bluuebunny/crossref_metadata_2025 huggingface dataset:
The Cost Effectiveness of Urethral Stents
Authors: WILLIAMS GORDON
Published: November 2008

Stents to relieve bladder outflow obstruction were first developed as an alternative to a long‐term indwelling urethral catheter (Fabian, 1980). With improved technology and methods of insertion the indications for the use of stents in the male urethra have increased.
Risk of Bacteraemia During Extracorporeal Shock Wave Lithotripsy
Authors: GASSER T.C. , FREI R.
Published: November 2008

Summary Extracorporeal shock wave lithotripsy (ESWL) is widely used to treat urinary calculi. With increasing numbers of ESWL, more patients prone to infectious complications will be treated. However, little is known about the infectious risks of ESWL. To provide a basis for the rational use of antimicrobial prophylaxis, we studied the incidence of bacteraemia during ESWL. A total of 23 patients with urinary calculi were treated. Blood cultures (4–7 per patient) were taken before, during and immediately after ESWL, adding up to a total of 154 cultures. In 22 of these patients no bacteraemia was detected. In 1 patient small numbers of 2 different micro‐organisms were found in 2 blood samples only. This finding, and the circumstances of blood collection, suggested contamination rather than bacteraemia. It was concluded that the risk of bacteraemia during ESWL is very low.
Periurethral Teflon for Stress Urinary Incontinence: Medium‐term Results
Authors: HARRISON S. C. W. , BROWN CHRISTINE , O'BOYLE P. J.
Published: November 2008

Summary Medium‐term results are presented for the periurethral injection of Teflon in the treatment of stress urinary incontinence. Follow‐up data were obtained on 36 women by means of case note review and the completion of a postal questionnaire. Mean follow‐up was 5.1 years. Subjective results showed 12 patients to be dry or much improved while the remaining 24 patients did not obtain significant benefit from the procedure. Repeat injections in 12 women resulted in only 3 obtaining useful improvement, while a subgroup of patients who had undergone previous procedures showed a better response. No significant complications were observed. Periurethral Teflon injection is a minor surgical procedure which can produce worthwhile improvement, although an initially good result may not be sustained with longer follow‐up. This method may be advocated as treatment for poor risk patients who are unsuitable for surgery, particularly when previous attempts at formal surgical correction have been unsuccessful.
Why do Most Primary Bladder Neoplasms First Appear Around the Ureteric Orifices?
Authors: STEWART L. H. , O'NEILL K. L. , McKELVEY V. J. , GILLESPIE E. S. , JOHNSTON S. R. , BIGGART J. D. , McKENNA P. G.
Published: November 2008

Summary The majority of primary bladder neoplasms are known to arise within the mucosa around the ureteric orifices and bladder base. This may be due to the mucosa in this area being more susceptible to carcinogens than other areas of the bladder. Deficiency in the nucleotide salvage pathway enzyme thymidine kinase (TK), and especially its TK 1 isozyme, has been shown to predispose cell lines to increased mutagenesis. Total TK and TK 1 activities were measured in mucosal samples taken adjacent to the ureteric orifices and dome in 32 normal bladders and both total TK and TK 1 were shown to be significantly decreased in the mucosa adjacent to the ureteric orifices.

This may explain why primary bladder neoplasms occur more commonly in this site.
Urinary Continence Following Radical Retropubic Prostatectomy
Authors: RAMON J. , LEANDRI P. , ROSSIGNOL G. , GAUTIER J.R.
Published: November 2008

Summary Between 1983 and 1989,484 men (46–82 years old) underwent radical retropubic prostatectomy for prostate cancer. Six months after surgery, 434 patients (90%) achieved complete urinary control; stress incontinence was present in 50 patients (10%) and no patient was totally incontinent. Of the 398 patients who were followed up for more than 1 year, 377 (95%) achieved complete urinary control and 21 (5%) experienced stress incontinence.

Prior open prostatectomy or transurethral resection of the prostate had no influence on the return of urinary control. Pathological stage and preservation or not of the neurovascular bundles also had no significant influence on the long‐term state of continence. Age was the only factor that adversely affected the return of urinary continence. The average interval between surgery and return of continence was shorter in patients less than 70 years old. When the impact of age was examined 1 year or more after surgery, no significant difference was noted between the age groups.

Several technical considerations that contribute to these results are discussed, especially the use of a gradual approach to the apex of the prostate to facilitate exposure and haemostasis and to preserve as much of the striated urethral sphincter as possible.
Abstracts of the Proceedings of the Urological Society of Australasia, 45th Annual Scientific Meeting, Adelaide, Australia, 1992
Authors: Marshall V. R. , Sutherland P. D'A. , Millard R.J.
Published: November 2008

The 45th Annual Scientific Meeting of the Urological Society of Australasia was held between 29 March and 2 April 1992 at the Adelaide Convention Centre, South Australia. The meeting was organised by Professor Villis Marshall, President of the Society, and a committee of local urologists. Invited guests included the R.A.C.S. Foundation Visitor Professor E. Tanagho from San Francisco, together with Professor Donald Coffey from Baltimore, Professor Urs Studer from Berne and Professor John Blandy from London.

The Harry Harris Memorial Oration was given by Professor Donald Coffey on the subject “Science, creativity and human destiny”. The Keith Kirkland Prize was won by R. Thomas for his presentation on “Oral N‐acetyl cysteine in urinary tract mucolysis”. The Alban Gee prize for the best poster was won by P. K. Grover for his poster on the promotion of calcium oxalate crystallisation by urate: epitaxy is not its cause.

Each of the invited guests gave keynote presentations on his work. The meeting again encompassed sections on C.M.E. and the entire membership agreed to undertake a multiple choice “Practice profile” examination during the meeting. This will be repeated after 2–3 years to assess whether a selection of C.M.E. measures can alter “practice profiles” and the urological knowledgebase of members.

The 46th Annual Scientific Meeting of the Society will be held between 28 February and 5 March 1993 at the Sheraton Hotel, Hobart, Tasmania.
New Method for Discriminating between Calcium Stone Formers and Healthy Individuals
Authors: FUREDI‐MILHOFER H. , KISS K. , KAHANA F. , SARIG S.
Published: November 2008

Summary— A new method for discriminating between the urine of potential calcium stone formers and healthy persons has been proposed, based on determination of the calcium binding capacity of urine (CBC) by titration of early morning urine with a calcium chloride solution. For this purpose a new PVC matrix calcium ion selectrode for measuring calcium ion concentration in whole urine was used. The selectrode has a disposable membrane which can easily be prepared and replaced in the laboratory. Plots of the calcium ion concentration versus the concentration of total added calcium were linear up to a point where precipitation of calcium salts commenced. The slopes of these titration lines were used as criteria for discrimination. Statistical evaluation showed good separation between the urine of healthy and stone forming donors. A 2‐sample t test with unequal variances gave mean values of 0.31 for healthy urine (13 samples) and 0.64 for stone forming urine (26 samples). Individual 99% confidence intervals were 0.21‐0.40 for the controls and 0.54‐0.73 for the patients respectively. D iscriminant analysis showed that from a group of treated patients with low DI (13 samples), 3 were classified as stone formers and 10 were non‐formers. Thus there was good correlation with the clinical situation and with the previously proposed DI test.
Is Retrograde Ureterography Indicated in Pelviureteric Junction Obstruction?
Authors: CONNOLLY J. A. , GLEESON M. J. , GRAINGER R. , McDERMOTT T. E. D. , BUTLER M. R.
Published: November 2008

Summary— The role of retrograde ureterography in the management of pelviureteric junction (PUJ) obstruction remains controversial and it has recently been reiterated that visualisation of the entire ureter on the affected side is mandatory owing to the high incidence of other ureteric abnormalities. In a review of 119 consecutive adult pyeloplasties carried out over a 9‐year period, only 2 ureteric abnormalities were found in association with PUJ obstruction (duplex ureter/3‐cm proximal stricture). Other anatomical abnormalities included aberrant vessels, fascial bands and renal anomalies. Most secondary abnormalities were undiagnosed prior to surgery and all were easily dealt with per‐operatively.
Metabolic Complications of the Urinary Intestinal Diversion: lleo‐caecal Bladder Compared with Ileal Conduit
Authors: OLIVO G. , BIASIOLI S. , BONCIARELLI M. , NOTO L.
Published: November 2008

Summary— Five patients with an ileal conduit and 5 with an ileo‐caecal bladder substitute have been studied metabolically. All had undergone cystectomy for infiltrating carcinoma and they formed 2 homogeneous groups in terms of age and follow‐up.

Function in both groups was within normal limits but closer examination of patients with an ileo‐caecal bladder revealed mild functional damage as shown by reduced creatinine secretion, a lower level of bicarbonate and lower urinary acid valency secretion.

It was concluded that the ileal conduit is more satisfactory from a metabolic point of view than the ileo‐caecal bladder, which requires closer follow‐up and treatment with bicarbonates if necessary.
Mitomycin‐C in Superficial Bladder Cancer. Is Long‐term Maintenance Therapy Worthwhile After Initial Treatment?
Authors: HAMDY F. C. , HASTIE K. J. , KERRY R. , WILLIAMS J. L.
Published: November 2008

Summary— A total of 72 patients with recurrent superficial transitional cell carcinoma of the bladder (TCC) were treated with 40 mg intravesical instillations of mitomycin‐C (MMC) weekly for 10 weeks, followed by monthly maintenance doses. With a mean follow‐up period of 41 months, 30 patients (42%) had a complete and sustained response after the initial treatment course, and a further 14 (19%) achieved a complete response on maintenance therapy. Sixteen patients (22%) continued to have recurrent tumours and the remaining 12(17%) developed recurrent tumours after an initial complete response. Of these, 4 patients with carcinoma in situ (CIS) showed symptomatic improvement, but the histological changes persisted and all of those with tumours > 2 cm in size did not respond. We conclude that maintenance treatment with MMC is beneficial in superficial bladder cancer but is of limited value in the presence of bulky tumours or CIS.
PAEDIATRIC UROLOGY: The Failed Exstrophy Closure: Strategy for Management
Authors: GEARHART J. P. , PEPPAS D. S. , JEFFS R. D.
Published: November 2008

Summary— In the last 7 years, 29 boys and 11 girls have been referred with failure of their exstrophy closure; 38 patients had classic bladder exstrophy and 2 had cloacal exstrophy. Reclosure was performed for complete bladder dehiscence in 28 cases and for significant bladder prolapse in 10. Two patients underwent revision of the posterior urethra after primary closure due to a severe urethral stricture secondary to the use of para‐exstrophy skin flaps. Six patients underwent posterior iliac osteotomy at the time of initial bladder closure and in 34 no osteotomy was performed. Thirty‐seven patients underwent either posterior iliac osteotomy (15) or anterior innominate osteotomy (22). Epispadias repair together with reclosure of bladder exstrophy was done in 20 boys.

The upper tract has remained normal in all patients. Fourteen have undergone subsequent bladder neck reconstruction. Seven patients have undergone simultaneous bladder neck reconstruction and augmentation cystoplasty and 1 has undergone augmentation cystoplasty and Mitrofanoff procedure; all are dry on intermittent self‐catheterisation.

The failed exstrophy reconstruction represents a formidable dilemma. However, a well planned reconstruction including osteotomy (even if previously performed), reclosure with or without epispadias repair or revision of the urethra can be performed with an excellent chance of proceeding with staged reconstruction.
GRAP Repair: Single‐stage Reconstruction of Hypospadias as an Out‐patient Procedure
Authors: GILPIN D. , CLEMENTS W. D. B. , BOSTON V. E.
Published: November 2008

Summary— A novel repair of the distal urethra with glanular and preputial reconstruction is described for distal penile hypospadias; 52 consecutive patients underwent this procedure without catheter splintage or urinary diversion. All voided without problems on the day of operation; 44 (85%) were treated as day cases, while the remaining 8 boys stayed in hospital for at least 1 night post‐operatively for reasons not associated with the operation. Follow‐up was complete and ranged from 15 to 30 months (mean 18). There was no evidence of meatal stenosis, phimosis or urethral stricture; 26 boys (50%) had associated chordee pre‐operatively which was incompletely corrected in 2 (8%). These have a minor degree of chordee of glans on penile shaft and neither has required further treatment. Four boys (8%) developed partial wound breakdown which necessitated reconstruction in 2 and both of these have now been treated successfully. Functional and cosmetic results are excellent.
Endometrioid Carcinoma of the Prostate. The Diagnostic Value of Leu7 and Prostatic Specific Antigen
Authors: STAVROPOULOS N. E. , IOACKIM‐VELOGIANNI E. , SIDONI K. , STEFANOU D. , KLOUVAS G. , PAVLIDIS N.
Published: November 2008

Summary— In a case of endometrioid carcinoma of the prostate the expression of Leu7 and prostatic specific antigen (PSA) was studied immunohistochemically on paraffin sections. The same markers were studied in 14 cases of prostatic cancer and 14 cases of uterine endometrial carcinoma. Endometrioid carcinoma of the prostate was negative for Leu7 and PSA, while all prostatic cancer specimens were positive for the above markers. All uterine endometrial carcinomas were negative for PSA and only a small percentage of cells in 4 specimens were positive for Leu7. The absence of Leu7 and PSA in this case of endometrioid carcinoma strongly suggests a müllerian origin.
Primary Retroperitoneal Lymph Node Dissection in Clinical Stage A Non‐seminomatous Germ Cell Testis Cancer Review of the Indiana University Experience 1965–1989
Authors: DONOHUE J. P. , THORNHILL J. A. , FOSTER R. S. , ROWLAND R. G. , BIHRLE R.
Published: November 2008

Summary— The results of primary retroperitoneal lymph node dissection (RPLND) in 464 patients with clinical stage A non‐seminomatous germ cell (NSGC) testis cancer treated over 25 years (1965–1989) were reviewed. The results were analysed in clinical terms and subdivided into early (1965–1978) and contemporary (1979–1989) groups in order to be comparable with series using radiotherapy or surveillance. Between 1965 and 1978 (86 clinical stage A patients) the overall relapse rate of 15% (n = 13) was similar to that of radiotherapy series but survival (97.7% after RPLND) was superior to that achieved with irradiation (87%). From 1979 to 1989, 378 clinical stage A patients had primary RPLND and 30% of them (n = 112) had cancerous nodes. The relapse rate for pathological stage A (n = 266) was 12% and 2 patients died. The relapse rate in pathological stage B patients without adjuvant chemotherapy was 34%. No relapse was seen among 48 pathological stage B patients who received post‐operative adjuvant chemotherapy. The death rate was 0.8% among 378 clinical stage A RPLND patients.

While not statistically significantly different from death rates reported in current surveillance series, these consistent results spanning 2 eras (before and after cisplatin) over 25 years suggest a sound basis for the surgical approach. The anatomical and medical principles in oncology, which have supported this approach, still remain cogent today. Now that nerve‐sparing techniques have been developed, the only long‐term morbidity of RPLND (anejaculation) has been avoided. It would seem appropriate to include nerve‐sparing RPLND techniques in the management of clinical stage A disease.
Female Genito‐urethroplasty and Submucosal Periurethral Collagen Injection as Adjunctive Procedures for Continence in the Exstrophy‐epispadias Complex Preliminary Results
Authors: CAIONE P. , CAPOZZA NICOLA , LAIS A. , CRETI G. , DE GENNARO M.
Published: November 2008

Summary— Continence is the main goal in the treatment of patients with bladder exstrophy and prognosis is necessarily long‐term. Over an 8‐year period, 44 patients presented with bladder exstrophy and/or incontinent epispadias. Twenty‐five bladder closures (7 secondary), 23 male urethroplasties, 19 bladder neck (BN) reconstructions and 6 bladder augmentations were performed in these patients. In 18 children 2 additional procedures were employed in the last 3 years: female genito‐urethroplasty (15) and submucosal periurethral collagen injection (11). Eight children underwent both procedures.

Genito‐urethroplasty and collagen injection were performed before BN reconstruction in 6 and 5 cases respectively, in order to increase bladder outlet resistance. The submucosal injection was performed at 3, 9 and 12 o'clock in the BN or sphincteric urethra, using 0.75 to 2.5 ml of cross‐linked bovine collagen. Continence in the children who underwent the complete staged reconstruction was good in 58%, fair in 32% and poor in 11%. Following female genito‐urethroplasty and periurethral collagen injection, bladder capacities increased by 25%.

These complementary procedures are effective in increasing outlet resistance and bladder capacity in patients with exstrophy and/or epispadias; they may improve continence and lessen the need for further bladder augmentation.
The Mobile Lithotriptor: An Answer for the Smaller Centre
Authors: DICKINSON A. J. , CRANSTON D. , DOBLE A. , FAWCETT D. P. , FELLOWS G. J. , PENGELLY A. W. , C. SMITH J.
Published: November 2008

Summary— The mobile lithotriptor is a new method of providing extracorporeal shock wave lithotripsy (ESWL) directly to the smaller urological centres. The unit, containing a Dornier HM4 lithotriptor, has treated 135 patients with a total of 168 treatments in 2 centres in the Oxford region. The overall success rate was 87% with no serious morbidity or mortality. The results compare well with the results from larger centres and the system is cost‐effective. We suggest that it is one of the best methods of providing ESWL to the smaller urological centres.
Surgical versus Endoscopic Treatment of Non‐malignant Uretero‐ileal Anastomotic Strictures
Authors: VANDENBROUCKE F. , Van POPPEL H. , VANDEURSEN H. , OYEN R. , BAERT L.
Published: November 2008

Summary— The classical treatment of uretero‐ileal anastomotic strictures after Bricker ureteroileostomy is open surgical revision. Recent progress in endourology has provided a number of alternatives. The success rate of these endoscopic techniques is less than the success rate of the open surgical revision.
The Prostakath Stent: Four Years' Experience
Authors: THOMAS P. J. , BRITTON J. P. , HARRISON N. W.
Published: November 2008

Summary— The Prostakath stent is recommended as an option in the treatment of acute urinary retention in the patient at high risk from a transurethral resection of the prostate. In 57 of 64 patients with acute retention, voiding was re‐established. A stent‐related problem developed in 16 patients and further treatment was usually required. Patients with satisfactorily functioning stents have been followed up for 12.0 ± 9.9 months. The most frequent complication was displacement of the stent. Infection and stone formation were uncommon. Our results do not support the use of the Prostakath in patients with symptoms of outflow obstruction or chronic retention.
Ultrasonically Determined Patterns of Enlargement in Benign Prostatic Hyperplasia
Authors: COLLINS G. N. , LEE R. J. , RUSSELL E. BARBARA , RAAB G. M. , HEHIR M.
Published: November 2008

Summary— A series of 430 men aged 40 to 79 years underwent transrectal ultrasonography (TRUS) as part of a community survey of benign prostatic hyperplasia (BPH). We describe a reproducible method of prostate volume estimation and discuss the implications of prostate dimension changes in BPH.

The mean prostate and adenoma volumes for the group were 32 ml (SD 14) and 15 ml (SD 11) respectively. The antero‐posterior dimension of the prostate (APD) had the strongest correlation with gland volume compared with the transverse dimension (TD) and length (L). The mean ratio of adenoma volume to prostate volume was 0.45 (SD 0.13) and this increased with increasing gland volume. There was a modest correlation between the ratio and prostate volume.

BPH is characterised by a proportionally greater increase in the APD compared with L and TD and by an increasing adenoma/prostate ratio. TRUS is useful in assessing the type and extent of adenoma and prostate enlargement in BPH.
Transrectal Ultrasound Examination of the Prostate: Complications and Acceptance by Patients
Authors: AUS G. , HERMANSSON C. G. , HUGOSSON J. , PEDERSEN K. V.
Published: November 2008

Summary— Transrectal ultrasound scan (TRUS) of the prostate was performed on 511 patients, 391 of whom also underwent between 1 and 5 transrectal 1.2 mm core biopsies. The infection rate in the whole group was 4.1%; 32% of the patients were given antibiotic prophylaxis with norfloxacin 400 mg twice daily for 1 week and in this group the infection rate was 0.8%. In the remaining patients, who received 400 mg norfloxacin at the time of biopsy and another 400 mg the same evening, the infection rate was 5.6%. The only risk factor identified for post–biopsy infection was steroid medication.

Only minor discomfort (or none at all) was reported by 95% of patients during the examination procedure. If TRUS was combined with core biopsy 92% reported either minor or no discomfort. Of 78 patients who experienced both finger‐guided fine needle aspiration biopsy and TRUS‐guided core biopsy 82% preferred the latter procedure.

TRUS and core biopsy proved acceptable to most patients. Antibiotic treatment with 2 tablets of norfloxacin failed to prevent infection.
Fetal Ureteric Reflux: A Follow–up Study
Authors: SCOTT J. E. S.
Published: November 2008

Summary— The findings in 21 children (17 males) with ureteric reflux diagnosed in the first 3 months of life and likely to have been present antenatally are described; 19 were followed up for between 2 and 8 years. Reflux was grade 3 and bilateral in 13 babies. Radioisotope studies showed evidence of renal parenchymal abnormalities in 45% of non–infected refluxing kidneys. Non‐operative treatment was adopted initially. The reflux disappeared completely in 6 children: evidence that it would do so was apparent within 2 years. Two children developed pelviureteric junction obstruction that was secondary to the dilatation accompanying the reflux. Anti‐reflux surgery was performed in 10 children because the degree of reflux and upper urinary tract dilatation were increasing. Operative treatment for fetal ureteric reflux of advanced grades should be considered if there is no improvement after 2 years; gigantic reflux may otherwise ensue.
Laser Lithotripsy with the Candela MDL‐2000 Laser Tripter
Authors: MacDERMOTT J. P. , GROVE J. , CLARK P. B.
Published: November 2008

Summary— The Yorkshire Lithotriptor Centre acquired a Candela MDL‐2000 Laser Tripter and a 7.2F Miniscope in February 1990. We present the results obtained in the first 200 patients referred for treatment of ureteric stones or stone fragments.

Of 175 patients who were evaluable, 58 had upper ureteric stones, 41 mid‐ureteric and 76 lower ureteric stones. Successful laser fragmentation was achieved in 77% of cases and a further 10% were rendered stone‐free by the push‐bang technique. Ureterolithotomy was required in 9% and the major complication rate was 4%. Ureteric dilatation was not used. Maximum laser energy was required to break 19% of the stones, but no stone was encountered which could not be broken.

Laser lithotripsy with this system is highly effective at all levels of the ureter; it is safe and it complements ultrasound‐guided extracorporeal lithotripsy.
Increased Fractional Excretion of Sulphate in Stone Formers
Authors: PUCHE R. C. , VACCARO D. , SANCHEZ A. , GONZALEZ A. , SARANO H. D.
Published: November 2008

Summary— This study was performed to determine urinary sulphate excretion in patients with renal stone disease. Stone formers showed a significantly higher fractional excretion of sulphate than control subjects; 80% of stone formers had fractional excretions > 0.26. No significant relationship was established between increased urinary sulphate excretion and any identifiable metabolic disorder, or the recurrence rate of stone episodes.

The increase in fractional excretion of sulphate appears to be a more prevalent tubular defect among stone formers than has hitherto been reported.
The Role of the Radionuclide Renal Study in the Management of Renal Colic
Authors: GUTMAN M. , BRAF Z. , KAVER I. , SALTZMANN S. , BARON J. M.
Published: November 2008

Summary— If renal colic is suspected in the patient presenting with acute flank or lower abdominal pain it must be established whether or not the affected kidney is obstructed and whether there is functional impairment that may require urological intervention.

The radionuclide renal study developed in this hospital and used routinely for over 10 years can reveal obstruction when the results of commonly used tests are negative. It also provides information on renal function, morphology and blood flow. It is a cost‐effective, safe and reliable procedure for the initial investigation of patients presenting with suspected renal colic.
Experimental Model of Bladder Outflow Tract Obstruction in the Guinea‐pig
Authors: WILLIAMS J. H. , TURNER W. H. , SAINSBURY GILLIAN M. , BRADING ALISON F.
Published: November 2008

Summary— Bladder outflow tract obstruction was produced in immature female guinea‐pigs. Obstruction caused an increase in voiding pressure and bladder weight and a decrease in bladder compliance. No change occurred in the sensitivity of obstructed detrusor strips to exogenous agonists, but the force of contraction and response to electrical stimulation of the intrinsic nerves were less than in the strips from controls. The response of strips from sham‐operated animals to exogenous agonists and to electrical stimulation was greater than that from obstructed animals. The effects of length and tension could not account for the in vitro responses from obstructed animals. Histology after obstruction showed muscle hypertrophy, connective tissue infiltration and decrease in nerve density. Many of the changes resembled those seen in the obstructed human bladder.
LHRH Analogues as Primary Treatment for Urinary Retention in Patients with Prostatic Carcinoma
Authors: HAMPSON S. J. , DAVIES J. H. , CHAR1G C. R. , SHEARER R. J.
Published: November 2008

Summary— Thirty‐one patients with retention of urine and carcinoma of the prostate were treated with LHRH analogues as primary therapy rather than prostatectomy; 21 patients voided without the need for surgical intervention. Patients presenting in acute retention of urine voided more readily than those presenting in chronic retention, with only 20% requiring surgery. This approach to treatment is safe, efficacious and cost effective.
Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep
Authors: CORMIO L. , CROVACE A. , LACALANDRA G. , BELLO A. DI , SELVAGGI F. P.
Published: November 2008

Summary— There is general acceptance that the best substitute for a damaged distal ureter is an elongated bladder and that the bladder psoas hitch is the most reliable procedure. Nevertheless, it is not always sufficient to bridge a long ureteric gap.

In order to obtain an equally safe but wider bladder elongation than the psoas hitch can provide, we have previously studied the effect of several Z‐shaped incisions on isolated pig bladders. The aim of the present study was to verify, in vivo, the efficacy and safety of the new technique. Five sheep underwent the psoas hitch procedure and 6 the Z‐plasty procedure. The results showed that Z‐plasty provides an equally safe but longer bladder elongation than the psoas hitch procedure.
Retroperitoneal Malignancy Masquerading as Ureteric Colic
Authors: DUNNING J. J. , PENNY J. A. , COOKSEY G. , OSBORN D. E.
Published: November 2008

Summary— This study reviews 6 patients who were referred with severe loin pain radiating to the groin and in whom a presumptive diagnosis of ureteric colic was made. Of these, 3 patients were found to have carcinoma of the pancreas and the remaining 3 had retroperitoneal lymph node metastases. Retroperitoneal malignancies rarely present with loin pain, but this diagnosis should be considered in patients with long‐standing loin pain in whom an obvious diagnosis is not apparent.
Extracorporeal Shock Wave Lithotripsy for Vesical Lithiasis: Initial Experience
Authors: BHATIA V. , BIYANI C. S.
Published: November 2008

Summary— The classical treatment for vesical lithiasis consists of surgery or endoscopic transurethral disintegration. These procedures require anaesthesia and hospitalisation. We report our experience with the Siemens Lithostar in 18 male patients with bladder stones. Complete fragmentation was achieved after a single session in 14 patients and 4 required 2 sessions. A 3‐way Foley catheter with saline irrigation was used during treatment. Patients were treated in the prone position followed by immediate evacuation of stone fragments in 9 cases. Morbidity was minimal. Two patients developed impacted fragments and required stone retrieval.

Extracorporeal shock wave lithotripsy (ESWL) for vesical lithiasis appears to be a simple, well tolerated and effective form of treatment.
Continuous Flow Resectoscopes. Are the Theory and Design Wrong?
Authors: BRIGGS T. P. , PARKER C. , JONES A. , MILLER R. , SCHROTER R. C. , RICHARDSON S. M.
Published: November 2008

Summary— The optical design of rod‐lens telescopes has now reached a zenith. The only way of improving the resectoscope is to investigate the ergonomics and flow dynamics. We present a comparative analysis of the flow mechanics of continuous flow resectoscopes. The morphology, flow characteristics and irrigating potential (washout gradient) of several instruments were examined. It was found that when used with balanced continuous flow (inflow and outflow balanced), all of the endoscopes had poor visibility compared with unbalanced continuous flow (inflow > outflow). Possible changes in the design of the instruments are discussed.
Evaluation and Treatment of Incontinence after Bladder Neck Reconstruction in Exstrophy and Epispadias
Authors: HOLLOWELL JEAN G. , HILL P. D. , DUFFY P. G. , RANSLEY P. G.
Published: November 2008

Summary— Twenty‐five children with exstrophy/epispadias who had had at least one bladder neck operation (but no augmentation) for incontinence underwent cystometrography (CMG) and urethral pressure profile (UPP) studies. The purpose of this study was to examine all components of lower urinary tract function and to determine how the properties of the bladder and the properties of the bladder neck/urethra interacted to achieve continence or to result in incontinence in the individual child.

Examination of detrusor function during filling revealed involuntary contractions in 12 children and an end‐fill pressure >10cm H2O in 8. Of the 21 children in whom voiding could be evaluated only 6 could initiate a detrusor contraction. In the 18 incontinent children leak pressure could be measured and was 15 cm H2O in 12. Five of the 7 continent children also demonstrated at least one abnormality in lower tract function. The maximum pressure of the UPP did not agree with the leak pressure and may not be a valid measure of the closing pressure of the bladder neck/urethra in this patient population.

Detailed urodynamic investigation is necessary in these children to guide the next step of management and to evaluate objectively each form of treatment.
Varicocele‐A Clinical Enigma
Authors: HARGREAVE T. B.
Published: November 2008

“But when the disease has spread also over the testicle and its cord the testicle sinks a little lower, and becomes smaller than its fellow, in as much as its nutrition has become defective.” Amelius Cornelius Celsus (42BC‐37 AD)

“Varicocele is a compact pack of vessels quite filled with melancholic blood.” Ambroise Pare (1550)
Longitudinal Observations on Normal and Abnormal Voiding in Men Over the Age of 50 Years
Authors: JφRGENSEN J. BALSLEV , JENSEN K. M. ‐E. , MOGENSEN P.
Published: November 2008

A cohort of 200 men over the age of 50 years was selected at random. Initially 112 men participated. After 5 years 61 were participating, and 2 years later 34 men still had no voiding problems, while 19 had had treatment for prostatism. A history was obtained and all 112 had symptom analysis and uroflow examination. The uroflow variables Qmax, Qave, Qmax‐time, Q“corrected”, volume and the ratio Qmax/Qmax‐time were recorded together with the symptom score and subjective evaluation. After 5 and 7 years all primary data were reviewed in the 61 and 34 men respectively, while a full history was obtained in the rest. The 3 sets of data were evaluated separately as 3 cross‐sectional investigations and as paired data sets by means of non‐parametrical statistical analysis. Comparing the 3 sets of data longitudinally, significant differences were found in Qmax, Qave, Qcor and Ace. A correlation analysis showed that Qmax, Qave, Q“corrected” and volume decreases significantly with advancing age in asymptomatic men, while no correlation with age was found in the 19 treated men. On the basis of the 93 men, untreated for 7 years, nomograms of Qmax, Volume and Ace were constructed using 2.5, 25, 50, 75 and 97.5% percentiles in 5‐year groups. Likewise, a nomogram on symptom score was constructed on the basis of the 82 men, asymptomatic and untreated for 7 years.

In conclusion, uroflow in subjectively normal men over the age of 50 years shows increasing abnormality with advancing age. At the same time elderly men tolerate a considerable amount of symptoms of intravesical obstruction. The severity of symptoms increased with advancing age, but differently in persons likely and not likely to need operation.
Histopathological Changes in Kock Pouch
Authors: CHEN K. K. , HO D. M. , CHEN M. T. , CHANG L. S.
Published: November 2008

To investigate whether tumour recurrence or histological changes occur in the Kock pouch, periodic endoscopy with biopsy of the pouch was performed in 15 patients 6 to 66 months after radical cystectomy and urinary diversion for invasive bladder cancer. Endoscopy was undertaken 1 to 4 times in each patient (a total of 37 times in all patients). During endoscopy, random biopsies were taken from the pouch wall, and from the afferent and the efferent nipples. The histological changes were graded as: (1) villous atrophy (grade 0 to 3, 0: nearly normal; 1: shortening, villi/crypt of Lieberkuhn [length] between 1.5 and 4.0; 2: moderate flattening, villi/crypt < 1.5; and 3: almost complete disappearance of villi); (2) fibrosis; and (3) chronic inflammation (grade 0 to 3, based on the amount of fibrous tissue and inflammatory cell infiltration in the lamina propria, respectively). There was no dysplasia or malignant tumour in the Kock pouch in any of the 15 patients. The histology of the ileum changed in terms of villous atrophy, fibrosis and chronic inflammation in the lamina propria and thickening of the muscularis mucosa. The same grade of villous atrophy of the pouch wall, the afferent and the efferent nipples was only found in 3 patients. More fibrosis and less chronic inflammation in the lamina propria were found at the efferent nipple than at the afferent nipple or pouch wall in 8 patients and 5 patients, respectively. Thickening of the muscularis mucosa was found in 13 of 15 patients (86.7%).

In conclusion, there was no dysplasia or recurrent tumour in the Kock pouch in patients who were followed for up to 66 months. Various grades of histological changes of the ileum in terms of villous atrophy, fibrosis and chronic inflammation of the lamina propria, and thickening of the muscularis mucosa were found in the pouch wall, and in the afferent and efferent nipples. More fibrosis and less chronic inflammation were commonly observed at the efferent nipple than at the afferent nipple or pouch wall. The degree of histological changes varied even among patients followed over the same period after operation. The time to progression of villous atrophy also varied. The histological changes in some patients were dissimilar even at the same site of the Kock pouch.
Superficial Bladder Cancer: Timing of Check Cystoscopies in the First Year
Authors: MORRIS S. B. , SHEARER R. J. , GORDON E. M. , WOODHOUSE C. R. J.
Published: November 2008

We report a prospective study of 141 patients presenting for the first time with a small, solitary, non‐invasive, moderately or well differentiated transitional cell carcinoma of the bladder. The pattern of recurrence in the first year was assessed and recurrence rates calculated; 80% of patients without recurrence at 3 months remained clear in the first year. There was a highly significant reduction in recurrence rates for those free of recurrence at 3 months. It has been suggested that this group should have the second check cystoscopy at 1 year and yearly cystoscopies thereafter. Our findings support that proposal.
Does Flexible Cystoscopy miss more Tumours than Rod‐lens Examination?
Authors: WALKER L. , LISTON T. G. , LLOYD‐DAVIES R. W.
Published: November 2008

The first blind, prospective, randomised comparison of flexible cystoscopy with rod‐lens cystoscopy was carried out on 53 consecutive volunteers with bladder tumours or haematuria. Three patients' recurrences were missed on flexible cystoscopy and 3 others on rod‐lens examination. It was expected that the 9% rate of missed tumours would lessen with increased experience of flexible cystoscopy, as 2 of them occurred in the first 12 examinations and all of the lesions missed were < 5 mm in diameter. Rod‐lens cystoscopy, the accuracy of which appears to have been measured for the first time, was no more sensitive.
Quantitation of Potentially Undiagnosed Incidental Carcinoma of the Prostate in Patients Treated Non‐surgically for Benign Prostatic Hyperplasia
Authors: ANDERSON G. A. , LAWSON R. K. , GOTTLIEB M. S.
Published: November 2008

Prostatectomy is the standard treatment for benign prostatic hyperplasia (BPH) and non‐surgical treatment of prostatism would reduce the detection of Stage A prostate cancer. We wished to identify the number of potentially undiagnosed cancers resulting if non‐surgical therapy were used to treat a presenting complaint of BPH. We also sought to identify the age group which would most clearly benefit from treatment of Stage A prostate cancer. Our series of transurethral prostatectomy specimens showed 92/996 patients (9.2%) positive for incidental carcinoma; 26/92 patients (28%) received further treatment and 25 of the 26 patients had Stage A2 disease. After evaluating life‐tables and survival data on untreated A2 disease, the population aged 72 years had a relative benefit of treatment ratio > 1.0, i.e. had a greater likelihood of dying from prostate cancer than from natural causes; 17/616 (2.8%) of the population aged < 72 years had their A2 disease treated and would have potentially been denied early cancer treatment if non‐surgical management of BPH had been employed. The above figures assume 100% non‐surgical treatment of BPH and no screening for prostate cancer pre‐treatment. Stage A2 patients in this study demonstrated no significant difference in cause‐specific survival rates between treated and untreated study groups (both 0%) or between treated study patients and untreated historical patients. Treated A2 patients demonstrated a significantly lower 5‐year progression rate (0 vs 32%) relative to untreated patients reported in the literature, and a trend toward a significantly lower progression rate (0 vs 25%) relative to untreated study patients.
Analysis of Biopsy Findings and Implant Quality following Ultrasonically‐guided 125l Implantation for Localised Prostatic Carcinoma
Authors: VIJVERBERG P. L. M. , BLANK L. E. C. M. , DABHOIWALA N. F. , de REIJKE Th. M. , KOEDOODER C. , HART A. A. M. , KURTH K. H. , GONZALEZ D. GONZALEZ
Published: November 2008

Transperineal ultrasound‐guided 125I implantation was undertaken in 52 patients with localised prostate cancer. After implantation, ultrasound‐guided biopsies were taken from the previous malignant areas every 6 months in all patients. The percentage of negative biopsies increased from 22% at 6 months to 50% at 48 months. Implant quality was analysed in 37 patients. The difference between isodose levels encompassing the prostate and the aimed levels of 160 Gy was taken as a measure of implant quality. A good quality implant (< 10% underdosage) was found in 43% of patients, a moderate quality (10–25% underdosage) in 35%, and a poor quality implant (> 25% underdosage) in 22%. A statistically significant correlation was found between the quality of the implant and resulting negative biopsy at the original tumour site.

Determination of prostate specific antigen (PSA) was not possible from the beginning of the study but an analysis with biopsy findings, implant quality and prostate volume reduction during follow‐up has been performed since 1989.

A significant correlation was observed between implant quality and serum PSA, and also between volume reduction and serum PSA.
Deoxyribonucleic Acid Histogram of Testes in Primary Transsexualism
Authors: CHIU A. W. , CHEN M. ‐T. , CHIANG H. , WU L. ‐H. , FANG R. ‐H. , CHANG L. S.
Published: November 2008

The influence of oestrogen on spermatogenesis was evaluated by comparing its effect on the testes of primary male transsexuals and those who had undergone hormone therapy for prostatic carcinoma. Eight primary transsexuals were studied. They had been diagnosed on clinical and psychiatric evidence and had been on oestrogen therapy for several years since puberty. Histological sections of testicular tissue obtained at reassignment surgery from 8 phenotypic male transsexuals (aged 24–32 years) with an XY chromosome complement were studied by light microscopy. The formalin‐embedded specimens were analysed by flow cytometry for deoxyribonucleic acid (DNA) histograms. Both the histology and DNA histograms revealed a pattern of maturation arrest in 12 of 16 testes in which the diploid cell compartment occupied most of the spermatogenetic element, followed by tetraploid and monoploid cells. Two testes showed impaired spermatogenesis and 2 were normal. The DNA histograms and pathology were also evaluated in 20 testes after 3 to 8 years of hormone therapy in patients with advanced prostatic carcinoma (aged 60–78 years). No maturation arrest was found in these patients. Sixteen of them had a pattern of fibrosis and atrophy and 4 had impaired spermatogenesis. It was concluded that oestrogen influenced spermatogenesis and affected the maturation of spermatogonia mostly during puberty.
Chemical Analysis of Post‐lithotripsy Stone Fragments: a Critical Evaluation
Authors: DAS G. , HALLSON P. C. , KASIDAS G. P. , SAMUELL C. T. , VIRDI J. S. , WICKHAM J. E. A.
Published: November 2008

A scheme for the chemical microanalysis of renal stone fragments recovered from urine voided immediately after lithotripsy has been developed and evaluated. The analytical procedure includes assay of calcium, magnesium, phosphate, oxalate and urate and has been applied to 78 such urine samples. Problems relating to co‐existing crystalluria and blood and urine contaminants have been recognised and overcome. However, significant loss of all stone components due to fragment dissolution in urine prior to recovery was found to occur and was investigated. The distribution of stone components found in these analyses was similar to that seen in previous surveys of intact stones.
Extracorporeal Shock Wave Lithotripsy in Patients with Renal Malformations
Authors: THEISS M. , WIRTH M. P. , FROHMÜLLER H. G. W.
Published: November 2008

Summary Twenty‐four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth.

ESWL is a safe and successful non‐invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitoring.
Bacterial Factors in the Formation of Renal Scars. An Experimental Study on the Role of Escherichia coli P‐fimbriation and Hydrophobicity
Authors: ARNOLD A. J. , SUNDERLAND D. , RICKWOOD A. M. K. , HART C. A.
Published: November 2008

Summary A model capable of comparing the effects of bacterial virulence factors on renal scarring in vivo has been developed using the female piglet. By creating, at open surgery, unilateral vesicoureteric reflux (VUR) and quantifying scarring both by uptake of an isotope bound to functioning renal parenchyma and by planimetry of the surface area scarred, the effects of 2 organisms, a P‐fimbriate Escherichia coli and an E. coli K 1 have been compared. The P‐fimbriate E. coli was shown to express P‐fimbriae in freshly voided urine, was more hydrophobic and produced smaller scars. This indicates that neither the hydrophobicity nor P‐fimbriation of the organism causing urinary tract infection (UTI) is of prime importance for the development of renal scars and is evidence against the “big bang” theory for the development of renal scars.

Studies on the association of UTI with VUR showed that infection with both E. coli under study led to VUR on the side contralateral to the side undergoing surgery. It seems likely that a nonspecific effect of UTI, such as bladder oedema, is responsible for this acquired VUR.

An effect of the 2 bacteria under study on the lower urinary tract was observed in that infection with the P‐fimbriate E. coli allowed the retention of an intravesical wax plug, whereas infection with E. coli K1 did not. Epidemiological data have shown that the majority of upper urinary tract infections in children are associated with UTI by P‐fimbriate organisms. Such an association may be explained in part by an effect of P‐fimbriate bacteria on lower urinary tract function rather than an effect on the upper urinary tract.