bluuebunny/crossref_metadata_2025 huggingface dataset:
Fertility and histological studies in a unilateral cryptorchid rat model during early and late adulthood
Authors: Zakaria  , Shono  , Imajima  , Suita
Published: March 2003

Objective

 To investigate the effect of age on fertility and testicular development in rats with untreated unilateral undescended testes.

Materials and methods

 Newborn male Wistar King‐A rats were divided into two groups. In group 1, a mechanical model of unilateral undescended testis was created by performing extra‐abdominal fixation of the gubernaculum in the neonatal period, and in group 2, sham‐operated rats were used as controls. At 90 days old (early adulthood), the fertility of both groups was assessed by mating the rats with mature virgin females for 2 weeks. Thereafter, some of the rats were killed and their testes examined histologically, while the remaining rats were allowed to develop further. At the age of 180 days (late adulthood), fertility was re‐assessed in the same way. All the rats were then killed and their testes removed for histological examination.

Results

 There was no significant difference in pregnancy rate of females mated with males from either group in early adulthood. However, in late adulthood there was a significant reduction in pregnancy rate in females coupled with cryptorchid rats compared with that of females coupled with control rats. There was a significant degeneration of the unilateral cryptorchid testes compared with control testes in both early and late adulthood. In contrast, there were no significant changes in histological development between the contralateral scrotal testes and the controls in early adulthood, although they were significantly different from the controls in late adulthood.

Conclusion

 These results suggest that fertility is affected by ageing in untreated unilateral cryptorchidism; this may be induced by extensive damage not only in the undescended testes, but also in the contralateral scrotal testis, in this mechanically induced model of unilateral cryptorchidism.
Clinical aspects associated with Sertoli‐cell‐only histology
Authors: Bettocchi  , Parkinson  , Ralph  , Pryor
Published: March 2003

Objective

 To assess the clinical features found in infertile men in whom the histological diagnosis of Sertoli‐cell‐only (SCO) was made on testicular biopsy.

Patients and methods

 A retrospective review was carried out of the seminal fluid analysis, testis size and follicle‐stimulating hormone (FSH) levels of 72 men who had bilateral testicular biopsies due to infertility when one (30) or both (42) of bilateral testicular biopsies showed tubules containing only Sertoli cells. In a subgroup of 15 men, the biopsies were re‐examined to correlate the morphological features with the plasma FSH level.

Results

 When both biopsies showed bilateral SCO the patient had azoospermia (86%) or oligozoospermia (14%); the testicular size was normal in 36% and the FSH level was normal (43%), raised (21%) or grossly elevated (more than twice normal, 36%). When one biopsy showed SCO, the opposite testis showed appearances which varied from grossly impaired spermatogenesis to almost normal spermatogenesis. The clinical findings were also very variable.

Conclusions

 The clinical features associated with the histological diagnosis of SCO are extremely variable. Biopsy evidence of bilateral SCO cannot be relied upon to indicate a total absence of spermatogenesis in the testes.
The physicochemical basis of urinary catheter encrustation
Authors: Choong  , Hallson  , Whitfield  , Fry
Published: March 2003

Objectives

To determine the relationship between urinary pH and Ca2+ solubility in urine samples from patients who experienced either frequent (‘blockers’) or infrequent (‘nonblockers’) catheter blockage by crystalline deposits of divalent cation salts.

Materials and methods

Fresh urine samples from ‘blockers’ and ‘nonblockers’ were collected and the ionic calcium concentration ([Ca2+ ]) measured using a Ca2+‐selective electrode whilst the urinary pH was increased in 0.25 increments between 4.75 and 9.00. The pH at which crystallization occurred (nucleation) was determined and crystal composition analysed.

Results

The mean (sd) voided urinary pH of catheter ‘blockers’ was significantly more alkaline than that from ‘nonblockers’, at 7.63 (0.64) and 5.97 (0.80), respectively (P=0.001). The nucleation pH of catheter ‘blockers’ was significantly more acid than in ‘nonblockers’, at 7.43 (0.73) and 6.45 (0.65), respectively (P=0.005). Urine from ‘blockers’ had significantly more Ca phosphate and Mg ammonium phosphate crystals. ‘Blockers’ were further divided into two subsets with and without urease‐based urinary tract infection; both showed a decrease in the nucleation pH.

Conclusion

In the urine from ‘nonblockers’ there is a wide safety margin between voided and nucleation pHs; this margin was less in the urine from ‘blockers’. This reduction in the safety margin arises partly because the voided pH in those with a urinary tract infection is more alkaline. However, the decrease in the nucleation pH also suggests that a fundamental property of urine is altered, which reduces Ca2+ solubility at more neutral pH values. The long‐term goal is to increase the nucleation pH of catheter ‘blockers’ and increase the margin of safety.
Radical cystoprostatectomy combined with Mainz pouch bladder substitution to the urethra: long‐term results
Authors: Leissner  , Stein  , Hohenfellner  , Köhl  , Riedmiller  , Schröder  , Lampel  , Thüroff
Published: March 2003

Objective

To analyse, in a retrospective study, the oncological outcome, pouch‐related complications, continence and micturition after radical cystoprostatectomy combined with Mainz pouch orthotopic bladder substitution to the urethra for the treatment of bladder cancer.

Patients and methods

Between 1986 and 1996, three urological departments contributed 108 male patients to the review. The same exclusion criteria from orthotopic bladder substitution were applied by all centres, i.e. multifocal or concomitant carcinoma in situ, tumour at the bladder neck, positive biopsy from the prostatic urethra, locally advanced tumour and lymph node involvement. In all, 103 patients were evaluable for follow‐up, with a mean (range) follow‐up of 42 (3–132) months.

Results

Pathological examination of the cystectomy specimen revealed 81% organ‐confined tumours. During follow‐up, 84% of patients remained free of tumour, 7% developed distant metastases, 5% local recurrences, 4% urethral recurrences, and 1% upper tract urothelial cancer; 85% of patients are capable of spontaneous voiding, with a mean pouch capacity of 720 mL. Daytime continence was achieved in 88%, including 17% wearing one safety pad; 9% had stress incontinence and 3% total incontinence; 67% could sleep through the night, with either complete continence (34%) or one safety pad (33%). Nocturnal incontinence occurred in 11%. Uretero‐intestinal stenosis occurred in 15 of 205 (7%) renal units, requiring ureteric reimplantations in 11, nephrectomy in three and antegrade dilatation in one. Reflux was not noted in any patient. About half the patients were on anti‐acidotic prophylaxis.

Conclusion

The large bowel segment in the Mainz‐pouch technique of orthotopic bladder substitution provides good reservoir capacity and continence rates, with less ileum used than in all‐ileum pouches. The surgical technique is simple and reproducible, and in particular the antireflux ureteric implantation into the caecum protects the upper urinary tracts.
The incidence of hypospadias in two English cities: a case‐control comparison of possible causal factors
Authors: Chambers  , Malone
Published: March 2003

Objectives

To determine the incidence and severity of hypospadias amongst children born in Southampton and Portsmouth during 1992–94, and to identify possible causal factors by comparing patients with a control group.

Patients and methods

All patients with hypospadias born in Southampton and Portsmouth during 1992–94 were identified. The Southampton cases were matched with controls; the case notes of each affected child were reviewed. The incidence determined by this study was compared with data provided by the Central Statistics Office.

Results

There was no apparent increase in the incidence of hypospadias in Southampton and Portsmouth during 1982–94. However, there was a clear local variation in incidence, with a significantly lower incidence in Portsmouth than in Southampton and the rest of England and Wales. The severity of hypospadias was also more marked in Southampton than in Portsmouth. The only recognisable aetiological factor was a positive family history, supporting the concept of a polygenic mode of inheritance. All the environmental factors investigated were unrelated, but there was a suggestion of clustering in a single water‐quality zone.

Conclusions

This study identified no increase in the incidence of hypospadias but it did detect local variations in both the incidence and severity of the condition, and these need to be considered when planning surgical services.
Gonadal morphology in cloacal exstrophy: implications in gender assignment
Authors: Mathews  , Perlman  , Marsh  , Gearhart
Published: March 2003

Objective

To compare the histology of gonads excised from males with cloacal exstrophy (the most severe variant of the exstrophy‐epispadias complex) undergoing early gonadectomy and gender reassignment (to obviate difficulties in reconstructing male external genitalia) with those published previously.

Patients and methods

Testicular tissue was obtained from males with cloacal exstrophy undergoing gender reassignment shortly after birth. Slides were stained for histological evaluation and reviewed by one author. The histology was compared with known normal features for newborn testicular tissue. The mean age at the time of gender reassignment was 6 months.

Results

There were no significant abnormalities in the architecture of the rete testis, epididymis or vas of the study specimens. There were more germ cells in some patients with cloacal exstrophy, but this finding was not specific and is of unknown clinical significance.

Conclusions

Despite the severity of the malformations in cloacal exstrophy, testicular histology is preserved. In highly selected genotypic males who have adequate phallic structures, congruent gender assignment is appropriate and early orchidopexy is recommended.
A prospective study of nonmedical prophylaxis after a first kidney stone
Authors: Kočvara  , Plasgura  , Petřík  , Louženský  , Bartoníčková  , Dvořáček
Published: March 2003

Objective

To assess, in a multicentre prospective randomized study, the effectiveness of specific nonmedical prophylaxis and nonspecific dietary prophylaxis in patients treated after experiencing their first idiopathic calcium‐containing kidney stone.

Patients and methods

From 1991 to 1994, 242 patients with idiopathic calcium urinary stones from three urological centres were randomly assigned into two groups. In group 1 (intervention, 113 patients), a specific dietary regimen was recommended and thereafter corrected according to a comprehensive metabolic evaluation. Group 2 (control, 94 patients) underwent only minimal metabolic screening and used general dietary measures, with no regular follow‐up. An increased fluid intake was recommended in both groups. After 3 years, the effectiveness of the prophylactic and dietary regimens was evaluated in 207 patients.

Results

At entry, the clinical characteristics were comparable in the two groups, with only extracorporeal lithotripsy being more frequent in group 2. Almost 80% of patients reported a high intake of meat and a low intake of dairy products. In group 1 and 2, a recurrent stone was encountered in seven (6%) and 18 (19%) patients, respectively; recurrent and growing stones were found in eight (8%) and 22 (23%) patients, respectively (P<0.01). There was a higher incidence of bilateral residual (or untreated) stones, and Weddellite stones (P<0.001) among patients with a recurrent or growing stone. An analysis of the dynamics of the metabolic variables indicated the significance of repeated dietary counselling.

Conclusion

Specific dietary therapy, adjusted according to a metabolic evaluation, is more effective than nonspecific general dietary recommendations in preventing the formation of a second urinary stone.
Comorbidity in patients with prostate cancer and its relevance to treatment choice
Authors: Post  , Kil  , Hendrikx¶  , Janssen‐Heijnen  , Crommelin  , Coebergh
Published: March 2003

Objective

 To evaluate the prevalence of comorbidity among patients with prostate cancer in relation to tumour and patient characteristics and to assess if comorbidity was a determining factor in the treatment choice for patients with localized prostate cancer.

Patients and methods

 Serious comorbidity was recorded in the Eindhoven Cancer Registry (according to a published list of such diseases) for all patients (2941) with prostate cancer newly diagnosed between 1993 and 1996 in the southern part of The Netherlands. Logistic regression was then used to assess which factors determined the treatment choice.

Results

 The prevalence of at least one serious comorbid condition was 38% for patients aged 60–69 years, 48% when aged 70–74 years and 53% for those aged ≥75 years, the cardiovascular and chronic obstructive lung diseases being most frequent. Patients aged 60–69 years were more likely to be treated with radical prostatectomy for moderately differentiated tumour confined to the prostate, or when younger and diagnosed in a hospital with a high case‐load. The presence of comorbidity had little influence of this choice.

Conclusion

 Comorbidity was common in patients with prostate cancer, but the decision of urologists in the southern Netherlands to use radical prostatectomy was determined largely by the patient’s age and the urologist’s experience.
Intraurethral sphincter prosthesis to treat hyporeflexic bladders in women: does it work?
Authors: Schurch  , Suter  , Dubs
Published: March 2003

Objective

 To assess the efficacy and safety of a new intraurethral sphincter prosthesis to treat hyporeflexic bladders in women.

Patients and methods

 Between July 1997 and December 1998, 18 women (mean age 45.8 years, range 26–84) with neurogenic voiding disorders and a hyporeflexic bladder were examined prospectively. All but one patient (who used the Crédé manoeuvre) emptied their bladder using clean intermittent catheterization. The women were fitted with a prosthesis consisting of a valve and a pump inside a short self‐retaining silicone device, which was activated by a magnetic remote control unit. The evaluation before implantation comprised a medical history, a neurological evaluation, urodynamic recordings and urine cultures. The follow‐up after implantation included a monthly clinical assessment, a symptom questionnaire, urine culture, ultrasonographic examinations and replacement of the device if necessary. Urine samples were also cultured if there was any discomfort or fever.

Results

 At 16 months of follow‐up, only six of 18 patients continued to use the implant (mean follow‐up 9.6 months) and were satisfied. In 10 patients major incontinence around the catheter, or irritation, led to removal of the device. Two patients were unable to learn how to transfer to the toilet to empty their bladder; therefore, their implant was removed and they were treated with a suprapubic catheter. Two patients died from unrelated causes. Twelve patients had positive bacteriuria while fitted with the device; six of them became symptomatic. Usually, only symptomatic lower urinary tract infections were treated. Technical problems occurred often; 14 catheters showed technical dysfunction and had to be replaced early and three external remote control units broke for no reason. Despite normal short‐term cystoscopic findings (three patients), long‐term urethral damage cannot be excluded. Indeed, the six patients who remain fitted with the device already show some widening of their urethra.

Conclusion

 This experience with the new device was disappointing; in eight of the 18 patients incontinence appeared or worsened and led to removal of the device. Technical problems were common. The other concern is that significant long‐term urethral damage could be expected, as observed with indwelling catheters over time. Thus, although this device may function for a short period, it is unsuitable for long‐term use.
Hybrid laser treatment compared with transurethral resection of the prostate for symptomatic bladder outlet obstruction caused by a large benign prostate: a prospective, randomized trial with a 6‐month follow‐up
Authors: Tuhkanen  , Heino  , Alaopas
Published: March 2003

Objective

 To compare the efficacy and safety of hybrid laser treatment, i.e. the combination of visual Nd‐YAG laser ablation of prostate and contact Nd‐YAG laser vaporization of prostate, with transurethral resection of the prostate (TURP) in the treatment of patients with symptomatic bladder outlet obstruction secondary to a benign high‐volume prostate.

Patients and methods

 Forty‐five symptomatic patients with hyperplastic prostates of >40 mL were randomized to undergo either hybrid laser treatment (21) or TURP (24). All patients were evaluated before and after treatment with a complex urodynamic assessment, and were accepted into the study only if they had infravesical obstruction in the pressure‐flow study. In the hybrid method, Nd‐YAG laser energy was first delivered by an ‘adenoma‐dependent’ approach to all areas of the obstructing lateral lobe tissue through a side‐firing gold‐alloy tip fibre at 40 W for 90 s of ‘burn’. The prostatic urethra was then opened and the median lobe vaporized using the a contact probe at 40 W. Patients were re‐evaluated 3 and 6 months after treatment.

Results

 Both treatments proved to be safe, and improved the subjective and objective outcome measures at 3 and 6 months compared with baseline values. After 3 months, there was a greater improvement in the TURP group in peak urinary flow rate (Qmax ; P<0.01), mean urinary flow rate (Qave ; P<0.01) and postvoid residual urine volume (P<0.05) than in the hybrid laser group. After 6 months, there was a greater improvement in the TURP group in detrusor pressure at Qmax (P<0.01), Qave (P<0.05) and prostate size (P<0.001) than in the hybrid laser group. In the pressure‐flow study at 6 months, a higher proportion of patients (seven of 19) were still obstructed in the hybrid laser group than in TURP group (two of 21; P<0.05). TURP caused more intraoperative blood loss (P<0.001) and postoperative problems associated with bleeding; 38% of hybrid laser patients were discharged with a suprapubic catheter, whereas all TURP patients could urinate at discharge (P<0.01). The duration of bladder drainage was longer after hybrid laser treatment (P<0.001).

Conclusion

 The hybrid laser method was a safe but less effective treatment than TURP for benign prostatic enlargement in patients with prostates of >40 mL.
The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction
Authors: Pfister  , Dacher  , Gaucher  , Liard‐Zmuda  , Grise  , Mitrofanoff
Published: March 2003

Objective

To report our experience of assessing children with chronic voiding dysfunction (>6 months’ duration) using a minimal urodynamic evaluation, and the management of detrusor‐sphincter dyscoordination (DSdc) using pelvic floor biofeedback.

Patients and methods

From 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto‐urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory.

Results

DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico‐ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re‐education in four.

Conclusion

A minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.
Distribution of α1‐adrenoceptor subtype mRNAs in human renal cortex
Authors: Kurooka  , Moriyama  , Nasu  , Kameyama  , Fukasawa  , Yano  , Kawabe
Published: March 2003

Objective

To determine the quantity and distribution of α1‐adrenoceptor subtype mRNAs in human renal cortex.

Materials and methods

Specimens of renal cortex tissue were obtained at the time of radical nephrectomy or total nephroureterectomy from 46 patients (mean age 59.0 years, sd 14.7) with renal cell carcinoma, renal pelvic or ureteric tumour. Using the reverse‐transcriptase polymerase chain reaction (RT‐PCR), the RNase protection assay and in situ hybridization, the presentation, quantity and distribution of α1‐adrenoceptor subtype mRNAs were determined.

Results

Expression of the three α1‐adrenoceptor subtype mRNAs (α1a, α1b and α1d) was confirmed in the arteries of the renal cortex (arciform, interlobular, arteriole), but among the three subtypes, the α1b was less apparent by in situ hybridization. Intense α1‐mRNA staining was apparent especially in the smooth muscle of arterial walls. In both proximal and distal renal tubules, each of the α1‐mRNAs was less marked in cytoplasm than in the arteries. In the glomeruli weak staining was detected in the endothelium but there was no obvious staining in the veins. RT‐PCR showed all three subtypes of α1‐adrenoceptor. The RNase protection assay showed that the predominant α1‐adrenoceptor subtype mRNA in human renal cortex was α1a. However, the abundance of α1a‐mRNA in human kidney was much less than in the prostate.

Conclusion

Three α1‐adrenoceptor subtype mRNAs were recognized in human renal cortex and detected particularly in the smooth muscle of the arteries. There was more α1a‐adrenoceptor subtype in human renal cortex than the other subtypes. It is not known how each subtype operates against adrenergic stimulation; further studies are needed to examine receptor density or receptor function.
Effects of androgens on the expression of nitric oxide synthase mRNAs in rat corpus cavernosum
Authors: Park  , Kim  , Kim  , Paick
Published: March 2003

Objective

To examine the effects of androgens on erectile response and the expression of nitric oxide synthase (NOS) isoform mRNAs in the penile corpus cavernosum of castrated rats.

Materials and methods

The study comprised 50 adult male Sprague‐Dawley rats in five groups: sham controls; castrated; castrated and receiving testosterone; castrated and receiving dihydrotestosterone (DHT); castrated and receiving testosterone and 5α‐reductase inhibitor (finasteride). Androgen replacements were administered via implants of silicone tubing. After 7 days, some animals underwent electrical stimulation of the cavernosal nerves and the remainder were used for further analysis. NOS activity was measured in the soluble fraction of the corpus cavernosum, using the Griess reaction. Total RNA was isolated and nNOS and eNOS mRNA expression examined using semiquantitative reverse‐transcriptase polymerase chain reaction.

Results

Castration caused a marked decrease in erectile response and the ratio of maximal intracavernosal pressure (ICPmax) to systemic blood pressure (SBP), although both testosterone and DHT effectively restored the response to normal. NOS activity and the amount of nNOS mRNA were reduced in castrated rats but restored by androgen replacement. Although there was no significant difference in NOS activity between the androgens, nNOS mRNA expression was higher in rats treated with DHT. There were no effects of androgen in rats treated with finasteride, as the ICPmax/SBP ratio, NOS activity and amount of nNOS mRNA decreased. eNOS mRNA expression was independent of androgen.

Conclusions

Androgens enhance nNOS gene expression in the penile corpus cavernosum of rats, suggesting that they play an important role in maintaining NOS activity. Of the two androgens, DHT was more potent.
Paternity after bilateral vasectomy
Authors: Verhulst  , Hoekstra
Published: March 2003

Objectives

To determine whether the occurrence of recanalization depends on the technique of vasectomy.

Materials and methods

A survey was conducted among Dutch urologists using a questionnaire in which information was gathered about the surgical procedure, postoperative complications, results of semen analysis after vasectomy, time between vasectomy and occurrence of paternity, results of semen analysis after paternity, performance of revasectomy, results of histological examination of the revasectomy specimen and whether the event had changed the protocol of the urologists.

Results

In all, 32 cases of paternity after vasectomy were registered. Surgical techniques and the criteria for a successful vasectomy differed among the responding urologists. There was a difference in time to paternity between men who did and did not correspond with the criteria. In most cases, semen analysis after paternity showed numerous motile sperm. Six men initiated litigation after paternity and the vasectomy protocol was modified by five urologists.

Conclusion

Paternity consequent on recanalization can occur at any time after bilateral vasectomy and does not depend on the surgical procedure or criteria for sterility. Because of the major consequences of paternity after vasectomy for both the man and urologist, accurate information about the possibility of recanalization should be given to the man beforehand.
Optimal conditions for the long‐term modulation of the micturition reflex by intravesical electrical stimulation: an experimental study in the rat
Authors: Jiang  , Lindström
Published: March 2003

Objective

To determine whether induced bladder contractions influence the modulation by intravesical electrical stimulation (IVES) of the micturition reflex in anaesthetized rats, and to identify the optimal IVES frequency and duration.

Materials and methods

Seventy‐six adult female rats, anaesthetized by α‐chloralose, were divided into four groups to study the effect of: (i) IVES in combination with bladder contractions; (ii) bladder contractions alone; (iii) IVES frequency; and (iv) IVES duration. IVES was administered using a catheter electrode in the bladder. The effect of various IVES procedures was evaluated by determining the micturition threshold volume obtained from repeated cystometries before and after stimulation.

Results

Administering IVES with standard parameters induced a significant decrease in the micturition threshold volume for about an hour. There was no difference in outcome between IVES with the bladder filled and contracting during the stimulation or empty and not contracting. Imposed bladder contractions per se had no effect on the micturition threshold volume. IVES at low frequencies (≤20 Hz) had a better modulatory effect than higher frequencies and the optimum duration of IVES was 5 min.

Conclusions

Evoked bladder contractions did not improve the IVES‐induced modulation of the micturition reflex. These findings might help to improve the clinical application of the IVES procedure.
The management of brain metastasis in nonseminomatous germ cell tumours
Authors: Mahalati  , Bilen  , Özen  , Aki  , Kendi
Published: March 2003

Objective

To review our experience of patients with brain metastases from nonseminomatous germ cell tumours (NSGCTs) and to indicate important clinical observations.

Patients and methods

Between 1990 and 1996, 167 patients with metastatic NSGCT were treated in our department; 11 had brain metastases (eight with solitary metastases and three with multiple lesions, mean age 27 years, range 18–41). These patients were treated initially with either; cisplatin, bleomycin, etoposide and/or cisplatin, vincristin, methotrexate, bleomycin, actinomycin‐D, cyclophosphamide, etoposide and intrathecal methotrexate chemotherapy protocols. Six patients received chemotherapy alone, one had chemotherapy plus radiotherapy and four had all three treatments. Patients with brain metastases were classified according to mode of presentation, and their treatments and outcomes analysed.

Results

Ten patients presented with symptoms related to intracranial lesions, e.g. intractable headache, seizures, severe vomiting, hallucinations and hemiparesis. All patients with brain metastasis had bulky thoracic disease. The incidence of clinical brain metastases in patients with advanced thoracic disease was 32% (11/34). Four patients with brain metastases at presentation were alive after 3, 12, 34 and 47 months. The only patient with isolated brain relapse died within 7 months, despite combined treatment. Two of the five patients who developed brain metastases during the course of the disease are alive with no evidence of disease at 3 and 6 months after salvage chemotherapy.

Conclusion

Patients with single brain metastasis seem to have a better prognosis in the present than in other reported series. Chemotherapy was used initially, followed by surgery and radiotherapy in those who did not achieve complete remission with chemotherapy. Patients with progressive disease and multiple brain metastasis do not seem to benefit from initial surgical resection. Importantly, a significant proportion (32%) of patients with bulky lung metastases had or subsequently developed brain metastases. Thus it is suggested that routine cranial imaging should be performed in patients with bulky thoracic disease.
Diagnosis and prediction of recurrence and progression in superficial bladder cancers with DNA image cytometry and urinary cytology
Authors: Desgrippes A. , Izadifar V. , Assailly J. , Fontaine E. , Beurton D.
Published: March 2003

ObjectiveTo investigate the roles of urinary cytology and image cytometric analysis of nuclear DNA ploidy pattern in the diagnosis and prediction of recurrence and/or progression of superficial bladder cancers.

Patients and methodsAliquots of catheterized urine from 92 patients with primary (23) or previous (69) superficial bladder cancers were assessed using urine cytology and image‐analysis cytometry independently.

ResultsOf the 23 primary superficial transitional cell carcinomas (TCCs), 11 (48%) were detected by urinary cytology while 12 (52%) were detected by image‐analysis cytometry (P > 0.05) and 13 (57%) were revealed by combined cytology and cytometry. Of 42 recurrent superficial TCCs, 29 (69%) were detected by urinary cytology, whilst 19 (45%) were diagnosed by cytometry (P < 0.05) and 29 (69%) by combined cytology and cytometry. The degree of ploidy in relation to pathological stage and/or grade showed an increasing frequency of aneuploid pattern in more invasive and undifferentiated tumours, but with no statistical significance (P > 0.05). The positivity of DNA image cytometry had no significant association (P > 0.05) with tumour recurrence and/or progression.

ConclusionsDNA image cytometry can provide a limited but not significant advantage over urinary cytology in the detection of primary superficial TCCs, but it does not seem to be indicated for the prediction of tumour recurrence and/or progression.
Cremaster muscles obtained from boys with an undescended testis show significant neurological changes
Authors: Tanyel F.C. , Erdem S. , Büyükpamukçu N. , Tan E.
Published: March 2003

Objective To compare cremaster muscles (CMs) obtained from boys with inguinal hernia, hydrocele or an undescended testis and those obtained from girls with inguinal hernia, thus defining the changes associated with each clinical condition.

Materials and methods CM samples were obtained from 26 boys and three girls with inguinal hernia, and 18 boys who had undergone surgery for an undescended testis (12) or hydrocele (six). The samples were frozen in isopentane cooled in liquid nitrogen and were processed for sectioning by cryostat. Sections (12 µm) were stained with a several histochemical stains. The presence of central nuclei, fibre splitting, basophilic fibres, fibre necrosis, inflammatory changes, small angular fibres, fibre hypertrophy, grouped atrophy, and endo‐ and perimysial fibrosis were evaluated. From each specimen, 200 fibres were also analysed morphometrically using a computerized image analysis system.

Results Neurogenic changes were apparent in all the CMs from patients with an undescended testis but none of the samples obtained from girls showed any changes. While only two specimens of 26 from boys with inguinal hernia (8%) had evidence of neurological alterations, eight CM (31%) had general changes. The mean (SD) fibre diameters did not differ significantly among the groups with inguinal hernia, hydrocele and undescended testis, at 23.0 (8.6), 24.4 (4.5) and 23.0 (10.5) µm, respectively.

Conclusion Cremasteric muscles associated with an inguinal hernia or an undescended testis differ; neurogenic changes were detected within all the CM of boys with an undescended testis. These changes in the CM may have influenced the location of the testis.
The effectiveness of terazosin, an α1‐blocker, on bladder neck obstruction as assessed by urodynamic hydraulic energy
Authors: Yamanishi T. , Yasuda K. , Sakakibara R. , Hattori T. , Tojo M.
Published: March 2003

Objective To investigate the effectiveness of terazosin, an α1‐adrenoceptor blocking agent, on bladder neck obstruction (BNO), by assessing the urodynamic hydraulic energy profile.

Patients, subjects and methods The study included 17 men (mean age 60.1 years, range 24–84), comprising 11 patients with BNO (mean age 66.5 years) and six normal volunteers (mean age 48.1 years). A five‐transducer microtip catheter was used to measure the pressure in the bladder and at the bladder neck, and in the membranous and bulbous urethra during voiding. All the subjects then received terazosin, 1 mg/day orally for 2 weeks, and were re‐assessed.

Results The bladder neck diameter at maximum flow significantly (P < 0.02) increased in the 11 patients with BNO after treatment with terazosin. The relative hydraulic energy profiles before terazosin treatment showed the greatest hydraulic energy loss between the membranous and the bulbous urethra in the normal subjects, and between the bladder neck and the membranous urethra in the men with BNO. After terazosin treatment, the greatest energy loss was between the membranous and the bulbous urethra in men with BNO, similar to that in the normal controls, i.e. the whole profile of relative hydraulic energy became normal.

Conclusion Terazosin was effective in opening the bladder neck and improving the hydraulic energy profile in men with BNO.
The effect of pregnancy and delivery on the function and ultrastructure of the rat bladder and urethra
Authors: Bakircioglu M.E. , Sievert K.‐D. , Lau A. , Lin C.‐S. , Lue T.F.
Published: March 2003

Objective To examine the effect of pregnancy and delivery on the function and ultrastructure of the bladder and urethra in rats.

Material and methods The study comprised six virgin and 18 pregnant rats; both groups underwent cystometry (at the 19th day of gestation, and 2 days and 6 weeks after parturition). Tissues from the bladder and urethra were collected for electron microscopy, western blotting and immunostaining for caveolin‐1 and caveolin‐3.

Results The bladder capacity was greater and the modified leak‐point pressures lower in pregnant and 2‐day postpartum rats than in virgin and 6‐week postpartum rats. The residual volume was significantly higher in the pregnant group. Electron microscopy showed more sarcolemmal caveolae in the smooth muscle cells of both the bladder and urethra of virgin rats than in the other groups. Lipid droplets and subsarcolemmal mitochondria accumulated in pregnant and 2‐day postpartum rats. Caveolin‐1 protein was detected in the cytoplasmic membrane of urethra and bladder smooth muscle cells. Caveolin‐3 was detected in the membrane of striated muscle in the intrinsic sphincter. Western blotting showed increased caveolin‐1 protein expression in the bladder and urethra of 2‐day postpartum rats; in contrast, levels of caveolin‐1 were lower in pregnant rats than in virgin and 6‐week postpartum rats.

Conclusions During pregnancy there was a significant decrease in sarcolemmal caveolae and caveolin‐1 in the smooth muscle cells of the rat bladder and urethra. The changes in caveolae and the membrane protein caveolin may play a role in the functional changes associated with pregnancy and after delivery.
Is bowel preparation useful before radiography of the renal tract in patients with spinal cord injury?
Authors: Subramonian K. , McNaught J. , Spencer N. , Harrison S.C.W.
Published: March 2003

Objectives To assess, in a blinded study, the usefulness of bowel preparation in improving the quality of radiography of the renal tract in patients with spinal cord injury (SCI).

Patients and methods Plain abdominal radiographs of 56 patients with SCI were selected; 24 of the patients had received bowel preparation and 32 had not. The films were independently assessed by one radiologist and one urologist unaware of the treatment and identity of the patients. Each film was divided into five regions of interest and scores of 1–4 (1 for least and 4 for best visibility) assigned to each area. In films with a low aggregate visibility score ( 12), the cause of poor visibility was assessed in relation to faecal residue and gas.

Results The difference between the overall mean visibility score for bowel‐prepared and unprepared patients was not statistically significant. In films with poor visibility, gas shadows predominated over bowel shadows in the bowel‐prepared group, although this trend was not statistically significant. Of the five areas, the bladder was scored as being the most clearly seen in both groups.

Conclusions These findings suggest that bowel preparation does not increase the diagnostic value of radiographs of the renal tract in patients with SCI.
Artificial sphincter insertion after radiotherapy: is it worthwhile?
Authors: Manunta A. , Guillé F. , Patard J.J. , Lobel B.
Published: March 2003

Objective To determine the influence of radiotherapy on the outcome of artificial urinary sphincter implantation.

Patients and methods A series of 72 men who had an artificial urinary sphincter inserted were reviewed retrospectively, analysing in detail the information from 15 patients with a past history of pelvic radiotherapy.

Results In those who had undergone radiotherapy, the complication rate was higher, both for re‐operation (eight of 15) and infection (three); 11 of the 15 patients were continent after surgery, compared with 51 (89%) of the 57 in the unirradiated group.

Conclusions An artificial sphincter can be inserted after pelvic radiotherapy reasonably successfully, but at the cost of a high complication and re‐operation rate. Patients with a previous history of radiotherapy should be informed of the higher risk of surgical revision associated with insertion of the prosthesis.
Early observations of the effect of extracorporeal shockwave lithotripsy on blood pressure: a prospective randomized control clinical trial
Authors: Elves A.W.S. , Tilling K. , Menezes P. , Wills M. , Rao P.N. , Feneley R.C.L.
Published: March 2003

Objective To determine, in a randomized controlled clinical trial, the effect of extracorporeal shock wave lithotripsy (ESWL) on blood pressure.

Patients and methods The trial included 228 patients with small (< 15 mm) asymptomatic calyceal stones who were randomised to undergo ESWL (113 patients) or to an untreated (observed) control group (115 patients). Blood pressure was recorded at randomization using a standardized protocol. Patients undergoing ESWL received a mean (
sd) of 5281 (3462) shocks over a mean of 1.75 sessions on one of two lithotripters. Patients were then followed annually, assessing blood pressure and changes in medication. Data were analysed on an intention‐to‐treat basis.

Results At randomization, 43% of patients in the control group and 53% in the ESWL group were hypertensive. Of the 228 randomized, 200 patients completed at least one annual follow‐up, of whom 192 (93 in the control and 99 in the ESWL group) had their blood pressure recorded. The mean follow‐up was 2.2 years; 35 (37%) patients in the control and 46 (46%) in the ESWL group were hypertensive (P = 0.19). Seven (7%) patients in the control group and 11 (11%) in the ESWL group were newly diagnosed to be hypertensive (P = 0.35).

Conclusions In this randomized controlled clinical trial there was no evidence that ESWL causes changes in blood pressure.
The effectiveness of tenoxicam vs isosorbide dinitrate plus tenoxicam in the treatment of acute renal colic
Authors: Kekeç Z. , Yilmaz U. , Sözüer E.
Published: March 2003

Objective To determine the effectiveness of isosorbide dinitrate in combination with tenoxicam compared with tenoxicam alone for the relief of acute renal colic.

Patients and methods Fifty patients with acute renal colic were randomly and in a double blind fashion divided into two treatment groups of 25 each. Group 1 received tenoxicam (40 mg intravenously) and group 2 received tenoxicam (40 mg intravenously) plus sublingual isosorbide dinitrate (5 mg). The patients were compared for visual pain scores, heart rate and blood pressure between and within the groups before and after treatment.

Results Comparing the groups, group 2 had significantly lower pain scores after treatment (P < 0.05) but no other variables were significantly different (P > 0.05 for each). Within the groups the pain scores were significantly lower after treatment in both groups (P < 0.05). Group 2 also had a significantly lower heart rate and blood pressure after treatment (P < 0.05). There were no side‐effects caused by tenoxicam and isosorbide dinitrate in either group.

Conclusion The use of tenoxicam alone or combined with isosorbide dinitrate was effective in relieving of renal colic, but the relief obtained with the combination was significantly greater than tenoxicam alone.
Bladder calculi in children who perform clean intermittent catheterization
Authors: Barroso U. , Jednak R. , Fleming P. , Barthold J.S. , González R.
Published: March 2003

Objective To examine the role of clean intermittent catheterization (CIC) as a possible predisposing risk factor for bladder calculi, assessing risk factors in patients with and without bladder augmentation, and to evaluate management options for bladder calculi in these patients.

Patients and methods The records of 403 patients who were using a regimen of CIC between January 1981 and March 1998 were reviewed to identify those forming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who catheterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, group 1b); group 2, patients with augmented bladders who catheterized urethrally (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidence of bladder calculi in each group was determined and compared statistically where applicable. The success of the treatment options for stone management was reviewed.

Results Bladder calculi developed in 5% of patients in group 1a, 8% in group 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was not significantly different among the groups. Of these patients, 18 (64%) were asymptomatic at the time of diagnosis and significant bacteriuria was found in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi were more often solitary (71%) and typically composed of struvite or apatite. Calculi were managed by open cystolithotomy in 15 patients (54%) and endoscopically in 13 (46%). Stones recurred in nine patients (32%) after treatment, comprising four of six patients treated endoscopically with electrohydraulic lithotripsy and in five of 15 after open cystolithotomy. The mean interval to recurrence was 22.8 months.

Conclusion These results suggest that patients on a regimen of CIC are at risk of developing bladder calculi but the incidence of calculi is not influenced by bladder augmentation. The presence of a Mitrofanoff conduit was associated with a slightly increased incidence of calculus formation. Open cystolithotomy was associated with a lower stone recurrence rate but there were too few patients to draw definitive conclusions.
Failed vasectomy reversal: is a further attempt using microsurgery worthwhile?
Authors: Fox M.
Published: March 2003

Objective To determine, in failed vasectomy reversal, the usefulness of a revised anastomosis using microsurgery in achieving sperm in the ejaculate and fertility, and to relate the outcome to the site of the anastomosis, length of time from vasectomy, and presence or absence of sperm in the vas at surgery.

Patients and methods In a series of 28 patients with confirmed anastomotic obstruction undergoing vasectomy reversal (over a 10‐year period), a microsurgical technique using an oblique end‐to‐end two‐layer interrupted anastomosis with 10/0 Nylon was used to establish vasal continuity. Subsequent seminal analysis at 3–6 months and ensuing paternity were related to several variables. The results were compared with those obtained after 137 cases of primary microsurgical vasovasostomy.

Results Sperm was restored to the ejaculate in 16 (57%) of the patients and successful fertilization was reported in nine (32%). The interval between vasectomy and reversal surgery was relevant to the outcome, with four out of four men having sperm in the ejaculate within 5 years and three achieving paternity. However, the fertility rate was still moderate after an interval of 6–10 years (two of six) and at > 10 years (four of 18). The presence of sperm in the ejaculate was related to whether or not sperm were found in the testicular end of the vas at operation, but absence did not preclude a successful outcome. The overall results were not significantly different from those after primary microsurgical reversal surgery.

Conclusion Microscopic vasovasostomy after previous obstructive failure provides the patient with a further reasonable chance of becoming fertile; although diminishing with time from vasectomy, even after a prolonged period there can be success. The absence of sperm at the time of vasovasostomy does not necessarily indicate failure, but in these cases the presence of thick creamy fluid in the vas predicts a poor outcome, and alternative methods of management should be considered. A microsurgical technique extending, if necessary, well into the convoluted part of the vas, is recommended. Microsurgical skills, relevant equipment and adequate time are required.