bluuebunny/crossref_metadata_2025 huggingface dataset:
Do low molecular weight heparin and dextran increase the blood loss in transurethral resection of the prostate?
Authors: Hjertberg H. , Olsson J. , Ekström T. , Lisander B.
Published: November 2003

Objective To evaluate whether the use of dextran or the combination of low molecular weight heparin and dextran increases the blood loss in elective transurethral resection for benign prostatic hyperplasia.

Patients and methods This open randomized controlled study included 198 patients operated under spinal anaesthesia who were allocated to four groups differing in the combination of prophylactic treatment used for thrombosis and for the substitution of blood loss. The prophylactic treatment was either dalteparin sodium, continued each day until mobilization, or 3% Ringer dextran‐60 just before operation and continued with 6% dextran‐70 for 2 days post‐operatively, and the volume substitute was Ringer dextran or Ringer's acetate. Thus, the four treatments (by prophylaxis and volume substitute, respectively) were dalteparin and Ringer's acetate, dalteparin and dextran, dextran and Ringer's acetate, and dextran and dextran. The haemoglobin lost to the irrigation fluid was measured and used to calculate blood loss.

Results Patients receiving dextran had a larger post‐operative and total blood loss than those who did not. The need for transfusion did not differ between the treatment groups.

Conclusion The combination of dalteparin and dextran was not associated with an increased blood loss above that with dextran alone.
Urinary tract infections following laser prostatectomy: is there a need for antibiotic prophylaxis?
Authors: te Slaa E. , de Wildt M. J. A. M. , Debruyne F. M. J. , de Graaf R. , de la Rosette J. M. C. H.
Published: November 2003

Objective To evaluate the incidence of urinary tract infections (UTIs) after transurethral laser therapy of the prostate and the need for peri‐operative antibiotics.

Patients and methods One‐hundred and sixteen patients (mean age 65 years, range 51–85) with benign prostatic enlargement (BPE) were treated with a Nd:YAG laser, using either the TULIP device, the Urolase fibre or the Ultraline fibre. The incidence of voiding complaints, UTIs and the need for catheterization after treatment were assessed. The first 43 patients (Group I) received no antibiotics peri‐operatively and the next 73 patients (Group II) received co‐trimoxazole for 5 days.

Results The patients treated using the TULIP device had more urinary complaints after treatment than those treated using the Ultraline and Urolase fibres. In Group I, 48% of the patients developed a UTI and in Group II the incidence of UTIs decreased to 30% after treatment. The incidence of UTIs was unrelated to the procedure performed. Although not statistically significant, peri‐operative antibiotics tended to reduce the incidence of UTIs. Prolonged catheterization was correlated with the incidence of UTI. In Group I, patients who were treated using the Ultraline procedure had their catheter removed after a mean of 24 days, compared with 21 days for those treated with the Urolase and 19 days with the TULIP device. In Group II, the patients needed catheterization for a mean of 17 days following Ultraline treatment and 16 days following the Urolase procedure.

Conclusions Antibiotic prophylaxis tended to decrease the incidence of post‐treatment UTIs. However, there was no clear association between the presentation and duration of complaints and the presence of UTIs.
Long‐term follow‐up results with the Stamey operation for stress incontinence of urine
Authors: Mills R. , Persad R. , Handley Ashken M.
Published: November 2003

Objective To assess the results of the Stamey operation for genuine stress incontinence in those patients with over 10 years of follow‐up.

Patients and methods Of 46 patients who had undergone a Stamey procedure and had a follow‐up of over 10 years, 30 were willing to attend for a clinical review and pad testing.

Results Of the 30 patients assessed, 20 were initially cured, a further eight were significantly improved and two were no better. At 10 years, the number totally dry had fallen to 10, but a further 15 were still symptomatically improved. Only three that had shown some initial benefit were subjectively no better than before the operation.

Conclusion There appears to be a continuous decline in the cure rate with time from the Stamey procedure. However, most patients maintain some lasting benefit.
Post‐surgical recurrent varicocele: efficacy of internal spermatic venography and steel‐coil embolization
Authors: Punekar S.V. , Prem A.R. , Ridhorkar V.R. , Deshmukh H.L. , Kelkar A.R.
Published: November 2003

Objective To delineate the venographic anatomy of the varicoceles which recur following conventional inguinal varicocele ligation and to determine the therapeutic efficacy of steel‐coil embolization as assessed by improvements in seminal parameters and paternity.

Patients and methods Thirty‐nine patients with post‐surgical recurrent varicoceles underwent bilateral internal spermatic venography approached through the right femoral vein. The collateral venous channels were identified and occluded using appropriate sizes of steel coils.

Results The procedure was technically successful in 33 patients (85%). Analysis of the 33 venograms showed a unilateral left‐sided recurrent varicocele in 28 patients (85%) and bilateral recurrent varicoceles in five patients (15%). The mid and lower parallel collateral channels were observed in 27 patients (82%). The recurrences were treated easily with stainless steel‐coil embolization. Five patients were lost to follow‐up. Of the remaining 28 patients the sperm count and motility became normal in 16 (57%); only the motility improved in three patients (10%) while in nine patients (33%) there were no changes in either of the seminal parameters. Five patients achieved paternity.

Conclusions Internal spermatic venography allowed a precise anatomical definition of the recurrent varicocele and the use of steel‐coil embolization provided satisfactory improvements in sperm quality and paternity.
Comparison of anti‐desmin and anti‐actin staining for the computerized analysis of cavernous smooth muscle density
Authors: Sattar A. A. , Haot J. , Schulman C. C. , Wespes E.
Published: November 2003

Objective To compare the staining properties of anti‐desmin and anti‐actin in cavernous biopsies and thus determine the optimal antibody for quantifying intracavernous smooth muscle content in the evaluation of erectile dysfunction.

Patients and methods Twenty‐two penile biopsies were taken from five normal potent patients, seven with venous leak and 10 with arterial disease, with mean ages of 34.4, 48.8 and 54.8 years, respectively. Biopsies were sectioned and successive sections stained immunohistochemically with antibodies for actin or desmin. Image analysis was used to quantify the proportion of smooth muscle fibres in the cavernous tissue.

Results There was a significant difference (P=0.0001) between the mean percentage of cavernous smooth muscle fibres in normal potent men, stained with anti‐desmin (38.5%,sd 3.2) or anti‐actin (45.2%, sd 3.2) and that in the venous group (anti‐desmin 27.4%, sd 4.0%; anti‐actin 34.2%, sd 5.3%) or the arteriogenic group (anti‐desmin 23.7%, sd 4.4, anti‐actin 28.9%, sd 4.9). There was no significant difference in the estimates with either staining method between the venogenic and arteriogenic patients. There was a direct relationship between the cavernous smooth muscle density estimated by anti‐desmin and anti‐actin staining (r=0.96).

Conclusion The anti‐actin and anti‐desmin staining methods gave equivalent results for discriminating between normal and impotent patients on the basis of the percentage of cavernous muscle fibres. However, anti‐actin staining tended to be more sensitive than anti‐desmin.
Paratesticular sarcomas revisited: a review of cases in the British Testicular Tumour Panel and Registry
Authors: Soosay G.N. , Parkinson M.C. , Paradinas J. , Fisher C.
Published: November 2003

Objective To assess differences in the histopathological diagnoses of a series of paratesticular sarcomas following changes in the morphological classification of these tumours and the availability of investigations to define their immunophenotype, and to consider the impact of these changes on clinical management.

Materials and methods Thirty‐six soft tissue tumours of the paratesticular region, originally submitted to the British Testicular Tumour Panel and Registry between 1958 and 1967 were re‐examined histologically using modern diagnostic criteria, including immunohistochemical features. Where possible, follow‐up was brought up to date.

Results Thirteen (35%) of the diagnoses made in 1967 were changed; of these, seven changes were attributable to the results of immunohistochemical tests and one involved the identification of an entity not recognized in 1967 (spindle cell rhabdomyosarcoma).

Conclusion The changes in diagnoses of major clinical relevance involved three neoplasms (8%) in which the recent opinion was rhabdomyosarcoma, a tumour for which successful treatment protocols are currently available.
Accumulation of p53 and expression of CD44 in human prostatic cancer and benign prostatic hyperplasia: an immunohistochemical study
Authors: Zhang X.‐H. , Sakamoto H. , Takenaka I.
Published: November 2003

Objective To investigate the expression of mutant p53 and wild‐type CD44 in human benign and neoplastic prostate.

Patients and methods The accumulation of p53 and the expression of CD44 were investigated immunohistochemically in formalin‐fixed and paraffin‐embedded tissue specimens (obtained by transurethral resection and open prostatectomy) from 16 patients with primary prostatic cancer (median age 65 years, range 54–75) and six patients with benign prostatic hyperplasia (BPH) (median age 67 years, range 58–75).

Results Positive immunoreactivity for p53 and CD44 was detected in six and eight samples of prostatic cancer tissue, respectively. Additionally, all six prostatic cancer samples showing positive immunoreactivity for p53 were also positive for CD44. There were more samples expressing p53 and CD44 in prostatic cancer with a high Gleason grade score than in samples from cancer with a lower score. In samples from six patients with BPH, positive immunoreactivity for p53 and CD44 was observed in one and two, respectively; stained cells were restricted to the secretory cell layer of the gland.

Conclusions There was an association between prostatic tumour grade and the increasing expression of p53 and CD44, although there were too few samples for statistical significance. The staining pattern of cells expressing p53 and CD44 may be different between prostatic cancer and BPH tissues.
Microwave ablation of the adrenal gland: experimental study and clinical application
Authors: Kigure T. , Harada T. , Satoh Y. , Fujieda N. , Wakayama Y.
Published: November 2003

Objective To evaluate the heating effect of microwave irradiation on the dog adrenal gland and to assess the clinical feasibility of microwave ablation of adrenal tumours.

Materials and methods The thermal distribution and histology were evaluated after dog adrenal glands were irradiated at different intensities with microwaves. Irradiation at 70 W for 30 s was also performed, after laparotomy, on the adrenal tumour of a patient with primary aldosteronism.

Results Microwave irradiation at 70 W for 30 s provided a sufficiently high temperature to produce coagulation within a 5mm radius of the microwave electrode. The adrenal tumour in the patient with primary aldosteronism was coagulated successfully by this dose of microwave irradiation.

Conclusion Microwave ablation of the adrenal gland may be clinically applicable in the treatment of adrenal tumours.
Vasoactive intestinal peptide and impotence in experimental diabetes mellitus
Authors: Maher E. , Bachoo M. , Elabbady A. , Polosa C. , Bégin L.R. , Collier B. , Elhilali M. , Hassouna M.
Published: November 2003

Objective To determine whether a defect in vasoactive intestinal peptide (VIP)‐mediated vasodilatation underlies diabetic impotence

Materials and methods Rats treated with streptozotocin for 8 weeks developed diabetes, as shown by hyperglycaemia and glycosuria, and had significant impairment of sexual function, as determined by tests of sexual behaviour. The VIP content of the penis and major pelvic ganglion, the VIP release by the penis in vitro and the responsiveness of the vasculature of the penis in vivo to intracavernous VIP injection were determined.

Results In diabetic rats, the VIP content of the major pelvic ganglion and penis was markedly increased, while the acetylcholine content of the penis was normal. The amount of VIP released in vitro by high potassium concentration or veratridine was similar for penile tissue slices of normal and diabetic rats. Intracavernous injection of VIP induced erection in the control rats but not in diabetic rats, whereas intracavernous injection of the adenylate‐cyclase activator forskolin produced erection in both control and diabetic rats.

Conclusion Because VIP induces vasodilatation by activating adenylate cyclase, and forskolin produced erection in the diabetic rats, the failure of VIP to produce erection in these rats is unlikely to be due to a defect in the second‐messenger mechanism or in the properties of vascular smooth muscle. Thus, a defect at the level of the VIP receptor or of the associated G‐protein possibly explains the failure of intracavernous VIP to produce erection in the diabetic rats. Hence, an abnormality in VIP is a component of sexual dysfunction in the diabetic rat and the defect is at the level of the VIP receptor or associated G‐protein.
How complete is a transurethral resection of the prostate ?
Authors: Green J.S.A. , Bose P. , Thomas D.P. , Thomas K. , Clements R. , Peeling W.B. , Bowsher W.G.
Published: November 2003

Objective To determine the completeness of transurethral resection of the prostate (TURP).

Patients and methods The prostate volume of 432 patients was measured by transrectal ultrasonography (TRUS) before they underwent a TURP performed by one of three consultant urological surgeons. The prostate tissue collected at resection was weighed, multiplied by 1.2 to compensate for ‘shrinkage’, and the amount of tissue removed expressed as a percentage of the pre‐operative prostate volume determined by TRUS (resection ratio). The patients were categorized into groups based on pre‐operative prostate size.

Results The mean weight of prostate tissue resected was 25.6 g. Resection ratios increased with prostate size, with the largest occurring in prostates of 71–110 g. The surgeon did not resect more than 50% of the gland volume in any group.

Conclusion This study counters the theory that a complete resection of the prostate is routinely achieved. The endoscopic appearances probably imply a complete resection of the adenoma but a considerable volume of the gland remains. This has important implications for the detection of prostate carcinoma at TURP and for the staging of the disease.
Microsurgical vasoepididymostomy in the treatment of occlusive azoospermia
Authors: Boeckx W. , van Helden S.
Published: November 2003

Objective To evaluate the practice and outcome of the end‐to‐end and end‐to‐side techniques of vasoepididymostomy for the treatment of occlusive azoospermia

Patients and methods This retrospective study comprised 31 unselected patients (mean age 32 years, range 22–59) operated on with one of two techniques, more usually a modified end‐to‐side technique. Sperm quality and paternity were assessed in 24 patients during a 2‐year follow‐up

Results Of the 15patients in whom sperm were found at anastomosis, sperm were retrieved from 11. Of 24 patients, 11 had patent anastomoses and paternity was achieved in three cases.

Conclusion Although performed by a proficient microsurgeon the operative success rate was low, partly because the operation was technically demanding but largely because of the difficulty in assessing intra‐operatively the level of occlusion and the quality of the sperm. Better techniques for the evaluation of sperm during the operation should be developed.
Lower urinary tract function in ambulatory children with spina bifida
Authors: Mevorach R.A. , Bogaert G.A. , Baskin L.S. , Lazzaretti C.C. , Edwards M.S.B. , Kogan B.A.
Published: November 2003

Objective To investigate lower urinary tract function in ambulatory children with myelomeningocele.

Patients and methods The urological course of 45 children with myelomeningocele who walked either independently (19 children) or with ankle‐foot orthotics (26 children) was reviewed. Follow‐up ranged from 9 months to 13.5 years (mean 4.75 years).

Results A normal pattern of voiding was observed both clinically and during urodynamic evaluation in only three of the 45 children, with the remainder displaying neurogenic lower urinary tract dysfunction. The independent walkers and those with orthotics did not differ in the spectrum of lower urinary tract dysfunction or other variables. Those patients with persistent incontinence underwent an initial urodynamic evaluation when older (mean 3.7 years versus 6.4 weeks in those who were continent).

Conclusion Ambulatory children with myelomeningocele suffer the full spectrum of lower urinary tract dysfunction. Given the potential danger of untreated lower urinary tract dysfunction, ambulatory children with myelomeningocele should receive the same diagnostic and therapeutic attention as their peers with more overt neurological deficits.
Posterior urethral injuries in children
Authors: Avanogˇlu A. , Ulman I. , Herek Ö. , Özok G. , Gökdemir A.
Published: November 2003

Objective To review the results of the operative treatment of posterior urethral injuries in children.

Patients and methods A total of 29 children (25 boys and two girls, age range 3–14 years) with injuries to the posterior urethra were admitted to this department over 14 years. Twenty‐three patients presented immediately after trauma and six were referred after unsuccessful attempt(s) at surgical repair.

Results Fourteen patients underwent suprapubic diversion and primary realignment over a catheter. Urethral continuity with normal urinary continence was achieved in seven of these patients. Four patients underwent a re‐operation; urethral reconstruction was successful in these patients, but one patient remained incontinent. Primary realignment with anastomosis was performed in nine patients; the results were satisfactory in six. Urethral stricture developed in all of four patients who were managed with a suprapubic cystostomy alone; a staged repair using the transpubic approach was carried out in two of them and one improved. Partial urethral tears in two patients healed with urethral catheterization alone.

Conclusion Primary realignment of the urethra with anastomosis and suprapubic diversion resulted in the highest rate of success for normal urethral continuity. Urethral strictures or urinary incontinence were not major problems in this group. Therefore, we recommend this approach for the initial management of urethral injuries in childhood. Transpubic urethroplasties may be reserved for secondary repair.
The effects of chemical sympathectomy on contralateral testicular histology, fertility and fecundity in unilateral abdominal testes
Authors: Karnak I. , Gedikoglu G. , Tanyel F.C. , Büyükpamukçu N. , Hiçsönmez A.
Published: November 2003

Objective To evaluate the effects of abdominal testis on ipsilateral and contralateral testicular histology, fertility and fecundity in rats which were chemically sympathectomized neonatally.

Materials and methods The study comprised 60 male albino rats, 30 receiving a placebo and 30 a chemical sympathectomic agent neonatally. When 21 days old, the two groups of 30 rats were each divided into three groups and underwent a control operation or abdominal fixation of one or both testes. After they were 8 weeks old, each male rat was housed with two fertile female rats for 25 days, after which their testes were harvested. Females were observed for an additional 25 days and any pregnancies and the number of offspring were recorded. Mean seminiferous tubular diameters and mean testicular biopsy scores were determined for each testis.

Results Although fertility and fecundity rates and mean testicular biopsy scores were not significantly different, chemical sympathectomy prevented the decrease in mean seminiferous tubular diameters which occurred in the contralateral testis.

Conclusion Chemical sympathectomy protected contralateral testicular histology to some degree. Therefore, the sympathetic system may play a role in contralateral testicular deterioration.
Late failure of the reconstructed exstrophy bladder
Authors: Woodhouse C.R.J. , Redgrave N.G.
Published: November 2003

Objective To establish whether successful bladder closure and bladder neck reconstruction in patients with exstrophy is durable into adulthood and whether bladder outlet obstruction, created during bladder‐neck tightening procedures, may lead ultimately to detrusor or urethral failure.

Patients and methods The outcome of 57 patients born with exstrophy between 1965 and 1974 was reviewed.

Results Of the 32 babies who underwent reconstruction, 19 failed in childhood and 13 still retained a native bladder into their second decade. Eight of 13 children with successful bladder closures and bladder neck reconstructions required further reconstruction or continent diversion in the second decade of life, most commonly because of poorly compliant, low‐capacity bladders associated with incontinence. Six had an augmentation cystoplasty (five with a continence procedure as well) and two had an artificial sphincter alone. Two patients have retained their native bladder but require self‐catheterization.

Conclusion Long‐term follow‐up of patients with initially successful exstrophy closures is required, as late detrusor or urethral failure may occur. This detrusor failure may be related to bladder outlet obstruction associated with bladder neck reconstruction.
Peyronie curvature treated by plication of the penile fasciae
Authors: Geertsen U.A. , Brok K.E. , Andersen B. , Victor Nielsen H.
Published: November 2003

Objective To evaluate the results of plication of the penile fascia in patients with penile curvature secondary to Peyronie's disease.

Patients and methods Twenty‐eight men with Peyronie curvature underwent plication of the penile fascia. Before operation, the deviation of the penis was so severe (median 60°) in 24 men that they were unable to perform sexual intercourse. Follow‐up was based on hospital records, one postal questionnaire sent to all patients and a clinical evaluation of the men in the out‐patient clinic.

Results After an uncomplicated operation and a median follow‐up of 34 months, 20 of the 28 men were able to perform sexual intercourse and 23 were satisfied with the result of the operation. The most frequent reasons for dissatisfaction with the outcome of the operation were insufficient straightening, pain from sutures and uncharacteristic pain related to the penis and/or scrotum.

Conclusion The technique is simple to perform and the method gives functional and cosmetic results equal to those of more invasive procedures. The provision of adequate information to patients before the operation is important to ensure their satisfaction with the outcome.
Increased nerve growth factor levels in the urinary bladder of women with idiopathic sensory urgency and interstitial cystitis
Authors: LOWE E.M. , ANAND P. , TERENGHI G. , WILLIAMS‐CHESTNUT R.E. , SINICROPI D.V. , OSBORNE J.L.
Published: November 2003

Objectives

 To determine whether nerve growth factor (NGF) is elevated in painful conditions of the urinary bladder (idiopathic sensory urgency, interstitial cystitis and painful chronic cystitis).

Patients and methods

 Sixteen women patients were recruited from the Urodynamic Clinic at The Elizabeth Garrett Anderson Hospital, London. Four each had idiopathic sensory urgency (mean age 34 years, range 24–51), chronic cystitis (mean age 51 years, range 40–79) and interstitial cystitis (mean age 41 years, range 29–53). Four women who had genuine stress incontinence on cystometry but with no irritative symptoms were used as controls (mean age 45 years, range 35–54). The levels of NGF were determined in bladder biopsies from all women and biopsy sections were immunostained to detect NGF.

Results

 The levels of NGF were higher in samples from all three painful bladder conditions than in samples from controls. Immunostaining showed increased NGF expression in the urothelium, most marked in patients with idiopathic sensory urgency.

Conclusions

 The increased level of NGF may explain several clinical and pathological features in these conditions, including sensitization of nociceptor fibres and increased numbers of mast cells. We propose that anti‐NGF treatment may be a rational and effective treatment in intractable bladder pain.
The striated urethral sphincter: muscle fibre types and distribution in the prostatic capsule
Authors: LIGHT J.K. , RAPOLL E. , WHEELER T.M.
Published: November 2003

Objective

 To clarify the muscle fibre types in the striated urethral sphincter and the pattern of distribution of this muscle in the prostatic capsule.

Materials and methods

Twenty‐three prostate glands obtained at radical prostatectomy were studied using a whole‐organ technique. Each gland was sectioned from prostatic apex to base, including the bladder neck and seminal vesicles. The slides were then traced on paper after staining with haematoxylin and eosin and the distribution of striated muscle mapped. Two prostates were studied after sectioning with a cryostat and staining with adenosine phosphatase at pH 4.2, 4.6 and 4.93 to distinguish between the subclassification of Type 2 fibres. Other sections were stained for nicotinamide adenine dinucleotide phosphate with nitroblue tetrazolium, to distinguish fast from slow twitch fibres.

Results

Striated muscle was present within the anterolateral aspect of the prostatic capsule, extending from the prostatic apex to the bladder neck. Three different fibre types were present; fast‐twitch fatigue‐sensitive, fast‐twitch fatigue‐resistant and slow‐twitch.

Conclusion

There are three distinct fibre types in the prostatic capsular striated muscle, representing displaced muscle fibres from the striated urethral sphincter. The composition of three types makes it eminently suitable to function as a sphincter muscle.
Ejaculation‐retarding properties of paroxetine in patients with primary premature ejaculation: a double‐blind, randomized, dose‐response study
Authors: WALDINGER M.D. , HENGEVELD M.W. , ZWINDERMAN A.H.
Published: November 2003

Objective

 To compare the influence of a daily dose of 20 or 40 mg of the serotonergic antidepressant drug paroxetine in delaying ejaculation in patients with primary premature ejaculation.

Patients and methods

 Thirty‐four patients with primary premature ejaculation were randomly assigned to receive 20 mg or 40 mg daily of paroxetine for 7 weeks in a double‐blind fixed‐dose trial after an initial dose of 20 mg/day in the first week. Patients and their female partners were interviewed separately. In the group receiving 20 mg, one of two capsules consisted of placebo and in the group receiving 40 mg, both capsules contained active drug.

Results

 The trial was completed by 27 men; both groups showed a statistically significant difference from the baseline values of ejaculation latency (P<0.001) and a clinically relevant improvement in ejaculation time. The increase in the intravaginal ejaculation latency time was not statistically significant different between the groups. The patient’s assessments were confirmed independently by their partners.

Conclusions

 The daily use of 20 mg paroxetine may be considered as an adequate treatment for primary premature ejaculation. Increasing the dose may lead to a further increase in ejaculation latency.
Written consent is haphazard for minor urological procedures
Authors: HROUDA D. , EMBERTON M. , HAMPSON S.J.
Published: November 2003

Objective

 To determine the current practice among British urologists for obtaining written consent for flexible cystoscopy and other minor procedures under local anaesthesia.

Methods

 Postal questionnaires were sent to full members of The British Association of Urological Surgeons practising in the UK asking if they obtained written informed consent for local anaesthetic procedures, e.g. flexible cystoscopy, urethral dilatation, and urethral catheterization for retention, for urodynamics or for intravesical chemotherapy. They were also asked whether they recorded that the risks and benefits of the procedure had been explained to the patient.

Results

 Respondents were divided on whether they obtained written consent for flexible cystoscopy and urethral dilatation. Most did not obtain written consent for catheterization for retention, urodynamics, intravesical chemotherapy or suprapubic catheterization. The policy was inconsistent both between and within urologists.

Conclusion

 Given the medicolegal importance of informed consent, consensus among urologists is required so that national guidelines can be developed and a more rational policy applied.
Neuroanatomical ontogeny of the human fetal penis
Authors: BASKIN L.S. , LEE Y.T. , CUNHA G.R.
Published: November 2003

Objective

 To determine the development of the human penis, and hence the cause of congenital anomalies, using an immunohistochemical analysis of fetal penile ontogeny.

Materials and methods

In 25 human fetal penile specimens (gestational age 8 to 23 weeks) various tissues were localized immunohistochemically using stains for α‐actin (smooth muscle), cytokeratin 8 and 14 (epithelium) and protein gene‐product (PGP) 9.5 (neurons).

Results

Nerves were identified in the penis with anti‐PGP in specimens of all ages, prominent dorsally at the 11 and 1 o’clock positions but also extending around the tunica to the junction of the corpus spongiosum and corpora cavernosa, suggesting that these structures may be injured in procedures which straighten the penis. The nerves continued into the glans on the dorsal aspect, suggesting that glans reduction in feminizing genitoplasties should be performed on the ventral aspect. Smooth muscle was first noted at 10 weeks’ gestation, with epithelial differentiation occurring in the earliest specimens studied (8 weeks’ gestation). With time, smooth muscle density was highest in the corpus spongiosum, especially between it and the corpora cavernosa. Smooth muscle also developed close to the urethral epithelium. The tunica albuginea showed consistent variations in thickness, with the mid‐dorsal 12 o’clock position being the thickest, followed by the 5 and 7 o’clock periurethral positions.

Conclusion

A better knowledge of penile development and of the relationship of the nerves to the corpora cavernosa is useful in the strategic design of penile straightening procedures and feminizing genitoplasties.
The clinical and histological features of transitional cell carcinoma of the bladder with microcysts: analysis of 12 cases
Authors: PAZ A. , RATH‐WOLFSON L. , LASK D. , KOREN R. , MANES A. , MUKAMEL E. , GAL R.
Published: November 2003

Objective

 To describe the clinical course and histological features of transitional cell carcinoma (TCC) of the bladder with microcysts.

Patients and methods

Among 940 patients with bladder TCC diagnosed at our institution during a 5 year period, 12 (1.2%; eight men and four women, mean age 71.1 years, range 52–85) were diagnosed histologically as having microcystic TCC. Sections of the tumours were stained with haematoxylin and eosin, periodic acid‐Schiff and Alcian blue and clinical data obtained from the patients’ records.

Results

Of the 12 patients with bladder TCC with microcysts, three had tumours confined to the epithelium, six had tumour invasion of the lamina propria and three had muscle invasion. One patient had low‐grade TCC and 11 had high‐grade TCC; six patients had a second primary tumour; three had a colon carcinoma, one a villous adenoma of the caecum, one a locally advanced carcinoma of the prostate and the last a squamous cell carcinoma of the uterine cervix.

Conclusions

Microcystic TCC was associated with high‐stage and high‐grade bladder tumours and with other primary tumours, especially of the colon. Screening these patients for asymptomatic tumours of the colon is suggested.
Cystitis associated with tiaprofenic acid: a survey of British and Irish urologists
Authors: HENLEY M.J. , HARRISS D , BISHOP M.C.
Published: November 2003

Objective

 To quantify the extent and natural history of cystitis in relation to treatment with the non‐steroidal anti‐inflammatory drug (NSAID) tiaprofenic acid.

Methods

 Anonymous postal questionnaires were sent to all UK and Irish consultant urologists enquiring about their awareness of the association between tiaprofenic acid (Surgam™ ) and cystitis, and the number, nature and clinical details of patients with the diagnosis.

Results

 Of the 357 urologists, 45.7% replied; 37.4% of those who responded had had cases of NSAID‐concurrent cystitis, 35.6% replied that they had no personal experience but were aware of the possibility of an adverse drug reaction and 27% were unaware of the possibility of NSAID‐related interstitial cystitis. There were 108 reported cases of cystitis; 55 (51%) were women, 12 (11%) were men and gender was not stated in 41 (38%). The median duration of treatment was 59 weeks (range 6 weeks–4 years). Symptoms abated completely on stopping the drug in 86% of patients, resolving in a median of 14 weeks (range 7 days–2 years). In seven cases (10%), resolution was incomplete; 17 patients had undergone reconstructive urological surgery.

Conclusion

 Tiaprofenic acid has caused at least 108 cases of cystitis and several of these patients underwent extensive urological surgery based on the assumption that they were suffering from chronic interstitial cystitis. Most cases were reversible on withdrawal of tiaprofenic acid, but 10% of patients had residual symptoms. Tiaprofenic acid causes a higher incidence of cystitis than any other NSAID and its withdrawal from the market should be considered.
Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer?
Authors: FERNANDES E.T. , SUNDARAM C.P. , LONG R. , SOLTANI M. , ERCOLE C.J.
Published: November 2003

Objective

 To evaluate the role of the Gleason score of needle biopsies of the prostate in predicting the final pathological staging of patients with carcinoma of the prostate treated by radical prostatectomy.

Patients and methods

 The records of 466 patients with carcinoma of the prostate treated by radical prostatectomy were reviewed, comparing the Gleason scores of the core‐needle biopsies with the Gleason score and final pathological staging of the surgical specimens.

Results

 The biopsy grade was the same as that of the prostatectomy specimen in 54% of the patients. The most common discordance was the upgrading of well‐differentiated tumours in 75% of the patients. When the biopsy grade was compared with the surgical pathological stage, 49% of low‐ and 82% of high‐grade lesions in the biopsy had capsular penetration by tumour or locally advanced disease (Stage C and D1).

Conclusion

 Well‐differentiated tumours on the biopsy core are not predictive of organ‐confined disease, but a poorly differentiated lesion is a good indicator of extracapsular extension of the cancer.
Gender reversal in 46XX congenital virilizing adrenal hyperplasia
Authors: SRIPATHI V. , AHMED S. , SAKATI N. , AL‐ASHWAL A.
Published: November 2003

Objective

 To review the results of gender reversal in six patients with 46XX congenital virilizing adrenal hyperplasia (CVAH).

Patients and methods

 Fifty‐one patients with 46XX CVAH were seen in an 8 year period; 45 were managed by conventional feminizing genitoplasty, but six underwent gender reversal and were managed as males. The clinical decision for gender reversal was made after appropriate counselling and was based primarily on parental choice, this being influenced significantly by a delayed diagnosis in four patients. Surgical management consisted of gonadectomy, excision of Müllerian structures and staged hypospadias repair/chordee correction in four patients, and circumcision in two completely masculinized children.

Results

 All six boys are well adjusted to their gender of rearing, with ages ranging from 3 years to 16.5 years (mean 8.5) at the time of review. Two children have normal penises and four have a satisfactory result after two‐stage repair of hypospadias/chordee.

Conclusion

 Most patients with 46XX CVAH are preferably raised as females and require a feminizing genitoplasty. However, the clinical decision may be influenced by many factors, including delay in diagnosis, social bias and the premium on male rearing in certain communities. When male rearing is chosen, early gonadectomy and excision of Müllerian structures, together with staged hypospadias repair, gives satisfactory results.
Significant association between simple renal cysts and arterial blood pressure
Authors: PEDERSEN J.F. , EMAMIAN S.A. , NIELSEN M.B.
Published: November 2003

Objective

 To test the hypothesis that there is an association between simple renal cysts and arterial blood pressure (BP).

Patients and methods

The study comprised a review of the case‐notes of 115 patients (mean age 67.7 years, range 31–91) in whom renal cyst(s) was an incidental ultrasonographic finding, and 115 age‐ and sex‐matched control patients. The notes were reviewed without knowledge of the origin or treatment.

Results

The systolic and diastolic BP were significantly higher in patients with a cyst(s) than in control patients (P=0.031 and P=0.0034; mean difference 6.9 mmHg and 5.0 mmHg, respectively). In those aged 30–70 years, the presence of one or more simple renal cysts increased the risk of having a diastolic BP ≥95 mmHg from seven in 58 to 17 in 58 patients (P=0.038).

Conclusion

The association between simple renal cysts and higher arterial BP probably arises from underlying renal disease causing both. Occasionally it is possible that renal ischaemia caused by cyst expansion, and therefore increased renin release, generates the elevation in BP. If so, methods to identify such cysts should be developed.
A comparison of endorectal magnetic resonance imaging and transrectal ultrasonography in the local staging of prostate cancer with histopathological correlation
Authors: BATES T.S. , GILLATT D.A. , CAVANAGH P.M. , SPEAKMAN M.
Published: November 2003

Objective

 To assess the staging accuracy of endorectal magnetic resonance imaging (MRI), using a mid‐field system, in patients with clinically localized prostate cancer and to compare the results with transrectal ultrasonography (TRUS).

Patients and methods

Twenty patients with clinically localized prostate cancer were prospectively staged with TRUS and endorectal MRI using a 0.5 T magnet. All patients subsequently underwent radical prostatectomy and the results of pre‐operative staging were compared with the histological findings.

Results

The sensitivity and specificity for diagnosing capsular penetration were 38% and 100%, respectively, for endorectal MRI, and 23% and 86% for TRUS. The sensitivity and specificity for diagnosing seminal vesicle invasion were 100% and 94%, respectively, for endorectal MRI, and 33% and 100% for TRUS. The overall staging accuracy for endorectal MRI was 75% compared with 50% for TRUS.

Conclusion

Compared with TRUS, endorectal MRI with a 0.5 T magnet provided greater sensitivity and specificity for capsular penetration and increased sensitivity for seminal vesicle invasion.
The performance characteristics of the bladder tumour antigen test
Authors: KIROLLOS M.M. , MCDERMOTT S. , BRADBROOK R.A.
Published: November 2003

Objective

 To evaluate the specificity and sensitivity of the Bard bladder tumour antigen (BTA) (Bard Inc, Covington, USA) test.

Patients and methods

 The performance of the BTA test was assessed prospectively in 98 patients (30 women and 68 men, mean age 64 years, median 67, sd 14.8) undergoing cystoscopy for various indications. The urine of the patients was assessed using the BTA test, cytology, culture and a dipstick test for haematuria, and the results compared with those from cystoscopy as the ‘standard’.

Results

 The overall specificity for the BTA test was 79% and the sensitivity 37%. The sensitivity was higher than for urine cytology (33%) but less than for the dipstick test (59%). The specificity was less than for cytology (100%) but higher than for the dipstick test (66%).

Conclusion

 The BTA test is a rapid, non‐invasive qualitative test identifying degradation products of the basement membrane of the transitional cell epithelium. It represents an advance in the search for a ‘tumour marker’ for carcinoma of the bladder. The specificity is acceptable but the sensitivity relatively low, which limits its value in everyday practice. Further research and development are needed to improve sensitivity.
A prospective, randomized, double‐blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy
Authors: CHOONG S. , WHITFIELD H.N. , MEGANATHAN V. , NATHAN M.S. , RAZACK A. , GLEESON M.
Published: November 2003

Objective

 To determine the optimum duration for the retention of 2% lignocaine gel intraurethrally as an anaesthetic for flexible cystoscopy in men.

Patients and methods

 A prospective, randomized, double‐blind, placebo‐controlled trial was conducted in two parts. Initially, the importance of duration was determined, i.e. whether pain relief was significantly improved when lignocaine gel was instilled for longer than is currently practised. As pain relief was improved by retaining the lignocaine gel for longer, the optimum time was determined in a second trial. Initially, 90 patients were divided into four groups receiving 20 mL of 2% lignocaine gel or plain lubricating gel for 5 or 25 min. Subsequently, 60 men were divided into two groups receiving 20 ml of 2% lignocaine gel for 15 or 25 min. The patients’ discomfort was recorded using a 4‐point descriptive pain scale and a 100 mm non‐graphical visual analogue scale.

Results

 In the first study, those patients receiving lignocaine gel for 25 min experienced significantly less pain than the other three groups. In the second, lignocaine gel in the urethra for 15 min provided the same level of pain relief as lignocaine for 25 min.

Conclusion

 Pain during flexible cystoscopy can be significantly reduced when 20 mL of 2% lignocaine gel is left in the urethra for 15 min; lignocaine gel would be more effective when left for longer than is currently practised.
The ‘Queen Square bladder stimulator’: a device for assisting emptying of the neurogenic bladder
Authors: DASGUPTA P. , HASLAM C. , GOODWIN R. , FOWLER C.J.
Published: November 2003

Objective

 To describe the effectiveness of a vibrating device for emptying the neurogenic bladder in patients with neurological disease.

Patients and methods

 The study involved 36 patients, comprising 29 with multiple sclerosis (MS), four with multiple system atrophy (MSA), one with radiation myelitis and two with neurological disease of uncertain aetiology. Most patients with MS (27) were able to walk unaided or with aids. Three of the 36 patients had loss of suprapubic sensation (two MS, one with uncertain diagnosis). All patients had free flow rates and ultrasonographic post‐void residual volumes (PVRs) measured before and after voiding while using a vibrating device (frequency 60 Hz) applied to the suprapubic region. They also completed questionnaires about their urinary symptoms before and after the continued use of this device. The mean follow‐up was 11.5 months (range 8–14).

Results

 The device improved the symptoms in 25 of 36 patients (70%) and reduced the PVR from a mean (standard deviation) of 175 (78) mL to 68 (32) mL. It was not useful in patients with PVRs of >400 mL, Kurtzke pyramidal function scores of >3, and in those with suprapubic numbness. There were no complications and most patients complied well.

Conclusions

 Suprapubic vibration is an effective means of emptying the neurogenic bladder in patients who are not severely disabled and who have detrusor hyper‐reflexia. It probably acts through a tonic vibration reflex which is under supraspinal influence. This device may be a useful alternative to clean intermittent self‐catheterization.
Is the expression of multidrug resistance gene product a prognostic indicator for the clinical outcome of patients with renal cancer?
Authors: HOFMOCKEL G. , BASSUKAS I.D. , WITTMANN A. , DÄMMRICH J.
Published: November 2003

Objective

 To determine the significance of the expression of the multidrug resistance gene product (MDR‐1) for the aggressiveness of renal cell carcinoma (RCC).

Patients and methods

 The study comprised 31 patients with clinically locally confined RCC treated with radical nephrectomy (mean age 64.1 years, range 41–78; mean follow‐up 5.4 years, range 4.3–7.3). Their survival time and disease‐free period were evaluated retrospectively. The expression of the MDR‐1 gene product was determined immunohistochemically using the JSB‐1 antibody in formalin‐fixed paraffin‐embedded tumour samples from these patients. The significance of this variable and tumour stage and malignancy grade was assessed for predicting the survival and disease‐free period using Kaplan‐Meier plots (log‐rank test or Tarone’s test) and the Cox multiple hazard regression analysis.

Results

 In a univariate analysis, tumour stage (P<0.002), malignancy grade (P<0.007) and MDR‐1 (P<0.03) were significant prognostic variables for both survival and disease‐free period. Lower MDR‐1 expression was correlated with poorer prognosis. On multivariate analysis, MDR‐1 and tumour stage were significant factors for predicting the disease‐free period, whereas tumour stage and malignancy grade were the most relevant factors for survival time. Calculating prognostic indices based on the results of the Cox analysis, MDR‐1 could replace malignancy grade, resulting in a better prediction of survival and disease‐free period (P<0.001 vs 0.0031, P<0.001 vs 0.021, respectively).

Conclusion

 MDR‐1, an established predictor for chemoresistance, may also be a potent prognostic factor for outcome in patients with locally confined RCC. Moreover, MDR‐1 expression seems to correlate with the differentiation of the RCC and thus its value as an objective measure of the degree of differentiation should be further explored.