bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Hydrophilic Polymer‐coated Latex, Uncoated Latex and PVC Indwelling Balloon Catheters in the Prevention of Urinary Infection
Authors: TIDD M. J. , GOW J. G. , PENNINGTON J. H. , SHELTON J. , SCOTT M. R.
Published: December 2008

Latex, hydrophilic polymer‐coated latex and PVC balloon indwelling urethral catheters were compared in respect of the urinary tract infections arising in association with their use in male patients.

The polymer (Hydron) coating conferred no benefit over uncoated latex which in turn was indistinguishable from PVC.

No significant differences in the spectra of infecting organismns were observed between the 3 catheter types.
Treatment of the Neuropathic Bladder by Enterocystoplasty and Selective Sphincterotomy or Sphincter Ablation and Replacement
Authors: STEPHENSON T. P. , MUNDY A. R.
Published: December 2008

Summary— Sixty‐one patients with lower urinary tract neuropathy were treated surgically, either to achieve continence or to prevent or arrest renal deterioration, or both. Most were myelodysplastics and all but two were ambulatory. Three techniques were employed, depending on the detrusor/sphincter behaviour and the sex of the patient: enterocystoplasty alone, with or without selective sphincterotomy and/or intermittent self‐catheterisation; total sphincter ablation and an artificial sphincter; or, most commonly, enterocystoplasty combined with sphincter ablation and an artificial sphincter. Continence was achieved in 58 patients, though nocturnal enuresis was sometimes a problem; renal deterioration was arrested in 13 of 14 patients and renal function remained stable in all of the other patients.
Intravesical Mitomycin C Therapy for Superficial Bladder Cancer. Report of a Multicentre Phase II Study
Authors: MacFARLANE J. R. , TOLLEY D. A. ,   SCOTTISH UROLOGICAL ONCOLOGY GROUP
Published: December 2008

Summary— Twenty‐five patients with early transitional cell carcinoma of the bladder (Tis Ta T1) received intravesical instillations of 40 mg mitomycin C in 40 ml water weekly for 7 weeks. The overall response rate was 70% (complete response 40%). In patients with Ta tumours the response rate was 86%. Minor toxic side effects occurred in four patients and only one patient was unable to complete the course of treatment because of side effects.
Prostatic Biopsy with the 21 Gauge Surecut® Needle. A Preliminary Report of a New Technique
Authors: TORP‐PEDERSEN S. , JUUL N. , RASMUSSEN F. , SEHESTED M.
Published: December 2008

Summary— The 21 gauge Surecut® needle is a fine needle system providing regular tissue cores for histological evaluation. Using the Franzén needle sheath, transrectal biopsies were performed on 13 patients and a tissue core obtained in 12 cases.

Ultrasonically guided transperineal biopsies were performed on 14 patients and a tissue core was obtained in 13 cases. It is concluded that the 21 gauge Surecut® needle is able to yield histological material for prostatic diagnosis.
Management of Congenital Posterior Urethral Valves
Authors: SCOTT J. E. S.
Published: December 2008

Summary— A series of 46 children treated by the author since January 1972 for congenital posterior urethral valves is presented: 22% were diagnosed at birth, 28% as neonates and 52% in the first 3 months of life.

Ninety‐three per cent had unilateral or bilateral dilatation of the upper urinary tract at the time the valves were diagnosed and 72% had ureteric reflux. Unilateral reflux occurred into the left ureter twice as often as the right. Renal failure was present at the time of diagnosis in 72% of all of the children but in 83% of those aged less than 3 months.

Surface urinary diversion was used minimally during post‐operative management and contributed little to the recovery of renal function. Reflux disappeared spontaneously in one‐third of the refluxing ureters. Ureteric dilatation subsided spontaneously in 57% of dilated ureters. Surgery was performed mostly for reflux. Non‐refluxing ureteric dilatation was made worse by surgery in a few instances and in others the dilatation improved with time rather than as a result of surgery.

Renal function returned to normal in over 60% of the children who were in renal failure at diagnosis. Measurement of glomerular filtration rate was the most accurate method of predicting recovery of renal function: a value of less than 50% of normal for age at the time of diagnosis forecast persistent chronic renal failure with all its attendant complications.
Renal Function Following Surgical Correction of Vesico‐ureteric Reflux in Childhood
Authors: SCOTT D. J. , BLACKFORD H. N. , JOYCE M. R. L. , MUNDY A. R. , KINDER C. H. , HAYCOCK G. B. , CHANTLER C.
Published: December 2008

Summary— To assess the effectiveness of the surgical correction of vesico‐ureteric reflux, current renal function was determined in 56 children with scarred kidneys who had undergone ureteric reimplantation between 1978 and 1983. The children were aged between 2 and 15 years, had no coexisting urological disease and a glomerular filtration rate (GFR) of <90ml/min/1.73m2. In the 32 patients who had bilateral reimplantation of ureters draining bilaterally scarred kidneys the improvement in GFR following surgery was highly significant (P<0.001), with improvement occurring in 75%. The greatest improvement was in patients where the GFR was <50 ml/min/1.73m2 (29%). Individual kidney GFR was estimated in 42 kidneys and 81% improved after surgery. This improvement was highly significant (P<0.001).
Treatment of Superficial (T1) Tumours of the Bladder by Radical Radiotherapy
Authors: QUILTY P. M. , DUNCAN W.
Published: December 2008

Summary— Local tumour control and survival is reported for 190 patients with T1 transitional cell cancer of the bladder who received a radical course of X‐ray therapy. There was no difference in survival by the histological grade of the cancer but patients with grade 3 cancers had the highest probability of local control. After initial complete local tumour regression there was a similar probability of subsequent distant metastases irrespective of the grade of the cancer.

Radical small field beam directed radiotherapy is commended for patients with T1/pT1 grade 3 transitional cell cancer of the bladder.
Coincident Vesical Transitional Cell Carcinoma and Prostatic Carcinoma Clinical Features and Treatment
Authors: ANDROULAKAKIS P. A. , SCHNEIDER H. M. , JACOBI G. H. , HOHENFELLNER R.
Published: December 2008

Summary— Twenty‐two patients with vesical urothelial carcinoma associated with prostatic carcinoma were reviewed. They represented 1.5% of the bladder and prostatic tumours treated in our department within a 12‐year period from 1968 to 1979. Their management included several treatment policies, based on the separate assessment of each tumour variant. For non‐infiltrating bladder tumours, transurethral tumour resection was combined with hormonal treatment, external radiotherapy or resection of the prostate depending on the stage of the prostatic tumour. Radical cystoprostatectomy was performed for two cases of infiltrating bladder tumour with well localised prostatic tumours. A conservative primary approach seems justifiable in the management of double carcinoma of the bladder and prostate. The coincidence of bladder urothelial carcinoma and prostatic carcinoma per se is not an adverse prognostic factor; prognosis is more closely related to the pathological stage and grade of the bladder tumour. Cystoprostatectomy for patients with infiltrating bladder tumours could be curative, in selected cases, for the prostatic cancer as well.
A Simple Technique for the Treatment of Benign Prostatic Hypertrophy
Authors: SHAFIK A.
Published: December 2008

Summary— Division of the anterior prostatic commissure and the bladder neck (but sparing the mucosa) achieves “urethral decompression”. This simple technique for the treatment of benign prostatic hypertrophy was performed in 68 poor risk patients.

The results were very satisfactory, especially in large prostates with lateral lobe enlargement. No patient required blood transfusion. Immediate and late post‐operative complications were not encountered and the hospital stay was short. The obstructive manifestations and the maximal urinary flow rate improved in 91% of patients. Failures were due to incomplete prostatic commissurotomy.
Diagnosis and Treatment of Posterior Urethral Injury
Authors: FOWLER J. W. , WATSON G. , SMITH M. F. , MacFARLANE J. R.
Published: December 2008

Summary— The initial investigation and diagnosis in 28 patients with posterior urethral trauma are presented. Twenty‐five patients underwent either primary realignment for complete rupture or cystostomy alone for partial rupture. The results of their management are reported.
The Use of Split‐skin Mesh Graft in the Management of Urethral Strictures
Authors: LIPSKY H.
Published: December 2008

Summary— In the last 3 years 268 patients with urethral strictures have attended this unit. We treat most strictures by urethrotomy and consider an open operation only after two recurrences or in patients whose strictures are considered unsuitable for urethrotomy. Open operations have been performed on 42 patients. Although several types of operation have been used, most comprised an end‐to‐end anastomosis or Blandy's scrotal flaps.

In the last few years a split‐skin mesh graft has been used to replace the posterior urethra and the advantage of this technique is that the new urethra is soft and hairless. We present our experience with this method and our overall results.
Indications for Ultrasound in the Evaluation of the Pathological Scrotum
Authors: SCOTT R. F. , BAYLISS A. P. , CALDER J. F. , GARVIE W. H. H.
Published: December 2008

Summary— Scrotal ultrasound scans carried out on 156 patients were reviewed in a retrospective study and the sonographic findings and indications evaluated. Ultrasound was able accurately to distinguish the normal from the pathological scrotum. Extratesticular lesions were readily differentiated from testicular lesions. Abnormal testicular echo patterns were usually associated with tumours, but orchitis, granulomas and haematomas were found to have a similar appearance. Occult testicular tumours could readily be identified. Ultrasound was also useful in excluding underlying pathology in hydroceles, in the diagnosis and follow‐up of epididymitis and other epididymal lesions and in the assessment of underlying testicular damage in traumatic haematoceles. Ultrasound may also be useful in post‐orchiectomy follow‐up examinations to exclude tumour in the contralateral testis.
Scanning Electron Microscopy of Adenomatoid Tumours
Authors: MORRIS J. A. , OATES K. , STAFF W. G.
Published: December 2008

Summary— Four adenomatoid tumours of the epididymis were embedded in paraffin wax, sectioned and the sectioned surfaces examined by scanning electron microscopy using the secondary electron mode. The solid faces of the sectioned neoplasms were damaged by the preparative technique but the depressed luminal surfaces of the tubules were well preserved and yielded useful information. Large areas of luminal surface were examined and the presence and distribution of microvilli were noted. In addition, there was a more complex cell surface pattern of intersecting cord‐like elevations. Desquamating cells were seen within the tubules and the cytoplasmic bridges noted by light microscopy were shown to be thin cytoplasmic partitions. These findings are consistent with the mesothelial theory of histogenesis.

Scanning electron microscopy can provide useful information about the internal structure of neoplasms even with simple preparative techniques.
Fecundability Rates from an Infertile Male Population
Authors: HARGREAVE T. B. , ELTON R. A.
Published: December 2008

Summary— From a computer file of 955 couples attending hospital because of an infertile marriage, 279 were identified where the female partner had normal investigation results. Follow‐up information was available for all couples and the fecundability (conception rate per month) for the first year of follow‐up has been calculated, stratified according to the husband's investigation results. The fecundability of couples where the wife had normal investigation results but the husband had reduced sperm density ranged from 0.4% for wives with azoospermic husbands to 5.9% when the husband had at least 10 million motile sperm/ml. For any given number of motile sperm the fecundability was also strongly dependent on the duration of involuntary infertility as recorded at the time of initial clinic attendance.

In view of the lack of effective treatment for most male infertility the fecundability rates reported herein are likely to represent those that would be found in an untreated population and should be useful as a base line when evaluating results of new treatments.
Assessment of Collagen Film for Use in Urinary Tract Surgery
Authors: SCOTT R. , BARAZA R. , GORHAM S. D. , McGREGOR I. , FRENCH D. A.
Published: December 2008

Summary— This investigation assessed a biodegradable collagen membrane which can be sutured around the ureter to prevent urine leakage, thus permitting healing to proceed more rapidly while the membrane itself is resorbed.

Following an early in vitro investigation in which collagen was assessed, a more comprehensive survey has now been carried out. Tissue compatibility and biodegradation were assessed by implanting the film into the lumbar muscles of rats; it was then used to cover experimental ureterotomies in New Zealand White rabbits.

The data obtained from the rabbits confirmed that a collagen membrane can prevent leakage of urine from the ureter during healing while it itself is biodegraded, indicating that a collagen membrane could be used to repair the injured urinary tract.
Clinical Significance of Minimal Changes on Intravenous Urography after Spinal Cord Injury
Authors: KUHLEMEIER K. V. , LLOYD L. K. , STOVER S. L.
Published: December 2008

Summary— Evidence is given to support the thesis that minimal pyelocaliectasis and ureterectasis are of little clinical significance in spinal cord injured patients. Such renal changes almost always improve or remain stable on sequential examinations. Since moderate or severe pyelocaliectasis is usually detected by renal scintillation procedures, these findings support its use as a urinary tract screening examination along with an abdominal radiograph to detect calculi. The need for long‐term serial examination of the urinary tract in spinal cord injury is emphasised.
The Urological Evaluation and Management of Patients with Myelodysplasia
Authors: WEBSTER G. D. , EL‐MAHROUKY A. , STONE A. R. , ZAKRZEWSKI C.
Published: December 2008

Summary— The urological evaluation and results of management of 183 myelodysplastic patients are presented. Our management protocol stresses upper tract and infection status surveillance during the early childhood years, and a clean intermittent catheterisation programme with pharmacological manipulation of detrusor and sphincter function as the optimal later management. Continence failures are few and are manageable by sphincter prosthetic surgery or bladder augmentation. Urodynamic results are valuable in children with difficult incontinence or poor upper tracts. The intermittent catheterisation programme reduces the incidence of symptomatic urinary infections in these patients, but the incidence of asymptomatic bacteriuria is high. The adverse results of supravesical diversion in myelodysplastic children rarely justify its use.
Origin of Carcinomas Causing Bladder Neck Obstruction Demonstrated by Immunoperoxidase Localisation of Specific Antigens
Authors: ADNANI M. S. AL
Published: December 2008

Summary— The immunohistological demonstration of prostate specific acid phosphatase, prostate specific antigen, epithelial membrane antigen and keratin was used to ascertain the origin of five advanced carcinomas involving the bladder neck and causing obstruction. Five prostatic carcinomas, 10 transitional cell and 10 squamous cell carcinomas with schistosomiasis of the bladder were studied for comparison. The concomitant localisation of prostate specific antigen and keratin was most useful in ascertaining the origin of tumour invading the bladder in contrast to the multiple use of other epithelial markers. It showed that 2/5 were of prostatic origin and 3/5 were urothelial. The markers did not discriminate with certainty between invasive poorly differentiated transitional or squamous cell carcinomas.
Treatment of Multiple Superficial Transitional Cell Carcinoma of the Bladder with Intravesical Yttrium‐90
Authors: ALCOCK C. J. , DURRANT K. R. , SMITH J. C. , FELLOWS G. J.
Published: December 2008

Summary— Thirty‐eight patients with extensive multiple superficial transitional cell carcinoma of the bladder which could not be controlled endoscopically were treated with intravesical yttrium‐90. Nineteen are alive at between 1 and 9 years. Short‐term control of the disease was achieved in most patients. In those followed up for at least 3 years, 48% remained alive and well and 36% avoided cystectomy or other major treatment.
Identification of the Poor Risk Patient with “Prostatism” and Detrusor Failure
Authors: GEORGE N. J. R. , FENELEY R. C. L. , ROBERTS J. B. M.
Published: December 2008

Summary— Twenty‐five patients with “prostatism” and chronic retention of urine have been followed up for 4 years to determine the natural history of the disorder and results of elective treatment.

Twenty‐one patients with low pressure during bladder filling maintained normal upper tracts and renal function; they were subdivided by micturition pressure into two groups which differed significantly in terms of both total bladder capacity and variance of capacity. Patients with good voiding pressures had a very satisfactory outcome following surgery, with almost complete relief of symptoms, but patients with poor voiding pressures obtained a poor symptomatic and urodynamic result from repeated surgical procedures. Four patients declined operation and the subsequent course of the disorder is described.

Four patients had painless retention associated with high pressure bladder filling, hydronephrosis and uraemia. Operation was successful in reversing these potentially terminal complications. None of the 25 patients developed acute retention.

Men with “prostatism” do not constitute a homogeneous population. Identification of specific patient groups enables an accurate prediction of the consequences of both conservative and operative management.
Current Optimum Management of Anaplastic Germ Cell Tumours of the Testis and Other Sites
Authors: NEWLANDS E. S. , BAGSHAWE K. D. , BEGENT R. H. J. , RUSTIN G. J. S. , CRAWFORD S. M. , HOLDEN L.
Published: December 2008

Summary— Between 1977 and 1985, 149 male patients with anaplastic germ cell tumours (AGCT) completed chemotherapy with POMB/ACE (platinum, vincristine (oncovine), methotrexate, bleomycin, actinomycin D, cyclophosphamide and etoposide). By increasing the number of courses of POMB in 1979, we have been able to compensate for adverse prognostic factors. Since then each patient has received at least three courses of POMB and 118 patients have completed therapy. The overall survival rate since 1979 is 89% and for the 100 patients who had not received prior radiotherapy it is 92%.

We established that an initial serum concentration of human chorionic gonadotrophin (HCG > 50,000 iu/l) and/or alphafetoprotein (AFP >500 ku/l) indicated a poor prognosis. Between 1977 and 1979 the survival rate in 12 patients in this category was only 45%. After increasing the number of courses of POMB, the survival rate rose to 89% in 31 patients. However, patients who had received prior radiotherapy and who presented with high tumour markers (HCG > 50,000 iu/l and/or AFP > 500 ku/l) continue to have a poor survival rate (20% in five patients).

With this chemotherapy, 14 of 16 patients (88%) presenting with liver metastases and 6 of 7 patients (86%) presenting with brain metastases are in complete remission. Neither the stage at presentation nor the volume of metastatic disease was a major adverse prognostic variable. We believe that POMB/ACE chemotherapy, followed by surgery in selected cases, is currently the best treatment for patients with AGCT.
Post‐treatment Fertility in Patients with Testicular Cancer
Authors: FOSSÅ SOPHIE D. , ÅBYHOLM T. , NORMANN N. , JETNE V.
Published: December 2008

Summary— Sperm analysis and serum hormone measurements (LH, FSH, testosterone) were performed in 29 patients after orchiectomy for seminoma before and after irradiation. Before radiotherapy 14 of 20 orchiectomised patients were azoospermic or had impaired spermatogenesis. A minimum sperm count was found 1 year after radiotherapy with gradual improvement up to 2 years. The recovery of sperm cell production was impaired most in patients with pre‐treatment sperm counts <3 million/ml.

Serum testosterone remained at low normal levels throughout the observation period. The mean serum FSH was increased 1 year after radiotherapy but returned to normal in 50% of patients within 3 years after treatment. This post‐treatment increase in FSH was significantly correlated with increased pre‐treatment FSH but not with the gonadal dose, which was 1 to 3% of the target dose.

Severe disturbances in spermatogenesis, observed 2 to 3 years after radiotherapy for early seminoma, are likely to be the expression of a highly impaired pre‐treatment sperm cell production and only to a lesser degree dependent on the irradiation of the remaining testicle.
A Computerised Urodynamic System
Authors: BEST B. G. , JOHNSTON S. R. , KENNEDY J. A. , LOUGHRIDGE W. G. G.
Published: December 2008

Summary— A new urodynamic investigation system, based on a microprocessor, is described. The design principles, versatility and advantages of the equipment are discussed. It is concluded that this system offers significant benefits to the urodynamic unit for both routine and research work.
Ultrasound Stone Localisation for Extracorporeal Shock Wave Lithotripsy
Authors: MARTIN X. , MESTAS J. L. , CATHIGNOL D. , MARGONARI J. , DUBEFNARD J. M.
Published: December 2008

Summary— An extracorporeal shock wave lithotriptor using an ultrasound scan head pantograph location system has been designed. The shock wave ellipsoid reflector position is adjusted to the stone with a computer assisted positioning device. Seven dogs with stones implanted into the renal pelvis were treated and stone fragmentation occurred in all cases. Subsequently, 45 patients with stones were treated. The stones ranged in size from 5 to 29 mm (mean 16). Radio‐opaque as well as poorly opaque or radiolucent stones were treated and fragmentation was achieved in 85% of cases. An additional endoscopic procedure was performed in four cases. No fragmentation occurred in four patients. Further shock wave treatment was necessary in two patients who presented with stones larger than 2 cm. Both radio‐opaque and poorly opaque stones can be treated with this system. Ultrasound localisation and the ellipsoid positioning device avoid the need for expensive fluoroscopic equipment and a hydraulic patient positioning system.
Low Grade Pelviureteric Junction Obstruction with Normal Diuretic Renography
Authors: WACKSMAN J. , BREWER E. , GELFAND M. J. , TOWBIN R. , STRIFE JANET
Published: December 2008

Summary— We report five patients with normal diuretic renograms who underwent Whitaker pressure perfusion testing. They were found to have normal pressure at low flow rates (2–4 ml/min) and an abnormally elevated pressure at high flow rates (8–10 ml/min). Because of persistent symptoms, two patients underwent surgery, while the other three have been followed up. Our findings indicate that a negative diuretic renogram in a well hydrated patient with good renal function may not rule out low grade obstruction. Renal pelvic perfusion at low flow rates as well as high flow rates is recommended to determine better the function of the pelviureteric junction.
Results of Surgery Following Radical Radiotherapy for Invasive Bladder Cancer
Authors: QUILTY P. M. , DUNCAN W. , CHISHOLM G. D. , FOWLER J. W. , HARGREAVE T. B. , NEWSAM J. E. , TOLLEY D. A.
Published: December 2008

Summary— Five hundred and ninety‐one of 889 patients with T1 to T4 transitional cell carcinoma of the bladder had persistent or recurrent cancer after radical radiotherapy. Durable local control was significantly poorer for patients with grade 1 or T4 cancer before radiotherapy. Three hundred and twenty‐two patients received additional surgical treatment: 211 were endoscopically managed and 111 had secondary cystectomy. The survival of patients with residual or recurrent cancer after radiotherapy was significantly improved by secondary local treatment (P<0.0001). A comparison was made between endoscopic treatment and cystectomy after radiotherapy. Patients having secondary cystectomy were younger (mean age 60.0 years) than those managed endoscopically (66.8 years). The 5‐year actuarial survival rate (from the date of radiotherapy) for patients who had endoscopic treatment was 47.1% compared with 62.5% for those who had cystectomy (P=0.16). After both treatments survival was significantly correlated with the T category of the tumour before radiotherapy. Local tumour control was better after cystectomy; 85.6% of patients were locally tumour‐free at the end of follow‐up compared with 44.5% of those managed endoscopically. There was no overall difference in the subsequent risk of metastases between the two forms of surgery. However, seven of 12 patients managed endoscopically prior to secondary cystectomy died of their cancer. Five of these patients died from metastases even though they were locally disease‐free. There was a significantly increased risk of metastases in patients managed endoscopically who were not locally disease‐free after treatment (P=0.0003). Caution is advised in persisting with endoscopic treatment after radiotherapy if local control is not readily achieved.
Orchiectomy and Delayed Radiotherapy as Treatment for Prostatic Carcinoma. A 10‐year survey
Authors: MEFFAN P. M. , NACEY J. N.
Published: December 2008

Summary— One hundred and fifty patients with carcinoma of the prostate treated between 1967 and 1982 have been reviewed. Thirty‐three patients were treated with stilboestrol alone, 36 by orchiectomy alone and in 81 cases radical radiotherapy was given to the prostate (and in 10 of the 81 cases to the regional and para‐aortic lymph nodes) 5 or 6 months after orchiectomy.

Although there was no significant difference between the results of those treated by stilboestrol alone and those treated by orchiectomy alone, in those patients receiving orchiectomy and delayed radiotherapy there was a significant improvement in survival. If patients with Stage D disease are excluded, this is a highly significant difference and indeed the survival in these patients does not differ significantly from the expected survival at this age. The 5‐year survival rate of Stage D patients treated by this method was 35%.
The Accuracy and Limitations of Ultrasound in the Assessment of Venous Extension in Renal Carcinoma
Authors: WEBB JUDITH A. W. , MURRAY A. , BARY P. R. , HENDRY W. F.
Published: December 2008

Summary— Ultrasound was used to assess venous extension in 28 patients with renal carcinoma, with particular reference to involvement of the inferior vena cava. The findings were correlated with surgical findings in all except two patients who had gross caval involvement and metastatic disease and in whom surgery was considered inappropriate.

In 10 of the 28 patients (36%), a diagnostic ultrasound examination of the cava from the renal veins to the diaphragm was obtained. In four of these, ultrasound showed tumour involvement of the vena cava. In 12 cases (43%) only the intrahepatic part of the cava was seen, but the examination nonetheless excluded tumour involvement of the upper cava. Visualisation of the vena cava was impossible in six cases (21%), usually because of bowel gas or obesity; CT scanning provided valuable additional information in two of these cases. Inferior vena cavography confirmed the findings of the less invasive imaging procedures in 10 patients and was falsely positive once. Cavography is now seldom necessary in the assessment of renal carcinoma.
Urine Eosinophil Cationic Protein in Painful Bladder Disease
Authors: LOSE G. , FRANDSEN B. , HOLM‐BENTZEN M. , LARSEN S. , JACOBSEN F.
Published: December 2008

Summary— Urine eosinophil cationic protein (U‐ECP), blood eosinophils and eosinophils in bladder biopsy specimens were studied in 30 patients with painful bladder disease (15 with detrusor mastocytosis, i.e. interstitial cystitis (IC) ≥28 mast cells/mm2 in the detrusor muscle) and 15 patients without detrusor mastocytosis).

In patients with IC the median concentration of U‐ECP was 140 arbitrary u/l versus 14 arb. u/l in the remaining patients (P<0.001). The mean peripheral leukocyte count was significantly lower in the IC group (P<0.05). Tissue infiltration with eosinophils was found in 43% of the bladder biopsies from patients with IC compared with 4% of the biopsies in the remaining patients (P<0.05). A negative correlation between peripheral eosinophils and U‐ECP was found in the patients with IC (r = 0.52, P<0.05).

These results suggest that eosinophils are attracted to the inflammatory site in the bladder wall where ECP is released. Eosinophils thus seem to participate actively in the inflammatory process.

U‐ECP seems to provide valuable diagnostic information when diagnosing IC in patients with painful bladder disease. It is suggested that ECP might be involved in the process of tissue destruction in IC.
Comparison of 0 Antigen‐specific Urinary Immunoglobulins to Escherichia coli in Normal Women and Women Prone to Escherichia coli Cystitis
Authors: SHORT K. L. , WEST C. A. , BRINSON D. , POLK H. C. , COST K. M. , BROWN G. L. , O'CONNOR C.
Published: December 2008

Summary— The enzyme‐linked immunosorbent assay (ELISA) measured urine and serum levels of 0 antigen‐specific IgA against Escherichia coli in five women prone to recurrent Esch. coli cystitis and in 20 normal women. Serial urine and serum samples were taken from the five women during Esch. coli infections and during uninfected intervals, while a single urine and serum sample was obtained from the 20 normal women. Elevation of any class of serum immunoglobulins for patients with uncomplicated Esch. coli cystitis was absent. A local antigen‐specific immunological response, predominantly of the IgA class, was present during Esch. coli cystitis. There was no significant difference (P>0.1) in the urinary or serum levels of any class of immunoglobulins between the recurrent cystitis group when uninfected and the normal women. There was a significant increase (P<0.001) in the levels of urinary IgA and secretory IgA during Esch. coli cystitis as compared with the same women when uninfected or with normal women. A deficiency in the local immunological response of women prone to recurrent Esch. coli cystitis is not supported by our data.
The Longer‐term Results of Undiversion
Authors: GALLOWAY N. T. M. , HEATHCOTE P. S. , GATELEY C. , SALAMAN J. R. , STEPHENSON T. P.
Published: December 2008

Summary— Thirty patients have been undiverted over the past 7 years. All but six were originally diverted for neuropathic problems of incontinence and/or upper tract compromise. Eighteen were undiverted because of deteriorating renal function. Only two were reconstructed for purely social reasons. Twenty‐eight patients have stable renal function, though three are enuretic and two have persistent Pseudomonas infection. Ureteric “failure” remains the most difficult problem.
Tumour Markers in Prostatic Carcinoma. A Comparison of Prostate‐specific Antigen with Acid Phosphatase
Authors: FERRO M. A. , BARNES I. , ROBERTS J. B. M. , SMITH P. J. B.
Published: December 2008

Summary— A study was performed on 130 men to compare the level of serum prostate‐specific antigen (PSA) in controls, patients with benign prostatic hyperplasia (BPH) and patients with prostatic carcinoma. The results showed that all 30 normal controls below 40 years of age had values less than 10 ng/ml. Of the 40 patients with BPH, all aged over 40 years, 13 (32.5%) had raised levels above 10 ng/ml. In the 60 patients with prostatic carcinoma, all over 40 years, 24 had localised disease (M0) and 36 had metastatic spread (M1), as judged by isotope bone scan. In patients with M0 disease, 16 (66.6%) had raised PSA levels compared with 34 (94.5%) of those with M1 disease. The corresponding figures for raised prostatic acid phosphatase (PAP) values were 4% in the M0 group and 52.7% in the M1 group.

PSA levels reflected neither the histological grade nor the local stage of the tumour and were of no value in estimating tumour burden.

PSA was found to be a valuable index in the management of prostatic cancer because of this sensitivity. Stable disease not requiring hormonal manipulation was reflected by unchanging levels of PSA, whereas progressive disease requiring hormonal therapy was reflected by an alteration in the PSA levels corresponding to the patients' response. The same group of progressive disease patients showed only a 50% rise in serum PAP levels, confirming the greater sensitivity of PSA as a measure of prostate cancer. PSA measurements should be included in any further trials on prostatic carcinoma and should be regarded as a standard marker for evaluating response to therapy.
The Hutson Hypothesis A Clinical Study
Authors: SCOTT J. E. S.
Published: December 2008

Summary— The hypothesis that testicular descent may be governed by Müllerian inhibiting substance (MIS) was investigated by observing the position of the testes in 13 children with XY karyotype and persistent Müllerian duct syndrome (PMDS). It was found that there was a direct relationship between failure of testicular descent and the degree of development of the Müllerian system. Where the Müllerian system was complete, the testes were in an ovarian position but where only the vagina was present, the testes were sometimes found in the inguinal region.

To discover whether excessive androgen activity in females might produce ovarian descent, the position of the ovaries in 15 children with severe adrenogenital syndrome was observed. Despite complete genital masculinisation in three children and almost complete in six, all but one ovary was in the normal position: that ovary had descended in an inguinal hernia sac.

These findings suggest that MIS rather than androgens may be responsible for the first or abdominal phase of testicular descent. Even excessive androgen activity failed to cause ovarian descent.
Diuretic‐induced Urinary Flow Rates at Varying Clearances and their Relevance to the Performance and Interpretation of Diuresis Renography
Authors: UPSDELL S. M. , LEESON S. M. , BROOMAN P. J. C. , O'REILLY P. H.
Published: December 2008

Summary— Minute‐by‐minute urinary flow rates before and after the intravenous injection of 40 mg frusemide were investigated in 29 well hydrated adult patients with varying creatinine clearances. Total urinary flow rates 3 to 6 min after frusemide ranged from 1 to 42 ml/min (mean 19). At 15 to 18 min after the diuretic, flow rates ranged from 8 to 46 ml/min (mean 23). Flow rates were proportional to creatinine clearance (r = 0.73; r = 0.8) and decreased with falling clearance, although significant diuresis (4 ml/min/kidney) was achieved down to single kidney clearances of 10 ml/min. Where single kidney clearances were less than 31 ml/min, single kidney flow rates of 10 ml/min or more were not guaranteed. Below this clearance, diuresis renography remains completely reliable and unequivocal in the majority of cases. However, perfusion pressure flow studies will not necessarily be urodynamically comparable and it should not be expected that the results of the two tests will agree in individual cases of upper tract dilatation. Recommended timing for frusemide administration should be 20 min into the test, or 15 min before radiopharmaceutical injection.
Acute Ureteric Dilatation for Ureteroscopy An Experimental Study
Authors: BODDY SU‐ANNA M. , NIMMON C. C. , JONES S. , RAMSAY J. W. A. , BRITTON K. E. , LEVISON D. A. , WHITIFIELD H. N.
Published: December 2008

Summary— The effects of three methods of acute ureteric dilatation (by graded Teflon dilators, low and high pressure balloon dilators) were evaluated radiologically, renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F.

All three methods caused upper urinary tract dilatation and an obstructive nephropathy which had not resolved 96 h after dilatation. Histology at 24 h showed destruction of the transitional epithelium, with inflammation throughout the ureteric wall. Four weeks after dilatation the ureter was still dilated and urothelial nests were seen in the lamina propria and in the muscle coats. There was no evidence of ischaemic necrosis or ureteric stricture formation. The implications of these findings for clinical practice are discussed.
Obstructed Voiding in the Female
Authors: MASSEY J. A. , ABRAMS P. H.
Published: December 2008

Summary— Bladder outlet obstruction in women is rare. The characteristics and aetiology of the condition in 163 females are discussed and their relation to treatment evaluated.
Urinary Undiversion in Young Adults
Authors: CUMMING J. , COX R. , WOODHOUSE C. R. J.
Published: December 2008

Summary— Eighteen patients who underwent urinary diversion in childhood were undiverted. There were three main groups: the neurologically intact bladder, the neuropathic bladder and the “occult” neuropathic bladder. The simplest procedure of anastomosing the proximal ureters to the distal ureters was preferred. The neuropathic group required excision of the bladder remnant and substitution with detubularised bowel.

In four patients the renal function was progressively deteriorating pre‐operatively and two have required transplants. Renal failure in one of these patients was accelerated by a post‐operative anastomotic stenosis and infection, although his early post‐operative course was uneventful.
Short‐course Etoposide, Bleomycin and Cisplatin in the Treatment of Metastatic Germ Cell Tumours. Appraisal of its Potential as Adjuvant Chemotherapy for Stage 1 Testis Tumours
Authors: OLIVER R. T. D. , DHALIWAL H. S. , HOPE‐STONE H. F. , BLANDY J. P.
Published: December 2008

Summary— Prompted by recent reports of the increasing incidence of late relapses in Stage 1 patients with both malignant teratoma and seminoma on surveillance, a low toxicity regimen combining etoposide, bleomycin and cisplatin [EBCi(3)] with prolonged infusion of bleomycin, given daily for 3 days, has been developed for possible use as adjuvant treatment. Forty of 44 patients treated remain free of disease with a median follow‐up of 21 months and actuarial disease free survival at 2 years of 91%. There have been no respiratory problems attributable to bleomycin lung toxicity in this study compared with four (3 associated with patient deaths) seen in 91 previously treated patients. The relatively low toxicity and high efficacy of this regime indicate that it may be suitable as adjuvant treatment.
Bulbocavernosus Reflex Latency in the Investigation of Diabetic Impotence
Authors: PARYS B. T. , EVANS C. M. , PARSONS K. F.
Published: December 2008

Summary— Impotence in males is a well recognised complication of diabetes mellitus, commonly held to be due to an autonomic neuropathy. The aim of this study was to determine the incidence of periphero‐conus neuropathy in diabetic impotence.

Nineteen diabetic males seeking treatment for loss of potency had bulbocavernosus reflex latency (BCRL) and sacral reflex latencies (SRLs) performed. The conduction studies indicated that impotence in these cases was associated with peripheral neuropathy in 21% of patients and that BCRL and SRLs are sensitive and useful diagnostic tests.
Neurophysiological Investigation of Diabetic Impotence. Are Sacral Response Studies of Value?
Authors: DESAI K. M. , DEMBNY K. , MORGAN HILARY , GINGELL J. C. , PROTHERO D.
Published: December 2008

Summary— The role of electrophysiologically elicited sacral responses in the detection of the neurological component of diabetic impotence has been evaluated in a detailed study using properly defined diagnostic criteria. The results prove that these tests are not reliable indicators of neuropathy and their relevance in the routine investigation of diabetic impotence is of questionable value.
Long‐term treatment of benign prostatic hyperplasia with alfuzosin: a 24–30 month survey
Authors: JARDIN A. , BENSADOUN H. , DELAUCHE–CAVALLIER M. C. , STALLA–BOURDILLON A. , Group P. ATTALI BPHALF
Published: December 2008

Objective To address the long‐term results of alfuzosin. an α1‐antagonist, in patients with benign prostatic hyperplasia (BPH).

Patients and methods A 6‐month, placebo‐controlled study involving 518 patients was followed by two successive one‐year, open extensions. Only centres who wished to continue the trial participated in the extensions: 131 patients entered the first extension, with 50 continuing into the second year extension. The results of the second year follow‐up are presented here.

Results Depending on their initial randomization to either the placebo or alfuzosin arm, patients were treated with alfuzosin for 24 (n=50) or 30 months (n=22). The data collected on those 50 patients in comparison to baseline confirmed that the clinical efficacy observed in short/medium‐term studies was maintained. A clinically significant improvement in urinary symptoms was observed: the Boyarsky score decreased from 8.7 (± 0.3) at baseline to 5.2 (±0.3) at 24 months, with no deterioration in the objective parameters. In patients treated for 30 months (n=22). symptomatic assessment and urodynamic parameters remained stable, indicating the sustained effectiveness of therapy. No serious or unexpected sideeffect related to long‐term exposure to alfuzosin was observed. No complications associated with BPH occurred. Two patients (4%) reported dizziness, neither of whom withdrew from the study. In this population, where 40% of patients were receiving concomitant cardiovascular therapy, no clinically significant change in standing systolic blood pressure, diastolic blood pressure or heart rate was apparent between baseline data and those at 24 months.

Conclusion These data demonstrate the usefulness of long‐term treatment with alfuzosin in patients with uncomplicated, moderate BPH.
Alpha1‐adrenoceptor subtypes in the human prostate
Authors: CHAPPLE C.R. , BURT R.P. , ANDERSSON P.O. , GREENGRASS P. , WYLLIE M. , MARSHALL I.
Published: December 2008

Objective To determine the subset of α1‐adrenoceptors mediating the functional abstraction of the prostate to noradrenaline.

Materials and methods Radioligand experiments were performed with membranes prepared from rat 1 fibroblasts trasfected with rat α1a, hamster α1b or bovine α1c adrenoceptor cDNA. Human prostatic tissue obtained from transurethral resection of the prostate with full informed consent was submitted to functional in vitro muscle strip experiments.

Results The binding experiments defined the potential subtype selectivity of various antagonists. Using this information, it was possible to define the functionally important α1‐adrenoceptor subtype in the human prostate.

Conclusion This work reports the results of the first functional characterization of the α1c‐adrenoceptor subtype. The most functionally important α1‐ceptor type in the human prostate appears to be the α1c subtype. This finding may aid the development of prostate‐selective adrenoceptor pharmacotherapy.
The diagnostic value of colour Doppler flow in the peripheral zone of the prostate, with histological correlation
Authors: PATEL U. , RICKARDS D.
Published: December 2008

Objective To study the discriminative value of the amount of colour flow on Doppler ultrasound within the peripheral zone of the prostate.

One‐hundred and twenty three men were studied using a 7 MHz transrectal probe, and 274 guided biopsies were undertaken. With each biopsy histological outcome was correlated with the grade of colour flow on ultrasound hard copy images. Biopsies with inflammatory cell infiltration, but without carcinoma, were subgraded according to the degree of inflammatory cell infiltration: and these grades were correlated with the corresponding colour flow grade.

Results Normal clour flow was seen with both normal and abnormal prostate biopsy. With increases; the highest grade of colour flow the likelihood of abnormal tissue increases: the highest grade of colour flow was seen with either carcinoma or prostatis (grade 0, 1, 2 and 3 colour flow=23%, 65%, 74% and 100% respectively of biopsies that were abnormal). In biopsies with inflammatory cell infilitation there was no linear relationship between the grades of colour flow and cellular infilitration (r=0.52, P>0.05, Kendall rank correlation). The mean grade of cellular infiltration was significantly greater in samples with grade 3 colour flow compared with grades 0–2.

Conclusion Grading of the amount of colour flow with Doppler ultrasound is of limited diagnostic discrimination, although with the greatest colour flow specificity for the diagnosis of abnormal prostate (either cancer or prostatitis) is very high. With Prostatitits, markedly increased colour flow reflects the severity of inflammatory cellular reaction.
Transrectal ultrasound versus magnetic resonance imaging in the estimation of prostatoc volume
Authors: AL‐RIMAWI M. , GRIFFITHS D.J. , BOAKE R.C. , BOAKE D.R. , JOHSON M.A.
Published: December 2008

Objective To establish which method of determining prostatic volume (transrectal ultrasound[TRUS] or magnetic resonance imaging [MRI] and which calculation formula give the most exact and least variable results: to determine the size and the source of the variability: and to establish which method is the more sensitive to drug‐induced changes in prostate volume.

Patients and methods Prostatic size was estimated by TRUS and MRI in 21 patients treated medically (either active treatment or placebo) for benign prostatic hyperlasia. Each patient was examined at baseline and after 3 months and 6 months of treatment. Prostatic volume was calculated at every visit using different formulae proposed in the literature.

Results With some of these formulae, including the classical ellipsoid formula there was a strong correlation (r>0.8) between TRUS and MRI volume estimates. For others the correlation was much weaker, suggesting unreliability. MRI gave a significantly larger volume than TRUS because of larger values for the cephalocaudal and anteroposterior diameters. For patients on placebo the visit‐to‐visit variability of the prostate volume was 10–12% of the mean volume. whether calculated by TRUS or MRI. Part of this variability was apparently due to natural variation of prostate size.

Conclusion The classical ellipsoid formula is adequate for determining prostate volume, MRI and TRUS give different volumes. Visit‐to‐visit variability is similar for both methods and is partly due to real, natural variation. MRI is better able than TRUS to detect drug‐induced changes in prostate volume.