bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Study of the Value of Conventional CT, Dynamic CT, Ultrasonography and Arteriography for Staging Renal Carcinoma
Authors: LONDON N. J. M. , MESSIOS N. , KINDER R. B. , SMART J. G. , OSBORN D. E. , WATKIN E. M. , FLYNN J.T.
Published: November 2008

Summary—
The value of dynamic CT scanning for staging renal carcinoma was studied prospectively in 28 patients and the results compared with those of ultrasonography, arteriography and conventional CT. Arteriography correctly staged 48% of tumours; ultrasonography and conventional CT correctly staged 50% and dynamic CT correctly staged 72%.

Dynamic CT staged renal carcinoma more accurately than ultrasonography, conventional CT or arteriography and it is suggested that arteriography should be restricted to specific indications such as the mapping of arterial anatomy and therapeutic renal artery embolisation.
Scintigraphic Assessment of Lower Urinary Tract Function in Children With and Without Outflow Tract Obstruction
Authors: van der VIS‐MELSEN M. J. E. , BAERT R. J. M. , RAJNHERC J. R. , GROEN J. M. , BEMELMANS L. M. M. J. , NEF J. J. E. M. De
Published: November 2008

Summary—
Analysis of lower urinary tract function with an extension of standard renography with 123I‐hippurate was carried out in 199 children.

Maximum bladder capacity, voiding and residual bladder volumes, average and maximum urine flow rates and urine flow patterns were estimated. The index of urine transport (IUT), representing the relationship between urine flow rate and bladder volume, was introduced as a measure of outflow capability.

Of 129 children without evidence of outflow obstruction, 90% had a normal urine flow pattern; in 96% the average IUT was 0.8 or higher and in 87% the maximum IUT was 1.2 or higher. A sawtooth‐shaped pattern with both normal and abnormal IUT values was observed in 10% of these children.

In 63% of the children with outflow tract obstruction there was a low, flat urine flow pattern together with decreased IUT values. A sawtooth‐shaped pattern with varying IUT values was observed in 15%, whereas in 20% the urine flow pattern and IUT values were normal.

This extension of standard radionuclide renography as a method of screening lower urinary tract function is recommended. It is at least as good as conventional direct urine flow rate recording, it has the advantage of being non‐invasive and it is also part of an established urological investigation.
The Loss of Circadian Rhythmicity of Urinary Solute Excretion in Idiopathic Stone Formers
Authors: SIDHU H. , VAIDYANATHAN S. , WANGOO D. , THIND S. K. , NATH R. , MALAKONDAIAH G. C. , KRISHAN K.
Published: November 2008

Summary—
Circadian rhythmicity in urinary volume and excretion of creatinine, calcium, oxalate, uric acid and phosphate was studied in 15 idiopathic stone formers and in 17 control subjects who were age‐matched, related adult males, living in the same house and engaged in similar occupations to those of the stone patients, but who had no clinically obvious stone disease. Three‐hourly urine samples were collected and creatinine, calcium, oxalate, uric acid and inorganic phosphate were estimated. The time series of data were analysed by cosinor rhythmometry. Circadian rhythmicity has been described in urinary volume and urinary excretion of creatinine, calcium, oxalate, uric acid and inorganic phosphate in normal subjects, but it was not detected in the stone formers. The control subjects exhibited a circadian rhythmicity only in urinary volume and creatinine excretion. Thus they occupied a position midway between healthy adults, who exhibit circadian rhythmicity in all of the above parameters, and the stone formers, who appear to have lost it altogether.
Asymptomatic Bladder Neck Incompetence in Nulliparous Females
Authors: CHAPPLE C. R. , HELM C. W. , BLEASE S. , MILROY E. J. G. , RICKARDS D. , OSBORNE J. L.
Published: November 2008

Summary—
This study investigated 29 nulliparous women using the technique of transvaginal ultrasound to assess whether their bladder necks were open or closed at rest. The patients comprised 2 groups: 4 reported occasional episodes of stress incontinence, all of whom had closed bladder necks; the remaining 25 patients were totally asymptomatic. Overall a 21% incidence of an open bladder neck was recorded. It is likely that the true incidence of open bladder necks in young nulliparous women is higher than this, since none of these patients had troublesome stress incontinence. Since women with open bladder necks are more likely to develop stress incontinence if the integrity of the distal sphincter mechanism is compromised by neural damage, antenatal recognition of this problem should provide a contraindication to traumatic vaginal delivery and may in the future reduce the incidence of symptomatic stress incontinence in the population.
Effects of External and Direct Pudendal Nerve Maximal Electrical Stimulation in the Treatment of the Uninhibited Overactive Bladder
Authors: OHLSSON B. L. , FALL M. , FRANKENBERG‐SOMMAR S.
Published: November 2008

Summary—
Maximal electrical stimulation (MES) administered from a laboratory device designed to deliver stimulation pulses of relatively high voltages and currents was performed in 29 patients. All had suffered from bladder overactivity for several years, either idiopathic detrusor instability or an uninhibited overactive bladder, and all had failed to respond to conservative treatment.

MES was performed in female patients by means of intravaginal and intra‐anal electrode carriers and in males by anal electrodes only. In some cases additional stimulation was administered by means of a single needle bipolar electrode inserted directly into the pudendal nerve. Maximal amplitude was attained after gradual increases in amplitude and the patient's adaptation to this. Stimulation was administered by the therapist but the amplitudes were determined by the patient and limited by his/her pain threshold. Alternating rectangular constant voltage pulses at a repetition rate of 10 Hz were used. Treatment consisted of 4 sessions of stimulation with intervals of 1 week between each application.

All patients showed a significant increase in functional bladder capacity and 11 reported a 30% decrease in the frequency of micturition. Two patients were unaffected by stimulation with external electrodes but responded well to direct pudendal nerve stimulation. MES seems to be an effective first‐line treatment for the uninhibited overactive bladder.
Urinary Retention after Renal and Ureteric Surgery
Authors: DEMIREL A. , POLAT Ö. , SIYEZ E. , BAYRAKTAR Y.
Published: November 2008

Summary— A retrospective study was carried out on 200 patients who underwent surgery between January 1989 and September 1991. The aim was to investigate the development of urinary retention following renal and ureteric surgery. The incidence of urinary retention was 55% for patients in the renal group and 26% for those in the ureteric group. In a control group of 100 patients undergoing cholecystectomy the incidence was 5%.

The results showed that bladder function was inhibited greatly after renal surgery. Catheterisation in the pre‐operative period may help to prevent post‐operative urinary retention.
Autoaugmentation Gastrocystoplasty in a Sheep Model
Authors: DEWAN P. A. , BYARD R. W.
Published: November 2008

Summary— Ten lambs had their bladders augmented with de‐epithelialised stomach muscle added to an intact urothelium. They were assessed functionally and histologically up to 2 months postoperatively. The urothelium remained viable with minimal inflammation and a neo‐bladder with good volume was formed.
Absorption of Irrigating Fluid and Height of Fluid Bag during Transurethral Resection of the Prostate
Authors: HAHN R. G. , EKENGREN J.
Published: November 2008

Summary— The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60–65, 70–75,80‐85 or 90–100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analysed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.
Recurrent symptoms of urinary tract infection in eight patients with refluxing ureteric stumps
Authors: PERSAD R. , KAMINENI S. , MOURIQUAND P. D. E.
Published: November 2008

Objectives To evaluate and discuss the recurrent symptoms presented by eight patients with refluxing ureteric stumps.

Patients and methods Eight patients (three boys, five girls: mean age: 8 years, range 11 months‐14 years) with refluxing ureteric stumps presented with recurrent urinary tract infections. Six developed symptoms mimicking pyelonephritis, even though the kidney had been partially [5] or totally [3] removed. The stump was removed in all patients.

Results The stumps that were excised measured between 5 and 10 cm in length and were always dilated and inflamed. The results of histological examination and follow‐up are reported.

Conclusions A dual approach is recommended when complete excision of the kidney and ureter is required. Symptoms of pyelonephritis are not pathognomonic of parenchymal infection but reflect infection above the vesico‐ureteric junction. The distinction between supra‐junctional and infra‐junctional urinary tract infections seems more appropriate and is discussed.
Significance of the evaluation of asymptomatic microscopic haematuria in young men
Authors: SPARWASSER C. , CIMNIAK H. U. , TREIBER U. , PUST R. A.
Published: November 2008

Objective To evaluate the extent of diagnostic evaluation that is necessary in young men with asymptomatic microscopic haematuria.

Patients and methods A group of 157 men (mean age 24.8 years [range 18–53]) who presented with asymptomatic haematuria were investigated with repeated urine analysis, Addis count, urinary cultures, blood tests, ultrasonography, pyelography, cystourethroscopy and finally renal biopsy.

Results The results showed pathological findings in 31.2% of patients. Of the 157 individuals, 33.1% did not complete the study. In 14.6% urological disease was found, including two patients with urothelial cancer. Renal biopsy detected glomerulopathy in 16.5% of all patients. IgA nephritis being the most common diagnosis (42% of all biopsies).

Conclusion Even in young patients, microscopic haematuria should be investigated and followed thoroughly. Renal biopsy seems to be optional: once a diagnosis is established repeated and unnecessary examinations can be avoided.
Extent of blood transfusion and cancer‐related mortality after cystectomy and urinary diversion for bladder cancer
Authors: JAHNSON S. , BERGSTRÖM R. , PEDERSEN J.
Published: November 2008

Objective To assess the possible adverse effect of peri‐operative blood transfusion on cancer‐relates survival after radical cystectomy for bladder cancer.

Patients and methods The hospital records of 130 patients treated with cystectomy and urinary diversion for bladder cancer between 1967 and 1986 were retrospectively reviewed.

Results Standard proportional hazards estimation revealed tumour stage and radiation response after pre‐operative irradiation to be significantly associated with cancer‐relates mortality, whereas age, tumour grade or the extent of peri‐operative blood transfusion were not. In models which allowed time varying effects a significantly changed effect of blood transfusion(≥ 7 versus ≤ 6 units) was observed, from an initially insignificantly increased relative hazard (RH) (RH=1.44 at 6 months) to an insignificantly decreased effect after longer follow‐up (RH=0.53 after 2 years).

Conclusion Although no overall association between blood transfusion and cancer‐related mortality was found, a tendency towards an increased risk early in the follow‐up period was observed if more than 6 units were transfused. However, these results need confirmation in further studies before a restrictive attitude towards peri‐operative blood transfusion is recommended.
Mercapto‐acetyltriglycine (MAG 3) renography and indirect radionuclide cystography in posterior urethral valves
Authors: DINNEEN M. D. , DUFFY P. G. , LYTHGOE M. F. , RANSLEY P. G. , GORDON I.
Published: November 2008

Objective To assess dynamic isotope renography with 99mTc‐labelled mercapto‐acetyltriglycine (MAG 3) in conjunction with indirect radionucleide cystography (IRC) in the follow‐up of boys with posterior urethral valves.

Patients and methods Fifty‐one boys (95 renal units: mean age=89 months range 65–118) with previously treated posterior urethral vales underwent MAG 3 renography followed by IRC. Glomerular filtration rate (GFR) was estimated form the plasma clearance of 51Cr‐ethylenediamine tetra‐acetic acid following single intravenous injection. Renographic paramenters noted were renal function based on the quality of renal visualization and background activity as well as renal drainage and the appearance of isotope in ureter and bladder. Following the dynamic 20 min MAG 3 renogram the child was allowed to leave the department and to return when he wished to void. IRC was then performed. Diuretics were not administered.

Results Initial drainage from 30 kidneys was normal in 36 drainage was delayed and in 25 drainage did not occur during the renogram phase. In four kidneys function was so poor as to preclude assessment. After the IRC, drainage was noted in 17 of 25 units which had not drained during the renogram, six units did not drain and in two drainage was equivocal due to the presence of vesico‐ureteric reflux. The quality of the scan was good or very good in 42 patients (mean GFR=92 ml/min/1.73 m2 SA) and moderate or poor in nine patients (median GFR=20 ml/min/1.73 m2 SA) (P < 0.001), A residual urine was noted following micturition in 35 boys; this was due to incomplete bladder emptying in 14 and to immediate secondary refilling from dilated upper tracts in the remainder.

Conclusion IRC in conjunction with traditional dynamic renography using MAG 3 provides valuable additional information about upper tract drainage. The necessity for diuresis renography is obviated in the majority of patients. IRC also allows an excellent non‐invasive, physiological assessment of both upper and lower urinary tract function which is superior to conventional single examination techniques. We recommend the use of MAG 3 with IRC in the routine follow‐up of boys with posterior urethral valves.
Long‐term results of intermittent low‐friction self‐catheterization in patients with recurrent urethral strictures
Authors: HARRISS D. R. , BECKINGHAM I. J. , LEMBERGER R. J. , LAWRENCE W. T.
Published: November 2008

Objective To ascertain the duration of intermittent low‐friction self‐catheterization (ILSC) required to cause stricture stabilization.

Patients and methods Over a 4 year period, 101 patients with a median age of 62 years (range 16–85) with recurrent urethral strictures were recruited the trial. All the strictures were treated by internal urethrotomy and the patients were then randomized to perform ILSC twice weekly for either 6 months (group 1) or 36 months (group 2). Out‐patient follow‐up with urinary flow rate was initially at 1 month and then at 3 monthly intervals. Stricture recurrence rates were compared between the two groups.

Results Of 101 patients, seven failed to attend after the first out‐patient appointment. A further 21 died of unrelated disease whilst on ILSC (although 13 had been followed up for at least 24 months and so were included in the analysis). The median follow‐up was 67 months (range 24–78). Ten patients in group 2, who has suffered from recurrent strictures, refused to stop catheterizing at the appointed time and all remain stricture‐free on permanent ILSC, Of the remaining 76 patients, 48 catheterized for 6 months and 28 patients performed ILSC for 6 months and 28 patients performed ILSC for 12 to 36 months (nine stopped earlier than intended). Forty per cent of patients who stopped at 6 months developed a recurrence compared with 14% who catheterized for more than 12 months (P<0.05) (chi‐square test with Yates' correction).

Conclusions Our results indicate that ILSC is safe and effective in preventing stricture recurrence in the long term. The recurrence rate of urethral strictures was significantly lower when ILSC was continued for more than 12 months compared with ILSC that was stopped at 6 months. We conclude that catheterization for at least 1 year required to achieve adequate urethral stabilization.
Combination of lymphokine‐activated killer cells and interleukin‐2 in treating metastatic renal cell carcinoma
Authors: FUJIOKA T. , NOMURA K. , HASEGAWA M. , ISHIKURA K. , KUBO T.
Published: November 2008

Objective To study the properties of lymphokine‐activated killer (LAK) cells and the effect of immunotherapy with a combination of autologous LAK cells and interleukin‐2 (IL‐2) [LAK therapy] in 10 patients with metastatic renal cell carcinoma (RCC).

Materials and methods The LAK cells were generated from peripheral blood lymphocytes (PBL) by incubation in a serum‐free medium (AIM‐V) supplemented with IL‐2 for 4 days and killer cells were administered intravenously twice a week. The LAK cells showed cytotoxicity against allogenic RCC cell lines and augmented NK and LAK activities. Their phenotypes were CD25 ‐, HLA‐DR+, CD3+, and CD16+. Furthermore, LAK cells released IFN‐γ, IL‐1β and TNF‐α. The total number of LAK cells administered ranged from 3.8 × 109 to 52.6 × l09 cells and the total amount of IL‐2 ranged from 150 times 105 to 900 times 105 U. The effect on pulmonary metastasis in response to LAK therapy was studied.

Results The outcome was complete response (1), partial response (1), minor response (2), no change (4) and disease progression (2). Toxic effects were transient and no serious side‐effects occurred. Evaluation of host immune parameters indicated that a clinical response was expected in patients with increasing proportions of CD16‐, CD25+, CD57+, HLA‐DR+ and CD3+ DR‐ cells among PBL and with augmentation of NK and LAK activities. Brain metastases were detected in three patients during or after treatment.

Conclusion LAK therapy appears to be effective in treating some patients with RCC and pulmonary metastasis. The potential for inducing brain metastasis, however, should be taken into account.
Retrograde manipulation for proximal ureteric stones before extracorporeal Shockwave lithotripsy: technique, observations and results
Authors: BIYANI C. S. , BHATIA V.
Published: November 2008

Objective To determine the factors affecting the success of retrograde manipulation (RM) of upper ureteric stones.

Patients and methods A total of 601 patients with upper ureteric calculi underwent attempted RM. In 216 patients, RM was performed irrespective of the respiratory phase, stone characteristics and ureteric anatomy (group 1). In the remaining 385 patients RM was performed at the height of expiration (group 2). Patients with large or impacted stones, ureters with a fusiform or funnel shape appearance on urography and grade IV hydronephrosis were not included in group 2.

Results The success rate was significantly greater in group 2. The rates of fever and perforation in groups 1 and 2 were 6.9/2.3% and 3.2/0.2% respectively. The incidence of residual fragments was also less in group 2.

Conclusion RM at the height of expiration is associated with a higher success rate and lower complication rate.
Small cell carcinoma of the urinary bladder. A clinicopathological study of six cases
Authors: LOPEZ J. I. , ANGULO J. C. , FLORES N. , TOLEDO J.D.
Published: November 2008

Objective To study the clinical, histological, and immuno‐histochemical findings of small cell carcinoma (SCC) of the urinary bladder, and also to delineate its behaviour in comparison with transitional cell carcinomas of the bladder.

Materials and methods A retrospective review of 552 patients with bladder cancer yielded six cases (1%) of small cell carcinoma which were histologically identical to pulmonary small cell anaplastic carcinoma. Clinical data and follow‐up were collected. Aside from the conventional histological parameters, an immunohistochemical study with AE1–AE3 and Cam 5.2 keratins, epithelial membrane antigen, neuron‐specific enolase, chromogranin, synaptophysin, ACTH, calcitonin, and prostatic specific antigen was performed.

Results The clinical presentation did not differ from conventional transitional cell carcinoma, haematuria being the most frequent complaint (four cases). All the cases presented as flat tumours. On light microscopy, there were oat cell (four cases), intermediate (one case) and mixed oat‐cellJintermediate (one case) variants. Three cases were associated with transitional cell carcinoma. Dysplastic changes were observed in the adjacent urothelium in one case only. At the time of diagnosis, all tumours were deeply invasive (pT3). Three cases were Stage III and three Stage IV, with involvement of regional lymph nodes and metastases to the liver (two cases) and lung (one case). Immunohistochemically, epithelial markers were variably expressed as AE1‐AE3 keratin (5J6), Cam 5.2 keratin (2/6) and epithelial membrane antigen (3/6). Neuron specific enolase was demonstrated in every case. Chromogranin, however, was expressed in only one case. Synaptophysin, ACTH, calcitonin, and prostatic specific antigen all gave negative results. All the patients died of the disease and the overall length of survival was very poor (range 5–2 5 months, mean 13.3).

Conclusion Small cell carcinomas show the same histological patterns as their pulmonary counterpart. Immunohistochemistry reveals a wide spectrum of activity, enolase and keratins being the most constant. The present study confirms that the overall prognosis of this tumour is very poor.
Combined bladder neck suspension and augmentation cystoplasty for neuropathic incontinence in female patients
Authors: FREEDMAN E. R. , SINGH G. , DONNELL S. C. , RICKWOOD A. M. K. , THOMAS D. G.
Published: November 2008

Objective To perform bladder neck suspension simultaneously with augmentation cystoplasty in female patients where sphincteric incompetence was not the sole cause of impaired functional bladder capacity.

Patients and methods During an 8‐year‐period, 26 female patients (mean age 14, range 5–39) were treated with a Marshall‐Marchetti plus cystoplasty (Liverpool) or a colposuspension plus clam cystoplasty (Sheffield). All had marked sphincteric incompetence compounded by detrusor hyper‐reflexia and/or non‐compliance. The patients were followed up for a mean period of 30 months (range 8–80).

Results There were no major complications. At follow‐up 23 (88%) were dry by day on a regime of intermittent self‐catheterization. Nine patients were taking adjuvant medication, usually for prevention of nocturnal enuresis.

Conclusion The results compare tolerably with those of all alternative procedures, including the more elaborate reconstructions (e.g. Kropp procedure) and the expensive artifical urinary sphincter.
Characterization of biofilm and encrustation on ureteric stents in vivo
Authors: KEANE P.F. , BONNER M.C. , JOHNSTON S.R. , ZAFAR A. , GORMAN S.P.
Published: November 2008

Objective To examine the relationship between encrustation and microbial biofilm formation on indwelling ureteric stents.

Patients and methods Ureteric stents from 40 patients were examined for the presence of a microbial biofilm and encrustations. Bacteria in stent biofilms were isolated and identified.

Results A profuse biofilm (> 104 c.f.u. cm3–3) was identified on 1J (28%) stents. Enterococcus faecalis was the most common biofilm organism identified and Proteus spp. were not present. Encrustation was seen in 23 (58%) of stents and was not associated with the level of urinary calcium. The major risk factor for stent encrustation was the presence of urolithiasis. Importantly, there was no causative link between stent biofilm formation and encrustation. Both biofilm formation and encrustation increased with the duration of stenting.

Conclusion The results indicate that polyurethane is readily encrusted and colonized by bacteria in vivo despite antibiotic prophylaxis. Newer materials must be sought if effective long‐term stenting is to be achieved.
Sir Henry Thompson BT, the first English urologist*
Authors: URQUHART‐HAY D.
Published: November 2008

Sir Henry Thompson was a gifted Victorian. As a surgeon he achieved early recognition by successfully removing King Leopold of Belgium's bladder stone where two other eminent surgeons had failed. He was undoubtedly the most famous surgeon of his age, a position he was to occupy for some 30 years. As well as professional eminence he achieved success in an extraordinarily wide range of endeavours. He was an accomplished artist, exhibiting 1 2 times at the Royal Academy, a connoisseur and collector of china, a keen astronomer, an authority on diet and cooking and a pioneer advocate of cremation. He was interested in poultry‐farming, market‐gardening and photography. He published two novels sandwiched between a book on tumours of the bladder and another on the prevention of calculous disease, He was a celebrated host and his dinners ‐ called ‘Octaves’ ‐ at which he served eight courses to eight guests were legendary. To be invited meant one had ‘arrived’. He was friendly with artists, scientists and men of letters ‐ Huxley. Browning, Ray Lankester and Thackeray. At the age of 80 he bought himself a motor‐car and 2 years later wrote a book on the anatomy of the motor‐car engine. Sir Zachary Cope described him as a versatile Victorian, a fitting description of an extra‐ordinarily gifted man. A commanding and slightly intimidating figure with little sense of humour, he achieved distinction in professional, artistic and social circles. Not only did he leave his mark on urology he left his mark on Victorian England.
Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis — a prospective randomized study
Authors: HOFBAUER J. , HÖBARTH K. , SZABO N. , MARBERGER M.
Published: November 2008

Objective To assess the efficacy of alkali citrate therapy in patients suffering from recurrent idiopathic calcium oxalate stone formation.

Patients and methods Fifty patients suffering from active stone formation who had had at least one stone annually over the previous 3 years were recruited and randomly divided into two groups. They were given either general prophylactic instructions, i.e. abundant liquid intake and dietary restrictions (group I, n = 25) ‐ or were additionally treated with alkali citrate (group 11, n=25).

Results In group I, the rate of stone formation was reduced from 1.8 to 0.7 stones per patient per year. Similar results were obtained for group 11, the corresponding figures being 2.1 and 0.9. There was a statistically significant higher urinary citrate excretion in group I1 than in group I. No difference was seen between the two groups regarding recurrent stone formation (Student's t‐test). Stone formation decreased in both groups (group I 27% group I1 31%). Subjectively, 56% of group I1 patients, all of whom had previously experienced severe colic, reported spontaneous stone elimination to be painless, whereas in group I all but one patient suffered pain.

Conclusion An objective benefit of alkali citrate could not be established.
Radiographer‐performed abdominal and pelvic ultrasound: its value in a urology out‐patient clinic
Authors: NARGUND V. H. , LOMAS K. , SAPHERSON D. A. , FLANNIGAN G. M. , STEWART P. A. HAMILTON
Published: November 2008

Objective To assess the efficacy of radiographer performed ultrasound examination as a routine investigative procedure in a urological out‐patient clinic.

Patients and methods A total of 151 patients attending a District General Hospital Urological Out‐patient Department underwent an ultrasound examination in the clinic.

Results Diagnosis by ultrasound was achieved in 93% of patients. The remaining patients underwent further investigations. Two (1%) patients with normal scans had small bladder tumours. Subsequent intravenousurography in these individuals showed normal upper tracts.

Conclusion Abdominal and pelvic ultrasound examination performed in the urological out‐patient clinic on unprepared patients was the only investigation necessary for evaluation of common problems such as non‐specilk urinary symptoms, recurrent urinary tract infections and bladder outlet obstruction.
Histological response to injected Polytef and Bioplastique in a rat model
Authors: DEWAN P. A. , BYARD R. W.
Published: November 2008

Objective To study, using a rat model, the tissue reaction in response to the migration of particulate plastics injected into the lungs and subcutaneous sites.

Materials and methods A total of 50 rats were included in the study. Histological examination of 30 rats was carried out up to 6 months after the subcutaneous injection of 0.1 ml of either Polytef or Bioplastique. Specimens from a further 18 rats underwent histologi‐ cal examination up to 3 months after the intravenous injection of 0.01 ml of either Polytef or Bioplastique. Two rats were injected with normal saline to act as controls. Representative sections of multiple organs were taken from each animal.

Results No systemic migration from the site of initial implantation was detected. This may have been due either to the animal used or to the limited number of sections taken. However, the intravenously injected plastics were found adjacent to the pulmonary arterioles 3 months after injection. The histological reaction at the local injection and lung sites was similar, with the giant cells being larger and the degree of fibrosis greater for Bioplastique than for Polytef.

Conclusion The histological reaction to Polytef and Bioplastique was similar in both the subcutaneous and lung sites. No migration or malignant change was seen.
Use of a eutectic mixture of local anaesthetics in the release of preputial adhesions: is it a worthwhile alternative?
Authors: LIM A. , SAW Y. , WAKE P. N. , CR0T0N R. S.
Published: November 2008

Objective To see if a eutectic mixture of local anaesthetics (EMLA) could be used effectively for the release of preputial adhesions as a day case procedure.

Patients and methods A total of 36 consecutive symptomatic children had their preputial adhesions separated under local anaesthetic with EMLA. Results The procedure was successful in 2 7 children. Of these, 16 remained symptom free at 9 to 12 months follow up although five children had slight recurrence of adhesions. The other 11 children were listed for circumcision at 2 weeks following the procedure because of marked recurrence of adhesions.

Conclusion EMLA cream is a good alternative to general anaesthetics in the separation of preputial adhesions. The technique is operator‐dependant and better results were obtained when one person was using it regularly. Separation of adhesions is a worthwhile procedure in boys with symptomatic non‐retractile foreskins.
Carcinoma in situ in boys with cryptorchidism: when can it be detected?
Authors: PARKINSON M. C. , SWERDLOW A. J. , PIKE M. C.
Published: November 2008

Objective To investigate the possibility of a pre‐invasive phase of adult germ cell tumours being detectable in childhood.

Patients and methods Seventy testicular biopsies were examined which had been taken at orchidopexies from 57 patients aged 1 to 16 years during the period 1951–1973, and for whom follow‐up data on cancers and deaths up to 1989 were available.

Results Malignant germ cell tumours had developed in three testes from which biopsies were available: a right‐sided teratoma and left‐sided mixed germ cell tumour in one patient and a left‐sided teratoma in a second patient. Carcinoma in situ was seen in only one of the 70 biopsies. This biopsy was taken from a patient aged 16 years and preceded the appearance of a teratoma by 4 years. Carcinoma in situ was not seen in a biopsy of this testis carried out 11 years before tumour diagnosis. Carcinoma in situ was also not seen in a biopsy of the contralateral testis in this patient carried out 22 years before tumour diagnosis in the testis, nor was it observed in a biopsy 17 years before the development of malignancy in the second patient.

Conclusion These findings bring into question the extent to which the appearance of testicular biopsies taken during childhood orchidopexy can exclude the development of a tumour in adult life. No evidence has been found in this study for histological pre‐malignant changes occurring before the onset of puberty.
Epidermoid cyst of the testis: a review of clinical and histogenetic considerations
Authors: DIECKMANN K.‐P. , LOY V.
Published: November 2008

Objective To review the records of patients with epidermoid cysts and those with germ cell tumours to determine the most appropriate method of treatment.

Patients and methods The records of the patients treated for epidermoid cysts and testicular germ‐cell tumours in a period covering 22 years were analysed retrospectively. Nine specimens with an epidermoid cyst were examined by immunohistology for the presence of testicular intraepithelial neoplasia (TIN) (or carcinoma in situ of the testis).

Results Ten patients with a simple epidermoid cyst and 481 patients with testicular germ‐cell tumour were treated during the observation period. The relative incidence of epidermoid cysts in relation to the number of patients with testicular germ‐cell tumours was 2.1% (95% confidence interval 0.8‐3.35%). The mean age of the 10 patients with an epidermoid cyst was 24.1 years. The right testis was affected in seven patients and the left in three. Six of these patients received conservative surgery with excellent cosmetic results. No relapse had occurred after a median observation period of 30 months. Immunohistological staining for placental alkaline phosphatase disclosed the absence of TIN in the parenchyma surrounding the cysts.

Conclusion The absence of TIN calls into question the common assumption that an epidermoid cyst constitutes a monodermal teratoma. Two distinct entities of epidermoid cyst are proposed ‐ one occurring in conjunction with a teratoma or a germ cell tumour (a ‘complex’ or ‘mixed’ epidermoid cyst) and the other a ‘simple’ epidermoid cyst without TIN in the adjacent tissue and thus representing a benign neoplasm that is not a teratoma. The absence of TIN near a simple epidermoid cyst justifies testis‐sparing surgery.
Dopamine D1and D2receptors in the human ureter and urinary bladder: a radioligand binding and autoradiographic study
Authors: ESCAF S. , CAVALLOTTI C. , RICCI A. , VEGA J.A. , AMENTA F.
Published: November 2008

ObjectiveTo analyse the pharmacological profile and the anatomical localization of the dopamine D, and D, receptors in sections of the pelvic part of the ureter and of the fundus of the urinary bladder.

Patients, materials and methodsSamples of the pelvic part of the ureter and of the fundus of the urinary bladder were taken in men (age range 61k4 years) who were undergoing lower urinary tract surgery. Biochemical characterization and autoradiographical techniques were used on frozen sections of the ureter or the urinary bladder. [3H]‐SCH 23390 was used as a ligand of dopamine D, receptors and [3H]‐spiroperido1 as a ligand of dopamine D2 receptors.

Results[3H]‐SCH 2 3 390 and [3H]‐spiroperidol were bound by specific sections of the ureter and of the urinary bladder. The pharmacological profile of the binding was consistent with the labelling of D, and D, receptors respectively. Light microscope analysis of the localization of D1 and D2 receptors revealed the accumulation of the two radioligands in the tunica muscularis of the ureter or of the urinary bladder. Conclusion A possible role of the dopaminergic system in the control of urine flow and of some dysfunctions of the lower urinary tract is suggested.
The scope and place of ultrasound‐monitored extracorporeal shock wave lithotripsy in a multimodality setting and the effects of experiential, audit‐evoked changes on the management of ureteric calculi
Authors: TALATI J. , KHAN L.A. , NOORDZIJ J.W. , MOHAMMAD N. , MEMON A. , HOTIANA M.Z.
Published: November 2008

Objective To assess the results from ultrasound‐monitored extracorporeal shock wave lithotripsy (ESWL) for ureteric stones, to compare the results with other treatment modalities and to evaluate experiential audit‐evoked gains.

Patients and methods A review of the records of 109 patients with ureteric stones who were treated during 1990 (Group I) and 69 patients treated by ESWL during the first 10 months of 1991 (Group II), was carried out. All patients with a steinstrasse or fragments secondary to ESWL were excluded from the study.

Results Of the 109 patients in Group I, 63 were treated with ESWL, nine underwent ureteroscopic push‐up of the stone and 11 underwent catheter push‐up prior to ESWL, 28 underwent ureteroscopic extraction/fragmentation, five underwent post‐ESWL ureteros‐copy and 29 underwent open ureterolithotomy (nine after failed ureteroscopy). Ureteroscopy was successful in fragmentation/extraction of 19 of 28 (68%) stones and 95% of patients were stone‐free at 3 months. All patients who underwent ureterolithotomy and 84% who underwent ESWL (and post‐ESWL ancillary procedures) were stone‐free at 3 months. All patients who underwent ureterolithotomy, 51% of those who underwent ureteroscopy and 56% of patients who underwent ESWL needed only one treatment. The mean stone burdens of patients in Groups I and II were comparable but more patients presented with larger stones (< 15 mm length, > 100 mm2 surface area) in Group II. The stone‐free rates for ESWL monotherapy with ESWL increased from 84% in 1990 to 92% in 1991. A higher proportion of stones were treated in situ in 1991 and a stent was used less frequently in obstructed ureters. Post‐ESWL procedures fell from 8% in 1990 to 6% in 1991 and the proportion of patients who required more than one treatment fell from 44% in 1990 to 14% in 1991.

Conclusions The choice of treatment for patients with ureteric stones is critical but will vary depending on the individual's circumstances, the availability of equipment, costs and time required to perform the procedure. The results obtained using ESWL for ureteric stones improved considerably over the course of the study as a result of experience and refinement of the technique. Stones located in more difficult systems such as in kidneys with a thin cortex and those located above the ischial spine were no longer subjected to ESWL. Audit of the results obtained following treatment allows identification of problem areas, alerts physicians to alternative methods of treatment and gives an objective quantification of experience, assisting rational decision making with consequent improved success.
In situ echoguided extracorporeal shock wave lithotripsy of ureteric stones with the Dornier MPL 9000: a multicentric study group
Authors: FRABBONI R. , SANTI V. , RONCHI M. , GAIANI S. , COSTANZA N. , FERRARI G. , FERRARI P. , CORRADO G. , CONCETTI S. , FORNAROLA V.
Published: November 2008

Objective To study the efficacy of the Dornier MPL 9000 lithotripter with a real time ultrasound transducer in the localization and treatment of upper and prevesical ureteric stones.

Patients and methods Two‐hundred and eighty‐five patients with pre‐vesical ureteric stones and 247 patients with upper ureteric stones underwent extracorporeal shock wave lithotripsy (ESWL) using ultrasound targeting, under no regional or general anaesthesia.

Results At follow‐up after 3 months 9 7% of patients with pre‐vesical stones and 96% with upper ureteric stones were stone free. Ninety‐nine patients were treated more than once. The average number of sessions of ESWL for all patients was 1.19 (1.17 for patients with prevesical stones and 1.22 for those with upper ureteric stones). Ureteric stenting was employed in 6% of cases. The infrequent use of ureteric stenting did not reduce ESWL efficacy, nor increase either the complication or the retreatment rates. In many cases upper urinary tract dilatation was provoked by administering intravenous fluid and a diuretic.

Conclusion
In situ echoguided ESWL is a simple, safe and effective technique for treating ureteric stones which can be detected on ultrasound
Pressure, volume and infusion speed criteria for the ice‐water test
Authors: GEIRSSON G. , LINDSTRÖM S. , FALL M.
Published: November 2008

Objective To define pressure, volume and infusion speed criteria for the ice‐water test (IWT).

Patients and methods In this prospective clinical study, cystometry and IWTs were performed in 115 patients.

Results The critical response for a positive IWT was found to be a peak detrusor pressure above 30 cm H2O, with or without fluid leakage. Neither the infusion speed nor the infused volume was critical for the outcome of the test provided that the bladder wall was sufficiently cooled.

Conclusion The IWT is a rapid, simple and robust test, whose results are easy to interpret. The test increases the precision of urodynamic diagnosis, especially in patients with an overactive detrusor dysfunction, at a small cost.
Abnormalities in p53 and DNA content in transitional cell carcinoma of the bladder
Authors: MELLON K. , WILKINSON S. , VICKERS J. , ROBINSON M.C. , SHENTON B.K. , NEAL D.E.
Published: November 2008

Objective To determine if transitional cell tumours of the bladder which contain mutations in the p53 gene have alterations in their DNA content.

Materials and methods In 33 transitional cell tumours of the bladder, DNA content was determined by flow cytometry and compared with expression of mutant p53 as assessed by immuno‐histochemistry.

Results Abnormal DNA content was associated with increased staining for p53 (P < 0.05), high tumour stage (P < 0.001) and increased histological grade (P < 0.01). Although positive staining for p53 was frequently associated with abnormal DNA content, a significant number of non‐diploid tumours stained negatively for mutant p53.

Conclusion These data demonstrate that increased staining for p53 is associated with abnormalities in DNA content suggesting that mutation of the p53 gene is associated with an increased rate of chromosomal abnormalities and an increased rate of cell proliferation.
Microsurgical arterio‐arterial and arterio‐venous penile revascularization in patients with pure arteriogenic impotence
Authors: JANSSEN Th. , SARRAMON J.P. , RISCHMANN P. , BENNIS S. , MALAVAUD B.
Published: November 2008

Objective To restore physiological erection by performing microsurgical penile revascularization.

Patients and methods The records of 21 patients with pure arteriogenic impotence were reviewed. Thirteen patients with localized obstruction of the internal pudendal or common penile artery underwent a Michal II arterio‐arterial penile revascularization. Eight patients with a more distal arterial obstruction underwent a penile deep dorsal vein arterialization (DDVA). The mean follow‐up period was 22 months. Surgery was considered successful when the patients had a permeable anastomosis and were able to achieve satisfactory erections resulting in normal intercourse.

Results Potency was restored in eight of the 13 patients who had a Michal II procedure and in five of the eight patients who had a DDVA. Under antithrombotic therapy graft occlusion occurred in four patients.

Conclusion Microsurgical penile revascularization restored erectile function in two‐thirds of patients in this study. However, further research must be performed to reach a greater understanding of the revascularization process.
The distribution of elastic fibrous elements within the human penis
Authors: HSU G.‐L. , BROCK G. , HEYDEN B. VON , NUNES L. , LUE T.F. , TANAGHO E.A.
Published: November 2008

Objective To determine the distribution of elastic fibres in the tunica albuginea and the erectile tissue of the penis.

Materials and methods Samples of tunica albuginea or penile erectile tissue were taken from seven cadavers and five patients undergoing surgery. Light and electron microscopy were performed.

Results There were two anatomical regions in which elastic fibres were seen rarely: the proximal crus and the distal tunica. In the rest of the corpora cavernosa where the tunica was more compliant, the elastic fibres were in relative abundance. In the corpus spongiosum, abundant irregularly oriented elastic fibres were present; the densest elastic network was found in the glans penis and was composed of coarse elastic fibres. A perisinusoidal fibroelastic shell was seen in the glans, which was probably an extension of Buck's fascia. The elastic components within the sinusoids (cavernosal, spongiosal, and glanular) were similar but finer than the elastic lamellae in the penile arterial wall.

Conclusion The elastic fibres were unevenly distributed, often forming an irregular network on which the collagen component rested. Elastic fibres were more abundant in the corpus spongiosum, around the blood vessels and surrounding the sinusoid of the corpus cavernosum.
Salvage radical prostatectomy in the management of locally recurrent prostate cancer after 125I implantation
Authors: Brenner P.C. , Russo P. , Wood D.P. , Morse M.J. , Donat S.M. , Fair W.R.
Published: November 2008

Objective To define the role of salvage prostatectomy in patients who have locally recurrent prostate cancer following pelvic lymph node dissection and 125 implantation.

Patients and methods Over 1000 patients underwent 125I implantation for localized prostate cancer at the Memorial Sloan Kettering Cancer Center between 1970 and 1986. Salvage radical prostatectomy was performed in a highly selected group of 10 patients with locally recurrent disease.

Results Three of the 10 patients had organ‐confined residual prostate cancer following salvage radical prostatectomy. The remaining seven patients had extra‐prostatic disease including four patients with positive surgical margins. Two patients with organ‐confined disease and one with extracapsular tumour had no evidence of locally recurrent or metastatic disease and continue to have undetectable prostate‐specific antigen (PSA) levels at 50, 44, and 31 months following salvage radical prostatectomy. After a mean follow‐up of 30 months, the remaining seven patients had a rising PSA level consistent with locally persistent and/or metastatic disease (median 5 ng/mL; range 1.0–144). This PSA elevation occurred within 20 months of salvage radical prostatectomy (median 6 months). Two of these patients developed clinically evident bone metastases.

Conclusion Salvage radical prostatectomy, although technically feasible in highly selected patients, should not be widely advocated as an effective treatment option for patients with locally recurrent prostate cancer after 125 implantation.
Quality of life 12 months after radical prostatectomy
Authors: Braslis K.G. , Santa‐Cruz C. , Brickman A.L. , Soloway M.S.
Published: November 2008

Objective To evaluate the impact of radical prostatectomy (RP) upon quality of life (QOL) in patients with prostate cancer.

Patients and methods Seventy‐nine patients with prostate cancer were recruited to evaluate the impact of RP upon QOL. The patients comprised two groups: the first group (n= 51) was evaluated 12 months or longer after RP; and the second group (n= 28) was evaluated 1 month prior to RP. All patients completed two previously reported QOL measures: the Functional Living Index Cancer (FLIC) and Profile of Mood States (POMS), and a series of questions which evaluated bladder, bowel and sexual function.

Results Comparison of patients before RP with those after RP at 12 month follow‐up revealed significant (P<0.05) deterioration in sexual function, continence and hardship scores following RP while tension scores improved significantly. Although 10 other subscale parameters were analysed, no other differences were observed. Of the 51 post‐RP patients, 46 (90%) stated that given a choice they would have their surgery again.

Conclusion The Results reported show that RP has minimal overall impact upon patient QOL. Although minimal voiding and bowel dysfunction was reported, many patients were dissatisfied with post‐operative sexual function.