bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic value of sarcomatoid histology and volume‐weighted mean nuclear volume in renal cell carcinoma
Authors: Kanamaru  , Sasaki  , Miwa  , Akino  , Okada
Published: March 2003

Objective

To determine the prognostic value of two histopathological factors, sarcomatoid histology and volume‐weighted mean nuclear volume (MNV) in renal cell carcinoma (RCC).

Patients and methods

The study included 106 patients (72 men and 34 women, mean age 63 years, range 32–83) with RCC, all of whom were surgically treated between 1985 and 1995. The presence of any sarcomatoid component was determined and MNV estimated using a stereological method in histological slides of tumour specimens from these patients. The prognostic significance of the two variables was evaluated by univariate and multivariate analyses in comparison with other histopathological variables (T, N and M categories, nuclear grade, tumour size, tumour type), using the cause‐specific and progression‐free survival of the patients as the endpoints.

Results

Among the 106 RCC cases examined, a sarcomatoid component was detected in 34 (32%); the MNV was 90–627 μm3 (mean 225). By univariate and multivariate analysis, both variables were significant prognostic factors for cause‐specific survival in all patients. In addition, multivariate analysis of the 74 patients with localized RCCs (T1–3, N0 M0) showed that sarcomatoid histology was a significant prognostic factor for disease progression.

Conclusion

The presence of sarcomatoid histology and the MNV, both of which can be examined with no specialized laboratory procedures, seem to be useful tumour‐related prognostic factors in RCC.
Autonomic nerve involvement and venous leakage in diabetic men with impotence
Authors: Çolakoglu  , Kutluay  , Ertekin  , Altay  , Killi  , Alkis
Published: March 2003

Objective

To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence.

Patients and methods

Thirty‐four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The results were compared with those from patients with idiopathic penile venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA).

Results

Of the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations. Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage.

Conclusion

Venous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.
Management of renal angiomyolipoma: a report of 53 cases
Authors: De Luca  , Terrone  , Rocca Rossetti
Published: March 2003

Objective

To evaluate the clinical, therapeutic and prognostic aspects of renal angiomyolipoma (AML) in patients either monitored by clinical and radiological follow‐up or treated by surgical therapy.

Patients and methods

Fifty‐three patients with renal AML were divided in two groups; 33 patients in group 1 were monitored by annual clinical and ultrasonographic follow‐up and 20 in group 2 were treated with surgical therapy. Two patients had tuberous sclerosis (TS) with synchronous bilateral and multiple lesions. Apart from the patients with TS, there were 38 lesions in group 1 and 25 in group 2. The mean (range) follow‐up of group 1 was 60.2 (12–164) months.

Results

In group 1, the diagnosis was most often incidental, after ultrasonography performed for symptoms unrelated to AML. In group 2, the suspicion of a malignant renal lesion, and spontaneous tumour rupture with bleeding and perirenal haematoma, were the main indications for surgical treatment. The mean lesion diameter was significantly greater in group 2 (5.4 cm) and in symptomatic patients (8.1 cm). In group 1, 92% of renal AMLs showed no radiographic changes, serious complications or new renal or extrarenal lesions during the follow‐up. Only three lesions grew, after 22, 85 and 164 months, respectively. Of the 20 patients in group 2, 14 underwent conservative surgery.

Conclusion

Small (<4 cm) isolated AMLs, detected incidentally, showed a low risk of developing during long‐term follow‐up. Such patients may be followed conservatively by ultrasonography every 2 years. Spontaneous perinephric haemorrhage is related to the size of the lesion. When surgery is indicated (by symptoms or diagnostic doubt), a conservative procedure can be performed in most of cases.
Evaluation of sexual life after orchidectomy followed by radiotherapy for early‐stage seminoma of the testis
Authors: Caffo  , Amichetti
Published: March 2003

Objective

To explore the changes perceived by patients in their sexual lives after orchidectomy and radiation therapy of the pelvic and para‐aortic nodes for early‐stage testicular seminoma (ST).

Patients and methods

A questionnaire mainly based on two self‐completed instruments, previously used to assess the sexual life of patients affected by testicular cancer (the UCLA/RAND sexual module and the Groningen sexual questionnaire) was mailed to a consecutive series of 143 patients treated for ST between 1961 and 1995, and who showed no signs of disease after primary treatment.

Results

Ninety‐eight questionnaires (69%) were returned and were evaluable. The median age of the patients was 48 years (range 26–85) at the time they completed the questionnaire, with the median follow‐up of 123 months (range 15–496). Most of the patients (86%) had been sexually active during the month before completing the questionnaire. Of these patients, 25% reported a low libido and 14% defined their sexual capacity as poor; 14% of the patients avoided sexual contact after treatment because of the disease and/or cancer therapies. After therapy, a minority of the patients found it more difficult to achieve and maintain an erection. Similarly, a few patients reached orgasm less intensely and less frequently. During the period after treatment, 24% reported a low semen volume, 14% premature ejaculation, 2% late ejaculation and 2% an absence of ejaculation. Most of the patients considered the information and counselling given by their physician about the sexual sequelae of therapy to be insufficient. However, the amount of information about the disease and treatment was considered to be good by, respectively, 64% and 61% of the patients. The only variable predictive of sexual adjustment was age at the time of the administration of the questionnaire.

Conclusion

The sexual adjustment of patients treated with orchidectomy and radiation therapy for early‐stage ST is generally good, but a few have negative experiences. Although the main predictive factor is age, communication is an important issue and better information tools could lead to better adjustment.
Early and late metabolic alterations in children and adolescents with a Kock urinary reservoir
Authors: Abd‐El‐Gawad  , Abrahamsson  , Hanson  , Norlén  , Sillén  , Sixt  , Hjälmås
Published: March 2003

Objective

To assess the early and late metabolic effects of urinary diversion in children and adolescents with a Kock urinary reservoir.

Patients and methods

Thirteen children (aged 10.8– 16 years) and seven adolescents (aged 16–18 years; 10 girls and 10 boys), underwent surgery for congenital urinary incontinence. They were followed for 3–10 years (mean 6.5), divided into an early (3 months to 2 years) and a late (2–10 years) period, and assessed for renal function and any metabolic effects.

Results

At the early and late follow‐up, one of 19 and three of 16 patients, respectively, had metabolic acidosis. Hyperchloraemia was present in four of 20 patients at the early and in eight of 18 at the late follow‐up. Serum creatinine was increased in four of 20 patients at the early and eight of 18 at the late follow‐up. In patients with infrequent reservoir emptying (≤4 times/day), the serum creatinine level was increased in seven of 13 at the early and eight of 10 at the late follow‐up (P<0.05). The glomerular filtration rate was below normal in four of 20 patients preoperatively, in six of 19 at the early and in eight of 18 at the late follow‐up.

Conclusions

The continent ileal reservoir in children and adolescents produces similar changes to those previously reported in adults. However, almost all patients with metabolic disorders were younger than 16 years at operation. The pre‐existing impairment of renal function, together with associated congenital anomalies, mental and/or physical disorders, young age, recurrent urinary tract infections and infrequent reservoir emptying, leads to deterioration in renal function after the Kock operation. Even with this risk, the Kock pouch remains a viable alternative to other forms of continent urinary diversion, because it has a wide calibre stoma, allowing large‐bore catheters, and is therefore especially suitable for individuals with weak hand function, e.g. quadriplegic or meningomyelocele patients. However, as shown by these results, the child with a Kock pouch requires continuous medical attention.
Radical transurethral resection and chemotherapy in
Authors: Thomas  , Roberts  , Hall  , Reading
Published: March 2003

Objective

To evaluate the treatment of patients with muscle‐invasive bladder cancer (T2‐T4a) by radical transurethral resection (TUR) and cisplatin‐methotrexate systemic chemotherapy.

Patients and methods

Fifty patients with transitional cell carcinoma (TCC) of the bladder (nine T2, 36 T3 and five T4a) were treated by ‘complete’ TUR of the bladder tumour followed by 2–6 cycles of cisplatin (70 mg/m2 ) and methotrexate (40 mg/m2 ) chemotherapy. The median (range) tumour size was 3 (1–7 cm). In six patients, attempted TUR at the dome of the bladder led to intraperitoneal perforation; the tumour was excised by partial cystectomy in these patients. The latest follow‐up results from 57 patients treated by radical TUR and methotrexate alone, reported previously, are included.

Results

At the first evaluation cystoscopy immediately after completing chemotherapy, 38 patients were tumour‐free, eight had persistent muscle‐invasive TCC and four had Ta, T1+CIS disease. With an overall median follow‐up of 47 months, 10 additional patients relapsed with muscle‐invasive carcinoma in the bladder after a median interval of 15.6 months; three patients developed Ta, T1 tumours, three Ta, T1+CIS, and six CIS only. Six of the 10 recurrent invasive tumours were at the same site, but four were at a different site in the bladder. Although during follow‐up 12 patients developed superficial recurrence that required endoscopic treatment, the bladder was preserved (free of muscle‐invasive cancer) in 37 of 50 patients. In 30 of these 37, this was achieved with no need for salvage radiotherapy or cystectomy. Six patients died from metastatic TCC with no tumour in the bladder.

Conclusion

In this selected group of patients, muscle‐invasive bladder cancer was controlled by TUR and systemic chemotherapy, preserving normal bladder function in 60% of patients without apparently comprising overall survival.
Inositol hexakisphosphate in urine: the relationship between oral intake and urinary excretion
Authors: Grases F. , Simonet B.M. , March J.G. , Prieto R.M.
Published: March 2003

Objective To study the relationship between the oral intake of inositol hexakisphosphate (InsP6, phytic acid, an inhibitor of urinary crystallization) and its urinary excretion, to establish their possible mutual influence.

Materials and methods Two groups of male Wistar rats (six animals each) received either; tap water and normal rat food pellets (controls); or a liquid diet in which InsP6 was absent and which then received gradually increasing amounts of InsP6. The urinary levels of InsP6 were then assessed regularly in both groups.

Results When InsP6 was absent from the diet, urinary excretion declined to undetectable levels after 22 days. The addition of increasing amounts of InsP6 to the liquid diet caused an increase in its urinary excretion after about 10 days. Adding InsP6 in amounts > 425 mg/L caused no further increases in urinary excretion. Adding inositol (with no InsP6) to the liquid diet caused only a slight increase in the urinary excretion of InsP6.

Conclusion These results showed that InsP6 urinary levels were related to its oral intake; consequently, a low consumption of InsP6 would cause a urinary deficit of this crystallization inhibitor and thus an increase in the risk of developing urinary calcium stones. Although urinary excretion was dose‐dependent, there was an ingested amount (20.9 mg/kg) above which there was no increase in the amount excreted. This intake is easily obtained by consuming a normal diet (rich in InsP6) indicating that to maintain appropriate urinary levels of InsP6, the consumption of InsP6 supplements is only necessary when the diet is particularly poor in InsP6.
A clinicopathological study of bladder cancer associated with upper urinary tract cancer
Authors: Miyake H. , Hara I. , Arakawa S. , Kamidono S.
Published: March 2003

ObjectivesTo analyse the clinicopathological features of bladder cancer associated with upper urinary tract cancer (UUTC).

Patients and methods Among 106 patients with primary UUTC (mean age 65 years, range 45–82) who underwent surgical treatment, 44 also had bladder cancer. The patients were divided into three groups according to the timing of the appearance of bladder cancer. In group 1, 10 patients had UUTC preceding bladder cancer, group 2 comprised 14 patients with concurrent bladder cancer and group 3, 20 with subsequent bladder cancer; their clinicopathological data were analysed.

Results Among several clinicopathological factors examined, only the number of UUT tumours was significantly correlated with the incidence of associated bladder cancer (P < 0.01). There was no significant difference between survival rates of patients with UUTC with and without associated bladder cancer. The incidence of high‐stage or high‐grade tumours in both the UUT and bladder in group 2 was higher than that in groups 1 and 3 (P < 0.05), and the survival rate in group 2 was significantly lower than in those in groups 1 and 3 (P < 0.05). Furthermore, the survival rate of patients in group 2 was significantly lower than that of all other patients (P < 0.01).

Conclusions These findings suggest that bladder cancer associated with UUTC has a different biological character depending on the timing of tumour appearance, and that patients with UUTC and concurrent bladder cancer should undergo careful follow‐up and aggressive adjuvant therapy.
The detection of prostate cells by the reverse transcription‐polymerase chain reaction in the circulation of patients undergoing transurethral resection of the prostate
Authors: Heung Y.M.M. , Walsh K. , Sriprasad S. , Mulvin D. , Sherwood R.A.
Published: March 2003

ObjectiveTo determine whether prostate cells are disseminated into the circulation of patients after transurethral resection of the prostate (TURP), as assessed by a reverse transcription‐polymerase chain reaction (RT‐PCR) assay for prostate specific antigen (PSA) mRNA.

Patients and methodsFifty‐one patients, comprising 34 with benign prostatic hyperplasia (BPH) and 17 with prostate cancer who were undergoing routine TURP, had blood samples taken before and 30 min after surgery. The blood mononuclear cell layer was isolated by density‐gradient centrifugation and total RNA extracted. Complementary DNA was synthesized by RT of the RNA. The target PSA sequence was amplified by PCR with specific PSA primers and the product detected on agarose‐gel electrophoresis with ethidium bromide staining.

ResultsFive patients (all with prostate cancer) were positive on PSA RT‐PCR before surgery and remained positive after TURP. Of the remaining 46 patients, five (11%; three with BPH and two with cancer) changed from a negative to a positive result after TURP.

ConclusionIn a proportion of patients TURP causes the dissemination of prostate cells into the circulation which are then detectable by RT‐PCR of PSA mRNA.
A double‐blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3‐year follow‐up
Authors: Keoghane S.R. , Lawrence K.C. , Gray A.M. , Doll H.A. , Hancock A.M. , Turner K. , Sullivan M.E. , Dyar O. , Cranston D.
Published: March 2003

ObjectiveTo evaluate the effect of contact laser prostate surgery in the treatment of benign prostatic hyperplasia.

Patients and methodsA prospective double‐blind ran‐domized controlled trial of transurethral resection of the prostate (TURP) and contact laser prostatectomy was conducted, with an economic evaluation of both procedures. The primary outcome measure was the change in the American Urologic Association symptom score, with secondary outcome measures being the peak urinary flow rate, treatment‐related complications, re‐operation rate and health service costs.

ResultsThe perioperative blood loss and transfusion requirements were statistically significantly lower for laser prostatectomy than for TURP. There was no clinically significant difference between TURP and contact laser prostatectomy in the mean change in symptom scores and flow rates. There were distinct perioperative advantages in favour of the contact laser treatment, but some disadvantages in terms of re‐catheterization and re‐operation rates.

ConclusionsContact laser prostatectomy is a valid treatment for benign prostatic hypertrophy. The performance of contact laser prostatectomy as day‐case surgery would have cost advantages to the National Health Service.
The after‐contraction: a true detrusor contraction or a late dyssynergic urethral sphincter contraction?
Authors: Vereecken R.L. , Vereecken R.L.
Published: March 2003

Objective To evaluate the mechanism and significance of the after‐contraction, recorded in bladder pressure by urodynamics, at the end of micturition.

Patients and methods The urodynamic recordings showing an after‐contraction of the detrusor in 65 patients of all ages and with a variety of pathologies were re‐examined. Special attention was directed to the anal or urethral sphincter needle electromyographic activity and to the monitored urethral pressure, to determine any relationships with the patterns of detrusor pressure.

Results An after‐contraction was noted in 61 patients with detrusor instability and in 11 with urethral instability. In 59 patients it was evident that the after‐contraction, i.e. a renewed increase in detrusor pressure during the declining contraction, correlated with a sphincter contraction preceding it by a fraction of a second. Similar increases in detrusor pressure were apparent in patients with detrusor‐sphincter dyssynergia throughout voiding. In six patients the relationship was less clear mainly because there were artefacts in the curves.

Conclusion The after‐contraction arises by a sudden stopping of the outflow of urine, provoked by a sphincter contraction. This may occur by involuntary dyssynergia or by an early voluntary interruption of the voiding stream. The ‘milk back’ of urine from the proximal urethra to the bladder and the inhibited detrusor contraction (if the perineal contraction is prolonged) may cause some postvoid residual urine. It occurs mainly in the presence of detrusor and/or urethral instability.
A randomized trial comparing lithoclast with an electrokinetic lithotripter in the management of ureteric stones
Authors: Menezes P. , Kumar P.V.S. , Timoney A.G.
Published: March 2003

ObjectiveTo compare two in situ ballistic lithotripters, the lithoclast and the electrokinetic lithotripter (EKL), both of which can be used through the newer small‐bore ureteroscopes, for their ease of use, robustness, fragmentation time, adequacy of fragmentation and stone‐free rate.

Patients and methodsForty‐six consecutive patients with ureteric stones refractory to treatment by extracorporeal shock wave lithotripsy were randomized to undergo fragmentation using the lithoclast (23 patients) or the EKL (23 patients). One patient was excluded from analysis in the EKL group. The adequacy of fragmentation was recorded, with the degree and significance of proximal migration for each device. After treatment patients were assessed by plain X‐ray and the stone‐free rate was determined.

ResultsThe mean (median) initial stone burdens in the lithoclast and EKL groups were 69 (50) mm2 and 72 (52) mm2, respectively. The respective mean (median) procedure duration and fragmentation time were 54 (50) min and 90 (49) s in the lithoclast group, and 50 (42.5) min and 87 (52.5) s in the EKL group; the differences were not statistically significant. In four (14%) patients of each group there was significant proximal migration of the stones. The stones were completely fragmented in 17 of 23 (74%) patients in the lithoclast group and 19 of 22 (86%) in the EKL group. There was no fragmentation in one patient in each group. In the lithoclast and EKL groups, 20 of 23 (87%) and 17 of 22 (77%) were rendered stone‐free, respectively (P > 0.5). The equipment failed on two occasions in each group.

ConclusionIn this randomized trial there was no significant difference in the stone‐free rate, procedure duration, fragmentation time, proximal stone migration rate and equipment failure between these in situ ballistic lithotripters.
Does endoscopic laser ablation of the prostate stand the test of time? Five‐year results from a multicentre randomized controlled trial of endoscopic laser ablation against transurethral resection of the prostate
Authors: Mcallister W.J. , Absalom M.J. , Mir K. , Shivde S. , Anson K. , Kirby R.S. , Lawrence W.T. , Paterson P.J. , Watson G.M. , Fowler C.G.
Published: March 2003

Objective To determine the long‐term objective and subjective outcome of patients with benign prostatic enlargement (BPE) treated by endoscopic laser ablation of the prostate (ELAP), as part of a multicentre randomized controlled trial of ELAP against TURP.

Patients and methods Initially, 151 patients with BPE were randomized to undergo either ELAP or TURP, starting in March 1992. ELAP was performed using the Urolase™ fibre (Bard, Covington, GA, USA) in conjunction with a Nd:YAG laser source. All patients who had originally participated in the study were approached 5 years later to obtain a urological history, American Urological Association (AUA) symptom score and two measurements of urinary flow rate, with an ultrasonographic assessment of the postvoid residual urine volume (PVR).

Results The mean duration of follow‐up was 61 months; 109 patients were traced, comprising 69 who were alive and well, and had undergone no further bladder outlet surgery, 26 who had required revision surgery, 12 who were dead or terminally ill and three who had dementia. Both ELAP and TURP produced sustained improvements in mean AUA score, maximum flow rate and PVR, with respective values at 5 years of 6.3, 17.8 mL/s and 76 mL, and 6.5, 20.0 mL/s and 55 mL. Eighteen of 47 ELAP patients (38%) and eight of 51 (16%) TURP patients underwent revision surgery within the follow‐up.

Conclusion ELAP and TURP produced similar subjective and objective outcomes at 5 years. The re‐operation rate after ELAP was more than double that after TURP and suggests that ELAP should not be used routinely in the management of men with BPE.
Radical retropubic prostatectomy: time trends, morbidity and mortality in Japan
Authors: Arai Y. , Egawa S. , Tobisu K. , Sagiyama K. , Sumiyoshi Y. , Hashine K. , Kawakita M. , Matsuda T. , Matsumoto K. , Fujimoto H. , Okada T. , Kakehi Y. , Terachi T. , Ogawa O.
Published: March 2003

Objectives To assess the time trends, morbidity and mortality of contemporary anatomical radical retropubic prostatectomy (RRP) in a multi‐institutional study in Japan, where RRP has become more popular in the last decade.

Patients and methods Between January 1991 and August 1998, 638 patients underwent RRP at seven urological centres in Japan. Major complications (within 30 days of surgery) and the 30‐day mortality were reviewed retrospectively. Of the patients, 12.9% were < 60 years old, 56.3% were 60–69 years old and 30.9% were  70 years old (median age 67).

Results The number of RRPs increased markedly, by more than sevenfold, from 1991–92 to 1996–97, mainly because there were more patients undergoing RRP in their sixth decade. The contribution of T1c disease increased in absolute and relative terms, from 13.9% in 1991–92 to 37.9% in 1997–98. Over time, the mean blood loss and the allogeneic transfusion rate decreased steadily. There was a trend toward more favourable outcomes for pathological variables (an increased percentage of organ‐confined disease, decreased margin positivity and a decreased incidence of positive lymph node metastasis). The most common complications were wound‐related (7.5%), or anastomotic leakage (4.1%). Major cardiopulmonary complications occurred in only two patients (0.31%, both pulmonary embolisms). One patient died from cerebral haemorrhage within 30 days of surgery, giving a mortality rate of 0.16%.

Conclusions This study indicates a trend towards selecting patients most likely to benefit from RRP. Although the procedure is technically demanding, it can have an acceptably low rate of early complications, little mortality and need for allogeneic transfusion. The assessment of morbidity suggests a lower incidence of catastrophic thrombo‐embolic and cardiac complications in Japanese patients than in Western men. The present data may be useful in decision‐analysis models evaluating the role of therapy for Asian men with early‐stage prostate cancer.
Trends in the curative treatment of localized prostate cancer after the introduction of prostate‐specific antigen: data from the Rotterdam Cancer Registry
Authors: Spapen S.J.J.C. , Damhuis R.A.M. , Kirkels W.J.
Published: March 2003

Objective To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing.

Patients and methods Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry.

Results In the period 1989–95, 4344 patients were diagnosed with prostate cancer and the age‐standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours.

Conclusion While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care.
The use of isolated caecal bowel segment in complicated vaginal reconstruction
Authors: Filipas D. , Black P. , Hohenfellner R.
Published: March 2003

Objective To report a one‐stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation.

Patients and methods The vagina was reconstructed using a 15‐cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstructions; four of these had undergone previous fistula formation. Fourteen patients were followed for a mean of 3.6 (1–9) years. The surgical outcome was evaluated using a questionnaire completed by the patients.

Results The postoperative course was unremarkable in all patients. Four patients developed an introital stenosis requiring surgical intervention. Two patients were minors at the time of follow‐up, while all the others had had sexual intercourse and reported that they were very satisfied with the functional and cosmetic result.

Conclusion In patients in whom previous vaginal reconstruction has failed, the caecal segment should be used to create a neovagina. By considering the patient’s age, the surgeon can optimize the surgical result.
Rising incidence of prostate cancer in Scotland: increased risk or increased detection?
Authors: Brewster D.H. , Fraser L.A. , Harris V. , Black R.J.
Published: March 2003

Objective To assess the extent to which the increasing incidence of prostate cancer in Scotland can be explained by increased detection, particularly through transurethral resection of the prostate (TURP) and use of the prostate‐specific antigen (PSA) test.

Subjects and methods This population‐based study was confined to men resident in Scotland and aged 50 years. Temporal trends were examined in age‐specific and age‐standardized incidence, mortality and TURP rates, and PSA testing rates during 1981–1996. Also analysed were the geographical variations in age‐standardized incidence and mortality rates during two distinct periods, 1984–1986 (before PSA testing) and 1994–1996 (after PSA testing). Finally, incidence rates and relative survival at 5 years were calculated by age group and 5‐year periods of diagnosis during 1968–1992.

Results The incidence of prostate cancer in men aged 50 years increased from an age‐standardized rate of 142.0 per 100 000 in 1981 to 240.9 in 1996, with the steepest increase occurring between 1992 and 1993. The mortality rate increased similarly until 1993, but was relatively stable thereafter, falling slightly in 1996. In 1981–1988, incidence rates were closely correlated with TURP rates (r = 0.98, P < 0.001). In 1989–1996, incidence was closely correlated with PSA testing rates (r = 0.98, P < 0.001). By 1994–1996, incidence rates varied substantially between Scottish mainland health boards (range 167.7–303.0 per 100 000), with much less variation in mortality rates (90.7–110.0). Relative survival has increased recently in all age groups although, in the era before PSA testing, survival was reasonably stable despite increasing incidence.

Conclusion Although there may have been a true increase in risk, much of the observed increase in the incidence of prostate cancer in Scotland between 1981 and 1996 has been caused by increased detection, leading recently to considerable variation among different areas of the country. The extent to which this represents the early diagnosis of tumours which would eventually cause symptoms or be life‐threatening, or detection of latent disease which would never have become symptomatic, is not clear. There is no evidence so far that the increased incidence is associated with any substantial reduction in mortality.
Comparison of the depth of the desiccated zone with selected vaporizing‐cutting electrodes: a basic study in animals
Authors: Ishikawa N. , Goya N. , Iguchi Y. , Toda F. , Nishino S. , Ishijima M. , Toma H.
Published: March 2003

Objective To evaluate in an animal model the haemostatic efficacy of vaporizing‐cutting (VC) electrodes recently developed for use in high‐energy transurethral resection of the prostate (TURP).

Materials and methods Four VC electrodes were assessed for their haemostatic efficacy in the muscle and liver of pigs (in vitro) and dogs (in vivo). The devices tested were the roller‐cutting and Vapor Cut (Karl Storz GmbH, Germany); the Wedge (Boston Scientific Corp., Boston, USA); and the Uroloop (Endocare Inc., Irvine, CA). In each the depth of the desiccated zone was compared with that produced by a standard cutting loop electrode. Each electrode was attached to a scanning system (developed previously) that allowed the electrode pressure on the tissue surface (in 3% sorbitol solution) and the running speed to be adjusted. The same generator was used with all devices. The tissue (muscle or liver) was cut by running the electrode over the surface at 200, 250 or 300 W, with the loop electrode used as the reference. After completing the procedure, the surgical wound and the surrounding tissue were dissected out and the depth of the heat‐affected zone (HAZ, defined as the desiccated zone) measured.

Results In pig muscle (stroke speed 5 mm/s) there was no significant difference in the depth of the HAZ between the four VC electrodes and the loop, or among the VC electrodes at any of the power levels tested. In pig liver (stroke speed 5 mm/s), the roller cutting and Vapor Cut electrodes produced a thicker HAZ than the loop at all power levels tested (P < 0.01). The Wedge electrode produced a significantly thicker HAZ than the loop at 200 and 300 W (P < 0.01). There were no significant differences in HAZ among the VC electrodes at any power level. In dog muscle in vivo (stroke speed 10 mm/s), the roller cutting, Vapor Cut and Wedge electrodes produced a significantly thicker HAZ at 250 W than the loop at 150 W (the usual power for TURP) (P < 0.01). There was no significant difference among the VC electrodes. In dog liver in vivo (stroke speed 10 mm/s), the roller cutting electrode produced a significantly thicker HAZ at 250 W than the loop at 150 W (P < 0.01).

Conclusions The present VC electrodes produced a thicker desiccation zone at higher powers (200–300 W) than the standard loop at the usual power (150 W). The four VC electrodes produced a similar desiccation zone. With pig muscle and liver in vitro, regular loops used at a higher power created a desiccation zone that was 70–80% of the depth created by the VC electrodes.
The transverse colonic reservoir: the Unicamp technique
Authors: Ferreira U. , Rodrigues Netto N. , Lucena R.
Published: March 2003

Objective To present the results of a continent and nonrefluxing transverse colonic urinary reservoir technique.

Patients and methods Twenty patients who had received high doses of irradiation underwent construction of transverse colonic reservoir as a primary form of urinary diversion. Fourteen patients had a vesicovaginal fistula after definitive radiation therapy for gynaecological tumours and six had radiation therapy for invasive bladder cancer as a definitive treatment. They were followed for a median (range) of 4.5(1–8) years. Intravenous pyelography before diversion showed mild hydronephrosis in 10 patients.

Results After diversion, hydronephrosis improved in four patients and no upper tract deteriorated. All but one of the pouchograms showed no ureteric reflux. All the patients required clean intermittent self‐catheterization every 3–4 h. Persistent asymptomatic bacteriuria was present in 14 patients, although clinical urinary tract infections were not reported. A moderate metabolic acidosis was present in 12 patients, but none required treatment. The urodynamic evaluation revealed a median (range) reservoir capacity of 450 (350–600) mL, with no contractions or contractions of < 35 cmH2O.

Conclusion These results suggest that the Unicamp technique for constructing a transverse colonic reservoir is a safe and effective diversion, and is recommended as an alternative method for patients treated by pelvic irradiation.
The effect of bladder outlet obstruction on tissue oxygen tension and blood flow in the pig bladder
Authors: Greenland J.E. , Hvistendahl J.J. , Andersen H. , Jörgensen T.M. , McMurray G. , Cortina‐Borja M. , Brading A.F. , Frøkiær J.
Published: March 2003

Objective To investigate the effect of partial bladder outlet obstruction on detrusor blood flow and oxygen tension (PdetO2) in female pigs.

Materials and methods Detrusor‐layer oxygen tension and blood flow were measured using oxygen‐sensitive electrode and radiolabelled microsphere techniques in five female Large White pigs with a partial urethral obstruction and in five sham‐operated controls. The effects of chronic outlet obstruction on bladder weight, and cholinergic nerve density and distribution, are also described.

Results In the obstructed bladders, blood flow and oxygen tension were, respectively, 54.9% and 74.3% of control values at low bladder volume, and 47.5% and 42.5% at cystometric capacity. Detrusor blood flow declined by 27.8% and 37.5% in the control and obstructed bladders, respectively, as a result of bladder filling, whilst PdetO2 did not decrease in the controls, but fell by 42.7% in the obstructed bladders. Bladder weight increased whilst cholinergic nerve density decreased in the obstructed animals.

Conclusion In pigs with chronic bladder outlet obstruction, blood flow and oxygen tension in the detrusor layer were lower than in control animals. In addition, increasing detrusor pressure during filling caused significantly greater decreases in blood flow and oxygen tension in the obstructed than in the control bladders.
A randomized controlled trial comparing the efficacy of controlled‐release oxybutynin tablets (10 mg once daily) with conventional oxybutynin tablets (5 mg twice daily) in patients whose symptoms were stabilized on 5 mg twice daily of oxybutynin
Authors: Birns J. , Lukkari E. , Malone‐lee J.G. ,   the Oxybutynin CR Clinical Trial Group
Published: March 2003

Objective To compare the efficacy of a controlled‐release (CR) formulation of oxybutynin with that of conventional oxybutynin in patients with detrusor instability or detrusor hyper‐reflexia whose symptoms were stabilized on conventional oral oxybutynin tablets.

Patients and methods The study comprised a randomized, double‐blind, parallel‐group trial involving 130 patients drawn from 15 centres in the UK. The study was of 6 weeks’ duration, i.e. 2 weeks of screening whilst taking conventional oxybutynin tablets (5 mg twice daily) followed by 4 weeks of double‐blind treatment with either CR oxybutynin tablets (10 mg once daily) or conventional oxybutynin tablets (5 mg twice daily). Outcome measures were changes in 24‐h frequency and 24‐h incontinence episodes recorded throughout the study on diary charts. Adverse events were recorded by patients in their diary charts and serum concentrations of oxybutynin and its active metabolite, N‐desethyloxybutynin, were measured at baseline and at completion of the study to detect possible drug accumulation.

Results The treatments did not differ significantly in any of the outcome measures. The primary efficacy criterion was the daytime continence at completion of the study; 53% and 58% of patients were continent on CR and conventional oxybutynin treatments, respectively (the 95% confidence interval of the difference in the proportion being − 22% to 13%; P = 0.62). The total number of side‐effects experienced by those patients receiving treatment with the CR formulation was 57% of that for patients receiving treatment with conventional oxybutynin. Individual side‐effects showed a similar distribution within treatment groups. There was no evidence of the accumulation of oxybutynin or N‐desethyloxybutynin during the multiple dosing of CR or conventional oxybutynin tablets.

Conclusion The CR and conventional formulations of oxybutynin did not differ in their efficacy, and the CR formulation was associated with fewer side‐effects. In addition, CR oxybutynin appeared to maintain therapeutic blood levels over the 24 h dosing interval with no accumulation of oxybutynin or its active metabolite. Once‐daily dosing with a CR tablet is seen as convenient for the patient and is expected to result in improved compliance in patients already stabilized on conventional oxybutynin treatment.
Surgical conversion of genitalia in transsexual patients
Authors: Jarolím L.
Published: March 2003

Objective To describe the techniques and outcome of genital and urethral reconstructive surgery during gender conversion as part of the treatment of transsexuals.

Patients and methods From 1992 to 1999, 82 patients were surgically converted after previous sexual and hormonal therapy. Using the male genital tissue to create new female genitalia, and vice versa, 30 male and 52 female transsexuals were converted. For male‐to‐female transsexuals, the technique of penile skin inversion was used 29 times and sigmoidocolpoplasty five times (in one patient primarily and in four patients to correct inadequate neovaginal size after penile skin inversion). In female‐to‐male transsexuals, 28 meta‐idoioplasties and seven neophalloplasties were performed using the groin skin‐flap technique, with 42 breast reductions also included as a part of the therapy.

Results Surgical gender reassignment of the male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm. Depending on the technique used in the reverse conversion, the patient maintained the ability to attain orgasm, and in many cases had a satisfactory appearance of the neopenis, with the potential to void while standing.

Conclusions The morphological proportions of each patient vary, and the different shapes and sizes of the tissues can be used for plastic operations. Thus the modelling of each individual genital in transsexuals can be considered ‘original’.
The postejaculatory refractory period: a neurophysiological study in the human male
Authors: Yilmaz U. , Aksu M.
Published: March 2003

Objective To investigate changes in the penile sensory threshold, and the variables of cortical somatosensory evoked potential and sacral evoked response tests in the early postejaculatory period in the human male.

Subjects and methods Twenty healthy volunteers (mean age 25.3 years, range 17–32) were evaluated before and after ejaculation for penile sensory threshold values, and the variables of sacral evoked response and cortical somatosensory evoked potential tests.

Results Three subjects were excluded from the statistical analyses because there were significant differences among the repeated tests. In the remaining 17 subjects the penile sensory threshold was significantly greater in the postejaculatory period (P < 0.05). There were no significant changes in the other variables of both the sacral evoked response and cortical somatosensory evoked potential tests after ejaculation (P > 0.05).

Conclusion The postejaculatory refractory period in the human male is accompanied by a greater penile sensory threshold but with no change in the values of the sacral evoked response and cortical somatosensory evoked potential.
Trends in prostate cancer incidence, mortality and survival in England and Wales 1971–1998
Authors: Majeed A. , Babb P. , Jones J. , Quinn M.
Published: March 2003

Objectives To examine trends in prostate cancer incidence and mortality in England and Wales between 1971 and 1998, using a newly developed and validated national cancer database and the national mortality database.

Methods Age‐standardized incidence and death rates were calculated directly and trends in relative survival rates among men with prostate cancer registered during 1971–1990 were examined.

Results The annual number of new cases of prostate cancer registered in England and Wales increased by 179% between 1971 and 1993, from 6174 to 17 210. Directly age‐standardized incidence rates increased by 104% between 1971 and 1993, from 29 to 59 per 100 000. The number of deaths from prostate cancer increased by 113% between 1971 and 1998, from 4027 to 8570. Directly age‐standardized death rates increased by 49% between 1971 and 1995 and then decreased by 8% between 1995 and 1998, an overall increase of 38% (20 to 27 per 100 000) between 1971 and 1998. The relative survival rate for prostate cancer among men diagnosed during 1986–1990 was 77% at 1 year and 42% at 5 years, compared with 67% and 33%, respectively, for cases diagnosed during 1971–1975. The increase in survival rates was confined to men diagnosed with prostate cancer up to 1985 and no increase was seen for cases diagnosed after 1985.

Conclusions Prostate cancer is becoming a growing burden on the health service. The explanation for the large increase in prostate cancer incidence and mortality is unclear and needs further investigation. The lack of any improvement in survival rates in cases diagnosed after 1985 is of concern, and suggests that the current management of prostate cancer in both primary and secondary care may need to be reviewed.
Effects of finasteride and bicalutamide on prostatic blood flow in the rat
Authors: Lekås E. , Bergh A. , Damber J.‐E.
Published: March 2003

ObjectiveTo determine whether finasteride and bicalutamide, both currently used in the clinical management of patients with prostate diseases because they have anti‐androgenic properties, have any effects on prostatic blood flow in a rat prostate model, as androgens are known to be involved in the regulation of prostatic blood flow and angiogenesis.

Materials and methodsBoth finasteride and bicalutamide were supplied as oral suspensions in water and given daily to rats for 7 days by tube feeding. Blood flows to the ventral and dorsal prostates, and to the kidneys, were measured using the radioactive microsphere technique. In the bicalutamide experiments, some rats were treated with the Leydig cell toxin ethane dimethane sulphonate (EDS), to obtain a castration‐like effect, and one group of these rats received testosterone.

ResultsFinasteride induced a clear decrease in blood flow to the ventral and dorsal prostates after 7 days of treatment, with no significant changes in blood pressure or kidney blood flow. Bicalutamide inhibited the testosterone‐induced increment of prostatic blood flow observed in EDS‐treated animals.

ConclusionsFinasteride, a blocker of 5α‐reductase, decreases prostate blood flow after 7 days of administration. The response was slower than that after castration, but was of similar magnitude. Blood flow was also decreased after treatment with the androgen‐receptor inhibitor bicalutamide. These observations suggest that prostatic blood flow is increased by dihydrotestosterone, and that the androgen receptor is responsible for mediating this effect.
Treatment of symptomatic benign prostatic hyperplasia with β‐sitosterol: an 18‐month follow‐up
Authors: Berges R.R. , Kassen A. , Senge T.
Published: March 2003

Objectives
 To determine the long‐term effects of phytotherapy with β‐sitosterol (the trade name for β‐sitosterol used in this study is Harzol®) for symptomatic benign prostatic hyperplasia (BPH).

Patient and methods
 At 18 months after enrolment in a 6‐month multicentre double‐blind placebo‐controlled clinical trial with β‐sitosterol (reported previously), patients were re‐evaluated using the modified Boyarsky score, the International Prostate Symptom Score and quality‐of‐life index, the maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR). In this open extension of the original trial (after 6 months of treatment or placebo), patients were free to chose their further treatment for BPH.

Results
 In all, 117 patients (59%) were eligible for analysis during the follow‐up. Of the formerβ‐sitosterol group, 38 patients who continued β‐sitosterol treatment had stable values for all outcome variables between the end of the double‐blind study and after 18 months of follow‐up. The 41 patients choosing no further therapy had slightly worse symptom scores and PVR, but no changes in Qmax. Of the former placebo group, 27 patients who started β‐sitosterol after the double‐blind trial improved to the same extent as the treated group for all outcome variables. The 18 patients choosing no further therapy showed no signs of improvement.

Conclusion  The beneficial effects of β‐sitosterol treatment recorded in the 6‐month double‐blind trial were maintained for 18 months. Further clinical trials should be conducted to confirm these results before concluding that phytotherapy with β‐sitosterol is effective.