bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability and validity of the International Prostate Symptom Score in a Malaysian population
Authors: Quek K.F. , Low W.Y. , Razack A.H. , Loh C.S.
Published: March 2003

Objective To validate the English version of the International Prostate Symptom Score (IPSS) in patients with and without urinary symptoms in a Malaysian population.

Patients and methods Validity and reliability were assessed in patients with lower urinary tract symptoms (LUTS) and in patients with no LUTS. Reliability was evaluated using the test‐retest method and internal consistency using Cronbach's α. Sensitivity to change was expressed as the effect size in the score before and after intervention in additional patients with LUTS who underwent transurethral resection of the prostate (TURP).

Results Internal consistency was excellent; there was a high degree of internal consistency for each of the seven domains and for the total score (Cronbach's α0.60 and  0.79, respectively) in the populations studied. The test‐retest correlation coefficient for the seven domain scores was highly significant. The intra‐class correlation coefficient was high ( 0.59). There was a high level of sensitivity and specificity for the effects of treatment, with a very significant change between the seven scores domains in the treated group but not in the control group.

Conclusions The IPSS is suitable, reliable, valid and sensitive to clinical change in the Malaysian population.
Intrarenal bacillus Calmette‐Guérin therapy for carcinoma in situ of the upper urinary tract: long‐term follow‐up and natural course in cases of failure
Authors: Okubo K. , Ichioka K. , Terada N. , Matsuta Y. , Yoshimura K. , Arai Y.
Published: March 2003

Objective To assess the long‐term efficacy of intrarenal bacillus Calmette‐Guérin (BCG) therapy for the treatment of cytologically diagnosed upper tract carcinoma in situ (CIS) and report the time course in cases of failure.

Patients and methods Fourteen renal units in 11 patients cytologically diagnosed as having upper urinary tract (UUT) CIS were treated with intrarenal BCG instillation. The BCG solution was administered by retrograde ureteric catheterization weekly for 6 weeks.

Results Seven units were radiologically and cytologically free of disease at a median follow‐up of 60 months. Two units which showed an initial response had recurrence with ipsilateral UUT CIS. The remaining five units did not respond to BCG. Of seven units with an initial negative response or recurrent UUT CIS, nephroureterectomy was undertaken in one because of coincidental renal cell carcinoma. In four of the remaining six units, invasive pelvic tumour developed at a mean follow‐up of 20.5 months after the final instillation. Computed tomography showed wall thickening of the renal pelvis in two and mass‐forming tumour in the renal parenchyma mimicking renal cell carcinoma in two. In three of these four cases, retrograde pyelography did not show typical findings of renal pelvic tumour, e.g. filling defect, infundibular obstruction or stenosis.

Conclusions Intrarenal BCG is effective in the treatment of UUT CIS in a long‐term follow‐up. In cases with a poor response or ipsilateral recurrence of CIS, there is a high risk of developing invasive tumour. Close follow‐up using computed tomography is recommended because of the atypical radiographic findings of such tumours.
99mTechnetium‐C595 radioimmunoscintigraphy: a potential staging tool for bladder cancer
Authors: Simms M.S. , Perkins A.C. , Price M.R. , Scholfield D.P. , Bishop M.C.
Published: March 2003

Objectives To assess whether immunoscintigraphy using a conjugate of the anti–MUC1 monoclonal antibody C595 and 99mTc could be used to target transitional cell bladder cancer after intravenous administration to patients.

Patients and methods Twenty‐one patients with invasive or metastatic transitional cell carcinoma were recruited. Patients received 1 mg of C595 labelled with 800 MBq 99mTc followed by imaging at 0.5, 6 and 24 h using a combination of planar and single‐photon emission computed tomography. Of these patients, 14 subsequently underwent cystectomy, four underwent radiotherapy and the remaining three had histologically confirmed metastatic disease. The results of immunoscintigraphy were compared with surgical findings and conventional radiology.

Results There were no adverse reactions in any patient. Of the 20 patients who were found to have tumour at the time of the study, positive localization of antibody in tumour was apparent in 16. Of the remaining four patients, false‐positive localization of antibody in presumed nodal tissue was detected in two. The remaining scan results were equivocal. In three patients, histologically confirmed pelvic nodal metastases that had not been detected on preoperative computed tomography were identified.

Conclusion These early results show the potential of 99mTc‐C595 immunoscintigraphy for staging bladder cancer. A larger study is needed to fully evaluate the technique.
Re‐auditing a regional lithotripsy service
Authors: Parkin J. , Keeley F.X. , Timoney A.G.
Published: March 2003

Objective To assess, in a repeat audit of a regional lithotripsy service, whether changes implemented after a regional audit in 1994 (which showed disappointing results from shock wave lithotripsy, attributable to both poor patient selection and an inadequate fixed‐site lithotripter) have had any effect.

Patients and methods A data‐collection sheet was devised to gather information on the site, size and number of stones treated, together with information on the lithotripsy treatment and outcome. Patients selected for the audit were the first 50 new patients treated with lithotripsy at each centre in 1999. As only one hospital has a fixed‐site lithotripsy machine, the results of mobile lithotripsy were grouped by machine for analysis.

Results There was an overall improvement in patient selection from the previous audits. Few stones of > 16 mm or < 4 mm were treated. Two units treated more ureteric stones, thought to reflect first the influence of a fixed‐site lithotripter, and second a willingness to insert a ureteric stent and await the next mobile lithotripter visit. The stone free rates were all disappointingly low (16.7–26.7%) but the results improved when fragments of < 4 mm were included as ‘successful’ giving an ‘overall success rate’ of 45.9–66.7%. The unit with a fixed‐site lithotripter appeared to perform better (two‐thirds successful) than the mobile machines (Modulith SLX, 51%; Modulith SLK, 46%). One centre visited by both mobile machines had a success rate of 65% but a high rate of auxiliary procedures (35% vs 16–19% vs the fixed‐site).

Conclusion Although these results show some improvement in patient selection for our regional lithotripsy service, stone‐free and success rates are poorer than those reported elsewhere. This may reflect the modern lithotripsy machines that allow day‐case treatment with minimal analgesia, and confirms reports by other authors who encourage a re‐examination of success rates of shock wave lithotripsy.
Renal and ureteric trauma: diagnosis and management in Poland
Authors: Dobrowolski Z. , Kusionowicz J. , Drewniak T. , Habrat W. , Lipczyn˜ski W. , Jakubik P. , Wêglarz W.
Published: March 2003

Objective To analyse retrospectively kidney and ureteric injuries (the former often associated with multiple‐organ trauma and thus optimize diagnostic and treatment methods.

Patients and methods The records and details of kidney and ureteric injures treated between 1995 and 1999 in 61 urological departments in Poland were analysed.

Results In all, 887 kidney injuries were analysed; blunt trauma comprised 97%, with most injuries classified as renal contusion and minor parenchymal damage (687 cases). Intravenous urography was used in 80% of the patients and computed tomography in only 20%. In all, 234 patients (26%) underwent surgery; nephrectomy was the most common surgical treatment, in 170 patients (73% of those undergoing surgery). Complications occurred in 9% of patients after conservative treatment and in 5% after surgery. Of the 452 ureteric injuries, 340 (75%) were iatrogenic, 81 (18%) blunt injuries and 31 (7%) open injuries. Of the iatrogenic injuries 73% occurred during gynaecological procedures, 14% in general surgery and 14% in urological procedures. The most frequent diagnostic method was intravenous urography (244 cases), with retrograde pyelography (98) and ureteric catheterization in 125. The diagnosis was established immediately during surgery in 104 patients. The most frequent surgical treatment was uretero‐neocystostomy (213, 47%), the others being a Boari flap (113, 25%), end‐to‐end anastomosis (92, 20%), reconstruction with an ileal loop (30, 7%) and autotransplantation (four, 1%).

Conclusion In Poland, patients with blunt kidney injuries often undergo surgery, with nephrectomy the most frequent procedure. Computed tomography with the intravenous administration of contrast medium should be considered the diagnostic method of choice for kidney injures. Catheterization of the ureters before surgery and an indigocarmine intravenous infusion (to stain the urine) when a ureteric injury is suspected may reduce the rate of iatrogenic injury and improve the rate of intraoperative diagnosis. We suggest catheterizing the ureters in any doubtful case to avoid injury, because prevention is better than treatment.
A randomized comparative dose‐ranging study of interferon‐α and mitomycin‐C as an internal control in primary or recurrent superficial transitional cell carcinoma of the bladder
Authors: Malmström P.‐U.
Published: March 2003

Objective To compare, in a phase II study, the activity and toxicity of three dose levels of interferon‐α, and of mitomycin‐C given intravesically (as an internal control to validate the results), the primary objective being to investigate the percentage of complete responses (complete disappearance of a marker lesion) induced by the three interferon‐α dose levels on a marker lesion; a secondary objective was to compare the interferon‐α doses for toxicity.

Patients and methods In all, 115 patients were enrolled, with the inclusion criteria being multiple grade 1 or 2, stage Ta or T1, primary or recurrent transitional cell carcinoma of the bladder. Interferon‐α (30, 50 and 80 MU) and mitomycin‐C (40 mg) intravesical treatments were given as follows. Patients randomized to one of three interferon‐α dose levels were treated weekly for 12 weeks. However, in week 9 (first cystoscopy after baseline) interferon‐α treatment was stopped if there was a complete response or disease progression. Patients randomized to mitomycin‐C were treated weekly for 8 weeks only and in week 9 underwent follow‐up cystoscopy.

Results Interferon‐α at doses of 30, 50 and 80 MU gave response rates at 13 weeks of 19%, 33% and 41%, respectively. Although the response rates were higher for 50 and 80 MU than for 30 MU, the differences were not statistically significant. All three interferon‐α groups had significantly lower response rates than the internal control, mitomycin‐C (72%). The safety analysis showed that most of the adverse events were of mild to moderate severity. Adverse events were experienced by 37%, 37% and 48% of patients receiving 30, 50 and 80 MU interferon‐α, respectively, and by 55% of patients receiving mitomycin‐C. The corresponding rates for severe adverse events related to treatment were 9% for interferon‐α and 10% for mitomycin‐C.

Conclusion Ablative therapy with interferon‐α was less effective than mitomycin‐C in patients with superficial bladder cancer. Both drugs were well tolerated, although interferon‐α appeared to have a slightly better overall safety profile.
Catheter‐less Cohen transtrigonal ureteric reimplantation
Authors: Anderson P.D. , Dewan P.A.
Published: March 2003

Objective To review the profile and outcome of patients in whom it was elected not to insert a bladder catheter as part of the management of Cohen transtrigonal ureteric reimplantation surgery.

Patients and methods Between April 2000 and April 2001, 37 patients underwent ureteric reimplantation by the senior author, using the Cohen transtrigonal technique. The use of the catheter‐less protocol began after the blockage of a suprapubic catheter soon after surgery; the catheter was removed with no adverse event. Subsequently, 27 of those undergoing ureteric reimplantation were selected not to have a bladder catheter. Later in the study a greater proportion of patients had no catheter inserted, as confidence with the catheter‐less technique increased. Caudal anaesthetic, oral analgesia and a single dose of intravesical bupivacaine were used for pain relief. The children were monitored closely after surgery and a urethral catheter inserted in the one patient who had not voided after 6 h.

Results The patients generally tolerated the lack of a bladder catheter well. Of the 27 patients who did not have a catheter inserted at surgery, one required catheterization (a girl with bilateral duplex systems and large ureteroceles). Two children stayed in hospital for 2 days after surgery, one was discharged on the day of surgery, and the remainder went home on oral analgesia on the first day after surgery. Since starting the catheter‐less approach, 10 patients have had a suprapubic catheter because they had more complex surgery, were older or because the approach had not developed sufficiently at the time of surgery.

Conclusions Intravesical ureteric reimplantation is not only safe when omitting a bladder catheter but, if used selectively, there appears to be a significant decrease in the hospital stay and discomfort after surgery.
Is mechanical bowel preparation necessary in patients undergoing cystectomy and urinary diversion?
Authors: Shafii M. , Murphy D.M. , Donovan M.G. , Hickey D.P.
Published: March 2003

Objective To compare the surgical outcome in patients with or with no bowel preparation before cystectomy and ileal conduit urinary diversion, specifically assessing local and systemic complications.

Patients and methods All patients undergoing cystectomy and ileal conduit urinary diversion between January 1991 and December 1999 were assessed retrospectively. Twenty‐two receive no bowel preparation (group 1) and were compared with 64 who had (group 2). Patients had similar demographic characteristics, stage and grade of tumour. Patients in group 2 received a standard 4‐day bowel preparation and group 1 received no lavage or enemas. All patients underwent a standard iliac and obturator lymph node dissection, and cystoprostatectomy or anterior exenteration and ileal conduit urinary diversion. All patients received intraoperative metronidazole and gentamicin intravenously, and two further doses after surgery.

Results Deaths after surgery were comparable in the two groups (two in group 1 and four in group 2) and the incidence of wound infection was similar (three and seven, respectively). There were no significant differences between the respective groups for fistula and anastomotic dehiscence (two and six) or sepsis (three and six). Group 2 had a higher incidence of wound dehiscence (one) than in group 1 (none). The incidence of prolonged postoperative ileus was lower in group 1 (one vs 12), as was the length of hospital stay (31.6 days vs 22.8 days).

Conclusions Bowel preparation had no advantage for the surgical outcome but it increased the length of hospital stay.
Blunt renal trauma in children with previously undiagnosed pre‐existing renal lesions and guidelines for effective initial management of kidney injury
Authors: Önen A. , Kaya M. , Ciǧdem M.K. , Otçu S. , Öztürk H. , Dokucu A.İ.
Published: March 2003

Objectives To record pre‐existing renal lesions (PERL) found incidentally during evaluation for blunt renal trauma in children, determine their importance, suggest guidelines for the effective initial management of children with significant renal trauma and to evaluate the role of temporary percutaneous nephrostomy tube drainage (TPND) in these patients.

Patients and methods We reviewed 338 children who were hospitalized with blunt abdominal trauma between 1992 and 2000. Thirty‐one patients had significant renal injury, 17 before 1997 (reviewed retrospectively) and the others reviewed and followed prospectively.

Results Eleven of the 31 children had a PERL, which had been undiagnosed before the injury. The mean (range) follow‐up was 52 (15–104) months. There were 22 boys and nine girls (mean age 9.1 years, range 2–13). The mean age was lower in patients with a PERL than in children with isolated renal injury. The most common cause of blunt renal injuries was a fall (45%) followed by motor vehicle accidents. Renal stones were present in five children, pelvi‐ureteric junction obstruction in four, megaureter in one and a renal cyst in one. The mean injury severity scores were 12 in the children with a PERL and 14 in patients without. TPND was used in seven (22%) children; four were associated with a PERL. The mean grade of injury score for the kidney was higher in patients with a PERL and in children who underwent TPND than in patients who previously had a normal kidney and in children who did not undergo TPND. Early surgical intervention was required in three children; all were associated with a PERL. Of the 13 children who underwent surgery 11 had previous disease.

Conclusions The frequency of PERL is high (36%) in children with blunt renal trauma. PERL can predispose minor trauma to cause kidney injury even with no evidence of hydronephrosis. When a minor trauma results in renal injury, it is important to seek a PERL. In selected patients, TPND may decrease the length of hospital stay and improve the outcome of the injured kidney, thereby decreasing the need for further surgery in those with isolated renal injury; however, it appears not to decrease the need for later operations in children with a PERL.
The relationship between desmopressin treatment and voiding pattern in children
Authors: Hvistendahl G.M. , Rawashdeh Y.F. , Kamperis K. , Hansen M.N. , Rittig S. , Djurhuus J.C.
Published: March 2003

Objective To collate data on voiding patterns at baseline (no treatment) and during short‐term desmopressin treatment, with special reference to the functional and the mean bladder capacity.

Patients and methods The study included 120 children (aged 6–16 years) with monosymptomatic nocturnal enuresis. While at home they recorded their fluid intake and diuresis in two separate periods, i.e. 2 weeks as a baseline registration and another 2 weeks during desmopressin titration. On four study days the children recorded the time and volume of all voids and of fluid intake. From the diaries their functional and mean bladder capacities, 24‐h diuresis and day/night ratio of diuresis were determined.

Results The mean 24‐h diuresis was significantly lower during short‐term desmopressin treatment. In most of the enuretics the mean day/night ratio increased on desmopressin treatment. The mean functional and mean bladder capacities were unaffected by desmopressin. Those not responding had bladder capacities of ≈ 100 mL less than full responders. Regardless of response, practically all the enuretics in the study had a smaller functional bladder capacity than expected for their age. Among responders the morning void was significantly larger than the following voids during the day, and among non‐responders the fourth void was significantly larger than the previous voids in the day. Desmopressin treatment did not influence these volumes significantly.

Conclusions Short‐term desmopressin treatment does not affect functional and mean bladder capacity; 24‐h urine production was reduced significantly (P<0.01) during desmopressin treatment.
Factors influencing testicular volume in young men: results of a community‐based survey
Authors: Ku J.H. , Kim M.E. , Jeon Y.S. , Lee N.K. , Park Y.H.
Published: March 2003

Objective To investigate the factors influencing testicular volume in young men in the community.

Subjects and methods Between May and November 2001, 2700 men aged 20 years and dwelling in the community were randomly selected at a 10% sampling fraction after a sampling process by census district; 2080 men agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. After excluding those with testicular diseases the study comprised 1792 men.

Results There were significant but weak correlations between testicular volumes and height, body weight and body mass index. In a multivariate model, high environmental temperature was associated with a decreased likelihood (odds ratio, OR, 0.42; 95% confidence interval, CI, 0.29–0.60; P < 0.001) of a paired testicular volume being below the 25th percentile of all participants. The likelihood of a low paired testicular volume varied by area, with a 1.6‐fold greater risk in men dwelling in large rural areas than in those in major towns. Increasing height was associated with a decreased likelihood (OR 0.60; 95% CI 0.38–0.96; P = 0.032) and low body weight with an increased likelihood of a low paired testicular volume (OR 2.54; 95% CI 1.57–4.12; P < 0.001).

Conclusion These results establish that demographic and environmental factors have an effect on testicular size and suggest that body size may be important in determining testicular size in late adolescents.
Determining the displacement of the pelvic floor and pelvic organs during voluntary contractions using magnetic resonance imaging in younger and older women
Authors: Constantinou C.E. , Hvistendahl G. , Ryhammer A. , Nagel L.L. , Djurhuus J.C.
Published: March 2003

Objectives  To: (i) visualize the effect of sustained voluntary contractions on the anatomical configuration of the pelvic floor (PF) muscles using magnetic resonance imaging (MRI); (ii) examine the effect of ageing on the range of displacement of the PF contents secondary to contraction and simulating incontinence exercises; and (iii) introduce the concept of contractile change in volume (ΔPF‐V) using three‐dimensional (3D) reconstruction from axial, sagittal and coronal MRI.

Subjects and methods

 Two groups of continent women volunteers, familiar with correct PF contraction, were evaluated. The mean (
sd
) age in group I was 34 (6) years and that of group II 55 (9) years; the mean parities were 0.7 and 2.2, respectively. MRI was conducted with the women supine and data were obtained in the axial, sagittal and coronal planes. In each plane, images were obtained with the PF relaxed and subsequently with the PF contracted over 10–20 s. Image processing was used to enhance the anatomical boundaries of the pelvic organs and to measure the displacement produced by the contraction. Displacements, observed between each image pair, were colour‐coded to highlight the geometric differences between a relaxed and contracted PF and to facilitate measuring displacement. Data measured from each group were pooled and the range of motion expressed as the mean (
sd
), compared using Student's
t ‐test.

Results

 Digitally processed imaging allowed an accurate comparison between the relaxed and contracted PF, and highlighted the differences between them. From these views, the levator ani displaced the vagina asymmetrically in nine of the 11 older subjects, and in six of the 17 younger subjects. The values from the imaging in the sagittal and coronal plane for the two groups were: levator ani displacement, 7.4 (1.1) and 1.4 (0.2) cm (
P

 < 0.002), superior bladder wall, 4.2 (0.5) and 1.0 (0.1) cm (
P

 < 0.002). There were also significant differences in the range of displacement produced by voluntary PF contraction in the internal structures; external outlines did not reflect these changes. The maximum displacement of the gluteal surface in the coronal plane did not change significantly; in group I it was 3.9 (1.8) to 2.9 (0.7) cm. From the 3D re‐construction, ΔPF‐V for the younger women was significantly larger, at 23.3 (3.9) mL (
P  < 0.01) than in the older women, at 9.1 (4.4) mL.

Conclusion  The range of motion over which voluntary PF contractions displace the bladder and vagina is age‐dependent, being higher in younger than in older subjects. It remains to be established whether range of movement is a limitation caused by neuronal factors, decrease in muscle strength/mass, or the substitution of spaces with fat (restricting free movement), or other factors.
Intra‐ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications
Authors: Playford D. , Kulkarni H. , Thomas M. , Vivian J. , Low A. , Mander J. , Perlman D. , Finch P.
Published: March 2003

Objective  To evaluate the safety and efficacy of intra‐ureteric capsaicin for loin pain haematuria syndrome (LPHS).

Patients and methods  In an open prospective pilot study, four middle‐aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra‐ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient‐controlled narcotic analgesic pump for pain control. Double‐concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete.

Results  The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi‐ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30‐mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months.

Conclusion  Intra‐ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.
Can shoe size predict penile length?
Authors: Shah J. , Christopher N.
Published: March 2003

Objective  To establish if the ‘myth’ about whether the size of a man's penis can be estimated from his shoe size has any basis, infact.

Subjects and methods  Two urologists measured the stretched penile length of 104 men in a prospective study and related this to their shoe size.

Results  The median stretched penile length for the sampled population was 13 cm and the median UK shoe size was 9 (European 43). There was no statistically significant correlation between shoe size and stretched penile length.

Conclusion  The supposed association of penile length and shoe size has no scientific basis.
Tissue reaction of the rabbit urinary bladder to tension‐free vaginal tape and porcine small intestinal submucosa
Authors: Rabah D.M. , Spiess P.E. , Begin L.R. , Corcos J.
Published: March 2003

Objectives  To compare the histological tissue reactions of urinary bladder in close contact with polypropylene mesh tension‐free vaginal tape (TVT) or porcine small intestinal submucosal (SIS) grafts, as the commercial availability of various materials has considerably simplified sling procedures for treating urinary incontinence, but erosion and infection after using artificial sling materials remain an important concern.

Materials and methods  Thirty female New Zealand rabbits were randomized to three groups, i.e. group A (TVT, 12 animals), group B (SIS, 12) and group C (surgical control, six). Through a laparotomy under anaesthesia and an aseptic technique, the bladder was approached at its dome, where a 0.5 × 1 cm piece of TVT or SIS was fixed in direct contact with the bladder wall. The control group underwent only bladder manipulation with no material applied. Half the animals in each group were killed after 6 weeks and the other half after 12 weeks. The urinary bladder was harvested and examined histologically.

Results  The grafts in both groups were characterized by dense foreign‐body type reactions and were mostly attached loosely to the bladder wall by a thin layer of fibrovascular tissue. More importantly, the bladder wall reactions showed no inflammation in all 12 animals in group A (TVT) but three of them had various grades of fibrosis. There was severe transmural inflammation in one animal in group B (SIS); one rabbit had grade I and two had grade II fibrosis. The controls, as expected, showed no bladder wall reactions.

Conclusion  In this descriptive analysis of reaction types elicited on the urinary bladder by these grafts, both materials appeared to be safe. Although TVT elicited fewer and less severe adverse reactions, no statistical conclusions can be drawn. The clinical significance of these findings should emerge from long‐term clinical data when they become available.
Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care
Authors: Wolters R. , Wensing M. , Van Weel C. , Van Der Wilt G.J. , Grol R.P.T.M.
Published: March 2003

Objective  To determine associations among lower urinary tract symptoms (LUTS), symptom severity, subjective beliefs and social influences when seeking primary medical care in men aged ≥ 50 years.

Subjects and methods  A population‐based survey was conducted among 5052 men aged ≥ 50 years, using patient registers of 22 general practitioners (GPs) in the Netherlands from November 1999 to May 2000. The questionnaire contained items concerning age, educational level, International Prostate Symptom Score (IPSS), bothersome score (BS), and questions from the Health Belief Model on attitude and social influences. The study population comprised men with an IPSS openface> 7. The odds ratios (ORs) corrected for the IPSS were calculated.

Results  In all, 3544 questionnaires (70.2%) were returned. Two groups of men with an IPSS openface> 7 were compared: those who consulted their GP in the previous 2 years because of voiding problems (268 cases) and the controls (272) who did not visit a GP for these symptoms. Cases more often thought a physician could improve their condition (OR 2.85), appeared to be more often advised by others to seek medical care (OR 6.36) and thought more often that this advice influenced their decision (OR 13.95). They also had more frequently received information from the media (OR 2.66) which affected their attendance (OR 12.52). In a multiple regression analysis, advice from others or information from the media were stronger predictors of seeking care than the influence of symptoms on daily life, the IPSS or the BS.

Conclusion  Social influences, i.e. advice from others or the media, were more important factors in the decision to seek medical care than symptom severity.
Magnetic resonance imaging‐guided laser thermal ablation of renal tumours
Authors: Dick E.A. , Joarder R. , De Jode M.G. , Wragg P. , Vale J.A. , Gedroyc W.M.W.
Published: March 2003

Objective To test the hypothesis that magnetic resonance imaging (MRI)‐guided laser thermal ablation (LTA) of inoperable renal tumours is a safe, tolerable and potentially effective treatment.

Patients and methods  Nine patients (aged 56–81 years) with malignant renal tumours underwent percutaneous LTA under MRI guidance in a 0.5 T open magnet. Real‐time colour thermal mapping was used to monitor tumour ablation, and the follow‐up was with gadolinium‐enhanced MRI at 6 weeks and (where appropriate) 3–4 months after the procedure. Tumour volume and percentage tumour enhancement before and after ablation were compared. The percentage of tumour ablated on real‐time T1‐weighted thermal maps was compared with that on gadolinium‐enhanced follow‐up MRI.

Results  The mean (range) follow‐up was 16.9 (3–32) months after the first ablation. The mean tumour size did not change significantly, but the mean percentage of viable tumour decreased significantly from 73.7% before to 29.5% after ablation (P = 0.012, Wilcoxon signed‐ranks test). Thermal maps correlated moderately well with follow‐up MRI in predicting the extent of tumour ablation (Pearson correlation coefficient 0.55). There were two minor and one major complication.

Conclusion  In this pilot study of patients unsuitable for surgery, MRI‐guided LTA of renal tumours was safe, feasible (being well tolerated by the patient) and significantly reduced enhancing tumour volume by a mean of 45%.
Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia
Authors: Nørby B. , Nielsen H.V. , Frimodt‐Møller P.C.
Published: March 2003

Objective  To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH).

Patients and methods  Forty‐eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/TUIP; they were followed for 6 months and the outcome analysed on an intention‐to‐treat basis.

Results  At 6 months the symptom scores and maximum urinary flow rate (Qmax) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group (P > 0.05); the mean Qmax was 20.6 mL/s in the control group, 16.2 in the ILC group (P > 0.05 vs control) and 13.2 in the TUMT group (P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Qmax than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the ‘well‐known’ complications of TURP occurred in the control group. Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the con‐trol group were re‐treated for BPH within the first 6 months.

Conclusion  In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.
The management of low‐flow priapism with the immediate insertion of a penile prosthesis
Authors: Rees R.W. , Kalsi J. , Minhas S. , Peters J. , Kell P. , Ralph D.J.
Published: March 2003

Objective  To evaluate the outcome of patients undergoing the immediate insertion of a penile prosthesis as a treatment for acute low‐flow priapism.

Patients and methods  Eight patients presenting with low‐flow priapism with a mean duration of 91 h (range 32–192)  were prospectively evaluated. All had failed conservative management with the instillation of α‐adrenergic agents, and four had already undergone shunt procedures elsewhere. Immediate management consisted of the insertion of a malleable prosthesis in six patients and an inflatable prosthesis in two. One of the malleable prostheses was subsequently changed to an inflatable device.

Results  There were no early complications, with all patients being satisfied with the end result, and seven having sexual intercourse. One patient developed a penile deformity after surgery, cause by fibrosis around one inflatable cylinder. All patients have maintained their penile length.

Conclusions  Prolonged low‐flow priapism results in a variable degree of cavernosal fibrosis and a subsequent loss of penile length. The delayed insertion of a penile prosthesis can be difficult, with high complication rates. The immediate insertion of a penile prosthesis in patients with prolonged low‐flow priapism is simple and maintains penile length. This should always be offered to the patient at initial presentation, as the complication rate is low and the subsequent outcome excellent.
The clinical implications of the difference between castration, gonadotrophin releasing‐hormone (GnRH) antagonists and agonist treatment on the morphology and expression of GnRH receptors in the rat ventral prostate
Authors: Tieva Å. , Bergh A. , Damber J.‐E.
Published: March 2003

OBJECTIVE

To examine the effects of castration and continuous gonadotrophin releasing‐hormone (GnRH) agonist and antagonist therapy on the expression of GnRH‐receptors type I (GnRH‐RI) in rat ventral prostate (VP) and pituitary tissue, and to compare the effects on prostate morphology.

MATERIAL AND METHODS

Mature Sprague‐Dawley rats were assigned to four treatment groups: group 1, vehicle only; group 2, GnRH agonist goserelin (100 µg/rat/day); group 3, GnRH antagonist cetrorelix (100 µg/rat/day); and group 4, orchidectomy. After 4 weeks the body weights were recorded and VP and pituitary tissue analysed for GnRH‐RI expression using a competitive reverse transcriptase–polymerase chain reaction and immunohistochemistry.

RESULTS

GnRH antagonist and orchidectomy decreased testosterone secretion and VP volume similarly, but the effects were not identical. The involution of the glandular lumina was more pronounced after orchidectomy while the antagonist therapy was more effective in suppressing epithelial cell proliferation. In the VP, GnRH‐RI mRNA levels were increased after GnRH analogue therapy, but were unaffected by orchidectomy. In the pituitary, GnRH‐RI mRNA expression was higher in response to orchidectomy and decreased after GnRH analogue treatment.

CONCLUSION

Treatment with a GnRH antagonist for 4 weeks is more effective than an agonist in suppressing testosterone and inducing VP involution. The GnRH antagonist was more effective in suppressing VP epithelial cell proliferation than was castration, suggesting that it induces reduced proliferation by interfering with effects of locally produced GnRH. These results suggest that different regulatory mechanisms may operate in the rat VP than in the pituitary to control GnRH‐RI mRNA expression.
The mesh wallstent in the treatment of detrusor external sphincter dyssynergia in men with spinal cord injury: a 12‐year follow‐up
Authors: Hamid R. , Arya M. , Patel H.R.H. , Shah P.J.R.
Published: March 2003

OBJECTIVE

To assess the long‐term effectiveness of the UroLume™ wallstent (Pfizer Inc., UK) in the treatment of detrusor external sphincter dyssynergia (DESD) in quadriplegic patients.

PATIENTS AND METHODS

Twelve patients with quadriplegia secondary to spinal trauma underwent external striated sphincter stenting with the UroLume wallstent instead of an external sphincterotomy for DESD (mean age 41.8 years, range 26–65). The level of injury was C4 in two, C5 in four, C6 in four, C7 in one and T6 in one. All patients were shown by preoperative video‐cystometrography (VCMG) to have DESD and high‐pressure, hyper‐reflexic bladders with incomplete emptying.

RESULTS

Seven of the 12 patients had a mean (range) follow‐up of 12.7 (12.17–13.6) years; two others were lost to follow‐up at 1 and 3 years and both remained free of complications during that time. Two patients developed encrustation causing obstruction, requiring stent removal within a year of insertion. Another patient with an adequately functioning stent died 7 years after surgery (chest infection). Urodynamic follow‐up of the seven patients showed a significantly sustained reduction in maximum detrusor pressure and duration of detrusor contraction at> 10 years of follow‐up. Five of the seven patients developed bladder neck dyssynergia of varying degrees, as shown on VCMG; all were successfully treated with bladder neck incision. There were no problems with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia.

CONCLUSION

Permanent urethral stenting using the UroLume wallstent is effective in managing DESD and provides an acceptable long‐term alternative to sphincterotomy. Subsequent bladder neck dyssynergia is the main complication but this can be managed successfully with bladder neck incision. Importantly, unlike sphincterotomy, there is no significant interference with erectile function. Also, the procedure is reversible, minimally invasive and requires a shorter hospital stay.
Matrix metalloproteinases (MMPs) in bladder cancer: the induction of MMP9 by epidermal growth factor and its detection in urine
Authors: Nutt J.E. , Durkan G.C. , Mellon J.K. , Lunec J.
Published: March 2003

OBJECTIVES

To investigate the matrix metalloproteinases (MMPs) 2 and 9 in bladder cancer cell lines stimulated with epidermal growth factor (EGF), and to investigate the presence of gelatinases in the urine of patients with bladder tumours, in relation to the stage and grade of tumour and the EGF receptor (EGFR) status.

PATIENTS, SUBJECTS AND METHODS

Conditioned media from cultured tumour cells were analysed by zymography. Urine samples from 28 patients with transitional cell carcinoma and 12 normal volunteers were also analysed. Western blotting was used to verify the bands of gelatinolytic activity. The EGFR status of the tumours was assessed by immunohistochemistry.

RESULTS

MMP9 was induced by EGF in the RT112 but not the RT4 bladder tumour cell line, whereas MMP2 production was unaffected by EGF. Gelatin zymography of urine samples from patients with bladder tumours showed high levels of MMP activity, with 78% positive for MMP9 and 28% positive for MMP2. The total gelatinolytic and MMP9 activity were significantly higher in patients with high‐stage invasive tumours than in those with superficial tumours (P < 0.05), and were higher than in normal controls. Gelatinolytic activity at 130 and 200 kDa in urine was identified as MMP9 and MMP2. There was no significant relationship of urinary MMP9 activity to EGFR status of the tumour.

CONCLUSION

EGF induces MMP9 but not MMP2 in bladder cells. Analysis of urinary gelatinases is a useful noninvasive technique and both total gelatinase and MMP9 activity are associated with high stages of bladder tumours.
Standardization of the renogram technique for investigating the dilated upper urinary tract and assessing the results of surgery
Authors: O'Reilly P.H. ,   for the Consensus Committee of the Society of Radionuclides in Nephrourology
Published: March 2003

OBJECTIVE

To recommend a standard technique for the renographic evaluation of the dilated upper urinary tract, and for evaluating the results of surgery.

METHODS

This review is an update of the previously recommended consensus report of the 9th International Symposium of Radionuclides in Nephrourology.

RESULTS

State‐of‐the‐art recommendations are detailed for standardizing common radionuclide investigations.

CONCLUSIONS

Where open, laparoscopic or endourological techniques for treating pelvi‐ureteric junction obstruction are under study, results can only be compared by standardizing the investigational techniques. The guidelines produced here are recommended for this purpose.
Chemosensitization of human prostate cancer using antisense agents targeting the type 1 insulin‐like growth factor receptor
Authors: Hellawell G.O. , Ferguson D.J.P. , Brewster S.F. , Macaulay V.M.
Published: March 2003

OBJECTIVE

To assess the effect of the downregulation of type 1 insulin‐like growth factor receptor (IGF1R) on the chemosensitivity of prostate cancer cells. IGF1R is overexpressed by prostate cancer compared with benign prostatic epithelium and IGF1R expression commonly persists in androgen‐independent metastatic disease at levels comparable to those in the primary.

MATERIALS AND METHODS

Human androgen‐independent DU145 prostate cancer cells were transfected with IGF1R antisense oligonucleotides or antisense RNA. Transfected cultures were treated with cisplatin, mitoxantrone, paclitaxel or vehicle control, and survival measured using a clonogenic assay.

RESULTS

Both antisense strategies suppressed IGF1R protein levels to 30–50% of those in control cultures. This was associated with 1.5–2‐fold enhancement of sensitivity to cisplatin, mitoxantrone and paclitaxel, and an increase in cisplatin‐induced apoptosis.

CONCLUSION

This approach has potential for development as a clinical treatment for advanced prostate cancer and other chemoresistant tumours.
Corticosteroid use after prostate brachytherapy reduces the risk of acute urinary retention
Authors: Sacco D.E. , Daller M. , Grocela J.A. , Babayan R.K. , Zietman A.L.
Published: March 2003

OBJECTIVES

To evaluate the role of short‐term steroids after prostate brachytherapy to reduce oedema and thus the risk of urinary retention associated with brachytherapy, as this can require surgical intervention and may even result in incontinence.

PATIENTS AND METHODS

A retrospective review was conducted on 400 consecutive patients with early‐stage prostate cancer who underwent ultrasonography‐guided transperineal brachytherapy. Androgen deprivation was given to 146 patients for 3 months before the implant and 280 received a 2‐week course of dexamethasone (4 mg twice daily for 1 week then 2 mg twice daily). Forty‐five patients developed acute urinary retention at a median of 12 days after implantation. Univariate and multivariate analyses were used to evaluate the potential risk factors for urinary retention.

RESULTS

Acute urinary retention developed in 11.1% of the patients and the risk was predicted by increasing prostate volume at the time of diagnosis. This risk was higher (18.8%) for men receiving no dexamethasone and lower (8.2%) for those who did. In the multivariate analysis the volume at diagnosis and the use of dexamethasone remained significant. The use of steroids counterbalanced the effect of increasing prostate volume on the incidence of retention. The risk of retention was higher in those men receiving androgen deprivation to shrink their prostates than in those whose prostates were of suitable size for implantation at the time of diagnosis.

CONCLUSION

Reducing prostate volume by androgen deprivation before brachytherapy may be less important in preventing brachytherapy‐related urinary retention than the use of corticosteroids to reduce oedema afterward.