bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term Results of Treatment of Urethral Injuries in Males Caused by External Trauma
Authors: JENKINS B. J. , BADENOCH D. F. , FOWLER C. G. , BLANDY J. P.
Published: November 2008

Summary— Of 134 males with traumatic rupture of the urethra seen between 1967 and 1989, 10 have been lost to follow‐up and 124 have been followed up for 1 to 22 years (mean 8); 100 patients had a pelvic fracture (3 with associated rectal injury) and 24 had perineal injuries. Prior to referral 31 patients (25%) had undergone treatment in addition to suprapubic cystostomy. Wherever possible, strictures were managed by optical urethrotomy (33) or intermittent dilatation (4). In 2 patients only a suprapubic cystostomy was possible. Skin inlay urethroplasty in 1 or 2 stages was performed in 75 cases, an end‐to‐end anastomosis with or without resection of the symphysis pubis in 7 and a scrotal tube pull‐through in 3.

The immediate and long‐term results depended on the severity of the original injury. With minimal displacement the management was simple and the long‐term prognosis good, a single urethrotomy being sufficient in 22 patients. Where there was considerable displacement the initial management was more difficult and there was a high incidence of long‐term complications: of 73 patients treated by urethroplasty or end‐to‐end anastomosis, significant post‐operative infection occurred in 11 (15%) and restenosis in 15 (20%), of whom 7 required a revision urethroplasty. Data in respect of potency were recorded in 80 patients: 28 of these were impotent, 20 of the 28 having sustained an injury with considerable displacement.
New Approach to the Management of Fournier's Gangrene
Authors: ATTAH C. A.
Published: November 2008

Summary— A new method of treating Fournier's gangrene is described in 13 patients. There was no mortality and the average hospital stay was 10 days. Considerable gain in man‐hours and expense was recorded when compared with the old method of treatment with antibiotics and wound debridement.
Vacuum Constriction Devices: Second‐line Conservative Treatment for Impotence
Authors: GILBERT H. W. , GINGELL J. C.
Published: November 2008

Summary— Intracavernosal pharmacotherapy is not a universally successful treatment of impotence. Vacuum constriction devices are reported to be an effective non‐operative alternative. This study investigated the value of these devices in 45 impotent men who had failed to become established on intracavernosal papaverine. Although 38 were able to obtain an erection‐like state using a vacuum constriction device, only 12 were able to enjoy satisfactory sexual intercourse and, of these, just 7 men found them of sufficient benefit to warrant purchase. Success is not predicted by aetiology. Vacuum constriction devices are of some use, but a trial period of use should be allowed to each patient before purchase.
Surgical Outcome of Orchiopexy. I. Previously Unoperated Testes
Authors: SAW K. C. , EARDLEY I. , DENNIS M. J. S. , WHITAKER R. H.
Published: November 2008

Summary— A total of 1209 undescended testes in 961 boys who had had no previous surgery for this problem have been reviewed with particular regard to the outcome of surgery in relation to the pre‐operative and intra‐operative assessment of the position of the testis. A third of impalpable testes were found at operation in the abdomen, a third in the inguinal canal and a quarter in the superficial inguinal pouch; 1% of all testes and 7% of impalpable testes were absent; 96% of all testes reached the scrotum at operation and this figure included 69% of abdominal and 94% of canalicular testes. In all 24 testes were excised—7 of which were abdominal, 8 canalicular and 9 were in the superficial inguinal pouch. The generalisation that the higher the undescended testis before operation the poorer the result, does not always hold true.
Arrhythmia during Extracorporeal Shock Wave Lithotripsy
Authors: ZENG Z. R. , LINDSTEDT E. , ROIJER A. , OLSSON S. B.
Published: November 2008

Summary A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12‐lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right‐sided and left‐sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s.

It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo‐analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oxymeter to be perfectly reliable for raising the alarm when depression of respiration and vaso‐vagal reactions occur.
Detection of Non‐palpable Prostate Cancer. A Mathematical and Laboratory Model
Authors: STRICKER H. J. , RUDDOCK L. J. , WAN J. , BELVILLE W. D.
Published: November 2008

Summary Prostate cancer is currently the most commonly diagnosed cancer among males in the United States. As technology improves and the search for this enigmatic condition intensifies, we are detecting greater numbers of non‐palpable tumours. These tumours are generally treated aggressively, given the uncertainty of their behaviour, but this approach may be over‐zealous for small volume disease. The likelihood of detecting any cancer volume can be derived from Bayes' theorem of conditional probability. A laboratory model using coloured clay was created to contrast tumour volumes of 2.5, 5 and 20% (n=75). Six random systematic biopsies were then taken from each model in a blind fashion; 36% of the 2.5%, 44% of the 5% and all of the 20% models had at least 1 positive biopsy. Twenty‐two of the 25 models representing 20% tumour had 3 or more biopsy cores positive. These data suggest that low volume disease with low biological potential will be found by random biopsy as the mathematical probability predicts. The high incidence of occult prostate cancer in the older population makes this a worrying observation. Also, and perhaps more important, there is a direct correlation between the volume of disease and the number of positive biopsies. This correlation is easily seen in both models and may allow for an estimation of tumour volume. This ability to estimate tumour volume may be a useful clinical tool that helps to guide therapy and assess prognosis.
Pelvic Floor Exercise versus Surgery in the Treatment of Impotence
Authors: CLAES H. , BAERT L.
Published: November 2008

Summary A group of 150 consecutive male patients with erectile dysfunction and proven venous leakage were randomised either to surgery or to a pelvic floor training programme. The operative procedure consisted of dissection and removal of the deep dorsal vein of the penis and its tributaries or large veins that drain into the internal or external pudendal system. The training programme was given 5 times, in weekly sessions, and the patients were supervised by trained physiotherapists. Surgery was not superior to the pelvic floor training programme either subjectively or objectively. Moreover, a significant improvement was found following the training programme; 42% were satisfied with the outcome and refused surgery. Pelvic floor exercise is a realistic alternative to surgery in patients with mild degrees of venous leakage.
Follow‐up Evaluation of Anomalies of the Vesicoureteric Junction
Authors: SZABÓ L. , VISSY Á. , BORBÁS É. , CSÍZY I. , KISS Á. L.
Published: November 2008

Summary Anomalies of the vesicoureteric junction are important, particularly obstruction and reflux, as they may predispose to urinary tract infection. Over a 5‐year period, 52 babies were referred with dilatation of the urinary tract detected antenatally or/and postnatally by ultrasound. Sixteen had an anomaly of the vesicoureteric junction: 9 had vesicoureteric reflux, 3 had ureteroceles, 1 had urethral stenosis with secondary reflux and 3 had stenosis of the vesicoureteric junction. Ten patients underwent 14 surgical procedures. The mean time to reconstructive surgery was 9·3 months. Ultrasonography showed regression of the dilatation in all patients who underwent surgery. Seven patients with minor dilatation are still under observation. In only 1 case was there loss of renal parenchyma. With conservative medical treatment the patients are 1 year old before reconstructive surgery is undertaken; with reflux, however, progression may indicate earlier surgery.
Effect of Desmodium styracifolium‐triterpenoidon Calcium Oxalate Renal Stones
Authors: HIRAYAMA H. , WANG Z. , NISHI K. , OGAWA A. , ISHIMATU T. , UEDA S. , KUBO T. , NOHARA T.
Published: November 2008

Summary— We have studied the inhibitory effects of Desmodium styracifolium‐triterpenoid (Ds‐t) (extracted from Desmodium styracifolium (Osbeck) Merr, a herbal medicine) on the formation of calcium oxalate renal stones induced experimentally by ethylene glycol (EG) and 1α(OH)D3(1αD3) in rats.

The incidence of urinary stone formation was 81% in the control group, which received EG and 1αD3, and 29% in the Ds‐t group, which received EG and 1αD3 supplemented by Ds‐t. The serum calcium (Ca) concentration in the Ds‐t group was significantly elevated and urinary Ca excretion was markedly reduced. Urinary excretion of citrate (Cit), a factor that prevents stone formation, was significantly increased in the Ds‐t group. Excretion of urinary phosphorus (P), which was elevated to a significantly greater extent in the controls than in the Ds‐t group, was increased in both groups. The increase in urine volume in the Ds‐t group was significantly greater than in the control group. The 24‐h creatinine clearance rate (Ccr) was significantly lower in the controls. These findings suggest that Ds‐t inhibits the formation of Ca oxalate stones in rat kidneys by increasing the output of urine, decreasing the excretion of calcium and increasing the urinary excretion of citrate.

Ds‐t may be useful in preventing the recurrence of urinary Ca oxalate stones in the clinical setting.
A Combined Urodynamic and Continence Unit—A Review of the First 19 Years
Authors: KEANE D. P. , WINDER ANN , LEWIS PAT , SHEPHERD ANGELA M. , ABRAMS P.
Published: November 2008

Summary— We have completed a 19‐year audit of all patients referred to the urodynamic/ continence unit since its inception in 1972 and their subsequent clinical management; a total of 20,437 patients were referred, increasing from 51 in the first year to 1564 in 1990. Although the annual number of referrals has remained constant for the last 8 years, the need for more complex urodynamic assessment such as video‐cystourethrography has increased from 5% (56/1164) in 1981 to 25% (385/1564) in 1990. The number of out‐patient attendances to medical, physiotherapy and continence clinics has also increased over that period. We conclude that the number of referrals represents increasing recognition of the value of urodynamic assessment. Accurate diagnosis leads to more effective treatment, whether surgical, medical or conservative. Some methods of diagnosis are complex and suitable only for a tertiary referral centre.
Iatrogenic Urogenital Fistulae
Authors: ONUORA V. C. , AL‐MOHALHAL S. , YOUSSEF A. M. , PATIL M.
Published: November 2008

Summary— Nineteen patients with iatrogenic urogenital fistulae were treated between 1985 and 1989. All resulted from obstetric and gynaecological surgery. Major symptoms were leakage of urine through the vagina, menouria and perineal dermatitis. The fistulae formed after treatment for benign conditions in 18 patients. Fistulae complicating cancer surgery were uncommon. All patients with uretero‐vaginal fistulae underwent preliminary percutaneous nephrostomy. Twelve patients underwent reconstruction using either the Boari‐Ockerblad flap (5), uretero‐neocystostomy (4) or other techniques (3), all with excellent results. Most of the remaining patients had treatment elsewhere. We consider that preliminary diversion, followed by delayed reconstruction, is a valuable option in the management of uretero‐vaginal fistulae.
Expression of C‐50 Antigen as a Prognostic Variable in Transitional Cell Bladder Tumours
Authors: LIPPONEN P. K. , ESKELINEN M. J.
Published: November 2008

Summary—The immunohistochemical expression of C‐50 antigen was quantitated in paraffin‐embedded biopsy specimens of 218 transitional cell bladder tumours. The patients were treated according to standard practice in one institution and followed up for over 10 years. The expression of C‐50 antigen was inversely correlated to T category, papillary status and WHO grade. Aneuploid tumours with a high S phase fraction (SPF) showed low expression of C‐50 antigen. Progression in T, N and M categories was inversely correlated to CA‐50 expression. Low expression of C‐50 antigen predicted progression in Ta‐T1 tumours. Expression of C‐50 antigen was related to a favourable prognosis in the whole series, in papillary tumours, in diploid tumours, in WHO grade 2 tumours and in Ta‐T1 tumours. The combination of DNA ploidy and expression of C‐50 antigen was a highly significant predictor of survival. In Cox's analysis, expression of CA‐50 had an independent predictive value in Ta‐T1 tumours, whereas in the whole cohort the T category and papillarity were independent predictors.
Extensive Condylomata Acuminata of Male Urethra: Management by Ventral Urethrotomy
Authors: KESNER K. M.
Published: November 2008

Summary— Between 1982 and 1990,4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia. When sepsis had settled all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts. Surgical and electro‐excision were the preferred methods of removal. Of 3 patients who developed recurrences 2 were lost to follow‐up. A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed. A fourth patient was lost to follow‐up for 4 years before returning with destruction of his external genitalia by a verrucous carcinoma.

The human immunodeficiency virus (HIV) did not appear to be a factor in the natural history of intraurethral warts in 2 patients who were negative for serum antibodies 2 and 8 years after presentation.
Efficacy and Causes of Failure of Endoscopic Subureteric Injection of Teflon in the Treatment of Primary Vesicoureteric Reflux
Authors: BHATTI H. A. , KHATTAK H. , BOSTON V. E.
Published: November 2008

Summary— A total of 135 consecutive patients with primary vesicoureteric reflux (VUR) were treated as day cases using submucosal Teflon injection (STING) between 1984 and 1988. Up to 3 repeat procedures were performed in the event of failure; 89% of patients and 92% of ureters were cured. None was obstructed and 2 recurred. Eight patients continue to have asymptomatic reflux Grade 2 or less, while 7 have had open surgery to correct the reflux. Most of the failures had a satisfactory appearance at STING but this deteriorated with time and appears to have been caused by leakage of Teflon from the injection site post‐operatively. There were no signs or symptoms of embolisation or migration of the implant material.
Is Impaired Perception of Bladder Filling during Cystometry a Sign of Neuropathy?
Authors: WYNDAELE J. J.
Published: November 2008

Summary— The sensation of bladder filling during cystometry was evaluated in 627 consecutive patients. The groups of patients with various patterns of impaired sensation included significantly more patients with confirmed neuropathy than did the group whose perception of bladder filling was normal. When sensation was absent, or only 1 of 3 types was reported by patients without known neuropathy, further investigation revealed abnormal afferent innervation of the lower urinary tract in 35%. These data suggest the need for further neurological evaluation in such patients.
Randomised Study of the Effect of Midnight versus 0600 Removal of Urinary Catheters
Authors: CROWE H. , CLIFT R. , DUGGAN G. , BOLTON D. M. , COSTELLO A. J.
Published: November 2008

Summary— A randomised controlled trial was undertaken to determine the effects of midnight removal of urinary catheters on patients' voiding patterns and subsequent discharge from hospital. Patients whose urinary catheters were removed at midnight showed a greater volume of initial void than those whose catheters were removed at the usual time of 0600. Removal of urinary catheters routinely at midnight permits earlier assessment of patients' voiding, which may allow for earlier discharge from hospital.
Hormonal Treatment of Obstructed Kidneys in Patients with Prostatic Cancer
Authors: DE LICHTENBERG M. HONNENS , MISKOWIAK J. , ROLFF H.
Published: November 2008

Summary— A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal therapy alone survived for a median of 26 months (range 1–111), while the patients who also needed diversion survived for a median of 13 months (range 1–28). The median time spent at home was 24 months (0–102) and 10 months (0–23) respectively, presumably reflecting the worse general condition of the patients who required diversion.
A Cooling Jacket to Reduce Renal Damage during Transplantation
Authors: STEPHENSON R. N.
Published: November 2008

Summary— There is evidence that warming of the cadaver kidney during transplantation is deleterious to its subsequent function. A simple cooling jacket to delay kidney warming during implantation is described. A controlled study of the temperature rise in 5 porcine kidneys exposed to body temperature showed significant reductions in renal core and cortical temperatures at 60 min from above 30°C to below 13°C when using the jacket. Advantages of this device in practice and some practical points in its use are discussed.
Lumbar Epidural Blockade for Management of Pain in Interstitial Cystitis
Authors: IRWIN P. P. , HAMMONDS W. D. , GALLOWAY N. T. M.
Published: November 2008

Summary— Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18‐month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain.

Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure.

Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.
Intralesional Alpha Interferon Therapy in Papillary Superficial Transitional Cell Carcinoma of the Bladder A Pilot Study
Authors: STASI S. M. DI , VIRGILI G. , VESPASIANI G. , PORENA M. , MICALI F.
Published: November 2008

Summary—The tolerability, toxicity and therapeutic efficacy of recombinant interferon alpha‐2a (rIFNα‐2a), administered by intralesional injection, were evaluated in 15 patients with papillary superficial transitional cell carcinoma of the bladder, rIFNα‐2a was delivered endoscopically in a single weekly dose of 3 × 106IU for 4 weeks (total 12 × 106IU). Transurethral resection of residual tumours was then performed. The response to treatment was assessed according to ultrasonographic, endoscopic and pathological findings. One patient achieved complete remission, 6 partial remission, 6 minor remission and 2 stabilisation of disease. All patients completed the course of treatment. A mild, transient, flu–like syndrome was documented after every injection. Immunological findings suggest that the antitumour effects of rIFNα2a are not mediated through the immune system.
Interstitial Laser Coagulation of the Prostate An Experimental Study
Authors: McNICHOLAS T. A. , STEGER A. C. , BOWN S. G.
Published: November 2008

Summary— We describe a percutaneous, low power, interstitial method of controlled coagulation of prostatic tissue by laser light which may prove an alternative or adjunct to existing therapy for benign and malignant prostatic disease. One or more 200–600 micron diameter fibres were implanted within the substance of the elderly male beagle prostate (n = 11) through which Neodymium‐Yttrium Aluminium Garnet (Nd‐YAG) laser energy could be transmitted. Using longer exposures (400–1500s) and lower powers (1–2W) than used in routine endoscopic laser therapy, well defined areas of coagulative necrosis could be created with little tissue charring or damage to the fibre. For an energy dose of 1000J a lesion approximately 1 cm in diameter resulted at 4 days. Ultrasound scanning methods could detect the fibre(s), the area(s) of coagulation and the healed lesions. Treatments were well tolerated. At 6 weeks the treated areas of canine prostate healed by fibrosis surrounding an area of cystic degeneration. Multiple fibre experiments produced larger volume lesions relevant to more extensive cancer or to the coagulation of benign adenomatous hyperplasia causing outflow symptoms. This technique may prove of value for the treatment of moderate benign enlargement of the prostate and for the destruction of small, focal prostatic tumours.
Relationship between Prostate Specific Antigen, Prostate Volume and Age in the Benign Prostate
Authors: COLLINS G. N. , LEE R. J. , McKELVIE G. B. , ROGERS A. C. N. , HEHIR M.
Published: November 2008

Summary— The relationship between prostate specific antigen (PSA) levels, prostate volume and age was examined in 472 men who underwent PSA assay (Hybritech), digital rectal examination (D RE) and transrectal ultrasound (TRUS) as part of a community survey of benign prostatic hyperplasia following exclusion of men with prostate cancer.

The mean age of the study population was 60 years (range 40–79). The mean PSA was 2.4 ng/ml and 85% of the men had levels <4 ng/ml. There was a modest correlation between PSA and both age and prostate volume. The mean prostate and adenoma volumes were 32 ml (SD 13.4) and 15 ml (SD 10.7) respectively. Prostate volume increased with age. Linear regression analysis revealed an independent association between PSA and age when controlling for volume. The mean ratio of PSA per unit of prostate volume was 0.072 ng/ml. This ratio also increased with age.

Age and prostate volume influences PSA levels independently. The sensitivity and specificity of PSA adjusted for volume and age in the diagnosis of prostate cancer need to be evaluated in association with DRE and TRUS.
Prediction of Recovery in Antenatally Diagnosed Hydronephrosis
Authors: O'FLYNN K. J. , GOUGH D. C. S. , GUPTA S. , LEWIS M. A. , POSTLETHWAITE R. J.
Published: November 2008

Summary— A series of 335 children with antenatally diagnosed hydronephrosis which persisted after the postnatal period was prospectively assessed. Idiopathic hydronephrosis (85 patients) and periureteric junction obstruction (73 patients) were the commonest conditions. All patients with idiopathic hydronephrosis were managed conservatively; 87% have had a complete resolution of hydronephrosis and 13% have remained unaltered. No patient managed conservatively has shown a deterioration in renal function.
Influence of Ionic Strength on Crystal Adsorption and Inhibitory Activity of Macromolecules
Authors: UTSUNOMIYA M. , KOIDE T. , YOSHIOKA T. , YAMAGUCHI S. , OKUYAMA A.
Published: November 2008

Summary— We investigated the influence of ionic strength on both the binding ability of macromolecules onto calcium oxalate crystals and the inhibitory activity of macromolecules related to calcium oxalate crystal growth and aggregation in vitro. The amount of heparin sodium salt adsorbed onto calcium oxalate crystals was studied in both a seed and a non‐seed crystal system at various ionic strengths with the aid of radiolabelled heparin. In both adsorption models, adsorption of heparin was greater in the buffered solutions of lower ionic strength, and significantly so in the range of physiological ionic strength. The inhibitory activity of heparin in the non‐seed crystal system, which was determined using a Coulter Multisizer, increased as the adsorbed dose increased. The naturally existing urinary macromolecules showed a similar change in their inhibitory activity on calcium oxalate crystal growth and/or aggregation in accordance with changes in ionic strength.

These results indicate that macromolecular inhibitory activity seems to be enhanced in urine of lower ionic strength as a result of an increased adsorption of macromolecules on the surface of calcium oxalate crystals.
Serum and Urinary Zinc Levels in Urolithiasis
Authors: RANGNEKAR G. V. , GAUR M. S.
Published: November 2008

Summary— Zinc has an important place amongst inhibitors of crystallisation and crystal growth. These views are supported by in vivo and in vitro studies which suggest that the urinary zinc level is a significant factor in urolithiasis. Some recent studies have given contradictory results.

Blood serum and urinary zinc levels were measured in 30 normal healthy controls and 42 stone forming patients (renal, ureteric and vesical). Statistically significant levels were found in all groups, varying according to the number of calculi. Increased urinary zinc levels and decreased serum zinc levels appear to be secondary to the process of stone formation. The role of zinc as an inhibitor of urolithiasis is questionable.
Improved Results Using a Modification of the Young‐Dees‐Leadbetter Bladder Neck Repair
Authors: JONES J. A. , MITCHELL M. E. , RINK R. C.
Published: November 2008

Summary— Forty‐seven patients with primary total incontinence underwent bladder neck reconstruction (BNR) between 1978 and 1988. This included 31 patients with exstrophy/epispadias, 14 with myelomeningocele and 2 with caecoureteroceles. The patients were divided into 5 groups based on the type of BNR: Group 1—standard Young‐Dees‐Leadbetter (YDL.) BNR; Group 2—YDL. + Silastic sheath; Group 3—modified YDL.; Group 4—Kropp BNR; Group 5—other BNRs; Group 1 included 18 patients with a 45% primary continence failure rate, a 44% reoperation rate and only a fair ability to void spontaneously after BNR. There were 11 patients in Group 3 with a 9% primary continence failure rate, a 27% reoperation rate and excellent post‐operative emptying. None of the 3 patients in Group 4 was incontinent post‐operatively, but they all required reoperation and had poor post‐operative emptying. We feel that the modified YDL BNR provides better overall voiding and continence with less morbidity than the other bladder neck/urethral reconstructive procedures.
Aspirin and Post‐prostatectomy Haemorrhage
Authors: THURSTON A. V. , BRIANT SANDRA L.
Published: November 2008

Summary— Haemorrhage occasionally occurs following transurethral prostatectomy, and it may be severe. In this study a relationship between severe haemorrhage and ingestion of aspirin is documented. This is explicable in terms of the anti‐aggregatory affects of aspirin on platelets. There may also be a problem with other types of non‐steroidal anti‐inflammatory agents. Surgery should be undertaken with caution on patients taking these common medications.
Urinary Tissue Factor Levels in Prostatic Carcinoma: A Potential. Marker of Metastatic Spread ?
Authors: ADAMSON A. S. , FRANCIS J. L. , WITHEROW R. O'N. , SNELL M. E.
Published: November 2008

Summary— Recent investigations have suggested that levels of urinary tissue factor (UTF) may be elevated in some forms of cancer. We have determined UTF levels in healthy controls, patients presenting for surgery with benign prostatic hypertrophy (BPH) and untreated prostate cancer. Patients undergoing check cystoscopy, who were free of recurrent bladder cancer, and a cohort of men with bone scan positive prostate cancer recently treated by androgen ablation were also studied. UTF levels were higher in patients with prostate cancer when compared with controls, those undergoing check cystoscopy and patients with BPH, In patients with prostate cancer, bone scan positive patients had higher levels than bone scan negative subjects. The androgen ablated group had UTF levels similar to those of the control groups and significantly lower than the bone scan positive group. A weak correlation was found between UTF and serum prostate specific antigen (PSA) levels when patients with BPH and untreated cancer were analysed, but no correlation was demonstrable between PSA and UTF when cancer patients alone were evaluated. It was concluded that UTF levels are elevated in untreated prostate cancer and reflect bone scan status. In patients with bone scan positive disease UTF also reflects disease activity and may therefore be a useful disease marker in prostate cancer.
Can Renal Blood Flow, Glomerular Filtration Rate or 99mTc‐DMSA Uptake Predict Outcome in Experimental Unilateral Renal Obstruction?
Authors: KELLEHER J. P. , ANDERSON P. J. , GORDON I. , RANSLEY P. G. , SNELL M. E.
Published: November 2008

Summary— Single kidney glomerular filtration rate (SKGFR), single kidney blood flow (SKBF) and differential renal function (DRF), using both technetium labelled diethylenepenta‐acetic acid (99mTc‐DTPA) and dimercaptosuccinic acid (99mTc‐DMSA), were examined as predictors of outcome in a pig model of complete unilateral ureteric obstruction. SKGFR and SKBF were unable to predict outcome following relief of obstruction but there was a high curvilinear correlation between DRF assessed at the end of defined periods of obstruction and after relief of obstruction using 99mTc‐DMSA. Functional recovery was near complete using DMSA when the loss in DRF did not exceed 30%, after which there was an exponential decline in expected recovery.

There was no difference between DRF using 99mTc‐DTPA or 99mTc‐DMSA in controls or before or after obstruction but significant differences between assessment by these radionuclides existed in the obstructed kidney at 24 h, 5 days, 10 days and 20 days. 99mTc‐DMSA is a sensitive agent in the prediction of outcome following acute complete obstruction in the pig but its assessment of DRF in the obstructed kidney differs markedly from that of 99mTc‐DTPA.
The Ice‐water Test—A Simple and Valuable Supplement to Routine Cystometry
Authors: GEIRSSON G. , FALL M. , LINDSTROM S.
Published: November 2008

Summary— The results of cystometrograms and ice‐water tests (IWTs) were retrospectively evaluated in 557 patients with overactive bladders, lower motor neuron lesions or pure stress incontinence. The IWT was considered positive when, following ice‐water instillation, the fluid was expelled from the bladder within 1 min. The test was considered false negative when no fluid escaped despite a sustained detrusor contraction of the same magnitude as the micturition contraction. Ninety‐seven percent of patients with complete and 91% of those with incomplete upper motor neuron lesions had a positive or a false negative IWT. About 75% of the patients with multiple sclerosis, Parkinson's disease or previous cerebrovascular accident had a positive IWT. All patients with lower motor neuron lesions or pure stress incontinence had a negative IWT. There was a significant correlation between a positive IWT and an abnormal sensation of bladder filling and inability to inhibit micturition voluntarily, as well as between a negative IWT and the occurrence of phasic detrusor contractions during cystometry. The study shows that the IWT is a sensitive test for differentiating upper from lower motor neuron lesions. It is also a useful parameter for functional subdivision of overactive bladders. In patients with voiding dysfunction in the absence of lower urinary tract inflammation, a positive test is an indicator of a silent or overt neurological disorder.
Neobladder after Cystectomy: An Indian Experience
Authors: KAMAT M. R. , KULKARNI J. N. , TONGAONKAR H. B.
Published: November 2008

Summary— A continent urinary reservoir was constructed from an ileocolonic segment and anastomosed to the urethra in 30 males after radical cystectomy for infiltrating bladder cancer. A small cuff of the prostate was retained for anastomosis with the reservoir and ureteric anastomosis was done from within the reservoir by the “pull through” method. Complete continence was achieved in 29 patients, all of whom had an adequate reservoir capacity exceeding 400 ml; they were able to empty the reservoirs satisfactorily as judged by the residual urine (<50 ml). Urodynamic study revealed an intra‐abdominal pressure <30 cm of water at rest and at reservoir capacity of 500 ml. Early post‐operative complications included urinary leaks in 3 patients, intestinal obstruction in 3 and a faecal fistula in 1. Deterioration of the upper tracts was noted in 5 cases. Twenty‐seven patients are alive after a mean follow‐up of 36 months.
Is Planned Continuous Irrigation Indicated for Haemorrhage following Transurethral Resection of the Prostate?
Authors: MOBB GILLIAN E. , FARRAR D. J.
Published: November 2008

Summary— A prospective audit was carried out of this unit's policy of non‐irrigation following transurethral prostatectomy (TURP). Over an 11‐month period 121 TURPs were performed.

Only 29 patients required intervention to maintain bladder drainage post‐operatively, 23 of these requiring bladder washout alone. In the remaining 6 patients catheter change and continuous irrigation were required.

The weight of tissue resected was the only factor investigated which bore a significant relationship to the necessity for further intervention in bladder drainage post‐operatively. Despite this, patients requiring continuous irrigation post‐operatively could not be easily identified prior to or during surgery.
Lipoprotein Levels Following Treatment with Cyproterone Acetate or LHRH Analogues
Authors: GILLATT D. A. , BOLTON C. H. , CHADWICK D. , DOWNS L. G. , HOPTON M. I. , GINGELL J. C.
Published: November 2008

Summary— Fasting serum lipoproteins were measured in patients with carcinoma of the prostate. Twelve patients were on no hormonal treatment (Group 1). Fifteen were on cyproterone acetate (Group 3), 17 were on the long‐acting LHRH analogue Zoladex (Group 4) and 11 on a combination of cyproterone acetate and Zoladex (group 5). In addition, 27 patients with benign urological disease were taken as controls (Group 2). In both groups in which cyproterone acetate was part of the treatment the total high density lipoprotein cholesterol levels were significantly lower than in the other groups. Patients on cyproterone acetate alone had significantly higher levels of very low density lipoprotein (VLDL) triglyceride levels than those not on cyproterone acetate. These results confirm changes in serum lipoprotein levels in patients taking cyproterone acetate and these changes may have potential adverse effects if the treatment is prolonged.
Primary Testicular Disease Presenting as Azoospermia or Oligozoospermia in an Infertility Clinic
Authors: JEQUIER ANNE M. , HOLMES S. C.
Published: November 2008

Summary— A group of 173 patients who made up 23% of a population of patients attending a male infertility clinic with primary testicular disease were examined; 63 patients (36%) were azoospermic and 110 (64%) were oligozoospermic. Their aetiology and clinical features are described, together with the endocrine findings, white blood cell karyotypes and, where available, the histology seen on a testicular biopsy. The relationship of these lesions with the presence or absence of a varicocele is discussed.
The Urethral Plug 11: An Alternative Treatment in Women with Genuine Urinary Stress Incontinence
Authors: NIELSEN K. K. , WALTER S. , MAEGAARD ELSEMARIE , KROMANN‐ANDERSEN B.
Published: November 2008

An improved design of the recently developed urethral plug was evaluated for the treatment of women with genuine urinary stress incontinence. The plug consists of an oval meatal plate, a soft stalk and 1 or 2 spheres along the stalk with fixed distances between the meatal plate and the spheres. Inside the stalk is a removable semi‐rigid guide pin to ease insertion. Forty women were randomly allocated to treatment with either the 2‐sphere or the 1 ‐sphere plug during period 1 (2 weeks). In period 2 (2 weeks) the patients used the other plug. They then continued with what they judged to be the better plug in period 3 (2 months). Eighteen patients (45%) completed period 3 with the “preference” plug and 17 were subjectively and objectively continent or improved. Fourteen of these women preferred the 2‐sphere device. The plugs were equally effective in patients with mild or severe incontinence. To accommodate variations in urethral length and to avoid the loss of plugs, the devices are available in different lengths. Six women developed urinary tract infections and 2 of these had a plug in the bladder.

The urethral plug is an effective treatment in a group of women with stress incontinence. Removal by hand is advisable in order to avoid retention of plugs in the bladder.
Proliferation Indices as Independent Prognostic Factors in Papillary Ta‐T1 Transitional Cell Bladder Tumours
Authors: LIPPONEN P. K. , ESKELINEN M. J. , JAUHIAINEN K. , TERHO R. , NORDLING S.
Published: November 2008

A cohort of 148 patients with papillary Ta‐T1 transitional cell carcinomas (TCCs) was followed up for over 10 years and flow cytometric (DNAploidy, S phase fraction) and morphometric variables (5 nuclear factors, volume corrected mitotic index) were related to prognosis during this period. Recurrence‐free survival was significantly related to DNAploidy, S phase fraction and M/V index. Progression in T‐category was predicted by M/V index, S phase fraction, DNA ploidy and WHO grade. The same variables predicted progression in N‐ and M‐categories. In a multivariate analysis only M/V index and S phase fraction were independent predictors of progression. Univariate analysis showed that M/V index, SPF, DNA ploidy and WHO grade predicted survival. In a multivariate survival analysis only M/V index and SPF were independent predictors. The results showed that proliferation indices had independent prognostic value in papillary Ta‐T1 TCCs and the grading of these tumours could be based on the proliferation indices. Papillary Ta‐T1 tumours with a M/V index value 10/mm2or SPF 10% had a favourable prognosis whereas tumours with M/V index > 10/mm2or SPF > 10% had a high malignant potential.
Positive Margins after Radical Prostatectomy: Correlation with Local Recurrence and Distant Progression
Authors: Van den OUDEN D. , BENTVELSEN F. M. , BOEVE E. R. , SCHRODER F. H.
Published: November 2008

The impact of positive and negative surgical margins of resection on the interval to and incidence of progression was analysed in 172 patients after radical retropubic prostatectomy combined with lymphadenectomy; 56 had positive margins. Lateral and apical positive margins were evaluated separately.

The status of surgical margins was correlated with other prognostic factors, such as the T category, the presence or absence of seminal vesicle invasion and the G category. This analysis showed that positive and negative margins significantly influenced time to progression independently of the other prognostic factors. Positive margins at the apex contrary to lateral margins did not significantly influence time to progression. This may be due to the definition of the status of apical margins used in this analysis. A total of 108 patients underwent a nerve‐sparing radical prostatectomy, which did not lead to a higher incidence of positive margins than the standard procedure.

Prostate specific antigen accurately predicted tumour recurrence after radical prostatectomy. A rise of 1.0 ng/ml preceded other evidence of recurrence by a mean of 11 months.
Intravesical Instillation of Oxybutynin Hydrochloride for Detrusor Hyper‐reflexia
Authors: O'FLYNN K. J. , THOMAS D. G.
Published: November 2008

Summary The effect of intravesical oxybutynin hydrochloride on detrusor behaviour was studied in 15 patients with urinary incontinence due to detrusor hyper‐reflexia by ambulatory bladder monitoring. Twelve patients had a reduction in the frequency and amplitude of hyper‐reflexic contractions and incontinence episodes following oxybutynin administration. Intravesical oxybutynin may have a role in the management of patients on intermittent self‐catheterisation with detrusor hyper‐reflexia who cannot tolerate the side effects of anticholinergic agents, including oxybutynin.
Alternatives to Urinary Diversion with a Bag: Results in 100 Patients
Authors: WOODHOUSE C. R. J. , POPE A. J.
Published: November 2008

Summary One hundred patients underwent surgery to free them from a cutaneous urinary diversion (n = 59) or to avoid having one (n = 41). The reconstruction was tailored to the needs of the patient: 7 had a simple undiversion, 35 a complex undiversion and 58 a continent suprapubic diversion. The outcome was satisfactory in 97%. Two patients were rediverted to an ileal conduit. The simpler the reconstruction the lower the re‐operation rate: simple undiversion 0%, complex undiversion 20%, Mitrofanoff 42%, Kock pouch 69%. In spite of the high complication rate, there is a strong demand for such reconstructions and a high satisfaction rate amongst patients.
Long‐term Treatment of Benign Prostatic Hyperplasia with Alfuzosin: a 12–18 Month Assessment
Authors: JARDIN A. , BENSADOUN H. , DELAUCHE‐CAVALLIER M. C. , ATTALI P.
Published: November 2008

Summary In order to assess the efficacy and safety of alfuzosin, an alpha‐1 blocker, in symptomatic patients with benign prostatic hyperplasia (BPH), 131 patients who had completed a 6‐month placebo‐controlled trial conducted on parallel groups entered a 12‐month open study; 122 patients were treated with alfuzosin for 12 months and 56 patients for 18 months. After 12 months, all obstructive and irritative symptoms assessed according to the Boyarsky scale were significantly improved, as were peak flow rates in obstructed patients and mean flow rates and residual urine in the whole population. Voiding symptoms showed sustained improvement after treatment for 12 to 18 months. Only 5.3% of patients experienced vasodilatory side effects, none of which led to withdrawal from the study. No side effect related to long‐term administration was reported. Alfuzosin has a beneficial effect on voiding symptoms in patients with BPH and can be safely used in long‐term administration.
Extracorporeal Shock Wave Lithotripsy for Ureteric Calculi with the Dornier MFL5000 Lithotriptor at a Multi‐user Centre
Authors: WATSON R. B. , JAMES A.N.
Published: November 2008

Summary We have reviewed 241 consecutive cases of ureteric calculi managed with the Dornier MFL5000 lithotriptor. The patients were individually managed by 24 visiting urologists between October 1990 and September 1991.

There were 153 cases of upper ureteric calculi, of which 59 were successfully manipulated back to the renal pelvis prior to treatment, and 94 were treated in situ. There were 27 mid‐ureteric and 61 lower ureteric cases; in 51% of stones treated in situ ureteric stents were placed prior to extracorporeal shock wave lithotripsy. All stones were radio‐opaque and localised with on‐line fluoroscopy.

The outcome of treatment was assessed at 3 months, with failure defined as residual calculi ≤4 mm. The follow‐up rate was 89%. The overall fragmentation rate after a single treatment was 72%, which increased to 81% with re‐treatment. Of the upper ureteric calculi, manipulated stones had a significantly higher fragmentation rate (85%) compared with in situ stones (63%). The fragmentation rate was 89% for mid‐ureteric stones and 71% for lower ureteric stones.

Factors that significantly influenced fragmentation were retrograde manipulation of stone, number of impulses delivered and age of the patient. Stone size, the presence of a ureteric stent and mode of anaesthesia did not significantly influence fragmentation. These results suggest the Dornier MFL5000 lithotriptor is effective for the management of ureteric calculi in a multi‐user setting.
Salvage Cystectomy after Radical Irradiation for Bladder Cancer–Prognostic Factors and Complications
Authors: ABRATT R. P. , WILSON JENNIFER A. , PONTIN A. R. , BARNES R. D.
Published: November 2008

Summary We have studied 46 patients who underwent salvage cystectomy between March 1981 and June 1992 for persistent or recurrent carcinoma after radical irradiation for bladder carcinoma.

The overall 5‐year survival rate was 43%. There was a higher 5‐year survival rate in patients with an incomplete response compared with those with a complete response to their prior irradiation (50 and 36%), in patients with grades 1 or 2 compared with grade 3 histology (75 and 28%), and in patients with T1 orT2 tumours compared with T3 tumours (59 and 32%).

The median interval between commencing irradiation and performing cystectomy was 11 months. In the 25 patients with a prior complete response the median interval was 16 months; this was statistically significantly longer than in the 21 patients with an incomplete response (median interval 7 months). A worsening of tumour grade and category was found in some patients when comparing the findings at cystectomy with those prior to irradiation. This was consistently higher in patients with a prior complete response than in those with an incomplete response.

There were 3 deaths and 12 non‐fatal major complications due to the prior irradiation or surgery, with a mortality rate of 7% and an overall 5‐year complications rate of 35%. Only one of the complications occurred in the 13 patients treated with conventional 2 Gy fractions alone (5 fractions/week). Their overall complication rate was statistically significantly lower than that of the others.

Salvage cystectomy is indicated for selected patients with persistent or recurrent disease after radical irradiation for bladder cancer. The expectation of a survival rate similar to that found in patients treated with immediate cystectomy may not be justified.
Ethanol Monitoring of Extravascular Absorption of Irrigating Fluid
Authors: HAHN R.G.
Published: November 2008

Summary Ethanol monitoring is a method for the early detection of fluid absorption by the intravascular route during transurethral prostatic resection. An analysis was made to determine whether ethanol detection could also be used to quantify extravascular absorption. The concentration‐time profile of ethanol in the breath was analysed in 13 men aged between 57 and 80 years with extravasation of 860 to 3600 ml of an irrigant containing glycine 1.5% and ethanol 1%. The results showed that the volume of irrigant absorbed could be predicted from the persistently elevated breath ethanol level at the end of surgery. This prediction had a median deviation of 22% from the value obtained by careful volumetric measurement.