bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeat testing for haematuria and underlying urological pathology
Authors: LYNCH T. H. , WAYMONT B. , DUNN J. A. , HUGHES M. A. , WALLACE D. M. A.
Published: November 2008

Objective To assess the incidence of urological pathology in a group of patients referred for the investigation of haematuria and whose symptoms had resolved at the time of investigation.

Patients and methods The results from examination of 395 patients attending for investigation of haematuria were analysed. The group comprised 198 men and 197 women with a mean age of 51 years (range 19–73).

Results In 220 patients (56%) no evidence of haematuria was detected despite its diagnosis in all patients at the time of referral. One‐hundred and thirteen patients (51%) without detectable haematuria had urological pathology and 16 of these (14%) had an underlying malignancy in the urinary tract.

Conclusion Repeat urine analysis to determine whether haematuria persists has been considered as a way to define a high risk group which requires urgent investigation. Our results clearly indicate that the finding of haematuria, even in one urine specimen, warrants full urological assessment.
Transrectal ultrasonography to assess local extent of prostatic cancer before radical prostatectomy
Authors: RØRVIK J. , HALVORSEN O. J. , SERVOLL E. , HAUKAAS S.
Published: November 2008

Objective To evaluate transrectal ultrasonography (TRUS) with a 7 mHz rotating probe as a staging procedure in 33 patients with localized prostatic carcinoma.

Patients and methods The ultrasound scans were compared to histopathological whole‐mount step sections of the surgical specimens. Twenty‐five of the patients had tumours with pathological stage T3 (pT3) and eight had tumours with stage pT2 giving a prevalence of extracapsular growth of 0.76.

Results The overall sensitivity, specificity, positive and negative predictive values for detection of extracapsular tumour growth by TRUS of prostatic cancer were found to be 0.68, 0.63, 0.85 and 0.38, respectively. Six tumours showed solely microscopic foci of extracapsular tumour growth.

Conclusion This technique gives a high percentage of both understaging (32%) and overstaging (37%) and therefore TRUS is an unreliable tool in the staging protocol prior to radical prostatectomy.
Role of penile vascular injury in erectile dysfunction after radical prostatectomy
Authors: ABOSEIF S. , SHINOHARA K. , BREZA J. , BENARD F. , NARAYAN P.
Published: November 2008

Objective To investigate the cause of erectile dysfunction after nerve‐sparing radical prostatectomy for clinically localized adenocarcinoma of the prostate (stage A or B).

Patients and methods Erectile function was evaluated in 20 patients, mean age 65 years (range 44–74), both pre‐operatively and 1 year after surgery by intracavernosal injection of a vasoactive agent (papaverine hydrochloride or prostaglandin E1) and pulsed Doppler ultrasonography. The degree of erection, the size of the cavernosal artery and penile arterial blood flow velocity were assessed

Results Results revealed that the decreased response to intracavernosal injection of a vasoactive agent was associated with a significant reduction in both the diameter and velocity of blood flow within cavernosal arteries in 40% of patients after surgery. The pathological stage of the tumour did not correlate with the degree of vascular injury.

Conclusion We conclude that post‐prostatectomy impotence is multifactorial but vascular injury plays a substantial role.
Xanthogranulomatous pyelonephritis in childhood: pre‐operative diagnosis is possible
Authors: HAMMADEH M.Y. , NICHOLLS G. , CALDER C.J. , BUICK R.G. , GORNALL P. , CORKERY J. J.
Published: November 2008

Objective To diagnose xanthogranulomatous pyelonephritis (XGP) in childhood pre‐operatively.

Patients and methods Eleven cases of XGP presenting to Birmingham Children's Hospital over a 10‐year‐period are reported. Nine (82%) were diagnosed pre‐operatively on the clinical and radiological findings.

Results The characteristic clinical findings were urinary tract infection (9 cases), palpable renal mass (8 cases) and anaemia (8 cases). The most common radiological findings were enlarged kidney (9 cases), renal calculi (7 cases) and non‐functioning kidney (6 cases). Renal ultrasound typically demonstrated a central echoic area (6 cases) and multiple hypoechoic areas in the parenchyma (7 cases). A computed tomography (CT) scan was performed in three cases. This showed characteristic multiple, low attenuation, unenhanced areas within the parenchyma with extension of the inflammatory process into peri‐nephric fat (two cases). Ten cases (91%) were of the diffuse type. There was extension into the peri‐nephric fat in eight cases (73%). Three cases (27%) were associated with congenital urological abnormalities. Nephrectomy was performed in 10 cases and a partial nephrectomy in one.

Conclusion XGP is uncommon in childhood but should always be considered in the differential diagnosis of renal masses, especially in the presence of anaemia. Nephrectomy usually results in a permanent cure.
The significance of vesicoureteric reflux on kidney development assessed by dimercaptosuccinate renal scintigraphy
Authors: WALLIN L. , BAJC M.
Published: November 2008

Objective To study the influence of vesicoureteric reflux on kidney parenchyma and renal length, and identify typical distribution patterns by dimercaptosuccinate (DMSA) renal scintigraphy.

Patients and methods DMSA renal scintigraphies in 101 children (152 renal units) with vesicoureteric reflux grade 1–5 were reviewed.

Results Three main types of pathological DMSA patterns were found: (i) dysplasia; (ii) medial defect; and (ill) pole defects. In children with no history of pyelonephritis a normal distribution pattern was found in 31%, dysplasia in 23%, medial defect in 25%, pole defects in 17% and no typical pattern in 4%. In those with a history of pyelonephritis a normal distribution pattern was found in 28%, dysplasia in 24%, medial defect in 21%, pole defects in 24% and no typical pattern in 3%. A normal pattern was significantly more frequent in kidneys with reflux grade 1–2. Dysplasia was significantly more frequent in kidneys with reflux grade 4–5. In children with no history of pyelonephritis 42% of the renal units had reduced length, 8% with no other sign of pathology. The frequency of reduced kidney length at reflux grade 1–2 did not differ significantly from that at higher grades of reflux. In children with a history of pyelonephritis 52% of the renal units had reduced length, 13% with no other sign of pathology. The frequency of reduced kidney length with a normal DMSA pattern did not differ significantly from that with a pathological pattern.

Conclusion The pathological DMSA distribution with vesicoureteric reflux generally conforms to one of three main patterns. Reduced kidney length is frequent even at lower grades of vesicoureteric reflux even in patients with no history of pyelonephritis, and can be the only sign of pathology.
Intravesical bacille Calmette‐Guérin in the treatment of superficial transitional cell carcinoma of the bladder
Authors: ROGERSON J.W.
Published: November 2008

Objective To determine the efficacy of intravesical bacillus Calmette‐Guérin (BCG) in the treatment of patients with superficial transitional cell carcinoma (TCC) of the bladder, and to assess the impact of fibrin clot inhibitors.

Patients and methods A retrospective review of 56 patients with superficial TCC of the bladder, treated with intravesical BCG after initial transurethral resection (TUR) of raised or papillary lesions or cold cup biopsy of areas of carcinoma in situ (CIS), was performed. Patient drug histories were reviewed for evidence of ingestion of medication known to inhibit fibrin clot formation. The impact of such medication was assessed using the Chi‐square test.

Results Fifty‐six patients were treated between 1987 and 1991 of whom 52 were evaluable. Eighteen patients (35%) had a complete response with a mean follow‐up of 19 months. Six patients (60%) in the group with CIS had a complete response rate with a mean follow‐up of 28 months. Seven patients (13%) developed local progression and required cystectomy or external beam radiotherapy. Six patients (12%) died from metastatic disease. Three patients (6%) had significant complications. The adverse impact of fibrin clot inhibitors was found to be significant.

Conclusion Intravesical BCG is effective in the treatment of superficial TCC, especially CIS. A careful drug history is important to identify fibrin clot inhibitors so that, if possible, they may be withdrawn prior to intravesical BCG treatment.
Transurethral resection of the prostate for benign prostatic hypertrophy: factors associated with a successful outcome at 1 year
Authors: DOLL H.A. , BLACK N.A. , McPHERSON K.
Published: November 2008

Objective To investigate which patient and health service factors are predictive of outcome following transurethral resection for benign prostatic hypertrophy.

Patients and methods A total of 388 men were assessed before and 3, 6 and 12 months following surgery. Twenty‐one patient characteristics and 12 health service factors were considered. Successful outcome was assessed in terms of avoidance of adverse effects of the operation (survival, lack of early complications and later problems) and improvement in symptoms, health status (assessed in three ways) and quality of life. An overall assessment based on all eight outcome measures was also used. Relationships between possible predictors and outcome were explored whilst controlling for three potential confounders: age, diagnostic category and co‐morbidity. A linear logistic model was employed.

Results Patients who had severe pre‐operative symptoms but who otherwise enjoyed good health gained the most benefit from surgery. Generally speaking, outcome was not associated with any of the 12 health service factors studied.

Conclusion The results support the policy of watchful waiting for mild or moderately symptomatic patients as even if surgery becomes necessary because of a deterioration in the condition, the benefit resulting will be greater. However, any benefits of waiting for surgery would have to be balanced against any increase in urinary tract pathology or co‐morbidity that men may suffer whilst waiting, as these will increase the likelihood of an adverse outcome of surgery. The question of whether to wait or not will only finally be resolved by means of a randomized controlled trial comparing transurethral resection of the prostate with watchful waiting.
Rapid processing in the management of prostatic cancer
Authors: MORRIS S.B. , HAMPSON S.J. , SHEARER R.J. , CORBISHLEY C.M.
Published: November 2008

Objective To carry out rapid histological processing of prostatic biopsies for the management of patients who present with urinary retention or other urological problems, or with a suspected diagnosis of prostatic cancer.

Patients and methods Biopsies were taken from each of 26 patients who presented with urinary retention or other urological problems, or with a suspected diagnosis of prostatic cancer. The biopsies were processed in a Shandon Hypercenter using a 3‐hour programme and were stained on a Shandon Linistainer automatic staining machine. The slides were reviewed both immediately and at weekly histopathology audit meetings.

Results Results were available within 4 h of receipt of the specimen in the laboratory. One false negative, due to a sampling error at the time of biopsy, was identified.

Conclusion We believe that this facility is of benefit to both surgeon and patient and should be more widely available.
Symptomatology of metastatic prostate cancer: prognostic significance
Authors: RANA A. , CHISHOLM G.D. , RASHWAN H.M. , SALIM A. , MERRICK M.V. , ELTON R.A.
Published: November 2008

Objective To identify the various presenting symptoms in patients with metastatic prostate cancer, quantify the metastatic load for each symptom group and compare their case‐specific survival.

Patients and methods A prospective and consecutive series of 279 men with metastatic cancer of the prostate was analysed. Based on the symptom at presentation, six different groups were identified: bladder outflow obstruction, bone pain, anaemia, weight loss, paraplegia and alteration of bowel habit.

Results Significant variations were observed in their metastatic load (Kruskal‐Wallis test, P= 0.003 5) and in case‐specific survival (log‐rank test, P = 0.0038).

Conclusion Bladder outflow obstruction, bone pain and anaemia not only dictate treatment selection but we provide evidence that each of these symptoms has considerable prognostic significance in patients with metastatic cancer of the prostate.
Serum level of immunosuppressive acidic protein in haemodialysis patients with or without renal cell carcinoma
Authors: SASAGAWA I. , NAKADA T. , KUBOTA Y. , SUZUKI H. , SAWAMURA T.
Published: November 2008

Objective To assess the significance of immunosuppressive acidic protein (IAP) for detection of renal cell carcinoma in patients undergoing haemodialysis.

Patients and methods The serum concentration of both IAP and creatinine was measured in 74 patients undergoing haemodialysis, 10 of whom had renal cell carcinoma and 64 of whom had no renal cell carcinoma. Control data was obtained from 13 healthy blood donors.

Results The serum IAP level of patients undergoing haemodialysis was significantly elevated compared with that of the controls. The serum level of IAP inpatients with renal cell carcinoma who were undergoing haemodialysis was also considerably higher than that of patients with no renal cell carcinoma. The serum creatinine levels were not significantly different between patients with and without renal cell carcinoma but were significantly elevated when compared with the controls.

Conclusion The measurement of serum IAP concentration is of value in the detection of renal cell carcinoma in patients undergoing haemodialysis.
Urinary calcium oxalate saturation in ‘stone formers' and normal subjects: an application of the EQUIL2 program
Authors: ROBERT M. , BOULARAN A. M. , COLETTE C. , AVEROUS M. , MONNIER M.
Published: November 2008

Objective To produce an index of lithogenic risk which identifies patients at risk of stone recurrence and facilitates the monitoring of prophylactic treatments.

Patients and methods The EQUIL2, program provides an evaluation of the state of urinary saturation, particularly of calcium oxalate, based on the pH and total concentrations (mmol/l) of sodium, potassium, calcium, magnesium, uric acid, chloride, ammonium, citrate, phosphate, sulphate, oxalate, pyrophosphate and carbon dioxide. The morning urinary calcium oxalate saturation coefficient was thus calculated for 30 stone‐formers (Group 1) and 30 normal control subjects (Group 2).

Results Urine from the majority of individuals was saturated, with no significant difference between the two groups. There appeared to be a correlation between the state of saturation and the urinary calcium oxalate molar product in both stone‐formers (r =0.931) and controls (r=0.914).

Conclusion In future studies on urinary calcium oxalate saturation, it should be possible to supplement the sophisticated coefficient determined by the EQUIL, program with the molar product, except in cases where monitoring therapies have little or no effect on urinary oxalate or urinary calcium levels.
P53 expression, ploidy and progression in pTl transitional cell carcinoma of the bladder
Authors: THOMAS D.J. , ROBINSON M.C. , CHARLTON R. , WILKINSON S. , SHENTON B.K. , NEAL D.E.
Published: November 2008

Objective To investigate a potential role for overexpres‐sion of the p53 protein in the identification of pTl bladder tumours destined to progress.

Patients and methods The protein expression of the tumour suppressor gene p53, nuclear ploidy and tumour grade were studied in 25 patients with pTl bladder tumours. Follow‐up data was available for 21 tumours over a 10 year period. p53 expression was determined by immuno‐histochemistry on paraffin embedded sections and flow cytometry was performed on cell suspensions derived from the same blocks.

zResults Ten of 21 (48%) tumours progressed to muscle invasive disease. Nuclear staining for the protein was seen in 16 (64%) tumours and of these nine (56%) progressed. All tumours with abnormal DNA content and all high grade tumours demonstrated overexpression of p53. Significantly more patients with high levels of p53 expression (> 10% nuclear staining) progressed compared with tumours with less than 10% of nuclei staining (P= 0.007). However, grade was the most specific predictor of progression (100%), with all grade 3 tumours progressing and grade was also the most significant prognostic indicator in terms of survival (P= 0.025).

Conclusion Tumour grade is likely to remain as the most useful aid to management decisions in pTl bladder tumours.
Neoadjuvant hormonal therapy and radical prostatectomy for clinical stage C carcinoma of the prostate
Authors: NARAYAN P. , LOWE B.A. , CARROLL P.R. , THOMPSON I.M.
Published: November 2008

Objective To determine whether hormonal therapy prior to radical prostatectomy (neoadjuvant hormonal therapy) leads to improved results in patients with stage C prostate cancer.

Patients and methods Thirty patients received neoadjuvant hormonal therapy for stage C carcinoma of the prostate. Eighteen patients who responded to treatment subsequently underwent extirpative surgery.

Results Fourteen of the 30 patients (47%) were diagnosed as being downstaged to clinical stage B disease following therapy. No major complications occurred. Pathology staging revealed only three patients (10%) to have organ‐confined disease after radical prostatectomy.

Conclusions Neoadjuvant hormonal therapy prior to radical prostatectomy offers little probability of rendering patients with clinical stage C carcinoma of the prostate free of disease. Further investigation of the efficacy of this treatment should be accomplished in randomized trials.
Iatrogenic ascent of the testis: an under‐recognized complication of inguinal hernia operation in children
Authors: SURANA R. , PURI P.
Published: November 2008

Objective To determine the incidence of iatrogenic ascent of the testis following inguinal hernia repair in children.

Patients and methods A total of 62 7 children underwent 747 groin explorations for inguinal hernia between January 1981 and December 1984. A retrospective review of their charts until December 1991 was undertaken.

Results Nine patients subsequently required orchidopex‐ies at a mean interval of 3 years 171 days (range 229 days ‐ 6 years 6 months). The incidence of iatrogenic ascent of the testis was 1.3% (6/459) for patients under 2 years of age at the initial operation, 1.3% (2/155) for those between 2 years and 5 years and 0.75% (1/133) for those above 5 years.

Conclusion The incidence of iatrogenic ascent of the testis was 1.2% after groin exploration for inguinal herniotomy in children, indicating the need for long‐term follow‐up.
Written information for transurethral resection of the prostate — a national audit
Authors: Montgomery B.S.I. , Venn S.N. , Beard R.C.
Published: November 2008

Objectives To assess the use and content of written information relating to transurethral resection of the prostate (TURP).

Materials and methods All 328 full members of the British Association of Urological Surgeons (BAUS) were requested to submit any information sheets or specialized consent forms given to patients about to undergo TURP. They were asked to record when the information was given and whether this was recorded in the notes. The sheets were analysed with reference to a nominally comprehensive list of topics suitable for inclusion in such sheets.

Results One‐hundred and eleven replies were received (34%) which represents 44% of urological departments. Of those replying, only 56 used information sheets for TURP. The overall comprehensiveness of the information was surprisingly poor, with 12% omitting to mention retrograde ejaculation and 19% failing to discuss the need for a catheter.

Conclusion The written information given to patients about to undergo TURP appears inadequate. There is a need for a nationally accepted information sheet that can be edited locally.
Post‐operative serial prostate‐specific antigen and transrectal ultrasound for staging incidental carcinoma of the prostate
Authors: Feneley M.R. , Webb J.A.W. , McLean A. , Kirby R.S.
Published: November 2008

Objectives To examine the value of post‐operative serum prostate‐specific antigen (PSA), PSA density, incremental change in serial serum PSA (PSA slope) and transrectal ultrasound (TRUS) in the assessment of residual malignancy after the diagnosis of clinically unsuspected prostatic adenocarcinoma at transur‐ethral resection of the prostate (TURP).

Patients and methods Forty‐eight untreated patients with incidental carcinoma of the prostate, demonstrated at TURP for a clinically benign gland, were evaluated post‐operatively with serum PSA and TRUS with multiple systematic prostatic biopsies. Prostatic volume was determined from TRUS measurements and PSA density was defined as serum PSA divided by gland volume. Those patients who did not undergo further treatment were monitored with serial PSA levels, and PSA slope was calculated as the overall annual percentage increase in serum PSA.

Results Among 36 patients staged T1A (A1), 11 (31%) had histologically proven residual carcinoma, and five of the 12 patients (42%) with T1B (A2) disease had no residual disease on biopsy. Serum PSA levels following TURP were greater in those patients with residual disease than those without (P= 0.001), but at a cut‐off of 4.0 ng/mL — providing a sensitivity of 89%— the specificity of PSA alone was 57%. PSA density had an 83% sensitivity and a 67% specificity with a cut‐off of 0.15 ng/mL/cm3. TRUS had a sensitivity of 63% and a specificity of 52%. An incremental rise in PSA exceeding 20% per year in untreated patients gave a sensitivity of 90% and specificity of 79% for biopsy proven residual malignancy.

Conclusion This study demonstrates the inaccuracy of staging incidental prostatic malignancy by TURP. Although the performance of PSA density is better than that of PSA alone, the reliability of both are limited by the lack of specificity, and TRUS imaging lacks both sensitivity and specificity. The PSA slope has sufficient sensitivity and specificity to distinguish reliably most patients with biopsy proven residual malignancy. Although ultrasound‐guided systematic biopsies provide a means for confirming residual malignancy, they may not be indicated in all patients with incidental carcinoma: for such patients, PSA progression may provide a rational basis for subsequent treatment.
Radical radiotherapy for localized adenocarcinoma of the prostate. A report of 191 cases
Authors: El‐Galley R.E.S. , Howard G.C.W. , Hawkyard S. , KLYS H. , Kerr G.R. , Duncan W. , Chisholm G.D. , Fowler J.W.
Published: November 2008

Objective To assess the Results of radiotherapy in the treatment of localized prostate cancer. End points for assessment were survival, local control, development of metastases, and the toxicity of therapy.

Materials and methods The case notes of 191 patients who were treated with radical radiotherapy between 1982 and 1992 were reviewed. The pathology of 130 patients was reviewed by a single pathologist. A multivariate analysis was performed to identify significant prognostic factors with regard to survival and relapse.

Results One‐hundred and eighty‐two patients were assessable. The minimum length of follow‐up was one year (median = 40 months). The actuarial cause‐specific 5 and 10 year survival rates were 63% and 35% respectively. Local progression occurred in 41% of patients with 37% developing metastases. Multivariate statistical analysis demonstrated that T stage and Gleason Score were significant predictors for survival. Late complications were usually mild, with only 4% developing serious bladder toxicity.

Conclusion Radical radiotherapy has a role in the curative treatment of prostate cancer. Survival is significantly related to T stage at the time of presentation, and to the Gleason Score of the tumour. Survival in this series was not as good as the best surgical series, but it is still not clear which patients should receive radiotherapy and which surgery as their primary management.
Anti‐bacterial activity of the fluid contents of spermatoceles and epididymal cysts
Authors: Günaydin G. , Özyurt C. , Koçak I. , Badak Z. , Girgin F.
Published: November 2008

Objective To show that the fluids obtained from spermatoceles and epididymal cysts are not infected, even though they may be present for long periods, and that these fluids have bactericidal activity.

Materials and methods Sixteen patients, 13 with a spermatocele and three with an epididymal cyst, were included in the study. Protein, glucose, chloride, inorganic phosphorus, calcium and magnesium contents were measured and cultures of the fluids were carried out. Bactericidal activity against the Escherichia coli NTCC 10418 clone was tested in different dilutions.

Results Biochemical analysis showed that the protein, glucose and ionic content of the fluids was lower than that of serum, except for chloride. Microbiological cultures were negative for all samples. A significant bactericidal effect was obtained with 1/1 dilution and no reproduction was seen with this dilution.

Conclusion These findings indicate that the fluids within spermatoceles and epididymal cysts do not become infected under normal circumstances.
Different susceptibilities of lymphokine‐activated killer cells (LAK cells) among primary and metastatic renal cell carcinoma derived from the same patient
Authors: Hattori T. , Satoh M. , Nishimura T. , Kawamura N. , Akimoto M.
Published: November 2008

Objective To investigate the susceptibility of primary renal cell carcinoma (RCC) and metastatic RCC to lymphokine‐activated killer (LAK) cells using three RCC cell lines derived from the primary and metastatic tumours in a male patient with advanced RCC.

Materials and methods Three RCC cell lines (named HANKS) were derived from a 44‐year‐old man with advanced RCC. HANKS‐Pr, HANKS‐Lu and HANKS‐LN were established from the primary lesion and the metastatic lung and lymph node lesions, respectively. The susceptibility of HANKS cell lines to 18 different LAK cells obtained from either patients with urological cancer or from healthy volunteers was studied. The three groups of LAK cells were divided as follows: (A) LAK cells from RCC patients (n= 6); (B) LAK cells from patients with transitional cell carcinoma (TCC)/prostatic carcinoma (CaP) (n= 4) and (C) healthy volunteers (n= 8). A 51Cr‐releasing cytotoxic assay was used to determine susceptibility.

Results The mean percentage lysis of the HANKS cell lines to the 18 allogenic LAK cells were 28.1% in HANKS‐Pr, 20.2% in HANKS‐Lu and 10.4% in HANKS‐LN. The susceptibility of HANKS‐LN to LAK cells was significantly lower than that of HANKS‐Pr and HANKS‐Lu in all three groups (P<0.05). In contrast, the susceptibility of HANKS‐Pr was significantly higher than HANKS‐Lu in group A only (P<0.01).

Conclusion This is the first report to describe the different susceptibilities of primary RCC and metastatic RCC derived from the same patient. HANKS‐LN itself might be the least susceptible to LAK cells because it was not related to the source of LAK cells. Furthermore, RCC may affect the cytotoxicity of LAK cells to HANKS‐Pr. These data indicate there are at least two different types of mechanisms leading to the different susceptibilities of HANKS cells to LAK cells.
Numerical chromosome aberrations in bladder cancer detected by in situ hybridization
Authors: Nemoto R. , Nakamura I. , Uchida K. , Harada M.
Published: November 2008

Objective To investigate the relationship between interphase cytogenetics and the grade and stage of bladder Cancer in patients with transitional cell carcinomas of the urinary bladder.

Patients and methods By use of in situ hybridization with chromosome‐specific DNA probes, the copy number of pericentromeric sequences on chromosomes 7, 10, 11, 17, 18, X and Y was detected within interphase nuclei in formalin‐fixed and paraffin‐embedded sections of the routinely processed bladder cancers from 20 patients. The percentage of hyperdi‐ploid cells (three or more spots) was estimated using light microscopy.

Results The percentage of hyperdiploid cells for chromosomes 7, 11 and 17 was highly correlated with increasing tumour grade (P<0.01, Spearman rank correlation) or increasing pathological stage (P<0.01). The percentage of hyperdiploid cells for chromosome Y was not correlated with either grade or stage (P>0.05). As high tumour grade and stage are both indicative of more aggressive tumour behaviour and a worse prognosis, these findings suggest that the percentage of hyperdiploid cells, especially for chromosomes 7,11 and 17, may be highly predictive of bladder tumour aggressiveness.

Conclusion These preliminary results suggest that measurement of numerical chromosome aberrations using in situ hybridization in bladder cancer may offer a new objective and quantitative assay of the biological potential of individual tumours.
Laparoscopic varicocelectomy: technique and results
Authors: Tan S.M. , Ng F.C. , Ravintharan T. , Lim P.H.C. , Chng H.C.
Published: November 2008

Objective To determine the safety and efficacy of laparoscopic varicocelectomy in the treatment of symptomatic varicocele.

Patients and methods Indications for surgery were subfertility in 98 patients and pain in nine. All varico‐celes were confirmed on Doppler ultrasound. Seventy‐two per cent of the patients had left‐sided varicoceles and bilateral varicoceles were seen in 27%. A three‐puncture technique was used with carbon dioxide insufflation. The spermatic vessels were individually identified and clips were used to ligate the veins. The spermatic artery was preserved in all cases. The operation was performed on a day surgery basis with an average operative time of 61.4 min (56.6 min for unilateral and 75.8 min for bilateral varicocelectomy).

Results Morbidity was low, with pneumoscrotum in two patients and wound infection in two others. Sixty‐one patients for whom pre‐ and post‐operative seminal analyses were available showed improvement in sperm count and motility, with a concomitant fall in the percentage of abnormal sperm forms.

Conclusion Laparoscopic varicocelectomy is safe and effective, causing minimal discomfort and allowing patients an early return to activity.
Delayed management of posterior urethral disruption in children
Authors: Kardar A.H. , Sundin T. , Ahmed S.
Published: November 2008

Objective To review the results of delayed operative treatment of total disruption of the posterior urethra in children.

Patients and methods Twelve boys (3–12 years, mean 7.5) with a suprapubic catheter were referred after primary management in other hospitals. All but one had been involved in road traffic accidents. In addition to their urethral injury, they all had pelvic fractures and the majority also had other major associated injuries. Six to 14 months after injury, abdominoperi‐neal transpubic urethroplasty was performed in 11 patients according to Turner—Warwick. In one case a perineal anastomotic urethroplasty was performed.

Results After the operation, voiding cysto‐urethro‐graphy showed a wide anastomosis in all cases. After 3 to 45 months follow‐up, there were no strictures. Eight boys were continent, two were totally incontinent, two had stress incontinence and one nocturnal enuresis. All patients with confirmed erections after injury also had erections after their operation.

Conclusion Primary suprapubic cystostomy and delayed repair can be used successfully for the treatment of posterior urethral disruption in children.
The influence of age on treatment choice and survival in 735 patients with renal carcinoma
Authors: Damhuis R.A.M. , Blom J.H.M.
Published: November 2008

Objective To determine whether age is related to treatment choice and survival in patients with renal carcinoma.

Patients and methods In this retrospective study 735 patients with renal carcinoma, diagnosed between 1982 and 1990 in one of the hospitals connected to the Rotterdam Cancer Registry, were evaluated with respect to treatment choice and survival.

Results Nephrectomy was performed less often in elderly patients, both with and without distant metastases. The resection rate for patients aged 70 years and older was 63% against 82% for younger patients (P < 0.001). Crude 5‐year survival rates for patients aged 20–59, 60–69 and 70+ were 54, 38 and 22% respectively. For patients with tumours restricted to the kidney (Robson stage 1), corrected survival rates were 80, 70 and 48% respectively. The overall postoperative mortality was 3.8% and was not related to age (P = 0.73).

Conclusion Treatment choice and outcome in patients with renal carcinoma were affected by age. As the proportion of patients aged 70 years and older, now 38%, will inevitably increase in the next decades, more attention is needed with respect to contraindications for surgical treatment in the elderly.
Expression of retinoblastoma gene product and p53 protein in bladder carcinoma: correlation with Ki67 index
Authors: Wright C. , Thomas D. , Mellon K. , Neal D.E. , Horne C.H. Wilson
Published: November 2008

Objectives To determine whether loss of the tumour suppressor gene retinoblastoma (Rb) and increased expression of the p53 protein were associated with increased tumour cell growth fraction.

Patients and methods Tumours from 105 patients (72 men, 33 women; median age 69 years, range 35–89) with newly diagnosed primary transitional cell bladder carcinoma were studied. Tumour samples were taken by means of cystoscopic resection. Expression of the retinoblastoma (Rb) and p53 gene products was assessed immunohistochemically in 98 of the carcinomas. The proportion of cells expressing the Ki67 antigen (Ki67 index which is a measure of growth fraction) was determined in 64 cases.

Results p53 protein was detectable in 50% and Rb protein in 82% of the tumours. Staining for p53 and lack of staining for Rb protein were associated with muscle‐invasive growth and high tumour grade (G3). The Ki67 index varied over a wide range (1–47%), but there were significant differences between mean indices for poorly differentiated (G3) and well or moderately differentiated (G1/G2) tumours, and between indices for muscle‐invasive and the remaining tumours. The mean Ki67 indices for Rb‐negative tumours and p53‐positive tumours were approximately twice those for Rb‐positive and p53‐negative tumours. Only 10% of the tumours expressed high levels of p53 protein and failed to express Rb.

Conclusion These observations are consistent with the hypothesis that loss of Rb and mutation and overexpr‐ession of p53 are associated with an increased tumour cell growth fraction and that such changes may play a role in the de‐regulation of cell proliferation in transitional cell carcinoma of the bladder.
Low‐dose bacille Calmette‐Guerin (BCG) therapy in superficial high‐risk bladder cancer: a phase II study with the BCG strain Connaught Canada
Authors: Mack D. , Frick J.
Published: November 2008

Objective To evaluate low‐dose bacille Calmette‐Guerin (BCG) therapy, with the Connaught Canada strain, in patients with superficial transitional cell carcinoma (STCC) of the urinary bladder.

Patients and methods Between September 1990 and December 1992 25 patients were entered into a phase II study to evaluate the feasibility, response and tox‐icity of BCG immunotherapy for patients with high‐risk STCC. Therapy consisted of six, weekly instillations of 27 mg (3 times 108 colony‐forming units) of the BCG strain Connaught Canada. Maintenance therapy was administered monthly for 1 year with the same dosage.

Results Of 25 eligible patients, 84% had complete responses after the initial cycle with low‐dose BCG and had stable disease. Four patients had no response, three of whom subsequently underwent radical cystec‐tomy. The mean length of follow‐up was 30.8 months (25–36). Toxicity included profound local reactions such as severe dysuria, frequency and gross haema‐turia. No systemic infections, except fever, were seen; none of the patients needed isoniazid. All reactions were treated symptomatically.

Conclusions The results of this study suggest that low‐dose BCG with the strain Connaught Canada can be successfully used in the treatment of patients with high‐risk STCC. Toxicity was not reduced substantially by the lower dosage of BCG used.
Results of radiotherapy on ureteric obstruction in muscle‐invasive bladder cancer
Authors: De Lichtenberg M. Honnens , Miskowiak J. , Rolff H.
Published: November 2008

Objective To evaluate the effect of radiotherapy on ureteric obstruction due to muscle‐invasive bladder cancer.

Patients and methods Retrospective evaluation of the records of 5 74 patients with muscle‐invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephros‐tomy or ureteric catheters in addition to radiotherapy.

Results Drainage improved in 20% of kidneys and the diverting catheter was withdrawn permanently in one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%).

Conclusion The results of this study raise doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle‐invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle‐invasive bladder cancer.
Correlation of transrectal ultrasound imaging and theResults of systematic biopsy with pathological examination of radical prostatectomy specimens
Authors: Gohji K. , Morisue K. , Kizaki T. , Fujii A.
Published: November 2008

Objective To determine the usefulness of transrectal ultrasound (TRUS) and systematic biopsy by correlating these Results with pathological findings after radical prostatectomy.

Patients and methods Pre‐operative TRUS examination combined with the findings on systematic biopsy in 15 patients (mean age 70.6 years, range 57‐87) who underwent radical prostatectomy between October 1992 and February 1994 were compared retrospectively to the histological features of whole mount sections of the surgical specimens.

Results In all cases, the tumour was visualized as a hypoechoic area on the sonogram. In addition, in six of 15 cases the tumour was localized in an isoechoic area which was examined before the operation by systematic biopsy. In this series, a systematic biopsy before operating detected tumour grade and localization of the tumour in 14 and 15 patients, respectively. The positive predictive value of capsular penetration and seminal vesicle invasion on the sonogram was 0.71 and 1.00, respectively, while sensitivity was 1.00 and 0.33, respectively. Five of seven patients with findings of capsular penetration on the sonogram revealed capsular penetration in the resected prostate, whereas, of three patients with pathologically detected seminal vesicle invasion, only one had findings of seminal vesicle invasion by ultrasonography. The serum prostate specific antigen level of all three patients was more than 30 ng/mL. Moreover, in this series of 15 patients TRUS detected the precise stage in 11 patients. In the remaining four patients, two were overstaged and two were understaged. Tumours with hypoechogenicity were of higher grade and larger than tumours with isoechogenicity. AH tumours with hypoechogenicity were palpable and all with isoechogenicity were not.

Conclusions TRUS combined with a systematic biopsy was useful in predicting tumour grade, exact location and capsular penetration. However, it was not useful for determining tumour stage or predicting seminal vesicle invasion of prostate cancer. TRUS‐guided seminal vesicle biopsy must be performed in patients with a serum prostate specific antigen of more than 30 ng/mL.
Are pelvic computed tomography, bone scan and pelvic lymphadenectomy necessary in the staging of prostatic cancer?
Authors: Levran Z. , Gonzalez J.A. , Diokno A.C. , Jafri S.Z.H. , Steinert B.W.
Published: November 2008

Objective To investigate the effectiveness and economy of pelvic computed tomography (CT), bone scan and pelvic lymphadenectomy as staging modalities in patients undergoing radical prostatectomy. The use of prostate specific antigen (PSA) and Gleason's score as adjuncts to predict extracapsular disease were also evaluated and their economic implications examined.

Patients and methods Between January 1990 and June 1993, 861 men were newly diagnosed with prostate cancer, of whom 409 underwent surgery. All patients underwent pelvic CT scans and PSA analysis. Patients undergoing surgery had pre‐operative bone scans and Gleason's scoring of their pathological tissue.

Results Only 13 (1.5%) of 861 men had positive pelvic CT scans. Of the 409 patients who underwent surgery, all had negative pelvic CT and bone scans, and all underwent a modified pelvic lymphadenectomy; 192 (47%) had extracapsular disease. Only 15 (3.7%) patients who underwent surgery were found to have positive nodes.

Conclusions The use of pelvic CT and bone scans for clinical staging in patients with a PSA level of ≤ 20 ng/mL should not be advocated because they have a very low yield and are not cost effective. We question the role of a modified pelvic lymphadenectomy for staging purposes, either by an open or laparoscopic procedure, because the yield of positive diagnoses is very low.
Occupational risk lor renal cell carcinoma. A case‐control study based on the New Zealand Cancer Registry
Authors: Delahunt B. , Bethwaite P.B. , Nacey J.N.
Published: November 2008

Objective To evaluate occupational risk factors for renal cell carcinoma.

Subjects and methods A case control design was employed using data reported to the New ZealandCancerRegistry from 1978 to 1986 inclusive. The occupational risk for renal cell carcinoma was derived by comparison with the occupation of cases of non‐urinary tract malignancy reported to the Registry over the same period.

Results An active occupational code was derived for 86.2% of all cases and 98.9% (710) of male cases. In a series of case‐control studies for selected occupational groups, adjusting for patient age and smoking history, a significantly increased relative risk for the development of renal cell carcinoma among firefighters (RR 4.89, 95% CI 2.47–8.93) and painters (RR 1.79, 95% CI 1.31–3.44) was demonstrated.

Conclusion The data suggest that both firefighters and painters may be at an increased risk of developing renal cell carcinoma, which is likely to be of significance as both occupational groups are frequently exposed to known carcinogens.
Lack of efficacy of low‐dose subcutaneous recombinant interleukin‐2 and interferon‐a in the treatment of metastatic renal cell carcinoma
Authors: Thiounn N. , Mathiot C. , Dorval T. , Flam T.A. , Tartour E. , Mosseri V. , Zerbib M. , Fridman W.H. , Debre B.
Published: November 2008

Objective To evaluate the efficacy and toxicity of subcutaneous immunotherapy using a combination of recombinant interleukin‐2 (r‐IL2) and interferon‐α (IFN‐α) for the treatment of patients with metastatic renal cell carcinoma (RCC).

Patients and methods Initially a maximum of 45 patients with advanced RCC were to be included in the study, according to a Fleming three‐stage procedure. To be included patients had to have measurable metastasis. Of a potential 45 patients with advanced RCC, 15 patients were included in the study (10 men and five women, mean age 51 years, range 25–69). From the first week of treatment r‐IL2 was given subcutaneously on day 1 to 5, at 18 times 106 units once a day and then 9 times 106 units once a day for the following 5 weeks. IFN‐α was given three times a week for the last 5 weeks. Minimum follow‐up was 6 months.

Results All patients initially underwent radical nephrec‐tomy. Seven patients were found to have metastases at the time of diagnosis. All patients received ambulatory therapy, except for the first 5 days of treatment.

Overall, 80% of the patients received more than 75% of the complete dose of r‐IL2. One patient suffered toxicity greater than the World Health Organization (WHO) grade 2 (neutropenia). No patient had a complete or partial response, two patients had a minor response, two patients had stable disease and 11 patients had disease progression.

Conclusions Subcutaneous r‐IL2 and IFN‐α had no beneficial effect on the first 15 patients and the study was discontinued, in accordance with the Fleming rules. The dose, administration and combination of r‐IL2 and IFN‐α may explain the lack of efficacy. Other studies have shown that low doses of r‐IL2 are not effective and the superiority of the combination of r‐IL2 and IFN‐α has not been proven. Therefore, a high dose of r‐IL2, in association with other cytokines, chemotherapy and adoptive immunotherapy, may be the only way to improve the response rate of metastatic RCC.
The application of a prognostic factor analysis for Ta.T1 bladder Cancer in routine urological practice
Authors: Reading J. , Hall R.R. , Parmar M.K.B.
Published: November 2008

Objective To assess the reproducibility of the prognostic factor findings of Parmar et al. [1], in a routine urological practice.

Patients and methods The superficial tumour recurrence‐free rate has been analysed for 232 newly diagnosed consecutive patients with Ta. Tl transitional cell carcinoma of the bladder. All patients were without carcinoma in situ or muscle invasion at the time of diagnosis.

Results Applying the prognostic factors recommended (number of tumours at diagnosis; tumour recurrence at first 3‐month cystoscopy) patients with Ta. Tl bladder Cancer may be divided into three distinct groups with significantly different chances of superficial bladder tumour recurrence.

Conclusion Two simple clinical criteria provide a reliable guide to the likelihood of tumour recurrence in patients with Ta. Tl bladder cancer. The modification of follow‐up cystoscopy schedules on this basis requires prospective study.
The International Prostate Symptom Score in a community‐based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume
Authors: Bosch J.L.H.R. , Hop W.C.J. , Kirkels W.J. , Schröder F.H.
Published: November 2008

Objectives To study the prevalence of symptoms of pro‐statism in the community and the correlation between these symptoms and age, prostate volume, flow rate and residual urine volume.

Subjects and methods The International Prostate Symptom Score (IPSS) was administered to a community‐based population of 502 men aged between 55 and 74 years with no prostate Cancer and no history of a prostate operation. Prostate volume parameters, flow rate variables and post‐void residual urine volume were measured.

Results Overall, 6 and 24% of the men were severely and moderately symptomatic, respectively. The results of a detailed questionnaire such as the IPSS (only 12% of the men scored 0) contrast with the men's global perception of their voiding function (82% claimed to have ‘no voiding complaints’). A good correlation was found between the total symptom score and the single disease‐specific quality of life question that is included in the IPSS (r= 0.74, P= 0.001). There was a weak correlation between the IPSS and total prostate volume (r= 0.19, P<0.001), and between the IPSS and physiological measures such as peak flow rate (r=— 0.18, P<0.001) and post‐void residual urine volume (r= 0.25, P<0.001). There was a very weak correlation between the IPSS and age (r=0.09, P= 0.04).

Conclusions The parameters used to characterize benign prostatic hyperplasia (BPH) should be considered independently because no predictions about the value of a certain parameter can be made by knowing one of the other parameter values. Symptom scores should therefore not be used as a pre‐selection criterion in the determination of the prevalence of clinical BPH without taking other measures into account. The interpretation of the parameter values in a clinical setting should take the lack of correlation and the variability of the parameter values into account.