bluuebunny/crossref_metadata_2025 huggingface dataset:
A noninvasive test for vesico‐ureteric reflux in children
Authors: Mevorach R.A. , Cilento B. , Zahorian S. , Badgett C. , Walker R. , Atala A. , Iannello S. , Meyer M.
Published: March 2003

Objective To report the development and testing of a device for the noninvasive diagnosis of vesico‐ureteric reflux (VUR) which avoids the need for urethral catheterization (currently required to reliably determine the presence of VUR), and which thus avoids the anxiety of parents and patients that causes many families to refuse such evaluation.

Patients and methods Fifty‐four children (49 girls and five boys, mean age 7.2 years, range 4–14) previously evaluated as having VUR volunteered to participate; no child was symptomatic at the time of the study. Refluxing units were known to be present by voiding cysto‐urethrography (within 1 year, mean 7 months) in 45 and absent in 16. The device developed acquires electronically processed acoustic signals from the child during an observed urination. The signals are then analysed ‘off‐line’ to determine the presence or absence of VUR. The initial preparation for the test included: (i) a full bladder [at least 0.80 ×  {(2 + age) × 30 mL}] measured by ultrasonography; and (ii) localization of the pelvi‐ureteric junction by ultrasonography to accurately place the device's sensors on the child's back. The children were then positioned at a commode after placing the sensors; the recording was started and continued until voiding occurred. The children were tested with the recording and analysis team unaware of the presence and/or degree of VUR. The first 47 studies were single‐kidney examinations and the remaining seven included simultaneous monitoring of both kidneys.

Results Sixty‐one renal units were assessed and interpretable signals were obtained from 54 (89%). There were seven episodes of ‘system failure’ when no interpretable data were obtained. One unit with no VUR had a ‘reflux’ signal; in four kidneys, spontaneous (two) and postsurgical (two) resolution of reflux was predicted by the testing and subsequently verified by cyclic radionuclide cystography.

Conclusions This noninvasive diagnostic technique detected VUR in 35 of 37 refluxing units and verified no reflux in 16 of 17 units without VUR. Further refinements may allow this technology to be used in all children with suspected VUR.
Endopyelotomy in the symptomatic older child
Authors: Nicholls G. , Hrouda D. , Kellett M.J. , Duffy P.G.
Published: March 2003

Objective To evaluate the results of endopyelotomy in children, an established method in adult practice as a treatment for pelvi‐ureteric junction (PUJ) obstruction.

Patients and methods Endopyelotomies undertaken between 1992 and 1999 by one surgeon in an established endourology unit were reviewed retrospectively. Children aged > 5 years presenting with pain and obstruction on isotope renography were selected for endopyelotomy. Patients with crossing vessels detectable on spiral computed tomography were treated by open pyeloplasty. Access to the renal pelvis was provided by a uroradiologist. Endopyelotomy was carried out through an Amplatz sheath of (median) 26 F. After applying traction to invaginate the PUJ an incision was made postero‐laterally using electrocautery via an 11 F paediatric resectoscope. Stenting was maintained for 6 weeks. In all, 13 patients (median age 10 years, range 5–14) were treated; two had associated calculi.

Results The symptoms resolved and the obstruction was relieved in only six patients, with a median (range) follow‐up of 50 (26–68) months. The seven patients in whom endopyelotomy failed, as indicated by persistent pain, proceeded to open pyeloplasty at a median (range) of 4 (1.3–79) months. Of these, two had presented with associated multiple calculi and significant hydronephrosis (one with an associated duplex system) and three had crossing lower pole vessels at open operation. One developed a urinoma after the original endopyelotomy and one had a retained stent fragment removed at the time of pyeloplasty.

Conclusions Endopyelotomy in the symptomatic child requires a careful preoperative evaluation. Crossing lower pole vessels warrant an open pyeloplasty.
The serum level of the amino‐terminal propeptide of type I procollagen is a sensitive marker for prostate cancer metastasis to bone
Authors: Koizumi M. , Yonese J. , Fukui I. , Ogata E.
Published: March 2003

Objective To assess the level of a bone‐formation marker, the amino‐terminal propeptide of type I procollagen (PINP), for its utility in indicating bone metastasis in patients with prostate cancer.

Patients and methods Several bone formation markers, i.e. PINP, the carboxy‐terminal propeptide of type I procollagen (PICP), bone‐specific alkaline phosphatase (BALP), and bone Gla protein (BGP), a bone resorption marker (pyridinoline cross‐linked carboxy‐terminal telopeptide, ICTP), and prostate specific antigen (PSA) were measured in 40 patients without and 25 patients with bone metastasis. No patient had undergone previous treatment, except for six who developed bone metastasis while undergoing hormone therapy.

Results All markers except BGP were significantly higher in patients with bone metastasis than in those without. The levels of PINP correlated best with the extent of disease, although the levels of PSA, BALP and ICTP also correlated well. While PINP had the largest area under the receiver‐operator characteristic curve, PSA, BALP and ICTP also produced useful curves.

Conclusion The bone formation marker PINP seems to be useful for discriminating patients with and without bone metastasis. PINP may help in the early and accurate diagnosis of bone metastasis in such patients.
A multi‐institutional analysis of laparoscopic orchidopexy
Authors: Baker L.A. , Docimo S.G. , Surer I. , Peters C. , Cisek L. , Diamond D.A. , Caldamone A. , Koyle M. , Strand W. , Moore R. , Mevorach R. , Brady J. , Jordan G. , Erhard M. , Franco I.
Published: March 2003

Objective To combine and analyse the results from centres with a large experience of laparoscopy for the impalpable testis with small series, to determine the expected success rate for laparoscopic orchidopexy.

Methods A questionnaire was distributed to participating paediatric urologists; each contributor retrospectively reviewed the clinical charts for their cases of therapeutic laparoscopy for an impalpable testis, detailing 36 variables for each patient. The data were collated centrally into a computerized database. For inclusion, the testis was intra‐abdominal (including ‘peeping’ at the internal ring) at laparoscopic examination, was not managed through an open approach and did not undergo orchidectomy. Three surgical groups were assessed, with success defined as lack of atrophy and intrascrotal position: group 1, primary laparoscopic orchidopexy; group 2, a one‐stage Fowler‐Stephens (F‐S) orchidopexy; and group 3, a two‐stage F‐S orchidopexy.

Results Data were gathered from 10 centres in the USA, covering the period 1990–1999; 252 patients representing 310 testes were included and overall, 15.2% were lost to follow‐up. There was no significant difference between success rates in the larger and smaller series. Atrophy occurred in 2.2% of 178 testes, 22.2% of 27 testes and 10.3% of 58 testes in groups 1–3, respectively. Testes were not in a satisfactory scrotal position in 0.6%, 7.4% and 1.7% of groups 1–3, respectively. The mean follow‐up for each group was 7.7, 8.6 and 20.0 months, respectively. The overall success for all groups was 92.8% (97.2% group 1; 74.1% group 2; 87.9% group 3), with an atrophy rate of 6.1%.

Conclusion Laparoscopic orchidopexy for the intra‐abdominal testis, in both large and small series, can be expected to have a success rate higher than that historically ascribed to open orchidopexy. Within this series, single‐stage F‐S laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the two‐stage repair. However, when considering both F‐S approaches, the laparoscopic approach gave greater success than previously reported for the same open approaches. Despite the weaknesses inherent in a retrospective unrandomized study, we conclude that laparoscopic orchidopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testicle.
A comparison of the lateral and posterior retroperitoneoscopic approach for complete and partial nephroureterectomy in children
Authors: Borzi P.A.
Published: March 2003

Objective To report the comparative results of a selective posterior or lateral retroperitoneoscopic approach (RPA) for nephroureterectomy in children.

Patients and methods Following an established experience with RPA, 36 complete and 19 partial nephrouretectomies were prospectively randomized to a posterior and lateral retroperitoneoscopic approach The patients were aged 4 months to 14 years, with a body weight at operation of 5.7–82 kg. For posterior RPA the child is positioned prone, with three access ports. The operating space was created with balloon dissection and maintained with CO2 insufflation. The child was then rotated 30° with the kidney in the dependent position, and the operator and assistant standing on the affected side. In the lateral approach the child is in the lateral decubitus position with the operator and assistant facing the dorsal aspect of the patient.

Results There was no significant difference in operative duration between the lateral and posterior approaches for nephrectomy (65 and 47 min) or partial nephrectomy (85 and 75 min). Two lateral nephrectomies required open conversion (one upper pole and one lower pole).

Conclusion The posterior approach gives easy and quick access to the renal pedicle. It is preferable for complete nephrectomy alone and partial or polar excision. In children under 5 years old a near complete ureterectomy can be achieved. The lateral approach creates more inferomedial space, gives better access to ectopic kidneys and allows complete ureterectomy in all cases. Access to the pedicle in the normal position requires more frequent positioning of the kidney. Care must be taken as peritoneal tears are more common.
Prophylactic efficacy of a new gentamicin‐releasing urethral catheter in short‐term catheterized rabbits
Authors: Cho Y.‐H. , Lee S.‐J. , Lee J.Y. , Kim S.W. , Kwon I.C. , Chung S.Y. , Yoon M.S.
Published: March 2003

Objective To describe an indwelling urethral catheter coated with gentamicin sulphate on the inner and outer surface of the catheter, and to evaluate the efficacy and safety of this catheter in preventing catheter‐associated infections in rabbits.

Materials and methods Sixty rabbits were divided equally into control and experimental groups which were then subdivided equally according to the duration of catheterization (1, 3 and 5 days). Silicone‐treated latex catheters were used in the control group and gentamicin‐releasing catheters in the experimental group. Urine samples and surface swabs from the catheter were cultured for bacteriological assessment, and the catheter surface examined by scanning electron microscopy to structurally analyse the biofilms.

Results The gentamicin‐releasing catheter reduced the incidence of bacteriuria (defined as  100 c.f.u./mL) after both 3 and 5 days of catheterization (eight and 10 rabbits, respectively, for the control catheter, vs two and four rabbits for the gentamicin‐releasing catheter, P < 0.05). The surfaces of the gentamicin‐releasing catheter were colonized less often than those of the control catheter after both 3 and 5 days (eight and 10, respectively, for the control, vs one and four for the gentamicin‐releasing catheter, P < 0.05). Scanning electron microscopy showed the formation of bacterial biofilm throughout the 3‐day and 5‐day control catheters, but deterioration of the bacterial biofilm was visible on the surface of the gentamicin‐releasing catheters.

Conclusion This new gentamicin‐releasing catheter produced an antibacterial barrier which inhibited catheter‐associated urinary tract infection with no toxicity for at least 5 days. These in vivo studies suggest that this new catheter may be useful for controlling infection, with systemic and local safety, in patients undergoing short‐term indwelling urethral catheterization.
Donor fascia in urogynaecological procedures: a canine model
Authors: Fitzgerald M.P. , Mollenhauer J. , Brubaker L.
Published: March 2003

Objective To explore the in vivo characteristics of donor fascia used in urogynaecological procedures, in a canine model.

Materials and methods Two experiments were conducted. In the first, donor fascia grafts were obtained from 12 dogs, the grafts freeze‐dried and half were irradiated. The grafts were used for sacrocolpopexy and suburethral slings in each of five dogs. The dogs were killed at 2, 6 and 12 weeks after graft implantation, the grafts retrieved and assessed using tensilometry. In the second experiment, unirradiated sacrocolpopexy grafts were implanted in eight dogs; four grafts were placed under no tension and four under moderate tension. At 8 weeks, the grafts were retrieved and assessed by tensilometry. Measures of strength in both experiments included the ultimate tensile strength, ultimate strain and stiffness. All measures were compared using Kruskal–Wallis nonparametric tests in both studies.

Results In the first experiment, a significant minority (23%) of grafts had complete loss of strength. Measures of graft strength did not vary when analysed according to donor dog, host dog, history of graft irradiation, duration of implantation or location of graft. In the second experiment, grafts placed under no tension tended to have lower tensile strength (χ2(1)= 3.125, P = 0.077), lower stiffness (χ2(1)= 3.125, P = 0.077) and lower ultimate strain (χ2(1)= 3.182, P = 0.074).

Conclusion Graft irradiation as an isolated variable did not predispose grafts to failure in vivo. Biomechanical factors at the implantation site are likely to play a critical role in determining ultimate graft strength.
Intravesical Escherichia coli lipopolysaccharide stimulates an increase in bladder nerve growth factor
Authors: Bjorling D.E. , Jacobsen H.E. , Blum J.R. , Shih A. , Beckman M. , Wang Z.‐Y. , Uehling D.T.
Published: March 2003

Objective To investigate the effects of the intravesical instillation of Escherichia coli lipopolysaccharide (LPS) on nerve growth factor (NGF, which may mediate the pain associated with inflammation) protein and mRNA in the bladders of mice.

Materials and methods
E. coli LPS was instilled into the bladders of female mice; the whole‐bladder NGF content was then determined by an enzyme‐linked immunosorbent assay and the NGF mRNA content of the bladder determined by semiquantitative reverse transcription‐polymerase chain reaction. Bladder NGF was also evaluated by immunohistochemistry in some of the mice.

Results LPS stimulated a significant increase in bladder NGF 90 min after instillation, but bladder NGF content was significantly less than that in bladders of control mice 3 and 7 h after LPS instillation. Twenty‐four hours after the intravesical infusion of saline or LPS, there was no difference in NGF content in bladders from saline or LPS‐infused mice. Immunohistochemistry confirmed the presence of increased NGF in the mucosa of detrusor from bladders 90 min after LPS instillation. Bladder NGF mRNA increased more slowly in response to LPS, and 7 and 24 h after LPS instillation the relative abundance of NGF mRNA was 1.5 and 2.0 times greater in LPS‐infused bladders, respectively.

Conclusions
E. coli LPS can stimulate increased NGF message and protein in the bladder. The increase in NGF protein preceded the increase in mRNA, suggesting that this increase was not the result of gene transcription. It is possible that NGF participates in the pathogenesis of pain associated with bacterial cystitis.
Does age influence the behaviour of localized prostate cancer?
Authors: Parker C.C. , Gospodarowicz M. , Warde P.
Published: March 2003

Objective To assess, in a meta‐analysis of published studies, whether age influences the behaviour of localized prostate cancer.

Methods The Medline database was searched from 1966 to 2000 to identify studies analysing the outcome of localized prostate cancer by age, using disease‐specific outcome measures, and having controlled for the established prognostic factors of grade, T stage and, where available, serum prostate‐specific antigen (PSA) level.

Results In all, 34 studies were identified, which included a total of 27 551 patients. The incomplete and heterogeneous nature of the reports precluded any quantitative overview. The findings of these reports are described and methodological shortcomings discussed.

Conclusion The evidence suggests that young age was an adverse prognostic factor in some series of radiation therapy before the advent of PSA assays, when men typically presented clinically with locally advanced disease, but that age has no significant prognostic effect in contemporary series of localized prostate cancer. Possible explanations for this difference are discussed, together with implications for further studies.
Variation in percentage‐free prostate‐specific antigen (PSA) with prostate volume, age and total PSA level
Authors: Törnblom M. , Norming U. , Becker C. , Lilja H. , Gustafsson O.
Published: March 2003

Objective To examine the correlation between prostate volume, patient age and total prostate‐specific antigen (tPSA) with the percentage‐free PSA (f/tPSA) in a population‐based cohort of men with no prostate cancer and with a tPSA of < 10.0 ng/mL.

Subjects and methods Men who in 1988–1989, after randomized selection in the general population, participated in a population‐based screening study for prostate cancer, were investigated. In all, 1622 of the men (aged 55–70 years) were considered free from prostate cancer and had a tPSA level of < 10.0 ng/mL. The f/tPSA and tPSA were determined in frozen sera from each individual, and related to prostate volume and age measured at the time of the study. The entire population was investigated, as were four subpopulations based on tPSA levels (<2.0, 2.0–3.9, 4.0–6.9 and 7.0–9.9 ng/mL). Statistical calculations included multiple regression and correlation analysis.

Results The f/tPSA level varied with prostate volume and age, but the decisive factor for this variation was the tPSA level. The closest correlation was in the tPSA interval 7.0–9.9 ng/mL, where volume and age together explained 47% of the variation in f/tPSA. Also, for men with tPSA levels in each of the intervals 2.0–3.9, 4.0–6.9 and 7.0–9.9 ng/mL, the f/tPSA increased with higher prostate volumes and age. In men with tPSA levels of < 2.0 ng/mL the f/tPSA was not affected by variations in prostate volume or age.

Conclusion The variation in f/tPSA with prostate volume, age and tPSA is highly dependent on the tPSA level. Volume and age in the tPSA interval 7.0–9.9 ng/mL can explain almost half the variation in f/tPSA, whereas this influence is insignificant in men with a tPSA of < 2.0 ng/mL.
Increased endothelin‐1 and decreased adrenomedullin gene expression in the stenotic tissue of congenital pelvi‐ureteric junction obstruction in children
Authors: Knerr I. , Nyul Z. , Miller J. , Rösch W. , Dötsch J. , Repp R. , Weidner W. , Rascher W.
Published: March 2003

Objectives To test the hypothesis that the gene expression of endothelin‐1 and adrenomedullin may be altered in stenotic tissues of patients with congenital hydronephrosis caused by pelvi‐ureteric junction (PUJ) obstruction.

Materials and methods Using real‐time reverse transcription‐polymerase chain reaction, mRNA of smooth muscle‐constricting endothelin‐1 and of smooth muscle‐relaxing adrenomedullin was quantified in tissue specimens of 20 patients with PUJ obstruction (mean age 5.1 years, sd 7.0) and of 21 controls with normal PUJs (mean age 23.5 years, sd 24.2).

Results The amount of endothelin‐1 mRNA in stenotic specimens was higher than in the controls, indicated by significantly lower threshold cycles (Ct values) in real‐time PCR for the target gene in the obstructive tissue, with mean (sd) values of 24.9 (1.6) and 26.0 (2.1) (P < 0.05), respectively. The endothelin‐1/CD31 ratio was significantly higher in the patients (P < 0.05) than in controls. In addition, adrenomedullin gene expression in the obstructed junctions was significantly lower than in normal junctions, with higher Ct values for the patient group of 26.7 (1.6) vs 25.2 (1.8) (P < 0.05) and lower adrenomedullin mRNA when standardized to glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH) (P < 0.05), CD31 (P < 0.01) and smooth muscle α‐actin mRNA (P < 0.01). The two groups showed no significant differences for GAPDH and CD31 mRNA content, whereas there was about twice as much α‐actin mRNA in stenotic tissues than in unaffected PUJs, shown by the lower Ct values for the patient group of 16.9 (2.0) vs 17.9 (2.6) (P < 0.05). Furthermore, endothelin‐1, adrenomedullin and α‐actin mRNA amounts were independent of age.

Conclusion Taken together these results provide evidence that the production of autocrine/paracrine acting endothelin‐1 and adrenomedullin is altered in tissues of patients with genuine PUJ obstruction, and may be involved in the pathogenesis of congenital hydronephrosis.
The protective effects of captopril and nitric oxide on solitary kidney after chronic partial ureteric obstruction
Authors: Öztürk H. , Dokucu A.I. , Otçu S. , Gezici A. , Ketani A. , Yildiz F.R. , Özdemir E. , Yücesan S.
Published: March 2003

Objective To determine whether vasodilator agents (captopril and nitric oxide) change the morphological and functional effects of chronic partial ureteric obstruction in solitary kidney tissue in unilaterally nephrectomized rats.

Materials and methods Each of 50 prepubertal Wistar albino rats underwent right nephrectomy and were then assigned to one of five groups. Rats in group 1 underwent a sham operation (control) and in the other groups the ureter of the remaining kidney was partially obstructed by surgery. In group 2, no drug treatments were given; in groups 3, 4 and 5 captopril, l‐arginine methyl ester (L‐Arg) or NG‐ nitro‐l‐arginine‐methyl ester, respectively, were given for 3 weeks. In all rats, diuretic scintigraphy was used to measure kidney perfusion, glomerular filtration rate (GFR) and concentration. Blood urea nitrogen (BUN), serum creatinine levels, kidney parenchymal weight and pelvic volume were measured and the kidneys evaluated histopathologically.

Results Renal perfusion was significantly greater in both group 3 and 4 than in group 2. The GFR was 18% greater in group 3 and 22.3% greater in group 4 than in group 2. The GFR was decreased by 67% in group 5 compared with the control group. The mean parenchymal weight, mean pelvic volume, BUN and serum creatinine in the four groups with a partially obstructed ureter were significantly different from the control group. There also were significant differences between group 2 and groups 3–5, and between group 2 and group 3. Histological damage was severe in all four groups with partial ureteric obstruction, but in the drug‐treated groups, medullary fibrosis was less frequent.

Conclusion After 3 weeks of treatment, captopril and l‐Arg both improved kidney perfusion, GFR, BUN and serum creatinine levels, but were less effective in preventing parenchymal atrophy and changes in pelvic volume.
The efficacy of laparoscopic mesh colposuspension: results of a prospective controlled study
Authors: El‐Toukhy T.A. , Davies A.E.
Published: March 2003

Objective To investigate the efficacy of laparoscopic mesh colposuspension as an equivalent approach to the ‘gold standard’ open Burch colposuspension.

Patients and methods A prospective controlled study of laparoscopic mesh colposuspension was conducted over 2 years; 87 patients with genuine stress incontinence (GSI) were recruited. The preoperative evaluation included a history, examination, midstream urine analysis, urinary voiding diary, a Urilos pad test, and twin‐channel subtracted cystometry, including urethral profilometry and measurement of the postvoid residual volume. The study included patients who had undergone previous incontinence surgery, but those with detrusor instability or neurogenic bladder were excluded. The patients were assessed at 6 weeks, 6 months and 1 year after surgery and then yearly thereafter. The urodynamic assessment was repeated 3 months after surgery.

Results Forty‐nine patients underwent laparoscopic colposuspension using Prolene mesh and titanium tacks to elevate the bladder neck, while 38 patients had open Burch colposuspension. There was no difference between the groups in age, parity, body mass index, menopausal status, medical history, previous bladder neck surgery and prolapse. At 6 weeks the cure rate was similarly high in the two groups (91% laparoscopic and 94% open). After a mean follow‐up of 32 months, both groups showed a decline in efficacy, which was more marked in the laparoscopic group. Cure rates were 62% for laparoscopy and 79% for open surgery, and the improvement rates were 77% and 89%, respectively (P < 0.05).

Conclusion Laparoscopic colposuspension using a mesh and tacker technique reduces the technical difficulty and operating time of the endoscopic procedure, but the long‐term cure rates are inferior to open Burch colposuspension.
Fears, sexual disturbances and personality features in men with prostatitis: a population‐based cross‐sectional study in Finland
Authors: Mehik A. , Hellström P. , Sarpola A. , Lukkarinen O. , Järvelin M.‐R.
Published: March 2003

Objective To determine the occurrence of mental distress related to prostatitis in Finnish men.

Subjects and methods A population‐based cross‐sectional survey was conducted of 2500 men aged 20–59 years living in the two northernmost provinces of Finland (Oulu and Lapland). The final response rate was 75% (1832 men).

Results The fear of undetected prostate cancer was reported by 17% of the men in the population who had had prostatitis, a value significantly higher (P < 0.001) than in healthy men. Fears of having a sexually transmitted disease and suicidal thinking were also slightly more common. The men who had had prostatitis preferred to be alone in a public toilet during voiding (58% vs 44%, P < 0.001). Erectile dysfunction was reported by 43% of the men with symptomatic prostatitis and decreased libido by 24%. Self‐assessment of personality, adjusted for age, showed that the men with prostatitis were more often busy and nervous than the healthy controls (P < 0.001), and that they had a more meticulous attitude to life and its problems. Marital difficulties were reported by 17% of the men who had had prostatitis at some point in their lives, and 4% were convinced that their illness had caused their divorce. Socio‐economic status and social well‐being had no apparent influence on the occurrence of prostatitis.

Conclusions This survey showed that psychological stress is common in men with prostatitis. Urologists and general practitioners should consider that a consultation with a psychiatrist may be appropriate for selected men with prostatitis.
The self‐expanding metallic ureteric stent in the long‐term management of benign ureteric strictures
Authors: Arya M. , Mostafid H. , Patel H.R.H. , Kellett M.J. , Philp T.
Published: March 2003

Objective To evaluate and assess the long‐term complications of using the thermo‐expandable, nickel‐titanium alloy stent (Memokath™ 051, Engineers & Doctors A/S, Hornbaek, Denmark) for managing benign ureteric strictures.

Patients and methods Over a 3‐year period, 13 Memokath stents were inserted in 11 patients (mean age 58 years, range 35–85) with 12 lower ureteric strictures. The cause of the stricture was benign in all cases, i.e. radiation fibrosis in three, retroperitoneal fibrosis, ischaemic uretero‐ileal anastomosis and scarring after ureteroscopy in two each, and diathermy damage, extraluminal endometriosis and stone passage in one each. Four stents were 9 F with proximal expansion to 17 F and the other nine used were 10.5 F with proximal expansion to 20 F. The patients were followed for a mean (range) of 18 (1.5–33) months.

Results No complications or side‐effects occurred with nine stents; four stents were removed at a mean (range) of 16.3 (4–33) months. Three of these had become encrusted, two of which had been placed in patients who had either a history of stone disease or recurrent urinary tract infection. The other stent had migrated.

Conclusion The Memokath stent appears to have a useful role in managing benign ureteric strictures, but it must be closely monitored in patients who are predisposed to encrustation.
Coated catheters for intermittent catheterization: smooth or sticky?
Authors: Fader M. , Moore K.N. , Cottenden A.M. , Pettersson L. , Brooks R. , Malone‐Lee J.
Published: March 2003

Objective To evaluate the current range of hydrophilic‐coated catheters for intermittent self‐catheterization, focusing on the adherence of the catheter to the urethral mucosa at the end of catheterization.

Subjects and methods In a prospective randomized study, 61 community‐based men tested each of four different hydrophilic‐coated catheters available in the UK at the time. Subjects used each of the four test catheters for 1 week in a random order, and were provided with the number and size of catheter they normally used. To assess the products, the subjects: (i) timed seven catheterizations using a stop‐watch to determine the time taken from extracting the catheter from the water‐filled package, to removing the catheter from the penis, having emptied the bladder; (ii) recorded the severity of ‘sticking’ on catheter removal on a three‐point scale (not at all, a little, a lot); and (iii) completed a product‐performance questionnaire.

Results There were no significant differences in ratings of ‘sticking’ between the ‘Easicath’ and ‘Lofric’ (P > 0.05), but there were significant differences between these two products and the ‘Aquacath’ and the ‘Silky’, which were found to ‘stick’ more (P < 0.001). The ‘Silky’ was reported to stick significantly more than the ‘Aquacath’ (P < 0.001).

Conclusions Adherence to the urethral mucosa on catheter removal was a common problem, occurring with all catheters, but two products were significantly more likely to stick than the other two. The clinical importance of ‘sticking’ and the long‐term implications are currently unknown. The relative ‘sticking’ of uncoated catheters has also not been established.
The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra
Authors: Andrich D.E. , Leach C.J. , Mundy A.R.
Published: March 2003

Objective To compare the surgical outcome using buccal mucosal free grafts in the Barbagli procedure (dorsal stricturotomy and patch technique) with the traditional ventral approach, for long bulbar urethral strictures.

Patients and methods Over a period of 6 years, a total of 71 patients with bulbar urethral strictures underwent buccal mucosal graft urethroplasty. Twenty‐nine patients had a traditional ventral urethroplasty and 42 were managed by the Barbagli procedure with the stricturotomy and patch on the dorsal aspect of the urethra.

Results At 5 years of follow‐up 5% of patients who underwent the Barbagli procedure developed recurrent strictures, compared to 14% in the traditional ventral stricturotomy group. All patients developed postmicturition dribble of urine to some degree, which was troublesome in 17% in the Barbagli group and 21% in the ventral stricturotomy group. Complications attributable to out‐pouching of the graft were not seen in either group.

Conclusions The dorsal stricturotomy and patch (Barbagli) procedure had a higher success rate than the traditional ventral urethroplasty. Comparing these results with our experience of skin inlay urethroplasty, buccal mucosal grafts seem to have advantages however they are used.
Renal calcium phosphate and oxalate deposition in prolonged vitamin B6 deficiency: studies on a rat model of urolithiasis
Authors: Di Tommaso L. , Tolomelli B. , Mezzini R. , Marchetti M. , Cenacchi G. , Foschini M.P. , Mancini A.M.
Published: March 2003

Objective To determine the effect on kidney oxalate‐salt deposition of a prolonged diet which induced vitamin B6 deficiency in adult rats, as there are reports of the pathogenic involvement of vitamin B6 deficiency in the formation of renal calcium oxalate calculi.

Materials and methods The study comprised 24 6‐month‐old male albino Wistar rats; 12 were fed with a purified vitamin B6‐deficient diet and the others provided with the same diet but supplemented with 6 mg/kg of vitamin B6. After 12 weeks, all rats were killed, and their kidneys fixed in formalin and routinely processed to paraffin for morphological examination; some fragments were fixed in glutaraldehyde and prepared for ultrastructural examination. From each rat consecutive sections of both kidneys were cut and stained with haematoxylin and eosin, periodic‐acid Schiff, Sirius red and the Von Kossa method for calcium. Sections were examined in polarized light and by electron microscopy.

Results The histopathological and ultrastructural features of the kidney of vitamin B6‐deficient rats were those of tubular‐interstitial nephritis, characterized by tubular atrophy, interstitial fibrosis and chronic inflammatory infiltration. Oxalate and phosphate crystals were present in the papillary and parenchymal connective tissue. Ultrastructural features confirmed severe tubular epithelial lesions and the presence of an interstitial and intraepithelial inflammatory infiltrate; there was mild interstitial fibrosis. None of these features were apparent in the kidney of control rats.

Conclusions Histopathological and ultrastructural data indicate that a prolonged vitamin B6‐deficient diet may contribute to the formation and deposition of calcium phosphate and oxalate crystals, which lead to severe damage of the renal parenchyma. This phenomenon may occur not only in growing rats, which have more active protein metabolism and consequently higher vitamin B6 requirements, but also in adult rats.
Does site‐specific labelling and individual processing of sextant biopsies improve the accuracy of prostate biopsy in predicting pathological stage in patients with T1c prostate cancer?
Authors: Tombal B. , Tajeddine N. , Cosyns J.‐P. , Feyaerts A. , Opsomer R. , Wese F.X. , Van Cangh P.J.
Published: March 2003

Objective To evaluate whether individual labelling and processing of the sextant of origin improves the accuracy of prostate biopsy in predicting the final pathological stage after radical prostatectomy in patients with T1c prostate cancer.

Patients and methods The charts of 386 patients treated for prostate cancer by radical prostatectomy between January 1996 and June 1999 were reviewed. In all, 124 patients fulfilled the following inclusion criteria: no abnormality on digital rectal examination (DRE) or transrectal ultrasonography, a prostate specific antigen (PSA) level before biopsy of  20 ng/mL, and prostate cancer diagnosed after one set of random sextant biopsies, with the cores being submitted in six separate containers individually labelled for the sextant of origin.

Results Within this series of patients with a low tumour burden, the preoperative PSA, biopsy Gleason score and unilateral vs bilateral involvement were not significant predictors of disease extension. The percentage of positive cores and the number and topography of positive sextants were both statistically significant predictors of organ‐confined disease. Although these two variables appeared to be statistically equivalent on a first analysis in the overall series, a subgroup of patients was identified who benefited from the complete topographical information, i.e. those 52 (42%) patients with a Gleason score of < 7, 25–75% positive biopsies and 3 positive sextants.

Conclusion These results support the individual labelling of biopsy cores in selected patients with a normal DRE and a moderately elevated PSA, as it helps to better predict the final pathological stage. This substantial benefit outweighs the additional effort by the pathologist.
Vascular angiographic asymmetry on three‐dimensional transrectal power Doppler ultrasonography in patients with organ‐confined prostate cancer
Authors: Dobrowolski Z.F. , Jaszczynski J. , Drewniak T. , Habrat W. , Kusionowicz J.
Published: March 2003

Objective To assess whether organ‐confined prostate cancer not detected on routine transrectal ultrasonography (TRUS) can be detected using three‐dimensional (3‐D) power Doppler methods.

Patients and methods A preliminary trial of the use of TRUS with 3‐D power Doppler image reconstruction was conducted in 116 patients being evaluated for lower urinary tract symptoms. Using a microbubble enhancing agent, an adequate horizontal plane allowed the simultaneous visualization and assessment of the symmetry of echogenicity and vascularization of the peripheral area of both prostate lobes, which is not possible in standard TRUS. The peripheral zone vascular asymmetry in the horizontal plane was also assessed retrospectively in those patients with pT2a,b prostate carcinoma.

Results Stage pT2a,b prostate carcinoma was confirmed in 26 patients; in this group, two independent investigators confirmed the vascular asymmetry between the left and right peripheral zone, in the horizontal plane, in 22 patients, giving a sensitivity of 85%.

Conclusions Vascular asymmetry allows guided biopsy in lesions that are invisible using standard TRUS. Microbubble agents are an effective method of increasing the acoustic signals from small vessels of the prostate.
Does the tension‐free vaginal tape procedure affect the voiding phase? Pressure‐flow studies before and 1 year after surgery
Authors: Sander P. , Møller L.M.A. , Rudnicki P.M. , Lose G.
Published: March 2003

Objective To evaluate the voiding phase before and 1 year after surgery in women who underwent a tension‐free vaginal tape (TVT) procedure for stress incontinence.

Patients and methods The study comprised 45 women with genuine stress urinary incontinence. To assess the voiding phase, patients were asked if their voiding had changed after surgery, and objectively the uroflowmetry, residual urine measurements and pressure‐flow data were compared.

Results At 1 year after surgery 39 women (87%) were subjectively cured and six (13%) improved. The objective cure rate was 88%; the pad‐test leakage and the number of leakage episodes decreased significantly after surgery. Subjectively, 78% of the patients reported that the voiding phase had become more difficult, and the spontaneous flow curve changed to a more obstructive pattern in 40%, with the mean urinary peak flow rate (Qmax), the corrected Qmax and the mean average flow rate decreasing significantly. The residual urine volume increased significantly, although no patient had volumes of > 25% of their bladder capacity. During the pressure‐flow study the Qmax decreased and the urethral resistance factor increased significantly. However, only one patient could be classified as obstructed. Two patients had clinical problems and used self‐catheterization once daily 1 year after surgery.

Conclusion There were subjective and objective changes in the voiding phase 1 year after the TVT procedure. The significance of these findings remains to be determined. Longitudinal studies are warranted to clarify whether the patients at risk can be characterized from subjective and objective findings.
Effects of the chronic use of finasteride on testicular weight and spermatogenesis in Wistar rats
Authors: Rhoden E.L. , Gobbi D. , Menti E. , Rhoden C. , Telöken C.
Published: March 2003

Objective To evaluate spermatogenesis in rats chronically exposed to finasteride, as the recent use of finasteride in young men to prevent hair loss has raised concerns about chronic use and fertility.

Materials and methods Male Wistar rats (4 months old) were selected and divided into two groups. Group 1 (17 rats) received a finasteride suspension of 2 mg/kg/day in saline solution, 5 days/week for 10 months; group 2 (eight rats of the same age) were treated with placebo for the same period. At the end of the exposure the testes were weighed and processed for histological analysis. Spermatogenesis was evaluated as the mean number of seminiferous tubules with and without spermatozoids in their lumen, in five random fields on the same slide. Student's t‐test was used to assess differences in the groups.

Results In group 1, the mean (sd) weight of the testes was 1.55 (0.29) g and in group 2 1.58 (0.34) g (P>0.05). The histological analysis showed a mean of 13.35 (1.66) seminiferous tubules per field and 1.20 (3.30) tubules with no spermatozoids in group 1; in group 2 the respective values were 13.53 (1.46) and 0.06 (0.14) (P>0.05).

Conclusion Finasteride had no detectable effects on the quantitative and qualitative analysis of spermatogenesis in rats.
Intestinal and renal handling of oxalate in magnesium‐deficient rats. Evaluation of intestinal in vivo14C‐oxalate perfusion
Authors: Straub B. , Müller M. , Schrader M. , Goessl C. , Heicappell R. , Miller K.
Published: March 2003

Objectives To clarify in vivo, using isolated small intestinal loops perfused with radioactive 14C‐oxalate, whether intestinal hyperabsorption or reduced secretion is important in magnesium deficiency (MgD), as this is a potential cause of calcium oxalate urolithiasis.

Materials and methods Twenty‐four Sprague‐Dawley rats were either fed a standard diet (control, 12 rats) or a magnesium‐deficient diet (MgD, 12 rats) for 19 weeks. One hour before the animals were killed, a defined length of a small intestinal loop was isolated and filled with 5 mL of 0.9% NaCl and a defined amount of intravenous 14C‐oxalate applied. Using this method it was possible to determine the secretion of unlabelled oxalate into the intestinal lumen, from the specific activity in plasma.

Results Plasma oxalate levels doubled under MgD; urinary calcium and phosphorus also increased significantly, while urine oxalate tended to decrease. The secretion of oxalate into the intestinal lumen of MgD animals increased significantly, by five times that of the control. The relative supersaturation for calcium oxalate remained constant. Elementary analysis of renal tissue showed an increase in calcium and phosphorus under MgD, in the sense of nephrocalcinosis, but no concretions were detected (no nephrolithiasis).

Conclusion In contrast to earlier studies, there is no evidence that hyperoxaluria is responsible for the possible development of urolithiasis in MgD. This was confirmed by calcium phosphate deposits in renal tissue, even though there was no evidence of oxalate urolithiasis. The increase in plasma oxalate seems to be completely compensated by strongly increased oxalate secretion into the intestinal lumen.
Distal hypospadias: which repair?
Authors: Samuel M. , Capps S. , Worthy A.
Published: March 2003

Objective  To compare the function, complications and cosmesis after a modified Thiersch‐Duplay and Mathieu unstented urethroplasty.

Patients and methods  Over a 5‐year period 381 consecutive patients (not randomized) with distal hypospadias were evaluated. A modified Thiersch‐Duplay with dorsal incised urethral plate tubularization (group A) was undertaken in 170 (45%) and a parameatal based flip‐flap Mathieu hypospadias repair (group B) in 211 (55%). No urinary diversion or stent was used in any of the 381 patients.

Results

 In both groups the mean (
sd
) follow‐up was 3.1 (1.4) years. All 381 patients voided spontaneously after surgery and none developed urinary retention needing catheterization. In groups A and B, respectively, the overall late complications were 12 (7.1%) and 32 (15.2%) (
P

=0.001), with urethrocutaneous fistula in six (3.5%) and 26 (12.3%;
P

=0.001); secondary surgery for fistula repair was successful in all boys in A and 89% in B. The glanular meatus was a vertical slit in all in group A and 86% in B (
P =0.02). In both groups, 71% of the children who are now toilet‐trained and standing to void have a good calibre, single and straight urinary stream in a forward direction.

Conclusions  Stenting or urinary diversion is unnecessary after distal hypospadias surgery. The functional results were good in those standing to void. A more natural vertical slit‐like glanular meatus was easily created using the modified Thiersch‐Duplay urethroplasty, with a lower fistula rate.
An oxalate‐binding protein with crystal growth promoter activity from human kidney stone matrix
Authors: Govindaraj A. , Selvam R.
Published: March 2003

Objective To fractionate renal‐stone matrix proteins, identify the presence of oxalate‐binding protein and assess its effect in a calcium oxalate (CaOx) crystal growth system.

Materials and methods Proteins were isolated from the matrix of kidney stones containing CaOx as the major constituent, using EDTA as a demineralizing agent. The solubilized proteins were subjected to cellulose‐column chromatography by eluting with increasing sodium chloride concentrations in Tris‐HCl buffer. Three protein fraction peaks were eluted, i.e. fraction I in buffer, fraction II in 0.05 mol/L NaCl in buffer and fraction III in 0.3 mol/L NaCl in buffer. The protein fractions were tested for their effects on CaOx crystal growth.

Results All three fractions had maximum CaOx binding activity at pH 7.4 but fraction II also had activity at pH 4.5. Fraction I promoted in vitro CaOx crystal growth, while fractions II and III were inhibitory. When fraction I was further separated on a Sephadex G‐200 column, two protein fractions (Ia and Ib) were obtained. Fraction Ia protein had high and fraction Ib low CaOx‐binding activity. Fraction Ia had a molecular weight of 48 kDa on gel electrophoresis and Western blotting. The 48 kDa protein did not cross‐react with crystal matrix protein antibody, band‐3 protein antibody, or albumin. The protein promoted CaOx crystal growth, with an optimum temperature of 37 °C and pH 6.5. The inhibitory effect of citrate on crystal growth was significantly lower in the presence of the 48 kDa protein. The protein promoted nucleation and aggregation of CaOx crystals in the in vitro crystallization system at pH 6.5, whereas fraction Ib (29 kDa) inhibited both nucleation and aggregation. Using the 48 kDa antibody, the yield of the protein from the stone matrix was 32% by EDTA extraction and only 3% with other methods. The protein was also detected in the nucleus and mitochondria, and in other matrix fractions of calcium phosphate and uric acid stones.

Conclusions The 48 kDa protein isolated from stone matrix is a potent promoter of CaOx crystal growth with high oxalate‐binding activity; it is enriched in the nucleus and mitochondria.