bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic Retroperitoneal Fibrosis. A Retrospective Analysis of 60 Cases
Authors: BAKER L. R. I. , MALLINSON W. J. W. , GREGORY M. C. , MENZIES E. A. D. , CATTELL W. R. , WHITFIELD H. N. , HENDRY W. F. , WICKHAM J. E. A. , JOEKES A. M.
Published: November 2008

Summary— Sixty patients with idiopathic retroperitoneal fibrosis presenting between 1965 and 1984 are reviewed. Their mean age at presentation was 56 years and the male: female ratio was 3:1. The commonest presenting symptoms were flank and abdominal pain, weight loss, nausea and polyuria. Physical examination was usually normal, expect for the presence of hypertension. Anaemia and elevation of erythrocyte sedimentation rate were usually present. Proteinuria was found in less than a third of patients at presentation and significant bacteriuria was uncommon. The correct diagnosis was made or suspected in very few patients before referral. The cumulative actuarial survival rate was 86% at 1 year and 78% at 2 years. Seventeen patients died; they were significantly older and more uraemic at the time of referral than those who survived.

A few patients did well with either corticosteroid therapy or ureterolysis alone. In the majority, both operation and steroid treatment were necessary. In bilateral obstruction with residual function in both kidneys, bilateral ureterolysis proved superior to unilateral operation (each followed by steroid therapy) in conserving renal function. Operation alone or steroid therapy alone should be considered in cases where steroids or surgery repectively present particular hazards. The less traumatic unilateral operation should be considered in poor risk patients and in those whose renal function is absent on one side.

In many survivors, disease activity has persisted for many years. Life‐long follow‐up is recommended.
Peripheral Neurology as a Predictor of Bladder Dysfunction in Congenital Neuropathic Bladder
Authors: WILLIAMS M. P. L. , KATZ Z. , ESCALA J. M. , RICKWOOD A. M. K.
Published: November 2008

Summary— Urodynamic findings and peripheral neurology were correlated in 62 patients with myelomeningocele. The primary motor and sensory levels bore no relation to bladder dysfunction. The ano‐cutaneous reflex was a useful predictor, in that where the reflex was positive there was likely to be detrusor hyper‐reflexia, a competent bladder neck and absence of sphincter weakness leakage. Where the reflex was absent, detrusor hyper‐reflexia was absent or mild, the bladder neck usually incompetent and sphincter weakness leakage common. (Detrusor compliance could not be predicted from peripheral neurological findings).

We consider the ano‐cutaneous reflex to be a useful indication of bladder dysfunction and urodynamic studies are often unnecessary when it is positive.
Prophylactic Treatment of Adult Nocturia with Bumetanide
Authors: PEDERSEN P. A. , JOHANSEN P. B.
Published: November 2008

Summary— The efficacy of 1 mg bumetanide on nocturia was compared with placebo in a randomised double‐blind cross‐over study in general practice. Twenty‐eight patients, 13 females and 15 males, completed two treatment periods of 2 weeks' duration. During the placebo period the weekly number of nocturia episodes was 13.8 and during bumetanide treatment the number was reduced by 3.8. Ten males had a history of prostatic hypertrophy and in these patients treatment with bumetanide was not beneficial. In the remaining 18 patients the weekly number of nocturia episodes was reduced by 4 during bumetanide treatment compared with the placebo period. Of these patients, 3 preferred treatment with placebo, 11 preferred bumetanide and 4 gave no preference. These results suggest that bumetanide offers an alternative in the treatment of adult nocturia not connected with enlargement of the prostate.
Long‐term Follow‐up of Unilateral Bladder Neck Incision
Authors: MOBB GILLIAN E. , MOISEY C. U.
Published: November 2008

Summary— Sixty‐four patients who underwent unilateral bladder neck incision (BNI) between 1980 and 1983 were reviewed. In 53 cases the flow rates showed no significant change from immediate post‐operative values. All patients were interviewed or completed a questionnaire which demonstrated that 87% were satisfied with the long‐term outcome of surgery. The incidence of repeat bladder neck incision or transurethral resection of prostate (TURP) compared well with the incidence reported in other studies, as did the recorded incidence of retrograde ejaculation at 16%, although 52.5% of patients noted a reduction in the volume of ejaculate.
Reappraisal of the Role of Radical Radiotherapy and Salvage Cystectomy in the Treatment of Invasive (T2/T3) Bladder Cancer
Authors: JENKINS B. J. , CAULFIELD M. J. , FOWLER C. G. , BADENOCH D. F. , TIPTAFT R. C. , PARIS A. M. I. , HOPE‐STONE H. F. , OLIVER R. T. D. , BLANDY J. P.
Published: November 2008

Summary— One hundred and eighty‐two patients with invasive (T2/T3) bladder cancer were treated by radical radiotherapy at the London Hospital between 1974 and December 1985. Cystectomy was reserved for patients whose tumours either did not respond completely to radiation or recurred later, provided they were fit for surgery and had not developed distant metastases.

The overall corrected 5‐year survival rate was 40%; 75 patients responded to radiation and did not relapse during the period of follow‐up; 20 patients had an initial response to radiation but subsequently relapsed, with a 5‐year survival rate following relapse of 20%. Of these, 11 patients had a cystectomy with a 5‐year survival following relapse of 36%, whereas all 9 patients who did not have a cystectomy died within 3 years; 87 patients who did not respond to radiation had a 5‐year survival rate of 18%. Of these, 22 patients underwent salvage cystectomy with a 5‐year survival of 47%, whereas the 65 patients who did not have a cystectomy had a 5‐year survival of 3%.

These results justify a policy of radical radiotherapy and salvage cystectomy rather than elective cystectomy in the treatment of invasive bladder cancer.
Serial Residual Volumes in Men with Prostatic Hypertrophy
Authors: BIRCH N. C. , HURST G. , DOYLE P. T.
Published: November 2008

Summary— Thirty men with prostatic hypertrophy were scanned on 3 occasions on the day before TURP. Five commonly used formulae to estimate residual urine were used. All of these methods are subject to large degrees of error; 66% of these patients had residual volumes that varied significantly on the same day.

We suggest that it is of no clinical value to perform a single residual urine measurement in patients with prostatic hypertrophy.
The Role of Magnesium in Cacium Oxalate Urolithiasis
Authors: KOHRI K. , GARSIDE J. , BLACKLOCK N. J.
Published: November 2008

Summary— The aim of this study was to evaluate the effect of magnesium on calcium oxalate crystal formation, both in physiological conditions and at slightly higher oxalate concentrations, using a mixed suspension mixed product removal crystallizer and scanning electron microscopy. True supersaturation ratios were calculated by allowing for complexation in solution.

Magnesium inhibited the nucleation rate at all oxalate concentrations. It also inhibited the growth rate at oxalate concentrations of less than ˜2.0 mmol/l but promoted the growth rate at higher concentrations. This suggests that, provided the oxalate concentration is sufficiently high, increase of magnesium concentration can increase the crystal growth rate. At physiological concentrations of oxalate, however, magnesium decreases both nucleation and growth rates. The SEM photographs showed that the predominant crystal was calcium oxalate trihydrate at low magnesium concentrations, with calcium oxalate dihydrate being observed in larger quantities at high magnesium concentrations.
Simple Method for the Study of Heterogeneous Nucleation in Calcium Oxalate Urolithiasis
Authors: GRASES F. , CONTE A. , GIL J. J.
Published: November 2008

Summary— A simple method, based on optic microscopy and a counting chamber, has been devised for the study of heterogeneous nucleation in calcium oxalate urolithiasis. Calcium phosphate, uric acid, silica and macromolecular mucoprotein are proposed as possible nucleants. The importance of heterogeneous nucleation as a fundamental step in the formation of calcium oxalate calculi is demonstrated.
Comparison of Pressure/Flow Studies with Micturitional Urethral Pressure Profiles in the Diagnosis of Urinary Outflow Obstruction
Authors: DESMOND A. D. , RAMAYYA G. R.
Published: November 2008

Summary— Computer technology has made it possible significantly to improve the technique and interpretation of the micturitional urethral pressure profile (MUPP). Thirty‐nine patients with lower urinary tract symptoms have been investigated by this technique and the results compared with those of standard pressure/flow studies. A good correlation was found between the two methods of diagnosing outflow obstruction, but micturitional urethral pressure profiles offered practical advantages in patients who were elderly, immobile or who had severe involuntary voiding, and diagnostic advantages in patients with absent or poor detrusor contractility and those with equivocal pressure/flow studies.
Detrusor Instability and Bladder Outflow Obstruction. Evidence for a Correlation between the Severity of Obstruction and the Presence of Instability
Authors: CUCCHI A.
Published: November 2008

Summary— Forty patients with bladder outflow obstruction due to benign prostatic hypertrophy were assessed by means of symptom analysis, rectal examination, intravenous urography and/or cystoscopy, medium‐fill water cystometry and pressure flow study.

No significant correlation was found between the severity of obstruction and the degree of instability, but the occurrence of instability did correlate with the degree of obstruction. This latter conclusion, though logical, had not been proved before, and was achieved by means of a new urodynamic parameter.
Fournier's Gangrene in Khartoum
Authors: FAHAL A. H. , HASSAN M. A.
Published: November 2008

Summary— Nine patients with Fournier's gangrene are presented and the relevant literature is reviewed. Fournier's gangrene is secondary to other predisposing conditions, the commonest causes being urethral and perianal sepsis. Local excision and antibiotics are the treatment of choice.
Bladder Replacement by lleocaeco‐urethrostomy or lleo‐urethrostomy with a Reservoir after Cystoprostato‐vesiculectomy for Bladder Cancer
Authors: ALCINI E. , GRASSETTI F. , D'ADDESSI A. , DI NOIA D. , VACILOTTO D. , PESCATORI M. , VINCENZONI M.
Published: November 2008

Summary— The purpose of this study was to evaluate the function of the intestinal segments used to replace the bladder after cystoprostato‐vesiculectomy. The series included 30 patients, 10 of whom underwent clinical, radiological, urodynamic and electromanometric investigations. Seven patients had an ileocaeco‐urethrostomy (ICUS) and 3 had an ileo‐urethrostomy with a reservoir (IR).

The results were good in all patients and there was no sign of tumour recurrence. All were completely continent during the day but during the night only those who observed the 2‐h intervals between voiding were continent. The radiological findings for 1 patient showed grade I asymptomatic vesicoureteric reflux. In all cases, periodic pressure waves were observed during electrocystomanometric tests at basal levels, with the IR patients showing waves higher in frequency and lower in amplitude. Prostigmin induced a significant variation in motor activity in IR patients only. The urodynamic tracings showed an almost physiological flow in both groups. Cystomanometry revealed good compliance in both types of new bladders. The height and width of contraction waves during filling was greater in ICUS than in IR patients. Good perineal sphincteric activity was demonstrated by electromyography. Low passive resistance was indicated by the urethral pressure profile.

Preliminary analysis of data indicated good functional micturition and renal function in both ICUS and I R patients. Slight differences were found between the two intestinal segments used for bladder replacement.
Assessment of the Safety of Regular D DAVP Therapy in Primary Nocturnal Enuresis
Authors: REW D. A. , RUNDLE J. S. H.
Published: November 2008

Summary— —A group of 7 patients with refractory primary nocturnal enuresis on long‐term DDAVP therapy (mean 13 months) were submitted to a standard water deprivation test in conjunction with a hormone profile and routine haematological and biochemical investigations. No abnormalities were demonstrated, which suggests that the drug is safe in this clinical situation.
The Dissolution of Urinary Mucus after Cystoplasty
Authors: GILLON G. , MUNDY A. R.
Published: November 2008

Summary— Three agents have been tested for mucolytic activity to prevent or treat difficulties in bladder emptying following augmentation and substitution cystoplasty, particularly in patients emptying by intermittent self‐catheterisation. Carbocysteine produced precipitation of mucus, which was found not to be helpful. N‐acetylcysteine and urea both dissolved mucus, but urea proved to be more effective.
Anti‐hormone Treatment for Prostate Cancer Relapsing after Treatment with Flutamide and Castration
Authors: LABRIE F. , DUPONT A. , BÉLANGER A. , CUSAN L. , BROCHU M. , TURINA E. , PINAULT S. , LACOURCIERE Y. , EMOND J.
Published: November 2008

Summary— The effect of further adrenal androgen blockade with aminoglutethimide (AG) plus low dose hydrocortisone (HC) was studied in 119 patients with clinical stage D2 prostate cancer who previously progressed after standard hormone therapy and were under progression while receiving the combination therapy with Flutamide and castration. Using the objective criteria of the US NPCP, 1 complete, 2 partial and 14 stable responses were obtained for a total response rate of 14.3%, while 102 patients continued to progress. The 50% probability of survival was 21.0 months for the responders and 9.2 months for the non‐responders. The present data indicate that further androgen blockade with AG + low dose HC is well tolerated and can be of benefit to a significant proportion of patients in progression at a very late stage of the disease.
Morphology of Testicular Germ Cell Tumours in Treated and Untreated Cryptorchidism
Authors: HALME A. , KELLOKUMPU‐LEHTINEN P. , LEHTONEN T. , TEPPO L.
Published: November 2008

Summary— The histology of 75 testicular germ cell tumours in 73 patients with treated or untreated cryptorchidism was investigated in a group of 503 patients with testicular germ cell tumour and evaluated according to the WHO classification. The proportion of pure seminoma was associated with the height of the testis, being 87% in abdominal. 78% in inguinal and 50% in normally positioned testes. In patients operated upon for cryptorchidism, the current site of the testis seemed to be a more important determinant of this proportion than the original site. The proportion of pure seminoma which developed in testes after successful orchiopexy was equal to that in normally‐descended testes (50%) and lower (39%) if orchiopexy had been performed before the age of 16 years. Similarly, among non‐seminomas, a higher proportion of tumours containing teratoma tissue was found if cryptorchidism was successfully treated in childhood. It was concluded that a successful orchiopexy in childhood decreases especially the risk of seminoma.
Linitis Plastica‐like Carcinoma of the Urinary Bladder
Authors: AZADEH B. , VIJAYAN P. , CHEJFEC G.
Published: November 2008

Summary—
Two cases of signet‐ring cell adenocarcinoma of the urinary bladder with a linitis plastica pattern of infiltration were studied. Mucin histochemistry indicated the presence of neutral and acid mucopolysaccharides and absence of sulphomucin. Immunocytochemistry of the tumour cells was positive for keratin and carcinoembryonic antigen, but negative for prostatic specific antigen and vimentin. The relevance of these observations to the differentiation and histogenesis of these tumours is discussed.
Characterisation of Human Prostatic Adrenoceptors using Pharmacology Receptor Binding and Localisation
Authors: CHAPPLE C. R. , AUBREY M. L. , JAYNES S. , BURNSTOCK G. , TURNER‐WARWICK R. T. , MILROY E. J. G. , DAVEY M. J.
Published: November 2008

Summary—
Benign prostatic enlargement is a common cause of bladder outlet obstruction. Recent work has demonstrated the important role played by the sympathetic nervous system in the control of prostatic muscle tone. Although isometric muscle strip studies and clinical trials have highlighted the influence of alpha‐1 adrenoceptors, radioisotope ligand binding studies have demonstrated a relatively increased density of alpha‐2 adrenoceptors in the muscle within prostatic tissue, the significance of which is as yet unexplained.

Forty patients entered a study using pharmacological muscle strip experiments, radioligand binding assays and receptor autoradiography. Pharmacological data from these studies confirmed that contraction of prostatic muscle is mediated predominantly by alpha‐1 adrenoceptor stimulation, with no evidence of significant alpha‐2 adrenoceptor or cholinergic mediated effects. Radioligand binding studies confirmed that there is a higher concentration of alpha‐ binding sites as contrasted to alpha‐2 within normal prostate, but that this relationship approaches equity in adenomatous prostate.

Autoradiographic localisation demonstrated that alpha‐1 adrenoceptor binding is predominant within prostatic stroma with only a small component of alpha‐2 adrenoceptors in this compartment. This comprehensive study supports the suggestion that prostatic muscular contraction is controlled by the influence of the sympathetic nervous system acting via alpha‐1 adrenoceptors. These findings support the therapeutic use of specific alpha‐1 adrenoceptor blockade in the management of benign prostatic hyperplasia.
Is the Investigation of Most Stress Incontinence Really Necessary?
Authors: HAYLEN B. T. , SUTHERST J. R. , FRAZER M. I.
Published: November 2008

Summary—
The case histories of 494 women referred to a urodynamic clinic with the symptom of stress incontinence were studied. None had undergone previous incontinence surgery. In only 12 patients was stress incontinence the sole symptom. In the remainder, symptoms suggestive of detrusor instability were present in 417, of a voiding disorder in 261 and of an inflammatory disorder in 166. The sign of stress incontinence was present in only 168 patients and was not a reliable guide to the diagnosis of genuine stress incontinence. Urodynamic studies were necessary in 488 patients in order to obtain an accurate diagnosis.
Cyclic Interferon Gamma Treatment of Patients with Metastatic Renal Carcinoma
Authors: GRUPS J. W. , FROHMÜLLER H. G. W.
Published: November 2008

Summary—
The treatment of metastatic renal carcinoma is still unsatisfactory because of the lack of effective systemic therapy. In 14 patients with metastatic renal carcinoma an attempt was made to influence the course of the disease by administration of recombinant human interferon (rHu‐IFN) gamma; 9 patients were evaluated after treatment.

There was partial remission in 3 patients, stable disease in 2 and tumour progression in 4. The cyclic application of rHu‐IFN at a dose of 0.25 mg/day for 8 days, with treatment‐free intervals of 3 to 4 weeks, was tolerated well. Side effects consisted mainly of fever and leucocytopenia. From this small series it seems that cyclic IFN gamma treatment might be helpful in some cases of metastatic renal carcinoma.
Absorption of Drugs from Continent Caecal Reservoir for Urine
Authors: EKMAN I. , MANSSON W. , NYBERG L.
Published: November 2008

Summary—
The possibility of drug absorption from a continent caecal reservoir for urine was studied in 3 men with well functioning reservoirs. Saline solutions of digoxin, theophylline or terbutaline were instilled into the reservoir, each on a separate occasion, and drug concentrations in plasma and urine were measured for 24 h thereafter. Theophylline, but not terbutaline or digoxin, was absorbed from the reservoir. Estimated from an intravenous reference dose, the uptake of theophylline from the reservoir was approximately 50%. In patients with this type of urinary diversion, therefore, reabsorption from the continent caecal reservoir may complicate drug therapy.
Genitourinary Malakoplakia
Authors: OLMO J. M. COZAR , CARCAMO P. , IRIARTE E. GASTON DE , JIMENEZ F. , MARTINEZPINEIRO L. , MARTINEZ‐PINEIRO J. A.
Published: November 2008

Summary— Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim‐sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discussed.
Extracorporeal Shock Wave Lithotripsy for Treatment of Ureterolithiasis in Patients with Cystinuria
Authors: KATZ G. , KOVALSKI N. , LANDAU E. H.
Published: November 2008

Summary— Ten of 42 patients with cystinuria admitted for extracorporeal shock wave lithotripsy (ESWL) treatment had ureterolithiasis. Of these, 3 had bilateral stones, 2 had only 1 functioning kidney, and 2 had stones in both the kidney and ureter on the same side. Only 1 patient was on medical treatment at the time of referral. After initiation of medical treatment for cystinuria, 2 patients were discharged without further intervention, 1 was discharged after placement of a ureteric stent and 10 were treated with ESWL. After an average of 1.5 ESWL treatment sessions per ureter, 8 patients became stone‐free and in the remaining 2, ureteroscopy was required to complete the treatment. Problems associated with the ESWL treatment of cystine stones are discussed. It was concluded that ESWL is the treatment of choice for ureterolithiasis in patients with cystinuria because it is effective and is the least invasive procedure even in patients with cystinuria.
Urinary Levels of Tumour Associated Antigens (CA 19‐9, TPAandCEA) in Patients with Neoplastic and Non‐neoplastic Urothelial Abnormalities
Authors: CASETTA G. , PIANA P. , CAVALLINI A. , VOTTERO M. , TIZZANI A.
Published: November 2008

Summary— The urinary excretion of carbohydrate antigen 19‐9 (CA 19‐9), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) was evaluated in 264 patients with bladder cancer. Cut‐off levels were established using a pool of healthy blood donors. The combined determination of CA 19‐9 and TPA had a sensitivity of 74% in pTa and 83% in pT1 tumours, and 62% in grade 1, well differentiated tumours. Absence of disease at follow‐up was related to a significant decrease in CA 19‐9 and TPA in 129 patients with superficial (pTaorpTI) bladder carcinoma, followed up for at least 3 years. Recurrences, defined as new tumours at the same site or elsewhere in the bladder, were associated with an increase in the mean values but this was not statistically significant. A poor prognosis was indicated in patients with infiltrating tumours and the following pre‐operative levels: TPA > 1500 u/l or CA 19‐9 > 300 u/ml or CEA > 50 ng/ml.
Haemodynamic Effects of Transurethral Prostatectomy
Authors: LAWSON ROSALIND A. , TURNER W. H. , REEDER M. K. , SEAR J. W. , SMITH J. C.
Published: November 2008

Summary— Thoracic bio‐impedance cardiography was used to study the haemodynamic changes in 28 patients undergoing transurethral prostatectomy (TURP) under either general or spinal anaesthesia. Cardiac output and mean arterial pressure fell with induction of general anaesthesia, whilst mean arterial pressure and systemic vascular resistance fell with induction of spinal anaesthesia. The transthoracic fluid index fell during resection under general anaesthesia, but no significant haemodynamic changes were seen during resection under either anaesthetic. This study suggests that resection has no specific adverse haemodynamic consequences. Spinal anaesthesia may produce less haemodynamic disturbance than general anaesthesia in patients undergoing TURP and formal comparison of the 2 techniques seems necessary.
Bladder neck anatomy and mobility: effect of vaginal ultrasound probe
Authors: MOURISTSEN L. , STRANDBERG C. , FRIMODT‐MOLLER C.
Published: November 2008

Objective To evaluate the effect of a vagianal ultrasound probe on bladder neck anatomy and mobility

Patients and methods Twenty women. 15 with urinary incontinence and five with ohter urological complaints, were studied. Colpcocysto‐urethrograpphy (CCU) during rest. Valsalva and withholding manoeures were compared with and without simultaneous vaginal endosonography. The CCU diagnosis and measurements of bladder neck position and mobility in relation to the symphysis pubis were compared with and without the probe inserted. A small 7 MHz vaginal probe (Brüel and Kjaer. type 1846), was used with the scanning field 45d̀ to the long axis of the probe.

Results The CCU diagnosis as well as the measurements of bladder neck position mobility relative o the symphysis pubis were unaffected by the insertion of this probe.

Conclution Vaginal ultrasonography is a minimally invaisve techinique; it is convenient for routine, first line evaluation of baldder neck anatomy and mobility in incontinent women.
Positron emission tomography with L‐methyl‐11 C‐methionine in the monitoring of therapy response in muscle‐invasive transitional cell carcinoma of the urinary bladder
Authors: LETOCHA H. , AHLSTRÖM H. , MALMSTRÖM P.‐U. , WESTLIN J.‐E. , FAST K.‐J. , NILSSON S.
Published: November 2008

Objective To investigate whether positron emission tomorgaphy (PET) with L‐methyl‐11 C‐methionine as a tracer could be used for diagnostic purposes and for evaluation of therapy in patients with varying stages of urinary bladder cancer treated with chemotherapy.

Patients and methods PET was employed in 44 separate examinations involving 29 patients (24 men and five women with a median age of 68 years [mean 66, range 47–78]) with localized or metastaic transitional cell carcinoma of the urinary bladder. In four patients PET examinations were performed prior to the commencement fo chemotherapy, and after one course and after there courses.

Resultes The diagnostic accuracy of PET was poor. The techinique did not monitor the therapeutic effect fo neoadjuvant chemotherapy, Producing results that correlated with therapy outcome. PET identified those patients who responded less successfully to therapy.

Conclusion PET with L‐methyl‐11 C‐methionine demonstrates alterations in tumour metabolism long before visible changes appear on computes tomography or magnetic resonance imaging. Further work is required to develop more specific tracers
Hydatid disease of the kidney
Authors: AFŞAR H. , YAḠCI F. , AYBASTI N. , METO Ş.
Published: November 2008

Objective To define the clinical manifestations of echinococcal involvement of the urinary tract and to propose guidelines for treatment.

Patients and methods A positive diagnosis of hydatid disease was made in seven patients and in all of these the cyst was located in the kidney only. The patients included four males and three females whose ages ranged from 6 to 56 years (mean 33.3).

Results Surgical treatment involved total nephrectomy in six patients and partial nephrectomy in one patient. There was no operative or post‐operative mortality and all patients were cured of the disease.

Conclusion Despite its rarity, hydatid disease should be considered in the differential diagnosis of space‐occupying lesions of the urinary tract.
Utilization of polyclonal serum prostate specific antigen levels in screening for prostate cancer: a comparison with corresponding monoclonal values
Authors: TERMS M. K. , STAMEY T. A.
Published: November 2008

Objectives Prostate specific antigen (PSA) measurement has become increasingly popular as a screening test for prostatic adenocarcinoma. Although this is a sensitive, organ‐specific assay, use as a screening tool is hampered by the lack of a clearly defined normal range in older men, frequent elevation of PSA levels by benign processes, and the availability of two different assays, one polyclonal and the other monoclonal, which produce very different values. This study was designed to evaluate the distribution of PSA levels by the Yang and corresponding Hybritech values in patients from the general population.

Subjects and methods A total of 478 volunteers over 40 years of age underwent serum PSA determination by the Yang polyclonal radioimmunoassay and digital rectal examination. The PSA levels were stratified and the patient distribution analysed.

Results In 69% of patients, PSA levels were ≤ 2.5 ng/ml (proposed normal range for the Yang polyclonal assay). In 89% of patients, PSA levels were ≤ 7.3 ng/ml by the polyclonal assay which corresponds approximately to the proposed normal range of 0–4.0 ng/ml by the Hybritech monoclonal assay. Nine per cent of patients fell between 7.4 and 18.4 ng/ml by the polyclonal assay (4.1–10 ng/ml by the monoclonal assay) and 2% had polyclonal PSA levels > 18.4 ng/ml (> 10 ng/ml by the monoclonal assay). Cancer detection rates (influenced by the percentage of patients undergoing biopsy) were 0.3% in patients with polyclonal PSA levels ≤ 2.5 ng/ml, 1.2% in patients ≤ 7.3 ng/ml, 20.9% between 7.4 and 18.4 ng/ml, and 50% of those > 18.4 ng/ml; the overall cancer detection rate was 3.8%.

Conclusions These data support the use of higher PSA levels as a criterion for further evaluation in screening for prostate cancer and establish the frequency distribution of PSA in a screening population when the Yang assay is used.
Congenital urethral obstruction: Cobb's collar or prolapsed congenital obstructive posterior urethral membrane (COPUM)
Authors: DEWAN P. A. , KEENAN R. J. , MORRIS L. L. , QUESNE G. W. LE
Published: November 2008

Objective To determine whether there are two distinct types of congenital obstruction of the proximal urethra.

Patients and methods Three boys with a congenital bulbar urethral narrowing (Cobb's collar) were examined. Recent papers on congenital obstructive posterior urethral membrane (COPUM) were reviewed.

Results The more proximal lesion is a membranous obstruction which is able to prolapse as far as the bulbar urethra, but has paramedian folds that attach along the posterior wall of the urethra to the verumon‐tanum, and is due to persistence of an embryological attachment between the distal verumontanum and the anterior wall of the posterior urethra. The more distal narrowing is not always obstructive and is primarily a bulbar urethral membrane, is independent of the verumontanum and external sphincter, and may represent a persistence of part of the urogenital membrane.

Conclusions There are two distinct types of congenital obstruction of the proximal urethra, with the association to the verumontanum being the distinguishing feature.
The pathophysiological changes in the bladder obstructed by benign prostatic hyperplasia
Authors: CHAPPLE C. R. , SMITH D.
Published: November 2008

None of the hypotheses to explain the genesis of obstructed detrusor instability covered in this report provide a satisfactory explanation, by themselves, for the condition. While symptoms associated with prostatic obstruction are a common cause of patient referral to a urologist, all therapeutic advances so far have been directed towards the relief of bladder outflow resistance. It is possible that pharmacotherapy, for example, with drugs which stabilize muscle cell membranes and autonomically active drugs such as α1‐antagonists, possibly combined with anticholinergics, will have a therapeutic role in the treatment of obstructive detrusor instability. Further studies of obstructed human bladder are necessary to investigate the importance of changes in receptor density, affinity and distribution, agonist release and degradation and subsequently the ultrastructural and physiological alterations following the relief of obstruction.
Intravesical Evans bacille Calmette‐Guérin for carcinoma in situ of the urinary bladder
Authors: TALIC R.F. , HARGREAVE T.B. , BISHOP M.C. , KIRK D. , PRESCOTT S. ,   Members Of The Scottish Urological Oncology Group
Published: November 2008

Objective To study the long‐term results of a single 8 week course of intravesical Evans bacillus Calmette‐Guérin (BCG) on carcinoma in situ (CIS) of the urinary bladder.

Patients and methods This study reports on 43 patients who each received a single 8 week course of intravesical BCG.

Results In spite of the good initial complete response rate of 70%, the long‐term follow‐up was disappointing with half the patients either having recurrence or progression of their disease by 2 years. The patients had a close follow‐up protocol with early radical treatment when disease progressed. The cause specific survival at 5 years was 70%.

Conclusion We feel that similar future treatment protocols without maintenance treatment are not justified.
Prognostic factors in pTa‐pT1 superficial bladder tumours treated with intravesical instillations
Authors: MULDERS P. F. A. , MEYDEN A. P. M. v. d. , DOESBURG W. H. , OOSTERHOF G. O. N. , DEBRUYNE F. M. J. ,   MEMBERS OF THE DUTCH SOUTH‐EASTERN UROLOGICAL COLLABORATIVE GROUP
Published: November 2008

Objective To identify prognostic factors that enable patients with superficial bladder cancer to be divided into groups who will probably respond to therapy and those who will not.

Patients and methods In a prospective randomized study 38 7 patients with pTn‐pT1 superficial bladder carcinoma received, after transurethral resection, intravesical instillations with immuno‐ or chemotherapy. A simultaneous computerized analysis of factors predicting the recurrence‐free interval was performed, All these patients had negative random biopsies. Pretreatment factors analysed for recurrence were gender, age, history (primary or recurrent disease), location of tumour, number of tumours, pT‐stage and grade.

Results Median follow‐up was 2 7 months (range 12–56). During the follow‐up period 37.2% of the patients had recurrence and eight patients (2.2%) had progression into muscle invasive disease. After a univariate analysis the number of tumours and location of the tumour in the bladder appeared to be a significant influence on the recurrence‐free interval. Location of at least one of the tumours in the prostatic urethra, bladder neck, posterior wall, and trigone area was significantly related to a shorter recurrence‐free interval: these areas were defined as high risk. Tumour stage showed borderline significance. By using multivariate methods to assess the relative importance of these factors, location of tumour in the high risk region was related especially to a short recurrence‐free interval. The factor found to be of significance for the prognosis for recurrence was tumour multiplicity. Gender, age, history of recurrent disease, size of the largest tumour, tumour stage or grade gave no additional information about the risk of recurrence.

Conclusion Prognostic factor analysis, as an auxilliary study of trials of patients treated for superficial bladder tumours, is mandatory. The prognostic factors related to recurrence‐free interval found in this study, location of the tumour and multiplicity, may be of use in the stratification necessary for current protocol design.
Criteria for differentiation of normal and abnormal uroflowmetrograms in adult men
Authors: NISHIMOTO K. , IIMORI H. , IKEMOTO S. , HAYAHARA N.
Published: November 2008

Objective To study parameters which serve as criteria for differentiation of normal and abnormal uroflowmetrograms.

Subjects and methods A total of 105 subjects were investigated, 43 of whom had no symptoms of dysuria, 57 of whom had dysuria demonstrated as an abnormal uroflowmetrogram, subjective symptoms and a small residual urine volume, and five patients who were about to undergo transurethral resection of the prostate. The three parameters used to specify the shapes of the uroflowmetrogram curves were: (i) the ratio of the maximum flow rate (Qmax) and the voiding time (T100)‐ Qmax/T100; (ii) the ratio of the time to peak flow (TQmax) and the voiding time, TQmax/T100; and (iii) the newly introduced voiding efficiency (e), measured by the ratio of the voided volume (VV) and T100× Qmax, 8 = VV/(T100× Qmax), were taken for each patient.

Results The criteria for normal uroflowmetrograms were: Qmax/T100 0.78, 0.32 TQmax/T100 0.54, 0.63 ε < l, respectively. In the patients who underwent transurethral resection of the prostate the values of all three parameters improved and returned almost to normal after operation.

Conclusion Using these three parameters the micturition pattern can be expressed quantitatively.
Involvement of the inferior vena cava by renal tumour: surgical excision using hypothermie circulatory arrest
Authors: Matthews P.N. , Evans C. , Breckenridge I.M.
Published: November 2008

Objective To evaluate the immediate and long‐term results of a radical surgical technique in the treatment of renal tumours with extensive involvement of the inferior vena cava (IVC).

Patients and methods Seven patients with extensive involvement of renal tumours into the IVC were operated upon using a cardiopulmonary by‐pass, hypothermia and cardiac arrest to facilitate surgery. Wide exposure of the IVC in a bloodless field permitted complete removal of all visible tumour in each case. Histological sections confirmed renal cell cancer in six patients and Wilms tumour in a 15‐year‐old girl.

Results All patients recovered well from their surgery with no major complications and spent one or two days in the Intensive Treatment Unit and an average of 13 days in hospital after the operation. Of the seven patients, four are alive and well with no obvious disease after an average follow‐up time of 30 months (range 8–54). The other three patients have died from disseminated renal cancer.

Conclusion This procedure provides good local control of the tumour and offers the only hope of cure in patients with this disease. In collaboration with the surgical cardiac team it can be safely carried out with acceptable morbidity and mortality.
A novel anti‐seminoma monoclonal antibody (M2A) labelled with technetium‐99m: potential application for radioimmunoscintigraphy
Authors: Marks A. , Ballinger J.R. , Reilly R.M. , Law J. , Baumal R.
Published: November 2008

Objective To study the potential usefulness of monoclonal antibody (mAb) M2A specific for seminoma to image tumour nodules in a preclinical nude mouse model.

Materials and methods MAb M2A was labelled with technetium‐99m (99mTc) following reduction and was administered intraperitoneally to nude mice bearing subcutaneous HEY cell xenografts against which the antibody was originally raised. Biodistribution and gamma scintigraphy studies were performed 24 h after administration of 99mTc‐M2A.

Results Biodistribution studies showed specific targeting of 99mTc‐M2A to HEY tumours in comparison with control mAb 99mTc‐6E8 and 99mTc‐2G3 which do not bind to HEY cells. Subcutaneous HEY cell tumours (0.5–1.0 g) were successfully imaged using gamma‐scintigraphy following administration of 99mTc‐M2A.

Conclusion The results of this study indicate the potential usefulness of 99mTc‐M2A as a clinical reagent for imaging seminoma metastases.
Immunohistochemical localization of neuromarkers and neuropeptides in human fetal and neonatal urinary bladder
Authors: Jen P.Y.P. , Dixon J.S. , GOSLING J.A.
Published: November 2008

Objective To use immunohistochemical techniques to determine the spatial and temporal distribution of a variety of neuropeptides in the human fetal and neonatal urinary bladder.

Materials and methods Thirteen pre‐natal specimens ranging in gestational age from 17 to 35 weeks were acquired following abortion or miscarriage. In addition two post‐natal specimens aged 8 and 12 weeks were obtained at post‐mortem and were included in this study. The overall innervation of each specimen was visualized using the general nerve marker protein gene product 9.5 (PGP). Localization of dopamine‐β‐hydroxylase (DBH) and tyrosine hydroxylase (TH) revealed putative noradrenergic nerves. The neuropeptides studied included neuropeptide Y (NPY), vasoac‐tive intestinal polypeptide (VIP), substance P (SP), and calcitonin gene‐related peptide (CGRP).

Results At 17 weeks a rich plexus of PGP and NPY‐containing nerves was present throughout the detrusor muscle coat. As gestational age increased, VIP, SP and CGRP‐containing nerves were observed with increasing frequency although SP and CGRP were mainly confined to perivascular nerve plexuses. TH‐ and DBH‐containing nerves were first observed in the intramural ureters at 30 weeks and the detrusor muscle at 35 weeks and were relatively numerous in the intramural ureters and muscle of the superficial trigone in the two post‐natal specimens. PGP‐containing nerves were first observed beneath the bladder epithelium at 23 weeks and gradually became more numerous with increasing age. Occasional NPY, VIP, SP and CGRP‐containing nerves were observed in the submucosa but TH‐ and DBH‐immunostained nerves were especially numerous in the mucosa of the trigone in the two post‐natal specimens, many such nerves being unrelated to the vascular supply.

Conclusions The bladder detrusor possesses a rich auto‐nomic innervation by 17 weeks of gestation and this presumptive cholinergic innervation is associated with NPY immunoreactivity. Presumptive noradrenergic nerves appear relatively late in pre‐natal development and mainly supply the intramural ureters and superficial trigone. A submucosal plexus of nerves has been demonstrated, the functional significance of which remains uncertain.
Percutaneous endoscopic treatment of urothelial tumours of the renal pelvis
Authors: Plancke H.R.F. , Strijbos W.E.M. , Delaere K.P.J.
Published: November 2008

Objective To evaluate the Results of percutaneous endoscopic treatment of renal pelvic transitional cell carcinoma (TCC).

Patients and methods Ten patients (median age, 70 years; range 56‐86) with a renal pelvic TCC were treated by percutaneous endoscopic resection. Seven had a normal contralateral kidney and were treated electively.

Results Follow‐up was from 3 to 77 months. There was one recurrence locally and one recurrence in the bladder. There have been no recurrences in the nephrostomy tract.

Conclusion We have shown that percutaneous resection of intrarenal TCC is a possible and safe technique. Further follow‐up is needed to confirm its safety.
Outcome of endoscopic bladder transection
Authors: Hasan S.T. , Robson W.A. , Ramsden P.D. , Essenhigh D.M. , Neal D.E.
Published: November 2008

Objective To determine the clinical, symptomatic and Objective urodynamic outcome of patients undergoing endoscopic bladder transection.

Patients and methods The study included 20 men and 30 women (mean age of 50±15 years, range 20–86) who underwent endoscopic bladder transection. Their underlying diagnoses were idiopathic detrusor instability (41), enuresis with instability (6), multiple sclerosis (2) and Parkinson's disease (1). A full‐thickness endoscopic transection of the bladder was performed under general anaesthesia. Subjective assessment was performed using symptom scores (0–14 points) and a Visick grading system (group A‐E). Objective assessment was carried out using urodynamic studies. The mean follow‐up period was 6 years (57 ± 22 months, range 6–85).

Results The mean hospital stay was 8 ± 3 days (range 3–22). No patients died after the operation. Postoperative complications included extra‐peritoneal extravasation (2), recurrent urinary tract infection (5) and urethral stricture (1). Symptom scores before and after the operation were 9±2 (range 4–14) and 8 ± 3 (range 1–14) points respectively. The overall outcome of the procedure was satisfactory in only eight (16%) patients. The mean duration of symptomatic relief was 17 weeks (range 3–53). There was no significant difference between urodynamic results before and after the operation. Bladder instability observed in all patients before operating was demonstrated in 93% of patients after the operation.

Conclusion The results of our study suggests that endoscopic bladder transection produces only a transient symptomatic relief in a few of those patients who have failed to respond to pharmacological manipulations. We do not feel that its continued role is justified.
Does catheter traction reduce post‐transurethral resection of the prostate blood loss?
Authors: Walker E.M. , Bera S. , Faiz M.
Published: November 2008

Objective To determine if traction on a catheter after transurethral resection of the prostate (TURP) reduces post‐operative bleeding.

Patients and methods This prospective trial included 115 consecutive patients undergoing TURP. After resection patients were randomly selected to have either traction (57) or no traction (58) on the catheter for 30 min. Blood loss was measured during and for 2 h after the operation. A simple method for applying constant traction is described.

Results. Catheter traction reduced post‐operative bleeding while applied, but had no further effect after the removal of traction.

Conclusion Catheter traction is a useful technique to aid the control of post‐TURP bleeding.
A urodynamic study of laser ablation of the prostate and a comparison of techniques
Authors: JAMES M.J. , HARRISS D.R. , CECCHERINI A. , MANHIRE A.R. , BATES C.P.
Published: November 2008

Objective To evaluate the effect of laser ablation of the prostate on symptomatic and urodynamic parameters and to compare laser delivery systems.

Patients and methods The study comprised 81 patients of whom 79 were waiting for transurethral resection of the prostate (TURP) and two who presented in acute urinary retention. The 79 patients (median age 65 years, range 45–82) underwent pre‐operative uro‐dynamics and all patients completed American Urological Association (AUA) symptom score questionnaires before surgery. Visually‐guided laser ablation of the prostate (VLAP) was performed and the urodyn‐amics and symptom scores were repeated 3 months later.

Results The improvements in symptom scores and flow rates were statistically significant and comparable with other published data. There were also significant improvements in voiding pressure. There were no significant differences between the various laser fibres used. There were few complications.

Conclusion The effectiveness of VLAP in improving symptoms and flow rates in patients with benign prostatic hyperplasia (BPH) is confirmed. The procedure also reduced voiding pressure, confirming the relief of bladder outflow tract obstruction. VLAP is confirmed as a safe and effective treatment for BPH. Continued follow‐up is needed to determine the long‐term effects.
Ultrasonographic evaluation and clinical correlation of intratesticular lesions: a series of 39 cases
Authors: CORET A. , LEIBOVITCH I. , HEYMAN Z. , GOLDWASSER B. , ITZCHAK Y.
Published: November 2008

Objective To assess the accuracy, specificity and sensitivity of ultrasonography (US) for diagnosing testicular tumours.

Patients and methods Ultrasonography of the scrotum was performed in 39 patients (mean age 20.3 years, range 3–61) referred to the hospital because of pain, tenderness, appearance of a mass in the scrotum or swelling of the scrotum after trauma.

Results Intratesticular lesions were detected by US in 35 patients and four had no suspicious findings after surgical exploration of the scrotum based solely on clinical findings. In five patients the findings on US were compatible with neoplasm, but at surgery or follow‐up, no tumour was found. In one case, the US findings suggested inflammation, but on exploration 3 weeks later, an embryonal cell carcinoma was found.

Conclusions While very sensitive in differentiating an intra‐from an extratesticular lesion, and in ruling out a testicular tumour (sensitivity 96.6%), the US examination is less specific (specificity 44.4%) as the US pattern of different benign process may be similar to those of tumours. The positive predictive value (85.3%) and the accuracy (84.6%) imply that when an intratesticular lesion is detected on US, even when there is no clinical suspicion of neoplasm, exploration of the scrotum is indicated.