bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary continence after radical retropubic prostatectomy. Analysis and synthesis of contributing factors: a unified concept
Authors: KAYE K.W. , CREED K.E. , WILSON G.J. , D’ANTUONO M. , DAWKINS H.J.S.
Published: November 2003

Objective

 To assess the effects of three types of apical dissection on urinary continence after radical retropubic prostatectomy and to evaluate possible contributing factors, e.g. preservation of the bladder neck and preprostatic sphincter, age, anastomotic strictures, previous transurethral resection and nerve‐sparing surgery.

Patients and methods

 Having undergone one of three types of apical dissection, 280 patients were evaluated: in Group 1 (sphincter‐damaging) 134 patients underwent the original technique of ligating and transecting the venous complex; in Group 2 (sphincter‐repairing), 76 patients had the venous complex with part of striated sphincter incorporated within anastomotic suture(s); and in Group 3 (sphincter‐preserving), 70 patients had the venous complex alone ligated using the ‘bunching’ technique of Myers. The outcome was analysed for the number becoming continent and the time to continence.

Results

 Continence was achieved in 93% overall, with 90%, 93% and 99% achieving continence in Groups 1, 2 and 3, respectively. The mean time to continence was 68 days overall, taking 100, 52 and 30 days for the respective groups. Twenty patients (7%) did not achieve full continence; 15 had minor incontinence and five severe, with none of the latter being in Group 3. The group (preservation of external sphincter), age and freedom from development of anastomotic strictures were the most important factors both in regaining continence and decreasing the time to continence.

Conclusions

 Preservation of as much as possible of the normal anatomy of the sphincter mechanisms and their nerve supplies results in an excellent return to continence after radical retropubic prostatectomy.
Bone metabolism following bladder substitution with the ileal urethral Kock reservoir
Authors: Poulsen A.L. , Overgaard K. , Steven K.
Published: November 2003

Objectives To assess bone metabolism following bladder substitution with the ileal Kock reservoir.

Patients, subjects and methods The investigation comprised two separate studies, one with baseline measurements before and after surgery, and the second after surgery only, of bone mass, made using single‐photon absorptiometry and dual‐energy X‐ray absorptiometry, biochemical variables of bone turnover, plasma analyses and measurements of renal calcium and phosphate excretion. After inclusion, both groups of patients were observed longitudinally for 2 years. The post‐surgery study included 25 patients who had undergone bladder substitution (median age 67 years, range 44–75), with a median post‐operative follow‐up of 1.0 year (range 0.3–3.7), and 16 control subjects (either healthy or with other minor urological complaints; median age 62 years, range 34–80), and the pre‐surgery study comprised seven patients who had undergone bladder substitution (median age 57 years, range 42–68).

Results Total body, forearm and spinal bone mineral contents were similar in patients with an ileal bladder substitute measured 1 year after surgery and in control subjects. There were equivalent significant changes in both the patients and control subjects during the 2‐year observation period, with a 2–3% decrease in total body and forearm bone mineral content. The values were similar in patients with and without a mild metabolic acidosis. Plasma calcium, phosphate, total alkaline phosphatase, intact parathyroid hormone, vitamin D and osteocalcin were normal in both patients and control subjects. Renal excretion of calcium and phosphate was also similar in patients and in control subjects.

Conclusions Ileal urethral Kock bladder substitution does not lead to accelerated bone mineral loss in elderly men, despite a mild metabolic acidosis in half of the patients.
A dose‐ranging study of the efficacy and safety of tamsulosin, the first prostate‐selective &agr;1A‐adrenoceptor antagonist*, in patients with benign prostatic obstruction
Authors: ABRAMS P. , SPEAKMAN M. , STOTT M. , ARKELL D. , POCOCK R.
Published: November 2003

Objective

 To evaluate the efficacy and safety in a dose‐ranging study of tamsulosin (once‐daily) as a modified‐release formulation compared with placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic obstruction (BPO), and to establish the optimum dosage for phase III clinical studies.

Patients and methods

 Of 169 patients with LUTS associated with BPO enrolled in a 3 week placebo run‐in period, 126 were subsequently randomized to receive placebo (28), or 0.2 mg (35), 0.4 mg (30), or 0.6 mg (33) of tamsulosin once daily for 4 weeks. Free‐flow and pressure‐flow measurements, and modified Boyarsky symptom scores were used to determine efficacy. Safety was evaluated by monitoring adverse events and vital signs (including 8 h after the first dose), and by laboratory determinations.

Results

 Tamsulosin 0.4 mg and 0.6 mg produced significantly greater improvements in maximum urinary flow rate (Qmax ) (2.2 mL/s, 22.6%, and 1.8 mL/s, 20.2%, respectively) than did placebo (−0.1 mL/s, −0.9%). The results from the pressure‐flow studies confirmed the results for Qmax in the free flow studies, with optimum and significant effects for tamsulosin 0.4 mg. This also applied for detrusor pressure at maximum flow, which decreased by 26.6 cmH2O (−28.2%) on 0.4 mg tamsulosin whereas it increased by 4.9 cm H2O (5.7%) on placebo. The greatest reductions in total symptom score were obtained with tamsulosin 0.4 mg and 0.6 mg (4.1, −28.7%, and 4.4 points, −28.2%, respectively) compared with reductions of 3.4 (−20.1%) in the tamsulosin (0.2 mg) and 2.9 points (−17.7%) in the placebo groups. The difference in effects on total symptom score between treatment groups was not statistically significant, which can be attributed to the small sample size. Tamsulosin was well tolerated; at least one adverse event was reported by 29%, 23%, 27% and 36% of patients in the placebo and tamsulosin 0.2 mg, 0.4 mg and 0.6 mg groups, respectively. There were no apparent tamsulosin dose‐dependent changes in vital signs from baseline to the end of 4 weeks of randomized treatment. Tamsulosin caused no statistically significantly greater changes in blood pressure than placebo during the initial 8 h after the first dose. There were no clinically significant changes in laboratory variables.

Conclusion

 Tamsulosin is well tolerated and effective in improving urinary flow and relieving LUTS associated with BPO. Optimal effects are achieved with tamsulosin 0.4 mg administered once daily.
Retrograde embolization and causes of failure in the primary treatment of varicocele
Authors: FENELEY M.R. , PAL M.K. , NOCKLER I.B. , HENDRY W.F.
Published: November 2003

Objective

 To assess retrograde embolization for the treatment of varicocele and to examine the causes of surgical and radiological treatment failure.

Patients and methods

 Of 154 patients with clinical varicocele associated with subfertility or symptoms who were treated, 100 underwent surgical high ligation, retrograde embolization under fluoroscopic control was attempted in 84 and 30 had both forms of treatment. Venographic findings were defined in those patients for whom embolization proved impossible and in those in whom prior high ligation had failed. Among subfertile patients, 64 had semen analyses before and at least 3 months after the procedure available for comparison. Those patients undergoing both radiological and surgical procedures were sent questionnaires to evaluate their experience.

Results

 Retrograde embolization was technically successful in 68 (81%) of the 84 patients. Two early failures were associated with venous spasm provoked by technical inexperience, while difficulties in the remainder were caused by anomalous venous anatomy. In patients who had recurrent varicocele after previous ligation, venography showed incomplete ligation of collateral channels; 14 of 18 patients were successfully re‐treated by embolization. The sperm concentration improved significantly in 83% of patients undergoing embolization and in 63% of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.

Conclusion

 In centres where there is a skilled interventional radiologist, embolization is an effective alternative to surgical ligation of varicocele. Carried out under local anaesthesia as an out‐patient procedure, it is cost‐effective, associated with minimal morbidity and most patients are able to return to normal daily activities immediately.
Flow cytometric analysis of tumour‐infiltrating lymphocytes in patients with renal cell carcinoma
Authors: KOWALCZYK D. , SKORUPSKI W. , KWIAS Z. , NOWAK J.
Published: November 2003

Objective

 To determine the immunophenotype of tumour‐infiltrating lymphocytes (TIL) and peripheral blood lymphocytes (PBL) isolated from patients with renal cell carcinoma (RCC) and to analyse the correlations between the quantity of analysed cell subsets and the progression of the disease.

Patients and methods

 PBL and TIL samples were obtained from 23 patients with RCC at different stages of disease. The immunophenotype of PBL and TIL was measured, and the TNM stage, tumour size, cellular type, histological grade, lymphocytic infiltration and performance status assessed.

Results

 The predominant mononuclear cells infiltrating the tumour, in all patients, were T lymphocytes (CD3+ median 66.9%, CD8+ median 34.6%, CD4+ median 26.7%). The cells possessing gamma/delta type T cell receptor accounted for a small fraction of the T cells in PBL and TIL (median 5.6% and 3.7%). Tumour‐infiltrating T lymphocytes had a significantly higher percentage of cells expressing human leucocyte antigen (HLA) DR (median 30.9%) and CD25 (median 6.2%) antigens than the equivalent populations in peripheral blood from the same patient group (P<0.001). The degree of T cell activation appeared to negatively correlate with the tumour stage (K=–0.3, P=0.04). The percentage of natural killer (NK) cells among TIL (median 15.4%) did not reflect the value in PBL. The percentage of B cells in TIL was slightly lower than in PBL and accounted for 5.0% of cells. There was no relationship between the degree of lymphocytic infiltration and either tumour stage or grade but there appeared to be a positive correlation between the intensity of lymphocytic infiltration and the percentage of CD4+ cells in TIL (K=0.5, P=0.001). Moreover, the composition of TIL depended on tumour grade, which positively correlated with the percentage of CD8+ cells (K=0.4, P=0.005) and negatively with the percentage of NK cells (K=−0.5, P=0.005). There was an inverse correlation with the percentage of gamma/delta T cells in PBL and the TIL concentration (K=−0.3, P<0.05).

Conclusions

 The TIL immunophenotype is different from PBL and is influenced by the histological grade of the tumour. The activation of TIL and its relationship with tumour progression suggests that they might be sensitized and activated by tumour cells.
Morphometric studies of intra‐prostatic volume relationships in localized prostatic cancer
Authors: HÄGGMAN M. , NORDIN B. , MATTSON S. , BUSCH C.
Published: November 2003

Objectives

 To further characterize patterns of tumour growth and the distribution of markers for the aggressiveness of prostate cancer by assessing the relationships among the volume of the ‘index’ tumour and that of the remaining foci, with pathological (pT) stage, histological grade and DNA ploidy, and with the amount of low‐ and high‐grade prostatic intraepithelial neoplasia (PIN).

Materials and methods

 Eighty‐eight step‐sectioned total prostatectomy specimens were analysed. The Gleason score, tumour stage and DNA ploidy (by flow cytometry) of multiple samples were determined. Tumour and PIN areas were outlined and their volumes estimated by computerized planimetry.

Results

 The pT stage, Gleason sum and DNA non‐diploidy increased, and PIN volumes decreased, with increasing volume of the index tumour focus (P<0.01), but did not differ significantly between uni‐and multifocal tumours. However, PIN volumes were significantly larger in multifocal cases with an index tumour volume of >3 mL than in unifocal tumours >3 mL (P<0.05). Small volume, unifocal tumours had little PIN. The most malignant features of each case were always represented in the index tumour but not generally in the remaining foci.

Conclusions

 The volume distribution, related to multicentricity and its concomitant PIN volumes, indicates that large index tumours, uni‐ or multifocal, of medium or high grade, are associated with low PIN volumes. However, multifocal medium‐ and high‐grade tumours with small index tumour volumes have higher PIN volumes. Small, single tumours are of low‐grade and may represent the slowly progressing cancers possibly resembling those found in autopsy studies.
A single‐centre observational study of surgery and late malignant events after chemotherapy for germ cell cancer
Authors: RAVI R. , OLIVER R.T.D. , ONG J. , BADENOCH D.F. , FOWLER C.G. , PARIS A.M.I. , HENDRY W.F.
Published: November 2003

Objective

 To review the impact of surgical staging after treatment on the late malignant events in an unselected group of patients treated with chemotherapy for germ cell cancer of the testis over the last 16 years.

Patients and methods

 The study comprised 256 patients treated between 1978 and 1994 who were reviewed for late relapse and development of second germ cell and non‐germ cell cancer.

Results

 At diagnosis, 142 patients had clinical stage 2, 30 stage 3 and 84 stage 4 disease; 57 patients relapsed within 20 months of treatment, while late germ‐cell cancer relapses (≥24 months after treatment) occurred in six patients. Of patients relapsing early or late, 42% and 33%, respectively, received surgery after treatment. Only two of those relapsing late remain progression‐free with further treatment. Four patients developed germ cell cancer in the contralateral testis, while six developed second non‐germ cell cancers.

Conclusion

 Late events occurred in 6.2% of 256 patients in this series, from 29 to 141 months after treatment. Given that the late relapse rate of six of 256 (2.3%) is less than the incidence of mature teratoma at routine retroperitoneal lymph node dissection, more patients may eventually relapse. These results suggest that there might be a case to evaluate the use of ultrasonographic surveillance of the retroperitoneum and testis at 5, 10 and 20 years, in addition to extending routine surveillance.
Nephrogenic adenoma — a study with special reference to clinical presentation
Authors: PEEKER R. , ALDENBORG F. , FALL M.
Published: November 2003

Objective

 To obtain information on the presenting symptoms, location, sex distribution, age, endoscopic appearance, histopathology, suitable treatment and recurrence of nephrogenic adenoma, a rare, benign lesion of the urinary tract mucosa.

Patients and methods

 The records of 31 patients with nephrogenic adenoma diagnosed at the Sahlgrenska University Hospital between 1980 and 1996 were reviewed to determine the symptomatology, imaging investigations, endoscopic presentation, clinical outcome after resection and the frequency of recurrence.

Results

 The lesions were found in the urinary bladder, bulbar urethra, urethral diverticula and the prostatic urethra. Eight patients presented with haematuria, 13 complained of urinary frequency and bladder pain and in 12 patients without subjective symptoms from the urinary tract, the lesion was found accidentally. Twenty‐seven of the patients had a history of previous urothelial trauma, either by instrumentation or inflammation. Seventeen of the lesions were polypoid at endoscopy, the remainder being flat except for two cases, in which they were not noted because they were concealed in another lesion to be resected. Seven patients had one or more recurrences. All patients with symptoms responded well to transurethral resection.

Conclusion

 Nephrogenic adenoma mimics tumour or chronic cystitis and it is rarely suspected on clinical grounds; instead, the diagnosis is almost always histological. This study supports the view that nephrogenic adenoma may represent a metaplastic response to trauma of the urothelium and that transurethral resection provides a good method of relieving the symptoms in symptomatic nephrogenic adenoma.
Willingness to pay for reduced incontinence symptoms
Authors: JOHANNESSON M. , O’CONOR R.M. , KOBELT‐NGUYEN G. , MATTIASSON A.
Published: November 2003

Objective

 To measure the willingness to pay for a reduction in the number of micturitions and urinary leakages for patients with urge incontinence.

Patients and methods

 A self‐administered questionnaire with a binary willingness‐to‐pay question was administered to 541 patients in Sweden with urge or mixed incontinence; 461 questionnaires were returned. The reduction in micturitions and urinary leakages valued in the willingness‐to‐pay question was varied randomly between 25% and 50% in two different subsamples. Information was also collected about the number of micturitions and urinary leakages, health‐related quality of life and socio‐economic characteristics of the patients in the study.

Results

 Quality of life was significantly related to the severity of the symptoms and was worse than that of the sex‐ and age‐matched general Swedish population. The median (mean) willingness to pay per month was 240 (530) Swedish krona (SEK, £1=SEK 11.50) for a 25% reduction in micturitions and leakages and SEK 470 (1030) for a 50% reduction in micturitions and leakages. As hypothesized, the willingness to pay was significantly related to the size of the reduction in micturitions and leakages, the initial number of micturitions and leakages, and income.

Conclusions

 Patients with incontinence problems are willing to pay substantial amounts for a reduction in the number of micturitions and leakages.
Tumour progression and survival in patients with T1G3 bladder tumours: 15‐year outcome
Authors: HERR H.W.
Published: November 2003

Objective

 To evaluate tumour progression and survival of patients with T1G3 bladder tumours who were followed for 15 years.

Patients and methods

 A subset of 48 patients with T1G3 bladder tumours was entered into a randomized trial of transurethral resection (TUR) or TUR plus bacille Calmette‐Guèrin (BCG) therapy and followed for a minimum of 15 years. Thirty‐nine (81%) patients received one or more courses of BCG. The endpoints of the study were stage progression (defined as muscle invasion or metastasis) and disease‐specific survival.

Results

 Of the 48 patients, 25 (52%) progressed and 15 (31%) died from the disease; 33 patients (69%) survived, including 24 (50%) with an intact bladder. The median progression‐free survival time was 151 months. Tumour progression occurred in 35% of the patients within the first 5 years, in 16% after 5–10 years and in 12% of those followed for 10–15 years. Deaths from cancer occurred in 25% of the patients in the first 5 years and in 10% of patients at risk from 5 to 15 years.

Conclusions

 Patients with T1G3 bladder tumours who are treated conservatively are at life‐long risk of having a muscle‐invasive tumour and dying from bladder cancer.
The influence of colonic enema irrigation on urodynamic findings in patients with neurogenic bladder dysfunction
Authors: De KORT L.M.O. , NESSELAAR C.H. , VAN GOOL J.D. , De JONG T.P.V.M.
Published: November 2003

Objective

 To evaluate whether colonic enema irrigation influences the urodynamic characteristics of patients with spina bifida, an overactive bladder and detrusor sphincter dyssynergia (DSD).

Patients and methods

 Since 1991, 83 patients with spina bifida at our institution have treated their bowel dysfunction by colonic irrigation every 24–48 h. In 12 patients (seven boys and five girls, mean age 7.7 years, range 0.7–13.8) with an overactive bladder and DSD, urodynamic studies of the bladder before and after enema treatment were available with no intercurrent changes in urological therapy.

Results

 There were no significant changes overall in bladder capacity, leak‐point pressure, bladder compliance and bladder instability in the selected group of children.

Conclusion

 Although enema therapy for bowel treatment in patients with spina bifida gave good results for faecal incontinence, with good patient compliance, no favourable effect on bladder function should be expected in most patients with a high‐risk urinary tract dysfunction. Further study is needed to determine factors in patients who will benefit urologically from enema treatment.
Construction and validation of a short‐form benign prostatic hypertrophy health‐related quality‐of‐life questionnaire
Authors: LUKACS B. , COMET D. , GRANGE J.C. , THIBAULT P. ,   the BPH group in General Practice
Published: November 2003

Objective

 To construct and validate a short‐form benign prostatic hypertrophy (BPH) health‐related quality‐of‐life (HRQL) questionnaire which is more practical in use and as informative as the 20‐item visual analogue scale questionnaire (QOL20) previously validated in French.

Patients and methods

 From the factorial structure of the QOL20, a nine‐item questionnaire (QOL9) was constructed using stepwise linear regression and factorial analysis. The feasibility and reliability of the QOL9 were analysed in a cross‐sectional case‐control study and a longitudinal cohort study, including symptomatic patients with BPH treated for 6 months with an &agr;1‐blocker (alfuzosin).

Results

 The reduction of the QOL20 to QOL9 showed a minimal loss of information (90–95% of the variance of QOL20 was explained by QOL9) and lead to a three‐dimensional structure: well being, patients’ perceived sexual‐life status, and BPH interference with activities. The QOL9 was practical in use (completion rate 87–100%; duration of completion at inclusion 11.6, sd 2.0 min), consistent (Cronbach’s alpha>0.7), reliable (intraclass correlation coefficient >0.80) and responsive (effect‐size index 0.9, sd 0.01 in the longitudinal study).

Conclusions

 The QOL9 is a good BPH HRQL questionnaire, including an assessment of patients’ perceived sexual‐life status; it easy to administer, accurate, reproducible and responsive to change with treatment. We suggest that the QOL9 be substituted for the QOL20 and administered in addition to the International Prostate Symptom Score to obtain a better assessment of the patients’ perception of their disease.
Prognostic implications of cytogenetic findings
Authors: ELFVING P. , MANDAHL N. , LUNDGREN R. , LIMON J. , BAK‐JENSEN E. , FERNÖ M. , OLSSON H. , MITELMAN F.
Published: November 2003

Objective

 To evaluate the prognostic impact of cytogenetic findings in renal cell carcinoma (RCC).

Patients and methods

 Tumour cytogenetics, histomorphology, DNA ploidy and S‐phase fraction, stage, size, and grade were related to survival in 50 consecutive patients with RCC. The mean follow‐up was 3.9 years (median 4.2, range 0–8.8).

Results

 The predictive probability for recurrence‐free survival at 5 years (5‐year RFS) for all 50 patients was 0.54. There was a significant association between the degree of cytogenetic complexity and survival, in that patients with five or less aberrations had a better prognosis than those with more than five changes (5‐year RFS 0.71 and 0.43, respectively; P<0.05). Patients with del(8p)/‐8, +12, and +20 had a significantly worse prognosis compared with those without these aberrations. Of the well‐known prognostic variables grade and stage, the former was far better for predicting prognosis. A Spearman correlation test showed a significant covariation of grade with the S‐phase fraction, T‐stage, and cytogenetic complexity.

Conclusion

 The degree of cytogenetic complexity and recurrent cytogenetic abnormalities affect the prognosis in RCC, although grade was the most reliable independent prognostic factor predicting disease recurrence.
Acute suppression of idiopathic detrusor instability with magnetic stimulation of the sacral nerve roots
Authors: McFARLANE J.P. , FOLEY S.J. , DE WINTER P. , SHAH P.J.R. , CRAGGS M.D.
Published: November 2003

Objective

 To assess the effect of magnetic stimulation of the S3 nerve root on unstable contractions in patients with idiopathic detrusor instability.

Patients and methods

 Twelve patients with idiopathic instability were studied. The S3 nerve root was localized by mapping the response of the toe flexor muscles and anal sphincter to magnetic stimulation at different sites. Unstable contractions were provoked by rapidly infusing saline into the bladder and the effect of magnetic stimulation of S3 on contractions was assessed.

Results

 Magnetic stimulation relieved the sensation of urinary urgency and reduced the duration and amplitude of provoked contractions in all patients. Stimulation reduced the area under the pressure/time curve by 80–98%. In some patients there was a short‐lived residual suppressive effect lasting up to 90 s.

Conclusions

 Magnetic stimulation of S3 acutely abolishes unstable contractions in patients with idiopathic detrusor instability.
A randomized controlled trial evaluating the use of sterile water as an irrigation fluid during transurethral electrovaporization of the prostate
Authors: GRUNDY P.L. , BUDD D.W.G. , ENGLAND R.
Published: November 2003

Objective

 To compare the safety of sterile water and glycine when used as bladder irrigation during transurethral electrovaporization of the prostate (TUVP) in a randomized controlled trial.

Patients and methods

 The study comprised 50 consecutive patients admitted for transurethral prostatic surgery who were randomly allocated to receive bladder irrigation with either sterile water or 1.5% glycine during TUVP. After surgery, serum electrolytes and the presence of free plasma haemoglobin (suggesting haemolysis) were determined and the patients observed for clinical evidence of the transurethral resection (TUR) syndrome.

Results

 There was no significant difference in the level of free plasma haemoglobin between the groups and no difference in serum sodium levels. None of the patients developed any signs of the TUR syndrome.

Conclusions

 Water is a safe irrigant for use during TUVP and has several advantages over 1.5% glycine.
Interstitial photodynamic therapy in the canine prostate
Authors: LEE L.K. , WHITEHURST C. , CHEN Q. , PANTELIDES M.L. , HETZEL F.W. , MOORE J.V.
Published: November 2003

Objective

 To determine the depth of tissue destruction and the minimum light dose required for necrosis in interstitial photodynamic therapy (PDT), as a prerequisite for the investigational therapy of patients.

Materials and methods

 Seven adult beagle dogs were given 2 mg/kg of the photosensitizer Photofrin™ intravenously and two controls received none. After 24 h, 450 J/cm of 630 nm wavelength laser light was delivered interstitially to the prostate via a 2 cm long diffuser fibre. Seven single‐fibre treatments were performed in five sensitized dogs and two single‐fibre treatments in the controls. The two remaining sensitized dogs had two fibres placed 10 mm apart within the prostate to determine the coalescence of PDT lesions. The penetration depth of light was measured in all prostates, and after PDT the extent of necrosis was assessed histologically.

Results

 The mean (standard deviation, sd) radius of PDT destruction around each diffuser was 5.3 (1.4) mm and PDT lesions overlapped in prostates treated with two fibres placed 10 mm apart. There was no observable tissue damage in the controls. The mean (sd) minimum light dose required for PDT necrosis was 84 (64) J/cm2 . Differences among animals in the light penetration depth were small, with a mean of 2.14 (0.2) mm, and did not correlate with the depth of necrosis (P=0.07). Bleeding around the optical diffuser fibre impeded light penetration.

Conclusion

 Interstitial PDT in the canine prostate using Photofrin™ produced modest volumes of tissue necrosis. The minimum light dose required to induce necrosis was variable because bleeding was unpredictable in relation to the optical fibre.
Using the ICSQoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS–‘BPH’ study
Authors: DONOVAN J.L. , KAY H.E. , PETERS T.J. , ABRAMS P. , COAST J. , MATOS‐FERREIRA A. , RENTZHOG L. , BOSCH J.L.H.R. , NORDLING J. , GAJEWSKI J. B. , BARBALIAS G. , SCHICK E. , MENDES SILVA M. , NISSENKORN I. , DE LA ROSETTE J. J. M. C. H. ,   the ICS‐‘BPH’ Study Group
Published: November 2003

Objective

 To present and describe the validity and reliability of the International Continence Society–Benign Prostatic Hyperplasia study quality‐of‐life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle‐aged and elderly men.

Patients and methods

 The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS‐‘BPH’ study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS‐‘BPH’ study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF‐36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test‐retest analysis.

Results

 The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test‐retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF‐36 and the EuroQol.

Conclusion

 ICSQoL items may be used individually or as a group in research studies or in clinical practice.
Effects of biodegradable self‐reinforced polyglycolic acid, poly‐dl‐lactic acid and stainless‐steel spiral stents on uroepithelium after Nd:YAG laser irradiation of the canine prostate
Authors: PÉTAS A. , KÄRKKÄINEN P. , TALJA M. , TAARI K. , LAATO M. , VÄLIMAA T. , TÖRMÄLÄ P.
Published: November 2003

Objective

 To evaluate the safety and tissue effects on canine uroepithelium and prostate of biodegradable self‐reinforced polyglycolic acid (SR‐PGA) and self‐reinforced poly‐dl‐lactic acid (SR‐PLA) spiral stents compared to stainless‐steel (SS) spiral stents.

Material and methods

 Twenty‐five dogs (median body weight 12 kg) underwent a one‐stage midline laparotomy and cystotomy. A side‐firing Nd:YAG laser fibre was placed in the prostatic urethra antegradely and laser power applied at a setting of 20 W for 10 s in each side lobe, followed by dilatation to 4 mm diameter and insertion of a spiral stent. Dogs were randomized to receive an SR‐PGA, SR‐PLA or SS stent and no catheter was placed post‐operatively. The dogs were killed after a follow‐up of 1, 3 or 6 months and the bladder, prostate and urethra removed. Routine histological sections were prepared from the bladder, prostate, the proximal urethra immediately below the prostate and the distal urethra.

Results

 Histological examination showed a mild to moderate foreign‐body reaction and an acute inflammatory reaction after 1 month in the SR‐PGA and the SR‐PLA groups. The tissue effect was minimal in the SR‐PGA group after 6 and 12 months. The SS stent group had more fibrosis, chronic inflammation and oedema at all follow‐up assessments. There were erosions of the epithelium with subepithelial oedema in the animals with the SS stent. No dysplasia was detected and some remnants of the suture material were evident in the area of the cystotomy closure. There was one stricture at the apex of prostate in the SR‐PGA group at 3 months in one re‐operated dog.

Conclusion

 The histopathological changes in tissues caused by SR‐PGA and SR‐PLA stents were generally minor and decreased during the follow‐up. The biocompatibility of SR‐PGA and SR‐PLA stents was good when combined with Nd:YAG laser treatment of the prostate.
A prospective randomized trial evaluating endoscopic Nd:YAG laser prostate ablation with or without potassium titanyl phosphate (KTP) laser bladder neck incision
Authors: LANGLEY S.E.M. , GALLEGOS C.R.R. , MOISEY C.U.
Published: November 2003

Objective

 To investigate whether performing a potassium titanyl phosphate (KTP) laser bladder neck incision (BNI) in conjunction with a Nd:YAG endoscopic ablation of the prostate (ELAP) compared with an ELAP alone, improves early post‐operative voiding rates and clinical outcome.

Patients and methods

 A prospective randomized trial that was both double‐blind and power‐determined (80%) compared 88 patients with benign prostatic enlargement undergoing ELAP and those undergoing KTP BNI and ELAP. A dual‐wavelength KPT/532TM (Laserscope) laser was used with Add/Stat side‐firing fibres. A urethral catheter was inserted post‐operatively and was removed after 18 h. Patients unable to void at this stage were then re‐catheterized, discharged and readmitted 2 weeks later for catheter removal. Patients were followed up at 3 month intervals.

Results

 Post‐operatively, 80% of the patients undergoing KTP BNI and ELAP were able to void on catheter removal at 18 h, compared with only 57% of the patients undergoing ELAP alone (P<0.05, chi‐square). After 1 month, two patients from the former and four from the latter group failed to void and required further surgery. At 3 months, there was a significant improvement in the post‐void residual volume, maximum flow rate, symptom and quality‐of‐life scores compared to the pre‐operative values for both groups (P<0.005). However, there was a greater improvement in the flow rate and symptom score in patients undergoing KTP BNI and ELAP (P<0.05).

Conclusion

 This study shows the benefit of performing a KTP BNI with ELAP in terms of early voiding rates and initial clinical outcome, and this treatment is recommended.
Post‐operative blood loss after transurethral prostatectomy is dependent on in situ fibrinolysis
Authors: NIELSEN J.D. , GRAM J. , HOLM‐NIELSEN A. , FABRIN K. , JESPERSEN J.
Published: November 2003

Objective

 To evaluate whether post‐operative blood loss in patients with benign prostatic hyperplasia, undergoing transurethral resection of the prostate (TURP), depends on in situ fibrinolysis in urine, and to determine the relative contributions of the urokinase and tissue‐type plasminogen activator systems.

Patients and methods

 TURP was performed in 24 men (median age 68.5 years, range 52–78) and the weight of resected tissue, the operative and post‐operative blood loss determined. The concentrations of the urokinase‐ (u‐PA) and tissue‐type plasminogen activator (t‐PA)‐related fibrinolysis in their urine was followed using sensitive and specific assays, and the changes related to post‐operative blood loss. Measurements of the urinary concentrations of free t‐PA activity, t‐PA antigen, free u‐PA activity, u‐PA antigen and fibrin degradation products (FbDP) were determined and the area under the curve for each of these quantities correlated with the post‐operative blood loss.

Results

 The post‐operative blood loss correlated significantly with the per‐operative loss (P=0.047) and the weight of resected tissue (P=0.029). There was a highly significant correlation between the area under the curve of FbDP in the urine and the post‐operative blood loss (P<0.005), while there was no significant positive correlation between the PA concentration or activity in the urine and post‐operative blood loss. There was a significant correlation between the urinary t‐PA activity and the amount of FbDP in the urine (P=0.047), and a significant correlation between the weight of resected tissue and the amount of FbDP in the urine (P=0.014).

Conclusion

 The post‐operative blood loss after TURP is significantly related to an increase of the urinary fibrinolytic activity and the enhanced fibrinolytic activity is probably caused by t‐PA.
Potentially useful materials for biodegradable ureteric stents
Authors: SCHLICK R.W. , PLANZ K.
Published: November 2003

Objectives

 To develop and test materials that may be useful in the design and further development of biodegradable ureteric stents.

Materials and methods

 Specimens of two plastics were placed in artificial urine of different pH for 30 days to examine the degree of dissolution of the plastic in alkaline and the stability in acidic conditions.

Results

 The specimens remained stable in the artificial urine at pH <7.0 for 30 days and dissolved completely at a pH≥7 within 48 h.

Conclusion

 Plastics can be designed which may be useful in the further development of biodegradable ureteric stents. The rate of dissolution could be changed by influencing urinary pH.
Segmental up‐regulation of transforming growth factor‐β in the pathogenesis of primary megaureter. An immunocytochemical study
Authors: NICOTINA P.A. , ROMEO C. , ARENA F. , ROMEO G.
Published: November 2003

Objective

 To examine the maturational‐delay hypothesis of primary megaureter (PM), i.e. that the condition arises by a segmental maturational delay of the ureteric wall that can resolve spontaneously within the first year of life, using comparative immunocytochemistry of ureters resected from infants and from homologous pre‐natal ureters.

Materials and methods

 Seventeen distal urinary tracts were obtained from children with PM who were referred for surgery (aged 6 months to 8 years, mean 2.1 years). These were compared with ureteric buds obtained from 11‐week‐old human and 11‐ to 38‐week‐old calf fetuses. The samples were immunostained using a monoclonal antibody specific for transforming growth factor β (TGF‐β).

Results

 The histological appearances of the narrowed ureteric segments from patients under 18 months old were like the fetal ureteric buds at 26–38 weeks of gestation. Positive TGF‐β immunoreactions were detected in the longitudinal muscle layer in the ureter from patients 6–12 months old. Such reactions weakened progressively in those patients older than 1 year, becoming negative in all children older than 3 years. The TGF‐β immunolabelling in resected ureters was closely similar to that in fetal ureters from 20 to 26‐week old calves.

Conclusions

 From these results, PM should be ascribed to a segmental developmental delay of the terminal ureter arising at about 20 weeks of gestation, with a possible pathogenetic involvement of autocrine TGF‐β overexpression.
The source of urinary nitrosamines in patients with enterocystoplasties
Authors: Creagh T.A. , Picramenos D. , Smalley E.T. , Walters C.L. , Mundy A.R.
Published: November 2003

Objective  To assess the factors influencing urinary nitrosamine production in patients with enterocystoplasties.

Patients, subjects and methods  The study comprised 100 patients with an enterocystoplasty, 20 patients with interstitial cystitis, 30 with infective cystitis and 120 control subjects drawn from hospital staff and out‐patients. Urinary nitrosamine levels were measured and the urine samples cultured for micro‐organisms.

Results  Nitrosamine levels were significantly higher only in patients with enterocystoplasties who also had higher urinary white cell counts or significant bacteriuria.

Conclusion  Patients with an enterocystoplasty and significant bacteriuria are most at risk from potential nitrosamine‐induced epithelial injury.
Interposition of ileum in the ureter: a clinical study with
Authors: Shokeir A.A.
Published: November 2003

Objective  To present the long‐term results of the interposition of ileum in the ureter.

Patients and methods An ileal loop was interposed to replace a long defect of the upper ureter, with preservation of lower ureteric continuity, in nine patients (mean age 35 years, range 18–58). Patients were followed regularly for a mean of 5.2 years (range 2–7) and assessed using renal ultrasonography, isotopic renography and intravenous urography.

Results Urinary drainage was satisfactory and renal function and configuration were improved. None of the patients experienced metabolic acidosis or electrolyte disturbances despite receiving no medication.

Conclusion These results were encouraging and further clinical experience is needed to confirm that ileal interposition of the ureter is a safe and effective procedure.
A placebo‐controlled study of intravesical pentosanpolysulphate for the treatment of interstitial cystitis
Authors: Bade J.J. , Laseur M. , Nieuwenburg A. , Th. van der Weele L. , Mensink H.J.A.
Published: November 2003

Objective To evaluate the therapeutic efficacy of intravesical pentosanpolysulphate (PPS) compared with placebo in patients with interstitial cystitis (IC).

Patients and methods Twenty patients who fullfilled the diagnostic criteria for IC participated in a double‐blind placebo‐controlled study; 10 received intravesical PPS (300 mg in 50 mL of 0.9% sodium chloride) applied twice a week for 3 months and the other 10 received a placebo. Symptomatic relief and objective variables (bladder capacity voiding volumes and urinary frequency) were assessed after 3 months and the long‐term outcome of those continuing treatment was determined.

Results Of the patients treated with PPS, four gained significant symptomatic relief compared with only two receiving placebo. Only the urodynamic bladder capacity showed a statistically significant increase in patients treated with PPS (P=0.047). At 18 months from the start of the study, the symptoms were relieved in eight patients while still receiving PPS instillations and in four without treatment.

Conclusions These results suggest that intravesical PPS is an effective option for the treatment of IC and shows that the intravesical application of PPS is a safe treatment with no important side‐effects.
Experience with an assay for prostate‐specific antigen and transrectal ultrasonography in the diagnosis of prostate cancer
Authors: Heman‐Ackah C.A. , Festenstein J.B. , Hibbert P. , Harvey D.J. , Bunce C.J. , Gelister J.S.K.
Published: November 2003

Objective To assess the detection of prostate cancer using the Ciba Corning ACS 180 prostate‐specific antigen (PSA) assay and transrectal ultrasonography (TRUS) in a district general hospital.

Patients and methods In a preliminary study, the serum PSA level in 130 patients was measured using both the Ciba Corning and the Hybritech Tandem‐R PSA assay and the results assessed using linear regression analysis. A further study comprised 204 consecutive patients who underwent TRUS and biopsy. The histology of the prostatic biopsies was analysed according to the pre‐biopsy PSA level (Ciba Corning assay), digital rectal examination (DRE) and TRUS findings.

Results The PSA levels measured using the Ciba Corning assay were about 50% higher than those using the Hybritech Tandem‐R assay. Of 204 men who had TRUS and biopsy, 56 (28%) had detectable prostate cancer, but no patient with a PSA of <6.0 ng/mL had. Five of 47 (11%), 21 of 83 (25%) and 30 of 65 (46%) patients with PSA levels in the range 6.1–15, 15.1–30 and >30 ng/mL, respectively, had cancer detected. When the DRE was negative, 18 of 111 (16%) patients had a positive biopsy, compared with 38 of 93 (41%) patients when the DRE was positive (P<0.001). In men with a PSA level of 6.1–15.0 ng/mL, positive biopsies were found in 3% when the DRE was negative, compared with 27% when it was positive (P<0.025). A TRUS abnormality was detected in 54 of 204 (26%) patients, of whom 25 (46%) had positive biopsies. Of these 54, there were 43 with hypoechoic lesions, of whom 22 (51%) had positive biopsies. The cancer detection rate was higher when both TRUS and DRE were positive (62%), with the highest detection rate (86%) occurring when the PSA level was also >30.0 ng/mL. When the DRE was positive, cancer was detected in 21 of 34 (62%) patients with a positive TRUS, but only in 17 of 59 (29%) patients with a negative TRUS (P<0.005). However, when the DRE was negative there was no significant difference in the cancer detection rates for TRUS‐positive and TRUS‐negative patients, where four of 20 and 14 of 91 (15%) patients were found to have cancer, respectively.

Conclusions The positive biopsy rates in this study were comparable with those from similar studies using other PSA assays. When the DRE was negative there was a low detection rate for cancer of 3% for men with PSA levels of 6.1–15.0 ng/mL. In patients with an elevated PSA level but a negative DRE, the positive biopsy rate for TRUS‐negative patients did not differ from TRUS‐positive patients, indicating the importance of random systematic biopsies.
Long‐term follow‐up of men undergoing modified inguinal lymphadenectomy for carcinoma of the penis
Authors: Colberg J.W. , Andriole G.L. , Catalona W.J.
Published: November 2003

Objective  To determine the long‐term outcome of men with carcinoma of the penis with clinically negative lymph nodes undergoing a modification of the standard inguinal lymphadenectomy.

Patients and methods  The study included nine men (mean age 56.2 years, range 41–72) with squamous cell carcinoma of the penis who underwent a modified inguinal lymphadenectomy.

Results  Of the nine patients, three had histologically positive lymph nodes; none of the patients with positive or negative nodes had evidence of recurrent disease. All patients were alive within a follow‐up of 13–108 months (mean 67.5). Early post‐operative complications occurred in two patients with skin‐flap necrosis, one with prolonged lymphatic drainage and one with a delayed groin lymphocele and cellulitis.

Conclusion  The modified inguinal lymphadenectomy is a reasonable alternative to surveillance and may accurately identify men with positive nodes. Long‐term survival and low morbidity seem to justify this approach in men with squamous cell carcinoma of the penis and clinically negative inguinal lymph nodes.
The significance of serum alkaline phosphatase bone isoenzyme in prostatic carcinoma with bony metastasis
Authors: Chen S.‐S. , Chen K.‐K. , Lin A.T.L. , Chang Y.‐H. , Wu H.H.H. , Hsu E.H.S. , Chang L.S.
Published: November 2003

Objective To evaluate the clinical significance of serum alkaline phosphatase (ALP), ALP bone isoenzyme (ALPb) and prostate specific antigen (PSA) levels in predicting bony metastasis in prostatic carcinoma.

Patients and methods The levels of serum ALP, ALPb and PSA were assessed in 32 patients with prostatic carcinoma and bony metastasis (group 1), 31 with prostatic carcinoma without bony metastasis (group 2), and 31 with benign prostatic hyperplasia (group 3). Bony metastases were detected using whole‐body bone scintigraphy and ALPb was estimated electrophoretically before surgical or medical treatment. The levels of the three markers were compared for their ability to predict bony metastasis.

Results In groups 1, 2 and 3, respectively, the mean (sd) serum levels of ALP were 304 (322.2), 76.6 (47.5) and 63.8 (14.7) IU/L, of ALPb were 79.9 (76.9), 23.6 (9.9) and 25.3 (9.0) IU/L and of PSA were 478.1 (352.2), 46.9 (32.1) and 8.1 (1.8) ng/mL. The differences in serum ALP and ALPb between groups 1 and 2, and between groups 1 and 3 were significant (P < 0.05), but not those between groups 2 and 3. The positive predictive value (PPV) for bony metastasis in patients with prostatic carcinoma was 91.3% (21/23) and 100% (18/18) and the negative predictive value (NPV) was 71.8% (28/39) and 68.9% (31/45) for ALP and ALPb, respectively.

Conclusion Both serum ALP and ALPb were increased significantly in patients with prostatic carcinoma with bony metastasis. The level of ALPb had a higher PPV and specificity for bony metastasis than had the level of ALP, but a lower NPV and sensitivity than ALP or PSA (at PSA levels>20 ng/mL).