A total of 62 patients with vesico-urethral dysfunction were investigated at the Urodynamic Laboratory (Universiti Kebangsaan Malaysia) at the Institute of Urology and Nephrology over a period of eleven months in 1985. In most instances the results significantly influenced a change in patient management strategy. These results are analysed and the usefulness and limitations of this modality of investigations are critically alluded to.
Retrograde ureteroscopy, using the 12.5 French Storsz Perez-Castro Ellendt operating ureteroscope provides excellent visual access to the whole of the ureteric lumen in most instances. A total of 41 ureteroscopies were performed on a similar number of patients over a period of 12 months since April 1986. Majority of them were for ureteric calculi. Success rate for patients with ureteric calculi below the pelvic brim was 77.4%. A lower success was noted for calculi above the pelvic brim (50%). Retrograde ureteroscopy will eventually make blind basketing of lower ureteric stones an unnecessarily risky procedure and perhaps even obsolete. Ureterolithotomy nevertheless will still have a place in the management of stones that cannot be extracted either due to acute bullous oedema of the ureteric mucosa or in previously explored rigid non-yielding ureters not suitable for ureteroscopy.
One hundred and fifty patients with urothelial tumours were reviewed. They form the majority of patients with bladder cancer referred to the Institute of Urology over the past three years. From the study it becomes very apparent that the majority of patients are seen late in the course of their disease. The results of treatment of patients with early lesions have been satisfactory but the patients with late invasive lesions have very poor prognosis. A plea is made that one be more aware of this condition and that symptoms of haematuria and urinary tract infections should have a full urological assessment early.
An uncommon problem that can present as a surgical emergency is described and the aetiology of priapism and its management is alluded to in the light of simpler surgical measures that are presently available.
Analysis of the investigations of 14 cases of spinal injury are presented. The significance of the level of injury and the pattern of bladder function is alluded too. Some aspects of the management of neurogenic bladder are discussed.
Over the six-veer periodfrom. 1976 to 1981, there were 241 neonates referred to the U.K.M. Paediatric Surgical Unit, General Hospital, Kuala Lumpur for alimentary tract obstruction and 207 were operated on. The three commonest conditions were anorectal anomalies (91 cases), Hirschsprung's disease (31 cases) and oesophageal atresia (30 cases). Overall operatioe mortality was 28.0 percent. This was high when preoperative complications lihe gut perforation (88.9 percent) or pneumonia (61.9 percent) and associated severe anomalies (90.9 percent) or chromosomal abnormalities (66.7 percent) were present. Emphasis is placed on the establishment of early diagnosis and the significance of the green vomit and maternal hydramnios is highlighted, The need is felt for more specialised nurses and the creation of a separate neonatal ICU in this hospital.
One hundred and six prostatic tissue samples obtained from transurethral resection were analysed for androgen and estrogen receptors. In 62 of these, progesterone and glucocorticoid receptors were also assayed. Steroid receptors were assayed using single saturation dose 3H-labelled ligand assays. Ninety percent of the 97 prostatic hyperplasia tissues and six of the nine prostatic carcinoma tissues were positive for androgen receptors. Estrogen receptors were only present in 19% and 33% respectively. Progesterone receptors were present in 70% of the tissues, but glucocorticoid receptors were present in only 16% of prostatic hyperplasia and none in prostatic carcinoma.
Review of the haemodialysis experience revealed patient survival between 1976 and 1982 to be 90%, 77% and 44% at one, three and six years respectively. This was similar to other published reports. Patients under the age of 50 years did better than those above 50 years, and diabetics did worst of all. There was a high rate of rehabilitation and return to employment or household responsibilities. Our policy of self-care dialysis allowed more patients to be treated without increasing the number of staff Dialysis encephalopathy and sudden deaths were important causes of death.