bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibroblast growth factor receptor‐2 mutation analysis in human prostate cancer
Authors: Mehta P. , Robson C.N. , Neal D.E. , Leung H.Y.
Published: March 2003

Objective To assess whether mutations in the hot‐spots of the fibroblast growth factor (FGF) receptor‐2 gene (FGFR2, exons encoding the IIIa, IIIb, IIIc and transmembrane domain, TMD) are associated with the development of prostate cancer, as the IIIb variant is the specific receptor for FGF7/KGF, an androgen‐inducible paracrine factor regulating prostatic growth.

Materials and methods Single‐strand conformational polymorphism‐polymerase chain reaction (SSCP‐PCR) and cycle‐sequencing analysis were used to screen FGFR2 mutations in 30 patients with prostate cancer; corresponding blood samples were analysed from 11 of the patients. The human prostate cell lines, LNCaP, PC3, DU145, PNT1A and PNT1B were also examined. In addition, 10 foci of invasive cancer from three patients who underwent radical prostatectomy were also assessed.

Results Positive controls containing FGFR2 mutations (Crouzon disease and Pfieffer syndrome) were confirmed by SSCP‐PCR and sequencing. Analysis of all prostate tumour samples and prostate‐derived cell lines revealed no polymorphisms or mutations in the IIIa, IIIb, IIIc and TMD regions of FGFR2.

Conclusion
FGFR2 mutations in the‐FGF binding domain and the TMD are not frequent events in human prostate cancer.
A comparison of fluid absorption during transurethral resection and transurethral vaporization for benign prostatic hyperplasia
Authors: Çetinkaya M. , Öztürk B. , Akdemir Ö. , Özden C. , Aki F. T.
Published: March 2003

Objectives To compare the absorption of irrigant fluid during transurethral vaporization of the prostate (TUVP) and transurethral resection of the prostate (TURP).

Patients and methods Thirty patients with clinical benign prostatic hyperplasia were randomly assigned to undergo TURP or TUVP; 1.5% glycine + 1% ethanol solution was used as the irrigating solution. The volume of irrigant absorbed during surgery was estimated from the ethanol concentration in the patient's expired breath, sampled every 10 min.

Results In both groups, the estimated absorbed fluid volume increased with the duration of surgery (P < 0.05). At the end of surgery, the mean (median, range) fluid absorption during TUVP was 672 (606, 0–1400) mL and during TURP was 1347 (975, 453–2965) mL; the difference was statistically significant (P < 0.05).

Conclusion Although TURP has a greater associated risk of fluid absorption than TUVP there may still be severe fluid absorption with the latter. Even though TUVP is potentially less harmful than TURP in poor‐risk patients, ethanol monitoring is beneficial for increasing patient safety.
The correction of penile curvature with the Essed–Schröder technique: a long‐term follow‐up assessing functional aspects and quality of life
Authors: Friedrich M.G. , Evans D. , Noldus J. , Huland H.
Published: March 2003

Objectives To investigate, in a retrospective analysis using a detailed questionnaire, the long‐term functional results in and quality of life (QoL) of patients after undergoing the Essed–Schröder procedure, a standard technique for correcting penile curvature.

Patients and methods From 1994 to 1999, 40 patients (median age 24 years) had their penile curvature corrected using a modified Essed–Schröder technique. Assessments by the investigators and a self‐completed questionnaire were used to evaluate the functional and cosmetic aspects of the procedure, and QoL issues.

Results Complete follow‐up data were available in 31 of the 40 (78%) patients (19 with congenital curvature and 12 with Peyronie's disease). The median follow‐up was 22 months. The degree of penile angulation before surgery was estimated as < 45° in five patients, 45–90° in 22 and > 90° in four. In 21 patients (68%) sexual intercourse was uncomfortable or impossible; 26 (84%) reported an impaired QoL because of the penile curvature. After surgery the cosmetic and functional result was good or sufficient in 25 patients (81%); all 25 were able to have sexual intercourse with no problems. Penile shortening (> 2 cm) was reported by six patients. A significant improvement in QoL was reported by 15 patients (48%), but of the 12 patients with Peyronie's disease before surgery, six reported impaired rigidity and two recurrence of their penile curvature afterward. Whereas only seven of 12 patients with Peyronie's disease reported good functional results, 18 of the 19 with congenital curvature reported good or excellent results after surgery.

Conclusion The Essed–Schröder method is a simple operation which provides good functional and cosmetic results. Patients with congenital curvature of the penis have better results than those with Peyronie's disease.
Re‐operative hypospadias repair using the Snodgrass incised plate urethroplasty
Authors: Shanberg A.M. , Sanderson K. , Duel B.
Published: March 2003

Objective To retrospectively assess the results of tubularized incised plate (Snodgrass) urethroplasty in a series of re‐operative hypospadias repairs in children.

Patients and methods The study comprised a follow‐up (from 1996 until 2000) of 13 patients (mean age 7.5 years, range 13 months to 27 years) who had at least one previous hypospadias repair and who then underwent a reconstruction using the Snodgrass repair. In all cases the urethroplasty was covered with an additional layer of subcutaneous tissue. The original location, associated complications and results were recorded. In some cases, the long‐term follow up was conducted by telephone.

Results Associated complications before the Snodgrass repair included urethral stricture in two, fistula in three and persistent chordee in one patient. The mean (range) follow‐up was 22 (9–34) months. The cosmetic results were excellent, with two complications (one patient with a glans dehiscence and a urethrocutaneous fistula, and a second with meatal stenosis). The remaining patients required no further procedures and were voiding normally at the last follow‐up.

Conclusion Excellent cosmetic and functional results can be obtained using the Snodgrass incised plate urethroplasty for re‐operative hypospadias repair. Only one patient in this series had an initial operation in which the urethral plate was previously incised. Therefore, caution should be used when considering an incised plate urethroplasty in these patients.
Scintigraphic screening for renal damage in siblings of children with symptomatic primary vesico‐ureteric reflux
Authors: Bonnin F. , Lottmann H. , Sauty L. , Garel C. , Archambaud F. , Baudouin V. , El Ghoneimi A. , Loirat C. , Bok B.D. , Aigrain Y.
Published: March 2003

Objective To define prospectively the incidence of renal parenchymal lesions in the siblings of patients treated at one institution for primary vesico‐ureteric reflux (VUR).

Patients and methods From January 1997 to October 1998, a prospective study including renal scintigraphy (using dimercaptosuccinic acid, DMSA) and a radionuclide cystogram was proposed systematically to the asymptomatic siblings of children treated for primary VUR. The radionuclide cystograms were interpreted as showing the presence or absence of VUR and the DMSA scan as symmetrical or asymmetrical differential function, with or with no renal defect.

Results Fifty‐five families gave informed consent, of whom 46 completed the study (eight refused secondarily and one was omitted by exclusion criteria), representing 46 symptomatic patients and 65 siblings. There were 17 siblings with VUR (26%) including two of 13 infants and 15 of 52 children aged > 18 months. One radionuclide cystogram failed. Of the 17 refluxing siblings, four had a history of symptomatic urinary tract infection; 62 of the 65 siblings had a DMSA scan, of which 56 were normal and six (10%) showed abnormalities (five asymmetrical differential function and one parenchymal defect). Only one of these six patients had VUR at the time of the evaluation and only one had a small kidney detected by ultrasonography on one side (and no VUR). There were no adverse effects associated with screening.

Conclusion This study confirms a significant overall incidence of VUR (26%) in the asymptomatic siblings of patients treated for primary VUR. From the results of the DMSA scan (only one sibling had a parenchymal defect), the systematic screening of asymptomatic siblings does not appear to be beneficial.
Are urologists prepared for latex‐allergic patients?
Authors: Sidwell R.U. , Green J.S.A. , Basarab T.
Published: March 2003

Objective To determine how prepared operating departments are to manage latex‐allergic patients, and particularly urologists, because the highest incidence of latex allergy occurs in patients with spina bifida who undergo frequent urological procedures.

Methods A standard questionnaire about the provision of latex‐free equipment within operating theatres was completed by the 72 hospitals surveyed (33 district general, 27 teaching, six children's and six private hospitals).

Results Anaesthetic latex‐free equipment was available in five of the children's hospitals, 56% of the teaching hospitals, 45% of the district general hospitals and two of the private hospitals. A latex‐free catheter only was provided in two of the children's hospitals, 30% of the teaching hospitals and 12% of the district general hospitals. In addition, one of the children's hospitals and one of the private hospitals had a comprehensive range of urological latex‐free equipment available.

Conclusion This survey shows that many hospitals are inadequately prepared to manage latex‐allergic patients, because they lack anaesthetic and urological latex‐free equipment.
Cost‐effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect
Authors: Berdeu D. , Sauze L. , Ha‐Vinh P. , Blum‐Boisgard C.
Published: March 2003

ObjectiveTo compare the cost‐effectiveness of surgery and topical steroids as treatments for phimosis (defined as a clinically verifiable, pathological, cicatricial stenosis of the prepuce) and to evaluate the financial basis of these treatments.

MethodsData on treatment using topical steroids was obtained from published reports and those for circumcision from claims by private hospitals for children < 13 years old registered at the health insurance department of our facility. The estimate of the French national financial cost of the treatments for 1998 was calculated from public and private institutional information.

ResultsTreatment with topical steroids for 4–8 weeks was successful in ≈ 85% of patients (mean age 5 years) and had no side‐effects; the remaining 15% were treated by circumcision. Topical steroid therapy costs (in French francs) F 360 per patient. For those primarily treated by circumcision (81 boys, mean age 4.3 years) and diagnosed as having phimosis, the cost was F 3330 per patient in the private sector. The total number of circumcisions performed in France, regardless of sector (public or private) for 1998 was estimated to be 51 080, which represents an annual cost of F 195.7 million.

ConclusionAs topical pharmacological treatment avoids the disadvantages, trauma and potential complications of penile surgery, including anaesthesia‐related risks, the use of topical steroids as a primary treatment appears to be justified in boys with clinically verifiable phimosis. This treatment could reduce costs by 75%, which represents a potential annual saving of ≈ F 150 million.
Complications of retroperitoneoscopic surgery at one centre
Authors: Kumar M. , Kumar R. , Hemal A.K. , Gupta N.P.
Published: March 2003

Objective To evaluate the complications of retroperitoneoscopic urological surgery at one centre and to analyse their causes and means of prevention.

Patients and methods The procedural details and complications were analysed retrospectively in 316 patients (aged 4–88 years) who underwent retroperitoneoscopic urological surgery between March 1994 and January 2000 at our centre. Nephrectomies and nephroureterectomies for benign and malignant diseases were the most common procedures. Other indications included urolithiasis, adrenal diseases, pelvi‐ureteric junction obstruction, chyluria, retrocaval ureter and malignant retroperitoneal lymph node enlargement. The specimens were retrieved intact by enlarging the port sites.

Results The mean (range) operative duration was 104.9 (30–400) min, the blood loss 130.86 (25–1200) mL and the hospital stay 3.2 (1–10) days; 3.5% of the patients had a major complication, including seven vascular injuries, five of which required immediate conversion to open surgery. Four patients (1.2%) had other major complications including colonic injury, retroperitoneal collections and incisional hernia. There were 50 minor complications (15.8%) of which peritoneal tears (17) were the commonest. Port‐site infections and subcutaneous emphysema contributed 2.2% each.

Conclusions As the stages of retroperitoneoscopic surgery become standardized and the outcome predictable, it is rapidly becoming accepted as an important method of treatment. The complications are few and predominantly minor. Increasing experience leads to a decrease in the complication rates. Individual surgeons can identify the common complications in their practice, ascertain the possible causes and devise methods of prevention.
An epidemiological study of nocturnal enuresis in Taiwanese children
Authors: Chang P. , Chen W.J. , Tsai W.‐Y. , Chiu Y.‐N.
Published: March 2003

Objective To estimate the prevalence of primary nocturnal enuresis (PNE) in Taiwanese children, and to examine factors associated with PNE and its severity.

Subjects and methods In all, 1683 questionnaires were sent to parents of schoolchildren aged 6–11 years randomly selected from three primary schools in Taipei City, Taiwan. The questionnaire was designed to collect information about the prevalence of and factors associated with PNE.

Results Of the questionnaires distributed, 1176 (70%) were completed. PNE was reported in 92 (8%) of the children; nine (10%) of these children were wet >3 nights per week. Factors associated with PNE included male gender, deep sleep, divorced parents or separated family and a positive family history of enuresis. Of these factors, only those children with deep sleep were more likely to have > 3 wet nights per week.

Conclusion The prevalence of and factors associated with PNE in Taiwan are similar to those reported in Western countries, but the percentage of children with severe enuresis is lower than in Sweden, France and Turkey. Deep sleepers are more likely to have severe enuresis.
The Dutch cohort of sildenafil users: baseline characteristics
Authors: Souverein P.C. , Egberts A.C.G. , Sturkenboom M.C.J.M. , Meuleman E.J.H. , Leufkens H.G.M. , Urquhart J.
Published: March 2003

Objective To identify a Dutch cohort of sildenafil users and describe their baseline characteristics.

Patients and methods Each pharmacy in The Netherlands (n = 1571) was asked to identify prospectively the first 20 sildenafil prescriptions in their pharmacy over 1 year, and to complete and return a registration form. The collected data included patient characteristics, the details of the sildenafil prescription (date, prescriber, number of prescriptions, dosing), and the use of co‐medication by the patient in the year preceding the sildenafil prescription.

Results Data were collected from 4460 sildenafil prescriptions during the year under study, relating to 3477 individual patients. Most of the cohort had cardiovascular morbidity or diabetes. Sildenafil seems to have been used by a new, previously untreated population of patients with erectile dysfunction. In addition, 69 men were identified who could have been using nitrates and sildenafil concomitantly.

Conclusion A cohort of patients using sildenafil was identified and characterized; they appeared to be representative of sildenafil users in The Netherlands. This cohort will be followed prospectively to evaluate the medical status (particularly cardiovascular) of the patients with time.
Histopathological mapping of open testicular biopsies in patients with unobstructive azoospermia
Authors: Altay B. , Hekimgil M. , Çikili N. , Turna B. , Soydan S.
Published: March 2003

Objective To evaluate, in patients with unobstructive azoospermia, the heterogeneity of spermatogenesis within the testes and thus whether there is any region of advanced spermatogenesis.

Patients and methods Seventy infertile men (mean age 34 years, sd 5.01) with no varicoceles or testicular atrophy had bilateral open testicular biopsies taken from six different sites. For each biopsy specimen the number of seminiferous tubules and of tubules with sperm maturation were counted (by light microscopy at × 400). The ratio of tubules with active spermatogenesis to the total number was calculated for each biopsy sample.

Results The mean (sd) right and left testicular volumes were 19.82 (7.8) and 18.84 (7.89) mL, respectively; the patients' follicle‐stimulating hormone level was 8.34 (1.17) IU/mL. On sextant biopsy spermatozoa were detected in 42 of the 70 patients (60%). The mean (sd) ratio of tubules with spermatozoa was 5.23 (0.8)% for the right and 5.37 (0.76)% for the left testes. There was no statistically significant difference in the ratio of seminiferous tubules positive for spermatozoa at the different biopsy sites in either the right or left testis. Spermatozoa were identified in only one to three biopsy sites in almost half of those with maturation arrest; this ratio increased to 74% in patients diagnosed as having Sertoli‐cell‐only syndrome with focal spermatogenesis.

Conclusion There is no region of the testis that is rich or advanced in spermatogenesis in patients with unobstructive azoospermia. Without multiple testicular biopsy it is possible to miss advanced spermatogenesis in some unobstructed patients. The sextant testis biopsy is a reliable method for detecting the presence and exact location of seminiferous tubules with spermatozoa in patients with unobstructive azoospermia.
How widespread are the symptoms of an overactive bladder and how are they managed? A population‐based prevalence study
Authors: Milsom I. , Abrams P. , Cardozo L. , Roberts R.G. , Thüroff J. , Wein A.J.
Published: March 2003

Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.

Subjects and methods Data were collected using a population‐based survey (conducted by telephone or direct interview) of men and women aged  40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms.

Results In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged  40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment.

Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.
Human papillomaviruses 6/11, 16/18 and 31/33/51 are not associated with squamous cell carcinoma of the urinary bladder
Authors: Westenend P.J. , Stoop J.A. , Hendriks J.G.M.
Published: March 2003

Objective To assess high‐risk human papillomavirus (HPV), mainly HPV type 16, 18, 31 and 33 (an important aetiological factor in squamous cell carcinoma, SCC, of the anogenital region) in SCC of the urinary bladder.

Material and methods Sixteen SCC from the urinary bladder were evaluated using non‐isotopic in situ hybridization with a sensitive detection system for the presence of high‐risk HPV 16/18, or 31/33/51, and for HPV6/11, a low‐risk type commonly found in condylomata. Previously published studies were also reviewed and assessed.

Results No high‐risk HPV was found in any of the SCC of the bladder evaluated. Previous reports identified nine HPV‐positive SCC of a total of 105, including the present series. In four of these positive cases, HPV types were found that are considered a high risk in anogenital carcinomas.

Conclusion From the present and previous results, we conclude that HPV has no major role in the pathogenesis of SCC of the urinary bladder.
Value of the serum prostate‐specific antigen‐α1‐antichymotrypsin complex and its density as a predictor for the extent of prostate cancer
Authors: Hara I. , Miyake H. , Hara S. , Yamanaka N. , Ono Y. , Eto H. , Takechi Y. , Arakawa S. , Kamidono S.
Published: March 2003

Objective To determine whether serum levels of the prostate‐specific antigen‐α1‐antichymotrypsin complex (PSA‐ACT) and its density (ACTD) in patients scheduled to undergo radical prostatectomy for clinically localized prostate cancer can predict organ‐confined vs extraprostatic disease.

Patients and methods Serum samples were obtained from 62 patients with clinically localized prostate cancer before they underwent radical prostatectomy. PSA and PSA‐ACT were measured using immunofluorometric techniques with different monoclonal antibodies against PSA and ACT, respectively. Furthermore, the PSA and PSA‐ACT densities of the whole prostate (PSAD and ACTD, respectively) were calculated. The relationships of serum PSA, PSA‐ACT, PSAD, ACTD and the pathological stage of the prostatectomy specimens were analysed.

Results The disease was organ‐confined or extraprostatic in 30 and 32 men, respectively. In men with organ‐confined cancer, the mean PSA and PSA‐ACT levels were significantly lower than in those with extraprostatic disease. Furthermore, there were significantly higher mean PSAD and ACTD levels in men with extraprostatic than with organ‐confined disease. There were also significant differences in PSA, PSA‐ACT, PSAD and ACTD levels at each pathological stage, whereas there was no significant association between these variables and the Gleason score. Receiver‐operating characteristic curve analysis for detecting organ‐confined disease showed that PSA‐ACT and ACTD had a larger area under the curve than PSA and PSAD, respectively, but these differences were not significant. Furthermore, PSA‐ACT and ACTD provided significantly better sensitivity for detecting organ‐confined disease than PSA and PSAD, respectively.

Conclusions Measuring PSA‐ACT and ACTD may improve the preoperative evaluation of patients scheduled to undergo radical prostatectomy, because these factors better differentiate extraprostatic from organ‐confined disease than PSA and PSAD.
Brucellar epididymo‐orchitis in Saudi Arabia: a retrospective study of 26 cases and review of the literature
Authors: Memish Z.A. , Venkatesh S.
Published: March 2003

Objective To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo‐orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously.

Patients and methods In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo‐orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of  1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo‐orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis.

Results Epididymo‐orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25–44 years old; ≈ 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory‐acquired brucellosis. Six patients had unilateral epididymo‐orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2–5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year.

Conclusion In brucellosis‐endemic areas, clinicians encountering epididymo‐orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo‐orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo‐orchitis.
p53, p21 and mdm2 expression vs the response to radiotherapy in transitional cell carcinoma of the bladder
Authors: Røtterud R. , Berner A. , Holm R. , Skovlund E. , Fosså S.D.
Published: March 2003

Objective To identify, in a retrospective study, possible molecular markers predictive of radioresponsiveness in patients with transitional cell carcinoma (TCC) of the bladder.

Patients and methods Patients with T2–T4a TCC treated with preoperative radiotherapy and cystectomy were included in the study if their cystectomy specimen was pT3b (in 42) or pT0 (in 17). Because treatment schedules changed over time, radiotherapy was given either as 2 Gy × 23 over 4–5 weeks with cystectomy 4–5 weeks later (in 23), or as 4 Gy × 5 during 1 week with cystectomy in the following week (in 36 patients). Protein expression of p53, mdm2 and p21 (CDKN1 A/WAF1/CIP1/SDI1) was assessed immunohistochemically in biopsies taken before radiotherapy.

Results There was no difference in protein expression when comparing all patients with pT0 and pT3b. However, for patients receiving 46 Gy, increased p53 expression (but not p21 or mdm2) predicted the absence of residual tumour (P = 0.005): six of seven patients with > 50% p53 expression had pT0 in the cystectomy specimen, whereas 10 of 12 patients with  5% expression had pT3b. Over‐expression of p53 correlated with longer overall (P = 0.045) and cancer‐specific survival (P = 0.020).

Conclusion The expression of mdm2 or p21 did not predict radioresponsiveness in patients with TCC of the bladder. The role of p53 remains unclear; the view that p53 over‐expression confers radioresistance in bladder cancer is not supported.
An autoradiographic study of regional blood flow distribution in the rat kidney during ureteric obstruction— the role of vasoactive compounds
Authors: Sweeney P. , Young L.S. , Fitzpatrick J.M.
Published: March 2003

Objective To determine the changes in regional renal blood flow during ureteric obstruction and to examine the role of vasoactive mediators in effecting these changes.

Materials and methods Renal blood flow in Sprague–Dawley rats was assessed after periods of ureteric obstruction using a quantitative autoradiographic technique based on Kety's theory of diffusion of an inert tracer (14C‐iodoantipyrine). Prostaglandins, thromboxanes and renin‐angiotensin were inhibited pharmacologically using diclofenac sodium and enalapril.

Results Baseline blood flow to the outer cortex, inner cortex and medulla was 807, 258 and 105 mL/100 g/min, respectively. There was an increase in outer cortical blood flow after 10 min of ureteric obstruction which became significant at 30 min (P < 0.05). There was a significant decrease in inner cortical and medullary blood flow at 30 min, to 210 and 68 mL/100 g/min, respectively (P < 0.05). Diclofenac sodium abolished the increase in outer cortical blood flow. After 24 h of unilateral ureteric obstruction, outer cortical blood flow decreased to 492 mL/100 g/min; inner cortical blood flow also decreased but to a lesser extent, to 190 mL/100 g/min. Inhibition of prostaglandins, thromboxanes and the renin‐angiotensin system reduced the degree of renal vasoconstriction but there was still a significant decrease in outer cortical perfusion despite the presence of these blocking agents.

Conclusions The control of the renal vasculature involves a complex interplay between a variety of vasoactive mediators. Quantitative autoradiography offers the opportunity to evaluate changes in regional renal perfusion with high resolution and will allow a greater understanding of the pathophysiology of renal diseases.
The association of androgen‐ and oestrogen‐receptor gene polymorphisms with urolithiasis in men
Authors: Chen W.‐C. , Wu H.‐C. , Lin W.‐C. , Wu M.‐C. , Hsu C.‐D. , Tsai F.‐J.
Published: March 2003

Objective To evaluate the association of urolithiasis with polymorphic microsatellite (encoding cytosine, adenine, and guanine, CAG) repeats in the exon 1 region of the androgen receptor (AR) gene and thymine/adenine (TA) repeats in the oestrogen receptor (ER).

Patients and methods Patients with urolithiasis (149) and a group of normal controls (102) were examined and compared. The CAG repeats of the AR gene and TA repeats of the ER gene were detected by polymerase chain reaction. The CAG repeats ranged from 171 bp (10 CAG repeats with 141 bp of amplified flanking sequences) to 270 bp (43 CAG repeats). The TA repeats ranged from 160 bp to 194 bp. Associations between calcium oxalate stone disease and the CAG repeats in AR gene and TA repeats in ER gene were then evaluated. The results were classified according to sex and peaks in allelic frequency distribution.

Results There was a significant difference between the male stone patients and the normal controls in the distribution of CAG repeats in the AR gene. Both groups showed a high percentage of 21‐repeats in the allelic distribution, at 17 (16%) and 20 (37%) in stone patients and normal controls, respectively. The results indicate that 21‐CAG repeats might be related to a lower risk of stone formation in men (P < 0.05). In the ER gene, the peak allelic distribution of TA repeats was 14, showing a significant difference between male stone patients and the normal control subjects (P < 0.01). There were no statistical differences between female stone patients and the control subjects in either the AR or the ER gene.

Conclusion Urolithiasis among men appears to be associated with AR gene CAG repeat and ER gene TA repeat polymorphisms, whereas there was no significant association among female stone patients. These sex hormone receptors seem to be related to the higher incidence of stone formation among men.
Perimesenteric detubularization of ileum for ileocystoplasty improves compliance and increases capacity
Authors: Nikolaev V.V.
Published: March 2003

Objective To describe a modified form of detubularization using a perimesenteric incision of the ileal segment, which increases the capacity of the neobladder and reduces the length of the ileal segment required.

Patients and methods From February 1993 to November 1999, ileocystoplasty was undertaken in 20 patients (mean age 8.4 years, range 4–16). Six had myelodysplasia, four had primary epispadias, five had bladder exstrophy, three had post‐traumatic lesions and two had cloacal exstrophy. The patients were divided into two groups; in the first (eight patients, mean age 9.6 years, range 5–15) the ileal segment was opened along the antemesenteric border and in the second (12 patients, mean age 7.7 years, range 4–16) the ileal segment was opened adjacent to the mesentery, perimesenterically. Each segment was then folded and the perimesenteric edges sutured to form the pouch.

Results The patients were assessed at 1 year after surgery; the neobladder capacity was evaluated as ((neobladder capacity − bladder capacity)/body weight), which shows the relative increase of bladder capacity after enterocystoplasty per unit of weight. There was a statistically significant increase in neobladder capacity in group 2 (perimesenteric transection; Kruskal–Wallis chi‐square, P = 0.005; Mann–Whitney U‐test, P = 0.006).

Conclusion These results indicate that augmentation can be carried out by perimesenteric transection of the intestinal segment, which improves compliance and increases capacity of the neobladder.
The cloacal plate: the missing link in anorectal and urogenital development
Authors: Penington E.C. , Hutson J.M.
Published: March 2003

Objective To determine whether differences in the embryology of the anorectal and urogenital area, previously examined in sheep, pigs, rats, rabbits and guinea pigs, producing varying conclusions, may be secondary to differences in species development.

Materials and methods Rat and human embryos were studied at the time of genital tubercle development and cloacal partition by standard serial‐section histology, and by immunohistochemistry, dissection and scanning electron microscopy. The images obtained were compared with those previously reported for pig and sheep embryos.

Results The cloacal plate, a vertically orientated midline plate of epithelial cells in the caudal half of the genital tubercle, was the key structure that varied between the different species. In rats the plate maintained a vertical height along its length, while in humans and pigs it reverted to a two‐layer membrane dorsally, shortly before it degenerated to expose both the anorectal and urogenital tracts. In sheep the plate was taller ventrally than in the other species but also reverted to a short membrane dorsally that exposed the hindgut when it degenerated. The anterior part of the cloacal plate persisted in all embryos as the urethral plate, which then participated in the formation of the urethra in the male and the vestibule in the female. The animal that most closely resembled humans in anogenital development was the pig.

Conclusions The cloacal plate is the key to understanding early anorectal and urogenital development and yet it is barely recognized in published reports. An appreciation of its relevance helps to explain the variations in the described embryology of the region, and is mandatory when interpreting embryological findings in animal models of human anomalies. Given the similarities between porcine and human development, the pig may be the most legitimate animal model for the study of anorectal and urogenital anomalies in humans.
Possible autocrine loop of the epidermal growth factor system in patients with benign prostatic hyperplasia treated with finasteride: a placebo‐controlled randomized study
Authors: TØrring N. , MØller‐Ernst Jensen K. , Lund L. , Nielsen J.E. , Djurhuus J.C. , Poulsen S.S. , NexØ E.
Published: March 2003

Objective To analyse the expression of the epidermal growth factor (EGF) system in prostate tissue and secretions obtained from patients with benign prostatic hyperplasia (BPH) treated with or without finasteride (which primarily targets the androgen‐sensitive secretory epithelial cells in the prostate, with little effect on basal epithelial and stromal cells).

Patients and methods The expression of the EGF system was evaluated by enzyme‐linked immunosorbent assay and immunohistochemistry in samples of prostate tissue and secretions from patients with BPH randomized for treatment with finasteride or placebo for 3 months before surgery.

Results Prostate tissue expressed the EGF receptor (HER1) and HER2, and the ligands EGF, transforming growth factor α (TGFα), heparin‐binding (HB) EGF, betacellulin and amphiregulin. Treatment with finasteride produced greater concentrations of amphiregulin (P < 0.05) than did placebo, did not change the level of TGFα, HER1 and HER2, and tended to decrease the concentration of EGF, betacellulin and HB‐EGF in prostate tissue. Using immunohistochemistry, HER1 and TGFα were both localized to the basal epithelial cells, and there was a strong positive correlation among the tissue concentrations of HER1, HER2 and TGFα. Amphiregulin localized to the luminal secretory epithelium. Prostate secretions contained only EGF, which was at levels ≈ 150 times higher than in prostate tissue; treatment with finasteride did not affect the concentration of EGF in prostate secretion.

Conclusions There were only minor changes in the expression of TGFα, HER1 and HER2 after finasteride treatment. This may represent an important system for the continuous growth and homeostasis of the androgen‐independent basal epithelial cells in the prostate.
Innervation of congenitally hydronephrotic and normal porcine upper urinary tract
Authors: Rolle U. , Andersen H.L. , Puri P. , Djurhuus J.‐C.
Published: March 2003

Objective To investigate the intrinsic innervation of the upper urinary tract in congenitally hydronephrotic and normal Goettingen minipigs, using the whole‐mount preparation technique.

Materials and methods Whole‐mount preparations of hydronephrotic (two with bilateral ectopic ureters, one with left distal ureteric stenosis) and normal (three) porcine upper urinary tracts were examined by immunohistochemistry with tyrosine hydroxylase (TH) and neurofilament and by histochemical staining with NADPH‐diaphorase and acetylcholinesterase. Staining results were evaluated using normal bright‐field and confocal laser scanning microscopy.

Results Neurofilament‐, TH‐immunoreactive and acetylcholinesterase‐positive nerve fibres and neuronal networks were identified in the adventitial, muscle and subepithelial layers of the whole upper urinary tract. An NADPH‐diaphorase‐positive network was expressed in the subepithelial layer and less densely in the muscle layer. The general distribution of the identified neuronal networks was similar in hydronephrotic and normal upper urinary tracts, but the density of these neuronal networks was less in the former. The most striking observation was the absence or marked reduction of neuronal networks in the stenotic part of the ureter in the pig with left distal ureteric stenosis.

Conclusion Whole‐mount preparations provide a method for assessing the three‐dimensional topography of neuronal networks in the different layers of the porcine upper urinary tract. Although the macroscopic differences between the hydronephrotic and normal porcine upper urinary tracts were striking, changes in the innervation pattern were less obvious, except in distal ureteric stenosis.
Evaluation of the influence of systemic neoadjuvant chemotherapy on the survival of patients treated for invasive bladder cancer
Authors: Kolaczyk W. , Dembowski J. , Lorenz J. , Dudek K.
Published: March 2003

Objective To assess the influence of neoadjuvant systemic chemotherapy using a modified methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) scheme in patients with invasive bladder cancer.

Patients and methods Two groups of patients were reviewed retrospectively; group 1 included 51 who received chemotherapy before cystectomy and group 2 included 62 who were treated only with surgery. The mean (range) duration of follow‐up was 3.2 (0.25–10.25) years. The patients in group 1 were divided into two subgroups: those with tumour confined to the bladder (T1, T2 and T3a) and the remaining patients with tumour beyond the bladder (T3b, T4a,b). The chemotherapy was administered as routine MVAC, except vinblastine and methotrexate were given at 15 and 22 days during the cycle. A mean of three cycles were administered.

Results The 5‐year survival rate in group 1 and 2 was 66% and 58%, respectively (P > 0.3); after 8 years of follow‐up the survival rates were 58% and 33%, respectively, and significantly different (P < 0.01).

Conclusion Systemic chemotherapy using the modified MVAC scheme in patients subsequently undergoing radical cystectomy improved the survival rate after 8 years of follow‐up.
The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis
Authors: Chen S.S. , Chen K.‐K. , Lin A.T.L. , Chang Y.‐H. , Wu H.H. , Chang L.S.
Published: March 2003

Objective To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment.

Patients and methods Between 1980 and 1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle‐stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow‐up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostate‐specific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2–4), intermediate (5–7) and high (8–10) using the Gleason score.

Results There were 43 patients in group 1 and 53 in group 2; the overall mean (sd) age was 72.5 (6.8) years and the follow‐up 29.5 (0.5) months. The respective mean (sd) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2.

Conclusion Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.
The clinical utility of the prostate specific membrane antigen reverse‐transcription/polymerase chain reaction to detect circulating prostate cells: an analysis in healthy men and women
Authors: Llanes L. , Ferruelo A. , Páez A. , Gómez J.M. , Moreno A. , Berenguer A.
Published: March 2003

Objective To evaluate the overall specificity of nested reverse transcriptase‐polymerase chain reaction (RT‐PCR) to detect prostate‐specific membrane antigen (PSM) mRNA in peripheral blood samples of healthy donors.

Subjects and methods Peripheral blood samples were taken from 60 healthy blood‐donors (30 men and 30 women aged < 50 years) and analysed for PSM‐mRNA using nested RT‐PCR (in ‘hot‐start’ conditions and confirmed using nested EcoRI restriction enzyme). Intron‐spanning primer pairs specific for human PSM were deduced from the GenBank sequence (M99487) using gene software. The outer primer pair for PSM was: fwd: 1368 5′‐TCACCGGGACTCATGGGTGT‐3′; reverse: 1860 5′‐GCCTGAAGCAATTCCAAGTCGG‐3′. Inner primer pair for PSM was: fwd: 1480 5′‐AAGGAAGGGTGGAGACCTAG‐3′; reverse: 5‐ACTGAACTCTGGGGAAGGAC‐3′. The integrity of cDNAs was checked using primer pairs specific for the housekeeping gene β‐actin. The specificity and false‐positive rate were calculated assuming that the underlying prostate cancer incidence was nil.

Results The first PCR was negative for all samples (100% specificity; 0% false‐positive rate). The nested PCR detected 23 positive samples (23/60, 38%) with an overall specificity of 62% (false positive rate, 38%).

Conclusion Nested RT‐PCR of PSM‐mRNA in peripheral blood is highly unspecific. Its clinical utility in the management of prostate cancer must be low. Further development is needed of quantitative RT‐PCR, primers that identify prostatic PSM or another prostate‐specific marker gene to differentiate PSM mRNA from circulating prostate cells and from non‐prostatic tissues.
Ileal T‐pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation
Authors: Marino G. , Laudi M.
Published: March 2003

Objective  To report the functional results of continent cutaneous urinary diversion with ileum, using the serous‐lined extramural valve and Mitrofanoff procedure for the continence mechanism.

Patients and methods  From April 1999 to October 2001, 18 patients (mean age 68 years) underwent radical cystectomy for invasive bladder cancer involving the bladder neck, urethra or prostate; they then had an ileal continent cutaneous T pouch constructed. The mean (range) follow‐up was 12 (4–20) months. The first five patients had reconstructions using the original orthotopic T‐pouch configuration, but in subsequent patients the technique was simplified, reducing the ileal segments. The ureteric‐intestinal anastomosis was made using a split‐cuff nipple technique.

Results  All patients were continent day and night, and there were no late complications. All cutaneous continent T pouches had a good capacity and low pressure, with no urinary reflux. No catheterization difficulties were reported and the evacuation intervals were ≈ 4 h.

Conclusions  This ileal cutaneous continent diversion is a versatile technique; the T‐valve can be used successfully as a continent mechanism, ensuring continence day and night. The simplified technique maintains a reservoir of good capacity and compliance, thus preserving ≈ 13 cm of ileal tract. The ureteric intestinal anastomosis by the split‐cuff nipple technique is suitable in undilated and peristaltic ureters.