bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical therapy of oligoasthenospermia associated with left varicocele
Authors: Cavallini G. , Biagiotti G. , Ferraretti A.P. , Gianaroli L. , Vitali G.
Published: December 2004

The authors from Ferrara show that a NSAID has a role in patients who have oligoasthenospermia associated with a left‐sided varicocele, although not in every case. Peyronie's disease is discussed in two papers; in the first of these, the authors make the case for histopathological diagnosis by drawing the reader's attention to the possible presence of penile epithelioid sarcoma. In the second paper, attention is drawn to the possibility of using a combination of vitamin E and colchicine in the early stages of the condition.

Objective

To ascertain whether a nonsteroidal anti‐inflammatory drug (cinnoxicam) or surgical varicocelectomy are suitable therapies for oligoasthenospermia associated with varicocele.

Patients and methods

Patients who were oligoasthenospermic and had a varicocele were blindly randomized into three groups and the varicocele graded using echo‐colour Doppler ultrasonography. In group 1, seven men had grade V, four grade IV and 30 grade III varicoceles; in group 2 eight had grade V, 10 grade IV and 43 grade III; in group 3 six had grade V, eight grade IV and 40 grade III. Group 1 underwent surgery, group 2 received cinnoxicam (one 30 mg suppository every 4 days for 12 months) and group 3 received a placebo (one glycerine suppository every 4 days for 12 months). Sperm was analysed at intervals to follow the response in the three groups, and any side‐effects considered.

Results

Surgery significantly increased sperm values in men with grade III–V varicocele within 4 months, the highest values being obtained at 8 and 12 months. Cinnoxicam significantly improved sperm quality after 2 months in men with grade III varicocele, but the results were best at 4 months and stable at 12 months; stopping therapy caused a decline to the baseline values. Cinnoxicam did not change the sperm quality of men with grade IV or V varicocele. The placebo was inactive, and there were no side‐effects of active treatment.

Conclusions

Cinnoxicam is a safe and reliable therapeutic option for men with oligoasthenospermia associated with a grade III varicocele, but surgery is better for those with grade II, IV and V.
Neural control of the urethra and development of pharmacotherapy for stress urinary incontinence
Authors: Fraser M.O. , Chancellor M.B.
Published: December 2004

This review discusses the control of the urethra by the central nervous system, emphasizing the importance of nervous system control and the role of serotonin and noradrenaline in storage, micturition and sphincter reflexes. The concept of pharmacological neuromodulation and the use of pharmacological therapy as first‐line therapy for stress urinary incontinence (SUI) is presented. Coordination between the urinary bladder and urethra is mediated by many reflex pathways organized in the brain and spinal cord. During bladder filling, activation of mechanoreceptor afferent nerves in the bladder wall triggers firing in the cholinergic efferent pathways to the external urethral sphincter and in sympathetic adrenergic pathways to the urethral smooth muscle. These storage reflexes depend on interneuronal circuitry in the spinal cord and are modulated by descending pathways. It would therefore seem that neurotransmission in the central nervous system and periphery may be important in SUI, and moreover that pharmacological agents affecting these neurotransmitter pathways may be used to treat SUI. The central and peripheral mechanisms of action of duloxetine affect serotonin and noradrenaline neurotransmission in ways that may ameliorate the symptoms of SUI.
Selenium supplementation, baseline plasma selenium status and incidence of prostate cancer: an analysis of the complete treatment period of the Nutritional Prevention of Cancer Trial
Authors: Duffield‐Lillico A.J. , Dalkin B.L. , Reid M.E. , Turnbull B.W. , Slate E.H. , Jacobs E.T. , Marshall J.R. , Clark L.C. ,   for the Nutritional Prevention of Cancer Study Group
Published: December 2004

OBJECTIVE

To present the results (to January 1996, the end of blinded treatment) of the Nutritional Prevention of Cancer (NPC) Trial, a randomized trial of selenium (200 µg daily) designed to test the hypothesis that selenium supplementation (SS) could reduce the risk of recurrent nonmelanoma skin cancer among 1312 residents of the Eastern USA.

MATERIALS AND METHODS

Original secondary analyses of the NPC to 1993 showed striking inverse associations between SS and prostate cancer incidence. A subsequent report revealed that this effect was accentuated among men with the lowest baseline plasma selenium concentrations. The effects of treatment overall and within subgroups of baseline prostate‐specific antigen (PSA) and plasma selenium concentrations were examined using incidence rate ratios and Cox proportional hazards models.

RESULTS

SS continued to significantly reduce the overall incidence (relative risk and 95% confidence interval) of prostate cancer (0.51, 0.29–0.87). The protective effect of SS appeared to be confined to those with a baseline PSA level of ≤ 4 ng/mL (0.35, 0.13–0.87), although the interaction of baseline PSA and treatment was not statistically significant. Participants with baseline plasma selenium concentrations only in the lowest two tertiles (< 123.2 ng/mL) had significant reductions in prostate cancer incidence. A significant interaction between baseline plasma selenium and treatment was detected.

CONCLUSION

To the end of the blinded treatment the NPC trial continued to show a significant protective effect of SS on the overall incidence of prostate cancer, although the effect was restricted to those with lower baseline PSA and plasma selenium concentrations.
Assessment of an electronic daily diary in patients with overactive bladder
Authors: Quinn P. , Goka J. , Richardson H.
Published: December 2004

OBJECTIVE

To assess the effectiveness of a portable electronic diary as a data collection device for overactive bladder symptoms, and to evaluate its level of patient acceptability compared with a conventional paper‐based voiding diary.

PATIENTS AND METHODS

Patients were identified through USA and UK hospital incontinence clinics. Patients were trained in the use of paper and electronic diaries before randomization, to complete either diary for 7 days. The diaries were then collected and, after a further training session, patients completed the other diary type for 7 days.

RESULTS

In all, 35 patients were recruited into the trial; overall, patients using the paper diaries (35) and electronic diaries (33) recorded similar data for the median number of incontinent episodes per week (8.2 and 7.0, respectively) and for the median number of significant leaks per day (0.4 and 0.5, respectively). However, the number of daily micturitions was slightly lower for the electronic than for the paper diary (7.3 vs 8.5, respectively). The frequency of urgency recorded in the electronic diary was higher than that recorded in the paper diary (5.8 vs 4.7). As 94% of patients found the electronic diary easy to use, and the electronic diary reflects real‐time data entries, the electronic diary data may provide a more accurate reflection of patient symptoms.

CONCLUSION

We confirmed that the electronic diary is a novel method of collecting clinically relevant symptom data from patients with an overactive bladder. In addition, the ease‐of‐use ratings support the use of the electronic diary as a superior alternative to paper diaries, providing real‐time data which can be rapidly analysed, and thus allowing a speedy review of data during ongoing clinical studies.
Desmopressin in elderly patients with nocturia: short‐term safety and effects on urine output, sleep and voiding patterns
Authors: Rembratt A. , Norgaard J.P. , Andersson K‐E.
Published: December 2004

OBJECTIVE

To investigate the short‐term safety of desmopressin in elderly patients with nocturia, with special focus on the risk of hyponatraemia, and to assess the short‐term effects on urine output, sleep and voiding patterns.

PATIENTS AND METHODS

Patients (72) were recruited from a study using frequency‐volume charts, which in turn was preceded by a questionnaire study. Each patient took one 0.2 mg desmopressin tablet at bedtime for three consecutive nights and kept a frequency‐volume chart. Serum sodium was assessed in the morning after the first and the third dose. Patients with a mean serum sodium level during treatment deviating more than five units from baseline were considered sensitive to change in serum sodium. Potential predictors for sodium sensitivity and response were investigated with logistic and multiple regression.

RESULTS

All 72 enrolled patients completed the trial; no serious adverse events occurred and no adverse events of severe intensity were recorded. Six patients were sensitive to change in serum sodium. The risk (odds ratio, 95% confidence interval) increased with increasing age (1.3, 1.1–1.6), concomitant cardiac disease (10.0, 0.9–105.8) and increasing baseline 24‐h urine output (1.2, 1.0–1.5). Patients sensitive to change in serum sodium were pharmacological responders and desmopressin had a greater effect on their 24‐h diuresis, indicating that the drug effect was not limited to the night only.

CONCLUSION

Desmopressin was well tolerated in elderly patients with nocturia, but the results suggest that serum sodium should be measured before and after a few days of treatment.
Infertility despite surgery for cryptorchidism in childhood can be classified by patients with normal or elevated follicle‐stimulating hormone and identified at orchidopexy
Authors: Cortes D. , Thorup J. , Lindenberg S. , Visfeldt J.
Published: December 2004

OBJECTIVE

To analyse infertility despite orchidopexy in childhood.

PATIENTS AND METHODS

The study comprised patients with cryptorchidism (70 bilateral and 65 unilateral) who had a simultaneous biopsy taken at orchidopexy in childhood, and in adulthood had analyses of semen and FSH. In adulthood 42 formerly bilateral cryptorchid boys had repeat testicular biopsies taken. Infertility was suspected in men with < 5 million sperm/mL in the best sample of semen and concomitant poor sperm motility, and who were classified by follicle‐stimulating hormone (FSH) values. At orchidopexy the number of spermatogonia/tubule and the germ cell differentiation were measured. In adulthood the percentage of tubules with complete spermatogenesis, spermatogenic arrest and Sertoli‐cell only status was assessed.

RESULTS

Infertility was suspected in 38 of 70 (54%) of formerly bilateral and six of 65 (9%) formerly unilateral cryptorchid patients. High FSH values were expected in these suspected infertile patients, but 15 of 38 (59%) formerly bilateral and five of six formerly unilateral cryptorchid patients had normal FSH values. These patients were identified in childhood at orchidopexy; those with bilateral cryptorchidism generally presented with germ cells, but the mean number of spermatogonia per tubule was < 30% of the lowest normal value, and the germ cells were seldom normally differentiated, whereas those with unilateral cryptorchidism generally lacked germ cells in the biopsies. No patients had a decreased FSH value.

CONCLUSION

Despite surgery for cryptorchidism, infertility was probable in a third (44 of 135) of the patients. We expected high FSH values in these patients, but in 45% (20/44) the FSH values were normal. These patients may have relative FSH deficiency. At orchidopexy these patients were identified to be bilaterally cryptorchid with few germ cells and those unilaterally cryptorchid had none in the biopsy. After orchidopexy in childhood, additional hormonal treatment, e.g. recombinant FSH or buserelin, may be indicated in these patients.
Detection of bladder dysplasia using 5‐aminolaevulinic acid‐induced porphyrin fluorescence
Authors: Landry J.L. , Gelet A. , Bouvier R. , Dubernard J.M. , Martin X. , Colombel M.
Published: December 2004

OBJECTIVE

To report results of a clinical investigation on the detection of bladder dysplasia and in situ carcinoma by using fluorescence induced by 5‐aminolaevulinic acid (ALA).

PATIENTS AND METHODS

The study included 50 patients with a primary bladder lesion, who had a bladder instillation of 50 mL of 3% ALA solution ≥ 1 h before transurethral resection of the tumour. Random biopsies were taken using white‐light cystoscopy, then using blue light to induce fluorescence; positive zones were noted and biopsied. The primary lesion was then resected. The frequency of dysplasia detected by ALA‐induced fluorescence was evaluated, as was the risk of recurrence with a follow‐up of ≥ 2 years.

RESULTS

In all patients the tumours were positive; in 21 fluorescence distant from the tumour was detected. The pathological report of the biopsies showed 11 cases of dysplasia, six of carcinoma in situ and four of inflammatory lesions. In 29 patients there was no fluorescence and quadrant biopsies were normal in all but three with moderate dysplasia. Within the minimum follow‐up patients with bladder dysplasia detected by ALA‐induced fluorescence had a higher risk of recurrence.

CONCLUSION

ALA‐induced fluorescence of the bladder significantly enhanced the detection of dysplasia and in situ carcinoma. However, this technique requires further investigation using well‐characterized instrumentation and study protocols to determine any effect on treatment choice.
Intermediate effects of the ileocaecal urinary reservoir (Charleston pouch 1) on serum vitamin B12 concentrations: can vitamin B12 deficiency be prevented?
Authors: Yakout H. , Bissada N.K.
Published: December 2004

OBJECTIVE

To assess the long‐term effects of a form of ileocolic urinary reservoir (Charleston Pouch 1) on vitamin B12 serum levels, as vitamin B12 deficiency may be an important long‐term risk after urinary diversion by this method.

PATIENTS AND METHODS

The study included 60 patients (mean age 52 years, range 27–77; 33 men and 27 women) who had a follow‐up of ≥ 36 months (36–132 months) after the construction of an ileocaecal urinary reservoir. Vitamin B12 serum levels were determined at the time of diversion and again when the patients were evaluated every 6 months.

RESULTS

Fifty‐eight patients had a normal serum vitamin B12 concentration before surgery (two patients were excluded from the study because they had low levels); the mean level was 464 pg/mL (normal range 247–1000). At 6 and 12 months, the mean vitamin B12 levels were 367.5 and 468.5 pg/mL; at 1.5, 2, 3, 4, 5, 6, 7, 8, 10 and 11 years, the mean levels were 305, 495.5, 436.5, 379.5, 423.5, 393, 529.5, 631, 333.5 and 340 pg/mL, respectively.

CONCLUSION

Ileocaecal urinary reservoirs have no adverse effects on serum vitamin B12 levels for up to 10 years after surgery. Patients with vitamin B12 deficiency must be identified and given adequate parenteral doses for life. Because body stores of vitamin B12 may not be depleted for many years, problems with B12 may be masked for a long time. We recommend that vitamin B12 levels be obtained annually, that a modest supplement twice yearly (by injection) may be beneficial and that serum vitamin B12 must be sampled before giving vitamin B12 injections, to avoid false results.
Self‐expanding stent insertion for urethral strictures: a 10‐year follow‐up
Authors: De Vocht T.F. , Van Venrooij G.E.P.M. , Boon T.A.
Published: December 2004

OBJECTIVE

To evaluate the safety and efficacy of the Urolume??? endourethral self‐expandable metallic stent (American Medical Systems, MI, USA) in treating urethral strictures, based on a follow‐up of> 10 years.

PATIENTS AND METHODS

Between November 1989 and June 1990, the Urolume stent was inserted into 15 patients (aged 25–77 years) who had recurrent urethral strictures. The mean duration of stricture before stent insertion was 10.9 years. The patients (all men) were followed using a questionnaire and uroflowmetry, and if necessary, retrograde cysto‐urethrography and/or urethroscopy and/or X‐ray urodynamics.

RESULTS

Two failures were caused by excessive tissue proliferation in the stent, which ended in stent removal or a suprapubic catheter. Another two stents were removed because of discomfort or pain. Two patients developed stenosis in the stent after 7 and 9 years. In the final evaluation only two of the 15 patients were satisfied with their stent. The mean maximum urinary flow rate at the last follow‐up was 15 mL/s, and half the patients noted ‘stent’ incontinence. Lower urinary tract infections, urge and stress incontinence, and discomfort with ejaculation, were all symptoms perceived at the last follow‐up.

CONCLUSION

The long‐term results of the Urolume stent in this study weaken the optimistic early results. Only two of the 15 patients were satisfied with their stent.
Neonatal scrotal haematoma: mimicker of neonatal testicular torsion
Authors: Diamond D.A. , Borer J.G. , Peters C.A. , Cilento B.G. , Sorcini A. , Kaefer M. , Paltiel H.J.
Published: December 2004

OBJECTIVE

To describe the clinical features of neonatal scrotal haematoma and distinguish them from those of neonatal testicular torsion.

PATIENTS AND METHODS

Five neonates presenting with an acute scrotum and initial diagnosis of neonatal testicular torsion were found to have neonatal scrotal haematoma. In one case the diagnosis was surgical and in four subsequent cases the diagnosis was by colour Doppler ultrasonography, and surgery was avoided. Four of the five children had risk factors associated with neonatal scrotal haematoma, including bleeding diathesis, birth trauma and high birth weight.

CONCLUSIONS

The importance of including haematoma in the differential diagnosis of the acute neonatal scrotum is emphasized, as is the value of contemporary Doppler ultrasonography in making this diagnosis.
Nitric oxide synthase gene transfer for erectile dysfunction in a rat model
Authors: Chancellor M.B. , Tirney S. , Mattes C.E. , Tzeng E. , Birder L.A. , Kanai A.J. , De Groat W.C. , Huard J. , Yoshimura N.
Published: December 2004

OBJECTIVE

To determine whether over‐expression of nitric oxide synthase (NOS) in the corpus cavernosum of the penis improves erectile function, as NO is an important transmitter for genitourinary tract function, mediating smooth muscle relaxation and being essential for penile erection.

MATERIALS AND METHODS

The inducible form of the enzyme NOS (iNOS) was introduced into the corpus cavernosum of adult Sprague‐Dawley rats (250–300 g) by injecting a solution of plasmid, adenovirus or adenovirus‐transduced myoblast cells (adeno‐myoblasts). Plasmid, adenovirus and adeno‐myoblasts encoding the expression of the β‐galactosidase reporter gene were also injected into rats.

RESULTS

Throughout the corpora cavernosum there was expression of β‐galactosidase after injecting each of the three solutions. Maximum staining was greatest for adeno‐myoblast, then adenovirus and then plasmid. The mean (sd) basal intracavernosal pressure (ICP) of iNOS‐treated animals (adenovirus and adeno‐myoblast) increased to 55 (23) cmH2O, compared with naive animals with a basal ICP of 5 (6) cmH2O (P = 0.001). Stimulating the cavernosal nerve (15 Hz, 1.5 ms, 10–40 V, 1 min) resulted in a doubling of the ICP (adenovirus and adeno‐myoblast) from the basal level of the iNOS‐treated animals. Direct in situ measurement of NO showed the release of 1–1.3 µmol/L in the adeno‐myoblast penis.

CONCLUSION

Myoblast‐mediated gene therapy was more successful for delivering iNOS into the corpus cavernosum than direct adenovirus injection or plasmid transfection. Surprisingly, implanting muscle cells into the penis is not only feasible but also beneficial. Gene therapy for NOS may open new avenues of treatment for erectile dysfunction. Control of NOS expression would be necessary to prevent priapism.
The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles
Authors: Bolduc S. , Upadhyay J. , Restrepo R. , Sherman C. , Farhat W. , Bägli D.J. , McLorie G.A. , Khoury A.E. , El Ghoneimi A.
Published: December 2004

OBJECTIVE

To compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy.

PATIENTS AND METHODS

Between 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty‐five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal (≤ 25%). Radiological features and the histology of UPN were then analysed, and correlated using Fisher's exact test and multivariate analysis.

RESULTS

Severe histological lesions were reported in 38 specimens (69%) and minimal lesions in 17 UPN specimens (31%). Severe parenchymal thinning was associated with a severe pathological lesion (P < 0.02). There was no correlation with the echogenicity or degree of hydronephrosis. Dysplasia, found in 64% of specimens, did not correlate with increased echogenicity. Minimally functioning upper poles on nuclear renal scan (≤ 4% overall function) were significantly associated with severe histological lesions (P = 0.01). There was no correlation between diagnostic imaging features and the mode of presentation or type of ureterocele.

CONCLUSIONS

Multivariate analysis, severe parenchymal thinning on renal US and minimal function on nuclear renal scan can be used to predict the severity of histological lesions of the upper pole. These results may be helpful in the making therapeutic decisions for patients with ureteroceles in duplex systems.
Analysis of the long‐term outcome of surgically corrected vesico‐ureteric reflux
Authors: Mor Y. , Leibovitch I. , Zalts R. , Lotan D. , Jonas P. , Ramon J.
Published: December 2004

Authors from Tel‐Aviv reviewed a group of patients who had VUR corrected in childhood, assessing their long‐term outcome. Even when patients were successfully treated during childhood they were still prone to recurrent UTI, renal scarring, hypertension and complications during pregnancy. They suggested that a protocol for long‐term follow‐up was required.

PUJ obstruction is evaluated in two studies. The first of these, from Athens, presents the characteristic clinical and imaging findings in patients with obstruction by crossing renal vessels. In the second, the authors from Toronto describe their experience with the technique of dismembered laparoscopic pyeloplasty via a retroperitoneal approach. They gave a very balanced view about their early experience with this procedure, which will be helpful to the reader. They end by suggesting that modifications in the method used for the anastomosis were required.

OBJECTIVE

To review patients who had vesico‐ureteric reflux corrected surgically by ureteric reimplantation during childhood, and thus assess their long‐term outcome.

PATIENTS AND METHODS

Between 1970 and 1979, 322 children underwent ureteric reimplantation; 100 (79 women and 21 men) were re‐assessed and the long‐term results evaluated using a questionnaire, a review of the patients’ current medical records and an appointment in the outpatient clinic. The evaluation focused on the frequency of late urinary tract infections (UTIs), current renal function tests, related complications during pregnancy and the incidence of hypertension at least 20 years after surgery.

RESULTS

Of the study group, 51% (66% of men and 47% of women) had no long‐term urological complications. The incidence of UTIs was 43% in women and 24% in men, and of pyelonephritis 27% and 9.5%, respectively. Hypertension was detected in 6% of the patients during assessment. There were new renal scars, despite surgery, in 20% of the patients. Forty‐seven women had been pregnant, 28% reporting UTIs during pregnancy. In 7% of 94 pregnancies the women also had pre‐eclampsia and two women had transient gestational ureteric obstruction which required drainage. Renal functional tests were worse in one man and one woman who developed end‐stage renal disease and had a renal transplant.

CONCLUSIONS

This series shows that even patients who were treated successfully by ureteric reimplantation during childhood are prone to recurrent UTIs, progressive renal scarring, hypertension and complications during pregnancy. There is a need to establish a protocol for the long‐term follow‐up of such patients.
Laparoscopic dismembered pyeloplasty by a retroperitoneal approach in children
Authors: El‐Ghoneimi A. , Farhat W. , Bolduc S. , Bagli D. , McLorie G. , Aigrain Y. , Khoury A.
Published: December 2004

OBJECTIVES

To report our experience with dismembered laparoscopic pyeloplasty by a retroperitoneal approach in children with pelvi‐ureteric junction (PUJ) obstruction.

PATIENTS AND METHODS

Between 1999 and 2002, retroperitoneal laparoscopic dismembered pyeloplasty was attempted in 21 children (one bilateral; mean age 8 years, range 1.7–17). In a flank position with four ports (one of 5 or 10 mm and three of 3 mm), the PUJ was resected and the anastomosis made using 6/0 absorbable sutures. Any redundant renal pelvis was reduced when needed. A JJ stent was inserted in all patients.

RESULTS

The procedure could not be completed by laparoscopy in four patients, the main reason being difficulty in completing the anastomosis; in the other 18 patients the procedure was successful. An aberrant crossing vessel was found in nine patients and dismembered pyeloplasty enabled ureteric transposition in all, with no conversion. The mean (range) operative duration was 228 (170–300) min and the mean hospital stay 2.5 (2–4) days. In three patients the JJ stents were not in the bladder at the time of removal by cystoscopy, and ureteroscopy was used to retrieve them. All children returned to full activities within 7 days of surgery. The mean (range) follow‐up was 12.7 (2–36) months, with six children followed for> 2 years; all were asymptomatic, with imaging confirming improved hydronephrosis.

CONCLUSIONS

These mid‐term results confirm that retroperitoneal laparoscopic dismembered pyeloplasty is a safe and feasible approach in children. Although the technique is very demanding it has the advantage of duplicating the principles of the open approach. The long operative duration and high conversion rate might be reduced with experience. Before expanding this approach to younger children, refinements in the anastomotic technique are needed.
Diagnostic accuracy of flow rate testing in urology
Authors: Patel H.R.H. , Garcia‐Montes F. , Christopher N. , Reeves B.C. , Emberton M.
Published: December 2004

OBJECTIVE

To highlight the importance of methodological standards in diagnostic testing in urology, by reviewing the extent of compliance with these standards in reports of published evaluations.

METHODS

Sixteen papers evaluating the diagnostic accuracy of urinary flow‐rate testing were independently assessed by two reviewers for compliance with the following methodological standards: specification of study population, analysis of pertinent subgroups, avoidance of evaluation (verification) bias, avoidance of review bias, reporting of precision of estimates of test accuracy, indeterminate test results, and test reproducibility. Compliance with each standard was expressed as a percentage with a 95% confidence interval.

RESULTS

Compliance ranged from just 12.5 (1.5–38)% for reporting of test reproducibility to 87.5 (62–98)% for specification of the study population. Only nine of the 16 evaluations complied with four or more of the methodological standards; one paper did not comply with any.

CONCLUSIONS

This evaluation of urological flow‐rate testing show poor compliance with accepted methodological standards. The study design, reporting and evaluation of new diagnostic tests can be improved by adhering to these standards. Policy‐makers, purchasers and providers would be less likely to adopt new diagnostic tests inappropriately if they were to appraise published evaluations against the standards. A reduction in the inappropriate use of tests would in turn lead to more cost‐effective use of healthcare resources.
The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women
Authors: Dallosso H.M. , McGrother C.W. , Matthews R.J. , Donaldson M.M.K. ,   the Leicestershire MRC Incontinence Study Group
Published: December 2004

OBJECTIVES

To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause.

SUBJECTS AND METHODS

A random sample of women aged ≥ 40 years living at home took part in a prospective cohort study. Baseline data on urinary symptoms, diet and lifestyle were collected from 7046 women using a postal survey and food‐frequency questionnaire. Follow‐up data on urinary symptoms were collected from 6424 of the women in a postal survey 1 year later. Logistic regression was used to investigate the association of food and drink consumption and other lifestyle factors with the incidence of overactive bladder and stress incontinence.

RESULTS

In the multivariate model for the onset of an overactive bladder, there were significantly increased risks associated with obesity, smoking and consumption of carbonated drinks, and reduced risks with higher consumption of vegetables, bread and chicken. Obesity and carbonated drinks were also significant risk factors for the onset of stress incontinence, while consumption of bread was associated with a reduced risk.

CONCLUSIONS

Causal associations with obesity, smoking and carbonated drinks are confirmed for bladder disorders associated with incontinence, and additional associations with diet are suggested. Behavioural modification of lifestyle may be important for preventing and treating these disorders.
Association between leptin receptor gene polymorphisms and early‐onset prostate cancer
Authors: Kote‐Jarai Z. , Singh R. , Durocher F. , Easton D. , Edwards S.M. , Ardern‐Jones A. , Dearnaley D.P. , Houlston R. , Kirby R. , Eeles R.
Published: December 2004

Significant tissue loss is a consistent feature of ureteric obstruction with, most studies showing increased programmed cell death or apoptosis of kidney epithelial cells. The study by Chuang et al. showed that there is also muscular damage during obstruction, specifically of the ureteric myocytes. More importantly they show for the first time that this induction of cell death is associated with the increased expression of cytochrome c and the caspases, key proteins that drive the induction of apoptosis. Admittedly they do not show whether cytochrome c is released from the mitochondria or that the caspases are truly activated, important events in the cell death pathway, but an increase in their expression does indicate their role in this process. Understanding the pathways leading to tissue loss during ureteric obstruction has important implications in the development of novel treatments for this condition.

OBJECTIVE

To report a case‐control study examining the relationship between polymorphisms in the leptin receptor (OBR) gene and the development of young‐onset prostate cancer, because epidemiological studies report that prostate cancer risk is associated with animal fat intake, and thus we investigated if this association occurs via this genetic mechanism.

PATIENTS, SUBJECTS AND METHODS

The Lys109Arg (OBR1) and Gln223Arg (OBR2) polymorphisms in the coding region of OBR were studied in blood DNA from 271 patients with prostate cancer aged < 56 years at diagnosis and 277 geographically matched control subjects. Cases were collected through the Cancer Research UK/British Prostate Group Familial Prostate Cancer Study. Blood DNA was genotyped using the polymerase chain reaction and a restriction enzyme digest.

RESULTS

There was no statistically significant association between the OBR genotype and prostate cancer risk; men homozygous for 109Arg genotype had a slightly increased risk for prostate cancer, with a relative risk (95% confidence interval) of 1.36 (0.65–2.85), and those homozygous for the 223Arg allele had some reduction in prostate cancer risk, at 0.82 (0.58–1.26), but neither was statistically significant.

CONCLUSION

This case‐control study showed no significant association between leptin receptor gene polymorphisms and the risk of young‐onset prostate cancer, suggesting that genetic variations in OBR are unlikely to have a major role in the development of early‐onset prostate cancer in the UK.
Stage I seminoma of the testis: a bi‐institutional retrospective analysis of patients treated with radiation therapy only
Authors: Santoni R. , Barbera F. , Bertoni F. , De Stefani A. , Livi L. , Paiar F. , Scoccianti S. , Magrini S.M.
Published: December 2004

OBJECTIVE

To analyse relapse patterns, toxicity and second malignancy in patients with stage I pure germ cell testicular tumours, treated in 1970–1999.

PATIENTS AND METHODS

In all, 487 patients received irradiation after surgery to the infra‐ (407, 83.5%) or infra‐ and supra‐diaphragmatic volumes (80, 16.5%). Treatment‐related toxicity was classified according to previous criteria and fertility investigated in 246 men. Second malignancies were identified by retrospective analysis of clinical records or telephone interviews in men who no longer needed a long‐term follow‐up.

RESULTS

The 10‐year overall survival was 97% (98% and 96%, respectively, for the aortic nodes only, or aortic and iliac nodes, i.e. the ‘dog leg’ field) and disease‐free survival was 94%. Twenty‐one patients relapsed (five with a true ‘in‐field’ recurrence, nine progressed to the mediastinum, and seven had disseminated disease). Acute toxicity was mainly gastrointestinal, with 7.6% classified as grade II. In all, 73 men achieved paternity after irradiation; nine did not but had normal sperm. Second malignancies were diagnosed in 16 (3.3%) men.

CONCLUSION

Para‐aortic irradiation may be used safely in patients with stage I seminoma and undisturbed testicular drainage, with equivalent results to the ‘dog‐leg’ group; these unrandomized data confirm the lower toxicity and equivalent survival rates of this treatment.
Colour Doppler ultrasonography for detecting perineural invasion (PNI) and the value of PNI in predicting final pathological stage: a prospective study of men with clinically localized prostate cancer
Authors: Kravchick S. , Cytron S. , Peled R. , Ben‐Dor D. , Kravchenko Y.
Published: December 2004

OBJECTIVES

To assess the ability of colour Doppler transrectal ultrasonography (CD‐TRUS) to improve the accuracy of detecting perineural invasion (PNI, reported to be an independent predictor of extraprostatic extension) and in predicting the pathological stage of the cancer, comparing it with the results of grey‐scale TRUS‐guided biopsies.

PATIENTS AND METHODS

This prospective study included 47 men with clinically localized disease; all underwent 10‐core TRUS‐guided biopsy and two bilateral CD‐TRUS‐guided biopsies, targeted on the area adjacent to the neurovascular bundle. The rates and accuracy of PNI detection on 10‐core and CD‐TRUS‐targeted biopsies were compared with the pathological outcome. Various patient, clinical and pathological factors were compared, and multivariate analysis used to assess the value of the technique in predicting PNI and pathological outcome.

RESULTS

CD‐TRUS‐guided biopsies predicted the presence of PNI in the radical prostatectomy specimens with a sensitivity of 89%, and specificity and positive predictive values of 100%. Seven of 24 (29%) patients with PNI on the needle biopsies had pT3 disease. Conversely, the absence of PNI on guided biopsy accurately predicted pathologically localized disease in 96% (negative predictive value) of patients. However, the results of multivariate analysis showed that serum prostate‐specific antigen was the only strong predictor of pT3.

CONCLUSION

CD‐TRUS is a useful tool for detecting PNI and predicting pathological localized cancer; it can be used in candidates for nerve‐sparing radical prostatectomy.
Effects of intravenous and infravesical administration of suramin, terazosin and BMY 7378 on bladder instability in conscious rats with bladder outlet obstruction
Authors: Velasco C. , Guarneri L. , Leonardi A. , Testa R.
Published: December 2004

OBJECTIVE

To evaluate the effect of the nonselective purinergic antagonist suramin and the α1‐adrenergic antagonists, terazosin and BMY 7378, given intravenously or infused directly into the bladder during cystometry in conscious rats with bladder outlet obstruction induced by urethral ligation.

MATERIALS AND METHODS

Cystometry was performed in conscious female rats recording bladder volume capacity (BVC), evaluated as the amount of saline infused between two voiding cycles, and micturition volume (MV). Changes in frequency and amplitude of spontaneous non‐voiding bladder contractions (NVC) were also recorded. The effects of the intravenous administration of suramin (100 mg/kg), BMY 7378 (1 mg/kg), and terazosin (0.3 mg/kg) on NVC, BVC and MV were evaluated in obstructed rats with bladder infusion of saline. The effects of infravesical infusion of suramin (3–10 µmol/L), terazosin (1 µmol/L) and BMY 7378 (10 µmol/L) were also evaluated and compared with values observed in control rats during saline infusion into the bladder.

RESULTS

Intravenous injection with suramin had no effects on NVC, BVC and MV, but suramin infused into the bladder induced a consistent reduction in the amplitude of NVC (significantly different from matched control animals) with a tendency to reduce their frequency. BVC and MV were slightly but significantly decreased by infravesical infusion of suramin. In contrast, BMY 7378 and terazosin, given intravenously, were extremely potent at inhibiting the frequency and amplitude of the NVC, but

were inactive on NVC when infused into bladder.

CONCLUSIONS

These findings confirm a role for α1‐adrenergic receptors in bladder instability caused by bladder outlet obstruction. In addition, a purinergic neurotransmitter, presumably ATP, is shown to be involved.
Release of cytochrome c and activation of caspases related to myocyte apoptosis in obstructed ureters in a rat model of obstructive uropathy
Authors: Chuang Y.‐H. , Chuang W.‐L. , Huang S.‐P. , Huang C.‐H.
Published: December 2004

OBJECTIVE

To investigate the roles of cytochrome c and caspases in the pathogenesis of muscular damage in obstructed ureters in a rat model.

MATERIALS AND METHODS

Apoptotic cells were detected using in situ end‐labelling of DNA fragments. The expression of cytochrome c, and caspases‐3, ‐8 and ‐9 was examined in 54 rats, using immunohistochemistry.

RESULTS

The severity of ureteric smooth muscle damage increased during obstruction. Apoptotic myocytes, and the expression of cytochrome c and the three caspases in the smooth muscle layer were apparent 14 days after ligation, reaching a peak at 21 days. The numbers of apoptotic cells in the smooth muscle layer correlated significantly with expression of cytochrome c and the three caspases (r = 0.8673, 0.8701, 0.5723 and 0.7910, respectively; all P < 0.01). The expression of cytochrome c in the smooth muscle layer correlated significantly with the expression of the three caspases (r = 0.8234, 0.7558 and 0.7825, respectively; all P < 0.001). The expression of caspase‐3 and ‐8, and ‐3 and ‐9 also correlated significantly (r = 0.6721 and 0.8501, respectively; both P < 0.002).

CONCLUSIONS

Cytochrome c and caspases are involved in ureteric myocyte apoptosis; the release of cytochrome c might be important in ureteric damage during obstructive uropathy.
Prophylaxis of calcium oxalate stones by Herniaria hirsuta on experimentally induced nephrolithiasis in rats
Authors: Atmani F. , Slimani Y. , Mimouni M. , Hacht B.
Published: December 2004

OBJECTIVE

To evaluate the prophylactic potential of a herbal decoction from Herniaria hirsuta, a medicinal plant widely used in Morocco to treat kidney stones, by assessing the effect of oral administration in experimentally induced calcium oxalate (CaOx) nephrolithiasis in rats.

MATERIAL AND METHODS

Two groups of six rats each were rendered nephrolithic by treating with ethylene glycol 0.75% and ammonium chloride 1% for 3 days, and then ethylene glycol only for 3 weeks. Maintained on ethylene glycol, one group of rats was also given 1 mL/day of the plant decoction, while the others received 1 mL of water instead for 2 weeks. Urine samples (24 h) were collected individually at 1, 3, 7, and 14 days for physicochemical analysis. On completing the treatment the kidneys were collected and analysed by light microscopy.

RESULTS

The water intake and diuresis decreased in the treated rats; there was no significant difference in urinary pH between the groups. Urinary chemistry was apparently unaffected by the plant extract, except for the magnesium content, which was higher in treated rats. Crystalluria was characterized by the excretion of large CaOx monohydrate and dihydrate crystals in untreated, but smaller crystals in treated rats. The histology showed large deposits of CaOx crystals in all parts of the kidney in untreated rats but with almost no deposits in those of treated rats.

CONCLUSION

H. hirsuta has an impressive prophylactic effect on CaOx stones in nephrolithic rats; the effect did not seem to be mediated by biochemical or diuretic changes.
The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum
Authors: Schiff Melissa A. , Reed Susan D. , Daling Janet R.
Published: December 2004

Objective  To evaluate the sex ratio among pregnancies complicated by first trimester hyperemesis gravidarum and extend previous findings to include a measure of severity.

Design  Population‐based case control study.

Setting  All non‐federal hospitals in Washington State.

Population  Two thousand and one hundred and ten pregnant women hospitalised for hyperemesis gravidarum and 9783 pregnant women without hyperemesis gravidarum.

Methods  The infant sex ratio for pregnant women admitted to the hospital for hyperemesis gravidarum was evaluated using the Washington State hospital discharge database linked to the birth certificate database for years 1987–1996. Cases were pregnant women hospitalised for hyperemesis gravidarum (International Classification for Diseases—9th edition [ICD‐9] diagnosis code 643) in the first trimester. Controls were women who experienced a singleton live birth and were not hospitalised for hyperemesis in Washington State during the same time period. Regression analysis with general estimating equations was used to calculate an odds ratio (OR) and 95% confidence interval (CI) to assess the association of hyperemesis gravidarum with infant sex ratio.

Main outcome measure  Infant sex ratio.

Results  Pregnant women hospitalised for hyperemesis gravidarum in the first trimester had a 50% increased odds of having a female infant compared with controls (OR 1.5, 95% CI 1.4, 1.7). Women hospitalised for three or more days had the greatest odds of having a female infant compared with control women (OR 1.8, 95% CI 1.5, 2.0).

Conclusion  Hyperemesis gravidarum is associated with an increase in female live births and may be a marker for high oestrogen levels in utero.
Birthweight by gestational age in preterm babies according to a Gaussian mixture model
Authors: Tentoni Stefania , Astolfi Paola , De Pasquale Antonio , Zonta Laura A.
Published: December 2004

Objective To provide a statistically sound criterion for identifying implausibly large birthweights for gestational age.

Design Review of ISTAT 1990–1994 national newborn records.

Setting Italy

Population Forty‐two thousand and twenty‐nine single first and second liveborn preterm babies.

Methods Two‐component Gaussian mixture models are used to describe the birthweight distributions stratified by gestational age. Implausibly large babies are identified through model‐based probabilistic clustering.

Main outcome measures Gestational age misclassification and weight‐for‐gestational age centile curves

Results Gestational age appears under‐estimated by about six weeks in 12.3% of the cases. Large babies are equally present in males and females, but are more frequent in second‐borns than in first‐borns, even when parity‐specific models are fitted.

Conclusions The approach allows for a quantification of the gestational age under‐estimate error and for data correction through model‐based clustering. Correct birthweight distributions and growth curves are also provided.
A randomised controlled trial of cytological surveillance versus patient choice between surveillance and colposcopy in managing mildly abnormal cervical smears
Authors: Kitchener H.C. , Burns S. , Nelson L. , Myers A.J. , Fletcher I. , Desai M. , Dunn G. , Maguire P.
Published: December 2004

Objective  To determine whether choice of colposcopy or six month cytological surveillance would be beneficial to women with mildly abnormal smears when compared with the national policy of six months surveillance in terms of psychological morbidity.

Design  A randomised trial based on the Zelen design.

Setting  A hospital‐based research clinic.

Population  Four hundred and seventy‐six women who had had a recurrent borderline or mildly dyskaryotic smear on routine cervical screening in primary care.

Methods  Women were randomised either to six months cytological surveillance or to make a choice between that or colposcopy and were followed up for 1 year.

Main outcome measures  The primary outcome measure was caseness (score ≥4) on the General Health Questionnaire at 12 months follow up. Other measures were the Spielberger State and Trait scores, default rates and cytology/colposcopy outcomes.

Results  There was no significant difference between the arms for General Health Questionnaire (GHQ) scores and Spielberger State and Trait at 12 months. There was a significant reduction in psychometric morbidity between baseline and 12 months in both arms. Overall rates of default from the protocol were the same in both arms, but default that led to uncertain ascertainment of cervical pathology was greater in the no‐choice arm.

Conclusions  This trial indicates that having choice did not impact favourably or harmfully on anxiety or feelings of wellbeing. If a patient is anxious, allowing the patient to choose immediate colposcopy may be preferable because it will improve ascertainment of underlying disease in a group who are more likely to default.