bluuebunny/crossref_metadata_2025 huggingface dataset:
Active properties of the urinary bladder: in vitro comparative studies between adult and neonatal rats
Authors: Oh S.J. , Lee K.H. , Kim S.J. , Kim K.W. , Kim K.M. , Choi H.
Published: March 2003

Objective To determine, using in vitro comparative studies, developmental aspects associated with the active properties of the urinary bladder in neonatal and adult rats.

Materials and methods Urinary bladders were removed from neonatal (1–3 days old) and adult (15 weeks old) male Sprague–Dawley rats. Anterior longitudinal muscle strips were obtained from each group and isometric tensions recorded. Nerve‐mediated contractions elicited by electrical field stimulation (0.8 ms pulse) or carbachol‐induced contractile responses in neonatal and adult bladder strips were compared. Contractile tensions were normalized using the wet weight of the bladder strip or by using the percentage contraction induced by 60 mmol/L KCl.

Results Nerve‐mediated contractile responses showed that the muscarinic component predominated in the neonatal rat bladder, which contrasted with the predominant purinergic components in adult bladder. The pattern of spontaneous activity and carbachol‐induced contraction differed in the two groups. Small spontaneous contractions in the basal state occurred in adult bladder strips, while short‐lived large spontaneous contractions were present in neonatal strips. The amplitude of carbachol‐induced contractions generated in the neonatal bladder was larger than that in the adult bladder. In addition, the time to achieve peak contraction elicited by carbachol (5 µmol/L) was shorter in the neonatal bladder. Repetitive carbachol applications induced an attenuation of the contractile response (desensitization), but the neonatal bladder was more resistant to desensitization than the adult bladder.

Conclusions These results show that nerve‐mediated or agonist‐induced contractile patterns, and spontaneous activity, in the neonatal bladder differ from those of the adult bladder in rats. The results suggest that in addition to neural immaturity, there are functional differences between the bladders of adult and neonatal rats.
Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone‐releasing hormone analogues and orchidectomy
Authors: Farrugia D. , Ansell W. , Singh M. , Philp T. , Chinegwundoh F. , Oliver R.T.D.
Published: March 2003

Objective To investigate the efficacy of low‐dose stilboestrol (SB) with hydrocortisone in patients with advanced prostate cancer refractory to androgen suppression.

Patients and methods Thirty‐four consecutive patients (median age 70 years, range 51–83) with metastatic disease who progressed on hormone therapy, as shown by recurrent/worsening symptoms and an increase in prostate‐specific antigen (PSA) level, were recruited and discontinued hormonal treatment before starting SB. Patients received SB (1 mg/day) combined with hydrocortisone (40 mg/day). In an attempt to reduce the incidence of thrombo‐embolic events, aspirin (75 mg/day) was also added.

Results Stilboestrol was the second‐line treatment in 19 patients and the third or fourth in 15. The median (range) duration of treatment with SB was 5 (0.5–21) months and the median follow‐up 7.5 months, with 18 patients still alive and 14 still on treatment. Of 29 symptomatic patients, 24 had symptomatic improvement and five had no clear benefit; the median duration of benefit was 6 (2–21) months. The PSA level decreased by 0–50% in six patients, by 50–90% in 13 and by > 90% in eight, while there was symptomatic improvement in these three categories in five, 11 and seven patients, respectively. The median times to PSA nadir and progression were 4 and 6 months, respectively. Some thrombo‐embolic events and fluid retention occurred but overall the treatment was well tolerated.

Conclusion Low‐dose SB with hydrocortisone is effective in refractory prostate cancer, although there is some toxicity. Randomized studies against hydrocortisone or SB alone are needed to establish the cost/benefit ratio of this combination.
The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves
Authors: De Gennaro M. , Capitanucci M.L. , Mosiello G. , Caione P. , Silveri M.
Published: March 2003

Objective To determine whether bladder dysfunction in boys with posterior urethral valves (PUV) changes from a uniform pattern of hypercontractility during infancy to the hypocontractility found in adolescence, by reviewing serial urodynamic studies.

Patients and methods Thirty boys with PUV and no voiding symptoms underwent a total of 86 urodynamic tests (mean 2.8 each). The first urodynamic study was undertaken at 1–4 years of age in 15 boys and at 5–13 years in 15. They were re‐evaluated at least 3 years later; 15 patients underwent the first and last urodynamic study, respectively, at a mean age of 2.8 and 7.7 years (group A), 10 boys at 6.2 and 8.8 years (group B) and five at 9.4 and 15.2 years (group C). In 10 boys aged > 5 years the first and last pressure‐flow studies (PFS) were analysed using an advanced analysis (PFA) to better identify hypocontractility.

Results Bladder dysfunction was found in 21 of 30 (70%) boys at the first evaluation and in 18 (60%) at the last. In 25 boys the urodynamic pattern changed. Of the 15 boys in group A, 10 of 12 who had hypercontractility changed to normal (seven), low compliance (one) or hypocontractility (two), and two remained stable; two of the remaining three with normal urodynamic studies changed to hypocontractility, while one was unchanged. Among the 10 boys in group B, six with hypercontractility changed to normal (three) or hypocontractility (three); two with normal urodynamic findings and one with low compliance changed to hypocontractility. Of the five boys in group C who showed severe hypocontractility after puberty, three had a normal pattern, one low compliance and one hypercontractility before puberty. The PFA showed a ‘weak’ detrusor in four of the seven boys who were considered normal on standard PFS. At the urodynamic follow‐up, the PFA pattern changed to a ‘weak’ detrusor in four boys who had a normal (two) or strong (two) detrusor at the first evaluation.

Conclusions Bladder dysfunction in boys with PUV changes during childhood and through adolescence. The urodynamic pattern of hypercontractility generally found soon after valve ablation gradually changes to hypocontractility in many boys and this pattern seems to be the rule after puberty. The evidence from this series supports the hypothesis that long‐term detrusor hyperactivity in boys with PUV leads to detrusor failure, but a longitudinal 15‐year follow‐up from birth to puberty is needed to validate this concept.
Prostatic manipulation has a minimal effect on complexed prostate‐specific antigen levels
Authors: Lynn N.N.K. , Collins G.N. , O'Reilly P.H.
Published: March 2003

Objective To assess the effect of prostatic manipulation on complexed prostate‐specific antigen (cPSA), as various forms of prostatic manipulation are known to increase the serum free and total PSA level.

Patients and methods A series of 92 men (58 after prostatic biopsy, 16 after digital rectal examination and 18 after flexible cystoscopy) were assessed. Blood samples were taken from each patient before and 30 min after manipulation. Total and cPSA levels were measured using appropriate assays, respectively.

Results There was no significant increase in cPSA levels after flexible cystoscopy and digital rectal examination, but prostate biopsy caused a statistically significant although minimal rise in cPSA level. There was no statistically significant increase in cPSA level after prostate biopsy in patients with prostate cancer (P = 0.35) although there was a statistically significant but minimal rise in cPSA level in patients with benign histology (P < 0.01, mean increase 2.13 ng/mL) compared with that of total PSA, which increased markedly (P < 0.01, mean increase 19.79 ng/mL).

Conclusion Prostatic manipulation has minimal effects on cPSA levels.
Time‐specific effects of mono‐n‐butyl phthalate on the transabdominal descent of the testis in rat fetuses
Authors: Shono T. , Kai H. , Suita S. , Nawata H.
Published: March 2003

Objective To determine the time‐specific effects of mono‐n‐butyl phthalate (MBP) on the transabdominal migration of the testis in fetal rats.

Materials and methods Three groups of pregnant rats were administered MBP by stomach‐tube feeding when the fetus was at 7–10 days of gestation in group 1, 11–14 days in group 2, and 15–18 days in group 3; controls (group 4) were given vehicle only from 7–18 days. At 20 days of gestation the fetuses were obtained by Caesarean section, and the position of the testes, the development of the gubernaculum, cranial suspensory ligament and the epididymis were examined.

Results The timed intervals of MBP administration showed that the maximum inhibition of transabdominal testicular descent was at 15–18 days of gestation. There was an elongated gubernaculum and hypertrophic cranial suspensory ligament in the MBP‐treated rat fetuses. Furthermore, the epididymis showed a few small ducti deferentia, although there were no remarkable changes in either the Sertoli and Leydig cells in these testes. The mean (sem) content of testicular testosterone was significantly less (P < 0.001) in the MBP‐treated rats, at 50.9 (3.8) pg/testis, than in the controls, at 676 (33.3) pg/testis.

Conclusions These findings indicate that a brief exposure to MBP during fetal development can inhibit the transabdominal migration of the testis and reduce testosterone content in rats, although the relationship between migration and the testicular testosterone content remains unknown.
Three‐dimensional contrast‐enhanced power Doppler ultrasonography and conventional examination methods: the value of diagnostic predictors of prostate cancer
Authors: Unal D. , Sedelaar J.P.M. , Aarnink R.G. , Van Leenders G.J.L.H. , Wijkstra H. , Debruyne F.M.J. , De La Rosette J.J.M.C.H.
Published: March 2003

Objective To investigate the value of three‐dimensional contrast‐enhanced power Doppler ultrasonography (3D‐CE‐PDU) in the diagnosis of prostate cancer and to compare 3D‐CE‐PDU with digital rectal examination (DRE), prostate‐specific antigen (PSA) levels, grey‐scale ultrasonography (GSU) and PDU.

Patients and methods The study comprised 30 patients with localized prostate cancer scheduled to undergo radical prostatectomy and 29 with clinical BPH scheduled to undergo transurethral microwave thermotherapy. The 3D‐CE‐PDU examinations were carried out using 2.5 g of microbubble ultrasound contrast medium; the images were stored digitally to allow off‐line analysis. All the reconstructed 3D images of the prostate were evaluated blindly in random order by two investigators (one expert and one novice). The images were scored according to asymmetry (0–2) and vessel distribution (0–3). Marked asymmetry (2) and/or a focal increase in vascularity (> 2) were considered as suspicious for prostate malignancy. Diagnostic predictions using the DRE, PSA level, GSU, PDU, 3D‐CE‐PDU and their combinations were investigated using receiver operating characteristic (ROC) curves.

Results True‐positive and true‐negative rates of the 3D‐CE‐PDU were 87% (26/30) and 79% (23/29), respectively, for the expert observer. The sensitivity of 3D‐CE‐PDU was higher than that of DRE, GSU and PDU, but not PSA level, and the specificity was lower, again except for PSA level. However, when compared with those of the other modalities in single‐test evaluations, 3D‐CE‐PDU, and a combination of 3D‐CE‐PDU and PSA level, had the largest area under the ROC curve (0.830 and 0.933, respectively). The diagnostic agreement between the examiners was 76% (Cohen kappa statistic, 0.5).

Conclusion In this selected group of patients, 3D‐CE‐PDU alone was a better diagnostic tool than the DRE, PSA level, GSU or PDU alone. The most suitable diagnostic predictor for prostate cancer was a combination of 3D‐CE‐PDU and PSA level.
Optimizing the therapeutic approach of transurethral alprostadil
Authors: Ekman P. , Sjögren L. , Englund G. , Persson B.‐E.
Published: March 2003

Objective To investigate the efficacy and safety of two different starting doses of transurethral alprostadil (250 µg and 500 µg, MUSE®, Vivus Inc., Menlo Park, CA, USA, and Astra Läkemedel AB, Södertälje, Sweden) and the need for dose titration in a general population with erectile dysfunction.

Patients and methods In a 12‐week randomized and open multicentre study with parallel groups, 166 patients were randomised to a starting dose of either 250 or 500 µg of MUSE and evaluated for safety. Of these patients, 142 were included in the analysis of efficacy. MUSE marked in four doses (125, 250, 500 and 1000 µg) was supplied and during the trial the dose could be increased or decreased step‐wise until a satisfactory response was attained. The efficacy was assessed using the Erection Assessment Scale (EAS), as coitus (by diary) and the International Index of Erectile Function.

Results The lowest dose of MUSE with which the patients achieved at least one EAS score of 4 or 5 was 125 µg for 1% of participants, 250 µg for 27%, 500 µg for 32%, 1000 µg for 6%, and finally 1000 µg plus a pubic band for 8%. Thirty‐five of the 142 patients (25%) did not report an EAS of 4 or 5. Most patients (> 60%) achieved an EAS of 4 or 5 on the lower doses (125, 250 and 500 µg). Almost all patients who had an EAS score of 4 or 5 also had intercourse. In all, 68% reported sexual intercourse at least once in course of the study. More patients reported penile pain while treated with 500 µg than with 250 µg (P < 0.05) during the first 4 weeks. However, the penile pain was severe in very few men and it was a minor problem. Hypotensive symptoms were reported six times, independently of dose level. The administration of MUSE was generally rated as comfortable. No patients reported urethral stricture, penile fibrosis, or priapism either in the clinic or at home.

Conclusion Recommending 500 µg as a starting dose increased the percentage of patients reporting at least one EAS of 4–5, with or without sexual intercourse, from 28% to 60%. No serious dose‐related systemic effects were seen. When starting on 500 µg, patients were more likely to find directly the dose that gave sufficient response and treatment satisfaction. We suggest that the appropriate starting dose of MUSE should be 500 µg.
Oestrogen and progesterone receptor expression in the female lower urinary tract, with reference to oestrogen status
Authors: Blakeman P.J. , Hilton P. , Bulmer J.N.
Published: March 2003

Objective To assess the incidence and distribution of both oestrogen and progesterone receptors throughout the female lower urinary tract, and to compare receptor expression in women of varying oestrogen status.

Patients and methods The study included 90 women undergoing surgery for urogynaecological conditions; 33 were premenopausal, 26 postmenopausal and taking no oestrogen supplementation, and 31 postmenopausal and receiving some form of hormone‐replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, proximal urethra, distal urethra, vagina and vesicovaginal fascia in the region of the bladder neck. All biopsies were routinely fixed and processed for histopathological assessment, and were then labelled immunohistochemically with monoclonal antibodies directed against human oestrogen (NCL‐ERLH2) and progesterone (NCL‐PGR) receptors. Both oestrogen and progesterone receptor expression were assessed in the epithelial, subepithelial and muscle/deeper fascial regions of all tissue for overall tissue positivity for each receptor, and by semiquantitative analysis of receptor concentration using histochemical scoring of the tissues.

Results Oestrogen receptors were consistently detected in the squamous epithelia and were consistently absent in the urothelial tissues of the lower urinary tract of all women irrespective of oestrogen status; there was no significant variation in histological score. Progesterone receptor expression was more variable, being mostly subepithelial, and significantly lower in postmenopausal women receiving no oestrogen replacement.

Conclusion These findings confirm the female lower urinary tract to be a target organ for the action of oestrogen and progesterone, and shed further light on the areas of the lower urinary tract likely to respond to hormone‐replacement therapy. This may have implications for the use of oestrogen supplementation in the treatment of lower urinary tract disorders of postmenopausal women.
Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction?
Authors: Bakker E. , Wyndaele J. J.
Published: March 2003

Objective To analyse the changes in toilet training of children in Belgium in the last three generations and to seek a possible cause for the apparent increase in lower urinary tract dysfunction over that period.

Patients and methods A questionnaire (25 questions) was developed and completed by 321 people who had toilet‐trained 812 children. The population was divided into three groups according to the age of those who trained the children.

Results There has been a major change in toilet training in the last 60 years; the age at which toilet training began has been significantly postponed. One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of sufficient bladder capacity) has become less important. Season (summer) has become a more important factor, as has starting school. Training by bladder drill, formerly widely used, was progressively abandoned and a more liberal attitude adopted by the youngest parents.

Conclusion There seems to be good concordance between the programmes currently proposed for treating bladder dysfunction in children and the traditional bladder‐training methods used by parents 60 years ago. To start bladder training when the child stays dry during the afternoon nap and using bladder drill might help to avoid permanent bladder dysfunction. The lack of formal bladder training may be responsible for an increase in lower urinary tract dysfunction.
Hormone‐resistant prostate cancer with symptomatic pelvic tumours: patient survival and prognostic factors
Authors: Hernes E.H. , Linja M. , Fosså S.D. , Visakorpi T. , Berner A. , Winderen M. , Koivisto P.A.
Published: March 2003

Objectives To determine the survival and investigate the prognostic significance of immunohistochemical variables and clinical factors in patients with hormone‐resistant prostate cancer (HRPC) and symptomatic pelvic tumours, in whom preliminary observations indicated that survival exceeded the median 8–10 months of patients with HRPC and painful bone metastases.

Patients and methods Seventy‐five patients with HRPC referred for palliative pelvic radiotherapy between 1980 and 1996 were identified. For all patients at least two prostate biopsies had been obtained, one before primary hormone treatment and at least one after clinical progression despite androgen deprivation (HRPC biopsy). Bone scans at the time of referral were assessed. The medical records were reviewed for clinical variables of possible prognostic significance. Histological grade was recorded, and prostate‐specific antigen (PSA), androgen receptors (ARs), Ki‐67 and p53 determined immunohistochemically. In 18 HRPC specimens the degree of AR amplification was analysed.

Results Positive staining for ARs was high in the HRPC biopsies, although there was no association with AR amplification. Ki‐67 positivity increased after the development of HRPC. The median (range) survival was 14 (1–141) months; age < 65 years was associated with increased survival. In a multivariate analysis the following variables remained independent prognostic factors for survival from the time of the HRPC biopsy: bone metastases (0–10 vs  > 10 lesions, P < 0.001), low Ki‐67 score (0 vs 1–3, P = 0.006) and low p53 positivity score (0 vs 1–3, P = 0.014) in the HRPC biopsy.

Conclusions The median survival of patients with HRPC and pelvic tumours requiring palliation seems to exceed that of patients with HRPC and dominating painful bone metastases by at least 4–6 months. Simple clinical (bone metastases) and immunohistochemical variables (Ki‐67, p53) enable patients with particularly long survival times to be identified, and in whom palliative treatment needs to be improved.
Genetic identification of bilateral primary or metastatic nonpapillary renal cell carcinoma
Authors: Kume H. , Oda H. , Nakatsuru Y. , Shimizu Y. , Takahashi Y. , Matsumoto T. , Inoue T. , Kameyama S. , Kitamura T. , Ishikawa T.
Published: March 2003

Objective To clarify the clonality of bilateral tumours by genetic analysis of bilateral renal cell carcinomas (RCCs) using the VHL gene, which is inactivated in ≈ 60% of RCCs and which plays a causal role in the development of most cases of nonpapillary RCC.

Patients and methods The study included 20 patients; seven had von Hippel‐Lindau disease, three had papillary RCC and 10 had nonpapillary RCC. Paraffin‐embedded blocks of tumour tissue were obtained from two of the three patients with papillary RCC and from nine of 10 with nonpapillary disease; all three exons of VHL were examined by direct sequencing.

Results As reported previously, no VHL mutations were found in papillary tumours. However, in five of the nine nonpapillary cases, VHL mutations were identified in tumours on one or both sides. Three of the tumours had the same mutation on both sides, confirming a common origin. In the remaining two patients, the mutation status differed between the sides, confirming a bilateral primary origin. The former cases were characterized by a relatively large tumour on one side and multiple tumours on the other.

Conclusions In nonpapillary RCC multiplicity may suggest a metastatic origin. Such genetic information will be useful in treating and following patients with bilateral renal tumours.
Angiotensin II in child urinary bladder: functional and autoradiographic studies
Authors: Lam D.S.H. , Dias L.S. , Moore K.H. , Burcher E.
Published: March 2003

Objectives To investigate the receptors for angiotensin II (AII, reported to be a potent contractile agent in human urinary bladder), using functional and autoradiographic techniques in child and adult bladder specimens.

Materials and methods Bladder specimens were obtained from 61 children (aged 4 months to 12 years) undergoing ureteric reimplantation for vesico‐ureteric reflux, and from 10 adults undergoing cystectomy. After overnight storage, the mucosa was removed and isometric contractions obtained from detrusor muscle strips in the presence of phosphoramidon (10 µmol/L). Only one concentration of AII was added to each preparation because of tachyphylaxis. The response to KCl (124 mmol/L) was 43% of that to carbachol (100 µmol/L). Sections of child bladder were radio‐labelled with the ligand [125I]Sar1,Ile8‐AII and binding sites visualized using emulsion autoradio‐ graphy.

Results The potency of AII was similar in child and adult detrusor strips, with mean (
sem) pD2 values of 6.9 (1.0) (n = 25) and 6.7 (0.2) (n = 9) respectively, and the maximum responses (to 10 µmol/L AII) rather low (39% and 49%, respectively, P > 0.05), compared with carbachol (100 µmol/L). There were no age‐ or gender‐related differences. Responses to AII in strips from children under 3 years old were antagonized by the AT1 receptor antagonist losartan (1 µmol/L) but not by the AT2 receptor antagonist PD 123319 (1 µmol/L), indicating interaction with the AT1 receptor. Sections of child bladder radiolabelled with [125I]Sar1,Ile8‐AII showed moderate specific binding over detrusor muscle and arterioles, with denser specific binding over subepithelial blood vessels. Specific binding was inhibited by co‐incubation with losartan (10 µmol/L) but not with PD 123319 (10 µmol/L).

Conclusion AII was a weak contractile agent of detrusor strips, with no significant differences in potency between child and adult bladder samples. These data show the presence of functional AT1 but not AT2 receptors in child detrusor smooth muscle.
Five‐year data from the Oxford Laser Prostatectomy Trial
Authors: Keoghane S.R. , Sullivan M.E. , Doll H.A. , Kourambas J. , Cranston D.W.
Published: March 2003

Objective To evaluate the natural history of a group of patients who underwent contact laser prostatectomy or transurethral resection of the prostate (TURP).

Patients and methods Patients were followed up at 5 years after enrolling in a prospective double‐blind randomized controlled trial of TURP vs contact laser prostatectomy.

Results Of the initial trial patients, 11.5% had died (seven in the laser and 10 in the TURP arm) and eight (5.4%) were too incapacitated by coexistent medical disease to respond to the questionnaires. Thirty‐eight patients were not available for follow‐up, despite numerous invitations. Thirteen of the laser patients (18%) and 11 of the TURP patients (14.5%) had undergone re‐operation. Two patients from each arm had received α‐blockers for worsening symptoms.

Conclusions Five years after prostatic surgery, a significant number of patients were dead or disabled by coexistent medical disease. The re‐operation rate after TURP and contact laser prostatectomy were similar.
Semen analysis after vasectomy: when and how many?
Authors: Badrakumar C. , Gogoi N.K. , SundAram S.K.
Published: March 2003

Objective To assess patient compliance for semen analysis after vasectomy, and to determine the timing and number of semen analyses required to confirm sterility.

Patients and methods The study included 1321 men who underwent vasectomy between October 1995 and June 1998. They were followed up in two groups; in group 1 (one‐test method) 961 consecutive patients were asked to provide a semen sample for analysis 4 months after vasectomy. Sterility was defined as the absence of sperm in one sample. If sperm were present in the sample, the test was repeated at monthly intervals until there were no sperm. In group 2 (two‐test method) 360 consecutive patients were advised to provide semen samples 3 and 4 months after vasectomy. The absence of sperm in two consecutive samples was defined as the criterion to declare the man azoospermic. The presence of sperm in one sample required further samples every month until two consecutive azoospermic samples were produced.

Results In group 1, 810 patients provided semen samples, of which 783 (97%) had no sperm and the men were thus declared azoospermic. The remaining 27 (3%) samples contained sperm; six men withdrew from follow‐up at various times but 21 patients produced a negative sample at some time within 7 months and were declared azoospermic. At the end of the follow‐up, 804 (84%) patients had been declared azoospermic. In group 2, 294 (82%) patients provided a semen sample after 3 months but only 259 (72%) did so after 4 months. Of the patients providing the first sample, 287 (98%) were azoospermic, and after the second 252 (97%) were azoospermic. At the end of the follow‐up 255 (71%) patients were declared azoospermic. There was no reported paternity in any of the men.

Conclusion These results suggest that compliance was better in group 1; when the patients in group 2 were asked to provide a second sample the compliance decreased significantly. The percentage of patients producing an azoospermic sample was similar for semen provided after 3 and 4 months. Thus, provided that the patient is adequately warned about the risk of failure of the vasectomy at any time during his life, a single semen analysis after 3 months is sufficient grounds for discontinuing other contraceptive precautions.
Testicular microlithiasis in a UK population: its incidence, associations and follow‐up
Authors: Skyrme R.J. , Fenn N.J. , Jones A.R. , Bowsher W.G.
Published: March 2003

Objectives To determine the incidence of testicular microlithiasis in men presenting for testicular ultrasonography, to identify any associated pathology (with particular reference to testicular neoplasia) and to report the follow‐up of those patients in whom testicular microlithiasis was identified.

Patients and methods In this retrospective study, the results of all testicular ultrasonography undertaken between July 1995 and March 1998 in a district general hospital were reviewed. The records of all patients diagnosed ultrasonographically to have testicular microlithiasis were retrieved and the pathology database was accessed for all testicular tumours diagnosed in the same period.

Results During the study period 2215 scans were taken; 34 cases of testicular microlithiasis were identified, giving an incidence of 1.4%. Thirty‐one testicular tumours were removed during the same period. Of the 34 cases with testicular microlithiasis, five had histologically confirmed testicular tumours (15%). The incidence of testicular tumours in the scans showing no microlithiasis was 26 in 2181 (1.1%). The differential incidence of tumours in the two groups is statistically significant (P < 0.001, chi‐square analysis). Patients with testicular microlithiasis but no tumour were followed up for a median (range) of 41 (19–54) months; no interval tumours have developed to date.

Conclusion This study confirms an incidence of testicular microlithiasis comparable with that in other reported series, albeit in a selected population. There was a strong association between testicular microlithiasis and testicular tumours. Whether this is a causal relationship has yet to be determined. Careful clinical and ultrasonographic follow‐up of these patients is therefore recommended until the significance of testicular microlithiasis is clear.
The influence of prostate volume on the prostate‐specific antigen (PSA) level adjusted for the transition zone volume and free‐to‐total PSA ratio: a prospective study
Authors: Moon D.G. , Yu J.W. , Lee J.G. , Kim J.J. , Koh S.K. , Cheon J.
Published: March 2003

Objectives To evaluate the influence of prostate volume on the prostate‐specific antigen (PSA) level adjusted for the transition zone volume (PSAT) and free‐to‐total PSA ratio (f/tPSA) in detecting prostate cancer in men with intermediate PSA levels of 4.1–10.0 ng/mL.

Patients and methods From March 1997 to June 1999, the f/tPSA and PSAT were measured in 105 patients who underwent ultrasound‐guided systemic biopsies and had a PSA level of 4.1–10.0 ng/mL, with an apparently normal prostate on a digital rectal examination. The PSAT and f/tPSA were evaluated in all patients and in subgroups of patients with small (< 40 mL) or large ( 40 mL) prostates, using receiver operating characteristic (ROC) curves.

Results Total prostate volume was highly correlated with transition zone volume in all patients and in both subgroups (P < 0.001). In all 105 patients, PSAT had a sensitivity of 82% and its use would have avoided the largest number of unnecessary biopsies (87% specificity) at a threshold value of 0.35 ng. In men with small prostates f/tPSA and PSAT had a high sensitivity and specificity, at threshold values of 0.12 and 0.35 ng, respectively. In large prostates the PSAT was superior to f/tPSA in detecting prostate cancer.

Conclusions These results suggest that both f/tPSA and PSAT are useful in detecting prostate cancer in men with small prostates, while PSAT is superior to f/tPSA in detecting prostate cancer in men with large prostates.
The role of adrenomedullin in varicocele and impotence
Authors: Ozbek E. , Yurekli M. , Soylu A. , Davarci M. , Balbay M.D.
Published: March 2003

Objective To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic vein in infertile patients with varicocele, comparing the results with levels in the brachial vein in the same patients.

Patients and methods Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine‐induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic vein and brachial vein in 14 infertile men with varicocele.

Results The mean (
sd) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine‐induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P < 0.05). Needle puncture alone had no effect on adrenomedullin levels. In men with varicocele, the adrenomedullin level of 139.0 (34.3) pmol/mL within the internal spermatic vein was significantly higher than that in the brachial vein, at 103.9 (37.6) pmol/mL (P < 0.05).

Conclusion Injection with papaverine increases adrenomedullin release into penile blood; this release may be responsible for the increase in penile blood flow and penile erection. Higher levels of adrenomedullin within the internal spermatic vein of patients with varicocele may result from the retrograde flow of venous blood from the left adrenal gland and kidney. Further studies are needed to determine the role of adrenomedullin in male infertility and impotence.
Combined bladder neck, urethral and penile reconstruction in boys with the exstrophy‐epispadias complex
Authors: Baka‐Jakubiak M.
Published: March 2003

Objective To describe a one‐stage combined bladder neck, urethral and penile reconstruction for achieving urinary continence and creating a penis with good cosmesis and function in boys with the exstrophy‐epispadias complex.

Patients and methods Seventy‐three boys underwent the combined procedure, including 36 after classic bladder exstrophy closure and 37 with epispadias. All were completely incontinent at the time of combined reconstruction. The bladder capacity just before surgery was 70–180 mL and was greater in those with epispadias. The boys were 2.5–11 years old, with those in the exstrophy group being slightly older.

Results Thirty‐three boys (89%) with epispadias were completely continent during the day but 15 had episodes of nocturnal enuresis. Of boys with classic exstrophy, 27 (75%) were continent during the day but nine had occasional nocturnal enuresis. Eleven boys required intermittent catheterization, which they found easy to perform. In seven boys (10%) a urethrocutaneous fistula or urethral stricture developed.

Conclusions Combined bladder neck, urethral and penile reconstruction can be carried out as a one‐stage procedure in selected patients with adequate bladder capacity. Reconstruction of the whole length of the urethra facilitates intermittent catheterization.
Insulin‐like growth factor II and androgen receptor expression in the prostate
Authors: Gnanapragasam V.J. , Mccahy P.J. , Neal D.E. , Robson C.N.
Published: March 2003

Objective To determine the effect of insulin‐like growth factor (IGF)‐II on androgen receptor (AR) expression in prostate tissue, as IGFs may be important in re‐activating androgen‐regulated genes in advanced prostate cancer because they can trans‐activate the AR in the absence of ligand.

Materials and methods Primary BPH stromal cells, LNCaP and U2OS cells were grown in full medium, medium devoid of growth factors and devoid medium supplemented with IGF‐II. The relationship between IGF‐II and AR expression was then investigated using the reverse‐transcription polymerase chain reaction, and the effects of anti‐androgens on IGF‐II expression assessed using northern blot analysis.

Results IGF‐II had no effect in benign tissue, but the AR expression doubled in LNCaP and U2OS cells after culture with IGF‐II. Androgens had a minimal effect on IGF‐II mRNA levels, but anti‐androgens reduced IGF‐II mRNA levels by more than half.

Conclusion These findings support the idea of a complementary paracrine (IGF) and autocrine (androgen) growth loop in prostate tissue. The study suggests that IGF‐II has a role in regulating AR expression in prostate cancer cells, and that the action of anti‐androgens is mediated partly by an ability to suppress IGF‐II expression.
A 3‐year follow‐up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy
Authors: Hammadeh M.Y. , Madaan S. , Singh M. , Philp T.
Published: March 2003

Objective To compare the safety, efficacy and durability of transurethral electrovaporization of the prostate (TUVP) with standard transurethral resection of the prostate (TURP).

Patients and methods In all, 104 patients admitted from the waiting list for surgery for BPH were randomized to either TUVP (52 patients, mean age 67.5 years) or TURP (52 patients, mean age 70.2 years); 51, 47 and 40 patients in each arm completed 1, 2 and 3 years of follow‐up, respectively. Patients were assessed at baseline and during the follow‐up using the International Prostate Symptom Score (IPSS), the associated quality‐of‐life score (QoL), postvoid residual volume (PVR) and maximum urinary flow rate (Qmax).

Results Both groups had comparable mean IPSS, QoL, Qmax and PVR at baseline. The mean (
sd) values for TUVP and TURP, respectively, at 3 years showed a significant and maintained improvement in IPSS, at 4.1 (3.3) and 7.1 (6.2) (P = 0.01), in QoL, at 1.0 (0.9) and 1.6 (1.4) (P = 0.04), and in Qmax, at 22.2 (8.5) and 18 (7.1) mL/s (P = 0.02), with decreases in PVR of 30 (38) and 21.9 (26.2) mL (P = 0.27). The re‐operation rate in each group was 4% during the first year, 4% during the second year and 5% during the third year. After surgery and at 1, 2 and 3 years of follow‐up, impotence was reported in 17% of the TUVP group and 11% of the TURP group (P = 0.49), and retrograde ejaculation in 72% of the TUVP group and 89% of the TURP group (P = 0.47).

Conclusion The 3‐year follow‐up results confirm that TUVP is as effective as standard TURP in the treatment of moderate‐sized BPH. The long‐term side‐effects and complications were comparable and the initial improvement was maintained over 3 years in most patients in both groups.
Preoperative simulation of partial nephrectomy with three‐dimensional computed tomography
Authors: Wunderlich H. , Reichelt O. , Schubert R. , Zermann D.‐H. , Schubert J.
Published: March 2003

Objective To evaluate prospectively the accuracy of computer‐aided three‐dimensional (3D) volume‐rendered computed tomography (CT) in determining the appropriate anatomical limits (tumour size, tumour location, multifocality and vascular supply) and as a potential tool in the preoperative simulation of nephron‐sparing surgery (NSS) in patients with small‐volume renal cell carcinoma (RCC).

Patients and methods The study included 36 patients who underwent transperitoneal radical nephrectomy for RCC of < 4 cm diameter. Helical CT was undertaken before surgery and the extent of the tumour, the course of major renal arteries and veins, and the relationship of the tumour to the collecting system were shown by 3D volume‐rendered CT. The CT findings were compared with the pathological results of all kidney specimens, obtained using 3‐mm step‐sections.

Results Before nephrectomy, 39 renal tumours were identified in the 36 patients; three renal lesions of < 4 mm were not detected. All main venous branches and 42 of 43 arteries were identified by 3D volume‐rendered CT. Knowing these features, a partial nephrectomy was simulated; a surgical lesion to the pelvicalyceal or vascular system which would have been produced by the simulated surgery was displayed in colour on the simulated surface of the section.

Conclusion Computer simulation provided an excellent 3D reconstruction of all kidneys, including the tumour, vasculature and renal hilum, allowing a significantly better preoperative evaluation of the renal mass. Visualizing possible resection margins and predicting the operative risks seem to be major advantages of this new method, especially when preparing for complex surgery. Reconstructed 3D CT appears to be a useful tool for defining the indications for and limitations of NSS.
Detecting circulating prostate cells in patients with clinically localized prostate cancer: clinical implications for molecular staging
Authors: Llanes L. , Páez A. , Ferruelo A. , Luján M. , Romero I. , Berenguer A.
Published: March 2003

Objective To evaluate the clinical utility of using the reverse transcriptase‐polymerase chain reaction (RT‐PCR) to detect prostate‐specific antigen (PSA) mRNA in peripheral blood samples from patients with prostate cancer, as a predictor of extraprostatic disease, and to assess any correlations with known predictive markers of this condition.

Patients and methods Immediately before radical prostatectomy, peripheral blood samples were taken from 25 men with clinically localized prostate cancer and analysed for PSA mRNA using RT‐PCR (in ‘hot‐start’ conditions and confirmed using ClaI restriction enzyme). The relationships between PSA mRNA positivity, pathological and clinical features were analysed; PSA mRNA positivity, PSA level and biopsy Gleason score were then compared as predictors of extraprostatic disease.

Results There was no relationship between PSA mRNA positivity and pathological stage (pT2 or pT3), and no association between PSA mRNA positivity and serum PSA level, PSA density, the findings on a digital rectal examination or transrectal ultrasonography, and perineural invasion in the prostatic biopsy. However, there was a significant correlation between the Gleason score of the preoperative biopsy and PSA mRNA positivity. The best predictors of extraprostatic disease were the biopsy Gleason score and the PSA level.

Conclusion There was no significant advantage in using the RT‐PCR assay of PSA mRNA before surgery to stage prostate cancer and to discriminate between organ‐confined and extraprostatic neoplasms.
A novel antireflux uretero‐ileal anastomosis for urinary diversion: an experimental study
Authors: Fujisawa M. , Isotani S. , Ishimura T. , Yamanaka K. , Arakawa S. , Kamidono S.
Published: March 2003

Objectives To assess a new antireflux valve technique in a dog model of urinary diversion, and thus provide a reliable and easily constructed antireflux system for an ileal reservoir.

Materials and methods In five female beagle dogs, 3 cm of ileum were intussuscepted into the reservoir formed using the adjacent 10 cm of ileum. The intussuscepted ileum was sutured to the reservoir wall after stripping the mucosa of the reservoir in a trapezoidal zone opposite the similarly stripped mucosa of the intussuscepted ileum, to avoid dessusception. After the distal 4 cm of the ureters was united and pulled through the intussuscepted segment of ileum, the combined distal ureter was sutured to the labial edge of the intussuscepted segment. Finally, the reservoir was anastomosed to the bladder as an enterocystoplasty. Dogs were evaluated by ascending cystography and intravenous pyelography at 1 and 6 months. The valve and upper urinary tract were evaluated histopathologically at 6 months.

Results In all dogs the antireflux system remained intact and prevented reflux. The intussuscepted ileum was firmly attached to the reservoir wall and the submucosa of each segment was united. The upper urinary tract was normal with no ureteric stenosis. Histopathologically, the ureter was surrounded by intact ileal serosa and showed no inflammation or scarring.

Conclusions The very short ileal segment required and the firm attachment of the constructed valve to the reservoir were the advantages of this practical and reliable new antireflux system.
Sacral nerve root stimulation for lower urinary tract dysfunction: overcoming the problem of lead migration
Authors: Carey M. , Fynes M. , Murray C. , Maher C.
Published: March 2003

Objective To evaluate lead migration for two different test electrodes and the response to trial stimulation of the S3 nerve root during the selection of patients for a sacral neuromodulation implant to manage lower urinary tract dysfunction.

Patients and methods Twelve women (mean age 49 years, range 23–79; seven with detrusor instability and five with sensory urgency) undergoing peripheral nerve evaluation for refractory lower urinary tract symptoms were recruited. Urodynamics and a urinary diary were completed before and during test stimulation. Two electrodes (the original 041830–002 and new 3057 models, Medtronics Inc, USA) were inserted under local anaesthesia into the S3 nerve roots bilaterally. The location was determined by the functional response to stimulation. Stimulation was applied for one week using the new lead; a positive response was defined as a subjective improvement (> 50%) in urinary symptoms. Lateral sacral X‐rays were taken after placement and before removing the lead. The distance from the lead tip to the ventral aspect of the S3 sacral foramen was measured by two assessors.

Results Ten of the women had a positive response; the mean (range) migration of the new lead (on X‐ray) was 4 (2–11) mm, and of the old lead was 12 (10–45) mm (P = 0.02).

Conclusion The response rate to trial stimulation was greater than in previous studies, possibly reflecting reduced migration of the new lead. The new electrode may reduce the number of test failures caused by lead migration rather than no response.
Advanced glycation end‐products are responsible for the impairment of corpus cavernosal smooth muscle relaxation seen in diabetes
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B.
Published: March 2003

Objective To determine if advanced glycation end‐products (AGEs) are responsible for the lower neuronal and endothelial‐derived nitric oxide (NO)‐mediated relaxation of corpus cavernosum in tissue in diabetic rats than in control rats.

Materials and methods Diabetes was induced in male Wistar rats by an intraperitoneal injection with streptozotocin (60 mg/kg). One group of diabetic rats was given free access to water and standard diet. A second group was given standard diet and aminoguanidine with their water (50 mg/100 mL) from the initiation of diabetes. Two groups of rats that were not diabetic acted as age‐matched controls. After 8 weeks animals were killed by cervical dislocation, corpus cavernosal tissue strips harvested and mounted in an organ bath to measure isometric tension. After 90 min of equilibration at optimal resting tension and contraction with 1 µmol/L noradrenaline, the response to either acetylcholine or electrical field stimulation (EFS) after adding guanethidine (5 µmol/L) and atropine (1 µmol/L) was determined for each group.

Results There was no difference between the baseline characteristics of all the experimental groups. After 8 weeks the mean body mass and glycosylated haemoglobin (HbA1c) were significantly greater in the diabetic than in control animals. Aminoguanidine had no effect on the recorded body mass or HbA1c. The in vitro relaxation response to the application of acetylcholine or EFS of tissue strips from age‐matched control animals fed a standard diet and those supplemented with aminoguanidine were the same. The administration of aminoguanidine to diabetic animals for 8 weeks reversed the expected impaired relaxation response to acetylcholine; the response to EFS was similar.

Conclusion AGEs are more prevalent in erectile tissue from diabetic than in control animals. Aminoguanidine reversed the impairment in neuronal and endothelial NO‐mediated penile smooth muscle relaxation seen in diabetes. As aminoguanidine prevents AGE formation, erectile dysfunction in diabetes is probably caused partly by the generation of AGEs.