bluuebunny/crossref_metadata_2025 huggingface dataset:
The expression of PAX5 in human transitional cell carcinoma of the bladder: relationship with de‐differentiation
Authors: Adshead  , Ogden  , Penny  , Stuart  , Kessling
Published: March 2003

Objective

To investigate the expression of PAX genes, a family of developmental control genes (which encode nine nuclear transcription factors essential for embryogenesis and are proto‐oncogenes in mice) in human transitional cell carcinoma (TCC) of the bladder.

Materials and methods

PAX gene expression was assessed in three established bladder cancer cell lines and 29 primary tumours using the reverse transcriptase‐polymerase chain reaction and Southern analysis.

Results

All three established TCC cell lines and 79% of primary TCCs expressed PAX5 mRNA. There was a significantly higher proportion of PAX5 expression in malignant than in benign urothelium (P=0.02, Fisher’s exact test); nine of 12 pTa tumours (mucosa‐confined), seven of eight pT1 (invading lamina propria) and eight of nine pT2 (invading muscle) expressed PAX5. A higher proportion of tumours with increasing de‐differentiation expressed PAX5, which correlates well with the expression pattern of PAX5 in development. In well‐differentiated tumours (grade 1), half expressed PAX5, compared with 84% of moderately to poorly differentiated tumours (grades 2/3). The odds ratio for PAX5 expression in malignancy suggests that it increases the risk of malignancy four‐fold.

Conclusion

These data support a role for the PAX family in oncogenesis, by identifying another human neoplasm in which they are inappropriately expressed. PAX5 expression in undifferentiated TCC cells may contribute to pathogenesis by supporting cellular proliferation in the de‐differentiated state. Furthermore, the high incidence of PAX5 expression suggests its potential use as a diagnostic tool and therapeutic target in TCC.
In vitro investigation of the bladder‐vascular selectivity of levcromakalim and YM934 in human tissues
Authors: Chess‐Williams  , Martin  , Korstanje  , Chapple
Published: March 2003

Objective

To examine the potencies of the potassium‐channel openers (KCOs) levcromakalim and YM934 as relaxing agents on human detrusor and human mesenteric artery smooth muscle, and to determine their bladder‐vascular selectivity in vitro.

Materials and methods

Strips of human detrusor muscle and mesenteric artery (with the endothelium removed) were set up in physiological salt solution and the tension developed by the tissues recorded. Tissues were precontracted with a concentration of carbachol (detrusor) or phenylephrine (artery) which caused 80% of maximal contraction, and relaxation responses to levcromakalim and YM934 were then obtained.

Results

Both KCOs caused relaxation of the bladder detrusor muscle and the mesenteric artery. Maximal responses, when plotted as a percentage of the precontraction, were greater for both KCOs in the bladder muscle than the artery, but the differences were small and not statistically significant. The sensitivity (drug potency) of the detrusor muscle to the KCOs was more than twice that of the artery but this selectivity was only statistically significant for YM934.

Conclusions

Only minor bladder‐vascular selectivity for levcromakalim and YM934 could be detected in vitro. This suggests that neither drug would be tolerated clinically, although the results suggest that further development of bladder‐selective KCO agents appears feasible.
Bladder augmentation: does it predispose to prosthetic infection of simultaneously placed artificial genitourinary sphincters or in situ ventriculoperitoneal shunts?
Authors: Furness  , Franzoni  , Decter
Published: March 2003

Objective

To review previous reports and our experience in assessing the risk of prosthetic infections in patients undergoing bladder augmentation simultaneously with artificial genitourinary sphincter (AGUS) implantation, and in patients with in situ ventriculoperitoneal (VP) shunts, implicated as a cause of shunt infection.

Patients and methods

The literature was searched to identify the number of prosthetic infections (AGUS or VP shunt) reported in patients who have undergone bladder augmentation. Additionally, the records of 53 myelodysplastic patients at our institution who had undergone bladder augmentation were reviewed to determine the incidence of AGUS and/or VP shunt infections. An AGUS was placed in 17 of these patients, who were then divided into three groups based upon the timing of their AGUS placement relative to bladder augmentation. Of the 53 patients, 47 had an in situ VP shunt at the time of their augmentation. All patients were followed for at least 12 months.

Results

The reported rate of AGUS infection at the time of simultaneous bladder augmentation was not significantly different from that when these procedures were staged. In the present series, the AGUS became infected in two patients (12%); one infection occurred in each of 10 patients undergoing simultaneous procedures (10%) and one developed in each of the seven patients undergoing staged procedures (14%). Although VP shunt infections have been reported after bladder augmentation, none of the present patients had a VP shunt infection after bladder augmentation.

Conclusion

These results suggest that bladder augmentation is not associated with an increased risk of prosthetic infection in patients undergoing simultaneous placement of an artificial sphincter or in those who have an in situ VP shunt.
Does maternal stress induce abnormal descent of the testis in prepubertal rats?
Authors: Shono  , Imajima  , Zakaria  , Suita
Published: March 2003

Objective

To investigate whether prenatal maternal stress, considered to alter plasma testosterone concentration and induce a lack of testosterone surge in male rat fetuses, has any effect on the growth of the processus vaginalis and testicular descent in male offspring.

Materials and methods

Pregnant rats were divided into two groups. In group 1, the rats were placed three times daily for 60 min each session in Plexiglas rat holders (13×6×8 cm) illuminated by two 150‐W flood lights from day 14 to day 18 of gestation during the dark phase of the animals’ light (12 h) and dark (12 h) cycle. In group 2, pregnant females were not handled and acted as controls. After birth, the anogenital distance of both the male and female rats was measured, and the length of the processus vaginalis was measured at 7 days of age in some rats. Thereafter, at 21, 24, 27 and 30 days of age, testicular descent was assessed in the remaining male rats.

Results

In group 1, at 21, 24, 27 days of age, testicular descent was delayed in the stressed rats compared with the control rats. At 30 days of age, five of 36 stressed male offspring showed abnormal testicular descent; three testes were in the superficial inguinal position and two were above the scrotum. Both the anogenital distance and the length of the processus vaginalis were significantly less in the stressed male rats than in the controls.

Conclusions

Maternal stress induced a female‐like anogenital distance in male rat fetuses, and caused delayed and abnormal descent of the testis, by inhibiting the growth of the processus vaginalis after birth. Prenatal stress may therefore be involved in the delay of testicular descent in neonatal rats by inducing a mild anti‐androgenic effect in the fetus.
Electrokinetic lithotripsy: safety, efficacy and limitations of a new form of ballistic lithotripsy
Authors: Keeley Jr  , Pillai  , Smith  , Chrisofos  , Tolley
Published: March 2003

Objective

To investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high‐energy magnetic fields to propel an impactor to fragment calculi.

Patients and methods

The records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi‐rigid ureteroscope, through which a 3 F EKL probe was passed.

Results

A total of 148 stones (mean stone size 11.5 mm, range 6–40) in 121 patients were treated using the EKL. One patient was lost to follow‐up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed‐dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone‐free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock‐wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent.

Conclusion

EKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi‐rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of ≥4 mm after EKL.
Low‐dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy‐epispadias complex
Authors: Caione  , Nappo  , De Castro  , Prestipino  , Capozza
Published: March 2003

Objective

To report our experience of the use of desmopressin to improve nocturnal dryness in patients who have undergone a staged reconstruction of the exstrophy‐epispadias complex (EEC), who although continent by day, have nocturnal incontinence because their nocturnal urinary output exceeds their bladder capacity.

Patients and methods

Seven children (aged 8–12 years) who had undergone a staged reconstruction for EEC (six with classical bladder exstrophy, one with incontinent epispadias) were treated with intranasal desmopressin for persistent nocturnal incontinence despite daytime dryness. Previous additional procedures for continence had been self‐augmentation in one and periurethral collagen injection in three others. The criteria for inclusion in the study were: normal renal function, no upper tract deterioration, no urinary tract infections, spontaneous voiding during the day with dry intervals between micturitions, a postvoid residual volume of <10% of bladder capacity and night‐time incontinence for 7 nights/week. Desmopressin was administered at bedtime at increasing dosages from 10 to 30 μg until effective. Body weight, arterial blood pressure, and serum electrolytes were measured, and all patients assessed using renal ultrasonography, a voiding diary and a nocturnal pad‐test.

Results

Desmopressin at doses of 10–30 μg was successful in keeping all the patients dry. The nocturnal urinary output was decreased so that it did not exceed bladder capacity. There was only one minor side‐effect (nose bleeding).

Conclusions

In selected patients with EEC, desmopressin is effective in improving nocturnal dryness, with no significant side‐effects.
Effects of a phytotherapeutic agent, PC‐SPES, on prostate cancer: a preliminary investigation on human cell lines and patients
Authors: De La Taille  , Hayek  , Buttyan  , Bagiella  , Burchardt  , Katz
Published: March 2003

Objectives

 To evaluate the in vitro activity of PC‐SPES, a complex phytotherapeutic agent, against prostate cancer cell lines, and to assess its activity in suppressing serum prostate specific antigen (PSA) level in patients with prostate cancer.

Patients and methods

 Four variant prostate cancer cell lines (LNCaP and an apoptosis‐resistant derivative, LNCaP‐bcl‐2, PC3 and DU145) were exposed to three different concentrations of PC‐SPES extract. Cell viability was measured at 3, 4 and 5 days of exposure using a colorimetric assay and was compared with control cultures receiving aliquots of the ethanolic extraction medium alone. Clinically, a prospective study was initiated in patients with prostate cancer who refused conventional therapy or who had failed previous cryosurgery, radiation therapy and/or hormonal therapy. The patients were treated with PC‐SPES (three capsules of 320 mg/day). The serum PSA responses and side‐effects were evaluated.

Results

 All cultured prostate cancer cell lines showed a significant dose‐dependent reduction in cellular viability (compared with control cultures) by exposure to 4 and 6 μL of PC‐SPES extract/mL of culture medium (P<0.001). In contrast to the hormone‐insensitive cell lines tested (LNCaP‐bcl‐2, PC‐3 and DU‐145), only the hormone‐sensitive cell line LNCaP was affected by the lowest dose of PC‐SPES extract tested (2 μL/mL medium). In the prospective clinical trial of 33 patients, with a mean (range) follow‐up of 6.8 (2–24) months after initiating PC‐SPES therapy, serum PSA levels were lower in 87% at 2 months and in 78% at 6 months (n=18, P=0.026). The side‐effects in these patients were nipple tenderness in two (6%) and leg clots requiring heparinization in two (6%). No gynaecomastia or hot flashes were observed in this group and the treatment was well tolerated.

Conclusions

 In this preliminary study, an extract of the phytotherapeutic agent PC‐SPES was active in suppressing the growth of cultured hormone‐sensitive and ‐insensitive prostate cancer cell lines. In the small clinical study, PC‐SPES therapy decreased serum PSA levels in most patients. However, a longer follow‐up and more patients will be required to evaluate the long‐term efficacy of this new phytotherapy.
Follow‐up of localized prostate cancer, with emphasis on previous undiagnosed incidental cancer
Authors: Berner A. , Harvei S. , Skjørten F.J.
Published: March 2003

Objective

To determine the natural course of incidental untreated transition zone prostate cancer and thus help to identify criteria to predict the prognosis and to determine treatment for individual patients.

Materials and methods

A total of 1135 unselected surgical specimens of the prostate, examined during 1974 and 1975, were reviewed while unaware of case by two experienced pathologists. The patients from which the samples were obtained were followed for up to 20 years or death by The Cancer Registry of Norway and the outcome compared with the histological review.

Results

The histology review revealed a total of 311 cancers, of which 73 had not been initially recorded; these patients had received no treatment. The kappa coefficient for interobserver reproducibility was 0.86 for carcinoma. The follow‐up showed that patient age was the strongest predictor of survival, followed by histological grade and percentage of tumour involvement. Only two of the 73 patients with untreated transition zone cancer died from prostate cancer during the follow‐up, compared with 78 of 144 patients with standard management of transition zone tumours. The 5‐ and 10‐year relative survival rates for the 144 patients with standard management of transitional zone tumours and for the 53 patients with peripheral zone tumours were 56% and 26%, and 45% and 33%, respectively. Metastasis (+ or −) was the only individual prognostic factor in the multivariate analysis.

Conclusion

This study shows that patients with incidental low‐grade tumours have a low probability of dying from prostate cancer and may thus be followed expectantly. The biological distinction between atypical hyperplasia and stage T1a cancer is unclear. The survival of men with prostate cancer is significantly reduced with loss of differentiation and with increasing tumour volvement.
Staging laparoscopic pelvic lymphadenectomy in prostate cancer
Authors: Shackley  , Irving  , Brough  , O'Reilly
Published: March 2003

Objective

To assess the results of transperitoneal laparoscopic pelvic lymphadenectomy as a separate staging procedure in patients with early prostate cancer.

Patients and methods

The results were reviewed from the first 27 patients with prostate cancer admitted for laparoscopic lymphadenectomy between January 1994 and March 1998. Initially, all patients with a negative bone scan and either a negative computed tomography or negative magnetic resonance scan were admitted for laparoscopic staging. After several reports detailing ways of reducing the number of negative lymphadenectomy operations, from July 1996 only those patients with a preoperative prostate specific antigen (PSA) serum level of >10 ng/mL were admitted to the study. All procedures were performed by one experienced laparoscopic surgeon. A radical retropubic prostatectomy was performed as a separate procedure by a consultant urologist within 2 weeks. The effectiveness of the staging operation was analysed by assessing the nodal yield, and the results, including operative duration, complications and length of stay, were compared with other published series. Further analysis was provided by reviewing the PSA levels, Gleason grade sum and clinical digital staging.

Results

The nodal yield was similar to that published in series from other institutions, with a median (range) of 6.5 (0–12). However, the operation was significantly quicker, at a median (range) of 55 (40–110) min for a bilateral dissection. There were only minor complications, with no detectable reduction in complications with experience; the median (range) postoperative stay was 1 (1–4) days. Two of the 27 patients had metastatic disease within the lymph nodes. If a PSA level of >10 ng/mL had been instituted as an entry criteria at the start of the study, six patients would have been excluded and thus the positive lymphadenectomy rate would have been two of 21 patients (10%). Of 54 patients eligible to enter the study, half did not require a lymphadenectomy.

Conclusions

Laparoscopic transperitoneal lymphadenectomy can be performed expeditiously and safely. A two‐stage procedure in some patients with prostate cancer is the management of choice. Attention to carefully closing the peritoneum with sutures minimizes any retropubic adhesions and no problems associated with the staging procedure were encountered during subsequent radical retropubic prostatectomy. In efforts to reduce negative staging lymphadenectomies, the exclusion values for staging should not be set too high (PSA and Gleason grading sum). Such practice, despite a relatively safe staging procedure, would lead to unnecessary radical prostatectomy.
The nature of spontaneous cavernosal activity
Authors: Çolakoglu  , Kutluay  , Ertekin
Published: March 2003

Objective

To determine the characteristics of spontaneous cavernosal activity (SCA) and to relate this to previous descriptions of spontaneous potentials from the cavernosum (single potential analysis of cavernosal activity, SPACE).

Subjects and methods

The SCA was recorded in 31 normal men with no sexual problems; various manipulations were applied using concentric‐needle (CN), bipolar needle (BN) and surface electrodes. The electrical activity was compared with the observed slow retractile movements of the flaccid penis and with other assessments of electrical activity from skin.

Results

SCA appeared synchronously from both sides of the cavernosal bodies in all normal subjects when detected by CN electrodes. The synchronous recordings both by CN and BN electrodes, or both by CN and surface electrodes registered similar oscillatory potentials. Slow retractile movements of the penis occurred synchronously with these potentials in all subjects and both were absent during erection.

Conclusion

SCA is apparently related to biomechanical slow movement artefacts of the flaccid penis; it may be a consequence of the summed contractions of smooth muscle groups in the cavernosum. Observing the small retractile slow movements of the flaccid penis and recording the SCA may be a useful indirect method to characterize cavernosal neural innervation and smooth muscle activity.
The pharmacovigilance of tamsulosin: event data on 12 484 patients
Authors: Mann R.D. , Biswas P. , Freemantle S. , Pearce G. , Wilton L.
Published: March 2003

Objective To determine drug effectiveness and adverse effects in a noninterventional observational cohort study of over 10 000 patients treated with tamsulosin in general medical practice.

Methods Using prescription‐event monitoring, data were collected of all prescriptions for tamsulosin issued nationally during June 1996 to January 1998. For each patient entered into the cohort a computerized longitudinal record of exposure was constructed. The outcome data, patient information and an opinion about the effectiveness of the drug were provided by the prescriber, using a standard questionnaire sent 6 months after the initial prescription for tamsulosin. The incidence of each of almost 2000 events listed in the Drug Safety Research Unit computerized dictionary was calculated and scrutinized by medical assessors for possible adverse reactions, and any difference determined between the incidence of each event in the first month and subsequent months of exposure. All deaths were followed up to detect possibly drug‐related causes.

Results Event data were obtained on 12 484 patients, from the 52.9% of questionnaires returned and that contained valid event data. Tamsulosin was reported to have been effective in 7428 (78.3%) of the 9487 patients in whom the general practitioners expressed an opinion about effectiveness. Suspected adverse drug reactions were reported in only 171 (1.4%) of the cohort. Dizziness, headache, malaise and hypotension were common to the reported adverse reactions, reasons for stopping the drug and events of greatest incidence density. None of the 282 deaths that occurred in this elderly cohort were attributed to the drug.

Conclusion This study suggests that tamsulosin has a highly acceptable benefit‐to‐risk ratio. No untoward features not already mentioned in the prescribing guidance were identified.
Reflex innervation of the bulbocavernosus muscle
Authors: Yang C.C. , Bradley W.E.
Published: March 2003

Objective To determine the somatic reflex innervation of the bulbocavernosus muscle (BCM) and to illustrate the role of the perineal nerve in BCM contraction, using electrophysiological techniques.

Subjects and methods Ten healthy, potent men underwent genital electrophysiological testing. Stimuli were applied to the dorsal nerve of the penis at the base of the penis, glans and anterior urethra, and the perineal nerve branch to the BCM. The electromyographic (EMG) responses of the BCM were recorded and onset latencies measured at baseline, both after anaesthetising the perineal nerve and after recovery from the anaesthetic.

Results A reflex BCM contraction was elicited from all stimulation sites. Anaesthetizing the perineal nerve resulted in alterations of the EMG response. After the anaesthetic effect wore off, the responses returned to baseline values.

Conclusions Three distinct somatic bulbocavernosus reflexes were detected which are components of normal ejaculation. BCM contraction can be elicited after stimulating the dorsal penile nerve at the glans and the anterior urethra; these are the flexor responses of the bulbocavernosus reflex. BCM contraction can also be induced on stimulating the perineal nerve, which is the pathway through which the stretch and the tendon organ reflexes are carried to mediate muscle tone. The motor innervation of the BCM for all reflexes is carried through a branch of the perineal nerve. The findings may be relevant to the evaluation of ejaculatory disorders.
Impairment of corpus cavernosal smooth muscle relaxation by glycosylated human haemoglobin
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B.
Published: March 2003

Objective To examine the effect of HbA1c, an isoform of glycosylated haemoglobin (GHb, a product of non‐enzymatic reactions between elevated blood glucose and haemoglobin), on nitric oxide‐mediated corpus cavernosal smooth muscle relaxation, and to categorize the mechanisms involved.

Materials and methods Corpus cavernosal tissue from Wistar rats (300–350 g body weight) was prepared for the measurement of isometric tension. After equilibration in Krebs solution gassed with 95% O2/5% CO2 at 37 °C for 90 min, optimal resting tension was applied. Tissue was precontracted with 1 µmol/L noradrenaline (NAd) and either relaxed with incremental doses of acetylcholine (ACh) or sodium nitroprusside (SNP). After washout, strips were again precontracted with NAd and then incubated with pyrogallol (100 µmol/L), 100 µL of haemoglobin or 100 µL of GHb in the presence of either
l‐arginine (100 µmol/L), indomethacin (10 µmol/L), allopurinol (100 µmol/L), deferoxamine (100 µmol/L), catalase (600 IU/mL), or superoxide dismutase (SOD) (120 IU/mL) before ACh‐ or SNP‐induced relaxation responses were repeated.

Results Haemoglobin and GHb significantly impaired the relaxation of rat corpus cavernosum to ACh in a dose‐dependent manner.
l‐arginine reversed the impairment caused by Hb, but not GHb. A donor of superoxide anions, pyrogallol, mimicked this impairment to ACh when added to control strips. Catalase, deferoxamine, indomethacin and allopurinol had no significant effect on the impaired relaxation response to ACh, whilst
l‐arginine partially reversed it. SOD completely reversed the GHb‐induced impaired relaxation; GHb did not alter the relaxation response to SNP.

Conclusion GHb significantly impairs endothelial NO‐mediated corpus cavernosal relaxation in the rat, in vitro. This effect is caused partly by the generation of superoxide anions and the extracellular inactivation of NO.
The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site
Authors: Franco O.E. , Arima K. , Yanagawa M. , Kawamura J.
Published: March 2003

Objective To correlate the findings of power Doppler ultrasonography (PDUS) of the prostate with those of site‐specific transrectal ultrasonography (TRUS)‐guided biopsy.

Patients and methods The study comprised 28 patients referred to our institution for TRUS‐guided prostate biopsy because of an elevated PSA level and/or abnormal digital rectal examination. PDUS findings were graded 0, 1 or 2; grades 0–1 were considered as negative and grade 2 as positive. The blood volume of each biopsy site was also determined using the mean number (MN) value that represents the average vascularity in a 5‐mm square sample. PDUS values were correlated with the histological findings of 147 biopsies with 19 focal lesions.

Results Grade 2 was assigned to 19 sites, grade 1 to 52 sites, and grade 0 to 76 sites. Fourteen of the 19 PDUS findings of grade 2 sites revealed carcinoma and five were grade 1. Ten of 35 TRUS‐positive sites were carcinomas, three benign prostatic hyperplasia (BPH) and 22 normal. The MN value for prostatic carcinoma was 4.33, for BPH 11.7 and for normal tissue 4.7. The overall sensitivity of PDUS was 74%, the specificity 96% and the positive predictive value 74%.

Conclusions Because TRUS alone cannot detect all cancers, PDUS should be used routinely in all patients undergoing TRUS‐guided biopsy, to improve the diagnostic yield of prostate cancer.
Gender specificity of tolterodine on micturition and the diurnal variation of urine production of the conscious rat
Authors: Yoshimura Y. , Schmidt F. , Constantinou C.E.
Published: March 2003

Objective To evaluate the effect of the oral administration of tolterodine on the diurnal micturition characteristics of the male and female conscious rat, and to examine the relative effect of tolterodine in influencing water consumption and urine production.

Materials and methods Baseline micturition volume and frequency characteristics of nine male and 10 female Sprague‐Dawley age‐matched adult rats (body weight 399 ± 15 and 249 ± 3 g, respectively) were evaluated over 24‐h. Initial hydration conditions were standardized with an oral dose (5 mL) of water. Rats were subsequently placed in a metabolic cage and had free access to water. Micturition volume/frequency characteristics were derived from the measurements of voided volume (measured using a digital balance below the metabolic cage and connected to a computer). The total volume of water consumed over the 24 h was also measured. Two separate baseline studies were conducted, followed by the administration of a single oral dose of 1 mg/mL of tolterodine dissolved in 5 mL of water. The mean frequency of micturition and mean volume voided per micturition were computed in 3‐h periods and plotted over the 24‐h period. In addition, the mean values of the number of micturitions and voided volumes during the day/dark cycle were evaluated.

Results Baseline data showed that females (when corrected for body weight) consistently imbibed significantly more water (83%) than did male rats. Tolterodine did not significantly affect water consumption in the males but significantly reduced water consumption in females by 42%. Tolterodine did not significantly affect the amount of urine produced by male rats but significantly reduced the total amount of urine production in females by 26%. Tolterodine significantly increased the number of voids in male rats compared with baseline during the day but not during the night. More importantly tolterodine produce no significant effect on the volume voided per micturition in male rats either during the day or night cycle, but significantly decreased the volume voided per micturition in females.

Conclusions These results suggest that the effect of tolterodine on micturition is gender‐specific, suppressing water consumption and urine production in female but not male rats, and decreasing bladder volume. There is a possibility that the reported clinical effects of tolterodine arise through the suppression of fluid consumption.
Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program
Authors: Corman J.M. , Penson D.F. , Hur K. , Khuri S.F. , Daley J. , Henderson W. , Krieger J.N.
Published: March 2003

ObjectiveTo determine whether radical nephrectomy causes less morbidity, less mortality and is associated with a shorter hospital stay than is partial nephrectomy.

Patients and methodsA total of 1885 nephrectomies (1373 radical and 512 partial) conducted between 1991 and 1998 in the Department of Veterans Affairs (VA) National Surgical Quality Improvement Program were evaluated. Using multivariate analyses, outcomes were risk‐adjusted based on 45 preoperative variables to compare mortality and morbidity rates.

ResultsThe unadjusted 30‐day mortality was 2.0% for radical and 1.6% for partial nephrectomy (P = 0.58). Risk‐adjusting the two groups did not result in a statistically significant difference in mortality. The 30‐day overall morbidity rate was 15% for radical and 16.2% for partial nephrectomy (P = 0.52); risk‐adjusted morbidity rates were not statistically different. There were no statistically significant differences in the rates of postoperative progressive renal failure, acute renal failure, urinary tract infection, prolonged ileus, transfusion requirement, deep wound infection, or extended length of stay.

ConclusionsPartial nephrectomy carried out in the VA program has low morbidity and mortality rates, comparable with the complication rates after radical nephrectomy.
A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate
Authors: Wilson I.D. , Bramwell S.P. , Hollins G.W.
Published: March 2003

Objective To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP).

Patients and methods The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients).

Results In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05).

Conclusion Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients.
Q‐flap reconstruction of panurethral strictures
Authors: Morey A.F. , Tran L.K. , Zinman L.M.
Published: March 2003

Objective To review our experience with an extended Q‐shaped penile skin flap for the reconstruction of panurethral strictures.

Patients and methods Between 1991 and 1999, 15 men with extensive strictures underwent a single‐stage urethral reconstruction with a distal circumferential penile skin flap incorporating a ventral midline extension (Q‐flap). None had undergone previous urethroplasty nor had any been circumcised.

Results The Q‐flap provided a pedicled strip of penile skin with a mean (range) length of 17 (15–24) cm; no additional graft materials were necessary. Excellent results were obtained in 10 patients; in the remainder, complications included recurrent stricture (in two) and (in one patient each) a cerebral vascular accident, urethrocutaneous fistula, meatal stenosis, femoral neuropathy and prolonged catheterization for focal extravasation.

Conclusion The Q‐flap provides an abundant hairless penile skin flap that enables single‐stage panurethral reconstruction while eliminating the additional time and morbidity of harvesting further grafts.
The influence of a high‐oxalate/low‐calcium diet on calcium oxalate renal stone risk factors in non‐stone‐forming black and white South African subjects
Authors: Lewandowski S. , Rodgers A. , Schloss I.
Published: March 2003

Objective To evaluate the influence of a high‐oxalate/low‐calcium diet on calcium oxalate stone risk factors in both black South Africans (who are largely immune to kidney stones) and white South Africans (in whom stones are more common).

Subjects and methods Urinary and dietary variables were examined in 11 black and 11 white South African men. None of the subjects had had a kidney stone or any metabolic illness. Their normal domestic food intake was assessed using a semiquantitative food frequency questionnaire. Subjects were given a standardized high‐oxalate/low‐calcium diet for 3 days; 24‐h urine samples were collected before the protocol and during the final day. The samples were analysed using routine modern laboratory techniques. The urine analysis data were used to calculate the Tiselius risk index and the relative urinary supersaturations of calcium oxalate, uric acid and calcium phosphate.

Results Urine analysis showed an intriguing anomaly; black subjects had significantly higher urinary pH and oxalate values than whites (6.50 vs 6.21 and 0.23 vs 0.14 mmol/24 h, respectively), while their urinary citrate was lower (1.47 vs 3.69 mmol/24 h). In addition, the Tiselius risk index and relative supersaturation of calcium oxalate were higher in black subjects. These results are contrary to those which might have been reasonably expected when comparing stone‐free and stone‐prone groups. After the dietary protocol, the only urinary variable which changed significantly was urinary oxalate, which increased by 57% in whites.

Conclusion Factors which are conventionally used to assess stone risk (pH, oxaluria, citraturia, relative supersaturation) are not helpful in identifying why South African blacks are relatively immune to stones. We suggest that relatively lower oxalate absorption rates may be a physiological feature of this racial group.
Functional evaluation of tubularized‐incised plate repair of midshaft‐proximal hypospadias using uroflowmetry
Authors: Marte A. , Di Iorio G. , De Pasquale M. , Cotrufo A.M. , Di Meglio D.
Published: March 2003

Objective To determine objectively, using uroflowmetry, the functional results of the tubularized‐incised plate urethroplasty to repair midshaft‐proximal hypospadias.

Patients and methods Twenty‐one patients (mean age 4 years, mean follow‐up 1.8 years) were selected from those undergoing surgery between January 1996 and January 1998 at our institution. All patients had midshaft‐proximal hypospadias and were treated using the Snodgrass technique. Patients were included if they were able to void volitionally and had no fistula. The flow pattern, maximum (Qmax) and mean flow rate (Qave) were measured; the results were expressed as percentiles and compared with published values from normal children. The Qmax and Qave were considered normal if > 25th percentile, as equivocally obstructed when in the 5–25th percentile and obstructed if < 5th percentile.

Results Fourteen patients were considered normal, four as equivocally obstructed and three as obstructed. Of the second group, one patient had a urethral diverticulum at the native meatus (confirmed by voiding cysto‐urethrography) and the remaining three patients had meatal stenosis that responded to dilatation, with normal flow in two and improvement in the other. Of the obstructed group, one patient responded to dilatation and two underwent meatoplasty.

Conclusion The tubularized‐incised plate repair provides satisfactory functional results for midshaft‐proximal hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. A long‐term follow‐up is needed to confirm these results.
Tumour angiogenesis and Ki‐67 expression in phaeochromocytoma
Authors: Ohji H. , Sasagawa I. , Iciyanagi O. , Suzuki Y. , Nakada T.
Published: March 2003

Objective To determine the expression of CD34 (to evaluate vascularity) and Ki‐67 (as a proliferative index) in a variety of phaeochromocytomas and thus assess the utility of these markers as possible predictors of malignancy.

Patients and methods Deparaffinized tissue sections from 21 patients with benign and four with malignant phaeochromocytoma were assessed immunohistochemically to evaluate microvascular counts (using CD34 antigen) and the proliferative index (Ki‐67 antigen, monoclonal antibody MIB‐1).

Results There was no statistical association between high microvascular counts and malignancy, but there was between the MIB‐1 score and malignancy (P < 0.001).

Conclusions A high MIB‐1 score in phaeochromocytoma suggests malignant behaviour in the component cells. The MIB‐1 score may be a useful indicator for diagnosing malignant phaeochromocytoma.
Low frequency of microsatellite instability in hereditary prostate cancer
Authors: Åhman A.‐K. , Jonsson B.‐A. , Damber J.‐E. , Bergh A. , Grönberg H.
Published: March 2003

Objective To investigate whether there is widespread microsatellite instability (MSI) in families with hereditary prostate cancer (HPC).

Patients and methods Eighty‐four prostate tumours from 80 Swedish men in 35 families with HPC were screened for genetic instability at microsatellite marker loci BAT‐25, BAT‐26, BAT‐34C4, D2S123 and D17S250.

Results MSI was detected in only five individuals from different families. Three tumours (4%) were unstable at more than two MSI loci and hence classified as high‐frequency MSI (MSI‐H) according to a previous definition. Interestingly, two of the MSI‐H tumours were from patients in families with both HPC and familial colon cancer.

Conclusions Widespread MSI is a rare event in hereditary prostate cancer, indicating that defective DNA mismatch repair is not an important element in the genesis of HPC.
The long‐term results of Anderson–Hynes pyeloplasty
Authors: O'Reilly P.H. , Brooman P.J.C. , Mak S. , Jones M. , Pickup C. , Atkinson C. , Pollard A.J.
Published: March 2003

Objectives To examine the durability of open pyeloplasty for pelvi‐ureteric junction obstruction.

Patients and methods The records of 56 Anderson‐Hynes pyeloplasties undertaken by two surgeons between 1981 and 1994 were examined. Attempts were made to trace all patients and for them to undergo diuretic renography to examine the current status of the operated renal unit.

Results In all, 41 evaluable patients were identified; 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 (6–19) years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%).

Conclusions The Anderson–Hynes pyeloplasty is an excellent procedure for treating pelvi‐ureteric junction obstruction, and produces a lasting improvement in function and drainage in most patients. It is the ‘gold standard’ against which newer techniques should be compared.
Characteristics of protein excretion in patients with acute urinary retention
Authors: Mustonen S. , Ala‐Houhala I.O. , Tammela T.L.J.
Published: March 2003

Objective To evaluate changes in protein leakage in the glomerular filtration barrier, and in the ability of the tubule to reabsorb proteins during and after acute urinary retention (AUR).

Patients and methods Glomerular and tubular function was investigated in 24 men during AUR (mean age 68 years, mean retention time 31 h and mean retention volume 1140 mL) who were then followed for 6 months by measuring the urinary excretion of glomerular and tubular proteins, and the glomerular filtration rate (GFR). Retention was relieved by inserting a suprapubic catheter and the cause of retention treated one month later. No patient had a previous renal disease or diabetes.

Results During AUR, and after 1 and 6 months, albuminuria was detected in 100%, 92% and 54% of patients, and increased excretion of α1‐microglobulin in 52%, 36% and 58%, of IgG in 79%, 58% and 40%, and of IgG4 in 67%, 42% and 20%, respectively. The mean GFR was normal during retention and during the follow‐up.

Conclusion AUR causes disturbances in both the glomerular filtration and tubular reabsorption of proteins. Albuminuria and increased excretion of IgG, IgG4 and α1‐microglobulin occurred in most patients during AUR. After relieving retention, the albuminuria and elevated α1‐microglobulin excretion persisted, indicating slight glomerular dysfunction and a permanent defect in the proximal tubule to reabsorb proteins. This could be caused partly by previous chronic obstruction. AUR should be relieved immediately and the basic cause treated effectively to prevent further deterioration of renal function.
Use of cyanoacrylate tissue adhesive under a diaper
Authors: Ferlise V.J. , Ankem M.K. , Barone J.G.
Published: March 2003

Objective To examine the utility of cyanoacrylate tissue adhesive (Dermabond, Ethicon, Somerville, NJ, USA; an effective means of epithelial skin closure) under a diaper (i.e. constantly exposed to bodily fluids) in 25 children (not toilet‐trained) undergoing inguinal surgery.

Patients and methods A retrospective review of charts between July 1998 and July 2000 was used to identify children who were not toilet‐trained and who had undergone inguinal surgery (e.g. orchidopexy, hernia and hydrocele repair). In addition to the type of surgery, the method of closure was also assessed; in all cases reported the subcutaneous tissues were approximated with 4/0 polyglactin suture. From July 1998 to October 1999 all epithelial skin was closed with 5/0 poliglecaprone, benzoin, sterile strips and collodion; from October 1999 to July 2000 all skin was closed with cyanoacrylate tissue adhesive.

Results The chart review identified 45 boys (mean age 15.3 months, range 1–26) of whom 26 (57%) had undergone either inguinal hernia or hydrocele repair, and 19 (42%) who had undergone orchidopexy. These procedures resulted in a total of 52 incisions in the 45 children. Of the 52 incisions, 27 were closed with suture and 25 with cyanoacrylate adhesive. All patients were followed up at 2 weeks; there were no instances of infection or wound dehiscence in either group. The incisions were cosmetically identical at 3 months of follow‐up.

Conclusion Cyanoacrylate adhesive is a safe and effective method of skin closure that can be used under a diaper.
Castration‐induced reduction of vascular endothelial growth factor expression in benign human prostate tissue is lost in advanced prostate cancer
Authors: Häggström S. , Stattin P. , Wikström P. , Bergh A. , Damber J.‐E.
Published: March 2003

Objective To determine the role of vascular response in the castration‐induced regression of benign and malignant human prostate tissue, as recent studies show that castration rapidly decreases blood flow and induces endothelial cell death, which may be important for subsequent epithelial cell death and involution of the glandular tissue of the prostate.

Materials and methods The expression of vascular endothelial growth factor (VEGF) and its receptors was analysed using the quantitative reverse transcriptase‐polymerase chain reaction, in benign and tumour areas of core biopsies taken before, and ≈ 1 week after castration therapy. The castration‐induced VEGF response was related to therapy‐induced changes in tumour cell apoptotic index and subsequent response in serum prostate‐specific antigen (PSA). In another set of patients, serum VEGF was quantified by enzyme‐linked immunosorbent assay before, and at 3–6 months after castration therapy.

Results VEGF mRNA was down‐regulated after castration in benign prostate tissue (P  0.05), whereas in tumour tissue, VEGF levels were reduced in some of the patients but unchanged or increased in others. In most patients whose tumour tissue responded with VEGF reduction, there was a corresponding increase in tumour cell apoptosis. Serum VEGF levels were not significantly changed after castration. Almost all patients responded with a substantial reduction in serum PSA after castration.

Conclusion Castration reduces VEGF mRNA expression in benign prostate tissue and generally in those prostate tumours where castration also induces tumour cell apoptosis. This suggests that a therapy‐induced down‐regulation of VEGF could be important for tumour cell death.
Murine renal cell carcinoma: evaluation of a dendritic‐cell tumour vaccine
Authors: Chagnon F. , Thompson‐Snipes L. , Elhilali M. , Tanguay S.
Published: March 2003

Objective To use a murine model of renal cell carcinoma (RCC), Renca, to aid in developing a dendritic cell (DC)‐mediated tumour vaccine for RCC; as conventional therapy has been unsuccessful for RCC and therapy using immune modulators has had limited success, novel therapies enhancing further the immune system must be developed.

Materials and methods DCs were obtained from mouse bone marrow enriched for the haematopoietic progenitors, and cultured in the presence of interleukin‐4 and granulocyte macrophage‐colony stimulating factor. In vivo vaccines and in vitro proliferation assays were used to assess ability of the DCs to present tumour antigen.

Results The presence of DCs was confirmed in the cultures by fluorescent‐activated cell sorting analysis. In vivo, tumour‐bearing animals receiving tumour extract‐pulsed DCs as a vaccine showed a two to threefold reduction in tumour growth at day 12 and day 16 but no significant difference at day 28. In vitro, tumour extract‐pulsed DCs stimulated significant proliferation of splenocytes from naive animals but not tumour‐bearing animals. In addition, splenocytes from tumour‐bearing animals had an attenuated immune response in vitro.

Conclusion These results show that it is possible to use the DC vaccine to modulate the immune response to achieve an antitumour effect, but further manipulation of the DC vaccine may be needed to overcome the tumour‐induced immune suppression.