bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances in the management of the craniosynostoses
Authors: David David J.
Published: November 2003

The spectacular beginning of craniofacial surgery in the modern era involved a case of craniosynostosis. Progress from that time to the present in the development of our understanding of this disease process and its management reflects the wider progress in the development and institutionalization of the discipline of craniofacial surgery. Complex surgical interventions have led the way to multidisciplinary units that have developed a greater understanding of the pathology and natural history of the craniosynostoses. New technologies have been developed to further advance the surgical techniques and these can now be evaluated by the institutions that have spawned them. This paper deals with the development of the discipline, the current status of the management of craniosynostosis, both syndromal and non‐syndromal, and discusses the technological advances including imaging, distraction osteogenesis and the current status of genetic investigations.
Cumulative strain theory for simulation and development of wire drawing
Authors: BITKOV V. V. , ZALAZINSKY A. G.
Published: November 2003

The problem of deformability of metal without fracture is of great importance. In drawing practice it is required that the wire of the finished size should have specific mechanical and technological properties. In choosing the diameter of the initial rolled wire it is necessary to know not only initial parameters of plasticity and strength but also the character of their change in drawing. In the absence of a generalized parameter of metal plasticity it is not possible to make a critical examination of wire‐drawing routes in terms of parameters of plasticity. In the present work an attempt is made to provide a mathematical apparatus based on a phenomenological model of fracture in order to compute the plasticity reserve of hot‐rolled rod when it is subjected to both drawing and to control tests.
Performance of the tobacco aphid Myzus persicae (Hemiptera: Aphididae) on Oriental and Virginia tobacco varieties
Authors: Goundoudaki Stavroula , Tsitsipis John A. , Margaritopoulos John T. , Zarpas Konstandinos D. , Divanidis Savas
Published: November 2003

Abstract  1 The life parameters of one red and one green clone of Myzus persicae reared on 11 Oriental tobacco type varieties (KP7, K63, KZ10/z, MA13/b, BX2/a, N34/4, KP14/a, Kolindros, S79, TA21 and BX81) and on five Virginia ones (VE9, VE3, SPG28‐VE2, Kleio‐KN1 and Niki‐NK3) at 20 °C and LD 16 : 8 h were examined.

2 In general, the clones, performed better on Oriental than on Virginia type varieties. The varieties TA21 and Kolindros could be considered as the most resistant among the Oriental ones. Aphids on Virginia varieties showed longer developmental time (9.1–9.6 days), a lower intrinsic rate of increase (0.2347–0.2647) and higher nymphal mortality (27.9–52.5%) than on Oriental varieties. The corresponding values in the latter were 7.3–9.0 days, 0.2784–0.3302 and 10.0–47.9%.

3 The leaves of Virginia type varieties (188–471 hairs/cm2) and one Oriental (K63) 273 hairs/cm2 were more hairy than the other Oriental type varieties (61–150 hairs/cm2). The Virginia type varieties showed also a lower level of reducing sugars (3.5–7.2%) than the Oriental ones (7.0–9.8%). Trichome density and level of reducing sugars were significantly negatively correlated with developmental time and intrinsic rate of increase.

4 An interclonal variation in performance, possibly related to the colour of aphids, was observed. The red clone performed better than the green one. The same trend was observed when the results of the previous clones on the variety KP14/a were analysed with the data obtained on the same variety from two other clones (one red and one green).
Anal fistulotomy between Skylla and Charybdis
Authors: Westerterp M. , Volkers N. A. , Poolman R. W. , Van Tets W. F.
Published: November 2003

Objective  This study was undertaken to assess the results of anal fistulotomy on faecal continence, recurrence and satisfaction.

Methods  We reviewed the records of 60 patients who underwent anal fistulotomy between 1997 and 2000. Follow‐up was by a questionnaire with 46 (77%) patients responding. Mean follow‐up was 1–4 years. Fistulas were intersphincteric in 12 patients and transsphincteric in 34 patients. Operative procedure consisted of fistulotomy.

Results  Of 11 patients with high fistula, 9 (82%) had impaired continence; Of 17 patients with midanal fistula, 4 (24%) suffered impaired continence. Eighteen patients had a low fistula and 8 (44%) developed impaired continence. In the whole group 50% had suffered faecal incontinence. There were no recurrences and there was satisfaction with the situation in 87% of patients.

Conclusions  Fistulotomy for primary fistula in ano in this retrospective study with a follow‐up up to 4 years was associated with no recurrences. Eighty‐two percent of patients with a high anal opening have impaired faecal continence, nevertheless patients' satisfaction is high.
Anal sphincter tears in patients with rectal prolapse and faecal incontinence
Authors: Woods R. , Voyvodic F. , Schloithe A. C. , Sage M. R. , Wattchow D. A.
Published: November 2003

Objective  Faecal incontinence often persists after surgery for rectal prolapse. Multiple mechanisms have been proposed as responsible, however, anal sphincter integrity has only been studied in a handful of cases. This study assesses the incidence of ultrasound detected anal sphincter tears in patients with rectal prolapse and faecal incontinence.

Methods  Retrospective search of medical records at Flinders Medical Centre over a 7‐year period to identify patients with full thickness rectal prolapse and faecal incontinence who had undergone endosonographical imaging of the anal sphincter complex. Anal manometry and pudendal nerve terminal motor latency studies were also included.

Results  Twenty‐one patients were identified (1 male, 20 female) of median age 67.5 years. Fifteen (71%) subjects had an abnormality in the anal sphincter complex on endoanal ultrasound. Of these, the defects in 4 (19%) patients were isolated to the internal sphincter, 3 (14%) to the external sphincter and in the remaining 8 (38%) subjects, defects were found in both internal and external sphincters. The degree of sphincteric defect was variable but at least 6 (29%) of the study group had full‐length external sphincter tears. In the 19 patients studied, anal manometry revealed reduced basal and squeeze pressures in the majority. Delayed pudendal nerve terminal motor latency was evident in 9 of 18 patients studied.

Conclusion  Anal sphincter tears are common in patients presenting with rectal prolapse and faecal incontinence. The faecal incontinence associated with prolapse appears to be multifactorial in aetiology. Anal sphincter defects are likely to contribute to persistent faecal incontinence or recurrence following rectal prolapse. Endoanal ultrasound derived knowledge of anal sphincter injury may guide surgical management in problematic cases.
Botulinum toxin injection inhibits myogenic tone and sympathetic nerve function in the porcine internal anal sphincter
Authors: Jones O. M. , Moore J. A. , Brading A. F. , Mortensen N. J. Mc. C.
Published: November 2003

Objective  Botulinum toxin is an effective treatment for anal fissure, though there is a lack of agreement over the optimal site for its injection. This reflects our current ignorance of its mechanism, and whether it has any action on the nerves of the internal anal sphincter (IAS). This study set out to resolve this issue through use of a pig model.

Materials and methods  Eight pigs were studied in pairs: one of each pair received a botulinum toxin injection into the anal sphincter, whilst the other acted as its control. Manometry was performed every two weeks under anaesthesia. Pigs were slaughtered at between four and six weeks after injection and the properties of the IAS compared in vitro.

Results  Whilst maximum anal resting pressure (MARP) increased slowly in control pigs during the experimental period, reflecting weight gain, a fall was observed in treated pigs. In vitro, IAS strips from control pigs generated 400 mg of spontaneous tone per gram of tissue (± 45; standard error), compared to 250 (± 25) mg/g tissue from treated pigs (P < 0.01). Electric Field Stimulation at 50Hz produced 150 (± 22) mg contraction/gram tissue in IAS strips from control pigs compared to 53 (± 13) mg/g tissue in treated pigs (P < 0.0005). This contractile response was blocked by guanethidine.

Conclusion  Botulinum toxin has a significant action on the IAS. It reduces myogenic tone and contractile responses of this tissue to sympathetic nerve stimulation. Further studies are required to clarify its mechanism of action more precisely.
Attitudes to the treatment of chronic anal fissure in ano after failed medical treatment
Authors: Karandikar S. , Brown G. M. , Carr N. D. , Beynon J.
Published: November 2003

Objective  The treatment of chronic fissure may be medical or surgical. Indications for assessment, which is the better treatment and under what circumstances, are vital for the appropriate management. The aim of the study was to assess the management of this condition by an expert group of surgeons.

Methods  Consultant members of the Association of Coloproctology of Great Britain and Ireland (n = 452) were approached and requested to answer a preset multiple‐choice questionnaire. The questionnaire was designed to assess their management strategy and their approach to investigation and treatment under different clinical situations.

Results  The overall response was 78% (n = 356). Medical treatment was the first line treatment in 95% of the responders. Lateral anal sphincterotomy without pre‐operative endoanal ultrasound and/or anorectal physiology was performed by 57%. Anal dilatation was performed selectively by 36% but only 35% of these would perform a pre‐operative endoanal ultrasound or anorectal physiology.

Conclusion  In the selected group of clinicians lateral anal sphincterotomy remains the procedure of choice in both sexes. Pre‐operative assessment using endoanal ultrasound and anorectal physiology is used selectively especially in postpartum women. Anal dilatation remains a subjective procedure and though used selectively, is performed without pre‐operative endoanal ultrasound and/or anorectal physiology in majority of cases.
Laparoscopy and its current role in the management of colorectal disease
Authors: Chung C. C. , Tsang W. W. C. , Kwok S. Y. , Li M. K. W.
Published: November 2003

Objective  To evaluate the current place of laparoscopy in the management of colorectal disease.

Method  A literature search was undertaken on Medline between the period 1991 and 2002.

Results  From the literature there is good evidence that the laparoscopic approach is associated with at least some short‐term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long‐term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter‐saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions.

Conclusion  The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.
Altered electrical properties of bladder smooth muscle in streptozotocin‐induced diabetic rats
Authors: Hashitani H. , Suzuki H.
Published: November 2003

Objective To examine the alterations in the electrical properties of bladder smooth muscle in rats with diabetes mellitus (DM) induced by streptozotocin.

Materials and methods The study comprised 34 control rats and 20 with DM induced experimentally by injection with streptozotocin. At 10–15 weeks after the induction of DM, control and treated rats were killed, the bladder removed and the electrical responses of membranes from the detrusor smooth muscle recorded using intracellular microelectrodes.

Results The resting membrane potential of the smooth muscle remained unaltered by DM but the frequency of spontaneous spike discharges sensitive to nicardipine was decreased. Transmural nerve stimulation elicited a purinergic excitatory junction potential (EJP) in muscles from both types of rat, but the threshold intensity of stimulation required to evoke an EJP was higher in muscle from the diabetic rat. Furthermore, EJPs large enough to trigger a nicardipine‐sensitive spike potential could be elicited easily in muscles from the control rat, but not in muscles from diabetic rats. Stimulation of muscarinic receptors with exogenous acetylcholine (ACh) caused greater depolarization in muscle from diabetic rats. Stimulation of purinergic receptors with α,β‐methylene ATP caused a similar depolarization in both groups of rats. Application of potassium‐free solution or ouabain depolarized the membrane by about 9 mV or 5 mV, respectively, in muscles from both groups of rat. Removal of potassium‐free solution produced an ouabain‐sensitive transient hyperpolarization which was larger in muscle from control rats, indicating that the potency of the Na‐K pump was weakened in rats with DM.

Conclusion In the detrusor smooth muscle of rats with DM, there were fewer spontaneous spike discharges, supersensitivity of post‐junctional muscarinic receptors, reduced potency of the post‐junctional Na‐K pump and a decrease in the release of neurotransmitter, possibly due to the impairment of pre‐junctional activity.
The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing
Authors: Jackson S. , Donovan J. , Brookes S. , Eckford S. , Swithinbank L. , Abrams P.
Published: November 2003

Objective To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome.

Patients, subjects and methods Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of ‘bother’ that symptoms were causing. Eighty‐five women with clinical symptoms attending for urodynamic assessment and 20 women with nonewere asked to self‐complete the questionnaire. The instrument's validity was assessed by interviewing patients and measuring levels of missing data, comparing symptom scores between clinical and non‐clinical populations and comparison with frequency/volume charts and data from pad tests. The instrument's reliability was assessed by measuring both internal consistency and stability, using a 2‐week test‐retest analysis.

Results The questionnaire was completed by the patients with a mean of only 2% of items missing; most questions were easily understood. Construct validity was good, with the instrument easily differentiating clinical and non‐clinical populations. Criterion validity, as tested against frequency/volume charts and pad‐test data, was acceptable, with Kappa coefficients of 0.29–0.79 for frequency/volume data and Spearman rank correlations of 0.50–0.97 and 0.31–0.67 for frequency/volume and pad‐test data, respectively. The reliability of the instrument was good; a Cronbach's alpha of 0.78 indicated that the symptom questions had high internal consistency, while stability was excellent, with 78% of symptoms and problems answered identically on two occasions, and Spearman rank correlations of 0.86 and 0.90, respectively.

Conclusion The instrument has good psychometric validity and reliability. The stability demonstrated at baseline and the ability to differentiate clearly between community and clinical populations suggest that it should be ideal for measuring changes following therapeutic intervention. The addition of life‐impact items and a ‘bother’ factor may provide the opportunity to identify those women who wish treatment for their symptoms; this dimension requires further exploration.
Incidentally detected renal cell carcinoma
Authors: Rodríguez‐Rubio F.I. , Díez‐Caballero F. , Martín‐Marquina A. , Abad J.I. , Berián J.M.
Published: November 2003

Objectives To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC.

Patients and methods In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n=55) or whether the renal tumour was suspected (n=102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses.

Results There were significant differences between the groups in the number of patients with T2 (P<0.001), T3a (P<0.05), T3b (P<0.01), T4 (P<0.05) and M1 (P<0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1–2 tumours (P<0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P<0.001) in the distribution of survival in the two groups.

Conclusion The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1–2), we consider that grade, size and particularly pathological stage determine the better prognosis.
Transplantation of horseshoe kidneys: a report of four cases
Authors: Botta G.C. , Capocasale E. , Mazzoni M.P.
Published: November 2003

Objective

 To increase the awareness of the successful use of horseshoe kidneys in renal transplantation.

Patients and methods

 Two donors were found to have horseshoe kidneys; these were divided at the midline and transplanted into four recipients.

Results

 All four recipients had a delayed return of renal function; all eventually functioned with no complications related to the horseshoe kidney.

Conclusion

 Transplantation of horseshoe kidneys has been performed infrequently but they should be considered as suitable for transplants, considering the shortage of cadaver donors and, when possible, should be divided at the isthmus and the halves transplanted into two recipients.
Staging with computed tomography, transrectal ultrasonography and transurethral resection of bladder tumour: comparison with final pathological stage in invasive bladder carcinoma
Authors: Yaman Ö. , Baltaci S. , Arikan N. , Yilmaz E. , Gögüs O.
Published: November 2003

Objective

 To assess the accuracy of clinical staging methods in patients with locally advanced bladder cancer.

Patients and methods

 Sixty‐five patients with invasive bladder cancer primarily staged using transrectal ultrasonography (TRUS), computed tomography (CT) and transurethral resection of the bladder tumour (TURBT) were compared with the final pathological stage determined after radical cystectomy.

Results

 Accurate staging was obtained by TRUS, CT and TURBT in 40, 35 and 46% of the patients, respectively. The rank correlation between primary clinical stage and final pathological stages was significant by all three methods, but not close.

Conclusions

 The results of this study raise doubts about the assumed benefit of TRUS and CT in the clinical staging of invasive bladder tumours. These methods did not improve the findings obtained by TURBT alone.
Conservative management of stage T2 or T3a bladder cancer with deep transurethral resection followed by four cycles of chemotherapy
Authors: Uygur M.C. , Yaman I. , Altug U. , Erol D.
Published: November 2003

Objective

 To evaluate the efficacy of the conservative management of stage T2 and T3a bladder cancer with deep (radical) transurethral resection (TUR) followed by four cycles of chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin (MVEC) and its impact on bladder preservation and tumour recurrences.

Patients and methods

Between May 1990 and June 1995, 19 patients with stage T2 or T3a transitional cell carcinoma of the bladder who refused radical cystectomy entered the study. The patients were re‐evaluated 4 weeks after completion of the treatment by cystoscopy, TUR of the tumour site and multiple deep bladder biopsies. The patients were maintained on periodic local and systemic surveillance with cystoscopy and deep biopsy every 3 months, and annual intravenous urography and computed tomography.

Results

Seventeen patients completed the treatment protocol; 13 patients were tumour‐free at the first evaluation after treatment and six of these had tumour recurrences in the bladder during surveillance. Eleven patients retained their bladder in a functional state for a mean duration of 36 months (range 12–62+) and seven of them remain free of recurrence after a mean duration of 41 months (range 8–58+).

Conclusion

 Deep TUR of the bladder tumour followed by four cycles of MVEC chemotherapy is an effective alternative in the conservative management of patients with stage T2 and T3a bladder cancer. We suggest this protocol for patients who refuse or are unsuitable for surgery.
Risk factors and mechanism of urethral injury in pelvic fractures
Authors: Koraitim M.M. , Marzouk M.E. , Atta M.A. , Orabi S.S.
Published: November 2003

Objective To determine the risk factors and mechanism of urethral injury associated with pelvic fractures.

Patients and methods A total of 203 consecutive male patients with pelvic fracture were studied prospectively, including a clinical examination, radiographic examination of the pelvis, excretory urography and retrograde urethrography.

Results Thirty‐nine (19%) patients had urethral injury, five (2.5%) had bladder injury and 12 (6%) had combined urethral and bladder injuries. Urethral injury was by stretching of the intact membranous urethra in 13 patients (25.5%), partial rupture in 13 (25.5%) and complete rupture in 25 (49%). Injury involved the prostatic urethra and bladder neck in three children. Urethral injury was consistently associated with pubic arch fractures. Involvement of the posterior pelvic arch, with fractures of the anterior arch, considerably increased the risk of urethral injury. Also, the risk was greater with an increase in the number of broken rami.

Conclusion The highest risk of urethral injury was found in cases with straddle fracture when combined with diastasis of the sacroiliac joint (24 times more than the rest of pelvic fractures); this was followed by straddle fracture alone (3.85 times) and Malgaigne's fracture (3.4 times). Stretching of the membranous urethra usually precedes its rupture, which classically occurs at the bulbomembranous junction.
Video‐resection does not stop corneal contamination during transurethral resection of the prostate
Authors: Muir G.H. , Davies J.H.
Published: November 2003

Objectives To determine the efficacy of video‐resection systems in reducing the risk of corneal contamination during transurethral resection of the prostate (TURP) and thus in decreasing the possibility of transmission of blood‐borne diseases from the patient.

Materials and methods After performing a TURP using a video camera system in 30 patients, the number of potential corneal droplets was measured for one operator wearing a pair of spectacles and, for a second operator, over an identically sized area of a standard disposable plastic eyeshield.

Results In 20 (67%) of cases, droplets were observed on the eye protection, correlating with potential corneal contamination. Splashes were also seen on the face‐mask of the eyeshield.

Conclusion Urologists should use eye and face protection when performing TURP using a video system.
Orgasm after radical prostatectomy
Authors: Koeman M. , Van Driel M.F. , Weijmar Schultz W.C.M. , Mensink H.J.A.
Published: November 2003

Objective To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy.

Patients and methods The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56–76) using a semi‐structured interview and a self‐administered questionnaire. In addition, the patients were asked to write a brief statement about their experiences and sensations during orgasm before and after the operation.

Results Eighteen patients returned the questionnaire and 17 completed a statement indicating what their orgasm was like before and after radical prostatectomy. After the operation, no patient was able to maintain a completely rigid erection, but for five patients the erection was sufficient for sexual intercourse. Nine patients used a vacuum device or intracavernosal self‐injection. Half the patients reported diminished sexual desire (libido) and arousal after the operation and reported the same to occur in their partners. During their ‘dry’ orgasm post‐operatively, none of the patients experienced the exquisite sensation of inevitability, the so‐called ‘point of no return’. Seven of the 14 patients experiencing orgasm complained that their orgasmic sensation was weakened. Four patients reported normal pleasure and sensation compared to that experienced pre‐operatively. Surprisingly, nine of the 14 patients had involuntary loss of urine at orgasm; for five of them this was sufficient reason to avoid any sexual contact with their partner.

Conclusion Radical prostatectomy may have serious consequences on libido and erectile function but sometimes other important factors, such as the absence of prostate and seminal vesicle contractions, the loss of ejaculation and involuntary loss of urine, may also compromise the orgasm.
Epidermoid cysts of the testis: diagnosis by ultrasonography and magnetic resonance imaging resulting in organ‐preserving surgery
Authors: Fu Y.‐T. , Wang H.‐H. , Yang T.‐H. , Chang S.‐Y. , Ma C.‐P.
Published: November 2003

Objective To present experience in the diagnosis and management of patients with an epidermoid cyst of the testes and to confirm the role of conservative surgery.

Patients and methods The records from the last 26.5 years of patients diagnosed as having a testicular tumour were reviewed retrospectively. Those patients with a confirmed epidermoid cyst were evaluated for age, clinical assessment, methods of diagnosis, treatment and follow‐up.

Results Amongst a total of 131 testicular tumours, 11 patients (8.4%; mean age 25.7 years, range 21–35) were diagnosed pathologically as having an epidermoid cyst. Pre‐operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in six patients and supplemented with magnetic resonance imaging (MRI) in one. An operation sparing the testicles was performed in eight patients after the diagnosis of epidermoid cyst was confirmed from frozen sections. Three patients were treated by radical orchidectomy. There were no relapses after a median follow‐up of 47.3 months (range 2–82).

Conclusion In this series, the relative incidence of epidermoid cyst was higher than that reported in the literature (1–2%). Ultrasonography and MRI of the testes may allow the diagnosis to be made pre‐operatively. The absence of relapse in these patients further supports the use of organ‐sparing surgery in these young men.
Reduction of urinary basic fibroblast growth factor using pentosan polysulphate sodium
Authors: Barrington J.W. , Fulford S. , Fraylin L. , Fish R. , Shelley M. , Stephenson T.P.
Published: November 2003

Objective To evaluate the use of pentosan polysulphate sodium (PPS) to reduce the level of urinary basic fibroblast growth factor (bFGF).

Patients and methods Forty‐one patients with a clam enterocystoplasty were randomized to receive either 200 mg three times daily of oral PPS (n=21) or placebo (n=20) for 6 weeks. Three patients acted as a cross‐over study. Urinary bFGF was measured before and after treatment and the degree of symptomatic benefit assessed using a questionnaire.

Results There was no reduction in bFGF in the patients receiving placebo (P=0.235) but there was a statistically significant reduction in bFGF (P=0.0251) in the patients receiving PPS, most of whom were symptomatically improved, especially with regard to mucus production.

Conclusion PPS may have a role in reducing urinary bFGF in patients with bladder tumours or following an enterocystoplasty and also in improving the quality of life of patients with a clam enterocystoplasty.
Assessment of alternative tissue approximation techniques for laparoscopy
Authors: Eden C.G. , Coptcoat M.J.
Published: November 2003

Objective

 To investigate the feasibility and results of applying alternative techniques of tissue approximation for experimental urothelial re‐anastomosis in an open and laparoscopic setting.

Materials and methods

 The study was carried out in two phases; in phase 1, an open porcine ureteric re‐anastomosis was performed using gelatin/resorcin/formaldehyde (GRF) glue, fibrin glue or potassium‐titanyl‐phosphate laser tissue‐welding with a fluorescein‐doped human albumin solder. The anastomoses were assessed both immediately, by leak pressure, and by the operating time, upper tract urodynamic studies and light and scanning electron microscopy, 6 weeks after surgery. In phase 2, the best technique from phase 1 was compared with sutured controls for porcine retroperitoneoscopic dismembered pyeloplasty, using the same assessment criteria.

Results

 In phase 1, GRF glue produced adhesion which was insufficiently flexible to withstand rotation of the anastomosis and this technique was therefore abandoned. Fibrin‐glued anastomoses withstood leak pressures equal to those from laser‐welding (P=0.91) and gave similar changes in maximum pressure with a Whitaker test at 6 weeks (P=0.30), but were superior in requiring a shorter operating time (P=0.02) and in their electron and light microscopic appearances. In phase 2, fibrin glue gave similar changes in maximum pressure with a Whitaker test to those from polyglactin 910 sutures (P=0.51) but withstood higher leak pressures (P=0.01), had a shorter operating time (P=0.01) and had superior electron and light microscopic appearances.

Conclusion

 Fibrin glue produced effective experimental laparoscopic pelvi‐ureteric anastomoses within less operating time than did sutured controls. Such anastomoses withstood supra‐physiological pressures, with no evidence of functional obstruction and with a more favourable histological result after 6 weeks. Laparoscopic evaluation of this modality in a clinical setting is now justified.
Penile prostheses in paraplegic men
Authors: Gross A.J. , Sauerwein D.H. , Kutzenberger J. , Ringert R.‐H.
Published: November 2003

Objectives

 To determine the efficacy of penile prostheses in paraplegic men.

Patients and methods

 Between 1980 and 1992, penile prostheses were implanted in 209 paralysed men of whom the records of 179 were evaluable. The indication for implantation was erectile dysfunction, penile retraction, or a combination of the two.

Results

 The outcome of the implantation of semi‐rigid prostheses was worse than that of semi‐flexible or flexible prostheses. Antibiotic treatment and body disinfection reduced the infection rate to below that in a normal population. The results were satisfactory for patients with either problem and patients treated successfully for erectile dysfunction became more self‐confident.

Conclusions

 When paraplegic patients are able to regain sexual activity after successful implantation of a penile prosthesis, their self‐confidence is increased. Prostheses might also be useful for patients who will not accept self‐injection and for those using external condom drainage. Penile prostheses clearly have a place in the treatment of paralysed men.
Intramuscular tenoxicam to treat acute renal colic
Authors: Dawood Al‐Waili N.S.
Published: November 2003

Objective To study the possible therapeutic effects on acute renal colic of a single 20 mg intramuscular dose of tenoxicam.

Patients and methods The study comprised 30 patients (22 men and eight women, mean age 32 years, range 17–60) who presented with acute renal colic and were diagnosed by intravenous urography, a general urine examination and ultrasonography. Each patient was treated with 20 mg of tenoxicam given intramuscularly. The severity of pain was assessed on a verbal six‐point scale.

Results Twenty‐four patients markedly improved within 1 h of receiving tenoxicam (P<0.001). No side‐effects were reported and the drug was tolerated well by all the patients.

Conclusion Tenoxicam can be used successfully to treat acute renal colic.
The day‐to‐day variation (test‐retest reliability) of residual urine measurement
Authors: Dunsmuir W.D. , Feneley M. , Corry D.A. , Bryan J. , Kirby R.S.
Published: November 2003

Objective To determine the variation in repeated measurements of post‐void residual urine volume (PVR), determined by transabdominal ultrasonography (TAUS), within an individual over time (test‐retest reliability).

Patients and methods Forty men with symptomatic benign prostatic hyperplasia and awaiting transurethral resection of the prostate were studied over 3 months. Each underwent TAUS to determine both pre‐and post‐micturition residual volumes on six occasions within the study period.

Results Although one‐third of the patients had approximately constant residual volumes (variation in range <120 mL), two‐thirds had wide intra‐individual variations over time (variation in range 150–670 mL). The values were log transformed to give a normal distribution and subjected to analysis of variance; there was a wide variation between and also within individuals. The larger the mean PVR, the larger was the overall variation in time. For those with a mean PVR of <100 mL, the variation was less marked and these patients showed a more consistent test‐retest repeatability.

Conclusions Although the PVR determined by TAUS may be useful to indicate aspects of bladder dysfunction or outlet obstruction, the wide variation in repeated measurements in the same individual limits its use for any clinical purpose that requires repeated assessment, e.g. in monitoring the response to treatment. There is poor test‐retest reliability and PVRs cannot be determined reliably from a single measurement.
Restoration of the continuity of dog ureter after resection of its 5 cm middle segment
Authors: Kuzaka B. , Szymanska K. , Borkowski A. , Krus S.
Published: November 2003

Objective To evaluate the restoration of the ureter of the dog after resection of a 5 cm‐long middle segment.

Materials and methods Eight dogs underwent resection of the middle segment of the ureter, after which a 6–8 F Bard ureteric stent modelling catheter was inserted into both remaining portions of the ureter for 3 months. One month after removal of the stent the animals were killed and their ureters examined both grossly and microscopically. Paraffin‐embedded sections were subjected to microscopic and immunohistochemical studies.

Results The continuity of the ureter was restored but the reconstructed segment was narrowed to a variable extent. The wall of the ureter was lined by normal urothelium but consisted of fibrous connective tissue which failed to produce a regular coat. The reconstructed segment showed no smooth muscle cells (negative staining with azan and a negative reaction with monoclonal antibodies against desmin). A few smooth myocytes were found only at the border with intact portions of the ureter.

Conclusions The surgical procedure resulted in the restoration of ureteric continuity by repair and not by regeneration of its wall.
Overexpression of p53 protein and its significance for recurrent progressive bladder tumours
Authors: Underwood M.A. , Reeves J. , Smith G. , Gardiner D.S. , Scott R. , Bartlett J. , Cooke T.G.
Published: November 2003

Objective To determine the prognostic value of the overexpression of p53 protein as determined by immunohistochemistry in recurrent progressive transitional cell carcinomas of the bladder.

Patients and methods A total of 222 tumours from 86 patients with recurrent disease, 20 from patients with no evidence of recurrence after resection of initial tumour and 11 normal bladder (controls) were investigated. Using a microwave technique to expose antigens, formalin‐fixed sections were immunohistochemically stained for p53 using a polyclonal antiserum. Two independent observers scored the sections for evidence of overexpression of p53.

Results Of 86 patients with recurrent disease, 51 demonstrated overexpression of p53 protein, as did six of 20 patients with non‐recurrent disease. Overexpression was not linked to recurrence (P=0.5) but was related to worsening histological stage (P<0.01) and increasing grade (P<0.01). Regression analysis showed that overexpression of p53 for the primary tumour was not of predictive prognostic value for death from bladder cancer, time to progression or time to recurrence. Tumour grade was the only variable of prognostic value in all the statistical models. Patients with overexpression of p53 showed no reduction in overall survival.

Conclusion These findings suggest that overexpression of p53, as determined immunohistochemically, appears to have no predictive prognostic value over stage and grade in bladder tumours.
A urodynamic evaluation of patients with renal, upper and lower ureteric stones
Authors: Çetinkaya M. , Öztürk B. , Adsan Ö. , Ataman T. , Ulusoy E. , Güner E.
Published: November 2003

Objective To investigate the urodynamic variables of the patients with renal, upper and lower ureteric stones and compare the results according to the location of the stone.

Patients and methods Pre‐operatively, 49 patients with kidney, upper and lower ureteric stones were evaluated to determine bladder capacity, compliance and urine volume at first sensation. Patients with urinary tract infection, neurogenic pathology and bladder outlet obstruction were excluded. The patients were divided into two groups; 20 patients with kidney and upper ureteric stones and 29 patients with lower ureteric stones.

Results The mean bladder compliance, bladder capacity and volume at first sensation were all significantly lower in patients with lower ureteric stones (P=0.026, P=0.005 and P=0.042, respectively). These patients also had more prominent irritative symptoms, urgency and frequency. However, the mean values of bladder capacity, compliance and volume at first sensation were within normal limits in both groups.

Conclusion Lower ureteric stones cause more irritative bladder symptoms than do renal and upper ureteric stones and lower ureteric stones should be considered as a possible cause of sensory urgency.
Conservative management of penetrating and blunt Type III renal injuries
Authors: Thall E.H. , Stone N.N. , Cheng D.L. , Cohen E.L. , Fine E.M. , Leventhal I. , Aldoroty R.A.
Published: November 2003

Objective To determine the optimal management, conservative or surgical, of patients with penetrating or blunt Type III renal injuries.

Patients and methods This retrospective study comprised 122 patients with blunt abdominal or penetrating trauma with suspected significant renal injuries. Forty‐five patients (32 penetrating and 13 blunt trauma) with Type III injury were identified. Of these patients, 28 (17 penetrating and 11 blunt trauma) had their renal injuries treated conservatively while 14 patients, all with penetrating injuries, underwent immediate surgical repair. Three patients died from multiple trauma shortly after arrival in the emergency room.

Results In the 42 surviving patients with Type III renal injuries, four required delayed intervention. These included two of those managed conservatively and two of the 14 who underwent initial surgical intervention. Three renal units were lost, all of which were in those treated surgically. Thus, of the 42 surviving patients with Type III renal trauma, 28 (67%) were successfully managed conservatively without renal loss.

Conclusion This study suggests that Type III penetrating trauma may be successfully managed conservatively with a similar outcome to those patients with Type III blunt injuries. Initial surgical intervention may only be necessary in those with associated intra‐abdominal injuries or haemodynamic instability.
The value of the gonadotrophin‐releasing hormone test as a prognostic factor in infertile patients with varicocele
Authors: Atikeler K. , Yeni E. , Semercioz A. , Yalcin O. , Baydinc C.
Published: November 2003

Objective To determine the value of the gonadotrophin‐releasing hormone (GnRH) test in selecting which infertile patients with varicocele would benefit from varicocelectomy.

Patients, subjects and methods The study comprised 30 patients with varicocele who presented between November 1993 and May 1994, and 10 control subjects. The basal serum level of follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were determined and all participants given 100 μg of GnRH nasally. The levels of FSH and LH were then determined for up to 2 h. The patients then underwent varicolectomy and the response was evaluated by comparing sperm quality before and after treatment and between those with increased or normal FSH and LH levels in response to the GnRH test.

Results Those patients who had increased FSH and LH levels after the GnRH test had a mean 121% increase in sperm density (P<0.001), a 23% increase in sperm motility (P<0.001) and a 40% decrease in sperm abnormality (P<0.05). The respective values for those with normal levels of FSH and LH were 15% (P<0.05), 11% (P>0.05) and 11% (P>0.05).

Conclusion The GnRH test is useful for determining those patients who should benefit from varicocelectomy.
Male reproductive function in uraemia: efficacy of haemodialysis and renal transplantation
Authors: Prem A.R. , Punekar S.V. , Kalpana M. , Kelkar A.R. , Acharya V.N.
Published: November 2003

Objective To evaluate the impact of maintenance haemodialysis and live‐related renal transplantation on the reproductive potential of men with end‐stage renal disease.

Patients and methods The plasma levels of testosterone, follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were determined, and semen analysed, in 19 men (22–41 years old) with advanced uraemia after 6 months of dialysis and again 6 months after renal transplantation. Eight patients who had azoospermia or severe oligospermia underwent testicular biopsy after 6 months of dialysis and again 6 months after the transplant.

Results Following dialysis, levels of testosterone were low in 17 patients and levels of LH and FSH were elevated in 15 and eight patients, respectively. Four patients each had azoospermia and severe oligospermia. The testicular tissue was hypospermatogenic in three patients, showed late‐maturation arrest in four and germ cell aplasia in one. After renal transplantation, testosterone and LH levels returned to normal in 15 and 13 patients, respectively, while FSH levels became normal in only two patients. The recovery of testosterone and LH levels after transplantation was statistically significant. Semen quality improved in 13 patients, with the improvement in sperm density and motility being statistically significant. Testicular histology revealed normal spermatogenesis in four patients, while three continued to show late‐maturation arrest. The wives of five of the transplanted patients conceived.

Conclusions The impairment of testicular function seen in advanced uraemia is not reversible by maintenance haemodialysis. In contrast, after successful transplantation, steroidogenic function became almost normal while spermatogenic function showed a striking if incomplete recovery.
Antegrade endopyelotomy for pelvi‐ureteric junction obstruction in children
Authors: Rodrigues Netto Jr N. , Ikari O. , Esteves S.C. , D'Ancona C.A.L.
Published: November 2003

Objective To compare the results of repairing pelvi‐ureteric junction (PUJ) obstruction by percutaneous endopyelotomy in children with a similar series carried out in adults.

Patients and methods Nine children with primary (six) or secondary (three) PUJ obstruction were treated using a one‐stage cold‐knife percutaneous endopyelotomy. The success and morbidity rates were compared with a series of 61 adults with primary (46) or secondary (15) PUJ obstruction treated similarly.

Results In children, endopyelotomy was successful in five of six with primary and two of three with secondary PUJ obstruction, with a mean follow‐up of 30 months (range 18–56). In the adults, endopyelotomy was successful in 38 of 46 (83%) with primary and 12 of 15 with secondary PUJ obstruction, an overall success rate of 82%, with a mean follow‐up of 42 months (range 9–86). There was no statistical difference in the success rates with primary and secondary endopyelotomy between adults and children (P=0.58). Failures were associated with high‐grade hydronephrosis, a stenotic segment >1.5 cm long and technical problems. Morbidity occurred in one of nine children and 3.2% of the adults.

Conclusion This early experience suggests that percutaneous endopyelotomy can be performed safely and successfully in children with primary PUJ obstruction. However, in secondary stenosis, the results were less than optimal. Larger series should be analysed to form definitive conclusions on the role of endopyelotomy for the treatment of PUJ obstruction in children, given the high rate of success of open pyeloplasty and its minimal morbidity.
Management of invasive squamous cell carcinoma of the bulbomembranous male urethra with co‐ordinated chemo‐radiotherapy and genital preservation
Authors: Oberfield R.A. , Zinman L.N. , Leibenhaut M. , Girshovich L. , Silverman M.L.
Published: November 2003

Objective To determine the success of chemo‐radiotherapy for squamous cell carcinoma (SCC) of the bulbar male urethra, an uncommon but aggressive cancer usually treated by radical deforming surgery.

Patients and methods Two men, aged 42 and 49 years, with locally advanced SCC of the proximal deep urethra were treated with a modified Nigro chemo‐radiation protocol. The initial treatment was by suprapubic cystotomy urinary diversion followed by 45 Gy in 25 fractions over 5 weeks to the penis, perineum and regional lymphatics. Chemotherapy consisted of a single intravenous dose of mitomycin C (10 mg/m2 ) and an intravenous infusion of 5‐fluorouracil (1 g/m2 /day) for 96 h starting on the first day of radiation therapy and repeated 28 days later.

Results Follow‐up evaluation with urethral biopsies, retrograde urethrography, computed tomography of the pelvis and cysto‐urethroscopy under anaesthesia showed no residual tumour in either patient but the development of a proximal urethral stricture at 1.5 and 4 years, respectively.

Conclusion This report presents the first evidence of a successful reduction of tumour stage with the local eradication of invasive SCC and penile preservation with no recurrence of the tumour or the need to excise the urethra.