W. De Sy

Correlation between the Findings of a Clinical Neurological Examination and the Urodynamic Dysfunction in Children with Myelodysplasia

Clinical neurological findings in 47 children with lumbosacral myelodysplasia did not correlate well with the existing dysfunction of the lower urinary tract as diagnosed by urodynamic studies. The level of intact skin sensation, and the presence or absence of bulbocavernosus and anal reflexes could not significantly predict the function of the detrusor muscle, proximal urethra and striated urethral sphincter. Therefore, one should not rely on a clinical neurological examination to outline the urological management in such patients.

Evaluation of different methods of bladder drainage used in the early care of spinal cord injury patients

In a series of 115 spinal cord injury patients four different methods of bladder drainage were used mainly during spinal shock. That is a) suprapubic fine bore cystostomy, b), indwelling Foley catheter, c) intermittent catheterisation; and d) both last methods consecutively.The methods of bladder drainage used did not influence the number of patients becoming catheterfree but determined significantly the length of period before patients became catheterfree. Patients on intermittent catheterisation had the shortest time from injury to established micturition.Patients on intermittent catheterisation and on cystostomy had few complications but in those patients treated with an indwelling Foley catheter the complication rate was high.

A Clinical Study of 99m Technetium Dimercaptosuccinic Acid Uptake in Obstructed Kidneys: Comparison with the Creatinine Clearance

We studied 17 hydronephrotic kidneys owing to stenosis of the pyeloureteral junction. Preoperative uptake of 99mtechnetium dimercaptosuccinic acid was compared to early postoperative unilateral creatinine clearance, measured by urine collection from the nephrostomy tube. An excellent correlation was found. Therefore, uptake of 99mtechnetium dimercaptosuccinic acid represents a reliable parameter of renal function even in the presence of severe urinary tract obstruction. However, 99mtechnetium dimercaptosuccinic acid uptake should be measured more than 24 hours after injection of the tracer.

Preliminary clinical experience with meptazinol, a new analgesic

The analgesic effect of intravenous meptazinol at various dosage levels was studied in 30 patients suffering from acute renal colic. Out of a total of 41 injections (dose range: 20 to 120 mg.) a favourable analgesic response was recorded on 39 occasions. The onset of action was rapid with the minimun duration of action of 1 hour. Higher doses increased the drugs action but were accompanied by nausea and dizziness. There was no overall effect on blood pressure or heart rate.

A plea for antireflux operations in adults: review of 50 cases.

The results of antireflux operations in 41 cases of primary and 9 cases of secondary vesicoureteral reflux in adults are presented. Reflux was eliminated in all cases and there were no postoperative complications. Most patients had a long history of urinary tract infection preoperatively, which was eliminated in 64.1 per cent of the cases after surgical correction of the reflux. A relapse of infection occurred in 30.8 per cent of these cases. Chronic pyelonephritis remains active in 5.1 per cent of the cases. There were 6 patients with serum creatinine levels higher than 1.8 mg. per cent who underwent a successful antireflux procedure without an increase of serum creatinine levels. An antireflux operation should be preferred over long-term conservative management in most cases of symptomatic vesicoureteral reflux in adults less than 50 years old.

Results of urometabolic evaluation in 127 patients with renal calculous disease

One hundred twenty-seven selected stone formers were evaluated. With the simple ambulatory tests proposed by Pak for metabolic screening and a complete urologic evaluation an anomaly was found in more than 90 per cent of the cases. The patients were divided into three groups: (1) patients operated on for staghorn stones; (2) patients with episodes of spontaneous stone eliminations or young people with only one stone episode; and (3) patients operated on for stone disease. No significant differences were noted except for the occurrence of urinary tract infection and for struvite and calcium oxalate occurrence in the different groups. Urinary tract infection combined with a metabolic disorder appear to make the evolution from small kidney stone to staghorn stone a reality.

Experimental and Preliminary Clinical Experience with Thermography for Avascular Nephrotomy

A simple method is presented for demarcation between different arterial areas, which allows the performance of nephrotomies with minimal bleeding and subsequent renal ischemia. The thermal gradient that exists between the segment with occluded blood supply and the adjacent ones retaining their blood supply is defined by a liquid cholesterol crystal sheet.

The use of the bladder wash-out test in patients with spinal cord lesions who have urinary tract infection

In 42 patients with a spinal cord lesion and chronic urinary tract infection the bladder wash-out test was performed to locate the site of infection.The test was easy to perform and no complications occurred. The test could not be performed in only one patient.Differentiation between upper and lower urinary tract infection was possible in 36 patients (43 tests). By using the test, precise treatment was possible for 23 patients, of whom 17 were cured.

A double-blind comparison between meptazinol (Wy 22811) and ‘Buscopan’ Compositum in renal colic

SummaryThe analgesic effect of a single intravenous injection of 60 mg. meptazinol or of a spasmolytic-analgesic combination (‘Buscopan’ Compositum: 20 mg. hyoscine-N-butylbromide plus 2.5 g. nor-amidopyrine)was studied in a double-blind trial in 40 patients with acute renal colic. The results showed that meptazinol provided greater pain relief and was faster acting. Pain relief after meptazinol persisted for at least 1 hour in all but 1 of the 20 patients treated. Dizziness was a frequent but well tolerated side-effect of meptazinol, and nausea and vomiting were reported almost equally after both treatments.

Blunt Ureteral Trauma with Perineal Urine Fistulization: Review of the Literature

The first case of blunt ureteral disruption with external urine fistulization is presented. Reanastomosis with temporary urine diversion by a nephrostomy tube was successful. A review of the literature since 1950 revealed only 49 cases that proved this pathology should be considered in the differential diagnosis of post-traumatic hematuria or the development of mass in the flank. Nephrectomy is no longer used since a thorough attempt at reconstructive surgery will provide good functional results.