Management of the fetus with a correctable malformation in Paris maternity units: evolution 1985-1994

OBJECTIVE

To analyze the evolution of the management of delivery and neonatal care in a population of children with correctable malformations born in Parisian maternity hospitals during the period 1985-1994.

METHODS

Data were collected by the Paris Registry of Congenital Anomalies from 400,000 births recorded in Parisian maternity hospitals over a 10-year period. Chromosomal anomalies were excluded. The evolution between the first period (1985-1989) and the second (1990-1994) was analyzed for the following indicators in the management of liveborn children: place of delivery; frequency of prenatal diagnosis; transfer to intensive care units, and mortality.

RESULTS

More than 60% of the births of malformed children took place in public maternity hospitals where better management is offered. Most of them were prenatally diagnosed, except for esophageal and anorectal atresia for which the rate of prenatal diagnosis was low. For malformations with poor prognoses (diaphragmatic and abdominal wall anomalies), the rate of deliveries in public maternity hospitals reached about 90%, mostly in those with intensive care units. The evolution between the two periods was characterized by a quicker transfer to intensive care units, during the first day of life for most cases. Lethality during the first day, which was already low during the first period, decreased further. The early neonatal mortality rate decreased for cardiac anomalies, but not significantly. The prognosis remained poor for diaphragmatic anomalies: 49% of liveborn children died during the first week of life.

Prostatic stents for benign prostatic hyperplasia

Treatment options for benign prostatic hyperplasia (BPH) have developed rapidly over the past several years. These options include surgical intervention, medical therapy, and minimally invasive modalities such as prostatic stents. Prostatectomy remains the treatment of choice for symptoms that are the result of bladder outflow obstruction, with success rates of 85-90%. Medical therapy with selective alpha-1 antagonists, 5 alpha-reductase inhibitors, LHRH antagonists, antiandrogens, and aromatase inhibitors have increased in popularity and are mainly used to treat patients with mild to moderate prostatic obstruction. Prostatic urethral stents have recently emerged as an alternative treatment for BPH throughout Europe and Asia, but few investigators have used prostatic stents in the United States because of strict regulatory forces and a debate concerning the indications for these devices. The possibility of providing a treatment option for BPH to patients who are frail and elderly, as well as to patients with multiple medical problems, has prompted enthusiasm toward prostatic stents in the urologic community. The focus of this review will be an up-to-date discussion of the types of prostatic stent available, including a review of recent clinical trials involving the use of each available stent.

The Glidewire technique for overcoming urethral obstruction

PURPOSE

Using the hydrophilic Terumo Glidewire we developed a less traumatic, yet effective alternative method to filiforms and followers for cases of urethral obstruction.

MATERIALS AND METHODS

The initial step and cornerstone of our method is the passage of the Glidewire per urethra in a manner similar to a filiform. After the appropriate intravesical location of the Glidewire is confirmed using a ureteral catheter, it is exchanged for a standard polytetrafluoroethylene (Teflon) coated guide wire. Urethral dilation and/or catheter placement is then performed.

RESULTS

This technique was successful in 19 of 20 attempts, several of which followed unsuccessful passage of filliform catheters. Urethral obstruction due to strictures, bladder neck contractures and benign prostatic hyperplasia in our group was treated effectively. Furthermore, no complications occurred due to the technique.

CONCLUSIONS

The Glidewire method is safe and effective for treating most cases of urethral obstruction. Therefore, we recommend this technique over standard filiforms and followers when flexible or rigid cystourethroscopy is not immediately available.

Medical management of iatrogenic rents in the wall of the feline urinary bladder

Surgical closure may not be necessary to successfully manage all patients with ruptured urinary bladders. If the margins of the walls of tears in the bladder wall are not devitalized, and if they remain in close apposition via maintenance of the bladder lumen in a nondistended state for an appropriate period, these conditions may simulate those created by use of surgical sutures. This is not advocating an all-or-none choice. Because the clinical status of patients with ruptured urinary bladders can range from that characterized by only hematuria and dysuria to life-threatening postrenal uremia, a range of surgical and medical options should be considered.

Medical management of feline urethral obstruction

A step-by-step priority of procedures is recommended when attempting to restore urethral patency in an obstructed male cat. In order of priority they are: (1) massage of the distal urethra, (2) attempts to induce voiding by gentle palpation of the urinary bladder, (3) cystocentesis, (4) retrograde urethral flushing, (5) combinations of 1 through 4, (6) diagnostic radiology to determine if the cause of urethral obstruction is intraluminal, mural or extramural, and if absolutely necessary, (7) surgical procedures.

[Interdisciplinary management of fetal obstructive uropathy]

The joint care of children with obstructive uropathy by perinatologists, pediatric intensivists, pediatric nephrologists and urologists can preserve as much renal function as possible. Complications such as urinary tract infections and problems with renal insufficiency can be prevented. Preterm delivery for early surgical decompression of the urinary tract postpartal should be performed only in exceptional cases. We want to underline that supporting and counselling parents in coping with severe findings and prognosis of the disease is among our main aims. We will present two selected cases to demonstrate the spectrum of methods for handling fetal obstructive uropathy.

Changes in pressure-flow parameters in patients treated with transurethral microwave thermotherapy

PURPOSE

We document changes in pressure-flow study parameters in patients treated by transurethral microwave thermotherapy.

MATERIALS AND METHODS

Pressure-flow study tracings before and after therapy from 75 patients with benign prostatic hyperplasia were analyzed. Patients were stratified according to the predominant type of obstruction at screening (constrictive or obstructive).

RESULTS

An improvement in Madsen score and flow rates was noted at 6 months in both groups. In contrast to compressive obstruction patients, however, those with constrictive obstruction also showed significant changes in pressure-flow study parameters, including detrusor pressure at maximum flow, maximum flow rate and urethral resistance factor.

CONCLUSIONS

Patients with predominantly constrictive obstruction are the best candidates for microwave thermotherapy.

The prediction of clinical outcome from transurethral microwave thermotherapy by pressure-flow analysis: a European multicenter study

A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.

[Obstruction of the urethral conduct following implantation of the endoprosthesis Urolume: therapeutic management]

The introduction of self-expandable urethral endoprostheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprosthesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

Improved subjective responses to orchiectomy plus nilutamide (anandron) in comparison to orchiectomy plus placebo in metastatic prostate cancer. International Anandron Study Group

Patients with advanced prostate cancer have a beneficial effect from maximal androgen blockade in terms of the subjective and objective delay of progression and median duration of survival, although side effects do occur more often in the combination treatment than in testicular suppression alone. Significant improvement or delayed deterioration in subjective parameters such as metastatic pain, performance status and urinary disorders strongly suggest (in the absence of validated questionnaires of quality of life at the time of this study) that orchiectomy plus nilutamide improves the quality of life as assessed by the subjective delay of progression, according to NPCP criteria, to an extent which outweighs the majority of adverse events.

A new self-expansive intraurethral stent using shape memory alloy: a preliminary report of its availability

OBJECTIVES

We describe a new stent made from shape memory alloy (SMA) first developed by our collaborative group, its structure, and a simple and easy procedure for its placement and removal without the need for a monitoring system or sedation.

METHODS

The stent made of SMA was placed in 5 dogs for 10 months. It was left in situ in the shape of thermal expansion while the obturator Foley catheter was removed.

RESULTS

Placement and removal of the stent was very easy and quick on each occasion in all 5 dogs. No proximal or distal dislodgement was observed in 5 dogs during the indwelling period. There was no encrustation of calcification on the surface of the stent at its removal.

CONCLUSIONS

These preliminary results suggest that the SMA spiral stent might be an alternative for the relief of prostatic obstruction and be well tolerated in patients with bladder outlet obstruction. The SMA spiral stent is being developed for clinical use.

Long-term results of intermittent low-friction self-catheterization in patients with recurrent urethral strictures

OBJECTIVE

To ascertain the duration of intermittent low-friction self-catheterization (ILSC) required to cause stricture stabilization.

PATIENTS AND METHODS

Over a 4 year period, 101 patients with a median age of 62 years (range 16-85) with recurrent urethral strictures were recruited to the trial. All the strictures were treated by internal urethrotomy and the patients were then randomized to perform ILSC twice weekly for either 6 months (group 1) or 36 months (group 2). Out-patient follow-up with urinary flow rate was initially at 1 month and then at 3 monthly intervals. Stricture recurrence rates were compared between the two groups.

RESULTS

Of 101 patients, seven failed to attend after the first out-patient appointment. A further 21 died of unrelated disease whilst on ILSC (although 13 had been followed up for at least 24 months and so were included in the analysis). The median follow-up was 67 months (range 24-78). Ten patients in group 2, who had suffered from recurrent strictures, refused to stop catheterizing at the appointed time and all remain stricture-free on permanent ILSC. Of the remaining 76 patients, 48 catheterized for 6 months and 28 patients performed ILSC for 12 to 36 months (nine stopped earlier than intended). Forty per cent of patients who stopped at 6 months developed a recurrence compared with 14% who catheterized for more than 12 months (P < 0.05) (chi-square test with Yates' correction).

CONCLUSIONS

Our results indicate that ILSC is safe and effective in preventing stricture recurrence in the long term. The recurrence rate of urethral strictures was significantly lower when ILSC was continued for more than 12 months compared with ILSC that was stopped at 6 months. We conclude that catheterization for at least 1 year is required to achieve adequate urethral stabilization.

A novel canine model of partial outlet obstruction secondary to prostatic hypertrophy

Benign prostatic hyperplasia (BPH) is a major medical problem in the United States. The primary medical complication of BPH is progressive obstruction of the urethra and a subsequent in reduction the ability or the bladder to empty efficiently. The urodynamic characteristics associated with BPH include hyperreflexia, increased bladder capacity, increased frequency, decreased flow rate, and increased residual volume. Although there currently are individual animal models of prostate enlargement and animal models of partial outlet obstruction, there is no model of progressive obstruction secondary to prostate enlargement. The primary objective of the current study was to develop a canine model of BPH that would secondarily result in partial urethral obstruction and impaired urodynamics. Our model consists of encapsulating the prostate in a nylon mesh to prevent the growth of the prostate into the peritoneal cavity and then treating the dog with steroids to induce prostate growth and subsequently produce urethral constriction. The results demonstrate that encapsulation of the dog prostate and administration of steroids results in an increase in prostate mass simultaneously with an increase in urethral pressure and in changes in bladder contraction consistent with the presence of partial outlet obstruction. This preliminary study demonstrates that by preventing the outward growth of the steroid-stimulated prostate, urethral obstruction resembling BPH can be produced.

Inability to pass a urethral catheter: the bedside role of the flexible cystoscope

An all too common cause of urologic consultation is the inability to place a urethral catheter. Often other health care providers have unsuccessfully attempted catheter placement. Urethral false passages, perforations, and edema are common sequelae. Diseases such as urethral strictures, bladder neck contractures, and prostate cancer are often the underlying etiologies for failed catheterization. Traditionally, the use of filiforms and followers or the placement of a suprapubic tube is required to drain the lower urinary tract. Bedside flexible endoscopy was performed in this series not only to define the area and etiology of urethral obstruction, but also to facilitate catheter placement. Fifty-four patients were studied prospectively. Initial endoscopic assessment was based on bedside flexible cystoscopy. Most procedures were performed under topical lidocaine anesthetic. Under direct vision a 0.038 inch standard guide wire was directed through the area or areas of obstruction. Strictures, fibrosis, and false passages were dilated using a series of graduated Nottingham dilators over the guide wire. A Council-tipped urethral catheter was then placed over the guide wire to assure bladder drainage. In 52 of the 54 patients urethral obstructions were dilated and drainage catheters were placed into the bladder. No complications were encountered. This technique is simple, it avoids suprapubic puncture, and it minimizes unneeded trips to the operating room.

The posterior urethral valve uropathy: results of treatment

Nineteen children treated for posterior urethral obstruction due to congenital valve in the University of Benin Teaching Hospital, Benin City, Nigeria, over a 9-year period have been analysed. Their ages ranged from birth to 12 years. Results show that associated kidney pathology may be irreversible even after successful excision of the valve. This determines the final prognosis, which is worse the younger the child at presentation.

New therapeutic options in prostatic enlargement

Benign prostatic hyperplasia occurs in the majority of men past middle age. Transurethral prostatectomy has stood the test of time, but it may not be suitable for some men by virtue of concurrent medical problems or because patients prefer to avoid the risks and complications associated with surgery. This article outlines some of the alternative therapeutic options that are available.

Stent of shape-memory alloy for urethral obstruction caused by benign prostatic hyperplasia

Dilation and positioning a stent in the prostatic urethra have become important alternatives for the management of benign prostatic hyperplasia (BPH), but both have significant drawbacks, namely the need to repeat the treatment in the former case and the conflict between the introducing means and the generation of sufficient expansile force in the latter case. A spiral of a Chinese titanium-nickel alloy with shape memory was implanted in 25 patients with BPH using a self-made coaxial sheath. With a follow-up of 3 to 20 months, the success rate is 92%. There has been no encrustation or migration of the spirals. We deem the spiral of this shape-memory alloy to be a good alternative in patients with BPH who are unfit for surgery.

Self-retaining intraurethral device for treatment of prostatic obstruction

We report our experience about insertion of 32 self-retaining intraurethral device (IUC) in patients with prostatic obstruction. Follow-up ranged between 2 and 38 weeks. Success rate of IUC insertion was 93.7% and 46.6% of patients have IUC in place without complications during follow-up. IUC is easy and quick to introduce, it allows spontaneous voiding, full continence, sexual activity and routine life-style. It represents a useful alternative to indwelling catheter in patients at high risk or refusing surgery and it might be used in patients who are waiting for surgery or need long term catheterization.

Investigations on dietary treatment of struvite urolithiasis: 3. Effect of an acidifying diet on acid-base- and mineral-balance of cats after acute urethral obstruction

The effect of a commercial acidifying diet on acid-base-balance and urinary mineral concentration was compared in five healthy cats and five cats with urethral obstruction for six days after the removal of lower urinary tract obstruction. There were no significant differences in urine pH throughout the experiment between the groups. Blood pH was decreased in obstructed animals at the time of presentation at the clinic, but thereafter it did not differ from data from healthy cats on the same diet. The concentration of phosphorus and potassium in urine decreased, sodium and chloride did not change, while magnesium and calcium content increased.

Prostatic heat treatments for urinary outflow obstruction

A nonrandomized pilot study was done of 139 patients with symptomatic benign prostatic hyperplasia treated with 3 prostatic heating devices. Of the patients 19 underwent transrectal hyperthermia with the Biodan Prostathermer and in 15 the Primus Prostate Machine was used. At 2 1/2 years 7 of 19 patients (37%) patients in the Prostathermer group and 6 of 15 (40%) in the Primus group had adequate sustained improvement and had not undergone further treatment. At 1 year 55 of 100 patients (55%) treated with the Thermex-II section transurethral thermotherapy unit had a satisfactory result, with 40 (40%) having undergone transurethral resection of the prostate. The number of patients who failed therapy increased with each followup. Analysis of pretreatment parameters, including patient age, prostate size, peak urinary flow rate, post-void residual urine volume and symptom score, did not predict a successful outcome. Although these devices have minimal effect on peak urinary flow rate, a subset of patients enjoy symptomatic improvement.

[Application of intraurethral catheter for geriatric male patients complaining of urethral obstruction due to malignancy--comparison with benign prostatic hypertrophy]

Intraurethral catheters (IUC) were used for elderly male patients with prostatic urethral obstruction (PUO) due to malignancy (MA) and benign prostatic hypertrophy (BPH). Thirty-three men complaining of urinary retention in spite of medical therapy at the risk for prostatic surgery underwent insertion of IUC (16Fr Puroflex, Angiomed Co., Ltd., Germany). Six of 33 were patients with PUO due to MA (5 prostatic cancer, and 1 urethral invasion of rectal cancer, mean 82.7 years old), and the other 27 were patients with BPH (average 80.1 years old). Follow-up period of the former ranged from 2 to 9 (mean 6.5) months, and that of the latter ranged from 6 to 23 months. Water filling cystometry (CMG) before the insertion of IUC and fluoroscopic voiding cystourethrography (VCU) just after insertion of IUC were performed. We defined normal CMG and normal VCU as normal bladder, overactive CMG and normal VCU as overactive bladder, and normal or poor sensitive CMG and underactive VCU as underactive bladder. Five of 27 BPH patients had previous prostatic operations (TUR-P, and/or balloon dilation), but 6 MA did not. All of MA (3 normal bladder, 2 overactive bladder, and 1 underactive bladder) voided satisfactorily, and average duration of IUC in place was 6.5 months without exchange of IUC. Although sixteen of 27 (59.3%) BPH patients voided satisfactorily, and average duration of IUC in place was 12.1 months without exchange of IUC, in the other 11 of these 27 BPH patients were removed IUC, and average duration of IUC in place was 4.7 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

The prostatron transurethral microwave device in the treatment of bladder outflow obstruction due to benign prostatic hyperplasia

There is currently considerable interest in the development of non-surgical means of managing bladder outflow obstruction due to benign prostatic hyperplasia (BPH). We report the results of a 1-year follow-up of 140 men (mean age 67.2 years) presenting with symptoms of bladder outflow obstruction treated for 1 h in a single session by the Prostatron transurethral thermotherapy system. Symptom scores, using a system modified from Boyarsky, fell from baseline values of 23.7 to 11.6. Maximum urinary flow values increased from a mean of 10.1 to 12.4 ml/s. Although residual urine volumes decreased slightly, this was not statistically significant. A self-administered postal questionnaire returned by 114 patients 1 year after Prostatron treatment, and by 87 patients of similar age who had undergone transurethral resection of the prostate (TURP) in the same institution, revealed that patient satisfaction regarding the outcome of each procedure was higher for TURP than thermotherapy. However, more patients suffered sexual dysfunction after TURP than after microwave treatment. It was concluded that although treatment with the Prostatron device produces subjective and objective improvement in a proportion of patients with BPH, more work needs to be done to improve the overall results and to pre-identify patients who experience little or no benefit from this therapy.

Use of multiple Wallstents in treatment of bladder outlet obstruction

Of 23 patients being treated with the Urolume Wallstent for bladder outlet obstruction, 4--3 with anterior urethral strictures and 1 with benign prostatic hyperplasia--required two to four stents. When placing multiple stents, there should be enough overlap to prevent the opening of a gap as the stents expand and shorten over the ensuing weeks. Use of more than 1 stent is indicated when the stricture or the prostatic urethra is longer than 3 cm or when stricture recurs beyond the end of a previously placed stent.

The management of meatal obstruction due to Kaposi's sarcoma of the glans penis

Kaposi's sarcoma involving the glans penis was first described in 1902, with a subsequent report of meatal disease in 1943. With the recognition of the acquired immunodeficiency syndrome, genital lesions are becoming more frequently reported, with 51 cases cited in the literature. To date only 4 additional cases of meatal or fossa navicularis involvement have appeared in the literature, 3 of which described difficulty with micturition. We report a case of Kaposi's sarcoma involving the urethral meatus resulting in documented outflow obstruction, relieved with simple urethral serial dilation performed on an outpatient basis followed by intermittent obturation. We believe that this therapy represents a low risk, cost-effective treatment modality aimed at resolution of symptoms and alleviation of a potential source of infection in the patient with the acquired immunodeficiency syndrome.

[Shape memory alloy spiral for urethrostenosis caused by benign prostatic hyperplasia]

The nitinol (shape memory alloy, SMA) spiral was used in 39 patients with benign prostatic hyperplasia (BPH). Caine experiment indicated that the spiral could be embedded by prostatic urethra epithelium in 6 months. The new transitional epithelium between spiral wires was originated from the urethra transitional epithelium as proved by immunohistochemical staining. The parts of spiral project over the bladder cavity formed incrustation on the spiral tip. The nitinol is of super-elastic property, corrosive-resistance and excellent biocompatibility, in addition to unique shape memory effect. We treated 39 patients with BPH by self-made coaxial sheath introducing Chinese nitinol spiral into the prostatic urethra, with a successful rate of 89.7%. Follow-up for 3-26 months showed no incrustation and migration of the spiral.

Efficacy of transurethral hyperthermia in benign prostatic hyperplasia

From February 1990 through May 1991, 37 patients with benign prostatic hyperplasia were treated by transurethral hyperthermia according to two different protocols. In group I, 10 patients with an indwelling catheter underwent six one-hour sessions twice a week for three weeks, at a temperature of 43 degrees C. The 27 patients from group II (11 with indwelling catheter) had two sessions of two hours each for one week, at a temperature of 44.5 degrees C. Prostatic volume, Madsen symptom score, two estimates of peak flow, average flow, and residual urine measurements were recorded before treatment and one week, one month, six months, and one year after completing the sessions. Hyperthermia was applied through a metal ring, which was used both for heating and temperature control, mounted on a 16-F Foley-Tieman-like catheter. The follow-up period was five to fifteen months. From those who had an indwelling catheter, 5 of 10 patients (50%) from group I and 8 of 11 patients (72.7%) from group II regained spontaneous micturition and continued to void satisfactorily throughout the follow-up period. Nine of 16 patients without catheter (56.3%), showed objective and subjective improvement. Transurethral hyperthermia is a new, simple, noninvasive, and well-tolerated method for the treatment of benign prostatic hyperplasia.

Endoluminal urethral stents: a review

Although Fabian first introduced the concept of an endourethral stent in 1980, recent developments in biomedical technology and the treatment philosophy of urethral obstruction has led to a resurgence of this concept. We review the past and current literature with regard to both temporary and permanent stents. Available stents are described, clinical results summarized, and indications discussed.

Balloon expanded titanium prostatic urethral stent

A new balloon expanded titanium prostatic urethral stent has been devised for the treatment of outflow obstruction. This stent is inserted under endoscopic guidance and endourethral anesthesia. We have treated 9 male patients in urinary retention with a mean follow-up of eighteen months. Six of our 9 patients had a good and prolonged response to stenting. Complications were minimal and the procedure was well tolerated. We believe that the balloon expandable titanium stent is a viable alternative for the treatment of urinary retention particularly in the very ill patient.

The use of intraurethral prostatic spiral in high risk patients for surgery with benign prostatic hyperplasia

Under local anaesthesia, 31 patients underwent insertion of an expandable stainless steel tubular spiral into the prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. Most of them had long-term indwelling urethral catheters (14 patients). The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary obstruction if they are unfit for surgery.

Transurethral balloon divulsion of prostate

Benign prostatic hypertrophy (BPH) is the most common cause of urinary outflow obstruction. Transurethral resection of the prostate (TURP) is the preferred treatment for symptomatic BPH and is considered the gold standard of treatment. Balloon dilatation of the prostate (TUBD), besides some criticism, represents a nonoperative treatment alternative for treatment of symptomatic BPH which is simple and safe. We describe the technique of TUBD, balloon technology, as well as advantages and disadvantages of balloon dilatation.

Use of an implant for intraosseous infusion as supportive therapy for a Vietnamese pot-bellied pig with urethral obstruction caused by a polyp

A Vietnamese pot-bellied pig with a urethral polyp was supported by total parenteral nutrition given through an intraosseous implant. Peripheral vascular access was difficult to establish and maintain in this anorectic pig, so a pediatric intraosseous implant was placed in the left tibia. Surgical repair of the urethra was not considered possible, and alternative techniques of a functional bypass were unacceptable to the owners, so euthanasia was elected. Histologic examination of the urethra revealed a polypoid structure believed to be similar to benign congenital polyps described in young boys.

[Balloon dilatation for prostatic obstruction]

Balloon catheter dilatation of the prostate (BCDP) was performed in 25 patients with prostatic hypertrophy. All patients suffered from dysuria or urinary retention. Follow-up for 8-14 months showed that 20 patients had satisfactory results. The balloon catheter of 25 mm x 50 mm was inflated at 4-6 atm for 10-15 minutes. BCDP was modified for the use in the local hospitals.

Iatrogenic omental percutaneous shunt and resolution of obstructive fetal uropathy. A case report

A double pigtail stent was placed to decompress an obstructed fetal kidney. The stent was dislodged, causing an iatrogenic marsupialization between the renal pelvis omentum and skin. The omentum acted as a drain, decompressing the kidney.

Localised deep microwave hyperthermia in the treatment of benign prostatic hyperplasia: long-term assessment

A group of 133 patients with benign prostatic hyperplasia who were either poor operative risks or who had refused surgery underwent localised deep microwave hyperthermia, without supplementary drugs. In 59% of patients who had had an indwelling catheter, freedom from urological obstruction and satisfactory voiding were maintained for 7 years and catheterisation was not required. In patients with severe prostatic symptoms, 65% showed general improvement and satisfactory voiding for 8 years. There were no side effects. Patients who relapsed were given a second course of treatment and 75% responded positively. This positive response and the lack of side effects suggest that localised deep microwave hyperthermia may be an effective alternative to surgery in the management of high risk patients and those who are reluctant to undergo surgery.

Effect of therapy on susceptibility to urinary tract infection in male cats with indwelling urethral catheters

Indwelling urinary catheters with a closed urine collection system were maintained in 30 male cats for 3 days after induction of irritant cystitis. All cats received subcutaneous fluids during the 3 days the catheters were in place. The effects of four different treatment regimens on urinary tract infection rates, incidence of urethral obstruction, and development of urinary tract lesions over a 10-day period were compared with results in a nontreated group. Treatments were 1) amoxicillin for 5 days PO; 2) prednisolone for 5 days PO; 3) both amoxicillin and prednisolone for 5 days PO; and 4) dimethylsulfoxide (DMSO) for 3 days intravesicularly. Euthanasia was done before the end of the 10-day experimental period if the cats had two bouts of urethral obstruction or if the cats became uremic for causes unrelated to urethral obstruction. Seven cats were euthanatized before the conclusion of the experiment. These cats had been treated with prednisolone, prednisolone and amoxicillin, or DMSO. All cats that received amoxicillin alone or no therapy survived the 10-day period. Mortality was due to repeated urethral obstruction or to uremia associated with pyelonephritis or papillitis. Urinary tract infection rate was similar in all groups. The group treated with prednisolone alone had the highest incidence of renal infection. Inflammatory lesions in the lower urinary tract were similar in all groups. In conclusion, persistent urinary tract infection often develops in cats with cystitis after indwelling urethral catheterization even when closed systems of urine drainage are used.(ABSTRACT TRUNCATED AT 250 WORDS)

The Intraprostatic Spiral: Clinical Results In 150 Consecutive Patients

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.