bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Efficacy of the Combination of Urine Cytology, Urine Analysis and History in the Follow‐up of Bladder Carcinoma
Authors: MEULEMAN E. J. H. , DELAERE K. P. J.
Published: November 2008

Summary— In the follow‐up of low stage, low grade transitional cell carcinoma of the bladder, cystoscopy is used as a diagnostic standard. Because of the lack of well defined prognostic parameters, cystoscopic follow‐up is based upon empirical grounds.

In this study, 82 patients with a primary superficial transitional cell carcinoma of the bladder were studied with respect to the time interval before recurrence. The mean number of cystoscopies leading to detection of recurrence (i.e. the ratio of positive to negative cystoscopy) was reviewed. Eighteen cystoscopies had to be done to detect each recurrence. Because of this excessive number of cystoscopies, the diagnostic value of the combination of red cell count in urine, cytology and history of micturition symptoms and haematuria was assessed in a retrospective study of 86 recurrences of bladder carcinoma. The results indicated that the combination of these non‐invasive diagnostic tests may constitute a sensitive procedure for the follow‐up of bladder tumours. In the case of T1G3 and muscle‐invasive recurrences (> T1), the sensitivity rate was 100%.
Pre‐emptive (Neo‐adjuvant) Chemotherapy Prior to Radical Radiotherapy for Fit Septuagenarians with Bladder Cancer: Age Itself is not a Contra‐indication
Authors: RAGHAVAN D. , GRUNDY R. , GREENAWAY T. M. , PEARSON B. S. , ROGERS J. , DUVAL P. , MEAGHER M. , MAMEGHAN HEDY
Published: November 2008

Summary— Advanced age has often been cited as a contra‐indication to the use of cytotoxic chemotherapy or aggressive combined treatment regimens. Fifteen patients, aged between 70 and 79 years (mean 73.1), have been treated for high grade, invasive bladder cancer using neoadjuvant intravenous cisplatin (80–100 mg/m2) plus radical radiotherapy (60 Gy in 6 weeks). Objective response was achieved in 14 patients. The median survival was 22 months, with 6 patients surviving 3 years or longer. Acute and late side effects were not excessive (no cases of W.H.O. grade IV toxicity), as demonstrated by clinical examination and the use of questionnaires (including linear analogue self‐assessment scales) to assess quality of life. This aggressive treatment programme can achieve a high remission rate and prolonged survival in elderly patients with high risk bladder cancer without causing excessive morbidity.
Effect of Stilboestrol and Testosterone on the Incorporation of 75Selenomethionine by Prostatic Carcinoma Cells
Authors: FERRO M. A. , HEINEMANN D. , SMITH P. J. B. , SYMES M. O.
Published: November 2008

Summary— Controversy still exists as to whether oestrogens exert a direct effect on the prostatic cell. Incorporation of 75Selenomethionine (SeM) was used as a measure of protein synthesis by prostatic carcinoma cells in vitro to investigate the action of hormones on prostatic carcinoma cells in tissue culture.

Stilboestrol (DES) and stilboestrol diphosphate (Honvan) inhibited protein synthesis in a proportion of patients, while testosterone was stimulatory. A similar effect was noted in cells from patients with benign hyperplasia (BPH).

This work confirms that oestrogens have a direct inhibitory effect on prostatic cells at high concentrations which can be attained in patients given intravenous stilboestrol diphosphate.
Spontaneous Perirenal Haematoma Secondary to Polyarteritis Nodosa
Authors: TASDEMIR I. , TURGAN C. , EMRI S. , YASAVUL U. , CAGLAR S. , BAKKALOGLU M. , ERKAN I.
Published: November 2008

Summary— Spontaneous perirenal haematoma (SPH) is an unusual but serious complication of polyarteritis nodosa (PAN). We present 3 patients with PAN‐associated SPH. One was diagnosed pre‐operatively and underwent emergency nephrectomy in order to stop the persistent bleeding; the second patient had surgical drainage of the haematoma and the third recovered without undergoing surgery. The diagnosis is discussed.
Provisional Study to Quantify and Compare Parameters of Urine Leakage in Stress and Instability Incontinence
Authors: JAMES E. D. , NIBLETT P. G.
Published: November 2008

Summary— Apart from measuring the total volume of urine leaked over prescribed periods of time, the characteristics of urine losses have been ignored. In this provisional study, conducted on 217 female patients, parameters such as the number and volume of the individual losses contributing to the total have been measured and related to the simultaneous pressure changes recorded during natural‐filling urodynamic investigations. Each episode of incontinence can thus be attributed unequivocally to stress or to detrusor instability. This enables the quantified parameters of urine losses of both groups to be compared. The results indicate that interesting differences exist between the two types of incontinence, the recognition of which might be valuable for diagnostic purposes and for the design, development and suggested usage of incontinence aids.
The Use of Noxythiolin (Noxyflex ‘S’) as an Antiseptic Irrigant in Upper Urinary Tract Drainage Following Percutaneous Nephrolithotomy
Authors: BUCK A. C.
Published: November 2008

Summary— Percutaneous nephrostomy drainage for the relief of obstruction or stone removal has become a common procedure. Despite the routine use of prophylactic antibiotics, nephrostomy urine frequently becomes infected (˜ 30% of cases). Noxythiolin irrigation has been used to prevent and treat bladder infections. A double‐blind, placebo controlled study was carried out in 20 patients undergoing a single‐stage percutaneous nephrolithotomy to evaluate the use of noxythiolin as an upper urinary tract antiseptic.

In the patients whose nephrostomy tubes were irrigated with a 2.5% solution of noxythiolin, significant bacterial infection was eliminated from the nephrostomy urine and colonisation of the catheter tip was markedly reduced. Noxythiolin also rendered pre‐operative infected bladder urine sterile. There were no untoward local or systemic sequelae in either group of patients. This study indicates that irrigation of the upper urinary tract with noxythiolin solution is safe and may be a useful adjunct to reduce the risk of sepsis in patients undergoing percutaneous drainage procedures.
Oxybutynin: is it Safe?
Authors: BAIGRIE R. J. , KELLEHER J. P. , FAWCETT D. P. , PENGELLY A. W.
Published: November 2008

Summary— Oxybutynin has been widely prescribed in the United Kingdom for more than 5 years on a named patient basis. Complete knowledge of its side effects is therefore particularly important. The literature contains remarkably little data on this topic. We therefore reviewed 192 consecutive patients for whom the drug had been prescribed in a district general hospital; 57% derived benefit while 76% noted side effects, none of which was dangerous or irreversible. Oxybutynin obtained from the two principal suppliers did not appear to differ either in efficacy or side effects. We discuss the uncertain medicolegal implications of named patient prescriptions.
Management of Refractory Detrusor Instability by Transvesical Phenol Injection
Authors: CAMERON‐STRANGE A. , MILLARD R. J.
Published: November 2008

Summary— The results of transvesical phenol injection into the paravesical nerve plexuses are reported in 40 consecutive patients. A 58% success rate was achieved in the treatment of refractory detrusor instability and 73% success was seen in detrusor hyper‐reflexia in 11 patients with multiple sclerosis. Urinary retention occurred in 8%. Troublesome complications were seen in 2 patients who had had previous pelvic radiotherapy, which should be regarded as an absolute contraindication to the procedure.
Diuretic Response to Fluid Load in Women with Urinary Incontinence: Optimum Duration of Pad Test
Authors: HAYLEN B. T. , FRAZER M. I. , SUTHERST J. R.
Published: November 2008

Summary— The pattern of bladder filling in response to a 1‐litre fluid load was assessed in 20 women with urinary incontinence. The period between 60 and 120 min after the fluid load was identified as best for pad testing because of consistently high bladder volumes and filling rates. A 2‐h pad test is recommended as achieving effective and reproducible test conditions for the quantification of urine loss.
Differing Interpretations by Pathologists of the pT Category and Grade of Transitional Cell Cancer of the Bladder
Authors: ABEL P. D. , HENDERSON D. , BENNETT M. K. , HALL R. R. , WILLIAMS GORDON
Published: November 2008

Summary— The UICC pT category for transitional cell cancer (TCC) of the bladder was recorded as assigned from the routine service of a pathology laboratory. All reports had been passed for release after review by pathologists of the status of senior registrar or above. After 99 cases had been collected, the slides available to the original pathologist were reviewed by one dedicated pathologist in continuous session who was ignorant of the original report. No new sections were cut. There was disagreement with the original report of pT category in 14 cases: 13 were downstaged (including 6 from invasive to superficial) and 1 upstaged. There was disagreement with the original differentiation grade in 13 cases: 10 TCC were considered to be more differentiated and 3 less differentiated than the original report.

A second pathologist reviewed the pT category only of 13 of the 14 cases, disagreeing with the original pT category on 8 occasions and with the pT category assigned by the dedicated pathologist on 7 occasions.

These findings have important implications for advising patients on prognosis and clinical management and in the design and reporting of therapeutic trials.
Evaluation of Extravesical and Leadbetter‐Politano Ureteroneocystostomy in Renal Transplantation
Authors: SHAH S. , NATH V. , GOPALKRISHNAN G. , PANDEY A. P. , SHASTRI J. C. M.
Published: November 2008

Summary— In a series of 650 renal transplantations performed over a 4‐year period, the results were evaluated of 125 Leadbetter‐Politano and 125 extravesical ureteroneocystostomies. The Leadbetter‐Politano technique had a complication rate of 4%, with 3.2% of these patients having a vesical leak. Extravesical ureteroneocystostomy also had a 4% complication rate but only 1.6% of these patients had a vesical leak.

Although there was no statistical difference between the two groups with regard to complications, we feel that extravesical ureteroneocystostomy is a quick and simple procedure and well suited to the special challenge presented by renal transplant recipients.
Ultrasonic Fragmentation in the Treatment of Male Urethral Calculi
Authors: DURAZI M. H. , SAMIEI M. R.
Published: November 2008

Summary— In the last 8 months, 7 patients have presented with acute retention of urine due to impacted urethral stones. Four stones were in the posterior urethra, 2 in the penile urethra and 1 proximal to the external urethral meatus. The patients were managed as emergencies. Stone fragmentation by ultrasound (US) through a 24F obliquely offset eyepiece nephroscope was achieved with minimal urethral trauma. Follow‐up was for 6 months and no evidence of urethral stricture or recurrent stones was found. It was concluded that US fragmentation of urethral calculi is a safe and efficient procedure with minimal complications when used in the management of impacted urethral stones.
The Value of Cystourethroscopy in the Investigation of Microscopic Haematuria in Adult Males under 40 years A Prospective Study of 100 Patients
Authors: JONES D. J. , LANGSTAFF R. J. , HOLT S. D. , MORGANS B. T.
Published: November 2008

Summary— Microscopic haematuria is a common finding in young men. Controversy exists as to its significance and how it is best investigated. A prospective study of 100 young men under the age of 40 with microscopic haematuria has been performed. A positive diagnosis was made in 32 patients. Cystourethroscopy was of diagnostic value in only 3 patients and of therapeutic value in a further 3.

It was concluded that cystourethroscopy is of minimal diagnostic value in young men with microscopic haematuria. Its routine use is unnecessary and should be reserved for those patients in whom investigation suggests that a treatable cause may be found in the lower urinary tract.
Videourodynamic Assessment of the Stamey Procedure for Stress Incontinence
Authors: ENGLISH P. J. , FOWLER J. W.
Published: November 2008

Summary— Fifty‐three patients underwent the Stamey procedure after stress incontinence was demonstrated by videourodynamic assessment. It was possible to repeat this assessment in 45 patients post‐operatively; 58% were shown to be continent and in 20% the leakage was less. Failed operations were unrelated to age, weight, parity, degree of bladder neck descent or previous pelvic surgery. Coexisting detrusor instability was not a contraindication to surgery. Delayed voiding was common immediately after surgery but voiding problems were not encountered once micturition had been re‐established. Although a significant objective failure rate was demonstrated, the Stamey procedure has many advantages and it can be recommended as first‐line treatment in cases of stress incontinence.
Urethral Strictures in Childhood
Authors: FRANK J. D. , POCOCK R. D. , STOWER M. J.
Published: November 2008

Summary— Thirty‐six children have been treated for a non‐hypospadiac urethral stricture. Of 12 patients with meatal or submeatal stenosis, 10 had undergone circumcision for balanitis xerotica obliterans. The strictures were successfully treated by meatoplasty or meatal dilatation. Twenty‐four children had a more proximal urethral stricture: 16 were caused by urethral catheterisation, 4 were post‐traumatic, 2 were congenital and 2 were idiopathic. Sixteen children were treated by visual urethrotomy; this was successful in 12 after a maximum of 2 urethrotomies. Two children required 4 or more urethrotomies and 2 required urethroplasty for restricturing. Seven children were treated by a formal urethroplasty. There were no complications. Two patients died of unrelated medical conditions. Follow‐up was for a mean of 2 years.
Flutamide versus Stilboestrol in the Management of Advanced Prostatic Cancer: A Controlled Prospective Study
Authors: LUND F. , RASMUSSEN F.
Published: November 2008

Summary— In a prospective randomised study the effect of flutamide 750 mg daily was compared with that of stilboestrol 3 mg daily in the treatment of 40 previously untreated patients with advanced prostatic cancer. There was a good subjective response to both treatments. After 12 months, a response was demonstrated in 13 of 20 patients treated with flutamide and 8 of 20 patients treated with stilboestrol. The difference was not statistically significant. Treatment with stilboestrol caused more frequent, and more severe, side effects than flutamide.
Diagnosis and Treatment of Venous Leakage: a Curable Cause of Impotence
Authors: WILLIAMS GORDON , MULCAHY M. J. , HARTNELL G. , KIELY E.
Published: November 2008

Summary— Sixteen of 149 patients complaining of impotence of a non‐neurogenic or endocrine aetiology and with a penile brachial index of > 0.7 failed to achieve an erection following intracavernosal injection of 30 mg papaverine and 1 mg phentolamine. All 16 were shown to have a significant venous leak using digital subtraction cavernosography. Nine of the 13 so far operated upon have had a full return of potency. Repeat cavernosography in three failures showed persistent leakage into crural veins in two and non‐ligated superficial veins in one.

Impotent men with a normal penile brachial index who fail to respond to papaverine and phentolamine have a venous leak, a curable cause of impotence. Surgical access should allow ligation of all identified leaking veins.
Lasertripsy for Ureteric Stones in 120 Cases: Lessons Learned
Authors: COPTCOAT M. J. , ISON K. T. , WATSON G. , WICKHAM J. E. A.
Published: November 2008

Summary— The pulsed dye laser has proved to be an effective and safe method of treating ureteric stones; 120 patients have been treated. Ureteroscopic lasertripsy (107 cases) had an overall success rate of 84%. The failures were due to mobile stones inadvertently flushed back into the kidney (14%) and 2% of patients required open ureterolithotomy after failure of two ureteroscopic procedures. “Blind” lasertrimv (13 cases) was safe but not as efficient, the success rate being only 23%.
Autonomic Control and Vascular Changes during Penile Erection in Monkeys
Authors: CREED K. E. , CARATI C. J. , KEOGH E. J.
Published: November 2008

Summary— The mean pressure in the unstimulated corpus cavernosum of monkeys was 12.1 mm Hg. Pelvic nerve stimulation at 8 to 10 Hz produced penile extension and the mean pressure increased to 64.3 mm Hg (47–84% of carotid artery pressure) after a latency of 10 s. On stopping stimulation, recovery to resting levels occurred within 2 min. The response was not blocked by atropine or propranolol. Blood flow through two 19 gauge needles inserted into the corpus cavernosum increased in parallel with the pressure changes, indicating that arterial inflow increased.

Stimulation of either hypogastric nerves or the sympathetic chain produced penile retraction but increased corpus cavernosal pressure. The response to pelvic nerve stimulation was partially blocked. It was concluded that both of these nerves contract penile erectile tissue within the corpus cavernosum and constrict arterial inflow.
Surveillance for Stage I Non‐seminomatous Germ Cell Tumours of the Testis: the Optimal Protocol Has Not Yet Been Defined
Authors: RAGHAVAN D. , COLLS B. , LEVI J. , FITZHARRIS B. , TAITERSALL M. H. N. , ATKINSON C. , WOODS R. , COOREY G. , FARRELL C. , WINES R.
Published: November 2008

Summary— Forty‐six patients with clinical stage I testicular non‐seminomatous germ cell tumours were followed up according to a protocol of active surveillance between 1979 and 1987. The median follow‐up time was 40+ months. Thirteen patients (28%) relapsed, predominantly in retroperitoneum and/or lung. Ten of these relapses (76%) occurred within 8 months of orchiectomy. Relapses occurred in 7/35 T1 tumours and 5/10 T2 to T4 tumours. No correlation was detected between the histological type and relapse rate. Three late relapses were diagnosed at 23, 29 and 36 months. Eleven of the relapsed patients remain in prolonged complete remission after PVB chemotherapy ± surgery; one patient, who initially refused treatment at the time of relapse, has died. Another relapsed with predominant elements of rhabdomyosarcoma intermingled with malignant teratoma in a bone metastasis. He had a partial response to PVB chemotherapy but subsequently died. Thirty‐four patients (74%) did not undergo lymphography (LG) and had a higher relapse rate (11/34) than those who had LG (2/12); this was not a statistically significant difference in this small series. The policy of active surveillance is not yet the “state of the art” and should be under constant scrutiny with respect to safety and practice.
YAG Laser Treatment of Early Carcinoma of the Prostate
Authors: McNICHOLAS T. A. , CARTER S. St C. , WICKHAM J. E. A. , O'DONOGHUE E. P. N.
Published: November 2008

Summary— We describe our initial experience of a method which develops the role of endoscopic surgery in the treatment of early prostatic carcinoma. An “extended” transurethral resection of the prostate (TURP) under ultrasound control reduces the prostatic tissue to a thin residual capsule suitable for subsequent transmural coagulation by endoscopic YAG laser. Twenty patients with early disease were entered into the pilot study. Three were excluded after staging (2 T0a and 1 with positive nodes on pelvioscopy‐T2 N1 M0); 17 received a full course of treatment. Mean follow‐up was 6 months (range 1–14). Two early patients with excessive residual tissue had initially positive biopsies and underwent second treatments with subsequently negative biopsies. Two patients continue to have positive biopsies and the rest are negative. No tumour has progressed and complications have been minimal. One patient experienced reduced frequency of erections and 1 required bladder neck incision for symptomatic bladder neck stenosis at routine follow‐up endoscopy. There were no other effects on either potency or continence.
Management of Posterior Urethral Rupture: A Personal View
Authors: MOREHOUSE D.D.
Published: November 2008

The management of urethral injury continues to be controversial and no one policy has received universal acceptance. This review describes the current three‐step approach which we use for the investigation and management of this serious injury. This approach has evolved during the management of a large number of these injuries over the past 22 years. It is relatively simple and can be expected to give a high success and low complication rate. We believe that many of the complications encountered following the management of this injury are avoidable.
Transurethral Prostatotomy versus Transurethral Prostatectomy in Benign Prostatic Hypertrophy A Prospective Randomised Study
Authors: NIELSEN H. O.
Published: November 2008

Summary— Transurethral prostatotomy (TUT) in 24 patients was compared with transurethral prostatectomy (TUR) in 25 patients in a prospective randomised trial. All patients were aged 60 years or more and presented with symptomatic benign hypertrophy. One half of the patients had acute retention.

Shorter operative time and less post‐operative bleeding were found in the TUT group, which included 3 failures. No difference was found in post‐operative duration of catheterisation or duration of hospitalisation.

No significant differences were seen after 1 year's follow‐up in the number of patients with positive urinary culture or urinary flow rate. One patient in the TUT group had a recurrence of symptoms, thus giving a total of 4 failures and a success rate of 82%. One patient became incontinent after TU R and 4 developed a stricture. The success rate after TU R was 78%.

It was concluded that TUT and TU R produce similar functional results in cases where the gland is not too large.
Referral Pattern of Urological Malignancy in Indonesia
Authors: SUGANDI S.
Published: November 2008

Summary— In the 10 years between 1976 and 1985, 202, 111 patients were admitted to Hasan Sadikin Hospital, Bandung. Of these, 211 (0.1%) had a urological malignancy. Bladder tumours were commonest and constituted 39%. Testicular tumours accounted for 24%, renal tumours 18%, prostatic carcinoma 13% and penile tumours 6%.

Bladder tumours were predominantly transitional cell carcinoma; only 2 patients presented with squamous cell tumours associated with bladder stones. In 50 cases of testicular tumour, 72% were seminomas and 22% were embryonal cell carcinomas. Wilms' tumours accounted for 21 of 39 cases of renal malignancy; the other 18 were renal carcinomas.

No urogenital malignant disease was sufficiently common to be included in either the top 10 malignancy list or the male top 10 malignant diseases in Indonesia.
Urine Microscopy and Culture in the Selection of Patients for Urinary Tract Investigation
Authors: MASKELL ROSALIND
Published: November 2008

Summary— In a 1‐year laboratory‐based study the validity of certain findings on microscopy and culture of mid‐stream urine specimens as predictive of the presence of structural or functional abnormalities of the urinary tract was tested. During 1986, infection was diagnosed in 12,705 specimens sent to the laboratory by general practitioners; in the light of the findings a comment suggesting the possibility of underlying urinary tract pathology was appended to the reports of specimens from 652 patients. Data were available from the investigation of 233 of these patients. The percentage in whom abnormalities were detected considerably exceeded that reported from studies of bacteriuric children and of adult women with symptoms. It is suggested that the use of these criteria may assist clinicians to select, from the very large number of patients who suffer from urinary tract infection, those who require investigation.
Poor Compliance Early in Filling in the Neuropathic Bladder
Authors: WESTON P. M. T. , ROBINSON L. Q. , WILLIAMS S. , THOMAS M. , STEPHENSON T. P.
Published: November 2008

Summary— A total of 30 patients with known neuropathy, mostly spina bifida, developed poor bladder compliance early in filling demonstrated urodynamically; 20 had bilateral hydronephrosis at the time of presentation and 5 also had severely impaired renal function. After appropriate treatment all of those with normal upper tracts or with bilateral hydronephrosis but normal renal function stabilised or improved. However, all 5 with severely impaired renal function progressed to end‐stage renal failure. Poor compliance early in filling is an absolute indication for surgical intervention.
Three Years' Experience with an Ileal Low Pressure Bladder Substitute
Authors: STUDER U. E. , ACKERMANN D. , CASANOVA G. A. , ZINGG E. J.
Published: November 2008

Summary— At the beginning of this century it was realised that peristalsis would cause incontinence if bowel was used for augmentation or substitution of the bladder. Trans‐section of the antimesenteric border and cross‐folding of the intestinal segments (Goodwin's cup‐patch technique) is an efficient means of solving this problem and has been successfully used in the Kock pouch.

We anastomosed the ileal low pressure reservoir to the membranous urethra in 22 male patients following radical cystoprostatectomy for bladder cancer. The mean observation time was 16 months (range 3–36). The capacity of the bladder substitute increased with time, the average being 450 ml after 6 months. In the first 4 patients with a short (2–5 cm) intestinal segment between the pouch and the urethra, micturition was prolonged, residual urine varied from 50 to 300 ml and bacteriuria was found. Occasional expulsions of several ml of urine were caused by peristalsis within this short tubular segment. In the following 18 patients, the low pressure reservoir was anastomosed directly to the membranous urethra. Micturition was good, with no notable residual urine, no bacteriuria and no paroxysmal urinary incontinence. However, a safety pad is used by half of the patients because once or twice a week, mainly at night, a few ml of urine may be lost. No significant changes in serum electrolytes, bicarbonate or creatinine were noted. With the three different antireflux techniques used, no obstructive or inflammatory changes in the upper urinary tracts were found, although no long‐term antibiotic prophylaxis was given.
Oestrogen in the Treatment of Prostatic Carcinoma
Authors: LANGEVELD J. W. , LYCKLAMA A. A. B. , NIJEHOLT A. , JONAS U.
Published: November 2008

Summary— The treatment of prostatic carcinoma with diethylstilboestrol (DES) and ethinyloestradiol (Lynoral) has become less popular since the introduction of new forms of treatment such as antiandrogens, estramustine phosphate and LHRH analogues. One of the reasons for this decline in popularity is the risk of cardiovascular side effects during treatment with oestrogens.

In the literature, different dosages of DES and ethinyloestradiol are recommended and different rates of cardiovascular side effects are reported. In a prospective study, 18 patients were treated with ethinyloestradiol 0.05 mg/day. In most cases this lowered the plasma testosterone permanently below castrate level during therapy. Also, because the acid phosphatase returned to normal in almost all patients, this treatment seemed adequate. In 4 patients the treatment was stopped because of side effects, in 3 of these because of cardiovascular complications. The cardiovascular side effect at this dose are considerable (29%) but comparable rates are reported in some studies following placebo treatment of patients with prostatic carcinoma.
Acute Epididymitis: a Microbiological and Ultrasonographic Study
Authors: DOBLE A. , TAYLOR‐ROBINSON D. , THOMAS B. J. , JALIL N. , HARRIS J. R. W. , WITHEROW R. O'N.
Published: November 2008

Summary— in a prospective study of 24 men (mean age 28.3 years) with acute epididymitis who underwent epididymal aspiration, micro‐organisms were detected in 15 (62.5%). Chlamydia trachomatis accounted for 10 (42%) of the cases, being located in both the urethra and epididymis in 5 individuals. Chlamydial serology supported the diagnosis of chlamydial infection, there being a strong correlation between the detection of C. trachomatis and elevated titres of both chlamydial IgG and IgM antibodies. In 4 patients (mean age 55.5 years), Escherichia coli was cultured from both mid‐stream urine and epididymal aspirate. Transrectal ultrasound revealed abnormal prostatic scans in 19 patients (79%). These data confirm the aetiological role of C. trachomatis, support the notion that micro‐organisms spread intra‐canalicularly and suggest that the prostate is also involved in the inflammatory process in acute epididymitis.
Intrarenal Duplication
Authors: MacKENZIE J. R. , AZMY A. F.
Published: November 2008

Summary— We report the anomaly of intrarenal duplication seen during the course of investigation of urinary tract infection in 6 children. The anomaly and its embryological basis are described.
Leiomyosarcoma of the Kidney. Immunohistological and Ultrastructural Findings with Special Emphasis on the Growth Fraction
Authors: KRECH R. H. , LOY V. , DIECKMANN K. P. , GERDES J. , STEIN H.
Published: November 2008

Summary— This report deals with a case of renal smooth muscle tumour. Considering the low mitotic rate, this neoplasm would have been classified as leiomyoma. However, it displayed a relatively large growth fraction by immunostaining with the monoclonal antibody Ki‐67. This led us to the diagnosis “leiomyosarcoma”, which is in line with the unfavourable clinical course. We suggest that assessment of the growth fraction with Ki‐67 seems to be more objective than the conventional criteria for determining the malignant potential of smooth muscle tumours.
Radionuclide Imaging of Ureteric Peristalsis
Authors: LEWIS C. A. , COPTCOAT M. J. , CARTER S. ST. C. , HILSON A. J. W. , WICKHAM J. E. A. , SHAH P. J. R.
Published: November 2008

Summary— Dynamic renal scintigraphy is a successful and minimally invasive technique for evaluating renal function. An extension to the basic technique involving fast‐frame acquisition and a modified analysis is described which enables ureteric function to be examined.

Ureteric peristalsis was assessed in 32 patients using this technique. The results from 5 representative studies are described in detail. Normally functioning ureters exhibit peristaltic contractions at a frequency of up to 3/min. Hyperperistalsis that exceeds 4 contractions/min is associated with obstruction. Peristaltic behaviour in 9 patients examined before and after ESWL was not altered.
The Accuracy of Measurement of Residual Urine in Women by Urethral Catheterisation
Authors: HAYLEN B. T. , FRAZER M. I. , SUTHERST J. R. , ASHBY DEBORAH
Published: November 2008

Summary— Two potential sources of error in the measurement of residual urine volumes in women were quantified. These were (i) whether a diuresis is operating at the time of measurement, and (ii) the time between voiding and residual urine volume collection.

A regime is suggested for the accurate measurement of residual urine in women by urethral catheterisation.
Intravesical Evans Bacille Calmette‐Guérin in the Treatment of Carcinoma in situ
Authors: CUMMING J. A. , HARGREAVE T. B. , WEBB J. N. , McINTYRE MARGARET A. , CHISHOLM G. D.
Published: November 2008

Summary— We report our experience in the treatment of carcinoma in situ of the urinary bladder using Evans strain Bacille Calmette‐Guérin (BCG). The mean period of follow‐up was 30 months; 18 patients received intravesical therapy and 16 of these were evaluable. They received 8 weekly instillations of 60 mg Evans strain BCG in 50 ml of saline. No intradermal BCG was given. The response rate was 93.75% at 3 months; this declined to 57% at 2 years. The complications of therapy were frequent but mild. Seven patients failed to complete the course. These results were comparable to those obtained with other strains of Bacille Calmette‐Guérin.
HLA—DR Expression by High Grade Superficial Bladder Cancer Treated with BCG
Authors: PRESCOTT S. , JAMES K. , BUSUTTIL A. , HARGREAVE T. B. , CHISHOLM G. D. , SMYTH J. F.
Published: November 2008

Summary— The local immune response to intravesical BCG therapy for widespread carcinoma in situ and superficial bladder tumour was assessed using immunohistochemical methods on serial biopsies obtained during treatment. The main findings were the induction of a strong level of HLA–DR expression by urothelial cells which persisted for several months after completion of therapy. This coincided with a mononuclear cell infiltrate in the bladder wall consisting predominantly of activated helper T lymphocytes. Smaller numbers of macrophages, suppressor cytotoxic T lymphocytes and B lymphocytes were also found. These new findings confirm that the inflammatory response to BCG involves the urothelium in an immunological reaction and suggest that the success of immunotherapy with intravesical BCG may be due to enhanced tumour antigen recognition.
Vaginal Endosonography in the Post‐operative Assessment of Colposuspension
Authors: QUINN M. J. , BEYNON J. , MORTENSEN N. N. McC. , SMITH P. J. B.
Published: November 2008

Summary— Vaginal endosonography has been used to investigate the post‐operative results of colposuspension. The anatomical relationships of the bladder neck, proximal urethra and symphysis pubis can be demonstrated with this technique. A successful symptomatic and anatomical result was observed in 29/40 women; 11/40 had persistent or recurrent symptoms at varying intervals after the operation. Four different anatomical configurations were associated with these symptoms, which included “early” and “late” recurrent stress incontinence, persistent incontinence, voiding difficulties and the frequency‐urgency syndrome.

Persistent or recurrent urinary symptoms were associated with a variety of anatomical configurations after colposuspension. Vaginal endosonography is a simple and convenient method to investigate the early and late post‐operative results of operations for urinary stress incontinence.
Is Grade or Stage of Primary Importance in Determining the Outcome after Radical Prostatectomy for Disease Clinically Confined to the Prostate?
Authors: PAULSON D. F. , WALTHER P. J.
Published: November 2008

Summary— A series of 145 patients with T1–2NOMO prostatic carcinoma underwent radical prostatectomy. Specimens were analysed by Gleason sum and categorised according to whether the disease was organ‐confined, specimen‐confined or margin‐positive. The failure of treatment was indicated by elevation of acid phosphatase, by the appearance of biopsy proven local disease or distant nodal disease, or by parenchymal or nodal disease by any imaging modality. Analysis of the data demonstrated that the outcome of surgical intervention was related to the anatomical extent of disease. The Gleason sum was related to the extent of disease and predicted the probability of disease outside the organ of origin.
Laparoscopy and the Management of the Impalpable Testis
Authors: GUINEY E. J. , CORBALLY M. , MALONE P. S.
Published: November 2008

Summary— We describe the technique of laparoscopy when seeking to locate an impalpable testis. The procedure was used in 86 boys with unilateral or bilateral undescended testes; of the 103 testes which were sought, 64 were present, 39 were absent and 53 were intra‐abdominal. Laparoscopy is useful in the management of the impalpable testis. The information gained from the study is valuable when advising parents of the significance of an impalpable testis. For example, there is a 39% chance it will be absent, a 29% chance that it will be easily placed in the scrotum and a 38% chance that a staged procedure may be necessary.
Effect of Animal and Vegetable Protein Intake on Oxalate Excretion in Idiopathic Calcium Stone Disease
Authors: MARANGELLA M. , BIANCO O. , MARTINI C. , PETRARULO M. , VITALE C. , LINARI F.
Published: November 2008

Summary— Oxalate excretion was measured in healthy subjects and idiopathic calcium stone‐formers on dietary regimens which differed in the type and amount of protein allowed; 24‐h urine collections were obtained from 41 practising vegetarians and 40 normal persons on a free, mixed, “mediterranean” diet. Twenty idiopathic calcium stone‐formers were also studied while on two low calcium, low oxalate diets which differed in that animal protein was high in one and restricted in the other.

Vegetarians had higher urinary oxalate levels than controls and although the calcium levels were markedly lower, urinary saturation with calcium/oxalate was significantly higher. This mild hypercalciuria was interpreted as being secondary to both a higher intake and increased fractional intestinal absorption of oxalate.

Changing calcium stone‐formers from a high to a low animal protein intake produced a significant decrease in calcium excretion but there was no variation in urinary oxalate. As a result, the decrease in calcium oxalate saturation was only marginal and not significant.

It was concluded that dietary animal protein has a minimal effect on oxalate excretion. Mild hyperoxaluria of idiopathic calcium stone disease is likely to be intestinal in origin. Calcium stone‐formers should be advised to avoid an excess of animal protein but the risks of a vegetable‐rich diet should also be borne in mind.
Evaluation of the Retrograde Contamination Guard in a Bacteriologically Challenged Rabbit Model
Authors: KHOURY A. E. , OLSON MERLE E. , LAM K. , NICKEL J. C. , COSTERTON J. W.
Published: November 2008

Summary— We compared a newly developed closed urinary drainage system incorporating a retrograde contamination guard (RCG) with the conventional closed drainage system. The new system contains a solid bactericide (povidone iodine) pellet enclosed in a porous cartridge at the drain port of the urine collection bag. A catheterised rabbit model was used. The urine drainage bags were challenged daily for 8 days with an auxotrophically marked uropathogenic strain of Escherichia coli at the outlet tube. The bag urine was infected with the marked organism in 10 of the 11 rabbits in the control group (conventional collection bags) in 3.8 ± 1.03 days and in only 1 of the 13 rabbits fitted with the RCG. The RCG effectively prevents contamination of the urine drainage bag and thus may play an important role in reducing the incidence of nosocomial urinary tract infections.
Urethral Strictures following Transurethral Resection of the Prostate. The Role of the Catheter
Authors: HAMMARSTEN J. , LINDQVIST K. , SUNZEL H.
Published: November 2008

Summary— Urethral stricture is the most common late complication of transurethral prostatectomy (TURP). The cause is unknown. A prospective, randomised study was undertaken to investigate the role of the transurethral catheter in stricture formation. A total of 205 patients subjected to TURP were studied. Following resection, they were randomly divided into 2 groups: those drained by a transurethral siliconised latex catheter and those drained by a suprapubic siliconised latex catheter. At follow‐up, 6 to 24 months later, 17% of the patients in the transurethral group had developed urethral stricture; the corresponding figure in the suprapubic group was 4%. As a consequence of the higher incidence of stricture in the transurethrally drained group, more patients in that group were dissatisfied with the results of the operation. It was concluded that the post‐operative transurethral catheter was an important factor in stricture formation following TURP and that transurethral drainage with a siliconised latex catheter resulted in a higher incidence of stricture. This led to a greater number of patients being dissatisfied with the results of the operation, but the catheter did not affect the results in any other way.
Gynaecomastia and Occult Leydig Cell Tumour of the Testis
Authors: MELLOR S. G. , McCUTCHAN J. D. S.
Published: November 2008

Summary— Two patients with Leydig cell tumours of the testis are described. Both presented with gynaecomastia, but on initial examination had apparently normal testes. The causative tumour did not become obvious for some months, despite being carefully sought. Review of the literature suggests that gynaecomastia preceding a readily palpable tumour is a recognised problem.

The detection and management of Leydig cell tumours of the testis are discussed.
Responses of Erectile Tissue from Impotent Men to Pharmacological Agents
Authors: CREED K. E. , CARATI C. J. , ADAMSON G. M. , CALLAHAN S. M.
Published: November 2008

Summary— Erectile tissue was removed from the corpora cavernosa of 25 impotent men undergoing surgery for insertion of penile prostheses. Strips, set up in an organ bath, were contracted by the alpha‐adrenergic agonist phenylephrine. There was no significant difference between tissue taken from men with diabetes, alcoholism, Peyronie's disease or men with no obvious condition causing the impotence. The sensitivity of tissues from hypertensive patients was significantly reduced but this was probably due to drugs being taken for hypertension. Precontracted tissues could be relaxed by acetylcholine or isoprenaline. The responses, however, were inconsistent, so that no difference between the different groups of patients was apparent.
Idiopathic Hydronephrosis: Diagnosis, Management and Outcome
Authors: O'REILLY P. H.
Published: November 2008

Summary— The results of the diagnosis, management and treatment of 50 consecutive patients presenting with renal pelvic dilatation suggestive of pelviureteric junction obstruction are presented. Modern assessment methods were used to investigate both pre‐operative status and also the results of management of the 37 obstructed and 13 non‐obstructive patients. The role and influence of the new assessment techniques on clinical decision making are discussed.
Dietary Habits in Renal Stone Patients Compared with Healthy Subjects
Authors: FELLSTRÖM B. , DANIELSON B. G. , KARLSTRÖM BRITA , LITHELL H. , LJUNGHALL S. , VESSBY B.
Published: November 2008

Summary— The dietary habits of renal calcium stone patients were investigated both by dietary history and by 4‐day food records and compared with the dietary habits of control subjects, matched on the basis of age, sex, social and professional status. The method using 4‐day records seemed to be more precise, judged by the correlation to the urinary output of nutrients. There was no difference in the daily intake of major nutrients between stone formers and controls, but a higher ingestion of vitamin C in controls and a larger consumption of alcohol among stone formers. In contrast to some epidemiological evidence, there were no significant differences in consumption of animal protein when stone formers were matched for social class. Despite a similar total intake of calcium, the stone formers excreted more calcium in the urine, probably reflecting a higher intestinal absorption of calcium. There seem to be only marginally different dietary habits between stone formers and carefully matched control subjects. Differences in the urinary output of minerals and electrolytes are mainly due to variations in gastrointestinal uptake.
Screening Renal Stone Formers for Distal Renal Tubular Acidosis
Authors: OSTHER P. J. , HANSEN A. B. , RØHL H. F.
Published: November 2008

Summary— A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted; 13 had incomplete and 1 had complete distal RTA. Distal RTA was found particularly in recurrent stone formers (17%), and especially in those with bilateral stone disease, where a distal renal tubular acidification defect was found in 50%.

We have been unable to differentiate primary from secondary RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use in daily clinical practice, is applied to all stone formers and not restricted to patients with recurrent stone disease.
Nephrectomy in Renal Carcinoma with Distant Metastasis
Authors: ONISHI T. , MACHIDA T. , MASUDA F. , KURAUCHI H. , MORI Y. , SUZUKI M. , IIZUKA N. , KONDO I. , FURUTA N. , SHIRAKAWA H.
Published: November 2008

Summary— A total of 96 cases of renal carcinoma with distant metastasis at the time of diagnosis was studied. The patients were classified into 4 groups: Group O (16) in whom nephrectomy was not performed, Group A (51) who died due to carcinoma within 1 year of nephrectomy, Group B (25) who died due to carcinoma 1 to 3 years after nephrectomy, and Group C (4) who survived for 3 years or more after nephrectomy.

Six clinical measurements were evaluated: haemoglobin, ESR, α2 globulin, temperature, weight and C reactive protein. In addition, performance status, the number of organs with metastases, number of metastatic lesions and tumour growth rate were measured.

The results showed that in patients surviving for 1 year or more after nephrectomy, there was an abnormality in the results of 3 or less of the 6 clinical measurements, performance was 0 or 1, and the carcinoma had metastasised to only one organ. In addition, it was found that the growth of metastatic lesions in patients who survived for 3 years or more was much slower than in the other patients. Nephrectomy was found to be effective in only 27% of our cases and we consider that careful deliberation should be made pre‐operatively as to whether nephrectomy is really necessary in patients with metastasis. The decision should be made on the basis of the results obtained in the 6 clinical measurements given above.
Recombinant Interferon‐alpha with or without Vinblastine in Metastatic Renal Carcinoma Results of a Randomised Phase II Study
Authors: FOSSÅ SOPHIE D. , RAABE N. , MOE BRIT
Published: November 2008

Summary— In a randomised phase II study, 5 of 24 patients with metastatic renal carcinoma responded to treatment with interferon (IFN) (Roferon A, Roche, Basle, Switzerland) (18 times 106 u i.m. 3 times/week). The combination of IFN with vinblastine (0.1 mg/kg every third week) yielded a response rate of 16% (4 of 25 patients). Three patients continue to show a response (2 complete, 1 partial) more than 20 months after cessation of treatment.

Flu‐like symptoms represented the major side effect and often led to modification or discontinuation of treatment.

It was concluded that IFN is the treatment of choice in patients with metastatic renal carcinoma who are candidates for medical treatment. The significance of additional vinblastine is uncertain.
Is the Treatment of Urgency Incontinence a Placebo Response? Results of a Five‐year Follow‐up
Authors: AITCHISON M. , CARTER R. , PATERSON P. , FERRIE B.
Published: November 2008

Summary— The treatment and symptomatic outcome were reviewed in 50 women who had presented with urgency incontinence as their main symptom 5 years previously. All had idiopathic urgency incontinence and, on the basis of urodynamic investigation, 40 were considered to have detrusor instability and 10 sensory urge incontinence. The results indicate that the natural history of sensory urgency is one of spontaneous resolution; all treatments of detrusor instability (including surgery) produced an unsustained short‐term symptomatic response. This pattern of response to therapy may be interpreted as being largely of a placebo nature and this emphasises the need for long‐term follow‐up in the assessment of new treatment modalities.