bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging for the diagnosis of prostate cancer metastatic to bone
Authors: Fujii Y. , Higashi Y. , Owada F. , Okuno T. , Mizuno Hitomi , Mizuno Hideaki
Published: November 2008

Objective To examine the role of magnetic resonance imaging (MRI) in the evaluation of osseous metastasis in patients with prostate cancer.

Patients and methods A series of 36 patients with known prostate cancer, who were undergoing MRI and an isotope bone scan, were studied.

Results Of 19 positive bone scans, MRI was read as negative for metastasis in one. Of eight equivocal scans, two MR images were interpreted as positive and six as negative. Of nine negative scans MRI was positive in one. Further MRI demonstrated additional metastatic lesions that were not shown by bone scin‐tigraphy in six patients. MRI clearly indicated the areas of spinal cord compression in five patients with spinal metastases and associated myelopathy.

Conclusion MRI is helpful in the diagnosis of metastatic prostate cancer, especially when other radiographic examinations are inconclusive or spinal cord compression is suspected.
The long‐term Results of skin inlay urethroplasty
Authors: Mundy A.R.
Published: November 2008

Objective To report the Results of a 10‐year follow‐up of 73 patients who underwent skin‐inlay urethroplasty for the treatment of strictures that failed to respond to a trial of endoscopic surgery.

Patients and methods The 10 year follow‐up of 48 patients with patch urethroplasties and 25 with tube urethroplasties of pedicled preputial, penile and scrotal skin is reported.

Results The patients with patch urethroplasties tended to do well in the medium term whatever the source of skin, although there was a steady annual attrition rate after 4 years of about 5%/year requiring revision. The 2 5 patients with tube urethroplasties did less well, particularly those with scrotal skin tubes. The patients with preputial/penile tube urethroplasties did rather better but, in general, all these tube urethroplasties seem to narrow uniformly with time. Urethrotomy was never curative when a stricture recurred in relation to a urethroplasty.

Conclusion If the initial result is satisfactory, then patch urethroplasties tend to do well in the medium term whatever the source of the flap. No matter how good the initial result, scrotal skin tube urethroplasties do badly; preputial/penile skin performs better but tube urethroplasties tend to narrow down nonetheless. In the long term ‐ more than 10 years ‐ all skin inlays seem to have a tendency to deteriorate.
Impotence following pelvic fracture urethral injury: incidence, aetiology and management
Authors: Mark S.D. , Keane T.E. , Vandemark R.M. , Webster G.D.
Published: November 2008

Objective To evaluate the potency status of patients undergoing delayed perineal repair following a pelvic fracture urethral injury to determine the incidence and aetiology of impotence.

Patients and methods Long‐term potency (> 6 months post‐operatively) was subjectively evaluated in 92 patients and correlated with their pre‐operative and intra‐operative findings. The management of their impotence was also reviewed. Thirty original pelvic radiographs were assessed independently to determine if the pattern of bony injury was associated with the development of impotence.

Results Fifty‐seven patients (62%) remained impotent in the long term with a median follow‐up of 48 months (range 12–128) and the operation did not render any potent patient impotent. Self‐injection with vasoactive agents was successful in 24 of 27 (89%), suggesting a neurogenic aetiology in the majority. Bilateral pubic rami fracture was also associated with a high incidence of impotence.

Conclusion Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the sym‐physis pubis is the most likely cause of impotence in this injury.
The importance of accurate assessment and conservative management of the open bladder neck in patients with post‐pelvic fracture membranous urethral distraction defects
Authors: MacDiarmid S. , Rosario D. , Chapple C.R.
Published: November 2008

Objective To review the pre‐operative assessment of bladder neck competence and assess the success of non‐operative management of the bladder neck in patients with pelvic fracture membranous urethral distraction defects.

Patients and methods A series of four patients with long‐standing post‐pelvic fracture urethral distraction defects and open bladder necks demonstrated on pre‐operative investigation are presented.

Results All four patients were managed by perineal urethroplasty without surgery to the bladder neck. All patients were continent post‐operatively despite the injury having ablated the distal sphincter mechanism.

Conclusion We believe that the majority of patients can be managed successfully by a non‐operative approach to the bladder neck, sparing them the unnecessary operative morbidity of an abdomino‐perineal repair, which should be reserved for those with obviously scarred or distorted bladder necks.
Clinical presentation and pathophysiology of meatal stenosis following circumcision
Authors: Persad R. , Sharma S. , McTavish J. , Imber C. , Mouriquand P.D.E.
Published: November 2008

Objective To describe the clinical presentation and pathophysiology of meatal stenosis occurring after circumcision.

Patients and methods The clinical presentation and operative findings are reported in 12 children who presented with meatal stenosis over a period of 3 years.

Results The cardinal symptoms of meatal stenosis were penile pain at the initiation of micturition (12 of 12), narrow, high velocity stream (8 of 12) and the need to sit or stand back from the toilet bowl to urinate (6 of 12). Following surgical correction with meatotomy there was no recurrence of stenosis after a mean follow‐up of 13 months. Traumatic meatitis of the unprotected post‐circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis.

Conclusion Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.
Nocturnal enuresis
Authors: Mark S.D. , Frank J.D.
Published: November 2008

Nocturnal enuresis is common. Although its aetiology remains unclear recent evidence increasingly supports the lack of a normal nocturnal increase in ADH leading to nocturnal polyuria exceeding functional bladder capacity. Sleep patterns are probably normal although an arousal disorder might be a factor. Treatment should follow careful evaluation to determine if one is dealing with ‘uncomplicated’ or ‘complicated’ enuresis. Complicated enuresis requires further investigation. ‘Uncomplicated enuresis’ always requires reassurance and patient and parent education. Resource centres such as ERIC can provide information and advice.

Active treatment should be tailored to the patients age, motivation and parental wishes. Behavioural modification techniques yield the highest long‐term cure rate but require the most commitment and are rarely successful before the age of 7–8 years. Pharmacotherapy has been revolutionized by DDAVP which gives a response rate of up to 70% relatively free from side‐effects but at the price of a high relapse rate after medication. Imipramine is less expensive than DDAVP but may be fatal in overdose. Anticholinergics should be reserved for those patients with significant diurnal symptoms or those who fail first‐line pharmacotherapy.

Overall patients and parents should be reassured by the high spontaneous cure rate.
Trospium chloride versus oxybutynin: a randomized, double‐blind, multicentre trial in the treatment of detrusor hyper‐reflexia
Authors: Madersbacher H. , Stöhrer M. , Richter R. , Burgdörfer H. , Hachen H.J. , Mürtz G.
Published: November 2008

Objective To compare trospium chloride (TCI), a quaternary ammonium derivative with atropine‐like effects and predominantly antispasmodic activity, with oxybutynin (Oxy) in terms of efficacy and adverse effects.

Patients and methods In a randomized, double‐blind, multicentre trial, 95 patients with spinal cord injuries and detrusor hyper‐reflexia were studied. Treatment consisted of three doses per day over a 2 week period, with either Oxy (5 mg three times daily) or with TCl (20 mg twice daily) with an additional placebo at midday. The Results were evaluated with regard to changes in Objective (urodynamic) data and subjective symptoms as well as the incidence/severity of adverse effects.

Results With both drugs there was a significant increase in maximum bladder capacity, a significant decrease in maximum voiding detrusor pressure and a significant increase in compliance and residual urine; there were no statistically significant differences between the treatment groups. The percentage of patients who reported severe dryness of the mouth was considerably lower (4%) in those receiving TCl 2times20 mg/day than in those receiving Oxy (23%) 3times5 mg/day. Withdrawal from treatment was also less frequent in those receiving TCl (6%) than in those receiving Oxy (16%).

Conclusion Trospium chloride and oxybutynin, judged in terms of Objective urodynamic parameters, are of substantially equal value as parasympathetic antagonists. However, assessment of tolerance in terms of adverse drug effects showed that TCl had certain advantages.
Is there a role for in vivo methylene blue staining in the prediction of bladder tumour recurrence?
Authors: Creagh T.A. , Gleeson M. , Travis D. , Grainger R. , McDermott T.E.D. , Butler M.R.
Published: November 2008

Objective To assess the role of in vivo staining with intravesical methylene blue in predicting tumour recurrence.

Patients and methods Thirty‐nine patients (2 7 men and 12 women, age range 43–75 years) newly diagnosed with bladder tumours were prospectively studied and followed for a minimum of 2 years. Potential biopsy sites were identified by staining intravesically with a 1% methylene blue solution and compared with random biopsy sites.

Results Biopsy directed by methylene blue staining detected carcinoma in situ more often than random biopsy. Rates of recurrence were similar in both stained and unstained groups.

Conclusion methylene blue staining does not add significantly to the management of patients presenting with bladder tumours.
Natural filling cystometry in infants and children
Authors: Yeung C.K. , Godley M.L. , Duffy P.G. , Ransley P.G.
Published: November 2008

Objective To evaluate natural filling cystometry in infants and young children.

Patients and methods The study group comprised 57 infants and young children (mean age. 4.1 years) with various urological conditions. Suprapubic catheters were used in all patients with urethral sensation. Natural filling urodynamic (NFU) studies were performed using an ambulatory recorder and with an observer present throughout. For comparison. 17 of the 37 patients also had slow filling conventional cystometry (CMG).

Results All NFU studies were successfully completed and the great majority of patients were unaffected by the investigation procedures. In comparison with conventional cystometry there were significant differences. For NFU, there was a lower bladder capacity (means. NFU 122 mL vs CMG, 188 mL. P <0.031: lower pressure rise on filling (means. NFU 5.7cmH2, O vs CMG 16.1cmH2O. P <0.001) and higher maximum detrusor pressures during micturition (means. NFU 130cmH2O) vs CMG. 78 cmH2O. P<0.0***. Voiding efficiency was also slightly greater with NFU compared with CMG. Detrusor instability was recorded in five patients only during NFU and in two other patients only during CMG.

Conclusion A natural filling cystometry method which incorporates an unobtrusive recording system is likely to be superior to conventional CMG for assessing bladder function in infants and children. This is because (i) bladder function is investigated in near to natural conditions. (ii) the patients are mostly unaffected by the investigation procedures. (iii) there are significant differences between NFU and CMG in the measurements obtained, indicating that CMG may give false indices of bladder function.
Endoscopic treatment of vesico‐ureteric reflux and urinary incontinence: technical problems in the paediatric patient
Authors: Capozza N. , Caione P. , Gennaro M. De , Nappo S. , Patricolo M.
Published: November 2008

Objective Bovine collagen has been successfully used for the endoscopic treatment of urinary incontinence (UI) and vesico‐ureteric reflux (VUR) in children for more than 8 years, although its long‐term efficacy has sometimes been questioned. Its failure is generally ascribed either to technical difficulties or to instability of collagen at the site of the implant. To assess the efficacy of the procedure we evaluated the children treated at this hospital between 1990 and 1993.

Patients and methods A total of 156 children, aged 5 months to 13 years, were treated for VUR. Over the same period, 25 patients aged between 2 and 14 years (nine with neuropathic bladder and 16 with exstro‐phy‐epispadias complex who were still incontinent after bladder neck reconstruction) had periurethral or pericervical glutaraldehyde cross‐linked bovine collagen injection for UI. Five more children with exstro‐phy‐epispadias complex (aged 1–3 years) underwent periurethral collagen injection to stimulate bladder enhancement and allow subsequent bladder neck reconstruction.

Results In children treated for VUR, a single injection proved successful in 72.2% of cases (127 ureters); a second collagen injection raised the success rate to 81%. Continence improved in all nine neuropathic bladders and in 10 of 16 children with exstrophy‐epispadias complex treated for UI after bladder neck reconstruction. In four of the five exstrophy‐epispadias complex patients who were treated to stimulate bladder enhancement, bladder capacity increased by 25%.

Conclusions Endoscopic treatment of VUR seems to be a valid alternative to open surgery, even though concerns remain about the long‐term efficacy of collagen implantation. An important distinction should be made between early and late failure of the procedure. Early failure, which we define as persistence of reflux, is usually due to incorrect technique or technical difficulties. Late failure, or recurrence of reflux, which has previously been attributed to the biodegradability of collagen, seems to be due to the displacement of the injected collagen. Micturition itself or high bladder pressure (such as detrusor instability) could be responsible for the displacement of the injected collagen medially and distally, where it can no longer support the submucosal ureteric tunnel. In the treatment of urinary incontinence, both the implant technique and the choice of the site of injection seem to have a considerable effect on the results. In our experience, endoscopic collagen injection is effective in the treatment of both urinary incontinence and VUR in paediatric patients. Accurate selection of patients and technical adjustments and refinements are essential to obtain the best results.
The significance of abdominal straining in men with lower urinary tract symptoms
Authors: Reynard J.M. , Peters T.J. , Lamond E. , Abrams P.
Published: November 2008

Objective To determine the relationship between the symptom of straining to void, the presence of objectively demonstrated abdominal straining and bladder outflow obstruction in men with lower urinary tract symptoms (LUTS), and to assess the effect of straining on flow rate in these men.

Patients and methods The presence of straining to void as a symptom was determined from a symptom questionnaire in 61 men presenting with LUTS. Objective evidence of straining to void was assessed by rectal pressure measurement and the presence of bladder outflow obstruction was determined by pressure‐flow studies. The effect of straining on flow rate was assessed in a separate group of 58 men with LUTS, by comparing the maximum flow rate on non‐strain and strain voids of similar volume.

Results There was poor agreement between the complaint of straining and the presence of straining as measured by rectal pressure recording. Twelve of the 53 patients who claimed they never or occasionally strained to void in fact showed straining on each of four voids. There was no significant difference in the proportion of men who complained of straining in the obstructed and non‐obstructed groups (P= 0.86). The probability of obstruction in those men with objective evidence of straining on all voids was 80% and in those who did not strain on all voids was 51%, but this difference was not statistically significant (P= 0.53). There was no clinically significant effect of straining on maximum flow rate in men with LUTS.

Conclusion As a symptom, straining is an uncommon complaint in men with benign prostatic hyperplasia (BPH), and the relationship between the symptom and objective evidence of its presence is poor. Both as a symptom and as an objectively measured voiding disorder, straining lacks sufficient sensitivity and specificity for it to be of value in the diagnosis of bladder outlet obstruction (BOO). Abdominal straining does not have a marked effect on flow rate in men with BPH. This study suggests that straining is an unreliable symptom of BOO, that it does not influence voiding function in elderly men and that its inclusion in symptom scores for BPH should be reconsidered.
Bladder mast cell expression of high affinity oestrogen receptors in patients with interstitial cystitis
Authors: Pang X. , Cotreau‐Bibbo M.M. , Sant G.R. , Theoharides T.C.
Published: November 2008

Objective To investigate the role of oestrogens in the pathophysiology of interstitial cystitis (IC), specifically with respect to activated bladder mast cells (MC), as well as urine concentrations of MC‐derived histamine and methylhistamine, all of which are increased in patients with IC. This goal appeared important because IC is a bladder disorder which occurs almost exclusively in women, and is characterized by polyuria, nocturia and pelvic pain, which worsen peri‐menstrually.

Patients and methods Biopsies from six patients with IC and four control patients were analysed blindly for the presence of oestrogen receptors (OR) using both custom‐made and commercially available antibodies against OR.

Results Bladder MC alone were shown to express high‐affinity OR and there was a higher number of such cells present in patients with IC compared with controls. The identity of MC in the bladder was documented with immunohistochemistry for tryptase. OR were also identified in human MC (HMC‐1), a MC line kept in culture. These steps were necessary because of the unique finding that only MC express OR, in spite of the inflammatory infiltrate present.

Conclusion These findings may help to explain why IC occurs primarily in women, why IC and other associated symptoms tend to be worst at the midcycle, and may also suggest the prognostic usefulness of staining bladder biopsies for OR. These results are particularly interesting because oestradiol has been shown to augment MC histamine secretion in response to the neuropeptide, substance P, which may be released in certain neuroinflammatory disorders which have a high prevalence in women, such as IC and irritable bowel syndrome.
Proliferating cell nuclear antigen cyclin in human transitional cell carcinoma
Authors: Hattori K. , Uchida K. , Akaza H. , Koiso K. , Nemoto R. , Harada M.
Published: November 2008

Objectives To confirm the value of the proliferating cell nuclear antigen (PCNA) labelling index in relation to histological grade, stage and prognosis.

Materials and methods Tissue specimens from 56 patients (49 men, 7 women; mean age 65 years [range 34–86J) with newly diagnosed transitional cell carcinoma of the urinary bladder were stained by an avidin‐biotin peroxidase method using an anti‐PCNA monoclonal antibody. Irnmunohistochemical analysis was performed on ethanol‐fixed, paraffin‐embedded tissue sections obtained by endoscopic biopsy or trans‐urethral resection (TUR). The PCNA labelling index was determined by counting the number of PCNA‐labelled cells in the tissue sections.

Results Grade 1 tumours averaged 5.1 ±3.0% labelling versus 10.9 ± 5.2% in grade 2 tumours, and grade 3 tumours had a PCNA labelling index of 21.8 ±10.4%. The average labelling indices for superficial tumour (37 patients) and invasive tumour (19 patients) were 7.5±5.3% and 20.8 ±10.0% respectively. A distant metastatic bladder tumour showed an average labelling index of 42.3%. To analyse survival, tumours with PCNA indices above and below the median level (12%) were compared. Those patients with an index of < 12% (the mean of all of the PCNA values) had a worse prognosis than those with an index of > 12%. The mean PCNA labelling indices in recurrent and non‐recurrent tumours were 6.4 ±0.7% and 8.2 ±1.7% respectively, statistically not significant.

Conclusion The higher PCNA labelling index may indicate biological malignancy. These results suggest that measurement of the PCNA labelling index in bladder cancer may prove to be an objective and quantitative assay of biological aggressiveness and provide significant prognostic information, though it does not help to select patients at high risk of recurrence in superficial tumours.
Spindle and giant cell carcinoma of the urinary bladder: a clinicopathological light microscopic and immunohistochemical study
Authors: Sfrio G. , Zampatti C. , Ceppi M.
Published: November 2008

Objective To evaluate the cellular nature and biological behaviour of spindle and giant cell carcinoma (SGCC) of the urinary bladder. The clinicopathological. light microscopic and immunohistochemical features of seven patients are reported.

Patients and methods Paraffin‐embedded I issue was available from each patient for microscopic and immu‐nohistochemical studies. There were five men and two women, ranging in age from 48 to 79 years. Clinical histories and follow ‐up information were obtained by review of ihe patients' churts. The clinical outcome was compared with that of transitional cell carcinoma (TCC) and small cell carcinoma (SCC).

Results The tumours were large, polypoid and frequently ulcerated. They diffusely permeated the bladder musculature or the perivesical fat. On microscopic examination live tumours were composed mainly of interlacing sheets of spindle cells and occasional giant cells: two comprised giant cells only. Foci of identiliable TCC (papillary or in situ) were present in four tumours. Immunohislochemistry demonstrated that SGCCs exhibit a phenotype indicative of an epithelial nature.

Conclusions The median survival (11 months) of the seven patients indicates that SGCCs have a poor prognosis and they are more aggressive than TcYs of the same stage. The unfavourable clinical course is similar to the rapidly fatal outcome of small cell carcinomas of the bladder. The prolonged survival periods of three patients who received additional chemotherapy suggest that this treatment may be profitable.
Does neoadjuvant cisplatin‐based chemotherapy improve the survival of patients with locally advanced bladder cancer: a meta‐analysis of individual patient data from randomized clinical trials*
Authors:   Advanced Bladder Cancer Overview Collaboration: (Collaborators: D. Ghersi L.A. Stewart, M.K.B. Parmar, C. Coppin, J. Martinez‐Pineiro, D. Raghavan, M.A. Wallace)
Published: November 2008

Objectives To assess whether neoadjuvant or concurrent platinum‐based chemotherapy improves the survival of patients with locally advanced bladder cancer, and to determine whether there is any evidence that chemotherapy is more or less effective within well‐defined subgroups of patients.

Patients and methods A formal meta‐analysis (overview) was carried out using updated individual data from 479 patients (301 deaths) from four randomized trials comparing local definitive treatment alone with neoadjuvant or concurrent single‐agent cisplatin followed by local definitive treatment. Further summary data were available from a similar randomized trial of cisplatin and doxorubicin in 325 patients (127 deaths).

Results Combined analysis of the individual patient data gave an overall hazard ratio of 1.02 in favour of local therapy alone (P= 0.845, 95% confidence interval = 0.81–1.26), representing a 2% increase in the relative risk of death with the use of chemotherapy. When this analysis was supplemented by data from the only trial for which individual patient information was not available, the hazard ratio was 0.91 in favour of chemotherapy (P= 0.328, 95% confidence interval = 0.75–1.10), representing a 9% reduction in the relative risk of death. The only prognostic factor for which the evidence suggested a differential treatment effect (interaction) across groups was age (chi‐square test for trend = 3.833, P= 0.05), with younger age groups (<60 years) exhibiting a possible effect in favour of chemotherapy.

Conclusions Despite a meta‐analysis of all known randomized trials, there is still insufficient information to obtain a definitive answer to the question of whether neoadjuvant cisplatin‐based chemotherapy improves the survival of patients with locally advanced bladder cancer. Such chemotherapy cannot therefore be currently recommended for routine use and any planned clinical trial should include a ‘no chemotherapy’ control arm.
Implications of cavitation phenomena for shot intervals in extracorporeal shock wave lithotripsy
Authors: Wiksell H. , Kinn A.‐C.
Published: November 2008

ObjectiveTo study the influence of shot intervals and the quality of the coupling medium (degassed water) in extracorporeal shock wave lithotripsy (ESWL).

Materials and methodsAcoustic scattering and damping (and thereby also the focal size) were modelled with respect to the conditions of the coupling medium, using continuous wave high intensity ultrasound. The influence of the shot interval on rise time and attained shock wave pressure were quantified with a modified ESWL apparatus and a specially designed hydrophone.

ResultsIn tap water, which has a high content of dissolved gases, the focus produced was bulb‐shaped, with a diameter of approximately 4 cm, whereas degassed water gave a small focus that produced a water jet only a few millimetres in diameter. The efficacy of the acoustic energy decreased with shot intervals shorter than 1.2 s. Longer pauses resulted only in prolonged treatment times.

ConclusionESWL becomes inefficient if the intervals between pulses are too short, particularly when ECG R‐wave triggered pulses are used on patients with tachycardia. The gas content of the coupling medium is also important for successful ESWL. The efficacy of the system used for degassing the water should be checked at regular intervals.
Percutaneous drainage of renal hydatid cyst: early Results and follow‐up
Authors: Goel M.C. , Agarwal M.R. , Misra A.
Published: November 2008

Objective To evaluate a combination of percutaneous drainage and medical prophylaxis in the treatment of renal hydatid cyst to assist renal preservation, decrease morbidity and shorten the duration of hospital stay.

Patients and methods Four patients (three men and a woman, age range 26‐31 years) with non‐communicating renal hydatid cysts were selected for treatment using percutaneous drainage. This was performed under medical prophylaxis with albendazole and praziquentel. Ethanol (95%) was used as a scolici‐dal agent.

Results The method was successful in preserving three of four renal units but one unit was ablated because of secondary infection and haematuria. The kidneys of three patients were functioning adequately after a mean follow‐up of 21.6 months from percutaneous drainage.

Conclusions Percutaneous drainage of renal hydatid cysts is a safe and effective method for preventing renal loss, and decreasing morbidity and the duration of hospital stay. It should be employed as the first option for renal hydatid disease.
Is the transplant‐preserving management of renal allograft rupture justified?
Authors: Heimbach D. , Miersch W.‐D. , Buszello H. , Schoeneich G. , Klehr H.‐U.
Published: November 2008

Objective To evaluate the transplant‐preserving management of renal allograft rupture.

Patients and methods From April 1982 to January 1994 a total of 238 renal transplantations were performed on 227 patients. Eight cases (3.5%) of renal allograft rupture occurred. Transplant nephrectomy was necessary in one patient. Seven patients were surgically treated with collagen foam, fibrin glue and vicryl mesh.

Results In all seven cases treated conservatively, renal salvage and satisfactory graft function was achieved. After a mean follow‐up of 52.9 months (range 2‐94) the mean creatinine level was 15.6 mg/L (range 11‐21). Of these seven patients with renal allograft rupture one returned to haemodialysis 22 months after transplantation and had several episodes of rejection. Almost 4.5 years after renal allograft rupture, the creatinine value in six of the seven patients was only slightly higher than the mean creatinine values of all donor kidney recipients (14.4 ± 5.5 mg/L).

Conclusion There should be an attempt to salvage the transplant after allograft rupture in all cases. Using these transplant‐preserving techniques, renal function could be achieved for all patients with allograft rupture.
The expression of ferritin on renal cancers and its relationship with cellular differentiation and tumour stage
Authors: Yu D.‐S. , Yueh K.‐C. , Chang S.‐Y. , Yang T.‐H. , Ma C.‐P.
Published: November 2008

Objectives To investigate ferritin expression in renal carcinoma and the correlation of expression with tumour differentiation and stage.

Patients and methods Ferritin was immunohistologically detected in 35 patients (23 men and 12 women; mean age 58.2 years, range 40‐82) with renal carcinoma and the findings compared with cellular type, tumour stage and the ferritin expression of a similar control population of 16 patients.

Results The incidence of ferritin expression in renal carcinomas was 51%. Expression was significantly related to tumour stage and not cellular type.

Conclusion The Results of this study re‐emphasize the high expression of ferritin in renal cell carcinoma and the correlation of expression with tumour behaviour.
Intravesical mitozantrone in recurrent superficial bladder cancer: a phase II study
Authors: Namasivayam S. , Whelan P.
Published: November 2008

Objective To assess the efficacy of adjuvant intravesical mitozantrone in recurrent superficial bladder cancer.

Patients and methods Twenty‐one patients (15 men and six women, mean age 69 years, range 50‐91) with recurrent superficial bladder cancer were recruited for the trial between 1990 and 1992. After transurethral resection or diathermy of the tumour, each patient received 20 mg mitozantrone intravesically in 50 mL normal saline, which was retained for 1 h. The instillations were repeated at 2‐weekly intervals to a total of four instillations. The patients were followed up for 1 year.

Results Ten patients had a complete response, but only four were free of tumour at 1 year. Seven patients had a partial response whilst four had progression of their tumour. Only two patients withdrew from treatment due to chemical cystitis.

Conclusion Mitozantrone at the dose used in this study produced a high response rate and a low incidence of side‐effects compared with established agents.
Malignancies of the genito‐urinary system following renal transplantation
Authors: Schmidt R. , Stippel D. , Krings F. , Pollok M.
Published: November 2008

Objective To analyse the development of malignancies of the genito‐urinary system after renal transplantation.

Patients and methods A total of 868 renal graft recipients were followed up over a mean period of 41.8±45 months. Fifteen patients received grafts from living related donors and 853 were transplanted with kidneys from cadavers.

Results Twelve patients (1.4%) exhibited Cancer of the genito‐urinary system: 11 tumours were de novo malignancies. One small renal carcinoma was transplanted from a living related donor. The incidence of tumours of the genito‐urinary system was 34 in 100000 patient years in the patients treated with cyclosporin and 32 in 100000 patient years in the conventional therapy group. Four patients died within a mean survival time of 14.4 months. Comparison of our results with sex‐ and age‐specific incidence rates in a reference population showed an increase in malignant tumours of the genitourinary system by a factor of 7.3 in males and 11.2 in females.

Conclusions The frequency of disorders after transplantation necessitates routine examinations in organ transplanted recipients both before and at regular intervals after transplantation, including the patient's native kidneys and cervical smears in females.
Differential suppression of serum prostatic acid phosphatase and prostate‐specific antigen by 5‐alpha‐reductase inhibitor
Authors: Narayan P. , Tewari A. , Jacob G. , Mahmood I. , Gajendran V. , Presti J.
Published: November 2008

Objective To evaluate the effect of finasteride (Proscar®) on the serum levels of prostatic acid phosphatase (PAP) and prostate‐specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH).

Patients and methods Thirty patients on finasteride therapy for BPH formed the study group. Serum PSA and PAP levels were monitored for 2 years while the patients were receiving finasteride.

Results During 12 months of finasteride therapy the serum PSA was suppressed but serum PAP was unaffected. The baseline mean PAP value was 1.303 ng/mL prior to finasteride therapy; this changed to 1.510 ng/mL (P=0.195) at 6 months and 1.166 ng/mL (P= 0.383) at 12 months. The serum PSA was 2.630 ng/mL at baseline, 1.757 ng/mL (P<0.001) at 6 months and 1.545 ng/mL (P= 0.001) at 12 months.

Conclusions Further studies are warranted to determine if PAP has a role as a tumour marker in patients whose PSA is suppressed as a result of finasteride therapy.
The Kropp‐onlay procedure (Pippi Salle procedure): a simplification of the technique of urethral lengthening. Preliminary Results in eight patients
Authors: Mouriquand P.D.E. , Sheard R. , Phillips N. , White J. , Sharma S. , Vandeberg C.
Published: November 2008

Objective To lengthen the urethra to increase bladder outlet resistance in adolescent girls with a neuro‐genic bladder.

Patients and methods During a 2‐year period (1992–94), eight girls (mean age 13.5 years, range 9–19) underwent a Kropp‐onlay urethral lengthening associated, for six of them, with a bladder augmentation. Seven of the eight patients patients were spina biflda and confined to a wheelchair. One patient had had a previous transverse myelitis. A Benchekroun hydraulic valve (in three cases) and a Malone procedure (in two cases) were performed at the same stage. The technique of Kropp‐onlay urethral lengthening, which creates a flap valve mechanism which leaks when the bladder is too full, is described and illustrated.

Results Seven of eight patients were dry during the day and four were occasionally damp during the second part of the night. One could not be dry for more than 2 h during the day but had a very hyperactive detrusor. She developed two bladder stones which required an open vesicotomy. One developed a urethral fistula requiring a second Kropp‐onlay procedure and became dry afterwards. Two patients, who did not undergo a bladder augmentation, needed oxybutinin therapy to obtain a satisfactory result. Post‐operative urodynamic measurements are discussed.

Conclusion The Kropp‐onlay urethral lengthening is easier to perform than the original Kropp procedure. The preliminary Resultsare similar to those of alternative techniques (e.g. urethral suspension) but long‐term reliability of this technique remains unknown.
Histological response to injected Polytef and Bioplastique in the sheep brain
Authors: Dewan P.A. , Owen A.J. , Byard R.W.
Published: November 2008

Objective To assess the histological response of the sheep brain to the intra‐arterial injection of particulate plastic.

Materials and methods Four sheep had either polyte‐trafluoroethyene‐containing Polytef or silicone‐containing Bioplastique injected into the left carotid artery under direct vision. Two were killed soon after and the others were studied at 6 months. The brains of the animals were examined using routine histology, phase contrast and polarized light.

Results The polytetrafluoroethylene or silicone particles were identified in the two animals killed soon after the injection, and the two animals examined 6 months later. There was no evidence of demyelination and only a minimal inflammatory response to the plastic particles which had found their way into the brain parenchyma.

Conclusion Demyelination does not occur in the sheep brain after intra‐arterial injection of Polytef and Bioplastique, and inflammation occurs only to a minor degree.
Acid mucin and high molecular weight cytokeratin in prostatic lesions: evaluation of a combined histochemical and immunohistochemical stain
Authors: GAL R. , HALPERN M. , KOREN R. , RATH‐WOLFSON L. , KLEIN B. , SIEGAL A.
Published: November 2008

Objective To evaluate the presence of acid mucins and high molecular weight cytokeratin (KER) in prostatic lesions using a combined histochemical and immunohistochemical stain consisting of Alcian blue at pH 2.5(AB) with a strept‐avidin‐biotin complex (SAB) staining for KER (SAB‐KER).

Materials and methods Sections were obtained from archival paraffin blocks which included 20 cases of prostatic carcinoma, 30 cases of benign hyperplasia, and five cases of basal cell hyperplasia. Sections were stained for mucosubstances using the AB stain, for KER using SAB‐KER and by both AB and SAB‐KER, the combined stain (CS).

Results With the CS stain KER, which is present in the prostatic basal cells, was not detected in malignant glands and in 60% of these cases intraluminal blue‐stained acidic mucin was seen. On the other hand, all benign hyperplastic prostatic glands were devoid of intraluminal acidic mucin and showed staining for KER of their basal cells. Areas of basal cell hyperplasia were strongly positive for KER and intraluminal acidic mucin was seen in one case. Each of the stains separately gave similar results to the CS method but the contrast between the areas of carcinoma and hyperplasia was accentuated by the CS. and small foci of carcinoma were easily detected.

Conclusion The combined AB + SAB‐KER stain is quicker to perform and allows the simultaneous appraisal of acid mucin and KER.
Venous leak surgery: long‐term follow‐up of patients undergoing excision and ligation of the deep dorsal vein of the penis
Authors: VALE J.A. , FENELEY M.R. , LEE W.R. , KIRBY R.S.
Published: November 2008

Objective To review the long‐term results and satisfaction of patients after venous leak surgery for the management of impotence caused by a failure of passive venous occlusion.

Patients and methods Twenty‐seven patients (mean age 56 years, range 26–63) with erectile failure due to venous leakage, diagnosed on colour Doppler imaging (CDI) and pharmacocavernosometry and cavernoso‐graphy, underwent venous leak surgery. In all cases the deep dorsal vein of the penis was excised and ligated along with any other large accessory veins. Patients were reviewed in out‐patients at 3 months and asked to complete a questionnaire 1 year after surgery.

Results Three months after surgery, 19 of 27 patients (70%) had been able to resume sexual intercourse, 17 (63%) had spontaneous erections and two (7%) required papaverine/prostaglandin Ej. One year after

surgery, 14 of 22 patients were able to achieve erections sufficient for sexual intercourse, although four of these required self‐injection with papaverine. There were no serious complications, and when asked whether or not they would undergo the operation again, 13 of 20 said they would.

Conclusions We conclude that venous leak surgery is a useful treatment modality in patients with pure venous leakage proven by pharmacocavernosometry and/or cavernosography, and in whom arteriogenic impotence has been excluded using CDI. These are often desperate patients who would rather accept the risk that this relatively minor procedure may fail in preference to undergoing implant surgery in the first instance or use a vacuum device. However, well‐informed consent is essential.
Surgical management of elephantiasis of male genitalia
Authors: OLLAPALLIL J.J. , WATTERS D.A.K.
Published: November 2008

Objective To assess the outcome of the surgical management of severe elephantiasis of male external genitalia.

Patients and methods Twelve patients with gross oedema of their penis and scrotum were managed by excision of the lymphoedematous skin and subcutaneous tissue and a split‐skin graft.

Results The cosmetic and functional results were satisfactory in all cases. There was no recurrence and all patients were able to resume sexual activity.

Conclusion Surgical excision of affected tissue and split‐skin graft is an effective management for severe lymphoedema of the scrotum and penis.
Serum intercellular adhesion molecule (ICAM‐1), a marker of renal scarring in infants with vesico‐ureteric reflux
Authors: MIYAKITA H. , PURI P. , SURANA R. , KOBAYASHI H. , REEN D.J.
Published: November 2008

Objective To determine if serum intercellular adhesion molecule (ICAM‐1) levels correlate with renal scarring in children with vesico‐ureteric reflux (VUR).

Patients and methods Serum ICAM‐1 levels were measured in 81 children (29 boys and 52 girls, age range 2 months‐13 years) with VUR using an enzyme‐linked immunosorbent assay (ELISA) and compared with levels in a control group of 24 children (16 boys and eight girls, age range 2 days‐13 years) with no urological abnormalities.

Results The mean serum ICAM‐1 level in the control group was 202±79 ng/mL (mean±l SD) compared with 347±96 ng/mL in children with VUR (P<0.001). Fifteen of 26 children under 2 years of age demonstrated renal scarring while 18 of 44 children older than 2 years exhibited renal scarring. The mean serum ICAM‐1 level in patients who were <2 years of age and had renal scarring was 408 +ng/mL, significantly higher than in those who had no renal scarring (296± 68 ng/mL, P > 0.01). In contrast, there was no difference in serum ICAM‐1 levels in patients > 2 years of age with or with no renal scarring (353 + 87 and 325 + 91 ng/mL, respectively).

Conclusion Serum ICAM‐1 levels are significantly higher in children with VUR and may represent a valuable marker of tubular damage in younger children with VUR.
Experience with the Memotherm™ permanently implanted prostatic stent
Authors: WILLIAMS G. , WHITE R.
Published: November 2008

Objective To evaluate the Memotherm™ (Angiomed) permanently implantable prostatic stent.

Patients and methods Forty‐eight men (mean age 70.3 years, range 57–86) with symptoms and urodynamics suggestive of bladder outflow obstruction had a Memotherm™ stent inserted into the prostatic urethra. Subjective and objective follow‐up was performed at 1, 3 and 6 months.

Results All but one patient was eventually able to void. Ten stents have been removed and three patients are awaiting stent removal. Subjective benefits bore no correlation with the maximum urinary flow rate and the findings on cystoscopy. Only 15 of the 48 patients had a satisfactory result.

Conclusion Permanently implanted prostatic stents should be considered experimental and only marketed after intensive investigation. As a result of this study, the Memotherm™ stent is to undergo significant modifications.
Effect of age, comorbidity and type of surgery on perioperative complications and mortality of prostatectomy
Authors: IBRAHIM A.I.A. , EL‐MALIK E. , GHALI A.M. , MURAD N. , SAAD M.
Published: November 2008

Objective To study the effect of age, type of surgery and comorbidities (cardiovascular diseases, chronic lung diseases, diabetes mellitus and renal impairment) on the peri‐operative complications and mortality of prostatectomy.

Patients and methods A series of 236 consecutive patients who underwent prostatectomy (171 by transurethral resection, TUR, and 65 by open procedure) were reviewed. Ninety patients at risk with one or more of the comorbidities were grouped together and compared with the remaining 146 fit patients. Also, 148 patients aged ≤ 70 years were compared with 88 patients aged > 70 years. The peri‐operative morbidity variables compared were haemorrhage, ≥ 3 units of blood transfusion, bacteriuria, orchitis, pyrexia, uraemia and bed‐stay.

Results Mean post‐operative bed‐stay for patients at risk was significantly longer than that for fit patients (12 ± 7 and 9.7 ± 6 days, respectively). Mortality and the other morbidity variables, apart from postoperative bacteriuria which was more frequent in diabetics, were not significantly different between the groups. Similarly, comparing age groups revealed no significant differences. However, open surgery was associated with more haemorrhage, blood transfusion, post‐operative pyrexia and a longer bed‐stay.

Conclusion The comorbidities studied and age did not significantly influence the complications and mortality of prostatectomy. However, comorbidities prolonged post‐operative bed‐stay. Open surgery was associated with more bleeding and pyrexia and a longer bed‐stay than TUR.
Immunological infertility among Nigerian men: incidence of circulating antisperm auto‐antibodies and some clinical observations: a preliminary report
Authors: EKWERE P.D.
Published: November 2008

Objectives To (i) establish the incidence of circulating antisperm auto‐antibodies among infertile men; (ii) relate this incidence to the high prevalence of sexually‐transmitted diseases (STDs) in sub‐Saharan Africa and; (iii) elucidate the effect of steroid and other therapy on semen quality and subsequent fertility of the patients.

Patients and methods Serum samples from 50 infertile men and 50 age‐matched controls were assayed by two agglutination techniques for anti‐sperm antibodies. Mean sperm concentrations were determined before and after steroid treatment of patients having antibody titres of 1:64 or above. Serum levels of follicle‐stimulating hormone, luteinizing hormone, testosterone and prolactin were also determined by radioimmunoassay in 38 patients. Seminal fluid analysis and culture were performed in 35 patients and testicular histology determined in 21.

Results Agglutination was demonstrated in 22 of 50 sera (44%), whilst non‐agglutinating cytotoxic antibodies were detected in two. Only two of the 50 control sera (4%) were positive. After steroid therapy, antibody titres were significantly decreased and there was a sixfold improvement in mean sperm concentration and a threefold improvement in motility and morphological characteristics. Bacterial (46%) and non‐bacterial (17%) infection were recorded in 22 of 35 patients, 13 of whom showed the presence of antisperm antibodies in their sera. Staphylococcus aureus was the commonest single bacterial isolate. Overall, 13 of 29 patients (45%) improved, nine accounting for 12 pregnancies. Pregnancies and/or improvements in semen quality were observed only among patients with mild histological changes. Low testosterone and prolactinaemia occurred in 29% and 21% of the patients, respectively. Among these, anti‐sperm antibodies were also recorded in 18% and 13%, respectively.

Conclusion The incidence of antisperm antibodies among infertile men is high in Nigeria and may be related to high prevalence of STDs. Immunologically infertile men can be treated successfully with steroids. Concomitant antibiotic and hormone therapy may also be essential in appropriate cases. Clinicians are advised to adopt a multimodal approach to the treatment of male infertility in sub‐Saharan Africa. The presence of non‐agglutinating cytotoxic antibodies calls for further investigation of the role of complement in the pathogenesis of immunological infertility.