Robert Blute

Urodynamic Evaluation of Prostatic Enlargements with Micturitional Vesicourethral Static Pressure Profiles

We studied 58 men with prostatism, who were between 58 and 75 years old, with micturitional vesicourethral static pressure profiles. The study consisted of recording static (lateral) pressures of successive segments of the posterior urethra during voiding, with synchronous monitoring of the vesical pressure activity. An abnormal pressure decrease across the supramontane urethra was considered to be a functional compromise to the prostatic urethra. The studies indicated that the degree of prostatic urethral obstruction was not related to the clinical and endoscopic assessment of prostatic enlargement. Three major patterns emerged from our studies: 1) moderate to severe prostatic enlargement with severe obstruction, 2) moderate to severe prostatic enlargement with minimal or no obstruction and 3) minimal prostatic enlargement with severe obstruction. Also, a good correlation became apparent between micturitional vesicourethral static pressure profilometry and uroflowmetry.

Urodynamic Localization of Isolated Bladder Neck Obstruction in Men Studies with Micturitional Vesicourethral Static Pressure Profile

Micturitional vesicourethral static pressure profile, a method of recording the static (lateral) component of voiding pressure in the successive urethral segments contiguous with the bladder, has allowed us to establish directly the site and degree of bladder outlet obstruction in 16 men. The diagnosis of isolated bladder neck obstruction was confirmed with greater confidence by using this technique with a 10F trilumen catheter in conjunction with uroflowmetry and radiologic studies. Repeat studies with a 5F single lumen catheter have suggested that the obstructions recognized with the 10F catheter ware not entirely artifactual. Our experience with this technique in several men with non-neurogenic bladder neck obstruction indicates the importance of including this study in the urodynamic armamentarium.

Renal Brush Biopsy: Survey of Indications, Techniques and Results

Urine cytology is inaccurate in the diagnosis of low grade tumors of the ureter and pelvis. In 1973 the retrograde brush biopsy technique was introduced in an effort to improve diagnostic capabilities. We herein review our experience with retrograde brushing of upper urinary tract radiolucent filling defects in 21 patients during a 6-year period. In addition, we have surveyed other urologists concerning their experience with this new technique. The data accrued from both sources, involving 68 procedures, were analyzed with respect to the results, technique and complications of this procedure. In lesions from which tissue was obtained we found an over-all diagnostic accuracy rate of 78 per cent. The major and minor complication rates were 7 and 34 per cent, respectively. Our results support the conclusion that this procedure is of value in the management of selected patients with problem radiolucent filling defects of the renal pelvis and ureter.

Isolated bladder neck obstruction of undetermined etiology (primary) in adult male Recognition and management

Varying degrees of isolated bladder neck obstruction of undetermined etiology were identified with micturitional vesicourethral static pressure profiles. Our experience with the urodynamic studies in 15 patients suggests that isolated bladder neck obstruction is a real entity in young adult males. Our experience also suggests that pharmacologic success with alpha-adrenergic blockade of the dosage tolerated by the patients is inconsistent. Successful clinical results achieved with appropriate bladder neck surgery could be confirmed with uroflowmetry and detailed urodynamic studies during postoperative period.

Radiocolloid Scintigraphic Mapping of the Lymphatic Drainage of the Prostate

Radionuclide lymphoscintigraphy with the new microcolloid 99mtechnetium antimony sulfide is a diagnostic technique with potential application in patients with urologic malignancy. Scintigraphic images were obtained after simple interstitial injection into the prostate of 9 normal dogs and 2 patients with prostatic cancer and into the testis in 2 dogs. The images show the physiologic lymphatic drainage of the organs injected.

Signet ring cell carcinoma of bladder Evaluation of three cases with review of literature

Three cases of adenocarcinoma involving the bladder and consisting mainly of signet-ring-shaped cells are presented. Each case represents a different form that the lesion may take, and these forms are compared. This unusual neoplasm has a worse prognosis than transitional cell carcinoma of the bladder, possibly because of factors that lead to delays in management. Radiation therapy is ineffective, and the results of treatment with segmental resection of the involved area of the bladder are equivalent to those of total cystectomy.