bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of local immune response after intravesical bacille Calmette‐Guérin treatment for superficial bladder cancer
Authors: Patard J‐J. , Muscatelli‐Groux B. , Saint F. , Popov Z. , Maille P. , Abbou C. , Chopin D.
Published: November 2003

Objective To help define the optimal protocol of Bacille Calmette‐Guérin (BCG) treatment for transitional cell carcinoma (TCC) of the bladder by examining cytokine production and antigen presentation to effector cells after instillations of BCG in patients with bladder TCC.

Patients and methods Sixty‐four urine samples from 11 patients were tested for the production of interferon γ (IFN‐γ) using a modified commercial enzyme‐linked immunosorbent assay (ELISA) kit. Urine was collected before and at intervals up to 24 h after the intravesical instillation of BCG. Immunohistological studies were also carried out using a two‐step alkaline phosphatase technique to explore the expression of tumour‐associated antigens (TAAs) (E7, 19A211, T138), major histocompatibility complex (MHC) molecules and lymphocyte subset infiltrates (CD3, CD4, CD8) in bladder biopsies before and 3 weeks after the completion of treatment in seven patients.

Results IFN‐γ was only detected 4, 6 and 8 h after instillation, with a maximum concentration at 6 h (2.9–34.7 IU/mL in 10 patients). During a 6‐week course of BCG, IFN‐γ was barely detectable after the first two instillations, but gradually increased from the third instillation onwards. TAA and MHC II antigens, which were absent or faintly expressed on normal urothelial cells before treatment, were expressed strongly in five patients after treatment. The local recruitment of immunocompetent cells was detected in all patients.

Conclusion These results suggest that the local immune response after the intravesical instillation of BCG can be quantified using simple ELISA tests and could be useful in defining objective criteria for rationalizing treatment (dose and duration), and in determining the relation between the immune response and anti‐tumour activity. There is evidence that antigen presentation is enhanced after BCG instillations, suggesting that a T cell‐MHC restricted pathway might be involved in the anti‐tumour response. This study supports the search for tumour‐rejection antigens in bladder cancer.
Decreasing bladder cancer mortality in the Netherlands
Authors: Kiemeney L.A.L.M. , Straatman H. , Witjes J.A.
Published: November 2003

Objective To evaluate the prediction that the observed increasing trend in male bladder cancer mortality in the Netherlands between 1955 and 1988 would change to a decreasing trend.

Materials and methods Using demographic and mortality data from the Netherlands Central Bureau of Statistics, male and female bladder cancer mortality per 105 person‐years from 1955 to 1994 were calculated. Changes in the age structure of the Dutch population were adjusted using direct standardization to the European ‘standard’ population. The effects of age, calendar period and birth cohort on the temporal trend in mortality were evaluated using log‐linear modelling.

Results Male mortality from bladder cancer increased from 6.2 per 105 in 1955 to 12.6 per 105 in 1990, but decreased thereafter. Female mortality from bladder cancer has remained stable throughout the study period, at 2.8 and 2.7 per 105 in 1955 and 1994, respectively. The changing trend among men is consistent with an increasing risk for successive birth cohorts until the 1910 cohort and a decreasing risk for cohorts born after 1930. This cohort effect is probably caused by changes in the smoking behaviour of the male Dutch population. There were no differences in risk for successive birth cohorts of females.

Conclusion Male mortality from bladder cancer in the Netherlands will probably decrease for at least another decade. A future increase in female mortality from bladder cancer, as recorded for lung cancer, is unlikely.
Comparison of real‐time ultrasonography and magnetic resonance imaging in the assessment of urinary bladder volume
Authors: Walton J.M. , Irwin K.S. , Whitehouse G.H.
Published: November 2003

Objective To compare estimates of bladder volume obtained by conventional real‐time ultrasonography with those obtained from magnetic resonance imaging (MRI) by the Cavalieri method of unbiased stereology.

Subjects and methods The study comprised nine subjects (four men and five women, mean age 23 years, range 18–34) with no history of bladder disease. Before micturition, each volunteer underwent ultrasonography, immediately followed by MRI. The volunteers then voided, the true voided volume of urine was measured and the imaging protocols were repeated in the same order after micturition. The bladder volume was estimated from ultrasonography using the formula; volume=0.7 (L×TS×AP), (where L is the maximum supero‐inferior diameter, AP the maximum anteroposterior diameter and TS the maximum transverse diameter) and from MRI using the Cavalieri method. For each imaging modality, the volume of urine voided was estimated as the difference in the volume estimate before and after micturition.

Results The mean percentage coefficient of variation for the estimates of bladder volume by ultrasonography was 2.17 before and 4.43 after micturition. There was no significant difference in the replicate estimates of each bladder diameter by ultrasonography before and after micturition (P=0.98). The MRI method consistently underestimated the voided volume; the mean discrepancy between the estimated voided volume and the true voided volume was 7.7 mL and –67.7 mL for the ultrasonographic and MRI estimates, respectively, which are significantly different (P=0.02) when assessed using a multifactor ANOVA. Further analysis using multiple‐range tests showed a significant difference between the voided volume estimated by MRI and the corresponding true voided volume. There was no difference between the voided volume estimated by ultrasonography and the corresponding true volume.

Conclusion Ultrasonographic estimates of voided volume were more reliable than the those obtained using the MRI method. This is possibly due to a delay between micturition and the acquisition of MR images after micturition, which allowed the bladder to partly refill with urine. The empirical approach using measurements from ultrasonograms provides a fast and reliable technique; ultrasonography remains the recommended imaging modality for estimating bladder volume.
Sociodemographic and symptomatic characteristics of women undergoing stress incontinence surgery in the UK
Authors: Black N.A. , Griffiths J.M. , Pope C. , Stanley J. , Bowling A. , Abel P.D.
Published: November 2003

Objectives To: (i) describe the sociodemographic characteristics of women undergoing surgery for stress incontinence in the UK and the ways in which they differ from women of a similar age in the general population; (ii) the severity and impact of their symptoms and their expectations of surgery and; (iii) their general state of health.

Patients and methods A prospective cohort study was carried out on 442 women undergoing surgery for stress incontinence in 18 hospitals in the North Thames region between January 1993 and June 1994. Sociodemographic factors, stress incontinence severity, symptom impact scores, and general health status were measured.

Results Women undergoing surgery for stress incontinence were similar to their peers in the general population apart from being more likely to have smoked (61.4 against 51.1%), to have subsequently given up (39.5 and 25.3%) and to be of higher parity (≥4; 19.7 and 12.0%). Most women (81.6%) reported moderate to very severe stress incontinence. The impact of symptoms was correlated positively with severity (P<0.001) after accounting for its positive correlation with mental health status (P<0.005), socioeconomic status (P<0.05) and its negative correlation with age (P<0.02). Many women also suffered from other urinary symptoms including urgency (76%) and frequency (42.3%). Apart from their urinary problems, women were in good health (77% reported no or only mild coexistent conditions). However, a very high proportion (34.2%) had previously undergone a hysterectomy.

Conclusions These results suggest that women undergoing stress incontinence surgery are remarkably similar to their peers, apart from their primary condition. The effect that stress incontinence has on women's lives depends not only on the severity of the problem but also on other factors. The high rate of previous hysterectomy warrants further study.
Concrement formation and urease‐induced crystallization in urine from patients with continent ileal reservoirs
Authors: Edin‐Liljegren A. , Grenabo L. , Hedelin H. , Jonsson O. , Åkerlund O. , Pettersson S.
Published: November 2003

Objectives To study the relationship between urinary tract infection, urine composition and concrement formation in patients with continent ileal reservoirs for urinary diversion.

Patients and methods The study comprised 27 patients (seven men and 20 women, mean age 47 years, range 23–76) with continent ileal reservoirs who were followed for a mean of 67 months (range 13–146) by annual reservoiroscopy, intravenous urography and urine culture; at the final follow‐up, a sample of their morning urine was analysed for a range of compounds and the number and size of any particles present or produced in response to incubation with urease.

Results The presence of urease‐producing bacteria was associated with the formation of concrement. However, a few patients in whom an infection with urease‐producing organisms was not detected also formed concrement. Urine from those patients forming stones tended to have a high calcium and a low citrate concentration. After incubation with urease, significantly more and larger particles were formed in the urine from stone formers. There was a strong correlation (r=0.8) between urinary calcium content and urinary pH when the urease‐induced precipitation commenced, and between urinary calcium and the size and volume of the crystals developed (r=0.9) after 4 h of incubation.

Conclusions There are many factors which might influence the formation of concrement, e.g. outflow conditions, the presence of staples or infection in the reservoir, and the composition of the urine is also important. It thus appears appropriate to determine if measures to reduce urinary calcium and increase urinary citrate can decrease the episodes of stone formation in those patients with continent ileal reservoirs for urinary diversion who frequently form stones.
Visual laser ablation of the prostate for patients with
Authors: Farsi H.M.A.
Published: November 2003

Objective To evaluate the efficacy of visual laser ablation of the prostate (VLAP) and bladder neck incision in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia (BPH).

Patients and methods Twenty‐three patients (mean age 62 years, range 50–80) with acute urinary retention due to BPH were treated in a prospective trial of VLAP (using a neodymium : YAG laser) with bladder neck incision carried out using the KTP laser. Patients were assessed before and after treatment using the American Urological Association symptom score, prostate volume and peak urinary flow rates.

Results There was a significant and durable objective improvement in measured urinary flow rates and a subjective improvement of symptoms, with minimal morbidity.

Conclusion VLAP is a promising alternative treatment for patients with acute urinary retention secondary to BPH.
Prostatic adenocarcinoma labelled with a monoclonal antibody and polyclonal serum: a quantitative assessment
Authors: Gray E. , Allison L.J. , Edgar S. , Robinson E. , Cohen R.J.
Published: November 2003

Objective To investigate the detection of tissue prostate‐specific antigen (PSA) using a monoclonal antibody or polyclonal serum in patients with localized prostate cancer.

Patients and methods Fifteen samples of prostatic tissue from patients with localized prostate cancer were assessed for PSA using monoclonal antibodies and polyclonal serum. The intensity and area of chromogen precipitation in several microscopic fields was determined using image analysis.

Results There were significant differences in the intensity and distribution of PSA labelling in the tumour between the methods; polyclonal serum was more sensitive in detecting PSA in tissue sections. Notably, there was a focal ‘possible clonal’ pattern of negative labelling with the monoclonal antibody, which contrasted with the positivity of the polyclonal marker.

Conclusions The loss of PSA expression in some poorly differentiated cancers may represent the loss of specific epitopes rather than loss of the entire protein.
Transurethral interstitial laser coagulation for benign prostatic hyperplasia: treatment outcome and quality of life
Authors: Arai Y. , Ishitoya S. , Okubo K. , Suzuki Y.
Published: November 2003

Objective To assess the efficacy and safety of transurethral interstitial laser coagulation (ILC) in the treatment of benign prostatic hyperplasia (BPH).

Patients and methods From December 1993 to March 1995, 61 patients (mean age 69.7 years, range 55–89) with symptomatic BPH were treated with ILC. A neodymium:YAG laser was used in combination with specially designed interstitial thermotherapy light‐guides. The tip of the light guide was inserted repeatedly into each lobe of the prostate transurethrally, under direct vision. The number of fibre placements depended on the size and configuration of the gland. The prostatic urethra was preserved during the procedure. Treatment outcome was evaluated using the International Prostatic Symptom Score (IPSS), measurement of urinary flow rate and post‐void residual urine volume (PVR). The disease‐specific quality of life (QOL) was assessed using a QOL assessment score and a BPH impact index. Independently of the symptom assessment, a self‐reporting questionnaire was completed 3 months after treatment to determine the patients' satisfaction with the treatment and their sexual function.

Results Among the 31 patients followed for 6 months, the mean IPSS decreased significantly, from 18.9 at baseline to 7.7 (59% improvement; P<0.001), the mean peak flow rate increased from 6.7 mL/s to 10.0 mL/s (49% improvement; n=29; P<0.001), the mean PVR decreased from 119 mL to 29 mL (76% improvement; n=28, P<0.001) and the mean prostate volume decreased significantly, from 37.1 mL to 31.6 mL (15 % reduction at 3 months; n=52, P<0.001). There was a steady and progressive improvement in both the QOL assessment and the BPH impact index scores at 3 and 6 months. More than 90% of the patients reported satisfaction with the treatment and none reported the new onset of erectile dysfunction. There were no serious side‐effects, except for two cases of loss of ejaculation.

Conclusions The early clinical results suggest that the ILC procedure is a safe and effective less‐invasive treatment for BPH that appears to have favourable effects on the patients' quality of life.
Testis conservation studies in germ cell cancer justified by improved primary chemotherapy response and reduced delay, 1978–1994
Authors: Oliver R.T.D. , Ong J. , Blandy J.P. , Altman D.G.
Published: November 2003

Objective To investigate the need for the continued encouragement of early diagnosis of germ cell cancer of the testis, in view of the prevailing cure rate of 95%.

Patients and methods The study comprised a retrospective review of 453 unselected and previously untreated patients referred to one centre between 1978 and 1984, comparing the delay from first symptoms with the histological diagnosis.

Results With a delay of <30 days, 20% of patients had overt metastases at presentation and if the delay was >4 months, 55% had metastases (chi‐squared trend=15.9, P<0.001); 18% of Stage‐1 patients under surveillance with a delay of <30 days relapsed, compared with 38% of those with a delay of >4 months. During the period 1978–1983, 16% of patients were seen after a delay of <60 days, during the period 1984–1988 the proportion was 22% and during 1989–1994, 31% (chi‐squared trend=8.2, P<0.004). There was a non‐significant trend for a more prolonged delay in those aged <21 years and >40 years. Thirty‐two patients had chemotherapy with the primary tumour in situ; at orchidectomy, 13 of 18 had no viable malignancy and four of five with viable malignancy also had drug‐resistant metastases. Fourteen did not undergo orchidectomy; within a median follow‐up of 9 years, one developed a second (histologically different) tumour after 12 years. The outcome of preliminary attempts to use neoadjuvant chemotherapy with or without partial orchidectomy for patients with tumours in a solitary testis is discussed.

Conclusion These findings clearly justify the continued encouragement of early diagnosis, possibly best performed as part of an extended educational programme of genital health at puberty. The long‐term potential for testis conservation should be explored initially in tumours in a solitary testis.
Mucosal permeability of ileal and colonic reservoirs for urine
Authors: Davidsson T. , Åkerlund S. , White T. , Olaisson G. , Månsson W.
Published: November 2003

Objectives To evaluate the intestinal mucosal permeability in continent reservoirs for urine.

Patients and methods The mucosal permeability in continent urinary reservoirs, constructed either from an ileal or a colonic segment (six patients each), was assessed by analysing serial samples of plasma, after instilling the reservoir with 51Cr‐ethylene diaminetetra‐acetic acid (51Cr‐EDTA), and serum, after instillation with polyethylene glycol (PEG 400).

Results There was no or negligible permeation of 51Cr‐EDTA and PEG 400 in either type of reservoir, as there was no significant increase of the markers in plasma and serum, respectively.

Conclusion The intestinal barrier to medium‐sized hydrophilic molecules seems intact in continent urinary reservoirs. The lack of significant permeation of 51Cr‐EDTA confirms the usefulness of a single injection of 51Cr‐EDTA for the determination of glomerular filtration rate in patients with intestinal urinary diversion.
Comparison of prostatic volume and dimensions by transrectal and transurethral ultrasonography
Authors: Nathan M.S. , Mei Q. , Seenivasagam K. , Davies B. , Wickham J.E.A. , Miller R.A.
Published: November 2003

Objective To compare the volumes and dimensions of the prostate gland as measured by transrectal and transurethral ultrasonography (TRUS and TUUS) and to study the prostatic changes that occur in the presence of an urethral instrument.

Patients and methods Twenty men (mean age 71 years, range 43–85) with symptoms of prostatic enlargement underwent TRUS and the dimensions and volumes of their prostates were obtained by the dimensional method and by step planimetry. Within 24 h, all the men were examined cystoscopically under sedoanalgesia and underwent TUUS. Their prostatic volumes and dimensions were again measured by the dimensional method and by step planimetry. Step planimetry was carried out using a specially designed indexer firmly attached to the examination couch or operating table. All the static images and planimetry slices were video recorded for later computer enhancement and to study the three‐dimensional changes occurring in the prostate. The volumes and dimensions obtained by TRUS and TUUS were compared.

Results Volumes obtained by transurethral step planimetry were 22% greater than those from transrectal planimetry. Although there was a good correlation (r=0.984) between transurethral planimetry and the volumes derived using the transurethral dimensions with the prolate ellipsoid formula, the latter produced values 17% and 25% lower by the transurethral and transrectal routes, respectively. These volume estimates varied widely, indicating that the simple addition of a constant to the prolate ellipsoid formula would not correct the volume. Three‐dimensional changes of the prostate occurred with TRUS and TUUS; with TUUS, the craniocaudal and anteroposterior diameters were significantly larger (by 7% and 18%, respectively) while the transverse diameter was smaller by 20%.

Conclusion The estimated volumes and dimensions of the prostate differed when measured by TRUS and TUUS and three‐dimensional changes in the prostate occurred in the presence of an urethral instrument.
Reproducibility of penile arterial colour duplex ultrasonography
Authors: Mills R.D. , Sethia K.K.
Published: November 2003

Objective To assess the reproducibility of penile arterial colour duplex ultrasonography (CDU) in patients with impotence.

Patients and methods Fifty‐eight patients underwent CDU of their penile arteries on two occasions 2 weeks apart. Group A (n=34) received 60 mg of papaverine intracavernosally before CDU and group B (n=24) received a combination of papaverine, prostaglandin E1 and phentolamine. The variables measured during CDU were peak systolic velocity (PSV) and the end diastolic velocity (EDV), with the systolic rise‐time (SRT) also recorded in group B.

Results In both groups of patients the reproducibility between the first and second recordings was poor for all variables. The mean variation in PSV was 31.5% and 40.2%, and in EDV was 44.9% and 50.1%, for groups A and B, respectively. For the SRT, measured only in group B, the mean variation was 25.7%.

Conclusions These results show that CDU is a poorly reproducible technique for assessing vascular status in patients with impotence. Therefore, it is not reliable in the long‐term follow‐up of patients and single measurements should be interpreted with caution.
The fate of the defunctioned bladder following supravesical urinary diversion
Authors: Adeyoju A.B. , Thornhill J. , Lynch T. , Grainger R. , McDermott T. , Butler M.R.
Published: November 2003

Objective To determine the nature, incidence and severity of bladder complications after supravesical urinary diversion without cystectomy and to identify preventative risk factors.

Patients and methods A retrospective study of the last 25 years identified 35 patients who had supravesical urinary diversion without concomitant cystectomy (33 ileal loop diversions and two cutaneous ureterostomies). Urinary diversion was performed for a variety of lower urinary tract pathologies. Patients with urinary tract neoplasia were excluded. There were 15 males (mean age 41 years, range 13–72) and 20 females (mean age 49 years, range 15–81) with a mean follow‐up of 5.2 years (range 1–25).

Results There were bladder complications in 10 patients (28%) including pyocystis (one mild and two severe), haemorrhage (two mild and one severe) and pain/spasm (four mild and three severe). Patients with interstitial cystitis, bladder outflow obstruction and/or a vesical fistula appeared to have a higher risk of complications. Four patients required cystectomy to treat severe symptoms while the remaining six achieved control of symptoms with no surgery. No patient developed carcinoma during the follow‐up.

Conclusion We recommend that cystectomy is considered at the time of supravesical urinary diversion, particularly in patients with interstitial cystitis, bladder outflow obstruction or a chronically infected bladder and especially in those with a vesical fistula.
Artificial urinary sphincter implantation for neurogenic bladder: a multi‐institutional study in 107 children
Authors: Simeoni J. , Guys J.M. , Mollard P. , Buzelin J.M. , Moscovici J. , Bondonny J.M. , Melin Y. , Lortat‐Jacob S. , Aubert D. , Costa F. , Galifer B. , Debeugny P.
Published: November 2003

Objectives

 To evaluate the outcome of implantation of the AMS 800 artificial urinary sphincter in children with neurogenic bladder.

Patients and methods

 The records of 107 children (74 boys and 33 girls) treated for neurogenic urinary incontinence by implantation of the AMS 800 artificial sphincter between 1983 and 1993 were reviewed retrospectively. The underlying cause of incontinence in 92 patients was spina bifida, the mean age at implantation was 13.7 years and 30 patients had undergone previous bladder neck surgery. Implantation was carried out in combination with another surgical procedure in 24.3% of patients. The mean follow‐up was 61 months (minimum 12).

Results

 The mean operational life of the sphincter was 56 months. No deaths occurred but removal of the artificial sphincter was necessary in 20 patients (19%). Surgical revision was not required in 44 patients (41%) but at least one revision was performed in 63 and more than one in 42. There were 21 mechanical failures, 40 surgical complications and 39 cases involving changes in the dynamics of bladder function. Of the 87 children (81%) in whom the device is still in place, 72 are completely continent (83%), 10 are slightly wet, and five are incontinent. The overall success rate was 77%.

Conclusions

 The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre‐operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long‐term follow‐up.
Impaired production of interferon‐α in whole‐blood cultures from patients with renal cell carcinoma
Authors: Kuo J.Y. , Kita M. , Imanishi J. , Yoshida O.
Published: November 2003

Objective To determine the immune status of patients with renal cell carcinoma (RCC) by estimating the production of interferon‐α (IFN‐α) in whole‐blood cultures from these patients and from healthy subjects.

Patients, subjects and methods Peripheral blood (2 mL) was collected from 30 untreated patients (23 men and seven women, mean age 59 years, range 35–78) with RCC and 30 healthy subjects (23 men and seven women, mean age 62 years). The patients with RCC comprised 17 with low‐stage (stage I, II) and 13 patients with high‐stage (stage III, IV) RCC. Sendai virus was added to the samples and incubated at 37°C for 20 h, the supernatants collected and the activity of IFN‐α determined by a conventional cytopathic‐effect inhibition assay performed in microtitre plates with FL cells and challenged with vesicular stomatitis virus.

Results The production of IFN‐α was suppressed significantly in patients with high‐stage RCC compared with that in the control subjects (P<0.05), but there was no significant difference when compared to patients with low‐stage RCC.

Conclusion This study demonstrated that the immune status of patients with high‐stage RCC was impaired significantly and exogenous IFN‐α therapy might be beneficial clinically for this group.
Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy
Authors: Carringer M. , Swartz R. , Johansson J.E.
Published: November 2003

Objective To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy.

Patients and methods Four pregnant women (mean age 29.5 years, range 27–35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26–35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four).

Results All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure.

Conclusions Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.
Quantitative assessment of vascular surface density in renal cell carcinomas
Authors: Köhler H.H. , Barth P.J. , Siebel A. , Gerharz E.W. , Bittinger A.
Published: November 2003

Objective To evaluate the extent of vascularization by assessing vascular surface density in renal cell carcinomas (RCCs) of different nuclear grades, and in normal renal cortex and medulla.

Materials and methods Specimens of 79 RCCs of different nuclear grades (16 of G1, 42 of G2 and 21 of G3) were immunostained with the lectin Ulex europaeus agglutinin‐I (UEA I). The vascular surface density of tumour tissue was assessed stereologically using a test grid at ×400 magnification and compared to the values obtained in normal renal tissue.

Results G3 tumours had a lower vascular surface density than had G1 and G2 RCCs and normal renal tissue of the cortex and medulla (P<0.001, respectively). G1 tumours had a significantly higher vessel density than had normal medullary parenchyma and G2 carcinomas (P<0.001). Vessel density was not significantly different among G1 tumours and cortical parenchyma in controls and among normal medullary tissue and G2 tumours. Statistical analysis showed that the vascular surface density was independent of tumour stage and size and the age and sex of the patients.

Conclusion The degree of vascularization in RCCs decreased with their grade of differentiation, suggesting that the extent of neovascularization in tumour tissue reflects the relationship between tumour cell proliferation and vascular growth. The values of vascular surface density in normal renal tissue of the cortex and medulla partially overlapped with those obtained in tumour tissue.
The symptom questionnaire for benign prostatic hyperplasia: an ambiguous indicator for an ambiguous disease
Authors: Stoevelaar H.J. , van de Beek C. , Nijs H.G.T. , Casparie A.F. , McDonnell J. , Janknegt R.A.
Published: November 2003

Objective To assess the criterion validity of the American Urological Association (AUA) symptom index for benign prostatic hyperplasia (BPH) in urological practice.

Patients and methods The study comprised 1414 consecutive men ≥50 years of age, newly referred to a urologist in a stratified sample of 12 hospitals throughout the Netherlands, who completed the AUA symptom questionnaire at their first visit. The 39 urologists completed a questionnaire on the diagnosis. The discriminative power of the index for BPH versus other urological diagnoses was calculated by receiver operating characteristic (ROC) analysis. Subsequently, criterion sensibility was studied by assessing the effect of particular variables on the probability of the diagnosis of BPH.

Results ROC areas were low for BPH versus prostate cancer (0.57, se 0.04), chronic prostatitis/prostatodynia (0.65, se 0.03), and other diseases of the lower urinary tract (0.57, se 0.04). Satisfactory to good values were found for BPH versus diseases of the upper urinary tract (0.79, se 0.03), impotence/infertility (0.79, se 0.04), penile‐scrotal diseases (0.85, se 0.02), and no abnormalities (0.84, se 0.03). The diagnosis of BPH, as made by urologists in daily practice, appeared to be a weak criterion. Irrespective of other characteristics, the chance of being diagnosed with BPH was affected by differences in definition and the type of hospital.

Conclusion Although the AUA index discriminated fairly well between BPH and diseases of the upper urinary tract, as well as genital diseases, it has no potential for distinguishing BPH from other diseases of the lower urinary tract. In addition, the lack of consensus in defining clinical BPH underscores the weakness of the index as a tool in the diagnostic process of this disease.
Sensitivity of cell lines to mitomycin C
Authors: Watts P.L. , Plumb J.A. , Courtney J.M. , Scott R.
Published: November 2003

Objectives To determine the effect of pH on the cytotoxicity of mitomycin C on a wide range of established cell lines.

Materials and methods Cultures of three human tumour cell lines, including two bladder carcinomas and one renal adenocarcinoma, and two mouse cell lines were treated with mitomycin C (concentration range 320 pm‐50 μm) at a range of pH (5.8–7.8) for 2 h. The cytotoxicity of mitomycin C over this range was determined using a tetrazolium‐dye‐based microtitration assay.

Results The cytotoxicity of mitomycin C was significantly greater (confidence level≥95%) in acidic conditions (pH 5.8–6.0) than in neutral to alkaline pH (7.2–7.8) for three of the five cell lines. The same trend, although less marked, also occurred in the other two cell lines.

Conclusion The cytotoxicity of mitomycin C was greater under acidic conditions for all these cell lines confirming that the activity of mitomycin C depends on pH and suggesting that the pH of the vehicle used for intravesical chemotherapy may be an important factor in the successful treatment of bladder carcinomas. The modification of pH by urine may explain some of the variation in success rates among patients treated intravesically with mitomycin C.
Determination and reversal of resistance to epirubicin intravesical chemotherapy. A flow cytometric model
Authors: Duffy P.M. , Hayes M.C. , Cooper A. , Smart C.J.
Published: November 2003

Objective To develop a method of determining the characteristics of epirubicin resistance and to study the reversal of such resistance in the intravesical treatment of superficial bladder cancer, using sensitive and resistant derivatives of a bladder cancer cell line in vitro.

Materials and methods Epirubicin fluorescence and flow cytometry were used to measure the intracellular levels of epirubicin in both sensitive and resistant live cultured bladder tumour cells, with and without different doses of the resistance‐reversing agent verapamil.

Results There was a reliable, highly significant and consistent difference in intracellular epirubicin concentration between the resistant and sensitive bladder tumour cells. In addition, it was possible to substantially reverse the features of resistant cell subline with additional verapamil.

Conclusion Application of this assay to clinical specimens should allow better targeting of epirubicin intravesical chemotherapy and avoid the premature termination of such treatment in patients whose tumours remain sensitive to this agent. Furthermore, the addition of verapamil to intravesical epirubicin may permit effective treatment of those patients whose tumours have inherent or acquired resistance to epirubicin.
Long‐term catheterization of the bladder:
Authors: Kohler‐Ockmore J. , Feneley R.C.L.
Published: November 2003

Objective To estimate the prevalence and morbidity of long‐term catheterization (LTC) of the urinary bladder.

Patients and methods A postal survey was conducted over two successive years from February 1989 to determine the incidence of LTC in three Bristol Health Districts with a total population of 827 595. During the first year the number of patients requiring emergency treatment for complications of LTC was also monitored over a 6‐month period. In the second year, 54 patients were selected from the first survey and each was visited by one investigator every 2 weeks for 12 weeks to obtain information on catheter management, the incidence and type of complications, the attitudes of the patients or carers about the catheter and to assess the pH and microbiology of the patient's urine.

Results The initial surveys identified 457 and 467 patients with long‐term catheters during the 2 years, respectively; there were similar numbers of men and women in both years. The survey of catheter complications recorded 506 emergency referrals during the 6 months and the detailed study of 54 patients showed that 48% experienced catheter blockage, 37% reported urine by‐passing the catheter and 30% noted haematuria. Patients found the catheter uncomfortable and depended on nursing support. Catheter blockage was associated with bladder stones, a high urinary pH and the presence of Proteus spp in the urine.

Conclusion The prevalence and high morbidity of LTC cause a considerable demand on the available District and Hospital nursing services; most patients with long‐term catheters are elderly, disabled or debilitated and more nurses need to be trained in the technique of catheterization and the management of the catheterized patient. Further research is required to reduce the morbidity of LTC by investigating measures to reduce catheter blockage and encrustation at the urine/biomaterial interface.
The value of exfoliative urine cytology in combination with flexible cystoscopy in the diagnosis of recurrent transitional cell carcinoma of the urinary bladder
Authors: Loh C.S. , Spedding A.V. , Ashworth M.T. , Kenyon W.E. , Desmond A.D.
Published: November 2003

Objective To study the value of exfoliative urine cytology in predicting recurrent tumour in patients undergoing surveillance for transitional cell carcinoma (TCC) and to assess the suitability of these patients for flexible cystoscopy.

Patients and methods Specimens of early‐morning and freshly voided urine were submitted 2 weeks before surveillance cystoscopy by 111 consecutive patients with known TCC. All patients then underwent cystoscopy under general anaesthesia. The urine specimens were analysed by two pathologists with no knowledge of the patients' history. Cytological findings were correlated with the findings of cystoscopy.

Results Urine cytology predicted 82% of all recurrent tumours found subsequently at cystoscopy; 60% of patients with non‐neoplastic pathology had normal cystoscopy. Only 51% of patients with positive urine cytology were shown to have recurrent TCC, but 87% of patients with negative cytology had no recurrent tumours.

Conclusion Urine cytology is a good adjunct to assessing the suitability of flexible cystoscopy in the follow‐up of patients with transitional cell tumours.
Determination and reversal of resistance to epirubicin intravesical chemotherapy. A confocal imaging study
Authors: Duffy P.M. , Hayes M.C. , Gatrell S.K.E. , Cooper A. , Smart C.J.
Published: November 2003

Objective To evaluate the use of confocal microscopy in the study of resistance to epirubicin and to determine the effect of temperature, viability and a resistance‐reversing agent on the intracellular distribution of this drug in sensitive and resistant derivatives of a superficial bladder cancer cell line.

Materials and methods Viable and non‐viable adherent cells were incubated in epirubicin solutions under various conditions. After incubation, the distribution of intracellular epirubicin fluorescence was visualized using confocal microscopy and a ×50 water‐immersion lens.

Results There was a striking and consistent difference between resistant and sensitive cells in the intracellular distribution of the drug. In addition to having greater overall levels of epirubicin fluorescence, sensitive cells accumulated epirubicin predominantly in the nucleus. Epirubicin fluorescence in resistant cells was cytoplasmic and granular in appearance. When incubated at 0°C, both cell lines showed no nuclear uptake and thus resembled resistant cells at 37°C. However, dead cells rapidly acquired brightly fluorescent nuclei. The resistance‐reversing agent verapamil appeared to cause reversion of the resistant to the sensitive phenotype.

Conclusion Confocal microscopy allows epirubicin‐sensitive and resistant cultured tumour cells to be differentiated reliably and provides information about the mechanisms of action of, and resistance to, epirubicin. Applying this technique to clinical specimens should enable patients who have the resistant phenotype to be detected and the efficacy of intravesical resistance‐reversing agents to be evaluated in such cases.
Polymorphism and smoking in bladder carcinogenesis
Authors: Chinegwundoh F.I. , Kaisary A.V.
Published: November 2003

Objective To study the relationship between smoking, a cytochrome P‐450 gene polymorphism and the development of bladder cancer.

Patients and methods The study comprised 126 patients with a diagnosis of bladder cancer from whom a full history was obtained. Genomic DNA was extracted from blood sampled from each patient and genotyping of the CYP2D6 locus, the gene responsible for debrisoquine hydroxylase activity, was performed using a polymerase chain‐reaction technique.

Results Of the 126 patients, 78% had a history of smoking. There was a relationship between the number of cigarettes smoked and the grade of the presenting bladder tumour; heavy smokers developed high‐grade disease. There was a trend for those heterozygous at the CYP2D6 locus and with a history of smoking to develop more aggressive disease, but this trend did not reach statistical significance.

Conclusion The link between smoking and bladder cancer was confirmed. Furthermore, the grade of the presenting tumour was related to the ‘cigarette‐years’. The CYP2D6 genotype may influence the type of bladder cancer that develops in smokers.
Computer‐controlled monitoring of bladder pressure in the prevention of ‘TUR syndrome’: a randomized study of 53 cases
Authors: Hubert J. , Cormier L. , Gerbaud P.F. , Guillemin F. , Pertek J.P. , Mangin P.
Published: November 2003

Objective

 To evaluate the performance of a computer‐controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome.

Patients and methods

 The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0–500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood.

Results

 When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings.

Conclusion

 The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.
Urodynamic changes during therapeutic intravesical instillations of capsaicin
Authors: Chandiramani V.A. , Peterson T. , Duthie G.S. , Fowler C.J.
Published: November 2003

Objective To describe the technique for and urodynamic changes during therapeutic instillations of intravesical capsaicin in patients with detrusor hyper‐reflexia.

Patients and methods Ninety intravesicalinstillationsof capsaicin were performed as a therapeutic procedure in 30 patients; 21 patients had various causes of non‐traumatic spinal cord disease, five patients were very severely neurologically impaired and were bed‐bound with an indwelling catheter, and four were neurologically normal. Simultaneous cystometry was performed in 25 patients during the instillation of capsaicin; 100 mL of 1 or 2 mmol/L capsaicin in 30% ethanol/saline was instilled into the bladder for 30 min and two patients received 30% ethanol/saline only. The last 56 capsaicin treatments were preceded by the instillation of 40 mL of 2% lignocaine for 20 min. Detrusor hyper‐reflexia was decreased and urinary continence improved for 3–6 months after a single instillation; the instillation was then repeated. Two patients who received only ethanol/saline showed no clinical or urodynamic improvement.

Results The treatment was not abandoned in any patient due to discomfort and there were no short‐ or medium‐term complications. All patients with spinal cord disease and phasic detrusor hyper‐reflexia had similar, frequent and repetitive detrusor contractions during the instillation of capsaicin. These acute reactive contractions did not occur in the neurologically normal patients. Similarly, the instillation of intravesical lignocaine only caused no phasic detrusor contractions. Intravesical lignocaine instillation before capsaicin markedly reduced and sometimes abolished the detrusor overactivity and lessened the discomfort for the patients. The instillation of lignocaine before capsaicin did not alter the benefit from each instillation of intravesical capsaicin.

Conclusion A method has been developed for administering capsaicin intravesically which diminishes discomfort for the patient and in the short‐and medium‐term is free of complications. The study also provides functional evidence of the role of capsaicin‐sensitive afferents in phasic detrusor hyper‐reflexia due to spinal cord disease.
Long‐term effects of potassium citrate therapy on the formation of new stones in groups of recurrent stone formers with hypocitraturia
Authors: Whalley (nee Laminski) N.A. , Meyers A.M. , Martins M. , Margolius L.P.
Published: November 2003

Objective To compare stone formation rates before (as total rates and during remote periods) and after therapy with potassium citrate in patients with hypocitraturia.

Patients and methods  The study comprised 15 patients with hypocitraturia only (Group I) and 12 patients with hypocitraturia associated with other abnormalities (Group II), all of whom were recurrent stone formers. Their urine chemistry, including citrate, was measured before and after treatment.

Results In both groups, the urinary citrate concentration increased significantly to within normal limits during therapy with potassium citrate (P<0.005). The rate of total stone formation in patients in Group I decreased significantly from 0.7/year before to 0.13/year after treatment (P<0.005). The corresponding remote stone formation rate before (0.88/year) was significantly greater than the rate after treatment (0.13/year; P<0.005; follow‐up 4.6±1.9 years). Patients in Group II showed a similar striking decrease in total stone formation rate, from 1.2/year to 0.08/year after treatment (P<0.005). The corresponding remote stone formation rate (1.66/year) before was significantly greater than that after treatment (0.08/year; P<0.005; follow‐up 4.1±1.6 years). There was a remission rate of 93% for stone formation over the complete follow‐up.

Conclusion Potassium citrate appears to be the drug of choice in the long‐term treatment of patients with hypocitraturia as it not only decreases the rate of stone formation but also maintains normal citrate levels in the urine.