Adenocarcinoma of the prostate and Eaton-Lambert syndrome. A previously unreported association.

Eaton-Lambert myasthenic syndrome is rare. We report the first case of adenocarcinoma of prostate associated with this syndrome. Subsequent treatment by orchidectomy caused tumour regression and remission of the syndrome.

Acute urinary retention secondary to carcinoma of the prostate. Is initial channel TURP beneficial?

Over a 2-year period patients presenting with acute urinary retention secondary to locally advanced prostate carcinoma (stage T3/T4) were randomized to one of two treatments. Ten patients underwent channel transurethral resection of prostate (TURP) and bilateral orchidectomy, 12 patients underwent bilateral orchidectomy alone. Treatment by channel TURP and bilateral orchidectomy was complicated by difficulties in voiding in four patients, one requiring a further TURP.

Urinary retention and the lunisolar cycle: is it a lunatic phenomenon?

Objective: To determine whether a relation between urinary retention and temporal rhythms exists.

Design: Retrospective analysis of patients presenting over three years.

Setting: Urology departments in two hospitals.

The "plain film" bladder shadow in outflow obstruction: as accurate a discriminant of residual urine as ultrasound.

The height, width and area of the bladder shadow on post-micturition plain abdominal radiography was compared with the residual urine obtained at endoscopy from 58 men presenting with pure bladder outflow obstruction. Each parameter of the bladder shadow correlated significantly with the residual urine in patients in whom this shadow was visible. Post-micturition plain abdominal radiography is considerably cheaper than ultrasound and appears to be equally effective in the determination of residual urine.

Partial nephrectomy: an option in calculus disease?

Thirty-seven patients treated by partial nephrectomy for calculus disease between 1971 and 1986 were reviewed retrospectively. Of the 25 patients available for analysis, 20% developed immediate surgical complications, 20% had residual post-operative stone and 33% developed true ipsilateral stone recurrence during the period of follow-up. Our results from partial nephrectomy for calculus disease are compared with the results of treatment by percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy.

Modified nephro-ureterectomy. Long-term follow-up with particular reference to subsequent bladder tumours.

Nephro-ureterectomy is the standard treatment for transitional carcinoma of the renal pelvis and caliceal system. In recent years a modification of the conventional two-incision technique has been described in which the intramural ureter is resected endoscopically and the remaining ureter is removed in continuity with the kidney through a single loin incision. Twenty-one patients had their renal pelvic tumours treated by this modified technique between 1970 and 1983.

Endoscopic bladder transection.

Endoscopic bladder transection has been performed in 30 patients with symptoms as a result of unstable bladder activity. The symptomatic improvement produced justifies the use of this new operation which should replace the open procedure.

Conservative surgery for vesicocolic fistula.

Vesicocolic fistula due to diverticular disease of the colon is conventionally treated by resection of the diseased bowel and closure of the vesical defect. Three cases are described in which separation of the viscera and simple suture of the vesical and colonic defects was carried out. A greater omental graft was interposed between the rectum and bladder.

Transverse preputial island flap neo-urethroplasty.

The first account of transverse preputial island flap neo-urethroplasty was given in 1978 by Duckett (unpublished material) from Philadelphia to this association. The procedure, commonly known as the Duckett operation, is for the repair of hypospadias in boys whose urethral defect is too long for them to be treated by meatal advancement and glanduloplasty, also described by Duckett in 1980. These 2 operations leave only a very small number of hypospadiacs with a urethral defect so long that more complicated surgery is needed.

Retroperitoneal fibrosis: practical problems in management.

Nineteen patients with retroperitoneal fibrosis were reviewed. Eighteen patients had idiopathic disease and one had taken methysergide for 15 years. Primary bilateral ureterolysis was undertaken in 13 cases.

Hypokalaemic hyperchloraemic metabolic acidosis and vesical stone complicating appendicovesical fistulae.

Two patients with appendicovesical fistulae are described. Both presented with gastrointestinal and urinary symptoms. Biochemical examination showed hypokalaemic hyperchloraemic metabolic acidosis; radiographic investigations showed a vesical stone and a communication between the bladder and the bowel.

Total cystectomy--a review.

Anlysis of 99 total cystectomies for malignant disease over a 10-year period in one unit has been carried out, in order to clarify the place of the operation in the overall management of the disease and to assess the quality of life in the patients so treated.

Polycystic renal disease--occurrence of malignant change and role of nephrectomy in potential transplant recipients.

28 cases of malignant renal neoplasms in patients with polycystic kidneys are reviewed from the literature and 2 new cases are reported. The difficulty in diagnosing this malignant change together with the increased survival of patients with polycystic kidneys on dialysis and transplant programmes leads to the recommendation that all such patients should be considered for nephrectomies. The reasons for this recommendation and its advantages and disadvantages are discussed.

Abacterial cystitis.

5 young male patients with all the symptoms and signs of genito-urinary tuberculosis but in whom no organism could be cultured from the urine are described. 4 of them rapidly responded to a course of tetracycline. Various organisms are suggested as a cause of this condition, and careful bacteriological investigation in the future might discover the cause.