bluuebunny/crossref_metadata_2025 huggingface dataset:
Are serial bone scans useful for the follow‐up of clinically localized, low to intermediate grade prostate cancer managed with watchful observation alone?
Authors: Yap B.K. , Choo R. , Deboer G. , Klotz L. , Danjoux C. , Morton G.
Published: December 2004

OBJECTIVE

To assess the predictive value of serial bone scans as a surveillance tool for bone metastasis in men with clinically localized prostate cancer and managed with watchful observation.

PATIENTS AND METHODS

A prospective single‐arm study was conducted to assess the feasibility of a watchful observation protocol with selective delayed intervention for patients with clinically localized prostate cancer, i.e. T1b‐T2bN0M0, a Gleason score of ≤ 7 and a prostate‐specific antigen (PSA) level of ≤ 15 ng/mL. Patients were managed expectantly as long as they did not meet the empirically predefined criteria of clinical, histological or PSA progression. Bone scintigraphy was repeated every year for the first 2 years, then every 2 years thereafter if the patient remained on watchful observation. When the follow‐up PSA level was> 15 ng/mL the patient underwent bone scintigraphy every year.

RESULTS

In all, 244 eligible patients were enrolled into the study. With a median follow‐up of 30 months, 449 bone scans were taken (150 at baseline and 299 in follow‐up evaluations); all 299 follow‐up scans were negative for bone metastasis. Hence, the true rate of positive follow‐up bone scans was estimated to be 0–1.0% (95% confidence). In all, 171 patients had at least one follow‐up bone scan; of these, the number (%) of patients who had 1, 2, 3, 4 and ≥ 5 follow‐up scans was 89 (52), 53 (31), 17 (10), eight (4.7) and four (2.3), respectively. The PSA levels (ng/mL) corresponding to all follow‐up bone scans were: 214 scans at PSA < 10, 61 at 10–14.9, 18 at 15–19.9 and six at ≥ 20 (range 20.2–24.9). The probability of a negative bone scan was estimated to be 88–100% (95% confidence interval) when a PSA threshold of 15 ng/mL was used.

CONCLUSION

The probability of positive findings in serial bone scans in untreated, localized, low to intermediate grade prostate cancer was low when the follow‐up PSA level remained < 15 ng/mL. Avoiding bone scans in this group of patients would translate into a significant cost saving and reduction in their psychological and physical burden. As for those with a follow‐up PSA of> 15 ng/mL, the role of serial bone scintigraphy remains undefined, as a longer follow‐up and a larger sample are needed.
An investigation into nonresponse bias in a postal survey on urinary symptoms
Authors: Dallosso H.M. , Matthews R.J. , McGrother C.W. , Clarke M. , Perry S.I. , Shaw C. , Jagger C. ,   the Leicestershire MRC Incontinence Study Team
Published: December 2004

OBJECTIVE

To investigate nonresponse bias in a postal survey on urinary symptoms in people aged ≥ 40 years.

SUBJECTS AND METHODS

Nonresponders to a postal survey on incontinence and other urinary symptoms were studied. A random sample of 1050 nonresponders (stratified for age and sex) was traced by a team of interviewers. Eligible nonresponders were asked several questions from the postal questionnaire, and their reason for not participating in the postal survey.

RESULTS

Only 1% of those not responding were not traced in person or accounted for, and 12% were identified as not eligible to be in the survey sample (moved from address, deceased, residential home). Half of the eligible nonresponders (51%) did not answer the interviewer's questions, the main reason being general unwillingness or disinterest. The number in whom poor health was the reason increased with age. Comparing nonresponders who answered the interviewer's questions with a random sample of responders from the postal survey showed little difference in the reporting of urinary symptoms, although there were differences in general health and long‐term health problems. Separate analyses by age showed greater reporting of some urinary symptoms and of poorer general health in the older nonresponders (≥ 70 years).

CONCLUSION

Overall, for people aged ≥ 40 years there was no evidence of a nonresponse bias in the reporting of urinary symptoms, providing confidence in such prevalence rates. However, poorer general health and greater reporting of some urinary symptoms by the older nonresponders (≥ 70 years) suggests prevalence rates in this age group may be underestimated.
A comparison of the International Index of Erectile Function and erectile dysfunction studies
Authors: Kassouf W. , Carrier S.
Published: December 2004

OBJECTIVE

To evaluate the ability of the five‐item version of the International Index of Erectile Function (IIEF‐5) to diagnose the vascular aetiology and severity of erectile dysfunction (ED), and to compare it with pharmacological testing and duplex Doppler ultrasonography, as such questionnaires are widely used by the pharmaceutical industry to categorize the severity of ED and to assess the efficacy of drug therapy.

PATIENTS AND METHODS

In all, 80 patients (mean age 45.2 years, sd 14.0; mean duration of ED 3.5 years) were reviewed by an examiner unaware of their IIEF scores during testing. Penile blood flow was assessed in each patient after an intracavernosal injection with prostaglandin‐E1 (10 µg), with self‐stimulation in privacy. The peak systolic velocity, end diastolic velocity and resistive index were measured for the vascular diagnosis. Visual ratings of erectile responses were also used for analysis.

RESULTS

Of the 80 patients, 30 had a normal vascular response, 38 arterial insufficiency and 12 were diagnosed with venous leakage. There was no significant difference in the IIEF scores among patients with a normal vascular response, arterial insufficiency or venous leakage. Analysis of visual ratings of erections showed no difference in IIEF scores among the different groups of patients.

CONCLUSION

The IIEF was designed and developed specifically for assessing and evaluating sexual function in clinical trials. However, as shown here, the IIEF cannot and should not be used as a tool to diagnose or compare specific vascular causes of ED.
Screening for renal cell carcinoma using ultrasonography: a feasibility study
Authors: Filipas D. , Spix C. , Schulz‐Lampel D. , Michaelis J. , Hohenfellner R. , Roth S. , Thüroff J.W.
Published: December 2004

OBJECTIVE

To assess the practicability and efficacy of systematic screening for renal cell carcinoma (RCC) by ultrasonography (US), as more small RCCs are being detected incidentally by US.

SUBJECTS AND METHODS

A 2‐year screening programme for RCC was established for the general population (aged ≥ 40 years) in two German cities, Mainz and Wuppertal. In cooperation with different health insurers, the organisers recruited general practitioners, internists and urologists in private practice who were experienced in and equipped to conduct renal US. The screening was offered in the form of cost‐free renal US in the first year and a re‐examination in the second. For any equivocal or positive renal mass, a reference ultrasonogram was provided by the urology departments at the two university hospitals.

RESULTS

In all, 9959 volunteers participated in the screening programme (49% men, 51% women, mean age 61 years, range 40–94) in the first year. Of these participants, 79% returned for re‐examination in the second year. Thirteen (0.1%) subjects were found to have a renal mass, of which nine were RCC. The sensitivity of the programme was 82% (at the 1‐year follow‐up), and the predictive value 2% for equivocal findings on initial examination and 50% for positive findings. The incidence of other abnormal findings was 12%.

CONCLUSION

The screening programme was well accepted by physicians in private practice and by the eligible population. The method was effective, especially if equivocal findings were re‐assessed by reference US before using further imaging studies, e.g. computed tomography or magnetic resonance imaging.
Posterior urethral valves: prognostic factors
Authors: Lopez Pereira P. , Espinosa L. , Martinez Urrutina M.J. , Lobato R. , Navarro M. , Jaureguizar E.
Published: December 2004

OBJECTIVE

To determine which variables besides bladder dysfunction can help to predict the outcome of renal function in boys with posterior urethral valves (PUV).

PATIENTS AND METHODS

All 40 patients with PUV in this retrospective study were diagnosed and began treatment in our hospital within the first 3 months of life, and have had ≥ 5 years of follow‐up. At the time of diagnosis, 33 were in renal insufficiency (RI) and seven had normal renal function (RF). At the time of the study 16 were in chronic renal failure (CRF) and 24 had normal RF. We compared their RF (initial and during follow‐up), vesico‐ureteric reflux (VUR), urinary tract infection (UTI), proteinuria, hypertension, renal echogenicity, final patient age and initial management.

RESULTS

The mean serum creatinine values before and after initial treatment were worse in boys who developed CRF than in those who did not (P = 0.08); the mean glomerular filtrate rate (GFR) at 1 year old was 52 mL/min/1.73 m2in the former and 102 in the latter (P < 0.001). Proteinuria was present during the follow‐up in 79% of patients in CRF and in only 17% of those with normal RF. All patients who developed CRF had echogenic renal changes while only 53% of the others had (P < 0.01). Other variables showed no statistically significant differences (VUR, UTI, hypertension and final patient age). Of 33 patients in RI at diagnosis, nine were treated by valve ablation and 24 by temporary pyelo‐ureterostomy. The initial mean serum creatinine value was worse in the latter than in the former (20.8 vs 13.0 mg/L). However, at 1 year old the mean GFR was better in the latter than in the former (P < 0.05). These GFR differences persisted during the first years of life but had disappeared by the fifth.

CONCLUSIONS

The most significant prognostic factor for the future development of CRF is the GFR at 1 year old. The onset of proteinuria during the follow‐up is associated with a worse prognosis. Echogenic renal changes may help to identify those dysplastic kidneys that will develop RI. Neonatal boys in RI who underwent pyelo‐ureterostomy had better RF during the first years of life than those who underwent valve ablation.
The evaluation of the effects of renal failure on erectile dysfunction in a rabbit model of chronic renal failure
Authors: Bagcivan I. , Kilicarslan H. , Sarac B. , Gokce G. , Yildirim S. , Ayan S. , Sarioglu Y.
Published: December 2004

OBJECTIVE

To determine whether chronic renal failure (CRF) reduces nitrergic relaxant responses in a rabbit model.

MATERIALS AND METHODS

Ten rabbits underwent surgery to induce uraemia (CRF rabbits) and a further 10 a sham operation (controls). Corpus cavernosal tissue was prepared and used in organ‐chamber experiments, with relaxation assessed against a background of pre‐contraction with phenylephrine. At the plateau of contraction, relaxation responses to cumulative concentrations of carbachol or sodium nitroprusside (SNP), to test endothelium‐dependent and ‐independent relaxations, respectively, were assessed. Before electrical‐field stimulation (EFS), the tissue was treated with an adrenergic nerve blocker and a muscarinic receptor blocker to eliminate the adrenergic and cholinergic components, and to determine the relaxation responses to the stimulation of nonadrenergic, noncholinergic (NANC) nerves. The relaxation responses in corporal strips obtained from CRF rabbits were compared with those from controls.

RESULTS

When tissues were contracted with KCl, tensions were similar in all groups. The impairment in concentration‐dependent relaxation with carbachol was significant in CRF rabbits, but SNP‐ and papaverine‐induced concentration‐dependent relaxation responses were no different among the groups. EFS‐induced frequency‐dependent relaxations were significantly lower in CRF rabbits than in controls.

CONCLUSION

CRF inhibits the NANC‐mediated relaxation of rabbit corpus cavernosum smooth muscle. Changes in NANC‐mediated and carbachol‐induced (endothelium‐dependent) relaxation of corporal smooth muscle in the rabbit are probably caused by uraemia and subsequently, hyperthyroidism, hyperparathyroidism or low testosterone levels in CRF. These results also suggest that if vasoactive agents are to be used for treating erectile dysfunction in uraemic patients, direct‐acting vasodilators and phosphodiesterase inhibitors will be useful.
Motivations and influences on the use of complementary medicine in patients with localized prostate cancer treated with curative intent: results of a pilot study
Authors: Hall J.D. , Bissonette E.A. , Boyd J.C. , Theodorescu D.
Published: December 2004

OBJECTIVES

To analyse descriptively the use of complementary medicine (CM) by patients with localized prostate cancer treated with curative intent, assessing the major influences on their choice to use CM, and the major critics and advocates of CM.

PATIENTS AND METHODS

From January 1997 to June 2000, 351 men with stage T1c‐T3 adenocarcinoma of the prostate were treated with either radical prostatectomy (RP) or brachytherapy. On the final date all patients were mailed a questionnaire relating to their use of CM and the results analysed cross‐sectionally.

RESULTS

In all, 238 (67.8%) patients returned the questionnaires, of whom 37% acknowledged using some type of CM, with a similar overall use of CM among those treated with RP or brachytherapy. Of these, 43% began using CM before and 32% after starting conventional treatment, and most indicated they would never discontinue these therapies. The most common reason for using CM was the patient's impression that it made them feel better, and secondarily that they felt it helped to cure their cancer. Physicians were the most common source of information about CM, with twice as many patients identifying physicians as being advocates rather than critics of CM. Many patients felt their urologist or radiation oncologist was neutral or chose not to discuss CM. However, when these physicians discussed CM, more patients felt that they encouraged rather than discouraged the use of CM.

CONCLUSIONS

These data on the motivations for patient choices relating to CM are novel; the sources of information, both positive and negative, that patients find useful in their decision to use these therapies were explored. Interestingly, physicians were generally supportive of the use of such approaches.
Improved sacral neuromodulation in the treatment of the hyperactive detrusor: signal modification in an animal model
Authors: Seif C. , Cherwon E. , Martinez Portilló F.J. , Alken P. , Jünemann K.P. , Braun P.M.
Published: December 2004

OBJECTIVE

To investigate different stimulation signals for the peripheral nerve evaluation test (PNE, carried out before implanting a sacral neuromodulator for functional voiding dysfunction) in an animal model and to determine their efficacy, as up to 80% of patients do not respond to the PNE test.

MATERIALS AND METHODS

PNE foramen electrodes were placed in the S3 of 12 anaesthetized Göttingen minipigs. First, detrusor instabilities were induced by the intravesical instillation of formalin. A 10‐min stimulation phase with both a quasi‐trapezoidal (QT) signal and a rectangular signal followed. An interval of 30 min elapsed between the series of stimulations. The attained bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as a control group.

RESULTS

After formalin instillation, the mean (sd) number of involuntary detrusor contractions was 3.5 (0.8)/min and the sum of amplitudes 7.2 (1.1) cmH2O/min. Subsequent NaCl instillation and QT‐stimulation reduced the contractions to 0.3 (0.3)/min and the sum of amplitudes to 0.8 (0.4) cmH2O/min. Stimulation with a rectangular signal, as used in the PNE test, followed after an interval of 10 min, giving 1.1 (0.1) contractions/min and a sum of amplitudes of 5.1 (2.4) cmH2O/min. Within the control group there was no significant reduction.

CONCLUSIONS

These results show that QT‐stimulation suppresses uncontrollable detrusor contractions in the minipig more effectively than the conventional rectangular stimulation presently applied in sacral neuromodulation.
High serum prostate‐specific antigen levels in the absence of prostate cancer in Middle‐Eastern men: the clinician's dilemma
Authors: Kehinde E.O. , Sheikh M. , Mojimoniyi O.A. , Francis I. , Anim J.T. , Nkansa‐Dwamena D. , Al‐Awadi K.A.
Published: December 2004

OBJECTIVE

To investigate the common causes of total serum prostate‐specific antigen (PSA) values of> 10 ng/mL in an Arab population, as in the USA and Europe the risk of prostate cancer is considered high in men with such PSA levels.

PATIENTS AND METHODS

Serum total PSA was measured in men presenting to our hospital as part of the investigation for prostate cancer screening and/or in elderly men with prostatism. Men with a serum PSA level of> 10 ng/mL were further investigated by transrectal ultrasonography (TRUS) of the prostate and biopsy of suspicious lesions for histological diagnosis. In addition, the percentage of free PSA, PSA velocity and PSA density were determined. All the patients included in this study were men of Arab origin residing in Kuwait.

RESULTS

In all, 1700 men (mean age 55.6 years, range 35–94) were assessed; of these, 161 had a serum PSA of> 10 ng/mL, attributable to benign prostatic hyperplasia (BPH) in 110 (68%), BPH with histological features of prostatitis in 33 (21%) and prostate cancer in 18 (11%). TRUS of the prostate in 143 of the 161 men with either BPH or BPH with prostatitis showed varying grades of intraprostatic calcifications in 22 (15%). Both PSA density and percentage free PSA did not contribute to determining the causes of total PSA levels of> 10 ng/mL. There was a progressive decline in PSA in all patients with BPH and prostatitis, except one who at re‐biopsy had prostate cancer (T1N0M0, G1).

CONCLUSION

Total PSA values of> 10 ng/mL in Arab men may be a result of BPH, BPH with prostatitis or prostate cancer, in that order. A gradual decline in total PSA (decreased PSA velocity) with time to < 4 ng/mL often confirms the diagnosis of BPH with prostatitis. The percentage of free PSA and PSA density may not be helpful in diagnosing prostate cancer with certainty in these patients. Compared with Caucasians in the USA and Europe, BPH and BPH with prostatitis appear to be more frequent causes of serum PSA levels of> 10 ng/mL in Arab men.
Improved prognosis of patients with intermediate‐ and poor‐risk nonseminomatous germ cell tumours by optimizing combined treatment
Authors: Pentheroudakis G. , De Bono J.S. , Kaye S.B. , Simpson A. , Paul J. , Brown I. , Pamenter B. , Kirk A. , Vasey P. , Raby N. , Kirk D.
Published: December 2004

OBJECTIVE

To assess whether the optimal use of combined treatment with chemotherapy and appropriately timed surgical intervention by a specialized team might improve the outcome for patients with poor‐ and intermediate‐prognosis (International Germ Cell Consensus Classification, IGCCC) nonseminomatous germ cell tumours (NSGCTs).

PATIENTS AND METHODS

Between 1984 and 1998, 47 patients with intermediate (16) and poor prognosis (31) NSGCT were treated; 43 had a testicular and four a retroperitoneal primary.

RESULTS

Of the 47 patients only seven (15%) had a complete radiological response after primary chemotherapy; 36 (77%) required surgery after chemotherapy (29 para‐aortic lymphadenectomy, 13 resection of pulmonary metastases, two each excision of supraclavicular and retrocrural lymph nodes and one resection of brain metastases; 13 required surgery at more than one site). There was no surgical mortality, with postoperative wound pain the commonest morbidity. On pathology, the resected masses were mature teratoma in 13, necrosis in 12 and malignant disease in 11 patients, the resection being complete in 30. There were microscopically positive margins in the other six patients, all but one having viable residual cancer. Of the 47 patients, 18 needed treatment for relapse, with four having surgery for growing mature teratoma, six chemotherapy plus surgery and eight salvage chemotherapy alone. Of 31 patients, 22 (71%) with a poor and 13 of 16 with an intermediate prognosis were alive at a median (range) follow‐up of 94 (41–171) months; of all 47, 34 (72%) remain in complete remission. Ten patients died from disease progression. The presence of residual malignant disease at the resection margin was significantly associated with poorer survival (hazard ratio 7.21, P = 0.0016). Prognostic factors, e.g. number of involved sites, IGCCC group and viable tumour in resected masses, were not significant. The 5‐year overall and relapse‐free survival (95% confidence interval) was 81 (69–93)% and 57 (43–71)%, respectively.

CONCLUSION

The optimal delivery and timing of chemotherapy and surgical resection by a specialist team of oncologists, urological and cardiothoracic surgeons is critical in treating poor‐risk NSGCT and might be responsible for improving the outcome of these patients. The detection of residual malignant disease after chemotherapy by positron emission tomography should be investigated to identify those who might benefit from further systemic treatment before complete surgical resection.
The effect of drotaverine hydrochloride in acute colicky pain caused by renal and ureteric stones
Authors: Romics I. , Molnár D.L. , Timberg G. , Mrklic B. , Jelakovic B. , Köszegi G. , Blaskó G.
Published: December 2004

OBJECTIVE

To assess the spasmolytic effect of drotaverine hydrochloride in colicky pain caused by renal and ureteric stones.

PATIENTS AND METHODS

In a placebo‐controlled, multicentre, multinational, randomized, double‐blind study changes in the intensity of pain were recorded using a visual analogue scale (VAS), a four‐grade (five points) pain intensity (PI) scale and a pain‐relief scale. The primary endpoint was the evaluation of the antispasmodic effect of drotaverine during a 3‐h study period, to confirm that drotaverine abolished or significantly decreased the intensity of pain in renal colic. The painkilling effect was defined as a decrease by at least half in the PI scale, and/or a ≥ 40% decrease in the VAS 40 min after either the first or the second injection of 80 mg drotaverine or placebo (if necessary the dose could be repeated once). In all, 140 patients were enrolled but 38 withdrew, leaving 102 patients for analysis (48 drotaverine, 54 placebo; mean age 42.5 years, sd 11.25, and 41.7, sd 10.79).

RESULTS

Drotaverine was effective in 79% of patients and placebo in only 46% (P < 0.001). There were no serious adverse effects. There were 20 minor side‐effects in the drotaverine and four in the placebo group; none of the patients required treatment. The most frequent side‐effects were a transitory decrease in blood pressure, vertigo, nausea or vomiting.

CONCLUSION

Intravenous drotaverine provides effective pain relief in more than two‐thirds of patients with renal colic, with no serious side‐effects.
Analysis of compartmental models of type 4 nuclear renograms with calculation of flow rate parameters and instantaneous drainage rates
Authors: Coffey J.P.
Published: December 2004

The first of the two articles in this section examines the dynamic rates of arterial delivery and renal drainage in patients whose renogram showed a Homsy sign, using optimised computer compartmental modelling. The author found that the standard model was unlikely to be correct, and that the Homsy sign was probably an artefact seen in patients with impeded urinary drainage.

In the second, the authors from Budapest studied the effect of drotaverine in patients with ureteric colic; it was of significant help in this condition.

OBJECTIVE

To estimate the dynamic rates of arterial delivery and renal drainage in renograms with the Homsy sign, using optimized computed compartmental modelling.

METHODS

Eleven F−15 renograms and one F+15 renogram (using 99mTc‐mercaptoacetyltriglycine) with the Homsy sign were studied, with 26 controls. Compartmental models were constructed for each renogram using components (blood, renal, bladder) linked by variables (arterial rate, drainage rate). Each model was optimized using the Marquadt least‐squares method to numerical data from the time‐activity curves (TACs). The model renal component at sample points along the TAC was minimized and the corresponding drainage rates calculated.

RESULTS

The models were optimized, with a mean (range) r2 of 0.811 (0.68–0.88). There were continuous low drainage rates for all type 4 renograms, with no quadrupling of the flow rate, as predicted by the standard model.

CONCLUSION

The standard model is unlikely to be correct and the Homsy sign is probably an artefact seen in patients with impeded urinary drainage. Computer modelling of individual renograms is feasible and can provide useful insights into the pathophysiology of renal uptake and drainage.
Lifestyle and behavioural interventions for men on watchful waiting with uncomplicated lower urinary tract symptoms: a national multidisciplinary survey
Authors: Brown C.T. , Van Der Meulen J. , Mundy A.R. , Emberton M.
Published: December 2004

Authors from London sent a survey to British urologists, nurse practitioners and continence advisors to determine the use of lifestyle and behavioural interventions in the UK for symptom control in men with uncomplicated urinary tract symptoms in the event of a watchful waiting policy being adopted. There was an 83% response rate, and the results showed that these interventions are indeed advised by many in such circumstances; however, the wide variation in their use has lead to the suggestion by the authors that it is necessary to test their effectiveness.

A further article from the same institution attempts to highlight the importance of methodological standards in diagnostic testing by reviewing the extent of compliance with these standards in report of evaluations of, in this case, uroflowmetry, in the medical literature. They found that the evaluations assessed showed poor compliance, and felt that this had a negative effect on cost‐effectiveness and health‐case resources

OBJECTIVE

To determine the use of lifestyle and behavioural interventions in the UK for symptom control in men with uncomplicated lower urinary tract symptoms (LUTS) on watchful waiting (WW).

METHOD

Semi‐structured interviews with urologists, nurse practitioners and continence advisors were used to obtain a list of lifestyle and behavioural interventions used in men with LUTS. From the 18 interventions identified, a survey was constructed asking how often these interventions were used in routine practice. The survey was sent to 100 consultant urologists (British Association of Urological Surgeons), 100 nurse practitioners (British Association of Urological Nurses), and 100 continence advisors (International Continence Society) with an interest in male urology, all randomly selected.

RESULTS

Of 248 (83%) responses, 236 were suitable for analysis; 193 (82%) of the respondents reported using lifestyle or behavioural interventions in men on WW with uncomplicated LUTS. The most frequently used interventions were education about the prostate and bladder, avoiding caffeine, urethral milking and reassuring men that they do not have prostate cancer. The use of lifestyle and behavioural interventions showed an ‘all‐or‐none’ pattern. Respondents used either few or many of the 18 interventions identified. There was considerable variation in the extent to which these interventions were used among the survey groups (P < 0.01); urologists used these interventions the least and continence advisors the most.

CONCLUSIONS

Lifestyle and behavioural interventions are advised by many medical professionals to men on WW with uncomplicated LUTS. However, the use varies considerably, with some medical professionals advising many of these interventions and some a few or none at all. Further research is required to define and test the effectiveness of these interventions in reducing LUTS.
Comparison of cadaveric pericardial, dermal, vein, and synthetic grafts for tunica albuginea substitution using a rat model
Authors: Leungwattanakij S. , Bivalacqua T.J. , Yang D.‐Y. , Hyun J.‐S. , Hellstrom W.J.G.
Published: December 2004

OBJECTIVE

To evaluate in an animal model the intermediate and long‐term efficacy of cadaveric pericardium, dermis, vein and Gore‐Tex‰ as grafting materials for tunica albuginea substitution after plaque excision for Peyronie's disease.

MATERIALS AND METHODS

The study comprised 100 male Sprague‐Dawley rats (300–325 g) divided into five equal groups: group 1, sham‐operated controls; and groups 2–5 which underwent wedge excision of the tunica albuginea and replacement with either cadaveric pericardium, dermis, vein or Gore‐Tex grafts. Ten rats in each group had the cavernosal nerve stimulated electrically to assess erectile function at 4 months, and the remaining 10 rats at 6 months. After death the sampled tissues were fixed in 10% formalin, paraffin‐embedded, and stained with Masson's trichrome and Verhoff's van Giesen for collagen and elastic fibres.

RESULTS

Erectile function, assessed by cavernosal nerve stimulation, did not differ significantly in any of the groups (P > 0.05). The histological assessment of penile cross‐sections showed minimal fibrosis surrounding the patch in the dermal and vein grafts, and moderate to severe fibrosis in the Gore‐Tex graft at 4 and 6 months. In the pericardial graft there was a moderate degree of fibrosis at 4 months with only minimal fibrosis at 6 months.

CONCLUSIONS

These results show that cadaveric pericardium allows complete penile expansion and is strong enough to withstand normal intracorporal pressures. There was minimal fibrosis in the pericardial, dermal and vein grafts, and moderate fibrosis in the Gore‐Tex graft at 6 months. The pericardial graft is a satisfactory grafting material when used for tunica albuginea substitution, including the surgical management of Peyronie's disease.
Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part I: apical dissection
Authors: Gillitzer R. , Thüroff J.W.
Published: December 2004

Radical retropubic prostatectomy is currently the most widely used surgical treatment for localized prostate cancer. This once cumbersome procedure has developed technically over the last 20 years, reducing dramatically the associated complications and morbidity, e.g. blood loss, incontinence and impotence. Currently the operation is safe and is the best choice for eradicating localized disease, with little loss in quality of life. However, differences in reported outcomes indicate that there is still a need for standardization and continued efforts for surgical excellence. This review focuses on the crucial steps of the procedure, in two parts: the first covers apical dissection and the second the steps related to vesico‐urethral anastomosis and the nerve‐sparing procedure. This evaluation of the technical modifications aims to offer a choice, to vary the procedure according to the individual situation and thus improve the results. Current trends in surgical technique are also presented.
Technical advances in radical retropubic prostatectomy techniques for avoiding complications. Part II: vesico‐urethral anastomosis and nerve‐sparing prostatectomy
Authors: Gillitzer R. , Thüroff J.W.
Published: December 2004

We previously reviewed different technical modifications and improvements in apical dissection in radical retropubic prostatectomy which have a considerable effect in optimizing the results. This second paper focuses on the vesico‐urethral anastomosis and aspects of nerve‐sparing prostatectomy.
Bilateral testicular cancer: a preventable problem? Experience from a large cancer centre
Authors: Pamenter B. , De Bono J.S. , Brown I.L. , Nandini M. , Kaye S.B. , Russell J.M. , Yates A.J. , Kirk D.
Published: December 2004

OBJECTIVE

To report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8–5% of such patients will subsequently develop a new primary tumour in the contralateral testis.

PATIENTS AND METHODS

From a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified.

RESULTS

Nineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11–181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinoma in situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease‐free, with a median follow‐up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients.

CONCLUSIONS

Chemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow‐up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the second testis in most patients questions the value of biopsy of the contralateral testis. Improved methods of detecting patients at risk of second testicular tumours are needed.
Hypospadias surgery: when, what and by whom?
Authors: Manzoni Gianantonio , Bracka Aivar , Palminteri Enzo , Marrocco Giacinto
Published: December 2004

Hypospadias is repaired by paediatric surgeons, paediatric urologists, adult reconstructive urologists and plastic surgeons. This review is unique in representing all four specialities, to provide a unified policy on the management of hypospadias. The surgeon of whichever speciality should have a dedicated interest in this challenging work, ideally having an annual volume of at least 40–50 cases. The ideal time for primary repair is at 6–12 months old, although when this is not practicable there is another opportunity at 3–4 years old. A surgical protocol is presented which emphasises both functional and cosmetic refinement. Using a logical progression of a very few related procedures allows the reliable correction of almost any hypospadias deformity. A one‐stage repair is used when the urethral plate does not require transection and its axial integrity can be maintained. Occasionally, when the plate is of adequate width and depth, it can be tubularized directly using the second stage of the two‐stage repair. When (usually) the urethral plate is not adequately developed and requires augmentation before it can be tubularized, then that second‐stage procedure is modified by adding a dorsal releasing incision ± a graft (alias Snodgrass and ‘Snodgraft’ procedures). The two‐stage repair offers the most reliable and refined solution for those patients who require transection of the urethral plate and a full circumferential substitution urethroplasty. From available evidence this protocol combines excellent function and cosmesis with optimum reliability. Nevertheless, it would be complacent to assume that these gratifying results will be maintained into adult life. We therefore recommend that there is still a need for active follow‐up through to genital maturity.
Randomised comparison of distension media for outpatient hysteroscopy
Authors: Shankar Meena , Davidson Allan , Taub Nick , Habiba Marwan
Published: December 2004

Objective  To compare saline with and without added lignocaine and carbon dioxide distension for out patient hysteroscopy with regards to patient discomfort and hysteroscopic view.

Design  Single blind prospective randomised controlled trial.

Setting  Specialist out patient clinics in a large teaching hospital.

Population  Women undergoing out patient hysteroscopy and endometrial biopsy for abnormal uterine bleeding.

Method  Out patient hysteroscopy using carbon dioxide, saline or saline with lignocaine.

Main outcome measures  Visual analogue score (VAS) for pain and present pain intensity (PPI) as assessed by patients and the quality of hysteroscopic view as assessed by the operator.

Results  Of the 305 women approached, 300 women were randomised into the study. The mean [SD] VAS for pain in the carbon dioxide group was 2.9 [2.3] and in the saline group was 3.1 [2.6], the difference was not statistically significant (P= 0.49). The mean [SD] VAS for pain in the saline plus lignocaine group was 3.2 [2.4]. This was not significantly different from the saline group (P= 0.72). There was a statistically significant difference between the confidence rating for the hysteroscopic view for the carbon dioxide compared with the saline group; mean [SD] was 8.3 [2.1] and 9.6 [1.1], respectively (P= 0.001).

Conclusion  Carbon dioxide and saline as distension media are comparable in terms of overall patient discomfort and satisfaction, but saline provides better views and increases confidence in diagnosis. Adding lignocaine to the saline distension medium does not confer any additional benefit.
Automated self‐initiated blood pressure or 24‐hour ambulatory blood pressure monitoring in pregnancy?
Authors: Brown M.A. , McHugh L. , Mangos G. , Davis G.
Published: December 2004

Objective  To determine whether self‐initiated and recorded automated blood pressure measurement can provide an accurate estimate of ambulatory blood pressure in pregnant women suspected of having ‘white coat hypertension’.

Design  A prospective observational study.

Setting  Women's and Children's Health Unit, St George Hospital, a teaching hospital of the University of New South Wales.

Population  Pregnant women being assessed for possible ‘white‐coat hypertension’.

Methods  Sixty‐six pregnant women who were undergoing 24 hour ambulatory blood pressure monitoring (ABPM) in their home or work environment also measured their blood pressure six times during this interval using a self‐initiated automated blood pressure recorder (Omron HEM 705CP). Agreement between awake ABPM and Omron recorded blood pressures was tested by Bland–Altman analysis.

Main outcome measure  Limits of agreement between blood pressures measured by each device.

Results  Average blood pressures obtained by the two devices were identical (125/77 mmHg) but limits of agreement were wide, −20 to +23 mmHg for systolic blood pressure and −9 to +15 mmHg for diastolic blood pressure.

Conclusion  The Omron HEM 705CP is a useful device for measuring group average blood pressures in pregnant women suspected of having white coat hypertension but cannot reliably replace ABPM for clinical management of individual pregnant women.
Monoamniotic twin pregnancies: antenatal management and perinatal results of 19 consecutive cases
Authors: Demaria Fabien , Goffinet François , Kayem Gilles , Tsatsaris Vassilis , Hessabi Madieh , Cabrol Dominique
Published: December 2004

Objective  To describe the obstetric management and perinatal outcome of antenatally diagnosed monoamniotic twin pregnancies (MATP) in a tertiary level maternity unit.

Setting  Port‐Royal Maternity Hospital, Paris, France.

Population  MATP that progressed beyond 22 weeks seen from 1993 to 2001.

Methods  A retrospective chart review of all twin pregnancies. Diagnosis of MATP was made by ultrasonography and confirmed by placental pathology.

Main outcome measure  Perinatal mortality.

Results  Among the 1242 twins pregnancies delivered during the study period, 19 were monoamniotic. Four fetuses (10% of all births) had malformations. Perinatal mortality was high (n= 12, 32%) because of fetal deaths (nine cases) and very preterm births (three neonatal deaths). No fetal deaths occurred after 29 weeks. Of the 15 women with at least one live fetus before labour, 6 gave birth by vaginal delivery (40%). No obstetric accidents occurred during vaginal deliveries.

Conclusion  Perinatal mortality of MATP is still very high, even with accurate, early antenatal diagnosis, intensified surveillance and delivery provided in a tertiary level hospital. The main causes of perinatal deaths are cord accidents in utero, congenital anomalies and very preterm births.
A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction
Authors: van Gemund N. , Scherjon S. , Le Cessie S. , Schagen van Leeuwen J.H. , van Roosmalen J. , Kanhai H.H.H.
Published: December 2004

Objective  To compare vaginal misoprostol with dinoprostone for induction of labour.

Design  Randomised multicentre trial.

Setting  Labour wards of one university hospital and two teaching hospitals.

Population  Six hundred and eighty‐one women with indication for labour induction at ≥36 weeks of gestation, singleton pregnancy and no previous ceasarean section.

Methods  Misoprostol (25 mcg, hospital‐prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary.

Main outcome measures  Primary: ‘adverse neonatal outcome’ (5‐minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction.

Results  Three hundred and forty‐one women received misoprostol and 340 dinoprostone. The median induction–delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6–1.04). ‘Adverse neonatal outcome’ was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5–0.98).

Conclusions  Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.
A randomised controlled trial of ursodeoxycholic acid and S‐adenosyl‐l‐methionine in the treatment of gestational cholestasis
Authors: Roncaglia Nadia , Locatelli Anna , Arreghini Alessandra , Assi Francesca , Cameroni Irene , Pezzullo John C. , Ghidini Alessandro
Published: December 2004

Objective  To compare the efficacy of S‐adenosyl‐l‐methionine and ursodeoxycholic acid in improving serum biochemical abnormalities in gestational cholestasis.

Design  Randomised clinical trial.

Setting  University hospital.

Population  All women at <36 weeks of gestation with severe gestational cholestasis during June 1996 to December 2001.

Methods  Enrolled women were randomly assigned oral S‐adenosyl‐l‐methionine 500 mg twice daily or oral ursodeoxycholic acid 300 mg twice daily until delivery.

Main outcome measures  Reduction in the concentration of serum bile acids. Other variables considered included obstetric and neonatal outcome, clinical symptoms and other laboratory measurements (serum levels of transaminases and bilirubin). The two groups were compared using Student's t test, Wilcoxon's signed rank sum test and Fisher's exact test, with a two‐tailed P < 0.05 being considered significant.

Results  Of the 46 women enrolled, 24 received ursodeoxycholic acid and 22 S‐adenosyl‐l‐methionine. At enrolment, gestational age, duration of therapy, rate of nulliparity, pruritus score and biochemical characteristics were similar between the groups. Both therapies significantly and equally improved pruritus. Women receiving ursodeoxycholic acid had a significantly greater improvement in the concentration of serum bile acids (P= 0.001), aspartate aminotransferase (P= 0.01), alanine aminotransferase (<0.001) and bilirubin (P= 0.002) compared with those receiving S‐adenosyl‐l‐methionine. Duration of therapy was significantly greater in women receiving ursodeoxycholic acid compared with S‐adenosyl‐l‐methionine (P= 0.04), whereas gestational age at delivery and rate of prematurity were similar in the two groups.

Conclusions  In women with intrahepatic cholestasis of pregnancy, ursodeoxycholic acid is more effective than S‐adenosyl‐l‐methionine at improving the concentration of serum bile acids and other tests of liver function, whereas both therapies are equally effective at improving pruritus.
Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii
Authors:   European Multicentre Study on Congenital Toxoplasmosis,   Participants are listed on page 119
Published: December 2004

Objective To determine the effects on mother to child transmission of the timing and type of prenatal treatment, taking into account gestational age at maternal seroconversion.

Design Prospective cohort study.

Setting European centres offering prenatal screening for toxoplasmosis.

Population Children born to a cohort of pregnant women with toxoplasma infection.

Methods We determined the effects on mother to child transmission of the interval between seroconversion and start of treatment (treatment delay), and the type of treatment, taking into account gestational age at maternal seroconversion.

Main outcome measure Congenital infection status confirmed by toxoplasma IgG results at one year postnatal age.

Results Of 1208 women analysed, 72% were first prescribed spiramycin, 19% pyrimethamine–sulphonamide and 9% (mostly infected during the last trimester) were untreated. The odds ratios for mother to child transmission for all women treated after a delay of four to seven weeks was 0.77 (95% CI 0.34–1.69), and after eight weeks or more was 1.33 (0.56–2.89) compared with less than four weeks. The odds ratio per week of treatment delay was 1.01 (0.93–1.08). There was no evidence that transmission risk differed in women first treated with pyrimethamine–sulphonamide versus spiramycin: odds ratio 1.10 (0.63–1.91) or in untreated versus treated women: odds ratio 0.57 (0.27–1.17).

Conclusion We were unable to demonstrate a beneficial effect of the timing or type of prenatal treatment on the risk of mother to child transmission but we could not exclude a clinically important effect. Randomised controlled trials are required to determine the effect of prenatal treatment on mother to child transmission.