bluuebunny/crossref_metadata_2025 huggingface dataset:
Mean time to cancer‐specific death of apparently clinically localized prostate cancer: policy implications for threshold ages in prostate‐specific antigen screening and ablative therapy
Authors: Horan A.H. , McGehee M.
Published: March 2003

Objective To assess the mean time to cancer‐specific death in patients with prostate cancer, using a minimum follow‐up of 14 years at one institution, and thus evaluate the minimum life‐expectancy for eligibility for radical surgery, radiotherapy and, implicitly, prostate specific antigen (PSA) screening.

Patients and methods The tumour registry of the authors’ institution was searched for the records of patients with prostate cancer (stages T1 and nonmetastatic T2–3) over the period 1976–1983, chosen to give a maximum follow‐up with sufficient numbers of patients. Kaplan–Meier curves and the mean time to death to 1995 for palpable and impalpable cancers were calculated. Deaths not from cancer and from unknown causes were censored. Patients still alive were also censored, except for in the calculation of mean time to death.

Results Patients with both stages of disease had a steep increase in mortality at 16 years. The mean (sem) time to prostate cancer‐specific death for T1 disease was 17 (1.8) years and for T2‐T3 (palpable) was 11.7 (1.2 years).

Conclusion These results suggest that, if there is to be one at all, the upper age limit for prostate cancer screening should be 62 years.
Comparison of modified one‐ and two‐layer microsurgical vasovasostomy
Authors: Fischer M.A. , Grantmyre J.E.
Published: March 2003

Objective To compare the outcome of a modified one‐layer and two‐layer vasovasotomy (VV) in two groups of similar men undergoing vasectomy reversal.

Patients and methods The charts and surgical records of all surgical procedures performed on men undergoing a modified one‐ or two‐layer VV between June 1992 and July 1994 were retrospectively reviewed. A successful outcome (patency) was defined as sperm present at follow‐up (mean follow‐up 8 weeks). A modified one‐layer VV was used in 17 men (group 1) and a two‐layer VV in 23 (group 2).

Results Sperm were present in both groups if surgery was undertaken after vasal obstruction lasting < 36 months. The modified one‐ and two‐layer VV had equal patency (88% and 90%, respectively) when undertaken after an obstructed interval of 36–96 months; outcomes were poorer if surgery was performed after > 96 months. The mean operative duration was 96 min for a modified one‐layer VV and 167 min for the two‐layer VV.

Conclusions The simpler and faster modified one‐layer VV provides sufficient accuracy for successful vasectomy reversal in most cases. For most patients, both procedures have equivalent patency.
Renal transplantation in patients with an augmentation cystoplasty
Authors: Power R.E. , O'Malley K.J. , Khan M.S. , Murphy D.M. , Hickey D.P.
Published: March 2003

Objective To retrospectively review our experience over a 10‐year period of renal transplantation in patients with augmented bladders and thus assess the safety of this procedure.

Patients and methods Ten transplant recipients who had previously undergone augmentation cystoplasty were reviewed; a cadaveric kidney was transplant in each case. The donor ureter was anastomosed to the augment bladder in six patients, in three to the native ureter and in one the donor renal pelvis was anastomosed to the native ureter.

Results No patients died and nine of the 10 grafts were functioning at a mean follow‐up of 27 months. The mean (sd) serum creatinine level at the follow‐up was 100.8 (27.25) mmol/L. Four patients had 10 episodes of urosepsis requiring hospital admission, with only one graft lost.

Conclusion Renal transplantation can be performed safely in patients with an augmentation cystoplasty.
Ethanol‐glycine irrigating fluid for transurethral resection of the prostate in practice
Authors: Okeke A.A. , Lodge R. , Hinchliffe A. , Walker A. , Dickerson D. , Gillatt D.A.
Published: March 2003

Objective To evaluate the usefulness of a tracer of 1% ethanol in 1.5% glycine in the early detection of irrigation fluid absorption during transurethral resection of the prostate (TURP).

Patients and methods Patients (120) undergoing TURP were irrigated with 1% ethanol in 1.5% glycine solution and their expired air tested for alcohol every 10 min during the procedure.

Results In all, 112 patients were assessed; over half of the patients absorbed the irrigation fluid and they had a significantly lower postoperative serum sodium concentration (P < 0.002). Fourteen patients (12.5%) absorbed over 500 mL and two (1.8%) developed clinical features of the TUR syndrome. The experience of the surgeon, the weight of resected chips and the operative duration were not significantly predictive of absorption.

Conclusion A tracer amount of ethanol in the irrigant is reliable for detecting absorption. Irrigating fluid absorption was unpredictable, thus supporting the case for routine monitoring.
The management of children with complete ureteric duplication: selective use of uretero‐ureterostomy as a primary and salvage procedure
Authors: Choi H. , Oh S.‐J.
Published: March 2003

Objective To determine the optimum management of duplex urinary tracts with refluxing or obstructed units.

Patients and methods Sixty‐three children (19 boys and 44 girls) with complete duplex‐system anomalies (84 duplex system units) who underwent corrective surgery by one surgeon (H.C.) between March 1983 and June 1997 were reviewed, analysing their diagnosis and treatment.

Results Most children had presented with urinary tract infection; a ureterocele was found in 26 renal units, reflux in 12 and a combined anomaly in 18. Ectopic insertion of the ureter causing incontinence was found in six and ureteric obstruction in nine ureteric units. Patients were managed so that whenever possible, functional renal tissue was preserved; thus surgical strategies were basically staged, conservative, and planned preoperatively on the basis of renal function. Initial surgery was undertaken in 71 units (all patients; ureterocele incision in 12, upper pole nephrectomy in 30, ureteric reimplantation in 14, uretero‐ureterostomy in 13 and others in two). The median (range) follow‐up was 7.6 (2.1–16) years. Secondary procedures were undertaken in 24 units (34%); ureterocele incision (11 of 12 units) was the most common procedure of additional surgery, followed by ureteric reimplantation (six of 27 units), upper pole nephrectomy (eight of 37 units) and uretero‐ureterostomy (two of 18 units).

Conclusions Uretero‐ureterostomy was the most successful nephron‐sparing additional operation. When the upper pole is salvageable, uretero‐ureterostomy may be the preferred alternative for managing complete duplex system anomalies.
The role of colour Doppler ultrasonography in detecting prostate cancer
Authors: Shigeno K. , Igawa M. , Shiina H. , Wada H. , Yoneda T.
Published: March 2003

Objective To determine the usefulness of colour Doppler ultrasonography (CDUS) in detecting prostate cancer, by comparing CDUS with grey‐scale transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI).

Patients and methods In all, 278 patients who underwent prostate biopsies because of an abnormal digital rectal examination, elevated prostate specific antigen levels, and/or abnormal TRUS between May 1998 and November 1999 were evaluated. The diagnostic accuracies of TRUS, CDUS, MRI and combinations of these imaging techniques in detecting prostate cancer were compared, based on the biopsy results.

Results Carcinoma was detected in 233 of 1696 specimens, and 87 patients were diagnosed with prostate cancer. For each detected cancer site, the sensitivity of CDUS was lower than those of other imaging techniques, but CDUS had high a specificity and positive predictive value. The combination of grey‐scale TRUS and CDUS or MRI improved the sensitivity and negative predictive value. The specificity and positive predictive value of the combination of grey‐scale TRUS and MRI were less than those for grey‐scale TRUS alone, while those for the combination of grey‐scale TRUS and CDUS were higher than those for grey‐scale TRUS alone. Five tumours were isoechoic but seen as hypervascular lesions with CDUS.

Conclusion CDUS provides information useful for detecting prostate cancer when used in combination with grey‐scale TRUS, and should be included in the routine examination for prostate cancer.
Elevation of sensory thresholds in the prostatic urethra after microwave thermotherapy
Authors: Brehmer M. , Nilsson B.Y.
Published: March 2003

Objectives To determine whether transurethral microwave thermotherapy (TUMT) affects the sensory threshold in the posterior urethra and whether such an effect influences urinary storage symptoms.

Patients and methods The sensory threshold was measured before and at 3 and 12 weeks after TUMT in 13 men with minor obstructive symptoms caused by benign prostatic hyperplasia. Sensations were evoked by electrical stimulation at different frequencies, using a bipolar ring‐electrode mounted on a urethral catheter. Changes in sensory thresholds were evaluated in the patients both as a group and individually. The patients were interviewed about their symptoms at each measurement.

Results After TUMT, 12 patients were satisfied and reported decreased irritative symptoms, primarily less frequent nocturnal micturition; two patients were cured of urgency incontinence. In 11 of the satisfied patients, and the unsuccessful patient, decreased urge accompanied increased sensory thresholds. Thresholds elevated by  30% were correlated with decreased irritative symptoms.

Conclusions TUMT decreases sensitivity in the posterior urethra, which may alleviate storage symptoms.
Patient self‐injection: a new approach to administering luteinizing hormone‐releasing hormone analogues
Authors: Hamm R. , Patel B. , Whittlestone T. , Persad R.
Published: March 2003

Objective To investigate the feasibility and advantages of self‐injection of a depot dose of luteinizing hormone‐releasing hormone (LHRH) analogue in patients with prostate cancer.

Patients and methods Twenty patients (mean age 70.9 years, range 53–85) with locally advanced or metastatic prostate cancer were recruited from urology clinics and, using a defined protocol, were taught to perform self‐injection of a depot LHRH analogue (Prostap SR® or Prostap 3®, leuprorelin acetate, Wyeth Laboratories, Berks, UK). Patients were then followed for 1 year.

Results Of the 20 patients, 11 successfully learned to use self‐injection and administered injections for the duration of the study. Ten of the patients chose self‐injection and continued to self‐inject after the end of this study.

Conclusions This pilot study of 20 patients showed that it is feasible for a selected group of patients to be taught self‐injection of an LHRH analogue, and that some patients prefer this mode of drug administration.
Towards a minimum dataset in urology
Authors: Thomas K. , Emberton M. , Mundy A.R.
Published: March 2003

Objective To establish and prospectively collect data for a minimum dataset in urology by agreeing a dataset amongst a group of urologists, designing structured forms around the data items and implementing them in clinical practice.

Methods Consultant urologists decided the initial dataset. Structured forms, which incorporated the dataset items, were designed. These forms were piloted before implementation in two urology departments. They were used to document clinical information instead of writing this in the traditional medical record. After use forms were ‘scanned’ before being filed in the medical record, thus storing the data in an electronic format.

Results Nine forms were designed; inpatient and outpatient activity was captured separately. There were six outpatient forms; a generic new patient form and five specific follow‐up forms (lower urinary tract symptoms, oncology, erectile dysfunction, female urology and stones). Three generic inpatient forms were designed. The forms were used by nine registrars, five senior house officers and six clinical nurse practitioners, who required minimal training.

Conclusion It is possible to agree a minimum dataset amongst a relatively small group of urologists. The information can be acquired prospectively using structured forms instead of the traditional medical record. This locally agreed dataset could form the basis for a national consensus on a minimum dataset in urology.
Urological cancers: do early detection strategies exist?
Authors: Webb V. , Holmes A.
Published: March 2003

Objective To determine the perceptions of healthcare professionals and the general public about the symptoms, diagnosis and available treatment of urological cancers, and thus the perceived value of screening for their early detection.

Subjects and methods Two questionnaires were developed, based on semi‐structured interviews, and distributed to 288 healthcare professionals, comprising 182 general practitioners (GPs), 56 practice nurses and 50 urology nurses, and to 250 members of the general public in three different socio‐economic groups. The questionnaires asked about the symptoms, diagnosis and treatment of prostate, bladder and testicular cancer, and whether the respondents considered that screening for these cancers would be useful in ameliorating morbidity or death from these diseases.

Results The response rate was very poor (13 of the GPs, 7%; 34 of the nurses, 32%; and 58 members of the general public, 23%). This severely limited the interpretation of the results, but the responses highlighted areas which need addressing. Obvious symptoms were well understood by all the groups but less well‐known symptoms could be missed. No GP supported screening for prostate cancer and only seven of the GPs believed in teaching testicular self‐examination, but practice nurses were considerably more active in all aspects of patient education. The general public felt that they needed more information to make decisions about urological cancers, although there was a general feeling that ‘screening saved lives’.

Conclusion This survey showed that no healthcare professional seems to have a clearly defined role in informing potential patients about screening. The general public, who seem to perceive from the media that early detection is beneficial, are confused by the lack of clarity about policies for urological cancers.
Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis
Authors: Onishi T. , Oishi Y. , Suzuki Y. , Asano K.
Published: March 2003

Objective To evaluate the efficacy of transcatheter arterial embolization (TAE) in patients with unresectable renal cell carcinoma (RCC) and distant metastasis at the time of diagnosis.

Patients and methods The study included 54 patients with histologically defined RCC (by biopsy in 28 and autopsy in 26) who were unable to undergo nephrectomy mainly because their performance status was poor (score  2). The patients were classified into two groups; 24 patients who underwent TAE with ethanol and 30 patients who did not. The two groups were compared for several clinical factors, mainly focusing on the prognosis.

Results There were no significant differences in the clinical factors, including performance status, tumour diameter, vascular invasion, lymph node involvement, adjuvant therapy, metastatic organs or the number of metastases between the groups. However, the proportion of patients with para‐neoplastic signs in those undergoing TAE was greater than that in those not, and the difference was significant (chi squared 0.35, P < 0.05). The median survival of the two groups was 229 days (TAE) and 116 days (no TAE). The 1‐, 2‐ and 3‐year survival rates in the TAE group were 29%, 15% and 10%, respectively, and in those not undergoing TAE were 13%, 7% and 3%, respectively. Those undergoing TAE had a significantly better prognosis than those who did not (P = 0.019). The adverse effects in patients undergoing TAE with ethanol included fever, back pain on the affected side, nausea and vomiting, but all the patients recovered from these adverse effects.

Conclusion TAE with ethanol is a safe and effective treatment for patients with unresectable disseminated RCC and a poor performance status; TAE with ethanol not only induces ablation of the primary tumour, but also prolongs survival.
A conservative approach to major blunt renal lacerations with urinary extravasation and devitalized renal segments
Authors: Moudouni S.M. , Patard J.J. , Manunta A. , Guiraud P. , Guille F. , Lobel B.
Published: March 2003

Objectives To determine the feasibility of a conservative (expectant) approach to major blunt renal laceration with urinary extravasation and devitalized renal segments.

Patients and methods All patients treated conservatively who presented between 1990 and 1999 with major renal laceration (grade 4 and 5) were retrospectively reviewed to determine whether urinary extravasation and devitalized segments adversely affected the outcome. For each patient the data collected included the initial emergency department evaluation, findings on computed tomography, associated injuries, duration of hospital stay, transfusion requirements, complications and follow‐up imaging.

Results Of 20 patients who sustained blunt trauma resulting in a major renal laceration (five grade 5 and 15 grade 4) with urinary extravasation, 11 had coexisting devitalized segments. There was a statistically significant difference in the length of hospital stay (16.3 vs 7.3 days), blood transfusions (six vs two patients, P < 0.08) and the need for delayed surgical intervention (nine vs two, P < 0.01) between patients with and with no devitalized segments, respectively. Urinary extravasation spontaneously resolved in two of 11 patients with and in seven of nine with no devitalized segment, respectively (P < 0.05)

Conclusions Urinary extravasation will resolve spontaneously in most patients with blunt renal trauma, and expectant treatment does not adversely affect the outcome or prolong hospitalization. In patients who present with a major renal laceration associated with devascularized segments, conservative management is feasible in those who are clinically stable with blunt trauma. However, the physician must be especially aware of the probable complications within this subset of patients.
Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective
Authors: Rowland D.L. , De Gouveia Brazao C.A. , Koos Slob A.
Published: March 2003

Objective. To determine whether men with premature ejaculation who fail to respond to 25 mg clomipramine as needed improve when taking 10–30 mg clomipramine daily.

Subjects and methods Four men with premature ejaculation whose ejaculation latencies increased minimally or not at all when taking 25 mg clomipramine as needed participated in a prospective 12‐week study consisting of four treatment phases, beginning with baseline (0 mg) and progressing through increasing daily doses of 10, 20, and 30 mg clomipramine. The subjects maintained daily logs of their sexual activities and estimated their ejaculatory response, sexual arousal and penile rigidity during intercourse. The subjects were contacted 8–15 weeks after the experiment to assess their satisfaction with and continued use of clomipramine.

Results There was a dose‐response effect on ejaculatory latency with increasing levels of clomipramine; 30 mg increased the latency from 25 s to 220 s, a clinically significant increase. In addition, 30 mg taken daily was significantly more effective than 25 mg as required. Other variables of sexual response (sexual interest, arousal and penile rigidity) were unaffected. At follow‐up all four subjects expressed satisfaction and three continued the dose.

Conclusion Men with premature ejaculation who do not respond to clomipramine ‘as required’ are probably not insensitive to pharmacological treatment, but may simply require higher doses or a different regimen. All four subjects improved when taking daily clomipramine at varying doses. These results suggest that if initial treatment is unsuccessful, 20–30 mg daily clomipramine should be considered.
Varicocele in adolescence induces left and right testicular volume loss
Authors: Kass E.J. , Stork B.R. , Steinert B.W.
Published: March 2003

Objective To determine the effect of a palpable left‐sided varicocele (which in adolescent patients can adversely affect left testicular volume) on right testicular volume with progressive Tanner development and increasing varicocele grade.

Patients and methods The right and left testicular volumes were measured with a standard orchidometer in 70 control patients (mean age 14.6 years,

sd 2.2) with no palpable testicular abnormality and in 434 (mean age 14.3 years,

sd 2.3) with a palpable left‐sided varicocele. Patients with bilateral and right‐sided varicoceles were excluded from the study.

Results There was no significant difference between the left and right testicular volumes in the control patients. The testicular volumes of patients with a grade I varicocele were similar to those in control patients. Patients with a grade II varicocele had a significantly smaller left testis than the controls at Tanner stages 4 and 5 (P  0.05). Patients with a grade III varicocele had a significantly smaller left testis than controls at each Tanner stage (P  0.05) and significantly smaller right testis than controls at Tanner stages 4 and 5 (P  0.05).

Conclusion The presence of a grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually. Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.
The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele—avoiding postoperative hydrocele
Authors: Oswald J. , Körner I. , Riccabona M.
Published: March 2003

Objective To assess whether identifying and preserving the lymphatic vessels, using vital dyes, avoids postoperative hydrocele in adolescents with varicocele undergoing high retroperitoneal ligation (Palomo procedure).

Patients and methods The results were assessed from 28 consecutive adolescent patients undergoing varicocelectomy, treated between 1998 and 1999 by the Palomo procedure. The lymphatic vessels were identified and preserved using vital dyes, to avoid postoperative hydrocele formation.

Results In 24 of the 28 patients (86%) the identification and preservation of lymphatic vessels was feasible. Over a mean (range) follow‐up of 14 (4–24) months there were no postoperative hydroceles and no clinical recurrences.

Conclusion Identifying and preserving the lymphatic drainage of the testis and tunica vaginalis using vital dyes prevents the development of postoperative hydrocele in adolescents undergoing the Palomo procedure.
Urinary levels of substance P and its metabolites are not increased in interstitial cystitis
Authors: Campbell D.J. , Tenis N. , Rosamilia A. , Clements J.A. , Dwyer P.L.
Published: March 2003

Objectives To determine whether interstitial cystitis is associated with the increased release of substance P from the bladder wall into urine, by measuring urinary excretion rates of substance P and its metabolites in women with interstitial cystitis and in a control group of women with stress incontinence and normal bladder function.

Patients and methods Catheter urine was collected from 13 patients and 10 controls during a water diuresis (≈ 10 mL/min) before and after instilling the bladder with 100 mL of water. The contribution of the bladder wall to urinary substance P peptides was assessed by measuring the change in substance P peptide levels after 2 min of bladder stasis before and after instillation.

Results Absolute substance P excretion rates were similar in patients with interstitial cystitis and controls; 2 min of bladder stasis reduced the substance P excretion rate (P = 0.03) and increased the excretion rate of substance P metabolites (P = 0.01).

Conclusions The release of substance P from the bladder wall was not increased in patients with interstitial cystitis.
Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double‐blind placebo‐controlled trial
Authors: Thilagarajah R. , Witherow R. O'N. , Walker M.M.
Published: March 2003

Objective To evaluate the efficacy of oral cimetidine as a treatment for painful bladder disease (PBD, variously described as a ‘symptom complex’ of suprapubic pain, frequency, dysuria and nocturia in the absence of overt urine infection) by assessing symptom relief and histological changes in the bladder wall tissue components, compared with placebo.

Patients and methods The study comprised 36 patients with PBD enrolled into a double‐blind clinical study with two treatment arms, i.e. oral cimetidine or placebo, for a 3‐month trial. Patients were asked to complete a symptom questionnaire (maximum score 35), and underwent cystoscopy and bladder biopsy before treatment allocation. On completing treatment the patients were re‐evaluated by the questionnaire and biopsy. The symptom scores and bladder mucosal histology were compared before and after treatment, and the results analysed statistically to assess the efficacy of cimetidine.

Results Of the 36 patients recruited, 34 (94%) completed the study. Those receiving cimetidine had a significant improvement in symptoms, with median symptom scores decreasing from 19 to 11 (P < 0.001). Suprapubic pain and nocturia decreased markedly (P = 0.009 and 0.006, respectively). However, histologically the bladder mucosa showed no qualitative change in the glycosaminoglycan layer or basement membrane, or in muscle collagen deposition, in either group. The T cell infiltrate was marginally decreased in the cimetidine group (median 203 before and 193 after) and increased in the placebo group (median 243 and 250, P > 0.3 and > 0.2, respectively). Angiogenesis remained relatively unchanged. The incidence of mast cells and B cells was sporadic in both groups.

Conclusions Oral cimetidine is very effective in relieving symptoms in patients with PBD but there is no apparent histological change in the bladder mucosa after treatment; the mechanism of symptom relief remains to be elucidated.
Diversion colitis in children with colovaginoplasty
Authors: Syed H.A. , Malone P.S.J. , Hitchcock R.J.
Published: March 2003

Objective To highlight the occurrence of diversion colitis and its effects in colovaginoplasty.

Patients and methods The records of 18 children who had undergone colovaginoplasty were reviewed retrospectively. Nine patients had androgen‐insensitivity syndrome and three each had congenital adrenal hyperplasia, vaginal agenesis and Mayer–Rokitansky syndrome. Through an abdominoperineal approach a segment of sigmoid colon was isolated on its vascular pedicle and brought to the perineum in the plane between the urethra and rectum, as a blind pouch or as an interposition between the proximal vagina and the perineum. The mean (range) follow‐up was 5 (1.5–8) years.

Results There were no major complications during the early follow‐up. Three patients developed severe vaginal discharge with bleeding 2–7 years after colovaginoplasty; examination showed erythema, oedema, ulceration and bleeding. Histology confirmed the classic features of diversion colitis in all three patients. One child responded to vaginal irrigation with a solution of short‐chain fatty acids, and the other two were treated with steroid enemas and mesalazine after a poor response to short‐chain fatty acids. One of these patients has required surgical reduction of an excessively long neovagina.

Conclusion Symptomatic diversion colitis can occur after colovaginoplasty. The severity of the symptoms raises concerns about the use of colovaginoplasty in children and alternative techniques of vaginal replacement should be considered in the first instance.
The prevalence of loss of heterozygosity in chromosome 3, including FHIT, in bladder cancer, using the fluorescent multiplex polymerase chain reaction
Authors: Wada T. , Louhelainen J. , Hemminki K. , Adolfsson J. , Wijkström H. , Norming U. , Borgström E. , Hansson J. , Steineck G.
Published: March 2003

Objective To determine some of the genetic alterations involved in the pathogenesis and progression of transitional cell carcinoma of the bladder.

Materials and methods In a population‐based study, freshly frozen tissue was collected from all patients newly diagnosed with urinary bladder cancer in the Stockholm region during 1995–1996. The prevalence of loss of heterozygosity (LOH) was assessed at seven sites on chromosome 3, analysed in 151 patients, using a fluorescent multiplex polymerase chain reaction based on DNA from the tumour and peripheral blood.

Results LOH was detected in 12.1% (at 3q25–26.2) to 22.1% (at 3p11–12) of the informative cases. Relatively frequent LOH was detected at 3p22–24.2 (21.6%), at 3p14.2 within FHIT (21.5%), and at 3p11–12 (22.1%). Of 151 tumours, 72 (47.7%) showed LOH at one or more loci on chromosome 3. LOH on chromosome 3 was weakly associated with tumour grade (P = 0.095), but not with tumour stage (P = 0.701). However, when the frequency of LOH was analysed individually at each site, the prevalence of LOH at 3p11–12 was closely correlated with higher tumour stage (P = 0.011). Replication errors were detected in only four of 151 (2.6%) tumours.

Conclusion These findings suggest that the 3p11–12 locus may involve a putative candidate tumour‐suppressor gene which might be associated with bladder tumour invasiveness. The FHIT gene locus showed a relatively high frequency of LOH even in Ta tumours.
The serous‐lined tunnel principle for urinary reconstruction: a more rational method
Authors: Kato H. , Kiyokawa H. , Igawa Y. , Nishizawa O.
Published: March 2003

Objective To examine the feasibility of using the serous‐lined‐tunnel principle for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment.

Patients and methods We created: (i) an orthotopic ileal neobladder using the serous‐lined technique for antirefluxing ureteric implantation in 16 patients; (ii) a continent ileal pouch, adopting the principle for continent‐valve construction and for ureteric implantation, in 10 patients (another patient with a failed continent valve underwent revision using an adaptation of this principle; and (iii) by applying the same principle an ileal ureter with a proximal antirefluxing mechanism was constructed in two patients (with lower ureteric cancer), and total replacement of the ureter by a tubular segment of the colon in association with a continent transverse colon pouch in one irradiated patient.

Results In all, 52 ureters implanted into ileal neobladders or continent pouches functioned well, with neither obstruction nor reflux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo‐ureteric reflux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional flow into the pouch.

Conclusion Ureteric reimplantation and continent valve formation achieved by adopting the serous‐lined tunnel principle provided satisfactory results. The versatility of the principle is apparent in the present experience and the creative application of the serous‐lined tunnel principle should be possible in urinary reconstruction.
Gracilis muscle flap with a tissue‐engineered lining for experimental bladder wall reconstruction
Authors: Schoeller T. , Lille S. , Bauer T. , Piza‐Katzer H. , Wechselberger G.
Published: March 2003

Objective To assess a pedicled gracilis muscle flap pre‐laminated with autologous, in vitro‐expanded urothelial cells to reconstruct an entire supratrigonal bladder‐wall defect in rats.

Materials and methods A gracilis muscle flap was harvested from 36 male Wistar rats, transposed into the abdomen and wrapped around a silicon‐block space holder. Urothelial cells were harvested and expanded ex vivo. Cells were then suspended in fibrin glue and seeded into the gracilis muscle pocket. One week later this pre‐laminated flap was transposed into a surgically created supratrigonal bladder‐wall defect. All animals underwent such a pre‐laminated gracilis flap bladder reconstruction and were categorized into three experimental groups. All surviving animals with urothelial‐culture pre‐laminated gracilis flap bladder reconstruction were killed 12 weeks (group 1) later. Control rats had gracilis flaps with no cell seeding and treated only with fibrin glue (group 2) or a standard culture medium (group 3) before reconstruction.

Results Specimens stained with haematoxylin and eosin, and a specific immunohistochemical staining (AE1 and AE3‐anti‐cytokeratin monoclonal antibody stain) showed a continuous, multilayered functioning urothelial lining along the transposed pre‐laminated gracilis flap in group 1. All animals in group 1 with an intact urothelial lining on the gracilis muscle survived, in contrast to most animals in groups 2 and 3, where eight and all 12 animals died, respectively. The surviving four animals in group 2 had no detectable urothelial lining.

Conclusion Successful urinary reconstruction requires a contractile neo‐reservoir resistant to resorption over time and a stable, protective urothelial lining. A gracilis muscle flap can be seeded with autologous cultured urothelial cells suspended in fibrin glue. This pre‐laminated flap can be safely transposed on its pedicle and be successfully integrated into the remaining bladder wall, with a urothelial lining and the potential to contract. Further studies in larger animals, with a urodynamic assessment, are warranted to determine if this type of bladder‐wall replacement technique is suitable for urinary reconstruction in humans.
The role of the adult urologist in the care of children: findings of a UK survey
Authors: Thomas D.F.M. , Fraser M.
Published: March 2003

Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines.

Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital.

Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for  10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day‐case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children.

Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence.
Undiagnosed macroscopic haematuria revisited: a follow‐up of 146 patients
Authors: Sells H. , Cox R.
Published: March 2003

Objective To further investigate a group of patients with macroscopic haematuria who had no abnormalities on upper tract imaging and cystoscopy, to determine the appropriate follow up.

Patients and methods The hospital notes of patients who presented with frank haematuria between 1990 and 1998 and had no abnormality on cystoscopy and/or upper tract imaging were reviewed, with particular note made of any further bleeding or any other further urological problems. Those with <2 years of follow‐up in the hospital notes were investigated by telephone or via their general practitioner to ensure that all patients had at least 2 years of follow‐up after the initial investigation.

Results Of the 146 patients in the study, 98 were alive and had no more bleeding after the initial investigation. None of them were found to have renal or urothelial tumours during the follow‐up. Thirty‐three patients had recurrent episodes of bleeding after the initial investigation; 26 of these had repeat investigations and one was found to have a renal pelvic transitional cell carcinoma on repeat intravenous urography. One patient in this subgroup had died from a subarachnoid haemorrhage; 15 other patients had died, 13 of non‐urological causes and two of unknown causes.

Conclusions Of 146 patients with undiagnosed macroscopic haematuria, only one had a missed tumour and this was detected on further investigation for recurrent bleeding. These results confirm that repeat cystoscopy and upper tract imaging is only warranted in patients who have recurrent bleeding after initial investigation.
Routine bone scans in patients with prostate cancer related to serum prostate‐specific antigen and alkaline phosphatase
Authors: Wymenga L.F.A. , Boomsma J.H.B. , Groenier K. , Piers D.A. , Mensink H.J.A.
Published: March 2003

Objective To evaluate the need for a bone scan as a routine staging procedure in patients with newly diagnosed prostate cancer in relation to serum prostate‐specific antigen (PSA) and alkaline phosphatase (ALP) levels, and thus determine whether a reduction of the use of this staging method is possible in patients with a low probability of osseous metastasis.

Patients and methods The results of bone scans were related retrospectively to levels of serum PSA and ALP in 363 patients with prostate cancer newly diagnosed between 1989 and 1997.

Results Of 363 consecutive patients, 111 had a positive bone scan. In 19 of 144 (13%, ‘missed diagnosis’) patients with a PSA level of < 20 ng/mL the bone scan was positive. In 125 patients (49%, ‘false‐positives’) with a PSA level of > 20 ng/mL the bone scan was negative. A threshold level of 100 U/L for ALP gave a better balance for the number of ‘false‐positives’ and ‘missed diagnosis’. ALP values correlated better with an abnormal bone scan than did PSA levels; ALP levels of > 90 U/L indicated a 60% chance for the presence of bone metastases.

Conclusion Patients with newly diagnosed and untreated prostate cancer should undergo bone scintigraphy if there is bone pain or if ALP levels are > 90 U/L. Recent reports discourage the routine use of a bone scan when the serum PSA level is <20 ng/mL. However, the present series suggests there is a greater chance of a positive bone scan in patients with low PSA levels; these findings need further confirmation.
Autoaugmentation peritoneocystoplasty in a sheep model
Authors: Close C.E. , Dewan P.A. , Ashwood P.J. , Byard R.J. , Mitchell M.E.
Published: March 2003

Objective To report our experience with autoaugmentation peritoneocystoplasty (AAPC) in a sheep model, and to compare the results with autoaugmentation gastrocystoplasty (AAGC) in a sheep model and in paediatric patients.

Materials and methods Ten 6‐month‐old male lambs underwent bladder augmentation by detrusorotomy. A flap of parietal peritoneum, dissected from the anterior abdominal wall, was used to cover the bladder mucosa. The sheep were evaluated by urodynamics 6 months after surgery. Bladder compliance (bladder volume/intravesical pressure) was calculated for the bladder capacity at leakage. The urodynamic results were compared with age‐matched control sheep and with 12 sheep that had undergone AAGC; the results were assessed using the Mann–Whitney U‐test.

Results In two of the 10 sheep, bladder volumes after AAPC increased by > 100%, although for the group, the mean (range) bladder volume after augmentation, at 159 (42–261) mL, was not significantly different from that before surgery (mean 143 mL). Bladder volumes after AAPC were not significantly different from those in the control sheep (mean 205 mL) but were significantly less than in the AAGC group (mean 317 mL; P < 0.05). Bladder compliance at leak capacity in the AAPC group (mean 5.4 mL/cmH2O) was also not significantly different from the controls (mean 9.1 mL/cmH2O), but was lower than the in the AAGC animals (median 14.6 mL/cmH2O; P < 0.05).

Conclusions AAPC in a sheep model does not result in a reliable increase in bladder volume or compliance. The volume and compliance are inferior to those found in bladders augmented by AAGC.
The role of imipramine therapy in bladder exstrophy after bladder neck reconstruction
Authors: Dave S. , Grover V.P. , Agarwala S. , Mitra D.K. , Bhatnagar V.
Published: March 2003

Objective To assess the role of imipramine therapy after bladder neck reconstruction in patients with bladder exstrophy.

Patients and methods Seventeen children with bladder exstrophy who achieved partial continence after bladder neck reconstruction received imipramine (1.5–2 mg/kg body weight) for a mean duration of 9.5 months. Assessment before and after therapy included an objective classification of the continence status and artificial slow‐fill cystometry.

Results Eleven of the 17 patients had a good clinical response to imipramine, with an increase in the continent period to > 2 h, and in nocturnal continence. The urodynamic findings showed a significant improvement in the capacity, end‐fill pressure, uninhibited contractions and ‘20 below’ capacity. Only minor side‐effects of the drug were reported.

Conclusion Imipramine has a role in patients who achieve partial continence after reconstruction, and who have a moderately small capacity bladder with poor compliance and uninhibited contractions.
A demographic profile of patients undergoing transurethral resection of the prostate for benign prostate hyperplasia and presenting in acute urinary retention
Authors: Loh S.‐Y. , Chin C.‐M.
Published: March 2003

Objective To evaluate, in a prospective study, the demographic profile of patients with benign prostate enlargement who presented in acute urinary retention (AUR).

Patients and methods The study comprised all patients admitted for transurethral resection of the prostate and categorised into two groups, i.e. those presenting in AUR or electively. The factors evaluated included the length of hospitalization, the patients' occupation, their duration of symptoms and reasons for not seeking treatment.

Results There was no significant difference in the mean age and occupational status of the two groups but those in AUR had more complications and a longer hospital stay after surgery; 60% of these men had had their urinary symptoms for > 1 year. When asked why they did not seek treatment earlier, 35% reported fear of surgery, while 41% thought that their symptoms were a normal part of ageing.

Conclusion There is a need to raise the level of public awareness of benign prostatic enlargement because those who present with AUR incur excess morbidity and longer hospitalization that could otherwise be avoided through earlier treatment and elective surgery.
Correlations among prostatic‐specific antigen, Gleason score, staging and grading in patients after radical prostatectomy
Authors: Szymanowski J. , Dudek P. , Ratajski J. , Wysocki M.
Published: March 2003

Objectives To evaluate the correlation between Gleason grade, T stage, tumour grade and preoperative prostate‐specific antigen (PSA) level (< or > 20 ng/mL) in patients after radical prostatectomy (RP).

Patients and methods The serum total PSA level was measured 3 months before surgery in 87 patients who then underwent RP between 1994 and 2000; the tumour specimens were staged and graded.

Results There were 57 (66%) patients with a PSA level of < 20 ng/mL; in this group only four (7%) patients had a Gleason grade of > 7 and eight (14%) had G3 tumours. Thirty (34%) patients had a PSA level of > 20 ng/mL; in this group only two (7%) patients had a Gleason grade of > 7 and 26 (87%) had G1 and G2 tumours.

Conclusions These results confirm our previous observations that the PSA level cannot be use as the only factor to indicate RP in patients with prostate cancer, but further evaluation on more patients is needed.
Microangiographic imaging of the prostate
Authors: Slojewski M. , Czerwinski F. , Sikorski A.
Published: March 2003

Objective To present the results of microangiography in visualizing prostatic microvascularization.

Materials and methods A contrast medium was injected into the vessels of prostate specimens obtained during surgery, to fill small vessels; nine specimens were obtained after cystoprostatectomy and two after radical prostatectomy. Branches of prostatic or seminal vesicle arteries were used for the injection, the specimens then fixed in formalin, sectioned and X‐rayed.

Results In five samples the quality of the images was sufficient to visualize small arteries; the remaining vessels were partially filled. The vascular map was compared with previous results from historadiographic studies.

Conclusions Microangiographic imaging of prostate specimens provides a unique view of the angioarchitecture of the prostate and correlates closely with historadiographic studies. The correlation with other imaging methods, e.g. Doppler ultrasonography, needs further evaluation.
Treatment of posterior and anterior urethral trauma
Authors: Dobrowolski Z.F. , Weglarz W. , Jakubik P. , Lipczynski W. , Dobrowolska B.
Published: March 2003

Objective To assess the occurrence and treatment of posterior urethral (most often caused by traffic accidents and comprising half of all cases of urinary tract traumas and anterior urethral injury (usually iatrogenic during catheterization or cystoscopy, or caused by blunt trauma, e.g. straddle injury or penetrating trauma).

Patients and methods The records and details of patients with posterior and anterior urethral trauma were analysed from 61 urological departments in Poland between 1995 and 1999.

Results During the 5‐year period there were 268 cases of posterior and 255 of anterior urethral injury; for the former, most occurred during traffic accidents, and of the latter 206 were iatrogenic (during catheterization or cystoscopy), of which 48 were accompanied by perineal injury. The posterior injuries were isolated or involved many organs, mainly pelvic bones. Both types of injuries were diagnosed using ascending urethrography, voiding cysto‐urethrography and urethroscopy/endoscopy. Treatment for posterior injuries included cystostomy alone or cystostomy with abdominal drainage or perineal drainage; some patients also had their urethra reconstructed. The treatment for anterior injuries was conservative in 193 patients and surgical in 62.

Conclusion The early detection and appropriate surgical treatment of posterior and anterior urethral injury is crucial for the recovery of urethral function, and avoids many complications.