bluuebunny/crossref_metadata_2025 huggingface dataset:
Asymptomatic inflammation and/or infection in benign prostatic hyperplasia
Authors: Nickel  , Downey  , Young  , Boag
Published: March 2003

Objective

To determine the extent, pattern and clinical significance of asymptomatic histological inflammation and latent infection (National Institute of Health Category IV prostatitis) in benign prostatic hyperplasia (BPH).

Patients and methods

The study included 80 patients (from a cohort of 100 consecutive potentially eligible subjects) with a diagnosis of BPH, but no history or symptoms of prostatitis. Histological sections were obtained from specimens collected prospectively at transurethral resection of the prostate (TURP), immunostained for leukocyte common antigen and scanned using a computerized image‐analysis system. Foci of inflammation were categorized as glandular, periglandular, stromal or peri‐urethral, and the inflammatory cell density graded from 1 to 3. Relationships and correlations were calculated between the volume, degree and type of inflammation, presence and type of bacteria (culture of deep prostatic biopsies), the use of catheters and prostate specific antigen (PSA) levels.

Results

Inflammation was identified in all patients but the mean tissue surface area involved was only 1.1% of the total specimen, with periglandular inflammation being the predominant pattern (0.5%). Of the prostate specimens, 44% showed bacterial growth (in 67% of the catheterized patients and 28% of those uncatheterized; 42% of patients were catheterized before TURP). There was no significant difference between any combination of inflammation pattern, volume or grade of inflammation in those catheterized or not (P=0.15) or culture‐positive (pathogenic or not) and culture‐negative cases (P=0.06). Neither total PSA or PSA density was significantly correlated (P>0.05) with the amount, degree or distribution of inflammation.

Conclusion

Prostatic inflammation is an extremely common histological finding in patients with symptoms of BPH who have no symptoms of prostatitis. There was no correlation between the degree and pattern of inflammation, catheterization, presence of bacteria, serum PSA or PSA density. The clinical significance of asymptomatic Category IV chronic prostatitis associated with BPH has yet to be determined.
Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13‐year retrospective study of the incidence and natural history of T1a‐T1b prostate cancers
Authors: Tombal  , De Visccher  , Cosyns  , Lorge  , Opsomer  , Wese  , Van Cangh
Published: March 2003

Objective

To determine the incidence and natural history of stage T1a‐T1b prostate cancer in patients undergoing surgery for benign prostatic hypertrophy (BPH), and thus evaluate the effect that recent medical and ‘minimally invasive’ treatments (which provide no prostate sample for pathological examination) might have on the percentage of patients with unsuspected prostate cancer.

Patients and methods

A series of 1648 patients undergoing surgery for BPH over a 13‐year period were reviewed retrospectively; the period overlapped the introduction of serum prostate specific antigen (PSA) as a detection method.

Results

Stage T1 prostate cancer was found in 182 patients (11%), comprising 126 (11%) of 1199 transurethral resections and 56 (12%) of 449 open enucleations. The introduction of systematic PSA assays gradually reduced the mean incidence of T1 cancer from 23% to 7%, with a greater effect on T1b (from 15% to 2%), while the incidence of T1a remained nearly constant (±5%). The pathological features of surgical specimens from 43 radical prostatectomies undertaken for T1 tumours were reviewed. Locally advanced disease (stage ≥pT3) was apparent in 13% of T1a and 28% of T1b tumours. Amongst the patients electing for surveillance, only 8% of those with T1a progressed within 30–97 months of follow‐up (mean progression time 73 months), whereas 29% of those with stage T1b progressed within 36 months of follow‐up (mean progression time 17 months).

Conclusion

These results show that the use of the PSA assay has decreased but not suppressed the incidence of pT1 prostate cancer, with a greater effect on those tumours at higher risk of progression (T1b). This suggests that the detection of prostate cancer based on PSA and transrectal ultrasonography is appropriate for screening patients and is sufficiently accurate that treatments for BPH that provide no pathological materials can be applied safely.
The incidence of detrusor instability before and after colposuspension: a study using conventional and ambulatory urodynamic monitoring
Authors: Brown  , Hilton
Published: March 2003

Objective

To determine the incidence of detrusor instability (DI) detected by conventional and ambulatory bladder pressure monitoring, any link between urodynamic findings before and after colposuspension, and between patients’ symptoms and the urodynamic findings.

Patients and methods

Sixty‐five patients, scheduled to undergo colposuspension on the basis of pure genuine stress incontinence on conventional cystometrography (CMG), also underwent ambulatory monitoring (AM) before surgery. All were requested to return 3 months afterward for repeat CMG and AM in random order. In all, 56 patients completed all assessments before and after surgery. In addition to the urodynamic assessment, the patients’ symptoms before and after surgery were compared using a detailed questionnaire.

Results

On AM before surgery, half the patients showed some DI; afterward, the incidence on AM was 70% and on CMG was 27%. However, on AM, 25% of patients who had DI before surgery showed no evidence of it afterward. Of the 19 women who complained of urgency preoperatively, 16 showed DI on preoperative AM. However, of the 37 women denying urgency preoperatively, 12 (32%) also showed evidence of DI on preoperative AM.

Conclusions

There is a significant incidence of DI detected by CMG after colposuspension in patients who are stable before surgery. The incidence of DI on AM was significantly higher than on CMG both before and after surgery. However, the preoperative urodynamic finding of increased DI on AM does not exclusively predict its presence postoperatively on AM or CMG. In addition, a patient history of urgency does not correlate well with the urodynamic findings before or after surgery. Therefore, from this study it appears that the postoperative symptomatic or urodynamic state cannot be predicted reliably from those before surgery.
Angiotensin II, type 2 receptor in the development of vesico‐ureteric reflux
Authors: Hohenfellner  , Hunley  , Yerkes  , Habermehl  , Hohenfellner  , Kon
Published: March 2003

Objective

To investigate if mutation of the angiotensin II (Ang II) receptors AT2 is involved in primary vesico‐ureteric reflux (VUR) in humans.

Patients and methods

Genetic polymorphisms in the AT1 and AT2 receptors was evaluated in 23 patients having the most common congenital urological abnormality, namely primary congenital VUR. The occurrence of the A1166C transition in the AT1 receptor gene and the A‐1332G transition in the AT2 receptor gene were evaluated and compared with the incidence in normal controls with no urological abnormalities.

Result

The distribution of the AT1 receptor genotypes was no different between patients with VUR and healthy controls. Furthermore, 10 of 23 (44%) patients with VUR and seven of 19 (42%) controls carried the AT2 receptor gene variation. These results contrast with our previous finding of an association between the A‐1332G transition in the AT2 receptor gene and primary obstructive megaureter, and pelvi‐ureteric junction obstruction.

Conclusions

We propose that while the AT2 receptor is crucial for the normal development of the ureter, it does not contribute to the processes which culminate in VUR, which is primarily an abnormality in the bladder trigone.
A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1‐year follow‐up
Authors: Carter  , Sells  , Speakman  , Ewings  , MacDonagh  , O'Boyle
Published: March 2003

Objective

To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP).

Patients and methods

A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a ‘free‐paint’ application of 60 W Nd:YAG coagulation energy. Patients were re‐assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods.

Results

In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0.001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re‐operation because of poor resolution of symptoms.

Conclusions

At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post‐void residual urine.
The significance of serum levels of insulin‐like growth factor‐1 in patients with prostate cancer
Authors: Kurek R. , Tunn U.W. , Eckart O. , Aumüller G. , Wong J. , Renneberg H.
Published: March 2003

Objectives To compare the serum levels of insulin‐like growth factor‐1 (IGF‐1) in patients with prostate cancer and in control patients with no malignancy, and to evaluate any possible influence of testicular androgen withdrawal on the level of IGF‐1 in patients with prostate cancer.

Patients and methods IGF‐1 was measured in serum samples from 238 patients using both a chemiluminescence method and a radio‐immunoassay. From a subgroup of 19 patients presenting with newly diagnosed carcinoma of the prostate, IGF‐1 and testosterone values were measured before and during the course of testicular androgen with‐drawal, achieved by the administration of luteinizing hormone‐releasing hormone (LHRH) analogues combined with anti‐androgens.

Results There were no significant differences in the mean serum levels of IGF‐1 patients with and without prostate cancer (158.6 and 159.1 ng/mL, respect‐ively). There were no significant differences in mean IGF‐1 levels before and after antiandrogen therapy; the mean (median, sd, range) levels of testosterone (µg/L) and IGF‐1 (ng/mL) before androgen withdrawal were 4.81 (4.84, 1.26, 3.11–6.93) and 157.1 (152.5, 26.7, 122.8–195.1). After androgen withdrawal the corresponding values were 0.303 (0.218, 0.24, 0.13–0.81) and 169.7 (31.7, 168.6, 124.9–227.6). A linear regression analysis (P = 0.76) and Spearman rank order correlation test (correlation coefficient –0.0613, P = 0.64) showed no association between levels of testosterone and IGF‐1. Freeze and thaw cycles applied to the samples had no effect on the IGF‐1 values measured.

Conclusions There was no significant association between IGF‐1 serum levels and prostate cancer. Short‐term androgen withdrawal using LHRH anal‐ogues combined with anti‐androgens had no effect on the levels of IGF‐1.
Penile fibrotic changes after radical retropubic prostatectomy
Authors: Ciancio S.J. , Kim E.D.
Published: March 2003

Objective To investigate the type of penile deformity, response to treatment of and predictive factors for the formation of penile fibrotic changes after radical retropubic prostatectomy (RRP).

Patients and methods Between July 1996 and September 1998, 110 men who had undergone RRP a mean (SD, range) of 35 (20, 5–145) months previously were evaluated by one physician for their erectile dysfunction. Those men affected by penile fibrotic changes were advised to initiate medical therapy for possible Peyronie’s disease; their charts were reviewed and they were interviewed to determine the outcome.

Results Overall, 45 of 110 patients (41%) with erectile dysfunction after RRP had penile fibrotic changes, representing 11% of all patients undergoing RRP in the specified period. The primary clinical presentation included penile curvature in 42 men (93%) and ‘waistband’ deformity in 11 (24%; some had both); palpable plaques were present in 31 (69%). On assessing the outcome in 40 men, 16 (40%) felt that their condition had improved, half were unchanged and 10% progressed, within a mean follow‐up of 24 months after diagnosis. Of the 16 improved, 14 were regularly using a vacuum constriction device or injection therapy. No significant factors predictive of the fibrotic changes could be identified, including the use of intracavernosal injection therapy before onset, neurovascular bundle resection, operative duration, estimated blood loss and pathological tumour grade or stage.

Conclusions Penile fibrotic changes are a significant but previously undescribed problem in men after RRP. Although predisposing factors could not be identified, most men felt that their condition stabilized or improved during treatment. Corroborative confirmation of this association and its aetiology will require prospective studies.
Apoptosis in the erectile tissues of diabetic and healthy rats
Authors: Alici B. , Gümüstas M.K. , Özkara H. , Akkus E. , Demirel G. , Yencilek F. , Hattat H.
Published: March 2003

Objective To compare the frequency of apoptosis in the erectile tissue of chronic diabetic and healthy rats.

Materials and methods Fourteen chronic diabetic and 10 healthy Sprague–Dawley rats were killed, their penises harvested and stored at –70°C until staining and flow cytometric analysis for apoptosis. A cell suspension was obtained from the penile tissue by scraping the inside of the cavernosum with a scalpel and filtering through a mesh. Samples of the cell suspension (0.5 × 106 cells) were stained with Annexin V (an indicator of apoptosis) and propidium iodide (PI, which stains dead cells), incubated for 15 min at room temperature and analysed by flow cytometry. The DNA content was also analysed in each sample.

Results In normal erectile tissue, a mean of 6.2% of cells were stained with Annexin V, while only 2.7% were stained with PI; DNA content analyses showed 7.5% were hypodiploid cells. In diabetic rats 19.5% of cells were stained with Annexin V and 5.2% with PI; 22.9% of cells were hypodiploid.

Conclusion The ratio of apoptotic cells in the erectile tissues of diabetic rats was significantly greater than in normal rats. The high rate of apoptosis in diabetic rats may play a role in the pathophysiology of erectile dysfunction.
Testicular adenomatoid tumours: clinical and ultrasonographic characteristics
Authors: Kassis A.
Published: March 2003

Objective To determine if benign testicular tumours can be identified clinically and ultrasonographically before surgery.

Patients and methods The clinical and ultrasonographic findings of six patients with testicular adenomatoid tumours and 16 with testicular germ cell tumours were assessed retrospectively and compared.

Results All adenomatoid tumours were characterized on physical examination by a well‐defined, painful and unfixed nodule, contrasting with the painless and ill‐defined malignant lesions. On ultrasonography, of the six adenomatoid tumours, two appeared hypoechoic, one hyperechoic, two isoechoic and one was normal, whereas none of the 16 tumours appeared normal or isoechoic.

Conclusions While isoechogenicity was not apparent in the group of testicular malignancies, the two groups had hypo‐ and hyperechoic patterns. Small, superficial, painful and unfixed testicular tumours that appear isoechoic on ultrasonography should be biopsied through an inguinal approach, with frozen sections assessed, instead of the patients undergoing immediate radical orchidectomy.
Transurethral implantation of silicone polymer for stress incontinence: evaluation of a porcine model and mechanism of action in vivo
Authors: Radley S.C. , Chapple C.R. , Lee J.A.
Published: March 2003

Objective To evaluate the anatomical location, histological appearances and mechanism of action of sili‐cone polymer (Macroplastique®) after transurethral implantation.

Materials and methods An in vivo pig model was developed to investigate the organization of Macroplastique 6 weeks after injection. The results were compared with the immediate appearance of injected Macroplastique in a surgical training device (using isolated pig urethrae) and with the histological appearances of Macroplastique in an explanted human specimen.

Results Macroplastique was subserosal in all specimens; it provoked a marked foreign‐body inflammatory reaction, producing firm nodules 6 weeks after implantation. The histological appearances in the in vivo pig model and the human specimen were indistinguishable.

Conclusions These findings indicate that the mechanism of action of Macroplastique is to augment pressure transmission to the proximal urethra by producing focal but firm expansion of periurethral tissues.
The production of nerve growth factor by human bladder smooth muscle cells in vivo and in vitro
Authors: Tanner R. , Chambers P. , Khadra M.H. , Gillespie J.I.
Published: March 2003

Objective To measure the concentrations of nerve growth factor (NGF) in tissue biopsies taken from subjects with a normal bladder and from patients diagnosed to have idiopathic detrusor instability (associated with a reduction in the density of motor nerves), and to use anin vitromodel to study the mechanisms of NGF expression.

Materials and methods Biopsy specimens were obtained during endoscopic and open surgery from patients undergoing routine bladder surgery. The patients were divided into two categories based upon urodynamic characterization. The NGF content in samples from 11 normal bladders and seven idiopathic unstable bladders were measured using an enzyme‐linked immunosorbent assay. The mechanisms influencing net NGF production were explored using detrusor cellsin vitro.

Results The mean (sem) NGF content was significantly higher in unstable tissues, at 0.96 (0.05) pg/µg protein, than in the normal bladder, at 0.53 (0.05) pg/µg protein. In the cell model, acetylcholine (10 µmol/L), noradrenaline (1 and 10 µmol/L) and ATP (1 µmol/L) caused a significant increase in net NGF production; acetylcholine at 1 µmol/L had no effect. Direct stimulation of protein kinase C (PKC) by phorbol ester (33 ng/mL) or elevation of cAMP using forskolin (10 µmol/L) increased NGF, suggesting that at least two intracellular pathways (PKC‐ and PKA‐dependent) are involved. The expression ofc‐Foswas increased by phorbol 12‐myristate 13‐acetate added before NGF, suggesting thatc‐Fosmay be involved in regulating NGF production.

Conclusion These data suggest a role for NGF in the physiology and pathophysiology of the human bladder, and indicate some of the possible mechanisms which might regulate NGF production.
Delayed testosterone replacement restores nitric oxide synthase‐containing nerve fibres and the erectile response in rat penis
Authors: Baba K. , Yajima M. , Carrier S. , Morgan D.M. , Nunes L. , Lue T.F. , Iwamoto T.
Published: March 2003

Objective To elucidate the effect of testosterone on penile innervation.

Materials and methods Three groups of six rats each were assessed; two groups (1 and 2) were castrated and the third (group 3) underwent a sham operation (control). Eight weeks after castration, group 2 received a subcutaneous injection with testosterone. At 8 weeks, the rats in group 1 and 3 underwent a final functional analysis while those in group 2 did so at 12 weeks. The evaluation included a subcutaneous injection with apomorphine to study centrally mediated erection, and cavernosal nerve electrostimulation and papaverine injection to study peripherally mediated erection. At death a penile mid‐shaft specimen was taken for NADPH‐diaphorase staining.

Results In the apomorphine study, castration resulted in significantly fewer yawns and erections than in the control, and those in group 2 significantly better central erectile function than in the controls. The mean (
sem) number of nitric oxide synthase (NOS)–containing nerve fibres in the corpora cavernosa and both dorsal nerves of castrated rats, at 46.2 (9.1) and 203 (32.1), respectively, were significantly lower than in rats in group 2, at 84.1 (11.2) and 300.6 (17.1), and than in the controls, at 88.6 (10.9) and 306.3 (22.9), respectively. The intracavernosal pressure decreased significantly in the absence of testosterone, both after electrostimulation and intracavernosal papaverine injection. However, there was no difference between the control and group 2 rats in either the number of NOS‐containing nerve fibres or in the peripheral erectile functional study.

Conclusions Testosterone acts on the nervous system to mediate erection; when it is absent there may be down‐regulation of both the production and activity of NO, thereby decreasing the response to peripheral stimulation via the NO pathway. The restoration of erectile function seen in rats in group 2 supports this phenomenon. Delayed testosterone replacement has no detrimental effect on the restoration of the erectile mechanism after castration.
Doxazosin: a new cytotoxic agent for prostate cancer?
Authors: Cal C. , Uslu R. , Gunaydin G. , Ozyurt C. , Omay S.B.
Published: March 2003

Objective To determine the sensitivity of drug‐resistant prostate cancer cell lines to doxazosin‐mediated cell death, and the effects of combining doxazosin and chemotherapeutic agents on these cell lines.

Materials and methods The cytotoxic effect of doxazosin was initially evaluated in the prostate carcinoma cell lines DU145 and PC‐3. Doxazosin was combined either with adriamycin, etoposide or paclitaxel after its cytotoxic effects were detected in these cell lines. The tetrazolium dye (MTT) assay and trypan blue dye‐exclusion tests were used to determine drug‐mediated cytotoxicity. Experiments were performed at least three times and representative data are presented.

Results Both cell lines were sensitive to doxazosin‐mediated cytotoxicity and the maximum cytotoxicity was achieved after 72 h. While cell death increased with increasing concentrations of doxazosin, 60 µmol/L doxazosin killed more than half of the cells in these cell lines. The combination of doxazosin with both adriamycin and etoposide resulted in significant synergistic cytotoxic activity at subtoxic concentrations of the drugs. Interestingly, the combination of doxazosin and paclitaxel resulted in antagonistic activity.

Conclusion Doxazosin‐mediated cytotoxicity in the drug‐resistant human prostate carcinoma cell lines was confirmed. Combinations of doxazosin with either adriamycin and etoposide, but not paclitaxel, had synergistic cytotoxic activity in these tumour cell lines. These results suggest that doxazosin could be a new cytotoxic agent, either used alone or combined, in the treatment of prostate cancer.
Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood
Authors: Gracia J. , Sánchez Zalabardo J. , Sánchez García J. , García C. , Ferrández A.
Published: March 2003

Objective To determine the clinical, physical, sperm and hormonal status during adulthood in cryptorchid patients operated on during childhood, and to assess these variables according to the age at surgery and preoperative testicular position.

Patients and methods A letter was sent to all 890 patients > 18 years old who underwent surgery for cryptorchidism during childhood; 274 responded and were assessed using a sexual history, physical examination, pituitary axis study and sperm analysis. Data were complete for 251 patients (mean age 21 years, range 18–30); 196 had unilateral (25 anorchic) and 55 had bilateral cryptorchidism. Clinical, surgical and anatomopathological records at surgery during childhood were also reviewed.

Results The mean (sd) age at orchidopexy was 6.4 (3.3) years and the mean age at assessment 21.1 (2.7) years. Semen samples generally showed abnormalities; 10 patients (4%) with bilateral and 57 (23%) with unilateral cryptorchidism had semen values within the normal range. There was no correlation between the sperm count and age at surgery for unilateral or bilateral cases (Spearman test). There was a significant correlation (r = − 0.41) between the sperm count and level of follicle‐stimulating hormone (FSH). There were no significant differences in the sperm count for patients with different testicular locations (anova) or in those treated or untreated with human chorionic gonadotrophin (Student’s t‐test). The only significant relationship (P < 0.001) was between the sperm count and unilateral or bilateral cryptorchidism.

Conclusions The sperm quality of adults operated on for cryptorchidism during childhood is independent of the age at surgery or testicular location, but is influenced by whether the cryptorchidism was unilateral or bilateral. FSH levels were negatively correlated with sperm density.
A urethral stent for the treatment of detrusor‐striated sphincter dyssynergia
Authors: Chartier‐Kastler E.J. , Thomas L. , Bussel B. , Chancellor M.B. , Richard F. , Denys P.
Published: March 2003

Objective To assess the technique, efficacy and complications of the Ultraflex® urethral stent (Boston Scientific Corp., Boston, MA) for the treatment of detrusor‐striated sphincter dyssynergia (DSD).

Patients and methods Forty consecutive patients with DSD who had a Ultraflex® stent placed in the membranous urethra were evaluated prospectively. DSD was caused by spinal cord injury in 30, multiple sclerosis in six and other neurological diseases in four. All patients were either tetraplegic or paraplegic and unable to use intermittent self‐catheterization. Previous bladder management consisted of an indwelling catheter in 15 patients, chronic suprapubic catheters in two, intermittent catheterization in nine, and trigger reflex micturition in 14. The Ultraflex stent was placed under local anaesthesia. The stents were 50 mm long in 36 patients, 45 mm in two and 40 mm in two. The mean (sd) follow‐up was 16.9 (13.8) months.

Results The mean (sd) residual urine decreased from 245.9 (117) mL before stenting to 65.2 (19.3) mL at 12 months afterward (n = 19). One stent was removed at 13 months for chronic prostatic and urinary tract infection leading to autonomic dysreflexia. There was no stent stenosis and 17 of 18 stents had  > 75% epithelial coverage at one year. None of the stents migrated. Seven patients underwent secondary bladder neck incision through the stent. The stent length was increased in four patients using a second overlapping distal stent, twice during the first procedure and twice within 6 months because the sphincter was inadequately covered.

Conclusions The Ultraflex® stent achieved the expected results for a prosthetic sphincterotomy and appears to be an appropriate but less invasive treatment for DSD.
The role of the activated form of matrix metalloproteinase‐2 in urothelial cancer
Authors: Kanda K. , Takahashi M. , Murakami Y. , Kanayama H. , Kagawa S.
Published: March 2003

Objective To investigate the expression of matrix metalloproteinase‐2 (MMP‐2, reportedly associated with cancer cell invasion and metastasis in many human cancers) in urothelial tumours and thus define its role in this disease.

Materials and methods The expression of both the activated form of MMP‐2 and total MMP‐2 (activated + latent form) was measured using gelatine zymography in tissue obtained surgically from 61 patients with urothelial cancer. The correlation between the level of the activated form of MMP‐2 and clinical and histological variables was assessed.

Results The expression of activated and total MMP‐2 were significantly higher in invasive tumour tissue and both levels were correlated with histological grade. In particular, the level of activated MMP‐2 was more closely correlated than that of total MMP‐2 in invasive tumour tissue. Moreover, high levels of activated MMP‐2 were strongly associated with shorter disease‐specific survival (P = 0.0016).

Conclusion These findings suggest that activated MMP‐2 plays a significant role in invasion of urothelial cancer and that the level of activated MMP‐2 expression is a useful prognostic indicator.
The contribution of cholinergic detrusor excitation in a pig model of bladder hypocompliance
Authors: Mills I.W. , Drake M.J. , Greenland J.E. , Noble J.G. , Brading A.F.
Published: March 2003

Objective To investigate the role of cholinergic excitation in mediating changes in detrusor compliance (manifested on conventional cystometry as an incremental rise in detrusor pressure as bladder volume increases) under conditions of propofol‐sedation in the pig.

Materials and methods Consecutive cystometrograms (CMGs) were obtained from eight female Large White pigs at a bladder filling rate of 50 mL/min. The first CMG was obtained while the pig was awake and unsedated. Two subsequent CMGs were obtained after light to moderate sedation with propofol (2–8 mg/kg/h) before and after the administration of intravenous atropine (0.02 mg/kg).

Results All bladders were highly compliant over the volumes instilled (before sedation) with a maximum pressure during the filling phase of 0.9 cmH2O and a compliance of 943 mL/cmH2O. After sedation with propofol, the maximum pressure during the filling phase increased to 14 cmH2O with a compliance of 69 mL/cmH2O. Atropine antagonized this change in compliance; after sedation and atropine, the maximum pressure during the filling phase decreased to 4 cmH2O (P < 0.05) and the compliance increased to 337 mL/cmH2O (P < 0.05).

Conclusion The decrease in compliance seen in the pig bladder after sedation with propofol is mediated via muscarinic excitation. This probably occurs as a result of low‐level tonic release of acetylcholine by the efferent parasympathetic nerves. The existence of such efferent excitatory activity during the storage phase in the overactive human bladder might explain the efficacy of bladder‐selective muscarinic antagonists in a proportion of patients with detrusor hyper‐reflexia and instability.
Iliac nodal metastases from carcinoma of the penis treated surgically
Authors: Lopes A. , Bezerra A.L.R. , Serrano S.V. , Hidalgo G.S.
Published: March 2003

Objective To evaluate survival in patients with metastatic iliac nodal involvement from carcinoma of the penis.

Patients and methods Thirteen patients with metastases to the iliac nodes were selected from 68 with squamous cell carcinoma of the penis who had undergone amputation and bilateral ilio‐inguinal lymphadenectomy. The 1978 Tumour‐Nodes‐Metastasis system was used for staging. Deep and superficial lymph nodes were removed during the inguinal procedure. Lymph nodes below the common iliac artery (external and obturator) were removed and histologically evaluated for the presence of metastases.

Results The mean (median, range) follow‐up was 55.5 (8.8, 0.3–235) months, at the end of which five patients were free of cancer, seven had died from cancer or treatment‐related complications and one was lost to follow‐up. Four of the five survivors had metastases to only one iliac lymph node.

Conclusion Ilio‐inguinal lymphadenectomy may have a significant role in increasing the survival of patients with metastases to only one iliac lymph node.
Computed tomography 21 days after chemotherapy, three‐dimensional estimates of metastatic volume and the need for surgery in patients with germ cell cancer
Authors: Bozcuk H.S. , Ravi R. , Turner B. , Tsetis D. , Thomas J.M. , Chan O. , Reznek R. , Hendry W.F. , Oliver R.T.D.
Published: March 2003

Objective To assess whether the response visible on computed tomography (CT) 21 days after the first course of chemotherapy in patients with nonseminomatous germ cell tumour predicts the need for surgery and whether three‐dimensional (3D) reconstruction adds to the diagnostic accuracy.

Patients and methods CT scans from 52 patients treated with cisplatin‐based chemotherapy were assessed for tumour shrinkage by measuring the changes of a one‐dimensional (1D) measurement of the maximum transverse diameter, and comparing CT scans before, 21 days after the first course and at the end of chemotherapy (1D method). In a subset of patients, using a special formula, the 1D‐derived 2D and 3D shrinkage (2Dder and 3Dder) were compared with four other computed or calculated methods (1D, 2D, 3Dcalc, 3Dcomp).

Results At day 21, in 32 of 52 patients (62%) there was < 50% tumour shrinkage using the 1D assessment; 21 of them (66%) needed surgery, compared with none of the 20 patients with > 50% tumour shrinkage by day 21 (χ2 = 22.83, P < 0.001). The 1D method showed significantly less shrinkage than all the other methods but when this was used to derive a 3D shrinkage, assuming the mass to be spherical (3Dder), it was not statistically different from that of 3Dcomp.

Conclusions The assessment of the response from 1D CT scan estimates 21 days after initiating chemotherapy identifies a subgroup of patients who have a high probability of needing surgery. Although expected to be more accurate, the 3Dcomp estimate of tumour shrinkage was no better than the 3Dder estimate.
The staged management of complex entero‐urinary fistulae
Authors: Shackley D.C. , Brew C.J. , Bryden A.A.G. , Anderson I.D. , Carlson G.L. , Scott N.A. , Clarke N.W.
Published: March 2003

Objective To present the results of the staged management of complex entero‐urinary fistulae.

Patients and methods Ten patients with complex entero‐urinary fistulae were reviewed; all patients were referred to a national intestinal failure unit after failed treatment in other centres. Each patient was treated in three stages. The acute stage involved proximal defunctioning and distal drainage of both the gastrointestinal and urinary tracts to isolate the fistula, together with the eradication of sepsis. The recovery stage involved total parenteral nutrition, organ support, radiological planning of surgical reconstruction and intensive nursing. The reconstructive stage followed when the patient was stable, nutritionally replenished and intra‐abdominal sepsis was controlled. Surgery was undertaken jointly by urological and gastrointestinal surgeons.

Results The fistulae were treated successfully in all patients, with functional restoration in four, and/or diversion of the gastrointestinal and urological tracts in six. The mean (range) time to reconstruction was 5 (1–20) months. There were no postoperative deaths.

Conclusion A staged multidisciplinary approach with delayed reconstruction can achieve a successful outcome in the management of complex entero‐urinary fistulae.
Neuromodulation reduces urinary frequency in rats with hydrochloric acid‐induced cystitis
Authors: Wang Y. , Zhou Y. , Mourad M.S. , Hassouna M.M.
Published: March 2003

Objective To evaluate the effect of sacral neuromodulation on interstitial cystitis (IC) and determine the underlying mechanism of neuromodulation in the treatment of IC.

Materials and methods Twenty Sprague–Dawley rats (body weight 220–250 g) were randomly divided into four equal groups; normal controls, a sham treatment (IC induced by 0.4 mol/L HCl, + saline), a second sham treatment (HCl‐induced IC + acetic acid) and a stimulated group (HCl‐induced IC + acetic acid, with electrical stimulation). In the last group bilateral electrodes were implanted into the S1 dorsal foramina and electrical stimulation applied for 8 h/day for 3 weeks. Acetic acid was instilled into the bladder to induce c‐fos expression. After 3 weeks the rats were perfused with 4% paraformaldehyde, spinal segments dissected out and an immunocytochemical method used to stain the segments for fos protein encoded byc‐fos.

Results The mean (
sem) micturition frequency (voids/17 h) in the sham groups increased from 10.8 (2.7) to 23.4 (3.4) 3 weeks after the intravesical instillation of HCl. The micturition frequency in the stimulated group, at 16.2 (2.7), was significantly less than in the sham group (P = 0.04) after electrical stimulation for 3 weeks. There was no significant difference in the mean (
sem) number of fos‐positive neurones in the L6 spinal cord segment between the stimulated and the sham + acetic acid group, at 43.6 (9.4) and 35.8 (7.8) cells/section, respectively (P = 0.32).

Conclusions In rats with HCl‐induced cystitis, electrical stimulation reduced the micturition frequency, but not by inhibiting afferent c‐fibre activity.
The absorption of pirarubicin instilled intravesically immediately after transurethral resection of superficial bladder cancer
Authors: Yamamoto Y. , Nasu Y. , Saika T. , Akaeda T. , Tsushima T. , Kumon H.
Published: March 2003

Objectives To assess the validity of the prophylactic use of pirarubicin ([2′R]‐4‐O‐tetrahydropyranyl‐doxorubicin) immediately after transurethral resection of bladder tumour (TURBT), using pharmacodynamic studies.

Patients and methods The study included 20 consecutive patients with superficial bladder cancer. Pirarubicin (30 mg/50 mL or 30 mg/100 mL, 10 patients each) was instilled immediately after TURBT and retained in the bladder for 1 h. Blood samples were obtained before and at 15, 30, 60 and 120 min after the instillation. After retaining the drug for 1 h all the intravesical fluid was collected and assayed for pirarubicin.

Results The plasma pirarubicin concentration in those receiving either dose was below detectable levels at any time after instillation. The mean recovery rate of pirarubicin in the drained fluid was 73%.

Conclusion The intravesical instillation of pirarubicin immediately after TURBT caused no detectable plasma concentration and few systemic side‐effects.
Population‐based outcomes after 28 246 in‐hospital vasectomies and 1902 vasovasostomies in Western Australia
Authors: Holman C.D.J. , Wisniewski Z.S. , Semmens J.B. , Rouse I.L. , Bass A.J.
Published: March 2003

Objectives To examine trends in vasectomy and vasovasostomy, and the surgical complications and factors associated with reversal after vasectomy, and paternity after vasovasostomy.

Patients and methods Procedure rates were estimated from 1980 to 1996 in the population of Western Australia. Linked hospital morbidity records were used in the follow‐up of men after vasectomy to estimate the risks of complications and reversals. Records of vasovasostomies were linked to the paternity field on birth registrations. Independent effects of the study factors were examined using Cox regression.

Results There was little net change in vasectomy rates, whereas vasovasostomy rates increased in men aged 30–49 years. Risks of surgical complications were low and decreased for vasovasostomy. At 12–15 years after vasectomy, the risk of reversal levelled at 2.4% in the total cohort and at 11.1% in men aged 20–24 years. The risk of vasovasostomy was 69% greater after vasectomy performed in 1994–96 than in 1980–84 (P = 0.011). The factors strongly associated with reversal were age  < 30 years and being single, divorced or separated at the time of vasectomy. Paternity was achieved after an estimated 53% of vasovasostomies. Successful reversal was more likely if the man was younger at vasectomy and the time elapsed was comparatively short. Compared with vasovasostomies performed in 1980–84, the success rate of those in 1994–96 was almost four times higher.

Conclusion Population rates of vasectomy are stable but the risk of seeking a reversal has increased. Outcomes after vasovasostomy have improved. Care should be taken during the counselling of men before vasectomy, and especially in those aged <30 years.
Retroperitoneoscopic dismembered pyeloplasty for pelvi‐ureteric junction obstruction in infants and children
Authors: Yeung C.K. , Tam Y.H. , Sihoe J.D.Y. , Lee K.H. , Liu K.W.
Published: March 2003

Objective To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi‐ureteric junction (PUJ) obstruction.

Patients and methods Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25–10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi‐prone (for left‐sided) or a semilateral position (for right‐sided PUJ obstruction). The retroperitoneal space was entered via a 1‐cm incision over the mid‐axillary line and further developed using a glove balloon. Video‐retroperitoneoscopy was undertaken using a 5‐mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi‐ureteric anastomosis fashioned using fine polydioxanone sutures over a double‐pigtail ureteric stent.

Results The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103–235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow‐up scan.

Conclusions Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long‐term results await further studies.
Postoperative mortality in patients with liver cirrhosis undergoing transurethral resection of the prostate: a Danish nationwide cohort study
Authors: Nielsen S.S. , Thulstrup A.M. , Lund L. , Vilstrup H. , Sørensen H.T.
Published: March 2003

Objective To examine the risk of 30‐day postoperative mortality from transurethral resection of the prostate (TURP) in patients with liver cirrhosis, who are reportedly at considerably increased perioperative risk.

Patients and methods For the period 1 January 1977 to 31 December 1993, a population‐based cohort was identified comprising Danish patients diagnosed with liver cirrhosis and a random sample of Danes also undergoing TURP. Logistic regression models were used to estimate the association between liver cirrhosis, age, type of admission, comorbidity and 30‐day mortality.

Results In a cohort of 23 133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure. Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 (95% confidence interval 0.4–22.9) for the 30‐day postoperative mortality in patients with liver cirrhosis compared with patients without (mortality 2%). Advanced age, comorbidity and acute admission seemed to be associated with an increased postoperative mortality.

Conclusion This study indicates that TURP in patients with liver cirrhosis was associated with increased mortality.
Bladder reconstruction with autotransplanted ileum in the dog: better functional results than standard enterocystoplasty
Authors: Ueno K. , Yamanaka N. , Kimura K. , Arakawa S. , Kamidono S. , Hara I.
Published: March 2003

Objective To compare, in a dog model, the properties of a reconstructed bladder (peristalsis, histological changes and absorption) using an autotransplanted ileal segment with standard enterocystoplasty.

Materials and methods Female beagle dogs were divided into two groups. In group 1 (autotransplantation, six dogs), a Heineke–Mikulicz‐type pouch was constructed using autotransplanted terminal ileum. The artery and vein of the terminal ileum were anastomosed to the iliac artery and vein, respectively. The pouch was anastomosed to the bladder remnant immediately above the vesical triangle. In group 2 (control, five dogs) the same type of bladder reconstruction using terminal ileum was undertaken but with no vessel anastomosis. Bladder function in these two groups was then compared for peristalsis (by monitoring intravesical pressure), histological changes (by microscopy) and glucose reabsorption (by measuring the amount of glucose remaining in the reconstructed bladder). The mean (range) follow‐up was 11 (7–18) months for group 1 and 9.2 (7–12) months for group 2; the recovery time before examination was 4.6 (2–7) months for group 1 and 4.0 (2–6) months for group 2.

Results In group 1, there were no major complications in five dogs after the procedure and they survived for > 7 months; the autotransplant became necrotic in one dog where the arterial diameter was < 1 mm. In the control group, all five dogs survived for  7 months after surgery. Intestinal peristalsis was inhibited in group 1 but not in group 2. The bladder was oval/spherical in group 1 and elongated in group 2, with a thinner epithelium and fewer goblet cells in the latter. Glucose reabsorption was greater in group 2 than in group 1.

Conclusion Bladder reconstruction using autotransplanted terminal ileum in dogs is technically feasible. For bowel peristalsis and reabsorption of glucose, autotransplanted ileum may have functional advantages over a standard enterocystoplasty.
A quantitative analysis of purinoceptor expression in the bladders of patients with symptomatic outlet obstruction
Authors: O'Reilly B.A. , Kosaka A.H. , Chang T.K. , Ford A.P.D.W. , Popert R. , McMahon S.B.
Published: March 2003

Objective To compare the expression of the seven known P2X receptors in human bladder from male patients with detrusor instability caused by symptomatic bladder outlet obstruction with that from control bladders, using a quantitative reverse transcription‐polymerase chain reaction (RT‐PCR) method.

Patients and methods Real‐time quantitative RT‐PCR provides a system for detecting and analysing RNA. Bladder biopsies were obtained from nine patients undergoing prostate surgery and control biopsies were obtained from eight age‐matched men undergoing routine bladder endoscopy studies, and who were asymptomatic. Total RNA was extracted from each sample and 10 ng of this used for individual PCR reactions. The expression levels of the seven P2X genes in the total RNA were then determined.

Results In the control bladder, P2X1 was by far the predominant purinergic receptor at the RNA level, the remainder consistently present in the order P2X1≫ P2X4 > P2X2 > P2X7 > P2X5≫ P2X3= P2X6=0. Calponin, a smooth muscle‐specific protein, was used as a marker for smooth muscle content. In bladder from symptomatic patients, the P2X1/calponin ratio was greater than that in controls (P = 0.016). There appeared to be no difference in P2X2, but P2X4, P2X5, and P2X7 were all greater in the symptomatic bladder than in the controls, although these differences were not significant.

Conclusion P2X1 is the predominant purinoceptor subtype in the human male bladder, consistent with pharmacological evidence. The amount of P2X1 receptor per smooth muscle cell is greater in the obstructed than in control bladder, suggesting an increase in purinergic function in the unstable bladder arising from bladder outlet obstruction.