bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of the nervous systems in presumptive progenetic dinophilid and dorvilleid polychaetes (Annelida) by immunohistochemistry and cLSM
Authors: Müller Monika C. M , Westheide Wilfried
Published: March 2003

Entire nervous systems of the dinophilids Dinophilus (two species) and Trilobodrilus (three species) and the dorvilleids Parapodrilus psammophilus and Ophryotrocha gracilis (larva) were stained with antisera directed against serotonin, Phe‐Met‐Arg‐Phe‐NH2 (FMRFamide) and acetylated α‐tubulin and analysed by confocal laser scanning microscopy (cLSM). Adult dinophilids and the dorvilleid larva exhibit the same structure of the ventral nerve cord, with two main nerves spaced far apart, one median and two paramedian nerves. A serotonergic plexus is situated between the paramedian nerve pair, above the ventral locomotory ciliary band. These similarities between adults and larva corroborate the presumed progenetic origin of dinophilids. However, since larval nervous systems of other polychaete taxa also seem to be organized in this way, this result cannot support the view that dinophilids originate from dorvilleids. In P.psammophilus the main nerve cords are widely separated only in the last segment, indicating that this pattern may be correlated with the absence of parapodia. The unpaired median nerve of dinophilids, P. psammophilus and many other polychaetes, is considered to be part of the basic annelid body plan. The ground pattern of the ventral paired dinophilid ganglia is represented by three (anterior, main, posterior) commissures, conserved in most of the ganglia in the Dinophilus species and mostly reduced to a main commissure in the Trilobodrilus species. The dinophilid species and P. psammophilus possess six pairs of ganglia indicating six trunk segments – in contrast to former views. The two rings behind the prostomium in both the dinophilid and the dorvilleid species contain one pair of ganglia only, corroborating the presumed homology of this peristomial region in the two taxa. The Dinophilus nervous system with 12 longitudinal nerves and three perpendicular nerve rings per segment resembles orthogonal nervous structures characteristic of platyhelminths.
On the absence of circular muscle elements in the body wall of Dysponetus pygmaeus (Chrysopetalidae, ‘Polychaeta’, Annelida)
Authors: Tzetlin Alexander B , Zhadan Anna , Ivanov Ilia , Müller Monika C. M , Purschke Günter
Published: March 2003

The annelid body wall generally comprises an outer layer of circular muscle fibres and an inner layer of longitudinal muscle fibres as well as parapodial and chaetal muscles. An investigation of Dysponetuspygmaeus (Chrysopetalidae) with confocal laser scanning microscopy showed that circular muscles are entirely absent. Further studies indicate that this feature is characteristic for all Chrysopetalidae. A scrutiny of the literature showed a similar situation in many other polychaetes. This lack of circular muscle fibres may either be due to convergence or represent a plesiomorphic character. Since circular muscles are very likely important for burrowing forms but not necessary for animals which proceed by movements of their parapodial appendages or cilia, this problem is also related to the question of whether the ancestral polychaete was epi‐ or endobenthic.
Eye morphology and optics of the double‐eyed mysid Euchaetomera typica
Authors: Gaten E. , Herring P. J. , Shelton P. M. J.
Published: March 2003

The structure and optics of the mesopelagic double‐eyed mysid crustacean Euchaetomera typica Sars, 1884 are described for the first time. The lateral eye is a typical refracting superposition eye with a wide field of view (172°) and low resolution (interommatidial angle of 7.3°). The antero‐dorsal part of the eye is elongated due to the extension of the clear zone. This dorsal eye has a restricted field of view (33°) but much higher resolution (1.5°). The dorsal eye also uses refracting superposition optics, although the optical array is unusual as many of the peripheral ommatidia lack crystalline cones. The centre of curvature of the cornea is in front of the flattened rhabdom layer whereas the axes of the crystalline cones are centred on a point about twice as deep as the rhabdom layer. This results in a well‐focused eye, free of spherical aberration. There is a remarkable similarity in eye structure between this species and some mesopelagic double‐eyed euphausiid crustaceans.
Coding errors: a comparative analysis of hospital and prospectively collected departmental data
Authors: Khwaja H.A. , Syed H. , Cranston D.W.
Published: March 2003

Objectives To assess the accuracy of a hospital coding database at a busy tertiary referral urological unit.

Methods Prospectively collected departmental coding data for all urological patients attending the Churchill Hospital, Oxford between 1 May 1999 and 30 April 2000 were compared with the coding data entered by hospital coding clerks on the Oxford Radcliffe NHS Trust database.

Results There were significant discrepancies between the number of patients on the hospital and the departmental database (639 vs 1109). There were gross procedural coding errors in 74 cases.

Conclusion Hospital‐coded data in this study were incomplete and inaccurate. This has important implications when considering the validity of hospital‐trust databases when used as a source for medical research, clinical audit and as a representation of a consultants' clinical workload.
The role of pelvic traction in the management of primary monosymptomatic nocturnal enuresis
Authors: Hussein Mohamed E.E.H.
Published: March 2003

Objective To determine whether pelvic traction is beneficial in children with primary nocturnal enuresis.

Patients and methods There can be disproportionate growth between the spinal column and neural tube in prepubertal children. The normal elongation of the vertebral column in children during sleep could stretch the filum terminale and nerve roots, representing a minor degree of tethering that affects neural function and contributes to nocturnal enuresis. Pelvic traction induces a similar or more intense stretch while a patient is fully awake (and able to control their bladder). Releasing the potential tethering in this way, combined with conditioning therapy, could be beneficial. Fifty patients (aged 7–17 years) with monosymptomatic primary nocturnal enuresis were evaluated in a prospective study. All had 10 sessions of pelvic traction applied over 4 weeks and were followed up for 3 months afterward; no other medications were given.

Results All patients had fewer wet nights, with variable degrees of success (20–80%) during and 3 months after traction.

Conclusion Pelvic traction is a safe, simple, economic and effective treatment for primary monosymptomatic nocturnal enuresis.
A randomized trial comparing the effectiveness and preference of a touch‐screen computer system with a leaflet for providing women with information on urinary symptoms suggestive of detrusor instability
Authors: Bulmer P.J. , James M. , Ellis‐Jones J. , Smith D. , Timoney A.G. , Donovan J.
Published: March 2003

Objectives To evaluate how well women learned and retained information given to them by either a leaflet or a computer‐generated information system, and which system they preferred to use for obtaining information about urinary symptoms.

Subjects and methods Forty women answered 11 questions on the aetiology, investigation and treatment of lower urinary tract symptoms. They were then randomized to use one of the information systems for 20 min, after which they answered the same urological questions. The women then crossed over to use the other information system for 20 min and afterwards completed a preference questionnaire.

Results The mean baseline scores from a possible total of 11 were 3.9 and 4.3 for the computer and leaflet groups, respectively. The mean improvements in scores were 3.6 (P < 0.001) and 2.8 (P < 0.001) for the computer and leaflet groups, respectively. Both information systems were well liked by all of the women and 26 (65%) said they would prefer to use a computer‐generated system in the future if given a choice.

Conclusions Women significantly increased their knowledge of urinary problems after using a computer‐generated information system or a leaflet. Although there were few subjects, there appeared to be a trend for the computer system to be both better liked and slightly more effective.
Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study
Authors: Ficarra V. , Porcaro A.B. , Righetti R. , Cerruto M.A. , Pilloni S. , Cavalleri S. , Malossini G. , Artibani W.
Published: March 2003

Objective To assess the results of our experience in correcting primary varicocele using a modified technique of antegrade scrotal sclerotherapy.

Patients and methods From December 1997 to February 2000, 201 patients with primary varicocele underwent antegrade scrotal sclerotherapy. Before treatment all patients were evaluated by a physical examination, colour Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography. Sperm samples were analysed only in patients aged > 18 years. The treatment was administered using a special venous catheter system with a Y‐adapter. Complications after treatment and the rate of persistence of reflux were assessed 3 and 6 months after the antegrade scrotal treatment, by clinical examination and colour‐Doppler ultrasonography of the spermatic cord.

Results The mean operative duration was 15 min; there were no significant complications during treatment and all patients were discharged within 4 h. Complications after treatment occurred in 10 of the 201 patients (5%); four patients had epididymo‐orchitis, three a scrotal haematoma, one a surgical wound infection, one persistent scrotal pain and one persistent flank pain on the same side as the surgery. Reflux was persistent in 12 patients (6%).

Conclusions Antegrade scrotal sclerotherapy is a simple, minimally invasive and highly effective technique for blocking spermatic vein reflux, with a low rate of complications. The technical changes simplified the cannulation of the spermatic vein and facilitated antegrade phlebography and sclerotherapy using the air‐block technique.
The ability of the American Joint Committee On Cancer Staging system to predict progression‐free survival after radical prostatectomy
Authors: May F. , Hartung R. , Breul J.
Published: March 2003

Objective To examine, in a retrospective analysis of outcome based on prostate‐specific antigen (PSA) levels, whether the 1992 and revised 1997 staging criteria for prostate cancer can be used to predict progression‐free survival for patients after radical prostatectomy for pT2 and pT3 prostate cancer.

Patients and methods In all, 291 patients with a PSA determination during a 6‐month interval after radical prostatectomy were analysed (mean follow‐up 5.2 years). In the absence of a uniform system of pathological staging, the histopathological stage was defined according to the 1992 and 1997 American Joint Cancer Committee/Union Internationale Contre le Cancer (AJCC/UICC) tumour‐nodes‐metastases (TNM) staging classification. Findings were correlated with the PSA value after surgery. The subgroups of pT2 and pT3 disease were compared for the time to PSA progression, using Kaplan‐Meier data analysis and the log‐rank test.

Results The biochemical progression‐free 5‐year survival rates for stage pT2 were 83% (pT2a), 81% (pT2b) and 62% (pT2c); there were no significant differences in the pT2 subgroups. The recurrence‐free rates for pT3 were 79% (pT3a), 65% (pT3b) and 50% (pT3c); the actuarial recurrence‐free rate was significantly different for patients with 1997 AJCC pT3a vs pT3b disease (P = 0.0132). There was no significant difference in the 1992 AJCC stages pT2a vs pT2b (P = 0.1232) and the recurrence‐free rate was not significantly different for patients with 1992 AJCC pT3a vs pT3b disease (P = 0.9). There was a significant difference in the likelihood of a PSA relapse between patients with positive and negative surgical margins (P = 0.131).

Conclusion These results support the current revised 1997 AJCC/UICC staging system for prostate cancer. There is an urgent need to develop a pathological equivalent to the AJCC/UIC TNM clinical staging system. Greater clinical input and evaluation from different institutions are essential to reach consensus on pathological staging categories that maximize the predictability of outcome after definitive therapy. Crucial issues are the definition and quantification of extraprostatic extension and definition of surgical margin categories.
(L)‐2‐oxothiazolidine‐4‐carboxylate in the treatment of primary hyperoxaluria type 1
Authors: Holmes R.P. , Assimos D.G. , Wilson D.M. , Milliner D.S.
Published: March 2003

Objective To evaluate the short‐term efficacy of (l)‐2‐oxothiaolidine‐4‐carboxylate (OTZ, which reduces urinary oxalate excretion in normal subjects) in the treatment of primary hyperoxaluria type 1 (PH1) in a phase II study.

Patients and methods Two patients with PH1 received intravenous infusions of OTZ (100 mg/kg body weight for 2 h) given every 8 h for four doses. One patient also received a placebo treatment. Urine samples (24‐h collections) were obtained before and during OTZ treatment and assayed for oxalate, citrate, creatinine, sulphate and pH. Daily blood samples were assayed for plasma oxalate and serum creatinine.

Results Urinary oxalate excretion was unaffected by OTZ treatment. Plasma oxalate declined in both individuals with OTZ treatment, but the effect was small. Plasma cysteine was normal in one patient, rising from a mean (sd) of 36 (3.7) µmol/L before treatment to a peak of 141 µmol/L after OTZ, but was not detected in samples from the other patient. The ratio of oxalate to creatinine clearances was high in both patients, with mean values of 3.1 and 3.8.

Conclusions Treatment with OTZ did not lead to clinically significant changes in urinary oxalate excretion. The high clearance of oxalate in these patients suggests a substantial renal secretion of oxalate.
Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis
Authors: Kawauchi A. , Imada N. , Tanaka Y. , Minami M. , Watanabe H. , Shirakawa S.
Published: March 2003

Objective

To evaluate the mechanism of the dysfunction of arousal in patients with Type I and Type IIa enuresis.

Patients and methods

The numbers of sleep spindles and delta waves were analysed during electroencephalography in 19 patients with enuresis (17 male, two female, mean age 9.7 years, range 8–14).

Results

In four patients with Type I enuresis, who awoke spontaneously and remained dry as a result of urinary sensation, the numbers of sleep spindles and delta waves diminished gradually and finally disappeared just before the patients awoke completely. In the remaining nine patients with Type I enuresis, there was no decrease in the number of sleep spindles and delta waves, and enuresis occurred without the subjects awakening. In the six patients with Type IIa enuresis, there was no arousal reaction or generation of sleep spindles on urination while asleep.

Conclusions

An immaturity in the function of the thalamus might be a cause of the arousal dysfunction in patients with Type I enuresis. In Type IIa enuresis, a possible abnormal or immature arousal mechanism in the pons or the lower tract may be responsible.
Transitional cell carcinoma in renal transplant recipients: the influence of compound analgesics
Authors: Swindle  , Falk  , Rigby  , Petrie  , Hawley  , Nicol
Published: March 2003

Objectives

 To determine the incidence of transitional cell carcinoma (TCC) in a renal transplant population and to compare the pattern of neoplasia in patients with analgesic nephropathy (AN) with that in other patients.

Patients and methods

Using the Australia and New Zealand Dialysis and Transplant Registry, renal transplant recipients of the Princess Alexandra Hospital with TCC were identified. They were separated into two groups based on their primary disease, i.e. AN (group 1) and other causes of renal failure (group 2). The age at diagnosis of TCC, site, grade, stage of TCC and outcome were then compared between the groups.

Results

There were 250 (15%) patients in group 1 and 1424 (85%) in group 2; seven patients in each group were found to have TCC, which thus occurred more frequently in the AN group (2.8%) than in group 2 (0.49%). In group 1, five patients died, four from metastatic disease; of these, the mean time from transplantation to diagnosis of the initial tumour was 4.4 years, with a mean time from diagnosis to death of 9 months. In contrast, there were no deaths from metastatic disease in group 2. In group 1, all patients had upper tract tumours, with five patients also having bladder involvement. The upper tract tumours tended to be of a high stage and grade (grade II–III) and were aggressive. In group 2, all the tumours were confined to the bladder and tended to be of low stage and grade (grade I–II Ta).

Conclusions

Patients undergoing renal transplantation as a result of AN are at high risk of developing TCCs of the upper urinary tracts. These tumours tend to be of a high grade and stage and the patients have a poor outcome. Screening with urine analysis and voided urine cytology do not appear to be reliable for the early diagnosis of upper renal tract TCCs in the renal transplant patient. We advocate annual cystoscopy and retrograde ureteric catheterization with washings, brushings and radiological imaging to diagnose upper tract TCCs at an early stage. These patients should also be screened before transplantation using the same technique.
Structural and ultrastructural changes in ileal neobladder mucosa: a 7‐year follow‐up
Authors: Aragona  , De Caro  , Parenti  , Artibani  , Bassi  , Munari  , Pagano
Published: March 2003

Objective

 To investigate the long‐term morphological changes in the intestinal segment used to create an orthotopic ileal neobladder.

Materials and methods

 Periodic endoscopy with biopsy of the ileal mucosa was performed in 90 patients 3–84 months after radical cystectomy and urinary diversion via an orthotopic neobladder. Three cold‐cup biopsies were taken from each patient and mucosal specimens processed for light and electronic microscopy.

Results

 Early changes (up to 1 year after surgery) comprised a marked shortening of the villi with loss of microvilli. After 4 years, the prevalent finding was of flat, avillous epithelium that tended to stratify in some areas. The avillous areas were mixed with islets of villous mucosa. There was no dysplasia or malignancy in any of the 90 patients.

Conclusions

 Prolonged contact with urine elicited a biphasic response in the ileal mucosa, i.e. an early inflammatory phase, ascribed to the noxious action of urine, followed by a regressive phase in which the epithelium tended to assume a morphology similar to the urothelium. The atrophic changes were almost totally completed after 4 years, although areas with marked modifications alternated with others where the morphology was normal, even many years after surgery. Late changes in the ileal neobladder mucosa appear to be an expression of a functional adaptation of the mucosa to the new environment.
An animal model for the neuromodulation of neurogenic bladder dysfunction
Authors: Zvara  , Sahi  , Hassouna
Published: March 2003

Objective

 To develop an animal model to examine the pathophysiology by which S3 sacral root electrostimulation alters the micturition reflex in patients with bladder hyper‐reflexia.

Materials and methods

 Chronic sacral nerve root electrostimulation was applied to spinally transected rats; 21 animals were divided into four groups. The spinal cord was completely transected at the T10–11 level and stainless‐steel electrodes implanted into the sacral foramen in 17 animals; these animals were subsequently divided into two groups (1 and 2). Six rats in group 1 underwent sacral root electrostimulation for 2 h/day and five in group 2 for 6 h/day, for 21 days. The sham group (group 3, six rats) received no stimulation and four rats were used as healthy controls (group 4). Voiding frequency was recorded and each animal was evaluated cystometrically at the end of the stimulation period. The results were compared with the sham and control groups.

Results

 Spinal cord transection resulted in bladder areflexia and complete urinary retention; 7–9 days after the injury, the bladder recovered its activity. Twenty‐one days after transection all animals had evidence of uninhibited bladder contractions. The mean (sd) hourly frequency of urination was 0.66 (0.18) in healthy controls, 0.83 (0.21) in group 1, 0.87 (0.34) in group 2 and 1.1 (0.31) in group 3. There was a significant decrease in the cystometric signs of bladder hyper‐reflexia in groups 1 and 2 when compared with group 3.

Conclusions

 This work reports an initial study showing that chronic electrostimulation of sacral nerve roots can reduce the signs of bladder hyper‐reflexia in the spinally injured rat. To our knowledge, this is the first report describing the rat as an animal model to determine the effects of chronic electrostimulation on the micturition reflex.
Prolonged increase in micturition threshold volume by anogenital afferent stimulation in the rat
Authors: Jiang  , LindstrÖM
Published: March 2003

Objective

 To investigate whether anogenital afferent stimulation induces a prolonged increase in the micturition threshold volume of anaesthetized rats.

Materials and methods

 Thirteen female rats, anaesthetized by α‐chloralose and paralysed by pancuronium bromide were used for the experiments. The micturition threshold volume was determined by repeated cystometry. In two experiments, afferent activity was recorded from the exposed pudendal nerve; vaginal and anal afferents were stimulated electrically by ring electrodes. In one experiment, the dorsal clitoris nerves were exposed bilaterally and mounted for electrical stimulation. The afferents were stimulated continuously for 5 min at 10 Hz, using unipolar cathodic pulses of 0.5 ms duration with an amplitude of 10 mA (or 0.8 mA for the dorsal clitoral nerves).

Results

 Anogenital stimulation for 5 min induced a significant and prolonged increase in the micturition threshold volume (from a median value of 0.35 mL before to 0.45 mL after stimulation; P<0.01). The increase in threshold volume was maintained for about 40 min after the end of stimulation. There was no obvious difference in effect between the stimulation sites nor with direct dorsal clitoral nerve stimulation. Neither the micturition threshold pressure nor the maximal contraction pressure were altered by stimulation. No tonic afferent after‐discharge could be detected in the pudendal nerve recordings.

Conclusions

 Artificial electrical stimulation of anogenital afferents induced a prolonged increase in the micturition threshold volume of anaesthetized rats. The change presumably involved the modulation of the synaptic transmission in the central micturition reflex pathway. It is proposed that the observed change represents the first step in the curative ‘re‐education’ process induced in patients with urge incontinence by electrical stimulation of anovaginal afferents.
The significance of lymphadenectomy in transitional cell carcinoma of the upper urinary tract
Authors: Miyake  , Hara  , Gohji  , Arakawa  , Kamidono
Published: March 2003

Objective

 To determine the efficacy of lymphadenectomy after nephroureterectomy in patients with transitional cell carcinoma (TCC) of the upper urinary tract.

Patients and methods

 Between January 1986 and December 1995, 72 patients (mean age 67 years, range 45–82) underwent nephroureterectomy for primary TCC of the upper urinary tract. In 35 patients, a lymphadenectomy was also performed. The clinicopathological data were analysed retrospectively, focusing on the significance of lymphadenectomy.

Results

 Lymph vessel invasion was found in 28 patients and its incidence was closely correlated with both tumour grade and pathological stage. Of the 35 patients who underwent lymphadenectomy, lymph node metastases were found in 13 patients, all of whom had lymph vessel invasion. There was no significant difference in the survival rate between patients with and without lymphadenectomy; however, among the 44 patients with no lymph vessel invasion, the survival rate of those with lymphadenectomy was significantly higher than in those without (P<0.05).

Conclusion

 Lymphadenectomy may provide a therapeutic advantage in patients with upper urinary tract TCC and no lymph vessel invasion. However, patients with lymph vessel invasion seem to have systemic disease; therefore, aggressive systemic adjuvant therapies rather than regional lymphadenectomy should be applied in these patients.
Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy
Authors: Dalbagni  , Zhang  , Lacombe  , Herr
Published: March 2003

Objective

 To evaluate our experience with primary carcinomas of the female urethra, by analysing the impact of tumour variables and treatment on overall, disease‐specific, local recurrence‐ and metastasis‐free survival.

Patients and methods

 Between 1958 and 1994, 72 women (median age 60 years, mean 59, range 21–84) with primary urethral carcinoma were identified. They were followed for a median (range) of 85 (0–384) months. The patients were stratified by stage, nodal status, histology, treatment, type of surgery, site of disease, year of diagnosis and smoking habit.

Results

 In a univariate analysis, stage, nodal status, type of surgery and site of the disease were important factors for survival and recurrence. In a multivariate analysis, primary stage, nodal status and site of disease were independent predictors of survival.

Conclusion

 Current modalities of treatment are ineffective for local control and survival; new treatment strategies are needed for female urethral cancers.
The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners
Authors: Williams  , Abbou  , Amar  , Desvaux  , Flam  , Lycklama À Nijeholt  , Lynch  , Morgan  , MÜller  , Porst  , Pryor  , Ryan  , Witzsch  , Hall  , Place  , Spivack  , Todd  , Gesundheit
Published: March 2003

Objective To evaluate the impact of treatment for erectile dysfunction on the quality of life of men and their partners.

Patients and methods The study included 249 men with organic erectile dysfunction of more than 3 months’ duration who self‐administered transurethral alprostadil in an open‐label, dose‐escalating manner in an outpatient medical setting. Patients with a sufficient response (159) were randomly assigned in a double‐blind protocol to either active medication or placebo for 3 months at home. Patients and partners each completed quality‐of‐life questionnaires before and after treatment.

Results In the clinic 159 of the 249 men (64%) had an erection sufficient for intercourse when using transurethral alprostadil. At home, 46 of 67 men (69%) reported intercourse at least once on transurethral alprostadil, compared with eight of 73 (11%) on placebo (P<0.001). Patients on alprostadil showed a 34% improvement in their ‘relationship with partner’, a 5% improvement in ‘personal wellness’, and a 71% improvement in ‘quality of erection’ domains, compared with a decline of 11%, 8% and 1%, respectively, in patients on placebo (P<0.005 for each comparison). Partners of patients on alprostadil showed a 35% improvement in the ‘relationship with partner’ domain, compared with a 12% improvement in the placebo group (P=0.028). There was a trend toward improvement in other partner domains. Urogenital pain was reported by 14% of patients during home treatment.

Conclusion The resumption of sexual intercourse with the use of transurethral alprostadil was accompanied by an improvement in several important quality‐of‐life domains in patients and their partners.
The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography‐guided biopsy of the prostate: a prospective randomized placebo‐controlled study
Authors: Desgrandchamps  , Meria  , Irani  , Desgrippes  , Teillac  , Le Duc
Published: March 2003

Objective

To evaluate the effect of the rectal administration of lidocaine gel on the tolerance of systematic sextant transrectal ultrasonography (TRUS)‐guided prostatic biopsies.

Patients and methods

From January to September 1997, patients undergoing initial biopsy mapping of the prostate (with six systematic TRUS‐guided transrectal biopsies) were randomized using a pre‐established randomization list into two groups. In group 1, 15 mL of 2% lidocaine gel (Astra, Södertälje, Sweden) was administered intrarectally 15 min before the biopsies. In group 2 (placebo), 15 mL of trans‐sonic hydrophilic gel (Rivadis Laboratory, Thouars, France) was administered transrectally under the same conditions. Patients were randomized and the gel administered by a nurse; neither the patients nor the urologists were aware of which product was administered. At the end of the procedure, patients were asked to score the severity of discomfort of the biopsies, using a self‐administered rating scale.

Results

In all, 109 patients were included, in either group 1 (56 patients) or group 2 (53 patients). Slight pain or no pain was experienced by the vast majority of patients in both groups. Moderate to severe pain was experienced in 12.5% of patients in group 1 and 11.3% of patients in group 2. There was no difference in patient tolerance between the groups (P=0.39). Only minor complications occurred and complication rates were not significantly different between the groups.

Conclusion

The rectal administration of lidocaine has no impact on the tolerance to prostatic biopsy.
Uric acid‐binding proteins in calcium oxalate stone formers and their effect on calcium oxalate crystallization
Authors: Kalaiselvi  , Udayapriya  , Selvam
Published: March 2003

Objectives

To study the effect of urinary uric acid‐binding proteins of controls and stone formers on calcium oxalate crystal nucleation and aggregation.

Materials and methods

Urine samples were collected over 24 h from 20 stone formers and from 20 age‐matched normal controls. Uric acid crystallization was induced by adding equal volumes of 2.5 mmol/L uric acid. The bound proteins were separated on a cellulose column, and by sodium dodecyl sulphate‐polyacrylamide gel electrophoresis. The effect of the separated fractions on calcium oxalate crystal nucleation and aggregation was assessed.

Results

The protein bound to unit mass of uric acid crystals was higher in hyperoxaluric urine than in control urine. On cellulose‐column separation, the uric acid‐crystal binding proteins produced three major protein peaks, i.e. fraction I (buffer), fraction II (0.05 mol/L sodium chloride in Tris‐HCl buffer) and fraction III (0.3 mol/L sodium chloride in buffer), with a minor peak obtained on elution with increasing concentrations of sodium chloride in Tris‐HCl buffer (pH 7.0). Fraction I derived from either stone formers or controls promoted calcium oxalate crystallization. Fraction II from the control samples was a strong inhibitor, whereas hyperoxaluric fraction II was less inhibitory.

Conclusion

Uric acid‐binding proteins isolated either from the urine of stone formers or controls modulated calcium oxalate crystal growth. Proteins isolated from stone formers were less inhibitory of crystal nucleation and aggregation. These proteins may act as a bridge, leading to the epitaxial deposition of calcium oxalate over a urate core.
The free‐to‐total serum prostatic specific antigen ratio as a predictor of the pathological features of prostate cancer
Authors: Morote  , Encabo  , Lopez  , De Torres
Published: March 2003

Objectives

To analyse the role of the ratio of serum free (f) to total (t) prostatic specific antigen (f/tPSA) as a predictor of the pathological features in patients with clinical stage T1c disease submitted for radical prostatectomy.

Patients and methods

Total and fPSA were determined before surgery in 76 consecutive patients with clinical stage T1cN0M0 disease and a serum tPSA level of 4–20 ng/mL. The pathological stage was defined as organ‐confined in 47 (62%), with capsular penetration in 27 (35%) and seminal vesicle infiltration in two (3%). In 18 of the specimens (24%) the surgical margins were positive. The pathology was favourable in 41 patients (55%). Total and fPSA were determined using the Tandem and Tandem‐free PSA immunoassays (Hybritech Inc, Belgium)

Results

The mean tPSA was: 8.7 ng/mL when the tumour was organ‐confined and 8.6 ng/mL when the disease was extraprostatic (P>0.05); 8.4 ng/mL when the tumour was specimen‐confined and 9.3 ng/mL when positive margins or seminal vesicle involvement were detected (P>0.05); and 8.3 ng/mL when the pathology was favourable and 9.0 ng/mL when unfavourable (P>0.05). The f/tPSA was 11.8% when the tumour was organ‐confined and 9.1% when it was not (P<0.03), 11.9% when the tumour was specimen‐confined and 7.6% when not (P<0.002) and 12.1% when the pathology was favourable and 9.1% when unfavourable (P<0.008). A threshold of 11% f/tPSA provided an odds ratio for organ‐confined disease of 2.7, for specimen‐confined disease of 7.6 and for a favourable pathology of 3.9.

Conclusion

The f/tPSA seems to provide useful information in the prediction of the pathological features of patients with clinical T1c prostate cancer and a tPSA of 4.1–20 ng/mL.
Urinary continence and erectile function after bladder neck sling suspension in male patients with spinal dysraphism
Authors: Dik  , Van Gool  , De Jong
Published: March 2003

Objective

To assess the outcome of using sling suspensions combined with clean intermittent catheterization (CIC) in patients with spina bifida, of whom a third are incontinent through pelvic floor paralysis.

Patients and methods

Between March 1992 and April 1997, 14 male patients (mean age at surgery 11.7 years, range 6.5–15.2) with spina bifida and neurogenic sphincter incontinence underwent a puboprostatic sling suspension as a primary treatment. The procedure, via an abdominoperineal approach, consists of suspending the bladder neck by placing a simple U‐shaped rectus abdominus fascial sling. The perineal approach is used to develop the plane between the rectum and Denonvillier’s fascia, and to prepare the passage of the sling alongside the prostate. Apart from the sling procedure, eight of the 14 patients underwent autoaugmentation of the bladder and two underwent ileocystoplasty during the same operation. All patients used CIC daily. Erectile function was assessed by reports from the patients and their parents, and continence by report and urodynamic studies.

Results

Of the 14 patients, 13 achieved urinary continence with no additional procedures; one required a subsequent submucosal injection at the suspension site with silicone particles in povidone (Macroplastique® ) to become continent. Two patients reported slight leakage at night. Before surgery, all but one patient reported having spontaneous or mechanically manipulated erections; none had erections on psychological stimulation. After surgery, erectile function was preserved in 13 of the 14 patients; in one there were problems establishing the right dissection plane between the rectum and prostate, but spontaneous erections returned a year after surgery.

Conclusion

In males, the abdominoperineal puboprostatic sling suspension using rectus abdominis fascia appears to be a successful treatment for sphincter incontinence in patients with spina bifida, and safely maintains erectile function.
Complications of the preputial island flap‐tube urethroplasty
Authors: Elbakry
Published: March 2003

Objective

To report the long‐term results of hypospadias repair using tubularized transverse preputial island flaps.

Patients and methods

Seventy‐four patients (mean age 7 years, range 2–19) underwent a transverse preputial island flap‐tube repair for hypospadias. All patients had chordee, 14 had anterior, 41 mid‐penile and 19 penoscrotal hypospadias. The mean (range) follow‐up was 43 (14–77) months and the outcome assessed by function and cosmesis.

Results

The repair was functionally and cosmetically successful in 43 patients (58%) as a single‐stage repair. Necrosis and sloughing of the neourethra occurred in five patients (7%), urethrocutaneous fistula in 17 (23%), strictures in seven (9%), diverticula in three (4%) and insignificant urethral misalignment was detected by urethrography in three (4%); thus the overall complication rate was 42%. All of these complications were treated successfully in one or two re‐operations.

Conclusions

The transverse preputial island flap‐tube repair of hypospadias is a demanding technique. Even in experienced hands it has a relatively high complication rate. Every effort should be made to preserve the urethral plate during orthoplasty, minimizing the need to use tubularized preputial island flaps and expanding the application of onlay procedures.
Developmental factors of urethral human papillomavirus lesions: correlation with circumcision
Authors: Aynaud  , Piron  , Bijaoui  , Casanova
Published: March 2003

Objective

To assess the relationship between circumcision and urethral human papillomavirus (HPV) lesions, and the influence of urethritis on the development of urethral HPV infections on inducing squamous metaplasia of the urethral epithelium.

Patients and methods

The study included 210 heterosexual, HIV‐negative men (median age 29 years) who all had female partners with genital HPV infection. The patients were divided into three groups according to clinical findings, i.e. 97 patients with no clinical HPV lesions on peniscopy and urethroscopy, 70 patients with balanopreputial lesions but no urethral lesions, and 43 patients with urethral HPV lesions, including 17 who had associated penile lesions. They all underwent meatopeniscopy for HPV screening, urethral biopsy for histological analysis, and bacterial cultures were taken. The results in each subgroup were compared between circumcised and uncircumcised men.

Results

There was no significant difference in the incidence of HPV infection (58% vs 42%, odds ratio, OR, 1.8; 95% confidence interval, CI, 0.98–3.62) between uncircumcised and circumcised men, but this relationship differed with the developmental site of HPV lesions (shaft‐foreskin, P<0.02; urethra, not significant). There was also a significant difference in the prevalence of urethritis between uncircumcised and circumcised men (34.5% vs 19%, OR 2.35, 95% CI 1.08–5.11), and between HPV‐infected and uninfected men (41.5% vs 18%, OR 3.17, 95% CI 1.71–5.83). This positive relationship of the prevalence of urethritis for both factors (circumcision and HPV) depended on the type of organism (sexually transmitted disease, not significant; common organism, P<0.02). The frequency of urethritis was related to the site of HPV lesions; urethritis was present in 36% of the patients with preputial HPV lesions, compared with 51% of those with urethral HPV lesions. Chlamydia trachomatis was detected in 1% of the patients without and in 7% of those with HPV lesions. In 68% of the patients, histological analysis of the urethral mucosa showed a squamous metaplasia of the urethral epithelium associated with urethritis.

Conclusions

Being uncircumcised did not seem to increase the risk of HPV urethral infection in young men. Genital bacterial infections and urethral HPV lesions appear to be linked. Urethritis can induce squamous metaplasia of the urethral epithelium, which appears to favour the colonization of the anterior urethra by HPVs.
Symptom characteristics and the development of tolerance with time in patients with indwelling double‐pigtail ureteric stents
Authors: Irani  , Siquier  , Pirès  , Lefebvre  , Doré  , Aubert
Published: March 2003

Objective

To determine the symptoms of and factors predicting the tolerance to double‐pigtail ureteric stents, and the development of tolerance with time.

Patients and methods

The study included 39 patients (median age 49.0 years, range 26–74; 24 men and 15 women) who were treated in our department for ureteric obstruction caused by benign conditions, excluding pregnancy and associated open surgery. All patients received a polyether‐urethane double‐pigtail ureteric stent (7 F, 28 cm long). Tolerance to the procedure was assessed using a questionnaire and a 10‐cm linear visual analogue scale (VAS) at 24 h and again one week after placement, and on the day before stent removal.

Results

From the end of the first week to before removal of the stent, fewer patients reported dysuria, haematuria and having recourse to painkillers than during the first week. However, analysis of variance for repeated measures showed no significant difference between the VAS scores for first day, the first week and the day before removal, either overall or stratified by gender (P=0.15). A factorial analysis of variance analysing the VAS score for the first week as a function of gender, age and type of occupation (sedentary or mobile occupation) showed a significant effect only for gender (P=0.005) and gender‐age interaction (P=0.02): VAS scores were higher in men and particularly in younger men.

Conclusion

Almost all patients with short‐term placement of indwelling double‐pigtail ureteric stents have untoward symptoms. Although some symptoms, e.g. dysuria and haematuria, significantly improve with time, the general tolerance remains unchanged. Tolerance in men, and particular in younger men, was significantly poorer.
The long‐term culture of porcine urothelial cells and induction of urothelial stratification
Authors: Ludwikowski  , Zhang  , Frey
Published: March 2003

Objective

To assess porcine urothelial cell cultures and the in vitro induction of urothelial stratification in long‐term cultures, to study their morphological, functional and genetic behaviour, and thus provide potential autologous urothelium for tissue‐engineered substitutes for demucosalized gastric or colonic tissue.

Materials and methods

Primary cultures of porcine urothelium were established and the cells passaged thereafter. Cell specificity was confirmed by cytokeratin analysis, cell membrane stability assessed using lactate dehydrogenase leakage, cell de‐differentiation by γ‐glutamyl transferase activity and genomic stability by karyotype investigations. Histology and scanning electron microscopy were performed to study the cultured cells and the stratified constructs. Furthermore, collagen matrices were tested as cell scaffolds.

Results

The cells were cultured for 180 days; 10 subcultures were established during this period. Stratification was induced in a culture flask and on a collagen matrix. Cytokeratins 7, 8, 17 and 18 were expressed in all cultures, and cell membranes were stable, with no evident de‐differentiation. The cultures were stable in their genotype and no chromosomal aberrations were found. The histology and immunohistochemistry of the stratified porcine constructs, and cell membrane stability and cell de‐differentiation, were compared with those in the human system.

Conclusion

Pig and human urothelial cells can be cultured over a long period with no signs of senescence. Urothelial stratification can be induced in vitro. The collagen matrix seems to be an excellent scaffold, allowing cell adherence and growth.
Pharmacological and urodynamic changes in rat urinary bladder function after multiple pregnancies
Authors: Grandadam  , Lluel  , Palea  , Martin
Published: March 2003

Objective

 To investigate the changes in bladder function after multiple pregnancies and parturition in rats, and to establish links between the changes in voiding profiles and in vitro pharmacological responses.

Materials and methods

 Cystometry was used in conscious virgin and multiparous female Wistar rats (2 weeks after the last parturition) with chronically implanted lines to continuously record bladder pressure during five reproducible voiding cycles. In vitro, detrusor muscle contractile responses induced by cumulative concentrations of KCl, carbachol, noradrenaline and α,β‐methylene‐ATP (mATP) were compared.

Results

 In multiparous rats, there was a significant increase in the amplitude of voiding pressure (+31%), bladder capacity (+83%) and residual volume (about threefold); 60% of the multiparous rats but only 10% of the virgin rats showed bladder instability during the filling phase. Cumulative concentration‐response curves to KCl, expressed as the tension developed vs tissue weight, were identical in the two groups of rats. Contractile responses induced by carbachol (0.1–30 μmol/L) were significantly larger in multiparous than in virgin rats. Similarly, noradrenaline‐induced contractions (0.3–10 μmol/L) were significantly higher for multiparous animals. However, the sensitivity of the detrusor muscle to mATP was not modified by multiple pregnancies.

Conclusion

 After multiple gestations, female rats develop bladder hypertrophy, bladder instabilities and a higher amplitude of voiding pressure associated with an increased residual volume. These altered patterns are similar to those found in rats after chronic infravesical outlet obstruction. We propose that pregnancies and parturition modify urinary bladder function, leading to a dysfunction similar to that induced by obstruction, and involving an increased sensitivity to adrenergic and cholinergic stimulation.
A comparison of the sperm mixed‐agglutination reaction test with the peroxidase‐labelled protein A test for detecting antisperm antibodies in infertile men with varicocele
Authors: Isitmangil  , Yildirim  , Orhan  , Kadiogˇlu  , Akinci
Published: March 2003

Objective

 To compare the sperm mixed‐agglutination reaction (sMAR) with the peroxidase‐labelled protein A method (POPA) in infertile patients with varicocele.

Patients, subjects and methods

The study comprised 30 men with a history of varicocele‐associated infertility and 30 fertile men (control group). Antisperm antibodies against spermatozoa in the semen and against progenitor spermatozoa in testicular tissue were detected using the two methods.

Results

The tests were positive in 15 (50%) of patients with both the sMAR and the POPA methods, while no autoantibodies were detected in the control group. There were no significant differences between the methods. The sensitivity and specificity of both tests was ≈93%, with no significant difference between them (P>0.05).

Conclusion

Both methods may be used for detecting sperm autoantibodies in infertile patients with varicocele.