Carl A. Olsson

The flow rate nomogram: I. Development.

In normal individuals the flow rate depends on the initial bladder volume in a non-linear fashion. A flow rate nomogram taking this relationship into account was developed as an aid in the interpretation of urinary flow rate data. With this approach excellent differentiation of normal from obstructed individuals was achieved. In addition, the variability in a single individuals flow rate over time was estimated to be relatively small and, thus, uroflowmetry may be used to identify changes in outflow resistance after medical or surgical therapy.

The Flow Rate Nomogram: II. Clinical Correlation

Using the previously demonstrated statistical relationship between urinary flow rate and bladder volume we tested 53 patients with clinically evident outflow obstruction by uroflowmetry. Of these patients 32 were tested before and after a successful operation for outflow obstruction. In 98 per cent of the maximum flow measurements in obstructed patients the nomogram values were less than minus 2 standard deviations, indicating a clear separation from the normal population. After operative relief of the obstruction repeat uroflowmetry demonstrated all values to be in the normal range. Furthermore, in each patient the peak flow rate value increased an average of 2.7 standard deviations (minimum increase of 1.5 standard deviations). No significant correlation could be demonstrated between the size of the prostatic resection and the degree of urinary flow impairment. The use of a flow rate nomogram appears to differentiate reliably normal from obstructed individuals and also is highly useful in the postoperative followup of urinary outflow obstruction.

Clinical Management of Non-Testicular Intrascrotal Tumors

Our 10-year experience with non-testicular intrascrotal tumors has been combined with an extensive survey of the literature. The over-all incidence of malignancy affecting intrascrotal structures is high: 1) 25 per cent of epididymal neoplasms are malignant, 2) excluding cord lipomas, 56 per cent of cord tumors are malignant and 3) 59 per cent of scrotal tunic neoplasms are of malignant origin. Because of the high incidence of malignancy and because tumors of these structures are often misdiagnosed, a clinical approach to the diagnosis and management of non-testicular intrascrotal masses is presented.

Nephrostomy Drainage for Renal Transplant Complications

The use of temporary diverting nephrostomy drainage in the management of immunosuppressed renal transplant patients with supravesical urinary extravasation, fistulas or ureteral obstruction is reviewed. In a literature survey covering an 11-year interval and 4,307 transplants there were 204 cases (4.7 per cent) of ureteral extravasation or fistula and 113 cases (2.6 per cent) of ureteral obstruction. Attempts at urologic repair in these 317 cases resulted in 30.9 per cent failure rate (98 cases), of which 86.7 per cent (85 cases) occurred in patients without nephrostomy compared to 13.3 per cent (13 cases) in patients with nephrostomy. In our 255 consecutive renal transplant patients there were 7 (2.7 per cent) with ureteral extravasation or fistula and 14 (5.5 per cent) with ureteral obstruction. Temporary nephrostomy was done in all 21 patients to protect the urologic repair and, when necessary, to control sepsis and allow for patient stabilization before delayed urinary tract reconstruction. In our series there was no mortality and only 1 renal unit (4.7 per cent) was lost as a consequence of urologic complications. The use of nephrostomy in transplant patients with ureteral extravasation, fistulas or ureteral obstruction is encouraged strongly to optimize patient and renal unit survival.

The Phentolamine Test in Neurogenic Bladder Dysfunction

In an attempt to improve the selection of patients with neurogenic bladder dysfunction likely to benefit from phenoxybenzamine therapy, the effect of intravenous phentolamine (Regitine) on the urinary flow rate was determined in normal and abnormal subjects. A nomogram relating mean flow rate to volume voided was constructed to aid in the interpretation of results. In 16 patients with neurogenic bladder dysfunction it was found that a response of more than 0.8 nomogram units indicates a likelihood of clinical improvement with phenoxybenzamine therapy. The clinical applications of this test are discussed.

Retroperitoneal fibrosis with ureteral obstruction secondary to actinomyces israeli

A case of Actinomycosis israeli causing retroperitoneal fibrosis and ureteral obstruction is presented. This rare occurrence followed direct extension of the infectious process from intra-abdominal abscesses to the retroperitoneum, resulting in dense fibrosis. Diagnosis is most commonly established by histologic identification of sulfur granules obtained at abdominal exploration. The pathogenesis and treatment of genitourinary as well as retroperitoneal actinomycosis is discussed.

Development of A Carbon Dioxide Laser Cystoscope

A 50-watt carbon dioxide continuous laser coupled to a Zeiss surgical microscope was used to study the characteristics of laser-induced lesions on the exteriorized canine bladder. The relationship of energy to the depth of the lesion created by the laser was evaluated. Healing, vertical temperature transmission and hemostasis were studied. A prototype carbon dioxide laser cystoscope then was constructed and used endoscopically to create surgical lesions in the intact canine bladder.

Testis Tumor Markers: How Accurate are They?

AbstractInitial reports on the usefulness of radioimmunoassays for the beta chain of human chorionic gonadotropin and for alpha-fetoprotein suggested that these 2 tests would detect metastatic nonseminomatous testicular cancer in 93 per cent of the cases. In a review of 30 patients with stages 2 and 3 non-seminomatous testicular cancer in our institutions we found a 20 per cent falsely negative rate for these serum assays. In all of these cases the beta-human chorionic gonadotropin and alphafetoprotein levels were simultaneously negative despite proved existence of metastatic disease.

Pancreatic pseudocyst simulating perinephric abscess

Abstract A case of pseudocyst of the pancreas simulating perinephric abscess is described. This condition is rare compared with most reported cases of pseudocyst causing pyelographic abnormalities by extrinsic compression. Spontaneous rupture of the pseudocyst is proposed as the mechanism by which the normally protective Gerotas fascia is penetrated.

Keyhole-Limpet Haemocyanin (KLH) immunotherapy of murine transitional cell carcinoma

SummaryThe antigenicity of transitional cell carcinoma of the bladder has stimulated the search for effective immunotherapeutic agents in the treatment of this disease. Non-specific immunotherapy with local (intravesical/intralesional) and systemic Keyhole Limpet Haemocyanin (KLH) in a FANFT induced murine bladder tumor model was studied. Results showed no difference between control or treated groups in either tumor growth or animal survival.