Forty-five patients with Peyronie's disease are described. No patient received treatment for one year from the time of presentation. Three had a complete resolution of their symptoms and signs during this period. The remaining patients received injections of triamcinolone hexacetonide (Lederle) into the plaques at 6-weekly intervals for 36 weeks. Thirty-three per cent had complete or marked improvement in their symptoms; those responding were younger patients with small, firm, discrete plaques in the distal penis. We recommend a non-operative approach in this group. Surgery or chemotherapy should be reserved for those older patients with harder, larger or confluent plaques.
Distigmine bromide (Ubretid) is a long-acting anticholinesterase which is thought to improve detrusor function, restoring normal voiding patterns which may have been disturbed by autonomic overactivity, particularly after surgery. Ninety-three patients entered a double-blind study of the effect of distigmine bromide versus placebo on voiding after prostatectomy. The results demonstrated that there was a trend towards improvement but no statistically significant increase in post-operative flow rates, in reduction in bladder volume, and in the incidence of re-catheterisation in the patients treated with distigmine bromide.
Sixty patients with recurrent superficial bladder tumours (Ta or T1) entered an open controlled trial of single dose Adriamycin. After transurethral resection of tumor recurrences, patients were alternately allocated to the control group or to the Adriamycin group, who received an instillation of 50 mg of Adriamycin in 50 ml of saline for 30 min. Six months later all patients were readmitted for endoscopy. In the Adriamycin group significantly more patients showed a decrease in the number of recurrent papillomas (72%) than in the control group (39%). This study shows that the use of adjuvant chemotherapy in the form of single dose Adriamycin is effective in reducing tumour recurrence.
An anatomical study of cadaver prostates has demonstrated that, in all cases, adenomatous tissue lies inferior to the verumontanum. The proportion of tissue distal to the verumontanum varies from less than 10 to 50%. In a series of 100 patients the post-operative urodynamic studies showed that in the tansurethral resection group the mean urethral length was longer, the flow rate lower and the residual urine higher than in the retropubic prostatectomy group. It is suggested that prostatectomy by the transurethral route is less complete due to residual sub-verumontanal prostatic tissue. However, it is likely that by restricting resection to supra-verumontanal tissue many patients are spared post-operative stress incontinence.
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