bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Angiomyolipoma of the Kidney Associated with Hypercalcaemia
Authors: BYRNE D. J. , STEWART P. A. HAMILTON , LOWE J. W.
Published: November 2008

Angiomyolipomas are tumours of uncertain histogenesis which occur only in the kidney. They may represent hamartomas or true benign tumours. Renal angiomyolipomas are uncommon, except in patients with tuberous sclerosis, where 40 to 80% have small bilateral tumours discovered incidentally at autopsy (Lynne et al., 1979). About 200 cases in the general population had been described by 1976 (Busch et al., 1976), but with newer techniques of investigation more asymptomatic tumours are being picked up incidentally. Histologically, the tumours from patients with tuberous sclerosis are indistinguishable from those found in patients without this condition. In patients with tuberous sclerosis the tumours tend to be small, multiple, bilateral and asymptomatic, while in other patients they are large and unilateral. The patients may present with recurrent renal symptoms or as an acute abdomen following haemorrhage. Despite microscopic features which might suggest aggressive behaviour, the tumours are usually benign and only endanger life from the effects of haemorrhage and renal failure (Farrow et al., 1968). On rare occasions they may recur following surgical treatment and invade adjacent soft tissue (Kragel and Toker, 1985).
Percutaneous Nephrolithotomy in Horseshoe Kidneys Applied Anatomy and Clinical Experience
Authors: JANETSCHEK G. , KUNZEL K. H.
Published: November 2008

Summary— The arterial supply of horseshoe kidneys was studied in 6 anatomical specimens to establish whether there is a risk of haemorrhage when performing percutaneous nephrolithotomy. The anatomy of the collecting system was studied on patients' X‐rays, taken in different planes to obtain a three‐dimensional view.

It was found that there is no increased risk of arterial bleeding in horseshoe kidneys compared with normal kidneys. The orientation of the collecting system offers good access.

Eight patients with horseshoe kidneys and 1 with a malrotated kidney were treated with percutaneous nephrolithotomy because of solitary or multiple renal pelvic and caliceal stones and 1 ureteric stone. Four patients had had previous operations for calculi. All of the stones were removed without complications.
Cephradine Prophylaxis in Transurethral Procedures for Carcinoma of the Bladder
Authors: MacDERMOTT J. P. , EWING R. E. , SOMERVILLE J. F. S. , GRAY B. K.
Published: November 2008

Summary— The value of cephradine prophylaxis in reducing urinary infection was assessed in 243 patients undergoing endoscopy for bladder carcinoma. Patients were randomised either to receive 3 peri‐operative doses of cephradine or to receive no antibiotic. Urine specimens taken on the fifth post‐operative day showed a significantly lower urinary infection rate in those patients receiving cephradine prophylaxis.
Comparison of the Efficacy of “Trisdine” and Kanamycin‐Colistin Bladder Instillations in Reducing Bacteriuria during Intermittent Catheterisation of Patients with Acute Spinal Cord Trauma
Authors: PEARMAN J. W. , BAILEY M. , HARPER W. E. S.
Published: November 2008

Summary— An open, prospective, randomised, comparative study of “Trisdine” and kanamycincolistin bladder instillations in reducing significant bacteriuria during intermittent urethral catheterisation was conducted. Trisdine is an aqueous solution of chlorhexidine gluconate 0.01% with added ethylenediaminetetra‐acetic acid disodium salt and TRIS buffer at final concentrations of 1.34 mMoles and 0.01 Molar respectively. All patients (15 males and 3 females) admitted with acute spinal cord trauma and bladder involvement requiring intermittent catheterisation for more than 5 days during a 12‐month period were studied.

There was no significant difference in the mean incidence of significant bacteriuria during intermittent catheterisation in the 7 males who had kanamycin‐colistin bladder instillations compared with the 8 males who had Trisdine instillations. A comparison could not be made in the females because there were only 3 patients. Because Trisdine is more stable at ambient temperatures, is less likely to select antibiotic‐resistant bacteria and is less expensive, it is concluded that Trisdine is preferable to kanamycin‐colistin solution for bladder instillations during intermittent catheterisation.
Electrohydraulic Lithotripsy of Bladder Stones A Hong Kong Experience
Authors: YIP Y.L. , TIN H.
Published: November 2008

Summary— Forty transurethral electrohydraulic lithotripsy procedures for bladder stones have been done. The rigid cystoscope was adequate in most cases but the rigid nephroscope was advantageous in large stones because of its larger bore and range of accessories. Use of the flexible cystoscope for stone extraction was difficult but it could be used with a few friable stones of less than 1 cm or for follow‐up.
Response of the Benign Hypertrophied Prostate to Treatment with an LHRH Analogue
Authors: KEANE P. F. , TIMONEY A. G. , KIELY E. , WILLIAMS GORDON , STAMP G.
Published: November 2008

Summary— Twenty patients with outflow tract obstruction secondary to benign prostatic hypertrophy were treated with an LHRH analogue, buserelin, for up to 6 months. Despite maintaining castrate levels of testosterone and achieving a significant reduction in tissue levels of dihydrotestosterone, no significant improvement was seen in flow rate or residual volume.
Prolonged Erections Following Intracorporeal Injection of Medications to Overcome Impotence
Authors: WAITERS G. R. , KEOGH E. J. , CARATI C. J. , EARLE CAROLYN M. , WISNIEWSKI Z. S. , TULLOCH A. G. S. , LORD D.J.
Published: November 2008

Summary— We describe the management of 17 men who developed prolonged erections following the intracorporeal injection of vasoactive drugs (e.g. papaverine) for the treatment of erectile dysfunction. Twelve men who had psychogenic impotence developed prolonged erections following injection compared with 5 who had an organic aetiology. The aspiration of 20 to 50 ml of blood from the penis together with the intracorporeal injection of 1 to 2 mg metaraminol is an effective treatment of this complication.
Traumatic Rupture of the Testis
Authors: MacDERMOTT J. P. , GRAY B. K. , STEWART P. A. HAMILTON
Published: November 2008

Summary— We present 6 cases of traumatic rupture of the testis. Early scrotal exploration is indicated in this condition and may involve either repair or removal of the injured testis.

The extent of microvascular damage to the testis determines the outcome of a repair operation.
Percutaneous Surgery for Stones in Pyelocaliceal Diverticula
Authors: HEDELIN H. , GETERUD K. , GRENABO L. , HENRIKSSON C. , PETTERSSON S. , ZACHRISSON B. F.
Published: November 2008

Summary— The technique used for percutaneous extraction of stones in pyelocaliceal diverticula and the results of the procedure in 13 patients are presented. Nine patients have been free of their pre‐operative symptoms, pain and/or bacteriuria, since removal of the stones.
Prognosis of Radiologically Non‐functioning Obstructed Kidneys
Authors: TAHA S. A. , AL‐MOHAYA S. , ABDULKADER A. , KAMAL B. , YOUSIF A. , ANIKWE R. M.
Published: November 2008

Summary— Twenty patients found to have unilateral radiologically non‐functioning obstructed kidneys on excretory urography (IVU), and who had normal contralateral kidneys, were further evaluated. Ultrasonography, radionuclide imaging and CT scan were carried out pre‐operatively to try to predict which of the kidneys were potentially recoverable after relief of obstruction. Percutaneous nephrostomy was also performed on the last consecutive 7 patients 4 weeks before definitive treatment and the function of the kidneys determined daily. The patients were reevaluated 2 months after the relief of obstruction. Ultrasonography, radionuclide imaging and CT scan were not found to be reliable in predicting whether these kidneys were potentially recoverable. We consider percutaneous nephrostomy a good procedure for obtaining prognostic information prior to definitive surgery.
Quality of Life after Cystectomy Comparison between Patients with Conduit and those with Continent Caecal Reservoir Urinary Diversion
Authors: MÅNSSON ÅSA , JOHNSON G. , MÅNSSON W.
Published: November 2008

Summary— A questionnaire survey was carried out to assess the quality of life of 60 patients who had undergone cystectomy because of bladder carcinoma. Urinary diversion was by a continent caecal reservoir in 20 patients and by a conduit in 40. The patients' replies showed that cystectomy could cause severe problems in all aspects of life. Diversion with a continent caecal reservoir was associated with fewer stoma‐related problems and seemed to allow the patients greater freedom to continue activities such as sport, travel and social life. Sexual problems, disturbed relationships with partners and emotional and mental problems were common and did not differ between the two groups of patients. It is recommended that patients judged to be prone to mental and emotional disturbance after cystectomy should be identified pre‐operatively and given extra psychological support.
Bilateral Testicular Germ Cell Tumours: an Increasing Incidence and Prevention by Chemotherapy
Authors: THOMPSON JOYCE , WILLIAMS C. J. , WHITEHOUSE J. M. A. , MEAD G. M.
Published: November 2008

Summary— Of 120 patients with germ cell tumours of the testis, 6 (5%) developed contralateral tumours; 63 patients received cisplatin‐based combination chemotherapy for metastatic disease and none developed contralateral disease. By contrast, of 57 patients treated with orchiectomy alone or abdominal radiotherapy, 5 (8.8%) developed contralateral disease.
Tethered Ureteric Stents—a Clinical Assessment
Authors: BIRCH B. R. P. , DAS G. , WICKHAM J. E. A.
Published: November 2008

Summary— The acceptability and complications of tethered double‐J stents were assessed in 17 patients. The study snowed tethered ureteric stents to be safe, well tolerated and easy to remove. The technique avoids unnecessary urethral instrumentation and general anaesthesia and has benefits for both patients and hospital resources.
Closed Prostatic Commissurotomy An Endoscopic Technique for the Treatment of Benign Prostatic Hypertrophy
Authors: SHAFIK A.
Published: November 2008

Summary— Closed prostatic commissurotomy was performed in 27 patients with benign prostatic hypertrophy. The procedure was done under local anaesthesia. Through a 1 ‐cm suprapubic incision, the retropubic space was insufflated with carbon dioxide or nitrous oxide and the endotherm introduced. The laparoscope was also introduced into the retropubic space through a second puncture. The prostatic commissure was identified, coagulated and divided, sparing the mucosa of the prostatic urethra. Commissurotomy causes urethral decompression, which is the aim of any treatment for benign prostatic hypertrophy.

The result was satisfactory in 85% of patients. Failures were due to incomplete commissurotomy; laparoscopic revision led to good results. Urethral stricture, incontinence or epididymitis did not occur. Ejaculation was normal. The technique is simple and easy and the patient can leave the hospital on the same day.
Primary Mediastinal Seminoma
Authors: CEFARO G. AUSILI , LUZI S. , TURRIZIANI A. , SALVI G. , MARMIROLI L.
Published: November 2008

Summary— Two new cases of primary mediastinal seminoma are presented and 126 cases from the literature are analysed. Radiotherapy, alone or combined with surgery, is thought by some authors to be the treatment of choice and the role of chemotherapy is uncertain. We propose a classification by which it is possible to compare various therapeutic approaches and to establish their value.
Low Pressure Transurethral Resection of the Prostate Using a Suprapubic Trocar
Authors: YACHIA D.
Published: November 2008

The TUR syndrome was described by Creevy (1947) and is caused by absorption of irrigating fluid with rising intravesical pressure. To maintain low intravesical pressure and permit a clear view, the “return flow resectoscope” was developed. However, Matouschek and Wimmer (1984) showed that even when a suction pump was used with this resectoscope the return flow channel was unable to drain the returning fluids properly even if a 28 F resectoscope was used. Thus the “transurethral resection controller” was developed in order to monitor the intravesical pressures continuously when using a return flow resectoscope (Perez, unpublished data).
TNM Classification of Genitourinary Tumours 1987—Position of the EORTC Genitourinary Group
Authors: SCHRÖDER F. H. , COOPER E. H. , DEBRUYNE F. M. J. , DENIS L. , NEWLING D. W. W. , PAVONE‐MACALUSO M. , SMITH P. H. , SYLVESTER R.
Published: November 2008

Summary— This report analyses the changes in the classification of the genitourinary tumours introduced by the 1987 edition of the TNM system. Criticism and suggestions for improvement are given. These are based on the extensive experience of the EORTC GU Group with clinical trial work, particularly the identification of prognostic factors, on their success in reaching international consensus on tumour classification, and on information from the literature.

Many of the changes introduced in the 1987 system are not considered to be strictly necessary. These include the introduction of the new additional descriptors, including “C” and “R”, the changes in the T classification of prostatic and renal cancer, and the introduction of uniform N categories for all tumours and other features. We regret the omission of minimal requirements, the omission of the V classification for macroscopic or microscopic vascular invasion, the changes in the T categories of carcinoma of the bladder and the introduction of stage groupings for all urological tumours. Some of these changes are considered unacceptable. The attitude of the EORTC GU Group toward the use of the new TNM classification is indicated in detail.
Partial Nephrectomy: An Option in Calculus Disease?
Authors: TIMONEY A. G. , PAYNE S. R. , WALMSLEY B. H. , VINNICOMBE J. , ABERCROMBIE G. F.
Published: November 2008

Summary— Thirty‐seven patients treated by partial nephrectomy for calculus disease between 1971 and 1986 were reviewed retrospectively. Of the 25 patients available for analysis, 20% developed immediate surgical complications, 20% had residual post‐operative stone and 33% developed true ipsilateral stone recurrence during the period of follow‐up.

Our results from partial nephrectomy for calculus disease are compared with the results of treatment by percutaneous nephrolithotomy and extracorporeal Shockwave lithotripsy. It was concluded that partial nephrectomy should be reserved for situations where stone disease is associated with anatomical abnormalities which cannot be treated by the newer modalities of stone management.
Rigid versus Flexible Cystoscopy A Controlled Trial of Patient Tolerance
Authors: FLANNIGAN G. M. , GELISTER J. S. K. , NOBLE J. G. , MILROY E. J. G.
Published: November 2008

Summary— The cost‐efficiency and time‐saving associated with out‐patient flexible cystoscopy have propagated its use nationwide. However, only minimal attention has been paid to the feelings of patients exposed to this physically and emotionally invasive technique. We studied 53 consecutive patients attending for check cystoscopy at the time of their first flexible cystoscopy. Acting as their own historical controls, their feelings about rigid cystoscopy under general anaesthesia and subsequent flexible cystoscopy under local anaesthesia were assessed: 6/53 (11%) preferred rigid cystoscopy under general anaesthesia. The only significant association with their dislike of flexible cystoscopy, was their desire to stay in hospital overnight. It was concluded that with careful counselling and attention to individual needs, the preference for flexible cystoscopy over rigid cystoscopy under general anaesthesia can approach 100%.
Chronic Urinary Retention—a Sensory Problem?
Authors: PARYS B. T. , MACHIN D. G. , WOOLFENDEN K. A. , PARSONS K. F.
Published: November 2008

Summary— Factors which predispose some men with benign prostatic hyperplasia to chronic urinary retention whilst others develop acute retention are not understood. In order to assess whether there is an occult neuropathy associated with chronic retention, neurophysiological measurements were used to test the integrity of the lower urinary tract nerve supply. A series of 22 male patients with chronic urinary retention secondary to prostatic hyperplasia underwent sacral reflex latency measurement; 73% demonstrated a sensory suprasacral abnormality with intact spinal reflex arcs. These results suggest that although the sacral reflex pathways are intact, there is a sensory/proprioceptive abnormality in the higher neurological centres which may be an adaptive mechanism to the presence of bladder outflow obstruction.
The Value of the Measurement of Serum Prostate Specific Antigen in Patients with Benign Prostatic Hyperplasia and Untreated Prostate Cancer
Authors: ARMITAGE T. G. , COOPER E. H. , NEWLING D. W. W. , ROBINSON M. R. G. , APPLEYARD I.
Published: November 2008

Summary— Serum prostate specific antigen (PSA) levels were measured in 139 patients with benign prostatic hyperplasia (BPH) and in 88 patients with prostate cancer who were managed by deferred treatment. Acute urinary retention and large prostate glands tended to be associated with high PSA levels, but at levels > 10 ng/ml there was a significant risk of carcinoma being found on subsequent histological examination. The risk of progression of untreated prostate cancer was associated with levels of PSA > 20 ng/ml and with a high rate of change of PSA level. The value of measuring PSA in these patients is discussed.
Prognostic Significance of the Zona‐free Hamster Egg Test
Authors: HARGREAVE T. B. , AITKEN R. J. , ELTON R. A.
Published: November 2008

Summary— Hamster tests were performed on sperm samples submitted by 111 men attending a fertility clinic. The method used involved exposure of the sperm to an ionophore to stimulate capacitation as this has been shown to give better egg penetration rates. The men were followed up for a total of 166 couple years and note was made of any pregnancies. At the time of their initial assessment most of the men had poor sperm measurements using conventional methods of semen analysis. The hamster test results gave no additional prognostic information to that already known from the duration of involuntary infertility reported by the couple at their first clinic visit and sperm motility and concentration determined by conventional semen analysis. It was concluded that the hamster test was not useful in this situation.
Grading in Superficial Bladder Cancer. (1) Morphological Criteria
Authors: PAUWELS R. P. E. , SCHAPERS R. F. M. , SMEETS A. W. G. B. , DEBRUYNE F. M. J. , GERAEDTS J. P. M.
Published: November 2008

Summary— In a prospective study on the grading of superficial papillary neoplasms of the bladder a distinction was made between tumours showing only increased cellularity without appreciable cellular and nuclear deviation (grade l), tumours showing slight cellular variation (grade 2a), and tumours showing clear cytological deviation and a tendency to lose normal polarity (grade 2b).

Ninety‐one patients with a superficial tumour were followed up for a mean of 24 months. Grade 2a tumours recurred later and in fewer patients than grade 2b tumours. Progression was seen in 4% of grade 2a tumours and in 33% of grade 2b carcinomas. Adapting our results to the WHO grading system, we suggest that all tumours in this study defined as grades 1 and 2a should be classified as low grade and tumours defined as grade 2b should be classified as intermediate grade.
Acupuncture in the Treatment of Bladder Instability
Authors: PHILP T. , SHAH P. J. R. , WORTH P. H. L.
Published: November 2008

Summary— Twenty patients with lower urinary tract symptoms attributable to bladder instability or sensory urgency were treated with traditional Chinese acupuncture; 77% of patients with idiopathic detrusor instability were symptomatically cured. Urodynamic assessment after treatment showed no consistent changes and instability was abolished in only 1 patient. Bladder capacity rose in those who responded. Acupuncture is safe and free of complications and side effects. In patients with diurnal symptoms associated with idiopathic bladder instability it offers a therapy as effective as other non‐invasive treatments.
Occupational Bladder Cancer: A Guide for Clinicians: THE BAUS SUBCOMMIUEE ON INDUSTRIAL BLADDER CANCER
Authors: Hendry W. F. , Blandy J. P. , Glashan R. W. , Hall R. R. , Wallace D. M. A. , Baxter P. J. , Couch J. A. , Finch W. M. , Howe Dr W. , Parkes Dr H. Guy , Westbrook M. B.
Published: November 2008

Summary— In 1961 the British Association of Urological Surgeons published its original guide to urologists and surgeons on occupational tumours of the urinary tract. This revised guide has been produced by the BAUS Committee on Occupational Urothelial Cancers and has broadly the same objectives as the first:

1. To give guidance on the industries and occupations

(a) In which the known urothelial carcinogens have been manufactured or used and with which occupational tumours have been associated.

(b) In which epidemiological studies have revealed an increased risk of urothelial cancer but the exact carcinogens have not been identified.

(c) In which occupational urothelial cancers might be expected to occur but are not yet established or reported.

2. To assist the urologist in recognising cases with a possible occupational association.

3. To describe how these cases should be reported for industrial injuries benefit and occupational disease reporting (RIDDOR).

4 To outline the benefits that may be available to the patient.

5. To explain the changes that were introduced on 3 October 1983 following the report by the Industrial Injuries Advisory Council on the prescription of Neoplasm of the Bladder as a Prescribed Industrial Disease (now disease number C23) (Table 1).
Modified Nephro‐ureterectomy. Long‐term Follow‐up with Particular Reference to Subsequent Bladder Tumours
Authors: ABERCROMBIE G F. , EARDLEY I. , PAYNE S R. , WALMSLEY B H. , VINNICOMBE J.
Published: November 2008

Summary— Nephro‐ureterectomy is the standard treatment for transitional carcinoma of the renal pelvis and caliceal system. In recent years a modification of the conventional two‐incision technique has been described in which the intramural ureter is resected endoscopically and the remaining ureter is removed in continuity with the kidney through a single loin incision.

Twenty‐one patients had their renal pelvic tumours treated by this modified technique between 1970 and 1983. Of 16 patients available for analysis, 37.5% subsequently developed bladder tumours. It was concluded that this modified technique has no greater incidence of subsequent bladder tumour development than the conventional technique of nephro‐ureterectomy, whilst giving considerable benefit to the patient.
Urodynamic Findings following Radiotherapy for Cervical Carcinoma
Authors: PARKIN D. E. , DAVIS J. A. , SYMONDS R. P.
Published: November 2008

Summary— Forty patients were assessed urodynamically 5 to 11 years after radiotherapy for cervical carcinoma and compared with 27 patients prior to treatment. The mean volume of first bladder sensation after radiotherapy was significantly lower than the mean volume before treatment, as was the mean maximum cystometric capacity. The mean filling detrusor pressure was higher after radiotherapy than before treatment. Unstable detrusor contractions were found only in the 12 symptomatic patients. There was a significant reduction in maximal urethral closure pressure and functional profile length in the post‐radiotherapy group. Detrusor instability was a common finding following radiotherapy. The reduction in bladder capacity alone was not sufficient to account for the symptoms of frequency, urgency and urge incontinence.
Prostatectomy: Patients' Perception and Long‐term Follow‐UP
Authors: MALONE P. R. , COOK A. , EDMONSON R. , GILL M. W. , SHEARER R. J.
Published: November 2008

Summary— We have reviewed 500 consecutive prostatectomies with a follow‐up period of between 5 and 8 years; 184 surviving patients were sent a questionnaire and patients with residual urinary symptoms were interviewed, examined and a flow rate was performed. The operative mortality rate was 0.5%. Patients who presented with retention of urine had a high mortality rate in the first 3 years after the operation. Thirty‐six per cent of surviving patients with chronic retention and 24% of those who underwent elective prostatectomy had residual urinary symptoms at the time of the study. Of patients who were sexually active pre‐operatively, 34% felt that the operation was responsible for a deterioration in their sex lives. The incidence of retrograde ejaculation was 93%.

It was concluded that prostatectomy is a safe operation with good patient acceptability. Patients with symptoms of prostatism require careful evaluation before prostatectomy and sexually active patients should be warned of the risks of impotence and decreased satisfaction due to retrograde ejaculation.
Physician‐dependent Prognostic Variables in the Management of Testicular Cancer
Authors: THORNHILL J. A. , WALSH A. , CONROY R. M. , FENNELLY J. J. , KELLY D. G. , FITZPATRICK J. M.
Published: November 2008

Summary— A study of 246 cases of germ cell testicular cancer in Ireland between 1980 and 1985 confirmed that the personnel and the manner of management can significantly influence the outcome. Inadequate staging by omitting marker assays or CT scan reduced prognosis. Failure to use standard chemotherapy (PVB, BEP, POMBACE, VAB) or a reduced dosage diminished survival. Regular investigations are necessary during treatment, including marker assays, chest X‐ray and CT scan. Frequent monitoring is important in later follow‐up. Management by a urologist improved survival, especially if he was involved from the outset. The results also favoured the concept of combined management by a urologist and an oncologist.
Development of a Penile Rigidity Indicator and New Concepts in the Quanitification of Rigidity
Authors: DESI K.M. , FLOYD T.J. , FOLLETT D.H. , PEAKE D.R. , GINGELL J.C
Published: November 2008

Summary— A new non‐invasive device has been developed for the continuous measurement of penile rigidity. We describe its design and performance in experimental and clinical studies, both of which have demonstrated its high degree of sensitivity, reliability and reproducibility. We also report two new concepts in quantifying penile rigidity.
Reduction of the Urinary Risk Factors of Urolithiasis with Magnesium and Tartrate Mixture: a New Treatment
Authors: HALLSON P. C. , ROSE G. A.
Published: November 2008

Summary—Magnesium and tartrate each reduce calcium oxalate crystal formation in urine. Since the effects are additive, a palatable mixture of magnesium and tartrate salts was devised and fed to 6 healthy volunteers. There were no side effects. There was a moderate fall in urinary calcium, moderate rises in urinary magnesium, tartrate and citrate, and no change in urinary oxalate. Hence there are good grounds for supposing that this mixture could be used to prevent urinary stone recurrence.
The Diagnosis of Hypercalciuria in Children
Authors: VOSKAKI I. , MENGRELI C. , KIPOUROU K. , VRETOS C. , SBYRAKIS S.
Published: November 2008

Summary— Calcium loading tests were performed in 21 children with hypercalciuria, haematuria and/or nephrolithiasis and 10 control subjects. Comparisons of 24‐h calcium excretion before and after loading were evaluated rather than fasting urinary calcium to urinary creatinine ratio. The differences in calcium excretion before and after loading clearly distinguished absorptive from renal hypercalciuria. A difference higher than 0.035 mmol/kg indicated absorptive hypercalciuria in 6 of 21 patients, whereas in the remaining 15 much lower differences indicated renal hypercalciuria. Resorptive hypercalciuria caused by low serum values of 25‐hydroxyvitamin D was considered in 6 of the 15 patients with renal hypercalciuria. These patients had low values of phosphate reabsorption (TmP/GFR) and could be clearly separated by high values of calcium reabsorption (TmCa/GFR), in contrast to patients with renal hypercalciuria who had normal values of TmP/GFR and low values of TmCa/GFR. The correct treatment and prevention of nephrolithiasis caused by hypercalciuria in children should be based on accurate diagnosis; this can be achieved by using the calcium loading test described in this report.
The Mitrofanoff Principle for Continent Urinary Diversion
Authors: WOODHOUSE C. R. J. , MALONE P. R. , CUMMING J. , REILLY TINA M.
Published: November 2008

Summary— A continent urinary diversion was formed for 16 patients using the Mitrofanoff principle for continence. As originally described, this system used the appendix tunnelled into the bladder to form a continent catheterisable vesicostomy. We have expanded the technique and have used all available narrow tubes as continent conduits (ureter 10 cases, appendix 5, Fallopian tube 1). The urine container was made of large and small intestine and bladder in several combinations. The system has been very satisfactory: 14 patients were continent and able to catheterise; 1 required a revision to achieve continence and 1 awaits revision; 3 patients required revision procedures for stricture.
Urethral Substitution in Women
Authors: MUNDY A. R.
Published: November 2008

Summary— A series of 30 female patients underwent total urethral substitution for a variety of conditions, usually urogenital sinus abnormalities or post‐irradiation vesicourethrovaginal fistulae. Five different techniques were used: bladder flap neourethroplasty, neourethroplasty using a urinary tract remnant, vaginal/urogenital sinus neourethroplasty, pedicled labial skin tube neourethroplasty and colonic substitution neourethroplasty with synchronous implantation of an artificial sphincter.

Bladder flap neourethroplasty is appropriate if the bladder size is adequate and if the bladder neck is incompetent, but stress incontinence is a common complication which must be anticipated and dealt with proleptically. Vaginal/UG sinus neourethroplasty is preferred if the bladder neck is competent enough to preserve continence. When no other tissue is available, particularly after radiotherapy, a pedicled labial skin tube neourethroplasty gives the best results. Colonic substitution with the implantation of an artificial sphincter is not satisfactory.

Any surgically created neourethra should be wrapped with either labial fat pads or omentum and, in the absence of a competent bladder neck, with an artificial sphincter cuff to support the urethra and to prevent it telescoping, and for use as a back‐up if continence is not adequate.
Are Urodynamics Necessary in Female Patients Presenting with Stress Incontinence?
Authors: HASTIE K. J. , MOISEY C. U.
Published: November 2008

Summary— A urological and urodynamic database was used in a prospective study of female patients whose initial symptom was stress incontinence alone. The urodynamic diagnoses in 89 such patients were analysed against any additional symptoms. Fifty‐four patients complained of stress incontinence without other symptoms and none of these had detrusor instability. One patient from a group of 25 who had frequency with stress incontinence had low bladder compliance but the others had normal urodynamic studies. Of the 10 patients with urgency in addition to stress incontinence, 5 had unstable bladders.

A detailed urological history must be taken in all patients who are assessed for stress incontinence. Urodynamics are unnecessary in patients with stress incontinence alone but should be considered in those with additional urgency.
Change in Glycoconjugate for the Binding Site of the Lectin Ulex europeus 1 following Malignant Transformation of Prostatic Epithelium
Authors: ABEL P. D. , KEANE P. , LEATHEM A. , BUTT SUSAN TEB , WILLIAMS GORDON
Published: November 2008

Summary— Immunoperoxidase techniques were used to detect Ulex europeus (UEA1) binding sites on benign and malignant prostatic epithelium. Formalin‐fixed, paraffin‐embedded (FFPE) and cryostat sections were compared. In benign epithelium, less than 10% of cells on FFPE sections but between 50 and 90% of cells on cryostat sections expressed UEA1 binding sites. In malignant epithelium, more than 90% of cells bound UEA1, irrespective of whether FFPE or cryostat sections were used. Lipid solvents are required for FFPE (but not cryostat) processing and may cause glycolipid extraction. Glycoproteins are not affected. These results suggest that the UEA1 binding site is predominantly glycolipid‐based in benign prostatic epithelium but, following malignant transformation, becomes predominantly glycoprotein‐based.
Retrograde Ejaculation: Successful Treatment with Artificial Insemination
Authors: SCAMMELL G. E. , STEDRONSKA‐CLARK J. , EDMONDS D. K. , HENDRY W. F.
Published: November 2008

Summary— Between 1977 and 1987, 14 couples in whom the male partner had retrograde ejaculation were treated with artificial insemination using the husband's sperm (AIH). There were 6 pregnancies in 4 couples, giving a cumulative probability of pregnancy at 12 months of 72%. The success rate depended on a number of factors, including semen quality, methods of sperm extraction from the urine, timing of ovulation and other complicating fertility factors.
Scanning Electron Microscopic Findings in Interstitial Cystitis
Authors: ANDERSTRÖM C. R. K. , FALL M. , JOHANSSON S. L.
Published: November 2008

Summary— Scanning electron microscopy (SEM) was performed on transurethral resection biopsies from 13 patients with classic interstitial cystitis. Biopsies from 9 patients with stress incontinence served as controls. The SEM appearance of the bladder surface in interstitial cystitis varied considerably, exhibiting small round and large polygonal cells. The proportion of cells displaying round uniform and pleomorphic microvilli was high and sometimes dominated the area examined. SEM characteristics earlier assigned to bladder tumours were detected in patients with interstitial cystitis and, at a lower frequency, also in control patients. The mucin layer covering the urothelial cells seemed reduced in interstitial cystitis compared with control specimens. Surface characteristics specific for interstitial cystitis were, however, not detected by SEM.
The Effects of Cromakalim on the Detrusor Muscle of Human and Pig Urinary Bladder
Authors: FOSTER C. D. , SPEAKMAN M. J. , FUJII K. , BRADING A. F.
Published: November 2008

Summary—The effects of cromakalim, a potassium channel activating drug, have been studied on isolated detrusor muscle strips from normal Landrace boar, normal and unstable mini‐pig and unstable human bladder. Cromakalim abolished spontaneous activity in all strips but did not abolish the ability of the detrusor muscle from any of the specimens studied to respond to carbachol, increased extracellular K+or transmural nerve stimulation.

Intravenous infusion of cromakalim in the urethral obstructed mini‐pig caused the characteristic unstable contractions associated with bladder outflow obstruction to be abolished, leaving the animal able to void.

Experiments with potassium isotopes and the sucrose gap technique demonstrated that cromakalim increased the potassium permeability and hyperpolarised the cell membrane, consistent with its reported actions on other smooth muscles.

These results suggest that drugs such as cromakalim, which act by reducing membrane excitability without inhibiting responses to existing innervation, may have a clinical application in the treatment of instability which is secondary to bladder outflow obstruction.
Value of the Gamma Camera Renogram in the Differential Diagnosis of Acute Tubular Necrosis and Rejection in the Early Post‐transplant Period: Comparison with Biopsy Findings
Authors: NOTGHI A. , MERRICK M. V. , ANDERTON J. L. , YATES P. A.
Published: November 2008

Summary— A group of 128 consecutive patients was identified on whom renal isotope studies had been performed during the first 2 months after renal transplantation and within 7 days of transplant biopsy. The prospective renogram and biopsy reports were reviewed and graded into 4 categories: severe rejection, predominant rejection, predominant acute tubular necrosis (ATN) and pure ATN. Two extreme patterns of renogram were identified: a sharp rise with a fast decline in the first min, attributed to ATN, and a slowly rising curve with no early peak occurring in severe rejection although not specific to this condition. There was a continuous intermediate spectrum. There was no inter‐observer variation in gradings at the 2 ends of the spectrum. In the middle part the difference between 2 independent observers never exceeded more than 1 grade.

There was good correlation between the biopsy and renogram gradings, with a discrepancy of more than 1 grade in only 5 patients; 2 of these, with severe rejection on the renogram, showed predominant ATN on biopsy, but the final clinical diagnosis was severe rejection (false positive biopsies). Two patients with biopsies showing severe rejection had a sharp initial up‐slope in the renograms but a slower down‐slope (over 4 min compared with 1 min in true ATN). With better definition of the criteria these renograms would not have been graded as ATN. There was 1 patient in whom no satisfactory explanation for the discrepancy was found (presumed false positive renogram). When properly defined criteria are used to interpret renograms, this simple test is at least as reliable as renal biopsy in differentiating ATN from rejection in the early post‐transplant period, especially in the presence of anuria or severe oligurea.
Assessment of the Malignant Potential of Cystoplasty
Authors: NURSE DIANE E. , MUNDY A. R.
Published: November 2008

Summary— The study group comprised 34 patients with either an ileal augmentation cystoplasty or a colonic substitution cystoplasty. The histological appearance of the intestinal segment, suture line, bladder remnant and bacterial colonisation of the urine and urinary nitrosamine levels were recorded.

There was a high incidence of histological abnormalities, the more significant of which correlated with heavy mixed bacterial growth on urine culture and with high levels of urinary N‐nitrosamines. This group of compounds is thought to act as carcinogens in both bladder and bowel under certain circumstances.

It was concluded that patients undergoing lower urinary tract reconstruction using intestinal segments should be considered at risk of developing malignant change either in the intestinal segment or in the bladder remnant. Close long‐term follow‐up of these patients is essential.
Assessment of Volume Measurement of the Prostate Using Per‐rectal Ultrasonography
Authors: JONES D. R. , ROBERTS E. E. , GRIFFITHS G. J. , PARKINSON M. C. , EVANS K. T. , PEELING W. B.
Published: November 2008

Summary— A study was made of 100 cadaveric prostates (71 benign glands and 29 invaded by adenocarcinoma) using a technique that enabled per‐rectal ultrasonography to be carried out and their volumes measured by computed planimetry. These volumes were compared directly with the actual volumes of the glands measured after dissection from the cadaver specimens.

A high degree of correlation was obtained for the measurement of benign glands (r= 0.982) and glands containing cancers confined within the capsule (r= 0.961). Estimation of the size of cancers unconfined to the gland was poor and measurement was not possible with 3 malignant prostates that had extended beyond the prostatic capsule so that the ultrasonic boundary could not be defined.
Fertility after Orchiopexy for Cryptorchidism: a New Approach to Assessment
Authors: KUMAR D. , BREMNER D. N. , BROWN P. W.
Published: November 2008

Summary— Fifty‐six patients treated surgically for cryptorchidism between 1950 and 1975 were assessed for fertility. Their age at the birth of their first child was used as the parameter. A direct comparision with the normal population of different regions was available from the General Register Office of Scotland, obviating the need to use female statistics for comparison. The results showed that only very late surgical treatment of unilateral cryptorchidism affected fertility.
Priapism in Childhood
Authors: DEWAN P. A. , TAN H. L. , AULDIST A. W. , MOSS D. I. McL.
Published: November 2008

Summary— Priapism is a rare condition in childhood; the majority of reported cases are in boys with sickle cell disease, where conservative management is often appropriate. Our experience with 4 cases, with differing aetiologies, and a review of the literature highlight the need for aggressive therapy when conservative measures fail.
The Fate of G3pT1 Bladder Cancer
Authors: JENKINS B. J. , NAUTH‐MISIR R. R. , MARTIN J. E. , FOWLER C. G. , HOPE‐STONE H. F. , BLANDY J. P.
Published: November 2008

Summary— Poorly differentiated (G3) cancers are known to have a worse prognosis than other superficial bladder tumours. In the period 1976 to 1987, 53 patients with G3pT1 disease were treated by radical radiotherapy with a 5‐year survival rate of 64%. Thirteen patients (25%) developed an invasive tumour during the follow‐up period. The presence of secondary carcinoma in situ was associated with a poor prognosis. These results are better than those reported for transurethral resection alone and suggest that radiotherapy is the treatment of choice in G3 superficial tumours.
Ultrasound and Plain X‐ray Screening in Childhood Urinary Tract Infection
Authors: HANBURY D. C. , WHITAKER R. H. , SHERWOOD T. , FARMAN P.
Published: November 2008

Summary— A group of 309 children over the age of 2 years was investigated with ultrasound and plain X‐ray for suspected urinary infection. In 29 cases there were abnormal findings and in 10 the abnormalities were confirmed with cystography and intravenous urography. Of 280 children whose ultrasound and plain X‐ray findings were normal, 26 re‐presented with further symptoms and investigation with cystography and urography showed abnormalities in only 4. The remaining 254 children have remained well and have been spared the uncomfortable and potentially dangerous examinations of cystography and urography.
Extracorporeal Shockwave Lithotripsy using Ultrasonic Imaging: Urologists' Experience
Authors: KIELY E. A. , RYAN P. C. , McDERMOTT T. E. D. , BUTLER M. R.
Published: November 2008

Summary— The EDAP LT.01 is a second generation shockwave lithotripter which employs ultrasound imaging and piezoelectric shockwave generation. We describe the first 12 months of its use in the treatment of urinary calculi by urologists with no previous practical experience of ultrasonography. A total of 406 calculi (359 renal and 47 ureteric) in 317 patients were treated. Analgesia or sedation was not routinely used and 59% of all treatments were performed as outpatient procedures. The clearance rate of renal calculi smaller than 1 cm was 81%, while that of calculi larger than 3 cm was 80% (mean clearance 77.5%). Lithotripsy of ureteric calculi following retrograde manipulation to a renal site resulted in 94.4% clearance compared with 39% for those treated at a ureteric site; 93% of 684 lithotripsy treatments were either painless or caused only mild pain. Our experience with imaging and treating urinary calculi with the EDAP LT.01 lithotripter has been excellent. Patients are treated effectively and inexpensively as out‐patients without analgesia or sedation.
Combination of Blood Group ABH Antigen Status and DNA Ploidy as Independent Prognostic Factor in Transitional Cell Carcinoma of the Urinary Bladder
Authors: MALMSTRÖM P.‐U. , NORLÉN B. J. , ANDERSSON B. , BUSCH C.
Published: November 2008

Summary— The prognostic value of DNA ploidy and blood group (ABH) antigen reactivity was studied in a consecutive retrospective study of 230 patients with primary transitional cell carcinoma of the urinary bladder. In 195 cases the DNA ploidy and ABH reactivity could be assessed in paraffin‐embedded tissue. Early progression (in the first 3 years) occurred in 2% of the patients with diploid ABH positive tumours and in 31% of those with aneuploid ABH negative tumours. The 5‐year survival rates corrected for intercurrent mortality were 95 and 56% respectively. In a Cox multivariate analysis, T category, age at diagnosis and histological grade emerged as significant independent prognostic indicators of bladder cancer death, whereas ABH reactivity and DNA ploidy had no significant independent value. However, if the combination of ABH reactivity and DNA ploidy was included in the Cox model, this and T category were independent predictors. When this Cox model was applied to assess the risk of progression, the only independent prognostic factor was the combination of ABH reactivity and DNA ploidy.
Long‐term Clinical Results using the Artificial Urinary Sphincter around Bowel
Authors: LIGHT J.K.
Published: November 2008

Summary— Four patients are presented in whom bowel was used to reconstruct a bladder. As a sphincteric mechanism was absent in all 4, the cuff from the artificial urinary sphincter was placed around the bowel to provide continence. This allowed for “normal” urination. The longest follow‐up period was 11 years and the shortest 1.5 years. Both clinical and experimental data show that bowel will tolerate compression from the artificial urinary sphincter provided infection does not supervene and the pressure does not exceed 80 cm of water
The Risk of Radical Cystectomy
Authors: MONTIE J. E. , WOOD J. P.
Published: November 2008

Summary—
A review of the operative risk of cystectomy and urinary diversion performed by one surgeon at one institution over an 8½‐year period was performed. Operative mortality was 0.4% (1/229). There were no urinary leaks, 1 bowel leak, 2 bowel obstructions, no rectal injuries and 3 pelvic abscesses. Cystectomy is a safer operation than is usually appreciated, based on improvements in pre‐operative preparation, intra‐operative monitoring and blood product replacement, and post‐operative support if a complication does occur.
The Failed MAGPI: Management and Prevention
Authors: ISSA M. M. , GEARHART J. P.
Published: November 2008

Summary—
Of 142 patients with hypospadias seen at this institute over the past 2 years, 8 developed meatal regression following repair of their anterior hypospadias with the meatal advancement and glanuloplasty technique (MAGPI); 5 had meatal regression which was attributed to a technical failure and 3 had severe regression of the meatus with significant subcoronal positioning, suggesting poor patient selection. None of these patients had chordee on intraoperative artificial erection. Five were treated successfully with a repeat MAGPI procedure and the remaining 3 required a Mathieu procedure. Although best indicated for mild degrees of anterior hypospadias, the success of the MAGPI procedure still requires meticulous technique and proper patient selection.
Penile Response to Intracavernosal Vasoactive Intestinal Polypeptide Alone and in Combination with Other Vasoactive Agents
Authors: KIELY E. A. , BLOOM S. R. , WILLIAMS GORDON
Published: November 2008

Summary—
Intracavernosally injected vasoactive intestinal polypeptide (VIP) (2 μg and 4 μg) resulted in penile tumescence even in men with predominantly organic impotence. Papaverine and phentolamine were successful in inducing erections in all subjects studied but the addition of VIP to this combination improved the erectile response further. A combination of papaverine and VIP produced penile rigidity similar to that with papaverine and phentolamine.

While intracavernosal VIP alone produced disappointing penile responses, its combination with papaverine potentiated the response to this drug, probably by increasing venous outflow resistance.