bluuebunny/crossref_metadata_2025 huggingface dataset:
Salvage procedures for failed Benchekroun hydraulic valves: experience in four patients
Authors: Mouriquand P.D.E. , Boddy S.
Published: November 2003

Objective To describe the complications encountered with the Benchekroun hydraulic valve and the salvage procedures used to convert it into a successful continent diversion.

Patients and methods Seven patients with spina‐bifida (two males and five females) presenting with neurogenic incontinence were treated originally with a combined urethral lengthening (Pippi‐Salle procedure), detubularized ileocystoplasty and Benchekroun hydraulic valve. Four of these patients presented with immediate (three) or subsequent (one) complications related to the devagination or the overdistension of the hydraulic valve, and stomal problems. Two techniques were used to create a catheterizable conduit with the intestinal material of the Benchekroun hydraulic valve; one used the inner tube of the valve and the other one used the appendix. These techniques are described and illustrated.

Results All four patients made a satisfactory recovery and had no difficulty in catheterizing their bladder through the revised continent diversion. However, the follow‐up of these patients was short (1–8 months) and a long‐term assessment is required to evaluate these salvage procedures.

Conclusions The Mitrofanoff procedure remains our first choice to create a continent diversion in children with neuropathic bladders. However, when the appendix is not available or unusable, alternative procedures such as the Benchekroun hydraulic valve might be used to create a continent catheterizable conduit. Nevertheless, complications or failure of the Benchekroun valve and its variants (e.g. Guzman's technique) are common and salvage procedures are often necessary to recreate an efficient continent conduit.
Stones in enterocystoplasties
Authors: Nurse D.E. , McInerney P.D. , Thomas P.J. , Mundy A.R.
Published: November 2003

Objectives To assess the aetiology of stones which occur in enterocystoplasties and continent diversions, generally attributed to the presence of foreign material, e.g. staples, or to recurrent urinary infection, in patients with augmented or substituted bladders.

Patients and methods The study comprised 467 patients who had undergone reconstruction of the lower urinary tract and had been followed up for at least 3 years using videourodynamics and ultrasonography.

Results Stones were found in 42 patients (9%); 50% were found incidentally and the remaining patients presented with symptomatic infections (27%) or deterioration in urinary continence (23%). Stones occurred in 6% of patients with augmentation, in 7% of those with substitution cystoplasty and in 22% of patients with continent diversions. Most patients with stones (88%) used clean intermittent self‐catheterization (CISC). Stones were 5–10 times commoner in patients using CISC than in patients voiding spontaneously.

Conclusion Urinary stasis was a more important cause of stone formation than was bacteriuria in patients with cystoplasty. The presence of mucus and bacteriuria are presumed to be contributory. To reduce the risk of stone formation, orthotopic cystoplasty and spontaneous voiding are to be preferred to continent diversion and CISC. Periodic bladder washouts may be an alternative solution.
Bladder replacement by detubularized ileal loop:
Authors: Alcini E. , Racioppi M. , D'Addessi A. , Menchinelli P. , Grassetti F. , Alcini A.
Published: November 2003

Objective To evaluate the results obtained with a technique of bladder replacement using a detubularized ileal tract, developed by the authors.

Patients and methods Since 1983, 34 patients have undergone an orthotopic bladder replacement using 35–40 cm of ileum, detubularized and shaped into an ‘S’ to create a neobladder with a capacity of 100–120 mL. The ureters were anastomosed directly to a 10 cm long intact afferent loop which serves as an anti‐reflux mechanism, while a 2 cm long efferent, spatulated loop was used for urethral anastomosis. The mean (sd) follow‐up was 32 (33) months.

Results All the patients were continent during the day, with socially convenient intervals between voids; 3 years after the operation, 10 of 12 patients were continent during the night, with intervals of 2–4 h between voids. The mean post‐void residual urine volume was 41 mL and no patient required self‐catheterization. There were no derangements of the metabolic status of patients.

Conclusion This technique was applied knowing that a detubularized intestinal loop has the remarkable ability to increase in capacity over time. Therefore, to maintain the reservoir in good condition over a long period it is important to construct it with an intra‐operative capacity of <120 mL, thus reducing the length of intestine required. This may explain the satisfactory metabolic status of these patients. Moreover, the triplication of the mesentery helps to maintain the sphericity of the neobladder and provides support for the neobladder in the lower pelvis, where it retains the same position as a normal bladder.
A comparison of various methods to burst Foley catheter balloons and the risk of free‐fragment formation
Authors: Gülmez I. , Ekmekcioglu O. , Karacagil M.
Published: November 2003

Objective To compare the efficiencies of bursting balloons and the risks of forming free fragments after rupture using needles, the stylet of a ureteric catheter, instillation with ether or overinflation.

Materials and methods Two hundred 18 F ‘silkolatex’ Foley balloon catheters were divided into four groups of 50. Each balloon was inflated with 30 mL of distilled water, the catheters immersed in urine collected from healthy volunteers and maintained at 37°C for 48 h. Attempts were made to burst the balloons with a needle (group 1), by overinflation (group 2), by ether instillation (group 3) and using the stylet of 7 F ureteric catheter through the inflation channel (group 4).

Results The ratio of the burst to deflated balloons and the formation of free fragments were 100% and 0% in the group 1, 94% and 83% in the group 2, 100% and 100% in group 3 and 16% and 0% in the group 4, respectively.

Conclusion Bursting the catheter balloons using a needle seems to be the most appropriate method, being efficient and having little risk of forming free fragments.
A single positive prostate biopsy in six does not predict a low‐volume prostate tumour
Authors: Ravery V. , Szabo J. , Toublanc M. , Boccon‐Gibod L.A. , Billebaud T. , Hermieu J.F. , Delmas V. , Boccon‐Gibod L.
Published: November 2003

Objective To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)‐guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen.

Patients and methods Of 158 patients submitted to RP for T1–T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extracapsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with post‐operative biological progression (P+), having a prostate‐specific antigen (PSA) level>0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively.

Results The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with <10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow‐up of 22 months.

Conclusion A single positive needle‐biopsy in six systematic TRUS‐guided prostate biopsies is not predictive of low‐volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.
A 3‐year follow‐up of patients with localized prostate cancer operated on with or without pre‐treatment with the GnRH‐agonist triptorelin
Authors: Hellström M. , Häggman M. , Pedersen K. , Busch C. , Brändstedt S.
Published: November 2003

Objective To examine the effect of pre‐operative androgen deprivation on the progression rate of malignancy in patients operated on for localized prostate cancer.

Patients and methods A total of 53 patients received no hormone therapy (group 1) and a further 38 patients (group 2) received the generic releasing‐hormone agonist triptorelin during the 3 months before surgery. The patients in group 1 had T1b‐T2 tumours, whereas 12 of those in group 2 had clinical stage T3 tumours. Despite this, the surgical specimens from the patients in group 2 showed a rate of cancer invasion of the surgical margins 20% lower than those from the patients in group 1. After prostatectomy, the patients were followed for 3 years by repeated analyses of prostate‐specific antigen (PSA) in serum.

Results During the follow‐up, the PSA level exceeded the upper threshold (0.6 ng/mL) in 16 % of the patients in group 1 and in 43 % of those in group 2 (P<0.05). This difference was mainly related to the pre‐treatment stage of the tumour. Some of the patients in group 1 received post‐operative radiotherapy but this was not reflected in their PSA levels. Of the patients in group 1 and 2, 4% and 14% respectively (P>0.05), developed symptoms from skeletal metastases.

Conclusion There was no evidence that pre‐operative hormone therapy slowed the progression of prostate cancer.
Urinary diversion in children and young adults using the Mainz Pouch I technique
Authors: Stein R. , Fisch M. , Beetz R. , Matani Y. , Doi Y. , Hohenfellner K. , Bürger R.A. , Abol‐Enein H. , Hohenfellner R.
Published: November 2003

Objectives To determine the late complications and consequences for renal function, vitamin and acid‐base metabolism after application of the Mainz Pouch I (MZP‐I) technique in children and young adults.

Patients and methods To November 1994, the MZP‐I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (≤20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow‐up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1–10.5).

Results At the last examination, 23 of 55 (42%) pre‐operatively dilated RUs had improved, 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre‐operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re‐operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1 , B2 , B6 , E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre‐operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm.

Conclusion The MZP‐I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long‐term protection of the upper urinary tract.
Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study
Authors: Cookson M.S. , Sogani P.C. , Russo P. , Sheinfeld J. , Herr H. , Dalbagni G. , Reuter V.E. , Begg C.B. , Fair W.R.
Published: November 2003

Objectives To assess the pathological staging and biochemical progression‐free survival (assessed using serum prostate‐specific antigen level) of patients with clinically localized prostate cancer using neoadjuvant androgen deprivation therapy (ADT) in combination with radical retropubic prostatectomy (RRP).

Patients and methods A prospective study was carried out on 69 patients with localized prostate cancer who were enrolled in a trial of 3 months of ADT followed by RRP (group 1). These patients were compared with 72 patients matched for age and clinical stage who declined ADT therapy and had RRP concurrently (group 2). Assignment to the individual treatment groups was thus determined by the patient's preference and not the physician's selection. Pathological staging and biochemical progression‐free recurrence were compared between the groups.

Results The rate of organ‐confined (pT2) tumours was 74% in group 1 and 49% in group 2 (P<0.01), and the rate of margin‐negative tumours was 87% in group 1 and 64% in group 2 (P<0.01). Within a median follow‐up of 35 months, there was no significant difference in biochemical failure between the groups (P=0.37). Patients with pT2 disease, regardless of treatment, had similar biochemical failure rates. In the patients with margin‐positive disease, there was a significantly higher biochemical failure rate in group 1 (P=0.02).

Conclusions The rates of organ‐ and specimen‐confined disease were higher among the patients treated with ADT. The preliminary follow‐up suggested that patients with pT2 disease after ADT have a biochemical progression‐free recurrence rate similar to pT2 patients treated with RRP alone. Additionally, high biochemical failure rates in patients with margin‐positive disease after ADT may identify a subset of more biologically aggressive tumours in need of early adjuvant treatment.
Assessment of testicular cytology by fine‐needle aspiration and the imprint technique: are they reliable diagnostic modalities?
Authors: Odabas Ö. , Ugras S. , Aydin S. , Yilmaz Y. , Kemal Atilla M.
Published: November 2003

Objective To investigate whether testicular cytology may be considered diagnostic in the evaluation of infertile men.

Patients and methods Specimens of testicular tissue obtained either surgically (imprint smear) or through fine‐needle aspiration (FNA) were used as a source of cytological smears; 58 testes from 24 men with azoospermia or severe oligospermia and from five men with advanced prostate cancer were evaluated cytologically and compared with the histological diagnosis.

Results FNA caused no apparent trauma. The results from FNA smears generally agreed with the histological findings but four patients with no spermatozoa in the FNA smears were diagnosed histologically as hypospermatogenic and two others judged histologically as having Sertoli‐cell‐only (SCO) syndrome and spermatogenic arrest had detectable spermatozoa in their FNA smears. There was complete agreement between the results of imprint smears and histological findings in those patients with SCO syndrome and spermatogenic arrest. There were no evident differences in sperm counts between hypospermatogenesis and normal spermatogenesis on the imprint slides, but FNA smears detected this difference.

Conclusion FNA of the testis is a relatively non‐invasive and reproducible technique for evaluating qualitative and quantitative cytology. However, it is insufficient for diagnosing some testicular pathologies. Imprint smears supplement the histological diagnosis, especially if the histological slides are stained unsatisfactorily.
Spontaneously released substance P and bradykinin from isolated guinea‐pig bladder
Authors: SABAN R. , FRANZ J. , BJORLING D.E.
Published: November 2003

Objectives

 To investigate whether the isolated urinary bladder spontaneously releases substance P (SP) or bradykinin (BK), which can act as potent mediators of pain and inflammation of the urinary bladder, and whether peptidase inhibitors enhance peptide release.

Materials and methods

 Urinary bladder segments (2×10×0.8–1 mm) were isolated from guinea pigs and studied in vitro; tissue contraction was assessed using force‐displacement transducers and the release of peptides by specific enzyme immunoassays.

Results

 In the absence of any exogenous agonists, the inhibition of neutral endopeptidase and angiotensin‐converting enzyme by phosphoramidon and captopril, respectively, increased the frequency and magnitude of spontaneous motility of isolated bladder strips. Phosphoramidon increased the net release of SP‐like immunoreactivity (SP‐LI) and captopril increased the net release of SP‐LI and BK‐LI, concomitant with contraction. Peptide‐LI was recovered primarily from bladder mucosa and to a lesser degree from detrusor smooth muscle. Similarly, peptidase inhibitors primarily affected the bladder mucosa; phosphoramidon induced a fourfold increase in SP‐LI and captopril induced a significant increase of SP‐LI and BK‐LI from the mucosa. Tissues contracted in response to peptidase inhibitors in the presence of atropine and indomethacin, but contraction was reduced significantly by in vitro capsaicin desensitization or removal of bladder mucosa. BK stimulated SP‐LI release from mucosa but not detrusor. SP stimulated increased BK‐LI release from mucosa and detrusor.

Conclusions

 These findings indicate the basal release of peptide‐like immunoreactivity by isolated bladder and further support the concept that peptidases located in the bladder mucosa are important in terminating the effects of endogenous peptides.
Exogenous calcitonin gene‐related peptide can induce the testis to cross the scrotal septum
Authors: CLARNETTE T.D. , HUTSON J.M.
Published: November 2003

Objectives

 To determine: (i) whether the pattern of gubernacular migration can be changed by local injections of calcitonin gene‐related peptide (CGRP) in rats with a normal testicular position, (ii) the effects of both endogenous and exogenous CGRP on contralateral gubernacular migration and (iii) whether the scrotal septum acts as a barrier to prevent gubernacular migration.

Materials and methods

Four groups of neonatal rats were used, all of which underwent right orchidectomy with: group 1 (29 rats) division of the genitofemoral nerve (GFN) on both sides; group 2 (31 rats) division of the left GFN; group 3 (31 rats) division of the left GFN and injections of oil into the right hemiscrotum; and group 4 (34 rats) division of the left GFN and injections of CGRP into the right hemiscrotum. After 26–38 days, the rats were killed and the testicular positions determined.

Results

In rats receiving no injections (groups 1 and 2), the testes were oriented further to the right side where the right GFN was not divided (group 2). With the addition of oil into the right hemiscrotum where the right GFN was not divided (group 3), the testes were oriented further to the left compared with those in group 2. Injections of CGRP into the right hemiscrotum in the presence of an intact right GFN (group 4) resulted in more testes where the axis was orientated to the right side of the scrotum compared with the other groups with an intact right GFN (groups 1 and 3) but this was not reflected in the mean distance from the midline, which was similar among these groups. A significant number of testes in groups 1,2 and 4 crossed the midline.

Conclusions

The presence of an intact GFN on the right side where the left nerve was divided provides a directional signal influencing migration of the contralateral gubernaculum to the right side of the scrotum. Oil injected into the scrotum interferes with the normal concentration gradient of CGRP released from the right GFN, resulting in gubernacular migration further toward the left side. CGRP injections were poorly localized to the right hemiscrotum, resulting in gubernacular migration toward in some and away from the site of injection in others. The midline scrotal septum is not a barrier to gubernacular migration and most likely forms as a secondary event following descent of the testis.
Free and total prostate‐specific antigen in a screened population
Authors: BANGMA C.H. , KRANSE R. , BLIJENBERG B.G. , SCHRÖDER F.H.
Published: November 2003

Objectives

 To determine whether the ratio of free to total (F/T) prostate‐specific antigen (PSA) can differentiate between men with prostate carcinoma or benign conditions in a screened population.

Subjects and methods

 Total and free serum PSA (measured using Delfia PSA assays, Abbott IMx and Hybritech Tandem E methods) were determined retrospectively in 1726 men aged 55–77 years, in whom 67 prostate carcinomas were detected by screening with a digital rectal examination, transrectal ultrasonography, and total serum PSA level. Predictors for a positive biopsy result were estimated as a function of total PSA, free PSA and the combination of both.

Results

 There was an excellent correlation between the Delfia ProStatus, the Abbott IMx and the Hybritech Tandem E assays. Compared with the total serum PSA level, the F/T ratio improved the specificity significantly only in those men with a total PSA of ≥7 ng/mL. Using the information given by the total and free PSA values, a maximum sensitivity of 75% at a specificity of 74% was obtained for the whole PSA range from 4 to 10 ng/mL; the maximum sensitivity was 79% with a specificity of 71%.

Conclusion

 The optimal mathematical combination of free and total serum PSA improves the specificity of total serum PSA level in detecting prostate carcinoma more than the does the F/T PSA ratio.
The ice‐water test in the diagnosis and treatment of the neurogenic bladder
Authors: RONZONI G. , MENCHINELLI P. , MANCA A. , DE GIOVANNI L.
Published: November 2003

Objective

 To determine the usefulness of the ice‐water test (IWT) in the diagnosis and treatment of neurological bladder disease.

Patients and methods

 The IWT was carried out in 148 patients with neuropathic bladder dysfunction resulting from a traumatic lesion, to assist in their diagnosis and treatment, and in 130 patients with neuropathic bladder dysfunction and multiple pathogenic disorders; the results of the IWT were used to classify those patients with hyperactive bladders.

Results

 The IWT was positive in 95% of patients affected by complete and in 86% of patients with incomplete medullary lesions. The IWT in patients with lower motor neuron medullary lesions was always negative. The test was used diagnostically in all patients with lower and in 43% of those with upper motor neuron lesions. In the latter, it was used in 48% of patients as a rehabilitation method during the medullary‐shock phase to accelerate the appearance of the micturition reflex. In 9% of patients it was used to induce micturition during cystography.

Conclusion

 Because it is simple to perform, the IWT is a useful complement to urodynamic examinations in patients with neurological bladder disease and in patients with micturitional disorders that are otherwise difficult to interpret.
Tubulogenesis by microvascular endothelial cells is mediated by vascular endothelial growth factor (VEGF) in renal cell carcinoma
Authors: NAKAGAWA M. , EMOTO A. , HANADA T. , NASU N. , NOMURA Y.
Published: November 2003

Objective

 To investigate the role of vascular endothelial growth factor (VEGF) in tumour angiogenesis in renal cell carcinoma (RCC).

Materials and methods

 The expression of VEGF was examined in tissue samples from 25 patients with RCC using the reverse‐transcriptase polymerase chain reaction (RT‐PCR). Cellular localization of VEGF was studied in normal kidney and RCC tissues. Tube formation by human omental microvascular endothelial (HOME) cells co‐cultured with A498 RCC cells was quantified in a three‐dimensional collagen gel using computer‐image analysis.

Results

 RT‐PCR detected VEGF m‐RNA in tissue from 20 of 25 patients with RCC. An immunohistochemical study revealed that VEGF was primarily localized in the cytosol of normal renal tubule cells and RCC cells. Tube formation by HOME cells was increased in the presence of A498 cells overexpressing VEGF mRNA, induced by exogenous VEGF in a dose‐dependent manner and completely inhibited by an anti‐VEGF antibody.

Conclusion

 VEGF, which is produced and released from RCC cells, may elicit tumour angiogenesis by inducing microvessel tubulogenesis in patients with RCC. The co‐culture system may be useful for screening inhibitors of tumour angiogenesis in RCC.
The anatomy and reconstruction of the adult female genitalia in classical exstrophy
Authors: WOODHOUSE C.R.J. , HINSCH R.
Published: November 2003

Objective

 To review the anatomy and reconstruction of the external genitalia in adult females born with exstrophy.

Patients and methods

Between 1981 and 1995, 47 females (born between 1953 and 1980) were seen in the adolescent clinic at St Peter’s Hospital. The notes of 42 were reviewed to obtain data on genital reconstruction and sexual function. When patients were no longer under personal review, a telephone contact was made to obtain further information.

Results

The pelvic structures were displaced forwards so that the introitus was a structure of the lower abdominal wall. The clitoris was bifid and the labia were not united anteriorly; the introitus was very narrow. The pubic hair lay on either side of the introitus. Twenty‐eight patients had a modified episiotomy and two a vaginoplasty to allow penetrative intercourse. Fifteen patients had a vulvoplasty and a monsplasty. The surgical results were good in all but one case. One patient had partial necrosis of the skin flaps for the monsplasty. All patients who had an episiotomy were able to have intercourse while only four unreconstructed cases could do so.

Conclusions

The genital anatomy in females with exstrophy is abnormal. Reconstructive surgery can improve the appearances and allows penetrative sexual intercourse.
A high‐risk group for prostatism: a population‐based epidemiological study in Korea
Authors: LEE E. , PARK M‐S. , SHIN C. , LEE H. , YOO K. , KIM Y. , SHIN Y. , PAIK H‐Y. , LEE C.
Published: November 2003

Objective

 To evaluate the effect of sociodemographic, dietary and physical factors on prostatism in Korean men aged 50 and over.

Subjects and methods

 A community‐based cross‐sectional epidemiological study was performed in Yonchon County, Korea. The Korean version of the International Prostate Symptom Score (IPSS) was used to assess the severity of prostatism. Data on occupation, marital status, education, smoking habits, alcohol intake, daily consumption of nutrients, body mass index, abdominal circumference, waist‐to‐hip ratio, blood pressure, serum glucose, cholesterol, triglyceride and high‐density lipoprotein (HDL) levels were analysed. The age‐adjusted relative risk of these factors was calculated for moderate to severe prostatism (IPSS ≥8). A multivariate analysis of all significant factors was performed to examine the joint effect of risk factors.

Results

 Of 514 subjects, 119 (23.2%) had moderate to severe prostatism, the risk for which was related to age and alcohol consumption; waist‐to‐hip ratio (which represents the degree of abdominal obesity) and the serum level of HDL showed a biphasic association with prostatism in the multivariate analysis.

Conclusion

 In addition to previously reported risk factors, these data suggest that there might be an association between the development of prostatism and abnormal lipid metabolism.
Lymph‐node revealing solution: a new method for detecting minute lymph nodes in cystectomy specimens
Authors: KOREN R. , PAZ A. , LASK D. , KYZER S. , KLEIN B. , SCHWARTZ A. , GAL R.
Published: November 2003

Objective

 To describe the use of a new lymph‐node revealing solution (LNRS) for detecting lymph node involvement in total cystectomy specimens from patients with locally confined invasive transitional cell carcinoma (TCC) of the bladder, and to compare the results obtained with those using the conventional method (palpation and sectioning perivesical fat) that may fail to detect very small lymph nodes.

Materials and methods

 Of 12 cystectomy specimens obtained from patients with TCC, six in which 0–3 metastatic nodes were identified by the conventional method were further investigated using LNRS. The revealing solution comprised 95% ethanol, diethyl ether, glacial acetic acid and buffered formalin (65:20:5:10 v/v) prepared under a fume‐hood. After evaluation using the conventional method, the specimens were immersed for 6–12 h in the solution, washed under running tap water and the adipose tissue sectioned at intervals of 2–3 mm. Lymph nodes were identified as white, chalky nodules against the background of yellow fat. The number of the lymph nodes identified by conventional and the LNRS methods was recorded and classified according the TNM system.

Result

 Twenty‐two lymph nodes were detected by the conventional method, of which four were positive for tumour metastasis. Using the LNRS, an additional 21 nodes were identified among which 12 were positive. The mean size of the lymph nodes detected by the conventional and LNRS methods was 7.96 mm and 3.81 mm, respectively. The stage of three patients was increased (Nx to N2, N0 to N2 and N1 to N2) and therefore two of these patients received adjuvant chemotherapy.

Conclusions

 LNRS significantly enhanced the yield of normal and metastatic nodes of cystectomy specimens and may identify smaller nodes. The LNRS method allows a more accurate staging with better assessment of the prognosis and need for adjuvant therapy.
Prostatic asymmetry as a risk factor for prostatic carcinoma: serial prostate‐specific antigen monitoring and cancer detection
Authors: HANSEN JR J.G. , DALKIN B.L. , HARRIS C.H. , JOHNSON C.S. , AHMANN F.R.
Published: November 2003

Objective

 To compare the rates of cancer detection in men with a normal, asymmetric, or suspicious prostate on digital rectal examination (DRE) initially and after 3 years of serial monitoring of prostate specific antigen (PSA) level.

Patients and methods

Prostatic ‘asymmetry’ was defined as asymmetric growth of the lateral lobes of the prostate without induration or nodules, as assessed by a DRE. The study included 963 men with no clinical evidence of prostate cancer and whose serum PSA levels were monitored at 4 month intervals. Prostatic biopsy was recommended if the PSA level became persistently abnormal (>4ng/mL) or increased by >20% after having been initially abnormal. Cancer detection rates were compared among groups categorized by the initial DRE findings and serum PSA level.

Results

On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels both, as expected, were associated with a statistically significant increase in cancer detection. However, an asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a normal prostate, regardless of PSA level.

Conclusions

An asymmetric prostate does not appear to be an independent risk factor for detecting prostate cancer. Therefore, an asymmetric prostate with no abnormality in PSA level should not mandate prostatic biopsy, or even an increase in monitoring frequency above the presently recommended annual interval.
Endovascular treatment of renal artery aneurysms with conventional non‐detachable microcoils and Guglielmi detachable coils
Authors: KLEIN G.E. , SZOLAR D.H. , BREINL E. , RAITH J. , SCHREYER H.H.
Published: November 2003

Objective

 To evaluate the efficacy and safety of endovascular occlusion of true renal artery aneurysms (RAAs) with conventional non‐detachable microcoils (NDCs) and Guglielmi detachable coils (GDCs).

Patients and methods

 Over a 5‐year period, 12 RAAs were treated by endovascular selective embolization. Four RAAs were occluded using NDCs and eight were treated with GDCs. All coils were delivered through a microcatheter. Eight RAAs were located in the bifurcation of the main renal artery, two in the main renal artery and two were intrarenal. Before treatment, four patients presented with hypertension, one associated with renal infarction and a second had flank pain due to microembolization. Two other patients had renal infarction, associated with haematuria in one; one other patient also had haematuria and five patients were asymptomatic. All patients were followed using clinical and angiographic examinations after 6 months, 1 and 2 years.

Results

 All RAAs were occluded successfully. In two patients treated with NDCs there were minor complications, i.e. one subsegmental peripheral infarction and one misembolization, both without clinical symptoms. In the group treated with GDCs there were no complications. Five of seven patients were clinically improved, while two patients remained clinically unchanged.

Conclusion

 Superselective endovascular treatment of RAAs with microcoils is a safe, efficient, and less invasive alternative to surgical treatment. The high flexibility and softness of the GDC and the controlled detachment enables a safer and more complete occlusion of RAA than current alternatives.
Radiofrequency heat‐treatment to the prostate for bladder outlet obstruction associated with benign prostatic hyperplasia: a 4‐year outcome study
Authors: DAWKINS G.P.C. , HARRISON N.W. , ANSELL W.
Published: November 2003

Objectives

 To evaluate the long‐term effect on symptom relief and voiding performance of prostatic radiofrequency thermal treatment for bladder outlet obstruction (BOO) associated with benign prostatic enlargement (BPE).

Patients and methods

 During 1991–1994, 151 patients (mean age 76 years, range 49–91) with symptomatic BOO associated with BPE (i.e. reduced urinary flow rate and persistent residual urine) but with no clinical evidence of carcinoma of the prostate, were treated using the Thermex II (Direx, Israel) intraurethral radiofrequency (RF) prostatic thermal treatment system. This treatment raises the intraurethral temperature to 48°C for 3 h in a single session under local anaesthesia. The patients were followed using symptom scores and uroflowmetry for 24–48 months after treatment.

Results

 At 1 year, 70% had a good outcome, but by 3 years this had fallen to 40% and at 4 years to 22%. An increase in mean urinary flow rate, from 9 to 12 mL/s, was sustained throughout the follow‐up. There was a reduction in mean residual urine from 83 to 51 mL at 6 months, but this increased to 70 mL by 3 years (not significant). The voiding pressure, which declined at 6–12 months, increased again to near pre‐treatment values at 1–2 years.

Conclusions

 In patients with symptomatic BPE, prostatic thermal treatment with RF relieves symptoms in 60% for at least 2–3 years. In selected cases it is a useful form of management, as it can be performed as a day‐case with minimal risk. Changes in standard objective variables were small but statistically significant for at least one year. The study highlights the importance of waiting for late results from clinical trials.
Spinal abnormalities in classic bladder exstrophy
Authors: CADEDDU J.A. , BENSON J.E. , SILVER R.I. , LAKSHMANAN Y. , JEFFS R.D. , GEARHART J.P.
Published: November 2003

Objective

 To determine the frequency and clinical sequelae of significant spinal malformations in children born with classic bladder exstrophy.

Patients and methods

 All patients evaluated or treated for classic bladder exstrophy at this institution were reviewed retrospectively. Radiographs or reports pertinent to the spine were retrieved and reviewed with a paediatric radiologist and all vertebral abnormalities categorized. Clinical charts of those with spinal anomalies were reviewed to determine any clinical neurological disorders associated with the radiographic findings.

Results

 Of 423 patients with classic bladder exstrophy who were identified, 299 had radiographs or reports available for adequate review. Of these, 34 (11%) normal variants, e.g. spina bifida occulta and lumbarization or sacralization of vertebrae, were identified. Abnormalities of spinal curvature were identified in eight patients (2.7%), all with uncomplicated scoliosis. Spinal dysraphism was diagnosed in 12 patients (4%) and included myelomeningocele, lipomeningocele, scimitar sacrum, posterior laminal defects in two or more vertebrae, vertebral fusion and hemivertebrae. The one patient with myelomeningocele had clinical neurological dysfunction, giving an overall incidence of 0.3%.

Conclusions

 Spinal anomalies, excluding normal variants, occur in children born with classic bladder exstrophy at a rate of about 6.7%. The incidence of this association is much less than that for cloacal exstrophy. Although rare, neurological dysfunction can occur in the case of spinal dysraphism. Paediatric urologists and neurologists should be aware of this significant difference between patients with classic bladder and cloacal exstrophy to properly diagnose, evaluate and treat the attendant neurological problems.
Effects of sildenafil, a type‐5 cGMP phosphodiesterase inhibitor, and papaverine on cyclic GMP and cyclic AMP levels in the rabbit corpus cavernosum in vitro
Authors: JEREMY J.Y. , BALLARD S.A. , NAYLOR A.M. , MILLER M.A.W. , ANGELINI G.D.
Published: November 2003

Objective

 To investigate further the mechanisms of action of sildenafil, a highly selective and potent inhibitor of type 5 cGMP phosphodiesterase (PDE5) that has proved effective in the treatment of erectile dysfunction, by assessing its effect on the in vitro formation of cGMP and cAMP in the corpus cavernosum of the rabbit.

Materials and methods

 Male New Zealand White rabbits (2.5 kg) were killed and their penises rapidly excised, cut into segments and pooled. Penile segments were then incubated with various concentrations of sildenafil or papaverine. The formation of cGMP was stimulated with increasing concentrations of sodium nitroprusside (SNP) and the cGMP and cAMP concentrations measured by radioimmunoassay. Responses were compared to those obtained with papaverine, which is used therapeutically as an erectogen.

Results

 In the presence or absence of SNP, sildenafil increased cGMP concentrations in rabbit penile tissue with increasing dose; the increase was greatest (about 28‐fold) when cGMP was stimulated with SNP (up to 10 μmol/L). At all stimulatory concentrations of SNP, the effective concentrations for 50% stimulation (EC50 ) of sildenafil were 430–520 nmol/L. Concentrations of cAMP were unaltered by sildenafil. Papaverine enhanced cGMP formation in response to SNP, but at much higher concentrations than did sildenafil (≥10 μmol/L).

Conclusions

 Sildenafil specifically increases cGMP levels in rabbit corpora cavernosa; the increase is greater in the presence of SNP indicating that, in vivo, sildenafil may enhance erection by the augmentation of nitric oxide‐mediated relaxation pathways. The erectogenic effect of sildenafil is mediated by a specific enhancement of cGMP accumulation in the corpus cavernosum, consistent with the known activity of sildenafil as a potent and highly selective inhibitor of cGMP‐specific PDE.
Ischaemia‐reperfusion injury in the rat kidney: the effect of preconditioning
Authors: ISLAM C.F. , MATHIE R.T. , DINNEEN M.D. , KIELY E.A. , PETERS A.M. , GRACE P.A.
Published: November 2003

Objectives

 To design and establish a model to examine whether brief periods of renal artery occlusion (ischaemic preconditioning, IP) confers protection from the effects of a subsequent period of ischaemia and reperfusion of the rat kidney.

Materials and methods

 Ninety rats were randomized into six groups, i.e. sham‐operated controls; IP alone; a 20 or 40 min period of left renal ischaemia (RI) alone; and IP followed by a 20 or 40 min period of RI. Preconditioning involved the sequential clamping of the left renal artery for 4 min and its release for 11 min, a total of four times, a ‘critical interval’ of 30 min before the ischaemic insult. Left renal tissue integrity was determined by dimercapto‐succinic acid (DMSA) radionuclide imaging on a γ‐camera both immediately (day 0) and 2 and 9 days later. Acute tubular necrosis was also assessed histologically.

Results

 RI for 20 min resulted in a significant decrease in left renal tissue integrity on day 2 only (P<0.001), whereas RI for 40 min caused significant left renal dysfunction on day 0, day 2 and day 9 (P≤0.01). For a given duration of ischaemia, there was no significant difference between results from (IP+RI) rats compared with RI‐only rats at any of the three times. There was no significant alteration in renal tissue integrity in the IP‐only rats compared with sham‐operated controls. Histological findings paralleled the data obtained from DMSA uptake.

Conclusions

 The IP regimen and 30 min ‘critical interval’ confers no protection to the kidney from a 20 or 40 min ischaemic episode. The IP regimen itself appears to have no effect, confirming the validity of our experimental model.
Which patients will benefit from psychosocial intervention after cystectomy for bladder cancer?
Authors: MÅNSSON Å. , COLLEEN S. , HERMERÉN G. , JOHNSON G.
Published: November 2003

Objectives

 To investigate: (i) if early psychosocial intervention after cystectomy for bladder cancer can assist psychosocial rehabilitation; (ii) if the outcome of such intervention correlates with the patient’s psychological defensive strategies as revealed with the meta‐contrast technique (MCT); and (iii) if the patient’s general philosophical outlook is important in this context.

Patients and methods

 Of 50 patients who had undergone radical cystectomy for bladder cancer, 17 received an ileal conduit, 17 a continent urinary reservoir with abdominal stoma and 16 an orthotopic neobladder. Twenty‐four of the patients were randomized to psychosocial intervention, comprising weekly counselling 4–9 weeks after surgery. All patients were then evaluated with the Sickness‐Impact Profile (SIP) standard questionnaire and the MCT (a projective test of percept‐genetic model) was used to reflect individual defensive strategies at the subconscious or unconscious level. The patient’s general philosophical outlook was recorded before and after surgery.

Results

 There was no significant difference in the results of the SIP between the intervention and the non‐intervention group, as a whole or in its psychosocial dimension. However, intervention benefited patients with continent cutaneous diversion, whose scores on the psychosocial SIP dimension were lower than in the groups with ileal conduit diversion or orthotopic bladder replacement (P<0.05). The MCT analysis of defensive strategies identified three clusters of patients characterized mainly by isolation and repression, repression and stereotypy or sensitivity and stereotypy. Analysis for cluster identification showed no significant SIP score differences between intervention and non‐intervention groups. In an analysis of single defensive strategies, stereotypy was associated with higher total SIP score, but not significantly. Three clusters of philosophical outlook were identified; in one cluster, characterized by a belief in a supernatural power and philosophical interest, the psychosocial SIP scores were lower in the patients who obtained emotional support and the reverse in a cluster with contrary attitudes, although neither differences were significant.

Conclusion

 Psychosocial intervention assisted the psychosocial rehabilitation of patients with continent cutaneous urinary diversion. Defensive strategies and philosophical outlook generally did not influence the outcome of intervention. However, such programmes may be helpful for some patients, mainly those with a basically pessimistic disposition, a general interest in philosophical questions and often using defensive strategies of stereotypy and repression.
On the enlargement of the normal congenitally solitary kidney
Authors: MALUF N.S.R.
Published: November 2003

Objective

 To determine the anatomy of the normal congenitally solitary kidney and to complement an earlier investigation of the major functional parameters of congenitally and acquired normal solitary kidneys.

Materials and methods

 A healthy congenitally solitary kidney was compared anatomically with a normal control kidney from an equal pair in a man of similar height and age.

Results

 The solitary kidney was about 1.8 times heavier than the control; the diameter of its glomeruli and convoluted tubules were similar to those of the control kidney but there were twice as many glomeruli in the solitary kidney than in the control. The total mass of glomeruli, as a percentage of the renal mass (about 5%), was the same for both kidneys and essentially similar to that for mammals in general. However, the total mass of glomeruli as a percentage of cortical mass was considerably greater in the congenitally solitary kidney than in the control, suggesting a relative deficit of convoluted tubular mass in the solitary kidney.

Conclusion

 The normal congenitally solitary kidney is hyperplastic, i.e. there are more elements (nephrons), and apparently not hypertrophic, i.e. having larger nephrons.
Significantly increased complication risks with mass circumcisions
Authors: ÖZDEMIR E.
Published: November 2003

Objectives

 To present the most serious complications from circumcision and to compare the complications caused during mass and single circumcisions performed by medically trained or untrained operators.

Patients and methods

 The study comprised both a retrospective and prospective analysis of 220 cases of complications from circumcisions occurring during the last decade and a comparison of the frequency and distribution of complications in mass (n=700) and single (n=600) circumcisions.

Results

 Traditional (medically untrained) circumcisers were responsible for 85% of the complications and almost all the disastrous ones. The frequency of complications from mass circumcision was statistically significantly higher than that from circumcisions performed singly in operating room conditions (relative ratio 3.05 and P<0.001).

Conclusion

 Circumcision can have serious life‐threatening and prolonged complications. It should only be performed in medical institutions by suitably trained surgeons. Mass circumcisions organized for any purpose carry significantly greater risk and should be prevented.