bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory Monitoring and Electronic Measurement of Urinary Leakage in the Diagnosis of Detrusor Instability and Incontinence
Authors: WEBB R. J. , RAMSDEN P. D. , NEAL D. E.
Published: December 2008

Summary— The ability of conventional artificial filling urodynamic studies (CMG) and ambulatory monitoring during natural bladder filling (AM) to detect phasic detrusor activity (detrusor instability) and incontinence was studied in 52 patients suspected on clinical grounds of having bladder dysfunction, but in whom a CMG had not provided an adequate explanation of their symptoms. Detrusor instability (DI) was found on AM in 31 patients who were not unstable on conventional CMG using the criteria of the International Continence Society: DI was diagnosed on filling in 20 patients and on provocation in a further 11. Incontinence was demonstrated by electronic nappy testing in 23 patients: 13 had urge incontinence due to DI, 7 had genuine stress incontinence alone and 3 had both genuine stress incontinence and detrusor instability.

Thus DI was diagnosed significantly more frequently by AM than by CMG. Ambulatory monitoring was more sensitive in the diagnosis of instability and incontinence and it may prove to be a valuable aid in the diagnosis of bladder dysfunction not detected during conventional cystometry.
Problems in the Surgical Treatment of Interstitial Cystitis
Authors: NURSE DIANE E. , PARRY J. R. W. , MUNDY A. R.
Published: December 2008

Summary— Two series of patients with histologically proven interstitial cystitis that was unresponsive to hydrostatic bladder distension and intravesical chemotherapy with dimethyl sulfoxide have been studied. In the first series 24 patients were treated by subtotal cystectomy and substitution cystoplasty without further consideration; 8 of these 24 patients had persistent frequency due to active disease in the remaining trigone and/or urethra and in 2 cases this was severe.

Because of this experience the second group of patients had routine biopsy of the trigone and assessment of urethral sensation as part of the initial assessment. In those in whom the trigone was unaffected, treatment was unchanged. If the trigone was affected, total cystourethrectomy was performed with substitution cystourethroplasty unless the patient chose or was advised to avoid surgery altogether or to have a simpler option such as conduit or continent urinary diversion.

Trigonal biopsies should be part of the routine assessment of all patients being considered for surgery, since residual active disease is a major cause of dissatisfaction after subtotal cystectomy and substitution cystoplasty.
The Value of Ultrasound Scanning of the Upper Urinary Tract in Patients with Bladder Outlet Obstruction
Authors: COURTNEY S. P. , WIGHTMAN J. A. K.
Published: December 2008

Summary— Ultrasound scanning of the upper urinary tract enables a urologist to allocate a degree of urgency for surgery when upper tract dilatation is present. We have studied whether other assessments of bladder outlet obstruction could eliminate this investigation. The study group comprised 223 consecutive patients who had ultrasound scans for bladder outlet obstruction. Estimation of urea, creatinine, residual urine and flow rate could not predict the presence of upper tract dilatation and it was concluded that ultrasound scanning of the upper tracts should continue to be used as a means of deciding how urgently a patient requires prostatic surgery.
Experience with the Fowler Stephens and Microvascular Procedures in the Management of Intra‐abdominal Testes
Authors: BODDY S.‐A. M. , GORDON A. C. , THOMAS D. F. M. , BROWNING F. S. C.
Published: December 2008

Summary— The Fowler Stephens operation and microvascular procedures were compared for the management of 23 intra‐abdominal testes in 15 boys, 7 of whom had the prune belly syndrome. The Fowler Stephens operation was used for 15 testes (4 single‐stage and 11 two‐stage) and microvascular transfer was used for 8 testes. Eleven testes treated by the Fowler Stephens procedure (73%) and 7 treated by microvascular procedures (88%) were viable and intrascrotal after an average follow‐up of 3.0 years, giving an overall success rate of 78%. Eight of 9 post‐pubertal testes were biopsied. Severe maturational arrest was evident in all and carcinoma in situ was present in one.
Oral Trazodone in the Treatment of Total Secondary Impotence in a Diabetic Patient
Authors: ADAIKAN P. G. , NG S. C. , CHAN C. , RATNAM S. S.
Published: December 2008

The antidepressant trazodone differs in both pharmacological properties and structure from the tricyclic antidepressants and offers some advantages over them in terms of side effects and toxicity. However, there are reports of priapism as a side effect associated with the oral use of trazodone and alpha‐adrenoceptor blocking activity was suggested as the mechanism. It is known that the intracavernous injection of alpha‐adrenoceptor blocking agents produces erection (Brindley, 1983). We report the effect of oral trazodone in the treatment of impotence.
An Aid to Rigid Ureteroscopy—Stone Basket
Authors: VIJAYAN P.
Published: December 2008

In centres where extracorporeal shock wave lithotripsy is not available, ureteroscopy has established itself as the method of choice for the removal of calculi from the ureter.
Stenting the Extravesical Ureteroneocystostomy in Kidney Transplantation
Authors: GERMAN K. , FERNANDO O. N.
Published: December 2008

Extravesical ureteroneocystostomy is becoming a more popular method for urinary tract reconstruction in kidney transplantation (Barry, 1983). The procedure involves a small cystotomy and only limited exposure of the bladder. A technique for stenting the anastomosis has been developed which allows accurate placement of the stent without the need for a large cystotomy.
Cystine Stones: The Impact of New Treatment
Authors: MARTIN X. , SALAS M. , LABEEUW M. , POZET N. , GELET A. , DUBERNARD J. M.
Published: December 2008

Summary The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17–54) were treated and followed up over a period of 30 months (range 2–40). Most patients had a previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones.

Over the follow‐up period recurrence was observed in 23 instances in 11 patients, leading to 38 “stone treatments” on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N‐(2‐mercaptopropionyl)glycine) in 6 patients. The overall stone‐free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non‐cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.
The Effect of Diclofenac Sodium on Urinary Concentration of Calcium, Uric Acid and Glycosaminoglycans in Traumatic Paraplegics
Authors: SHARMA S. , VAIDYANATHAN S. , THIND S. K. , NATH R. , SANKARANARAYANAN A.
Published: December 2008

Summary Non‐steroidal anti‐inflammatory drugs (NSAID) have been shown to decrease calcium excretion in the experimental animal, in human volunteers and in calcium stone formers. Paraplegics tend to be hypercalciuric during the first 2 years after their injury and this is said to be a predisposing factor for stone formation in these patients. The effect of the NSAID diclofenac sodium was studied in 12 traumatic paraplegics who had sustained their injury 1 to 6 months previously; 24‐h urine samples collected before and 2 weeks and 4 weeks after oral diclofenac sodium 50 mg tds were analysed for calcium, uric acid, glycosaminoglycans (GAGs) and volume. There were no significant changes in urinary volume, uric acid and GAGs excretion. However, urinary calcium concentration and 24‐h calcium excretion decreased significantly following 2 weeks' and 4 weeks' treatment with diclofenac sodium.
Cytokeratin Shedding in Urine as a Biological Marker for Bladder Cancer: Monoclonal Antibody‐Based Evaluation
Authors: HELMY H. , SEDDEK M. N. , BASTA M. T. , SHAABAN A. , EL‐BAZ M. , EL‐MASRY S. , AL‐HILALY E. S. , MD M. A. GHONEIM
Published: December 2008

Summary Cytokeratin shedding into urine was measured using a double‐antibody sandwich enzyme‐linked immunosorbent assay (ELISA) in 282 individuals. Samples included urine from normal controls, patients with urogenital conditions and bladder cancer patients. A monoclonal antibody prepared against cytokeratins extracted from a hyperkeratotic low grade squamous cell carcinoma (UNME/K1) was used in the assay. The results indicated reasonable levels of sensitivity (83%), specificity (67%) and overall accuracy (70%) in the detection of bladder cancer. The levels of sensitivity in detecting squamous and transitional cell carcinoma patients were 87 and 73% respectively. The low level of specificity was due to a high frequency of false positive results (55%) within the urogenital controls; this suggests that further immunochemical and immunohistopathological analyses of associated urothelial cytokeratins are required.
Urethral Pressures: Analysis of Transmission Pressure Ratios
Authors: VERSI E. , CARDOZO LINDA , COOPER D. J.
Published: December 2008

Summary Transmission pressure ratio (TPR) analysis of urethral pressure profilometry data has been advocated for the diagnosis of genuine stress incontinence (GSI). However, the clinical usefulness of the technique has not been adequately evaluated. Using videourodynamics as the gold standard, the TPR results of 150 continent women and 153 with GSI have been compared. The mean TPR for each quartile of the functional urethral length was computed, as was the maximum TPR value (TPR‐max) and the position on the urethra where it occurred (TPR‐mode). There was a statistically significant difference between the 2 groups for TPR values in the distal 2 quartiles of the urethra and for TPR‐max and TPR‐mode. With the use of the Kappa statistic it was found that the TPR‐mode was the most discriminatory of the TPR parameters. Even using this measure, the overlap between normal and GSI was so great as to make accurate diagnosis impossible. It was therefore concluded that TPR analysis is useless for the diagnosis of GSI. However, such an analysis is helpful for the understanding of the pathophysiology of GSI and its treatment.
The Intraurethral Catheter: Long‐term Follow‐up in Patients with Urinary Retention due to Intravesical Obstruction
Authors: NISSENKORN I. , SLUTZKER D.
Published: December 2008

Summary Insertion of 43 intraurethral catheters (IUC) was performed on 31 patients in order to replace an indwelling catheter for urinary retention due to benign prostatic hyperplasia. The insertion of the IUC was done under local anaesthesia with lignocaine jelly in the out‐patient clinic. The device has been in place for 3 to 14 months (mean 7), in 14 cases for > 3 months and in 29 cases for > 6 months. In 7 of the 43 inserted IUCs the device had to be removed earlier than intended (after 4.2–8 months) for reasons related to the device. Of the remaining 36 devices which were functioning well, 6 were removed at prostatectomy 3.5 to 8 months after insertion and an additional 6 IUCs had to be removed for reasons not related to the device; 24 IUCs are still in place and functioning satisfactorily. The mean maximal flow rate in these patients is 13.9 ml/s. Of the 31 patients, 27 had a positive urine culture before IUC insertion. None of the patients with the IUC had a clinically evident urinary tract infection, although in 7 cases the urine culture was positive during the follow‐up period. All patients were in a better psychological state, and those who were able to perform sexually before they had the indwelling catheter were also able to perform sexually with the device in place. After long‐term follow‐up, the IUC has proved to be a cost‐effective, successful alternative to an indwelling catheter and can be used as an alternative to prostatectomy in patients who are at high risk for surgery.
Cysts of the Tunica Albuginea—More Common Testicular Masses than Previously Thought?
Authors: TAMMELA T. L. J. , KARTTUNEN T. J. , MATTILA S. I. , MÄKÄRÄINEN H. P. , HELLSTRÖM P. A. , KONTTURI M. J.
Published: December 2008

Summary Cysts of the tunica albuginea have been considered very rare. Their clinical significance lies in their presentation as discrete testicular masses often diagnosed as malignancies prior to removal. We report our experience with 6 cases of cysts of the tunica albuginea over a 12‐year period and review the relevant literature. It is obvious that these cysts can be both of epithelial and of mesothelial origin. Our material includes a cyst lined by a transitional‐like epithelium, of a kind to our knowledge not reported previously. All of the cysts were found by palpation and they constituted 6% of the testicular tumours examined over the same period. High‐resolution ultrasound examination can distinguish them from solid testicular masses, as in 2 cases here, thus enabling unnecessary operations to be avoided.
Imaging Properties of Polydioxanone and Titanium Ligating Clips following Para‐aortic Lymphadenectomy for Testicular Cancer
Authors: GELISTER J. S. K. , KING D. M. , FRCP A. HORWICH , ChM W. F. HENDRY
Published: December 2008

Summary Stainless steel ligating clips produce serious artefacts on CT scans. Polydioxanone (PDS) and titanium ligating clips were used in 15 patients during para‐aortic lymphadenectomy for residual metastatic testicular teratoma following chemotherapy, and follow‐up CT images were compared with those following the use of stainless steel ligating clips. PDS ligating clips did not produce any artefacts and were progressively absorbed. Titanium ligating clips produced artefacts similar to but less intense than those of stainless steel. PDS ligating clips should be used when follow‐up CT scanning is important.
Antenatally Detected Pelviureteric Junction Obstruction. Is Non‐operation Safe?
Authors: MADDEN N. P. , THOMAS D. F. M. , GORDON A. C. , ARTHUR ROSEMARY J. , IRVING H. C. , SMITH S. E.W.
Published: December 2008

Summary We report follow‐up data (minimum of 1 year) on 63 kidneys with antenatally detected pelviureteric junction obstruction, as defined by renographic criteria. The condition was bilateral in 10 patients (i.e. 20 kidneys), 2 patients had unilateral obstruction with contralateral multicystic dysplastic kidneys, and 41 patients had unilateral obstruction with a normal contralateral kidney. In the latter group, 29 (71%) had good function (>40%) at initial assessment.

Of the 63 kidneys, 24 (38%) were operated upon following initial assessment, mainly for impaired function. Of 39 patients, initially managed non‐operatively, 8 (21%) were operated upon subsequently: 3 for deteriorating function (2 of whom have been reassessed and both have regained their lost function) and 5 for other renographic or ultrasonic indications).

Of the original 63 kidneys, 31 (49%) continue to be managed non‐operatively; 16 of these (52%) show improving ultrasound appearances, 8 of 17 studied show improved drainage, and all unilateral cases have stable good function.

It is concluded that non‐operative management of selected cases of antenatally detected pelviureteric junction obstruction is safe.
Application of the Onlay Island Flap Urethroplasty to Penile Hypospadias with Severe Chordee
Authors: MOLLARD P. , MOURIQUAND P. , FELFELA T.
Published: December 2008

Summary The onlay island flap urethroplasty was originally used to repair anterior hypospadias without chordee and was later used to repair penile hypospadias with a well developed urethral plate exhibiting little or no chordee after release of skin tethering. It is possible to treat all cases of penile hypospadias even with severe chordee by releasing the chordee without dividing the urethral plate and by reconstructing the urethra with an onlay island flap.
Inhibitory Role of Gamma‐amino‐butyric Acid in the Rabbit Urinary Bladder
Authors: CHEN T. F. , DOYLE P. T. , FERGUSON D. R.
Published: December 2008

Summary— Gamma‐amino‐butyric acid (GABA) is an established inhibitory neurotransmitter in the central nervous system (CNS) and it has also been identified in the bladder. We have investigated in the rabbit the effect of GABA on detrusor activity.

Rabbit detrusor muscle strips were made to contract by electrical stimulation of their autonomic nerves or by the addition of carbachol. The addition of GABA caused substantial inhibition of muscle contraction. GABA acts on 2 classes of receptors‐GABAA and GABAB. The inhibition was mediated via the GABAB receptors as its effect was mimicked by baclofen (a GABAB agonist) and inhibited by 2‐hydroxysaclofen (a GABAB receptor antagonist). Inhibition was not prevented by bicuculline (a GABAA receptor antagonist). This inhibition may be due to a direct muscle effect since the inhibition, which occurred with carbachol‐induced contraction, was not abolished by the addition of tetrodotoxin.

GABA, acting via the GABAB receptor, produces substantial inhibition of muscle contraction in the rabbit uinary bladder. This raises the possibility of using GABAB analogues in the treatment of detrusor instability.
Agreement between Clinical Methods of Measurement of Urinary Frequency and Functional Bladder Capacity
Authors: McCORMACK M. , INFANTE‐RIVARD CLAIRE , SCHICK E.
Published: December 2008

Summary— We assessed the agreement between 2 methods of data gathering of particular interest in urology: patient questionnaire and examination vs. frequency‐volume charts. One hundred consecutive patients consulting our out‐patient clinic were chosen for this study; 88 completed the study. Urinary frequency and bladder capacity were evaluated in each patient by using the above methods. The agreement between different methods of measurement was assessed by determining whether the 2 methods were interchangeable, a condition occurring if results of both methods fall within predetermined limits of variability. The results showed poor agreement between subjectively estimated unnary frequency and chart‐determined urinary frequency. Moreover, different methods of measuring bladder capacity (endoscopic vs. chart) gave different results. Since chart‐determined data are probably a more valid indication of urinary habits, we suggest that frequency‐volume charts should be used more often in the investigation and follow‐up of patients with micturition disorders.
The Use of a Bladder Pressure Warning Device during Transurethral Prostatic Resection Decreases Absorption of Irrigation Fluid
Authors: HJERTBERG H. , PETTERSSON B.
Published: December 2008

Summary— During a period of 4 weeks 102 patients underwent transurethral prostatic resection (TURP). Of these, 50 were randomly allocated to the use of an intravesical pressure device which warned the surgeon at a pressure elevation of 1.5 kPa. Ethanol (1%) was used as a marker in the irrigation fluid (glycine 2.2%), and absorption of ethanol‐tagged irrigation fluid was detected by measurements in the expired air. In 28 patients absorption took place (in 8 of the 50 patients equipped with the warning device and in 20 of the 52 without the device). The greatest absorption was seen in the group without the device. No differences were found between the groups with regard to age, resected mass, resection time, resection speed, or haemorrhage. Patients who absorbed irrigation fluid were slightly older and bled more, and the resected mass was larger. The use of a pressure warning device reduces the amount of irrigation fluid absorbed and the number of patients who absorb irrigation fluid, and minimises the risk of the TUR syndrome.
Treatment Decision for Stage I Non‐seminomatous Germ Cell Tumours Based on the Risk Factor “Vascular Invasion”
Authors: HOELTL W. , PONT J. , KOSAK D. , HONETZ N. , MARBERGER M.
Published: December 2008

Summary— Surveillance has become an alternative treatment modality for stage I non‐seminomatous germ cell tumours with reported relapse rates of up to 30% in retrospective studies. Results obtained in our retrospective study showed vascular invasion in primary tumours to be the risk factor with the highest negative predictive value. Since January 1985 patients with stage I non‐seminomatous germ cell tumours have been stratified by the presence or absence of vascular invasion in the primary tumour: those without vascular invasion (n = 26; group A) were subjected to a rigorous surveillance programme, while those with vascular invasion (n = 22; group B) were given 2 chemotherapy courses of bleomycin, etoposide and platinum in the hope of preventing progression. Relapse rates were 3.8% and 9% in groups A and B, respectively. The pooled relapse rate for both groups A and B (n = 48) was 6.2% (3/48). After a mean follow‐up time of 36 months 95.8% (46/48) of the patients were without evidence of disease.
Squamous Cell Carcinoma of the Urinary Bladder
Authors: SHARFI A. R. A. , SIR S. EL , BELEIL O.
Published: December 2008

Summary— A series of 52 patients with squamous cell carcinoma of the urinary bladder were studied over a 6‐year period. They constituted 27% of all bladder tumours. The male: female ratio was 12: 1; 62% of the patients were below the age of 50 years (mean 47) and 31% had a previous history of urinary bilharziasis. Associated stigmata of Schistosoma haematobium, as sandy patches, were detected in 69% of patients. Fourteen had bilharzial ureteric strictures as seen on intravenous urography and most of the tumours occurred in the region of the trigone; 60% had T3 NO MO tumours at presentation. Eighteen patients received radical radiotherapy and 16 patients under the age of 55 years underwent radical cystectomy with diversion of urine to an isolated rectum. The 5‐year survival rate in the radical cystectomy group was 75%. Other modalities of treatment and their results are discussed.
Ethics, Logistics and a Trial of Transurethral versus Open Prostatectomy
Authors: JENKINS B. J. , SHARMA P. , BADENOCH D. F. , FOWLER C. G. , BLANDY J. P.
Published: December 2008

Summary— An increased long‐term morbidity rate after transurethral compared with open prostatectomy has recently been claimed on the basis of retrospective studies of operations done up to 20 years ago. These studies have led to a demand for a prospective trial. Most reports show that peri‐operative mortality following prostatectomy is virtually confined to unfit men over 80 years old. Before agreeing to participate in a trial we examined our operative mortality in this group of patients. Between 1981 and 1987, 123 octogenarians underwent transurethral prostatectomy: 64 operations were elective and 59 were performed for retention. There were 2 operative deaths (1.6%), both from gram‐negative septicaemia despite prophylactic antibiotics. There were no additional deaths in the first 12 months following surgery. Few of these patients would have been considered fit to undergo an open prostatectomy. Any proposed randomised trial would have to exclude such high risk patients until it can be shown that open prostatectomy is equally safe.
A Simple Method for Insertion of an Intraprostatic Coil
Authors: NIEBEN O. G. , NORDLING J. , NIELSEN K. K. , KROMANN‐ANDERSEN B. , ABSALOM MARY J. , FOWLER C.
Published: December 2008

Summary— A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients.

The prostatic urethra is measured either by abdominal/transrectal ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 21 coils were correctly positioned at the first attempt using this new method–a success rate equivalent to that of ultrasound‐guided insertion.
Circulating Prostate Specific Antigen‐positive Cells Correlate with Metastatic Prostate Cancer
Authors: HAMDY F. C. , LAWRY J. , ANDERSON J. B. , PARSONS M. A. , REES R. C. , WILLIAMS J. L.
Published: December 2008

Summary— Analytical flow cytometry was used to study circulating prostate specific antigen (PSA)‐positive cells in 40 consecutive patients with newly diagnosed, untreated prostate cancer; 25 patients (63%) had metastatic disease confirmed by a positive bone scan. Cell suspensions were prepared for each patient from both the primary tumour and peripheral blood samples. The cells were stained with a monoclonal antibody against PSA, and analysed by flow cytometry; PSA‐positive cells were sorted according to their immunofluorescence and light scatter properties. The cellular deoxyribonucleic acid (DNA) content of each specimen was also analysed to establish ploidy status. PSA‐positive cells were detected in the peripheral blood of 33 patients (83%). The presence of these cells in the circulation showed a higher degree of sensitivity and specificity in predicting positive bone scans than did serum PSA levels. Circulating PSA‐positive cells may represent either a subpopulation of tumour cells with distinct metastatic properties or, alternatively, host immunocytes which take up PSA in an active or passive manner.
Germ Cell Alkaline Phosphatase in Human Seminal Plasma following Vasectomy
Authors: LEWIS‐JONES D. I. , JOHNSON P. M. , DESMOND A. D. , McLAUGHLIN P. J.
Published: December 2008

Summary— Germ cell alkaline phosphatase (also termed placental‐like alkaline phosphatase or Nagao isoenzyme) was assayed in seminal plasma using monoclonal antibody‐based enzyme immunoassays in samples obtained both before and after vasectomy. In all cases, germ cell alkaline phosphatase fell to undetectable levels within 14 days of operation. A fall in seminal plasma germ cell alkaline phosphatase may thus be an early indication of successful vasectomy.
Norfloxacin Prophylaxis for Endoscopic Urological Surgery
Authors: CUTAJAR C. L.
Published: December 2008

Summary— A series of 140 patients, undergoing various types of urological endoscopic procedures, was divided into 2 equal, parallel, randomised groups. The first group of 70 patients, undergoing lower urinary tract surgery, was randomised, half to receive norfloxacin prophylaxis and half no antibiotic cover; the other 70 patients, undergoing percutaneous renal surgery, were randomised, half to receive norfloxacin and half cefuroxime. It was found that 26% of patients not receiving antibiotic prophylaxis and 11% on cefuroxime prophylaxis developed post‐operative bacteriuria, with a high incidence of urinary tract infection (UTI). Only 1 patient of 70 on norfloxacin prophylaxis developed post‐operative bacteriuria, which quickly responded to prolongation of norfloxacin therapy.

Prior to surgery, 10% of all patients were found to have previously undetected bacteriuria. This group was at high risk of developing post‐operative infection. Norfloxacin effectively prevented post‐operative bacteriuria and urinary tract infection in these patients. This study suggests that norfloxacin is a safe and effective prophylactic antibiotic in all forms of urological endoscopic procedures.
PAEDIATRIC UROLOGY Laser Treatment of Posterior Urethral Valves in Neonates
Authors: BIEWALD W. , SCHIER F.
Published: December 2008

Summary— The posterior valves of 13 neonates were resected using the neodymium:YAG laser in retrograde transurethral endoscopy. There were no strictures or other complications.
Extracorporeal Shock Wave Lithotripsy with the Storz Modulith SL20: the First 500 Patients
Authors: LISTON T. G. , MONTGOMERY B. S. I. , BULTITUDE M. I. , TIPTAFT R. C.
Published: December 2008

Summary— Our initial experience of extracorporeal shock wave lithotripsy (ESWL) with the Storz Modulith SL20 is reported. A total of 500 patients with 551 renal and 120 ureteric stones, mean diameter 11.9 mm, underwent 746 treatments; 68.2% of patients required a single treatment. The mean treatment rate for renal calculi was 1.4 and for ureteric calculi it was 1.5, rising to 4.2 for staghorns; 62.2% of treatments were performed on an out‐patient basis. Analgesia (intravenous fentanyl) was required in 60.9% of treatments for renal calculi but in only 38.2% of those for ureteric calculi. The overall stone‐free rate at 3 months was 77.6%, with a further 14.7% of patients having fragments <3 mm in diameter that required no further treatment. The stone‐free rate was dependent on the site of the stone, with the majority of residual fragments lying in a lower pole calix. There were few complications. The Modulith is an efficient and safe lithotripter capable of treating stones in the kidney and throughout the ureter.
Hydatid Disease of the Urinary Tract: Evaluation of Diagnostic Methods
Authors: SHETTY S. D. , AL‐SAIGH A. A. , IBRAHIM A. I. A. , MALATANI T. , PATIL K. P.
Published: December 2008

Summary— Eight patients with histologically proven hydatid disease of the urinary tract underwent eosinophil count, ultrasonography (US) and computed tomography (CT). The findings were compared with those in 8 age‐matched controls with simple renal cysts. Eosinophilia was not significantly different in the 2 groups. Mixed echogenicity on US and multivesicular cyst with mixed density on CT were the diagnostic features of hydatid cysts. Using these factors, both US and CT could diagnose or exclude hydatid disease in a significant number of patients with renal cysts. However, CT was more sensitive (88 vs 50%) and accurate (94 vs 75%) than US in the diagnosis of urinary tract hydatid disease. Retrograde pyelography confirmed communicating renal hydatid cysts in 2 patients. A practical algorithm for the investigation of urinary tract hydatid disease is suggested.
Continent Urinary Reservoirs
Authors: KULKARNI J. N. , TONGAONKAR H. B. , RAVI R. , KAMAT M. R.
Published: December 2008

Summary— We report our experience of 30 continent urinary reservoirs (CURs) after radical cystectomy. The patients ranged in age from 35 to 70 years. There were 22 males and 8 females. Pre‐operative urograms showed normal upper tracts in 22 patients, unilateral hydronephrosis in 4 and bilateral hydronephrosis in 4. The first 20 patients had a standard CUR procedure and the last 10 had a modified CUR. The mean operative time, blood loss and post‐operative stay were 6.6 h, 900 ml and 25 days respectively for standard CURs and 5.7 h, 825 ml and 21 days respectively for the modified CURs. Post‐operatively, urinary leaks from the caecostomy site occurred in 2 patients (1 of which was fatal) while 3 other patients had prolonged ileus, burst abdomen and intestinal obstruction probably due to non‐demonstrable urinary leaks. All 5 complications occurred in the first 20 patients. Upper tract status was evaluated in 28 patients 3 months after surgery and showed normal upper tracts in 19 patients, improvement in 6 (35%) and worsening in 3 (12.5%). Pouchograms showed no reflux in 25 patients, unilateral reflux in 2 and bilateral reflux in 1. Complete continence was achieved in 25 patients–2 of them had revision surgery, giving a success rate of 89% with a follow‐up of 6 to 48 months (median 24). The remaining 3 patients were incontinent.
Multicystic Renal Dysplasia Detected by Prenatal Ultrasonography. Natural History and Results of Conservative Management
Authors: RICKWOOD A. M. K. , ANDERSON P. A. M. , WILLIAMS M. P. L.
Published: December 2008

Summary— In a review of 44 infants with multicystic renal dysplasia diagnosed prenatally by ultrasonography, contralateral anomalies, bilateral disease and other non‐urinary congenital anomalies were rare. In approximately two‐thirds of infants the lesion was impalpable and in 2 cases involution had ocurred prenatally. All but 5 were managed conservatively and without complications, and partial or complete involution of the lesion occurred in more than 50% during follow‐up. It was concluded that the natural history of this anomaly is usually benign and that conservative management is advisable.
Laser Ablation of the Prostate in Patients with Benign Prostatic Hypertrophy
Authors: COSTELLO A. J. , BOWSHER W. G. , BOLTON D. M. , BRASLIS K. G. , BURT J.
Published: December 2008

Summary— Seventeen patients with bladder neck obstruction due to benign prostatic hypertrophy have been treated with the Neodymium: YAG laser. We review our experience since the first patient was treated in September 1990.

Using a prototype deflecting gold alloy tip on a quartz laser fibre (Lateralase TM), we ablated obstructing prostatic adenoma and constricting bladder neck tissue. Experience with this technique has enabled a patient population to be defined in whom laser therapy for prostatic obstruction may be effective. The treatment is relatively simple, speedy and attended by virtually no blood loss. Laser ablation therapy may offer some advantages over conventional transurethral resection of the prostate (TURP) in a selected subgroup of patients. The advent of new delivery systems may make laser ablation therapy a practical alternative to TURP.
Phase III Randomised Study of Zoladex versus Stilboestrol in the Treatment of Advanced Prostate Cancer
Authors: WAYMONT B. , LYNCH T. H. , DUNN J. A. , EMTAGE L. A. , ARKELL D. G. , WALLACE D. M. A. , BLACKLEDGE G. R. P.
Published: December 2008

Summary— An open randomised Phase III trial was conducted of the depot GnRH analogue goserelin (Zoladex) versus stilboestrol (3 mg/day) in patients with advanced or metastatic prostate cancer. The study included 250 patients and the median follow‐up was 43 months. In the Zoladex arm the time to first response was achieved earlier and more patients reported an improvement in symptoms. There was no statistically significant difference between the Zoladex and the stilboestrol arms with regard to survival and time to treatment failure.

A major reason for treatment failure was the preponderance of adverse events in patients receiving stilboestrol. It is suggested that stilboestrol should no longer be used for prostate cancer when equally effective alternative treatments are available.
Pre‐operative Assessment of Peyronie's Disease Using Colour Doppler Sonography
Authors: RALPH D. J. , HUGHES T. , LEES W. R. , PRYOR J. P.
Published: December 2008

Summary— Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's disease with a suspected organic cause for their impotence.

In 20 patients who complained of a uniform loss of erection, the impotence was likely to be functional in origin (90%) or occasionally venogenic (10%), the penile arterial blood flow being normal. However, patients who complained of distal flaccidity were likely to have an organic cause for their impotence (68%). This was due to proximal arterial disease (10%), plaque involvement of the distal vessels (37%), veno‐occlusive dysfunction (5%) or to the soft glans syndrome (16%).
The Development of Synthetic Polymers that Resist Encrustation on Exposure to Urine
Authors: HOLMES S. A. V. , CHENG C. , WHITFIELD H. N.
Published: December 2008

Summary— The consequences of long‐term exposure of synthetic materials to urine have prevented the development of alloplastic replacement of diseased or damaged parts of the urinary tract. Similarly, urethral and ureteric catheters require regular replacement if the complications of encrustation and blockage are to be avoided. The mechanism of encrustation is not understood completely and thus it is unclear why certain materials appear better able to resist encrustation. This study has involved the development of a new encrustation model to provide a reproducible and quantitative assessment of the susceptibility of polymers to encrustation. This model will allow beneficial characteristics of co‐polymer design to be recognised, with the aim of finding new materials that are tolerant of exposure to urine. Results of co‐polymers examined show that the incorporation of fluorine‐containing components confers significant resistance to the formation of encrustation. It is suggested that the physico‐chemical properties of polymer surfaces may be important determinants of resistance to encrustation.
Continent Urinary Diversion Using an Artificial Urinary Sphincter
Authors: MITROFANOFF P. , BONNET O. , ANNOOT M. P. , BAWAB F. , GRISE P.
Published: December 2008

Summary— We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra‐prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure‐regulating balloon is implanted within the area of abdominal pressure, retroperitoneally.

After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow‐up of 20 months.

These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir.

Although long‐term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.
Urinary Flow Rates in Patients with Benign Prostatic Hypertrophy following Treatment with Alfuzosin
Authors: TEILLAC P. , DELAUCHE‐CAVALLIER M. C. , Group P. ATTALI and the DUALF
Published: December 2008

Summary—In order to document further the onset of action of alfuzosin, a selective alpha‐1 blocker, 93 symptomatic patients with benign prostatic hypertrophy were randomly allocated to a single oral dose of either alfuzosin 1.25 mg or 2.5 mg, or placebo, after a 1‐week placebo lead‐in period. The effects on flow rates were assessed 1 h 30 min after administration. Peak and mean flow rates were significantly increased in the alfuzosin groups, as compared with placebo, in a dose‐dependent manner. After a single intake of placebo, the mean values of these 2 parameters showed little change. The effect on the cardiovascular system (heart rate and blood pressure) was mild. This study indicates that the action of alfuzosin is already present 1 h 30 min after administration.
Finasteride in the Treatment of Benign Prostatic Hyperplasia. A Urodynamic Evaluation
Authors: KIRBY R. S. , BRYAN JENNY , EARDLEY I. , CHRISTMAS T. J. , LIU S. , HOLMES S. A. V. , VALE J. A. , SHANMUGANATHAN K. , WEBB JUDITH A.
Published: December 2008

Summary— A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia (BPH) were treated in a double‐blind, placebo‐controlled study with finasteride (Proscar, MK‐906), a 5‐alpha reductase inhibitor, 5 mg or 10 mg/day or placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study. In treated patients dihydrotestosterone declined by over 60%, remaining unchanged with placebo. Symptom scores fell significantly in all 3 groups. Mean maximum flow rates fell slightly in placebo‐treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group. After 1 year's treatment, the reduction in symptom score and increase in flow rate were well maintained; the mean prostate volume was reduced by 14% and prostatic specific antigen declined by 28%. It was concluded that finasteride shows some efficacy in the treatment of BPH, with minimal toxicity, but 12 months of therapy or longer may be necessary to achieve maximal effect.
Treatment of Hydrocele: Randomised Prospective Study of Simple Aspiration and Sclerotherapy with Tetracycline
Authors: BREDA G. , GIUNTA A. , GHERARDI L. , XAUSA D. , SILVESTRE P. , TAMAI A.
Published: December 2008

Summary— Following reports in the literature on the efficacy of tetracycline sclerotherapy in the treatment of hydroceles, we carried out a randomised prospective study of 45 patients (50 hydroceles), comparing simple evacuation with tetracycline sclerotherapy. The results revealed no statistically significant difference in the percentage of success between the 2 groups, but complications were more common in the patients treated with tetracycline. The good results reported by other authors in non‐randomised studies are, therefore, not confirmed.
Ten‐year Review of Treatment of the Undescended Testis in the West of Ireland
Authors: McKIERNAN M. V. , MURPHY P. D. , JOHNSTON J. G.
Published: December 2008

Summary— Advances continue to be made in the treatment of the undescended testis, and treatment recommendations are continually changing. We reviewed 543 patients admitted for treatment of undescended testes in the 10‐year period 1977 to 1986. The side and position of the testis were recorded, the patient's age at operation and the procedure carried out. The presence of an associated inguinal hernia was noted. The necessity for reoperation was recorded and predisposing factors sought. We found the mean age at operation to be 9.5 years and this decreased significantly over the study period. Dartos pouch orchiopexy was the commonest operation (69%). No significant link was found between the procedure performed or the presence of a hernia and the need for further procedures; 2.7% of patients required such further procedures. A coherent classification of position is lacking for abnormally descended testes. We report a classification which we used to tackle this situation.
Surgical Outcome of Orchiopexy. I. Previously Unoperated Testes
Authors: SAW K. C. , EARDLEY I. , DENNIS M. J. S. , WHITAKER R. H.
Published: December 2008

Summary— A total of 1209 undescended testes in 961 boys who had had no previous surgery for this problem have been reviewed with particular regard to the outcome of surgery in relation to the pre‐operative and intra‐operative assessment of the position of the testis. A third of impalpable testes were found at operation in the abdomen, a third in the inguinal canal and a quarter in the superficial inguinal pouch; 1% of all testes and 7% of impalpable testes were absent; 96% of all testes reached the scrotum at operation and this figure included 69% of abdominal and 94% of canalicular testes. In all 24 testes were excised—7 of which were abdominal, 8 canalicular and 9 were in the superficial inguinal pouch. The generalisation that the higher the undescended testis before operation the poorer the result, does not always hold true.
Reasons for patient drop‐out from an intracavernous autoinjection programme for erectile dysfunction
Authors: ARMSTRONG D.K.B. , CONVERY A.G. , DINSMORE W. W.
Published: December 2008

Objective To identify factors that contribute to patient drop‐out rates from an intracavernous auto‐injection programme for erectile dysfunction.

Patients and methods Forty‐seven patients who had been successfully treated with intracavernous vasoactive agents but who subsequently failed to attend follow‐up appointments were included in the study. Each patient completed a self‐administred questionnaire.

Results Thirty (64%) completed questionnaires were returned. The reasons for withdrawal from treatment are outlined.

Conclusions The majority of patients who discontinued intracavernous therapy did so for reasons unrelated to treatment associated problems.
Accounting for Public Hospitals: A Case Study of Modified GAAP
Authors: Ellwood Sheila
Published: December 2008

Public hospitals in the U.K. apply GAAP as modified by the Treasury, the Financial Reporting Advisory Board (FRAB) and the Department of Health. Individual National Health Service (NHS) Trusts apply their interpretation of the accounting manuals with further guidance and scrutiny from oversight bodies such as the Audit Commission. This article uses a case study approach to investigate how GAAP is modified and to outline the consequences of the constructed reality. The modifications are layered and often opaque. The accounts are constructed according to accounting requirements stipulated by Government and the account preparers adapt the requirements at Trust level. The accounting statements play a part in constructing a reality (Hines, 1988) that has consequences through the NHS control regime and in how the financial position is portrayed to the public. It appears that GAAP is used to legitimate the NHS as a modern organization applying commercial accounting practice, but the accounting statements provide a distorted view of GAAP compliant statements. The accounting, while not itself real, is real in its consequences and can lead to biased decision‐making, service closures and job losses. The planned compliance of NHS Trusts with international GAAP may provide further scope for modification and manipulation in constructing NHS accounting reality.
The Dialogus de Scaccario (c.1179): The First Western Book on Accounting?
Authors: Jones Michael John
Published: December 2008

There has been much interest in the first books on accounting in the Western world. However, generally this has focused on books on double‐entry bookkeeping. Double‐entry bookkeeping emerged in the twelfth and thirteenth centuries and was first expounded in printed form in Pacioli's famous treatise in 1494. The system which double‐entry gradually supplanted was charge and discharge accounting. Charge and discharge accounting was widespread in medieval Britain. Its origins appear to have been in the English Exchequer about 1110. By the late twelfth century, it was well‐established. In 1177–79, Richard fitz Nigel wrote the Dialogus de Scaccario (Dialogue of the Exchequer) which explained its workings. This treatise, written in the form of a dialogue between master and disciple, outlines not only the duties of the parties involved, but also the accounting system which was employed. This book represents perhaps the first Western book on accounting.
‘It's them faulty genes again’: women, men and the gendered nature of genetic responsibility in prenatal blood screening
Authors: Reed Kate
Published: December 2008

Prenatal blood tests are routinely offered to pregnant women in the UK. Male partners are tested only where a combined positive male and female test could detect fetal abnormality such as sickle cell anaemia. Little is known about the gendered nature of screening and the impact it has on lay feelings of genetic responsibility. For example, do women take exclusive ‘maternal responsibility’ for the fetus? How is this responsibility challenged when men are also screened? Drawing on empirical research with pregnant women and their male partners in a northern city in the UK, this paper aims to explore the gendered nature of genetic responsibility in prenatal blood screening. The paper will argue that women and men feel a sense of genetic responsibility for the fetus throughout screening. However, while women's sense of responsibility is directly ‘embodied’ and is heightened by the detection of ‘faulty genes’, men's manifests itself indirectly through shared responsibility with their pregnant partners and directly through their own genetic connections to the fetus. The paper concludes that the gendered nature of genetic responsibility is complex and contradictory, producing a set of gender roles that both challenges and reinforces a traditional gender division of labour.