bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure of pre‐natal ultrasonography to prevent urinary infection associated with underlying urological abnormalities
Authors: Lakhoo K. , Thomas D.F.M. , Fuenfer M. , D'Cruz A.J.
Published: November 2003

Objectives To analyse the reasons underlying the failure of routine pre‐natal ultrasonography to prevent the subsequent development of urinary tract infection (UTI) in children with predisposing urological abnormalities.

Patients and methods This retrospective study comprised 39 children (22 females and 17 males) who had at least one documented UTI, the presence of an anatomical anomaly of the urinary tract recognized as predisposing to UTI and had undergone ultrasonography of the urinary tract undertaken in fetal life as part of routine maternal ante‐natal ultrasonography. Four categories of patients were defined: Group A, those with normal findings on pre‐natal ultrasonography and no urological abnormality detected; Group B, those with a urological abnormality detected but where there was a subsequent failure of communication among clinicians; Group C, those with a urological abnormality but who received inappropriate or sub‐optimal post‐natal management and; Group D, those with a urological abnormality but who had a UTI despite appropriate post‐natal management. In each case, the most severe documented episode of UTI was categorized as: Grade I, asymptomatic bacteriuria; Grade II, mild/moderate symptomatic UTI and; Grade III, severe symptomatic UTI necessitating hospital admission.

Results Group A comprised 22 (56%), Group B three (9%), Group C two (5%) and Group D 12 children (31%). Of the 22 children in Group A, nine experienced a UTI of sufficient severity to necessitate hospital admission. Of the 12 children in Group D only one required hospital admission.

Conclusions The failure of pre‐natal ultrasonography to identify the underlying predisposing urological abnormality was the most important factor contributing to subsequent UTI in post‐natal life. Failure of communication and inappropriate post‐natal management were numerically unimportant. In some children, UTI occurred despite pre‐natal detection of their underlying anomaly and appropriate post‐natal management. However, in this group the UTI was less severe than in those children whose urological anomalies had not been detected by pre‐natal ultrasonography.
Treatment of prostate cancer using external beam radiotherapy after laparoscopic pelvic lymph node dissection
Authors: Gerber G.S. , Bales G.T. , Gornik H.L. , Haraf D.J. , Chodak G.W. , Rukstalis D.B.
Published: November 2003

Objectives To evaluate the results of prostatic irradiation in men with clinically localized prostate cancer and no laparoscopic evidence of nodal metastases compared with a cohort of patients who received radiation therapy with no prior surgical staging.

Patients and methods Thirty‐one men with clinically localized prostate cancer and no evidence of pelvic nodal metastases after laparoscopic pelvic lymph node dissection received external beam radiation therapy to the prostate (65–70 Gy). The mean and median prostate specific antigen (PSA) levels in these men before treatment were 41.6 ng/mL and 28.0 ng/mL, respectively, and the mean Gleason sum was 6.1 (range 3–7). During the same interval, a group of 42 consecutive men with clinically localized prostate cancer were treated by external beam radiation therapy with no laparoscopic staging of the pelvic nodes. Treatment failure was defined by the development of bone metastases or a rising PSA level at least 6 months after the completion of radiotherapy.

Results Radiation therapy was generally well tolerated after laparoscopy and no patient required hospitalization or surgery for side‐effects related to the treatment. The median duration of follow‐up in the 31 men who underwent laparoscopy was 21.5 months. The probability of treatment failure in this group was 41.8% and 56.3% with 24 and 30 months follow‐up, respectively. When controlling for pre‐treatment PSA level, grade and stage, there was no significant difference in the treatment failure rate between the groups treated with and without laparoscopic staging.

Conclusions These results suggest that there is no difference in treatment outcome with laparoscopic pelvic lymphadenectomy before external beam radiation therapy in high‐risk patients who have significant pre‐treatment elevations of PSA level.
An assessment of the usefulness of serum prostate‐specific antigen level and cancer volume in biopsy specimens to predict the extent of prostate cancer
Authors: GOHJI K. , NOMI M. , KIZAKI T. , MORISUE K. , OKAMOTO M. , TAKENAKA A. , FUJII A.
Published: November 2003

Objective

 To evaluate the usefulness of the combination of serum prostate‐specific antigen (PSA) and cancer volume in biopsy specimens as markers to predict the extent of prostate cancer.

Patients and methods

Of patients presenting at our hospital with urinary symptoms suggesting prostatic disease, 311 (median age 70 years, range 42–88) with either nodules in the prostate detected by digital rectal examination or with elevated serum PSA levels (>2.0 ng/mL) underwent systematic biopsy; 69 had prostate cancer. The cancer volume in the biopsy specimens was examined pathologically by measuring the percentage of the biopsy core involved with cancer, the length of cancer tissue per biopsy core and the percentage of cancer in the biopsy specimen. The relationship of serum PSA level, cancer volume in the biopsy specimen and the extent of disease was examined.

Results

The volume of cancer in the biopsy specimens increased with increasing serum PSA concentration and the incidence of skeletal metastasis. The number of patients with extraprostatic disease or bony metastasis was significantly higher for these Japanese patients with a serum PSA of <10 ng/mL. All six patients with a positive bone scan and who had a serum PSA level of <10 ng/mL had a larger volume of cancer in their biopsy specimens. Among patients who underwent radical prostatectomy and pelvic lymphadenectomy, the incidence of extraprostatic disease increased with the value of each biopsy variable. Among patients with similar serum PSA levels, those showing higher values for the biopsy variables also showed extraprostatic disease. Among those with extraprostatic disease, seminal vesicles were involved by cancer in four of six patients with >40% positivity in the biopsy cores, >1.5 mm of cancer per biopsy core or >20% cancer in the biopsy specimens. Lymph node metastasis was found in four of five patients with serum PSA levels of >20 ng/mL and a large cancer volume in the biopsy specimen.

Conclusions

These results indicate that a combination of serum PSA level and cancer volume in the biopsy specimen could be useful markers for predicting the extent of prostate cancer.
The electrical properties and responses to nerve stimulation of the proximal urethra of the male rabbit
Authors: CREED K.E. , OIKE M. , ITO Y.
Published: November 2003

Objective

 To identify the nature of neurotransmitters acting on the smooth muscle cells of the proximal urethra and the electrical activity underlying the mechanical responses to nerve stimulation.

Materials and methods

The electrical activity of longitudinal strips of proximal urethra obtained from male rabbits was recorded with microelectrode and double sucrose‐gap techniques. Intramural nerves were stimulated with 200 μs pulses. Drugs which selectively affected neurotransmission were added to the perfusing fluid.

Results

The mean resting potential of smooth muscle cells was −39 mV and they had infrequent spontaneous action potentials. The frequency was increased by noradrenaline without depolarization; ATP produced depolarization with increased action‐potential frequency. Small (≤16 mV) spontaneous depolarizations and hyperpolarizations could be recorded from <50% of cells; large (≤40 mV) hyperpolarizations also occurred. Electrical field stimulation evoked excitatory and inhibitory junction potentials (EJPs and IJPs). Most EJPs reached a maximum within 500 ms, decayed with a time‐constant of 200–300 ms and were blocked by α,β‐methylene ATP. IJPs had a latency of >1 s and showed much variation in amplitude and duration. IJPs could still be recorded in the presence of N‐nitro‐L‐arginine methyl ester (L‐NAME). In the double sucrose‐gap, depolarization and associated contraction were reduced by α,β‐methylene ATP. Further reduction occurred with phentolamine and the remaining response was blocked by atropine. A large hyperpolarization could occur in response to a single stimulus but this decreased progressively with repeated stimulation. The hyperpolarization was partially blocked by L‐NAME.

Conclusions

The proximal urethra receives excitatory innervation involving three neurotransmitters, i.e. ATP, acetylcholine and noradrenaline, and inhibition is associated with hyperpolarization which results at least in part from action of non‐nitrergic nerves.
Urological complications in renal transplantation: impact of a change of technique
Authors: BUTTERWORTH P.C. , HORSBURGH T. , VEITCH P.S. , BELL P.R.F. , NICHOLSON M.L.
Published: November 2003

Objective

 To determine whether the change from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis in renal transplantation has altered the incidence of urological complications.

Patients and methods

 Data were retrieved from a prospective computerized database and by case‐note review on 248 consecutive renal transplants performed between January 1990 and June 1996. The characteristics of the donor, recipient and organ were noted, together with the technique used for the vesico‐ureteric anastomosis and the occurrence of major and minor urological complications.

Results

 The Leadbetter‐Politano technique was used in 140 transplants and the stented extravesical technique in 108. There were no significant differences in the donor, recipient or organ characteristics between the groups. The stented extravesical technique was associated with a significantly lower rate of major complications (<2%) and clinically significant haematuria than with the Leadbetter‐Politano technique.

Conclusion

 Changing from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis has been a major factor in reducing the incidence of urological complications in our transplant practice.
Patient tolerance of transrectal ultrasound‐guided biopsy of the prostate
Authors: IRANI J. , FOURNIER F. , BON D. , GREMMO E. , DORÉ B. , AUBERT J.
Published: November 2003

Objectives

 To determine the acceptability by patients of ultrasound‐guided prostatic biopsy without anaesthesia.

Patients and methods

 From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound‐guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post‐operative questionnaire including a 10 cm linear visual analogue scale (VAS).

Results

 The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of ≥5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia.

Conclusions

 Even when anaesthesia‐free, transrectal ultrasound‐guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out‐patient setting should be reassessed.
Clinical uroselectivity: evidence from patients treated with slow‐release alfuzosin for symptomatic benign prostatic obstruction
Authors: BUZELIN J.M. , DELAUCHE‐CAVALLIER M.C. , ROTH S. , GEFFRIAUD‐RICOUARD C. , SANTONI J.P.
Published: November 2003

Objective

 To assess the safety profile of slow‐release (SR) alfuzosin in the treatment of benign prostatic obstruction (BPO), with special attention to orthostatic blood pressure changes, postural symptoms and efficacy.

Patients and methods

Two placebo‐controlled studies involving 588 patients (292 receiving SR alfuzosin 5 mg twice daily and 296 a placebo) were pooled; 51% of the patients were ≥65 years of age and 43% had associated cardiovascular disease including hypertension and/or were receiving concomitant antihypertensive drugs.

Results

SR alfuzosin was very well tolerated with an overall incidence of adverse events similar to that of placebo (18.5% and 15.8% of patients, respectively) and an overall incidence of withdrawal from therapy for adverse events lower than that of placebo (3.4% and 5.7%, respectively). Adverse events potentially related to vasodilatation were infrequent with SR alfuzosin (the same incidence as with placebo, i.e. 2.7% of patients) and these adverse events occurred mainly during the first month of alfuzosin treatment. The effect on supine blood pressure was minimal. In the subgroups of elderly and hypertensive patients treated with SR alfuzosin, the cumulative incidence of asymptomatic orthostatic hypotension during the first month of treatment was slightly higher than with placebo with no objective consequences on the incidence of adverse events. The clinical efficacy of SR alfuzosin was confirmed by a significant improvement in urinary symptoms and a significant increase in maximum flow rates.

Conclusion

SR alfuzosin (10 mg/day) can be administered safely without titration in patients with BPO, even in elderly and hypertensive patients. Its favourable benefit/risk ratio allows alfuzosin to be classified as a clinically uroselective α1‐blocker. Specific analysis of orthostatic changes in blood pressure is important when assessing the safety profile of an α1‐blocker in patients with BPO.
Treatment‐seeking behaviour and stated preferences for prostatectomy in Spanish men with lower urinary tract symptoms
Authors: HUNTER D.J.W. , BERRA‐UNAMUNO A.
Published: November 2003

Objectives

 To determine whether men in the community with lower urinary tract symptoms sought treatment, would choose to have a prostatectomy, and the factors that might influence their decision.

Subjects and methods

 The study was a cross‐sectional population survey using interviewers in the autonomous community of Madrid and comprised 2002 men aged ≥50 years. The main outcome measures were self‐reported International Prostate Symptom Scores (IPSS), treatment‐seeking behaviour and the patients’ stated preference for prostatectomy.

Results

 The response rate among eligible subjects was 68.1%; overall, 38.2% of men sought medical advice for their lower urinary tract symptoms. Whether a man sought medical advice was related to symptom severity, ‘bothersomeness’, interference in daily activities and his perception of the future; of these, bothersomeness and interference in activities were more likely to determine whether or not a man consulted his doctor. Most men in the sample (84.9%) reported that they would choose a prostatectomy, although this value depended on whether they had had a previous prostatectomy, were younger, and on the content of the information presented. Men were more likely to report that they would accept surgery if their doctor recommended it and less likely when presented with information on the outcomes of treatment.

Conclusion

 Many Spanish men with lower urinary tract symptoms do not seek medical advice for their symptoms, although most stated that they would accept a prostatectomy on the recommendation of their doctor. Further research should examine whether reported patient preferences correspond to actual behaviour and what is the most appropriate type of information to give to potential patients.
Pressure‐flow studies in the diagnosis of bladder outlet obstruction: a study comparing suprapubic and transurethral techniques
Authors: WALKER R.M.H. , DI PASQUALE B. , HUBREGTSE M. , ST CLAIR CARTER S.
Published: November 2003

Objective

 To compare suprapubic and transurethral methods of measuring intravesical pressure in a group of men undergoing investigation for lower urinary tract symptoms (LUTS), to identify which urodynamic variables are affected by the presence of an urethral catheter during the voiding phase, and consequently whether there is any change in the grading of bladder outflow obstruction (BOO) using the commonly recognised grading systems.

Patients and methods

Thirty‐five men with LUTS underwent both suprapubic and transurethral pressure‐flow studies during a single session. Standard pressure flow variables were measured in all patients with both methods, enabling calculation of obstruction using the commonly used grading systems, i.e. the Abrams‐Griffith number, linear passive urethral resistance ratio (LPURR) and urethral resistance algorithm (URA).

Results

There were statistically significant differences between the methods in the mean values of maximum flow rate and the detrusor pressure at that maximum; 60% of men were in the same LPURR class with either method. Using the transurethral method, 26% of patients increased the LPURR class by one and 6% by two classes. Using the Abrams‐Griffiths nomogram, 17% moved from a classification of equivocal to obstructed and 3% from unobstructed to equivocal. Using the criterion of a value of URA >29, 57% were obstructed using the suprapubic and 74% using the transurethral method.

Conclusion

According to the method used, there were differences in the classification of obstruction between the suprapubic and transurethral routes; transurethral studies tended to indicate greater obstruction. The interpretation of urodynamic studies should take into account the technique used and where the route is transurethral, the smallest catheter available should be used.
The urodynamic evaluation of neuromodulation in patients with voiding dysfunction
Authors: EVERAERT K. , PLANCKE H. , LEFEVERE F. , OOSTERLINCK W.
Published: November 2003

Objectives

 To determine which patients with voiding dysfunction might be suitable for treatment with neuromodulation, using urodynamics to obtain an objective measure of improvement and to illustrate the effect of neuromodulation on voiding dysfunction.

Patients and methods

 Patients were selected for implantation of a neuroprosthesis using a urodynamic evaluation before and during subchronic stimulation; 27 such patients (four men and 23 women, mean age 33 years, sd 15) were evaluated.

Results

 Of the 27 patients, the 17 who responded well to neuromodulation all had hypocontractile detrusors and sphincter hypertonicity; sphincter relaxation during micturition was impaired. The urodynamic evaluation showed that these patients were not obstructed. Of 10 patients with spastic pelvic floor syndrome, nine responded well to the treatment. Those not responding to neuromodulation had mainly acontractile detrusors.

Conclusion

 The ideal candidates for neuromodulation are those patients with a spastic pelvic floor syndrome or with a hypocontractile detrusor, in combination with sphincter instability, and impaired sphincter relaxation. An increase of bladder contractility, enhancement of sphincter relaxation and decrease in bladder capacity and residual urine are the most important features of the response.
A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissues after simultaneous oral ingestion
Authors: PNG J.C.D. , TAN E. , FOO K.T. , LI M.K. , CHENG C. , REKHRAJ I.R.
Published: November 2003

Objectives

 To determine the levels of two quinolones, ofloxacin and ciprofloxacin, potent broad‐spectrum antibiotics with very good oral bioavailability and low minimum inhibitory concentrations (MICs) for most pathogens, in the prostates of patients who underwent transurethral resection of the prostate (TURP) after oral ingestion for surgical prophylaxis.

Patients and methods

 Twenty‐eight patients with BPH requiring a TURP ingested 250 mg of both drugs 2–4 h before operation. The levels of the drugs in the serum and prostate were measured using high‐performance liquid chromatography and the levels of both drugs determined at the 6 and 9 o’clock positions in the prostate to examine any local variations in drug concentration.

Results

 Ofloxacin concentrations were significantly higher in the serum and prostatic tissues compared with ciprofloxacin for the same dose, but its penetrance into the prostate was lower. This mainly reflected its higher oral bioavailability. Both drugs were present in concentrations 50% higher at the 6 o’clock than at the 9 o’clock position but both exceeded the MICs for most Gram‐negative organisms except Pseudomonas.

Conclusion

 Ofloxacin has the advantage against ciprofloxacin of exceeding the MICs for Staphylococcus and Chlamydia. However, ciprofloxacin has the advantage of having prostate‐to‐serum ratios of unity, but for the same dose the prostatic concentrations of ofloxacin is significantly higher.
Intracavernosal drug‐induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction
Authors: SODERDAHL D.W. , THRASHER J.B. , HANSBERRY K.L.
Published: November 2003

Objectives

 To determine if there is a significant difference between intracavernosal self‐injection and external vacuum devices when compared directly for satisfaction, effectiveness and side‐effects.

Patients and methods

Fifty men were randomized into two groups and received either instruction on the use of the Osbon ErecAid® system or self‐injection therapy. After 15 uses, each group completed a questionnaire detailing efficacy, satisfaction and side‐effects, and then changed to the other modality after appropriate instruction. A questionnaire was completed by study participants and their sexual partners after using both methods. Patients were followed for 18–24 months using telephone interviews.

Results

Forty‐four patients (mean age 62.3 years, range 38–84) completed the study. Patients and their partners reported a superior quality of erections with the injection method but the difference did not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual experience was significantly better when using injections. Side‐effects were similar between the modalities. Subgroups analysed for age, duration and aetiology of impotence showed that younger patients (<60 years), those with a shorter duration of impotence (<12 months) and those impotent secondary to radical prostatectomy strongly favoured injection therapy (P<0.05). Overall, of the 44 couples, the final preferences of the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, both or neither, respectively, and of the partners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively. At 18–24 months, 80% of patients were still using either the vacuum device, injections, or both.

Conclusion

Both the vacuum device and injections are effective treatment modalities for impotence and are associated with good long‐term success. Overall, there was a trend favouring injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and those impotent secondary to radical prostatectomy.
The fate of the ‘modern’ artificial urinary sphincter with a follow‐up of more than 10 years
Authors: FULFORD S.C.V. , SUTTON C. , BALES G. , HICKLING M. , STEPHENSON T.P.
Published: November 2003

Objective

 To assess the long‐term outcome of patients who had an artificial urinary sphincter (AUS) implanted between 10 and 15 years ago.

Patients and methods

Of 68 patients who had an AUS implanted more than 10 years ago, 61 were followed with sufficient detail for analysis. Thirty‐four had a neuropathic bladder with sphincter dysfunction, 15 had post‐prostatectomy sphincter weakness incontinence and 12 further patients had a variety of indications.

Results

The 61 patients experienced a total of 58 major complications and 49 have required at least one revision procedure. Currently eight (13%) patients are satisfactorily continent with their original AUS in situ and 29 others have a satisfactory revised AUS. Thus 37 of 61 (61%) are continent using an AUS at least 10 years after first implantation. Eleven patients died and of these two had a satisfactory original AUS in situ and seven had successful revisions. In two patients the AUS failed but they were considered unfit for revision. Four female patients were continent and used intermittent catheterization after the explantation of eroded AUS cuffs. In seven patients the AUS was abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary diversions fashioned. Thus, if those who died with a functioning AUS are included, 46 of 61 (75%) achieved long‐term continence with the AUS.

Conclusions

Despite the high complication and revision rate, these results show that acceptable continence rates can be achieved in the long‐term, particularly in the male neuropathic bladder and in those with post‐prostatectomy sphincter weakness. Many of the complications encountered may be less common with the current re‐designed models of the AUS. However, it is essential that both surgeon and patient recognize and accept the likelihood of complications and revisions before using the AUS. The continued use of the AUS where simpler methods of obtaining continence are inappropriate remains justified.
A case‐control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder
Authors: CUKIER J.M. , CORTINA‐BORJA M. , BRADING A.F.
Published: November 2003

Objective

 To assess whether there are common malfunctions (e.g. of the autonomic nervous system and smooth muscle) that underlie disorders of the urinary and gastrointestinal tracts by determining whether there is an increased prevalence (i) of urinary symptoms in patients with irritable bowel syndrome (IBS) and (ii) of gastrointestinal symptoms in patients with idiopathic detrusor instability (IDI).

Patients and methods

Questionnaires were sent to patients with a diagnosis of IBS or IDI who were seen in the Departments of Gynaecology, Gastroenterology and Urology at the John Radcliffe and Churchill Hospitals, Oxford, during the 3 year period 1993– 1995. The questionnaires were also distributed to control patients who were recruited from the day‐surgery unit of the Churchill Hospital. Of 236 questionnaires sent out, 168 replies were analysed; 64 from patients with IBS, 49 from patients with detrusor instability and 55 from controls. The questionnaire included questions about micturition and defecatory behaviour (frequency, regularity, urgency, continence, pain, and ease in passing urine and stools).

Results

Patients with IBS were more likely to experience certain urinary symptoms than controls (nocturia, urgency and some forms of urinary urge incontinence) and patients with IDI were as likely as patients with IBS to experience gastrointestinal symptoms more frequently than controls. Control patients showed an unexpectedly high probability of experiencing many of the gastrointestinal and urinary symptoms.

Conclusions

The frequent occurrence of symptoms in control patients makes the significance of the results less clear, but the association between certain symptoms of urinary tract disorder and patients with IBS, and of symptoms of gastrointestinal tract disorder with patients with IDI, suggests that they may share some common underlying dysfunction.
The use of the detrusorrhaphy for vesico‐ureteric reflux: the way forward?
Authors: STEINBRECHER H.A. , RANGECROFT L.
Published: November 2003

Objective

 To assess the outcome of all detrusorrhaphies carried out for simple single‐system vesico‐ureteric reflux (VUR) in children at one institution over a 4‐year period.

Patients and methods

 Twenty‐nine patients (11 boys, 18 girls, 43 renal units; mean age at presentation 23 months; range, antenatal to 72 months) were analysed in two groups. Group 1 comprised those undergoing asynchronous bilateral procedures (two patients, four units) and unilateral procedures (15 patients, 15 units), and group 2, those undergoing synchronous bilateral procedures (12 patients, 24 units). The mean (range) follow‐up was 17 months (6–39) and 15 months (7–24), respectively.

Results

 Three patients had antenatal hydronephrosis related to VUR post‐natally and 26 had urinary tract infections (13 recurrent, one with haematuria, seven ‘breakthrough’, one with calculi and four with enuresis). The mean age at operation was 54 months (range 14–167). The mean (range) duration of anaesthesia was 69 min (40–120) in group 1 and 80 min (65–120) in group 2. All patients were catheterized urethrally for a mean (range) duration of 3 days (2–4) in group 1 and 5 days (2–15) in group 2 and the mean hospital stay was 3 days (2–6) and 6 days (4–16), respectively. Post‐operative complications occurred in 14 patients including one bladder spasm, five urinary tract infections, two with urinary retention, three with haematuria and one each of pneumonia, epididymo‐orchitis, anuria, failure to stent and conversion to Cohen reimplantation. Operative success and clinical success were similar within groups but differed between groups, although not significantly (15 of 17 in group 1 and eight of 12 in group 2).

Conclusion

 Unilateral but not synchronous bilateral detrusorrhaphy seems an appropriate surgical treatment for VUR.
Diagnosis and management of high‐pressure peristaltic contractions in cystoplasties
Authors: CHRISTMAS T.J. , SMITH G.L. , RICKARDS D.
Published: November 2003

Objective

 To define the aetiology of and therapeutic strategy for high‐pressure peristaltic contractions within colo‐ and caecocystoplasties associated with symptoms of frequency, urgency and urge incontinence.

Patients and methods

In a series of over 150 subtotal supratrigonal colo‐ and caeco‐cystoplasties, nine patients were identified with such symptoms. These patients underwent videocystometrography (VCMG) confirming the presence of phasic peristaltic contractions of >35 cmH2O.

Results

In three cases, there was urodynamic evidence of outlet obstruction and symptoms resolved when the obstruction was surgically relieved. In the other six cases, high‐pressure peristaltic contractions were present without bladder outlet obstruction. The symptoms did not respond to anticholinergic medication. Three of the six patients had tolerable symptoms which did not warrant further intervention. The other three cases had disabling urge incontinence and underwent ileal patch cystoplasty. The symptoms resolved in all three cases, although later recurred in one patient, probably due to incomplete division of the taenia coli during ileal patch cystoplasty.

Conclusion

It appears that colonic smooth muscle can develop high‐pressure contractions in response to neobladder outlet obstruction. Relieving the obstruction ameliorates symptoms associated with these contractions and reduces the magnitude of the peristaltic waves. Symptoms related to high‐pressure peristaltic contractions without neobladder outlet obstruction do not respond to anticholinergic medication but can be successfully treated by ileal patch cystoplasty.
Glycosaminoglycans in crystal‐surface binding substances and their role in calcium oxalate crystal growth
Authors: YOSHIMURA K. , YOSHIOKA T. , MIYAKE O. , HONDA M. , YAMAGUCHI S. , KOIDE T. , OKUYAMA A.
Published: November 2003

Objective

 To clarify the role of glycosaminoglycans (GAGs) in crystal‐surface binding substances (CSBS) on the growth of calcium oxalate crystals in urine.

Materials and methods

 Urine samples (24 h) were collected from healthy men (aged 25–42 years) and CSBS were obtained from the pooled urine samples. The CSBS were digested with heparitinase or proteinase and the inhibition of crystal growth assessed before and after enzyme digestion. Anion‐exchange chromatography and high‐performance liquid chromatography (HPLC) were used to determine the types of GAGs contained in the CSBS.

Results

 The inhibitory activity of CSBS on crystal growth decreased with concentration when digested with heparitinase or proteinase. HPLC showed that CSBS contained a small amount of dermatan sulphate and abundant heparan sulphate, both of which inhibited crystal growth.

Conclusion

 Both heparan sulphate and dermatan sulphate may inhibit calcium oxalate crystallization, the former being the predominant GAG in CSBS.
Antioxidant deficiency following clam enterocystoplasty
Authors: BARRINGTON J.W. , JONES A. , JAMES D. , SMITH S. , STEPHENSON T.P.
Published: November 2003

Objective

 To assess whether there is a reduction in serum antioxidant activity in patients who have undergone a clam enterocystoplasty procedure.

Patients and methods

 Serum glutathione peroxidase (GPase) activity was measured in 20 patients who had undergone clam enterocystoplasty. Serum selenium concentration was also measured in 62 similar patients and compared with 56 healthy controls and 44 patients with a neuropathic bladder, mainly patients with spinal cord injuries who had not undergone surgery.

Results

 GPase activity correlated well with serum selenium measurement. There was a significant reduction (P<0.001) in serum selenium level in young (<50 years old) non‐neuropathic bladder patients following clam enterocystoplasty. This reduction in serum selenium was similar to that found in both unoperated patients with a neuropathic bladder (who are known to have an increased risk of developing bladder cancer) and those patients with a neuropathic bladder who had undergone augmentation. This reduction was not related to urinary tract infection nor the time since surgery.

Conclusion

 A reduction in serum selenium has been shown to increase susceptibility to bladder cancer following carcinogenic exposure to compounds such as nitrosamines. This study suggests that patients with idiopathic and congenital instability may be at an equally high risk as a result of undergoing this procedure.
The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms
Authors: WITJES W.P.J. , AARNINK R.G. , EZZ‐EL‐DIN K. , WIJKSTRA H. , DEBRUYNE F.M.J. , De La ROSETTE J.J.M.C.H.
Published: November 2003

Objective

 To determine if, in patients with lower urinary tract symptoms (LUTS), measurement of the transition zone (TZ) of the prostate by transrectal ultrasonography (TRUS) and the ratio between the TZ volume and total prostate volume (TZ index) correlates better with clinical and urodynamic investigations than total prostate volume alone.

Patients and methods

 In total, 150 consecutive patients with LUTS underwent a standardized screening programme including the International Prostate Symptom Sore (IPSS), a physical examination, TRUS of the prostate and urodynamic investigations with pressure‐flow studies. The total prostate volume and TZ volume were assessed from TRUS using the ellipsoid formula. Spearman’s rank correlation coefficients were calculated between different prostate volume measurements and specific symptomatic and urodynamic variables.

Results

 The relationships between specific IPSS symptoms, symptom scores and the prostate volume measurements were not statistically significant except for one domain, nocturia, that appeared to be statistically significantly correlated with the TZ index (r=0.25). The correlations for free flow, pressure‐flow variables and prostate volume measurements were stronger, but only moderate at best. The highest correlations were between TZ volume and the linear passive urethral resistance obstruction category, urethral resistance factor and detrusor pressure at maximum flow (r=0.43, 0.44 and 0.40, respectively). The differences between the correlations of prostate volume and TZ index and these variables were small (r=0.39, 0.38 and 0.37, respectively for prostate volume and r=0.38, 0.40 and 0.33 respectively for TZ index).

Conclusions

 There were very small differences between the correlations of total prostate volume, TZ volume and TZ index, and clinical and pressure‐flow variables. In the assessment of the last two, the estimation of the total prostate volume by TRUS was a reasonable way to obtain the required information about prostate size and measuring TZ volume and calculating TZ index was of limited additional value. Symptoms and bladder outlet obstruction were mainly determined by other factors than the prostate and, specifically, TZ volume. As earlier studies have indicated that including pressure‐flow data in the pre‐operative evaluation and selection of patients for interventional therapies may improve the overall clinical results, we think that prostate volume, TZ volume or symptoms alone should not be used as the main indication for deciding on the appropriate invasive treatment options.
Surgical management of the renal manifestations of von Hippel‐Lindau disease: a review of a United Kingdom case series
Authors: PERSAD R.A. , PROBERT J.L. , SHARMA S.D. , HAQ A. , DOYLE P.T.
Published: November 2003

Objectives

 To review the results of nephron‐sparing surgery in a group of patients with von Hippel‐Lindau (VHL) disease, a rare familial cancer syndrome which is dominantly inherited and predisposes affected individuals to developing various tumours, including haemangioblastomas of the retina and central nervous system, and multicentric renal cell carcinoma (RCC).

Patients and methods

 The 11 patients (seven men and four women, age range 27–62 years) assessed had been referred for surveillance to the Department of Clinical Genetics, Addenbrooke’s Hospital, often having presented with neurological or ocular manifestations of the disease. Their case notes were reviewed to assess the results of conservative surgery. Five patients had more than one parenchymal‐sparing operation (either partial nephrectomy or enucleation, i.e. removal of a malignant lesion with a 0.5 cm rim of normal tissue) while four had bilateral procedures. At the time of surgery, co‐existent cysts were aspirated to allow a more accurate definition on computed tomography during follow‐up.

Results

 At a mean follow‐up of 60 months after surgery, eight patients were alive with good renal function. Three patients were alive with paraplegia or paraparesis from spinal cord lesions. The three patients who died (aged 50, 40 and 31 years) were diagnosed when RCC was already advanced and renal tissue‐preserving surgery was not possible.

Conclusion

 Nephron‐sparing surgery may be justified because morbidity is reduced in patients whose quality of life may already be compromised by neurological and other problems, and because the lesions of RCC are often small, enucleation may also be justifiable in the attempt to conserve renal tissue and delay disease progression.
Analysis of the local control in lymph‐node staged localized prostate cancer treated by external beam radiotherapy, assessed by digital rectal examination, serum prostate‐specific antigen and biopsy
Authors: BORGHEDE G. , ALDENBORG F. , WURZINGER E. , JOHANSSON K.‐A. , HEDELIN H.
Published: November 2003

Objective

 To describe local disease control after radical external beam radiotherapy of prostatic carcinoma, as judged by digital rectal examination (DRE), transrectal ultrasonography (TRUS)‐guided biopsies and estimates of serum prostate‐specific antigen (PSA).

Patients and methods

 The study comprised 175 patients (mean age 67.5 years, range 49–82; >90% aged ≥60 years) with localized prostatic carcinoma (T1‐T3C, N0, M0) who underwent external beam radiation therapy (70 Gy), and were then regularly followed with a DRE, measurements of serum PSA and TRUS‐guided biopsies to determine the outcome.

Results

 The DRE revealed four patients with evidence of residual cancer in the prostate and biopsies showed no evidence of residual cancer in 131 (75%) of the patients. There was no correlation of residual cancer with tumour stage or grade but tumour size, as estimated by TRUS, correlated with the results of the biopsy. The nadir serum PSA level was ≤1.0 ng/mL in 116 (66%) of the patients, of whom 76 (43%) had a nadir serum PSA level of ≤0.5 ng/mL. The median time to the nadir level was 11 months. Serum PSA progression (>4.0 ng/mL) at the latest PSA measurement after reaching the nadir occurred in 13% of the patients with a nadir PSA of ≤0.5 ng/mL and in 25 of the 29 (86%) patients with a nadir serum PSA >2.0 ng/mL. Cox regression analysis showed that tumour size and rectal irradiation dose were the most important factors for local control.

Conclusions

 Radiotherapy is effective in achieving local control in small prostate cancer tumours but less effective in large tumours. Tumour size and dorsal extension of the irradiated target, the rectal dose, were the two important factors for local control. A serum PSA level of ≤1.0 ng/mL was associated with a higher chance of prolonged disease control.
Immunohistochemical detection of sialosyl‐Tn antigen in carcinoma of the prostate
Authors: KUWABARA H. , UDA H. , TAKENAKA I.
Published: November 2003

Objective

 To investigate the expression of sialosyl‐Tn antigen (STn) in human benign and malignant prostate.

Materials and methods

 The expression of STn was investigated immunohistochemically in formalin‐fixed and paraffin‐embedded tissue specimens from 56 patients with primary prostatic adenocarcinoma (median age 74.3 years, range 47–89) and 20 patients with benign prostatic hyperplasia (median age 73.4 years, range 60–87).

Results

 STn was expressed in only three (4%) of the 20 hyperplastic glands and the benign areas adjacent to the 54 carcinomas; by contrast, STn was expressed in 34 (61%) of the 56 carcinomas. The frequency of STn positivity was much higher in well‐differentiated carcinomas than in those poorly differentiated.

Conclusion

 STn is expressed with malignant transformation of the prostatic epithelial cells and immunohistochemical methods using commercially available STn monoclonal antibody may be useful as an adjunct for distinguishing carcinoma from benign tissue.
The biodegradable self‐reinforced poly‐dl‐lactic acid spiral stent compared with a suprapubic catheter in the treatment of post‐operative urinary retention after visual laser ablation of the prostate
Authors: PÉTAS A. , TALJA M. , TAMMELA T.L.J. , TAARI K. , VÄLIMAA T. , TÖRMÄLÄ P.
Published: November 2003

Objective

 To evaluate the efficacy and safety of a biodegradable self‐reinforced poly‐dl‐lactic acid (SR‐PLA) spiral stent compared with a suprapubic catheter after visual laser ablation of the prostate (VLAP) in a randomized study.

Patients and methods

 The study comprised 45 patients (mean age 67.6 years, range 52–81) with bladder outlet obstruction caused by benign prostatic hyperplasia who received either a SR‐PLA stent (22 patients) and a suprapubic catheter, or a suprapubic catheter only (23 patients) after undergoing VLAP. The suprapubic catheter was removed when voiding started. The response to VLAP and the effect of the stent or catheter were assessed using symptom scores, peak flow rate (Qmax ), post‐void residual volume (PVR), stent degradation, infection and outcome.

Results

 Voiding started on the first or second day after treatment in 18 (median one day) of 22 patients with a spiral stent and in eight (median 6 days) of 23 patients with only the suprapubic catheter. The mean degradation time of the SR‐PLA stent was 6 months; spiral fragments were found in the prostatic urethra or the urinary bladder in 20 of the patients on cystoscopy. Improvements in patient‐weighted symptom score, mean Qmax and PVR were significant in both groups at the 6 month follow‐up. The infection rate increased with the duration of suprapubic catheterization, from 25% (0–3 days) to 44% (>3 days). Stones were seen in two stented patients during the follow‐up.

Conclusion

 The SR‐PLA spiral stent is safe and effective for the treatment of post‐operative urinary retention after laser therapy. The degradation time of the stent was unnecessarily long compared with the duration of prostatic swelling and tissue sloughing after laser therapy. The infection rate depends on the duration of suprapubic catheterization.
Comparison of polidocanol and tetracycline in the sclerotherapy of testicular hydrocele and epididymal cyst
Authors: DÆHLIN L. , TØNDER B. , KAPSTAD L.
Published: November 2003

Objective

 To compare the effects and side‐effects of polidocanol and tetracycline when used as sclerosants for testicular hydrocele and epididymal cyst.

Patients and methods

 Forty‐five men (median age 67 years, range 42–81) with 46 hydroceles or epididymal cysts were assessed. After puncture and aspiration, the empty sac was instilled with either polidocanol or tetracycline, assigned randomly. Patients recorded any treatment‐associated pain on a visual analogue scale.

Results

 At 9 months of follow‐up, nine of 17 men were cured after sclerotherapy with polidocanol compared with 17 of 20 men treated with tetracycline (P<0.05). Tetracycline produced some pain for 3 days after treatment while polidocanol therapy was almost pain‐free. Re‐instillation should be considered for recurrences. At the follow‐up after 35 months, 16 of 18 men treated with polidocanol and 20 of 22 men treated with tetracycline were satisfied with the outcome.

Conclusion

 Both polidocanol and tetracycline are useful sclerosants for treating testicular hydrocele and epididymal cyst. We prefer polidocanol as a first choice in older patients because there were few short‐term side‐effects.
Extraperitoneal laparoscopic dismembered fibrin‐glued pyeloplasty: medium‐term results
Authors: EDEN C.G. , SULTANA S.R. , MURRAY K.H.A. , CARRUTHERS R.K.
Published: November 2003

Objective

 To assess the feasibility and results of performing retroperitoneoscopic dismembered fibrin‐glued pyeloplasty in a clinical series of patients with pelvi‐ureteric junction (PUJ) obstruction.

Patients and methods

 A balloon‐dissecting four‐port extraperitoneal laparoscopic approach was used in each of nine patients (aged 21–60 years) to dismember the PUJ over a previously placed double‐pigtail stent, insert stay sutures to appose the urothelium and complete the pelvi‐ureteric anastomosis using fibrin glue. Anastomoses were assessed by diuresis renography 3 months after surgery and at yearly intervals thereafter.

Results

 Eight of the nine attempted procedures were completed successfully in a median (range) operating time of 180 (150–230) min. The median (range) post‐operative parenteral opiate requirement was 0 (0–80) mg morphine sulphate and the post‐operative hospitalization was 2 (2–4) nights. A shortened fibrotic ureter prevented the laparoscopic completion of the second case, which was converted to an open procedure. Follow‐up imaging after 1–2 years showed satisfactory upper tract drainage in those cases completed successfully. One patient developed a renal pelvic calculus that was treated by extracorporeal shock wave lithotripsy.

Conclusion

 This technique is associated with a significantly shorter operating time than historical laparoscopic controls, and with a significantly lower post‐operative opiate analgesic requirement and shorter post‐operative hospitalization than in a contemporaneous series of patients undergoing open pyeloplasty. However, longer term follow‐up is needed to fully assess the performance of these anastomoses.