bluuebunny/crossref_metadata_2025 huggingface dataset:
30  Radical cystectomy for primary bladder malignancy: a 10‐year review
Authors: LOUIE‐JOHNSUN M. , HENRY M. , BRASLIS K. , MURPHY D. , NEERHUT G. , GRILLS R.
Published: February 2006

Purpose:  Radical cystectomy has long been the gold standard in the definitive management of muscle invasive bladder cancer and preventing stage progression in high risk groups. There are few recent reviews outside of major international centres. We compared our institution's results to published literature.

Methodology:  Records of 50 consecutive patients treated with radical cystectomy for biopsy proven bladder carcinoma between 1995 and 2005 were reviewed.

Results:  The mean age was 70 years and 76% were male. Median follow up was 37 (1–111) months. 23 patients (46%) had known history of superficial TCC and 12 patients (24%) had previous intravesical therapy. Transitional cell tumours accounted for 94% of cases and most (76%) were poorly differentiated. 24 (48%) had ≥pT3 disease. Regional lymph nodes were involved in 35%. 23 patients (46%) developed recurrence and over half (12 patients) recurred within 12 months. Both lymph node involvement and recurrence were associated with higher pT stage (P < 0.001). All patients with recurrent disease were dead within a year (median 103 days). Median hospital stay was 19 days and there was 1 postoperative death (2%). 5‐year disease free and overall survival were 42% and 34% respectively.

Conclusion:  Survival following curative resection for primary bladder malignancy is at best modest. Our overall proportion of higher staged disease contributed to poorer survival rates. An earlier more aggressive approach to definitive treatment may be warranted.
32  Postoperative tumour antigen presentation in murine models of malignancy
Authors: BROWN M.D. , VIVIAN J.B. , CURRIE A.J. , ROBINSON B.W.S.
Published: February 2006

As biological therapies emerge for urological malignancy, determining the impact of surgery on immune function is increasingly important. By uncovering the effects of surgery on tumour antigen, we have enabled a logical approach to immune therapy type, timing, and mode of delivery. Syngeneic AB1‐HA mesothelial tumour was grown subcutaneously in 100 female BALB/c mice aged 6–8 weeks. Once the tumour was 4 × 4 mm in size, complete resection was undertaken. Beginning from the day of surgery and extending to 4 weeks postoperatively, animals were subject to the adoptive transfer of carboxyfluoroscein diacetate succinimidyl ester (CFSE) stained tumour‐specific CD8 cells, followed by fluorescence activated cell sorting (FACS) analysis. Antigen presentation occurred only in the draining lymph nodes (P < 0.005), and was absent by the second postoperative week (P = 0.35). Our results suggest local adjuvant therapy may be effective in the early postoperative phase, and tumour vaccines in the longer term.
34  In vivo tumour hypoxia and carbonic anhydrase IX expression in xenografted human renal cell carcinoma animal models using probes, 124I‐G250 pet, biodistribution and immunohistochemistry immunobiodistribution, and oxygen studies
Authors: LAWRENTSCHUK N. , MURONE C. , RIGOPOLOUS A. , MOUNTAIN A. , O'KEEFE G. , JONES G. , LEE F.T. , DAVIS I.D. , SCOTT A.M. , BOLTON D.M.
Published: February 2006

Introduction:  Hypoxia stimulates angiogenesis and has been demonstrated in tumours where it correlates with resistance to treatment and poor prognosis. We have previously demonstrated hypoxia in human Renal Cell Carcinoma (RCC). The purpose of animal models was to further evaluate oxygen levels within RCC whilst also focusing on expression of the protein carbonic anhydrase IX (CA IX). This protein is stimulated by hypoxia and involved in angiogenesis and may be a potential tumour target for imaging and future therapies.

Methods:  Balb/c nude mice had human RCC (SK‐RC‐52) xenografted subcutaneously. Tumours were grown to different volumes with oxygen levels measured. Further groups then had the radiolabelled monoclonal antibody 124I‐G250 (that binds to CA IX) injected intravenously and had Positron Emission Tomography (PET), gamma counting and oxygen studies performed on days 0,1,2,3,5,7,10 and 14 post injection. Immunohistochemistry and autoradiography was also performed.

Results:  An inverse relationship between tumour volume and hypoxia within the model was established (P < 0.001). Furthermore, CA IX was expressed by tumours with maximal uptake of 124I‐G250 on days 2/3 by distribution with gamma counting that could be correlated with uptake on PET imaging.

Conclusions:  The xenograft model confirms human RCC are hypoxic. Also, that the level of hypoxia is inversely proportional to tumour sise. A correlation was made between PET scanning with 124I‐G250 and biodistribution within tumours by gamma counting confirming CAIX as an imaging and potential therapeutic target in RCC.
35  A novel method for transplanting a reproducible volume of xenograft tumour beneath the renal capsule using automated biopsy equipment and an epidural needle
Authors: LAWRENTSCHUK N. , RIGOPOLOUS A. , MURONE C. , LEE F.T. , DAVIS I.D. , SCOTT A.M , BOLTON D.M.
Published: February 2006

Introduction:  The growth of human tumours under the renal capsule in animal models has been performed successfully for many years. However, the use of modern surgical equipment has not always been translated into the animal laboratory. We report on a novel method for human renal tumour transplants using an automated biopsy gun to obtain tumour tissue and an epidural needle with introducer to easily deploy the grafts under the renal capsule.

Methods:  Nude mice had human xenografted tumours grown subcutaneously after implantation of cells from culture. Tumours were then biopsied using a 16 gauge automated biopsy gun. Digital callipers were used to measure a 2 mm segment of the biopsy core that was cut and placed inside a hollow needle (epidural needle). The needle was placed under the renal capsule and the trochar introduced to deploy the graft beneath the capsule with minimal trauma.

Results:  Tumour grafts were be established in ninety percent of grafted kidneys in this renal subcapsular model. Grafts were confirmed by direct observation and histology.

Conclusion:  Modern surgical equipment may be utilised to allow tumour transplantation to be undertaken in a more precise fashion than has previously been possible, with the volume of deployed tumour able to be identified and reliably reproduced. Surgical researchers and laboratory‐based scientists need to embrace new techniques and utilise them where appropriate in order to allow for a more objective comparison of results of xenograft transplantation.
36  Clinical disagreement in histological diagnosis and pathological stage in a series of nephrectomy specimens: the impact of recent changes to the WHO and TNM systems
Authors: CAMPBELL P.A. , PERRY‐KEENE J. , WILSON I. , MACTAGGART P. , NICOL D.L. , CAMPBELL C.M.
Published: February 2006

Introduction:  The prognosis and treatment of carcinoma of the kidney is predicted by the histological subtype and the pathological stage of the tumour. These are determined by pathological examination of the surgical specimen and the application of accepted classification and staging systems. We aimed to document how frequently disagreement in diagnosis and staging occurred in a retrospective review of a series of nephrectomy specimens.

Materials and methods:  All nephrectomies performed for tumour (all originally diagnosed as ‘renal cell carcinoma’) in the years 1990–1995 were identified. The original pathology report and the archived histological material were re‐examined. Cases were re‐classified using the 2004 WHO histological classification and clear cell renal cell carcinomas (RCC) were re‐staged using the 2002 TNM staging system. The revised and original classifications were compared for disagreement.

Results:  One hundred and twenty four (124) nephrectomy specimens were reviewed and a discrepant diagnosis was recorded in 24 (19%). Re‐classification of 123 primary tumours identified 100 clear cell RCC, 1 multilocular cystic clear cell RCC, 9 papillary RCC, 4 chromophobe RCC and 9 oncocytomas. When the 2002 and 1997 TNM stages were compared there was agreement for all cases of pT1a, pT3b, pT3c and pT4 tumours. Four pT1b and 2 pT2 cases were originally staged as pT3a. In 19 cases of pT3a tumours, 2 were originally staged as pT1, 6 as pT2 and 2 as pT3b. This represents a disagreement in 16% of cases (16/97). In 24/60 (40%) cases of organ confined disease, renal sinus fat had not been sampled and a pT3a stage could not be excluded.

Conclusion:  A retrospective review of nephrectomy specimens performed for tumour re‐assessed using the 2004 WHO classification and the 2002 TNM staging systems, demonstrated clinical disagreement in 19% and 16% of cases respectively. In 40% of cases of presumed organ confined disease the specimen had not been adequately sampled to exclude pT3a stage disease.
37  Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy
Authors: VASUDEVAN A. , DAVIES R.J. , SHANNON B. , COHEN R.
Published: February 2006

Objective:  The growing use of abdominal imaging has increased the detection of small incidental renal tumours. The aim of this study was to determine if the incidence of benign lesions in these radiologically detected masses is similar to the reported incidence of more advanced tumours and if preoperative renal core biopsy is effective in identifying benign lesions where nephrectomy can be safely avoided.

Materials and Methods:  In a retrospective study, renal core biopsy data of incidental tumours were analysed over a 5 year period. The biopsies were correlated with the final pathology of the nephrectomy specimens and with patient follow‐up if nephrectomy was avoided.

Results:  Of 70 diagnostic core biopsies, a third of cases were considered benign. The sensitivity and specificity for both benign and malignant lesions when compared to definitive pathology was 100% in all cases subjected to nephrectomy. Of the 30 non‐diagnostic biopsies, 3 were proven to be benign and a further 18, likely to be benign. The only complication of renal biopsy was one case of postbiopsy bleeding.

Conclusion:  A higher than previously anticipated proportion of incidentally detected small renal masses are benign. Based on the high sensitivity and specificity, there is value in core biopsy of small incidental renal lesions, a procedure which has a low complication rate (1%). When analysed by an experienced pathologist familiar with renal biopsy this may avoid radical nephrectomy in a significant number of patients.
39  A sterile disposable sheath system for flexible cystoscopes
Authors: LAWRENTSCHUK N. , BOLTON D.M. , CHAMBERLAIN M.
Published: February 2006

Introduction:  Flexible cystourethroscopy is a routine procedure in urology. Sterilization of instruments is time‐consuming and may damage flexible instruments but is essential to prevent contamination. This study is the first to document experience using a flexible cystoscope with a disposable sheath as an alternative to sterilization in a urological setting.

Methods:  Two hundred consecutive patients (172 men; 28 women) had flexible cystourethroscopy performed in an office setting using flexible endoscopes with disposable sheaths (Endosheath System, Vision‐Sciences Inc, Natick, MA) using a standardised procedure. Cystoscopies were performed for surveillance of bladder carcinoma (107), haematuria for investigation (59), lower urinary tract voiding systems (16), removal of stent (12), assessment of urethral stricture (5) and removal of calculus (1). Costings were calculated comparing a session using standard cystoscopes for ten procedures to the first ten procedures with this disposable sheath system.

Results:  There were no breaches of the sheath or contamination of the cystoscope and no infections recorded. There were nine technical failures with the disposable sheath system due to an inability to insert the cystoscope easily using the sheath, but these all occurred in the first one hundred procedures. Costings were comparable.

Conclusions:  Potential advantages of a disposable sheath system include eliminating sterilizing of the cystoscope between patients, saving staff time and minimising exposure to hazardous cleaning and sterilizing preparations. Costs are comparable but there is a learning curve for placing the instrument within the sheath. Endoscopes with disposable sheaths are safe, comply with universal precautions and are an alternative to current instrumentation and sterilizing systems.
44  Erythropoietin reduces functional impairment following renal ischaemia/ reperfusion injury in pigs
Authors: FORMAN C.J. , NICOL D. , JOHNSON D.
Published: February 2006

Introduction:  The advent of laparoscopic partial nephrectomy has led to renewed interest in tolerance of, and treatments for, ischaemic renal injury.

Materials and Methods:  Thirteen pigs underwent a 2‐stage procedure. First a right nephrectomy, followed a week later by clamping of the left renal artery for one hour and placement of a catheter. They were randomised to receive either i.v. Erythropoietin one hour prior to clamping, followed by daily s/c doses (n = 6) or no treatment (n = 7). 24 h urine collections and daily blood tests were used to calculate creatinine clearances.

Results:  Creatinine clearance expressed as a percentage of pre‐op baseline.

Pre‐op
Day 1
Day 2

Control
100
68 ± 6
74 ± 13

Treatment
100
95 ± 8.9
96 ± 12

Significance

P = 0.027
P = 0.23

By day 5 both groups had recovered to baseline levels. Serum creatinine concentration in umol/l, mean ± SEM.

Pre‐op
Day 1
Day 2
Day 5

Control
92 ± 9
132 ± 14
123 ± 13
89 ± 7

Treatment
94 ± 6
113 ± 10
106 ± 7
76 ± 3

Significance
P = 0.86
P = 0.29
P = 0.28
P = 0.15

The difference in means did not reach significance at the 0.05 level, but results are included to illustrate the degree of injury.

Conclusion:  Recent research has shown erythropoietin to be more than just a promoter of erythropoiesis. It is a tissue‐protective cytokine active in brain, heart and kidney. This is the first time that a functional benefit has been shown in a large animal model of renal ischaemic injury.
54  Robotic assisted laparoscopic pyeloplasty – the initial Australasian experience
Authors: KEARSLEY J.A.
Published: February 2006

Introduction:  Laparoscopic pyeloplasty is a proven treatment for PUJ obstruction but can be difficult to master due to the laparoscopic suturing involved. The Da Vinci operating system (Intuiative, CA, USA) has been used for other urological procedures, notable radical prostatectomy, and has been shown to reduce the learning curve for laparoscopically naïve surgeons. The initial Australasian experience of robotic assisted laparoscopic pyeloplasty is presented.

Patients and Methods:  Six patients with PUJ obstruction requiring treatment (five primary, one recurrent) who were suitable for pyeloplasty were offered the option of having their surgery using the Da Vinci operating system. The initial dissection was undertaken laparoscopically and the robot used for dismemberment and anastomosis.

Results:  Five of the six had their surgery completed robotically; open conversion was required in the patient who had undergone previous open pyeloplasty, the same patient required a blood transfusion due to haemolysis. Other surgical parameters (length of stay, operating time, complications, return to normal activities) were all in an acceptable range.

Six month postoperative nuclear renography revealed no obstruction in any patient and all were asymptomatic.

Conclusion:  Robotic assisted pyeloplasty is technically feasible for the surgeon with little experience of laparoscopic suturing. Operative data and early follow‐up results are encouraging.
69  Are we succeeding in teaching urology and encouraging it as a career choice for future doctors?
Authors: DIAS M. , LIM K. , TEMELCOS C.
Published: February 2006

Introduction:  With Australia's ageing population, there will be increased demand for urologists and their services in the future. We examine students’ perceptions of urology, and identify factors influencing career choice.

Methods:  Questionnaires were distributed to 135 final year medical students. Respondents were asked questions regarding career interests and their perceptions of urology. Their exposure to common clinical problems, examinations, and procedures of the specialty were also assessed.

Results:  One hundred and seventeen questionnaires were completed (response rate 82%). 68% of respondents received less than 10 h structured teaching in urology. 45% were interested in a surgical career, with 35% of these in urology. 47% indicated males were more suited to a career in urology, and 53% indicated both genders were equally suited. Compared to other surgical specialties, respondents rated urology as being amongst the easiest to gain entry, involved the least hours worked and least intellectual stimulation. The two most typical problems thought to occupy an urologist's time were prostatomegaly and outlet obstruction (75%) and incontinence (57%). The two least typical areas were bladder cancer (71%) and other non‐prostate urological malignancies (89%). Only 43% of respondents ranked stone disease amongst the three most typical problems. 52% of respondents had seen a TURP, 19% a nephrectomy and 13% a radical prostatectomy. 41% were comfortable performing a scrotal examination, 58% for male catheterisation and 53% for rectal examination.

Conclusion:  Deficiencies are evident in students’ knowledge of and exposure to urology and this may have an impact on the recruitment of young doctors into the specialty.
70  The life and trials of Diamond Jim Beaney, colonial lithotomist Melbourne 1876
Authors: MURPHY D.
Published: February 2006

Diamond Jim Beaney, (1828–1891), otherwise known as Champagne Jimmy led a controversial and colourful surgical life in Melbourne. He arrived in Melbourne in 1857 and was elected as an honorary surgeon to The Melbourne Hospital in 1860 for 5 years and then re‐elected under controversial circumstances in 1875 until 1890. He was the first in Australia to publish a medical text book and is seen by some as a true colonial pioneer in the area of colo‐rectal as well as children's medicine and welfare, in his adopted land. He was charged with murder on one occasion. He was the subject of a controversial coronial inquest into the death of a patient, subsequent to a trans‐perineal cysto‐lithotomy. His notoriety during his life has changed to benevolent acceptance in death, in that he is remembered at The University of Melbourne for bequeathing an annual award to the principal surgical and pathology scholars, in their final exams ‘The Beaney Prize’.
71  2005 Australia and New Zealand female urology survey: where are we and where are we going?
Authors: PILLAY S. , FOREMAN D.
Published: February 2006

Introduction:  Historically Urologists have had more training in the management of incontinence than prolapse, yet these conditions often coexist. As public hospitals perform less elective surgery there is an erosion of trainee exposure to female urology. Do Urological Society members see incontinence and prolapse as important areas for Urologists to continue managing?

Methods:  A survey was sent to all Urologists and Trainees in Australia and New Zealand about training, current practice and interest in female urology.

Results:  Sixty‐nine per cent perform SUI surgery in current practice, and 94% of these had exposure to SUI surgery during their training. 50% of those performing SUI surgery would have liked more training, and 99% believe Urologists should be able to perform SUI surgery. 23% perform prolapse surgery in current practice, and 52% of these had exposure to prolapse surgery during their training. 55% of those performing prolapse surgery would have liked more training. 92% believe Urologists should be able to competently assess women for prolapse and 76% believe Urologists should be able to perform prolapse surgery. 51% have a chaperone present when performing vaginal examination and greater than 50% indicated an interest in attending workshops in female urology. 99% believed trainees should be trained in female urology, and 67% believed there should be a fellowship in female urology.

Conclusions:  Most believe Urologists should manage incontinence and prolapse. Many wish they had more training in this area. Female urology fellowships are widely supported. There is sufficient interest to run workshops in this area.
73  Utility of video‐urodynamic studies in adults with neurogenic voiding dysfunction
Authors: KAMALAKANNAN R. , LEE T.K. , TUCKEY J.
Published: February 2006

Objective:  To study the utility of Video‐Urodynamics (VUDS) in patients with neurogenic voiding dysfunction (who were managed on clinical signs and symptoms) and compare the results of Multi‐Channel urodynamics (UDS) and VUDS in these patients.

Introduction:  Patients with neurogenic bladder may present with similar symptoms even though the underlying voiding dysfunction are different. In addition, it is difficult to predict bladder behavior based on the level and nature of neurological deficit as the correlation with the type of voiding dysfunction is poor.

Materials:  One hundred and six VUDS were performed over 36‐month period, of which 80 were for adults (68 males and 12 females) with neurogenic voiding dysfunction. Mean age was 47 (12–81 years). 73 were spinal cord patients (91%).

Results:  In addition to cytometrogram and pressure flow study findings, fluoroscopy revealed reflux in three (4%) patients, diverticuli in 16(20%), Fir‐tree appearance in nine (11%) and bladder outlet obstruction in nine (11%). The anatomic sites of obstruction were external sphincter in two patients and prostate in seven. Overall 53 patients (66%) had change in management after VUDS. Of the 53 patients three had reflux and nine had obstruction (External sphincter‐2 and prostate‐7) accounting for total 12 (15%) which could have been missed in UDS. Twenty patients had prior standard urodynamic studies and yet nine (45%) had to have their diagnoses updated and management changed.

Conclusion:  VUDS gives more information compared to UDS on the function and anatomy of the lower urinary tract and helps in the better management of patients with neurogenic voiding dysfunction.
80  Trial use of salmon calcitonin in chronic bladder pain
Authors: KUAN M.
Published: February 2006

Purpose:  To pilot use of Salmon Calcitonin (a peptide hormone for treatment of hypercalcaemia) in chronic bladder pain syndromes including interstitial cystitis. Calcitonin has been trailed with some success on other chronic regional pain syndromes such as phantom limb pain.

Method:  This is an ethics approved, double blinded, randomised crossover trial of 200IU intravenous Salmon Calcitonin vs. Placebo (Saline). Chronic bladder pain patients were recruited using standard NIDDK exclusion criteria. Patients were randomised to two arms, to receive either calcitonin or a saline infusion over 4 h. Bladder pain scores, bother, nocturia and frequency voiding were noted via visual analogue scales immediately prior to and 24 h after administration. Two weeks after first administration, patients arms were crossed over and the alternative infusion administered, again noting pre and postinfusion symptom scores.

Results:  Eight patients were enrolled in the trial. Analysis of pain scores via Wilcoxon Matched‐Pairs Signed‐Ranks Test showed a significant difference between pre and postcalcitonin (P ≤ 0.04688) as opposed to pre and postplacebo (P ≤ 0.125). No statistically significant difference was found in bother scores pre and post calcitonin or placebo. There was no significant difference found between pre and postcalcitonin or placebo for nocturia and daytime frequency.

Conclusions:  Calcitonin is a possible adjunct to conventional analgesia with little benefit for voiding symptoms. More numbers are required to further quantify the exact analgesic benefit.
83  Cystoscopic injection of polydimethylsiloxane to treat mitrofanoff channel leakage ‐ is it effective?
Authors: AGRAVAL V. , PATKI P. , ARUMUGAM K. , SHAH P.J.R.
Published: February 2006

Introduction:  Leakage of urine via the Mitrofanoff channel is a difficult clinical problem. We report use of injections of Polydimethylsiloxane as a bulking agent to cure this problem.

Methods:  We performed 21 Polydimethylsiloxane implantations in the leaking Mitrofanoff channels in 14 women at a tertiary referral centre. Analysis of improvement in leakage was done at six‐weeks. Patients with partial or no improvement in leakage were re‐injected. Twelve bladders were neuropathic treated with augmentation ileo‐cystoplasty and Mitrofanoff and two were overactive. Double Monti technique was used in nine and appendix in five.

Results:  The mean age was 45 years (range 26–60), with a mean follow up of 11 months (range 2–29). The mean volume injected was 2.78 ml. (range 0.5–5). Multiple implantations were required in 4. Leakage stopped in 4/14 patients requiring only one injection. Partial improvement was seen in 3 patients. In seven no improvement was seen after an average of two injections (range 1–4). Urinary diversion was performed in two while three have had revision of Mitrofanoff channel.

Conclusions:  Injection of bulking agent like Polydimethylsiloxane was successful in 28.5% of patients, and partially successful in 21.4% patients. Half the patients (7/14) found no benefit from the procedure.
9  Open radical retropubic prostatectomy ‐ a single surgeon series assessing long term oncological outcomes
Authors: RAO R. , CORCORAN N. , BOUCHIER‐HAYES D. , PETERS J. , COSTELLO. A.
Published: February 2006

Purpose:  •To critically analyse a single surgeon experience of open RRP over 8 years

• To assess outcomes up to 10 years

• To analyse mortality

• To analyse positive margin rates and outcomes

• To identify prognostic indicators of PSA failure

• To assess outcomes of those patients with PSA failure

Methods:  A retrospective chart review of all patients between 1994 to 2002 was performed. Sub group analysis of those patients with positive margins and PSA failures was performed.

Results: 

Intra‐op/Early mortality‐
 0 (0%)

Overall mortality‐
 4 (2.5%)

Cancer Specific mortality
 2 (1.25%)

Positive margins‐
16 (9.9%)

Positive nodes‐
 1 (0.6%)

PSA failures
48 (29.6%)

Conclusions:  Open RRP is a durable oncological procedure with low mortality and morbidity
94  Postoperative prostate specific antigen (PSA) decline predicts adequacy of adenoma removal with BPH surgical techniques.
Authors: GILLING P.J. , FONG E. , KENNETT K.M. , WESTENBURG A.M. , WILSON L. , FRAUNDORFER M.R.
Published: February 2006

Introduction:  PSA, in patients with BPH, is correlated with total prostate and transition zone volume. The decline in serum PSA levels may therefore be an important marker of completeness of tissue removal in patients undergoing invasive surgical procedures for BPH (Tinmouth et al 2005). In many techniques no tissue is retrieved therefore PSA decline may be a surrogate for adequacy of surgical treatment.

Methods:  A Medline search of original articles concerning current endoscopic BPH therapies was undertaken to identify papers in which PSA decline was documented. The amount of tissue retrieved (when relevant) and change in US volume was also recorded.

In addition four RCT's performed at this institution involving TURP(two studies) HoLEP(2 studies, HoLRP, Gyrus Enucleation and HoBNI (one study each) were analysed. PSA decline, TRUS and urodynamic data before and after surgery and tissue weight were recorded and correlated.

Results:  The mean % PSA and %TRUS volume decline noted following various treatments by literature search was as follows: TUNA (0% and 0%), BNI (NA and 0%) CLAP (45% and 15%) PVP (41% and 37%) TURP (73% and 50%) and HoLEP (83% and 76%).

Local RCT data ‐ PSA% and TRUS volume decline : HoBNI (36% and 0%), TURP (51% and 46%) HoLRP (56% and 44%), HoLEP (86% and 67%). The following significant correlations were noted on pooled analysis of the four RCT's: PSA % decline and % TRUS volume decline with path. weight and PSA % decline with improvement in urodynamic parameters. Path. weight also correlated with symptom score improvement.

Conclusions:  BNI, laser ablation and microwave appear to result in less PSA decline and TRUS volume fall than after TURP and by inference less complete removal of adenoma. HoLEP gives larger % falls. A greater fall appears to be associated with better clinical results and may ultimately impact on durability.
95  Critical review of a modified technique in buccal mucosa graft urethroplasty
Authors: WONG J. , WANG A. , PAPADOPOULOS B. , SOWTER S.
Published: February 2006

Introduction:  This presentation will be discussing the modified technique used by the author in his repair of complex urethra strictures. Barbagli et al renewed interest in buccal mucosa (BM) onlaid graft urethroplasty in early 90's. He described the technique of dorsal onlaid graft to improve the revascularisation of the free graft, to prevent shrinkage of the graft, and minimised diverticulum formation. The technique has one major drawback, namely the dorsal onlaid graft is limited to mid and distal bulbar urethra only. The author modified this original technique by employing the BM graft as a ventral onlaid graft and successfully repaired over 126 urethral strictures extending from urethral meatus to proximal bulbar urethra over the period of 1996 to 2005.

Result:  Using this modified ventral onlaid BM graft, mobilisation of the urethra is not necessary. This preserves the integrity of the urethral blood supply. After the stricture is identified using the Lister sound, a ventral urethrotomy is carried out. The extend of the stricture and surrounding spongiofibrosis are carefully evaluated visually as well as re‐calibration of the distal and proximal extension of the stricturing process until normal urethra is identified. 1.5 cm wide graft is then harvested with variable length depending on the extend of the stricture. All donor sites are closed primarily. Finally, the graft is sutured in situ and surrounding spongiosum is re‐deployed to provide a vascular and supporting bed for the free graft. At the penile urethra, the dartos fascia is employed to provide support to the free graft. The length of the graft ranged from 2.5 to 15 cm. The stricture sites varied extending from urethra meatus to proximal bulbar urethra just below the external sphincter. 12% recurrent stricture was reported in this group after follow up longer than 15 months. All patients had cystoscopy at 3 and 15 months to evaluate their graft calibre and recurrent stricture rate. Two out of 126 patients required complete graft revision due to sclerosing of the entire graft secondary to recurrent UTI postoperatively. Recurrent stricture tends to occur at the junctional site of the graft and usually diagnosed at their first cystoscopy. Postmicturition dribbling, UTI, ejaculatory dysfunction, erectile dysfunction, stone formation and diverticulum formation is rarely reported when compared to pedicle penile skin graft urethroplasty or pedicle scrotal graft urethroplasty. No patients have reported donor site morbidity.

Conclusion:  The modified ventral onlaid BM graft has proven to be a reliable graft in dealing of complex urethral stricture.
97  Flap or no flap in repair of urethral stricture
Authors: WONG J. , WANG A. , PAPADOPOULAS B. , SOWTER S.
Published: February 2006

Introduction:  When recurrent strictures become troublesome to deal with endoscopically and excision and anastomotic repair is not possible, substitution urethroplasty employing various pedicle flaps repair is the treatment of choice. In the past, foreskin flap, penile skin and scrotal skin had been employed with varying success. Unfortunately with long term follow up all skin repairs have high degree of recurrent UTI, recurrent stricture, stone formation, lichen sclerosus changes at the flap and diverticulum formation. Buccal mucosal free patch graft repair has gained wide acceptance after early reporting by G Barbagli in its use as dorsal onlaid graft in early 90's. The author reported his early work back in 1998, modifying the dorsal onlaid graft to ventral graft attracted criticism. With long‐term follow up and recent reporting from the Barbagli unit using the dorsal onlaid graft, the result presented from our unit is comparable to other major units around the world with minimal complications.

Result:  Between 1996 and 2005, 126 patients had BM ventral onlaid graft urethroplasty for recurrent strictures. All patients tertiary referred had previous dilatation, optical urethrotomy and some had previous substitution urethroplasties. Before 1996, pedicle penile skin graft was commonly used in our unit to repair urethral stricture at the bulbar or penile urethra. Many scrotal onlaid grafts were revised. In this group of pedicle skin urethroplasties, UTI and postmicturition dribbling were commonly reported by pts. All pts after BM graft urethroplasty had follow up cystoscopy at 3 and 15 months to assess and calibrate their graft luminal size before discharge from the unit. The length of the graft ranged from 2.5 to 15 cm. The graft has been employed to repair stricture from meatus to proximal bulbar urethra. The recurrent stricture usually occurs at the junctional area, either proximal or distal graft anastomotic site. Recurrent stricture tends to occur in the three and six months period. Revision urethroplasty for recurrent stricture in this group of patients was 12%. Two out of 126 patients required complete revision of their graft due to significant shrinkage secondary to recurrent UTI. One pt developed urethral cutaneous fistula at the penile scrotal junction. Postmicturition dribbling secondary to diverticulum formation is not a feature in this group of pts and ejaculatory dysfunction has not been reported.

Conclusion:  Modified ventral onlaid BM graft urethroplasty has been proven a reliable long‐term solution to pts with recurrent stricture that require substitution urethral reconstruction. The use of pedicle skin flap substitution urethroplasty is limited due to high complication rate in long‐term follow up.
98  Management of urethro rectal fistulae: experience utilising the York Mason approach
Authors: GRAY K.M. , WINKLE D.
Published: February 2006

Introduction:  Urethro rectal fistulae are a rarely seen clinical entity. These fistulae pose a difficult problem to the treating urologist. The majority of cases require surgical repair. Different approaches to surgical correction have evolved over time. We report our hospitals experience utilising the posterior transphincteric approach.

Patients and Methods:  Six patients in our hospital have undergone repair of this type over a two year period. Three fistulas occurred after radical retropubic prostatectomy. The remainder as a result of laser prostatectomy, transurethral resection of the prostate and rectal surgery. Five of these underwent preoperative faecal and urinary diversion. Once treatment was complete data was reviewed retrospectively.

Results:  All patients had a favourable outcome postoperatively. No faecal nor urinary incontinence is reported. No anal stenosis has developed. Postoperative recovery is rapid with minimal morbidity.

Conclusion:  Posterior transphincteric approach provides excellent exposure through healthy tissue planes. Favourable repair with symptom resolution was obtained in all patients treated at our hospital with minimal morbidity.
99  Perks, freebies and incentives: zero ethical responsibility?
Authors: GRUMMET J.P. , SNOW R.M.
Published: February 2006

Introduction:  The literature suggests that there is concern about the relationship between industry and doctors. Whilst industry sponsorship of education and research activities is highly valued, evidence suggests that promotional activities may influence doctors in ways that are not always beneficial to patients. The industry‐doctor relationship must therefore be transparent and comply with ethical standards of the community to preserve professional integrity and maintain patients’ trust. The aims of this study are 1) to determine the opinions of patients on the ethics of various practical aspects of urologists’ relationship with industry; 2) to compare these opinions to those of urologists.

Methods:  A questionnaire comprising 22 aspects of the industry‐urologist relationship was formulated. Approval was obtained from the hospital ethics unit to distribute the questionnaire to urology outpatients. The questionnaire was also given to patients at private practices of urologists, and distributed to urologists and trainees in Australia and New Zealand.

Results:  Over 200 questionnaires were returned for analysis. Urologists and their patients were found to hold very similar views on the ethics of the industry‐urologist relationship. Whilst industry funding for education and research activities was generally looked upon favourably, other promotional activities and conditional funding were generally not approved of. Notably, there was also a wide variation of opinion amongst urologists on several specific aspects of the industry‐urologist relationship.

Conclusions:  Australian and New Zealand urologists’ standard of ethics regarding their relationship with industry appears to be in line with that of their patients. Such concordance of opinion is desirable as it may help to preserve professional integrity and maintain patients’ trust.
Rules, safety and the narrativisation of identity: a hospital operating theatre case study
Authors: McDonald Ruth , Waring Justin , Harrison Stephen
Published: February 2006

Patient safety has become a health policy priority around the world. Acknowledging that ‘to err is human’ has led to attempts to design systems and rules that limit the capacity for individual discretion and thereby reduce clinical errors. In addition, great emphasis is being placed on the need to eradicate cultures of blame, which are assumed to discourage clinicians from reporting errors, and to establish a ‘safety culture’, which encourages openness and honesty. These efforts are underpinned by cognitive psychological explanations of the way individuals process information, which leads them to make errors of judgement. This paper examines the attitudes of hospital doctors and managers to the implementation of rules in the context of patient safety. Our analysis, using interpretive research focused on narrative identity, provides an alternative perspective to that offered by the current safety orthodoxy. This leads us to suggest that the achievement of a ‘safety culture’ is a remote prospect. The failure to follow formal written rules relates not to a deficiency in the cognitive capacity of individuals acting in isolation, but to the identities which individuals occupy, create and negotiate and the social rules (as opposed to clinical guidelines or protocols) which correspond to those identities.
Home range and habitat use by Geoffroy's cat (Oncifelis geoffroyi) in a wet grassland in Argentina
Authors: Manfredi C. , Soler L. , Lucherini M. , Casanave E. B.
Published: February 2006

Geoffroy's cat Oncifelis geoffroyi is a little‐known South American small felid. We report data on the spatial ecology of four adults (two males and two females) that were radiotracked in an area of wet grassland of the Argentine Pampas from February 2000 to April 2001. The mean home range size varied from 248 ha [90% minimum convex polygon (MCP)] to 342 ha (100% MCP), with male home ranges c. 2.5 larger than those of females. Home range overlap averaged 44.7%, and was more extensive between males than between females but it decreased markedly when outliers were excluded. Forest patches were used more than expected by their availability within home ranges. These patches hosted many large defecation sites, possibly acting as ‘communication centres’ where information was exchanged among individuals in the form of scent marks. Despite the lack of a clear preference for tall grasslands, this was the most frequently used habitat. We argue that natural grasslands in the Pampas ecoregion are important for O. geoffroyi and that their alteration can affect the conservation status of this cat. The comparison of our data with those reported previously suggests that Geoffroy's cat can show a certain degree of flexibility in its spatial behaviour.
Evidence of seasonal migration in a tropical subterranean vertebrate
Authors: Measey G. J. , Barot S.
Published: February 2006

Many animals undergo migrations that depend on a range of biotic or abiotic factors provoking daily, seasonal or annual movement of individuals and/or populations. Temperate amphibians frequently have their life cycles dominated by annual temperature fluctuations, but in the tropics it is often presumed that distinct rainy seasons will influence amphibians more than small changes in temperature. Here, we direct the seasonal changes in abundance hypothesis to a caecilian amphibian Boulengerula boulengeri found in monthly randomized quantitative surveys in the top 30 cm of soil. Meteorological data are used to interpret the significant changes found in relation to rainfall and temperature variables. Instead of the expected correlation of migration with rainfall, we find that frequency varies significantly and positively with temperature. In addition, data on the depth at which individual caecilians are collected suggest that animals undergo a vertical (rather than horizontal) migration within the soil. This is the first example of vertical migrations with temperature (as opposed to rainfall) of any tropical subterranean fauna. We discuss the possible influences that stimulate migration in this species (abiotic factors, feeding, reproduction and predation). The ecology of caecilians has lagged behind that of all other tetrapods, and this study has importance for future ecological studies, as well as biodiversity assessments and monitoring methodologies.
Isolation and characterization of five microsatellite loci in the Glanville fritillary butterfly (Melitaea cinxia)
Authors: SARHAN ALIA
Published: February 2006

The Glanville fritillary butterfly offers unique opportunities for population genetic studies in a metapopulation. Here I report the characterization of five polymorphic loci inMelitaea cinxia. I found high levels of polymorphism, with allele numbers ranging from nine to 43, and very broad size ranges.
New microsatellite loci for the European bushcricket, Ephippiger ephippiger (Orthoptera: Tettigoniidae)
Authors: HAMILL RUTH M. , NOOR MOHAMED A. F. , WATSON ERIC T. , RITCHIE MICHAEL G.
Published: February 2006

Ephippiger ephippiger is a model organism for studies of sexual selection and phylogeography but little is known about fine‐scale population structure. Available microsatellite loci have null allele problems so we used an enrichment technique to isolate 21 new microsatellite loci for E. ephippiger. We present primer pairs for 10 polymorphic loci (3–11 alleles per locus). Observed heterozygosities at polymorphic loci ranged from 0.118 to 0.787, but several were significantly lower than expected.
Isolation of microsatellites from Girella tricuspidata
Authors: CURLEY BELINDA G. , GILLINGS MICHAEL R.
Published: February 2006

Microsatellites were isolated from Girella tricuspidata (Girellidae) and screened for 64 individuals collected from coastal reefs in New South Wales, Australia. All seven loci tested were highly polymorphic, having seven to 42 alleles with average heterozygosities between 0.44 and 1.0. One locus (GT1N8) had a significant excess of homozygotes, probably due to the presence of null alleles. These microsatellite loci should be informative for examining population genetics of this species.
Budgeting for Contracting in Local Government
Authors: RUBIN IRENE
Published: February 2006

While the amount of contracting out seems to be leveling off, the number of larger, long‐term contracts seems to be increasing. Such contracts are generally not well described in local budgets. Recent efforts in some cities to shift to more outcome‐oriented performance budgeting should push toward more clarity in reporting on major contracts in the budget. This article examines how a handful of major cities handle contracts in their budgets—in some cities contracts are omitted from the budget or all merged into one budget line—and makes some suggestions for improvements.
Cities, Tax Revenues, and a State's Fiscal Future: The Value of Major Urban Centers
Authors: BOWEN WILLIAM M. , HAYNES MARIE ELLEN , ROSENTRAUB MARK S.
Published: February 2006

Competition among core cities or urban centers and suburban and rural areas besets numerous states. The competition often occurs amid a political environment in which suburban and rural areas enjoy a political majority in the state legislature, a majority that directs state investments to their areas. With Ohio as a case study, the issues that have created the urban–suburban–rural trichotomy are reviewed and an analysis of the tax returns, by area, to state investments is presented. The findings illustrate that urban centers produce more tax dollars per dollar of state investment than other areas, implying that state underinvestment in urban areas harms overall state tax revenues.
Do State‐Funded Property Tax Exemptions Increase Local Government Inefficiency? An Analysis of New York State's STAR Program
Authors: EOM TAE HO , RUBENSTEIN ROSS
Published: February 2006

This study tests the effects of a growing form of indirect state aid—state‐supported property tax exemptions—on local government efficiency. We hypothesize that larger exemptions, by lowering the effective tax price paid by local homeowners and thus their incentive to monitor efficiency, will reduce local government efficiency. We test this hypothesis by examining the introduction of New York State's large state‐subsidized property tax exemption program, which began in 1999. We find evidence that, all else constant, the exemptions have reduced efficiency in districts with larger exemptions, but the effects appear to diminish as taxpayers become accustomed to the exemptions.
Selective Renal Arterial Infusion of Fenoldopam for the Prevention of Contrast‐Induced Nephropathy
Authors: NG MARTIN K. C. , TREMMEL JENNIFER , FITZGERALD PETER J. , FEARON WILLIAM F.
Published: February 2006

Contrast‐induced nephropathy (CIN) remains an important complication of angiographic procedures, particularly among patients with significant renal impairment. To date, vasodilator therapies such as fenoldopam have failed to prevent CIN, possibly because significant hypotension as a result of systemic infusion has limited the ability to deliver adequate drug levels to the renal vasculature. We present a case of averted CIN after multivessel coronary intervention in a diabetic patient with severe renal insufficiency, potentially due to bilateral renal arterial infusion of fenoldopam. Our subsequent experience with intrarenal fenoldopam in nine additional procedures in eight other high risk patients resulted in one case of asymptomatic transient CIN. Further studies are warranted to evaluate the efficacy of intrarenal administration of vasodilator therapies such as fenoldopam for the prevention of CIN.
Recurrent Acute Profound Thrombocytopenia Related to Readministration of Eptifibatide
Authors: CHEEMA AAMIR ADNAN , TEKLINSKI ANDREW HENRY , MARIA VIQAR , CHILUKURI KARUNA , FRANK JOHN JOSEPH , GOSSELIN MARC OLIVER
Published: February 2006

We describe the case of an 86‐year‐old woman who presented with unstable angina. She was given heparin and eptifibatide, and she underwent percutaneous coronary intervention (PCI). Shortly thereafter, she developed acute profound thrombocytopenia (6,000 platelets/mm3), which resolved after the discontinuation of heparin and eptifibatide. Four months later, she presented again with unstable angina and underwent PCI. Soon after the procedure, she again developed acute profound thrombocytopenia (2,000 platelets/mm3). To our knowledge, acute profound thrombocytopenia due to eptifibatide treatment in the same patient at two different times has not been reported before.