bluuebunny/crossref_metadata_2025 huggingface dataset:
External and iatrogenic trauma of the urinary bladder: a survey in Poland
Authors: Dobrowolski Z.F. , Lipczyn˜ski W. , Drewniak T. , Jakubik P. , Kusionowicz J.
Published: March 2003

Objective To assess incidence of urinary bladder injuries (frequently associated with pelvic trauma and often iatrogenic in Poland.

Materials and methods The records and details of urinary bladder injuries treated between 1995 and 1999 were analysed for 61 urological departments in Poland.

Results During the 5‐year period 512 patients had urinary bladder injuries; in 210 (41%) the injury was caused by a road traffic accident, in eight (2%) by compression (crushing injury) within the limits of the pelvic bones, in 40 (8%) by a fall from a height, in three by a gunshot wound and in the remaining 251 (49%) the injury was iatrogenic. Among the 261 bladder injuries that were not iatrogenic, 41 (16%) were associated with pelvic bone trauma. In 36 patients there was simultaneous injury of the urinary bladder and posterior urethra, constituting 14% of such injuries and 7% of all trauma cases. The iatrogenic injuries were in 98 patients (39%) in urological departments, in 130 (52%) women in gynaecological departments and in 23 (9%) on surgical wards. The injury was open in 102 patients (20%) and closed in 372 (73%); there was bladder contusion in 38 patients (7%). The injuries were intraperitoneal in 225 patients (44%) and extraperitoneal in 287 (56%). For diagnosis, abdominal ultrasonography was used in 455 (89%) patients, intravenous pyelography in 266 (52%), cystography in 388 (76%) and computed tomography in 15 (3%). The delay between trauma and diagnosis was 0.5–124 h. Surgical treatment of the injury comprised a monolayer suture of the bladder wall in 51 patients (10%), a two‐layered suture in 461 (90%), perivesical drainage in 468 (91%) and inspection of the peritoneal cavity in 232 (45%). The mean (range) interval between diagnosis and treatment was 14 (7–70) days. Seven patients died after the treatment failed.

Conclusions Almost half the patients had iatrogenic injuries, of which over half occurred in gynaecological and maternity wards. Thus it is important teach the basic range of urological operations to trainee doctors. The commonest diagnostic method was not ascending cystography but ultrasonography; we recommend ascending cystography be used with at least two views after filling the urinary bladder with ≈ 300 mL of contrast medium, with an additional film after emptying the contrast medium. In patients with pelvic bone trauma it is reasonable to use spiral computed tomography with virtual analysis before surgery. A two‐layered suture of the bladder wall with perivesical drainage should be used.
Localization of peripheral dopamine D1 and D2 receptors in rat corpus cavernosum
Authors: Hyun J.‐S. , Bivalacqua T.J. , Baig M.R. , Yang D.‐Y. , Leungwattanakij S. , Abdel‐Mageed A. , Kim K.‐D. , Hellstrom W.J.G.
Published: March 2003

Objective  To detect and locate anatomically peripheral dopamine D1 and D2 receptors in rat cavernosa, as dopamine is important in sexual drive and penile erection through receptors located in the central nervous system.

Materials and methods

 Corpora cavernosa were obtained from Sprague‐Dawley rats; total RNA and membrane proteins were extracted and cryostat sections prepared. The rat brain hypothalamus was used as a control for dopamine D1 and D2 receptors. The presence and expression of peripheral dopamine D1 and D2 receptor mRNAs in rat corpus cavernosa was assessed using reverse transcription and polymerase chain reaction (RT‐PCR), and Northern blot hybridization using
32
P‐UTP‐labelled RNA probes. Concurrently, corresponding proteins from D1 and D2 receptors were assayed and detected by a Western blotting technique. The anatomical location of dopamine D1 and D2 receptor mRNAs in rat penile tissues was identified by
in situ
hybridization using
35 S‐UTP‐labelled RNA probes in cryostat sections. Immunohistochemical staining was used to locate peripheral dopamine D1 and D2 receptor proteins in rat corpora cavernosa.

Results

 Dopamine D1 and D2 receptor gene expression was detected in rat corpora cavernosa.
In situ hybridization signals for dopamine D1 and D2 receptor mRNAs were localized to corpus cavernosal tissues and dorsal vessels in the rat penis. Western blot analyses showed peripheral dopamine D1 and D2 receptor proteins in rat corpora cavernosa. Immunohistochemically, peripheral dopamine D1 and D2 receptor proteins were detected in dorsal nerves, dorsal vessels and corpus cavernosal smooth muscle of the rat penile tissues.

Conclusions  Peripheral dopamine D1 and D2 receptors are present in the corpora cavernosa of rats. The functional significance of these receptors and signal transduction pathways in modulating the vascular tone of the penis warrants further investigation.
Efficacy of desmopressin in the treatment of nocturia: a double‐blind placebo‐controlled study in men
Authors: Mattiasson A. , Abrams P. , Van Kerrebroeck P. , Walter S. , Weiss J.
Published: March 2003

Objective To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men.

Patients and methods Men aged 18 years with verified nocturia (two voids/night) and nocturnal urine production greater than their maximum functional bladder capacity were recruited. A 3‐week dose‐titration phase established the optimum desmopressin dose (0.1, 0.2 or 0.4 mg). After a 1‐week ‘washout’ period, patients who responded in the dose‐titration period were randomized to receive the optimal dose of desmopressin or placebo in a double‐blind design for 3 weeks.

Results In all, 151 patients entered the double‐blind period (86 treated with desmopressin, 65 with placebo). In the desmopressin group 28 (34%) patients and in the placebo group two (3%) patients (P<0.001) had fewer than half the number of nocturnal voids relative to baseline; the mean number of nocturnal voids decreased from 3.0 to 1.7 and from 3.2 to 2.7, respectively, reflecting a mean decrease of 43% and 12% (P<0.001). The mean duration of the first sleep period increased by 59% (from 2.7 to 4.5 h) in the desmopressin group, compared with an increase of 21% (from 2.5 to 2.9 h) in the placebo group (P<0.001). The mean nocturnal diuresis decreased by 36% (from 1.5 to 0.9 mL/min) in the desmopressin group and by 6% (from 1.7 to 1.5 mL/min) in the placebo group (P<0.001). The mean ratio of night/24‐h urine volume decreased by 23% and 1% (P<0.001), and the mean ratio of night/day urine volume decreased by 27% and increased by 3% (P<0.001) for the desmopressin and placebo groups, respectively. In the double‐blind treatment period, similar numbers of patients had adverse events; 15 (17%) patients in the desmopressin and 16 (25%) patients in the placebo group. Most adverse events were mild. Serum sodium levels were <130 mmol/L in 10 (4%) patients and this occurred during dose‐titration.

Conclusions Orally administered desmopressin is an effective and well‐tolerated treatment for nocturia in men.
Prognostic significance of nuclear morphometry in renal cell carcinoma
Authors: Özer E. , Yörükoğlu K. , Sagol Ö. , Mungan U. , Demirel D. , Tüzel E. , Kirkali Z.
Published: March 2003

Objective  To assess nuclear morphometry as a predictor of prognosis in patients with renal cell carcinoma (RCC).

Patients and methods  The study included 65 consecutive patients with RCC who underwent radical nephrectomy and were followed up for a median (range) of 80 (27–138) months. Nuclear morphometry was assessed using a computer‐assisted image analysis system on histological sections and characterized by five nuclear variables (area, perimeter, major and minor diameter, and form factor). From the patients' records and pathology specimens, the clinicopathological prognostic variables (histological type, Fuhrman grade and pathological stage) were recorded. The proliferative activity was assessed using immunohistochemical staining with Ki‐67 antibody.

Results

 Higher values of mean nuclear area, perimeter, and major and minor diameter were significantly related to higher nuclear grade, proliferative activity and advanced tumour stage. They were significant predictors of disease progression and survival, together with grade, stage, sarcomatoid histology and proliferative activity. Of all significant prognostic factors predicting progression‐free survival, only stage was independent (T4 vs T1, hazard ratio 6.55, 95% CI 1.63–26.13,
P =0.008).

Conclusion  Although the significance of these preliminary results must not be overstated, nuclear morphometry might provide significant prognostic information in predicting survival and tumours at high risk of progression in RCC.
Clinical experience with a new ultrasonic and LithoClast combination for percutaneous litholapaxy
Authors: Hofmann R. , Olbert P. , Weber J. , Wille S. , Varga Z.
Published: March 2003

Objective  To assess a new lithotripter for intracorporal lithotripsy, which combines the mechanically driven pneumatic LithoClast™ (Electro‐Medical Systems, Nyon, Switzerland) and a new ultrasonic device (Electro‐Medical Systems), for use in percutaneous nephrolitholapaxy (PNL).

Patients and methods  The new lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new ultrasonic device. The 1.0 mm LithoClast probe is advanced off‐centre through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system with a pinch valve compressing the irrigation tube, a foot‐switch for activating the ultrasound, the LithoClast and both together, and a stone bucket at the outlet tube are new features. Between February 1999 and August 2001, 68 patients were treated by PNL with the new device; 35 had complete and 33 had partial staghorn calculi. PNL was administered under fluoroscopic control and with the patient prone.

Results  The mean (range) duration of surgery was 61 (42–119) min. The complete stone‐free rate was 66% after the first PNL; of the 68 patients, 16 received a second PNL, giving a final stone‐free rate of 76% and 80%. The stone was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in 35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very effective, producing smaller stone particles and thus fewer residual stone fragments after PNL than with the LithoClast or ultrasonic fragmentation alone.

Conclusion  The new lithotripter provides easily managed and highly effective stone fragmentation of all stones, regardless of their composition.
Does smoking status influence the prognosis of bladder cancer? A systematic review
Authors: Aveyard P. , Adab P. , Cheng K.K. , Wallace D.M.A. , Hey K. , Murphy M.F.G.
Published: March 2003

Objectives To summarize, in a systematic review, the evidence for the effect of stopping smoking on recurrence, cancer‐specific and all cause‐mortality among smokers with newly diagnosed bladder cancer.

Materials and methods Two electronic databases and the reference lists of identified primary studies and reviews were searched. Studies were included if a hazard ratio and its confidence intervals could be extracted. A predefined set of study characteristics was extracted which defined whether studies were giving valid prognostic data on the effects of smoking in reasonably homogenous cohorts. The results of studies were synthesized qualitatively.

Results Fifteen relevant studies were identified; former and current smokers were combined in many studies. Many studies produced information on prognosis that was confounded by the mixing of incident and prevalent cases. Only three studies examined the influence of smoking on prognosis in only incident cases, most of whom had superficial disease. Of these, only one was of high quality. These three studies and the other 12 showed suggestive evidence that continued smoking or a lifetime of smoking constitutes a moderate risk factor for recurrence and death, and that stopping smoking could favourably change this. However, the evidence base for this is weak because of the methodological shortcomings and because most studies' results were not statistically significant. A life‐table model showed that if stopping smoking altered the prognosis, the size of the benefit would be clinically worthwhile.

Conclusions There is suggestive evidence that stopping smoking might favourably alter the course of bladder cancer, but this is insufficient for clinicians to inform patients that doing so will improve their prognosis, and for providing specialized services to assist in stopping smoking to patients with bladder cancer.
Validity and reliability of an interviewer‐administered questionnaire to measure the severity of lower urinary tract symptoms of storage abnormality: the Leicester Urinary Symptom Questionnaire
Authors: Shaw C. , Matthews R.J. , Perry S.I. , Assassa R.P. , Williams K. , Mcgrother C. , Dallosso H. , Jagger C. , Mayne C. , Clarke M. ,   the Leicestershire MRC Incontinence Study Team
Published: March 2003

Objective To develop a valid and reliable interviewer‐administered questionnaire to measure the presence and severity of storage abnormality symptoms of incontinence, urgency, frequency and nocturia.

Subjects and methods Subjects were 930 men and women aged 40 years, taking part in a randomized controlled trial of a continence nurse practitioner (CNP) service. Criterion validity was tested by comparing questionnaire responses to 24‐h pad test and 3‐day urinary diary. Responsiveness was assessed by comparing questionnaire responses before and after treatment. Questions about urgency were investigated for construct validity in patients taking part in the trial who underwent urodynamic investigation (243). Test‐retest and inter‐rater reliability was measured at ≈ 6 days in subjects recruited to an associated epidemiological study (104 and 102, respectively).

Results The questionnaire responses showed significant associations with pad‐test and diary measures. Questions about the severity of daytime incontinence performed better than those measuring night‐time incontinence. The response categories of soaked, wet, damp and almost dry had better associations with the pad test than other measures of the severity of incontinence. Test‐retest and inter‐rater reliability was good for all questions, and all were responsive to change in symptoms, showing significant differences before and after treatment.

Conclusion There is a clear need for standardization of measurement using well‐validated instruments. This interviewer‐administered questionnaire is valid, reliable and sensitive to change in a wide range of severity of symptoms, and in both men and women aged 40 years. The questionnaire provides a useful assessment tool for primary and secondary care in research and clinical settings.
A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results
Authors: Soulié M. , Seguin P. , Martel P. , Vazzoler N. , Mouly P. , Plante P.
Published: March 2003

Objective  To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions.

Patients and methods  From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21–74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed.

Results

 The median (range) follow‐up was 47.6 (10–124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re‐operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (
P   =  0.13).

Conclusion  Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.
Effects of vaginal distension on urethral anatomy and function
Authors: Cannon T.W. , Wojcik E.M. , Ferguson C.L. , Saraga S. , Thomas C. , Damaser M.S.
Published: March 2003

Objective  To determine the effect of repeated and prolonged vaginal distension on the leak‐point pressure (LPP) and urethral anatomy in the female rat, as prolonged vaginal distension has been clinically correlated with signs of stress urinary incontinence (SUI).

Materials and methods

 Sixty female rats were placed into one of five groups; four groups underwent one of four vaginal distension protocols using a modified 10 F Foley catheter, i.e. prolonged (1 h), brief (0.5 h), intermittent (cycling inflated/deflated for 0.5 h) or sham distension. All animals had a suprapubic bladder catheter implanted 2 days after and were assessed urodynamically 4 days after vaginal distension. The fifth group of rats acted as controls and did not undergo vaginal distension, but did have a suprapubic bladder catheter placed and urodynamics assessed. To measure LPP the rats were anaesthetized with urethane, placed supine and the bladder filled with saline (5 mL/h) while bladder pressure was measured via the bladder catheter. LPPs were measured three times in each animal by manually increasing the abdominal pressure until leakage at the urethral meatus, when the external abdominal pressure was rapidly released. Peak bladder pressure was taken as the LPP and a mean value calculated for each animal. Immediately after measuring LPP the urethra was removed and processed routinely for histology (5 µm sections, stained with haematoxylin/eosin and trichrome). The means (
sem
) were compared using a Kruskal–Wallis one‐way
anova
on ranks, followed by a Dunn's test, with
P  < 0.05 indicating a significant difference.

Results

 Both LPP and the external increase in abdominal pressure were significantly lower after prolonged distension, at 31.4 (1.7) and 19.8 (1.2) cmH
2
O, than in the sham group, at 41.1 (3.2) and 32.0 (4.7) cmH
2 O, respectively. There were no significant differences in LPP or in the increase in abdominal pressure between the brief, intermittent and sham groups. Qualitative histology showed that prolonged distension resulted in extensive disruption and marked thinning of urethral skeletal muscle fibres. Brief and intermittent distension showed mild and focal disruptions, respectively.

Conclusions  As observed clinically, prolonged vaginal distension results in a lower LPP, greater anatomical injury and increased severity of SUI. These results suggest that ischaemia is important in the development of SUI after prolonged vaginal distension.
Three‐month neoadjuvant hormonal therapy before radical prostatectomy: a 7‐year follow‐up of a randomized controlled trial
Authors: Aus G. , Abrahamsson P.‐A. , Ahlgren G. , Hugosson J. , Lundberg S. , Schain M. , Schelin S. , Pedersen K.
Published: March 2003

Objective  To describe the outcome, assessed as the level of prostate specific antigen (PSA), of a mature (more than half the events recorded) prospective randomized study with a median follow‐up of 82 months of neoadjuvant hormonal therapy before radical prostatectomy, as this has been suggested to decrease the rate of positive surgical margins (i.e. provide greater potential to completely excise the tumour).

Patient and methods  From December 1991 to March 1994, 126 patients with clinically localized prostate cancer were randomized between direct radical prostatectomy or a 3‐month course of a gonadotrophin‐releasing hormone analogue before surgery. The patients were followed by PSA determinations and a value of > 0.5 ng/mL used to define progression.

Results
 The incidence of positive surgical margins decreased from 45.5% to 23.6% (
P
 = 0.016) with hormone treatment. Despite this there was no difference in PSA progression‐free survival at the last follow‐up; it was 51.5% for those undergoing radical prostatectomy only and 49.8% for those who received hormonal pretreatment (
P  = 0.588).

Conclusions  Three months of neoadjuvant hormonal therapy before radical prostatectomy offers no benefit to the patient and cannot be recommended for routine clinical use.
125Iodine prostate brachytherapy: outcome from the first 100 consecutive patients and selection strategies incorporating urodynamics
Authors: Henderson A. , Cahill D. , Laing R.W. , Langley S.E.M.
Published: March 2003

Objective
 To report the results from the first 100 consecutive patients treated with
125 I transperineal interstitial prostate brachytherapy between March 1999 and June 2001, and to determine if the International Prostate Symptom Score (IPSS), prostate volume or urodynamic variables correlate with acute morbidity.

Patients and methods  Patients were assessed prospectively by uroflowmetry, the IPSS, a physical examination and transrectal ultrasonography. Of the 100 patients, 57 had a full urodynamic assessment, 61 presented with lower urinary tract symptoms (LUTS), 25 were screen‐detected and 14 presented with other problems. The IPSS was recorded at 1, 6 and 12 weeks, and then at 3‐monthly intervals after treatment; significant events, e.g. acute urinary retention (AUR) and rectal symptoms, were recorded prospectively; the mean follow‐up was 16 months.

Results  No patients were incontinent after treatment. There was a temporary deterioration in IPSS in 89% of patients. Peak symptoms occurred at 6 weeks and a statistically significant deterioration in IPSS persisted until 9 months, but continued to improve throughout the follow‐up. AUR affected seven patients, with a further 20 using clean intermittent self‐catheterization (CISC) for symptoms. In most patients the symptoms resolved spontaneously to the levels before treatment, with only two patients requiring surgery for bladder outlet obstruction. The IPSS before treatment did not predict urodynamic obstruction. Urodynamically unobstructed patients did not require catheterization. By 2 years after implantation the mean IPSS was better than before treatment. Five patients had mild, transient proctitis.

Conclusion  Selecting patients with a low prostate volume and IPSS is likely to optimize the outcome of brachytherapy. Urodynamic studies may be helpful in predicting the risk of AUR and symptoms requiring CISC. Despite many patients presenting with LUTS, acute morbidity was no worse than that reported in large American series of predominantly screening‐detected cancers. Prostate brachytherapy is well tolerated and may be safely delivered to patients with prostate cancer in the UK.
Treating neuropathic incontinence in children with seromuscular colocystoplasty and an artificial urinary sphincter
Authors: González R. , Jednak R. , Franc‐Guimond J. , Schimke C.M.
Published: March 2003

Purpose  To review the results of artificial urinary sphincter (AUS) implantation combined with seromuscular colocystoplasty (SCLU) in the treatment of mixed neurogenic urinary incontinence in children.

Patients and methods  Patients (27, six females) who had undergone SCLU were interviewed, and their charts and imaging studies reviewed retrospectively. Their urodynamic data were analysed and bladder capacity, end‐filling pressure, safe capacity and percentage of expected capacity for age compared before and after surgery. Continence was defined as dryness between catheterizations or voiding with no need for protective pads.

Results  The mean (sd) follow‐up since the SCLU was 1.7 (1.1) years; continence was achieved in 24 of the 27 (89%) patients with no additional procedures. No significant upper tract changes developed. Bladder capacity, safe capacity for age and end‐filling pressure were all improved significantly. There were two AUS erosions necessitating removal and in one patient the augmentation failed. Six patients early in the series developed an ‘hourglass’ deformity that required correction. Modifications to the technique to avoid this complication are discussed.

Conclusions  For children with neuropathic incontinence who require both augmentation of outlet resistance and bladder storage capacity, the combination of the AUS and SCLU effectively achieves continence with no upper tract deterioration. SCLU is also the preferred method of augmentation when adverse bladder changes occur after implanting the AUS.
Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons
Authors: Quinn M. , Babb P.
Published: March 2003

The international patterns and trends in prostate cancer incidence, survival, prevalence and mortality were examined. Age‐standardized incidence and death rates among men in a variety of countries worldwide were obtained from various sources, survival rates from European sources and elsewhere, and prevalence estimates from the EUROPREVAL study. Results from many published studies were summarized. The incidence of prostate cancer varies widely around the world, with by far the highest rates in the USA and Canada. There has been a gradual increase in the incidence of prostate cancer since the 1960s in many countries and in most continents; there were large increases in the late 1980s and early 1990s in the USA, but increases have also occurred in countries with comparatively low incidence, e.g. India. Survival from prostate cancer improved during the 1970s and 1980s; further increases in the 1990s may be largely a result of earlier diagnosis. There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA. There was wide variation in the prevalence of prostate cancer in Europe; in some countries with high incidence and high life‐expectancy, prostate cancers formed ≈ 15% of all prevalent cancers in men. Mortality from prostate cancer has also increased in many countries, but to a lesser extent than incidence; this is consistent with the observed trends in survival. Mortality decreased slightly in the mid to late 1990s in several countries, including the USA, Canada, England, France and Austria. Part of the apparent increases in the incidence of prostate cancer has been associated with diagnostic artefacts (particularly detecting preclinical tumours through the increased use of transurethral resection) which may also have had an effect on death certification through the incorrect attribution of prostate cancer as the underlying cause of death. However, the greatest effect on the registration of new cases of prostate cancer has been the increased availability of prostate specific antigen testing during the early‐ to mid‐1990s. Possibly, in addition to the effect of attribution bias, the earlier diagnosis of prostate cancers has contributed to the recent slight decreases in mortality. However, this is unlikely to account for much of the reduction, given the slow development of the disease from onset to death. Changes in disease management are probably more important. There are many strong arguments against introducing population‐based screening for prostate cancer.
Transrectal colour Doppler ultrasonography for quantifying angiogenesis in prostate cancer
Authors: Shigeno K. , Igawa M. , Shiina H. , Kishi H. , Urakami S.
Published: March 2003

OBJECTIVE

To assess the correlation between angiogenesis and Doppler signal intensity using transrectal colour Doppler ultrasonography (CDUS) in patients with prostate cancer.

PATIENTS AND METHODS

The study comprised 56 patients who underwent radical prostatectomy and had untreated tumours with a volume of> 0.1 mL in the peripheral zone. CDUS images were recorded on videotape before surgery. The Doppler signal intensity in tumours was evaluated using the colour pixel intensity (PI). Microvessel density (MVD) and vascular endothelial growth factor (VEGF) immunoreactivity were determined in the prostatectomy specimens. Microvessels were identified by immunohistochemical staining of endothelial cells for CD31.

RESULTS

The PI in the tumour correlated with MVD (P < 0.001) and increased with higher levels of VEGF immunoreactivity (P = 0.004). There was no correlation between Gleason score and MVD or PI in the tumour.

CONCLUSION

Blood flow assessed by CDUS may reflect the state of angiogenesis in prostate cancer. CDUS may be a useful technique for predicting tumour progression or prognosis, and may be useful for monitoring the effects of anti‐angiogenic agents in the future.
Intraprostatic ethanol chemoablation via transurethral and transperineal injection
Authors: Plante M.K. , Gross A.L. , Kliment J. , Kida M. , Zvara P.
Published: March 2003

OBJECTIVES

To further assess the safety and feasibility of prostatic chemoablation with ethanol and to address previous concerns associated with transperineal injection using a canine model.

MATERIALS AND METHODS

The study included 25 dogs; normal saline or 98% dehydrated ethanol were injected into the prostate using both routes, at volumes of 25–50% of the total prostate volume. The prostate and adjacent structures were examined grossly and histopathologically after the dogs were killed humanely at 4 h, 7 days and 12 weeks after injection.

RESULTS

Transperineal injection resulted in tissue necrosis in all prostates and significant extraprostatic necrosis in two of three animals treated. With transurethral injection, the control groups showed minimal change, whereas the group injected with ethanol resulted in lesions with variable necrosis and location.

CONCLUSIONS

Intraprostatic chemoablation is possible with ethanol injection both transperineally and transurethrally. Transperineal ethanol injections were associated with more extraprostatic necrosis. Transurethral injections resulted in larger amounts of necrosis in the prostatic parenchyma with minimal extraprostatic effects. However, the extent of prostatic necrosis/ablation was inconsistent and further research is warranted.
A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function
Authors: McNicholas T.A. , Dean J.D. , Mulder H. , Carnegie C. , Jones N.A.
Published: March 2003

OBJECTIVE

To compare the safety and efficacy of two doses of a new testosterone gel formulation (Testim™, Auxilium Pharmaceuticals, Inc., Norristown, PA, USA) to a permeation‐enhanced testosterone patch (Andropatch®, GlaxoSmithKline, UK) for treating men with confirmed low serum testosterone levels, and associated signs and symptoms of hypogonadism.

PATIENTS AND METHODS

In all, 208 men were randomized and treated at 29 centres in Denmark, Germany, Netherlands, Sweden and the UK. The men were treated for 90 days, and the pharmacokinetics and treatment effectiveness of Testim at two doses (50 and 100 mg/day, delivering a daily dose of 5 and 10 mg testosterone, respectively) and Andropatch (2 × 2.5 mg patches, each delivering 2.5 mg testosterone and containing 12.2 mg of testosterone) were compared. Pharmacokinetic profiles were obtained, body composition measured, and mood and sexual function data recorded.

RESULTS

Testim produced dose‐dependent improvements in all pharmacokinetic variables compared with Andropatch. The mean increases from baseline to 90 days in testosterone were 12.41, 6.54 and 3.82 nmol/L for Testim 100 and 50 mg/day and the Andropatch, respectively. Both doses of Testim significantly improved positive and negative mood over baseline; Andropatch did not. All three treatments increased lean body mass, and the higher dose of Testim produced a significant decrease in percentage body fat. At all sample times both doses of Testim significantly improved sexual performance, sexual motivation, sexual desire and spontaneous erections. Andropatch provided insignificant improvements from baseline at all sample times for sexual desire, an inconsistent improvement in sexual motivation, but no effect on spontaneous erections. These results are similar to those previously reported for testosterone replacement therapy in hypogonadal men, suggesting that normalization of serum testosterone restores sexual function. However, the present data suggest that higher serum testosterone levels may further improve sexual function. Gel treatment was well tolerated, while patch treatment produced higher rates of application‐site reactions and study discontinuation.

CONCLUSION

The favourable pharmacokinetic profile and treatment outcome, combined with the enhanced tolerability of Testim, suggest that this new gel formulation is a safe and effective treatment in men with low serum testosterone levels and associated signs and symptoms of hypogonadism.
Estimation of glomerular filtration rate and bladder capacity: the effect of maturation, ageing, gender and size
Authors: Wahl E.F. , Lahdes‐Vasama T.T. , Churchill B.M.
Published: March 2003

OBJECTIVE

To show that glomerular filtration rate (GFR) and bladder capacity (BC) develop isometrically, and to provide graphs for estimating GFR and BC for specific individuals of any age, sex, height and weight, for cystometric purposes.

MATERIALS AND METHODS

GFR and BC data were collected from published reports; graphs relating GFR and BC to age, sex, height and weight were obtained by using a computerized curve‐fitting technique that minimizes the 1.1 power of the absolute error.

RESULTS

The plots show the GFR and BC for individuals of 10th, 50th and 90th percentile height and weight as a function of age and sex for different physiological conditions. GFR increases up to age 20 years and thereafter declines, whereas GFR per unit body surface area reaches a maximum at 3.25 years old and declines thereafter.

CONCLUSIONS

The clinical management strategy to preserve or enhance renal function in paediatric and adult nephrological disease should incorporate the present data on development, growth, ageing and deterioration of function. These data should be used when interpreting cystometrograms and evaluating compliance. The graphs are useful for clinically estimating GFR and BC, especially when estimating infusion rate and BC for individual patients. BC and GFR develop isometrically with a proportionality constant of 4.56 min, except from birth to 1.5 years of age. Accordingly, individuals with healthy urinary systems, irrespective of age, sex and size, in the same physiological conditions have, on average, the same time to reach BC, ranging from 7 h at a normal 1% GFR to 41 min at the maximum diuresis of 10% GFR.
Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study
Authors: Gacci M. , Bartoletti R. , Figlioli S. , Sarti E. , Eisner B. , Boddi V. , Rizzo M.
Published: March 2003

OBJECTIVE

To evaluate urinary symptoms, sexual dysfunction and quality of life in patients with benign prostatic hypertrophy (BPH) before and after open prostatectomy, using the International Prostate Symptom Score (IPSS), the International Continence Society (ICS)‐‘BPH’ (ICS‐male, ICS‐sex and ICS‐QoL) and International Index of Erectile Function (IIEF) questionnaires.

PATIENTS AND METHODS

Sixty men with BPH (mean age 68 years) underwent a digital rectal examination, transurethral ultrasonography, measurement of total prostatic specific antigen serum level and uroflowmetry. Their urinary symptoms, sexual function and quality of life were fully evaluated using the IPSS, ICS‐‘BPH’ and IIEF before and 6 months after suprapubic prostatectomy. The body mass index (BMI) was also calculated for each patient. Univariate analysis was used to examine the relationship between symptom scores and age, tobacco use, alcohol intake and BMI.

RESULTS

In a univariate analysis, age was the most important prognostic factor for both urinary and sexual symptoms. Prostatectomy resulted in a significant improvement in obstructive (mean 9.68 to 3.38) and irritative symptom (6.70 to 3.06), and quality‐of‐life scores (3.41 to 1.34). ICS‐male scores were both significantly decreased, the mean voiding score from 13.72 to 10.28 and the incontinence score from 10.43 to 7.81. There was also a significant decrease in the ICS‐QoL symptom score (from 9.20 to 7.27). Comparative results between IIEF and ICS‐sex showed no improvement in sexual scores after open surgery, but there was a significant increase in sexual desire and overall satisfaction (both P = 0.035).

CONCLUSIONS

The combined use of the IPSS, ICS‐‘BPH’ and IIEF allows an evaluation of the relationship between age, prostatic symptoms and sexual dysfunction. Age may be considered both a direct and indirect (BPH‐related) prognostic factor for sexual activity. Suprapubic prostatectomy resolves obstructive symptoms, and maintains sexual desire, overall sexual satisfaction and an improvement in quality of life. However, irritative symptoms, erection, orgasm and sexual intercourse satisfaction are not significantly altered.
Preoperative urodynamic and symptom evaluation of patients undergoing transurethral prostatectomy: analysis of variables relevant for outcome
Authors: Hakenberg O.W. , Pinnock C.B. , Marshall V.R.
Published: March 2003

OBJECTIVE

To assess the value of preoperative symptom score assessment and pressure‐flow measurement in men undergoing transurethral prostatectomy (TURP).

PATIENTS AND METHODS

In a prospective study, 95 men (mean age 74.3 years) scheduled for TURP because of their lower urinary tract symptoms, flow rates and urinary residual volumes were assessed using the self‐administered International Prostate Symptom Score (IPSS) and urodynamic pressure‐flow studies. At 3 months after TURP the patients were reassessed with a flow rate measurement and the IPSS. The baseline IPSS and urodynamic values were analysed with respect to the endpoints of the study, flow rate and IPSS after TURP, and the improvements thereof, respectively.

RESULTS

There were significant improvements in mean IPSS (− 10.87 points) and peak flow rate (+ 7.06 mL/s) 3 months after TURP. Classifying the patients into subgroups with distinctly different initial values for IPSS, flow rate, residual urine volume and degree of obstruction (as expressed by Abrams‐Griffiths number) showed that the flow rate and degree of obstruction influenced the improvement in flow rate but not in symptoms after TURP. Symptom improvement was only related to the initial level of symptoms. In a multivariate analysis, only age was an independent predictor of the outcome variables of flow rate and symptoms.

CONCLUSIONS

Clinical decision‐making remains a valid instrument for selecting patients for TURP. Both the IPSS and pressure‐flow assessment are useful to exclude patients who are unlikely to benefit from TURP. Age is an important predictor of the improvement in symptoms and flow rates after TURP for the lower urinary tract symptom complex associated with benign prostatic enlargement.
Time after surgery, symptoms and well‐being in survivors of urinary bladder cancer
Authors: Henningsohn L. , Wijkström H. , Pedersen J. , Ahlstrand C. , Aus G. , Bergmark K. , Onelöv E. , Steineck G.
Published: March 2003

OBJECTIVE

To evaluate how an increasing burden of symptoms influences well‐being, anxiety and depression at different intervals after a radical cystectomy with urostomy for bladder cancer, as this therapy can induce long‐term distressful symptoms.

PATIENTS AND METHODS

Patients with bladder cancer undergoing radical cystectomy in Stockholm between 1969 and 1995 were matched with 434 controls from the normal population; all 404 patients operated on between 1985 and 1995 at three other hospitals in Sweden were invited to enter the study. The final analysis included 306 patients and 310 controls, all assessed for symptoms and well‐being.

RESULTS

A low or moderate level of well‐being was reported by 35% of the patients having none or one of the symptoms studied, by 39% with two symptoms, by 45% with three symptoms and by 66% of those with four or more symptoms. The values, irrespective of symptom burden, were 45% after 2–5 years of follow‐up, 58% after 6–10 years and 38% at>10 years after surgery. The total symptom burden also influenced the risk of anxiety and depression. Symptom prevalence remained largely unaffected by the duration of follow‐up, except for defecation urgency.

CONCLUSIONS

The number of long‐term symptoms after radical surgery with a urostomy for urinary bladder cancer affects the risk of anxiety, depression and low or moderate well‐being.
Why do foot ulcers recur in diabetic patients?
Authors: Mantey I. , Foster A. V. M. , Spencer S. , Edmonds M. E.
Published: March 2003

Aim To investigate factors predisposing to recurrent foot ulceration in patients with diabetes mellitus.

Methods Two groups of patients who had attended a specialist Diabetes Foot Centre were assessed: relapsers (n = 26), whose foot ulceration had recurred at least twice, and nonrelapsers (n = 25), whose initial ulcer had not recurred for at least 2 years.

Results In the relapser group 10/26 patients waited at least 24 h before reporting symptoms compared with only 2/25 in the nonrelapser group (P < 0.05). Vibration perception threshold (volts) was 38 ± 12 (mean ± sd) in relapsers compared with 25 ± 13 in nonrelapsers (P < 0.005). Cold perception threshold (°C) was 9.1 ± 4.6 in relapsers compared with 5.1 ± 3.5 in nonrelapsers (P < 0.005). HbA1c (%) was significantly raised at 8.5 ± 1.7 in relapsers compared with 7.6 ± 1.2 in nonrelapsers (P = 0.03). Alcohol intake was 0.5 (median, interquartile range 0–2) units per day in relapsers compared with 0.0 (median, interquartile range 0–0.25) units in nonrelapsers (P = 0.04). Smoking habits, housing conditions, visual acuity, threshold for warm perception and the Doppler pressure index were not significantly different in the two groups.

Conclusions Patients who develop recurrent foot ulceration delay in reporting symptoms, when compared with diabetic patients whose foot ulceration does not recur. The relapsers also have evidence of poorer glycaemic control, more neuropathy and increased alcohol intake.

Diabet. Med. 16, 245–249 (1999)
Relationship between HLA‐DQ and ‐DR genotypes and clinical characteristics in a French population of Type 1 diabetic patients
Authors: Zevaco‐Mattei C. , Reviron D. , Atlan‐Gepner C. , Botti G. , Simonin G. , Lassmann‐Vague V. , Vague P. , Mercier P. , Vialettes B.
Published: March 2003

Aims The present study was designed to look for a heterogeneity in the association between Type 1 diabetes mellitus (DM) and class II alleles of major histocompatibility complex (MHC) according to clinical presentation and C‐peptide secretion during the first year of the disease, in a population living in south of France.

Methods HLA DRB1 and DQB1 genotypes were determined in 129 Caucasoid patients with Type 1 DM and compared to a control group (n = 88). In a subgroup of 46 young adult diabetic patients, basal and postglucagon C‐peptide secretion was followed during the first year of the disease (at 0, 1, 3, 6, 9 and 12 months).

Results The two main haplotypes associated with Type 1 DM were DRB1*04DQB1*0302 and DRB1*03DQB1*02. The genotypes DRB1* 04DQB1*0302/DRB1*04DQB1*0302 and DRB1*03DQB1*02/DRB1*04DQB1* 0302 were associated with an early onset of diabetes, while homozygosity for DRB1*03DQB1*02 was characterized by later onset. Levels of residual insulin secretion in patients genotyped DRB1*03DQA1*0501DQB1* 02/DRB1* 04DQA1*0301DQB1*0302 were higher than in patients genotyped DRB1* 3DQA1*0501DQB1*02/DRB1*XDQA1*XDQB1*X or DRB1* XDQA1* XDQB1*X/DRB1*XDQA1*XDQB1*X.

Conclusions This study confirms some clinical heterogeneity of Type 1 DM linked to HLA DR and DQ genotypes, and leads to a paradoxical finding: DQB1*02/DQB1*0302 combination predisposes to an early onset in the whole population but residual secretion of insulin disappears more slowly in a subgroup of young adults with recently diagnosed diabetes. These data suggest that interrelations between MHC genotype and diabetogenic process could be different at various ages of life.

Diabet. Med. 16, 201–206 (1999)
Endothelial function in offspring of Type 1 diabetic patients with and without diabetic nephropathy
Authors: McAllister A. S. , Atkinson A. B. , Johnston G. D. , McCance D. R.
Published: March 2003

Aims Familial aggregation of diabetes and nephropathy has been observed in several populations. Various interpretations have included underlying genetic mechanisms possibly mediated by a predisposition to hypertension. Endothelial dysfunction is now recognized as central to these conditions and offers a unifying mechanism to explain the disease aggregation. To test this hypothesis, we have examined endothelial function in healthy subjects at differing risks for diabetic nephropathy.

Methods Endothelial function was assessed in 12 healthy offspring (nine male (M)/three female (F); age 25.8 ± 1.2 years, mean ± sem) of parents with Type 1 diabetes mellitus (DM) and end‐stage renal disease compared with 12 control offspring (9 M/3 F; age 26.3 ± 1.3 years) of parents with long duration (> 20 years) Type 1 DM but without evidence of nephropathy. Forearm blood flow responses to brachial artery infusion of acetylcholine (endothelium‐dependent), sodium nitroprusside (endothelium‐independent), noradrenaline and the competitive inhibitor of basal nitric oxide release NG‐monomethyl‐
l‐arginine were assessed using venous occlusion plethysmography.

Results There were no significant differences between the groups in von Willebrand factor, fasting plasma glucose (4.2 ± 0.1 vs. 4.0 ± 0.2 mmol/l) or in 24‐h ambulatory blood pressure. Similarly, the groups did not differ in vasodilation to acetylcholine (P = 0.75) and sodium nitroprusside (P = 0.79) or in vasoconstriction to noradrenaline (P = 0.45) and NG‐monomethyl‐
l‐arginine (P = 0.30).

Conclusion These data do not support a role for endothelial dysfunction in the familial aggregation of diabetic nephropathy.

Diabet. Med. 16, 298–303 (1999)
Angiotensin‐converting enzyme gene and diabetes mellitus
Authors: Kennon B. , Petrie J. R. , Small M. , Connell J. M. C.
Published: March 2003

Aims The association of the insertion/deletion polymorphism in the angiotensin‐converting enzyme (ACE) gene with cardiovascular disease and diabetic nephropathy remains a controversial issue. This review aims to give an overview of the research to date assessing the impact of the ACE polymorphism in Type 1 and Type 2 diabetes mellitus (DM).

Methods A systematic review of the literature was performed in the databases of MEDLINE, PubMed and EMBASE for the key words ‘diabetes mellitus’, ‘diabetic nephropathy’, ‘ACE polymorphism’ and ‘genotype’ and relevant articles were considered.

Results A meta‐analysis assessing the influence of the ACE polymorphism on disease susceptibility demonstrated significant odds ratios in individuals with the DD genotype for coronary heart disease, myocardial infarction and both diabetic and nondiabetic renal disease. No association was found for left ventricular hypertrophy or hypertension in nondiabetic subjects.

Conclusions The ACE polymorphism appears to have a significant impact on the progression of diabetic nephropathy and may have therapeutic implications for identifying those individuals resistant to the effects of ACE inhibitors. It also appears to be indicative of an increased vascular risk in diabetic patients; however, larger prospective studies are required to clarify this situation.