bluuebunny/crossref_metadata_2025 huggingface dataset:
Protective effects of cranberries on infection‐induced oxidative renal damage in a rabbit model of vesico‐ureteric reflux
Authors: Han Chang Hee , Kim Soo Hwan , Kang Sung Hak , Shin Ok Ran , Lee Hae Kyung , Kim Hee Jeong , Cho Yong‐Hyun
Published: September 2007

OBJECTIVE

To evaluate the protective effects of cranberry fruit, which have known antioxidant effects, on infection‐induced oxidative renal damage in a rabbit model of vesico‐ureteric reflux (VUR).

MATERIALS AND METHODS

In all, 36 New Zealand male rabbits were divided into five groups, with a sham operation in four rabbits serving as the control (group 1). To create unilateral VUR the roof of the left intravesical ureter was incised, and VUR confirmed 2 weeks after surgery. In all, 32 rabbits with VUR were divided into four groups; 2, VUR alone (with sterile urine); 3, a group infected with Escherichia coli; 4, with intravesical E. coli instillation but fed cranberries; and 5, intravesical E. coli instillation plus an intraperitoneal injection with melatonin group. At 3 weeks after surgery the rabbits were killed, the kidneys obtained and examined histopathologically to evaluate inflammation, fibrosis and tubular changes. Oxidative renal damage was evaluated by measuring malondialdehyde in the renal tissue.

RESULTS

Grossly, the refluxing kidney was larger than the contralateral normal kidney, and the refluxing ureter was dilated and tortuous. Microscopy of tissues from the kidneys in group 3 showed apparent periglomerular mononuclear cell infiltration, tubular dilatation and atrophy, and interstitial fibrosis. The kidneys from groups 2, 4 and 5 showed mild mononuclear cell infiltration with no interstitial fibrosis. The level of malondialdehyde in the kidneys of group 3 was significantly higher than that in group 2, 4 and 5 (P < 0.05); the level in groups 4 and 5 did not differ significantly from that in group 2.

CONCLUSIONS

This study shows that cranberries have an anti‐inflammatory effect through their antioxidant function and might prevent infection‐induced oxidative renal damage. Thus, clinically cranberries might be used as a beneficial adjuvant treatment to prevent damage due to pyelonephritis in children with VUR.
A novel murine model for the study of human renal cryoablation
Authors: Hedican Sean P. , Wilkinson Eric R. , Lee Fred T. , Warner Thomas F. , Nakada Stephen Y.
Published: September 2007

OBJECTIVE

To develop a reproducible, non‐debilitating in vivo murine model of human renal cryoablation using a standard closed argon‐delivery system.

MATERIALS AND METHODS

Custom engineered 2‐mm conical tip cryoprobes for use on the standard argon‐based cryoablation unit (Endocare, Inc. Irvine, CA, USA) were used to create small controllable iceballs (−160 °C) in the mouse kidney. The time to create a 4‐mm cryolesion was compared using a contact vs puncture technique in 10 mice. To show consistency of the induced‐freeze injury, a 4‐mm iceball was created in 20 murine renal units and the time to creation and the size of the resultant cryolesion measured. To investigate lesion regression and histological changes, we created a 4‐mm renal cryolesion in 28 mice and killed four each at 1, 3, 7, 14, 21, 28, and 35 days. The measured coronal cross‐sectional area of the cryoablation site at necroscopy was compared to the initial calculated area as a percentage. To assess renal preservation, blood urea nitrogen (BUN) and creatinine levels at 1 week after cryoablation or sham ablation was compared (10 mononephric mice in each group).

RESULTS

The time to create the desired iceball was 1.9 times quicker using the puncture vs the contact technique. The mean (sd) time to forming a 4‐mm iceball was 35.3 (4.8) s with a mean maximum length of the resultant post‐thaw injury of 5.7 (0.5) mm and a 9% coefficient of variance. Regression analysis of the two‐dimensional cross‐sectional coronal area of the cryolesion showed a statistically significant linear pattern of regression over time (P = 0.037) and classic histological findings. There was no significant difference in the BUN or creatinine levels in mononephric mice 1 week after cryotherapy compared with the sham‐ablated controls.

CONCLUSIONS

We describe a reproducible, non‐debilitating, easily manipulated murine model for the study of human renal cryoablation.
Outcomes using a fourth‐generation lithotripter: a new benchmark for comparison?
Authors: Nomikos Michael S. , Sowter Steven J. , Tolley David A.
Published: September 2007

OBJECTIVE

To evaluate the efficacy of a fourth‐generation lithotripter, the Sonolith Vision (Technomed Medical Systems, Vaulx‐en‐Velin, France) for treating single previously untreated renal calculi, and to compare the results with the reference standard HM‐3 (Dornier MedTech Europe GmbH, Wessling, Germany) in the same population originally studied by the USA Cooperative Study Group in 1986.

PATIENTS AND METHODS

The Sonolith Vision uses an innovative electroconductive shock‐wave generator with an elliptical reflector specially designed to give the maximum concentration of energy on the stone. We reviewed the treatment sessions from our prospectively maintained database of the first 1000 consecutive patients with urinary stone disease who were treated with the Sonolith Vision between September 2004 and March 2006. Patients with previously untreated solitary renal calculi in anatomically normal kidneys were included. The outcome was assessed by plain films for radio‐opaque stones, and renal ultrasonography for radiolucent stones, at 1 and 3 months after lithotripsy; the results were analysed according to stone size and location.

RESULTS

Data from 309 patients who had a complete follow‐up and with 373 renal calculi that matched the above criteria were analysed. The initial fragmentation rate was 94%. The stone‐free rate for stones of <10 mm was 77%, for 11–20 mm was 69% and for >20 mm was 50%. The overall stone‐free rate 3 months after lithotripsy was 75%. Within a month of lithotripsy, 221 patients (59%) became stone‐free. Additional procedures to render patients stone‐free after lithotripsy were needed in only 22 cases (7%). The overall efficiency quotient was 62%. The stone‐free rates for lower, upper, middle calyceal and renal pelvic calculi were 74%, 70%, 78.5% and 75%, respectively. There were no serious complications.

CONCLUSIONS

When similar populations of stone formers were assessed the Sonolith Vision achieved a high success rate, comparable with that using the HM‐3 machine but with lower analgesia requirements and very low re‐treatment rates. This method of comparison belies the commonly held view that newer lithotripters are less effective than the original spark‐gap machines.
Prostate adenocarcinoma detected after high‐grade prostatic intraepithelial neoplasia or atypical small acinar proliferation
Authors: López José I.
Published: September 2007

OBJECTIVE

To review specific histological variables in patients with prostate cancer who previously had diagnoses of high‐grade prostatic intraepithelial neoplasia (HGPIN) and/or atypical small acinar proliferation (ASAP), compared with those who had no such diagnoses.

PATIENTS AND METHODS

The histological characteristics of prostate cancers which were detected after a previous diagnosis of HGPIN and/or ASAP during 1998–2005 were investigated and correlated with the biopsies from patients with prostate cancer but with no such previous diagnoses.

RESULTS

HGPIN was followed by prostate cancer on repeat biopsy in 16.8% of patients, and ASAP in 26.7%. The mean age of patients with HGPIN or ASAP was higher than in those with no such diagnoses (P < 0.001). Similarly, patients with these previous diagnoses had a lower Gleason score (P = 0.017 and <0.001, respectively) and lower tumour volume variables (fewer tumour foci, P = 0.033 and 0.041, respectively) and shorter cancer (P = 0.048 and 0.030) in core biopsies than those without.

CONCLUSIONS

Patients with prostate cancer who had previous biopsies with HGPIN or ASAP were older and has lower grade‐ and volume‐cancers than those who had not.
The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity
Authors: Raina Rupesh , Pahlajani Geetu , Agarwal Ashok , Zippe Craig D.
Published: September 2007

OBJECTIVE

To assess whether early introduction of the Medicated Urethral System for Erection (MUSETM, Vivus Inc., Mountain View, CA, USA) after radical prostatectomy (RP) results in a shorter recovery time for the return to functional erections and successful sexual activity.

PATIENTS AND METHODS

In a prospective study of 91 sexually active men who had a nerve‐sparing RP for prostate cancer, 56 were treated with MUSE (125 or 250 µg three times per week for 6 months) while the remaining 35 had no erectogenic aids, except as necessary when attempting sexual activity. Self‐administration of MUSE was initiated ≈ 3 weeks after RP. Treatment efficacy was analysed by the patient’s response to the Sexual Health Inventory for Men (SHIM) questionnaire.

RESULTS

The mean patient age was ≈ 59 years and the median follow‐up 6 months; the compliance rate was 68%. Patients reported a significant improvement in all domains of the SHIM questionnaire after using MUSE. At the end of 6 months 74% of the patients who remained on MUSE were able to have successful vaginal intercourse. Of patients who completed the 6‐month course of MUSE, half were able to have successful vaginal intercourse by the end of treatment. Most of these patients reported the recovery of spontaneous erections and required no additional erectogenic aids for successful intercourse. They had a mean SHIM score of 18.9. All 56 patients who received MUSE reported mild penile aching or urethral burning, and of these, 32% discontinued treatment. In the untreated control group, 37% regained erections sufficient for vaginal intercourse at the 6‐month follow‐up, with a mean SHIM score of 15.8. Of the control patients who recovered penile function, 71% were dissatisfied with the quality of their erections and sought adjuvant therapy.

CONCLUSIONS

Initiating MUSE shortly after RP is safe and tolerable, and appears to shorten the recovery time to reagin erectile function.
Why potential live renal donors prefer laparoscopic nephrectomy: a survey of live donor attitudes
Authors: Chung Eric , Grant Alexander B.F. , Hibberd Adrian D. , Sprott Phillip
Published: September 2007

OBJECTIVES

To address donor attitudes and reasons for selecting either laparoscopic or open donor nephrectomy (LDN, ODN), as despite the increased interest in laparoscopic procedures, organ donation continues to lag behind the demand for organs, and many new initiatives have failed to reduce the gap.

PATIENTS AND METHODS

This case series comprised a 10‐year review of medical records and a transplant database on donor demographics, analgesic requirements, postoperative complications and length of hospital stay. A structured telephone interview was conducted for all live donors to evaluate donor awareness, reasons for selecting LDN and the psychosocial impact of DN on donors’ rehabilitation.

RESULTS

Between 1995 and 2004, 38 LDN and 38 ODN were carried out; 70% were women in both groups, with a respective mean age of 44.4 and 47.1 years. Three LDNs were converted to ODN due to technical difficulties. The mean operative duration for LDN (194.8 min) was 78 min longer than for ODN (116.8 min). As expected, the mean analgesia requirement and length of hospital stay was less for LDN than ODN, by 55.4 mg of morphine equivalent and 2.3 days. Although all renal donors were aware of the option of LDN, one patient chose ODN due to safety concerns. The primary source of donor information was derived predominantly from the donor assessment process. The main reason for choosing LDN was the earlier return to work (54%), followed by less postoperative pain (33%). In general, there was minimal psychosocial impact after renal transplantation and the overall donor experience was very positive (85%).

CONCLUSION

LDN has remained a safe, less‐invasive but effective technique for allograft procurement, with minimal morbidity. Overall, there is less postoperative pain and fewer surgical complications, and an earlier return to normal functioning. The level of satisfaction with the whole renal donation process was very positive, with minimal psychosocial impact.
The incidence of chronic scrotal pain after vasectomy: a prospective audit
Authors: Leslie Thomas A. , Illing Rowland O. , Cranston David W. , Guillebaud John
Published: September 2007

OBJECTIVE

To assess the extent of scrotal pain in men before and after vasectomy, to produce accurate data for the benefit of men considering this procedure, and hence improved informed consent about the outcomes, as chronic scrotal pain after vasectomy is a poorly quantified clinical problem.

PATIENTS AND METHODS

Between November 2004 and January 2006 nine surgeons carried out vasectomies in 625 men (mean age 39.9 years, sd 5.6) under local anaesthesia. A questionnaire was devised to establish the presence of any scrotal or testicular pain, and to characterize this discomfort; 6 months after the procedure a modified version of the same questionnaire was administered.

RESULTS

In all, 593 (94.7%) men returned the preoperative questionnaires and were entered into the study; 488 (82.2%) of these completed the follow‐up questionnaire, giving a mean (sd) follow‐up of 6.8 (1.6) months. In all, 65 men reported new‐onset scrotal pain at 7 months (14.7%). The mean visual analogue score for this pain was 3.4/10. Four men (0.9%) in the responding group described pain after vasectomy as ‘quite severe and noticeably affecting their quality of life’.

CONCLUSION

At 7 months after vasectomy about 15% of previously asymptomatic men have some degree of scrotal discomfort. These early data indicate that chronic scrotal pain after vasectomy is a genuine entity, but a longer‐term follow‐up in this group will be important to allow further evaluation of how this pain develops with time.
The retroperitoneal laparoscopic Hellström technique for pelvi‐ureteric junction obstruction from a crossing vessel
Authors: Zhang Xu , Xu Kai , Fu Bin , Zhang Jun , Lang Bin , Ai Xing , Wang Baojun , Shi Taoping , Ma Xin
Published: September 2007

Associate Editor

Ash Tewari

Editorial Board

Ralph Clayman, USA

Inderbir Gill, USA

Roger Kirby, UK

Mani Menon, USA

OBJECTIVE

To report our experience with the treatment of pelvi‐ureteric junction obstruction (PUJO) using the retroperitoneal laparoscopic Hellström (RLH) technique to relocate the crossing vessel.

PATIENTS AND METHODS

We used the RLH technique selectively in eight patients with PUJO from an aberrant crossing vessel, according to observations during surgery. The crossing vessel was mobilized and embedded in the generous pelvic wall with 4–0 polyglactin sutures to relieve the PUJO. Follow‐up studies included intravenous urography, ultrasonography and renal functional scintigraphy at 1 month after surgery and every 3 months thereafter.

RESULTS

The mean (range) operative duration was 45 (40–60) min; the blood loss was negligible. Crossing vessels were identified to be anterior to the renal pelvis in two patients and posterior in six. The hospital stay after surgery was 5 (4–7) days. No paregoric was required after surgery. The collecting systems were intact and no JJ stent was required in any patient. The mean (range) follow‐up was 13.6 (12–15) months. In all patients the obstruction was resolved or significantly improved, and there were no complications, e.g. urine leakage and infection. A long‐term follow‐up is mandatory.

CONCLUSIONS

The RLH technique is a minimally invasive alternative for patients with PUJO caused by a crossing vessel. Embedding the crossing vessels in the pelvic wall is feasible and safe for such patients; empirical judgement during surgery is prudent for success.
Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique
Authors: Simforoosh Nasser , Aminsharifi Alireza , Tabibi Ali , Fattahi Mohammadreza , Mahmoodi Hossein , Tavakoli Mahmmoud
Published: September 2007

OBJECTIVES

To report a novel approach to overcome the problems associated with a short right renal vein harvested by clipping the vein during right laparoscopic donor nephrectomy (RLDN).

PATIENTS AND METHODS

This prospective study included 32 donors and their recipients; all donors had transperitoneal RLDN. The right renal artery and vein were ligated by Hem‐o‐lok and titanium clips, which resulted in a very short renal vein (<1.5 cm). When the kidney was positioned inverted in the recipient, the renal vein was placed posteriorly, adjacent to the external iliac vein, making a safe and simple venous anastomosis possible.

RESULTS

All RLDN were completed with no conversion or re‐operation. The mean (range) warm ischaemia time was 9.59 (3–17) min and there was no malfunction of the vascular clips on the major vessels. After a mean follow‐up of 14 months the recipient survival rate was 97%. Graft function was excellent, with a mean (sd) serum creatinine level of 1.35 (0.31) mg/dL at 3 months after surgery, and there was no renal artery or vein thrombosis in any of the grafts. There were two ureteric complications (6%), i.e. one ureterocutaneous fistula resolved by secondary ureteroureterostomy, and one stricture at the site of ureteric anastomosis, which was managed by ureteroneocystostomy.

CONCLUSION

The right renal vein obtained by LDN, after clipping the renal vein, is quite short, but by placing the kidney upside‐down in the right iliac fossa transplantation is possible with no increased incidence of vascular thrombosis. This simple modification might obviate the need for removing a patch from the inferior vena cava, which is a challenging procedure for laparoscopic surgeons during RLDN.
Molecular markers and mortality in prostate cancer
Authors: Concato John , Jain Dhanpat , Li William W. , Risch Harvey A. , Uchio Edward M. , Wells Carolyn K.
Published: September 2007

OBJECTIVE

To evaluate prognosis in prostate cancer by assessing the independent effect of selected molecular factors (e.g. markers of cell‐cycle regulation), in addition to the effect of traditional clinical factors (e.g. anatomical stage, histological grade), in predicting long‐term mortality among men newly diagnosed with prostate cancer.

PATIENTS AND METHODS

In a community‐based population of 64 545 USA veterans aged ≥ 50 years and receiving ambulatory care during 1989–90 at nine Veterans Affairs (VA) medical centres in New England, 1274 had incident prostate cancer during 1991–95. We obtained the medical records and diagnostic tissue for these men, and then extracted demographic data and clinical information, and conducted immunohistochemical assays of molecular markers in biopsy tissue, as potential prognostic factors. In this interim analysis, data on 250 patients were analysed; the main outcome was overall mortality to 31 December 2003, providing 8–13 years of follow‐up.

RESULTS

In 228 (91%) patients with available medical record and laboratory data, the median age was 72 years and the median prostate‐specific antigen level was 10.4 ng/mL. In adjusted (multivariate) analyses that included traditional prognostic factors, bcl‐2 staining (hazard ratio 2.14, 95% confidence interval 1.27–3.58, P = 0.004) and high microvessel density (1.76, 1.19–2.60; P = 0.005) had an independent effect on the outcome.

CONCLUSIONS

Bcl‐2 and microvessel density are independent predictors of subsequent death among men with prostate cancer and might have a clinical role in assisting in deciding on treatment.
Effect of autologous blood transfusion on the rate of biochemical recurrence after radical prostatectomy
Authors: Gallina Andrea , Briganti Alberto , Chun Felix K.‐H. , Walz Jochen , Hutterer Georg C. , Erbersdobler Andreas , Eichelberg Christian , Schlomm Thorsten , Ahyai Sascha A. , Perrotte Paul , Saad Fred , Montorsi Francesco , Huland Hartwig , Graefen Markus , Karakiewicz Pierre I.
Published: September 2007

OBJECTIVE

To test the association between autologous blood transfusion (ABT) and biochemical recurrence (BCR) after radical prostatectomy (RP) in a large group of contemporary patients.

PATIENTS AND METHODS

We analysed 1291 patients treated with RP; Kaplan‐Meier analysis was used to graphically explore the association between ABT and BCR. Cox regression models addressed the association between ABT and BCR in univariate and multivariate analyses, after adjusting for preoperative prostate specific antigen level, pathological Gleason sum, extracapsular extension, seminal vesicle invasion and lymph node invasion.

RESULTS

Of all patients, 205 (15.4%) received perioperative ABT. The mean (median, range) follow‐up was 43.2 (40.9, 0.3–145) months. BCR was recorded in 347 (26.9%) patients and the time to BCR was 25.2 (20.5, 0.3–107) months. Neither in univariate (P = 0.053) nor in multivariate (P = 0.2) Cox regression analyses was ABT a statistically significant or independent predictor of BCR.

CONCLUSION

Perioperative ABT does not predispose to a higher rate of BCR in patients after RP.
Effect of letrozole on urinary bladder function in the female rabbit
Authors: Lin Wei‐Yu , Rehfuss Alexandra , Whitbeck Catherine , Juan Yung‐Shun , Chichester Paul , Mannikarottu Anita , Levin Robert M.
Published: September 2007

OBJECTIVE

To investigate the effect of letrozole (a potent aromatase inhibitor that effectively inhibit the synthesis of oestrogen) on bladder contraction with changes in morphology and biochemistry.

MATERIALS AND METHODS

Sixteen female New Zealand white rabbits were separated into four equal groups; groups 1–3 were given oral letrozole for 1, 2 and 3 weeks, and group 4 was given saline and served as the control group. At the end of the medication period each rabbit was anaesthetized and the bladder muscle strips were used for contractile, histological and biochemical studies.

RESULTS

The concentration of serum oestrogen was significantly lower and testosterone was significantly higher in letrozole‐treated rabbits than in the control group. The rabbits treated for 1 week with letrozole showed significant decreases in the contractile responses to electrical field stimulation, ATP and carbachol, but not to KCl. Contractility returned to normal in the rabbits treated for 2 and 3 weeks. Letrozole resulted in an increased volume percentage of collagens and decreased bladder compliance. The volume percentage of the smooth muscle component also changed, with a significant decrease at 1 week and then a gradual increase at 2 and 3 weeks. Contractile dysfunction was absent at 2 and 3 weeks, which was consistent with no change in sarcoplasmic reticulum Ca2+‐ATPase content or mitochondrial function.

CONCLUSIONS

The bladder contractility decline in the first week and was restored at 2 and 3 weeks. The present study unexpectedly showed the possibility that testosterone might be as important as oestrogen in the contractile function of the female bladder.
A validated mouse model for orthotopic bladder cancer using transurethral tumour inoculation and bioluminescence imaging
Authors: Hadaschik Boris A. , Black Peter C. , Sea Jason C. , Metwalli Adam R. , Fazli Ladan , Dinney Colin P. , Gleave Martin E. , So Alan I.
Published: September 2007

OBJECTIVES

To describe a technique for transurethral tumour inoculation, bioluminescence imaging (BLI) and validation of this approach using ex vivo magnetic resonance imaging (MRI), as a reproducible and quantifiable model of orthotopic bladder cancer is required to enable preclinical pharmacological studies of intravesically administered anticancer agents and the use of BLI provides a sensitive method to monitor tumour growth over time.

MATERIALS AND METHODS

Human KU‐7 bladder tumour cells were transduced with a lentiviral construct to stably express the firefly luciferase gene. These cells were then inoculated in female nude mice by intravesical instillation. BLI was performed weekly and the mice were killed after 4 weeks. Ex vivo MRI and whole‐mount step‐sections were obtained to assess bladder tumour volume.

RESULTS

KU‐7 tumour cells were highly tumorigenic and were successfully inoculated in 96% of mice. After 4 weeks, all tumours were confined to the mucosa and submucosa (≤pT1). There was an excellent correlation between tumour volume and BLI for both ex vivo bladder MRI (R2 = 0.929) and end‐point histological measurements (R2 = 0.836).

CONCLUSIONS

We have established and validated a reliable model of orthotopic bladder cancer that can be used to evaluate various methods of intravesical therapy. BLI allows excellent longitudinal surveillance and quantification of tumour burden.
A 10‐year retrospective audit of penile cancer management in the UK
Authors: Mistry Tina , Jones Rob W.A. , Dannatt Erica , Prasad Krishna K. , Stockdale Andrew D.
Published: September 2007

OBJECTIVE

To audit the penile cancer workload, management and outcome within a regional cancer network serving a population of ≈ 1 million in the West Midlands (UK), comparing these data to that published by the British Association of Urological Surgeons National Cancer Registry, the UK National Institute of Clinical Excellence and the European Associations of Urology guidelines.

PATIENTS AND METHODS

Patients diagnosed with or treated for penile cancer within the Arden Cancer Network over a 10‐year period were identified retrospectively, and data relating to histology, local treatment, lymph node management, outcome and survival were recorded.

RESULTS

Data were obtained for 65 patients; 61 (94%) had histologically confirmed squamous cell carcinoma (SCC) of the penis, equating to ≈ 0.6 cases per 100 000 population per year. Their mean age at diagnosis was 63 years. Of SCCs, 86% were located on the glans and/or foreskin. Thirty‐six patients had conservative primary local therapy, mostly for T0 or T1 disease. The 5‐year relapse‐free survival after radiotherapy was 63%, although survival after salvage penectomy was 75% at 4 years. Forty‐seven patients had lymph node surveillance; 11 developed lymph node disease and had lymph node dissection (LND) with or with no radiotherapy, but survival was poor. Primary inguinal LND with or without radiotherapy was used in eight patients, and was associated with a good survival, although three were found to have negative histology after LND. Survival was strongly influenced by T and N stage at presentation and the 5‐year survival for the whole group was 71%.

CONCLUSION

The workload, incidence and overall mortality from penile cancer within the Arden Cancer Network are in line with those in the rest of the UK. Rates of conservative therapy were good in this group and associated with good survival. Survival could be improved by identifying and aggressively treating those patients at high risk of lymph node disease.
The outcome with ureteric stents for managing non‐urological malignant ureteric obstruction
Authors: Jeong In Gab , Han Kyung Seok , Joung Jae Young , Seo Ho Kyung , Chung Jinsoo
Published: September 2007

OBJECTIVE

To investigate the clinical outcome using ureteric stents to manage ureteric obstruction in advanced non‐urological malignancies.

PATIENTS AND METHODS

We retrospectively reviewed the use of ureteric stents (Endo‐sof, Cook Urological, Spencer, IN, USA) placed for malignant ureteric obstruction from June 2001 to September 2006. The clinical and radiological variables for predicting the failure of stent insertion, functional stent failure and death were analysed.

RESULTS

In all, 86 patients with a non‐urological malignant ureteric obstruction were treated by ureteric stenting; 13 (15%) had failure of retrograde stent insertion, and of the remaining 73, 12 (16%) had stent failures during the subsequent follow‐up. The risk of failure for stent insertion significantly increased with male gender (hazard ratio 6.45, P = 0.028) and the presence of bladder invasion (hazard ratio 27.04, P < 0.001). There was no independent predictor of stent failure in univariate analysis. Of the 86 patients, 54 (63%) died with a mean survival time of 8.6 months after an initial attempt to place a stent, and 41 (48%) died within 1 year. Multivariate analysis showed that low performance status, upper ureteric obstruction and no chemotherapy after stenting were independently associated with a poor prognosis (P = 0.03, 0.004 and 0.003, respectively).

CONCLUSION

The method of diversion for a malignant ureteric obstruction should be carefully discussed with male patients or if there is bladder invasion. Patients with a low performance status, upper ureteric obstruction and no scheduled chemotherapy after stenting had a poor survival time.
Lack of prognostic significance of prostate biopsies in metastatic androgen independent prostate cancer
Authors: Aragon‐Ching Jeanny B. , Gillespie John , Price Douglas K. , Chuaqui Rodrigo , Rodriguez‐Canales Jaime , Steinberg Seth M. , Dahut William L. , Figg William D.
Published: September 2007

OBJECTIVE

To assess the significance of viable tumour in the prostate of patients with metastatic androgen‐independent prostate cancer (AIPC).

PATIENTS AND METHODS

We evaluated the clinicopathological features, including follow‐up, of 40 men with metastatic AIPC who had a transrectal biopsy of the prostate.

RESULTS

Prostate biopsies (median three cores per biopsy) showed viable tumour in 19 of 40 patients (48%). Of the 18 patients who had received radiotherapy (RT), nine had negative on‐study biopsy results. A previous history of RT was not associated with overall survival in patients with biopsy‐positive tumours (P = 0.84). Also, there was no statistically significant association between positive or negative biopsy status and overall survival (OS) in these 40 patients (P = 0.39), with a similar median OS of 19.6 months for biopsy‐negative and 19.8 months for biopsy‐positive patients, respectively.

CONCLUSIONS

Taking prostate biopsies at the time of documented metastatic AIPC yielded tumour in about half the patients. A previous history of RT was not associated with a negative prostate biopsy; the latter appears to have no influence on the prognosis.
The influence of prostate volume on prostate cancer detection using a combined approach of contrast‐enhanced ultrasonography‐targeted and systematic grey‐scale biopsy
Authors: Colleselli Daniela , Bektic Jasmin , Schaefer Georg , Frauscher Ferdinand , Mitterberger Michael , Brunner Andrea , Schwentner Christian , Bartsch Georg , Horninger Wolfgang , Pelzer Alexandre E.
Published: September 2007

OBJECTIVE

To evaluate the influence of prostate volume (PV) on the detection of prostate cancer using a combined approach of contrast‐enhanced ultrasonography (CEUS) and grey‐scale US‐guided systematic biopsy (SB).

PATIENTS AND METHODS

We evaluated 345 patients with prostate cancer and a total prostate‐specific antigen (PSA) level of ≥ 1.32 ng/mL (1.32–35.3, mean 6.6). Biopsies were taken by two independent examiners; one took five CEUS (Doppler) targeted biopsies of hypervascular regions in the peripheral zone, and subsequently the other took 10 systematic prostate biopsies. We assessed the cancer detection rates for the five different subgroups of prostate volumes, i.e. <20, 20–30, 30–40, 40–50 and > 50 mL.

RESULTS

Each technique, SB and CEUS, detected 73.4% and 77.1% of all detected cancers, respectively, but there were statistically significant differences in detection rate only in small glands. Only 69.0% and 70.4% of all cancers were detected by SB in glands of <20 and 20–30 mL, respectively, whereas 88.1% and 80.8% were detected by CEUS.

CONCLUSION

The prostate cancer detection rate for CEUS was significantly higher in prostates of <30 mL (48.1% of the study population) than for SB. Therefore the combined approach of CEUS and SB allows improved cancer detection in patients with small glands and low total PSA values.
Prostate‐specific antigen velocity in untreated, localized prostate cancer
Authors: Venkitaraman Ramachandran , Norman Andrew , Woode‐Amissah Ruth , Dearnaley David , Horwich Alan , Huddart Robert , Parker Chris
Published: September 2007

OBJECTIVE

To report the results of a prospective study of active surveillance of untreated prostate cancer, with a focus on baseline predictors of prostate‐specific antigen (PSA) velocity, as PSA velocity before treatment is an important predictor of prostate cancer mortality, and patients on active surveillance are monitored for several years to estimate the PSA velocity and thus select patients for radical treatment.

PATIENTS AND METHODS

A prospective study of active surveillance for localized prostate cancer opened at the Royal Marsden Hospital in 2002. Eligible patients had clinical stage T1/T2a, N0/Nx, M0/Mx adenocarcinoma of the prostate with a serum PSA level of <15 ng/mL, a Gleason score of ≤7 with primary grade ≤3, and less than half the biopsy cores positive. The PSA velocity before treatment was analysed in relation to baseline clinical characteristics.

RESULTS

In all, 237 patients on surveillance were followed for a median of 24 months (median age 67 years; median initial PSA level 6.5 ng/mL; median pretreatment PSA velocity 0.44 ng/mL per year). On multivariate analysis, PSA density (i.e. serum PSA level/prostate volume) was the only significant determinant of PSA velocity (P < 0.001). Patients with a PSA density above or below the median (0.185 ng/mL/mL) had a median (interquartile range) PSA velocity of 0.92 (0.34–1.77) ng/mL per year and 0.35 (− 0.06, 0.80) ng/mL per year, respectively.

CONCLUSIONS

PSA density, which is readily available at the time of diagnosis, is an independent determinant of PSA velocity in untreated, localized prostate cancer. If this is confirmed, PSA density could be used to inform the often difficult choice between active surveillance and immediate radical treatment.
Intermediate‐term prospective results of radiofrequency‐assisted laparoscopic partial nephrectomy: a non‐ischaemic coagulative technique
Authors: Zeltser Ilia S. , Moonat Saurabh , Park Sangtae , Anderson J. Kyle , Cadeddu Jeffrey A.
Published: September 2007

OBJECTIVE

To report the first intermediate‐term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF‐LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney.

PATIENTS AND METHODS

A prospective database was searched to identify patients treated with RF‐LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks. In all, 32 tumours were treated with this approach, and a radiographic follow‐up was completed yearly.

RESULTS

All PNs were accomplished with no hilar clamping, with a mean blood loss of 80 mL; 72% of masses were renal cell carcinoma. There was a positive margin in four masses (13%); 29 tumours (mean size 1.9 cm) were eligible for analysis of oncological outcomes, with a mean follow‐up of 31 months. There were no tumour recurrences at the last follow‐up, giving a cancer‐specific survival rate of 100%.

CONCLUSIONS

RF‐LPN with no hilar clamping simplifies the surgical technique and appears to have excellent cancer control in the intermediate term. In the few patients with a positive surgical margin, it is possible that coagulation beyond the tumour margin kills any residual microscopic tumour, minimizing or obviating the risk of tumour recurrence. Nevertheless, vigilance during tumour excision and margin identification is mandatory.
Anandamide improves the impaired nitric oxide‐mediated neurogenic relaxation of the corpus cavernosum in diabetic rats: involvement of cannabinoid CB1 and vanilloid VR1 receptors
Authors: Ghasemi Mehdi , Sadeghipour Hamed , Dehpour Ahmad R.
Published: September 2007

OBJECTIVE

To investigate the ability of acute administration of the endogenous cannabinoid, anandamide, in vitro to alter the nonadrenegic noncholinergic (NANC)‐mediated relaxation of corpus cavernosum (CC) in diabetic rats and the possible role of nitric oxide (NO), as it is well known that erectile dysfunction (ED) affects 35–75% of men with diabetes mellitus and several studies have been conducted to find appropriate strategies for treating diabetes‐induced ED.

MATERIALS AND METHODS

Diabetes was induced in rats by streptozotocin administration and was maintained for 8 weeks. The CC were removed and isolated in organ baths for pharmacological studies. Agonist‐evoked or electrical‐field stimulation (EFS)‐evoked smooth muscle tensions in CC strips from control and diabetic rats were measured.

RESULTS

The neurogenic relaxation of phenylephrine (7.5 µm)‐precontracted isolated CC strips was impaired in diabetic rats. Anandamide (0.3, 1 and 3 µm) enhanced the relaxant responses to EFS in diabetic CC strips in a dose‐dependent manner. This effect was antagonized by the selective cannabinoid CB1 receptor antagonist AM251 (1 µm) and the selective vanilloid receptor antagonist capsazepine (3 µm). Concurrent administration of partially effective doses of l‐arginine (10 µm) and anandamide (0.3 µm) exerted a synergistic improvement in EFS‐induced relaxation of diabetic CC strips (P < 0.001). The relaxant responses to the NO donor, sodium nitroprusside, were similar between diabetic and control groups.

CONCLUSION

For the first time, we show that acute administration of anandamide, an endogenous cannabinoid, alone or combined with l‐arginine can improve nitrergic nerve‐mediated relaxation of the CC in diabetic rats. This effect was mediated by cannabinoid CB1 and vanilloid VR1 receptors within the CC.
Surveillance of patients with bladder carcinoma using fluorescent in‐situ hybridization on bladder washings
Authors: Bergman Jonathan , Reznichek Richard C. , Rajfer Jacob
Published: September 2007

OBJECTIVES

To compare the sensitivity and specificity of the UroVysionTM (Abbott Laboratories Inc., Downers Grove, IL, USA) fluorescent in‐situ hybridization (FISH) assay to that of urinary cytology obtained from bladder irrigation during cystoscopic surveillance in patients with bladder carcinoma.

PATIENTS AND METHODS

The medical records were retrospectively reviewed for 41 consecutive patients screened at the authors’ institution between August 2000 and December 2006 for recurrence of pathologically confirmed bladder cancer. All 162 cytology examinations and 141 FISH assay results obtained from bladder washing were included. Recurrence was determined by cystoscopy, bladder biopsy and upper‐tract imaging. Sensitivity, specificity, positive predictive and negative predictive values were assessed using a chi‐square distribution with one degree of freedom.

RESULTS

There were 24 men and 17 women (male to female ratio 0.59), the mean (range) age was 56 (33–73) years and the mean follow‐up 30 (2–57) months. At the initial diagnosis, 35 of the 41 patients (85%) had superficial tumours (stage ≤ T1), while six (15%) had muscle‐invasive tumours (stage ≥T2). Twenty‐six (63%) had low‐grade and 15 (37%) had high‐grade tumours. In 16 of 141 (11%) of the FISH assays and 16 of 162 (10%) of the cytological samples that were collected from bladder irrigations, there were too few cells for an adequate analysis. The FISH assay correctly correlated with subsequent cystoscopy, bladder biopsy or upper‐tract imaging in 110/125 (88%) cases but not in 15/125 (12%). Cytology correctly correlated with the subsequent evaluation in 112/146 (77%) cases but did not in 34/146 (23%). When the FISH was compared with cytology in this setting, the sensitivity was 77% (30/39) vs 74% (37/50; P > 0.1), the specificity was 93% (80/86) vs 78% (75/96; P < 0.01), the positive predictive value was 83% (30/36) vs 64% (37/58; P < 0.05), and the negative predictive value was 90% (80/89) vs 85% (75/88; P > 0.1), respectively.

CONCLUSION

The UroVysion FISH assay obtained from bladder washings during cystoscopic surveillance of patients with a history of bladder cancer provides a similar specificity but greater sensitivity than that of cytology for detecting bladder cancer recurrences. Given the better specificity and similar sensitivity of UroVysion compared with urine cytology obtained from bladder washings, a reasonable approach might be to use the UroVysion assay as the primary marker for recurrence, with urine cytology used as a complementary examination.
Frozen section‐guided wide local excision in the treatment of penoscrotal extramammary Paget’s disease
Authors: Zhu Yao , Ye Ding W. , Chen Zhong W. , Zhang Shi L. , Qin Xiao J.
Published: September 2007

OBJECTIVE

To analyse the clinicopathological characteristics of penoscrotal extramammary Paget’s disease (EMPD) and to discuss the outcomes after frozen section‐guided wide local excision.

PATIENTS AND METHODS

From 1990 to 2005, at our institution, 38 patients with penoscrotal EMPD received wide local excision with intraoperative frozen‐section analysis. Their medical records were reviewed for patient demographics, lesion characteristics, surgical margin status, and clinical outcome.

RESULTS

No patients had EMPD secondary to a non‐cutaneous malignancy; 23 patients had intraepithelial EMPD, 12 had invasive EMPD and three had EMPD with underlying adnexal adenocarcinoma. The median (range) largest diameter of the lesion was 6 (1–20) cm. Of 38 patients, 12 (32%) had positive frozen‐section results and had extended surgical excision until a negative margin was obtained. Additional margin examination of the gross specimen and final examination of the frozen sections showed that five patients had false‐negative results. There was a microscopic positive margin in 15 of 38 (40%) patients when a conventional 2 cm clinical tumour‐free border was maintained. Skin erythematous patches were significantly correlated with the spread of disease (P = 0.03). After a median (range) follow‐up of 33.5 (3–140) months, six of 38 (16%) patients had recurrent disease, of whom only two had recurrent skin lesions, while four had systemic progression.

CONCLUSION

Frozen section‐guided wide local excision gave an acceptable recurrence rate in the treatment of penoscrotal EMPD. Primary EMPD with dermal invasion should be actively monitored for possible aggressive behaviour.
The maximum tumour length in biopsy cores as a predictor of outcome after radical prostatectomy
Authors: Hayashi Norihiro , Urashima Mitsuyoshi , Kuruma Hidetoshi , Arai Yoichi , Kuwao Sadahito , Iwamura Masatsugu , Egawa Shin
Published: September 2007

OBJECTIVES

To evaluate maximum tumour length (MTL) in biopsy cores as a predictor of prostate‐specific antigen (PSA)‐failure, systemic failure, and death from prostate cancer after radical prostatectomy (RP).

PATIENTS AND METHODS

We assessed 209 men with clinically localized prostate cancer treated with RP; preoperative variables were correlated with unfavourable pathological characteristics in the RP specimens and with outcome after surgery, using univariate and multivariate analysis.

RESULTS

The median (range) MTL was 4 (0.2–19) mm and correlated with adverse pathological findings, including specimen Gleason score (P = 0.003), pT3 (P < 0.001), seminal vesicle invasion (P < 0.001) and lymph node involvement (P = 0.019) in multivariate analysis. Preoperative PSA (P < 0.001), biopsy Gleason score (P = 0.002), and MTL (P = 0.045) were independent predictors of PSA failure, whereas only MTL remained a predictor of systemic‐failure (P < 0.001) and death from prostate cancer (P = 0.004). The median (range) follow‐up after surgery was 90 (17–152) months, during which 83 patients had PSA failure, 20 developed systemic failure and 15 died from prostate cancer.

CONCLUSIONS

The MTL correlates well with adverse pathological findings and appears to be an independent predictor of outcome after RP. Patients with a greater MTL might have cancer with an aggressive phenotype and therefore be candidates for more aggressive therapies.
Active surveillance; a reasonable management alternative for patients with prostate cancer: the Miami experience
Authors: Soloway Mark S. , Soloway Cynthia T. , Williams Steve , Ayyathurai Rajinikanth , Kava Bruce , Manoharan Murugesan
Published: September 2007

OBJECTIVE

To examine the outcome of patients diagnosed with ‘low‐risk’ prostate cancer managed by active surveillance (AS).

PATIENTS AND METHODS

In all, 157 men with localized prostate cancer were followed on AS. The inclusion criteria for AS included: Gleason score of ≤ 6, a serum prostate‐specific antigen (PSA) level of ≤15 ng/mL, stage ≤ T2, low‐volume disease and >12 months of follow‐up. The follow‐up was rigorous, with PSA tests and a digital rectal examination every 3 months for 2 years, and a repeat biopsy 6–12 months after the initial diagnosis and yearly when indicated. Continuance of AS was based on the PSA doubling time, re‐biopsy score, Gleason score, tumour volume, stage progression and patient preference.

RESULTS

In all 99 patients met the inclusion criteria; their mean age at diagnosis was 66 years, their mean PSA level 5.77 ng/mL and the mean follow‐up 45.3 months. On initial repeat biopsy, 63% had no cancer and 34% had a Gleason sum of ≤ 6. Eight patients were treated (three with hormones; five with curative intent); two had radical prostatectomy (one had pT2c pNO Gleason 7 disease); three had radiotherapy. The probability is that 85% would remain treatment‐free at 5 years; no patient died from prostate cancer. The PSA doubling time and clinical stage at diagnosis were predictive of progression.

CONCLUSION

Patients who are followed on AS must be selected using narrowly defined inclusion criteria and closely followed with a standard regimen of PSA testing, digital rectal examination and repeat biopsy.
Bladder carcinoma among live‐donor renal transplant recipients: a single‐centre experience and a review of the literature
Authors: Kamal Mohamed M. , Soliman Shady M. , Shokeir Ahmed A. , Abol‐Enein Hassan , Ghoneim Mohamed A.
Published: September 2007

OBJECTIVES

To present our experience with bladder cancer among a renal transplant population and to review critically the relevant literature.

PATIENTS AND METHODS

In all, 1865 renal graft recipients were followed for a mean (sd) of 6.5 (5) years. Seven recipients (all men) developed a urothelial bladder tumour. The stage and grade of the tumours were determined. The method of the treatment was selected on the basis of the tumour characteristics and graft function. Patients were regularly followed; the endpoints were cancer‐specific survival, recurrence or metastasis.

RESULTS

All patients presented with gross haematuria. There was non‐muscle‐invasive disease in two patients who were treated by transurethral resection and adjuvant intravesical bacille Calmette‐Guérin immunotherapy. One patient died 24 months later due to complications of end‐stage renal disease. To date the second patient is alive and free of the recurrence. Five recipients with muscle‐invasive disease had a radical cystectomy and orthotopic bladder substitution. The mean (sd) time to the last follow‐up or death was 14.6 (3.1) months. Three patients died with stable graft function; two from distant metastasis and one from a cerebrovascular stroke. The remaining two patients are still alive, free of disease and with good graft function.

CONCLUSIONS

Urothelial bladder tumours are generally uncommon. The presence of haematuria in renal allograft recipients should be thoroughly investigated. Early diagnosis and prompt treatment are required for managing such tumours, because they are aggressive. Orthotopic bladder substitution is feasible with a good functional outcome for patients in whom cystectomy is indicated.