bluuebunny/crossref_metadata_2025 huggingface dataset:
Clam Enterocystoplasty in the Neuropathic Bladder
Authors: McRAE P. , MURRAY K. H. A. , NURSE D. E. , STEPHENSON T. P. , MUNDY A. R.
Published: November 2008

Summary— Clam enterocystoplasty has proved to be the most effective treatment for severe detrusor instability resistant to conservative treatment (Bramble, 1982; Mundy and Stephenson, 1985). More recently it has become the procedure of choice in patients with neuropathic bladders with hyper‐reflexia or severely impaired compliance, provided that the bladder is of reasonable size and that gross fibrosis and/or diverticular formation of the bladder wall has not occurred. Fifty‐nine patients have undergone the clam procedure as part or all of their reconstruction in the past 4 years. Although uncontrolled incontinence was the commonest indication, impaired renal function was the indication in 14 patients and need for undiversion in seven. Currently all but four are voiding satisfactorily or are on intermittent self‐catheterisation, though six have significant stress incontinence.

The clam procedure is easier, quicker and as satisfactory as substitution cystoplasty in selected cases.
Indoramin—an Effective New Drug in the Management of Bladder Outflow Obstruction
Authors: IACOVOU J. W. , DUNN M.
Published: November 2008

Summary— There is a need for symptomatic relief in some patients with bladder outflow obstruction. The alpha blocker indoramin was tested in a prospective, double‐blind, placebo‐controlled trial. Thirty men were given indoramin or placebo. Flow rates and cystometrograms were performed before inclusion and at the end of 8 weeks' treatment. lndoramin gave significant relief of symptoms and dramatically improved peak flow rates. There were three withdrawals because of adverse effects and two withdrawals in the placebo group because of retention. Other side effects were either minor or transient.
Basement Membranes in Urothelial Carcinoma
Authors: CONN I. G. , CROCKER J. , WALLACE D. M. A. , HUGHES M. A. , HILTON C. J.
Published: November 2008

Summary— Invasion of a bladder tumour involves the degradation and penetration of the sub‐epithelial basement membrane. A retrospective study of 69 superficial and 15 invasive transitional cell carcinomas of bladder and a prospective study of 43 mucosal biopsies were performed in order to assess the usefulness of immunohistochemical staining of the basement membrane components, type IV collagen and laminin as prognostic indicators in superficial bladder cancer.

There was a significant association between pT category and basement membrane staining. The incidence of progression of superficial tumours with patchy or absent basement membranes was significantly greater than those with completer basement membranes but there was no association with superficial recurrence. Biopsies of dysplastic epithelium had thickened and reduplicated basement membranes, possibly as a result of increased cell turnover.

The results suggest that a balance exists between basement membrane production and degration in early malignancy. This technique may be of value in the early identification of microinvasion an in the prediction of subsequnet progrossion.
Local Immune Responses after Intravesical BCG Treatment for Carcinoma in situ
Authors: EL‐DEMIRY M. I. M. , SMITH G. , RITCHIE A. W. S. , JAMES K. , CUMMING J. A. , HARGREAVE T. B. , CHISHOLM G. D.
Published: November 2008

Summary— The lymphoid cellular infiltrates in the bladder biopsies from patients with carcinoma in situ before and after BCG intravesical therapy have been determined and characterised. This has been achieved using a panel of monoclonal antibody probes in an indirect immunoperoxidase technique. These studies have revealed the predominance of T‐cells of the helper/inducer phenotype (T4+), β‐lymphocytes (B1+) and macrophages (Leu M3+, 3.9+) in bladder biopsies after BCG therapy. HLA.DR antigens were also expressed on the lymphoid cells infiltrate as well as the urothelial cells. These results suggest that the components of an active immune response were present and enhanced in the bladder wall after BCG therapy.
Centenary of the First Prostatectomy in Britain*
Authors: CLARK P. B.
Published: November 2008

Summary— The first suprapubic prostatectomy in Britain was performed in the General Infirmary at Leeds on 24 March 1887 by Arthur Fergusson McGill. During 1887 six other prostatectomies were performed by McGill and his colleagues. Before he died in 1890 McGill had performed complete enucleation of an adenomatous prostate.
Results of lnvestigation of Impotence in Patients with Overt or Probable Neuropathy
Authors: ROBINSON L. O. , WOODCOCK J. P. , STEPHENSON T. P.
Published: November 2008

Summary— The results of investigations in 50 impotent patients with neurological disease are presented. Using intracorporeal papaverine, Doppler duplex scanning, cardiovascular reflex testing and skin thermal threshold monitoring, the vascular and neurological components were assessed in each of three clinical groups with probable or overt neuropathy. These comprised spinal injury, diabetes and pelvic trauma. Anatomical detail of the penis was well seen using these techniques.

In 15 patients with spinal injuries, although the aetiology was predominantly neurological, six exhibited poor flow in the deep penile arteries following injection of papaverine. This was associated with poor erections in these patients, suggesting a vascular pathology.

In 27 patients with diabetes the results showed a mixed pattern. Vascular disease was almost universal, combined with varying degrees of autonomic and peripheral neuropathy, and only three had full erections with papaverine.

Those with pelvic trauma (8 patients) also had a mixed picture, although some had good erections following papaverine injection.

Duplex Doppler scanning of the deep penile arteries correlated with the quality of papaverineinduced erection. Thermal testing was a highly sensitive indicator of small nerve fibre dysfunction, possibly at an earlier stage than standard autonomic testing.

A vascular component to impotence was shown to be common in those with neurological impairment, and may alter management.
Augmentation and Replacement Sigmoid Colocystoplasty: A Review of 10 Patients
Authors: TAGUCHI Y.
Published: November 2008

Summary—
Ten cases of sigmoid colocytoplasty carried out over a 19‐year period have been reviewed. The indications were bladder gangrene (1) interstitial cystitis (2), bladder fibrosis (1), failed vesico‐vaginal fistual (1), tuberculous contracture (2), atonic baldder (1) and invasive baldder carcinoma (2). All aptients void with control every 2 to 4 h throughout the day and twice at night. There has been no long‐term deterioraion of the upper tract and no delayed complications.
Carcinoma Associated with Augmentation Cystoplasty
Authors: STONE A. R. , DAVIES N. , STEPHENSON T. P.
Published: November 2008

Summary—
Three patients with augmentation ileocystoplasties developed carcinoma at the ileovesical junction 7,22 and 24 years after surgery. All were originally reconstructed for genitourinary tuberculosis and all had developed huge capacity ileal segments with large residual urines, associated with recurrent urinary tract infecton.

With the current trends for using samll bowel for both augemntation and substitution cystoplasty, balanced voiding must be achieved and maintained, and long‐term follow‐up is mandatory.
Bacteraemia Following Perineal Prostatic Biopsy
Authors: HILLYARD J. W.
Published: November 2008

Summary—
Forty patients undergoing needle biopsy of the prostate via the perineal route were studied bacteriologically.

Four had positive blood cultures 5 min after the biopsy but none developed septicaemia, although no prophylactic antibiotics were used.

Three of the four patients developing bacteraemia were found to have an unsuspected urinary tract infection and the same organisms were cultured from blood and urine, suggesting that this was the source of the bacteraemia.
Congenital Penile Deviation and its Treatment with the Nesbit‐Kelåmi Technique
Authors: KELÅMI A.
Published: November 2008

Summary—
Ten years' experience in the treatment of 100 cases of congenital penile deviation using the Nesbit‐Kelåmi technique showed excellent results in 96 patients, all of the whom had a straight penis with full ability to penetrate. only four patients wished to have a “straighter” penis, althought penetration was possible.
Candida Pyelonephritis Complicated by Fungaemia in Obstructive Uropathy
Authors: BEILKE M.A. , KIRMANI N.
Published: November 2008

Summary— Fungal pyelonephritis caused by Candida species and Torulopsis without evidence of systemic organ involvement is uncommon. Most reported cases have been in diabetic females or in patients on immunosuppressive drugs. We report 3 cases of elderly men who had fungal pyelonephritis presumed secondary to obstructive uropathy. All subsequently developed fungaemia. Two were managed successfully with percutaneous or ureteric stents and systemic antifungal therapy; the third died despite systemic amphotericin B.
The Value of the Pre‐clinic Intravenous Urogram In the Earlier Diagnosis of the Cause of Haematuria
Authors: JONES M. W. , COX R. , DAVIES K. I. , ROSE M. B.
Published: November 2008

Summary— The early treatment of patients with bladder cancer reduces mortality. By arranging a pre‐clinic intravenous urogram we reduced the time from receipt of the General Practitioner's referral letter to making a diagnosis from 85 to 67 days and saved on clinic time and resources. A further reduction to 52 days was made by not using any out‐patient time at all. Significant saving of time and resources is possible without any disadvantage to the patient.
Transitional Cell Carcinoma of the Bladder in a Young Man A Multidisciplinary Approach
Authors: MIGLIARI R. , SCARPA R.M. , VANNI R. , RUGGIERO V. , USAI E.
Published: November 2008

Summary— A multidisciplinary diagnostic approach to a case of bladder carcinoma in a 19‐year‐old male smoker is presented. The transitional cell carcinoma was submitted to conventional histological examination, flow cytometry and cytogenetic analysis. Serum and urine tumour markers were also investigated. The tumour was diploid, with an increased proliferative phase, and a chromosome marker was found. A net decrease in serum and urine ferritin concentrations was noted after transurethral resection of the neoplasm and its low malignancy was confirmed at follow‐up.
The Effect of Testicular Torsion on the Contralateral Testis and the Value of Various Types of Treatment
Authors: SADE M. , AMATO S. , BUYUKSU C. , MERTAN S. , CANDA M. S. , KAPLANOGLU N.
Published: November 2008

Summary— In an attempt to investigate the effect of testicular torsion and various forms of treatment on the contralateral testis, an experimental study on rats was undertaken. The first group comprised control animals. In the second group the left testes were twisted 720° and the right testes were removed 4 weeks later for histopathological examination. In the third group the rats were subjected to a left detorsion procedure 24 h after torsion, while in the fourth group cortisone treatment was added to the above procedure. The fifth group consisted of rats which had undergone left orchiectomy 24 h after torsion and the sixth group had cortisone treatment plus orchiectomy after torsion. Cortisone treatment was started 24 h after testicular torsion and continued for 4 weeks. Histopathological examination of the contralateral testes which were removed 4 weeks later showed that either orchiectomy plus cortisone or detorsion plus cortisone was more successful than other forms of treatment.
The Frequency of Chlamydia trachomatis in Acute Epididymitis
Authors: DE JONG Z. , PONTONNIER F. , PLANTE P. , GAUTIER J. R. , IOUALALEN A. , ARCHAMBAUD M. , CHABANON G.
Published: November 2008

Summary— Twenty‐five patients with bacteriologically proven epididymitis were studied between 1984 and 1986. Thirteen were less than 35 years old and in 11 of them Chlamydia trachomatis was isolated; of the 2 remaining patients Escherichia coli was found in 1 and Neisseria gonorrhoeae in the other. In patients more than 35 years old, gram negative bacteria were the cause of infection in 10 and only 1 case was attributable to Chlamydia trachomatis. These results suggest that Chlamydia trachomatis is much more frequent in men under the age of 35 and the difference is statistically significant.
Seminal Analysis after Orchiectomy in Stage I Teratoma
Authors: HORWICH A. , NICHOLLS E. J. , HENDRY W. F.
Published: November 2008

Summary— Seminal analysis was performed within 2 months of orchiectomy on 97 patients with clinical Stage I malignant testicular teratoma managed by surveillance following orchiectomy. Relapse of malignant disease occurred in 28% of 47 patients with a sperm count < 10 × 106/ml and in 32% of 50 patients with a sperm count ≤ 10 × 106/ml. Of 11 patients with azoospermia, 4 relapsed and 1 developed contralateral testicular germ cell tumour. Of 35 patients with malignant teratoma undifferentiated the relapse rate was 68% in 16 patients with a sperm count < 10 × 106/ml and 42% in 19 patients with a sperm count ≤ 10 × 106/ml. It was concluded that sperm count analysis is non‐contributory in estimating the risk of relapse in clinical Stage I teratoma.
Giant Congenital Hydronephrosis with Fatal Thromboembolic Complication in an Adult
Authors: JEREMENDY G. , IANYI A. , KÁRPÁTI P. , DÖMÖTÖR L.
Published: November 2008

Giant congenital hydronephrosis in adults is an unusual condition, although four cases have been reported by Ochsner et al. (1977).
Analysis of Magnesium and Trace Elements in Urinary Calculi by Atomic Absorption Spectrophotometry
Authors: DURAK I. , YASAR A. , YURTARSLANI Z. , AKPOYRAZ M. , TASMAN S.
Published: November 2008

Summary— Magnesium and trace element determinations in 29 urinary tract calculi were carried out using an atomic absorption spectrophotometric method. Of the calculi examined, 9 were pure calcium oxalate, 5 were mixed calcium oxalate/uric acid, 5 were mixed calcium oxalate/phosphate, 5 were magnesium ammonium phosphate and 5 were pure cystine.

The measurement of magnesium and trace element levels has been considered useful in the elucidation of the mechanism of stone formation and the evaluation of factors leading to pathological consequences. In this study, the Mg, Zn, Cu, Fe, Cd and Pb content in all of the samples was determined and an attempt was made to compare the levels of these elements in calculi with the levels in normal hair.
Digital Subtraction Angiography of the Kidney
Authors: GATTONI F. , AVOGADRO ANDREA , BALDINI U. , POZZATO C. , BONFANTI MARIA T. , GANDINI DANIELA , FRANCH L. , USLENGHI C.
Published: November 2008

Summary— Intravenous and intra‐arterial digital subtraction angiography (DSA) was performed in 88 patients: 34 with tumours, 10 with renal trauma, 26 with suspected renovascular hypertension, 6 with vascular impression on the renal pelvis, 8 with nephrolithiasis and 4 with sonographically abnormal kidneys. Venous and arterial DSA always gave diagnostically useful images. Intravenous DSA is valuable in patients with suspected renovascular hypertension or after vascular surgery, percutaneous transluminal angioplasty and transcatheter embolisation.

Arterial DSA is preferable to venous DSA in other clinical situations, particularly in the evaluation of renal tumours, and may be recommended in preference to conventional angiography.
Antenatal Diagnosis of Congenital Abnormalities in the Urinary Tract Results from the Northern Region Fetal Abnormality Survey
Authors: SCOTT J. E. S. , RENWICK M.
Published: November 2008

Summary— One hundred and sixty‐two cases of suspected congenital abnormalities of the urinary tract notified to the Northern Region Fetal Abnormality Survey Register between the beginning of 1984 and the end of 1986 were studied. These cases represented 14.3% of total notifications, which in turn were 0.93% of total births. There were a further 25 cases notified but not due for delivery until early 1987; 10 of these were urological.

Thirty‐five cases (22%) notified proved postnatally to have normal urinary tracts and 21 (13.2%) had unsuspected urinary tract abnormalities.

Of the 106 cases in which a suspected urinary tract abnormality was confirmed postnatally, confirmation was obtained at perinatal death in 32 and by ultrasound, radiographic and radioisotope investigation in the remainder; 34.5% of all urological cases registered and 75% of the confirmed survivors were treated surgically.

The urological abnormality most frequently missed was posterior urethral valves.

Attempts to diagnose the fetal sex were seldom made but when they were the prediction was usually male and usually correct.

The perinatal mortality in this group was 0.43/1000 births, a contribution of nearly 4% to overall perinatal mortality in the Northern Region.
Combined Transrectal Ultrasonography and Urodynamics in the Evaluation of Detrusor‐sphincter Dyssynergia
Authors: SHABSIGH R. , FISHMAN I.J. , KREBS M.
Published: November 2008

Summary— Thirty‐one combined transrectal ultrasonographic and urodynamic studies were performed in 24 patients with spinal cord lesions at different levels between C4 and T12. Ultrasonography provided accurate real‐time imaging of the bladder neck, prostatic urethra and external sphincter during the bladder filling phase as well as during the voiding phase. Bladder and rectal pressures, sphincter EMG and uroflow were recorded simultaneously. Transrectal ultrasonography contributed significantly to the accuracy of diagnosing detrusor‐sphincter dyssynergia. Sphincter contractions were clearly visualised with ultrasonographic video monitoring. This imaging method was especially helpful in sorting out the problems of 3 patients with poor emptying of bladder after endoscopic sphincterotomy. One had a urethral stricture and the other 2 had sphincters that opened adequately but bladders that emptied poorly because of detrusor hypocontractility. Other problems, such as benign prostatic hyperplasia and false passage, were also easily recognised. Transrectal ultrasonography not only provides accurate information but also involves no exposure to radiation and thus precludes the need for costly lead‐shielded examination rooms.
The Effect of Unilateral Experimental Testicular Torsion on Spermatogenesis and Fertility
Authors: RYAN P. C. , WHELAN C. A. , GAFFNEY E. F. , FITZPATRICK J. M.
Published: November 2008

Summary— Significant subfertility exists in patients following unilateral testicular torsion, implying bilateral testicular disease. Immunological activation has been detected after experimental torsion and the present study sought to demonstrate immunologically mediated effects on contralateral spermatogenesis following experimental torsion, as well as quantifying ipsilateral damage. Early and late effects of torsion on bilateral spermatogenesis were studied at 1 and 6 months in 10 groups each containing 20 rats. Gross and histological examination, direct immunofluorescence tests, vas deferens counts and copulation studies were performed. Severe ipsilateral damage was noted, even after brief torsion periods. No contralateral testicular effects, immunological or otherwise, were observed. Ipsilateral damage after torsion may have been underestimated. There is no damage to contralateral testicular exocrine function following unilateral experimental torsion.
Installation and Use of a Neodymium‐YAG Laser In a Urology Department
Authors: ARKELL D. G. , RANDALL J.
Published: November 2008

Summary— We report our experience in setting up a urological laser unit. An operating theatre was upgraded to include the required safety features and a neodymium‐YAG laser was installed. A preliminary study using cadaver bladders was performed to establish the technique of cystoscopic laser application. We treated 55 bladder tumours in 12 patients by laser coagulation, with total destruction of 54 tumours and no serious complications; 6 patients developed recurrent tumours.

Twenty‐one patients underwent surgery with the contact laser scalpel. The instrument proved slow but effective, with excellent haemostasis and almost painless wounds. Healing was delayed in 2 cases but there were no wound infections. All wounds healed with good cosmetic scars.

The neodymium‐YAG laser is an effective means of destroying superficial non‐invasive bladder tumours endoscopically and can also be used in conjunction with a laser scalpel for open surgery.
Transvaginal Endosonography: a New Method to Study the Anatomy of the Lower Urinary Tract in Urinary Stress Incontinence
Authors: QUINN M. J. , BEYNON J. , MORTENSEN N. J. McC. , SMITH P. J. B.
Published: November 2008

Summary— A new method to investigate the anatomy of the lower urinary tract in women is described. Direct ultrasound images of the bladder neck and proximal urethra were obtained using a vaginal endoprobe; the series comprised 100 women with a range of urinary symptoms. The technique was well tolerated by patients and there was no morbidity. Transvaginal endosonography is suitable for the assessment of many aspects of urinary incontinence.
The Value of Acid Phosphatase Measurements in Predicting Extraprostatic Cancer Growth before Radical Prostatectomy
Authors: SALO J. O. , RANNIKKO S.
Published: November 2008

Summary— Acid phosphatase levels were determined using both an enzymatic method (32 cases) and radioimmunoassay (35 cases) in 35 patients with clinically localised prostatic cancer. All patients underwent total prostatectomy and pelvic lymphadenectomy. In cases of intracapsular prostatic cancer the level of prostatic acid phosphatase (PAP) measured by radioimmunoassay was 1.4 ± 0.8 μg/l. In patients with either local extraprostatic disease or pelvic lymph node metastases the mean level of PAP was 3.5 ± 2.8 μg/l. The difference was statistically significant. The specificity, sensitivity and accuracy of an elevated PAP (> 3.0 μg/l) in revealing extraprostatic extension of clinically localised prostatic cancer were 100, 37 and 66% respectively. When the enzymatic method was used, the level of acid phosphatase was elevated (> 13 u/l) in only 1 case. The specificity, sensitivity and accuracy of the enzymatic method were 100, 6 and 47% respectively. Elevation of PAP predicts, with a high degree of probability, either local extension outside the prostate or lymph node metastases. A normal PAP does not exclude extraprostatic extension of prostatic cancer.
Chemotherapy for Poor Risk Germ Cell Tumours An Independent Evaluation of the POM B/ACE Regime
Authors: CULLEN M. H. , HARPER P. G. , WOODROFFE CHARLOTTE M. , KIRKBRIDE P. , CLARKE JULIE
Published: November 2008

Summary— We have evaluated the 7‐drug, alternating, high‐dose cisplatin regime for germ cell tumours, designated POM B/ACE, in 55 patients with advanced malignant teratomas and 5 patients with bulky metastatic seminomas. All of the latter and 5 of the teratoma patients had relapsed following radiotherapy, chemotherapy or both. The previously untreated teratoma patients included 13 whose tumours were extragonadal. The primary testicular tumour patients comprised 16 with large and 21 with very large volume metastases according to the Medical Research Council criteria. POM B/ACE is effective therapy for poor risk patients with germ cell tumours (including those with the most advanced disease, i.e. hepatic and cerebral metastases) and prolonged treatment after marker normality seems unnecessary. It is a complex regime with significant toxicity and cannot be recommended for the treatment of patients with germ cell tumours who have an excellent prognosis with simpler, shorter and less toxic treatment.
Is Extracorporeal Shockwave Lithotripsy Suitable Treatment for Lower Ureteric Stones?
Authors: COLE R. S. , SHUTTLEWORTH K. E. D.
Published: November 2008

Summary— Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal Shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone‐free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The re‐treatment rate, post‐treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.
Experience with the Brindley Anterior Sacral Root Stimulator
Authors: ROBINSON L. Q. , GRANT A. , WESTON P. , STEPHENSON T. P. , LUCAS M. , THOMAS D. G.
Published: November 2008

Summary— Brindley anterior sacral root stimulators have been implanted into 22 spinal cord injured patients from the spinal injury units in Cardiff and Sheffield. The group comprised 20 men and 2 women (15 paraplegics and 7 tetraplegics); 16 patients are using the implant, of whom 11 (68%) are continent. Of the remaining 5, 4, who empty completely, are incontinent because of inability to use the implant with sufficient frequency; 6 patients are not using their implant, though 4 are continent. Of 11 patients with detrusor/sphincter dyssynergia, sphincterotomy was necessary in 3 patients before implantation and in a further 3 after implantation. Of 4 patients with abnormal upper tracts prior to implantation, 2 resolved and 2 deteriorated, in the presence of dyssynergia; 1 patient developed hydronephrosis after implantation, having previously had normal upper tracts.

Although erectile function with the stimulator was clinically adequate in 6 patients, in no patient has intercourse been achieved because of concurrent lower limb spasm.
Adjuvant Chemotherapy in T3 Carcinoma of the Bladder A Prospective Trial: Preliminary Report
Authors: SHEARER R. J. , CHILVERS C. E. D. , BLOOM H. J. G. , BLISS J. M. , HORWICH A. , GROUP A. BABIKER for THE CO‐OPERATIVE UROLOGICAL CANCER
Published: November 2008

Summary— We report the early results of a multi‐centre, randomised prospective trial of neoadjuvant and maintenance chemotherapy with methotrexate (MTX) in 376 patients with advanced (T3) carcinoma of the bladder. In patients under 65 years of age, treatment consisted of radical radiotherapy (64 Gy) or, in some centres, pre‐operative radiotherapy (44 Gy) and elective cystectomy. All patients over 65 had radical radiotherapy. MTX was administered to 188 patients. There was no increase in toxicity attributable to the MTX. MTX did not significantly increase the proportion of patients whose tumours responded to radiotherapy; 50% (70/141) responded to radiotherapy and 56% (76/136) to MTX and radiotherapy. The development of metastases and survival was also similar in both groups (3‐year survival: radiotherapy 37.3%, MTX+radiotherapy 38.6%). We report the logistic difficulties of the administration of prolonged courses of maintenance chemotherapy. Further controlled trials of neo‐adjuvant chemotherapy in advanced bladder cancer are required, involving more active regimes.
Ratio of Post‐prostatic Massage Urinary Zinc Concentration to Initial Urinary Zinc Concentration An Improved Method of Assessing Prostatic Function
Authors: McCALLUM K. A. , KAVANAGH J. P. , FARRAGHER E. B. , BLACKLOCK N. J.
Published: November 2008

Summary— Various methods have been used clinically to assess prostatic function. We evaluated a number of ways of using zinc in post‐prostatic massage urine (VB3) and found that the ratio of VB3 zinc concentration to initial urinary zinc concentration was a good indicator of prostatic secretory activity. This ratio can differentiate hormonally treated patients with carcinoma of the prostate from those untreated and from those with benign prostatic hypertrophy. The specificity is increased for individuals by repeat samples. Comparison of samples before and after resection showed no loss of function and no difference was found between groups treated with orchiectomy or LHRH agonist (Zoladex). The VB3/VB1 zinc concentration could be used in a prospective study of hormonal treatments directed against the prostate, where it could give objective evidence of a fall in secretory function of the gland.
Comparative Study of the Clinical Usefulness of Prostate Specific Antigen and Prostatic Acid Phosphatase in Prostatic Disease
Authors: BUAMAH P. K. , JOHNSON P. , SKILLEN A. W.
Published: November 2008

Summary— The clinical usefulness of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) activity measurements has been compared in 45 patients with benign prostatic hyperplasia (BPH) and 132 patients with prostatic carcinoma (PC), 21 of whom had metastatic disease (MPC) and 111 of whom had intracapsular cancer. No BPH patient had increased PAP but 47% had increased PSA. Of the PC patients only 27% had increased PAP and 70% increased PSA. All of the MPC patients had increased PSA but only 62% had increased PAP. Increased PAP was found only in MPC but increased PSA was also found in BPH.

In identifying PC, the predictive value of an increased PSA concentration is 83% and an increased PAP activity is 100%. On the other hand, the predictive value of a normal PSA concentration is 51% and of a normal PAP activity only 34%. As the PAP test is much less efficient than the PSA test, it should be discontinued.
The Value of Ultrasound Screening of the Upper Urinary Tract in Hypospadias
Authors: DAVENPORT M. , MacKINNON A. E.
Published: November 2008

Summary— Renal tract ultrasonography was performed in 82 of 111 patients with varying degrees of hypospadias.

There were 2 true positive results (2.4%) and 1 false negative (1.2%). However, 2 of these patients would have been fully investigated because of the presence of an anorectal anomaly. The third boy had a pelvic ectopic kidney with no clinical significance.

It was concluded that routine ultrasonography is not justified in this condition unless it is severe or there is an associated anomaly.
Chyluria as a Cause of Haematuria in Patients from Endemic Areas
Authors: EDWARDS B. D. , EASTWOOD J. B. , SHEARER R. J.
Published: November 2008

Summary— Chyluria is an unusual cause of haematuria in temperate regions and is rarely considered even when no apparent cause has been found. We report 3 Guyanese men who presented with macroscopic haematuria in whom pyelo‐lymphatic fistulae were found. In none of the patients were the symptoms severe enough for surgical disconnection of the fistula to be required.
Grading in Superficial Bladder Cancer. (2) Cytogenetic Classification
Authors: PAUWELS R. P. E. , SMEETS A. W. G. B. , SCHAPERS R. F. M. , GERAEDTS J. P. M. , DEBRUYNE F. M.J.
Published: November 2008

Summary— Cytogenic analysis was performed in 92 newly diagnosed transitional cell bladder carcinomas and the results were correlated with the clinical course in superficial tumours. Low grade tumours appeared to have hypodiploid or peridiploid chromosomal numbers. Intermediate grade tumours were characterised by chromosomal counts up to the hyperdiploid range but could have a peridiploid modal number. In high grade tumours the modal number was hyperdiploid. The range in chromosomal counts appeared to be more reliable than the modal number as a predictor of the course of superficial tumours. The significant difference in chromosome numbers between low, intermediate and high grade tumours indicates that grading reflects major cytogenetic changes in the tumour cells.
Monitoring of Upper Urinary Tract Pressures in the Ambulatory Patient
Authors: COPTCOAT M. J. , WATKINSON L. , DUFFY P.
Published: November 2008

Summary— A new method to measure simultaneous intrarenal, intravesical and rectal pressures has been evaluated in 6 ambulatory patients with equivocal upper tract obstruction on radiological, renographic and standard Whitaker investigations.
Experience with Electrohydraulic Shockwave Lithotripsy in the Treatment of Vesical Calculi
Authors: ZHAOWU Z. , XIWEN W. , FENLING Z.
Published: November 2008

Summary— Five hundred and two patients with bladder stones have been treated by electrohydraulic shockwave lithotripsy (EHSWL) with the Wolf RIWOLTH‐2135 disintegrator. The patients were aged between 18 and 80 years. The largest stone measured 3.6 times 4.8 cm but most were less than 3 cm; 533 stones were disintegrated in the 502 patients. The indications and complications of the treatment are discussed.
Combined Free Autologous Bladder Mucosa/Skin Tube for Urethral Reconstruction: an Update
Authors: DUFFY P. G. , RANSLEY P. G. , MALONE P. S. , VAN OYEN P.
Published: November 2008

Summary— A combined free autologous bladder mucosa/skin graft was used to reconstruct the urethra in 23 patients. Although the complication rate remains high (61%), the results represent a significant improvement over the use of complete mucosal tubes to the tip of the penis. The technique is recommended for those patients with failed hypospadias surgery, where sufficient skin is not available for urethral reconstruction
Is the Incidence of Testis Cancer Related to Trauma or Temperature?
Authors: SWERDLOW A. J. , HUTTLY SHARON R. A. , SMITH P. G.
Published: November 2008

Summary— The position of the testes reduces their temperature but makes them vulnerable to trauma. Patients with testis cancer frequently report prior testicular trauma, but this trauma may have triggered diagnosis of the tumour rather than been aetiological. In this study, the frequencies of various prior traumatic and temperature exposures in 259 patients with testis cancer were compared with their frequencies in two sets of control patients who did not have testis cancer. Particular effort was made to prevent bias. Testis cancer was not significantly associated with any temperature or trauma exposure and the confidence limits of the findings excluded substantially raised risks. The evidence suggests that raised temperatures and traumas commonly encountered in everyday life are not important risk factors for testis cancer. The possible aetiological roles of extreme trauma sufficient to cause atrophy, and of the trauma and raised temperature which can occur in cryptorchidism, however, need investigation by other methods.
Treatment of Vesicoureteric Reflux: Preliminary Report of a Prospective Study
Authors: SCHOLTMEIJER R. J. , GRIFFITHS D. J.
Published: November 2008

Summary— Between 1982 and 1986 95 children with non‐obstructive vesicoureteric reflux were treated in a prospective study. Preliminary results are reported on 94 children with 137 refluxing ureters and a follow‐up period of at least 18 months. All children with reflux grade III or less had antibiotic treatment only. Those with reflux grade IV were randomised for antibiotic treatment alone versus surgery plus antibiotic treatment, while the primary treatment of reflux grade V was reimplantation.

In 91 ureters treated by antibiotics alone, reflux disappeared in 49 cases; in 20 cases the grade of reflux was reduced. In 46 ureters treated by reimplantation, reflux was cured in 40 cases and no severe ureteric obstruction was seen. Conservative management of reflux grade IV seems to be less successful than surgery.

The results of conservative, non‐surgical treatment of reflux grades I to Ill are satisfactory, but for grades IV and V reflux surgery seems to be the treatment of choice if detrusor instability can be excluded.
Suprapubic Endoscopy: a Percutaneous Approach
Authors: McNICHOLAS T. A. , RAMSAY J. W. A. , CARTER S. St C. , MILLER R. A.
Published: November 2008

Summary— We have assessed whether suprapubic endoscopic surgery can be helpful in situations where transurethral access is inadequate, difficult or likely to be associated with urethral damage and have applied a modified version of the well known techniques for creating and dilating a track for percutaneous renal access to the bladder. This method has been used in a series of clinical cases and in certain experimental studies. Assessment of the techniques has allowed their modification and the development of a specially designed access cannula—the St Peter's Hospital cannula.
The Dilated Urinary Tract in Children; Prospective Analysis with Correlation of Radiological, Isotope, Pressure Perfusion and Surgical Findings*
Authors: GILL B. , LEVITT S. , KOGAN S. , REDA E. , WEINER S. , DONNER K.
Published: November 2008

Summary— Moderate and even severe dilatation of the urinary tract in the absence of vesicoureteric reflux may remain stable or show spontaneous resolution. Two such cases are described. Twenty‐five children with dilated urinary systems were studied to correlate the radiological, isotope, pressure perfusion and surgical findings. A positive Whitaker test correlated well with the surgical findings and post‐operative improvement in renal function in all patients with pelviureteric junction (PUJ) and vesicoureteric junction (VUJ) obstruction. High flow rates of 8.6 and 12 ml are required even in neonates and infants in order to demonstrate obstruction by Whitaker testing.
The Problems of Substitution Cystoplasty
Authors: NURSE D. E. , McCRAE P. , STEPHENSON T. P. , MUNDY A. R.
Published: November 2008

Summary— Substitution cystoplasty was performed in 157 patients aged 4 to 71 years; 62% suffered no post‐operative complication. The commonest complication was sphincter‐weakness incontinence, found in 18%, mainly in patients having a cystoplasty for interstitial cystitis; it was rare for the patient to complain of this incontinence. Ten per cent suffered incontinence due to colonic overactivity and this occurred in patients with neuropathic sphincter‐weakness incontinence or an artificial sphincter; all of these patients complained of their incontinence. This was corrected by “patching” in all cases. Voiding difficulties requiring clean intermittent self‐catheterisation occurred in 15%. More worrying was the universal finding, when looked for by blood gas analysis, of a metabolic acidosis with respiratory compensation.

It was concluded that in the absence of neuropathy, sphincter weakness or an artificial sphincter, an unmodified ileocaecal segment substitution cystoplasty is adequate; in the presence of neuropathy, sphincter weakness or an artificial sphincter, a “pouch” type of substitution cystoplasty should be performed. All patients should have blood gas analyses from time to time as part of their routine post‐operative follow‐up.
Pelvic Rhabdomyosarcoma in Children
Authors: BROECKER B. H. , PLOWMAN N. , PRITCHARD J. , RANSLEY P. G.
Published: November 2008

Summary— Twenty children with pelvic rhabdomyosarcoma treated between 1976 and 1983 are reviewed. The survival rate was 55% (11/20), with a bladder salvage rate of 54.5% among survivors. Systemic chemotherapy combined with radiotherapy and/or surgery was most effective in producing cure.
Neurological Defects of the Voiding Reflex Arcs in Chronic Urinary Retention and their Relation to Spina Bifida Occulta
Authors: FIDAS A. , MacDONALD HELEN L. , ELTON R. A. , McINNES A. , CHISHOLM G. D.
Published: November 2008

Summary— A group of 37 patients (24 female and 13 male) with chronic urinary retention and without demonstrable mechanical obstruction had neurophysiological measurements of their lower urinary tracts to detect any neurological abnormality which might relate to the disorder. These consisted of measurements of the electrosensitivity of the dorsal nerve of the penis/clitoris and of the urethra, measurement of the sacral reflex latencies (SAL) from dorsal nerve to urethra and to anus and between urethra and anus and EMG studies of the urethral and anal sphincters. The results suggest that female patients in particular have significant neurogenic defects in the voiding reflex arcs which find their clinical expression in detrusor underactivity with urinary retention. Plain X‐rays of the renal tracts (KUB films) were also studied for the presence of spina bifida occulta. The prevalence of this defect was significantly higher than in normal controls, suggesting that in some of these patients the nerve defect might be related to a tethered cord in association with spina bifida occulta.
The Enigma of Interstitial Cystitis—an Autoimmune Disease?
Authors: ANDERSON J. B. , PARIVAR F. , LEE G. , WALLINGTON T. B. , MacIVER A. G. , BRADBROOK R. A. , GINGELL J. C.
Published: November 2008

Summary— Interstitial cystitis (IC) is characterised by recurrent inflammation and destruction of bladder tissue without obvious cause. To determine whether this self‐perpetuating disease is the result of an autoimmune disorder, we studied 26 patients with IC of mean duration 5 years and compared the results with those of a control group of similar age and sex with other urological complaints.

We performed a standard autoimmune profile and looked for specific antibodies to normal human bladder in the serum, using an indirect immunofluorescence technique. Deep bladder biopsies were examined by conventional histology and cryostat sections were studied with peroxidase‐conjugated anti‐human antibodies in a search for immunoglobulin deposition within the bladder.

Seventeen of 26 patients with IC (65%) and 5 of 14 controls (36%) demonstrated non‐organ‐specific antibodies; 40% of those with IC had anti‐nuclear antibodies; 18 IC patients (75%) and 4 of 10 controls (40%) had anti‐bladder antibodies present in the serum, but 5 healthy volunteers showed no such antibody activity. There was no statistically significant difference between the two groups for either type of antibody (Fisher's exact test). Only 5 of 17 patients with IC (29%) showed immunoglobulin deposition in the bladder epithelium, a similar proportion to controls (38%); 4 of these 5 had circulating anti‐bladder antibodies present in the serum.

Although IC patients demonstrated a non‐specific increase in antibody formation, this was not significantly different from a similar group of other urological patients. The lack of specificity makes this immunological response more likely to be a secondary phenomenon associated with inflammatory damage to the bladder rather than the primary cause of the disease.
Volatile N‐nitrosamines in Urinary Catheters
Authors: HEENAN M. P. , NACEY J. N. , DELAHUNT B. , FERGUSON A. F. , DICKSON S. J.
Published: November 2008

Summary— Levels of volatile N‐nitrosamines were measured in 10 brands of latex and 2 brands of silicone catheters using high performance liquid chromatography. The cytotoxicity of catheters from identical batches was determined by measuring the inhibitory effect of catheter extracts on the uptake of 3H‐labelled thymidine into L‐929 fibroblasts in culture (IC50).

The most frequently encountered nitrosamines were N‐nitrosodi‐n‐butylamine and N‐nitrosodiethylamine. Total N‐nitrosamine levels in excess of 100 ng/g were found in 6 of the 16 catheters tested. When compared with the cytotoxicity of the catheters a significant correlation was found, with increasing nitrosamine content being associated with greater cytotoxicity. In view of the reported toxic and carcinogenic effects of these compounds it is suggested that the nitrosamine content of catheters be routinely monitored and safe regulatory limits be imposed.
Transitional Cell Carcinoma of the Renal Pelvis and Ureter
Authors: MUFTI G. R. , GOVE J. R. W. , BADENOCH D. F. , FOWLER C. G. , TIPTAFT R. C. , ENGLAND H. R. , PARIS A. M. I. , SINGH M. , HALL M. H. , BLANDY J. P.
Published: November 2008

Summary— In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was > 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post‐operative radiotherapy did not improve survival.
Stamey Needle Suspension for Stress Urinary Incontinence: A Prospective Study of 40 Patients
Authors: WUJANTO R. , O'REILLY P. H.
Published: November 2008

Summary— A series of 40 consecutive patients with proven stress urinary incontinence underwent Stamey endoscopic bladder neck suspension. There were 5 cases of detrusor instability and the results were poor in this group. Excluding these patients, 77% were cured and 12% reported significant improvement. There were 4 unpredictable failures; all but 1 occurred within 3 months of surgery and the fourth before 6 months. There were no late failures up to the mean follow‐up period of 21 months (range 9–33 months; 35 cases > 12 months); 3 of the failures had the same procedure repeated but it was again unsuccessful. The Stamey procedure is quick, entails minimum high dependency nursing and has a short hospital stay (mean 7 days). As assessed in the medium term, it represents a useful addition to the surgical procedures available for the relief of stress urinary incontinence.
Metabolic Complications of Cystoplasty
Authors: NURSE D. E. , MUNDY A. R.
Published: November 2008

Summary— A series of 48 patients with intestinal segments incorporated into the urinary tract underwent assessment of acid‐base and electrolyte balance. All patients had abnormal blood gas analyses, usually a metabolic acidosis with respiratory compensation; 33% had hyperchloraemia. Radioisotope studies using sodium, potassium and bromine showed that all were absorbed and that absorption was unaffected by renal function.

The results suggest that all such patients, but particularly women and children, may be at risk of the secondary effects of chronic acidosis, especially skeletal demineralisation, unless some compensatory mechanism is working to offset the effects of the acidosis.
Blood Group Antigen Expression in Frozen Sections of Presenting Bladder Cancer: 3‐year Prospective Follow‐up of Prognostic Value
Authors: ABEL P. D. , THORPE SUSAN J. , WILLIAMS GORDON
Published: November 2008

Summary— Blood group antigen (BGA) expression was studied on frozen sections from the initial, presenting, transitional cell bladder cancers of 73 patients. Clinical follow‐up was prospective and, after 3 years, 59 patients were available for assessment. Of 32 tumours that retained substantial BGA (BGA+ and BGA±), 11 progressed. Of 27 tumours with < 5%or undetectable BGA expression (BGA‐), 14 did not progress.

Of 24 pTa tumours, 17 had substantial BGA expression and 7 were BGA‐; 5 patients progressed, 4 substantially BGA positive and 1 BGA‐, all to category pT1; 15 tumours were category pT1, 7 substantially BGA positive and 8 BGA‐; 7 patients progressed, 1 substantially BGA positive and 6 BGA‐, all of whom died from bladder cancer; 20 were pT2 or deeper, 8 substantially BGA positive and 12 BGA‐; 12 patients progressed, 6 substantially BGA positive and 6 BGA‐, all of whom died from bladder cancer.

Despite improved understanding of the biochemistry and techniques of detection of BGA, these results preclude the use of BGA determination as a guide to prognosis in individual transitional cell carcinoma, whether used alone or in combination with pT category.