bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of transrectal ultrasonography and endorectal magnetic resonance imaging in the local staging of prostatic carcinoma
Authors: Ekici  , Özen  , Agˇildere  , Ergen  , Özkardeş  , Ayhan  , Kendi
Published: March 2003

Objective

To compare the staging accuracy of transrectal ultrasonography (TRUS) and endorectal magnetic resonance imaging (eMRI) for organ‐confined prostatic carcinoma.

Patients and methods

Twenty‐five patients with clinically confined prostatic adenocarcinoma were evaluated to be candidates for radical prostatectomy. All underwent TRUS and eMRI before surgery. Imaging findings evaluated prospectively in each patient were extracapsular extension (ECE), seminal vesicle invasion (SVI) and the site of involvement. The results of the imaging techniques were compared with the histopathological findings. As two patients with metastatic lymph nodes (detected on frozen‐section examination during surgery) were spared radical prostatectomy, the final evaluation included 23 patients.

Results

Endorectal coil MRI was more sensitive than TRUS for detecting both ECE, SVI and the site of ECE involvement in organ‐confined prostatic carcinoma. TRUS was more accurate than eMRI for detecting the site of SVI involvement. However, the overall staging accuracy rates for both imaging modalities were equal.

Conclusions

Neither TRUS nor eMRI was significantly better than the other for determining the local extent of prostatic carcinoma. Therefore, TRUS should be the study of choice until MRI technology improves sufficiently in the preoperative staging of localized prostate cancer.
Panax ginseng protects the testis against 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin induced testicular damage in guinea pigs
Authors: Kim  , Hwang  , Lee  , Song  , Kim
Published: March 2003

Objectives

To investigate histopathologically the beneficial effects of Panax ginseng extract on guinea pig testes damaged by 2,3,7,8‐tetrachlorodibenzo‐p‐dioxin (TCDD).

Materials and methods

Ninety guinea pigs were divided into six equal groups. The normal controls (group 1) received vehicle and saline; group 2 received TCDD (1 μg/kg) intraperitoneally; group 3 and 4 received 100 or 200 mg/kg per day of Panax ginseng water extract (PG‐WE) intraperitoneally for 28 days from 1 week before TCDD injection; groups 5 and 6 received PG‐WE for 14 days from 1 week after TCDD treatment.

Results

The gain in body weight was less in groups treated with TCDD than in controls. Moreover, the body weight of group 2 decreased from 14 days after TCDD exposure, while that of groups 3 and 4 increased; there was no decrease in body weight in groups 3–6. The decrease in testicular weight caused by TCDD was prevented by PG‐WE. Light microscopy showed smaller tubules and late maturation arrest in group 2; electron microscopy showed a dissolution of the germinal epithelium, disrupted tight junctions between adjacent Sertoli cells, and altered germ cells at all developmental stages. The maturation arrest in germ cells caused by TCDD was ameliorated in groups 3–6. The testes almost completely recovered in groups 3 and 4 and there was some therapeutic effect of PG‐WE in groups 5 and 6.

Conclusions

These results confirm the protective and therapeutic effects of Panax ginseng on atrophy and testicular damage induced by TCDD, providing evidence that ginseng might be a useful agent in preventing and treating testicular damage induced by environmental pollutants.
The re‐use of irrigating equipment for flexible cystoscopy is not safe
Authors: Molina‐Navarro  , Bhatia  , Awogu  , Ochai  , Jones
Published: March 2003

Objective

To determine the incidence of fluid reflux from the lower urinary tract into the connecting tubing used for irrigation in patients undergoing flexible cystoscopy.

Patients and methods

The study was conducted in 94 consecutive male and female patients attending routine outpatient flexible cystoscopy lists. A sensor was designed and constructed to determine the presence of any retrograde flow of irrigating fluid, and the volume of any reflux through the connecting tubing. The mean (sd) cystoscope internal channel volume was 2.56 (0.25) mL; the level of significant reflux was set at ≥2.25 mL.

Results

Reflux of irrigating fluid occurred in 11 males (17%) and was significant in six (9%) of 65 male patients, with the irrigating fluid reservoir set at a height of 0.78 m above the patient’s mid‐coronal level. No reflux occurred in the 29 females studied.

Conclusions

Significant reflux can occur in males and hence the connecting tubing should be regarded as contaminated. Infection‐control measures must include the prevention of transmission of blood‐borne infections, e.g. hepatitis B and C viruses, and human immunodeficiency virus, because of the risk that blood may contaminate urine, and they should be implemented in all cases regardless of patient risk factors. From the available evidence, flexible cystoscopy should always be performed with single‐use irrigation systems.
The outcome of artificial urinary sphincter placement after a mean 15‐year follow‐up in a paediatric population
Authors: Kryger  , Spencer Barthold  , Fleming  , González
Published: March 2003

Objective

To evaluate the long‐term outcome in children who had an artificial urinary sphincter (AUS) placed, after a minimum of 10 years of follow‐up.

Patients and methods

The medical records of patients who had an AUS placed at the Children’s Hospital of Michigan were reviewed and a telephone questionnaire was then completed by all patients with an AUS currently in place.

Results

Forty‐seven children initially had an AUS placed between October 1978 and August 1986; medical records and follow‐up were available for 32. After a mean follow‐up of 15.4 years, 13 patients had had the AUS removed and 19 currently have an intact AUS. Erosion or infection was responsible for all AUS removals. Possible risk factors for AUS removal were prior AUS erosion, prior bladder neck surgery and a balloon pressure of >70 cmH2O. Eighteen of 19 patients with an intact AUS are dry and seven void volitionally. Revision was the most common reason for additional surgery, but the revision rate has decreased with the most current AS‐800 model, to 0.03 revisions per patient‐year. Of the 13 patients with an AS‐800 model placed after 1987, nine have not required revision. Upper tract changes were mild and uncommon.

Conclusion

The AUS is a durable and effective surgical option in the management of neurogenic urinary incontinence, and is the only reliable technique that can preserve volitional voiding. With technical improvements to the AUS and a longer follow‐up, the revision rate has decreased. Causes of AUS removal may be preventable with improvements in surgical technique and patient selection. AUS placement should be considered as a first choice for the surgical management of neurogenic sphincteric incompetence.
Mortality and prostate cancer risk in 19 598 men after surgery for benign prostatic hyperplasia
Authors: Holman  , Wisniewski  , Semmens  , Rouse  , Bass
Published: March 2003

Objectives

To examine postoperative mortality and prostate cancer risk after the first prostatectomy for benign prostatic hypertrophy over a 17‐year period in a population‐based cohort of men in Western Australia, using improved methods to adjust for comorbidity.

Patients and methods

The relative survival from death and prostate cancer incidence was calculated against the background population rates. The outcomes of transurethral resection of the prostate (TURP) and open prostatectomy (OP) were compared adjusting for calendar year, age, admission type and comorbidity using Cox regression. Fractional polynomials were used to take account of nonlinearity in confounder effects.

Results

At 10 years, the relative survival was 116.5% in TURP patients and 123.5% after OP. Adjusting only for confounding by age, calendar year and admission type, TURP had a higher mortality rate than OP (rate ratio, RR, 1.20; 95% confidence interval 1.08–1.34). The RR fell to 1.10 (0.99–1.23) after adjustment for comorbidity and to 1.07 (0.95–1.19) when accounting for nonlinearity. The relative survival from the incidence of prostate cancer at 10 years was 103.7% after TURP and 104.5% after OP. The RR adjusted for age and calendar year was 1.44 (0.94–2.21) for incidence and 1.37 (0.81–2.29) for prostate cancer mortality.

Conclusion

There is at most a small and clinically unimportant excess mortality risk from TURP; any difference could be due to a protective effect of OP on the long‐term risk of prostate cancer and a lower rate of repeat prostatectomy.
The effect of colonoscopy on serum prostate specific antigen levels
Authors: Schwartz  , Faught  , Jezior
Published: March 2003

Objective

To evaluate, in a prospective trial, the effect of colonoscopy on serum prostate specific antigen (PSA) levels (which are known to increase after cystoscopy and prostatic needle biopsy) in men aged 50–70 years, as they commonly undergo colonoscopy and PSA screening together.

Subjects and methods

Twenty‐four consecutive men (mean age 61 years, range 37–78) were enrolled in the study. All subjects had their serum PSA measured 24–72 h before undergoing colonoscopy. Further values were obtained 24 h, 7 and 30 days after the procedure. The values before and after colonoscopy were compared to evaluate the effect of colonoscopy on serum PSA levels.

Results

Of 24 patients, seven (35%) had insignificant increases at 24 h after colonoscopy; 12 (50%) patients had an insignificant increase in PSA level 30 days after the procedure. None of the 24 patients had a significant increase after colonoscopy when compared with baseline values.

Conclusion

Flexible colonoscopy does not adversely affect serum PSA levels. Although individuals may have a 30% daily fluctuation in serum values, this study detected no significant change in serum PSA levels after prolonged transrectal prostatic manipulation with a colonoscope.
An in vivo evaluation of the therapeutic potential of sympatholytic agents on premature ejaculation
Authors: Hsieh  , Liu  , Hsieh  , Cheng
Published: March 2003

Objective

To evaluate the therapeutic potential of sympatholytic agents on premature ejaculation in an animal model, using monitoring of rat seminal vesicle pressure change in response to electrical stimulation of the lesser splanchnic nerve.

Materials and methods

Male Wistar rats (aged 12–14 weeks) were injected intra‐arterially with sympatholytic agents (phenoxybenzamine, prazosin, WB‐4101, chloroethylclomidine, yohimbine and RX 821002) at various concentrations 10 min before electrical stimulation of the lesser splanchnic nerve. The change in phasic tension (▵mmHg) of the seminal vesicle induced by electrical nerve stimulation before and after the addition of sympatholytic agents was used for statistical analysis. The maximum inhibition and the concentration required to induce 50% inhibition of the maximal contractile response (IC50 ) were obtained from the concentration‐response curves, and used to determine the potency of test agents.

Results

The seminal vesicle contractile response to electrical nerve stimulation was suppressed in a dose‐dependent manner by all test drugs except RX 821002. The mean (sd) maximal inhibition was 78.4 (9.3)% by 0.03 mg/kg of phenoxybenzamine, 77.1 (10.1)% by 0.03 mg/kg of WB‐4101, 73.4 (6.0)% by 0.1 mg/kg of yohimbine, 67.9 (9.7)% by 0.1 mg/kg of prazosin, 75.5 (7.5)% by 3 mg/kg of chloroethylclomidine and 25.3 (4.8)% by 0.01 mg/kg of RX 821002. The potencies of WB‐4101 (IC50 3 μg/kg) and yohimbine (IC50 0.8 μg/kg) were similar to that of phenoxybenzamine (IC50 0.5 μg/kg) and much higher than that of prazosin (IC50 0.03 mg/kg) or chloroethylclomidine (IC50 0.3 mg/kg).

Conclusions

Phenoxybenzamine, prazosin, WB‐4101, chloroethylclomidine and yohimbine all inhibit the contractile response of the rat seminal vesicle to electrical nerve stimulation. As phenoxybenzamine is effective in treating premature ejaculation, the comparable in vivo potencies of WB‐4101 and yohimbine strongly suggest that they have clinical therapeutic potential.
Prediction of prostatic cancer progression after radical prostatectomy using artificial neural networks: a feasibility study
Authors: Mattfeldt  , Kestler  , Hautmann  , Gottfried
Published: March 2003

Objective

To report a methodological feasibility study in a small series of patients with node‐negative organ‐confined prostatic cancer, using artificial neural networks to predict tumour progression after radical prostatectomy and thus help to identify high‐risk patients who would benefit from adjuvant treatment.

Patients and methods

A group of 20 patients with pT2N0 prostatic cancer and postoperative tumour progression was compared with a control group of 20 patients with no progression, matched for age, duration of follow‐up and preoperative serum prostate‐specific antigen level. Histopathological data were obtained from the radical prostatectomy specimens, i.e. the Gleason score, World Health Organisation (WHO) grade and maximum diameter of the tumour transects. The volume and surface area of the epithelial tumour component and of the lumina of the neoplastic glands per unit tissue volume were estimated by morphometric methods. To predict recurrence, multilayer feedforward networks with backpropagation (MLFF‐BP), two implementations of learning vector quantization (LVQ), and linear discriminant analysis (LDA) were applied. The ability of these models to correctly classify new cases was tested using the ‘leave‐one‐out’ technique.

Results

Progression was predicted correctly in 85% of newly presented cases from the three routine histopathological variables alone. On the basis of the four morphometric variables alone progression was predicted correctly in 93% of cases. The use of all seven variables as input data only slightly improved the quality of prediction. The best results were obtained by the LVQ networks and LDA, followed by MLFF‐BP networks.

Conclusions

In this methodological feasibility study, the progression of pT2N0 prostatic cancer after radical prostatectomy could be predicted with good accuracy, sensitivity and specificity from routine variables or morphometric texture variables using artificial neural networks. These results suggest that this approach should be assessed in a prospective study with more cases.
A prospective randomized study comparing absorbable and nonabsorbable staples in constructing antireflux valves of urethral hemi‐Kock pouches
Authors: Arif  , Madbouly  , Mahran  , Ashamallah  , Ghoneim
Published: March 2003

Objective

To determine the long‐term complications associated with constructing an antireflux nipple valve using absorbable or nonabsorbable staples in the urethral hemi‐Kock pouch.

Patients and methods

Fifty patients (all men, median age 47 years, range 28–73) undergoing construction of a urethral hemi‐Kock pouch were randomized prospectively into two equal groups. In group 1, absorbable (polyglyconate) staples were used for the construction, and in group 2 nonabsorbable (metal) staples were used but omitting the staples applied at the tip of nipple valve. Assessment during the follow‐up of 6–88 months comprised urine analysis, culture and sensitivity, measurement of serum creatinine, electrolytes and blood gases, and plain abdominal radiography, intravenous urography and micturating pouchography.

Results

In group 1, 21 patients were evaluable; a pouch stone was detected in one, extussusception of the valve in one and valve stenosis in one. In group 2, 20 patients were evaluable; pouch stones were detected in six, extussusception of the valve in three and valve stenosis in one.

Conclusion

Compared with nonabsorbable (metal) staples, the use of absorbable (polyglyconate) staples significantly decreased the incidence of pouch stone formation and improved valve stability in patients with a urethral hemi‐Kock pouch.
A comparative study of the effects of a colorectal valve on the oro‐anal transit time in patients with an augmented and valved rectum for urinary diversion
Authors: Mahran  , Kock
Published: March 2003

Objectives

To evaluate the effect of the interposed colorectal valve on the flow of the proximal colonic contents to the rectum in patients with a valved urinary diversion to the rectum.

Patients and methods

The oro‐anal transit time (OATT) and segmental colonic transit time (SCTT) were estimated in two groups of 15 patients each (10 women and five men). In group 1, patients had a colorectal valve and in group 2 (control) they had no valve in the rectosigmoid area. The OATT and SCTT were evaluated using the 7‐day method, whereby each patient swallowed 10 ring‐shaped radio‐opaque markers daily for 6 days, and a single abdominal radiograph was taken on day 7. The OATT and SCTT were then estimated as the number of retained markers divided by the daily dose of markers.

Results

The mean (sd) OATT was not significantly different (P=0.185), at 1.85 (1.21) days in group 1 and 2.49 (1.38) days in group 2. There were no sex differences in the values between the groups. The SCTT in the four areas of the colon again showed no significant differences within or between groups (P>0.05).

Conclusion

Using a colorectal valve to functionally isolate the urinary rectal reservoir and thus reduce the high incidence of metabolic acidosis has no significant effect on intestinal transit times.
An analysis of risk factors for upper urinary tract deterioration in patients with myelodysplasia
Authors: Seki  , Akazawa  , Senoh  , Kubo  , Tsunoda  , Kimoto  , Naito
Published: March 2003

Objective

 To identify the risk factors for upper urinary tract deterioration in a retrospective study of patients with myelodysplasia.

Patients and methods

 The medical history, radiographic studies and urodynamic results from 39 children with myelodysplasia who were treated at our hospital were reviewed retrospectively to obtain more accurate data in the prognosis of such patients. The upper urinary tracts were assessed by cysto‐urethrography and excretory urography to determine the incidence of vesico‐ureteric reflux (VUR) and hydronephrosis. The relationships between the urodynamic variables, including vesical compliance, detrusor hyper‐reflexia, detrusor‐sphincter dyssynergia (DSD) and the maximum urethral closing pressure (MUCP) to such upper tract deterioration were evaluated using both univariate and multiple logistic regression analysis.

Results

 The univariate analysis showed low vesical compliance, a high level of MUCP and the presence of DSD to be significant factors for the incidence of VUR. Low vesical compliance and a high level of MUCP also correlated with the incidence of hydronephrosis. The multivariate analysis showed a significant relationship between urodynamic values and upper urinary tract deterioration. The incidence of VUR was strongly correlated with a high MUCP and the presence of DSD. A high MUCP was also a significant factor in the incidence of hydronephrosis.

Conclusion

 Urodynamic results associated directly with the abnormal function of urethral control are significantly correlated with the cause of upper tract deterioration in patients with myelodysplasia.
Mast cell variations in tumour tissue and with histopathological grading in specimens of prostatic adenocarcinoma
Authors: Sari  , Serel  , Çandir Ö. , Öztürk  , Kosar
Published: March 2003

Objective

 To determine whether the number of mast cells (MCs) varies in and around prostatic carcinoma tissue, and with histopathological grading.

Materials and methods

 Specimens of 27 prostatic carcinomas were stained with the toluidine blue and staged histopathologically using the Gleason grading system. The MCs were counted in five high‐power microscopy fields within and around the tissue samples, and the results analysed using the Wilcoxon signed‐rank test and Spearman’s correlation.

Results

 The mean number of MCs was 1.7 per field within and 3.31 per field around the cancer tissue, the difference between these being significant (P<0.05). There was a close correlation between the numbers of MCs within the tumour and Gleason grade (r=0.56, P=0.002) but not between grade and counts around the tumour (r=−0.18, P=0.35).

Conclusion

 These results suggest that some MCs aggregate at the periphery of the prostatic adenocarcinoma and that the number of MCs within the tumour tissue is related to tumour differentiation.
A 7‐year audit in a single centre of the results of the modified template retroperitoneal lymph node dissection for testicular teratoma
Authors: Bell  , Sibley
Published: March 2003

Objective

 To audit the results of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular nonseminomatous germ cell tumour (NSGCT) in a single centre over a 7‐year period, using a modified template technique via a midline transabdominal approach.

Patients and methods

 Outcome data were collected prospectively on all patients undergoing RPLND for a residual retroperitoneal mass after chemotherapy for NSGCT between October 1990 and March 1998; 28 patients underwent 32 RPLNDs over this period.

Results

 The clinical stage at presentation was stage I in three patients (12%), stage II in 15 (54%), stage III in one (4%) and stage IV in nine (32%). The histological classification included malignant teratoma differentiated in one patient, malignant teratoma intermediate in 12 (43%) and malignant teratoma undifferentiated in 12. Tumour markers were positive immediately before surgery in four patients. A midline transabdominal approach was used in 31 of the procedures. The size of the retroperitoneal tumour mass was <3 cm in four patients (13%), 4–8 cm in 16 (50%) and >9 cm in 12 (38%). Histology of the mass showed residual differentiated teratoma in 17 (53%), undifferentiated teratoma in six (19%), necrosis only in six (19%), adenocarcinoma in one and angiosarcomatous differentiation in two. There was no perioperative mortality. Eight patients had permanent loss of ejaculation (29%) and two had erectile dysfunction (7%). Five patients (20%) subsequently developed recurrent disease; three (12%) underwent reoperation for disease relapse (one requiring two further procedures), whilst two (8%) died from recurrent disease.

Conclusion

 An abdominal approach via a midline incision provides satisfactory access with minimal morbidity in most patients. Results comparable with larger series can be achieved in regional centres.
Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review
Authors: Devarajan  , Jaganathan  , Harriss  , Chua  , Bishop
Published: March 2003

Objective

 To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations.

Patients and methods

The study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection.

Results

The 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney’s darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia.

Conclusions

The recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein’s mesh repair.
Treatment for human immunodeficiency virus with indinavir may cause relevant urological side‐effects, effectively treatable by rehydration
Authors: Hug  , Naef  , Bucher  , Sponagel  , Lehmann  , Battegay
Published: March 2003

Objective

 To explore the occurrence of, and diagnostic and therapeutic procedures for urological side‐effects (e.g. micro‐ and macrohaematuria, and kidney stone formation) in individuals treated with indinavir for the human immunodeficiency virus (HIV).

Patients and methods

The study comprised a retrospective follow‐up of 74 individuals infected with HIV‐1 and who were treated with indinavir orally at a daily dose of 2.4 g. Data were collected at the outpatient department of our institution between March 1996 and November 1997.

Results

Of the 74 individuals treated with indinavir, 15 (20%) had indinavir‐related urological side‐effects (19 episodes), most commonly dull flank pain and dysuria. Microhaematuria occurred in 16 of the 19 episodes. Four patients showed urinary tract distension ultrasonographically as a possible indirect sign of urolithiasis and one patient passed a kidney stone. In four patients treatment had to be stopped permanently, but in the remaining 11 patients treatment was continued. Some patients required dose reduction and/or interruption of treatment; only conservative therapeutic measures were required, consisting of rehydration (fluid intake >1.5 L/day) and analgesics.

Conclusions

Urological side‐effects of indinavir may be apparent in 20% of patients so treated; some (5%) may require permanent withdrawal. In addition to a history and clinical examination, urine analysis and ultrasonography were the only diagnostic procedures required. Therapy is mainly conservative, using rehydration, analgesics and a brief discontinuation of therapy, according to the severity of the symptoms.
Screening for fetal urological abnormalities: how effective?
Authors: Scott  , Renwick
Published: March 2003

Objective

 To analyse urological cases registered with the Northern Congenital Abnormality Survey (NorCAS) and thus assess antenatal diagnostic sensitivity, measure regional interhospital variation and determine whether antenatal ultrasonography has contributed to the prevention of urinary tract disease in childhood.

Methods

All notification documents forwarded to NorCAS from its inception in 1984 until 31 December 1996 were inspected and those relating to urological abnormalities were abstracted. Information about postnatal progress was often missing. Twenty‐three hospitals delivering maternity services were identified and randomly allocated a code letter a–w. Data were analysed in two periods, 1984–90 and 1991–96. To quantify hospital performance an ‘expected number’ for each hospital was calculated from the overall incidence per 1000 births and the number of births in each hospital.

Results

There was a clear improvement in antenatal diagnostic sensitivity for the major urological abnormalities in the second period, but there was considerable variation among hospitals in the number of cases notified; this applied particularly to antenatal renal dilatation. Two hospitals notified significantly more cases in this category than all the others. The difference in notification rates among hospitals was caused by diagnoses such as vesico‐ureteric reflux (VUR), pelvi‐ureteric junction obstruction and megaureter, which often produce antenatal renal dilatation. Hospitals which notified more of these cases performed more micturating cystograms and identified more children with VUR. Measurements of the fetal renal pelvis were regularly made by only seven hospitals; one of these had difficulties with postnatal follow‐up. There was evidence that moderate degrees of antenatal renal dilatation (4–10 mm) were associated with VUR; 8.5% of the children in whom VUR was diagnosed had fetal renal dilatation of this order.

Conclusion

Antenatal renal dilatation and its significance are either not being recognized or not appreciated in some hospitals. The high incidence of VUR in cases with moderate antenatal renal dilatation indicates that children with this condition may be escaping diagnosis.
The implementation of clinical paths for six common urological procedures, and an analysis of variances
Authors: Chang  , Wang  , Huang  , Hsieh  , Tsui  , Lai
Published: March 2003

Objective

 To evaluate the outcomes of treatment after implementing clinical paths for six common urological procedures, and analyse the variances from these paths.

Patients and methods

 The study comprised 1006 consecutive patients treated according to the recommendations of the clinical path for six common urological procedures; the results of treatment were compared with those from 1006 patients treated by the same physicians before implementing the clinical paths. Total admission charges were divided into five categories, i.e. operation and anaesthesia, laboratory, radiology, pharmacy and other. The differences in these five categories before and after implementation were determined; the variance data were also tracked and analysed. Five quality indicators were monitored during implementation and compared with the data before implementation.

Results

 The mean length of hospital stay (LOS) and admission charges were significantly lower (P=0.03 and P<0.01) after implementation. The charges for laboratory, radiology, pharmacy and other were significantly decreased after the use of clinical paths. The common variations from the clinical paths were patient‐related variance (33%) and discharge variance (26%). Variances affecting the LOS only or the admission charge only were more common than those affecting neither the LOS nor admission charges (both P<0.01), or both (both P<0.01). After implementation, the results of the five quality indicators were significantly improved and the number of patients with surgical complications was significantly reduced (P<0.01), but the mortality and readmission rate did not increase.

Conclusions

 The implementation of clinical paths for six common urological procedures decreased the LOS, admission charges and surgical complications, and improved the quality of care. During implementation, variances can affect the LOS and/or admission charges.
Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third‐generation lithotripter
Authors: Gnanapragasam  , Ramsden  , Murthy  , Thomas
Published: March 2003

Objective

 To review the results of primary in situ extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones using a third‐generation lithotripter, the Dornier MFL 5000 (Dornier Medizentechnic, Germany).

Patients and methods

 The study comprised a retrospective review of treatment outcome in 180 patients with 196 stones who were treated with primary in situ ESWL, assessing the success of this approach and establishing reasons for failure.

Results

 At the 3‐month follow‐up, 88% of patients were stone‐free; 21 patients failed ESWL and were treated by ureteroscopic stone extraction with no complications. Stone‐free rates were 90% for upper ureteric, 89% for middle‐third and 86% for lower‐third calculi. Twenty‐one patients required auxiliary procedures in the form of JJ stenting or nephrostomy. Failure of ESWL was associated with stone size (>1.3 cm) but not location or inadequate treatment.

Conclusion

 Where prompt access to ESWL is available, primary in situ ESWL remains an effective form of treatment for all ureteric calculi, although stone‐free rates are lower for larger stones.
Late results of surveillance of clinical stage I nonseminoma germ cell testicular tumours: 17 years’ experience in a national study in New Zealand
Authors: Colls B.M. , Harvey V.J. , Skelton L. , Frampton C.M.A. , Thompson P.I. , Bennett M. , Perez D.J. , Dady P.J. , Forgeson G.V. , Kennedy I.C.S.
Published: March 2003

Objective

To re‐evaluate a national prospective study in New Zealand after 17 years to define whether orchidectomy alone and surveillance for nonseminoma germ cell testicular tumour (NSGCTT) is a sound policy and matches the results achieved by other treatment protocols.

Patients and methods

Between 1980 and 1997, 248 men with stage I NSGCTT, from six New Zealand centres, were managed by orchidectomy alone and surveillance, with treatment of relapses using combination chemotherapy.

Results

Seventy of the 248 patients (28%) relapsed; 42 of 92 (46%) with vascular and/or lymphatic invasion (VLI) in the primary tumour relapsed, whereas only 26 of 151 (17%) without this feature relapsed (P<0.001). VLI was the only identifiable risk factor for relapse in this series. Only one relapse occurred >28 months after orchidectomy. Despite poor compliance in some patients (12%) their survival was not prejudiced. Three patients died from disease despite chemotherapy at relapse. At 17 years and a median follow‐up of 53 months, 242 of the 248 men are disease‐free and the disease‐specific survival rate is 98%.

Conclusions

This study shows that orchidectomy alone and treatment of relapses produces excellent long‐term results without the adverse effects associated with retroperitoneal node dissection or elective chemotherapy for high‐risk cases.
Corporal reactivity to adenosine and prostaglandin E1in alloxan‐induced diabetic rabbit corpus cavernosum, and the effect of insulin therapy
Authors: Ayan S. , Yildirim S. , Uçar C. , Sarioglu Y. , Gültekin Y. , Bütüner C.
Published: March 2003

Objective

To investigate the changes in corporal reactivity to adenosine and prostaglandin E1(PGE1 ) in corpus cavernosal strips from alloxan‐induced diabetic rabbits and to determine the effects of insulin therapy.

Materials and methods

Twenty‐four New Zealand white rabbits were studied in three equal groups: group 1, control; group 2, diabetes induced by the administration of alloxan hydrochloride intravenously; group 3, as group 2 but with insulin administered after the induction of diabetes. At the end of 8 weeks, the reactivity of corpus cavernosal strips from the animals was assessed in organ chambers.

Results

The relaxation responses of corpus cavernosal strips to adenosine were similar in all groups, but the response to PGE1was impaired in groups 2 and 3 compared with that in controls.

Conclusion

If vasoactive drugs are to be used for the diagnosis or treatment of diabetic erectile impotence, direct‐acting vasodilators, e.g. adenosine, must be used. In alloxan‐induced diabetes, the corporal reactivity to PGE1was impaired and insulin therapy did not restore the relaxation responses.
Helical computed tomography angiography in the evaluation of Chinese living renal donors
Authors: Tang  , Chan  , Tso  , Ho  , Chan  , Lai
Published: March 2003

Objective

To determine the suitability of helical computed tomography angiography (CTA), recently used in the anatomical evaluation of potential living renal donors (LRDs) in the Caucasian population, for Chinese LRDs.

Subjects and methods

Eighteen consecutive potential LRD candidates underwent both CTA and conventional renal angiography (CRA). Results from each were interpreted while unaware of the results from the other. Renal function was monitored after each radiological procedure.

Results

Both procedures were able to identify all four accessory renal arteries present. One prehilar branch of <1 mm in diameter was not recognized on CTA. Renal artery ostial stenosis in one subject with normal blood pressure was identified on CTA, but not on CRA. CTA better delineated the renal venous and parenchymal anatomy and cost 60% less than CRA. There was no change in renal function after either procedure.

Conclusion

Despite there being few subjects, CTA has potential value as an alternative to CRA for the anatomical assessment of potential LRDs in Hong Kong. Advantages include a short examination time, non‐invasiveness and lower cost. CTA may provide an opportunity to living‐related and unrelated renal donor transplantation in this conservative Chinese culture.
Frequency and causes of fluid absorption: a comparison of three techniques for resection of the prostate under continuous pressure monitoring
Authors: Heidler
Published: March 2003

Objective

To compare in a prospective study three techniques for draining irrigation fluid during transurethral resection of the prostate (TURP) and to assess which method minimizes the risk of increased intravesical pressure and decreased plasma sodium level, as a sign of fluid absorption.

Patients and methods

The study included 90 patients with benign prostatic hyperplasia (BPH), randomized into three equal groups, who underwent TURP using different techniques for draining the irrigation fluid. Group 1 had suprapubic drainage via the Freka® CystTUR Standard device (Fresenius, Germany); group 2 underwent TURP with an Iglesias continuous‐flow resectoscope; and group 3 had suprapubic drainage using the Korth ‘flow controller’ (Olympus, Germany). The intravesical pressure was monitored continuously during surgery; an ‘increased’ pressure was defined as being >20 cmH2O. As fluid absorption decreases the plasma sodium level during surgery, the latter was also determined and the difference before and after surgery calculated.

Results

The intravesical pressure was increased in 10% of those in group 1, 90% in group 2 and none of group 3. The differences between group 1 and 2 and between group 2 and 3 were significant (P<0.001). The differences in the decrease of plasma sodium levels in groups 1–3 were not significant, but there was a significant correlation (P=0.0075) between increased intravesical pressure and minimum levels of plasma sodium.

Conclusions

The three techniques for draining irrigation fluid produced significant differences in ‘increased’ intravesical pressure. In general, the levels of plasma sodium were not significantly different among the three techniques but patients with lower plasma sodium levels tended to have an increased intravesical pressure. In these cases, fluid absorption seems to be avoidable by an appropriate drainage technique. Nevertheless, considerable fluid absorption can occur at pressures of <20 cmH2O.
The impact of transurethral resection of bladder tumour on serum levels of soluble E‐cadherin
Authors: Durkan  , Brotherick  , Mellon
Published: March 2003

Objective

To evaluate soluble E‐cadherin (sE‐cadherin) as a potential tumour marker in patients with transitional cell carcinoma (TCC) of the bladder (previously shown to correlate with tumour grade, number of Ta/T1 tumours at presentation and a positive 3‐month check cystoscopy) by assessing its serum concentration in relation to transurethral resection of bladder tumour (TURBT).

Patients and methods

Samples of venous blood were obtained from 25 patients with bladder cancer: (i) before cystoscopy/TURBT; (ii) intraoperatively, during tumour resection; and (iii) on the first day after surgery. Levels of sE‐cadherin were measured using an enzyme‐linked immunosorbent assay.

Results

Sixty‐three serum samples from patients with TCC of the bladder were available for analysis (23 before, 21 during and 19 after surgery). Patients with G2/3 tumours had significantly higher median preoperative levels of sE‐cadherin (16.37 and 13.03 μg/mL, respectively) than those with G1 tumours (9.493 μg/mL; P=0.0164). There was no correlation between tumour stage and preoperative sE‐cadherin concentration. The median concentrations of sE‐cadherin were not significantly different before, during and after TURBT.

Conclusions

This study confirmed the previous finding that higher levels of serum sE‐cadherin correlate with increasing tumour grade but not with clinicopathological stage. Serum sE‐cadherin levels are not significantly altered by TURBT in the immediate perioperative period.
Transitional cell carcinoma expresses high levels of Fas ligand in vivo
Authors: Lee  , Lee  , Park  , Kim  , Jang  , Yoo
Published: March 2003

Objective

To characterize the Fas‐Fas ligand system, a main apoptotic pathway, in transitional cell carcinoma (TCC) of the urinary bladder, by analysing the expression of Fas and Fas ligand (FasL) in TCC samples.

Materials and methods

Archival paraffin‐embedded tissues from 37 patients with TCC were analysed by immunohistochemistry to determine Fas and FasL expression.

Results

Fas and FasL were detected on the cell surface and cytoplasm of respectively 34 (92%) and all cases analysed. The expression of Fas and FasL did not differ with the cytological grade of TCC.

Conclusion

The high expression of FasL in TCC, reported for the first time in the present study, suggests that FasL may contribute to the immune escape of TCC through killing Fas‐bearing lymphocytes. Co‐expression of Fas with FasL also suggests that TCC may have pathways resistant to Fas‐mediated autocrine cell suicide.
Comparative physiology and biochemistry of rat and rabbit urinary bladder
Authors: Damaser M.S. , Whitbeck C. , Barreto M. , Horan P. , Benno H. , O’Connor L.J. , Levin R.M.
Published: March 2003

Objective To compare directly the biochemistry and contractile responses of rat and rabbit bladder to different stimuli.

Materials and methods Sexually mature male New Zealand White rabbits and Sprague Dawley rats were compared. Each bladder was excised while the animal was anaesthetized; longitudinal bladder strips were cut and then mounted in an organ bath. Tension (2 g) was placed on all strips and each underwent field stimulation (FS) for a total of 20 s at 1–32 Hz, 1 ms and 80 V and was exposed to carbachol (100 μmol/L), ATP (2 mmol/L) and KCl (120 mmol/L). The tension was monitored continually using a polygraph and data stored digitally in a computer. The responses to each stimulus were determined as the maximum tension generated, oaximum rate of tension generation and duration to a maximum response. The Ca2+‐ ATPase activity of the rat and rabbit bladder was determined. Bladder pressures were then predicted from the strip data using Laplace’s law and compared with published values.

Results Contractile responses (per unit tissue mass) of rat bladder strips were significantly greater than those of rabbit bladder strips at all frequencies of FS and to carbachol, KCl and ATP. The rate of contractile force generated by rat bladder strips in response to all stimuli were significantly greater than that generated by rabbit strips. Rabbit bladder strips took significantly longer to generate maximum tension than did rat bladder strips in response to pharmacological stimuli. In response to FS, rat strips took significantly longer than rabbit strips to generate maximum tension. Although the predicted rat bladder pressures were significantly greater than those for rabbit, the predicted pressures for both the rat and rabbit were significantly lower than the pressure responses of the isolated whole bladder model. The contractile data correlated well with the Ca2+‐ATPase activity data; rat bladder had seven times the enzyme activity of rabbit bladder.

Conclusion Per unit mass, rat bladder is capable of generating more than five times the tension of rabbit bladder. Similarly, the rate of tension generation by rat bladder is three to five times greater than that by rabbit bladder. The duration to maximum tension generated in response to FS compared with pharmacological stimuli was affected by the inherent difference in the rate of contractile response to electrical activation compared with agents which diffuse through tissue, and by the difference in size between rat and rabbit bladder smooth muscle cells.
Gastrinaemia and G‐cell density in the antral gastrocystoplasty: an experimental study in rats
Authors: Ortiz V. , Goldenberg S.
Published: March 2003

Objective To evaluate gastrinaemia and G‐cell density in the antrum incorporated into the bladder of rats after antrocystoplasty.

Materials and methods Thirty‐two adult, female Wistar EPM‐1 rats (body weight 200–220 g) were divided into four equal groups that underwent; group 1, no treatment (controls); group 2, a sham operation; group 3, antrectomy; and group 4, antrocystoplasty. The rats were assessed 2 months after treatment, and gastrinaemia and the G‐cell density determined in the antrum mucosa incorporated into the bladder.

Results Compared with group 1, serum gastrin was significantly lower in group 3 (P < 0.05) and the G‐cell density lower in group 4 (P < 0.05), although there was no decrease in gastrinaemia in group 4.

Conclusion Antrocystoplasty in rats did not affect gastrinaemia but reduced the number of G cells in the antrum incorporated into the bladder.
The relationship between early biochemical failure and perineural invasion in pathological T2 prostate cancer
Authors: Endrizzi J. , Seay T.
Published: March 2003

Objectives To evaluate, in patients with pathologically localized prostate cancer, the relationship between early biochemical failure, i.e. an increasing prostate‐specific antigen (PSA) level, and perineural invasion (PNI) on final pathology.

Patients and methods The records were reviewed of 171 patients with prostate cancer who underwent prostatectomy at one institution between January 1992 and December 1995. Data on the histology, therapy and PSA level were collected and evaluated.

Results Of the 171 patients with pathologically localized (pT2) prostate cancer, 131 were evaluable; 17 (13%) had a detectable PSA level in the first 5 years after surgery and 63 had PNI in the pathological specimen. Of those with PSA recurrence, 14 had PNI, one had no PNI and in two there was no comment on PNI. In comparison, only 10 of the 17 patients with recurrence had a Gleason sum of  7.

Conclusion Perineural invasion seems to be an important predictor of early outcome in patients with organ‐confined prostate cancer treated by prostatectomy. In this series it was the most sensitive predictor of biochemical failure. A more detailed pathological evaluation of prostate cancer may allow the clinician to provide closer surveillance and better informed clinical decision‐making.
Transrectal power Doppler imaging in the detection of prostate cancer
Authors: Okihara K. , Kojima M. , Nakanouchi T. , Okada K. , Miki T.
Published: March 2003

Objectives To evaluate the clinical utility of transrectal power Doppler imaging (PDI) of the prostate for detecting prostate cancer in patients with abnormally high serum levels of prostate specific antigen (PSA).

Patients and methods Patients (107) with abnormally high serum PSA levels were assessed using a digital rectal examination (DRE), transrectal ultrasonography (TRUS) and PDI. Any hypervascular lesion on PDI was graded on a scale of 0–3, where grade 1–3 was considered positive and grade 0 negative. Patients were then diagnosed by prostatic needle biopsy and the results compared with the other detection methods.

Results Needle biopsy confirmed prostate cancer in 41 (24%) of the 170 patients. PDI was positive in 68, of whom 40 (59%) had prostate cancer; all those but one having prostate cancer were positive on PDI. Thus, PDI had a high sensitivity of 98% (40/41) and a negative predictive value of 99% (101/102). PDI could have saved a significant number of patients from undergoing unnecessary biopsies, compared with DRE and TRUS (P < 0.001).

Conclusion The use of PDI in detecting prostate cancer might reduce the number of unnecessary needle biopsies of the prostate in patients with abnormally high serum PSA levels.
A prospective evaluation of scrotal ultrasonography in clinical practice
Authors: Adeyoju A.B. , Collins G.N. , Pollard A.J. , Liaw J. , Brooman P.J. , O'Reilly P.H.
Published: March 2003

Objectives To prospectively evaluate scrotal ultrasonography (SUS) in patients presenting with scrotal symptoms and to make recommendations about use of SUS in clinical practice.

Patients and methods Forty‐eight men with scrotal symptoms were examined by a urologist and independently underwent SUS by one radiologist with no knowledge of the clinical diagnosis. The clinical and SUS diagnoses were compared and the effect on subsequent management recorded.

Results The clinical and SUS diagnoses agreed in 35 men (73%) although SUS provided an additional diagnosis in half of these men. The SUS diagnosis differed in 13 men (27%) although the management was altered in only four patients.

Conclusion The clinical diagnosis is correct in most men with scrotal symptoms; the routine use of SUS is inappropriate and should be reserved for specific indications.