bluuebunny/crossref_metadata_2025 huggingface dataset:
The prognostic value of inducible nitric oxide synthase in local prostate cancer
Authors: Aaltomaa S.H. , Lipponen P.K. , Viitanen J. , Kankkunen J‐P. , Ala‐Opas M.Y. , Kosma V.‐M.
Published: March 2003

Objective To compare the clinical and histological data from patients with prostate cancer with the results of the immunohistochemical analysis of inducible nitric oxide synthase (iNOS), and thus determine the prognostic value of iNOS.

Patients and methods The study included 82 patients (mean age 64.6 years,
sd 6.1) with local prostate cancer treated by radical prostatectomy in two Finnish hospitals. Their mean (
sd) follow‐up was 3.3 (2.2) years. An immunohistochemical method was used to detect the expression of iNOS in these specimens, and the expression graded according to staining intensity as none, weak or strong.

Results There was weak or strong expression of iNOS in 25 (31%) and 56 (68%) of the patients, respectively, and one specimen was negative for iNOS. Strong expression of iNOS was related to high a preoperative prostate specific antigen (PSA) level (P = 0.006) and high pT classification (P < 0.001), but not to nodal status, grade, seminal vesicle or capsular invasion, surgical margin status, perineural infiltration, tumour infiltrating lymphocytes or proliferation rate of cancer cells. A PSA failure was detected in 29 patients but was not predicted by iNOS expression. A Cox multivariate analysis showed that surgical margin positivity, seminal vesicle involvement and number of tumour infiltrating lymphocytes predicted the PSA failure.

Conclusion A high expression of iNOS was related to a high pT classification and the preoperative PSA level but not to other established prognostic factors; iNOS expression was not a predictor of PSA failure in patients with local prostate cancer.
5‐Hydroxytryptamine‐induced potentiation of cholinergic responses to electrical field stimulation in pig detrusor muscle
Authors: Sellers D.J. , Chess‐Williams R. , Chapple C.R.
Published: March 2003

Objective To determine whether detrusor muscle from the pig can be used as a model to study presynaptic 5‐hydroxytryptamine (HT)4‐receptor‐mediated effects on the electrical field stimulated (EFS) cholinergic responses previously identified in the human bladder.

Materials and methods Strips of detrusor muscle were mounted in physiological Krebs' solution under 1 g tension and field stimulated (25 Hz, 0.01 ms duration, 60 V for 5 s) at 100‐s intervals and allowed to equilibrate. Concentration‐response curves to 5‐HT (1 nmol/L to 300 µmol/L) were constructed in the presence and absence of the 5‐HT4‐selective antagonists RS‐100235 and GR‐113808 (both at 0.3, 1 and 3 nmol/L). All experiments were conducted in the presence of methiothepin and ondansetron (both 1 µmol/L) to block 5‐HT1, ‐HT2 and ‐HT3 receptors.

Results 5‐HT potentiated the cholinergic responses to EFS in pig bladder strips in a concentration‐dependent manner, with a maximum mean (
sem) potentiation of 48.3 (7.7)% of the resting tension (n = 25). BothRS‐100235 and GR‐113808 antagonized the effect of 5‐HT with high affinity, yielding apparent pKB values which were consistent with the responses being mediated via the 5‐HT4 receptor subtype.

Conclusion These data indicate that 5‐HT can potentiate EFS responses in isolated pig bladder strips and that the 5‐HT4 receptor subtype mediates this response. Therefore, the pig may be used as an effective model to study presynaptic 5‐HT4 receptors previously reported in the human bladder.
Extracorporeal shock wave lithotripsy in children: experience using two second‐generation lithotripters
Authors: Elsobky E. , Sheir K.Z. , Madbouly K. , Mokhtar A.A.
Published: March 2003

Objectives To assess the value of extracorporeal shock wave lithotripsy (ESWL) in treating paediatric urolithiasis, and to determine factors that may affect the results.

Patients and methods Using two types of lithotripters (MFL 5000, Dornier MedTech GmbH, Germany, and the Echolith, Toshiba Medical Systems, Japan), 148 children and adolescents (mean age 11.2 years,
sd 4.7, range 1–18) were treated for urinary stones. Of these, 137 patients had renal stones and 11 had ureteric stones. The respective mean (
sd) stone width and length were 10.2 (4.1) and 12.9 (5.6) mm for renal stones and 7.6 (2.7) and 9.1 (2.7) mm for ureteric stones. The patients were assessed 3 months after treatment and the results compared using the chi‐square test to detect factors that might be associated with the stone‐free rate.

Results For those with renal stones, the overall stone‐free rate was 86% and the re‐treatment rate 64%. The only significant factor associated with the stone‐free rate was the transverse diameter of the stone (P = 0.012); there was no significant effect of the type of lithotripter but there was a significant difference in re‐treatment rate (P = 0.016) in favour of the MFL 5000. All those with ureteric stones were rendered stone‐free and only four required re‐treatment. Only one child among those with renal stones developed steinstrasse; this was managed by ureteroscopy and otherwise no other complications were recorded in either group.

Conclusions ESWL is a safe and effective treatment for paediatric urolithiasis. The stone‐free rate is influenced significantly by stone size. The re‐treatment rate differed significantly between the electrohydraulic and piezoelectric lithotripters, but the stone‐free rate did not.
One thousand video‐urodynamic studies in children with non‐neurogenic bladder sphincter dysfunction
Authors: Hoebeke P. , Van Laecke E. , Van Camp C. , Raes A. , Van De Walle J.
Published: March 2003

Objective To ascertain the aetiology and epidemiology of non‐neurogenic bladder sphincter dysfunction (NNBSD) by assessing the results of prospective video‐urodynamic studies (VUD) in 1000 children.

Patients and methods During a 4‐year study period (January 1995 to December 1998) 1000 children prospectively underwent VUD to further define their NNBSD. After a noninvasive screening assessment consisting of a history, voiding diary, clinical examination, urine analysis, ultrasonography and uroflowmetry, those children who would benefit from further VUD were selected. The selection criteria included a history of urinary tract infection (UTI), a small bladder capacity not responding to training, dysfunctional uroflow, ultrasonographic abnormalities and resistance to therapy. During the study period 3500 children were screened for incontinence problems, including monosymptomatic nocturnal enuresis; 1000 of these were selected for VUD (524 boys and 476 girls).

Results The urodynamic diagnosis was of normal bladder‐sphincter function in 62 (6.2%, male : female 44 : 56), urge syndrome in 582 (58%, 58 : 42), dysfunctional voiding in 316 (32%, 49 : 51) and ‘lazy bladder’ in 40 (4%, 20 : 80). Boys diagnosed with a ‘lazy bladder’ were younger than those with urge syndrome and dysfunctional voiding. Girls with dysfunctional voiding were younger than those with urge syndrome. The incidence of UTI was significantly higher in girls than in boys; boys with NNBSD had no greater risk for UTI and in girls the general risk was 34%. Only in girls with a lazy bladder was there a significantly higher incidence of UTI (53%). Reflux occurred equally in all groups, with an overall incidence of 15%. The incidence of obstipation was significantly higher in girls with a lazy bladder, and overall was 17%.

Conclusion These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD. The age distribution provides evidence against a dysfunctional voiding sequence. The risk of developing UTI in NNBSD is greater only in girls. In children with a lazy bladder the risk is also significantly higher, indicating that residual urine is a greater risk factor than detrusor instability. Urge syndrome and dysfunctional voiding in girls carry the same risk for developing UTI, indicating that bladder instability is a higher risk factor for UTI than detrusor sphincter discoordination. All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence, UTIs, reflux and obstipation.
Laparoscopic excision of prostatic utricles in children
Authors: Yeung C.K. , Sihoe J.D.Y. , Tam Y.H. , Lee K.H.
Published: March 2003

Objective To report our experience of laparoscopic excision of symptomatic prostatic utricles in children.

Patients and methods Prostatic utricles were excised laparoscopically in four boys (mean age 6.3 years, range 1.5–17). Cysto‐urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure. Laparoscopy was conducted via a 5‐mm port inserted through a supra‐umbilical incision. Two more 5 mm working ports were inserted at the right and left mid‐abdomen. The prostatic utricle was easily identified with the guidance of cystoscopic transillumination. Dissection was further facilitated by lifting and counter‐traction of the prostatic utricle using the indwelling cystoscope. The prostatic utricle was completely mobilized and divided at its confluence with the urethra using an ultrasonic scalpel.

Results Laparoscopic excision of the prostatic utricle was successful in all four patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in one. One patient also had a nonfunctioning dysplastic kidney associated with an ectopic ureter joining into the prostatic utricle, and underwent nephroureterectomy at the same setting. The mean (range) operative duration was 148 (105–225) min. All four patients recovered uneventfully with no complications.

Conclusions Laparoscopic excision under cystoscopic guidance is effective for symptomatic prostatic utricles, offering a good surgical view and allowing easy dissection in a deep and narrow pelvic cavity.
The effect of superoxide dismutase on nitric oxide‐mediated and electrical field‐stimulated diabetic rabbit cavernosal smooth muscle relaxation
Authors: Khan M.A. , Thompson C.S. , Jeremy J.Y. , Mumtaz F.H. , Mikhailidis P. , Morgan R.J.
Published: March 2003

Objective To investigate the effect of superoxide dismutase (SOD, the enzyme that accelerates the breakdown of the superoxide anion, O2– to H2O) on nitric oxide (NO)‐mediated and electrical field stimulated (EFS) relaxation in diabetic rabbit cavernosal smooth muscle.

Materials and methods Diabetes was induced with alloxan (65 mg/kg) in six adult New Zealand White rabbits. After 6 months, cavernosal smooth muscle strips from age‐matched controls and diabetic animals were mounted in organ baths. After precontraction with phenylephrine (10 µmol/L) in the presence of atropine (1 µmol/L), guanethidine (5 µmol/L) and indomethacin (10 µmol/L), relaxation responses to EFS (1–20 Hz), carbachol (10−8−10−4 mol/L) and sodium nitroprusside (SNP, 10−9−10−4 mol/L) were assessed in the presence and absence of SOD (100 IU/mL).

Results SNP‐ and carbachol‐mediated (endothelium‐independent and ‐dependent, respectively) relaxations were impaired in the diabetic cavernosal smooth muscle strips compared with controls (concentration required for 50% inhibition, 1.4 µmol/L for diabetic and 0.75 µmol/L for control with SNP, and 44 µmol/L for diabetic and 0.4 µmol/L for control with carbachol). SOD significantly enhanced both SNP‐ and carbachol‐mediated diabetic cavernosal smooth muscle relaxations (both P < 0.05). EFS‐mediated relaxations were also significantly (P < 0.05) impaired in the diabetic cavernosal smooth muscle strips; these relaxations were also significantly (P < 0.05) enhanced by SOD.

Conclusion NO‐ and EFS‐mediated cavernosal smooth muscle relaxation is impaired in a rabbit model of diabetes but SOD significantly reversed the impaired relaxation. Therefore, in diabetes, the generation of reactive oxygen species may play an important role in the development of erectile dysfunction.
Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico‐ureteric reflux
Authors: McLaren C.J. , Simpson E.T.
Published: March 2003

Objective To determine the sensitivity of the direct radionuclide cystogram (DRC) in detecting vesico‐ureteric reflux compared with the micturating cysto‐urethrogram (MCU) in the same initial setting, in infants younger than one year.

Patients and methods The results from the dual cystograms of 62 refluxing infants < 1 year old (mean 0.58) were compared. Results from same‐day renal scintigraphy with dimercaptosuccinic acid (DMSA) in 60 of the 62 infants were also compared with the reflux grades.

Results Reflux was detected in 105 units, 96 detected on the DRC and 47 on the MCU, representing a sensitivity of 91% and 45%, respectively. The DRC missed half of grade 1, 20% of grade 2 and 6% of grade 3 reflux. Reflux at low bladder filling rates (DRC) represented 40% of all reflux units, and a half (52%) of scarred renal units detected by DMSA scintigraphy.

Conclusions In young infants the MCU may fail to detect significant reflux and the DRC may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information.
Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia
Authors: Tanyel F.C. , Müftüoglu S. , Dagdeviren A. , Kaymaz F.F. , Büyükpamukçu N.
Published: March 2003

Objective To ascertain the presence of myofibroblasts in sacs associated with inguinal hernia in children, through an ultrastructural evaluation using electron microscopy

Materials and methods Sacs were obtained from 10 boys and 10 girls (of similar age, ≈ 45 months) with inguinal hernia and processed for electron microscopy. Thin sections were examined specifically for the presence of myofibroblasts.

Results The ultrastructural evaluation showed myofibroblasts with classical electron microscopic features within all of the sacs, regardless of the gender of origin.

Conclusion The persistence of smooth muscle hinders the obliteration of the processus vaginalis; myofibroblasts are found in association with smooth muscle and thus such cells within the sac walls seem to originate from the smooth muscle, reflecting the dedifferentiation of smooth muscle. This dedifferentiated state may represent attempted apoptosis, which usually causes the disappearance of the smooth muscle and obliteration of the processus vaginalis after the descent of the testis into the scrotum.
The action of cysteinyl‐leukotrienes on intracellular calcium mobilization in human detrusor myocytes
Authors: Bouchelouche K. , Horn T. , Nordling J. , Larsen S. , Hald T.
Published: March 2003

Objective To investigate the presence of leukotriene D4 receptors in fura‐2‐loaded human detrusor smooth muscle cells (DSMCs) by examining the ability of leukotriene D4 to raise intracellular‐free Ca2+ concentration ([Ca2+]i), to determine the origin of the leukotriene D4‐mediated rise in [Ca2+]i and to investigate whether the specific leukotriene D4 receptor antagonist montelukast inhibits the Ca2+ response induced by leukotriene D4.

Materials and methods Detrusor muscle biopsies were obtained from patients with benign noninvasive bladder diseases undergoing cystoscopy. DSMCs were isolated using an explant technique and maintained in culture. Only primary cultures or cells passaged up to three times were used for experiments. DSMCs were characterized with immunohistochemical staining and their identity confirmed by transmission electron microscopy. [Ca2+]i was measured in single DSMCs using the Ca2+ probe fura‐2 and fluorescence‐ratio microscopy.

Results Immunohistochemical staining showed that 80–99% of the cells were positive for smooth muscle α‐actin. The ultrastructural features of the cultured cells were those of smooth muscle cells and showed no differentiation in a fibroblastic or myofibroblastic direction. Leukotriene D4 increased the level of [Ca2+]i in a dose‐dependent manner. Calcium was mobilized almost exclusively from intracellular Ca2+ stores. There was a dose‐dependent inhibition of the increase in [Ca2+]i by montelukast.

Conclusion The present study is the first to show the presence of specific leukotriene D4 receptors in human detrusor myocytes. This may have implications for a potential pathophysiological role of leukotriene D4 in patients with interstitial cystitis and other functional or inflammatory bladder disorders.
The effect of methylene blue on histological damage after spermatic cord torsion in a rat model
Authors: Greenstein A. , Schreiber L. , Matzkin H.
Published: March 2003

Objective To investigate, in a rat model, whether methylene blue (a free‐radical scavenger) is effective in alleviating the histological testicular damage caused by reperfusion after spermatic cord torsion.

Materials and methods Male Wistar rats underwent a clockwise 720° left spermatic cord torsion lasting 3 h; they were then randomly assigned to treatment and control groups. In the treated group, 2 mg/kg methylene blue was injected intraperitoneally 20 min before the cord was untwisted, and an additional 1 mg/kg injected into the penile vein 1–2 min beforehand. After 14 days, the left testicle was removed and assessed histologically. The control group was not treated.

Results Thirty‐three rats in the treatment group and 35 untreated controls were suitable for evaluation. Treatment with methylene blue was not significantly predictive of histological damage; the colour of the testis before detorsion was not correlated with histological damage.

Conclusion Anti‐oxidant treatment with methylene blue had no palliative effect on the histological changes after torsion and detorsion of the spermatic cord in this rat model.
Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter‐blocking Proteus mirabilis biofilms?
Authors: Morris N.S. , Stickler D.J.
Published: March 2003

Objective To test the recommendation that to avoid the complications of long‐term indwelling bladder catheterization (e.g. encrustation and blockage by crystalline Proteus mirabilis biofilms) patients should drink cranberry juice.

Materials and methods Urine was collected from groups of volunteers who had drunk up to 2 × 500 mL of cranberry juice or water within an 8‐h period. Laboratory models of the catheterized bladder were supplied with urine from these groups and inoculated with P. mirabilis. After incubation for 24 or 48 h, the extent of catheter encrustation was determined by chemical analysis for calcium and magnesium. Encrustation was also visualized by scanning electron microscopy.

Results The amounts of calcium and magnesium recovered from catheters incubated in urine pooled from individuals who had drunk 500 mL of cranberry juice was not significantly different from that on catheters incubated in pooled urine from control subjects who had drunk 500 mL of water. However, there was significantly less encrustation (P = 0.007) on catheters from models receiving urine from volunteers who had drunk 2 × 500 mL of water than on catheters incubated in models supplied with urine from volunteers who had drunk 2 × 500 mL of cranberry juice. The amounts of encrustation on these two groups of catheters were also significantly less than that on catheters incubated in models supplied with urine from volunteers who had not supplemented their normal fluid intake. (P < 0.001). Experiments in the models using artificial urine showed that increasing the low fluid intake (720 mL/24 h) characteristic of many patients undergoing long‐term catheterization by factors of three and six, significantly (P < 0.01) reduced the amounts of calcium and magnesium that formed on catheters. At a simulated fluid intake of 720 mL/24 h, catheters blocked with encrustation after a mean of 42.5 h, while those supplied with urine produced from an intake of 4320 mL/24 h, drained freely for > 10 days.

Conclusion In this in vitro study, drinking cranberry juice did not produce urine that was inhibitory to the development of crystalline catheter‐blocking P. mirabilis biofilms. The important factor in preventing catheter encrustation is a high fluid intake.
The efficacy of a range of contact media as coupling agents in extracorporeal shockwave lithotripsy
Authors: Cartledge J.J. , Cross W.R. , Lloyd S.N. , Joyce A.D.
Published: March 2003

Objective To determine if the nature of the coupling agent normally used between the lithotripter and the patient affects the stone fragmentation rate during extracorporeal shock wave lithotripsy.

Materials and methods A jig designed to hold ‘phantom’ 10‐mm stones at the focal point was fixed against the shock wave delivery point of an electromagnetic lithotripter (Dornier Compact, Germany). A layer of either petroleum jelly (Vaseline™, Cheeseborough‐Ponds Ltd, London, UK) ultrasonography jelly, a eutectic mixture of local anaesthetic (EMLA) cream, Instillagel (Farco‐Pharma, Cologne, Germany) or a commercial water‐soluble lubricating jelly was placed between the jig and shockwave head, and the number of shock waves required to fragment the stones was recorded.

Results Significantly more shock waves were required to fragment stones when petroleum jelly was used as the coupling agent than with all the other agents under test, whereas significantly fewer shock waves were required when using Instillagel or lubricating jelly than for all other agents.

Conclusion The coupling agent used in water‐free lithotripsy can affect the stone fragmentation rate and should not be considered inert. Ultrasonography jelly is probably the optimum agent available for use as a lithotripsy coupling agent.
Assessing the vascular‐stromal coefficient in patients with benign prostatic hyperplasia or prostate cancer using transrectal ultrasonography and power Doppler analysis
Authors: Dobrowolski Z. , Jaszczynski J. , Drewniak T. , Habrat W.
Published: March 2003

Objectives To assess a coefficient of the prostatic blood supply in patients with prostate cancer or benign prostatic hyperplasia (BPH), and thus improve the diagnostic and prognostic variables needed to evaluate patients with prostate cancer.

Patients and methods The vascular‐stromal coefficient was defined as the ratio of the blood vessel surface area and the surface area of the prostate, using power Doppler functions and transrectal ultrasonography. The index was calculated for the plane of the prostatic surface from the apex to the widest points of the peripheral zone, and for the plane across the highest density of blood vessels in the transition zone. A micobubble contrast agent was used to intensify the acoustic signals from prostatic vessels. The images were reconstructed in three dimensions. In all, 61 patients with BPH and 32 with confirmed prostate cancer were examined, and compared with a control group of young men.

Results In the horizontal plane crossing the apex of the prostate, the vascular‐stromal coefficient was 0.0054 for the controls, 0.0072 for BPH and 0.0067 for cancer. At the level of the highest density of blood vessels the respective values were 0.0083, 0.038 and 0.029. The respective values for the first plane after using the contrast agent were 0.025, 0.092 and 0.0365, and in the second level 0.04, 0.15 and 0.14.

Conclusion The vascular‐stromal coefficient measured at both levels was higher in patients with BPH than in those with cancer or than in the controls. The prostatic vascular system can be computer‐reconstructed in three dimensions, allowing an evaluation of asymmetry and other vascular abnormalities. The contrast agent effectively increases the vascular acoustic signals from the prostate, enhancing by a factor of five the visualization of blood vessels when using the power Doppler option.
Intracavernosal injection therapy with and without sexological counselling in men with erectile dysfunction
Authors: Van Der Windt F. , Dohle G.R. , Van Der Tak J. , Slob A.K.
Published: March 2003

Objective To compare the acceptance of and satisfaction with intracavernosal injection (ICI) therapy with and without sexological counselling in men with erectile dysfunction (ED).

Patients and methods In a prospective randomized study, men were alternately assigned to ICI without sexological counselling (−SC) or with sexological counselling (+SC). In all, 70 patients were included, i.e. 35 in each group; 57 (28 −SC, 29 +SC) were interviewed by telephone after a mean follow‐up of 11.3 months to determine their use of ICI and reasons for discontinuing.

Results There were no differences between the groups in discontinuation of ICI (overall 30%), in reasons for discontinuing ICI (24% did so because of the return of spontaneous erections) or in sexual functioning.

Conclusion There was no positive contribution from additional sexological counselling but extensive information and support by the urologist seems to be sufficient, resulting in a high acceptance rate of ICI. The discontinuation rate (30%) is one of the lowest reported.
Detrusor myotomy: a 5‐year review in unstable and non‐compliant bladders
Authors: Potter J.M. , Duffy P.G. , Gordon E.M. , Malone P.R.
Published: March 2003

Objective To identify urodynamic factors that might determine the clinical outcome of detrusor myotomy in incontinent children.

Patients and methods Six girls and three boys (aged 5–14 years) underwent detrusor myotomy for severe urinary incontinence. Seven children had spina bifida, one had traumatic paraplegia and one had low bladder compliance. The patients were followed for a minimum of 5 years.

Results Urodynamic studies before surgery showed that three patients had normal compliance with grossly unstable detrusor contractions, and six had low bladder compliance with few phasic detrusor contractions. Detrusor leak‐point pressures were > 40 cmH2O in five patients and < 40 cmH2O in four. Only two patients, both with grossly unstable detrusor contractions and leak‐point pressures of > 40 cmH2O, had a successful 5‐year outcome. The other seven patients remained incontinent; six underwent further surgery and one died from unrelated causes.

Conclusion Detrusor myotomy appears to have the best outcome in those patients with marked phasic unstable detrusor contractions with a competent urethral sphincter. In this group it may have distinct advantages over more commonly used procedures.
Surgical sperm retrieval after previous vasectomy and failed reversal: clinical implications for in vitro fertilization
Authors: Wood S. , Vang E. , Troup S. , Kingsland C.R. , Lewis‐Jones D.I.
Published: March 2003

Objective To investigate the effect of the interval between previous vasectomy reversal on retrieval rates of epididymal and testicular spermatozoa using percutaneous epididymal sperm aspiration (PESA), or testicular sperm extraction (TESE), and the subsequent reproductive potential of these gametes in intracytoplasmic sperm injection (ICSI) cycles.

Patients and methods Sixty‐six consecutive sperm retrievals were considered in patients who were azoospermic after previous vasectomy, of whom 54 had had a previous failed reversal, the remainder deciding against a reversal. PESA and TESE retrieval rates were noted, as were the time since vasectomy and the interval between vasectomy and unsuccessful reversal. The presence of palpable epididymal cysts was noted, with their effect on sperm retrieval rates. Fertilization and pregnancy rates were analysed in subsequent ICSI cycles using freshly retrieved spermatozoa or frozen‐thawed cryopreserved spermatozoa.

Results All 66 patients had sperm retrieved successfully; the success rates for PESA were not significantly affected by previous failed reversal when compared with patients who had not had a reversal, at 14 of 54 (26%) vs five of 12 (P=0.3). The interval since vasectomy did not affect PESA retrieval rates but there was a significantly poorer retrieval rate for PESA in the presence of palpable epididymal cysts, at seven of 35 (20%) vs 12 of 23 (52%) (P=0.012). Fertilization rates were significantly lower using cryopreserved spermatozoa retrieved from either the epididymis or testis (50% vs 70%, P=0.007), although subsequent implantation and pregnancy rates were not significantly different.

Conclusions Surgical sperm retrieval is successful in all cases of azoospermia secondary to vasectomy, either by PESA or TESE. There are no clinical markers to indicate which patients will have successful PESA after vasectomy, although the presence of epididymal cysts is associated with significantly lower retrieval rates. The reduction in fertilising ability of cryopreserved spermatozoa does not affect clinical pregnancy rates in ICSI cycles.
Is ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative study
Authors: Chapple A. , Ziebland S. , Herxheimer A. , Mcpherson A. , Shepperd S. , Miller R.
Published: March 2003

Objective To understand what leads men to choose ‘watchful waiting’ rather than active treatment for cancer of the prostate.

Patients and methods Fifty men with confirmed prostate cancer in England, Wales and Scotland were interviewed about all aspects of their illness, for a Database of Individual Patients' Experience of illness. The sample included men at different stages of diagnosis and with experience of a wide range of treatments. We report here only what men said about their choice of treatment and the decision‐making process.

Results Watchful waiting would have been clinically inappropriate for almost half of the men (those with serious urinary symptoms and those with metastatic disease). However, few of the men who might have chosen watchful‐waiting remembered this being presented as a serious option. Most in this group chose radical prostatectomy, radiotherapy, brachytherapy or cryosurgery. The few who chose watchful waiting had found doctors who supported their decision, had assessed the evidence from Internet sites, and were concerned about the side‐effects and uncertain outcome of treatment. Men who chose watchful waiting, as well as those who opted for treatment, described considerable pressure from family members, doctors or support groups, to seek active treatment.

Conclusion This study helps to explain why some men will not contemplate watchful waiting, and why others may find it difficult to pursue that option. Understanding men's concerns may help clinicians to support men's treatment decisions. Treatment for prostate cancer is highly controversial because no randomized, controlled trials have shown whether or not active intervention increases survival. If trials are not completed it cannot be determined whether active treatments are the best course of action for men with prostate cancer.
Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control
Authors: Bakker E. , Van Gool J.D. , Van Sprundel M. , Van der Auwera C. , Wyndaele J.J.
Published: March 2003

Objective To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control.

Subjects and methods A questionnaire with 41 questions was distributed to 4332 parents of children completing the last 2 years of normal primary school. The questionnaire had been tested for reproducibility of the answers in a random subgroup of 80 parents. The aims of the investigation were explained in an accompanying letter and the response rate was 76.7%. The result were analysed using the chi‐square test (Yates corrected).

Results Two groups of children were identified, one with no lower urinary tract symptoms (3404) and one with complaints of daytime and night‐time wetting, and urinary tract infections (928). The groups were termed the ‘control’ and ‘symptom’ groups, respectively. There were no differences in the family situation between the groups. The symptom group reported more ‘below average’ school results and less independence in homework and hygiene. The age at which toilet training started was significantly higher in the symptom group and scheduled voiding was used significantly less. The reaction of the parents when the attempt at voiding was unsuccessful was significantly different; in the control group most parents just postponed the effort and had the child try again later, whereas in the symptom group more parents asked the child to push, made special noises or opened the water tap.

Conclusions These data show significant differences in toilet training between children with and with no lasting problems of bladder control. Postponing the onset of the training after 18 months of age and using certain methods to provoke voiding (asking to push, opening the water tap) probably increases the risk of later problems with bladder control.
Prosthetic replacement of the inferior vena cava and the iliofemoral vein for urologically related malignancies
Authors: Caldarelli G. , Minervini A. , Guerra M. , Bonari G. , Caldarelli C. , Minervini R.
Published: March 2003

Objective  To evaluate the feasibility and results of prosthetic venous replacement, as inferior vena cava (IVC) and iliofemoral vein resection and replacement are sometimes necessary when they are extensively involved by a large and fixed tumour thrombus from renal cell carcinoma (RCC) or other urological malignancies.

Patients and methods  Five men and two women (age range 41–75 years) were treated over a 10‐year period (1991–2001) by aggressive venous surgery to achieve complete tumour resection, with prosthetic graft replacement to re‐establish venous flow. The tumours included RCC of the right kidney (two), retroperitoneal liposarcoma (two), bladder cancer (one), retroperitoneal fibrosarcoma (one) and inguino‐pelvic lymphoma (one). Two patients had a vena caval replacement, of whom one had a circular reinforced PTFE and one a Dacron silver graft; five patients had either an iliofemoral or an ilio‐iliac circular reinforced PTFE graft. The prosthetic diameter was 18–20 mm for the IVC grafts and 8–10 mm for the iliac grafts. In all the patients, graft patency was evaluated during the follow‐up by colour flow duplex imaging, and in one it was determined by angio‐computed tomography scan and venography.

Results  One patient died 30 days after surgery; of the remaining six patients one had no evidence of regional recurrence or metastatic disease at 12 months, and five died from recurrent tumour 8–30 months after surgery. The mean time to death was 23 months. At 3 months all six prosthesis were patent; at 6 months four were patent and at 12 months three of five prostheses were patent.

Conclusion  Resecting and replacing the IVC allows complete tumour resection and avoids renal failure, providing durable relief from the symptoms of venous obstruction. Iliofemoral prosthetic reconstruction for urological‐related malignancies represents a viable option to avoid venous engorgement and lower extremity swelling, at least in the early postoperative period. The mean time to death for the present patients must be considered the limit for these aggressive operations.
Hand‐assisted laparoscopic nephrectomy: complications related to the hand‐port site
Authors: Okeke A.A. , Timoney A.G. , Keeley F.X.
Published: March 2003

Objective  To evaluate the early results of hand‐assisted radical nephrectomy and nephroureterectomy in our institution.

Patients and methods  The records of 13 patients with malignant disease of the kidney who underwent hand‐assisted laparoscopic radical nephrectomy and nephroureterectomy were reviewed retrospectively. Clinical outcomes were compared with a series of 16 patients who underwent similar procedures via a standard laparoscopic approach.

Results  There were three major hand‐port wound complications in those who underwent hand‐assisted procedures, while one other patient required conversion because of technical failure of the device. The operative duration, length of hospital stay, estimated blood loss, transfusion rate, analgesic requirement, conversion rates, and minor complications were similar between the hand‐assisted and standard laparoscopy groups.

Conclusion  There was little difference between hand‐assisted and standard laparoscopy in operative duration or recovery, but there were problems with wound complications which may be related to the hand‐assisted approach. We have consequently abandoned the technique in favour of a standard laparoscopic approach.
Sexual function after using tension‐free vaginal tape for the surgical treatment of genuine stress incontinence
Authors: Maaita M. , Bhaumik J. , Davies A.E.
Published: March 2003

Objective  To determine whether the use of the tension‐free vaginal polypropylene tape (TVT) procedure for the treatment of genuine stress incontinence (GSI) affects sexual activity.

Patients and methods  Sixty‐seven women treated by insertion of a TVT between September 1998 and March 2001 for GSI were sent questionnaires 6–36 months after surgery to determine any urinary symptoms, sexual activity, patient satisfaction and the use of hormone‐replacement therapy.

Results  The questionnaire was returned by 57 patients (87%); 43 (76%) reported being sexually active and 14 (25%) were not. Of the former, 31 (72%) reported no change in sexual function after surgery and only two reported an improvement; six (14%) reported that sexual function was worse and four did not reply to the questions. The patients reporting that sexual function was worse cited loss of libido as the main reason. No patients complained of dyspareunia.

Conclusions  There was no significant change in sexual function or activity after the TVT procedure and patients can thus be reassured that this operation will not affect their sex life.
An experimental study of self‐expanding ureteric metallic stents: macroscopic and microscopic changes in the canine ureter
Authors: Nishino S. , Goya N. , Ishikawa N. , Tomizawa Y. , Toma H.
Published: March 2003

Objective  To evaluate the efficacy and safety of self‐expanding metallic stents after insertion into the canine ureter.

Materials and methods  Actively expanding metallic (Nitinol) stents (diameter 8–10 mm, length 4–6 cm) were placed in eight mongrel dogs (18–34 kg). Under general anaesthesia, a midline abdominal incision was made and a stent inserted directly into the ureter through a small incision; each animal was stented on one side. The dogs were assessed after 6 or 19 days or 2, 5 (two), 6 (two) and 7 months. Ureteric specimens were evaluated both macroscopically and microscopically.

Results  Macroscopically there was no leakage of urine in any of the animals. On day 6 the inserted stent was patent despite blood clots in the mesh. The lumen was smooth and shiny in three dogs examined at 5, 6 and 7 months. One of the two dogs assessed at both 5 and 6 months had hydronephrosis associated with papillary hyper‐epithelialization inside the stent, while the other animals had no dilatation of the renal pelvis. Microscopically there was loss of epithelium and bleeding of the ureteric wall at 6 days. Epithelial regeneration started after 19 days and was complete in the lumen at 2 months, with the stent incorporated into the wall of the ureter. Epithelialization was maintained up to 7 months, after which the problem of urothelial hyperplasia persisted, but an adequate lumen was maintained by epithelial regeneration. This epithelium was smooth and shiny, and composed of thin layers of cells.

Conclusion  Self‐expanding metallic stents may be effective if hyperplastic epithelialization does not occur, as the stent was epithelialized within 2 months and the regenerated epithelium maintained for up to 7 months. Metallic stents may be useful for treating patients with renal failure caused by ureteric stenosis from malignant tumours.
Changes in molecular forms of prostate‐specific antigen during treatment with finasteride
Authors: España F. , Martínez M. , Royo M. , Estellés A. , Alapont J.M. , Navarro S. , Aznar J. , Jiménez‐Cruz J.F.
Published: March 2003

Objective  To study the influence of finasteride treatment on the molecular forms of prostate‐specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH).

Patients and methods  Total PSA, free PSA and PSA complexed to α1‐antichymotrypsin (PSA‐α1ACT) were measured in plasma and serum from 40 men with BPH and a total PSA of < 20 ng/mL, using in‐house and commercial immunoassays, before and during treatment with finasteride (30 men) or placebo (10 men).

Results  The baseline values were not significantly different between the groups, with mean (sd) total plasma PSA levels of 3.6 (4.3) and 4.8 (5.9) ng/mL in the finasteride and placebo groups, respectively. Finasteride, but not placebo, induced a significant reduction in total PSA, free PSA and PSA‐α1ACT levels in plasma and serum (P < 0.001). However, complexed‐to‐total (c/t) and free‐to‐total (f/t) PSA ratios remained constant in both groups, both in plasma and serum, during the follow‐up.

Conclusion  The decrease in total PSA after finasteride treatment results from a proportional reduction in its two major molecular forms, free PSA and PSA‐α1ACT, which explains why the c/t and f/tPSA ratios do not change significantly despite treatment. This suggests that routine analysis of molecular forms of PSA could improve the utility of the change in total PSA associated with finasteride for the early diagnosis of prostate cancer. It also suggests that any subsequent change in both ratios, particularly an increase in c/tPSA or a decrease in f/tPSA ratio, could be considered an early sign of neoplastic degeneration rather than a therapeutic consequence.
Flexible ureteroscopes: a user's guide
Authors: Parkin J. , Keeley F.X. , Timoney A.G.
Published: March 2003

Objective  To compare, quantitatively and qualitatively, four small‐diameter flexible ureteroscopes.

Materials and methods  Four flexible ureteroscopes from different manufacturers, i.e. the DUR‐8 (ACMI, Southborough, MA, USA), Olympus UPF‐3 (Keymed, Southend‐on‐Sea, UK), Storz 11274AA (Karl Storz GmbH, Tuttlingen, Germany) and the Wolf 9 F (Henke Sass Wolf GmbH, Tuttlingen, Germany), were assessed quantitatively by measuring the active tip deflection and irrigation flow rate with laser fibres (200 µm, 365 µm), an electrohydraulic lithotripter (1.9 F) and grasping forceps (3 F) in position. They were then assessed subjectively by two endourologists who scored them, using a visual analogue scale (maximum 10), for insertion, deflection mechanism, manoeuvrability, rigidity, image quality and overall satisfaction.

Results  All the endoscopes are < 9 F at the tip, although the length of the smallest diameter (bevelled tip vs section of shaft) was variable. Tip deflection was 87–100% of the manufacturers’ specifications and decreased by similar percentages with instruments in the working channel. The irrigation flow rate was comparable for instruments with a 3.6 F working channel (72–88 mL/min with an empty working channel), although much greater for the Wolf, which has a 4 F channel (116 mL/min). Direction and image size were nearly identical, as was the field of view, apart from the Wolf (60° vs 90°). There was agreement in the user assessment for three instruments, with overall satisfaction scores being Storz (4), ACMI (7.5) and Olympus (8.6), but disagreement in scores for Wolf (1.9 vs 5.3).

Conclusions  Whilst there were considerable similarities in the objective assessment among the instruments, the user assessment showed qualitative variability. Thus it is important to try the different instruments before selecting one. Additional variables to consider include durability, cost and service/warranty, which vary considerably among instruments.
Thymidine phosphorylase levels as a prognostic factor in renal cell carcinoma
Authors: Wada S. , Yoshimura R. , Naganuma T. , Yoshida N. , Narita K. , Ikemoto S.
Published: March 2003

OBJECTIVE

To investigate the relationship between thymidine phosphorylase (TP), a vascular growth factor, and established prognostic factors for renal cell carcinoma (RCC), e.g. histological grade or Tumour‐Node‐Metastasis (TNM) classification.

PATIENTS AND METHODS

TP levels were measured in RCC tissue (tumour TP) and in adjacent non‐neoplastic kidney tissue (normal tissue TP), using a sandwich‐type enzyme‐linked immunosorbent assay. The 59 patients, diagnosed with organ‐confined RCC before surgery and who had undergone radical nephrectomy, were divided into two groups according to their prognosis after surgery. Group 1 (nine patients) had a poor prognosis and group 2 (50) had no evidence of disease within a 65‐month follow‐up. The relationships among TP level, TNM classification, histological subtypes, V factor and prognosis, and of tumour TP to normal tissue TP levels were investigated. Multiple regression analysis was used to determine the importance of factors associated with increased TP levels.

RESULTS

Normal tissue TP levels correlated with histological grade (r = 0.31, P < 0.01); in patients with venous invasion or with a poor prognosis, the levels were significantly higher than in those without (P < 0.05 and < 0.001, respectively). The normal tissue TP levels were also significantly higher in the non‐clear cell than in the clear cell subtype. Multiple regression analysis showed that the independent factor associated with elevated normal tissue TP levels was histological grade (R2 = 0.189, P < 0.01). There was no correlation between tumour TP and other factors.

CONCLUSION

Normal tissue TP levels in localized hypervascular RCC were associated with histological grade. These data suggest that normal tissue TP levels could be a prognostic factor.
RhoA is associated with invasion and lymph node metastasis in upper urinary tract cancer
Authors: Kamai T. , Kawakami S. , Koga F. , Arai G. , Takagi K. , Arai K. , Tsujii T. , Yoshida K‐I.
Published: March 2003

OBJECTIVE

To assess the roles of RhoA small GTPase (RhoA) in upper urinary tract cancer by analysing the mRNA and protein levels of RhoA.

PATIENTS AND METHODS

The mRNA and protein levels of RhoA in matched sets of tumour, non‐tumour and metastatic lymph node tissues of surgical specimens were analysed in 47 consecutive patients with renal pelvic/ureteric cancer, using the polymerase chain reaction after reverse transcription and Western blotting. The relationship between mRNA and protein levels of RhoA in tumour tissues and the clinicopathological features of the patients was also assessed.

RESULTS

The mRNA levels of RhoA and RhoA protein were greater in tumour and metastatic lymph node tissues than in non‐tumour tissues (all P < 0.001). The expression levels of RhoA mRNA and protein levels in primary tumours was related to poorly differentiated grade (both P < 0.05) and muscle invasion (P < 0.01 and < 0.001, respectively). Kaplan‐Meier plots of survival in patients with low or high RhoA showed that high mRNA and protein levels were associated with a shorter disease‐free (P < 0.01) and overall survival (P < 0.001). Multivariate analysis using the Cox proportional hazards model showed that a high RhoA protein level was an independent prognostic factor, second to stage, in disease‐free and overall survival (both P < 0.05).

CONCLUSIONS

These findings suggest that RhoA is involved in the invasion and metastasis of upper urinary tract cancer, indicating that RhoA may be a useful prognostic factor in this disease.