bluuebunny/crossref_metadata_2025 huggingface dataset:
Urolthelial cancer and cigarette smoking: findings from a regional case‐controlled study
Authors: SORAHAN T. , LANCASHIRE R. J. , SOLE G.
Published: November 2008

Objective To quantify the risks of urothelial cancer associated with smoking cigarettes.

Subjects and methods Histories were taken from 989 patients diagnosed with urothelial cancer, 2059 electoral register controls and 1599 General Practitioner controls. Histories of patients and controls were compared by means of logistic regression.

Results Statistically significant trends were observed for the risk of urothelial cancer to increase with estimated lifetime consumption of cigarettes. Among ex‐smokers, risks reduced with time since quitting, and ex‐smokers who quit 20 or more years ago experienced risks similar to lifelong non‐smokers. Type of cigarette was not an important predictor of risk. The two control series provided estimates of 45% and 33% respectively for the percentage of cancers in the series attributable to cigarette smoking.

Conclusion Cigarette smoking is the single most important cause of urothelial cancer, but stopping smoking leads quickly to reductions in risk.
Quantification of angiongenesis as an independent predictor of prognosis in invasive bladder carcinomas
Authors: DICKINSON A. J. , FOX S. B. , PERSAD R. A. , HOLLYER J. , SIBLEY G. N. A. , HARRIS A. L.
Published: November 2008

ObjectiveTo evaluate angiogenesis as a prognositic marker of transitional cell carcinoma of the bladder and to assess its relationship to established variables for survival.

Materials and methods Forty‐five tumours (two G2T2, seven G3T2 and 36 G3T3) from 36 men and nine women with a mean age of 73 years (range 50–91), who has been fokllowed‐up for a median of 37 months (range 1–50), were examined, Wessels w ere immunohistochemically highlighted using an antibody to the platelet endothelial cell adhesion molecule, CD31. Microvessel density was quantified using a Chalkley point eyepiece graticule.

Results Univariate analysis of survival showed stage, grade and vascular count were significant inducatiors of prognosis (P=0.002. P=0.007, P=0.019 respectively). No relationship was observed between stage and grade and vascular count. In a Cox proportional hazard model, adjiusted for age and stage, microvessel d ensity not only remained a significant prognositc indicator (P=0.026) but was as informative as stage in predicting overall survival. A high vascular count conferred a 2.5 increased risk of mortality.

Conclusions These findings suggest that assessment of anigogenesis by microvessel quantification is an independent predictor of survival in patients with invasive bladder carcinoma and might be useful in selecting those who would benefit from adjuvant therapy.
Partial bladder reconstruction with pedicled rectus and gracilis muscle flaps: an experimental study in dogs
Authors: EROL A. , ÖZGÜR S. , EROL U. , ÖZGÜR F. , AMKIAN Y. , ÖZGÜVEN V. , HAZIROǴLU R. , CETIN S.
Published: November 2008

Objective To investigate the functional, anatomical and histopathological results of partial bladder reconstruction with skeletal muscle flaps.

Materials and methods Partial bladder reconstruction with gracilis or rectus muscle flaps was performed in 10 mongrel dogs, Bladder compliance and uninhibited contractions were investigated in five female dogs. Pre‐Operative and post‐operative cystograms were performed in four female dogs. The dogs were killed 8–125 weeks after the operation. Bladders and muscle flaps were grossly examined and removed for histopathological examination.

Results There was no extravasation on post‐operative cystography. Bladder compliance was normal and uninhibited contractions were not present. Severe contracture and atrophy of the muscle flaps were observed in all dogs at necropsy. Bladder volumes were not changed significantly (p > 0.05). Histo‐pathological examination revealed severe mesenchymal metaplasia in all of the flaps.

Conclusion Partial reconstruction of the bladder with skeletal muscle flaps did not result in extravasation and bladder function was not altered. However, bladder volume could not be increased because of contracture and atrophy of the flaps.
Transverse colon conduit urinary diversion in patients treated with very high dose pelvic irradiation
Authors: RAVI R. , DEWAN A. K. , PANDEY K. K.
Published: November 2008

Objective To study the results of transverse colon conduit urinary diversion in patients receiving very high dose pelvic irradiation (≥ 65 Gy).

Patients and methods Records were reviewed for 30 such patients who underwent transverse colon conduit as a primary form of urinary diversion between January 1986 and June 1992. Most of the conduits were constructed using refluxing ureterocolic anastomoses with stents.

Results There was no operative mortality. Although the procedure was associated with a complication rate of 37% and a re‐operation rate of 20%, there were no bowel or urinary anastomotic leaks. The operation could be safely performed on patients with renal failure, with 83% of such patients showing normal or improved serum creatinine levels post‐operatively.

Conclusion The advantages of transverse colon conduit urinary diversion are the use of non‐irradiated bowel and ureters for diversion. We recommend it as a primary form of urinary diversion in these high risk cases.
The Mitrofanoff principle for urethral failure
Authors: WOODHOUSE C. R. J. , GORDON E. M.
Published: November 2008

Objective To assess the outcome of surgery for urethral failure.

Patients and methods Patients undergoing lower urinary tract reconstruction are recorded prospectively by protocol. Thirty‐four are presented whose urethra had failed as a conduit; in 23 the urethra was incontinent and in 11 it was spastic causing chronic retention. The incontinent patients had failed a variety of reconstructions, in five including insertion of an artificial sphincter. Those with chronic retention were unable to self‐catheterize the urethra.

Results A continent supra‐pubic diversion using the Mitrofanoff principle was performed. In two patients a new technique was used in which a detrusor tube formed the continent conduit. Ninety‐four per cent of patients were continent. Two patients voided to completion, the remainder emptied by self‐catheterization. Five minor revisions were required to allow easy catheterization. There was one death. The complication rate was 17%.

Conclusion This type of reconstruction is preferable to the formation of an ileal conduit in this difficult group of patients.
Complications and length of hospital stay following stented and unstented paediatric pyeloplasties
Authors: HUSSAIN S. , FRANK J. D.
Published: November 2008

Objectives To ascertain the necessity for the use of nephrostomies and ureteric stents after paediatric pyeloplasties.

Patients and methods Seventy children with a pelviureteric junction obstruction underwent a dismembered pyeloplasty between March 1983 and March 1991 at The Bristol Royal Hospital for Sick Children. A nephrostomy and stent were not used routinely except for the first few months of the survey. Indications for their use were: surgery on a single kidney, an inflamed renal pelvis or a revision pyeloplasty. Urinary catheters were only used for those patients with proven or suspected vesicoureteric reflux.

Results Thirteen patients had a nephrostomy and stent inserted (Group 1) of whom three patients (23%) developed complications. Fifty‐seven patients had only a wound drain inserted (Group 2) of whom nine (16%) developed complications. The hospital stay of 12.1 days for patients in Group 1 was significantly longer than the 5.4 days for Group 2 (P value <0.05). Long‐term radiological and/or radio‐isotopic follow‐up showed improvement in function and/or drainage in 95% of both groups.

Conclusions These findings support the concept that paediatric pyeloplasties can be safely performed at any age without the insertion of a nephrostomy tube or stent and that hospital stay is therefore significantly reduced.
Serum immunosuppressive acid protein predicts lymph node metastases in patients with renal cell carcinoma
Authors: PUMMER K. , PÜRSTNER P. , AUNER H. L. , STETTNER H. , TRUMMER H. , PENKOFF H. , RAUCHENWALD M.
Published: November 2008

Objective To evaluate the usefulness of serum immunosuppressive acid protein (IAP) as a marker for lymph node metastases in patients with renal cell carcinoma.

Patients and methods Serum IAP levels were studied in 73 patients with renal cell carcinoma, prior to therapy. Serum IAP levels were correlated with the clinical and the post‐operative histopathological stage. A threshold value of 800 μg/ml was applied.

Results Statistical analysis revealed a better correlation between IAP concentration and disease than with any other variable. Sensitivity and specificity were 94% and 84%, respectively, thus providing good positive (65%) and negative (98%) predictive values regarding lymph node involvement.

Conclusion Measuring serum IAP levels can be a valuable contribution to lymph node staging in patients with renal cell cancer. The choice of cut‐off value of 800 μg/ml has yet to be supported by a larger series.
A simplified grading method of transitional cell carcinoma of the urinary bladder: reproducibility, clinical significance and comparison with other prognostic parameters
Authors: SCHAPERS R.F.M. , PAUWELS R.P.E. , WIJNEN J.Th.M. , ARENDS J.W. , THUNNISSEN F.B.J.M. , COEBERGH J.W.W. , SMEETS A.W.G.B. , BOSMANH F.T.
Published: November 2008

Objective To determine the extent to which the biological potential of transitional cell neoplasms can be predicted by histological grading of the primary tumour in a two grade system using simple histological criteria and to evaluate the additional value of grading when combined with other prognostic factors. The inter‐observer variability of the World Health Organization grading and the two grade system was tested.

Patients and methods The study included 311 patients with newly diagnosed transitional cell carcinoma of the urinary bladder. Two‐hundred and fifty‐six patients (82.3%) were men and 55 (17.7%) were women. Age ranged from 17 to 92 years with a mean of 66 years. The median follow‐up was 38 months, with a maximum of 150 months (mean 46.2 months).

Results A simplified grading system was developed in which only low‐grade and high‐grade tumours were distinguished. Reproducibility of this grading system was good to excellent with a group kappa value of 0.78. The survival of patients with low‐grade tumours was significantly better than that of patients with high‐grade tumours (P< 0.0001). The progressionfree interval was also significantly longer in patients with low‐grade tumours than in patients with high‐grade tumours (P= 0.0032). Combining low‐high grading, histological stage, mitotic index and age, histological stage appeared to be the most important parameter in predicting survival and progression.

Conclusion A reproducible and discriminating system such as this low‐high grade system is an important prognostic factor when stage cannot be established with certainty.
Prevention of urethral stricture recurrence using clean intermittent self‐catheterization
Authors: KJÆRGAARD B. , WALTER S. , BARTHOLIN J. , ANDERSEN J.T. , NØHR S. , BECK H. , JENSEN B.N. , LOKDAM A. , GLAVIND K.
Published: November 2008

Objective To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy.

Patients and methods Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1 year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery.

Results Significantly fewer (P < 0.01) patients developed recurrence of urethral stricture within the first postoperative year in the CIC group (n= 4) compared with the control group (n= 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable.

Conclusion Weekly CIC is a simple method of reducing the frequency of urethral stricture recurrence after internal urethrotomy.
Loss of heterozygosity of the retinoblastoma and adenomatous polyposis susceptibility gene loci and in chromosomes 10p, 10q and 16q in human prostate cancer
Authors: PHILLIPS S. M. A. , MORTON D. G. , LEE S. J. , WALLACE D. M. A. , NEOPTOLEMOSH J. P.
Published: November 2008

Objective To examine prostate tumours for losses of known or suspected tumour suppressor genes to determine some of the important events in the genesis of this common cancer.

Materials and methods Paired tumour and blood samples were obtained from 21 patients who underwent transurethral resection of malignant prostate glands for urinary outflow obstruction. Paired tumour and normal tissue (leucocytes) DNA was extracted and examined for possible losses of several known or suspected tumour suppressor genes, using restriction fragment length polymorphism techniques to detect loss of heterozygosity.

Results Deletions of the retinoblastoma susceptibility gene (RB1) locus were found in six of nine informative cases using two intragenic probes (p68RS2.0 and p123m1.8). The locus related to the familial adenomatous polyposis susceptibility (APC) gene demonstrated loss of heterozygosity in three of seven informative cases using the EF5.44 probe. Losses were also noted in loci on chromosome 10p in four of 19 informative cases (probe cTBQ7), chromosome 10q in eight out of 19 informative cases (probes EFD75 and D10S90) and in 16q in three of 17 informative cases (probe D16S7).

Conclusion These finding suggest that losses of the RE31 and APC tumour suppressor genes and suspected tumour suppressor genes on lop, 1Oq and 16q may be important events in the genesis of prostatic tumours.
Reducing the loss of implants following penile prosthetic surgery*
Authors: LYNCH M. J. , SCOTT G. M. , INGLIS J. A. , PRYOR J. P.
Published: November 2008

Objective To assess the factors associated with loss of implant following penile prosthetic surgery and to make alterations in the management of patients to prevent this from occurring.

Patients and methods A retrospective analysis was carried out of the factors associated with post‐operative infection and erosion in 188 patients who underwent implantation of penile prostheses. A prospective study was then established in which 62 patients were managed by a set protocol designed to counteract the factors identified as being contributory to loss of implants in the retrospective review.

Results In the retrospective study nine (4.8%) patients lost a prosthesis due to erosion. Erosion was noted to be more common with one type of implant which has since been modified. Infection was the cause of prosthesis loss in 12.2% of patients in the retrospective review. The new protocol resulted in a signi6cantly reduced infection rate in penile prostheses to 1.6% (P<0.05). Conclusion With attention to simple antiseptic prophylaxis, antibiotic penetration and continuing audit, a significant improvement in the loss of penile prostheses can be achieved along with a reduction in the amount of antibiotics prescribed.
Treatment of interstitial cystitis with intravesical heparin
Authors: PARSONS C. L. , HOUSLEY T. , SCHMIDT J. D. , LEBOW D.
Published: November 2008

Objective To control the symptoms of interstitial cystitis with chronic self‐administered intravesical heparin and determine whether the drug's continued use can sustain remission.

Patients and methods A total of 48 patients were selected to undergo intravesical heparin therapy, 10000 units in 10 ml sterile water, three times per week for 3 months. For patients who attained a good clinical remission, therapy was available for up to a further 9 months.

Results At 3 months 27 of 48 patients (56%) attained good clinical remissions. All were offered continuous therapy and 23 elected for an additional 3 months. Twenty of the 23 continued in remission. Sixteen of these patients elected to have a further 6 months of therapy (12 months total) and 15 of 1ft remained in remission.

Conclusion In over half of the patients studied, intravesical heparin controls the symptoms of interstitial cystitis with continued improvement even after one year of therapy.
Lymphocyte sub‐populations in the bladder wall in normal bladder, bacterial cystitis and interstitial cystitis
Authors: CHRISTMAS T. J.
Published: November 2008

Objective To identify lymphocyte sub‐populations within the bladder wall in normal controls, in patients with bacterial cystitis (BC) or interstitial cystitis (IC).

Patients and methods Bladder biopsies were taken from 21 patients with IC, four with BC and five normal controls. Immunofluorescent staining of biopsies was performed using monoclonal antibodies to the Tcell markers CD3, CD4, CD8, TCRδ1, δTCS1, βF1 and IML. Plasma cells were identified using monoclonal antibodies to IgA, IgG and IgM. The location and numbers of cells were determined. Peripheral blood lymphocyte counts were also performed in each case.

Results T cells (CD4+ and CD8 +) were significantly more abundant within the bladder biopsies from patients with interstitial cystitis than in those from the normal controls, and were present within the urothelium and submucosa but not the detrusor. There was no difference between the numbers of T cells present in the biopsies from patients with interstitial cystitis and in those with bacterial cystitis. However, the presence of γδγ T cells was significantly associated with interstitial cystitis. IgA + and IgM + plasma cells were located within the urothelium and submucosa but not the detrusor in patients with IC and the numbers present in these patients were significantly greater than in those with BC or the normal controls. The peripheral blood lymphocyte counts were not altered in any of the study cases.

Conclusion The increased numbers of CD4 +, CD8 + and γδ T cells as well as IgA +, IgG+ and IgM + plasma cells within the urothelium and submucosa in patients with IC suggest that these cells play an active role in the pathogenesis of the disorder. The previously described abnormal urothelial expression of HLA‐DR and hyperexpression of Class I molecules in patients with IC may enable these cells to cause destruction of the urothelium ‐ the end stage of IC.
Can regional lymph node involvement be predicted in patients with carcinoma of the penis?
Authors: AYYAPPAN K. , ANANTHAKRISHNAN N. , SANKARAN V.
Published: November 2008

Objective To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre‐operatively by clinical and histological parameters.

Patients and methods Seventy‐eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes.

Results The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases.

Conclusions In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow‐up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow‐up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.
Sexuality in patients treated for penile cancer: patients' experience and doctors' judgement
Authors: OPJORDSMOEN S. , WAEHRE H. , AASS N. , FOSSA S.D.
Published: November 2008

Objective To evaluate sexuality after successful treatment of penile cancer.

Patients and methods Post‐therapy sexuality was evaluated in 30 men (median age 57 years; range 28–75) treated for cancer of the penis 80 months previously (median; range: 11–225 months). Treatment regimes were: local excision/laser beam treatment, 5; definitive radio‐therapy, 12; partial penectomy, 9; total penectomy, 4. Patients underwent a semi‐structured interview and completed three self‐administered questionnaires (psychosocial adjustment to severe illness [PAIS], mental symptoms [GHQ], quality of life [EORTC QLQ C‐30]). A global score of overall sexual functioning was constructed consisting of sexual interest, sexual ability, sexual satisfaction, sexual identity, partner relationship and frequency of coitus.

Results In 10 of 12 patients treated by irradiation the sexual global score was not or only slightly reduced compared with two of nine patients after partial penectomy and one of five patients with local surgery/laser beam treatment. All four patients who had undergone total penectomy recorded a severely reduced sexual global score. Of the six single domains, sexual identity and partner relationship did not change with increasing age, whereas the other scores of sexual life deteriorated as the patient became older. In the patients treated by irradiation doctors evaluated the patients' post‐treatment sexuality to be more impaired than that experienced by the patients.

Conclusion Within the limitations due to the small number of patients studied, radiotherapy seems to be the treatment of choice in limited cancer of the penis if preservation of sexuality is a major therapeutic aim. Physicians counselling patients with this rare malignancy need more information about treatment‐related problems of sexuality after different therapeutic modalities.
A method of demonstrating intra‐renal reflux
Authors: WHITAKER R.H. , CUCKOW P.M.
Published: November 2008

Objective To develop a method for demonstrating intra‐renal reflux as a permanent resin cast, and subsequently to show the relationship between the shape of the papilla and the presence and extent of reflux and to determine, by histological examination of the resin casts, the extent of filling of the nephron.

Subjects and methods The pericaliceal systems of fresh pig's kidneys were filled retrogradely with a dilute resin that sets within 2 h. The parenchyma was then macerated in potassium hydroxide to obtain the casts.

Results The extent of the intra‐renal reflux was variable, was usually polar and appeared independent of the injection pressure. Microscopy showed branching of the collecting ducts and nephron filling to the proximal tubules.

Conclusion This method could prove a useful tool in the further study of intra‐renal reflux.
Erectile function following transurethral prostatectomy
Authors: Hanbury D.C. , Sethia K.K.
Published: November 2008

Objective To determine the true incidence and possible aetiology of impotence following transurethral prostatectomy.

Patients and methods Over a 9‐month‐period 268 patients who were about to undergo transurethral prostatectomy were interviewed about their sexual function. Full details of each operation were recorded including size of prostate, operative time, grade of surgeon and the occurrence of capsular perforation. The interviews were repeated by letter or telephone 3 months after operation.

Results Of the 268 men interviewed, 246 (91.8%) were suitable for inclusion in the study. Pre‐operatively, 137 (55.7%) were fully potent, 43 (17.5%) could achieve a partial erection and 66 (26.8%) were impotent. Of the fully potent patients, 20 (14.6%) became partially potent and four (2.9%) became impotent post‐operatively. Of those who were partially potent before operation, 16 (37.2%) became impotent post‐operatively. Overall, the risk of impotence was 28.1% if the prostatic capsule was breached at operation but only 10.0% if it was not (P<0.01).

Conclusion In fully potent men the risk of impotence after transurethral prostatectomy is fairly low, but it is higher in men who already have a degree of erectile failure. The risk of impotence is related to the incidence of capsular perforation at the time of surgery.
Should we reconsider the indications for ileo‐obturator node dissection with localized prostate cancer?
Authors: Sullivan L.D. , Rabbani F.
Published: November 2008

Objective To evaluate the need for ileo‐obturator node dissection in patients with localized prostate cancer who are undergoing radical retropubic prostatectomy.

Patients and methods Over a 5‐year‐period, 95 patients underwent bilateral pelvic lymphadenectomy. Ninety were performed in association with planned radical prostatectomy and five were staging procedures in clinical stage T3 patients prior to radiotherapy or hormonal therapy. The patients with localized prostate cancer were stage T1a (one patient), T1b (21), T2a (30), and T2b (38). Pre‐operative biopsies in the patients with localized cancer were well differentiated in 44 patients, moderately well differentiated in 45 and poorly differentiated in one. In the patients with T3 tumours, pre‐operative biopsies were well differentiated in one, moderately well differentiated in two and poorly differentiated in two. Prostate‐specific antigen (PSA) levels ranged from 0.4 to 110.1 ng/mL (Hybritech assay).

Results Two patients had positive lymph node dissections on fixed section. These two patients had well‐differentiated T1b disease with a PSA level of 72.4 ng/mL and poorly differentiated T3 disease with a PSA level of 58.5 ng/mL. There was significant upstaging (P< 0.001) and upgrading (P< 0.001) on pathological examination. None of the 71 patients with a PSA 10 ng/mL had positive lymph nodes compared with 8.3% of the 24 patients with a PSA > 10 ng/mL (P= 0.0618). Lymph node metastases were present in 1% of patients with well or moderately well‐differentiated prostate cancer on pre‐operative biopsy versus 33% with poorly differentiated disease (P= 0.0625). These P values strongly suggest an association, achieving significance only at the 10% level which might be the more appropriate level given the relative lack of power of the study due to the small number of patients with positive lymph nodes.

Conclusion These Results suggest that routine ileo‐obturator node dissection in patients with well or moderately well‐differentiated, localized prostate cancer and a PSA level <10 ng/mL may be unnecessary, especially as a separate procedure.
Absolute concentration of urinary endogenous β‐glucuronidase determined by an ELISA method as a sensitive but non‐specific indicator for active renal parenchymal damage
Authors: Ho K.‐J.
Published: November 2008

Objective To demonstrate that the absolute concentration, instead of the activity, of urinary endogenous P‐glucuronidase is a better indicator for active renal parenchymal damage.

Materials and methods Urine samples were obtained from 143 adult patients comprising 60 control subjects with no evidence of urinary tract disease and 83 patients with serum creatinine >1.5 mg/dL. The absolute concentration of urinary endogenous β‐glucuronidase was determined by an enzyme‐linked immunosorbant assay (ELISA) method recently developed by us. The maximal velocity of the enzyme was determined by the enzyme kinetic method. The bacterial β‐glucuronidase and bilirubin in the urine were also detected.

Results The urinary p‐glucuronidase activity was affected by certain inhibitors (d‐glucaro‐1, 4‐lactone), intrinsic substrates (conjugated bilirubin) and bacterial β‐glucuronidase present in the urine. Its concentration, determined by the ELISA method, was not interfered with by such factors. When those urine samples which were contaminated with bacteria and/or bilirubin were excluded, the β‐glucuronidase concentration (X ng/umol creatinine) was significantly correlated with its maximal velocity (Y nmol/ min/μmol creatinine): Y = 0.003 + 0.103X. Contrary to blood urea nitrogen, which increases with the increase in serum creatinine, the urinary β‐glucuronidase activity and its concentration reached a peak at a serum creatinine of 1.6 ∼ 3.0 mg/dL and declined at higher serum creatinine levels. Episodic elevation of serum creatinine due to acute insult to the kidney or flare up of disease activity was often preceded by an increase in the level of urinary β‐glucuronidase.

Conclusion The absolute concentration of the urinary β‐glucuronidase was not affected by several factors in the urine which interfere with its activity, and was a sensitive indicator for renal parenchymal damage, particularly in the early stage when the disease is active.
Clam enterocystoplasty and pregnancy
Authors: Fenn N. , Barrington J.W. , Stephenson T.P.
Published: November 2008

Objective To assess the course and outcome of pregnancy in patients who have undergone clam enterocystoplasty.

Patients and methods A retrospective study was carried out of 19 pregnancies in 18 women aged from 21 to 36 years who had undergone clam enterocystoplasty.

Results Urinary tract infection was common but renal function remained normal with prompt treatment with antibiotics. No other adverse antenatal factors were identified and all pregnancies had a normal fetal outcome. Vaginal delivery was a safer option for these patients, even in those who had undergone an anti‐incontinence procedure in addition to enterocystoplasty.

Conclusion Careful antenatal monitoring by both an obstetrician and a urologist resulted in a successful pregnancy and vaginal delivery in these patients.
The application of continent urinary stomas to bladder augmentation or replacement in the failed exstrophy reconstruction
Authors: Gearhart J.P. , Peppas D.S. , Jeffs R.D.
Published: November 2008

Objective To determine the application and success of continent urinary stomas in the failed bladder exstrophy reconstruction.

Patients and methods A total of 3 5 patients underwent construction of a continent urinary stoma during bladder replacement or bladder augmentation between 1987 and 1993. The continent stoma was constructed with appendix (19 patients), tapered ileum (2), Benchekroun (12), Indiana (1) and Mainz type stoma (1).

Results Three patients required revision of their continent stoma, one for incontinence and two for difficulty in catheterization. Overall, 95% experienced daytime continence on an intermittent catheterization regimen, while 90% were dry at night. The upper tract remained normal in 34 of 3 5 patients.

Conclusions While the Benchekroun technique is reliable in producing continence, difficulty with catheterization has been a chronic problem due to stomal stenosis. Our positive experience with using the appendix as a cath‐eterizable conduit into either the bladder template or bowel segment has led us to prefer this method of continent stoma construction in the patient with a failed exstrophy. In the absence of an appendix, our preference is a tapered ileal segment. The failed exstrophy reconstruction can be salvaged with a continent stoma and substitution or augmentation cystoplasty in most patients, thus avoiding urinary diversion.
Extracorporeal piezoelectric shock wave lithotripsy as mono and multiple therapy of large renal calculi including staghorn stones in unanaesthetized patients under semi‐ambulant conditions
Authors: Bruns T. , Stein J. , Tauber R.
Published: November 2008

Objective To examine the effectiveness and complication rate of extracorporeal piezoelectric shock wave lithotripsy (EPL) as monotherapy for the treatment of large renal calculi.

Patients and methods Treatment consisted of semi‐ambulant EPL as monotherapy combined with protective ureteric stenting in 84 patients. Three groups were established according to stone volume (borderline‐stone, partial and complete staghorn). An average of 18 230 shock waves was applied in 3.76 sessions to each patient.

Results No major complications were observed but there were minor complications in 33% of patients. Invasive auxiliary methods were necessary in only 12%. After a mean follow‐up of 9 months (n= 72), 54% of patients were stone‐free and in 22% the fragments passed spontaneously. Thus the success rate was 76%.

Analysis of the three groups showed no difference in stone status during follow‐up. There was no relation between the outcome of treatment and stone volume. Analysis of the patients who failed to respond to treatment showed that they were treated for longer than the stone‐free group, with significantly fewer sessions per week (0.71 vs 1.28 sessions/week). It appears that higher rates of stone removal can be achieved with more frequent treatment sessions at shorter intervals.

Conclusion We consider semi‐ambulant EPL monotherapy to be a minimally invasive alternative treatment in patients with large renal calculi, including staghorn stones.
Should Stamey colposuspension be our primary surgery for stress incontinence?
Authors: O'Sullivan D.C. , Chilton C.P. , Munson K.W.
Published: November 2008

Objective To evaluate the outcome of the Stamey procedure for stress incontinence and to decide if it is an acceptable first‐line option for the treatment of patients.

Patients and methods Between June 1987 and March 1993 67 women had Stamey bladder neck suspension carried out for the treatment of stress incontinence. In September 1993 all patients received a detailed questionnaire to ascertain their present status.

Results Immediately after surgery 70% of patients were dry and 15% were much improved. At 6 months 56% of patients were dry and 21% were much improved. More than 1 year following surgery, of 58 patients responding only 31% were dry and 28% were much improved. More than 5 years after surgery only 18% of the 28 women responding were dry. The factors which were significantly associated with failure were obesity (P< 0.005) and the number of pads used per day (P<0.05). Previous surgery may also be an important factor.

Conclusion The Stamey vesical neck suspension has a good early success rate but the results in the longer term are not acceptable. This operation should not be used as a first‐line treatment for stress incontinence and should be reserved for specific patient subgroups.
Correlation of morphometry, nucleolar organizer regions, proliferating cell nuclear antigen and Ki67 antigen expression with grading and staging in urinary bladder carcinomas
Authors: Krüger S. , Müller H.
Published: November 2008

Objective To investigate the correlation of four different indicators of proliferation — mean nuclear area (MNA) morphometry, nucleolar organizer region (NOR) count, proliferating cell nuclear antigen (PCNA) and Ki67 antigen expression — in specimens of invasive and non‐invasive urinary bladder carcinomas with the grading and staging of the tumour and to determine which indicator is most suitable for discriminating between non‐invasive and invasive carcinomas.

Materials and methods Biopsies of 58 urinary bladder carcinomas of different grade and stage (38 invasive, 20 non‐invasive) and 11 carcinomata in situ were included in the study. Ten specimens of normal bladder mucosa served as controls. Analysis of indicators was performed on sequential serial paraffin sections of the same tissue, applying each test once to one of four serial sections.

Results In comparison to normal bladder mucosa the values of the four indicators were significantly greater (P<0.001) in all carcinomata in situ and in carcinomas. Values also increased from grade 1 to grade 3 carcinomas, but indicator values were similar for carcinomata in situ and grade 2 carcinomas. All indicators correlated with each other and allowed a significant discrimination between grade 1 and 2 or grade 2 and 3 carcinomas. Non‐invasive carcinomas (Ta) showed a significantly lower proliferative activity (P< 0.001) than invasive carcinomas but there were overlapping values within the invasive carcinomas (T1, T2 and T3/4).

Conclusions MNA, NOR count, PCNA index and Ki67 index could be correlated with tumour grade, but not with stage, of transitional bladder carcinoma. Of the indicators studied the Ki67 antigen was the most useful in differentiating between invasive and non‐invasive carcinomas. This could be of prognostic relevance, especially for the heterogeneous group of grade 2 carcinomas.
Computerized analysis of transrectal ultrasonography images in the detection of prostate carcinoma
Authors: de la Rosette J.J.M.C.H. , Giesen R.J.B. , Huynen A.L. , Aarnink R.G. , Debruyne F.M.J. , Wijkstra H.
Published: November 2008

Objective To report on the use of automated image analysis in the interpretation of transrectal ultrasono‐graphic images of the prostate.

Patients and methods During transrectal ultrasonography, images were recorded from biopsies performed in 127 patients. Subsequently in the image, the puncture place was marked and analysed. Analysis of the images was performed with the Automated Urologic Diagnostic Expert (AUDEX) system, consisting of a personal computer connected to the ultrasound machine. From the images collected, parameters can be calculated for image classification. The parameters obtained with this procedure were correlated with the histological result.

Results Evaluation showed a sensitivity of 84.8% and specificity of 87.5%. The positive and negative predictive values, to predict prostate carcinoma, were 84.8% and 87.5%, respectively.

Conclusion Automated image analysis can help in the diagnosis of prostate carcinoma. In patients with non‐palpable lesions or with poorly visualized tumours, image analysis is superior to the standard current diagnostic techniques.
Nitric oxide and cyclic GMP formation following relaxant nerve stimulation in isolated human corpus cavernosum
Authors: Pickard R.S. , Powell P.H. , Zar M.A.
Published: November 2008

Objective To investigate further the role of the nitric oxide (NO)‐cyclic GMP pathway as the mediator of relaxant neurotransmission in human corpus cavernosum and to establish whether impaired activity of this pathway contributes to the pathophysiology of impotence.

Patients and methods Samples of cavernosal tissue were obtained from 59 men undergoing penile operations. The controls comprised four men with penile carcinoma and 17 with Peyronie's disease. Of the impotent men, 35 had clinical evidence of penile vascular disease on pre‐operative investigation, whilst three had non‐vascular impotence. Each biopsy was divided into two strips which were then suspended under tension in organ bath chambers. The relaxant inner‐vation of one strip of each pair was stimulated electrically whilst the other strip was left unstimulated. The formation of NO and cyclic GMP was calculated by comparing their respective tissue content in the stimulated and unstimulated strips.

Results Overall, stimulation of the relaxant innervation produced significant increases in the tissue content of both NO and cyclic GMP. Incubation with an inhibitor of NO biosynthesis abolished the mechanical relaxant response and the formation of both NO and cyclic GMP. The magnitude of relaxant response and the formation of NO was diminished in tissue from men with vascular impotence compared to controls. The increase in cyclic GMP content was similar in both these groups. Relaxant response, NO formation and cyclic GMP formation in tissue from men with non‐vascular impotence was similar to controls.

Conclusions This study provides further evidence that the NO‐cyclic GMP pathway acts as the mediator of nerve‐evoked smooth muscle relaxation in human corpus cavernosum. Diminished NO formation following relaxant nerve stimulation may account for impaired relaxant responses found in tissue from men with vascular impotence and may contribute to the cause of their erectile dysfunction.
‘Congenital’ hydronephrosis: limitations of diagnosis by fetal ultrasonography
Authors: Rickwood A.M.K. , Harney J.V. , Jones M.O. , Oak S.
Published: November 2008

Objective To determine whether children presenting clinically with pelvi‐ureteric junction obstruction had fetal hydronephrosis.

Patients and methods Forty‐three children, born during or after 1985, presented clinically with pelvi‐ureteric junction obstruction. Records of the maternal pregnancies were reviewed with reference to the findings of any fetal ultrasonography.

Results In 25 patients fetal ultrasonography was per‐formed at or beyond 30 weeks' gestation (mean 33.2). None had significant fetal hydronephrosis.

Conclusion Hydronephrosis due to pelvi‐ureteric obstruction is not necessarily congenital and patients presenting clinically may differ inherently from those detected fetally.
Percutaneous cryosurgery for renal tumours
Authors: Uchida M. , Imaide Y. , Sugimoto K. , Uehara H. , Watanabe H.
Published: November 2008

Objective To evaluate the use of percutaneous cryosurgery in the treatment of renal tumours.

Materials and methods A cryoprobe using liquid nitrogen was designed. The tolerance of renal cancer cells to cooling was tested. Freezing tests on two extirpated kidneys involved with hypervascular tumour were performed in water at 40d̀C. A clinical trial of percutaneous cryosurgery was carried out in two patients with advanced renal carcinoma.

Results The cooling function of the new probe was similar to that of a conventional probe. The tolerance test on renal cancer cells showed that the cooling temperature should be below — 20d̀C to render them necrotic. Freezing tests on two nephrectomized kidneys with hypervascular renal cancer suggested that embolization of the renal artery might be advisable before treatment. The clinical trial in two patients with advanced renal carcinoma showed that the whole kidney, including the tumour, became necrotic and shrunken post‐operatively. The patients' Karnofsky performance scale showed a marked improvement 3 months after the operation, but their general condition gradually deteriorated. Patient 1 died 10 months and patient 2 died 5 months after the procedure.

Conclusion Percutaneous cryosurgery was performed successfully in two patients with hypervascular renal tumours. Cryo‐immunological activity was assumed to have contributed to the temporary improvement in their condition. These results suggest that percutaneous cryosurgery might be useful as minimally invasive treatment in a limited number of patients with advanced renal carcinoma.
The persistence of bacille Calmette‐Guerin in the bladder after intravesical treatment for bladder cancer
Authors: Bowyer L. , Hall R.R. , Reading J. , Marsh M.M.
Published: November 2008

Objective To determine the incidence of bacille Calmette‐Guerin (BCG) bacilli persisting in the urinary tract of patients treated previously with intravesical BCG for carcinoma in situ or multiple Ta.T1 transitional cell carcinoma.

Patients and methods One‐hundred and twenty‐five patients were treated at the Freeman Hospital, Newcastle upon Tyne, UK over an 8‐year period, 90 of whom submitted early morning urine samples for culture for acid‐fast bacilli at varying intervals following BCG treatment. The records of all patients were reviewed to determine the incidence of caseating granulomata containing acid‐fast bacilli together with the incidence of toxicity and the outcome of treatment.

Results Five patients were found to have persisting acid‐fast mycobacteria in their urine or bladder up to 16.5 months after completing intravesical instillations of BCG. In one patient this probably accounted for bladder symptoms that required palliative cystectomy. In four patients the ‘infection’ was not severe. Two patients were treated with antituberculous chemotherapy without complication. Three years after intravesical BCG therapy 36 of 69 patients (52%) had remained tumour free.

Conclusion BCG organisms can persist in the urinary tract for at least 16.5 months after the completion of intravesical BCG instillation therapy.
Superficial bladder cancer: for how long should a tumour‐free patient have check cystoscopies?
Authors: Morris S.B. , Gordon E.M. , Shearer R.J. , Woodhouse C.R.J.
Published: November 2008

Objective To determine the probability of a patient with superficial bladder cancer developing a recurrent tumour after having remained tumour free for 2 or more years.

Patients and methods One‐hundred and seventy‐nine patients with Ta or T1 tumours at diagnosis, a minimum follow‐up of 3 years and a minimum of 2 years remaining tumour free were identified. Thirteen patients had more than one episode that was eligible for inclusion and there were therefore 192 tumour‐free episodes for analysis. Survival curves of the probability of being recurrence‐free against time were constructed for the whole group, for subgroups of Ta and T1 tumours and for subgroups with characteristics at diagnosis suggesting a good, intermediate and poor prognosis.

Results The probability of a patient developing a recurrence after 2, 5 and 10 years of being tumour free was 43, 22 and 2% respectively. No patient had a recurrence after remaining tumour free for 12 years. No patient who had been tumour free for at least 2 years progressed to muscle invasion or metastases. There was no significant difference in the probability of recurrence between Ta and Tl tumours after 2 years of remaining tumour free.

Conclusion The optimum length of cystoscopic follow‐up for patients with superficial bladder cancer is unknown, but patients continue to develop recurrences even after many years of being tumour free. If a patient is to discontinue cystoscopic follow‐up, then alternative methods of assessment should be applied.
Use of the rectus abdominis myocutaneous flap in treating advanced carcinomas of the penis
Authors: Thomas J.A. , Matanhelia S.S. , Dickson W.A. , Rees R.W.M. , Matthews P.N.
Published: November 2008

Objective To examine the methods used to obtain skin closure after radical surgery for carcinomas of the penis, with special reference to the rectus abdominis myocutaneous flap.

Patients and methods Over a 20 year period, 21 patients underwent surgery for carcinomas of the penis. Seven had advanced tumours, requiring radical surgery for complete local tumour control. The resulting wounds were repaired with scrotal skin transfer in three patients and with a rectus abdominis myocutaneous flap in the other four.

Results These methods of repair were a 100% reliable, all wounds being healed within 10 days.

Conclusions Scrotal skin transfer is a simple and effective method of achieving wound closure. Where removal of the scrotum is required along with curative or palliative surgery, and after ilio‐inguinal lympha‐denectomy, a rectus abdominis myocutaneous flap is useful for skin closure.