bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients
Authors: Okada H. , Kamidono S. , Yoshioka T. , Okuyama A. , Ozono S. , Hirao Y. , Okajima E. , Yamamoto K. , Kishimoto T. , Park Y. , Kurita T.
Published: March 2003

Objective To compare the efficacy and safety of an incremental‐dose regimen of terazosin (1–2 mg daily) and a fixed‐dose regimen of tamsulosin (0.2 mg daily), on Japanese patients with symptomatic benign prostatic hyperplasia (BPH).

Patients and methods This multicentre, single‐blind, randomized trial compared terazosin and tamsulosin over 4 weeks, in 61 patients with symptomatic BPH randomly assigned to terazosin (n = 31) or tamsulosin (n = 30). Terazosin 0.5 mg twice daily was administered for 2 weeks, followed by 1 mg twice daily for 2 weeks. Tamsulosin (0.2 mg) was administered once daily for 4 weeks. Symptoms were evaluated using the International Prostate Symptom Score (IPSS), and quality of life (QOL) was assessed subjectively before treatment, and again after 2 and 4 weeks of treatment. Objective measurements taken before and after the treatment period were the maximum (Qmax) and average (Qave) urinary flow rates, and the percentage residual urine volume. Improvement was defined as a 25% decrease from baseline in IPSS, > 1 point increase in QOL score, and > 2.5 mL/s increase in Qmax. Adverse reactions potentially related to the study drugs were recorded throughout the treatment period.

Results Both terazosin and tamsulosin produced statistically significant improvements in subjective and objective variables. Neither treatment affected systolic or diastolic blood pressure or pulse rate. Adverse reactions were noted in four patients (three in the terazosin group and one in the tamsulosin group). However, there was no statistically significant difference in the incidence of adverse effects between the groups.

Conclusions Despite the limitations of small sample size and relatively short treatment periods, terazosin and tamsulosin were equally effective in the treatment of symptomatic BPH in Japanese patients, using relatively lower doses than those used in Western countries.
Angiogenesis and lymphangiogenesis in stage 1 germ cell tumours of the testis
Authors: Jones A. , Fujiyama C. , Turner K. , Fuggle S. , Cranston D. , Turley H. , Valtola R. , Bicknell R. , Harris A.L.
Published: March 2003

Objective To determine whether angiogenesis can be used as an additional prognostic indicator in patients with stage 1 germ cell tumours of the testis.

Patients and methods Paraffin sections were assessed immunohistochemically from 51 patients with clinical stage 1 germ cell tumours of the testis (28 seminoma, 23 teratoma) treated by orchidectomy and surveillance only. Sections were analysed for microvascular density (MVD), and expression of the angiogenic factors vascular endothelial growth factor (VEGF) and thymidine phosphorylase (TP). In addition, in the seminoma cases the presence of mRNA for the lymphangiogenic factor VEGF‐C was examined by in situ hybridization, and its corresponding receptor VEGFR‐3 by immunohistochemistry.

Results Teratoma specimens had a significantly higher mean (range) MVD (85, 26–163; P < 0.01) than both seminoma (37, 16–91) and four normal specimens (26, 18–30). Teratoma specimens also had significantly higher VEGF expression than both seminoma and normal specimens (P < 0.01). Despite these differences between groups, and indeed individual tumours, there was no significant correlation between MVD and VEGF, or between either MVD or VEGF and relapse‐free survival. TP expression was significantly greater in tumours than in normal specimens (P < 0.02) but with very little inter‐tumour variation. VEGF‐C mRNA and VEGFR‐3 protein were detected in a third to a half of cases, with expression mostly around endothelial vessels.

Conclusions The marked differences between normal testis and tumours implicate angiogenesis in the biology of germ cell tumours of the testis. In addition, the detection of factors involved in lymphangiogenesis in some seminomas, tumours which initially metastasize primarily to lymph nodes, indicate that although not prognostic in this study, further studies are warranted in both these areas in the search for further prognostic indicators and therapeutic targets.
Induction of apoptosis by mitomycin‐C in an ex vivo model of bladder cancer
Authors: Kelly J.D. , Williamson K.E. , Weir H.P. , McManus D.T. , Hamilton P.W. , Keane P.F. , Johnston S.R.
Published: March 2003

Objective To examine mitomycin‐C (MMC)‐induced apoptosis in an ex vivo model of superficial TCC, and relate it to the in vivo response to chemotherapy.

Materials and methods Dose‐ and time‐response curves were constructed to determine the optimal conditions for the induction of apoptosis by MMC in an ex vivo model of superficial bladder cancer. Subsequently, 41 individual tumours were exposed to MMC in the model and the effects assessed by measuring of apoptosis before and after chemotherapy. The relationships between tumour grade and stage and the intrinsic and induced apoptotic counts were determined. In tandem, in a clinical study, the relationship between in vivo response of a marker tumour to MMC and the ex vivo induction of apoptosis was determined.

Results In the ex vivo model, apoptosis was induced at a MMC concentration of 0.5 mg/mL after an incubation time of 8 h. In 41 tumours the intrinsic apoptotic index (AI) was higher with increased grade and stage of tumour (P = 0.048). There was no correlation between the intrinsic AI and the AI after treatment with MMC (induced AI). In 21 tumours (51%) the induced AI did not increase above a predetermined response threshold and these tumours were considered resistant to MMC. Resistance to MMC was related to tumour grade (P = 0.037) with a trend for G3 pT1 tumours to be resistant to the therapy. There was a significant association between ex vivo sensitivity and in vivo marker tumour response (P = 0.02).

Conclusions Apoptosis is differentially induced in an ex vivo incubation model of superficial TCC by MMC and evidence suggests that this response matches that seen in vivo. The measurement of apoptosis before therapy does not predict the apoptotic response of a tumour to chemotherapy. The ability to undergo apoptosis correlates with clinical outcome.
Paediatric urinary tract infection and the necessity of complete urological imaging
Authors: Kass E.J. , Kernen K.M. , Carey J.M.
Published: March 2003

Objective To evaluate voiding cysto‐urethrography (VCUG) in assessing children with urinary tract infection (UTI) when renal/bladder ultrasonography and renal scintigraphy show no abnormality.

Patients and methods A total of 468 renal scintigrams taken in children for an indication of UTI between January 1996 and December 1998 were reviewed. The renal and bladder ultrasonograms of those children with a normal renal scan were then reviewed. Children with both normal renal scans and normal ultrasonography were then evaluated for the frequency and grade of vesico‐ureteric reflux (VUR) on VCUG.

Results Of the 468 patients, 453 (97%) had complete imaging studies; 152 of the children evaluated had normal renal scans, of whom 101 had a normal renal ultrasonogram. Twenty‐three (23%) children with both a normal renal scan and renal/bladder ultrasonogram showed VUR on VCUG, of whom 14 had bilateral VUR and 13 grade III or higher VUR.

Conclusion This study indicates that about 23% of patients may have significant VUR despite both a normal renal scan and ultrasonogram. Therefore, VCUG remains important in evaluating and managing children with UTI.
Long‐term follow‐up of female patients with congenital adrenal hyperplasia from 21‐hydroxylase deficiency, with special emphasis on the results of vaginoplasty
Authors: Krege S. , Walz K.H. , Hauffa B.P. , Körner I. , Rübben H.
Published: March 2003

Objective To assess, in a long‐term follow‐up, female patients with congenital adrenal hyperplasia (CAH), with special emphasis on vaginal functional outcome and sexual activity after vaginoplasty.

Patients and methods Twenty‐seven patients with CAH (aged 14–33 years; six Prader grade II, 14 grade III, six grade IV and one grade V) underwent surgery between 1972 and 1988. Three of the patients underwent clitoridectomy, 24 clitoroplasty and 25 vaginoplasty (24 with a Fortunoff flap and one a ‘pull‐through’ procedure). In 20 patients the vaginoplasty was a one‐stage procedure, undertaken at a mean (range) age of 3.6 (1–9) years, and in five patients a two‐stage operation. The analysis was based on the patients' history and examination; the patients also completed a questionnaire, including a psychological profile.

Results Nine of the 25 patients (36%) who underwent vaginoplasty developed intravaginal stenosis; of these nine, six were Prader grade III and three grade IV. All had undergone a single‐stage procedure at a mean (range) age of 4.7 (2–9) years. Of the 16 patients who answered the questionnaire, 14 had problems with their overall body image; patients in whom vaginal stenosis was corrected were particularly anxious about sexual intercourse and had problems with orgasm.

Conclusion The main problem during the long‐term follow‐up was intravaginal stenosis; all the affected patients had undergone a single‐stage procedure early in life to correct ambiguous genitalia. This high rate of vaginal stenosis suggests that vaginoplasty should be undertaken at the beginning of puberty, because higher oestrogen levels may prevent stenosis and, if necessary, dilatation can be performed by the patient. These data also underscore the importance of psychological support in the treatment of children with CAH.
Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience
Authors: Husain J. , Lynn N.N.K. , Jones D.K. , Collins G.N. , O'reilly P.H.
Published: March 2003

Objective To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease.

Patients and methods After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0–5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11–0.17 mJ/mm2) at 3‐week intervals. The results were analysed using the Wilcoxon signed‐rank test.

Results Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4–60) months and the mean follow‐up 7.5 (5–11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3° (10°−60°) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1–4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side‐effects were reported.

Conclusion ESWT is an effective and safe treatment for Peyronie's disease; the long‐term follow‐up and results are awaited.
The clinical implications of telomerase activity in upper tract urothelial cancer and washings
Authors: Wu W.‐J. , Liu L.‐T. , Huang C.‐N. , Huang C.‐H. , Chang L.‐L.
Published: March 2003

Objective To measure telomerase activity in upper tract urothelial carcinomas (as renal pelvic tumours comprise nearly half of all kidney tumours in Taiwan, a much higher percentage than in other countries) and to determine whether telomerase activity could be used as an additional diagnostic marker in exfoliated cancer cells present in upper tract urothelial washing fluids, thus providing earlier diagnosis and treatment.

Materials and methods Telomerase activity was assessed using the telomeric repeat amplification protocol assay in tissue samples from 31 upper tract urothelial carcinomas (from 29 patients). The feasibility of identifying cancer using telomerase activity in exfoliated cancer cells in 17 upper tract urothelial washing samples was also investigated.

Results Telomerase activity was found in 30 (97%) of the 31 upper tract urothelial cancer tissue samples; telomerase activity was detectable in 95% of superficial cancers and in all 11 invasive tumours. The sensitivity of measuring telomerase activity was 100% for grade 1, 93% for grade 2 and 100% for grade 3 tumours. In contrast, telomerase activity was detected in only two (8%) of 26 normal adjacent tissue samples. When the telomerase activity of urothelial washing fluid was compared with that in the corresponding tumours, there was compatible telomerase activity in 15 of the 17 samples. Telomerase activity was more sensitive than voided urine cytology (15%) and washing fluid cytology (53%). In addition, the telomerase activity was high in metastatic lesions.

Conclusion Telomerase activity is present in most upper tract urothelial cancer tissues and may be present at an early stage of carcinogenesis. Telomerase activity can be detected in exfoliated cells in urothelial washing fluids in a high proportion of patients with upper tract urothelial cancer. These results suggest that measuring telomerase activity in the exfoliated cancer cells obtained from urothelial washing could be a potentially useful addition to the conventional diagnostic tools used to identify patients with upper tract urothelial carcinoma.
Rectal examination and urethral catheterization by medical students and house officers: taught but not used
Authors: Turner K.J. , Brewster S.F.
Published: March 2003

Objective To assess the acquisition of skills in digital rectal examination (DRE) and urethral catheterization by medical students and house officers associated with a UK medical school, and to determine their confidence in these techniques.

Subjects and methods Questionnaires were sent to all final‐year medical students at Oxford Medical School immediately before their final examinations. Similar questionnaires were sent to all pre‐registration house officers who had graduated from Oxford in the previous year.

Results Responses were received from 71% of the students and 84% of the graduates; 88% of the students and 94% of the graduates had been taught how to perform a DRE as a medical student, but 42% of medical students had performed fewer than five DREs before qualification. Their findings were rarely checked by a doctor. Of the students, 44% had never felt a clinically malignant prostate gland and 41% were ‘not at all confident’ in their ability to give an opinion based on their findings on a DRE. House officers performed DRE regularly (53%  50 DREs) but rarely received additional instruction, and exposure to pathology remained limited. House officers' findings on DRE were rarely confirmed by a more senior doctor. Most respondents had been taught how to perform male urethral catheterization as a medical student (92% of students, 89% of house officers) but 48% of students had performed fewer than two catheterizations on qualification and 68% of house officers had received no additional instruction; however, 69% of house officers were ‘very confident’ in their ability to perform male urethral catheterization.

Conclusions The DRE is a critical skill in assessing the prostate; students conduct few DREs, lack confidence and are exposed to minimal pathology. Legitimate concerns over students carrying out intimate examinations may be mitigating against the acquisition of skills. Possible solutions are explored. House officers perform DREs regularly, but with no additional instruction they may continue to lack confidence. Students lack experience in male urethral catheterization and rarely receive postgraduate instruction. House officers' confidence in their ability to perform male urethral catheterization may be misplaced.
Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners
Authors: Cliff A.M. , Macdonagh R.P.
Published: March 2003

Objective To assess psychometrically a new questionnaire for measuring the psychosocial morbidity in patients with prostate cancer and in their partners, and to compare the morbidity of patients and their partners.

Patients and methods A sequential sample of patients with any stage of prostate cancer and attending general urology outpatient clinics was identified. The questionnaire was administered to 135 patients and their partners in their homes. The Hospital Anxiety and Depression Scale (HADS) questionnaire was also administered to permit construct validation of the new measure. Test‐retest reliability was calculated by re‐administering the questionnaire to 60 individuals. The hypothetical general cancer distress and social subscales of the questionnaire were also tested for internal consistency. Psychosocial morbidity scores obtained by the patients and partners were compared.

Results The questionnaire had good test‐retest reliability and construct validity when tested against the HADS. The general cancer distress and social subscales were internally consistent. General cancer distress was highly prevalent and significantly more severe in partners than in patients. There was some degree of general cancer distress in 47% of patients and 76% of partners, whereas severe distress was detected in 11% and 30%, respectively. Social morbidity was limited and of equal severity between the groups. Treatment‐related worries and concerns about pain and physical limitation were more common among partners than patients, whereas there was no difference for worries about urinary symptoms. Sexual concerns were the least prevalent and were more of a problem for patients than partners.

Conclusion Psychosocial morbidity in prostate cancer is highly prevalent, not only among patients but particularly among their partners. The new questionnaire showed adequate psychometric properties for use in identifying individuals with significant psychosocial morbidity. Applying the questionnaire should permit emotional and informational support to be targeted at the most vulnerable.
High‐pressure bladder: an underlying factor mediating renal damage in the absence of reflux?
Authors: Vega‐P J.M. , Pascual L.A.
Published: March 2003

Objective To assess urodynamic studies of children with nonrefluxing pyelonephritis, investigate the possible connection between renal damage (as ≈ 40% of children with febrile urinary tract infections and no evidence of vesico‐ureteric reflux have irreversible renal cortical scarring) and lower urinary tract dysfunction, to test the hypothesis that bladders with high storage and voiding pressures may be the cause of renal damage in these patients.

Patients and methods The clinical records and urodynamic studies of 52 children (46 girls and six boys, mean age 6.6 years) with febrile urinary infections, no evidence of reflux and photopenic areas on renal scintigraphy were evaluated retrospectively. Each child was evaluated by urinary ultrasonography, a voiding cystogram, 99mTc‐dimercaptosuccinic acid (DMSA) scan and urodynamic studies. The storage phase of the urodynamic study was divided into two equal segments to consider the filling variables of each. During the emptying phase, voiding pressures and voiding pressures with reference to peak detrusor contraction were evaluated.

Results Despite no child having reflux, the DMSA scans showed bilateral renal scarring in 39 (75%) and unilateral scarring in the remaining children. Forty‐eight (93%) children had abnormal urodynamic values: high filling pressures (34), high‐pressure uninhibited contractions (32), high voiding pressures (31) and discoordinated voiding (28). The cystometric bladder capacity was lower than the expected bladder capacity (– 75 mL) in 82% of the patients; in only four patients were the urodynamics considered normal.

Conclusions Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of reflux.
The relationship between early renal status, and the resolution of vesico‐ureteric reflux and bladder function at 16 months
Authors: Godley M.L. , Desai D. , Yeung C.K. , Dhillon H.K. , Duffy P.G. , Ransley P.G.
Published: March 2003

Objective To examine, in infants presenting with vesico‐ureteric reflux (VUR), the relationship between the presence of initial renal abnormalities with the outcome of VUR and bladder function at 16 months of age.

Patients and methods The study group comprised 40 infants (32 boys) presenting consecutively (29 after prenatal detection) with VUR grade III or greater (bilateral in 29) on the initial micturating cystogram (median age 8 weeks). The initial presence of abnormal kidneys was determined from isotopic renography and/or ultrasonography. These data were correlated with the outcome of VUR, from direct isotope cystography, and bladder function assessed by natural filling urodynamics, examined at age 16 months (mean 16.4 months,

sd 2.1).

Results Three groups were identified. Group 1 (eight boys and six girls) had normal kidneys bilaterally; initially grade III VUR was common. At 16 months bladder function was normal in 10 children and none had VUR (complete resolution). Group 2 (14 boys and two girls) had unilateral renal abnormalities; initially VUR was predominantly grade IV or grade V. At 16 months bladder function was normal in eight children and VUR resolved in eight, five of these with normal bladder function. Group 3 (10 boys) had bilateral renal abnormalities. Initially grade V VUR predominated; at 16 months the bladder function was normal in only one, and in the rest the emptying dynamics were abnormal. All 10 boys had persisting VUR (no resolution).

Conclusions In infants with moderate or severe VUR, resolution at 16 months old is associated with normal kidneys in a similar proportion of boys and girls. Resolution also correlates well with normal bladder function. Presentation in infancy with bilateral abnormal kidneys, associated with severe VUR in boys, is a poor prognostic sign for the early outcome of VUR and for bladder function.
Imaging for staging bladder cancer: a clinical study of intravenous 111indium‐labelled anti‐MUC1 mucin monoclonal antibody C595
Authors: Hughes O.D.M. , Perkins A.C. , Frier M. , Wastie M.L. , Denton G. , Price M.R. , Denley H. , Bishop M.C.
Published: March 2003

Objective To investigate the clinical application of an 111In‐labelled anti‐MUC1 mucin monoclonal antibody (mAb) imaging for staging invasive bladder cancer.

Patients and methods Indirect immunohistochemistry was used to confirm the expression of the MUC1 target antigen by metastatic tumours. Twelve patients with bladder cancer (two with superficial and 10 with locally invasive/metastatic disease) underwent planar γ‐scintigraphy 48 h after an intravenous injection with 111In‐labelled anti‐MUC1 mucin mAb C595.

Results No bladder uptake was detected in the two patients with superficial disease, but scintigraphy showed primary and recurrent bladder tumours and metastases in nine of the remaining 10 patients with invasive disease. In three patients additional staging information was obtained from the mAb imaging which would have altered patient management. There were no reported side‐effects.

Conclusion This study confirmed the ability of the mAb technique to detect both primary and recurrent invasive bladder tumours and distant metastases. Some lesions shown by mAb imaging were not detected by other methods. The use of mAb imaging has the potential to improve clinical staging and assist in selecting those patients most likely to benefit from radical therapy.
A dose‐escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction
Authors: Meuleman E. , Cuzin B. , Opsomer R.J. , Hartmann U. , Bailey M.J. , Maytom M.C. , Smith M.D. , Osterloh I.H.
Published: March 2003

Objective To assess the efficacy and safety of sildenafil citrate (Viagra®, Pfizer Inc., USA) in a double‐blind, placebo‐controlled, dose‐escalation study over a period of 26 weeks in men with erectile dysfunction of a broad spectrum of aetiology.

Patients and methods In all, 315 patients from five countries were randomized to receive treatment with placebo (156 men) or sildenafil (159 men). Significant concomitant medical conditions were hypertension (20%), a history of pelvic surgery (19%), diabetes mellitus (15%), and ischaemic heart disease (10%). Patients randomized to treatment received a starting dose of 25 mg of sildenafil or matching placebo, which could be increased to 50 mg and then to 100 mg of sildenafil, based on efficacy and tolerability. Assessments of efficacy comprised the 15‐item International Index of Erectile Function (IIEF), including question three (ability to achieve an erection) and question four (ability to maintain an erection), a partner questionnaire, an overall efficacy question, and event‐log data.

Results After 12 weeks of treatment, 26%, 32% and 42% of patients were taking 25, 50 and 100 mg of sildenafil, respectively. A similar distribution of doses was reported after 26 weeks of treatment. Treatment with sildenafil significantly improved the patients' abilities to achieve and maintain an erection compared with treatment with placebo (P < 0.001). Scores for four of the five sexual function domains of the IIEF (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) also improved significantly (P < 0.001). There was a significant improvement in the mean score for the erectile function domain, regardless of the aetiology of erectile dysfunction (P < 0.001). After 12 weeks and 26 weeks of treatment, 82% and 79% of patients receiving sildenafil reported improved erections, compared with 24% and 23% of patients receiving placebo, respectively (P < 0.001). Treatment‐related adverse events were mild to moderate and occurred in 27% of patients receiving sildenafil, compared with 8% of patients receiving placebo.

Conclusion Sildenafil is an effective and well‐tolerated treatment for men with erectile dysfunction of a broad spectrum of aetiology.
Side‐effects of oral or intravesical oxybutynin chloride in children with spina bifida
Authors: Ferrara P. , D'Aleo C.M. , Tarquini E. , Salvatore S. , Salvaggio E.
Published: March 2003

Objective To evaluate the incidence of side‐effects of oral and intravesical oxybutynin chloride in children with meningomyelocele (MMC) and a neurogenic bladder.

Patients and methods The study comprised 225 children with a neurogenic bladder from MMC who were evaluated with urodynamic testing and voiding cysto‐urethrography to identify those at high risk of upper tract damage. In all, 101 children (mean age 4.2 years, range 0.25–10) had unco‐ordinated detrusor‐sphincter function and low compliance; they were treated with either oral or intravesical oxybutynin and clean intermittent catheterization.

Results Of the 101 patients, 67 were treated with oral oxybutynin; in 11 the treatment was discontinued because of the side‐effects. The other 34 patients used both clean intermittent catheterization and intravesical oxybutynin. In this group there were side‐effects in six patients, including drowsiness, hallucinations and cognitive changes.

Conclusions Oral and intravesical oxybutynin is effective for managing neurogenic bladder dysfunction, but intravesical administration is safer and better tolerated than oral oxybutynin in the treatment of children with MMC. However, adverse effects such as cognitive impairment can also occur in children treated with intravesical oxybutynin and these patients must be closely monitored because these effects may differ from those with oral administration.
Peyronie's disease—the Plymouth experience of extracorporeal shockwave treatment
Authors: Hamm R. , Mclarty E. , Ashdown J. , Natale S. , Dickinson A.
Published: March 2003

ObjectiveTo describe our experience of the use of extracorporeal shockwave treatment (EST) for Peyronie's disease.

Patients and methodsThe study included 28 patients (mean age 57 years, range 34–72) with stable Peyronie's disease who were treated with 3.9 (3–5) sessions of EST to the Peyronie's plaque. The patients' erectile function, pain and penile angle were assessed before and after treatment with EST.

ResultsOf the 28 patients, 20 felt that their erection improved after the procedure; 11 patients were able to recommence sexual intercourse and the index of erectile function increased in all but one patient.

ConclusionEST produces a significant improvement in pain and penile angle, with no serious complications.
Finasteride and tamsulosin used in benign prostatic hypertrophy: a review of the prescription‐event monitoring data
Authors: Shakir S. , Pearce G. , Mann R.D.
Published: March 2003

Objective To review the results of non‐interventional observational cohort studies of 14 772 patients treated with finasteride and 12 484 patients treated with tamsulosin, both studies being of national proportions and undertaken in general medical practice in England.

Methods Both studies were undertaken by prescription‐event monitoring (PEM), whereby the exposure data are derived from information provided in strict confidence by the Prescription Pricing Authority of the National Health Service. The outcome data are derived from ‘green form’ questionnaires completed by the prescribing general practitioners (GPs). Additional data are obtained by medical follow‐up with the attending practitioners. Adverse experience was measured in three ways; as reports of events which the doctors considered to represent adverse drug reactions; as reports of reasons for stopping the drug; and by studying the incidence density of each reported event. For these purposes a computerized dictionary containing 1430 higher level terms was used. The duration of exposure in the finasteride study was ≈ 1 year and was ≈ 6 months in the tamsulosin study.

Results The outcome data on the 14 772 and 12 484 patients treated in the finasteride and tamsulosin studies were derived from the 63% and 57.4% of the green forms sent out and returned, respectively. The finasteride cohort included two women and the tamsulosin cohort 70 women. The mean (sd) age of the men in the two cohorts was, respectively, 69.0 (9.2) and 66.2 (11.7) years. Both drugs were well tolerated on long‐term therapy and 69.6% (10 274 patients) of the total finasteride and 62.0% (7739 patients) of the total tamsulosin cohort were still receiving the drug at the end of 6 months. In the finasteride study, impotence or ejaculatory failure was reported in 2.0% of the patients still receiving the drug; there were reports of decreased libido in 1.0% and gynaecomastia was reported whilst the drug was still being prescribed in 39 patients (0.3% of the cohort). With tamsulosin, uncommon cases of dizziness, headache, malaise and hypotension (89 reports in 12 484 patients, i.e. 0.7% of the cohort) were common to the findings of reported adverse reactions, reasons for stopping the drug and events of highest incidence density. None of the deaths which occurred in either of these large cohorts was attributed by either the reporting GPs or the PEM medical staff to the drugs examined.

Conclusion The GPs rated the drugs effective in most patients; tolerance and adverse experience was consistent with the known pharmacology of the two drugs. No serious, unexpected adverse effects were identified.
The Yang–Monti ileovesicostomy: a problematic channel?
Authors: Narayanaswamy B. , Wilcox D.T. , Cuckow P.M. , Duffy P.G. , Ransley P.G.
Published: March 2003

Objective To compare the differences in the quality of Mitrofanoff channels created using appendix and re‐tubularized small bowel (the Yang–Monti ileovesicostomy).

Patients and methods The case‐notes were reviewed retrospectively for all patients who underwent a Mitrofanoff procedure using either appendix or small bowel, over a 5‐year period from June 1994 to July 1999.

Results In all, 92 patients underwent 94 Mitrofanoff procedures; the appendix was used in 69 and small bowel in 25. The underlying diagnoses were exstrophy‐epispadias complex (38), neuropathic bladder (21), anorectal malformations and cloacal anomalies (15), posterior urethral valves (nine) and miscellaneous (nine). The mean (range) age at operation was 9.2 (1.1–18.3) years. The mean (range) follow‐up for the appendix group was 37 (6.7–65) months and for the Monti group 25 (6–66) months. Catheterization problems occurred in 18 (27%) patients from the appendix group; two needed an adjustment of technique, six dilatation and 10 revision. Stomal stenosis occurred in 10 (15%) patients, bladder level stenosis in four (6%) and conduit necrosis in two. Catheterization problems were reported in 15 (60%) patients from the Monti group; five needed revision, three dilatation and seven are being managed conservatively. The incidences of stomal stenosis (four, 16%) and bladder level stenosis (two, 8%) were comparable with the appendix group. In addition, two patients had distal channel (sub‐stomal) stenosis and two had mid‐channel stenosis. The problem unique to the Yang–Monti channel was a pouch‐like dilatation in seven patients (28%), all of whom presented with catheterization problems; five are being managed conservatively and two have needed pouch resection. Stomal prolapse occurred in five (7%) patients in the appendix group, but in none of the Monti group.

Conclusions The appendix is the conduit of choice for a Mitrofanoff procedure. Re‐tubularized small bowel conduits have a considerably higher incidence of catheterization problems. Anatomical factors may contribute to the unique incidence of pouch formation.
Vaginal retropubic urethropexy with intraoperative cystometry for treating urinary stress incontinence
Authors: Clark A.D. , Salloum M.S.
Published: March 2003

Objective To determine the effectiveness of a vaginal retropubic urethropexy with intraoperative cystometry in treating urinary stress incontinence.

Patients and methods One hundred patients with genuine stress incontinence on urodynamic examination underwent the procedure and were followed up for 1 year; 96 completed the follow‐up (four were lost to follow‐up).

Results At 1 year, 91 patients (95%) were cured of their stress incontinence and five (5%) failed, with recurrent stress incontinence developing. The complications were mainly of suture erosion (6%).

Conclusion This method of urethropexy has produced excellent results to date, with low complication and morbidity rates, and continues to be our treatment of choice. A randomized control trial comparing it with standard established procedures would be welcomed.
The 2‐year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy vs transurethral resection of the prostate
Authors: Hindley R.G. , Mostafid A.H. , Brierly R.D. , Harrison N.W. , Thomas P.J. , Fletcher M.S.
Published: March 2003

Objective To assess the 2‐year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy of the prostate (IRFT) vs transurethral resection of the prostate (TURP).

Patients and methods Patients with lower urinary tract symptoms (LUTS) and urodynamic evidence of bladder outlet obstruction (BOO) were randomized to undergo IRFT or TURP and were followed up using the International Prostate Symptom Score (IPSS) and urodynamic assessment for 2 years.

Results At 2 years there was a clinically relevant reduction in the IPSS in the IRFT (20 to 9) and TURP groups (22 to 4). There was also a statistically significant reduction in the detrusor pressure at maximum urinary flow in both groups, but the reduction in the IRFT group was probably not sufficient to explain the observed symptomatic improvements solely from a reduction in BOO.

Conclusion IRFT can produce a sustained improvement in LUTS for at least 2 years. However, such improvements are unlikely to be entirely the result of a reduction in BOO. The effects of radiofrequency energy may, at least partly, be independent of any thermal effect and depend instead on neuromodulation of lower urinary tract nerves.
Modified plication of the tunica albuginea in treating congenital penile curvature
Authors: Hsieh J.T. , Huang H.E. , Chen J. , Chang H.C. , Liu S.P.
Published: March 2003

Objective To describe a modified plication technique and compare the results with the Nesbit procedure for treating congenital penile curvature.

Patients and methods Eleven men with congenital penile curvature were treated by a modified tunica albuginea plication technique. An artificial erection was induced by normal saline injection; in the areas where plication was planned, Buck's fascia was opened longitudinally and dissected a short distance toward the midline to free the neurovascular bundles. Allis clamps were used to grasp the tunica albuginea and ‘bumps’ created. Two interrupted U‐shaped sutures using 2/0 polyglactin were placed underneath each Allis clamp to secure the bump. The results were analysed retrospectively and compared with the results of 11 other men treated using the Nesbit procedure.

Results The mean (range) follow‐up was 25 (12–47) months for the Nesbit procedure and 15 (8–26) months for the modified plication procedure. In the Nesbit group, eight patients had satisfactory cosmetic and functional results; three complained of penile shortening and one had erectile dysfunction. In the modified plication group, 10 patients reported satisfactory cosmetic and functional results; one complained of penile shortening, two were concerned about the indurations of the penis but none had erectile dysfunction.

Conclusions The modified plication technique is easier to perform, is more often successful and causes fewer surgical complications than the Nesbit procedure for treating congenital penile curvature.
Histopathological examination of both ipsilateral and contralateral testes with different obstructive models in prepubertal and adult rats
Authors: Altay B. , Hekimgil M. , KEFi A. , Çikili N.
Published: March 2003

Objective To determine the histopathological changes in both the ipsilateral and contralateral testes of prepubertal and adult male rats 60 days after creating different obstructive models.

Material and methods Thirty‐six prepubertal and 32 adult albino male rats were examined in three different obstructive models of the right testis. In group 1 the spermatic cord was ligated, in group 2 the ligation was between the caput epididymis and testis, and in group 3 the vas deferens was ligated. Sixty days after ligation both testes were removed and evaluated for testis diameter, mean seminiferous tubule diameter (MSTD), and degenerative, obstructive and inflammatory changes.

Results The diameter of the obstructed right testis and MSTD were significantly greater in prepubertal rats but there was no apparent difference in adult rats. For obstructive changes, sloughing of germ cells in the prepubertal rats and germ cell absence in adult rats were significantly more common in group 3. The contralateral testis diameter and MSTD of group 3 was significantly greater only in prepubertal rats. Statistically significant values of obstructive change, e.g. sloughing of germ cells and apical vacuolation in Sertoli cells, were apparent in prepubertal rats, but tubular ectasis was the only statistically significant criterion of obstruction in adult rats.

Conclusion The testes are more susceptible to obstruction of the vas deferens in prepubertal than in adults rats, resulting in increased hydrostatic pressure and oedema of both the ipsilateral and contralateral testes, which might be caused by collateral circulation and rat testicular microcirculation, with a rhythmic pattern of arteriolar dilatation and constriction (vasomotion). Although the presence of oedema and high hydrostatic pressure was not prominent in adults, formation of spermatic granulomas and absence or sloughing of germ cells in the obstructed and contralateral testes reflect the early effects of vas ligation on spermatogenesis in adulthood.
Chronic ethanol consumption impairs adrenoceptor‐ and purinoceptor‐mediated relaxations of isolated rat detrusor smooth muscle
Authors: Utkan T. , Erden F. , Yildiz F. , Özdemirci S. , Ulak G. , Gacar M.N.
Published: March 2003

Objective To investigate the effects of chronic ethanol consumption on the reactivity of detrusor smooth muscle.

Materials and methods Eight male rats received ethanol (7.2% v/v) in a modified liquid diet for 4 weeks. Two control groups were assessed; eight rats in one group were fed sucrose and received a liquid diet, and 12 rats in the second group received standard rat chow and water for 4 weeks. The reactivity of detrusor smooth muscle strips from ethanol‐fed animals and control animals was evaluated in organ chambers.

Results The relaxation response elicited by isoprenaline or adenosine was unaffected in the both control groups while it was significantly inhibited, with decreased maximum responses and pD2 values, in the ethanol‐fed group. Contractile responses of detrusor smooth muscle to carbachol or 80 mmol/L KCl and relaxant responses to papaverine were similar in the control groups and the ethanol‐fed group. There was no change in agonist potency among the groups.

Conclusion Chronic ethanol consumption impairs β‐adrenoceptor‐ and purinoceptor‐mediated relaxation but not cholinoceptor‐mediated contraction of the rat detrusor smooth muscle. Thus, it appears that different regulatory mechanisms are involved in ethanol‐induced alterations in β‐adrenergic, purinergic and muscarinic receptors in detrusor strip.
Mercurochrome as an adjunct to local preoperative preparation in children undergoing hypospadias repair
Authors: Ratan S.K. , Sen A. , Ratan J. , Pandey R.M.
Published: March 2003

Objective To determine whether the local application of mercurochrome over genital skin before surgery, in addition to soap/water scrubs, can help to decrease the incidence of infection patients undergoing hypospadias repair, and thereby the incidence of fistula formation.

Patients and methods The study comprised 44 consecutive boys undergoing primary or repeat surgery for hypospadias between October 1999 and April 2000. They were arbitrarily divided into two groups; group 1 received a conventional local scrub with soap/water 48 h before surgery and group 2, a conventional local scrub with soap/water was followed by a local application of 2% mercurochrome for 48 h before surgery. Both groups were comparable in age, location of the meatus and stage of repair. All patients were exposed to similar conditions during and after surgery. Urine, skin and wound swabs taken before during and after surgery were assessed microbiologically, using standard precautions. The incidence of infection and complications was then compared.

Results Mercurochrome significantly decreased local infection, especially before surgery, but its effect in decreasing fistula formation, although appreciable, was not statistically significant.

Conclusion The local application of mercurochrome after a soap/water scrub for at least 48 h before surgery is a simple, economic and effective means to decrease postoperative wound infection. Future studies are needed, keeping other determinants of fistula formation constant, to evaluate its role in decreasing fistula formation in patients undergoing hypospadias repair.
The radiolucent ureteric calculus at the end of a contrast‐medium column: where to focus the shock waves
Authors: Buchholz N.‐P.N. , Van Rossum M.
Published: March 2003

Objective To compare the outcome of two different targeting strategies for treating radiolucent ureteric calculi by extracorporeal shock wave lithotripsy (ESWL), focusing the shock waves either at the end or 5 mm beyond the column of contrast medium visible in the ureter.

Patients and methods A total of 156 patients undergoing ESWL for a radiolucent ureteric stone were randomized into two groups. Group 1 comprised 74 patients in whom the shock waves were focused on the end of the contrast medium column, and group 2 comprised 82 patients in whom the shock waves were focused 5 mm beyond the end of the column.

Results Both groups had comparable distributions of age, gender, treatment methods and stone characteristics. There were no adverse reactions to the contrast medium. The stone‐free rate after 2 months was 17% greater in group 2 (91%) than in group 1 (74%; P < 0.05).

Conclusions The administration of intravenous contrast medium for ESWL of radiolucent ureteric calculi is effective and safe. We recommend that the shock waves are focused 5 mm beyond the end of the column of contrast medium, except where a stone becomes clearly visible within the column.
Immunohistochemical analysis of Ki‐67, p21waf1/cip1 and apoptosis in marker lesions from patients with superficial bladder tumours treated with vinorelbine intravesical therapy in a preliminary phase I trial
Authors: Bonfil R.D. , Gonzalez A.D. , Siguelboim D. , Cuello Carrion F.D. , Ciocca D.R. , Villaronga A. , Metz L. , Mosso F. , Fayad E. , Reale M. , Schmilovich A.J.
Published: March 2003

Objective To investigate Ki‐67 and p21Waf1/Cip1 expression and apoptosis, before and after treatment, in tumour biopsies obtained from patients with superficial bladder cancer who underwent vinorelbine intravesical therapy.

Patients and methods Twenty patients with high‐risk superficial bladder cancer (including one or more of the following parameters: tumour diameter > 3 cm, histological grade 3, or multicentric tumours) were treated 1–6 times (weekly) with intravesical vinorelbine (50 mg/mL) instillations. Transurethral tumour marker biopsies were obtained one week before the first instillation of the drug and one week after the last. The biopsies were immunostained for Ki‐67 and p21Waf1/Cip1 with monoclonal antibodies, on tissue sections derived from paraffin‐embedded samples obtained before and after vinorelbine treatments. In addition, apoptosis was determined using a terminal deoxynucleotidyl transferase‐mediated dUTP biotin nick‐end labelling (TUNEL) technique.

Results There were no significant differences in the cell proliferation marker Ki‐67 in biopsies taken before or after treatment. However, p21Waf1/Cip1 showed significantly higher expression in biopsies obtained after vinorelbine treatment, with median (range) values of 40 (20–90)% before and 70 (50–80)% after (P < 0.001, paired nonparametric Wilcoxon test). The apoptotic index was significantly higher after vinorelbine therapy, with median (range) values of 0.89 (0.06–3.8)% before and 2.25 (0.17–18.7)% after treatment (P < 0.001, paired nonparametric Wilcoxon test). Despite the brief treatment and few patients there was a clinical response in nine patients, together with low toxicity in all.

Conclusion The intravesical treatment of tumours with vinorelbine affects p21Waf1/Cip1 expression without blocking cell proliferation, although increasing apoptosis. The preliminary results suggest that vinorelbine may be useful for treating superficial bladder tumours, and thus a phase II study is warranted.