bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermogravimetric Analysis of Urinary Stones
Authors: SHARMA R. N. , SHAH I. , GUPTA S. , SHARMA P. , BEIGH A. A.
Published: November 2008

Summary— Routine thermogravimetric (TG) analysis of 501 upper urinary calculi from the State of Jammu and Kashmir is described. The technique is simple, rapid and quantitative, and the equipment is easily maintained. The technique was found to be helpful in 95.4% of urinary stones and it is suggested that TG analysis may be employed as a technique of first choice in the routine quantitative analysis of all urinary calculi.
Testicular Size in Infertile Men: Relationship to Semen Characteristics and Hormonal Blood Levels
Authors: BUJAN L. , MIEUSSET R. , MANSAT A. , MOATTI J. P. , MONDINAT C. , PONTONNIER F.
Published: November 2008

Summary— Testicular volume was assessed in 1029 infertile men and found to be normal in 704; 71 patients had unilateral and 213 had bilateral testicular hypotrophy; 4 had unilateral and 37 had bilateral atrophy. Sperm count and motility decreased in accordance with testicular volume. The lowest mean sperm counts and lowest mean motility percentages were found in patients with bilateral testicular atrophy. An increase in mean FSH and LH was also significantly linked to decreasing testicular volume; the increase in the former was not related to a drop in sperm count.

A significant correlation was found between testicular volume and spermatogenesis and testicular volume is considered to be a reliable indicator of testicular function.
Extracorporeal Piezoelectric Lithotripsy for all Renal Stones: Effectiveness and Limitations
Authors: NEERHUT G. J. , RlTCHIE A. W. S. , TOLLEY D. A.
Published: November 2008

Summary— An unselected group of patients with renal stones was treated with extracorporeal piezoelectric lithotripsy (EPL) monotherapy. The results showed that this minimally invasive treatment was very effective for patients with stones smaller than 20 mm. After a minimum follow‐up of 1 month, 65% of these patients were stone‐free and 22% of the remainder had only small fragments. Patients with larger stones (20 mm or larger) required multiple treatment sessions (mean 5.8) and had less favourable results. One month or more after treatment, only 46% of these patients were free of stone and 21% required secondary operative procedures for obstructing ureteric fragments. Most of these patients are better treated initially by percutaneous nephrolithotomy.
Urothelial Tumours of the Upper Urinary Tract
Authors: KIRKALI Z. , MOFFAT L. E. F. , DEANE R. F. , KYLE K. F. , GRAHAM A. G.
Published: November 2008

Summary— We present a retrospective 10 year analysis of 76 patients with urothelial tumours of the upper urinary tract. Patients older than 65 years, and female patients, presented with more advanced stages and had a worse prognosis. The grade and stage of the tumour has the greatest impact on survival. No conclusions can be drawn on the efficacy of various types of surgery, but simple nephrectomy gave a 5‐year survival of 68%, with a stump recurrence rate of 15%.

We observed that patients with urothelial tumours had 4 fold increased chance of developing gastrointestinal cancer.
Maximum and Average Urine Flow Rates in Normal Male and Female Populations—the Liverposl Nomograms
Authors: HAYLEN B. T. , ASHBY DEBORAH , SUTHERST J. R. , FRAZER M. I. , WEST C. R.
Published: November 2008

Summary— The study of voiding in men and women has been handicapped by the lack of a normal reference range covering urinary flow rates over a wide range of voided volumes.

Normal volunteers (331 males and 249 females) were studied. Each voided once into a calibrated Dantec Urodyn 1000 mictiograph. On a second occasion 282 men and 46 women voided. The maximum and average urine flow rates of the first voids in both sexes were compared with the respective voided volumes.

Nomogram charts, in centile form, for both the maximum and average urine flow rates were constructed using statistical transformations of the data. Males showed a significant decline in both urinary flow rates with age, although there was no statistically significant variation in either urine flow rate with respect to first versus repeated voiding. Females showed no statistically significant variation in either urine flow rate with respect to age, parity or first versus repeated voiding.

The maximum and average urine flow rates in both sexes showed an equally strong relationship to voided volume. No artificial restriction of voided volume, erg. minimum 200 ml, appeared appropriate. These nomograms offer reference ranges for both maximum and average urinary flow rates in both sexes covering a wide range of voided volumes (15–600 ml).
Interstitial Cystitis and the Urethral Syndrome: a Possible Answer
Authors: WILKINS E. G. L. , PAYNE S. R. , PEAD P. J. , MOSS S. T. , MASKELL ROSALIND M.
Published: November 2008

Summary— A study was made of 20 patients fulfilling the criteria customarily used for the diagnosis of interstitial cystitis. A possible infective aetiology was sought by culture of bladder tissue, catheter and midstream specimens of urine, and urethral swabs by methods capable of detecting fastidious bacteria as well as aerobic pathogens. All bladder biopsies showed the histological appearances usually associated with interstitial cystitis, and bacteria were isolated from the catheter specimens and/or bladder biopsies of 12 patients. Eight of these isolates were fastidious bacteria, Gardnerella vaginalis (6) and Lactobacillus sp. (2). Fastidious bacteria were isolated from the midstream specimen of urine (MSU) and/or urethral swab of 6 other patients. The correlation of the histological and bacteriological findings supports the hypothesis of an infective aetiology and suggests that the so‐called urethral syndrome and interstitial cystitis may be the earlier and later stages of the same disease process. The importance of early diagnosis of infection in these patients is emphasised.
Study of Appropriate Antibiotic Therapy in Transurethral Prostatectomy
Authors: KIELY E. A. , McCORMACK T. , CAFFERKEY M. T. , FALKINER F. R. , BUTLER M. R.
Published: November 2008

Summary— Septicaemia is the commonest cause of morbidity and mortality following transurethral prostatectomy. Routine blind antibiotic prophylaxis is not always effective and there is a tendency to over‐use potent new and expensive antimicrobials. Attempts to “sterilise” the urine pre‐operatively are also expensive and disruptive. However, appropriate treatment/prophylaxis can be administered economically using rapidly obtained laboratory results. We describe here a technique of routine direct antibiotic sensitivity testing (DST) of the patient's urine pre‐operatively and before catheter removal. Such testing can be performed by junior medical staff in a ward side‐room. An appropriate antibiotic may then be administered parenterally 1 h before surgery or catheter removal.

A total of 102 consecutive patients underwent TURP and only 1 of those with infected urine became septicaemic. In this instance, an appropriate antibiotic had been incorrectly given orally before removal of the catheter.

If the antibiotic sensitivities of a patient's urine are known, and an appropriate antibiotic is given parenterally 1 h pre‐operatively or before catheter removal, the incidence of septicaemia following transurethral surgery may be significantly reduced.
Prognostic Factors in the Surgical Treatment of Azoospermia
Authors: KAPUR M. M. , SOOD S. , KOCHAR K. P. , PAUL S. , RAO S. V. S.
Published: November 2008

Summary— Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre‐operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre‐operative finding. Adverse operative findings included non‐canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre‐operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.
Transvesical Phenol Injection of Pelvic Nerve Plexuses in Females with Refractory Urge Incontinence
Authors: WALL L. L. , STANTON S. L.
Published: November 2008

Summary—
A series of 28 female patients with urge incontinence refractory to other forms of treatment underwent a total of 40 transvesical injections of phenol into the pelvic nerve plexuses. Following primary phenol injection only 8 patients (29%) had a significant response to therapy and all relapsed during follow‐up. Only 3 of 11 patients undergoing a second injection had a clinical response to this therapy and 1 developed a vesicovaginal fistula. This suggests that phenol injections have little place in the management of urge incontinence and it is unwise to proceed to 2 or more injections because of the risk of fistula.
Long‐term Antibiotic Treatment of Chronic Bacterial Prostatitis. Effect on Bacterial Flora
Authors: BERGMAN B. , WEDREN H. , Holm S. E.
Published: November 2008

Summary—
The bacterial flora in patients referred with chronic bacterial prostatitis were studied. Only 13% had Gram‐negative bacteria in significant numbers but 43% had Gram‐positives using the same criteria. Half of the patients were symptom‐free by the end of a 12‐week course of antibiotics and remained so after 6 months; in one‐third the symptoms were unchanged 6 months after completing treatment. The relief of symptoms correlated with the disappearance of white blood cells in the expressed prostatic secretion (EPS) and with a lowered pH in the EPS.

Thus only 1 of the 14 patients without symptoms at 6 months had a significant growth of bacteria at the prostatic level, whereas 7 of 10 patients with unchanged symptoms had a significant bacterial colonisation. Although the initially infecting organism was eliminated in about half of the patients, new Gram‐positive bacteria were isolated after treatment in 13 of 29 patients; 12 of these resolved spontaneously within 6 months. Five patients with Gram‐positive bacteria were colonised with new Gram‐negatives at the end of treatment. Two healed spontaneously but 3 remained colonised with Gram‐negatives at the end of the follow‐up period. These findings make it likely that many patients infected with Gram‐positive bacteria benefit from antibiotic treatment. However, disturbances in the bacterial flora by antibiotic treatment may facilitate invasion by new types of bacteria.
Neurophysiological Assessment of the Central Motor Pathway to the External Urethral Sphincter in Man
Authors: THIRY A. J. , DELTENRE P. F.
Published: November 2008

Summary—
A recently developed neurophysiological method by which the motor cortex in man can be electrically stimulated has been applied to the assessment of the central motor pathway to the external urethral sphincter. It was observed that there was parallel activation of the anal sphincter, the pelvic floor and the lower limb muscles, voluntary facilitation and marked inhibition during micturition.

This method can be used to assess the volitional and the various segmental and suprasegmental influences on the behaviour of the external urethral sphincter. Unfortunately, the poor tolerance of subjects to the scalp sensations caused by the electrical stimulus is a major limitation to its clinical use, though this should be obviated by the introduction of a cortical magnetic stimulator.
Histopathological Changes in Adult Cryptorchid Testes
Authors: OZEN H. , AYHAN A. , ESEN A. , ERGEN A. , DOGAN A. , RUACAN S. , REMZI D.
Published: November 2008

Summary—
The histological specimens of 73 patients who presented with undescended testes after puberty were re‐evaluated. None of the specimens revealed carcinoma in situ but in the specimens of 5 patients severe atypia was detected. None of the patients, including 5 with severe atypia, has shown any evidence of invasive testicular tumour during follow‐up.
Treatment of Disseminated Germ Cell Tumours of the Testis
Authors: ATHANASSIOU A. , PECTASIDES D. , BAFALOUKOS D. , BARBOUNIS V. , DIMITRIADIS M. , CHRISTODOULOU K.
Published: November 2008

Summary—
Between 1979 and 1987 64 men with non‐seminomatous germ cell tumours of the testis were treated with chemotherapy. Nearly half of these patients had large volume disease. The most frequently used combinations were VAB‐6 and POMB/ACE. Chemotherapy lasted 3.9 months for small volume disease and 5.5 months for large volume disease. Seven patients (11%) underwent resection of residual masses; viable malignancy was found in only 1 of these. Relapse occurred in 6 complete responders, 3 of whom were salvaged with further chemotherapy. Fifty‐three patients are presently alive and have received no treatment for periods of 5 to 86 months. Life table analysis forecasts a survival of 81%. Adverse prognostic factors have been recognised and include high initial serum concentrations of β‐human chorionic gonadotrophin (β‐HCG) and alpha fetoprotein (AFP), large volume disease and prior irradiation. Although the survival time of patients with advanced disease has improved in recent years, it remains considerably below that of patients who present with less advanced disease. Such patients should be treated aggressively from the outset in order to obtain maximum benefit from chemotherapy. Selected cases also require adjunctive surgery.
Ambulatory Monitoring of Bladder Pressures in Patients with Low Compliance as a Result of Neurogenic Bladder Dysfunction
Authors: WEBB R. J. , STYLES ROSEMARY A. , GRIFFITHS C. J. , RAMSDEN P. D. , NEAL D. E.
Published: November 2008

Summary—
A group of 28 patients with neurogenic bladder dysfunction and low bladder compliance was studied using medium fill cystometry (CMG) and ambulatory monitoring (AM) during natural bladder filling. The aims of the study were to compare the 2 techniques and to determine if ambulatory monitoring might be useful in predicting upper tract dilatation.

AM demonstrated significantly lower end filling pressures compared with CMG. Phasic detrusor contractions were found more commonly during AM and the frequency of phasic detrusor contractions during AM was associated significantly with poor compliance identified during CMG.

Patients with upper tract dilatation had significantly greater residual urine volumes, higher pressure rises during CMG and higher frequencies of phasic detrusor contractions compared with those patients with normal upper tracts.

The high pressures seen at the end of a medium fill CMG were not found during AM and therefore are unlikely to be the underlying explanation of upper tract dilatation in such patients.
Penile Venous Drainage in Erectile Dysfunction. Anatomical, Radiological and Functional Considerations
Authors: ABOSEIF S. R. , BREZA J. , LUE T. F. , TANAGHO E. A.
Published: November 2008

Summary—
To elucidate further the penile venous anatomy and its role in the haemodynamics of erection, we performed pharmacological cavernometry and cavernography in 95 patients with venogenic impotence and in 12 patients with psychogenic impotence. The findings were correlated with those of dissection in 10 adult male cadavers. Cavernography confirmed that the main venous drainage of the corpora cavernosa is via the cavernous veins, with additional drainage through the crural, circumflex and deep dorsal veins and demonstrated that, in patients with venogenic impotence, the cavernous veins are the common site of leakage.

Cavernometry provided valuable parameters for the quantification of the degree of venous leakage. Detailed knowledge of the penile venous system and cavernometry and cavernography are essential for the proper diagnosis and treatment of patients with venogenic impotence.
Maps for Diagnosis and Management of Antenatal Urinary Tract Dilatation
Authors: HANBURY D. C. , WHITAKER R. H. , TUDOR J. , DIXON A. K. , WRAIGHT E. P.
Published: November 2008

Summary—
Despite advances in radiological imaging techniques, the ideal management of antenatally diagnosed hydronephrosis remains controversial. A map, showing diagnostic and management pathways, has been designed in an attempt to provide maximum information from the most appropriate and minimum number of investigations.
Radiological Changes and Circulating Immune Complexes in Patients with Urinary Schistosomiasis
Authors: CAUDA R. , CRUCIANI E. , LAGHI V. , FINI D. , TRESALTI E. , SILVERIO F. Dl , ORTONA L.
Published: November 2008

Summary—
The degree of infection and the urographic picture was correlated to the presence and level of circulating immune complexes (CICs) in 69 patients affected by urinary schistosomiasis. Patients were divided into 2 groups: those eliminating less and those eliminating more than 25 eggs/10 ml of urine. Radiological changes in the urinary tract were present in 67% of patients, the most frequent finding being single or multiple filling defects in the bladder. CICs were present in 39 patients. A positive correlation was found between the presence and level of CICs and the output of Schistosoma haematobium eggs, as well as between the presence of CIC and single or multiple filling defects of the bladder.

Our findings indicated that CICs were present in patients with urinary schistosomiasis, but the different incidence in patients with a large egg output and radiological filling defects suggests a possible pathogenic role only in the earlier phase of the infection.
Relationship between Detrusor Pressure and Urinary Flow Rate in Males with an Intraurethral Prostatic Spiral
Authors: NIELSEN K. K. , KROMANN‐ANDERSEN B. , NORDLING J.
Published: November 2008

Summary—
Six patients with acute urinary retention and 2 with prostatic obstruction and urge incontinence were treated with an intraurethral prostatic spiral and underwent pressure‐flow studies 51 days (median) later.

Evaluation of pressure‐flow parameters and pressure‐flow plots by different methods gave conflicting results regarding the presence of intravesical obstruction; 6 patients showed no voiding symptoms and in 2 patients only moderate irritative symptoms remained.

The spiral allowed unobstructed voiding and is a good alternative to an indwelling urethral catheter. We recommend insertion of a spiral in patients with urinary retention if the waiting period for TURP is long or if the patient is unfit for surgery.
A Search for Infectious Agents in Chronic Abacterial Prostatitis Using Ultrasound Guided Biopsy
Authors: DOBLE A. , THOMAS B. J. , FURR P. M. , WALKER M. M. , HARRIS J. R. W. , WITHEROW R. O'N. , TAYLOR‐ROBINSON D.
Published: November 2008

Summary—
A series of 60 patients with a diagnosis of chronic abacterial prostatitis, as defined by the Stamey procedure, was studied by transrectal prostatic ultrasound and subsequent transperineal biopsy of the abnormal areas of the prostate in order to ascertain the role of micro‐organisms in this condition.

Histological assessment revealed a chronic inflammatory infiltrate, generally of low grade, in 53 patients (88%). Organisms were isolated from the prostatic tissue of only 9 patients (15%) and were considered to be contaminants from the perineal skin, since treatment with an appropriate antimicrobial agent failed to alter symptoms or affect the leucocyte count in the urine or prostatic fluid. Chronic abacterial prostatitis may be a non‐organismal inflammatory process.
Extracorporeal Shockwave Lithotripsy Monotherapy for Large Renal Calculi
Authors: GLEESON M. J. , GRIFFITH D. P.
Published: November 2008

Summary—
Extracorporeal Shockwave lithotripsy (ESWL) monotherapy with a Dornier HM3 lithotripter was used to treat 199 large (≥ 3 cm) renal calculi. Calculi were classified as solitary (29), multiple (152) orstaghorn (18) with stone‐free rates of 55.2, 39.5 and 55.6% respectively. The stone‐free rate was not statistically related to stone size, site or multiplicity. Complications occurred in 24 patients (12.8%) and were more common with solitary and staghorn calculi. ESWL is not recommended as primary treatment for most patients with large renal calculi.
Residual Urine Volumes in a Normal Female Population: Application of Transvaginal Ultrasound
Authors: HAYLEN B.T.
Published: November 2008

Summary—
The volume of residual urine in a normal female population has not been studied and consequently no clear definition of its upper limit exists.

Transvaginal ultrasound has been described as a method of identifying and measuring small bladder volumes in the range 2 to 175 ml. This allows the measurement of residual urine volumes without the need for catheterisation.

Fifty‐three women, who were attending for colposcopic examination agreed to take part in the study. They were deemed normal after denying specific urinary symptoms. Immediately following voiding, transvaginal sonocystography was used to measure residual urine.

Forty‐five women were found to empty their bladders completely (under 2 ml residual urine). The mean residual volume was 4.8 ml. The upper limit of normal for residual urine volume (taken at the 90th centile) was 10 ml.
Verification of the Accuracy and Range of Transvaginal Ultrasound in Measuring Bladder Volumes in Women
Authors: HAYLEN B. T.
Published: November 2008

Summary—
Transvaginal ultrasound has been presented as a technique for measuring bladder volumes in women in the range 2 to 175 ml, thus overcoming the limitations of abdominal ultrasound at these smaller, though clinically important volumes. The mean error of the technique in a preliminary study using known volumes from 10 to 175 ml was 23%.

The present study used the unknown bladder volumes of 41 women undergoing gynaecological surgery who required initial urethral catheterisation. The bladder volumes predicted by transvaginal ultrasound were compared with the volumes obtained when the bladder was emptied by urethral catheterisation. The mean accuracy rate was 24% and the optimum range was 50 to 200 ml.

The applications of this technique to the measurement of residual urine in clinical practice include the management of women with voiding difficulties and monitoring women who are either self‐catheterising or who have indwelling suprapubic catheters.
The Value of Urethral Sphincter Electromyography in the Differential Diagnosis of Parkinsonism
Authors: EARDLEY I. , QUINN N. P. , FOWLER C. J. , KIRBY R. S. , PARKHOUSE H. F. , MARSDEN C. D. , BANNISTER R.
Published: November 2008

Summary—
A series of 54 patients presenting with parkinsonism underwent clinical assessment and urethral sphincter electromyography (EMG).

After clinical assessment, 26 were thought to be suffering from probable multiple system atrophy (MSA), 15 were thought to have possible MSA and 13 were diagnosed as having probable idiopathic Parkinson's disease (IPD).

Of those with probable MSA, 16 were found to have an abnormal urethral sphincter EMG. In the group with possible MSA, only 5 patients had an abnormal EMG while in the group with probable IPD, only 1 patient had an abnormal EMG.

It was concluded that urethral sphincter electromyography provides a useful method of distinguishing between idiopathic Parkinson's disease and multiple system atrophy. It also provides a means of identifying those patients with parkinsonism whose incontinence may well be worsened, or in whom incontinence may develop following lower urinary tract surgery.
The Neurogenic Overactive Bladder. Classification Based on Urodynamics
Authors: FALL M. , OHLSSON B. L. , CARLSSON C.‐A.
Published: November 2008

Summary—
The aetiology and pathogenesis of bladder overactivity are very variable and the classification is rather crude. By careful interpretation of clinical findings and urodynamic assessments, refinement of the diagnosis is possible. From a therapeutic and prognostic stand‐point, it is of interest to distinguish between “idiopathic detrusor instability” and the “uninhibited overactive bladder”. Based on neurological investigation and cystometric recordings, including the ice water test, characteristics of the 2 entities are described.
DNA Ploidy and the Prognosis of Stage pT1 Bladder Cancer
Authors: MASTERS J. R. W. , CAMPLEJOHN R. S. , PARKINSON M. CONSTANCE , WOODHOUSE C. R. J.
Published: November 2008

Summary—
The histopathological grade, proportion of “S”‐phase nuclei and DNA ploidy values were linked and of prognostic significance in a retrospective series of stage pT1 bladder cancers. Nuclei were extracted from paraffin sections of 75 biopsies (56 patients). DNA ploidy and the proportion of “S”‐phase nuclei were measured using flow cytometry. Progressive disease (pT2 or greater) developed within 3 years in 35% (6/17) of patients with poorly differentiated tumours, 35% (8/23) with aneuploid tumours and 35% (7/20) of those with a high proportion of “S”‐phase nuclei. Of 8 tumours with all 3 features, progressive disease developed in 6 cases (75%). Of 9 patients who developed progressive disease, 8 (89%) had aneuploid tumours. Progressive disease did not develop in 11 patients with well differentiated tumours, compared with 4% (1 /24) in diploid/tetraploid tumours and 7% (2/27) in those with a low/medium percentage of “S”‐phase nuclei. In contrast to muscle‐invasive disease, recurrent superficial tumours developed with a high incidence in all groups. Only 6/56 patients (11%) remained alive and disease‐free for 3 years. It is concluded that these 3 features are of similar prognostic significance and accuracy in identifying patients requiring more aggressive therapy.
Prevalence and Significance of Urethral Instability in Women with Detrusor Instability
Authors: WISE B. G. , CARDOZO LINDA D. , CUTNER A. , BENNESS C. J. , BURTON G.
Published: November 2008

Summary— The phenomenon of urethral instability has been poorly defined and its significance is disputed. The aim of this study was to investigate the prevalence and significance of urethral instability in a group of women with idiopathic detrusor instability. Urethral instability was defined as a spontaneous fall in maximum urethral pressure of one‐third or more, in the absence of detrusor activity, over a 2‐min period. Urethral instability occurred in 42% of patients with detrusor instability and was strongly associated with the sequence of relaxation of the urethra prior to unprovoked detrusor contraction. Women with detrusor instability and a stable urethra exhibited primary contraction of the detrusor. The symptom of stress incontinence was more common in women with urethral instability.

Women with detrusor instability may be subdivided into 2 groups on the basis of urethral instability, the presence of which suggests a primary dysfunction of the urethra. Such patients may derive more benefit from treatment with an alpha adrenoceptor agonist in addition to (or instead of) standard anticholinergic therapy.
Activity Patterns of Pubococcygeal Muscles in Nulliparous Continent Women
Authors: DEINDL F. M. , VODUSEK D. B. , HESSE U. , SCHUSSLER B.
Published: November 2008

Summary— Simultaneous electromyographic (EMG) recordings from the left and right pubococcygeal muscles were obtained in 10 continent nulliparous women (aged 22–32 years) via wire electrodes inserted percutaneously. During relaxation, sustained motor unit firing was obtained in 14 and no EMG activity in 4 of the 20 recorded muscle sites. During voluntary squeeze, stopping urine in midstream and coughing there was always bilateral recruitment of motor units that was gradual in the recording sites with ongoing EMG activity and brisk in the sites without EMG activity; the 2 different patterns of activity were called “tonic” and “phasic” respectively. Voluntary squeeze led to activation of motor units sustained for 26 to 647 s (median 193.9) with the bladder empty and 25 to 600 s (median 198.4) with a full bladder. A marked decrease in ongoing tonic motor unit activity was seen during the attempt to urinate. Bladder filling caused an increase in tonic activity in 7 females bilaterally and in 1 unilaterally, whereas there was no change in 3 women.

During the Valsalva manoeuvre, simultaneous motor unit recruitment was seen in all subjects bilaterally with the bladder empty and in all but one with the bladder full: in the latter case the motor unit recruitment with an empty bladder changed into simultaneous bilateral inhibition of firing of motor units with a full bladder (both in the supine and erect position); this pattern changed to bilateral recruitment of motor units again after bladder emptying.

It is important to be familiar with the normal patterns of activity of the pubococcygeal muscles in continent nulliparous women since the denervation injury caused by childbirth might not only weaken these muscles but also influence their behaviour.
Transurethral Grooving of the Prostate in the Treatment of Patients with Benign Prostatic Hyperplasia. An Alternative to Transurethral Incision
Authors: ŞIMŞEK F. , TÜRKERI L. N. , ILKER Y. N. , AKDAŞ A.
Published: November 2008

Summary— Various alternatives exist for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Incision of the bladder neck and prostate has proved its efficacy in many studies, especially in small prostates. The major drawback of the procedure is inability to obtain tissue specimens to exclude malignancy. We introduced a method to overcome this drawback by incising grooves at 5 and 7 o'clock with standard resection loops which created not only the incisions but also provided enough tissue for pathological examination. Twenty‐five patients with BPH underwent transurethral grooving. Pre‐ and post‐operative urodynamic studies revealed significant improvement in both maximum and average flow rates. The re‐operation rate in the entire group was 12%. Transitional cell carcinoma of the prostatic urethra was detected in 1 patient, which proved its superiority to standard incision procedures.
Distinction between Focally Accelerated Bone Formation and Osteomalacia in Carcinoma of Prostate Metastasised to Bone
Authors: TAUBE T. , BENETON M. N. C. , WILLIAMS J. L. , McCLOSKEY E. V. , KANIS J. A.
Published: November 2008

Summary— We studied the histological indices of skeletal turnover in 40 patients with carcinoma of the prostate and skeletal metastases in order to determine the prevalence of osteomalacia. In 20 patients biopsied through uninvolved bone, the histological indices of bone turnover were normal. In particular, osteoid seam width and bone formation rates were consistently normal, indicating the absence of osteomalacia. In biopsies from tumour‐laden bone, hyperosteoidosis was present, usually associated with increased amounts of woven collagen and consistently associated with high rates of bone formation and mineralisation. It was concluded that hyperosteoidosis in prostatic cancer is rarely due to osteomalacia.
A comparison of intramuscular ketorolac and pethidine in the alleviation of renal colic
Authors: SANDHU D.P.S. , IACOVOU0 J.W. , FLETCHER M.S. , KAISARY A.V. , PHILIP N.H. , ARKELL D.G.
Published: November 2008

Objective To compare the analgesic efficacy of a single 30 mg intramuscular dose of ketorolac with that of intramuscular pethidine 100 mg. in a double‐blind, parallel‐group investigation of patients presenting with pain suggestive of renal colic.

Patients and methods Seventy‐six patients (17 women, 15 men; mean age 45.2 years, range 20–80) were allocated by means of a pre‐determined randomization schedule to receive ketorolac and 78 patients (20 women, 58 men; mean age 42.1, years range 18–70) to receive pethidine. Data from eight patients in the ketorolac group and six in the pethidine group were excluded from the efficacy analyses because of protocol violations. The severity of each patient's pain was assessed on a four‐point verbal rating scale (VRS) and a 10 cm visual analogue scale at pre‐dose and at 15 min intervals for the first hour post dosing. The time to first administration of rescue analgesic, up to 24 h following dosing with the study medication, was recorded. Adverse events were elicited by general questioning.

Results Eighty‐eight per cent of patients in each treatment group had improved according to the VRS of pain severity 1 h after dosing; the summed pain intensity differences up to 1 h were statistically significantly different in favour of ketorolac (P<0.05). Fifty‐six per cent of patients who were receiving ketorolac required rescue analgesia during the study period compared with 74% receiving pethidine. The incidences of adverse events were lower in the ketorolac group (28%) than the pethidine group (51%).

Conclusion Ketorolac can be considered a viable alternative to pethidine for the treatment of renal colic.
Ultrasonography of ureteric abnormalities induced by Schistosoma haematobium infection before and after praziquantel treatment
Authors: KARDORFF R. , TRAORÉ M. , DOEHRING‐SCHWERDTFERGER E. , VESTER U. , EHRICH J.H.H.
Published: November 2008

Objective To describe the ultrasonographic appearance of ureteric lesions due to Schistosoma haematobium infection and to report prevalence rates of such lesions in endemic communities in Mali before and after praziquantel treatment.

Subjects and methods The total population (n = 961) of three S. haematobium‐endemic villages in Mali was examined ultrasonographically to detect urinary tract morbidity. Urine was tested for S. haematobium ova and for haematuria. An identical follow‐up study was performed 1 year after mass treatment with praziquantel.

Results Prevalence rates of S. haematobium infection in the three villages were 53%, 72% and 73%. Ultrasonography revealed dilatation of the ureters in 143 subjects (15%). In 20 of these, mainly children and adolescents, thickening and irregularities of the ureteric wall with distal ureter obstruction were directly visualized on ultrasonography. Within the bladder of two others, an intraluminal structure of ureterocele‐like appearance was seen. None of these alterations has been previously described as an ultrasonographic feature of schistosomal uropathy. Active S. haematobium infection and microhaematuria were found in 21 and 20 of these 22 subjects respectively. Significant renal obstruction was present in 10 of them. One year after treatment, an entirely normal urinary tract was found in 85% of 104 re‐examined individuals who had had ureter dilatation. Ureteric wall thickening or ureterocele‐like lesions had disappeared in 95% of subjects.

Conclusions The role of ultrasound in the evaluation of schistosomal uropathy is confirmed. Ureteric wall abnormalities causing strictures and ureterocele‐like lesions of the ostium must be regarded as further ultrasonographic features of this condition. The study documents the excellent reversibility of ureteric abnormalities after antischistosomal treatment in children and adolescents, thus emphasizing the need for early and efficient medical treatment of the infection.
An assessment of the contribution of visco‐elastic factors in the aetiology of poor compliance in the human neurophathic bladder
Authors: GERMAN K. , BEDWANI J. , DAVIES J. , BRADING A.F. , STEPHENSON T.P.
Published: November 2008

ObjectiveTo compare the mechanical properties of full‐thickness bladder strips from poorly complaint neuropathic bladders with controls and to determine the overall contribution that mechanical factors might have in the actiology of the poor compliance of medium‐fill cyctomerty.

Patients and methods The visco‐elastic properties of full‐thickness bladder strips from 11 neuropathic patients (with poorly complaint during medium‐fill cystomerty) were compared with strips from 11 control bladders. A Strip (measuring 2 cm long and 0.5 cm wide) was mounted in an organ bath and streched by 1 cm at a slow and at a fast rate. The streches were repeated in modified Krebs solution containing Zero calcium and 12mM magnesium. The final experiment involoved stretching the strip by 1 cm in <1 s (instantaneous strech)

Result only modest differences in the peak tensions of both tissues were uncovered by the slow and fast streches (fast stretch: 14.6 ± 5.5 in neuropaths vs 10.1 ± 4.1 g in controls. P = NS; slow stretch: 9.6 ± 3.5 in neuropaths vs 6.7 ± 2.5 g in controls. P <0.05). Straches carries out in modified Krebs solution resulted in lower tensions. Fast, intermediate and slow components of viscous decay (derived from the rate of tension decay following the instantaneous stretch) were not significantly different in neuropaths compared to controls (P = NS).

Conclusion The differences in the mechanical properties between neuropathic and control bladder strips were small and could not alone have accounted for the large differnces in bladder compliance that was observed between neuropathic and normal patients during medium‐fill cystometry. This implied that neurogenic rather than mechanical factors were more important in the aetiology of the observed poor compliance in these patients.
Ureteric retrieval net: comparison with stone extraction by Dormia baskets in an in vitro porcine model
Authors: PHAN C. N. , STOLLER M. L.
Published: November 2008

Objective To develop a ureteric retrieval net with advantages over existing stone retrieval methods.

Materials and methods In vitro experimental trials comparing the ureteric retrieval net with Dormia baskets were performed with porcine ureters and artificial calculi placed in a proximal or distal position.

Results For removing a single, large stone (9 times 6 × 5 mm) the net was slightly better than baskets (100% versus 90%) and it was significantly (P < 0.001) more effective for removing multiple small stones (2 times 2 × 3 mm to 5 times 4 × 3 mm) in one pass (76% versus 40% with three distal stones; 73% versus 13% with three proximal stones; and 53% versus 3% with six proximal stones).

Conclusion This newly developed ureteric retrieval net has a compact design, resulting in minimal resistance during retraction. Its smooth hydrophilic outer surface enhances scooping properties against the luminal wall. The mesh is similar to that in nylon stockings — porous enough to allow flow, yet small enough to capture fragments. It can capture numerous small fragments with one scoop, but can easily disengage them if extraction is not possible. The loop encompasses the entire lumen with the ‘pusher’ offset to a side wall, allowing maximal space and visualization, and the device can dilate the ureter to facilitate extraction. Clinical studies are in progress to evaluate the full potential of this new device.
The effect of transrectal ultrasonography (TRUS) including digital rectal examination (DRE) of the prostate on the level of prostate specific antigen (PSA)
Authors: KLOMP M. L. F. , HENDRIKX A. J. M. , KEYZER J. J.
Published: November 2008

Objective To study the effect of transrectal ultrasonography (TRUS) including digital rectal examination (DRE) of the prostate on serum prostate specific antigen (PSA).

Patients and methods In a diagnostic centre for general practitioners serum PSA was determined in patients before, immediately after, and one week after TRUS including DRE. In a small group of patients PSA was determined at various times after DRE and TRUS.

Results The PSA levels showed a statistically significant rise of 20% immediately after DRE and TRUS. After 7 days the PSA levels had returned to their initial levels. This decrease appeared to occur within the first 24 h.

Conclusion When applying the diagnostic triad PSA, DRE and TRUS blood samples for PSA should preferably be taken before DRE and TRUS. If blood samples are taken afterwards, it is safe to do so after seven days.
The diagnostic yield of intravenous urography: a demographic study
Authors: COLLIE D. A. , PAUL A. B. , WILD S. R.
Published: November 2008

Objective To examine the impact of intravenous urography (IVU) on patient management in unselected patients in an effort to identify groups in which the use of urography could be reduced.

Patients and methods The results of IVU in 235 consecutive unselected patients were assessed prospectively to establish the value of IVU in patient management. Patients were divided into subgroups on the basis of age, sex, presenting symptoms and source of referral. The percentage of examinations with findings affecting patient management was taken as the ‘positive diagnostic yield.’ Differences between the positive diagnostic yields of IVU in the various groups were examined using the ξ2 test.

Results For all patients the diagnostic yield was 37.4%. In patients over 50 years of age the yield was 46% while below that age the yield fell to 20%. This difference was significant (ξ2= 13.88, P < 0.001). There were no significant differences between the other defined groups. Specifically, patients referred by general practitioners were as likely to have an IVU abnormality as were patients referred by a hospital practitioner. Patients with painless microscopic hae‐maturia had a lower diagnostic yield (20%) than the other groups examined but this was not significant.

Conclusion IVU has a high diagnostic yield in an unselected population. Although the yield is lower in younger patients IVU offers advantages over other techniques in the investigation of urolithiasis — the commonest positive diagnosis in this study. We argue that it should retain its position as the primary investigation for the majority of patients with urological disease, particularly those suffering loin pain or haematuria.
Controlled trial evaluation of a General Practitioner education package on incontinence: use of a mailed questionnaire
Authors: SZONYI G. , MILLARD R.J.
Published: November 2008

Objective To evaluate whether an education package will significantly improve General Practitioners' knowledge of the aetiology, diagnosis and treatment of incontinence.

Subjects and methods Of the 510 General Practitioners contacted 124 returned a 27 item questionnaire (q1). The doctors were randomized into a test group (n= 80) who received an education package and a control group (n= 44) who did not. Follow‐up questionnaires (q2) were sent to those in the test group at 6 weeks and to those in the control group at 4 weeks post‐randomization. The answers to 18 of the 27 questions were found in the education package and the remaining nine were not. The test group was asked to rate the usefulness of the package.

Results There was a mean increase in scores for the two questionnaires of 5.2 in the test group compared with 0.4 in the control group. The average increase in scores in the test group was highly significant compared with that in the control group (P< 0.001). The results remained significant when the non‐responders were included. The change inscoresin the test group was significant only for those 18 questions with answers contained in the education package. There was no significant improvement between the two groups for the change in scores for the nine questions not answered in the education package (P= 0.74). General Practitioners gave the package a mean rating of 4.2/5 and it was still being used more than 6 weeks after delivery by at least 31 of 49 General Practitioners.

Conclusions For the General Practitioners who expressed an interest in receiving an education package on incontinence, and who answered the questionnaires, there was an improvement in the knowledge of incontinence directly attributable to the package
Marker tumour response to Evans and Pasteur bacilie Calmette‐Guérin in multiple recurrent pTa/pT1 bladder tumours: report from the Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party)
Authors: FELLOWS G.J. , PARMAR M.K.B. , GRIGOR K.M. , HALL R.R. , HEAL M.R. , WALLACE D.M.A.
Published: November 2008

Objective To compare the efficacy of Evans bacilie Calmette‐Guérin (BCG) and Pasteur BCG in eradicating marker bladder tumours and to compare the toxicity of the two strains.

Patients and methods Ninety‐nine patients with multiple recurrent pTa or pT1 bladder tumours were allocated at random to six instillations at weekly intervals of either Evans BCG or Pasteur BCG. All tumours were resected except one marker tumour. At cystoscopy 3 months after randomization all tumours including the marker tumour, if still present, were resected.

Results The incidence of adverse events was similar in the two groups but numbers were small and only large differences would have been detected. No statistically significant difference in efficacy regarding the response of the marker tumour or the appearance of other tumours at 3 months was noted in the two groups. There was no evidence of stage progression of the marker tumours.

Conclusions In multiple recurrent pTa or pT1 bladder tumours clearing the bladder of all except one marker tumour provides a safe and convenient way of measuring the response to intravesical therapy. No significant difference in efficacy or toxicity was detected between Evans BCG and Pasteur BCG.
Immunotherapy with bacille Calmette‐Guérin in patients with superficial transitional cell carcinoma of the bladder associated with bilharziasis
Authors: WISHAHI M.M. , ISMAIL I.M.H. , EL‐SHERBINI M.
Published: November 2008

Objective To test the effectiveness and possible side‐effects that may result from intravesical immunotherapy with bacillus Calmette‐Guérin (BCG) for superficial bladder cancer associated with bilharziasis.

Patients and methods Intravesical instillation of the Pasteur strain of BCG was carried out in 13 patients after transurethral resection of superficial transitional cell carcinoma (TCC) associated with bilharziasis. The recurrence rate in these patients was compared retrospectively with that of 17 patients with superficial TCC associated with bilharziasis in whom a recurrence had occurred previously and who had not received immunotherapy.

Results There was a statistically significant decrease in the recurrence of tumours after intravesical BCG therapy. The tumour‐free period after BCG treatment was 15.7 months compared with 6.7 months in the control group.

Conclusion The presence of bilharziasis does not appear to influence the effectiveness of immunotherapy with BCG for superficial bladder cancer.
Transrectal prostatic sonography as a useful diagnostic means for patients with chronic prostatitis or prostatodynia
Authors: LUDWIG M. , WEIDNER W. , SCHROEDER‐PRINTZEN I. , ZIMMERMANN O. , RINGERT R. H.
Published: November 2008

Objective To evaluate the sonographic changes that occur in patients with chronic prostatitis and compare them with those of non‐inflammatory prostatodynia using transrectal prostatic sonography (TPS).

Patients and methods In a prospective study, TPS findings were analysed in 88 men with chronic prostatitis and 53 patients with prostatodynia, all of whom had undergone a standardized diagnostic procedure to detect inflammation.

Results A statistically significant accumulation of prostatic calcifications and unilateral seminal gland alterations was demonstrated in patients with chronic inflammation. Nevertheless, both findings were also present in patients with prostatodynia (22% and 11%, respectively).

Conclusion TPS is widely recommended for differential diagnosis in cases of chronic prostatitis and prostatodynia. Prostatic calcifications and seminal vesical abnormalities are regarded as typical signs of inflammation. The results of this study show that these sonographic abnormalities are indicative but do not prove the presence of chronic prostatitis.