bluuebunny/crossref_metadata_2025 huggingface dataset:
Spermatic‐cord block improves analgesia for day‐case testicular surgery
Authors: BURDEN R.J. , O’KELLY S.W. , SUTTON D. , CUMMING J.
Published: November 2003

Objective

 To assess whether the use of a spermatic‐cord block contributes any additional analgesia to that of a conventional analgesic regimen in day‐case testicular surgery.

Patients and methods

 In a randomized, double‐blind controlled study, 48 patients undergoing day‐case testicular surgery received general anaesthesia together with fentanyl and diclofenac for analgesia. In addition, 22 of these patients received 10 mL of 0.5% plain bupivacaine into the spermatic cord at the conclusion of surgery. Visual‐analogue pain scores were recorded for each group over the following 24 h.

Results

 The visual‐analogue pain scores were significantly lower in the immediate recovery period in patients receiving the spermatic‐cord block.

Conclusion

 The spermatic‐cord block reduced discomfort in the immediate post‐operative period in patients undergoing testicular surgery and the procedure should be encouraged to improve the quality of post‐operative pain management in such procedures.
The characteristics of primary vesico‐ureteric reflux in male and female infants with pre‐natal hydronephrosis
Authors: YEUNG C.K. , GODLEY M.L. , DHILLON H.K. , GORDON I. , DUFFY P.G. , RANSLEY P.G.
Published: November 2003

Objective

 To examine the characteristics of primary vesico‐ureteric reflux (VUR) in young infants following prenatal hydronephrosis.

Patients and methods

 The study comprised 155 consecutive infants with VUR detected at a mean age of 8.7 weeks (sd 6.3). Reflux units (n=236) were analysed for relationships between gender, severity of reflux, exposure to urinary tract infection (UTI) and the presence of focal and generalized types of kidney damage on imaging. Bladder wall thickness (from ultrasonography) was examined in comparison with a further group of 29 males without VUR.

Results

 Male infants predominated (117 of 155, 75%); bilateral VUR affected the same proportion (52%) of males and females. Most kidneys exposed to VUR (158 of 236, 67%) were normal and of the 78 abnormal kidneys (57 without UTI), 53 showed generalized damage (only eight exposed to UTI) and 71 (91%) were associated with severe (grades IV and V) reflux that predominantly affected males (P<0.001). Grade V reflux was almost exclusively a male disorder. Most female units (45 of 58, 78%) compared with 46% (82/178) of male units had mild (grades I to III) reflux that was independently associated with normal kidneys. The mean bladder wall thickness was significantly greater for males with VUR than for females with VUR and for males without VUR.

Conclusions

 Two distinct but not exclusive patterns of VUR were identified: (i) mild reflux associated with normal kidneys that affected most females and a proportion of males; (ii) severe reflux combined with kidney damage, most likely fetal in origin, that is almost exclusively a male disorder.
Is open pyeloplasty still justified?
Authors: ARUN N. , KEKRE N.S. , NATH V. , GOPALAKRISHNAN G.
Published: November 2003

Objective

 To determine the success rate, complications and morbidity from open pyeloplasty.

Patients and methods

 The study included 63 patients with confirmed pelvi‐ureteric junction (PUJ) obstruction who underwent 66 pyeloplasties. Their records were analysed retrospectively for age, clinical presentation, serum creatinine level, presence of infection, surgical technique, and pre‐ and post‐operative isotopic renography. The mean (range) follow‐up was 15.5 (3–60) months.

Results

 Pain was the most common presenting symptom; most pyeloplasties were dismembered and 77% of the procedures were performed by urological trainees. Retrograde pyelography did not alter the management in any patient. The complications were persisting PUJ obstruction in four, urinary leakage in two, transient vesico‐ureteric obstruction in two and meatal stenosis in one. There were no complications in non‐intubated pyeloplasties. Pain was successfully relieved in 98% of patients, renal function improved or remained stable in 92% and deteriorated in 7.7%. One patient underwent a revision pyeloplasty and another required nephrectomy. A younger patient, absence of urinary tract infection and absence of palpable mass were favourable factors.

Conclusion

 Pyeloplasty is the most effective and permanent treatment for PUJ obstruction. Newer endoscopic procedures currently used must be carefully assessed against this ‘gold standard’ before becoming widespread.
Balloon‐occluded arterial infusion as a useful neoadjuvant chemotherapy for bladder cancer
Authors: ARIMA K. , TOCHIGI H. , SUGIMURA Y. , KAWAMURA J.
Published: November 2003

Objective

 To evaluate the balloon‐occluded arterial infusion (BOAI) of cisplatin and adriamycin as a pre‐operative adjuvant chemotherapy in patients with bladder cancer of stage ≥T2 or in those with stage T1 and multiple large tumours.

Patients and methods

 The study comprised 120 patients with bladder cancer who underwent BOAI from November 1984 to December 1995. BOAI chemotherapy (adriamycin and cisplatin) was administered under ischaemia through a 7 F torque‐control balloon catheter, both sides of which were inserted into the contralateral internal iliac artery. The regression rate of tumours and any improvement in tumour stage was assessed.

Results

 The clinical response rate (complete or partial) was 66% and the tumour stage improved in 39% of the patients after BOAI. Of 26 patients with stage T3a diagnosed before BOAI, 12 were diagnosed as T2 or less after treatment. Of 27 patients who underwent total cystectomy because the tumour was diagnosed as T2 after BOAI, the post‐operative histopathological examination showed that 22 (82%) were stage pT1 or below. The features associated with a good response to BOAI in patients with up to pT3a disease were grade 3, non‐papillary tumours with a diameter of <3 cm.

Conclusion

 In patients diagnosed as stage T2 and T3a, or stage T1 with multiple large tumours difficult to be treat by transurethral resection, BOAI should be considered as the first choice to decrease the stage or to confirm the pathological staging.
A case‐control study of percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy
Authors: Saxby M.F. , Sorahan T. , Slaney P. , Coppinger S.W.V.
Published: November 2003

Objectives To assess the relative efficacy of percutaneous nephrolithotomy (PCN) and extracorporeal shock wave lithotripsy (ESWL) in clearing stones and to examine factors which affected the results from each treatment.

Patients and methods The study comprised 390 patients treated with PCN who were compared to 618 patients treated with ESWL. Unconditional logistic regression analysis was used to compare the odds of success and failure in the PCN group with those in the ESWL group, whilst controlling for any potential effects of age, sex, laterality, presence of other stones, previous stone history, pre‐operative treatment and centre.

Results PCN was more successful in obtaining satisfactory results than ESWL, with an odds ratio of 2.67 (P<0.001, 95% confidence intervals 1.84–3.87). The odds ratio in favour of PCN was increased after controlling for differences by centre (odds ratio 5.18, 95% confidence intervals 2.89–9.16). No other factors significantly influenced the odds ratio. ESWL was less successful in treating stones >2 cm in diameter compared to treating stones <2 cm in diameter(P=0.001). ESWL results were also affected by re‐treatment rates, which were influenced by distance of the local hospital from the lithotripter. The results with PCN improved with experience. The results of ESWL were satisfactory and the treatment cheaper, with a lower morbidity and hospital stay than after PCN for stones <2 cm in diameter, making it the treatment of choice. However for stones >2 cm, the results of ESWL were not as good and costs of treatment, morbidity and hospital stay were much closer to those of PCN for similar sized stones.

Conclusions PCN is more effective than ESWL in clearing stones. However, ESWL is an effective treatment and is usually the treatment of choice for most stones. Nevertheless, PCN remains an important and extremely effective method of treatment. The choice of treatment for stones will be influenced by the distance of a centre from a static lithotripter, and the potential availability of a mobile lithotripter.
The use of salivary stimulant pastilles to improve compliance in women taking oxybutynin hydrochloride for detrusor instability: a pilot study
Authors: HOOPER P. , TINCELLO D.G. , RICHMOND D.H.
Published: November 2003

Objective

 To assess the efficacy of salivary stimulant pastilles in improving tolerance of and compliance with oxybutynin chloride for detrusor instability.

Patients and methods

 Thirty women with detrusor instability were treated with oxybutynin in either a fixed or variable dose. After 3 weeks, patients were given salivary stimulant pastilles (Salivix, Thames Laboratories, Clwyd, UK) to chew as often as required. Symptom diaries were used to record episodes of dry mouth (xerostomia) together with a 100 mm visual analogue scale (VAS) score of the severity of xerostomia.

Results

 The frequency of xerostomia was unchanged but there was a significant decrease in median severity from 71 to 39 on the VAS (P<0.05, Mann–Whitney U‐test). Nine patients on the variable‐dose regimen tolerated a higher dose of oxybutynin when taking the pastilles (P<0.01, Wilcoxon’s matched‐pairs test).

Conclusion

 Salivary stimulant pastilles appear to be a useful adjuvant therapy for patients receiving oxybutynin chloride for detrusor instability, allowing higher doses of oxybutynin to be tolerated.
A comparative study of guidewire electrical resistance
Authors: DESGRANDCHAMPS F. , PEDRON P. , HOFFMANN P. , TEILLAC P. , LE DUC A.
Published: November 2003

Objective

 To evaluate the electrical resistance to current conduction of different guidewires used routinely in endourology and thus determine the risk of short circuits between the active electrode and the guide.

Materials and methods

 Using a standard resistance meter, the electrical resistance of four different types of guidewires was measured. Pure stainless‐steel, polytetrafluoroethylene (PTFE)‐painted, PTFE‐sheathed and hydrogel‐sheathed guidewires were tested, both when new and after mechanical abrasion of the external layer to reproduce their condition after use.

Results

 The pure stainless‐steel guidewire had no resistance to electrical current. The electrical insulation of the PTFE‐painted guidewires was poor and was eliminated by mechanical abrasion of the paint. New PTFE‐sheathed and hydrogel‐sheathed guidewires had a safe electrical resistance (>10 kΩ) but this insulation was easily eliminated by mechanical abrasion of the external layer.

Conclusions

 To minimize the risk of electrosurgical adverse effects during a guidewire‐assisted endoscopic procedure, the operator should preferably use a new guidewire for each procedure, use sheathed guidewires and ensure that the guidewire is in good condition, or cover it with a ureteric catheter, before applying current.
Clinical comparison of selective and non‐selective &agr;1A‐adrenoreceptor antagonists in benign prostatic hyperplasia: studies on tamsulosin in a fixed dose and terazosin in increasing doses
Authors: LEE E. , LEE C.
Published: November 2003

Objective

 To compare the efficacy and safety of a fixed dose (0.2 mg) of tamsulosin, a selective &agr;1A‐adrenoreceptor antagonist, with an increasing dose (1–5 mg) of terazosin, a non‐selective antagonist, in the treatment of urinary outflow obstruction associated with benign prostatic hyperplasia (BPH) in Korean patients.

Patients and methods

 The study comprised a single‐blind and randomized design with tamsulosin or terazosin taken once daily for 8 weeks. A total of 98 patients was enrolled, with 72 patients included in the analyses after 4 and 8 weeks. The primary variables assessed were changes in the maximum urinary flow rate (Qmax ) and the total International Prostate Symptom Score (IPSS), with the post‐void residual urine volume, ‘obstructive’ and ‘irritative’ questions in the IPSS, and the investigators’ global assessment of efficacy also determined. The number of patients with a clinically significant response to treatment with tamsulosin or terazosin was determined and defined as those with >20% improvement from the baseline Qmax or >20% decrease in total IPSS. Adverse reactions possibly or probably related to study medication were recorded throughout the treatment period.

Results

 Both tamsulosin and terazosin produced similar significant improvements in subjective and objective symptoms of urinary outflow obstruction (P>0.05). Systolic and diastolic (standing) blood pressures decreased significantly in patients treated with terazosin (P<0.05). The adverse reactions, most frequently dry mouth and dizziness which were usually mild and transient, were significantly higher in patients on terazosin (18 patients, versus one on tamsulosin, P<0.001). The changes led to discontinuation of therapy in two patients on terazosin.

Conclusion

 Tamsulosin was as effective as terazosin in treating urinary outflow obstruction associated with BPH, but had a markedly better safety profile.
Histology of the upper pole in complete urinary duplication — does it affect surgical management?
Authors: ABEL C. , LENDON M. , GOUGH D.C.S.
Published: November 2003

Objective

 To review the histological change in the upper pole of excised duplex kidneys and assess whether ante‐natal diagnosis might predispose to more conservative surgical management of this abnormality.

Patients and methods

 Fifty consecutive patients undergoing upper pole hemi‐nephroureterectomy for ectopic ureter or ectopic ureterocele between 1980 and 1992 had their histology reviewed and assessed for dysplastic, inflammatory and obstructive change.

Results

 Segmental scarring and chronic and acute inflammatory change occurred consistently and the degree of inflammation seemed unaffected by ante‐natal diagnosis. Dysplasia was seen in 70% of patients with ureterocele and in only 30% of those with ectopic ureter. One patient had normal histology.

Conclusion

 There was no evidence of reversible histological change in patients with ectopic ureter and ectopic ureterocele who were diagnosed ante‐natally. Preservation of the upper pole of the kidney does not seem justified in the light of the histological evidence.
Kinetics of peptide‐induced release of inflammatory mediators by the urinary bladder
Authors: SABAN M.R. , SABAN R. , BJORLING D.E.
Published: November 2003

Objective

 To investigate the release of inflammatory mediators by the urinary bladder in response to exposure to pro‐inflammatory peptides.

Materials and methods

 Isolated guinea pig urinary bladder was incubated with 10 &mgr;mol/L each of substance P (SP), neurokinin A (NKA), calcitonin gene‐related peptide (CGRP), vasoactive intestinal peptide (VIP), octreotide acetate (a long‐acting analogue of somatostatin, SOM), or bradykinin (BK), and the release of histamine, prostaglandin (PG) E2 , PGF2&agr; and leukotriene B4 (LTB4 ) was determined during 0–5, 5–30 and 30–120 min after addition.

Results

 Substance P, NKA, VIP and BK stimulated the release of histamine, while CGRP and SOM suppressed the release to below the spontaneous rates. All peptides, except CGRP and SOM, stimulated the release of PGE2 between 0 and 30 min, and only VIP failed to stimulate the release of PGF2&agr; within 5 min of exposure. Substance P, NKA, VIP and BK stimulated the release of LTB4 and this required >5 min of exposure.

Conclusion

 These results indicate that the peptides evaluated induce an immediate and transient release of histamine and activation of cyclooxygenase and delayed activation of 5‐lipoxygenase. These actions may directly regulate the participation of these peptides in the pathogenesis of cystitis.
Pitfalls of measuring residual urine volume in orthotopic neobladders
Authors: OKADA H. , GOTOH A. , FUJISAWA M. , HARA I. , GOHJI K. , ARAKAWA S. , KAMIDONO S.
Published: November 2003

Objective

 To investigate the pitfalls of measuring post‐void residual urine volume (PVR) in patients with orthotopic neobladders, in an out‐patient clinic.

Patients and methods

 Fifteen patients with orthotopic neobladders were enrolled in the study; five patients had a colonic neobladder, five an ileocolic neobladder and five a sigmoid neobladder. The PVR was compared after measuring by catheterization under fluoroscopic monitoring after normal or forced voiding.

Results

 The PVR after forced voiding was always less than that after natural voiding, regardless of the type of neobladder.

Conclusions

 Patients with orthotopic neobladders may have a higher PVR after voiding naturally at home than when the PVR measured in hospital.
Transurethral prostatectomy: a prospective randomized study of conventional resection and electrovaporization in benign prostatic hyperplasia
Authors: SHOKEIR A.A. , AL‐SISI H. , FARAGE Y.M. , EL‐MAABOUD M.A. , SAEED M. , MUTABAGANI H.
Published: November 2003

Objective

 To compare transurethral electrovaporization of the prostate (TUVP) with conventional transurethral resection of the prostate (TURP) in the treatment of men with benign prostatic hyperplasia (BPH).

Patients and methods

 Seventy consecutive patients with symptomatic BPH and a prostate size of <60 g were prospectively randomized between equal treatment groups; one group underwent standard TURP and the other TUVP. Patients were assessed at baseline and 1, 3, 6 and 12 months after treatment, giving a mean (sd) duration of follow‐up of 14.4 (1.9) months (range 12–17). Variables evaluated included the duration of operation, catheterization and hospital stay, and changes in blood levels of haemoglobin, haematocrit and sodium 1 h after the operation. The American Urologic Association (AUA)‐7 symptom score, peak urinary flow rate (Qmax ), post‐voiding residual urine volume (PVR) and sexual function were also evaluated during the follow‐up.

Results

 Patients of both groups were balanced for the different baseline variables. The mean (sd) operative duration of TUVP was 52 (12.5) min, significantly longer than that of TURP, at 39.7 (8.8) min (P<0.001). One hour after TURP, patients had significantly lower levels of haemoglobin, haematocrit and Na. The mean (sd) duration of catheterization after TURP was 2 (0.8) days, significantly more than after TUVP, at 1.1 (0.4) days (P<0.001). The mean (sd) hospital stay was 2.5 (1) days after TURP and 1.5 (0.7) after TUVP (P<0.001). Compared with baseline values, the AUA‐7 symptom score, Qmax and PVR improved significantly in both groups at all intervals of follow‐up and there were no significant differences between the groups during the follow‐up. None of 15 potent men undergoing TURP and two of 18 potent men undergoing TUVP complained of impotence during the follow‐up.

Conclusions

 TUVP is as effective as TURP in the treatment of BPH in men with a prostate size of <60 g. TUVP has the advantages of less blood loss, less absorption of irrigant and a shorter hospital stay, but it had a significantly longer operative duration.
A possible explanation of wet and dry nights in enuretic children
Authors: HANSEN A.F. , JØRGENSEN T.M.
Published: November 2003

Objective

 To clarify the relationship between nocturnal urine production and the occurrence of both wet and dry nights in patients with nocturnal enuresis and to estimate the effect on nocturnal urine production of treatment with the antidiuretic hormone desmopressin in a group of enuretics with none or only a partial reduction in the number of wet nights in response to desmopressin treatment.

Patients and methods

 The nocturnal urine production of 60 children with monosymptomatic nocturnal enuresis was measured for 14 nights with no treatment (baseline) and for 14 nights with desmopressin treatment. Sixteen children having both wet and dry nights in the two periods were chosen for the subsequent analysis.

Results

 There was significantly less nocturnal urine production during desmopressin treatment (202 mL/night) than during the baseline period (279 mL/night; P<0.001) and a corresponding decrease in the number of wet nights, from 10 during baseline to five during desmopressin treatment. When expressed as mL/kg body weight per hour, the urine production during baseline was 0.89 on wet and 0.625 on dry nights (P<0.001), and during desmopressin treatment was 0.716 and 0.535, respectively (P<0.01).

Conclusion

 In this group of enuretics there was a clear reduction in the number of wet nights and in nocturnal urine production during desmopressin treatment, even though none became totally dry on desmopressin. There was a markedly higher nocturnal urine production on wet nights during both the baseline period and during desmopressin treatment. The higher urine production on wet nights could explain the enuretic episode, with urine production exceeding bladder capacity.
Preliminary experience with a urinary control device in the management of women with genuine stress incontinence
Authors: TINCELLO D.G. , BOLDERSON J. , RICHMOND D.H.
Published: November 2003

Objective

 To evaluate the efficacy and acceptability of the FemAssist™ urinary control device (Insight Medical UK Ltd).

Patients and methods

 Twenty‐seven women with cystometrically confirmed genuine stress incontinence performed a perineal 1 h pad‐test; the pad test was then repeated with the FemAssist device in place and the difference in pad weights compared with and without the device in place. Patients were given 100 mm visual analogue scales (VAS) to measure discomfort, acceptability and embarrassment associated with using the device.

Results

 The median (range) loss with and without the FemAssist device was 4.9 (0–65) mL and 21 (1–94), respectively (P<0.01); 20 patients were less wet when using the device. The median (range) VAS scores were; discomfort 35 (4–93), embarrassment 11 (0–75), and acceptability 65 (3–100). Discomfort was greater among the women with a greater loss. The acceptability correlated negatively with discomfort (r=–0.53) and negatively with embarrassment (r=−0.39); 15 patients (56%) reported that they would use the device in the long‐term.

Conclusion

 The FemAssist device produced a significant reduction in urine loss. The magnitude of benefit could not be predicted for an individual and the device was ineffective in some women. The use of the device was influenced by discomfort and associated embarrassment. The device has a role in the management of stress incontinence but patients must be assessed individually for suitability.
The natural history of pelvi‐ureteric junction obstruction in children presenting clinically with the complaint
Authors: RICKWOOD A.M.K. , GODIWALLA S.Y.
Published: November 2003

Objective

 To determine the natural history of untreated pelvi‐ureteric junction (PUJ) obstruction in children presenting clinically with the complaint.

Patients and methods

 The study comprised 42 children with anatomical PUJ obstruction (three with bilateral lesions) who were managed expectantly in the first instance, who had no immediately troublesome symptoms and differential function in the affected kidney(s) of >40%. They were followed by serial ultrasonography and dynamic diuresis renography. Pyeloplasty was advised for those with persistent symptoms or where differential renal function fell below 40%.

Results

 Only 15 children had presented with clearly relevant symptoms (loin pain or febrile urinary infection). Thirty‐four kidneys showed obstructive renographic curves initially and 38 had moderate or severe hydronephrosis. During the follow‐up (range 14–120 months, mean 56) patients remained asymptomatic except for four of the nine presenting with loin pain. Renographic curves were apt to change, with ‘obstruction’ increasing or decreasing with time, in the latter instance usually with lessening or resolution of hydronephrosis. Eleven patients underwent pyeloplasty, five for symptoms and six because of deteriorating renal function. Renal function did not decline in any patient with mild hydronephrosis and/or a non‐obstructive renographic curve at presentation, but did so disproportionately in those with severe hydronephrosis or a Type IV renographic curve.

Conclusions

 Patients effectively asymptomatic at presentation are likely to remain so. Expectant management is appropriate for patients with mild hydronephrosis and/or non‐obstructive renographic curves at the outset. Conversely, pyeloplasty may be advisable for those with severe hydronephrosis or Type IV renographic curves. Otherwise, for most the natural history of the complaint remains to be determined.
Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?
Authors: SABNIS R.B. , NAIK K. , PATEL S.H. , DESAI M.R. , BAPAT S.D.
Published: November 2003

Objective

 To determine the influence of pelvicalyceal angle, size of the lower calyx infundibulum and lower‐pole calyceal anatomy in predicting the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) for lower calyceal stones.

Patients and methods

 The study comprised a retrospective analysis of 133 patients, divided into 92 who were considered to be completely clear of fragments 6 months after ESWL and 41 who had residual stones. The pelvicalyceal angle, diameter of the lower calyx infundibulum and lower‐pole calyceal pattern were determined from intravenous urograms.

Results

 There were residual stones in 64% of the patients with a pelvicalyceal angle <90°, in 12% of those with an angle >90°, in 70% of patients with an infundibular diameter <4 mm, in 16% of those with a diameter >4 mm, in 78% with a complex calyceal pattern and 12% with a simple calyceal pattern.

Conclusions

 These three anatomical factors play a key role in predicting the clearance of stone and they should be assessed during intravenous urography to facilitate the planning of treatment for lower calyceal stones.
Histological evidence of decreased contralateral testicular blood flow during ipsilateral testicular torsion
Authors: CIFTCI A.O. , MÜFTÜOGLU S. , ÇAKAR N. , TANYEL F.C.
Published: November 2003

Objective

 To evaluate contralateral testicular blood flow by histological examination of arterioles during ipsilateral testicular torsion.

Materials and methods

 The study comprised two groups of 20 male albino rats (weight 250–270 g). The control group underwent a sham operation, while in the second group the left testes were twisted clockwise by 720°. All rats underwent bilateral orchidectomy 24 h after the initial intervention. Three slides for each testis (n=240) were evaluated randomly while unaware of treatment to determine the total number of arterioles, the percentage of collapsed and open arterioles, the diameter of open arterioles and the presence or absence of blood cells in the lumen. Differences were assessed using t‐tests for paired and independent samples.

Results

 Very few arterioles were collapsed in both testes of the control group and in the ipsilateral testes of the torsion group, but half the arterioles in the contralateral testes of the torsion group were collapsed. The difference between the contralateral testes of the two groups and between the ipsilateral and contralateral testes in the torsion group were significant. The diameter of uncollapsed arterioles did not differ significantly among either testes of the control and torsion groups and either testes in each group. Both testes in the torsion group had significantly more arterioles containing blood cells than those in the control group. The difference between the testes in the torsion group was also significant, but was not in the control group.

Conclusion

 There was histological evidence of decreased blood flow in the contralateral testis during unilateral testicular torsion; contralateral testicular damage during unilateral testicular torsion may result from hypoxia caused by decreased blood flow.
Management of the long‐term urinary catheter in the asymptomatic patient in the Accident and Emergency department
Authors: WISEMAN O.
Published: November 2003

Objective

 To determine the management of long‐term urinary catheters in the asymptomatic patient in the Accident and Emergency (A&E) Department.

Patients and methods

 Using data obtained from patient records, a retrospective study was undertaken of 41 patients who presented to the A&E department of a large district general hospital, on a total of 80 occasions in a 6‐month period, with blocked or bypassing long‐term urinary catheters, but who were otherwise asymptomatic.

Results

 In 78% of presentations, patients had one or more investigations performed on their urine, which in 15% was on urine aspirated through an old, unchanged catheter. In 23% of presentations, patients were discharged only having had their catheters flushed, and in only 41% was the catheter changed as the first line of management. Finally, in 63% of episodes, patients were discharged with antibiotics, despite having no symptoms of a urinary tract infection.

Conclusions

 All patients with long‐term urinary catheters will have bacteriuria and performing investigations on this urine if the patient is asymptomatic is a waste of resources. Long‐term urinary catheters which become blocked usually do so by encrustation on the luminal surface of the catheter. Flushing these catheters may dislodge some of these encrustations, but ideally the catheter should be changed. The prescribing of antibiotics to asymptomatic patients with bacteriuria has no proven benefit, but on the contrary it may cause harmful side‐effects and also selects for antibiotic‐resistant bacteria. These patients should be managed in the A&E department with a simple catheter change.
Evaluation of the utility of video‐urodynamics in children with urinary tract infection and voiding dysfunction
Authors: GLAZIER D.B. , MURPHY D.P. , FLEISHER M.H. , CUMMINGS K.B. , BARONE J.G.
Published: November 2003

Objective

 To assess the use of video‐urodynamic studies (VUDS) in children with urinary tract infection (UTI) and symptoms of voiding dysfunction (frequency, urgency, incontinence), to ascertain whether VUDS significantly assists in diagnosis and deciding treatment.

Patients and methods

 Over a 16‐month period, all children seen at our centre with a UTI in conjunction with previous symptoms suggestive of voiding dysfunction underwent free and pressure‐flow VUDS. Forty‐two children underwent VUDS and 38 (mean age 9 years, range 4–16, 15 male, 23 female) had sufficient information to be included in the study.

Results

 All children had a prior history of voiding dysfunction (mean 55 months). Only five patients were found to have reflux and three of these had associated detrusor instability. In addition, 24 of 33 patients who did not have reflux had abnormalities on urodynamic study, the most common problem being detrusor instability in 17 of 24 patients. Other abnormalities included sphincter dyssynergia (five patients), poor bladder compliance (two) and hypersensitivity on bladder filling (three).

Conclusion

 VUDS can provide information about the aetiology of UTI and voiding dysfunction in children that cannot be obtained from any other source. The results of VUDS can be used to select specific treatments, to avoid inappropriate therapy and to identify children who may benefit from follow‐up studies despite normal findings on voiding cysto‐urethrography. From these results, we believe that VUDS should be considered for children with UTI and voiding dysfunction.
Clinical review of 100 consecutive surgically treated patients with upper urinary tract transitional tumours
Authors: RACIOPPI M. , D’ADDESSI A. , ALCINI A. , DESTITO A. , ALCINI E.
Published: November 2003

Objective

 To determine the outcome of conservative or radical treatment in a retrospective study of 100 consecutive patients with upper urinary tract tumours.

Patients and methods

 From 1965 to 1995, 100 patients (78 men and 22 women, mean age 65 years, range 27–82) with upper urinary tract tumours were treated surgically, using nephroureterectomy with excision of a cuff of bladder in 53 and organ‐sparing treatment in 47. The outcome was assessed as survival and recurrence during a follow‐up of up to 15 years.

Results

 After radical and organ‐sparing treatment, the 15‐year cancer‐specific survival was 69% and 25%, respectively; metastases developed in 17% and 19% and global recurrence in 40% and 70%, respectively. While locoregional and bladder recurrences were similar in the two groups (9% vs 8% and 30% vs 38%, respectively), ureteric‐stump recurrence in the conservative group was 23%. There were no significant differences in survival rates between patients with single or multiple presentation, or for localization, while the grading of the lesions proved to be an accurate prognostic indicator.

Conclusion

 This experience of urothelial neoplasia of the upper tract highlights the difficulty in diagnosing this pathology and in entrusting screening to a non‐invasive technique such as urinary cytology. The percentage recurrence observed after organ‐sparing therapy indicates that this treatment should be used cautiously.
Collagen for female genuine stress incontinence after
Authors: SWAMI S. , BATISTA J.E. , ABRAMS P.
Published: November 2003

Objective

 To evaluate the medium‐term outcome of gluteraldehyde cross‐linked (GAX) collagen in the treatment of genuine stress incontinence in women.

Patients and methods

 The study comprised 111 women (age range 33–90 years) with genuine stress incontinence who were treated with para‐urethral collagen injections between 1990 and 1995. The patients were followed prospectively and their clinical outcome documented. Pre‐ and post‐operative urodynamic data were examined to determine any prognostic indicators.

Results

 The overall results at a minimum 2‐year follow‐up (mean 3.3) showed 25% of patients to be dry and a further 40% improved. Although there were significant changes in some urodynamic values, no predictive factors of success were identified. Previous surgery for stress incontinence did not influence the final outcome.

Conclusion

 Para‐urethral collagen injection is a safe and relatively simple procedure with acceptable results at the medium‐term follow‐up. It could be offered as a primary or secondary procedure to women with genuine stress incontinence who are unable or unwilling to undergo surgical treatment. Objective urodynamic assessment revealed no factors of prognostic significance.
Variability in penile appearance and penile findings: a prospective study
Authors: VAN HOWE R.S.
Published: November 2003

Objective

 To document prospectively variation in penile morphology and clinical findings in children.

Patients and methods

 The study comprised a consecutive sample of 468 boys whose consultation with a physician included a genital examination in a primary‐care paediatric practice in rural northern Wisconsin.

Results

 Circumcised boys under 3 years of age were significantly more likely to have a partially or completely covered glans, a reddened meatus, balanitis, or trapped epithelial debris, and less likely to have a fully exposed glans than were circumcised boys of 3 years or older. Among the 238 boys under 3 years, those circumcised were significantly more likely to have non‐cosmetic problems, including coronal adhesions, trapped epithelial debris, a reddened meatus, preputial stenosis (phimosis) and balanitis, than were boys with a foreskin. Findings in the circumcised group under 3 years included: fully exposed glans (n = 78, 35.6%), partially covered glans (n = 67, 30.6%), adhesions (25.6%), completely covered glans (20.1%), entrapped desquamated epithelial debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and preputial stenosis (0.9%). Only two genital examinations in boys with foreskins revealed pertinent findings. Coronal adhesions develop in circumcised boys at 2–6 months of age and usually resolve by 24 months. The degree of skin covering the glans after neonatal circumcision peaks at 6 months of age.

Conclusions

 There are significant variations of appearance in circumcised boys; clinical findings are much more common in these boys than previously reported in retrospective studies. The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) affects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds.
Prognostic factors in squamous cell carcinoma of the penis and implications for management
Authors: ADEYOJU A.B. , THORNHILL J. , CORR J. , GRAINGER R. , McDERMOTT T.E.D. , BUTLER M.
Published: November 2003

Objective

 To determine the clinical and pathological features, methods and outcome of management in squamous cell carcinoma of the penis (SCCP).

Patients and methods

 A retrospective study was carried out of 42 patients (mean age 63 years, range 28–86) with a histological diagnosis of SCCP. The disease stage, grade, treatment of primary tumour, lymph node disease and survival were recorded; the mean follow‐up was 4 years (range 1.5–25).

Results

 The disease stage was T1 in 24 patients (57%), T2 in 14 (33%), T3 in three (7%) and T4 in one (2%); the tumour grade was well differentiated in 20 (47%), moderately differentiated in 14 (33%) and poorly differentiated in three (7%). Eight patients had histologically confirmed inguinal node disease at presentation, six of whom underwent lymph node dissection, while two underwent radiotherapy. Five patients developed inguinal node disease during follow‐up (mean 10 months, range 4–21). Three of these patients were irradiated and two underwent lymph node dissection. Six patients (14%) had local recurrence, five of whom were managed surgically. One patient developed a local recurrence 11 years after initial surgery. Seven patients died from their disease (17%); four died within 2 years, being patients with high‐stage and/or high‐grade disease.

Conclusions

 Modern management should include a standard staging classification and treatment protocols to maximize survival.
The role of vimentin expression in predicting the long‐term outcome of patients with localized renal cell carcinoma
Authors: SABO E. , MISELEVICH I. , BEJAR J. , SEGENREICH M. , WALD M. , MOSKOVITZ B. , NATIV O.
Published: November 2003

Objective

 To evaluate the prognostic significance of vimentin intermediary filament expression by tumour cells in patients with renal cell carcinoma (RCC) localized to the kidney.

Patients and methods

 Thirty‐nine patients with localized RCC (pT1,pT2) were assessed in a retrospective study. Tumour cells were evaluated immunohistochemically for vimentin, epithelial membrane antigen (EMA) and polyclonal cytokeratin expression. The prognosis of cases expressing positive vimentin expression in tumour cells was compared with that of cases with no expression. Additional clinical information and conventional histological grade of the tumours were also included in the survival analysis.

Results

 Univariate analysis of patient survival and tumour recurrence showed a statistically significant association between vimentin‐positive tumours and poor patient outcome; the EMA stain showed borderline significance and histological grade was significantly associated with prognosis. The combination of tumour vimentin expression and histological grade provided a better predictor of prognosis and proved to be the best independent prognosticator of survival by multivariate analysis.

Conclusions

 Vimentin expression by tumour cells provides important prognostic information for patients with localized RCC; the combination of vimentin expression and histological grade is a better predictor for survival than grade or vimentin expression alone.
Supravesical diversion for incontinence: a long‐term follow‐up
Authors: Singh G. , Wilkinson J.M. , Thomas D.G.
Published: November 2003

Objectives To report the long‐term follow‐up of patients with an ileal conduit urinary diversion, constructed for intractable incontinence in patients with benign disease where the native bladder was left in situ, and to determine the fate of the bladder and the effects on the upper tracts.

Patients and methods Ninety‐three patients (mean age at operation 50 years, range 8–78) were followed for a minimum of 2 (mean 5) years after undergoing an ileal conduit urinary diversion. Seventy‐one patients (76%) had neurological disease (18 traumatic and 53 non‐traumatic) and the single largest group of patients (28) suffered from disseminated sclerosis. Twenty‐two patients with no obvious neurological disease underwent the procedure for unmanageable incontinence or intractable bladder symptoms or for interstitial cystitis. The patients were assessed for problems in the bladder remnant, stomal problems and upper tract changes following surgery.

Results Forty‐eight patients (52%) had recurrent vesical infections and pyocystis and of these, 23 (48%) required admission for in‐patient bladder irrigations. To control recurrent bladder problems, five patients required creation of a vesico‐vaginal fistula; this did not suffice in two and they subsequently underwent cystectomy; in total, five patients underwent cystectomy. Twenty‐nine patients (31%) had stomal problems, those with the skin being commonest. Parastomal hernia repair was required in 10 (10%) patients and three had further surgery for recurrence. Of 83 patients with normal upper tracts before diversion, post‐operative radiological assessment showed upper tract dilatation in 28 (34%) and in 10 (12%) this was bilateral. In one patient with a neuropathic bladder, the ileal diversion resulted regression of the dilated upper tracts.

Conclusions Supravesical diversion is safe and well tolerated but assessing the long‐term follow‐up, the incidence of bladder problems in over half these patients and upper tract changes in over a third suggests an indefinite follow‐up is mandatory. Despite these problems, most patients are delighted with the outcome of their surgery.
Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study
Authors: Ahmed M. , Bell T. , Lawrence W.T. , Ward J.P. , Watson G.M.
Published: November 2003

Objective To compare transurethral microwave thermotherapy (TUMT) with urethral cooling in a high‐energy protocol (Prostatron version 2.5), with transurethral resection of the prostate (TURP) for the treatment of symptomatic, uncomplicated, urodynamically obstructive benign prostatic hyperplasia (BPH).

Patients and methods Patients with moderate to severe symptomatic, uncomplicated BPH, unequivocally obstructed as assessed from the Abrams‐Griffith nomogram, who were technically suitable for either form of treatment, were randomized into two groups of 30 patients each to undergo either TUMT or TURP. Five efficacy variables, i.e. the American Urological Association (AUA) symptom score, maximum flow rate (Qmax), post‐void residual urine volume (PVR), voiding pressure at maximal flow (Pdet max) and prostatic volume determined by ultrasonography (PV) were measured initially and 6 months after treatment using a defined protocol. Complications were recorded during and up to 6 months after the treatment. As the variables were independent, the data were analysed using a paired t‐test for each to assess the treatment effect for each group.

Results After TURP, all the variables improved significantly; after TUMT, the symptoms improved both clinically and statistically (P<0.001), with the mean AUA symptom score decreasing from 18.4 to 5.2. However, none of the objective variables improved after TUMT. The energy delivered under software control correlated poorly with prostatic volume (r=0.322). TUMT had considerably lower morbidity than TURP, but failure of ejaculation occurred in four of 18 sexually active men after TUMT.

Conclusions Despite considerable improvement in their symptoms, TUMT using the Prostatron and Prostasoft v2.5 did not alleviate obstruction in patients with BPH. Patients treated using TUMT controlled by this software should be informed of the possibility of ejaculatory dysfunction.
The influence of pH on urinary ionized [Ca+]: differences between urinary tract stone formers and normal subjects
Authors: Langley S.E.M. , Fry C.H.
Published: November 2003

Objective
 To assess the role of pH in determining the solubility of Ca2+ in urine from normal subjects and stone formers and to determine the conditions which cause the formation of crystalline products.

Materials and methods
 Urine, collected from normal subjects and urinary tract stone‐formers, was used in vitro. The concentration of ionized calcium, [Ca2+ ], and pH were measured with ion‐selective electrodes and the formation of crystalline products measured as the change in turbidity of the specimen. The composition of the crystalline products was analysed by infra‐red spectroscopy.

Results
 The [Ca2+ ] decreased with increasing pH and showed a biphasic relationship with a critical pH (pHn ) at which Ca‐containing precipitates appeared. Compared with normal subjects, the mean (sd) value of pHn was significantly lower in urine from stone‐formers, at 7.67 (0.62) and 7.21 (0.54), respectively, and nearer to their voided pH of 5.92 (0.70) and 6.26 (0.71), respectively. The lower pHn in stone‐formers could not be explained by altered concentrations or binding properties of Ca2+‐binding ligands. pHn increased after diluting the urine and the value of pHn was strongly dependent on the [Ca2+ ] at a standardized pH.

Conclusions
 Crystalline precipitates appear in urine at a critical pH which is closer to the voided pH in stone‐formers than in normal subjects and might explain the greater propensity of this group to form stones. The value of pHn is critically dependent on the urinary [Ca2+ ] and manoeuvres which reduced its concentration would reduce the tendency to form stones.
An in vitro comparison of urease‐induced encrustation of JJ stents in human urine
Authors: Desgrandchamps F. , Moulinier F. , Daudon M. , Teillac P. , Le Duc A.
Published: November 2003

Objective
 To report the results of a comparative study of in vitro encrustation of five different types of JJ stents in human urine.

Materials and methods  Samples of five JJ stents (polyurethane, silicone, Percuflex, C‐Flex and hydrogel‐coated C‐Flex) were immersed for 24 h at 37°C in fresh human urine supplemented with urease, and the surface photographed and dried. The crystals formed on the stents were dissolved in hydrochloric acid and the calcium and magnesium concentrations determined.

Results  Large crystals were deposited on the surface of the hydrogel‐coated C‐Flex stent and significantly higher levels of calcium and magnesium salts were obtained after acidic dissolution. There were no differences in crystal deposition among the remaining stents.

Conclusion
 Hydrogel‐coated stents have an higher risk of becoming encrusted in vitro than do uncoated stents made of the same substrate polymer or made of different materials. These results emphasize the need for the regular follow‐up of patients with hydrophilic stents in place.