bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum free prostate‐specific antigen in the diagnosis of prostate cancer
Authors: LEUNG H.Y. , LAI L.C. , DAY J. , THOMSON J. , NEAL D.E. , HAMDY F.C.
Published: November 2003

Objective

 To determine the value of the ratio of free prostate‐specific antigen (fPSA) to total PSA (tPSA) in the diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer in a cohort of patients undergoing prostatic transrectal ultrasonography (TRUS).

Patients and methods

 The study comprised 153 patients (99 with BPH and 54 with prostate cancer) undergoing diagnostic TRUS of the prostate. Patients with a tPSA of >30 ng/mL were excluded from analysis. Free PSA was assayed using an immunoassay specific for unbound PSA (CanAg Diagnostics, Sweden). Total PSA was measured using the HybriTech Tandem‐R PSA immunoradiometric assay in routine clinical use and this estimate was validated using the CanAg tPSA assay.

Results

 The measurements of tPSA from both assay systems correlated closely. The f/tPSA ratios in patients with prostate cancer were significantly lower than in those with BPH (median values 0.152 and 0.2, respectively, P<0.01). In patients with prostate cancer, the median f/t PSA levels apparently declined with increasing tPSA levels but in those with BPH, the levels of tPSA were not significantly associated with the f/tPSA ratio; the ratios did not vary significantly with age in either group. A f/tPSA ratio at a threshold of 0.16 had positive and negative predictive values of 44% and 74%, respectively; the corresponding values for a tPSA of >4 ng/mL were 30% and 52%.

Conclusion

 The f/tPSA ratio differs significantly between patients with BPH and cancer but because there is a considerable overlap of f/tPSA ratios between the groups, f/tPSA values alone were not sufficiently specific to be used as a single diagnostic test.
Decreased bcl‐2 expression in segmental renal dysplasia suggests a role in its morphogenesis
Authors: GRANATA C. , WANG Y. , PURI P. , TANAKA K. , O’BRIAIN D.S.
Published: November 2003

Objective

 To evaluate the potential role of bcl‐2 and apoptosis in the histogenesis of segmental renal dysplasia.

Materials and methods

 Surgically resected specimens of dysplastic upper poles of duplex kidneys were studied from 19 patients (mean age 3.4 years, range 2 months–9 years). Bcl‐2 expression was detected immunohistochemically and apoptosis was investigated using the in situ end‐labelling technique (ISEL).

Results

 In the histologically normal areas of the specimens, bcl‐2 expression was intense in the proximal and distal convoluted tubules, moderate in Henle’s loops and weak or absent in Bowman’s capsule. In contrast, in the dysplastic areas there was no or markedly reduced expression of bcl‐2 in mesenchyme and tubules. In the normal areas, apoptotic cells were extremely rare (0–1 per 25 high‐power fields, HPFs), whereas in the dysplastic areas, some apoptotic cells were identified both in tubules (1–2 per 25 HPF) and in mesenchyme (5–8 per 25 HPF).

Conclusions

 As bcl‐2 expression is required for normal kidney morphogenesis, finding no or markedly decreased expression of bcl‐2 in the dysplastic areas may be related to the persistence of dysplastic fetal‐type structures. Finding apoptosis adds further support to the concept that dysplasia represents arrested development at an early stage of morphogenesis before the period when bcl‐2 assumes major importance.
Uroflowmetry in women with urinary incontinence and pelvic organ prolapse
Authors: COATES K.W. , HARRIS R.L. , CUNDIFF G.W. , BUMP R.C.
Published: November 2003

Objective

 To characterize uroflowmetry parameters in women with pelvic organ prolapse (POP) and urinary incontinence (UI) and to assess the effects of clinical and urodynamic variables on these parameters.

Patients and methods

 The study comprised 655 consecutive women who presented with UI or POP and who had interpretable uroflowmetry values. Normal uroflowmetry values were defined as a maximum flow (Qmax ) ≥15 mL/s, a mean flow (Qmean ) ≥10 mL/s, a post‐void residual volume (PVR) ≤100 mL and a continuous, single‐peak waveform. Parametric and non‐parametric analysis of variance and chi‐square analysis were used to compare differences between diagnostic groups. Multiple linear regression models were developed to evaluate factors considered to influence uroflowmetry.

Results

 Of the 655 patients, 471 (72%) had UI of whom 16% had pure detrusor instability (DI), 69% pure genuine stress incontinence (GSI) and 15% with both, and 184 (28%) had POP, 26% of whom also had DI. Of all patients, 72% had normal uroflowmetry patterns, 13% had multiple peaks and 15% had patterns with interrupted flow; 56% had completely normal uroflowmetry. There were significant differences in uroflowmetry values between the POP and UI groups, with the former having a lower Qmax and Qmean (P<0.001), larger PVRs (P<0.001) and a lower percentage of totally normal uroflowmetry (33% and 64%, respectively, P<0.001). Of patients with POP, 30% had a PVR >100 mL. Because of the differences, the POP and UI groups were evaluated separately in the regression analysis. In both groups, the most important determinants of flow rate were the volume voided and pressure transmission ratio (PTR). However, when several factors (including age, voided volume, PTR and maximum detrusor pressure with flow and at Qmax ) were included in the model, they accounted for only 23–26% of the variability of flow in the patients with UI and 36–39% of the variability in patients with POP. The subsets of patients with pure DI in both the UI and POP groups had higher PVR volumes than the other subsets.

Conclusions

 These results show that the positive correlation between flow rate and voided volume described in normal populations is also observed in women with UI and POP. However, most of the variability in urine flow was not attributable to factors such as age, voided volume and PTR, confirming the complexity of the micturition mechanism. Women with POP had more objective evidence of emptying‐phase dysfunction than women with UI, although most emptied their bladders efficiently. Finally, the results suggest that women with DI exhibit dysfunction of both inhibitory and facilitory detrusor control.
How to recognize patients with parkinsonism who should not have urological surgery
Authors: CHANDIRAMANI V.A. , PALACE J. , FOWLER C.J.
Published: November 2003

Objective

 To examine whether there are urogenital criteria that the urologist could apply to a patient with idiopathic Parkinson’s disease (IPD) and bladder symptoms, and so avoid operating on patients with multiple system atrophy (MSA).

Patients and methods

 The clinical features of 52 patients with probable MSA and 41 patients with IPD were studied retrospectively with particular attention to the nature of lower urinary tract symptoms and erectile dysfunction in relation to the onset of parkinsonism. Anal sphincter electromyography (EMG) was recorded in all the patients with MSA and in 12 of the patients with IPD.

Results

 Of the patients with MSA, 60% had urinary symptoms preceding or presenting with IPD but in 94% of the patients with IPD the neurological diagnosis preceded the onset of urogenital symptoms. Most of the patients with MSA (73%) had troublesome urinary incontinence whereas the majority of those with IPD (85%) had urgency and frequency but were not incontinent; 66% of the patients with MSA and 16% of patients with IPD had a significant post‐void residual volume. Of the men with MSA, 93% had erectile dysfunction and in 48% of them this complaint preceded the diagnosis of MSA. All 11 men with MSA who had a TURP were incontinent post‐operatively.

Conclusion

 The urogenital criteria which favour a diagnosis of MSA are: (i) urinary symptoms preceding or presenting with parkinsonism; (ii) urinary incontinence and IPD; (iii) a significant post‐void residual urine volume; (iv) erectile failure preceding or presenting with parkinsonism; and (v) worsening bladder control after urological surgery. Patients with parkinsonism and these features should be offered medical management rather than urological surgery.
Factors influencing blood loss in transurethral resection of the prostate (TURP): auditing TURP
Authors: KIROLLOS M.M. , CAMPBELL N.
Published: November 2003

Objectives

 To assess the blood loss accompanying TURP and investigate its association with the resected weight of prostatic tissue, type of anaesthesia, type of presentation, histology, different surgeons and their differing techniques, and thus to reduce the morbidity associated with blood loss and transfusion.

Patients and methods

 All prostatectomies carried out in a district general hospital were audited prospectively, recording the pre‐ and post‐operative haemoglobin concentration (Hb), blood transfusions and the variables listed above. The audit was repeated a year later.

Results

 The peri‐operative blood loss, as assessed by various indicators, was equivalent to a decrease in Hb of 10–15 g/L (8–11%). The weight of the resected prostatic tissue was the most important measurable factor in determining blood loss. Regional anaesthesia was associated with less blood loss than general anaesthesia. The added use of a suprapubic catheter for irrigation appeared to have a marginal advantage in large resections. The type of presentation, elective or otherwise, and the histological nature of the prostate did not influence blood loss. Smaller transfusions were probably avoidable in patients having smaller resections and a normal pre‐operative Hb. On re‐auditing, the overall transfusion rate was reduced from 10.8% to 8.2% and from 4.4% to 1% in patients having resections of <30 g.

Conclusion

 Blood transfusion can be reduced and rationalized. Patients with a normal pre‐operative Hb and undergoing resections of <30 g do not usually require transfusion. Regional anaesthesia is associated with less blood loss but its advantage is overshadowed in practice by the weight of the resected tissue. An audit of this type is repeatable and is useful in raising awareness, objectively assessing differences and advocating and assessing any changes made.
Differences in detrusor contractile function in women with neuropathic and idiopathic detrusor instability
Authors: GRAY R. , WAGG A. , MALONE‐LEE J.G.
Published: November 2003

Objective

 To compare urodynamic indices of isometric and isotonic detrusor contractile function between patients with idiopathic detrusor instability and patients with multiple sclerosis (MS) and detrusor hyper‐reflexia and thus determine whether the different types of detrusor instability share a common pathophysiological pathway.

Patients and methods

 Two groups of women were studied; 1139 neurologically normal patients with detrusor instability (mean age 55 years, sd 17) and 141 with multiple sclerosis (MS) and detrusor hyper‐reflexia (mean age 45 years, sd 11). Patients were assessed using static water cystometry, examining storage function, isometric and isotonic detrusor contractile function and voiding outflow function.

Results

 Bladder capacities were lower in the MS group, with a median of 357 mL, 95% confidence interval (CI) 305–400 mL, compared with the neurologically normal patients (median 450 mL, 95% CI 425–450, P<0.001, Mann–Whitney U‐test). Voiding was incomplete in the MS group, with a median (95%CI) residual volume of 100 (100–125) mL, but complete in the normal group, at 10 (10–10) mL. Higher median (95% CI) detrusor pressures at urethral opening (Pdet open ) and closing (Pdet close ) were recorded in the MS group than in the neurologically normal group, at 35.5 (33.2–46.6) cmH2O and 30 (27.6–31.6) cmH2O for Pdet open , respectively (P=0.003), and 25.3 (20.9–31.6) cmH2O and 16.6 (15.0–18.1) for Pdet close , respectively, (P=0.001). In the MS group, the median (95% CI) isometric unstable contractions were less well maintained, but were more powerful, at 17.6 (15.6–18.9) N, compared to the neurologically intact group at 14.4 (14.0–14.9) N (P=0.002). In the MS group, contractions frequently did not relax back to baseline, whereas in the group with detrusor instability, full relaxation after contraction was more usual. There was no significant difference in the maximum speed of detrusor shortening (isotonic activity), measured by the velocity constant Q*, between the groups (median for both groups 20 mL/s, 95% CI 17–23).

Conclusion

 These results show differences in storage function, isometric detrusor contractile function and voiding outflow function between detrusor instability and detrusor hyper‐reflexia, indicating that the two conditions may not share a common pathophysiological pathway.
Morphological changes in prostatic adenomas after transurethral microwave thermotherapy
Authors: BREHMER M.
Published: November 2003

Objective

 To study the extension and type of tissue damage in prostatic adenomas after transurethral microwave thermotherapy (TUMT).

Patients and methods

 Seven patients with benign prostatic hyperplasia and scheduled for open adenectomy underwent TUMT before surgery. TUMT was performed 2 h before operation in one patient, 24 h before in five and one week before in the remaining patient. The excised adenomas were examined by routine light microscopy. In addition, the terminal deoxynucleotidyl nick‐end labelling (TUNEL) technique was used to search for DNA‐strand breaks in areas with morphological alterations suggestive of apoptosis. Due to technical problems, TUMT was inadequate for one patient, i.e. the effect given was extremely low.

Results

 In six cases, histopathological changes were found in limited areas extending from the urethra for 20–25 mm into the prostatic tissue. The predominant histopathological findings were areas of necrosis surrounded by cells with apoptotic features. The latter proved to be TUNEL‐positive, i.e. they contained nuclei with DNA fragmentation of the apoptotic type. In the case with inadequate TUMT, there was no heat‐induced tissue damage.

Conclusion

 The area of tissue damage seen after TUMT was relatively small compared with the volume of the prostates. The main histopathological finding was massive necrosis, but cells undergoing apoptosis were also identified. Obviously, temperatures lower than those leading to necrosis induced apoptosis, which is a discrete type of cell death not associated with oedema or inflammatory reaction.
Quality‐of‐life assessment in patients after laser prostatectomy
Authors: Te SLAA E. , FRANCISCA E.A.E. , HENDRIKS J.C.M. , KIEMENEY L.A.L.M. , DEBRUYNE F.M.J. , De La ROSETTE J.J.M.C.H.
Published: November 2003

Objective

 To determine the importance of the assessment of quality of life in patients who have undergone laser prostatectomy.

Patients and methods

 Patients undergoing laser prostatectomy were evaluated using the International prostate symptom score (IPSS) questionnaire, uroflowmetry, post‐void residual volume (PVR) measurements, and quality‐of‐life (QOL) and sexual function questionnaires.

Results

 In all, 103 patients were evaluated; there was an overall significant improvement in the mean IPSS, maximum flow, PVR and QOL score and no apparent subjective change in sexual function. There was a good correlation between the IPSS and the QOL score, but no correlation between the QOL score and the maximum flow rate, and only a weak correlation between the IPSS and the maximum flow rate.

Conclusion

 Laser prostatectomy significantly changed the patients’ quality of life. This may be more important for the patient than the improvement in the voiding variables alone. In future (changes in) quality of life will probably contribute significantly to selecting patients with voiding complaints for particular treatments.
The urological management of men with lower urinary tract symptoms, recorded using an interactive computer program
Authors: HANSEN M.V. , ZDANOWSKI A.
Published: November 2003

Objective

 To analyse the level of agreement among urologists from the industrialized world in the management of men with lower urinary tract symptoms (LUTS).

Methods

Thirty‐three urological departments participated in the study. A computer program was used to provide an unbiased format of 18 simulated cases of men with LUTS which individual urologists then evaluated diagnostically and made therapeutic decisions about their management. The management of the patients was assessed for the probability that a diagnostic test was used, that a therapy was offered to a particular patient, the first‐choice therapies selected, the mean cost and range for the diagnostic process per patient and the number of first‐choice therapies offered by one urologist for all the patients. Various discriminators for these therapeutic decisions were evaluated, analysing the correlations between the information provided by the diagnostic tests and the probability of a particular therapy.

Results

For the 18 patients, the urologists, as a first choice, treated a mean (sd, range) of 8.3 (3.4, 3–16) patients with TURP, 3.9 (3.6, 0–11) with alpha‐blockers, 2.3 (1.7, 0–6) with watchful waiting and 1.7 (2.4, 0–9) with finasteride. The other therapy options were only offered as a first choice by a few of the urologists in a few of the cases. The mean (sd, range) cost per patient of the diagnostic process was US$ 594 (209, 326–1350).

Conclusion

There was considerable disagreement among the urologists about the management of men with LUTS, which included both the choice of diagnostic tests and the criteria for offering therapy to patients. If such disagreement prevails generally, it may be detrimental for the outcome of patients seeking medical attention for LUTS, and the cost of the medical care of these patients will be unnecessarily high.
Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair
Authors: MILLER M.A.W. , GRANT D.B.
Published: November 2003

Objective

 To obtain the long‐term follow‐up information on children born with severe perineoscrotal hypospadias associated with genital ambiguity who underwent a staged surgical correction of their hypospadias and were raised as males.

Patients and methods

 The study comprised patients who had undergone a surgical correction of hypospadias before 1978 and were traced successfully. Postal questionnaires which were completed and returned by 19 patients and 28 general practitioners (GPs) were evaluated; in addition, nine cases were clinically reviewed.

Results

 Of the 19 patients who completed and returned the questionnaire, four were married or living with a partner and 12 had had intercourse, with debut at a median age of 17 years. Satisfactory erection and orgasm were reported by 15 men but only seven had satisfactory ejaculation. Nine men had continued difficulties with micturition and urological function. Four men considered that their psychological well‐being and quality of life had been markedly impaired by their condition and two other men had evidence of mild depression. Nine patients did not complete the questionnaires but allowed their GPs to provide information about them; only one was reported to have marked psychological impairment and impaired general health. Two of the patients who did not participate in the study are known to have significant psychiatric problems.

Conclusions

 Staged hypospadias repair in men with severe perineoscrotal hypospadias is associated with continued difficulty with both ejaculation and micturition, but is not usually associated with major psychiatric or psychological disturbance. The findings indicate the importance of follow‐up in adolescence and adult life with adequate counselling when necessary.
mRNA and protein expression of nitric oxide synthase and adrenoceptor alpha 1 in young and old rat penile tissues
Authors: DAHIYA R. , LIN A. , BAKIRCIOGLU M.E. , HUANG S.‐T. , LUE T.F.
Published: November 2003

Objective

 To investigate alterations of neuronal structure and the mRNA expression of nitric oxide synthase (NOS) and adrenoceptor alpha 1 in young and old rat penile tissues, and assess the importance of these factors in erectile dysfunction (ED) associated with ageing.

Materials and methods

 NOS was determined in the pelvic ganglia of 32 rats using nicotinamide adenine dinucleotide phosphate (NADPH)‐diaphorase staining. Adrenergic neurons were identified by histofluorescence staining. The gene expression for NOS and for adrenoceptor alpha 1 was investigated in corporal tissue by differential reverse transcriptase‐polymerase chain reaction (RT‐PCR) using specific oligonucleotide primers. b‐actin was used as an internal standard in each tube to quantify the baseline gene expression.

Results

 The following changes occurred in old rats: (i) an increase of lipofuscin and a decrease in both bNOS‐containing neurons and fluorescent adrenergic neurons in the pelvic ganglia; (ii) significantly less expression of NOS mRNA than in young rat penile tissues; and (iii) no significant alteration in adrenoreceptor alpha 1 mRNA expression.

Conclusions

 The fewer adrenergic and NOS‐containing neurons and neurotransmitters in pelvic ganglia from old rats may explain the enhanced penile smooth muscle tone previously reported in older impotent men. Furthermore, lower mRNA expression of NOS may be associated with structural and functional changes associated with ageing penile tissue.
Adrenal cortical carcinoma associated with venous tumour thrombus extension
Authors: FIGUEROA A.J. , STEIN J.P. , LIESKOVSKY G. , SKINNER D.G.
Published: November 2003

Objective

 To report the diagnosis and treatment of six patients with adrenocortical adenocarcinoma and venous tumour thrombus extension.

Patients and methods

 All six patients (four female and two male, age range 14–83 years) were approached surgically through a thoracoabdominal incision and all underwent radical ablative surgery with removal of the primary tumour, regional retroperitoneal lymphadenectomy and en bloc extraction of the venous tumour thrombus.

Results

 Five patients with right‐sided tumours had vena caval tumour thrombus involvement and one patient with a left‐sided tumour had extension of tumour thrombus into the splenic vein. All patients had appropriate radiographic evaluation pre‐operatively and all underwent successful radical surgery with en bloc resection of the venous tumour thrombus.

Conclusion

 For optimal management of this rare neoplasm, it is paramount that accurate diagnostic imaging be performed pre‐operatively to help dictate the ideal surgical approach and to optimize successful treatment of this disease.
Treatment of high‐risk patients with subvesical obstruction from advanced prostatic carcinoma using a thermosensitive mesh stent
Authors: GOTTFRIED H.‐W. , GNANN R. , BRÄNDLE E. , BACHOR R. , GSCHWEND J.E. , KLEINSCHMIDT K.
Published: November 2003

Objective

 To evaluate the results obtained using a permanent prostatic stent system (Memotherm® , Bard/Angiomed, Karlsruhe, Germany) in high‐risk patients with advanced prostatic carcinoma and subvesical obstruction.

Patients and methods

 The study included 35 patients (mean age 75.3 years, range 53–89) with advanced prostatic carcinoma and persistent subvesical obstruction despite androgen ablation. Because of serious concurrent diseases, 49% of these patients were classified as American Society of Anesthesiologists (ASA) grade 3 and 51% as ASA grade 4. The patients were treated using the Memotherm® stent, a thermosensitive NitinolTM mesh stent. The outcome was assessed by measuring voiding variables, a symptom score and as the incidence of complications.

Results

 After inserting the stent, 33 (94%) of the patients were able to void spontaneously and there was a statistically significant improvement in the voiding variables. These results remained unchanged over a mean (range) follow‐up of 15.2 months (3–38). There were no serious complications arising from the insertion of the stent.

Conclusion

 For high‐risk patients with subvesical obstruction caused by prostatic carcinoma, the insertion of a permanent metal stent system offers a useful alternative treatment to transurethral resection.
Electrovaporization of the prostate in patients with benign prostatic enlargement
Authors: MATOS‐FERREIRA A. , VARREGOSO J.
Published: November 2003

Objective

 To determine the effectiveness and safety of transurethral electrovaporization in the treatment of benign prostatic enlargement (BPE).

Patients and methods

 The study comprised 91 patients (median age 65 years) with BPE (median prostate volume 61 mL). Patients were assessed with a general and urological history, the International prostate symptom score (IPSS), urinary tract and prostatic ultrasonography, uroflowmetry and biopsy of the prostate. An electrosurgical generator (cutting at 200 W and coagulating at 70 W) with grooved electrodes was used to vaporize the prostate. The variables assessed before and after treatment were the IPSS, quality‐of‐life score, uroflowmetry, complications, and the duration of hospitalization.

Results

 The mean operative duration was 45 min, blood loss was negligible and the mean duration of catheterization was 24 h. Recatheterization was necessary in 5.5% of patients. The median values before and after treatment were: IPSS, 19 and 5; QOL score, 4 and 2; and maximum urinary flow rate 8.3 and 22.1 mL/s (all P<0.001). In nearly all cases, the Siroky nomogram showed that patients became unobstructed.

Conclusions

 Electrovaporization of the prostate has many advantages over other techniques used in the treatment of BPE, including transurethral resection (TURP). It is cheaper than laser‐assisted prostatectomy in particular and is also simpler to perform. Higher‐risk patients can be treated, it uses existing electrosurgical equipment with minor modifications and only the electrodes, which are inexpensive, differ from TUR loops; the TURP resectoscope can be used and there is almost no need for blood transfusion. Intra‐ and post‐operative morbidity is very low, recatheterization rare, the hospital stay brief and the results equal to or better than those obtained with TURP. Convalescence is generally uneventful and rapid because haematuria is rare and, when present, mild. Patients can return to work earlier than after TURP. Although a promising technique, only a longer follow‐up will allow firm conclusions about its suitability.
Long‐term clinical results and quality of life after insertion of a self‐expanding flexible endourethral prosthesis
Authors: ANJUM M.I. , CHARI R. , SHETTY A. , KEEN M. , PALMER J.H.
Published: November 2003

Objective

 To evaluate the safety and efficacy of the Urolume self‐expanding flexible endourethral stent, based on a long‐term follow‐up, and to determine its role amongst the various modalities of treatment available for the relief of bladder outlet obstruction (BOO) arising from benign prostatic hyperplasia (BPH).

Patients and methods

 From January 1991 to April 1992, the Urolume wallstent (American Medical Systems, USA) was placed successfully in each of 62 patients (aged 50–89 years) who had significant subjective and objective evidence of BOO. The stent was placed as a daycase procedure under general anaesthesia. Pre‐operatively, each patient was assessed fully in an out‐patient clinic by symptoms, a flow rate measurement and a rectal examination. Post‐operatively, patients were assessed using transrectal ultrasonography, cystoscopy, symptoms and flow rate measurement, and after 5 years, the International Prostate Symptom Score and satisfaction score were obtained.

Results

 After 5 years, 27 (39%) patients survived and 10 (14%) died with their Urolume stent intact; 22 (32%) completed the follow‐up and five refused or were lost to follow‐up. Day and night‐time frequencies and flow rates improved continuously. Complete epithelialization occurred in 16 of the 22 patients assessed. Of those in whom the Urolume was removed, 20 are alive and five dead.

Conclusion

 The effectiveness of the Urolume in improving symptoms and flow rates in patients with BPH was confirmed. However, the high failure rate arose largely from inexperience in selection and deployment. There are no absolute criteria to predict a successful outcome. This study confirms the Urolume as a safe device. Most patients whose symptoms settled in the first year maintained a good flow rate and a significant improvement in symptoms for 5 years; their quality of life at the last follow‐up was good.
A prospective randomized study comparing a catheter‐valve with a standard drainage system
Authors: WILSON C. , SANDHU S.S. , KAISARY A.V.
Published: November 2003

Objective

 To determine if the use of a catheter‐valve rather than a standard drainage system decreases the morbidity associated with the use of a long‐term catheter.

Patients and methods

 One hundred patients undergoing long‐term catheterization were recruited into a prospective randomized study to investigate the acceptability and determine any increase in infection associated with the use of a catheter‐valve, compared with the standard drainage system. Each patient participated in the study protocol for 3 months, during which the frequency of urinary tract infection was assessed, and the patients’ views obtained using a standard questionnaire and by interview.

Results

 Ninety‐four patients completed the study; most (92%) were happy or satisfied with the valve, as opposed to only 35% of those using a standard drainage bag. There was no significant difference between the groups in the incidence of urinary tract infections.

Conclusion

 The patients who used the standard drainage system felt their level of activity was impaired, whereas the group who were using the valve did not. In the long‐term the valve was cheaper and caused less morbidity, but because it is constructed to allow one‐way flow, this was not associated with an increase in the incidence of urinary tract infections.
Laser therapy in dogs and humans—is there a difference?
Authors: Gottfried H.W. , Brändle E. , Hefty R. , Mattfeldt T. , Badura W. , Vogel U. , Hautmann R.E.
Published: November 2003

Objective To compare quantitatively the reduction of volume of benign prostatic hyperplasia (BPH) achieved by laser therapy in dogs and men.

Patients, materials and methods Twelve mongrels, with a mean prostatic volume of 33.4 mL, underwent transurethral laser treatment using an Nd:YAG laser with an Ultraline}}rm fibre at 60 W power setting. The reduction in prostatic volume was assessed quantitatively 3 months after treatment using stereological methods. Forty patients (mean age 70.2 years, range 51–84) with symptomatic BPH (pre‐operative mean prostate volume 46.3 mL) were treated under similar operative conditions with the same laser, power and fibre system. Their urinary performance was assessed before and 6 months after treatment using urinary flow rates, residual volume and a symptom score, and their prostatic volume and necrosis assessed using transrectal ultrasonography.

Results After laser treatment, the mean reduction in the dog prostate volume was 50% and in the patients was only 21%. The different impact was probably caused by anatomical differences between the human and dog prostate; the human prostate consists mainly of stromal tissue and the canine prostate of glandular epithelium.

Conclusions The canine model gives only an approximate guide to the extent of tissue destruction that laser treatment can achieve in men with BPH. Furthermore, tissue differences between men may also affect the response to laser treatment.
The ice‐water test in detrusor hyper‐reflexia and bladder instability
Authors: Petersen T. , Chandiramani V. , Fowler C.J.
Published: November 2003

Objectives To determine: (i) the outcome of the ice‐water test (IWT) in patients with an overactive detrusor and to define the sensitivity of the test in differentiating bladder instability from detrusor hyper‐reflexia; and (ii) to investigate any differences in sensitivity to the IWT with detrusor hyper‐reflexia caused by suprapontine and spinal pathologies.

Patients and methods Of 130 consecutive patients with urinary symptoms who underwent a urodynamic evaluation and IWT, 80 had detrusor overactivity; of these 60 had detrusor hyper‐reflexia and 20 had bladder instability. The patients with detrusor hyper‐reflexia were further subdivided into two groups, suprapontine or spinal, based on the site of the neurological lesion.

Results The overall sensitivity of the test in patients with detrusor hyper‐reflexia was 65% and the specificity 85%. In patients with a spinal pathology causing detrusor hyper‐reflexia, the test was positive in 70%, while 46% with suprapontine causes of detrusor hyper‐reflexia had a positive test.

Conclusions Although 65% of the patients with detrusor hyper‐reflexia and known neurological disease had a positive IWT, so did 15% of the patients with no neurological disease and bladder instability. Patients with suprapontine pathology had a lower sensitivity than those with infrapontine pathology, but this was not statistically significant. The relatively larger number of false‐negative tests in patients with a suprapontine pathology is one reason why the test is insufficiently sensitive to discriminate between detrusor hyper‐reflexia and bladder instability.
Early experience with high‐intensity focused ultrasound for the treatment of benign prostatic hypertrophy
Authors: Sullivan L.D. , McLoughlin M.G. , Goldenberg L.G. , Gleave M.E. , Marich K.W.
Published: November 2003

Objective To evaluate the safety and effectiveness of high‐intensity focused ultrasound (HIFU) in patients with benign prostatic hypertrophy (BPH).

Patients and methods The study comprised 25 patients (mean age 67 years, range 47–84) with BPH treated using the Sonoblate HIFU device. Patients were evaluated before and after one treatment of HIFU using the American Urological Association (AUA) symptom score, peak urinary flow rate (Qmax) and a quality‐of‐life (QOL) score, and any complications were noted.

Results Five patients with large glands were withdrawn because the failure rate was high in these patients. The remaining 20 patients showed a mean improvements in the AUA symptom score (20.25 to 9.56), Qmax (9.2 to 13.7 mL/s) and QOL score (4.75 to 2.50). There were no major complications.

Conclusions HIFU is safe, produces minimal side‐effects or complications and relieves the symptoms of prostatism.
The expression of waf‐1, p53 and bcl‐2 in prostatic adenocarcinoma
Authors: Byrne R.L. , Wilson Horne C.H. , Robinson M.C. , Autzen P. , Apakama I. , Bishop R.I. , Neal D.E. , Hamdy F.C.
Published: November 2003

Objective To determine the associations between the expression of waf‐1 (a cyclin‐dependent kinase inhibitor regulated by p53), p53, bcl‐2 and tumour progression in prostate cancer.

Patients and methods Samples of prostatic tissue were obtained by biopsy or at prostatectomy from 40 men (mean age 73 years, range 55–88) with histologically confirmed prostate cancer, examined using immunohistochemical staining for the three gene products, and the expression related to the stage, grade, disease progression and survival of the patients.

Results Fifteen of 18 patients whose tumours were positive for waf‐1, 10 of 12 positive for bcl‐2 and 17 of 19 positive for p53 had disease progression. Fifteen of 19 patients positive for p53 had poorly differentiated tumours compared with 11 of 21 negative for p53 (P<0.05). A significant number of patients positive for p53 progressed and had a shorter time to progression compared to those negative for p53 (P<0.05). There was no correlation between either waf‐1 and/or bcl‐2 staining and clinical grade, stage or tumour progression.

Conclusions This study confirmed the association of p53 protein accumulation with aggressive behaviour in prostate cancer and identified waf‐1 protein in prostatic tumours. There was no evidence that the upregulation of waf‐1 was associated with a better outcome in patients with prostate cancer.
Spontaneous ascent of the testis
Authors: Gracia J. , Navarro E. , Guirado F. , Pueyo C. , Ferrández A.
Published: November 2003

Objective  To report confirmed cases of spontaneous testicular ascent in patients with a cryptorchid testis which had been previously placed in the scrotum.

Patients and methods  Between 1972 and 1992, 46 cryptorchid testes (36 patients), which were previously verified to be in the scrotum by staff paediatricians or paediatric surgeons, were treated surgically. The clinical, surgical and anatomicopathological records were reviewed to determine testicular position and associated conditions, and biopsies were taken from 35 testes.

Results  The mean time between the last ‘normal’ exploration until the testes ascended was 4.5 years. Before ascent, the testes were confirmed to be in the scrotum by up to seven separate recorded examinations. During surgical treatment, an open processus vaginalis was found in 18 testes. The mean (sd) tubular fertility index was 40 (37)%.

Conclusion  This study confirms that a previously descended testis can ascend spontaneously. The clinical and anatomicopathological characteristics of these testes were similar to those of the cryptorchid testis.
Neoadjuvant androgen deprivation therapy before radical prostatectomy: who is unlikely to benefit?
Authors: Rabbani F. , Sullivan L.D. , Goldenberg S.L. , Stothers L.
Published: November 2003

Objective To determine which patients undergoing radical prostatectomy for localized cancer are unlikely to benefit from neoadjuvant androgen withdrawal therapy.

Patients and methods Over a 5‐year period, 173 patients underwent radical retropubic prostatectomy; 87 patients received no pre‐operative androgen withdrawal therapy, for whom the clinical stages were T1b (17 patients), T1c (3), T2a (31) and T2b/c (36). Pre‐operative prostate biopsies contained well‐differentiated cancer in 43 and moderately differentiated cancer in 44 patients. Serum prostate‐specific antigen (PSA) ranged from 0.4 ng/mL to 110.1 ng/mL (median 5.0). The presence of extracapsular disease, positive surgical margins and seminal vesicle involvement were correlated with pre‐operative PSA, PSA density (PSAD), the natural logarithm of PSA [ln(PSA)], biopsy grade, clinical stage, and sparing of neurovascular bundles.

Results Patients with a PSA ≤4.0 ng/mL had a rate of extracapsular disease and positive margins of 8.3% and none had seminal vesicle invasion; corresponding rates for patients with a PSA >4.0 ng/mL were 57%, 51% and 12%, respectively. Multivariate analysis revealed ln(PSA) to be the best predictor of extracapsular disease (P0.001), margin positivity (P0.001) and seminal vesicle invasion (P=0.0019).

Conclusions These results suggest that in patients who have clinically localized, well or moderately differentiated prostate cancer, a PSA ≤4.0 ng/mL is predictive for organ‐confined disease. This group is unlikely to benefit from neoadjuvant androgen deprivation. Ln(PSA) may be able to improve the accuracy of mathematical multivariate models predicting the presence of extracapsular disease or margin positivity, but this will require verification in larger population‐based studies.
Persistent Müllerian duct syndrome with or without transverse testicular ectopia and testis tumours
Authors: Berkmen F.
Published: November 2003

Objective  To report three patients with persistent Müllerian duct syndrome (PMDS) associated with a unilateral testicular tumour.

Patients and methods  Three adults with PMDS and an associated testicular malignancy were evaluated using physical examination, imaging, measurement of tumour markers, surgical exploration and chromosome analysis.

Results  The position of the uterus and fallopian tubes differed in all patients; one was in the scrotal sac, another in the abdomen and the third in the left inguinal canal. Two of the patients were cousins and their pedigree showed that they were probably in a sex‐limited group. Both also had transverse testicular ectopia; fertility was documented in the younger patient. In all cases, the karyotype was proved to be 46, XY.

Conclusion  We recommend that the diagnosis of PMDS is made radiologically and that the detection of Müllerian inhibiting factor is mandatory. As malignancy does not occur in the retained Müllerian ducts, hysterectomy should not be performed at abdominal exploration, although orchidectomy should be, because orchidopexy offers only limited protection against future malignancy if performed after 2 years of age. It is not necessary to perform testicular biopsy to detect tumour in the scrotal testis in this syndrome, because an impalpable tumour can be localized by ultrasonography.
Complications of the post‐chemotherapy resection of retroperitoneal residual tumour mass in patients with
Authors: Gels M.E. , Nijboer A.P. , Hoekstra H.J. , Sleijfer D.Th. , Molenaar W.M. , Plukker J.Th. , Droste J.H.J. , Schraffordt Koops H.
Published: November 2003

Objective To evaluate the resection of the retroperitoneal residual tumour mass (RRTM) for histological examination after chemotherapy in patients with disseminated non‐seminomatous testicular germ cell tumours (NSTGCTs), with particular attention to surgical morbidity.

Patients and methods From 1979 to 1995, 112 patients (mean age 28 years, range 16–53) with NSTGCT had residual disease after chemotherapy for which surgical evaluation was indicated; the histology of the residual tumour and the surgical complications were assessed. Possible associations between the occurrence of surgical complications and the age of the patient, size of the residual tumour, operative duration, previous laparotomy and pathological findings were evaluated.

Results The median size of the residual tumour was 4 cm (range 0–18); histological examination revealed viable tumour in 9%, mature teratoma in 44% and necrosis/fibrosis in 44% of the patients. In three patients (2.8%) no residual tumour mass was found at laparotomy. There were 26 complications in 20 patients (18%); urinary tract infection was the most common, occurring in nine patients (8%). One patient died during the induction of anaesthesia. There were no significant relationships between the occurrence of complications and age, size of the residual tumour, operative duration, previous laparotomy or pathological findings.

Conclusion The resection of RRTM after polychemotherapy treatment for disseminated NSTGCT is a safe surgical procedure, with low treatment morbidity consisting mainly of urinary tract infection. Knowledge of the potential complications may help to prevent morbidity. However, the surgical evaluation of the ultimate effect of polychemotherapy remains the gold standard.
A randomized cross‐over study comparing the use of a catheter valve and a leg‐bag in urethrally catheterized male patients
Authors: German K. , Rowley P. , Stone D. , Kumar U. , Blackford H.N.
Published: November 2003

Objectives  To evaluate the use of a catheter valve (CV) and a leg‐bag (LB) in men with urethral catheters and to determine the preferred modality.

Patients and methods  Eighteen men (mean age 71.4 years, sd 3.4, range 63–76) presenting in acute retention and catheterized urethrally were enrolled in a 6‐week randomized cross‐over study comparing the CV with the LB (3 weeks with each modality). The outcome was assessed using a questionnaire which quantified the incidence of bladder spasms, nocturnal frequency, the extent of any by‐passing episodes and the degree of discomfort. At the end of the study, the patients were asked to express a preference (using a subjective scoring scale) for either the CV or the LB and to give the reasons why.

Results
 There was no difference in the reported incidence of bladder spasms or discomfort and no difference in positive urine cultures with each modality. However, with the CV, there was a slightly higher incidence in nocturnal frequency and by‐passing episodes. Thirteen patients preferred the CV whilst five preferred the LB. With the subjective scoring scale (range 0–10), the CV scored significantly higher than the LB (7.2, sd 3.1 and 5.2, sd 2.8, P<0.05: paired t‐test).

Conclusions  Most patients preferred to use the CV, reporting that it felt more comfortable and discreet, and many patients did not like the sensation of urine ‘sloshing about’ when using the leg‐bag. Some patients using the CV were troubled by nocturnal frequency. In these patients we suggest that a combination of a valve during the day and an overnight bag may be the ideal solution.
Bladder and urethral anaesthesia with electromotive drug administration (EMDA): a technique for invasive endoscopic procedure
Authors: Fontanella U.A. , Rossi C.A. , Stephen R.L.
Published: November 2003

Objective To assess the efficacy of the electromotive administration of lignocaine and adrenalin as local anaesthesia (EMDA/LA) for invasive lower urinary tract procedures.

Patients and methods Electric current generators, catheters and electrodes were designed and fabricated, using defined electrochemical principles, to carry out EMDA/LA of the bladder and prostatic urethra of 91 patients who underwent 27 bladder‐mapping biopsies, 62 transurethral resections (TURs) of bladder tumours, 21 transurethral incisions on the prostate or bladder neck incisions, 12 TURs of the prostate (122 operations in total) and nine miscellaneous interventions, all using rigid instruments. Resections were performed using electrocautery. Most patients, while minimally sedated and fully conscious, completed an assessment of EMDA/LA using a simple pain scale.

Results In five of the 122 procedures, the pain was described as intolerable, six were recorded as painful but tolerable and the remaining 111 procedures were recorded as having minimal to no discomfort only. Side‐effects were few, there was no clinical evidence of lignocaine toxicity and serial serum lignocaine levels measured in four patients were innocuous.

Conclusions EMDA/LA provides safe, effective anaesthesia for most invasive endoscopic procedures in the lower urinary tract.
The agreement among urological experts on the diagnostic management of patients with common urological problems
Authors: HANSEN M.V. , ZDANOWSKI A.
Published: November 2003

Objective

 To assess the level of agreement among randomly selected international urologists on the diagnostic management of patients with prostate cancer, bladder cancer, urinary stones or lower urinary tract symptoms (LUTS) arising from benign prostatic hyperplasia (BPH).

Methods

 A computer program was used to provide an unbiased format of 53 simulated patients, comprising 13 with prostate cancer, 10 with bladder cancer, 10 with stones in the upper urinary tract and 20 with LUTS from BPH. For each case, the history was provided to the user while information from 60 diagnostic tests could be chosen interactively. Thirty‐three university‐based urologists participated in the study. The probability that a certain test was used by them in a certain patient []> P(test)] and the related costs (Swedish 1995 prices) were recorded. The probability that two urologists would agree (relative measure of agreement, RMA) on whether or not to use one particular test in a certain case was RMA(test)=P(test)2+[1–P(test)]2 and the mean of this RMA(test) for a certain patient [RMA(case)] was used as a measure of the inter‐individual agreement among the urologists on the diagnostic management. The significance levels of the generalized kappa statistic, KG , were also calculated. The correlation between the RMA(case) and the diagnostic groups was analysed.

Results

 The KG was statistically significant for all cases; the RMA(case) was significantly correlated with the diagnostic groups (rs=0.86). The agreement in the diagnostic management was the strongest for stones, then for bladder cancer and prostate cancer, and the weakest for BPH. The mean cost for the diagnostic evaluation for one case varied from $455 to $1771 (mean 898) and varied in the diagnostic groups, i.e. $1718 for prostate cancer, $947 for bladder cancer, $400 for stones and $594 for BPH.

Conclusion

 The diagnostic management of urological patients varies greatly among urological experts from the industrial world. As a consequence, the related diagnostic costs might vary by about 400% if prices were similar everywhere. The agreement on the diagnostic management of cases is strongly correlated to the diagnosis. LUTS from BPH seems to be managed with the poorest agreement.