Marco Caine

Adrenergic response of bladder muscle in prostatic obstruction: Its relation to detrusor instability

In vitro isometric studies of bladder dome muscle taken at operation from 47 patients with benign prostatic obstruction, revealed an alpha-adrenergic response instead of the normal beta response in 23 per cent. The relationship between this finding and the presence of irritative symptoms and an unstable detrusor is examined. This finding may explain the beneficial effect of alpha-blockers on these symptoms in many patients with prostatic obstruction.

Phenoxybenzamine for benign prostatic obstruction review of 200 cases

Two hundred patients treated with phenoxybenzamine for benign prostatic obstruction were reviewed. In 171 of these patients the treatment was given to relieve symptoms in patients not requiring operation, or in patients in whom operation was postponed. Eighty per cent of these patients derived benefit from the treatment, most commonly for the obstructive symptoms (78.7 per cent) but almost as often for nocturia (76 per cent). The treatment was also found to be useful in aiding catheter removal after an attack of acute retention, and in preventing recurrent attacks of acute retention. Side effects occurred in 30 per cent of patients, but necessitated cessation of treatment in only 10 per cent. They consisted of other alpha-blocking effects, and caused after stopping or reducing treatment.

Diagnosis and management of renal angiomyolipoma

Renal angiomyolipoma (hamartoma) is an uncommon benign tumor of the kidney. Although about 400 cases of renal angiomyolipoma have been reported, it still causes difficulties in diagnosis and treatment. Until a few years ago it was almost impossible to arrive at a correct diagnosis preoperatively, and most of the cases underwent nephrectomy with the wrong diagnosis of renal carcinoma. More recently, abdominal computerized tomography and renal sonography have made it possible to reach the correct preoperative diagnosis in many cases, and thus to avoid unnecessary nephrectomies. We report on our experience with 13 cases of renal angiomyolipoma, and our conservative approach in a number of cases, which has enabled us to preserve renal tissue and function.

Treatment of complete staghorn calculi by extracorporeal shock wave lithotripsy monotherapy with special reference to internal stenting

Extracorporeal shock wave lithotripsy monotherapy was used to treat 41 patients with complete staghorn calculi. In 20 patients polyethylene angiographic pigtail catheters were inserted prophylactically as ureteral stents and the other 21 patients did not receive stents. Prophylactic stenting reduced the incidence of complications and the need for percutaneous nephrostomy tubes to relieve subsequent ureteral obstruction. Internal stenting maintained the sterility of the urinary tract and reduced the average hospital stay by a third. Residual stone fragments representing less than 5 per cent of the original stone mass remained in 56 per cent of the patients, particularly in those with hydronephrotic kidneys. We suggest that extracorporeal shock wave lithotripsy monotherapy with prophylactic stenting is the preferred treatment for noninfected complete staghorn calculi.