Transurethral electrovaporization of the prostate--a possible alternative to transurethral resection: a one-year follow-up of a prospective randomized trial

OBJECTIVE

To compare the efficacy, safety and durability of transurethral electrovaporization of the prostate (TUVP) with standard transurethral resection (TURP) in a prospective randomized trial.

PATIENTS AND METHODS

The study included 104 consecutive men with symptomatic benign prostatic hyperplasia (BPH) admitted for surgery who were randomized to TUVP or TURP. The variables evaluated included the duration of surgery, catheterization and hospital stay, the International Prostate Symptom Score (IPSS), a quality-of-life assessment (QOL), the maximum urinary flow rate (Qmax) and the postvoid residual urine volume (PVR).

RESULTS

Both groups showed a comparable significant and maintained decline in the mean IPSS, from 26.5 to 4.4 (TUVP) and from 26.6 to 5.9 (TURP), and increase in mean Qmax, from 8.6 to 20.8 mL/s [corrected] (TUVP) and 8.6 to 22.8 mL/s (TURP) after 1 year. However, there were significant differences in the mean duration of catheterization (TUVP 20.9 h, TURP 46.6 h, P<0.001), hospital stay (TUVP 2.2 day, TURP 3.1 days, P<0.001), and the duration and volume of post-operative irrigation (TUVP none, TURP 18.1 h with 17.5 L of saline). Two patients in each group developed urethral strictures (4%) and two patients in each group required re-operation for residual adenoma (4%); two patients undergoing TURP had a bladder neck stricture (4%).

CONCLUSION

The results suggest that TUVP is as effective as standard TURP in the treatment of moderate-sized BPH. TUVP offers the advantage of using established instruments, has excellent peri-operative haemostasis and requires a shorter hospital stay.

The Cost Effectiveness of Combined Rapid Tests (Multistix) in Screening for Urinary Tract Infections

Urinary tract infections (UTI) are relatively common in the urology outpatient's department and the renal transplant unit. Clinical diagnosis is imprecise and laboratory methods take time and are costly. Combined rapid tests (Multistix) were used to screen 400 consecutive mid stream specimens of urine: 200 from urology outpatients and 200 from renal transplant patients. All specimens were also tested in the laboratory. The negative predictive value for excluding UTI was excellent (>98%) but positive predictive value for confirming presence of UTI was only 50%. However, with this simple screening method, up to 75% of urines can be excluded from laboratory analysis. Since there is a 20-fold difference in cost between dipstix and laboratory testing, the potential savings from this simple screening test is considerable.

Preliminary report--combined surgical and radiological penile vein occlusion for the management of impotence caused by venous-sinusoidal incompetence

OBJECTIVES

To combine surgical and radiological penile vein occlusion therapy in the treatment of patients with venogenic impotence, to try to improve on the results of either treatment used separately.

PATIENTS AND METHODS

Fourteen patients, with a mean age of 46 years (range 25-71), with pure venous-sinusoidal impotence were treated by surgical ligation of accessible veins and embolization of surgically inaccessible veins. The preliminary results over a follow-up period of at least 8 months are reported for each patient.

RESULTS

Venous embolization was considered complete in 11 patients. Overall, 13 had improved erectile function. Post-operatively, eight patients developed spontaneous erections and four (aged < 40 years) have maintained this for 8-24 months.

CONCLUSION

Combined surgery and radiology treats the end result of the failure of the sinusoidal smooth muscle to relax. Although some patients, the majority of whom are young (aged < 40 years), will achieve short-term benefit, all individuals need to be fully counselled with regard to the likelihood of long-term benefit before undergoing this invasive method of treatment.

PCR-analyzed microsatellites of the mouse genome--additional polymorphisms among ten inbred mouse strains

Eighty sequences from the mouse genome database containing microsatellites (simple sequence repeats) have been analyzed for size variation among ten different inbred strains of mice; 62/80 (77.5%) showed polymorphism of at least three alleles. We have been able to detect all the polymorphisms by agarose gel electrophoresis, often running the gels for up to 3 h. Between individual pairs of mouse strains to be used in chromosomal mapping studies in our laboratory, 35-60% polymorphism occurred. There are potentially enough microsatellites within the mouse and human genome to have a marker at every 1-cM distance. This simple approach will, therefore, continue to be useful in genome mapping studies, leading eventually to high-resolution maps of both the mouse and human genomes; this should allow for physical mapping and cloning of specific genes.

Extrarenal adult Wilms tumour: presentation, diagnosis and management

Adult Wilms tumour is an uncommon entity, with fewer than 200 cases reported in the world literature. Strict criteria for the definition of this tumour have been specified, amongst which was the need for it to be a primary renal neoplasm. We present radiological and histological evidence of this tumour occurring at an extrarenal site, and make the case for relaxation of these criteria to include this eventuality.

Biliary colic after micro dieting

A 33 year old man presented with biliary colic and transient obstructive jaundice. In the 4 weeks preceding admission he had been taking a very low calorie diet (the Cambridge Diet) and celebrated achieving his target weight with a fatty meal on the morning of admission. An ultrasound of the gallbladder suggested biliary sludge. We suggest that he developed the biliary sludge as a consequence of calorie restriction and that, following the fatty meal, the gall bladder contracted causing biliary colic and transient obstructive jaundice.