bluuebunny/crossref_metadata_2025 huggingface dataset:
Tubularized incised plate urethroplasty for proximal hypospadias
Authors: Chen S.C. , Yang S.S.D. , Hsieh C.H. , Chen Y.T.
Published: March 2003

Objective To review our experience of using the tubularized incised plate (TIP) urethroplasty (useful in the treatment of distal hypospadias) to treat proximal hypospadias.

Materials and methods From March 1997 to March 2000 primary repairs were carried out on 40 boys (mean age 4.5 years) with proximal hypospadias. After degloving the penile skin the meatus was at the mid‐shaft in 10 boys, at the proximal penile shaft in 11, at the penoscrotal junction in 16, at the scrotum in two and at the perineum in one. The 21 patients with a mid or proximal shaft meatus were categorized as having mid‐shaft and the other 19 as having posterior hypospadias. Tunica albuginea plication (TAP) was used to correct residual ventral curvature. The method of urethroplasty was adapted from that described by Snodgrass. The key step of the TIP repair is a midline incision of the urethral plate; a subcutaneous tissue flap dissected from the inner prepuce is used to cover the neourethra. An 8 or 10 F nasogastric tube is used as a urethral stent and removed 7 or 8 days after surgery. Follow‐up endoscopy and urethral sounding were carried out in 17 of the patients aged < 6 years; the mean follow‐up was 12.5 months.

Results TAP was used to correct penile curvature in nine (23%) of the patients. Excluding stenosis, the TIP repair was successful in 20 (90%) of those with mid‐shaft and in 16 of the 19 with posterior hypospadias; for all complications the respective rates were 19 of 22 and 15 of 19. The overall success rate was 88% for all 40 patients with proximal hypospadias; a urethrocutaneous fistula occurred in two of those with mid‐shaft and three of those with posterior hypospadias. Urethral meatal stenosis occurred in four (12%) of the patients (two in each group); two were associated with a fistula and the other two had only mild meatal stenosis. The overall complication rate was 17.5% (three and four in the mid and the posterior hypospadias groups, respectively). The meatal stenosis was managed by simple dilatation in three and meatoplasty in one patient. Endoscopically, the mucosa of neourethra was pink and smooth in all 17 patients assessed. The calibre of all 17 neourethra was  8 F and in 13 was  10 F.

Conclusion TIP repair is a reliable method for treating both mid‐shaft and posterior hypospadias.
Nitric oxide‐mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B.
Published: March 2003

Objective To examine nitric‐oxide (NO)‐mediated relaxation in cavernosal smooth muscle in a rat model of diabetes, as previous experiments showed that HbA1c (an isoform of glycosylated haemoglobin and a marker of long‐term diabetic control) impaired NO‐mediated relaxation of normal corpus cavernosal tissue through the generation of superoxide anions.

Materials and methods Eight weeks after the induction of diabetes, male Wistar rats were killed and cavernosal tissue obtained. Strips were contracted with 1 µmol/L noradrenaline before applying acetylcholine or electrical field stimulation (EFS) or sodium nitroprusside (SNP). Relaxation responses were repeated in the presence of l‐arginine (100 µmol/L), indomethacin (10 µmol/L) or superoxide dismutase (SOD, 120 IU/mL). Young and age‐matched control animals were examined in the same way.

Results Eight weeks of uncontrolled diabetes caused a significant impairment in mean relaxation responses to acetylcholine (P < 0.05) and to EFS (P < 0.05), but not to SNP, compared with young and age‐matched controls, respectively. l‐arginine, indomethacin and SOD had no significant effect on this impairment. Ageing caused a lesser but significant impairment in EFS‐mediated cavernosal smooth muscle relaxation (P < 0.05).

Conclusion Diabetes impairs endothelial and neuronal NO‐mediated cavernosal smooth muscle relaxation in rats in vitro. This effect is not mediated by an alteration in the intracellular action of NO, the availability of NO, superoxide anion inactivation of NO or the generation of constrictor prostanoids. It is possible that cholesterol or advanced glycation end products are responsible for the effect of diabetes on penile smooth function.
Ontogeny of bladder agenesis in rats induced by adriamycin
Authors: Liu M.I.‐P. , Hutson J.M.
Published: March 2003

Objectives To determine the anatomical steps leading to bladder agenesis in rats prenatally exposed as fetuses on gestational days (GD) 6–9 to adriamycin.

Materials and methods Timed‐pregnant Sprague–Dawley rats were injected intraperitoneally with adriamycin at 2 mg/kg (n = 28) on GD 6–9 (vaginal plug = day 0). The control group (n = 21) received saline. Fetuses were harvested on GD 10, 11, 12, 13, 14, 15 and 16. Serial paraffin sections were prepared from a minimum of 10 experimental and five control fetuses at each gestational age, and stained with either trichrome or haematoxylin and eosin, and examined by light microscopy.

Results In the control group the urorectal septum first became visible and the mesonephric ducts apparently abutting the anterior cloaca on GD 12. The presumptive urinary bladder was clearly defined on GD 14. On GD 15, the common excretory ducts became incorporated into the newly formed urogenital sinus and the ureters opened into the bladder. In the treated animals, beginning on GD 11, the undivided cloaca was noticeably smaller and by GD 13–14, the vesical extension of the urogenital sinus was conspicuously absent. Instead, opposite ureters joined to drain directly into the proximal blind‐ending urethra or the persistent distal urogenital sinus.

Conclusions Prenatal exposure of rat fetuses to adriamycin resulted in primary agenesis rather than secondary resorption of the bladder. The ontogeny showed that the mechanism underpinning bladder development is unique and is under the influence of factors that can be targeted by adriamycin. Further work will elucidate the unique nature of bladder organogenesis and should have important applications in future research into artificial bladders.
Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones
Authors: Keeley F.X. , Tilling K. , Elves A. , Menezes P. , Wills M. , Rao N. , Feneley R.
Published: March 2003

Objective To report a prospective, randomized study to determine whether prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a treatment for small, asymptomatic calyceal stones.

Patients and methods The study included 228 patients with small (< 15 mm total diameter) asymptomatic calyceal stones; 113 patients were randomized to undergo ESWL and 115 to the control group who were kept under observation. Outcome measurements included the stone‐free rate, requirement for additional treatment, symptoms, quality of life and renal function.

Results In all, 200 patients had at least one annual follow‐up; all outcome measurements reported were those at the most recent follow‐up (mean 2.2 years, range 1–5). In the ESWL group 28 patients (28%) were stone‐free, compared with 16 (17%) in the observation group (odds ratio 1.95, 95% confidence interval, CI, 0.97–3.89, P = 0.06). Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 (21%) patients in the observation group and 15 (15%) in the ESWL group (odds ratio 0.66, 95% CI 0.32–1.37, P = 0.27). Ten patients in the observation group required invasive procedures, vs none in the ESWL group. There was no evidence of differences in the symptoms, quality of life or renal function tests between the arms of the trial at the final follow‐up.

Conclusions Prophylactic ESWL for small asymptomatic renal calyceal stones does not appear to offer any advantage to patients in terms of stone‐free rate, quality of life, renal function, symptoms or hospital admissions. However, a policy of observation is associated with a greater risk of requiring more invasive procedures. A longer follow‐up is required to assess the validity of these preliminary findings.
Effect of experimental hyperoxaluria on renal calcium oxalate monohydrate binding proteins in the rat
Authors: Kalaiselvi P. , Selvam R.
Published: March 2003

Objective To determine the functional role of calcium oxalate binding proteins in the nucleation, aggregation and retention of calcium oxalate crystals under physiological and hyperoxaluric conditions.

Materials and methods Hyperoxaluria was induced in rats using 0.75% of ethylene glycol in drinking water. Calcium oxalate binding proteins were isolated and fractionated by cellulose column chromatography. Three major protein peak fractions were obtained (73 kDa in Tris‐HCl buffer, 20 kDa in 0.05 mol/L NaCl buffer and 23 kDa in 0.3 mol/L buffer). Oxalate binding and the inhibition of crystal nucleation and aggregation by these fractions were determined.

Results The adsorption of calcium oxalate monohydrate (COM) was ubiquitous in rat tissues and subcellular organelles, but the percentage adsorption varied; maximum absorption occurred in kidneys and pancreas, with microsomes showing maximal adsorption in the kidney. Hyperoxaluric rat tissues showed a greater percentage adsorption. Microsomes were enriched with the 20 kDa protein, while nuclei contained the 23 kDa protein in higher concentrations. COM‐binding proteins derived from hyperoxaluric rat kidney had a greater content of 74 kDa and 23 kDa proteins with increased oxalate‐binding activities. In the crystal‐growth studies, the 74 kDa protein was a promoter, while the other protein fractions inhibited crystallization. In hyperoxaluria, the crystal‐growth promoting activity of the 74 kDa protein was further increased, while the inhibition by the 20 and 23 kDa proteins was decreased. The 74 kDa protein derived from control rats formed single COM crystals in a crystal growth system, while the hyperoxaluric rat fraction induced the aggregation of COM crystals.

Conclusion COM‐binding proteins (the 74 and 23 kDa fractions) were expressed more in hyperoxaluric rats. In hyperoxaluria the 74 kDa protein tended to promote crystal nucleation and aggregation, and the 20 and 23 kDa proteins were less inhibitory, which increases the risk of stone formation.
Does the time of administration (morning or evening) affect the tolerability or efficacy of tamsulosin?
Authors: Michel M.C. , Neumann H.G. , Mehlburger L. , Schumacher H. , Goepel M.
Published: March 2003

Objective To determine whether the time of dosing (morning or evening) affects the tolerability or efficacy of tamsulosin in the treatment of lower urinary tract symptoms.

Patients and methods Data were analysed from an open‐label, observational study in which patients were treated with 0.4 mg tamsulosin once daily for 12 weeks. Treatment effects were determined using the Benign Prostatic Hyperplasia Impact Index, the quality‐of‐life question of the International Prostate Symptom Score, a similarly phrased question about sexual satisfaction, the maximum urinary flow rate, the postvoid residual urine volume, and the overall efficacy and tolerability. The results were analysed statistically for differences between dosing times, using analysis of covariance for the quantitative variables and logistic regression for the qualitative variables.

Results While no specific recommendation about the dosing time was given in the trial, the retrospective analysis showed that 4420 and 2087 patients received tamsulosin in the morning and evening, respectively. Both groups had similar values for all variables before treatment. The efficacy and tolerability of tamsulosin treatment was also similar in both groups; there were small advantages for morning dosing, which were statistically significant because there were many patients.

Conclusion In contrast to other α‐blockers, night‐time dosing is not necessary to improve the tolerability or efficacy of tamsulosin.
The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy
Authors: Ouyang R.C. , Kenwright D.N. , Nacey J.N. , Delahunt< B.
Published: March 2003

Objective To determine the clinical significance of nondiagnostic small acini showing cellular atypia (atypical small acinar proliferation) in prostatic biopsies of patients with clinical findings suggestive of malignancy.

Patients and methods Of 331 patients who underwent thin‐core biopsy of the prostate over a 30‐month period, 21 (6.3%) had atypical histological features, and of these 17 underwent repeat biopsy. In addition, a further 20 patients with normal histology underwent repeat biopsy for persistent abnormal clinical findings. The incidence and Gleason score of carcinomas subsequently diagnosed in the two groups were compared. The predictive significance of patient age, prostate specific antigen (PSA) level and digital rectal examination (DRE) findings were compared between both patient groups, those in each group subsequently found to have carcinoma, and between patients with malignant or normal repeat biopsies who had either atypical or normal initial biopsies.

Results Nine patients with atypical histology and four with normal histology on initial biopsy were found to have carcinoma on subsequent biopsy (P = 0.036). The site of carcinoma diagnosed in the repeat biopsy frequently differed from that of the initial atypical biopsy. The Gleason primary pattern was not significantly different between the groups. Neither patient age, PSA level nor DRE findings differed between patients with initial normal or atypical biopsy, or in these groups for those in whom carcinoma was subsequently diagnosed. These clinical features did not distinguish between those with carcinoma or normal findings on repeat biopsy who had an initial atypical biopsy, while only PSA level varied significantly in patients with normal or malignant repeat biopsy in the group with an initial normal biopsy.

Conclusion The presence of atypia on initial biopsy is a strong predictor of malignancy in subsequent biopsy specimens.
The use of the diode laser for treating urethral strictures
Authors: Kamal B.A.
Published: March 2003

Objective To evaluate the efficacy of the diode laser as a new tool for treating urethral strictures.

Patients and methods The study comprised 22 patients with urethral strictures; a diode laser was used to circumferentially ablate the scar tissue of the strictures. Through a cystoscope, a 400–600 µm semirigid fibre was used to transmit the laser energy in the direct‐contact mode. The procedure was carried out with the patient under general or spinal anaesthesia, but the last three patients successfully tolerated local anaesthesia. A catheter was then left in place for 1–5 days.

Results The patients were followed for a mean (range) of 26.7 (9–39) months; in the 14 with previously untreated strictures the procedure was successful in 11, with no recurrence during the follow‐up. However, seven of the eight patients with a recurrent stricture after previous internal cold‐knife urethrotomy had a further recurrence, but occurring at longer intervals than after the internal urethrotomy.

Conclusion This experience with the diode laser for treating urethral strictures suggests that it is safe and reliable, especially as the first line of treatment.
Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation
Authors: Peters J.L. , Thompson A.C. , Mcnicholas T.A. , Hines J.E.W. , Hanbury D.C. , Boustead G.B.
Published: March 2003

Objective To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation.

Patients and methods A retrospective questionnaire was sent to 100 patients who had undergone transrectal biopsy between January and August 1998. Levels of patient acceptability and satisfaction were assessed using visual analogue scales (VAS, with a maximum score of 10 being the least satisfactory or acceptable) and direct questions about the side‐effects of the procedure. A subsequent prospective study was undertaken on 130 patients undergoing transrectal biopsy with sedation between January 1999 and January 2000.

Results The mean score for patient discomfort with sedation was 1.5, compared with 3.5 with no sedation. The overall satisfaction score improved from 3.1 to 0.9 with sedation. Complication rates were comparable, although slightly higher overall in the prospective group.

Conclusion Sedation can significantly reduce patient discomfort and make the transrectal biopsy a more satisfactory experience for the patient. This is particularly important in the proportion of men who need to be considered for repeat biopsies.
The use and efficacy of the American Urological Association Symptom Index in assessing the outcome of urethroplasty for post‐traumatic complete posterior urethral strictures
Authors: Aydos M.M. , Memis A. , Yakupoglu Y.K. , Ozdal O.L. , Oztekin V.
Published: March 2003

Objective To determine if the American Urological Association (AUA) Symptom Index is an accurate and reliable instrument for use in assessing the outcome after urethroplasty.

Patients and methods The AUA Symptom Index questionnaire was answered by 33 men (mean age 31.3 years) who underwent end‐to‐end urethral reconstruction after complete urethral disruption; the index was completed at a mean of 6 months after surgery. The scores were then correlated with maximum flow rates (Qmax) and presence of re‐stenosis on retrograde urethrography.

Results The initial mean (sd) AUA score was 10.42 (9.6) and the Qmax 22.12 (9.37) mL/s. Of the 33 patients, six (18%) had re‐stenosis, with a mean score of 30 and Qmax of 6 mL/s. There was a significant inverse correlation between the AUA symptom score and Qmax (r = − 0.401, P < 0.05).

Conclusion The AUA Symptom Index is inversely correlated with Qmax and may indicate the presence of re‐stenosis after urethroplasty. The AUA score can thus be used as a cost‐effective and easy method in the first‐line screening of the outcome of urethroplasty.
Frequency and spectrum of Malassezia yeasts in the area of the prepuce and glans penis
Authors: Mayser P. , Schütz M. , Schuppe H.‐C. , Jung A. , Schill W.‐B.
Published: March 2003

Objective To investigate the frequency and spectrum of lipophilic Malassezia yeasts within the area of the glans penis and preputial space in healthy men, most of whom were uncircumcised.

Subjects and methods As the glans penis and the prepuce are abundant in sebaceous glands, 130 clinically healthy men were examined for the presence of Malassezia spp. Two impression preparations each were made on modified Dixon (mDixon) and Leeming‐Notman agar. The media were used with no added cycloheximide to allow the identification of the full spectrum of Candida yeasts. After 10 days of incubation at 32 °C Malassezia and Candida yeasts were differentiated by micromorphological and biochemical criteria.

Results
Malassezia spp. were found as part of the microflora of the glans penis in 49% of the men. The two media yielded comparable results for isolation frequency and spectrum: On mDixon agar, 47.6% of the isolates were identified as M. sympodialis, 42.8% as M. globosa, 4.8% as M. pachydermatis and 2.4% as M. furfur. Candida spp. (especially C. albicans) were found in 20.8%. There were no significant differences in the distribution of different Malassezia spp with age.

Conclusions
Malassezia yeasts may belong to the resident microflora of the male genital region, which is supported by the finding that free sebaceous glands (‘Tyson's glands') normally occur at this site. They may also be involved in pathological processes of the glans penis, e.g. balanitis, seborrheic eczema or psoriasis.
Survival in patients with rare subtypes of renal cell carcinoma
Authors: Grabowski M. , Huzarski T. , Lubinski J. , Sikorski A.
Published: March 2003

Objective To evaluate the survival of patients with rare malignant histological subtypes of renal cancer.

Patients and methods The Heidelberg classification of renal cell carcinoma (RCC) divides tumours into clear cell carcinoma (CCC), papillary cancer (PC), chromophobic cancer (ChC) and collecting duct carcinoma (CDC). Sarcomatoid tumours are in a different subgroup treated as a final stage of histological progression. Between 1990 and 1997, 319 nephrectomies were undertaken because of RCC in 317 patients. In 42 patients (13%) the pathological findings showed other than CCC; in 13 PC was confirmed histologically, in nine ChC, in 11 a mixed type of CCC and sarcomatoid type, in seven a sarcomatoid tumour and in four, CDC.

Results One patient of the 13 with PC and two of the nine with ChC died. The worst prognosis was in those with CDC, CCC‐sarcomatoid and sarcomatoid tumours, as all these patients died.

Conclusion The histopathological differentiation of RCC into subtypes gives additional useful prognostic information.
Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy
Authors: Floratos D.L. , Sonke G.S. , Rapidou C.A. , Alivizatos G.J. , Deliveliotis C. , Constantinides C.A. , Theodorou C.
Published: March 2003

Objective To evaluate the comparative effectiveness of electromyographic (EMG) biofeedback with verbal instructions as learning tools of pelvic muscle exercises (PMEs) in the early management of urinary incontinence after radical prostatectomy.

Patients and methods Forty‐two consecutive patients (mean age 64 years, sd 4.2), with urinary incontinence after radical retropubic prostatectomy for localized prostate cancer, were randomized to receive biofeedback (group A, 28 men) or verbal feedback (group B, 14 men) as learning tools for PMEs immediately after catheter removal. Group A received 15 sessions of EMG biofeedback (three times weekly, 30 min each) and group B verbal instructions. Evaluation at baseline and 1, 2, 3 and 6 months included the 1‐h pad‐test and a questionnaire (number of pads/day and incontinence episodes).

Results By the last follow‐up, 27 patients had received biofeedback and 15 verbal instructions. Data were analysed according to the intention‐to‐treat principle. Urine loss as assessed by the 1‐h pad‐test at baseline, 1, 2, 3 and 6 months was 39, 18, 7, 4 and 3 g for group A and 31, 11, 3, 1 and 0 g for group B, respectively (P > 0.05). The number of pads/day was 3.9, 3.4, 1.2, 0.8 and 0.4 for group A and 3.6, 1.8, 0.9, 0.4 and 0.2 for group B, respectively (P > 0.05). The overall continence rate at 6 months was objectively (urine loss > 1 g) 91% and subjectively (0–1 pad/day) 95%.

Conclusion Intensive verbal instructions and biofeedback were both very effective behavioural methods and learning tools for PMEs in the early management of urinary incontinence after radical prostatectomy.
Stromal and acinar components of the transition zone in normal and hyperplastic human prostate
Authors: Chagas M.A. , Babinski M.A. , Costa W.S. , Sampaio F.J.B.
Published: March 2003

Objective To analyse the histological components of the transition zone in both normal human prostate and benign prostatic hyperplasia (BPH), and to determine the volumetric density (Vv) of the different elements (connective tissue, smooth muscle cells, acini and total stroma).

Materials and methods Samples of BPH tissue from the transition zone were obtained from 16 patients with clinical symptoms of bladder outlet obstruction who underwent open prostatectomy. The control samples comprised 16 transition zone samples from prostates obtained during necropsy of adults aged < 30 years (killed in accidents). The Vv of these components was determined by stereological methods.

Results The mean (sd) Vv in the controls and BPH samples were, respectively: connective tissue 40.47 (5.16) and 46.71 (9.91)%; smooth muscle cells 24.86 (2.74) and 31.56 (5.49)%; acini 28.73 (6.25) and 17.78 (10.87)%; all differences were statistically significant.

Conclusions These results confirm the hypothesis that in BPH there is an increase in the stromal component, both smooth muscle fibres and connective tissue.
The role of serial free/total prostate‐specific antigen ratios in a watchful observation protocol for men with localized prostate cancer
Authors: Do V. , Choo R. , De Boer G. , Klotz L. , Danjoux C. , Morton G. , Szumacher E. , Fleshner N. , Bunting P.
Published: March 2003

Objective To examine the change in the free/total prostate specific antigen ratio (f/tPSA) with time and to assess the potential value of serial measurements of f/tPSA as a determinant of disease progression in untreated, low‐to‐intermediate grade prostate cancer (T1b‐T2b N0M0, Gleason score  7 and PSA  15 ng/mL).

Patients and methods In a prospective single‐arm cohort study from November 1995, patients were conservatively managed with watchful observation alone unless they met arbitrarily defined criteria (clinical, histological and biochemical) of disease progression. Patients were followed regularly and underwent blood tests including PSA and f/tPSA. The initial and mean f/tPSA and the rate of change of f/tPSA with time were evaluated against the rate constant for the PSA doubling time (PSATd). Correlation analyses were used to evaluate any association between baseline clinical variables and either the rate of change of f/tPSA or initial f/tPSA.

Results As of December 2000, 161 of a total of 206 accrued patients had three or more f/tPSA measurements and formed the basis of the study (median age 70 years; median follow‐up 2.7 years). The median initial f/tPSA was 0.16; there was a significant negative correlation between this value and the initial total PSA. The mean f/tPSA and rate of change of f/tPSA with time were significantly negatively correlated with the rate constant for PSATd. Also, the rate of change of f/tPSA correlated negatively with clinical T stage, but not with other baseline variables, including initial PSA, age and Gleason score.

Conclusion The f/tPSA in men with untreated, clinically localized prostate cancer varied widely. The negative correlation between the rate of change of f/tPSA with time and rate constant for PSATd suggests that both might provide valuable information to allow clinicians to develop a strategy for optimizing the timing of therapeutic intervention for those patients choosing watchful observation alone.
Risk factors for developing renal stones in inflammatory bowel disease
Authors: McConnell N. , Campbell S. , Gillanders I. , Rolton H. , Danesh B.
Published: March 2003

Objective To correlate renal calculi and other clinical factors with urinary biochemical analytes in patients with inflammatory bowel disease, and to investigate the relative importance of hyperoxaluria (associated with fat malabsorption) or reduced stone inhibitors in the development of calculi in these patients.

Patients, subjects and methods Samples were obtained from 25 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects (controls). Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography. Urine oxalate and citrate were analysed using commercial enzymatic assays; magnesium was measured using atomic absorption and other analytes assayed using standard methods on automated analysers.

Results Renal calculi were found in two patients with CD and in none with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in those with UC. Analysis of covariance showed an association between low urinary citrate/creatinine ratio and renal stones (P=0.02), and between a combined urinary citrate and magnesium deficit relative to calcium, as expressed in the CMC index ((citrate×magnesium)/calcium), and renal stones (P=0.017). Changes in urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not associated with the presence of stones. There was no independent relationship between any clinical factor and the presence of stones.

Conclusion Lower urinary concentrations of magnesium and citrate (stone inhibitors), relative to calcium (stone promoter; the CMC index) may be more important in lithogenesis in inflammatory bowel disease than is hyperoxaluria. In patients with a functioning colon, a low CMC index may predict likely stone‐formers; this requires a prospective evaluation. Avoiding low urinary levels of magnesium and citrate may aid in preventing and treating renal calculi.
Penile fracture in Kermanshah, Iran: the long‐term results of surgical treatment
Authors: Zargooshi Javaad
Published: March 2003

Objective To determine the long‐term outcome of the surgical management of penile fracture.

Patients and methods In all, 170 patients (mean age 27 years, sd 13, median 24, range 13–80) with penile fracture undergoing surgery between April 1990 and December 2000 were reviewed. In addition to a history, physical examination and hospital records, long‐term potency (> 6 months after surgery) was evaluated using the patients' self‐rated assessment of erectile function and the International Index of Erectile Function (IIEF‐5) questionnaire. The results were correlated with the surgical findings. A control group of 200 men also self‐rated their erectile function and completed the IIEF‐5. For those patients who presented with their partners, the partner's satisfaction with erections was also evaluated. The mean (median, range) follow‐up after injury was 53 (61, 6–132) months.

Results Satisfactory and painless erectile function with a soft straight penis was reported by 162 patients (95.2%). Complications occurred in eight patients (4.7%), of whom seven developed a mild (four) to moderate (three) penile curvature; five had penile nodules and four reported mild paresthesia over the scar line. Mild and moderate erectile dysfunction (ED) was reported by five and three patients, and four and five of controls, respectively (P > 0.05). There was no difference between the surgical findings of six patients with complications and those of the remaining 162. However, in the two remaining cases extensive injury was associated with moderate ED after surgery. Of eight patients with ED, seven responded to intracavernosal injection with papaverine/phentolamine. Erectile function returned within a mean (range) of 2 (1–5) days and coitus was possible ≈ 2 weeks after the repair. Of the patients' partners, 94.1% reported satisfaction with erections and only one reported de novo dyspareunia. Penile fracture was not associated with an increased risk of ED (odds ratio 0.95; 95% confidence interval, 0.35–2.53). In sexually active participants, the mean (sd, range) IIEF‐5 score for 162 patients was 23.2 (2.7, 13–25) and not significantly different from that for the 194 controls, at 22.8 (2.1, 11–25). However, patients had higher scores than controls for erectile firmness and maintenance ability (P < 0.05).

Conclusions Surgery for a fractured penis is safe and effective, restoring erectile function to that of controls. Surgical treatment is very satisfactory for patients and partners. Considering these encouraging results, surgical intervention is strongly recommended.
Does monosymptomatic enuresis exist? A molecular genetic exploration of 32 families with enuresis/incontinence
Authors: Loeys B. , Hoebeke P. , Raes A. , Messiaen L. , De Paepe A. , Vande Walle J.
Published: March 2003

Objectives  To confirm linkage to microsatellite markers on chromosome 8q, 12q, 13q and 22q in families with nocturnal enuresis/incontinence segregating with an autosomal dominant pattern, and to determine if there is an association between the clinical subtype and these linked loci.

Patients and methods

 Families with at least three members with nocturnal enuresis in two generations were included in the study. The index patient was  7 years old and had evidence of bladder dysfunction; all other family members were  5 years old. Bladder dysfunction in the index patients was documented by video‐urodynamics when indicated. A nycthemeral rhythm of diuresis was documented in all index patients. The clinical diagnosis of all family members was based on a questionnaire on voiding problems and micturition habits, uroflowmetry, measurement of functional bladder capacity and nocturnal diuresis. Linkage was analysed using an autosomal dominant model with a gene frequency equal to 0.05 and a penetrance of 0.9.

Results  Thirty‐two families with nocturnal enuresis/incontinence (one with four, 25 with three and six with two generations) were included. The mean number of persons included per family was 10 and on average five members were symptomatic. Linkage of nocturnal enuresis to a region on chromosome 22q11 was found in nine families, to 13q13–14 in six and to 12q in four. There was no convincing evidence for linkage to chromosome 8q. Clinical findings in the proband and their family members with possible linkage to a given locus were heterogeneous, and hence no clear genotype/phenotype correlation could be postulated.

Conclusion  These findings support the hypothesis of the genetic and phenotypic heterogeneity of nocturnal enuresis/incontinence. Putative linkage was confirmed to the same chromosomal loci as in previous studies of ‘monosymptomatic’ enuresis and different phenotypes were linked to the same loci.
Anterior prostate cancer: is it more difficult to diagnose?
Authors: Bott S.R.J. , Young M.P.A. , Kellett M.J. , Parkinson M.C. ,   Contributors to the UCL Hospitals' Trust Radical Prostatectomy Database
Published: March 2003

Objective To determine whether anterior prostatic tumours are adequately sampled using the Stamey sextant protocol, as a fifth of prostate cancers are anterior in distribution at radical prostatectomy.

Materials and methods All tumours (62) with an anterior distribution (75% of the tumour anterior to the urethra) on radical prostatectomy whole‐mounts, and in which the number and results of the sextant biopsies were available, were extracted from a prostate cancer database. Sixty‐one posterior tumours (75% of the malignant tissue posterior to the urethra) and their corresponding sextant biopsies were also retrieved for comparison. The number of biopsy sessions, the number of cores involved and the summated tumour length were recorded, together with the prostate gland weight, the tumour volume and the site of 75% of tumour in the superior‐inferior axis.

Results Anterior tumours required significantly more biopsy sessions to diagnose prostate cancer than posterior neoplasms (anterior, one set 47; > one set 15; posterior, one set 57; > one set, four, P=0.007). Anterior tumours had fewer cores with tumour involvement and less summated tumour length than had posterior cancers. The mean (sd) number of positive cores was; anterior 1.8 (1.01), posterior 2.50 (1.30) (P=0.001); the summated tumour length was; anterior 5.05 (4.10) mm, posterior 9.25 (7.80) mm (P<0.001). There was no significant difference in gland weight (mean anterior 43.8 g; posterior 48.3 g, P=0.3) or tumour volume (mean anterior 1.85 mL; posterior 1.49 mL, P=0.11) between the groups. There was no significant difference between the incidence of anterior and posterior neoplasms with respect to their position in the superior‐inferior axis (P=0.96).

Conclusions Anterior prostate tumours account for 21% of all prostate cancers. They more often require multiple sets of sextant biopsies for diagnosis, and yield smaller areas of cancer on core biopsies than do posterior tumours in glands of similar weight and tumour volume. If prostate cancer is suspected clinically but biopsies are negative, targeting the anterior gland at subsequent prostatic biopsy should be considered.
The prevalence and predictors of psychological distress in patients with early localized prostate cancer
Authors: Bisson J.I. , Chubb H.L. , Bennett S. , Mason M. , Jones D. , Kynaston H.
Published: March 2003

Objective  To determine the level of psychopathology, traumatic distress and quality of life in men with newly diagnosed clinically localized prostate cancer, the effect on these of a consultation in a combined‐specialist early‐prostate clinic, and predictors of psychopathology.

Patients and methods  Eighty‐eight patients were recruited from the combined clinic; they completed a battery of questionnaires including the Hospital Anxiety and Depression Scale (HADS), the revised Impact of Event Scale (IES) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, before their first appointment. Two weeks later they completed the HADS, IES and a patient‐satisfaction survey.

Results  The overall level of psychopathology varied among the questionnaires used, from 0% on the HADS depression scale, 8% on the HADS anxiety scale and 14% on the IES. Anxiety and traumatic stress symptoms were commoner than depressive symptoms. The quality‐of‐life scores showed a relatively good level of functioning. Pre‐morbid factors and disease status did not predict psychological distress. Younger age was mildly predictive of poorer psychological functioning. Anxiety symptoms reduced slightly after a joint clinic appointment, whereas depressive symptoms showed a slight increase.

Conclusion  This study suggests that men with early localized prostate cancer have low levels of psychopathology overall. However, some men experience distressing psychological symptoms and it is important that future research is conducted to help develop clear guidelines on the optimal methods of detecting and managing men with prostate cancer who have mental health difficulties.
Detrusor after‐contractions in children with normal urinary tracts
Authors: Ruarte A.C. , Podestá M.L. , Medel R.
Published: March 2003

Objective To assess the clinical significance of after‐contractions (A‐Cs) in children with normal urinary tracts.

Patients and methods Urodynamic records obtained in 315 children with urinary infection or enuresis were reviewed retrospectively; 184 were selected for analysis of A‐Cs. All patients had normal urinary tracts and none showed signs of an overt neuropathy. The urodynamic method comprised standard measurements of pressures and flowmetry (42 had video‐urodynamic studies).

Results After‐contractions occurred in 151 of the 184 patients; the incidence tended to decrease with age. The mean amplitude of the A‐Cs was 77.9 cmH2O; in 36% of the records it was higher than the voiding contraction. Residual urine was found in 12 of 151 records with A‐Cs, but in only one patient was such residual urine confirmed in control voids. The patterns were assessed in 131 patients: in 36% they resembled stop‐test responses, in 31% they were preceded by brief peaks of pressure or had jagged limbs, and in 33% they were grossly irregular. In 137 records the content of the bladder was estimated at the start of A‐Cs; in 51% the bladder was empty or had evacuated >95% of its content, in 39% 95–80% and in 10% <80%. In only 7% of the patients had the A‐Cs started after the voiding contraction had completely subsided. There was no difference in the incidence of A‐Cs in girls with enuresis (84%) and girls with a history of urinary infections (85%). Detrusor instability was detected in 81% of the children with A‐Cs and in 70% of those without; there was no correlation between the amplitudes of uninhibited detrusor contractions and of A‐Cs. Characteristic images of external sphincter activity were found in only three of 14 video‐urodynamic recordings with A‐Cs.

Conclusions After‐contractions are common in children with normal urinary tracts but they tend to disappear with age. In clinical urodynamics they are of limited practical use because their appearance is unpredictable and there are artefacts related to recording the final phase of micturition. The relationship with detrusor instability may be explained as a coincidence of two common but unrelated findings, and A‐Cs are unrelated to urinary infection. External sphincter activity is not the only cause of A‐Cs and when it occurs it does not alter the course of voiding, as it does in neuropathic dysfunctions. As their clinical significance is uncertain, treatment of A‐Cs is not advocated.
Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis
Authors: Yeung C.K. , Sit F.K.Y. , To L.K.C. , Chiu H.N. , Sihoe J.D.Y. , Lee E. , Wong C.
Published: March 2003

Objective To evaluate the diurnal and nocturnal bladder reservoir function in patients with refractory primary nocturnal enuresis (PNE).

Patients and methods Ninety‐five children (68 boys, 27 girls, mean age 9.3 years) with significant PNE (3 wet nights/week) that was refractory to treatment with desmopressin ± an enuretic alarm were assessed using detailed recording of voiding frequency and urinary volume both day and night, natural filling cystometry during the day and continuous cystometry with simultaneous electroencephalogram monitoring during sleep at night.

Results Patients could be broadly categorized into two groups. Group A comprised those with normal daytime urodynamics and functional bladder capacity (FBC) on detailed frequency‐volume recording, but who developed marked detrusor instability associated with a significant reduction in nocturnal FBC and small‐volume voiding only after sleep at night (33 patients, 35%); and group B, those with abnormal daytime urodynamics and with reduced FBC and small‐volume voiding both day and night, but who somehow managed to mask their bladder symptoms during the day (62 patients, 65%). There was no evidence of nocturnal polyuria in either group and the ratios of day : night urinary output volumes for type A and type B patients were 1.48 and 1.99, respectively.

Conclusions A reduction in nocturnal FBC, either occurring only after sleep at night in association with the appearance of detrusor instability in patients with normal daytime urodynamics and FBC, or as a manifestation of occult voiding dysfunction or bladder outlet obstruction that affects the bladder reservoir function both day and night, appears to be a common factor and probably the main cause for a mismatch between nocturnal urine output and bladder storage capacity in patients with severe bed‐wetting that was refractory to treatment.
Radical prostatectomy in Britain and Ireland at the millennium
Authors: Ravichandran S. , Dasgupta P. , Booth C.M.
Published: March 2003

Objective  To report a national questionnaire survey of all consultant urologists, providing a ‘snapshot’ of attitudes, current practice and referral patterns for radical prostatectomy (RP) in Britain and Ireland at the millennium.

Methods  During 1999/2000 a simple questionnaire about RP was sent to the 487 urologists registered as full BAUS members. From 418 (86%) returns nine were excluded, to leave a study group of 409 urologists.

Results  In all, 157 (38%) consultants were undertaking RP, whilst 252 (62%) were not; 29 (18.5%) performed > 20 operations/year, 44 (28%) undertook 11–20, but 84 (53.5%) carried out ≤ 10. During the survey period, 741 (51%) RPs were conducted in teaching hospitals and 724 (49%) in district general hospitals. Of the 252 not undertaking RP, 23 (9%) stated they wished to learn the technique.

Conclusions  This questionnaire suggests that the number of urologists undertaking RP in the UK and Ireland has stabilized but confirms that over half perform ≤ 10/year; outcome data are now required. Any change towards concentrating cases will have significant consequences for patient distribution and resources.
Intravesical pH: a potentially important variable affecting efficacy and the further development of anthracycline chemotherapy for superficial bladder cancer
Authors: Harris N.M. , Duffy P.M. , Crook T.J. , Anderson W.R. , Sharpe P. , Hayes M.C. , Cooper A.J. , Solomon L.Z.
Published: March 2003

Objective  To assess, using epirubicin‐sensitive and multidrug resistant (MDR) derivatives of human bladder cancer cell lines in vitro, the probable effect of intravesical pH changes, with and without the MDR antagonist verapamil, on the uptake, intracellular distribution and cytotoxicity of epirubicin during intravesical chemotherapy.

Materials and methods  Incubations for cytotoxicity testing were carried out in buffered medium containing epirubicin, at pH values of 6.0–8.5, with verapamil where appropriate. The cytotoxicity of epirubicin, with and without verapamil, was determined using the tetrazolium cytotoxicity assay. Intracellular epirubicin fluorescence was assessed using flow cytometry and confocal microscopy. Flow cytometric total intracellular epirubicin fluorescence was measured at pH 6.0, 6.4, 6.8, 7.2, and 7.6, and confocal microscopy was carried out at pH 6.0 and 8.0. The MDR‐reversing agent verapamil was added at 100 µg/mL to some incubations.

Results  Epirubicin cytotoxicity in resistant cell lines appears considerably enhanced by adding verapamil and further improved, especially in MDR cells, by alkalinization of the drug solution to pH 8.0. Flow cytometry results showed striking and consistent differences in epirubicin handling with pH. Sensitive cells can be induced to absorb considerably more drug at alkaline pH, whilst resistant cells show no such behaviour. Nuclear drug fluorescence was greater in sensitive cells at alkaline pH, but cytoplasmic drug fluorescence in the resistant cells was little changed by pH. Adding verapamil to resistant cells restored the sensitive phenotype of drug handling.

Conclusion  Buffering epirubicin to an alkaline pH before intravesical application should increase its intrinsic cytotoxicity. The potential for synergy at certain drug combinations will be enhanced by applying these findings. MDR reversal and fatty acid augmentation of drug uptake are discussed as examples.
Prostatitis‐like symptoms: one year later
Authors: Nickel J.C. , Downey J.A. , Nickel K.R. , Clark J.M.
Published: March 2003

Objectives  To re‐survey (after 1 year) men identified in 1999 as having perineal and/or ejaculatory pain/discomfort severe enough to suggest a clinical diagnosis of chronic prostatitis (using the National Institutes of Health‐Chronic Prostatitis Symptom Index, NIH‐CPSI), and to compare them with an age‐matched population of men who had no prostatitis‐like symptoms in the initial survey, to determine the effect of time on specific symptoms associated with the diagnosis of chronic prostatitis.

Subjects and methods  A comprehensive questionnaire incorporating the pain and voiding domains of the NIH‐CPSI, and data on demographics, medical history, socio‐economic status, health‐seeking behaviour and a quality of life assessment, was sent to 67 men who had reported prostatitis‐like symptoms in the 1999 survey, and to 202 age‐matched controls (1 : 3) who reported no prostatitis‐like symptoms in the same survey.

Results  Forty men (60%) with previous prostatitis‐like symptoms, i.e. a mean (sd) 1999 NIH‐CPSI pain score of 8.8 (0.4), and 119 (59%) of the control population completed and returned the survey. There was no difference in the 1999 demographics (P = 0.82) or NIH‐CPSI pain score (P = 0.49) between patients who returned the recent questionnaire and those who could not be located or declined to complete the survey. Fifteen men (38%) identified with prostatitis in 1999 did not report similar symptoms in 2000. The initial mean NIH‐CPSI pain score (0–21) for the men who had resolution of their prostatitis‐like symptoms was 7.5 (0.6); 1 year later it was 0.73 (0.3). Their mean age was 51.1 (3.9) years and mean duration of symptoms 1.1 (0.3) years. Those with persistent symptoms had an initial NIH‐CPSI pain score of 9.6 (0.5); 1 year later it was 8.68 (0.4), at mean age of 51.4 (2.5) years and duration of symptoms 2.2 (0.3) years. Four men (3%) in the control group who had no symptoms in 1999 reported prostatitis‐like symptoms in 2000; these men had a mean age of 52.5 (5.9) and NIH‐CPSI pain score of 7.0 (0.9).

Conclusion  About a third of men reporting prostatitis‐like symptoms in the general population had resolution of their symptoms (usually those with a shorter duration and less severe symptoms) 1 year later. The severity of symptoms of men with persistent chronic prostatitis remained relatively unchanged over the year.