bluuebunny/crossref_metadata_2025 huggingface dataset:
Suture tracks after hypospadias repair
Authors: Snodgrass
Published: March 2003

Objective

 To determine the incidence of suture tracks after hypospadias repair in which 6–0 chromic catgut was used to close the skin.

Patients and methods

From an initial series of 72 boys undergoing tubularized, incised‐plate hypospadias repair, 23 (32%) were evaluated 1 year or more after surgery.

Results

Of the 23 boys, 10 (43%) were found to have suture tracks. In all cases tracks were located on the ventral shaft skin and did not involve the glans or dorsal aspect of the circumcision. These tracks had not been detected at an earlier follow‐up.

Conclusions

Tracks resulting from small absorbable sutures may not be apparent soon after surgery because the sinus is small. With time, the sinuses fill with keratin and thereby become obvious. The location of these tracks suggests that relative hypovascularity of ventral shaft skin may contribute to their development. The use of subcutaneous sutures may diminish the incidence of this minor complication of hypospadias surgery.
The neonatal management and surgical correction of urinary hydrometrocolpos caused by a persistent urogenital sinus
Authors: Arena F. , Romeo C. , Cruccetti A. , Antonuccio P. , Basile M. , Romeo G.
Published: March 2003

Objective To define the neonatal management and ultimate surgical correction via the anterior sagittal transanorectal approach (ASTRA) in cases of neonatal urinary hydrometrocolpos associated with a persistent urogenital sinus (UGS).

Patients and methods We report three patients with UGS (with no ambiguous genitalia) and urinary hydrometrocolpos in whom prenatal ultrasonography showed cystic dilatation of the pelvis. Two patients were temporarily treated with intermittent vaginal catheterization and antibiotic prophylaxis, and in one a cystostomy was necessary to temporarily drain the urine. At the age of 6–8 months the patients underwent reconstructive surgery of the UGS via the ASTRA, under a previous protective colostomy.

Results The mean (range) age of the patients at the last follow‐up was 18.7 (8–32) months. A good cosmetic result was obtained in all patients. The vagina was dilated briefly with no anaesthesia in each patient. Patients had normal faecal control after the colostomy was closed and none had urinary incontinence.

Conclusions When possible, intermittent vaginal catheterization permits sufficient temporary drainage of the urinary hydrometrocolpos associated with a persistent UGS. Subsequent ASTRA allows good exposure of the UGS, assuring the preservation of the anorectal innervation and of the sphincteric mechanism.
Short‐term morbidity and acceptability of 125iodine implantation for localized carcinoma of the prostate
Authors: Al‐Booz H. , Ash D. , Bottomley D.M. , Carey B.M.
Published: March 2003

Objective

To report the short‐term morbidity and acceptability of the first 50 patients treated with the percutaneous implantation of radioactive iodine seeds for localized carcinoma of the prostate at the Cookridge Hospital.

Patients and methods

Fifty patients were treated with transrectal ultrasonography‐guided percutaneous implants with radioactive (125I) iodine seeds for localized carcinoma of the prostate. The mean hospital stay was 36 h and most patients were able to return to work or normal activity within one week of implantation.

Results

All patients developed urethritis which was most marked within the first 3 months of treatment; 8% of patients developed acute retention which resolved after temporary catheterization. At 3 months, 36% of patients still had moderate frequency and 18% moderate dysuria, but by 12 months these had resolved and only 5% of patients still complained of moderate nocturia. There were no cases of incontinence. The incidence of proctitis was very low, with only 2% still complaining of moderate symptoms at one year. Of those potent before implantation, 72% retained potency at one year.

Conclusions

Although it is too early to comment either on late morbidity or on outcome, the results of this study show a side‐effect profile similar to that reported by other centres using the same technique.
Bladder augmentation with different forms of intestinal grafts: an experimental study in the pig
Authors: Clementson Kockum  , Willén  , Malmfors
Published: March 2003

Objective

To create an experimental animal model to examine changes in bladder volume and histology after bladder augmentation in growing individuals and from the model, evaluate a method using demucosalized intestinal grafts and short‐term bladder drainage.

Materials and methods

The study comprised 21 piglets: in group 1, seven underwent a sham operation; in group 2, seven piglets underwent bladder augmentation with full‐thickness caecum after a major bladder resection; in group 3 seven underwent the same procedure but with demucosalized caecum. The bladder volume and area of the intestinal segment were measured peroperatively and when the animals were killed 2 months later. Bladder specimens were taken for histological examination.

Results

The mean preoperative bladder volumes were similar among the groups; in the control group, volumes increased from 58 to 165 mL and in group 2 from 63 to 255 mL, with an increase in area of the intestinal segment from 59 to 138 cm2 . In group 3 the volume was unchanged, from 63 to 71 mL, with a decrease in area from 58 to 5 cm2 . Control bladders showed normal urothelium with neutral mucins and sialomucins. In group 2, there was metaplasia in the border between urothelium and colonic epithelium, with enhancement of sialo‐ and sulphomucins. Demucosalization resulted in extensive fibrosis, with a monolayer of urothelial cells showing metaplasia.

Conclusions

The experimental model was successful; the observed changes in bladder volume correlated well with the fate of the intestinal implant, because the bladder resection was major. This is essential, as the bladder remnant has some growth potential. Full‐thickness grafts grew faster than the normal bladder. Mechanical demucosalization, including submucosa, results in shrinkage despite short‐term drainage. Glandular metaplasia, with production of sialomucins and sulphomucins, occurs at the junction between bladder and colon, irrespective of mucosal removal.
Results of the Gil Vernet procedure in preventing contralateral reflux in unilateral ureteric reflux
Authors: Liard  , Pfister  , Bachy  , Mitrofanoff
Published: March 2003

Objective

To evaluate whether contralateral meatal advancement based on the technique described by Gil Vernet decreases the risk of postoperative contralateral reflux, which may occur after a unilateral reimplantation.

Patients and methods

From January 1986 to 1997, 321 reimplantations were performed for unilateral vesico‐ureteric reflux (VUR) using the Cohen procedure. In cases where the contralateral meatus was symmetrical or had a pathological appearance, preventive contralateral surgery with meatal advancement was performed.

Results

Ureteric reimplantation was exclusively performed unilaterally in 254 patients and in 67 a contralateral meatal advancement was performed. There were 29 cases of contralateral reflux at the 4‐month follow‐up. In nine patients contralateral reimplantation was necessary for persistent symptomatic VUR, the reflux resolved spontaneously in 14 and a radiological examination was necessary in six. Reflux also appeared on the Gil Vernet side in only 6% of patients; there were no clinical symptoms and the outcome was favourable.

Conclusion

The advancement of the meatus using the Gil Vernet procedure is simple, with no surgical complications. We suggest that this technique constitutes a useful surgical alternative in the prevention of contralateral reflux.
Intravesical bacille Calmette‐Guérin in the treatment of carcinoma in situ or high‐grade superficial bladder carcinoma after radiotherapy for bladder carcinoma
Authors: Palou  , Sánchez‐Martín  , Rosales  , Salvador  , Algaba  , Vicente
Published: March 2003

Objective

To evaluate the effectiveness and tolerance of endovesical bacille Calmette‐Guérin (BCG) after pelvic radiation therapy for bladder cancer in patients with recurrence as carcinoma in situ (CIS) and/or high‐grade superficial bladder cancer.

Patients and methods

In a prospective study, 13 patients were treated with weekly instillations of 81 mg BCG Connaught for 6 weeks, for CIS and/or high‐grade superficial bladder carcinoma. All had been treated previously with radical radiation therapy for bladder carcinoma.

Results

Five patients had no recurrences and six patients retained their bladders, within a median follow‐up of 74.5 months. Five patients progressed; two underwent radical surgery and are alive after 75 months of follow‐up, and three died from the disease (two were high‐risk surgical patients and one had metastatic disease). Another two patients died from intercurrent disease without bladder cancer. Eight patients were alive at a mean (sd, range) follow‐up of 85 (12, 65–97) months.

Conclusion

Intravesical BCG is useful for controlling CIS and/or high‐grade superficial bladder carcinoma in irradiated bladders and has an acceptable local tolerance; more than a third of patients were free of disease and preserved their bladders. This proportion is acceptable in patients currently scheduled for cystectomy.
Calculating the direct costs of urinary incontinence: a new test instrument
Authors: Dowell  , Bryant  , Moore  , Simons
Published: March 2003

Objectives

To develop a universally applicable test instrument to measure the total direct costs of urinary incontinence, including personal costs and treatment costs, i.e. the Dowell‐Bryant Incontinence Cost Index (DBICI), and to study the construct validity and test‐retest reliability of the instrument.

Patients and methods

In a prospective observational study, 100 consecutive community‐dwelling ambulatory women who presented with stress, urge or mixed incontinence were asked to complete the DBICI questionnaire on two occasions, 7 days apart, before any treatment. The construct validity of the DBICI was ascertained by correlation with other standard measures of urinary incontinence severity; (i) a visual analogue scale (VAS) to assess the impact of leakage upon lifestyle; (ii) frequency‐volume charts (voids/24 h, leaks/week); (iii) urine loss during a standard 1 h pad test; and (iv) two disease‐specific quality of life questionnaires. The test‐retest reliability was measured by comparing the two test results and the construct validity of the individual subsets (personal and treatment) of the DBICI similarly assessed.

Results

Ninety‐seven women completed the baseline assessment and 84 completed the re‐test. The median (interquartile range) total direct incontinence cost (in Au$) was 12.89 (5.26–22.67) per week, which comprised the median personal costs of 5.61 (1.68–10.36) and the median treatment costs of 4.96 (1.22–13.37). The total direct incontinence cost was significantly correlated with the severity of urinary leakage on a 1 h pad test (Kendall’s rank correlation, P=0.01), with the VAS impact score (P<0.001) and with the number of leaks/week (P=0.005). The correlation between the personal cost subset and other quantitative measures was also highly significant. Test‐retest analysis of the personal costs subset revealed that this subset was robust and satisfied the statistical criteria of repeatability.

Conclusions

The DBICI gives a detailed measure of the direct economic costs of urinary incontinence in ambulatory home‐dwelling women, with the construct validity confirmed by the significant correlation with other quantitative measures of incontinence. By substituting local prices into the test format, the index should be useful in other countries. In the current climate of economic rationalization, such an index should be a part of future urinary incontinence research.
Radiographic vs surgical size of renal tumours after partial nephrectomy
Authors: Herr H.W.
Published: March 2003

Objective To compare the radiographic with the surgical size of renal tumours selected for partial nephrectomy.

Patients and methods In 50 patients undergoing elective partial nephrectomy for renal carcinoma (31 men and 19 women, preoperative tumour size 1.5–5.2 cm) the maximum size of the renal tumour, as assessed from computed tomography (CT) before surgery, was compared with the tumour size at surgery. All patients had their renal artery temporarily occluded before surgery to shrink the kidney.

Results After partial nephrectomy, the renal tumours were a mean of 0.63 cm smaller than the estimate from CT; tumours of  3.5 cm on CT were particularly reduced.

Conclusion Incidentally discovered tumours on CT that are < 3.5 cm and favourably located are often selected for partial nephrectomy. If temporary vascular occlusion and surface hypothermia of the kidney causes shrinkage of most tumours of  3.5 cm, then surgeons might attempt partial nephrectomy in borderline cases, with a better chance of complete resection.
A comparison of the relative merits of radical perineal and radical retropubic prostatectomy
Authors: Sullivan L.D. , Weir M.J. , Kinahan J.F. , Taylor D.L.
Published: March 2003

ObjectiveTo compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon.

Patients and methodsThis unrandomized study included 138 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP), based on the specific conditions or the patient’s choice; 79 patients (mean age 64.6 years) underwent RPP and 59 (mean age 61.7 years) RRP. Outcome measures included estimated blood loss, the incidence of blood transfusions, positive margins and complications, operative duration, analgesic use, days in hospital and quality of life.

Results There was no difference in operative duration, and the incidence of positive margins or complications between the groups. The mean estimated blood loss in the RPP and RRP groups was 415 and 1138 mL, respectively. The RPP group stayed a mean of 2.2 days less in hospital and took 2.8 days less to regain a full diet than the RRP group; the RPP group needed 1.7 days before using oral analgesics and the RRP group 3.8 days. Of patients in both groups, 85% were pad‐free at one year and their overall quality of life was similar.

ConclusionsThe results of RRP and RPP are comparable; the advantages of the perineal approach include minimal blood loss, low‐intensity postoperative nurs‐ing care, low analgesic use and earlier discharge from hospital.
Do experimentally induced ipsilateral testicular torsion, vas deferens obstruction, intra‐abdominal testis or venous obstruction damage the contralateral testis through a common mechanism?
Authors: Andiran F. , Okur D.H. , KiLiNç A. , Gedikog¯lu G. , KiLiNç K. , Tanyel F.C.
Published: March 2003

Objective To evaluate if various conditions affecting the ipsilateral testis which also damage the contralateral testis share a common pathway for their effects.

Materials and methods The study comprised five groups of 10 adult rats which underwent surgery to produce (on their left sides); group 1, a sham operation (control); group 2, testicular torsion; group 3, vas deferens obstruction; group 4, an intra‐abdominal testis; and group 5, venous obstruction. The ipsilateral and contralateral testes were harvested 4 weeks after surgery. The relative proportions of haploid cells, the mean seminiferous tubular diameter (MSTD), mean testicular biopsy scores (MTBS), and lactate and hypoxanthine levels were determined and compared.

Results The proportions of haploid cells in the ipsilateral and the contralateral testes of groups 2–5 were significantly lower than those of the corresponding testes of the control group. The MSTD and MTBS of the ipsilateral testes in groups 2–5 were also significantly lower than the ipsilateral testes of controls and the contralateral testes within the same groups. While the MSTD and MTBS of the contralateral testes of groups 1 and 5 were not significantly different, those of the contralateral testes of groups 2–4 were significantly less than that of group 1. The lactic acid and hypoxanthine levels of the ipsilateral and contralateral testes were significantly increased in groups 2 and 3. While only the hypoxanthine level of group 5 increased significantly, both variables were not significantly different between the ipsilateral testes of groups 1 and 4.

Conclusions These four treatments damaged both the ipsilateral and contralateral testes. As the lactic acid and hypoxanthine levels within the contralateral testis were greater than in the controls, testicular torsion and vas deferens obstruction seem to share a common pathway (which may be a reflex decrease in contralateral testicular blood flow) for their effects on the contralateral testis.
Congenital megaprepuce: an emerging condition – how to recognize and treat it
Authors: Summerton D.J. , Mcnally J. , Denny A.J. , Malone P.S.J.
Published: March 2003

Objective To highlight the clinical presentation, pathological anatomy and surgical management of an emerging condition, the congenital megaprepuce (CM).

Patients and methods All patients with CM treated at Southampton between 1994 and 1998 were reviewed retrospectively; 20 patients underwent surgery (mean age at operation 16 months, range 6–43). Surgical correction developed over this period and variations on a basic technique are now used, depending on the precise pathological anatomy. These techniques are described and illustrated. Cosmetic and functional success, and parental satisfaction, were assessed by a review of the case‐notes.

Results After a follow‐up of  6 months, the cosmetic and functional outcome was very successful, with the parents of 19 of the 20 patients satisfied. Five patients underwent re‐operation, all requiring excision of redundant penile skin.

Conclusions CM is a striking condition which cannot be easily missed or hidden; we propose that it is a newly emerging and distinct condition which should not be confused with a buried, concealed, webbed, trapped or micropenis. Early surgical correction is recommended and circumcision should be avoided.
Long‐term follow‐up of noninvasive bladder tumours(stage Ta): recurrence and progression
Authors: Zieger K. , Wolf H. , Olsen P.R. , Højgaard K.
Published: March 2003

Objective To evaluate long‐term recurrence‐free and progression‐free survival of noninvasive bladder tumours (stage Ta), and the significance of simple risk factors, including concomitant epithelial dysplasia.

Patients and methods The study included 217 patients with primary noninvasive bladder tumour (stage Ta) who were followed routinely for up to 20 years. Voided urine cytology (VUC) and preselected site biopsies (PSB) were obtained prospectively to evaluate the significance of concomitant epithelial dysplasia.

Results The mean follow‐up was 84 months (maximum 238). Of all tumours, 39% did not relapse, a further 20% recurred infrequently (less than once a year) and 41% recurred frequently, amongst which the most frequent were multiple and early recurrent tumours; 42 (19%) tumours progressed to stage T1+ and 23 (11%) progressed further (stage T2+ or metastases). No grade 1 tumours became invasive. Positive VUC or PSB, a short recurrence‐free period or multiplicity, and size > 3 cm were significant predictive factors. The treatment and surveillance of epithelium‐confined bladder tumours are discussed.

Conclusion Concomitant dysplasia and early recurrence are associated with considerable risk of progression in the long‐term follow‐up in a group of otherwise low‐risk superficial bladder tumours (stage Ta).
Bcl‐2 expression identifies patients with advanced bladder cancer treated by radiotherapy who benefit from neoadjuvant chemotherapy
Authors: Cooke P.W. , James N.D. , Ganesan R. , Burton A. , Young L.S. , Wallace D.M.A.
Published: March 2003

Objective To assess the prognostic significance of Bcl‐2 expression on the clinical outcome after radiotherapy for muscle‐invasive bladder cancer, and to determine if it is possible to identify a subgroup of patients to whom neoadjuvant chemotherapy can be targeted to improve survival.

Patients and methods Immunohistochemical staining for Bcl‐2 and p53 was performed on the tumours of 51 patients with stage T2‐T4a NXM0 transitional cell carcinoma of the bladder who had been included in a randomized clinical trial of radiotherapy with or without neoadjuvant cisplatin. The association between positive staining and salvage cystectomy rate and overall survival was examined, with a median follow‐up of 12 years.

Results Bcl‐2 and p53 expression was positive in 31 (61%) and 39 (76%) of the tumours, with no association between either, or with tumour stage or grade. There was no difference according to Bcl‐2 positivity in the salvage cystectomy rate (P = 0.83) or survival (P = 0.68) for the 51 patients as a whole, but Bcl‐2‐negative patients receiving neoadjuvant cisplatin had a significantly better prognosis, with a median survival of 72 months compared to 17 months in Bcl‐2‐positive patients, and a 5‐year survival rate of 55% (P = 0.03).

Conclusions Quantifying Bcl‐2 in patients undergoing radiotherapy for advanced bladder cancer identifies those who may benefit from neoadjuvant chemotherapy. Further studies of other members of the Bcl‐2 family and other proteins controlling both cell proliferation and apoptosis are warranted, to define the roles and the interactions between them that may contribute to oncogenesis and resistance to standard treatments. This may allow the targeting of specific treatments to patients known to be sensitive to them, and aid the future development of novel therapies for bladder cancer.
The short‐term prostate‐specific antigen velocity before biopsy can be used to predict prostatic histology
Authors: Lynn N.N.K. , Collins G.N. , O’Reilly P.H.
Published: March 2003

Objectives To evaluate whether the short‐term prostate‐specific antigen (PSA) velocity before biopsy can be used to predict prostatic histology, and to assess the role of a second PSA measurement before prostate biopsy.

Patients and methods The study comprised 197 patients who were referred for transrectal ultrasonography (TRUS) and prostate biopsy. The PSA level was initially measured at the first outpatient assessment; patients with a serum PSA level of < 4 ng/mL and > 50 ng/mL were excluded. Blood samples were taken just before prostate biopsy for the second PSA measurement. The mean interval between the measurements was 2.2 months. The short‐term PSA velocity was calculated and correlations between this variable and age, prostate volume and initial PSA levels determined.

Results There was a statistically significant difference between the short‐term PSA velocity of patients with benign prostate histology and those with prostate cancer (P < 0.05). The short‐term PSA velocity alone had the same diagnostic accuracy as the serum PSA level (area under the receiver‐operating characteristic curve 0.612). There was only a weak correlation between the short‐term PSA velocity and prostate volume. However, there was no correlation with age and initial PSA level in patients with benign histology. The second PSA measurement had higher specificity without losing sensitivity.

Conclusion The short‐term PSA velocity estimated before biopsy can be used to predict prostatic histology. By measuring serum PSA 2 months after the first in patients with serum PSA level of 4–10 ng/mL, the number of negative biopsies can be reduced by 17%.
Intravasal azoospermia: a surgical dilemma
Authors: Sheynkin Y.R. , Chen M.E. , Goldstein M.
Published: March 2003

Objectives To determine the incidence of intravasal azoospermia (IVA) and evaluate which factors before and during surgery influence outcome, by prospectively and intentionally performing bilateral vasovasostomies (VVs) only in men with intraoperative IVA.

Patients and methods Using a multilayer technique, 472 men underwent microsurgical reconstructive procedures. Intravasal fluid was examined for sperm by the surgeon and a pathologist. Strict enrolment criteria included total absence of sperm or sperm parts and bilateral VV as a treatment procedure. Patients were followed up by semen analysis and paternity assessed only by naturally conceived pregnancies.

Results Of the 472 patients, 27 (5.7%) had bilateral IVA; 15 of these patients were available for a follow‐up of 1–47 months. Eleven patients had identical gross appearance of intravasal fluid bilaterally. Of these patients, five had sperm in the ejaculate after surgery (three with clear intravasal fluid and two with no fluid). Bilaterally different vasal fluid was found in four men. Unilateral clear fluid was present in three patients, two of whom had sperm in semen analysed after VV. Overall, there was sperm in the ejaculate in seven of 15 patients with IVA; five of these seven had clear fluid in at least one vas deferens. One patient with unilaterally clear fluid achieved paternity by a naturally conceived pregnancy. The difference between the mean (sem) obstruction interval in men who had sperm in a semen sample after VV, at 16.7 (3.30) years, and in persistently azoospermic patients, at 15.5 (1.89) years, was not statistically significant (P = 0.741).

Conclusion The results of VV in patients with IVA are unsatisfactory; the patency rate is higher in men with copious clear fluid in at least one vas. The obstructive interval in patients with IVA does not appear to influence the outcome of VV.
Morbidity and the impact on daily activities associated with catheter drainage after acute urinary retention
Authors: Khoubehi B. , Watkin N.A. , Mee A.D. , Ogden C.W.
Published: March 2003

Objective To evaluate the effect on quality of life of being discharged home with a catheter before definitive treatment in patients with acute urinary retention (AUR).

Patients and methods Patients attending the emergency department with AUR were assessed and discharged home with a catheter if they fulfilled predetermined criteria. They were admitted to the day‐care unit for urological assessment and completed a disease‐specific quality‐of‐life questionnaire.

Results Of 101 patients presenting to the emergency department in AUR, 84 were sent home after catheterization (83%); 78 (93%) patients completed the questionnaire. The major side‐effects reported were urinary leak (46%), mild haematuria (44%), urgency (42%), pain around the penis (42%), painful erection (31%) and catheter blockage (26%). Only 12% of patients felt having a catheter was very inconvenient and 93% would find it acceptable to have a catheter in future.

Conclusion A significant minority of patients discharged home with a catheter had side‐effects related to their catheter but were not greatly inconvenienced, and their capacity to carry out normal daily activities was not impaired. The immediate discharge of patients in AUR and planned treatment will enable better use of inpatient urology resources.
Cloacal and urogenital malformations in adriamycin‐exposed rat fetuses
Authors: Liu M.i‐P. , Hutson J.M.
Published: March 2003

Objectives To determine the spectrum of cloacal and urogenital malformations in rat fetuses prenatally exposed to adriamycin, which causes abnormalities that strongly resemble the VATER association (vertebral defects, anal atresia, tracheo‐oesophageal fistula with oesophageal atresia, renal defects and radial limb dysplasia) in humans, and to evaluate how closely such anomalies resemble those seen in humans.

Materials and methods Timed‐pregnant rats were injected intraperitoneally with adriamycin at 6–9 days of gestation; a control group received saline only. Fetuses (35 treated and 30 control) were recovered at 21 days of gestation, and examined macroscopically and microscopically for cloacal and urogenital abnormalities.

Results All the treated fetuses had no bladders and severe hydroureter/hydronephrosis on one or both sides. Male fetuses had a proximal blind‐ending urethra communicating with dilated ureters and giving rise to vasa. Female fetuses had a persistent urogenital sinus communicating with the ureters and cervix/uterus; 57% of the treated group had an imperforate anus and some had recto‐urethral fistulae (males) or recto‐urogenital fistulae (females).

Conclusion Rat fetuses exposed to adriamycin have a spectrum of cloacal and urogenital anomalies (predominantly no bladder) which is more severe than those of the human VATER association. None‐theless, this is an excellent animal model for the study of genitourinary embryology, especially bladder development.
Abdominal relapse in stage 1 nonseminomatous germ cell tumours of the testis managed by surveillance or with adjuvant chemotherapy
Authors: Hendry W.F. , Norman A. , Nicholls J. , Dearnaley D.P. , Peckham M.J. , Horwich A.
Published: March 2003

Objective To assess the impact on patterns of recurrence of adjuvant chemotherapy in patients with stage 1 nonseminomatous germ cell tumours (NSGCT) of the testis, who have a high likelihood of relapse on surveillance if certain risk factors are identified in the orchidectomy specimen, and thus the theoretical need for retroperitoneal lymph node dissection (RPLND).

Patients and methods The incidence of abdominal relapse was recorded in 417 men presenting with stage 1 NSGCT over the past 18 years. Up to 1986, 161 men were managed by surveillance alone, and abdominal relapse occurred in 26. From 1986 onwards, men with positive risk factors in the orchidectomy specimen were offered two courses of chemotherapy; 60 accepted and one relapsed in the abdomen, and 196 underwent surveillance and 19 relapsed in the abdomen.

Results Abdominal relapse was significantly reduced from 16% before 1986 to 8% afterward (P = 0.014). Mortality from testicular tumour or treatment toxicity remained low, at 0.6% before 1986 and 2.0% since then.

Conclusion The need for RPLND in stage 1 NSGCT remains highly doubtful.
Paediatric lower urinary tract rhabdomyosarcoma: a single‐centre experience of 30 patients
Authors: El‐Sherbiny M.T. , El‐Mekresh M.H. , El‐Baz M.A. , Ghoneim M.A.
Published: March 2003

Objective To retrospectively analyse the long‐term outcome of children with bladder and/or prostate rhabdomyosarcoma who were diagnosed at the authors' institution over the last 17 years.

Patients and methods The study comprised 30 children (26 boys and four girls, mean age 5 years, range 15 days to 15 years); 23 had stage III and seven had stage II disease. The initial biopsy showed an embryonal variant in 27 and round‐cell sarcoma in three patients. All patients received eight weekly doses of vincristine, actinomycin D and cyclophosphamide (VAC). Subsequent treatment depended upon the response to chemotherapy.

Results Fourteen patients had a complete or partial response to chemotherapy (> 50% reduction in tumour size); they were maintained on VAC chemotherapy for 2 years. Twelve patients in this group survived with no evidence of disease for 7 months to 10 years. Additional therapies were used in three patients, i.e. radical cystectomy in one and external irradiation in two. Sixteen patients had a minimal response to chemotherapy; in six, radical cystectomy was feasible and was followed by one year of chemotherapy. All patients were free of disease for 4–11 years. Radiotherapy was given to the remaining 10 patients; thereafter radical cystectomy became feasible in five while partial cystectomy was possible in three. Only three of these 10 patients survived for 4–11 years.

Conclusion The tumour response to initial chemotherapy can be used to stratify patients into two risk‐groups, i.e. low‐risk patients with a complete or partial response in whom the bladder could be salvaged, and high‐risk patients with a minimal response, in whom intensive treatment should be pursued, with no attempt at bladder salvage.
Inactive free : total prostate specific antigen ratios in ejaculate from men with suspected and known prostate cancer, compared with young control men
Authors: Clements J.A. , Merritt T. , DeVoss K. , Swanson C. , Hamlyn L. , Scells B. , Rohde P. , Lavin M.F. , Yaxley J. , Gardiner R.A.
Published: March 2003

Objective To measure free : total prostate specific antigen (PSA) ratios in ejaculate from men with suspected and known prostate cancer, and in young control men, to determine if this ratio might be useful in discriminating benign from malignant prostatic conditions.

Patients, subjects and methods Forty‐seven men with prostate cancer (positive biopsies), 52 men with suspected prostate cancer but who had negative biopsies and 28 young men (< 30 years old) and with no family history of cancer, provided either a single ejaculate specimen (total 59) or multiple specimens (total 193) on subsequent occasions. Free and total PSA were measured using appropriate assays. All specimens were diluted in a PSA‐negative female serum pool.

Results The median free : total PSA ratios were 0.76–0.81 among the patient groups and control men, and there was no statistical difference between the groups. These data presumably only reflect the inactive component of free PSA, given that any α2‐macroglobulin or α1‐antichymotrypsin in the assay serum diluent was likely to have bound the active free PSA component in these samples. Similar results were obtained from those providing single and multiple samples, suggesting that a single specimen is sufficient to reflect the seminal plasma free : total PSA ratio over that period. There was no relationship between seminal plasma free : total PSA ratio and age for the controls or the positive biopsy group, although there was a negative relationship (i.e. a decline with age) that almost reached significance in those with negative biopsies (P = 0.058, R2 = 0.07).

Conclusions This is the first report of free : total PSA ratios in the ejaculate of men with suspected and known prostate cancer compared with young control men. Although no significant changes were detected in the free : total PSA ratios in ejaculate, these results may be confounded by differences in ratios with age, as is the case for serum PSA or different molecular forms of PSA. Indeed, these data suggest that a large proportion of free PSA in seminal plasma may be inactive. Further studies are needed to determine the potential utility of measuring free : total PSA, or other candidate markers, in ejaculate to better discriminate benign from malignant prostate disease.
Light penetration in bladder tissue: implications for the intravesical photodynamic therapy of bladder tumours
Authors: Shackley D.C. , Whitehurst C. , Moore J.V. , George N.J.R. , Betts C.D. , Clarke N.W.
Published: March 2003

Objectives To assess (i) the optical properties and depth of penetration of varying wavelengths of light in ex‐vivo human bladder tissue, using specimens of normal bladder wall, transitional cell carcinoma (TCC) and bladder tissue after exposure to ionizing radiation; and (ii) to estimate the depth of bladder wall containing cancer that could potentially be treated with intravesical photodynamic therapy (PDT), assuming satisfactory tissue levels of photosensitizer.

Materials and methods The study included 11 cystectomy specimens containing invasive TCC (five from patients who had previously received external‐beam bladder radiotherapy, but with recurrent TCC) and three ‘normal’ bladders removed from patients treated by exenteration surgery for extravesical pelvic cancer. Full‐thickness bladder wall and tumour samples were taken from these specimens and using an ‘intravesical’ and a previously validated interstitial model, the optical penetration depths (i.e. the tissue depth at which the light fluence is 37% of incident) were calculated at wavelengths of 633, 673 and 693 nm.

Results There were no significant differences in light penetration between normal and tumour‐affected bladder tissue at each wavelength. There were significant differences in light penetration among wavelengths; light at 693 nm penetrated ≈ 40% further than light at 633 nm (P < 0.002). The light currently used in bladder PDT (633 nm) has a mean (
sem) optical penetration depth of 4.0 (0.1) mm within TCC. In addition, at this wavelength, there was 29% greater light penetration in previously irradiated than in unirradiated bladder wall (P = 0.001). This did not occur in the tumour‐affected bladder.

Conclusions Bladder tissue is relatively more translucent than other human tissues and there is therefore great potential for PDT in the treatment of bladder cancer. As there is no difference in light penetration between TCC and normal bladder tissue, a tumour‐specific response with diffuse illumination of the bladder will depend on drug localization within the tumour. The currently used wavelength of 633 nm can be expected to exert a PDT effect within bladder tumour up to a depth of 20 mm. Increasing the wavelength will allow deeper pathology to be treated.
A prospective study of conservatively managed acute urinary retention: prostate size matters
Authors: Kumar V. , Marr C. , Bhuvangiri A. , Irwin P.
Published: March 2003

Objective To evaluate in a prospective study the medium‐ to long‐term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC).

Patients and methods All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality‐of‐life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR).

Results Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow‐up of 8–24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality‐of‐life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC.

Conclusion A TWOC is justified in the long‐term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial.
Laparoscopic retroperitoneal renal and adrenal surgery in children
Authors: Shanberg A.M. , Sanderson K. , Rajpoot D. , Duel B.
Published: March 2003

Objective To retrospectively assess the use of a retroperitoneal laparoscopic approach for simple nephrectomy and adrenalectomy in children.

Patients and methods All retroperitoneal laparoscopic renal and adrenal procedures carried out in children and completed between 1993 and March 2000 were reviewed retrospectively. Analgesic requirements, hospital stay, complications and blood loss were reviewed. The technique is described in detail.

Results Forty‐eight retroperitoneal laparoscopic procedures were completed in 48 patients (mean age 5.5 years, range 0.5–16). The procedures included nephrectomy (22), nephroureterectomy (15), renal biopsy (six), cyst ablation (two) and simple adrenalectomy (three). In all, 11 procedures were undertaken in children aged < 2 years. Forty‐one (91%) of the children undergoing renal procedures were discharged in < 24 h. Two patients underwent three adrenalectomies. Two children required conversion to open surgery, one undergoing a right‐sided adrenalectomy and one a nephrectomy. The mean operative duration for nephrectomy and nephroureterectomy was 75 min, and for adrenalectomy was 115 min.

Conclusion Renal and adrenal surgery in children is a safe and rapid procedure with retroperitoneal laparoscopy. The operative duration for nephrectomy and nephroureterectomy are frequently < 1 h. In addition, laparoscopic surgery offers significant advantages in terms of cosmesis and a quicker recovery.
Expression of endothelial nitric oxide synthase in the Sertoli cells of men with infertility of various causes
Authors: Fujisawa M. , Yamanaka K. , Tanaka H. , Tanaka H. , Okada H. , Arakawa S. , Kamidono S.
Published: March 2003

Objective To investigate how endothelial nitric oxide (eNOS) expression in the seminiferous tubules might be related to spermatogenesis, by examining eNOS expression in testicular tissue of patients infertile from various causes.

Patients and methods The study included five fertile men with a normal sperm concentration, nine patients with obstructive azoospermia, 20 with varicocele testes and eight with idiopathic azoospermia (Sertoli cell‐only syndrome). Testicular biopsy specimens were examined by immunohistochemistry for eNOS protein expression, in addition to a routine pathological assessment. eNOS protein was detected using an eNOS monoclonal antibody. A Sertoli cell staining index (SSI) was defined as the ratio of stained Sertoli cells per total number of Sertoli cells, and was compared among the groups.

Results eNOS was localized to Sertoli cells in the seminiferous tubules and Leydig cells in the interstium; although some degenerating germ cells stained, normal germ cells did not. The SSI was significantly lower in patients with Sertoli cell‐only syndrome than in either fertile men or patients with obstructive azoospermia or varicocele. However, the SSI did not correlate significantly with the Johnsen score.

Conclusion The expression of eNOS in Sertoli cells may depend on the existence of germ cells and be associated with germ cell development.
Cellular resistance to mitomycin C is associated with overexpression of MDR‐1 in a urothelial cancer cell line (MGH‐U1)
Authors: Hayes M.C. , Birch B.R. , Cooper A.J. , Primrose J.N.
Published: March 2003

Objective To compare multidrug resistance (MDR)‐1 and MDR‐3 gene expression in a new urothelial cancer cell line (MGHU‐1, with resistance to mitomycin C) against controls and the established (epirubicin‐resistant) MDR clone, and to correlate MDR with cytotoxicity data.

Materials and methods Resistance to mitomycin C was induced by the long‐term exposure of wild‐type MGHU‐1 cells to increasing concentrations (20–400 nmol/L) of mitomycin C. The cytotoxicity of mitomycin C or epirubicin was then compared in MGHU‐1, MGHU‐MMC (mitomycin C‐resistant) and MGHU‐1R (established MDR) cells, using the tetrazolium biomass assay. The expression of MDR‐1 and ‐3 was investigated by the reverse transcriptase‐polymerase chain reaction, using cDNA‐specific primers after titration, and compared with DNA and negative controls.

Results MDR‐1 and ‐3 were significantly and equally overexpressed in MGHU‐1R, and associated with a dramatic increase in the 50% inhibitory drug concentration (P < 0.001) for mitomycin C and epirubicin against controls. In MGHU‐MMC, the overexpression of MDR‐1 was three times greater than that of MDR‐3. The cytotoxicity profile for both agents was very similar to that of MGHU‐1R. Trace amounts of MDR‐1, but not MDR‐3, were identified in the MGHU‐1 wild‐type.

Conclusions Urothelial cancer cell resistance to mitomycin C is associated with cross‐resistance to epirubicin and overexpression of MDR‐1, suggesting that mitomycin C falls within the MDR category. Clinical application of this methodology may allow patients to be identified who are unlikely to benefit from intravesical chemotherapy.
Detection of chromosomal alterations in bladder cancer by comparative genomic hybridization
Authors: Yu D.‐S. , Hsieh D.‐S. , Chang S.‐Y.
Published: March 2003

Objectives To characterize which genomic alterations occur in bladder cancers of different grades and stages, and to evaluate the prognostic implication of chromosomal imbalances.

Materials and methods Twelve transitional cell carcinoma cell lines were used to study chromosomal aberrations, using comparative genomic hybridization to examine metaphase cells.

Results There was a mean of 6.0 aberrations per tumour with 4.9 gains and 1.08 deletions per tumour cell line. The mean number of aberrations was the same in grade 2 and 3 tumours. High‐stage ( T2) carcinomas had markedly more genomic gains than had low‐stage (T1) tumours, with 7.2 gains and 1.3 deletions per  T2 tumour, and 2.7 gains and 0.8 deletions per T1 tumour, although the difference was not statistically significant. The most frequent changes were gains of chromosome 1 (seven), 9 and 16 (six), and losses of chromosomes 14 (three), 21 and Y (two). The changes 1p+, 3p+, 9q+, 14p–, 16q+ and Yp– were significantly more frequent in low‐grade tumours, with 1p+, 3p+ and Yq– the most frequent in stage T1 tumours, and 16p+, 9q+ and 13q– the most frequent in stage  T2 tumours.

Conclusion These findings indicate several genomic regions in chromosomes 1, 9, 14 and 16 that may carry genes for the development and progression of bladder cancers.
The choice of timing for diuresis renography:the F+0 method
Authors: Adeyoju A.A.B. , Burke D. , Atkinson C. , Mckie C. , Pollard A.J. , O'Reilly P.H.
Published: March 2003

Objective To investigate a method of diuresis renography where the radiopharmaceutical and frusemide (diuretic) are given simultaneously, in contrast to conventional renography which involves an intravenous injection with frusemide 20 min after administering the radiopharmaceutical (F+20) or 15 min before (F−15), with particular interest in the effect of this change on assessing split renal function and interpreting upper tract drainage dynamics.

Patients and methods In a prospective study, 29 patients (18 women and 11 men, mean age 47 years, range 21–86) were assessed. Each patient had two renograms taken over a 48‐h period, either by the F+20 or F−15, and the F+0 method. Data for split renal function and drainage curves were obtained in the usual way. Two independent assessments of the drainage curves were obtained and the results compared.

Results The split function assessments were identical (<5% variation) in all but two patients; 26 of 29 (90%) gave identical conclusions about the drainage curves. The three patients with discrepancies between the studies had either hugely dilated upper tracts or otherwise had multiple complicating factors, e.g. impaired renal function, neuropathic bladder.

Conclusions F+0 renography has been used in paediatric urological practice before, but there are no comparative studies and no data on its use in adults. This prospective study confirmed that in investigating dilated upper tracts, the F+0 technique gives similar results to the conventional techniques. The F+0 method has the potential to reduce the time required to undertake standard F+20 renography but it may not be useful in evaluating the grossly dilated upper tract, where the F−15 technique has the best record in terms of reducing equivocal results.