bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Magnetic Resonance Imaging in Blunt Renal Parenchymal Trauma
Authors: LEPPÄNIEMI A. K. , KIVISAARI A. O. , HAAPIAINEN R. K. , LEHTONEN T. A.
Published: November 2008

Summary The accuracy of magnetic resonance imaging (MRI) in the evaluation of blunt renal parenchymal trauma was compared with that of contrast‐enhanced computed tomography (CT) and ultrasonography (US) in a prospective study of 12 patients. CT was superior to other methods in identifying and characterising the renal parenchymal lesion, and both CT and US exceeded low field MRI in recognising a perirenal fluid collection. The role of high field MRI in the evaluation of blunt renal trauma requires further study.
Histopathology of Benign Prostatic Hyperplasia after Failure of Hyperthermia Treatment
Authors: SIEGEL Y. I. , ZAIDEL L. , HAMMEL I. , KORCZAK D. , LINDNER A.
Published: November 2008

Summary We have used a fine morphometric method to evaluate hyperplastic prostate tissue after treatment by local hyperthermia and compare it with untreated specimens. Local hyperthermia was delivered to the prostate gland by a transrectal applicator using microwaves at 915 MHz. Prostatic tissue was obtained from 13 patients who had completed a course of local hyperthermia treatment and who underwent prostatectomy 3 to 12 months later because the treatment had failed. Prostatic tissue from 9 patients who had undergone prostatectomy with no previous treatment served as a control. A significant reduction in the volume fraction of fibrous tissue was found in the study group (37%) compared with the general population (48%). No inter‐group difference was observed in the volume fractions of vascular or glandular tissue. We suggest that the difference observed in the fibrous elements may be the reason for the failure of treatment and that the histological composition of the diseased gland may, therefore, be a key factor in determining the outcome.
Thirty‐year Review of Intrascrotal Rhabdomyosarcoma
Authors: STEWART L. H. , LIOE T. F. , JOHNSTON S. R.
Published: November 2008

Summary Between 1957 and 1987,6 cases of intrascrotal rhabdomyosarcoma were found in the pathology records for Northern Ireland. Four of these tumours arose from paratesticular tissue and 2 were confined to the testis. Only 1 patient has died of his disease. Two were lost to follow‐up after 21 years and are presumed cured. The remaining 3 remain alive and disease‐free between 2 and 33 years after presentation.
Megalourethra
Authors: REISSIGL A. , EBERLE J. , BARTSCH G.
Published: November 2008

Megalourethra is a rare congenital anomaly characterised by a failure of development of erectile tissue and subsequent dilatation of the penile urethra. The term was first used by Nesbitt (1955) and since then many of these defects concerning the corpus spongiosum and the corpora cavernosa have been reported (Mortensen et al., 1985; Appel et al., 1986; Aigen et al., 1987).

Concomitant malformations, which are sometimes incompatible with survival, have important implications for therapy and prognosis. Associated anomalies may involve the urinary tract (renal hypoplasia, ureterohydronephrosis, megaureter, megacystis, reflux, bladder diverticula, hypospadias, manifestations of intersex, urethral valves, prune belly syndrome) as well as other organs (teeth, heart, intestines).
Characteristics of Mast Cells in Normal Bladder, Bacterial Cystitis and Interstitial Cystitis
Authors: CHRISTMAS T. J. , RODE J.
Published: November 2008

Summary An analysis was made of the numbers and characteristics of mast cells in lateral bladder wall biopsies from 22 patients with interstitial cystitis, 6 with bacterial cystitis and 8 normal controls, using toluidine blue stains and computerised video image analysis techniques. A significantly greater number of mast cells were found within the detrusor muscle in interstitial cystitis than in bacterial cystitis or normal controls. Within the urothelium and submucosa, mast cell numbers were significantly greater than in normal controls in both interstitial and bacterial cystitis. In interstitial cystitis mast cells were significantly larger within the detrusor than in the urothelium/submucosa and they appeared to degranulate predominantly within the superficial layers. Differential staining techniques, using long and short toluidine blue stains, failed to reveal statistically significant evidence of mast cell heterogeneity within the bladder wall in interstitial cystitis.
Clam Ileocystoplasty
Authors: GEORGE V. K. , RUSSELL G. L. , SHUTT A. , GACHES C. G. C. , ASHKEN M. H.
Published: November 2008

Summary Clam enterocystoplasty has been used successfully in the treatment of refractory urge incontinence. We report 31 patients who underwent ileocystoplasty between 1982 and 1989. The majority of patients were pleased with the outcome of the operation. The main post‐operative complication was voiding dysfunction due to relative bladder outflow obstruction. Urinary tract infection and mucus production were significant long‐term problems.
Seminal White Blood Cells in Men with Urethral Tract Infection. A Monoclonal Antibody Study
Authors: BARRATT C. L. R. , HARRISON P. E. , ROBINSON ANGELA , KESSOPOULOU E. , COOKE I. D.
Published: November 2008

Summary Monoclonal antibodies were used to detect seminal leucocytes in 19 men with urethritis. A wide range in the number and type of leucocytes between individuals was documented (median 2.06 × 106/ml, range 0.6–29.89 × 106/ml); 22% of the men had ≤ 1 × 106 leucocytes/ml. The results suggest that the threshold of ≥ 1 × 106/ml proposed by the World Health Organisation to indicate genital tract infection is unsuitable for men with urethritis.
Informed Consent—Issues for the 1990s
Authors: DUDLEY H. A. F.
Published: November 2008

It is my contention that enough words have already been written on the core matters of informed consent and what is now needed is for the medical mind to focus on some residual but key issues. As with other features of our professional world unless we do so, others are likely to take them over from us, imposing a new interpretation which may ignore or even actively oppose a long tradition of medical understanding and a hard won relationship of trust. I wish to tackle 3 matters: the meaning of “informed”, randomisation in clinical trials, and the use of volunteers in research.
Does Further Extracorporeal Lithotripsy Promote Clearance of Small Residual Fragments?
Authors: PARR N. J. , RITCHIE A. W. S. , SMITH G. , MOUSSA S. A. , TOLLEY D. A.
Published: November 2008

Summary— Small persistent fragments (≤ 4 mm) following extracorporeal shock wave lithotripsy have been termed clinically insignificant residual fragments (CIRF), but their presence may be associated with an increased rate of development of recurrent symtomatic renal calculi. We have adopted a policy of further extracorporeal piezoelectric shock wave lithotripsy (EPL) for patients with CIRF in an attempt to promote complete clearance.

A series of 22 patients with a mean initial stone burden of 16 mm (range 7–48) developed CIRF after a median of 2 EPL treatment sessions (range 1–9). CIRF were in the lower calices (n = 20), middle calices (n = 1) and upper calices (n = 1). These calices were normal (n = 6), slightly dilated (n = 9), moderately dilated (n = 2) or grossly dilated (n = 5). After 6 to 14 months, patients underwent a further session of EPL. One month later, 3 patients with normal calices had become stone‐free, 1 patient with normal calices and 3 with slightly dilated calices showed a considerable reduction in CIRF, but all other patients showed no change.

When CIRF form in normal calices a further session of EPL may promote clearance. However, when calices containing CIRF are significantly dilated, further EPL is of no value.
Bilharzial Vesicoureteric Reflux and Bladder Neck Stenosis: Fact or Fiction ?
Authors: IBRAHIM A. I. A. , PATIL K. P. , TAHIR M. I. EL , SHETTY S. D. , ANANDAN N.
Published: November 2008

Summary— A group of 47 patients with histologically confirmed chronic urinary bilharziasis underwent micturating cystourethrography to look for vesicoureteric reflux (VUR) and bladder neck stenosis (BNS); 13 patients were found to have VUR of varying grades (8 unilateral and 5 bilateral). None had evidence of BNS.

Urinary tract infection (UTI), loin pain, hydroureter and renal failure were compared in patients with and without VUR. Of the 13 patients with reflux, 3 had UTI, loin pain was present in 8, 11 had an ipsilateral hydroureter and 2 presented with renal failure. In the 34 patients without reflux, 8 had UTI, loin pain was present in 22, 30 had hydroureter and 3 presented with renal failure.

It was concluded that the incidence of UTI, loin pain, hydroureter and renal deterioration associated with bilharzial VUR was not significantly different from that found in bilharzial patients without VUR. Thus the clinical significance and the need for surgical correction of isolated VUR in bilharziasis are questionable.
Peri‐operative Blood Transfusion in Relation to Tumour Recurrence and Death after Surgery for Prostatic Cancer
Authors: EICKHOFF J. H. , GOTE H. , BAECK J.
Published: November 2008

Summary—Several reports have suggested that peri‐operative blood transfusion promotes tumour recurrence and death after surgery for cancer. We have studied the effect of transfusion in 156 patients operated on for prostatic cancer. A retrospective review was made of the clinical, histopathological and transfusion data in their hospital records. Sixty patients received blood transfusions and 96 did not. The 5‐year prostatic cancer specific survival rate was 0.56 in the transfused patients and 0.69 in the non‐transfused group. The transfused patients had a higher prevalence of risk factors than did the non‐transfused. When the differences in risk factors were accounted for by Cox regression analysis, peri‐operative blood transfusion reduced the prostatic cancer death intensity by 36%. The study does not support the hypothesis that blood transfusion promotes recurrence following surgery for prostatic cancer.
Traumatic Rupture of the Corpus Cavernosum
Authors: TAN LIA‐BENG , CHIANG CHIN‐PEI , HUANG CHUN‐HSIUNG , CHOU YII‐HER , WANG CHII‐JYE
Published: November 2008

Summary— Twelve patients with fracture of the penis have been treated in this department during the last 18 years. Their mean age was 41.5 years (range 25–55) and two‐thirds of the injuries resulted from coitus. Eleven patients underwent immediate exploration and repair of the tunica albuginea and only 1 still has sexual dysfunction. One patient was treated conservatively and remains impotent. Immediate surgical treatment is recommended, since it avoids the formation of penile plaque, penile fibrosis and angulation and accelerates restoration of normal penile function.
Erectile Response to Visual Erotic Stimuli Before and After Intracavernosal Papaverine, and its Relationship to Nocturnal Penile Tumescence and Psychometric Assessment
Authors: BANCROFT J. , SMITH G. , MUNOZ M. , RONALD P.
Published: November 2008

Summary—Three methods of assessing erectile capacity—nocturnal penile tumescence (NPT), response to visual erotic stimuli (VES) and to intracavernosal papaverine (ICI)—have been assessed in 42 men presenting with erectile dysfunction. There was some overlap but also important differences between the 3 measures.

Subjects were divided into “high” and “low” NPT groups. The “high” group produced greater erectile responses to both VES and ICI. The combination of VES and ICI was the best discriminator of the two NPT groups, and may be of diagnostic value, particularly in younger men, reducing the need for repeated injections and higher doses of papaverine.

In the “low” NPT group, presumed predominantly organic, the ICI response correlated better than the VES response with NPT. In the “high” NPT group, the opposite applied, suggesting that in “psychogenic” cases, response to ICI may be modified by psychological mechanisms which could be of aetiological importance and which deserve further study.

These three methods should be regarded as measuring different aspects of erectile function and not as alternative diagnostic procedures. More research is required before their respective diagnostic values are established.
The Importance of Renal Function in the Interpretation of Diuresis Renography
Authors: BROWN S. C. W. , UPSDELL S. M. , O'REILLY P. H.
Published: November 2008

Interpretation of the diuresis renogram is dependent on a full understanding of the factors that contribute to the washout curve, a major determinant being the urinary flow rate induced by the diuretic. Frusemide‐induced flow rates were measured in 86 patients over a 30‐min period and related to creatinine clearance in 39, 99mTc‐DTPA clearance (glomerular filtration rate (GFR)) in 27, and 123l‐Hippuran clearance (effective renal plasma flow) in 20. The flow rates 3 to 6 min and 15 to 18 min after administration of the diuretic received specific attention because of their importance to F + 20 and F ‐ 15 diuresis renography respectively. The mean urinary flow rate 15 to 18 min after frusemide was 3.5 ml/min greater than at 3 to 6 min (P <0.001), explaining the value of the F ‐ 15 renogram in further evaluating equivocal F + 20 curves. Linear relationships were observed between each parameter of function and the 3 to 6 min and 15 to 18 min periods as follows: creatinine clearance r=0.66, r=0.77; 99mTc‐DTPA clearance r=0.66, r=0.77; 123l‐Hippuran clearance r=0.59, r=0.71. From regression analysis of the data presented it is possible, with knowledge of total and split function, to predict single‐kidney flow rates. It is demonstrated that these may commonly exceed flow rates used for perfusion studies if function is normal, but a single‐kidney flow rate of 10 ml/min is unlikely to be attained if the single‐kidney GFR is less than 15 ml/min.
Intravesical BCG Treatment for Superficial Bladder Cancer: Long‐term Results using Two Different Strains of BCG
Authors: MUKHERJEE A. , PERSAD R. , SMITH P. J. B.
Published: November 2008

A total of 21 patients received intravesical BCG for the prevention of recurrence of superficial transitional cell carcinoma of the bladder. Twelve patients received the Glaxo strain and 9 the Pasteur strain of the bacillus. Although thought to have different anti‐tumour activities owing to a difference in antigenicity, these 2 strains produced similar tumour‐free rates at 5 years' mean follow‐up with an overall tumour‐free rate of 43%.
Deferred Treatment in Clinically Localised Prostatic Carcinoma
Authors: ADOLFSSON J. , CARSTENSEN J. , LÖWHAGEN T.
Published: November 2008

A series of 122 patients with a cytological diagnosis of well or moderately differentiated and clinically localised (T1‐2) prostatic carcinoma were followed up without any initial anti‐tumour therapy. The median observation time was 91 months. During follow‐up the local tumour progressed to stage T3 in 67 patients (55%) and distant metastases developed in 17 (14%); 47 patients died (38%), 9 of them (7%) from prostatic carcinoma. The risk of dying from prostatic carcinoma was 1% after 5 years and 16% after 10 years for patients not dying from other causes.
Prevalence of Upper Urinary Tract Stone Disease in a Rural Community of North‐eastern Thailand
Authors: SRIBOONLUE P. , PRASONGWATANA V. , CHATA K. , TUNGSANGA K.
Published: November 2008

A survey was conducted of upper urinary tract stone (UUTS) disease in an administrative subdivision of Khon Kaen Province in Thailand. Initial case screening was done by direct contact with the village health volunteers and village health communicators. A positive patient was defined as one who had had surgery for UUTS, previously been diagnosed by physicians, or had a history of stone passage. Those who belonged to the latter 2 categories were confirmed radiologically. The prevalence of UUTS was 3.76/1000. The male/female ratio was 2:1. The average age was 50‐13 years (range 8–71). Common associated symptoms were back pain, abdominal pain, painful urination, stone passage and blood‐stained urine; 75% of the patients were from a poor socio‐economic class. The data suggest that UUTS is common in north‐eastern Thailand. Although this is an approximate and, perhaps, an underestimated prevalence, the present method is cost‐effective, efficient and appropriate for conducting community surveys in developing nations.
Long‐term Follow‐up of Patients with Hydronephrosis Treated by Anderson‐Hynes Pyeloplasty
Authors: MIKKELSEN S. S. , RASMUSSEN B. S. , JENSEN T. M. , HANGHØJ‐PETERSEN W. , CHRISTENSEN P. O.
Published: November 2008

Summary— A series of 21 patients with hydronephrosis (mean age 37 years) underwent an Anderson‐Hynes pyeloplasty; a nephrostomy catheter was not used routinely. One patient developed urinary leakage post‐operatively but this ceased following insertion of a ureteric catheter. Assessment was carried out after a mean observation time of 85 months. Clinical examination, laboratory investigations, urography and renography were performed pre‐operatively and at follow‐up. There was no evidence of stones or stenosis in the pelvis. Patients operated upon before the age of 30 years showed improved renal function. All patients had symptoms pre‐operatively but only one had symptoms post‐operatively. It was concluded that the results of surgical intervention in hydronephrosis are excellent, especially in patients aged less than 30 years.
Initial Combination Chemotherapy with Cisplatin, Methotrexate and Vinblastine in Locally Advanced Transitional Cell Carcinoma—Response Rate and Pitfalls
Authors: FOSSÅ S. D. , HARLAND S. J. , KAYE S. B. , RAGHAVAN D. , RUSSELL J. M. , PARMAR M. K. B. , USCINSKA BARBARA M. , WOOD R.
Published: November 2008

Summary— A total of 51 patients with locally advanced transitional cell carcinoma of the bladder were entered into a phase II study to evaluate the effect of initial cisplatin (100 mg/m2, Day 2) combined with methotrexate (30 mg/m2. Days 1 and 8) and vinblastine (4 mg/m2, Days 1 and 8). Of 44 evaluable patients, 25 (57%) achieved an objective response of their primary bladder tumour (complete response (CR): 4 patients; partial response (PR): 21 patients); 30 of the 36 patients with micturition disturbances obtained relief. Toxicity was acceptable, but dose modifications due to haematological or renal toxicity were required in 153 of the 690 drug courses. Non‐protocol dose modifications were performed 45 times.

The experience gained in this trial emphasises the need for improved co‐operation between urologists, radiologists and clinical oncologists in such multicentre phase II studies. Difficulties were observed in adhering to dose modification rules, assessing pre‐treatment tumour size (due to variation in quality of measure and in timing relative to initial transurethral resection (TUR)) and defining response to chemotherapy (due to failure to perform mandatory investigations at the right time). This study also illustrates that the accepted criteria for assessing response in the primary bladder tumour are difficult to apply in practice and that the results of any study using this indicator lesion require caution in their interpretation.
Agglomeration of Calcium Oxalate Monohydrate in Synthetic Urine
Authors: GRASES F. , MASÁROVÁ L. , SÖHNEL O. , COSTA‐BAUZÁ A.
Published: November 2008

Summary— The development of agglomerated particles of calcium oxalate monohydrate (COM) on the semi‐batch precipitation from a synthetic urine carried out at physiological conditions (37°C, pH = 5.5) was studied by optical and electron scanning microscopy. COM agglomerates develop by primary and secondary agglomeration proceeding simultaneously; the latter mechanism is, however, less important than the former. Citrate ions modify slightly the COM crystal shape and inhibit primary agglomeration. Mucin particles serve as a substrate for preferential formation (nucleation) of new COM crystals. The structure of formed agglomerates closely resembles that of a certain type of COM renal calculi. A combination of primary agglomeration of crystals forming stones and nucleation of new crystals on a mucoprotein layer partially covering their surface constitutes the possible mechanism of such stone development. Experimental data support this mechanism.
Management of Impacted Upper Ureteric Calculi: Results of Lithotripsy and Percutaneous Litholapaxy
Authors: SRIVASTAVA A. , AHLAWAT R. , KUMAR A. , KAPOOR R. , BHANDARI M.
Published: November 2008

Summary— Despite the availability of lithotripsy and endourology, clear guidelines on the management of impacted upper ureteric calculi are lacking. In this study, 51 upper ureteric calculi treated with in situ extracorporeal shock wave lithotripsy (ESWL) were classified according to the degree of impaction as indicated by proximal back pressure changes. Patients with mild proximal hydronephrosis (or none at all) had a success rate of 93% but only 35% of those in the impacted group (moderate to severe hydronephrosis) had a successful outcome. A percutaneous antegrade approach to 29 impacted upper ureteric calculi resulted in total clearance in 23 cases; 4 other patients were rendered stone‐free following additional procedures, an overall success rate of 93%. The only complication was a ureteric stricture in 1 patient. We recommend the percutaneous approach in the management of impacted upper ureteric calculi.
Management of Hydatid Cysts of the Urinary Tract
Authors: SHETTY S. D. , AL‐SAIGH A. , IBRAHIM A. I. A. , PATIL K. P. , BHATTACHAN C. L.
Published: November 2008

Summary— Eleven patients with hydatid disease of the urinary tract have been seen in the last 5 years. Seven patients had cysts of the kidneys and 4 had large retrovesical hydatids. Seven of the 8 patients with renal hydatids presented with loin pain and mass. Three patients with renal communicating hydatids also presented with haematuria which was due to passing “grape skin” (hydatid membrane) in the urine. Two patients with retrovesical hydatids had bladder outflow obstruction and 2 had bilateral ureteric obstruction leading to uraemia. Eight of 11 patients had associated hydatids of other organs such as the liver (4 patients), peritoneal cavity (2) and lungs (1). Computed tomography was the most useful and specific investigation. In both renal and pelvic (retrovesical) hydatid cysts, endocystectomy with either partial excision or plication of the ectocyst is the standard treatment. In renal communicating hydatids the options are either nephrectomy (partial or total) or endocystectomy with closure of the communication. The use of cryocone and scolicidal agents is mandatory during surgery.
Vesica Fellea—A New Substitute for the Bladder? An Experimental Study
Authors: GÜÇER T. , ÖZKARDES H.
Published: November 2008

Summary— The urinary bladders of 8 dogs were removed and replaced with their own gallbladders using microvascular anastomoses. Post‐operative assessment included measurement of blood urea nitrogen (BUN) and creatinine (Cr), intravenous urography and histological examination of the autotransplanted gallbladders.

The neobladders proved to be good reservoirs without urinary leakage. Renal function was well preserved in 6 dogs; post‐operative BUN and Cr levels were raised in 2 dogs and the concentrating ability of the kidneys was reduced. The neobladders were perfect histologically.
A 12‐Week Placebo‐controlled Double‐blind Study of Prazosin in the Treatment of Prostatic Obstruction due to Benign Prostatic Hyperplasia
Authors: CHAPPLE C. R. , STOTT M. , ABRAMS P. H. , CHRISTMAS T. J. , MILROY E. J. G.
Published: November 2008

Summary— A series of 93 normotensive patients with benign prostatic hyperplasia and maximum urinary flow rates < 15 ml/s, treated at 2 hospital centres using an identical protocol, was randomly assigned to receive a 12‐week course of treatment with prazosin or placebo in a double‐blind parallel group trial. A total of 75 patients completed the study and were suitable for the final analysis. Prazosin was administered orally in doses of 0.5 mg and then 1 mg twice daily for 4 days and 2 mg twice daily for the remainder of the trial.

Patients on treatment with prazosin exhibited a significantly increased maximum urinary flow rate as compared with placebo, with a significant reduction in maximum voiding detrusor pressure. Prazosin therapy did not produce a significant effect on either frequency or standard parameters of detrusor instability. A double‐blind overall assessment of drug efficacy and tolerance significantly favoured prazosin therapy. A total of 30 patients receiving prazosin and 28 receiving placebo reported varied adverse effects. Eighteen patients were excluded from the final analysis, 10 being withdrawn because of adverse effects, 7 on treatment with prazosin and 3 in the placebo group.

In long‐term usage oral prazosin was well tolerated and appeared to improve obstructed voiding in patients with benign prostatic hyperplasia.
Levels of Prostate Specific Antigen that Predict Skeletal Spread in Prostate Cancer
Authors: PANTELIDES M. L. , BOWMAN S. P. , GEORGE N. J. R.
Published: November 2008

Summary— The ability of serum prostate specific antigen (PSA) and serum acid phosphatase (SAP) to identify skeletal spread was evaluated in untreated patients with prostatic cancer. Twenty patients with scintigraphic evidence of metastatic disease in bone (M 1) at diagnosis were compared with 50 untreated patients in whom scans were repeatedly negative during long‐term surveillance. Using the present laboratory upper limit of normal (ULN) of 3 iu/l, the sensitivity and specificity of SAP for M1 disease were 80 and 86% respectively. Stepwise discriminant analysis demonstrated that SAP was able to stage patients correctly (bone scan positive or negative) with 81% predictive accuracy at an optimum cut‐off limit of 4.6 iu/l. By contrast, whilst PSA (Hybritech) was 100% sensitive for skeletal disease at 10 ng/ml—at the expense of poor (36%) specificity—analysis determined that an optimum cut‐off limit of 58 ng/ml led to 79% predictive accuracy for disease in bone. It was concluded that PSA levels > 58 ng/ml are highly indicative of spread to the skeleton, even in the absence of radiological or scintigraphic evidence of metastases.
Does DNA Flow Cytometry Give Useful Prognostic Information in Renal Parenchymal Adenocarcinoma?
Authors: MASTERS J. R. W. , CAMPLEJOHN R. S. , PARKINSON M. CONSTANCE , WOODHOUSE C. R. J. , O'REILLY SUSAN M.
Published: November 2008

Summary— DNA ploidy and S‐phase fraction (SPF) were measured by flow cytometry on 381 paraffin blocks from 93 unselected primary renal parenchymal adenocarcinomas (RPA). The results were compared with tumour grade and T category and patient survival, with a mean follow‐up of 87 months. Only 21% of the tumours were uniformly diploid and ploidy was heterogeneous in 49% of cases. DNA ploidy and SPF were significantly associated with grade, but not T category of disease. Both flow cytometric parameters were significantly related to survival in a univariate analysis. However, when tumour grade was taken into account, both DNA ploidy and SPF lost their prognostic significance. Thus, neither of these parameters gave prognostic information additional to that provided by tumour grade in unselected cases of primary RPA.
Loss of Sensory Neuropeptides in the Obstructed Human Bladder
Authors: CHAPPLE C. R. , MILNER P. , MOSS H. E. , BURNSTOCK G.
Published: November 2008

Summary—This is the first investigation of alterations in the innervation of the obstructed human bladder by nerves containing neuropeptides. The patient groups studied were those with stable detrusor function, those with unstable detrusor function, and those presenting with acute retention of urine. Specimens of bladder tissue were taken from the lateral wall of the bladder below the peritoneal reflection. A total of 23 patients was studied (control, n = 4; acute retention, n = 5; stable obstruction, n = 5; unstable obstruction, n = 9). Substance P, calcitonin gene‐related peptide and vasoactive intestinal polypeptide levels in the bladder were quantified by immunoassay. The density of innervation of the bladder detrusor by nerves containing these neurotransmitters and by those containing neuropeptide Y and somatostatin was assessed using both semiquantitative and quantitative immunohistochemical techniques.

A reduction in the density of innervation by vasoactive intestinal polypeptide, calcitonin gene‐related peptide, substance P and somatostatin‐immunoreactive but not neuropeptide Y‐immunoreactive nerve fibres was shown in the obstructed bladder. These findings, combined with the significant reduction in substance P content of the obstructed bladder and in particular of the acute retention bladder, indicate that there may be an afferent nerve dysfunction resulting from prostatic bladder outflow obstruction.
Is Indoramin an Effective Alternative to Prostatectomy?
Authors: LLOYD S. N. , McMAHON A. , MULLER W. , BUCKLEY J. F. , DEANE R. F. , KIRK D. , KYLE K. F.
Published: November 2008

Summary— Alpha‐1 ‐adrenergic antagonists are recommended for symptomatic treatment of patients awaiting prostatic surgery. Their efficacy has been confirmed in placebo controlled clinical trials, but to date no comparison of their effects with the results of subsequent prostatectomy has been made.

Fifty‐five patients awaiting prostatectomy were assessed (by symptom scores and peak urinary flow rates) prior to treatment, on indoramin 20 mg bd, and 2 months following prostatectomy. Side effects while taking indoramin were experienced by 36% of patients. Despite an overall improvement in mean symptom scores, 26% of patients with obstructive and 30% of those with irritative symptoms who were assessed while taking indoramin failed to experience any improvement. Of the 31 patients assessed while on indoramin and again following surgery, prostatectomy produced a greater symptomatic relief than indoramin. The increase in peak flow rate following prostatectomy was 11.7 ml/s compared with 3.2 ml/s on indoramin. However, 5 patients preferred to continue taking indoramin rather than proceeding to surgery.

Indoramin is no substitute for prostatectomy. Although some patients might benefit from treatment while awaiting surgery, significant side effects may severely restrict its use for this purpose. The response to indoramin cannot be used as an accurate predictor of response to prostatectomy.
Extracorporeal Shock Wave Lithotripsy of Ureteric Stones with the Modulith SL 20
Authors: RASSWEILER J. , HENKEL T. O. , JOYCE A. D. , KÖHRMANN K. U. , MANNING MARTINA , ALKEN P.
Published: November 2008

Summary A series of 138 patients with ureteric calculi was treated by in situ extracorporeal shock wave lithotripsy (ESWL) during the clinical introduction of the Modulith SL 20. This machine represents a newly developed lithotriptor with an electromagnetic cylinder as shock wave source and a dual localisation system consisting of in‐line ultrasound and an integrated fluoroscope C‐arm. During the first 2 months, 12 patients (phase 1) were treated under ultrasound localisation alone; during the next 5 months, 37 patients (phase 2) were treated using dual imaging modalities with reduced peak pressure (max. 18 kV = 800 bar); during the final 7 months, 89 patients (phase 3) were treated under ultrasonic and fluoroscopic localisation combined with an increased maximal shock wave pressure (20 kV= 1024 bar).

The introduction of fluoroscopic targeting (phases 2 and 3) resulted in satisfactory localisation of calculi in the mid‐ureter, previously limited by use of only coaxial ultrasound. The extension of stone localisation to the whole length of the ureter was associated with a marked decrease in treatment time, reflecting the easy handling of the dual localisation system. The rise in generator voltage (phase 3) improved the disintegration rate from 81% (phase 2) to 85%, whereas the number of impulses remained unchanged. However, the rate of auxiliary procedures following ESWL (adjuvant and curative) was reduced from 33% (phase 2) to 24.5%.

Thus the Modulith SL 20 in its final design enables in situ ESWL to be the treatment of choice for all ureteric calculi, rendering special positioning techniques or multiple treatment unnecessary.
Proteinuria and Enzymuria in Vesicoureteric Reflux
Authors: HANBURY D. C. , CALVIN J.
Published: November 2008

Summary Vesicoureteric reflux is a common abnormality of the urinary tract leading to significant renal morbidity and premature mortality. No reliable non‐invasive method exists for its diagnosis. This study investigated the presence of urinary proteins and enzymes in healthy children and those with reflux. A log normal distribution was found for all analyte/creatinine ratios. Significantly higher tubular protein/creatinine ratios were found in patients with reflux nephropathy. Three enzyme/ creatinine ratios (n‐acetyl‐B‐D‐glucosaminidase, gamma‐glutamyl transferase and lactate dehydrogenase) were higher in children with reflux who had no renal scarring, but the degree of overlap with the normal range was such that it is doubtful whether any will be of use as a urinary marker.
The Treatment of Peyronie's Disease with Tamoxifen
Authors: RALPH D. J. , BROOKS M. D. , BOTTAZZO G. F. , PRYOR J. P.
Published: November 2008

Summary This is a preliminary study of the treatment of 36 patients with Peyronie's disease who received tamoxifen 20 mg twice daily for 3 months.

An improvement occurred in 16 of 20 patients with penile pain, in 11 of 31 patients with an erectile deformity and 12 of 35 patients had a plaque shrinkage of at least 1 cm. Some improvement occurred in 6 of the 8 patients with a histologically confirmed inflammatory infiltrate of the plaque but not in any of the 4 patients without an infiltrate. The inflammatory infiltrate was found in patients in whom the duration of the disease was less than 4 months.
Instillation of Silver Nitrate in the Treatment of Chyluria
Authors: SABNIS R. B. , PUNEKAR S. V. , DESAI R. M. , BRADOO A. M. , BAPAT S. D.
Published: November 2008

SummaryA series of 62 patients with chyluria received instillations of 1% silver nitrate in the renal pelvis over an 8‐year period; 51 patients responded well but 11 showed no response to treatment. Follow‐up ranged from 2 to 7 years.

The treatment was found to be safe, effective and minimally invasive.
Bladder Exstrophy and Anterior Pelvic Osteotomy
Authors: PEROVlC̀ S. , BRDAR R. , ŠČEPANOVlC̀ D.
Published: November 2008

Summary Between August 1988 and December 1991, 36 children with bladder exstrophy underwent surgery for primary bladder reconstruction. Each child was either untreated or had already been treated unsuccessfully. The operative technique involved bilateral osteotomy of the superior ramus of the pubic bone. In infants the cartilaginous ischiopubic junction, acting as an articulation, allowed symphyseal approximation, while in older children this was achieved by fracture of the inferior ramus of the pubic bone. The bladder was either closed or, in most cases, the exstrophic bladder plate was inserted deep into the pelvis, allowing subsequent epithelialisation of the bladder and further formation and growth. Follow‐up up for 3.5 years showed bladder capacities of 40 to 150 ml. Some patients underwent an additional augmentation enterocystoplasty. Primary bladder reconstruction remained uncompromised in 7 patients who developed moderate (and 1 complete) rediastasis of the pubic bones. All exstrophic bladders are reconstructible, particularly in older children.
Results of Surgical Treatment in Children with Bladder Exstrophy
Authors: CSONTAI A. , MERKSZ M. , PIRÓT L. , TÓTH J.
Published: November 2008

Summary A series of 42 children (30 boys and 12 girls) underwent surgery for bladder exstrophy between 1972 and 1989. Primary bladder closure was performed in 11 patients and was successful in 6. Four of these children are about 2 years old and so it is not yet possible to assess their continence. Ureterosigmoidostomy was performed in 35 children, one of whom was converted to cutaneous ureterostomy. Follow‐up ranges from 2 to 20 years (average 9 years 3 months) and 50% of the patients are symptom‐free. The most frequent problems were acidosis and urinary tract dilatation. Other complications, such as hypokalaemia and pyelonephritis, were seldom seen. Although ureterosigmoidostomy has some disadvantages, our patients have adapted well and lead a normal life.
Placebo‐controlled Study of Terazosin in the Treatment of Benign Prostatic Hyperplasia with 2‐Year Follow‐up
Authors: FABRICIUS P. GERHARD , HANNAFORD J. MAC
Published: November 2008

Summary— This randomised, placebo‐controlled, double‐blind study was performed to evaluate the efficacy and safety of once‐a‐day terazosin (10 mg/d) in ambulatory patients (n = 57) with benign prostatic hyperplasia (BPH). After a 4‐week placebo lead‐in and a 24‐week treatment period with terazosin (with both phases being single‐blind), 30 patients who responded to terazosin were randomly assigned to either the terazosin or placebo treatment group for 12 weeks. During the single‐blind treatment period, the peak urine flow rate increased 54% from a baseline average of 7.76 ml/s to 11.92 ml/s after terazosin administration; the mean flow rate increased 55% from a baseline of 4.90 ml/s to 7.59 ml/s; and the residual volume decreased 56% from 93. 1 ml to 40.7 ml. The mean obstructive symptom score, irritative symptom score and physician global assessment score improved by 68%, 34% and 27%, respectively. All these changes were significant when compared with baseline values.

During the double‐blind period, the improvement in all the variables was sustained in the terazosin group but not in the placebo group. Peak and mean urinary flow rates, and physician assessment showed significant differences at the end of the double‐blind period. Adverse events occurred only during the single‐blind period. The most frequently experienced events were headache (n = 6), asthenia (n = 3) and hypotension (n = 3).

A follow‐up study that initially included 12 patients showed no significant loss of improvement in symptoms and no change in urodynamic parameters with the 5 mg terazosin dose at 1 year. At 2 years, the 9 remaining patients showed sustained improvement and no signs of tachyphylaxis.
Terazosin in the Treatment of Benign Prostatic Hyperplasia: A Multicentre, Placebo‐Controlled Trial
Authors: LLOYD S. N. , BUCKLEY J. F. , CHILTON C. P. , IBRAHIM I. , KAISARY A. V. , KIRK D.
Published: November 2008

Summary— The dynamic component of bladder outflow obstruction due to benign prostatic hyperplasia (BPH) has been shown to be modified by alpha, adrenergic receptors. Terazosin is an alpha, receptor‐blocking agent with a long half‐life permitting once‐daily dosing. This drug was administered in a multicentre, randomised, placebo‐controlled trial involving patients with symptomatic bladder outflow obstruction. Of 132 patients recruited for the study, 86 were randomised to receive placebo or terazosin, 81 completed the study, and 80 were considered eligible for efficacy analysis. All terazosin treatment groups showed dramatic improvement in obstructive symptoms when compared with the placebo group, but these differences were not statistically significant because of the small numbers of patients in each group. There were improvements in peak urinary flow rates, mean urinary flow rates, and residual urine volumes for the placebo and terazosin groups, but there were no statistically significant differences in the changes between the groups. Terazosin was well tolerated by patients in this study and may provide symptomatic relief in patients with BPH.
Management of Stage C Adenocarcinoma of the Prostate
Authors: LYNCH J. H. , GRAHAM C. W.
Published: November 2008

Summary— A review of numerous clinical series dealing with the treatment of patients with clinical stage C prostate cancer failed to find the treatment or a combination of treatments that is superior to any other. Accurate staging, which was difficult in older studies, and stage migration, which complicates the comparison of recent to older studies, may contribute to this lack of identification. The majority of patients ultimately experience disease progression and are therefore treated with hormonal therapy, the use of which obscures survival data for initial modes of treatment. These observations point to the need for control of randomised clinical trials to identify effective treatments in the future.
Electromyographic Abnormalities in the Urethral and Anal Sphincters of Women with Idiopathic Retention of Urine
Authors: WEBB R. J. , FAWCETT P. R. W. , NEAL D. E.
Published: November 2008

Summary— Previous concentric needle studies of the urethral sphincter in women with idiopathic urinary retention have found evidence of denervation and reinnervation as well as abnormal patterns of muscle fibre discharge—complex repetitive discharges (CRDs). In order to test the hypothesis that these abnormalities represented a more widespread disease process of pelvic floor function, we carried out an electromyographic (EMG) study of both anal and urethral sphincters in 18 women with idiopathic urinary retention.

The urethral sphincter EMG was abnormal in 15 patients. These abnormalities included polyphasic and long duration potentials. Complex repetitive discharges were identified in 8 women. However, abnormalities of the anal sphincter were found in 14 of the 15 patients with abnormal urethral sphincter EMGs, polyphasic and abnormally long duration potentials being found in the anal sphincters of all 14 patients. In addition, 7 of the 8 women who had complex repetitive discharges in the urethral sphincters had similar complex repetitive discharges in their anal sphincters. Women with complex repetitive discharges had a significantly greater proportion of abnormal potentials than women with no such repetitive discharges.

These results support the previous findings of electromyographic urethral sphincter abnormalities in women with idiopathic urinary retention, but also suggest that these abnormalities reflect a widespread disease process involving the pelvic floor in such patients.
Urinary Flow Rates in Patients with Benign Prostatic Hypertrophy following Treatment with Alfuzosin
Authors: TEILLAC P. , DELAUCHE‐CAVALLIER M. C. , Group P. ATTALI and the DUALF
Published: November 2008

Summary—In order to document further the onset of action of alfuzosin, a selective alpha‐1 blocker, 93 symptomatic patients with benign prostatic hypertrophy were randomly allocated to a single oral dose of either alfuzosin 1.25 mg or 2.5 mg, or placebo, after a 1‐week placebo lead‐in period. The effects on flow rates were assessed 1 h 30 min after administration. Peak and mean flow rates were significantly increased in the alfuzosin groups, as compared with placebo, in a dose‐dependent manner. After a single intake of placebo, the mean values of these 2 parameters showed little change. The effect on the cardiovascular system (heart rate and blood pressure) was mild. This study indicates that the action of alfuzosin is already present 1 h 30 min after administration.
Treatment of Hydrocele: Randomised Prospective Study of Simple Aspiration and Sclerotherapy with Tetracycline
Authors: BREDA G. , GIUNTA A. , GHERARDI L. , XAUSA D. , SILVESTRE P. , TAMAI A.
Published: November 2008

Summary— Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non‐randomised studies are, therefore, not confirmed.
Decontamination of Urological Equipment: Interim Report of a Working Group of the Standing Committee on Urological Instruments of the British Association of Urological Surgeons
Authors: COOKE R. P. D. , FENELEY R. C. L. , AYLIFFE G. , LAWRENCE W. T. , EMMERSON A. M. , GREENGRASS S. M.
Published: November 2008

Infections following cystoscopy are rare and often asymptomatic (Richards and Bastable, 1977; Manson, 1988; Clark and Higgs, 1990). However, outbreaks may occur if instruments are either poorly decontaminated or have been previously damaged. Many urologists now perform flexible fibreoptic cystoscopy on an out‐patient basis. In such endoscopy units, infection control measures must include the prevention of transmission of blood borne infections such as hepatitis B virus (HBV) and human immunodeficiency virus (HIV) due to the risk of blood contamination of urine and should be implemented in all cases regardless of patient risk factors (UK Health Departments, 1990). In hospitals that classify patients into low and high risk groups, medical staff may fail to recognise a number of significant risk factors (Parry et al., 1991). Though to date there have been only 2 reports of viral (HBV) transmission following endoscopy (both gastrointestinal) (Birnie et al., 1983; Gorse and Messner, 1991), the potential risk for cross‐infection remains. Thus the appropriate decontamination of fibreoptic endoscopes continues to be an extremely important issue.
Ultrastructural Observations on Cystitis Cystica in Human Bladder Urothelium
Authors: JOST S. P. , DIXON J. S. , GOSLING J. A.
Published: November 2008

Summary Cystitis cystica, a common urothelial pathology whose aetiology, morphology and clinical significance are poorly understood, affects the human urinary bladder and trigone in both sexes. We have studied the fine structure of urothelial cysts in 11 patients diagnosed cystoscopically as suffering from cystitis cystica. Several abnormal features were observed in the adjacent urothelium, including large intracellular vacuoles (4 patients), Brunn's nest (5), lymphocyte infiltration (10) and generally disorganised urothelial architecture (10). Squamous metaplasia was observed in one case.

The wall of each cyst consisted of a 2–3 layered epithelium with either tall columnar or flattened cells lining the fluid‐filled lumen. Both types of lining cell possessed short microvilli, while the columnar type also contained numerous membrane‐bound, electron dense secretory granules in the apical cytoplasm. Rough endoplasmic reticulum, mitochondria and Golgi membranes were plentiful in the surface cells. Junctional complexes joined adjacent lining cells. The deeper cells contained relatively fewer organelles, while a basal lamina separated the cyst wall from the underlying connective tissue.
Bladder Neck Mobility Evaluated by Vaginal Ultrasonography
Authors: MOURITSEN L. , RASMUSSEN ANNLISE
Published: November 2008

Summary— Factors involved in monitoring bladder neck mobility were studied by means of vaginal ultrasonography. Thirty‐three continent, 28 incontinent and 39 patients who had undergone surgery for incontinence were examined in the supine and sitting positions during rest, the Valsalva manoeuvre and withholding urine.

Bladder neck mobility can be described as a semicircular movement with the tip of the symphysis pubis as the centre and a line from the tip to the bladder neck as the radius (BS). Movement can be measured by 2 independent factors: BS distance and size of the angle between the BS line and the midline of the symphysis, at rest, during the Valsalva manoeuvre and withholding urine.

The continent controls were characterised by a 90° angle at rest, a long BS (2.4 cm) and a fixed bladder neck. The incontinent patients had a shorter BS (2.1 cm), angles at rest of approximately 100°—the angle increased with the grade of incontinence—and a mobile bladder neck.

If 2 of the 3 criteria (angle at rest ≥ 95°, BS ≤ 2.3 cm and mobility ≥ 20°) are regarded as diagnostic of incontinence, diagnostic sensitivity was 84% and specificity 82%.

In the surgical group, patients who failed to respond to treatment had a shorter BS, larger angles and greater bladder neck mobility than their successfully treated counterparts.