bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic significance of angiogenesis in transitional cell carcinoma of the human urinary bladder
Authors: Philp E.A. , Stephenson T.J. , Reed M.W.R.
Published: November 2003

Objectives To quantify tumour angiogenesis in bladder cancer and determine whether it correlates with tumour stage, grade and survival.

Patients and methods Archival samples from a total of 113 patients newly presenting with transitional cell carcinomas of the urinary bladder were graded and staged, and analysed for angiogenic blood vessel density by a double immunohistochemical technique. The findings were correlated with the information obtained during a minimum follow‐up of 12 years.

Results Univariate analysis showed that TNM stage (P=0.02) and mean vessel count (P=0.01) were significant predictors of death from bladder cancer. Blood vessel density was significantly correlated with tumour stage (P=0.01) and the presence of vascular invasion (P=0.007). Trained observers were essential for the accurate counting of blood vessels to prevent excessive inter‐observer variability. Multiple regression analysis showed that the combination of mean vessel count and stage was a significant prognostic indicator.

Conclusion Angiogenesis in primary bladder cancer is a predictor of death from the disease. Further work to determine whether it predicts invasion and recurrences in superficial tumours may be valuable.
Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature‐sensitive device
Authors: Eckford S.D. , Finney R. , Jackson S.R. , Abrams P.
Published: November 2003

Objectives To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode‐based temperature‐sensitive device in the detection of episodes of urinary incontinence in long‐term ambulatory monitoring (LTAM) studies.

Subjects and methods Perineal temperature recordings were made in 46 women during various activities. A temperature‐sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects.

Results A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature‐sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test.

Conclusions This temperature‐sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integrated voiding channel.
Increased urinary excretion of lipids by patients with kidney stones
Authors: Khan S.R. , Glenton P.A.
Published: November 2003

Objective To test the hypothesis that patients with calcific kidney stones (stone formers) excrete more lipids and cell membranes in their urine than do normal individuals.

Patients, subjects and methods Lipids were isolated from the urine of patients with calcific stones (four women and six men, age range 28–69 years) and from normal subjects (three men and three women, age range 31–54 years). Different phospholipids, neutral lipids and glycolipids were identified using thin layer chromatography and individual lipids were characterized by several assays after scraping the spots from the plates, or by densitometry.

Results Stone formers excreted more lipids and acidic phospholipids than did normal individuals; the urinary excretion of glycolipid, cholesterol and cholesterol esters was also increased.

Conclusions The greater excretion of lipids may reflect the increased turnover of cells in the tubular epithelium and sloughing of cells into the urine in response to a challenge by oxalate and calcium oxalate crystals. Acidic phospholipids from cellular membranes of the sloughed epithelial cells may be involved in crystal nucleation and retention within the kidneys and thus the initial development of stone nidus and the continued growth thereafter.
Experience in renal autotransplantation:
Authors: Plas E. , Kretschmer G. , Stackl W. , Steininger R. , Mühlbacher F. , Pflüger H.
Published: November 2003

Objective To determine the benefit of renal autotransplantation in selected patients with either renovascular lesions, renal or urothelial carcinomas or other disorders of the urinary collecting system.

Patients and methods Between 1977 and 1994, 12 patients underwent renal autotransplantation, six involving renovascular hypertension, two involving tumours of the renal parenchyma, two with urothelial tumours and two with long ureteric stenoses. Pre‐operative renal function was normal in six patients and impaired in five. One patient was on haemodialysis. Five patients had a solitary kidney and four patients had functionally solitary kidneys. The follow‐up period ranged from 1 to 93 months (mean 34.9).

Results Post‐operatively, six patients had normal kidney function (serum creatinine ≤12 mg/L), five patients had impaired renal function (creatinine content ≤26 mg/L) and one patient was on haemodialysis due to arterial graft thrombosis. Serum creatinine levels improved in four patients and were stable in another four. Renal function deteriorated in three patients and one patient required a graft‐nephrectomy. Immediate post‐operative complications included arterial thrombosis in one patient, perirenal haematoma in two, pulmonary oedema in one and severe intra‐operative bradycardia requiring a transient cardiac pacemaker in one.

Conclusion Renal autotransplantation represents an effective alternative treatment with good long‐term results for selected patients with long ureteric lesions and renovascular disorders. It is also an effective method for patients with urological malignancies, especially those with solitary kidneys where the maintenance of renal function is of major concern.
Long‐term predictive role of urodynamics: an 8‐year follow‐up of prostatic surgery for lower urinary tract symptoms
Authors: Jensen K.M.‐E. , Jørgensen J.B. , Mogensen P.
Published: November 2003

Objective

 To investigate the long‐term predictive value of urodynamics for the outcome of patients undergoing prostatic surgery for lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) and to determine the long‐term effectiveness on symptoms, maximum flow rate and the rate of re‐operation.

Patients and methods

 Of 139 elderly men who had undergone prostatic surgery, selected without reference to urodynamic assessment but having extensive (blinded) urodynamic testing included in their evaluation, 79 were followed for 8 years using a history, symptom score analysis, uroflowmetry and review of their records.

Results

 Comparing the results in groups of men with a pre‐operative maximum flow rate < or ≥15 mL/s, there was a similar difference in the rate of success to that noted 6 months post‐operatively. Similar results were obtained when comparing those with BOO or a normal bladder outlet function. However, although the tendency was clear it was not statistically significant because of the small sample size (type‐2 error). There was a significant reduction in all symptom scores from those assessed pre‐operatively and during the 8 years (P<0.001). The median pre‐operative maximum flow rate was 8.5 mL/s, compared with 12.5 mL/s after 8 years (P<0.001). Of the 79 patients, 14 (18%) had 28 re‐operations during the 8‐year follow‐up, 12 being repeat resections of the prostate, giving a repeat resection rate of 1.8% per year and a success rate of 71%. During the 8 years, 82% of the patients had an unchanged overall evaluation of the post‐operative outcome. In general, those having an unsatisfactory outcome were slightly younger than the whole group.

Conclusion

 Uroflowmetry and pressure‐flow studies can predict to some degree the long‐term result after prostatic surgery. There was a durable effect on symptom scores and maximum flow rates after the operation. The annual rate of repeat resection (1.8%) was relatively low.
Long‐term follow‐up of patients with erectile dysfunction commenced on self injection with intracavernosal papaverine with or without phentolamine
Authors: Flynn R.J. , Williams G.
Published: November 2003

Objectives To determine the usage, complications and satisfaction with intracavernosal agents in patients with erectile dysfunction commenced on self‐injection treatment at home.

Patients and methods A total of 344 patients who had commenced intracavernosal treatment before December 1992 and had requested a repeat prescription were sent a questionnaire to determine the usage, complications, satisfaction and reasons for discontinuing treatment.

Results Replies were received from 216 patients; of those who replied, only 126 were still using the treatment. The mean duration of treatment was 3.9 years in those continuing treatment. Whilst satisfaction ratings were high in those continuing therapy, most patients had experienced some side‐effects.

Conclusion The long‐term follow‐up revealed a high attrition rate and a significant number of complications. Patients receiving auto‐injection therapy should be offered regular long‐term follow‐up.
Is the conservative management of the acute scrotum justified on clinical grounds?
Authors: Watkin N.A. , Reiger N.A. , Moisey C.U.
Published: November 2003

Objective To determine whether there is justification for a policy of conservative management of acute scrotal emergencies, based on the ability to exclude a twisted testicle or the assumption that there is a ‘missed torsion’ when the duration of symptoms is prolonged.

Patients and methods The case notes of 209 consecutive emergency scrotal explorations, carried out in one district general hospital over a 7‐year period, were reviewed. The decision to operate was based solely on a clinical diagnosis, with no information from additional radiological investigations.

Results The commonest finding was testicular torsion (39.5%) with an orchidectomy rate of 22%. Only 5% of scrotal torsions occurred in patients <12 years of age, whereas 26% occurred in those >20 years of age. In five of 82 cases (6%) of confirmed testicular torsion, the surgeon did not consider this the most likely diagnosis. With a pain duration of <16 h, 89% of testes were salvaged, but with pain for >16 h this decreased to 25%. In three cases the testis was viable after pain had been present for >24 h.

Conclusion In the absence of supportive radiological investigations, a small but significant number of twisted testes will be missed if conservative management is adopted.
Artificial urinary sphincter for post‐prostatectomy incontinence
Authors: Singh G. , Thomas D.G.
Published: November 2003

Objective To assess the role of the artificial urinary sphincter in the management of patients with post‐prostatectomy incontinence.

Patients and methods The study comprised 28 patients (mean age 71 years, range 45–81) with post‐prostatectomy incontinence caused by sphincter deficiency who underwent implantation of an artificial sphincter and were followed for a mean of 41 months (range 6–79).

Results Twenty‐one (75%) patients had a bulbar cuff and seven (25%) had a membranous urethral cuff implanted. Problems with the bulbar urethral cuff included persistent stress leakage in six, system failure in two and infection in one patient. Nine patients with the bulbar urethral cuff and one patient with the membranous urethral cuff required revision. Of the nine re‐operations in those fitted with a bulbar urethral cuff, five required a higher pressure balloon, one a smaller cuff, two had system failures replaced and one had a membranous urethral cuff implanted because of infection. Three of these nine patients needed a third operation and in all of these a membranous urethral cuff was inserted. A total of 33 operations were performed in 21 patients with bulbar urethral cuffs (a re‐operation rate of 57%) and eight operations were carried out in seven patients with membranous urethral cuffs (a re‐operation rate of 14%). Three patients needed anticholinergic therapy and one needed a clam cystoplasty for intractable instability. Twenty‐four patients (86%) are dry and fully continent, three (11%) have occasional stress leakage and one patient had a cerebro‐vascular accident9 months after surgery and now has an indwelling catheter.

Conclusions Patients who had artificial sphincters implanted to treat post‐prostatectomy incontinence achieved a social continence rate of 96%. With bulbar urethral sphincters there was a high incidence of post‐implantation incontinence and a high re‐operation rate to achieve this success.
The pathogenesis of cryptorchidism and splenogonadal fusion: a new hypothesis
Authors: Cortes D. , Thorup J.M. , Visfeldt J.
Published: November 2003

Objective To obtain new information about the pathogenesis of cryptorchidism.

Materials and methods Published reports of 111 males with splenogonadal fusion were examined and the presence and type of cryptorchidism and the degree of continuity between the spleen and gonads determined.

Results Of the 111 cases, 31% had cryptorchidism and of these 59% were bilaterally cryptorchid; 26% and 65% had right and left intra‐abdominal testes, respectively. Of those with continuous splenogonadal fusion, 44% had cryptorchidism. Solely cryptorchid cases with splenogonadal fusion had reported bilateral absence of both legs, imperforate anus, spina bifida, diaphragmatic hernia and hypospadias.

Conclusion An hypothesis is proposed that the abnormal development of the diaphragmatic ligaments of the testes may lead to lack of their involution, with consequent cryptorchidism. In the case of splenogonadal fusion, the abnormal ligaments are colonized by splenic cells, possibly because of an abnormal proximity to the splenic anlage, with the resulting abnormal ligament persisting as the splenic cord and thus resulting in cryptorchidism. The basic abnormality may be in the connections of the diaphragmatic ligaments, caused by abnormal midline development in the third to fourth week of gestation.
The role of pentoxifylline in the treatment of erectile dysfunction due to borderline arterial insufficiency
Authors: Peşkirciogˇlu L. , Karabulut A. , Deniz I.E. , Germiyanogˇlu C. , Erol D.
Published: November 2003

Objective To investigate the effects of pentoxifylline on penile blood flow and potency in patients with erectile dysfunction due to borderline arterial insufficiency.

Patients and methods Following a routine diagnostic evaluation, 36 patients with borderline arterial disease diagnosed using penile duplex ultrasonography were included in the study. Of these patients, 20 (mean age 54 years, range 40–66) received 1.2 g of pentoxifylline daily, divided into three doses orally, for 2 months and 16 (mean age 54 years, range 34–65) received a placebo. Peak systolic velocities (PSVs) before and after the treatment were compared with those in patients receiving a placebo. The clinical improvement in erectile function was also evaluated.

Results Twelve of 20 patients receiving pentoxifylline had an increase in PSV at the end of the treatment period. The mean change in PSV achieved by pentoxifylline treatment (6.25 cm/s) was significantly higher than that achieved by the placebo (0.38 cm/s). Seven patients had a positive response (successful coitus achieved after treatment with pentoxifylline). No serious side‐effects occurred.

Conclusion Pentoxifylline was well tolerated and could increase penile arterial inflow, shown objectively as an increase in PSV on penile duplex ultrasonography. These findings should encourage further studies of the efficacy of pentoxifylline in the treatment of impotence.
The use of RT‐PCR for prostate‐specific antigen assay to predict potential surgical failures before radical prostatectomy: molecular staging of prostate cancer
Authors: Olsson C.A. , de Vries G.M. , Benson M.C. , Raffo A. , Buttyan R. , Cama C. , O'Toole K. , Katz A.E.
Published: November 2003

Objective To assess the potential role of a recently developed reverse transcriptase‐polymerase chain reaction (RT‐PCR) assay for prostate‐specific antigen (PSA), that detects circulating prostate cells in patients with prostate cancer, in the management of clinically localized cancer.

Patients and methods A total of 138 men (mean age 62.5 years, range 49–70) scheduled for radical retropubic prostatectomy had an RT‐PCR assay before surgery. The results were compared with the final pathological stage of disease, the results from local imaging techniques, serum PSA levels, digital rectal examination (DRE) and Gleason score.

Results Enhanced RT‐PCR for PSA was the best predictor of potential surgical failures; 70% of patients with positive surgical margins or invasion into the seminal vesicle were identified pre‐operatively by a positive RT‐PCR assay (odds ratio=12.0, positive predictive value=64%, negative predictive value=87%). RTPCR was able to identify pre‐operatively patients with adverse pathology, despite low serum PSA values (<4.0 ng/mL). In patients with high PSA level (>10 ng/mL), RT‐PCR discriminated between potentially curable candidates and those with established extraprostatic disease.

Conclusions RT‐PCR for PSA adds unique prognostic information when considering patients for radical surgery. The final role for the RT‐PCR assay is as yet undefined; however, the ability to detect potential surgical failures pre‐operatively using a molecular approach should have a significant impact on the management of patients with prostate cancer.
The ICS–‘BPH’ Study: the psychometric validity and reliability of the ICSmale questionnaire
Authors: Donovan J.L. , Abrams P. , Peters T.J. , Kay H.E. , Reynard J. , Chapple C. , de la Rosette J.M.C.H. , Kondo A.
Published: November 2003

Objective To assess the validity and reliability of the ICSmale questionnaire developed for the International Continence Society‐'Benign Prostatic Hyperplasia' (ICS–'BPH') study.

Patients and methods Urology departments in 12 countries recruited 1271 consecutive men >45 years old, with lower urinary tract symptoms and possible benign prostatic obstruction, to the ICS–'BPH' study (the clinical group); 423 ambulent men were recruited from a general practice in the UK to provide a community group. Each individual was asked to complete the wide‐ranging ICSmale questionnaire, comprising questions concerned with urinary symptoms, the bother they cause, and issues of quality of life and sexual function. Content, construct and criterion validity of the symptom and problem questions were assessed by interviews with patients and urologists, testing hypotheses within sub‐studies, and in relation to frequency‐volume diaries and uroflowmetry. Reliability was assessed by measures of internal consistency and a test‐retest analysis.

Results The ICSmale questionnaire was easy to complete. It was clearly able to differentiate between men in clinical and community populations, and detected the expected positive age gradient for most symptoms in the community group. There was reasonable agreement between relevant parts of the questionnaire and frequency‐volume charts when a relatively flexible approach was taken, but there was a very poor relationship between questions assessing strength of stream and the results of uroflowmetry. Internal consistency was high, and overall the questionnaire demonstrated good test‐retest reliability.

Conclusion The self‐completed ICSmale questionnaire had high levels of psychometric validity and reliability.
Retroperitoneal surgery: its wider role in the management of malignant teratoma
Authors: Hollins G.W. , Thomas S. , Lanigan D.J. , Dahar N. , Jodrell D. , Kaye S.B. , Kirk D.
Published: November 2003

Objective To review the results of the use of laparotomy to excise retroperitoneal metastases in patients with malignant teratoma of the testis.

Patients and methods The results of surgery for retroperitoneal teratoma metastases in 37 patients during the 5‐year period from 1988 to 1993 were reviewed. Information on sexual dysfunction was obtained using a postal questionnaire.

Results Patients were divided into three groups: the first comprised 28 patients who underwent elective surgery (excision of residual disease) after platinum and bleomycin‐based chemotherapy. The second group comprised four patients who underwent interventional surgery to excise disease not responding to treatment, after which they completed chemotherapy. The third group comprised five patients who underwent surgery for relapsed disease; two had suffered an early and three a late relapse. Overall, 34 patients are alive, four are considered to have residual disease and two have recently undergone re‐operation.

Conclusions In addition to removing residual disease after primary chemotherapy, surgery has a wider role in the management of metastatic teratoma. Carefully timed interventional surgery for disease not responding to chemotherapy can be lifesaving. Surgery for early relapse should be preceded by chemotherapy but surgery alone is appropriate where relapse occurs several years after primary treatment, although raised levels of tumour markers or extensive recurrence might be an indication for preliminary chemotherapy.
The continence control pad—a new external urethral occlusion device in the management of stress incontinence
Authors: Eckford S.D. , Jackson S.R. , Lewis P.A. , Abrams P.
Published: November 2003

Objective To assess the use of an external urethral occlusion pad (the continence control pad, CCP) in the management of stress incontinence.

Patients and methods Nineteen women (median age 47 years, range 36–72) complaining of stress incontinence were taught to use the CCP. The patients were assessed during the week before, and again after using the CCPs for 2 weeks, by urinary diaries, pad‐tests and a review of their symptoms.

Results Use of the CCP was associated with a cure or improvement in 17 women, as assessed by the number of incontinent episodes per week. There was a significant decrease in both the number of incontinent episodes (P<0.001) and pad‐test leakage (P=0.002) when using the CCP. Minor difficulties in placement and removal were described in a minority of women.

Conclusion The CCP offers a simple, non‐invasive treatment for women complaining of stress incontinence. The short‐term success rate was better than that with other conservative methods of treatment, is independent of the general practitioner and safe. It is a promising home‐based method of managing stress incontinence.
Glycine 1.0%versus glycine 1.5% as irrigating fluid during transurethral resection of the prostate
Authors: Hahn R G. , Shemais H. , Essén P.
Published: November 2003

Objective To evaluate the potential benefits of reducing the glycine concentration from 1.5% to 1.0% in the irrigating fluid used during transurethral resection of the prostate (TURP) when 1% ethanol is used as the tracer of absorption.

Patients and methods The effect of 1% ethanol on the tendency for blood to haemolyse was tested in vitro and the optical condition of the irrigating fluids were studied during 10 TURPs. The breath ethanol level was monitored during 423 operations where these fluids were used in a randomized double‐blind study. The incidence of 13 symptoms was recorded in the 77 patients who absorbed irrigating fluid.

Results Ethanol slightly lowered the tendency for blood to haemolyse. Reducing the glycine concentration did not alter the optical conditions during TURP. The incidence of symptoms increased significantly as more glycine solution was absorbed, arterial hypotension and nausea being the most usual. Bradycardia, prickling skin sensations and feelings of uneasiness were less common when 1.0% glycine was used, but the choice of irrigating fluid had no effect on the total incidence of symptoms.

Conclusion We found no clear advantage in lowering the glycine concentration of the irrigating fluid used during TURP.
Severe cystitis associated with tiaprofenic acid
Authors: CRAWFORD M.L.A. , WALLER P.C. , WOOD S.M.
Published: November 2003

Objective

 To review the UK spontaneous reports of urinary disorders associated with tiaprofenic acid and other non‐steroidal anti‐inflammatory drugs (NSAIDs) and put them into context of the usage of these preparations in the UK.

Methods

 Suspected adverse drug reaction (ADR) reports of urinary disorders associated with tiaprofenic acid and other NSAIDs received by the UKs spontaneous ADR reporting scheme were analysed.

Results

 Between 1982, when tiaprofenic acid was introduced in the UK, and August 1994, 69 cases of cystitis were reported, with a further 32 reports describing related urinary symptoms including frequency, dysuria and haematuria. Only eight cases of cystitis were reported for all other NSAIDs. The duration of treatment with tiaprofenic acid before the onset of urinary symptoms varied markedly (range 2 days to >3 years). In patients in whom a drug‐induced cause was suspected and the drug was stopped promptly, recovery usually occurred within weeks. However, many patients continued on long‐term treatment with tiaprofenic acid and underwent extensive investigations to determine the cause of their urinary symptoms. On cystoscopy and biopsy, the findings were similar to interstitial cystitis. Most patients with chronic cystitis recovered after withdrawal of tiaprofenic acid, but some patients had surgery before the drug was stopped.

Conclusion

 Tiaprofenic acid can cause severe cystitis. These reports highlight the importance of taking a full drug history in patients with unexplained chronic cystitis. Tiaprofenic acid should be stopped immediately in all patients developing urinary symptoms.
Intra‐operative autotransfusion in radical cystectomy
Authors: PARK K.I. , KOJIMA O. , TOMOYOSHI T.
Published: November 2003

Objective

 To assess the feasibility of intra‐operative autotransfusion (IAT) as a method of decreasing or avoiding homologous blood transfusion during radical cystectomy.

Patients and methods

 IAT was performed in 10 patients with bladder cancer who underwent radical cystectomy. The patients were divided into two groups: group 1 consisted of six patients without and group 2 of four patients with pre‐deposited blood. Blood shed in the operative field was collected and processed with an IAT device.

Results

 In group 1, the intra‐operative blood loss ranged from 1.08 to 2.67 L (mean 1.82) and homologous blood transfusion ranged from 0 to 1 L (mean 0.47). The amount of autologous blood processed and transfused by the IAT device ranged from 0.38 to 0.98 L (mean 0.64). Two patients did not require homologous blood transfusion. In group 2, the volume of pre‐deposited blood ranged from 0.8 to 1.2 L (mean 0.9). The intra‐operative blood loss ranged from 1.03 to 3.24 L (mean 1.8). The amount of processed autologous blood transfused ranged from 0.4 to 0.6 L (mean 0.45). None of the patients in group 2 required homologous blood transfusion.

Conclusion

 Although there are theoretical risks with IAT, they were not substantiated by the clinical data. IAT seems to be a feasible method of reducing or avoiding homologous blood transfusion in radical cystectomy. These results suggest that IAT in combination with pre‐deposited blood will abolish the need for homologous blood transfusion during radical cystectomy.
Does vasectomy predispose to osteoporosis?
Authors: BYRNE P.A.C. , EVANS W.D. , RAJAN K.T.
Published: November 2003

Objective

 To investigate whether vasectomy, which causes immunological and histological changes to the testes and changes to the hypothalamo‐pituitary axis, could influence bone mineral density (BMD) and predispose to osteoporosis.

Patients and methods

 From patients referred to the Bone Densitometry Clinic, the BMD of L1–L4 and of the hip was analysed in 25 vasectomized men and compared with that in age‐matched controls, ensuring that both groups had no secondary causes which might predispose to osteoporosis.

Results

 In the spine, the mean (standard deviation) BMD was 1.00 (0.19) g/cm2 for the vasectomized men and 0.96 (0.14) g/cm2 for the controls. In the hip (femoral neck and total, respectively) the means were 0.79 g/cm2 and 0.90 g/cm2 for the vasectomized men and 0.72 g/cm2 and 0.96 g/cm2 for the controls. None of the differences were statistically significant.

Conclusion

 This study does not support the hypothesis that vasectomy may be a risk factor for osteoporosis.
Acute epididymitis in boys: are antibiotics indicated?
Authors: LAU P. , ANDERSON P.A. , GIACOMANTONIO J.M. , SCHWARZ R.D.
Published: November 2003

Objectives

 To report the results of using supportive therapy only, rather than antibiotics, in managing boys with acute sterile epididymitis.

Patients and methods

From 1991 to 1995, 48 boys presented with acute epididymitis. The diagnosis was confirmed by radionuclide scan in 43 cases, ultrasonography in one, surgical exploration in one and physical examination in three. Urine was collected for microscopy and culture; if pyuria was detected, antibiotics were prescribed. If the urine analysis was normal, the patient was advised to minimize physical activity and analgesics were prescribed.

Results

Of the 48 boys, five (10%) had pyuria; seven patients with either no urine tested or negative urine culture were given antibiotics. The remaining 36 were managed with supportive therapy only. The mean follow‐up was 87 days (with three patients lost to follow‐up). No boys showed any evidence of testicular atrophy or other complications.

Conclusion

Only a minority of boys with acute epididymitis, as defined by increased flow on radionuclide scanning of the scrotum, have a bacterial aetiology. For those without pyuria or positive urine culture, the condition is self‐limiting and does not lead to testicular atrophy. We recommend that for boys with acute epididymitis who have no urinary abnormalities, antibiotics are not indicated. The aetiology of acute sterile epididymitis in boys remains obscure.
Urodynamic investigations in reversed ileal seromuscular enterocystoplasty: an experimental study in a rabbit model
Authors: CELAYIR S. , BÜYÜKÜNAL S.N.C. , KILIÇ N. , DERVISOGLU S.
Published: November 2003

Objective

 To investigate the efficacy of the reversed ileal seromuscular enterocystoplasty (RISMEC) technique and assess the urodynamic findings.

Materials and method

 A large bladder defect was created in 12 New Zealand White rabbits; in six the bladder was closed primarily (control group) and in the remaining six the bladder was augmented using the RISMEC technique combined with omentoplasty. The results were assessed using intravenous pyelography (IVP), voiding cysto‐urethrography (VCUG), histopathological investigations and urodynamic studies after 4 and 12 weeks.

Results

 The IVP and VCUG revealed an apparently normal urinary system and voiding pattern in both groups. Histopathologically, in all rabbits undergoing RISMEC, the serosal surface of the reversed ileum was lined with transitional urinary epithelium; there was no evidence of severe fibrosis, inflammation, stone or mucus production. Urodynamic studies showed a significant decrease in the mean bladder capacity in the controls, but no significant change in the RISMEC group. The mean bladder compliance decreased from 5.85 to 1.36 mL/cmH2O in the controls (P<0.02) but there was no significant decrease in compliance in the RISMEC group.

Conclusion

 The results suggest that in this rabbit model, the RISMEC technique combined with omentoplasty increases bladder capacity with minimal graft shrinkage; the peritoneal surface is rapidly covered with transitional epithelium and the integrity of the kidneys preserved. Urodynamic investigations showed neobladders with adequate storage capacity, low intravesical pressures and improved compliance rates.
Use of patient‐controlled analgesia in extracorporeal shockwave lithotripsy
Authors: CHIN C.M. , TAY K.P. , NG F.C. , LIM P.H.C. , CHNG H.C.
Published: November 2003

Objective

 To assess the advantages of patient‐controlled analgesia (PCA) in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for urinary stones.

Patients and methods

 Between December 1995 and May 1996, a prospective study was carried out on 100 patients who underwent ESWL for urinary stones. The patients were assigned to two equal groups, one receiving PCA and the other pethidine (control). Patients in the PCA group self‐administered varying doses of intravenous alfentanil according to their pain tolerance, while those in the control group were given a single bolus dose of 1 mg/kg body weight intravenous pethidine by the attending urologist before the start of the procedure. The stone site, maximum energy level achieved, number of shock waves given, duration of procedure, pain scores, patient tolerance and acceptance were recorded to assess the efficacy of PCA compared with analgesia controlled by the physician.

Results

 Both groups were matched for age, body weight, stone location and number of shocks given. The PCA group received a mean of 1.03 mg alfentanil while the control group received a mean of 62.5 mg pethidine. The maximum discharge voltage of 16 kV was achieved in all but one patient (98%) in the PCA group whereas only 21 patients (42%) in the control group attained this level. The mean treatment duration was less in the PCA group (32.8 min) than in the control group (44.5 min), the mean pain score lower (3.76 and 4.62, respectively) and the incidence of nausea and vomiting much less (22% and 60%, respectively). In addition, all 21 patients in the PCA group who had received intravenous pethidine during previous sessions of ESWL chose PCA as the better form of analgesia. There were no adverse effects in the PCA group except for one patient whose arterial oxygen saturation decreased transiently.

Conclusion

 PCA enables the urologist to achieve better patient compliance through better pain control; its application has maximized the use of lithotripsy and the patients’ acceptability for this form of analgesia is confirmed. We recommend that this form of analgesia be used for ESWL.
Evaluation by magnetic resonance imaging of the inferior vena cava in patients with non‐seminomatous germ cell tumours of the testis metastatic to the retroperitoneum
Authors: NG C.S. , HUSBAND J.E.S. , PADHANI A.R. , LONG M.A. , HORWICH A. , HENDRY W.F. , DEARNALEY D.P.
Published: November 2003

Objective

 To assess the role of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in evaluating suspected occlusion of the inferior vena cava (IVC) in patients with abdominal nodal metastases from non‐seminomatous germ cell tumours, thus giving information that may be helpful in planning surgery and for determining the need for anticoagulant therapy.

Patients and methods

 Five patients with abdominal nodal metastases in whom occlusion of the IVC was suspected on computed tomography (CT) were imaged using a 1.5 T MRI scanner. The MRI findings were compared with those from CT.

Results

 The MR images successfully and clearly detected partial and total occlusions of the IVC by both intraluminal thrombus and extrinsic compression. The technique also clearly detected extensive collateral venous circulation in several cases and in one a cavernous transformation of the IVC. In all patients, the MRI studies provided better information than that from CT.

Conclusion

 MRI, and particularly MRA, is a comparatively new technique that is non‐invasive and offers the potential of evaluating vascular structures with no need for ionizing radiation or contrast media. This technique, if available, should be chosen for imaging the IVC in patients suspected of having compression or occlusion of the IVC.
Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms?
Authors: MADERSBACHER S. , KLINGLER H.C. , DJAVAN B. , STULNIG T. , SCHATZL G. , SCHMIDBAUER C.P. , MARBERGER M.
Published: November 2003

Objective

 To determine whether it is possible to predict the presence of bladder outlet obstruction (BOO) by non‐invasive clinical variables in patients with lower urinary tract symptoms (LUTS) suggestive of BOO.

Patients and methods

 Patients with LUTS suggestive of BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), prostate size, non‐invasive uroflow, post‐void residual urine volume (PVR) and a pressure flow study. Only patients with a maximum flow rate (Qmax ) of≤15 mL/s and an IPSS≥7 were included. The study comprised 253 patients; the degree of obstruction was correlated to several non‐invasive clinical variables. Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of BOO in patients with LUTS.

Results

 Prostate volume, Qmax , PVR and voided volume correlated significantly with the degree of BOO rated according to the linear passive urethral resistance relation (linPURR). In contrast, there was no such correlation for the IPSS and the quality‐of‐life question of the IPSS. The percentage of patients with BOO defined by a linPURR of 3–6 decreased from 85% in those with a Qmax of 0–5 mL/s to 60% (Qmax 6–10 mL/s) and 44% (Qmax 11–15 mL/s). In parallel, the percentage of patients with BOO increased from 53% of those with a prostate volume of ≤50 mL, to 79% of those with prostates of 51–100 mL and 75% of those >100 mL. Based on Qmax , PVR and prostate volume, nomograms were established by multiple logistic regression analysis for the probability of BOO in patients with LUTS.

Conclusion

 The nomograms presented herein should help the clinician to identify patients with LUTS who should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and in whom these studies can be safely spared.
The use of surgical sympathectomy in the treatment of chronic renal pain
Authors: ANDREWS B.T. , JONES N.F. , BROWSE N.L.
Published: November 2003

Objective

 To assess the efficacy of renal sympathetic denervation in the treatment of chronic renal pain.

Patients and methods

In a 10‐year period, 21 patients suffering from chronic renal pain underwent 27 renal denervation operations, six of which were bilateral. The cause of pain was the loin pain haematuria syndrome in 18 patients.

Results

 Four operations resulted in complete pain relief to date (median follow‐up 53.5 months). Pain relief after the other 23 operations in 18 patients lasted a median of 6 months. Assuming that recurrent pain was due to neuronal regeneration, nine of the 18 patients with recurrent pain underwent a total of 10 re‐explorations of the renal pedicle, stripping it of all nerve fibres and areolar tissue. Three of these re‐explorations produced complete pain relief to date (median follow‐up 40 months). The median pain‐free interval of the other seven re‐explorations in six patients was 19 months.

Conclusion

 Renal denervation cures severe intractable pain in about 25% of patients. Recurrence of pain could be prevented in more patients if there was a way of preventing re‐innervation.
Serum pyridinoline crosslinks as markers of tumour‐induced bone resorption
Authors: NEMOTO R. , NAKAMURA I. , NISHIJIMA Y. , SHIOBARA K. , SHIMIZU M. , TAKEHARA T. , OHTA T. , KIYOKI M.
Published: November 2003

Objective

 To assess serum pyridinoline (Py) and deoxypyridinoline (dPy), using a new high‐performance liquid chromatography (HPLC) method, as a serum marker to determine the incidence of metastatic bone disease in an animal model and in the monitoring of patients with or without metastatic bone disease from prostate cancer and renal cell carcinoma (RCC).

Patients, materials and methods

 Female C3H/He mice (8–12 weeks old) received a subcutaneous injection of tumour‐cell suspensions of serially transplanted MBT tumours. The tumour cells induced osteolysis associated with osteoclast proliferation and serum samples were evaluated for Py and dPy using HPLC. The growth of the tumour macroscopically and histologically, and the extent of bone loss assessed by radiography, were compared with the serum Py and dPy level. In the clinical study, patients with or without bone metastases from RCC (24 patients) or prostate cancer (37 patients) were monitored using the same techniques and the number and extent of bone metastases compared with serum Py and dPy levels both in these patients and in 84 healthy control subjects.

Results

 There was a significant correlation between the bone loss evaluated by radiography and the level of serum Py in the animal model. Patients with bone metastases from RCC had higher values of Py and dPy than patients without known metastatic bone disease. The serum Py level increased in two patients as metastatic bone disease progressed. Similarly, in patients with prostate cancer, the mean level of serum Py and dPy was higher in patients with bone metastasis than in the control group, and also higher than that in patients without metastases. The serum Py and dPy levels could also distinguish patients with metastatic bone disease with and without a lytic component.

Conclusion

 Measurements of serum Py appear to provide a good index of increased bone resorption induced by experimental tumours and in patients with bone metastases from RCC and prostate cancer.
British urological surgery practice: 1. Prostate cancer
Authors: SAVAGE P. , BATES C. , ABEL P. , WAXMAN J.
Published: November 2003

Objective

 To investigate the treatment of prostate cancer in the United Kingdom.

Methods

 A postal survey was conducted of consultant urologists and general surgeons with an interest in urology to assess the current patterns of management of patients with prostate cancer in the UK and to determine patterns of clinical practice.

Results

 Two‐hundred and seventy‐four replies were analysed. Radical radiotherapy (50%) and radical prostatectomy (29%) were the most favoured treatment options for patients <70 years old with poorly differentiated T1 disease; for those aged >70 years, active treatment was favoured by 183 (67%) consultants with radical radiotherapy (37%) and hormonal intervention (29%) the most frequent choices. In well‐differentiated T1 disease, active treatment was favoured by 226 (83%) of consultants for patients <70 years, with radical prostatectomy (44%) the most frequent choice. For patients >70 years, observational management was preferred by 190 (69%) of consultants. In poorly differentiated T1 prostate cancer, active treatment was favoured by 252 (91%) for patients <70, with radiotherapy (50%) the most frequent choice and for patients >70 years, active treatment was favoured by 67% with radical radiotherapy the most common preference being chosen, by 102 (37%). For asymptomatic locally advanced disease, 55% of consultants favoured active treatment, whilst 63% favoured the active treatment of asymptomatic metastatic disease. For patients with symptomatic metastatic disease, GnRH agonist therapy was the treatment of choice of 66% of urologists and was given as monotherapy by 44% or as part of maximal androgen blockade by 22%. In clinical practice, 82% of urologists have close links with oncology, available through joint clinics or on‐site referral. However, <5% of urologists refer patients to an oncologist before the development of hormone refractory disease. At relapse, only 53% of urologists referred their patients to oncologists or palliative‐care clinicians. A wide variety of hormonal treatments was offered at relapse; only 24% of urologists treated their patients by antiandrogen withdrawal or introduction, which is currently the most effective second‐line hormonal treatment for recurrent prostate cancer.

Conclusion

 There is a wide variation in the clinical management of prostate cancer and we recommend the establishment of standards of practice.
Lack of correlation between blood fibrinolysis and the immediate or post‐operative blood loss in transurethral resection of the prostate
Authors: NIELSEN J.D. , GRAM J. , FABRIN K. , HOLM‐NIELSEN A. , JESPERSEN J.
Published: November 2003

Objective

 To evaluate whether the activation of the extrinsic tissue‐type plasminogen activator‐related fibrinolysis is implicated in the blood loss in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP).

Patients and methods

 TURP was performed in 24 men and the operative and post‐operative blood loss determined. The activation of the tissue‐type plasminogen activator‐related fibrinolysis was followed using new sensitive and specific assays, and the changes related to the blood loss. Measurements of the plasma concentrations of free tissue‐type plasminogen activator (t‐PA) activity, tissue‐type plasminogen activator (t‐PA) antigen, plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI‐1) antigen, plasminogen (Plg) activity, plasminogen (Plg) antigen, α2‐antiplasmin (α2‐AP), d‐dimer and fibrin degradation products (FbDP) were all determined and the area under the curve (AUC) for each of these quantities correlated with the blood loss.

Results

 TURP was followed by a marked activation of the fibrinolytic system. There was an immediate increase in systemic t‐PA activity and t‐PA antigen, coinciding with a significant drop in PAI activity. Post‐operatively, PAI activity and PAI‐1 antigen increased. The formation of plasmin was indicated by a fall in the plasma concentration of Plg activity and Plg‐antigen and α2‐AP but which increased significantly at the end of the study period. Increased systemic fibrinolytic activity was further confirmed by a marked increase in fibrin d‐dimer and FbDP. There was no correlation between the AUC in the operative period of any of the fibrinolytic variables and the measured blood loss. In the post‐operative period, t‐PA antigen (P=0.004), PAI activity (P=0.043), PAI‐1 antigen (P=0.016) and α2‐AP (P=0.047) all correlated with the post‐operative blood loss, while there was no correlation between fibrin d‐dimer or FbDP and blood loss.

Conclusion

 The fibrinolytic system is activated during and after TURP, but the increased activity is not of pathophysiological importance for the blood loss.
Desmopressin for nocturnal enuresis: urinary osmolality and response
Authors: FOLWELL A.J. , MACDIARMID S.A. , CROWDER H.J. , LORD A. DE M. , ARNOLD E.P.
Published: November 2003

Objective

 To measure the effect of intranasal desmopressin (1‐deamino 8‐d‐arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment.

Patients and methods

 Thirty‐seven patients with persistent primary nocturnal enuresis were entered into a double‐blind placebo‐controlled crossover trial of 20 μg intranasal DDAVP spray. Morning urinary osmolality was measured on two occasions during each phase of treatment and the clinical response recorded in a diary.

Results

 Thirty‐one patients (22 males and nine females) were evaluable at the end of the trial period. A good clinical response, defined as enuresis on two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and in those with less frequent enuresis. The mean and peak urinary osmolality of the morning urine samples were higher while on treatment with DDAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome in improving the enuresis.

Conclusions

 Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refractory nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to treatment.