bluuebunny/crossref_metadata_2025 huggingface dataset:
New genus and new species of myrmecomorphic plant bug from Australia (Heteroptera: Miridae: Mirini)
Authors: Schwartz Michael D , Cassis Gerasimos
Published: July 2003

Abstract Oecophyllodes bipunctatus gen. n. and sp. n., from northern Queensland, is associated with the green tree ant, Oecophylla smaragdina (Fabricius), on rattlepod, Crotalaria sp. (Fabaceae). Illustrations of the genitalic structures, scanning electron photomicrographs of various external structures, illustration of the dorsal habitus, and a comparative photograph conveying the ant‐like habitus of the discussed taxa are provided.
Urination assessment after the removal of bladder catheter using a novel urination chart
Authors: Owan Tomoko , Kohra Takehiro , Miyara Yoshimi , Kohki Miyoko , Shimo Yukari , Bise Toshiko , Sugaya Kimio , Kiriyama Masako , Sunagawa Yoko , Kohno Shinzo
Published: July 2003

AbstractWe investigated the difficulties involved in assessing post prostatectomy voiding according to 20 nurses working in urology and dermatology wards. Problems they encountered included completing a urination (frequency/volume) chart and performing an assessment. We constructed a hourly urination chart for basic nursing education in urinary incontinence. This was used for a 76‐year‐old male patient with hypertension and diabetes mellitus who underwent a prostatectomy. Urination was recorded for 17 consecutive days after catheter removal. Detailed pathological findings were more distinct in the hourly rather than daily recordings of voluntary micturition. Voluntary micturition appeared 12 h after catheter removal, but it was very scanty. After the onset of urination, frequency and amount of daily voluntary micturition was inversely related to incontinence during the 17 days after catheter removal. We drafted a set of urination recovery stages to enable the analysis of a patient's urination status. Nurses understood its importance and were able to reach a consensus on how to manage patients with postoperative incontinence. We have constructed a practical system for use by specialist urology nurses.
Health education for nurses in Japan to combat child abuse
Authors: Henry Beverly M. , Ueda Reiko , Shinjo Masaki , Yoshikawa Chieko
Published: July 2003

Abstract A health education program for nurses was conducted to address the complex problem of child abuse, which has reached epidemic proportions. In Japan, the number of consultations has risen 23‐fold over the past 11 years. Maltreatment of children is a public health problem as perilous as any contagious disease. The International Council of Nurses asks for nurses’ leadership to strengthen measures to combat abuse throughout the world. The Japanese Nursing Association has published statements for prevention, detection and support. Yet, few community‐based education programs with a multidisciplinary perspective have been reported that focus on nurses, the largest group of health providers. More than 200 nurse educators, clinicians and managers met for a one‐day program designed to improve understanding of the nurses’ role in combating the abuse and neglect of children and to formulate action plans. This significant health problem is addressed in the context of a health education program's needs, objectives, content and evaluation.
Musculoskeletal disorders among female nurses in a rural Japanese hospital
Authors: Smith Derek Richard , Ohmura Kumeko , Yamagata Zentaro , Minai Junko
Published: July 2003

Abstract The present research investigated the prevalence of musculoskeletal disorders (MSD) among a previously understudied group of Asian nursing professionals in a rural setting. A total of 305 female nurses (84% response rate) were recruited from a university teaching hospital in Yamanashi prefecture, central Japan. Data were gathered by means of a self‐reporting questionnaire. Lower back pain (LBP) was the most commonly reported MSD, affecting 59% of all nurses. This was followed by MSD of the shoulder (46.6%), neck (27.9%), knees (16.4%) and upper leg (11.8%). Working in the surgical department was shown to increase the risk of any MSD 2.7 times when compared to nurses in the other departments (odds ratio 2.7, 95% confidence interval 1.2–6.7, P = 0.0202). Overall, our study shows that MSD are reasonably common among registered nurses in a rural Japanese hospital. These staff may also be at greater risk of suffering MSD than their city‐based nursing counterparts and foreign colleagues, particularly with respect to LBP.
Understanding uncertainty and minimizing families’ anxiety at the time of transfer from intensive care
Authors: Mitchell Marion L. , Courtney Mary , Coyer Fiona
Published: July 2003

Abstract When general ward registered nurses (RN) receive patients from an intensive care unit (ICU) they report that much of their time in the initial phases revolves around meeting family needs (Farvis, 2002). Families experience anxiety when leaving the security of the close monitoring seen in ICU (Leith, 1999) and their anxiety reduces their ability to play a key role in the patient's recovery (McShane, 1991; Leske, 1992) as it can impair their decision‐making (Cagan, 1988; Halm et al., 1993). By reducing a family's anxiety, they may be more able to cope with the necessary transition to a general ward and support the patient's recovery. A literature search from 1990 onwards was performed within the CINAHL, Medline and Cochrane databases using the key words: intensive care, family, General System Theory, uncertainty, anxiety and transfer. Further articles were retrieved from citation references from the Web of Science or through the reference lists of retrieved literature. Library catalogues were searched using the same key words for books and book chapters. von Bertalanffy's General System Theory provides a framework for understanding the importance of family in a critical illness situation. Critical illness permits little or no time to adapt, thus reducing the family's ability to cope with the situation. Transfer out of ICU is a significant anxiety‐producing event for families. Uncertainty in illness is reported in other illness situations to reduce family's adaptation to illness events, but has not been researched with an ICU cohort of families. Seven out of the top 10 needs of ICU families are information needs, highlighting the importance of communication regarding progress and future plans. Nurses require an increased awareness that transfer anxiety exists for families and to be knowledgable about ways to reduce its occurrence. Research is required to evaluate the efficacy of interventions to reduce anxiety for families and examine the level of uncertainty in illness in this cohort.
Academic nursing education guidelines: Tool for bridging the gap between theory, research and practice
Authors: Jerlock Margaretha , Falk Kristin , Severinsson Elisabeth
Published: July 2003

Abstract The aim of the present study was to develop educational guidelines to be used as a tool for the integration of theory, research and practice to ensure that nursing knowledge and practical skills form the basis of academic nursing education. An additional aim was to describe the nursing competence expected of the students at four academic levels: introductory, intermediate and advanced levels I and II. Clinical nursing education plays a crucial role in assisting nursing students to integrate the theory and practice of nursing at the baccalaureate level, as well as in further specialization and in‐depth nursing studies at the advanced level. A research group consisting of lecturers from the Institute of Nursing, Göteborg University, Sweden, was given the objective to formulate educational guidelines for clinical practice within nursing education. The study took the form of a literature search. In addition, the Delphi method, aimed at reaching a consensus of opinion among colleagues, was used. Based on the literature review and the collegial discussions, four core concepts emerged: professional stance, reflective processes, problem‐solving processes, and practical skills, from which the educational guidelines were developed. Guidelines were formulated both in general and abstract form. They were not connected to a specific care context, specific patient group or specific nursing problems. The most important objective of academic education is that the student develops abilities and techniques necessary for life‐long learning. Students will, in their professional life as nurses, continuously meet situations where they are challenged to take appropriate decisions and actions. This demands training in problem‐solving, reflection, decision‐making and the ability to use both deductive and inductive learning strategies. The guidelines describe what is expected of the students in terms of nursing competence and personal qualifications to ensure that they will be ready to meet the demands of their future profession.
Decision analysis as a tool to support an analytical pattern‐of‐reasoning
Authors: Narayan Suzanne M. , Corcoran‐Perry Sheila , Drew Debra , Hoyman Kathryn , Lewis Marsha
Published: July 2003

Abstract Decision analysis is offered as a tool to aid nurses’ decision‐making in complex and troublesome situations where there are mutually exclusive actions and time is available for deliberation. Decision analysis can be formal or informal. Formal decision analysis provides a structure for representing the decision situation and a mathematical procedure for prescribing the alternative action that is most consistent with what is known and what one values. Informal decision analysis uses the concepts and sometimes the structure of decision analysis, but usually does not include the mathematical calculations. In the present paper, the authors illustrate how formal and informal decision analysis might be used by nurses to: (i) enhance their own decision‐making; (ii) assist patients or family caregivers with decision‐making and; (iii) promote informed health care policy development. Finally, the advantages and limitations of decision analysis are discussed.
Ablation of Nonsustained or Hemodynamically Unstable Ventricular Arrhythmia Originating From the Right Ventricular Outflow Tract Guided by Noncontact Mapping
Authors: FUNG JEFFREY W.H. , CHAN HAMISH C.K. , CHAN JOSEPH Y.S. , CHAN WINNIE W.L. , KUM LEO C.C. , SANDERSON JOHN E.
Published: July 2003

Conventional activation or pacemapping is effective in guiding ablation of ventricular tachyarrhythmia originating from right ventricular outflow tract (RVOT). However, in selected patients with hemodynamically unstable or nonsustained tachycardia, noncontact mapping may be an effective alternative method to guide ablation in RVOT. Five patients with symptomatic hypotension during ventricular tachycardia (VT) or nonsustained tachyarrhythmia originating from the RVOT had radiofrequency ablation guided by noncontact mapping. All patients had a history of syncope and the tachyarrhythmias were refractory to antiarrhythmic therapy. Four patients had spontaneous sustained VT of a cycle length from 250 to 300 ms and one had symptomatic ventricular ectopic beats. Two patients were diagnosed to have arrhythmogenic right ventricular cardiomyopathy (ARVC). Sustained VT with hypotension was induced in two patients and nonsustained VT in three patients. Isopotential color maps were used to locate the earliest activation site of the tachyarrhythmia in RVOT. Three patients had tachyarrhythmia exit sites at the septal region and two at lateral region of RVOT. Low voltage area and diastolic activity were detected in the two patients with ARVC. Radiofrequency ablation guided by noncontact mapping was performed during sinus rhythm in all patients. The number of ablation attempts ranged from 1 to 14. After follow‐up for

12 ± 5.8 months

, there was no recurrence of tachyarrhythmia and syncope in all five patients. Noncontact mapping is a safe and effective alternative method to guide ablation of hemodynamically unstable or nonsustained ventricular arrhythmia originating from RVOT. (PACE 2003; 26:1699–1705)
Screening for prostate cancer: have you had your cholesterol measured?
Authors: Boyle P.
Published: July 2003

Screening for prostate cancer has become one of the most common topics of conversation at urological oncology meetings. Most people have a bias as to whether there should or should not be a national screening programme. Unfortunately there are many unanswered questions, which may or may not be possible to answer definitively. In a balanced and scholarly review of the subject, Professor Peter Boyle indicates several flaws in the agreement for screening, but feels that PSA testing will continue unabated.

The authors from the University of Stellenbosch review the plentiful literature relating to testicular torsion and functional recovery. They also review the mechanism of injury and the effect on the contralateral testis.
Comparative efficacy of triptorelin pamoate and leuprolide acetate in men with advanced prostate cancer
Authors: Heyns C.F. , Simonin M.‐P. , Grosgurin P. , Schall R. , Porchet H.C. ,   for the South African Triptorelin Study Group
Published: July 2003

OBJECTIVE

To compare the efficacy of monthly administrations of the luteinizing hormone‐releasing hormone agonists triptorelin pamoate and leuprolide acetate to induce and maintain castrate levels of serum testosterone in men with advanced prostate cancer.

PATIENTS AND METHODS

Men with advanced prostate cancer were randomly assigned to receive triptorelin 3.75 mg or leuprolide 7.5 mg. The agent was injected intramuscularly every 28 days for nine injections. Primary endpoints were the percentages of men whose serum testosterone concentrations declined to and were maintained at or below castrate levels (≤ 1.735 nmol/L or ≤ 500 ng/L) during 9 months (253 days) of treatment. Secondary endpoints were luteinizing hormone levels, bone pain, prostate specific antigen levels, quality of life, testosterone pharmacodynamics, survival, and safety variables.

RESULTS

In all, 284 men received either triptorelin (140) or leuprolide (144). The percentage of men with castrate levels of serum testosterone was lower at 29 days for triptorelin than for leuprolide (91.2% vs 99.3%; point estimate − 8.0, 95% confidence interval − 16.9% to − 1.4%), but equivalent at 57 days (97.7% vs 97.1%). The mean (98.8% vs 97.3%) and cumulative (96.2% vs 91.2%) castration maintenance rates between 29 and 253 days were equivalent between the treatment groups. Secondary endpoints were equivalent between treatment groups except for the 9‐month survival rate, which was significantly higher for triptorelin than for leuprolide (97.0% vs 90.5%; P = 0.033). Both treatments were well tolerated.

CONCLUSION

Triptorelin reduced testosterone concentrations less rapidly, but maintained castration as effectively as leuprolide. There was no evidence that the slower onset of castration caused deleterious effects.
Safety and efficacy of alfuzosin 10 mg once‐daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double‐blind, placebo‐controlled studies
Authors: Roehrborn C.G. , Van Kerrebroeck P. , Nordling J.
Published: July 2003

OBJECTIVES

To examine the efficacy and safety of a once‐daily formulation of alfuzosin in a pooled analysis of three parallel, randomized, double‐blind, placebo‐controlled 3‐month studies of patients with lower urinary tract symptoms (LUTS) consistent with clinical benign prostatic hyperplasia.

PATIENTS AND METHODS

Patients were randomized to receive alfuzosin, 10 mg once‐daily (473) or placebo (482) for 12 weeks. Primary efficacy criteria were improvements in the International Prostate Symptom Score (IPSS) and peak urinary flow rate (PFR).

RESULTS

Alfuzosin significantly improved the mean (sd) IPSS, by − 6.0 (5.1) vs − 4.2 (5.7) with placebo (P < 0.005) and the PFR, by + 2.3 (3.8) vs + 1.1 (3.1) ml/s with placebo (P < 0.001), irrespective of prostate size. The significant improvement in LUTS included the irritative and the obstructive subscore of the IPSS and the nocturia criterion; the PFR increased rapidly and significantly, from the first visit (14 days). The quality‐of‐life score also improved significantly in alfuzosin‐treated patients. Alfuzosin was well tolerated; the number of withdrawals for adverse events was comparable in both treatment groups. The most frequently reported adverse event was dizziness (placebo 2.9%, alfuzosin 6.1%). There were no significant changes in blood pressure with alfuzosin compared with placebo, including in elderly and hypertensive patients. Sexual adverse events were rare (abnormal ejaculation, 0.6%).

CONCLUSIONS

The once‐daily formulation of alfuzosin, administered at 10 mg with no dose titration is effective, with a good safety profile, especially in elderly and hypertensive patients.
Improvements in benign prostatic hyperplasia‐specific quality of life with dutasteride, the novel dual 5α‐reductase inhibitor
Authors: O'Leary M.P. , Roehrborn C. , Andriole G. , Nickel C. , Boyle P. , Höfner K.
Published: July 2003

OBJECTIVES

To examine the effect of the dual‐action 5α−reductase inhibitor dutasteride on benign prostatic hyperplasia (BPH)‐specific health status, as measured by the BPH Impact Index (BII), and to identify baseline and treatment risk factors for those most bothered by their BPH symptoms at the end of the protocol.

PATIENTS AND METHODS

Data were derived from three randomized, double‐blind, placebo‐controlled, 2‐year studies conducted in 4325 men with lower urinary tract symptoms caused by benign prostatic enlargement. Each study comprised a 1‐month single‐blind placebo run‐in period, followed by randomization to oral dutasteride 0.5 mg once daily or placebo for 2 years. Patients eligible for inclusion were consenting men aged ≥ 50 years with moderate to severe symptoms (American Urological Symptom Index, AUA‐SI, score ≥ 12), a prostate volume of ≥ 30 mL, a serum prostate‐specific antigen (PSA) level of ≥ 1.5 or < 10 ng/mL, and a maximum urinary flow rate (Qmax) of ≤ 15 mL/s. BII scores were recorded at baseline and each study visit. Clinically and statistically significant changes in BII scores from baseline were investigated for each study visit. Logistical regression analysis was used to assess the significance of baseline prostate volume, symptoms, BII item 3, baseline Qmax, serum dihydrotestosterone, testosterone, PSA, age and weight in predicting the BII score at 2 years.

RESULTS

Dutasteride, but not placebo, resulted in clinically and statistically significant improvements in mean BII score from 6 months. Of patients with a baseline BII score of ≥ 5 (greatest symptomatic burden) treatment with dutasteride improved the scores by 2.41, while the scores in placebo‐treated patients only improved by 1.64. Dutasteride‐treated patients with a baseline BII score of < 5 (least symptom burden) had a clinically significant improvement in health status, while placebo‐treated patients deteriorated. Regression analysis showed that men with a combination of a baseline BII item‐3 score of 3 (bothered a lot) and a high symptom score (AUA‐SI ≥ 20) were more likely to be bothered by their symptoms at the end of the study. Men receiving placebo were also more likely to be bothered at the end of the study than were those receiving dutasteride.

CONCLUSIONS

Dutasteride treatment is associated with clinically significant improvements in BII score, reflecting improvements in the quality of life of men with BPH. Taken together with previously reported improvements in prostate volume, lower urinary tract symptoms and urinary flow, and diminution of the risk of acute urinary retention and the need for BPH‐related surgery, dutasteride offers demonstrable efficacy in the management of BPH.
A prospective comparison of radical retropubic and robot‐assisted prostatectomy: experience in one institution
Authors: Tewari A. , Srivasatava A. , Menon M. ,   members of the VIP Team
Published: July 2003

The authors from the Vattikuti Institute in the USA report a prospective comparison of radical prostatectomy and robot‐assisted prostatectomy. They found that the robot‐assisted procedure was safer, and yielded favourable oncological and functional results. They also present work in association with the Department of Urology in Mansoura into robot‐assisted radical cystoprostatectomy and urinary diversion, and point out the advantages and disadvantages associated with performing the most complex types of urinary diversion.

There is also an interesting paper relating to the association between sexual factors and prostate cancer, from authors in institutions in Australia, New Zealand and Italy. They found that in a case‐control study of men aged <70 years, ejaculatory frequency was negatively associated with the risk of prostate cancer.

Technology has made many contributions to the management of urological patients. The classic example is that of urinary stone management. Authors from the USA evaluated cyroablation of renal carcinoma in patients with solitary kidneys. They are encouraged by their results and suggest that there is merit in this treatment, but indicate the need for a longer follow‐up.

OBJECTIVE

To prospectively compare standard radical retropubic prostatectomy (RRP) and the robotically assisted Vattikuti Institute prostatectomy (VIP) in the management of localized prostate cancer.

PATIENTS AND METHODS

The study was a single‐institution, prospective, unrandomized comparison of histopathological, and functional outcomes, at baseline and during and after surgery, in 100 patients undergoing RRP and 200 undergoing VIP.

RESULTS

While the variables before surgery, the operative duration (163 vs 160 min) and pathological stages were comparable, there were significant differences in the measured outcomes. The blood loss was 910 and 150 mL for RRP and VIP, respectively, and transfusion was greater after RRP (67% vs none; both P < 0.001). There were four times as many complications after RRP (20% vs 5%, P < 0.05), the haemoglobin level at discharge was lower (100 vs 130 g/L, P < 0.005) and the hospital stay longer (3.5 vs 1.2 days; P < 0.05). Most (93%) of VIP and none of the RRP patients were discharged within 24 h (P < 0.001); the duration of catheterization was twice as long after RRP (15.8 vs 7 days; P < 0.05). Positive margin was more frequent after RRP (23% vs 9%, P < 0.05). After VIP, patients achieved continence and return of erections more quickly than after RRP (160 vs 44, and 180 vs 440 days, both P < 0.5). The median return to intercourse was 340 days after VIP but after RRP half the patients have as yet not resumed intercourse at 700 days (P < 0.05).

CONCLUSIONS

The VIP procedure appears to be safer, less bloody and requires shorter hospitalization and catheterization. The oncological and functional results were favourable in patients undergoing VIP.
The Finnish version of The National Institutes Of Health Chronic Prostatitis Symptom Index correlates well with the visual pain scale: translation and results of a modified linguistic validation study
Authors: Leskinen M.J. , Mehik A. , Sarpola A. , Tammela T.L.J. , Järvelin M.‐R.
Published: July 2003

Authors from Finland have assessed a version in their language of the National Institutes of Health‐Chronic Prostatitis Symptom Index; they found that their translated version was valid and easily understandable in the management of the symptoms of chronic pelvic pain syndrome. They felt it should be used as a primary outcome measure in studies with these patients.

There are three papers in this issue relating to the effect of drugs on LUTS; the first of these is a pooled analysis of three double‐blind placebo‐controlled studies into the safety and efficacy of the 10 mg dose of alfuzosin. The second evaluates the effect on quality‐of‐life issues of treatment with dutasteride. Finally, authors from Australia compare the effect of a Serenoa repens extract with placebo for LUTS.

OBJECTIVES

To provide a fluent and easily comprehensible Finnish version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH‐CPSI) and to study its linguistic validity and correlation with a visual pain scale (VAS).

PATIENTS AND METHODS

The double‐back translation method with two interim modifications was used to produce the Finnish version of the NIH‐CPSI. The validity was tested by presenting the questionnaire to 155 men with clinically confirmed chronic pelvic pain syndrome (CPPS) and 12 controls with no previous urological symptoms. Convergent validity of the NIH‐CPSI was tested by determining the correlation between the Finnish NIH‐CPSI and VAS. Patients’ and urologists’ opinions about the utility of the Finnish NIH‐CPSI were also reviewed.

RESULTS

The total Finnish NIH‐CPSI scores and the pain domain and voiding symptom domain scores differed significantly (P < 0.001) between the groups, suggesting good discriminant validity of the symptom index. The NIH‐CPSI scores correlated well with the VAS (Pearson's correlation 0.76). The preciseness and comprehensibility of the questionnaire were consistently evaluated to be ‘good’ or ‘excellent’ both by patients and urologists.

CONCLUSIONS

The Finnish version of the NIH‐CPSI is valid and easily comprehensible for measuring CPPS symptoms. In addition, it provides good discriminant and convergent validity in distinguishing CPPS symptoms and should be used as primary outcome measure in CPPS studies.
The role of transarterial embolization in the treatment of renal cell carcinoma
Authors: Munro N.P. , Woodhams S. , Nawrocki J.D. , Fletcher M.S. , Thomas P.J.
Published: July 2003

OBJECTIVE

To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC).

PATIENTS AND METHODS

Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively.

RESULTS

Most patients (14 of 25) presented with less advanced (stage I–III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I–III patients were alive (median follow‐up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re‐staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed.

CONCLUSION

Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.
Squamous cell carcinoma antigen: a role in the early identification of nodal metastases in men with squamous cell carcinoma of the penis
Authors: Laniado M.E. , Lowdell C. , Mitchell H. , Christmas T.J.
Published: July 2003

OBJECTIVE

To evaluate whether serum squamous cell carcinoma antigen (SCCAg) measurements may be of use in identifying nodal metastases in patients with SCC of the penis after treating the primary tumour.

PATIENTS AND METHODS

The levels of SCCAg were analysed in 11 men with penile SCC between 1994 and 2001.

RESULTS

An elevated SCCAg level had a sensitivity of 57% (95% confidence interval, CI, 18–90%) and a specificity of 100% (CI 40–100%) for nodal metastases. Levels of SCCAg increased exponentially in patients who developed nodal metastases after treatment of the primary tumour, and were elevated before clinical or radiological evidence of nodal disease.

CONCLUSION

Either the absolute level or the rate of rise of SCCAg may be a useful tool with which to follow patients after excision of the primary tumour. It may be more sensitive than computed tomography and magnetic resonance imaging in detecting recurrence, but further evaluation is needed.
Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial
Authors: Willetts K.E. , Clements M.S. , Champion S. , Ehsman S. , Eden J.A.
Published: July 2003

OBJECTIVE

To compare the effect of a Serenoa repens extract with placebo for symptoms of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

In a double‐blind placebo‐controlled randomized trial between January 1999 and March 2000, 100 men with symptoms of BPH, aged < 80 years, with a maximum urinary flow rate of 5–15 mL/s for a voiding volume of 150 mL, were randomly and equally allocated to 320 mg S. repens extract or placebo (paraffin oil). The main outcome measures were the International Prostate Symptom Score (IPSS), peak urinary flow rate, and the Rosen International Index of Erectile Function (IIEF) questionnaire.

RESULTS

There was no significant difference between the treatments over the 12 weeks of the study in the IPSS, peak urinary flow rate or for the IIEF questionnaire.

CONCLUSIONS

During the trial all participants had some improvement in their symptoms of BPH but there was no significant beneficial effect of this S. repens extract over placebo in this 12‐week trial.
Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma?
Authors: Hack W.W.M. , Meijer R.W. , Van Der Voort‐Doedens L.M. , Bos S.D. , De Kok M.E.
Published: July 2003

OBJECTIVE

To investigate the significance of the acquired undescended testis (UDT), which is differentiated into congenital and acquired forms, by assessing the previous testicular position in affected boys.

PATIENTS AND METHODS

The study comprised 261 boys who had been referred for a non‐scrotal testis to the outpatient clinic during an 8‐year period (1993–2000). There was a bimodal distribution of age, with peaks at 2.0 and 10.0 years. In each boy with UDT the previous testicular position was ascertained.

RESULTS

On referral, 340 testes were not in the scrotum (182 uni‐ and 79 bilateral). Of the 340 testes, 82 (24%) in 61 boys were diagnosed as retractile, whereas the remaining 258 in 221 boys were undescended. The previous testicular position was known in 208 of 221 boys (94%), with 244 UDTs. In 65 of these 244 (26.6%) the testis had never been scrotal (congenital UDT); in 179 (73.4%) a previous intrascrotal position was recorded in early childhood (acquired UDT) at least once, in 149 (61%) at least twice and in 117 (48%) at least three times. The mean age at referral for congenital UDT was 2.1 years and for acquired UDT was 8.4 years.

CONCLUSIONS

These results show that acquired UDT is frequent, and occurs at about three times the rate of congenital UDT. Because these boys are referred for treatment later in childhood, the acquired UDT probably accounts for the high rate of (late) orchidopexy.
The growth inhibitory effect of p21 adenovirus on androgen‐dependent and ‐independent human prostate cancer cells
Authors: Gotoh A. , Shirakawa T. , Wada Y. , Fujisawa M. , Okada H. , Kamidono S. , Hamada K.
Published: July 2003

OBJECTIVE

To assess the potential of p21 as a gene therapy treatment for prostate cancer, by introducing p21 into both androgen‐dependent (AD) and ‐independent (AI) human prostate cancer cell lines via a recombinant adenoviral vector, Ad5CMV‐p21, carrying human p21 cDNA.

MATERIALS AND METHODS

The LNCaP, DU145 and PC‐3 human prostate cancer cell lines were cultured and infected with Ad5CMV‐p21. Cell growth, cell‐cycle progression and tumorigenicity were then assessed by thymidine incorporation into cellular DNA, and cell number, flow cytometry, and tumour growth after inoculating the cells into nude mice.

RESULTS

Growth was inhibited in Ad5CMV‐p21 viral‐infected AD and AI prostate cancer cells. The effects were dose‐dependent, regardless of the androgen status of the cell lines. Flow cytometric analysis showed that Ad5CMV‐p21 arrested cell‐cycle progression at G1/S with no appreciable effect on the levels of apoptotic cells. The tumorigenicity of cancer cells infected with Ad5CMV‐p21 was greatly reduced in athymic mice.

CONCLUSIONS

These results suggest that Ad5CMV‐p21 may be a new therapeutic agent for human prostate cancer gene therapy.
Sexual factors and prostate cancer
Authors: Giles G.G. , Severi G. , English D.R. , McCredie M.R.E. , Borland R. , Boyle P. , Hopper J.L.
Published: July 2003

OBJECTIVE

To assess whether prostate cancer might be related to hormone levels and, by inference, to differences in sexual activity.

PATIENTS, SUBJECTS AND METHODS

In a case‐control study of men with prostate cancer aged < 70 years at diagnosis and age‐matched control subjects, information was collected on two aspects of sexual activity; the number of sexual partners and the frequency of total ejaculations during the third to fifth decades of life.

RESULTS

There was no association of prostate cancer with the number of sexual partners or with the maximum number of ejaculations in 24 h. There was a negative trend (P < 0.01) for the association between risk and number of ejaculations in the third decade, independent of those in the fourth or fifth. Men who averaged five or more ejaculations weekly in their 20s had an odds ratio (95% confidence interval) of 0.66 (0.49–0.87) compared with those who ejaculated less often.

CONCLUSIONS

The null association with the number of sexual partners argues against infection as a cause of prostate cancer in this population. Ejaculatory frequency, especially in early adult life, is negatively associated with the risk of prostate cancer, and thus the molecular biological consequences of suppressed or diminished ejaculation are worthy of further research.
Health‐related quality of life and psychosocial factors in patients with prostate cancer scheduled for radical prostatectomy or external radiation therapy
Authors: Van Andel G. , Visser A.P. , Hulshof M.C.C.M. , Horenblas S. , Kurth K.H.
Published: July 2003

OBJECTIVE

To assess whether baseline health‐related quality of life (HRQOL) and psychosocial profiles differ in patients with prostate cancer scheduled for radical prostatectomy (RP) or external radiation therapy (ERT), as there is evidence that HRQOL is influenced by psychosocial factors (PFs), so that any variation at baseline should be considered when comparing the effect of therapy on HRQOL.

PATIENTS AND METHODS

Before receiving therapy, HRQOL and PFs were assessed in 65 patients scheduled for RP and in 73 scheduled for ERT. To measure HRQOL (generic and disease‐specific) and PFs, an extended questionnaire was constructed, using validated and standardized instruments. Clinical data were collected from patients’ medical records. Comparisons adjusted for age and socio‐economic status (SES) were analysed using Student's t‐test and univariate analyses of variance and covariance.

RESULTS

Patients scheduled for ERT were 7.9 years older and had a lower SES (both P < 0.001), more often had stage T3 and T4 disease, had poorer histopathological differentiation and higher levels of prostate‐specific antigen (all P < 0.01). They also reported a worse physical, role, cognitive and social function, more fatigue, more pain, a lower overall HRQOL and worse sexual function than patients scheduled for RP. There were no differences in urinary and bowel function, nor in the PFs assessed.

CONCLUSION

The baseline HRQOL profile of patients scheduled for RP is better than in those scheduled for ERT. These results are in line with those from the few other studies on this subject. Knowing the impact of RP and ERT on HRQOL should therefore be based mainly on longitudinal studies including baseline measures, the analyses of which should be adjusted for age and SES. In the present small study, baseline PFs did not differ between the treatments.
Cryoablation of renal tumours in patients with solitary kidneys
Authors: Shingleton W.B. , Sewell P.E.
Published: July 2003

OBJECTIVE

To investigate the use of cryoablation for small renal tumours (≤ 5 cm) in patients with solitary kidneys, as the advantage of this technique might be to preserve nephrons for maintaining renal function with minimal morbidity.

PATIENTS AND METHODS

Patients with a radiographically documented solid renal mass in a solitary kidney were evaluated for treatment with percutaneous cryoablation. Under general anaesthesia the patients were placed in an interventional magnetic resonance imaging (MRI) unit. A gradient imaging technique was used to locate the tumour and one to four 3‐mm cryoprobes placed percutaneously into the tumour. An argon‐based cryoablation system was used to treat the tumour with three freeze‐thaw cycles, at a probe tip temperature of −120°C. Patients were admitted for 23 h observation and assessed for follow‐up at 1 week, 1, 3 and 6 months, and then every 6 months. Radiological imaging studies (computed tomography or MRI) were used at 1, 3 and 6 months and every 6 months afterward, to assess for recurrent or new tumour appearance.

RESULTS

To date, 14 patients with renal masses in a solitary kidney have been treated; two were lost to follow‐up and excluded from the analysis, leaving 10 men and two women (mean age 62.5 years, range 29–76). In all, 15 tumours (mean diameter 3.1 cm) were treated; the mean (range) treatment time was 96.7 (30–143) min. There were no complications during treatment. Two patients had gross haematuria afterward that resolved within 24 h. The mean follow‐up was 17  (2–30) months, with three patients requiring re‐treatment for incomplete tumour ablation. There is no radiographic evidence of local tumour recurrence to date. In two patients the tumour was not completely ablated. There was no significant change in serum creatinine from preoperative values.

CONCLUSION

Percutaneous cryoablation of tumours in solitary kidneys caused minimal morbidity and little change in serum creatinine levels. Although the follow‐up is brief there was no local recurrence. Cryoablation may be a treatment option for patients with tumour in solitary kidneys but a long‐term follow‐up is needed to confirm these results.
Effect of renal transplantation on sperm quality and sex hormone levels
Authors: Akbari F. , Alavi M. , Esteghamati A. , Mehrsai A. , Djaladat H. , Zohrevand R. , Pourmand G.
Published: July 2003

OBJECTIVE

To assess the effect of successful renal transplantation on semen variables, sexual function and sex hormone profiles in a clinical trial.

PATIENTS AND METHODS

Thirty patients on haemodialysis underwent renal transplantation; before and after surgery, their sperm density, motility and morphology were analysed, follicle‐stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone levels measured and compared, and sexual function assessed using an abbreviated version of the International Index of Erectile Function (IIEF), with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5‐point scale. The paired t‐test was used to assess the statistically significance of differences in all analyses.

RESULTS

Sperm motility improved significantly (P < 0.001) but there were no significant changes in morphology or density (P = 0.33 and 0.068, respectively). Testosterone levels increased and FSH, LH and prolactin decreased significantly (P < 0.05) after renal transplantation. The IIEF showed that of the 30 patients, 14 were impotent before surgery and only six remained so afterward (P < 0.05).

CONCLUSION

Although sperm morphology and density did not improve after renal transplantation, there were highly significant changes in sperm motility. Hormonal levels in patients on haemodialysis improved after transplantation and returned to nearly normal; sexual function was also significantly better. Further studies are needed to confirm these results.
Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year
Authors: Kim S.C. , Chang I.H. , Jeon H.J.
Published: July 2003

Authors from Seoul describe their experience with patients already on triple therapy by intracavernosal injection who changed to oral sildenafil. Rather surprisingly, they found that patients had had a greater preference than expected for triple therapy, feeling that they had a better quality of erection on intracavernosal injection.

The subject of the effect of renal transplantation on sperm quality and sex hormone levels is discussed by authors from Teheran. They found that sperm morphology and density remained unchanged, but there were significant improvements in sperm mobility. There was also an improvement in hormone levels and sexual function.

OBJECTIVE

To investigate the efficacy and preference for oral sildenafil or intracavernosal injection (ICI) therapy in patients with erectile dysfunction (ED) already using ICI.

PATIENTS AND METHODS

In all, 69 patients with ED (mean age 55.1 years, sd 12.3) on ICI therapy with triple solution (papaverine/phentolamine/prostaglandin‐E1) for > 1 year were recruited for the study. Their erection quality, adverse reactions and selection rate of oral sildenafil or ICI as treatment, after using sildenafil for 3 months, and the reasons for their preferences, were compared between the regimens,

RESULTS

Overall, 52 men (75%) responded to sildenafil; of these men, the erection quality with ICI was better than that with sildenafil in 46 (89%) and 16 (31%) preferred ICI as their treatment. Eighteen patients (35%) used each treatment alternately and 18 (35%) used sildenafil exclusively. The main reason given by patients for choosing ICI was a better quality of erection (74%).

CONCLUSION

More patients with ED and using ICI preferred it as their main treatment than was expected, even though they had a good response to oral sildenafil. A better quality of erection with ICI was the reason why experienced patients chose this method, differing from the choice of patients starting treatment for ED.
Treatment of vesico‐ureteric reflux: a new algorithm based on parental preference
Authors: Capozza N. , Lais A. , Matarazzo E. , Nappo S. , Patricolo M. , Caione P.
Published: July 2003

Authors from Rome evaluated parental preference for treatment in children with grade III VUR. Parents were provided with detailed information about the three treatment options: antibiotic treatment, open surgery, endoscopic treatment. Most parents chose endoscopic management; with this in mind, the authors proposed a new treatment algorithm for VUR.

OBJECTIVE

To assess parental preference (acknowledged in treatment guidelines as important when choosing therapy) about treatments for vesico‐ureteric reflux (VUR, commonly associated with urinary tract infection and which can cause long‐term renal damage if left untreated), as at present there is no definitive treatment for VUR of moderate severity (grade III).

SUBJECTS AND METHODS

The parents of 100 children with grade III reflux (38 boys and 62 girls, mean age 4 years, range 1–15) were provided with detailed information about the three treatment options available for treating VUR (antibiotic prophylaxis, open surgery and endoscopic treatment), including the mode of action, cure rate and possible complications, and the practical advantages and disadvantages. They were then presented with a questionnaire asking them to choose their preferred treatment.

RESULTS

Most parents preferred endoscopic treatment (80%), rather than antibiotic prophylaxis (5%) or open surgery (2%); 13% could not decide among the three options and endoscopic treatment was recommended.

CONCLUSION

Given the strong preference for endoscopic treatment we propose a new algorithm for treating VUR; endoscopic treatment would be considered as the first option for persistent VUR, except in severe cases where open surgery would still be recommended.
Neurovesical dysfunction in children after treating pelvic neoplasms
Authors: Mosiello G. , Gatti C. , De Gennaro M. , Capitanucci M.L. , Silveri M. , Inserra A. , Milano G.M. , De Laurentis C. , Boglino C.
Published: July 2003

OBJECTIVE

To evaluate 10 years of experience, and thus define the occurrence and causes, of neurogenic lower urinary tract dysfunction in children with pelvic neoplasms treated by surgery.

PATIENTS AND METHODS

From 1991 to 2000, 33 children were operated by the same surgeons for pelvic neoplasms; 11 were analysed, comprising four each with sacrococcygeal teratoma (ST) and ganglioneuroma, and one each with yolk sac tumour (YST), neuroblastoma and myofibroblastic bladder sarcoma (MBS). The other patients were not assessed because eight had died or were in severe progression, three were treated by bladder substitution and the others were lost to follow‐up or refused a urological evaluation. All 11 children were evaluated at ≥ 6 months after surgery with a questionnaire about bowel and voiding habits, a neurological and orthopaedic assessment, a noninvasive urodynamic study, renal ultrasonography and spinal and pelvic magnetic resonance imaging (MRI). All patients with signs of bladder dysfunction were evaluated by a pressure‐flow study. The results were analysed for surgical approach and anatomical involvement, i.e. group A, extensive surgery for complete tumour excision in the sacral area (ST and YST); group B, surgery for tumour resection in the paraspinal ganglia area (neuroblastoma and ganglioneuroma); and group C, bladder tumour with partial bladder resection (MBS).

RESULTS

Eight patients had signs or symptoms related to bladder sphincter dysfunction. One child refused the invasive urodynamic evaluation, leaving seven for analysis (two each ST and ganglioneuroma, one each YST, neuroblastoma and MBS). The urodynamic findings were normal in three children. On spinal and pelvic MRI a presacral lipoma with syringomyelia was discovered in one child with ST. Eight children had bladder dysfunction and two had no neurogenic damage (which was only in sacral tumours); in one child it was related to an upper motor neurone lesion from spinal dysraphism and in the other to a lower motor neurone lesion from surgical injury to the splanchnic nerves. Patients operated for paraspinal tumours had more bladder dysfunction but no signs of neurogenic damage, as did the patient with partial bladder resection. However in Group B, there may have been a transient or incomplete nerve injury in one patient.

CONCLUSIONS

Deficits of parasympathetic, sympathetic and somatic innervation of the bladder and the urethra may occur in children after surgery for pelvic neoplasms, related to minor or major surgical trauma. In ST, a tethered cord may be associated with mixed neurogenic damage. Knowledge of bladder dysfunction in anorectal malformations, spinal dysraphism, etc. and the clinical protocol used in these patients also seemed to be useful for understanding the development of voiding dysfunction in patients with neoplasm.