Fifty-one patients undergoing abdominoperineal resection of the rectum for carcinoma were studied with regard to bladder function after surgery. Fifty-nine per cent had motor denervation of the bladder due to tumour or operative damage to the pelvic parasympathetic nerves and this produced symptoms of incomplete bladder emptying requiring treatment in 90% of this group. The factors affecting the incidence of nerve damage were discussed. The long-term effect of parasympathetic nerve damage was investigated and the management is discussed.
Five hundred and ninety-one of 889 patients with T1 to T4 transitional cell carcinoma of the bladder had persistent or recurrent cancer after radical radiotherapy. Durable local control was significantly poorer for patients with grade 1 or T4 cancer before radiotherapy. Three hundred and twenty-two patients received additional surgical treatment: 21 1 were endoscopically managed and 11 1 had secondary cystectomy. The survival of patients with residual or recurrent cancer after radiotherapy was significantly improved by secondary local treatment (P< 0.0001 ). A comparison
During a 4-year period we have treated 3 young patients with severe epididymo-orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of "high risk" activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV-positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure. Investigations for atypical pathogens should be performed when young patients present with refractory epididymo-orchitis. These patients should also be counselled with regard to HIV testing.
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