Acute irritant reaction to an antiseptic bath emollient

Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients.

Effect of an educational multimedia prostate program on the International Prostate Symptom Score

OBJECTIVE

To determine the effect of an interactive multimedia prostate education program (MMP) on self assessment of symptom scores due to benign prostatic hyperplasia (BPH).

METHODS

The interactive MMP was developed including a computer-administered version of the International Prostate Symptom Score (IPSS) questionnaire. Eighty-eight men referred to the Urology Out-patients with prostatic symptoms entered the study. They first completed the IPSS on paper and secondly used the MMP before completing the computer-administered IPSS. A final feedback questionnaire enquiring into their experience including previous exposure to computers, ease of use, and value of the program content was completed.

RESULTS

The use of the MMP resulted in a significant decrease in mean IPSS score from 16.6 to 13.9 (t = 7.456, d.f. = 87, p < 0.01), but no change in quality of life. Patients felt that their knowledge had increased (chi2(1) = 21.253, p < 0.01) and that they had completed the IPSS more accurately (chi2(1) = 10.227, p < 0.01) with the MMP IPSS module compared to the IPSS on paper. Previous use of patient education, patient characteristics and MMP use beyond the information required for the IPSS did not affect IPSS difference (IPSS before versus after MMP use).

CONCLUSION

The use of the MMP enhanced patients' knowledge of their condition and reduced patients' IPSS score. The results were independent of previous exposure to information, previous IPSS completion, computer use and age.

A step towards day case prostatectomy

OBJECTIVE

To compare laser prostatectomy, using both side-fire and contact lasers, with transurethral resection of the prostate (TURP) to identify the advantages and disadvantages of all three in the short-and long-term (1 year).

PATIENTS AND METHODS

Forty patients were randomized into one of four groups undergoing TURP, side-fire laser prostatectomy alone, side-fire with debridement and contact laser prostatectomy. Strict entry criteria ensured that no patients with malignancy were selected. The patients were reviewed after 3, 6 and 12 months.

RESULTS

The duration of operation and length of hospital stay were significantly shorter in those undergoing laser side-fire treatment than those undergoing TURP. However, the early (3-month) symptom score was significantly worse in those treated by side-fire laser than in those treated by side-fire laser with debridement. After 1 year there was no significant difference in mean symptom score and mean urinary flow rate among the four groups.

CONCLUSION

Laser prostatectomy offers the prospect of a shorter theatre and hospital stay and, by debriding the thermocoagulated tissue, the early irritative symptoms were reduced, with a significant improvement in symptom score after 3 months in patients with small prostates.

European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate

A prospective randomised trial was undertaken in nine European Hospitals to test antibiotic prophylaxis for men undergoing transurethral resection of the prostate. Of the men with no significant growth (< 10(4) cfu ml-1) in their preoperative urine, 247 received a single 1 gram dose of ceftazidime with the induction of anaesthesia, 256 received 1 g daily from the time of induction of anaesthesia until removal of the urethral catheter (but < or = 5 days) and 261 received no prophylaxis. Of evaluable patients 83 (33.9%), 45 (18.7%) and 29 (11.6%) of the no-prophylaxis, single-dose and multidose groups, respectively, developed urinary tract infection in the immediate post-operative period. There were significantly fewer febrile episodes and fewer prescriptions for alternative antibiotics in teh ceftazidime-treated groups. For men developed peri-operative septicaemia and all were in the no-prophylaxis group. We conclude that patients, even those with culture-negative urine pre-operatively, benefit from antibiotic prophylaxis and that antibiotic prophylaxis should be considered for all men undergoing prostatic surgery as a routine procedure.

Post-hysterectomy urethral dysfunction: evaluation and management

A retrospective study of the functional alteration of the urethra following hysterectomy was made in 98 patients. Three groups were identified. Sixty per cent (group A) had stable stress urinary incontinence, 27.8% (group B) had high pressure detrusor instability and 12.2% (group C) had voiding dysfunction. Some of the patients in group A were treated medically and others surgically. Those in group B were treated with oxybutinin and those in group C were treated surgically. The cure rate in group A ranged from 55 to 89%; in group B it was 82% and in group C between 90 and 100%.

Bladder instability. Is the primary defect in the urethra?

The urethral response to bladder filling has been studied by synchronous measurement of four points in the proximal urethra and bladder using microtip transducers. Twelve male patients with urodynamically proven bladder instability had falls in urethral closure pressure of 30 cm of water 3 s before the unstable detrusor contraction. There was a lack of awareness of the urethral relaxation, the sensation of urgency occurring only when the detrusor contracted. The suggestion is made that the sequence of events occurring in these patients with bladder instability is fundamentally no different from a normal voiding sequence and that it may be more appropriate to re-educate the muscles of the proximal urethra than to treat the detrusor instability.

Observations on the ultrastructure of human urothelium: the response of normal bladder of elderly subjects to hyperthermia

An electron microscopic study of normal bladder urothelium of elderly subjects treated by hyperthermic perfusions has shown that the tissue responds, sooner or later, in every instance by desquamation. There is no evidence of cell death prior to desquamation although various organelles undergo structural alterations. Mitochondria are especially prone to suffer varying degrees of damage. A short heat shock has revealed differences in the initial response of the thick and thin regions of bladder urothelium known to occur in elderly subjects. After a long, fractionated treatment, regeneration is evident within 3 days of the end of treatment, and follow-up biopsies have revealed a hyperplastic urothelium within 10 to 12 weeks. The constituent cells show signs of cytodifferentiation at this time but it remains unknown when an ultrastructurally normal urothelium with characteristic cell layers will be restored. The various treatments in this study suggest that the stem cells in the epithelium are unaffected by the levels of hyperthermia employed and that their unimpaired proliferative capacity ensures regeneration of the urothelium.

Short-term prophylaxis with cefotaxime for prostatic surgery

A randomised controlled trial of a new cephalosporin, cefotaxime, was carried out in men undergoing transurethral resection of the prostate. The purpose of the trial was to determine whether 48-hour prophylaxis with this new broad-spectrum, non-nephrotoxic cephalosporin would reduce postoperative bacteriuria and postoperative complications. The treated patients fared significantly better than the non-treated patients in having fewer febrile episodes, fewer episodes of tachycardia, a lower incidence of appreciable bacteriuria postoperatively, and fewer complications, and spending on average one day less in hospital. There was no difference in postoperative urea and creatinine concentrations between the groups, and no other side effects of cefotaxime occurred in this elderly population. Prophylaxis with cefotaxime would appear to make prostatic surgery safer.

Transitional cell carcinoma involving the prostate

Transitional cell carcinoma involving the prostate gland was studied in 27 patients. Three different groups were recognised on the basis of the clinical pattern and histological findings. Each group has a different prognosis and merits a different approach to treatment. Thus, stromal involvement of the prostate by transitional cell carcinoma is a sinister finding that requires radical treatment, whereas ductal involvement by either carcinoma in situ or non-invasive papillary tumours can be managed less aggressively. This study emphasises that the present classification for these tumours is unsatisfactory and that adequate histopathological information is essential for their management.

Is the enuretic female bladder without instability normal?

Twenty-one females with a history of nocturnal enuresis were found to have stable bladders on cystometric testing. A stable detrusor is defined as one that is capable of contraction but does not develop abnormal contractions on filling inspite of provocative testing by rapid filling, standing, coughing and erect filling. A detailed assessment of 10 measurements revealed abnormalities in 19 of the 21 cases. This result strengthens the theory that for nocturnal enuresis to occur, two abnormalities are necessary: (a) failure of a full bladder to arouse from sleep, and (b) an abnormality of bladder/urethral function. Identifiable causes of nocturnal enuresis included a small functional bladder capacity, outlet obstruction, increased detrusor contractility and low urethral closure pressure.

TNM (1978) in bladder cancer: use and abuse

Modifications to the TNM classification for bladder cancer, introduced in 1979, are described. The use of this classification was evaluated in 106 new patients. It proved to be satisfactory for in situ and papillary tumours but major problems occurred in attempting to separate superficially invasive from deeply invasive tumours. Several aspects of this classification require further consideration and modifications are proposed.

Adult enuresis--a symptomatic and urodynamic assessment

Sixty-five patients (33 females and 32 males) with adult enuresis have been assessed cystometrically. Patients with primary enuresis may have either nocturnal enuresis alone or diurnal symptoms as well. Abnormal cystometric patterns were found in a high percentage of both types of enuresis. There was a significant correlation between the presence of diurnal symptoms and bladder instability and between nocturia and instability.

The role of multiple mucosal biopsies in the management of patients with bladder cancer

The results of multiple biopsies from apparently non-tumour bearing bladder mucosa were studied in 154 patients with bladder cancer; 33% of the biopsies from apparently normal mucosa showed histological abnormalities including 4.5% with carcinoma. When the mucosa appeared red but flat, 52% of the biopsies showed histological abnormalities including 14% with carcinoma. Biopsies from mucosa that had a granular or mossy appearance showed carcinoma in 42%. A more aggressive management policy was adopted in 12 patients (8%) as a direct result of the biopsy findings.

Indications for bladder transection

Over the last 8 years 64 cases of bladder hyperactivity have been subjected to bladder transection. The patients seleced have been mainly adult enuretics, but have also included some others with daytime bladder hyperactivity without nocturnal incontinence who had failed to respond to medical and simple surgical procedures. A bladder capacity greater than 400 ml under general anaesthesia was used as a major criterion in selecting the cases for operation. The operation was very successful in the enuretic syndrome where the daytime symptoms or urgency and urge incontinence were severe. Other patients who had frequency, urgency and urge incontinence without demonstrable neurological or urological abnormalities also responded well.

Bladder transection for adult enuresis

45 patients with adult enuresis have been treated by bladder transection between 1969 and 1975 and followed-up from 6 months to 7 years. 24 patients are now asymptomatic. Bladder transection gave very worthwhile results in 53% of cases.

Hyperthermia in the treatment of bladder tumours

High temperature bladder irrigation was employed in 4 men as an alternative to cystectomy because of their age and frailty. Hyperthermic irrigation of the bladder from 63 degree C for 70 minutes to 82 degree C for 25 minutes caused partial, but not total, necrosis of the bladder. Transitional cell carcinoma appears to be resistant in vivo, in some cases, to heating at temperatures that destroy adjacent normal structures. Hyperthermic irrigation of the bladder at these high temperatures may be hazardous. In view of these findings we cannot recommend high temperature bladder irrigation as an alternative to cystectomy even in poor risk patients.