findings could have been due to bias. The World Health Organisation is studying the risk of cancer in women using medroxyprogesterone at centres in Thailand, Kenya, and Mexico.' The most recent report from this case-control study (based on 39 cases who had used medroxyprogesterone) yielded a relative risk for all women using the drug of 1-0 (95% confidence interval 0-7 to 1 5).3 Relative risks were not shown separately for women diagnosed as having breast cancer before age 35, for women who used the drug before age 25, or for women who reported using it recently; it will be important to see whether more detailed analyses replicate our findings and, if so, which of these groups are specifically at risk.If our results are confirmed the indications for using medroxyprogesterone will need to be reassessed. The findings will also contribute to discussions about the relevance of the beagle model and about the pathogenesis of breast cancer.

A range of baseline urodynamic values has been established which could provide the basis for future studies of ambulatory monitoring.

We assessed 6 methods for calculating bladder volume from ultrasonic cross-sectional scans. The technique that used the largest number of features from the scans gave the best results. For volumes greater than 150 ml. an accuracy of 0.87 and repeatability of +/- 9 per cent (standard deviation) were obtained.

The proposed nomogram combined with the additional flow rate criterion can classify more than two-thirds of cases without recourse to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the treatment of men with LUTS.

No abstract

25 patients with interstitial cystitis were treated by prolonged bladder distension. 16 patients are symptom-free, but 5 of these have had 1 or more previous prolonged bladder distensions. 6 patients are improved, whilst 3 remain symptomatically unchanged. Prolonged bladder distension can be repeated successfully when symptoms return. These results suggest that prolonged bladder distension has a place in the treatment of interstitial cystitis.

We investigated 41 men with chronic retention of urine owing to bladder outflow obstruction by long-term monitoring of bladder pressure and conventional cystometry to determine the relationship between detrusor pressure and upper tract dilatation. We confirmed that high pressures during conventional filling cystometry were common in men with upper tract dilatation. However, important differences were demonstrated between long-term monitoring and conventional cystometry. The pressure increase during the natural filling phase of long-term monitoring was significantly smaller than that during conventional cystometry. Detrusor instability was found in 88 per cent of the men during long-term monitoring but in only 51 per cent during conventional cystometry (p less than 0.001). High frequency unstable detrusor contractions during long-term bladder pressure monitoring were associated significantly with upper tract dilatation (p less than 0.0001) and correlated significantly with impairment of glomerular filtration rate (rs equals -0.7339, p less than 0.001).

Twenty-five men with chronic retention of urine were studied in order to investigate the relationship between upper tract dilatation and bladder pressure. Each underwent assessment of upper tract dilatation and urodynamic investigation before bladder drainage. Patients were reassessed 3 or more months after operation. Residual urine and detrusor contraction pressure decreased significantly after operation (P less than 0.0001:P less than 0.01). A significant increase in effective cystometric capacity and a significant decrease in pressure rise during filling led to an improvement in compliance. At pre-operative assessment, patients with upper tract dilatation had a significantly greater resting bladder pressure (P less than 0.05), end filling pressure (P less than 0.002) and pressure rise during filling (P less than 0.02) than those without upper tract dilatation. In addition, statistically significant correlations were found between serum creatinine and end filling pressure (P less than 0.05) and between upper tract dilatation and both high end filling pressure (greater than 25 cm H2O) and high pressure rise during filling (greater than 15 cm H2O: both P less than 0.05). Whilst high end filling pressure and high pressure rise during filling were found to be closely associated with upper tract dilatation (sensitivity 93 and 100%), there was a high false positive rate (specificity 64 and 45%). Furthermore, statistical analysis demonstrated that these data had a continuous though skewed distribution, suggesting that it is not possible to make a clear distinction between high and low pressure chronic retention.