bluuebunny/crossref_metadata_2025 huggingface dataset:
Attempted Transurethral Resection of Suprapubic Catheter
Authors: CROSFILL M. L.
Published: November 2008

The patient, a 79‐year‐old man, had been relieved of his acute retention by means of a Porges 12 F suprapubic catheter. This was noted at preliminary cystoscopy to lie slightly coiled in the bladder. During subsequent transurethral resection of the prostate the loop became embroiled with the catheter and could not be freed. An attempt was made to draw catheter and loop out through the urethra but this only resulted in disintegration of the loop. The shaft of the loop was withdrawn without difficulty but some of the cutting wire was seen to be missing, and on further examination this was found to transfix the shaft of the catheter into which it was fused. Catheter and wire were pulled out through the urethra using biopsy forceps, after which the resection proceeded uneventfully.
Photodynamic
Authors: POPE A.J. , BOWN S.G.
Published: November 2008

Photodynamic therapy (PDT) is an innovative approach to the local ablation of malignant tumours. It has attracted a great deal of interest as a possible means of selectively destroying small cancers. The concept is simple:
Extracorporeal Shockwave Lithotripsy or Extracorporeal Piezoelectric Lithotripsy? Comparison of Costs and Results
Authors: SOFRAS F. , KARAYANNIS A. , KASTRIOTIS J. , VLASSOPOULOS G. , DIMOPOULOS C.
Published: November 2008

Summary One thousand patients with renal stones up to 3 cm in diameter were divided equally into 2 groups matched for age, sex and stone size. One group was treated on the Dornier HM3 lithotriptor and the other on the EDAP LT01. The results showed that for stones <1 cm both lithotriptors were equally effective, with a stone‐free rate of 87.5% for the Dornier and 90.4% for the EDAP at 3 months. The success rate fell more steeply for the EDAP machine, however, to become 77.2 and 42.5% respectively as the stone size increased to 3 cm. Treatment time was longer on the EDAP lithotriptor and more sessions were required but patients preferred it to the Dornier. Running costs per patient were higher on the EDAP.
Clam Enterocystoplasty in General Urological Practice
Authors: BERGH R. C. KOCKEL , TAN J. B. L. , BATES C. P. , BISHOP M. C. , ChM M. DUNN , LEMBERGER R. J.
Published: November 2008

Summary A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases.

Improvement occurred in 71% and those younger than 30 years had better overall results; 29% remained incontinent, with 9% requiring a urinary diversion. Many patients did not achieve maximum benefit until 9 months post‐operatively. Surgery had no statistically significant effect on any urodynamic parameter and post‐operative complications were common.

The operation was performed in either the coronal (19) or the sagittal plane (26); this did not influence results. In general, surgery was found to be technically simpler in the sagittal group and it is recommended that this becomes the standard procedure. We feel that this operation involves major surgery and should only be offered with reluctance.
Hospitalisation of Prostatic Cancer Patients Undergoing Orchiectomy
Authors: JOHANSEN T. E. B. , FJAERE H. T.
Published: November 2008

Summary We report our experience with 100 orchiectomies for advanced prostatic cancer in hospitalised patients. Approximately 60% of the patients required hospitalisation for additional treatment and investigation of complications due to their disease at the time of orchiectomy. In 51 cases the orchiectomy was combined with transurethral resection of the prostate (TURP); 37 patients had pathological levels of serum creatinine and 17 had pathological dilatation of the upper urinary tract, 6 of whom required a nephrostomy catheter. Because of anaemia on admission, 21 patients received a perioperative blood transfusion. Two patients had significant post‐operative bleeding, 2 developed a wound infection and 1 had a deep thrombophlebitis.

The patients' mean age was 76.4 years and the period of hospitalisation ranged from 3 to 150 days with peaks at 3 and 8 days. The most important reason for prolonged hospitalisation was social problems.

It was concluded that many patients who were hospitalised as a direct consequence of their prostatic carcinoma would have been in hospital for a similar period regardless of the method of hormonal manipulation used. Because so many patients have other reasons for hospitalisation, or require additional surgical procedures such as TURP, the true average cost of orchiectomy for advanced prostatic cancer is difficult to determine.
Possible Relationship of Bladder Exstrophy and Epispadias with Progestins Taken during Early Pregnancy
Authors: BLICKSTEIN I. , KATZ Z.
Published: November 2008

The effectiveness and safety of progesterone and its derivatives in the treatment of first‐trimester bleeding are still controversial. Of concern is the possible causal relationship between progestins and congenital anomalies. A cluster of infants with bladder exstrophy and epispadias born to women treated with progestins in early pregnancy is reported.
Bladder Exstrophy Complicated by Adenocarcinoma
Authors: DAVILLAS N. , THANOS A. , LIAKATAS J. , DAVILLAS E.
Published: November 2008

Exstrophy of the urinary bladder is an uncommoncongenital deformity occurring in every 30,000 to40,000 live births. A greater risk of developingcarcinoma has been well documented, especially inpatients surviving to adulthood. Since the first casewas reported by Bergenhem in 1895 (Goyann, 1951), about 80 cases have been added to theliterature (Witters and Da, 1987). We report a 52‐year‐old man with adenocarcinoma of the bladderand untreated exstrophy.
Results of Medical Research Council Phase II Study of Low Dose Cisplatin and Methotrexate in the Primary Treatment of Locally Advanced (T3 and T4) Transitional Cell Carcinoma of the Bladder
Authors: ROBERTS J. T. , FOSSA SOPHIE D. , RICHARDS B. , KAYE S. B. , WHITE E. F. , ROBINSON M. C. , USCINSKA B. , PARMAR M. K. B.
Published: November 2008

Summary— A series of 49 previously untreated patients with category T3 or T4 bladder cancer underwent treatment with low dose methotrexate and cisplatin; 44 patients were eligible for assessment of response. Complete response (CR) was seen in 5 patients (11%) and partial response in 15 (34%) (overall response rate 45%). Treatment was reasonably well tolerated with no major morbidity and no treatment‐related deaths.

After a median follow‐up of 3.5 years, the 1‐year and 2‐year survival rates were 70 and 30% respectively. Ten patients remain recurrence‐free without having received “definitive local therapy” (cystectomy and/or radiotherapy) at follow‐up extending from 20 to 50 months.
Acute Scrotal Pain in Two Brothers
Authors: CRUICKSHANK MARGARET E.
Published: November 2008

Torsion of the testis and of the testicular appendage is not uncommon and in many cases a clear distinction cannot be made. In these cases urgent exploration of the testis is required.
Bladder Dysfunction due to Human T‐lymphotrophic Virus Type I Associated Myelopathy
Authors: SAITO M. , KONDO A. , KATO K. , GOTOH M.
Published: November 2008

Summary Bladder dysfunction is a major complication of human T‐lymphotrophic virus type I associated myelopathy (HAM). Four patients (3 females and 1 male, aged between 23 and 44 years), who had suffered from HAM for an average of 6 years complained variously of difficulty in micturition, frequency, bed wetting and/or urge incontinence. They were investigated urodynamically. A significant amount of urine was retained in the bladder of 3 patients. During the storage phase, bladder sensation was well preserved in all 4 patients but severe uninhibited detrusor contractions were observed in 3. At micturition, detrusor contractility was present in 3 and completely lost in 1. Of the 4 patients with HAM, 3 suffered from detrusor hyper‐reflexia and 1 from detrusor areflexia.
Colonoscopic Control of Uretero‐enteric Anastomoses in Internal Urinary Diversion
Authors: GALLUCCI M. , ALPI G. , ZACCARA A. , FRIERI G. , LATELLA G. , DI SILVERIO F.
Published: November 2008

Summary Twenty‐four patients with internal urinary diversion following total bladder ablation underwent colonoscopic control of the uretero‐enteric anastomoses. The techniques performed were: rectal bladder with colostomy according to Mauclaire (11 patients); rectal bladder with abdomino‐perineal pull‐through according to Heitz‐Boyer/Hovelacque (6); ureterosigmoidostomy (7). The uretero‐enteric anastomoses were divided into 3 categories according to the colonoscopic appearance: “nipple‐like”, nearly flat and flat anastomosis. Urographic examinations were carried out in all patients and the results demonstrated that the “nipple‐like” anastomosis was the most successful for the preservation of upper urinary tract integrity.
Fluoride Metabolism and Fluoride Content of Stones from Children with Endemic Vesical Stones
Authors: TEOTIA M. , RODGERS A. , TEOTIA S. P. S. , WANDT A. E. , NATH M.
Published: November 2008

Summary Twenty children with endemic vesical stones showed normal plasma and urinary excretion of fluoride on a mean fluoride intake of 2.5 ± 0.8 mg/24 h. The mean fluoride content of the stones obtained from these children was 315.6 ± 264.9 μg/g in the nucleus and 229.9 ± 212.8 μg/g in the periphery (this was not statistically significant). Calcium‐containing stones had a higher fluoride content than stones containing uric acid and ammonium urate. It was concluded that children with endemic vesical stones have normal fluoride metabolism. Trace quantities of fluoride present equally in the nucleus and peripheral parts of the stones suggest that fluoride does not cause initiation or growth of the nucleus of vesical stones and is adventitiously deposited with calcium salts in these stones.
Stone Formation on Ureteric Stents in Children
Authors: MacKINNON A. E. , OZUZUHS B.
Published: November 2008

The use of indwelling ureteric stents, either as definitive treatment for obstructive uropathy or as a temporary adjunct to urinary tract surgery, has been increasing in the last few years. We have used it to support renal tract surgery for varying pathological conditions in which post‐operative stricturing, particularly at the vesicoureteric junction, might occur. We have also tried to use such stenting in an attempt to treat a minor degree of obstruction, with a few complications. However, 3 patients have developed calculi associated with their stents.
Basal Cell Carcinoma of the Scrotum—A Rare Clinical Entity
Authors: PARYS B. T.
Published: November 2008

Basal cell carcinoma (BCC) of the scrotum is a rare disease which, because of its less aggressive character, must be differentiated from the more common squamous cell carcinoma (SCC). Two cases of basal cell carcinoma of the scrotum are presented and the literature is reviewed.
Idiopathic Retroperitoneal Fibrosis Treated with Ureterolysis and Wrapping with Expanded Polytetrafluoroethylene Vascular Graft
Authors: LOH A. , SOUTH L. M.
Published: November 2008

We present a patient with idiopathic retroperitoneal fibrosis treated with ureterolysis and omental wrapping on one side and expanded PTFE (Goretex) vascular graft wrapping on the other. The latter has been shown to work well in this patient with a 4‐year follow‐up.
Which Ureteric Stent Length?
Authors: WILLS M. I. , GILBERT H. W. , CHADWICK D. J. , HARRISON S. C. W.
Published: November 2008

The value of ureteric stenting is well established (Pocock et al., 1986). The correct length of ureteric stent should be used. If the stent is too long it may cause symptoms of trigonal irritation and if it is too short it may retract. At present, the length for each patient is selected by estimation. The possibility of developing a simple formula for more accurate selection of length was investigated.
Use of Monofilament Nylon for Accurately Localising a Blockage in the Vas Deferens
Authors: LAVELLE M. A.
Published: November 2008

In the investigation of azoospermia in the presence of dilated epididymes and testicular biopsies showing normal spermatogenesis, vasograms are useful to show the site of a blockage. However, it is sometimes difficult to match up the X‐ray appearances with the anatomical site of the blockage. A technique is described for accurately locating a blockage in the vas deferens at the time of operation.
Comparison of Clinical and Pathological Characteristics in Incidentally Detected and Suspected Renal Carcinoma
Authors: UEDA T. , YASUMASU T. , UOZUMI J. , NAITO S.
Published: November 2008

Summary In a study of the clinical and pathological characteristics of incidentally detected and suspected renal carcinoma, we reviewed the manner of presentation, serum immunosuppressive acidic protein (IAP), tumour stage and size in 112 consecutive patients with renal carcinoma who were diagnosed clinically and surgically between 1980 and 1989. The results showed an increase in the proportion of incidentally diagnosed cases. The routine use of radiological imaging, especially ultrasound and computed tomography (CT), has led to tumours being diagnosed earlier than when IAP is used as a tumour marker in patients with incidentally detected renal carcinoma. Tumours were lower stage and smaller in patients with incidentally detected renal carcinoma than in patients in whom the diagnosis was suspected.
Sex Distribution of Adult Idiopathic Detrusor Instability in Relation to Childhood Bedwetting
Authors: MOORE KATE H. , RICHMOND D. H. , PARYS B. T.
Published: November 2008

Summary The urodynamic case records of 1000 consecutive men and women were reviewed to study the link between idiopathic detrusor instability (Dl) and childhood nocturnal enuresis and to determine whether a sex difference in this relationship may exist.

Idiopathic Dl was found in 10% of the men, 63% of whom had suffered from childhood bedwetting; 29% of the women had idiopathic instability, of whom 38% had been nocturnal enuretics. Thus the link between adult idiopathic DI and childhood bedwetting appeared to be stronger for men than for women.

The sex distribution of subjects is not always reported in urodynamic studies of bedwetters and adults with an unstable bladder. We suggest that this should become routine practice as it may help to shed light on the aetiology of idiopathic detrusor instability.
Neoadjuvant Chemotherapy with Methotrexate and Cisplatln prior to Radiotherapy for Invasive Transitional Cell Carcinoma of the Bladder. Assessment of Feasibility and Toxicity
Authors: HOWARD G. C. W. , CORNBLEET M. A. , WHILLIS D. , HARGREAVE T. B. , CHISHOLM G. D.
Published: November 2008

Summary A prospective study has been performed to assess the feasibility and toxicity of administering neoadjuvant chemotherapy with methotrexate (200 mg/m2) and cisplatin (100 mg/m2) prior to radical radiotherapy. Twenty patients with advanced transitional cell carcinoma of the bladder were assessed after each of 3 courses of chemotherapy, after radiotherapy and 6 months following treatment. Of particular concern was whether neoadjuvant chemotherapy compromised the ability to give potentially curative radical radiotherapy, delayed effective palliation of distressing urinary symptoms, or allowed local tumour progression prior to definitive treatment.

It was concluded that this chemotherapy regimen was well tolerated, did not compromise the ability to give radical radiotherapy and resulted in the prompt palliation of urinary symptoms. This treatment, however, did not stop the development or progression of metastatic disease in some patients. In only 1 patient was there local progression during chemotherapy.
Unusual Foreign Bodies in the Urethra and Bladder
Authors: OSCA J.‐M. , BROSETA E. , SERVER G. , RUIZ J.‐L. , GALLEGO J. , JIMENEZ‐CRUZ J. F.
Published: November 2008

Summary We report 8 cases of self‐inserted unusual foreign bodies in the lower urinary tract, all being treated from 1976 to 1990. Three of them were located in the urethra and 5 in the bladder. Several objects were found (electric cable, tweezers, hairpin, drawing pin, pebbles, paper clip). In 4 cases the objects were inserted for masturbatory purposes. Five of the patients were psychologically ill or handicapped. The most common reason for consultation was dysuria, and the treatment procedures were endoscopy in 5 patients and cystotomy in the other 3.
Penile Strangulation
Authors: BHAT A. L. , KUMAR A. , MATHUR S. C. , GANGWAL K. C.
Published: November 2008

Summary— Penile strangulation is a rare injury that requires urgent management. Non‐metallic, thin objects are easy to remove but can cause severe injury. Metallic objects are difficult to remove but the injuries are usually less severe. Penile ulceration and oedema in children may well indicate the presence of a strangulation object. We describe a new hammer and chisel method for removing such objects.
Initial Urethral Pressure Increase during Stress Episodes in Genuine Stress Incontinent Women
Authors: THIND P. , LOSE G. , COLSTRUP H.
Published: November 2008

The urethral and bladder pressure increments registered during a cough were investigated in 30 woman with genuine stress incontinence (GSI) and compared with those from 30 previously investigated healthy women. The pressures were measured by means of a double microtip transducer catheter with the bladder sensor uncovered and the urethral sensor covered with a water‐filled rubber cylinder and placed at the bladder neck, midurethrally, or distally in the urethra. In GSI women the pressure increment preceding the pressure spike produced by coughing was significantly higher in the bladder compared with the urethra, and the pressure increment seemed to be initiated in the bladder and all along the urethra simultaneously. In healthy women the pressure increment preceding a pressure spike was significantly higher in the midurethra compared with the bladder and it seemed to be initiated in the midurethra. These findings seem to reflect a defective active closure mechanism in GSI which may be a contributing factor in its pathogenesis.
Testicular Function in Patients with Hypospadias Associated with Enlarged Prostatic Utricle
Authors: SHIMA H. , YABUMOTO H. , OKAMOTO E. , ORESTANO L. , IKOMA F.
Published: November 2008

Of 485 patients with hypospadias who underwent urethrography, enlarged prostatic utricles were found in 173 (35.7%). Utricles with a higher grade of enlargement were seen mainly in patients with a severe degree of hypospadias. Serum testosterone levels before and after 3 days' treatment with human chorionic gonadotrophin were determined by radioimmunoassay in 97 prepubertal boys with hypospadias and enlarged prostatic utricles. Lower levels of serum testosterone were found after hormonal stimulation in 22 patients with high grade utricular enlargement when compared with 5 controls and 75 patients with low grade enlargement; the difference was statistically significant. This finding supports the hypothesis that utricular enlargement may be due to androgenic insufficiency during the critical period of organogenesis.
Combined Papaverine Test and Radionuclide Penile Blood Flow in Impotence: Method and Preliminary Results
Authors: GRECH P. , DAVE S. , CUNNINGHAM D. A. , WITHEROW R. O'N.
Published: November 2008

Summary— The investigation of vascular impotence requires a simple, reliable and non‐invasive method of estimating penile arterial supply. A method for measuring flow to the dependent portion of the penis has been developed using technetium‐labelled red blood cells (99mTc‐RBC). Its use, in conjunction with the intracavernous injection of papaverine, was investigated in 32 patients with various causes of impotence.

Intracavernous papaverine was administered and a pneumatic cuff was inflated around the base of the penis both to isolate the penile circulation and to prevent dispersion of papaverine. The remaining blood pool was labelled with 99mTc‐RBC. A gamma camera was used to produce a time‐activity curve for the penis following release of the cuff. Penile blood flow was calculated from the initial gradient of the time‐activity curve.

Papaverine‐stimulated penile blood flow was significantly greater in patients without evidence of arterial insufficiency. None of the subjects with arterial disease achieved flows greater than 20 ml/min/100 ml, while flow in patients without arterial disease exceeded this value. Flow estimation without the use of papaverine was not able reliably to discriminate between the 2 groups.

There was no difference in papaverine‐stimulated blood flow between impotent subjects with veno‐sinusoidal leakage, in the absence of arterial disease, and a control group who achieved full erection with papaverine. It was therefore possible, by assessing the response to papaverine and measuring arterial blood flow, to distinguish between arterial insufficiency, veno‐sinusoidal leakage and non‐vascular causes of impotence.

The method requires little skill and can be modified for use with inexpensive equipment.
Spinal Cord Compression in Prostate Cancer. A 10‐year Experience
Authors: ROSENTHAL M. A. , ROSEN D. , RAGHAVAN D. , LEICESTER J. , DUVAL P. , BESSER M. , PEARSON B.
Published: November 2008

Summary— Of 478 patients treated at a single institution for prostate cancer, 29 developed spinal cord or cauda equina compression. In 5 patients, spinal cord compression was the first evidence of malignancy. Clinical features were predominantly pain, weakness, sensory and sphincter disturbance. The median duration of symptoms was 2 weeks, although the diagnosis was made rapidly at presentation. Clinical diagnosis correlated well with myelographic findings. Only 1 patient suffered neurological deterioration as a consequence of myelography. The functional outcome was dependent on the ability to walk prior to treatment. The median survival in those who were bedridden following treatment was 6 weeks (range 3.5–13) and 21 weeks (range 7–110+) in those who were ambulant following therapy.
Urological Audit: the Role for an Aggressive Approach to High Grade Superficial Bladder Tumours
Authors: MOHAMED S. R. , MISHRIKI S. F. , PERSAD R. A. , ABRAMS P. , GINGELL J. C. , FENELEY R. C. L.
Published: November 2008

Summary— A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted.

There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3).

A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted.

This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning “established” surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.
Urine Transparency as an Index of Absence of Infection
Authors: PHILLIPS GABRIELLE , FLEMING LAURA W. , KHAN I. , STEWART W. K.
Published: November 2008

Summary— A visual assessment of the clarity of urine was used as an exclusion test to indicate the absence of infection; verified by dipslide culture, it was applied to 363 urine samples collected from patients attending 2 adult nephrology clinics over a period of 6 months. The crimped aluminium bowl used for collection of samples assisted the assessment of clarity. The sensitivity of the method compared with dipslide culture was 73%, with specificity and efficiency both 58%.

The predictive value of a negative test (clarity) was 97% with a false negative rate of 3%, enabling this simple examination to be used as an exclusion test for further testing. In simple terms, a clear urine is unlikely to be infected. It is also an advantage to have an immediate indicator of the absence of infection available at the clinic. Analysis of only those urines assessed as cloudy could result in financial savings and, from the clinics, a 56% reduction in workload.
Laparoscopic Pelvic Lymph Node Dissection
Authors: BOWSHER W. G. , CLARKE A. , CLARKE D. G. , COSTELLO A. J.
Published: November 2008

Summary— The infiltration of pelvic lymph nodes by carcinoma of the prostate or carcinoma of the bladder is an important factor in disease staging. Until now, this could be accurately assessed only by means of open surgery, an undesirable option as an investigation. Recent advances in laparoscopic instruments and camera systems have allowed the performance of laparoscopic pelvic lymph node dissection. A series of dissections in 14 patients is reported.
Screening for Bacteriuria in Urological Patients using Reagent Strips
Authors: MILLS SARAH J. , FORD M. , GOULD F. KATE , BURTON SALLY , NEAL D. E.
Published: November 2008

Summary— A rapid and accurate ward‐based method of diagnosing urinary infection would be of value in determining the prescription of antibiotics in pre‐operative urological patients. This study describes the sensitivity and specificity of a screening technique based on commercially available reagent strips in the diagnosis of urinary infection. A total of 222 pre‐operative samples and 83 post‐operative samples was studied to compare the results of formal urine culture and reagent strips.

Using a definition of a positive nitrite or a positive leucocyte esterase on the reagent strips as being suggestive of infection, it was found that the strips had a sensitivity of 91% and a specificity of 85% compared with formal culture in pre‐operative samples. The results from post‐operative samples were less satisfactory, the strips having a sensitivity of only 71% and specificity of 55%. The strips were insensitive but specific in the identification of pyuria in pre‐operative specimens.

These results suggest that reagent strips can be used as a ward‐based method to identify men at risk of infection before urological procedures, and may allow selectivity in the use of peri‐operative antibiotics.
Clinicopathological Study of Nephroblastomas in Ibadan
Authors: AKANG E. E. U. , OKPALA J. U. , ILIYASU Y. , J.
Published: November 2008

Summary— The present study reviews 31 patients with histologically confirmed nephroblastoma seen over a 5‐year period (1985–1989). There was a predominance of female patients with a male: female ratio of 1:1.7, and the average age of the patients was 47 months. The patients invariably presented with a palpable abdominal mass, but haematuria was exceptional. The neoplasms tended to be larger on average than those reported previously among Caucasian children. Carcinomatous transformation of the epithelial components was observed in 2 renal neoplasms. Poorly differentiated neoplasms were commoner in male than in female patients. Our findings indicate an unfavourable prognosis for nephroblastoma in this environment because of late clinical presentation with advanced disease and inadequate treatment and follow‐up.
Natural History of Obstructed and Pseudo‐obstructed Megaureters Detected by Prenatal Ultrasonography
Authors: RICKWOOD A. M. K. , JEE L. D. , WILLIAMS M. P. L. , ANDERSON P. A. M.
Published: November 2008

Summary— In a series of 38 patients with non‐refluxing megaureters detected by prenatal ultrasonography, 89% were males and 16% had associated ipsilateral or contralateral urinary anomalies. By renographic criteria, 36% of ureters were not obstructed; renal function was never impaired initially and, on follow‐up, spontaneous resolution of dilatation was common. Infective urinary calculi developed in 3 of the boys. In ureters obstructed by renographic or pressure‐perfusion criteria, 79% exhibited normal renal function initially. Most such patients were managed expectantly; on follow‐up, functional deterioration occurred in 2 patients, while in the remainder dilatation usually persists but without change in function.
Late Malignancy Risk in Urology
Authors: R. J. WOODHOUSE C.
Published: November 2008

The long‐term survival of children with congenital urological abnormalities is now taken for granted. In general, they have been found to grow up well after many operations and often in the face of considerable handicaps. Their survival carries with it numerous complications, the most frightening of which is the development of cancer. Successful treatment of congenital abnormalities does not excuse the patient from developing cancers to which the general population is prone, but some conditions and some treatments raise specific risks.
The Use of Extracorporeal Shock Wave Lithotripsy for Medullary Sponge Kidneys
Authors: HOLMES S. A. V. , EARDLEY I. , CORRY D. A. , NOCKLER I. , WHITFIELD H. N.
Published: November 2008

Summary— A number of patients with medullary sponge kidney recurrently form and pass stones with the risk of developing an obstructive nephropathy. These patients may benefit from extracorporeal shock wave lithotripsy to the medullary collections, as this appears to reduce the frequency of symptomatic stone passage.
Pyonephrosis: Diagnosis and Treatment
Authors: LEZIN M. ST , HOFMANN R. , STOLLER M. L.
Published: November 2008

Summary— A series of 23 confirmed cases of pyonephrosis initially treated by percutaneous nephrostomy drainage were reviewed. Presentation was extremely variable, ranging from sepsis to asymptomatic bacteriuria. Fever, flank pain and leukocytosis were often absent. Ultrasonography was diagnostic in only 3 of 12 patients. In all, 17 patients had associated nephrolithiasis, and 5 patients ultimately required nephrectomy. Renal urine cultures were positive in 16 of 21 instances, with multiple organisms found in 8 of 21, and added bacteriological data not provided by bladder urine cultures in 11 cases. A pre‐existing history of urinary tract infection, hypertension and malignancy was common. Percutaneous drainage was a safe, quick and effective diagnostic and therapeutic method.
Is There Still a Place for Prolonged Bladder Distension?
Authors: LLOYD S. N. , LLOYD S. M. , ROGERS K. , DEANE R. F. , KIRK D. , KYLE K. F.
Published: November 2008

Summary— Over a 2‐year period, 31 patients underwent prolonged hydrostatic bladder distension for benign and malignant bladder disease in this unit. Of these, 29 patients had benign functional disorders or bladder contracture, and in 2 patients hydrodistension was performed for complications of treatment for bladder neoplasia. Of the 29 patients with benign disease, 6 observed marked improvement and 8 some improvement in their symptoms, and 12 received no benefit. Patients with detrusor hypersensitivity fared better than those with detrusor instability or interstitial cystitis. A patient with malignant bladder disease died soon after the procedure as a result of a myocardial infarction. Problems attributed to the hydrostatic balloon catheter were responsible for 2 failures. The regional anaesthetic technique failed to provide adequate anaesthesia for hydrodistension in 9 procedures and limited the duration to 2 h in 13 others. Following recall of the perished balloon catheters by the manufacturer, and the introduction of continuous spinal anaesthesia, the number of technical failures has been reduced. This technique still has an important role to play in the relief of severe symptoms unresponsive to medical treatment, but it is important that ideal conditions are provided for hydrodistension in order to ensure maximum success, particularly when the alternative is major surgery.
Botulinum Toxin in the Treatment of Chronic Urinary Retention in Women
Authors: FOWLER CLARE J. , BETTS C. D. , CHRISTMAS T. J. , SWASH M. , FOWLER C. G.
Published: November 2008

Summary— Six women were identified as having difficulty in voiding or complete urinary retention due to abnormal myotonic‐like electromyographic (EMG) activity in the striated muscle of the urethral sphincter. An attempt was made to improve voiding by injection of botulinum toxin into the striated sphincter muscle. Although 3 patients then developed transient stress incontinence, demonstrating that sufficient botulinum toxin had been given to cause sphincter weakness, no patient had significant symptomatic benefit.
Effect of Substance P on Detrusor Muscle in Rats with Diabetic Cystopathy
Authors: DAHLSTRAND C. , DAHLSTRÖM A. , AHLMAN H. , JONSSON O. , LUNDSTAM S. , NORLÉN L. , PETTERSSON S.
Published: November 2008

Summary—Diabetic cystopathy (DCP) is a well known complication in diabetes mellitus (DM). In the present experimental study, DM was induced in rats by streptozotocin and DCP was confirmed on cystometry.

In vitrostudies on detrusor strips from diabetic rats showed an increased contractile response to substance P (SP) compared with controls, indicating denervation supersensitivity. A decreased response to capsaicin in diabetic detrusor strips indicated a decreased neuronal content of SP or a diminished number of SP‐containing sensory nerves. This suggests that DM induces alterations in nerves containing SP which may be at least partly responsible for sensory loss and the development of DCP.
Preliminary Results of Concurrent Cisplatin and Radiation Therapy in Locally Advanced Bladder Cancer
Authors: UTSUNOMIYA M. , ITOH H. , YOSHIOKA T. , MASAKI N. , ITATANI H.
Published: November 2008

Summary— Between March 1981 and March 1990, 15 patients with locally advanced transitional cell carcinoma of the bladder were treated concurrently with cisplatin and radiotherapy. Treatment comprised a radiation dose of 40‐50 Gy in 20‐25 fractions over 4‐5 weeks and intravenous infusion of cisplatin with hydration during days 1‐5 and 22‐26. The total scheduled dose of cisplatin was 200 mg. A complete response (CR) was seen in 3 patients (2 T2 tumours and 1 T3) and the other 12 were regarded as partial responders. Two of the 12 partial responders (1 T2 tumour and 1 T4) underwent cystectomy after treatment, but 9 patients (2 T2,6 T3 and 1 T4) underwent only transurethral resection. The remaining patient (with a T4 tumour) died from systemic disease, further treatment not being possible because of unrelated heart failure. In 3 CR patients and 9 with a partial response (PR), bladder function was preserved and they have survived for a mean of 18.3 months (range 5‐47) after therapy. Although 4 patients in this group had recurrent bladder tumours and 1 died from cancer in another part of the body, 7 have survived with normal bladder function and no recurrence.

It is concluded that concurrent cisplatin and radiation therapy is a safe and viable regimen and may be considered as a means of preserving the bladder in patients with locally advanced transitional cell carcinoma.
Testicular Denervation. A New Surgical Procedure for Intractable Testicular Pain
Authors: CHOA R. G. , SWAMI K.S.
Published: November 2008

Summary— Chronic testicular pain has many different aetiologies. Identification and treatment of an underlying problem resolve the issue in most cases. However, a proportion of patients with chronic testicular pain have no demonstrable aetiological factor and pose a difficult treatment problem. All of these patients are initially treated by non‐surgical measures. Various operations advocated in the literature for non‐responders include epididymectomy, scrotal orchiectomy and inguinal orchiectomy, all of which have a significant failure rate. We describe a hitherto unreported operative procedure in a series of 4 patients, with immediate and lasting relief of their pain.
Testicular Prostheses: the Patient's Perception
Authors: LYNCH M. J. , PRYOR J. P.
Published: November 2008

Summary— There is a paucity of data to determine if the insertion of a testicular prosthesis is effective in overcoming the psychological effects of an absent testis. A review of 25 patients who had had testicular prostheses showed a high overall level of satisfaction in the 19 patients who were traced. This satisfaction was subject to some qualification.
Results of the Surveillance Policy of Stage I Non‐seminomatous Germ Cell Testicular Tumours
Authors: COLLS B. M. , HARVEY V. J. , SKELTON L. , THOMPSON P. I. , DADY P. J. , FORGESON G. V. , PEREZ D.J.
Published: November 2008

Summary— A series of 1 15 patients with clinical Stage I non‐seminomatous germ cell testicular tumours were managed with orchiectomy and close surveillance (median follow‐up 36 months, range 3‐1 19); 34 (29.5%) relapsed, 21 within 6 months, 29 within a year and the latest at 28 months. At relapse all patients were treated with platinum or analogue‐based drug combinations, supplemented in 7 by retroperitoneal node dissection; 30 patients achieved durable remissions and 2 have had further relapses successfully treated. Two died; both had malignant teratoma intermediate with primary stage T1 and vascular and/or lymphatic invasion of primary tumour. At a median follow‐up time of 36 months, the survivors (98.3%) demonstrate no evidence of disease, these results matching the outcome of other methods of management.

Vascular and/or lymphatic invasion was associated with an enhanced relapse rate but specific histology, T stage of the primary and pre‐orchiectomy serum alpha‐fetoprotein status did not appear to favour relapse. The first sign of relapse was tumour marker alone in 10 patients, radiological features alone in 12, or both in 10 patients. However, in 2 cases the relapse was first detected clinically. Furthermore, pre‐orchiectomy and relapse marker status did not correlate well. These points emphasise the importance of all aspects of follow‐up, none of which can be safely omitted.
Familial Hollow Visceral Myopathy with Varying Urological Manifestations
Authors: HIGMAN D. , PETERS P. , STEWART M.
Published: November 2008

Summary— A family with hereditary hollow visceral myopathy is described, with characteristic variation in expression between affected members. Very severe and widespread involvement of the gastrointestinal and urinary tracts in 1 patient contrasted with isolated urinary tract involvement in 2 others, and it is suggested that hollow visceral myopathy should be considered in the differential diagnosis of primary detrusor failure. The management of urinary tract involvement is discussed and a conservative approach is recommended.
Surgical Management of Renal Carcinoma with Extensive Involvement of the Vena Cava and Right Atrium
Authors: DAVITS R.J. A. M. , BLOM J. H. M. , SCHRÖDER F. H.
Published: November 2008

Summary Between 1988 and 1990,8 patients with a renal tumour extending into the vena cava and with supradiaphragmatic extension were treated by an operative technique involving extracorporeal circulation and deep hypothermic circulatory arrest. In 4 patients the thrombus extended into the right atrium. Six patients appeared to have a renal carcinoma. Intra‐operatively one patient's tumour proved to be a metastasis of a squamous cell carcinoma of the lung and another patient was found post‐operatively to have a leiomyosarcoma of the vena cava. Two of these 6 patients died from metastases 6 weeks and 8 months post‐operatively. Four patients are symptom‐free, although 3 of them have liver or lung metastases 10,20 and 37 months postoperatively. One has no evidence of disease 18 months post‐operatively.

The use of extracorporeal circulation and deep hypothermic circulatory arrest provides optimal surgical exposure and gives the patients a considerable complaint‐free interval post‐operatively. How often cure is also achieved is as yet unclear.
Assessment of the Use of Bladder Washouts/Instillations in Patients with Long‐term Indwelling Catheters
Authors: KENNEDY ANNE P. , BROCKLEHURST J. C. , ROBINSON JEAN M. , FARAGHER E. B.
Published: November 2008

Summary A randomised cross‐over study of 3 bladder washout treatments–saline, Suby G and Solution R–was conducted on 25 elderly females with long‐term catheters in order to examine crystal formation and catheter encrustation. With 2 exceptions, all patients produced crystals; only 14 completed the study. While a significant reduction in struvite crystals was found in the returned acidic washout fluid, there was no significant reduction of crystals in the neutral (saline) washout following any of the 3‐week periods of treatment. Uric acid crystals appeared with Suby G and Solution R and these solutions were associated with higher red cell deposits in the urine. There was no significant difference in catheter encrustation between the various washouts.
Clinical Information System that Enhances the Use of Resources in Endoscopic Prostatic Procedures
Authors: EMBERTON M. , ELLIS B. W.
Published: November 2008

Summary In this study we evaluated, by means of an automated management system, the identification of subgroups of patients within certain operative categories whose predictable length of stay was compatible with treatment on a 5‐day ward. This was achieved by using a computer directed analysis of urological workload on prospectively collected clinical data. Graphical presentation of the results was achieved by a technique known as the patient‐bed dissociation curve.

Patients with bladder outflow obstruction treated by transurethral prostatic resection (701) and bladder neck incision (113) were selected from a total of 7162 hospital admissions. The main outcome measures were length of stay and complication rates for the 2 procedures.

The results demonstrated that a group of patients about to undergo transurethral resection could be selected by age and source which would indicate an 18% greater probability of discharge within 5 days. These patients were easily identifiable in advance and would be suitable for treatment on a 5‐day ward.

It was concluded that computer‐held clinical data were easily accessible to the surgeon. The process of detailed analysis need not take time. With properly directed studies the information retrieved could be used to effect change. The patient‐bed dissociation curve may prove a valuable tool in examining and comparing discharge patterns in any groups of patients.
Rectal Obstruction Secondary to Carcinoma of the Prostate Treated by Transanal Resection of the Prostate
Authors: CHEN T. F. , EARDLEY L. , DOYLE P. T. , BULLOCK K. N.
Published: November 2008

Summary Rectal obstruction caused by carcinoma of the prostate is uncommon. If the disease does not respond to either hormonal treatment or radiotherapy, the only surgical means of relieving the obstruction has been the formation of a colostomy. We present an alternative treatment, since many of these patients are elderly with a short life expectancy and they may have difficulty coping with a stoma. Seven transanal endoscopic resections of the prostate (TARP) have been performed on 5 patients. The procedure is not without complications, but it does offer simple surgical palliation of the rectal obstruction and obviates the need for a colostomy.
Future Directions in the Management of Benign Prostatic Hyperplasia
Authors: KHOURY S.
Published: November 2008

Summary— A meeting of the International Consultation on Benign Prostatic Hyperplasia (BPH) in June 1991 provided an update on the management of BPH. It is recognised that the development of complications in what may be regarded as a relatively well tolerated disease may necessitate surgical intervention. Current treatment is directed towards circumventing or ameliorating the complications of BPH and perhaps to find minimally invasive or non‐invasive alternatives to surgery that could eliminate this modality altogether. Anticipated changes in the management of BPH include establishment of an improved scoring system and response criteria; implementation of stenting techniques, physical modalities such as hyperthermia and laser therapy to replace transurethral resection of the prostate; development of more specific alpha blockers with fewer adverse effects; and administration of hormonal therapy, possibly as an eventual preventative of BPH.

The 1991 International Consultation on Benign Prostatic Hyperplasia (BPH), which took place in Paris, France, under the joint sponsorship of the World Health Organization and the major international and national societies of urology, provided an excellent opportunity to review current knowledge on the subject of BPH and to explore future trends in its management. Most of the information included in this report is drawn from the conclusions of the consultation participants.
Selective Renal Tumour Biopsy under Ultrasonic Guidance
Authors: ABE M. , SAITOH M.
Published: November 2008

Summary— Selective renal biopsy under ultrasonic guidance has been used widely because it provides safe and accurate tissue sampling. Using this technique, we biopsied 36 renal tumours and obtained specimens in 35 cases. Histology of the biopsy coincided with that of the surgical specimen in 18/21 cases. Dissemination of tumour cells, thought to have been caused by needle biopsy and/or surgical manipulation, was observed in only 1 case of sarcoma. The method thus proved effective in determining treatment and it is suggested that it should be used in accordance with the criteria which we have devised.
Is Pre‐operative Imaging of the Urinary Tract Worthwhile in the Assessment of Prostatism?
Authors: WILKINSON A. G. , WILD S. R.
Published: November 2008

Summary— The reports of routine pre‐operative imaging investigations performed on patients presenting with symptoms of uncomplicated benign prostatic hypertrophy were compared with management decisions and clinical outcome. In 175 patients with prostatism no urological abnormality which altered management was discovered on plain films of the abdomen and pelvis and ultrasound of the urinary tract which were performed routinely.

Post‐micturition residual volume (PMRV), estimated by ultrasound, was compared with the maximum urine flow rate (Q max) in 57 patients. PMRV showed negative correlation with Q max. Both high PMRV and low Q max were associated with the urologist's decision to operate, but multiple logistic regression revealed that ultrasound residual volume was not a significant predictor of operation when adjusted for Q max. Urologists in this hospital therefore use flow rates as the primary indication of the need to operate.

We suggest that no routine pre‐operative imaging need be performed in patients presenting with prostatism.
Finasteride in the Treatment of Benign Prostatic Hyperplasia. A Urodynamic Evaluation
Authors: KIRBY R. S. , BRYAN JENNY , EARDLEY I. , CHRISTMAS T. J. , LIU S. , HOLMES S. A. V. , VALE J. A. , SHANMUGANATHAN K. , WEBB JUDITH A.
Published: November 2008

Summary— A group of 69 men with bladder outflow obstruction due to benign prostatic hyperplasia (BPH) were treated in a double‐blind, placebo‐controlled study with finasteride (Proscar, MK‐906), a 5‐alpha reductase inhibitor, 5 mg or 10 mg/day or placebo for 3 months; subsequently, 20 patients received finasteride 5 mg/day for a further 9 months in an open extension study. In treated patients dihydrotestosterone declined by over 60%, remaining unchanged with placebo. Symptom scores fell significantly in all 3 groups. Mean maximum flow rates fell slightly in placebo‐treated patients but improved by 1.5 ml/s in the 10 mg group and by 3.3 ml/s in the 5 mg group. After 1 year's treatment, the reduction in symptom score and increase in flow rate were well maintained; the mean prostate volume was reduced by 14% and prostatic specific antigen declined by 28%. It was concluded that finasteride shows some efficacy in the treatment of BPH, with minimal toxicity, but 12 months of therapy or longer may be necessary to achieve maximal effect.