Search

- We present the results of a prospective randomised trial of Estradurin, a long-acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy. The inevitable relapse in hormone sensitivity sometimes occurred very soon after the start of oestrogen treatment. Many patients had poorly suppressed plasma testosterone expressed as a mean of monthly serial measurements, but then responded to secondary orchiectomy. These data only suggest that, in the treatment of hormone-sensitive prostatic carcinoma, it may be necessary to reduce plasma testosterone to midway between castrate and normal ranges. The data support the theory that response to androgen withdrawal is qualitative rather than quantative. The effective dose of oestrogen may therefore be reduced and the risk of thrombo-embolic complications minimised. [ABSTRACT FROM AUTHOR]

- From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30%'blind' basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985-86), the majority following failed ureteroscopic extraction. In the same year both 'blind' basket extraction and ureteroscopy were successful in 82 and 86% of attempts respectively. Electrohydraulic and ultrasonic lithotripsy were used in 12 patients to reduce large impacted calculi. The commonest complication of ureteroscopic stone surgery was perforation; this occurred in 14% of cases, though it was usually trivial and near the vesicoureteric junction. Perforations higher in the ureter tended to follow endoscopic lithotripsy and were often associated with urinary extravasation. Extra-ureteric stone fragments were also occasionally observed in such cases. There were no serious sequelae, although the in-patient stay was prolonged beyond the 48 h customary for uncomplicated extraction. The results suggest that ureteroscopic stone extraction, which can be conveniently introduced into urological practice, should become a standard endoscopic procedure. [ABSTRACT FROM AUTHOR]

- One hundred and twenty-seven patients with locally advanced prostatic cancer were evaluated for the presence and progress of bone metastases before and during hormonal therapy, by serial radionuclide imaging and frequent measurement of plasma acid (tartrate-labile) and alkaline phosphatase. For comparison, serial changes in imaging and phosphatases were classified in each patient into one of six groups. Of 71 patients with negative imaging before treatment, 82% had normal alkaline phosphatase levels and 83% had normal acid phosphatase levels. Of 56 patients with bone metastases at presentation, false negative alkaline and acid phosphatase levels were noted in 18% and 36% respectively, though a few patients eventually developed abnormal levels. Serial plasma biochemistry and particularly alkaline phosphatase showed a response to treatment which was not always obvious on imaging. An assessment of the hepatic component of alkaline phosphatase by reference to plasma gamma glutamyl transpeptidase and isoenzyme electrophoresis was helpful in the evaluation of a false positive result but unnecessary where imaging was positive and phosphatase elevated. It is concluded that serial alkaline phosphatase estimation is essential in the follow-up of patients with prostatic cancer and bone metastases, and probably renders serial imaging studies superfluous once the presence of skeletal metastases has been proven. By comparison, acid phosphatase is a much less effective marker. [ABSTRACT FROM AUTHOR]

- Thirty-nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate-specific antigen in all ductal carcinomas. [ABSTRACT FROM AUTHOR]

- Nineteen patients with Peyronie's disease were treated by a modification of Nesbit's operation. The deformity was completely corrected in 18 patients. Potency was restored to 4 of the 6 impotent patients and satisfactory coitus became possible for 15 patients, whereas it had been possible for only 3 before operation. [ABSTRACT FROM AUTHOR]

A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases. Improvement occurred in 71% and those younger than 30 years had better overall results; 29% remained incontinent, with 9% requiring a urinary diversion. Many patients did not achieve maximum benefit until 9 months post-operatively. Surgery had no statistically significant effect on any urodynamic parameter and post-operative complications were common. The operation was performed in either the coronal (19) or the sagittal plane (26); this did not influence results. In general, surgery was found to be technically simpler in the sagittal group and it is recommended that this becomes the standard procedure. We feel that this operation involves major surgery and should only be offered with reluctance.

Fourteen patients with atherosclerotic aneurysms of the popliteal artery, which were bilateral in 13, have been managed in a vascular unit where ultrasound, xerography, and isotope angiography are available for investigation. Although these methods are useful in confirming a suspected diagnosis, they cannot replace an awareness of the condition and clinical methods of examining the ischaemic lower limb. Reconstructive vascular surgery was effective in preserving the presenting leg in 5 cases and amputation was needed in 6, while no operation was needed in 3. Elective arterial surgery was carried out on the asymptomatic contralateral leg in 7 cases with good results and this active approach to treatment is recommended.