Bhupendra M. Tolia

Renovascular hypertension: Prospective diagnostic yield in a random access population

Abstract Over a five-year period, 104 patients with diastolic hypertension were clinically evaluated and studied by arteriography, differential renal function studies, and radioisotopic renography. Based on either a positive differential renal function study and/or response to surgery, the incidence of renovascular hypertension was determined to be 6 per cent. Of the entire group studied, 15 per cent ( 16 104 ) of patients were found to have renal artery stenosis by arteriography. Eight of these patients had normal differential function studies and were excluded from the renovascular group. In the group with a final diagnosis of essential hypertension (87), 22 patients met roentgen criteria for chronic pyelonephritis. All 6 patients with renovascular hypertension had abnormal renograms; 5 of 8 patients with renal artery stenosis and normal differential function studies had abnormal renograms. However, there was an incidence of 15 per cent false positive renograms. Differential renal function studies were carried out on 75 patients, utilizing a modification of the Stamey technique. Of the 6 patients with renovascular hypertension, 2 had negative results on tests by Stameys criteria; 2 had negative findings on tests by Rapoports criteria; and there was 1 negative result on a test utilizing PAH (para-aminohippuric acid) excretion ratios as criteria.

Continence mechanisms following transphincteric urethroplasty.

Urinary continence mechanisms were studied in 6 patients, 5 of whom had undergone end-to-end urethroplasty for membranous urethral strictures. All patients were able to interrupt the urinary stream on command by contracting the distal intrinsic sphincteric mechanism, despite an absent extrinsic sphincter. In 2 patients with prostatectomy and transphincteric urethroplasty, the intrinsic sphincteric mechanism was the sole remaining sphincter. These observations suggest that the intrinsic sphincteric mechanism is intramurally located, is also under somatic innervation and alone is capable of performing all of the sphincteric function required in the male.

Unstable bladder: urodynamic diagnosis and observations in evaluating urinary incontinence in the female.

Unstable bladder in the female has been the subject of controversy with regard to its etiology, identification, and treatment. One hundred thirty consecutive female patients referred with incontinence were evaluated as to their symptoms and urodynamic findings. A stress cystometrogram, systematically done, was introduced and observations were made regarding certain findings on the urodynamic examination. These criteria were used subsequently for making a diagnosis of unstable bladder. Forty per cent of these patients were found to have an unstable bladder. History of frequency and urgency correlated best with a diagnosis in 70 to 80 per cent of our cases, and the new stress cystometrogram proved to be the most sensitive urodynamic test (78%) for detecting this condition. A systematic approach such as we describe is advocated as a first step toward gaining a better understanding of this puzzling entity.

On percutaneous drainage of retroperitoneal collections: when is primary surgical drainage preferable?

Percutaneous drainage of retroperitoneal collections is a method employed with an ever-increasing frequency. The indication for primary surgical drainage of these collections is rapidly decreasing. Herein we describe what we consider to be the indications for primary surgical drainage of retroperitoneal collections illustrated by the recurrence of the abscess in 3 of our patients following adequate primary percutaneous drainage.

Prostate cancer screening using fine-needle aspiration cytology prior to open prostatectomy.

We performed a prospective study to evaluate fine-needle aspiration (FNA) cytology as a screening tool of carcinoma of the prostate in 159 men with normal digital rectal examinations and acid phosphatase prior to open prostatectomy for voiding symptoms. The incidence of carcinoma of the prostate was 5.6%. 4 patients had A1 lesions and 5 had A2 lesions. Only one A2 lesion was malignant cytologically. The sensitivity was 56%, specificity 69%, positive predictive value 24% and negative predictive value 90%. Sufficient cytologic specimens were provided in 66% of cases. While FNA is at least equal to core biopsy as a diagnostic modality of palpable prostatic abnormalities, it does not prove to be an adequate screening modality for occult carcinoma of the prostate in the prostatectomy candidate.