bluuebunny/crossref_metadata_2025 huggingface dataset:
An Experimental Model of Detrusor Instability in the Obstructed Pig
Authors: SIBLEY G. N. A.
Published: November 2008

Summary— Bladder outflow obstruction was produced in 18 young male pigs using either a silver ring or a silk ligature placed around the proximal urethra. Normal growth of the animals resulted in progressive obstruction. This was monitored by urodynamic studies in conscious animals, using either long‐term indwelling bladder cannulae or by intermittent suprapubic catheterisation.

At urodynamic assessment 3 to 5 months later, the obstructed pigs voided at an elevated pressure and with a diminished flow rate compared with control animals. Sixty‐four per cent of the obstructed pigs developed detrusor instability, with spontaneous contractions exceeding 15 cm H2O during bladder filling; another 14% had decreased bladder compliance. In control animals the filling cystometrogram was stable, with little pressure rise during filling and no spontaneous contractions.

This animal model provides the opportunity to study the physiological changes responsible for the development of detrusor instability in the obstructed bladder. It may also be useful for evaluating new treatment regimes for detrusor instability.
Bladder Neck Contracture Following Prostatectomy
Authors: SIKAFI Z. , BUTLER M. R. , LANE V. , O'FLYNN J. D. , FITZPATRICK J. M.
Published: November 2008

Summary— In an 11‐year period, 49 patients developed bladder neck contracture after prostatectomy—an incidence of 0.86%. This complication was found to be more common after resection of small fibrous hyperplastic prostates. The best results for treatment of the contracture were obtained after bladder neck incision, which gave a 9% incidence of recurrence; after transurethral resection of the bladder neck contracture the recurrence rate was 46%, and after bladder neck dilatation it rose to 100%.
Use of a Ureteric Nipple in the Surgical Management of Bilharzial Ureteric Strictures
Authors: ELEM B.
Published: November 2008

Summary— Experience in the use of a ureteric nipple in ten patients with bilharzial strictures of 1 5 ureters is presented. It is recommended that this method should be the procedure of choice in the surgical management of selected cases of bilharzial ureteropathy. The need for further experience in its use in calcified ureters is stressed.
Transurethral Resection of the Prostate and Bladder Neck Incision: a Review of 700 Cases
Authors: EDWARDS L. E. , BUCKNALL T. E. , PITTAM M. R. , RICHARDSON D. R. , STANEK J.
Published: November 2008

Summary— Transurethral resection (TUR) is regarded as the treatment of choice for relief of outflow tract obstruction in the male, but bladder neck incision (BNI) is an acceptable alternative when the gland is small.

Seven hundred cases of TUR/BNI have been reviewed (TUR = 388; BNI = 312). BNI was performed when the gland was less than 35 g and where there was no clinical suspicion of malignancy. The operative details of our single incision technique are given.

While the patients in the BNI group were younger, catheter stay was shorter, there was less infection, a significantly reduced need for blood transfusion and a satisfactory outcome in terms of control and need for further surgery.

BNI is a technically simpler procedure than TUR and is easy to teach and learn. Results show it is safe and effective for patients in acute retention as well as those treated electively and it is the operation of choice for small benign prostates.
The Control of Male Stress Incontinence by Implantable Prostheses
Authors: FOWLER J. W. , AULD C. D.
Published: November 2008

Summary— Twenty‐six patients were treated by implantable prostheses in a 10‐year period, 22 by primary Kaufman Ill and four by primary Rosen. Sixteen of 22 patients having the Kaufman Ill procedure were cured or markedly improved over a follow‐up period of 6 months to 10 years. The Rosen prosthesis, whilst simple to install and making the patient continent, eventually produced urethral fistulae in all cases. The Kaufman Ill prosthesis appears to be the procedure of choice in uncomplicated male stress incontinence.
A Pararenal Pseudocyst of Unusual Aetiology
Authors: WORRELL J.
Published: November 2008

Pararenal pseudocysts are well recognised following blunt abdominal trauma, and may also occur after surgery to the upper renal tract (Hudson and Hundley, 1967) or above an impacted calculus (Leemans and Kotowicz, 1977). This report describes such a cyst arising after colonic surgery.
Pressure Changes in the Dilated Upper Urinary Tract on Perfusion at Varying Flow Rates
Authors: LUPTON E. W. , HOLDEN D. , GEORGE N. J. R. , BARNARD R. J. , RICKARDS D.
Published: November 2008

Summary— The conventional Whitaker test assesses the pressure response to a constant perfusion rate of 10 ml/min. Twenty‐eight kidneys were perfused at increasing flow rates up to 20 ml/min. Nine became obstructed at rates of 12 to 20 ml/min. The feasibility of such a high urine output has been tested and confirmed. The standard Whitaker test may therefore miss some cases with potentially obstructive hydronephrosis, the effects of which may be deleterious to renal function.
Cord Compression and Carcinoma of the Prostate: is Laminectomy Justified?
Authors: IACOVOU J. W. , MARKS J. C. , ABRAMS P. H. , GINGELL J. C. , BALL A. J.
Published: November 2008

Summary— Metastatic carcinoma of the prostate is a common cause of spinal cord compression. In this review of 37 men who underwent laminectomy for this condition this was the first presentation of previously undiagnosed cancer in 11 (29%).

One year after decompression 17 (50%) were alive. Twenty patients (59%) could walk after laminectomy. All but 8 were relieved of pain and bladder function was improved in 1 3 (38%). Those ambulant before laminectomy (7) and those with occult prostate cancer did particularly well. Poor results were associated with a rapid onset of paraparesis and pre‐operative progression to paraplegia. A delay in diagnosis was detrimental to outcome.

A high index of suspicion in patients with carcinoma of the prostate is essential so that early diagnosis can be made before paraplegia is established. Carcinoma of the prostate must always be excluded in men with cord compression of unknown aetiology.
Urinary Tract Lymphoma
Authors: LEWI H. J. E. , STEWART I. D. , SEYWRIGHT M. , FLEMING S. , DEANE R. F. , KYLE K. F.
Published: November 2008

Summary— Urinary tract involvement by non‐Hodgkin's. lymphoma is uncommon and whilst extranodal disease may be the first manifestation of NHL in 15% of patients, the primary site of origin of NHL in the urinary tract is very rare. At the time of diagnosis, apparently primary urogenital lymphoma is often widely disseminated, with a correspondingly poor prognosis.
Epidermoid Cyst of the Testis: a Critical Analysis
Authors: MALEK R. S. , ROSEN J. S. , FARROW G. M.
Published: November 2008

Summary— Our experience with 163 patients (11 from our institution) with simple epidermoid cyst of the testis was analysed. The lesion is nearly as common as interstitial cell tumour of the testis. In its simple form it is a benign lesion that usually appears as a solitary, asymptomatic, testicular, 2‐cm mass in non‐black young men (usually 20 to 40 years of age). It has been suspected on circumstantial clinical evidence in a few patients (17.5%) who have been successfully treated by simple enucleation. In the majority, however, fear of looking for a zebra in a herd of horses or not thinking of zebras at all has led to radical orchiectomy. None of the 80 patients followed up for a maximum of 37 years has suffered any ill effects.
Fracture of the Penis and Long‐term Results of Surgical Treatment
Authors: ÖZEN H. A. , ERKAN I. , ALKIBAY T. , KENDI S. , REMZI D.
Published: November 2008

Summary— Twenty‐five patients with fracture of the penis were treated surgically between 1 968 and 1984. Long‐term follow‐up was obtained in 17. In no case were there any early post‐operative complications.

All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.
Rice‐bran Treatment for Calcium Stone Formers with Idiopathic Hypercalciuria
Authors: EBISUNO S. , MORIMOTO S. , YOSHIDA T. , FUKATANI T. , YASUKAWA S. , OHKAWA T.
Published: November 2008

Summary—
The efficacy of rice‐bran therapy was studied in patients with hypercalciuria who were suffering from calcium stones. The frequency of stone episodes was reduced dramatically, especially in “active recurrent stone formers”. Urinary calcium excretion was considerably reduced, while urinary phosphate and oxalate were slightly increased. Urinary magnesium, uric acid, serum calcium, phosphate, magnesium and uric acid were not affected. There were no changes in serum iron, copper and zinc even when patients were treated for long periods. The treatment was tolerated well and there were no serious side effects. Rice‐bran therapy is particularly useful in patients with hyperabsorptive hypercalciuria and it is effective in the prevention of recurrent urinary stone disease.
Microproteinuria in Children with Vesicoureteric Reflux
Authors: BELL F. G. , WILKIN T. J. , ATWELL J. D.
Published: November 2008

Summary—
Microproteinuria was assessed by the measurement of albumin, retinol binding protein (RBP) and creatinine concentrations in random midstream urine samples using a single enzyme linked immunoassay (ELISA) in 36 children with vesicoureteric reflux (VUR) and 36 control patients. Infection was excluded by culture and microscopy of the specimens of urine. No patient was hypertensive. Albumin excretion increased in patients with increasing severity of VUR and with renal scarring. Similar findings were observed with RBP excretion. The results show that glomerular and tubular handling of proteins is altered in VUR. The degree of microproteinuria correlates well with the severity of the VUR and is evidence of tubular dysfunction. The effects of medical management and anti‐reflux surgery on microproteinuria require further evaluation.
Complex Urinary Undiversion
Authors: MUNDY A. R. , NURSE D. E. , DICK J. A. , MURRAY K. H. A.
Published: November 2008

Summary—
Thirty‐one previously diverted patients with various complex lower urinary tract problems have been undiverted with simultaneous reconstruction of the anorectum and vagina when these structures were also affected. No patient Was denied undiversion on the basis of pelvic pathology. The only contraindications were a lack of motivation and when the patient's general condition, intelligence and mobility made it an unrealistic proposition.
Comparison of Long‐term Monitoring and Standard Cystometry in Chronic Retention of Urine
Authors: A. STYLES ROSEMARY , NEAL D. E. , RAMSDEN P. D.
Published: November 2008

Summary—
Twenty‐eight men with chronic retention of urine were investigated by means of a standard medium fill cystometrogram and by long‐term monitoring of bladder pressure whilst the bladder filled naturally.

Effective cystometric capacity was greater in each patient during standard cystometry (297 ± 180 ml) than during long‐term monitoring (99 ± 100 ml; p < 0.002). The incidence of detrusor instability was also greater during long‐term monitoring than during standard cystometry (p < 0.02).

During filling, the detrusor pressure increased significantly both in standard cystometry (27.9 ± 22.8 cm H2 O; p < 0.002) and in long‐term monitoring (4.9 ± 6.5 cm H2 O; p < 0.002). The detrusor pressure rise during filling was significantly greater during the standard cystometrogram than during long‐term monitoring (p < 0.00). Even when the detrusor pressure rise was corrected to take account of the different cystometric capacities this difference persisted (p < 0.05).

High end filling pressures are common in men with chronic retention investigated by means of a standard cystometrogram but are not observed during long‐term monitoring. Such high pressures are probably due to the unphysiological rates of filling and the large volumes of fluid instilled during standard cystometry.
Non‐invasive Measurement of Intravesical Pressure
Authors: SETHIA K. K. , SMITH J. C.
Published: November 2008

Summary—
A simple non‐invasive method is described for measuring intravesical pressure in patients with chronic retention of urine.
Biochemical Monitoring of Carcinoma of Prostate Treated with an LH‐RH Analogue (Zoladex)
Authors: SIDDALL J. K. , HETHERINGTON J. W. , COOPER E. H. , NEWLING D. W. W. , ROBINSON M. R. G. , RICHARDS B. , DENIS L.
Published: November 2008

Summary—
The levels of prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP), both measured by radioimmunoassay, and two cancer indices given by the ratio of serum alpha‐I acid glycoprotein to prealbumin (AGP: Palb) and alpha)‐1 acid glycoprotein to alpha‐2 HS globulin (AGP:HS) were evaluated as markers to assess the response of prostatic cancer to treatment with Zoladex, an LH‐RH agonist.

A rise in PSA and PAP occurred in 8/65 patients (12%) during the initial induction phase. In metastatic disease prior to treatment none of these indices was significantly different between patients who attained a sustained response and those whose response was nil or only transient. Responders and non‐responders could, however, be distinguished by the levels of various analytes after treatment. At 6 months the median PSA in those who responded was 2.5 ng/ml compared with 51.5 ng/ml in the non‐responders. At 12 months the figures were 3.0 and 155 ng/ml respectively. The corresponding median PAP levels were 1.4 and 19 ng/ml at 6 months and 1.3 and 18 ng/ml at 12 months. The AGP: Palb ratio was also significantly different in these two groups at 6 and 12 months.

PSA appears to be the most sensitive indicator of the response to treatment. The likelihood of obtaining a prolonged clinical response can be assessed within 6 months of the start of treatment.
An Ecological Study of Infected Urinary Stone Genesis in an Animal Model
Authors: NICKEL J. C. , OLSON M. , McLEAN R. J. C. , GRANT S. K. , COSTERTON J. W.
Published: November 2008

Summary— Direct molecular and morphological techniques of modern microbiology were used to monitor the sequential development of bacterial microcolonies and biofilms in a rat model of urinary infection and to demonstrate that the urease activity of the infecting organisms sets in course a series of reactions in which struvite and apatite crystals develop within the matrix of the enlarging bacterial aggregate. This forms multiple stone nidi on the uroepithelial surface upon which succeeding bacterial biofilms develop and with the incorporation of other urine components, such as urinary mucroproteins, establishes a matrix skeleton that becomes mineralised, thus allowing for the growth of the stone in concentric layers.

To arrive at this hypothesis, we studied infection stone genesis using a newly developed model for infection‐induced bladder stone formation in the rat. We examined in detail the sequential events in the evolving microbial ecology of progressive struvite calculogenesis, using conventional microbiological techniques, direct ultrastructural observation, newly developed ultrastructural cytochemical localisation techniques and immunological procedures for stabilisation of the biofilm glycocalix and stone matrix in the rat model. It was concluded that the organic glycocalix material secreted by the associated bacteria comprises a substantial and aetiologically important part of the infection stone calculogenesis and matrix production.
Eicosanoid Synthesis by Human Urinary Bladder Mucosa: Pathological Implications
Authors: JEREMY J. Y. , TSANG V. , MIKHAILIDIS D. P. , ROGERS H. , MORGAN R. J. , DANDONA P.
Published: November 2008

Summary— Biopsies of human urinary bladder mucosa obtained during cystoscopy were shown to release eicosanoids in the following order: prostacyclin (PGI2), prostaglandin E2 (PGE2), prostaglandin F2x (PGF2x) and thromboxane A2 (TXA2). The total and the relative amounts of eicosanoids released were similar to those reported for the rat urinary bladder. These eicosanoids may play a role in modulating the tone and contractility of the bladder as well as affecting cytoprotection of the mucosa. In view of the abundant release of eicosanoids by the bladder, caution must be exercised when considering urinary eicosanoid excretion as reflecting production by the systemic vasculature and/or the kidneys.
Bilharziasis in Malignant Tumours of the Urinary Bladder
Authors: AL‐SHUKRI S. , ALWAN M. H. , NAYEF M. , RAHMAN A. A.
Published: November 2008

Summary— In a review of 2248 cystoscopic examinations conducted over 10 years, malignant tumours of the urinary bladder were found in 172 patients. In 128 of these the condition was associated with bilharziasis. The lateral wall of the bladder was the commonest site (52.3%).

Squamous cell carcinoma occurred in 78.1%. Forty‐nine patients refused surgery and eight were found to have advanced inoperable tumours. Seventy‐one patients had a total cystectomy. There were no operative deaths but post‐operative complications occurred in nine cases. Eight patients died within 2 years but 21 were well and tumour‐free at 5 years.

It was concluded that there is a marked association between bilharziasis and bladder cancer. When the tumour is operable, cystectomy is the treatment of choice.
Testicular Tumour Markers in Spermatic Vein Blood
Authors: LIGHT P. A. , TYRRELL C.J.
Published: November 2008

Summary— The markers for testicular cancer, alpha‐fetoprotein and human chorionic gonadotropin, were measured in spermatic vein and peripheral blood taken at the time of orchiectomy. In all cases where markers were produced by the tumour, concentrations were found to be higher in spermatic vein than in peripheral blood, presumably because the former drains from the site of the tumour and dilution in the circulation has not yet occurred. Such measurements could be of particular value in patients whose tumours produce such small amounts of marker(s) that they are below the level of detection in peripheral blood.
Surgical Salvage of Advanced Testicular Tumours
Authors: EWING R. , HETHERINGTON J. W. , JONES W. G. , WILLIAMS R. E.
Published: November 2008

Summary— After combination chemotherapy, 19 patients underwent salvage surgery for testicular neoplasia. Active malignancy was found in nine patients, three of whom have died of the disease. Those with benign residual disease have had a good prognosis without further treatment. Biopsy alone of the residual masses proved reliable in determining which patients were to be simply followed or given further chemotherapy. If active malignancy was not resected fully, the prognosis was very poor. Our policy continues to be to attempt complete excision of residual masses after induction chemotherapy and to give salvage chemotherapy to patients with residual active malignancy.
Experience with Intracorporeal Injection of Papaverine and Duplex Ultrasound Scanning for Assessment of Arteriogenic Impotence
Authors: COLLINS J. P. , LEWANDOWSKI B. J.
Published: November 2008

Summary— We present our experience with the intracorporeal injection of papaverine and duplex sonography in the assessment of 47 patients with suspected vasculogenic impotence. Sonography and Doppler analysis were performed before and after the papaverine injection. The anatomy of the penis was easily seen. Flow in the deep arteries was obtained in most patients in both the flaccid and erect state. Patients with a good erectile response to papaverine injection had a larger increase in the inner diameter of the deep cavernosal artery than did those with a poor response. However, the percentage change in the diameter did not correlate with the degree of clinical response. Following injection, the systolic peak flow rates and diastolic minimum flow rates were higher in patients with some clinical response but only the increase in diastolic flow rates correlated in a stepwise fashion with the degree of clinical response.

This technique provides a method for the objective assessment of response to intracorporeal papaverine injection. Its potential as a diagnostic test will only be determined after normal values are established. At present it appears most useful in patients responding poorly to papaverine injection by indicating the possible area of vascular impairment and the direction for further evaluation.
Giant Renal Calculus
Authors: MAHANT T. S. , MERWAHA D. C. , GUPTA R. R. , KAPOOR S.
Published: November 2008

Renal calculi weighing more than 100g are rare, since most stones cause arrest of renal function before they reach such proportions. We report a giant renal calculus weighing 2260g; to our knowledge this is the largest reported.
Stomas Continent and Incontinent
Authors: ASHKEN M. HANDLEY
Published: November 2008

Urinary diversion is not a subject for dogmatic or didactic teaching. It requires a wide repertoire of management, ranging from non‐operative conservative treatment to aggressive major surgical procedures, in dealing with a common urological problem.
Management and Early Reconstruction of Urinary Tract Abnormalities Detected in utero
Authors: THON W. , SCHLICKENRIEDER J. H. M. , THON A. , ALTWEIN J. E.
Published: November 2008

Summary— Pre‐natal detection of urinary tract anomalies by ultrasound prevents delay in post‐natal diagnosis and enables appropriate treatment to be instituted for potentially destructive uropathies. Over a 3‐year period 42 cases (60 renoureteric units) of fetal urinary tract abnormality were diagnosed by maternal ultrasound. Sixteen of the 35 survivors underwent corrective urological surgery during the first months of life. Follow‐up studies indicate that this early management results in satisfactory preservation of renal function.
Quantification of Urine Loss by Weighing Perineal Pads. Observation on the Exercise Regimen
Authors: RICHMOND D. H. , SUTHERST J. R. , BROWN M. C.
Published: November 2008

Summary— Two variations on a test for quantifying urine loss in patients with urinary incontinence were compared. In the first series (Padtest 1), 335 patients underwent a 2‐h pad weighing test. A fluid load of 1 litre was administered and followed 1 h later by six separate exercises, each lasting 10 min. One of six sanitary towels was worn during each exercise. Each pad was weighed before and after use to provide information about the severity of the incontinence. In the second series (Padtest 2), 104 patients were studied. The test took the same format but the exercises were rearranged in an attempt to provide information about the importance of the individual exercises. Hand washing was found to be a very provocative test both in women with unstable and those with stable bladders. The order in which the exercises were performed did not influence the overall identification of incontinence in the 2‐h test period, and this supports the conclusion that the optimum length of the test is 2 h.
The Role of Urodynamics in Female Urinary Stress Incontinence
Authors: BYRNE D. J. , STEWART P. A. HAMILTON , GRAY B. K.
Published: November 2008

Summary— The cystometrograms of 61 patients with a history of stress incontinence and no other urinary symptoms were evaluated. Of the sixty‐one patients, seven had unstable bladders and in seven of the patients stress incontinence could not be demonstrated. It was concluded that all patients with stress incontinence in whom surgery is being contemplated should be subjected to urodynamic study regardless of their history.
Urinary Excretion of a Metabolite of Histamine (1,4‐methyl‐imidazole‐acetic‐acid) in Painful Bladder Disease
Authors: HOLM‐BENTZEN M. , SØNDERGAARD I. , HALD T.
Published: November 2008

Summary— Thirteen patients with interstitial cystitis (detrusor mastocytosis) and 12 other patients with painful bladder disease without mastocytosis collected 24‐h urine specimens that were analysed for the major metabolite of histamine, 1,4‐methyl‐imidazole‐acetic‐acid (1,4‐MIAA), by reversed phase ion‐pair high performance liquid chromatography. The median urinary excretion of 1,4‐MIAA was 3.34 mg/24 h (range 1.47–4.66) in the patients with detrusor mastocytosis and 1.75 mg/24 h (range 0.18–4.30) in the other patients with a painful bladder (P<0.01).

It was concluded from this study that patients with a painful bladder and detrusor mastocytosis had a significantly elevated urinary excretion of 1,4‐MIAA compared with other painful bladder patients without mastocytosis, whose urinary excretion of 1,4‐MIAA was within the normal range (0.72–2.34 mg/24 h). We suggest that the urinary excretion of 1,4‐MIAA might be useful in the diagnosis of interstitial cystitis.
Androgen Suppression by Hydrocortisone without Aminoglutethimide in Orchiectomised Men with Prostatic Cancer
Authors: PLOWMAN P. N. , PERRY L. A. , CHARD T.
Published: November 2008

Summary— The effects of hydrocortisone (HC) alone and in combination with aminoglutethimide (AG) have been studied on circulating blood levels of androgens in orchiectomised men with metastatic prostatic cancer. Serum testosterone levels were significantly lower in both early and late hydrocortisone‐treated patients compared with pre‐treatment levels. The regimen of HC + AG increased serum testosterone almost back to pre‐treatment levels. Similar observations were noted with serum androstenedione, dehydroepiandrosterone sulphate and sex hormone binding globulin (SHBG) levels. Clinical responses to hydrocortisone alone have been observed in this series of patients. It is concluded that aminoglutethimide has no place in the therapy of prostatic cancer and that physiological doses of hydrocortisone represent the best second hormonal manoeuvre for prostatic cancer patients.
Idiopathic Urethritis in Male Children
Authors: HARRISON S. C. W. , WHITAKER R. H.
Published: November 2008

Summary— Nineteen cases of idiopathic urethritis affecting male children are presented. Details of the symptoms and the course of the illness are given along with recommendations regarding management. Symptoms usually occurred in a recurrent pattern and lasted, on average, 2 years. The diagnosis was made on clinical grounds after bacterial infection had been excluded; urethroscopy was used to confirm the diagnosis when necessary. The prognosis was generally good, although no specific treatment is available.
Prevention of Xanthine Stone Formation by Augmented Dose of Allopurinol in the Lesch‐Nyhan Syndrome
Authors: HIRAISHI K. , NAKAMURA S. , YAMAMOTO S. , KUROKAWA K.
Published: November 2008

Xanthine stone formation in patients with the Lesch‐Nyhan syndrome who are being treated with allopurinol may be prevented by increasing the dosage of the drug.
The Use of a Rigid Paediatric Resectoscope in the Management of Distal Ureteric Tumours
Authors: GILLON G. , NISSENKORN I. , SLUTZKER D. , SERVADIO C.
Published: November 2008

The field of upper tract intervention and manipulation has gained much popularity in recent years (Bush et al., 1982; Lyon et al., 1984) and the instruments for ureteric endoscopy are quite diverse. The successful use of a paediatric cystoscope and resectoscope in a case of transitional cell carcinoma in the distal diverted ureter is described.
Prediction of Pyelocaliectasis in Follow‐up of Patients with Spinal Cord Injury
Authors: LLOYD L. K. , KUHLEMEIER K. V. , FINE P. R. , McEACHRAN A. B. , STOVER S. L.
Published: November 2008

Summary— Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis.

The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.
Are Biopsies from the Prostatic Urethra Useful in Patients with Superficial Bladder Carcinoma?
Authors: RIKKEN C. H. M. , HELSDINGEN P. J. R. O. VAN , KAZZAZ B. A.
Published: November 2008

Summary— Fifty male patients entered a Mitomycin C trial for superficial bladder cancer and biopsies in the prostatic urethra were taken with a cold cup biopsy forceps. In one patient this procedure failed. In 21 of 49 patients no abnormalities were detected but in the remaining 28 patients (57.1%) histological changes were found in the prostatic urethra. In 13 of these patients (26.5%) the changes were either carcinoma in situ (CIS) or superficial bladder carcinoma.

Carcinoma in situ in the prostatic urethra was found in nine patients (18%) and in all but one it was combined with CIS in the bladder.

These results indicate that biopsies from the prostatic urethra must be taken routinely in order to plan adequate therapy.
Large Leiomyoma of Prostate
Authors: MUZAFER M. H.
Published: November 2008

A leiomyoma of prostate weighing 500 g which presented as an intravesical mass was removed.
Xanthogranulomatous Pyelonephritis in Children and Adults
Authors: KURAL A. R. , AKAYDIN A. , ONER A. , OZBAY G. , SOLOK V. , ORUC N. , EROZENCI A.
Published: November 2008

Summary— Sixteen patients with xanthogranulomatous pyelonephritis (XGP) are reported. The preoperative diagnosis of XGP may be difficult because of its clinical and radiological similarities to various other renal lesions, but in four patients XGP was suspected pre‐operatively. Nephrectomy is necessary in most patients, although medical treatment may help a few.
Intravenous Indomethacin and Oxycone‐papaverine in the Treatment of Acute Renal Colic. A Double‐blind Study
Authors: JÖNSSON P.‐E. , OLSSON A. M. , PETERSSON B.‐Å. , JOHANSSON K.
Published: November 2008

Summary— In a prospective double‐blind, cross‐over study, 61 patients with acute renal colic were treated with either indomethacin (50 mg) or oxycone‐papaverine (5 mg + 50 mg) administered intravenously. For those patients requiring a second injection the drugs were reversed. The intensity of pain was evaluated before and 20 min after each injection according to an analogue visual scale 0 to 100. Both drug regimens provided comparable and significant pain relief; a pain score of <20 appeared to be satisfactory and was achieved in almost all cases.
The Role of Dilatation in Bilharzial Ureters
Authors: WISHAHI M. M.
Published: November 2008

Summary— Endoscopic dilatation of bilharzial ureteric strictures was carried out in 35 men and four women. The procedure had to be repeated in 10 patients after 2 months and three patients have required regular dilatation every 4 months for the last 2 years. The selection of patients is important since they should have neither an active lesion nor a stenotic calcific one.
Disposable Vaginal Surface Electrode for Urethral Sphincter Electromyography
Authors: LOSE G. , ANDERSEN J. T. , KRISTENSEN J. K.
Published: November 2008

Summary— During the last 2 years we have developed a disposable vaginal surface electrode for electromyographic (EMG) recording from the urethral striated sphincter. We describe the design of the electrode and report the results of laboratory testing, including directional selectivity of the electrode, electrode impedance, testing for movement artefacts and stability of position. Clinical studies which included 138 cystometries with sphincter EMG, 133 pressure‐flow EMG studies and four urethral pressure profile studies with sphincter EMG, demonstrated that the electrode gave technically good and reliable electromyographic data. The registration caused no discomfort to the patient and did not disturb the act of micturition. We recommend this technique for the evaluation of urethral striated muscle activity during urodynamic studies in women, since it is simple, inexpensive and reliable.
The Physiological Response of the Detrusor Muscle to Experimental Bladder Outflow Obstruction in the Pig
Authors: SIBLEY G. N. A.
Published: November 2008

Summary—An animal model of bladder outflow obstruction in the pig was used to study the physiological response of the detrusor muscle to obstruction. Bladder muscle strips from obstructed pigs showed a significant increase in sensitivity to acetylcholine and other pharmacological agents compared with controls. In contrast, the response to intramural nerve stimulation was significantly reduced in obstruction, with both cholinergic and non‐cholinergic neurotransmission being affected. These findings are consistent with partial denervation of the bladder as a result of obstruction, with the subsequent development of supersensitivity of the detrusor smooth muscle. The occurrence of detrusor instability secondary to bladder outflow obstruction may represent the clinical manifestation of such physiological changes.
Urological Trauma and Severe Associated Injuries
Authors: MONSTREY S. J. M. , vander WERKEN C. , DEBRUYNE F. M. J. , GORIS R. J. A.
Published: November 2008

Summary— Our experience with 212 cases of urinary tract injury in multiple trauma patients treated between 1972 and 1983 has been analysed and compared with data collected from 441 cases of isolated urinary tract injury during the same period.

The following points are emphasised: (1) incidence and severity of urological trauma in multiple injured patients; (2) obstacles in diagnosis and the need for immediate radiographic assessment; (3) lower urinary tract injuries and the need for urinary diversion; (4) differences in therapeutic approach to renal injuries in multiple trauma patients. We paid special attention to the indication for surgical exploration in patients with a renal laceration and severe associated injuries.
Quantitative Study of Phenol as a Neurolytic Agent in the Urinary Bladder
Authors: PARKHOUSE HELEN FITZMAURICE , GILPIN SALLY‐ANN , GOSLING J. A. , TURNER‐WARWICK R. T.
Published: November 2008

Summary— The endoscopic subtrigonal injection of a 6% aqueous phenol solution is an effective technique for denervating the bladder but its clinical usefulness is limited by unpredictable side effects. This study explored the possibility of making this procedure safer by comparing the neurolytic effects of different concentrations and carriers of phenol. Phenol in 2.5 and 5% solutions in three different carriers (water, glycerine and oil) was injected into the rectovesical pouch in 35 rats. After 3 weeks the bladders were excised and the effects on the density of acetylcholinesterase‐positive nerves were assessed in each animal using morphometric techniques. The density of enzyme‐containing nerves was reduced by 20% in the phenolised animals when compared with controls. This reduction was maximum when water was used as the carrier for either 2.5 or 5% phenol solutions.
Extra‐urethral Ectopic Prostate
Authors: EWING R. , HARNDEN‐MAYOR P. , MASON M. K. , ANDERSON C. K.
Published: November 2008

Summary— Extra‐urethral ectopic prostatic tissue is a distinct entity which has been identified in the bladder of seven patients and may be more common than previously thought. Such tissue probably derives from the subtrigonal glands of Lowsley.
Extracorporeal Shock Wave Lithotripsy. Is Sessional Access Worthwhile?
Authors: RAMSAY J. W. A. , MILLER R. A. , WHITEWAY JANET A. , WHITFIELD H. N.
Published: November 2008

Summary— One hundred and fifty‐three patients with renal stones referred to one teaching hospital have received extracorporeal shock wave lithotripsy (ESWL) treatment as a result of a monthly sessional arrangement organised with a neighbouring lithotripter unit. The results of treatment, assessed 3 months after lithotripsy, showed results comparable with those from any lithotripter centre.

Sessional access for lithotripsy may provide a satisfactory way of increasing the number of patients who are treated with lithotripsy by reducing the demand for beds at the hospitals where a lithotripter is sited.
Pathophysiology of Idiopathic Detrusor Instability and Detrusor Hyper‐reflexia
Authors: KINDER R. B. , MUNDY A. R.
Published: November 2008

Summary— Muscle strips from urodynamically normal bladders and from bladders exhibiting idiopathic detrusor instability or detrusor hyper‐reflexia were compared under isometric conditions in an organ bath. Spontaneous contractions developed more often in unstable and hyper‐reflexic muscle and were of greater amplitude, frequency and basal tension.

Electrical field stimulation caused a frequency‐dependent contraction which was largely abolished by both tetrodotoxin (TTX) and atropine in all three muscle types. Comparison of their frequency response curves demonstrated a significantly greater sensitivity than that of unstable and hyper‐reflexic muscle to low stimulation frequencies.

Acetylcholine caused a dose‐related contractile response in all muscle types. There were no significant differences between the dose response curves of unstable and hyper‐reflexic muscle, and those of normal muscle.

The results suggest that the pathophysiology of the involuntary detrusor contraction is common to both idiopathic detrusor instability and detrusor hyper‐reflexia and that this is related to a disorder of an intrinsic neuromodulatory mechanism within the detrusor muscle.
Mechanisms of Continence during Raised Intraabdominal Pressure
Authors: MASSEY J. A. , ANDERSON R. S. , ABRAMS PAUL
Published: November 2008

Summary— Patients undergoing Stamey endoscopic bladder neck suspension were investigated urodynamically to ascertain the contribution of passive and active components in the maintenance of continence. Transmission of pressure to the proximal urethra was improved by the procedure even under muscular paralysis. This suggests that passive effects due to intra‐abdominal replacement of the urethra are most significant.
Secreto‐motor Function of Intestinal Segments used in Lower Urinary Tract Reconstruction
Authors: MURRAY K. , NURSE D. E. , MUNDY A. R.
Published: November 2008

Summary— Mucus excretion, sialic acid excretion and secretory IgA (slgA) production from patients with a substitution caecocystoplasty (20), augmentation “clam” ileocystoplasty (20) or ileal conduit (10) were measured. Significant amounts of all of these substances were present in the urine of reconstructed patients and showed no evidence of diminution with time. Motility was studied by videocystourethrography. In patients with a neuropathic aetiology the amplitude of contractions was significantly increased and produced incontinence. The results demonstrate that intestinal secreto‐motor function in gut segments incorporated into the lower urinary tract continues normally and must be taken into account when considering the long‐term management of these patients.
The Role of Prostate Specific Antigen in the Baseline Assessment of Patients undergoing Hormone Therapy for Advanced Prostate Cancer
Authors: EMTAGE L. A. , LEWIS P. W. , BLACKLEDGE G. R. P.
Published: November 2008

Summary— One hundred and thirty‐nine patients with advanced prostate cancer were entered into a randomised trial to test the efficacy and tolerance of goserelin 3.6 mg depot (Zoladex) versus stilboestrol 3 mg/day. As well as the usual clinical and radiological assessments of extent of disease, we used an immunoradiometric assay of prostate specific antigen (PSA) (Hybritech Europe) and normal laboratory enzymatic assays of acid phosphatase (AP) and alkaline phosphatase (ALKP) for biochemical assessment. The upper limit of normal for PSA was taken as 10 μg/l.

The range of PSA was wide and differed significantly from that of AP and to a lesser extent ALKP in metastatic cases. PSA outperformed both AP and ALKP in both the local and advanced groups in terms of sensitivity. There was no correlation, however, between histological grade and level of PSA, AP or ALKP (the latter in cases with bone disease). In patients with metastatic disease diagnosed by bone scan, nine patients had one abnormal site/one “hot spot”, and all of these had a PSA greater than twice the normal upper limit. Early death due to prostate cancer was noted in four patients with levels of PSA > 2500 μ/l.

PSA is more sensitive than either enzymatic AP or ALKP in both locally advanced and metastatic prostate cancer and is useful in identifying those advanced cases who have single lesions on bone scan. In this series PSA gave an overall sensitivity of 89%, compared with 63% for AP and 64% for ALKP in patients with metastatic disease.
Treatment of Massive Haematuria with Aluminous Salts
Authors: ARRIZABALAGA M. , EXTRAMINA J. , PARRA J. L. , RAMOS C. , GONZÀLEZ R. DIAZ , LEIVA O.
Published: November 2008

Summary—
Fifteen patients with massive vesical haematuria were treated with a 1% aluminium potassium sulphate solution in sterile distilled water, using continuous intravesical lavage with a double channel catheter. The haematuria was caused by vesical tumours in 13 patients, radiation cystitis in one and transurethral resection in one. Immediate side effects were few and none were noted in the long term, as judged by randomised biopsies from vesical mucosa. A complete response was noted in 66% of the patients, partial response in 15% and failure in 20%.

This treatment is recommended for intractable bleeding from radiation cystitis and bladder
Intrascrotal Adenomatoid Tumours
Authors: KIELY E. A. , FLANAGAN A. , WILLIAMS GORDON
Published: November 2008

Summary—
The adenomatoid tumour occurs in the genital tract of both sexes and is probably of mesothelial origin. We describe its occurrence in five men, two of whom had an intratesticular tumour, and discuss the clinical features of this lesion and the lessons to be learned regarding the management of testicular and paratesticular swellings.
The Effect of Urothelial Damage on Ureteric Motility An Ultrastructural and Functional Study
Authors: UGAILY‐THULESIUS L. , THULESIUS O. , SABHA M.
Published: November 2008

Summary— Evidence of a leaky urothelial barrier in bilharzial uropathy is presented. The ultrastructural basis of this concept is demonstrated together with its functional consequences. The study was conducted on 4 ureters obtained at surgery from patients with non‐functioning kidneys due to chronic bilharzial infections. Six normal ureters from kidney donors served as controls. Light and electron microscopic studies showed a reduced thickness of the transitional epithelium together with localised disruption of intercellular junctions and infiltration of red blood cells. The functional studies involved in vitro demonstration of stable phasic peristaltic contractions which were fundamentally altered by the addition of urine. The changes in motility included increase in contractile frequency and elevation of basal tone, inducing a state of hypermotility which could be equated with ureteric spasm. These changes were partly reversible upon administration of the histamine I‐blocker, mepyramine. Evidence is presented to show that these changes might be induced in vivo by histamine released from mast cells triggered by urine leaking through a damaged urothelial barrier. The functional consequences (pain, spasm) are discussed.
The Evolution of a Biodegradable Membrane for Use in Urological Surgery A summary of 109 in vivo Experiments
Authors: SCOTT R. , MOHAMMED R. , GORHAM S. D. , FRENCH D. A. , MONSOUR M. J. , SHIVAS A. , HYLAND T.
Published: November 2008

Summary— The evolution of a collagen/vicryl composite membrane designed as a prosthetic material for use in urinary tract surgery is described. The early experiments in which collagen film alone was used to repair experimental ureterotomies are reviewed together with our first experiments with the collagen/vicryl prosthesis in the repair of partial nephrectomies and of full thickness defects created in the urinary bladder of experimental rabbits.

These early results led to the preparation of a composite using a more highly purified collagen and employing a method of sterilisation (gamma irradiation) which would be acceptable for regular use in medical products. The results of a further series of partial nephrectomy and full thickness bladder repairs show that irradiation does not compromise the efficacy of the collagen/vicryl composite in vivo.
Neurophysiological Measurements in Patients with Genuine Stress Incontinence of Urine and the Relation of Neurogenic Defects to the Presence of Spina Bifida Occulta
Authors: FIDAS A. , MacDONALD HELEN L. , ELTON R. A. , McINNES A. , BROWN A. , CHISHOLM G. D.
Published: November 2008

Summary— Neurophysiological measurements comprising surface electromyography (EMG) of the urethral and anal sphincters, measurement of the sensory thresholds of the dorsal nerve (DN) of the clitoris and the urethra and sacral reflex latencies from the dorsal nerve to urethra and anus and from the urethra to anus were performed in 44 females with genuine stress incontinence, in order to detect any relationship between the clinical disorder and a neurogenic defect in the innervation of the muscles involved in maintaining continence. Plain X‐rays of the renal tracts (KUB films) were also studied to establish whether the prevalence of spina bifida occulta was increased in this group of patients and was a likely explanation for the nerve defects. Forty‐three patients were found to have abnormal neurophysiological responses and the prevalence of spina bifida occulta was 50%, which compares with a prevalence of 17% in normal female controls. Genuine stress incontinence appears to be at least partly associated with defective innervation of the lower urinary tract and it is likely that in some cases the defect may be related to the presence of spina bifida occulta.
The Relevance of Chlamydia trachomatis in Acute Epididymitis in Young Men
Authors: PEARSON R. C. , BAUMBER C. D. , McGHIE D. , THAMBAR I. V.
Published: November 2008

Summary— Young men presenting to a General Surgical Unit with acute epididymitis underwent microbiological investigation, including culture for Chlamydia trachomatis. The results were compared with similar investigations in an asymptomatic control population and with patients presenting to the Department of Genito‐urinary Medicine with urethral discharge.

Chlamydia trachomatis was cultured from 15% of patients with acute epididymitis and a further 15% had serological evidence of exposure to Chlamydia. Nearly 50% of patients attending the Genito‐urinary clinic grew Chlamydia from the urethra. The background prevalence of Chlamydia in the control population was low.

It is necessary to identify the significant minority of young men with acute epididymitis associated with chlamydial infection, because of the risk of pelvic inflammation and infertility in their female partners. At present this can only be achieved by submitting all young men with acute epididymitis to full microbiological investigation.
Low Sperm Counts as a Prognostic Factor of Progression in Stage I Non‐seminomatous Germ Cell Testicular Tumours
Authors: ONDRUS D. , HORNAK M. , VRABEC J.
Published: November 2008

Summary— The prognostic factors of disease progression were studied in a prospective study in patients with Stage I non‐seminomatous testicular tumours. Patients received no treatment after orchiectomy until progression of disease was confirmed. The results showed a good correlation between sperm counts in semen collected around the time of orchiectomy and progression of disease. While progression of disease occurred in 9 of the 20 patients with sperm counts lower than 10 × 106/ml, it was not found in any of the patients with a sperm count exceeding 10 × 106/ml.
Post‐menopausal Ureteric Endometriosis
Authors: KIELY E. A. , GRAINGER R. , KAY E. W. , BUTLER M. R.
Published: November 2008

Only 6 cases of ureteric endometriosis in postmenopausal women have been reported and in 3 of these oestrogen replacement therapy had been used (Pious et al, 1985; Ray et al, 1985). We report ureteric obstruction secondary to endometriosis in a post‐menopausal woman who had not been treated with exogenous oestrogen.