bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of an extract from Herniaria hirsuta on calcium oxalate crystallization in vitro
Authors: Atmani F. , Khan S.R.
Published: March 2003

Objective To evaluate the effectiveness of an extract obtained from Herniaria hirsuta on calcium oxalate crystallization in vitro.

Materials and methods An extract was prepared from H. hirsuta at different concentrations (0.0625–1 mg/mL). Crystallization was induced in whole normal human urine samples in the absence or presence of the extract. Crystals generated in the urine were harvested and analysed by scanning electron microscopy. The nucleation and aggregation of calcium oxalate crystals were measured separately using spectrophotometric methods. The nucleation rate was followed at 620 nm after mixing calcium chloride and sodium oxalate solution at 37 °C, with stirring. The induction time in the presence of herb extract was compared with that of the control. The aggregation rate was also followed at 620 nm in a buffered solution containing calcium oxalate monohydrate crystals after stopping the stirring. The rate was evaluated by comparing the slope of turbidity in the presence of the extract with that of the control.

Results The herb extract promoted the precipitation of calcium oxalate particles in whole urine.
sem showed that there were more crystals with increasing concentration of extract but that they were proportionally smaller. Moreover, the presence of herb extract favoured the formation of calcium oxalate dihydrate rather than monohydrate crystals. The extract inhibited calcium oxalate crystal aggregation. In an independent experiment, the herb extract was dialysed and filtered before inducing crystallization, to eliminate any fibrous particles and oxalate. The treated herb extract promoted more crystallization, especially at high concentrations.

Conclusion An extract of H. hirsuta promoted the nucleation of calcium oxalate crystals, increasing their number but decreasing their size. It also promoted the formation of calcium oxalate dihydrate crystals, despite the presence of calcium oxalate monohydrate particles. The extract may contain substances that inhibit calcium oxalate crystal aggregation. These properties of H. hirsuta might be beneficial in preventing kidney stone formation.
Is only meatoplasty a legitimate surgical solution for extreme distal hypospadias? A long‐term follow‐up after adolescence
Authors: Mor Y. , Ramon J. , Jonas P.
Published: March 2003

Objective To review the long‐term outcome of glanular hypospadias repair for extreme distal hypospadias based on simple dorsal Browne meatoplasty and circumcision, with particular attention to patient satisfaction.

Patients and methods A review of medical records identified 124 patients who underwent surgery for hypospadias between 1970 and 1979. Their age at operation ranged from 3 months to 13 years. The operation, performed as a day‐case, included dorsal Browne meatoplasty for meatal advancement, based upon the Heineke‐Mikulicz principle, using three absorbable sutures and often circumcision. There were no immediate complications. A questionnaire was sent to 111 patients whose present address was available. Two patients had died since the operation and of the 109 remaining patients, 43 (39%) replied.

Results The patients were aged 16–31 years at the time of assessment, giving a follow‐up of 18 (13–23) years. Seven of the 43 patients were married. Seven patients had complained of some difficulties with urination, four reporting a poor urinary flow. The stream was directed forward in 32 patients and to some degree downwards in 11, still enabling all the patients to urinate while standing with a single stream. Thirty‐two patients had had sexual experience, with no functional problems. Twenty‐three defined their penile appearance as normal and 20 as abnormal. Overall, 24 (56%) reported complete satisfaction, 11 (25%) partial satisfaction and eight (19%) were dissatisfied with the surgical result.

Conclusion As there are few published reports about the long‐term outcome and patient satisfaction after hypospadias repair, it is difficult to draw clear conclusions. However, this simple procedure is a legitimate surgical option for extremely distal glanular hypospadias.
A randomized double‐blind placebo‐controlled crossover trial of the efficacy of l‐arginine in the treatment of interstitial cystitis
Authors: Cartledge J.J. , Davies A.‐M. , Eardley I.
Published: March 2003

Objectives To determine, in a double‐blind placebo‐controlled crossover study, whether l‐arginine improves the symptoms of interstitial cystitis (IC), a chronic condition in which nitric oxide (NO) may be important, as previous open pilot studies suggested that l‐arginine reduced the pain and frequency associated with IC.

Patients and methods Patients fulfilling the standard diagnostic criteria for IC were randomized to receive l‐arginine (2.4 g/day) or placebo for one month. After a 2‐week ‘washout’ period they received the other medication. Patients were assessed at each stage using a validated symptom index, a voiding diary, urine analysis and records of adverse events. Patients were asked about overall efficacy at the close of the study. The results were compared using a t‐test, with significance indicated at P < 0.05.

Results Sixteen (16) patients (mean age 51.3 years) were enrolled; the mean duration of IC was 5.4 years, the IC symptom index score 29.1, their nocturnal frequency 3.5 (voided volume 182 mL) and daytime frequency 12.7 (124 mL). Patients on placebo showed no differences in any recorded variable over the baseline values. l‐arginine caused a statistically significant reduction in the overall symptom score of 2.2 over baseline, but there was no difference in voided volume, frequency or nocturia. As there was no significant difference for any variable between l‐arginine and placebo, this reduction in score should be regarded with caution. Three patients withdrew because of side‐effects (severe headaches, night sweats and flushing).

Conclusion Oral l‐arginine produces a statistically significant improvement in the IC symptom index in patients with IC, but the effect is small. This effect may not be clinically significant as there were no improvements in the other variables assessed and no significant difference between the response to l‐arginine and placebo. From these results the use of l‐arginine cannot be recommended for treating IC.
The Mitrofanoff procedure: does it last?
Authors: Fishwick J.E. , Gough D.C.S. , O’Flynn K.J.
Published: March 2003

Objective To examine the long‐term effectiveness of the Mitrofanoff principle and establish if the catheterizing channel is sufficiently robust for long‐term use.

Patients and methods Ten patients who had undergone Mitrofanoff reconstruction between 1989 and 1991 (minimum follow‐up 10 years) were offered reinterview by one of the authors (J.F.), which involved a structured questionnaire assessing catheterization, continence and complications.

Results One patient had died; nine patients were alive and eight agreed to the structured interview. All the patients had their original stoma and all were completely continent. Four of the patients had experienced stenosis, four had had stones and four had been ill with urinary tract infection(s).

Conclusion Despite the complications of infection, stones and some episodic stenosis, the Mitrofanoff channel remains functional for long periods without sustaining structural damage.
Photodynamic therapy of rat bladder and urethra: evaluation of urinary and reproductive function after inducing protoporphyrin IX with 5‐aminolaevulinic acid
Authors: Chang S.‐C. , Chern I. , Bown S.G.
Published: March 2003

Objective To assess the urinary and reproductive function of rats after inducing protoporphyrin IX with 5‐aminolaevulinic acid (ALA) and subsequent intraurethral photodynamic therapy (PDT).

Materials and methods Twelve female Wistar rats were given ALA orally or intravesically (four each), followed by intraurethral PDT through a 10‐mm cylindrical fibre at 100 mW for 500 s (argon laser, 632 nm). Urinary frequency, the number of gestations and histological changes were then evaluated and compared with a group of eight control rats.

Results There was only a slight increase in urinary frequency during the first 2 weeks after PDT in the group given oral ALA, while the same degree of urinary frequency was evident for up to 4 weeks in those given intravesical ALA. Despite the occurrence of urinary incontinence from undefined causes in two rats, reproductive function remained unchanged. There was no histological evidence of damage to the reproductive system adjacent to the bladder.

Conclusions PDT of the urethra with ALA is relatively safe and carries few risks of inducing permanent urological complications.
The development and validation of a quality‐of‐life measure to assess partner morbidity in benign prostatic enlargement
Authors: Sells H. , Donovan J. , Ewings P. , Macdonagh R.P.
Published: March 2003

Objective To investigate morbidity in the partners of patients with benign prostatic enlargement (BPE) by developing and validating a disease‐specific questionnaire.

Patients and methods Phase 1 of the study comprised preliminary interviews with 15 patients who had newly diagnosed BPE, and with their partners, to determine the relevant issues for the partners. In phase 2, using these issues, a questionnaire was produced and tested on the 15 partners. In phase 3 the questionnaire was completed by 90 further partners, 50 at interview and the next 40 by post. As part of the validation process, the partners were also asked to complete the Short‐Form‐36 questionnaire, and the patients the Internation Prostate Symptom Score (IPSS) and the ICSmale questionnaires.

Results In phase 1 all 15 of the partners were affected by the patients’ disease and nine issues were identified. In phase 2, of the 90 partners, only one had no morbidity from the patient’s symptoms; 71% were worried that the patient may have cancer and 69% concerned that the patient may require an operation. Only six partners were present at the patients’ urological consultation. The partners’ questionnaire scores were related significantly to the Mental Health and Vitality domains of the SF36 and with the patients’ IPSS.

Conclusions The study confirmed the presence of significant morbidity in the partners of patients with BPE. The degree of partner morbidity was related to the severity of the patients’ symptoms. Many of the questionnaire issues can be addressed in the consulting room by open discussion with patient and partner.
Differential response of prostate specific antigen to testosterone surge after luteinizing hormone‐releasing hormone analogue in prostate cancer and benign prostatic hyperplasia
Authors: Agarwal D.K. , Costello A.J. , Peters J. , Sikaris K. , Crowe H.
Published: March 2003

Objective To investigate any differences in changes in serum prostate specific antigen (PSA) levels in patients with benign and malignant prostatic disease in response to the testosterone surge after administering a luteinizing hormone‐releasing hormone (LHRH) analogue.

Patients and methods The study included 54 patients referred to the urology clinic with intermediate PSA levels (4–10 ng/mL) or an abnormal digital rectal examination. Forty‐five patients received a single injection of LHRH analogue depot each at one week before prostate biopsy and nine served as a control group. Changes in PSA levels in response to the testosterone surge from the LHRH analogue were recorded after 5 and 7 days, and were correlated with the biopsy results. The PSA changes were compared with basal PSA levels and the free/total PSA ratio(f/tPSA).

Results Of the 45 patients who underwent prostate biopsy, histopathology showed prostate cancer in 11, benign prostatic hyperplasia in 33 and prostatic intraepithelial neoplasia in one. Patients with cancer had a significantly greater increase in serum PSA levels during the first week after LHRH injection than those in the benign and control groups. Receiver operating characteristic curves showed that the percentage change in PSA level on day 5 was more diagnostic than total PSA and f/tPSA.

Conclusions There was a marked difference in the PSA response of patients with benign or malignant disease to the testosterone surge produced by the LHRH analogue. Although a larger study would be needed before LHRH‐induced provocation could be proposed as a clinical test, in this small series the response was better than that for total PSA or f/tPSA in differentiating benign and malignant disease.
Twelve prostate biopsies detect significant cancer volumes (> 0.5 mL)
Authors: Brössner C. , Bayer G. , Madersbacher S. , Kuber W. , Klingler C. , Pycha A.
Published: March 2003

Objectives To compare, in a retrospective study, pathological specimens of prostate cancer detected in additional areas of a 12‐core biopsy with tumours detected using traditional sextant biopsy.

Patients and methods The study included 27 patients who had undergone radical prostatectomy (RP) for prostate cancer. Prostatectomy specimens of cancers detected using standard sextant biopsies were compared with those detected using six additional core biopsies. The RP specimens were analysed for cancer volume, Gleason score, tumour grade (Mostofi) and pathological stage.

Results Of the 27 patients, six (29%) had cancer detected in the extra six biopsy cores which would have otherwise have been undetected using sextant biopsy. Only two insignificant cancers were detected. The mean Gleason score was 6.1 for cancer detected by the sextant or 12‐core method (P = 0.907); the mean grade (Mostofi) was 2.1 and 2.33, respectively (P = 0.29). The final tumour stage in the 21 patients undergoing sextant biopsy was pT2 in 13 and pT3 in eight, compared with six pT2 tumours in the six patients diagnosed using extra biopsies. The mean (median, range) tumour volume was 5.7 (3.5, 0.312–23.75) mL for cancers detected on sextant biopsy and 1.99 (1.85, 0.4–3.6) mL in the six cancers detected using extra cores (P = 0.0138).

Conclusion The detection of prostate cancer was increased using extra biopsy cores. There was a significant difference in tumour volume but not in Gleason score, Mostofi grade or final pathological tumour stage between tumours diagnosed using 12 cores and those detected on sextant biopsy.
Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study
Authors: Aron M. , Rajeev T.P. , Gupta N.P.
Published: March 2003

Objectives To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate.

Patients and methods Between June 1996 and September 1998, 231 patients who satisfied the inclusion and exclusion criteria entered the study; the patients were randomized into three groups. Each patient underwent transrectal needle biopsy of the prostate after a cleansing enema at 06:00 hours. Patients in group 1 (75) then received a placebo tablet twice a day for 3 days; those in group 2 (79) were given a single dose of ciprofloxacin (500 mg) and tinidazole (600 mg), while those in group 3 (77) were given the same combination twice a day for 3 days. Urine cultures were obtained 48 h after the biopsy and blood cultures only from patients who developed fever. The complications (categorized as infective or noninfective) occurring in the three groups were compared using the chi‐square test.

Results Noninfective complications included were lower urinary tract symptoms, rectal bleeding, haematuria and perineal pain. The infective complications included urinary tract infection and fever. There was no significant difference among the three groups in noninfective complications (27, 29 and 31 in groups 1–3, respectively) but the incidence of infective complications (19, six and eight, respectively) was significantly higher in group 1 (P = 0.003). However, the difference was significant only for urinary tract infection (P = 0.01) and not for fever.

Conclusions In selected patients a single dose of ciprofloxacin‐tinidazole is adequate prophylaxis for transrectal needle biopsy of the prostate. The present urinary infection rate was higher if no antibiotics were used. Continuing the antibiotic prophylaxis for 3 days offered no benefit over single‐dose prophylaxis.
An epidemiological study of enuresis in Korean children
Authors: Lee S.D. , Sohn D.W. , Lee J.Z. , Park N.C. , Chung M.K.
Published: March 2003

Objective To estimate the prevalence of enuresis in children of elementary school age, to evaluate the impact of enuresis on these children and their parents, and to identify the methods and effectiveness of managing enuresis.

Subjects and methods A randomly selected cross‐sectional study was conducted in one elementary school in each urban ward (nine schools) in Pusan, Korea. The parents of these 12 570 children aged 7–12 years were asked to complete questionnaires which included items about the presence and frequency of enuresis, its perceived impact and management. Enuresis was defined as an episode of wetting occurring at least once per month.

Results The overall response rate to the questionnaire was 55.8% (girls 28.2%, boys 27.6%). The prevalence of nocturnal, diurnal and combined enuresis was 9.2%, 2.2% and 1.4%, respectively. The overall prevalence of enuresis declined with age from 20.4% at 7 years old to 5.6% at 12 years old; 342 (57.0%) parents and 318 (55.6%) children were concerned about enuresis. The common self‐help strategies were waking the child at night to void (38.1%) and restriction of water intake (25.7%). Of the enuretic children, only 13.7% had consulted a health worker.

Conclusion The prevalence rates for enuresis in Pusan are similar to those reported from European countries. Enuretic children and their parents were moderately concerned about enuresis and the parents primarily used self‐management within the family.
Epididymectomy is an effective treatment for scrotal pain after vasectomy
Authors: West A.F. , Leung H.Y. , Powell P.H.
Published: March 2003

Objective To investigate the efficacy of epididymectomy in patients with significant scrotal pain after vasectomy.

Patient and methods Sixteen patients were identified retrospectively to have undergone epididymectomy for pain after vasectomy; 19 epididymectomies were performed (three bilateral and 13 unilateral). Details from the preoperative investigations, histological examination and follow‐up of symptoms were analysed and correlated. Outcomes were initially assessed at the routine outpatient clinic review 3 months after surgery and the long‐term outcomes were assessed by a telephone interview 3–8 years after epididymectomy (mean 5.5 years).

Results Of the 16 patients, 14 had excellent initial symptomatic benefit from epididymectomy. At 3–8 years afterward, nine of 10 patients interviewed had a sustained improvement of their scrotal pain. The following were indicators of a poor outcome: atypical symptoms including testicular or groin pain; erectile dysfunction and normal appearance of the epididymis on ultrasonography. Patients with bilateral scrotal pain can have a good outcome after epididymectomy.

Conclusion Epididymectomy in well‐selected patients is a reliable and effective treatment for pain after vasectomy.
A prospective pilot evaluation of urinary and immunohistochemical markers as predictors of clinical stage of urothelial carcinoma of the bladder
Authors: Krupski T. , Moskaluk C. , Boyd J.C. , Theodorescu D.
Published: March 2003

Objective To determine, in patients newly diagnosed with bladder cancer, whether p53, epidermal growth factor receptor (EGFR), microvessel density (MVD), urinary bladder tumour antigen (BTA TRAK™, Bion Diagnostic Sciences, Redmond, WA) and cytology were predictive of clinical stage, evaluated as a function of the clinical stage obtained at transurethral resection of the bladder tumour with and without the addition of clinical grade, a known strong predictor of clinical stage.

Patients and methods Between December 1997 and September 1998, 22 men and seven women with a cystoscopic diagnosis of urothelial bladder carcinoma were prospectively enrolled in the study. Urine was collected for cytological and BTA TRAK evaluation before transurethral resection. Tumour grade and clinical stage were obtained from the transurethral resection specimen. MVD was evaluated by computerized calculations of ‘optimal MVD’ (OMVD) and ‘area‐weighted MVD’ (AWMVD) while p53 and EGFR information was obtained by manual immunohistochemical techniques; 21 patients had sufficient tissue for all immunohistochemical assessments and comprised the study group. Univariate and multivariate comparisons were carried out to determine the contribution of each variable to the prediction of clinical stage.

Results Although there was a trend, cytological analysis and p53 and MVD immunoreactivity did not significantly correlate with clinical stage, while tumour grade, BTA TRAK and EGFR immunoreactivity did. In a univariate analysis, tumour grade and BTA TRAK were related to clinical stage. In a multivariate analysis, grade was the single best predictor of clinical stage. This analysis also showed that the addition of BTA TRAK and MVD information to grade incrementally improved the predictive ability of grade.

Conclusions This pilot study suggests that BTA TRAK and MVD contribute incremental information to tumour grade in predicting the clinical stage of urothelial carcinomas of the bladder; grade remains the most important predictor. These results suggest that further work with BTA TRAK and MVD in more patients and on biopsy material obtained during clinic cystoscopy is warranted for the future development of less invasive methods of identifying patients with invasive bladder cancer.
Diagnostic delay and risk of relapse in patients with stage I nonseminomatous germ cell tumour followed on active surveillance
Authors: Napier M.P. , Rustin G.J.S.
Published: March 2003

Objective To determine whether delayed diagnosis affects the outcome of patients with stage I nonseminomatous germ cell tumour (NSGCT) followed by a policy of ‘active surveillance’.

Patients and methods A series of 185 consecutive patients with either low‐risk (no vascular invasion) or unknown risk stage I NSGCT referred to Mount Vernon Hospital between 1983 and 1998 were analysed retrospectively for the type and duration of symptoms before orchidectomy, time to relapse, and for site and stage of relapse.

Results Twenty‐six patients (14%) relapsed within a medium follow‐up of 98 months. The median (range) time to relapse was 4 (1–14) months. All patients were effectively salvaged with chemotherapy and in some by surgery. The median duration of symptoms before orchidectomy for those patients relapsing was 2 months, and not significantly different from those who did not relapse.

Conclusions In patients with stage I NSGCT the duration of symptoms before diagnosis did not influence the probability of relapse.
Does intraprostatic vasopressin prevent the transurethral resection syndrome?
Authors: Sharma D.P. , Harvey A.B.
Published: March 2003

Objective To determine whether intraprostatic vasopressin (IPVP) prevents the transurethral resection (TUR) syndrome during prostatectomy.

Patients and methods The study comprised 36 consecutive patients (mean age 68 years) with prostates clinically assessed as ≥ 20 g who underwent standard transurethral prostatectomy (TURP). Ten units of vasopressin in 0.5 mL were diluted with 9.5 mL isotonic saline and injected into the prostate transrectally before TURP. Blood samples were taken before and immediately after TURP to measure serum sodium concentration and free haemoglobin levels. The TURP irrigant used was cooled, boiled water maintained at 70–80 cmH2O pressure during resection. Twenty patients had alcohol added to the irrigant and their breath alcohol assessed at 10‐min intervals during TURP. All patients had their pulse rate, blood pressure and sensorium monitored continuously. Extreme care was taken to avoid and/or identify capsular damage during resection.

Results The mean weight of tissue resected was 36 g and the mean resection time 24 min. There was no significant change in clinical variables during TURP. In 19 patients the breath alcohol changes were insignificant. Changes in free haemoglobin were not significant, but the levels decreased after TURP in four patients, caused by the dilution consequent on the infusion of 800–1000 mL isotonic saline during surgery. Serum sodium concentrations showed only insignificant decreases, except in one patient whose breath alcohol suggested the absorption of 500 mL of irrigant. This patient's serum sodium concentration decreased by 9 mmol/L; 1 L of 5% dextrose was infused during the procedure and capsular damage was recognized early during TURP.

Conclusion Insignificant volumes of irrigant entered the circulation of the patients during TURP with water irrigation and IPVP. The greatest risk factor for fluid entry during TURP is capsular damage. IPVP decreases bleeding and therefore improves visibility, so allowing the early identification of capsular damage. IPVP seems therefore to be of help during TURP by decreasing bleeding and allowing insignificant volumes of irrigant to enter the vasoconstricted vessels; it appears to prevent the TUR syndrome.
Epidemiology of prostatitis in Finnish men: a population‐based cross‐sectional study
Authors: Mehik A. , Hellström P. , Lukkarinen O. , Sarpola A. , Järvelin M.‐R.
Published: March 2003

Objective To study the lifetime occurrence of prostatitis in Finnish men and their exposure to the disease.

Subjects and methods A population‐based cross‐sectional survey was conducted in the two most northerly provinces of Finland (Oulu and Lapland). Altogether, 2500 male residents aged 20–59 years were chosen at random to complete a questionnaire on prostatitis. The data were collected between June 1996 and October 1997. Replies were received from 1832 men, giving a response rate of 75%.

Results The overall lifetime prevalence of prostatitis was 14.2%. The risk of having or having had prostatitis increased with age, being 1.7 times greater in men aged 40–49 years than in those aged 20–39 years, and 3.1 times greater in those aged 50–59 years. The overall incidence was 37.8/10 000 person years. More than a quarter of the 261 men who had or had had prostatitis symptoms (27%) suffered from them at least once a year, while 16% suffered from persistent symptoms; 63% of the men with prostatitis had their worst symptoms during the winter (November‐March). Neither education nor profession had much influence on the occurrence of prostatitis, but divorced and single men had a lower risk than married men. Most patients felt they had not received enough information about the disease at their first visit to a general practitioner.

Conclusions The results of this survey showed that the occurrence of prostatitis symptoms in men living in northern Finland is higher than that reported in other parts of the world. This could be partly caused by the cold climate.
Allogeneic whole‐tumour cell vaccination in the rat model of prostate cancer
Authors: Hrouda D. , Todryk S.M. , Perry M.J.A. , Souberbielle B.E. , Kayaga J. , Kirby R.S. , Dalgleish A.G.
Published: March 2003

Objective To investigate cancer immunotherapy using whole allogeneic (differing tissue‐type) tumour cells as vaccines in the rat prostate cancer model.

Materials and methods Two rat models of prostate cancer were used; MAT‐LyLu tumours which grow in Copenhagen rats and PAIII tumours which grow in Lobund–Wistar rats, with crossover of the cell lines to test allogeneic vaccination. The cell lines were immunologically characterized by flow cytometry. Irradiated tumour cells were administered as subcutaneous vaccines either before tumour challenge or after tumour establishment (both subcutaneous). A preparation of heat‐killed Mycobacterium vaccae bacilli (SRL172) was used as an adjuvant to increase vaccine efficiency.

Results Flow cytometry analysis of the cell lines showed that the PAIII cells had higher levels of major histocompatibility complex (MHC) class I and intercellular adhesion molecule (ICAM‐1) expression than the MAT‐LyLu cells. However, both tumour cell lines were rejected in their allogeneic hosts. Prophylactic vaccination with allogeneic MAT‐LyLu cells protected against PAIII tumour challenge in Lobund–Wistar rats, with 80% of animals surviving for > 5 months, compared with 40% for animals receiving autologous cells. The immunity was prolonged, as rats were protected when rechallenged 5 months later. In Copenhagen rats allogeneic PAIII cells protected against the more aggressive MAT‐LyLu tumour challenge only when the cells were combined with SRL172. Initial therapy experiments showed that vaccination with the cell lines mediated only limited tumour regression in the Lobund‐Wistar rats.

Conclusion The allogeneic tumour cell vaccination model described is valuable for assessing the principle and efficacy of allogeneic prostate cancer cell vaccines for clinical use.
Ultrasonography of urinary tract lesions caused by bilharziasis in Yemeni patients
Authors: Salah M.A.
Published: March 2003

Objective To evaluate abnormalities detected by ultrasonography in Yemeni patients with active Schistosoma haematobium infection.

Patients and methods As part of a co‐operation between a private hospital and the Schistosomiasis Control Project in Yemen, laboratory and ultrasonographic examinations were undertaken in 158 patients (eight female, 150 male, mean age 17 years) with active S. haematobium infection. Upper urinary tract dilatation, lower ureteric changes and bladder wall abnormalities (thickness, hyper‐echogenicity and polypoid lesions) were recorded. Laboratory findings and ultrasonographic changes were evaluated and categorized according to the age of the patients.

Results Twenty‐eight patients (18%) showed no morphological lesion on ultrasonography. Bladder abnormalities (thickness, hyper‐echogenicity and polypoid lesions) were found in 130 patients (82%) and upper tract lesions in 86 (54%). There were no upper tract lesions seen without an associated bladder abnormality. There were polyps within the lower ureteric lumen in four patients; in these patients there was a higher incidence of severe infection. One patient had a urinary bladder tumour.

Conclusion Urinary bilharziasis has typical ultrasonographic features, but may occur with no morphological lesion detectable on ultrasonography. Upper tract lesions seem to develop only with lower tract abnormalities.
A model of superficial bladder cancer using fluorescent tumour cells in an organ‐culture system
Authors: Crook T.J. , Hall I.S. , Solomon L.Z. , Birch B.R. , Cooper A.J.
Published: March 2003

Objective To develop a reproducible in vitro simulation of superficial bladder cancer for testing cytotoxic agents at clinically relevant concentrations.

Materials and methods Square explants (5 mm) of rat bladder were cultured in Petri dishes in minimal volumes of Waymouth's MB 752/1 medium supplemented with 10% fetal calf serum, antibiotics and glutamine. Parental and resistant MGH‐U1 urothelial cancer cells were transfected with a green fluorescent protein (GFP) vector. Transfectants were purified by flow cytometry. Cells were seeded onto the prepared organ cultures and images obtained using confocal microscopy. The tumour colonies were confirmed using scanning electron microscopy. Conventional intravesical cytotoxic agents including epirubicin, mitomycin‐C and estramustine were tested in the system.

Results Colonies of GFP‐MGH‐U1 cells became established on the explants and were identified by confocal microscopy; the development of the colonies was then followed over several days. Staining the explant for viability allowed imaging of normal urothelium on the explant surface or surrounding skirt of urothelial cells. The conventional cytotoxic agents epirubicin, mitomycin C and estramustine showed the expected differential responses to parental and resistant cell types. The colonies were able to survive high concentrations of the drug, equivalent to those in clinical use. The colonies were imaged serially over a period of several days.

Conclusion This system provides a more realistic model for testing cytotoxic agents for use in intravesical therapy, by allowing clinically relevant concentrations of drugs to be tested. The differential properties of the parental and resistant cells are maintained. The model also enables the same tumour colony to be imaged over several days in culture. The model may also be adapted for use in testing the effects of drugs on normal urothelium and the study of the effects of growth factors.
Vaginoplasty in male transsexuals using penile skin and a urethral flap
Authors: Perovic S.V. , Stanojevic D.S. , Djordjevic M.L.J.
Published: March 2003

Objectives To describe and present the results of a one‐stage vaginoplasty in male‐to‐female sex reassignment surgery.

Patients and methods The present technique is based on penile disassembly and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and the urethral flap, is inverted, thus forming the neovagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder and rectum. The neovagina is then fixed to the sacrospinous ligament. The labia minora and majora are formed from remaining penile and scrotal skin. The new method was used in 89 patients (mean age 28 years, range 18–56) with a mean (range) follow‐up of 4.6 (0.25–6) years.

Results Good cosmetic and functional results were obtained in 77 of the 89 patients (87%). Importantly, the neovagina produced in most patients was of satisfactory depth and width. There was only one major complication, a rectovaginal fistula caused by intraoperative injury to the rectum.

Conclusions The technique produces a vagina with more normal anatomical and physiological characteristics than those produced by other methods, as all the penile components are used (except for the corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral flap is a good alternative to other methods of vaginoplasty in male‐to‐female sex reassignment surgery.
Permeability of intestinal mucosa from urinary reservoirs in man and rat
Authors: Nejdfors P. , Könyves J. , Davidsson T. , Ekelund M. , Månsson W. , Weström B.R.
Published: March 2003

Objective To evaluate the barrier properties of intestinal mucosa chronically exposed to urine and to evaluate possible differences between ileal and colonic segments used in the reconstruction of the urinary tract.

Materials and methods Mucosal specimens from patients with continent reservoirs with an abdominal stoma, or orthotopic neobladders constructed from colonic segments, were obtained at revisional surgery. Control segments were obtained during right‐sided hemicolectomy. In addition, ileal and colonic segments from enterocystoplasties in rats were assessed. The mucosa‐to‐serosa passage of marker molecules, i.e. 14C‐mannitol, 3H‐glucose, fluorescein isothiocyanate‐dextran 4400 and ovalbumin, was measured using modified Ussing diffusion chambers.

Results In man, there were no permeability differences between segments exposed to urine and control segments for any of the marker molecules. In rats, there was less passage of markers in ileal and colonic transplanted segments than in intestinal segments from sham‐operated animals.

Conclusions Intestinal mucosa that has been in chronic contact with urine maintains its barrier function; in the rat model the permeability was even decreased. In addition, there were no detectable differences between ileal and colonic segments in this model.
Bacterial adherence to ofloxacin‐blended polylactone‐coated self‐reinforced l‐lactic acid polymer urological stents
Authors: Multanen M. , Talja M. , Hallanvuo S. , Siitonen A. , Välimaa T. , Tammela T.L.J. , Seppälä J. , Törmälä P.
Published: March 2003

Objective To determine whether ofloxacin coating has any effect on bacterial adherence to bioresorbable self‐reinforced
l‐lactic acid polymer (SR‐PLLA) urological stents.

Materials and methods SR‐PLLA stents were coated with ε‐caprolactone/l‐lactide copolymer blended with ofloxacin at three different concentrations of ofloxacin (0.5, 2 and 5% w/w). The adherence of five bacterial strains (Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis and two strains of Escherichia coli) to the coated SR‐PLLA stents was analysed. Uncoated stent pieces were used as controls. The effect of ofloxacin coating on bacterial growth in the microenvironment of the stent pieces was also analysed.

Results Ofloxacin coating prevented bacterial adherence to SR‐PLLA stent material; this effect correlated significantly with the ofloxacin concentration of the caprolactone coating. Ofloxacin coating reduced the amount of bacteria in the microenvironment of the stent, but because of natural resistance, ofloxacin coating had little effect on E. faecalis.

Conclusion Except for E. faecalis, ofloxacin coating may reduce stent‐associated infections. However, further studies are needed to confirm its biocompatibility and efficacy in clinical use.
Magnetic resonance urography enhanced by gadolinium and diuretics: a comparison with conventional urography in diagnosing the cause of ureteric obstruction
Authors: Jung P. , Brauers A. , Nolte‐Ernsting C.A. , Jakse G. , Günther R.W.
Published: March 2003

Objective To compare the ability of magnetic resonance urography (MRU), enhanced using gadolinium and frusemide diuresis, and conventional intravenous urography (IVU) to diagnose the cause of ureteric obstruction.

Patients and methods The study included 82 patients in whom IVU showed or suggested obstruction and who also underwent MRU. The images from both methods were interpreted by various investigators independently; two evaluated the IVU and two others the MRU, the latter being unaware of the diagnosis after IVU. If the diagnosis remained unclear, further investigations (e.g. computed tomography, retrograde pyelography or ureteroscopy) were conducted.

Results The diagnoses were ureteric calculi in 72 patients, ureteric tumours in eight and extra‐ureteric tumours in two. In those with urolithiasis, the diagnosis was correct with IVU in 49 patients and with MRU in 64. The diagnosis in this group was incorrect with MRU in only two patients. The main reason for the failure of IVU was absent contrast medium excretion. Three of eight patients with ureteric tumours were correctly diagnosed by IVU but in three patients the diagnosis was incorrect. MRU correctly diagnosed seven of the eight patients in this group, with no false diagnosis.

Conclusion IVU is currently likely to remain the standard procedure for imaging the upper urinary tract, but this study shows the potential of MRU when enhanced with gadolinium and frusemide. MRU may be helpful if there is a dilated system with no excretory function, in pregnant women, in children and in those with contrast medium allergy.
The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele
Authors: Ku J.H. , Kim M.E. , Lee N.K. , Park Y.H.
Published: March 2003

Objective To assess the results of the excision, plication and internal drainage techniques for hydrocele repair.

Patients and methods Between January 1990 and June 1998, 132 patients (mean age 54.36 years, range 16–83) underwent repair for idiopathic hydrocele using one of three techniques (excision, eversion/plication or internal drainage); the complication and recurrence rates of each technique were evaluated.

Results The excisional technique resulted in the highest complication rate (81%) and the internal drainage technique the lowest (7%). Postoperative scrotal oedema occurred in 74% of patients after plication and this was the highest rate among the techniques (P < 0.001). Differences in the rates of wound infection and haematoma among the three techniques were not statistically significant. The internal drainage technique had the highest recurrence rate (85%) and the excisional technique the lowest (1.3%; P < 0.001).

Conclusions Although useful, the internal drainage technique has a high recurrence rate and we suggest abandoning its use for hydrocele repair. The present results suggest that plication is better than excision, causing fewer complications, and better than internal drainage, as the results are more favourable.
An assessment of the clinical efficacy of intranasal desmopressin spray in the treatment of renal colic
Authors: Lopes T. , Dias J.S. , Marcelino J. , Varela J. , Ribeiro S. , Dias J.
Published: March 2003

Objectives To assess the efficacy of desmopressin nasal spray compared with diclofenac given intramuscularly in patients with acute renal colic caused by urolithiasis.

Patients and methods The study included 61 patients randomized into three different groups; group A received desmopressin (40 µg, nasal spray), group B diclofenac (75 mg) intramuscularly and group C, both desmopressin and diclofenac. Pain was assessed using a visual analogue scale (a 10‐cm horizontal scale ranging from ‘no pain’ to ‘unbearable pain’) at baseline, 10, 20 and 30 min after administering the treatments.

Results On admission, the pain level was the same in all three groups. At 10 min the pain decreased in all groups to a level that was not significantly different. At 20 min groups B and C had similar mean pain levels (3.7), whereas in group A it was 5.0. At 30 min, groups B and C scored 2–3, and group A 5.6. All three treatments were equally effective at 10 and 20 min but at 30 min there was a stabilization/slight increase in pain level in group A.

Conclusions Desmopressin has several advantages, e.g. ease of administration, simplicity of delivery and apparent lack of side‐effects, which makes it suitable for ambulatory use. Desmopressin acts rapidly and seems to be effective in both single and combined therapy with diclofenac; it decreases the need for a second treatment and increases the analgesic effect of diclofenac. Some patients responded well to desmopressin, with rapid and complete pain relief. These results indicate that desmopressin may be used to treat renal colic either alone or combined, increasing the analgesic effect of other drugs. More studies are needed to validate and confirm the results; it would also be useful to determine factors that may identify the subgroup of patients who respond quickly and with almost complete pain relief.
The renal‐resistive index from the last 3 months of pregnancy to 6 months old
Authors: Andriani G. , Persico A. , Tursini S. , Ballone E. , Cirotti D. , LellI Chiesa P.
Published: March 2003

Objective To measure the renal resistive index (RI, an estimate of renal vascular resistance, used to assess upper tract obstructive uropathy) from the last trimester of pregnancy to the sixth month of life in a large series of healthy subjects, and thus to identify normal values that can be used routinely. During the first semester of life significant haemodynamic changes during the physiological development of the kidney cause considerable variability in RI, which is thus considered less reliable in this period.

Subjects and methods From September 1998 to October 1999, 93 subjects (186 renal units, RU) were enrolled; 32 were fetuses in the last trimester of pregnancy (group 1, 64 RU) and 61 were children (122 RU), 30 aged 0–1 month (group 2, 60 RU), 20 aged 1–3 months (group 3, 40 RU) and 11 aged 3–6 months (group 4, 22 RU). All subjects underwent colour Doppler ultrasonography and the RI of the renal artery was measured for each kidney.

Results The RI was very high in group 1 but decreased noticeably during the first 6 months of life, reaching values similar to those in adults after the third month. The variability in RI continuously declined with age, becoming less important. The normal ranges for groups 1–4 were 0.67–0.88, 0.57–0.90, 0.60–0.84 and 0.65–0.75, respectively. There were no statistically significant differences between the left and right kidneys.

Conclusion In the first semester of life there is more than one landmark value of RI depending on the month of age of the infant. This should be considered when assessing upper tract obstructive uropathies after birth and the RI should be compared with the normal ranges reported herein.
Overexpression of RhoA mRNA is associated with advanced stage in testicular germ cell tumour
Authors: Kamai T. , Arai K. , Tsujii T. , Honda M. , Yoshida K.
Published: March 2003

Objective To clarify the role of Rho small GTP‐binding protein (Rho) in the progression of testicular germ cell tumour (GCT), by examining the expression levels of mRNAs of Rho genes in testicular GCT.

Patients and methods The mRNA levels of the RhoA, RhoB and RhoC genes were analysed in the surgical specimens of testicular GCT tissues from 45 consecutive Japanese patients, and in the corresponding unaffected tissue originating from the same patient, using reverse transcription‐polymerase chain reaction. The expression levels in tumour tissues were compared with those in unaffected tissues and the relationship between their expression levels in tumours and tumour stage evaluated. The expression levels of mRNAs of the Rho genes were also evaluated between tumours with seminoma only, and mixed tumours with seminoma and nonseminoma.

Results The mRNA levels of RhoA were greater in tumour tissues than in unaffected tissues of the resected testis (P < 0.01); the mRNAs of RhoB and RhoC were not detected in either tissue. The increase in RhoA mRNA levels was related to tumour stage (P < 0.05). The mRNA levels of RhoA in seminomatous and nonseminomatous areas where both were present were higher than those in tumours with seminoma only (P < 0.05).

Conclusions These results suggest that RhoA is involved in testicular germinal epithelial carcinogenesis and progression in testicular GCT, indicating that RhoA may be a useful prognostic marker for progression in testicular GCT.
Outpatient ureteric procedures: a new method for retrograde ureteropyelography and ureteric stent placement
Authors: Mcfarlane J.P. , Cowan C. , Holt S.J. , Cowan M.J.
Published: March 2003

Objective To evaluate a new method for retrograde ureteropyelography and retrograde ureteric stent placement.

Patients and methods Procedures were undertaken using a flexible cystoscope and digital C‐arm fluoroscopy in outpatients under sedoanalgesia. The flexible cystoscope was used to identify the ureteric orifice and a straight 0.9 mm hydrophilic guidewire inserted and passed into the renal pelvis under fluoroscopic guidance. A 4 F general‐purpose catheter was then passed over the wire and ureteropyelography performed. To place the stent the hydrophilic guidewire was exchanged for an ultra‐stiff wire, over which the stent was passed directly.

Results Over a 47‐month period, 723 procedures were carried out in 472 patients. The clinical indications were ureteric obstruction in 229 (32%), stone disease in 165 (23%), unexplained hydronephrosis in 150 (21%), haematuria in 94 (13%) and others in 85 (12%). Of the 723 procedures, 643 (89%) were technically successful. Failure was most commonly caused by failure to cannulate the ureteric orifice (51, 7%). Just over half the procedures (366, 51%) involved stent placement or replacement. Immediate complications occurred in 17 patients (3%). Of those who were questioned, 94% (282 of 300) reported the procedure to be acceptable.

Conclusion Retrograde ureterography and ureteric stent placement may be satisfactorily undertaken with the patient under sedoanalgesia on an outpatient basis. This technique can reduce costs, hospital admissions, general anaesthetic use, demands on theatre time and complication rates.