bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphology of the spermatozoon of a murid rodent from Africa, Dasymys incomtus
Authors: Breed W. G. , Pillay N.
Published: March 2003

The structural organization of the head of the spermatozoon from the African murid rodent Dasymys incomtus was investigated by light and transmission electron microscopy and after incubation in various chemical agents. The results show that it is falciform in shape with a bifurcated rostral extension lying just caudal to the apical hook. The nucleus protrudes into the base of this extension but it is largely composed of a massive elaboration of the sperm head cytoskeleton which is very resistant to dispersion by chemical agents. This elaborate accessory structure of the sperm head shows similar morphology to the ventral processes on the sperm head of Australasian hydromyine rodents. The possible functional and evolutionary significance of these findings are discussed.
Structure and development of the ctenial spines on the scales of a teleost fish, the cichlid Cichlasoma nigrofasciatum
Authors: Sire Jean‐Yves , Arnulf Isabelle
Published: March 2003

Sire, J.‐Y. and Arnulf, I. 2000. Structure and development of the ctenial spines on the scales of a teleost fish, the cichlid Cichlasoma nigrofasciatum. — Acta Zoologica (Stockholm) 81: 139–158

Numerous teleost species possess ctenoid scales characterized by the presence of ctenial spines arranged in rows (the cteni) along their posterior, free margin. Whilst the morphology and function of the ctenial spines are similar to those of odontodes (extra‐oral teeth), e.g. in armored catfish, their homology is questionable. To address this problem, we have studied ctenial spine development, structure, attachment to a bony support, and replacement with the aim of comparing these features to those described for odontodes. The ctenial spines have been studied in a growth series of the cichlid Cichlasoma nigrofasciatum, using light, scanning and transmission electron microscopy. Ctenial spines are entirely constituted of a collagen matrix. They lack a pulp cavity and, although their distal end can be in contact with the epidermal basal layer cells, they are not covered by an enameloid‐like tissue. They are attached to the scale by means of a narrow strand of unmineralized collagen matrix acting as a ligament and allowing spines to be movable. The ctenial spines develop as prolongations of the external layer of the scale, a woven‐fibroid collagen matrix, and subsequently grow by addition of parallel‐fibred collagen matrix. New ctenial spines are added at the posterior scale border in waves that follow the same rhythm as the deposition of circuli in the anterior region. From the focus region to the scale border, the ctenial spines constitute lines in which only the most posterior ctenial spine is functional. The other spines that are no longer functional are not shed but resorbed from the top, and their attachment region mineralizes and thickens by deposition of new material. The remnants of spines constitute the main part of the superficial layer of the scale in which anchoring bundles attach; this region is covered afterwards by the limiting layer, a tissue devoid of collagen fibrils.

Because of their tooth‐like morphology (shape and size), their posterior orientation and their attachment to the scale surface, the ctenial spines resemble odontodes. Moreover, both elements perform a similar hydrodynamic function. Nevertheless, the structure and development of the ctenial spines differ completely from those of odontodes and consequently, they cannot be considered homologous elements. Ctenial spines and odontodes in teleosts provide us with a beautiful example of homoplasy; they share shape and function, but have a different origin as evidenced by their different structure and process of development.
Calcitonin‐immunoreactive cells of the digestive tract of the amphioxus are distributed concentrically in a restricted region of the mid‐gut
Authors: Urata M. , Sasayama Y. , Matada M. , Kambegawa A. , Suzuki N. , Srivastav A. K.
Published: March 2003

In amphioxus (Branchiostoma belcheri), calcitonin‐immunoreactive cells of the digestive tract were distributed concentrically in a 1‐mm region of the latter half of the mid‐gut. In the mid‐gut caecum these cells were also present, but were dispersed throughout the length. The total number of cells in both parts ranged from 280 to 1157, varying from individual to individual, although the number in the mid‐gut caecum was only 100–200. These cells were morphologically typical gut endocrine cells. Considering their morphology and the characteristics of their distribution pattern, these cells may be related to some phenomena of digestive processes.
Transurethral needle ablation for chronic nonbacterial prostatitis
Authors: Lee K.C. , Jung P.B. , Park H.S. , Whang J.H. , Lee J.G.
Published: March 2003

Objective To investigate the efficacy of transurethral needle ablation (TUNA) of the prostate for treating chronic nonbacterial prostatitis unresponsive to conservative therapies.

Patients and methods Forty‐two patients (mean age 38.5 years, range 25–52) with nonbacterial prostatitis in whom clinical management was unsuccessful in relieving the symptoms or signs of prostatitis were treated using TUNA. All patients had a high leukocyte count (> 15 per high‐power field) in expressed prostatic secretions (EPS) with no bacterial growth in either urine or prostatic secretion cultures. Before TUNA all patients were evaluated using a symptom score, satisfaction score (quality of life) and an examination of prostatic secretions. All patients were reassessed using the same variables 1 and 3 months after TUNA. Of the 42 patients, 10 had their semen analysed before and 3 months after treatment.

Results The mean (sd) symptom and satisfaction scores improved significantly, from 11.02 (2.90) to 5.00 (2.61) and from 4.84 (0.57) to 1.26 (1.18), respectively, 3 months after TUNA (both P < 0.05). Of the 42 patients, 30 (71%) had normal EPS results within 3 months of TUNA. Also, of 37 patients with high leukocyte counts (> 100 per high‐power field) before TUNA, 26 (70%) had normal EPS results within 3 months afterward, and 29 (78%) had a satisfaction score of < 3 points.

Conclusions TUNA may be a possible treatment option for patients with chronic nonbacterial prostatitis that is unresponsive to conservative therapies. A long‐term follow‐up and randomized studies are needed to confirm the efficacy of the TUNA against intractable chronic prostatitis.
Prevalence of undiagnosed prostate cancer in men with erectile dysfunction
Authors: Sairam K. , Kulinskaya E. , Boustead G.B. , Hanbury D.C. , McNicholas T.A.
Published: March 2003

Objective To explore the prevalence of prostate cancer in men presenting with erectile dysfunction (ED).

Patients and methods In a prospective study, 127 men with ED of at least 6 months duration underwent screening for prostate cancer using prostate specific antigen (PSA) and a digital rectal examination (DRE). Men with a high PSA level (> 4 ng/mL) had sextant biopsies taken under sedoanalgesia. The serum testosterone level was measured in all the men.

Results Twenty‐six men were aged < 50 years and all had a normal PSA level; of 101 men aged > 50 years, 20 had an abnormal PSA. The detection rate for prostate cancer using PSA and DRE was 5%, which was not significantly higher than in the general population. All the detected cancers were clinically significant (> T2a, Gleason grade > 4). Two of the five men diagnosed with prostate cancer were Afro‐Caribbean. Of the 127 men, 31% had a low serum testosterone level, but there was no association between testosterone and PSA levels.

Conclusions Prostate cancer is no more common in men with ED than in the normal male population. Therefore, routine screening for prostate cancer in men with ED is not indicated.
Genetic changes in stage pT2N0 prostate cancer studied by comparative genomic hybridization
Authors: Wolter H. , Gottfried H.W. , Mattfeldt T.
Published: March 2003

Objective To identify chromosomal regions important for progression in clinically organ‐confined prostate cancer, as the genetic changes underlying the development and progression of prostate cancer are poorly understood.

Materials and methods Comparative genomic hybridization (CGH) was used to search for DNA sequence copy‐number changes in a series of 50 primary organ‐confined prostate adenocarcinomas (pT2N0) removed by radical prostatectomy.

Results CGH analysis indicated that 23 (46%) of the primary prostate adenocarcinomas showed chromosome alterations. The percentage of tumours with losses (38%) was higher than with gains (28%). Losses of 13q (24%), 8p (18%), 6q (10%), 16q (8%), 18q (6%) and 5q (6%) and gains of 17q (12%), 20q (12%), 9q (10%), 17p (8%) and 8q (6%) were the most frequent alterations. Amplifications were found at 8q24‐qter. Minimal overlapping regions of loss, indicative of the presence of tumour‐suppressor genes, were mapped to 13q21.1‐q21.3 and 8p21.2, and minimal overlapping regions of gain, indicative of the presence of oncogenes, were found at 9q34.4‐qter, 17q25‐qter and 20q13.3‐qter. There was a significant association between Gleason score and losses and gains (P = 0.003), and an association between chromosomal imbalance and high histological grade (P = 0.008).

Conclusion These results suggest that losses or gains of DNA in these regions are important for prostate cancer progression, and document the spectrum of chromosomal alterations in stage pT2N0 of clinically organ‐confined prostate cancer.
Contralateral response in renal pelvic pressure and diuresis during increasing ipsilateral pelvic pressure and flow: a study of the normal and denervated upper urinary tract in pigs
Authors: Holst U. , Tuckus G. , Frokiaer J. , Djurhuus J.C. , Mortensen J.
Published: March 2003

Objective  To examine, in young pigs, changes in baseline pelvic pressure and diuresis in the contralateral kidney during conditions of increasing pelvic pressure and perfusion with isotonic saline in the ipsilateral renal pelvis; the role of a reno‐renal nervous mechanism was examined by denervating the kidneys, and the effect of bladder filling on these variables assessed.

Materials and methods  Female pigs (37–40 kg) were assessed under general anaesthesia. Transparenchymally, one 6 F and two 6 F catheters were introduced into the right and left renal pelvis, respectively. Through a bladder incision an 8 F catheter was introduced 10 cm into the right ureter to collect urine and the orifice closed around the catheter. For bladder drainage and to measure bladder pressure a 10 F catheter was placed in the bladder and both the 8 F and 10 F catheters lead out through the urethra. In group A, five animals served as controls, with group B comprising eight with intact nerves and group C eight with denervated kidneys. In group B and C the left renal pelvis was perfused with isotonic saline at 2, 4, 6, 8, 10, 12 and 16 mL/min while the bilateral pelvic pressure and right renal diuresis were recorded; the bladder was kept empty and 0.5 h later the left pelvis was perfused with 10 mL/min while the bladder catheter was closed. Perfusion continued until micturition occurred. The bilateral pelvic pressure, bladder pressure and right renal diuresis were recorded. In group C the kidneys were surgically denervated, dividing all adhesions and all connective tissue around the pelvis and the vascular pedicle. The renal artery was freed to the aortic level.

Results  During the pressure‐perfusion study the mean (sd) right pelvic pressure was 7.4 (0.2) mmHg in group B and 8.6 (0.2) mmHg in group C. The diuresis from the right kidney in both groups was similar and the same as that in group A. The perfusion rate and pressure on the left side had no influence on pelvic pressure and diuresis on the right side. During perfusion with a full bladder the right pelvic pressure was 8.6 mmHg in group B and 9.5 mmHg in group C. Diuresis in group B was ≈ 0.6 mL/min and a little higher in group C, at ≈ 1 mL/min, but identical to that in group A.

Conclusion  These results indicate that a reno‐renal reflex mechanism has no apparent role in young pigs during pressure‐perfusion measurements with an empty or full bladder.
Percutaneous transperineal radiofrequency ablation of prostate tumour: safety, feasibility and pathological effects on human prostate cancer
Authors: Zlotta  , Djavan  , Matos  , Noel  , Peny  , Silverman  , Marberger  , Schulman
Published: March 2003

Objective

 To evaluate the safety of radiofrequency (RF) energy delivered interstitially in patients with prostate cancer scheduled for radical prostatectomy and to correlate the proposed theoretical lesion size with the pathological findings.

Patients and methods

 Radiofrequency interstitial tumour ablation (RITA) was performed in 15 patients with localized prostate cancer before radical surgery. RF energy was delivered to the prostate by active needle electrodes (monopolar or bipolar) placed transperineally under transrectal ultrasonography guidance. Needle electrodes were used with different configurations and in some cases were covered by retractable shields to vary the length and circumference of the thermal lesions created. In eight patients, the procedure was performed immediately before radical prostatectomy, in six RITA was performed under spinal anaesthesia 1 week before surgery and in one patient, no surgery was performed but the patient was followed by serial determinations of prostate specific antigen (PSA). At least two lesions were created in each prostate, including both capsule and peripheral zones. NADPH and haematoxylin & eosin (H&E) staining were used to assess the extent of the necrotic lesion in the radical prostatectomy specimen.

Results

 The mean energy delivered was 10.5 kJ, with central temperatures reaching up to 105 °C during 12 min of ablation; rectal temperature remained at <38 °C. There were no complications. Macroscopic examination showed well‐demarcated lesions including the prostatic capsule, up to 2.2×1.5×4.5 cm. With monopolar energy, the observed lesion size was comparable to the predicted 2×2×2 cm lesion, while with bipolar energy, lesion size was related to interneedle distance and uncovered needle length. Microscopic examination showed clearly delineated lesions both with NADPH (in prostates immediately removed after surgery) and H&E (at 1 week after RITA) staining. The lesion size observed on pathological analysis correlated with the predicted lesion size. In one patient, no residual cancer was found in the specimen. In the patient whose entire prostate was targeted and followed by serial PSA measurements, the latter were undetectable at 3 months of follow‐up.

Conclusion

 Transperineally delivered RF energy is capable of safely creating extensive coagulative necrotic lesions in prostate cancer tissue, in a reproducible and controlled manner. The results presented here provide basic information for the potential future application of this form of energy for localized prostate cancer.
Transurethral incision versus resection of the prostate for small to medium benign prostatic hyperplasia
Authors: Jahnson  , DalÉn  , Gustavsson  , Pedersen
Published: March 2003

Objective

 To compare the effects of transurethral incision and resection of the prostate in patients with small to medium benign prostatic hyperplasia.

Patients and methods

 Patients were assessed pre‐operatively using the Madsen‐Iversen symptom score, post‐ void residual urine volume, urinary flow and cystoscopy. Those eligible for the study were randomized to undergo either transurethral incision or resection of the prostate. Follow‐up visits were scheduled at 2–3, 6, 12, 24 and 60 months post‐operatively with an assessment by symptom score and urinary flow rate; most patients also underwent cystoscopy at 24 and 60 months.

Results

 The maximum urinary flow rate was significantly higher in those undergoing resection than incision at all but the last follow‐up visits. Cystoscopy 24 months after surgery showed adhesions between the lateral lobes, closed incisions or obstructing prostatic lobes in most of the patients undergoing incision, but not in those resected (P<0.001, chi‐square test). During follow‐up, a second transurethral procedure was carried out for persistent or recurrent symptoms, combined with a maximum urinary flow rate of <10.0 mL/s, in 10 patients who underwent incision and in three who were resected (P=0.039, chi‐square test).

Conclusion

 Transurethral resection is preferable to transurethral incision of the prostate in the treatment of small to medium benign prostatic hyperplasia.
Autologous and allogenic hybrid cell vaccine in patients with metastatic renal cell carcinoma
Authors: Kugler  , Seseke  , Thelen  , Kallerhoff  , MÜller  , Stuhler  , MÜller  , Ringert
Published: March 2003

Objective

 To evaluate the safety, acute and long‐term toxicity and therapeutic activity of an allogenic and an autologous hybrid cell vaccine in patients with progressive metastatic renal cell carcinoma (RCC).

Patients and methods

 Eleven patients were vaccinated with a lethally irradiated hybrid cell vaccine of allogenic RCC tumour cells fused with major histocompatibility complex class I‐matched and class II‐unmatched activated allogenic lymphocytes. These patients were then followed for a mean of 11 months. Another 13 patients were vaccinated with a hybrid cell vaccine of autologous tumour cells fused with allogenic activated lymphocytes and followed for a mean of 6 months.

Results

 Six of the 11 patients receiving the allogenic vaccination showed an initial response, with two complete and two partial responses to date. Only three patients who received autologous vaccination responded to treatment.

Conclusions

 Hybrid cell vaccination is a promising new approach in the treatment of patients with advanced RCC.
No difference in survival between sporadic, familial and hereditary prostate cancer
Authors: GRÖnberg  , Damber  , Tavelin  , Damber
Published: March 2003

Objective

 To estimate the survival of men with familial prostate cancer and compare them with prostate cancer cases unselected for family history.

Patients and methods

 The overall and prostate cancer‐specific survival was calculated in two large (249 and 304 men, respectively) population‐based cohorts of men with familial prostate cancer. The tumour grade at diagnosis was also obtained in one of the cohorts.

Results

 There were no significant differences in either overall or prostate cancer‐specific survival between familial and sporadic cases. The spectrum of tumour grades at diagnosis in familial cases did not differ from that in a population with prostate cancer unselected for family history.

Conclusion

 No differences in treatment between men with or without a positive family history of prostate cancer are justified, based on the result from this study.
A circumcision service for religious reasons
Authors: Shah  , Raistrick  , Taylor  , Young  , Menebhi  , Stevens
Published: March 2003

Objective

To review the results of a pioneering service introduced under National Health Service (NHS) cover, providing circumcision on religious grounds.

Subjects and methods

The service was offered to all male babies aged 6–14 weeks. Circumcision was carried out using the Plastibell technique under 1% lignocaine ring block/penile block anaesthesia. Between July 1996 and August 1998, 168 circumcisions were performed and assessed postoperatively by telephone enquiry, visiting at home by the nurse and review at the hospital if and when required.

Results

Of the 168 babies, 31 required some follow‐up care. In six babies the separated ring tracked back onto the shaft of the penis and had to be removed using a ring‐cutter. Ten babies were referred for incomplete separation of the Plastibell ring; only two required removal, the rest of the rings detaching spontaneously within a few days. Two babies were reviewed for early separation of the ring and seven were reviewed for bleeding within 24 h of the operation. Two of these were immediately after circumcision, when the bleeding was seen to be from the torn frenulum. They were converted to a more formal circumcision without the Plastibell under the same anaesthesia. Surveillance with no intervention was required in the others, except one who needed a compression dressing. One baby had apyrexia, requiring antibiotics. Four babies had suspected wound infection but none was clinically significant. One parent remained dissatisfied and complained about the inadequate removal of the foreskin.

Conclusion

The aim of the service was to provide safe circumcision requested on religious grounds. The technique was simple and easily learned by nurses. Parents have generally been very satisfied and the complication rate was acceptable, with most problems occurring early in the series, suggesting an improvement with experience.
The epidemiology of benign prostatic hyperplasia: a study in Greece
Authors: Signorello  , Tzonou  , Lagiou  , Samoli  , Zavitsanos  , Trichopoulos
Published: March 2003

Objective

To assess the epidemiology of benign prostatic hyperplasia (BPH) in a case‐control study in greater Athens, Greece.

Patients and methods

The study comprised 184 patients surgically treated for BPH within one year of its diagnosis (cases) and 246 patients with no symptoms of BPH who were treated in the same hospitals for minor diseases or conditions (controls). All cases and controls were permanent residents of the greater Athens area, Greece. The data were assessed using unconditional logistic regression.

Results

After controlling for age and education, cases and controls had similar distributions for height, body mass index, sibship size and birth order in the parental family, marital status, number of offspring and a series of previous medical diagnoses or surgical operations. The sole exception was surgery for haemorrhoids, that appeared to be related to the incidence of BPH, possibly by chance. There was no evidence that vertex baldness, tobacco smoking, alcohol consumption or coffee drinking increased the risk for BPH. Men who had spent most of their lives in a rural rather than an urban environment appeared to be at reduced risk for BPH.

Conclusion

The lifestyle factors assessed here have no major effect on the aetiology of BPH.
Safer circumcision in patients with haemophilia: the use of fibrin glue for local haemostasis
Authors: Avanoglu A. , Çelik A. , Ulman İ. , Özcan C. , Kavakli K. , Nişli G. , Gökdemir A.
Published: March 2003

Objective

To evaluate the efficacy and the reduced costs of factor concentrates in circumcision by using fibrin glue in patients with haemophilia.

Patients and methods

Eleven patients with haemophilia (age range 6–14 years, 10 with haemophilia A, one with haemophilia B) were circumcised using fibrin glue for local haemostasis and to reduce the duration of clotting factor replacement after surgery. Circumcision was carried out under general anaesthesia; the prepuce was incised circumferentially and excised using the Gomco clamp technique. Haemophiliac patients were divided into two groups: in group 1 (four patients, three with haemophilia A and one with haemophilia B) the factor levels were assessed every 8 h and bolus injections of factor repeated during the first 4 days after surgery; in group 2, the seven remaining haemophilia A patients received a postoperative bolus injection and ≈4 U/kg per hour of factor substitution for the first 2 days after surgery by continuous infusion. Eleven other patients with haemophilia A underwent circumcision using same surgical procedure but were given only factor substitution without fibrin glue, and served as a control group (group 3).

Results

None of the patients had significant bleeding or complications. The total costs were significantly reduced, to $8898 per patient in group 1 and $4866 per patient in group 2, when compared with $12875 per patient in group 3 (both P<0.05).

Conclusion

Fibrin glue is a useful treatment for circumcision in patients with haemophilia; it lessens the need for factor substitution after circumcision and thus reduces the high cost of treatment.
Treatment of idiopathic and postvaricocelectomy oligozoospermia with oral tamoxifen citrate
Authors: Kadioglu  , Köksal  , Tunç  , Nane  , Tellaloglu
Published: March 2003

Objective

To identify a subgroup of men who may benefit from tamoxifen citrate (a widely prescribed drug for male infertility) among those with normogonadotrophic and hypergonadotrophic oligozoospermia, either idiopathic or after varicocelectomy.

Patients and methods

The study included infertile men with oligozoospermia, 136 referred to our outpatient clinic and 84 infertile after varicocelectomy. All patients received tamoxifen citrate (10 mg twice daily); semen analysis and hormone tests were repeated at the end of 3 and 6 months of treatment, the values being compared with those before treatment.

Results

The levels of follicle‐stimulating hormone, luteinizing hormone and testosterone increased in all groups receiving tamoxifen citrate. Normogonadotrophic patients had a significant increase in sperm count and concentration, while the slight increase detected in the hypergonadotrophic group was statistically insignificant.

Conclusion

In patients with normogonadotrophic oligozoospermia, tamoxifen citrate may be offered as a practical and economic alternative before using any assisted reproduction techniques. However, double‐blind placebo‐controlled trials are needed to confirm the findings of this preliminary study.
Outpatient flexible cystoscope‐assisted insertion of ureteric catheters and ureteric stents
Authors: Adeyoju  , Collins  , Brooman  , O’Reilly
Published: March 2003

Objective

To examine the feasibility of inserting ureteric catheters (before retrograde ureterography) and JJ ureteric stents (both traditionally performed under general anaesthesia on inpatients) using local anaesthesia in an outpatient setting and with no patient selection bias, thus providing procedures to ease the demand on inpatient lists.

Patients and methods

All patients presenting with an appropriate clinical indication for either of the procedures underwent insertion during a scheduled flexible cystoscopy session in the outpatient department; information was collected on a standard proforma. Antibiotic prophylaxis and a nonsteroidal analgesic were administered 30 min before the procedure.

Results

To date, 20 patients (seven men, age range 32–74 years, and 13 women, age range 23–86 years) have undergone one of the two procedures. Fourteen patients had attempted retrograde catheter insertion, with success in 12, and six other patients underwent attempted JJ ureteric stent insertion, with success in five. The three failures were caused by an inability to see the relevant ureteric orifice. The mean duration of each procedure was 11 min; 14 of the 17 patients who had a successful procedure had no significant pain or discomfort, while the remaining three experienced significant pain and discomfort. There were no infective complications.

Conclusion

These two procedures are suitable for the outpatient/day‐case situation, and are well tolerated and accepted by most patients.
The role of a clinical score in the assessment of ambiguous genitalia
Authors: Ahmed S.F. , Khwaja O. , Hughes I.A.
Published: March 2003

Objective To improve the initial assessment of ambiguous genitalia in infants.

Subjects and methods Using a specially devised scoring system, the external genitalia (external masculinization score, EMS, range 0–12) and internal reproductive structures (internal masculinization score, IMS, range 0–10) were assessed in 426 male newborns and 291 cases of ambiguous genitalia.

Results In normal male newborns, the median (10th centile) EMS was 11 (10). In the affected infants, the sex of rearing was male in 202 and female in 89 cases, respectively. The median (10–90th centile) EMS in those cases reared male, at 3.5 (2–8), was significantly higher than in cases reared as females, at 2 (1–6) (P < 0.001). The median IMS in cases reared as males and females was the same, at 10, but the scatter of values was higher for males (10–90th centile, 4–10) than for females (0–10) (P = 0.01). Infants reared as females were more likely to have a micropenis, a uterus and/or a urogenital sinus, but there were 12 cases where the sex of rearing was male despite the presence of a uterus; five infants without micropenis were reared as female and 23 with a urogenital sinus were reared as male.

Conclusion The masculinization score provides a standardized format to summarize clinical features in newborn infants with ambiguous genitalia. Gender assignment does not solely depend on the appearance of the external genitalia and the nature of internal sexual organs.
A magnetic device for increasing the urethral resistance to flow: an experimental study in female dogs
Authors: Ali‐el‐dein B. , El‐demerdash R. , Kock N.G. , Ghoneim M.A.
Published: March 2003

Objective To test a new magnetic device for increasing the urethral resistance to flow in a dog model, and thus provide a potential mechanical device for the treatment of incontinence in women.

Materials and methods The study comprised 12 female mongrel dogs; three dogs were used to study the effect on urethral resistance of inserting a vaginal magnet (control experiment) and five were assessed in a urodynamic study. With the animals under general anaesthesia, the bladder and the urethra were exposed by a low midline incision. One magnet, embedded in a silicon layer, was placed on the anterior side of the urethra 3 cm distal to the bladder neck and fixed with a few sutures. To increase the urethral resistance as required, a second magnet was inserted into the vagina and the device activated. Urethral pressure profiles and leak‐point pressures were recorded in the anaesthetized animals under resting conditions and after the urethra was compressed between the magnets. Recordings were also made after pharmacological blockade of the urethral musculature. In four additional dogs, chronic experiments were conducted to evaluate the effect of continuous compression of the urethra and the vaginal wall for 14 days.

Results Urethral compression between the magnets resulted in a doubling of the maximal pressure in the proximal urethra and in a threefold increase of the leak‐point pressure. After pharmacological denervation of the urethra the differences between the control pressures and those after activating the device were even greater, although not significantly so. After 2 weeks of continuous compression of the vaginal wall and the urethra between the magnets there was no detectable tissue damage.

Conclusion These results suggest that the magnetic device can efficiently increase urethral pressure and that prolonged compression caused no apparent damage to the urethra or vagina. It may therefore be a useful potential method of providing urinary continence in women.
Unilateral pedal lymphography in patients with filarial chyluria
Authors: Koga S. , Nagata Y. , Arakaki Y. , Matsuoka M. , Ohyama C.
Published: March 2003

Objective To evaluate the usefulness of unilateral pedal lymphography in patients with filarial chyluria.

Patients and methods Of 114 patients with filarial chyluria, all underwent lymphography (unilateral pedal in 106) and 55 underwent selective ureteric sampling for chyle.

Results Unilateral pedal lymphography in the 106 patients detected lymphaticorenal fistulae (LRF) in 104 (98%). Lymphatic crossover was seen in all 106 patients, from the second sacral segment to the first lumbar segment. The most frequent crossover site was at the L5 level (87%). There was complete correlation between the side of LRF and the side of chyluria as assessed by selective ureteric sampling.

Conclusion Unilateral pedal lymphography can detect LRF via lymphatic crossover even when it is on the opposite side from that injected with contrast agent. The advantages of unilateral lymphography over bilateral procedures are that it is easy to identify crossover channels, and the discomfort for the patient is reduced because there are fewer incisions and it is quicker. Unilateral lymphography is recommended as the initial method when lymphography is indicated in filarial chyluria.
Quality of life after radical cystectomy and orthotopic bladder substitution: a comparison between Italian and Swedish men
Authors: Månsson Å. , Caruso A. , Capovilla E. , Colleen S. , Bassi P. , Pagano F. , Månsson W.
Published: March 2003

ObjectiveTo investigate possible differences between Italian and Swedish men in health‐related quality of life (HRQL) after cystectomy and orthotopic bladder substitution for bladder cancer.

Patients and methodsThirty‐three men in Padua, Italy and 33 in Lund, Sweden were assessed after respective mean postoperative periods of 42 and 52 months. Three questionnaires were used: (i) dealing with view‐of‐life issues; (ii) the core questionnaire QLQ‐C30(+3) from the European Organization for Research and Treatment of Cacncer, with added questions on urinary symptoms and sexuality; and (iii) one focusing on postoperative psychosocial and sexual adjustment.

ResultsWhile Italian and Swedish men did not differ in their central values, they differed significantly in belief‐related values, such as religion. Urinary prob‐lems and erectile dysfunction were common in both groups, the former possibly commoner in the Swedish men and the latter in the Italians. Changes in mood and self‐esteem were common in both groups. On a visual analogue scale, the Italian men reported a worse present mood than the Swedish men, but expressed a more favourable outlook on their future.

ConclusionDespite differences in philosophical attitudes between Italian and Swedish men, there were no major differences in HRQL. Caution is required in interpreting these findings because there were few participants and the possible inadequacy of the methods used to evaluate the complex concept of quality of life.
Continence and some properties of the urethral striated muscle of male greyhounds
Authors: Van Der Werf B.A. , Hidaka T. , Creed K.E.
Published: March 2003

Objective To determine the properties of the striated muscle of the greyhound (dog) urethra and to consider its role in maintaining continence.

Materials and methods The thickness of the muscle layers and the muscle types were determined by examining sections stained with haematoxylin and eosin or Masson’s trichrome. These factors were correlated with the mechanical and electrical responses of muscle strips to nerve stimulation, and compared with muscle from other breeds of dog and other parts of the animal.

Results The striated muscle formed ≈70% of the membranous urethra and was predominantly (68%) type IIa muscle (i.e. fast but fatigue‐resistant). The mean resting membrane potential was –74 mV; nerve stimulation produced an action potential with a mean amplitude of 97 mV and contraction lasting about 200 ms. All responses were abolished by
d‐tubocurarine. The contractions were well maintained with continuous or intermittent stimulation. The properties were intermediate between those of the anconeus (slow) and the extensor carpi radialis (fast) muscles.

Conclusions The distribution, fibre type and contractile characteristics would enable the striated urethral muscle to maintain tension for continence at rest and provide additional continence during sprints.
Elevated serum vascular endothelial growth factor in patients with hormone‐escaped prostate cancer
Authors: Jones A. , Fujiyama C. , Turner K. , Fuggle S. , Cranston D. , Bicknell R. , Harris A.L.
Published: March 2003

Objective To investigate the role of serum vascular endothelial growth factor (VEGF) in the assessment of patients with prostate cancer.

Patients, subjects and methods Serum from 78 men was assayed for VEGF using a commercially available enzyme‐linked immunosorbent assay kit. Forty‐eight patients had a histopathological diagnosis of prostate cancer (16 local disease, 32 metastatic), nine had benign prostatic hyperplasia (BPH) and 21 were healthy controls.

ResultsThe mean serum VEGF level was significantly higher in patients with hormone‐escaped prostate cancer than in all other groups (P  0.02). There were no significant differences in serum VEGF levels among the other groups. In 18 patients with serial measurements there was no significant difference in serum VEGF level during either response to or escape from hormonal therapy.

Conclusions The significantly higher serum VEGF level in patients with hormone‐escaped prostate cancer suggests a role in the pathogenesis of advanced disease. However, the lack of significant differences among the other groups and the failure to indicate either response to or escape from hormonal therapy suggests that serum VEGF in this setting is of limited use.
In vitro contractile responses of detrusor to carbachol and neurokinin A, in children with recurrent urinary tract infection or day wetting
Authors: Werkstrom V. , Lam D.S.H. , Farnsworth R.H. , Awad N. , Burcher E. , Moore K.H.
Published: March 2003

Objective To investigate whether a history of recurrent urinary tract infection (UTI) and/or the presence of day‐wetting/urge symptoms might influence the contractile responses to the cholinergic agonist carbachol or to the sensory neuropeptide neurokinin A (NKA) in the urinary bladder in children.

Patients and methods Small detrusor strips were taken from the margin of the cystotomy incision of the bladder dome during surgery to correct vesico‐ureteric reflux (VUR) in 62 children (aged 4 months to 12 years) or for unrelated bladder conditions in five controls (aged 3 months to 13 years). Concentration‐response curves to carbachol and NKA were constructed using organ‐bath techniques, and results compared for age, sex, weight of the detrusor strip, UTI history or day‐wetting syndrome.

Results The contractile responses to NKA were no different for any of the features investigated. The contractile response to carbachol and NKA in detrusor from control and VUR patients was not significantly different. The children with a history of UTI were significantly older than those without. The contractility in response to carbachol was greater in older girls (aged 4–12 years) than younger girls (< 4 years) and than in all boys (< 4 years and 4–12 years;
anovaP = 0.013). The mean (
sem) maximum contractile response to carbachol in the group of 20 young children (4–30 months) with previous UTI was 3.0 (0.3) g, whereas the maximum response in the age‐matched group of 11 without UTI was 1.8 (0.3) g (P = 0.046). There were no significant differences in maximum responses between those with day‐wetting and those without (aged > 4 years), although there was a significant difference in pD2 value, at 6.19 (0.13) and 5.58 (0.14), respectively (P = 0.018).

Conclusion Carbachol produced a larger contractile response in detrusor from children with a history of UTI than from those without, indicating possible alterations in muscarinic receptor characteristics. An increased sensitivity to muscarinic stimulation in day‐wetting children was also suggested, whereas NKA is unlikely to be involved in any of these pathophysiological conditions.
The dietary habits of idiopathic calcium stone‐formers and normal control subjects
Authors: Al Zahrani H. , Norman R.W. , Thompson C. , Weerasinghe S.
Published: March 2003

Objectives To examine the relationship between 12 macro‐ and micro‐nutrients and the risk of recurrent calcium stone formation by comparing the diets of a large outpatient clinic‐based group of patients who had formed calcium‐based urinary tract calculi with that of a population‐based control group matched for age, gender and body mass index.

Patients, subjects and methods The dietary intake of 500 patients (cases) randomly selected from the adult population attending an outpatient renal‐stone clinic and being evaluated and/or treated for biochemically or radiologically diagnosed calcium‐based upper urinary tract calculi were compared with those of 500 control subjects selected to match for age, sex and body mass index from a stratified probability sample of 2212 adults (not institutionalized) living in the same geographical area.

Results Comparing the mean nutritional intakes showed a statistically higher consumption of energy, carbohydrates, sodium, fibre, vitamin C, fat and folic acid among cases than in controls. The intake of calcium, alcohol and vitamin A was significantly higher among the controls. There were no significant differences in the intake of protein, niacin or iron. The results of these comparisons varied when the groups were stratified by sex, age and body mass index.

Conclusions Dietary risk factors for calcium‐based urinary tract calculi are many and complex, and a detailed consideration of sex, age and body mass index is important in interpreting such data. While it is difficult to draw firm conclusions about causes and effects of individual nutrients from the available data, this study indicates a possibly more important role for dietary fat in stone formation than has been previously recognized. This relationship needs to be further explored in relation to urinary risk factors, as it may be possible to advise patients to reduce dietary fat as a prophylactic measure for stone formation. As dietary fat has been associated with cardiovascular diseases and possibly cancer, an overall recommendation to these patients for a low dietary fat intake may be easier to follow.
Nonhomologous bioinjectable materials in urology: ‘size matters’?
Authors: Solomon L.Z. , Birch B.R. , Cooper A.J. , Davies C.L. , Holmes S.A.V.
Published: March 2003

Objective To assess the factors that influence how particles might become fixed in tissues or migrate from them, by measuring the size of the injectable particles, their susceptibility to phagocytosis and their affinity for fibroblast attachment in culture.

Materials and methods The particle size of three types of particulate unphysiological bioinjectable material, i.e. Urocol (Genesis Medical, Ltd., London), Macroplastique™ (Uroplasty Ltd., Reading, UK) and Urethrin (Mentor Medical Systems, Wantage, UK) was analysed using phase‐contrast light microscopy and confocal microscopy. Human monocytes from peripheral blood were incubated with the three materials in phagocytic studies, where ingestion was determined by confocal microscopy. A fibroblast cell line was used to ascertain the ability of the particles to act as a substrate for cell attachment in culture.

Results The mean (
sem) maximum particle diameters of Macroplastique, Urethrin and Urocol were 209 (5.10) µm, 49 (1.52) µm and 14 (0.39) µm, respectively. Rat peritoneal macrophages and human peripheral blood monocytes commonly ingested Urocol particles; the phagocytosis of Urethrin was rare and that of Macroplastique was not detected. Fibroblasts adhered to Urocol paste and Urethrin particles, but not to Macroplastique.

Conclusion Published reports of particle size and phagocytosis are confusing, but a relationship clearly exists. Macroplastique is the largest particle and is least likely to be phagocytosed by human mononuclear phagocytes. Urocol paste is the slowest to dissipate in culture conditions; the flat surfaces of Urethrin, but not Macroplastique, can serve as a substrate for fibroblast anchorage.
A comparison of six commercial assays for total and free prostate specific antigen (PSA): the predictive value of the ratio of free to total PSA
Authors: Patel D. , White P.A.E. , Milford Ward A.
Published: March 2003

Objective To evaluate the clinical utility of six commercial assays for free prostate specific antigen (fPSA) and the derived ratio of fPSA to total PSA in distinguishing between patients with prostate cancer or benign prostate hyperplasia (BPH).

Materials and methods Each assay was evaluated against a panel of serum samples comprising those from patients with prostatic disease, other malignancies, normal subjects and sera containing substances which might interfere with the immunoassay.

Results The levels of total (tPSA), fPSA and their ratio (f/tPSA) were compared among the different samples. All assays showed similar specificities for prostate carcinoma but differed in the positive predictive values of f/tPSA.

Conclusions Although all six assays were equimolar, there were differences in calibration, particularly for fPSA. The ability of f/tPSA to discriminate between benign and malignant prostatic disease depended on the assay used. The f/tPSA is not valid when the tPSA and fPSA assays are obtained from different manufacturers.
Lack of neuropeptide Y receptor detection in human bladder and prostate
Authors: Davis B. , Goepel M. , Bein S. , Chess‐williams R. , Chapple C.R. , Michel M.C.
Published: March 2003

Objective To investigate the presence of functional neuropeptide Y (NPY) receptors in human bladder and prostate (both richly endowed with NPY‐containing nerve fibers) using peptide YY (PYY) as the agonist.

Materials and methods Binding studies were conducted using [125I]PYY as the radioligand. Organ‐bath studies were performed on isolated tissue strips for direct (postjunctional) contractile effects and for (prejunctional) inhibition of field stimulation effects. Any possible degradation of PYY was determined using high‐performance liquid chromatography (HPLC).

Results In the radioligand binding studies no quantifiable specific [125I]PYY binding was detected in human bladder or prostate, while specific high‐affinity binding was readily seen in rat cerebral cortex. In organ‐bath experiments, PYY (up to 1 µmol/L) caused no contraction of human prostate or bladder, whereas noradrenaline and carbachol, respectively, were effective; the potency or efficacy of noradrenaline and carbachol were not altered by PYY. Field stimulation‐induced contraction was not affected by PYY in either human bladder or prostate, but was readily inhibited in rat vas deferens. HPLC detected no relevant PYY degradation by human bladder or prostate homogenates.

Conclusion Human bladder and prostate express only very few if any functional NPY receptors.
Bilateral germ cell cancer of the testis: a report of 11 patients with a long‐term follow‐up
Authors: Tekin A. , Aygun Y.C. , Aki F.T. , Ozen H.
Published: March 2003

Objective To describe the incidence, clinical characteristics, treatment methods and long‐term follow‐up of bilateral germ cell tumours of the testis (GCTT) in patients treated at one institution.

Patients and methods Of 552 patients with GCTT, 11 (2%, mean age 26.9 years) developed bilateral disease; all 11 underwent radical orchidectomy. Additional treatment was planned according to the histological type and clinical stage of the tumour, and previous treatments. Intramuscular testosterone was administered periodically after total castration. The data on survival, sexual status and treatment complications were reviewed.

Results Of the 11 patients, seven developed a second tumour metachronously (median interval 87 months) and four had synchronous bilateral GCTT. Cryptorchidism, infertility or atrophic testis was associated with the development of bilateral GCTT in seven of the 11 patients. All synchronous tumours and most of the sequential tumours had identical histology on both sides. Although all sequential tumours presented at an early clinical stage, three of four synchronous bilateral GCTTs presented at an advanced stage. Five patients received platinum‐based chemotherapy; three patients underwent post‐ chemotherapy resection of the retroperitoneal residual mass. Sexual libido and potency were conserved in all patients. No significant morbidity was recorded as being caused by any of these treatments. At a median follow‐up of 11.6 years, all patients were alive with no evidence of cancer.

Conclusions All patients with unilateral GCTT have an increased risk of developing a contralateral testicular tumour, even decades after diagnosis. Management should be adapted to each patient. As all patients in this series survived in the long‐term, developing a second germ cell cancer does not necessarily predict a poor prognosis.