bluuebunny/crossref_metadata_2025 huggingface dataset:
NK‐2 is the predominant tachykinin receptor subtype in the swine ureter
Authors: Jerde  , Saban  , Bjorling  , Nakada
Published: March 2003

Objective

To determine which of the known tachykinin receptor subtypes is predominant in the swine ureter.

Materials and methods

Ureters from adult pigs were harvested, cut into longitudinal strips and placed in 10 mL tissue baths containing Krebs buffer, under 4 g of initial tension. The magnitude and frequency of contractions were recorded. Tissues were incubated with 1 μmol/L solutions of peptidase inhibitors (phosphoramidon and captopril) for 1 h to inhibit degradation of peptides and treated with either CP 96,345 (NK‐1 receptor antagonist), SR 48,968 (NK‐2 receptor antagonist) or saline (control). Concentration–response curves to the tachykinins substance P (SP), neurokinin A (NKA) and neurokinin B (NKB) were determined.

Results

Ureteric segments showed a concentration‐dependent response to all tachykinins; NKA stimulated increased contractions at a lower concentration than either SP or NKB (P<0.05). This was reflected by the difference in the effective concentration required to obtain half the maximal response (EC50 ) for each of the peptides. The mean (sd) EC50 values were (μmol/L): NKA, 0.2 (0.02); SP, 3.5 (0.7); and NKB, 4.5 (1.7). In addition, the selective NK‐2 antagonist (SR 48,968) significantly reduced contractile responses to all peptides, as indicated by a 10‐fold rightward shift of the concentration–response curves (P<0.05), whereas the NK‐1 antagonist (CP 96,345) had no significant effect.

Conclusion

These results indicate that NK‐2 is the predominant tachykinin receptor subtype responsible for contraction of ureteric smooth muscle. The use of mediators which act on NK‐2 receptors may have clinical applications for the treatment of ureteric disease.
Resistive index in renal colic: a prospective study
Authors: Shokeir  , Abdulmaaboud
Published: March 2003

Objective

To study the role of Doppler ultrasonography (DU) in the diagnosis of acute unilateral renal obstruction.

Patients and methods

In all, 117 patients with suspected renal colic were evaluated by intravenous urography (IVU) and DU, with determination of the resistive index (RI) and the difference between the RI of ipsilateral and contralateral kidneys (ΔRI). RI and ΔRI were considered positive with values of ≥0.70 and ≥0.06, respectively. IVU results were considered the ‘gold standard’ with which renal DU findings were compared.

Results

IVU showed both kidneys to be normal in 49 patients and unilateral ureteric obstruction with a normal contralateral kidney in 68. The mean (sd) RI was 0.73 (0.05) in 68 obstructed kidneys, significantly higher than the mean RI of 0.64 (0.05) in 166 normal kidneys (P<0.001). The ΔRI in patients with unilateral obstruction was significantly higher than that in patients with both kidneys normal, at 0.09 (0.05) and −0.001 (0.02), respectively (P<0.001). For all the patients, RI was sensitive in 77% and specific in 83%, and ΔRI was sensitive in 88% and specific in 98%. Obstructed kidneys showing delayed pelvicalyceal filling with excretion of contrast medium (n=42) had significantly higher values of RI and ΔRI than obstructed kidneys without delayed filling (n=26). The RI and ΔRI were more sensitive in the former group. Among patients with obstruction, the RI did not relate to the time of delay of filling with contrast medium, the duration of renal colic or the level of ureteric obstruction.

Conclusions

Renal DU is a sensitive and highly specific test that can contribute significantly to the diagnosis of acute unilateral renal obstruction. It can replace the IVU, particularly in situations where IVU is undesirable.
Total urogenital sinus mobilization: expanded applications
Authors: Ludwikowski  , Oesch Hayward  , González
Published: March 2003

Objective

To report further applications of total urogenital sinus mobilization, earlier described as an easier method to correct a cloaca.

Patients and methods

Seven children (six girls and one boy, mean age 4 years, range 3 months to 10.5 years) underwent surgery and were followed for a mean of 1 year; their diagnoses included persistent cloaca and congenital adrenal hyperplasia (CAH) in two each, and a urogenital sinus (UGS), bladder exstrophy and penile agenesis in one each. The UGS is approached through a posterior sagittal incision and dissected circumferentially to the retropubic space, allowing the UGS to descend. It is then excised and separate openings of the vagina and urethra created. This technique is applicable to a UGS of ≤3 cm.

Results

In all patients, separate openings for the urethra and vagina were created. In three patients urinary continence was preserved after surgery. The patient with bladder exstrophy remains incontinent. The remaining patients are too young to assess (not yet toilet‐trained).

Conclusion

This technique simplifies the surgical correction of UGS malformation; we confirm its usefulness in cases of persistent cloaca. It is also valuable in patients with CAH, primary UGS and in selected patients with bladder exstrophy and penile agenesis. When the UGS is not associated with a cloaca, the procedure can be performed perineally. Despite circumferential mobilization of the UGS, urinary continence is preserved.
Do we do what they say we do? Coding errors in urology
Authors: Ballaro A. , Oliver S. , Emberton M.
Published: March 2003

Objective To determine the accuracy of routine data coding in a large multispeciality urological unit.

Materials and methods From the clinical records, the diagnosis and procedure codes were ascribed to 106 finished consultant episodes (FCEs) in urology, by two urological trainees. The codes were compared with those ascribed by professional hospital coders (and of which the trainees were unaware) from information written on the audit form by junior medical staff. Where there were discrepancies in codes an error was recorded and the stage in the coding process in which it occurred was determined.

Results Forty‐eight coding errors were found in 38 of the 106 (36%) FCEs; 34 (71%) were caused by inaccurate coding and 14 (29%) were the result of the incorrect completion of audit forms.

Conclusion The clinical codes generated from the authors’ department do not accurately reflect the clinical practice. If coding errors of this magnitude are typical of urology units in general, the concept of hospital performance tables (which will be generated using routine clinical data) is untenable unless data recording is given higher priority.
The nurse cystoscopist: a feasible option?
Authors: Gidlow A.B. , Laniado M.E. , Ellis B.W.
Published: March 2003

Objectives To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy.

Patients and methods Eighty‐three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other’s findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy.

Results Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance‐corrected proportional agreement (Κ) was 0.94, indicating very close agreement.

Conclusion A UNP can be trained to perform cystoscopy and detect suspicious lesions as accurately as can a consultant urologist. Legal and training issues in implementation are important.
One year’s clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic
Authors: Greenwell T.J. , Woodhams S. , Denton E.R.M. , Mackenzie A. , Rankin S.C. , Popert R.
Published: March 2003

Objective To assess the use of unenhanced spiral computed tomography (CT) as the primary investigation of choice for suspected acute renal colic in clinical urological practice.

Patients and Methods Between 1 August 1997 and 31 July 1998, all patients attending a hospital accident and emergency department with acute loin pain suggestive of renal colic underwent a physical examination, urine analysis, plain abdominal radiography (if clinically indicated) and unenhanced spiral CT. The effective radiation dose and financial cost of unenhanced spiral CT and standard three‐film emergency intravenous urography (IVU) were calculated.

Results In all, 116 patients were assessed, 63 of whom had calculi and related secondary phenomena of obstruction identified on unenhanced spiral CT. There were two false‐positive and one false‐negative result. An alternative urinary tract diagnosis was made in four patients, including two with renal cell carcinoma and one ureteric transitional cell carcinoma. Causes other than in the urinary tract were diagnosed in three patients, i.e. two with ovarian cyst and one with sigmoid diverticulitis. The effective radiation dose of unenhanced spiral CT was 4.7 mSv and that for three‐film IVU was 1.5 mSv. The costs of both IVU and unenhanced spiral CT were identical.

Conclusions Unenhanced spiral CT allows a rapid, contrast‐medium‐free, anatomically accurate diagnosis of urinary tract calculi and in the present series had a sensitivity of 98% and a specificity of 97%. CT provided an alternative diagnosis in 6% of patients. These advantages must be weighed against the threefold greater radiation dose of unenhanced spiral CT than with three‐film IVU, and in practice the requirement for a radiologist to interpret routine axial scans.
Benign prostatic hyperplasia and prostate carcinoma in native Africans
Authors: Dawam D. , Rafindadi A.H. , Kalayi G.D.
Published: March 2003

Objective To study the factors associated with morbidity and mortality in benign prostatic hyperplasia (BPH) and carcinoma of the prostate in native Africans.

Patients and methods A prospective study was conducted from 1993 to 1998 at the Ahmadu Bello University Teaching Hospitals, Zaria, Nigeria. During this 5‐year period 686 patients were investigated and treated for symptoms and signs of prostatism. They were followed up for a mean (range) of 19.5 (1–60) months.

Results BPH was found in 588 and clinical carcinoma in 98 patients. Adequate results, including a histological diagnosis, were available for 640 patients; there were 545 patients with BPH and 95 patients with histologically diagnosed prostate cancer. Treatment consisted of open prostatectomy for BPH, and subcapsular orchidectomy and/or open bladder‐neck wedge resection for patients with prostate cancer and bladder neck obstruction. Within 6 months of surgery, four of 545 (0.7%) patients with BPH and 25 of 95 (26.3%) with prostate cancer had died. Two‐thirds of the patients with cancer presented with paraparesis or paraplegia.

Conclusions BPH and prostate cancer cause significant morbidity and mortality in African men. There is a need for health education about the early recognition of symptoms. Provision of facilities for transurethral prostatectomy would minimize the complications of surgery and ensure better use of the meagre resources available for health care.
The role of reactive oxygen species in testicular dysfunction associated with varicocele
Authors: Köksal I.T. , Tefekli A. , Usta M. , Erol H. , Abbasoglu S. , Kadioglu A.
Published: March 2003

Objective To determine the level of malondialdehyde (MDA), an indirect indicator of lipid peroxidation‐induced injury by reactive oxygen species, in testicular biopsy specimens from infertile patients with and without varicocele.

Patients and methods Levels of MDA were measured in the testicular biopsy specimens from 25 infertile men (15 with varicocele, mean age 30.0 years,
sd 5.7, range 23–45, and 10 without, mean age 28.7 years,
sd 4.2, range 21–34). All patients were evaluated by a detailed history, physical examination, semen analysis (at least twice), serum follicle‐stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The level of MDA in testicular biopsy specimens was measured using the thiobarbituric acid test and the results expressed per unit tissue weight.

Results As a causal factor for infertility, varicocele was identified in 15 men (60%), testicular failure in four (16%), idiopathic infertility in four (16%) and obstruction in two (8%). Of the 15 patients with varicocele, eight had bilateral varicocele and it was subclinical in three; the varicocele was grade I in four, grade II in six and grade III in two. The mean (
sd) MDA level in the men with a subclinical varicocele was 15.7 (3.1) pmol/mg tissue, while in those with grade I–III varicocele it was 32.9 (12.25), 37.1 (12.25) and 86.9 (2.89) pmol/mg tissue, respectively. The levels in patients with grade III varicocele were significantly greater than in the other groups (P < 0.05). The mean MDA level in patients with or without varicocele was 38.3 (22.92) and 33.5 (18.93) pmol/mg tissue, respectively (P > 0.05).

Conclusion These results suggest that increasing levels of MDA are associated with higher grades of varicocele and support a possible rationale for controlled trials in infertile men with varicocele.
Urology and the Internet: an evaluation of Internet use by urology patients and of information available on urological topics
Authors: Hellawell G.O. , Turner K.J. , Le Monnier K.J. , Brewster S.F.
Published: March 2003

Objective To determine the use of the Internet by urological patients for obtaining information about their disease, and to conduct an evaluation of urological websites to determine the quality of information available.

Patients and methods Questionnaires about Internet use were completed by 180 patients attending a general urological outpatient clinic and by 143 patients attending a prostate cancer outpatient clinic. The Internet evaluation was conducted by reviewing 50 websites listed by the Hotbot™ search engine for two urological topics, prostate cancer and testicular cancer, and recording details such as authorship, information content, references and information scores.

Results Of the patients actively seeking further information about their health, 19% of the general urological outpatient group and 24% of the prostate cancer group used the Internet to obtain this information. Most websites were either academic or biomedical (62%), provided conventional information (95%), and were not referenced (71%). The information score (range 10–100) was 44.3 for testicular cancer and 50.7 for prostate cancer; the difference in scores was not significant.

Conclusion The use of the Internet by patients is increasing, with > 20% of urology patients using the Internet to obtain further information about their health. Most Internet websites for urological topics provide conventional and good quality information. Urologists should be aware of the need to familiarize themselves with urological websites. Patients can then be directed to high‐quality sites to allow them to educate themselves and to help them avoid misleading or unconventional websites.
The effects of chemical sympathectomy on testicular injury in varicocele
Authors: Öztürk H. , Tander B. , Aydin A. , Okumus Z. , Çetinkursun S.
Published: March 2003

Objective To determine whether the sympathetic nervous system plays a role in the contralateral testicular deterioration encountered in varicocele.

Materials and methods Forty male Sprague‐Dawley albino rats (28 days old) were divided equally into four treatment groups, i.e. (1) sham operation, (2) with varicocele, (3) treated by chemical sympathectomy plus varicocele, and (4) chemical sympathectomy only. Chemical sympathectomy was induced by administering intraperitoneal 6‐OH dopamine (100 µg/g for 5 days) in groups 3 and 4; groups 1 and 2 received equal volumes of physiological saline by the same route. All rats underwent laparotomy and part of the left renal vein (distal to the spermatic vein confluence) was isolated and encircled with a 4/0 silk suture. The suture was left untied in group 2, and tied around a 24 F peripheral venous cannula in groups 3 and 4. The testes were then excised when the rats were 70 days old; malondialdehyde (MDA) in the testicular tissue was assayed by the thiobarbituric acid‐reactive substances method, and superoxide dismutase (SOD) and glutathione peroxidase (GSH‐Px) levels were determined by spectrophotometric analysis.

Results Varicocele resulted in a significant increase in MDA levels in both testes and chemical sympathectomy prevented this effect. SOD and GSH‐Px values were significantly decreased in both testes in group 2; chemical sympathectomy also prevented this effect.

Conclusion An induced unilateral varicocele significantly increases the biochemical indicators of tissue hypoxia in both testes. As this increase was prevented by chemical sympathectomy, the sympathetic nervous system may play a role in the testicular degeneration associated with varicocele.
The role of serial transrectal ultrasonography in a ‘watchful waiting’ protocol for men with localized prostate cancer
Authors: Hruby G. , Choo R. , Klotz L. , Danjoux C. , Murphy J. , DeBoer G. , Morton G. , Rakovitch E. , Szumacher E. , Fleshner N.
Published: March 2003

Objective To determine the value of serial 6‐monthly transrectal ultrasonography (TRUS) in a cohort of men with localized prostate cancer who consented to a programme of watchful waiting with selective delayed intervention.

Patients and methods Since November 1995, 180 men were accrued into an ongoing prospective study of watchful waiting with selective delayed intervention; 174 patients enrolled before 31 December 1999 comprised the cohort for the present study. The prospectively collected clinical data, including the TRUS reports, were reviewed systematically. Twenty‐eight men met the arbitrarily predefined criteria of disease progression and required definitive treatment. The TRUS findings were scored as being consistent with the clinical scenario (i.e. clinical, biochemical or histological progression) if they reported a new or enlarging hypoechoic peripheral zone lesion, or a  30% increase in overall prostate volume at the time of progression. In 136 men who had undergone two or more serial TRUS examinations the relationships between the rate of change of prostate‐specific antigen (PSA) and changes in both gland volume and the number of hypoechoic lesions were also examined.

Results The group of 28 men who progressed to require radical intervention underwent 83 TRUS examinations (median number per patient, three). Two men underwent TRUS only once at baseline because of progression within 6 months. Of these 28 men, only seven had changes on TRUS that were regarded as being consistent with progression; all seven consisted of the growth of an existing nodule or the appearance of a new nodule. In only one case was this accompanied by an increase of  30% in gland volume. In the 136 men who underwent two or more serial TRUS examinations (median three, maximum nine), there was no correlation between the rate of change of PSA and changes in either gland volume or the number of peripheral zone hypoechoic lesions.

Conclusion The use of serial TRUS in men with known but untreated prostate cancer is of limited value as a determinant of disease progression.
P53, bcl‐2 and bax immunoreactivity as predictors of response and outcome after chemotherapy for metastatic germ cell testicular tumours
Authors: Baltaci S. , Orhan D. , Türkölmez K. , Yesilli C. , Bedük Y. , Tulunay O.
Published: March 2003

Objective To evaluate the roles of p53, bcl‐2 and bax as determinants of chemosensitivity in testicular cancers and to assess whether immunohistochemical expression of these proteins in testicular germ cell tumours (GCTs) could be used to predict the outcome in patients with metastatic testicular GCTs.

Patients and methods Immunoreactivity for p53, bcl‐2 and bax were examined in primary testicular tumours from 24 patients with metastatic GCTs who were treated with bleomycin, etoposide and cisplatin chemotherapy. All immunostaining results were scored for the appropriate percentage of positive tumour cells and relative immunostaining intensity (score range 0–15) and compared with the response of the patients to chemotherapy.

Results Overall, 20 (83%), 13 (54%) and 24 of the 24 GCTs showed  1% immunoreactivity with p53, bcl‐2 and bax, respectively. Only the bax immunostaining intensity and score had statistically higher mean values in the nonseminoma than in seminoma GCTs (P = 0.047 and P = 0.027, respectively). Only p53 immunostaining intensity, percentage of p53 immunopositive cells and p53 staining score were sig‐nificantly different among the response groups. The median survival after chemotherapy was 30.5 months; however, taking the median values of the immunostaining scores as threshold values for the survival analysis, none of the three proteins were associated with significant differences in survival.

Conclusions The incidence of p53 and bax immuno‐reactivity in testicular GCTs is higher than that of bcl‐2 immunoreactivity. However, only p53 immuno‐reactivity could be used to predict the response to chemotherapy. P53, bcl‐2 and bax scores were not significant prognostic factors for survival after chemotherapy.
The independent prognostic value of comorbidity among men aged < 75 years with localized prostate cancer: a population‐based study
Authors: Post P.N. , Hansen B.E. , Kil P.J.M. , Janssen‐Heijnen M.L.G. , Coebergh J.W.W.
Published: March 2003

ObjectiveTo investigate which prognostic factors apply in patients with localized prostate cancer diagnosed after the introduction of prostate‐specific antigen (PSA) testing, as comorbidity has significant prognostic value for patients who were diagnosed with localized prostate cancer in the 1970s.

Patients and methodsUsing the Eindhoven Cancer Registry, we assessed a population‐based cohort of patients aged < 75 years with localized (T1‐T3M0) prostate cancer diagnosed between 1993 and 1995 in a defined area with 2 million inhabitants in the southern Netherlands (n = 894). After a mean follow‐up of 2.9 years, overall survival was modelled by Cox regression analyses.

ResultsComorbidity was the most important prognostic factor, especially for those aged < 70 years; at 60 years old, patients with one concomitant disease were twice as likely to die than those with no comorbidity (95% confidence interval, CI, 1.0–4.3), whereas the hazard ratio (HR) was 7.2 (3.1–16.6) for two or more diseases. This was not caused by a reduced use of curative treatment for these patients. At the age of 74 years, comorbidity was no longer a significant prognostic factor. Poor differentiation of the tumour was also an important prognostic factor at all ages; this became increasingly apparent 2 years after diagnosis (HR 3.4, CI 1.5–7.7).

ConclusionComorbidity had a decisive influence on the prognosis for patients with localized prostate cancer. Because this effect was stronger in younger patients the assessment of comorbidity seems most important when evaluating the risk of early death.
Consensus development of a histopathological classification system for chronic prostatic inflammation
Authors: Nickel J.C. , True L.D. , Krieger J.N. , Berger R.E. , Boag A.H. , Young I.D. ,   participating members of the North American Chronic Prostatitis Collaborative Research Network and the International Prostatitis Collaborative Network (see )
Published: March 2003

Objective To develop a standardized histopathological classification system for chronic prostatitis (standardized description of prostatic inflammatory infiltrates) based on a literature review, extensive prospective evaluations in two recognized prostatitis research centres and widespread consensus of international urological centres identified as having major expertise or interest in chronic prostatitis.

Methods Relevant articles for review were identified by a Medline search undertaken by the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, and cross‐checking bibliographies of retrieved studies, reviews, book chapters and abstracts of the American Urological Association and International Prostatitis Collaborative Network Annual Meetings. Initial drafts were based on classification systems independently developed by the Prostatitis Research Centers at Queen's University in Canada and University of Washington in the USA. A collaborative draft was distributed to 20 urological/pathological clinical centres who participated in the North American Chronic Prostatitis Collaborative Research Network and First International Prostatitis Collaborative Network. A consensus classification system was then distributed to the participating panel for acceptance.

Results The literature review identified a reasonably consistent description of inflammatory infiltrate locations and patterns that were further incorporated into the draft based on the Queen's University and University of Washington proposals. Eighteen (90%) of the identified Prostatitis Centers participated in the revision of the draft and the final consensus process. The final consensus document classifies prostatic inflammation according to its extent and grade/severity in each tissue compartment (location).

Conclusion The consensus of the expert panel was that this classification system can be used in the evaluation of prostatic inflammation in prostate biopsies, transurethral resected prostate chips or prostatectomy specimens. A standardized accepted framework to describe histopathological prostate inflammation will prove useful in evaluating prostate disease.
Benign scrotal pathology: should all patients undergo surgery?
Authors: Menon V.S. , Sheridan W.G.
Published: March 2003

Objective To evaluate the justification for operative intervention in patients undergoing surgery for benign scrotal pathology, and to assess the associated morbidity.

Patients and methods Consecutive patients in two surgical firms who underwent surgery for benign intrascrotal pathology over a 5‐year period were studied retrospectively.

Results In all, 102 patients were included in the study (mean age 51.6 years, range 16–86). Most patients had either epididymal cysts (59) or hydroceles (31) or a combination of the two (eight). Some patients (37) underwent ultrasonography before surgery. The indications for surgery were deemed to be strong in 25% of patients but weak or absent in the remainder. Complications occurred in 31 patients, being minor in 18, but significant in 13, resulting in four re‐admissions to hospital. There was no significant difference in the complication rate between those patients with strong indications for surgery (37%) and those with weak indications (28%).

Conclusions Surgery for benign intrascrotal pathology is frequently undertaken for weak clinical indications and carries significant associated morbidity. This could be avoided in many cases by simple reassurance. Judicious use of ultrasonography is advised. A policy of selective surgical intervention is strongly advocated.
Nurse‐led cystoscopy: the next step
Authors: Taylor J.M. , Pearce I. , O'Flynn K.J.
Published: March 2003

Objectives  To determine and compare the accuracy of flexible cystoscopy and subsequent management by a specialist urology registrar (SpR) and a specialist urology nurse (SUN).

Patients and methods  Flexible cystoscopy was undertaken on 50 patients by both endoscopists each unaware of the results of the other's examination. The findings and management plans were independently declared and then compared. Any cystoscopic discrepancies were assessed by one consultant with the patients under a general anaesthetic.

Results  Tumours were found in 20% of patients; there was a consensus of the endoscopic findings and subsequent management plan between the SpR and the SUN in 94% of the patients. Any missed tumours (all surveillance) were minute and clinically insignificant. The chance‐corrected proportional agreement (kappa value) between the SUN and final diagnosis and management was 0.94.

Conclusion  A properly trained SUN can undertake both diagnostic and surveillance flexible cystoscopy, and decide upon further management to the same degree as can a urology SpR.
Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches
Authors: Naya Y. , Nagata M. , Ichikawa T. , Amakasu M. , Omura M. , Nishikawa T. , Yamaguchi K. , Ito H.
Published: March 2003

Objective To compare the effectiveness and efficiency of transperitoneal anterior laparoscopic adrenalectomy with that of retroperitoneal posterior laparoscopic adrenalectomy.

Patients and methods A retrospective comparison was undertaken of 28 patients who underwent transperitoneal anterior laparoscopy with 22 patients who underwent retroperitoneal posterior laparoscopy between April 1994 and November 2000. There were 18 men and 32 women (mean age 51.0 years, range 23–68) with varying diagnoses. Of the 50 patients, 31 had primary aldosteronism, eight had Cushing's syndrome, three had phaeochromocytoma, one had an 18‐hydroxydeoxycorticosterone‐induced adenoma and seven had non‐functioning adrenal adenoma. Adrenal tumours were confirmed by hormonal assays, biochemical tests and computed tomography. To determine the site of the functioning adenoma, hormones were assayed from adrenal vein sampling. Thirty adrenal tumours were located on the right and 20 on the left.

Results There were no significant differences in general demographic variables between the transperitoneal and retroperitoneal groups. The mean duration of surgery for transperitoneal and retroperitoneal laparoscopy was 202 and 221 min, respectively, and the mean blood loss 113 and 192 mL, respectively. The time to first oral intake, days to full diet, time until ambulatory and duration of hospitalization did not differ significantly between the two approaches. As the body mass index increased, the duration of surgery increased for both approaches. As more procedures were performed the duration of surgery decreased for both approaches.

Conclusions There were no significant differences between the transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy.
The use of porcine dermal implant in a minimally invasive pubovaginal sling procedure for genuine stress incontinence
Authors: Barrington J.W. , Edwards G. , Arunkalaivanan A.S. , Swart M.
Published: March 2003

Objective To assess the outcome of a suburethral sling using a porcine dermal implant (Pelvicol™, Bard Urology, UK) in the surgical management of urinary stress incontinence.

Patients and methods Forty women with urodynamically confirmed genuine stress incontinence were recruited into the study and followed up at 6 weeks and at least 6 months (mean 12 months, range 6–18). The sling was inserted using a minimal‐access technique, which allowed 23 women to be operated as day‐cases. Outcome measures included continence rates, voiding dysfunction, satisfaction scores and whether the patients would recommend the operation to a friend or relative.

Results The cure rate was 85%, with sustained benefit; a further 10% of the women were improved by surgery. Voiding dysfunction rates were low and satisfaction scores high. Most women would undergo the procedure again if they became incontinent in the future and would recommend the procedure to a friend or relative.

Conclusion A minimal access pubovaginal sling using Pelvicol™ is effective in treating stress incontinence. The complication rate is low and the procedure can be performed as a day‐case with no loss of efficacy.
How to master absorption during transurethral resection of the prostate: basic measures guided by the ethanol method
Authors: Hultén J.O.
Published: March 2003

Objective To evaluate the effect of basic measures to minimize the absorption of irrigating fluid during transurethral resection of the prostate (TURP) to the planned end‐point, using the ethanol method to guide the surgeon.

Patients and methods Forty‐six patients underwent TURP with intermittent irrigation using sterile water and 2% ethanol. The ethanol content in the expired breath of the patients was assessed every 5 min using a breath‐alcohol monitor. In 25 patients no absorption was indicated but 21 showed some absorption according to the ethanol analyses. The operator was then immediately alerted, paused briefly to determine the route of absorption and to take advantage of blood clots to seal off leakage sites. On resuming the resection, attention was given to the pressure gradients in the operating field, based on bladder compliance and the flow in the irrigating jet. Repeated ethanol analyses were used to assess the result and to guide the surgeon's efforts.

Results No operation had to be terminated prematurely; the mean absorption in the 21 patients in whom any ethanol was detected was 121 (75–230) mL. In 14 patients absorption occurred once, in six twice and in one there were three small absorption events. The group with absorption did not differ significantly from that with no absorption in operative duration (mean 48 and 47 min), resected weight (mean 32.8 and 31.6 g) or blood loss (mean 550 and 483 mL).

Conclusions If the surgeon is alerted at the first positive ethanol reading, effective measures to minimize absorption can be taken early. Regular use of the ethanol method as an alarm system should permit TURP with a minimum of absorption and avoid an early interruption or premature termination of surgery because of absorption.
Mechanical properties and innervation of the smooth muscle layers of the urethra of greyhounds
Authors: Van der Werf B.A. , Creed K.E.
Published: March 2003

Objective To investigate the properties of the smooth muscle layers in the urethral wall of male and female greyhounds, and to consider their roles in continence and micturition.

Materials and methods The distribution and innervation of the smooth muscle layers of the prostate capsule and membranous urethra of male greyhounds were assessed. Strips of smooth muscle from these regions were used to determine the neuropharmacological properties by assessing the excitatory and inhibitory responses to nerve stimulation, and the effects of blocking agents. These were compared with strips from the proximal urethra and from the female urethra.

Results The smooth muscle of the membranous urethra comprised 9% of the wall and received its innervation exclusively in branches from the pelvic plexus. The cholinergic innervation in the male produced 80% of the total contractile response in the longitudinal membranous urethra, 50% in the prostate capsule and 13% in the circular muscle of the proximal urethra. In the female all areas had poor contractile responses. Inhibitory fibres produced relaxation in all parts of male and female urethrae with the major effect caused by nitric oxide. Adrenergic nerves contributed to both residual excitation (α receptors) and inhibition (β receptors).

Conclusions The longitudinal smooth muscle of the male membranous urethra probably shortens the urethra during micturition, through the activity of cholinergic nerves, whereas the circular smooth muscle of the proximal urethra, under adrenergic control, may be contracted during continence and ejaculation. In the female, the smooth muscle plays a minor role.
Intermittent testicular pain: fix the testes
Authors: Kamaledeen S. , Surana R.
Published: March 2003

OBJECTIVE

To analyse the presenting features, signs and operative findings of children presenting with intermittent testicular pain, as testicular torsion is a relatively common and serious emergency in children that can lead to testicular loss in up to 80%, although half of these children have previous episodes of pain suggestive of intermittent torsion.

PATIENTS AND METHODS

Data were collected prospectively for all patients presenting with recurrent pain between December 2000 and June 2001. Variables assessed included presenting symptoms, age, size, lie and position of the testis when supine and erect, the operative findings and follow‐up.

RESULTS

Eight children had at least two previous episodes of testicular pain; four of these were admitted on six occasions. Two had undergone previous scrotal exploration. On clinical examination, six boys had a transverse testicle and two a discrepancy in testicular size. All children had their testes fixed. At operation in all patients there was abnormal attachment of the tunica vaginalis with a typical ‘bell clapper’ deformity. On follow‐up only one patient still complains of pain.

CONCLUSION

In view of high incidence of abnormalities we consider that to improve the testicular salvage rate and prevent testicular atrophy, bilateral testicular fixation is recommended for boys with intermittent testicular pain and positive clinical findings.
The role of the human bladder lamina propria myofibroblast
Authors: Wiseman O.J. , Fowler C.J. , Landon D.N.
Published: March 2003

OBJECTIVES

To describe the ultrastructure and relationship to nerves of the myofibroblast in the human bladder lamina propria, and discuss its possible role in bladder function, including sensing stretch, as the response of the bladder to stretch has been thoroughly investigated by afferent nerve recordings, but specialized stretch sensing organs have yet to be identified.

MATERIALS AND METHODS

Flexible cystoscopic bladder biopsies were obtained from patients with detrusor hyper‐reflexia and from controls. Systematic electron micrographs were obtained throughout the lamina propria, and the presence and location of cells with ultrastructural characteristics of myofibroblasts noted, together with their relation to surrounding nerves.

RESULTS

Within the lamina propria there was a layer of cells with the cytological characteristics of both fibroblasts and smooth muscle cells, that included bundles of fine cytoplasmic filaments, dense bodies, linear arrays of subsurface vacuoles, and the presence of an interrupted basal lamina. This combination of features is characteristic of the myofibroblast. These cells had close contacts with unmyelinated axonal varicosities containing a mixture of clear and large dense‐cored vesicles, or clear vesicles alone.

CONCLUSIONS

There is a layer of cells with the ultrastructural characteristics of myofibroblasts within the human bladder lamina propria. Their close contacts with nerves containing both small clear, and small clear with dense‐cored, vesicles implies they have both an efferent and an afferent nerve supply, possibly functioning as a bladder stretch receptor. Furthermore, because of their similarities with the interstitial cells of Cajal in the gut, which are claimed to modulate small intestinal function, we discuss other possible roles for bladder lamina propria myofibroblasts.
The fear of prostate cancer in men with lower urinary tract symptoms: should symptomatic men be screened?
Authors: Brown C.T. , O'Flynn E. , Van Der Meulen J. , Newman S. , Mundy A.R. , Emberton M.
Published: March 2003

OBJECTIVE

To explore the concerns and worries in men with uncomplicated lower urinary tract symptoms (LUTS, but no evidence of prostate cancer) relating to their symptoms.

Patients and methods

There is no current prostate cancer screening programme in the UK. Evidence suggests that men with LUTS have the same risk of prostate cancer as aged‐matched asymptomatic men. However, most men with LUTS are ‘screened’ with a digital rectal examination (DRE) and prostate specific antigen (PSA) testing as part of routine assessment. Whether this screening offers any benefit to patients and whether national screening for prostate cancer and subsequent early treatment offer any long‐term survival or quality of life benefit is uncertain. Thus 30 men with uncomplicated LUTS were qualitatively interviewed to explore their concerns and worries about their symptoms. Interviews were transcribed verbatim and subjected to content analysis using validated techniques.

RESULTS

Of the 30 men, 22 (73%) expressed a fear of prostate cancer at the time of their initial presentation. This fear was independent of race, social class and symptom severity; older men were less worried. Of the 22, 15 (68%) stated that after reassurance their symptoms were less bothersome and easier to cope with.

CONCLUSIONS

These findings suggest there is a considerable gain in health by explicitly addressing the concerns of prostate cancer in men with uncomplicated LUTS. Informing these men of their true risk of prostate cancer (before or after a DRE and PSA estimate) may alleviate much of the bother associated with their symptoms. Despite no evidence of any greater risk of prostate cancer than in asymptomatic men, symptomatic men should continue to be screened after appropriate counselling.
The role of antiandrogen monotherapy in the treatment of prostate cancer
Authors: Anderson J.
Published: March 2003

The mainstay of hormonal therapy in prostate cancer has been medical or surgical castration, both of which are associated with loss of libido and impotence, and may not always be acceptable to the patient. Antiandrogen monotherapy is an alternative treatment option to castration. There are two types of antiandrogen, i.e. steroidal (cyproterone acetate, CPA), and nonsteroidal (bicalutamide, flutamide and nilutamide). Data comparing survival outcome with CPA and castration are limited and conflicting. Furthermore, CPA is associated with loss of libido and erectile dysfunction. Large phase III trials have established that monotherapy with bicalutamide 150 mg once daily provides a survival outcome that is not significantly different to that after castration in men with locally advanced, non‐metastatic disease, while conferring significant advantages for sexual interest and physical capacity. Current data are inadequate to draw conclusions on the comparative efficacy of flutamide and castration, while nilutamide is not licensed for monotherapy. Recent data reveal that bicalutamide 150 mg given once daily in addition to standard care (radical prostatectomy, radiotherapy or ‘watchful waiting’) significantly delays the progression of early (localized or locally advanced) prostate cancer. Bicalutamide has a more favourable side‐effect profile than the other antiandrogens and is more likely to promote compliance.
Time‐action profile of the soluble, fatty acid acylated, long‐acting insulin analogue NN304
Authors: Heinemann L. , Sinha K. , Weyer C. , Loftager M. , Hirschberger S. , Heise T.
Published: March 2003

Aims To compare the pharmacokinetic and pharmacodynamic properties of subcutaneously injected NN304, a novel long‐acting insulin analogue, to NPH‐insulin during euglycaemic glucose clamps in 11 healthy volunteers.

Methods On three study days NN304 was injected in three different doses (0.15, 0.3, 0.6 U/kg body weight), while NPH‐insulin (0.3 U/kg) was injected in identical dose on two other days.

Results Injection of NN304 resulted in a linear and proportional increase in total NN304 concentrations (AUC0–1440 min: 0.15 U/kg: 344 ± 43, 0.3 U/kg: 666 ± 82, 0.6 U/kg: 1295 ± 210 nmol/l; P < 0.001). Maximal concentrations (609 ± 140, 1046 ± 283, 2033 ± 460 pmol/l; P < 0.001) were reached after 4–6 h. The metabolic response (expressed as maximal glucose infusion rates (GIR)) induced by subcutaneous injection of NN304 did not show the pronounced peak seen with NPH‐insulin in an identical dose: GIRmax 3.2 ± 1.1 vs. 4.4 ± 1.8 mg/kg/min (P < 0.05 for 0.3 U/kg NN304 vs. NPH‐insulin; mean of both study days with NPH‐insulin, all others not significant). NN304 also showed a slower onset of action, as indicated by a significantly higher tmax (446 ± 162 vs. 359 ± 175 min) and lower AUC0–240 min (0.5 ± 0.3 vs. 0.8 ± 0.4 g/kg/240 min; P < 0.05, respectively). The three different doses of NN304 induced a significantly different glucose consumption in the first 720 min after injection (AUC0–720 min 1.1 ± 0.6, 1.9 ± 0.8, 1.7 ± 0.8 g/kg; P < 0.05 for 0.15 U/kg), but not over the whole study period (AUC0–1440 min 1.8 ± 1.1, 3.1 ± 1.3, 2.8 ± 1.4 g/kg).

Conclusions Injection of NN304 at different doses resulted in an increase in total NN304 concentration in a linear dose–response effect and a more even metabolic effect than NPH‐insulin. However, we found no clear dose–response in its metabolic effect.

Diabet. Med. 16, 332–338 (1999)
Novel surgical treatment and gastric pathology in diabetic gastroparesis
Authors: Ejskjaer N. T. , Bradley J. L. , Buxton‐Thomas M. S. , Edmonds M. E. , Howard E. R. , Purewal T. , Thomas P. K. , Watkins P. J.
Published: March 2003

Aims Observations are made on four Type 1 diabetic patients with the rare syndrome of intractable vomiting from confirmed gastroparesis, to determine whether radical surgery would alleviate their symptoms and subsequently to examine in detail the gastric histopathology.

Methods The surgical approach consisted of an ≈ 70% resection of the stomach, including the antrum and pylorus, with closure of the duodenum and restoration of gastrointestinal continuity with a 60‐cm Roux‐en‐Y jejunal loop. Four longstanding Type 1 diabetic patients were examined and treated as described. They were all women in the age range 27–41 years with grossly abnormal autonomic function tests in whom other causes for gastric paresis had been excluded.

Results Vomiting episodes leading to multiple hospital admissions (6–8) in the year preceeding surgery were eliminated in three of the four patients, while in the fourth initial success was followed by the need for dialysis for renal failure. Gastric histopathology showed evidence of smooth muscle degeneration and fibrosis, with eosinophilic inclusion bodies (M‐bodies) which appear to be unique to this condition. The findings suggest the presence of a gastromyopathy.

Conclusions Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure. Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.
Type 1 diabetes mellitus, coeliac disease, and lymphoma: a report of four cases
Authors: O’connor T. M. , Cronin C. C. , Loane J. F. , O’meara N. M. , Firth R. G. , Shanahan F. , O’halloran D. J.
Published: March 2003

Introduction Patients with Type 1 diabetes mellitus have a high prevalence of coeliac disease, symptoms of which are often mild, atypical, or absent. Untreated coeliac disease is associated with an increased risk of malignancy, particularly of lymphoma. We describe four patients with Type 1 diabetes mellitus and coeliac disease who developed lymphoma.

Case reports Two patients were male and two female. In three patients, coeliac disease and lymphoma were diagnosed simultaneously. Enteropathy‐associated T cell lymphoma occurred in two patients, Hodgkin’s disease in one, and B cell lymphoma in one. Response to treatment was in general poor, and three patients died soon after the diagnosis of lymphoma was made.

Conclusion As the relative risk of lymphoma is reduced by a gluten‐free diet, a high index of suspicion for coeliac disease should exist in all Type 1 diabetic patients with unexplained constitutional or gastro‐ intestinal symptoms.

Keywords coeliac disease, lymphoma, Type 1 diabetes mellitus
Ions, genes and insulin release: from basic science to clinical disease Based on the 1998 R. D. Lawrence Lecture
Authors: Dunne M. J.
Published: March 2003

In 1968, reports of the first microelectrode recordings of insulin‐secreting cells were published. Thirty years later it is now established that electrical responses of β‐cells play a critical role in stimulus‐secretion coupling. It is now also clear that defects in ion channel genes compromise the mechanisms which govern secretion and lead to the onset of disease. Here, the physiology of insulin release is reviewed in the context of ion channels, the ionic control of insulin release and the pathophysiology of hyperinsulinism of infancy.