bluuebunny/crossref_metadata_2025 huggingface dataset:
Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography
Authors: Robert M. , Segui B. , Vergnes C. , Taourel P. , Guiter J.
Published: March 2003

Objective To assess the effects of the interposition of pelvic bones and abdominal gas in the shockwave pathway during piezoelectric extracorporeal shock wave lithotripsy (ESWL) of distal ureteric stones.

Patients and methods The study included 35 patients who were evaluated with unenhanced spiral computed tomography (CT), used according to their positioning during ESWL. The shockwave pathway was simulated on the sagittal and coronal views crossing the ureteric calculi, allowing a theoretical evaluation of the effective shockwave focusing (with no bone or gas interference). Vertical and oblique approaches were statistically compared for bone and gas interposition.

Results Overall, the effective shockwave focusing during in situ piezoelectric ESWL of distal ureteric stones was 71% of the theoretical area. The interposition of bone and gas was significantly lower for an oblique access than for a vertical approach in the sagittal plane (P < 0.001 and 0.03 on the sagittal and coronal views, respectively). Using stepwise logistic regression, the difference between vertical and oblique accesses in the sagittal plane was mainly affected by the bladder volume (P < 0.001). On the coronal views, the interposition of bone and gas affected 31 patients (89%). Such interference was eliminated in 73% of the patients with a contralateral inclination of the shockwave axis in the coronal plane.

Conclusion The interposition of pelvic bones and abdominal gas in the shockwave pathway can affect the performance of piezoelectric ESWL of distal ureteric stones. While awaiting clinical confirmation of these theoretical data, we recommend that patients are treated with the bladder full and that the shockwave generator is inclined in both the coronal and sagittal planes.
Trends in testicular carcinoma in England and Wales, 1971–99
Authors: Power D.A. , Brown R.S.D. , Brock C.S. , Payne H.A. , Majeed A. , Babb P.
Published: March 2003

Objectives To examine incidence, mortality and survival trends in England and Wales for testicular cancer, using the recently developed national cancer and national mortality databases.

Methods The directly age‐standardized incidence rates for testicular cancer in England and Wales were calculated for the period 1971–97 and age‐standardized mortality for years 1971–99. Trends in the data were then assessed, including the influence of social deprivation on testicular cancer incidence and survival.

Results The number of newly diagnosed cases of testicular carcinoma in 1971–97 in England and Wales increased from almost 650 to 1400. The age‐standardized rates were 2.9 per 100 000 cases in 1971 and 5.4 per 100 000 in 1997, an increase of 88% over 26 years. There was a large decrease in mortality since the mid‐1970s, with an age‐standardized mortality of < 0.5 per 100 000 since 1985. For men with testicular carcinoma diagnosed in 1991–93, the 1‐year relative survival was almost 98% and 5‐year relative survival almost 95%, compared with 82% and 69%, respectively, for men diagnosed during 1971–75. There is a ‘deprivation gap’ for the 5‐year survival of > 6% in favour of the most affluent socio‐economic group, with no significant change over recent years.

Conclusions The incidence of testicular cancer is increasing in England and Wales, consistent with the trend documented in other developed countries. The reduction in mortality has been marked since the mid‐1970s, reflecting improved cancer management, in particular the introduction of platinum‐based chemotherapy regimens for advanced disease. Survival rates in England and Wales are as good as in other European countries. Further developments in chemotherapy are unlikely to produce such a marked improvement in survival rates again, and minimizing the effect of social status on survival rates should be an important target of future care.
Increased incidence of hypospadias in small‐for‐gestational age infants in a neonatal intensive‐care unit
Authors: Gatti J.M. , Kirsch A.J. , Troyer W.A. , Perez‐Brayfield M.R. , Smith E.A. , Scherz H.C.
Published: March 2003

Objective To identify the incidence of hypospadias in children born prematurely and small‐for‐gestational age (SGA), and to compare this subgroup with infants of similar age and weight without hypospadias.

Patients and methods Records from the neonatal intensive‐care unit (NICU) of a major metropolitan hospital active in labour and delivery were reviewed over a 3‐year period, specifically examining newborns admitted with the diagnosis of SGA, defined as a birth weight of < 10th percentile for gestational age. In all, 154 patients were identified and their charts reviewed, recording the presence and severity of hypospadias, gestational age, birth weight, placental weight, cord length, cord vessels, maternal age, parity, multiple births, drug exposure and associated comorbidity. A control group of age‐ and weight‐matched infants without hypospadias were also identified and compared.

Results Of the 154 patients, 17 (11%) had hypospadias; the hypospadias was distal in nine, mid‐shaft in four and proximal in four. The severity of hypospadias did not correlate with the degree of prematurity or weight for gestational age. Placental weight, fetal weight, fetal to placental weight ratio and cord length were all lower in the hypospadias group than in the control group, but the differences were not statistically significant. The maternal age was evenly distributed (median 32 years, range 20–43). Most mothers were multiparous and births were multiple in five of 17 (30%). Cryptorchidism (three) and inguinal hernia (three) were present in four of the infants.

Conclusions The incidence of hypospadias in SGA infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower placental and fetal weight in SGA infants with hypospadias than in the controls. This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.
Laparoscopic orchidopexy: a review of a large clinical series
Authors: Chang B. , Palmer L.S. , Franco I.
Published: March 2003

Objective To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures.

Patients and methods The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one‐stage and staged Fowler–Stephens (F‐S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery.

Results From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra‐abdominal in 46, iliac in 14, in the internal ring in 22, ‘peeping’ in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one‐stage F‐S in 20 and a two‐stage F‐S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5–12 years); the mean (range) follow‐up was 5 (1–36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow‐up available). Four patients (4%) had testicular atrophy from failed F‐S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow‐up, was 96% (90 of 94). Of the 20 one‐stage F‐S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F‐S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy.

Conclusion The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra‐abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.
The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up
Authors: Misseri R. , Gershbein A.B. , Horowitz M. , Glassberg K.I.
Published: March 2003

Objective To determine, in adolescent boys after varicocelectomy, the incidence of hydroceles, when they develop and whether the development is procedure‐related.

Patients and methods The records were retrospectively reviewed of 77 boys who underwent 95 varicocelectomies and had an examination at  6 months after surgery. Fifty‐six patients underwent a standard Palomo procedure (45 left and 11 bilateral) and 21 a modified Ivanissevich repair (14 left and seven bilateral). The mean (range) age of the patients at surgery was 14.1 (10–22) years and the mean follow‐up 25.5 (6–84) months.

Results Of the 67 Palomo varicocelectomies 19 (24%) were complicated by hydroceles after surgery, compared with four of 28 (14%) Ivanissevich procedures (P = 0.034). Of the Ivanissevich repairs, none of the 14 unilateral repairs developed hydroceles. Three hydroceles (one bilateral and one left) developed in two of seven patients after bilateral varicocelectomy. Of the Palomo repairs, 12 of 45 unilateral repairs were complicated by hydroceles, and seven developed in five of 11 patients after bilateral varicocelectomy. Although more hydroceles developed after bilateral varicocelectomy, there was no significant difference from the unilateral group. However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P = 0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6–12 months, three at 13–18 months, five at 19–24 months and four at > 2 years after surgery. Three patients had late varicocele recurrence, i.e. 15, 37 and 76 months after surgery; these patients had not had varicoceles on palpation after surgery at 3, 14 and 63 months, respectively.

Conclusion Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic‐sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months after varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.
Systemic effects of intravesical atropine sulphate
Authors: Enskat R. , Deaney C.N. , Glickman S.
Published: March 2003

Objective To investigate systemic antimuscarinic activity after the intravesical administration of 6 mg of atropine sulphate.

Subjects and methods Ten subjects were recruited to an open study in accordance with strict inclusion and exclusion criteria. Each subject received an instillation of 6 mg atropine sulphate diluted to 20 mL with normal saline. All variables were measured at baseline (before instillation) and the instilled solution retained for at least 2 h. After instillation systemic antimuscarinic activity was monitored every 20 min for 2 h then hourly for the next 4 h. The measurements included blood pressure, sublingual temperature, pulse rate, peak expiratory flow rate, lacrimation and salivation rates; all variables were analysed statistically. Facial skin was also observed for hyperaemia. All subjects were questioned about any known symptoms produced by antimuscarinic agents. The heart rate was recorded continuously before and after instillation using a Holter monitor.

Results None of the variables changed significantly after instillation and the Holter analysis showed no relevant variation in heart rate. All subjects consistently denied any antimuscarinic symptoms. One subject had mild cutaneous hyperaemia, as reportedly occurred consistently when her bladder was distended (> 500 mL). Immediate catheterization drained 600 mL and the hyperaemia resolved.

Conclusion The failure to detect systemic antimuscarinic activity at a dose which has previously been shown to suppress detrusor activity suggests that intravesical atropine therapy is safe for further study by clinical trial, and might provide a treatment for detrusor hyper‐reflexia that is free from side‐effects.
The Nesbit operation for Peyronie's disease: an analysis of the failures
Authors: Andrews H.O. , Al‐Akraa M. , Pryor J.P. , Ralph D.J.
Published: March 2003

Objective To analyse critically the reasons for a poor outcome of the Nesbit operation for Peyronie's disease in 51 patients over a 20‐year period.

Patients and methods Fifty‐one patients who were classified as having a poor result from the Nesbit operation were reviewed (mean age 53 years, mean follow‐up 21 months). The factors responsible for a poor result were analysed and classified into three groups: (i) deformity > 30°; (ii) penile shortening > 2 cm; and (iii) impaired erection. Patients with a recurrent deformity were further classified according to the interval from surgery to the presentation of the recurrence.

Results Thirty‐one patients had a deformity of > 30°; this occurred immediately in three patients through surgical error, soon after surgery in eight patients because of suture failure and after 11 months in the remaining 20 patients because their Peyronie's disease progressed. Penile shortening of > 2 cm was present in 19 patients but this only affected coital function in four. Erection was impaired in 10 patients but this was present before surgery in most.

Conclusion The results of the Nesbit operation for Peyronie's disease can be improved by a preoperative assessment of erectile function and the use of sutures of high tensile strength. Patients should be warned that the disease may progress and that some penile shortening should be expected, although this does not affect coital function.
False‐positive pregnancy tests in patients with enterocystoplasties
Authors: Nethercliffe J. , Trewick A. , Samuell C. , Leaver R. , Woodhouse C.R.J.
Published: March 2003

Objective To determine the incidence and causes of false‐positive pregnancy tests in patients with enterocystoplasties.

Patients and methods In a pilot study, 15 consecutive patients (both sexes, with any type of urinary diversion) provided a urine sample for testing using the Clearview pregnancy test (Unipath Ltd, Bedford, England). False‐positive results occurred only in patients with continent reservoirs; patients with ileal conduits produced no false‐positive results and were excluded from the main study. The main study included 23 patients with a urinary reservoir constructed partly or solely of large bowel or ileum, who provided urine and blood samples for the assay of β human chorionic gonadotrophin and protein. Each urine sample was also analysed with the Clearview test.

Results In the pilot study, three men and two women had positive pregnancy test results. In the main study, 14 patients had a positive Clearview test (nine women and five men). One women was found to be pregnant and was therefore excluded from further analysis, giving a false‐positive rate of 57%. There was no difference in the type of reservoir, urine biochemistry and urine analysis results between the positive and negative groups. Frozen/thawed samples all tested negatively.

Conclusion It is possible that the mucus produced in enterocystoplasties may be interfering with the pregnancy test. Patients should be aware of this and not rely on commercial test kits. There is some potential that this test system could be adapted for measuring mucus production in urinary diversions.
Prevalence of urinary incontinence in women with cystic fibrosis
Authors: Cornacchia M. , Zenorini A. , Perobelli S. , Zanolla L. , Mastella G. , Braggion C.
Published: March 2003

Objective To determine the prevalence of urinary incontinence (UI) in female patients (aged 15 years) attending a cystic fibrosis (CF) centre, in whom stress UI could be common, as chronic coughing and sputum production are frequent symptoms associated with progressive lung disease in these patients.

Patients and methods An anonymous questionnaire was completed by 176 women with CF (mean age 24.6 years, sd 5.8) during routine assessments as outpatients.

Results In all, 72 patients (41%) were classified as never incontinent; occasional UI was reported in 61 women (35%). Regular UI, occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 patients (24%). Regular UI was associated with increasing age and a lower mean (sd) forced expiratory volume/s (of that predicted) than in women with no urinary symptoms, at 26.9 (6.5) years and 53.5 (23.5)%, and 23.1 (5.4) years and 65.5 (23.2)%, respectively (P < 0.01 and P < 0.05, respectively). All incontinent women recorded stress UI; coughing, laughing and physical activity were associated with UI in 92%, 33% and 21% of the patients, respectively.

Conclusion Stress UI is a common symptom in women with CF. As urine loss can be under‐reported to the healthcare providers, women should be asked about incontinence as part of their routine follow‐up. Pelvic floor muscle exercises are effective in treating stress UI and should be considered for those with CF and regular UI.
Selective urological evaluation in men with febrile urinary tract infection
Authors: Ulleryd P. , Zackrisson B. , Aus G. , Bergdahl S. , Hugosson J. , Sandberg T.
Published: March 2003

Objective To investigate the prevalence and clinical importance of urological abnormalities in men with community‐acquired febrile urinary tract infection (UTI).

Patients and methods In this prospective study, 85 men (median age 63 years, range 18–86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto‐urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography.

Results The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow‐up after one month, or early recurrent symptomatic UTI.

Conclusion Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.
Cimetidine in painful bladder syndrome: a histopathological study
Authors: Dasgupta P. , Sharma S.D. , Womack C. , Blackford H.N. , Dennis P.
Published: March 2003

Objective To determine whether oral cimetidine, which reportedly improves symptoms in 60–70% of patients with painful bladder syndrome/interstitial cystitis has a similar mechanism of action on the human bladder and involving a similar peptidergic pathway as it has in human stomach, where it alters histamine‐gastrin reactions mediated via H2 receptors and a proton pump.

Patients and methods Fourteen patients (13 women and one man, mean age 51 years) with refractory bladder pain and irritative urinary symptoms were treated with cimetidine. The response to cimetidine was assessed by outpatient follow‐up and an analogue pain score. Bladder biopsies from eight patients were stained with haematoxylin and eosin, and a polyclonal antibody to gastrin, with counterstaining using toluidine blue, to detect mast cell granules containing histamine. Biopsies from normal areas of the bladder from an age‐matched control group of patients with transitional cell carcinoma of the bladder were stained similarly. Human stomach and colon were used as positive controls for gastrin and toluidine blue, respectively. The clinical response to cimetidine was compared with the histology in a blinded fashion.

Results Eight of the patients responded well to cimetidine; none of the biopsies showed evidence of carcinoma in situ. Although G cells in the stomach stained well for gastrin none of the bladder biopsies showed gastrin‐like immunoreactivity, apart from some nonspecific urothelial staining. Numerous mast cells with crimson granules and pale nuclei were visible in three patients and fewer in three others; their presence or absence did not correlate with the symptomatic response.

Conclusions Cimetidine is a useful medical treatment for bladder pain but the presence or absence of gastrin or histamine‐like immunoreactivity does not explain its therapeutic benefit.
HOSE: an objective scoring system for evaluating the results of hypospadias surgery
Authors: Holland A.J.A. , Smith G.H.H. , Ross F.I. , Cass D.T.
Published: March 2003

Objective To determine the accuracy and utility of a scoring system designed to allow an objective appraisal of the outcome of hypospadias repair, based on evaluating meatal location, meatal shape, urinary stream, straightness of erection, and the presence and complexity of any complicating urethral fistula.

Patients and methods Twenty patients (median age 23 months) were randomly selected and reviewed at a median of 8.9 months after their hypospadias repair. Two paediatric surgeons, a nurse and one of the child's parents independently assessed each patient using the ‘hypospadias objective scoring evaluation’ (HOSE) system. The results were collated and the level of interobserver variation assessed using the weighted kappa test.

Results The mean weighted kappa was 0.66, indicating good agreement among observers. The level of agreement was highest between surgeon and nurse at 0.70, but remained good between surgeon and parent, at 0.65.

Conclusions Interobserver variation using the HOSE system was minimal, supporting its use as an objective outcome measure after hypospadias surgery, and facilitating an impartial evaluation of operations used in correcting hypospadias.
Regional lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with no suspected adenopathy before or during surgery?
Authors: Minervini A. , Lilas L. , Morelli G. , Traversi C. , Battaglia S. , Cristofani R. , Minervini R.
Published: March 2003

Objectives To evaluate the role of regional lymph node dissection (LND) in a series of patients with renal cell carcinoma (RCC) with no suspicion of nodal metastases before or during surgery.

Patients and methods A series of 167 patients with RCC, free from distant metastases at diagnosis, and who underwent radical nephrectomy at our hospital between January 1990 and October 1997, was reviewed. The mean (median, range) follow‐up was 51 (45, 19–112) months. Of the 167 patients, 108 underwent radical nephrectomy alone and 59 had radical nephrectomy with regional LND limited to the anterior, posterior and lateral sides of the ipsilateral great vessel, from the level of the renal pedicle to the inferior mesenteric artery. Of these 59 patients, 49 had no evidence of nodal metastases before or during surgery. The probability of survival was estimated by the Kaplan–Meier method, using the log‐rank test to estimate differences among levels of the analysed variables.

Results The overall 5‐year survival was 79%; the 5‐year survival rate for the 108 patients who underwent radical nephrectomy alone was 79% and for the 49 who underwent LND was 78%. Of the 49 patients with no suspicion of lymph node metastases, one (2%) was found to have histologically confirmed positive nodes.

Conclusion These results suggest that there is no clinical benefit in terms of overall outcome in undertaking regional LND in the absence of enlarged nodes detected before or during surgery.
Functioning adrenocortical neoplasms in children
Authors: Patil K.K. , Ransley P.G. , McCullagh M. , Malone M. , Spitz L.
Published: March 2003

Objective To describe the clinical features, treatment and outcome of functioning adrenocortical tumours in children, and to assess the value of tumour size as a marker for malignant potential.

Patients and methods Twenty‐one children (mean age at presentation 4.9 years, range 0.6–11; 12 girls and nine boys) who presented with a functioning adrenal mass over a 29‐year period (1972–2000) were assessed. Clinicopathological features and outcome information were obtained from a structured review of the case‐notes. Before 1980 the diagnosis and staging was mainly obtained by intravenous pyelography and plain X‐ray. Since 1980, ultrasonography, computed tomography and more recently magnetic resonance imaging were the methods of choice.

Results The mean (range) duration of symptoms before diagnosis was 31 (2–108) months. The symptoms and signs at presentation comprised virilization (18 children), Cushingoid features (three), precocious puberty (three) and hypertension (four). Three children had malignant neoplasms, one presented with metastasis and of the other two, one died from the disease within 6 months, despite adjuvant chemotherapy and radiotherapy. The third girl is disease‐free 11 years after complete excision of the neoplasm. Eighteen children had a benign neoplasm and all are alive and free of recurrence. In most of the children surgical extirpation was relatively simple, blood loss minimal, recovery uneventful and the hospital stay short (mean 5 days). The virilizing effects of all the neoplasms gradually resolved after surgery within a median (range) of 27 (6–108) months.

Conclusions Functioning adrenocortical neoplasms in children are rare, with a peak incidence in the first decade, are predominantly unilateral and more common in girls. Most are benign, but both benign and malignant lesions can present with virilizing and Cushingoid features. The malignant neoplasms have an extremely poor prognosis, especially if excision is incomplete, despite adjuvant chemotherapy and radiotherapy. Although there is an association between tumour size and malignancy, this cannot be used as a reliable individual discriminator.
The provision of transurethral prostatectomy on a day‐case basis using bipolar plasma kinetic technology
Authors: Eaton A.C. , Francis R.N.
Published: March 2003

Objective To evaluate, in a prospective study, the potential for providing elective transurethral prostatectomy on a day‐case basis, using new bipolar electrosurgical technology.

Patients and methods Forty men with confirmed bladder outlet obstruction caused by benign prostatic enlargement underwent plasma kinetic vaporization of the prostate (PKVP) in the Day Surgery Unit; they were scheduled to be discharged on the day of surgery with an indwelling catheter, returning for a trial removal of the catheter at 48 h, and followed up at 2 and 4 months after surgery.

Results Thirty‐four (85%) of the 40 patients were able to return home on the day of surgery. All patients, including the six who failed to return home as a day‐case, successfully voided at 48 h; 78% felt the procedure was acceptable on a day‐case basis. At 4 months the mean improvement in the International Prostate Symptom Score and Quality of Life score were 64% and 84%, respectively. The mean improvement in flow rate was 200–250%.

Conclusion PKVP effectively relieves prostatic obstruction, at least in the short‐term (a longer term follow‐up is required). The procedure can be delivered safely on a day‐case basis and was very acceptable to the patients.
Oral propionyl‐l‐carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease
Authors: Cavallini G. , Biagiotti G. , Koverech A. , Vitali G.
Published: March 2003

Objective To ascertain whether oral propionyl‐l‐carnitine combined with intraplaque verapamil is a useful therapy for advanced or resistant Peyronie's disease.

Patients and methods The combined drugs were assessed in two studies. In the first, 60 patients with advanced Peyronie's disease, diagnosed using accepted definitions, were randomized in two subgroups treated with verapamil intraplaque infiltration (10 mg weekly for 10 weeks) plus a 3‐month administration of propionyl‐l‐carnitine (2 g/day), or verapamil infiltration plus oral tamoxifen (40 mg/day) for 3 months. In the second study, 15 patients with resistant Peyronie's disease (progression despite previous therapy) received verapamil plus propionyl‐l‐carnitine. The differences between subgroups or between the variables before and after therapy were compared using analysis of variance or the chi‐squared test.

Results In the first study, the reduction in pain was the same in both subgroups. Propionyl‐l‐carnitine plus verapamil significantly reduced penile curvature, plaque size, cavernosal artery end‐diastolic velocity, the need for surgery and disease progression, and increased the International Index of Erectile Function score and resistivity index of the cavernosal arteries. Tamoxifen plus verapamil had none of these effects. No drug combination affected the peak systolic velocity. Patients receiving verapamil had no side‐effects but those taking tamoxifen did. In the second study propionyl‐l‐carnitine and verapamil modified the disease patterns as in the first and no patient had side‐effects.

Conclusion The combination of propionyl‐l‐carnitine and verapamil can be considered the therapy of choice for advanced and resistant Peyronie's disease.
Time‐dependent changes of resistive index in acute renal obstruction during nonsteroidal drug administration
Authors: Kmetec A. , Peskar‐Babnik D. , Buturovic‐Ponikvar J.
Published: March 2003

Objective To evaluate Doppler ultrasonography (DUS) and assess time‐dependent changes of the renal resistive index (RI) in acute unilateral renal obstruction during treatment with nonsteroidal analgesic for the relief of renal colic.

Patients and methods In 31 patients with symptoms of renal colic, treated with ketoprofen, unilateral obstruction was confirmed by intravenous urography. The patients were divided into four groups according to the duration of their symptoms, i.e. < 23 h, 24–47 h, 48–72 h and > 72 h. In each patient, the RI was measured over the arcuate, segmental and renal arteries of both kidneys using DUS. The values obtained in the obstructed kidney were compared with those for the contralateral kidney.

Results The mean (sd) RIs for all 31 patients were 0.71 (0.05) for the obstructed and 0.60 (0.05) for the contralateral kidney (P < 0.001), the mean difference (dRI) being 0.12 (0.07). In those with obstruction for < 23 h the mean RI of the obstructed kidney was 0.70 (0.05) and of the contralateral healthy one 0.62 (0.07). Values of RI were similar in the group with obstruction for 24–47 h and 48–71 h. In those with obstruction for > 72 h the mean RI of the obstructed kidney was 0.69 (0.07) and of the contralateral one 0.60 (0.04), with a dRI of 0.09 (P < 0.005). The RI was 87% sensitive and 90% specific for detecting renal obstruction.

Conclusion Although the patients were given ketoprofen, their mean RI for the obstructed kidney remained above the discriminatory threshold (> 0.70) during the first 71 h of obstruction. Only in those obstructed for > 72 h was the mean RI on the obstructed side slightly below the threshold, but the difference between the kidneys was significant. The measurement of RI is a reliable diagnostic method for detecting acute renal obstruction. With a longer duration of symptoms, the difference in RI between the kidneys becomes clinically more relevant.
18F‐fluoro‐2‐deoxyglucose‐positron emission tomography in the evaluation of nonseminomatous germ cell tumours at relapse
Authors: Sanchez D. , Zudaire J.J. , Fernandez J.M. , Lopez J. , Arocena J. , Sanz G. , Gimenez M. , Rosell D. , Robles J.E. , Berian J.M.
Published: March 2003

Objectives To compare the performance of 18F‐fluoro‐2‐deoxyglucose‐positron emission tomography (FDG‐PET) and computed tomography (CT) in the follow‐up of nonseminomatous germ cell tumours (NSGCT) in the retroperitoneum.

Patients and methods FDG‐PET was used 25 times in 15 patients diagnosed with NSGCT. At the time of diagnosis five patients each were in stage I, II and III. Five patients had pure embryonal carcinoma, two had yolk sac tumours, one choriocarcinoma and seven had mixed tumours.

Results Eleven patients either presented with retroperitoneal disease or this did not disappear after chemotherapy. The results of both examinations coincided in 18 cases and were contradictory in the other seven, the difference being statistically significant (P=0.042).

Conclusion In these patients FDG‐PET detected the retroperitoneal relapse of NSGCT, in advanced stages treated with surgery plus chemotherapy, earlier than did CT; it also detected the presence of mature teratoma in residual retroperitoneal masses more accurately than CT. More extensive trials are needed before making conclusions about FDG‐PET imaging as a routine method for NSGCT.
Gender as a prognostic factor in patients with renal cell carcinoma
Authors: Onishi T. , Oishi Y. , Goto H. , Yanada S. , Abe K.
Published: March 2003

Objective  To evaluate gender as a prognostic factor in patients with renal cell carcinoma (RCC), using a retrospective review of patients with RCC stratified according to gender and analysing factors affecting prognosis.

Patients and methods  From January 1957 to December 1995, 768 patients with pathologically defined RCC (all of whom underwent nephrectomy) were classified as having clear cell carcinoma in 662 (follow‐up in 648), papillary RCC in 43 (follow‐up in 42), chromophobe cell carcinoma in 36 (follow‐up in 34) and cyst‐associated RCC in 27 (all followed up) according to the criteria proposed by the World Health Organization. The survival rates were compared between men and women, calculated and stratified according to the subtype of RCC.

Results

 There tended to be a more favourable prognosis in women than in men but the difference was not quite significant (
P

=0.061). Of those with clear cell carcinoma, women had a more favourable prognosis than men and the difference in survival was significant (
P

=0.012). No other subtype of RCC was associated with a significant difference in survival between the sexes. There was a smaller proportion of patients with stage IV and a larger proportion with stage I disease in women than in men (
P
<0.05). Of stage I patients, women had a more favourable prognosis than men (
P
<0.011). Women had better survival after recurrence than had men, the difference being significant (
P =0.007).

Conclusion  The prognosis is significantly better in women than men with clear cell carcinoma. The factors that contribute to a favourable prognosis in women are the greater proportion of lower stage disease and better survival after recurrence.
The management of stress urinary incontinence after radical prostatectomy
Authors: Peyromaure M. , Ravery V. , Boccon‐Gibod L.
Published: March 2003

Up to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects <5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.
Bladder dysfunction as a prognostic factor in patients with posterior urethral valves
Authors: Lopez Pereira P. , Martinez Urrutia M.J. , Espinosa L. , Lobato R. , Navarro M. , Jaureguizar E.
Published: March 2003

Objective To investigate the extent to which different types of bladder dysfunction can affect long‐term renal function in boys with posterior urethral valves (PUV).

Patients and methods Renal and bladder function were retrospectively assessed in 59 boys with PUV (mean age 10 years, range 5–17). All patients included in the study had at least 4 years of follow‐up and their bladder behaviour had been evaluated in at least two urodynamic studies. At the time of the study, of the 59 PUV boys, 37 had normal renal function and 22 had end‐stage renal disease (ESRD).

Results Of the 59 boys with PUV evaluated by urodynamic studies, 25 had normally behaving bladders (42%) and 34 had some type of bladder dysfunction (58%). Of the 22 in ESRD, 15 had abnormally behaving bladders (68%) and only seven had bladders with normal behaviour (32%). Of the 37 boys with normal renal function, 19 had dysfunctional bladders (51%) and 18 had normal bladders (49%). Instability was found in 17 of 19 boys with bladder dysfunction and normal renal function. On the contrary among 22 boys with ESRD, poor compliance was the most frequent urodynamic pattern (eight, 53%) while instability was only found in five. Overall, eight of nine boys with poorly compliant bladders, two of three with myogenic failure and a five of 22 with instability were in ESRD, and this situation occurred at an earlier age in patients with poorly compliant bladders.

Conclusions Bladder dysfunction should be considered as a prognostic factor in renal failure. Those with poor bladder compliance and myogenic failure have the worst outcome, while bladder instability was associated with the lowest incidence of renal failure.
Cadaveric fascia lata pubovaginal slings: early results on safety, efficacy and patient satisfaction
Authors: Walsh I.K. , Nambirajan T. , Donellan S.M. , Mahendra V. , Stone A.R.
Published: March 2003

Objective  To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI).

Patients and methods  Thirty‐one women with SUI (25 type II and six type III; mean age 63 years, range 40–75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3‐day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales).

Results

 The mean (range) operative time was 71 (50–120) min, blood loss 78.7 (20–250) mL and hospital stay 1.2 (1–2) days; there were no surgical complications. Over the mean follow‐up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (< 15 cmH
2
O) voiding pressures before surgery required self‐catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty‐four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (
P

 < 0.05). The severity of leak and storage symptoms was also significantly less (
P  < 0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, ≈ 80% of the patients said they would undergo the procedure again and/or recommend it to a friend.

Conclusion  Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.
The urological complications of renal transplantation: a series of 1535 patients
Authors: Streeter E.H. , Little D.M. , Cranston D.W. , Morris P.J.
Published: March 2003

Objective  To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors.

Patients and methods  A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk‐factor analysis. An unstented Leadbetter‐Politano anastomosis was the preferred method of ureteric reimplantation.

Results  There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living‐donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ‐sharing scheme vs the use of local kidneys. The management of these complications is discussed.

Conclusion  The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.
Urinary catheter ‘deflation cuff’ formation: clinical audit and quantitative in vitro analysis
Authors: Parkin J. , Scanlan J. , Woolley M. , Grover D. , Evans A. , Feneley R.C.L.
Published: March 2003

Objective  To investigate reports from district nursing staff of difficulty in removing long‐term urinary catheters (LTCs) because of the formation of a ‘cuff’ on deflating the self‐retaining balloon.

Patients and methods  Problems experienced by district nurses when removing urethral and suprapubic LTCs were audited, noting the type of problem, the catheter and any action taken. Quantitative in vitro studies were conducted on the deflated self‐retaining balloons after incubating a similar range of catheters in saline at 37 °C for 6 weeks, using suprapubic profilometry to assess the resistance to withdrawal (retention force).

Results  Questionnaires were returned on 154 patients with LTCs; 56% had urethral and 44% suprapubic catheters. The catheters were hydrogel‐coated (83%), all‐silicone (13%) and PTFE‐coated (3%). Twenty‐two (14%) of the sample reported problems with catheter removal in the previous year, including 15 (68%) with all‐silicone catheters and 15 (68%) with suprapubic catheters; cuff formation was noted in 60%. In the laboratory, 10 of the balloons formed a ‘cuff’ on deflation, but there was great variability in the effect this had on the retention force, with values of 0.5–3 N for different catheters.

Conclusions  Most problems with catheter removal involved all‐silicone and suprapubic catheters. Suprapubic profilometry confirmed increased resistance to withdrawal by formation of a ‘cuff’ on deflation of the balloon of all‐silicone catheters. These results suggest that the first choice of catheter material for long‐term urethral and suprapubic use should be hydrogel‐coated latex.
Enlargement of calcium oxalate stones to clinically significant size in an in‐vitro stone generator
Authors: Ananth K. , Kavanagh J.P. , Walton R.C. , Rao P.N.
Published: March 2003

Objective  To develop and validate an in vitro method suitable for the quantitative investigation of the growth of calcium oxalate stones through to a clinically significant size.

Materials and methods  Small fragments of calcium oxalate calculi were suspended in a mixed suspension/mixed product removal crystalliser supplied with artificial urine supersaturated with calcium oxalate. The fragments were weighed at regular intervals until they reached ≈ 500 mg. The results were plotted as weight against time and fitted to equations corresponding to constant increase in diameter, surface area‐controlled and constant‐deposition growth patterns. The choice of the most appropriate model was based on the squared regression coefficient (r2).

Results  Eight fragments (2–6 mm in diameter) were grown to ≈ 10 mm in diameter over periods from 137 to 369 h. Seven of the growth curves were best‐fitted (r2 ≥ 0.988) by the equation w = kt(3/2) + c, where w is the weight, k is a growth constant, t is the time and c is a constant approximating to the initial weight. This corresponds to a surface area‐dependent mechanism.

Conclusions  The growth of these small fragments to a clinically significant size accelerated throughout the experimental period in a way which was consistent with a surface area‐dependent mechanism. We have developed a resilient model suitable for studying the kinetics of calcium oxalate stone growth in vitro.