198 (3.8% comprising 4.7% of the males and 2.9% of the females) out of 5220 surgical patients developed total urinary retention postoperatively. The frequency of this condition increased with age and was highest after thoracotomies and endoprosthetic surgery of the hip joints. Voiding history was abnormal in 80% of the patients affected. Subclinical obstructive bladder dysfunction, over-distension of the bladder during the operation and in the recovery room after the operation, sympathomimetic and anticholinergic medication during or after anaesthesia, and an inability to stand or sit after surgery were common causes of retention. Premedication, type of anaesthesia, nature of the liquids given and postoperative analgetics seemed not to affect the incidence of retention. Postoperative urinary retention is an underestimated and mostly avoidable complication. Every patient should be asked for a urinary history before an elective operation. Infravesical obstruction should be relieved before any other elective surgical procedures are undertaken. In cases of emergency surgery prophylactic catheterization to prevent postoperative retention is recommended for patients with obstructive symptoms.

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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.

Seven unconjugated neutral steroids, including testosterone and some of its precursors and metabolites, were measured in the peripheral and spermatic venous blood males, employing specific radioimmunoassays after the fractionation of steroids on Lipidex-5000 (hydroxyalkoxypropyl Sephadex) microcolumns. Respective mean concentrations (ng/ml) and ranges of steroids estimated in peripheral and spermatic venous blood in all groups of patients were as follows: pregnenolone, 0.71 (0.29-2.39) and 10.97 (0.83-30.1); progesterone, 0.31 (0.02-0.57) and 10.17 (1.51-33.24); 17 alpha-hydroxyprogesterone, 1.04 (0.48-2.20) and 37.33 (1.68-141.00); androstenedione, 1.01 (0.26-2.65) and 11.87 (0.97-30.18); testosterone, 3.84 (0.63-10.64) and 255.1 (2.85-619.1); 5alpha-dihydrotestosterone, 0.19 (0.07-0.28) and 3.74 (0.04-9.71); androsterone, 0.27 (0.12-0.47) and 0.97 (0.20-2.15). Concentrations are similar to those estimated by mass spectrometry and protein binding assays, except for androsterone which has not previously been measured in this context. The low, but significant testicular secretion of both 5alpha-hydrotestosterone and androsterone suggests that these two steroids are testicular androgen metabolites, and that androgen metabolism in this tissue may be monitored by way of their measurement in spermatic vein blood.

Transurethral electroresection of the prostate (TURP) was compared with bladder neck incision (BNI) in the treatment of 24 patients with urinary obstruction caused by a small benign prostate. An evaluation of the urodynamic findings and subjective symptoms was undertaken before the operation and 6 months afterwards. Thirteen patients underwent TURP and 11 BNI. All patients except one in the BNI group subjectively considered the result good. The urodynamic evaluation showed that the detrusor pressure at maximum flow rate decreased more in the TURP group than in the BNI group and the urethral pressure profile was shorter after the operation. The maximum flow rates after the operation were similar in both groups. Retrograde ejaculation developed in 62% of the patients after TURP but none after BNI. BNI is recommended for men under 60 years with minimal prostatic hypertrophy and with an active sexual life.

(Klein, 1979; Elder and Catalona, 1984). Bone metastases occur in approximately 85% of patients who die of the disease (McCrea et al., 1958;Jacobs et al., 1983). Although bone-forming metast are charactenrstic of prostate cancer, bone resorption is also accelerated, as evidenced by an increase in the urinary hydroxyproline excretion and by the presence of lytic bone lesions in radiographs (Hopkins et al., 1983;Urwin et al., 1985;Percival et al., 1987;Shimazaki et al., 1990). Also, histomorphometnrc examination of skeletal biopsies has confirmed an enhanced osteolysis (Charhon et al., 1983;Urwin et al., 1985; Clarke et al., 1992;Taube et al., 1994). The main symptom of bone metastases is pain, but lytic lesions may sometimes also lead to pathological fractures and hypercalcaemia. Although most patients with bony metastases respond to the first-line hormonal therapy, the median survival is between 2 and 3 years, and only 30% are alive after 5 years (Murphy et al., 1983).The major structural protein in bone is type I collagen, which is synthesised by osteoblasts and accounts for about 90% of the organic matrix of bone (Risteli et al., 1993 (1988). The types of metastases were evaluated by radiographs, which showed sclerotic metastases without a visible lytic component (S) in 23 patients (58%) and mixed metastases with sclerotic and lytic components (S + L) in 17 patients (42%). Intermittent or constant bone pain had led to

Bladder function was evaluated urodynamically in 17 patients operated on 2 to 3 years previously for the cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. Of the patients 10 (59 per cent) reported the bladder function to be normal, while the other 7 had symptoms of obstruction or incontinence. Urodynamic findings were normal in 4 patients (24 per cent). In 3 patients (18 per cent) no detrusor contraction could be demonstrated in the pressure-flow electromyography study. Two patients (12 per cent) used the detrusor and straining during voiding. Cystometry showed an unstable detrusor in 3 patients (18 per cent). The remaining 5 patients (29 per cent) had either an increased bladder capacity or a decreased maximum flow rate. Neurological findings were normal in 2 patients (12 per cent). All of the patients with a decentralized detrusor had defective perianal sensation but detrusor contraction could be demonstrated in 3 who also had sensory impairment in the perianal region. Bladder function can be disturbed seriously in cauda equina patients without symptoms and, thus, all patients with the cauda equina syndrome should be tested urodynamically. An emergency operation seems to be capable of reducing late disturbances in bladder function. Regeneration of the autonomous nerves supplying the bladder and genitals may require an interval of several months to years.

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