bluuebunny/crossref_metadata_2025 huggingface dataset:
Early voiding difficulty after colposuspension
Authors: SMITH R.N.J. , CARDOZO L.
Published: November 2003

Objective

 To determine the incidence of post‐operative voiding dysfunction (POVD) after colposuspension and to identify pre‐operative risk factors.

Patients and methods

 A retrospective study of 100 women having colposuspension to determine the pre‐operative clinical assessment (history, physical examination, symptom‐specific questionnaire and visual analogue score assessment of urological symptoms), pre‐operative urodynamic investigations (uroflowmetry, twin‐channel subtracted cystometry and video‐cystourethrography), information on post‐operative catheter management and the presence and management of any POVD.

Results

 Twenty‐one women experienced significant POVD attributable to their colposuspension. This resolved within 6 months in 19, but persisted beyond 6 months in two. Women experiencing POVD were significantly older and were more likely to have previously undergone a hysterectomy. The risk of POVD was 12% for those aged <50 years, 25% at age 50–64, and 50% for those over 65 years. The duration of post‐operative catheterization was related to the presence of symptoms of voiding difficulty.

Conclusions

 The risk of POVD after colposuspension increases with age. In women over 65 years old, consideration should be given to an elective temporary discharge home with a suprapubic catheter in situ for 7–10 days before initiating a catheter‐clamping regimen.
Validation of a rapid method to quantify apoptosis in superficial bladder cancer
Authors: KELLY J.D. , HAMILTON P.W. , WILLIAMSON K.E. , WEIR H.P. , MCMANUS D.T. , KEANE P.F. , JOHNSTON S.R.
Published: November 2003

Objectives

 To derive and validate a rapid method for calculating apoptotic indices in superficial transitional cell carcinoma (TCC) as a measure of chemosensitivity to mitomycin.

Materials and methods

 Apoptotic cells, identified by light microscopy in 20 superficial TCC specimens, were expressed as an index of the total tumour cell population within defined fields. For a given field, the total cell population was estimated by: (i) an exhaustive count of the total number of cells in the field and (ii) an abbreviated method in which the number of cells in a subfield was multiplied to provide an estimate of the total field number. Field and specimen estimates were compared using agreement statistics and the intra‐ and inter‐observer reproducibility of apoptotic indices calculated.

Results

 Cellularity and apoptotic indices obtained using method (ii) were correlated significantly with the true cell counts (P<0.001). Agreement statistics showed that only 9.4% of counts fell outside two standard deviations (sd) from the mean in field analysis, and only 10% of counts fell outside 2 sd from the mean in specimen analysis. There was a fivefold variation in tumour cell counts among individual fields.

Conclusions

 The reported variation in cellularity among fields shows that the calculation of apoptosis must use the total cell population as the reference. The limits of agreement for the estimated and true cell counts are small enough to be confident that the shorter method to estimate cellularity can be used in place of counting all cells.
The ‘watering‐can’ perineum: presentation and management
Authors: SHARFI A.R.A. , ELARABI Y.E.
Published: November 2003

Objectives

 To assess the frequency of ‘watering‐can’ perineum among patients with post‐inflammatory urethral strictures, to evaluate methods of anatomical location and to assess the efficacy of direct‐vision internal urethrotomy (DVIU) in this condition.

Patients and methods

 From 1990 to 1996, 216 patients with post‐inflammatory urethral strictures were evaluated; all underwent ascending urethrography and urethroscopy and 44 were found to have a ‘watering‐can’ perineum. These patients were evaluated further for the presence of associated urethral pathology, e.g. calculi and diverticulae. DVIU was performed as the primary method of treatment and any associated urethral pathology treated at the same time. The follow‐up ranged from 3 to 36 months (mean 20).

Results

 Ascending urethrography and urethroscopy located the site of the stricture in all 44 patients; 12 had associated urethral calculi. In 28 patients, the fistulae healed completely after a single DVIU, a further 11 required two urethrotomies, while the remaining five required more than two urethrotomies to treat the stricture.

Conclusion

 DVIU can be used to treat strictures complicated by urethrocutaneous fistulae, and for detecting associated urethral pathology. It has the advantage of requiring a minimal hospital stay, provoking minimal morbidity and the procedure can be repeated as a day‐case if the stricture recurs.
Chronic systemic treatment with epidermal growth factor induces smooth muscle cell hyperplasia and hypertrophy in the urinary tract of mature Goettingen minipigs
Authors: VINTER‐JENSEN L. , JUHL C.O. , DAJANI E.Z. , NIELSEN K. , DJURHUUS J.C.
Published: November 2003

Objective

 To determine the effect of systemic treatment with epidermal growth factor (EGF) on the induction of growth in the urinary tract.

Materials and methods

Mature Goettingen minipigs were treated daily with vehicle (Tris‐HCl; n=5) or EGF (30 μg/kg) (n=6) for 4 weeks. The total number of smooth muscle cells was counted using an optical disector in a 20 μm thick cross‐section of the ureter and the mean smooth muscle cell volume estimated. Cell proliferation was detected by immunostaining for the marker Ki67.

Results

The ureters of the animals treated with EGF were longer and thicker than those of the controls and the median cross‐sectional area of the ureter was 3.3‐fold larger; the growth involved all wall layers. The median (range) number of smooth muscle cells in a 20 μm thick cross‐section of the ureter was 11 (9–12) × 103 in the pigs treated with placebo and 55 (19–80) × 103 in those treated with EGF, and the median (range) volume of the smooth muscle cells was 2.3 (2.2–2.4) × 103 and 4.0 (3.0–4.5) × 103 mm3 , respectively.

Conclusions

There were two likely mechanisms contributing to smooth muscle cell hyperplasia, the division of fully differentiated smooth muscle cells and division of fibroblasts in the borderline between the submucosal layer and muscular coat, with ensuing differentiation into smooth muscle cells. Treatment with EGF induces the growth of all wall layers in the urinary tract with remarkable hyperplastic and hypertrophic changes of the smooth muscle cells in the muscular coat.
Transuretero‐ureterostomy: a review of 253 cases
Authors: Noble J.G. , Lee K.T. , Mundy A.R.
Published: November 2003

Objectives  To review our experience of transuretero‐ureterostomy (TUU), which can be a dangerous procedure if a problem arises with the anastomosis, because both upper urinary tracts are put at risk to deal with a problem that initially affected only one side.

Patients and methods  TUU was performed in 253 patients following undiversion, trauma or strictures of the distal ureter, with a Mitrofanoff‐type of continent urinary diversion, or otherwise during reconstructive urological surgery, mainly in association with cystectomy and substitution cystoplasty. The patients were followed and complications or problems reviewed.

Results  Five patients had problems with the distal ureter below the TUU and one had problems as a result of stone disease in the transposed ureter some distance proximal to the TUU, but there were no long‐term complications as a direct result of the TUU.

Conclusions  Providing the anastomosis is stented until there is radiological evidence of healing of the TUU, then TUU is a safe and reliable procedure.
Effect of androgen deprivation on epithelial and mesenchymal tissue components in localized prostate cancer
Authors: Hellström M. , Ranefall P. , Wester K. , Brändstedt S. , Busch C.
Published: November 2003

Objective To measure the area distribution of epithelial and mesenchymal components in the prostate of patients with localized prostate cancer after temporary androgen deprivation.

Patients and methods Surgical specimens from 38 patients treated with the gonadotrophin‐releasing hormone agonist triptorelin for 3 months before radical prostatectomy were examined (group 1). Specimens from a second group of 54 patients who underwent the same surgical procedure with no prior therapy were used as controls (group 2). The specimens were serially step‐sectioned and whole‐mount tissue sections prepared. The epithelial, smooth muscle and connective tissue components were stained separately with immunohistochemical and histochemical techniques, respectively. Using colour‐based image analyses, the tissue components were classified into three categories, displayed in different colours. The percentage of tumour areas occupied by cancer epithelial cells, connective tissue and smooth muscle was determined.

Results In specimens from group 1, the cancer epithelium was sparse and scattered throughout the tumour area. A mean (sd) of 21 (11)% of the area was occupied by cancer cells, compared with 40 (11)% in the corresponding material from group 2 (P<0.001). The connective tissue/smooth muscle ratio in stroma (about 1:1) was similar in both groups.

Conclusions Neoadjuvant hormone treatment of patients with localized prostate cancer was associated with a marked reduction in tumour density and thus in the total amount of cancer epithelium.
Urodynamic services, personnel and training in the United Kingdom
Authors: Hosker G.L. , Kilcoyne P.M. , Lord J.C. , Smith A.R.B.
Published: November 2003

Objective To audit the provision of urodynamic services in the UK, with particular emphasis on the personnel involved and the training they received.

Methods A questionnaire was sent to 163 centres carrying out urodynamics in the UK asking for information on the department providing the service, the frequency of use, the number of patients investigated, professional training of the personnel and whether the personnel thought that the training was adequate.

Results Most urodynamic facilities in the UK function on a part‐time basis. Urodynamics are carried out by a variety of healthcare professionals but most are performed by doctors and nurses. Half the respondents considered the training to be inadequate.

Conclusion Consideration should be given to requiring a minimum standard of training for personnel carrying out urodynamics in the UK to ensure that a quality service is provided.
Testicular and adrenocortical function in men with prostatic cancer and in healthy age‐matched controls
Authors: Carlström K. , Stege R.
Published: November 2003

Objective To compare the endocrine status of patients with prostate cancer with that of age‐matched healthy controls.

Patients, subjects and methods Basal serum concentrations of sex steroids, sex hormone‐binding globulin (SHBG) and gonadotrophins, and the basal levels and response to adreno‐corticotropic hormone (ACTH) of adrenocortical steroids, were measured before treatment in 72 patients with prostate cancer and in 42 age‐matched healthy controls.

Results Patients aged <60 years with prostate cancer had significantly elevated levels of total testosterone and unconjugated (E1) and total (tE1) oestrone while patients aged ≥60 years had significantly elevated levels of total and non‐SHBG‐bound testosterone (NST), 17α‐hydroxyprogesterone and tE1. Gonadotrophins, SHBG levels and relationships between total testosterone and SHBG were normal in both age groups of patients, as were basal levels and ACTH‐induced increments of adrenocortical steroids. The patients had normal age‐related variations in SHBG and NST and in basal levels and ACTH‐induced increments of adrenocortical steroids. There was a significant age‐related increase in serum E1 in the control subjects but not in the patients. Patients with metastatic disease had significantly lower tE1 levels than had patients without metastases.

Conclusions The results suggest an increased sensitivity of the testis to gonadotrophic stimulation, as well as an increased peripheral oestrogen synthesis in patients with prostate cancer, the latter being most pronounced in younger subjects. Men developing prostate cancer may have been exposed to a combination of elevated endogenous oestrogen and androgen levels for a long time. These findings support the theory of a synergism between oestrogens and androgens as an important factor in the aetiology of prostate cancer.
The ileocaeco‐urethrostomy with multiple transverse taeniamyotomies for bladder replacement: an alternative to detubularized neobladders. Morphological, functional and metabolic results after 9 years' experience
Authors: Alcini E. , Racioppi M. , D'Addessi A. , Alcini A. , Menchinelli P. , Grassetti F. , Destito A. , Sasso F. , Giustacchini M.
Published: November 2003

Objective To evaluate the results from the long‐term follow‐up of ileocaeco‐urethrostomy with multiple transverse taeniamyotomies for bladder replacement.

Patients and methods Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco‐urethrostomy with multiple transverse taeniamyotomies. Avoiding detubularization, sectioning the caecal taeniae improved reservoir morphology and reduced internal pressures and wall tension, limiting the potential complications of the operation.

Results All patients achieved diurnal continence with socially acceptable intervals between micturitions. Immediately after the operation, the nocturnal continence rate was good (79% of patients with a follow up <3 years), reaching 86% after >3 years. After 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 47.6 cmH2O, while the mean post‐micturition residual volume was 28 mL; no patient needs to use self‐catheterization. Given the short intestinal length used, no metabolic clinical problems have occurred.

Conclusions The concept of using the caecum arose from physiological and anatomical assumptions, i.e. receptive relaxation, the presence of taeniae and ileocaecal sphincter. Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pressure and a near‐spherical shape, but, in contrast, by leaving the circular muscle intact, they allow a good basal tone to be maintained thus obtaining optimal emptying and avoiding deterioration of the reservoir.
High‐intensity focused ultrasound in the treatment of benign prostatic hyperplasia
Authors: Mulligan E.D. , Lynch T.H. , Mulvin D. , Greene D. , Smith J.M. , Fitzpatrick J.M.
Published: November 2003

Objective To assess the role of high‐intensity focused ultrasound (HIFU) in the treatment of symptomatic benign prostatic hyperplasia (BPH).

Patients and methods Thirteen patients (mean age 65 years, range 58–74) were treated with HIFU as part of a phase‐2 clinical trial and evaluated prospectively using the International Prostate Symptom Score, uroflowmetry, and transrectal and transabdominal ultrasonography to determine prostate size and post‐void residual urine volume, respectively. The results and the patients' satisfaction were assessed at regular intervals for 2 years.

Results The new procedure was learned quickly and was easy to perform. Symptom scores decreased from a mean of 23 before treatment to 5 after 12 months and 7 after 2 years. There was an initial improvement in flow rates but they then declined. The size of the prostate and the post‐void residual volume were both decreased after treatment.

Conclusions The treatment is safe, easy to implement and was effective in substantially reducing symptom scores in these few patients. However, we would not encourage its use as an alternative to other well established treatment modalities until it has been assessed fully in a randomized trial.
Unique synergism or antagonism of combinations of chemotherapeutic and hormonal agents in human prostate cancer cell lines
Authors: Kreis W. , Budman D.R. , Calabro A.
Published: November 2003

Objective To evaluate combinations of anti‐tumour agents in tissue cultures using three established cell lines derived from patients with prostate cancer to obtain potential candidates for therapeutic testing in patients with prostate cancer.

Materials and methods Seventeen anti‐tumour agents were tested for synergism or antagonism in combination studies in DU 145, PC 3 and LnCaP cell lines. After determining the dose required for 50% inhibition of growth in each, combinations were screened using the median‐effect plot and combination‐index isobolograms.

Results Estramustine (the primary product of dephosphorylation of estramustine phosphate) showed strong synergism in all three cell lines with hydroxyflutamide, the non‐immunosuppressive cyclosporin analogue PSC 833, and Liarozole . In the hormone‐sensitive cell line LnCaP alone, synergism was also observed with vinblastine, paclitaxel, docetaxel, bicalutamide, ketoconazole and all‐trans‐retinoic acid. Other synergistic combinations of two agents were: Liarozole plus docetaxel in LnCaP, PSC 833 plus bicalutamide in DU 145 and PC 3, dexamethasone plus docetaxel in LnCaP, and finasteride plus hydroxyflutamide. Synergistic combinations of three agents were: estramustine plus PSC 833 and Liarozole and schedule‐dependent combinations of estramustine, PSC 833, and all‐trans‐retinoic acid.

Conclusion Some of the synergistic combinations have shown clinical effects in patients with hormone‐refractory prostate cancer. Based on these findings, new combinations, e.g. estramustine with either PSC 833 or Liarozole, need to be clinically evaluated.
Nuclear accumulation of mutant p53 protein: a possible predictor of failure of intravesical therapy in bladder cancer
Authors: Caliskan M. , Turkeri L.N. , Mansuroglu B. , Toktas G. , Aksoy B. , Unluer E. , Akdas A.
Published: November 2003

Objective To investigate the expression and importance of the nuclear accumulation of p53 in superficial transitional cell carcinoma (TCC) of the bladder and its role as a predictor of response to treatment.

Patients and methods Tumour samples from 30 patients (two women and 28 men, mean age 60.1 years, range 44–75) with pTa/pT1 tumours were assessed immunohistochemically using the Pab1801 monoclonal antibody and standard avidin‐biotin peroxidase staining for p53 protein.

Results Tumours from six patients (20%) showed nuclear accumulation of p53; five of these patients failed intravesical therapy with bacille Calmette‐Guèrin (BCG) and progressed to muscle invasive and/or metastatic disease, in contrast to six of 24 patients with no detectable nuclear oncoprotein.

Conclusions The nuclear accumulation of p53 appears to be a prognostic indicator of tumour unresponsive to intravesical treatment, even with the most potent agent (BCG). Therefore, early radical treatment modalities must be seriously considered in this group of patients.
Daycase transurethral incision of the prostate using the holmium:YAG laser: initial experience
Authors: Cornford P.A. , Biyani C.S. , Brough S.J. , Powell C.S.
Published: November 2003

Objective To ascertain whether the holmium:YAG laser can be used for transurethral incision of the prostate (TUIP), without the need for post‐operative catheterization.

Patients and methods The study comprised 100 men with symptomatic bladder outlet obstruction and clinically benign glands (<30 g). The International Prostate Symptom Score (IPSS), flow rates and post‐void residual urine volume were measured before and 6 weeks after surgery. The first 22 patients were admitted overnight for observation, but the remaining 78 patients were discharged on the day of the procedure, once they had successfully voided.

Results Ninety‐seven men voided successfully on the day of the procedure. The mean IPSS, flow rate and residual urine volume were all significantly improved at the time of review. Six patients developed a urinary tract infection post‐operatively and eight men reported retrograde ejaculation.

Conclusion The holmium:YAG laser facilitates a bloodless TUIP thus avoiding catheterization, allowing the procedure to be carried out as a day case.
Epidermal growth factor (EGF) and EGF receptor in hypospadias
Authors: El‐Galley R.E.S. , Smith E. , Cohen C. , Petros J.A. , Woodard J. , Galloway N.T.M.
Published: November 2003

Objective  To determine whether alterations in epidermal growth factor (EGF), which plays a major role both in the masculinization of the genitourinary tract and in wound healing, or EGF receptor (EGFR) expression are associated with hypospadias.

Patients and methods  The prepuces from 22 children undergoing circumcision (median age 27 months, range 5–87) and skin biopsies from 16 children undergoing surgery for hypospadias (median age 12 months, range 3–57) were studied. Fourteen patients had distal, one had mid‐shaft and one had penoscrotal hypospadias. Immunoperoxidase staining was carried out for EGF and EGFR and the density of the staining quantified using image cytometry by an operator unaware of the diagnosis.

Results
 The median EGF density in foreskins obtained by circumcision was 75% (mean 73, se 2.1) compared with 54% (mean 52, se 3.9) for tissue samples from patients with hypospadias (P<0.001); the mean EGFR was similar in both materials.

Conclusion  The mean EGF value was deficient in skin adjacent to hypospadias defects compared to normal phallic skin, suggesting that the inadequate expression of EGF may be related to the aetiology of hypospadias and to possible wound complications following surgery for hypospadias.
Structural alterations in the tunica albuginea of the penis: impact of Peyronie's disease, ageing and impotence
Authors: Akkus E. , Carrier S. , Baba K. , Hsu G.‐L. , Padma‐Nathan H. , Nunes L. , Lue T.F.
Published: November 2003

Objective  To investigate whether changes in the structure of the tunica albuginea influence the development of erectile dysfunction.

Patients and methods  Biopsy specimens taken from the tunica of 64 patients (both potent and impotent) with and without Peyronie's disease were evaluated. Tissue samples were stained and examined under light and electron microscopy, and the concentration of elastic fibres present in each was measured using computerized image analysis.

Results
 The concentration of elastic fibres was lower in impotent than in potent patients (P=0.0365) and was also significantly less in patients with Peyronie's disease. Furthermore, the concentration of elastic fibres decreased with age. Electron and light microscopy revealed the presence of distinct alterations in the tunica albuginea in impotent patients and patients with Peyronie's disease that might interfere with function.

Conclusion  The decrease in elastic fibre concentration and changes in microscopic features may contribute to erectile dysfunction by impairing the veno‐occlusive function of the tunica albuginea.
A short vas deferens limiting successful laparoscopic testicular descent
Authors: Perovic S. , Janic N.
Published: November 2003

Objective To highlight the problem of the short vas deferens in a single stage or staged laparoscopic orchidopexy.

Patients and methods From October 1992 to February 1996, 23 patients (mean age 4.9 years, range 12 months to 12 years) underwent a laparoscopic staged Fowler‐Stephens orchidopexy. During the second stage (open surgery), a short vas deferens was found in three patients; two testes were located retrovesically and one was in the internal inguinal ring. Two testes could not be brought into the scrotum, but only to the inguinal region, and one testis was placed in the scrotum but under tension.

Results The patients were followed for 12, 19 and 28 months; the testis under tension became fully atrophic. One of the two testes that could not be placed further than the inguinal canal developed marked hypotrophy, while the other ‘survived’.

Conclusion A laparoscopic staged Fowler‐Stephens orchidopexy should not used in patients with a very short vas deferens; patients with such a short vas deferens are extremely rare.
Histological evidence of an inflammatory reaction to suture material in the dog vas deferens
Authors: Fallick M.L. , Sable D.B. , Faller G. , LaRock D. , Sant G.R. , Schlesinger R.M. , Schwaitzberg S.D.
Published: November 2003

Objective  To evaluate changes in histology and semen variables after using an elastomeric‐hydrogel matrix plug as a reversible vasectomy device in dogs, and to determine the potential applications for improving fertility after vasectomy reversal.

Materials and methods  Semen samples from six adult male dogs were obtained after left vasal ligation, placement of the plug in the right vas deferens, and subsequent removal of the plug. The vasa, epididymides and testes were evaluated histologically in four of the dogs after removal of the implant.

Results  No sperm were present in the ejaculate after the plug was removed. Histological sections showed intraluminal spermatids in areas where the plug had been placed. The lumen was occluded, secondary to foreign‐body giant‐cell reaction, at the vasotomy suture site, but other areas of the vas previously containing the implant remained patent after it was removed.

Conclusions  There were no sperm in the ejaculate after the plug was removed because the vasal lumen was occluded as a result of an inflammatory reaction to the suture material. In contrast, areas that had contained the implant but without a vasotomy suture were not inflamed. We suggest that further trials comparing various suture materials are carried out to determine if patency rates can be improved during vasotomy closure or vasovasostomy.
Rectus abdominis muscle flap (RAMF) technique for the management of bladder exstrophies: late clinical outcome and urodynamic findings
Authors: Celayir S. , Kiliç N. , Eliçevik M. , Büyükünal C.
Published: November 2003

Objective To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, non‐compliant bladder extrophies.

Patients and methods The RAMF technique was used in two girls and two boys (mean age at operation, 31.7 months, range 3–72) with bladder exstrophy. The clinical outcome and urodynamics were assessed during a follow‐up of 29 months to 6 years (mean 49.2 months) and included imaging, cystoscopy, biochemical and microbiological studies.

Results There were no urinary tract infections, metabolic problems or electrolyte disturbances and kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMF with uroepithelium. No stone formation or mucus production were detected. Currently, three patients void using clean intermittent catheterization through the native urethra and the fourth through an appendiceal Mitrofanoff valve. However, the bladder volume was insufficient at the late follow‐up and three patients required bladder augmentation.

Conclusions The RAMF technique is a good alternative for closing bladder extrophies and achieves an increase in bladder capacity; however, although there is a mild improvement in bladder capacity and compliance, RAMF should not be used as a bladder augmentation procedure. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non‐compliant bladder remnants and failed primary closures.
Long‐term effects of cigarette‐smoke exposure on plasma testosterone, luteinizing hormone and follicle‐stimulating hormone levels in male rats
Authors: Yardimci S. , Atan A. , Delibasi T. , Sunguroglu K. , Güven M.C.
Published: November 2003

Objectives  To determine the effects of long‐term cigarette smoking on the levels of plasma testosterone, luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) in male adult rats and to examine morphological and histological changes in the testes.

Materials and methods  Cigarette smoke was generated by a smoking‐machine and 12 rats were exposed to cigarette smoke diluted with 90% air for 60 days (2 h/day). Twelve rats were exposed to room air only under similar conditions as controls. The concentrations of plasma testosterone, LH and FSH were measured before and after exposure using a radioimmunoassay and the testes were examined histologically.

Results  In rats exposed to smoke, the mean plasma testosterone level decreased significantly but there were no significant changes in testosterone in the control rats. The mean plasma LH and FSH levels of the two groups did not change significantly after exposure. In rats exposed to smoke, histological examination of the testes showed fewer Leydig cells and degeneration of the remaining cells.

Conclusion  These results indicate that the decrease in plasma testosterone levels induced by exposure to smoke was not associated with changes in plasma gonadotrophin levels. The decrease in testosterone levels may be related to the toxic effects of smoke on Leydig cells.
Physical predictors of infection in patients treated with clean intermittent catheterization: a prospective 7‐year study
Authors: Bakke A. , Digranes A. , Høisœter P.Å.
Published: November 2003

Objective  To study urinary tract complications in patients treated using long‐term clean intermittent catheterization (CIC), and to evaluate the physical factors which might be implicated in these complications.

Patients and methods  During 1995, 170 patients (84 men and 86 women, mean age 56.9 years) with a mean duration of use of CIC for 8.8 years were assessed for complications related to CIC. The same patients had participated in a thorough follow‐up study during 1988–9 and were examined again using questionnaires and the analysis of urine samples. CIC was practised by two‐thirds of the patients because they had neurogenic bladder dysfunction and for non‐neurogenic dysfunction in the remainder.

Results
 In this prevalence study, 111 patients (65%) had no signs of clinical urinary tract infection (UTI), while 10 patients (6%) had pronounced symptoms. The remaining 29% had only minor signs of UTI. There were three predictive factors of clinical UTI; women reported more infections than men, the patients most affected by UTI in the present study were those suffering UTI during the 1988–9 study and patients with UTI had the highest mean catheterization volume now, and the highest increase in mean catheterization volume from 1989 to 1995. Bacteriuria was found in 61% of the urine samples, with Escherichia coli the dominant species among women and Gram‐positive cocci among men. Patients who did not use anti‐infective agents had a 31% rate of sterile urine while the corresponding value among those using antibiotics was 54%. The frequency of catheterization was the only variable predictive of bacteriuria apart from the use of antibiotics.

Conclusion  This study confirms previous reports showing CIC to be an excellent procedure for minimizing urinary tract complications and supports the current recommendations, e.g. restricting the use of antibiotics in patients using CIC and ensuring that they catheterize sufficiently often to ensure that the mean volume of each catheterization is kept to <400 mL in adults.
The accuracy of recording of occupational history in patients with bladder cancer
Authors: McCahy P.J. , Harris C.A. , Neal D.E.
Published: November 2003

Objective  To determine how accurately information on the occupations of patients with transitional cell carcinoma of the bladder (TCC) was recorded.

Patients and methods  Using a semi‐structured interview and a standard proforma, 108 patients with TCC of the urinary tract were studied and the results compared with records in their case notes.

Results  Case notes were substantially correct in only 39% of patients. Occupations that might have been a significant factor in the aetiology of TCC were omitted in 71% of potentially exposed male patients and no occupational history was recorded in 12% of all patients.

Conclusions  Important clinical information was missing from the case notes that might have been of practical use in determining whether patients might be eligible for financial redress and which might be of use in future clinical research. It is recommended that details of occupational history should be taken using a structured proforma; this could be a suitable topic for regular audit.
B‐mode and colour‐flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?
Authors: Hendrikx A.J.M. , Linh Dang C. , Vroegindeweij D. , Korte J.H.
Published: November 2003

Objective  To determine the value of ultrasonography (US) and colour‐flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies.

Patients and methods  The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the ‘gold standard’ (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3.

Results  The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia.

Conclusion  For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.
The incidence of cystic fibrosis gene mutations in patients with congenital bilateral absence of the vas deferens in Scotland
Authors: Donat R. , McNeill A.S. , FitzPatrick D.R. , Hargreave T.B.
Published: November 2003

Objective  To examine the incidence of cystic fibrosis transmembrane‐conductance regulator (CFTR) gene mutations in Scottish patients with congenital bilateral absence of the vas deferens (CBAVD).

Patients and methods  Thirty patients with CBAVD presenting consecutively to the Edinburgh infertility clinic were examined for CFTR gene mutations. All patients were assessed clinically and tested for 15 gene mutations using a single‐tube polymerase chain‐reaction multiplex system.

Results  All patients were in good health and without clinical evidence of cystic fibrosis. CFTR gene mutations were found in 70% of patients with CBAVD.

Conclusion  CFTR gene‐testing and genetic counselling are important in all men with CBAVD.
Immersion in antibiotic solution prevents bacterial adhesion onto biodegradable prostatic stents
Authors: Cormio L. , La Forgia P. , Siitonen A. , Ruutu M. , Törmälä P. , Talja M.
Published: November 2003

Objective  To determine whether immersion in antibiotic solution reduces or prevents bacterial adhesion onto biodegradable prostatic stents.

Materials and methods Pre‐cut segments of polyglycolic acid (PGA) and polylactic acid (PLA) prostatic stents were incubated with two common uropathogenic bacterial strains (Enterococcus faecalis and Escherichia coli) with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI).

Results Immersion in ciprofloxacin solution prevented the adherence of both bacterial strains. Immersion in ceftriaxone solution prevented only the adherence of the E. coli strain. Immersion in tobramycin solution had no effect on either of the strains. The stent materials per se did not influence bacterial adhesion. After immersion in ciprofloxacin, the stent segments retained significant antibacterial activity even after one day's incubation in saline.

Conclusion Immersion in a suitable antibiotic solution may significantly reduce and even prevent bacterial adhesion onto biodegradable prostatic stents. Preventing bacterial adhesion may reduce the risk of UTI during the use of these devices.
Early endocrine therapy versus radical prostatectomy combined with early endocrine therapy for stage D1 prostate cancer
Authors: Schmeller N. , Lubos W.
Published: November 2003

Objective To compare disease progression and survival of patients with stage D1 adenocarcinoma after treatment with either early androgen ablation alone or combined with radical prostatectomy.

Patients and methods A retrospective non‐randomized study was performed in a series of 76 consecutive patients who underwent pelvic lymphadenectomy and had pathological stage D1 (T1–3, pN1–2, M0) prostate cancer; 37 patients underwent early endocrine therapy (EET) and 39 underwent radical prostatectomy with immediate adjuvant endocrine therapy (combined therapy, COM). The median follow‐up was 3.8 years (range 0.26–13). The patients were statistically homogeneous for tumour grade, local tumour stage and nodal involvement, but not for age at lymphadenectomy (67 years and 62 years, respectively, P=0.019, a confounding factor in favour of COM).

Results Twelve patients (32%) in the EET group and 11 (28%) in the COM group died; the Kaplan‐Meier actuarial overall survival curves showed no statistically significant difference between the treatment groups, but there was a trend in favour of the COM group. There was also no significant difference in the cause‐specific survival. In the EET group, 17 men (46 %) had local (five of 37, 14%) or systemic (13 of 37, 35%) progression and in the COM group 23 patients (59%) had local (eight of 39, 21%) or systemic (20 of 39, 51%) progression. Four patients had an elevated level of prostate specific antigen with no clinical recurrence. Transurethral resection of the prostate was necessary for three (8%) patients in the EET group and for two (5%) of those receiving COM. The Kaplan‐Meier actuarial disease‐free survival curves were not significantly different. Similar results were obtained when the 25 patients with early‐stage (T1 and T2) and the 51 patients with advanced primary tumours (T3 and T4) were analysed separately.

Conclusion These results suggest that in patients with stage D1 prostate cancer, radical prostatectomy combined with adjuvant endocrine therapy offers no advantage over endocrine therapy alone, neither for curative nor palliative intent.
Observations on the vomeronasal organ of prenatal Tarsius bancanus borneanus with implications for ancestral morphology
Authors: Smith T. D. , Siegel M. I. , Bhatnagar K. P.
Published: November 2003

Adult primates have at least five known phenotypes of vomeronasal organ (VNO), ranging from the typical morphology seen in most other mammals to complete absence. With such morphological disparity, the phylogenetic value and any inferences on ancestral VNO morphology of the primate VNO are left uncertain. The present study investigated the VNO of embryonic and fetal Tarsius bancanus borneanus (n = 4) in comparison with prenatal specimens from four other species of primates in an effort to clarify adult morphological variations. In all except one of the fetal primates, the VNO communicated to the nasopalatine duct. One exception occurred in the largest fetal Tarsius (25 mm crown–rump length), in which the VNO communicated with the nasal cavity alone. The vomeronasal neuroepithelium was well differentiated from a thinner, non‐sensory epithelium in all Tarsius and New World monkeys studied, as well as late embryonic and fetal Microcebus myoxinus. In anterior sections, this neuroepithelium was found in a more superior location in Tarsius and New World monkeys compared with Microcebus myoxinus. In all primates, masses of cell bodies were found superior to the VNO, intermingled with nerve fibres. These morphologically resembled luteinizing hormone‐releasing hormone neurons described in other mammals, including humans, suggesting that a primitive association of these neurons with the VNO may exist in all primate taxa. The present study revealed that prenatal similarities exist in Tarsius and New World primates in VNO epithelial morphology. However, these are transient stages of morphology. If tarsiers and anthropoids do represent a clade (Haplorhini), then the atypical morphology seen in adult tarsiers and New World monkeys probably represents the adult VNO morphology of a haplorhine common ancestor.
Histochemical analysis of lymphatic endothelial cells in the pancreas of non‐obese diabetic mice
Authors: Qu P. , Ji R. C. , Kato S.
Published: November 2003

We studied the relationship between insulitic development and function–structural changes of pancreatic lymphatics in non‐obese diabetic (NOD) mice using combined 5′‐nucleotidase (5′‐Nase) enzyme histochemical and secondary lymphoid tissue chemokine (SLC/CCL21) immunohistochemical methods. Interlobular lymphatic vessels were positive for 5′‐Nase throughout the pancreas, and dependent on both blood vessels and pancreatic ducts. Intralobular initial lymphatics were rare and occasionally ran in the neighbourhood of islets. During the non‐insulitic stage, the 5′‐Nase‐reactive product was evenly distributed on the surface of lymphatic endothelial cells (LECs) with weak expression of CCL21. The activity of 5′‐Nase on lymphatic vessels became slightly reduced as insulitis developed. The increasing blood glucose values appeared to be consistent with an increasing CCL21 expression by the endothelial lining, especially on the surface of LECs adjacent to the infiltrated islets and tissues. Lymphocytes and dendritic cells (DCs) were frequently located in the connective tissue, surrounding the lymphatic wall with deposition of 5′‐Nase precipitates. As the infiltration became severe, lymphocytes and DCs accumulated within lymphatic vessels and expressed high levels of CCL21. The most significant finding was that many DCs adhered to lymphatic vessels, transmigrating via the thin and indented endothelial walls. The activity of 5′‐Nase was increased on the adhesion surface between DCs (or lymphocytes) and LECs. The latter were characterized by open intercellular junctions and obvious cytoplasmic protrusions. These results suggest that LECs closely interact with DCs and lymphocytes, and play a key role in the migration of DCs and lymphocytes via lymphatic vessels during the pathological processes of insulitis in NOD mice.
Postnatal development of the basolateral complex of rabbit amygdala: a stereological and histochemical study
Authors: Jagalska‐Majewska H. , Wójcik S. , Dziewia̧tkowski J. , Łuczyńska A. , Kurlapska R. , Moryś J.
Published: November 2003

The aim of the study was to estimate developmental changes in the rabbit basolateral complex (BLC) by stereological and histochemical methods. Material consisted of 45 brains of New Zealand rabbits (aged from 2 to 180 days, P2 to P180) of both sexes, divided into nine groups. The following parameters were estimated: volume of the cerebral hemisphere; volume of the whole BLC and of particular BLC nuclei; neuronal density and total number of neurons in these nuclei. Developmental changes in acetylcholinesterase (AChE) activity in the BLC were also examined. The volume of the cerebral hemisphere increased until P30, whereas volumes of nuclei increased for longer – until P90. The density of neurons in all nuclei studied reached the level characteristic for an adult animal at about P30. The total number of neurons in the dorsolateral division of the lateral nucleus (Ldl) stabilized the earliest – between P30 and P60, whereas in the ventromedial division of the lateral nucleus (Lvm), basomedial (BM) and basolateral (BL) nuclei the number stabilized later – between P60 and P90. AChE activity appears minimal in the BLC on P2, reaches a maximum on P30 and then decreases to the level characteristic of an adult animal on P60. AChE activity was greater in BL than in other nuclei in all age groups. Reaching adult AChE activity 1 month earlier than the total number of neurons in the BLC may indicate a role of the cholinergic system in BLC maturation.
Changes in function and ultrastructure of striatal dopaminergic terminals that regenerate following partial lesions of the SNpc
Authors: Stanic D. , Parish C. L. , Zhu W. M. , Krstew E. V. , Lawrence A. J. , Drago J. , Finkelstein D. I. , Horne M. K.
Published: November 2003

Following partial substantia nigra lesions, remaining dopaminergic neurones sprout, returning terminal density in the dorsal striatum to normal by 16 weeks. This suggests regeneration and maintenance of terminal density is regulated to release appropriate levels of dopamine. This study examined the structure and function of these reinnervated terminals, defining characteristics of dopamine uptake and release, density and affinity of the dopamine transporter (DAT) and ultrastructural morphology of dopamine terminals in the reinnervated dorsal striatum. Finally, rotational behaviour of animals in response to amphetamine was examined 4 and 16 weeks after substantia nigra pars compacta (SNpc) lesions. Dopamine transport was markedly reduced 16 weeks after lesioning along with reduced density and affinity of DAT. Rate of dopamine release and peak concentration, measured electrochemically, was similar in lesioned and control animals, while clearance was prolonged after lesioning. Ultrastructurally, terminals after lesioning were morphologically distinct, having increased bouton size, vesicle number and mitochondria, and more proximal contacts on post‐synaptic cells. After 4 weeks, tendency to rotate in response to amphetamine was proportional to lesion size. By 16 weeks, rotational behaviour returned to near normal in animals where lesions were less than 70%, although some animals demonstrated unusual rotational patterns at the beginning and end of the amphetamine effect. Together, these changes indicate that sprouted terminals are well compensated for dopamine release but that transport mechanisms are functionally impaired. We discuss these results in terms of implications for dyskinesia and other behavioural states.
Human catecholamine sulfotransferase (SULT1A3) pharmacogenetics: functional genetic polymorphism
Authors: Thomae Bianca A. , Rifki Oktay F. , Theobald Michelle A. , Eckloff Bruce W. , Wieben Eric D. , Weinshilboum Richard M.
Published: November 2003

Sulfotransferase (SULT) 1A3 catalyzes the sulfate conjugation of catecholamines and structurally related drugs. As a step toward studies of the possible contribution of inherited variation in SULT1A3 to the pathophysiology of human disease and/or variation in response to drugs related to catecholamines, we have resequenced all seven coding exons, three upstream non‐coding exons, exon–intron splice junctions and the 5′‐flanking region of SULT1A3 using DNA samples from 60 African‐American (AA) and 60 Caucasian‐American (CA) subjects. Eight single nucleotide polymorphisms (SNPs) were observed in AA and five in CA subjects, including one non‐synonymous cSNP (Lys234Asn) that was observed only in AA subjects with an allele frequency of 4.2%. This change in amino acid sequence resulted in only 28 ± 4.5% (mean ± SEM) of the enzyme activity of the wild‐type (WT) sequence after transient expression in COS‐1 cells, with a parallel decrease (54 ± 2.2% of WT) in level of SULT1A3 immunoreactive protein. Substrate kinetic studies failed to show significant differences in apparent Km values of the two allozymes for either dopamine (10.5 versus 10.2 µm for WT and variant, respectively) or the cosubstrate 3′‐phosphoadenosine 5′‐phosphosulfate (0.114 versus 0.122 µm, respectively). The decrease in level of immunoreactive protein in response to this single change in amino acid sequence was due, at least in part, to accelerated SULT1A3 degradation through a proteasome‐mediated process. These observations raise the possibility of ethnic‐specific inherited alterations in catecholamine sulfation in humans.