bluuebunny/crossref_metadata_2025 huggingface dataset:
Transferrin Receptor Expression in Primary Superficial Human Bladder Tumours Identifies Patients who Develop Recurrences
Authors: SMITH N. W. , STRUTTON G. M. , WALSH M. D. , WRIGHT G. R. , SEYMOUR G. J. , LAVIN M. F. , GARDINER R. A.
Published: November 2008

Summary— A group of 65 patients with superficial bladder carcinoma was followed for 2 years and tumour recurrence rate was correlated both with transferrin receptor status of the initial primary tumour and with the results of voided urine cytology. Nine of 24 patients with transferrin receptor negative tumours had recurrences compared with 30 of 41 patients with transferrin receptor positive tumours. This difference was highly significant.

Urine cytology at presentation was also predictive of further tumour formation: of 30 patients who were transferrin receptor positive and had positive urine cytology, 25 developed recurrences.
Silver Alloy Coated Catheters Reduce Catheter‐associated Bacteriuria
Authors: LIEDBERG H. , LUNDEBERG T.
Published: November 2008

Summary— The tendency of indwelling catheters to cause urinary tract infection was evaluated in a randomised clinical study of 223 patients. A Foley catheter coated with silver alloy on both inner and outer surfaces was used in 60 patients; 60 others received a Teflonised latex Foley's catheter and the remaining 103 patients were excluded because of antibiotic treatment, diabetes, etc.

There was a statistically significant difference in the incidence of catheter‐associated bacteriuria (> 105 organisms/ml) in the 2 groups after 6 days' catheterisation: 6 patients with the silver coated catheter developed bacteriuria compared with 22 who had the Teflonised latex catheter. This suggests that the silver impregnated urethral catheters reduce the incidence of catheter‐associated urinary tract infection.
The Natural Course of Low Grade, Non‐metastatic Prostatic Carcinoma
Authors: ADOLFSSON J. , RÖNSTRÖM L. , CARSTENSEN J. , LÖWHAGEN T. , HEDLUND P. O.
Published: November 2008

Summary—A surveillance study was carried out on 167 patients with low grade, low stage prostatic carcinoma without known metastases; of these, 146 were evaluated, the mean follow‐up time being 50 months. Local tumour progression occurred in 77 patients (53%), corresponding to a 5‐year cumulative probability of progression of 67%. Ten patients developed metastases, 5 died of prostatic carcinoma and 24 died of other causes. Cox's regression analysis showed that the initial cytological grade of the tumour was of prognostic importance, but initial local tumour stage, prostatic acid phosphatase activity and age had no statistically significant prognostic value. Although the number of patients developing metastases and dying of prostatic carcinoma was low, most tumours seemed to progress locally.
Risk of Recurrent Stricture following Internal Urethrotomy: Prospective Ultrasound Study of Distal Male Urethra
Authors: MERKLE W. , WAGNER W.
Published: November 2008

Summary— A group of 60 patients was examined prior to surgery in a prospective ultrasound study of the distal male urethra to predict the individual rate of stricture recurrence after internal urethrotomy. The patients were divided into 2 groups according to the ultrasound findings. One group had no evidence of scarred tissue and no recurrence was predicted. The other group did have periurethral scarring and stricture recurrence within approximately 6 months was predicted. We present the ultrasound findings and discuss the accuracy of the predictions. Correct prognoses were made in 92.9% of cases.
Computed Tomography and Magnetic Resonance Imaging before Salvage Cystectomy
Authors: DIXON A. K. , DEANE A. M. , DOYLE P. T.
Published: November 2008

Summary— Nine patients who developed recurrence of bladder carcinoma following radical radiotherapy were assessed for salvage cystectomy by computed tomography (CT) and magnetic resonance imaging (MRI) to predict extravesical spread. Both tests correctly identified a patient with such advanced local disease that surgery was deemed inappropriate at examination under anaesthesia and both tests indicated that surgery might be difficult in a further patient with inoperable disease. Both tests demonstrated abnormalities in the perivesical and pelvic fat planes in all patients but they had difficulty in distinguishing between malignant infiltration and the effects of radiotherapy. Nevertheless, each test is useful in excluding gross pelvic disease and predicting involvement of adjacent organs. The advantages of the multiplanar images provided by MRI must be balanced against the high cost. CT readily demonstrates the upper abdomen, the kidneys and para‐aortic nodes as well as the pelvis and is more widely available.
Identifiable Factors in Post‐prostatectomy Haemorrhage: the Role of Aspirin
Authors: WATSON C. J. E. , DEANE A. M. , DOYLE P. T. , BULLOCK K. N.
Published: November 2008

Summary— Post‐operative haemorrhagic complications following the ingestion of aspirin have been reported after several types of surgery, most notably coronary artery bypass surgery. In this study, aspirin ingestion also appeared to be a significant aetiological factor in post‐prostatectomy haemorrhage. This is explained in terms of its inhibitory effect on platelet aggregation. A history of aspirin ingestion should be carefully sought and its haemorrhagic implications considered prior to prostatectomy.
A New Device for Self‐catheterisation in Wheelchair‐bound Women
Authors: HUNT GILLIAN M. , WHITAKER R. H.
Published: November 2008

Summary The Deavin‐Hunt device is designed to help paraplegic and incontinent women to catheterise themselves whilst in a wheelchair. Such patients with neuropathic bladder might otherwise be unable to use intermittent catheterisation, an effective method of controlling incontinence and preserving the kidneys.
Protease and Plasminogen Activator Activity in Human Bladder Carcinoma
Authors: GORELIK U. , LINDNER A. , MAYER M.
Published: November 2008

Summary The ability of human bladder tissue extracts to cleave 14C‐labelled globin in the absence and in the presence of plasminogen was assayed to quantify non‐specific protease and plasminogen activator (PA) activity, respectively. In normal human bladder tissue the non‐specific protease activity was approximately 2‐fold higher than in tissue samples obtained from transitional cell carcinoma of the bladder (TCC). In contrast, PA activity was almost 4‐fold higher in TCC than in normal transition cell epithelium. Acid‐treated urine from 19 patients with TCC of the bladder exhibited significantly higher levels of plasminogen activator activity than similarly treated urine from controls. These results indicate that malignant transformation of the bladder epithelial tissue results in elevated levels of PA in the tissue and in urine. Further studies are needed to assess the potential of PA determination in the management of bladder cancer patients.
Does Microinvasion of the Capsule and/or Micrometastases in Regional Lymph Nodes Influence Disease‐free Survival after Radical Prostatectomy?
Authors: HERING F. , RIST M. , ROTH J. , MIHATSCH M. , RUTISHAUSER G.
Published: November 2008

Summary –Since 1976, 126 patients with clinically localised carcinoma of the prostate have been managed by radical retropubic prostatectomy. All patients with tumour spread beyond the capsule or metastasis in lymph nodes received radiotherapy. Tumour category pT3 was divided into invasion of the capsule or infiltration of the seminal vesicle.

The disease‐free 10‐year survival rate in patients with minimal invasion of the capsule was 72% and in patients with infiltration of the seminal vesicles it was 26%. Unilateral lymph node metastases were classified as microscopic disease or macroscopic infiltration.

The disease‐free 10‐year survival rate in patients with metastasis in 1 lymph node (micro‐ and macro‐metastasis) was 65% in contrast to 0% in patients with bilateral disease.
Nuclear Techniques for the Analysis of Urinary Calculi
Authors: SAINT A. , DYSON N.A.
Published: November 2008

Summary— Sections of urinary calculi were prepared and point‐by‐point analyses along a line‐scan were carried out using the techniques of proton‐induced X‐ray emission (PIXE) and nuclear reaction analysis (NRA). Correlations between several pairs of elements (including trace elements) were noted and it was also clear that the composition of a stone varied markedly at different stages of development.
Superficial Bladder Cancer in Patients under 40 Years of Age. Efficacy of Topical Prophylaxis
Authors: FLAMM J.
Published: November 2008

Summary— In patients under the age of 40 years with primary superficial bladder cancer the efficacy of adjuvant topical treatment was the same as in elderly patients (recurrences 23%, progression rate 8%). Patients should therefore be treated on the basis of stage and grade of the tumour regardless of their age.
The Encased Ureter: Bullet and Bodkin Pattern, a Reliable Radiographic Sign
Authors: KUNIN M. , GOODWIN W. E.
Published: November 2008

Summary— Among the causes of constricted ureter is benign or malignant encasement. The diagnosis of ureteric encasement is frequently overlooked, even by well informed clinicians and radiologists. The most common benign cause is retroperitoneal fibrosis and the most frequent malignant causes are extension from an adjacent primary tumour, true metastases to the ureter and lymphoma. Lack of recognition of the process may lead to mistaken diagnosis of an inflammatory stricture or infiltrating transitional cell tumour, with resultant inappropriate management. A sign which appears to be almost specific for encasement, the bullet and bodkin configuration, is described here. Newer imaging modalities such as computed tomography and ultrasound, while helpful, are probably less sensitive and less specific than the retrograde ureterogram because a detectable mass is not always present.
The Perineal Artificial Sphincter for Acquired Incontinence–a Cut and Dried Solution?
Authors: WARWICK D. J. , ABRAMS P.
Published: November 2008

Summary— Sixteen males with stress incontinence due to sphincter damage were investigated with videourodynamic studies after implantation of a perineal artificial urinary sphincter. Twelve patients were rendered dry; 4 remained incontinent, all of whom were shown by cystometry to have incontinence from detrusor instability. Of these, 2 also had stress incontinence proven by videourography.

Detrusor instability was present in 9 patients before implantation; the instability worsened considerably in 2 patients and new instability was shown in another 2 patients.

The limitations of the artificial urinary sphincter and the implications of detrusor instability in patients with an artificial sphincter are discussed.

The artificial urinary sphincter is an extremely successful device for the treatment of acquired stress incontinence.
Serum Levels of Sex Hormone Binding Globulin and Oestradiol in Patients with Testicular Cancer
Authors: FOSSÅ SOPHIE D. , HAUG E.
Published: November 2008

Summary— Serum testosterone (T), oestradiol (E‐2) and sex hormone binding globulin (SHBG) were measured in 84 orchiectomised testicular cancer patients before further treatment and 4 to 6 and 12 to 15 months after therapy. Patients were divided into 3 groups according to treatment: Group 1: cisplatin‐based chemotherapy (27 patients); Group 2. abdominal radiotherapy (32 patients); Group 3: no antiproliferative treatment (chemotherapy/radiotherapy) (25 patients). Between 4 and 6 months after antiproliferative treatment, particularly after chemotherapy, a reversible significant increase in E‐2 and SHBG was observed. Patients without antiproliferative treatment showed no significant changes in their comparable hormone levels; 15% of all normal T values were associated with elevated levels of SHBG and E‐2. Although the aetiology of these hormonal changes remains unknown, they may be related to the clinical symptoms of hypogonadism displayed by 10 to 30% of patients undergoing treatment for testicular cancer.
Activation of Complement Kallikrein‐kinin, Fibrinolysis and Coagulation Systems by Urinary Catheters. Effect of Time and Temperature in Biocompatibility Studies
Authors: SIEMSSEN P. A. , GARRED P. , OLSEN J. , AASEN A. O. , MOLLNES T. E.
Published: November 2008

Summary— Urethral strictures induced by the use of latex catheters and combined silicone/latex catheters following open‐heart surgery have been reported. These strictures differ from the post‐catheterisation type in affecting a greater length of urethra. Recently it was shown that complement was activated by catheters which cause inflammation, in contrast to clinically silent catheters. The present study was designed to investigate a possible association between catheter‐induced inflammation and activation of another mediator of inflammation, the contact system. We also investigated various in vitro conditions to optimise biocompatibility studies. Our data indicate that both the complement and the kallikrein‐kinin system are activated by potentially harmful silicone/latex catheters and may be involved in the pathophysiology of catheter‐induced urethral strictures. In vitro biocompatibility tests may be performed at both 20 and 37°C. Glass test tubes may be used for in vitro complement but not for kallikrein‐kinin investigations.
Management of Acute Retention of Urine: A Reappraisal
Authors: HIGGINS P. M. , FRENCH M. E. , CHADALAVADA V. S. R.
Published: November 2008

Summary— Our standard policy for the management of retention of urine due to prostatic hypertrophy is that the patient is catheterised and sent home, later to be seen and assessed in the Out‐patient Department where he is given an admission date for operation. A detailed audit of 166 patients cared for in this way is presented and the results compared with those in 25 patients who remained in hospital in the interval between catheterisation and operation and in 402 patients not previously catheterised. Although the mortality rate was significantly higher in the retention group (3.3 vs 0.25%), we feel that this is a reflection of the fitness of the patients with retention rather than a consequence of the management policy. The advantages of the “catheterise and send home” policy are discussed.
Abstracts of the Proceedings of the Urological Society of Australasia, 43rd Annual Scientific Meeting, Darwin, Australia, 1990
Authors: Maher P. O. , Millard R. J. , Golovsky D.
Published: November 2008

The 43rd Annual General Meeting of the Urological Society of Australasia was held at the Beaufort Hotel, Darwin, Australia from 27 May to 3 June 1990. The meeting was organised by Mr Peter Maher, President of the Society, and a committee from Sydney. Principal guests of the meeting were Mr R. Hall from Newcastle upon Tyne, England, Professor R. Hartung of the Technische Universität, Munich, Germany, and Professor M. Resnick from Case Western University, Cleveland, USA.

The programme featured keynote presentations from principal guests on the topics of laser therapy, stones, bladder outlet obstruction, cancer and paediatrics. The Harry Harris Oration was delivered by Professor Alan Powell, Dean of Arts, North Territory University, on the subject, “The Australian Aborigines; Past, Present, and the Future”.

The Keith Kirkland prize for the best paper presented by a trainee was awarded to Dr M. Frydenberg for his paper on Growth Factor receptors in prostatic disease.

The Alban Gee prize for the best poster went to Mr A. Low for his presentation on the Brindley Sacral Root Stimulator.

The 44th ASM of the Society will be held at the Sheraton Mirage Hotel, Gold Coast, Queensland, between 14 and 19 April 1991.
Pedicle Patch Urethroplasty
Authors: DEWAN P. A. , DINNEEN M. D. , DUFFY P. G. , WINKLE D. , RANSLEY P. G.
Published: November 2008

Summary— The pedicle patch urethroplasty provides an alternative single‐stage vascularised graft procedure for the repair of moderately severe hypospadias. Over a 7‐year period, 38 primary hypospadias repairs were performed employing this technique. The fistula rate was 18% in the 34 patients reviewed, but there were few other significant complications. The operation is recommended when the urethral plate can be preserved and the penis straightened in boys who are unsuitable for a meatal‐based flap.
Diagnosis and Treatment of Neurogenic Bladder due to Partial Sacral Agenesis
Authors: SAITO M. , KONDO A. , KATO K.
Published: November 2008

Summary— Fifteen patients with partial sacral agenesis were treated over a mean period of 68 months. Partial unilateral agenesis was present in 7 and bilateral sacral agenesis was present in 8. Three important diagnostic features are emphasised: symptoms referable to neurogenic bladder without an obvious neurogenic lesion (all 15 patients); skin or hair abnormalities in the lumbosacral region (9/15) and paraesthesia or other neurological disorders of the lower extremities (8/15). The definitive diagnosis can be made by careful inspection of a plain film of the lumbosacrum.

Detrusor contractility was absent in 13 patients but preserved in 2; 11 patients were managed by clean intermittent catheterisation, 2 voided using detrusor contractility and 2 voided by means of the Valsalva/Crede manoeuvre. In 5 patients surgery in the intradural space preserved sexual function and prevented further deterioration in function of the lower extremities but could not restore bladder function that had already deteriorated. Complete continence was achieved in 11 patients and socially acceptable continence in 4. Early diagnosis and conservative treatment with clean intermittent catheterisation are extremely important in management. Should functional deterioration of the bladder and/or sensomotor function of the lower limbs occur, neurosurgery should be performed promptly.
Cisplatin Combination Chemotherapy for Elderly Patients with Urothelial Tumours
Authors: SELLA A. , LOGOTHETIS C. J. , DEXEUS F. H. , AMATO R. , FINN L. , FITZ KAREN
Published: November 2008

Summary— The proportion of cancer patients who receive potentially curative therapy declines with increasing chronological age. Between January 1979 and January 1988, 36 patients aged from 76 to 84 years (median 78) consented to cisplatin combination chemotherapy. Eighteen patients received 1 to 7 cycles of adjuvant chemotherapy (median 5). This resulted in a drop in creatinine clearance rate from 70 ± 28.5 ml/min to 49 ± 20 ml/min. Eight patients (44%) are alive without evidence of disease, with a whole group median survival of 23 months. The dose intensity of cisplatin was found to predict recurrence. Eighteen other patients were treated for metastatic disease; 39% had an objective response after receiving 2 to 9 cycles (median 7). Only 2 patients (11%) are alive and free of disease. In this group no significant kidney damage occurred and the dose intensity of cisplatin did not predict response. Treatment resulted in a significant sepsis rate (39%) and 6 patients (17%) withdrew from treatment because of toxicity.

It was concluded that cisplatin combination chemotherapy can be administered without treatment‐related death and its efficacy is similar to that in younger patients. Age should not exclude patients from the potential benefit of such therapy. An important cause of reduced benefit from chemotherapy among elderly patients may be the reduced dosage of cisplatin.
Pelvic Lipomatosis
Authors: JONES B. J. , BUTLER M. R.
Published: November 2008

Pelvic lipomatosis is a rare disease in Caucasians. We describe a patient who presented originally with bladder outlet obstruction and later developed vesicoureteric obstruction.
The Human Prostate Gland: A Histochemical and Immunohistochemical Study of Neuropeptides, Serotonin, Dopamine β‐hydroxylase and Acetylcholinesterase in Autonomic Nerves and Ganglia
Authors: CROWE R. , CHAPPLE C. R. , BURNSTOCK G.
Published: November 2008

SummaryDifferent regions of the prostate gland, namely the prostatic capsule, peripheral prostate, and proximal and distal central prostate, were obtained from 5 patients with carcinoma of the bladder and studied histochemically and immunohistochemically to localise acetylcholinesterase (AChE)‐, dopamine β‐hydroxylase (DBH)‐, serotonin‐ and peptide‐containing nerves. Autonomic ganglia were found in all regions of the prostate studied. The greatest number of ganglia contained AChE and neuropeptide Y (NPY) followed (in decreasing order) by DBH; [Met]enkephalin (mENK) and [Leu]enkephalin (IENK); calcitonin gene‐related peptide (CGRP) and vasoactive intestinal polypeptide (VIP); and serotonin, but not somatostatin. The greatest density of nerve fibres was found in the proximal central prostate, followed by the anterior capsule and distal central prostate, with the least in the peripheral prostate. The greatest number of nerve fibres contained ACh and NPY, followed in decreasing order by VIP and DBH; IENK, serotonin and CGRP; mENK; substance P and somatostatin. The functions of the neurotransmitter substances in the human prostate remain to be elucidated.
Transbrachial Approach in Spermatic Phlebography
Authors: SILVERIO F. Dl , GENTILE V. , LA PERA G. , MINUCCI S. , MORUCCI M.
Published: November 2008

Of 131 patients undergoing phlebography, a newpercutaneous transbrachial approach was used in67. Both catheterisation and embolisation of theright and left internal spermatic veins (ISV) wereeasier than with the transfemoral approach, particularlyon the right side as a result of the craniocaudalprogression of the catheter. This newtechnique is recommended for the management notonly of right‐sided or bilateral varicoceles, but alsoleft‐sided ones.
Single‐blind, Randomised, Parallel Group Study of the Bard Biocath Catheter and a Silicone Elastomer Coated Catheter
Authors: BULL E. , CHILTON C. P. , GOULD C. A. L. , SUTTON T. M.
Published: November 2008

Summary A group of 69 community patients undergoing long‐term urethral catheterisation for urinary incontinence took part in this study; 33 patients with a mean age of 70.03 years (± 16.6) received the Dow Corning Silastic catheter (16 F 10‐ml balloon) and 36 patients with a mean age of 75.61 years (± 12.6) received the Bard Biocath catheter (16 F 10‐ml balloon). Over a 16‐week period catheters were monitored every 2 weeks and changed as necessary. The Bard Biocath catheter remained in situ for an average of 89.61 days (± 35.31) and the Silastic catheter remained in situ for an average of 56.7 days (± 38.8); this difference was statistically significant.

Used catheters were analysed for encrustation using scanning electron microscopy (SEM). The average time in situ for non‐encrusted Biocath catheters was 83.7 days and 25.28 days for non‐encrusted Silastic catheters.

It was found that 70% of patients who received Biocath catheters preferred them to their previous catheters whereas only 30% of patients in the Silastic group preferred the trial catheter. The incidence of bypassing was 28% in the Biocath group and 52.8% in the Silastic group.
Fifteen‐year Experience of Carcinoma of the Scrotum
Authors: PARYS B. T. , HUTTON JANE L.
Published: November 2008

Summary Between January 1975 and December 1989, 13 men were treated for carcinoma of the scrotum; 11 lesions were squamous cell and 2 basal cell carcinomas. Eleven patients initially underwent local wide excision and 1 local excision with inguinal node dissection. Two patients died of recurrent disease and 4 from unrelated causes, giving a corrected 5‐year survival rate of 62.5%.
First Clinical Report of a New Biodegradable Membrane for Use in Urological Surgery
Authors: SCOTT R. , GORHAM S. D. , AITCHESON M. , BRAMWELL S. P. , SPEAKMAN M. J. , MEDDINGS R. N.
Published: November 2008

Summary Following preliminary in vitro and in vivo experiments a new collagen Vicryl mesh has been devised. The membrane has been extensively tested in the laboratory and has been found to resist the passage of urine. It holds sutures well and has been shown on an experimental animal to be biodegradable.

The membrane has now been applied in human subjects. It has been particularly efficacious in renal surgery and as a means of sealing a bladder after it has been opened. With respect to the ureter the sealing effect is excellent, to the extent of having produced a urinoma. The membrane has been found to be easily applied in vesicovaginal fistulae but difficulties have been experienced in the presence of infection. It is also an ideal membrane for repair of a urethrovaginal fistula—an area where natural tissues are less easily available.

This is the first recorded use of this new biodegradable membrane in the human subject.
Meconium Vaginalitis
Authors: GARAT J. M. , ALGABA F. , PARRA L. , GÓMEZ L.
Published: November 2008

Meconium peritonitis is a form of chemical peritonitis resulting from in utero perforation of the gastrointestinal tract and may occur as early as 24 weeks of fetal life (Heydenrich and Marcus, 1976). The meconium that is spilled into the peritoneal cavity may traverse a patent processus vaginalis into the vaginal cavity and be confused with intrauterine torsion or a testicular tumour.

Since Olnick and Hatcher (1953) described the first case of meconium vaginalitis in 1953, approximately 20 cases have been reported.
Percutaneous Ultrasound‐guided Injection of Sodium Morrhuate in the Treatment of Cystic Renal Masses
Authors: ZOU S. Z. , FAN W. N. , HE X. H.
Published: November 2008

Between December 1985 and November 1988, 40 patients with a total of 48 cystic renal masses were treated by percutaneous ultrasound‐guided injection of sodium morrhuate into the cystic cavity. The group comprised 32 males and 8 females, ranging in age from 29 to 71 years; in 36 cases the cysts were single and in 4 they were multiple.
Hyperoxaluria in Patients with Recurrent Calcium Oxalate Calculi: Dietary and Other Risk Factors
Authors: LAMINSKI N. A. , MEYERS A. M. , KRUGER M. , SONNEKUS M. I. , MARGOLIUS L. P.
Published: November 2008

Summary The presence of mild hyperoxaluria in recurrent calcium oxalate stone formers is controversial. The aim of this study was to identify recurrent stone formers with mild hyperoxaluria and to classify them further by assessing their response to a low oxalate diet. In addition, the prevalence of other risk factors for stone formation in this group of patients was investigated. A total of 207 consecutive patients with recurrent renal calculi were screened and 40 (19%) were found to have mild hyperoxaluria. Of these, 18 (45%) responded to dietary oxalate restriction by normalising their urinary oxalate. The remaining 22 patients were classified as having idiopathic hyperoxaluria and were subdivided into those in whom urinary oxalate excretion was consistently elevated in all specimens measured and those in whom the elevation was intermittent in nature. Dietary oxalate restriction had a partially beneficial effect in lowering oxalate excretion in the patients with persistent hyperoxaluria. No difference in urinary oxalate excretion was found after dietary restriction in the patients with intermittent hyperoxaluria. Other risk factors, including dietary, absorptive and renal hypercalciuria and hypocitraturia, were documented, the prevalence of which (65%) was not significantly different from that (62.5%) found in 40 age‐ and sex‐matched calcium stone formers without hyperoxaluria. The prevalence of hyperuricosuria was significantly greater in patients with hyperoxaluria when compared with stone controls. Further studies are required to elucidate the underlying mechanisms of hyperoxaluria in recurrent stone formers.
Microsurgical Epididymovasostomy by Loop Intussusception
Authors: STEFANOVIĆ KSENIJA B. , CLARK SHARON A. , BUNCKE H. J.
Published: November 2008

Summary A new technique, epididymal loop intussusception into the vas deferens, is offered as an improved form compared with the side‐to‐end method. Loop intussusception has been experimentally studied bilaterally in 15 adult male rats. This report provides details of the technique. A 3‐month anatomical and histological follow‐up showed a 100% patency rate, no anastomotic stricture, and reabsorption of the blind intussuscepted loop in all but 3 cases. Macroscopic sperm granulomas were present in only 10% of the anastomoses examined. Advantages and disadvantages of microsurgical epididymovasostomy techniques are discussed.
Urinary Stone Formation in Children with Prenatally Diagnosed Uropathies
Authors: RICKWOOD A. M. K. , REINER I.
Published: November 2008

Summary Among a series of 312 patients with prenatally diagnosed uropathies, 4 male children developed urinary calculi at ages varying from 2 to 5 years. All had upper urinary tract dilatation not associated with vesicoureteric reflux or with renographically defined obstruction; 3 followed Proteus urinary infections. Strategies for prevention are discussed.
Magnetic Resonance Imaging of Renal Carcinoma with Extension into the Vena Cava: Staging Accuracy and Recent Advances
Authors: MYNENI L. , HRICAK H. , CARROLL P. R.
Published: November 2008

Summary— In 16 patients with surgical confirmation of inferior vena cava thrombi from renal carcinoma, magnetic resonance imaging (MRI) and computed tomography (CT) were compared to assess the ability of non‐invasive, cross‐sectional imaging techniques to detect tumour thrombus, the level of its extension, and vessel wall invasion. MRI accurately detected tumour thrombus in the inferior vena cava in all 16 cases (CT in 14) and demonstrated the cephalad extent of tumour thrombi in 15 of 16 (CT in 11). The level of extension was more easily seen on MRI, as was the presence of extension into the hepatic veins—a finding not detected by CT. Tumour invasion of the wall of the inferior vena cava was correctly demonstrated in 7 cases on MRI and in 1 case on CT. In 8 of 16 patients, gradient recall acquisition in steady state (GRASS imaging) was performed in addition to conventional spin echo sequences and it correctly identified the composition of thrombus in all: tumour in 6 patients, blood clot in 1 and both tumour and blood clot in the remaining patient.

MRI and CT are excellent for detection of tumour but MRI is superior in the evaluation of vascular extension. In addition, the use of GRASS imaging allows differentiation of tumour from blood thrombus.
15‐Hydroxyprostaglandin Dehydrogenase Activity in the Lower Genitourinary Tract A Preliminary Report
Authors: CHANG C. C. , LIN S. N. , CHEN F. S. , CHANG W. C.
Published: November 2008

Summary— In the pathway of prostaglandin inactivation, 15‐hydroxyprostaglandin dehydrogenase (15‐OHPGDH) has been proven to be the catalyst of the primary catabolic step in the oxidation of the 15‐hydroxyl group into a 15‐keto moiety in most derivatives of prostaglandins. In this study, we analysed 15‐OHPGDH activity in the lower genitourinary tract. The specimens were obtained with permission from patients who underwent surgery. These specimens were then sent for quantitative determination using a tritium release assay specific for 15‐OHPGDH. The highest enzyme activity was found in the ureter with a mean ± SE (pmol/min/mg) of 94.99 ± 51.00; the lowest activity was in the vas deferens, with a value of 0.18 ± 0.21. This preliminary study indicated that the activity of 15‐OHPGDH in the lower genitourinary tract was significant and that prostaglandin levels in the genitourinary tract may be regulated by this enzyme.
The Neurourology of Tropical Spastic Paraparesis
Authors: EARDLEY I. , FOWLER C. J. , NAGENDRAN K. , KIRBY R. S. , RUDGE P.
Published: November 2008

Summary— We report the clinical features, urodynamic results and neurophysiological findings in 6 patients with urinary symptoms related to tropical spastic paraplegia. The widespread nature of the pathological changes within the nervous system result in a complex variety of urodynamic and neurophysiological features.
Effect of Percutaneous Nephrolithotomy on Thermoregulation
Authors: LLOYD S. N. , KIRK D. , DEANE R. F. , KYLE K. F.
Published: November 2008

Hypothermia is a well recognised complication of open surgery. We had observed hypothermia, occasionally followed by rebound hyperthermia in the early post‐operative period, in patients undergoing percutaneous nephrolithotomy, and therefore decided to monitor patients undergoing this procedure more closely. During a 12‐month period, 32 patients were monitored during 38 percutaneous nephrolithotomies; 12 procedures were performed using irrigation fluid at room temperature (22°C) and 26 with fluid warmed to 37°C. Although no statistically significant differences between temperature changes were seen, the most profound temperature falls occurred in patients who received fluid at room temperature. The recovery ward staff observed improved post‐operative recovery in patients who had received warmed fluid. Three of the 5 patients who underwent more than 1 percutaneous procedure received fluid at 22°C and fluid at 37°C on separate occasions. In each patient a more profound temperature fall occurred when the cold fluid was used. Only 1 patient, who received cold fluid, developed rebound hyperthermia in the early post‐operative period. Warming of irrigation fluid and close monitoring of core temperature may prevent unnecessary morbidity in patients undergoing percutaneous nephrolithotomy.
Prostate‐specific Antigen and other Prognostic Factors in Patients with Hormone‐resistant Prostatic Cancer Undergoing Experimental Treatment
Authors: FOSSÅ SOPHIE D. , PAUS ELISABETH , LINDEGAARD METTE , NEWLING D. W. W.
Published: November 2008

In 58 patients with progressive hormone‐resistant metastatic cancer of the prostate, prostate‐specific antigen (PSA) > 100 μg/l, haemoglobin < 12.0 g/dl and pronounced fatigue were found to be independent adverse prognostic factors. These risk factors distinguished a subgroup of patients with a median survival of 9 months (none or only 1 risk factor present) from a subgroup with a median survival of 4 months ( 2 risk factors present).

The clinician should be reluctant to enter patients from the second group into complicated and resource‐demanding clinical studies, particularly if such trials require frequent and inconvenient follow‐up examinations.
Chronic Testicular Pain following Vasectomy
Authors: McMAHON A. J. , BUCKLEY J. , TAYLOR A. , LLOYD S. N. , DEANE R. F. , KIRK D.
Published: November 2008

The incidence of chronic testicular pain following vasectomy has not been previously assessed. We have carried out a survey by postal questionnaire and telephone interview of 172 patients 4 years after vasectomy to assess the incidence of chronic testicular pain. Significant early post‐operative complications occurred in 6 patients (3.5%): 2 infection, 3 haematoma and 1 orchitis. Chronic testicular discomfort was present in 56 patients (33%), considered by 26 (15%) to be troublesome but not by the other 30 (17%). Testicular discomfort related to sexual intercourse occurred in 9 cases (5%). Of the 9 patients who had sought further medical help only 2 had had further surgery (1 an epididymectomy and 1 excision of a hydrocele). Only 3 patients regretted having had the vasectomy because of chronic pain. On ultrasound examination, epididymal cysts were a common finding on both asymptomatic and symptomatic patients following vasectomy. Prior to vasectomy, all patients should be counselled with regard to the risk of chronic testicular pain.
The Value of Nuclear Area as a Prognostic Factor in T1 Papillary Transitional Cell Carcinoma of the Bladder
Authors: PORTILLO J. A. , VAL‐BERNAL J. F. , GARIJO M. F. , BUELTA L. , GUTIÉRREZ J. L.
Published: November 2008

Summary In a series of 131 T1 papillary transitional cell carcinomas of the bladder, the nuclear areas of 100 nuclei (50 from the external papillary zone and 50 from the internal papillary zone) were measured. An attempt was made to correlate retrospectively the value of the mean nuclear area with histological grade and with survival. A higher value was obtained for the mean nuclear area of the internal papillary zone than for that of the external papillary zone. A better survival rate was found after 10 years'follow‐up for those tumours whose mean nuclear area in the internal papillary zone was ≤ 28 μm2, which suggests that it is in this zone that the nuclear area should be measured. A correlation was observed between the increase in the mean nuclear area value and higher histological grade.
Terazosin in the Treatment of Benign Prostatic Hyperplasia: The United States Experience
Authors: LEPOR H. , LADDU A.
Published: November 2008

Summary— The rationale for selective alpha1 blockade in benign prostatic hyperplasia (BPH) is based upon the observations that the prostate adenoma contains between 20% and 40% smooth muscle and the contractile properties of prostatic smooth muscle are mediated by the alpha1 adrenoceptor. Terazosin is a selective alpha1 adrenoceptor antagonist that is currently under clinical investigation for the treatment of clinical BPH. The United States experience with this drug is reviewed in the present report. The outcome measures used to assess the efficacy of terazosin in BPH includes Boyarsky symptom scores and uroflowmetry. The total Boyarsky symptom score decreased 55% and the peak urinary flow increased 47% following terazosin therapy in the cumulative open‐label and single‐blind studies. Three hundred and thirteen subjects with clinical BPH were randomised into a phase III double‐blind parallel‐group 3‐month placebo‐controlled study of once‐a‐day administration of terazosin. The total Boyarsky symptom score decreased 43% and 21% in the 10 mg and placebo treatment groups, respectively. The peak urinary flow increased 37% and 12% in the 10 mg and placebo‐treated groups, respectively. The adverse events associated with terazosin were relatively minor and reversible. The United States experience has unequivocally demonstrated the short‐term safety and efficacy of terazosin therapy in BPH. Studies are currently under way to determine the long‐term safety and efficacy associated with terazosin therapy in BPH.
Challenges in the Management of Prostate Cancer
Authors: CRAWFORD E. D.
Published: November 2008

Summary— An estimated 32,000 American men will die of prostate cancer this year. Local prostate cancer may be successfully treated by radical prostatectomy or radiotherapy. Advanced cases may necessitate the use of hormonal ablation with bilateral orchiectomy, an approach that is regarded as the gold standard of therapy but not always the preferred treatment of patients. Oestrogen therapy is an alternative but is associated with side effects, such as hot flushes and gynaecomastia, which frequently lead to treatment cessation. Luteinising hormone‐releasing hormone (LHRH) analogues work by initially producing a surge of androgen, followed by a down‐regulation in hormone production to effect a medical castration. Various groups have studied the effects of androgen blockade administered as monotherapy and as combination therapy (LHRH analogue plus anti‐androgen). The National Cancer Institute intergroup protocol 0036, which is the largest cooperative study to date of patients with advanced prostatic cancer, showed that combination therapy with leuprolide and flutamide offered greater benefit in both time to disease progression and median survival while circumventing tumour flare and its associated symptoms. Thus, combination therapy for total androgen ablation may become the new treatment standard for advanced prostatic cancer, pending further studies in the efficacy and cost‐effectiveness of all available treatments.
Ten‐year Review of Treatment of the Undescended Testis in the West of Ireland
Authors: McKIERNAN M. V. , MURPHY P. D. , JOHNSTON J. G.
Published: November 2008

Summary— Advances continue to be made in the treatment of the undescended testis, and treatment recommendations are continually changing. We reviewed 543 patients admitted for treatment of undescended testes in the 10‐year period 1977 to 1986. The side and position of the testis were recorded, the patient's age at operation and the procedure carried out. The presence of an associated inguinal hernia was noted. The necessity for reoperation was recorded and predisposing factors sought. We found the mean age at operation to be 9.5 years and this decreased significantly over the study period. Dartos pouch orchiopexy was the commonest operation (69%). No significant link was found between the procedure performed or the presence of a hernia and the need for further procedures; 2.7% of patients required such further procedures. A coherent classification of position is lacking for abnormally descended testes. We report a classification which we used to tackle this situation.
Spontaneous Rupture of Renal Tumours Presenting as Surgical Emergency
Authors: CHAN K. W. , CHAN K. L.
Published: November 2008

Summary— A study of renal tumours filed in the pathology department of a regional hospital in Hong Kong during 1971–1990 showed 6 cases of surgical emergency due to spontaneous rupture of the kidney by tumour. All occurred as a complication of renal angiomyolipoma, a rare tumour or hamartoma. A literature review showed that the renal tumour most frequently reported to cause spontaneous rupture was renal carcinoma. Chinese patients appear to have more renal ruptures due to angiomyolipoma than to renal carcinoma. It is proposed that intra‐operative frozen section diagnosis should be sought, when this can be safely performed, in cases of rupture of the kidney by tumour. Surgery aiming at conserving functional renal parenchyma is appropriate for benign lesions such as angiomyolipoma.
The Value of Videourodynamics in the Investigation of Neurologically Normal Children who Wet
Authors: WEERASINGHE NINETHRIE , MALONE P. S.
Published: November 2008

Summary— Videourodynamic studies were performed on 57 wet children, 35 of whom were assessed retrospectively and 22 prospectively. Thirty‐two studies (56%) were abnormal; detrusor instability or reduced compliance was found in 26, increased bladder sensitivity in 3, detrusor sphincter dyssynergia in 2 and sphincter weakness incontinence in 1. A detailed micturition history sheet and the results of routine preliminary investigations (mid‐stream urine and ultrasonography) were used in an attempt to predict the outcome of urodynamics. Since only 5 of the 25 normal studies and 18 of the 32 abnormal studies were correctly predicted, it was concluded that accurate prediction was not possible. Urodynamic investigations are therefore required to identify the underlying cause of wetting and to guide appropriate treatment.
Magnetic Resonance Imaging in the Staging of Bladder Cancer
Authors: PERSAD R. , KABALA J. , GILLATT D. , PENRY B. , GINGELL J. C. , SMITH P. J. B.
Published: November 2008

Summary— Magnetic resonance imaging (MRI) scans were performed on 55 bladder cancer patients on whom clinicopathological staging was available from transurethral resection and cystectomy specimens. The overall accuracy of MRI scanning in this group was 84%, although true concordance rates are debatable without open surgical correlation. In the subgroup of 25 patients who had accurate open surgical correlation (from cystectomy, laparotomy or post mortem) the concordance rate was 76% with MRI. Errors occurred mainly in the T3 group of tumours, with 2 being overstaged and 2 being understaged out of a total of 12 in the open surgical correlation group (66% accuracy). Difficulties were also encountered in staging tumours at the bladder base, with an error rate of 22% (2 of 9) for T4 tumours in this area. With regard to lymph node staging there was a 100% (5 of 5) specificity in defining pathologically involved nodes but there was a false negative rate of 15% (3 of 19).

Although it has many advantages over CT scanning, MRI produces a significant error rate in terms of over‐and under‐staging invasive tumours. There are difficulties associated with detecting minimal involvement of adjacent organs and lymph nodes as well as determining the exact depth of muscle penetration. Improvements may come in the future with the use of contrast enhancement agents such as gadolinium as well as more advanced machines.
Does Vasectomy Cause Testicular Cancer?
Authors: HEWITT G. , LOGAN C. J. H. , CURRY R. C.
Published: November 2008

Summary— Between 1975 and 1990, 330 men developed testicular tumours in Northern Ireland. Their names were cross matched with a sample of 2904 men who had undergone vasectomy between 1970 and 1985. The expected numbers of tumours in vasectomised patients was 2, while the actual number was 1. Our experience does not indicate that vasectomy causes testicular cancer.
Prolapse of the Urethral Mucosa in Prepubertal West Indian Girls
Authors: TROTMAN M. D. W. , BREWSTER E. M.
Published: November 2008

Forty‐two cases of urethral mucosal prolapse were reviewed in Trinidad, West Indies. The main presenting symptom was vaginal bleeding; 31% of patients had associated infection and 97% belonged to social classes III to V; 33% had conservative management and 67% had surgical treatment. It was concluded that treatment should be medical rather than surgical and it is suggested that this is a disease of the low socio‐economic group.
Mechanical Characteristics of Tubular and Detubularised Bowel for Bladder Substitution: Theory, Urodynamicsand Clinical Results
Authors: COLDING‐JØRGENSEN M. , POULSEN A. L. , STEVEN K.
Published: November 2008

Summary A theoretical analysis of the mechanics of tubular and detubularised bowel bladders is presented. The results are compared with clinical findings following bladder substitution with the tubular ileocaecal and the detubularised urethral Kock reservoir. The theoretical results are consistent with clinical observations showing that detubularisation increases reservoir capacity substantially, delays the onset and reduces the amplitude of the pressure rise produced by contractions. These findings account for the markedly improved nocturnal continence (80 versus 17% at 2 years), the longer voiding intervals (4 versus 2.5 h at 1 year) and the predisposition to urinary retention (25 versus 0% at 1 year) with detubularised bladder substitution. A simple equation is derived to calculate the capacities of both near‐spherical and cylindrical reservoirs. The capacity of the U pouch is calculated to be less than that of the W‐shaped, S‐shaped and Kock reservoirs. Altering the shape of a reservoir from spherical to ellipsoid is calculated to have only a slight effect on its mechanical characteristics. Consequently the essence of detubularisation is to create a reservoir with high capacity, while shape is of secondary importance.
The Effect of Prostatic Capsule Perforation on the Absorption of Irrigating Fluid during Transurethral Resection
Authors: SALMELA L. , AROMAA U. , LEHTONEN T. , PEURA P. , OLKKOLA K. T.
Published: November 2008

Summary Thirty patients undergoing transurethral resection of the prostate using ethanol‐tagged irrigating fluid were investigated in order to study the effects of a breach in the prostatic capsule. Measurements were made of end‐tidal ethanol (ET‐ethanol) in the expired air, serum glycine and sodium, haemoglobin, blood loss and volumetric determination of irrigating fluid absorption. Perforation of the prostatic capsule occurred in 13 patients (Group P), with 17 judged to have no perforation (Group NP). In all Group NP patients the ET‐ethanol remained below 0.05%o, serum sodium decreased by ≥ 3 mmol/l and serum glycine remained < 1.5 mmol/l. ET‐ethanol was significantly increased in Group P, rising to between 0.1 and 0.45%o in 5 patients, 3 of whom showed a reduction in serum sodium >5 mmol/l. Five patients in Group P demonstrated significantly raised serum glycine concentrations up to 15 mmol/l.

These findings suggest that perforation of the prostatic capsule may lead to rapid absorption of irrigating fluid, and that ET‐ethanol monitoring is a useful method of detecting this quickly.