bluuebunny/crossref_metadata_2025 huggingface dataset:
Co‐localization of nitric oxide synthase, neuropeptides and tyrosine hydroxylase in nerves supplying the human post‐natal vas deferens and seminal vesicle
Authors: JEN P.Y.P. , DIXON J.S. , GOSLING J.A.
Published: November 2003

Objective

 To determine the distribution and patterns of co‐localization of nitric oxide synthase (NOS), neuropeptides and tyrosine hydroxylase (TH) in intrinsic nerves of the human post‐natal vas deferens and seminal vesicle.

Materials and methods

 Double and triple immunolabelling methods were used in tissue from 10 male infants and children (age range 2 months to 3 years) obtained at post‐mortem examinations carried out within 12 h of death.

Results

 Most nerves supplying the muscle coat of either organ were TH‐immunoreactive (‐IR), most of which also contained neuropeptide Y (NPY) while a smaller proportion contained both NPY and NOS. Minor populations of the TH/NPY‐IR intramuscular nerves contained calcitonin gene‐related peptide (CGRP), galanin (GAL), met‐enkephalin (m‐ENK) or vasoactive intestinal polypeptide (VIP). Non‐TH‐IR intramuscular nerves were relatively infrequent and most contained NPY and either VIP or NOS. Presumptive secretomotor nerves formed subepithelial plexuses in both organs, most of which contained NPY co‐localized with either VIP or NOS, with minor populations containing CGRP and/or GAL. TH‐ and substance P (SP) ‐IR nerves were not observed subepithelially. Perivascular nerve plexuses were mainly formed by TH‐IR varicose nerves, most of which contained co‐localized NPY and CGRP, with a smaller proportion containing NPY and NOS and minor populations containing VIP, m‐ENK, SP or GAL.

Conclusion

 These results indicate that the autonomic control of the human vas deferens and seminal vesicle is provided by several immunohistochemically distinct nerve populations. Furthermore, NOS is present in a proportion of both the noradrenergic and non‐noradrenergic nerves. Pharmacological studies are now required to elucidate the precise roles of nitric oxide and neuropeptides in the functional control of these organs.
Combined chemotherapy and radiation with selective organ preservation for muscle‐invasive bladder carcinoma. A single‐institution phase II study
Authors: FELLIN G. , GRAFFER U. , BOLNER A. , AMBROSINI G. , CAFFO O. , LUCIANI L.
Published: November 2003

Objective

 To assess in a phase II trial the effectiveness and toxicity of combined chemotherapy and radiation with selective bladder preservation by response in the treatment of muscle‐invasive bladder carcinoma.

Patients and methods

 Fifty‐six eligible patients with T2–4 M0 transitional cell bladder cancer suitable for radical surgery and multi‐agent chemotherapy received two courses of methotrexate, cisplatin and vinblastine, followed by 40 Gy of pelvic radiotherapy in 1.8 Gy fractions with concomitant cisplatin. Tumour response was evaluated by cystoscopy and biopsy. Those responding completely were given a 24 Gy bladder boost plus cisplatin; patients with residual tumour were assigned to immediate cystectomy.

Results

 After induction therapy, 28 patients (50%) responded completely; 22 operable patients with residual tumour underwent immediate cystectomy, while 34 patients were consolidated with cisplatin and radiation. Bladder relapses developed in 16 patients; seven had successful endovesical therapy for superficial disease and salvage cystectomy was possible in four of nine cases with invasive recurrence. Distant metastases occurred in 22 cases (39%). After a median follow‐up of 46 months, the 5‐year actuarial disease‐specific survival was 59%, disease‐free survival 54% and local control without cystectomy (bladder preservation) 41%. There were no treatment‐related deaths; grade 3 late complications occurred in two patients.

Conclusion

This combined chemotherapy–radiotherapy regimen with selective organ preservation should be considered as an option for muscle‐invasive bladder carcinoma. The initial results suggest the possibility of retaining a functioning bladder in many patients, without compromising survival, compared with elective cystectomy approaches. A longer follow‐up and quality‐of‐life assessment remain essential for a better definition of selection criteria and long‐term results of this combined modality.
Tumour size measured by transrectal ultrasonography in the staging of prostate cancer before radical prostatectomy
Authors: RØRVIK J. , ALBREKTSEN G. , HALVORSEN O.J. , HAUKAAS S.
Published: November 2003

Objective

 To assess the diagnostic accuracy of transrectal ultrasonography (TRUS) in predicting the local extent of prostate cancer before radical prostatectomy.

Patients and methods

 From April 1990 to April 1993, 59 consecutive patients (mean age 63 years, range 49–71) with clinically localized prostate cancer were examined using TRUS before radical prostatectomy. Primary tumours were clinically categorized according to the TNM classification and biopsies graded histologically. Tumour size was measured as length on a longitudinal and height and width on a transverse ultrasonogram. The results from TRUS were compared with those from the histopathological examination of whole‐mount step sections of the surgical specimens.

Results

 In 50 patients, TRUS using standard criteria achieved sensitivity, specificity, positive‐ and negative predictive values (PPV, NPV) of 0.47, 0.63, 0.73 and 0.36, respectively, in predicting pathological stage. Dimensions were obtained from 45 patients with hypoechoic tumours; in a multivariate linear discriminant analysis the TRUS estimate of width was the best predictor of pathological stage. The sensitivity, specificity, PPV and NPV for tumour width from TRUS, using a threshold of 19 mm, were 0.42, 0.93, 0.93 and 0.43, respectively.

Conclusion

 Tumour width measured by TRUS may improve the assessment of the local extent of prostate cancer.
The staging pelvic lymphadenectomy: implications as an adjunctive procedure for clinically localized prostate cancer
Authors: ALAGIRI M. , COLTON M.D. , SEIDMON E.J. , GREENBERG R.E. , HANNO P.M.
Published: November 2003

Objectives

 To evaluate the utility of staging pelvic lymphadenectomy and to identify factors associated with nodal metastases in which a node dissection would be of clinical benefit.

Patients and methods

 A retrospective analysis (1989–1993) was performed on 303 consecutive patients who underwent staging bilateral modified pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analysis was used to evaluate age, race, clinical stage, prostate‐specific antigen (PSA) level and Gleason score for predicting nodal metastases.

Results

 Twenty‐eight patients had nodal metastases, giving an overall prevalence of 9.2%. PSA and Gleason score (both P<0.001) were significantly predictive of nodal involvement when combined or as independent variables. Relative to PSA and Gleason score, the patients’ age, race and clinical stage were less relevant. Sensitivity analysis determined that combining a PSA of ≥20 ng/mL (normal 0–4) and a Gleason score of ≥8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% and an overall accuracy of 91% for predicting nodal metastases.

Conclusion

 From this data, lymph node metastases are unlikely in patients with clinically localized prostate cancer who have a PSA of <20 ng/mL and a Gleason score <8, and that a pelvic lymph node dissection as an adjunctive procedure should be avoided in such individuals.
Anaemia associated with androgen deprivation in patients with prostate cancer receiving combined hormone blockade
Authors: STRUM S.B. , McDERMED J.E. , SCHOLZ M.C. , JOHNSON H. , TISMAN G.
Published: November 2003

Objectives

 To describe the incidence, time to onset and extent of anaemia occurring in patients with prostate cancer receiving combined hormone blockade (CHB) and the timing and extent of recovery from anaemia in those patients where CHB was discontinued.

Patients and methods

 Patients with prostate cancer were evaluated prospectively by physical examination and laboratory tests at baseline and at routine intervals while receiving CHB. Of 142 patients who received CHB, 133 were evaluable for the assessment of anaemia; CHB was discontinued in 76 patients, of whom 64 were assessable for recovery from their anaemia.

Results

 Haemoglobin levels declined significantly in all patients from a mean baseline of 149 g/L to means of 139 g/L, 132 g/L and 131 g/L at 1, 2 and 3 months, respectively. Haemoglobin levels continued to decline during CHB to a mean nadir of 123 g/L at a mean of 5.6 months of CHB, representing a mean absolute haemoglobin decline at nadir of 25.4 g/L. In 120 of the 133 (90%) patients, the relative decline in haemoglobin at nadir was ≥10% and was ≥25% in 17 (13%) others, representing a mean absolute haemoglobin decline in this subset of 42.7 g/L. Significant symptoms related to anaemia occurred in 17 patients (13%). Anaemia and symptoms in these patients were easily corrected with the subcutaneous administration of recombinant human erythropoietin.

Conclusions

 The anaemia associated with androgen deprivation is significant and occurs routinely in men receiving CHB. It is normochromic, normocytic, temporally‐related to the initiation of androgen blockade and usually resolves after CHB is discontinued. We suggest that patients receiving CHB undergo haematological testing at baseline, 1–2 months after initiating CHB and periodically thereafter. Patients developing anaemia should be questioned about symptoms reflecting physiological compromise (e.g. angina, dyspnoea on exertion). In the absence of other causes, CHB should be suspected in the development of anaemia in patients receiving this treatment.
Transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia: a collaborative multicentre study
Authors: RAMON J. , LYNCH T.H. , EARDLEY I. , EKMAN P. , FRICK J. , JUNGWIRTH A. , PILLAI M. , WIKLUND P. , GOLDWASSER B. , FITZPATRICK J.M.
Published: November 2003

Objective

 To assess the efficacy and safety of transurethral needle ablation of the prostate (TUNA) for patients with symptomatic benign prostatic hyperplasia (BPH) in a multicentre trial.

Patients and methods

 Seventy‐six patients were recruited from five centres; all were treated with the TUNA system consisting of a powered radiofrequency generator and a TUNA catheter. The patients were evaluated prospectively using the international prostate symptom score (IPSS), uroflowmetry, quality‐of‐life score, and other variables, and followed for a mean of 12 months after treatment.

Results

 Sixty‐eight patients were available for follow‐up; TUNA produced significant improvements in the IPSS (median 22 before, to 7.5 after treatment), urinary flow rate (mean 8.7 before, to 11.6 mL/s after treatment) and quality‐of‐life score (median 5 before, to 2 after treatment) at 12 months.

Conclusions

 If these early promising results are maintained in the medium to long term, TUNA therapy will be a useful low‐morbidity alternative for patients with symptomatic BPH.
Detection of telomerase activity in human prostate: a diagnostic marker for prostatic cancer?
Authors: SCATES D.K. , MUIR G.H. , VENITT S. , CARMICHAEL P.L.
Published: November 2003

Objective

 To assess the role of telomerase activity as a marker for the development of prostate cancer in men with existing benign prostatic hyperplasia (BPH), a known risk factor for prostatic carcinoma.

Materials and methods

 Telomerase activity was assayed, using a highly sensitive polymerase‐chain reaction‐based assay, in nine biopsies from patients with prostatic cancer, 16 from patients clinically diagnosed with BPH and 11 from patients with no evidence of prostatic disease.

Results

 Telomerase activity was detectable in eight of the nine prostate cancer biopsies, in none of the normal prostates and in six of the 16 BPH biopsies.

Conclusion

 The finding of telomerase activity in six of 16 biopsies from patients with BPH could indicate early prostate cancer and suggests that telomerase activity may be of use as a biomarker in patients diagnosed with BPH and who may subsequently develop prostate cancer.
High scrotal orchidopexy for palpable maldescended testes
Authors: JAWAD A.J.
Published: November 2003

Objective

 To confirm that most spermatic cords of palpable maldescended testes are long enough to place the testes in the scrotum and therefore that a satisfactory scrotal testicular position can be achieved by a single high scrotal incision with less dissection of the inguinal region.

Patients and method

 Between January 1991 and June 1995, 106 high scrotal orchidopexies (HSOs) for clinically palpable maldescended testes were carried out in 96 patients (mean age 41 months, range 14 months to 11 years). Ten patients had bilateral undescended testes. Regardless of the initial testicular position or the age of the patients, all orchidopexies were commenced with a high scrotal incision. Ninety‐two testes (87%) were placed satisfactorily in the scrotum and the remaining 14 testes (13%) required a second inguinal incision.

Results

 During the follow‐up (mean 16 months, range 8 months to 3 years), 85 testes (80%) showed good anatomical and cosmetic results. Five testes required a repeat conventional orchidopexy 6 months after the HSO. Three testes were excised because they showed atrophic changes; 11 of the 14 testes which required two incisions initially have shown good results.

Conclusion

 High scrotal orchidopexy is a satisfactory approach to any palpable maldescended testis, having the advantage of using a single incision and requiring less dissection and anatomical disruption of the inguinal region, with excellent cosmesis.
Relaxant effects of potassium‐channel openers on normal and hyper‐reflexic detrusor muscle
Authors: MARTIN S.W. , RADLEY S.C. , CHESS‐WILLIAMS R. , KORSTANJE C. , CHAPPLE C.R.
Published: November 2003

Objective

 To compare the effects of the potassium‐channel openers, levcromakalim and YM934, in isolated human detrusor muscle from normal and hyper‐reflexic bladders.

Materials and methods

 Strips of human detrusor muscle from normal and hyper‐reflexic bladder were pre‐contracted with carbachol and the potassium‐channel openers (0.1–0.3 μmol/L) were added cumulatively to the organ baths. Other strips were field‐stimulated at frequencies producing 25% and 75% of the maximum response to field stimulation. Contractions could be abolished by atropine (10 μmol/L) and tetrodotoxin (1 μmol/L).

Results

 The hyper‐reflexic bladder was significantly more sensitive to carbachol than the normal bladder but the maximum response was significantly lower in the hyper‐reflexic tissue. There was no significant difference between the potency of the potassium‐channel openers in normal and hyper‐reflexic detrusor muscle. Hyper‐reflexic bladder was significantly more sensitive to electrical field stimulation than was normal bladder; maximum responses to field stimulation were not significantly different. Concentration‐response curves for the potassium‐channel openers were displaced to the left in hyper‐reflexic bladder at both 25% and 75% maximum frequencies; however, only with levcromakalim at 75% of the maximum frequency was the shift significant.

Conclusion

 The greater sensitivity of hyper‐reflexic bladder to carbachol and field stimulation supports existing evidence for post‐junctional supersensitivity in detrusor instability. The results of this study also suggest that there are no appreciable changes in KATP channel function in the unstable bladder.
A prospective randomized trial of interstitial radiofrequency therapy versus transurethral resection for the treatment of benign prostatic hyperplasia
Authors: MOSTAFID A.H. , HARRISON N.W. , THOMAS P.J. , FLETCHER M.S.
Published: November 2003

Objective

 To carry out a prospective randomized trial comparing interstitial radiofrequency therapy (IRFT) with transurethral resection of the prostate (TURP) in the treatment of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia.

Patients and methods

 The change in detrusor pressure at maximum flow (PdetQmax ) was chosen as the primary measure of outcome but the symptom score, Qmax and residual volume were also measured. Patients with urodynamic evidence of BOO were randomized to receive IRFT (n=25) or TURP (n=25); the urodynamics were repeated 6 months after treatment.

Results

 There was a statistically significant reduction in PdetQmax at 6 months for TURP (P<0.001) and IRFT (P<0.01) although the change seen in the latter group was probably not clinically relevant. Nevertheless, a clinically relevant reduction in symptom score occurred in both groups. Both techniques were associated with a low morbidity.

Conclusion

 IRFT is a cheap and safe technique which may be useful in the treatment of lower urinary tract symptoms in certain groups of patients in whom symptomatic improvement is a priority rather than objective outcome. The underlying mechanism for this symptomatic improvement is at present unclear.
The in vitro effect of vitamin D3 analogue EB‐1089 on a human prostate cancer cell line (PC‐3)
Authors: WANG X. , CHEN X. , AKHTER J. , MORRIS D.L.
Published: November 2003

Objective

 To determine the effect of vitamin D3 analogue (EB‐1089) on the growth and proliferation of a prostate cancer cell line (PC‐3).

Materials and methods

 PC‐3 cells (104 cells per well) were plated into 24‐well tissue culture plates. After 24 h, the culture medium was replaced with one containing the vitamin D3 analogue EB‐1089; a control treatment using only replacement medium was conducted in parallel. Cell proliferation was measured by the incorporation of 3H‐thymidine 7 and 12 days after the addition of the vitamin D3 analogue. Cells were precipitated with 5% trichloroacetic acid and the radioactivity determined using a scintillation counter. Each experiment was performed at least five times.

Results

 There was a significant dose‐dependent inhibition of cell growth after 7 and 12 days of treatment with EB‐1089, varying from 40 to 70% of the 3H‐thymidine incorporation by controls, respectively. The maximum inhibition occurred with 0.1 μmol/L EB‐1089 on day 7 and day 12 (both P<0.01). Longer incubation times appeared to have a greater effect when higher concentrations of EB‐1089 were used.

Conclusion

 These in vitro studies have shown that the vitamin D3 analogue EB‐1089 can significantly reduce the growth rate of the prostate cancer cell line PC‐3. This would support the hypothesis that deficiency of vitamin D increases the risk of prostate cancer and further in vivo testing of vitamin D is warranted for its potential role in active therapy.
Renal Doppler ultrasonography in children with equivocal obstructive uropathy: effect of intravenous normal saline fluid load and frusemide
Authors: SHOKEIR A.A. , PROVOOST A.P. , EL‐AZAB M. , DAWABA M. , SHOKEIR M.A. , NIJMAN R.J.
Published: November 2003

Objective

 To study the effect of hyperhydration with normal saline and frusemide on the renal resistive index (RI) in children with equivocal obstructive uropathy.

Patients and methods

 Twelve children (24 kidneys) with unilateral or bilateral hydronephrosis underwent isotopic diuretic renography and Doppler ultrasonography. All children had equivocal obstruction of the hydronephrotic kidneys with half‐time drainage (T/2) values of 10–20 min. Doppler studies were carried out both at baseline and after the infusion of normal saline and frusemide.

Results

 Of the 24 kidneys, five were normal and 19 were hydronephrotic; compared with normal kidneys, the hydronephrotic units had a significantly lower glomerular filtration rate (GFR) and longer T/2. At baseline, the mean RI values of normal and hydronephrotic kidneys were not significantly different (0.70, sd 0.03 and 0.71, sd 0.04, respectively). After the infusion of saline and frusemide, the mean RI of hydronephrotic kidneys (0.67, sd 0.07) was significantly (P=0.01) higher than that of normal kidneys (0.60, sd 0.02), but the response of RI in hydronephrotic kidneys was variable. Based on the RI at baseline and after infusion, hydronephrotic kidneys could be categorized into three groups. Group 1 (n=6) had an RI<0.7 before and after infusion, group 2 (n=6) had a baseline RI>0.7 and <0.7 after infusion, and in group 3 (n=7) both RIs were >0.7. Kidneys in group 3 had the lowest GFR and the highest T/2 values. Five of these seven hydronephrotic kidneys eventually had deteriorating GFRs requiring surgical correction; the GFR of the remaining hydronephrotic kidneys remained stable.

Conclusion

 In children with equivocal obstructive uropathy based on diuretic renography, the determination of RI before and after infusion of normal saline and frusemide could be helpful in distinguishing obstructed from non‐obstructed kidneys.
Neuroendocrine differentiation and prognosis in prostatic adenocarcinoma
Authors: McWILLIAM L.J. , MANSON C. , GEORGE N.J.R.
Published: November 2003

Objectives

 To assess the prognostic importance of neuroendocrine differentiation in conventional (non‐small cell) prostatic adenocarcinoma.

Materials and methods

 Ninety‐two samples from patients with prostatic adenocarcinoma were studied retrospectively. The immunohistochemical analysis of chromogranin A and neuron‐specific enolase in formalin‐fixed, paraffin wax embedded prostatic tissue chips was related to other prognostic variables and patient survival.

Results

 Neuroendocrine differentiation was detected in 48 cases; there was a significant correlation with worsening tumour differentiation, the presence of bone metastases and with worsening survival, but no independent effect of neuroendocrine differentiation on survival.

Conclusion

 The detection of neuroendocrine differentiation in conventional prostatic adenocarcinoma is not an independent indicator of prognosis.
The relationship of smooth muscle damage to age, severity of pre‐operative hydronephrosis and post‐operative outcome in obstructive uropathies
Authors: PINTÉR A.B. , HORVÁTH A. , HRABOVSZKY Z.
Published: November 2003

Objective

 To determine the relationship, in patients with pelvi‐ureteric junction (PUJ) obstruction, of histopathological abnormalities to their age at surgery, the severity of pre‐operative hydronephrosis and the post‐operative outcome.

Materials and methods

 Surgical specimens from 60 consecutive PUJ complexes excised at pyeloplasty were evaluated histologically.

Results

 There was a close relationship of smooth muscle abnormality and fibrosis with the severity of pre‐operative hydronephrosis and post‐operative outcome, with no significant correlation between histopathological abnormality and patient age.

Conclusion

 This study appears to support the practice of the initial non‐operative management of congenital PUJ obstruction, potentially reducing the number of early and/or unnecessary interventions. Further investigations and research are necessary to direct appropriate management.
Neuroendocrine stains and proliferative indices of prostatic adenocarcinomas in transurethral resection samples
Authors: SPEIGHTS Jr V.O. , COHEN M.K. , RIGGS M.W. , COFFIELD K.S. , KEEGAN G. , ARBER D.A.
Published: November 2003

Objective

 To determine whether the quantification of certain neuroendocrine and proliferative markers would help in the prognostic evaluation of prostatic adenocarcinomas obtained during transurethral resection of the prostate (TURP).

Materials and methods

 Samples from two groups of patients with prostate cancer were examined. One group comprised 23 patients, of whom 12 were stage IV and 11 stage III, all with Gleason scores of ≥7; this group was designated as high‐grade, high‐stage (HGHS). The second group comprised 10 consecutive patients with stage T1a adenocarcinoma of the prostate with Gleason scores of ≤6, designated as low‐grade, low‐stage (LGLS) tumours. Tumour tissue from each TURP was stained with MIB‐1 (an indicator of cell proliferation), neuron‐specific enolase (NSE), chromogranin A (ChA) and synaptophysin (Syn), and 1000 cells counted to determine the percentages of positive cells in both benign and malignant tissue. The percentage of MIB‐1‐positive cells was designated as the proliferative index (PI). Patients were clinically followed to evaluate tumour progression, documented by rising prostate‐specific antigen (PSA) levels, X‐ray evidence of recurrent or metastatic carcinoma, or tissue biopsy showing malignancy.

Results

 The mean number of neuroendocrine cells (NEC) for each marker and the mean PI were greater in the HGHS tumours than in the LGLS tumours or surrounding benign tissue of either group (P<0.01). The LGLS tumours were remarkable for a having mean PI of about twice that of the benign tissue (2.9 and 1.3, respectively, P<0.01); the NEC in these cases were more frequent in the benign than in the malignant tissue. There was no significant difference between the mean PIs and the mean percentages of NEC in the 14 HGHS tumours that progressed and the nine HGHS tumours that did not (P values 0.37–0.96).

Conclusions

 Although the PI assessed by MIB‐1 and the number of NEC‐positive cells were much higher in HGHS than LGLS tumours, this finding did not appear to have independent prognostic significance. The significance of the higher PI in LGLS tumours than in corresponding benign tissue is uncertain; LGLS tumours had fewer NEC than the surrounding benign tissue. The quantification of any of these four markers (MIB‐1, NSE, ChA, Syn) was not prognostically helpful in these groups of cancers present in TURP specimens.
Prognostic significance of microscopic vascularity for clear cell renal cell carcinoma
Authors: DELAHUNT B. , BETHWAITE P.B. , THORNTON A.
Published: November 2003

Objective

 To investigate the association between tumour vascularity and patient survival in a series of clear‐cell renal cell carcinoma (RCC), which often metastasizes via the vascular route and frequently has a prominent vascular network.

Materials and methods

 Vessels were labelled in sections from 150 cases of clear cell RCC by factor VIII immunohistochemistry. The mean microvessel density (MMD), expressed as the number of vessels per 10 high‐power fields (HPFs, ×400, aggregate field area 1.452 mm2 ) and tumour microvessel area (TMA), expressed as the percentage of the total tumour area within 10 HPFs, were measured for each case. The relationship between MMD and TMA, tumour stage and grade, and patient survival over a 5‐year follow‐up was determined.

Results

 Tumour MMD ranged from 1 to 238 vessels per HPF, while the TMA was 1.2–60.8%. There was a weak but significant difference for MMD between tumour grades (P<0.01) and stages (P<0.05). There was no significant association between TMA and either tumour stage or grade. Division of cases according to MMD ≤40 and >40 per HPF showed a significant difference in survival curves between both groups, with a higher MMD being associated with longer patient survival. The significant association between MMD and survival was retained for stage 3 tumours only when cases were stratified according to Robson’s stage at presentation. TMA did not correlate with survival.

Conclusions

 The assessment of tumour vascularity is of prognostic significance for clear cell RCC. The significant inverse relationship between MMD and patient survival suggests that for tumours with a poor prognosis, decreased MMD is associated with tumour fibrosis and the development of large diameter vascular channels.
The diagnostic value of urinary Crosslaps and serum alkaline phosphatase in patients with prostate cancer
Authors: NGUYEN‐PAMART M. , CATY A. , FEUTRIE M.L. , FOURNIER C. , GOSSELIN P. , MAZEMAN E.
Published: November 2003

Objective

 To determine whether the urinary excretion of Crosslaps and serum alkaline phosphatase (ALP) are useful bone markers in patients with prostate cancer.

Patients and methods

 The study included 112 patients, comprising 25 with benign prostatic hyperplasia and 87 with carcinoma of the prostate, 41 of whom had localized prostate cancer and 46 with bone metastases. In the last group, 16 were stable and 30 were in clinical progression. Prostate‐specific antigen (PSA) and the bone markers serum bone ALP and urinary Crosslaps were determined on the same day.

Results

 The rates of excretion of Crosslaps were significantly greater in patients with than in those without bone metastases. Only Crosslaps showed a significant difference between patients with stabilized metastatic disease and those with no bone involvement. Crosslaps had a higher specificity and positive predictive value than had PSA level in patients with bone metastases, and a higher sensitivity than bone ALP.

Conclusion

 These preliminary findings suggest that Crosslaps may be useful as an additional bone marker in patients with prostate cancer and may provide information of the metastatic spread to bone in these patients. Prospective studies with serial measurements of bone markers are currently underway to relate these results to the progression of disease and to evaluate the response to treatment of bone metastases.
Frequency‐volume chart data from incontinent children
Authors: BOWER W.F. , MOORE K.H. , ADAMS R.D. , SHEPHERD R.B.
Published: November 2003

Objective

 To establish the mean and standard deviation about the mean for voiding variables of incontinent children aged 6–11 years as measured on a frequency‐volume chart (FVC), and to determine the effect of type of incontinence, gender and age on these values.

Patients and methods

 All children attending two continence clinics over a 3‐year period completed a FVC as a routine part of their assessment. Voided volume and voiding interval data were collected from these charts. The mean maximum, mean minimum and overall mean voided volume and voiding interval were established for the whole group and then for each age, gender and type of incontinence.

Results

 The voiding patterns of incontinent children were very variable and thus the standard deviation for each voiding parameter was large. Multivariate analysis showed that the only variable that affected any of these apparent storage parameters was the child’s age; gender and type of incontinence did not influence bladder storage patterns. Children with daytime incontinence did not have smaller voided volumes than those with nocturnal enuresis.

Conclusion

 Both the mean and the standard deviation about the mean of all voided volumes varied widely amongst incontinent children. Only age appeared to influence trends in voided volumes. Any clinical investigation using the FVC in children should consider the high standard deviation when calculating sample size.
Soluble urinary CD14 after intravesical bacille Calmette‐Guérin immunotherapy for carcinoma in situ
Authors: JACKSON A.M. , LIEN E. , ALEXANDROFF A.B. , PRESCOTT S. , ESPEVIK T. , JAMES K. , SELBY P.J. , SUNDAN A.
Published: November 2003

Objective

 To characterize the production of the monocyte activation marker, soluble CD14 (sCD14), after bacille Calmette‐Guérin (BCG) immunotherapy for superficial bladder cancer.

Patients and methods

 Nineteen patients with carcinoma in situ were treated with a standard regimen of intravesical BCG. Urine samples were collected after each instillation and analysed; the levels of soluble CD14 were determined by an enzyme‐linked immunosorbent assay, the molecular weight confirmed by Western blotting and the possible cell source investigated using immunohistochemistry.

Results

 The mean levels of sCD14 were higher in patients with persistent carcinoma (designated as failures) than in those who had successful complete responses (responders) to BCG immunotherapy. The differences were statistically significant, with P=0.034 at instillation 4 and P=0.027 at instillation 5 for the total mass of sCD14, and P=0.049 at instillation 4 for the concentration of sCD14. The predominant type of sCD14 in urine was the 48 kDa form, although in most patients there was a minor band of reactivity at 54 kDa. A panel of human bladder cancer cell lines did not react with the anti‐CD14 monoclonal antibodies 3C10, 5C5 and BA8, and the antibodies also failed to react with malignant epithelial cells in frozen sections of untreated bladder tumour. Furthermore, sCD14 was not secreted by cultured bladder tumour cells. The source of urinary sCD14 is likely to be the resident and infiltrating macrophages in the bladder wall. Freshly isolated peripheral blood monocytes secreted sCD14 in response to BCG in a manner analogous to stimulation with bacterial lipopolysaccharide.

Conclusion

 A soluble form of CD14 is secreted into the urine of patients who receive intravesical BCG. The measurement of soluble urinary CD14 could be of prognostic significance for the response to immunotherapy.
Prevalence of enuresis and other bladder symptoms in patients with active Graves’ disease
Authors: GOSWAMI R. , SETH A. , GOSWAMI A.K. , KOCHUPILLAI N.
Published: November 2003

Objective

 To determine the prevalence of bladder symptoms in patients with Graves’ disease and assess their abnormalities on urodynamic studies.

Patients and methods

 The study comprised 30 consecutive patients (13 female, 17 male, mean age 31 years, sd 10) with active Graves’ disease. Before and after attaining euthyroidism with carbimazole, their bladder symptoms were assessed using a questionnaire adapted from the American Urologic Association voiding symptom score, the serum levels of total triiodo‐l‐thyronine (T3), serum thyroxine (T4) and thyroid‐stimulating hormone (TSH) were measured by radioimmunoassay, and uroflowmetry, cystometry and perineal muscle electromyography were performed.

Results

 Twelve of the 30 patients (40%) had the onset of bladder symptoms 1–6 months after the onset of symptoms of Graves’ disease; four of the 12 patients had enuresis. Urodynamic studies were possible in five patients and showed reduced flow rates in all, a significant post‐void residual volume in four, and enlarged bladder capacity and increased perineal muscle electromyographic activity during the voiding phase in three. Voiding disturbances and urodynamic abnormalities resolved after attaining euthyroidism.

Conclusion

 Significant bladder symptoms can occur in about 40% of patients with active Graves’ disease but resolve on euthyroidism; in some patients, urodynamic studies show significant abnormalities which are also reversible.
Surgical disconnection of lymphorenal communication for chyluria: a 15‐year experience
Authors: PUNEKAR S.V. , KELKAR A.R. , PREM A.R. , DESHMUKH H.L. , GAVANDE P.M.
Published: November 2003

Objective

 To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria.

Patients and methods

 Seventy‐eight patients (40 men and 38 women, age 22–58 years) with severe chyluria of variable duration (5 months to 14 years), underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules, lymphangiography to delineate the side, site and extent of lymphorenal communication, and cystoscopy to decide the side to be operated. The areolar tissue containing dilated lymphatics travelling to the kidney in the perirenal and hilar region was dissected and divided between ligatures, thus stripping these structures completely; only one side was operated at a time.

Results

 All 78 patients were available for a minimum follow‐up of 1 year, with the longest follow‐up 15 years. Lymphangiography showed unilateral communication in 52 (66%) and bilateral in 26 (34%). If the patient was given a high‐fat meal before surgery, the intra‐operative visualization of the lymphatics was improved. With unilateral surgery, clearance was achieved in 74 (94%) immediately, with final success in 69 (88%) patients. Of the 26 (34%) patients with bilateral lesions, nine (12%) required bilateral surgery, giving a clearance rate of 97%. In two cases of failure, repeat surgery was successful in one; thus the overall success rate was 98%.

Conclusion

 Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Bilateral lymphorenal communication seen on lymphangiography does not always warrant bilateral surgery.
The use of a multipurpose stent in children
Authors: ZAIDI Z. , MOURIQUAND P.D.E.
Published: November 2003

Objectives

 To assess the use of a multipurpose stent (the ‘Blue stent’, Angiomed Urosoft Pyeloplasty Stent, Bard, UK) in children undergoing pyeloplasty and ureteric reimplantation.

Patients and methods

 Between August 1994 and August 1996, the Blue stent was used in 50 renal units in 46 children aged 2 months to 12 years and 6 months. Twenty‐five children underwent pyeloplasty, 11 had ureteric reimplantation for vesico‐ureteric reflux (VUR), eight had ureteric reimplantation with remodelling for obstructed megaureters and in two patients it was used during the removal of stones. The mean follow‐up was 18 months (range 6–30 months).

Results

 After pyeloplasty, 22 patients (88%) had improved renal function and drainage with a decrease in hydronephrosis; two patients had a decrease in hydronephrosis only, one had an anastomotic leak and needed a repeat pyeloplasty and four developed a urinary tract infection (UTI). After ureteric reimplantation, VUR was not detected in any patient. Two patients had no change in drainage after remodelling and reimplantation of a megaureter, one was later diagnosed as having a neuropathic bladder and one child developed a UTI after ureteric reimplantation. The hospital stay was 3 days after pyeloplasty and 5 days after reimplantation.

Conclusion

 The design of the multipurpose Blue stent provides versatility; it can be used as a stent, and both an internal and external drain. Its use does not prolong the hospital stay. Insertion causes minimal trauma to the renal parenchyma, and removal is easy, pain‐free and requires no anaesthesia. The complication rates in the present series compare favourably with other reported series.
The effect of cryosurgical ablation of the prostate on erectile function
Authors: ABOSEIF S. , SHINOHARA K. , BORIRAKCHANYAVAT S. , DEIRMENJIAN J. , CARROLL P.R.
Published: November 2003

Objective

 To investigate the incidence and identify the possible cause of erectile dysfunction after cryoablation of the prostate.

Patients and methods

 Erectile function was examined prospectively in 15 sexually active men (aged 59–72 years) who underwent cryoablation of the prostate for clinically localized prostate cancer. Erectile function was assessed before and 6 months after treatment; after intracavernosal injection with 10 μg of prostaglandin E1 (PGE1), the degree and duration of erection, the size of the cavernosal arteries, the penile arterial blood flow velocity, and the time to achieve peak flow were evaluated using high‐resolution ultrasonography and colour pulsed‐Doppler spectral analysis.

Results

 Post‐operatively, all patients initially reported an inability to achieve an erection sufficient for vaginal intercourse. At 6 months′ follow‐up, erectile dysfunction persisted in nine, with minimal or no response to the intracavernosal PGE1 injections, there was a significant decrease in the peak velocity of blood flow within cavernosal arteries and a significant increase in the time to achieve peak arterial flow.

Conclusion

 Although many factors may contribute to erectile dysfunction after cryoablation of the prostate, vascular injury plays a major role.
Effect of oral administration of prostaglandin E1
Authors: SATO Y. , HORITA H. , ADACHI H. , SUZUKI N. , TANDA H. , KUMAMOTO Y. , TSUKAMOTO T.
Published: November 2003

Objectives

 To investigate the effect of limaprost, an oral prostaglandin E1 (PGE1) derivative, on erectile dysfunction and to compare the effects of limaprost with a Chinese herbal drug, gosyajinki‐gan.

Patients and methods

 The study comprised 50 consecutive patients with mild erectile dysfunction who showed a good erectile response to intracavernosal injection with 20 &mgr;g of PGE1. Limaprost was administered to the first 25 patients (30 &mgr;g three times daily) and gosyajinki‐gan (7.5 g three times daily) to the next 25 patients, for 8 consecutive weeks. Patients were evaluated by their ability to achieve vaginal penetration and by a subjective assessment of erectile function (penile rigidity and maintenance of erection) before and after the treatment, using a self‐administered questionnaire. Objective measurements (nocturnal penile tumescence, NPT, values) were also evaluated.

Results

 Eleven of the 24 patients who received limaprost without interruption and four of the 24 taking gosyajinki‐gan succeeded in vaginal penetration; the difference in the positive response rate was significant. The mean increment of NPT was significantly higher with limaprost treatment. However, all positive responders in both groups did not experience a full erection. There were no side‐effects in any patient except one in the limaprost group who developed a facial flush. Thus the treatment was mild enough to be tolerated.

Conclusion

 Limaprost was more effective for mild erectile dysfunction than was gosyajinki‐gan.
The treatment of benign prostatic hyperplasia with alpha blockers in men over the age of 80 years
Authors: KAPLAN S.A. , TE A.E. , IKEGUCHI E. , SANTAROSA R.P.
Published: November 2003

Objective

 To determine the safety and efficacy of alpha blockade with doxazosin and terazosin in men over the age of 80 years with symptomatic benign prostatic hyperplasia (BPH).

Patients and methods

 Thirty‐six men (mean age 83.6 years, sd 5.6, range 80‐96) received either doxazosin 4 mg (11 men) or 8 mg (10 men), or terazosin 5 mg (five men) or 10 mg (10 men), once daily at night. Twenty‐eight men (78%) were on other anti‐hypertensive medication; the type and dosage were not changed during the study. Efficacy and safety were assessed using measurements of peak urinary flow rate, symptom scores and the incidence of adverse events.

Results

 Of the 36 men, 33 (92%) remained on study medication at 6 months; the remaining three (8%) discontinued because of asthenia. After 3 months of treatment, the peak urinary flow rate increased significantly (P<0.008) for both doxazosin (+3.7 mL/s) and terazosin (+3.2 mL/s). The American Urological Association symptom score improved significantly (P<0.01) with both alpha blockers after 3 months of treatment and efficacy was maintained at 6 months. There were small, non‐significant decreases in blood pressure in patients receiving doxazosin or terazosin, but no differences between patients who were normotensive at baseline and those whose blood pressure was controlled by other anti‐hypertensive drugs.

Conclusion

 These results suggest that alpha blockade with either doxazosin or terazosin is well tolerated and effective in older men with symptomatic BPH. Furthermore, patients on concomitant anti‐hypertensive medication need no alteration of their therapeutic regimen before the initiation of alpha blockade for BPH.
The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy
Authors: COLOMBO T. , AUGUSTIN H. , BREINL E. , SCHIPS L. , HUBMER G.
Published: November 2003

Objective

 To report the results of transurethral submucosal injection therapy of polydimethylsiloxane (PDS) to treat incontinence after radical prostatectomy (RP).

Patients and methods

 Since 1993, about 80 retropubic RPs have been carried out at our institution each year. Severe post‐operative incontinence occurred in six patients, with a mean duration of incontinence after RP of 28 months. The pre‐operative evaluation consisted of cysto‐urethroscopy and urodynamics. Because we have no experience with artificial sphincter implantation, transurethral injection therapy was used to treat the post‐operative incontinence, using PDS (vulcanized silicone rubber particles). This material has a mean particle size of 188 μm, providing stability of the material at the injection site. The six patients with severe post‐operative incontinence were treated using injection therapy with PDS.

Results

 After a mean follow‐up of 15.5 months, five patients, who suffered from day and night incontinence and required at least five pads per day, were dry after injection therapy. One patient improved significantly but still required two pads during the day, but was continent during the night; three patients required a second injection. A mean of 7.5 mL of PDS was used per patient and the side‐effects of therapy (dysuria and urinary retention) were minimal.

Conclusion

 Because PDS has excellent biocompatibility, few side‐effects or complications, transurethral injection therapy using silicone particles is a justifiable procedure for treating incontinence after RP.
Differential expression of acidic and basic fibroblast growth factors in benign prostatic hyperplasia identified by immunohistochemistry
Authors: DESHMUKH N. , SCOTSON J. , DODSON A.R. , SMITH P. H. , KE Y. , FOSTER C.S.
Published: November 2003

Objectives

 To detect the expression and to determine the relative cellular locations of the two peptide growth factors, acidic fibroblast growth factor (a‐FGF) and basic (b)‐FGF in tissues from human benign prostatic hyperplasia (BPH).

Materials and methods

 A series of 50 sequential and unselected cases of human BPH tissues, obtained after transurethral prostatectomy, was examined. Adjacent sections of formalin‐fixed and paraffin wax‐embedded tissues were stained immunohistochemically for expression of a‐FGF and b‐FGF using well‐characterized and commercially available antibodies. The stained tissue sections were assessed for the cellular distribution of immunohistochemical products and analysed according to the relative intensity of staining as well as the spatial relationships of positively stained cells.

Results

 Acidic‐FGF was weakly expressed with a pan‐cytoplasmic distribution within luminal glandular epithelial cells in regions of prostatic intra‐epithelial neoplasia (both PIN I and II) but not by non‐dysplastic normal or hyperplastic tissues. No expression of a‐FGF was detected in basal epithelial cells or in the stromal compartment of any tissue examined. In contrast, b‐FGF was strongly expressed within the cytoplasm of all basal epithelial cells, but not by luminal epithelial cells, in morphologically normal regions of all cases examined. Basal expression of b‐FGF was diminished, or absent, in regions of mild epithelial dysplasia, particularly those strongly expressing a‐FGF. Extensive nuclear and cytoplasmic expression of b‐FGF occurred predominantly in smooth muscle‐type stromal cells but not in all types of stromal cells.

Conclusions

 This study confirmed both a differential and a reciprocal expression of a‐ and b‐FGF in non‐dysplastic prostatic hyperplasia and in mildly dysplastic regions of prostatic tissues. While only small amounts of a‐FGF were expressed in BPH, exclusively in the luminal epithelial compartment, its consistent appearance in PIN I and II suggests that it might contribute to the early stages of PIN. Conversely, b‐FGF may be an important mediator of stromal‐epithelial interaction during the pathogenesis of BPH. These results provide new information about the relative expression of these growth factors, particularly in the architectural relationships between different cell‐types within normal and non‐malignant prostatic tissues.