bluuebunny/crossref_metadata_2025 huggingface dataset:
The urodynamic profile of prostatodynia
Authors: Theodorou CH. , Konidaris  , Moutzouris  , Becopoulos TH.
Published: March 2003

Objective

To evaluate urodynamically patients with prostatodynia, and thus define a specific urodynamic pattern that might add to the pathophysiology of the syndrome and possibly aid definitive treatment.

Patients and methods

Forty‐three patients (mean age 38.1 years, sd 9.25, range 24–59) with symptoms suggestive of chronic prostatitis, e.g. dysuria, frequency of micturition and a burning sensation in the perineum, were classified as having prostatodynia after excluding prostatic infection by standard bacteriological methods. Thereafter, the patients were evaluated urodynamically, including the measurement of free flow‐rate, filling (water) cystometry, a pressure/flow study of micturition, with fluoroscopy and electromyography of the external urethral sphincter.

Results

Twenty‐eight patients (65%) had a low maximum free flow rate (Qmax ), with a mean (sd) of 10.91 (1.26) mL/s. Of the 42 patients who underwent filling cystometry, 26 (62%) had a first sensation of filling, and 28 (67%) a first desire to void, at low volumes (<150 mL and <300 mL, respectively). Of the 25 patients who underwent a pressure/flow study, 16 (64%) had an obstructive pattern of micturition, as defined by a low Qmax of 10.04 (1.38) mL/s and a high intravesical pressure at Qmax of 83.3 (5.3) cmH2O. The site of obstruction was at the level of the bladder neck, as confirmed by fluoroscopy.

Conclusion

A significant proportion of these patients had a particular urodynamic pattern of functional infravesical obstruction at the level of the bladder neck and sensory disturbances.
The Mitrofanoff urinary diversion for complex vesicovaginal fistulae: experience from Uganda
Authors: Hodges
Published: March 2003

Objective

To evaluate the results of Mitrofanoff continent urinary diversion in a group of women with persistent severe incontinence after vesicovaginal fistula (VVF) secondary to obstructed labour.

Patients and methods

Seven women with severe incontinence following a VVF were offered the Mitrofanoff procedure after all other attempts had failed to restore continence. In three patients a caecocystoplasty formed the urinary reservoir and in four the bladder was used. In all seven patients the appendix was used as the conduit for self‐catheterization. The mean (range) follow‐up was 10 (3–14) months.

Results

One patient died postoperatively from hepatic failure, which could not be attributed to the particular procedure. One patient required re‐operation at 10 days to adjust the conduit, but of the six patients who recovered, all are fully continent and self‐catheterizing with no difficulty.

Conclusion

The Mitrofanoff procedure appears to be a valuable technique to restore continence in this difficult group of patients.
Elevated urinary fibronectin levels after transurethral resection of bladder tumour: a possible role in patients failing therapy with bacillus Calmette–Guérin
Authors: Laufer  , Kaver  , Sela  , Matzkin
Published: March 2003

Objective

To investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediately and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette–Guérin (BCG), might lower the efficacy of BCG therapy over this period.

Patients and methods

Urinary fibronectin was measured using an enzyme‐linked immunosorbent assay in 25 patients with superficial bladder TCC who underwent TURBT for complete resection. Eight samples were collected for each patient, one before and seven during the 4 weeks after TURBT.

Results

High levels of urinary fibronectin were detected in 18 patients (72%) after TURBT. In 16 patients the fibronectin level returned to normal within 2 weeks of surgery. The other two patients showed elevated levels of fibronectin for > 4 weeks.

Conclusions

These results show that urinary fibronectin concentration is significantly increased in most patients after TURBT and this should be considered in patients who receive BCG therapy. Treatment within the first 2 weeks after TURBT may be associated with a high failure rate, as urinary fibronectin levels were increased significantly in about three‐quarters of these patients during that period. Indeed, the persistent elevation of fibronectin, occurring in two of the present patients, may be responsible for some of the failures of BCG therapy when it is administered 2–5 weeks after surgery.
A new automated system for urine analysis: a simple, cost‐effective and reliable method for distinguishing between glomerular and nonglomerular sources of haematuria
Authors: Kore  , Dow  , Desai
Published: March 2003

Objective

To determine the ability, reliability and accuracy of a new automated system of urine analysis in differentiating glomerular from nonglomerular bleeding in the initial investigation of haematuria, and compare its efficacy with conventional phase‐contrast microscopy (PCM).

Patients and methods

One hundred and six urine samples from patients in whom the final diagnosis was available were analysed using electrical flow impedance to detect, enumerate and size red blood cells in a conductive fluid (the cellfacts analyser, Microbial Systems Ltd, Coventry, UK). All the samples were also tested using a dipstick method and PCM was carried out for comparison on 45 of the 106 urine specimens. The results of cellfacts analysis were correlated with the final diagnoses to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this method; the costs were also analysed.

Results

Sixty‐nine urine samples tested positive for blood on dipstick urine analysis and all these were confirmed to have red blood cells on cellfacts analysis. The remaining 37 samples were negative for blood on dipstick testing and cellfacts analysis, although seven patients had been referred with previously detected microscopic haematuria, none of whom were found to have any detectable pathology in the urinary tract on clinical examination and investigations. The remaining 30 patients were diagnosed to have urological or nephrological conditions with no haematuria. In the positive group, 20 (29%) patients were from the glomerular group, with a mean (range) red blood cell size of 4.25 (4–5.1) μm, and 49 (71%) from the nonglomerular group, with red blood cells of 5.47 (4.67–5.70) μm. These ranges overlapped at 4.67–5.1 μm; at the decision threshold of 4.75 μm, the distribution of dysmorphic and eumorphic red blood cells for the glomerular group was 18 (90%) and two (10%), respectively, and for the nonglomerular group was 2 (4%) and 47 (96%), respectively. The sensitivity, specificity, PPV and NPV were 90%, 96%, 90% and 96%, respectively. Consumable and labour costs were very low.

Conclusions

Cellfacts analysis is a simple, rapid, objective and cost‐effective method for differentiating glomerular from nonglomerular urinary red blood cells, especially when few such cells are present.
Contractile responses to α1‐adrenoceptor agonists in isolated human male and female urethra
Authors: Nishimatsu  , Moriyama  , Hamada  , Ukai  , Yamazaki  , Kameyama  , Konno  , Ishida  , Ishii  , Murayama  , Kitamura
Published: March 2003

Objective

To investigate the contractile responses mediated through α1‐adrenoceptors in human urethra and to evaluate the effectiveness of NS‐49 [(R)‐(–)‐3′‐(2‐amino‐1‐hydroxyethyl)‐4′‐fluoromethanesulphonanilide hydrochloride], a novel α1‐adrenoceptor agonist, against contraction of the human urethra.

Materials and methods

The contractile responses were assessed in 10 male prostatic urethrae and six female urethrae. Antagonism was evaluated in the urethra using phenylephrine, a nonselective α1‐adrenoceptor agonist, cumulatively applied > 20 min after applying 0.1 μmol/L prazosin or 0.1 μmol/L 5‐methylurapidil, a selective α1A‐adrenoceptor antagonist. Agonism was determined in both male and female urethrae to obtain the concentration‐response curve for the agonist.

Results

Phenylephrine caused both male and female urethrae to contract, and showed high potency and efficacy. Prazosin antagonized these contractions with low affinity (apparent pKB of 8.30 in male urethrae). 5‐Methylurapidil, also antagonized the contractions with low affinity (apparent pKB of 7.88 in male urethrae). Noradrenaline and phenylephrine caused both male and female urethrae to contract, with high potency and efficacy. A novel and selective α1A‐and α1L‐adrenoceptor agonist, NS‐49, induced contractile responses with high potency and moderate efficacy, whereas methoxamine induced contractions with low potency and moderate efficacy. Norephedrine was a very weak contractile agonist.

Conclusion

In the human urethra, phenylephrine‐induced contractions were mediated through α1L‐adrenoceptors and not through α1A‐adrenoceptors. Contractions of the human urethra induced by NS‐49 were also mediated mainly through α1L‐adrenoceptors, with high potency and moderate efficacy. NS‐49 may therefore be useful for the treatment of urinary stress incontinence, with minimal side‐effects because it has subtype selectivity.
Evaluation of nuclear matrix protein 22 as a tumour marker in the detection of transitional cell carcinoma of the bladder
Authors: Sánchez‐Carbayo  , Herrero  , Megías  , Mira  , Soria
Published: March 2003

Objectives

 To evaluate the sensitivity and specificity of urinary nuclear matrix protein‐22 (NMP22) in detecting bladder cancer, to compare the diagnostic performance of NMP22 alone and when corrected by urinary creatinine level, and to correlate NMP22 level with the histological and clinical characteristics of bladder cancer.

Patients, subjects and methods

 The study included 267 patients classified into five groups: group 1 comprised 111 patients with active transitional cell carcinoma (TCC) of the bladder; group 2 included 76 patients who had had bladder TCC but were being followed and were free of disease, as confirmed by cystoscopy; group 3 comprised 25 patients with benign urological diseases; group 4 included 25 patients with other malignant pathological conditions; group 5 constituted a control group of 30 healthy subjects free of urological diseases. Urinary NMP22 was measured using an enzyme‐linked immunosorbent assay. Receiver operating characteristic (ROC) curves were constructed to obtain the thresholds which gave optimal sensitivity and specificity for combinations of NMP22 alone and when corrected by urinary creatinine level. Stage, grade, tumour size, pattern of growth, focality and the presence of recurrence were recorded and their associations with NMP22 evaluated.

Results

 The mean levels of NMP22 were 122.8, 5.1, 3.7, 2.3 and 0.3 U/mL for groups 1–5, respectively; overall, these values were significantly different (P<0.001). The mean (95% CI) optimal combination of 78.2% (69.3–85.5) sensitivity and 95.5% (87.3–99.0) specificity was obtained from the ROC analysis with a threshold value of 13.7 U/mL NMP22. When values were corrected by urinary creatinine levels, the threshold given by the best combination of sensitivity and specificity, at 73.2% (63.2–81.7) and 97.0% (89.6–99.5), respectively, was 3.0 U/mg creatinine. NMP22 level was statistically associated with stage, grade, tumour size and focality.

Conclusions

 Urinary NMP22 appeared to be a potential tumour marker for detecting TCC of the bladder; when corrected by urinary creatinine level, it might provide a better interpretation than when used alone. NMP22 correlated with the most relevant variables in bladder cancer. As a noninvasive adjunct, NMP22 might have a role in guiding urologists about the need for cystoscopy in such patients.
Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy
Authors: Asgari  , Safarinejad  , Hosseini  , Dadkhah
Published: March 2003

Objective

 To evaluate the safety of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL) during pregnancy.

Patients and methods

 Data from 824 women of reproductive age who were treated by ESWL were analysed and the patients surveyed using a questionnaire about pregnancies, to which 636 (76%) responded. Of these patients, six had inadvertently undergone ESWL for renal stones during the first month of pregnancy. The stones were detected and located during ESWL using ultrasonography.

Results

 The six patients gave birth to six children who had no detectable malformations or chromosomal anomalies.

Conclusion

 Although these results suggest that there were no adverse effects of ESWL during early pregnancy, a larger series should be assessed to confirm the safety and long‐term effects of ultrasound‐guided ESWL in the treatment of renal calculi during pregnancy. We do not advocate lithotripsy as a treatment for renal calculi in pregnancy, but inadvertent lithotripsy in a pregnant woman is not a cause for concern.
Purinergic sensory neurotransmission in the urinary bladder: an in vitro study in the rat
Authors: Namasivayam  , Eardley  , Morrison
Published: March 2003

Objectives

 To determine the response of mechanosensitive pelvic nerve afferents, arising from the rat urinary bladder, to the purinergic agonist α,β‐methylene ATP and to the purinergic antagonist suramin.

Materials and methods

 Using a newly developed in vitro bladder‐pelvic nerve afferent model, multiunit recordings were taken from mechanosensitive pelvic nerve afferents arising from the rat urinary bladder, in response to bladder distension. Control experiments were performed by distending the bladder with saline at 0.04 mL/min, and recording the total afferent nerve activity and the bladder pressure response to the distension. Bladder distensions were then repeated using a solution of the stable purinergic agonist α,β‐methylene ATP (10 μmol/L), which is known to desensitize P2X‐purinoceptors after prolonged exposure, and the total afferent activity and bladder pressure response were again measured. In a separate series of experiments the afferent nerve activity and bladder pressure response to bladder distension with saline was determined in the presence of the purinergic antagonist suramin (10 μmol/L) and repeated after washout of the drug. In both series of experiments, afferent nerve responses were compared with control using the paired t‐test, whilst the bladder pressure responses were compared using one‐way analysis of variance.

Results

 Bladder distension with α,β‐methylene‐ATP produced a statistically significant reduction in afferent nerve activity, by up to 75% compared with the control, whilst having no significant effect on the bladder pressure response. Bladder distension with saline in the presence of suramin (10 μmol/L) produced a significant reduction in the resultant afferent nerve activity, by 50%, which returned to normal after washout of the drug.

Conclusion

 These findings are consistent with the notion that ATP is released endogenously during bladder distension in the rat and is involved significantly in the activation of pelvic nerve afferents arising from the rat urinary bladder.
Time‐dependent up‐regulation of endothelin‐A receptors and down‐regulation of endothelin‐B receptors and nitric oxide synthase binding sites in the renal medulla of a rabbit model of partial bladder outlet obstruction: potential clinical relevance
Authors: Khan  , Dashwood  , Thompson  , Mumtaz  , Mikhailidis  , Morgan
Published: March 2003

Objective

To assess the density of endothelin (ET) receptors (ET‐1 is a potent vasoconstrictor peptide acting on two known receptors, ETA and ETB ) and nitric oxide synthase (NOS) binding sites in the kidney of a rabbit model of bladder outlet obstruction (BOO).

Materials and methods

Partial BOO was created in adult New Zealand White rabbits; after 1, 3, 4 and 6 weeks of BOO, kidney sections were incubated with radioligands for ET‐1, ETA , ETB receptors and with [3H]‐NOARG (a ligand for NOS). Autoradiographs were generated and analysed densitometrically. Sections were also assessed by NADPH histochemistry. Plasma creatinine, urea and electrolyte levels were regularly monitored. The control and 6‐week BOO kidneys were also evaluated ultrastructurally by electron microscopy.

Results

There was no significant change in plasma creatinine, urea and electrolyte levels. ETA and ETB receptor density was significantly greater in the medulla than in the cortex (P<0.001) in all animals. There was an up‐regulation of ETA receptors (P=0.03) and down‐regulation of ETB receptors (P=0.03) and NOS binding sites (P<0.001), as well as decreased NADPH staining in the medulla of 6‐week partial BOO kidneys. Electron microscopy detected glomerular disruption of the obstructed kidneys.

Conclusion

The time‐dependent changes in ETA and ETB receptors, NOS binding sites and NADPH staining in the renal medulla, as well as ultrastructural changes, occur despite normal renal function. These changes appear to be an early event and may play a role in the development of renal failure. Hence, the use of ETA receptor antagonists at this early stage may prevent the development of renal failure/impairment in BOO.
Does anaesthetic technique affect the outcome after transurethral resection of the prostate?
Authors: Reeves  , Myles
Published: March 2003

Objective

To determine if the choice of anaesthetic (spinal or general) has any influence on outcomes after transurethral resection of the prostate (TURP).

Patients and methods

The records of 261 patients undergoing TURP between October 1995 and July 1998 were selected for a matched‐cohort study. There were 87 complete datasets for cases performed under general anaesthesia and each was matched to two patients (174) from those undergoing spinal anaesthesia. The cohorts were matched by age, physical status score and date of operation. The primary outcome measures were length of stay in the recovery room and satisfaction with postoperative analgesia.

Results

There were no significant differences in major outcomes. There was a higher incidence of some minor adverse events in the group having general anaesthesia. Back pain was more common after spinal anaesthesia.

Conclusion

Spinal anaesthesia was not associated with an improved outcome after TURP. The choice of anaesthesia should be made by the patient, surgeon and anaesthetist on the basis of the known risks of particular adverse events.
Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes
Authors: Semmens  , Wisniewski  , Bass  , Holman  , Rouse
Published: March 2003

Objective

To compare the risk of repeat prostatectomy for benign prostatic hyperplasia (BPH) in a population‐based cohort of 19 598 men in Western Australia treated by transurethral resection of the prostate (TURP) or open prostatectomy over a 16‐year period.

Patients and methods

The Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records and prostate cancer registrations for men who had prostate surgery for BPH in 1980–95. The cumulative incidence of first repeat prostatectomy calculated using the actuarial life‐table and incidence‐rate ratios of the first repeat prostatectomy, comparing TURP and open prostatectomy, were obtained using Cox regression.

Results

The cases comprised 18 464 TURPs and 1134 open prostatectomies, from which there were 1095 subsequent repeat prostatectomies. After adjustment for calendar time, age and admission type, the incidence rate of the first repeat prostatectomy was up to 2.30 times higher (95% confidence interval, 1.62–3.27) after initial TURP than for initial open prostatectomy. The absolute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatectomy.

Conclusion

The absolute risk of a repeat prostatectomy for TURP and open prostatectomy were consistent with the best reported international experience. There was evidence that the risk in 1990–95 had declined compared with earlier periods, despite a shift towards more closed procedures. The differential risks of repeat prostatectomy should be explained to patients and considered in the development of clinical guidelines, notwithstanding the advantages of TURP over open prostatectomy in terms of surgical morbidity and cost.
Anaemia in men receiving combined finasteride and flutamide therapy for advanced prostate cancer
Authors: Ornstein D.K. , Beiser J.A. , Andriole G.L.
Published: March 2003

Objective

To determine the effect of combined finasteride and flutamide therapy on haemoglobin and haematocrit values in men with advanced prostate cancer.

Patients and methods

Nineteen men, previously untreated by hormone therapy, with histologically confirmed adenocarcinoma of the prostate and clinical evidence of advanced disease, were treated with combined finasteride (5 mg/day) and flutamide (750 mg/day) for at least 6 months. Complete blood counts were performed before initiation and after 6 months of therapy.

Results

After 6 months of finasteride and flutamide therapy both haemoglobin levels and haematocrit decreased in all men, with a mean (sd, range) decrease of 16 (10, 3–42) g/L and 4.6 (2.7, 0.8–9.9)%, respectively.

Conclusion

Combined finasteride and flutamide therapy significantly lowers haemoglobin and haematocrit levels in men with advanced prostate cancer, and further study of this effect is warranted.
Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation
Authors: Moore K.N. , Griffiths D. , Hughton A.
Published: March 2003

Objectives

To assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy.

Patients and methods

Sixty‐three men with urinary incontinence ≥ 8 weeks after radical prostatectomy were randomized to one of three groups; group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME); or group 3, PME plus electrical stimulation (PME+ES). Group 1 received verbal and written instructions about postoperative PME from their urologist and from the nurses at the pre‐admission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24‐h pad test, two validated quality‐of‐life questionnaires and a urine symptom inventory, all obtained at baseline, 12, 16 and 24 weeks after enrolment. The final pad test was carried out ≈8 months after surgery.

Results

Fifty‐eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3; five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F=0.16, P=0.69). There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis.

Conclusions

From the initial assessment to the final pad‐test at ≈8 months after surgery, incontinence improved greatly in all three groups. This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone‐based follow‐up soon after discharge may alleviate many of the concerns expressed.
Increased expression of endothelin B receptors in the diabetic rabbit urinary bladder: functional relevance
Authors: Mumtaz F.H. , Dashwood M.R. , Thompson C.S. , Sullivan M.E. , Mikhailidis D.P. , Morgan R.J.
Published: March 2003

Objectives

To determine the effect of diabetes mellitus on the density and distribution of endothelin A (ETA ) and endothelin B (ETB ) receptor subtypes in the rabbit urinary bladder, and to assess the in vitro functional properties of endothelin‐1 (ET‐1) receptors in bladder smooth muscle strips from diabetic and healthy rabbits.

Materials and methods

Diabetes mellitus was induced in six male New Zealand White rabbits with alloxan and their urinary bladders excised 6 months after the induction of diabetes. On serial detrusor and bladder neck sections, low‐ and high‐resolution autoradiography was performed using radioligands for ET‐1, ETA and ETB receptors; these sections were then analysed densitometrically. The results were compared with those from six age‐matched healthy control rabbits. Functional responses were investigated using isometric tension studies.

Results

ETA and ETB receptor binding sites were localized to both the urothelium and smooth muscle of the detrusor and bladder neck. There were significantly more ETB receptor binding sites in the diabetic detrusor and bladder neck sections than in controls. ET‐1 smooth muscle contractile responses were ETA receptor‐mediated. The smooth muscle contractile responses to ET‐1 were unaltered in the detrusor, but significantly impaired in the bladder neck of diabetic animals compared with controls.

Conclusion

Alteration in the expression of ETB receptors and in vitro contractile smooth muscle responses to ET‐1 in the diabetic rabbit urinary bladder neck may play a role in the pathophysiology of diabetic cystopathy.
A pilot study for a randomized controlled trial comparing the efficacy, safety and cost‐effectiveness of surgical treatments of the prostate
Authors: Bryan  , Byrne  , Hastie  , Anderson  , Moore  , Chapple
Published: March 2003

Objective

To assess the numbers of men in outpatients and subsequently undergoing transurethral resection of the prostate (TURP) who were referred during 1993–94 and 1996–97, thereby assessing the feasibility of a subsequent study of treatment efficacy in men with bladder outlet obstruction secondary to benign prostatic hyperplasia, prospectively randomized to the surgical treatment options, i.e. TURP, laser ablation of the prostate, transurethral needle ablation and T3 thermotherapy, to investigate treatment outcome, cost‐efficacy and cost‐benefit.

Patients and methods

All patients considered and consenting for prostate surgery were reviewed prospectively with a view to inclusion in the proposed trial. The diagnosis was based on two estimates of flow rate from voids of >150 mL and from symptoms assessed using the International Prostate Symptom Score. All patients had TURP explained by a urological surgeon and nursing staff, and subsequently had further consultation with research staff.

Results

Patients seen in clinic as new referrals increased by 11% between the periods assessed, although the numbers undergoing TURP decreased by 19%. Of the 383 patients screened, who were on the waiting list for TURP, only 13 elected to enter the trial. Of the 383 men, 267 (67%) ultimately had prostate surgery, with 39 (10%) electing to continue with watchful waiting and 34 (9%) continuing with pharmacotherapy.

Conclusion

Although more men with benign prostatic disease and lower urinary tract symptoms are being seen in clinics, the reduced proportion of patients continuing to surgical intervention will lead to increasing difficulty in carrying out randomized controlled clinical trials assessing surgical options. With ever more therapeutic options available, patients find it difficult to make decisions in both the clinical situation and when asked to enter a trial. Fully informed decisions by both the surgeon and the patient will only be possible when objective data are available from trials that investigate outcome, cost‐efficacy and cost‐benefit. This study suggests that when presented with more information and counselling, fewer men decide to undergo prostate surgery for symptomatic BPH.
An assessment of the immunological environment based on intratumoral cytokine production in renal cell carcinoma
Authors: Onishi  , Ohishi  , Imagawa  , Ohmoto  , Murata
Published: March 2003

Objective

To assess the immunological relationship between tumour and host, focusing on the production of T‐cell helper (Th) subset‐derived cytokines in patients with renal cell carcinoma (RCC).

Patients and methods

The study comprised 35 patients (19 men and 16 women, mean age 56.9 years, range 39–78) with RCC, who had undergone nephrectomy. Using enzyme‐linked immunosorbent assays, the levels of Th1‐derived cytokines were measured, including interleukin (IL)‐2 and interferon (IFN)‐γ, and Th2‐ derived cytokines, including IL‐4, IL‐5, IL‐6, IL‐10 and others.

Results

There was no detectable IL‐2 or IFN‐γ production (below the detection limit) except in two patients; IL‐4 was produced in 18 patients (51%) and of these, 15 (43%) showed a higher level than the mean. IL‐5 was produced in 12 patients (34%), all of whom showed a higher level than the mean, and IL‐6 was produced in 32 (91%) of whom 10 (29%) showed a higher level than the mean. IL‐10 was detected in 28 patients (80%) of whom 14 (40%) showed a higher level than the mean. The production of these cytokines was closely related to the stage and grade of malignancy. Furthermore, there were significant correlations between the levels of production of IL‐4 and IL‐5 (r2=0.92), IL‐4 and IL‐10 (r2=0.91), and IL‐5 and IL‐10 (r2=0.85).

Conclusion

The intratumoral immunological environment in patients with RCC shows a tendency to produce Th2‐related cytokines in accordance with the stage and grade; this suggests a role in humoral but not in cellular immunity.
The difficult orchidopexy: the value of the abdominal pre‐peritoneal approach
Authors: Adam  , Allaway
Published: March 2003

Objective

To analyse the outcome of using the abdominal pre‐peritoneal (APP) approach to orchidopexy.

Patients and methods

During an 8‐year period, the experience of one surgeon in the management of 553 boys (median age 4.5 years, range 1–13) with undescended testes (596 testes) was assessed. The analysis emphasized those patients who had an orchidopexy performed using the APP approach detailing; the original position of the testis at exploration, whether successful placement within the scrotum was possible, and whether atrophy or ascent of the gonad occurred subsequently.

Results

In 98 boys (110 testes) the testes were impalpable or high within the inguinal canal and they were explored using the APP approach. Of the 34 testes (31%) which were found abdominally, 12 were high intra‐abdominal and the remaining 22 just deep to the internal inguinal ring. These included seven bilateral and 20 unilateral intra‐abdominal testes. The remaining 76 undescended testes included five with bilateral high testes, 29 high unilateral testes, 13 repeat orchidopexies, 17 ‘vanishing testis syndrome’ and seven atrophic testes. The remaining 486 undescended testes were treated using a standard orchidopexy and were therefore excluded from analysis.

Conclusion

The value and advantages of this operative approach and its place in the management strategy of the difficult orchidopexy are discussed.
Metallic stents for malignant and benign ureteric obstruction
Authors: Wakui M. , Takeuchi S. , Isioka J. , Iwabuchi K. , Morimoto S.
Published: March 2003

Objective To report our experience of using metallic stents to treat ureteric obstruction caused by malignant or benign disease.

Patients and methods Nine patients with obstruction in 11 ureters caused by malignant or benign disease (mean age 61 years, range 35–82, mean follow‐up 7 months, range 3–11) were treated using metallic stents. A balloon‐expandable metallic stent was used in one patient and self‐expandable metallic stents in the remaining eight. All stents were inserted via a percutaneous antegrade approach.

Results Of the 11 ureters, nine remained patent with no further manipulation during the follow‐up of 3–11 months. An additional stent was placed in continuity with the first in two ureters of two patients at 4 and 5 weeks after the first procedure because of persistent obstruction. After the second intervention, their obstruction was improved. Transient vesico‐ureteric reflux occurred in two of three stented distal ureters, but the reflux resolved spontaneously within 2 months after stent implantation. Ureteric patency was maintained in all patients and no major complications related to stenting occurred during the follow‐up. Two patients died from cervical cancer at 3 and 5 months after stenting.

Conclusion In patients with difficult ureteric obstructions a metallic stent provides a safe and effective alternative to an indwelling double‐pigtail catheter or percutaneous nephrostomy.
A prospective, controlled, randomized study of the effect of a slow‐release silver device on the frequency of urinary tract infection in newly catheterized patients
Authors: Reiche T. , Lisby G. , Jørgensen S. , Christensen A.‐B. , Nordling J.
Published: March 2003

Objective To test the effect on urinary tract infections (UTIs) in patients needing continuous indwelling catheterization, of a newly designed urine‐collecting system containing an antibacterial device which slowly releases silver ions onto the inner surface of the system.

Patients and methods The study comprised a prospective controlled randomized trial; 213 patients fulfilled the inclusion criteria. They were randomized to a urine drainage system (comprising a Unometer 400 metering system or PP 2000N closed urine‐bag system, both from Maersk Medical, Denmark) either with or without the antibacterial device. The efficacy was assessed as the number of UTIs and the time to infection in the 170 patients eligible for analysis.

Results There were fewer UTIs in those using the system containing the antibacterial device (19% vs 24%), but the difference was not statistically significant (P < 0.05).

Conclusion The potential importance of different infection routes were highlighted, suggesting that modifications to Foley catheters and urine‐collecting systems attempting to prevent UTIs should focus not only on the intraluminal pathway, but on the internal and external pathways of infection.
Heat‐induced apoptosis in human prostatic stromal cells
Authors: Brehmer M. , Svensson I.
Published: March 2003

Objective To determine whether heat, used in transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia and which causes necrotic lesions within the adenoma, induces apoptosis in benign human prostatic stromal cells.

Materials and methods Prostatic stromal cells were cultured from benign human prostatic tissue. The origin of the cells was identified by immunohistochemical staining and transmission electron microscopy. Cell cultures were exposed to moderate hyperthermia (47 °C) for 1 h and any apoptosis detected by light microscopy, transmission electron microscopy and the measurement of induced caspase‐3‐like activity.

Results The cultures contained a mixed population of smooth muscle cells and myofibroblasts. Twenty‐four hours after heat exposure, 76% of the cells were apoptotic and the caspase activity had increased, whereas only 14% of the cells were necrotic.

Conclusion Moderate hyperthermia induces apoptosis in cultured human prostatic stromal cells.
Bladder neck reconstruction in classic bladder exstrophy: the role of osteotomy in the development of continence
Authors: Mathews R. , Sponseller P.D. , Jeffs R.D. , Gearhart J.P.
Published: March 2003

Objective To assess the role of osteotomy at the time of bladder neck reconstruction (BNR) for continence in classic bladder exstrophy, in which closure of the pelvic ring and reconstitution of the pelvic diaphragm may affect eventual continence.

Patients and methods The results of using osteotomy at the time of BNR in 29 children were reviewed. The mean bladder capacity before BNR was 76 mL. The indications for osteotomy were a wide pubic diastasis and a soft intersymphyseal bar. After osteotomy, all children were maintained in external fixation and lower‐extremity traction for 6–8 weeks.

Results Complications of osteotomy were limited to a partial femoral nerve palsy (one patient) and delayed union of fragments (one patient). Complications of BNR included urethral stricture (five patients) and bladder calculi (six patients). Continence results were modest, with 11 of 29 children (38%) dry during the day (dry interval > 3 h) and eight of 29 (28%) dry at night. Eight children had daytime dry intervals of ≈3 h. The mean preoperative bladder capacity in children who were dry both day and night was 101 mL.

Conclusions The preoperative bladder capacity remains a key determinant for the attainment of continence after BNR in the reconstruction of classic bladder exstrophy. Osteotomy allows pelvic closure and thus improves cosmesis of the mons and stabilizes the BNR in patients with a soft intersymphyseal bar, but seems to have no effect on continence when performed at the time of bladder neck plasty.
Effect of age on the responses of rat bladder detrusor strips to adenosine triphosphate
Authors: Kageyama S. , Fujita K. , Suzuki K. , Shinbo H. , Masuda N. , Uchida W.
Published: March 2003

Objective To assess age‐related changes in bladder function using the contractile responses to ATP of detrusor strips from rats of various ages.

Materials and methods Urinary bladders were obtained from male Wistar rats aged 9 weeks (young), 24 weeks (adult) and 24 months (aged). Contractions of urinary bladder muscle strips to ATP were measured isometrically. The size of the initial phasic response and the secondary contractile response that developed after washing out ATP (postwashout contraction) were measured. The magnitudes of the ATP‐induced phasic and postwashout contraction were compared among the age groups. During the contractions, prostanoid concentrations in the organ‐bath medium were measured using an enzyme immunoassay.

Results The ATP‐induced postwashout contraction did not occur after stimulation with KCl or acetylcholine, but was induced by α,β‐methylene ATP. Both the phasic and postwashout contractions were concentration‐dependent. Although the phasic contraction did not change progressively with age, the magnitude and duration of the postwashout contraction increased substantially with age. Nicardipine (a calcium antagonist) slightly inhibited both contractions. Suramin (a nonselective P2‐receptor antagonist) did not significantly inhibit the phasic contraction, but reduced the postwashout contraction. PPADS (a selective P2X receptor antagonist) did not inhibit either contraction. Indomethacin (a prostaglandin synthesis inhibitor) had no effect on the phasic contraction but almost completely blocked the postwashout contraction when added before ATP stimulation, but was less effective when added after ATP. The prostaglandin E2 concentration in the organ bath increased during the postwashout contraction.

Conclusions These findings suggest that the ATP‐induced postwashout contraction is not directly mediated by P2x purinoceptors, but results from the synthesis of prostaglandins, especially E2, which is a sensory autacoid. The age‐linked increase in postwashout contraction may be involved in the changes in sensory and voiding mechanisms seen in the aged urinary bladder.
Urothelium‐preserving augmentation cystoplasty covered with a peritoneal flap
Authors: Oge O. , Tekgul S. , Ergen A. , Kendi S.
Published: March 2003

Objectives To present the results of bladder autoaugmentation covered with a peritoneal flap in patients with bladder dysfunction.

Patients and methods Thirteen patients (seven male and six female, mean age 11.9 years, range 4–25) who underwent autoaugmentation covered with a peritoneal flap were evaluated. Seven had different forms of myelodysplasia, four had spinal cord injury and two had Hinman syndrome as the cause of bladder dysfunction. Indications for augmentation included upper tract deterioration, urinary incontinence and recurrent urinary tract infection, despite anticholin‐ergic therapy.

Results The mean bladder capacity increased by 18.6% after surgery and the mean compliance at capacity increased from 3.4 to 5.8 cmH2O/mL. All patients were incontinent before surgery and continence was achieved in only six afterward. Four patients showed no clinical or urodynamic improvement and required re‐augmentation using intestinal segments. Only three patients needed no anticholinergic therapy after surgery. All four patients in whom the procedure failed had capacities of < 30% of that expected for their age. There were no metabolic problems.

Conclusion Autoaugmentation combined with a peritoneal flap is an easy procedure but the clinical results are poor in some patients, especially those with a small initial bladder capacity. The need for secondary augmentation with enteric segments was common. The use of a peritoneal flap does not appear to increase the capacity and compliance more than is obtained with the classical technique; it may prevent adhesion to the abdominal wall and make a secondary procedure easier. As the increase in capacity and compliance is limited with this technique, a urothelium‐preserving augmentation should be reserved for those bladders with a relatively good initial capacity.
Are dedicated bladder films necessary as part of intravenous urography for haematuria?
Authors: Corrigan N.T. , Crooks J. , Shand J.
Published: March 2003

Objective To determine the use and assess the value of full‐bladder films during intravenous urography (IVU) which, despite the widespread availability of flexible cystoscopy, remain part of IVU in many radiology departments.

Materials and methods A telephone survey of all Scottish radiology departments where IVU is regularly used showed that half routinely included a full‐bladder film in the series. The reports of all IVU over 2 years in the authors’ department were analysed retrospectively. The index urogram of all patients with bladder tumours confirmed during this period was reviewed independently by three observers, and together with the initial radiological reports was correlated with the cystoscopic and histological findings.

Results From 2625 patients, 139 (5.2%) IVU reports commented on the bladder; 1423 patients presented with no haematuria. None of the patients without haematuria, where a comment was made about the bladder, had pathological evidence of a tumour. Overall 121 of 464 (26%) new bladder tumours were diagnosed on IVU before cystoscopy. Multiple tumours were always undetected and large tumours were often overlooked.

Conclusions Despite its continuing popularity, IVU is a poor means of identifying bladder tumours and routine views of the full bladder should be abandoned.
Unconsummated marriage: clarification of aetiology; treatment with intracorporeal injection
Authors: Zargooshi Javaad
Published: March 2003

Objective To clarify the aetiological factors in unconsummated marriage in Iran, and to report the results of intracorporeal injection therapy for erectile dysfunction in these circumstances.

Patients and methods During a 2‐year period, 200 cases of unconsummated marriage were evaluated. A detailed history was obtained to clarify the circumstances of the problem; if simple measures failed to resolve the problem, intracorporeal injection with papaverine ± phentolamine was used.

Results The main factor associated with an unconsummated marriage was the intense social pressure to accomplish hasty coitus with an unfamiliar woman (some men having had no social contact with their new bride) and in the presence of relatives waiting nearby for evidence of the bride's virginity and confirmation of coitus. The initial problem was then further compounded with resultant erectile failure caused by anxiety about sexual performance. Inability to consummate the marriage was caused by premature ejaculation in 23%, erectile dysfunction in 61%, and a combination in 16%; 70% of patients were able to consummate the union after intracorporeal injection with papaverine ± phentolamine.

Conclusions In addition to psychological causes and a lack of sexual education, the social circumstances in which partners are obliged to initiate and complete coitus are important factors in the aetiology of unconsummated marriage. Intracorporeal injection is useful in treating this problem and it should be the therapy of choice for unconsummated marriage in developing countries, where the conditions do not favour psychotherapy and where alternative erectogenic agents are expensive or unavailable.
Safety and efficacy of transurethral resection of the prostate under sedoanalgesia
Authors: Chander J. , Gupta U. , Mehra R. , Ramteke V.K.
Published: March 2003

Objective To assess the safety and efficacy of sedoanalgesia (local anaesthesia with sedation) in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP).

Patients and methods The study comprised 50 patients with BPH, two‐thirds of whom were graded III–IV using the American Society of Anesthesiologists system. All patients had a topical instillation of lignocaine jelly 2% into their urethra, combined with 1% lignocaine (100–200 mg) with 1 : 400 000 adrenaline infiltration of the prostate via the perineal route. Sedation and anxiolysis were obtained with the intramuscular pethidine (0.5 mg/kg) and promethazine (1 mg/kg). Standard TURP was then carried out, with pain monitored during surgery using a visual analogue scale (VAS, maximum 10 points) and the amount of analgesic required after TURP recorded. The amount of prostatic tissue excised, duration of surgery, blood requirement, catheter interval, complications and hospital stay were recorded. The effectiveness of TURP was assessed by comparing symptom scores, uroflowmetry and postvoid residual volume before and after surgery.

Results The mean intraoperative VAS was ≤ 1 at any time during or after surgery; no patient required any postoperative analgesics. Only two patients complained of discomfort during the procedure and even they were comfortable after a supplemental dose of pethidine (12.5 mg). There were no conversions to general or regional anaesthesia. No blood transfusion was required in any patient. All patients began a normal diet 30 min after surgery and all were discharged within 48 h of surgery. There were no deaths; one patient had transient urinary incontinence and three had mild urinary tract infection.

Conclusion Sedoanalgesia was an effective, safe and simple alternative to general or regional anaesthesia for TURP in patients with BPH.