bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Parenteral Oestrogen on the Coagulation System in Patients with Prostatic Carcinoma
Authors: HENRIKSSON P. , BLOMBÄCK M. , ERIKSSON A. , STEGE R. , CARLSTRÖM K.
Published: November 2008

Summary— Patients with prostatic carcinoma on oral oestrogen therapy have an altered coagulation system and suffer cardiovascular side effects. Oestrogens—especially oral oestrogens—are potent inducers of liver synthesised proteins, including coagulation factors.

We have assessed the effect of non‐oral oestrogen on the coagulation system in patients with prostatic carcinoma. Twelve patients were given monthly intramuscular injections of 320 mg polyoestradiol phosphate (PEP). No additional oestrogens were given. No change was found in any of the coagulation factors, including factor VII, with the exception of a significant decrease in antithrombin III. No patient, including 38 patients treated with PEP, had any cardiovascular complications after a mean follow‐up period of 12.9 ±0.7 months; 76% of the patients responded to treatment.

Parenteral administration of oestrogen caused a less marked change in the coagulation system than oral administration and should be the treatment of choice for prostatic carcinoma.
Endoscopic Transvesical Extramural Ureterolithotomy
Authors: LLOYD S. N. , KENNEDY C.
Published: November 2008

Summary— The technique of endoscopic transvesical extramural ureterolithotomy for calculi impacted in the lower ureter is described. Ten patients are presented in whom calculi could not be extracted using conventional methods; 9 of the 10 calculi were successfully removed using this approach with no long‐term complications.
Clinical Studies on Cell‐mediated Immunity in Patients with Urinary Bladder Carcinoma: Blastogenic Response, Interleukin‐2 Production and Interferon‐y Production of Lymphocytes
Authors: IKEMOTO S. , KISHIMOTO T. , WADA S. , NISHIO S. , MAEKAWA M.
Published: November 2008

Summary— Patients with advanced malignant neoplasms have a variety of abnormal lymphocyte functions. We examined the PHA blastogenic response, interleukin‐2 (IL‐2) production and interferon‐y (IFN‐y) production of lymphocytes in 39 bladder cancer patients and 20 control subjects. Correlation between these parameters was also studied. IL‐2 production was measured by 3H‐thymidine‐labelled CTLL‐2 assay, and IFN‐γ production was measured by immunoradiometric assay using 2 mouse monoclonal antibodies. As a result, in high stage bladder cancer patients, the PHA blastogenic response, IL‐2 production and IFN‐γ production were impaired. However, these parameters were not significantly different between low stage bladder cancer patients and control subjects. There was a significant correlation between the PHA blastogenic response and IL‐2 production but no significant correlation between the PHA blastogenic response and IFN‐γ production.
Report of 200 Cases:Video Transurethral Resection
Authors: WIDRAN J.
Published: November 2008

Summary— Two hundred transurethral resections of the prostate (TURPs) were performed using a controlled continuous flow (CCF) resectoscope attached to a video camera by direct‐beam coupler. Standing comfortably, the surgeon used a video monitor as the source of judgment for manipulating the loop. Data obtained were statistically similar to those obtained from 400 previous resections using the same resectoscope by the conventional viewing method. TURP can be performed safely, more efficiently and more comfortably with the CCF video technique.
Is Routine Primary Retroperitoneal Lymph Node Dissection Still Justified in Patients with Low Stage Non‐seminomatous Testicular Cancer?
Authors: AASS NINA , FOSSA SOPHIE D. , OUS S. , LIEN H. H. , STENWIG ANNA E. , PAUS ELISABETH , KAALHUS O.
Published: November 2008

Summary— We present 8 years' experience of primary retroperitoneal lymph node dissection (RLND) in 190 patients with low stage non‐seminoma; 154 patients had clinical stage I (CSI) and 36 had clinical stage lla (CSIIa) disease. Of the 154 patients with CSI tumours, 33 had increased serum AFP and/or HCG before RLND (CSIM +)and 121 had normal tumour markers (CSIM‐).

Retroperitoneal lymph node metastases (pathological stage II) (PSII) were found in 38 of 121 patients with CSIM ‐, in 19 of 33 patients with CSIIM + and in 26 of 36 patients with CSIIa. In a multivariate analysis, the presence of small vessel infiltration (demonstrated in histological sections of the primary tumour) and a prolonged tumour marker half‐life were predictive factors for PSII. These 2 factors enabled a group of non‐seminoma patients with CSI disease to be identified who had a 15% risk of retroperitoneal tumour growth (low risk group) as compared with a high risk group where 60 to 70% of patients had retroperitoneal lymph node metastases.

Relapses occurred in 7 of 107 patients with PSI and in 6 of 83 patients with PSII disease; in the latter group, 5 relapses developed before the start of routine adjuvant chemotherapy; 6% of patients developed major post‐operative complications. In addition, “dry ejaculation” was the principal side effect following RLND (unilateral RLND: 20/132 patients; bilateral RLND: 50/54 patients).

The comparative cost to the health service during the first year of follow‐up was estimated for low risk non‐seminoma patients with CSI subjected to RLND and for those in whom a surveillance policy was adopted. The latter approach was preferable.

It was concluded that a surveillance policy should be followed in low risk non‐seminoma CSI patients provided that frequent follow‐up is possible. A more active policy is recommended in high risk patients (e.g. adjuvant chemotherapy without RLND). Nerve‐sparing RLND may be considered in patients with CSIIa disease and negative tumour markers.
Circumcision—Which Dressing?
Authors: GOUGH D. C. S. , LAWTON NORA
Published: November 2008

Summary— Three methods of circumcision dressing were compared in a prospective trial. The results showed that dressings containing tincture of benzoin adversely affected wound healing in children. Dressing the wound with greasy tulle gave better results; the addition of soframycin did not produce better results than those achieved with ordinary paraffin tulle.
Ureterovaginal Fistula: Summary of 18 Years' Experience
Authors: MANDAL A. K. , SHARMA S. K. , VAIDYANATHAN S. , GOSWAMI A. K.
Published: November 2008

Summary— Ureterovaginal fistula is an uncommon complication of pelvic operations. We report 31 such cases seen over an 18‐year period, all of which followed surgery for benign gynaecological conditions. Most patients had no urinary symptoms until the sudden onset of incontinence 1 to 4 weeks post‐operatively. Diagnosis was established by a combination of intravenous urography, cystography, cystoscopy, retrograde ureteropyelography and dye studies. Twenty‐nine patients underwent ureteroneocystostomy, 10 with a Boari flap and 19 by a direct method; fistulas healed in 2 patients following conservative treatment. Renal salvage was achieved in all cases.
Pituitary Adrenal and Gonadal Endocrine Suppression for the Primary Treatment of Prostate Cancer
Authors: WILLIAMS GORDON , ASOPA R. , ABEL P. D. , SMITH C.
Published: November 2008

Summary— Sixty new patients with advanced local or metastatic prostatic cancer were randomised to receive either bilateral orchiectomy, orchiectomy plus dexamethasone 0.5 mg in the morning and 0.3 mg at night, or orchiectomy plus cyproterone acetate 100 mg 3 times per day. All surviving patients have been followed up for a minimum of 2 years. An improvement in both objective and subjective responses in patients receiving dexamethasone compared with those receiving cyproterone acetate suggests a possible additional role for the pituitary in the control of prostatic tumour growth. A larger study with longer follow‐up may be indicated.
Radical Nerve‐sparing Prostatectomy with Epidural Anaesthesia in 100 Patients
Authors: DRAGO J. R. , BADALAMENT R. A. , NESBITT J. A. , YORK J. P.
Published: November 2008

Summary— From August 1985 to January 1989, 100 patients were treated with radical nerve‐sparing prostatectomy with epidural anaesthesia. Transrectal ultrasound evaluation was available for most of these patients. Using the anatomical techniques of early dorsal vein ligation, hypogastric artery control and epidural anaesthesia, blood loss was minimised and 55 patients required no transfusions. In addition, with the use of ultrasound, PSA determination and pelvic CAT scan, 73 of these 100 patients had organ‐confined disease; 66 patients were potent pre‐operatively and 42 are potent post‐operatively.
Inflammatory Infiltrate in Prostatic Hyperplasia—Evidence of a Host Response to Intraprostatic Spermatozoa?
Authors: McCLINTON S. , EREMIN O. , MILLER I. D.
Published: November 2008

Summary— The inflammatory infiltrate was characterised in 20 samples of prostatic hyperplasia using cell surface specific monoclonal antibodies. The infiltrate was composed predominantly of CD‐3 + T‐lymphocytes. The distribution of the T‐lymphocyte subsets (CD‐4 and CD‐8) between the epithelial and stromal components of the gland was significantly different, with most of the intra‐epithelial infiltrate being CD8 +, T cytotoxic/suppressor cells. This may be a necessary immunological barrier, as in the epididymis, to prevent the development of autoimmunisation to sperm antigens.

Large numbers of CD4+ T helper/inducer cells and significant numbers of CD‐11c + macrophages were demonstrated in the extra‐glandular stromal tissues, suggesting a delayed type hypersensitivity reaction.

Intraprostatic spermatozoa have been demonstrated recently and we have confirmed this finding on post mortem specimens. It is postulated that the presence of an intra‐epithelial cytotoxic barrier and the marked stromal infiltrate may be due, in part, to the intermittent presence of spermatozoa within the prostate.
Validation of a Non‐invasive Device to Measure Intracavernous Pressure as an Index of Penile Rigidity
Authors: LAVOISIER P. , COURTOIS F. , PROULX J. , DURAND L.‐G. , de CARUFEL F.
Published: November 2008

Summary— Many authors agree with the importance of developing devices to measure penile rigidity. The devices that have been developed over recent years have defined penile rigidity in terms of stiffness. Penile stiffness, however, is believed to result from an increase in intracavernous pressure. The device presented here was therefore designed to estimate intracavernous pressure, rather than penile stiffness, as an index of penile rigidity. Validation of the penile cuff device was achieved by simultaneously recording penile cuff pressure and intracavernous pressure on patients undergoing artificial erections. The results showed a linear relationship and highly positive correlation coefficients between the 2 measures. The results demonstrate that the penile cuff may be used to estimate intracavernous pressure as an index of penile rigidity. The findings are discussed in terms of the possible applications of the cuff as a clinical tool to measure both penile tumescence and penile rigidity.
The Use of Prostatic Stents in Patients with Urinary Retention who are Unfit for Surgery: An Interim Report
Authors: McLOUGHLIN J. , JAGER R. , ABEL P. D. , DIN A. EL , ADAM A. , WILLIAMS GORDON
Published: November 2008

Summary— Under local anaesthesia, 19 patients (18 with acute and 1 with chronic urinary retention) underwent insertion of an expandable stainless steel tubular “stent” into their prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. The 18 patients with acute retention voided spontaneously following the initial stent procedure, but the patient with chronic retention required a period of suprapubic catheterisation. Following the endoscopic insertion of an additional stent this patient also voided spontaneously.

During a follow‐up period of 3 to 7 months (mean 4), 4 patients were lost to follow‐up. The remaining 15 patients all void spontaneously. Recurrent asymptomatic urinary tract infections were seen in all but 1 patient initially, but none of those who were followed up for over 5 months had evidence of infection.

Although the follow‐up period is limited, the results to date demonstrate that the insertion of an expandable prostatic stent is a safe and reliable method of treating acute urinary retention in patients unfit for surgery. Further follow‐up is required to assess long‐term safety and to exclude late complications.
Carcinoma of the Prostate Masquerading as Rectal Carcinoma
Authors: FOSTER M. C. , O'REILLY P. H.
Published: November 2008

Summary –We present 3 patients with prostatic tumours who presented with symptoms of rectal stenosis. In all 3 cases digital examination of the rectum revealed a mass suggestive of rectal carcinoma, but carcinoma of the prostate was suspected because of other clinical features and this was confirmed by biopsy. Treatment by hormonal manipulation resulted in a dramatic improvement in symptoms. The diagnostic and management difficulties associated with this unusual presentation of carcinoma of the prostate are described, together with a review of the literature.
Silent Testicular Metastasis from Carcinoma of the Prostate
Authors: KIRKALI Z. , REID R. , DEANE R. F. , KYLE K. F.
Published: November 2008

Summary –Secondary testicular tumours are rare, but metastasis of prostatic carcinoma to the testis is being reported more frequently. While this may not reflect a true increased incidence, more cases are detected by bilateral orchiectomy. Of 916 patients with carcinoma of the prostate diagnosed and treated over a period of 10 years, 124 underwent bilateral orchiectomy. Three patients were found to have testicular metastasis, 1 being bilateral. The route of spread seems to be through the lumen and/or lymphatics of the vas deferens. Although it is a sign of advanced disease, the prognostic significance is undetermined.
The Long‐term Outcome following “Special Clearance” after Vasectomy
Authors: DAVIES A. H. , SHARP R. J. , CRANSTON D. , MITCHELL R. G.
Published: November 2008

Summary –Between 1980 and 1985, 6067 out‐patient vasectomies were performed under local anaesthesia at the Elliot Smith Clinic in Oxford. During this period 151 men (2.5%) were given a “special clearance”. This sanctioned the discontinuation of other forms of contraception despite the persistence of scanty (< 10,000/ml) sperm in 2 consecutively examined semen samples at least 7 months after vasectomy. These men have been reviewed and further specimens of semen requested after a minimum follow‐up of 3 years (range 3–8); 50 patients supplied a specimen and all except 1 were azoospermic. No pregnancies attributable to failure of the vasectomy have been identified.
Immunofluorescentand Histochemical Staining Confirm the Identification of the Many Diseases Called Interstitial Cystitis
Authors: GILLESPIE LARRIAN , SAID J. , SOSTRIN S. , KLEIWER K.
Published: November 2008

Summary— Interstitial cystitis comprises a complex of diseases typified by symptoms of pelvic pain. Functional complaints do not aid the clinician in determining loss of anatomical capacity. Histochemical staining with PAS‐colloidal iron/Van Geison's counterstain offers improved diagnostic ability for the pathologist and correlates well with immunofluorescent findings. Four distinct diseases can be identified through immunofluorescent staining, indicating that each is the result of different responses of the urothelium and endothelium to injury. Loss of bladder capacity associated with these diseases can be expected with age, but immunofluorescent staining for IgM within the capillaries of the interstitium is a more sensitive predictor.
Assessment of Residual Urine in Men Following Catheterisation
Authors: PURKISS S. F.
Published: November 2008

Summary— There is a certain volume of urine left within the bladder which cannot be drained by a catheter. A dilutional method was used to calculate this residual volume in 15 men; 10 had acute retention secondary to benign prostatic hyperplasia and 5 had permanent indwelling catheters for neurogenic urinary incontinence.

The mean catheterised residual volume was 98.53 ml for patients with acute retention and 14.48 ml for patients with long‐term catheters.

The explanation for higher post‐catheterisation volumes in the acute retention group is probably multifactorial; bladder sacculation and diverticula, detrusor tone and reflux may all play a role.
Cell Cycling in Bladder Carcinoma Determined by Monoclonal Antibody Ki67
Authors: MELLON K. , NEAL D. E. , ROBINSON M. C. , MARSH C. , WRIGHT C.
Published: November 2008

Summary— Current methods of predicting prognosis in transitional cell carcinoma of the bladder fail to provide consistently reliable information about future tumour behaviour. The monoclonal antibody Ki67 recognises an antigen present in actively dividing cells and Ki67 reactivity has been shown to correlate with conventional prognostic indicators in several tumours. In this study, Ki67 antibody was used to determine the proportions of cells undergoing active division in 26 transitional cell carcinomas of the bladder.

The proportion of cells stained in muscle invasive tumours (12.3 ± 5.4%) was significantly greater than in superficial tumours (4.3 ± 1.9%) and poorly differentiated tumours showed significantly greater proportions of cells staining compared with well or moderately well differentiated tumours.

These results show that Ki67 reactivity correlates with high tumour stage and poor differentiation. Ki67 staining provides an easy method of determining tumour cell turnover that might provide additional prognostic information.
Assessment of Factors Influencing the Outcome of Radiotherapy for Bladder Cancer
Authors: DAVIDSON S. E. , SYMONDS R. P. , SNEE M. P. , UPADHYAY S. , HABESHAW T. , ROBERTSON A. G.
Published: November 2008

Summary— The results of treatment of 709 patients with carcinoma of the bladder are reported. Inclusion of the pelvic lymph nodes in the treatment volume failed to lead to any improvement in survival. The factors influencing survival were stage, tumour histology and differentiation. The presence of tumour at follow‐up cystoscopy at 3 months was of great prognostic significance.
Serum Follicle Stimulating Hormone–Predictor of Cancer in the Remaining Testis in Patients with Unilateral Testicular Cancer
Authors: WANDERAS EVA HOFF , FOSSA SOPHIE D. , HEILO A. , STENWIG ANNA E. , NORMAN N.
Published: November 2008

Summary— In 10 of 13 patients with unilateral testicular cancer and subsequent invasive cancer or carcinoma in situ in the remaining testis, the follicle stimulating hormone (FSH) level was elevated after the first orchiectomy and before further treatment. In only 4 of 26 comparable control patients was the FSH level raised. This may be because elevated serum FSH often reflects disturbances in spermatogenesis and fertility, the latter being a known risk factor for testicular cancer.

An elevated FSH level that occurs after orchiectomy for unilateral testicular cancer and before further treatment identifies patients at high risk of developing a tumour in the remaining testis.
The Use of Internalised Ureteric Stents in Renal Transplant Recipients
Authors: THOMALLA J. V. , LEAPMAN S. B. , FILO R. S.
Published: November 2008

Summary—Since 1982, we have used internal indwelling ureteric stents for the management and prevention of ureteric reconstruction complications in 28 renal allograft recipients.

A total of 30 stents were placed in 18 patients either diagnostically or therapeutically in the management of allograft ureteric obstruction. In 16 patients internal stents were placed at the time of reconstruction for primary ureteropyelostomy (3), secondary ureteropyelostomy (8), repeat reimplant (3) and repair of ureteric or pelviureteric junction injury (2).

Complications included 3 episodes of transplant pyelonephritis, proximal stent migration (1), persistent bacteriuria (1) and prolonged healing of a ureteropyelostomy (1).

Internalised ureteric stenting is a safe and effective means of managing or preventing ureteric reconstruction complications in renal transplant recipients.
Effect of Bladder Outflow Obstruction on the Innervation of the Rabbit Urinary Bladder
Authors: HARRISON S. C. W. , FERGUSON D. R. , DOYLE P. T.
Published: November 2008

Summary—The effects of bladder outflow obstruction on the innervation of the bladder were studied using a rabbit animal model. Partial occlusion of the bladder neck was obtained by the placement of a silk ligature at that level; control animals underwent a sham procedure. After a 3‐month period, the presence of outflow tract obstruction was confirmed using urodynamic studies. The animals were then killed and pharmacological assessments of the bladder innervation undertaken.

Detrusor muscle strip studies provided evidence of damage to the cholinergic innervation of the detrusor. Also, muscle strips from obstructed animals showed reduced inhibitory responses to p‐adrenergic stimulation with isoprenaline. In addition to these muscle strip studies, the bladder content of the neuropeptide substance P was assayed, but no significant change was observed in response to obstruction. This finding suggests that substance P‐containing sensory nerves may be spared from the denervating effect of bladder outflow obstruction.
Reduced Bladder Capacity in Patients Receiving Intravesical Chemoprophylaxis with Mitomycin C
Authors: EIJSTEN A. , KNÖNAGEL H. , HOTZ E. , BRÜTSCH H. P. , HAURI D.
Published: November 2008

Summary— After complete resection of superficial bladder carcinoma (Tis‐2, G1‐3), 75 patients were treated prophylactically with either 20 or 30 mg mitomycin C. Six patients developed a substantial reduction in bladder capacity (less than 200 ml). In 2 patients radical cystectomy of an otherwise tumour‐free fibrotic bladder was necessary. The results of long‐term treatment (2 years) suggest that reduced bladder capacity correlates with the cumulative dosage of mitomycin C.
Variations in Urethral and Bladder Pressure during Stress Episodes in Healthy Women
Authors: THIND P. , LOSE G. , J0RGENSEN LISBETH , COLSTRUP H.
Published: November 2008

Summary— Pressure variations in the urethra and bladder during stress episodes and their time separations were investigated in 30 healthy female volunteers. The pressure was measured by means of a double microtip transducer catheter with the distal sensor in the bladder and the proximal sensor at the bladder neck, the mid‐urethra and the distal urethra. In advance of the pressure spike during cough a pressure rise was demonstrated in the bladder and at all 3 sites of measurement in the urethra. The urethral pressure increments preceding and following the pressure spike were statistically significantly higher in the mid‐urethra than the corresponding bladder pressures. This active urethral pressure generation in the mid‐urethra and distal urethra was initiated 200 ms before the bladder pressure began to rise. The pressure in the urethral high pressure zone was higher than the bladder pressure in all cases. Passive pressure transmission to the urethral high pressure zone can take place only insignificantly due to a continuous higher pressure inside the urethra than in the bladder and due to the location of the high pressure zone in the demarcation of the abdominal cavity. It was concluded that the urethral pressure rise in the high pressure zone during stress episodes is mainly generated actively by intra‐ and/or peri‐urethral structures.
Treatment of Outflow Tract Obstruction due to Benign Prostatic Hyperplasia with the Pollen Extract Cernilton
Authors: BUCK A. C. , COX R. , REES R. W. M. , EBELING L. , JOHN A.
Published: November 2008

Summary— Whilst prostatectomy remains the “gold standard” for the treatment of outflow tract obstruction due to benign prostatic hyperplasia, medical treatment–if only for symptomatic relief–appears to be an attractive alternative. Most of the pharmacological agents in use block the hormonal or the sympathetic neurological pathways that influence prostate growth and function. All of these drugs are known to have side effects.

Sixty patients with outflow obstruction due to benign prostatic hyperplasia (BPH) were entered into a double‐blind, placebo‐controlled study to evaluate the effect of a 6‐month course of the pollen extract, Cernilton. There was a statistically significant subjective improvement with Cernilton (69% of the patients) compared with placebo (30%). There was a significant decrease in residual urine in the patients treated with Cernilton and in the antero‐posterior (A‐P) diameter of the prostate on ultrasound. However, differences in respect of flow rate and voided volume were not statistically significant. It is concluded that Cernilton has a beneficial effect in BPH and may have a place in the treatment of patients with mild or moderate symptoms of outflow obstruction.
Prostatic Carcinoma: Histological and Immunohistological Factors Affecting Prognosis
Authors: COHEN R. J. , GLEZERSOIM G. , HAFFEJEE ZENOBIA , AFRIKA D.
Published: November 2008

Summary— Neuroendocrine or paracrine cells of the human prostate and urethra have been identified by various methods, predominantly silver stains and immunocytochemistry. The incidence of neuro‐endocrine differentiation in prostatic carcinoma has varied considerably from 10 to 100%, but has not been studied previously as an independent factor affecting prognosis.

Nucleolar organiser regions (NORs) are loops of ribosomal RNA occurring in the nucleoli of cells which ultimately process RNA genes. NORs have been demonstrated by silver (Ag) staining techniques and have been studied in numerous malignant tumours. A pilot study from this laboratory has shown a distinct and significant difference in AgNOR staining between prostatic carcinoma and benign prostatic epithelial hyperplasia.

A retrospective study was performed with at least 6 years' follow‐up. This confirmed the presence of neuro‐endocrine cells in more than half of the patients under investigation. A significant correlation between survival and the absence of neuro‐endocrine cells was demonstrated. AgNOR staining was shown to be of no prognostic value.
Family Screening for Duplex Kidneys
Authors: O'NEILL EILEEN M.
Published: November 2008

Summary— Family screening was offered to the relatives of 57 patients with duplex renal systems and this resulted in the detection of another 37 cases. A further 5 first degree relatives had abnormal intravenous urography, so that 25% of the screened relatives had significant renal abnormalities. It is suggested that there may be a place for screening the whole family if renal tract duplex is detected.
Crystalluria, Medullary Matrix Crystal Deposits and Bladder Calculi Associated with an Acutely Induced Renal Papillary Necrosis
Authors: BACH P. H.
Published: November 2008

Summary— A single (100 mg/kg) intraperitoneal dose of 2‐bromoethanamine hydrobromide induced renal papillary necrosis (RPN) acutely in rodents and caused a transient crystalluria between 4 and 8 h after dosing. These crystals comprised struvite or magnesium ammonium phosphate (MAP) as assessed by shape, solubility, infra‐red spectrum and X‐ray microprobe analysis. Acid‐soluble, bi‐refringent crystals were also present within the renal medullary matrix during the same time period as the crystalluria. The presence of the MAP was associated with loss of the anionic renal medullary mucopolysaccharides staining. A total of 5/64 rats with a 2‐bromoethanamine‐induced renal papillary necrosis and monitored for up to 160 days had bladder calculi that were predominantly MAP. These data suggest that medullary mucopolysaccharide matrix disruption associated with RPN leads to a release of previously bound cations, super‐saturation and the nucleation of crystalline MAP. These processes could also be implicated in the formation of MAP bladder calculi.
Bladder Function in the Mentally Retarded
Authors: HELLSTRÖM P. A. , JÄRVELIN MARJO‐RIITTA , KONTTURI M. J. , HUTTUNEN N.‐P.
Published: November 2008

Summary— A group of 21 mentally retarded patients with severe, long‐standing urinary symptoms underwent urodynamical investigation. The most common abnormalities were detrusor areflexia and detrusor hyper‐reflexia. Of 11 patients treated surgically, 10 derived marked benefit. Drugs were successful in reducing micturition problems in 3/6 patients. Severely retarded patients with spastic quadriplegia are difficult to investigate and if this is associated with detrusor hyper‐reflexia it is impossible to treat them in any way. Severely retarded patients with detrusor areflexia and infrequent voiding can benefit from bladder outlet surgery. Patients with moderate (especially mild) retardation can be investigated and treated in the same way as non‐retarded people.
Origin and Structure of Benign Prostatic Hyperplasia
Authors: JONES D. R. , PARKINSON M. C. , GRIFFITHS G. J. , DAVIES R. LI. , PEELING W. B.
Published: November 2008

Summary— The development of microradiography of the prostate gland has provided a new approach to investigating the origin and structure of benign hyperplasia. It has demonstrated that benign prostatic hyperplasia is usually microadenomatous in structure, although reticular types do occur. It originates at the lateral boundary of the periurethral muscle in the position of the transitional zone. In contrast, stromal nodules are homogeneous and amorphous in structure and develop at the site of the short straight urethral ducts within the periurethral muscle.
Blunt Renal Trauma in Childhood. Features Indicating Severe Injury
Authors: QUINLAN D. M. , GEARHART J. P.
Published: November 2008

Summary— The clinical presentation of children with blunt renal trauma may differ from that of adults. The clinical features at presentation of 50 consecutive children (20 severe injuries, no pedicle injuries) admitted over a period of almost 8 years were reviewed to determine if there were clinical clues to major renal trauma in childhood. Gross haematuria and low haematocrit were the most helpful factors at the time of presentation and correlated well with severe renal injury. Hypotension was seen in 4 patients and only 1 had severe renal trauma. Suspicion of a major renal injury should be high when there is gross haematuria or a low haematocrit. In this study only 1 of 20 patients with major renal injury demonstrated clinical signs of shock. Unlike adults, hypotension does not appear to be a reliable indicator of the severity of renal injury in children and diagnostic evaluation should not be reserved only for those in shock.
Mobile Extracorporeal Shockwave Lithotripsy
Authors: RAJAGOPAL V. , BAILEY M. J.
Published: November 2008

Summary— During the last 18 months, extracorporeal Shockwave lithotripsy (ESWL) has been provided at Epsom District Hospital using a mobile unit containing a Dornier HM4 lithotriptor. Patients with upper ureteric and renal stones were selected for treatment, which was performed without anaesthesia or sedation as a day‐case procedure; 83 patients were treated, 5 of them with bilateral stones. Seventy patients required 1 treatment session, 17 required 2 and 1 patient required 3. There were no serious complications but 3 patients needed ureteroscopy to remove obstructing stones. The overall success rate was 86%. The cost to treat each NHS patient was £253.

Mobile lithotripsy as a day‐case procedure is a safe and cost‐effective means of treating urolithiasis and can be performed in a District General Hospital.
First UK Consensus Conference on Lithotriptor Terminology–1989
Authors: TOLLEY D. A. , WALLACE D. M. A. , TIPTAFT R. C.
Published: November 2008

Summary— Recommended definitions to be used in the reporting of results of lithotripsy treatment are presented. It is suggested that these are the minimum requirements for reporting such treatment.
Management of Staghorn Stones Using a Combination of Lithotripsy, Percutaneous Nephrolithotomy and Solution R Irrigation
Authors: HOLDEN D. , RAO P. N.
Published: November 2008

Summary— The treatment of staghorn and partial staghorn calculi remains complex despite modern methods of stone removal. We describe the results following treatment of 112 stones. Three methods were used: percutaneous nephrolithotomy, extracorporeal Shockwave lithotripsy and Solution R irrigation, either alone or in combination; 57 stones (55.8%) were completely cleared, with Solution R irrigation helping to achieve complete clearance in 6 of these. A further 24 stones were not completely cleared (small asymptomatic fragments <3 mm remained). A satisfactory outcome (stone‐free or asymptomatic fragments < 3 mm) was achieved in 81 stones (79%).
The Impact of Extracorporeal Piezoelectric Lithotripsy on the Management of Ureteric Calculi: an Audit
Authors: PARR N. J. , RITCHIE A. W. S. , MOUSSA S. A. , TOLLEY D. A.
Published: November 2008

Summary— The presentation and management of 153 patients with ureteric calculi requiring active treatment over a 12‐month period were reviewed; 74% of patients had primary ureteric calculi and 26% had ureteric calculi composed of fragments resulting from extracorporeal piezoelectric Shockwave lithotripsy (EPL) to renal calculi; 32 patients (21%) had more than 1 calculus or a steinstrasse.

The primary procedures included were in situ EPL (n = 54), push‐bang (44), retrograde ureteroscopy (40), Dormia basket extraction (6), push‐pull (1), antegrade ureteroscopy (1) and combinations of these (7). The success of the primary procedure could not be predicted from stone size, site or duration in the ureter, but upper tract dilatation was significantly less (p<0.01) in the successful group. The overall success rate for complete stone extraction was 97%, but 54 patients (35%) required more than 1 procedure to achieve this. In situ EPL and push‐bang, as either primary or secondary procedures, were successful in treating 79 patients (52%); 2 patients required ureterolithotomy (1.3%). The overall complication rate was 18%.

Since EPL is only successful in treating approximately half of ureteric calculi, a range of other treatments should be available to maintain a low rate of open surgery.
Upper Tract Tumours following Cystectomy for Bladder Cancer. Is Routine Intravenous Urography Worthwhile?
Authors: HASTIE K. J. , HAMDY F. C. , COLLINS M. C. , WILLIAMS J. L.
Published: November 2008

Summary— The incidence and presentation of upper tract tumours were studied in 180 patients who had previously undergone cystectomy for transitional cell carcinoma of the bladder. Intravenous urography was performed routinely 3 months after cystectomy, 1 year later and at 3‐yearly intervals thereafter. Ten patients developed upper tract tumours; 1 presented with loin pain and the remainder with haematuria.

Six patients underwent nephroureterectomy and 5 of them lived for at least 4 years; 4 were inoperable and only 1 survived longer than 6 months.

In this series, all patients with upper tract tumours presented with symptoms and routine intravenous urography failed to detect any asymptomatic lesions. Routine radiological assessment of the upper tracts to detect tumours is not justified following cystectomy.
Urodynamic Morbidity and Dysuria Prophylaxis
Authors: CARTER P. G. , LEWIS PATRICIA , ABRAMS P.
Published: November 2008

Summary— A group of 324 patients received prophylactic treatment with either sodium bicarbonate, potassium citrate or a glucose placebo following urodynamic studies. Urine was screened for infection both before and after testing and the incidence of dysuria assessed by postal questionnaire; 63% of patients experienced some degree of dysuria and this was severe and prolonged in 6.3%, the majority of whom were male. Neither sodium bicarbonate nor potassium citrate was any more effective in preventing dysuria than placebo. The presence of severe prolonged dysuria was not associated with a urinary tract infection or with any particular urodynamic diagnosis.
Clinical Significance of the “Palpable Mass” in Patients with Muscle‐infiltrating Bladder Cancer Undergoing Cystectomy after Pre‐operative Radiotherapy
Authors: FOSSÅ SOPHIE D. , OUS S. , BERNER A.
Published: November 2008

Summary— Between 1976 and 1985, 132 patients with T2/T3/T4a bladder cancer underwent cystectomy after pre‐operative radiotherapy (46 Gy: 67 patients; 20 Gy: 65 patients). After a median time of 41 months, 62 patients were alive; 51 had died from recurrent bladder cancer and 19 from intercurrent disease without recurrence of their malignancy. Distant metastases developed in 40 patients, accompanied in 5 cases by local recurrence. Local recurrence was the first sign of relapse in 11 patients. In 3 patients the localisation of the relapse remained unknown.

The corrected 5‐year survival rate was 60%. T category and a palpable bladder tumour were independent pre‐treatment prognostic factors in a Cox regression analysis, together with the interval between initial diagnosis and cystectomy. The presence of a palpable tumour before the start of treatment was associated with a particularly poor prognosis in T3/T4a tumours, whereas the survival of patients with non‐palpable T3/T4a tumours was similar to that of patients with T2 bladder cancer. Another important prognostic factor was post‐irradiation stage reduction (no residual muscle infiltration in the cystectomy specimen). Significantly more patients with nonpalpable bladder tumours experienced post‐radiation stage reduction than did those with a palpable tumour. However, the prognostic value of stage reduction was statistically significant only in patients with palpable bladder tumours.
Radical Radiation Treatment of Invasive and Locally Advanced Bladder Carcinoma in Elderly Patients
Authors: SMAALAND R. , AKSLEN L. A. , TØNDER B. , MEHUS A. , LOTE K. , ALBREKTSEN G.
Published: November 2008

Summary— A total of 146 patients with invasive or locally advanced carcinoma of the bladder (T2‐T4) underwent radiation treatment. A significantly higher complete response rate was observed with doses equal to or above 55 Gy and with doses corresponding to cumulative radiation effect (CRE) values of 1700 radiation effect units (reu) or more. In multivariate analysis, decreasing time from the first diagnosis of bladder carcinoma to radiation treatment and 1 or more transurethral resections was associated with a significant increase in survival; increases in T category and sedimentation rate were negative prognostic factors. Although both radiation dose and CRE levels had a significant effect on survival in univariate analysis, an increase in CRE levels alone was associated with a significant increase in survival in multivariate analysis. However, the most important predictor of survival was whether the patient showed a complete local response or not. This study emphasises the importance of treating patients with an adequate radiation dose over a short period of time in order to achieve the maximum radiobiological effect and thereby increase the possibility of cure.
Quantitative Analysis of the Accuracy of Linear Array Transrectal Ultrasound in Measurement of the Prostate
Authors: YIP Y. L. , CHAN C. W. , LI C. K. , CHU V. , LAU M. L.
Published: November 2008

Summary— In 61 prostate autopsy specimens, linear array transrectal ultrasound and electronic vernier calipers were used to measure 3 maximal diameters along the longitudinal, anterior‐posterior and transverse axes. The results were comparable. We assessed the reliability of empirical formulae, derived from various combinations of these 3 diameters, for the prediction of prostatic volume and weight. Formulae using all 3 diameters were accurate. The combination of longitudinal and anterior‐posterior diameters, which was used clinically for prostate measurement, was less accurate.
Renal Oncocytomas–An Australian Experience
Authors: FRYDENBERG M. , ECKSTEIN R. P. , SAALFIELD J. A. A. H. , BRESLIN F. H. D. , ALEXANDER J. H. , ROCHE J.
Published: November 2008

Summary— A review was made of 24 cases of renal oncocytoma seen between 1978 and 1989. There was considerable overlap between the clinical presentation of renal oncocytomas and renal carcinomas. Although pre‐operative radiological, cytological and pathological investigations may suggest the presence of an oncocytoma, these studies cannot make a definitive diagnosis. We recommend that these tumours be treated as potential renal carcinomas until post‐operative microscopic evaluation proves otherwise.
Urethral Blood Circulation during Cardiopulmonary Bypass
Authors: TALJA M. , LEHTOLA A. , SALMENPERÄ M. , RUUTU M. , KARONEN S.‐L. , ALFTHAN O.
Published: November 2008

Summary— The haemodynamic changes induced by extracorporeal circulation (ECC) are thought to be important in the induction of urethral strictures in open heart surgery when indwelling latex catheters are used.

In the present study, 6 piglets were cannulated and connected to extracorporeal perfusion apparatus. Pump flows correlated with human ECC values with non‐haemic prime were used. The mucosal and submucosal blood circulation in the urethra reduced by 66% during ECC (P<0.05). The brain and hepatic arterial flows increased. A significant reduction was seen in renal blood circulation.

The changes in the urethral blood circulation during ECC correlated with previous findings. The reduced wash out levels of chemicals leaching from the indwelling latex catheters as a result of reduced local blood circulation are the main trigger for the induction of urethral strictures during ECC and in other shock‐like circulatory disturbances in the human body.
Effect of Clean Intermittent Catheterisation on Radiological Appearance of the Upper Urinary Tract in Children with Myelomeningocele
Authors: LINDEHALL BIRGITTA , CLAESSON I. , HJÄLMÅS K. , JODAL U.
Published: November 2008

Summary— Of the 102 consecutive children with myelomeningocele who were treated by intermittent catheterisation between 1977 and 1985, 89 were investigated with regard to the development of the upper urinary tract. The median follow‐up period was 6.7 years. Dilatation and vesicoureteric reflux were assessed by means of repeated urography and voiding cystourethrography. Of the 49 children with normal radiology at the start of catheterisation, all but 2 remained normal. In 27 with isolated dilatation of the upper urinary tractor reflux at the start, 17 subsequently became normal. Dilatation together with reflux was seen in 13 patients at the start; 3 became normal, 4 still had reflux and in 6 patients both dilatation and reflux persisted. Intermittent catheterisation thus had a positive effect on the upper urinary tract in the vast majority of cases. In children with both dilatation and reflux, however, there is a risk of deterioration and they should be followed up closely.
One‐stage Hypospadias Repair: Experience of 367 Cases
Authors: RICKWOOD A. M. K. , ANDERSON P. A. M.
Published: November 2008

Summary— Over a 6½‐year period we performed 374 primary hypospadias repairs, all but 7 as single‐stage procedures. We usually employed the MAGPI, tubed preputial island flap and Mathieu reconstructions. Complications were comparatively few, with an overall incidence of 5% fistulae, 3% anastomotic strictures and 7% meatal retraction or stenosis. The cosmetic results were superior to those of staged procedures in that it was almost always possible to obtain a glanular meatus which was both terminal and realistic.
Urinary Retention after Pyeloplasty
Authors: DAVIES A. H. , CRANSTON D.
Published: November 2008

Summary— A retrospective review of 37 pyeloplasties, performed between 1984 and 1988, revealed that 38% of patients had post‐operative retention requiring catheterisation, compared with 8% in an age and sex matched group of patients undergoing cholecystectomy. This suggests that direct surgical trauma to the upper genitourinary system may inhibit bladder function. We therefore suggest that pre‐operative catheterisation should be considered in theatre, for patients undergoing pyeloplasty.
Incontinence in the Elderly: Objective Demonstration and Quantitative Assessment
Authors: GRIFFITHS D. J. , McCRACKEN P. N. , HARRISON GLORIA M.
Published: November 2008

Summary— Subjective and objective methods of demonstrating incontinence and assessing its severity have been compared in a group of elderly patients with a high incidence of severe urge incontinence. It was found that 24‐h in‐patient monitoring of urine leakage was the most sensitive method of demonstrating incontinence, with videourodynamic testing almost as good. In comparison, a 1 ‐h pad test was poor. Visual inspection during physical examination seldom demonstrated leakage. For quantitative assessment of severity, 24‐h monitoring gave the most reproducible results; it was also able to reveal significant changes in severity in response to pharmaceutical treatment. A 1 ‐h pad test was less reproducible and suggested changes that were only poorly consistent with 24‐h monitoring. The subjective responses of the patients were not useful in assessing changes in the severity of incontinence. Twenty‐four hour monitoring thus stands out as a superior method of demonstrating and assessing incontinence.
Bladder Instillations of Trisdine Compared with Catheter Introducer for Reduction of Bacteriuria during Intermittent Catheterisation of Patients with Acute Spinal Cord Trauma
Authors: PEARMAN J. W. , BAILEY M. , RILEY L. P.
Published: November 2008

Summary— An open, prospective, randomised trial was conducted to compare the incidence of significant bacteriuria following 2 methods of intermittent urethral catheterisation in patients with acute spinal cord trauma. Twenty‐two patients were catheterised with a Nelaton catheter and 50 ml of Trisdine were instilled into the bladder and left there immediately prior to withdrawal of the catheter. Fifteen patients were catheterised with a Nelaton catheter with a special introducer to improve asepsis (O'Neil catheter). The mean incidence of significant bacteriuria in males and females who received Trisdine bladder instillations was 0.58 and 0.48% per catheterisation respectively; in males and females catheterised with the O'Neil catheter it was 1.16 and 2.93% per catheterisation respectively. The instillation of Trisdine into the bladder after each passage of a catheter resulted in a significantly lower incidence of bacteriuria compared with that which resulted from the use of the O'Neil catheter. The former method is therefore to be preferred for aseptic intermittent urethral catheterisation in patients with acute spinal cord trauma.
Relationship between Urease‐producing Bacteria, Urinary pH and Encrustation on Indwelling Urinary Catheters
Authors: HEDELIN H. , BRATT C.‐G. , ECKERDAL G. , LINCOLN K.
Published: November 2008

Summary— In 11 patients with long‐term indwelling catheters the amount of catheter encrustation and urinary pH were measured and the urine regularly cultured over a prolonged period of time (median of 7 periods of 3 weeks). The mean urinary pH was related to the persistent presence of urease‐producing micro‐organisms (P. mirabilis) and urinary pH governed the precipitation of catheter encrustation. The critical pH appeared to be around 6.8. In patients with a mean urinary pH below this level the encrustation was minute (≤2.9 mg phosphate). In patients with a mean urinary pH above 6.8 it was considerable but with a marked interindividual variation (35.5–138.7 mg phosphate). The composition of the encrustation was also strongly pH‐related, with a much higher proportion present as magnesium ammonium phosphate in patients with a mean urinary pH above 6.8. The persistent presence of urease producers was not associated with a high pH or a more pronounced precipitation of phosphate in all patients. The amount of encrustation thus appears to depend not only on the presence of urease‐producing micro‐organisms but also on individual factors such as urinary composition.