bluuebunny/crossref_metadata_2025 huggingface dataset:
A new small‐calibre diagnostic flexible cystoscope
Authors: Dryhurst D.J. , Fowler C.G.
Published: March 2003

Objective To determine whether flexible cystoscopy with a prototype slim flexible instrument is less uncomfortable than flexible cystoscopy using a standard flexible cystoscope.

Patients and methods In all, 200 men scheduled to undergo flexible cystoscopy for the follow‐up of transitional cell carcinoma of the bladder were randomized in equal groups to flexible cystoscopy using the standard instrument or using the prototype slim‐scope. Each patient had 11 mL of 2% lignocaine gel instilled intraurethrally 5 min before the procedure. At the end of the procedure the patient was asked to complete a 100‐mm non‐graphical visual analogue scale to rate how uncomfortable the procedure was.

Results The slim‐scope was very significantly less uncomfortable than the conventional instrument (anovaP < 0.001). The ease of use and views of the bladder were similar to those obtained with the conventional cystoscope.

Conclusion The slim‐scope offers a significant benefit in patient comfort, with little loss of image quality or ease of use.
The prevalence of Peyronie's disease: results of a large survey
Authors: Schwarzer U. , Sommer F. , Klotz T. , Braun M. , Reifenrath B. , Engelmann U.
Published: March 2003

Objectives To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany.

Subjects and methods A standardized questionnaire was sent to 8000 male inhabitants (age range 30–80 years) of the greater Cologne area (≈ 1.5 million inhabitants). Three questions about the self‐diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men.

Results The response rate after the third mailing was 55.4% (4432 men); 142 men (3.2%, mean age 57.4 years, sd 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30–39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40–49 and 50–59 years, 4.0% in those 60–69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction.

Conclusions This is the first large cross‐sectional, community‐based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this ‘rare’ disease is more widespread than previously thought.
Prostatic fluid‐free insulin‐like growth factor‐1 in relation to prostate cancer
Authors: Perk H. , Serel T.A. , Delibas N. , Sütçü R.
Published: March 2003

Objectives To establish the feasibility of measuring free insulin‐like growth factor‐1 (IGF‐1) in prostatic fluid and to determine if there is a difference in free IGF‐1 levels in the prostatic fluid of patients with prostatic adenocarcinoma and in normal men.

Patients and methods Prostatic fluid samples were collected from men with histologically confirmed prostate cancer and from control subjects with no malignancy. Prostatic fluid and serum free IGF‐1 levels were measured in duplicate by radioimmunoassay, and the differences analysed using the Mann–Whitney U‐test and Pearson correlation.

Results Prostatic fluid free IGF‐1 concentrations did not differ significantly (P = 0.23) and there was no difference in serum free IGF‐1 levels between the groups. While serum PSA level was significantly correlated with age (P < 0.001) the free IGF‐1 level of prostatic fluid was not. There was also no correlation between prostatic fluid free IGF‐1 and serum PSA levels.

Conclusions Free IGF‐1 can be detected in prostatic fluid with acceptable sensitivity. However, the free IGF‐1 level in prostatic fluid does not help to detect patients with prostate cancer and is not a tumour marker.
Bladder autoaugmentation in the rabbit using de‐epithelialized segments of small intestine, stomach
Authors: Cranidis  , Nestoridis  , Delakas  , Lumbakis  , Kanavaros
Published: March 2003

Objective

 To develop an animal model of partial detrusorectomy (autoaugmentation) and thus avoid the consequences of the direct contact of intestinal mucosa with the urinary tract in bladder augmentation.

Materials and methods

 A diverticular urothelial bulge was created and patched with demucosalized segments of small bowel (group A), stomach (group B) and with lyophilized human dura mater (group C). The surgery was performed on 50 New Zealand rabbits which were compared with 10 control animals and killed at 2, 4 and 6 weeks after surgery. Urodynamic studies and cystography were performed before operation and at death, and the augmented bladders examined histologically.

Results

 Six weeks after the procedure, the mean (sd) bladder compliance was 22.7 (5.7) in group A (intestinal patch, n=6), 2.3 (0.5) in group B (stomach patch, n=3), 3.1 (1.9) in group C (lyophilized human dura, n=3) and 9.4 (0.4) in the control group (n=4). Histological studies showed residual enteric and gastric mucosa but an intact urothelium under the intestinal patch.

Conclusion

 The results of this experimental study suggest that a demucosalized segment of small bowel is the best material to increase bladder compliance in detrusorectomy (autoaugmentation) as applied in this animal model.
Relief of urinary tract obstruction in tuberculosis to improve renal function. Analysis of predictive factors
Authors: Ramanathan  , Kumar  , Kapoor  , Bhandari
Published: March 2003

Objective

 To assess the effect of the relief of obstruction on the ultimate function of the affected renal unit in urinary tuberculosis, and to identify predictors of functional recoverability.

Patients and methods

Of a total of 82 patients with urinary tuberculosis presenting over 7 years, 38 with evidence of upper tract obstruction were analysed. All patients were assessed with pre‐operative excretory urography, urinary mycobacterial cultures and serum chemistry. Patients with subnormally functioning kidneys were assessed with baseline renal scans. Preliminary intervention in the form of JJ stenting or percutaneous nephrostomy (PCN) was carried out in patients with reasonable renal function. Function was reassessed after 4 weeks to detect evidence of improvement and factors which could affect the outcome were determined.

Results

Thirty‐eight patients had documented upper tract obstruction, of whom six had bilateral obstruction (total of 44 renal units). Ten renal units were not functioning at presentation, with a mean (sd) glomerular filtration rate (GFR) of 3.0 (5.73) mL/min, and no preliminary intervention was performed. In the remaining 34, preliminary intervention was carried out before definitive surgery (JJ stenting in 14, PCN in 15 and PCN followed by antegrade JJ stenting in five); 21 of these renal units were salvaged but 13 were lost despite overcoming the obstruction. Three of the 13 units deteriorated from having acceptable pre‐treatment GFRs to becoming non‐functional. Good renal cortical thickness, a low grade of renal involvement (Semb 1 or 2), the presence of more distal disease in the form of ureteric stricture and a GFR of >15 mL/min were good predictors of renal recovery after diversion.

Conclusions

The loss of some renal units seems inevitable in patients with urinary tuberculosis, despite advances in chemotherapy. Having pre‐operative predictors of renal recovery may ensure optimal patient selection, thereby reducing the number of procedures and economic burden on the patient who does not require intervention.
A pilot study of intermittent androgen deprivation in advanced prostate cancer
Authors: Horwich  , Huddart  , Gadd  , Boyd  , Hetherington  , Whelan  , Dearnaley
Published: March 2003

Objective

 To assess the feasibility of intermittent hormone therapy for metastatic prostate cancer.

Patients and methods

 Sixteen patients with metastatic carcinoma of the prostate were treated using a protocol of intermittent hormone therapy with the luteinizing hormone‐releasing hormone (LHRH) analogue leuprorelin at a dose of 3.75 mg every 4 weeks. The protocol required that hormone therapy be stopped when the response was stable, and was designed to assess the duration of the unmaintained response and the probability of a second response to re‐initiation of leuprorelin.

Results

 Eleven of the 16 patients had a stable hormone response and stopped therapy 3–9 months (mean 5.5) from the start of treatment. The mean (range) duration of the unmaintained response, as judged by monitoring symptoms and serum prostate specific antigen (PSA) levels every month was 4 (2–8) months in the seven patients who had bone metastases and was 3, 3 and 6 months in the three with only loco‐regional disease (one patient temporarily discontinued follow‐up). As the immediate re‐induction of hormone therapy was not mandatory in asymptomatic patients at the time of progression, the mean (range) period off hormone therapy was 8 (3–13) months in those eight patients with bone metastases and was 3, 36 and 42+ months in the three presenting with loco‐regional disease. All 10 patients who re‐initiated hormone therapy had a second hormone response, in six of which led to a decline in PSA level to <2 ng/mL. During the period off hormone therapy no patient developed irreversible symptoms.

Conclusions

 The temporary cessation of hormone therapy early during the response in patients with metastatic carcinoma of prostate is associated with biochemical evidence of relatively early progression in most cases, but can be associated with significant periods off therapy and with a high chance of a second hormone response. The value of this approach to the quality and duration of patients’ lives requires a prospective comparative evaluation.
Transurethral resection of the prostate vs high‐energy thermotherapy of the prostate in patients with benign prostatic hyperplasia: long‐term results
Authors: D’ancona  , Francisca  , Witjes  , Welling  , Debruyne  , De La Rosette
Published: March 2003

Objective

 To evaluate the outcome and durability of high‐energy transurethral microwave thermotherapy (HE‐TUMT) in comparison with transurethral resection of the prostate (TURP).

Patients and methods

 Fifty‐two patients with BPH and lower urinary tract symptoms were randomized and treated either by TURP (21 patients; mean prostate volume 45 mL, sd 15) or HE‐TUMT (31 patients, mean prostate volume 43 mL, sd 12). Long‐term results were obtained at a mean (sd) follow‐up of 2.4 (0.5) years.

Results

 During the follow‐up, the mean symptomatic improvement stabilized at 56% after TUMT and 74% after TURP. The mean maximum urinary flow rate increased by 62% after TUMT and 105% after TURP. Before treatment, 78% of patients in the TURP group were obstructed according to urodynamic investigation and after treatment, 14% remained obstructed. In the TUMT group, 67% of patients were obstructed before treatment and 33% remained so afterward. Six patients (19%) underwent TURP after TUMT (four after 1 year) and two patients were also treated with medication. One patient underwent a bladder neck incision after TURP to treat bladder neck sclerosis. Three patients were not satisfied with the outcome after the additional TURP.

Conclusion

 Both treatment modalities show good symptomatic and objective results at >2 years of follow‐up. Most re‐treatments were performed ≥1 year after treatment and were based on subjective findings.
Changes in white blood cell counts in men undergoing thrice‐weekly prostatic massage, microbial diagnosis and antimicrobial therapy for genitourinary complaints
Authors: Hennenfent  , Feliciano
Published: March 2003

Objective

 To report changes in the white blood cell (WBC) counts in expressed prostatic secretions (EPS) in men with pelvic symptoms undergoing thrice‐weekly prostatic massage combined with antimicrobial therapy.

Patients and methods

 The study comprised a retrospective analysis of the records of 35 patients (mean age 45.3 years, range 28–70, SD, 12.03) with pelvic pain, pain in the lower back, obstructive urinary symptoms, irritative urinary symptoms, or sexual dysfunction, who had undergone the same diagnosis and treatment protocol in a genitourinary clinic in Manila, Philippines, from September 1992 to September 1995.

Results

 EPS were obtained 347 times in 35 patients (median 9 times per patient, range 6–16). In 26 of the 35 (74%) patients the WBC count in the EPS was <10 per oil‐immersion field (OIF, ×1000) at the first prostatic massage. In 34 of 35 (97%) patients the WBC count rose to ≥10 as prostatic massage continued on a thrice‐weekly schedule. The mean (range, SD) initial WBC count in the EPS was 8.4 (1–48, 8.43) and the maximum was 40.9 (6–60, 19.05); the difference between these values was 32.5 (3–57, 18.78; 95% confidence interval 26.1–40.1) and the difference was statistically significant (paired t‐test, P<0.001).

Conclusions

 The classification of patients into those with prostatodynia or prostatitis based on one EPS examination is misleading and thrice‐weekly massage of the prostate is better than a single collection of EPS to obtain the most purulent sample for Gram staining and culture.
Free/total serum prostate‐specific antigen ratio: how helpful is it in detecting prostate cancer?
Authors: Masters  , Keegan  , Hildreth  , Greene
Published: March 2003

Objective

 To determine whether the use of free/total (f/t) serum prostate specific antigen (PSA) ratio would help reduce the number of prostate biopsies performed without compromising the detection of prostate cancer, in the setting of a transrectal ultrasonography (TRUS) clinic.

Patients and methods

 The study included 93 consecutive patients referred to the clinic for TRUS and biopsy. Serum samples were assessed for total PSA and free PSA, and the f/t PSA ratio calculated; 70 biopsies were taken. Patients over the age of 70 years with TRUS findings consistent with benign prostatic hyperplasia and with PSA levels <10 ng/mL were not biopsied.

Results

 Tumour was detected in 23 patients; receiver operating characteristic curves showed no advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. If a f/t PSA ratio of <0.15 had been used to determine the necessity for biopsy in the group with a total PSA of 4–10 ng/mL, then two‐thirds of all tumours would have been undetected.

Conclusion

 The f/t PSA ratio had no advantage over total PSA in improving specificity at a given sensitivity for detecting prostate cancer. Therefore, it cannot be recommended as a means of decreasing unnecessary biopsies in patients with a raised PSA level and/or an abnormal digital rectal examination. This applied particularly to the group of patients with a total PSA of 4–10 ng/mL.
The vesico‐ureteric junction in three cases of primary obstructive megaureter associated with ectopic
Authors: Dixon  , Jen  , Yeung  , Gosling
Published: March 2003

Objective

 To examine the histological structure and autonomic innervation of the vesico‐ureteric junction (VUJ) in three cases of primary obstructive megaureter occurring in association with ectopic ureteric insertion.

Patients and methods

 Specimens of VUJ were obtained from one male and two females with primary obstructive megaureter and ectopic ureteric insertions. Serial frozen sections were cut and stained with either Masson’s trichrome or immunostained for protein gene product (PGP 9.5; a general nerve marker) or dopamine beta‐hydroxylase (DβH), a marker for noradrenergic nerves.

Results

 In each case examined the terminal ureter was encircled by a thick collar of smooth muscle on the inside of which lay normal narrow‐diameter longitudinally orientated ureteric muscle bundles. Loose connective tissue separated the surrounding detrusor muscle from this abnormal muscle collar, which was formed of distinctive smooth muscle cells arranged in a meshwork. The autonomic innervation of the ureteric and detrusor muscle bundles was similar to that previously reported for the normal VUJ while the thick muscle collar was richly innervated by DβH‐immunoreactive noradrenergic nerves.

Conclusion

 The presence of an additional smooth muscle collar surrounding the terminal ureter may impede the normal flow of urine from ureter to bladder and be the cause of megaureter in these patients. We propose that the presence of this muscular collar arises from the developmental anomaly and suggest that these cases represent a subgroup that requires early surgical treatment.
Urological complications of bladder‐drained pancreatic allografts
Authors: Del Pizzo  , Jacobs  , Bartlett  , Sklar
Published: March 2003

Objective

 To examine the spectrum of urological complications associated with bladder drainage of pancreatic allografts.

Patients and method

 Between July 1991 and October 1996, 140 consecutive bladder–drained pancreatic allografts were performed and were reviewed retrospectively to determine the spectrum of post‐operative urological complications. Ninety‐five patients (68%) underwent simultaneous pancreas‐kidney transplantation, 35 (25%) had the pancreas transplanted after the kidney, while 10 (7%) had a pancreas transplant alone. The mean follow–up was 35 months.

Results

 Seventy patients (50%) had urological complications necessitating intervention: 17 (12%) had retained foreign bodies, bladder tumours occurred in three, 14 had bladder calculi and 15 (11%) had cystoscopic evidence of duodenitis. One patient developed an arteriovenous fistula and one had a necrotic duodenal allograft. Reflux pancreatitis occurred in six patients. Other complications included urethral stricture (three), urethral erosion (three), epididymitis (three), acute prostatitis (one) and prostatic abscess (one). One patient developed a urethrocutaneous fistula and another developed a vesicocutaneous fistula. In the series, 30 of the 140 patients (21%) required eventual conversion to enteric drainage of their allograft as definitive therapy.

Conclusions

 Pancreatic transplantation with bladder drainage is associated with a wide range of significant urological problems. Although appropriate treatment can resolve most of the complications, this often entails additional operative intervention, which may increase the long‐term morbidity or jeopardize graft function. As a result of the severity of these urological complications, some centres use primary enteric drainage as the method of choice for pancreatic transplantation.
Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials
Authors: Berghmans  , Hendriks  , BØ  , Hay‐Smith  , De Bie  , Van Waalwijk van Doorn
Published: March 2003

Objective

 To assess the efficacy of physical therapies for first‐line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs).

Materials and methods

 A computer‐aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, was carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research.

Results

 Twenty‐four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels‐of‐evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high‐intensity vs a low‐intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.

Conclusions

 More research of high methodological quality is required to further evaluate the effects of physical therapies used to treat and prevent SUI.
Adjuvant chemotherapy for high‐risk urothelial transitional cell carcinoma: the Princess Margaret Hospital experience
Authors: Michael  , Tannock  , Czaykowski  , Moore
Published: March 2003

Objective

 To review the outcome of adjuvant systemic chemotherapy after surgery for patients with locally advanced urothelial transitional cell carcinoma (TCC) of the bladder and upper urinary tract who were at high risk for recurrence or metastatic spread.

Patients and methods

Thirty‐five patients (27 men and eight women, median age 59 years) received adjuvant chemotherapy and were followed for a median of 31 months from surgery (range 12–109). All patients had undergone surgery (cystectomy, nephrectomy, nephrouretectomy), with removal of all evident tumour from the following primary sites: bladder (29), renal pelvis (three) and ureter (three). Thirty patients had stage pT3 or greater, 22 had node‐positive disease and 16 had vascular invasion. The median interval from surgery to chemotherapy was 2 months. Patients received a median of four courses of cisplatin, methotrexate and vinblastine (n=23) or the same drugs with doxorubicin (n=12).

Results

Toxicity included nine episodes of febrile neutropenia (one fatal) and six episodes of thromboembolism (one fatal). Eighteen patients (51%) remain alive and free of apparent disease with a median follow‐up of 31 months. Actuarial overall and relapse‐free survival were 64% and 57% at 2 years and 47% and 53% at 5 years, respectively. For the 22 node‐positive patients, the median relapse‐free survival and overall survival was 22 months and 33 months, respectively.

Conclusions

Patients with urothelial TCC at high risk of relapse after radical surgery can have a reasonable chance of long‐term survival with systemic adjuvant chemotherapy. Treatment is associated with toxicity. The benefits of treatment should be addressed in a large randomized controlled trial.
The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder and prostate
Authors: Pantuck  , Murphy  , Amenta  , Das  , Cummings  , Weiss
Published: March 2003

Objective

 To determine if the monoclonal antibody 7E12H12 , which reacts with a 40 kDa protein in normal human enterocytes and has been shown to be a marker for intestinal metaplasia and adenocarcinoma arising in the bladder, could assist in distinguishing prostatic, urachal and vesical adenocarcinoma, using a sensitive immunohistochemical assay.

Materials and methods

 Fifteen primary prostatic adenocarcinomas and five adenocarcinomas of the urinary bladder were selected for a retrospective evaluation. The monoclonal antibody 7E12H12 (IgM isotype) was used in an immunoperoxidase assay to survey formalin‐fixed, paraffin‐embedded archival tissue specimens.

Results

 All vesical adenocarcinomas reacted positively with the antibody, regardless of grade; none of the 15 prostatic specimens reacted positively in either the benign or malignant glandular epithelium.

Conclusion

 The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma arising in the prostate and may be a useful tool in diagnostic pathology.
Hydrolysis of androgen receptor by cathepsin D: its biological significance in human prostate cancer
Authors: Mordente  , Choudhury  , Tazaki  , Mallouh  , Konno
Published: March 2003

Objective

 To elicit the biological role of a lysosomal protease, cathepsin D (CatD) in prostate cancer, by investigating its regulatory effect on the androgen receptor (AR) using human prostate cancer LNCaP cells and prostate tissue specimens.

Materials and methods

 Cell extracts were prepared from LNCaP or prostate specimens by cell lysis and tissue homogenization. Proteolytic assays were performed by incubating these extracts in acidic buffer (pH 3–4) at 37°C. The resulting effects on AR and CatD were then analysed using Western immunoblots.

Results

 The Western blots showed that AR was virtually hydrolysed with acid treatment, because endogenous CatD was activated; this activation only occurred at pH 3.2–3.5, but no specific acid appeared to be required. Further analyses suggested that CatD activation could be attributed to acid‐induced autoproteolysis of mature CatD. Similar assays were also performed on prostate tissues, including normal and malignant specimens. These studies revealed that CatD‐mediated AR hydrolysis was observed only in cancer specimens, while no such hydrolysis occurred in normal specimens.

Conclusion

 Endogenous CatD can hydrolyse AR, thereby possibly modulating AR function/metabolism in LNCaP cells, and in cancer specimens. CatD activity also appears to differ significantly between normal and malignant tissue. Thus, CatD may play a pivotal role as a growth modulator in androgen‐dependent prostate cancer.
The predictive value of baseline variables in the treatment of benign prostatic hyperplasia using high‐energy transurethral microwave thermotherapy
Authors: D’ancona  , Francisca  , Hendriks  , Debruyne  , De La Rosette
Published: March 2003

Objective

 To evaluate the combination of patient age, prostate size, grade of outlet obstruction and total amount of energy, all independent predictive variables of treatment outcome in patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) treated with high‐energy transurethral microwave thermotherapy (HE‐TUMT), and thus provide nomograms for predicting treatment outcome after HE‐TUMT.

Patients and methods

 Between October 1993 and July 1996, 247 patients with LUTS and BPH were treated with HE‐TUMT using the ProstatronTM device, software version 2.5 (EDAP Technomed, Lyon, France). The World Health Organisation Response Evaluation Criteria were used to evaluate the outcome. Patient age, prostate volume, total amount of energy and grade of outlet obstruction were categorized using the Akaike information criterion (AIC). The probabilities of a good/intermediate vs a poor response at 26 weeks according to the AIC were calculated.

Results

 Nomograms are presented providing the estimated probability (95% confidence interval) for a good/intermediate response of the evaluation of the International Prostate Symptom Score at 26 weeks by categories of prostate volume, total amount of TUMT energy and age, and of maximum urinary flow rate by categories of bladder outlet obstruction (linear passive urethral resistance ratio, linPURR) and total amount of energy, and of linPURR by categories of prostate volume and total amount of energy. The total amount of energy appeared to have the most impact in the prediction of good/intermediate and poor response in all three response evaluation criteria.

Conclusions

 These nomograms may assist urologists in making clinical recommendations for the treatment of men with LUTS and BPH using HE‐TUMT.
Is the ratio of transition zone to total prostate volume higher in African‐American men than in their Caucasian or
Authors: Kaplan  , Reis  , Staimen  , TE
Published: March 2003

Objective

 To determine if the transition zone index (TZI, the ratio between transition zone volume, TZV, and total prostate volume, as estimated by transrectal ultrasonography, TRUS) differs among African‐American (AA), Hispanic and Caucasian men.

Patients and methods

 The study group consisted of 104 age‐matched men (36 AA, 34 Hispanic and 34 Caucasian) with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). A control group of 55 age‐matched men, equally distributed among the three ethnic groups, but with no BPH (based on a digital rectal examination) were also evaluated. All men completed the International Prostate Symptom Score (IPSS) and a measurement of peak urinary flow rate (Qmax ), prostate volume and TZV (by TRUS) and the TZI calculated.

Results

 In the control group, the mean prostate volume was 20.9, 18.2 and 19.8 mL, the TZV 6.9, 4.9, and 5.4 mL and the TZI 0.33, 0.27 and 0.25 for AA, Hispanic and Caucasian men, respectively. The TZI was significantly higher in AA than in either Hispanic or Caucasian men (P<0.03). Although there were no differences in prostate volume among the three ethnic groups with BPH, the mean (sd) TZV and TZI were significantly higher in AA men than in either their Hispanic or Caucasian counterparts, at 15.8 (7.6) mL and 0.43, 12.7 (8.1) mL and 0.37, and 13.8 (6.7) mL and 0.37, respectively. For all groups, age correlated with the IPSS (r=0.22, P<0.04); the mean (sd) IPSS was 14.3 (5.7), 10.2 (2.9) and 10.6 (4.9) for AA, Hispanic and Caucasian men, respectively. There was no correlation between the IPSS and either prostate volume or TZV, but there was a strong correlation with the TZI (r=0.29, P<0.01), regardless of race.

Conclusions

 These results suggest that AA men have a greater TZV and a higher TZI than their Caucasian or Hispanic counterparts, regardless of the presence of lower urinary tract symptoms. Studies are underway to determine if these differences are clinically significant and correlate with either subjective and/or objective parameters of BPH.
Changes in urinary output during laparoscopic adrenalectomy
Authors: Nishio  , Takeda  , Yokoyama
Published: March 2003

Objective

To better understand the physiological effects of pneumoperitoneum, by examining changes in urinary output during gaseous and gasless laparoscopic adrenalectomy.

Patients and methods

Laparoscopic adrenalectomy was performed with gas in six patients and without in three. Urinary output was measured during insufflation and after desufflation.

Results

In all patients who received gas, the urinary output was significantly decreased during insufflation and significantly increased after desufflation. However, there were no changes in urinary output in patients who did not receive gas.

Conclusion

For the safety of laparoscopic surgery it is important to recognise that oliguria occurs during pneumoperitoneum, although the changes in urinary output caused no complications in renal function.
MUC1 mucin as a tumour marker in bladder cancer
Authors: Simms  , Hughes  , Limb  , Price  , Bishop
Published: March 2003

Objective

To evaluate serum MUC1 levels (a high molecular weight glycoprotein which is upregulated and abnormally glycosylated in bladder cancer and other carcinomas) in patients with a variety of stages and grades of transitional cell carcinoma (TCC) of the bladder, to assess its potential as a tumour marker.

Patients and methods

Blood samples were taken before treatment in 87 patients with TCC of the bladder and in 31 controls undergoing cystoscopy for benign conditions. Serum MUC1 levels were estimated with an enzyme‐linked immunosorbent assay using the C595 monoclonal antibody.

Results

Of patients with T4 tumours, 47% had MUC1 levels above the normal range (P<0.001); patients with T3 tumours also had significantly higher MUC1 levels than controls. The overall sensitivity was only 24% for all tumours when the upper limit of normal was defined as 4.8 U/mL; the specificity was 97%.

Conclusion

Serum MUC1 is not as useful tumour marker for screening, as it has a low sensitivity. However, MUC1 levels are high in advanced disease and serum MUC1 levels may be useful for disease monitoring.
The importance of measuring the prostatic transition zone: an anatomical and radiological study
Authors: Zlotta  , Djavan  , Damoun  , Roumeguere  , Petein  , Entezari  , Marberger  , Schulman
Published: March 2003

Objective

 To assess the accuracy and reliability of measurements of the volume of the transition zone (TZ, representing the hypertrophied benign component) and whole prostate by TRUS in patients with BPH or cancer, by comparing the radiological with pathological findings after surgery.

Patients and methods

 The study comprised 36 patients with prostate cancer undergoing radical prostatectomy and 34 patients with symptomatic BPH treated using retropubic adenectomy. The weights of the radical prostatectomy specimens and of the enucleated adenomas were correlated with the corresponding volumes of the TZ and of the whole prostate, respectively, measured by TRUS using the prolate ellipsoid method.

Results

 The mean (sd) TZ volume measured by TRUS was 36.9 (25.48) mL, whereas the weight of the enucleated specimen was 42.7 (33.58) g (correlation coefficient r=0.95, P<0.001). The TRUS estimate of the volume of the whole prostate was 29.2 (9.24) mL, while the radical prostatectomy specimens weighed 34.5 (10.76) g (r=0.78, P<0.001). The variability in the TZ volume estimate ranged from −17% to +18%, whereas the variability for whole prostate was −21% to +30% (P<0.05).

Conclusions

 Measurements of the TZ of the prostate by TRUS are more accurate than those for the whole prostate. An assessment of the TZ volume may be sufficiently reliable to be used in the clinical management of BPH and to detect prostate cancer using the prostate‐specific antigen density of the TZ as a marker.
Assessment of a new bone anchor system for the treatment of female genuine stress incontinence
Authors: El‐Toukhy  , Tolba  , Davies
Published: March 2003

Objective

 To evaluate the efficacy of the In‐Tac bone‐anchor system (using shape‐memory metal bone anchors, Influence Medical Technologies, Lancs, UK) as a vaginal procedure for the treatment of female genuine stress incontinence (GSI).

Patients and methods

 Between January 1997 and April 1998, 30 patients with GSI were recruited into the study (age range 36–74 years); patients who had undergone previous failed continence surgery were not excluded. All patients underwent a urodynamic assessment before and 3 months after surgery. All In‐Tac bone‐anchor procedures were performed under general anaesthesia. Patients were reviewed after surgery at 6 weeks, 3, 6 and 12 months, and yearly thereafter.

Results

 The mean (range) operative duration was 42 (20–75) min and the blood loss 60 (10–200) mL (median 30). There were no intraoperative complications and minimal analgesia was required postoperatively. At 6 weeks, 27 patients (90%) were subjectively cured. The urodynamic assessment at 3 months revealed that 22 patients (73%) were objectively cured; at 6 months and one year the subjective cure rate was 80%.

Conclusion

 The In‐Tac bone‐anchor system is simple and safe, the procedure easily learned and the operation brief. It offers promise as an incision‐less vaginal procedure that may have wide application for the treatment of women with GSI. A longer follow‐up is needed to fully confirm its durability and effectiveness.
Chromosomal aberrations in transitional cell carcinoma that are predictive of disease outcome are independent of polyploidy
Authors: Bartlett  , Adie  , Watters  , Going  , Grigor
Published: March 2003

Objective

 To determine whether aneusomy for chromosomes 7, 9 and 17 (reported to predict recurrence in up to 65% of patients with superficial transitional cell bladder cancer and thus providing the opportunity for early and effective treatment) reflects specific genetic events on these chromosomes or merely wider unspecific genetic damage to the cell, e.g. that increased copy numbers for 7 and 17 reflect tumour polyploidy.

Materials and methods

The study comprised 25 primary tumours; 6 μm thick sections from formalin‐fixed and paraffin‐embedded tumours were analysed. Chromosome copy numbers were determined by fluorescence in situ hybridization (FISH) using pericentromeric probes for chromosomes 7, 8, 9, 10, 11 and 17. A minimum of 200 nuclei per tumour area were scored by two independent observers.

Results

Eight of the 25 tumours examined (32%) showed no evidence of chromosomal abnormalities as detected by FISH for any chromosomes analysed. Twelve tumours (48%) showed abnormalities for one or two chromosomes, five tumours (20%) showed abnormalities for multiple chromosomes and one tumour showed abnormalities for all chromosomes analysed, suggestive of polyploidy.

Conclusions

Chromosomal abnormalities predictive of recurrence occur largely in the absence of other gross chromosomal lesions. In a small proportion of cases other chromosomes are affected, but this is almost always distinct from tumour polyploidy.
Laparoscopic ureterolithotomy: the Edinburgh experience
Authors: Keeley  , Gialas  , Pillai  , Chrisofos  , Tolley
Published: March 2003

Objective

 To review our experience with laparoscopic ureterolithotomy.

Patients and methods

 Since 1993, we have performed laparoscopic ureterolithotomy in 14 patients with ureteric stones. Laparoscopy was carried out in nine patients as a salvage procedure after failed ureteroscopy (six), shock wave lithotripsy (two), or both (one), and in five patients as a primary procedure for large stones (mean 27.2 mm, range 18–40). Patients in the former group had already undergone a mean of 1.88 procedures (range 1–4). Laparoscopic ureterolithotomy was carried out via a transperitoneal approach. Associated ureteric strictures were incised at the time of ureterotomy.

Results

 All procedures were completed laparoscopically and all patients were rendered stone‐free after a single procedure. The mean operative duration was 105 min. Ureteric strictures were incised in three patients, in two of whom dilatation was subsequently required; all three had a successful result. There were three minor complications.

Conclusions

 Laparoscopic ureterolithotomy can be a safe and effective procedure; it should be considered as a primary procedure for large mid‐ and upper ureteric stones.
An interstitial light assembly for photodynamic therapy in prostatic carcinoma
Authors: Lee  , Whitehurst  , Pantelides  , Moore
Published: March 2003

Objective

 To develop an interstitial laser light delivery system using multiple optical fibres for photodynamic therapy (PDT) in the treatment of prostate cancer.

Patients and methods

 A laser beam was divided equally with a 1×4 fibre splitter to deliver PDT simultaneously through four 2‐cm long, flexible cylindrical optical diffusers. Biplanar transrectal ultrasonography (TRUS) and a template were used to position the optical fibres percutaneously. In vivo measurements of light penetration depth (1/μeff ) in prostate tissue were made in seven patients, using a sheathed isoprobe to measure light fluence rates at varying radial distances from the diffuser. The prostate was fixed with stabilization needles to minimize displacement during needle placement.

Results

 The mean (sd, range) μeff in the prostates of the seven patients was 0.35 (0.07, 0.22–0.44) mm−1 , which produced closely parallel slopes of light attenuation. However, there was up to a 10‐fold variation in absolute light levels at the same diffuser–detector separation distances amongst the seven patients, probably caused by blood pooling around the diffuser light source. A similar problem around the isoprobe detector was overcome by sheathing the probe in clear plastic tubing. By stabilizing the prostate, the optical fibre positioning was precise to within 2 mm.

Conclusion

 Although this light delivery and TRUS assembly were developed for clinical PDT in the prostate, the same instrumentation can be used reliably for in vivo light‐penetration studies. Haemorrhage was unpredictable and highlighted one of the main problems which needs to be overcome.
How is follow‐up after transurethral prostatectomy best performed?
Authors: Puri  , Smaling  , Lloyd
Published: March 2003

Objective

 To evaluate the role of the nurse practitioner (NP) in screening patients for potential discharge after routine transurethral prostatectomy (TURP) or bladder neck incision (BNI) where, although urologists continue to follow such patients, the trend is away from clinic attendance.

Patients and methods

 The NP telephoned 70 patients 4 weeks after surgery; information about expected postoperative problems, change in symptoms and the need to visit their general practitioner (GP) was recorded. A doctor then saw all the patients in a clinic 3 months after TURP or BNI.

Results

 Complete records were available for 66 patients (TURP 56, BNI 10). Four weeks after their operation, 39 (59%) patients still had one or more significant symptoms but only nine (23%) had consulted their GP. After a telephone interview the NP considered that 38 of the 66 patients were fit to be discharged. At the 3‐month outpatient appointment, 37 of these 38 patients were subsequently discharged. Of the remaining 29 patients, 15 (seven with carcinoma of the prostate and eight with significant symptoms) were given follow‐up appointments.

Conclusions

 The persistence of significant symptoms in 12% of patients 3 months after TURP justifies the follow‐up of all patients. A telephone interview by the NP at one month is recommended. This could result in safe discharge of more than half the patients and allow follow‐up of those who need specialist input.
To determine whether the temperature of 2% lignocaine gel affects the initial discomfort which may be associated with its instillation into the male urethra
Authors: Thompson  , Thompson  , O’Brien  , Young  , Mccleane
Published: March 2003

Objective

To determine whether the temperature of 2% lignocaine hydrochloride gel affects the initial discomfort during instillation into the male urethra.

Patients and methods

Sixty consenting men were randomized to receive 11 mL of 2% lignocaine hydrochloride gel (Instillagel, Farco‐Pharma GmbH, Cologne, Germany) at 4°C, 22°C or 40°C. The three groups were well matched for age and numbers of previous flexible cystoscopies. The gel was instilled by one operator and the patients were then immediately asked to score the pain on instillation using a 100‐mm nongraphical visual analogue scale.

Results

Compared with the control group (at 22°C), there was a statistically significant reduction in pain score in the group receiving cold gel (Student’s t‐test, P<0.05).

Conclusion

The cooling of 2% lignocaine gel significantly reduced the initial discomfort associated with its delivery into the male urethra before any form of urethral instrumentation.
Does proximal genitofemoral nerve division induce testicular maldescent or ascent in the rat?
Authors: Shono  , Zakaria  , Imajima  , Suita
Published: March 2003

Objective

To investigate whether the division of the proximal genitofemoral nerve (GFN) in neonatal rats induces testicular undescent or ascent in adulthood.

Materials and methods

Neonatal Wistar King A rats underwent a unilateral proximal GFN transection on either the right or left side. At the age of 30 days, testicular descent was examined in all rats and the position of the testis recorded. The animals were allowed to develop further and the position of the testis re‐examined at the age of 90–180 days, when the testes were removed and weighed. Sham‐operated rats were used as controls.

Results

At the age of 30 days, four of the 46 (9%) operated rats showed a unilateral undescended testis on the operated side. At the age of 90–180 days, 43 rats were re‐examined (three rats died before re‐examination); 34 (79%) of these rats showed undescended testes on the operated side. The occurrence of cryptorchidism was significantly higher in the 90–180‐day‐old mature rats than in 30‐day‐old prepubertal rats (P<0.01). The mean (sd) weight of the undescended testes, at 2.36 (0.21) mg/g body weight, was significantly less than that of the contralateral scrotal testes, at 3.83 (0.23) mg/g; P<0.01) and of the control testes at the age of 90–180 days. In the sham‐operated rats, all testes were located at the bottom of the scrotum at 30 days of age and no rats showed any testicular ascent thereafter.

Conclusions

The proximal division of the GFN in neonatal rats not only causes inguinoscrotal testicular maldescent but may also induce testicular ascent in adulthood. Testicular ascent may thus be caused by some intrauterine disorders of the GFN in patients with ascending testis.
Antitumour effects of the angiogenesis inhibitor AGM‐1470 on rat urinary bladder tumours induced by N‐butyl‐N‐(4‐hydroxybutyl) nitrosamine
Authors: Osawa S. , Terashima Y. , Kimura G. , Akimoto M.
Published: March 2003

Objective

To examine the antitumour effects of the angiogenesis inhibitor AGM‐1470 (TNP‐470) on rat urinary bladder tumours induced by N‐butyl‐N‐(4‐hydroxybutyl) nitrosamine (BBN).

Materials and methods

Fischer‐344 rats were allocated to one of four groups of 15 rats each; in group 1, rats were administered AGM‐1470 intraperitoneally, with group 2 acting as the control and given only saline; in group 3, AGM‐1470 was instillation intravesically and group 4 acting as control (intravesical saline). All rats were given 0.05% BBN in their drinking water for 8 weeks and then given water with no BBN. AGM‐1470 was administered at a dose of 30 mg/kg every other day for 6 weeks in group 1 and at 15 mg/kg once a week for 6 weeks in group 3. This treatment was commenced at 21 weeks after the start of BBN treatment, when tumorigenesis was apparent in all rat bladders; ≈70–80% of the tumours were carcinomas. All rats were killed in the 27th week. The antitumour effects of AGM‐1470 on the BBN‐induced bladder tumours were evaluated macroscopically and histologically. The inhibitory effect of AGM‐1470 on endothelial cell proliferation was assessed in groups 1 and 2 by immunohistochemical staining for Factor VIII‐related antigen and by counting the microvessels.

Results

The number and volume of bladder tumours were significantly less in group 1 than group 2. In the latter, at least one bladder tumour developed in each of the 15 rats. Histologically, transitional cell carcinoma (TCC) was found in 13 rats and papilloma in two, with invasive cancer in three of the 13 TCCs. Bladder tumours developed in only four of the 15 rats in group 1. Carcinomas were found in three of these four rats and no invasive cancer was detected. The rats in group 1 had significantly fewer microvessels than the controls. The rats in group 4 also showed slightly but insignificantly less tumour growth and fewer carcinomas. In neither experiment were any major side‐effects seen except for mild weight loss after AGM‐1470 treatment.

Conclusion

AGM‐1470 inhibited the growth and malignant progression of BBN‐induced bladder tumours in rats, apparently mainly by the inhibition of tumour vessel development. The intraperitoneal administration of AGM‐1470 produced better results than did intravesical instillation. These results suggest that the angiogenesis inhibitor AGM‐1470 is a promising agent for the treatment of human bladder cancer.