bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Realignment of Posterior Urethral Ruptures in Children
Authors: GÜNDOĜDU H. , TANYEL F. C. , BÜYÜKPAMUKÇU N. , HIÇSÖNMEZ A.
Published: November 2008

Summary— Primary realignment was used in the treatment of 12 children with complete rupture of the posterior urethra; 10 developed strictures but 7 of these responded to dilatation. Problems of continence were encountered only in patients who developed strictures. Since primary realignment results in dilatable strictures in most patients, it is suggested that this should be the treatment of choice in children.
The Changing Practice of Percutaneous Stone Surgery. Review of 1000 Cases 1981–1988
Authors: JONES D. J. , RUSSELL G. L. , KELLETT M. J. , WICKHAM J. E. A.
Published: November 2008

Summary— A review was carried out on 1000 cases of percutaneous nephrolithotomy (PCNL), Group 1 (500), 1981–1985, being compared with Group 2 (500), 1985–1988. Previous renal surgery had been performed in 17.4% of patients in Group 1 and 36% in Group 2. There were 17.2% complicated patients in Group 1 and 51% in Group 2. The stone burden included 30.2% multiple, partial staghorn and staghorn calculi in Group 1 and 47.2% in Group 2. The use of in situ stone disintegration increased from 22.2% in Group 1 to 73.4% in Group 2 and nephrostomy drainage was necessary in 29.6% compared with 75%. Post‐operative complications increased from 13.6 to 24%. Stone‐free rates decreased from 92 to 51%, but the addition of other methods of treatment and the inclusion of patients with stone fragments of 2 mm or less increased these figures to 98% in Group 1 and 83% in Group 2.

More complicated patients with complex stones are now being referred for PCNL. These patients require multiple treatments, including extracorporeal shock wave lithotripsy (ESWL) and percutaneous surgery, in combination with other endoscopic and radiological procedures.
Voiding Dysfunction due to Neurosyphilis
Authors: GARBER S. J. , CHRISTMAS T. J. , RICKARDS D.
Published: November 2008

Summary— Three patients with neurosyphilis presenting with urinary frequency, incontinence and voiding dysfunction were investigated. Unlike the previously reported finding of areflexia in tabes dorsalis, all 3 had hypocompliant detrusor hyper‐reflexia with detrusor‐sphincter dyssynergia and post‐micturition residual urine. One patient also had bladder neck dyssynergia treated by bladder neck incision. The other 2 patients were initially managed by intermittent catheterisation but 1 ultimately underwent urinary diversion. The clinical relevance of these findings and the treatment of this condition are discussed.
Acceleration of Flow Rate In Obstructive Detrusor Instability
Authors: CUCCHI A.
Published: November 2008

Summary— The acceleration of flow rate (ǎ) was calculated from spontaneous free flow uroflowmetry in 86 males with bladder outflow obstruction due to benign prostatic hypertrophy. Forty patients had stable bladders and 46 had detrusor instability. The parameter a was also determined in 30 controls.

All of the obstructed patients had lower values of ǎ than the controls but patients with detrusor instability tended to show a higher acceleration of flow rate than those with stable bladders. In individual cases, however, parameter a was unreliable in distinguishing stable from unstable patients.
Clinical Study of Prognostic Factors of Superficial Bladder Cancer Treated with Intravesical Bacillus Calmette‐Guerin
Authors: SHINKA T. , HIRANO A. , UEKADO Y. , OHKAWA T.
Published: November 2008

Summary— Intravesical instillation of Tokyo 172 strain Bacillus Calmette‐Guérin (BCG) was performed in 96 patients with initial superficial bladder cancer (Ta andT1) after transurethral resection (TUR) of tumour as a prophylaxis against tumour recurrence. The recurrence rate of tumours was estimated by the person‐years method, comparing it with that of historical controls. There were statistically significant decreases in recurrent tumours following BCG therapy.

To clarify the efficacy of intravesical BCG therapy, the prognostic significance of several factors was evaluated in patients with bladder cancer treated with TUR and instillation of BCG. The prophylactic effects were statistically better for those with multiple tumours, grade 3 lesions or Ta lesions than for control patients. No correlation between purified protein derivative (PPD) responsiveness and favourable results could be observed.

Our results suggest that intravesical BCG instillation can alter the biological behaviour that affects the recurrence of superficial bladder cancer, especially for multiple, high grade or Ta tumours.
Fractionated Urinary Cytology in the Follow‐up of Bladder Cancer
Authors: HASTIE K. J. , AHMAD R. , MOISEY C. U.
Published: November 2008

Summary— Cytological examination of voided urine is an established investigation in urological practice. In a pilot study of 50 patients with histologically proven transitional cell carcinoma of the bladder, urine cytology was undertaken on samples from the initial, mid‐stream and terminal parts of the void. Analysis showed that although the cell density varied between the samples in some cases, no part of the void was consistently richer in benign or malignant cells and similar cell types were seen in every sample from any given patient. It was concluded that fractionated cytology did not improve the diagnostic accuracy of urinary cytology and that any sample of urine was suitable for cytological purposes.
Osmotic and Metabolic Sequelae of Volumetric Overload in Relation to the TU R Syndrome
Authors: GHANEM A. N. , WARD J. P.
Published: November 2008

Summary— In an attempt to understand the pathophysiology of the transurethral resection syndrome this prospective metabolic study was conducted on 100 consecutive patients undergoing transurethral resection of the prostate (TURP). The volume of glycine absorbed, intravenous fluid given and blood loss were calculated, and serum osmolality, sodium and glycine were measured before, during and after operation. The mean volume of glycine absorbed, fluid gain and blood loss were 0.6, 1.57 and 0.356 litres respectively. The mean weight of prostate resected was 30.8 g and resection time was 56.5 min. The mean serum osmolality dropped from 291 to 286 mOsm/l, sodium dropped from 138 to 132 mmol/l and glycine concentration increased from 293 to 3599 /imo/// post‐operatively.

Ten patients developed signs suggestive of the TURP syndrome. Multiple regression analysis showed that the most consistent statistically significant factors in relation to the syndrome were volumetric gain and hypo‐osmolality. The latter proved to be the only significant factor later postoperatively. The increase in serum glycine and drop in serum sodium concentrations were the best serological markers, reaching significance only after excluding volumetric gain and osmolality from the analysis.
Prostatic Cancer with Bone Metastases: Serum Alkaline Phosphatase (SAP) as a Predictor of Response and the Significance of the SAP “Flare”
Authors: MACKINTOSH J. , SIMES J. , RAGHAVAN D. , PEARSON B.
Published: November 2008

Summary— The predictive value of serum alkaline phosphatase (SAP) and of prostatic acid phosphatase (PAP) for response to treatment (NPCP criteria) was retrospectively assessed in patients with bone metastases from prostate cancer. Fifty‐one patients had SAP measured at the start of treatment and at 1 and 2 months. In 31 of these, corresponding PAP levels were also available at each time point. SAP/PAP profiles at 2 months were classified as “increased” (increment 15% or greater), “decreased” (reduction greater than 15%) or “stable”, compared with baseline levels. An additional category, SAP “flare”, was also identified (SAP increment greater than 15% at 1 month, with subsequent fall at 2 months).

There was a strong association between the SAP profile at 2 months and the response category, whereas the PAP profile at 2 months was more weakly associated. Using results from the 31 patients with both SAP and PAP profiles, the level of SAP was significantly better in predicting the category of response (SAP: sensitivity 94%, specificity 79%; PAP: sensitivity 53%, specificity 57%).

An SAP “flare” was associated with response in 8 of 12 patients. An increase in SAP at 1 month is therefore a poor guide to progressive disease and should not be used in isolation to discontinue treatment early.

The SAP profile is of value as an earlier predictor of response than X‐rays or bone scans and is more realiable than the PAP profile in monitoring patients with prostate cancer and bone metastases.
Morphostructural Patterns in Staghorn Renal Calculi seen under the Scanning Electron Microscope
Authors: NAVARRO A. , CAMPOS A. , CRESPO P. V. , ZULUAGA A. , RODRIGUEZ T. , AGUILAR J.
Published: November 2008

Summary A total of 43 surgically removed staghorn urinary calculi were examined under a scanning electron microscope; the findings, together with microanalytical data, were used to determine morphostructural patterns corresponding to different mineral compositions. The stones were classified into 3 groups: phosphatic, urate and cystine.
Ultrasonography versus Intravenous Urography In the Evaluation of Patients with Microscopic Haematuria
Authors: ASLAKSEN A. , GADEHOLT G. , GOTHLIN J. H.
Published: November 2008

Summary Urography and transabdominal ultrasonography of the urinary tract were compared in 193 patients with microhaematuria. Of 16 expansile lesions described at urography, 1 renal carcinoma was detected by both methods. Although the number of patients studied is too small for firm conclusions to be drawn, ultrasonography seems to offer advantages when compared with urography.
Bacteriological State of the Urine in Symptom‐free Adult Males
Authors: SUGARMAN I. D. , PEAD L. J. , PAYNE S. R. , MASKELL R. M.
Published: November 2008

Summary Mid‐stream urine specimens from 120 symptom‐free males aged between 15 and 60 years were examined for cells and bacteria. Only 3 specimens showed pyuria, all of which yielded fastidious organisms. No specimen yielded a pure growth of an aerobe. Fastidious organisms in pure or mixed growth were isolated from 26% of the specimens, none in a count < 108/l and the majority in counts < 107/l. It was concluded that pure growths of aerobes in any count in patients with symptoms are indicative of infection. Fastidious organisms should be sought in the urine of patients with symptoms or pyuria before more intensive and expensive investigations are pursued.
Morbidity Following Cystoscopy: Comparison of Flexible and Rigid Techniques
Authors: DENHOLM S. W. , CONN I. G. , NEWSAM J. E. , CHISHOLM G. D.
Published: November 2008

Summary Recent reports on the value of local anaesthetic flexible cystoscopy have emphasised excellent tolerance and preference for the technique over general anaesthetic rigid cystoscopy. However, no study has yet compared the post‐operative morbidity rates of these procedures.

Tolerance, preference and post‐operative symptoms in 100 patients undergoing local anaesthetic flexible cystoscopy were compared with those in 100 patients undergoing general anaesthetic rigid cystoscopy. On initial questioning, 89% of patients found flexible cystoscopy painless and 92% expressed a preference for the same procedure on a future occasion; 98 patients who underwent flexible cystoscopy and 87 who underwent rigid cystoscopy returned a questionnaire on symptoms 1 week after the procedure. The incidence of post‐operative symptoms was 33% following flexible cystoscopy and 76% following rigid cystoscopy. Patients in both groups who were undergoing check cystoscopy had a lower incidence of morbidity than those undergoing cystoscopy for other reasons.

results suggest that flexible cystoscopy was well tolerated and preferred by most patients. The morbidity associated with the procedure was also significantly less than that associated with rigid cystoscopy under general anaesthesia.
Prevalence of Urinary Symptoms in Men Aged over 60
Authors: BRITTON J. P. , DOWELL A. C. , WHELAN P.
Published: November 2008

Summary –The prevalence of urological symptoms in elderly males in the community is poorly documented. A series of 578 men, aged 60 to 85 years and registered with one inner city health centre, completed a self‐administered questionnaire which enquired about current urological symptoms. Many symptoms were common, including a lengthening of the time to pass urine (26%), a deterioration in urinary flow (30%), dribbling (26%), urgency (31%), increased day‐time frequency (32%) and nocturia (57%); 102 men (18%) gave 5 or more positive responses to the 13 questions relating to urological symptoms. In contrast, during a 2‐year period, only 17 men, aged 60 to 85 years, were referred to a urology department from the same health centre. The implications of these findings are discussed.
Treatment of Stage D2 Prostatic Cancer Refractory to or Relapsed following Castration plus Oestrogens
Authors: BEZWODA W. R.
Published: November 2008

Summary –A total of 59 patients with advanced prostate cancer relapsed from or refractory to castration plus oestrogen were treated in a randomised trial comparing 1000 to 1250 mg aminoglutethimide+ 40 mg hydrocortisone (AG + HC) with 500 mg medroxyprogesterone acetate + 40 mg hydrocortisone (MPA+ HC). A significantly higher objective response rate and better symptomatic control was noted in patients treated with AG + HC (31%) compared with those treated with MPA+ HC (3%). The median time to treatment failure was also significantly longer for patients treated with AG + HC. These findings suggest a role for AG in the treatment of advanced prostate cancer. While both second‐line hormone treatment regimens resulted in significant suppression of adrenal androgen secretion, the differences in response rate could not be explained by alterations in peripheral blood hormone levels. AG in high doses may have cellular effects which require further study.
Flexible Cystoscopy as an Adjunct to Extracorporeal Shockwave Lithotripsy
Authors: MARK S. D. , GRAY J. M. , WRIGHT W. L.
Published: November 2008

Summary— Ancillary procedures associated with extracorporeal Shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out‐patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.
Renal Carcinoma in a Solitary Kidney
Authors: GOHJI K. , KAMIDONO S. , YAMANAKA N.
Published: November 2008

Summary— We studied the clinical and pathological features of 26 patients with renal carcinoma of a solitary kidney, including 6 treated at this hospital. Four patients had a contracted kidney and 22 had previously undergone nephrectomy. Partial nephrectomy was performed in 16 patients, enucleation of the tumour in 5 and radical nephrectomy in 5 because of the size of the tumour. Ex vivo surgery was carried out in 4 patients. The duration of ischaemia ranged from 15 to 365 min but was longer in those who underwent ex vivo surgery (149 to 365 min). Of the 21 patients who underwent partial nephrectomy or enucleation, the serum creatinine level increased (>2.0 mg/dl) post‐operatively in 16 patients, of whom 9 required temporary haemodialysis. No recurrence has been noted in those who underwent partial nephrectomy, but 1 patient who underwent enucleation of the tumour developed a solitary pancreatic metastasis 2 years 6 months after surgery and was treated by a partial pancreatectomy. Kidney‐preserving surgical procedures are considered to improve the quality of life, but careful follow‐up is necessary.
Do Women with Idiopathic Sensory Urgency have Early Interstitial Cystitis?
Authors: FRAZER M. I. , HAYLEN B. T. , SISSONS M.
Published: November 2008

Summary— Interstitial cystitis is rarely considered as a cause of urinary symptoms in referrals to gynaecology clinics. Recent concepts in the diagnosis of this condition mean that it is emerging as a much more common entity, with both early and late forms of the disease being described. Mast cell density in the detrusor muscle has been reported to be useful as a disease marker to substantiate the diagnosis of interstitial cystitis where no classical diagnostic features exist. We assessed mast cell counts in bladder biopsies from 27 women with idiopathic sensory urgency and 10 control patients about to undergo a colposuspension procedure for pure genuine stress incontinence; 30% of the study group had a clear increase in the detrusor muscle mast cell population (detrusor mastocytosis). No control patient showed such an increase. Early interstitial cystitis should be considered as a possible cause of lower urinary tract symptoms in patients with apparently idiopathic sensory urgency.
Permanent External Striated Sphincter Stents in Patients with Spinal Injuries
Authors: SHAW P. J. R. , MILROY E. J. G. , TIMONEY A. G. , DIN A. EL , MITCHELL NAN
Published: November 2008

Summary— Nine patients with complete quadriplegia underwent external striated sphincter stenting with the Wallstent in place of an external striated sphincterotomy. Although suprapubic catheters were placed to provide an outlet should problems develop with the stent, they were successfully removed within 6 weeks in all but 1 patient. Complete bladder emptying with reduced voiding pressures was achieved, together with a significant reduction in the duration of hyper‐reflexic contractions. Epithelialisation of the stent was almost complete within 3 months and intermittent catheterisation or endoscopy (and resection) is possible through the stent. Although this is a preliminary report of this new technique, it is hoped that sphincter stenting will provide a rapid, safe and effective method of treating high pressure hyper‐reflexia and detrusor sphincter dyssynergia in quadriplegic patients.

Based on a Poster Demonstration at the 45th Annual Meeting of the British Association of Urological Surgeons inStHelier, June l989
Symptoms versus Flow Rates versus Urodynamics in the Selection of Patients for Prostatectomy
Authors: McLOUGHLIN J. , GILL K. P. , ABEL P. D. , WILLIAMS GORDON
Published: November 2008

Summary— Many prostatectomies are performed on the basis of symptoms alone; 39% of patients referred by their family doctors and 23% of patients who were on waiting lists for prostatectomy of other hospitals, but who had not undergone any urodynamic investigations, were found to be unobstructed on urodynamic criteria. A screening peak urinary flow rate of 12 ml/s or less was associated with urodynamic evidence of obstruction in 95% of cases; 35% of patients with symptoms of outflow obstruction and a flow rate > 12 ml/s were also found to be obstructed.

One year post‐operatively, 84% of patients who were selected for surgery on combined symptomatic and urodynamic criteria were pleased symptomatically with their result. The failure of detrusor instability to resolve following prostatectomy was associated with symptomatic failure of treatment. Residual obstruction was demonstrated in 5 patients who had undergone prostatectomy and were asymptomatic at this time.

This study illustrates that objective measures are necessary in the assessment of patients prior to prostatectomy in order to select only patients who are obstructed. The importance of a screening flow rate is emphasised. All patients who underwent surgery had cystometric evidence of obstruction but the symptomatic results of surgery were no better than the results in patients who had been assessed according to non‐urodynamic selection criteria. We have thus failed to identify a need for routine cystometry in the pre‐operative assessment of these patients. Cystometry does, however, have a role in assessing patients with pre‐operative flow rates > 12 ml/s and in those who remain symptomatic following prostatectomy.
Granulomatous Orchitis
Authors: AITCHISON M. , MUFTI G. R. , FARRELL J. , PATERSON P. J. , SCOTT R.
Published: November 2008

Summary— Granulomatous orchitis is a rare lesion of the testis which can clinically simulate malignancy. The clinical, radiological and pathological features of 15 patients are presented and discussed.
Sedoanalgesia in Urology: A Safe, Cost‐effective Alternative to General Anaesthesia
Authors: BIRCH B. R. P. , ANSON K. M. , MILLER R. A.
Published: November 2008

Summary— Sedoanalgesia is a technique developed to provide safe and satisfactory operating conditions for a wide range of patients independent of age and overall level of fitness (although its use in children remains to be established). It is suitable for both endoscopic and open procedures, day‐cases and in‐patients. When used in day‐case surgery it significantly improves overall efficiency.

It is recognised that day‐case surgery is an important and cost‐effective element in surgical care. With increasing restraints being imposed upon hospital finances, patient beds and staffing levels, any strategies designed to improve efficiency in this sphere of surgical activity are to be welcomed. That 93% of patients prefer sedoanalgesia to conventional general anaesthesia attests to its high degree of acceptability. The technique of sedoanalgesia, its applications and potential impact for urology are detailed.
Distribution of Bony Metastases in Prostatic Carcinoma
Authors: CUMMING J. , HACKING N. , FAIRHURST J. , ACKERY D. , JENKINS J. D.
Published: November 2008

Summary— Fifty‐five prostate cancer and 55 breast cancer patients with positive bone scintigrams were studied. The pattern of spread in the axial skeleton and pelvis showed differences between the 2 groups. This difference was not related primarily to bone volume at the site of metastasis. The difference in distribution of bony metastases between breast and prostate is explained by our knowledge of Batson's vertebral venous plexus.
Double‐blind, Placebo‐controlled, Cross‐over Study of Flavoxate in the Treatment of Idiopathic Detrusor Instability
Authors: CHAPPLE C. R. , PARKHOUSE H. , GARDENER C. , MILROY E. J. G.
Published: November 2008

Summary— Detrusor instability occurs in approximately 10% of the adult population, producing troublesome symptoms. The pharmacotherapy currently available is usually only partially effective and cannot be adequately evaluated except under “blind” conditions because of the significant component attributable to placebo effects. The results of the present study revealed no advantage resulting from treatment with flavoxate, as assessed both subjectively and objectively. We suggest that this therapy does not appear to be beneficial in the medical management of detrusor instability.
Surgical Approach to the Retrocrural Lymph Nodes
Authors: HOELTL W. , AHARINEJAD S.
Published: November 2008

Summary— Removal of retrocrural lymph nodes requires an approach other than the infradiaphragmatic retroperitoneal access generally used in the surgical management of testicular tumours. The transperitoneal route given access, at best, to the origin of the superior mesenteric artery, but advanced testicular tumours occasionally require retrocrural node dissection. We describe a useful surgical approach to these nodes and the underlying anatomy.
Treatment of Infants with Neurogenic Bladder Dysfunction using Anticholinergic Drugs and Intermittent Catheterisation
Authors: BASKIN L. S. , KOGAN B. A. , BENARD F.
Published: November 2008

Summary— The use of anticholinergic drugs in infants with neurogenic dysfunction has not been well documented. In this study, 35 neonates at risk of upper urinary tract damage from neurogenic dysfunction were treated from infancy with anticholinergics, in combination with clean intermittent catheterisation. None of the patients showed upper urinary tract deterioration with follow‐up ranging from 6 to 72 months, although 2 required vesicostomy–1 due to difficulty with catheterisation and 1 due to possible anticholinergic side effects. Only 2 (6%) have had clinical pyelonephritis. Twenty‐five (76%) are virtually dry between catheterisation. We conclude that anticholinergics are safe and effective, even in the neonatal period, when used in combination with clean intermittent catheterisation for the treatment of neonates with neurogenic bladder dysfunction.
Treatment with Desmopressin in Severe Nocturnal Enuresis in Childhood
Authors: JANKNEGT R. A. , SMANS A. J.
Published: November 2008

Summary— A series of 22 patients with severe nocturnal enuresis were treated with desmopressin in a randomised double‐blind cross‐over study. Treatment with 20 and 40 μg was highly effective compared with placebo. No difference in dry nights was found between the 2 dosages. Desmopressin proved to be a safe and effective treatment.
Night Studies for Primary Diurnal and Nocturnal Enuresis and Preliminary Results of the “Clam” Ileocystoplasty
Authors: McINERNEY P. D. , HARRIS S. A. B. , PRITCHARD A. , STEPHENSON T. P.
Published: November 2008

Summary— Modified conventional urodynamic apparatus was used to provide overnight monitoring of bladder and rectal pressure. A group of 26 patients with primary diurnal and nocturnal enuresis underwent both daytime rapid fill cystometry and overnight natural fill cystometry. The overnight study was effective in detecting detrusor instability in 10 patients deemed normal on rapid fill cystometry; 6 of these have now undergone clam ileocystoplasty and 5 are dry; 3 are awaiting this procedure. The clam remains very effective in the management of patients with resistant nocturnal and diurnal enuresis if careful selection is adopted. Overnight cystometry has proved to be an invaluable adjunct to the investigation of patients with primary diurnal and nocturnal enuresis previously felt to be urodynamically normal.
Can Histological Assessment Predict the Outcome in Interstitial Cystitis?
Authors: MACDERMOTT J. P. , CHARPIED G. C. , TESLUK H. , STONE A. R.
Published: November 2008

Summary— In a retrospective study we compared the outcome of 39 patients with interstitial cystitis to the histological findings at initial diagnostic bladder biopsy. The degree of inflammation and fibrosis and the mast cell counts were assessed on each biopsy. The prognostic relevance of the clinical features of age, duration of symptoms, frequency, nocturia, pain and bladder capacity was assessed.

The study showed no statistical correlation between the severity of histological findings at diagnosis and the eventual outcome of the disease. Over 50% of patients with severe histological abnormalities responded to conservative treatment. Although the majority of patients with mild pathological changes responded to conservative treatment, some did require surgical intervention.

The clinical features of pain, nocturia and bladder capacity showed significant differences between the 2 patient groups. However, the former 2 features are subject to many variables and the latter probably has too wide a range to be useful as a prognostic indicator.

Only the response of patients to conservative treatment will indicate those who are not being helped and who may eventually require surgical treatment.
Is Voided Urine Suitable for Flow Cytometric DNA Analysis?
Authors: MELLON K. , SHENTON B. K. , NEAL D. E.
Published: November 2008

Summary— Samples of bladder washings are frequently used to provide cellular material for flow cytometric DNA analysis. Since voided urine is a potential source of similar material, the aim of this study was to determine whether voided urine yields satisfactory specimens.

We compared the qualitative results of flow cytometric DNA analysis of the cells in 53 specimens of voided urine and 109 samples of bladder washings; 45% (24/53) of urine specimens gave satisfactory DNA histograms compared with 93% (101/109) of bladder washings. This difference was apparent regardless of whether the bladder contained a tumour.

It was concluded that bladder washings provide superior material for flow cytometric DNA analysis and that flow cytometric DNA analysis of freshly voided urine may have deficiencies which preclude its use in routine clinical practice.
Haemospermia: a Prospective Study
Authors: JONES D. J.
Published: November 2008

Summary— A prospective study of 74 men with haemospermia is presented. Most (76%) had experienced 1 or 2 episodes only and 9 (12%) were over 40 years old. Simple investigations led to a diagnosis in all 9 of these men and of those under 40, no pathology could be detected in 48%. A diagnosis was made in 32 of the remaining 34 men by simple investigations. In patients over 40 years of age with haemospermia, a potentially treatable cause will normally be found by routine investigation which should include cystoscopy. In younger men, non‐invasive investigation alone should identify any pathology. Invasive investigations should be reserved for those patients in whom the problem is prolonged, excessive or in association with other symptoms.
Orchiectomy versus Oestrogen in the Treatment of Advanced Prostatic Cancer
Authors: HAAPIAINEN R. , RANNIKKO S. , RUUTU M. , ALA‐OPAS M. , HANSSON E. , JUUSELA H. , PERMI J. , SAARIALHO M. , VIITANEN J. , ALFTHAN O.
Published: November 2008

Summary— The primary clinical efficacy of orchiectomy and the combination therapy of intramuscular polyoestradiol phosphate 80 mg monthly and oral ethinyl oestradiol 0.15 mg daily was evaluated by progression and cancer mortality rates in a series of 277 prostatic cancer patients representing part of the Finnprostate study. After a follow‐up of 5 years there was a significant difference between the groups in terms of progression rate and prostatic cancer deaths. The oestrogen combination was more effective in delaying progression of the disease. The overall mortality rate was similar in both groups. About one‐third of the patients were alive after 5 years.
Ureteroureterostomy and Pyeloureterostomy without Native Nephrectomy in Renal Transplantation
Authors: LORD ROZANNE H. H. , PEPERA T. , WILLIAMS GORDON
Published: November 2008

Summary— A series of 23 patients, receiving full immunosuppression following renal transplantation, underwent a uretero‐ or pyelo‐ureterostomy with ligation of the native ureter and no nephrectomy. In 5 patients this was carried out at the time of transplantation because of a short donor ureter and in 18 patients, at a median of 47 days after transplantation, following ureteric complications. With a median follow‐up of 22 months, no complications have been seen in relation to the native kidney.

Ureteroureterostomy was successful in all but 3 patients. A ureteroureterostomy without native nephrectomy is a safe and effective treatment for the management of ureteric complications following renal transplantation.
Lower Urinary Tract Reconstruction in Patients with Bladder Exstrophy after Failed Primary Treatment in Early Childhood
Authors: MUNDY A. R. , NURSE DIANE E. , PARRY J. R. W.
Published: November 2008

Summary— The results of neonatal surgery for bladder exstrophy are not very satisfactory. A significant percentage of patients present in later childhood or adolescence for correction of their residual deformities.

We have reconstructed 26 patients, correcting their entire urogenital and cosmetic deformity in a one‐stage procedure. The results show that one‐stage total reconstruction is possible and is preferable to serial correction of the various individual abnormalities. The principles of surgical reoperation in adolescence are the same as those now established for the primary correction in neonatal life.
Pneumoscrotuman Unusual Complication of Cardiopulmonary Resuscitation
Authors: MENZIES D. , NOBLE J. G. , DENT C. M. , COX P. J.
Published: November 2008

Scrotal inflation is a rare condition which may prompt urgent surgical opinion. We report a case which occurred following cardiopulmonary resuscitation (CPR).
Indoramin in the Treatment of Prostatic Bladder Outflow Obstruction
Authors: STOTT M. A. , ABRAMS P.
Published: November 2008

Summary— A series of 40 patients took part in a double‐blind, placebo‐controlled trial of indoramin in prostatic bladder outflow obstruction. Patients were assessed clinically and urodynamically before and after 4 weeks' treatment. Significant improvement was seen in nocturia, volume voided, flow rates and residual urine. The drug was well tolerated, although 7 patients on treatment and 7 on placebo noted side effects.

These results suggest that indoramin may be a useful agent in the symptomatic management of bladder outflow obstruction.
Comparison of LHRH Analogue (Zoladex) with Orchiectomy in Patients with Metastatic Prostatic Carcinoma
Authors: KAISARY A. V. , TYRRELL C. J. , PEELING W. B. , GRIFFITHS K.
Published: November 2008

Summary— Between November 1983 and February 1986,358 patients with previously untreated metastatic prostatic carcinoma entered a multicentre, randomised trial in the United Kingdom and the Republic of Ireland, in which the LHRH analogue Zoladex (ICI Pharmaceuticals PLC), administered subcutaneously every 28 days, was compared with orchiectomy. Both treatments were equally effective in lowering serum testosterone concentrations to within the surgically castrate range and this was accompanied by equivalent subjective and objective response rates and times to treatment failure. At a median follow‐up of 2 years there was no difference in overall survival, confirming that Zoladex is an effective medical alternative to orchiectomy in patients with metastatic disease.
Modern Paediatric Urology*
Authors: J. SCHOLTMEIJER R.
Published: November 2008

The scope of paediatric urology was defined in the 1960s and the basic knowledge of disorders to be treated was also established at that time. In the 1970s there was a considerable increase in our understanding of the physiological aspects of urinary tract malformations. In addition, the contributions that were made to paediatric urology by other disciplines in medicine and science were more and more appreciated. For instance, in the late 1960s all children with any disorder vaguely associated with the urinary tract underwent an intravenous urogram and voiding cystogram. An interested group of radiologists, however, effected a change in these concepts: they emphasised noninvasive and more precise functional studies involving far less radiation. Thus the understanding, diagnosis and management of various disorders of the urogenital tract have been tremendously improved by ultrasonography, renography and renal scan techniques, urodynamics, CT scan and magnetic resonance imaging (MRI).
Neo‐adjuvant (Pre‐emptive) Cisplatin Therapy in Invasive Transitional Cell Carcinoma of the Bladder
Authors: WALLACE D. M. A. , RAGHAVAN D. , KELLY K. A. , SANDEMAN T. F. , CONN I. G. , TERIANA N. , DUNN J. , BOULAS J. , LATIEF T.
Published: November 2008

Summary— Following 2 pilot studies which showed 57 and 61% response rates to intravenous cisplatin for transitional cell carcinoma of the bladder prior to definitive treatment, the West Midlands Urological Research Group (WMURG) and the Australian Bladder Cancer Study Group (ABCSG) independently began randomised trials to test the survival benefit of neo‐adjuvant intravenous cisplatin prior to radiotherapy in T2‐T4 M0 transitional cell carcinoma of the bladder.

Both trials failed to recruit their target numbers of 250 patients in the West Midlands and 320 in Australia. Since they had similar treatment protocols and eligibility criteria, they were combined in an overview analysis, achieving a total number of 255 patients.

Each treatment group was compared with its own control group and the differences were pooled to give an overall result. There was no difference in survival between treated and control patients. The odds ratio was 1.13 with the control groups faring marginally better than the chemotherapy groups. Even with 255 patients the 95% confidence interval of the odds ratio was wide (0.80–1.57). Although there is no clear evidence of a clinically worthwhile benefit from neo‐adjuvant cisplatin, this approach must be tested in a larger study using combination treatments with greater activity in metastatic disease.
Comparison of Transrectal Ultrasound and Magnetic Resonance Imaging in the Staging of Prostate Cancer
Authors: CHADWICK D. J. , COBBY M. , GODDARD P. , GINGELL J. C.
Published: November 2008

Summary— A group of 32 patients with a histological diagnosis of prostate cancer underwent transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) to stage the disease. TRUS was more sensitive in the detection of tumour and in the detection of direct extracapsular spread. MRI was more sensitive in the detection of tumour involvement of the seminal vesicles and bladder base. MRI allowed the detection of lymphadenopathy and bone metastases in the lumbosacral spine and pelvis. During MRI the short tau inversion recovery (STIR) sequence was found to be particularly useful for the detection of tumour spread. TRUS and MRI are complementary investigations and for the accurate staging of prostatic malignancy both investigations should be used.
Treatment of Organic Impotence
Authors: CUMMING J. , PRYOR J. P.
Published: November 2008

Summary— A review of 86 patients referred to a urological clinic with impotence showed that in 58% the causation was predominantly psychogenic. These patients were managed with psychosexual counselling. The various treatment options were discussed with those patients with organic impotence and 14 underwent the implantation of a penile prosthesis.

A review of 130 patients who received penile prostheses in the period 1983 to 1987 was carried out to compare the complications and results obtained with the various types of prosthesis. The overall satisfaction rate was 81%; dissatisfaction usually arose as a result of complications of surgery. These were highest in patients with diabetes and priapism. The complications were also related to the type of prosthesis used.
Seeding of Transitional Cell Carcinoma within the Vagina
Authors: RALPH D. J. , CHAPPLE C. R. , EVANS J. W. H.
Published: November 2008

Transitional cell carcinoma of the bladder is extremely common in urological practice. It is well recognised that intravesical seeding of tumour cells can lead to recurrent disease after local endoscopic resection (Soloway and Masters, 1980). It is surprising that more previous cases of local vaginal seeding of transitional cell carcinoma to the introital or vaginal mucosa have been reported.
Ureteric Obstruction by Ligature Treated by Endoscopic Diathermy
Authors: GIGABHOY S. , KIELY D.
Published: November 2008

The incidence of ureteric obstruction after hysterectomy is 2 to 3% (Symmonds, 1966). Open surgery has so far been the method of treatment of such obstruction.

A cold coaxial knife has recently been used to treat ureteric strictures, with better short‐term results than those achieved following other endoscopic procedures associated with dilatation (Selikowitz, 1990).

We present what we believe to be the first reported case where total occlusion of the ureter by ligature was successfully treated by endoscopic diathermy.
Anaesthesia‐free Extracorporeal Shock Wave Lithotripsy in Patients with Renal Calculi
Authors: VANDEURSEN H. , TJANDRAMAGA B. , VERBESSELT R. , SMET G. , BAERT L.
Published: November 2008

Summary Modern extracorporeal shock wave lithotripsy can be performed with combined ECG and respiratory triggered shock wave release. Disconnecting the ECG triggering increases the risk of ventricular arrhythmias, including potentially malignant ones. The aim of this study was to assess the relationship of any sympatho‐adrenal excitation as a possible explanation for the occurrence of cardiac arrhythmia.

Plasma catecholamine levels were assessed in 5 patients during and after 50 min of anaesthesia‐free extracorporeal shock wave lithotripsy for the treatment of calculi in the upper pole of the left kidney. Venous blood sampling showed no significant increase in catecholamines (epinephrine, norepinephrine and dopamine) during or after treatment. The heart rate and arterial blood pressure were measured simultaneously and showed no significant increase when shock waves were released during ECG triggering. However, when disconnecting the ECG‐triggering mode, the incidence of ventricular extrasystoles on Holter monitoring became more apparent during respiratory triggered shock wave release only, although there was no rise in plasma catecholamine levels.

These data suggest that cardiac arrhythmias are related to direct and accidental mechanical stimulation of the heart rather than to any sympatho‐adrenal discharge during shock wave release.
Do not Catheterise your Nephrectomies
Authors: WILLIAMS J. R. , STOTT M. A. , MOISEY C. U.
Published: November 2008

Summary A retrospective study of 100 consecutive nephrectomy patients showed a 20% catheterisation rate. Of the 11 carried out post‐operatively only 4 were for urinary retention. The post‐operative catheterisation rate for males was 7.1 % and for females 2%. The rate of postoperative retention was 4.4%, which is much lower than that reported from other units. This rate of post‐operative catheterisation for retention is so low that in spite of the very mild increase in complications compared with intra‐operative catheterisation, the practice of routine prophylactic catheterisation of nephrectomy patients is unnecessary and cannot be recommended.
The Effect of Cromakalim on the Normal and Hyperreflexic Human Detrusor Muscle
Authors: NURSE DIANE E. , RESTORICK J. M. , MUNDY A. R.
Published: November 2008

Summary Cromakalim is a benzopyran derivative which relaxes smooth muscle, probably by opening membrane potassium channels.

This study tested the effect of cromakalim on spontaneous, electrically induced and pharmacologically induced contractile activity of normal and hyper‐reflexic human detrusor muscle samples. All 3 types of contractile activity were reduced in the presence of cromakalim.

A preliminary clinical trial of cromakalim was conducted, the results of which also suggest that this type of drug may have a significant role in the treatment of detrusor instability and hyperreflexia.
Measurement of in vivo Urological Tumour Cell Kinetics Using Multiparameter Flow Cytometry Preliminary Study
Authors: REW D. A. , THOMAS D. J. , COPTCOAT M. , WILSON G. D.
Published: November 2008

Summary The in vivo labelling of urological tumour cells using the S phase marker bromodeoxyuridine (BRdU) for histochemical studies is reported. The use of multiparameter flow cytometry (FCM) with BRdU labelling to study tumour proliferation offers significant advantages. It provides simultaneous measurements of the DNA ploidy (Dl), the duration of the S phase (Ts), the potential doubling time (Tpot) and the total and aneuploid tumour labelling indices (LI) from a single specimen. Heterogenous tumour cell populations can be measured with high sensitivity. We report a preliminary study to evaluate the method in the measurement of the kinetics of transitional cell carcinoma of the bladder (TCCB).

Nineteen patients with TCCB, 1 with leukoplakia of the bladder, 2 with renal carcinoma, 1 with prostatic carcinoma and 1 with a squamous carcinoma of the penis were studied. Of the bladder tumours, 3 were aneuploid, Dl = 1.32, 1.58 and 1.89. BRdU uptake was detected in all tumours. The median LI was 1.5% (range 0.5–10.0). In 15/19 tumours the labelling profile was satisfactory for calculation of the Ts and Tpot. The median Ts was 6.2 h and the median Tpot was 17.1 days.

This study demonstrates that measurement of multiple parameters of urological tumour proliferation in vivo is possible. These parameters require further assessment as indices of biological aggressiveness and clinical prognosis.
Neurophysiology of the Striated Urethral Sphincter in Multiple Sclerosis
Authors: EARDLEY I. , NAGENDRAN K. , LECKY B. , CHAPPLE C. R. , KIRBY R. S. , FOWLER CLARE J.
Published: November 2008

Summary Urethrovesical dysfunction is common in patients with multiple sclerosis. We present the results of urodynamic and neurophysiological studies in a series of 24 patients with multiple sclerosis associated with urinary symptoms. Urethral sphincter electromyography showed only minor abnormalities but studies of central conduction demonstrated abnormal sensory conduction in 88% and abnormal motor conduction in 80% of the patients studied. These abnormalities of central conduction correlated well with the urodynamic findings.
Spontaneous Regression of Metastatic Renal Carcinoma with Long‐term Survival
Authors: DE RIESE W. , GOLDENBERG K. , ALLHOFF E. , JONAS U.
Published: November 2008

Some authors doubt if spontaneous regression of metastatic renal carcinoma ever occurs. Of 125 patients who underwent nephrectomy for metastatic renal carcinoma between 1972 and 1987 we found 2 with spontaneous regression of pulmonary metastases and subsequent long‐term survival.
Rupture of False Aneurysm Secondary to Passage of Ureteric Stent
Authors: JAEGER H. J. , KERIN M. J. , KRUEGENER G. H. , MacFIE J.
Published: November 2008

We report the first case of rupture of a false aneurysm of the iliac artery due to retrograde passage of a ureteric stent.
Use of a Straw for Suprapubic Stab Puncture—an Alternative Method
Authors: TILAK A. G.
Published: November 2008

The technique of suprapubic stab puncture has been used in 80 cases. The use of a straw to introduce a large size Foley catheter is considerably cheaper than using a sophisticated peel‐away sheath introducer.

Using a straw as a third (outer) sheath over the commonly used Reuter trocar and cannula provides all of the features of a peel‐away sheath introducer and is a cost‐effective alternative method.
Renal Carcinoma with Inferior Vena Cava Malignant Thrombosis
Authors: PROCA E.
Published: November 2008

Summary During an 11 ‐year period a total of 314 patients underwent surgery for renal carcinoma; 70 had venous extension of the tumour, 31 had extension to the main renal vein and were staged V1 and 39 had involvement of the inferior vena cava and were staged V2.

Special attention was paid to the latter group, which was divided into 2 subgroups: V2a for caval extension without ingrowth and V2b for caval extension with infiltration of the caval wall. Thirty‐eight patients with caval involvement underwent surgery, with a 13% post‐operative mortality rate.

Most of the patients with malignant caval ingrowth (V2b) had concomitant lymph node and distant metastases. However, some had negative lymph nodes and no metastases at the time of operation.

Perifascial nephrectomy associated with caval tumour removal or lateral subhepatic caval resection for patients staged V2aN0M0 significantly increased the survival rate when compared with that of patients with no surgery on the obstructed vena cava.

Total resection of the completely obstructed subhepatic vena cava for patients staged V2bN0M0 has limited indications but, in selected cases, may prolong survival.

This retrospective study supports the reintroduction of indicator V in the TNM staging of renal carcinoma and suggests the splitting of stage V2 into V2a for patients with free‐floating caval extension and V2b for caval thrombus with ingrowth and caval wall infiltration.
Reliability of the Urethral Closure Pressure Profile during Stress in the Diagnosis of Genuine Stress Incontinence
Authors: HANZAL E. , BERGER EVA , KOELBL H.
Published: November 2008

Summary Urethral pressure profile (UPP) measurements were recorded during stress using the method of Brown and Wickham in 981 patients with lower urinary tract symptoms. This procedure was used to identify patients with genuine stress incontinence (GSI). A clinical stress test in the supine and erect position served to confirm urinary leakage. GSI was diagnosed in 661 patients (67%), whereas no incontinence was demonstrable in 320 (33%). UPP during stress has a high sensitivity (93.3%) and specificity (82.5%). Compared with other urodynamic investigations, the ease with which it can be performed at the same time as other urodynamic procedures makes a reliable diagnostic adjunct in the assessment of patients with GSI.