bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Chronic Prostatitis and Prostatodynia with Pollen Extract
Authors: BUCK A. C. , REES R. W. M. , EBELING L.
Published: November 2008

Summary— Chronic abacterial prostatitis and prostatodynia are notoriously difficult both to diagnose and to treat. These patients tend to have received several courses of antibiotics, antiinflammatory agents or adrenergic blockade and various other therapeutic manoeuvres with little success. The pollen extract, Cernilton, is reported to be effective in the treatment of this condition and we present the results of an open trial with Cernilton in a group of 15 patients with chronic prostatitis and prostatodynia. In 13 patients there was either complete and lasting relief of symptoms or a marked improvement; 2 patients failed to respond.

Cernilton was found to be effective in the treatment of chronic prostatitis and prostatodynia. Its precise mode of action is not known, although experimental studies suggest that it has antiinflammatory and anti‐androgenic properties.
Features of Computed Tomography in Hydatid Cysts of the Urinary Tract
Authors: KARABEKIOS S. , GOULIAMOS A. , KALOVIDOURIS A. , VLAHOS L. , PAPAVASILIOU C. , SAKKAS J.
Published: November 2008

Summary— The features of computed tomography (CT) in 5 patients with hydatid disease of the urinary tract are described. The diagnosis of hydatid disease was based on the demonstration of unilocular or multilocular cysts with well defined walls which enhanced with contrast, which were often calcified and which contained daughter cysts within the large parent cyst. It is difficult to differentiate between a unilocular hydatid cyst without mural calcification and an infected simple renal cyst.
Factors Determining the Outcome following Implantation of the AMS 800 Artificial Urinary Sphincter
Authors: KIL P. J. M. , VRIES J. D. M. DE , KERREBROECK P. E. V. A. VAN , ZWIERS W. , DEBRUYNE F. M. J.
Published: November 2008

Summary— Erosion and infection are major complications following implantation of the AMS 800 artificial urinary sphincter. In the present study, 17 patients with this prosthesis were investigated urodynamically. All were continent. Urethral pressure profilometry showed a significantly lower intra‐urethral pressure than would have been expected from the pressure installed in the pressure regulating balloon during operation. The maximal urethral pressure was 69.9% of the expected pressure and did not vary significantly in relation to the various balloon pressures. The mean maximal urethral pressure (± SEM) between the cuff when inflated and when deflated was also significantly different, although the absolute difference was small (14.1 cm H2O± 10.0). There was good correlation between maximal urethral pressure and urethral leakage pressure as measured by retrograde perfusion sphincterometry. The mean functional urethral length became significantly longer after implantation of the cuff.

A combination of low urethral pressure and increased functional length may help to prevent cuff erosion and maintain continence.
Early Experience of the Gittes “No‐incision” Pubovaginal Suspension for Stress Urinary Incontinence
Authors: FOSTER M. C. , O'REILLY P. H.
Published: November 2008

Summary— A series of 20 women with stress urinary incontinence underwent bladder neck suspension according to the method in which there are no suprapubic or vaginal incisions and no buttresses. Follow‐up was between 9 weeks and 8 months. Twelve patients (60%) were cured, 2 (10%) were significantly improved and 6 (30%) were not improved; 3 patients had pre‐operative detrusor instability; when they were excluded the failure rate fell to 23%. These results are inferior to those obtained in this unit using the Stamey procedure, although the difference is not significant. The operation is quick and easy to perform and was well tolerated with minimal complications; we believe it is worthy of further evaluation.
Phase II Study of Carboplatin in Locally Advanced and Metastatic Transitional Cell Carcinoma of the Urinary Bladder
Authors: RAABE N. K. , FOSSÅ SOPHIE D. , PARØ G.
Published: November 2008

Summary— Twenty‐five previously untreated patients with measurable locally advanced and/or metastatic transitional cell carcinoma of the urinary bladder were included in a phase II study with carboplatin. Bolus injections were administered in 2 courses every 4 weeks at an initial dose of 400 to 450 mg/m2 with the option of increasing the dose to 450 to 500 mg/m2 in individual patients during the second cycle, depending on haematological toxicity. Two patients had a complete response (CR), 13 showed no change (NC) and 9 had progression of disease (PD), including 4 early progressions. There was no delay in treatment because of myelosuppression. Thrombocytopenia led to a reduction in drug dosage. No reduction in renal function was observed. Increased dosage did not increase the response rate.

This study indicated the low effectiveness of single agent carboplatin in transitional cell carcinoma of the urinary bladder.
Bladder Outflow Tract Obstruction and Urinary Retention from Benign Prostatic Hypertrophy Treated by Balloon Dilatation
Authors: GILL K. P. , MACHAN L. S. , ALLISON D. J. , WILLIAMS GORDON
Published: November 2008

Summary— Forty‐eight men with urodynamically proven bladder outflow tract obstruction (BOO) and 19 with retention secondary to benign prostatic hypertrophy were treated by balloon dilatation of the prostate as out‐patients; 31 were dilated with 20 mm and 36 with 25 mm balloons. Of the 48 men with BOO, 37 had repeat cystometrograms at intervals ranging from 3 to 11 months after dilatation and 33 (89%) remained obstructed by urodynamic criteria. Of 6 who only had a peak flow rate assessment, 5 had a flow < 12 ml/s. Of the 19 patients in retention only 3 were able to void and all are obstructed. Symptoms of hesitancy, poor stream, frequency and nocturia were improved in less than 50% of patients. No reliable correlation was found between objective response and balloon size, length of time of dilatation, prostate size or morphology, detrusor pressure or stability, or post‐dilatation urethrogram appearances. Balloon dilatation to 25 mm is not adequate therapy for bladder outflow tract obstruction or urinary retention from prostatic hypertrophy.
Transurethral Resection of the Prostate and Bladder Tumour without Withdrawal of Warfarin Therapy
Authors: PARR N. J. , LOH C. S. , Article A. D. DESMONDOriginal
Published: November 2008

Summary— Twelve resections of prostate and 1 extensive bladder tumour were performed in patients on long‐term anticoagulation without withdrawal of warfarin therapy. The mean preoperative prothrombin index was 2.3. Four patients required blood transfusion. There were no major complications.

The effects of surgery and infusion of fresh frozen plasma (FFP) on the level of anticoagulation were monitored. FFP reduced the prothrombin index by 0.25/unit. Transurethral resection can be carried out safely by an experienced urologist on patients anticoagulated with warfarin, reducing the risk of serious thromboembolic complications associated with withdrawal of anticoagulation.
Inter‐observer Variation in Assessment of Undescended Testis Analysis of Kappa Statistics as a Coefficient of Reliability
Authors: H. OLSEN L.
Published: November 2008

Summary— In a prospective study the inter‐observer variation in the diagnosis of undescended testis was analysed. Two physicians assessed independently the position and motility of the testes of 37 boys referred for undescended testis. The boys were examined in the supine and squatting positions. The observed agreement rate between the observers was 0.90 to 0.97. Using kappa (K) statistics, the values were adjusted for the expected chance agreement; k values between 0.47 and 0.81 were obtained, slightly higher values for patients in the supine position. Complete agreement on all observations was reached in 13.5% of the patients. Inter‐observer variation may be a substantial source of bias in diagnosing the undescended testis and one of the reasons for the varying results in studies of hormonal treatment of this condition. It is also a fact that the number of orchiopexies in some countries exceeds the incidence of this condition.
Testing the Chemosensitivity of Renal Carcinoma in vitro
Authors: LAI TERESA , FERRO M.A. , KAISARY A. V. , SMITH P.J. B. , SYMES M.O.
Published: November 2008

Summary— Tumour cells from 23 renal carcinomas were exposed in vitro to increasing concentrations of medroxyprogesterone acetate (MPA) or one of several cytotoxic agents. Thereafter the uptake of 75Selenomethionine (75SeM) was compared to that of tumour cells not exposed to the drug.

Using drug concentrations similar to those seen following in vivo administration in patients, MPA produced 50% inhibition of 75SeM uptake in 5 of 23 cases. The comparable proportion for doxorubicin was 4 of 5 and for mitozantrone 7 of 12. Methotrexate and Vinblastine were much less effective. In all cases where 2 50% inhibition was obtained with doxorubicin and mitozantrone the carcinoma had spread beyond the kidney. Thus drug sensitivity may be associated with a high mitotic rate.
Hypogastric Plexus Stimulators for Obtaining Semen from Paraplegic Men
Authors: BRINDLEY G. S. , SAUERWEIN D. , HENDRY W. F.
Published: November 2008

Summary— Radio‐linked devices to stimulate the hypogastric plexus have been implanted into 7 patients with spinal injuries and 1 with primary anorgasmia. They caused seminal emission in all patients and still do so in the spinal injury patients. Insemination with semen thus obtained has yielded 5 pregnancies (2 live births) in the wives of 4 patients. The range of application is discussed.
Intra‐individual Comparative Study of Dynamic and Pharmacocavernography
Authors: STIEF C. G. , WETTERAUER U. , SOMMERKAMP H.
Published: November 2008

Summary— A series of 65 consecutive patients with suspected venous leakage as a cause of their erectile dysfunction underwent dynamic and pharmacocavernometry/cavernography. This comparison of methods for diagnosing venous leakage produced divergent findings in 25/65 patients (38.5%). Because of its theoretical advantages, pharmacocavernometry/cavernography is recommended for the diagnosis of venous leakage.
Late Presentation of Congenital Posterior Urethral Valves
Authors: HEATON N. D. , KADOW C. , YATES‐BELL A. J.
Published: November 2008

Bladder outflow obstruction caused by congenital posterior urethral valves is a well defined surgical condition which presents in early life. Presentation after the age of 10 years is rare.
Non‐functioning Tumours of the Adrenal Cortex
Authors: CHANG S.‐Y. , LEE S.‐S. , MA C.‐P. , LEE S.‐K.
Published: November 2008

Summary—
Twelve cases of non‐functioning adrenal tumours are presented. All were discovered incidentally during radiological investigation of abdominal conditions or staging of known malignancies. Adrenal tumours in patients with known malignancies are not necessarily metastases. Size remains the most important factor in determining their management and tumours larger than 3.5 cm should be operated on because of the possibility of malignancy. Smaller tumours should be assessed by computed tomography (CT) every 3 months for 1 year. Any change in contour, margin, density or hormone function during the follow‐up period indicates the need for surgery.
Comparative Histopathology, Microradiography and Per‐rectal Ultrasonography of the Prostate using Cadaver Specimens
Authors: JONES D. R. , GRIFFITHS G. J. , PARKINSON M. C. , EVANS K. T. , ROBERTS E. E. , DAVIES R. LI. , PEELING W. B.
Published: November 2008

Summary—
A technique for examining cadaver prostates by per‐rectal ultrasonography has been developed. The ultrasonic plane was defined and corresponding sections taken for microradiographic and histopathological examination. The technique has enabled a comparison to be made of the structural changes that occur in the prostate in disease states and the corresponding ultrasonic features.
Contralateral Testicular Blood Flow during Unilateral Testicular Torsion
Authors: TANYEL F. C. , BÜYÜKPAMUKÇU N. , HIÇSÖNMEZ A.
Published: November 2008

Summary—
Changes in contralateral testicular blood flow during unilateral testicular torsion were evaluated using an electromagnetic flowmeter in 13 adult male New Zealand White rabbits. There was an immediate and then a progressive decrease during torsion and a gradual increase following detorsion. A decrease in testicular blood flow over a critical period of time may be associated with contralateral testicular damage following unilateral testicular torsion.
Use of the “Correctaid” Device in the Management of Impotence
Authors: ASOPA R. , WILLIAMS GORDON
Published: November 2008

Summary—
A series of 20 unselected patients with impotence of various aetiologies were given a custom fitted external erection assistance device, the Correctaid. They have been followed up for 14 months. Only 4 patients are still using the device regularly to attain satisfactory intercourse and a further 4 use it occasionally. This device is a useful, non‐invasive alternative for the treatment of impotence in well selected, motivated patients and their partners.
Primary Endoscopic Surgery for Ureteric Stones
Authors: TOLLEY D.A.
Published: November 2008

Summary—
A group of 184 consecutive patients requiring surgery for ureteric stones was studied over a 4‐year period. The success rate for primary endoscopic management was 90.3%; 12 patients required ureterolithotomy for failed endoscopic manoeuvres and complications occurred in 5.5%. Optimum methods of treatment for ureteric stones according to size and location are suggested.
Conservative Treatment of Diffuse Carcinoma in situ of the Bladder with Repeated Courses of Intravesical Therapy
Authors: MUKAMEL E. , DeKERNION J. B.
Published: November 2008

Summary—
We present a series of 13 patients with diffuse carcinoma in situ (CIS) of the bladder who failed an initial induction course of intravesical therapy with Mitomycin C, thiotepa, doxorubicin or Bacillus Calmette Guérin (BCG). Cystectomy, although indicated, was, for various reasons, not performed after the first failure of intravesical therapy and all patients were subsequently treated topically with the same or different agents. Of the 7 patients treated with 2 induction courses, 6 showed a complete response during a follow‐up period of 24 to 42 months. Although 1 patient initially responded completely, he developed invasive transitional cell carcinoma (TCC) Grade IV 30 months later. Among the 3 patients who underwent 3 induction courses, 2 had a complete response at 42 and 60 months of follow‐up and 1 developed TCC Grade IV with muscle invasion 18 months later. Two of the 3 patients treated with 4 induction courses are free of disease at 48 and 57 months; the third developed low grade, low stage TCC. This experience suggests that the majority of patients with CIS who fail initial treatment usually respond to further treatment with the same or a different drug. The question as to whether a second course of intravesical therapy, subsequent to failure of the first course, should be given before cystectomy requires further investigation.
Inhibitory Effect of Pyrophosphate, Citrate, Magnesium and Chondroitin Sulphate in Calcium Oxalate Urolithiasis
Authors: GRASES F. , GENESTAR C. , CONTE A. , MARCH P. , COSTA‐BAUZA A.
Published: November 2008

Summary—
The inhibitory capacity of pyrophosphate, citrate, magnesium and chondroitin sulphate was investigated, using the urine of 21 calcium oxalate stone‐forming patients without metabolic alterations. The inhibitory effect of these substances was assessed by a combination of nephelometry (light scattering) and optical microscopy. The results showed that citrate and magnesium had an inhibitory effect in a significant number of cases. Pyrophosphate and chondroitin sulphate had a less marked effect. The main urinary lithogenic biochemical parameters of the patients were also studied to see if there was a relationship between them and the inhibitory capacity of the compounds.
Beta Human Chorionic Gonadotrophin in Serum and Urine. A Marker for Metastatic Urothelial Cancer
Authors: ILES R. K. , JENKINS B. J. , OLIVER R. T. D. , BLANDY J. P. , CHARD T.
Published: November 2008

Summary—
Beta human chorionic gonadotrophin (βHCG) was measured in 127 urine and 85 serum samples from 175 untreated patients with urothelial cancer. Serum levels of βHCG were substantially elevated in 16 of 21 patients (76%) with widespread metastases but in only 2 of 64 patients (3%) with disease confined to the pelvis. Urine βJHCG levels were moderately raised in 11 of 25 patients (44%) with locally advanced disease, but greatly elevated in 5 of 7 patients (71%) with metastases. Measurement of serum and/or urine βSHCG appears to be an efficient diagnostic marker for the presence of distant metastases in bladder carcinoma.
Placenta Percreta Invading the Urinary Bladder
Authors: LITWIN M. S. , LOUGHLIN K. R. , BENSON CAROL B. , DROEGE G. F. , RICHIE J. P.
Published: November 2008

Summary—
The placenta, normally confined to the decidual lining of the uterine cavity, can in some circumstances invade the muscular wall of the uterus, a condition known as placenta accreta. Less common is placenta increta, in which placental cotyledons become intertwined with the muscular stroma of the uterus. Placenta percreta, in which the trophoblastic tissues penetrate the serosa of the uterus and may extend directly to adjacent structures, is even more rare and is potentially life‐threatening.

There have been only 10 reports of direct invasion of placenta percreta into the urinary bladder. We review these cases and report 3 recent patients, one of whom was diagnosed pre‐operatively by ultrasonography.
Oestrogen Dosage in Prostatic Cancer: the Threshold Effect?
Authors: BISHOP M. C. , LEMBERGER R. J. , SELBY C. , LAWRENCE W. T.
Published: November 2008

Summary—
We present the results of a prospective randomised trial of Estradurin, a long‐acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy. The inevitable relapse in hormone sensitivity sometimes occurred very soon after the start of oestrogen treatment. Many patients had poorly suppressed plasma testosterone expressed as a mean of monthly serial measurements, but then responded to secondary orchiectomy. These data only suggest that, in the treatment of hormone‐sensitive prostatic carcinoma, it may be necessary to reduce plasma testosterone to midway between castrate and normal ranges. The data support the theory that response to androgen withdrawal is qualitative rather than quantative. The effective dose of oestrogen may therefore be reduced and the risk of thrombo‐embolic complications minimised.
Lumbar Pain in Stage 1 Testicular Germ Cell Tumours: a Symptom Preceding Radiological Abnormality
Authors: SMITH D. B. , NEWLANDS E. S. , RUSTIN G. J. S. , BEGENT R. H. J. , BAGSHAWE K. D.
Published: November 2008

Summary—
In a series of 114 stage 1 testicular tumour patients managed by a surveillance policy there have been 26 relapses. Three of these patients presented with lumbar pain as the first sign of relapse. All 3 were tumour marker non‐producers and the onset of pain pre‐dated radiological abnormality by up to 4 months. Stage 1 surveillance patients who develop lumbar pain must be considered to be at high risk of relapse to avoid delay in diagnosis which may prejudice survival.
The Duplex Ureter in Burnley, Pendle and Rossendale
Authors: BARNES D. G. , McGEORGE A.
Published: November 2008

Summary—
Following the report of an unusually high number of patients presenting with duplex ureter in the Dorchester area, we reviewed the incidence of duplex ureter in the Burnley, Pendle and Rossendale district. Based on a review of intravenous urograms, the prevalence was found to be 3.7% (16 of 432). This confirmed the authors' clinical impression that the incidence was higher than previously quoted figures.
Assessing the Effectiveness of Different Urinary Catheters in Emptying the Bladder: an Application of Transvaginal Ultrasound
Authors: HAYLEN B. T. , FRAZER M. I. , MacDONALD J. H.
Published: November 2008

Summary—
The effectiveness of different types of urinary catheters in completely draining the bladder has not been tested. Transvaginal ultrasound, which is able to measure bladder volumes in women from 2 to 175 ml, provides a means of measuring any fluid volume remaining in the bladder following catheter drainage.

Using transvaginal ultrasound, the post‐catheterisation bladder volumes were measured in 26 female patients; 14 underwent urethral catheterisation using either a 14F short plastic female catheter or a Foley catheter of the same size (balloon not inflated); 12 had an indwelling 12F suprapublic catheter following bladder neck surgery.

The mean post‐catheterisation bladder volumes after using the short plastic female and Foley catheters were less than 1 ml and 77 ml respectively. A short plastic catheter should be used in women to collect the residual urine volume by urethral catheterisation. A Foley catheter is relatively ineffective in this task.

A 12F suprapubic catheter was found to drain the bladder relatively well. The mean post‐catheterisation bladder volume was 35 ml. Prior to removing a suprapubic catheter post‐operatively, it is recommended that the residual urine volume (measured using the suprapubic catheter) be checked by measuring the post‐catheterisation bladder volume (using either a short plastic catheter or transvaginal ultrasound).
Urinary Bladder Cortical Evoked Potentials in Man: Suitable Stimulation Techniques
Authors: DELTENRE P. F. , THIRY A. J.
Published: November 2008

Summary—
A practical and easily applicable method of recording cortical potentials evoked by bipolar electrical stimulation of the bladder wall is described. This constitutes an objective electrophysiological test of afferent bladder central projections.

Comparison of bipolar and monopolar methods of intravesical stimulation led to the conclusion that the simpler monopolar intravesical electrode technique is unsuitable because it yields potentials contaminated by extravesical components.
Sequential Morphological Changes in the Pig Detrusor in Response to Chronic Partial Urethral Obstruction
Authors: DIXON J. S. , GILPIN C. J. , GILPIN S. A. , GOSLING J. A. , BRADING A. F. , SPEAKMAN M. J.
Published: November 2008

Summary—
The sequential morphological changes which occur in the wall of the porcine urinary bladder in response to experimentally induced partial outflow obstruction have been determined using morphometric light and electron microscope techniques. The initial morphological response to urethral obstruction was a reduction of approximately 50% in the density of autonomic nerves in the bladder wall which occurred within the first 3 months. During this period the morphology of smooth muscle cells and the distribution of connective tissue were unaltered. Longer periods of obstruction produced a gradual further reduction in the density of innervation. However, from 3 months onwards the detrusor muscle bundles became infiltrated by connective tissue, although significant change in muscle cell size was not detected after obstruction for 12 months. Using electron microscopy, smooth muscle cells were observed to possess extensive amounts of perinuclear granular reticulum, this feature being particularly marked in bladders subjected to longer periods of obstruction. The underlying mechanisms responsible for these structural changes remain to be determined.
Prostatectomy in the Over 80‐year‐old
Authors: WYATT M. G. , STOWER M. J. , SMITH P. J. B. , ROBERTS J. B. M.
Published: November 2008

Summary—
With an ageing population the demand for prostatectomy in the over 80‐year‐olds is increasing. This study assesses the place of prostatectomy in this age group.

All patients over the age of 80 who underwent prostatectomy in a 2‐year period were studied retrospectively; 90 such patients underwent 94 operations, 90 of which were TURPs. Serious concomitant disease was found in 64 patients (71%) and 11 (12%) had had a previous prostatectomy at least 1 year before. The mean weight of tissue removed was 24.8 g. In 18 men histology showed malignant change.

Two men died from cardiovascular disease immediately after surgery (2.1%); a further 5 patients (7.8%) died within 6 months. Post‐operative morbidity was high, with 64 patients (71%) developing complications. These were related to pre‐operative urinary tract infections and uraemia. Nevertheless, at 6 weeks 72 patients (80%) were considered to have had a satisfactory result.

Prostatectomy in the over 80‐year‐old has a good long‐term outcome. Although the morbidity rate is high, these patients should be considered for operation provided they undergo careful preoperative assessment.
Effect of Histamine on Human Vas Deferens in vitro
Authors: LAU L. C. , ADAIKAN P. G. , RATNAM S. S.
Published: November 2008

Summary—
Histamine, 2‐methylhistamine and 4‐methylhistamine produced concentration‐related contractions in some isolated human vas deferens preparations. The contractions produced by histamine and its analogues were reversibly and competitively antagonised by the H, ‐receptor blocker, mepyramine, but not the H2‐receptor blockers, burimamide and cimetidine. Phentolamine, atropine and guanethidine did not affect the excitatory action of histamine. Histamine and 4‐methylhistamine did not show any inhibitory effect on KCl‐induced tone. The results showed that histamine receptors were present in the human vas deferens and the histamine receptors mediating the excitatory response were likely to be H1‐receptors.
Evaluation of Ki‐67 Monoclonal Antibody as Prognostic Indicator for Prostatic Carcinoma
Authors: McLOUGHLIN J. , FOSTER C. S. , PRICE P. , WILLIAMS GORDON , ABEL P. D.
Published: November 2008

Summary— Prostate tissue containing either primary adenocarcinoma (45 patients) or benign hyperplasia (15 patients) was immunostained with the monoclonal antibody Ki‐67, which recognises a human nuclear antigen expressed by human cycling cells. The percentage of cells staining positive was considered a measure of proliferation. This derived Ki‐67 index was higher for carcinomas than for hyperplastic glands. Within the group of carcinomas, KI‐67 indices in patients with metastatic disease were significantly higher than in those without and there was a trend towards increasing Ki‐67 indices with increasing Gleason grade. When patients with prostate cancer were prospectively followed up, the Ki‐67 index did not predict either disease progression or hormone responsiveness.

Ki‐67 immunostaining may define a group of patients with prostate cancer of poor prognosis.
Epididymo‐orchitis due to Brucellosis
Authors: AFŞAR H. , BAYDAR I. , SIRMATEL F.
Published: November 2008

Summary— A diagnosis of epididymo‐orchitis due to brucellosis was made in 13 patients between 1989 and 1991. Both testis and epididymis were involved in 8 patients, 3 had bilateral epididymo‐orchitis and 2 presented with orchitis alone. Patients were treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 weeks and complete resolution was achieved in 10.
A modified extravesical technique for megaureter repair*
Authors: McLORIE G.A. , JAYANTHI V.R. , KINAHAN T.J. , KHOURY A.E. , CHURCHILL B.M.
Published: November 2008

Objective To report on the use of extravesical detrusorraphy for megaureter repair.

Patients and methods Twenty‐three children underwent an extravesical megaureter repair over a 25 month period. There were 17 boys and 6 girls with an average age of 4.4 years. Three children had bilateral megaureters for a total of 26 repairs. Ureters were defined as megaureters if the ureteric diameter exceeded 1.0 cm on pre‐operative imaging. There were 14 obstructing and 12 refluxing ureters. Three of the refluxing ureters were tapered while five of the obstructing megaureters were tapered.

Results Twenty‐one of the 23 patients were successfully repaired using this method. Complications were minimal.

Conclusion The extravesical approach can be used to correct reflux or obstruction in dilated ureters with efficacy equivalent to transvesical repairs.
Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis
Authors: ECKFORD S.D. , SWAMI K.S. , JACKSON S.R. , ABRAMS P.H.
Published: November 2008

Objectives To assess whether the synthetic vasopressin analogue desmopressin [1‐desamino 8‐D‐arginine vasopressin] is efficacious and safe in the management of nocturia ± enuresis in patients with multiple sclerosis.

Patients and methods Twenty‐two women and 11 men, under 65 years of age, with clinically definite multiple sclerosis and nocturnal frequency ± enuresis were entered into the study. A two week placebo run‐in, to establish normal voiding patterns, followed by a double‐blind, placebo‐controlled, cross‐over study of 20 μg intranasal desmopressin at night‐time was carried out.

Results Desmopressin caused a significant decrease in nocturnal urinary frequency, nocturnal urinary volume and the percentage of total daily urine passed at night. There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia.

Conclusion Desmopressin is an efficacious and safe treatment for nocturia ± enuresis in patients with multiple sclerosis.
c‐jun oncogene expression in transitional cell carcinoma of the urinary bladder
Authors: TINIAKOS D. G. , MELLON K. , ANDERSON J. J. , ROBINSON M. C. , NEAL D. E. , HORNE C. H. W.
Published: November 2008

Objective To investigate c‐jun oncoprotein expression in transitional cell carcinomas (TCCs) of the urinary bladder and to determine its relationship to tumour grade and stage, and to the expression of eptdermal growth factor receptor (EGFR), c‐erbB‐2 and p53 oncoproteins.

Materials and methods The expression of c‐jun was studied using immunohistochemistry in a series of 48 TCCs of known EGFR, c‐erbB‐2 and p53 status.

Results Forty‐four of 48 (92%) tumours showed c‐jun specific nuclear immunoreactivity of variable intensity. The intensity of c‐jun immunostaining was significantly related to tumour stage (P=0.009) and EGFR status (P= 0.01). There was no correlation between c‐jun oncoprotein expression and c‐erbB‐2 or p53 immunoreactivity. c‐jun expression was not related to clinical outcome in terms of patient survival or rate of tumour recurrence.

Conclusion The c‐jun oncoprotein is expressed in the majority of TCCs of the urinary bladder. There is a positive association between intense c‐jun immunoreactivity and muscle invasive growth, and EGFR positivity in TCCs.
Analysis of factors associated with complications following renal transplant needle core biopsy
Authors: BECKINGHAM I. J. , NICHOLSON M. L. , BELL P.R.F.
Published: November 2008

Objective To determine factors associated with complications in patients undergoing renal transplant biopsy.

Patients and methods A total of 210 consecutive renal transplant patients biopsied for acute graft dysfunction or as part of a long term surveillance programme. Biopsies were performed under ultrasound control at two centres (Nottingham City and Leicester General Hospitals).

Results Seventeen patients developed macroscopic haematuria following biopsy (8%). There were no graft losses. In cases where at least one biopsy core contained only renal medullary tissue, there was a significantly higher risk of a post‐biopsy bleed (P < 0.001).

Conclusion This study demonstrates that even with careful ultrasound guidance, renal transplant biopsy has an important complication rate. Every effort must be made to obtain very superficial biopsies which consist largely or exclusively of renal cortex.
Volume determinations of the whole prostate and of adenomas by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: correlation of resected weight, blood loss and duration of operation
Authors: AUS G. , BERGDAHL S. , HUGOSSON I. , NORLÉN L.
Published: November 2008

Objective To study whether transrectal ultrasound (TRUS) volume determinations of the whole prostate and of the adenomas alone correlate to resected weight, operation time and blood loss in patients operated upon with transurethral resection of the prostate because of presumed benign prostatic hyperplasia (BPH).

Patients and methods The whole prostate and the transition zone, which corresponds to the adenomas, were measured separately in 159 patients with presumed BPH, pre‐operatively and 4 months post‐operatively.

Results The transition zone volume correlated well with the resected weight (r=0.91; P < 0.0001), the blood loss (r=0.67; P < 0.0001) and the operation time (r= 0.67; P <0.0001). Four months post‐operatively a reduction of the total prostate volume was recorded which corresponded well with the resected weight (r= 0.91; P <0.0001).

Conclusion TRUS with high resolution 7 MHz probes successfully estimated the size of the whole prostate and that of the adenomas alone. The transition zone volume predicted the expected resection weight of adenomas and to some extent the duration of the operation and the blood loss. These calculations may be used for more accurate pre‐operative planning. Together with its superior detection rate for prostate cancer, TRUS seems to be a powerful tool in the pre‐operative morphological assessment of patients with prostatism.
The use of bladder wash‐outs to reduce urinary catheter encrustation
Authors: GETLIFFE K.A.
Published: November 2008

Objective To examine the effectiveness of bladder washouts in reducing catheter encrustation.

Materials and methods A model of the catheterized bladder was developed and used to produce catheter encrustation in vitro. The effects of bladder wash‐outs with Suby G, mandelic acid 1% or saline 0.9% were compared with control catheters that did not receive wash‐outs, by measuring the area of patent catheter lumen and the changes in urinary calcium and magnesium concentrations after wash‐outs.

Results Encrustation was reduced significantly, compared with the controls, in catheters washed out with the acidic reagents, Suby G and mandelic acid. Saline wash‐outs did not reduce encrustation.

Conclusion The model of the catheterized bladder provided a reliable technique with which to examine the effects of bladder wash‐out on catheter encrustation under controlled conditions. The results indicate that bladder wash‐outs with Suby G or mandelic acid may be beneficial for patients who suffer from recurrent catheter encrustation and blockage.
Radiographic evaluation of renal trauma: evaluation of 1103 consecutive patients
Authors: McANDREW J. D. , CORRIERE J. N.
Published: November 2008

Objective To review the records of patients with suspected urinary tract trauma to determine whethe reliminating imaging studies would have missed any significant injuries.

Patients and methods The records of 1103 consecutive patients who underwent radiographic evaluation of the urinary tract because of suspected renal trauma were evaluated retrospectively. A comprehensive review was made of the group of patients who were normotensive and had only microscopic haematuria.

Results Abnormal intravenous pyelograms (IVP) were found in 10% of patients with normotension and microscopic haematuria. In patients with injuries due to penetrating trauma, five of 16 with an abnormal IVP required operative intervention, while in patients with injuries due to blunt trauma, only one of 60 had a significant renal injury. None of the 605 patients with a blunt injury, microscopic haematuria, no his‐ tory of hypotension, and no significant associated injuries required operative intervention solely for the renal injury. Conclusion Radiographic evaluation of the urinary tract is recommended for all patients with penetrating trauma and any degree of haematuria, but only for patients with blunt trauma if associated with gross haematuria, microscopic haematuria and hypotension, or microscopic haematuria and significant associated injuries.
Trends in death rates and registration rates for prostate cancer in England and Wales
Authors: MAJEED F. A. , BURGESS N. A.
Published: November 2008

Objective To describe trends in deaths from prostate cancer between 1970 and 1990, and trends in registrations of prostate cancer between 1971 and 1986.

Methods Data on prostate cancer deaths and registrations were obtained from the Office of Population Censuses and Surveys, and age specific rates were calculated.

Results The number of deaths from prostate cancer rose by 107% between 1970 and 1990, from 3906 to 8098. The number of registrations of prostate cancer rose by 75% between 1971 and 1986, from 5819 to 10 180. Age‐specific death rates and registration rates also increased but by a smaller amount than the rise in absolute numbers.

Conclusions A component of the increase seen in both the number of prostate cancer deaths and registrations can be explained by a concomitant increase in the elderly male population, the group at highest risk, but the rises seen in rates are more difficult to explain, The rises are likely to have had considerable implications for the workload of urologists and should be taken into account when planning future health services. With further increases expected over the next decade in the elderly male population, deaths and registrations from prostate cancer will continue to rise. Research will be required to determine possible reasons for the increase seen in prostate cancer rates over the last 20 years, to determine the true incidence and prevalence of prostate cancer in the general population and to identify possible aetiological factors.
Smoking and drinking habits in relation to prostate cancer
Authors: GULDEN J. W. J. VAN DER , VERBEEK A. L. M. , KOLK J. J.
Published: November 2008

Objective To evaluate the role of tobacco and alcohol consumption in the aetiology of prostate cancer.

Patients and methods In a case‐control study conducted in the Netherlands, information on smoking and drinking habits was obtained from questionnaires completed by 345 patients exhibiting primary prostate cancer and by 1346 controls with benign prostate hyperplasia. The response rate was 79%.

Results No association was observed between drinking habits and the risk of prostate cancer (324 cases versus 123‐7 controls; odds ratio 1.36; 95%CI 0.84‐2.22). A significantly elevated odds ratio was found for individuals who had smoked at any time during their lives (329 cases versus 1212 controls: odds ratio 2.12; 95%CI 1.24‐3.62). However, no relationship was observed between the number of cigarettes smoked, the duration of smoking, the age at which the subjects started smoking or with the calendar period in which they were born. Odds ratios calculated for individuals who smoked in consecutive 5‐year periods between 1940 and 1989 did not show any trend. Furthermore, the risk of prostate cancer among ex‐smokers did not differ significantly from the risk among current smokers, even when smoking was stopped more than 25 years previously.

Conclusion From these findings, which do not point to the causative agent, it would appear that neither smoking nor alcohol consumption seriously increases the risk of prostate cancer.
Ectopic human chorionic gonadotrophin (HCG) production: is the detection by serum analysis of HCG of clinical relevance in transitional cell carcinoma of the bladder?
Authors: SMITH D. J. , EVANS H. J. , NEWMAN J. , CHAPPLE C. R.
Published: November 2008

Objective To assess the potential value of ectopic β‐human chorionic gonadotrophin (βHCG) measurement in the clinical management of transitional cell carcinoma (TCC).

Patients and methods A prospective serological study of 16 3 consecutive patients undergoing cystoscopy as new or review cases was performed to assess any correlation between βHCG production and histological grading or stage.

Results Ten per cent of patients with TCC had a raised βHCG level but there was no correlation with tumour differentiation, staging or prognosis.

ConclusionsβHCG has no role as a tumour marker for TCC and therefore appears unlikely to play a part in the clinical management or treatment of urothelial tumours.
Pelvic floor activity patterns: comparison of nulliparous continent and parous urinary stress incontinent women. A kinesiological EMG study
Authors: DEINDL F. M. , VODUSEK D. B. , HESSE U. , SCHÜSSLER B.
Published: November 2008

Objective To introduce neurophysiological methods to search for damage to neuromuscular structures involved in sustaining continence in women who experienced stress urinary incontinence during pregnancy andlor after delivery.

Patients and methods Eight stress urinary incontinent parous women (mean of 2.75 vaginal deliveries [range 2–41 median age 45.3 years [range 31–60]) were examined using simultaneous electromyogram recordings of the left and right pubococcygeus muscle via wire electrodes. Comparisons were made with 10 nulliparous continent women (median age 2 7.2 years [range 22–32]).

Results Individual muscle activation patterns in stress urinary incontinent parous women were in principle similar to those observed in the continent nulliparous women, with two significant exceptions: (i) voluntary ‘squeeze’ showed significant differences in the holding time between the parous stress urinary incontinent patients and the nulliparous Continent controls, with an empty bladder (49.0 s versus 193.9 s median value) and a full bladder (39.2 s versus 198.4 s); (ii) asymmetrical and uncoordinated levator activation patterns were demonstrated in four of eight parous stress incontinent women, i.e. inhibition of motor unit firing on coughing (n = 3) and dissociated recruitment of motor units during voluntary and reflex activation (n= 1). Conclusion Childbirth appeared to induce both quantitative and qualitative changes in the pelvic floor which jeopardized the continence mechanism. Sphincter weakness appeared to result not only from the loss of motor units but also from altered activation patterns in the remaining units: shorter activation periods, lack of response or paradoxical inhibition. Kinesiological EMG recordings revealed behavioural abnormalities which appeared relevant for planning treatment.
Immunohistological expression of p53 in primary pTl transitional cell bladder cancer in relation to tumour progression
Authors: GARDINER R.A. , WALSH M.D. , ALLEN V. , RAHMAN S. , SAMARATUNGA M.L.T.H. , SEYMOUR G.J. , LAVIN M.F.
Published: November 2008

Objective To determine whether p53 expression is a marker of tumour progression in superficially invasive (pTl) transitional cell carcinoma of the bladder.

Patients and methods The immunohistochemical status of the p53 protein in 28 pTl primary bladder cancers was determined on frozen tissue and archival paraffin block sections using three primary antibodies (CM‐1, PAB1801 and D07). The findings were compared with the patients' progress. All the patients, except for those who died during the course of the study, were followed up by check cystoscopy for a minimum of 2 years.

Results Immediately adjacent frozen sections stained identically in 10 of 16 cases for CM‐1 and PAB1801. For paraffin sections, identical staining patterns were seen for PAB1801 and D07 in 21 of 26 sections. However, inter‐ and intra‐tumour staining for p5 3 was very variable, even with the same antibody. The heterogeneity of p53 positive cell distribution in the tumours indicates potential for significant sampling errors if random sections are chosen as representative of p53 status.

Conclusion The p53 status of the primary tumours did not relate to patient outcome. The results obtained do not support the use of immunohistological p53 expression as a discriminating prognostic indicator in pTl transitional cell carcinoma of the bladder.
Prostate‐specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ‐confined prostatic cancer
Authors: SEMJONOW A. , HAMM M. , RATHERT P. , HERTLE L.
Published: November 2008

Objective To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma.

Patients and methods Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate‐specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal × anterior‐posterior × transverse diameter × 0.52), allows a better differentiation than the absolute PSA values.

Results In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml × cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml × cm3).

Conclusion The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.
Ureterocystoplasty: the ‘bladder’ augmentation of choice
Authors: HITCHCOCK R.J.I. , DUFFY P.G. , MALONE P.S.
Published: November 2008

Objective To reduce the complications of enterocystoplasty by augmenting the bladder with a megaureter.

Patients and methods Ureterocystoplasty was performed in eight children aged 20 months‐15 years. Three had impaired renal function and three were in established chronic polyuric renal failure.

Results The seven older children were dry by day with clean intermittent catheterization and the youngest, at the age of 31/2 years, had a dry interval of 2 h after catheterization. The three children with polyuric renal failure required nocturnal catheterization or were wet at night. The post‐operative urodynamics showed a significant improvement in all cases with abolition of detrusor instability in seven patients and a reduction in end filling pressure. Bladder volume increased from a mean of 100 ml (range 45–215) to 311 ml (range 150–450) (P= 0.01). There was no deterioration in renal function.

Conclusion The early results of ureterocystoplasty compare favourably with those of enterocystoplasty without the risks of long‐term metabolic and neoplastic complications.
Prostate‐specific antigen obtained under optimal conditions determines extracapsular adenocarcinoma of the prostate
Authors: Ehreth J.T. , Miller J.I. , McBeath R.B. , Hansen K.K. , Ahmann F.R. , Dalkin B.L. , Jr M. Schiff
Published: November 2008

Objective To assess the relationship of prostate‐specific antigen (PSA) obtained under optimal conditions with the presence or absence of organ‐confined prostate cancer following radical prostatectomy.

Patients and methods The medical records of 300 consecutive patients who underwent radical retropubic prostatectomy were retrospectively reviewed. Ninety‐three patients were excluded who had a pre‐operative PSA level potentially altered by various factors (prostate infection, manipulation or instrumentation).

Results A pre‐operative PSA value < 4 ng/mL accurately predicted pathologically confined disease in 42 of 51 patients (82%) which contrasted with extracapsular disease in 74 of 84 patients (88%) who had a PSA value > 10 ng/mL. One of the 53 patients with a PSA > 15 ng/mL had organ‐confined disease at surgery.

Conclusion These data demonstrate that optimal serum PSA values correlate well with pathological stage.