Peter Mogensen

Local Anesthesia for Extracorporeal Shock Wave Lithotripsy: A Study Comparing Eutetic Mixture of Local Anesthetics Cream and Lidocaine Infiltration

A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.

Intravesical Therapy of Noninvasive Bladder Tumors (Stage Ta) with Doxorubicin and Urokinase

A double-blind investigation was done on 44 patients with noninvasive bladder tumors (stage Ta) given randomized intravesical treatment with doxorubicin with or without urokinase. The bladder tumors were not removed before treatment in any patient. No significant difference in response was detected between the 2 types of treatment. Of the patients 86 per cent responded to treatment, including 52 per cent who achieved complete remission. At 12 and 42 months after termination of treatment 42 and 35 per cent of the patients, respectively, remained free of recurrent tumor.

Extracorporeal Shock Wave Lithotripsy of Kidney Stones does not Induce Transient Bacteremia. A Prospective Study

AbstractDuring 58 extracorporeal shock wave lithotripsies 161 blood cultures were drawn to evaluate the incidence of bacteremia during the procedure. Only 3 blood cultures drawn during the procedure yielded bacteria, in all cases probably skin flora contaminants. Post-lithotripsy fever was noted in 29% of the patients, and could not be associated with transient bacteremia and was not influenced by antimicrobial prophylaxis. Patients with a positive urine culture after extracorporeal shock wave lithotripsy may have an increased risk of septicemia.

Inflammatory fibrous histiocytoma of the urinary bladder: clinicopathological report of a case.

Malignant fibrous histiocytomas of the retroperitoneum and abdominal cavity constitute 10–16 per cent of reported cases of this sarcoma. Primary location in organs is only rarely found. The clinicopathological aspects of a case of inflammatory fibrous histiocytoma in the urinary bladder are reported. The serious prognosis of deeply situated malignant fibrous histiocytomas calls for a long follow-up period.

Anesthesia and Complications of Extracorporeal Shock Wave Lithotripsy of Urinary Calculi

The techniques of anesthesia for extracorporeal shock wave lithotripsy of urinary calculi and the associated complications in 600 treatments with the second generation lithotriptor Siemens Lithostar were studied. General anesthesia was used in 17 treatments (2.8%) and epidural anesthesia was applied in 73 (12%), primarily in children and patients in need of simultaneous surgical auxiliary procedures. A total of 510 treatments (85%) was performed with a combination of local infiltration anesthesia and supplementary intravenous opiates. In 65% of the cases only 2 injections of opiates were sufficient for pain relief. There were no complications in 394 treatments (77%) and minor complications, such as arrhythmia (9.2%) and nausea/vomiting (7.6%), were easily treated. Respiratory depression was observed in 10 cases (2%) and this potentially dangerous complication was associated with simultaneous administration of opiates and midazolam. Only 9 treatments (1.8%) had to be terminated due to complications. It is concluded that most treatments of urinary calculi with this second generation extracorporeal shock wave lithotriptor can be performed with local infiltration anesthesia combined with supplementary short-acting opiates intravenously for pain relief and sedation. When administering supplementary midazolam for sedation the risk of respiratory depression should be considered.

Extracorporeal Shock Wave Lithotripsy as First Line Monotherapy of Solitary Calyceal Calculi

Eighty-four patients with solitary calyceal stones were treated with Extracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infection in 11 patients (13%), pain and infection in 18 patients (21%) and others in 4 patients (5%). Stone size (largest diameter) was median 9 mm (range 2-25 mm). Follow-up consisted of clinical control, isotope renography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureteral fragments, and 1 ureteroscopic manipulation). Retreatment of the calyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary procedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 months and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ-stent in 2 patients and atrio-ventricular dissociation in 1 patient. To conclude: ESWL as first line therapy for solitary calyceal calculi offers good results with regard to pain and clearance of infection, but leaves 55% with residual stone material.

Transurethral ultrasound scanning in the evaluation of invasive bladder cancer

One hundred and sixty-six patients suspected of having bladder tumours underwent transurethral ultrasound scanning before cystoscopy. Forty-nine patients had no tumour either at cystoscopy or on ultrasonography. Nine of the remaining 117 patients (8%) had false positive results and in a further 8 (7%) the ultrasound failed to show the tumour. The diagnostic accuracy for superficial tumours was 73%, whereas the accuracy in assessing muscle infiltrating and more advanced tumours was almost identical, 58-59%. It is concluded that transurethral ultrasound scanning does not add to the information obtained from cystoscopy and bimanual palpation in patients with bladder tumours.

Gangrenous Cystitis: A Case Report

Below is presented a case of bladder gangrene, delivery of the entire bladder wall per urethram, and spontaneous healing. The aetiology and treatment of gangrenous cystitis are reviewed in 21 cases reported in the literature over the past 45 years.

Long-term probability of prostatism vs general morbidity and mortality. Prospectively obtained data in a randomly selected cohort aged > 50 years.

In a 7-year study of 178 randomly selected healthy men older than 50, data were respectively obtained concerning treatment for benign prostatic hypertrophy (BPH) and overall morbidity and mortality. Plain symptom scores were calculated in all cases and urinary voiding was recorded in 112. The maximum flow rate was read and the pattern of flow curve determined. Log rank test and survival curves were used in evaluation of results. The general risk of death or disease overshadowing BPH greatly exceeded the probability of surgery for prostatism. The only factor predicting need for prostatectomy was a symptom score higher than 6 points. If the symptom score is low and indications for treatment are otherwise, relative, an expectant attitude to surgery for BPH is advocated.