bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular genetic diversity within and among German ecotypes in comparison to European perennial ryegrass cultivars
Authors: Bolaric S. , Barth S. , Melchinger A. E. , Posselt U. K.
Published: July 2005

Perennial ryegrass (Lolium perenne L.) is the most important grass species for temperate grassland agriculture. The level and distribution of genetic variation in gene bank ecotype collections is still largely unknown but of great interest for the planning of breeding programmes. The objectives of this study were to (i) assess the molecular variance and population structure of German ecotypes at the regional and population level, (ii) assign ecotypes to germplasm pools and (iii) compare the relationship between German ecotypes and previously‐investigated European cultivars of perennial ryegrass, A total of 22 ecotypes originating from three geographic areas in Germany. each with a sample size of 20 individual plants, were investigated with 156 polymorphic RAPD markers. Genetic distance among ecotypes ranged from 0,27 to 0.48, An analysis of molecular variance (AMOVA) revealed a much larger variation within populations (71%) than among them (29%). Ecotypes from North Germany were significantly different from those of South and Middle Germany. Thus, two distinct germplasm pools could be identified. The 22 ecotypes and 22 previously investigated cultivars shared 98% of the molecular variance.
The use of pethidine as pre‐medication to prevent anoxic spells in patients with tetralogy of Fallot
Authors: Shimizu Mikiko , Inai Kei , Nakazawa Makoto
Published: July 2005

Objective
: The aim of this study was to determine whether morphine‐HCl or pethidine‐HCl differ as pre‐medication to prevent anoxic spell in patients with tetralogy of Fallot (TOF) at catheterization.

Methods
: A 3 year retrospective case notes review study of 46 consecutive patients who underwent cardiac catheterization from 1998 to 2001 was conducted. In a prospective 1 year randomized control study, 10 patients diagnosed as TOF and admitted to Tokyo Women's Medical University, The Heart Institute of Japan, Tokyo, in 2002 were randomized to receive morphine or pethidine as pre‐medication for cardiac catheterization. The incidence of anoxic spell before and after cardiac catheterization was investigated in both studies.

Results
: In the case notes review, a total of 10 out of the 46 patients showed anoxic spell study: eight out of 24 patients in the morphine group and two out of 22 in the pethidine group. The difference in the incidence was statistically significant (P < 0.05, Fisher's exact test). Four patients in the prospective study showed anoxic spell: three out of six in the morphine group and one out of four in the pethidine group (odds ratio = 3.0). Overall, 14 out of 56 patients had anoxic spell: 11 out of 30 in the morphine group and three out of 26 in the pethidine group (P = 0.03).

Conclusion
: The incidence of hypoxic spells in patients with TOF undergoing cardiac catheterization is reduced by the use of pethidine‐HCl as pre‐medication compared to morphine. This has important clinical implications.
Relationship of serum interleukin‐7 concentration and the coagulation state in children with nephrotic syndrome
Authors: Wasilewska Anna , Zoch‐Zwierz Walentyna M , Tomaszewska Barbara , Zelazowska Beata
Published: July 2005

Background
: Enhanced platelet reactivity may play a significant role in the hypercoagulable state of nephrotic syndrome (NS). Thrombocytosis with platelet aggregation cause the release of some cytokines, among them interleukin‐7 (IL‐7). The aim of the study was to evaluate serum IL‐7 levels in children with the symptoms of NS and to determine a correlation between its concentration and platelet count, other hemostatic factors, and NS intensity.

Methods
: The study was performed in two groups. I – the examined group of 26 children with NS (12 boys, 14 girls) aged 6.8 ± 2.1 years, subjected to two examinations: A – before treatment, B – during treatment with prednisone (60 mg/kg 24 h after albuminuria regression); and II – the control group (C) of 20 healthy children. Serum IL‐7 level was assayed by enzyme‐linked immunosorbent assay method using a R & D Quantikine set.

Results
: In group I, IL‐7 level in examination A (33.33 ± 33.24 pg/mL) was higher than in the control subjects (P < 0.01). In examination B, IL‐7 concentration was reduced to the level of 10.86 ± 5.22 pg/mL and did not differ from the controls (P > 0.05). A positive correlation was observed between IL‐7 and platelet count and serum fibrinogen level. A negative correlation was noted with antithrombin III concentration. No correlation was found with serum levels of albumin and cholesterol or urine protein.

Conclusion
: In children with NS, serum IL‐7 level increases proportionally to the elevated platelet count and other hemostatic components, but shows no correlation with serum albumin or urine protein.
Serum malondialdehyde level in children infected with Vampirolepis nana
Authors: Yazar Süleyman , Kilic Eser , Saraymen Recep , Ozbilge Hatice
Published: July 2005

Background
: Vampirolepis nana is the only human tapeworm in which the intermediate host is not necessary and transmission is from person to person. In this study the changes of serum malondialdehyde level, that is, the oxidative stress hypothesis in patients infected with V. nana, was investigated.

Methods
: Serum malondialdehyde concentration activity was measured in 32 patients who were positive for intestinal parasite of V. nana. Levels were obtained for the positively infected patients and their age and gender were matched to 32 healthy controls.

Results
: The difference between malondialdehyde levels of patients infected with V. nana and the control group was statistically significant both for females (P < 0.05) and males (P < 0.05). In the patient and control groups, no correlation was found between age and malondialdehyde levels both in females and males. In addition, no significant correlation could be found between malondialdehyde levels of both females and males for the patient and control groups.

Conclusion
: Malondialdehyde levels were clearly increased in the patients infected with V. nana.
Selecting therapy for maintaining sexual function in patients with benign prostatic hyperplasia
Authors: Nehra Ajay
Published: July 2005

In the first of these mini–reviews the selection of therapy for the maintenance of sexual function in patients with BPH is outlined, along with an explanation of how altered regulation of neurotransmitters, especially noradrenaline, may underlie the syndrome of LUTS and sexual dysfunction.

Other mini‐reviews outline the current status of robotic surgery to treat renal and adrenal disorders, and its future applications, and the potential use of the nitric oxide/cGMP pathway as a potential target to treat BOO associated with benign prostatic enlargement.

Finally, the capacity to be creative in academic departments is extolled as a core property of academicians, and its surfacing described as having the potential to revitalize individuals and departments.
Phosphodiesterase type 5 inhibitors for erectile dysfunction
Authors: Carson Culley C. , Lue Tom F.
Published: July 2005

This is our first presentation of Great Drug Classes, and we start with a description of phosphodiesterase type 5 inhibitors and their use in erectile dysfunction. This is an in‐depth review of this class of drugs, offering the reader a description of how they work, in which conditions they may be particularly beneficial, and a comparison of the three different drugs. It is of necessity longer than the usual manuscript accepted for the BJU International, with a full list of references.

The cyclic nucleotide signalling pathway mediates the smooth‐muscle relaxing effects of nitric oxide necessary for normal erectile function. Down‐regulation of this pathway is central to the pathophysiology of many forms of erectile dysfunction (ED), which is often associated with other chronic diseases (e.g. hypertension, type 2 diabetes mellitus) and treatments (e.g. certain drugs, radical prostatectomy). Conversely, selective inhibition of the enzyme that catalyses the degradation of cGMP (phosphodiesterase type 5, PDE‐5) promotes erectile responses to sexual stimulation. The successful launch and commercialization of the selective PDE5 inhibitor (PDE5I) sildenafil transformed the treatment of ED, not only by providing an effective, well tolerated oral ED therapy, but also by fostering greater candour about the problem among men. Sildenafil is highly effective in promoting erectile responses across a wide spectrum of severity and causes of ED, including patients with ED that is often refractory to treatment. The recent advent of vardenafil, which has the highest in vitro potency of all available PDE5Is, and tadalafil, which has a prolonged half‐life that may enable couples to have sexual activity with less planning, represent further advances. Other PDE5Is offering further potential improvements are under active investigation.
Carbonic anhydrase IX and the future of molecular markers in renal cell carcinoma
Authors: Leppert John T. , Lam John S. , Pantuck Allan J. , Figlin Robert A. , Belldegrun Arie S.
Published: July 2005

The use of carbonic anhydrase IX as a promising molecular marker in RCC is described by authors from Los Angeles, who discuss the promise that molecular markers hold to improve diagnosis, staging, treatment, surveillance and survival of patients with RCC.

There is a whole range of new treatments being introduced in the management of metastatic renal cancer. The use of VEGF–targeted therapy has particular importance, especially as it has a strong genetically linked rationale for its potential success in this area. Authors from the USA show that substantial clinical activity has been reported in initial clinical trials.

In prostate cancer, drugs targeting microtubules, such as taxanes, have already been introduced clinically, and their success has received widespread attention. A new group of drugs, the epothilones, have similar but not identical binding properties to microtubules, and authors from the USA describe how they have shown activity in hormone‐refractory prostate cancer, and are moving to phase III testing.
Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: a study and review
Authors: Lawrentschuk Nathan , Gani Johan , Riordan Richard , Esler Steven , Bolton Damien M.
Published: July 2005

OBJECTIVE

To compare the findings of multidetector computed tomography (CT) with surgical pathology and magnetic resonance imaging (MRI), to determine the accuracy of delineating the superior extent of inferior vena cava (IVC) thrombotic involvement in renal cell cancer (RCC).

PATIENTS AND METHODS

A prospective database was examined of 11 patients (median age 65 years, range 45–77) being assessed for suspected IVC extension of RCC tumour thrombus with both multidetector CT and MRI. All had pathology confirming RCC, and eight of those undergoing surgery had pathological confirmation of tumour thrombus extent. All images were analysed originally, then re‐analysed by two independent radiologists, an experienced urologist and a urological trainee unaware of the original reports and other imaging results, with a final determination on tumour thrombus level by consensus.

RESULTS

The multidetector CT results were completely accurate when compared with surgical specimens and were in agreement with MRI on all but one occasion, where MRI determined the renal vein to be clear when it was involved on CT and at surgery, giving MRI an accuracy of seven of eight samples.

CONCLUSIONS

Whilst there were few patients and further studies are needed, multidetector CT was comparable with MRI in determining tumour thrombus level. More importantly, in the eight patients with surgical pathological confirmation, multidetector CT was accurate in all. Ultimately, it may replace MRI as the ‘gold standard’ for imaging to delineate the upper limit of tumour thrombosis in RCC.
Tumour markers for managing men who present with metastatic prostate cancer and serum prostate‐specific antigen levels of <10 ng/mL
Authors: Birtle Alison J. , Freeman Alex , Masters John R.W. , Payne Heather A. , Harland Stephen J. ,   contributors to the BAUS Section of Oncology Cancer Registry
Published: July 2005

OBJECTIVE

To define immunohistochemical features of the primary cancers that might help in the differential diagnosis and monitoring of treatment in men presenting with metastatic prostate cancer and low serum levels of prostate‐specific antigen (PSA), who can be difficult to diagnose and manage.

PATIENTS AND METHODS

Paraffin blocks of prostate biopsies were obtained for 33 patients presenting with untreated metastatic prostate cancer and serum PSA levels of <10 ng/mL. Sections were immunostained for PSA, prostatic acid phosphatase (PAP), prostate‐specific membrane antigen (PSMA), androgen receptor (AR), chromogranin A and CD 56.

RESULTS

The combined Gleason scores were 8–10 in 25 men (76%) and 6 or 7 in the other eight (24%). Morphologically, there were no neuroendocrine features. PSA immunostaining was equivocal in 12 (36%) cases and in a further 19 (58%) was strong but focal and could be missed on biopsy sampling. PSMA was expressed in 90% of cases, and staining was widely distributed in nine of the 12 in which PSA staining was equivocal. There was strong AR expression in 30 (91%) cases and it was present in areas where PSA was absent.

CONCLUSION

In this patient group, immunohistochemical assessments of PSMA and AR are potentially useful as diagnostic markers.
Age‐specific reference levels of serum prostate‐specific antigen and prostate volume in healthy Arab men
Authors: Kehinde Elijah O. , Mojiminiyi Olusegun A. , Sheikh Mehraj , Al‐Awadi Kaleel A. , Daar Abdallah S. , Al‐Hunayan Adel , Anim Jehoram T. , Al‐Sumait Aisha A.
Published: July 2005

OBJECTIVE

To determine age‐specific reference ranges for serum prostate‐specific antigen (PSA) concentration and prostate volumes in a population of healthy Arab men.

SUBJECTS AND METHODS

Blood samples were taken from 396 healthy Arab men (from Kuwait and Oman) aged 15–79 years and from across the social spectrum. Men aged >40 years had a digital rectal examination and transrectal ultrasonography of the prostate to determine prostate volume. The serum PSA level was measured using commercial kits, and age‐specific ranges for PSA levels and prostate volume determined.

RESULTS

The serum PSA ranges (ng/mL) for each age range in Arab men were: 40–49 years, 0–0.9; 60–69, 0–2.7; 70–79, 0–5.5 ng/mL; the respective prostate volumes were 8–22, 9–30 and 10–33 mL. The serum PSA level and prostate volume correlated with age (P < 0.001). Arab men had lower serum PSA levels and prostate volumes than those reported for Caucasians, but similar to those reported for Asians (Japanese and Chinese).

CONCLUSION

These results indicate that Arab men have lower PSA levels and prostate volumes than Caucasians. The levels are slightly lower than those reported in the Japanese and, as in the Japanese, low PSA levels and small prostate volumes might be related to the low incidence of clinical prostate cancer in Arab men.
Analysis of peripheral blood for prostate cells after autologous transfusion given during radical prostatectomy
Authors: Stoffel John T. , Topjian Linda , Libertino John A.
Published: July 2005

OBJECTIVES

To determine if cells expressing prostate‐specific antigen (PSA) can be detected in blood collected by a cell‐saver during radical prostatectomy (RP) or in the peripheral blood after intraoperative autotransfusion (IAT).

PATIENTS AND METHODS

In all, 112 men with clinical T1c–T2 prostate cancer undergoing RP were prospectively assessed. A cell‐saver system was used in each to collect blood from the surgical field after prostate manipulation. IAT was given based on clinical indications. Standardized peripheral blood samples were collected from patients before RP, in the recovery room afterward, and at 3–5 weeks after surgery. A reverse‐transcriptase‐polymerase chain reaction assay for PSA mRNA was used to detect prostate cells in cell‐saver and peripheral blood samples. Patients were followed after surgery with PSA measurements to assess biochemical failure.

RESULTS

PSA‐expressing cells were detected in 88% of cell‐saver reservoir and 13% of preoperative blood samples. No PSA‐expressing prostate cells were detected in any peripheral blood samples collected 3–5 weeks after surgery. Analysis of data with 40 months of follow‐up showed IAT was not an independent predictor of biochemical failure in multivariate analysis.

CONCLUSIONS

Although IAT blood contains PSA‐expressing cells, none could be detected 3–5 weeks after surgery. IAT during RP was not associated with a greater risk of biochemical failure.
New perioperative management reduces bleeding in radical retropubic prostatectomy
Authors: Schostak Martin , Matischak Klaudia , Müller Markus , Schäfer Michel , Schrader Mark , Christoph Frank , Miller Kurt
Published: July 2005

OBJECTIVE

To describe the effect of modifications to radical retropubic prostatectomy (RRP, known to be associated with severe bleeding) on blood loss in a retrospective analysis comparing RRPs by one experienced surgeon before and after the changes.

PATIENTS AND METHODS

The new method comprised reducing the intravenously applied volume, using a peridural catheter and maintaining a 25–30° Trendelenburg position. The difference in haemoglobin before and after RRP was analysed before the changes (group 1) and after (group 2). If transfusions were required the haemoglobin value was corrected, whereby 1 mL of erythrocyte concentrate increased the patient's haemoglobin by 0.03 g/L.

RESULTS

Assessment was possible in 201 of 234 patients, 110 from group 1 and 91 from group 2. The mean transfusion‐corrected difference in haemoglobin was 53 g/L in group 1 (20% transfusion rate) and 35.2 g/L in group 2 (1.09% transfusion rate; P > 0.001). The median intravenous volume applied was 5.96 L in group 1 and 3.49 L in group 2 (P < 0.001). The complication rate did not differ between the groups.

CONCLUSION

This new method minimizes the intraoperative blood loss during RRP; transfusions are only necessary in rare cases and the complication rate remained unaltered.
Do all patients with high‐grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?
Authors: Izawa Jonathan I. , Lega Iliana , Downey Donal , Chin Joseph L. , Luke Patrick P.
Published: July 2005

OBJECTIVE

To assess the clinical outcome of patients with a diagnosis of high‐grade prostatic intraepithelial neoplasia (PIN) on initial prostatic biopsy, with a minimum of 5 years of follow‐up, as such patients are at greater risk of having prostate cancer on subsequent biopsy.

PATIENTS AND METHODS

Between November 1992 and October 1998, 21 patients were identified as having PIN on their initial transrectal ultrasonography‐guided prostate biopsy. None of these patients had a focus of cancer on the initial biopsy. Their medical data were reviewed retrospectively to determine the natural history of PIN in these patients. Patients who were not identified as having cancer were followed every 6–12 months with prostate‐specific antigen (PSA) testing and digital rectal examinations (DRE).

RESULTS

A mean (range) of 7 (2–8) cores were taken at initial biopsy; the mean age of the patients was 63 (53–77) years and mean PSA level 9.1 (4.9–17.6) ng/mL. Six patients had an abnormal DRE at presentation. A mean of 8 (7–10) cores were obtained on the second biopsy; six patients were diagnosed with cancer, with a mean Gleason score of 6 (5–7), while three were diagnosed with persistent PIN. These three patients had a third prostate biopsy which showed cancer of Gleason score 6 in one and benign prostatic hyperplasia in two. After a mean follow‐up of 72.2  (60–84) months, none of the remaining 12 patients was diagnosed with clinically significant cancer. Five of these patients went on to a third prostate biopsy, with no evidence of cancer. One patient died from unrelated causes during this period.

CONCLUSION

This study affirms our current practice of following patients with PIN conservatively if a second or third subsequent prostate biopsy is negative. Whether PIN is a premalignant lesion or merely a lesion associated with cancer needs to be addressed in multicentre studies with a follow‐up of > 10 years.
Increasing the number of biopsy cores improves the concordance of biopsy Gleason score to prostatectomy Gleason score
Authors: Coogan Christopher L. , Latchamsetty Kalyan C. , Greenfield Jason , Corman John M. , Lynch Barlow , Porter Christopher R.
Published: July 2005

OBJECTIVE

To evaluate taking more biopsy cores for predicting the radical prostatectomy (RP) Gleason score compared with the biopsy Gleason score, as although random sextant biopsies are the standard for a tissue diagnosis of prostate cancer, and taking more biopsies increases the detection rate, it is uncertain whether taking more cores improves the prediction of the RP Gleason score.

PATIENTS AND METHODS

We analysed retrospectively 404 patients from three centres (Seattle 162, Washington 107 and Chicago 135) who had RP for prostate cancer. Six, eight or 10 biopsies were taken based on the physician's preference and the patient's characteristics.

RESULTS

Before RP, 158 (39%) patients had six, 65 (16%) had eight and 181 (45%) had 10 biopsy cores taken. The accuracy of the Gleason sum of the three groups was 65/158 (41%), 26/65 (40%) and 104/181 (57.5%), respectively (P < 0.004, 10‐core vs six‐core). However, when comparing the Gleason score separately (i.e. 4 + 3 is not equal to 3 + 4), the accuracy of the three groups was 48/158 (30%), 20/65 (31%), and 95/181 (52.5%), respectively (P < 0.001, 10‐core vs six core).

CONCLUSIONS

Taking more biopsy cores improves the accuracy of the biopsy Gleason score in predicting the final Gleason score at RP; the predictive accuracy of the final Gleason score may be increased from 41% to 58% by increasing the number of biopsies from six to 10.
Serum thyroid‐stimulating hormone is elevated in men with Gleason 8 prostate cancer
Authors: Lehrer Steven , Diamond Edward J. , Stone Nelson N. , Stock Richard G.
Published: July 2005

OBJECTIVE

To measure the levels of serum thyroid‐ stimulating hormone (TSH) in men with prostate cancer, as those with a Gleason score of ≥ 8 are at high risk of skeletal metastases (and should be considered for bone scintigraphy at diagnosis), and because the structural integrity of the skeleton depends on constant remodelling controlled by many local and systemic factors, including TSH, an important regulator of this process.

PATIENTS AND METHODS

We evaluated 51 men referred for treatment of localized prostate cancer and 10 with biopsy‐confirmed benign prostatic hypertrophy. Serum TSH was determined with a chemoluminescent immunoassay and a commercially available instrument (Immulite, Diagnostic Products Corporation, Los Angeles).

RESULTS

There was significant variation in TSH levels with Gleason score (P = 0.004); men with Gleason 8 tumours had the highest serum TSH levels. Because serum TSH levels increase with age, we used a multivariate analysis of variance with both age and Gleason score as covariates. The effect of Gleason score on TSH level was significant (P = 0.036) and independent of the effect of age (P = 0.392).

CONCLUSION

We propose that the high serum TSH levels in men with Gleason 8 prostate cancer is a result of the elaboration of TSH by cancer cells. Bone mineral density in the face of normal levels of thyroid hormone depends on an intact response to TSH, which ordinarily suppresses both osteoblast and osteoclast differentiation, thereby exerting control over bone remodelling. However, with abnormally high TSH levels this process may become deranged, promoting the development of bone metastases. If TSH production by prostate cancer cells could be suppressed, the incidence of bone metastases might be reduced.
Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach
Authors: Antunes Alberto Azoubel , Dall’oglio Marcos , Crippa Alexandre , Srougi Miguel
Published: July 2005

OBJECTIVE

To report the results of the simultaneous inguinal hernia repair during radical retropubic prostatectomy (RRP) with the preperitoneal tension‐free Stoppa technique, using a polypropylene mesh.

PATIENTS AND METHODS

During 855 consecutive RRPs, 40 (5%) patients (median age 66.9 years, range 52–81) with 49 inguinal hernias had a simultaneous inguinal hernioplasty. The RRP was performed according to the Walsh modified technique. After the prostate and seminal vesicles were removed and the urethrovesical anastomosis completed, a polypropylene mesh of maximum size 15 × 7.5 cm and a small slit on its medial side was then created and placed in the preperitoneal space, embracing the spermatic cord and covering the myopectinal orifice. Preoperative risk factors, e.g. constipation, pulmonary disease or urinary obstructive symptoms, were collected retrospectively from the files. Complications after surgery, including wound infection, pelvic collections, urinary fistula and recurrence of the hernia, were assessed.

RESULTS

Preoperative risk factors for hernia development were identified in 23 (58%) patients; three had recurrent hernias. With a median 23.1 months of follow‐up period two (4%) hernias recurred. There were no complications after surgery.

CONCLUSION

Preperitoneal hernia repair with polypropylene mesh is safe, effective and practical. The procedure simultaneous with RRP gave a 96% success rate and with no significant increase in operating time or additional complications.
An office‐based immunodiagnostic assay for detecting urinary nuclear matrix protein 52 in patients with bladder cancer
Authors: Attallah Abdelfattah M. , Sakr Hanem A. , Ismail Hisham , Abdel‐Hady El‐Sayed K. , El‐Dosoky Ibrahim
Published: July 2005

OBJECTIVE

To report the rapid (5 min) and simple detection of a nuclear matrix protein (NMP) in the urine of patients with bladder cancer, using a newly developed office‐based dot‐enzyme‐linked immunosorbent assay (ELISA).

PATIENTS AND METHODS

Western blot and specific immunoglobulin‐G antibody were used to identify the urinary NMP marker. Urine samples from 149 patients with bladder cancer and 72 controls were evaluated using the developed dot‐ELISA. The initial responses of 43 patients treated by irradiation were followed using the assay.

RESULTS

The NMP marker was identified in the urine of patients with bladder cancer at 52 kDa (NMP‐52) by Western blot. The dot‐ELISA detected the urinary NMP‐52 marker in 92% of patients with squamous cell carcinoma, 98% with transitional cell carcinoma, and all six of those with adenocarcinoma of the bladder, with a specificity of 94%. The positive and negative predictive values (97% and 94%, respectively) and efficiency (96%) of the dot‐ELISA were high. In addition, the NMP‐52 tumour marker was not detected in the urine of patients who showed a response after radiotherapy.

CONCLUSION

Detecting the urinary NMP‐52 marker using dot‐ELISA would be helpful in the rapid diagnosis and follow‐up of patients with bladder cancer.
Detrusor myectomy: long‐term results with a minimum follow‐up of 2 years
Authors: Kumar Sunil P.V. , Abrams Paul H.
Published: July 2005

Detrusor myectomy was introduced as an alternative to enterocystoplasty for refractory detrusor overactivity. The early results of this procedure were described by the authors from Bristol as encouraging, and they now present their long‐term follow‐up with a median of 79 months. They found that the results were sustained in a significant group of these patients.

The value of frequency‐volume urinary diaries is undoubted in patients of either sex who have LUTS, particularly in those with symptoms suggestive of overactive bladder. Authors from Chicago compare such diaries between asymptomatic controls and women with symptoms of overactive bladder. A whole range of diary variables was compared, and the interesting findings used as a potential method to define important outcome goals in therapeutic trials.

OBJECTIVES

To assess the long‐term results of detrusor myectomy, which has obvious theoretical advantages over enterocystoplasty for refractory detrusor overactivity (DO), and for which the early results have been encouraging.

PATIENTS AND METHODS

The medical records were reviewed of 30 consecutive patients (median age 33 years, range 10–62) who had a detrusor myectomy between November 1992 and April 2002 in our unit. Twenty‐four patients (80%) had idiopathic DO (six males and 18 females) and six (20%) had neurogenic DO (four males and two females). The median (range) follow‐up was 79 (28–142) months. All patients were confirmed to have DO on urodynamics before surgery and 26 (87%) had urodynamics afterward.

RESULTS

Nineteen (79%) of those with idiopathic DO and two with neurogenic DO showed a continued overall improvement. The cystometric capacity improved in 80% of patients after surgery, whilst the detrusor pressure at maximum flow and the bladder contractility index decreased in 60% and 78% of the patients, respectively. Ten patients (45%) had to start clean intermittent self‐catheterization after surgery.

CONCLUSIONS

Detrusor myectomy is successful in ≈ 80% of patients with idiopathic DO, although detrusor contractility is affected in most and almost half of the patients required clean intermittent self‐catheterization afterward. This procedure should be offered as an alternative to enterocystoplasty as it is less morbid and does not preclude subsequent surgery if required. However, further evaluation of this technique is required in neuropathic patients.
Are conventional pressure‐flow measurements dependent upon filled volume?
Authors: Sahadevan Kanagasabai , Leonard Ann S. , Pickard Robert S.
Published: July 2005

OBJECTIVE

To determine, in a prospective study, whether detrusor pressure (pdet.Qmax) and maximum urinary flow rate (Qmax) measurements obtained after filling to maximum cystometric capacity (MCC) differ from those obtained with filling restricted to average voided volume (Vvoid), as standard protocols for pressure flow studies (PFS) mandate bladder filling until the subject has a strong desire to void, which aids standardization but further divorces the test from real‐life experience.

PATIENTS AND METHODS

After calculating the appropriate sample size, 84 patients attending for PFS with an adequately completed 3‐day frequency‐volume chart were recruited. Each underwent two consecutive PFS with filling to MCC and average Vvoid in a random order, and measurements of pdet.Qmax and Qmax were compared. For men, the agreement for a diagnosis of obstruction between the tests was also assessed.

RESULTS

Complete data were obtained from 76 (90%) of the patients, with a mean (range) age of 64 (20–94) years. The mean (sd) difference between MCC and average Vvoid was 134 (113) mL (P < 0.01). There were no significant differences between estimates of Qmax, at − 0.1 (3) mL/s (P = 0.75), and of pdet.Qmax, at − 1 (13) cmH2O (P = 0.91), obtained within each patient. For men there was 91% agreement (32 of 35) in the classification of obstruction.

CONCLUSIONS

Restriction of filling to the average Vvoid during PFS allows a closer approximation to normal voiding and results in no clinically relevant change to the value of standard pressure‐flow measurements or alters individual classification of obstruction.
Validation of a patient‐administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire
Authors: Clayson Darren , Wild Diane , Doll Helen , Keating Karen , Gondek Kathleen
Published: July 2005

OBJECTIVE

To develop and validate a self‐administered questionnaire to assess the ‘severity’ and ‘bothersomeness’ of the most frequently reported signs and symptoms of uncomplicated urinary tract infection (uUTI).

SUBJECTS AND METHODS

The UTI Symptoms Assessment questionnaire (UTISA) is a 14‐item instrument asking about the severity and bothersomeness of seven key uUTI symptoms. It was developed after comprehensive literature and data review and administration in draft form to a sample of 30 women with uUTI. The final questionnaire was completed by 276 women with uUTI who participated in a noncomparative clinical trial of ciprofloxacin. The women completed the questionnaire in electronic format at baseline (before the first dose of ciprofloxacin once‐daily), at 3‐h and 8‐h intervals until all UTI symptoms were resolved, and at the test‐of‐cure visit. Baseline scores on the King's Health Questionnaire (KHQ) were used to assess convergent and divergent validity; responses to the Global Rating of Change (GRC) were used to assess both responsiveness and the ‘minimally important difference’. Discriminant validity and responsiveness were assessed by comparing UTISA scores with a clinical evaluation of UTI symptoms performed by the investigator at baseline and at the test‐of‐cure visit.

RESULTS

The UTISA was found to comprise three four‐item domains named ‘urination regularity’, ‘problems with urination’, and ‘pain associated with UTI’. Two questions asking about haematuria loaded on a fourth factor. The three domains were homogeneous (with high inter‐item correlations) and internally consistent. Convergent validity was shown by high correlations between similar UTISA and KHQ domains (all rs > 0.40), and divergent validity by small correlations between unlike domains (all rs < 0.15). In general, the UTISA domains showed excellent discriminant validity, with scores on selected domains discriminating between women with different clinical evaluations. The responsiveness of the UTISA was also excellent, with high correlations between changes in domain scores and the clinical evaluation and GRC items. Symptom improvement was highest in the first 3 h, leading to greater responsiveness and minimally important difference during this period. However, the UTISA could detect even small subsequent changes.

CONCLUSION

The three‐domain UTISA has excellent psychometric properties and it is likely to prove an excellent tool for assessing uUTI outcome from a patient's perspective, both in research and clinical settings.
A novel midstream urine‐collection device reduces contamination rates in urine cultures amongst women
Authors: Jackson Simon R. , Dryden Mathew , Gillett Paul , Kearney Paddy , Weatherall Rosemary
Published: July 2005

OBJECTIVE

To evaluate a novel urine‐collection device (UCD) that automatically collects a midstream urine (MSU) sample, and compare contamination rates to those of the conventional MSU sampling method, as the contamination of urine samples for microbiological analysis in women leads to diagnostic ambiguity and unnecessary costs, and may result in part from an incorrect collection procedure.

PATIENTS AND METHODS

In all, 2823 women from four centres, most from antenatal clinics, were randomized to two urine‐collection methods: conventional MSU collection and collection with a novel MSU UCD (the Whiz®, JBOL Ltd, Oxford, UK). Semi‐quantitative growth and user acceptability were compared between the collection methods.

RESULTS

MSU samples collected with the UCD had significantly fewer mixed growth samples (9% vs 14%, P = 0.001; 36% relative reduction), significantly fewer heavy mixed growth samples (1.2% vs 3.0%, P = 0.004; 60% relative reduction) and required significantly fewer re‐tests (11% vs 16%, P = 0.002; 31% relative reduction). There were more samples with clinically insignificant growth than the conventional MSU group (86% vs 82%, P = 0.005). Those using the UCD preferred it to the conventional method (67.5%) and experienced significantly less spillage during sample collection (27% vs 46%, P = 0.001; relative reduction 41%).

CONCLUSION

The UCD reduced contamination rates in urine samples and improved the predictive value of the urine culture in a manner acceptable to patients and staff.
How do urinary diaries of women with an overactive bladder differ from those of asymptomatic controls?
Authors: Fitzgerald Mary P. , Ayuste Deborah , Brubaker Linda
Published: July 2005

OBJECTIVE

To quantify clinically important differences in common diary variables between asymptomatic controls and women with symptoms of overactive bladder (OAB), controlling for the effects of age and race.

PATIENTS, SUBJECTS AND METHODS

The 24‐h urinary diaries of 49 women with symptoms of OAB were compared to those of age‐ and race‐matched asymptomatic controls. Control subjects did not have a physical examination.

RESULTS

The 49 patients with OAB symptoms had a median (range) age of 51 (20–85) years, a body mass index of 25 (17–46) kg/m2 and a parity of 2 (0–5). The median number of voids was significantly greater in women with OAB than asymptomatic controls (P < 0.001). The median value for mean voided volume was significantly lower in women with OAB than asymptomatic controls (P = 0.014). There was no difference in the maximum voided volume, total voided volume, daytime or night‐time diuresis rates, voids per litre intake, or total fluid intake.

CONCLUSIONS

This preliminary study suggests that a median reduction of three voids/24 h and an increase of 70 mL in the mean voided volume might be clinically important goals in therapeutic trials for treating OAB symptoms. This remains to be confirmed by further studies linking improvements in quality of life and the overall impression of bladder health with these quantitative diary variable changes.
A comparison of the effect of 1.5% glycine and 5% glucose irrigants on plasma serum physiology and the incidence of transurethral resection syndrome during prostate resection
Authors: Collins Justin W. , MacDermott Seamus , Bradbrook Richard A. , Keeley Francis X. , Timoney Anthony G.
Published: July 2005

OBJECTIVE

To examine changes in the pathophysiology and frequency of the transurethral resection (TUR) syndrome with two irrigation fluids, as variable amounts of irrigation fluid are absorbed during TUR of the prostate (TURP), and although polar solutes are required to prevent an effect on diathermy, the solutes may have effects when absorbed.

PATIENTS AND METHODS

Between December 2001 and March 2003, 250 patients were included in a prospective randomized trial comparing glycine 1.5% with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, temperature change, biochemistry including a glycine assay, and peri‐operative symptoms. Blood samples were taken immediately before and immediately, 5 and 24 h after TURP. Irrigating fluid absorption during TURP was measured with 1% ethanol as a marker and breath ethanol measurements. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri‐operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of ≤ 125 mmol/L with two or more associated symptoms or signs of TUR syndrome.

RESULTS

Five (2%) patients had TUR syndrome; all five were irrigated with glycine, although this difference was not statistically significant (P = 0.06). Of the five men, three had hypotension, four were tired, one was nauseous, two had parasthesia, two had ‘uneasiness’, one had blurred vision and two were confused; none had chest pain. There was a large variation between the groups in the level of glycine assayed immediately after TURP; a high glycine level was associated with the TUR syndrome (P = 0.01). There was no difference between the groups in levels of sodium, potassium, urea, creatinine, osmolality, calcium, haematocrit, albumin serum levels or peri‐operative blood loss (defined as a change from before to after TURP in haemoglobin level, accounting for transfusions).

CONCLUSIONS

An increase in serum glycine was associated with TUR syndrome; there were large variations in the amounts of glycine absorbed, reaching levels many times the upper limit of normal. In other studies, glycine was reportedly toxic, and that the levels recorded were many times the upper limit of normal may have both immediate and long‐term effects.
The management of penile fracture based on clinical and magnetic resonance imaging findings
Authors: Abolyosr Ahmad , Moneim Alaa E. Abdel , Abdelatif Atef M. , Abdalla Medhat A. , Imam Hisham M.K.
Published: July 2005

Associate Editor Michael G. Wyllie

Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands

OBJECTIVE

To present our experience with repairing penile fracture, based on clinical and magnetic resonance imaging (MRI) findings.

PATIENTS AND METHODS

Between December 2002 and October 2004, 14 men (19–64 years old) presented to our centre with a penile fracture. Two patients had urethral bleeding. MRI was used before surgery in all patients, and the repair comprised a localized longitudinal penile incision in 13 men. This incision was designed according to the tunical tear site and size already depicted by MRI. One case was managed conservatively, as MRI confirmed an intercavernosal haematoma with no tunical tear. The follow‐up was 4–21 months.

RESULTS

The tear involved one corpus cavernosum in 11 patients; two were associated with urethral injury. The course after repair was uneventful in all men; the follow‐up showed no erectile dysfunction in any. The patients reported neither pain nor penile curvature during erection.

CONCLUSION

MRI is a simple and informative investigation for evaluating and documenting a penile fracture, and it improves the management plan.
Outcome from percutaneous nephrolithotomy in patients with spinal cord injury, using a single‐stage dilator for access
Authors: Lawrentschuk Nathan , Pan David , Grills Richard , Rogerson John , Angus David , Webb David R. , Bolton Damien M.
Published: July 2005

The use of percutaneous nephrolithotomy to treat renal calculi in patients with spinal cord injury is described by authors from Melbourne. This is the first contemporary series reported for over 13 years, and the authors describe various unique features about their series and compare their results to previously reported studies.

Authors from London describe the largest single series of renal transplant patients in adults and children with urolithiasis, study risk factors associated with this condition in renal transplant recipients, and report on their multimodal management by endourological and open procedures.

OBJECTIVE

To present our experience of percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with spinal cord injury (SCI) using a single‐stage dilator for percutaneous access.

PATIENTS AND METHODS

A prospective database of patients with SCI having PCNL using the single‐stage dilator was assessed, analysing patient data, stone‐free rates, morbidity and the follow‐up outcome.

RESULTS

In all, 26 patients had 54 PCNLs on 32 kidneys; 20 had unilateral and six bilateral stone disease; there were many staghorn calculi (24/54). Major complications occurred in three of 54 PCNLs (6%). The complete stone‐clearance rate was 87% for PCNL alone, rising to 29 of 32 kidneys (91%) or 24 of 26 patients (92%) with adjuvant procedures. A further three kidneys required no further treatment and were monitored, having residual fragments of ≤ 2 mm.

CONCLUSIONS

PCNL has a high success rate and acceptable complication rate compared to extracorporeal shock‐wave lithotripsy, and remains a valid first‐line treatment option for kidney stones in patients with SCI.
Multimodal management of urolithiasis in renal transplantation
Authors: Challacombe Ben , Dasgupta Prokar , Tiptaft Richard , Glass Jonathan , Koffman Geoff , Goldsmith David , Khan Mohammed S.
Published: July 2005

OBJECTIVE

To report the largest single series of renal transplant patients (adults and children) with urolithiasis, assess the risk factors associated with urolithiasis in renal transplant recipients, and report the outcome of the multimodal management by endourological and open procedures.

PATIENTS AND METHODS

The records of all patients undergoing renal transplantation between 1977 and 2003 were reviewed. In all, 2085 patients had a renal transplant at our centre and 21 (17 adults and four children) developed urinary tract calculi. Their mode of presentation, investigations, treatments, complications and outcomes were recorded. Investigations included one or more of the following; ultrasonography (US), plain abdominal X‐ray, intravenous urography, nephrostogram and computed tomography. Management of these calculi involved extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy and in situ lithotripsy, percutaneous nephrolithotomy (PCNL), open pyelolithotomy and open cystolitholapaxy.

RESULTS

Thirteen patients had renal calculi, seven had ureteric calculi and one had bladder calculi. The incidence of urolithiasis was 21/2085 (1.01%) in the series. Urolithiasis was incidentally discovered on routine US in six patients, six presented with oliguria or anuria, including one with acute renal failure, four with a painful graft, three with haematuria, one with sepsis secondary to obstruction and infection and in one, urolithiasis was found after failure to remove a stent. Ten patients (63%) had an identifiable metabolic cause for urolithiasis, two by obstruction, two stent‐related, one secondary to infection and in six no cause was identifiable. Thirteen required more than one treatment method; 13 (69%) were treated by ESWL, eight of whom required multiple sessions; eight required ureteric stent insertion before a second procedure and four required a nephrostomy tube to relieve obstruction. Two patients had flexible ureteroscopy and stone extraction, three had a PCNL and one had open cystolithotomy. PCNL failed in one patient who subsequently had successful open pyelolithotomy. All patients were rendered stone‐free when different treatments were combined.

CONCLUSIONS

The incidence of urolithiasis in renal transplant patients is low. There is a high incidence of metabolic causes and therefore renal transplant patients with urolithiasis should undergo comprehensive metabolic screening. Management of these patients requires a multidisciplinary approach by renal physicians, transplant surgeons and urologists.