alpha- and beta-adrenergic receptors. The former could be located on the short parasympathetic intramural neurons while the latter probably are located on muscle cells.

Pressure Flow Studies in Hydronephrosis

44 patients with idiopathic hydronephrosis underwent intrapelvic pressure flow studies. An increased basal pressure and an increased pressure during flow loading were found compared with the findings in 10 control kidneys. The method is relatively easy to perform and has few complications. It may be of value in determining the degree of obstruction in equivocal cases of dilated pelvis.

Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia: Subjective Response and Urodynamic Changes

Results of transurethral microwave thermotherapy for benign prostatic hyperplasia were good after 1 year in 68% of 66 cases. Despite good correlation between subjective assessment of results and improvement in urodynamic parameters, no predictive factors for probably successful outcome could be identified. Diminution in frequency of micturition (diurnal from 8.8 to 6.8 times, nocturnal from 3.0 to 1.6 times), increased flow rates (Q max from 8.8 to 14.2 ml/s) and reduction of detrusor pressures during voiding (Pdet max from 86.9 to 75.0 cm H2O) were significant, but the change in residual volume (from 52 to 37 ml) was of lesser degree (all mean values). Transurethral microwave thermotherapy can be tried for relief of moderate obstruction when transurethral prostatic resection involves risk, or the patient himself requests noninvasive treatment.