bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical significance of routine pre‐cystectomy bone scans in patients with muscle‐invasive bladder cancer
Authors: Brændengen M. , Winderen M. , Fosså S.D.
Published: November 2003

Objective To evaluate the clinical significance of bone scans taken routinely before total cystectomy in patients with bladder cancer of clinical stage ≥T2.

Patients and methods Of 227 consecutive patients with stage ≥T2 bladder cancer diagnosed between 1980 and 1990 but with no clinical suspicion of bone metastases, 91 had a pre‐cystectomy bone scan performed at the Norwegian Radium Hospital. The medical records of these patients were reviewed to examine the subsequent development of distant metastases and survival.

Results Of the 91 patients, 37 (41%) developed skeletal bone metastases after cystectomy, unrelated to the clinical T category. In 35 patients, the pre‐cystectomy bone scan showed pathological uptake of isotope which was interpreted by the specialist in nuclear medicine as suspicious of (13 patients) or probably caused by (22 patients) skeletal metastases. In either circumstance, the clinician decided that total cystectomy was precluded, particularly as most of the changes could be explained radiologically as being degenerative. In the individual patient, there was no clinically useful correlation between the findings on the pre‐cystectomy bone scan and the clinical course of disease, nor if serum alkaline phosphatase (SAP) level was included as an additional predictive factor. However, although not statistically significant, the follow‐up of all patients revealed an association between the degree of change on the pre‐cystectomy bone scan and the subsequent development of skeletal metastases and cancer‐corrected survival.

Conclusion Unless further investigations, particularly magnetic resonance imaging (MRI), can be performed, the findings of a routine pre‐operative bone scan are usually unable to identify patients with bladder cancer of stage ≥T2 who will not be cured by total cystectomy. An increased level of SAP did not improve the predictive accuracy of a pre‐cystectomy bone scan. However, the results indicate that future clinical research should be directed at combining the findings of bone scans and MRI in the search for micrometastases.
Benign prostatic hyperplasia in an unselected community‐based population: a survey of urinary symptoms, bothersomeness and prostatic enlargement
Authors: Simpson R.J. , Fisher W. , Lee A.J. , Russell E.B.A.W. , Garraway M.
Published: November 2003

Objectives To determine the prevalence of (anatomical)benign prostatic hyperplasia/enlargement (BPH/BPE)in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH.

Subjects and methods All men aged 40–79 years and living in three ex‐mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire.

Results Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50–69 was >60%. Age‐specific prevalence rates for BPE (prostate size >20 g) per 1000 men were: 40–49 years, 615; 50–59 years, 776; 60–69 years, 892; and 70–79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of >20 mL/s were very unlikely to have prostates >40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate‐specific antigen (PSA) were the only independent variables associated with prostate size.

Conclusion Compared to published studies, BPEwas substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non‐intervention/watchful waiting.
Expired breath ethanol measurement to calculate irrigating fluid absorption during transurethral resection of the prostate: experience in a district general hospital
Authors: Checketts M.R. , Duthie W.H.
Published: November 2003

Objective To estimate differences in the absorption of ethanol‐tagged irrigant fluid in patients undergoing transurethral resection of the prostate (TURP) using measurements of ethanol concentration in the breath.

Patients and methods The study comprised 100 randomly selected patients (mean age 71 years, range 38–85) undergoing TURP. At frequent intervals during TURP, the ethanol content of end‐expiratory breath samples was measured using an alcometer, venous blood samples were drawn for determination of serum sodium, ethanol and haemoglobin concentration and the absorption of irrigant fluid and blood loss were estimated. These variables were compared between patients operated on by experienced and inexperienced surgeons.

Results Ethanol was detected in the expired breath of 39 patients. Patients who absorbed irrigant fluid underwent longer operations than those who did not (median 33 min and 23 min, respectively; P<0.01), had a greater weight of prostatic tissue resected (median 27.5 g and 16.5 g, respectively ; P<0.01) and lost more blood intra‐operatively (median 295 mL and 143 mL, respectively; P<0.01). Consultant urologists performed 75 of the operations, with 25 patients (33%) having detectable breath ethanol, and trainees carried out the remaining 25 operations, where 14 (56%) patients had ethanol detected in the expired breath. The difference in peak end‐expiratory ethanol values between patients in the consultant and trainee group was significant (P<0.01). Furthermore, the incidence of ‘significant’ irrigant fluid absorption, i.e. a peak breath alcohol >300 mg/L (indicating >1 L of irrigant absorption) was one patient (1.3%) from those operated upon by a consultant and four (16%) from those treated by a trainee (P<0.05).

Conclusions Irrigant absorption occurs frequently during TURP and is more likely to occur in operations performed by trainee urologists.
Ureteric drainage and peristalsis after stenting studied using colour Doppler ultrasound
Authors: Patel U. , Kellett M.J.
Published: November 2003

Objective To study peristalsis and drainage of the stented ureter under normal physiological conditions.

Patients and methods Fifteen non‐obstructed patients with ureteric stents and 15 control subjects (i.e. 45 unstented ureters and 15 stented ureters) had ureteric jets and flow analysed using colour Doppler ultrasound (CDU). Cross‐sectional and longitudinal studies were performed.

Results Unstented ureters had forceful ureteric jets at a frequency of 0.5–4 jets/min per ureter. Asymmetry of frequency within subjects was common (1–3 jets/min). Some patent stented ureters had no recordable flow on CDU (four cases, three within the first week of stenting). In the remainder, three types of flow pattern were recorded; weak peristaltic jets were seen in a minority (four of 15), flow around the stent (periprosthetic flow) in 11 of 15 and flow through the lumen (luminal flow) in eight of 15. Jets were only seen late after stenting(>2 months). The periprosthetic flow was mildly peristaltic in some patients and periprosthetic and jet flow increased relative to luminal flow during peak diuresis.

Conclusions Passive drainage (periprosthetic and luminal flow) is the principal mode of urine transport in the stented ureter throughout the diuretic response and particularly within a week of stenting. With longer duration of stenting (>2 months) weak peristaltic activity and active ureteric transport became more evident, notably during peak diuresis. CDU is not reliable for diagnosing obstruction of the stented ureter.
The role of the nurse practitioner in a urology service
Authors: Leung H.Y. , Davis M. , Arnold D. , Hamdy F.C. , Neal D.E.
Published: November 2003

Objective To evaluate the role of the nurse practitioner in urology and to determine the impact on the work of junior doctors.

Methods Written criteria were defined before the postholder was appointed and subsequent performance was assessed against these criteria. Training was provided and the quality of work was assessed by direct observation. Senior House Officers (SHOs) were asked whether the post had increased their opportunities to attend theatre, outpatients and post‐graduate training sessions and had decreased the number of ‘inappropriate’ tasks they had to perform.

Results The nurse practitioner accomplished all the tasks that were defined before the appointment. The assessment of patients in pre‐admission and haematuria clinics was satisfactory. The continuity of information, care of patients and counselling for patients receiving complex surgery were improved. Sixty‐three per cent of all patients seen in the pre‐admission clinic and all patients in a haematuria clinic were assessed initially by the nurse practitioner. Because the nurse practitioner was involved in setting up intravenous drug administration and infusions, administrative tasks and in obtaining results from the laboratory, the number of ‘inappropriate’ tasks performed by the SHOs decreased and they were able to attend more sessions of training and education.

Conclusions The nurse practitioner in clinical urological practice constitutes an effective use of resources and relieves junior medical staff from other tasks, allowing them to receive a more focused training. In addition, the quality of patient care was thought to be improved in some areas. The framework of a job plan for a nurse practitioner is described.
Long‐term outcome of permanent urethral stents in the treatment of detrusor‐sphincter dyssynergia
Authors: McFarlane J.P. , Foley S.J. , Shah P.J.R.
Published: November 2003

Objectives To evaluate the long‐term efficacy of a permanently implanted urethral stent in the treatment of spinally injured patients with detrusor‐sphincter dyssynergia.

Patients and methods Twelve patients underwent external sphincter stenting in our institution between 1988 and 1990. They were reviewed at least annually and investigated with serial urodynamic and ultrasonographic studies.

Results Ten patients were followed for at least 5 years. Two patients required stent removal and five patients developed bladder neck obstruction requiring surgical intervention. There were no problems with stent migration, ulceration or infection.

Conclusion Stenting is an effective alternative to sphincterotomy in the long‐term, although secondary bladder neck obstruction is a frequent problem.
The epidemiology of childhood enuresis in Australia
Authors: Bower W.F. , Moore K.H. , Shepherd R.B. , Adams R.D.
Published: November 2003

Objective To establish the prevalence of enuresis in 5–12‐year‐old Australian children, to evaluate the impact of enuresis on the children and their families and to identify common methods of managing enuresis.

Subjects and methods A self‐administered questionnaire was completed voluntarily by the parents of 2292 5–12‐year‐old children during attendance at electoral polling booths in Sydney, Australia. The questionnaire inquired specifically after the child's age, gender and frequency of wetting.

Results From a response rate of 74%, the overall prevalence of any reported nocturnal enuresis was 18.9% and any day wetting 5.5%. The prevalence of marked nocturnal enuresis (at least weekly) and marked day wetting was 5.1% and 1.4%, respectively. Using a 10‐point visual analogue scale to measure parental concern about their child's enuresis, the mean concern score was 3.1. There was a moderate but significant relationship between the frequency of enuretic episodes and the parental concern score. Of the enuretic children, 34% had consulted with a health worker. These children were 1.4 years older and wet more frequently than those enuretic children who had not sought help. The management of enuresis involved a mean of 3.9 strategies, primarily behavioural techniques administered by the family. The lowest cure rate was seen in the children who wet more frequently. Significantly more of the dry children woke spontaneously at night to void compared with the enuretic children. There was a trend towards greater spontaneous arousal in the children who wet less frequently.

Conclusion These results suggest that prevalence rates for day and night wetting in Australia are similar to those in previous studies reported from the northern hemisphere. Australian families did not report a high level of concern about enuresis, even in the older child. The problem was managed primarily within the family.
Development of the urodynamic pattern in infants with myelomeningocele
Authors: Sillén U. , Hansson E. , Hermansson G. , Hjälmås K. , Jacobsson B. , Jodal U.
Published: November 2003

Objective To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract.

Patients methods Thirty‐four infants with MMC were investigated using cystometry, micturating cysto‐urethrography and urography at 1, 4 and 10 months of age.

Results Detrusor contractility was characterized by an increase in activity, with hyper‐reflexia in 45% initially, increasing to 65% at the 4‐month investigation. During the same period, the number of infants with areflexia decreased from 25% to 12%. Between 4 and 10 months, there were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the first and fourth month. The number of patients with elevated outlet resistance increased only slightly during the first year, from 32% of all infants at the initial investigation to 40% at the 10‐month follow‐up. Vesico‐ureteric reflux was detected in 12 of the patients during the year, with five already diagnosed at the first investigation. Almost all refluxes were cured with clean intermittent catheterization, with additional pharmacological therapy in two patients; one patient required a vesicostomy.

Conclusions This study indicates that detrusor activity, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in activity and occurred mostly between the first and fourth months of age. There was a strong correlation between the occurrence of reflux and poor compliance, hypercontractility and outlet obstruction.
Inflatable penile prosthesis: results of 150 cases
Authors: Garber B.B.
Published: November 2003

Objectives To evaluate the reliability of the prosthesis and the rate of complications in organically impotent men who were implanted with an inflatable penile prosthesis.

Patients and methods A consecutive series of 150 men (mean age 60 years, range 25–90) were followed for a mean of 19 months (range 0–65) after implantation of the Mentor Alpha 1 penile prosthesis. Information was obtained from their medical records and by telephone interview, but the satisfaction of the patients was not assessed quantitatively.

Results There were no complications in 145 of the patients and they currently have functioning prostheses. Complications occurred in five patients (3%), including two peri‐prosthetic infections (1%) and two intra‐operative and one post‐operative cylinder aneurysm. Complications requiring re‐operation occurred in three (2%) of patients; none of the implants leaked.

Conclusions These results suggest that for men with organic impotence, a Mentor Alpha 1 implant is an effective treatment option with acceptable morbidity and good mechanical reliability.
Thrombelastographic evaluation of coagulation in transurethral prostatectomy
Authors: Bell C.R.W. , Cox D.J.A. , Murdock P.J. , Sullivan M.E. , Pasi K.J. , Morgan R.J.
Published: November 2003

Objective To assess the changes in overall coagulation status and define the degree of systemic fibrinolysis occurring in patients undergoing transurethral prostatectomy (TURP).

Patients and methods Thirty patients undergoing TURP, 23 for benign prostatic hyperplasia and seven for prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two‐syringe technique. Samples were taken before, during and at intervals up to 72 h and 10–14 days after surgery. Thrombelastography (TEG) was performed on native whole blood samples. Peri‐operative blood loss was assessed, until the catheter was removed, by photometric estimation of the haemoglobin content of the irrigant fluid and the measurement of clot volume.

Results There was no evidence of fibrinolysis (TEG Percentage Clot Lysis Ly60 >15%) in any patient over the whole peri‐operative period. There was a significant change in the mean TEG variables towards hypercoagulation from 3 h until 10–14 days post‐operatively, compared with the pre‐operative values (P<0.05). There was a significant correlation between blood loss and clot volume.

Conclusion These results question the role of systemic fibrinolysis in primary and secondary haemorrhage following TURP and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post‐operatively indicates a possible role of hypercoagulability in clot retention.
A prospective audit of the use of a prostate clinic
Authors: Cutinha P.E. , Potts K.L. , Rosario D.J. , Hastie K.J. , Moore K.T.H. , Chapple C.R.
Published: November 2003

Objective To assess the efficiency of a prostate clinic and to determine the treatment outcomes and the proportion of patients who could potentially be managed by their General Practitioners (GPs).

Patients and methods Referral letters from GPs were screened by the consultant urologists and appropriate patients seen in the next available prostate clinic. The initial assessment consisted of an International Prostate Symptom Score and a medical history, uroflowmetry, ultrasonographically determined post‐void urine volumes, renal function tests and measurement of prostate specific antigen, in addition to a physical examination and a digital rectal examination. Further investigations were requested as required.

Results Over a period of 18 months, 403 patients were seen, 90% of them within 12 weeks from the time of referral. Uroflowmetry was performed in 96% of patients and further urodynamics in 22%. Bladder outlet obstruction was diagnosed in 246 (61%) patients and primary detrusor instability was detected in 20 (5%) patients. Fourteen per cent of patients were returned to the care of the GP following their first visit. The audit identified a potential group of patients (52%) who could be managed by their GP. Seven per cent underwent prostate surgery for the relief of bladder outlet obstruction.

Conclusion The prostate clinic significantly reduced the delay for patients to be seen at the hospital and facilitated rapid assessment and investigation, much of which was carried out by a nurse practitioner during the first visit (in most cases). Several patients were identified who could be managed in the community.
A standard protocol for the evaluation of laser treatment of the prostate
Authors: Carter A.C.
Published: November 2003

Objectives To present a standardized protocol, suitable for general use, for the evaluation of laser treatment of the prostate.

Methods Many new operative treatments which are available to treat symptomatic prostatic enlargement are being accepted and offered to patients after scanty clinical evaluation, e.g. interventions using lasers. A consistent and standard protocol was developed, comprising data‐recording sheets for patients' admission details, pre‐operative assessments, operative details of laser ablation, post‐operative in‐patient progress and re‐attendance, and subsequent out‐patient follow‐up.

Results The protocol was tested by the members of BLUES and fulfilled their requirement for easy use in any department of Urology. It provides a simple way of accurately recording relevant data within a structured format with the additional advantage of permitting results to be expressed uniformly.

Conclusion The adoption of this protocol will allow valid comparisons of core data between studies assessing different procedures. The flexibility of the protocol enables it to be used, with minor modification, for the evaluation of any operative intervention aimed at relieving prostatic symptoms.
The aetiological significance of human papillomavirus in bladder cancer
Authors: Boucher N.R. , Scholefield J.H. , Anderson J.B.
Published: November 2003

Objective To determine the prevalence of human papillomavirus (HPV) DNA types 6, 11 and 16 in histological sections of human bladder cancer.

Materials and methods Fifty‐five formalin‐fixed, paraffin‐embedded bladder tumour specimens were analysed for the presence of HPV infection using Southern blotting DNA hybridization and radiolabelled probes for HPV DNA types 6/11 and 16.

Results Despite the detection of HPV DNA type 6, 11 and 16 in positive control samples and the successful detection of HPV DNA in anogenital cancer using the same technique, no HPV DNA was found in any of the bladder tumour specimens examined.

Conclusions Using a technique with proven efficacy in the detection of HPV DNA from histological specimens, no HPV DNA was present in any of the bladder tumours examined. This finding is in agreement with most recently published studies suggesting that HPV has no significant role in the development of human bladder cancer.
Financial analysis of antegrade scrotal sclerotherapy for men with varicoceles
Authors: Johnsen N. , Tauber R.
Published: November 2003

Objective To calculate and compare the costs of the treatment of varicocele by antegrade scrotal sclerotherapy with other modalities.

Patients and methods A total of 2305 operations using antegrade scrotal sclerotherapy to treat varicocele in childhood and adolescence were analysed for cost factors and compared with different surgical treatment methods for varicocele.

Results Calculation of the pre‐, intra‐ and post‐operative costs showed that antegrade scrotal sclerotherapy was the most economically effective of all forms of surgical management for varicocele.

Conclusions Because antegrade scrotal sclerotherapy is a cost‐effective treatment for varicocele, the indications for treatment may be widened to include more men with potential infertility, and thus avoid the need for expensive methods of artificial fertilization.
An intra‐operative seminal and prostate emission test as a control for nerve‐sparing procedures in primary and secondary retroperitoneal lymphadenectomy
Authors: Recker F. , Goepel M. , Otto T. , Krege S. , Wernli M. , Stucki P. , Tscholl R. , Rübben H.
Published: November 2003

Objective To determine the value of an intra‐operative electrostimulatory test of post‐ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph‐node dissection (RLND).

Patients and methods Between 1991 and 1994, 21 patients with non‐seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post‐ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3–10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients).

Results A positive intra‐operative emission test in 15 pathological stage A (with bilateral nerve‐sparing) and six pathological stage B (with contralateral nerve‐sparing) patients predicted the post‐operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission‐related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery.

Conclusions A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission‐relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.
The Oxford Laser Prostate Trial: economic issues surrounding contact laser prostatectomy
Authors: Keoghane S.R. , Lawrence K.C. , Gray A.M. , Chappel D. , Hancock A.M. , Cranston D.W.
Published: November 2003

Objective To compare the economic implications of transurethral resection of the prostate (TURP) and contact‐laser vaporization of the prostate (with the SLT system) using data obtained from a randomized controlled trial.

Methods All aspects of management before, during and after surgery on 102 patients, followed up for 3 months, were costed and analysed. Based on the data from the trial, the mean costs were calculated. A sensitivity analysis was then performed to examine the effect of changes in some of the relevant variables. The mean difference in cost between laser treatment and TURP was plotted against the cost of laser consumables, assuming a 5% re‐operation rate for both operations at 5 years and a 5% discount rate. A range of laser re‐operation rates was compared with the mean difference in costs, assuming a hospital stay of one night and two district‐nurse visits. Other assumptions on discounts and re‐operation rates, based on collected data, were also tested.

Results TURP will remain more economical until the cost of laser consumables is reduced to 20% of the current list price, or a hospital stay of one night is introduced.

Conclusions The costs of contact‐laser vaporization of the prostate are likely to exceed the costs of TURP unless laser treatment is accompanied by a more active approach to post‐operative management, including a hospital stay of one night and, if necessary, the removal of the patient's catheter at home by a district nurse.
Urinary concentration of human chorionic gonadotrophin and its fragments as a prognostic marker in bladder cancer
Authors: Iles R.K. , Persad R. , Trivedi M. , Sharma K.B. , Dickinson A. , Smith P. , Chard T.
Published: November 2003

Objective To examine the prognostic significance of elevated urinary beta human chorionic gonadotrophin (beta‐hCG) in patients with bladder cancer.

Patients and methods Total beta‐hCG was measured in the urine of 142 patients referred for cystoscopic examination. Patients were followed for a minimum of 17 months and grouped according to stage of disease. Because the water output by individual patients varied, urinary creatinine levels were measured as an indicator of the concentration of the urine sample. Patient outcomes were correlated with urinary total beta‐hCG levels both corrected and uncorrected for creatinine concentration. After correcting for urinary creatinine levels, 40 patients were excluded because the sample was too dilute (undetectable beta‐hCG and a creatinine level of <4 mmol/L). A further four patients were excluded as they had concurrent malignancies not in the bladder and one patient was lost to follow up.

Results None of the 52 patients with benign conditions, nine of the 27 with Ta–T1, and nine of the 25 with T2–T4 bladder disease had urinary total beta‐hCG levels >3.74 IU/mmol/L creatinine. There was no significant association between urinary total beta‐hCG concentrations and the rates of recurrence or progression for Ta–T1 disease at 17 months of follow‐up. For patients with T2–T4 disease there was a significant association with widespread metastasis (P<0.01) and mortality (P<0.01) at 17 months of follow‐up. These associations persisted when urinary total beta‐hCG levels were not corrected for urinary creatinine concentration (metastasis, P<0.01; mortality, P=0.07; Kaplan–Meier survival time analysis, uncorrected for creatinine P=0.027, corrected for creatinine P<0.001). This association could not be accounted for by differences in age, histopathology or treatment.

Conclusion Although sample concentration was a serious confounding factor, after correcting for dilution using the creatinine content, the elevated urinary levels of total beta‐hCG indicated those T2–T4 lesions which were likely to metastasize and those patients likely to die early. If this test is to be used clinically, concentrated samples, i.e. early‐morning urine, and a more sensitive beta‐hCG assay are required. Nevertheless, for T2–T4 bladder tumours, an elevated pre‐treatment level of urinary beta‐hCG is a marker of poor prognosis and may prove useful in deciding appropriate therapy.
The prepuce: specialized mucosa of the penis and its loss to circumcision
Authors: Taylor J.R. , Lockwood A.P. , Taylor A.J.
Published: November 2003

Objective To assess the type and amount of tissue missing from the adult circumcised penis.

Materials and methods The gross and histological features of the prepuces of 22 adults obtained at autopsy were assessed, primarily focusing on the inner or mucosal surface of the prepuce.

Results Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa.

Conclusion The amount of tissue loss estimated in the present study is more than most parents envisage from pre‐operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.
Electrical activity of the corpus cavernosum in patients with corporal veno‐occlusive dysfunction
Authors: Kayigil Ö. , Atahan Ö. , Metin A.
Published: November 2003

Objective To determine whether the pattern of discoordination (an increase in electrical activity of the corpus cavernosum after an intracavernous injection with papaverine and which results in the contraction of the cavernous smooth muscles instead of relaxation) is an aetiological factor in veno‐occlusive dysfunction (VOD).

Patients and methods Electromyography of the corpus cavernosum was performed before and after an intracavernous injection with 60 mg papaverine in 45 patients diagnosed as having venogenic erectile dysfunction by colour Doppler ultrasonic flowmetry and dynamic infusion cavernosometry and cavernosography. Cavernosometric values were compared in patients with and with no pattern of discoordination.

Results A pattern of discoordination occurred in 14 patients (31%). There were significant differences in the cavernosometric values of patients with and with no discoordination. A poor response to papaverine and greater venous leakage were observed in the patients showing discoordination.

Conclusion The pattern of discoordination diagnosed by electromyography after injection with papaverine may explain some aspects of VOD and highlights the importance of performing electromyography of the corpus cavernosum in the diagnostic evaluation of VOD.
Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non‐organic male sexual dysfunction
Authors: Aydin S. , Odabas Ö. , Ercan M. , Kara H. , Agˇargün M.Y.
Published: November 2003

Objective To examine the effects of hypnotic suggestions or the administration of testosterone or trazodone to impotent men with no detectable organic cause for the impotence.

Patients and methods The study comprised 79 men in whom clinical and laboratory examinations revealed no organic cause for their impotence; 20 men (mean age 38.7±11.47 years) received testosterone, 21 men (mean age 39.5±10.73 years) received trazodone, 20 men (mean age 34.2±11.69 years) underwent hypnosis and 18 men (mean age 39.1 ±11.46 years) served as controls. They were assessed by interview 4, 6 and 8 weeks after starting treatment; the patient's reports were verified by interviewing their partners.

Results Men who received a placebo had a 39% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of testosterone and trazodone treatment and hypnotic suggestions were 60%, 67% and 80%, respectively.

Conclusion Although the improvement was not statistically significant, treatment with testosterone and trazodone could be used as an adjuvant therapy in non‐organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.
Penile fracture: differential diagnosis, management and outcome
Authors: Karadeniz T. , Topsakal M. , Arýman A. , Erton H. , Basak D.
Published: November 2003

Objective To determine the value of a diagnostic and therapeutic approach for patients presenting with acute penis and the effects of this management on the outcome.

Patients and methods The study comprises 21 consecutive patients (mean age 33.3 years, range 19–53) who presented with acute penis (acute pain and swelling during and soon after intercourse). The mean interval between the accident and the treatment was 6 h (range 2–20). All patients initially underwent cavernosography, followed by surgical exploration.

Results Cavernosography showed extravasation of the contrast medium, indicating a corporal tear, in 19 of 21 patients. Surgical exploration revealed rupture of the deep dorsal vein in two patients whose radiological examinations were normal. In the remaining 19 patients, corporeal tears were repaired. The mean follow‐up was 26.7 months; all patients regained penile function (potency). Penile curvature was the only adverse effect in three of the 21 patients, all of whom presented for medical treatment relatively late after the initial accident.

Conclusion In the management of the acute penis, cavernosography should be performed first and the treatment policy should be determined from the radiological findings. Conservative therapy should be chosen only when the corporeal bodies are intact.
Impalpable prostate cancer: clinicopathological features
Authors: Rogers E. , Eastham J.A. , Ohori M. , Sariyuce O. , Aihara M. , Wheeler T.M. , Scardino P.T.
Published: November 2003

Objective To determine the clinicopathological features of impalpable prostate cancer.

Patients, materials and methods The numbers of T1a and T1b cancers detected in transurethral resections of the prostate (TURP) performed before and after the advent of the test for serum prostate‐specific antigen (PSA) were compared and the incidence of T1 disease in specimens from 400 consecutive radical prostatectomies examined.

Results The incidence of T1b disease detected at TURP decreased significantly between the periods examined, but that of T1a was unaffected. Similarly, in radical prostatectomy specimens, T1b cancers were largely replaced by T1c and impalpable T2 cancers detected by ultrasonography.

Conclusions Cancers detected incidentally at TURP tend to be small T1a tumours, possibly suitable for conservative management. T1b cancers are likely to be detected by PSA level and treated radically. T1c and impalpable T2 cancers are morphologically unlike T1b disease and justifiably belong in separate stages in the current UICC staging system.
Serum prostate specific antigen levels in non‐specific granulomatous prostatitis
Authors: Speights Jr V.O. , Brawn P.N.
Published: November 2003

Objective To evaluate serum prostate‐specific antigen (PSA) levels in patients with granulomatous prostatitis, an inflammatory condition that can clinically mimic malignancy.

Patients and methods The study comprised 10 consecutive patients (age range 53–80 years) with histologically‐documented granulomatous prostatitis and who had serum PSA levels recorded before and after diagnosis.

Results PSA levels in six of the patients were normal (<4.0 ng/mL) at diagnosis. The other four had slightly elevated PSA levels, with three being between 4.0 and 6.0 ng/mL and the other 10.1 ng/mL. In six of the patients, there was a dramatic decrease (>40%) in PSA level within 6–12 months after the histological documentation of granulomatous prostatitis. At the final follow‐up, all 10 patients had normal PSA levels.

Conclusion Granulomatous prostatitis may cause a relatively mild and transient increase in serum PSA level which resolves when the inflammation subsides.
Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention
Authors: Zlotta A.R. , Peny M‐O. , Matos C. , Schulman C.C.
Published: November 2003

Objective To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using transurethral needle ablation (TUNA), an outpatient procedure requiring only local intra‐urethral anaesthesia and intravenous sedoanalgesia.

Patients and methods The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cystoscopic catheter device delivered low‐level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months.

Results The mean prostate size was 43.1 g (range 18–90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2–27). After 6 months, the sustained mean peak flow rate was 10.4±3.4 mL/s and the mean residual volume was 76±45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume.

Conclusion This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.
A comparison of isotope penile blood flow and colour Doppler ultrasonography in the assessment of erectile dysfunction
Authors: Glass J.M. , Vale J.A. , Belcaro G. , Nicolaides A. , Witherow R.O'N.
Published: November 2003

Objectives To determine whether the measurement of penile blood flow by colour Doppler imaging (CDI) and the subjective impressions generated from CDI correlate with the results of measuring isotope penile blood flow (IPBF), and thus determine if CDI is a useful screening investigation for vasculogenic impotence.

Patients and methods The study comprised 37 men with impotence of >6 months duration. All patients underwent CDI of the penis; the maximum systolic (vmax ) and minimum diastolic velocity (vmin ) were recorded. Video recordings of the CDI were reviewed subsequently with no knowledge of the erectile response. Twenty‐seven patients then underwent measurement of IPBF.

Results There was no relationship between the results obtained from IPBF and those from CDI, nor was there a significant difference between the vmax of patients identified as having arteriogenic impotence on IPBF and that of normal men or those with venous leakage on IPBF. There was no relationship between the subjective impressions from CDI and the results from IPBF, or with erectile response.

Conclusions There was no correlation between the results obtained on IPBF and those obtained from CDI; the latter is not useful in differentiating between venogenic and arteriogenic impotence in men who have failed to have a full response to papaverine.
High‐dose pelvic irradiation followed by ileal neobladder urinary diversion: complications and long‐term results
Authors: Gschwend J.E. , May F. , Paiss T. , Gottfried H.W. , Hautmann R.E.
Published: November 2003

Objective To determine the risk of post‐operative complications in patients receiving high‐dose pelvic irradiation before radical cystectomy and urinary diversion.

Patients and methods Of 300 patients who underwent orthotopic bladder replacement at our institution from 1986 to 1994, 11 patients (mean age 63 years, range 53–74) did so after receiving high‐dose pelvic irradiation. The indication for cystectomy and urinary reconstruction was bladder cancer in seven men, prostate cancer in two men and a contracted bladder due to combined external pelvic irradiation and afterloading radiotherapy in two women.

Results The post‐operative course, including the duration of hospital stay, peri‐operative complications and early functional results, did not differ from a control group of non‐irradiated patients, and no patients died. The mean follow‐up was 22 months (range 10–37) and revealed satisfactory results in seven of 11 patients. A neovesicoperitoneal fistula developed in one woman 10 months after surgery and was repaired by laparotomy. A neovesicovaginal fistula led to supravesical urinary diversion in the second woman.

Conclusions High‐dose pelvic irradiation should not be a primary contra‐indication for orthotopic urinary diversion using segments of small intestine. For patients who undergo combined external and afterloading radiotherapy, the indication for orthotopic bladder replacement should be considered critically.
Penile Mondors' disease: an underestimated pathology
Authors: Sasso F. , Gulino G. , Basar M. , Carbone A.D. , Torricelli P. , Alcini E.
Published: November 2003

Objective To report the aetiological, diagnostic and therapeutic aspects of penile Mondor's disease treated with non‐steroidal anti‐inflammatory drugs (NSAIDs) or surgery.

Patients and methods During the last 3 years, 10 patients (mean age 35 years, range 20–57) were treated for superficial penile vein thrombophlebitis. The main aetiological factors were prolonged and excessive sexual intercourse, operations for inguinal hernia and deep vein thrombosis. All patients had noticed sudden and almost painless cord‐like induration on the penile dorsal surface. Doppler ultrasonography was useful in both diagnosis and follow‐up. Eight patients were treated with NSAIDs and platelet drugs.

Results The mean interval to resolution of symptoms was 3 weeks. Two patients who did not respond to drug therapy underwent surgery (dorsal vein resection).

Conclusion Medical therapy and, when indicated, vein resection are successful and effective in treating penile Mondor's disease.
Histochemical detection of intranuclear DNA fragmentation and its relation to the expression of bcl‐2 oncoprotein in human prostatic cancer
Authors: Taniguchi J. , Moriyama N. , Kurimoto S. , Kameyama S. , Kawabe K.
Published: November 2003

Objective To assess the incidence of intranuclear DNA fragmentation and the expression of the bcl‐2 oncoprotein in prostatic carcinoma, both of which are related to programmed cell death.

Patients, materials and methods Specimens of tumour obtained from 17 patients with newly diagnosed prostatic carcinoma and 16 with hormone‐treated prostatic carcinoma undergoing total prostatectomy were evaluated. DNA fragmentation was detected using the terminal‐labelling method (d‐uridine triphosphate conjugated with digoxigenin) and the expression of bcl‐2 was detected immunohistochemically.

Results There was a high incidence of intranuclear DNA fragmentation in 14 of 17 untreated tumours and 15 of 16 hormone‐treated tumours. There were no differences between the positive cases in hormone‐treated tumours and untreated tumours. There was significantly greater expression of bcl‐2 in tumours treated with non‐steroidal anti‐androgen drugs (eight of nine were positive) than in those untreated (seven of 17) or treated with other drugs (one of seven) (P<0.05). There was a consistent and marked dissociation between DNA fragmentation and bcl‐2 positivity; most of the cells positive for bcl‐2 showed no DNA fragmentation.

Conclusion The results indicated that cells positive for bcl‐2 might potentially be hormone resistant and that the administration of non‐steroidal anti‐androgen drugs might have a role in the induction of hormone‐resistant cells.
The frequency of posterior urethral valves in Oman
Authors: Rajab A. , Freeman N.V. , Patton M.
Published: November 2003

Objective To ascertain the frequency of posterior urethral valves (PUV) in Oman, using hospital records.

Materials and methods The resident population of Oman is 1.5 million and all complex paediatric surgical cases are referred to a single unit in the capital city of Muscat. A register of patients has been kept in that unit since 1988. Hospital case‐records were reviewed to determine associated abnormalities, date and place of birth, tribal origin and, from further interviews, the family pedigree and degree of consanguinity.

Results This retrospective survey identified 56 Omani children born between 1989 and 1994 who were treated in the Paediatric Surgery Department at the Royal Hospital, Muscat for congenital PUV. The calculated incidence was 1 in 2375 newborn males, which is 2–4 times higher than that previously reported in other populations. There was no relation to the estimated month of conception and therefore environmental hyperthermia due to the extreme ambient temperature does not seems not to be a causative factor. There was consanguinity in 40 of 46 cases (87%) where a complete family history was available. Parents were first cousins in 54% of cases, compared with the background rate of 24% in over 6000 families interviewed in the antenatal clinics at six hospitals in Oman. There was also a concentration of PUV within specific tribes. About one‐third of the cases also had associated congenital abnormalities, the most frequent of which were genitourinary (17%), but gastrointestinal (9%) and spinal (7%) defects were also observed.

Conclusion The frequency of PUV in newborn Omani males was 1 in 2375, which is considerably higher than any previously reported series. This was associated with an increased rate of consanguinity, but there was no clear pattern of inheritance.