Torben Bilde

Ureteroscopy: Results and Complications

The results and complications of 100 consecutive ureteroscopy studies are reported. Introduction through the orifice or the intramural ureter failed in 11 per cent of the patients and in 14 per cent the ureteroscope could not be advanced up to the level of the lesion. Ureteroscopy was successful in 75 per cent of the patients and stone extraction was successful in 69 per cent. Complications occurred in 9 patients: 4 had an uncomplicated urinary tract infection, 4 had a ureteral perforation and 1 presented with ureteral stenosis at the site of the extracted stone a few weeks later. At followup 1 to 3 months after ureteroscopy clinical examination, excretory urography and/or renography revealed no further late sequelae.

Retroperitoneal Fibrosis Treated with Methylprednisolon Pulse and Disease-Modifying Antirheumatic Drugs

The conventional treatment of patients with ureteric obstruction due to retroperitoneal fibrosis (RF) is surgery in combination with long-term corticosteroids. This report describes 11 cases of RF with ureteric obstruction treated with methyl-prednisolon pulse therapy (MPPT) in combination with azathioprine or penicillamine following initial insertion of ureteral stents. The medial treatment suggested was successful in 7 patients, but only moderately effective in the last 4 patients. This principle of non-operative management of RF has not been previously reported.

Prevention of urethral stricture formation after transurethral resection of the prostate: a controlled randomized study of Otis urethrotomy versus urethral dilation and the use of the polytetrafluoroethylene coated versus the uninsulated metal sheath.

Stricture formation after transurethral prostatectomy was studied in a randomized clinical trial including 185 patients. The patients were allocated to either a 2-day urethral catheter-dilation or internal Otis urethrotomy and to an operation with either a polytetrafluoroethylene coated or an uninsulated metal resectoscope. Urethral stricture was defined as an obstruction resulting in a maximum urine flow rate of less than 15 ml. per second and not permitting the passage of a 21F cystoscope. The frequency of urethral strictures was significantly lower after Otis internal urethrotomy (4 per cent) than after a 2-day urethral catheter dilation (16 per cent). The incidence of stricture formation was similar in patients operated on with a polytetrafluoroethylene coated (8 per cent) and with an uninsulated metal (12 per cent) resectoscope sheath. The incidence of stricture formation was unrelated to age, duration of preoperative and postoperative catheterization, operating time and presence of urinary tract infection.

Prostatectomy in Denmark: Regional Variation and the Diffusion of Medical Technology 1977-1985

In many countries prostatectomy is one of the most common surgical operations in elderly men. We used administrative data for the entire male population of Denmark to study temporal and regional variations in the use of prostatectomy from 1977 to 1985. The total annual number of prostatectomies increased by 43% during the period, when the transurethral procedure (TURP) gradually replaced traditional open surgery. TURP accounted for 56% of all operations in 1977 but increased its share to 92% in 1985. Substantial regional variations occurred with index values for prostatectomy in 72 recruitment areas ranging from 0.56 to 1.62 (SCV x 100 = 5.3). The amount of variation decreased during the process of technology diffusion, but remained at a relatively high level (as in other countries) even after the process had been completed (SCV x 100 = 5.1).

Vascular Resistance in Hypothermically Perfused Kidneys Damaged by Warm Ischemia

Vascular resistance was determined during hypothermic perfusion of rabbit kidneys after various periods of warm ischemia. Ischemia was induced by clamping of the renal artery, or of the renal artery and vein, in situ. Studies were made after periods of clamping ranging from 0 to 180 min. The perfusing fluid was 5% Dextran of low molecular weight in balanced saline solution (Tis-U-Sol), with addition of 5 mg % Papaverin. When the renal artery was clamped for more than 15 min, vascular resistance increased. Maximal resistance was reached after 60 min of clamping, and was 3 times as high as that value in the control group of kidneys which were not clamped. The vascular resistance attained after 60 min of clamping did not further increase when clamping was maintained for 180 min. When both the renal artery and the renal vein were clamped vascular resistance first increased after 30 min. Maximal resistance was reached after 60 min of clamping, but was only 1/2 of that level seen when the renal artery alone was clamped.

The collateral blood flow and hippuran clearance of the rabbit kidney after occlusion of the renal artery.

The collateral blood flow to the rabbit kidney was determined by two methods: (1) measurement of the venous flow after clamping of the renal artery and (2) Hippuran clearance of the clamped kidney. The collateral blood flow was found to be 0.012 ml/min/g kidney equivalent to 0.2% of the entire blood flow to the rabbit kidney. Compared with collateral blood flow in other mammals (as humans and dogs) with a collateral flow of 6.2% of the normal flow, the collateral blood flow in the rabbit is very modest. The cranial ureteric artery contributes more than 90% of the entire blood flow, while capsular perforants, important in other mammals, play no role in the supply of the rabbit kidney. Only 50% of the collateral blood flow passes the tubular system. Flow to the medulla calculated from Hippuran clearance was 35% greater than flow to the cortical part of the kidney. The subcapsular cortical tubuli were able to absorb Hippuran from the peritoneal fluid and surrounding tissues after the kidney was dissected free from its surroundings and all vessels severed. Absorption corresponded to an arbitrary serum flow of 0.0002 ml/min/g.

Is Micturition Disorder a Pathogenic Factor in Acute Epididymitis? An Evaluation of Simultaneous Bladder Pressure and Urine Flow in Men with Previous Acute Epididymitis

We evaluated 22 men 22 to 70 years old with previous acute epididymitis by pressure-flow study 3 to 12 months after the inflammation had resolved. Nine healthy men 20 to 62 years old were evaluated as controls. The patients had no symptoms from the lower urinary tract except for 2 men with slight prostatism. The maximum intravesical and maximum voiding pressures were elevated significantly in the patients compared to the controls (p less than 0.05). In most patients and in all of the controls the maximum urinary flow rates were within the normal range according to age. Because of the frequency of high voiding pressures in patients with previous acute epididymitis, this condition may be a pathogenic factor by promoting urethrovasal reflux. The high voiding pressures may be transmitted to the proximal urethra or in cases of a narrow and rigid bladder neck they may produce increased turbulence in the urine stream.

The effect of chlorpromazine pretreatment on tubular function in kidney preservation.

The effect of Chlorpromazine pretreatment on tubular function was investigated. Hippuran uptake in cortex slices from rabbit kidneys was measured after one hour of incubation in a medium containing Hippuran. Before measurement the kidneys were exposed to varying periods of warm ischaemia or/and cooled and preserved for 24 hours in Collins solution. Chlorpromazine treated and untreated groups of animals were compared, the results obtained were identical in both groups. In contra distinction to these findings, addition of Chlorpromazine to the incubation fluid inhibited uptake of Hippuran in the kidney slices. The effects of pretreatment with Chlorpromazine on the kidney function after ischaemic damage were demonstrated. Serum-creatinine and survival were compared in a treated and an untreated group after 3 hours of temporary clamping of the renal artery. Pretreatment resulted in earlier onset of function and better survival. It is concluded that the antimetabolic effect of Chlorpromazine is opposed to its vasodilatory properties is of little practical importance for the viability of the kidney damaged by ischaemia.

Human Umbilical Vein for Vascular Access in Chronic Hemodialysis

Since 1979 we have used human umbilical vein graft as the ultimate vascular access for hemodialysis in patients with chronic renal failure. In 24 patients 33 graft fistulas were performed. Several complications were encountered. Among these infection was the most serious, occurring in seven grafts. All these grafts were removed and never used for hemodialysis. Thrombosis occurred 25 times, and five grafts were lost because of this, whereas 20 grafts had successful thrombectomy and continued to function. Aneurysm formation occurred four times, two grafts were lost. Stenosis was seen in three cases, one graft was lost. In the material 26 grafts were used for hemodialysis and a median function time of 8.5 months was obtained. At the end of the observation period 10 grafts were open, eight were used for hemodialysis, two were not used because of successful transplantation. The umbilical vein graft is an acceptable alternative as vascular access where conventional methods of fistula formation have been exhausted.

The Effect of Temporary Clamping of the Renal Vessels on the Vascular Resistance in Rabbit Kidneys

In studies of 45 rabbits, either the renal artery (35 animals), or the renal artery and vein (10 animals) were clamped in situ. The effect of the clamping--of the warm ischemia--on the vascular resistance of the kidney after reestablishment of the circulation was examined in perfusion studies made after removal of the kidneys from groups of 5 animals between 1 and 5 days after revascularization. Resistance patterns were measured during hypothermic perfusion. The results confirm earlier findings that vascular resistance increases in proportion to the duration of warm ischemia up to 60 min, but not thereafter. The renal vascular resistance falls over the days following revascularization, more slowly after longer periods of ischemia. Thus after 60 min of warm ischemia the vascular resistance became normal within 24 hours, but after 180 min of warm ischemia, the normal resistance range was not reached until 96 hours after reestablishment of the circulation. When both the renal artery and the renal vein were clamped, the pattern was the same but much less emphatic. The vascular resistance never attained such high values as seen after clamping of the renal artery alone, and became normal after 24 hours of revascularization, even when the period of warm ischemia was as long as 180 min.