bluuebunny/crossref_metadata_2025 huggingface dataset:
An immunogold investigation of the distribution of GABA and glycine in nerve terminals on the somata of spherical bushy cells in the anteroventral cochlear nucleus of guinea pig
Authors: Mahendrasingam S. , Wallam C. A. , Polwart A. , Hackney C. M.
Published: February 2004

Spherical bushy neurons in the anteroventral cochlear nucleus receive glutamatergic primary terminals from the cochlear nerve and terminals of noncochlear (i.e. nonprimary) origin, many of which colocalize gamma‐aminobutyric acid (GABA) and glycine. Here the relationship between GABA and glycine in these terminals has been investigated using postembedding immunogold labelling. A significant negative correlation was found between the density of terminal labelling for GABA and for glycine in four guinea pigs. Terminals could be divided into three categories, GABA‐only, glycine‐only, or colocalizing depending on whether they had a significantly higher labelling density for either amino acid than the primary terminals. The overall labelling density in all four animals was significantly greater for GABA in GABA‐only terminals than colocalizing ones but similar for glycine in both. Within the terminals, the labelling density over synaptic vesicles, nonvesicular regions of cytoplasm and mitochondria was also investigated. No significant difference was detected in the labelling density of vesicles compared with nonvesicular regions for either amino acid. However, a significant difference was found between the overall labelling density over mitochondria and nonvesicular regions for both. There was also significantly more mitochondrial GABA labelling in GABA‐only terminals compared to colocalizing terminals but mitochondrial glycine labelling was similar in glycine‐only and colocalizing terminals. Thus the level of GABA is higher in single than in colocalizing terminals, particularly in the mitochondria, but similar for glycine in both. It is possible therefore that the presence of glycine affects the level of GABA in the nonprimary terminals but that the presence of GABA does not affect the level of glycine.
Postnatal regulation by monoamines of vasopressin expression in the neuroendocrine hypothalamus of MAO‐A‐deficient mice
Authors: Vacher Claire‐Marie , Calas André , Maltonti Fabrice , Hardin‐Pouzet Hélène
Published: February 2004

We studied the influence of noradrenaline (NA) and serotonin (5‐HT) on arginine–vasopressin (AVP) expression in the mouse neuroendocrine hypothalamus during the postnatal period. We used 11‐day‐old transgenic Tg8 mice knock‐out for the monoamine oxidase A gene, which are characterized by increased amounts of NA (two‐fold) and 5‐HT (nine‐fold) in the brain compared with wild‐type littermates. AVP expression, determined by enzyme immunoassay and in situ hybridization, was increased in the suprachiasmatic nucleus (SCN), decreased in the supraoptic nucleus (SON), and unchanged in the paraventricular nucleus of Tg8 mice compared with wild‐types. Inhibiting NA synthesis by injecting α‐methylparatyrosine to Tg8 mice, AVP levels were decreased in the SCN but increased in the SON. Moreover, the administration of parachlorophenylalanine, a 5‐HT synthesis inhibitor, was associated with increased AVP contents in the SCN only. Together, these data show a marked region‐specific sensitivity of AVP expression to NA and 5‐HT during the postnatal period in the mouse hypothalamus.
Auditory perception vs. recognition: representation of complex communication sounds in the mouse auditory cortical fields
Authors: Geissler Diana B. , Ehret Günter
Published: February 2004

Details of brain areas for acoustical Gestalt perception and the recognition of species‐specific vocalizations are not known. Here we show how spectral properties and the recognition of the acoustical Gestalt of wriggling calls of mouse pups based on a temporal property are represented in auditory cortical fields and an association area (dorsal field) of the pups' mothers. We stimulated either with a call model releasing maternal behaviour at a high rate (call recognition) or with two models of low behavioural significance (perception without recognition). Brain activation was quantified using c‐Fos immunocytochemistry, counting Fos‐positive cells in electrophysiologically mapped auditory cortical fields and the dorsal field. A frequency‐specific labelling in two primary auditory fields is related to call perception but not to the discrimination of the biological significance of the call models used. Labelling related to call recognition is present in the second auditory field (AII). A left hemisphere advantage of labelling in the dorsoposterior field seems to reflect an integration of call recognition with maternal responsiveness. The dorsal field is activated only in the left hemisphere. The spatial extent of Fos‐positive cells within the auditory cortex and its fields is larger in the left than in the right hemisphere. Our data show that a left hemisphere advantage in processing of a species‐specific vocalization up to recognition is present in mice. The differential representation of vocalizations of high vs. low biological significance, as seen only in higher‐order and not in primary fields of the auditory cortex, is discussed in the context of perceptual strategies.
AMPA receptor properties and coexpression with sodium–calcium exchangers in rat hypothalamic neurons
Authors: Sergeeva O. A. , Amberger B. T. , Vorobjev V. S. , Eriksson K. S. , Haas H. L.
Published: February 2004

The histaminergic tuberomamillary (TM) nucleus, a center for the regulation of wakefulness, is excited by glutamatergic, aminergic and peptidergic inputs. AMPA receptor properties in relation to their expression were investigated in acutely isolated TM neurons with the help of whole‐cell patch‐clamp recordings combined with single‐cell RT‐PCR. The mRNAs encoding for the AMPA receptor GluR2 (100% of the neurons) and GluR1 (75%) were the most frequently detected, followed by the mRNA for GluR4 (56%), whereas GluR3 cDNA amplification did not yield a PCR product in any neuron. Flip splice variants prevailed over flop, in keeping with a strong glutamate‐response potentiation by cyclothiazide. The expression pattern of AMPA subunits in their two splice variants was correlated with the different subtypes of Na+/Ca2+ (NCX) and Na+/Ca2+/K+ (NCKX) exchangers: glutamate receptor subunits GluR1–4 displayed no coordinated pattern with NCX. However, NCKX2 mRNA occurred only in TM cells with a fast desensitizing glutamate response, where it was coexpressed with the GluR4 subunit in the flop splice variant. NCKX3 mRNA was detected in neurons with fast or slow desensitization of glutamate responses. AMPA receptors in TM neurons were Ca2+‐impermeable. As reverse Na+/Ca2+ exchange contributes to the immediate rise in intracellular calcium resulting from glutamate receptor activation, we suggest that the coordinated expression of NCKX2 with the fast desensitizing AMPA receptor‐type reflects either a receptor–exchanger coupling or separate mechanisms for maintaining calcium homeostasis in neurons with fast or slow glutamate responses.
Pattern motion is present in V1 of awake but not anaesthetized monkeys
Authors: Guo Kun , Benson Philip J. , Blakemore Colin
Published: February 2004

We compared responses of neurons, recorded in striate cortex (area V1) of awake, fixating monkeys, to a single drifting grating with those to a ‘plaid’ pattern comprised of two superimposed drifting gratings separated in orientation by 90°. Five out of 54 (9%) of V1 direction selective neurons responded to the direction of motion of the whole pattern [pattern motion (PM) selectivity]. Tuning curves for plaid stimuli were similar in both optimum direction and width of tuning to those for single gratings. Twenty nine out of 54 (54%) responded simply to the motion of individual orientated gratings within the pattern [component motion (CM) selectivity]. The remaining 37% (20/54) neurons were unclassified. In control experiments, 39 direction selective neurons were recorded in area V1 of anaesthetized monkey and cats. Unlike area V1 in behaving monkeys, none of these neurons exhibited PM selectivity to the drifting plaids. Twenty eight out of 39 (72%) of them responded to the direction of the component gratings and were classified as CM selectivity. Our results indicate that although most V1 neurons are CM selective, as described in anaesthetized animals, a subpopulation is clearly PM selective in behaving monkeys, reflecting integration of locally derived motion signals. Neurons in V1 therefore carry signals that may contribute to pattern motion processing and perception. This perceptual interpretation in V1 might depend much more critically on information integration mechanisms that only function properly in awake, perceiving animals.
Spatially and temporally restricted chemoattractive and chemorepulsive cues direct the formation of the nigro‐striatal circuit
Authors: Gates Monte A. , Coupe Victoria M. , Torres Eduardo M. , Fricker‐Gates Rosemary A. , Dunnett Stephen B.
Published: February 2004

Identifying cellular and molecular mechanisms that direct the formation of circuits during development is thought to be the key to reconstructing circuitry lost in adulthood to neurodegenerative disorders or common traumatic injuries. Here we have tested whether brain regions situated in and around the developing nigro‐striatal pathway have particular chemoattractive or chemorepulsive effects on mesencephalic dopamine axons, and whether these effects are temporally restricted. Mesencephalic explants from embryonic day (E)12 rats were either cultured alone or with coexplants from the embryonic, postnatal or adult medial forebrain bundle region (MFB), striatum, cortex, brain stem or thalamus. Statistical analysis of axon growth responses revealed a potent chemoattraction to the early embryonic MFB (i.e. E12–15) that diminished (temporally) in concert with the emergence of chemoattraction to the striatum in the late embryonic period (i.e. E19+). Repulsive responses by dopaminergic axons were obvious in cocultures with embryonic brain stem and cortex, however, there was no effect by the thalamus. Such results suggest that the nigro‐striatal circuit is formed via spatially and temporally distributed chemoattractive and chemorepulsive elements that: (i) orientate the circuit in a rostral direction (via brain stem repulsion); (ii) initiate outgrowth (via MFB attraction); (iii) prevent growth beyond the target region (via cortical repulsion); and (iv) facilitate target innervation (via striatal chemoattraction). Subsequent studies will focus on identifying genes responsible for these events so that their products may be exploited to increase the integration of neuronal transplants to the mature brain, or provide a means to (re)establish the nigro‐striatal circuit in vivo.
Gene therapy for prostate cancer
Authors: Mazhar D. , Waxman J.
Published: February 2004

In this section there are, as usual, four papers of general interest. The use of gene therapy has become topical, but is in need of further development. Its current status in prostate cancer is updated by the authors from London. In a mini‐review on what is termed ‘hypospadiology’, David Thomas reports on a topic that is one of the most commonly written about in paediatric urology. The authors from Israel review abdominal compartment syndrome, an important complication seen in critically ill patients. Finally, Jim Gillespie introduces us to his interesting views on the origin of the overactive bladder and sensory urgency.
Intravesical administration of gemcitabine in superficial bladder cancer: a phase I study with pharmacodynamic evaluation
Authors: De Berardinis E. , Antonini G. , Peters G.J. , Loves W.J.P. , Van Der Born K. , Codacci‐Pisanelli G. , Di Silverio F.
Published: February 2004

OBJECTIVE

To determine, in a phase I trial, the local and systemic toxicity and pharmacodynamics of intravesical gemcitabine in patients with superficial bladder cancer.

PATIENTS AND METHODS

Twelve patients with histologically confirmed carcinoma localized to the bladder wall (stage T1 or Ta) resistant to previous administration of anticancer drugs and/or of bacille Calmette‐Guérin were enrolled. They initially received intravesical gemcitabine starting at 500 mg and increased in 500 mg increments to 2000 mg. Three patients were treated at each dose level.

RESULTS

There was no evidence of systemic toxicity and local toxicity was minimal. A pharmacological evaluation showed that gemcitabine was undetectable in plasma and its inactive metabolite (2′,2′‐difluorodeoxyuridine) was present at a mean (sd) concentration of 1.39 (1.05) µmol/L. Deoxycytidine kinase was present in tumour tissue samples, and its activity was 27.3 (12.6) pmol/h/mg tissue; deoxycytidine deaminase activity varied from undetectable to 616 pmol/h/mg tissue.

CONCLUSION

Intravesical gemcitabine appears to be well tolerated with no systemic and minimal local toxicity even at the highest dose (2000 mg). A phase II trial of intravesical gemcitabine at 2000 mg given weekly for six consecutive weeks is now in progress in patients with superficial bladder cancer.
Characterizing prostatic adenocarcinomas in men with a serum prostate specific antigen level of <4.0 ng/mL
Authors: Sokoloff M.H. , Yang X.J. , Fumo M. , Mhoon D. , Brendler C.B.
Published: February 2004

OBJECTIVE

To characterize prostate cancer in men undergoing radical prostatectomy who have a prostate‐specific antigen (PSA) level of < 4.0 ng/mL, hypothesising that a low PSA is not caused by diminished tumour production of PSA, nor does it signify clinically insignificant disease.

PATIENTS AND METHODS

Seventy‐nine men (mean age 59.3 years, range 43–77) with a PSA level of < 4.0 ng/mL were identified from 702 who had a radical prostatectomy between 1994 and 2000. Demographic and clinical data were analysed; pathological specimens were evaluated by routine haematoxylin and eosin staining and immunohistochemistry with anti‐PSA antibody, for both pathological staging and grading, and for the presence of PSA production. Tumours were classified as ‘clinically insignificant’ if the tumour volume was < 0.5 mL and the Gleason score < 7.

RESULTS

The mean (sd, range) preoperative PSA level was 3.04 (0.85, 0.8–3.8) ng/mL. Indications for biopsy included an abnormal digital rectal examination (61%), a PSA velocity of >0.75 ng/mL/year (12%), a strong family history of prostate cancer (3%), obstructive urinary symptoms (2%), or no obvious indication (23%). Thirty‐eight (48%) tumours were clinically insignificant. Of 41 clinically significant cancers, 13 had a final Gleason score of ≥ 7, 20 had extraprostatic extension and 11 had a tumour volume of ≥ 10 mL. Of the 79 prostate cancer specimens 78 stained strongly for PSA; the exception was a Gleason 9 tumour. With a mean (range) follow‐up of 3.5 (0.18–6) years only one patient had a biochemical recurrence (PSA ≥ 0.1 ng/mL).

CONCLUSIONS

Most prostate cancers in men with a PSA level of < 4.0 ng/mL are clinically significant and PSA‐producing. Many of these tumours are high‐grade, high‐volume and extraprostatic. We are currently exploring factors to explain why serum PSA is not elevated in these men, including tumour location, pattern of invasion and microvessel density.
The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer
Authors: Kumar V. , Toussi H. , Marr C. , Hough C. , Javle P.
Published: February 2004

OBJECTIVE

To evaluate lower urinary tract symptoms (LUTS) and the symptom‐associated quality of life (QoL) after radical prostatectomy.

PATIENTS AND METHODS

We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse‐led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self‐administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self‐administered continence questionnaire at 6 weeks, 3 and 6 months after surgery.

RESULTS

In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom‐associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty‐eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used < 2 pads/day for protection before heavy physical activity at 3 months after surgery.

CONCLUSIONS

Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS.
Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: ‘the chair’
Authors: Chandi D.D. , Groenendijk P.M. , Venema P.L.
Published: February 2004

OBJECTIVE

To evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women.

PATIENTS AND METHODS

FMS was provided by a ‘magnetic chair’; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction.

RESULTS

In 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001).

CONCLUSION

FMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.
Urethral calculi: presentation and management
Authors: Kamal B.A. , Anikwe R.M. , Darawani H. , Hashish M. , Taha S.A.
Published: February 2004

OBJECTIVE

To determine the occurrence, symptoms, treatment and outcome in patients with urethral stones.

PATIENTS AND METHODS

Fifty‐one consecutive patients with urethral calculi were assessed prospectively; all were male and one was an infant.

RESULTS

Acute retention of urine occurred in 78% of patients, urethral anatomical pathology in 6% and posterior urethral calculi in 88%. The urethral stones, solitary in each patient, consisted of calcium oxalate in 86%, struvite in 6%, mixed stones in 4%, calcium phosphate in 2% and uric acid in 2%. A methodical approach to therapy was used which aimed to clearly define the circumstances in which a given procedure was used, and the resulting success rate.

CONCLUSION

The common belief that most urethral calculi in patients in developing countries originate from the bladder does not seem to be generally applicable. Urethral anatomical pathology does not seem to be a necessary condition for most of these calculi.
Quantitative assessment of a new preparatory tool for board certification in urology
Authors: MacNeily A.E. , Baverstock R.J. , Cole G. , Morales A.
Published: February 2004

OBJECTIVE

To analyse the performance of candidates in a Canadian national mock‐examination for final‐year urology residents with respect to North American speciality examinations in urology.

METHODS

In 1997 the Queen's Urology Examination Skills Training Program (QUEST) was established as an annual national mock examination for final‐year Canadian urology residents. It consists of a short answer question component and an objective structured clinical examination. During the 5‐year period (1997–2001), 91 final‐year residents from all 11 Canadian urology residency‐training programmes participated in QUEST and the Royal College of Physicians and Surgeons of Canada certifying examinations (RCPSCE); 43 (47%) of candidates also attempted the American Board of Urology part 1 qualifying examinations (ABU 1). Performance on QUEST was correlated with the RCPSCE and ABU 1 in a blinded fashion after submitting QUEST scores to governing bodies. Thresholds were determined to help to predict a candidate's performance on the RCPSCE and ABU 1, based on QUEST scores.

RESULTS

There was a moderately close correlation between overall QUEST and RCPSCE performance (r = 0.68, P < 0.001) and a moderate correlation between overall QUEST and ABU 1 performance (r = 0.42, P = 0.005). For the following QUEST scores, the probability of success on the RCPSCE was: <65%, 67% pass; 66–75%, 80% pass; > 75%, 100% pass (P = 0.002). For ABU 1, QUEST overall score of 80% gave a 69% probability of scoring ≥ 70% on ABU 1 (P = 0.003).

CONCLUSIONS

QUEST is a moderate predictor of performance on speciality examinations in urology. We consider that the time, effort and expense to maintain QUEST are justified.
Prevalence of sexual dysfunction in Chinese men with chronic prostatitis
Authors: Liang Chao‐Zhao , Zhang Xue‐Jun , Hao Zong‐Yao , Shi Hao‐Qiang , Wang Ke‐Xiao
Published: February 2004

OBJECTIVE

To investigate the prevalence and risk factors of sexual dysfunction in Chinese men with chronic prostatitis.

PATIENTS AND METHODS

A questionnaire survey was conducted among 2000 men diagnosed as having chronic prostatitis using the National Institutes of Health Chronic Prostatitis Index and analysis of expressed prostatic secretions. The survey was designed to elicit information about age, height, weight, occupation and history of disease and treatment. The erectile capacity of the men was assessed using the five‐question version of the International Index of Erectile Function.

RESULTS

Of the 2000 men with chronic prostatitis selected, 1786 completed the survey; the overall prevalence of sexual dysfunction in these patients was 49%. The prevalence of premature ejaculation and erectile dysfunction accounted for 26% and 15%, respectively; 7.7% had both premature ejaculation and erectile dysfunction. There was a negative correlation between prevalence and age, and with the duration of chronic prostatitis (both P < 0.001).

CONCLUSIONS

The prevalence rate of sexual dysfunction in Chinese men with chronic prostatitis is high and related to age.
Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years
Authors: Manikandan R. , Srirangam S.J. , Pearson E. , Collins G.N.
Published: February 2004

OBJECTIVE

To evaluate the incidence and timing of the onset of chronic scrotal pain after vasectomy in two populations at 1 and 10 years after surgery.

PATIENTS AND METHODS

In a retrospective questionnaire‐based study two groups of men were compared; 460 who had a vasectomy in 1991–92 (group A) and another 460 who had a vasectomy in 2000–1 (group B; 10 and 1 year after surgery, respectively). Data were collected on immediate complications, and the incidence and nature of chronic scrotal pain. Pain severity was graded using a visual analogue score (VAS). Patients were also asked if they regretted having a vasectomy because of pain.

RESULTS

In all, 182 and 220 replies were received from patients in group A and B, respectively. Early complications included haematoma in five (2%) and two (0.9%) patients, respectively, and wound infection in 24 (13%) and 17 (7.7%). Eight patients who had scrotal pain even before vasectomy were excluded from the analysis (two in group A and six in group B). In group A, 25 of 180 (13.8%) had a new onset of scrotal pain of some nature, with eight (4.3%) having a VAS of > 5; one patient had an epididymectomy for this. Three of the 25 regretted having a vasectomy because of pain. In group B, 36 of 214 (16.8%) reported persistent scrotal pain, with 13 (5.9%) having a VAS of > 5. Six of the 36 regretted having a vasectomy because of the pain. The incidence of scrotal pain was not significantly different between the groups (P = 0.48, Fisher's exact test).

CONCLUSION

Chronic scrotal pain after vasectomy is more common than previously described, affecting almost one in seven patients. All patients undergoing vasectomy must receive appropriate preoperative counselling about this. The incidence of this complication does not appear to increase with time.
Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol
Authors: Hensle T.W. , Bingham J. , Lam J. , Shabsigh A.
Published: February 2004

One of the problems associated with bowel reservoirs is the development of calculi. The authors from New York describe their use of an irrigation protocol in 91 patients who had either an augmentation cystoplasty or continent urinary diversion. In addition to finding that patients with an abdominal stoma had a much higher chance of developing reservoir calculi, they found that using a definitive postoperative irrigation programme considerably reduced the incidence of calculi.

OBJECTIVE

To evaluate the influence of an irrigation protocol in preventing reservoir calculi forming after augmentation cystoplasty and continent urinary diversion.

PATIENTS AND METHODS

Between 1985 and 1995, 91 patients had an augmentation cystoplasty and/or continent urinary diversion (group 1; 54 females and 37 males, mean age 11.1 years, range 1–31); these patients were not routinely instructed to use irrigation after surgery. The segments used included ileum (44), colon (36), stomach (eight) and ureter (three). Between 1995 and 2000, 42 patients (group 2) underwent urinary reconstruction (22 females and 20 males, mean age 14.8 years, range 4–27), the segment used being ileum (30), colon (five), ureter (five) and stomach (two) but in contrast to group 1 they then were placed on a standard prophylactic irrigation protocol. The occurrence of stones in the reservoir was then assessed.

RESULTS

Thirty‐nine of the 91 patients (42.8%) in group 1 presented with reservoir calculi after reconstruction and 22 had several episodes. The mean time to presentation was 30 months. The incidence of stone formation by underlying diagnosis included: myelomeningocele, 32/48 (66%), exstrophy five/25 (25%), posterior urethral valves two/20 (10%) and rhabdomyosarcoma, none of three. Fifty of the 91 patients had an abdominal stoma, with stone formation in 33 (66%), while 41 used the native urethra, with stone formation in six (15%). Three (7%) of the 42 patients in group 2 developed reservoir calculi after reconstruction, two in patients with myelomeningocele and one in a trauma patient who had residual bone spicules in the bladder; the mean time to presentation was 26.5 months.

CONCLUSIONS

These data suggest that the irrigation protocol used in group 2 significantly reduced the number of reservoir calculi after urinary tract reconstruction when bowel was used as part of the reconstruction (43% vs. 7%). The most calculi in both groups were in immobile patients with sensory impairment. Also, patients with an abdominal stoma had a greater risk of reservoir calculi (66%) than those using the native urethra (15%).
The urological care and outcome of pregnancy after urinary tract reconstruction
Authors: Hensle T.W. , Bingham J.B. , Reiley E.A. , Cleary‐Goldman J.E. , Malone F.D. , Robinson J.N.
Published: February 2004

OBJECTIVE

To assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus.

PATIENTS AND METHODS

We retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated.

RESULTS

All the patients had some difficulty with clean intermittent catheterization (CIC) during pregnancy, and four needed continuous indwelling catheters. During pregnancy 10 women had several bladder infections and all received antibiotic suppression. There were eight Caesarean sections, two vaginal deliveries and one combined delivery. Six Caesareans were elective and three were emergent. The use of CIC returned to normal in all patients after delivery.

CONCLUSIONS

Women with a urinary reconstruction can have successful pregnancies. The complexity of the surgery and the concern for possible emergency Caesarean section resulted in most patients having an elective Caesarean delivery before term. Antibiotic prophylaxis is recommended and patients may require indwelling dwelling catheters while pregnant but normal CIC can be resumed after delivery.
The autonomous bladder: a view of the origin of bladder overactivity and sensory urge
Authors: Gillespie J.I.
Published: February 2004

Incontinence and the generation of excessive sensory urges are common problems that can seriously influence the quality of life of both men and women. The underlying causes have in some instances been associated with uncontrolled bladder activity. However, the mechanisms generating such activity are still poorly understood and pharmacological tools to control it remain relatively ineffective. There are no effective treatments for bladder overactivity possibly because the bladder mechanisms are not understand or targeted. The purpose of this short review is to raise questions and re‐visit ideas from some older possibly forgotten and neglected publications, but which may shed new light on this problem.
Delayed therapy with curative intent in a contemporary prostate cancer watchful‐waiting cohort
Authors: El‐Geneidy M. , Garzotto M. , Panagiotou I. , Hsieh Y.‐C. , Mori M. , Peters L. , Klein T. , Beer T.M.
Published: February 2004

OBJECTIVE

To identify predictors of delayed therapy with curative intent, an increasingly common option in contemporary patients with prostate cancer who initially choose watchful waiting.

PATIENTS AND METHODS

The characteristics of all patients at one institution and diagnosed with T1–4NXM0 prostate cancer between 1993 and 2000 were prospectively recorded. Factors recorded included: age, tumour stage, histological type, Gleason score, serum prostate specific antigen (PSA) level, prostate volume, PSA density (PSAD), percentage of positive biopsy cores, and the initial treatment selection. Outcomes, including all cancer‐directed interventions, all serum PSA values, and initial outcomes of all interventions with curative intent, were determined by review of all medical records and cancer registry data.

RESULTS

Of 187 patients on watchful waiting, 175 had stage T1 or T2 cancer and were analysed primarily. Thirty‐eight (22%) of these patients received delayed intervention with curative intent (15 radical prostatectomy, 17 external beam radiotherapy, six brachytherapy). Age (P < 0.001) and percentage of positive biopsy cores (P = 0.042) were significant independent predictors of intervention with curative intent. When the PSA doubling time was added to the model it became a significant predictor (P = 0.018), with percentage positive biopsy cores (P = 0.022) and age (P < 0.001).

CONCLUSIONS

Therapy with curative intent is common in contemporary patients with prostate cancer who initially choose watchful waiting. Age and percentage positive biopsy cores are independent predictors of such intervention, with PSA doubling time also an independent predictor.
Prediction of prostate cancer in extended‐field biopsies of the prostate
Authors: Winkler M.H. , Kulinskaya E. , Gillatt D.A.
Published: February 2004

OBJECTIVES

To assess the prediction of prostate cancer using extended‐field prostatic biopsies (8–11 cores), as such biopsy protocols are recommended to increase the detection of prostate cancer, and as fewer cancers are missed this should improve the prediction of biopsy outcome from the patients’ history, transrectal ultrasonography (TRUS) and serum markers.

PATIENTS AND METHODS

In all, 260 patients were prospectively evaluated and 206 with a total prostate‐specific antigen (PSA) level of < 20 ng/mL were included. All patients were evaluated for age, family history, lower urinary tract symptoms (LUTS), medication for LUTS, previous prostate biopsy, the presence of cysts, a digital rectal examination, calcifications or hypoechoic lesions on TRUS, total and transitional zone volume, total PSA (tPSA), PSA density (tPSAD), total PSA transition zone density (tPSATZD), complexed PSA (cPSA), cPSA density (cPSAD), cPSA transitional zone density (cPSATZD), free/total (f/t)PSA ratio and free/complexed PSA ratio (f/cPSA). Logistic regression was used to predict the outcome; 80% of the patients were used to generate the models and 20% to test the prediction.

RESULTS

Two models were constructed; the most accurate contained family history, cPSA, cPSAD, cPSATZD, f/cPSA, PSAD and tPSATZD (sensitivity 91%, specificity 70%). A workable and concise model contained tPSATZD, cPSATZD and f/cPSA, and had a sensitivity of 93% and a specificity of 60%. The best single predictor was tPSATZD with a sensitivity of 92% and a specificity of 55%. Using regression models can produce considerable gains in specificity. This would allow unnecessary prostate biopsies to be avoided for a third of patients compared with tPSA alone.

CONCLUSIONS

The present analysis for PSA indices appeared to be slightly more accurate than those in previously published studies. Most of this improvement in diagnostic accuracy was ascribed to the use of an extended‐field biopsy protocol. Prostate cancer in a first‐degree relative was the only variable that contributed significantly to the regression model. tPSATZD was the best volume‐adjusted PSA index. The f/tPSA appeared to be the best test with no volume adjustment, followed by f/cPSA and cPSA. Although the models are cumbersome and expensive for use in general urological practice they could be used to optimize biopsy strategies on the basis of predicted cancer probabilities in screening studies. The cost of the models may compare favourably with tPSA because of the high specificity that can be achieved.
Presumptive coding. A preliminary study of the aggregation of input diagnoses to determine their relevance to clinical governance and urological resourcing
Authors: Payne S.R. , Napier‐Hemy R.D. , Ganesan T. , Turner W.H.
Published: February 2004

OBJECTIVE

To determine the validity of a system for coding the reason for urological referral from primary care, using ICD10, and thus enable benchmarking of urological outpatient activity.

PATIENTS AND METHODS

Four studies were conducted: (i) A pilot study to aggregate information into a few input diagnosis codes (925 patients); (ii) Validation of the aggregated codes using input diagnoses from a second centre (928 patients); (iii) A prospective study by three urologists to determine the system's generic utility (918 patients); (iv) A study to aggregate the presumptive codes for 2771 patients to gain an insight into the case‐mix of patients referred to a general urological service via the outpatient department.

RESULTS

The aggregation of input diagnoses from general practice referrals into 36 ‘presumptive codes’ was possible and could be validated. Prospective coding, for 96% of eligible patients, was possible with < 1% of referral diagnoses not being codable. Further aggregation of the data for 2771 patients showed that 31% were referred with urological malignancy whilst 69% had symptoms suggesting benign urological disease.

CONCLUSIONS

This preliminary study of presumptive coding suggests that it is a feasible and valid method of recording the input diagnoses for patients presented to a urological service. The information it provides has relevance for the structuring, benchmarking, resourcing and manpower requirements of that service, essential components for clinical governance. It also has relevance to the prospective collection of patient data for research and audit.
Ileal ureteric replacement in complex reconstruction of the urinary tract
Authors: Bonfig R. , Gerharz E.W. , Riedmiller H.
Published: February 2004

Authors from Wurzburg report their experience over a 10‐year period with the use of ileal segments in partial or total ureteric substitution. They felt it was a safe and reliable procedure, but that it should only be used as a last resort, even in difficult cases.

A free graft of fat from the anterior abdominal wall was used by authors from Cairo in 26 female patients having a retropubic repair of genitourinary fistula. They found it to be an easy procedure with a high success rate, and with few postoperative complications.

OBJECTIVE

To report 10 years’ experience with ileal ureteric replacement as a last resort in complex reconstruction of the urinary tract.

PATIENTS AND METHODS

From March 1991 to February 2002 ileal segments were used for partial or total substitution of the ureter in 43 patients (mean age 45.6 years) with structural or functional ureteric loss secondary to irradiation, surgical complications or various other pathological conditions. Ileum was either implanted into the native urinary bladder (in 14) or an intestinal reservoir (in 29). In the latter group the technique was used at the time of primary urinary diversion in eight, in a secondary approach for treating early or late complications in nine and in undiversion or conversion procedures in 12. The ileal ureter was implanted into the urinary reservoir using a serous‐lined extramural tunnel or distal intussusception for reflux prevention (in 31). All patients were followed prospectively according to a standardized protocol.

RESULTS

There were no perioperative deaths; the mean (range) follow‐up was 40.8 (1.5–109.5) months. In 41 patients with dilatation of the upper urinary tract before surgery there was a significant improvement radiographically in 34, no change in five and deterioration in two. The serum creatinine level decreased or remained stable in all. Reflux occurred in the 12 cases without and in three with an antireflux mechanism. Shortening of an elongated kinking ileal ureter became necessary because of recurrent severe metabolic acidosis and mucus obstruction in two; in one case mucus obstruction was treated endoscopically. There was pyelonephritis only in three patients with refluxing implantation into an intestinal reservoir.

CONCLUSION

Ileal ureteric replacement is a safe and reliable last resort even in difficult cases. Whenever feasible, antirefluxing implantation into intestinal urinary reservoirs is recommended.
A surgical model of composite cystoplasty with cultured urothelial cells: a controlled study of gross outcome and urothelial phenotype
Authors: Fraser M. , Thomas D.F.M. , Pitt E. , Harnden P. , Trejdosiewicz L.K. , Southgate J.
Published: February 2004

OBJECTIVES

To study the outcome of composite cystoplasty using cultured urothelial cells combined with de‐epithelialized colon or uterus in a porcine surgical model, using appropriate controls, and to characterize the neo‐epithelium created by composite cystoplasty.

MATERIALS AND METHODS

Urothelial cells were isolated and propagated in vitro from open bladder biopsies taken from nine female minipigs. Cohesive sheets of confluent urothelial cells were transferred to polyglactin carrier meshes and sutured to de‐epithelialized autologous colon in four animals and de‐epithelialized autologous uterus in five. These composite segments were then used for augmentation cystoplasty. Conventional colocystoplasty, de‐epithelialized colocystoplasty and sham operations were carried out in six control animals. After killing the animals at ≈ 90 days the bladders were removed for examination and immunohistochemical analysis, using a panel of antibodies against cytokeratins and urothelial differentiation‐associated antigens.

RESULTS

Macroscopically, the bladders augmented with composite segments derived from uterine muscle had no evidence of shrinkage or contracture. Histological analysis showed that in four of five composite uterocystoplasties, the neo‐urothelium was stratified and had a transitional morphology, although in some areas coverage was incomplete. Immunohistochemical analysis showed evidence of squamous differentiation in both native and augmented segments. All composite and de‐epithelialized colonic segments showed significant contraction with poor urothelial coverage, reflecting the unsuitability of the thin‐walled porcine colon for de‐epithelialization.

CONCLUSIONS

The functional and macroscopic outcome of bladder augmentation with a composite derived from cultured urothelium and de‐epithelialized smooth muscle of uterine origin endorses the feasibility of composite cystoplasty.
Early tissue reactions in the rat bladder wall after contact with three different synthetic mesh materials
Authors: Murat Samli M. , Demirbas M. , Guler C. , Aktepe F. , Dincel C.
Published: February 2004

OBJECTIVES

To investigate bladder tissue reactions to three types of implanted mesh material, i.e. polypropylene, polyglactin and polypropylene‐polyglactin combined.

MATERIALS AND METHODS

Forty‐eight adult female Wistar albino rats were randomized to four equal groups, i.e. group 1 (sham‐operated controls), group 2 (polypropylene mesh), group 3 (polyglactin mesh) and group 4 (polypropylene‐polyglactin mesh). A laparotomy incision was made to access the bladder and fix a 0.5 × 1 cm piece of mesh directly on the bladder wall. Each group was randomly divided into two subgroups of six animals, killed at 7 and 14 days after mesh implantation, respectively, to study mesh and tissue features with time. Bladders were harvested for histological and immunohistochemical investigation. Microvessels that developed around the mesh were detected with the avidin‐biotin peroxidase system, using antibody to Factor VIII‐related antigen as an endothelial marker. Vessels were counted in the most intensely stained area of one section from each animal's bladder.

RESULTS

Compared with the other groups, group 4 had more inflammatory reaction at 7 days but the tissue reactions to all mesh materials were similar at 14 days; the mesh penetrated the bladder muscularis propria at 14 days in all six rats in group 2, in one in group 3, and two in group 4. Group 4 tended to have a greater microvessel density at 14 than at 7 days. In contrast, groups 2 and 3 had lower microvessel densities at 14 than at 7 days.

CONCLUSION

The rat bladder wall had a similar early response to all three types of mesh materials. Penetration was more marked with polypropylene mesh than with the other materials. This nonabsorbable material persists in tissue and is currently widely used for clinical applications. These results for penetration suggest that the use of polypropylene mesh risks serious postoperative complications, e.g. urethral tissue erosion.
Retropubic repair of genitourinary fistula using a free supporting graft
Authors: El‐Lateef Moharram A.A. , Abd El‐Raouf M.A.
Published: February 2004

OBJECTIVE

To report the repair of genitourinary fistulae using a retropubic extraperitoneal transvesical approach using a support graft (free graft) from the anterior abdominal wall fat.

PATIENTS AND METHODS

In all, 26 women with genitourinary fistulae (25 with vesicovaginal and one uterovesical) were operated using the free graft method.

RESULTS

All patients had no leakage after surgery; while 15 developed urgency three had recurrent urinary tract infection and one developed a small bladder capacity.

CONCLUSION

This operation has the advantages of a short operative duration, an easy technique and fewer postoperative complications with a high success rate.
Home‐dilatation of the urethral meatus in boys
Authors: Searles J.M. , MacKinnon A.E.
Published: February 2004

OBJECTIVES

To evaluate the efficacy of dilatation of the stenotic urethral meatus in boys at home.

PATIENTS AND METHODS

Eighteen boys aged 3–15 years, or their parents, were taught to dilate the urethral meatus at home. The cause of the stricture was balanitis xerotica obliterans (BXO) in five and consequent upon hypospadias surgery in 12, of whom two were complicated by BXO, and one after circumcision for cultural reasons. One boy was re‐referred after an interval of 3 years because of apparent deterioration of the stream of urine. Meatal dilatation was taught in the home by one of the authors (J.M.S.)

RESULTS

Nine patients were cured by the first course of dilatation, four relapsed early after initial success but responded to further treatment, and three proceeded to meatoplasty because they had no response. Two relapsed late and one responded to further dilatation but the other required surgery.

CONCLUSION

Dilatation of the urethral meatus can be taught successfully to boys or their families at home, thus avoiding repeated hospital attendance and often general anaesthesia.
Serotonin‐induced potentiation of cholinergic responses to electrical field stimulation in normal and neurogenic overactive human detrusor muscle
Authors: Chapple C.R. , Radley S.C. , Martin S.W. , Sellers D.J. , Chess‐Williams R.
Published: February 2004

The smooth muscle cells of the urinary tract are again the subject of much study, as is reflected by the papers in this section. Authors from Sheffield evaluate the effects of 5‐HT on the potentiation of cholinergic responses in isolated strips of detrusor muscle. In another study authors from France compare the effects of tamsulosin and alfuzosin on neurally evoked increases of bladder neck and seminal vesicle pressures in rats. The smooth muscle of the renal artery is assessed by authors from Germany, where they investigate the involvement of signal‐transducing GTP‐binding proteins in renal artery smooth muscle contraction.

OBJECTIVE

To compare the serotonin (5‐HT)4‐receptor‐mediated effects of 5‐HT on the potentiation of cholinergic responses to electrical‐field stimulation (EFS) in isolated strips of detrusor muscle from patients with normal or neurogenic overactive bladders.

MATERIAL AND METHODS

Strips of detrusor muscle were field‐stimulated (10 Hz, 0.01 ms duration, 60 V for 5 s) at 100‐s intervals until consistent responses were obtained. In the presence of methiothepin, ketanserin and ondansetron (all 1 µmol/L) to block 5‐HT1, 5‐HT2 and 5‐HT3 receptors, respectively, the cumulative administration of 5‐HT or the selective 5‐HT4 agonist cisapride, produced concentration‐dependent enhancement of responses to EFS in both types of tissue.

RESULTS

The maximum potentiation induced by 5‐HT in neurogenic overactive detrusor muscle was reduced (P < 0.05) by about half compared to normal detrusor muscle, but EC50 values obtained in normal and overactive tissue were not significantly different. Cisapride was less potent than 5‐HT and acted as a partial agonist relative to 5‐HT. The selective 5‐HT4 receptor antagonist RS‐100235 was a potent antagonist of the 5‐HT‐induced potentiation of responses to EFS. At 3 nmol/L RS‐100235 antagonized the effects of 5‐HT in both groups of tissues without affecting the maximum responses. The affinity estimates (apparent pKB values of 9.2–9.5) for this antagonist were similar in normal and overactive detrusor muscle.

CONCLUSIONS

These results indicate that 5‐HT4 receptor‐mediated potentiation of field‐stimulated responses is lower in the neurogenic overactive detrusor muscle than in normal tissue. 5‐HT4 receptor antagonist affinity is unchanged in the neurogenic overactive bladder.