- Email: [email protected]
Vasography, its Indications and Complications
638
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY
help if no alternatives are offered. They suggest that approximately 40 per cent of these patients can be returned to normal voiding by urethrotomy, overdilation or bladder neck incision. They suggest that the risks of stress incontinence after such procedures may have been over emphasized. It is not clear from the results what objective measures of satisfactory voiding were obtained. A. J. W.
Teflon Injection in Stress Incontinence A. M. DEANE, P. ENGLISH, M. HEHIR, J.P. WILLIAMS AND P. H. L. WORTH, St. Peter's Hospitals, London, England
Brit. J. Urol., 57: 78-80 (Feb.) 1985 A total of 28 female patients with stress incontinence and 18 male patients with post-prostatectomy sphincteric incontinence underwent periurethral or urethral injection of polytetrafluoroethylene (Teflon) paste. The injections were made at the bladder neck at the 3, 6 and 9 o'clock positions in the female patients, and at the prostatic apex in the male patients. A repeat procedure was necessary in 60 per cent of the cases. Incontinence in the female patients was classified as either grade I (normal resting anatomy with bladder neck incompetence and descent on coughing) or grade II (bladder neck incompetence at rest with descent present but not below the level of the symphysis). More gross levels of descent were not considered for polytetrafluoroethylene injection. Of the 28 female patients 11 had already had an unsuccessful colposuspension procedure or anterior repair. Of the 6 female patients with grade I incontinence 4 were cured and 2 were improved, compared to 5 cured, 6 improved and 11 failures among the 22 with grade II disease. A previous operation (Kaufman procedure) had been performed on 10 of the 18 male patients. Only 1 of 8 patients who underwent periurethral injections reported improvement at 3 months. The other 10 male patients had endoscopic urethral injections and the initial results were encouraging, most patients leaving the hospital with improved continence. However, at the 3-month followup only 2 patients reported some lasting improvement and repeated injection did not seem to produce further improvement. No serious complications were seen in either group, although fever and transient voiding difficulties were common. Subsequent procedures were not jeopardized but the authors do not specify exactly what these subsequent procedures were. They conclude that polytetrafluoroethylene injection provides a simple alternative for the control of early to moderate female stress incontinence but expressed distinct reservations about its use in the male patient with post-prostatectomy incontinence. 8 references Abstracter's comment. Periurethral polytetrafluoroethylene injection is an interesting and innovative modality whose ultimate place in the treatment of urinary incontinence secondary to sphincter insufficiency remains to be established. Those wishing to use this form of therapy in the United States should note that Food and Drug Administration approval for the use of this substance has been extended only to vocal cord reconstruction, although deliberations currently are in progress about approval for other uses. A. J. W.
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY A Comparison Between Diuresis Renography and the Whitaker Test in 64 Kidneys A. M. HAY, W. J. NORMAN, M. L. RICE AND R. D. STEVENTON, Departments of Urology and Radiology, Royal Shrewsbury Hospital, Shrewsbury, England
Brit. J. Urol., 56: 561-564 (Dec.) 1984 Sixty-four dilated pelviocaliceal units in 57 patients were studied by diuresis renography and the Whitaker test for the presence of obstruction. Renography was performed in well hydrated subjects with 123iodine-hippurate followed by 0.5 mg./ kg. furosemide. Four kinds of renographic responses were identified, 2 of which were classified as unobstructed, with type I showing prompt uptake and elimination phases, and a defined peak, and type IIIA showing only a defending phase in response to the diuretic (believed to characterize hypotonic dilatation of the collecting system). Of the 45 kidneys showing 1 of the 2 types of unobstructed renographic responses 32 were obstructed according to criteria of the Whitaker test, 8 fell into an equivocal zone and only 5 were unobstructed. Of these kidneys 35 were operated on for presumed obstruction, and generally excellent symptomatic and renographic results were obtained. Detection of a type I or IIIA renographic response in a dilated painful system cannot be taken to exclude obstruction. Better correlation was obtained between renographic and Whitaker results in patients exhibiting 1 of 2 types of obstructed responses. 5 figures, 5 references Abstracter's comment. On the surface this article seems to condemn diuresis renography, compared to the Whitaker test, as an effective discriminant between obstructed and nonobstructed dilatations of the upper urinary tract. However, the authors do not describe in great detail the types of renographic responses obtained or their interpretations. They actually conclude that "this study suggests that even minor deviations of the diuresis renogram from normal may be associated with urodynamic obstruction. Diuresis renography is, therefore, an exquisitely sensitive screening test for obstruction. It would seem merely that the criteria governing its application requires some revision". A. J. W. Vasography, its Indications and Complications S.
R. PAYNE, J. P. PRYOR AND C. M. PARKS, St. Peter's Hospital and Institute of Urology, London, England
Brit. J. Urol., 57: 215-217 (Apr.) 1985 A total of 482 men underwent vasography from 1975 to 1983 (usually during scrotal exploration): 265 for azoospermia, 175 for infertility (usually severe oligospermia but some during varicocele ligation) and 46 for miscellaneous conditions (hemospermia in 26, ejaculatory problems in 10 and undiagnosed testicular or epididymal pain in 4). A normal vasogram was seen in 427 men. Radiological abnormalities were reported in 55 patients (11 per cent) and were most common in the miscellaneous group, in which abnormalities were seen in 22 patients (52 per cent), particularly 73 per' cent of those with hemospermia. Abnormalities were seen in 26 patients (10 per
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY
help if no alternatives are offered. They suggest that approximately 40 per cent of these patients can be returned to normal voiding by urethrotomy, overdilation or bladder neck incision. They suggest that the risks of stress incontinence after such procedures may have been over emphasized. It is not clear from the results what objective measures of satisfactory voiding were obtained. A. J. W.
Teflon Injection in Stress Incontinence A. M. DEANE, P. ENGLISH, M. HEHIR, J.P. WILLIAMS AND P. H. L. WORTH, St. Peter's Hospitals, London, England
Brit. J. Urol., 57: 78-80 (Feb.) 1985 A total of 28 female patients with stress incontinence and 18 male patients with post-prostatectomy sphincteric incontinence underwent periurethral or urethral injection of polytetrafluoroethylene (Teflon) paste. The injections were made at the bladder neck at the 3, 6 and 9 o'clock positions in the female patients, and at the prostatic apex in the male patients. A repeat procedure was necessary in 60 per cent of the cases. Incontinence in the female patients was classified as either grade I (normal resting anatomy with bladder neck incompetence and descent on coughing) or grade II (bladder neck incompetence at rest with descent present but not below the level of the symphysis). More gross levels of descent were not considered for polytetrafluoroethylene injection. Of the 28 female patients 11 had already had an unsuccessful colposuspension procedure or anterior repair. Of the 6 female patients with grade I incontinence 4 were cured and 2 were improved, compared to 5 cured, 6 improved and 11 failures among the 22 with grade II disease. A previous operation (Kaufman procedure) had been performed on 10 of the 18 male patients. Only 1 of 8 patients who underwent periurethral injections reported improvement at 3 months. The other 10 male patients had endoscopic urethral injections and the initial results were encouraging, most patients leaving the hospital with improved continence. However, at the 3-month followup only 2 patients reported some lasting improvement and repeated injection did not seem to produce further improvement. No serious complications were seen in either group, although fever and transient voiding difficulties were common. Subsequent procedures were not jeopardized but the authors do not specify exactly what these subsequent procedures were. They conclude that polytetrafluoroethylene injection provides a simple alternative for the control of early to moderate female stress incontinence but expressed distinct reservations about its use in the male patient with post-prostatectomy incontinence. 8 references Abstracter's comment. Periurethral polytetrafluoroethylene injection is an interesting and innovative modality whose ultimate place in the treatment of urinary incontinence secondary to sphincter insufficiency remains to be established. Those wishing to use this form of therapy in the United States should note that Food and Drug Administration approval for the use of this substance has been extended only to vocal cord reconstruction, although deliberations currently are in progress about approval for other uses. A. J. W.
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY A Comparison Between Diuresis Renography and the Whitaker Test in 64 Kidneys A. M. HAY, W. J. NORMAN, M. L. RICE AND R. D. STEVENTON, Departments of Urology and Radiology, Royal Shrewsbury Hospital, Shrewsbury, England
Brit. J. Urol., 56: 561-564 (Dec.) 1984 Sixty-four dilated pelviocaliceal units in 57 patients were studied by diuresis renography and the Whitaker test for the presence of obstruction. Renography was performed in well hydrated subjects with 123iodine-hippurate followed by 0.5 mg./ kg. furosemide. Four kinds of renographic responses were identified, 2 of which were classified as unobstructed, with type I showing prompt uptake and elimination phases, and a defined peak, and type IIIA showing only a defending phase in response to the diuretic (believed to characterize hypotonic dilatation of the collecting system). Of the 45 kidneys showing 1 of the 2 types of unobstructed renographic responses 32 were obstructed according to criteria of the Whitaker test, 8 fell into an equivocal zone and only 5 were unobstructed. Of these kidneys 35 were operated on for presumed obstruction, and generally excellent symptomatic and renographic results were obtained. Detection of a type I or IIIA renographic response in a dilated painful system cannot be taken to exclude obstruction. Better correlation was obtained between renographic and Whitaker results in patients exhibiting 1 of 2 types of obstructed responses. 5 figures, 5 references Abstracter's comment. On the surface this article seems to condemn diuresis renography, compared to the Whitaker test, as an effective discriminant between obstructed and nonobstructed dilatations of the upper urinary tract. However, the authors do not describe in great detail the types of renographic responses obtained or their interpretations. They actually conclude that "this study suggests that even minor deviations of the diuresis renogram from normal may be associated with urodynamic obstruction. Diuresis renography is, therefore, an exquisitely sensitive screening test for obstruction. It would seem merely that the criteria governing its application requires some revision". A. J. W. Vasography, its Indications and Complications S.
R. PAYNE, J. P. PRYOR AND C. M. PARKS, St. Peter's Hospital and Institute of Urology, London, England
Brit. J. Urol., 57: 215-217 (Apr.) 1985 A total of 482 men underwent vasography from 1975 to 1983 (usually during scrotal exploration): 265 for azoospermia, 175 for infertility (usually severe oligospermia but some during varicocele ligation) and 46 for miscellaneous conditions (hemospermia in 26, ejaculatory problems in 10 and undiagnosed testicular or epididymal pain in 4). A normal vasogram was seen in 427 men. Radiological abnormalities were reported in 55 patients (11 per cent) and were most common in the miscellaneous group, in which abnormalities were seen in 22 patients (52 per cent), particularly 73 per' cent of those with hemospermia. Abnormalities were seen in 26 patients (10 per