bluuebunny/crossref_metadata_2025 huggingface dataset:
Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management
Authors: Sayed M.A.‐B. , El‐Taher A.M. , Aboul‐Ella H.A. , Shaker S.E.
Published: March 2003

Objective To determine the causes of steinstrasse, methods of prevention and treatment strategies.

Patients and methods Fifty‐two patients with steinstrasse were identified and treated; all patients were initially treated conservatively but when there was obstruction, infection or no progression of the stone fragments, further treatment was used, ranging from repeated extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrostomy (PCN), endoscopic manipulations and finally open surgery, depending on the degree of obstruction, infection, renal function and response to each kind of therapy.

Results Conservative management was successful in 25 patients (48%), repeated ESWL in 12 (23%), PCN in 10 (19%), ureteroscopy in three (6%) and open surgery in two (4%).

Conclusion As many patients, and particularly those with larger stones, are treated by ESWL, the risk of developing steinstrasse will increase, with associated patient discomfort, infection or impaired renal function. The optimum selection of cases (aiming to pulverize the stones rather than fragment them) and accurate stone targeting are essential to minimise the development of steinstrasse. The meticulous follow‐up of patients with steinstrasse should prevent any loss of renal function. When there is obstruction and/or infection or renal damage, active treatment is indicated, of which ESWL and PCN are the most effective, with ureteroscopy and open surgery reserved for difficult cases.
The contribution of research to urological training in the United Kingdom
Authors: Feneley  , Feneley
Published: March 2003

Objectives

 To report the findings of a questionnaire survey among consultant urologists in the United Kingdom (UK) designed to examine their personal experience of research and their opinion of its contribution in urological training.

Methods

 A questionnaire was sent to 205 consultant urologists in the UK and 154 (75%) replied. Their replies were examined to ascertain the time spent in research, the production of publications, presentations and in gaining a higher university degree. Subsequent research activity was also related to the achievement of these endpoints.

Results

 Among the 154 consultant urologists who replied, 130 (84%) had undertaken research during their training, for a period varying from 6 months to more than 2 years. Among the 130, 99 (76%) considered this to have been well spent; 76 (58%) obtained a higher degree, 86 (66%) achieved at least three publications in peer‐reviewed journals and 90 (69%) had given at least five presentations to learned societies. Inadequate supervision in particular was cited as contributing to underachievement and motivation was also considered important to success.

Conclusions

 The contribution of research in urological training has been assessed traditionally by the presentation of a thesis to a university for a higher degree, but alternative methods of assessment should perhaps be sought for those wishing to spend less than 18 months in research.
The release of free prostate specific antigen into the circulation during transurethral resection of the prostate: kinetics and interaction with serum protease inhibitors
Authors: Coker  , Coptcoat  , Mulvin  , Cuomo  , Scott  , Sherwood
Published: March 2003

Objective

 To determine the nature and extent of the release of prostate specific antigen (PSA) and its interaction with its plasma protein‐derived inhibitors after transurethral resection of the prostate (TURP).

Materials and methods

 Twenty‐three consecutive patients undergoing routine TURP for benign prostatic hyperplasia had blood samples taken pre‐operatively and then post‐operatively at 8‐hourly intervals for 24 h. Further samples were obtained at 48 and 72 h post‐operatively. Serum free and total PSA were determined by immunofluorometric assay. The major plasma protein inhibitors for PSA were also determined by immunoassay.

Results

 The mean free and total PSA fractions increased significantly post‐operatively with levels greatest immediately after surgery. There was also a gradual increase in the complexed PSA fraction, reaching a peak at 48 h. The concentration of the major serum inhibitors of PSA (alpha‐1‐antichymotrypsin and alpha‐2‐macroglobulin) also declined immediately after surgery.

Conclusion

 Increases of serum total PSA in patients after TURP are caused by increases in the free PSA fraction. The exponential decline in free PSA concentrations is consistent with the complexing of PSA with its protease inhibitors present in the plasma. The formation of this complex suggests that the free PSA released into the circulation at the time of TURP is the enzymatically active form.
Treatment of mid‐ and lower ureteric calculi: extracorporeal shock‐wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness
Authors: Bierkens  , Hendrikx  , De La Rosette  , Stultiens  , Beerlage  , Arends  , Debruyne
Published: March 2003

Objectives

 To determine the efficacy and costs of extracorporeal shock‐wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid‐ and lower ureteric calculi.

Patients and methods

 The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 men and 21 women, mean age 52 years, range 23–78, 19 mid‐ and 44 lower ureteric calculi). All patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed‐dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 μm fibre. All ureteroscopies were performed with the patient under general (n=17) or spinal (n=87) anaesthesia in a mean treatment duration of 34 min. Stones were located in the mid‐ureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone‐free rates, re‐treatment rates, time to become stone‐free, complications and costs.

Results

 ESWL for mid‐ and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone‐free within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of <50 mm2 . The costs of URS were higher than those for ESWL.

Conclusions

 ESWL provides a noninvasive, simple and safe option for the management of mid‐ and lower ureteric calculi, provided that the stones are <50 mm2 ; larger stones are best treated by URS.
Is there a clinically significant change in pressure‐flow study values after urethral instrumentation in patients with lower urinary tract symptoms?
Authors: Walker  , Patel  , St Clair Carter
Published: March 2003

Objective

 To determine the effect of urethral instrumentation on pressure‐flow study values and subsequent grading of bladder outflow obstruction (BOO) in men with lower urinary tract symptoms (LUTS) using suprapubic intravesical pressure monitoring.

Patients and methods

 Seventy‐two men with LUTS underwent pressure‐flow study using suprapubic intravesical pressure monitoring. The urethra was then instrumented successively with a 12 F catheter and a 17 F cystoscope, and a further pressure‐flow study recorded after each procedure. Standard pressure‐flow variables were measured for the three recordings. The presence and degree of obstruction were determined using commonly recognized grading systems, i.e. the Abrams‐Griffiths nomogram, the linear passive urethral resistance ratio (LPURR) and the urethral resistance algorithm (URA).

Results

 There were statistically significant differences in the detrusor pressure at maximum flow and detrusor opening pressure between the uninstrumented and instrumented studies (12 F and 17 F) but no difference in peak flow rates between the groups or in the Abrams‐Griffiths number or URA value between studies. Using the LPURR, there was a tendency to a lower obstruction class after urethral instrumentation, ranking as 17 F>12 F> no instrumentation.

Conclusions

 The changes seen after urethral instrumentation represent no more than the biological intra‐individual variation normally seen in pressure‐flow studies and do not lead to a clinically significant change in obstruction class.
Cystometry in infants and children with no apparent voiding symptoms
Authors: Wen  , Tong
Published: March 2003

Objective

 To evaluate bladder function in infants and children with no apparent voiding symptoms.

Subjects and methods

 The study included 83 infants and children (51 boys and 32 girls, aged 3 days to 12 years) with no neurological and lower urinary tract pathology but who had undergone or were about to undergo surgery for upper urinary tract or other pathology. They were evaluated using slow‐filling cystometry, with simultaneous electromyography recorded using surface electrodes on the perineum. The voiding variables were compared among groups categorized by age, sex and body weight.

Results

 In boys and girls, respectively, the mean (sd) post‐void residual urine volume (PVR) was 6.3 (3.9) and 5.4 (4.8) mL, the maximum detrusor pressure during voiding was 66.1 (13.1) and 56.6 (14.7) cmH2O and the maximum voiding pressure was 73.9 (16.6) and 62.7 (16.2) cmH2O. There was no significant difference in these variables between the sexes or between infants and children (P>0.05). Detrusor instability (DI) was apparent in nine of 83 (10.8%) infants and children and occurred in the late filling phase. Bladder capacity increased with age and body weight (from 30 mL in neonates to 350 mL in 12‐year‐old children), and mean (sd) bladder compliance increased with age, from 3.6 (0.5) mL/cmH2O in infants to 13.3 (3.0) mL/cmH2O in older children, at a filling rate of 5–7 mL/min.

Conclusions

 In these infants and children with no apparent voiding symptoms, most bladders were stable, DI could occur in the late filling phase of cystometry, voiding was nearly complete, the PVR being usually <10 mL, and bladder capacity increased with age and body weight.
A single‐system ectopic ureter draining an ectopic dysplastic kidney: delayed diagnosis in the young female with continuous urinary incontinence
Authors: Borer  , Bauer  , Peters  , Diamond  , Decter  , Shapiro
Published: March 2003

Objective

 To document the array of diagnostic modalities, the variety of errant diagnoses and treatments, and the time from initial presentation to ultimate diagnosis in girls with an ectopic single‐system ureter draining an ectopic hypoplastic and/or dysplastic kidney.

Patients and methods

 Between 1990 and 1997, seven females were identified who had an ectopic hypoplastic and/or dysplastic kidney with an ectopically draining ureter, and who were treated at our institutions, either initially or upon referral. The nature and number of all diagnostic evaluations, previous diagnoses and treatments, and the time from presentation to definitive diagnosis were recorded.

Results

 All seven females had a classical history of successful toilet training, a normal voiding pattern and continuous urinary incontinence. Typically, a solitary kidney was noted on the initial diagnostic evaluation by ultrasonography and/or intravenous urography. The mean (range) age at initial presentation was 3.2 (2–6) years. Additionally, voiding cysto‐urethrography, urodynamics, radionuclide scintigraphy, computed tomography, magnetic resonance imaging and endoscopy were performed. The age at definitive diagnosis was 3–16.5 years and the mean (range) time from initial presentation to diagnosis was 5.7 (1–10) years. Nephroureterectomy was curative and all kidneys were dysplastic.

Conclusion

 Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia. When the initial evaluation yields the diagnosis of a solitary kidney, clinicians should be aware of the possibility of a hypoplastic and/or dysplastic, often ectopic, contralateral kidney with an ectopically draining ureter. Identification of this entity should allow curative surgical treatment.
Improvements in the efficiency of care after implementing a clinical‐care pathway for transurethral prostatectomy
Authors: Chang  , Huang  , Wang  , Hsieh  , Tsui
Published: March 2003

Objective

 To investigate the efficiency of care, length of hospital stay and admission charges after implementing a clinical‐care pathway for transurethral prostatectomy (TURP).

Patients and methods

 Changes in the length of hospital stay and admission charges were identified by comparing a series of 100 patients undergoing TURP and treated after implementing a clinical‐care pathway with 100 patients treated by the same physicians before implementation.

Results

 After implementing the care pathway, the mean length of hospital stay and admission charges were significantly lower (P<0.01). The shorter length of stay was caused by a significant reduction (P<0.05) in patient‐related psychological/social delay after implementation. The number of laboratory tests and use of pharmacological agents were also significantly lower (P<0.001) after implementation, with the decreases in these last variables significantly greater (P<0.001) among junior physicians.

Conclusions

 The advantages of the TURP clinical‐care pathway were the shorter hospital stay, arising from reduced patient‐related psychological or social delay, and reduced admission charges consequent on the decreased use of laboratory tests and drugs, particularly for patients treated by junior physicians. These results suggest that physicians are likely to modify their management methods to improve efficiency when a clinical path is implemented.
Bowel motility after enterocystoplasty
Authors: Wood  , Heathcote  , Nicol
Published: March 2003

Objective

 To determine whether the distension of bowel‐augmented bladders during filling and urine storage stimulates gastrointestinal peristalsis, resulting in diarrhoea and increased bowel frequency.

Patients and methods

 Five patients with symptomatic diarrhoea occurring after enterocystoplasty were studied; all had undergone bladder augmentation using ileum or colon at least 6 months previously. Using bowel frequency charts and colonic transit‐time studies, their bowel function was assessed over 6 days while patients self‐catheterized 4‐hourly. This was repeated when the patient’s bladders were decompressed with an indwelling catheter, and the results before and after bladder decompression compared.

Results

 One patient showed a significant increase in colonic transit time, from 44.4 to 57.6 h, a decrease in the percentage of liquid motions from 50% to 42.8% and a corresponding small decrease in bowel frequency with bladder decompression. One patient reported an increase in liquid stools, but there was a minor decrease in colonic transit time. The remaining three patients showed no improvement with bladder decompression. When data were combined and analysed using Student’s paired t‐test, there were no significant changes in colonic transit time, bowel frequency and diarrhoea stools with bladder decompression.

Conclusions

 Eliminating bladder distension and hence distension of the incorporated bowel segment in reconstructed bladders has no impact on bowel motility.
Microwave thermotherapy: a long‐term follow‐up of 67 patients from a single centre
Authors: Glass  , Bdesha  , Witherow
Published: March 2003

Objective

 To determine the long‐term therapeutic value of transurethral microwave thermotherapy (TUMT) in the treatment of bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH).

Patients and methods

 A total of 67 patients with BPH, assessed using symptom scores and measurements of urinary flow rate, underwent TUMT using the Leo Microthermer system (Laser Electro Optics Ltd, London, UK) between October 1990 and June 1992. Follow‐up information was obtained on 60 patients (90%). If they had undergone no further treatment for their BPH, they were re‐assessed with symptom scores and measurements of flow rate.

Results

 The mean follow‐up was 52.4 months; eight of the 67 patients had died and seven were lost to follow‐up. Sixteen of the remaining 52 (31%) had undergone another treatment for BPH; one patient developed prostatitis and one developed localized carcinoma of the prostate. Thirty‐four patients had had no further treatment, 29 of whom attended for assessment. In these patients, a statistically significant improvement in both the symptom score and flow rate was maintained at 4 years. No patients developed retrograde ejaculation.

Conclusion

 This is the first study to report a follow‐up of at least 4 years after TUMT with any device. Treatment with the Leo Microthermer provided at least a 50% symptomatic improvement in 16 of 50 patients treated at 4 years. However, 30% of the patients needed further treatment for their BPH. TUMT is safe and effective in patients not wanting anaesthesia and in young patients concerned about retrograde ejaculation.
Frozen‐thawed epididymal sperm is effective for intracytoplasmic sperm injection: implications
Authors: Hutchon  , Thornton  , Hall  , Bishop
Published: March 2003

Objective

 To evaluate the pregnancy potential of frozen‐thawed surgically retrieved epididymal sperm when used with intracytoplasmic sperm injection (ICSI).

Patients and methods

 From August 1994 to January 1997, 20 thawed samples of sperm from 19 patients, surgically retrieved and frozen after percutaneous or open epididymal aspiration, were used for ICSI. The results were compared with those obtained using fresh sperm obtained at the same procedure.

Results

 Of the specimens of surgically retrieved sperm which had been frozen, stored and thawed, 15 had sufficient motile sperm for use with ICSI. The fertilization, cleavage and pregnancy rates in those cycles were similar to the same couples’ previous cycle using fresh sperm from the same collection and to the overall results in the NURTURE ICSI programme obtained with fresh epididymal sperm.

Conclusion

 Scrotal exploration for diagnostic testicular biopsy and/or reconstructive surgery without having access to sperm‐freezing and storage facilities could represent a lost opportunity for the patient.
Primary adenocarcinoma of the urinary bladder:
Authors: EL‐Mekresh  , EL‐Baz  , Abol‐Enein  , Ghoneim
Published: March 2003

Objective

 To evaluate the outcome after the treatment of primary non‐urachal vesical adenocarcinoma and to determine the significant prognostic factors.

Patients and methods

 The records of 185 patients with vesical adenocarcinoma were reviewed. The pathological evaluation included the determination of pathological stage, tumour grade, presence or absence of mucin and its location, evidence of bilharzial infestation and flow‐cytometric DNA analysis. The mean follow‐up of the treated patients was 3.1 years. Disease‐free survival was estimated and the results correlated with patient and tumour characteristics (univariate analysis). Cox’s proportional hazards analysis was used to determine prognostic factors.

Results

 The overall 5‐year disease‐free survival was 55%; only three factors had a significant impact on survival, the tumour pathological stage and grade, and lymph node involvement.

Conclusions

Radical cystectomy remains the only satisfactory treatment option for primary vesical adenocarcinoma. Tumour stage, grade and lymph node involvement are the only significant prognostic factors.
Growth inhibition of prostate cell lines in vitro by phyto‐oestrogens
Authors: Hempstock  , Kavanagh  , George
Published: March 2003

Objective

 To assess a range of phyto‐oestrogens as moderators of growth and metabolism in several prostate cell lines.

Materials and methods

 Four prostate cell lines (PNT‐1/A, PNT‐2, PC‐3 and DU145) were challenged with different doses of five phyto‐oestrogens (biochanin A, daidzein, genistein, genistin and nordihydroguaiaretic acid) over 3 days in culture. Cell proliferation was assessed by incorporation of 5‐bromo‐2′‐deoxyuridine (BrdU) and metabolic activity by cleavage of a tetrazolium salt (XTT).

Results

 Growth and metabolism were inhibited with all compounds and cell lines (e.g. the dose for 50% inhibition of proliferation of PC‐3 cells by genistein was 38 μmol/L); differences in the patterns of results suggested that different mechanisms operated, but there was no evidence for any synergistic activity on the inhibition of cell proliferation.

Conclusion

 These results offer further support for the hypothesized role of phyto‐oestrogens as dietary protectors against prostatic cancer.
Mycobacterium vaccae (SRL172): a potential immunological adjuvant evaluated in rat prostate cancer
Authors: Hrouda  , Souberbielle  , Kayaga  , Corbishley  , Kirby  , Dalgleish
Published: March 2003

Objective

 To evaluate the potential of heat‐killed Mycobacterium vaccae (SRL172) as a nonspecific immunostimulant and as an adjuvant to whole tumour cell vaccination in the rat model of prostate cancer.

Materials and methods

 SRL172 was used as a vaccine in the prevention and treatment of subcutaneous tumours in rats. Prevention experiments were conducted using subcutaneous MAT‐LyLu tumours in Copenhagen rats, comparing vaccination with SRL172 alone, SRL172 plus autologous cells, and bacille Calmette‐Guèrin (BCG) plus autologous cells before tumour implantation. Treatment experiments were conducted using subcutaneous MAT‐LyLu tumours in the Copenhagen rat and subcutaneous PAIII tumours in the Lobund‐Wistar rat. Tumours were induced by subcutaneous injection with tumour cells. Animals were then vaccinated with autologous cells, autologous cells plus SRL172, or SRL172 alone.

Results

 SRL172 was effective as an adjuvant to autologous whole tumour cell vaccination in the prevention of MAT‐LyLu tumours and the survival benefit was equivalent to that provided when the adjuvant was live‐attenuated BCG. SRL172 alone did not reduce tumour take or tumour growth in this model and neither strategy was effective in delaying the growth of established MAT‐LyLu tumours. In the Lobund‐Wistar rat vaccination with autologous whole tumour cells and SRL172 significantly delayed the growth of established tumours.

Conclusion

 Mycobacterium vaccae deserves further evaluation as an adjuvant to whole tumour cell vaccination in a phase I clinical trial in patients with prostate cancer.
Efficacy of escalating doses of intravesical interferon α‐2b in reducing recurrence rate and progression in superficial transitional cell carcinoma
Authors: Giannakopoulos  , Gekas  , Alivizatos  , Sofras  , Becopoulos  , Dimopoulos
Published: March 2003

Objective

 To compare the efficacy of three different doses of intravesical interferon α‐2b (IFNα‐2b) in reducing recurrence and progression rates in superficial grade II, transitional cell carcinoma (TCC).

Patients and methods

 Eighty‐nine patients with primary or recurrent TCC stage Ta/T1, grade II, were randomly allocated into four groups after transurethral resection (TUR) of the tumour. Group A (20 patients) received no further treatment, serving as the control group; group B (22 patients) received 40 MU of IFNα‐2b, group C (24 patients) 60 MU and group D (23 patients) 80 MU. The instillations started within 48–72 h after TUR and were performed weekly for 2 months, bimonthly for the next 4 months and thereafter monthly for 6 months. The patients were followed for 36 months. The four groups were compared for the number of recurrences (simple recurrence rate), progression in stage, disease‐free interval and recurrence rate per 100 patient‐months.

Results

 During the follow‐up, 33 patients had recurrence (13, eight, seven and five in groups A to D, respectively). The simple recurrence rate was 65% for group A, compared with 36% (P=0.06), 29% (P<0.05) and 22% (P<0.01) for groups B, C and D, respectively. The differences in simple recurrence rates between the groups treated with IFNα‐2b were not statistically significant. Eleven patients experienced progression in stage, with six, three, one and one in groups A to D, respectively. The differences were statistically significant only between groups A and C (P<0.05) and groups A and D (P<0.05). The disease‐free interval was 15 months for group A, compared with 21.4 (P<0.05), 26.1 (P<0.001) and 30 months (P<0.001) for groups C to D, respectively. The disease‐free intervals of the groups treated with IFNα‐2b were significantly different between all patients in groups B and D (P<0.01) and only for those with stage T1 between groups C and D (P<0.01). Finally the recurrence rate per 100 patient‐months was 2.91, 1.19, 0.88 and 0.63 for groups A to D, respectively (all P<0.001). The results were always in favour of the patients treated with the high dose, the only exception being the difference between groups C and D (P=0.026). No side‐effects of the drug were noted, nor was any adverse reaction reported from any patient.

Conclusion

 These results show a significant advantage for adjuvant intravesical IFNα‐2b treatment over TUR alone for the 36 months of follow up and indicate that IFNα‐2b can modify the clinical course of superficial TCC at least in the short term. The appropriate dose was apparently 80 MU, for although 40 MU was better than TUR alone, it was less effective than 60 MU and 80 MU; the 80 MU dose was slightly better than 60 MU and thus this regimen is recommended.
Desmopressin in the treatment of severe nocturnal enuresis in adolescents — a 7‐year follow‐up study
Authors: Läckgren G. , Lilja B. , Nevèus T. , Stenberg A.
Published: March 2003

Objectives

To evaluate the role of long‐term oral desmopressin (over a 7‐year follow‐up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure.

Patients and methods

The effect of oral desmopressin was investigated in 25 adolescents (aged 11–21 years) with severe monosymptomatic nocturnal enuresis. The long‐term study consisted of two 12‐week treatment periods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week. Subsequently, the patients were followed‐up for up to 7 years. Close contact was maintained with the families over this period (‘good doctoring’ approach). At ≈3‐, 5‐ and 7‐year intervals after completing the study, patients were assessed for dryness, frequency, treatment and sleeping habits, using postal questionnaires and telephone follow‐up.

Results

At the end of the long‐term study, 35% of the patients remained dry without therapy. Within 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years, 19 patients were cured. Nocturia occurred in 75% of the enuretic patients but in only 5% of the healthy controls.

Conclusions

Active treatment of primary nocturnal enuresis with oral desmopressin has a clinically significant effect on the cure rate, which is maintained after ceasing therapy. The cure rate was higher than would be expected from spontaneous recovery alone during the first 2 years of the study and there was a significant further increase in the cure rate 7 years after ending therapy, again greater than the expected spontaneous cure rate. There also seemed to be a better response to treatment when it was prolonged. Furthermore, this therapy is safe when administered in the long–term.
Contemporary results of radical radiotherapy for bladder transitional cell carcinoma in a district general hospital with cancer‐centre status
Authors: Bell  , Lydon  , Kernick  , Hong  , Penn  , Pocock  , Stott
Published: March 2003

Objective

To assess the current efficacy and safety of definitive external beam radiotherapy (EBRT) in the treatment of invasive bladder transitional cell carcinoma (TCC) in a district general hospital with cancer‐centre status.

Patients and Methods

The case notes of all patients with bladder TCC undergoing EBRT with curative intent over an 8‐year period (1988–95) were reviewed. Additional missing outcome data were collected.

Results

In all, 120 patients (109 men; median age 70 years, range 34–90) underwent radical EBRT (40–65 Gy; fraction median=20) over the 8‐year period. Staging, as assessed by examination under anaesthesia and computed tomography, was T1 in 16%, T2 in 43%, T3 in 38% and T4 in 3%. In 96 patients (80%) the tumour was poorly differentiated (G3). The overall morbidity at 12 months was 12%; proctitis occurred in nine patients (8%) and cystitis in five (4%). Sixty‐seven patients (59%) developed a local recurrence and in 36 (30%) this was invasive. The overall median survival was 60 months. Thirty‐three patients underwent salvage cystectomy with a subsequent median survival of 12.5 months.

Conclusion

Modern radical multifraction EBRT in invasive bladder TCC has a low morbidity, with an overall median survival of 5 years.
Oral desmopressin for nocturnal polyuria in elderly subjects: a double‐blind, placebo‐controlled randomized exploratory study
Authors: Asplund  , Sundberg  , Bengtsson
Published: March 2003

Objective

To evaluate the decrease in nocturnal diuresis, nocturnal polyuria and the safety of oral desmopressin in elderly subjects with nocturia.

Subjects and methods

After being identified using a population‐based questionnaire, subjects were included in the study if they; (i) were healthy and free from medication with possible influence on the diuresis or voiding pattern; (ii) had an increased nocturnal frequency (≥2 nocturnal voids/night, as reported before screening); (iii) had a nocturnal urinary output of ≥0.9 mL/min; (iv) completed and responded to an initial dose‐titration study. Twelve men and five women (mean age 67.7 years, sd 4.6 years) met these criteria and were treated with oral desmopressin or placebo at bedtime for 2 weeks on each medication in a randomized, double‐blind, crossover design.

Results

Subjects treated with desmopressin had a significantly reduced nocturnal diuresis of 0.59 mL/min compared with those on placebo (95% confidence interval, CI, 0.33–0.85). The 24‐h diuresis was unaffected by desmopressin treatment. Patients treated with desmopressin had fewer micturitions at night than had those on placebo (1.1 and 1.7, respectively; P<0.001; mean difference=0.59; 95% CI, 0.32–0.85). The reduction in nocturnal diuresis was dependent on the baseline level of night‐time diuresis (r=0.886; r2=0.785; P<0.0001) and the nocturnal part of the baseline 24 h‐diuresis (r=0.708; r2=0.502; P<0.001). After desmopressin treatment was withdrawn, diuresis returned to the levels before treatment. The time from falling asleep to first awakening was improved by 1.4 h in patients treated with desmopressin. There was no change in body weight or ankle circumference during desmopressin treatment. Overall, the treatment was well tolerated and no serious adverse events were observed.

Conclusion

Desmopressin was effective in reducing nocturnal diuresis and nocturnal voids in polyuric elderly subjects, with no significant adverse events or inconvenience to the patient. The length of uninterrupted sleep was also improved.
The value of central histopathological review of testicular tumours before treatment
Authors: Lee  , Mead  , Theaker
Published: March 2003

Objective

To assess the value of central histopathological review of testicular tumours.

Materials and methods

The histopathology reports of the referring hospital and central review were compared for all referred testicular specimens (201 orchidectomies and seven testicular biopsies) from 11 hospitals in one region, between 1992 and 1997.

Results

There were two main findings: First, there was a major discrepancy of tumour type in 12 specimens (6%). The most frequent change (in five cases) was from seminoma to nonseminomatous germ cell tumour (NSGCT). There were also difficulties with uncommon tumours such as spermatocytic seminoma, lymphoma and adenocarcinoma. Treatment was changed as result of the altered diagnosis in eight of these 12 patients. Second, there were discrepancies of interpretation of vascular invasion in 12 of 59 NSGCTs (20%). Differences of tumour elements recognized in NSGCTs were frequent.

Conclusions

The errors discovered on central histopathological review of testicular tumours were significant, though small in number. This supports the idea of central review and is consistent with the specialization recommended in the Calman–Hine cancer arrangements.
Immunohistochemical detection of neuronal plexuses and nerve cells within the upper urinary tract of pigs
Authors: Rolle  , Brylla  , Tillig
Published: March 2003

Objective

To investigate the distribution and topography of nervous structures within the renal pelvis and upper part of the ureter of pigs, and thus help to determine the origin, propagation and mechanisms of the modulation of pelvi‐ureteric peristalsis.

Materials and methods

Whole‐mount preparations of renal pelves from adult pigs were stained using a universal immunostaining method with streptavidin‐alkaline phosphatase. Anti‐neuron‐specific enolase antibody and anti‐neurofilament antibody were used as neuronal markers.

Results

The patterns of neuronal structures differed between the renal calyces, renal pelvis and upper ureter. In the calyx, there was one single dense nerve plexus; this network contained relatively thin nerve fibres running both circularly and longitudinally. In the wall of the renal pelvis and upper ureter there were two neuronal plexuses, one submucosal and another within the muscular layer; these nerve fibres were mainly orientated longitudinally. Some single nerve cells were also found at the pelvicalyceal border.

Conclusions

These findings suggest a potent nervous system within the upper urinary tract of pigs that connects the renal calyces with the renal pelvis, pelvi‐ureteric junction and ureter. The presence of these dense neuronal networks and nerve cells within the wall of the renal pelvis and ureter suggests that propagation, coordination and modulation of pelvi‐ureteric peristalsis in pigs may arise through intrinsic nervous stimulation.
The role of retroperitoneoscopy in the management of renal and adrenal pathology
Authors: Hemal  , Aron  , Gupta  , Seth  , Wadhwa
Published: March 2003

Objectives

To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys.

Patients and methods

Nine patients (six men and three women, mean age 56 years, range 44–68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6–14 cm) were treated by retroperitoneoscopic cyst ablation using three 10‐mm ports. Six further patients (two male and four female, mean age 24 years, range 13–38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys.

Results

Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50–85) min in patients with simple renal and adrenal cysts, and 185 (160–210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50–200) mL and hospital stay 2.33 (2–4) days. At the last follow‐up, 15–39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85–120) min; the mean (range) blood loss was 116 (75–150) mL and the analgesic requirement 208 (150–250) mg of diclofenac sodium. The hospital stay was 2–3 days and the delay before return to preoperative activity 7–14 days.

Conclusions

Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.
The pubofascial anchor sling procedure for recurrent genuine urinary stress incontinence
Authors: Kane  , Chung  , Lawrie  , Iskaros
Published: March 2003

Objective

To evaluate, in a preliminary study, the outcome of a modified pubovaginal sling operation with titanium bone anchors for recurrent genuine stress urinary incontinence (GSI) in women.

Patients and methods

This prospective study included 13 consecutive women who underwent the modified sling procedure between September 1994 and August 1996. The subjective and objective cure of urinary stress incontinence, and the occurrence of postoperative osteitis pubis, were assessed.

Results

All 13 patients subjectively claimed complete urinary continence and 12 were objectively cured (12 patients agreed to undergo a repeat urodynamic study) during a median (range) follow‐up of 26 (19–38) months. There were no cases of postoperative osteitis pubis, bladder injury or major complications. Mild suprapubic pain was a frequent and self‐limiting complication.

Conclusions

This innovative modified sling procedure is effective for recurrent urinary stress incontinence, with no complication of osteitis pubis. We suggest that this procedure should be considered as a treatment for recurrent GSI and perhaps for primary GSI. A study incorporating a longer follow‐up and more patients has been planned.
The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences
Authors: Aytaç  , Mckinlay  , Krane
Published: March 2003

Objectives

To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health‐policy consequences using the recent developments in the UK as a case study.

Methods

Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population‐based rates rather than rates based on clinical samples. All the projections were age‐adjusted.

Results

It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of ≈322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America.

Discussion

The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under‐funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.
Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy
Authors: Rehman  , Christ  , Kaynan  , Samadi  , Fleischmann
Published: March 2003

Objective

To explore the utility of intraoperative cavernosal nerve stimulation in facilitating atraumatic nerve dissection during radical prostatectomy, and thus help predict postoperative erectile function.

Patients and methods

Fourteen patients (aged 51–72 years) underwent nerve‐sparing radical retropubic prostatectomy (NSRRP); 10 were potent before surgery (group 1), and four had erectile dysfunction (group 2). A multi‐acquisition system (MacLab/8e) with a Macintosh computer was used for real‐time display and recording of intracavernosal pressure (ICP) during surgery. Nerves were stimulated with a bipolar probe (monophasic rectangular pulses, 10 mA, 20 Hz, 0.22 s) before and after removal of the gland. The follow‐up consisted of interviews with patients and their partners’ 12–18 months after treatment.

Results

The mean (sem) basal ICP of 8.0 (2.0) cmH2O remained unchanged during nerve dissection. The mean increase in ICP during electrical stimulation was >50 cmH2O in seven potent patients (group 1) and was sustained as long as the nerve was stimulated. Postoperatively, these seven patients reported erections sufficient for sexual intercourse. However, the three remaining patients in group 1 had pressure rises of <30 cmH2O, of whom two reported partial erections and one reported total impotence postoperatively. The recovery time for erectile function was 6–12 months after surgery. Two patients from group 2 had transient increases in ICP to <40 cmH2O; one had an increase to 20 cmH2O and one had no response at all. All four patients remained totally impotent postoperatively. There were no complications.

Conclusions

Intraoperative electrical stimulation of the cavernosal nerves with ICP monitoring before and after NSRRP is a safe and reliable method for documenting nerve continuity and its functional status. Patients who have normal preoperative erectile function and show an adequate rise in ICP upon electrical nerve stimulation during NSRRP will almost certainly be potent after surgery. This tool may be used to facilitate atraumatic nerve dissection during NSRRP.
Preliminary results of the alternating administration of natural interferon‐α and recombinant interferon‐γ for metastatic renal cell carcinoma
Authors: Fujii  , Yui‐En  , Ono  , Yamamoto  , Gohji  , Takenaka
Published: March 2003

Objective

To evaluate the efficacy and toxicity of the alternating administration of natural (n) interferon (IFN)‐α and recombinant (r) IFN‐γ for metastatic RCC.

Patients and methods

The study comprised 24 patients (median age 60 years, range 42–77), 20 of whom were evaluable for response and all 24 evaluable for toxicity. Initially, nIFN‐α was administered subcutaneously on days 1 and 3, and rIFN‐γ on day 2, for 1–2 weeks in the evening or at night, both at doses of 3 MU. If this regimen was tolerated, nIFN‐α and rIFN‐γ were administered at the same doses on days 1, 3 and 5, and on days 2 and 4, respectively.

Results

There were three complete remissions and two partial remissions, giving a total response rate of 25%. All responders (complete plus partial remission) had undergone nephrectomy. Multiple lung metastases completely disappeared from four responders. The median and maximum time to remission in the responders were 2 and 7 months, respectively. The survival time of the responders was significantly longer than that of those not responding (stable and progressive disease, P=0.0202). Toxicities were mostly limited to WHO grades 1 and 2, with grade 3 leucopenia and grade 4 hepatic dysfunction in only one patient each. These toxicities were transient and there were no treatment‐related deaths.

Conclusion

The alternating administration of nIFN‐α and rIFN‐γ is an effective treatment for metastatic RCC. This treatment is particularly suitable for patients who have undergone nephrectomy and have lung metastases.
Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure‐flow evaluation
Authors: Dæhlin  , Hedlund
Published: March 2003

Objectives

 To evaluate the effects on lower urinary tract symptoms and pressure‐flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo™ diode laser system (Indigo, Palo Alto, USA).

Patients and methods

 Forty‐nine men (median age 68 years, range 52–80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63–72) underwent pressure‐flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia.

Results

 The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure‐flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams–Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams–Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1–2 weeks. The re‐treatment rate was 15% within the first year.

Conclusion

 Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1–2 weeks in most cases. A long‐term follow‐up is necessary to determine the role of ILC.
Influence of high‐grade prostatic intra‐epithelial neoplasia on total and percentage free serum prostatic specific antigen
Authors: Morote  , Encabo  , Lopez  , De Torres
Published: March 2003

Objective

 To analyse the influence of high‐grade prostatic intra‐epithelial neoplasia (HGPIN) on total and percentage free serum prostatic specific antigen (PSA).

Patients and methods

The total and free serum PSA levels were measured (using a double‐monoclonal antibody immunoassay, Tandem and Tandem free PSA, Hybritech Inc, Liège, Belgium) in 570 consecutive patients undergoing sextant ultrasound‐guided prostatic biopsy because of an abnormal digital rectal examination or a serum PSA concentration of > 4.0 ng/mL. The main diagnosis was benign disease in 321 (56%) and prostate cancer in 249 (44%). HGPIN was detected in 85 (15%) of the patients; in 17 (20%) it was associated with benign tissue and in 68 (80%) with prostate cancer.

Results

Patients with benign disease had a median total serum PSA level of 7.2 with no HGPIN and 7.7 ng/mL when HGPIN was present (P>0.05); the corresponding values in patients with prostate cancer were 16.0 and 15.9 ng/mL (P>0.05). The median percentage free serum PSA was 15.8 in patients with HGPIN‐free benign disease and 14.1 when HGPIN was present (P>0.05); the corresponding values in patients with prostate cancer were 9.7 and 11.0 (P>0.05). In a multivariate analysis, prostate cancer was the major contributor to total and percentage free serum PSA levels.

Conclusion

The presence of HGPIN does not contribute significantly to total and percentage free serum PSA levels.