Transactions of the American Association of Genito-Urinary Surgeons最新文献

Experimentally, glucagon is an effective ureteral relaxant that induces a moderate diuresis. Our data suggest that in specified cases of ureteral colic, before the development of a ureteral bar, flaccid dilatation of the pelvis and renal shutdown, glucagon may facilitate the expulsion of small ureteral calculi. When the ureteral pain is due to hyperperistalsis the drug has promise in the alleviation of pain. The complexities of the pathophysiology of ureteral colic in an experimental model support the treatment of ureteral edema in colic with anti-inflammatory drugs but suggest certain precautions in the design of any investigation of drug therapy for colic, lest a good drug be found ineffective for the wrong reason-that it was used in an impossible situation.

The forces involved in shaping urinary calculi reside in crystalline characteristics and especially in local influences. Box pelves may restrict passage and, by allowing mobility, help shape a round calculus. Fixation, occurring with a rapidly growing infection stone, facilitates initial growth on a matrix mold in a funnel pelvis, further aided by pelviocaliceal paralysis from bacterial endotoxins and later by stasis. Branched calculi are further shaped by contact with the pelvic and infundibular walls. Through pressure and mucous coating they grow only at the ends. Late caliceal obstruction frees the ends for clubbing. Consideration of these forces aids in prognosis and surgical removal, and may offer opportunities for prevention.

A number of chemotherapeutic agents, including L-asparaginase, actinomycin D, chloroethylcyclohexy-nitrosourea, 5-flourouracil, cyclophosphamide, hydroxyurea, cis-platinum, adriamycin and methotrexate, alone and in combination and at variable dose levels, were applied against the Dunning R3327 rat prostatic adenocarcinoma-subline G. We found a continuing parallel between responses of the human and rat tumors and conclude that the usefulness of this animal model as a screening system for agents against the human tumor is further supported.

We investigated the effect of chronic non-toxic ingestion of cadmium chloride on the growth of the prostate, seminal vesicles and testes of the white rat. Cadmium chloride seems to have a statistically significant dose-related adjuvant effect on the weight of these organs when administered continuously to the white rat during a 6-month period.

Computerized tomography (CT scanning) of the chest and abdomen has been used as a diagnostic technique in more than 7,200 patients since 1974, 250 of whom had histological proved disorders of the genitourinary system and retroperitoneum. On the basis of this experience CT scanning has been found to be safe and effective, and offers certain advantages over conventional techniques. The number, extent and content of adrenal and renal mass lesions can be determined with relatively great accuracy. The presence and extent of metastases into the retroperitoneum, liver and chest often can be shown by CT scanning when other tests are negative. Placement of needles for aspiration, biopsy, injection of contrast medium or insertion of drainage tubes can be done accurately under computerized tomographic control. Air contrast scanning of the bladder can be of real help in staging bladder tumors, espically in obese patients. Computerized tomography in itself is non-invasive, carries a low radiation exposure comparable to other radiographic procedures and therefore, can, be valuable in following the course of patients with various diseases during and after therapy. While CT scanning will not replace other diagnostic procedures it should lead to a more judicious selection of potentially hazardous tests, such as angiography, aspiration and open biopsy.

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95 per cent of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81 per cent of the cases. Serum creatinine was unchanged or decreased in 75.7 per cent and the pyelogram was unchanged or showed decreased dilatation in 84.6 per cent of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5 per cent) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Few urologic problems require the consideration of so many factors as does an obstructing calculus in the ureter. The questions that arise in each case are whether an operation should be done for immediate relief of the obstruction or whether manipulation should be done, possibly subjecting the patient to a period of disability, painful attacks of colic and febrile reactions.

This preliminary report concerns our experience with the use of high dose, short course preoperative radiation therapy and immediate single state cystectomy for the management of bladder cancer. Data reveal that 1,660 rad delivered in 4 days and followed by immediate cystectomy do not increase operative morbidity or mortality. The operative mortality and morbidity of a single stage radical cystectomy with en bloc pelvic node dissection and urinary diversion are no greater than that reported for less radical procedures without node dessection. In this series the incidence of nodal involvement ranged from 10 percent for PIS and P1 tumors to 50 per cent for P3 tumors, implying the need for treatment of pelvic nodes whenever cystectomy seems indicated.

These studies indicate that the monkey Macaca nemestrina provides a suitable model to evaluate the neurological mechanism of micturition. This animal has a sacral spinal center for micturition whereby the classification of primary patterns of neurogenic disorder into spinal reflex after suprasacral spinal cord section and autonomous after cauda equina section is validated. Attempts at dissociation of the spinal and vesical neurons by section of the cauda equina were characterized generally by raised rather than lowered tonus, irrespective of previous urinary diversion to prevent inadvertent overstretch of the bladder. No evidence was obtained to indicate that overstretch of the autonomous bladder is followed by loss of tonus but the survival times of the animals after cauda equina section were comparatively short. There was some indication that overstretch may induce coordinated contractility of the bladder when only the peripheral neuron and sympathetic innervation of the bladder are intact. Evidence was obtained that the monkey has a dual innervation of the mid urethra, in which the pressure profile is supported by alpha adrenergic receptors as well as some somatic neural control. The resting urethral pressure profile is preserved after low level section of the spinal cord or division of the cauda equina but is lower in amplitide after overstretch of the autonomous bladder.