bluuebunny/crossref_metadata_2025 huggingface dataset:
Treating men with predominantly nonpsychogenic erectile dysfunction with intracavernosal vasoactive intestinal polypeptide and phentolamine mesylate in a novel
Authors: Dinsmore  , Gingell  , Hackett  , Kell  , Savage  , Oakes  , Frentz
Published: March 2003

Objective

To study the effect of intracorporeal injection (IC) of vasoactive intestinal polypeptide (VIP) and phentolamine mesylate (PM) on men with erectile dysfunction (ED) of nonpsychogenic aetiology.

Patients and methods

The study comprised 236 men with primarily nonpsychogenic ED attending sexual dysfunction clinics at eight institutions. In an initial dose‐assessment phase, the men were given IC injections of 25 μg VIP combined with PM 1.0 mg (VIP/P‐1) or 2.0 mg (VIP/P‐2) in a prefilled, single‐use auto‐injector. The main aetiologies of ED were arteriogenic (38), diabetes mellitus (DM) (39), neurogenic (35), mixed (90), and venous leakage (30). In a placebo‐controlled phase, 171 patients were subsequently treated and self‐administered up to 12 injections over a 6‐month interval.

Results

In the dose‐assessment phase there was an overall response rate of 82%, with responses by aetiology as follows: arteriogenic (82%), DM (85%), neurogenic (86%), mixed (80%), and venous leakage (77%). In a subgroup of 159 patients who withdrew from previous IC therapies for ED, 64% responded with an erection suitable for intercourse. Of the 171 patients treated in the placebo‐controlled phase, 75% responded to VIP/P‐1 and 12% to placebo (P<0.001); 66% responded to VIP/P‐2 and 18% to placebo (P<0.001), with a median duration of erection of 56 min. The principal adverse event was transient facial flushing accompanying 40% of 1711 injections. There was no pain after injection and one episode of priapism (0.06%); only seven patients withdrew because of adverse events. Over 88% and 92% of patients were satisfied with the drug and auto‐injector, respectively. More than 85% of patients and 77% of partners reported an improved quality of life.

Conclusion

The combination of VIP and PM at the dose used is a safe and effective means of treating male ED of primarily nonpsychogenic aetiology.
Prostate specific antigen is detectable in formalin‐fixed semen
Authors: Eyre  , Yin  , Kiessling
Published: March 2003

Objective

To conduct a pilot study to test whether or not prostate specific antigen (PSA) and/or PSA‐positive cells can be detected and characterized in semen specimens archived in aldehyde fixative.

Materials and methods

Specimens from 12 men were examined, six before elective vasectomy and six undergoing infertility evaluation. Fixed semen elements were assessed immunocytologically using monoclonal antibodies against PSA and leucocyte common antigen, CD 45, as a control.

Results

PSA was detectable in the semen from the fertile men as amorphous protein and contained within round vesicles (prostasomes). Semen from men undergoing infertility evaluation contained a greater variation in detectable forms and amount of PSA than the specimens from the fertile men, including PSA associated with some nonspermatozoal cells (NSCs).

Conclusion

PSA is detectable by immunocytological analysis of semen specimens archived in aldehyde‐based fixative. Three forms of PSA were detected; within round vesicles characteristic of prostasomes, associated with some NSCs, and as amorphous protein. The detected variations suggest that analysis of PSA‐positive semen elements may provide important insights into prostate physiology.
Monocyte tissue factor levels in patients with urological tumours: an association between tumour presence and progression
Authors: Lwaleed  , Francis  , Chisholm
Published: March 2003

Objective

To examine the hypothesis that increased monocyte tissue factor (mTF) levels may reflect urological tumour presence and progression.

Patients, subjects and methods

Using a two‐stage kinetic chromogenic assay, mTF levels were measured in 60 controls (normal subjects [60] and patients awaiting hernia repair or cholecystectomy [60]), patients with benign and malignant disease of the bladder (73), or prostate (81), and in patients with and without recurrent malignant disease of the bladder (30). The levels were assessed under fresh resting conditions (baseline) and after incubation for 6 h without (unstimulated) and with (stimulated) Escherichia coli endotoxin. Each benign disease group was subdivided into inflammatory and non‐inflammatory categories.

Results

Patients with bladder and prostate malignancy showed significantly higher mTF levels than did each control for baseline and stimulated cells. The benign inflammatory groups for both organs had significantly higher mTF levels than had each control for baseline cells. There was no difference between malignant and benign inflammatory groups. Stimulated mTF levels showed better discrimination between the study groups. The mTF levels were associated with histological tumour progression, serum prostate specific antigen level and static bone scan images. Levels were also higher in patients with bladder cancer recurrence than in those with a normal check cystoscopy.

Conclusion

Stimulated mTF levels are raised in malignant and inflammatory disease compared with controls and patients with non‐inflammatory conditions, and give maximal discrimination between these groups. mTF levels showed an association with tumour grade and other markers of tumour progression.
A new staging criterion for bladder carcinoma using gadolinium‐enhanced magnetic resonance imaging with an endorectal surface coil: a comparison with ultrasonography
Authors: Hayashi N. , Tochigi H. , Shiraishi T. , Takeda K. , Kawamura J.
Published: March 2003

ObjectiveTo evaluate the accuracy of a new staging criterion, submucosal linear enhancement (SLE) on gadolinium‐diethylenetriamine‐pentaacetic acid‐enhanced T1‐weighted magnetic resonance imaging (MRI) using an endorectal surface coil (endorectal enhanced MRI), and to compare the accuracy of this method with that of transurethral ultrasonography (TUUS).

Patients and methodsThe study included 71 patients with bladder tumours (63 men and eight women, mean age 65.5 years, range 31–85). The SLE coincided with abundant submucosal vascular beds, as reported in a previous study. When the SLE beneath the tumour maintained continuity, the tumour was diagnosed as superficial ( T1), but if the SLE was interrupted by the tumour, the disease was considered invasive ( T2a). Superficial muscle invasion (less than half the muscle layer) and deep muscle invasion (more than half the muscle layer) were classified as T2a and T2b, respectively. When the tumour formed an extravesical mass, the tumour was classified as T3b.

ResultsThe staging accuracy for bladder tumours using SLE on endorectal‐enhanced MRI or TUUS was 83% and 60%, respectively (P < 0.01). Using the SLE, muscle invasion of bladder tumour was diagnosed with an accuracy of 87%, a sensitivity of 91% and a specificity of 87%; this was significantly better than with TUUS (P < 0.01).

ConclusionThe criterion of SLE on Gd‐DTPA enhanced T1‐weighted MRI using an endorectal surface coil is useful for staging bladder tumour, and the staging accuracy is significantly better than with TUUS.
Evaluation of fine‐needle aspiration cytology for renal masses
Authors: Brierly R.D. , Thomas P.J. , Harrison N.W. , Fletcher M.S. , Nawrocki J.D. , Ashton‐key M.
Published: March 2003

Objective To evaluate the accuracy and use of fine‐needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, par‐ticularly small (< 5 cm) tumours, are being discovered more frequently.

Patients and methods Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42–88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (< 5 cm and  5 cm). Patients were followed up to the determination of a final diagnosis on tissue histology, after nephrectomy where possible.

Results Thirty‐six patients had histologically confirmed carcinoma at nephrectomy, and nine had presumed carcinoma (four unfit for surgery, five with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insufficient sample in eight cases (16%). The sensitivity was 89% for large ( 5 cm) solid masses, 64% for small (< 5 cm) solid masses and 50% for complex cysts.

Conclusion FNA does not contribute to the diagnosis of malignancy in large (> 5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (< 5 cm) masses and complex cysts, FNA can occasionally confirm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.
The correlation between clinical outcome and residual prostatic weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia
Authors: Chen S.‐S. , Hong J.‐G. , Hsiao Y.‐J. , Chang L.S.
Published: March 2003

ObjectiveTo assess in a prospective study the use of a new variable, the residual prostatic weight ratio (RPWR), for evaluating the clinical outcome after transurethral resection of the prostate (TURP).

Patients and methodsFrom April 1996 to June 1997, 40 men (mean age 70.4 years, range 53–85) with symptomatic benign prostatic hyperplasia were evaluated using the American Urological Association (AUA) symptom score, measurements of the mean and maximum urinary flow rate (Qave and Qmax), and by transrectal ultrasonography (TRUS) before and 16 weeks after TURP. The estimated total prostate weight was derived as 0.52 × length × width × height × the specific gravity of the prostate (1.010). The RPWR was calculated as the prostate weight after TURP divided by the initial weight, where the value after TURP was the initial weight minus that of the TURP specimen. The clinical outcome was evaluated by the difference (Δ) in AUA score, Qmax and Qave before and 16 weeks after surgery.

ResultsThere was a close correlation between the estimated prostate weight and the actual weight of the TURP specimen (r = 0.82 and 0.80 for the adenoma and total prostate, respectively). The mean (sd) RPWR, ΔAUA score, ΔQmax and ΔQave were 50.1 (17.1)%, 11.5 (5.3), 9.0 (4.2) mL/s and 6.2 (2.9) mL/s, respectively. There was a negative correlation between the RPWR and the ΔAUA, ΔQmax and ΔQave (r = −0.81, −0.68, and −0.70, respectively, P < 0.05). The prostate volume estimated by TRUS decreased significantly 16 weeks after TURP.

ConclusionsTRUS is a useful tool for estimating prostate weight before surgery. The smaller the RPWR at 16 weeks after TURP, the better the clinical outcome.
Early experience of intra‐ureteric capsaicin infusion in loin pain haematuria syndrome
Authors: Armstrong T. , Mclean A.D. , Hayes M. , Morgans B.T. , Tulloch D.N.
Published: March 2003

Objectives To evaluate early results of the intra‐ureteric instillation of capsaicin for the treatment of loin pain haematuria syndrome (LPHS).

Patients and methods Ten patients with LPHS were treated using intra‐ureteric capsaicin instillation. A solution of capsaicin was infused into the affected ureter through an embolectomy catheter, under anaesthesia. The success of the treatment was assessed using patient questionnaires and the quantitative reduction in the patients’ analgesic requirements measured.

Results During a mean follow‐up of 6 months, six of the 10 patients had short‐ to medium‐term symptomatic relief after one or more treatments; four had no relief from their symptoms. One patient had a mucosal ulceration in the bladder after extravasation of the capsaicin solution. Two patients subsequently underwent simple nephrectomy for symptomatic nonfunctioning kidneys.

Conclusion These results are consistent with other preliminary reports of the efficacy of capsaicin treatment in LPHS and such treatment therefore has a definite therapeutic role in this difficult condition. We are uncertain if the treatment contributed to the deterioration of the excised kidneys. This early experience suggests a need for careful consideration when contemplating this treatment, with attention directed to both the initial diagnosis and possibly the technique of capsaicin/instillation. We include a protocol to follow when preparing patients for capsaicin treatment.
An in vitro assessment of the flow characteristics of spiral‐ridged and smooth‐walled JJ ureteric stents
Authors: Stoller M.L. , Schwartz B.F. , Frigstad J.R. , Norris L. , Park J.B. , Magliochetti M.J.
Published: March 2003

Objective To assess drainage through spiral‐ridged and smooth‐walled JJ ureteric stents (designed to ensure upper tract drainage) and thus determine whether drainage preferentially occurs around rather than through the spiral‐ridged stent, promoting renal flow and potentially facilitating the passage of urinary stone fragments.

Materials and methods A mechanical ureteric model was constructed to mimic the funnel characteristics of the renal pelvis. A motor pump was used to help simulate respiratory and skeletal movement, resulting in differential motion between the intraluminal stent and the surrounding ureteric wall. Tubes of varying internal diameters were used to simulate different sizes of ureter. Flow rates of standard 7 F smooth‐walled stents were compared with 7 F spiral‐ridged stents with and without occluded lumens, and with and without standardized excursions.

Results Extraluminal flow (mean rates) with and without movements simulating respiratory excursions were significantly higher with the spiral stent for all stent diameters evaluated. All flow rates increased as the ureteric diameter increased. Total flow past the spiral stent was significantly greater than flow with the smooth‐walled stent under all conditions tested. Flows measured around the spiral stent under conditions of excursion were the highest of all categories, 20‐fold higher than in smooth‐walled, closed, stationary stents.

Conclusion Spiral‐ridged JJ stents provided substantially greater flow in this in vitro model. Extraluminal flow was markedly increased with the spiral‐ridged configuration. The difference in flow rates was more pronounced at the smaller pseudo‐ureteric tube diameters, simulating dimensions found in clinical practice. The flow rate also was increased when the central lumen remained open, and was greater still when there was dynamic excursion with respiratory movements.
Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis
Authors: Leissner J. , Hohenfellner R. , Thüroff J.W. , Wolf H.K.
Published: March 2003

Objective  To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma.

Patients and methods  The pelvic lymph nodes from 447 patients (mean age 62.8 years) who underwent radical cystectomy between 1986 and 1997 were evaluated. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes.

Results
 The clinical follow‐up was available for 302 patients (mean follow‐up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1–46). The number of lymph nodes removed varied significantly among different surgeons but not among pathologists. In pT3 and pT4 tumours, a more extended lymphadenectomy ( 16 lymph nodes) correlated with a higher percentage of patients with documented nodal metastases. There was a significant correlation between the number of lymph nodes removed and the tumour‐free 5‐year survival in patients with pT1, pT2 or pT3 tumours, and in patients with 1–5 positive lymph nodes (P < 0.01).

Conclusion  Extensive lymphadenectomy significantly improves the prognosis of patients with invasive bladder cancer and represents a potentially curative procedure in patients with nodal metastases, including micrometastases that may escape detection during routine histopathological evaluation. The results indicate the need for a standardized lymph node dissection.
Monitoring of renal function in patients with spinal cord injury
Authors: Macdiarmid S.A. , McIntyre W.J. , Anthony A. , Bailey R.R. , Turner J.G. , Arnold E.P.
Published: March 2003

Objective To assess the sensitivity of serum creatinine level in detecting clinically important and early deterioration of renal function in patients with spinal cord injury (SCI), and to evaluate the optimal method of determining creatinine clearance in these patients.

Patients and methods The serum creatinine level of 36 patients (25 paraplegics and 11 quadriplegics) was evaluated and compared with the corresponding measured creatinine clearance rate. Correlations were also assessed between the creatinine clearance measured by 24‐h endogenous clearance, single‐shot 99mTc‐labelled diethylenetriamine pentaacetic acid (99mTc‐DTPA) clearance technique, and the Cockcroft–Gault formula, to test their validity.

Results Of the 36 patients 11 (31%) had a measured creatinine clearance of < 100 mL/min (mean 84.8) and a corresponding normal serum creatinine level. Creatinine clearance calculated by the Cockcroft–Gault formula did not correlate well with that measured by the 24‐h endogenous clearance (r = 0.426) and 99mTc‐DTPA clearance (r = 0.366), overestimating creatinine clearance in all but three patients. The mean (sd) difference between the creatinine clearance measured by the 24‐h and DTPA clearance technique was 17.7 (16.5)% and the correlation between these techniques was good (r = 0.71).

Conclusion Serum creatinine level is not sensitive in detecting early deterioration of renal function in patients with SCI. The Cockcroft–Gault formula generally significantly overestimates the true creatinine clearance and is not recommended. The 24‐h endogenous creatinine clearance measured on appropriately collected urine samples is an acceptable accurate and practical method of determining glomerular filtration rate in patients with SCI.
Prognostic significance of p27Kip1 and Ki‐67 expression in carcinoma of the renal pelvis and ureter
Authors: Kamai T. , Takagi K. , Asami H. , Ito Y. , Arai K. , Yoshida K.‐I.
Published: March 2003

Objective To determine the significance of p27Kip1 (p27) for tumour behaviour and prognosis of patients with transitional cell carcinoma (TCC) of the renal pelvis and ureter.

Patients and methods Using immunohistochemical staining, the relationship was evaluated between p27 protein level (low  < 50%, high > 50%) and the Ki‐67 labelling index (low  < 30%, high > 30%) and clinicopathological features of 37 consecutive Japanese patients with TCC of the renal pelvis and ureter.

Results Low levels of p27 correlated with higher tumour stage (P < 0.05) and positive lymph node metastases (P < 0.05). There was no significant association between p27 staining and the grade and tumour proliferation as assessed by the Ki‐67 index. A high Ki‐67 index correlated with higher grade and stage (P < 0.05). Kaplan‐Meier plots of survival rate in patients with low or high p27 staining showed that low levels correlated with a shorter disease‐free and overall survival (P < 0.001 and P < 0.01, respectively). Similarly, patients with a high Ki‐67 index had lower disease‐free and overall survival than those with a low Ki‐67 index (P < 0.01 and P < 0.05, respectively). The Cox proportional hazards model showed that a low level of p27 was an independent predictor of a shorter disease‐free (P < 0.01) and overall survival (P < 0.05) on univariate analysis, but not of overall survival on multivariate analysis. A high Ki‐67 index was an independent prognostic marker for shorter disease‐free survival on univariate and multivariate analysis (P < 0.01) and for overall survival on multivariate analysis (P < 0.05). In those with a high Ki‐67 index, increased p27 staining was associated with a better prognosis than decreased staining for disease‐free and overall survival (log‐rank test, P < 0.01 and P < 0.05, respectively).

Conclusions The finding that a low level of p27 is associated with tumour invasion and unfavourable prognosis indicates that p27 may be a useful prognostic marker for survival in upper urinary tract cancer.
Couch or crouch? Examining the prostate: a randomized study comparing the knee‐elbow and the left‐lateral position
Authors: Frank J. , Thomas K. , Oliver S. , Andrews S. , Choong S. , Taylor R. , Emberton M.
Published: March 2003

Objective To compare two methods of examining the prostate, the knee‐elbow (KE) and left‐lateral (LL) positions, to establish which allows a more complete examination, and to determine if there is any difference in patients' perception of pain or embarrassment for either method.

Patients and methods All men attending two urology clinics who required a prostate examination were eligible for the study. Both the KE and LL methods were used for each participant, by the same clinician. The order in which the examinations were conducted was randomized using the last digit of the patient's hospital number.

Results Five clinicians examined 117 men; three patients refused to participate and the examination data were incomplete for two. Irrespective of the order in which the examinations were conducted (P = 0.6), the KE position permitted a greater proportion of the prostate to be palpated (Wilcoxon signed‐ranks test, z = − 4.7, P < 0.001) in 35% of patients, but there was no difference in 60%. Most patients found the examinations equally painful and embarrassing. However, for those who expressed a difference, the KE was 1.9 times more comfortable than the LL position and twice as embarrassing.

Conclusion The two methods of prostate examination were equal for completeness of examination, pain and embarrassment in most patients. However, the KE offers an alternative to the LL position for those patients in whom the prostate is difficult to palpate or who find the examination painful.
Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage
Authors: Gordon I.
Published: March 2003

Objective To present an explanation for impaired drainage on diuretic renography in infants with a prenatal diagnosis of unilateral renal pelvic dilatation (RPD) who are stable both in terms of renal function and dilatation on follow‐up investigations, despite undergoing no surgical intervention, and who undergo diuretic renography postnatally; this should provide some insight into whether impaired drainage is a sign of obstruction in these asymptomatic infants.

Materials and methods Using a combination of published studies on the technique of diuretic renography and an analysis of such studies, a theoretical model of the infant kidney was developed to assess the possibility of prolonged drainage.

Results The results from the model showed prolonged drainage in many different situations, thus offering an explanation of expected impaired drainage even if there was no obstruction.

Conclusion Understanding the pathophysiology of prenatally diagnosed RPD allows different interpretations of the diuretic renogram and may affect the treatment of these children.
The effects of physiotherapy for female urinary incontinence: individual compared with group treatment
Authors: Janssen C.C.M. , Lagro‐Janssen A.L.M. , Felling A.J.A.
Published: March 2003

Objectives To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP).

Patients and methods The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic floor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated.

Results There were no significant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% confidence interval, CI) frequency of urine loss decreased, by −8.7 (− 6.4 to −11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by – 8.4 ( − 6.8 to − 10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by −11.2 (4 to − 26.4) and after group therapy by −14 (− 9.1 to −18.9) times/month. All improvements persisted in full for up to 9 months.

Conclusion Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to benefit from therapy.
The interaction of nitric oxide and prostaglandins in the control of corporal smooth muscle tone: evidence for production of a cyclooxygenase‐derived endothelium‐contracting factor
Authors: Minhas S. , Cartledge J.J. , Eardley I. , Joyce A.D. , Morrison J.F.B.
Published: March 2003

Objective To investigate the interaction of endothelium‐derived nitric oxide (NO) and prostaglandins (PGs) in regulating corporal smooth muscle tone in vitro.

Materials and methods Strips of rabbit corpus cavernosum were mounted in organ chambers for the measurement of isometric tension. Strips were submaximally contracted with noradrenaline and concentration‐response curves (CRCs) to acetylcholine (ACh) were constructed before and after treatment with 5 µmol/L atropine, 20 µmol of the cyclooxygenase inhibitor indomethacin and 10 µmol of the PGH2/thromboxane A2 receptor antagonist SQ29548. The NO synthase (NOS) inhibitors L‐NG‐monomethyl arginine (L‐NMMA) and L‐NG‐nitroarginine (L‐NOARG) were added to strips at tonic tension in the presence and absence of indomethacin, and after this CRCs to ACh were constructed.

Results The addition of ACh to strips produced a concentration‐dependent relaxation which was inhibited by atropine. Indomethacin, but not SQ29548, significantly increased relaxation to ACh. Relaxation to ACh was impaired by L‐NMMA, but adding ACh to strips treated with L‐NOARG resulted in contractile responses, whilst both effects were reversed by indomethacin. L‐NMMA and L‐NOARG led to increases in tonic tone which were unaffected by indomethacin.

Conclusions In rabbit corpus cavernosum there is a tonic release of NO which does not appear to be inhibited by a vasoconstrictor prostanoid. Endothelium‐dependent relaxation to ACh results in the dual production of NO and a cyclooxygenase‐derived endothelium contracting factor which acts in opposition to NO; this factor is unlikely to act on PGH2/TXA2 receptors.
Inducible nitric oxide synthase expression in benign prostatic hyperplasia, low‐ and high‐grade prostatic intraepithelial neoplasia and prostatic carcinoma
Authors: Baltaci S. , Orhan D. , Gögüs Ç. , Türkölmez K. , Tulunay Ö. , Gögüs O.
Published: March 2003

Objective To elucidate the incidence of inducible nitric oxide synthase (iNOS) expression in benign prostatic hyperplasia (BPH), low‐ and high‐grade prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma lesions, and to explore the role of iNOS in prostate tumorigenesis.

Materials and methods Immunoreactivity for iNOS was examined in 20 samples each of BPH, high‐grade PIN, low‐grade PIN and prostatic carcinoma.

Results Positive iNOS immunostaining was detected in all samples from all patients; iNOS was detected in both basal epithelial cells and secretory cells of the glandular epithelium. High‐grade PIN and prostatic carcinoma samples had more intense iNOS immunostaining than low‐grade PIN and BPH samples. In all samples, smooth muscle cells showed weak or moderate iNOS immunoreactivity and endothelial cells showed moderate immunostaining.

Conclusions Nitric oxide generated by iNOS may be involved in prostate tumorigenesis and further studies with immunohistochemical and molecular biology are needed to determine the exact role of iNOS in the pathogenesis of prostatic carcinoma.
Colour Doppler ultrasonography of female urethral vascularization in normal young volunteers: a preliminary report
Authors: Siracusano S. , Bertolotto M. , D'Aloia G. , Silvestre G. , Stener S.
Published: March 2003

Objective To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography.

Subjects and methods Eleven healthy young women volunteers (mean age 33.6 years, range 24–46) with no pelvic floor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4–7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow flows in the anterior and posterior distal, middle and proximal urethra. A rank‐sum nonparametric test was used to assess differences between the resistive indices.

Results The statistical evaluation showed a significant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P = 0.002) and oestrogenic (P = 0.0127) phases.

Conclusions This study confirmed that the vascularization of the urethra plays an important role in the ‘seal’ effect, which is considered one of the most important factors in urethral closure. There was a significantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These findings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.
Acetyl‐l‐carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report
Authors: Biagiotti G. , Cavallini G.
Published: March 2003

Objective To detect whether oral acetyl‐l‐carnitine might be useful in the acute and early chronic phases of Peyronie's disease, compared with tamoxifen, a drug currently in use.

Patients and methods The study included 48 patients with Peyronie's disease (15 acute and 33 initial chronic), randomized equally into two groups. The first group used tamoxifen 20 mg twice daily for 3 months and the second acetyl‐l‐carnitine 1 g twice daily for 3 months. The disease and stages were diagnosed and identified using a history, objective examination, pharmacologically induced erection, autophotography during erection, and basic and dynamic colour Doppler ultrasonography. Penile curvature, plaque size, pain and disease progression were assessed. The differences between the groups or between the variables before and after therapy were compared using analysis of variance or the chi‐squared test.

Results Acetyl‐l‐carnitine was significantly more effective than tamoxifen in reducing pain and in inhibiting disease progression. Acetyl‐l‐carnitine reduced penile curvature significantly, while tamoxifen did not; both drugs significantly reduced plaque size. Tamoxifen induced significantly more side‐effects than acetyl‐l‐carnitine.

Conclusions These results suggest that acetyl‐l‐carnitine is significantly more effective and safe than tamoxifen in the therapy of acute and early chronic Peyronie's disease.
Cystometric evaluation of reconstructed classical bladder exstrophy
Authors: Dave S. , Grover V.P. , Agarwala S. , Mitra D.K. , Bhatnagar V.
Published: March 2003

Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy.

Patients and methods Thirty‐one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto‐urethrography, ultrasonography and artificial slow‐filling cystometry.

Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty‐one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end‐fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end‐fill pressure of < 40 cmH2O.

Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end‐fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment.
Amplification of the androgen receptor may not explain the development of androgen‐independent prostate cancer
Authors: Edwards J. , Krishna N.S. , Mukherjee R. , Watters A.D. , Underwood M.A. , Bartlett J.M.S.
Published: March 2003

Objective To examine the role of androgen receptor (AR) gene amplification and aneusomy of the X chromosome in the development of antiandrogen‐resistant prostate cancer.

Patients and methods Twenty patients with prostate cancer resistant to androgen‐deprivation therapy were selected for study. The records of patients with tumours before and after antiandrogen therapy, and with a full clinical follow‐up, were retrieved. AR gene amplification and X chromosome copy number were assessed by fluorescence in situ hybridization using a labelled probe at locus Xq11–13 for the AR gene and a labelled α‐satellite probe for the X chromosome. At least 20 nuclei were scored over three tumour areas by two independent observers.

Results Aneusomy of the X chromosome was reported respectively in seven (35%) and 11 (55%) tumours before and after hormone relapse, the AR gene copy number was increased in seven (35%) and 13 (65%), respectively, and AR gene amplification was detected in one (5%) and three (15%), respectively. Neither increased AR copy number nor AR amplification in primary tumours precluded a biological response to androgen‐deprivation therapy.

Conclusion The rate of AR gene amplification is too low to be solely responsible for the development of antiandrogen‐resistant prostate cancer. Also, the presence of amplified AR and cells aneusomic for the X chromosome in primary tumours that respond to androgen‐deprivation therapy suggests that an increase in AR gene copy number does not prevent a tumour from responding to this therapy. Therefore other mechanisms which could cause hormone‐refractory prostate cancer must be investigated before it is understood why so many patients relapse with this disease.
The value of endotoxin concentrations in expressed prostatic secretions for the diagnosis and classification of chronic prostatitis
Authors: Li L.J. , Shen Z.J. , Lu Y.L. , Fu S.Z.
Published: March 2003

Objective To clarify the value of endotoxin concentrations in expressed prostatic secretions (EPS) in the diagnosis and classification of chronic prostatitis.

Patients, subjects and methods The study included 88 consecutive patients with chronic prostatitis and 15 controls with no urological disease. The diagnosis and classification were based on a history, symptoms, a digital rectal examination of the prostate, and a white blood cell count in the EPS. Endotoxin concentrations in the EPS or urine were measured using a colorimetric assay and standard microbiological methods used to identify bacterial growth.

Results In men with chronic prostatitis caused by Gram‐negative or combined Gram‐negative and ‐positive bacteria, the endotoxin levels in urine collected immediately after prostatic massage were significantly greater (P < 0.01) than in a midstream urine sample, and the concentration in the EPS was significantly higher (P < 0.05) than that in the control group. The same was true of patients with chronic prostatitis and Gram‐positive bacteria isolated from the EPS or urine after massage. In patients with chronic pelvic pain syndrome (grade IIIA) the endotoxin level in the urine after massage was also significantly higher (P < 0.05) than that of the midstream sample, but there was no significant difference between the concentration in these samples in patients with grade IIIB, and no significant difference between the endotoxin concentration of the EPS in patients with grade IIIB and that in controls.

Conclusion Endotoxin concentrations are increased in the EPS or urine (after prostatic massage) of men with bacterial chronic prostatitis or chronic pelvic pain syndrome grade IIIA. The current routine examinations (including bacterial culture and routine examination of EPS or urine) before diagnosis and classification of chronic prostatitis are insufficient to describe the cause and pathogenesis of this condition. The endotoxin concentration of the EPS or urine after massage may provide a supplementary tool to identify the cause of chronic prostatitis.
A comparison of urinary nuclear matrix protein‐22 and bladder tumour antigen tests with voided urinary cytology in detecting and following bladder cancer:the prognostic value of false‐positive results
Authors: Poulakis V. , Witzsch U. , De Vries R. , Altmannsberger H.‐M. , Manyak M.J. , Becht E.
Published: March 2003

Objectives To evaluate the diagnostic and prognostic value of the nuclear matrix protein‐22 (NMP22) and bladder tumour antigen (BTAstat) tests compared with voided urinary cytology (VUC) in detecting and following bladder cancer, assessing particularly the prognostic value of false‐positive test results in patients followed up for bladder cancer.

Patients and methods From 739 patients suspected of having bladder cancer, voided urine samples for the NMP22 and BTAstat tests, and for VUC and urine analysis, were collected before cystoscopy. All patients underwent transurethral resection of bladder lesions or mapping, and were followed for a mean (range) of 27.3 (3–65) months.

Results In the 406 patients with bladder cancer, the overall sensitivity was 85% for NMP22, 70% for BTAstat and 62% for VUC. For histological grades 1–3 the sensitivity in detecting transitional cell carcinoma was 82%, 89% and 94% for NMP22, 53%, 76% and 90% for BTAstat, and 38%, 68% and 90% for VUC, respectively. Although the sensitivity in detecting invasive carcinoma was > 85% for all the tests, NMP22 and BTAstat were statistically more sensitive than VUC for superficial tumours. The optimal threshold value for NMP22, calculated using the receiver operating characteristics curve, was 8.25 U/mL. The specificity was 68% for NMP22, 67% for BTAstat, and 96% for VUC. The specificity of VUC remained > 87% and was independent of benign histological findings. In contrast, in patients with no apparent genitourinary disease on histology, NMP22 and BTAstat had significantly higher specificity (94% and 92%, respectively; P = 0.003) than in the group with chronic cystitis (52% for both tests). Forty patients having no bladder cancer at biopsy had a recurrence after a mean (range) follow‐up of 7.7 (3–15) months; all had a previous history of bladder cancer. According to subsequent recurrence, the prognostic positive and negative predictive values were 18% and 91% for NMP22, 13% and 88% for BTAstat, and 79% and 91% for VUC. Both false‐positive VUC and NMP22 tests predicted recurrence (log‐rank test, P < 0.001 and P = 0.004, respectively), but the BTAstat test produced no similar correlation (P = 0.778).

Conclusion The NMP22 and BTAstat tests are better than VUC for detecting superficial and low‐grade bladder cancer but they have significantly lower specificity. After excluding diseases with the potential to interfere in these tests the overall specificity of both tests is increased considerably. False‐positive results from NMP22 and VUC but not from BTAstat in patients followed up for bladder cancer correlate with future recurrences.
Magnetic resonance urography in patients with neurogenic bladder dysfunction and spinal dysraphism
Authors: Shipstone D.P. , Thomas D.G. , Darwent G. , Morcos S.K.
Published: March 2003

Objective To investigate the reliability of magnetic resonance urography (MRU) using heavily T2‐weighted very fast spin‐echo sequences in imaging the upper urinary tract in patients with spinal dysraphism and neuropathic bladder dysfunction.

Patients and methods Patients with neuropathic bladder dysfunction secondary to spinal dysraphism may have gross spinal deformity, which makes assessing the urinary tract extremely difficult by ultrasonography or intravenous urography. The study included 50 patients (median age 33 years, range 19–52) with a median (range) Cobb's angle of 60 (0–240)°. No contrast medium was given but all patients received 20 mg of intramuscular frusemide 20–30 min before MRU.

Results Thirty‐five patients had previous ultrasonography, during which only 42 kidneys and no ureters were visible. Of the 94 renal tracts, MRU visualized all kidneys and 86 (89%) ureters. There was good agreement amongst observers on assessing the kidneys and pelvicalyceal systems (kappa  0.61) but only moderate agreement on evaluating the ureters (kappa  0.61). There was disagreement on normality vs renal parenchymal scarring in 14 (15%) kidneys, about no dilatation vs dilatation of the pelvicalyceal system in 14 (15%) systems and about no dilatation vs dilatation of the ureter in 20 (22%) ureters. The overall quality of the MRU images was rated highly, with a mean (range) score of 4.6 (3–5).

Conclusion MRU provides a reliable noninvasive technique for imaging the upper tract in patients who were previously difficult to investigate.
The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience
Authors: Kuczyk M. , Münch T. , Machtens S. , Bokemeyer C. , Wefer A. , Hartmann J. , Kollmannsberger C. , Kondo M. , Jonas U.
Published: March 2003

Objectives To further clarify the need for routine adrenalectomy during the surgical treatment of renal cell cancer, as in the absence of clinically overt metastatic disease, tumorous lesions within the adrenal gland are found in only 2–10% of patients, with most being over‐treated by adrenalectomy.

Patients and methods The medical records of 819 patients undergoing adrenalectomy combined with nephrectomy, irrespective of the local extension of the primary tumour or the clinical stage at first diagnosis, were reviewed to determine the reliability of currently available imaging methods in predicting adrenal gland metastases. Several patient and tumour characteristics were correlated with the presence of intra‐adrenal metastases, and their possible independent prognostic value was determined by a multivariate logistic regression model.

Results There was metastatic spread into the adrenal gland in 27 of 819 (3.3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site were preoperative abdominal computed tomography scans interpreted as false‐negative. On multivariate statistical analysis only the presence of distant metastases, vascular invasion within the primary tumour and multifocal growth of renal cell cancer within the tumour‐bearing kidney were identified as independent predictors of the presence of intra‐adrenal metastases.

Conclusions None of the patient or tumour characteristics evaluated reliably predicted the likelihood of adrenal metastases in patients with no evidence of disseminated metastatic spread. However, previously published data indicate that the frequency of metachronous metastases within the contralateral kidney (1.8–3.8%) is significantly higher than the risk of a preoperatively undetected isolated intra‐adrenal metastatic lesion when currently available imaging modalities are applied. Therefore, routine adrenalectomy should not be recommended if the preoperative radiological examinations are normal.
Comparison of surgery alone with surgery and adjuvant radiotherapy for pT3N0 prostate cancer
Authors: Petrovich Z. , Lieskovsky G. , Stein J.P. , Huberman M. , Skinner D.G.
Published: March 2003

Objective To compare the outcome between patients with pT3N0 adenocarcinoma of the prostate treated with radical prostatectomy (RP) and those receiving RP followed by a planned course of postoperative radiation therapy (RT).

Patients and methods During a period of 22 years 622 patients with pT3N0 prostate cancer were treated in one medical centre by RP. Of these, 199 (32%) were treated with surgery alone while 423 (68%) received planned postoperative pelvic RT (median 48 Gy). Patients were selected for RT by having a higher incidence of adverse prognostic factors than those undergoing RP alone. These prognostic factors included pathological stage (P = 0.001) preoperative prostate specific antigen (PSA) level (P < 0.001) and Gleason score (P = 0.18). The patients' median age was 66 years; the median follow‐up was 6.1 years for all patients, 7 years for RP + RT and 5 years for the RP‐alone.

Results The 5‐ and 10‐year actuarial survival was 92% and 73%, respectively, for RP + RT patients, and nearly identical for those in the RP‐alone group (P = 0.73). The 5‐ and 10‐year disease‐free survival (DFS; PSA < 0.05 ng/mL) was 69% and 51%, respectively, for the former, and 71% and 60%, respectively, for the latter group. There was no significant difference in DFS between the treatment groups by pathological stage and Gleason score (P = 0.77). Likewise, there was no significant difference in mean and median time to relapse. A preoperative PSA level of  < 10 vs 10–25 vs  > 25 ng/mL did not influence overall survival but a PSA of  > 25 ng/mL was predictive of DFS (P = 0.02). In a multivariate analysis the Gleason score was the most important predictor for overall survival and DFS (P < 0.001), while pathological stage was predictive of clinical recurrence and DFS (P < 0.001). After controlling for pathological stage and Gleason score, RP + RT patients were predicted to recur at 92% of the rate of RP‐alone patients (P = 0.65). In all, 43 (10%) patients developed a clinical recurrence in the RP + RT group, including 30 (7%) patients with distant metastases alone, 13 (3%) with local recurrence, with an additional 88 (21%) who had PSA recurrence (PSA  > 0.05 ng/mL). This compared with 13 (6.5%) patients with clinical recurrence, including seven (3.5%) with local recurrence and 23 (11.6%) with PSA  > 0.05 ng/mL in the RP‐alone group. Postoperative RT was well tolerated and did not add to the incidence of surgical complications.

Conclusion We propose that postoperative RT, as described here, helped to reduce the incidence of local recurrence and improved DFS to equal that of a lower‐risk group of patients treated with RP alone. A randomized comparison is needed to define the role of adjuvant RT in patients with pT3N0 disease.