bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of detubularization and outflow competence in substitution cystoplasty
Authors: Thomas P.J. , DeSousa N. , Mundy A.R.
Published: November 2003

Objective To assess the effects of detubularization and outflow competence on the clinical and urodynamic results of patients undergoing substitution cystoplasty.

Patients and methods The study included 142 patients undergoing orthotopic substitution cystoplasty, of whom 85 underwent a ‘straight’ and 57 a detubularized substitution cystoplasty using the ileo‐colonic segment. All were assessed clinically and by video‐urodynamic studies before and after surgery.

Results In patients voiding spontaneously, detubularization produced a capacity 38% greater than that found with a ‘straight’ cystoplasty, but there was no difference in the contractility of the substitute bladder between the groups. In patients requiring clean intermittent self‐catheterization to empty, outflow competence was a more important factor in increasing capacity and reducing contractility.

Conclusions Detubularization produces a modest increase in bladder capacity but far less than that predicted by mathematical models. It has no substantial effect on contractility when compared with straight substitution cystoplasty. The effects of detubularization on both capacity and contractility are less than the ‘chronic retention’ effect produced by increasing outflow competence. Detubularization is therefore only one of several factors that influence the results of substitution cystoplasty.
A feasibility study for the non‐invasive treatment of superficial bladder tumours with focused ultrasound
Authors: Watkin N.A. , Morris S.B. , Rivens I.H. , Woodhouse C.R.J.
Published: November 2003

Objective To determine whether high‐intensity focused ultrasound can be used to ablate bladder wall tissue using a transabdominal approach in a large animal model, and whether it can be developed as a non‐invasive treatment for superficial bladder tumours.

Materials and methods The bladder wall of 25 large white pigs was treated with a 1.7 MHz extracorporeal focused‐bowl ultrasonic transducer. Animals were killed either 2 h, 3 days or 4 weeks after treatment and the bladder wall examined macroscopically and histologically.

Results Acute bladder wall damage was detected in 15 of 16 animals at 2 h and in all six animals examined after 3 days. Areas of healing were seen in 10 of 12 animals at 4 weeks. Histological analysis of the treated areas revealed that the urothelium was denuded within 2 h and was associated with an acute inflammatory response in the bladder wall. At 4 weeks, the urothelium had regenerated over a maturing scar.

Conclusions Focused ultrasound can be used successfully to destroy regions of the bladder wall in a large animal model in vivo.
Partial ureteric obstruction: a study of Doppler ultrasonography and diuretic renography in different grades and durations of obstruction
Authors: Shokeir A.A. , Nijman R.J.M. , El‐Azab M. , Provoost A.P.
Published: November 2003

Objectives To study the changes in renal resistive index (RI) and renal function with time during different grades of partial unilateral ureteric obstruction, and to determine the correlation between the ultrasonographic and renographic findings.

Materials and methods Ten dogs underwent right partial ureteric obstruction; grade 1 (mild) obstruction was applied in five dogs (group A) and grade 3 (moderate and severe) obstruction in the other five (group B). All dogs were assessed using excretory urography, diuretic renography with the calculation of half‐time drainage (Tn) and bilateral renal Doppler ultrasonography before the experiment began, after one week of obstruction, and every 2 weeks during 8 weeks of obstruction.

Results In both groups, after the induction of right ureteric obstruction, there was a progressive decrease of effective renal plasma flow (ERPF) and a progressive increase of the RI of the right kidney at the end of the first and second weeks of obstruction, with an almost stable value thereafter. The decrease of ERPF and the increase of RI in the right kidney were correlated with the degree of obstruction. There was also a dramatic increase of Tn of the right kidney that correlated with the degree of obstruction. Concomitantly, there was a significant compensatory increase of ERPF and a significant decrease of the RI of the left kidney in both groups. The compensatory increase in ERPF limited the loss in total ERPF in both groups. The contribution of obstructed kidney to the total ERPF was significantly reduced in both groups. At the end of the eighth week, taking all kidneys together, there was a statistically significant negative correlation between the ERPF and RI, and between ERPF and Tn, and a positive correlation between Tn and RI.

Conclusions Unilateral partial ureteric obstruction increased the RI and Tn and decreased the ERPF of the corresponding kidney, together with a decrease of RI and an increase in ERPF of the contralateral kidney. The more severe the obstruction, the greater the increase in RI and Tn and the decrease in ERPF. After the obstruction stabilized, RI and T n were positively correlated.
Long‐term renal morphology and function following enterocystoplasty (refluxing or anti‐reflux anastomosis): an experimental study
Authors: Kristjansson A. , Abol‐Enein MD H. , Alm P. , Mokhtar A.A. , Ghoneim M.A. , Månsson W.
Published: November 2003

Objective To study the morphology and function of the upper urinary tract over the long‐term in dogs with an enterocystoplasty and a refluxing or anti‐refluxing uretero‐intestinal anastomosis.

Materials and methods Subtotal cystectomy and ‘cup’ ileocystoplasty were performed in 13 dogs. The right ureter was implanted into the cystoplasty with a refluxing technique in seven and with an anti‐reflux procedure in six dogs. The le ft renal unit acted as an intact control in 11 dogs, while in two the intramural part of the left ureter was incised to produce reflux. Thus, of the 26 renal units, nine had a refluxing junction (anastomosis), six were anti‐refluxing and 11 served as intact controls. Total and separate glomerular filtration rates (GFRs) were measured pre‐operatively and regularly thereafter, and cystometry, urography and ascending enterocystography were performed. At necropsy, urine was obtained for culture from the cystoplasty and renal pelves, and both kidneys were examined histologically.

Results The cystometric pressure was low in 12 of the 13 dogs; urography showed no obstruction. The fall in separate GFR did not differ significantly among the groups (with and without reflux protection, and control units). Reflux was detected in three of nine renal units with refluxing anastomosis and in three of 11 control units. Bacteriuria was found in the cystoplasty in all dogs; the incidence in the upper urinary tract was seven of eight renal units with a refluxing anastomosis, one in five of those with an anti‐refluxing anastomosis and three of nine control units. Pyelonephritis was found in none of the control kidneys, in six of nine kidneys with a refluxing and in two of six with an anti‐refluxing anastomosis; it was less severe in the latter.

Conclusion Refluxing ureteric implantation in a low‐pressure enterocystoplasty was commonly associated with bacteriuria in the upper urinary tract and with pyelonephritis. Thus, anti‐reflux implantation was beneficial for renal preservation in this setting.
Micrometastatic adrenal invasion by renal carcinoma in patients undergoing nephrectomy
Authors: Li G .R. , Soulie M. , Escourrou G. , Plante P. , Pontonnier F.
Published: November 2003

Objective To examine adrenal invasion by renal cell carcinoma (RCC), particularly by adrenal micrometastasis, to determine whether adrenalectomy should be performed during radical nephrectomy.

Patients and methods From 1987 to 1994, 129 patients with RCC (90 men and 39 women, mean age 61.4 years, range 22–81) underwent radical nephrectomy with associated adrenalectomy because they had risk factors for adrenal invasion (tumour size >5 cm, or tumour of the superior pole). Pathological examinations were carried out systematically and records of these examinations reviewed. The tumour size was recorded and the frequency of invasion calculated.

Results There were 10 cases where the gland was invaded; one was a synchronous contralateral metastasis and nine (7%) were ipsilateral invasions of which two were tumours in the superior pole that invaded the gland by direct extension and the other seven invaded the gland by distant metastasis, six being micrometastatic (4.7%). A single micrometastasis was found in two cases (1.5%). There was no adrenal invasion by tumours of <5 cm in diameter from the superior pole. When only tumours >5 cm in diameter were considered, the ipsilateral invasion rate was 11% (9/80) and the micrometastatic rate was 7.5% (6/80).

Conclusion Adrenalectomy need not be performed routinely in small tumours which are detected early, but the possibility of adrenal micrometastasis from larger tumours (>5 cm) should be considered.
Bladder replacement by ileocystoplasty: the final treatment
Authors: Christmas T.J. , Holmes S.A.V. , Hendry W.F.
Published: November 2003

Objective To develop and improve the technique of bladder replacement with ileum in patients with interstitial cystitis.

Patients and methods A consecutive series of 27 patients (23 women and four men, median age 61 years, range 40–79) with chronic severe interstitial cystitis refractory to conservative therapies underwent cystectomy and bladder replacement using an ileal pouch. The relief of pain was assessed over a median follow‐up of 30 months (range 2–48).

Results Pain relief was complete in all patients and the median neo‐bladder capacity was 520 mL (range 350–700). Only four patients required intermittent self‐catheterization to drain post‐micturition residual urine. Bladder calculi formed in two patients and were removed successfully at cystoscopy.

Conclusion Bladder replacement with ileum in the form of the Kock pouch is an effective surgical treatment for intractable interstitial cystitis.
Ultrasonography and colour Doppler flow in the testes of adult patients after treatment of cryptorchidism
Authors: Taskinen S. , Lehtinen A. , Hovatta O. , Wikström S.
Published: November 2003

Objective

 To analyse the prevalence of post‐operative structural, parenchymal and vascular testicular abnormalities and the incidence of epididymal abnormalities in adult men treated for undescended testes in childhood.

Patients and methods

 The testes and epididymi of 76 adult men treated for cryptorchidism in childhood were evaluated 16 to 27 years after treatment, using colour Doppler ultrasonography.

Results

 The 61 spontaneously descended testes were significantly (P<0.01) larger (mean [sd], 22 [8] mL) than the 90 undescended testes (13 [6] mL). The echo pattern in all the spontaneously descended testes was normal, whereas in 15 cases (17%) the testicular tissue was abnormal after cryptorchidism. In 12 of these 15 cases, the echo pattern was very irregular, and two other cases had microlithiasis of the testicular parenchyma, one of them bilaterally. No normal testicular artery was detected in two cases (3%) of normally descended testes, against 18 (20%) amongst those with undescended testes. Epididymal abnormalities were found in two (3%) of the group of normally descended testes against 32 (36%) in the undescended group.

Conclusions

 Infertility in patients with cryptorchidism may be a result not only of primary parenchymal degenerative changes of the testis directly due to the condition, but also of operative vascular trauma and epididymal anomalies. Operative trauma may be more common than has generally been believed. Ultrasonography is a suitable method to evaluate post‐operatively the prevalence of the testicular abnormalities analysed in the present study.
Farmers at risk for prostate cancer
Authors: van der Gulden J.W.J. , Vogelzang P.F.J.
Published: November 2003

Objective To summarize the literature on the risk of prostate cancer among farmers and farm workers, to evaluate the magnitude of the risk and to determine the presence of risk factors peculiar to agricultural work.

Methods Recent literature was searched and reviewed, selecting only case‐control studies in which both positive and negative odds ratios were presented for several occupations, while only cohort studies and death‐certificate studies were selected which presented risk estimates for several cancer sites, elevated as well as decreased.

Results In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among farmers. It is as yet unclear whether this excess risk is caused by particular occupational exposures or by risk factors in their personal lifestyle (e.g. dietary habits). Evidence was found for a relationship between the use of pesticides and of other agricultural chemicals and the risk of prostate cancer.

Conclusion Farmers probably have a slightly elevated risk of contracting prostate cancer. However, the actual risk factors are still a matter of conjecture.
Obstetric and gynaecological ureteric injuries: treatment and results
Authors: Giberti C. , Germinale F. , Lillo M. , Bottino P. , Simonato A. , Carmignani G.
Published: November 2003

Objective To compare endourological techniques and open surgery in the treatment of ureteric injuries following obstetric and gynaecological surgery.

Patients and methods From January 1982 to February 1994, 63 women (mean age 51 years, range 22–70) were treated for 72 ureteric lesions consequent upon obstetric or gynaecological surgery. In nine patients, 10 ureteric lesions were detected intra‐operatively and repaired immediately. In the remaining 54 patients, the 62 ureteric injuries were diagnosed and treated after a delay; 29 patients with 37 ureteric injuries underwent repair by open surgery while 25 patients with a unilateral ureteric lesion underwent elective primary endourological treatment.

Results The results of repair were not related to the type of treatment; the cure rate was 87, 88 and 90% for delayed open surgical, endourological and immediate intra‐operative repair, respectively. The site (vesico‐ureteric junction, uterine artery or infundibulopelvic ligament) and the type (fistula or stenosis) of ureteric lesion had no influence on the results, regardless of the type of treatment. The results of ureteric repair were related to the surgery that caused the lesion; 88% of the poor results occurred in the patients who underwent radical hysterectomy alone or combined with radiotherapy and approximately half of the irradiated patients required major surgery.

Conclusion When the patients are correctly selected, endourological treatment plays an equally important role in the treatment of gynaecologically‐related ureteric injuries when compared to open surgery. Special attention should be paid to the treatment of lesions caused by radical hysterectomy alone or associated with radiotherapy, as these may lead to poor results.
Adrenalectomy — still a must in radical renal surgery?
Authors: Kozak W. , Höltl W. , Pummer K. , Maier U. , Jeschke K. , Bucher A.
Published: November 2003

Objective To investigate the incidence of adrenal involvement and survival in patients with renal cell carcinoma.

Patients and methods A retrospective, multicentre trial was initiated by the Austrian Association of Urologic Oncology (AUO); between January 1980 and December 1984, 225 patients were eligible for the study. All patients had unilateral renal tumours and nephrectomies were performed either with (group A, 109 patients) or without (group B, 116 patients) adrenalectomy. The two groups were matched for sex, age, laterality and nodal status. The mean follow‐up time was 78 months.

Results The location of the intrarenal tumour had no significant effect on adrenal involvement. By univariate and multivariate analysis (Cox's proportional hazards model) significant differences in outcome were found only for pT stages. The mean survival times of patients in group A were 122.9 months in those with stage pT1/2, 76.6 months with stage pT3 and 75.3 months with stage pT4. In group B, survival times were 109 months in those with stage pT1/2 (not significant) and 111 months in stage pT3 (P=0.0076). Eight patients had adrenal involvement and died from their tumours after a median of 15.3 months (range 4–63). The slightly longer survival of patients in group B with stage T1/2 tumours and the significantly better survival of patients with stage T3 disease may be attributable to statistical bias, but there was no benefit from adrenalectomy.

Conclusion The effect of adrenalectomy on the prognosis was at best comparable to that of lymphadenectomy and no curative effect was demonstrated. The removal of a healthy adrenal may be detrimental and cause subsequent problems in those patients requiring hormone replacement.
Intragranular activation of bladder mast cells and their association with nerve processes in interstitial cystitis
Authors: Letourneau R. , Pang X. , Sant G.R. , Theoharides T.C.
Published: November 2003

Objective To investigate the presence of progesterone receptors and the extent and type of degranulation exhibited by the increased numbers of mast cells (MCs) found in interstitial cystitis (IC), a painful bladder disorder which occurs almost exclusively in women, worsens perimenstrually and is characterized by increased numbers of oestradiol receptor (OR)positive MCs.

Patients and methods The state of MC degranulation was analysed blindly using electron microscopy of bladder biopsies from 26 patients with IC and six control patients which included five women with incontinence, with none of the established characteristics of IC, and one man with transitional carcinoma of the bladder. Emphasis was placed on preserving the secretory granule ultrastructure. The presence of progesterone receptors (PRs) in five patients with IC and three controls was investigated using commercially available antibodies against PRs.

Results Over 85% of bladder MCs expressed high affinity PRs, but the number of PR‐positive MCs in patients with IC did not differ significantly from that of controls despite the overall increase in MCs seen in IC. MCs were activated to various degrees and were often near to neuronal processes. The secretory granule content of MCs from patients with IC was in different stages of dissolution, ranging from heterogeneous loss of electron density to the appearance of crystalline substructure and target forms containing only remnants of the original material. Typical degranulation by compound exocytosis was not observed. MCs from control patients contained secretory granules with mostly intact, electron‐dense granules.

Conclusion These findings indicate that the symptoms of IC may depend on an imbalance of the relative number of oestrogen receptors (ORs) to PRs on bladder MCs resulting in a ‘progesterone deficient’ state. This possibility is strengthened by demonstration that oestradiol augments the secretion of MC histamine in response to the neuropeptide substance P, which is pro‐inflammatory, nociceptive and overexpressed in bladders with IC. Intragranular activation of bladder MCs is a characteristic pathological finding in patients with IC. The lack of extensive degranulation, typically seen in anaphylaxis, may indicate a unique mode of stimulation and/or differential release of mediators.
Biological characteristics of inverted papilloma of the urinary bladder
Authors: Urakami S. , Igawa M. , Shirakawa H. , Shiina H. , Ishibe T.
Published: November 2003

Objectives To elucidate the biological characteristics of inverted papilloma (IP) of the bladder.

Materials and methods The immunoreactivity of p53, nuclear DNA content (assessed by ploidy and 2c deviation index [2cDI]) and the expression of proliferating cell nuclear antigen (PCNA) in 17 IPs were evaluated using a computer‐assisted image analyser and compared with those in 12 superficial transitional cell carcinomas (TCCs), 29 invasive TCCs and one inverted papillary TCC of the bladder.

Results Positive staining for p53 and PCNA and intense staining with Feulgen were observed predominantly in the basal layer of the bladder mucosa. All IPs and most superficial TCCs were diploid, while most invasive TCCs were aneuploid. Although the 2cDI and the immunoreactivities for PCNA and p53 were significantly lower in IPs than in invasive TCCs, there was no significant difference in these three variables between IPs and superficial TCCs. However, some IPs were more immunoreactive for p53 than were the superficial TCCs.

Conclusions The distribution of cells with p53 and PCNA immunoreactivity, and with intense Feulgen staining, indicated that IP of the bladder might have high proliferative activity and that those IPs with a high immunoreactivity for p53 may be susceptible to malignant transformation.
Reproducibility of prostate volume measurements from transrectal ultrasonography by an automated and a manual technique
Authors: Aarnink R.G. , De La Rosette J.J.M.C.H. , Debruyne F.M.J. , Wijkstra H.
Published: November 2003

Objective

 To assess the reproducibility of estimates of prostate volume determined by planimetry from transrectal ultrasonography (TRUS) images.

Materials and methods

 Two sequential sessions of images obtained by TRUS were obtained from 30 patients, with the ultrasound probe removed and inserted between the sessions. The stored images were outlined, both manually and by computer, and measurements of prostate volume obtained planimetrically. In addition, the ability of the urologist to accurately draw the contour was assessed by outlining predefined contours.

Results

 The mean (sd) variability of manual outlining between sessions was 3.5 (3.4)%, within one session was 1.7 (1.3)% and of computer outlining between sessions was 4.3 (3.8)%. Comparing the results of manual and computer outlining showed a mean (sd) variability of 7.5 (5.6)%, with larger values obtained from computer outlining. The mean (sd) variation in manually outlining predefined contours was 1.4 (1.4)%.

Conclusions

 The variability of computer outlining was slightly higher than expected theoretically. The within‐session variability was higher than the variation caused by errors in outlining predefined contours, indicating that the interpretation of TRUS images differed with time. Automated determination of prostate volume can save time during clinical investigation and the variability is within the clinically acceptable range of 5%.
Intravesical instillation of epirubicin: effect on tumour recurrence in patients with dysplastic epithelium after transurethral resection of superficial bladder tumour
Authors: Igawa M. , Urakami S. , Shirakawa H. , Shiina H. , Ishibe T. , Kadena H. , Usui T. , Kawanishi M.
Published: November 2003

Objective To evaluate whether the intravesical instillation of epirubicin is effective in preventing the recurrence of tumour in the bladder where dysplastic mucosa remains after transurethral resection of tumour.

Patients and methods Biopsy specimens were taken from apparently normal areas of the bladder mucosa in patients undergoing transurethral resection of the primary tumours. Of the 75 evaluable patients, 18 (24%) had abnormalities in at least one or more specimens. The patients were divided into two groups, 57 with normal and 18 with abnormal biopsy results. Intravesical chemotherapy with epirubicin (20 mg/40 mL saline) was randomized to patients in each group. Tumour recurrence rates were estimated and compared amongst the groups. Factors related to tumour recurrence were evaluated using univariate and multivariate analyses.

Results The risks of tumour recurrence and progression were evaluated in 18 patients with concomitant mucosal abnormalities. All 10 patients with abnormal biopsy results who were treated with epirubicin had recurrence of tumour within a mean interval of 9 months, whereas six of eight controls had recurrence within a mean of 10.9 months. While there was progression in grade in four of 10 patients with abnormal biopsy results and treated with epirubicin, none of the recurrent tumours in six control patients with mucosal abnormalities progressed in grade. The overall recurrence‐free rate of the patients with mucosal abnormalities was higher in controls than in those receiving epirubicin, but the difference was not statistically significant. There were no significant differences in recurrence rate for those treated with epirubicin and controls in the 57 patients with normal biopsy results. Univariate analysis showed that the recurrence‐free rates were significantly influenced by tumour multiplicity and the mucosal biopsy results (P<0.001 and P=0.02, respectively). In a Cox proportional‐hazards model, tumour multiplicity alone had prognostic significance for tumour recurrence (P=0.002).

Conclusions The prophylactic intravesical instillation of epirubicin had no effect in preventing tumour recurrence and, conversely, it may promote tumour progression in bladders with dysplastic mucosal changes.
Femoral vein blood flow during transurethral resection of the prostate
Authors: Nilsson A. , Jogestrand T. , Ekengren J. , Hahn R.G.
Published: November 2003

Objective To determine whether bladder distension affects venous haemodynamics during transurethral resection of the prostate (TURP) such that irrigating fluid is more easily absorbed.

Patients and methods The right common femoral vein was examined using an ultrasound Doppler blood‐flow scanner in 10 patients (mean age 73 years, range 63–80) undergoing TURP. Measurements of blood flow were performed before, during and after the bladder was filled with irrigating solution. Fluid absorption was measured by the ethanol method.

Results Measurements before, half‐way through and immediately after the resection all showed that the luminal diameter and the cross‐sectional area of the femoral vein increased significantly when the bladder was filled with irrigating fluid. Furthermore, a decrease in the normal variation of blood flow with breathing often occurred when the bladder was filled, indicating that proximal venous obstruction was the cause of the increase in vessel diameter. However, there was no apparent association between these changes and the absorption of irrigating fluid.

Conclusions Filling the bladder with irrigating fluid with the patient in the lithotomy position during TURP was followed by signs of iliac venous obstruction but this did not correlate with the absorption of irrigating fluid.
Rectus abdominis muscle flap (RAMF) technique
Authors: Celayir S. , Kiliç N. , Dervisoglu S. , Büyükünal C.
Published: November 2003

Objective

 To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, inelastic bladder extrophies using a rabbit model with a large bladder defect.

Materials and methods

 Fifteen New Zealand White rabbits were studied in two groups; nine rabbits in group 1 underwent resection of 65% of the bladder and then bladder augmentation using a full‐thickness RAMF, including peritoneum, and six rabbits in group 2 (control) underwent a similar bladder resection but the bladder remnant was closed primarily. Urodynamic investigations were carried out in both groups pre‐operatively and 4 weeks after surgery. Intravenous pyelography (IVP), voiding cystourethrography (VCUG), urodynamic and histopathological investigations were also carried out for up to 4 months after surgery.

Results

 As assessed by IVP, the urinary system appeared normal, with no signs of upper urinary tract dilatation and VCUG showed a normal voiding pattern. After surgery, the bladder capacity and compliance decreased in both groups, but both variables partially recovered in group 1, although not significantly.

Conclusions

 This animal model indicates that the RAMF technique is a suitable alternative for the management of large bladder defects and bladder exstrophies with small, inelastic, non‐compliant bladders.
Delayed vasal reanastomosis in rats: comparison of a microsurgical technique and a fibrin‐glued procedure
Authors: Vankemmel O. , Rigot J.M. , Burnouf T. , Mazeman E.
Published: November 2003

Objectives

 To compare fibrin‐glued vasovasostomy to a conventional microsurgical technique in a protocol of delayed vasovasostomy.

Materials and methods

 Forty male Sprague‐Dawley rats underwent bilateral vasectomy through a midline abdominal incision. Two weeks later all animals underwent a bilateral vasectomy reversal through a bilateral inguino‐scrotal incision, following two different protocols. Invariably, the proximal segment had a larger lumen. The control group (20 rats) had a conventional modified one‐layer sutured vasal anastomosis with 10/0 nylon. The experimental group (20 rats) underwent vasal anastomosis using fibrin glue and consisting of three transmural sutures with 10/0 nylon followed by the application of fibrin glue circumferentially to seal the anastomosis. The fibrin‐tissue adhesive was obtained from pooled donor plasma and was virally inactivated by a solvent‐detergent treatment. Seven weeks after surgery all animals were killed and the vasal specimens were evaluated for gross patency and the incidence of sperm granuloma.

Results

 The control group had a patency rate of 85% and half had sperm granuloma. The experimental group had a patency rate of 92% and 40% had sperm granuloma; neither difference was significant. The mean operative time was significantly shorter for the fibrin glue‐assisted vasovasostomy (P<0.001).

Conclusion

 This study showed that a delayed fibrin‐glued vasovasostomy gave a comparable anatomical success and an incidence of sperm granuloma similar to that using a conventional microsurgical technique, but with the advantages of a shorter operative time and a less technically demanding anastomosis.
A step towards day case prostatectomy
Authors: Suvakovic N. , Hindmarsh J.R.
Published: November 2003

Objective To compare laser prostatectomy, using both side‐fire and contact lasers, with transurethral resection of the prostate (TURP) to identify the advantages and disadvantages of all three in the short‐and long‐term (1 year).

Patients and methods Forty patients were randomized into one of four groups undergoing TURP, side‐fire laser prostatectomy alone, side‐fire with debridement and contact laser prostatectomy. Strict entry criteria ensured that no patients with malignancy were selected. The patients were reviewed after 3, 6 and 12 months.

Results The duration of operation and length of hospital stay were significantly shorter in those undergoing laser side‐fire treatment than those undergoing TURP. However, the early (3‐month) symptom score was significantly worse in those treated by side‐fire laser than in those treated by side‐fire laser with debridement. After 1 year there was no significant difference in mean symptom score and mean urinary flow rate among the four groups.

Conclusion Laser prostatectomy offers the prospect of a shorter theatre and hospital stay and, by debriding the thermocoagulated tissue, the early irritative symptoms were reduced, with a significant improvement in symptom score after 3 months in patients with small prostates.
Detection and distribution of heat shock proteins 27 and 90 in human benign and malignant prostatic tissue
Authors: Thomas S.A. , Brown I.L. , Hollins G.W. , Hocken A. , Kirk D. , King R.J.B. , Leake R.E.
Published: November 2003

Objective To determine whether it is possible to predict the behaviour of prostate tumours by identifying cellular characteristics, specifically specific heat shock proteins (HSPs).

Materials and methods An immunohistochemical study staining for HSP 27 and 90 was undertaken on 15 benign and 13 malignant samples of freshly frozen prostatic tissue obtained from patients with a similar age range in each group (benign, mean age 71.6 years, range 61–86; malignant, mean age 72.7 years, range 58–87). Gleason scores for the tumours ranged from 2 to 8.

Results Consistent patterns of cytoplasmic staining were seen in all sections of tissue from benign prostatic hyperplasia (BPH). The stroma stained strongly positive for HSP 27, but negatively for HSP 90 and glandular epithelium showed positive apical staining for both HSPs. Stromal patterns in prostatic carcinoma tissue were similar to that of BPH tissue for both HSP 27 and 90. Areas of prostatic intra‐epithelial neoplasia stained as strongly as did adjacent areas of BPH. For HSP 27, there was varied staining of individual epithelial cells, suggesting cellular heterogeneity, with an apparent reduction in staining with increasing Gleason score and invasiveness. For HSP 90, this pattern was less marked, with a predominance for positive staining throughout all grades of carcinoma.

Conclusions The distribution of HSPs, primarily HSP 27, may aid in identifying different cell populations within prostatic carcinomas and thus help forecast biological behaviour.
Prostatic radioimmunoscintigraphy: preliminary results using technetium‐labelled monoclonal antibody, CYT‐351
Authors: Feneley M.R. , Chengazi V.U. , Kirby R.S. , Nimmon C.C. , Granowska M. , Mather S.J. , Ellison D. , Granowski A.R. , Britton K.E.
Published: November 2003

Objective To investigate the clinical application of a new technique for imaging prostatic malignancy using planar imaging and single‐photon emission tomography (SPET) with technetium‐99m‐labelled antibody to a prostatic cell surface membrane antigen.

Patients and methods Prostatic malignancy was imaged by radioimmunoscintigraphy (RIS) using a 99mTc‐labelled monoclonal antibody, CYT‐351, raised against a newly identified membrane antigen present in normal and malignant prostatic tissues. The protocol involved taking serial images and assessing the changes in activity, as the uptake of specific antibody increased with time and non‐specific uptake decreased. Data from planar images were collected at 10 min, 6 and 24 h after injection with antibody, and by SPET at 6 and 24 h using a Siemens Orbiter Large Field of View gamma camera. Twenty‐two RIS scans were evaluated, which included six patients with clinically localized disease, six patients with previous incidental carcinoma at prostatectomy for apparently benign disease, four patients with evidence of local recurrence after radical prostatectomy and six patients with metastatic disease.

Results Primary tumours and secondary lymphatic and bone metastases were demonstrated. Only one minor side‐effect was experienced.

Conclusion This RIS technique was capable of imaging primary prostatic malignancy and metastatic disease in lymph nodes and bone. Its clinical application remains to be defined, but potentially it provides a new means for tumour staging based upon tissue characterization. It may be particularly useful before radical prostatectomy and it is capable of imaging local recurrence following radical treatment of localized disease. Future applications include monitoring the progression of disease and the response to treatment.
Genetic instability of 3p12‐p21‐specific microsatellite sequences in renal cell carcinoma
Authors: Willers C.P. , Siebert R. , Bardenheuer W. , Lux A. , Michaelis S. , Seeber S. , Luboldt H.‐J. , Opalka B. , Schütte J.
Published: November 2003

Objective To determine the role of structural alterations of human chromosome region 3p12‐p21 in the possible inactivation of one or more tumour‐suppressor genes in the pathogenesis of renal cell carcinoma (RCC), lung cancer and other neoplasms.

Materials and methods As microsatellite instability (MI), in particular MI with loss of heterozygosity (LOH), may indicate putative tumour‐suppressor gene loci, 20 kidney tumours, including 14 clear cell carcinomas and six non‐clear cell neoplasms, were investigated with 10 polymorphic simple sequence‐repeat markers spanning 3p12‐p21. Six of these markers map to the region of deletion flanked by markers D3S1285 and D3S1295 bracketing the t(3;8) translocation breakpoint in 3p14.2 of hereditary RCC.

Results Twelve of 14 clear cell RCCs displayed MI for at least one locus, as opposed to none of the non‐clear cell tumours (P=0.001). Locus D3S1274 in 3p13 located in the region deleted in lung cancer line U2020 and loci D3S1313 and D3S1300 in 3p14.3 characterized common regions of instability and LOH. Two patients with RCC who also had lung cancer and colon cancer, respectively, showed LOH at D3S1313 or D3S1300 as the only alterations of their kidney tumours.

Conclusions These results suggest that human chromosome region 3p14.3 distal to the hereditary t(3;8) translocation breakpoint and the region deleted in the U2020 lung cancer cell line might be involved in the tumorigenesis or progression of clear cell RCC.
Bladder cancer in various population groups in the greater Durban area of KwaZulu‐Natal, South Africa
Authors: Groeneveld A.E. , Marszalek W.W. , Heyns C.F.
Published: November 2003

Objective

 To study the incidence of different histological types of bladder cancer in various racial groups living within the same geographical region.

Patients and methods

 The study included 615 new patients with bladder cancer seen at three Provincial hospitals in Durban from January 1980 to January 1990. The patients were classified as Caucasian (white people of European descent), African (indigenous black people), Asian (people originating from the Indian subcontinent) or Coloured (people of mixed race). The bladder tumours were classified according to standard histopathological criteria as transitional cell carcinoma, adenocarcinoma or sarcoma. Mixed tumours consisted of both carcinomatous and sarcomatous or undifferentiated elements.

Results

 Transitional cell carcinoma constituted 95% of the cancers in Caucasians, compared with only 30% in Africans, whereas squamous cell carcinoma occurred in 53% of the African patients, but in only 2% of the Caucasians. In Asian patients, 75% of the tumours were transitional cell and 18% were squamous cell carcinoma, whereas in Coloureds 82% were transitional cell and 9% squamous cell carcinoma. Undifferentiated carcinoma occurred in 8% of African and only 1% of Caucasian patients, whereas adenocarcinoma, mixed tumours and sarcoma occurred in 9% of African patients and only 2% of Caucasian patients. Ova of Schistosoma haematobium were seen in microscopic sections of the bladder tumour in 85% of the patients with squamous cell carcinoma, in 50% of those with undifferentiated tumours and adenocarcinoma, in 17% of those with mixed tumours or sarcoma, and in only 10% of the patients with transitional cell carcinoma. At presentation, African patients were a mean of >20 years younger than Caucasians. In African patients with squamous cell carcinoma, 90% had stage T3 or T4 disease at presentation, whereas in Caucasian patients with transitional cell carcinoma 76% had stage T1 or T2 disease at presentation. From the study group, it appears that bladder cancer is about six times more common in Caucasians than in Africans. However, the value for Caucasian patients with bladder cancer probably underestimates the true value by about five times, so that bladder cancer in the greater Durban area may be as much as 30 times more common in Caucasians than in Africans.

Conclusion

 In African patients, endemic Schistosomiasis appears to be related to a high incidence of not only squamous cell carcinoma, but also undifferentiated tumours and adenocarcinoma of the bladder. The effective management of squamous cell carcinoma of the bladder in African patients will depend on the eradication of Schistosomiasis and the early detection of bladder cancer at a stage when it may still be cured by radical treatment.
Bacillus Calmette‐Guérin perfusion therapy for carcinoma in situ of the upper urinary tract
Authors: Yokogi H. , Wada Y. , Mizutani M. , Igawa M. , Ishibe T.
Published: November 2003

Objective To analyse the clinical and therapeutic consequences of bacillus Calmette‐Guérin (BCG) perfusion therapy for carcinoma in situ (CIS) of the upper urinary tract.

Patients and methods Eight pyelo‐ureteric systems in five patients with cytologically confirmed CIS of the upper urinary tract were treated using perfusion of BCG through a percutaneous nephrostomy tube in five and a retrograde ureteric catheter in three. Follow‐up cystoscopy, retrograde pyelography and selective urinary cytology were obtained 4 weeks after the last treatment and every 3 months thereafter.

Results In three patients (five pyelo‐ureteric systems) the cytology remained negative for 10–46 months after the treatment was completed. The remaining two patients (three pyelo‐ureteric systems) had persistently positive cytology. Of two patients who received BCG therapy through a ureteric catheter, one developed a ureteric stricture and the other developed renal tuberculosis.

Conclusions Although long‐term adaptation to a nephrostomy tube disturbs the quality of life of the patient, percutaneous perfusion therapy through a nephrostomy tube seems to be safer than retrograde perfusion through a ureteric catheter.
Early clinical experience with 5‐aminolevulinic acid for the photodynamic therapy of superficial bladder cancer
Authors: Kriegmair M. , Baumgartner R. , Lumper W. , Waidelich R. , Hofstetter A.
Published: November 2003

Objective To report clinical experience with intravesical instillations of 5‐aminolevulinic acid (ALA) for the photodynamic therapy of superficial bladder cancer and to assess any side‐effects of the treatment.

Patients and methods Ten patients (six men and four women, mean age 62.3 years, range 42–73) with refractory superficial bladder cancer were treated with photodynamic therapy using 5 g of ALA dissolved in 30 mL sodium bicarbonate instilled intravesically. After a mean retention of 5.1 h, the bladder interior was illuminated transurethrally at radiation integrals of 15, 30 or 60 J/cm2 . At integrals of 15 or 30 J/cm2 red light (635 nm) was used and at 60 J/cm2 , green light (514 nm, 40 J/cm2 ) was combined with a subsequent application of red light (635 nm, 20 J/cm2 ).

Results After 10–12 weeks, four patients had a complete remission, two a partial remission, there was no change in three and one had progressive disease. Of those patients responding, the bladder was preserved in five after a mean follow‐up of 15 months (range 6–27). There were no photodermatoses or bladder shrinkage in any patient.

Conclusions Photodynamic therapy with intravesically applied ALA is effective in destroying superficial urothelial carcinomas of the bladder. There were no serious side‐effects which could preclude further clinical testing.
Sildenafil, a novel effective oral therapy for male erectile dysfunction
Authors: Boolell M. , Gepi‐Attee S. , Gingell J.C. , Allen M.J.
Published: November 2003

Objectives

 To determine the efficacy and safety of sildenafil, a novel orally active inhibitor of the type‐V cyclic guanosine monophosphate‐specific phosphodiesterase (the predominant isoenzyme in the human corpus cavernosum) on penile erectile activity in patients with male erectile dysfunction of no established organic cause.

Patients and methods

 Twelve patients (aged 36–63 years) with male erectile dysfunction of no established organic cause were entered into a double‐blind, randomized, placebo‐controlled, crossover study which was conducted in two phases. In the first phase (four‐way crossover), treatment efficacy was evaluated by measurements of penile rigidity using penile plethysmography during visual sexual stimulation at different doses of sildenafil (10, 25 and 50 mg or placebo). In the second phase (two‐way crossover), efficacy was assessed by a diary record of penile erectile activity after single daily doses of sildenafil (25 mg) or placebo for 7 days.

Results

 The mean (95% confidence interval, CI) duration of rigidity of >80% at the base of the penis was 1.3 min (0.4–3.1) in patients on placebo, 3.5 min (1.6–7.3; P = 0.009) on 10 mg, 8.0 min (3.7–16.7; P = 0.003) on 25 mg and 11.2 min (5.6–22.3; P < 0.001) on 50 mg of sildenafil. The mean (95% CI) duration of rigidity of >80% at the tip of the penis was 1.2 min (0.4–2.7) on placebo and 7.4 min (2.4–8.5; P=0.001) on 50 mg sildenafil. From the diary record of daily erectile activity, the mean (95% CI) total number of erections was significantly higher in patients receiving sildenafil was 6.1 (3.2–11.4), compared with 1.3 (0.5–2.7) in those on placebo; 10 of 12 patients reported improved erectile activity while receiving sildenafil, compared with two of 12 on placebo (P= 0.018). Six patients on active treatment and five on placebo reported mild and transient adverse events which included headache, dyspepsia and pelvic musculo‐skeletal pain.

Conclusion

 These results show that sildenafil is a well tolerated and effective oral therapy for male erectile dysfunction with no established organic cause and may represent a new class of peripherally acting drug for the treatment of this condition.
Urethroplasty for posterior urethral strictures
Authors: Mundy A.R.
Published: November 2003

Objective

 To assess the long‐term results and complications of urethroplasty for patients with pelvic fracture injuries of the posterior urethra and to determine which type of of procedure is most appropriate.

Patients and methods

 Eighty‐two patients were followed prospectively after undergoing transperineal bulbo‐prostatic anastomotic urethroplasty (AU). The results and complications in these patients were compared with 59 patients who had a ‘patch’ urethroplasty (PU) for a short stricture which in other circumstances might have been amenable to AU.

Results

 The 1‐, 5‐ and 10‐year re‐stricture rates were 7, 12 and 12%, respectively, for AU and 12, 20 and 31% for PU. Four of the 10 patients who re‐strictured during the 5‐year follow‐up after AU were >55 years of age and four of the seven patients who had an AU and who were >55 years old re‐strictured. All the patients who restrictured were impotent. The commonest complications after AU were principally a consequence of the original injury rather than the surgery, whereas the complications after PU were principally related to the surgery. Impotence sometimes occurred after both types of urethroplasty.

Conclusions

 Anastomotic urethroplasty is the best available procedure for traumatic proximal urethral strictures but was not tolerated well in the elderly and caused impotence in a small but significant proportion. The results of PU were less satisfactory and the difference became progressively more marked with a longer follow‐up.
An assessment of the ability of a silver‐releasing device to prevent bacterial contamination of urethral catheter drainage systems
Authors: Stickler D.J. , Morris N.S. , Williams T.J.
Published: November 2003

Objective To investigate the ability of a silver‐releasing device to protect the catheterized bladder from infection by blocking the ascending migration of bacteria from contaminated urine‐drainage bags.

Materials and methods A simple physical model of the catheterized bladder and drainage system was used with the device located in the drainage‐tube just below the sampling port. Urine was supplied to the model at 1.0 mL/min and the drainage bag was contaminated with Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis. Over 10 days, urine from the bag, catheter sampling‐port and bladder were examined for contamination.

Results Bacteriological analysis showed that the mean time for test organisms to reach the sampling ports of four different control bag systems ranged from 5.7 to 7.7 days. Urine from the sampling ports of the test systems incorporating the silver device remained sterile for 10 days. The device also prevented the growth of the large populations of bacteria (108 colony‐forming units per mL) that occurred in the control bags. While scanning electron microscopy showed the formation of bacterial biofilm throughout the control drainage systems, no bacterial colonization was visible on the surfaces of the test systems. Chemical analysis established that the devices consistently generated concentrations of silver in urine ranging from 1.0 to 2.0 μg/mL.

Conclusion The incorporation of the silver‐releasing device into the drainage systems produced an antibacterial barrier which protected the catheterized bladder from intraluminal contamination for at least 10 days. These in vitro tests suggest a useful role for the device in controlling infection in patients undergoing short‐term indwelling bladder catheterization.