bluuebunny/crossref_metadata_2025 huggingface dataset:
Incontinence aids in Sweden: users and costs
Authors: Samuelsson E. , Månsson L. , Milsom I.
Published: March 2003

Objective To study age‐ and sex‐specific use and costs of incontinence aids distributed free of charge in Sweden.

Subjects and methods The study was conducted in the county of Jämtland, Sweden (132 000 inhabitants). The use and cost of incontinence aids for people living in their homes and the total cost of incontinence aids for residents of special accommodation (e.g. nursing homes, homes for the elderly and sheltered housing) was obtained from a central database constructed for the purpose. Individual usage of incontinence aids by those in special accommodation was studied in two districts of Jämtland, representing 18% of the population.

Results Free incontinence products were used by 6.4% of all women and 2.4% of all men in the county. There was a sharp increase in usage from the age of 75 years. Of the users, 21% lived in special accommodation. If the data from Jämtland are extrapolated nationally, then 274 000 women and 93 000 men in Sweden (total population 8.8 million) are using free incontinence products. The total cost of incontinence aids for Jämtland during 1999 was 15.4 million Swedish krona (SK), and those in special accommodation accounted for 46% of these costs. This corresponds to an estimated total cost in Sweden of ≈ 925 million SK. Although 75% of the users were women, women only contributed 61% of the total costs. The mean annual cost of incontinence aids for an incontinent man was twice that of an incontinent woman. More than half of the costs were attributable to those aged 80 years.

Conclusions The estimated national costs of free incontinence aids accounts for 0.5% of the total costs of Swedish healthcare, including the care and nursing of older and disabled people, and for 0.05% of the gross national product.
A new intravaginal device for stress incontinence in women
Authors: Thyssen H. , Bidmead J. , Lose G. , Møller Bek K. , Dwyer P. , Cardozo L.
Published: March 2003

Objective To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebæk, Denmark) for treating stress incontinence in women.

Patients and methods Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24‐h pad‐test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study.

Results Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side‐effects were few and not serious. The women found both devices easy to prepare, insert and use; two‐thirds preferred the CCT to the CCG.

Conclusion The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior.
Making decisions about treatment for localized prostate cancer
Authors: Steginga S.K. , Occhipinti S. , Gardiner R.A. , Yaxley J. , Heathcote P.
Published: March 2003

Objective To describe the decision‐making processes used by men diagnosed with localized prostate cancer who were considering treatment.

Patients and methods Men newly diagnosed with localized prostate cancer from outpatient urology clinics and urologists' private practices were approached before treatment. Their decision‐making processes and information‐seeking behaviour was assessed; demographic information was also obtained.

Results Of 119 men approached, 108 (90%) were interviewed; 91% reported non‐systematic decision processes, with deferral to the doctor, positive and negative recollections of others' cancer experiences, and the pre‐existing belief that surgery is a better cancer treatment being most common. For systematic information processing the mean (sd, range) number of items considered was 4.19 (2.28, 0–11), with 57% of men considering four or fewer treatment/medical aspects of prostate cancer. Men most commonly considered cancer stage (59%), urinary incontinence (55%) and impotence (51%) after surgery, and low overall mortality (45%). Uncertainty about probabilities for cure was reported by 43% of men and fear of cancer spread by 37%. Men also described uncertainty about the probabilities of side‐effects (27%), decisional uncertainty (25%) and anticipated decisional regret (18%). Overall, 73% of men sought information about prostate cancer from external sources, most commonly the Internet, followed by family and friends.

Conclusions In general, men did not use information about medical treatments comprehensively or systematically when making treatment decisions, and their processing of medical information was biased by their previous beliefs about cancer and health. These findings have implications for the provision of informational and decisional support to men considering prostate cancer treatment.
Artificial urinary sphincter implantation in the irradiated patient: safety, efficacy and satisfaction
Authors: Walsh I.K. , Williams S.G. , Mahendra V. , Nambirajan T. , Stone A.R.
Published: March 2003

Objective To compare the long‐term outcome of artificial urinary sphincter (AUS) implantation in patients after prostatectomy, with and with no history of previous irradiation.

Patients and methods The study included 98 men (mean age 68 years) with urinary incontinence after prostatectomy for prostate cancer (85 radical, 13 transurethral resection) who had an AUS implanted. Twenty‐two of the patients had received adjuvant external beam irradiation before AUS implantation. Over a mean (range) follow‐up of 46 (5–118) months, the complication and surgical revision rates were recorded and compared between irradiated and unirradiated patients. The two groups were also compared for the resolution of incontinence and satisfaction, assessed using a questionnaire.

Results Overall, surgical revision was equally common in irradiated (36%) and unirradiated (24%) patients. After activating the AUS, urethral atrophy, infection and erosion requiring surgical revision were more common in irradiated patients (41% vs 11%; P < 0.05); 70% of patients reported a significant improvement in continence, regardless of previous irradiation. Patient satisfaction remained high, with > 80% of patients stating that they would undergo surgery again and/or recommend it to others, despite previous irradiation and/or the need for surgical revision.

Conclusions Despite higher complication and surgical revision rates in patients who have an AUS implanted and have a history of previous irradiation, the long‐term continence and patient satisfaction appear not to be adversely affected.
Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction
Authors: Androulakakis P.A. , Stephanidis A. , Antoniou A. , Christophoridis C.
Published: March 2003

Objective To assess the outcome of the distal ureteric stump (DUS) after (hemi)nephrectomy with subtotal ureterectomy.

Patients and methods The records of 89 patients (median age 2.7 years, range 0.25–12) who underwent nephrectomy (24) or heminephrectomy (65) with subtotal ureterectomy between 1982 and 1996 were reviewed retrospectively for symptoms caused by the DUS. The mean follow‐up was 9.8 years. Nephrectomy was undertaken for a poorly functioning dysplastic (in nine), scarred (in 10) or hydronephrotic (in five) kidney, and heminephrectomy for a poorly functioning upper moiety associated with ectopic ureterocele (in 26) or stenotic hydroureter (in 15), or for a poorly functioning lower moiety associated with reflux (in 24). There were 38 refluxing and 51 non‐refluxing ureteric stumps. Two additional patients primarily operated elsewhere were referred with DUS symptoms.

Results Only one patient had a symptomatic DUS, with recurrent haematuria and bacteriuria. The two patients referred from elsewhere presented with febrile UTIs. The first had been left with a long refluxing stump opening ectopically into the urethra, and the second with a long stump which was converted from nonrefluxing to a refluxing stump when he developed dysfunctional voiding. Surgical excision of the distal stump was curative in each case.

Conclusions The risk of a symptomatic DUS in patients who undergo subtotal ureterectomy in conjunction with (hemi)nephrectomy is very low, with no difference between refluxing and nonrefluxing stumps. Long ureteric stumps and dysfunctional voiding may cause symptoms. Because of the low morbidity associated with a short ureteric stump, we recommend subtotal ureterectomy in children who undergo (hemi)nephrectomy for reflux, vesico‐ureteric obstruction or ectopic ureterocele associated with a poorly functioning kidney or kidney moiety.
Synergistic effects of sildenafil on relaxation of rabbit and rat cavernosal smooth muscles when combined with various vasoactive agents
Authors: Seo K.K. , Kim S.C. , Jun I.O. , Oh M.M. , Lee M.Y.
Published: March 2003

Objective To evaluate which vasoactive agents have synergistic effects on the cavernosal smooth muscles of rabbits and rats when the agents are combined with sildenafil.

Materials and methods Relaxation responses of cavernosal smooth muscle to single agents (phentolamine, moxisylyte, sodium nitroprusside, forskolin, vasoactive intestinal peptide, VIP, papaverine and sildenafil) in the rabbit, and prostaglandin‐E1 and sildenafil in the rat, and to combinations of each agent plus sildenafil, were assessed in vitro. The response to sildenafil of the rabbit strips with and without incubation with l‐arginine (1 mmol/L) for 20 min was also evaluated. The effective concentrations for a half‐maximal response of single agents and combination solutions were compared.

Results All single agents induced concentration‐dependent relaxation of the rabbit and rat cavernosal smooth muscles. There was significant synergism on rabbit cavernosal smooth muscle when the sildenafil was combined with forskolin, sodium nitroprusside, VIP or phentolamine. There was also significant synergism with sildenafil plus prostaglandin‐E1 in rat cavernosal muscles. There were no synergistic effects of combinations of sildenafil plus moxisylyte, papaverine or l‐arginine.

Conclusions These results suggest potentially effective combined therapies of sildenafil and intraurethral or intracavernosal prostaglandin‐E1, intracavernosal forskolin or VIP, or oral phentolamine for patients with erectile dysfunction who have no success after monotherapy with these agents.
The effects of a selective noradrenaline reuptake inhibitor on the urethra: an in vitro and in vivo study
Authors: Bae J.H. , Moon D.G. , Lee J.G.
Published: March 2003

Objective To identify the effects of a selective noradrenaline reuptake inhibitor (venlafaxine) on urethral perfusion pressure (UPP) in rabbits and rats, and thus assess its therapeutic potential for treating stress urinary incontinence.

Materials and methods Strips of bladder and proximal urethra were prepared from female New Zealand White rabbits. Each strip was electrically stimulated and the contractile responses of controls strips compared with those after pretreatment with venlafaxine (100 µmol/L). In separate experiments using 80 adult female Sprague–Dawley rats (250–300 g), changes in intravesical pressure and UPP after the intra‐arterial and intra‐urethral administration of phenylephrine, phentolamine, fluoxetine and venlafaxine were monitored using double‐lumen catheters.

Results Pretreatment with venlafaxine significantly decreased the contraction of bladder strips (P = 0.01) and significantly increased the contraction of urethral strips (P = 0.008). In vivo, phenylephrine administered by both routes significantly increased UPP (P = 0.02); phentolamine (arterial) significantly decreased UPP (P = 0.001); fluoxetine (arterial) had no effect on UPP, and venlafaxine (both routes) significantly increased UPP (both P < 0.001). The intravesical pressure was not changed significantly in any animal.

Conclusions Venlafaxine effectively increased UPP both in vitro and in vivo; these results imply that venlafaxine may be useful for treating stress urinary incontinence, by increasing the UPP.
Molecular identification of Oxalobacter formigenes with the polymerase chain reaction in fresh or frozen fecal samples
Authors: Kwak C. , Jeong B.C. , Lee J.H. , Kim H.K. , Kim E.C. , Kim H.H.
Published: March 2003

Objective To develop a simple and rapid polymerase chain reaction (PCR) method for detecting Oxalobacter formigenes (which degrades oxalate in the gut) in fecal specimens from healthy volunteers and patients with urolithiasis, and to determine whether O. formigenes can be detected in frozen or fresh fecal samples.

Materials and methods Whole bacterial DNA was isolated directly from fresh and frozen fecal samples obtained from 30 healthy volunteers free from urolithiasis and from fresh fecal samples obtained from 38 patients with urolithiasis. Genus‐specific oligonucleotide sequences were designed, corresponding to homologous regions residing in the oxc gene that encodes for oxalyl‐coenzyme A decarboxylase. A PCR‐based assay was used on both fresh and frozen fecal samples, and the nucleotide sequences analysed to confirm oxc.

Results A PCR product of 416 bp encoding the oxc gene was detected in 23 (77%) of 30 healthy volunteers free from urolithiasis and in 14 (37%) of 38 patients with urolithiasis. In healthy volunteers, the results of PCR for the fresh and the frozen samples were identical in each subject. The nucleotide sequence analysis showed that the sequence of the amplified product was compatible with that of oxc.

Conclusion
O. formigenes can be identified easily and efficiently using this PCR‐based detection system. The colonization rate of O. formigenes in patients with urolithiasis was significantly lower than that in healthy volunteers known to be free from urolithiasis. Furthermore, as the PCR‐based assay results in the frozen fecal samples were identical to those from fresh samples in each subject, immediate processing of fecal samples may not be necessary to detect O. formigenes in the clinical setting.
The value of multiple core biopsies for predicting the Gleason score of prostate cancer
Authors: Egevad L. , Norlén B.J. , Norberg M.
Published: March 2003

Objective To evaluate the accuracy of Gleason grading of prostate cancer in multiple core biopsies, compared with the final Gleason score of total prostatectomy specimens, and to investigate whether the prediction of the correct Gleason score is improved by increasing the number of biopsies.

Patients and methods Before total prostatectomy, 121 men had a mean (range) of 10.0 (8–14) transrectal ultrasonography (TRUS)‐guided core biopsies taken from the apex, mid‐medial, mid‐lateral and basal regions, from the transition zone and from lesions detected on TRUS. The biopsies and prostatectomy specimens were reviewed and the Gleason scores assessed.

Results The preoperative biopsies predicted the prostatectomy Gleason score exactly in 45.5% of the patients and within one Gleason score in 93.4%. The biopsies under‐graded the prostate cancer in 38.8% and over‐graded it in 15.7%. The weighted kappa value for exact agreement was 0.502. If one biopsy was positive for cancer, the prostatectomy Gleason score was predicted correctly in 43.8% and within one score in 93.8%, compared with 53.8% and 92.3%, respectively, if cancer was found in at least seven biopsies. If the mid‐lateral and transition zone biopsies had been excluded from the biopsy protocol, 5% of the cancers would have been undetected. Among the remaining 115 cancers, grading accuracy only improved from 43.5% to 45.2% by adding biopsies to the sextant protocol.

Conclusion Despite a statistically significant agreement between biopsy and prostatectomy Gleason score, under‐grading remains a major problem. The prediction of the prostatectomy Gleason score is only marginally improved by increasing the number of biopsies.
α‐catenin expression pattern and DNA image‐analysis cytometry have no additional value over primary histology in clinical stage I nonseminomatous testicular cancer
Authors: Spermon J.R. , De Wilde P.C. , Hanselaar A.G.J.M. , Schaafsma H.E. , Ruijter T.E.G. , Witjes J.A. , Van Moorselaar R.J.A.
Published: March 2003

Objective To determine whether the α‐catenin expression pattern and DNA content have additional value over primary tumour histology, including information on vascular invasion and tunica albuginea invasion, in detecting occult metastasis in patients with clinical stage I nonseminomatous germ cell tumours of the testis (NSGCT).

Patients and methods Fifty consecutive patients with clinical stage I NSGCT underwent retroperitoneal lymphadenectomy (RPLND) between 1986 and 1992. The orchidectomy specimens were histopathologically reviewed and immunohistochemically stained with mouse monoclonal anti‐α‐catenin antibody. The presence of an aberrant or negative staining in >10% of the malignant cells was defined as abnormal; in all other cases tumours were classified as normal. Furthermore, intact nuclei were isolated from 50 µm thick paraffin sections of the primary tumour, Feulgen stained, and analysed with an image‐analysis system.

Results Of the 50 patients, 14 had positive retroperitoneal nodes (stage IIa, 28%), one pathologically staged I patient developed a lung metastasis (stage IV) within 3 months of RPLND. Univariate analysis showed that the presence of embryonal cell carcinoma, vascular invasion and tunica albuginea invasion were predictive for occult metastases. In multivariate logistic regression analysis only vascular and tunica albuginea invasion were significant. All 11 patients with no embryonal cell carcinoma in the primary tumour were classified as having pathological stage I disease. Also, the tumours which were DNA‐diploid (three) or DNA‐polyploid (two) were pathologically stage I. In screening for occult metastases the DNA content and the α‐catenin expression pattern had no additional value.

Conclusion Vascular and tunica albuginea invasion have prognostic value in identifying patients with clinical stage I NSGCT at high risk for occult retroperitoneal disease. In contrast, the absence of embryonal cell carcinoma could predict all patients at low risk for metastasis. The DNA‐ploidy also identified patients at low risk. Other DNA‐analyses and the α‐catenin expression pattern provided no additional information. Further studies are recommended to identify patients who are at low or high risk for metastasis.
Histological and ultrastructural alterations in an animal model of Peyronie’s disease
Authors: El‐Sakka  , Hassan  , Nunes  , Bhatnagar  , Yen  , Lue
Published: March 2003

Objective

 To determine the role of transforming growth factor beta (TGF‐β), one of the cytokines known to induce tissue fibrosis, in the induction of a Peyronie’s‐like condition, and to produce an animal model for the further study of Peyronie’s disease.

Materials and methods

 Twenty‐four adult male Sprague‐Dawley rats were divided into two groups: in group 1, different concentrations of cytomodulin, a synthetic heptapeptide with TGF‐β‐like activity, were injected into the tunica of each of 18 rats and six rats group 2 received saline injections as a control. The tunical tissues were taken after 3 days, 2 and 6 weeks and were examined histologically using Hart and trichrome stains. Electron microscopy was used to examine the ultrastructural changes in the same tissue samples.

Results

 There were histological and ultrastructural alterations in 15 of 18 rats in group 1 (cytomodulin‐injected), especially in tissue examined after 6 weeks. The most prominent histological changes were chronic inflammatory cellular infiltration, focal and diffuse elastosis, thickening, disorganization and clumping of the collagen bundles. The ultrastructural changes were in the form of densely packed collagen, fragmented and scarce elastic fibres, separation of neuronal fibres by interposing clumps of packed collagen, and perivascular collagen deposition as a part of the reorganization of the interstitial matrix.

Conclusion

 Cytomodulin can induce a Peyronie’s‐like condition in the rat penis, which may explain the role of TGF‐β in the pathogenesis of Peyronie’s disease. With further refinement, such rats may be used as an experimental model for studies of Peyronie’s disease.
Prophylaxis for transrectal prostatic biopsies: a randomized controlled study of intravenous co‐amoxiclav given as a single dose compared with an intravenous dose followed by oral co‐amoxiclav for 24 h
Authors: Bates  , Porter  , Gingell
Published: March 2003

Objective

 To compare in a randomized prospective study the infective complication rates of a single intravenous dose of co‐amoxiclav given alone before transrectal prostatic biopsy with an intravenous dose followed by oral co‐amoxiclav for 24 h.

Patients and methods

 Eighty‐three patients undergoing prostatic biopsy were randomized to receive 1.2 g co‐amoxiclav intravenously and then either three further doses of oral co‐amoxiclav (Group 1) or no further antibiotics (Group 2). The evaluation included analysis of a mid‐stream urine (MSU) sample before and 72 h after biopsy, and the recording of oral temperatures and symptoms in the first 44 patients. Patients with symptomatic urinary tract infections (UTIs), prostatitis, indwelling catheters, diabetes and those receiving steroid therapy were excluded.

Results

 Eight patients, four from each treatment arm, were found to have asymptomatic UTIs from their MSU before biopsy. Excluding these patients, four patients (11%) from Group 1 and six from Group 2 (16%) had positive MSUs at 72 h; two patients from Group 2 and one from Group l required admission to hospital. Of the patients returning symptom and temperature charts, a further six (14%; three from each group) reported signs and symptoms suggestive of infection despite negative urine cultures.

Conclusions

 There was no statistically significant difference in the rate of positive MSUs between the groups. The incidence of infections was considerably higher than in previously published series where other antibiotics were used, suggesting that co‐amoxiclav is not the drug of choice for transrectal prostatic biopsy.
Tissue damage and regeneration of ureteric smooth muscle in rats with obstructive uropathy
Authors: Chuang  , Chuang  , Liu  , Chen  , Huang
Published: March 2003

Objective

 To investigate regeneration in obstructed ureters and to elucidate the role of hyperplasia in the thickening of the smooth muscle layer in the late stages of complete ureteric obstruction.

Materials and methods

 The expression of Ki‐67 antigen, c‐Fos, c‐Jun and c‐Myc in the smooth muscle layer of obstructed ureters was determined using immunohistochemistry in 40 Sprague‐Dawley rats. After unilateral ligation of the ureter, five rats each were killed for examination at 1, 3, 7, 10, 14, 21, 28 and 42 days after ligation; five rats that underwent a sham operation were also examined as controls.

Results

 The severity of hydroureter and thickening of the smooth muscle layer progressed consistently in the ligated ureters, but no mitosis was detected in myocytes within 14 days of ligation. Fibrosis in the smooth muscle layer appeared 21 days after ligation and progressed. There was no expression of Ki‐67 antigen and oncoproteins until 14 days after ligation. The expression of Ki‐67 and c‐Myc increased gradually to a peak after 28 days, then declined. However, the expression of c‐Fos and c‐Jun was low and transient.

Conclusion

 Cell regeneration is impaired in the damaged muscle layer of obstructed ureters. Only hypertrophy and not hyperplasia of the smooth muscle layer developed during the course of complete ureteric obstruction in this rat model of obstructive uropathy.
MN/CA9 gene expression as a potential biomarker in renal cell carcinoma
Authors: Murakami  , Kanda  , Tsuji  , Kanayama  , Kagawa
Published: March 2003

Objective

To compare the levels of MN/CA9 expression with clinicopathological variables in renal cell carcinoma (RCC), and thus evaluate MN/CA9 expression as a possible biomarker for RCC.

Materials and methods

The level of expression of MN/CA9 was evaluated in 76 surgically obtained tissue samples (49 from RCC, 22 from normal kidney and five from oncocytoma) using semiquantitative reverse transcription‐polymerase chain reaction (RT‐PCR) analysis. In RCC, MN/CA9 expression was compared with stage, grade and cell type.

Results

MN/CA9 was expressed in 42 of 49 (86%) RCC samples, but in only two of 22 (9%) normal kidney and none of five oncocytoma samples. Levels of MN/CA9 expression were significantly higher in tumours consisting only of clear cells than in those containing other cell types (P=0.0189), and MN/CA9 was expressed in 34 of 37 (92%) RCC samples consisting only of clear cells. Tumours of low clinical stage showed a striking increase in MN/CA9 expression, and high MN/CA9 expression was associated with a good patient outcome.

Conclusion

These results suggest that MN/CA9 expression is a potential diagnostic biomarker of RCC, especially the clear‐cell type, and can be targeted using molecular biological techniques.
Changing practice in anterior urethroplasty
Authors: Greenwell  , Venn  , Mundy
Published: March 2003

Objective

To describe our experience of penile urethral repair and reconstruction, cataloguing the change in practice from one‐stage flap to two‐stage free graft procedures for anterior urethroplasty.

Patients and methods

Between January 1992 and December 1996, 79 patients underwent anterior urethroplasty. Of the 45 one‐stage bulbar patch urethroplasties, 37 (76%) used buccal mucosal free grafts rather than flaps. Of the 34 penile urethroplasties, 26 (82%) (including all of the circumferential reconstructions) were two‐stage procedures.

Results

Buccal mucosal free grafts were at least as good as local skin flaps for patch urethroplasty and two‐stage repairs gave much better results than one‐stage repairs for total circumferential reconstruction of the penile urethra.

Conclusions

For a patch urethroplasty of an uncomplicated stricture in the bulbar urethra, buccal mucosal free grafts are now the material of choice. For a patch urethroplasty of an uncomplicated stricture in the penile urethra the Orandi procedure remains the ‘gold standard’. For a circumferential repair of the urethra, particularly the penile urethra, a two‐stage repair using a free graft gives better results than a one‐stage repair using a flap.
Noradrenaline and nitrite‐nitrate concentrations in the contralateral testes during ipsilateral spermatic cord torsion in the presence or absence of a testis and epididymis
Authors: Tanyel  , Aydin  , Banoglu  , Isimer  , Büyükpamukçu
Published: March 2003

Objective

To determine the changes occurring during ipsilateral spermatic cord torsion either in the presence or absence of the ipsilateral testis and epididymis, by evaluating noradrenaline and nitrite‐nitrate concentrations in the contralateral testes.

Materials and methods

Forty male albino rats were allocated randomly to one of four equal groups undergoing: group 1, a sham operation; group 2, ipsilateral spermatic cord torsion; group 3, epididymo‐orchidectomy only; and group 4, spermatic cord torsion after epididymo‐orchidectomy. The contralateral testes were harvested after 24 h and the noradrenaline and nitrite‐nitrate contents determined. The levels in each group were compared using the Kruskal‐Wallis and Mann–Whitney U‐tests.

Results

The noradrenaline content of testes from group 2 was significantly lower than in those of groups 1 and 3, but there were no significant differences in content between groups 1 and 3, 1 and 4, and 2 and 4. The content in group 4 was significantly less than that in group 3. There were no significant differences in nitrite‐nitrate contents among any of the groups.

Conclusion

Spermatic cord torsion for 24 h, either in the presence or absence of a testis and epididymis, significantly decreased the noradrenaline content in the contralateral testis. This finding supports the suggestion that the sympathetic system is activated by exposure to noradrenaline in the contralateral testis during ipsilateral spermatic cord torsion, with no dependency on the presence of a testis and epididymis. As the nitrite‐nitrate concentrations were unaffected, nitric oxide seems to have no role in contralateral testicular deterioration.
Renal abnormalities in patients with Kallmann syndrome
Authors: Zenteno  , Méndez  , Maya‐Núñez  , Ulloa‐Aguirre  , Kofman‐Alfaro
Published: March 2003

Objective

To report experience in patients with Kallmann syndrome (KS) in whom urography was used to establish the type and frequency of renal anomalies associated with the disorder.

Patients and methods

Of 19 patients with KS, 15 had the X‐linked recessive form of the disease, whereas the remaining four were sporadic. Each patient underwent intravenous pyelography (IVP) using a non‐ionic, low osmolarity contrast medium.

Results

Of the 19 patients with KS, 10 had kidney abnormalities; four presented with unilateral renal agenesis and six had less severe forms of renal abnormality (renal malrotation in four and bilateral dilatation of the calyces and pelves in two). One of the patients with unilateral renal agenesis carried a deletion in KAL, the gene responsible for the X‐linked type of KS. Three of the four patients with renal malrotation had a confirmed X‐linked recessive form and one carried a point mutation in KAL.

Conclusion

These results suggest that kidney abnormalities are more frequent and diverse in patients with KS than previously reported. They also indicate that defects in the KAL gene may contribute to abnormal renal development. However, a review of the literature revealed no close correlation between KAL mutations and kidney anomalies in the X‐linked type of disease. Taken together, these data suggest that KAL mutations are not invariably associated with failure of renal development and that additional factors (epigenetic or local) may compensate for defects in the KAL protein.
Suprapubic catheterization: a suitable procedure for clinical nurse specialists in selected patients
Authors: Gujral  , Kirkwood  , Hinchliffe
Published: March 2003

Objective

To assess the feasibility and advantages of urology clinical nurse specialists (NSs) extending their professional role to include inserting initial suprapubic catheters in selected patients in the hospital and community setting.

Patients and methods

A urology NS, who is also the district continence adviser, was formally taught by a consultant urologist how to insert suprapubic catheters using the ‘Add‐a‐Cath’ introducer technique (Femcare, UK). Once deemed competent, the NS was indemnified by the Trust to carry out the procedure in carefully selected patients using a safe and unequivocal protocol.

Results

Over a period of 40 months, the NS undertook the procedure in 164 patients, with 64 being catheterized in the community. There were no serious complications in the series and during the period studied, only 17 patients were referred back to the urologists for catheterization under formal theatre conditions.

Conclusion

Initial suprapubic catheterization can be carried out safely by trained NSs in selected patients. This extended professional role has helped to improve the continuity and quality of care for patients who require long‐term catheterization. The NS was also a valuable source of training for junior medical staff who have limited experience with suprapubic catheterization.
Preoperative nested reverse transcription‐polymerase chain reaction for prostate specific membrane antigen predicts biochemical recurrence after radical prostatectomy
Authors: Okegawa  , Nutahara  , Higashihara
Published: March 2003

Objective

To assess the utility of the nested reverse transcription‐polymerase chain reaction (RT‐PCR) method for measuring prostate specific membrane antigen (PSM) and prostate specific antigen (PSA) in predicting serum PSA recurrence after radical prostatectomy.

Patients and methods

Nested RT‐PCRs for PSM and PSA were used in 40 patients who subsequently underwent radical prostatectomy. The accuracy of the RT‐PCR assays in predicting PSA failure was compared with those for the preoperative serum PSA level, Gleason score and final pathological staging. The patients were monitored using a PSA assay (Tandem‐R, Hybritech, San Diego, CA) at 3 weeks after radical prostatectomy and every 2 months thereafter. Biochemical recurrence was defined as a serum PSA level of ≥0.4 ng/mL.

Results

Statistical analysis indicated that the nested RT‐PCR assay for PSM was the most accurate preoperative predictor of potential surgical failure (PCR‐PSM, P<0.001; PCR‐PSA, P=0.018; serum PSA level, P=0.149; Gleason score P=0.388, by Fisher’s exact probability test). Biochemical recurrence was evaluated in relation to these methods during a mean (range) follow‐up of 16.7 (6–35) months. Of the 40 patients, eight (20%, one with organ‐confined cancer and seven with extraprostatic extension of cancer) developed biochemical recurrence. The Kaplan–Meier recurrence‐free actuarial probability curves differed significantly between patients with positive and those with negative results for the preoperative nested RT‐PCR for PSM (P<0.01, generalized Wilcoxon’s test). The nested RT‐PCR for PSA, preoperative serum PSA value and Gleason score were not significant predictors of biochemical recurrence (P=0.16, 0.12 and 0.24, respectively).

Conclusions

The nested RT‐PCR for PSM was the best preoperative predictor of biochemical recurrence among the factors examined.
The long‐term outcome in patients with superficial transitional cell carcinoma of the bladder: a single‐institutional experience
Authors: Haukaas  , Dæhlin  , Maartmann‐Moe  , Ulvik
Published: March 2003

Objective

To determine the natural history of transitional cell carcinoma (TCC) of the bladder, and to identify factors which place patients at lifelong risk of developing progression and dying from bladder carcinoma.

Patients and methods

The long‐term outcome was evaluated retrospectively in 231 patients with superficial bladder TCC, assessed for the first time within a 6‐year period from 1981 to 1986, with a median follow‐up of 108 months. Of 231 patients, 217 (94%) were initially treated by transurethral or segmental resection.

Results

Recurrence developed in 141 of 217 (65%) patients; the duration of the interval free of recurrence was significantly less for patients with initial G3 tumours than that for those with G1 (P<0.01) and for pT1 compared with pTa disease (P<0.01). The disease progressed in 42 of 231 (18%) patients. Differences in the progression‐free interval between patients with G1 and G3 tumours, and with pTa and pT1 disease, were statistically significant (P<0.005 and P<0.001, respectively). In 27 of 231 patients (12%), TCC of the bladder was the cause of death, whilst 118 (51%) died from unrelated causes. There were no deaths among patients with initial pTaG1 tumours, compared with 10 of 26 (38%) deaths in those with pT1G3 disease at presentation.

Conclusion

The long‐term prognosis is good for patients with pTaG1 tumours, whilst pT1G3 is a potentially aggressive disease. Lifelong endoscopic surveillance is mandatory in patients in whom new tumours are very active, at least in those of younger age. Routine cystoscopy can possibly be discontinued in patients with low‐grade, low‐stage disease in whom a low liability of recurrence has been shown during follow‐up.
Bleeding and activation of coagulation during and after transurethral prostatectomy: importance of the acute‐phase response and prostate specific antigen?
Authors: Nielsen  , Gram  , Holm‐Nielsen  , Jespersen
Published: March 2003

Objective

To evaluate the importance of coagulation activation in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP) and to examine whether changes in activity are related to blood loss, the circulatory entry of prostate specific antigen (PSA), operative trauma (resected tissue weight) and the inflammatory response, as assessed by C‐reactive protein (CRP).

Patients and methods

TURP was performed in 24 men and the weight of resected tissue and blood loss determined. The activation of coagulation was followed using new sensitive and specific assays, and the changes related to blood loss, the release of PSA, operative trauma and the acute‐phase response. The area under the curve (AUC) for the measured quantities was used in correlation analysis.

Results

TURP was followed by a marked activation in coagulation. There was no correlation between the markers of coagulation and the operative blood loss, but the latter correlated with the weight of resected tissue (P=0.001). Postoperatively, the blood loss correlated with prothrombin fragment (F1+2 ; P=0.010), with thrombin‐antithrombin complexes (TAT; P=0.024), and with the PSA concentrations (P=0.016) but not with fibrinogen. Serum concentrations of PSA increased significantly and the AUC in the operative period correlated with F1+2 (P=0.003) and TAT (P<0.005), but postoperatively only with F1+2 (P=0.013). The weight of resected tissue correlated operatively with PSA (P=0.012) but not with the concentrations of F1+2 or TAT. Postoperatively, there was a correlation with the acute‐phase proteins, CRP (P=0.005), fibrinogen (P=0.012) and with PSA (P=0.020).

Conclusion

The operative blood loss is caused by surgical factors and the observed postoperative hypercoagulable state can be explained as a physiological response to bleeding, i.e. to secure haemostasis. The activity of coagulation was unrelated to operative trauma, but the acute‐phase proteins were. The release of PSA into the circulation probably has an effect on blood coagulation.
The evaluation of sympathetic system‐related contractile activity of the rat vas deferens after ligation and intra‐abdominal placement of the testis
Authors: Türken  , Yenisehirli  , Onur  , Tanyel
Published: March 2003

Objective

To evaluate the contractile response of the vas deferens in a model of stress, to determine any changes in sympathetic activity as a result of stress in the ipsilateral testis, which decreases blood flow to the contralateral testis.

Materials and methods

The study comprised two groups of six rats each; group 1 underwent a sham operation, and in group 2 the right testis was placed into the abdominal cavity and the vas deferens ligated. After 30 days, the vasa deferentia were resected bilaterally and their isometric contractions recorded. Electrical‐field stimulation (EFS) was applied through a pair of platinum electrodes and concentration‐response curves constructed for noradrenaline at 37°C and to a solution containing 80 mmol/L K+ .

Results

The vasa deferentia in both groups showed similar contractile responses to EFS, which were frequency‐dependent and maximal at 80 Hz. Noradrenaline‐induced contractile activity was lower in amplitude in the vasa deferentia of group 2 than in the contralateral and ipsilateral vasa deferentia of group 1, which were not significantly different from each other. All groups responded similarly to high K+ .

Conclusion

Intra‐abdominal placement of the testes with vas deferens ligation decreased the contractile response to noradrenaline in the ipsilateral vas deferens without altering the contractile response to EFS and high K+ . This difference could be caused by a reduction in the number of postjunctional α‐adrenergic receptors or decreased receptor sensitivity. Both possibilities suggest that the vas deferens may initiate sympathetic activity, which may be responsible for contralateral testicular deterioration.
A double‐blind, randomized, controlled multicentre study to compare the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age
Authors: Eickhoff  , Frimodt‐Møller  , Walter  , Frimodt‐Møller
Published: March 2003

Objective

 To compare the efficacy and safety of ciprofloxacin 500 mg orally twice daily with pivampicillin 700 mg orally twice daily for 10 days in men with acute epididymitis and over 40 years of age.

Patients and methods

The study comprised 172 men who entered a prospective, controlled, randomized, double‐blind, trial of pivampicillin and ciprofloxacin. The median (range) age of the 158 patients eligible for the efficacy analysis was 58 (41–85) years; 41% had previously had a urinary tract infection and 27% had previously had epididymitis. Only one patient had a urethral catheter and 38% were sexually active. About half of the patients were admitted to hospital.

Results

No bacteria could be cultured from samples in 53% of the patients; Escherichia coli could be cultured from 35% and the remaining isolates were the expected urinary pathogens. None of the patients had Gonococci and only one in each group had Chlamydia. Mycoplasma hominis was detected in three patients only and M. genitalium was detected in three, while Ureaplasma was detected in 24 (15%). The treatment failed in 48 patients; in 15 of 76 (20%) receiving ciprofloxacin andin 33 of 82 (40%) receiving pivampicillin. This corresponds to a reduction in the risk of failure of 20.5% (95% confidence limits 6.6–40.2%, P=0.006). The principal cause of failure was an unsatisfactory clinical response requiring changed antibiotic treatment in 27 patients; adverse events were responsible for failure in 14. The in vitro resistance of cultured bacteria was low in both groups, at ≈4%. Adverse events, mainly gastro‐intestinal, occurred in 17 of 83 (21%) patients starting on ciprofloxacin and in 33 of 89 (37%) receiving pivampicillin (P=0.04).

Conclusion

For epididymitis in men over the age of 40 years ciprofloxacin 500 mg orally twice daily is more effective than pivampicillin 700 mg orally twice daily. Furthermore, ciprofloxacin has a lower incidence of adverse events.
Testicular prostheses: body image and sexual functioning
Authors: Incrocci  , Bosch  , Slob
Published: March 2003

Objectives

To evaluate retrospectively the body image and sexual functioning in patients who have a testicular prosthesis (TP).

Patients and methods

The medical charts were evaluated for 30 adult patients who received 32 TPs between 1985 and 1997. A questionnaire was mailed to each patient, asking about body image, satisfaction with the implant and with sexual functioning.

Results

Of the 30 patients, 22 (73%) replied; their mean (range) age was 30 (18–47) years. Most of the patients had a silicone gel‐filled TP. No complications were reported in 25 (83%) patients and 80% reported no sexual problems; 20% felt uncomfortable in intimate contacts, 68% found their body image improved after having a TP, 58% were satisfied with their current sexual life, 90% had no erectile dysfunction and 45% reported premature ejaculation.

Conclusions

Patients who have lost a testis for any reason should be informed about the availability of a TP. Prostheses were well accepted and no systemic disease was reported. Almost all patients reported an improvement in their body image. Sexual life and performance were apparently not compromised by having a TP. New surgical procedures are recommended to improve the cosmetic appearance of a TP in the scrotum.
Tubularization of the incised urethral plate (Snodgrass procedure) for primary hypospadias surgery
Authors: Sugarman I.D. , Trevett J. , Malone P.S.
Published: March 2003

Objective

To evaluate the Snodgrass procedure for patients with hypospadias who have not undergone previous surgery and whose urethral plate is too narrow for tubularization alone.

Patients and methods

Thirty‐two boys (mean age 18 months) underwent primary hypospadiac surgery performed by one surgeon (P.S.M.). Twenty‐five boys had a distal hypospadias (coronal, subcoronal) and seven had a more proximal defect (penile shaft, penoscrotal). The operation involved incision of the urethral plate, which was then tubularized (Snodgrass procedure). The neourethra was then covered with a de‐epithelialized pedicled dartos flap from the inner prepuce before glans and skin closure.

Results

With a mean follow‐up of 10 months (range 2–14) there were two complications; one child with a coronal hypospadias developed a fistula whist one with a penile shaft defect had complete breakdown of the neourethra. The cosmetic appearance in the other 30 patients is that of a normal slit‐like terminal meatus.

Conclusion

Tubularization of the incised urethral plate is a safe advance in the surgery of hypospadias. We recommend it for both distal and proximal defects, in patients where the urethral plate is insufficient for tubularization alone.
Analysis of the biological properties and use of comparative genomic hybridization to locate chromosomal aberrations in the human testicular seminoma cell line JKT‐1 and its highly metastatic cell line JKT‐HM
Authors: Jo  , Kinugawa  , Matsuki  , Morioka  , Tanaka
Published: March 2003

Objective

To examine the biological properties, and utility of comparative genomic hybridization (CGH) to locate chromosomal aberrations, in a new human testicular seminoma cell line, JKT‐1, and a highly metastatic cell line, JKT‐HM, developed as an animal model of spontaneous metastasis.

Materials and methods

JKT‐HM was isolated by transplanting cells of JKT‐1 into the dorsal skin of nude mice, using methods developed previously. The biological properties of JKT‐1 and JKT‐HM cells were examined using assays of cell proliferation and in vitro tumour cell invasion, and the DNA index (by flow cytometry). CGH was used to analyse chromosomal aberrations and to detect chromosomal regions causing metastasis in the testicular seminoma cell lines.

Results

The JKT‐1 and JKT‐HM cells showed no difference in morphology or cell proliferation. After transplanting JKT‐HM into mice, the cells metastasized to the lung and lymph nodes in all five mice by 50 days. The in vitro tumour cell invasion and animal assays suggested potential invasion and metastasis of JKT‐HM. The DNA index was 1.48 for JKT‐1 and 1.50 for JKT‐HM. CGH analysis revealed various chromosomal aberrations undetected by examining their karyotypes, e.g. loss of 18p, Yq and gain of Xq, and the technique has potential to detect genetic aberrations related to metastasis in this model.

Conclusions

The two cell lines JKT‐1 and JKT‐HM, and the metastatic animal model used, were useful in studying human testicular seminoma and the metastatic behaviour of cancer. In addition, CGH was useful for analysing the chromosomes of two different cell lines derived from the same parent line.