bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum chromogranin‐A in advanced prostate cancer
Authors: Ferrero‐Poüs M. , Hersant A.M. , Pecking A. , Brésard‐Leroy M. , Pichon M.F.
Published: March 2003

Objective To determine the value of serum chromogranin A (CgA), a marker of neuroendocrine differentiation, for monitoring prostate cancer; CgA levels were related to three other tumour markers, i.e. total prostate‐specific antigen (tPSA), prostatic acid phosphatase (PAP), neurone‐specific enolase (NSE), and to testosterone, to assess the importance of hormone withdrawal.

Patients and methods Serum samples (218) were obtained from 118 patients with prostate cancer, including 111 patients with advanced prostate cancer; 103 presented to our centre for systemic radionuclide therapy of painful skeletal metastases. CgA concentrations were measured using a new immunoradiometric assay (IRMA; Cis Bio International, Gif sur Yvette, France) and a threshold of 70 ng/mL was determined after receiver operating characteristic curve analysis. Testosterone was also measured with an IRMA assay; tPSA, PAP and NSE were assayed using the time‐resolved amplified cryptate emission.

Results Serum marker levels were high in 64% of the patients for CgA, 24% for NSE, 89% for tPSA and 81% for PAP. Patients resistant to endocrine treatments and with elevated tPSA (i.e. hormone‐independent) showed increased CgA and NSE in 62% and 29%, respectively. Patients with hormone‐dependent prostate cancer (i.e. with a normal tPSA level) had elevated CgA in 59% but no abnormal NSE. All patients of the latter group except one showed clinical progression of their disease. However, the mean (sd) concentrations of CgA in hormone‐independent (146) or hormone‐dependent (22) patients, at 185.3 (449.1) and 160.9 (293.9) ng/mL, respectively, were not statistically different (P = 0.8, Mann–Whitney U‐test). For 30 patients, blood samples were drawn and markers measured before and after systemic radionuclide therapy. There was a significant increase in the CgA and tPSA concentrations after treatment (P = 0.0146 and 0.0025, respectively).

Conclusions In association with tPSA, serum CgA appears to be a promising marker for monitoring patients with prostate cancer.
Upper and mid‐ureteric stones: a prospective unrandomized comparison of retroperitoneoscopic and open ureterolithotomy
Authors: Goel A. , Hemal A.K.
Published: March 2003

Objectives To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery.

Patients and methods Between March 1994 and mid‐December 2000, 55 patients with large (mean 2.1 cm) upper and mid‐ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium‐based.

Results The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P < 0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL.

Conclusions RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid‐ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.
The URO Mentor: development and evaluation of a new computer‐based interactive training system for virtual life‐like simulation of diagnostic and therapeutic endourological procedures
Authors: Michel M.S. , Knoll T. , Köhrmann K.U. , Alken P.
Published: March 2003

Objective To overcome the current disadvantages of traditional training methods for ureterorenoscopy and percutaneous nephrolitholapaxy, using the URO Mentor (Simbionix, Tel Aviv, Israel) computer‐assisted simulator.

Methods The URO Mentor device for training and quality control in ureterorenoscopy was developed using virtual reality, multimedia technology and intelligent tutoring systems. The central software system features a proprietary visualization engine (the SVE) which allows real‐time simulation by offering a high‐level object‐orientated application program interface (written in C++) available for use with either Microsoft®, DirectX 7® or OpenGL as platforms. The SVE includes general procedures to allow two‐ (2D) and three‐dimensional (3D) rendering, collision detection, collision correction, 3D morphing, 2D image manipulation, texture mapping, ‘bump’ mapping, video texture, X‐ray rendering, special effects (blood, smoke, stone fragments and more) and reflections.

Results The system allows a complete training session on a wide range of procedures by offering different types of cases and virtual patients, and features a full representation of the endourological procedures under direct vision and by using interactive fluoroscopy with a contrast agent. The supported tools include: baskets, graspers, intracorporal lithotripters, guidewires, catheters, stents, biopsy and dilatation devices. The endourological procedures that can be performed are lithotripsy, tumour resection, treatment of strictures and obstructions, stent placement and biopsies.

Conclusion The URO Mentor introduces a new generation of mannequin equipped with a special haptic device, providing trainees with an unparalleled life‐like sensation while training for diagnostic and therapeutic endourological procedures. By bringing key advances into urological simulation (e.g. with the real‐time X‐ray renderer) and by integrating in a single system both high‐quality simulation and learning tools, the URO Mentor provides new perspectives for computer‐based urological training systems and methods.
A study comparing various noninvasive methods of detecting bladder cancer in urine
Authors: Saad A. , Hanbury D.C. , McNicholas T.A. , Boustead G.B. , Morgan S. , Woodman A.C.
Published: March 2003

Objectives To compare the nuclear matrix protein (NMP)‐22 assay, bladder tumour specific antigen (BTAstat) test, telomerase activity (using the telomeric repeat amplification protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer.

Patients and methods The study included 120 urological patients prospectively recruited and assessed before surgery. A single freshly voided urine sample (≈100 mL) was collected from each patient and aliquoted for each test. All assays were conducted according to the manufactures' guidelines; 79 patients were tested for telomerase activity. The results were then compared with VUC and the diagnosis confirmed by cystoscopy and histology.

Results Fifty‐two patients had histologically confirmed transitional cell carcinoma. The overall sensitivity for BTAstat, NMP22, telomerase, VUC and dipstick testing was 63%, 81%, 84%, 48% and 50%, respectively. Combining the results for telomerase and NMP22 gave a sensitivity of 100%. For G1 tumours the respective sensitivities were 23%, 62%, 56%, 23% and 15%, for G2 tumours, 68%, 86%, 92%, 50% and 41% and for G3 tumours 88%, 88%, 100%, 71% and 82%. For pTa tumours the respective detection rates were 48%, 70%, 84%, 39% and 30%, for pT1 tumours 80%, 90%, 90%, 50% and 50%, for pT2/pTis tumours, 100/100%, 100/100%, 100/100%, 88/100% and 88/83%. The overall specificity for the respective tests was 82%, 87%, 93%, 87% and 54%; combining the results of NMP22 and telomerase activity increased the specificity to 96%.

Conclusions There was significantly better detection than VUC when using the NMP22 and TRAP assay, especially for well‐differentiated (P < 0.001 and 0.0027, respectively) and superficial tumours (P < 0.001 and 0.034, respectively). Combining the results of NMP22 and telomerase activity yielded values comparable with cystoscopy.
Resistive index: an experimental study of the effects of diuretic stimulation in the unobstructed porcine kidney
Authors: Rawashdeh Y.F. , Hørlyck A. , Djurhuus J.C. , Frokiaer J. , Mortensen J.
Published: March 2003

Objective To study the effects of diuretic stimulation with frusemide and mannitol on the renal resistive index (RI) of the undilated unobstructed porcine kidney.

Materials and methods Experiments were carried out on 14 pigs divided into two equal groups (A and B), under general anaesthesia. In all pigs both ureters were catheterized, thereby allowing urine output to be measured on each side separately, and an indwelling catheter in a femoral artery used to continuously measure the systemic blood pressure. Furthermore, in five pigs from each group, right renal blood flow was measured by ultrasonic flow probes placed around the renal arteries. The right kidney RI was measured at baseline and at 5‐min intervals after frusemide (group A) and mannitol (group B) stimulation, for 75 min.

Results Frusemide caused significant increases in diuresis (P < 0.001) and renal blood flow (P = 0.009). This was accompanied by a significant decrease in mean arterial pressure (P < 0.001). The RI was unaffected (P = 0.706), with mean values in group A of 0.58–0.65. Mannitol also caused a significant increase in diuresis (P < 0.001) and a subtle but significant decrease in mean arterial pressure (P < 0.001). However, renal blood flow was unaffected by the diuretic (P = 0.820); the mean RI values were unaffected, at 0.61–0.66 (P = 0.375).

Conclusions These results show that diuretic stimulation with frusemide or mannitol does not affect the RI of the unobstructed undilated porcine kidney, despite significant changes in diuresis, renal blood flow and mean arterial pressure.
Functional results of pyeloplasty in patients with ante‐natally diagnosed pelvi‐ureteric junction obstruction
Authors: Cornford  , Rickwood
Published: March 2003

Objective

 To assess the outcome after pyeloplasty in children with an ante‐natal diagnosis of hydronephrosis, shown on post‐natal renography to be due to pelvi‐ureteric junction (PUJ) obstruction, and in particular to review the outcome of those who had initially been managed expectantly.

Patients and methods

 Between 1984 and 1995, 321 patients were diagnosed as having PUJ obstruction, after investigating ante‐natal hydronephrosis. Of these, 47 had undergone pyeloplasty and also had a normal contralateral kidney; 26 patients had early pyeloplasty because of impaired function and 21 underwent surgery after a period of expectant management. Renal function was assessed renographically before and at least one year after surgery.

Results

 Relative renal function was stabilized in those patients who underwent early pyeloplasty (mean differential function 28.1% before and 32.7% after surgery). In patients who underwent pyeloplasty after a period of expectant management, the mean relative function decreased from 44.8% initially to 30.5% before surgery; this recovered to 37.5% at the post‐operative reassessment, representing a statistically significant loss of function (P<0.01).

Conclusion

 In patients born with PUJ obstruction and impaired renal function, pyeloplasty failed to significantly improve function, possibly because of cortical loss. In patients with ante‐natal PUJ obstruction managed expectantly there is a small but significant risk of a modest loss of renal function
Anatomical correction of the exstrophy–epispadias complex: analysis of 34 patients
Authors: Nicholls  , Duffy
Published: March 2003

Objective

 To evaluate the surgical procedures required for anatomical reconstruction of the bladder and penis in the exstrophy–epispadias complex.

Patients and methods

 All primary exstrophy–epispadias repairs carried out by one surgeon between 1987 and 1997 were reviewed. Bladder closure consisted of full extraperitoneal mobilization, transpositional omphaloplasty, drainage with ureteric and urethral catheters and immobilization with a ‘frog‐leg’ plaster‐cast or ‘mermaid’ dressings. Osteotomies were always performed when bladder closure was attempted after 37 h of age. Before 1990 the osteotomies were posterior vertical iliac (one patient) and subsequently anterior oblique iliac (10 patients). Pre‐peritoneal herniotomies, in the absence of a clinical hernia, were included in the primary procedure after 1992. A modified Cantwell technique was used for epispadias repair and this was undertaken at a median of 16 months after bladder closure (range 6–30).

Results

 Thirty‐four patients (27 male) were reviewed; one patient had a chromosomal abnormality, a deletion in the short arm of chromosome 4. The male infants required a median of four procedures (range 2–5) for bladder closure, epispadias reconstruction and herniotomies, while the females needed a median of two (range 2–5). Complete bladder dehiscence, requiring re‐closure with osteotomies, occurred in three cases (9%, two male). There were no dehiscences in the primary osteotomy group. Fistulae after epispadias repair occurred in four patients (17%). The bladder capacity increased to >60 mL in 10 of 15 males by 36 months after epispadias repair. Only two of seven female infants attained a capacity of >60 mL. Of the 15 infants who did not undergo herniotomy at primary closure, 13 subsequently developed inguinal hernias (one uni‐ and 11 bilateral) with incarceration occurring in two. Twelve infants underwent herniotomy at primary closure and six developed subsequent hernias (two uni‐ and four bilateral; P=0.05) with documented incarceration in two.

Conclusions

 Anatomical correction of the exstrophy‐ epispadias complex remains challenging, but can be achieved with complication rates of <20% for each stage. Bladder volumes large enough to permit adequate bladder neck reconstruction can be anticipated after epispadias repair in a large proportion of male infants, but remains small in female infants with low outlet resistance. Inguinal herniotomy at the time of bladder closure significantly reduces the incidence of subsequent herniation, which nevertheless remains high.
Pharmacokinetics and effects of intravesical oxybutynin on the paediatric neurogenic bladder
Authors: Åmark  , Eksborg  , Juneskans  , Bussman  , Palm
Published: March 2003

Objective

 To evaluate the pharmacokinetics of both oxybutynin and its active metabolite, N‐desethyl oxybutynin (NDO), when the drug is instilled directly into the bladder in children with myelodysplasia and neurogenic bladder disturbance, in whom it may improve continence and decrease the risk of upper urinary tract deterioration.

Patients and methods

 The study comprised 13 children (five girls and eight boys, mean age 9.3 years, range 1–15) with neurogenic bladders who were treated using clean intermittent catheterization and intravesical instillation of a sterile, pharmacy‐produced solution of oxybutynin. Steady‐state minimum plasma levels of oxybutynin and NDO, together with their effect on urodynamic variables and incontinence, were evaluated. The dose (0.04–0.17 mg/kg, mean 0.1 mg/kg) was instilled twice daily.

Results

 The effects of the drug on incontinence and urodynamic variables were pronounced, improving both in most cases. Minimum plasma levels were <0.3–7.2 ng/mL for oxybutynin and 0.8–14 ng/mL for NDO. The ratio of oxybutynin to NDO was 0.29–0.83 (mean 0.47).

Conclusion

 There was no clear relationship between minimum plasma levels of the drug or NDO and their clinical effects; however, the combination of oxybutynin and NDO seemed to be more strongly correlated with the clinical effects.
Long‐term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic children
Authors: Riccabona M. , Oswald J. , Glauninger P.
Published: March 2003

Objective

To determine the time taken to achieve complete dryness, the management of desmopressin dosage to reduce the relapse rate, the mean dosage in those responding and any side effects of long‐term treatment.

Patients and methods

Enuretic children (155, 68% boys and 32% girls, mean age 8 years, range 5–19) were treated with desmopressin and assessed. Treatment (intranasal spray) was started with 20 μg desmopressin and titrated to 40 μg (maximum 50 μg) after 2 days if the child did not become dry within 48 h. The maximum dosage was maintained for at least 4–6 weeks. After 4 weeks of complete dryness, the dosage was reduced by 10 μg initially, and after each additional 4 dry weeks, by a further 10 μg; medication was stopped only after 4 dry weeks at 10 μg.

Results

Of the children, 85% responded to intranasal desmopressin therapy; 71% achieved complete dryness with no relapses, remaining dry with no further treatment, 7% achieved dryness after relapses during or after therapy, 7% improved (no more than two wet nights per week) and 15% did not respond to therapy or improved only slightly (>2 wet nights per week). The mean duration of therapy was 28 weeks, the mean dose of desmopressin was 30 μg and the median follow‐up 18 months. There were no significant side‐effects.

Conclusion

This study indicates that rapid titration until dryness within 1–3 days, a long maintenance therapy of at least 4–6 weeks and a slow stepwise reduction of dose decreases the frequency of relapse and improves the outcome.
A new thermo‐expandable shape‐memory nickel‐titanium alloy stent for the management of ureteric strictures
Authors: Kulkarni  , Bellamy
Published: March 2003

Objective

To assess the ease on insertion, patient tolerance, undesirable side‐effects, degree of encrustation and duration of upper tract decompression with a new thermo‐expandable shape memory alloy ureteric stent.

Patients and methods

From November 1996 to October 1998, 15 patients with ureteric strictures were treated with a new nickel‐titanium shape‐memory alloy stent, the Memokath 051 (Engineers & Doctors A/S, Hornbaek, Denmark). A total of 22 insertions were carried out. Ureteric obstruction was caused by recurrent colorectal carcinoma in four patients; two patients each with transitional cell carcinoma of the bladder, iatrogenic injury or ischaemia at the uretero‐ileal anastomosis; and one patient each with metastatic lymph nodes from prostatic carcinoma, radiation‐induced fibrosis, pelvi‐ureteric junction obstruction, metastatic carcinoma of the vagina and extra‐luminal endometriosis. The stent has a shaft diameter of 9 F and its proximal end expands to 17 F. The first three patients were treated with the original version, which expanded to 14 F. The unexpanded stent is inserted into the ureter after initial dilatation of the stricture to 12 F. The stent is expanded by injection with sterile water preheated to 50 °C. The procedures were carried out under a general anaesthetic and patients were allowed home the next day. The follow‐up protocol included initial intravenous urography (IVU) at 6 weeks, with assessment of a mid‐stream urine sample and renal function tests. These were repeated at 3‐monthly intervals. Isotopic renography was performed when indicated.

Results

The mean (range) follow‐up was 10.6 (2–21) months; there was complete relief of upper tract obstruction in all patients. No stent‐related symptoms, e.g. pain, sepsis, haematuria or frequency, were noted and no encrustation has occurred so far. The stent migrated in the first three patients with the original smaller diameter of stent but decompression of the upper tracts was maintained. None of the modified wider stents have migrated. The return of peristalsis in the proximal ureter was detected during IVU. There was no apparent endothelial growth through the stent material and no re‐admissions for stent‐related complications.

Conclusion

Early experience with this new stent is very encouraging. All patients have maintained satisfactory decompression of their upper tracts with no need for repeated hospitalization for stent changes. There have been no untoward side‐effects so far. This stent appears to have a valuable place in the long‐term management of ureteric strictures; it is probably most suited for malignant ureteric obstruction. It should be considered in the management of selected benign strictures that require long‐term JJ stenting.
Minimally invasive treatment of urinary tract calculi in children
Authors: Fraser  , Joyce  , Thomas  , Eardley  , Clark
Published: March 2003

Objective

To report experience of a broad multimodality approach to the treatment of calculi in children using extracorporeal shock wave lithotripsy (ESWL), ureteroscopy/laser lithotripsy, lithoclast and percutaneous nephrolithotomy (PCNL).

Patients and methods

The treatment and outcome were reviewed in 43 children managed by a range of minimally invasive modalities, either singly or in combination, between 1990 and 1997. These patients represent a selected group deemed suitable for minimally invasive management during a period of developing experience with these techniques. Of this cohort, six children had previously undergone open stone surgery and contributory metabolic abnormalities were identified in seven. ESWL was the sole treatment modality in 24 children (56%). In five children (12%) ureteroscopy/laser lithotripsy was combined with ESWL, eight (18%) underwent ureteroscopy/laser lithotripsy alone, whilst three with bladder stones were treated with the lithoclast. Combined therapy including PCNL was required in three patients.

Results

Of the 43 children treated, 38 (88%) were rendered stone‐free. Metabolic disorders accounted for three of the five cases of residual calculi. Complications requiring intervention occurred in two children (7%) and three subsequently underwent open pyelolithotomy or ureterolithotomy after unsuccessful minimally invasive treatment.

Conclusions

Used selectively, the range of minimally invasive procedures available for adults, including ureteroscopy and PCNL, can be safely and effectively extended to the treatment of urinary tract calculi in children. The role of open surgery will diminish further with the availability of specialized instruments for paediatric PCNL.
Tubularized‐incised urethral plate urethroplasty: is regular dilatation necessary for success?
Authors: Elbakry
Published: March 2003

Objectives

 To report the results of the tubularized‐incised urethral plate repair of hypospadias.

Patients and methods

 Twenty‐seven patients (mean age 8 years, range 6–18) had their hypospadias corrected using the tubularized‐incised urethral plate technique. Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, and four patients required a second‐stage repair. The urethral plate was incised in the midline and tubularized over a suitably sized stent. In patients who required second‐stage repair a Thiersch–Duplay neourethra was constructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularization of the incised urethral plate.

Results

 The functional and cosmetic results were excellent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation of the glanular urethra, all fistulae resolved spontaneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. Other complications included haematoma formation in one patient, urinary tract infection in another and frequent bladder spasm in two.

Conclusions

 The tubularized‐incised urethral plate urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. It can be applied not only for the primary repair of distal hypospadias, but also for re‐operation of recurrent hypospadias. The technique is ideal for constructing a glanular urethra when the Thiersch–Duplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula.
Objective and subjective effects of treatment for testicular cancer on sexual function
Authors: Van Basten  , Van Driel  , Hoekstra  , Sleijfer  , Van De Wiel  , Droste  , Schraffordt Koops  , Mensink
Published: March 2003

Objective

 To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction.

Patients and methods

 Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity.

Results

 In contrast to the surveillance group, BEP‐treated patients had higher follicle‐stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP‐treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities.

Conclusions

 After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES‐evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.
Control of the unstable urinary bladder by graded thermoelectric cooling of the spinal cord
Authors: Callsen‐Cencic  , Mense
Published: March 2003

Objective

To evaluate local lumbosacral spinal‐cord cooling (a novel technique for neuromodulating urinary bladder reflexes) for its feasibility in possible clinical use, by determining the efficacy and the optimum temperature for suppressing reflex urinary incontinence in two rat models of neurogenic urinary bladder instability.

Materials and methods

Overactivity of the detrusor muscle was induced by inflammation of the urinary bladder in a group of rats. A second group of rats was examined 6 weeks after complete midthoracic spinal cord transection, when all animals had developed neurogenic bladder hyper‐reflexia. The intravesical pressure, urethral pressure and electromyographic (EMG) activity of the external urethral sphincter (EUS) were recorded simultaneously during repetitive local cooling and re‐warming of the dorsal L6/S1 spinal cord segments, using a thermoelectric cooling device.

Results

Spinal cord cooling at L6/S1 had no influence on the recorded values at >26°C, but markedly suppressed detrusor contraction frequency at 21– 25°C. Cooling to <20°C completely and reversibly eliminated inflammation‐induced bladder contractions in rats with an intact neural axis and significantly reduced the contraction amplitudes (mean reduction 61%) and duration of contractions in spinally transected rats. Cooling simultaneously increased tonic EUS EMG activity and urethral perfusion pressure in both experimental groups, indicating closure of the urethral outlet. Cooling of adjacent spinal cord segments had no influence on bladder and urethral functions.

Conclusion

Cooling the dorsal spinal cord at the origin of the parasympathetic innervation of the bladder can be used to reversibly suppress bladder instability with simultaneous closure of the urethral outlet. Therefore, local spinal cord cooling, e.g. as an implantable thermoelectric device, may offer a suitable method to treat detrusor overactivity and restore continence.
Angiogenic peptides in prostatic disease
Authors: Walsh  , Sherwood  , Dew  , Mulvin
Published: March 2003

Objective

To determine the value of measuring serum concentrations of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in patients with benign prostatic hyperplasia (BPH), advanced and localized prostate cancer, and thus assess the role of angiogenesis factors as markers of malignancy and the formation of metastasis.

Patients and methods

Serum was obtained from 106 suitable patients who attended a routine clinic during the study period. A histological diagnosis was confirmed for each patient and a bone scan was positive in those with metastatic disease. The level of serum prostate specific antigen (PSA) was measured and the serum concentrations of VEGF and bFGF measured using a quantitative sandwich immunoassay technique.

Results

There was a significant difference (1.6‐fold) in the serum concentration of bFGF between patients with local and advanced prostate cancer (P=0.006), but there was no significant difference for either of the growth factors between patients with BPH and metastatic prostate cancer (Mann–Whitney test).

Conclusion

The serum levels of VEGF and bFGF could not be used to distinguish benign from malignant prostatic disease; the serum PSA level is of more value than either, but the serum concentration of bFGF may be of some value in differentiating patients with local and advanced malignancy.
Quantitative sensory and autonomic testing in male diabetic patients with erectile dysfunction
Authors: Wellmer A. , Sharief M.K. , Knowles C.H. , Misra V.P. , Kopelman P. , Ralph D. , Anand P.
Published: March 2003

Objective

To correlate abnormalities of nerve fibres in the lower limbs with erectile dysfunction in male diabetic patients, using a range of quantitative sensory and autonomic function tests.

Patients and methods

The study included 68 male diabetic patients with symptomatic erectile dysfunction and 11 matched diabetics without erectile dysfunction; none had clinical evidence of peripheral vascular disease or psychological disorder. Patients were evaluated with a symptom questionnaire based on the Michigan Neuropathy Screening Instrument questionnaire and examined clinically. Sural and peroneal nerve‐conduction studies, and quantitative sensory and autonomic tests (vibration, thermal, light‐touch thresholds, sensory and autonomic cutaneous axon‐reflexes) were used to detect nerve abnormalities in the lower limbs, which were correlated with erectile dysfunction.

Results

Symptoms of neuropathy were more common in the group with male erectile dysfunction (MED), but statistically significant only for neuropathic pain (53% MED, 18% nonMED, P<0.05, chi‐square test) and gastroparesis (44% MED, 0% nonMED, P<0.05). Tests of unmyelinated afferents (warming perception and capsaicin‐induced sensory axon‐reflex vasodilatation) were most often abnormal, sometimes with no other abnormalities on tests or neurological examination. However, abnormality of warm perception was not significantly different between groups (81% MED, 70% nonMED), suggesting that it is a poorer discriminant than abnormal sensory axon‐reflex vasodilatation (89% MED, 22% nonMED, P<0.001). The only other significant test difference was decreased sural nerve action potential (70% MED, 22% non‐MED, P<0.01).

Conclusions

There appeared to be preferential involvement of unmyelinated sensory fibres that mediate axon‐reflex vasodilatation in the limbs of diabetic patients with erectile dysfunction. This test appears to be a helpful indicator of neurological involvement in erectile dysfunction, and may be used to monitor the effect of new treatments.
Urinary tract infection after urodynamic studies in women: incidence and natural history
Authors: Bombieri  , Dance  , Rienhardt  , Waterfield  , Freeman
Published: March 2003

Objective

To study the incidence, natural history and symptomatic effects of bacteriuria after urodynamic studies in women.

Patients and methods

In a prospective study in the urogynaecology clinic of a large District General Hospital, 214 women (mean age 52.3 years, range 23–81) underwent urodynamic studies. Bacteriuria was detected by semiquantitative culture at 2 and 7 days after the test. Women completed a 7‐day diary of symptoms and events.

Results

The incidence of bacteriuria after urodynamic studies was 7.9%. Bacteriuria was transient in four of 17 women but persisted in nine and developed late in four; only one of 17 infections gave rise to symptoms. Irritative bladder symptoms after the test occurred in 34% of women, but only three went to their doctors because of concern about a possible urinary tract infection. Advancing age was the only variable associated with bacteriuria after urodynamic studies (P=0.05). Menopausal status, past history of urinary tract infection, number of urethral instrumentations required, order number in a session, peak urinary flow rate and urodynamic diagnosis were not associated variables.

Conclusions

In a large series of women presenting to a urogynaecology clinic, urodynamic investigations were associated with a high incidence of transient irritative symptoms but a low incidence of bacteriuria (8%). Infection was asymptomatic in most patients, but its natural history was unpredictable. Transient, persistent and late cases of bacteriuria all occurred. In this population, urodynamic studies are associated with a low level of morbidity.
Natural‐fill urodynamics in chronically catheterized patients with spinal‐cord injury
Authors: Jamil  , Williamson  , Ahmed  , Harrison
Published: March 2003

Objective

To determine whether an indwelling catheter on free drainage provides a constantly low intravesical pressure in patients with a neuropathic bladder.

Patients and methods

Thirty patients with complete spinal‐cord injury (SCI) whose bladders were managed exclusively with an indwelling catheter were assessed urodynamically using natural‐fill urodynamics (ambulatory monitoring) while their catheters were left on free drainage. Their upper urinary tracts were assessed using plain X‐rays and ultrasonography.

Results

Detrusor contractions causing intravesical pressure rises of >40 cmH2O for up to 4.5 min were observed in 11 patients. Renal scarring was observed in nine patients; of these, six were in the group with contractions of >40 cmH2O, whereas only five of 21 patients with normal kidneys had such pressure rises.

Conclusion

An indwelling catheter on free drainage is no guarantee of a constantly low intravesical pressure. This study provides evidence to suggest that there is an association between phasic bladder contractions which occur despite catheter drainage and upper urinary tract damage in permanently catheterized patients with SCI.
Establishment and characterization of seven human renal cell carcinoma cell lines
Authors: Shin K.‐H. , Ku J.‐L. , Kim W.‐H. , Lee S.‐E. , Lee C. , Kim S.‐W. , Park J.‐G.
Published: March 2003

Objective To establish human renal cell carcinoma (RCC) cell lines, and to investigate the cell phenotypes and molecular characteristics of human RCC cell lines and their corresponding tumour tissues.

Materials and methods Seven human RCC cell lines from pathologically proven RCCs were established. The histopathology of the primary tumours, in vitro growth characteristics and status of tumour suppressor genes, mismatch repair genes and microsatellite instability (MSI) were examined in cell lines and their corresponding tumour tissues. Five of the cell lines were derived from clear cells (SNU‐228, ‐267, ‐328, ‐349, and ‐1272), one from granular cells (SNU‐482), and one from mixed clear and granular cell types (SNU‐333). The mutational status was compared for von Hippel‐Lindau (VHL), p53, TGF‐β type II receptor (TGF‐βRII), hMSH2, and hMLH1 genes in the cell lines and their corresponding tumour tissues. The MSI status of the cell lines was determined by screening for adenine repeat sequences, e.g. BAT‐25, BAT‐26, and BAT‐40.

Results All lines showed different doubling times and were confirmed by DNA fingerprinting analysis to be unique. Contamination by mycoplasma or bacteria was excluded. In two cell lines (SNU‐349 and ‐1272) and their tumour tissues, mutations in the VHL gene were found. The SNU‐267 line had a frameshift mutation in the p53 gene. A missense mutation of the TGF‐βRII gene was detected in the SNU‐1272 line and the corresponding tissue. Analysis of the repeat sequences showed one cell line (SNU‐349) to have MSI and the other six to have microsatellite stability. As MSI is a hallmark of the inactivation of mismatch repair genes, the presence of hMSH2 and hMLH1 mutations was investigated in all seven cell lines. An inactivating homozygous single base‐pair deletion of the hMLH1 gene was found only in the SNU‐349 cell line and corresponding tissue. Moreover, a frameshift mutation within an 8‐bp polyadenine repeat present in the hMSH3 coding region was found only in the MSI cell line and tumour tissue.

Conclusion These newly established RCC cell lines should provide a useful in vitro model for studies related to human RCC. The SNU‐349 cell line should be especially useful for studies of MSI and mismatch repair‐defective RCCs.
Aneusomy of chromosomes 7 and 17 predicts the recurrence of transitional cell carcinoma of the urinary bladder
Authors: Watters A.D. , Ballantyne S.A. , Going J.J. , Grigor K.M. , Bartlett J.M.S.
Published: March 2003

Objective To determine if changes in chromosome 7 and 17 copy number can be used to predict recurrence in patients with primary noninvasive (pTa) or superficially invasive (pT1) transitional cell carcinoma (TCC) of the urinary bladder.

Patients and methods Tissue specimens for 129 tumours from 52 patients (38 men and 14 women) with pTa/pT1 TCC at first diagnosis were retrieved from pathology archives. All patient notes were accessed and disease outcome documented for superficial (pTa/pT1) recurrence or progression to detrusor muscle invasion ( pT2). The tumours were examined for chromosomal copy number of chromosomes 7 and 17 using fluorescence in situ hybridization (FISH) with chromosome‐specific probes. The copy number of chromosomes 7 and 17 was determined in interphase nuclei on intact 6 µm tissue sections.

Results Aneusomy of chromosomes 7 and 17 was detected in the index primary tumours of 10 of 32 (31%) patients with subsequent recurrent disease. No aneusomy for these chromosomes was detected in primary tumours from 20 patients with no detect‐able recurrence (P = 0.0082). The relative risk of recurrence was 3.62 times greater (95% confi‐dence interval 1.6–8.1, Cox’s multiple regression P = 0.0019) for patients with chromosomal aneusomy in primary TCC. Neither stage nor grade of the primary tumours was associated with recurrence in these patients, nor was there a significant association with increased grade (G2/3) or stage ( pT2) at recurrence.

Conclusion These results suggest that the measurement of aneusomy by FISH, using markers for chromosomes 7 and 17, predict recurrence in a subgroup of patients with pTa/pT1 tumours at presentation. This finding may offer a new objective and quantitative test for patients destined to recur.
Prostate selectivity of JTH‐601‐G1, an active metabolite of JTH‐601, in dogs
Authors: Suzuki Y. , Kanada A. , Okaya Y. , Kurahashi Y. , Kogayu M. , Kobayashi T. , Aisaka K.
Published: March 2003

Objective To evaluate the effect of JTH‐601‐G1, an active metabolite and glucuronide conjugate of JTH‐601 (an α1‐adrenoceptor antagonist), on smooth muscle contraction in canine prostate and artery, and to examine the effect of JTH‐601‐G1 on prostatic urethral pressure and blood pressure in anaesthetized dogs.

Materials and methods Male beagle dogs were used in both an in vitro and an in vivo study. In the former, the prostate and right common carotid artery were isolated, and smooth muscle strips from the prostate and open‐ring strips from the carotid artery prepared. The effects of JTH‐601‐G1 on phenylephrine‐ and noradrenaline‐induced contraction were assessed in these tissues. In the in vivo study, four dogs were anaesthetized and the change in urethral pressure, blood pressure and heart rate measured continuously. Vehicle (saline) and JTH‐601‐G1 were then infused intravenously in increasing doses (0.33–3.3 µg/kg/min for 30 min). In three other dogs, the effect of JTH‐601‐G1 infusion at a higher rate (25 µg/kg/min for 3 h) on blood pressure was evaluated, and the plasma concentration of JTH‐601‐G1 measured using high‐performance liquid chromatography‐mass spectrometry.

Results Of the distinct metabolites of JTH‐601, JTH‐601‐G1 had the most potent α1‐adrenoceptor antagonistic effect in isolated canine prostate. JTH‐601‐G1 also antagonized α1‐adrenoceptor agonist‐induced contraction in common carotid artery, but the pA2 value in the artery was ≈25 times higher than that in the prostate. In anaesthetized dogs, JTH‐601‐G1 decreased urethral pressure in a dose‐dependent manner; at the highest dose, urethral pressure decreased by 24.5% and blood pressure by 7.0%. However, there was no significant change in heart rate at any dose. The plasma concentration of JTH‐601‐G1 increased with the dose of JTH‐601‐G1, but the concentration of both JTH‐601 and other metabolites was below the detection limit. The higher JTH‐601‐G1 infusion rate caused blood pressure to decrease by only 6–10% even at JTH‐601‐G1 plasma concentrations of ≈1500 ng/mL during the infusion. Although there was a negative correlation between mean blood pressure and plasma JTH‐601‐G1 concentration, the decrease in blood pressure was small compared with the reduction in urethral pressure.

Conclusion JTH‐601‐G1 appears to be a major active metabolite of JTH‐601 but with a higher selectivity for canine prostate than artery. The results also indicate that in addition to the α1A‐adrenoceptor, the α1L‐adrenoceptor plays an important prostatic selective role in smooth muscle contraction via the α1‐adrenoceptor.
The changing pattern of mortality and morbidity from radical cystectomy
Authors: Rosario D.J. , Becker M. , Anderson J.B.
Published: March 2003

Objectives To examine the morbidity and mortality of radical cystectomy as currently practised, and to compare the findings with historical data.

Patients and methods The operative mortality and early and late complications were recorded in 101 consecutive patients (median age 65 years, range 38–81; 33 aged > 70 years) undergoing radical cystectomy between April 1992 and October 1997. Fifteen patients had relapsed after previous radical radiotherapy.

Results The median postoperative stay was 14 days (range 8–44). There were two deaths within 60 days of surgery (of patients aged 46 and 59 years) from respiratory failure and sepsis, respectively. The mortality in the elderly was not more than in other age groups. The early morbidity included two cases of lower limb insufficiency, both in the salvage cystectomy group, where the morbidity was significantly higher than in those undergoing primary cystectomy (chi‐squared, P < 0.01). Three patients underwent early re‐exploration. There were four clinically significant episodes of deep vein thrombosis and two pulmonary emboli that were not fatal.

Conclusion As currently practised, radical cystectomy is associated with a lower mortality (< 2%) and morbidity than described previously. The added morbidity of salvage cystectomy and the acceptable mortality of primary cystectomy suggests that the treatment of choice for muscle‐invasive disease is primary cystectomy, with external beam radiotherapy reserved for those patients unfit for major surgical intervention. Age alone should no longer be considered a contraindication to cystectomy.
The efficacy and parenchymal consequences of extracorporeal shock wave lithotripsy in infants
Authors: Lottmann H.B. , Archambaud F. , Traxer O. , Mercier‐pageyral B. , Helal B.
Published: March 2003

Objectives To determine the efficacy of extracorporeal shock‐wave lithotripsy (ESWL) in young children and to evaluate, using renal scintigraphy, any possible adverse effects on renal parenchyma.

Patients and methods From January 1991 to October 1998, 19 infants (aged 5–24 months) underwent ESWL for kidney urolithiasis using a Sonolith 3000 (14 kV, Technomed Corp, Lyon, France) or a Nova (14–20 kV, Direx Medical Systems, Paris, France) lithotripter. The treatment and its effects were evaluated using a physical examination, conventional imaging (plain abdominal X‐ray and ultrasonography) and renal scintigraphy 24 h before ESWL and again at least 6 months after the last session of treatment.

Results Ten children were rendered stone‐free by ESWL after one session and 18 after two sessions. At the follow‐up (8 months to 8 years, mean 36 months) no hypertension was recorded and no acquired parenchymal damage was detected with conventional imaging. No scars or significant variation of differential function attributable to ESWL were identified on renal scintigraphy.

Conclusion ESWL is clearly effective for treating infant urolithiasis. There were no renal parenchymal lesions associated with ESWL, even in previously damaged kidneys or after the treatment of staghorn calculi. A long‐term follow‐up (assessing blood pressure) is mandatory and renal scintigraphy before and 6 months after ESWL in infants is recommended to confirm these results in a larger series.
Schistosoma haematobium infection in children in Britain
Authors: Samuel M. , Misra D. , Larcher V. , Price E.
Published: March 2003

Objective To highlight the existence of Schistosoma haematobium in certain ethnic minority groups in Britain and in English citizens who have recently visited Africa and the Middle East, so that general practitioners and paediatric nephrologists/urologists are aware of its occurrence and consider it among the differential diagnoses in children presenting with haematuria.

Patients and methods Over a 2‐year period, six consecutive boys (mean age 13.5 years, range 8–15) presented with haematuria and were subsequently diagnosed to be infected with S. haematobium. All patients were from Africa and had recently visited their native country. There had all reported paddling in freshwater lakes and streams.

Results Dysuria and haematuria was noted 2–3 months after the infection. Terminal urine samples taken after exercise at midday were positive for S. haematobium ova. Praziquantel anti‐schistosomal chemotherapy was effective in treating the infection.

Conclusion S. haematobium infection is treatable in the early stages and the changes are reversible before the development of fibrotic lesions, which may result in anatomical obstruction. A terminal urine sample taken at midday after exercise was diagnostic in showing Schistosoma ova in all cases. This infection must be considered in the differential diagnoses of haematuria in some ethnic minority British citizens and in those Britons who have visited Africa or the Middle East in the recent past.