bluuebunny/crossref_metadata_2025 huggingface dataset:
Ploidy and Prognosis in Renal Carcinoma
Authors: LANIGAN D. , McLEAN P. A. , MURPHY D. M. , DONOVAN M. G. , CURRAN B. , LEADER M.
Published: November 2008

SummaryThe value of tumour ploidy status as a prognostic indicator in renal carcinoma is disputed. In this retrospective study the DNA content of 90 primary and 10 secondary renal cell carcinomas was measured using flow cytometry. Data on recurrence and survival were available in all cases. Tumours were staged according to the TNM system and histological grade was based on nuclear morphology. Formalin‐fixed, paraffin‐embedded material was processed using standard techniques. Multiple samples were examined in 19 cases. Of the primary tumours, 52 were diploid, 24 were aneuploid and 6 were tetraploid; 8 patients had uninterpretable histograms. Ploidy of the secondary tumours was similar to that of their respective primaries. Aneuploidy correlated with higher grade but not with TNM category and, although associated with an increased risk of death, did not provide independent prognostic information. Heterogeneity of ploidy was found in 6 of the 19 cases where more than 1 sample was assessed. It was concluded that tumour DNA content in renal carcinoma is weakly linked to outcome, is subject to sample error and does not provide accurate prognostic information as a single independent variable.
A Study of Benign Prostatic Hyperplasia—a Challenge to British Urology
Authors: McKELVIE G. B. , COLLINS G. N. , HEHIR M. , ROGERS A. C. N.
Published: November 2008

Summary A community study to determine the prevalence and natural history of benign prostatic hyperplasia (BPH) in a typical Scottish community has been undertaken in men from 40 to 79 years of age. From 2497 eligible men, 1627 (65%) agreed to take part and after screening by symptom score and urinary flow rate 561 were offered a full investigation including transrectal ultrasonography; 492 (87.7%) attended and 415 were found to have BPH, which was defined as a prostate ≥ 20 g. Following urological consultation, 3 groups of patients with BPH were recognised: those requiring no therapy (39.5%), those in whom therapy options were considered (50.5%) and those where operation was advised (10%). Seventeen patients with prostatic carcinoma were found, 4 of whom were treated by radical prostatectomy. A total of 67 operations for BPH resulted from the study in patients not previously referred to our urological unit, the majority of whom had not consulted their GP for symptoms of prostatism. This represents a serious challenge to British urology.
Sclerosing Lipogranuloma of the Male Genitalia: Analysis of the Lipid Constituents and Histological Study
Authors: TAKIHARA H. , TAKAHASHI M. , UENO T. , ISHIHARA T. , NAITO K.
Published: November 2008

Summary An analysis of lipids and histological examination were performed on tissues resected from 2 patients with sclerosing lipogranuloma of the scrotum. The clinical course and histological characteristics were consistent with those reported previously for typical primary sclerosing lipogranuloma of the male genitalia. There was no history of the injection or topical application of oils or fats. Both of our patients had eosinophilia and the lesions snowed eosinophilic infiltration. Complete natural regression occurred several months after partial resection of the lesion in both cases, and no recurrence has been noted during follow‐up. This lipid analysis and histological study revealed that no exogenous fatty elements were present and suggested that degeneration of endogenous fat due to some allergic mechanism might be involved in the development of sclerosing lipogranuloma. The eosinophilia associated with this disease and its spontaneous regression after partial resection also support this assumption.
Retrograde Balloon Dilatation for Pelviureteric Junction Obstruction
Authors: McCLINTON S. , STEYN J. H. , HUSSEY J. K.
Published: November 2008

Summary— A total of 49 retrograde balloon dilatations for pelviureteric junction (PUJ) obstruction were carried out on 43 pelviureteric junctions in 42 patients from 1986 to 1991. The majority (34/ 43) were performed as primary treatment for PUJ obstruction, with 9 patients having a history of previous open pyeloplasty. Follow‐up ranged from 3 months to 4 years (mean 18 months). Clinical improvement, as assessed by absence of symptoms, was seen in 34 cases (80%). There was either no change or an improvement in renographic findings (t1/2 time and/or split function) in 40 patients (93%). Of the 9 patients who were undergoing secondary treatment, 5 showed clinical improvement and 8 showed no change or renographic improvement. Nine patients required 12 further procedures, of which 5 were interval nephrectomy.

Balloon pyelolysis is a simple procedure with good results over a 4‐year follow‐up period. It is less effective for the treatment of secondary pelviureteric junction obstruction. It has a low morbidity and no mortality, involves a short hospital stay and allows an immediate return to full activity. It is therefore an attractive alternative to open pyeloplasty as first‐line treatment for PUJ obstruction.
Peripheral Blood Lymphocyte Response in Patients with Superficial Transitional Cell Carcinoma of the Bladder Treated with Intravesical Bacillus Calmette‐Guérin—A Useful Marker of Response?
Authors: SCHMIDT A. C. , BOUIC P. J. , HEYNS C. F. , DE KOCK M. L. S.
Published: November 2008

Summary— Intravesical instillation of Bacillus Calmette‐Guerin (BCG) offers safe and effective short‐term/long‐term treatment for superficial transitional cell carcinoma (TCC) and TCC in situ of the bladder. However, 17 to 42% of patients may experience recurrence in spite of this therapy and a marker of effective treatment is of paramount importance. In this study the in vitro response of peripheral blood lymphocytes (PBL) to BCG was analysed in 10 patients with superficial TCC and TCC in situ before and during BCG instillations. The in vitro response of PBL to BCG, expressed as a stimulatory index (SI), revealed that 6 patients had a SI > 5 and 4 patients had a SI < 5. None of the former patients had recurrence of TCC during a mean follow‐up of 17 months, while all of the latter patients experienced recurrence of TCC within 9 months. It was concluded that the in vitro response of PBL to BCG may be used as a marker of response to intravesical BCG treatment.
Two Years' Experience with Photodynamic Therapy of Bladder Carcinoma
Authors: WINDAHL T. , LOFGREN L. A.
Published: November 2008

Summary— Eleven patients with intractable bladder carcinoma who were either unfit for radical surgery, or had refused it, were treated with whole bladder photodynamic therapy. Seven patients had carcinoma in situ and 4 had papillary tumours.

Four of the 11 patients had recurrent tumours after a full course of radiotherapy for invasive bladder cancer.

A complete local response was initially achieved in 9 patients with a mean follow‐up of 12 months. The patients previously treated with radiotherapy had a remarkable response, with local control in all cases, but they had severe local side effects and a pronounced reduction in bladder capacity. In the non‐irradiated group, bladder capacity was reduced permanently in only 1 of 7 patients.
Para‐aortic Lymphadenectomy after Chemotherapy for Metastatic Non‐seminomatous Germ Cell Tumours: Prognostic Value and Therapeutic Benefit
Authors: HENDRY W. F. , A'HERN R. P. , HETHERINGTON J. W. , PECKHAM M. J. , DEARNALEY D. P. , HORWICH A.
Published: November 2008

Summary— Between 1976 and 1990,231 patients had excision of para‐aortic lymph node masses remaining after chemotherapy for metastatic non‐seminomatous germ cell tumours. The overall 5‐year survival rate was 80%. Multivariate analysis of survival after surgery was performed and the following were found to be independent prognostic variables: completeness of surgical excision, pathology of excised mass, timing of surgery after chemotherapy (elective versus salvage) and year of treatment (before or after 1984). Para‐aortic lymphadenectomy provided both therapeutic benefit and histological information of prognostic value in planning future treatment and follow‐up. Size of mass and serum markers at the time of surgery were of no additional prognostic value once completeness of excision and pathology were taken into account. We therefore recommend that all residual masses should be removed soon after completion of chemotherapy.
Aspects of Hypertension in Renal Allograft Recipients A Study of 1000 Live Renal Transplants
Authors: MAMMEN N. I. , CHACKO N. , GANESH G. , JACOB C. K. , SHASTRY J. C. M. , PANDEY A. P.
Published: November 2008

Summary— A retrospective study of 1000 live renal transplants was performed in order to assess the factors associated with hypertension in renal transplant recipients. The prevalence of hypertension prior to transplantation was 48%. The need for antihypertensive drugs decreased in 43%, increased in 31% and remained the same in 26%. The presence of hypertension before transplantation, rejection episodes, transplant renal artery stenosis and native kidney disease were the main factors associated with post‐transplant hypertension. An algorithm for the management of post‐transplant hypertension is suggested.
The Incidence of Bladder Cancer in the Black Foot Disease Endemic Area in Taiwan
Authors: CHIANG H. S. , GUO H. R. , HONG C. L. , LIN S. M. , LEE E. F.
Published: November 2008

Summary— A high incidence of bladder cancer (23.53/100,000 population per annum from 1981–1985) was found in an endemic area of peripheral vascular disease known as black foot disease (BFD) on the southwest coast of Taiwan. The average incidence of bladder cancer in the whole of the Taiwan area was 2.29/100,000 during the same period.

The incidence of female bladder cancer (21.10/100,000) in this area was also high. The ratio of male to female bladder cancer in the BFD endemic area and the neighbouring area was 1.24 and 1.09, lower than that in the whole Taiwan area (2.75) and elsewhere around the world. The high content of arsenic and the high concentration of a “fluorescent substance” in artesian well water in this area are the only 2 related factors identified so far. Determination of the actual carcinogen requires further investigation.
Bromodeoxyuridine Labelling of Transitional Cell Carcinoma of the Bladder—an Index of Recurrence?
Authors: POPERT R. J. M. , JOYCE A. D. , THOMAS D. J. , WALMSLEY B. H. , COPTCOAT M. J.
Published: November 2008

Summary— Nineteen patients with newly diagnosed transitional cell carcinoma of the bladder consented to receive an intravenous bolus of bromodeoxyuridine (BrdUrd) 3 to 6 h prior to transurethral resection of bladder tumour. Routine paraffin embedded sections were stained with anti‐BrdUrd monoclonal antibody in order to determine the S phase fraction of the bladder tumours and to correlate this with tumour grade, category and the development of recurrence during follow‐up.

BrdUrd labelling of nuclei was reliably detected in 100% of the tumours. The mean labelling index of Ta tumours (n = 8) was 3.14%; in T1 tumours (n = 7) it was 8.6% and in T2‐3 tumours (n = 4) it was 16.4%. A similar correlation was found in association with tumour grade. The patients were followed up for a mean of 23 months (range 18–30). Seven of the 15 superficial tumours recurred during the period of follow‐up. These tumours had a mean labelling index (at diagnosis) of 8.4%, whereas the tumours that did not recur had a mean labelling index of 3.4%.

The in vivo determination of BrdUrd uptake in transitional cell carcinoma of the bladder may be useful in predicting which superficial tumours are likely to recur following resection and so rationalise both the time to follow‐up and intravesical chemoprophylaxis.
Multivariate Analysis of Progression in Superficial Bladder Cancer
Authors: MUELA P. SANCHEZ DELA , ROSELL D. , AGÜERA L. , DE CASTRO F. , ISA W. , ROBLES J. E. , ZUDAIRE J. J. , BERIÁN J. M.
Published: November 2008

Summary— A total of 217 patients with superficial bladder cancer (SBC) category Ta‐T1 were retrospectively analysed for tumour progression and prognostic factors; 46% of patients presented with recurrences, 13% with increasing grades of anaplasia and 12% with progression in tumour category. The mean annual index of recurrences was 0.7 ± 0.1; 4% of patients died from tumour progression and the overall 5‐year survival rate was 88% ± 5.3. Factors that influenced progression significantly were peritumoural dysplasia, inflammatory infiltrate, residual tumour following transurethral resections, increasing grade of anaplasia and index of recurrences >0.7. Multivariate statistical analysis revealed that only tumour category and increasing grade of anaplasia had significant prognostic value. Increasing grade of anaplasia predicts the likelihood of tumour progression with a 91% global predictive capacity. Thirty percent of patients with tumour progression did not have an increasing grade of anaplasia. Among these 87% were Ta, 50% were Gl and the mean index of recurrences was 0.9. All were conservatively treated and 87% are alive.

Among the patients with an increasing grade of anaplasia and tumour progression the mean index of recurrences was 1.7; 67% developed muscle infiltrating cancer and 7% metastatic spread without local progression; 64% of these patients died from cancer.

An increasing grade of anaplasia affects prognosis. It defines patients with a high risk of tumour progression and tumour‐related death, especially those with T1 bladder cancer.
New, Self‐expanding, Self‐retaining Temporary Coil Stent for Recurrent Urethral Strictures near the External Sphincter
Authors: YACHIA D. , BEYAR M.
Published: November 2008

Summary— Strictures near the external sphincter are a cause for concern. They can be managed by manipulation (e.g. urethral dilatation) or by anastomotic urethroplasty.

Permanently implanted metallic stents have recently been used to treat recurrent urethral strictures. This report presents the results of using a temporary metallic coil stent (UROCOIL‐S) in 20 patients with recurrent bulbomembranous strictures. In 13 patients the stent was left in place for 10 months and was then removed by a simple manipulation. After a mean follow‐up of 10 months (range 3–14), the stricture recurred in only 1 patient.

The use of a temporary (but long‐term) stent for the treatment of urethral stricture is a new approach and the results are encouraging.
Results and Complications of Urethroplasty and its Future
Authors: MUNDY A. R.
Published: November 2008

Summary— A consecutive series of 200 patients undergoing urethroplasty has been reviewed to assess the results and complications of surgery and thereby assess the role of urethroplasty in the treatment of urethral strictures with particular reference to the current interest in intraluminal “stenting” of strictures.

Anastomotic urethroplasty for post‐traumatic strictures and “patch” urethroplasty for post‐infective strictures give satisfactory results which at present do not seem to be bettered by any other form of treatment. Urethroplasty for so‐called “ischaemic” strictures gives less satisfactory results which could almost certainly be improved upon by intraluminal “stenting” or some other novel form of treatment.

The incidence of impotence, temporary and permanent, after urethroplasty is probably greater than is generally realised and the aetiology of this complication warrants serious investigation as this is the single most important limiting factor in urethroplasty.
Nerve‐sparing Retroperitoneal Lymphadenectomy for Low Stage Testicular Cancer
Authors: DE BRUIN M. J. F. M. , OOSTERHOF G. O. N. , DEBRUYNE F. M. J.
Published: November 2008

Summary— In order to maintain antegrade ejaculation after retroperitoneal lymphadenectomy (RLND) for low stage non‐seminomatous germ cell cancer, we implemented a nerve‐sparing technique in which the sympathetic nerves were preserved. Thirty‐eight patients were clinically staged: 27 were stage I and 11 were either IIa or IIb. Laparotomy revealed that in 2 patients the nerve‐sparing technique was not feasible. Fifteen patients had lymph node metastases at frozen section examination and underwent a bilateral nerve‐sparing RLND. In the remaining 21 patients the procedure was unilateral. Clinical understaging occurred in 26% of patients (10/38) and overstaging in 8% (3/38). Patients with lymph node metastases received 2 cycles of adjuvant chemotherapy. Mean follow‐up was 17 months. Antegrade ejaculation was preserved after bilateral and unilateral nerve‐sparing RLND in 86% (12/14) and 95% (19/20) respectively. No recurrences were seen and so far the good prognosis of these patients has not been affected by this new technique.
Treatment of Vesicoureteric Reflux Results of a Prospective Study
Authors: SCHOLTMEIJER R. J.
Published: November 2008

Summary— Between 1982 and 1986, 96 children with non‐obstructive vesicoureteric reflux were included in a prospective study. Three patients withdrew from the study and results are therefore presented on 93 children with 135 refluxing ureters who were followed up for at least 5 years.

Initially, all children with reflux grade III or less received antibiotic treatment only. Those with reflux grade IV were randomised to antibiotic treatment alone versus surgery plus antibiotic treatment; the primary treatment of reflux grade V was reimplantation.

In 85 ureters treated by antibiotics only, reflux disappeared in 64 cases and was reduced in 12. In 50 ureters treated by reimplantation, reflux was cured in 46 cases and no severe ureteric obstruction was seen. Conservative management of reflux grade IV was less successful than surgery. The results of conservative, non‐surgical treatment of reflux grades I‐III were satisfactory, but for grades IV and V surgery should be the treatment of choice if detrusor instability has been excluded.
Prophylactic Role of Extracorporeal Shock Wave Lithotripsy in the Management of Nephrocalcinosis
Authors: VANDEURSEN H. , BAERT L.
Published: November 2008

Summary— Electromagnetic extracorporeal shock wave llithotripsy (ESWL) was performed with a standard Siemens Lithostar on parenchymal calcifications in 10 medullary sponge kidneys in order to evaluate the eventual benefit of preventive lithotripsy.

The results of shock wave lithotripsy on precaliceal calcifications were disappointing and have been related to the lack of expansion during shock wave interaction and to the impaired drainage of particles. Three patients also had large impacted ureteric stones and in such cases ESWL remains the treatment of choice.
Tethered Cord Syndrome: An Unusual Cause of Adult Bladder Dysfunction
Authors: ADAMSON A. S. , GELISTER J. , HAYWARD R. , SNELL M. E.
Published: November 2008

Summary— Tethered cord syndrome is a complication of spinal dysraphism. The tethering of the cord does not permit the normal cranial migration of the conus within the vertebral canal and this results in neural dysfunction due to a traction neuropathy. Although this condition commonly presents in childhood, less severe degrees of tethering may remain asymptomatic until adult life. The clinical features, imaging and management of 5 adults with this condition are reviewed. Both urological and neurosurgical intervention are aimed at preservation of function as, unlike the sensorimotor deficit that commonly complicates this condition, improvement in bladder function is uncommon following cord release.
Results of Treatment with Pollen Extract (CerniltonR N) in Chronic Prostatitis and Prostatodynia
Authors: RUGENDORFF E. W. , WEIDNER W. , EBELING L. , BUCK A. C.
Published: November 2008

Summary— We report the results of a prospective study with the pollen extract, CerniltonR N, in a dose of 1 tablet tid for 6 months for the treatment of chronic prostatitis syndrome in 90 patients. The factors documented before and after 3 and 6 months' treatment were digital rectal examination (DRE) of the prostate, uroflowmetry, bacterial studies, leucocyte counts in urine and measurement of complement C3/coeruloplasmin in the seminal fluid.

The patients were divided into 2 groups: those without associated complicating factors (CFs) (n = 72) and those with complicating factors, i.e. urethral strictures, prostatic calculi, bladder neck sclerosis (n = 18). In the group without CFs, 56 (78%) had a favourable response; 26 (36%) were cured of their symptoms and signs and 30 (42%) improved significantly with an increase in flow rate, a reduction in leucocyturia in the post–prostate massage urine (VB3) and a decrease in complement C3/coeruloplasmin in the ejaculate. In the patients with CFs only 1 patient showed a response. Complicating factors should be considered in patients who fail to respond to treatment within 3 months. CerniltonR N was well tolerated by 97% of patients.
Treatment of Stage I Testicular Tumours
Authors: LLUCH J. R. GERMA , CLIMENT M. A. , VILLAVICENCIO H. , DE SEGURA G. GOMEZ , BLANCO R. , MERCEDES A. , DE ANDRES L. , BALCELLS F. J. SOLE
Published: November 2008

Summary— Between 1980 and 1989, 138 patients with stage I carcinoma of the testes were treated and followed up; 81 patients had seminoma and 57 had non‐seminomatous tumours. Between January 1980 and December 1983, patients with seminoma were treated by orchiectomy, followed by complementary radiotherapy to aortic and ipsilateral pelvic nodes. Retroperitoneal lymph node dissection (RPLND) was performed in patients with non‐seminomatous tumours. After January 1984 the treatment strategy was changed and orchiectomy was followed by a surveillance policy in all histological types. In seminoma patients, 1 of 36 patients (3%) treated with complementary radiotherapy and 5 of 45 (11%) on the surveillance policy relapsed. All achieved a complete response after chemotherapy. In non‐seminomatous tumours, 3 of 21 patients (14%) treated with complementary lymphadenectomy relapsed, in contrast to 11 of 36 (31%) surveillance policy patients. All patients who relapsed obtained a complete response with chemotherapy. All patients are currently free of disease. There were no differences in survival between both treatment policies. We conclude that a wait and see policy in stage I testicular tumours is feasible and provides the same results as more interventionist practices.
Relative Indications for Orthotopic Lower Urinary Tract Reconstruction, Continent Urinary Diversion and Conduit Urinary Diversion
Authors: NURSE DIANE E. , BRITTON J. P. , MUNDY A. R.
Published: November 2008

Summary— Continent urinary diversion has become increasingly popular in the last few years and there are now several situations in which ileal conduit diversion, continent diversion and orthotopic reconstruction of the Lower urinary tract are equally valid options. This review was intended to determine specific indications for each.

Of 513 patients treated for severe Lower urinary tract problems in the last 10 years, 399 underwent orthotopic reconstruction, 68 underwent continent diversion and 46 had an ileal conduit. Problems occurred 2 to 3 times more commonly in the continent diversion group than in either of the other groups.

Given a free choice, most patients would choose an orthotopic reconstruction and this should probably be regarded as the gold standard. Continent diversion is specifically indicated in male patients who require a total cystourethrectomy for bladder cancer, in severe post‐radiotherapy problems, and in patients with neuropathic bladder dysfunction in whom, for various reasons, self‐catheterisation is impossible. Ileal conduit diversion remains the simplest and safest technique in high‐risk patients and does not preclude a subsequent continent diversion or orthotopic reconstruction.
Effect of Parenteral Testosterone Therapy on Penile Development in Boys with Hypospadias
Authors: DAVITS R. J. A. M. , Van den AKER E. S. S. , SCHOLTMEIJER R. J. , KEIZER‐SCHRAMA S. M. P. F. DE MUINCK , NIJMAN R. J. M.
Published: November 2008

Summary— Forty boys with hypospadias received 2 mg/kg testosterone esters intramuscularly 5 and 2 weeks before surgical correction of the hypospadias. The effects on penile development were determined 3 and 5 weeks after the first injection and 3 and 12 months post‐operatively. A significant effect on penile development was shown. This effect disappeared during the first year following treatment. There was no effect on bone maturation, children's height and the ultimate testosterone level. All adverse effects disappeared after cessation of therapy. Androgen receptor deficiency as a possible cause of hypospadias is not supported by our observations.
Tumours of the Spermatic Cord and Paratesticular Tissue. A Clinicopathological Study
Authors: LIOE T. F. , BIGGART J. D.
Published: November 2008

Summary— A total of 85 patients with paratesticular tumours were diagnosed over a period of 36 years at this hospital; 66 patients (78%) had benign tumours, usually either an adenomatoid tumour or a lipoma Of the remaining 19 malignant cases, 10 were primary neoplasms and 9 were metastases. A rare mucin‐secreting epididymal adenocarcinoma was the only primary malignant epithelial tumour, the others being of mesenchymal origin. In 4/9 metastatic cases the initial presentation of a paratesticular swelling led to the discovery of the occult primary neoplasm following histological examination Clinical features of a painful or painless mass, with or without an accompanying hydrocele, do not help to distinguish a benign from a malignant lesion. The prognosis of malignant tumours of mesenchymal origin depends mainly on the histological grade Surgical resection remains the mainstay of treatment and adjuvant therapy significantly improves the chances of survival only in young patients with paratesticular rhabdomyosarcomas. Older patients with high grade tumours usually succumb to their disease despite chemotherapy and/or radiotherapy.
Choosing a Powerful Lithotriptor
Authors: MISHRIKI S. F. , COHEN N. P. , BAKER A. C. , WILLS M. I. , WHITFIELD H. N. , FENELEY R. C. L.
Published: November 2008

Summary— Clinicians have no yardstick to help them choose the most efficient lithotriptor. Their leading priority is a system allowing complete disintegration of the stone with the minimum number of shocks and a low re‐treatment rate. One of the prerequisites of this system is a powerful shock wave generator. “Power” is as yet ill defined in lithotripsy. Therefore clinicians' choice depends upon other factors.

Acoustic output measurements were recorded on 3 commercial lithotriptors representing the 3 main shock wave generating systems. These were the Dornier MPL 9000 (standard and X‐155 electrodes), the Siemens (Lithostar, Lithostar Plus and System C) and the Wolf Piezolith 2300. The shock wave measurements were correlated to the capability of the lithotriptors to disintegrate standard stone models in vitro.

Two factors were identified. The pulse intensity integral in the focus and the size of the focal zone proved to be the most important factors to assess and compare the efficacy or “power” of different lithotriptors. Together they can help clinicians to identify and choose the most efficient shock wave generating systems.
Relief of Pain following Intravesical Capsaicin in Patients with Hypersensitive Disorders of the Lower Urinary Tract
Authors: BARBANTI G. , MAGGI C. A. , BENEFORTI P. , BAROLDI P. , TURINI D.
Published: November 2008

Summary— We have extended our earlier observations on pain relief produced by intravesical instillation of capsaicin (10 μ.M in saline) in patients with hypersensitive disorders of the lower urinary tract.

Patients in group A (n = 15) received intravesical capsaicin on days 0, 14 and 28: on each occasion the drug produced a warm or burning sensation, reduction in bladder capacity and a delayed, transient improvement or disappearance of symptoms. Patients in group B (n = 5) received intravesical capsaicin (10 μ M at cystometry) 3 times on day 0. The initial sensation of warmth was experienced on each occasion, indicating that no significant desensitisation has been produced by the first instillation. Clinical improvement similar to that found in group A was observed. Three patients (group C) received warm saline (42°C) at cystometry. This produced a pricking sensation, no change at cystometry and no subjective clinical improvement. Apart from the initial sensation of warmth, no patient in group A or B experienced side effects, either local or systemic.

These findings confirm that intravesical instillation of capsaicin has a beneficial effect on patients with hypersensitive bladder disorders. Counter‐irritation rather than desensitisation of primary afferents could be a possible mechanism of action. Further studies are needed to establish whether the intravesical administration of capsaicin or capsaicin‐like agents represents a new form of treatment for relief of bladder pain.
The Impact of Histological Review on Clinical Management of Testicular Cancer
Authors: SEGELOV EVA , COX K. M. , RAGHAVAN D. , McNEIL E. , LANCASTER LETITIA , ROGERS J.
Published: November 2008

Summary— Accurate histological diagnosis and staging are critically important in determining the optimal management of patients with testicular cancer. We have assessed the importance of histological review of “outside” pathology reports from 87 patients referred to the Urological Cancer Research Unit. In 28 patients (32%), the reviewed pathology report differed from the outside report. In 10 of these patients (11%), the pathology review resulted in a change of treatment or prognosis from that which would have obtained in the absence of such histological review. Pathology review at a major cancer centre with a subspecialist interest in tumour pathology and a large experience in the management of germ cell malignancy is an essential first step in the treatment of testicular cancer.
Long‐term Results of Pelvic Floor Training in Female Stress Urinary Incontinence
Authors: HAHN I. , MILSOM I. , FALL M. , EKELUND P.
Published: November 2008

One hundred and seventy women with genuine stress urinary incontinence participated in a pelvic floor exercise (PFE) programme (duration 4.7 ± 0.2 months, range 1–18). Twenty‐seven women awaiting surgery for genuine stress urinary incontinence constituted the control group. The women were evaluated using a provocation test, vaginal palpation and subjective assessment before and after treatment. After the PFE programme, 23% of the women considered themselves cured, 48% were improved and 29% unchanged. According to the provocation test used in this study 64% were cured or improved following PFE. The long‐term results of PFE were assessed by means of a postal questionnaire 2 to 7 years after completion of the supervised training period (response rate 152/170; 89%). During this time 38 women (25%) had undergone operative treatment. Of the remaining patients, 13 (11%) reported that they were still cured, 50 (44%) continued to be improved, 35 (31%) were unchanged and 16 (14%) had deteriorated. However, the frequency of PFE training during the follow‐up period was unsatisfactory, as only 15% were training several times a day. This indicates that continued guidance from a physiotherapist could improve the long‐term efficacy of PFE training.
Prostatic Sarcoidosis Review of Genitourinary sarcoidosis
Authors: MORRIS S. B. , GORDON E. M. , CORBISHLEY C. M.
Published: November 2008

Sarcoidosis is seen by the urologist only rarely but it may present a diagnostic and therapeutic dilemma. We describe a rare case of prostatic sarcoidosis. The literature relating to sarcoidosis throughout the genitourinary system is reviewed.
Anatomical and Clinical Correlation with Histological and Histometric Patterns in Cryptorchism
Authors: GUTIERREZ A. , CAMPOS A. , CANIZARES F. J. , CRESPO P. V. , SANCHEZ C.
Published: November 2008

One feature rarely included in studies on cryptorchism is an adequate correlation between anatomical and clinical data and histological patterns of the testis. The present study correlates anatomical and clinical data from 50 patients (age range 2 months‐14 years) using 4 different histological and histometric patterns established previously. Three different patterns of progressively severe histological changes corresponding to increasingly marked dysgenetic alterations in the anatomical and clinical patterns were detected. Less severe changes were correlated with mature anatomical and clinical features, whereas testes showing severe histological‐histometric changes were correlated with immature anatomical and clinical features. Non‐abdominally located testes with Sertoli cell hyperplasia were not significantly correlated with any of the anatomical and clinical features.

The histometric patterns described should facilitate the diagnosis of the stage of testicular development on the basis of anatomical and clinical data.
Detection of Secondary Tumours in Patients with Renal Carcinoma: Comparative Study of ex vivo Ultrasonography and Histological Examination
Authors: JORION J. L. , DONNAY M. , PAULS C. , LEDENT G.
Published: November 2008

Summary Seventeen kidneys removed from patients with renal carcinoma were submitted to ex vivo ultrasonography and then to serial pathological examination in an attempt to detect secondary tumours in apparently normal tissue. Ex vivo ultrasonography failed to reveal further tumours, but 2 lesions measuring 5 and 8 mm were found on pathological examination. These preliminary data suggest that intra‐operative ultrasonography may be of little value in detecting secondary tumours in conservative surgery for renal carcinoma.
Fluid Absorption and Circulating Endotoxins during Transurethral Resection of the Prostate
Authors: SOHN M. H. , VOGT C. , HEINEN G. , ERKENS M. , NORDMEYER N. , JAKSE G.
Published: November 2008

Summary Recent publications report increased cardiovascular morbidity and mortality after transurethral prostatic resection (TURP). Repeated breath‐ethanol monitoring with a new infrared device permits a highly sensitive peroperative registration of fluid absorption. A prospective study in 52 patients revealed surprisingly high rates of intravascular fluid loads without clinical manifestations. Only 4 patients developed clinical signs of the TUR syndrome. Immunological work‐up in 41 patients demonstrated circulating endotoxins and significant rise of endogenous tumour necrosis factor (TNF) in 3 of these patients. In 11 patients transient endotoxins could be detected during resection under prophylactic parenteral antibiosis. In the face of less invasive approaches to benign prostatic hyperplasia, close intraoperative monitoring and antibiotic coverage should be demanded as a routine procedure during TURP. Elective surgery should be delayed until appropriate antibiotic therapy has been given.
Oral Cyclophosphamide for the Management of Hormone‐refractory Prostate Cancer
Authors: RAGHAVAN D. , COX K. , PEARSON B. S. , COOREY G. J. , ROGERS J. , WATT W. HUNTER , COATES A. S. , McNEIL E. , GRYGIEL J. J.
Published: November 2008

Summary Thirty patients with hormone‐refractory prostate cancer were treated with cycles of oral cyclophosphamide (100 mg/m2/dayfor 14 days, with a 14‐day gap). Eighteen patients had a significant improvement in symptoms of advanced disease, 6 had objective partial remissions and 13 had stabilisation of disease (criteria of National Prostatic Cancer Project). The median survival from the time of diagnosis was 33.3 months, and from the commencement of cyclophosphamide 12.7 months. The treatment was well tolerated. Oral cyclophosphamide is active in the treatment of advanced hormone‐refractory prostate cancer and yields symptomatic and objective remissions without undue side effects. This observation requires validation, with further testing of its impact on survival in randomised clinical trials.
Primary Use of a Double J Silicone Ureteric Stent in Renal Transplantation
Authors: KOO L. C. , LIN SEEN , BEWICK M. , KOFFMAN C. G.
Published: November 2008

Summary Vesicoureteric leakage and obstruction are the commonest urological complications after renal transplantation. A retrospective analysis of our initial experience using a double J silicone ureteric stent showed that primary splinting of the vesicoureteric anastomosis eliminated these complications, whereas their combined incidence was 13.6% in the non‐stented patients. The presence of the stent was not associated with increased risks of urosepsis.
Biphosphonates as an Adjunct to Palliative Therapy of Bone Metastases from Prostatic Carcinoma. A Pilot Study on Clodronate
Authors: VORREUTHER R.
Published: November 2008

Summary Clodronate (OstacR) is a specific inhibitor of osteolysis from the group of biphosphonates. The efficacy and side effects of palliative treatment with the substance were investigated in an open prospective non‐controlled pilot study in 41 patients with advanced, progressive, hormone‐resistant prostatic carcinoma. All patients suffered from symptomatic bone metastases. Initially, they underwent an 8‐day saturation course with 300 mg clodronate i.v. per day A good to very good analgesic effect was achieved within 3 to 5 days in 29 patients (71%). The mean duration of action was 7 weeks and the mean survival time 12 weeks. There were no side effects after i.v. administration. Slight gastrointestinal discomfort was reported in 3 patients following oral administration. Delayed progression of the metastases was not observed. Clodronate is a promising addition to the other therapeutic possibilities in hormone‐resistant prostatic carcinoma.
Humoral Hypercalcaemia in Renal Carcinoma due to Parathyroid Hormone Related Protein
Authors: SANDHU D. P. S. , MUNSON K. W. , HARROP J. S. , HOPTON M. R. , RATCLIFFE W. A.
Published: November 2008

Summary Parathyroid hormone related protein (PTHRP) has been implicated in humoral hypercalcaemia of malignancy (HHM). We describe a patient with a renal carcinoma and hypercalcaemia, and for the first time have demonstrated a 4‐fold PTH RP concentration gradient across a renal tumour bed. This provides further strong evidence that the primary tumour was the source of the PTH RP. The PTH RP 1 ‐86 content of the tumour tissue was 4.8 ng/g, similar to that previously found in tumours associated with HHM. In PTH RP‐secreting tumours, PTHRP may be a useful oncological marker after surgical resection.
Urinary Solute Transport by Ileal Segments. I. Effects of Nicotinic Acid
Authors: MARTÍNEZ‐PIÑEIRO L. , MATEOS F. , MONTERO A. , MADERO R. , MARTÍNEZ‐PIÑEIRO J. A.
Published: November 2008

Summary This study was conducted to quantify urinary solute transport by the ileum, using an in vivo human model, and to determine the effect of nicotinic acid on this process. Patients were studied under both basal conditions and niacin therapy. The rates of solute transport were established by analysis of excretion indexes for each solute. Potassium and ammonium were absorbed by the ileum, while phosphorus, sodium and bicarbonate were secreted. The percentage excretion index of sodium and bicarbonate increased by approximately 100 and 600% respectively, causing a significant rise in urinary pH. Although not statistically significant, there was a tendency for chloride to be absorbed and for water to pass into the bowel lumen. Nicotinic acid 3 g/day had no significant effect on urinary solute transport.
Effects of Abdominal Hysterectomy on Urinary and Sexual Symptoms
Authors: VIRTANEN H. , MÄKINEN J. , TENHO T. , KIILHOLMA P. , PITKÄNEN Y. , HIRVONEN T.
Published: November 2008

Summary A prospective study of 102 women undergoing abdominal hysterectomy for benign conditions was performed in order to evaluate pre‐ and post‐operative urinary and sexual symptoms. The mean age of the patients was 44.9 years (range 30–65). Urinary disorders such as urgency, dysuria, frequency, nocturia, slow bladder emptying, sensation of residual urine as well as stress and urge incontinence were observed pre‐operatively and 2, 6 and 12 months postoperatively. Dyspareunia, libido and the number of orgasms were evaluated as disorders affecting sexual life. At follow‐up 12 months post‐operatively a statistically significant decrease in stress incontinence, frequency and nocturia was observed. Dyspareunia was also significantly less frequent and increased libido was experienced. It was concluded that abdominal hysterectomy does not provoke adverse urinary or sexual symptoms and that it can have beneficial effects.
Urological Aspects of Hemicorporectomy
Authors: SANFORD E. J. , HELAL M. A. , NORMAN J. G. , KARL R. C. , O'KELLY K.
Published: November 2008

Summary The indications for hemicorporectomy are few. However, with improvements in surgical techniques, anaesthesia and post‐operative surgical care, hemicorporectomy may again become a reasonable treatment for certain patients with malignancies of the pelvis. A 2‐stage procedure is described which consists of an initial staging celiotomy with urinary and faecal diversions. A non‐refluxing colon conduit is the preferred form of urinary diversion. The hemicorporectomy is performed approximately 2 weeks later. No complications were encountered in the post‐operative period. Our experience and a review of the literature suggest that hemicorporectomy is a reasonable salvage procedure for certain patients with pelvic malignancies.
Early Removal of Catheter following Transurethral Resection of the Prostate
Authors: AGRAWAL S. K. , KUMAR A. S. V.
Published: November 2008

Summary This study was conducted on 83 patients who underwent an uncomplicated transurethral resection of the prostate for carcinoma or benign hyperplasia. In all cases the urethral catheter was removed within 24 h of surgery. Only 2 patients failed to void because of clot retention.

The total hospital stay was 3 days in 67 patients. There were no significant complications due to early removal of the catheter.
Urethral Stricture following Transurethral Resection of the Prostate. The Role of Local Anaesthetics
Authors: PANSADORO V. , EMILIOZZI P. , DEFIDIO L. , SCARPONE P. , TATI G.
Published: November 2008

Summary In a multicentre prospective study, 261 patients undergoing transurethral resection of the prostate (TURP) in 17 urology departments were randomised to receive lubricating jelly containing either 3% tetracaine hydrochloride, 1% lignocaine hydrochloride, or no local anaesthetic. No patient had a history of urethral instrumentation or a previous urethral stricture. After 6 months' follow‐up, 25/79 patients (32%) treated with 3% tetracaine jelly developed urethral strictures, as did 4/92 patients (4%) who received 1% lignocaine and 2/90 (2%) who received the jelly without anaesthetic. It was concluded that the use of 3% tetracaine jelly is associated with a high incidence of post‐TURP urethral strictures.
Suppurative Epididymo‐orchitis in Young “High Risk” Patients‐A New Problem?
Authors: PARR N. J. , PRASAD B. R. P. , HAYHURST V. , McMILLAN A. , LEEN C. S. , FOWLER J. W.
Published: November 2008

Summary During a 4‐year period we have treated 3 young patients with severe epididymo‐orchitis which progressed to suppuration (despite treatment with a range of antibiotics) and necessitated orchiectomy. All gave a history of “high risk” activity (2 homosexual, 1 sexual partner of intravenous drug user). One patient was suffering from acquired immune deficiency syndrome and another presented during seroconversion to HIV‐positive status. Cytomegalovirus was the infective organism in one patient, but the pathogenesis in the others remains obscure.

Investigations for atypical pathogens should be performed when young patients present with refractory epididymo‐orchitis. These patients should also be counselled with regard to HIV testing.
Treatment of Vesicoureteric Reflux in the Neurogenic Bladder
Authors: MERLINI E. , BESEGHI U. , DE CASTRO R. , PERLASCA E. , PODESTA E. , RICCIPETITONI G.
Published: November 2008

Summary A retrospective co‐operative study was conducted among 6 Italian paediatric surgical departments to assess the results of different forms of treatment of vesicoureteric reflux in patients with neurogenic bladder.

Between January 1980 and December 1989 we studied 641 neurogenic bladders in children, mainly due to spina bifida; reflux was detected in 199 patients with 263 refluxing ureters. Details of treatment were available for only 170 patients and they were divided into 2 main groups: conservative medical treatment (n = 127) and primary surgical treatment (n = 43). Medical treatment consisted mainly of clean intermittent catheterisation and the administration of appropriate drugs. In the surgical group 36 reimplantations, 6 cystostomies and 1 STING were performed. Fifteen patients underwent surgery as a secondary procedure.

The results showed that approximately 50% of patients with reflux were cured by clean intermittent catheterisation and drug therapy. Ureteric reimplantation can be safely performed in patients with neurogenic bladder provided that a normally compliant, non‐hyper‐reflexic bladder can be achieved by means of drugs or by bladder augmentation with bowel.
The effects of various indwelling JJ stents on renal pelvic pressure and renal parenchymal thickness in the pig
Authors: CORMIO L. , KOIVUSALO A. , MAKISALO H. , WOLFF H. , RUUTU M.
Published: November 2008

Objective To determine whether indwelling JJ stents significantly alter renal pelvic pressure and consequently have deleterious effects on renal function.

Materials and methods Thirteen piglets were used totalling 26 renal units. Using an open, sterile surgical procedure, 23 renal units were stented with 6F JJ catheters of eight different types; three renal units were not stented and served as controls. Intra‐pelvic pressure values during diuretic stress were measured before and after 6 weeks of intubation. The kidneys were then removed and sent for pathological evaluation of renal parenchymal thickness.

Results A marked increase in intra‐pelvic pressure values was found in two of the 19 stented renal units suitable for this measurement. A significant reduction (more than one third with respect to the control values) in renal parenchymal thickness was found in six of the 21 stented renal units suitable for this measurement, three of which had been intubated with a Cook polyurethane stent and three with an Angiomed Puroflex stent.

Conclusion In the present experimental study some JJ stents seemed to cause long‐lasting changes in renal pelvic pressure and consequently to have deleterious effects on renal function. Although experimental findings are not always fully related to clinical practice, a knowledge of the potential effects of these prostheses is essential to minimize complications related to their use.
Autoaugmentation gastrocystoplasty: early clinical results
Authors: DEWAN P.A. , STEFANEK W.
Published: November 2008

Objective To assess the urodynamic and clinical outcome of five patients following an autoaugmentation gastrocystoplasty.

Patients and methods Four patients, two boys and two girls aged between 8 and 16 years, with a neuropathic bladder and incontinence, and one boy, aged 16 years, with an ileal conduit were included in the study. The bladder augmentation technique combined autoaugmentation and the addition of a demucosalized patch of gastric muscle to the created bladder diverticulum.

Results All patients have improved bladder function, although one may require further surgery. Three had temporary difficulty tolerating full meals.

Conclusions This new technique seems to have a place in the management of the neuropathic bladder, but further laboratory study and cautious clinical application is required to ascertain its role in bladder augmentation.