bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Significance of Alkaline and Acid Phosphatase and Skeletal Scintigraphy in Carcinoma of the Prostate
Authors: MERRICK M. V. , DING C. L. , CHISHOLM G. D. , ELTON R. A.
Published: November 2008

Summary— The prognostic significance of skeletal scintigraphy has been reassessed in relation to other tests by extended follow‐up of 220 patients. Skeletal metastases increased in prevalence with T stage and were associated with shorter survival irrespective of age. Early disease, a normal acid or alkaline phosphatase at presentation and well differentiated tumours were associated with longer survival. Alkaline phosphatase alone accounted for all of the differences in survival.

Scintigraphic change preceded elevation of the prostatic acid phosphatase in 81% of the patients whose initial scintigraphy and prostatic acid phosphatase were normal but who developed evidence of distant metastases on follow‐up. The mean interval between scintigraphic conversion and the development of overt symptoms was 5.8 months. Our findings discount the value of skeletal scintigraphy for determining prognosis but do indicate that it is more sensitive than the acid phosphatase in identifying patients before they become symptomatic.

Scintigraphy is indicated as a routine staging procedure in all new patients with carcinoma of prostate. In patients with a normal alkaline phosphatase, a baseline and regular follow‐up are needed to identify patients likely soon to develop symptoms. If the alkaline phosphatase is elevated at presentation, scintigraphy is necessary to distinguish benign from malignant causes and to determine the extent of skeletal involvement.
The Fluid Bridge Test Applied to Urethral Sphincter Function with Special Reference to the Male Urethra
Authors: DESMOND A. D. , RAMAYYA G. R. , COWELL T. K.
Published: November 2008

Summary— A new method of performing urethral pressure profiles and fluid bridge tests using computer technology is described, demonstrating the advantages over standard equipment. The fluid bridge test has been used to detect bladder neck incompetence in the male both before and after bladder neck surgery and has been adapted to investigate sphincter weakness at the distal urethral sphincter. This study suggests that the fluid bridge test is useful in the urodynamic evaluation of retrograde ejaculation, post‐prostatectomy incontinence and vesico‐urethral neuropathy.
The Accuracy of CT Scanning Prior to Para‐aortic Lymphadenectomy in Patients with Bulky Metastases from Testicular Teratoma
Authors: KENNEDY C. L. , HUSBAND J. E. , BELLAMY E. A. , PECKHAM M. J. , HENDRY W. F.
Published: November 2008

Summary— The accuracy of CT scanning prior to para‐aortic lymphadenectomy was assessed in 108 patients with metastatic testicular teratoma. In 106 its presence was confirmed by surgery. The site was accurately predicted in 95%. A good correlation (P < 0.0025) was found between mean tumour cross‐sectional area assessed by CT scanning and that measured in the excised pathological specimens.
Why Does Vasectomy Reversal Fail?
Authors: ROYLE M. G. , HENDRY W. F.
Published: November 2008

Summary— The scrotum was explored in 32 patients who had vasectomy reversal which failed to restore their fertility. Twenty‐three patients were azoospermic and nine had severe or persistent oligozoospermia. Amongst the 23 azoospermic cases, the vasa were found to be blocked in 12; following repeat vaso‐vasostomy, normal sperm counts were produced in 10 patients; 8 of these patients followed up for 6 months or more successfully impregnated their wives. In four cases there was a secondary epididymal block: following epididymo‐vasostomy, three of four patients obtained normal sperm counts and two wives became pregnant. In seven patients there was a very high antisperm antibody titre (> 1024 by tray agglutination test) and despite reparative surgery and prednisolone therapy, no pregnancies were obtained. The overall pregnancy rate for this group was 7 of 19 (37%).

Amongst nine oligozoospermic cases, unilateral obstruction was found in eight. The block was found in the vas in five and in the epididymis in two, and in two there were very high antisperm antibody titres. After reconstructive surgery, four patients had normal sperm counts and one pregnancy has been obtained
Pre‐natal Diagnosis: How Useful is it?*
Authors: THOMAS D. F. M. , IRVING H. C. , ARTHUR R. J.
Published: November 2008

Summary— Dilatation of the fetal urinary tract can now be detected by ultrasound imaging in pregnancy. Forty‐six cases of prenatally diagnosed dilatation were analysed to assess the contribution of this information to subsequent urological management.

Positive pre‐natal scans proved accurate. Dilatation was confirmed by neonatal ultrasound imaging or by autopsy in 24 of 25 consecutive inborn neonates and two aborted fetuses.

Forty‐four live births were studied. Twelve neonates had physical signs at birth which rendered the pre‐natal diagnosis unnecessary. In 32 neonates (73%) the urinary tract anomaly was identified solely as a result of pre‐natal imaging and would otherwise have remained undetected. However, in seven neonates the information was of doubtful value (mild unilateral dilatation), in 16 it was of probable value (confirmed unilateral PUJ obstruction, multicystic kidney, etc.) and in only nine neonates (20%) was it of definite value (treatable conditions affecting both kidneys or a solitary kidney, e.g. urethral valves, PUJ obstruction in a solitary kidney, etc.).

Prenatally detected bilateral dilatation (18 infants) carried a poor prognosis—33% mortality and 56% incidence of coexistent abnormalities. No infants in our series had undergone intra‐uterine drainage, but the numbers of survivors and their renal function was comparable to the published results for fetal intervention.
The Value of Permixon in Benign Prostatic Hypertrophy
Authors: SMITH H. REECE , MEMON A. , SMART C. J. , DEWBURY K.
Published: November 2008

Summary— A double‐blind trial comparing the effect of Permixon (160 mg bd) against placebo in the treatment of benign prostatic hypertrophy is described. In both groups a significant improvement in flow rate and subjective assessment of symptoms was seen. There was no significant difference between the results of treatment in either group.
Renal Metastases from Carcinoma of the Lung
Authors: BECKER W. E. , SCHELLHAMMER P. F.
Published: November 2008

Summary— Five cases of clinically manifest solitary and bilateral renal lesions metastatic from the lung are presented. These cases are unusual in that renal metastases are usually silent lesions discovered at autopsy. Review of the autopsy data from this hospital identified renal metastases in 19% of patients who died from carcinoma of the lung. This incidence parallels that of other series.

A solid renal lesion which is identified in a patient with a history of pulmonary carcinoma should raise the suspicion of renal metastases, especially if computed tomography of the mass demonstrates relative homogeneity and minimal enhancement. More frequent use of the abdominal CT scan in staging patients with lung cancer will render metastatic carcinoma from lung to kidney a more frequent ante mortem diagnosis
The Use of Transabdominal Ultrasound in the Detection of Early Bladder Tumours
Authors: MALONE P. R. , WESTON‐UNDERWOOD J. , ARON P. M. , WILKINSON K. W. , JOSEPH A. E. A. , RIDDLE P. R.
Published: November 2008

Summary— We have studied the accuracy of transabdominal ultrasound (TAUS) in the diagnosis of early superficial bladder carcinoma. One hundred and twenty‐six patients returning for check cystoscopy were scanned pre‐operatively with the Technicare Autosector Scanner and the results compared with the endoscopic findings.

Forty‐four patients (37%) had a tumour recurrence. TAUS demonstrated a lesion in 50% of these with a false positive rate of 11 %. The diagnostic accuracy was proportional to the tumour size (82% of patients with tumours above 5 mm were detected compared with 38% below 5 mm), but was not affected by grade, stage or position in the bladder.

TAUS may prove a useful adjunct to cytology as a screening test for bladder cancer.
A New Hormonal Therapy for Prostatic Cancer: Long‐term Clinical and Hormonal Response
Authors: AHMED S. R. , GRANT J. B. F. , SHALET S. M. , HOWELL A. , COSTELLO C. B. , WEATHERSON T. , BLACKLOCK N. J.
Published: November 2008

Summary— Twenty‐four patients with advanced prostatic cancer were treated with daily injections of the LHRH analogue ICI 118630 (Zoladex) for up to 21/2 years. Successful long‐term suppression of LH (luteinising hormone) and testosterone was observed without any escape of testosterone. Immunoreactive LH concentrations rose significantly following the daily injection of LHRH analogue but there was no corresponding rise in testosterone concentrations, suggesting altered bioactivity of the LH.

A long‐term clinical response was obtained in 10 patients (41.6%) and the median duration of response in these patients was 25 months. Eight of the 10 had well to moderately differentiated tumours. The actuarial median survival of all patients was 22 months.
The Complications of Extracorporeal Shockwave Lithotripsy: Management and Prevention
Authors: COPTCOAT M. J. , WEBB D. R. , KELLETT M. J. , FLETCHER M. S. , McNICHOLAS T. A. , DICKINSON I. K. , WHITFIELD H. N. , WICKHAM J. E. A.
Published: November 2008

Summary—
Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, “Steinstrasse” formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.
Combination of Percutaneous Surgery and Extracorporeal Shockwave Lithotripsy for the Treatment of Large Renal Calculi
Authors: DICKINSON I. K. , FLETCHER M.S. , BAILEY M. J. , COPTCOAT M. J. , McNICHOLAS T. A. , KELLETT M. J. , WHITFIELD H. N. , WICKHAM J. E. A.
Published: November 2008

Summary—
Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCN L and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.
Risk Factors for Renal Stone Formation in Patients with Spinal Cord Injury
Authors: KOHLI A. , LAMID S.
Published: November 2008

Summary—
To determine factors that may influence kidney stone formation in spinal cord injury patients, the medical records of 893 patients who had been followed up by the Milwaukee Veterans Administration Medical Center from 1970 to 1984 were extensively reviewed. Urography showed that 12 patients had kidney stones. Twenty‐four non‐kidney stone patients with a similar age range, sex and duration of time since injury were selected as controls. Variables, such as level of spinal lesion, completeness of neurological dysfunction, presence of ureteric reflux etc, were compared and analysed statistically. The results showed that there was no difference between patients with and those without renal stone as far as the level of spinal injury and completeness of spinal cord lesion were concerned. There was no relationship between kidney stone formation and methods of urinary drainage or the presence of ureteric reflux. However, patients with good bladder control had no renal calculi. Serum creatinine, phosphorus, uric acid and calcium levels were similar in both groups of patients. There was a relationship between sepsis, positive urine culture and kidney stone formation. The absence of physical activity was not a risk factor for renal calculi and patients on a high fibre diet had the same incidence of stones as those on a regular diet.
Predictive Value of99m Tc‐DTPA Renography Studies under Conditions of Maximal Diuresis for the Functional Outcome of Reconstructive Surgery in Children with Obstructive Uropathy
Authors: SUKHAI R. N. , KOOY P. P. M. , WOLFF E. D. , SCHOLTMEIJER R. J.
Published: November 2008

Summary—
Renographic studies under standardised conditions of maximal diuresis provoked by infusion of hypotonic saline and frusemide were made on 51 patients with 54 dilated upper urinary tract systems in order to distinguish obstructed from non‐obstructed systems.

Of the 23 systems judged on clinical and radiological grounds to be obstructed only 12 were in fact obstructed following infusion of hypotonic saline and frusemide. In 10 of these systems (1 0 patients) an Anderson‐Hynes pyeloplasty was carried out. All systems showed improved renal function after operation and the renographic pattern became non‐obstructed.
Complications Associated with Ureteroscopy
Authors: CARTER S. St C. , COX R. , WICKHAM J. E. A.
Published: November 2008

Summary—
A review of 125 ureteroscopies in 111 patients is reported. Eight per cent suffered major complications of perforation or stricture formation and 3% required ureteric reimplantation. Clinical follow‐up and imaging studies performed more than a year after ureteroscopy produced no evidence that late complications arise.
Double J Stents: A Review of 100 Patients
Authors: POCOCK R. D. , STOWER M. J. , FERRO M. A. , SMITH P. J. B. , GINGELL J. C.
Published: November 2008

Summary—
Double J stents have been advocated for drainage or splintage of the ureter. One hundred and thirty‐eight attempts at stent insertion were made in 100 patients. In 78% of attempts the stent was satisfactorily placed. Their use in retroperitoneal fibrosis, ureteric trauma and acute hydronephrosis of pregnancy has been encouraging. Poor results have been obtained in patients with malignant obstruction or tuberculous stricture.
The Effect of Warm Irrigation on Blood Loss during Transurethral Prostatectomy under Spinal Anaesthesia
Authors: HEATHCOTE P. S. , DYER P. M.
Published: November 2008

Summary—
In this prospective trial a study was made of the effect of warm irrigation on blood loss during transurethral prostatectomy (TURP). A control group of 21 patients in whom irrigating fluid at operating room temperature (mean 21.5°C) had been used was compared with a statistically comparable group of 19 patients in whom warm irrigating fluid (mean 33.1°C) had been used.

Blood loss in ml, in ml/g of tissue resected and in ml/min of resection time was not increased by the use of warm rather than room temperature irrigation.

It was found that warm irrigation decreased heat loss and shivering in the patient during TURP and led to improved comfort both for patient and operator. The method of heating the irrigation bags was safe and economical.
Plasma Cell Balinitis of Zoon
Authors: MURRAY W. J. G. , FLETCHER M. S. , YATES‐BELL A. J. , PRYOR J. P. , DARBY A. J. , PACKHAM D.A.
Published: November 2008

Summary—
Superficial lesions of the glans penis can pose diagnostic difficulties. Plasma cell balanitis is such a condition and it may be confused clinically with erythroplasia of Queyrat. It is unresponsive to topical medication and curable only by circumcision.
Skeletal Anomalies Associated with Unilateral Renal Agenesis
Authors: GUPTA N. P. , GILL I. B. S.
Published: November 2008

Summary— Unilateral renal agenesis is sometimes associated with skeletal anomalies. The skeletal malformations are easily detectable and, if found, should suggest further urological investigations. The embryological aspect of the association is explored. Two cases are presented and the relevant literature is reviewed.
Neonatal Testicular Torsion and Infarction: Aetiology and Management
Authors: BURGE D.M.
Published: November 2008

Summary— Thirty neonates presented with signs of testicular ischaemia over a 20‐year period. Eighteen children had primary exploration revealing extravaginal torsion (10), intravaginal torsion (3), infarction without torsion (2) and torsion of the appendix testis (1). The other two children had simple biopsy of necrotic testes. In two instances the testis was untwisted and retained but both subsequently atrophied. The remainder underwent orchiectomy. Twelve children did not have initial exploration and 11 of these had subsequent testicular atrophy. At contralateral testis fixation, performed in 17 cases, signs of contralateral involvement in the ischaemic process were found in seven, suggesting that the primary event in the condition is infarction, with torsion occurring secondarily.
Paraffinoma of the Ureter
Authors: KELLEHER J. , WILSON S. , WITHEROW R. O'N.
Published: November 2008

Paraffinoma is a well recognised complication following instillation of paraffin into the tissues (Campbell and Henderson, 1973) but its deleterious effects have not been previously reported in the urinary tract.
Observations on in vitro and in vivo Calcium Oxalate Crystalluria in Primary Calcium Stone Formers and Normal Subjects
Authors: AZOURY R. , ROBERTSON W. G. , GARSIDE J.
Published: November 2008

Summary— Fresh urine samples from stone formers (SF) and normal subjects (N) were rapidly evaporated at 37°C to 1200 mosmol/kgH2O and the particle size distribution of the formed particles studied by Coulter Counter and chemical methods. No significant difference was found between the two groups in their relative supersaturation of calcium oxalate at the point of spontaneous precipitation. SF and N urines seem to have an equal driving force for particle precipitation. The major difference between them was in the volume of particles with diameters greater than 11.4 μm. SF urines showed an approximately 5‐fold increase in total particle volume (after evaporation) and N urines had about a 2‐fold increase over the volume in the freshly voided urine samples. The total volume of large particles (> 11.4 μm) increased more than 7‐fold in SF urine while only a 2‐fold increase was detected in the normal urines after evaporation.
Intravesical Mitomycin C for the Treatment of Recurrent Superficial Bladder Tumours
Authors: HETHERINGTON J. W. , NEWLING D. W. W. , ROBINSON M. R. G. , SMITH P. H. , ADIB R. S. , WHELAN P.
Published: November 2008

Summary— Forty‐three patients with recurrent multiple superficial bladder tumours (Tis, Ta and Tl) were treated with Mitomycin C 20 mg in 20 ml water intravesically weekly for 8 to 12 weeks, and monthly instillations were continued for 5 to 6 months. Residual tumour was resected at 12 weeks, at which time 40 patients (93%) showed a response to treatment. A complete response was seen in 24 (56%) and 16 (37%) showed a partial response. After a follow‐up of 12 to 48 months (median 19), 19 of 33 evaluable patients (58%) have shown tumour recurrence. Invasive tumour has developed in seven (17%) and transitional cell tumours of the ureter in two of those patients who showed an initial response to treatment.
Orchiectomy versus Long‐acting D‐Trp‐6‐LHRH in Advanced Prostatic Cancer
Authors: PARMAR H. , EDWARDS L. , PHILLIPS R. H. , ALLEN L. , LIGHTMAN S. L.
Published: November 2008

Summary— One hundred and four patients were randomised for the study. Fifty‐five were entered into the D‐Trp‐6‐LHRH group and 49 into the orchiectomy group. All pre‐treatment patient characteristics were similar and testosterone levels at 1 month or later were in the castrate range in both groups.

Forty‐six patients (83%) in the D‐Trp‐6‐LHRH group and 40 (82%) in the orchiectomy group had a partial remission or stable disease at 3 months or later. There was no significant difference between the groups for response or survival.

Three patients in the D‐Trp‐6‐LHRH group had a disease “flare” in the first 10 days of treatment. The flare symptoms resolved by the end of 4 to 8 weeks.

The incidence of flushing, decreased libido and impotence was similar in both groups. Although there was less psychological morbidity in the D‐Trp‐6‐LHRH group the difference did not reach statistical significance. Our results indicate that long‐acting D‐Trp‐6‐LHRH offers a safe and highly effective alternative to orchiectomy.
Post‐vasectomy Antisperm Immune Reaction after Testosterone‐induced Azoospermia
Authors: LENZI A. , GANDINI L. , CLARONI F. , DONDERO F.
Published: November 2008

Summary— We describe preliminary experiments on the effects of testosterone‐induced azoospermia on post‐vasectomy antisperm antibody reaction in two subjects. Progressive resumption of spermatogenesis following gradual suspension of testosterone therapy was still associated with antisperm antibody formation. Post‐vasectomy antisperm antibody production does not seem to be triggered exclusively by acute, sudden and massive reabsorption of spermatoza after vasectomy but also by slow, gradual and late sperm antigen reabsorption.
Mucous Metaplasia and Rupture of Urachal Cyst as a Rare Cause of Acute Abdomen
Authors: NAIR K. P. N.
Published: November 2008

Developmental anomalies related to non‐obliteration of the fetal allantoid canal are rare. The case reported here was due to glandular metaplasia in a urachal cyst which ruptured, delivering mucinous material intraperitoneally, and was treated successfully.
Crossed Testicular Ectopia Detected by Laparoscopy
Authors: GORNALL P. G. , PENDER D. J.
Published: November 2008

A case of crossed testicular ectopia which was detected by laparoscopy is presented.
Full‐length Ureteric Splintage in the Management of Bilharzial Ureteric Strictures
Authors: RADY M. Y. A. , RADY A. M.
Published: November 2008

Summary— Our experience with full‐length ureteric splintage is reviewed with a note on the technique and its outcome. It is safe, effective and simple, easy to teach and easy to learn. It is recommended as the operation of choice in bilharzial ureteropathy.
Sixth Report on the Standardisation of Terminology of Lower Urinary Tract Function
Authors: Abrams P. , Blaivas J. G. , Stanton S. L. , (Chairman) J. Andersen , Fowler Clare J. , Gerstenberg T. , Murray K.
Published: November 2008

The first four reports of the Standardisation Committee of the International Continence Society dealt with the nomenclature relating to urinary incontinence, procedures related to the evaluation of urine storage (cystometry, urethral closure pressure profile), units of measurement (Bates et al., 1976), procedures related to the evaluation of micturition (flow rate, pressure measurement), symbols (Bates et al., 1977), procedures related to the evaluation of micturition: pressure flow relationship, residual urine (Bates et al., 1980) and neuromuscular dysfunction of the lower urinary tract (Bates et al., 1981). The fifth report has remained an internal document of the Society and deals with the quantification of urine leakage.

This report deals with recommendations on terminology related to neurophysiological investigations of the lower urinary tract with particular reference to electromyography, nerve pathway studies and sensory testing.

These standards are proposed to facilitate comparison of results by investigators who use these investigations. It is recommended that the acknowledgement of these standards in written publications be indicated by a footnote to the section “Methods and Materials” or its equivalent: “Methods, definitions and units conform to the standards proposed by the International Continence Society except where specifically noted.”
Aminoglutethimide in Advanced Prostatic Carcinoma
Authors: HARNETT P. R. , RAGHAVAN D. , CATERSON I. , PEARSON B. , WATT H. , TERIANA N. , COATES A. , COOREY G.
Published: November 2008

Summary— We have treated 34 patients with advanced prostate cancer, resistant to orchiectomy or oestrogen therapy, with aminoglutethimide. Seven patients (21%) showed improvement in pain and performance status for prolonged periods. By NPCP criteria six patients had stable disease and one had partial tumour response. Six of these patients remained on oestrogen therapy. Suppressed gonadotrophin levels (FSH and LH), despite orchiectomy, correlated strongly with benefit from aminoglutethimide. No relationships between response to treatment and changes in serum testosterone, dehydroepiandrosterone, oestradiol or prolactin were found. Six patients had side effects requiring cessation of therapy. A further 27 patients developed less severe toxicity.

Despite its toxicity, these results show that aminoglutethimide has a role in the management of advanced prostatic cancer resistant to primary hormonal manipulation.
Studies on Intracavernosal VIP Levels during Pharmacologically Induced Penile Erections
Authors: KIELY E. A. , BLANK MARIAN A. , BLOOM S. R. , WILLIAMS GORDON
Published: November 2008

Summary— Intracavernosal and peripheral venous vasoactive intestinal polypeptide (VIP) levels were measured in men with predominantly organic or predominantly psychogenic impotence. The measurements were taken at intervals up to 30 min following intracavernosal injections of saline, papaverine hydrochloride and papaverine hydrochloride and phentolamine. Levels were also measured after tactile and visual sexual stimulation and following an intravenous injection of papaverine and phentolamine.

A penile erection occurred in all men receiving intracavernosal vasoactive compounds. The mean VIP concentration did not alter significantly in either cavernosal or peripheral venous blood during the erection. Mean VIP concentrations were significantly greater in the neurogenic (all diabetic) group than in the other groups studied. Mean cavernosal and peripheral VIP concentrations did not alter following tactile or visual sexual stimulation and no significant alteration in mean peripheral venous VIP concentration occurred following injection of papaverine and phentolamine. The putative role of VIP in the induction of penile erection has not been elucidated in these studies.
Prevalence of Calcified Upper Urinary Tract Stone Disease in a Random Population Survey Report of a Combined Study of General Practitioners and Hospital Staff
Authors: SCOTT R.
Published: November 2008

Summary— There are few randomised studies specifically designed to establish the prevalence of upper urinary tract stone disease. The present random study sampled a population of 7000 in the central belt of Scotland. Three thousand three hundred and ninety‐eight subjects were X‐rayed and possible calcified upper tract stones were further investigated, revealing a prevalence rate of 3.5% of the total surveyed population.

Socio‐economic characteristics of the population were determined, such as occupation, history of previous infection, stone disease and backache. Simple urine and blood analyses were undertaken.

There was no difference in stone prevalence between males and females (1.03:1) as distinct from treated stone patients. There were no differences between the sexes with respect to family history of stone disease but females have a greater chance of having had previous urinary tract infection.
Ureteric Stone Surgery in Practice
Authors: BISHOP M. C. , LAWRENCE W. T. , LEMBERGER R. J.
Published: November 2008

Summary— From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30%“blind” basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985–86), the majority following failed ureteroscopic extraction.

In the same year both “blind” basket extraction and ureteroscopy were successful in 82 and 86% of attempts respectively. Electrohydraulic and ultrasonic lithotripsy were used in 12 patients to reduce large impacted calculi. The commonest complication of ureteroscopic stone surgery was perforation; this occurred in 14% of cases, though it was usually trivial and near the vesicoureteric junction. Perforations higher in the ureter tended to follow endoscopic lithotripsy and were often associated with urinary extravasation. Extra‐ureteric stone fragments were also occasionally observed in such cases. There were no serious sequelae, although the in‐patient stay was prolonged beyond the 48 h customary for uncomplicated extraction.

The results suggest that ureteroscopic stone extraction, which can be conveniently introduced into urological practice, should become a standard endoscopic procedure.
Closure of Severe Vesico‐vagino‐rectal Fistulas Using Lehoczky's Island Flap
Authors: KELEMEN Z. , LEHOCZKY G.
Published: November 2008

Summary— Thirty large vesico‐vaginal and vesico‐vagino‐rectal fistulas developing after severe radiation injury were closed using Lehoczky's island flap. The pedicle flap of skin and adipose tissue was taken from the area bordered by the greater lip of the pudendum, the perineum and the thigh. It received its blood supply from the internal pudendal artery. Urinary or faecal diversion was not performed. Healing was satisfactory in all 30 patients and there was no recurrence of the fistula.
Calcium Phosphate in Catheter Encrustation
Authors: COX A. J. , HARRIES J. E. , HUKINS D. W. L. , KENNEDY A. P. , SUTTON T. M.
Published: November 2008

Summary— Encrusted catheters from nine female patients were the source of samples of deposits which were examined by X‐ray diffraction, atomic absorption spectroscopy, infra‐red spectroscopy and extended X‐ray absorption fine structure (EXAFS) spectroscopy. In eight samples the only crystalline phase which could be clearly distinguished by X‐ray diffraction was ammonium magnesium orthophosphate hexahydrate, NH4MgPO4.6H2O, which occurs naturally as the mineral struvite. However, atomic absorption spectroscopy revealed an appreciable concentration of calcium in all samples. Calcium phosphates have previously been detected in catheter deposits. Infra‐red and EXAFS spectra were consistent with the calcium phosphate being present as a poorly crystalline hydroxyapatite. Thus the deposits appear to consist of a mixture of crystalline struvite and a form of hydroxyapatite which is not fully crystalline.
Matrix Calculus Anuria
Authors: VARMA J. S.
Published: November 2008

Obstructive anuria secondary to matrix calculus is extremely rare and the diagnosis and management can be particularly difficult.
The Management of Obstructive Renal Candidiasis in the Neonate
Authors: ROBINSON P. J. , POCOCK R. D. , FRANK J. D.
Published: November 2008

Summary— Neonatal renal candidiasis is a rare complication of prematurity associated with a mortality rate of 50%. We describe a patient who was treated by nephrostomy drainage together with the removal of the fungal debris and both systemic and local antifungal therapy. The infection was eradicated and the baby survived with minimal renal morbidity. A rational plan of treatment is presented which may help to reduce the mortality rate in future.
Surgical Treatment of Renal Cancer with Vena Cava Extension
Authors: NEVES R.J. , ZINCKE H.
Published: November 2008

Summary— Fifty‐four patients with renal cancer and vena cava tumour thrombus underwent radical nephrectomy and removal of the thrombus; the operative mortality rate was 9.3% (5 patients). The extent of the vena cava thrombus did not affect survival.

Of 36 patients with no known pre‐operative metastases and complete (29 patients) and incomplete (7 patients) removal of the vena cava tumour thrombus, the 5‐year survival rate was 68 and 17%, respectively (P=0.01). Thirteen patients (45%) who underwent complete removal of the vena cava tumour thrombus are alive and free of disease, with a mean follow‐up of 51.2 months (range 4–144); three died without disease 110, 31 and 23 months after operation.

The 2‐year and 5‐year survival rates of 18 patients with known pre‐operative metastases was 37.5 and 12.5% respectively; 14 died between 1 and 27 months post‐operatively (mean 11.6) of metastatic disease. Two of these 18 patients experienced long‐term remission: one died of unrelated causes 151 months after operation; the other was lost to follow‐up 219 months after operation, with no evidence of disease. Of 14 patients with positive regional nodes, the mean survival in those with metastases compared with those without metastases was 7.5 versus 15 months, respectively; only one patient survived at 14 months.

Operative intervention in patients without metastatic disease (systemic or regional) and complete removal of the vena cava thrombus achieved a 5‐year survival rate of 68%. Variables which significantly decreased survival and may be considered contraindications for operation were systemic metastasis, regional lymph node involvement and incomplete removal of the vena cava thrombus.
Endoscopic Ureteric Stone Extraction. Experience with the Short Ureteroscope
Authors: TOLLEY D.A.
Published: November 2008

Summary— A modified short Storz ureteroscope is described. It was used for the extraction of ureteric stones in 56 patients with a success rate of 96%.
Non‐cholinergic, Non‐adrenergic Nerve‐mediated Relaxation of Pig and Human Detrusor Muscle in vitro
Authors: KLARSKOV P.
Published: November 2008

Summary— Previously unrecognised, nerve‐mediated relaxation in pig and human detrusor muscle is described. The relaxation was mediated via non‐cholinergic, non‐adrenergic and non‐prostaglandin transmitter or modulator systems and was present in 12 of 15 detrusor strips from six pigs and in four of 15 detrusor strips from seven patients. A contractile phase preceded relaxation in all strips; in contrast to the contractile phase, relaxation was augmented by an increase in basal tension in a complex way and possibly by the slowest stimulation frequencies.
Ileal Loop Diversion in Women with Incurable Stress Incontinence
Authors: COX R. , WORTH P. H. L.
Published: November 2008

Summary— Eighteen women with incurable stress incontinence underwent ileal loop urinary diversion. Eight patients required surgical revision of their stomas. Another eight patients required the formation of iatrogenic vesicovaginal fistulas but subsequently underwent cystectomy for persistent vesical discharge. Twelve patients with a psychiatric history underwent a total of 29 further operations after diversion compared with a total of six operations for the six patients without a psychiatric history.

Urinary diversion is an unsatisfactory solution to the problem of incurable stress incontinence and the relationship between psychiatric disorders and incurable stress incontinence requires further study.
Phase II Study of Megestrol Acetate for Metastatic Carcinoma of the Prostate
Authors: CROMBIE CATHERINE , RAGHAVAN D. , PAGE J. , WOODS R. , DALLEY D. , DEVINE RHONDA , ROSEN M.
Published: November 2008

Summary— Forty‐three males with recurrent and metastatic cancer of the prostate were treated with megestrol acetate (160 mg/day orally) after having failed first‐line hormonal treatment (orchiectomy or diethylstilboestrol). Thirty‐seven patients were evaluated objectively for response, 28 of whom received the drug for more than 6 weeks. One patient had a partial response (National Prostatic Cancer Project criteria) and seven had stable disease. Toxicity was usually mild, although five patients developed a transient rise in liver enzymes and one patient had a grand mal fit. Three patients showed evidence of tumour “flare”. Megestrol acetate has only limited efficacy in patients previously treated for prostatic cancer by hormonal manipulation.
Patients' Delay in the Presentation of Testis Cancer in Ireland
Authors: THORNHILL J. A. , FENNELLY J. J. , KELLY D. G. , WALSH A. , FITZPATRICK J. M.
Published: November 2008

Summary— A study of 217 cases of testis cancer in Ireland revealed a longer duration of symptoms (median 2.8 months, mean 10 months) than elsewhere: 32% of patients waited at least 6 months before seeking medical advice. Delay was associated with metastases (P=0.001), diminished prospects of cure (P=0.001) and increased mortality (P=0.002) but not with marker status or complexity of treatment required. Eleven per cent did not notice a detectable swelling and 25% waited at least 3 months after such a discovery. These facts and the incidence of maldescent (12%, with more than two‐thirds untreated) highlight the need for better health education in this area.
Allergy to Mitomycin C Complicating Topical Administration for Urothelial Cancer
Authors: INGLIS J. A. , TOLLEY D. A. , GRIGOR K. M.
Published: November 2008

Summary— Three cases are presented in which eosinophilic cystitis developed when patients who were known to have superficial bladder cancer were treated with instillations of the alkylating agent Mitomycin C.
Evaluation of Bladder Cancer with a Miniature High Frequency Transurethral Ultrasonography Probe
Authors: DEVONEC M. , CHAPELON J. Y. , CODAS H. , DUBERNARD J. M. , REVILLARD J. P. , CATHIGNOL D.
Published: November 2008

Summary— A miniature high frequency 10 MHz transurethral ultrasonography probe has been developed which is adaptable to any standard 17 F cystoscope sheath. High frequency contributed to a definite improvement in image resolution but did not allow distinct visualisation of different bladder wall layers. An 80% correlation between ultrasonographic and pathological staging was established after evaluation of 50 consecutive patients with newly diagnosed bladder tumours. Ta/T1 tumours tended to be overstaged with ultrasound. In some patients, the response to conservative treatment (external beam radiation therapy) of deeply infiltrating tumours could be assessed with the miniature probe on an out‐patient basis.
Vascular Corrosion Casts of the Dog Testis after Experimental Microvascular Surgical Orchiopexy A Scanning Electron Microscope Study
Authors: GARIBYAN H. , HODDE K. C.
Published: November 2008

Summary— Five mongrel dogs underwent microvascular surgical orchiopexy by anastomosing the testicular artery and vein with the respective caudal epigastric vessels. In order to assess the effec of a 40 to 50‐min period of warm ischaemia (the time required to make the anastomosis) on the testicular blood vasculature, plastic corrosion casts were made of the operated testes and compared with non‐operated control specimens. The resulting blood vessel casts were inspected in the scanning electron microscope. One case of testicular atrophy developed, caused by a postoperative wound abscess.

Comparing operated with non‐operated testes, no differences in vascularisation, pattern or density of arterial supply, capillary network and venous drainage were seen. These findings are in agreement with data from the literature concerning histological, hormonal and clinical results.
The Integrated Cystoscope: an Alternative to Conventional and Fibreoptic Cystoscopy
Authors: MILLER R. A. , COPTCOAT M. J. , PARRY J. , DAWKINS G. , WICKHAM J. E. A.
Published: November 2008

Summary— This report describes a new integrated rigid cystoscope which has been designed for diagnostic and therapeutic cystoscopy under local anaesthesia. The small external diameter (17.5 F) and large instrument channel permit maximum irrigant flow and operating potential whilst causing minimum discomfort to the patient. We believe this instrument to be a practical alternative to conventional cystoscopes, including the fibreoptic cystoscope.
Urinary Oxalate Levels are not Affected by Dietary Purine Intake or Allopurinol
Authors: MORRIS G. S. , SIMMONDS H. A. , TOSELAND P. A. , ACKER K. J. VAN , DAVIES P. M. , STUTCHBURY J. H.
Published: November 2008

Summary— We showed previously that ingestion of a non‐specific high purine diet by healthy subjects increased not only urinary uric acid levels but urinary oxalate as well. Both increments were reduced significantly during concomitant allopurinol therapy. The present study was undertaken to investigate these findings in more detail under carefully controlled dietary conditions where a single specific purine, guanosine, was used as an additive and several different methods for oxalate determination (GLC, HPLC, isotacophoresis) were compared with the enzymatic method used previously.

Results obtained by two direct techniques of oxalate determination showed no significant alteration in oxalate levels during any dietary regime, suggesting that the earlier results derived from problems inherent in the experimental design and methodology employed. The study confirmed that one of the beneficial effects of allopurinol was to reduce dietary purine absorption. The results may thus provide a logical explanation for the reduced incidence of urolithiasis during allopurinol therapy in some idiopathic oxalate stone formers addicted to purine‐rich foods and beverages.
The Composition of Four‐hour Urine Samples from Patients with Calcium Oxalate Stone Disease
Authors: BERG C. , LARSSON L. , TISELIUS H.‐G.
Published: November 2008

Summary— Urine collected during a 24‐h period between 06.00 and 10.00 h from 25 patients with recurrent CaOx stone disease was analysed with respect to calcium, oxalate, magnesium, citrate and creatinine. Urinary excretion of oxalate in relation to creatinine was slightly higher in 24‐h urine but the correlation between 24‐h and 4‐h values was good. Good correlations were also recorded for calcium and citrate, whereas a more variable result was obtained for magnesium. In terms of the risk of forming a supersaturated urine (CaOx risk index), a good correlation was observed between 24‐h and 4‐h urine samples, although the highest values were found in 24‐h urine. As a result of a low mean urine flow between 06.00 and 10.00 h, the highest supersaturation in terms of the AP(CaOx) index was observed in these samples. When the risk of calcium oxalate crystallisation (CaOx‐CR) was determined by means of the increment in oxalate concentration required for precipitation of CaOx, 7 of 11 samples had the highest values in the 4‐h urine.

Samples collected during a 4‐h period might thus be useful in the evaluation and follow‐up of CaOx stone formers and further studies will show to what extent they can replace 24‐h urine collections.
Non‐cholinergic, Non‐adrenergic Inhibitory Nerve Responses of Bladder Outlet Smooth Muscle in vitro
Authors: KLARSKOV P.
Published: November 2008

Summary— Pig trigone, bladder neck and urethral smooth muscle strips blocked with atropine, phentolamine, propanolol and the prostaglandin synthesis inhibitor ketoprofen were exposed to transmural electric field stimulation in vitro. The strips developed a fast and reproducible relaxation which was sustained during the period of stimulation and ceased slowly after stopping stimulation. The amplitude of the relaxation was proportional to the basal tension. The relaxation was nervemediated, since selective nerve blockade with tetrodotoxin abolished the response. Calcium influx inhibition with verapamil did not antagonise the relaxation, while omitting Ca++ from the bath solution caused maximal relaxation. Vasocactive intestinal polypeptide and adenosinetriphosphate evoked submaximal and slowly developing relaxation.
Double‐blind Study Comparing Aztreonam with Placebo for Prophylaxis of Infection following Prostatic Surgery
Authors: MILLAR M. R. , INGLIS T. , EWING R. , CLARK P. , WILLIAMS R. E. , LACEY R. W.
Published: November 2008

Summary— In a prospective, randomised, double‐blind study, 179 patients undergoing retropublic or transurethral prostatectomy were given pre‐operatively either 1 g aztreonam or a placebo. In patients treated with aztreonam there was a significant reduction in the number with post‐operative bacteriuria and in the number requiring treatment of post‐operative bacteriuria. Other differences were not significant. The mean duration of post‐operative hospital stay for patients receiving aztreonam was 7.1 days compared with 6.9 days for those receiving placebo. In patients treated with aztreonam there was no increase in the frequency of infection due to Gram‐positive bacterial species.
Improved Survival after Brain Metastases in Nonseminomatous Germ Cell Tumours with Combined Modality Treatment
Authors: RAGHAVAN D. , MACKINTOSH J. F. , FOX R. M. , ROGERS J. , DUVAL P. , BESSER M.
Published: November 2008

Summary— Long‐term disease‐free survival (78+ and 31+ months) has been achieved in two of four patients treated for brain metastases from non‐seminomatous germ cell tumours between 1980 and 1984. The incidence of cerebral metastases among 101 patients seen over the 5‐year period was 4%. The encouraging results from the use of combined modality treatment, incorporating cisplatin‐based chemotherapy, whole brain irradiation and surgery, are reviewed.
Controlled Trial of Chemical Disinfection of Urinary Drainage Bags: Reduction in Hospital‐acquired Catheter‐associated infection
Authors: HOLLIMAN R. , SEAL D. V. , ARCHER HELEN , DOMAN SUE
Published: November 2008

Summary— A controlled, prospective trial was conducted on an orthopaedic ward to test the use of peroxide disinfection of drainage bags as the only measure taken to affect the rate of hospital‐acquired, catheter‐associated urinary tract infection (UTI). A significant reduction (P<0.05) in the number of patients with catheter‐associated UTI occurred with the use of bag disinfectant when compared with patients in whom this technique was not used. We consider this technique to be suitable for the management of catheterised patients on general hospital wards to reduce catheter‐associated UTI and environmental spread of their bacteria.
Phase II Study of Zoladex Depot in Advanced Prostatic Cancer with Special Reference to Criteria of Response and Survival
Authors: EMTAGE L. A. , PERREN T. J. , STUART N. S. A. , ARKELL D. G. , WALLACE D. M. A. , HUGHES M. A. , COTTAM J. , FARRAR D. , YOUNG C. H. , BLACKLEDGE G. R.
Published: November 2008

Summary— Zoladex is a potent decapeptide analogue of luteinising hormone releasing hormone (LHRH). The drug is formulated as a 3.6 mg depot dispersed in a matrix of d'l‐lactide‐glycolide copolymer, which is totally biodegradable. This formula releases drug continuously for at least 28 days and reliably suppresses serum testosterone into the castrate range. The effect of the depot was studied in 29 patients with locally advanced or metastatic carcinoma of the prostate. Average age at entry was 71 years (range 52–87) and follow‐up was from 13.5 to 34.5 months (median 23). Endocrine studies showed that medical castration was maintained in all cases. Three patients experienced bone pain in the first month of treatment and two others had temporary nephrostomies for worsening ureteric obstruction.

Subjective improvement was seen in 23/28 cases (82%). There were no complete responses, but partial response was seen in 24/28 (85.7%) using our own criteria, 24/28 (85.7%) using the criteria recommended by the British Prostate Group (BPG) and 15/28 (53.6%) using NPCP criteria. Stable disease was seen in 3/28 patients (10.7%) by our own or BPG criteria, and in 12/28 patients (42.9%) according to NPCP criteria. Progression of disease was measurable in 21 patients (72.4%) whatever criteria were applied; 11/29 (37.9%) have died, giving a median survival of 10 months (range 2.4–26).

Following these encouraging results, a multicentre randomised comparative study with stilboestrol 3 mg daily is being undertaken.
Surgical Approach to Inferior Vena Caval Extension of Renal Carcinoma
Authors: O'DONOHOE M. K. , FLANAGAN F. , FITZPATRICK J. M. , SMITH J. M.
Published: November 2008

Summary— Between 1979 and 1985, 10 patients were treated for renal carcinoma with extension into the inferior vena cava but without evidence of disseminated disease. Two of these had tumour thrombus extension up to the level of the hepatic veins and in four the extension was above the level of the diaphragm, two of which entered the atrium.

Thrombus was removed en bloc at radical nephrectomy. Six patients are still alive, with a mean survival of 22 months. There was no correlation between the level of tumour thrombus and perinephric extension or indeed any correlation between tumour thrombus level and overall survival. It is suggested that tumour thrombus in the inferior vena cava, in the absence of metastatic disease, should be managed by radical surgery.