bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary incontinence in Northern Ireland: a prevalence study
Authors: Dolan  , Casson  , Mcdonald  , Ashe
Published: March 2003

Objective

To determine the prevalence of urinary incontinence in a Northern Ireland community drawn from four neighbouring geographical areas and to assess factors predisposing to the development of urinary incontinence.

Subjects and methods

A three‐page self‐administered postal questionnaire was sent to 1050 women (age range 35–74 years), recruited randomly from a target population of 43 829 women. The main survey was preceded by a pilot survey. Respondents and those not responding were compared.

Results

The overall response rate was 65.6% (689/1050); there was no significant difference between respondents and those not responding. Two‐hundred and thirty‐one women (33.5%) reported incontinence ‘sometimes’ and 161 (23.4%) ‘often’. Of those who had urinary incontinence, sanitary protection was required by 21.7% (85/392). This equates to 12.3% (85) of the total study population. Age (χ2=20.34; P<0.001) and parity (Mann–Whitney U‐test, P< 0.001) were associated with urinary incontinence, with a higher proportion of women aged 45–54 years having urinary incontinence. The menopause and postnatal pelvic floor exercises were not associated with urinary incontinence. Overall 19.9% (78/392) of women with urinary incontinence had consulted their general practitioner. Of those who required sanitary protection, 40% (34/85) had consulted their doctor.

Conclusion

Urinary incontinence is common; it is sufficiently severe to require sanitary protection in 12% of women aged 35–74 years in a Northern Ireland community.
The changing distribution of stage in nonseminomatous testicular germ cell tumours, from 1977 to 1996
Authors: Sonneveld  , Hoekstra  , Van Der Graaf  , Sluiter  , Schraffordt Koops  , Sleijfer D.tH.
Published: March 2003

Objective

To determine the changes between 1977 and 1996 in the distribution of stages of testicular cancer (TC).

Patients and methods

The stage distribution was assessed, using various classifications, i.e. the Royal Marsden (RM), Indiana, European Organization for Research and Treatment of Cancer (EORTC), International Germ Cell Cancer Collaborative Group (IGCCCG) and the Medical Research Council (MRC), in 517 patients with nonseminomatous testicular germ cell tumours (NSTGCTs) diagnosed at a single institution between 1977 and 1996.

Results

The number of patients in four consecutive 5‐year periods (1977–81, 1982–86, 1987–91, 1992–96) was 119, 141, 141, and 116, respectively. Frequency analyses showed a significant increase of RM stage I, in proportion to stage II–IV, in 1982–86 (55%, odds ratio, OR, 2.54), 1987–91 (53%, OR 2.33) and 1992–96 (61%, OR 3.24) compared to the period 1977–81 (33%). A separate analysis of patients with disseminated disease showed a proportionate significant decrease of RM stage II in 1992–96 (29%, OR 0.43) compared with 1977–81 (49%). There was also a relative decrease of good‐prognosis patients with disseminated disease in 1992–96 compared with 1977–81, using analyses of the Indiana (from 56% to 33%, OR 0.39) and EORTC classification (from 78% to 56%, OR 0.36). Analyses of the IGCCCG and MRC classification showed a significant decrease of good‐prognosis patients in the 1982–86 compared with the first 5‐year period (for IGCCCG, from 54% to 35%, OR 0.46, and for MRC, from 43% to 24%, OR 0.42).

Conclusion

The stage distribution of NSTGCT over the past two decades has changed. The proportion of stage I patients has increased since the early 1980s, apparently resulting from a shift of low‐extent disseminated disease to stage I disease. This finding is relevant in reducing the treatment required in a higher proportion of patients and the subsequent reduction of long‐term risk from treatment.
The effects of human urine on the adhesion of calcium oxalate crystal to Madin–Darby canine kidney cells
Authors: Ebisuno  , Umehara  , Kohjimoto  , Ohkawa
Published: March 2003

Objective

To determine the effect of human urine on the adhesion of calcium oxalate monohydrate (COM) crystals to Madin–Darby canine kidney (MDCK) cells in a model system in vitro.

Materials and methods

MDCK cells were exposed to COM crystals in the presence of various human urine samples. COM crystals adhering on MDCK cells were quantified by measuring the calcium concentration using atomic absorption analysis. The inhibitory activities were estimated individually for various urine samples from healthy subjects and recurrent stone formers.

Results

Human urine inhibited the adhesion of COM crystals to MDCK cells, with some variations between individual samples. The most potent inhibition of crystal adhesion was expressed by the macromolecular fraction of the urine. Pretreatment of crystals with human urine before exposure to the cells significantly reduced crystal adhesion, suggesting that human urine altered the properties of the crystal surface but not the cell surface.

Conclusion

Coating of the crystals by some component(s) of human urine might be an important physiological event in preventing adhesion or retention of crystals in the renal tubules. Although the mechanisms by which crystal adhesion is prevented are unknown, a low potential for inhibiting adhesion may be a risk factor in stone formation because it permits crystal adhesion and retention in the tubules.
Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones
Authors: Menezes  , Dickinson  , Timoney
Published: March 2003

Objective

To report our experience of using flexible ureterorenoscopy for upper urinary tract stones.

Patients and methods

Thirty‐seven patients (13 females, 24 males, mean age 48 years, range 10–76) with upper urinary tract stones not responding to other treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragments.

Results

Twenty‐three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ureteric stones, 14 were rendered stone‐free at the end of the procedure and 14 of the 22 patients with kidney stones were treated successfully; 80% of the lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no major complications.

Conclusion

Flexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be reserved for such cases.
A population‐based study of clinical and pathological prognostic characteristics of men with familial and
Authors: Norrish  , Mcrae  , Cohen  , Jackson
Published: March 2003

Objectives

To compare traditional prognostic characteristics of familial vs sporadic prostate cancers and to investigate potential detection biases arising from differences in the use of screening and investigative procedures.

Patients and methods

Familial and sporadic cancers were identified in a population‐based sample of incident prostate cancers (total 318) in Auckland, New Zealand. To examine the potential for detection biases in these comparisons, the sociodemographic and clinical characteristics were determined according to family history status for a sample of 959 patients newly referred to Auckland urology clinics by general practitioners for the investigation of prostate‐related conditions.

Results

Compared with sporadic prostate cancers, familial cancers were more likely to be diagnosed in patients at a younger age (P=0.05), after asymptomatic serum prostate‐specific antigen (PSA) screening (P=0.02), and to include a lower proportion with extraprostatic disease (P=0.009) and serum PSA levels before diagnosis of >20 ng/mL (P=0.04). This was consistent with the observed trend for patients referred to urology clinics with a positive family history to be of higher socio‐economic and educational status and to more frequently undergo screening and biopsy investigation.

Conclusion

Familial prostate cancers appeared to be diagnosed at an earlier stage of disease progression in this study population, possibly as the result of the higher socio‐economic status and greater use of screening and investigative procedures amongst patients reporting a positive family history. These features reduce the validity of cross‐sectional comparisons of prognostic variables for familial vs sporadic prostate cancer and emphasize the need for further longitudinal prognostic studies.
The role of fine‐needle aspiration cytology of the testis in the diagnostic evaluation of infertility
Authors: Mahajan  , Imdad Ali  , Walwalkar  , Rege  , Pathak
Published: March 2003

Objective

To compare the diagnostic value of cytological smears of fine‐needle aspirate with that of histological sections obtained by testicular biopsy in the evaluation of infertility.

Patients and methods

The study included 60 patients with azoospermia or severe oligospermia (sperm counts of < 5 million/mL). A detailed history was taken and the external genitalia examined. Testicular samples were obtained by fine‐needle aspiration using a 10 mL syringe and 21 G needle; the air‐dried smears were stained using the May–Grunwald–Giemsa method. A testicular biopsy was taken after exploring the same tract and these sections were stained with haematoxylin and eosin. The cytological smears and histological sections were examined separately and the results compared.

Results

The cytological smears were divided into three groups: normal, with all spermatogenic cells present; Sertoli‐cell only syndrome; and spermatogenic arrest (all spermatogenic cells present except spermatids and spermatozoa). There was a good correlation between the diagnosis on the cytological smears and histological sections in 58 of 60 patients (97%). In two patients there was scanty aspirate and few cells, giving an inaccurate diagnosis. Interstitial cells were not detected on cytological smears. In three patients, Sertoli‐cell only was diagnosed on cytology, and histology revealed additional features of Leydig cell hyperplasia.

Conclusion

Fine‐needle aspiration of the testis is a simple and minimally invasive technique for diagnostic evaluation, especially in patients with obstructive azoospermia. Patients with abnormal findings on fine‐needle aspiration cytology may be evaluated histologically by further biopsy.
Lithogenic risk factors in normal black volunteers, and black and white recurrent stone formers
Authors: Whalley  , Martins  , Van Dyk  , Meyers
Published: March 2003

Objective

To compare lithogenic risk factors in normal black volunteer men (BN), male black stone formers (BSF) and male white recurrent stone formers (WSF); in addition, the differential diagnoses in the stone formers were compared to determine if the causes of renal stones differed in the two groups.

Subjects and methods

The study included 22 BN, 22 consecutive BSF and 122 consecutive WSF seen over a 10‐year period. Each subject was assessed by a thorough medical history, dietary analysis and a full serum and urinary biochemical evaluation.

Results

Although the WSF were significantly more overweight (P<0.001) and obese (P<0.001) than the BSF, neither group had values significantly different from those of their respective normal populations. There was no significant difference in serum levels of Ca, phosphorus, ionised Ca, calcitriol and alkaline phosphatase in BSF and WSF, but levels of parathyroid hormone tended to be (P<0.1) and calcitriol was significantly higher in BSF than WSF (P<0.03). The BSF urinary excretion levels tended to be more like that of the WSF, with the following pattern present; BN<BSF<WSF, except for citrate, where BSF< BN<WSF. No dietary or metabolic abnormality was found in 9% of BSF and 5% of WSF. Pure dietary lithogenic risk factors were present in 9% of BSF and 21% of WSF. The prevalence of metabolic risk factors was similar in the two groups but the distribution differed. Renal hypercalciuria, absorptive hypercalciuria and mild metabolic hyperoxaluria were 2.5–3 times more prevalent in the WSF.

Conclusion

Although the urine of BSF tends to be more like that of WSF, the lithogenic risk factors present differed and were less severe. The increase in urinary calcium excretion, coupled with a lower citrate excretion, may be the most important reason for stone formation in the black population. An increased protein intake may also play a role. In this small group of BSF there was no family history of urolithiasis, supporting the view that there may be a more prominent genetic influence in WSF.
Follow‐up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy
Authors: Ljungberg  , Alamdari  , Rasmuson  , Roos
Published: March 2003

Objective

To define guidelines for the follow‐up management of nonmetastatic renal cell carcinoma (RCC), by assessing tumour recurrences and the clinical course in patients who had undergone radical nephrectomy.

Patients and methods

The records of 187 patients with pT1–3, N0–X, M0 RCC who underwent radical nephrectomy between 1982 and 1997 were reviewed prospectively. Clinicopathological variables were compared with the time of first recurrence, site of metastasis and reason for diagnosis.

Results

Metastases were diagnosed in 98 sites in 56 of the 187 patients (30%). The risk for developing metastases increased with stage; 80% of the patients had their metastases diagnosed within 3 years (median 14.5 months) after nephrectomy. The time to first diagnosis was longer for patients with pT1 tumours and for those with skeletal metastases. The cause‐specific 5‐year survival rate for pT1 tumours was 95%, for pT2 87% and for pT3 tumours 37%. All patients with diploid pT1–2 RCC survived, having a survival advantage over those with aneuploid pT1–2 tumours (P=0.018). Also, pT1–2 tumours of < 5 cm were associated with better survival rates. Among 74 patients with pT3 tumours, 45 got metastases; DNA ploidy in these tumours did not influence survival. Of 30 patients with lung metastases, 28 were diagnosed during follow‐up, while 25 of 26 other metastatic sites were diagnosed because of symptoms.

Conclusions

The risk for tumour progression depends mainly on stage; these results indicate no need for follow‐up in patients with diploid pT1–2 tumours or with aneuploid pT1 tumours of < 5 cm. For patients with aneuploid pT1–2 tumours of > 5 cm and pT3 tumours, follow‐up is indicated.
Failure of allograft suburethral slings
Authors: Fitzgerald  , Mollenhauer  , Brubaker
Published: March 2003

Objectives

 To report our experience of using freeze‐dried irradiated fascia lata allografts for suburethral sling procedures.

Patients and methods

 Between December 1996 and September 1998, 35 patients (mean age 60.25 years, range 37–79) underwent suburethral sling placement with fascia allograft. These patients were reviewed, with the findings at the time of any surgical re‐exploration. Eleven (31%) had undergone prior surgery for genuine stress incontinence and 32 (91%) had a preoperative diagnosis of intrinsic sphincter deficiency.

Results

 On re‐operation for persistent or recurrent stress incontinence, the allograft was present but grossly degenerated in two (6%) patients and completely absent in five (14%) patients. Histology of a retrieved graft fragment showed both fibroblast proliferation and degeneration within the graft.

Conclusion

 The use of freeze‐dried, irradiated fascia lata for suburethral sling procedures was associated with a material failure rate of ≥20%. We caution against its use in this setting.
Transurethral resection or incision of the prostate and other therapies: a survey of treatments for benign prostatic obstruction in the UK
Authors: Yang  , Abrams  , Donovan  , Mulligan  , Williams
Published: March 2003

Objective

 To establish the current usage of transurethral incision of the prostate (TUIP) and other forms of treatment for benign prostatic obstruction (BPO).

Methods

 The Prostate Trial Office (PROTO) sent a survey questionnaire to all 376 consultant urologists in the UK which asked for estimates of their clinical practice in treating BPO. The survey had three principle aims: to assess the role that the determination of prostate size has in clinical practice, to determine the nature and frequency of use of a range of therapies including TUIP, and to examine the feasibility of conducting a randomized controlled trial comparing transurethral resection of the prostate (TURP) and TUIP.

Results

 Of the 376 urologists, 349 replied (response rate 93%); most respondents used prostate size as a determinant when deciding on therapy for BPO (60%). Of their patients with BPO who were treated, 38% received surgical treatment, 33% drug therapies and 29% conservative management. Of the types of surgical treatment, the most commonly used procedure was TURP, in 79% of patients, with only 15% undergoing TUIP. When compared with TURP, TUIP tended to be used for patients with a mean prostate volume of ≤25 mL. Only 6% of surgical patients were treated using minimally invasive techniques.

Conclusion

 This survey provides some evidence that prostate size plays an important role in determining the treatment; TUIP appeared to be under‐used and other minimally invasive techniques are rarely used in the UK.
Efficacy and limitations of delayed/salvage radiation therapy after radical prostatectomy
Authors: Egawa  , Ohori  , Iwamura  , Kuwao  , Baba
Published: March 2003

Objective

 To assess the kinetics of prostate specific antigen (PSA) and the degree of PSA suppression, to better understand the efficacy and limitations of delayed/salvage radiation therapy after radical prostatectomy.

Patients and methods

 The PSA doubling time was calculated in patients with biochemical failure after radical prostatectomy and in those who underwent delayed/salvage radiation therapy. Patients in whom PSA was undetectable by conventional assay after irradiation were followed using a hypersensitive PSA assay.

Results

 Of 125 patients who underwent radical prostatectomy for clinically resectable prostate cancer, 47 developed biochemical failure at a mean of 11.8 months after surgery; 38 of these patients underwent radiotherapy (36 for isolated biochemical failure and two for local progression with elevated PSA levels). The mean (sd) PSA doubling time after surgery was 14.6 (16.2) months (n=44) and after radiation therapy it was 13.3 (23.9) months (n=32). Eleven of 30 evaluable patients (37%) had a sustained PSA suppression lasting at least 12 months after radiotherapy. Only the time to biochemical failure after surgery approached statistical significance for predicting a durable response to radiotherapy (P=0.08). The mean nadir value of PSA in the 11 patients with at least 12 months of sustained PSA suppression was 0.032 ng/mL at 26.9 months.

Conclusions

 The rapidity with which PSA levels double after surgery may provide a clinically significant indication of the nature of these recurrent tumours, which deserve the best possible attempt at cure. Slow‐growing tumours with longer PSA doubling times may be better candidates for delayed/salvage radiation therapy. Larger studies involving more patients are needed to determine whether the PSA doubling time can define subgroups for which specific treatment strategies should be developed.
Evaluation of ureteric contraction: a comparison among ring, spiral‐cut and longitudinal segments
Authors: Jerde T.J. , Saban R. , Nakada S.Y.
Published: March 2003

Objective

To determine the optimal contractile response of isolated ureters to inflammatory mediators and neurotransmitters by evaluating four common methods of ureteric suspension.

Materials and methods

Ureters from adult domestic swine were placed immediately in Krebs buffer and cut into 4–5 mm segments. Four methods of suspension were compared: (i) an unopened ring segment suspended horizontally; (ii) a spirally cut segment (lumen cut open at a 45° and suspended end‐to‐end); (iii) an open longitudinal segment; and (iv) a closed longitudinal segment. All segments were placed in individual water‐jacketed tissue baths containing Krebs buffer, the frequency of contraction measured using a force transducer and registered on a polygraph. The sensitivity of all four segments was tested by measuring the tension and frequency in response to increasing frequencies of electric field stimulation, and by a cumulative concentration–response curve to carbachol.

Results

Ureteric segments responded with an increased frequency of contraction depending on the intensity of stimulus to both electric field stimulation and carbachol. However, there were no significant differences in spontaneous levels of contraction, sensitivity or maximal response among the methods of suspension in response to electric field stimulation or carbachol.

Conclusion

These results indicate that all four methods of suspending the ureteric segments produce contractile responses sensitive enough to study the action of various neurotransmitters.
A modified corporoplasty for treating congenital penile curvature and reducing the incidence of palpable indurations
Authors: Popken G. , Wetterauer U. , Schultze‐Seemann W. , Deckart A.B. , Sommerkamp H.
Published: March 2003

Objective

To reduce the incidence of postoperative palpable induration after treating congenital penile curvature, using a modified corporoplasty technique.

Patients and methods

In a retrospective unrandomized clinical trial, 105 patients with a congenital penile angulation of >30° and for whom coitus was therefore difficult or impossible, underwent surgical correction. Of the 105 patients, 55 underwent the Nesbit–Kelâmi technique, whereby a diamond‐shaped section of the tunica albuginea is excised and the defect closed with an interrupted suture. The remaining 50 patients underwent the modified corporoplasty, the edges of the tunica albuginea being brought together with a continuous, blood‐tight, intratunical suture, and the end knots buried.

Results

The early results (<6 months) were comparable in both groups, with correction of the curvature in 94% and 95%, and postoperative complications in 14% and 15%. There were fewer postoperative haematomas in those undergoing modified corporoplasty (6% vs 18%). The late results (>6 months) also showed that these patients developed fewer palpable indurations (16% vs 44%).

Conclusion

The modified corporoplasty reduced the incidence of postoperative haematoma and late complications (e.g. palpable indurations) after the surgical correction of congenital penile curvature.
Prevalence of lower urinary tract symptoms and self‐reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community‐based survey of men in the UK
Authors: Trueman  , Hood  , Nayak  , Mrazek
Published: March 2003

Objectives

To assess the prevalence of lower urinary tract symptoms (LUTS) in a community‐based population in the UK, to measure the impact of these symptoms on quality of life and health status in men with self‐reported ‘benign prostatic hyperplasia’ (‘BPH’), and to evaluate health‐seeking behaviour in this population.

Subjects and methods

A postal survey was distributed to an age‐stratified random sample of 1500 men aged 50 years or older from throughout England, Scotland and Wales. The self‐administered survey included: demographic questions; the EuroQoL (EQ‐5D) instrument, consisting of a health‐status index questionnaire and a visual analogue scale (VAS) on which participants rated their current health status; the International Prostate Symptom Score (IPSS) questionnaire; and a questionnaire assessing the participants’ health‐seeking behaviour and awareness of BPH.

Results

Responses to the survey were received from 1115 (74%) of the 1500 men. Overall, 41% (450/ 1088) had an IPSS of ≥8, indicating moderate‐to‐severe LUTS, yet only 196 men (18%) reported that they had been diagnosed with ‘BPH’. Both quality of life (as measured by the EQ‐5D) and general health status (as measured by the VAS) decreased as urinary symptom severity increased, and the greater the severity, the more men who reported a problem with mobility, self‐care, usual activity, pain/discomfort, and anxiety/depression (the five domains of the EQ‐5D). The possibility of symptoms worsening appeared to be the key determinant in the respondents’ decisions to consult a medical professional for their LUTS. Less than 11% of the respondents were aware of the availability of specific prescription drug therapies or surgical options for the treatment of ‘BPH’. The most common first treatment strategy for those consulting for symptoms was watchful waiting (34%), followed by surgery (30%) and prescription drugs (21%).

Conclusions

Moderate‐to‐severe LUTS were relatively common in this UK population of men over the age of 50, yet relatively few had been diagnosed with ‘BPH’. As LUTS adversely affect quality of life, improved treatment options and increased public awareness of BPH and LUTS are needed to combat a problem facing the growing number of elderly men in the population.
The management of residual masses after chemotherapy in metastatic seminoma
Authors: Ravi  , Ong  , Oliver  , Badenoch  , Fowler  , Hendry
Published: March 2003

Objective

To review our experience in management of residual masses after chemotherapy for metastatic seminoma.

Patients and methods

The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty‐three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or ≥3 cm and as well‐ or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed.

Results

Viable cancer was present in six of 11 patients with well‐defined residual masses of ≥3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of ≥3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications).

Conclusion

Patients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of ≥3 cm can be observed, reserving intervention for recurrent or progressive disease. Well‐defined residual masses of ≥3 cm should be resected because there is a 55% likelihood of persistent tumour.
Kidney‐preserving tumour resection in renal cell carcinoma with photodynamic detection by 5‐aminolaevulinic acid: preclinical and preliminary clinical results
Authors: Popken  , Wetterauer  , Schultze‐Seemann
Published: March 2003

Objective

To identify the outer border of a renal cell carcinoma (RCC) during a kidney‐preserving tumour resection by photodynamically detecting RCC after the exogenous administration of 5‐aminolaevulinic acid (ALA) in an animal model and in humans.

Patients, materials and methods

Human RCC was xenotransplanted subcutaneously and orthotopically into the kidneys of nude mice. ALA was then administered orally or intravenously (100–400 mg/kg body weight). The tumours were removed and examined macroscopically and microscopically for fluorescence, and the concentrations of protoporphyrin IX (PPIX) evaluated in the subcutaneous tumours. In a pilot study, nine patients with RCC of <4 cm diameter underwent partial nephrectomy; 20 mg ALA/kg body weight was given orally 4 h before surgery. During the operation, the macroscopic fluorescence of the tumours was evaluated and any side‐effects recorded.

Results

In the mouse model, the RCC fluoresced in all tumours, both macro‐ and microscopically, reaching a maximum 1.5 h after intravenous and 4 h after oral administration. The tissue concentrations of PPIX in the subcutaneous tumours were also maximal 4 h after oral administration. In the patients undergoing surgery, the RCC also fluoresced clearly and was sufficiently intense to identify the outer margins of the tumours for kidney‐preserving tumour resection. There were no side‐effects of the ALA with the dosages and methods of administration used.

Conclusion

The photodynamic detection of RCC with ALA facilitates the identification of tumour margins in man and in the mouse model, producing no undesirable side‐effects. It may be helpful in determining the boundaries of the resected tissue when carrying out conservative kidney‐preserving surgery.
Repeat epididymovasostomies: are they worthwhile?
Authors: Nigam  , Hendry
Published: March 2003

Objective

To establish whether it is worthwhile repeating epididymovasostomy in men with persistent obstructive azoospermia.

Patients and methods

The study included 24 men with obstructive azoospermia, persisting after previous surgery for blockage in the body or tail of the epididymes, who underwent repeat epididymovasostomy proximal to the previous anastomoses. Semen was re‐analysed after 6 and 12 months, and information about pregnancy self‐reported or determined by postal survey.

Results

The postoperative sperm concentration was >107 /mL in 15 patients (62%) and 10 female partners became pregnant (41%). Antisperm antibodies were present in nine patients and three of their partners became pregnant after the man received steroid therapy. Unilateral revision did not produce a favourable outcome.

Conclusion

Having defined a favourable group of men with obstructive azoospermia by scrotal exploration, i.e. those with caudal epididymal blocks and patent vasa deferentia, initial technical failure should not preclude surgical revision of the anastomoses in selected cases.
The dissolution of urinary catheter encrustation
Authors: Getliffe K.A. , Hughes S.C. , Le Claire M.
Published: March 2003

Objectives To identify the optimum volume of acidic bladder washout solution to dissolve catheter encrustations and to compare the effectiveness of different bladder washout delivery devices.

Materials and methods Urinary catheter encrustation was generated in vitro using a model of the catheterized bladder adapted from previous work. An acidic bladder washout solution (Suby G) was applied via the catheter in the model and retained for 15 min. The amount of encrusting material dissolved was measured by colorimetric analysis of the magnesium and calcium content of the solution returned after the washout procedure. The relative effectiveness of different volumes of washout solution and different washout delivery devices (Optiflow, Bard Ltd, Crawley; UroTainer, B/Braun Medical Ltd, Aylesbury; and a bladder syringe) in dissolving catheter encrustations was compared to the ‘standardized’ conditions commonly used in practice.

Results There was no statistically significant difference between washouts with 100 mL and washouts with 50 mL for any of the delivery devices tested. Gentle agitation with 50 mL Suby G did not significantly improve the dissolution of encrustation but the total amount of material dissolved when two washouts with 50 mL Suby G were used sequentially was significantly better than a single washout with either 100 mL or 50 mL.

Conclusions Under controlled laboratory conditions, smaller volumes of acidic bladder washout solution (50 mL) are as effective as the 100 mL commonly used in practice, but two sequential washouts with 50 mL are more effective than a single washout. The newly designed Optiflow delivery device is at least as effective as the other devices tested. This study provides new evidence which may contribute to decision‐making by practitioners in relation to cath‐eter care.
Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer
Authors: Tosoni I. , Wagner U. , Sauter G. , Egloff M. , Knönagel H. , Alund G. , Bannwart F. , Mihatsch M.J. , Gasser T.C. , Maurer R.
Published: March 2003

Objective To assess the reliability of the histological diagnosis of bladder cancer by assessing the interobserver variability of staging and grading in pTa/pT1 tumours and evaluating the clinical significance of discrepancies.

Materials and methods All sections from 301 superficial bladder carcinomas were reviewed by one pathologist. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined in 128 patients for whom there was long‐term follow‐up information.

Results There were significant interobserver differences in both the grading and staging of tumours. From a total of 235 tumours that were initially considered pT1, the reviewer classified 35% as pTa, 56% as pT1, 6% as pT1‐ (at least pT1), and 3% as pT2–4. In 39% of all biopsies there were interobserver differences in tumour grade. The prognostic significance of grade and stage differed between the initial pathology report and the reviewer’s diagnosis. The reviewer’s staging allowed a better estimate of the risk of subsequent tumour progression than the initial staging. Progression was significantly more common in 49 tumours in which the reviewer agreed with stage pT1 than in 29 tumours that were down‐staged from pT1 to pTa (P = 0.0116). However, the initial tumour grade (P = 0.0386) but not the reviewer’s grade (P = 0.2645) was significantly linked to progression.

Conclusions These results show that grading and staging by different pathologists have varying prognostic implications. If possible, biopsies from bladder tumours should be independently evaluated by two different pathologists before radical therapy is administered.
A systematic review of Cernilton for the treatment of benign prostatic hyperplasia
Authors: MacDonald R. , Ishani A. , Rutks I. , Wilt T.J.
Published: March 2003

Objective To systematically review the evidence for the clinical effects and safety of the rye‐grass pollen extract (Cernilton) in men with symptomatic benign prostatic hyperplasia (BPH).

Methods Trials were identified by searching Medline, specialized databases (EMBASE, Cochrane Library, Phytodok), bibliographies, and contacting relevant trialists and manufacturers. Randomized or controlled clinical trials were included if: men with symptomatic BPH were treated with Cernilton; a control group received either placebo or pharmacological therapy; the treatment duration was  30 days; and clinical outcomes were reported.

Results In all, 444 men were enrolled in two placebo‐controlled and two comparative trials lasting 12–24 weeks. Three studies used a double‐blind method although the concealment of treatment allocation was unclear in all. Cernilton improved ‘self‐rated urinary symptoms’ (the proportion reporting satisfactory or improving symptoms) vs placebo and another plant product, Tadenan. The weighted mean (95% confidence interval) risk ratio (RR) for self‐rated improvement vs placebo was 2.40 (1.21–4.75) and the weighted RR vs Tadenan was 1.42 (1.21–4.75). Cernilton reduced nocturia compared with placebo or Paraprost (a mixture of amino acids); against placebo, the weighted RR was 2.05 (1.41–3.00), and against Paraprost the weighted mean difference for nocturia was – 0.40 times per evening (– 0.73 to 0.07). Cernilton did not improve urinary flow rates, residual volume or prostate size compared with placebo or the comparative study agents. Adverse events were rare and mild; the withdrawal rate for Cernilton was 4.8%, compared with 2.7% for placebo and 5.2% for Paraprost.

Conclusions The Cernilton trials analysed were limited by their short duration, limited number of enrolees, omissions in reported outcomes, and the unknown quality of the preparations used. The comparative trials had no confirmed active control. The available evidence suggests that Cernilton is well tolerated and modestly improves overall urological symptoms, including nocturia. Additional randomized placebo and active‐controlled trials are needed to evaluate the long‐term clinical effectiveness and safety of Cernilton.
The effect of intravesical capsaicin on the suburothelial innervation in patients with detrusor hyper‐reflexia
Authors: Dasgupta P. , Chandiramani V.A. , Beckett A. , Scaravilli F. , Fowler C.J.
Published: March 2003

Objective To determine the effect of intravesical capsaicin on the suburothelial innervation in patients with detrusor hyper‐reflexia, in whom a single dose of intravesical capsaicin (1–2 mmol/L) increases the bladder capacity for 3–6 months.

Patients and methods Thirteen patients with detrusor hyper‐reflexia underwent cystometry and had flexible cystoscopic biopsies taken before and 6 weeks after receiving instillations of intravesical capsaicin (1 mmol/L). Similar biopsies were also obtained from a control group of 12 neurologically normal patients with microscopic haematuria and normal bladders. Frozen sections were stained using antibodies to S100 and PGP 9.5. Using computerized analysis, the mean nerve density scores were expressed as nerves/mm2 for S100‐positive structures and ‘red%’ and ‘red in frame’ for PGP 9.5.

Results The mean (
sem) functional bladder capacity increased from 193.2 (28.17) mL before to 396.3 (41.96) mL at 6 weeks after treatment with capsaicin, in nine of the 13 patients. The mean nerve density of S100‐positive structures in the control group was 83 (3.18) nerves/mm2. In hyper‐reflexic patients who responded to capsaicin by improved bladder capacity, the mean nerve density of S100‐positive structures was reduced from 100 (12.2) before to 66 (9.4) nerves/mm2 6 weeks after treatment. In those who did not respond to capsaicin there was no significant difference in these scores. Similarly the ‘red%’ and ‘red in frame’ reduced from 3.41 (1.06) to 1.15 (0.32) and 824.7 (246.3) to 297.9 (83.5) units, respectively, before and 6 weeks after capsaicin treatment. The difference in those not responding was not significant.

Conclusions Intravesical capsaicin causes a reduction in suburothelial nerve densities in the bladder of patients with detrusor hyper‐reflexia. This may explain its prolonged beneficial effect in these patients.
A maternal vegetarian diet in pregnancy is associated with hypospadias
Authors: North K. , Golding J. ,   THE ALSPAC STUDY TEAM
Published: March 2003

Objective To investigate the possible role of the maternal diet, particularly vegetarianism and consumption of phytoestrogens, in the origin of hypospadias, which is reported to be increasing in prevalence.

Subjects and methods Detailed information was obtained prospectively from mothers, including previous ob‐stetric history, lifestyle and dietary practices, using structured self‐completed questionnaires during pregnancy. Previously recognized associations with en‐vironmental and parental factors were examined, focusing particularly on the hypothesized hormonal link. Multivariate logistic regression was used to identify independent associations.

Results Of 7928 boys born to mothers taking part in the Avon Longitudinal Study of Pregnancy and Childhood, 51 hypospadias cases were identified. There were no significant differences in the proportion of hypospadias cases among mothers who smoked, consumed alcohol or for any aspect of their previous reproductive history (including the number of previous pregnancies, number of miscarriages, use of the contraceptive pill, time to conception and age at menarche). Significant differences were detected for some aspects of the maternal diet, i.e. vegetarianism and iron supplementation in the first half of pregnancy. Mothers who were vegetarian in pregnancy had an adjusted odds ratio (OR) of 4.99 (95% confidence interval, CI, 2.10–11.88) of giving birth to a boy with hypospadias, compared with omnivores who did not supplement their diet with iron. Omnivores who supplemented their diet with iron had an adjusted OR of 2.07 (95% CI, 1.00–4.32). The only other statistically significant association for hypospadias was with influenza in the first 3 months of pregnancy (adjusted OR 3.19, 95% CI 1.50–6.78).

Conclusion As vegetarians have a greater exposure to phytoestrogens than do omnivores, these results support the possibility that phytoestrogens have a deleterious effect on the developing male reproductive system.
The role of the renal resistive index ratio in diagnosing obstruction and in the follow‐up of children with unilateral hydronephrosis
Authors: Patti G. , Menghini M.L. , Todini A.R. , Marrocco G. , Calisti A.
Published: March 2003

Objective To assess the role of the renal resistive index ratio (RIR) in discriminating equivocal upper urinary tract dilatation in children, and thus in establishing the need for surgery, in comparison with traditional diagnostic tools.

Patients and methods The study comprised 40 children with unilateral hydronephrosis unrelated to vesico‐ureteric reflux, posterior urethral valves, megaureter or a duplex system. In all patients one or more of the following ‘indices of obstruction’ were positive; an anteroposterior renal pelvic diameter of >20 mm, a half‐time diuretic ‘washout’ (T/2) of  > 20 min, a separate renal function of < 40%, and symptoms of obstruction (pain, sepsis). All these variables were measured on admission and after a mean (range) follow‐up of 9 (2–24) months. After this period, all patients who were symptomatic or with two or more of the variables above the normal range were considered as obstructed and underwent a dismembered pyeloplasty. The variables were then re‐assessed 6 months after surgery. The RIR was evaluated using duplex Doppler ultrasonography with a 3.5–5 MHz transducer, by the same operator. Differences between obstructive and unobstructive unilateral hydronephrosis were estimated from the mean values of the variables assessed and Student’s t‐test used to determine significant differences. The correlation between the T/2 and RIR before and after surgery was also evaluated.

Results During follow‐up the RIR was abnormal in 27 of 30 patients with hydronephrosis who were considered to be ‘obstructed’. Twenty‐three of these patients, selected for surgery, had a positive diuretic renogram; 11 had loss of differential renal function and 16 had recurrent clinical symptoms. There were significant differences in the mean RIR and T/2 between obstructed and unobstructed patients. Six months after dismembered pyeloplasty, the RIR returned to normal in all patients except three in whom it was previously > 1.1. The diuretic renogram, if initially showing pathology, always became normal. The RIR did not change in patients with an unchanged and severe loss of differential renal function before and after surgery.

Conclusions In this study the RIR was a good index of obstruction in children with unilateral hydronephrosis and it correlated well with the results of diuretic renography. The specificity of the RIR was reduced whenever there was severe renal damage.
Analysis of CD44 isoform v10 expression and its prognostic value in renal cell carcinoma
Authors: Li N. , Tsuji M. , Kanda K. , Murakami Y. , Kanayama H. , Kagawa S.
Published: March 2003

Objective To examine the expression of CD44 isoform v10 (CD44v10) in patients with renal cell carcinoma (RCC), analyse its role in RCC and its relationship with conventional clinical‐histopathological experience.

Materials and methods Sixty‐four RCC specimens and five metastatic specimens were analysed immunohistochemically using a CD44v10 specific antibody. The expression of CD44v10 was compared with the histological grade and clinical or pathological stage of the tumours.

Results Of the 64 primary tumour specimens, 22 (34%) expressed CD44v10 protein; all of these positive specimens were clear‐cell and mixed‐cell RCC. Staining was also positive in four of five metastatic specimens and negative in all four cases of granular cell carcinoma. CD44v10 expression was significantly correlated with the histological grade (P < 0.0001), clinical stage (P = 0.0050) and pathological stage (P = 0.0143) of the tumours. The prognosis for patients with clear‐cell RCC who were CD44v10‐positive was worse than for patients who were CD44v10‐negative (P < 0.0001). In subgroups with different tumour stage ( pT2 or  pT3), the prognosis for patients with positive CD44v10 expression was also worse than for those with no expression (P < 0.05).

Conclusion The expression of CD44v10 correlated significantly with histological grade, clinical and pathological stage, and with survival in patients with clear‐cell RCC. CD44v10 protein may play a role in the progression of clear‐cell and mixed‐cell RCC, and thus the analysis of CD44v10 expression may provide useful prognostic information.
Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst
Authors: Chung B.H. , Kim J.H. , Hong C.H. , Yang S.C. , Lee M.S.
Published: March 2003

Objective To compare the results of single and repeated percutaneous sclerotherapy in patients with simple renal cysts.

Patients and methods Eighty‐two patients with simple renal cysts underwent needle aspiration andsclerotherapy under ultrasonographic guidance. Forty‐two patients (group 1) underwent one session of sclerotherapy with 99% ethanol immediately after aspiration and 40 patients (group 2) underwent sclerotherapy at least twice. The patients were followed up using ultrasonography at 3‐month intervals. The complete disappearance or a reduction of more than half in the diameter of the renal cyst was considered a successful treatment.

Results The mean diameter of the renal cysts was not significantly different in group 1 (6.12 cm) and 2 (6.75 cm). There was complete or partial regression in eight (19%) and 16 (38%) in group 1, and in 29 (73%) and nine (23%) in group 2, respectively. The overall success rate was significantly better in group 2 (95%) than in group 1 (57%; P < 0.001).

Conclusions These results suggest that multiple sclerotherapy is better than a single injection of sclerosant for reducing the recurrence of simple renal cysts.
Is the conservative management of ureteric calculi of > 4 mm safe?
Authors: Irving S.O. , Calleja R. , Lee F. , Bullock K.N. , Wraight P. , Doble A.
Published: March 2003

Objective To determine the safety of the conservative management of ureteric calculi of > 4 mm in diameter, using mercapto‐acetyltriglycine (MAG3) radioisotope renography to monitor renal parenchymal function.

Patients and methods Patients with symptomatic unilateral ureteric calculi were recruited prospectively. After confirming the position of the stone using contrast urography, a MAG3 radioisotope renogram was taken within 48 h of admission and again 1 month after the patients became stone‐free. The indications for intervention were ipsilateral loss of function ( 5% loss), infection, pain or any combination of these factors. The recovery of function was determined by follow‐up renography.

Results In all, 54 patients were recruited; 18 were initially allocated to conservative treatment although four later required intervention for pain. The remainder required early intervention for pain (eight), diminished function only (15) or diminished function with infection (13). Of the 54 patients, 28% had ‘silent’ loss of renal function at presentation. No calculi of > 7 mm diameter passed without intervention. The mode of initial management was determined according to individual clinical need. The upper tracts of all patients were relieved of obstruction and all patients were rendered stone‐free. Intervention for reduced function only (at ≤ 7 days) gave a significantly better (P = 0.03) recovery of function than those undergoing later intervention. The combination of reduced function and infection were unrelated to outcome after intervention.

Conclusions The conservative management of stones of 5–7 mm diameter is safe, providing that radioisotope renography is used to identify those renal units requiring intervention. This approach allows timely intervention to maximize the recovery of renal function.