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- In a selected series of 14 patients, upper tract urothelial tumours were excised with preservation of the ipsilateral kidney. The 5-year survival rate was 83%. The ipsilateral local recurrence rate was 5/14 (36%) but in 4 cases salvage surgery was effective and in 2 cases a functioning kidney was still preserved. The results of conservative surgery and its indications are discussed. [ABSTRACT FROM AUTHOR]

- In 1961 the British Association of Urological Surgeons published its original guide to urologists and surgeons on occupational tumours of the urinary tract. This revised guide has been produced by the BAUS Committee on Occupational Urothelial Cancers and has broadly the same objectives as the first: 1. To give guidance on the industries and occupations (a) In which the known urothelial carcinogens have been manufactured or used and with which occupational tumours have been associated. (b) In which epidemiological studies have revealed an increased risk of urothelial cancer but the exact carcinogens have not been identified. (c) In which occupational urothelial cancers might be expected to occur but are not yet established or reported. 2. To assist the urologist in recognising cases with a possible occupational association. 3. To describe how these cases should be reported for industrial injuries benefit and occupational disease reporting (RIDDOR). 4 To outline the benefits that may be available to the patient. 5. To explain the changes that were introduced on 3 October 1983 following the report by the Industrial Injuries Advisory Council on the prescription of Neoplasm of the Bladder as a Prescribed Industrial Disease (now disease number C23) (Table 1). [ABSTRACT FROM AUTHOR]

- Invasion of a bladder tumour involves the degradation and penetration of the sub-epithelial basement membrane. A retrospective study of 69 superficial and 15 invasive transitional cell carcinomas of bladder and a prospective study of 43 mucosal biopsies were performed in order to assess the usefulness of immunohistochemical staining of the basement membrane components, type IV collagen and laminin as prognostic indicators in superficial bladder cancer. There was a significant association between pT category and basement membrane staining. The incidence of progression of superficial tumours with patchy or absent basement membranes was significantly greater than those with completer basement membranes but there was no association with superficial recurrence. Biopsies of dysplastic epithelium had thickened and reduplicated basement membranes, possibly as a result of increased cell turnover. The results suggest that a balance exists between basement membrane production and degration in early malignancy. This technique may be of value in the early identification of microinvasion an in the prediction of subsequnet progrossion. [ABSTRACT FROM AUTHOR]

- Zoladex is a potent decapeptide analogue of luteinising hormone releasing hormone (LHRH). The drug is formulated as a 3.6 mg depot dispersed in a matrix of d'l-lactide-glycolide copolymer, which is totally biodegradable. This formula releases drug continuously for at least 28 days and reliably suppresses serum testosterone into the castrate range. The effect of the depot was studied in 29 patients with locally advanced or metastatic carcinoma of the prostate. Average age at entry was 71 years (range 52-87) and follow-up was from 13.5 to 34.5 months (median 23). Endocrine studies showed that medical castration was maintained in all cases. Three patients experienced bone pain in the first month of treatment and two others had temporary nephrostomies for worsening ureteric obstruction. Subjective improvement was seen in 23/28 cases (82%). There were no complete responses, but partial response was seen in 24/28 (85.7%) using our own criteria, 24/28 (85.7%) using the criteria recommended by the British Prostate Group (BPG) and 15/28 (53.6%) using NPCP criteria. Stable disease was seen in 3/28 patients (10.7%) by our own or BPG criteria, and in 12/28 patients (42.9%) according to NPCP criteria. Progression of disease was measurable in 21 patients (72.4%) whatever criteria were applied; 11/29 (37.9%) have died, giving a median survival of 10 months (range 2.4-26). Following these encouraging results, a multicentre randomised comparative study with stilboestrol 3 mg daily is being undertaken. [ABSTRACT FROM AUTHOR]

- Retinoids influence bladder tumour development in animals and tumour recurrence in man. Some human tumours contain intracellular receptor proteins for retinoids. The effect of the presence of such retinoic acid receptors (RAR) on tumour response to conventional therapy has been studied in 59 patients. Thirty-two of 36 RAR + veand 11 of 23 RAR-ve tumour patients were alive after a mean follow-up period of 2.6 years. Higher stage and grade were more commonly associated with RAR-ve tumours. Independent of stage, recurrence was more common in RAR-ve tumours. These studies suggest that RAR-ve tumours are more likely to recur and more likely to become invasive. However, further studies are required to determine the clinical value of RAR receptor status as a prognostic indicator. [ABSTRACT FROM AUTHOR]

- An experimental study was performed to assess the possible tumour-promoting action of urothelial trauma caused by repeated intravesical diathermy, catheterisation, and the instillation of water, glycine and saline in the rat bladder which had previously been exposed to an initiating dose of the carcinogen N-methyl- N-nitrosourea. An increase in tumours and inflammatory changes was observed, especially in the group treated with water, and the significance of the findings is discussed. [ABSTRACT FROM AUTHOR]

- An experimental and a clinical study have been performed to elucidate the nature of contralateral testicular damage following unilateral testicular injury-sympathetic orchiopathia. In an experimental study significant impairment of sperm production was produced by contralateral testicular damage which did not seem to be immunologically mediated or to involve the breakdown of the 'blood-testis' barrier. In 5 subfertile patients with oligozoospermia and unilateral testicular damage, removal of the damaged testicle did not result in an improvement in their semen analysis. [ABSTRACT FROM AUTHOR]

- Thirty-two subfertile males with sperms in the ejaculate and unilateral testicular obstruction are reported: the diagnosis was established by exploration of scrotum in 26, clinically in 2, 3 had had previous partially successful epididymovasostomies, and 1 had had an epispadias repair. The past medical history gave relevant information in 27 (84%), and useful findings were made on clinical examination in a further 3 cases. Fifteen patients had sperm counts over 20 million per ml, and 15 were less than 10 million per ml. Twenty-six (81%) had serum antisperm antibodies detected by tray agglutination test (TAT), 21 (81%) of whom had evidence of head-to-head (HH) agglutinins in pure or mixed form. Comparison with 162 vasectomised males and 160 naturally infertile males with antisperm antibodies showed that 55% of the former and 24% of the latter had HH agglutinins on TAT, differences that were highly significant on statistical analysis. Evidence of obstruction was found in 14 (37%) of 38 naturally infertile males with antisperm antibodies and HH or mixed agglutination, but only in 12 (10%) of 122 with TT agglutinins: this difference was also highly significant. Clinical history, physical examination and serum antisperm antibodies, especially if HH agglutinins are present, can suggest the possibility of unilateral testicular obstruction, but confirmation of the diagnosis requires exploration of scrotum. [ABSTRACT FROM AUTHOR]

- The relative values of pre-operative pelvic radiotherapy (4000 rads) and elective radical cystectomy versus radical radiotherapy (4000 rads plus 2000 rads boost) for deeply invasive bladder cancer (category or stage T3 or B2C) have been explored in a multicentre prospective randomised trial involving 189 patients. All patients were eligible for analysis of 5-year results, 1 74 had been followed for 7 years and 81 patients for 10 years. The overall 3-year survival rates with no exclusions were 45% for pre-operative radiotherapy and cystectomy and 33% for radical radiotherapy; the corresponding 5-year figures were 38 and 29% respectively. Statistical analysis has shown no significant difference between these overall survival rates, but further analysis has revealed significant differences in certain subgroups of patients. The combined treatment produced better results in younger patients, especially those aged less than 60 (5-year survival rates of 49 and 25% respectively) and in males (5-year survival rates of 45 and 29% respectively); in contrast, there was no difference in survival rates for patients aged more than 65 and in females. Within each of the treatment groups, significantly better survival rates were obtained in patients showing a good response to radiotherapy, based on reduction of tumour stage in the surgical specimen or on reduction of tumour size at review cystoscopy. Following pre-operative radiotherapy, reduction in tumour stage in the cystectomy specimen occurred in 49% of patients: no tumour or only in situ changes were present in 31%. Significantly better results were obtained after elective cystectomy when the lymph nodes were not involved (5-year survival rate of 53% as against 1 6% when the nodes were positive). Metastases were found in the pelvic nodes in only 20% of all cases and were a rare finding in down-staged cases (5.5%). Extremely good results (60% 5-year survival rate) were obtained in 18 highly selected patients who had salvage cystectomy for local tumour recurrence following radical radiotherapy. The results of this trial indicate that the prognosis for patients with deeply invasive (T3 or B2C) carcinoma of bladder is influenced by such factors as age, sex, response to irradiation, tumour size and the presence or absence of pelvic metastases. These factors are analysed with a review of the relevant literature. We conclude that, at the present state of knowledge, it appears that cystectomy as an elective procedure after pre-operative radiotherapy is the treatment of choice for patients aged less than 65, especially males. In patients over 65, and perhaps in females generally, the most suitable primary treatment is radical radiotherapy with salvage cystectomy reserved for highly selected patients with local tumour recurrence. Future research should be directed towards achieving a more frequent and greater response to irradiation, whether it be given pre-operatively or as radical treatment. [ABSTRACT FROM AUTHOR]

- Deconvolution analysis of the gamma camera renogram has been used in a prospective study of 60 cases presenting with radiologically demonstrated ureteric dilatation. The results show that ureteric dilatation due to obstruction can be differentiated from ureteric dilatation without obstruction on the basis of parenchymal tracer transit times. [ABSTRACT FROM AUTHOR]

- Antisperm antibodies were measured in serum and seminal plasma in 1 30 males before and after vasectomy reversal and the occurrence of pregnancy was analysed in the partners of 77 who were followed for more than one year. Sperm-agglutinating antibodies were found in the serum of 79% of patients; seminal plasma antibodies were present in only 9.5% before reversal and this rose to 26% afterwards. Pregnancies occurred in the partners of 53% of those men who were trying to produce children. A pregnancy was significantly less likely when the pre-operative serum antisperm antibody titre was 51 2 or more, but no decrease in fertility was seen with titres below this. Several pregnancies were produced by patients with seminal plasma antibodies, but numbers and follow-up are too small to permit detailed analysis. A randomized controlled trial of per-operative steroids showed that they produced no benefit. The antis perm antibodies associated with vasectomy reversal appear to differ fundamentally from those occurring in naturally sub fertile males. [ABSTRACT FROM AUTHOR]

- Inosine, a purine nucleotide, has been used in 33 patients as a method of preventing ischaemic renal damage. The long-term results have been reviewed with a mean follow-up of 28 months. lnosine was administered either intra-arterially or intravenously. Renal function was assessed by serum creatinine, creatinine clearance and divided function renography. lnosine afforded satisfactory protection in ischaemic periods of up to 60 min, particularly if pre-operative function was normal. It was less reliable if pre-operative function was poor or in ischaemic periods greater than 60 min. lnosine is a helpful aid in ischaemic renal surgery. [ABSTRACT FROM AUTHOR]

- The use of the EMI CT 5005 scanner in patients with renal calculus disease is described. This investigation was found to be a useful aid in the accurate localisation of calculi within the renal collecting system prior to surgery. [ABSTRACT FROM AUTHOR]

- Fifty-one patients with pure squamous cell carcinoma of the bladder were treated between 1958 and 1978. The overall 5-year survival rate was 16%. Ninety-two per cent of cancer deaths were caused by failure to control local disease; treatment by radiotherapy and elective cystectomy resulted in no long-term survivors. It is concluded that earlier diagnosis would reduce the number of cases presenting with advanced local disease and that future research should be directed towards adjuvant studies with chemotherapeutic agents known to have activity against bladder cancer. [ABSTRACT FROM AUTHOR]

- Thirty-three patients with malignant testicular teratomas and para-aortic metastases exceeding 2 cm in diameter have been treated with radiotherapy, chemotherapy (vinblastine and bleomycin, with or without cis-platinum) or both, followed by surgical excision of the residual para-aortic mass. Removal of a poorly functioning ipsilateral kidney was necessary in 7 cases (21%) and a segment of vena cava was resected in 2 (12.5%) of 16 patients with primary right-sided tumours. Removal was incomplete in only one patient, who had femoral nerve root involvement, and he subsequently died of secondary haemorrhage (operative mortality 3%). Undifferentiated tumour was found in 8 (61%) of 13 patients (Group 1) after radiotherapy, compared with only 2 (15%) of 13 (Group 2) after chemotherapy and radiotherapy, and 4 (57%) of 7 (Group 3) who had chemotherapy only prior to surgery; however, 3 of the Group 3 patients were referred because of evidence of activity in the para-aortic region. [ABSTRACT FROM AUTHOR]

- 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 A more aggressive management policy was adopted in 12 patients (8%) as a direct result of the biopsy findings. [ABSTRACT FROM AUTHOR]

- We have followed up 83% of a series of 166 patients with vesicoureteric reflux who were treated surgically more than 10 years ago. We found an incidence of hypertension of 12.8%. The need for careful follow-up of the blood pressure of patients with reflux nephropathy is stressed. [ABSTRACT FROM AUTHOR]

All patients attending the Royal Marsden Hospital with urothelial tumours have their occupational histories taken. About 10% of histories suggest a possibility of past exposure to urinary carcinogens, and on examination 4% indicate definite exposures justifying claims for Prescribed Industrial Disease benefit. [ABSTRACT FROM AUTHOR]

The preliminary results are presented of a multicentre, co-operative randomised trial, sponsored by the Institute of Urology, London, in which radical irradiation (6,000 rads in 6 weeks) is compared with preoperative irradiation (4,000 rads in 4 weeks) plus radical cystectomy for deeply infiltrating carcinoma of the bladder (Stage T3 or B2C). 189 of the 199 cases entered into the trial between 1966 and 1975 were eligible for study. The overall 3- and 5-year survival rates for the combined treatment were 41% and 33%, respectively, compared with 28% and 21% for radical radiotherapy. The operative mortality was 7.8%. The difference between the two treatments in favour of the combined treatment has not yet reached the generally accepted level of significance ( P <0.05), the p factors for the 3- and 5-year results being 0.064 and 0.077, respectively. Of patients receiving the protocol combined treatment, reduction in tumour stage was found in the surgical specimen in 47% of cases. The overall incidence of nodal metastases was 23% (against the usual figure of 40-50%), and in the presence of a good response of the primary tumour to irradiation, only 8%. The 3- and 5-year survival rates for the down-staged cases were 66% and 55%, respectively, compared with 29% and 22% for patients showing no stage reduction in the surgical specimen. The aim of our future studies is to find effective radiosensitising and cytotoxic agents with which to try and increase the incidence and degree of tumour response to pre-operative irradiation in the combined modality treatment of T3 bladder cancers. We should like to acknowledge the considerable assistance given by Mr Brian Shepherd and Mr Alan Turner, past and present senior urological registrars at the Royal Marsden Hospital, and also our research assistants, Dr M. Hossain and Dr S. Morris in assembling and analysing the collective data from the 8 centres. Our gratitude is due to Mr Peter Payne, Director of the South Metropolitan Cancer Registry, for statistical advice and computer facilities. [ABSTRACT FROM AUTHOR]

228 bilateral pedal lymphograms in patients with bladder cancer have been correlated with the features of the primary bladder tumour and patient survival. In 70 cases, radiographic findings were correlated with operative node histology. The results show that it is not possible to predict accurately which cases have lymphatic spread without this investigation. Positive lymphograms were found in 91 cases, and were associated with a very poor prognosis. Only 6% of patients with unilaterally involved iliac nodes survived 5 years, and all patients with bilateral iliac or para-aortic disease died within 3 years. Histological correlation was found in 90% of cases, and the results indicate that this investigation slightly underestimates the incidence and extent of microscopic lymphatic metastases. It is concluded that this investigation is essential in planning the treatment of infiltrating bladder turnours. [ABSTRACT FROM AUTHOR]

Somatic and meiotic chromosomes have been studied prospectively in 200 subfertile males. The results have been correlated with clinical, seminal and endocrinological features, with histological findings in testicular biopsies and with response to conventional treatment. Somatic chromosome abnormalities were found in 3·5% of cases and variants of the Y chromosome were found in 10·5 %. Definite abnormalities in meiotic chromosomes were observed in 20% of these patients, including supernumerary chromosomes, low chiasma frequency and asynapsis, and translocations. Many of these abnormalities occurred as mosaics, presumably a result of meiotic mutation. In 4 cases, a previously unrecognised abnormality in pachynemas has been defined. Absence of meiosis was found in 12% of cases, which correlated well with the histological findings of germinal cell aplasia and elevated urinary FSH levels. It is concluded from this preliminary analysis that abnormalities in meiosis may account for the decreased spermatogenesis and poor response to treatment in at least 20% of subfertile men. However, these abnormalities do not constitute a contra-indication to treatment as normal pregnancies can still be produced, in a few cases albeit, sometimes requiring monitoring. [ABSTRACT FROM AUTHOR]

Intermittent intravenous methotrexate has been used to treat patients with locally advanced or metastatic transitional cell carcinoma of the bladder (40 cases) and of the renal pelvis (2 cases). Objective evidence of tumour regression, attributable to the methotrexate therapy, was observed in 11 patients (26 %) for 2 to 20 months. Several other patients gained relief of symptoms but in these there was no clear evidence of tumour regression. Toxic side-effects from methotrexate interrupted treatment for a time in 29 patients but were seldom serious and were never fatal. It is concluded that intravenous methotrexate therapy is of value in the management of advanced bladder cancer. The possibility of improving tumour response and decreasing drug toxicity is discussed. [ABSTRACT FROM AUTHOR]

Carcinoma of the prostate is a generalised disease in which most patients have metastases at the time of presentation. Anaemia is a frequent finding usually with evidence of metastatic disease. Orthodox treatment with oestrogens or orchidectomy have thromboembolic sequelae, which should be preventable. Some of the anaemias can be corrected. [ABSTRACT FROM AUTHOR]

A relaitively simple procedure th the measurement of urinary chemiluminesece is descirbed and some of the variable affecting such measurmnt are examined. Normal urinary chemiluminescence is due to a low molecular weight and freely dialysible compound. Addition of blood to urine causes chemiluminescence which is not dialysible. Although there was very considerable overlap between the groups, it was found that urinary chemiluminescence was higher in normal smokers than in normal non-smokers and higher still in patients with bladder cancer. These results were statistically significant. Considering only bladder cancer patients who were also tobacco smokers, the urinary chemiluminescence was higher when tumour was present than when tumour was absent. Oral distribution of ascorbic acid reduced urinary chemiluminescence of both normal smokers and non-smokers. There were no significant differences in urinary ascorbic acid levels between normal smokers and non-smokers, and patients with bladder cancer whether smokers or non-smokers. [ABSTRACT FROM AUTHOR]

CEA or CEA-like substances are present in small quantities in the urine of normal adults., Patients with transitional cell carcinoma of the urothelium have significantly raised levels of urinary CEA in 66 per cent of cases. Diagnostic elevation of plasma CEA occurs infrequently, but when found, is indicative of extravesical disease., We therefore suggest that the measurement of CEA in urine and plasma may be of value in the diagnosis and follow-up of patients with urothelial carcinoma. [ABSTRACT FROM AUTHOR]

SUMMARY Twenty-one patients with urinary incontinence were treated with portable electronic stimulators, the stimulus being delivered by a vaginal pessary, a rectal plug or an implantable device. Details are given of the degree of success achieved with each device. The results have proved sufficiently encouraging to warrant extension of the trials. It is suggested that the implantable device should not be regarded as the primary treatment, owing to the danger of electronic failure or lead migration. The investigations used to assess the suitability of patients for the various devices are described. [ABSTRACT FROM AUTHOR]