Chapter 8.Developments of X-Ray Generating Equipment Supporting Measurement Systems X-Ray Tubes X-Ray Quality Measurements Chapter 9.

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There was a 3:l male predominance. Mean follow-up was 21.4 months (range: 3-50 months). Six patients (27%) had one or more recurrences. All 22 cases had some form of previous bladder insult or surgery. Of the seven cases in the RT group, three were not ipsilateral to the side of the ureterovesical anastomosis. In the non-RT group, the bladder insults included recurrent UTI, urinary tract instrumentation, placements of ureteric stents, and cystodiathermy. Five cases were associated with TCC of the bladder, of which four had N A lesions directly over or close to the site of previous fulguration. In four patients, there was a temporal relationship between the administration of intravesical chemotherapy or BCG and the onset of N A lesions. All 22 cases were proven benign histologically with no malignant change on follow-up; however, one nephrogenic adenoma was found within a low-grade bladder TCC.The aetiology, biological behaviour and malignant potential of N A is not fully understood. Patients should have regular cystoscopies because of its association with bladder cancer. Fulguration or transurethral resection seems sufficient treatment at this stage. More research is warranted.There is considerable dispute about the best technique for performing debusor myectomy from excision of a small circular patch of muscle anteriorly and extrapentoneally to a much more extensive excision of up to half the debusor and protecting the exposed urothelium with omental cover.After several alterations of technique we have evolved what appears to be the easiest and most satisfactory method. The procedure is performed intrapentoneally. The omentum is mobilized off the colon (and off the stomach if necessary). The detrusor muscle is incised all the way round the bladder about 2 cm above the ureters and the whole of the upper half of the detrusor removed (ideally in one piece) from below upwards. This can often be achieved without perforating the urothelium in those patients with detrusor instability, but rarely in the more difficult neuropathic bladder. The exposed urothelium is then completely covered with a layer of omentum. The procedure has a much lower morbidity than clam cystoplasty, with equivalent symptomatic relief, but less urodynamic resolution.

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