Objective  To compare the efficacy and tolerability of the &agr;1A‐subtype selective drug tamsulosin with the non‐subtype‐selective agent alfuzosin in the treatment of patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), often termed symptomatic benign prostatic hyperplasia (BPH). Patients and methods  The study comprised 256 patients with benign prostatic enlargement and LUTS suggestive of BOO (symptomatic BPH) who received tamsulosin 0.4 mg once daily or alfuzosin 2.5 mg three times daily during 12 weeks of treatment. The response was assessed by measurements of maximum urinary flow rate (Qmax ), a symptom score (Boyarsky) and blood pressure at regular intervals. Results  Tamsulosin and alfuzosin produced comparable improvements in Qmax and total Boyarsky symptom score. Both treatments were well tolerated with respect to adverse events. Tamsulosin had no statistically significant effect on blood pressure compared with baseline but alfuzosin induced a significant reduction in both standing and supine blood pressure, compared with baseline (P<0.05). Conclusion  Tamsulosin is the first adrenoceptor antagonist that is selective for the &agr;1A‐subtype; this specificity may explain its lack of effect on blood pressure compared with alfuzosin, an agent that is not receptor subtype specific. Moreover, this finding may partly explain why tamsulosin, in contrast to other currently available &agr;1‐adrenoceptor antagonists, can be administered without dose titration. Another advantage compared with alfuzosin (and prazosin) is the once‐daily dosing regimen of tamsulosin.

These results show that an artificial sphincter has a role in the treatment of severe anal incontinence when local therapies are not applicable or have failed.

Implantation of an artificial sphincter is an alternative treatment for patients with severe faecal incontinence. This prospective study from one institution has evaluated the results from 13. Preoperative and postoperative incontinence scores, anal manometry, and quality of life were evaluated in 13 patients who had undergone implantation of an artificial sphincter over a 7-year period. Two patients were definitive failures. One developed acute total colitis after 5 years of satisfactory function, and a second had discomfort and demanded removal of an otherwise functioning device. After a median follow-up of 30 (range 5-76) months, 11 patients had an activated and functional device. These included 6 with a urinary AMS 800 and 5 with the newly designed anal ABS. The mean incontinence score decreased from 17 to 4, and quality of life improved markedly. Two of the 11 patients had undergone successful reimplantation, one following rupture of the cuff and the second following ulceration of the control pump through the labia. In no case was infection or erosion of the anal canal a cause of failure. While the cause of incontinence and age did not affect outcome, psychological reaction had a significant impact. The artificial anal sphincter may have a role to play in severe faecal incontinence.

Since its introduction by Lapides, clean intermittent catheterisation (Cle) has dramatically changed the urological management of spinal cord injury (SCI) patients. Since 1978 we have used CIC as a mode of drainage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium and long term. 12-14 Fr PVC catheters are used with lubricant. The objectives of this study were: first, in a population of 159 SCI patients (group 1), to evaluate the overall incidence of complications of CIC; Secondly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC, frequency of urinary tract infections, and rates of urethral strictures were evaluated. The analysis of group 1 showed a rate of lower urinary tract infection of 28% and of cytobacteriological infection of 60%. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5.3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The first factor for acceptance of long term CIC is continence, the second one is the ability to perform CIC independently. In group 3 we found a rate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on Cle. The method and the type of catheters used must also be considered. We need further studies of long term CIC in patients using non-reusable hydrophilic catheters from the acute period to see if these two complications can be prevented.

The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre-operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long-term follow-up.