bluuebunny/crossref_metadata_2025 huggingface dataset:
The heat is on — but how? A comparison of TUMT devices
Authors: Bolmsjö M. , Wagrell L. , Hallin A. , Eliasson T. , Erlandsson B‐E. , Mattiasson A.
Published: November 2003

Objective To compare the heat characteristics of the microwave antennae, the absorbed energy in the target volume and the cooling capacity of the catheters of three common devices for transurethral microwave thermotherapy (TUMT), i.e. the Prostcare, Prostatron and ProstaLund.

Materials and methods The microwave emission from the respective catheters or antennae was measured in a tissue‐equivalent ‘phantom’ prostate. From these measurements the distribution of absorbed energy from the respective catheters and antennae was calculated from the characteristics of the phantom, the absorbed energy and the temperature difference before and after heating. The cooling capacity of the different catheters were measured by submerging each catheter in a thermally isolated water bath at a known temperature and determining the cooling of the water bath caused by the catheter.

Results The design of the microwave antenna influenced the heating profile significantly. The energy absorbed by the prostate model varied among the devices, but was between 13 and 21% of the stated applied energy. The cooling capacity also varied, being least in the Prostcare and greatest in the ProstaLund catheters.

Conclusions Users of TUMT should be aware of possible back‐heating along the catheter, as this limits the microwave power that can be used safely. Furthermore, the ‘treatment energy’, which is commonly used as an indicator to describe the intensity of TUMT treatments, is ambiguous and not stringent, in that the microwave energy absorbed in the prostate is only a small fraction of this value.
Peri‐urethral silicone microimplants (Macroplastique ) for the treatment of genuine stress incontinence
Authors: Harriss D.R. , Iacovou J.W. , Lemberger R.J.
Published: November 2003

Objective To establish the safety and efficacy of the peri‐urethral injection of silicone microimplants (Macroplastique ) for the treatment of genuine stress incontinence in women.

Patients and methods Forty women (median age 50 years, range 27–74) with genuine stress incontinence confirmed on medium‐fill video‐cystometry were recruited to the study. Macroplastique (3–7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points ‘around the clock’ under cystoscopic control. Where possible, the urodynamic study was repeated after 3 months. Results were graded as excellent (dry, no protection), good (better, but not totally dry) or poor (no improvement).

Results Three months after a single injection, 16 (40%) were completely dry, 13 (33%) were improved and 11 (27%) were no better. Four patients who were improved were rendered dry by a second injection. After 3 years, 16 (40%) remained completely dry, seven (18%) were improved and 17 (42%) required alternative treatment with a Stamey bladder neck suspension. Dysuria for 48 h occurred in almost all patients; two were catheterized overnight and one required a catheter for 6 weeks. A comparison of maximum voiding pressures and flow rates before and 3 months after a single injection of Macroplastique revealed no urodynamic evidence of obstructed voiding (n=25).

Conclusion Injectable silicone microimplants produced a good to excellent result in 73% of patients in the short‐term and 58% of women maintained this response after 3 years. The injection is a day‐case procedure which provides a satisfactory medium‐term outcome in over half of patients with genuine stress incontinence. There are few side‐effects and those patients with no improvement may go on to be treated by open surgery without complication.
The effect of radiotherapy on urethral obstruction from carcinoma of the prostate
Authors: Wells P. , Hoskin P.J. , Towler J. , Saunders M.I. , Dische S.
Published: November 2003

Objective To assess the impact of radiotherapy on the relief of complete bladder outlet obstruction requiring catheterization secondary to prostatic carcinoma.

Patients and methods From a consecutive series of 151 patients treated with radiotherapy for localized carcinoma of the prostate, 19 (12.6%; median age 72 years, range 59–83) who had an indwelling catheter in situ at the time of irradiation because of urinary retention, were analysed retrospectively and grouped according to the stage and grade of tumour and the irradiation dose delivered.

Results The catheter was removed following radiotherapy in all but two patients, who both had stage 4 tumours, and normal urinary function was restored. The grade and stage of tumour did not influence the duration of catheterization. The median time from completion of radiotherapy to catheter removal was 10 weeks (range 0–46). Recatheterization was required in two patients at 3 and 64 months after radiotherapy and three patients, including these two, required transurethral prostatectomy (TURP) to relieve outlet obstruction.

Conclusion Prostatic radiotherapy is effective in relieving bladder neck obstruction caused by prostate cancer. Most patients will achieve normal urinary function without requiring TURP after treatment.
Assessment of germ‐cell kinetics in the testes of patients with varicocele using image analysis of immunostained proliferating cell nuclear antigen
Authors: Tanaka H. , Fujisawa M. , Okada H. , Arakawa S. , Kamidono S.
Published: November 2003

Objectives To examine the germ‐cell kinetics of varicocele testis using proliferating cell nuclear antigen (PCNA) immunostaining and image cytometry to evaluate the staining intensity, and to compare the proliferative index (PI) of varicocele and normal testes.

Patients and methods Fifty‐six testicular biopsy specimens were taken from 28 patients with varicocele during high ligation. The specimens were fixed and embedded in paraffin, and sections immunostained using an anti‐PCNA antibody. The PI was measured using an image analyser and expressed as the percentage of the total nuclear area stained positively with PCNA monoclonal antibody, assessed from >20 seminiferous tubules. Sections stained with haematoxylin and eosin were used to determine Johnsen's score using conventional microscopy. Normal control testicular biopsies were obtained from subjects undergoing vasectomy.

Results In patients with varicocele, both testes had a significantly lower PI than normal testes; the mean (sd) PI of the right and left testes was 11.3% (4.1) and 11.3% (4.8), respectively, and the PI of normal testes was 21.7% (3.1). There was no significant correlation between PI and sperm concentration or Johnsen's score.

Conclusion PI is useful for assessing germ‐cell kinetics; in patients with varicocele both testes showed a deterioration in DNA synthesis, suggesting that reduced DNA synthesis is one of the causes of spermatogenic dysfunction in the varicocele testes.
Latex allergy in patients with spinal dysraphism: the role of multiple surgery
Authors: Ziylan H.O. , Ander A.H. , Alp T. , Kadioglu T.C. , Esen T. , Besisik T.A. , Cuhadaroglu C.
Published: November 2003

Objective To investigate whether multiple surgery is responsible for the high prevalence of latex hypersensitivity in patients with spinal dysraphism by comparing the results of a skin‐prick test in three groups of patients with different surgical histories.

Patients and methods An in vivo diagnostic kit was used to determine the sensitivity to latex using a skin‐prick test in three groups of patients, 23 with spinal dysraphism who had undergone surgery, 20 patients who had undergone non‐urological surgery and urological patients who had not undergone surgery (control). There was no history of latex allergy in any individual from the three groups.

Results The skin‐test was positive in six patients with spinal dysraphism, in one who had undergone previous non‐urological surgery and in none of the control patients. The prevalence of latex hypersensitivity was significantly higher in patients with spinal dysraphism than in the other groups (non‐urological surgery P <0.05 and control P<0.01). This difference occurred despite the patients in each surgical group having undergone a mean of less than two operations. There was no significant difference in latex sensitivity between control patients and those undergoing non‐urological surgery.

Conclusion Despite having no history of latex hypersensitivity, about a quarter of patients with spinal dysraphism were sensitive to latex. Repeated surgery alone cannot be responsible for the greater incidence of latex hypersensitivity in these patients. Despite multiple surgery being accepted as playing a major role in the development of latex hypersensitivity, relatively fewer surgical episodes than reported previously seem to be sufficient to elicit latex allergy.
The conservative treatment of phimosis in boys
Authors: Golubovic Z. , Milanovic D. , Vukadinovic V. , Rakic I. , Perovic S.
Published: November 2003

Objective To further test the application of topical steroids in boys referred to a paediatric surgical practice with pathological, non‐retractable foreskins diagnosed as phimosis.

Patients and methods This prospective study comprised two groups of 20 boys each (mean age 4.1 years, range 3–6) diagnosed as having phimosis; twice daily, a topical steroid (0.05% betamethasone cream) was applied on the narrowed preputial skin in the first group and a neutral cream (Vaseline) in the second (control) group. Patients were treated for 4 weeks and the retractability of the foreskin and any side‐effects assessed.

Results Good retraction of the foreskin was achieved in 19 patients treated with betamethasone cream and the response was unsatisfactory in 16 patients from the control group; these 16 boys and one 6‐year‐old boy treated with betamethasone were circumsized. There were no side‐effects or problems after the application of either cream.

Conclusion Treatment with 0.05% betamethasone cream is a simple and safe method for the treatment of phimosis in boys older than 3 years. An early operation is necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed. We strongly support the saying, ‘The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner’.
Endoscopic laser ablation of the prostate (ELAP): changes in magnetic resonance imaging and clinical outcome at 1 year
Authors: Flynn R.J. , DeSouza N.M. , Puni R. , Williams G. , Kiely E.A.
Published: November 2003

Objective To assess the ability of magnetic resonance imaging (MRI) to detect tissue changes immediately after laser ablation of the prostate and to correlate these changes with clinical outcome by detecting changes that may improve the outcome by allowing the laser dosimetry to be adjusted during therapy by monitoring effects on gland morphology.

Patients and methods Eight men with proven bladder outlet obstruction had a standard four‐quadrant laser ablation of the prostate with a side‐firing non‐contact fibre. MRI scans were performed before, during and immediately after treatment and again after one week, 3 months and one year.

Results The clinical outcome was a decrease in the American Urological Association (AUA)‐7 symptom score from a pre‐operative mean of 21.3–12.0 1 year after treatment and a corresponding increase in peak urinary flow rates from a mean of 8.9 mL/s to 12.3 mL/s. Immediately after treatment, MRI showed marked swelling of the gland (mean increase in volume 34%, range 12–75) with the loss of internal architecture. A low‐signal thin periurethral band was present in six of the eight patients after 1 week and was replaced by a wider periurethral ring at 3 months in four of the six patients. No patient had evidence of prostatic cavitation after treatment or a significant reduction in prostate volume at 1 year.

Conclusion MRI can detect tissue changes after laser ablation of the prostate. The marked swelling seen on MRI immediately after laser prostatectomy may explain the delayed improvement in symptoms. The periurethral ring may indicate the depth to which laser energy has an effect on the tissue and could delineate an area of necrosis. The lack of cavitation at one year questions the durability of the effect of laser treatment delivered in this way.
The Whitaker hook in the treatment of posterior urethral valves
Authors: Chandna S. , Bruce J. , Dickson A. , Gough D.
Published: November 2003

Objective To assess the efficacy of the Whitaker diathermy hook in the treatment of posterior urethral valves (PUV).

Patients and methods Seventeen patients with PUV underwent primary treatment under general anaesthesia using a diathermy hook. The results were assessed by the clinical course of the patient, serial measurements of serum creatinine level and repeat cystography 6 weeks and 6 months after treatment.

Results There were no complications in 12 patients and they required no further treatment of the valves. Three patients required a repeat procedure which resolved the urethral obstruction. Two patients continued to show incomplete disruption of the valves and required endoscopic treatment. Two patients developed ureteric obstruction after disruption of the valves, which was treated by supravesical diversion and later reversed with no further treatment of the valves.

Conclusions The Whitaker diathermy hook is a safe and effective instrument which has not gained its rightful place in the treatment of patients with PUV.
Burns to the genitals and the perineum in children
Authors: Michielsen D. , Van Hee R. , Neetens C. , Lafaire C. , Peeters R.
Published: November 2003

Objective To determine the management of perineal and genital burns in children.

Patients and methods Twenty‐seven children (aged 6 months to 12 years) suffering from genital or perineal burns between 1981 and 1995 were reviewed. Most burns occurred in boys (70%), were due to scalds (85%) and caused superficial second‐degree lesions (63%). The initial treatment consisted of topical antimicrobials or grafting with allografts.

Results Spontaneous healing by conservative therapy, not early excision therapy, occurred in 96% of the patients. Contractures occurred in two patients and were treated with multiple Z‐plasties and circumcision.

Conclusion The management of perineal and genital burns in children should be conservative.
A one‐stage dorsal free‐graft urethroplasty for bulbar urethral strictures
Authors: Barbagli G. , Selli C. , Di Cello V. , Mottola A.
Published: November 2003

Objective To report the use of a one‐stage dorsal free‐graft urethroplasty to reduce the incidence of urethrocele.

Patients and methods From 1990 to 1994, 20 men (age range 21–86 years) underwent a one‐stage dorsal free‐graft urethroplasty of bulbar urethral strictures (iatrogenic in 12, traumatic in three, inflammatory in three and unknown in two). All patients except one had been treated previously by optical urethrotomy from one to 14 times.

Results Temporary fistulae were detected on post‐operative urethrography in three patients with particularly long grafts, but they all resolved spontaneously. Within a mean follow‐up of 46 months, only one patient had a short recurrent stricture, which was treated successfully by optical urethrotomy. Two patients complained of post‐voiding dribbling, but radiographic studies never showed graft weakening and the urinary flow rate was always >14 mL/s.

Conclusion Free skin grafts can be applied successfully to the dorsal aspect and by doing so the complications of urethral reconstruction can be reduced.
Cytokeratin 20 as an objective marker of urothelial dysplasia
Authors: Harnden P. , Eardley I. , Joyce A.D. , Southgate J.
Published: November 2003

Objective To investigate the dysregulation of cytokeratin 20 (CK20) expression in urothelial dysplasia and its potential as a diagnostic aid.

Patients and methods Twenty‐two patients were selected on the basis that they had undergone one or more biopsies showing dysplasia before the development of a transitional cell carcinoma (TCC); 15 of these patients also had a prior history of TCC. The dysplasia was classified as mild in 12, moderate in 14 or severe dysplasia/carcinoma in situ in 10 patients, ensuring that a spectrum of morphological appearances was represented. Control biopsies were obtained from seven children undergoing bladder reconstructions and 23 patients with recurrent urinary tract infections, haematuria or functional bladder symptoms, but no history of TCC.

Results The expression of CK20 was restricted to superficial ‘umbrella’ c ells and occasional intermediate cells in the control biopsies, even in the presence of severe inflammation. In 31 of the 36 cases of dysplasia, complete loss of restriction was seen at least focally, with positive expression in all layers of the urothelium.

Conclusion The abnormal expression of CK20 is a reliable, positive marker of urothelial dysplasia in the urinary bladder. Immunostaining for CK20 is therefore a useful adjunct to morphology in the diagnosis of dysplasia, of particular value in the distinction from reactive states where diagnostic difficulties are greatest.
Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia
Authors: Çetinkaya M. , Ulusoy E. , Adsan Ö. , Saglam H. , Öztürk B. , Basay S.
Published: November 2003

Objective To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia.

Patients and methods The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of <15 mL/s. Pre‐operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post‐void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre‐operatively and again 24 h after the operation. Patients were divided randomly into two groups; the first unde rwent a conventional TURP and the second TUEP using 240–300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups.

Results The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform.

Conclusion Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources; further studies with more patients and a longer follow‐up are required to determine the efficacy and safety of this procedure.
A follow‐up study of pre‐natally detected primary vesico‐ureteric reflux: a review of 61 patients
Authors: Bouachrine H. , Lemelle J.L. , Didier F. , Schmitt M.
Published: November 2003

Objective To describe the pre‐ and post‐natal characteristics of primary vesico‐ureteric reflux (VUR) in a retrospective study of babies presenting with VUR suspected from pre‐natal ultrasonography.

Patients and methods Between 1984 and 1994, 61 children (41 boys and 20 girls) with primary VUR were followed for 2 years after the pre‐natal detection of urinary tract anomalies. Patients with VUR secondary to infravesical obstruction and duplex systems were excluded. The mean age at ante‐natal diagnosis was 28.4 weeks of gestation; in 37 the reflux was bilateral and 98 refluxing units were reviewed.

Results According to the international classification of VUR, 8% were grade 1, 32% grade 2, 38% grade 3, 16% grade 4 and 6% grade 5. Twelve patients (22 refluxing units) underwent ureteric re‐implantation. Six kidneys showed renal scars on isotope renography and two nephrectomies were carried out in patients <2 years old; in 40 patients (64 renal units) the VUR resolved spontaneously. Of the latter, eight were grade 1, 20 grade 2, 27 grade 3 and nine grade 4; seven patients (10 refluxing units) are still being followed and awaiting a decision on treatment.

Conclusion This study confirms the predominance of boys in those with ante‐natally suspected VUR. The spontaneous resolution during the first 2 years of life was apparent in most cases, even in those with severe reflux (grade 3–5).
Patient acceptability of transurethral incision of the prostate under local anaesthesia
Authors: Irani J. , Bon D. , Fournier F. , Doré B. , Aubert J.
Published: November 2003

Objective To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia.

Patients and methods The study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and September 1995. Twenty‐two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons. Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance was determined using an immediate post‐operative questionnaire which included a linear visual analogue scale (VAS) to rate pain.

Results No patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean (se) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia.

Conclusion TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for the relief of obstruction in high‐risk patients with a small benign prostatic hyperplasia.
Evaluation of mucinous metaplasia of the prostate gland by mucin histochemistry
Authors: Gal R. , Koren R. , Nofech‐Mozes S. , Mukamel E. , His Y. , Zajdel L.
Published: November 2003

Objective To evaluate the presence of mucinous metaplasia in normal and benign hyperplastic prostates, using stains for neutral and acidic mucins.

Patients, materials and methods Normal prostate glands were removed during the post‐mortem examination of 11 consecutive subjects (median age 45 years, range 17–79) who had died accidentally. Specimens were also obtained from 10 patients (median age 70.2, range 61–82) undergoing suprapubic prostatectomy for prostatic hyperplasia. The specimens were examined histologically; sections were stained using the periodic acid‐Schiff (PAS) method for neutral mucins and the alcian blue (AB) method at pH 2.5 for acidic mucins. The positive sections were also immunostained for high molecular weight cytokeratin (KER), and prostate‐specific antigen (PSA) using the strept‐avidin‐biotin (SAB) method.

Results Mucinous metaplasia was found in six of the normal prostates and in three of the hyperplastic glands. Usually, the cells were tall columnar, containing both AB‐ and PAS‐positive material. The cells were negative both for PSA and KER. Mucinous metaplasia affected all ages, including a 17‐year‐old, and mostly involved the inferior periurethral area.

Conclusion Benign mucinous metaplasia was more frequent than previously appreciated, involved all ages, was mainly periurethral and did not correlate with the usual distribution of adenocarcinoma of the prostate.
A retrospective study of the investigation and management of muscle‐invasive bladder cancer in the South West Region
Authors: Dickinson A.J. , Howe K. , Bedford C. , Sanders T. , Prentice A. , Sibley G.N.A.
Published: November 2003

Objective To evaluate the present management of muscle‐invasive bladder cancer in the South West Region and to assess the workload resulting from the rationalization of treatment in specific centres.

Methods A retrospective survey was undertaken in all the hospitals in the South West Region, to assess the management of all patients presenting with muscle‐invasive bladder cancer in the years 1989 and 1993. Data were collected from histopathology records and hospital in‐patients' notes. The optimum standard of assessment and treatment were defined by a panel of specialists in urological tumours. The management of patients was compared against these defined standards.

Results A total of 186 and 199 patients in 1989 and 1993, respectively, were evaluated. When comparing their assessment against the defined standard, only 69% of patients in 1989 and 58% in 1993 had an intravenous urogram, with 7% and 4%, respectively, having no upper tract imaging (the remainder undergoing ultrasonography). Evidence from an examination under anaesthetic (EUA) was found for 80% of patients in 1989 and 84% of patients in 1993. Only 23% of patients in 1989 and 36% in 1993 were staged by either computed tomography or magnetic resonance imaging. In both 1989 and 1993, 54% of patients had definitive treatment, 31% had an endoscopic follow‐up only and 15% had no treatment; there were no differences in age or co‐morbidity among these groups. The median time elapsed between referral and diagnosis was 59 days (1989) and 52 days (1993), and the median delay to definitive treatment was 114 and 96 days, respectively.

Conclusion There was insufficient upper tract imaging, poor clinical staging in the EUA and too few investigations for staging. The low rate of definitive treatment may be a consequence of the delays in management, allowing the tumour to progress, and suggesting the need for a more rapid assessment of haematuria.
The effect of prostatectomy on symptom severity and quality of life
Authors: Emberton M. , Neal D.E. , Black N. , Fordham M. , Harrison M. , McBrien M.P. , Williams R.E. , McPherson K. , Devlin H.B.
Published: November 2003

Objective To determine the effectiveness of prostatectomy in reducing symptom severity and bother and in improving disease‐specific and general quality of life.

Patients and methods A prospective, cohort study was performed in National Health Service and private hospitals in the Northern, Wessex, Mersey, and South‐West Thames Health Regions which comprised 5276 men undergoing prostatectomy recruited by 101 of the 106 (96%) surgeons (specialist and non‐specialist) performing prostatectomy during a 6‐month period. Patients were assessed using the American Urological Association (AUA) Symptom Index Score, the AUA symptom bother score, disease‐specific and generic quality‐of‐life scores, the occurrence of adverse events (urinary incontinence, erectile impotence and retrograde ejaculation) and three global (general) questions on the results of their treatment. The outcome was assessed 3 months after surgery.

Results Prostatectomy was effective in reducing both symptoms (initial mean score 20.1 reduced to 7.4, P<0.001) and symptom bother (initial mean score 14.4 reduced to 4.3, P<0.001). Not all men experienced a good reduction in symptoms; 121 (3.9%) were worse, 301 (9.6%) were the same, and 721 (23%) experienced only slight improvement. The type of operation, grade of principal operator and use of pre‐operative investigations were not associated with the extent of symptomatic improvement. Changes in symptom severity were highly correlated with changes in bothersomeness and disease‐specific quality of life but not with generic quality of life. A third of men who were continent before surgery reported some incontinence 3 months later, although only 6% found it a problem. Two‐thirds of men experienced retrograde ejaculation and 31% experienced some erectile impotence following surgery.

Conclusions Prostatectomy is effective in reducing symptoms in most men. Men who experience a substantial reduction in symptoms were more likely to report a favourable outcome. The study confirmed that approximately one‐third of men reported an unfavourable result 3 months after their operation.
The use of ‘ultrasensitive’ prostate‐specific antigen assays in the detection of biochemical recurrence after radical prostatectomy
Authors: van Iersel M.P. , Thomas C.M.G. , Segers M.F.G. , Witjes W.P.J. , Debruyne F.M.J. , Oosterhof G.O.N.
Published: November 2003

Objective To determine the gain in lead time obtained when using ultrasensitive prostate‐specific antigen (PSA) assays in the diagnosis of biochemical progression after radical prostatectomy.

Patients and methods The post‐operative PSA serum concentrations of 137 patients who had undergone radical prostatectomy were evaluated retrospectively. From these patients, 12 were selected who showed biochemical recurrence, as measured by the Hybritech Tandem‐E Singlepoint PSA assay. Samples of the serum frozen at the time of the initial analysis were thawed and PSA values were remeasured by the Abbott IMx PSA assay and the Tandem‐E Multipoint PSA assay. Analytical thresholds (zero‐dose + 3 sd) for the Tandem‐E Singlepoint, IMx and Tandem‐E Multipoint assay were 1.0, 0.04 and 0.04 ng/mL, respectively. The lead time to the detection of a recurrence obtained when using the IMx and the Tandem‐E Multipoint PSA assay was compared with that attained using the Tandem‐E Singlepoint PSA assay. As a control, PSA values were determined in 58 serum specimens of nine patients having no evidence of recurrence after radical prostatectomy.

Results All 58 control specimens had PSA levels below the analytical thresholds of the three assays, except one which had a PSA serum concentration of 0.08 ng/mL, estimated by the IMx assay. When compared with the lead time obtained with the Tandem‐E Singlepoint assay, the 12 patients with a biochemical recurrence had a median gain in lead time of 327 days (range 60–627) with the IMx assay and of 369 days (range 60–639) with the Tandem‐E Multipoint assay.

Conclusion A PSA value >0.04 ng/mL after radical prostatectomy heralds further biochemical progression. The use of the ultrasensitive IMx and the Tandem‐E Multipoint assays provided more lead time, but there is no clear evidence that this gain is necessarily of benefit to the patient.
Retrograde balloon dilatation for primary pelvi‐ureteric junction stenosis in children
Authors: Sugita Y. , Clarnette T.D. , Hutson J.M.
Published: November 2003

Objective To evaluate the efficacy of retrograde balloon dilatation for primary pelvi‐ureteric junction (PUJ) stenosis (RBDP) in children.

Patients and methods Sixteen children (12 boys, four girls; mean age 29 months) with primary PUJ stenosis initially underwent RBDP. A double‐pigtail catheter was left in the ureter for 6 weeks to provide drainage. The initial diagnosis of PUJ stenosis and the subsequent post‐operative assessment were both made by diuretic renography in almost all patients. All children were followed up for between 9 and 38 months (mean 25) after the procedure.

Results RBDP was unsuccessful in nine of 17 renal units. In three of these, failure was caused by inability to pass the catheter through the PUJ or vesico‐ureteric junction (VUJ). In six cases, failure was caused by recurrent or persistent stenosis. In eight of 17 renal units, RBDP was successful in relieving the stenosis. The morbidity from the procedure was minimal.

Conclusions Long‐term follow‐up revealed a significant failure rate for RBDP, caused by the inability to pass the catheter through the VUJ or PUJ, or persistent and/or recurrent stenosis. Recurrent stenosis may result from excessive dilatation which traumatizes the PUJ and causes subsequent scarring. Failure to overcome the stenosis is thought to be caused by a large redundant renal pelvis, producing ‘kinking’ of the upper ureter. In these cases, only reduction pyeloplasty may be successful in relieving the obstruction.
Mortality after transurethral and open prostatectomy in Scotland
Authors: Hargreave MS T.B. , Heynes C.F. , Kendrick S.W. , Whyte B. , Clarke J.A.
Published: November 2003

Objective To use the linked medical and death records in Scotland to investigate the possible increased mortality that has been reported after transurethral prostatectomy (TURP) compared with open prostatectomy.

Patients and methods Scotland has maintained linkable hospital, cancer and death records for more than 20 years, representing one of the largest such databases in the world. From these computerized records, data on various cohorts of men aged 55–84 years selected from 81 997 men who underwent prostatectomy in Scotland between l968 and l989 were analysed. The risk of late mortality was calculated for each type of operation, whether there was prior comorbidity and for a range of specific causes (cancer, respiratory and circulatory conditions) after prostatectomy.

Results Among the largest cohort, consisting of 65 519 men who underwent prostatectomy between 1968 and June 1989, the relative risk of late mortality after TURP compared with open prostatectomy was 1.13 (95% CI, 1.10–1.16), after controlling for age and the presence of a diagnosis of cancer. A more restricted cohort of 18 732 men who underwent prostatectomy between 1974 and 1979 allowed adjustment for prior hospitalization with, or concurrent diagnosis of, circulatory and respiratory conditions. In this cohort, the relative risk of late mortality after TURP as compared with open prostatectomy was 1.15 (95% CI, 1.11–1.19) after adjusting for prior and comorbidity and age. Finally, a cohort of ‘healthy patients’ restricted to the 6932 men who underwent prostatectomy from 1974 to 1979 and with no evidence of hospitalization in the previous 5 years or any current diagnosis other than benign hypertrophy of the prostate, showed a relative risk of 1.14 (95% CI, 1.07–1.21). There was no evidence of an increased risk of dying from circulatory disease in general, ischaemic heart disease or acute myocardial infarction after TURP as opposed to open prostatectomy. However, there was an increased risk of dying from respiratory conditions and from cancer, especially of the prostate and bladder. The analysis suggested the possibility that open prostatectomy may have cured some patients with early prostatic cancer, because the late death rate from prostatic cancer was greater in patients who underwent TURP than open prostatectomy.

Conclusion The present analysis confirmed the increased risk of late mortality after TURP compared with open prostatectomy, as shown in previous studies based on administrative records. However, limitations in the coding of comorbidities and the absence of coding of more subtle aspects of the condition of the patient which may influence the choice between the forms of prostatectomy mean that the differential mortality after the two procedures could still be a reflection of the pre‐operative selection of patients rather than the effects of the surgical procedure.
Minimally invasive vasectomy
Authors: Holt B.A. , Higgins A.F.
Published: November 2003

Objective To evaluate the associated morbidity and patient comfort of the ‘minimally invasive, no scalpel’ (MINS) vasectomy.

Patients and methods Eighty‐nine consecutive patients presenting for vasectomy underwent a MINS procedure. Post‐operatively, the pain experienced, recovery time and complication rate were assessed using a postal questionnaire. The questionnaire was also used to assess a group of historical controls who had undergone a vasectomy using a standard technique.

Results The length of time to recovery was significantly reduced in patients who underwent the MINS vasectomy (P<0.05) and the pain, bruising, swelling and complication rate were also less than in patients who underwent a standard vasectomy.

Conclusions The MINS vasectomy is preferable to a standard technique, reducing both patient morbidity and the complication rate. This is attributable to the minimal dissection and reduced tissue handling required to expose and isolate the vas.
The significance of terminal dribbling in men with lower urinary tract symptoms
Authors: Reynard J. , Lim C. , Peters T. , Abrams P.
Published: November 2003

Objective To determine the relationship between the symptom of terminal dribbling, objective evidence of terminal dribbling on recordings of uroflow, benign prostatic enlargement (BPE) and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS).

Patients and methods The prevalence of the symptom of terminal dribbling was determined from a symptom questionnaire completed by 165 men presenting with LUTS. Objective evidence of terminal dribbling during voiding was assessed from uroflow recordings and prostate volume was measured by transrectal ultrasonography. Combined pressure‐flow studies were performed to determine the presence or absence of BOO.

Results There was relatively poor agreement between the symptom of terminal dribbling and objective evidence of its presence; 48% of the patients who reported terminal dribbling most or all of the time showed no objective evidence of terminal dribbling on uroflowmetry. The symptom of terminal dribbling was not significantly related to the presence of BOO (P=0.74) and the group‐specific urethral resistance factor (URA) did not differ significantly (P=0.79) between those men who complained of terminal dribbling and those who did not (median URA 33 and 31 cmH2O, respectively). However, objective evidence of terminal dribbling on uroflow traces was significantly related to BOO (P<0.001) and those patients with objective evidence of terminal dribbling had higher values of URA (median 39 compared with 28 cmH2O). Objective terminal dribbling had a specificity of 92% and positive predictive value of 88% for the presence of BOO. Neither the symptom of terminal dribbling nor objective evidence of its presence were significantly related to prostatic enlargement.

Conclusion While the symptom of terminal dribbling is probably not related to BOO or prostatic enlargement, objective evidence of terminal dribbling on flow curve recording is specific for BOO and as such, its presence could potentially be of value in the assessment of men with LUTS.
Ketanserin plus prostaglandin E1 (PGE‐1) as intracavernosal therapy for patients with erectile dysfunction unresponsive to PGE‐1 alone
Authors: Mirone V. , Imbimbo C. , Fabrizio F. , Longo N. , Palmieri A.
Published: November 2003

Objective To evaluate the treatment of patients with erectile dysfunction and who were unresponsive to intracavernosal injections of prostaglandin E‐1 (PGE‐1) alone with a combination of PGE‐1 and ketanserin, a peripheral vasodilator antagonizing 5‐hydroxytryptamine receptors and with mild alpha‐blocking effects.

Patients and methods The study comprised 98 men with erectile dysfunction all of whom received an intracavernosal injection of 5–40 μg of PGE‐1. The 45 patients unresponsive to the maximum dose of 40 μg were selected for further treatment using a combined dose of 40 μg PGE‐1 and 2–7 mg of ketanserin. Their erectile response was assessed both subjectively, by interviewing the patient and their partner, and objectively using the ‘Rigiscan’ monitor.

Results The combined therapy was effective in producing an erection sufficient for sexual intercourse in 34 (76%) of the patients. The combined dose was tolerated well and there were no adverse effects.

Conclusions The results of this preliminary study suggest that the combination of PGE‐1 and ketanserin may be a therapeutic alternative to the implantation of a prosthesis in patients unresponsive to PGE‐1.
Endoscopic rollerball electrovaporization of the prostate — the sandwich technique: evaluation of the initial efficacy and morbidity in the treatment of benign prostatic obstruction
Authors: Meade W.M. , McLoughlin M.G.
Published: November 2003

Objectives To evaluate the safety, initial efficacy and morbidity of a new treatment for benign prostatic hyperplasia (BPH), endoscopic rollerball electrovaporization (EREV) of the prostate.

Patients and methods Endoscopic rollerball electro‐vaporization with or without a modified transurethral prostatectomy (TURP) was performed in 51 patients (mean age 69 years). Before treatment, patients were evaluated by measuring maximum flow rate, post‐void residual volume (PVR) and a symptom score. After undergoing EREV and modified TURP the operative and hospital records were reviewed and the duration of the procedure, hospital stay and the incidence of complications and/or morbidity were recorded. The urodynamic variables were re‐evaluated after 3–8 months.

Results Five patients were operated on for retention: of the remaining patients, the pre‐operative mean symptom score was 18 (maximum 30), the mean maximum flow rate was 11.5 mL/s, the mean PVR was 159 mL and the mean duration of the procedure was 28 min. Of the 51 patients, 30 were discharged catheter‐free on the first day after surgery. No patient required transfusion for associated blood loss, none had evidence of symptomatic bacteraemia and the transurethral resection syndrome did not occur. One patient who had a bladder carcinoma resected at the same operation was readmitted 2 weeks later with haematuria and clots. Three patients presented as emergencies within 8 weeks because of retention; one was admitted and required further EREV. On re‐evaluation, the symptom scores decreased by a mean of 11 points, the maximum flow rate increased by a mean of 6.2 mL/s and the mean PVR decreased by 102 mL.

Conclusions EREV of the prostate is a safe, effective and economic alternative to a standard TURP.
The Oxford Laser Prostate Trial: a double‐blind randomized controlled trial of contact vaporization of the prostate against transurethral resection; preliminary results
Authors: Keoghane S.R. , Cranston D.W. , Lawrence K.C. , Doll H.A. , Fellows G.J. , Smith J.C.
Published: November 2003

Objective To compare the results of contact laser vaporization and transurethral resection of the prostate (TURP) in a double‐blind randomized controlled clinical trial.

Patients and methods The study comprised 148 patients with clinical benign prostatic hypertrophy (BPH) who were recruited and allocated randomly to undergo either TURP (72 patients) or laser ablation of the prostate (76 patients). The outcome was assessed using the American Urological Association (AUA −7) symptom score after 1 and 3 months as the primary measure and by urinary flow rates, haematological factors and the duration of hospital stay and length of catheterization.

Results With 90% statistical power, the results at 3 months showed no clinical or statistical difference between the treatments in change in AUA symptom score. A lower blood loss, hospital stay and duration of catheterization significantly favoured the laser treatment, although the failure rate of trial without catheter and the rate of re‐operation were higher after laser treatment.

Conclusions These early data are encouraging for this technique, although the outcome after one year requires evaluation before advocating the widespread uptake of this method.
A clinicopathological approach to cystitis — recommendations for simplified pathology reporting
Authors: THILAGARAJAH R. , VALE J.A. , WITHEROW R.O’N. , WALKER M.M.
Published: November 2003

Objective

 To assess the accuracy of histopathology reports of bladder biopsy specimens showing chronic cystitis and to develop a standard method of reporting in the form of a template which will aid both clinician and patient in the management of this condition.

Materials and methods

 Over a 4‐year period, the reports of 134 bladder biopsy specimens diagnosed as chronic inflammation of the bladder were examined for clinical details, cystoscopy findings, pathology details and conclusions. Within each of these groups, the common terms were assessed for their relevance to the final outcome.

Results

 The analysis of each part of these reports revealed no clinical details in 33%, no cystoscopy details in 26% and no histopathology conclusion in 20%. The commonest terms used were: macroscopic haematuria (25%) for clinical details; red patch/inflamed (40%) for cystoscopic details; morphological site involved (65%) for pathology details; and mild chronic cystitis (37%) for the conclusions. Standardized criteria were devised and after reassessing the reports, 75% were considered to be accurate and complete.

Conclusions

 Overall, the histopathology reports examined were more than adequate for the clinicians’ use but the spectrum of details provided did not add to the usefulness of the final report. By limiting the terms available, a more standardized report can be produced, benefiting both clinician and patient.
The in vivo and in vitro effects of hypoxia on pig urethral smooth muscle
Authors: GREENLAND J.E. , BRADING A.F.
Published: November 2003

Objective

 To assess the in vitro effects of hypoxia on urethral smooth muscle and the role that these may have in the fall in urethral luminal pressure consequent upon interruption of its arterial blood supply.

Materials and methods

 In eight anaesthetized female Large White pigs, femoral blood pressure, urethral luminal pressure and lamina propria blood flow were recorded before, during and after aortic occlusion. In three animals, changes in urethral intramural oxygen tension were also recorded. Smooth muscle strips taken from the mid‐urethra were studied in an organ bath under normal and hypoxic conditions, and in the presence of cyanide. The generation of spontaneous tone and the response to electrical‐field stimulation were also examined.

Results

 Urethral luminal pressure declined biphasically after aortic occlusion, from a mean of 83.8 to 39.0 cmH2O. The initial rapid phase seemed to be related to a decrease in urethral lamina propria blood flow, whilst the slower phase appeared to mirror the observed decline in intramural oxygen tension. In vitro, the high spontaneous tone of the muscle strips was abolished by hypoxia or metabolic inhibition whilst the contractile response to nerve stimulation was preserved.

Conclusions

 The decrease in urethral pressure after aortic occlusion appears to have two components, the first mediated through a decrease in vascular filling of the lamina propria and the second as a result of hypoxia‐induced smooth muscle relaxation. The in vitro effects of hypoxia upon urethral smooth muscle concur with the changes observed in vivo.
Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?
Authors: PROBST M. , PIECHOTA H.J. , HOHENFELLNER M. , GLEASON C.A. , TANAGHO E.A.
Published: November 2003

Objective

 To determine by anatomical and functional studies whether stimulation of sacral rootlets might permit selective stimulation of autonomic fibres, thus avoiding the detrusor/sphincter dyssynergia characteristic of current techniques of neurostimulation for bladder evacuation.

Materials and methods

In 10 male mongrel dogs, the S2 root was isolated and its constituent rootlets followed from their origin in the spinal cord to the point of exit from the dura. The entire root and the individual rootlets were then stimulated, including intra‐ and extra‐dural stimulation and at proximal, mid and distal levels.

Results

Neuroanatomical and histological findings showed that the rootlets of ventral S2 maintain their identity throughout their intradural course; some carry predominantly autonomic fibres, some predominantly somatic and some a mixture of the two.

Conclusion

It appears surgically feasible to identify, isolate and sever the predominantly somatic rootlets intradurally, sparing the predominantly autonomic rootlets for inclusion in extradural electrode placement around the entire sacral root, thus eliminating sphincteric interference with detrusor contraction for voiding at low pressure.