bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the endoscopic incision of ureteroceles reduce the indications for partial nephrectomy?
Authors: Petit  , Ravasse  , Delmas
Published: March 2003

Objective

To determine whether the endoscopic incision of ureteroceles reduces the indications for partial nephrectomy.

Patients and methods

Between 1987 and 1996, endoscopic incision was used as the first‐line treatment of 18 children (13 boys, five girls, aged 8 days to 6 months) with a duplex‐system ureterocele diagnosed antenatally (15) or in the first weeks of life during the course of a urinary infection (three). Of the 19 ureteroceles (one bilateral), four were intravesical and 15 ectopic, according to the American Academy of Paediatrics classification. Vesico‐ureteric reflux into the inferior pole of the kidney was present in 10 children, seven of whom had an ectopic ureterocele. A functioning upper pole was detected by intravenous pyelography (IVP) in half the intravesical and in a third of the ectopic ureteroceles.

Results

Endoscopic incision resulted in decompression and reduction of dilatation in 16 cases; three with inferior pole reflux resolved on control cystography, whilst in seven with an ectopic ureterocele, reflux into the upper urinary tract was induced by endoscopic incision. In three children with an ectopic ureterocele, renal function had improved at 3 months, as assessed by IVP. Endoscopic incision was the only treatment for half the intravesical and six of 15 ectopic ureteroceles. Overall, nephrectomy was required in four of 18 patients (three partial nephrectomies for persistent dilatation and one total nephrectomy). Five nonfunctioning, undilated upper poles with no reflux were left in place. Nine vesico‐ureteric reimplantations for persistent or induced reflux were carried out using the Cohen technique.

Conclusion

Endoscopic incision can allow the deferral of nephrectomy, facilitate lower urinary tract reconstruction and reduce the indications for partial nephrectomy, if it is accepted that a nonfunctioning, undilated renal pole with no reflux can safely be left in place.
Patients’ tolerance of transrectal ultrasound‐guided prostatic biopsy: an audit of 104 cases
Authors: Crundwell  , Cooke  , Wallace
Published: March 2003

Objective

To determine the frequency and severity of complications following transrectal ultrasonography (TRUS) guided prostatic biopsy, and of pain during the procedure.

Patients and methods

The study included 129 men undergoing TRUS‐guided prostatic biopsy who were asked to complete a questionnaire about pain and complications one week after biopsy.

Results

Of the 104 men who completed the questionnaire, 24% found the procedure moderately to extremely painful and 19% felt that they had had significant complications afterward, the commonest of these being painful or difficult voiding (13%) and haematuria (11%). Systemic symptoms of fever or ‘sweats’ occurred in 6%, with a diagnosis of septicaemia in three men, despite antibiotic prophylaxis. However, acute urinary retention occurred in only one man. Of all patients, 20% saw their general practitioner within a week, all of whom were prescribed antibiotics in addition to those given prophylactically in hospital.

Conclusion

TRUS‐guided biopsy is often a painful experience for patients and is commonly associated with complications, particularly voiding difficulties. Of particular concern were the three patients with septicaemia, and that one in five men felt sufficiently unwell to visit their doctor within a week of the procedure.
A KATP‐channel opener as a potential treatment modality for erectile dysfunction
Authors: Moon  , Byun  , Kim
Published: March 2003

Objectives

To assess the effects of pinacidil (a KATP‐channel opener) for the treatment of penile erectile dysfunction and to examine the role of the K+‐channel in cavernosal smooth muscle contractility.

Materials and methods

Using a feline model, the magnitude of penile erection caused by pinacidil was compared with that caused by erectogenic drugs, e.g. acetylcholine, prostaglandin E1 (PGE1) and l‐arginine. The effects of K+‐channel blockers (4‐aminopyridine, glibenclamide and tetraethylammonium) and pinacidil on penile erections induced by the drugs were investigated.

Results

The intra‐arterial injection of pinacidil caused a dose‐dependent increase in intracavernosal pressure (ICP) and the increase in ICP induced by pinacidil with acetylcholine, PGE1 or l‐arginine was more pronounced than with the compounds alone. Furthermore, pinacidil (1 mmol/L) effectively reversed the inhibitory effects of the K+‐channel blockers on the cavernosal relaxation induced by acetylcholine, PGE1 or l‐arginine (P<0.01). Notably, pinacidil induced cavernosal relaxation after injecting the drugs even in cases refractory to higher concentrations (0.1 mol/L) of the drugs (n=11, P<0.01).

Conclusions

These results suggest that pinacidil is effective in relaxing feline erectile tissue in vivo, probably via increased K+ permeability and subsequent hyperpolarization. Further comparative studies with erectogenic compounds on human erectile tissue and clinical testing are required to determine whether K+‐channel openers can be used in the diagnosis and treatment of erectile dysfunction. However, pinacidil seems promising as an intracavernosal agent combined with PGE1 to produce synergistic effects.
Changing trends in prostatic cancer
Authors: Murphy  , Johnston  , Whelan  , Rider  , Lloyd
Published: March 2003

Objectives

To examine the diagnosis and treatment of prostatic cancer in a population‐based study, reporting incidence trends and survival, in the decade before the introduction of prostate‐specific antigen (PSA) testing, and thus determine whether the overall incidence of prostatic cancer is increasing or not.

Patients and methods

The study included all men registered as having prostatic cancer in the Yorkshire region between 1981 and 1990. The Northern and Yorkshire Cancer Registry and Information Service has an active registration policy and after notification, the information received is validated by histopathology reports and case‐note review. Of the patients registered, 68% were over 70 years old at the time of diagnosis (mean age 74 years). Prostatic cancer was often diagnosed incidentally, after prostatectomy for presumed benign disease. Indications for treatment were not recorded, but most patients had treatment which was designed to control outlet bladder symptoms rather than with intent to cure cancer.

Results

In all, 8118 patients with prostatic cancer were registered, of whom 6587 had histological confirmation. There was a 30% increase in the age‐standardized incidence of prostatic cancer during the study period (P<0.001). The mortality from prostatic cancer increased by 35% (P<0.001) and the percentage of patients known to have metastases at the time of presentation increased from 18% to 24%. These changes were seen in all age groups. The overall survival was 49% at 5 years and 34% at 10 years.

Conclusions

There has been a real increase in the incidence of prostatic cancer which pre‐dates the use of serum PSA testing. The percentage relative survival of patients with prostatic cancer in Yorkshire during the study period is similar to that seen in other parts of the UK, but compares badly with reported survival in other countries.
Metabolic characteristics of the elderly with recurrent calcium oxalate stones
Authors: Yagisawa  , Hayashi  , Yoshida  , Okuda  , Kobayashi  , Ishikawa  , Goya  , Toma
Published: March 2003

Objective

To determine the metabolic characteristics of elderly patients with recurrent calcium oxalate stones.

Patients and methods

Metabolic abnormalities were investigated in 88 patients with recurrent calcium oxalate stones, including 70 aged <60 years and 18 aged ≥60 years. The frequency of each metabolic abnormality and the value of each urinary constituent were compared among subgroups of age and gender.

Results

Hyperoxaluria was the most common abnormality, present in 56% and 67% of patients aged <60 and ≥60 years, respectively. Hyperuricosuria was significantly more common in older than in younger patients. There were no significant differences in the frequencies of hypercalciuria and hypocitraturia between the age groups. The urinary excretion of oxalate and the ratio of oxalate to creatinine were significantly greater in older than in younger men. The frequency of low urine volume was lower in older than in younger patients and the mean urinary volume was also greater in the older group.

Conclusions

Hyperuricosuria and hyperoxaluria seem to be essential risk factors for calcium oxalate stone formation in elderly patients. Urinary oxalate excretion is significantly greater in older than in younger stone formers and is more prominent in men.
Serum insulin‐like growth factor‐1 is not a useful marker of prostate cancer
Authors: Cutting  , Hunt  , Nisbet  , Bland  , Dalgleish  , Kirby
Published: March 2003

Objective

To determine whether the use of serum insulin‐like growth factor 1 (IGF‐1) levels is more efficient than serum prostate specific antigen (PSA) levels in predicting prostate cancer in patients undergoing prostatic biopsy.

Patients and methods

The study included 94 consecutive patients who required transrectal ultrasonography (TRUS)‐guided biopsies of their prostate and who had blood samples taken before their biopsies. These samples were then analysed for IGF‐1 and PSA concentrations. Six prostatic biopsies were taken from each patient; they were assessed and a diagnosis made of prostate cancer or no malignancy.

Results

Thirty‐seven patients were found to have prostate cancer and 57 had no evidence of malignancy. There was no statistical difference in serum IGF‐1 levels between these groups. The PSA level and age of the patients differed significantly between the groups (both P<0.001). There was no correlation between IGF‐1 and PSA levels, and even when the age difference in the groups was considered, there was still no significant relationship between IGF‐1 levels and the incidence of prostate cancer. In patients with a PSA level of 4–20 μg/L there was no statistically significant difference in IGF‐1 levels between the groups.

Conclusion

Serum IGF‐1 as a tumour marker does not help to predict patients with prostate cancer. PSA level and even age were better predictors of the presence of prostate cancer than were serum IGF‐1 levels.
Nocturia and polyuria in men referred with lower urinary tract symptoms, assessed using a 7‐day frequency‐volume chart
Authors: Matthiesen  , Rittig  , Mortensen  , Djurhuus
Published: March 2003

Objectives

To investigate if a 7‐day frequency‐volume (FV) chart could identify nocturia on a polyuric basis in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

Patients and methods

The study included 23 patients (mean age 62.8 years, range 42–78) with LUTS who were referred for the evaluation of potential BPH and 11 men (control subjects, mean age 63.3 years, range 58–69); all completed a 7‐day FV chart investigation as outpatients.

Results

Nocturia was associated with nocturnal polyuria in 10 of 23 patients with LUTS; these 10 patients had a diminished diurnal variation of urine production, whereas 13 patients had a diurnal variation in urine production comparable with that in controls with no nocturia. The degree of nocturia correlated positively with nocturnal urine production but showed no relationship with sleep duration. The nocturnal polyuria in these patients was associated with a higher 24‐h urine production and seemed at least partly to be caused by a higher fluid intake during daytime.

Conclusion

Nocturia on a polyuric basis can be detected by using a FV chart. In these patients, a 3‐day FV chart would be sufficient to detect nocturia on a polyuric basis and seems therefore to be a valuable tool in evaluating patients with LUTS referred for potential BPH.
Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta‐analysis of trials identified in a systematic review
Authors: Weatherall
Published: March 2003

Objective

To test, by meta‐analysis, the conclusion of a systematic review that biofeedback was no more effective than pelvic floor muscle exercises alone for the treatment of female genuine stress urinary incontinence.

Materials and methods

Data extracted from the five trials identified in the systematic review were subjected to pooled analysis of odds ratios for the outcome of ‘cure’.

Results

The odds ratio for biofeedback combined with pelvic floor muscle exercises, compared with pelvic floor muscle exercises alone, leading to cure was 2.1 (95% confidence interval 0.99–4.4).

Conclusions

Biofeedback may be an important adjunct to pelvic floor muscle exercises alone in the treatment of female genuine stress urinary incontinence. A quantitative statistical analysis of the studies identified leads to different conclusions from those in the systematic review.
Intra‐uterine testicular torsion: early diagnosis and treatment
Authors: Al‐Salem
Published: March 2003

Objective

To review the incidence and treatment of intra‐uterine torsion of the testis which although rare is being recognized with increasing frequency.

Patients and methods

From 1988 to 1997, five newborns (mean birth weight 3.62 kg, range 3.15–4.12) with unilateral torsion of the testis were treated; all underwent emergency exploration. The right testis was affected in three and the left in two boys.

Results

In all except one child, the affected testis was enlarged, firm to hard, tender, the overlying skin dark red and the affected testis higher than the contralateral testis. In one child the right testis was enlarged and higher, but soft to firm, and the overlying skin was oedematous and red. The exploration revealed extravaginal torsion of the testis which was gangrenous in four; in one after detorsion there was haemorrhage and haematoma of the cord and the tunica, and the testis was slightly congested but not gangrenous. This testis was preserved and bilateral orchidopexies performed; at 18 months both testes are palpable and of normal size. In the remaining four children the testes were frankly necrotic; they underwent orchidectomy and contralateral orchidopexy. Histology in all four revealed a totally infarcted testis with extensive haemorrhage and vascular congestion.

Conclusion

The early diagnosis and treatment of intra‐uterine torsion of the testis is essential.
Desmopressin in the treatment of nocturnal polyuria in the male
Authors: Cannon  , Carter  , Mcconnell  , Abrams
Published: March 2003

Objectives

To assess whether desmopressin (1‐desamino 8‐d‐arginine vasopressin) is safe and effective in the treatment of nocturnal polyuria in elderly men.

Patients and methods

Twenty men (age 52–80 years) complaining of nocturia were found to have nocturnal polyuria, determined from frequency‐volume charts and defined as the production of >33% of the 24 h urine volume overnight, averaged over a 1‐week period. In a double‐blind study of cross‐over design, a 1‐week placebo run‐in period was followed by two 2‐week periods of placebo or 20 μg intranasal desmopressin, and ended with an open 2‐week treatment period with 40 μg desmopressin.

Results

Desmopressin caused a significant reduction in nocturnal urine volume and the percentage of urine passed at night, but the reduction in nocturnal frequency was only significant during treatment with 40 μg desmopressin. Four patients on desmopressin experienced side‐effects, three of which were thought to be due to fluid retention.

Conclusion

Desmopressin is an effective treatment for nocturnal polyuria in some elderly men. However, it can cause fluid retention and should not be given to patients with cardiac failure. Those undergoing treatment must be closely monitored.
Completeness and efficiency of prostate tissue removal: loop resection compared with a new operative technique of transurethral electrovaporization
Authors: Patel  , Fuchs  , Gutierrez‐Acéves  , Andrade‐Perez
Published: March 2003

Objective

To compare the completeness and efficiency of the removal of prostatic adenomatous tissue between transurethral resection (TURP) and a new operative technique of electrovaporization (TUEVAP) using a modified roller electrode.

Patients and methods

In a prospective double‐blind study, patients with moderate to severe lower urinary tract symptoms and objective evidence of obstruction, were randomized to undergo either TURP (using a standard cutting‐wire loop) or TUEVAP (performed with a new operative technique and the spiked‐bar electrode). The prostate volume measured using transrectal ultrasonography (TRUS‐PV) was used to assess the completeness of tissue clearance after treatment. Results were compared using group median values. For the TURP group, the TRUS‐PV estimate of tissue removed was divided by the dry resected weight to derive a correction factor for any discrepancy between the values. This factor was applied to the TRUS‐PV reduction in the TUEVAP group (where there was no tissue to be weighed) to estimate the actual tissue removal in this group. The efficiency of tissue removal for each treatment modality was derived by dividing the amount of tissue removed by the operative duration.

Results

There was no difference in the reduction in TRUS‐PV at 3 months (23.9 cm3 vs 21.45 cm3, P<0.9), or in the operative duration (45 min vs 52.5 min, P<0.2), between TURP and TUEVAP, respectively. The TRUS‐PV of tissue removed exceeded the actual dry resected weight after TURP (15 g) by a factor of 1.59. After applying this factor to the TRUS‐PV reduction for the TUEVAP group, the calculated dry weight of tissue removed for this group was 13.49 g (P<0.55); the difference in tissue removal rate by TRUS criteria was 0.48 cm3/min vs 0.37 cm3/min (P<0.15).

Conclusions

These data suggest an equivalent completeness of removal of adenomatous prostate tissue between TURP and TUEVAP. The efficiency of tissue removal for TUEVAP was slightly less than that of regular loop resection, but this difference was not statistically significant. These results are specific to the combination of electrode, electrosurgical unit and operative technique used in this study, and may differ if any of these variables are altered.
The role of urine cytology in the assessment of lower urinary tract symptoms
Authors: Potter  , Quigley  , Pengelly  , Fawcett  , Malone
Published: March 2003

Objective

To evaluate the role of urine cytology in the investigation of men with lower urinary tract symptoms (LUTS) in the absence of haematuria.

Patients and methods

The study comprised 336 men attending a LUTS assessment clinic, who had neither macroscopic nor microscopic haematuria. One sample of urine was collected for cytology. Those with suspicious urine cytology were investigated with intravenous urography and cystoscopy.

Results

Five men had abnormal urine cytology results; on further investigation one of them was found to have carcinoma in situ (CIS) and one to have a transitional cell carcinoma. Three had false‐positive urine cytology results.

Conclusion

A bladder tumour or CIS was detected in 0.6% of the population tested. The cost per cancer diagnosed was GB £2020. Urine cytology is a simple noninvasive way of assisting accurate diagnosis of men who have LUTS in the absence of haematuria.
Mortality in the elderly in relation to nocturnal micturition
Authors: Asplund
Published: March 2003

Objective

To study the relationship between nocturnal micturition and mortality in an elderly population.

Subjects and methods

All 10 216 members of the Swedish pensioners’ association (SPF) in two Swedish counties were asked to participate in a questionnaire survey. The questions concerned the general state of health, occurrence of somatic diseases and symptoms, number of voiding episodes per night, everyday habits and behaviour, and the use of drugs. After 6 years, data on deaths were extracted from the National Register of Deaths at the National Central Bureau of Statistics in Stockholm.

Results

There were 6143 evaluable questionnaires, of which 39.5% were from men. The mean (sd) ages of the men and women participating were 73.0 (6.0) and 72.6 (6.7) years, respectively. During a 54‐month period after the questionnaire was completed, 444 of the men and 384 of the women died. The men with three or more nocturnal voiding episodes had a higher death rate, at 1.9 (1.4–2.6) times more than the whole group of men (3.4% vs 1.9% per 6 months; P<0.001), and the corresponding women a death rate 1.3 (0.9–2.0) times higher than all women (1.4% vs 1.1% per 6 months, not significant). In a multiple logistic regression analysis, significant independent correlates of death during the study period were: being 70–79 years vs <70 years (odds ratio, OR, 1.92, 95% CI 1.52–2.43), being ≥80 years vs <70 years (5.14, 3.96–6.68), female gender (0.44, 0.37–0.52), health (1.81, 1.46–2.25), negative health development (1.70, 1.40–2.06), spasmodic chest pain (1.38, 1.09–1.74), diabetes (1.59, 1.18–2.15), stroke (1.82, 1.12–2.93), and three or more vs two or fewer voiding episodes (1.34, 1.01–1.79).

Conclusion

Elderly people who need to void three or more times per night had a greater mortality rate over a 54‐month observation period than those voiding less often.
Endourological renal salvage in patients with calculus nephropathy and advanced uraemia
Authors: Agrawal  , Aron  , Asopa
Published: March 2003

Objective

To document our experience with percutaneous nephrolithotripsy (PCNL) for the treatment of calculus nephropathy and advanced renal failure.

Patients and methods

Between October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16–67; mean serum creatinine level 663.8 μmol/L, range 282.8–1449.7) were treated in our department. Forty‐six of the patients had bilateral upper urinary calculi, while the remaining 32 had a solitary functioning kidney obstructed by stone. Thirty‐two patients had a normal urine output, 26 were oliguric and 20 presented with anuria. A preliminary percutaneous nephrostomy (PCN) was performed under local anaesthesia in 64 patients, and stone retrieved subsequently through the same nephrostomy track after improvement in their uraemic status. In the remaining 14 patients, the stones were removed at the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2–3 weeks, while 25 patients underwent simultaneous JJ stenting on the contralateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side.

Results

There were three deaths, caused by overwhelming sepsis; 64 of the remaining 75 patients recovered well from uraemia, while 11 showed no improvement, suggesting irreversible renal damage. Complications included five patients with nonfatal sepsis and five with secondary haemorrhage. At the last follow‐up 2.5–9 years after presentation, the mean serum creatinine level (271.3 μmol/L) was significantly better than the mean preoperative level. Six patients are on maintenance haemodialysis.

Conclusions

It is not uncommon in developing countries for patients with urolithiasis to present with advanced uraemia caused by long‐standing obstruction, almost invariably complicated by infection. A percutaneous endourological approach offers the best hope for these patients, and in our experience a significant percentage of these cases can be salvaged.
Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate‐specific antigen and transrectal ultrasonography
Authors: Ulleryd  , Zackrisson  , Aus  , Bergdahl  , Hugosson  , Sandberg
Published: March 2003

Objective

To determine the frequency of prostatic involvement in men with community‐acquired febrile urinary tract infection.

Patients and methods

This prospective study included 70 men (18–85 years old) who had a fever of ≥38.0 °C, symptoms or signs of urinary tract infection and a positive urine culture. Serum prostate‐specific antigen (PSA) was measured and transrectal ultrasonography of the prostate and seminal vesicles performed during the acute phase of the disease and during a 1‐year follow‐up.

Results

Although only six patients had a tender prostate on digital rectal examination, the initial serum PSA level was elevated in 58 (83%) patients (median 14 ng/mL, range 0.54–140). There was no correlation between PSA levels, patient age, inflammatory response to infection or presence of positive blood cultures. Despite a rapid decline in PSA level after one month, there was a protracted decrease in some patients. After 3 months the median prostate volume was reduced by 31% (range 11–54; P<0.001) in 46 of 55 patients examined, and the width of the right and left seminal vesicle was reduced by 14% and 22%, respectively. The reductions in PSA and prostate volume were significantly correlated (r=0.36, 95% confidence interval 0.09–0.58; P=0.01).

Conclusion

These results show that the prostate and seminal vesicles are frequently involved in men with febrile urinary tract infection and that PSA may be a useful marker of prostatic infection. The slow decline of PSA levels in some patients after appropriate antibiotic treatment indicates a protracted healing process and should be considered when PSA is used to detect prostate cancer.
The impact of contemporary bladder management techniques on struvite calculi associated with spinal cord injury
Authors: Donnellan  , Bolton
Published: March 2003

Objective

To evaluate the incidence, risk factors and complications of upper tract struvite calculi, often associated with spinal cord injury (SCI), as such patients have a high incidence of urinary infection complicating their neurogenic voiding dysfunction, by reviewing a large population of patients with SCI in whom modern techniques of bladder management were used.

Patients and methods

Between 1982 and 1996, 1669 patients with SCI were admitted to our institution; 1359 of these patients sustained their injuries during the study period. During this time, their bladder management was based on urodynamic and imaging criteria, using techniques such as early intermittent catheterization, sphincterotomy and bladder augmentation where possible to create a catheter‐free, low‐pressure reservoir. All instances of upper tract struvite calculi in this population were documented. Risk factors for stone development, presentation and complications, management and recurrence rates were assessed.

Results

Over the 15 years, 58 patients (3.5% of the SCI population) were treated for a total of 144 episodes of struvite calculi. The incidence of stones in those injured since 1982 was 1.5%; 67% of these patients had complete spinal cord lesions, 54% had lesions of the cervical cord and 53% developed their first stone >10 years after injury. Only 22% presented within 2 years of injury. The group of patients developing stones had a significantly higher incidence of indwelling catheters (49%), bladder stones (52%) and vesico‐ureteric reflux (28%) than those who were stone‐free. The development of recurrent urinary tract infections was the most common mode of presentation. The stone‐free rate after treatment was 87%. Normal renal function was preserved in 72% of patients.

Conclusions

In a large population of patients with SCI managed using contemporary bladder techniques the incidence of upper tract calculi was 3.5%; 30% of these stones were complete or partial staghorns. Those patients with complete cord lesions, permanent indwelling catheters and vesico‐ureteric reflux were at the highest risk. Stone clearance was 87% and recurrent stones occurred in 69% of patients. Struvite renal calculi continue to be a significant problem in the spinal cord injury population.
Is the measurement of serum testosterone routinely indicated in men with erectile dysfunction?
Authors: Fahmy  , Mitra  , Blacklock  , Desai
Published: March 2003

Objective

To investigate the usefulness of serum testosterone levels as a relevant or useful indicator of sexual potency in men attending an erectile dysfunction clinic.

Patients and methods

Ninety consecutive men attending the erectile dysfunction clinic completed a sexual‐activity questionnaire, and underwent a focused physical examination and questioning about their medical history. The serum testosterone level was measured in all patients and the results analysed in relation to the patient’s age. Patients with low serum testosterone levels commenced replacement therapy comprising three intramuscular injections of testosterone (Sustanon™ , Organon, The Netherlands) 250 mg every third week. Potency status and serum testosterone were reassessed after 3 months’ treatment.

Results

Of the 90 men, 28 (31%) were aged < 50 years whilst 62 (69%) were ≥50 years old. Nineteen (21%) patients overall had low testosterone levels; four of these were < 50 and 15 were ≥50 years old. Five of 90 patients had a decreased libido; two of these also had low testosterone levels and all were < 50 years old. Testosterone levels returned to normal in all patients who received replacement therapy but potency returned in only two (10%); both were in the older group.

Conclusion

Measuring testosterone was not helpful in assessing potency or libido and low serum levels were not related to age. Correcting low testosterone did not improve either impotence or libido.
The tolerability of urodynamic studies and flexible cysto‐urethroscopy used in the assessment of men with lower urinary tract symptoms
Authors: Kortmann  , Sonke  , D’Ancona  , Floratos  , Debruyne  , De La Rosette
Published: March 2003

Objective

To determine the overall tolerability of urodynamic studies used in the assessment of men with lower urinary tract symptoms (LUTS), by assessing the objective and subjective morbidity experienced during and after urodynamic studies, and to assess the voiding complaints caused by the combination of urodynamic studies with flexible cysto‐urethroscopy.

Patients and methods

A total of 103 men with LUTS, who underwent a urodynamic study combined with flexible cysto‐urethroscopy, completed a questionnaire designed to assess objective and subjective symptoms and degree of bother, with emphasis on the urodynamic study. In addition, a urine specimen was analysed and cultured. In all, 78 patients who underwent a second urodynamic study completed the questionnaire twice.

Results

The results of the first questionnaire showed that more than half of the patients experienced some urge after the urodynamic study and cysto‐urethroscopy (56%); 35% of the patients experienced little and 19% experienced severe voiding discomfort after the combined investigations, compared with 24% and 5%, respectively, after a urodynamic study alone. Three patients (3%) had a symptomatic urinary tract infection. Haematuria, increased voiding frequency and increased nocturia occurred occasionally. Most of the patients found the urodynamic study less bothersome than they had expected (64%) and only 9% found it worse than expected. The overall degree of discomfort, experienced during and after the urodynamic study combined with cysto‐urethroscopy, was low, and after a second urodynamic study was even lower.

Conclusion

In contrast with earlier results, this clinic‐based urodynamic investigation was associated with a low proportion of urinary tract infection, and low objective and subjective morbidity. The combination of a urodynamic study with a flexible cysto‐urethroscopy does not cause significant additional voiding complaints. Most patients find urodynamic studies tolerable and not very bothersome.
National bias in citations in urology journals: parochialism or availability?
Authors: Grange
Published: March 2003

Objective

 To determine any bias by authors of different nationalities in their citation rate of selected urological journals in papers published in the British Journal of Urology and the Journal of Urology.

Methods

 Using a simple computer program and text files of accepted reports in the BJU, or those available on CD‐ROM from J Urol, 212 recent papers in the BJU and 111 from J Urol were analysed to determine the number of citations to four major urological journals (BJU, J Urol, Eur Urol and Urology). The frequencies of citations to these journals were then compared with the national origin of the author(s), grouped as UK, Europe, North America and Other.

Results

 In both the BJU and J Urol the citation rates of the selected journals differed significantly among authors from different regions. In BJU papers, the citation rate of the BJU was highest by UK authors and their citation rate of J Urol was amongst the lowest of the rates for J Urol. The highest citation rate for J Urol was that by European authors. American authors cited the BJU least, citing the J Urol about five times more often than they cited the BJU. Of the papers in the J Urol sample, over 60% were from American authors, with only four from UK authors; thus the UK group was not analysed separately but included in the European group. The mean citation rate of J Urol was highest in papers by American authors, at about 14 times that for citations to the BJU. The citation rates for the other two journals were not significantly different with nationality or journal, but were generally much lower in J Urol than in the BJU.

Conclusion

 There are significant differences in citation rates both with authors’ nationality and between journals. Citation rates may be influenced by journal accessibility, perceived journal ‘prestige’ (impact factor) or national bias. Authors, editors and reviewers should be aware of this potential bias in citation habits. Authors should strive to conduct exhaustive searches using electronic methods, so that all relevant papers are assessed, regardless of their origin.
Sustained‐release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo‐controlled
Authors: Mcneill  , Daruwala  , Mitchell  , Shearer  , Hargreave
Published: March 2003

Objective

 To establish whether the administration of sustained‐release (SR) alfuzosin improves the outcome of a trial without catheter (TWOC) after an episode of acute urinary retention.

Patients and methods

 In a prospective, randomized, placebo‐controlled trial, 81 patients with acute urinary retention related to benign prostatic obstruction received either SR alfuzosin (n=40), an α1‐selective blocker, given at a dose of 5 mg twice daily, or placebo (n=41) for 48 h. The catheter was removed after 24 h of treatment. The main outcome measurement was success or failure of the TWOC. At the end of this double‐blind phase the patients were followed up on an open basis.

Results

 After removal of the catheter, 42% of patients voided successfully, 22 of 40 (55%) with SR alfuzosin and 12 of 41 (29%) with placebo (P=0.03). The mean age of patients voiding successfully, regardless of treatment group, was 68.4 years, whilst the mean age of those who were not successful was 72.9 years (P=0.015). In an intention‐to‐treat analysis of outcome adjusted for this age difference, the benefit in favour of those receiving SR alfuzosin was not significant, but at P=0.052 there was a strong suggestion of a positive treatment effect. The observed benefit remained significant in a per‐protocol analysis adjusted for age. Taken together, these results indicate that treatment with SR alfuzosin was effective and that the observed benefit was not simply the effect of age difference between the groups. Of the 34 patients who voided successfully 23 (68%) required no further intervention within a mean follow‐up of 7 months.

Conclusions

 Treatment with SR alfuzosin is effective in improving the success rate of a TWOC after an episode of acute urinary retention, although older patients are less likely to void successfully. By reducing the numbers of men sent home with urinary catheters, such treatment may result in a reduction in the associated perioperative morbidity in those undergoing prostatic surgery, and is clearly desirable for the patients’ comfort and convenience.
The follow‐up of patients with unfavourable early results of transurethral prostatectomy
Authors: Hakenberg  , Pinnock  , Marshall
Published: March 2003

Objective

 To determine the natural course of patients with subjectively disappointing early results after transurethral prostatectomy (TURP), who experience prolonged discomfort and an initial deterioration in symptoms.

Patients and methods

 A consecutive series of 127 patients undergoing urodynamic studies and TURP were assessed 3 months after surgery using symptom scores and measurements of urinary flow rate; 107 patients reported improved symptom and quality‐of‐life scores, but 20 did not improve, with no change or a deterioration. These 20 patients were followed for several months using symptom scores, and measurements of flow rates and residual urine volumes. Baseline variables, including preoperative urodynamic studies, were compared between those who improved and those who did not.

Results

 Over a mean (range) follow‐up of 10.6 (6–15) months, all those initially not improving showed spontaneous improvement in all three variables with no further treatment and eventually achieved the same significant degree of improvement as those who improved soon after TURP. Preoperatively, those initially not improving had mean lower symptom scores, more bladder irritability and less obstruction than did those who improved.

Conclusion

 A significant proportion (≈15%) of patients with obstructive symptoms will experience considerable symptomatic discomfort for a prolonged period after an uncomplicated TURP and will not gain the full symptomatic benefit from the procedure until 6–9 months afterward.
The prognostic value of different forms of prostate specific antigen and their ratios in patients with prostate cancer
Authors: Björk  , Lilja  , Christensson
Published: March 2003

Objective

To assess the prognostic value for patient survival of different forms of PSA and ratios thereof, before treatment for prostate cancer, by considering the forms and ratios both as independent markers and by comparing them with other commonly used prognostic markers, e.g. tumour grade, local stage (T‐stage) and absence or presence of skeletal metastases (M‐stage).

Patients and methods

Blood samples were collected consecutively from men diagnosed with prostate cancer at our department in 1988. From this group, 66 men were followed until death, or for ≥9 years. Twenty‐five patients died from their prostate cancer and 21 from other causes during the follow‐up period. Forty‐eight patients received hormonal treatment, whereas 18 remained untreated or received no treatment for their cancer before they died from other causes. Assays measuring the serum levels of free prostate specific antigen (fPSA), PSA complexed to α1‐antichymotrypsin (PSA‐ACT), and total PSA (tPSA) were used to calculate the percentage of free to total PSA (f/tPSA) fPSA/ACT and ACT/tPSA at diagnosis. Based on the initial levels or ratios of the PSA forms, the patients were divided into three numerically comparable groups (tertiles) for survival analysis. Prognostic factors predicting patient survival were evaluated using univariate (Kaplan–Meier life‐tables with the log‐rank test) and multivariate techniques (Cox proportional hazards regression model).

Results

Univariate analysis using the log‐rank test showed that the serum level of each molecular form of PSA, i.e. tPSA (P=0.001), PSA‐ACT (P<0.001) and fPSA (P<0.001), as well as grade (P<0.001), T‐stage (P=0.00355) and M‐stage (P<0.001), provided statistically significant prognostic information. Log‐rank tests showed that none of the ratios, i.e. f/tPSA, fPSA/ACT and ACT/tPSA, were informative of prognosis (P>0.05). However, in a multivariate analysis regression model, not only M‐stage (risk ratio 4.2; P=0.026) and grade (risk ratio 2.6; P=0.022), but also f/tPSA (risk ratio 1.8; P=0.037), provided significant prognostic information.

Conclusion

The values of tPSA, fPSA and PSA‐ACT, as well as grade and T‐ and M‐stage, are all independent prognostic factors of prostate cancer survival. In a multivariate analysis, not only M‐stage and grade but also f/tPSA provided significant prognostic information.
Paradoxical expression of E‐cadherin in prostatic bone metastases
Authors: Bryden  , Freemont  , Clarke  , George
Published: March 2003

Objective

To determine whether the calcium‐dependent cell adhesion molecule E‐cadherin is expressed in metastatic deposits of prostate cancer in bone.

Patients and methods

Ten bone biopsies containing metastatic deposits of untreated prostatic cancer were obtained and immunohistochemically stained for E‐cadherin with the monoclonal antibody HECD‐1, using the streptavidin–biotin complex technique. Benign prostatic tissue was used as the control.

Results

Of the 10 specimens, nine showed positive expression of E‐cadherin, graded as strong in four. E‐cadherin expression was strongest in well‐differentiated metastases and decreased with increasing tumour grade. In some specimens there were mixed patterns of expression.

Conclusion

E‐cadherin is strongly expressed in prostatic bone metastases and the degree of expression appears to reflect local tumour grade. This suggests that loss of E‐cadherin expression may not be critically linked to metastatic potential.
Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy?
Authors: Durkan G.C. , Greene D.R.
Published: March 2003

Objective

To determine the outcome of repeated prostatic biopsies in men attending with suspected prostate cancer but an initial negative biopsy.

Patients and methods

Patients who had undergone two or more transrectal ultrasonography (TRUS)‐guided prostate biopsies were identified from the Hospital Information Support System database. Indications for TRUS were a raised prostate‐specific antigen (PSA) level (>4.0 ng/mL), with or without an abnormal digital rectal examination (DRE). Sextant prostate biopsies plus biopsies of any suspicious hypoechoic area or area of DRE abnormality were obtained for histology. Forty‐eight patients underwent repeat TRUS‐guided prostatic biopsies (mean age 67.5, sd 7.25, range 53–82 years).

Results

The mean (sd, median, range) PSA level was 16.9 (13.5, 11.6, 5.2–61.8) ng/mL. Fifteen patients (31%) had carcinoma on repeat biopsy, 11 after the second and four after a third biopsy. The positive repeat biopsy rate was 24% where the PSA level was 4.0–9.9 ng/mL, 33% if the level was 10.0–19.9 ng/mL and 39% if it was ≥20.0 ng/mL. There was no significant difference in age or initial PSA concentration between those men with positive and those with negative repeat biopsies. However, patients with cancer had significantly higher PSA levels before repeat biopsy than at first biopsy (P=0.0043) and had greater PSA velocities than had patients with no diagnosis of cancer (P=0.0067).

Conclusion

Where sufficient clinical suspicion exists, despite an initial negative biopsy, repeat TRUS‐guided prostate biopsies should be carried out to exclude carcinoma of the prostate.
Predicting the extent of prostate cancer using the combination of systematic biopsy and serum prostate‐specific antigen in Japanese men
Authors: Gohji K. , Okamoto M. , Takenaka A. , Nomi M. , Fujii A.
Published: March 2003

Objective

To determine the utility of systematic biopsy alone or combined with an assay of serum prostate‐specific antigen (PSA) level to predict the extent of prostate cancer in Japanese men.

Patients and methods

Thirty‐two patients who were diagnosed as having clinically organ‐confined prostate cancer and who underwent prostatectomy were evaluated retrospectively for the results of systematic biopsy (percentage of positive biopsy cores and cancer location), serum PSA and the pathological stage of whole‐mount sections of the prostatectomy specimens.

Results

The incidence of extraprostatic disease (pT3N0M0 or N+) in patients with ≥ 8 ng/mL of serum PSA and cancer in bilateral lobes was significantly higher than in those with <8 ng/mL PSA and cancer in one lobe (83% vs 30%, P=0.020). In those with more than half the biopsy cores positive, extraprostatic disease was significantly more common than in those with less than half positive (93% vs 44%, P=0.0075); moreover, in patients with more than half the cores positive and ≥ 8 ng/mL serum PSA, it was significantly more common than in those with less than half positive and <8 ng/mL of serum PSA (93% vs 27%, P=0.0021). However, the incidence of extraprostatic disease predicted by three variables (cancer location, percentage positive biopsy cores and serum PSA) was not significantly better than that predicted by two variables (percentage positive cores and serum PSA).

Conclusions

The combination of systematic biopsy and serum PSA may be useful in predicting extraprostatic cancer. Patients with ≥ 8 ng/mL serum PSA and more than half the biopsy cores positive could avoid a prostatectomy because there is a high probability that they have extraprostatic disease.
Effect of oral administration of high‐dose nitric oxide donor l‐arginine in men with organic erectile dysfunction: results of a double‐blind, randomized, placebo‐controlled study
Authors: Chen  , Wollman  , Chernichovsky  , Iaina  , Sofer  , Matzkin
Published: March 2003

Objectives

To determine, in a prospective randomized, double‐blind placebo‐controlled study, the effect of 6 weeks of high‐dose (5 g/day) orally administered nitric oxide (NO) donor l‐arginine on men with organic erectile dysfunction (ED).

Patients and methods

The study included 50 men with confirmed organic ED who were randomized after a 2‐week placebo run‐in period to receive l‐arginine or placebo. A detailed medical and sexual history, O’Leary's questionnaire, a specially designed sexual function questionnaire and a sexual activity diary were obtained for each patient. All participants underwent a complete physical examination including an assessment of bulbocavernosus reflex and penile haemodynamics. Plasma and urine nitrite and nitrate (designated NOx ), both stable metabolites of nitric oxide, were determined at the end of the placebo run‐in period, and after 3 and 6 weeks.

Results

Nine of 29 (31%) patients taking l‐arginine and two of 17 controls reported a significant subjective improvement in sexual function. All objective variables assessed remained unchanged. All nine patients treated with l‐arginine and who had subjectively improved sexual performance had had an initially low urinary NOx , and this level had doubled at the end of the study.

Conclusions

Oral administration of l‐arginine in high doses seems to cause significant subjective improvement in sexual function in men with organic ED only if they have decreased NOx excretion or production. The haemodynamics of the corpus cavernosum were not affected by oral l‐arginine at the dosage used.