P. J. B. Smith

High-dose intravenous estrogen therapy in advanced prostatic carcinoma. Use of serum prostate-specific antigen to monitor response.

High-dose intravenous estrogen therapy was shown to be effective in relieving bone pain due to metastatic disease in 22 of 29 (75.9%) men with advanced hormone-resistant prostate cancer. This clinical response was accompanied by significant falls in serum prostate-specific antigen (PSA) levels in 13 (44.8%) patients. It is suggested that this clinical benefit is due to a direct inhibitory effect of estrogen on prostate cancer cells.

Periurethral granuloma: Unusual complication of teflon periurethral injection

Granuloma formation is an unusual complication of Teflon paste injection. A case resulting from periurethral injection is reported.

Bladder Irrigation with Chlorhexidine for the Prevention of Urinary Infection After Transurethral Operations: A Prospective Controlled Study

The value of postoperative bladder irrigation with the antiseptic agent chlorhexidine was assessed in a randomized prospective controlled study of men after transurethral operations. In patients with sterile preoperative urine the incidence of postoperative bacteriuria was 12.8 per cent, compared to 36.7 per cent in control patients. The difference is significant (chi-square 5.54, p less than 0.02). On the other hand, chlorhexidine irrigation did not eliminate pre-existing infection. Small amounts of chlorhexidine were demonstrated in the blood of some patients. There was no evidence of damage to the bladder and no toxic side effects.

The long-term effects of prostatectomy: a uroflowmetric analysis.

AbstractUroflowmetry was performed before and 5 years after elective prostatectomy for benign hypertrophy in 54 patients. A significant improvement in voiding ability was retained during this period, while hesitancy and a poor stream were the symptoms most often eradicated. However, a slow decrease in flow rate was observed during the first 5 years postoperatively in 37 patients who had undergone studies 4 months after the operation. If this trend were to continue flow rates would return to preoperative levels 24 to 30 years after prostatectomy.

Urodynamic factors in relation to outcome of prostatectomy

A pre- and postoperative five-year follow-up study on 83 patients undergoing elective prostatectomy for benign hypertrophy revealed good overall symptomatic results in 70 (84%). Hesitancy and a poor stream were improved more often than were frequency and nocturia. A high preoperative voiding pressure was significantly associated with a good result; less satisfactory results tended to be associated with a higher preoperative flow rate.

Surgical management of urethral stricture in the male.

Urethral dilatation has long been the standard treatment for patients with urethral stricture. However, in many patients such dilatations may be difficult, painful, or have to be done at frequent intervals. The alternative techniques of direct vision urethrotomy or urethroplasty have been considered in 101 patients over a twelve-year period. Skin inlay urethroplasty in this series showed a significant level of complications and an absolute failure rate of 15 per cent. A prospective study of 39 patients undergoing urethrotomy using the Sachse optical urethrotome has shown that 82 per cent of patients are symptom-free and 13 per cent symptomatically improved at a follow-up ranging from sixteen months to three and one-half years (mean twenty-five months). We believe that urethrotomy using the Sachse optical urethrotome should now be the initial treatment of choice in the management of urethral stricture. Urethral dilatations or urethroplasty should be reserved for those patients who have persisting stricture despite such urethrotomy.

Quantification of prostatic cancer metastaticdisease using prostate-specific antigen

The serum prostate-specific antigen (PSA) of 58 men with benign prostatic hypertrophy (BPH) and 17 men with carcinoma of the prostate (CaP) was correlated with the weight of prostatic tissue resected at transurethral prostatectomy (TURP). A significant correlation was identified between the weight of resected BPH tissue and the serum PSA (p less than or equal to 0.001; r = 0.54). No such correlation was seen in the CaP patients. By arbitrarily dividing the serum PSA by the prostate weight, it was possible to devise an index. This index corrected PSA in relation to prostatic size and unlike PSA in isolation did not differ significantly between normal controls and those with BPH. The index in CaP was significantly greater than that of either controls or BPH (p less than or equal to 0.001). Furthermore the index of metastatic CaP (M1) was significantly higher than that of nonmetastatic disease (MO) (p = 0.05). The higher index found in CaP would seem to be related to the bulk metastatic tumor, either manifest or occult. Comparing the index of CaPs to that found in normal and benign disease (a constant) offers a possible means of estimating the extent of local and metastatic tumor mass.

Histological and environmental changes in longstanding ileal conduits.

Fifty-three patients with symptomatic reflux oesophagitis were entered into a single centre randomized study comparing the effects of a dimethicone/antacid (Asilone Gel) and an alginate/antacid (Gaviscon liquid) on symptoms and endoscopic changes over an 8-week period. Both treatments significantly improved heartburn, acid regurgitation and flatulence. Dimethicone/antacid but not alginate/antacid, produced a significant improvement in oesophagitis, oesophageal ulceration and histological grade of inflammation over the 8-week treatment period so that 14 patients treated with dimethicone/antacid and 10 with alginate/antacid had normal endoscopic oesophageal appearances at the end of the study. The difference in improvement between the two patient groups did not reach significance however, except for dimethicone/antacid improving histological changes (P<0.05). These findings suggest that dimethicone/antacid and alginate/antacid are equally effective in treating symptomatic reflux oesophagitis although dimethicone/antacid may have an advantage in improving oesophageal histological appearances.

Spinal cord ischemia after ligation of both internal iliac arteries during radical cystoprostatectomy

In radical cystectomy where control of the blood supply is desirable, ligation of both internal iliac arteries is to be avoided. The lumbar part of the spinal cord and cauda equina receive arterial radicular branches via the posterior trunks of the internal iliac arteries. Thus, bilateral ligation of these vessels might cause ischemia of the lower part of the spinal cord.

Sachse optical urethrotome in management of urethral stricture in the male: preliminary communication.

Stricture of the male urethra is traditionally treated by regular dilatation or urethroplasty. Urethrotomy, the third method of dealing with stricture, has interesting historical associations (M urphy 1972) and though not used extensively in the past, when properly applied it has produced good results (Helmstein 1964). However, it is a blind procedure and even when urethroscopy is used before and after the incision (Helmstein 1964) it still remains a somewhat cumbersome technique. The development of an optical urethrotome has, however, altered this situation. The first optical urethrotome used electrocautery to incise the stricture (Ravasini 1957), but more recently Sachse (1974) has developed an optical urethrotome with a fine scalpel. This paper is a preliminary communication on our initial experience with the Sachse optical urethrotome.