bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacillus Calmette‐Guérin therapy in stage Ta/T1 bladder cancer: prognostic factors for time to recurrence and progression
Authors: Andius P. , Holmäng S.
Published: May 2004

OBJECTIVE

To report prognostic factors for time to recurrence and progression after bacillus Calmette‐Guérin (BCG) prophylaxis in patients with stage Ta/T1 papillary bladder cancer.

PATIENTS AND METHODS

The clinical records were assessed retrospectively for 236 patients with papillary stage Ta/T1 bladder cancer treated with BCG between 1986 and 2000. Patients with known carcinoma in situ were excluded. The median (range) follow‐up was 44 (4–155) months. The effect of 13 variables on the time to recurrence and progression was evaluated using multivariate Cox proportional hazard regression and Kaplan‐Meier analyses.

RESULTS

The recurrence rate was markedly reduced for all grades and stages. Patients with a negative first cystoscopy and maintenance BCG had a significantly longer time to recurrence than those treated with an induction course alone (P < 0.001). Thirty‐seven patients (16%) progressed in stage. The result of the first cystoscopy (P < 0.001), tumour grade (P = 0.003) and six or fewer initial instillations (P = 0.002) had prognostic importance for the time to progression. Twenty‐eight patients (12%) had a history of an upper tract tumour, which was 3–10 times the expected rate. Age, number of tumours, number of positive cystoscopies, length of tumour history before BCG, BCG strain and treatment year had no influence on time to recurrence and progression.

CONCLUSIONS

Maintenance treatment does not seem to be necessary among patients with TaG1‐G2 disease after a negative first cystoscopy, as the progression rate was very low. One new finding was that BCG seemed to be equally effective among patients with or with no history of an upper tract tumour. Another new and surprising finding was that patients treated with fewer than six induction instillations, because of very bothersome side‐effects, had an increased risk of tumour progression and of local failure.
A randomized placebo‐controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis)
Authors: Nickel J.C. , Downey J. , Pontari M.A. , Shoskes D.A. , Zeitlin S.I.
Published: May 2004

OBJECTIVE

To determine if finasteride can reduce symptoms in men with a clinical diagnosis of chronic nonbacterial prostatitis (National Institutes of Health, NIH, category IIIA chronic pelvic pain syndrome, CPPS) compared with placebo.

PATIENTS AND METHODS

Men (76) with category IIIA CPPS enrolled in four North American prostatitis research centres were randomized after a 2‐week placebo run‐in to finasteride or placebo for 6 months. The primary efficacy variable was a subjective overall assessment (SOA); the secondary efficacy variables included the NIH chronic prostatitis symptom index (NIH‐CPSI) and safety data. Patients were assessed at screening, baseline (after the 2‐week placebo run‐in), 3 and 6 months.

RESULTS

Sixty‐four patients had at least one assessment on medication (31 placebo, 33 finasteride); 75% of the finasteride and 54% of the placebo group had at least a mild improvement (defined as > 25% improvement in SOA), and 44% and 27%, respectively, a moderate or marked improvement (>50% improvement in SOA). The trend was similar in the NIH‐CPSI scores. Five patients in the finasteride and seven in the placebo group reported medication‐related adverse events.

CONCLUSION

This randomized placebo‐controlled pilot study suggests that finasteride was of benefit for some men with category IIIA CPPS, but the results do not justify recommending finasteride as monotherapy, except for men who also have benign prostatic hyperplasia. A larger, properly powered study, possibly evaluating combination with other therapies or specifically in men with prostatitis and benign prostatic hyperplasia, is required to confirm any clinical benefit.
Use of the short form of King's Health Questionnaire to measure quality of life in patients with an overactive bladder
Authors: Homma Y. , Uemura S.
Published: May 2004

OBJECTIVE

To develop a short version of the King's Health Questionnaire (KHQ), as there is a practical need to have a shorter version to summarize the eight domain scores into fewer domains.

PATIENTS AND METHODS

Data from 293 patients were obtained from a randomized, double‐blind, placebo‐controlled clinical trial in Japan of oxybutynin and tolterodine in patients with symptoms of an overactive bladder. The KHQ has two single‐item and six multiple‐item domains. To construct the short form of the KHQ one item was selected from the each of multiple‐item domains, based on standardized structural coefficients estimated by confirmatory factor analysis (CFA) in a previous study. These six items include the domains: ‘daily activities from role limitation’, ‘travel from physical limitation’, ‘social life from social limitation’, ‘family life from personal relationship’, ‘depressed from emotion’ and ‘tired from sleep and energy’. Based on the six selected items a series of psychometric analyses were conducted.

RESULTS

Exploratory factor analysis (EFA) with promax rotation identified two factors ‘limitation of daily life’ (LDL) and mental health. LDL consisted of ‘daily activities’, ‘travel’ and ‘social life’, and mental health included ‘family life’, ‘depressed’ and ‘tired’. Based on the results from the EFA, the second‐order factor structure was tested by CFA. The model fitted the data well for both the male and female model. The KHQ short form showed excellent reliability with Cronbach's α coefficients for LDL and mental health for both genders. The domains in the short form were responsive to clinical efficacy variables, and had statistically significant sensitivity to change in the patients’ perception of bladder condition in all domains.

CONCLUSION

These analyses confirm the psychometric properties and clinical validity of the short‐form KHQ, which appears to offer a practical, valid and reliable health‐related quality‐of‐life instrument.
Correlation of ultrasonographic and orchidometer measurements of testis volume in adults
Authors: Schiff J.D. , Li P.S. , Goldstein M.
Published: May 2004

A study from New York was aimed at determining the correlation between testicular volume measurements made with an orchidometer and with high‐resolution scrotal ultrasonography; the authors found that measurements made with the former strongly correlate with those from the latter.

Premature ejaculation remains a significant problem, and authors from Brazil reports a placebo‐controlled study into the use of topical anaesthetic in this condition.

OBJECTIVE

To determine the correlation between testicular volume measured with an orchidometer or high‐resolution scrotal ultrasonography (US) with colour‐flow Doppler analysis.

PATIENTS AND METHODS

In all, 159 men (mean age 36.6 years) presenting for infertility evaluation underwent both a physical examination by a one experienced examiner and high‐resolution US with colour‐flow Doppler analysis. An orchidometer was also used to measure testicular volume after stretching the scrotal skin tightly over the testis and after warming with a heating pad. The US was interpreted by a radiologist who had no knowledge of the orchidometer estimates. The volume was calculated as 0.71 × length × width × height.

RESULTS

For the right testes the mean orchidometer and US estimates were 18.4 and 18.3 mL, yielding a correlation coefficient of 0.72 (r 2 = 0.52, P < 0.01). On the left the respective values were 17.1 and 16.9 mL, with a correlation coefficient of 0.69 (r 2 = 0.48, P < 0.01).

CONCLUSION

Orchidometer estimates of testicular volume correlate closely and very significantly with US estimates in adults. In the hands of an experienced examiner orchidometer measurements provide an accurate, rapid and inexpensive assessment of testicular volume.
Topical anaesthetic use for treating premature ejaculation: a double‐blind, randomized, placebo‐controlled study
Authors: Busato W. , Galindo C.C.
Published: May 2004

OBJECTIVE

To assess the use of a topical anaesthetic mixture to improve premature ejaculation (PE), for which penile hypersensitivity might be a cause.

PATIENTS AND METHODS

The study included 42 men divided in two groups; group A used a lidocaine‐prilocaine solution and group B used an inert cream. The tubes of cream were distributed randomly and participants asked to note any unpleasant symptoms, difficulties and the results of each attempt at intercourse, assessed by the intravaginal ejaculatory latency time (IELT).

RESULTS

There was a significant increase in the mean (sd) IELT, from 1.49 (0.9) to 8.45 (0.9) min (P < 0.001) in group A but not in group B, at 1.67 (0.7) to 1.95 (0.12) min (P > 0.05).

CONCLUSION

We suggest that anaesthetic cream might be effective for treating PE.
Cost analysis of flexible ureterorenoscopy
Authors: Collins J.W. , Keeley F.X. , Timoney A.
Published: May 2004

The development of ureteroscopy, in the first instance with rigid ureteroscopes, and subsequently with flexible ureteroscopes, has been a huge contribution to the non‐operative removal of urinary tract calculi. Access can be gained to stones in the ureter and to many in the kidney. Two reports presented in this section examined aspects of ureteroscopy; the cost of the procedure, and whether stenting of the ureter is required after removing ureteric stones by this means.

OBJECTIVE

To assess the costs of flexible ureterorenoscopy.

MATERIALS AND METHODS

Data were collected prospectively for 100 cases using a new flexible ureteroscope (DUR8, Circon ACMI, Stamford, USA), including the indications for flexible ureterorenoscopy, use of laser probes, disposable instrumentation, and the cost and timing of ureteroscope repair.

RESULTS

Of the 100 procedures 68 were for stone disease, 21 for known or suspected transitional cell carcinoma (TCC), six were diagnostic only and five were for pelvi‐ureteric junction obstruction. The ureteroscope was repaired after the 29th and 88th cases. The ability of the ureteroscope to deflect was maintained throughout. At the time of purchase the ureteroscope was listed at £15 000 and each repair/exchange currently costs £4200, thus the total expenditure on the ureteroscope was £23 400. Total expenditure on ancillary equipment was £28 727, of which £22 927 was on disposables and £5800 on 10 laser probes.

CONCLUSION

In this series the costs of the ancillary equipment exceeded the purchase and maintenance of the ureteroscope, and we expect this trend to continue in the long term. The advent of more durable ureteroscopes may ultimately reduce the frequency of costly repairs. The cost of disposables should be considered in planning the budget.
An audit over 2 years’ practice of open and laparoscopic live‐donor nephrectomy at renal transplant centres in the UK and Ireland
Authors: Brook N.R. , Nicholson M.L.
Published: May 2004

OBJECTIVE

To collate information on the practice of live‐donor nephrectomy and compare this with the published British Transplantation Society (BTS) guidelines for best practice, using two questionnaires sent to all renal transplant centres in the UK and Ireland to cover practice for the years 2000 and 2002.

METHODS

A postal questionnaire was sent to all surgical kidney transplant consultants in the UK and Ireland, including questions on the practice of live‐donor nephrectomy in the year 2000 (the questionnaire was sent in 2001) and 2002 (questionnaire sent in 2003).

RESULTS

All 28 centres responded fully for both years; 27 centres used live kidney donation in 2000, decreasing to 24 in 2002. Consultants reported 356 operations in 2000, representing 19% of all kidney transplants, and 403 in 2002, representing 23% of all kidney transplants. Three centres offered laparoscopic donor nephrectomy in 2000, and five did so in 2002. Most centres organize donor and recipient operations synchronously, and most have a consultant anaesthetist present for the donor procedure. There were variations in the use of analgesia and thromboprophylaxis, and in donor follow‐up.

CONCLUSIONS

There is widespread application of live‐donor nephrectomy in the UK but BTS guidelines are not closely followed. Minimal access donor nephrectomy is offered at a few centres but many have plans to introduce this into their practice.
Mainz Pouch II technique: 10 years’ experience
Authors: D’elia G. , Pahernik S. , Fisch M. , Hohenfellner R. , Thüroff J.W.
Published: May 2004

In this section, the use of the Mainz Pouch II is examined in some detail, from Mainz (where it originated), and from London. Both groups of authors found the procedure to be valuable and helpful, and critically assess the results and complications.

OBJECTIVE

To report the long‐term results with the Mainz Pouch II procedure.

PATIENTS AND METHODS

Between 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1–73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four and cloacal malformation (sinus urogenitalis) in one. In all, 102 patients with a follow‐up of ≥ 12 months were evaluated (mean 46.2 months).

RESULTS

Day‐ and night‐time continence rates were 97% and 95%, respectively. The remaining patients occasionally lose some drops of urine during coughing or straining, or reported minimal soiling of undergarments during the night. The mean voiding frequency was six during the day and once at night. There were 14 ureteric implantation stenoses (7.2% of 194 evaluated reno‐ureteric units) and they were treated successfully by open repair (13) or antegrade balloon dilation (one). For metabolic disturbances, 69% of the patients had a capillary base excess of <–2.5 mmol/L and use oral alkalinizing drugs to prevent hyperchloraemic acidosis. There was no clinically evident metabolic acidosis.

CONCLUSION

Applying the principles of detubularization and spherical reconfiguration to create a low‐pressure reservoir and stratifying ureteric implantation between submucosal and serous‐lined extramural tunnel techniques succeeded in giving better continence rates and long‐term preservation of the upper urinary tract than a classical ureterosigmoidostomy. The Mainz Pouch II ureterosigmoidostomy is simple and reliable as a viable alternative for continent urinary diversion in selected patients.
Experience with non‐cycled artificial urinary sphincters
Authors: Herndon C.D.A. , Rink R.C. , Shaw M.B.K. , Cain M.P. , Casale A.J.
Published: May 2004

Papers in this section review experience with artificial urinary sphincters, hypospadias, and the exstrophy/epispadias complex. Also, in keeping with a significant theme of urological trauma in this issue of the journal, authors from Mansoura evaluate the late renal functional and morphological evaluation of high‐grade renal injuries in children after conservative treatment.

OBJECTIVE

To report our experience in children and adolescents with a non‐cycled artificial urinary sphincter. While some children with the AUS can void, others require clean intermittent catheterization (CIC) through the sphincter or an alternative site for catheterization; in some of the latter we have either not cycled (pumped) an activated AUS or the AUS has failed, and there is concern about ischaemia in some adults with a non‐cycled AUS.

PATIENTS AND METHODS

In all, 143 patients who had an AUS placed between 1980 and 2002 were reviewed retrospectively; 15 (10 boys and five girls) no longer cycled (pumped) their AUS. The mean age at AUS insertion was 11 years and the mean (range) follow‐up after insertion was 10.4 (1.64–22.2) years. The diagnoses included myelomeningocele in 11, sacral agenesis in three and cloaca in one. Nine patients have an activated functioning AUS and in six the AUS does not function; in the first nine the sphincter has not routinely been cycled (pumped) for a mean (range) of 1.6 (0.6–2.9) years. In the other six with a nonfunctioning AUS the mean (range) observation period is 6.4 (1.5–10) years since the system has not functioned.

RESULTS

All patients were completely continent, including the six with a nonfunctioning AUS. After inserting the AUS, two patients voided in combination with CIC (one each urethral and abdominal stoma) and 13 emptied by CIC (nine abdominal stoma, four urethral). There was a mechanical complication in eight patients; three had the AUS repaired and are dry, and five are dry with no repair. In one patient the AUS was never activated. To date there has been no erosion of the cuff in any of the 15 patients with a non‐cycled AUS.

CONCLUSION

The AUS remains an extremely reliable procedure to achieve continence in children and young adults. It is versatile and can be combined with other procedures that provide an alternative means for catheterization. While some have noted the need to routinely cycle the AUS to prevent erosion, this has not been our experience in these 15 patients.
THIS ARTICLE HAS BEEN RETRACTED  In vivo transfer of a neuronal nitric oxide synthase expression vector into the rat bladder by electroporation
Authors: Iwashita H. , Yoshida M. , Nishi T. , Otani M. , Ueda S.
Published: May 2004

OBJECTIVE

To investigate the possibility of in vivo gene transfer by attempting to transfer the neuronal nitric oxide synthase (nNOS) gene into rat bladder using electroporation.

MATERIALS AND METHODS

The bladder was exposed through an abdominal midline incision in 8‐week‐old male rats. Plasmid DNA of the marker genes green fluorescent protein (GFP) and luciferase, and the nNOS gene, was then injected into the subserosal space of the bladder and electroporation applied. At 72 h after gene transfer, GFP and luciferase were assayed in the isolated bladder and immunohistochemical staining used to detect nNOS; NOx released from isolated bladder strips was also assessed using microdialysis and high‐performance liquid chromatography.

RESULTS

From the luciferase assay, 45 V, 1 Hz, 50 ms and eight pulses were selected as the optimum conditions for electroporation. Bladder specimens with GFP genes injected by electroporation showed bright and numerous sites of GFP expression in the smooth muscle layer. In rats with the nNOS gene injected by electroporation there was marked nNOS immunoreactivity, and NOx released from bladder strips was significantly greater than in the control groups.

CONCLUSIONS

These results suggest that electroporation is a useful technique for in vivo gene transfer into rat bladder smooth muscles, and that the nNOS gene transferred by this procedure functionally expresses and contributes to NO production.
Quality of life compared during pharmacological treatments and clinical monitoring for non‐localized prostate cancer: a randomized controlled trial
Authors: Green H.J. , Pakenham K.I. , Headley B.C. , Yaxley J. , Nicol D.L. , Mactaggart P.N. , Swanson C.E. , Watson R.B. , Gardiner R.A.
Published: May 2004

OBJECTIVES

To investigate the effects of different management strategies for non‐localized prostate cancer on men's quality of life and cognitive functioning.

PATIENTS, SUBJECTS AND METHODS

Men with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated‐measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1‐year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions.

RESULTS

Sexual dysfunction increased for patients on androgen‐suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function.

Conclusions

In deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.
Guideline for the primary care management of male lower urinary tract symptoms
Authors: Speakman M.J. , Kirby R.S. , Joyce A. , Abrams P. , Pocock R.
Published: May 2004

As my Comment in the first section of the journal suggested, the MTOPS results have offered the possibility to general practitioners of reducing the risk of side‐effects of BPH, particularly urinary retention, by giving patients dual therapy with 5α‐reductase inhibitor and alpha‐adrenergic blocker. Authors from the UK present guidelines for the primary case management of male LUTS, which significantly fills this gap in the literature.

Any help in the management of chronic nonbacterial prostatitis is welcome to clinicians; many treatments have been proposed after non‐comparative trials, and so their value must be viewed cautiously. The authors from Canada and USA present the results of a randomized placebo‐controlled study into the use of finasteride in such patients.

The other papers in this section all deal with LUTS, e.g. frequency and nocturia, in a variety of situations. There is still great interest in the epidemiology of these symptoms, and in the various methods of grading their severity.
Antidiuresis: a new concept in managing female daytime urinary incontinence
Authors: Robinson D. , Cardozo L. , Akeson M. , Hvistendahl G. , Riis A. , Norgaard J.P.
Published: May 2004

OBJECTIVE

To investigate the efficacy of desmopressin nasal spray on daytime urinary incontinence in women.

PATIENTS AND METHODS

A multicentre, multinational, randomized, double‐blind, placebo‐controlled, cross‐over exploratory study of women (aged 18–80 years) complaining of severe daytime urinary incontinence was conducted in three centres (King's College Hospital; Boras County Hospital and Skejby Hospital). Seventy‐five patients were screened of whom 64 were randomized. In all, 60 women received study medication (safety population) and 57 completed the study. The intention‐to‐treat population comprised 59 patients and there were 41 in the per protocol analysis. The primary efficacy endpoint was the number of periods with no leakage for 4 h after dosing. Women were instructed to take the drug at a time of their choosing, but ≥ 4 h before bedtime. Secondary efficacy variables included the time to first void or incontinence episode, volume leaked per incontinence episode, total volume voided and number of periods with no leakage. All measurements were made over 7 days on desmopressin and 3 days on placebo.

RESULTS

There was a higher mean (sd) incidence of periods with no leakage in the first 4 h on desmopressin, at 62 (35)%, than on placebo, at 48 (40)%, and during the first 8 h, at 55 (37)% vs 40 (41)%. There was also a higher frequency of dry days on desmopressin than on placebo; 36% of patients had no leakage on virtually all treatment days (6 or 7) for 4 h after dosing. At 4–8 h the incidence of periods with no leakage on desmopressin was 68 (35)% vs 63 (41)% on placebo, and thereafter the incidence was similar. The time from dosing to first incontinence episode was longer on desmopressin, at 6.3 (2.5) h, vs 5.2 (3.3) h, whilst the volume leaked per incontinence episode was lower on desmopressin than placebo. The total volume voided was consistently lower on desmopressin, at 1180 (58) mL vs 1375 (57) mL, over the 24‐h period after administration. There were no serious or severe adverse events reported. Seven women (11%) withdrew from the study, of whom five did not attend for the final visit and two (3%) because of mild adverse events.

CONCLUSIONS

The results of this exploratory study suggest that desmopressin is an effective and safe treatment in women with daytime urinary incontinence, and allows them to choose when they need treatment, thus improving motivation, which may aid compliance with therapy.
Nocturia: impact on quality of life in a Dutch adult population
Authors: Van Dijk L. , Kooij D.G. , Schellevis F.G. , Kaptein A.A. , Boon T.A. , Wooning M.
Published: May 2004

OBJECTIVE

To estimate the effect of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems.

SUBJECTS AND METHODS

From a random sample of Dutch adults (≥ 18 years old) 1000 were selected after stratification to complete a written questionnaire. Respondents (819) were distributed over three groups: a target group (189, who felt bothered by ≥ one void/night); a reference group 1 (120 reporting ≥ two voids/night but with no bother); and reference group 2 (510, with 0–1 voids/night). Nocturia, other lower urinary tract symptoms and perceived impact on life were measured using the Bristol Lower Urinary Tract Symptoms Questionnaire (B‐LUTS). Sleep problems were measured using the Sleep Wake Experience List (SWEL) and QoL using two subscales from the RAND‐36, i.e. ‘physical functioning’ and ‘mental health’.

RESULTS

The perceived impact on life was highest in the target group (P < 0.05), which also had more sleep problems and scored lower on the QoL scores than both reference groups (P < 0.05). Statistically significant differences in mental health and physical functioning between the target and reference groups became insignificant after correcting for sleep problems, indicating that the effect of nocturia (with bother) is mediated by sleep problems.

CONCLUSIONS

Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients who contact them for sleep problems also have nocturia.
Nocturia in patients with lower urinary tract symptoms: association with diurnal voiding patterns
Authors: Ku J.H. , Lim D.J. , Byun S.‐S. , Paick J.‐S. , Oh S.‐J.
Published: May 2004

OBJECTIVE

To determine whether diurnal voiding patterns predict nocturia in patients with lower urinary tract symptoms (LUTS), as few studies have evaluated the association between diurnal and nocturnal voiding patterns.

PATIENTS AND METHODS

We prospectively analysed the frequency‐volume charts (FVCs) of consecutive patients with LUTS. At the initial visit patients had a detailed clinical evaluation and subsequently were requested to complete a 72‐h FVC. In all, 104 (41 men and 63 women, mean age 63 years, range 50–83) were included in the primary analyses. Associations between daytime variables and nocturia were described using maximum likelihood estimates of the relative risk and by 95% confidence intervals (CIs) based on logistic regression models.

RESULTS

When at least one night‐time void was used to define nocturia the multivariate logistic model showed a negative association of mean daytime voided volume with nocturia (P = 0.001). The odds ratio for nocturia decreased with this variable to 0.98 (95% CI 0.96–0.99). When ‘voiding at least twice per night’ was used to define nocturia only the number of daytime voids was positively related to nocturia (odds ratio 1.22; 95% CI 1.01–1.48; P= 0.040).

CONCLUSION

Nocturia may be associated with diurnal voiding patterns; these results also suggest that the causes of nocturia of one or of two or more voids may differ. This highlights the role of bladder function in more severe forms of nocturia.
Modified ureterosigmoidostomy (Mainz II): a long‐term follow‐up
Authors: Nitkunan T. , Leaver R. , Patel H.R.H. , Woodhouse C.R.J.
Published: May 2004

OBJECTIVE

To assess the long‐term results in patients treated using a modified ureterosigmoidostomy (Mainz II).

PATIENTS AND METHODS

Between 1994 and 1999, 17 patients had their lower urinary tract reconstructed by a ureterosigmoidostomy, modified by reconfiguring the rectum to make a low‐pressure reservoir (Mainz II). All patients were followed on a standard protocol. Data were extracted from the database and from a review of the case‐notes. In 12 patients the procedure was with a radical cystectomy for carcinoma. Five had a failed conventional ureterosigmoidostomy for bladder exstrophy and therefore proceeded to a Mainz II. The data on continence and complications were retrieved for a retrospective analysis; the mean (range) follow‐up was 6.4 (4–8.6) years.

RESULTS

Ten of those with bladder cancer and one in the revision group were continent. Two patients in the revision group had sufficiently severe nocturnal incontinence to require conversion to a colonic conduit. Seven of the 17 patients had hyperchloraemic acidosis, one had pyelonephritis and one had renal stones. There were no anastomotic neoplasms.

CONCLUSION

The Mainz II has a good outcome if used as the primary procedure. In patients with an existing ureterosigmoidostomy who are incontinent, detubularization of the rectosigmoid alone is unlikely to restore continence.
Late renal functional and morphological evaluation after non‐operative treatment of high‐grade renal injuries in children
Authors: El‐Sherbiny M.T. , Aboul‐Ghar M.E. , Hafez A.T. , Hammad A.A. , Bazeed M.A.
Published: May 2004

OBJECTIVE

To assess the long‐term results in children with high‐grade renal trauma who were managed without surgery, as such treatment was initially successful but little is known about the late ipsilateral renal function and morphology.

PATIENTS AND METHODS

The study included 13 children (nine boys and four girls; mean age 8 years, sd 5) with high‐grade renal injury who were managed without surgery between 1997 and 2001, and followed for a mean (sd, range) of 3 (2, 0.5–7) years. The trauma was caused by a motor‐car accident in five and falling from a height in eight children, and was on the right in 10 and on the left in three. There was gross and microscopic haematuria in 10 and three patients, respectively. The trauma was graded according to the American Association for Surgery of Trauma, with grades III, IV and V renal injury in six, four and three children, respectively. All patients were treated initially by observation; one required super‐selective embolization because of continuing haemorrhage. Three children with progressive urinary extravasation were treated with a percutaneous tube drain and JJ stent for 6 weeks. Patients were discharged after a mean (sd) hospital stay of 9 (6) days. Ultrasonography then showed resolving haematoma in all patients with a mean (sd) size of 7 (2) cm2. At the last follow‐up patients were re‐evaluated by a clinical examination, renal scintigraphy and computed tomography angiography.

RESULTS

None of the children was hypertensive nor had any abnormality on urine analysis; all had normal serum creatinine levels, and scintigraphy and angiography showed normal contralateral kidneys in all. Ipsilateral abnormalities were detected in 12 patients, and included a single scar in five, multiple scars in six and a cystic lesion with multiple septa in one. There was no vascular complication or hydronephrosis, and no significant functional loss, with all affected kidneys having a split function of 41–50% at the last follow‐up.

CONCLUSION

Although there is no late functional loss there are residual morphological changes in almost all children with high‐grade renal injury. This study provides objective support for the non‐operative management of high‐grade renal injury in children, but a prolonged follow‐up is warranted to assess the risk of progression of these abnormalities.
Comprehensive analysis of tubularized incised‐plate urethroplasty in primary and re‐operative hypospadias
Authors: El‐Sherbiny M.T. , Hafez A.T. , Dawaba M.S. , Shorrab A.A. , Bazeed M.A.
Published: May 2004

OBJECTIVE

To retrospectively review our experience of the tubularized incised‐plate (TIP) urethroplasty over the last 4 years.

PATIENTS AND METHODS

From 1998 to December 2001, 133 patients (mean age 7 years, sd 4, range 1–22), had a TIP urethroplasty by one surgeon for primary (103) and re‐operative (30) hypospadias; the defects included 106 (79%) distal and mid‐shaft, and 27 (21%) posterior shaft. The neourethra was covered by a subcutaneous flap in 66 (50%) patients or by corpus spongiosa (spongioplasty) in 31 (23%), with no cover in the remaining 36 (27%). In the last 20 patients (15%) a modified meatoplasty was used; the site and size of the new meatus was predetermined on the glans around a suitable catheter before any incision. Urethral stents were not used after repair in 39 (29%) patients, and regular meatal dilation was used only in patients with voiding difficulty and obvious tendency to stenosis. The presence of complications requiring re‐operation and overall general appearance were recorded.

RESULTS

The mean (sd) follow‐up was 10 (5) months; there were 24 complications in 20 patients (15%), including a small fistula in 12 (9%), complete disruption of the repair in 4 (3%), meatal stenosis in seven (5%) and neourethral stricture in one (0.8%). Complications were not significantly different between primary and re‐operative cases, and unaffected by the use of the stents. On univariate analysis complications were significantly higher with running than interrupted sutures, in repairs in the first 2 years of the study, in patients with posterior hypospadias, and in those with no neourethral coverage. However, the last two factors were the only significant independent risk factors in a multivariate analysis. Regular urethral dilatation was indicated in 43 patients (32%). Modified meatoplasty was associated with a significantly lower requirement for regular dilatation (P < 0.05) and no meatal stenosis. In the 113 complication‐free patients the operation gave an excellent cosmetic appearance with a vertical slit meatus on the tip of conical glans in 110 (97%); there was slight meatal retraction in the remaining three patients.

CONCLUSION

The TIP repair is a reliable method for treating both distal and proximal penile shaft hypospadias, is suitable for both primary and re‐operative cases, and is more versatile than other repairs. Covering the neourethra with a flap or spongioplasty significantly improves the results. Regular urethral dilatation is required in a third of patients but modified meatoplasty obviates the need for regular dilatation and eliminates the risk of meatal stenosis.
The exstrophy‐epispadias complex: is aesthetic appearance important?
Authors: Meyer K.F. , Freitas Filho L.G. , Martins D.M.S. , Vaccari M. , Carnevale J.
Published: May 2004

OBJECTIVE

To show the relevance of cosmetic appearance in the adequate treatment of patients with exstrophy‐epispadias complex (EEC), and to indicate that surgery by experienced teams can improve the long‐term treatment forecast and the patient's body image.

PATIENTS AND METHODS

From 1978 to 2002, 71 patients diagnosed with EEC were treated in the authors’ institution; 24 (aged 2–23 years) were selected to undergo different surgical procedures. The criterion for surgery considered interviews conducted by the psychology team with the parents and children. The plastic surgery and paediatric urology teams carried out the procedures jointly; the follow‐up was 0.33–7 years.

RESULTS

Five female patients and six male had abdominoplasty to treat multiple scars; eight had intermittent catheterization conduits repositioned from the right iliac fossa to the umbilicus. Six female patients had plastic surgery of the external genitalia and three had a broad mobilization of the urogenital sinus. Thirteen male patients had a small penis and had the corpora cavernosa fully mobilized and the penis reconstructed. Five female patients and one male had anterior osteotomy. One patient with no left testis had it replaced and one patient with uterine prolapse had the uterus fixed to the posterior abdominal wall. Six patients had a second procedure, in two because the outcome of the initial operation was poor and in the others to complement the initial treatment. In all but one patient there was an improvement in the objective criteria, e.g. school absences, difficulty in establishing long‐lasting social relationships and refusal to participate in sports activities. However, none of the patients would attempt sexual intercourse.

CONCLUSIONS

Body image, self‐esteem, sexuality, sexual function and fertility are deemed crucial by adolescents; in patients with EEC customised surgical procedures can give a satisfactory aesthetic outcome, and be a further reason for adequately following occasional urinary complications and renal function, to avoid loss to follow‐up.
Urothelium regeneration using viable cultured urothelial cell sheets grafted on demucosalized gastric flaps
Authors: Shiroyanagi Y. , Yamato M. , Yamazaki Y. , Toma H. , Okano T.
Published: May 2004

Most of the papers in this section are studies of cellular biology in urological cancer. Each of the four papers assess a particular aspect of four different types of cancer: prostate, bladder, renal, and testicular. The other two reports are on unrelated issues; in the first, the authors write about urothelial regeneration using viable cultured urothelial cell sheets grafted onto demucosalized gastric flaps, and in the second, on the in vivo expression of nitric oxide synthase.

OBJECTIVE

To evaluate urothelium regeneration by grafting viable cultured urothelial cell sheets, harvested from temperature‐responsive culture surfaces, on demucosalized gastric flaps in a dog model.

MATERIALS AND METHODS

Viable urothelium was obtained from eight beagle dogs by partial cystectomy. Harvested urothelial cells were seeded on temperature‐responsive culture dishes modified with the thermally sensitive polymer, poly(N‐isopropylacrylamide). Urothelial cells cultured for 3 weeks generated contiguous urothelial cell sheets that were noninvasively harvested with no enzymatic treatment from these dishes, by reducing culture temperature. Urothelial cell sheets were autografted onto surgically demucosalized gastric flaps. Three weeks after autografting the dogs were killed and the gastric flaps with the urothelial cell sheets were examined. Cell and tissue characteristics were compared between these urothelial cell sheet‐grafted gastric flaps and native urothelium. Ultrafine structures were also examined by electron microscopy.

RESULTS

Five of the eight urothelial cell sheet‐grafted flaps showed viable urothelial regeneration. Urothelial cell sheets attached spontaneously to demucosalized tissue surfaces completely, with no suture or fixing, and developed into a stratified viable epithelium very similar to native urothelium. Regenerated urothelium remained unstained by antiproton pump antibody, which typically stains epithelial cells positively in gastric mucosal layers. On three of the eight flaps where there were severe haematomas, grafted cell sheets were not adherent and there was no urothelial regeneration.

CONCLUSIONS

Urothelial cell sheets were autografted onto dog demucosalized gastric flaps successfully, with no suture or fixation, generating a multilayered urothelium in vivo. The novel intact cell‐sheet grafting method rapidly produces native‐like epithelium in vivo. This versatile technology should prove useful in urinary tract tissue engineering and surgical reconstruction.
Growth inhibition and cell cycle arrest effects of epigallocatechin gallate in the NBT‐II bladder tumour cell line
Authors: Chen J.J. , Ye Z.‐Q. , Koo M.W.L.
Published: May 2004

OBJECTIVES

To examine the growth inhibition and cell cycle arrest effects of epigallocatechin gallate (EGCG), a major constituent of green tea polyphenols, on the NBT‐II bladder tumour cell line.

MATERIALS AND METHODS

Growth inhibition and cell cycle arrest effects of EGCG were evaluated by the tetrazolium assay, flow cytometry and apoptotic DNA ladder tests. The cell cycle‐related oncogene and protein expressions in NBT‐II bladder tumour cells, when incubated with EGCG, were detected with reverse transcription‐polymerase chain reaction (RT‐PCR) and Western blot analysis.

RESULTS

EGCG inhibited growth of the NBT‐II bladder tumour cells in a dose‐ and time‐dependent manner. Flow cytometry showed a G0/G1 arrest in cells when cultured with EGCG at doses of 10, 20 or 40 µmol/L for 48 or 72 h. The apoptotic DNA ladder test showed that EGCG at 10 µmol/L induced early apoptosis after 48 h of incubation. A down‐regulation of cyclin D1 was detected by RT‐PCR when the cells were incubated with EGCG (20 µmol/L for 48 h. EGCG also down‐regulated protein expression of cyclin D1, cyclin‐dependent kinase 4/6 and phosphorylated retinoblastoma protein, in both a time‐ and dose‐dependent manner, when detected by Western blot.

CONCLUSION

EGCG had growth inhibition and cell‐cycle arrest effects in NBT‐II bladder tumour cells by down‐regulating the cyclin D1, cyclin‐dependent kinase 4/6 and retinoblastoma protein machinery for regulating cell‐cycle progression.
Prognostic value of the expression of Ki‐67, CD44 and vascular endothelial growth factor, and microvessel invasion, in renal cell carcinoma
Authors: Yildiz E. , Gokce G. , Kilicarslan H. , Ayan S. , Goze O.F. , Gultekin E.Y.
Published: May 2004

OBJECTIVE

To determine if use of cell proliferation, cell adhesion, level of angiogenesis‐related factors and presence of microscopic vascular invasion (MVI) could better predict the biological behaviour of renal cell carcinoma (RCC), which has a widely variable clinical outcome despite the use of conventional prognostic factors (staging and grading).

MATERIALS AND METHODS

The expression of Ki‐67, CD44H and vascular endothelial growth factor (VEGF) were assessed immunohistochemically in formalin‐fixed, paraffin‐embedded tissues from 48 RCCs, using a Ki‐67 labelling index (LI), CD44 LI and level of VEGF expression, respectively. In addition all the pathological slides were reviewed retrospectively for the presence and absence of MVI. The prognostic value of all the variables assessed was then evaluated, and correlated with the usual prognostic variables and cancer‐specific survival.

RESULTS

Univariate analysis of cancer‐specific survival showed that tumour stage (P < 0.001), tumour size (P = 0.005), metastasis, MVI, Ki‐67 LI, CD44H LI and VEGF expression (all P < 0.001) were predictors of tumour‐related death. There was a statistical correlation between CD44H LI and each of Ki‐67 LI (r = 0.61), expression level of VEGF (r = 0.72) and presence of MVI (r = 0.71). Independent predictors of cancer‐specific survival in a multivariate analysis were: in all patients with RCC, the MVI (P = 0.003) and VEGF expression (P = 0.01); in those with no metastases, MVI (P = 0.01); in patients with no MVI, VEGF (P = 0.04); and in patients with MVI, Ki‐67 LI (P = 0.003). No independent predictor was identified in patient with metastases.

CONCLUSION

This study suggests that cell proliferation, cell adhesion, the level of VEGF expression and the presence of MVI represent a complex tumour‐host interaction that may favour the progression of RCC. Cell proliferation, CD44H and VEGF expression appear to be powerful markers for identifying patients with an adverse prognosis.
Effect of insulin‐like growth factor‐1 on apoptosis of rat testicular germ cells induced by testicular torsion
Authors: Ozkurkcugil C. , Yardimoglu M. , Dalcik H. , Erdogan S. , Gokalp A.
Published: May 2004

OBJECTIVE

To investigate the possible protective role of insulin‐like growth factor‐1 (IGF‐1, reported to have a protective effect in experimental models of hypoxic ischaemia), and the involvement of apoptotic cell death in a model of torsion/detorsion of the rat testis.

MATERIALS AND METHODS

Adult male Wistar rats were divided into five groups of five rats each. Group 1 underwent a sham operation as a control; in group 2 the testis was twisted and in group 3 then untwisted; in group 4 IGF‐1 was injected subcutaneously just before bilateral torsion, and then the right testis removed after 4 h and the left after 24 h; in group 5, IGF‐1 was injected immediately after bilateral detorsion and then the testes removed as in group 4. Both testicles were examined histologically, with apoptosis detected using the in situ DNA fragmentation (TUNEL) system, with combined enzymology and immunohistochemistry techniques.

RESULTS

In groups 2 (torsion) and 3 (detorsion), light microscopy of the testis showed some degenerative changes in the germ cells. Compared to group 1, apoptosis was more significant in group 3 than in the other groups. Group 4 (torsion/IGF‐1) had a similar number of apoptotic germ cells as in group 2 (torsion) after 24 h, but fewer than the same group after 4 h. In group 5 (detorsion/IGF‐1), apoptosis was reduced by IGF‐1 significantly more than in group 3 (P < 0.05). Apoptosis was significantly less in spermatids in group 5 than in group 3 (P < 0.05).

CONCLUSIONS

IGF‐1 seems to lower the levels of germ cell apoptosis, which may be important for protecting the testes from torsion/detorsion injury. Further clinical studies are needed to evaluate this protective effect in testicular torsion/detorsion.
Ureteric stenting after ureteroscopy for ureteric stones: a prospective randomized study assessing symptoms and complications
Authors: Jeong H. , Kwak C. , Lee S.E.
Published: May 2004

OBJECTIVE

To compare patients with and with no stenting after ureteroscopy for ureteric calculi, as placing such stents is routine, although many patients complain of pain and urinary symptoms.

PATIENTS AND METHODS

In all, 45 patients with ureteric calculi amenable to ureteroscopic management were prospectively randomized into a stented (23) or an unstented (22) group. Standard ureteroscopic basketing and lithotripsy was used, through a ureteroscope (8.5 F) with or without ureteric dilatation. Symptom questionnaires were completed by the patients after treatment, and they were followed radiographically to assess stone‐free rate and evidence of obstruction.

RESULTS

There was no statistically significant difference in age, stone size, operative duration or hospital stay between the groups (P > 0.05). Furthermore, there was no statistical difference in flank pain or urinary symptoms (P > 0.05), except haematuria, between the groups; haematuria was more severe and prolonged in the stented group (P = 0.001).

CONCLUSIONS

Uncomplicated ureteroscopy for removing calculi is safe with no stent after treatment, and after considering complications and side‐effects we think that the routine use of ureteric stents after uncomplicated ureteroscopy for stone extraction is unnecessary.
Knowledge Discovery from Area‐Class Resource Maps: Data Preprocessing for Noise Reduction
Authors: Qi Feng
Published: May 2004

Spatial data mining techniques have been investigated to extract valuable knowledge from natural resource maps. One challenge in applying general‐purpose data mining algorithms to knowledge discovery from these maps is that the unavoidable existence of errors in traditional area‐class resource maps introduces noise to the process and impacts the accuracy of the extracted knowledge. This paper examines the effect of data preprocessing in knowledge discovery from area‐class resource maps. Presented here is a sampling method designed to obtain samples that exclude noise and are representative of the central concepts of the mapped classes. The method is based on selecting only the pixels that fall in modes of environmental histograms for each individual class. A case study in extracting knowledge from soil maps shows that data preprocessing plays an important role in the knowledge discovery process, and that the sampling method based on environmental histograms significantly improves the knowledge discovery performance.