bluuebunny/crossref_metadata_2025 huggingface dataset:
Would prostate cancer detected by screening withprostate‐specific antigen develop into clinical cancer if left undiagnosed? A comparison of two population‐based studies in Sweden
Authors: Hugosson J. , Aus G. , Becker C. , Carlsson S. , Eriksson H. , Lilja H. , Lodding P. , Tibblin G.
Published: March 2003

Objective To assess the risk of over‐diagnosing and over‐treating prostate cancer if population‐based screening with serum prostate‐specific antigen (PSA) is instituted.

Patients and methods From a serum bank stored in 1980, PSA was analysed in 658 men with no previously known prostate cancer from a well‐defined cohort from Göteborg, Sweden (men born in 1913); the incidence of clinical prostate cancer was registered until 1995. From the same area, and with the same selection criteria, another cohort of 710 men born in 1930–31, who in 1995 accepted an invitation for PSA screening, was also analysed.

Results Of men born in 1913, 18 (2.7%) had died from prostate cancer and the cumulative probability of being diagnosed with clinical prostate cancer was 11.1% (5.0% in those with a PSA level of < 3 ng/mL vs 32.9% in those with a PSA level of > 3 ng/mL, P < 0.01). The mean lead‐time from increased PSA (> 3 ng/mL) to clinical diagnosis was 7 years. The prostate cancer detection rate in men born in 1930–31 was 4.4% (22% among those with increased PSA levels) and 30 of 31 detected cancers were clinically localized.

Conclusions Screening and sextant biopsies resulted in a lower detection rate (22%) than the cumulative risk of having clinical prostate cancer (33%) in men with increased PSA levels, indicating that under‐diagnosis rather than over‐diagnosis is the case at least with ‘one‐time’ screening. Even if the stage distribution in screening‐detected cancers seems promising (and thus may result in reduced mortality) it is notable that screening 67‐year‐old men will result in treatment a mean of 7 years before clinical symptoms occur and only one in four men anticipated to develop prostate cancer will die from the disease within 15 years. Large randomized screening trials seem mandatory to further explore the benefits and hazards of PSA screening.
Effects of androgen and ageing on gene expression of vasoactive intestinal polypeptide in rat corpus cavernosum
Authors: Shen Z.J. , Lu Y.L. , Chen Z.D. , Chen F. , Chen Z.
Published: March 2003

Objective To clarify the effects of androgens (testosterone and dihydrotestosterone, DHT) and ageing on gene expression of vasoactive intestinal polypeptide (VIP), assessed as the expression of VIP mRNA, in rat corpus cavernosum.

Materials and methods The study comprised 160 male Sprague Dawley rats divided into group A (56 rats, 5 weeks old), group B (50 rats, 10 weeks old) and group C (54 rats, 58 weeks old). Groups A–C were subdivided, respectively, into subgroups 1 (intact controls), 2 (castrated), 3 (castrated but given testosterone undecanoate 25 mg/kg per month by intramuscular injection), 4 (castrated with testosterone undecanoate 50 mg/kg per month) and 5 (treated with finasteride 4.5 mg/kg per day, orally). At 4 and 10 weeks after these treatments half the rats were killed. Serum samples were taken for the measurement of total and free testosterone and DHT, using a radioimmunoassay. Penile samples (corpus cavernosum) were frozen in liquid nitrogen and stored at −80°C. VIP mRNA was estimated using a semi‐quantitative reverse‐transcription polymerase chain reaction.

Results There was no significant difference in VIP mRNA in rat corpus cavernosum between intact control and castrated subgroups, or subgroups treated with finasteride, in groups A–C, including both the 4‐ and 10‐week old animals (P > 0.05). Penile VIP mRNA was unchanged at any dose of testosterone in the castrated subgroups in all groups (P > 0.05). There was no significant relationship between penile VIP mRNA and ageing (P > 0.05).

Conclusions The gene expression of VIP in rat corpus cavernosum is independent of androgens (testosterone and DHT) and ageing. Androgens probably induce penile erection by pathways other than VIP; ageing may have little effect on penile VIP mRNA.
Inhibitory effect of calcium phosphate‐associated proteins on calcium oxalate crystallization: α2‐HS‐glycoprotein, prothrombin‐F1 and osteopontin
Authors: Nishio S. , Iseda T. , Takeda H. , Iwata H. , Yokoyama M.
Published: March 2003

Objective To analyse urinary calcium phosphate‐ associated proteins and assess their inhibitory effects on calcium oxalate crystallization.

Materials and methods Urine samples were collected over 24 h from five healthy men and calcium phosphate crystallization induced with NaOH solution. The bound proteins were separated on a cellulose column. To examine the effect of urinary calcium phosphate‐associated proteins on calcium oxalate crystallization, 60 L of urine was collected from the healthy men. The effect of the separated fractions was studied in a mixed suspension/mixed product removal system.

Results The separated proteins were identified as α2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin. Prothrombin fragment 1 and osteopontin strongly inhibited the growth of calcium oxalate crystals in artificial urine.

Conclusionα2‐HS‐glycoprotein, prothrombin fragment 1 and osteopontin selectively bound with calcium phosphate crystals in urine. Prothrombin fragment 1 and osteopontin in urine may strongly influence stone formation.
The effect of fasting or desmopressin before treatment on the concentration of mitomycin C during intravesical administration
Authors: Cliff A.M. , Heatherwick B. , Scoble J. , Parr N.J.
Published: March 2003

Objective To evaluate two methods of reducing the urine output during treatment (the most easily manipulated variable) in patients undergoing intravesical instillation with mitomycin C, where the concentration‐time curve also depends upon dose, diluent volume, residual urine volume, and drug absorption and degradation.

Patients and methods The study comprised 20 consecutive patients undergoing a course of six weekly instillations of mitomycin C (40 mg in 40 mL for 1 h) for superficial bladder carcinoma. Urine production during treatment was calculated by adding the voided volume and ultrasonographically measured residual urine after treatment, and subtracting 40 mL; the patient's bladder was emptied before instillation. Before the first and second visit the patients were asked to drink normally. Before the third and fourth visit patients fasted for 6 h before treatment. For the fifth and sixth visit the patients had not fasted, but 200 µg of desmopressin was given orally 1 h before instillation. Any urinary side‐effects were graded on a four‐point scale.

Results There were 17 patients with complete data; one patient failed to take desmopressin, one had detrusor instability and one developed chemical cystitis. The mean (
sd) urine production in unprepared patients was 209 (123) mL, which decreased to 143 (80) mL (P = 0.039, t‐test) after fasting and 103 (51) mL (P < 0.001) with desmopressin. This equates to a 20% increase in mean intravesical drug concentration with fasting and a 38% increase with desmopressin. Urinary side‐effects were graded as mild in each group.

Conclusion Unprepared patients produce variable and often substantial volumes of urine during intravesical chemotherapy. There was a significant reduction in urine output after fasting or by administering desmopressin before instillation. These measures increase the area under the concentration‐time curve for mitomycin C and potentially increase the efficacy of treatment.
Placebo‐associated remissions in a multicentre, randomized, double‐blind trial of interferon γ‐1b for the treatment of metastatic renal cell carcinoma
Authors: Elhilali M. M. , Gleave M. , Fradet Y. , Davis I. , Venner P. , Saad F. , Klotz L. , Moore R. , Ernst S. , Paton V. ,   Canadian Urologic Oncology Group
Published: March 2003

Objective To determine the validity of using an historical maximum spontaneous regression rate (reportedly 0–1.1% in those with lung metastases after nephrectomy) in clinical trials of treatments for patients with metastatic renal cell carcinoma (RCC), as the eligibility criteria for most studies will select patients with better performance status (and thus excluding those who are unlikely to respond) and more modern staging methods would potentially reduce the number of false‐positives.

Patients and methods A multicentre randomized,placebo‐controlled, double‐blind trial was recently completed in which 197 patients with metastatic RCC from 17 study centres across Canada were randomized to receive placebo or recombinant interferonγ‐1b (60 µg/m2) subcutaneously once every 7 days until disease progression. All tumour responses were validated by an independent response committee unaware of the treatment.

Results The median (95% confidence interval) overall response rate (complete, CR, and partial, PR) for those on interferon‐γ was 4 (1.4–11.5)% and for those on placebo was 6 (2.5–13.2)% (P = 0.75). In the six patients who were receiving placebo the CR and PR (three each) was considered to represent spontaneous remission. Of these six patients (aged 44–64 years) five had undergone nephrectomy, one a tumour embolization, four had clear cell carcinoma and one an adenocarcinoma, and all had regression of lung and/or lymph node metastases.

Conclusion The lack of efficacy of interferon‐γ in this trial underlines the importance of continued research to identify alternative therapeutic agents or combinations of agents in phase II studies. However, the threshold response rate for initiating phase III trials should be increased to 18% in the phase II trials, i.e. three times the response rate on placebo.
An evaluation of Bosniak's radiological classification of cystic renal masses
Authors: Koga S. , Nishikido M. , Inuzuka S. , Sakamoto I. , Hayashi T. , Hayashi K. , Saito Y. , Kanetake H.
Published: March 2003

Objective To determine the clinical usefulness of Bosniak's classification of cystic renal masses, the differentiation of which remains difficult despite significant advances in diagnostic imaging.

Patients and methods The computed tomography (CT) findings of all histopathologically examined cystic renal masses diagnosed at our institution were analysed retrospectively; 35 patients with cystic renal masses were treated between 1986 and 1998. Tissues surgically removed were examined pathologically and the final diagnosis compared with the preoperative CT category of Bosniak's classification.

Results The histopathological examined showed cystic renal cell carcinoma in 21 patients, a benign renal cyst in 12, haemangiosarcoma in one and transitional cell carcinoma in one. Most of the 35 masses (26, 74%) were found incidentally during evaluation for an unrelated disease or a routine health check. All 11 masses of Bosniak category I were benign and one category II mass was malignant. All 10 masses of category III and 12 of category IV were malignant.

Conclusions Bosniak's classification is useful for differentiating category I, III and IV cystic renal masses. There were too few samples to allow meaningful conclusions to be drawn for category II renal masses. It is critical to differentiate between complicated cysts of category II and III because of the major implications for prognosis and clinical management.
Adjuvant mitozantrone chemotherapy in advanced prostate cancer
Authors: Wang J. , Halford S. , Rigg A. , Roylance R. , Lynch M. , Waxman J.
Published: March 2003

Objective To assess the role of mitozantrone, active in relapsed prostate cancer, as an adjuvant to hormonal treatment in patients with advanced prostate cancer.

Patients and methods Between October 1990 and May 1995, 96 patients were entered into a stratified, randomized, single‐institution study of hormonal therapy with a luteinizing hormone‐releasing hormone agonist and flutamide, with or without four cycles of adjuvant mitozantrone. Of these, 93 patients were evaluable and the results were analysed in June 1999.

Results Patients with localized prostate cancer receiving adjuvant chemotherapy had a higher initial objective response rate (95% vs 53%, P = 0.008) and median survival (80 vs 36 months, P = 0.04) than patients who were treated with hormonal therapy alone. There was no advantage to adjuvant chemotherapy in patients with metastatic prostate cancer. There were insignificant advantages to chemotherapy in overall response rates (55% vs 39%, P = 0.3) and PSA responses (82% vs 64%, P = 0.11). There was no difference between the patient groups in time to treatment failure.

Conclusion There was a survival advantage in using adjuvant mitozantrone in patients with locally advanced prostate cancer. Although the study comprised relative few patients, the follow‐up period was long and the advantage significant. We recommend that the study be extended to include more patients.
Patient selection before endopyelotomy: can it improve the outcome?
Authors: Keeley F.X. , Tolley D.A. , Moussa S.A.
Published: March 2003

Objective To compare endopyelotomy and primary reconstructive procedures in patients with pelvi‐ureteric junction (PUJ) obstruction and with risk factors for endopyelotomy failure.

Patients and methods Nineteen patients (eight female and 11 male, mean age 34.5 years, range 15–82) underwent endoluminal ultrasonography (US) before treatment for PUJ obstruction; the US findings were used to direct the treatment. Patients with unavoidable crossing vessels, massive hydronephrosis and crossing vessels associated with previous failed endopyelotomy were selected for reconstructive surgery. The clinical results of these patients (group 1) were compared with 12 consecutive patients who had undergone endopyelotomy before the use of endoluminal ultrasonography (group 2).

Results Imaging detected 17 crossing vessels in 13 of the 19 patients. Six patients underwent primary reconstructive surgery and 13 underwent endopyelotomy. The endoluminal US findings changed treatment in some way in nine patients. Endopyelotomy was successful in 12 of the 13 patients and reconstructive surgery successful in five of six patients. The success after endopyelotomy improved from eight in 12 patients in group 2 to 12 of 13 in group 1 (P = 0.16, NS).

Conclusions Endoluminal US can be used to select patients in whom endopyelotomy is likely to fail. Using primary reconstructive procedures in these patients might improve the overall outcome, but these preliminary findings need to be confirmed in a larger study.
The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method
Authors: Hultén J.O. , Tran V.T. , Pettersson G.
Published: March 2003

Objective To determine whether the addition of ethanol to water for irrigation during transurethral resection of the prostate (TURP) and monitoring breath ethanol could be used to detect irrigant absorption and to limit free plasma haemoglobin in cases of absorption.

Patients and methods One hundred patients (46 in Piteå, Sweden and 54 in Uong bi, Vietnam) underwent surgery for benign prostatic hyperplasia (BPH) under an intermittent irrigation technique using water containing 2% ethanol. An expired breath alcohol meter was used to monitor ethanol in the patients' breath every 5 min. Blood samples taken after TURP were assessed for free haemoglobin in 99 patients, and other markers of haemolysis were also evaluated in the Swedish group.

Results Thirty‐two patients had detectable ethanol in their breath. There was a close correlation between the maximum ethanol reading during surgery and the level of free plasma haemoglobin after TURP (r = 0.90, P < 0.001). There was no correlation between the duration of TURP and the free haemoglobin level.

Conclusion Monitoring breath ethanol during TURP assesses absorption and so can help to keep control of haemolysis. It is suggested that the value on the alcohol meter should not be allowed to exceed 0.15 (corresponding to a blood ethanol level of 0.15‰), which should maintain the free plasma haemoglobin level at < 1.0 g/L after TURP. Restricting the operative duration per se is not a reliable safety measure.
A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group
Authors: Lance R.S. , Freidrichs P.A. , Kane C. , Powell C.R. , Pulos E. , Moul J.W. , Mcleod D.G. , Cornum R.L. , Brantley Thrasher J.
Published: March 2003

Objective To review and compare the outcome of patients undergoing radical retropubic prostatectomy (RRP) or radical perineal prostatectomy (RPP) for clinically localized prostate cancer.

Patients and methods From 1988 to 1997, 1382 men who were treated by RRP and 316 by RPP were identified from databases of the Uniformed Services Urology Research Group. The following variables were assessed; age, race, prostate‐specific antigen (PSA) level before surgery, clinical stage, biopsy Gleason sum, estimated blood loss (EBL), margin‐positive rate, pathological stage, biochemical recurrence rate, short and long‐term complication rates, impotence and incontinence rates. To eliminate selection bias, the analysis was concentrated on pairs of patients matched by race, preoperative PSA level, clinical stage and biopsy Gleason sum.

Results In the 190 matched patients there were no significant differences between the RRP and RPP groups in either organ‐confined (57% vs 55%), margin‐positive (39% vs 43%), or biochemical recurrence rates (12.9% vs 17.6% at a mean follow‐up of 47.1 vs 42.9 months), respectively. The mean EBL was 1575 mL in the RRP group and 802 mL in the RPP group (P < 0.001). The only significant difference in complication rates was a higher incidence of rectal injury in the RPP group (4.9%) than in the RRP group (none, P < 0.05).

Conclusions In similar populations of patients, RPP offers equivalent organ‐confined, margin‐positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.
The overactive bladder in children: a potential future indication for tolterodine
Authors: Hjälmås K. , Hellström A‐L. , Mogren K. , Läckgren G. , Stenberg A.
Published: March 2003

Objective To determine the safety, efficacy and pharmacokinetics of tolterodine in children with an overactive bladder.

Patients and methods Thirty‐three children (20 boys and 13 girls, aged 5–10 years) with an overactive bladder and symptoms of urgency, frequency and/or urge incontinence were enrolled in an open, dose‐escalation study. Patients were treated with oral tolterodine 0.5 mg (n = 11), 1 mg (n = 10) or 2 mg (n = 12) twice daily for 14 days. The primary safety endpoint was the change in residual urinary volume, as determined by ultrasonography. In addition, voiding diary variables (frequency and incontinence episodes) and pharmacokinetics were evaluated. Other safety endpoints included laboratory variables, electrocardiogram recordings and reported adverse events.

Results There were no safety concerns in terms of the change in residual urinary volume for any of the three dosage groups; values were comparable with baseline after 2 weeks of treatment for all three dosages. Adverse events were reported by 20 patients (six on 0.5 mg, five on 1 mg, and nine on 2 mg). Most adverse events were not considered to be drug‐related; of the 13 possibly related events, 10 occurred in those taking 2 mg. Headache was the most commonly reported adverse event. No serious adverse events were reported and there were no general safety concerns. There was an improvement in voiding diary variables in all treatment groups after 2 weeks of treatment, although the efficacy was greatest in those taking 1 mg and 2 mg. Pharmacokinetic findings were consistent with dose linearity over the range 0.5–2 mg.

Conclusion The results support the use of 1 mg twice daily as the optimal dose of tolterodine for treating children aged 5–10 years with an overactive bladder.
Is the vanished testis always a scrotal event?
Authors: Belman A.B. , Rushton H.G.
Published: March 2003

Objective To determine if perinatal testicular torsion resulting in a vanished testis is an event that primarily occurs in the scrotum.

Patients and methods The records of 54 boys identified as having a solitary testis were reviewed. The side of absence, size of the solitary testis, method of surgical evaluation (scrotal, inguinal or abdominal), surgical findings and histology of the tissue removed were noted.

Results The testis was absent twice as often on the left side, the solitary testis was hypertrophic in 25 of 42 boys in whom it was evaluated, and tissue grossly or histologically consistent with a testicular ‘nubbin’ was removed in 52 boys. Scrotal (47) or inguinal (seven) exploration was carried out in all. Laparoscopy (28) or abdominal exploration (two) was undertaken to confirm that no testicular tissue was present in the abdomen in 30 boys, including the two in whom no tissue was found on scrotal or inguinal exploration.

Conclusions Perinatal testicular torsion occurs after descent but before fixation of the tunica vaginalis to the scrotal wall. These testes atrophy, leaving a remnant of tissue in the scrotum that can be identified on scrotal exploration in almost all cases. Therefore, it is recommended that the evaluation of the child with a solitary palpable testis start with scrotal exploration. Laparoscopy should be reserved for those in whom no tissue consistent with a testicular nubbin is found in the scrotum.
Corporal plication for penile curvature caused by Peyronie's disease: the patients' perspective
Authors: Chahal R. , Gogoi N.K. , Sundaram S.K. , Weston P.M.T.
Published: March 2003

Objective To determine the acceptability by patients of corporal plication for Peyronie's disease.

Patients and methods A postal questionnaire was sent to 69 patients who had undergone corporal plication for Peyronie's disease between 1992 and 1999, to ascertain the subjective outcome and acceptance by the patients and their sexual partners of the results of the procedure. Of the 65 patients who were still alive, 44 (68%) returned the questionnaire.

Results The mean (range) follow‐up was 4.1 (0.5–7.25) years and the mean age of the patients 54.6 (32–80) years. Of the 44 patients responding, 24 (55%) were sexually active; after surgery, 16 (36%) had significant impairment of erections, seven (16%) continued to have significant penile discomfort and 15 (34%) could feel nodules at the suture site. Twenty‐five (57%) patients reported a mild and six (14%) a severe persistent penile deformity; 40 (90%) reported having a shorter penis, of whom 22 (55%) thought it significant. Overall, 14 (32%) reported ‘numbness’ of the glans penis. Only 23 (52%) of the patients would recommend the surgery, with 25 (57%) reporting a deterioration in their overall quality of life. Of the partners of the evaluable patients, 38 (86%) responded, and a significant deterioration in sexual performance was reported by 19 (35%).

Conclusions Overall, the long‐term results of corporal plication appear to be disappointing. These poor results could be related to a current lack of understanding of the natural history and progression of the disease, to case selection, or to the surgery. We intend to use these results to counsel our patients before such surgery and inform them of the possible outcome in the long term.
Laparoscopic partial upper pole nephrectomy in infants and children
Authors: Horowitz M. , Shah S.M. , Ferzli G. , Syad P.I. , Glassberg K.I.
Published: March 2003

Objective To retrospectively review 5 years' experience of transperitoneal laparoscopic partial nephrectomy (LPN) in infants and children.

Patients and methods Between January 1995 and December 1999, 14 upper‐pole partial nephrectomies (seven right and seven left) were undertaken in 13 children (mean age 3.8 years, range 0.4–14). One patient underwent bilateral upper‐pole LPN. No children required a lower‐pole partial nephrectomy during the study period. Evaluation included renal ultrasonography, voiding cystourethrography, renal scintigraphy and contrast‐enhanced computed tomography in some cases. Three ports (10, 5 and 5 mm) were used in all except two patients, who required an additional 2 mm port for liver retraction. The diseased parenchyma was transected with electrocautery or harmonic scalpel. The distal ureter was simply transected in the absence of reflux, but tied adjacent to the bladder if reflux was present.

Results The mean operative duration for LPN was 100 min, with an estimated blood loss of < 30 mL. A liquid diet was tolerated on the first morning after surgery and age‐appropriate regular diet that evening in all except one patient. The mean hospital stay was 2.6 days. One patient had a significant decrease in haematocrit, which was managed conservatively, not requiring transfusion. Follow‐up telephone interviews with the patients' parents showed that all were satisfied with the medical and cosmetic outcome.

Conclusion Transperitoneal LPN is preferable to open partial nephrectomy because: (i) The magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to the healthy tissue; (ii) There is minimal blood loss, fast recovery and less surgical scarring, and when upper‐pole partial nephrectomy is required, LPN is less damaging to the lower‐pole. Unlike total nephrectomy, where debate remains about open vs laparoscopic methods, the specific advantages of LPN make it clearly preferable.
The modified Koyanagi repair for severe proximal hypospadias
Authors: Hayashi Y. , Kojima Y. , Mizuno K. , Nakane A. , Kohri K.
Published: March 2003

Objective To report the method and results of a modified one‐stage Koyanagi repair (urethroplasty with a parameatal‐based and fully extended circumferential foreskin flap) to preserve the vascularity to the peripheral portion of the neourethra, in the repair of severe hypospadias.

Patients and methods Using a skin‐incision line as in the original Koyanagi repair, a circumferential incision is made ≈ 5 mm proximal to the corona and the urethral plate incised as for repair of chordee. A U‐shaped skin incision is then made surrounding the meatus, extended to the dorsal prepuce for ≈ 8 mm and parallel to the first incision. The tissue between the prepuce and dartos is dissected on the dorsal side to fix the prepuce as a neourethra to the dartos and to maintain blood supply. After mobilizing the loop‐shaped skin flap through the button‐hole of the pedicle, the internal and external sides of the loop are sutured to construct a neourethra. Twenty patients (aged 10 months to 9 years) with severe proximal hypospadias underwent the one‐stage modified Koyanagi repair.

Results The repair was successful after the initial procedure in 14 patients, but urethrocutaneous fistulae developed in three and meatal stenosis in three. The overall success rate was thus 70%.

Conclusions There were fewer complications than reported with the original Koyanagi repair, suggesting that the attempted vascular preservation of the neourethra was effective.
Neoplasia in adult exstrophy patients
Authors: Smeulders N. , Woodhouse C.R.J.
Published: March 2003

Objective To document the incidence of neoplasia in a cohort of 103 patients born with classical exstrophy.

Patients and methods The notes of patients born before 1964 with exstrophy were reviewed retrospectively. The patients were divided into two groups; 42 were thought to be at high risk of developing neoplasia because they had (at some time) had mixing of urine and faeces in a colorectal reservoir, whereas 61 had never been exposed to such a mixture and were thought to have a low risk of neoplasia.

Results At a minimum of 35 years of follow‐up, complete data were available for 61 patients; 42 were lost to follow‐up, of whom 14 were at high risk and 28 at low risk of neoplasia. In the high‐risk group, there were three with colonic carcinoma (two of whom presented before 1980 and died), one with carcinoma in situ of the colon, 10 with benign colonic neoplasms and three with bladder cancer (two of whom died). In the low‐risk group, there was one patient with bladder cancer (who died) and one with a clear cell carcinoma of the kidney. Three of the four patients with bladder cancer had undergone cystectomy before 5 years of age. Assuming that all the lost patients are alive and free of neoplasia, the risk of neoplasia in adults born with exstrophy is 17.5%. The main risk is in those who have been exposed to mixing of urine and faeces in a colorectal reservoir (38%). Even in low‐risk patients the risk of malignant neoplasia is 3.3% at a median (range) age of 42 (40–44) years, which is 27 times higher than that of the age‐matched general population.

Conclusions Annual colonoscopy of patients deemed at high risk of colorectal neoplasia appears to be an effective screen for colorectal carcinoma, by identifying a premalignant stage, as there were no deaths after this was introduced. Despite bladder closure or diversion surgery within the first few years of life, patients with exstrophy have an almost 700‐fold greater incidence of carcinoma of the bladder than the age‐matched general population. Early cystectomy is not protective.
The percentage of free prostate‐specific antigen does not predict extracapsular disease in patients with clinically localized prostate cancer before radical prostatectomy
Authors: Melchior S.W. , Noteboom J. , Gillitzer R. , Lange P.H. , Blumenstein B.A. , Vessella R.L.
Published: March 2003

Objective To determine whether the percentage of free/total prostate‐specific antigen (f/tPSA) can predict the pathological features in patients with clinically localized prostate cancer before radical prostatectomy.

Patients and methods Univariate and multivariate logistic regression was used to analyse data from 171 untreated patients who underwent radical prostatectomy. Variables included the total PSA (tPSA), fPSA, f/tPSA, biopsy Gleason score, clinical stage and patient age.

Results In 115 patients with pathologically organ‐confined tumours ( pT2N0) the mean (sd) tPSA value was 6.9 (5.6) ng/mL; in 56 patients with extracapsular disease ( pT3pN0/N+) it was 10.2 (7.6) ng/mL; the respective f/tPSA values were 14.9 (8.1)% and 14.2 (12.9)%. In the univariate and multivariate analysis, tPSA and biopsy Gleason score were highly significant in predicting extracapsular disease (P < 0.001 and 0.002) but the f/tPSA was not (P = 0.18). There was no significant difference between the mean f/tPSA and final Gleason scores.

Conclusion The f/tPSA does not predict extracapsular disease in patients with clinically localized prostate cancer before radical prostatectomy. Knowing the f/tPSA provides no significant additional information in predicting extracapsular disease when the biopsy Gleason score and tPSA are known.
Upper pole heminephrectomy: is complete ureterectomy necessary?
Authors: Ade‐Ajayi N. , Wilcox D.T. , Duffy P.G. , Ransley P.G.
Published: March 2003

Objective To determine the re‐operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy.

Patients and methods The case notes from one institution were reviewed retrospectively; 60 upper pole heminephrectomies with incomplete ureterectomy were undertaken in 39 girls and 16 boys (mean age at primary surgery 27 months, range 3–88).

Results Thirty‐two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty‐nine of the 60 renal units (48%) had an associated ureterocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underwent initial puncture of a ureterocele. Five patients (8%), all females, required lower urinary tract re‐operation. The indications for secondary surgery were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child.

Conclusions The re‐operation rate for a redundant ureteric stump in this series was 8%. The risk of injury to the good ureter may outweigh the benefits of a complete ureterectomy.
Comparative evaluation of treatments for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy
Authors: Baniel J. , Israilov S. , Segenreich E. , Livne P.M.
Published: March 2003

Objective To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer.

Patients and Methods The study included 85 patients (mean age 59.5 years, range 50–75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildenafil; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year.

Results Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection sufficient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildenafil and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow‐up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildenafil, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device.

Conclusion Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow‐up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.
Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction
Authors: Sairam K. , Kulinskaya E. , Boustead G.B. , Hanbury D.C. , Mcnicholas T.A.
Published: March 2003

Objective To determine the prevalence of previously undiagnosed diabetes mellitus (DM) in men presenting with erectile dysfunction (ED), using fasting blood glucose (FBG) compared with urinary dipstick testing for glycosuria.

Patients and methods A prospective prevalence study was carried out in an andrology outpatient clinic of a urology department in a district general hospital serving a mixed urban and rural population. In all, 129 consecutive men presenting with ED underwent FBG and urinary dipstick testing to detect undiagnosed DM in those presenting with ED.

Results The prevalence of known DM was 17% and the that of undiagnosed DM 4.7% of the 107 remaining men; an abnormal fasting glucose level was found in a further 12%. The sensitivity of urine dipstick test for diagnosing DM was 20%.

Conclusions The prevalence of undiagnosed DM is higher in men with ED than in the general population. ED is a marker symptom for DM and DM should be actively sought in men presenting with ED. Urinary dipstick testing for glycosuria, if used as a screening test, will miss the diagnosis in 80% of these men. FBG testing should be undertaken to reliably diagnose DM in men presenting with ED.
Pretreatment levels of urinary deoxypyridinoline as a potential marker in patients with prostate cancer with or without bone metastasis
Authors: Wymenga L.F.A. , Groenier K. , Schuurman J. , Boomsma J.H.B. , Oude Elferink R. , Mensink H.J.A.
Published: March 2003

Objective To assess the predictive role of the bone markers alkaline phosphatase (ALP) and urinary deoxypyridinoline (DPD), as indicators of bone turnover, at baseline in patients with prostate cancer.

Patients, subjects and methods Urinary DPD, serum ALP and prostate‐specific antigen (PSA) were evaluated in 23 patients with benign prostatic hyperplasia (BPH), 115 with prostatic carcinoma, of whom 21 had bone metastasis, and in 16 age‐matched control subjects.

Results Patients with newly diagnosed prostate cancer and bone metastasis had a higher urinary excretion of DPD, and a higher serum PSA and ALP than had patients with BPH and those with prostate cancer but no metastasis. Receiver operating curve analysis for PSA, ALP and DPD showed a significant discriminating ability for positive and negative bone scans (P = 0.0684). However, from logistic regression of the combinations, only serum ALP was a significant independent predictor of bone metastasis in patients with prostate cancer.

Conclusion Serum ALP or urinary DPD are the best predictors of bone metastasis in patients with prostate cancer; further studies with more patients are required.
A 10‐year experience of managing ureteric calculi: changing trends towards endourological intervention—is there a role for open surgery?
Authors: Ather M.H. , Paryani J. , Memon A. , Sulaiman M.N.
Published: March 2003

Objectives To study changing practices in the management of ureterolithiasis with the introduction of newer technologies, the efficacy and safety of endourology, extracorporeal shock wave lithotripsy (ESWL) and open surgery, and to determine if any indication remains for open ureterolithotomy in a tertiary endourology unit.

Patients and methods A 12‐year retrospective review (1987–1998) was conducted of all primary ureteric stones treated by ESWL, endoscopy, intracorporeal shock wave lithotripsy (ISWL) administered via ureteroscopy, and open surgery.

Results In all, 1195 patients were treated for primary ureteric stones, 44% by ESWL, 37% by ureteroscopy and ISWL, and 20% by open surgery. At the 3‐month follow‐up the stone‐free rates for ESWL monotherapy, ureteroscopy and open surgery were 95%, 85% and 97%, giving an efficiency quotient of 73%, 64% and 94%, respectively. The overall complication rate for ESWL was 13%, for ISWL 32% and for open surgery 13%, but the complications of open surgery were often serious and potentially life‐threatening.

Conclusions With recent advances in endourology the indications for open surgery have decreased considerably, from 26% in 1987–95 to 8% in 1996–98. However, the remaining indications for open ureterolithotomy include failure of less invasive modalities, the presence of medical/anatomical abnormalities, a concomitant open procedure, and the presence of large impacted calculi for which patients prefer to avoid multiple procedures.
The effects of flow rate, length and external pressure upon the pressure required for fluid to flow through a ureter
Authors: Karnak I. , Büyükpamukçu N. , Tanyel F.C.
Published: March 2003

Objective To determine in vitro the effects of increments of external pressure on the pressure required to conduct fluid through ureters of various lengths at different flow rates, as the flow of a fluid through a collapsible tube is influenced by various factors (e.g. external pressure, the pressure gradient between the ends, the length and diameter of the tube, and the viscosity of fluid).

Materials and methods Two in vitro systems were designed, composed of three parts, i.e. a perfusion line, an exit line and a container of two different widths in which short or long ureteric segments, obtained from cattle, could be placed; the ureter was connected to the perfusion and exit lines. Physiological saline was added to the container until the desired external pressure was applied to the ureter. The flow pressure (height of the perfusion line) was recorded when producing flows through ureters of varying length at 1.5 and 6 mL/min, and determined under various external pressures. The intra‐ureteric pressure during flow was also monitored by a pressure transducer. The four combinations of long and short ureters with high and low flow rates were compared using analysis of variance, with the Pearson correlation coefficient used to evaluate the relationships between the various pressures.

Results There were close relationships between flow pressure and external pressure (r = 0.727), intra‐ureteric and external pressure (r = 0.766), and the flow pressure and intra‐ureteric pressure (r = 0.940, all P < 0.001). Increments in external pressure resulted in greater flow and intra‐ureteric pressure (P < 0.05). Increases in flow pressure were more pronounced than increases in intra‐ureteric pressure at the same external pressure (P < 0.05) at high flow rates. A longer ureter and higher flow rates caused greater intra‐ureteric pressure (P < 0.05).

Conclusion External pressure increases the pressure required to conduct fluid through a ureter and the effect is more pronounced at high flow rates. The length of the ureter also affects the flow pressure at high flow rates. Therefore, flow through the ureter follows the Poiseuille equation only at high flow rates. Thus, increases in intra‐abdominal pressure may cause greater intrapelvic pressure and induce ureteric obstruction, contributing to the pathogenesis of hydronephrosis.
Feasibility of multi‐slice computed tomography in the diagnosis of arteriogenic erectile dysfunction
Authors: Kawanishi Y. , Lee K.S. , Kimura K. , Kojima K. , Yamamoto A. , Numata A.
Published: March 2003

Objective To compare computed tomography (CT) angiography (CTA) obtained by multi‐slice CT (a new minimally invasive method) with the current standard of arterial imaging, digital subtraction angiography (DSA), in diagnosing arteriogenic erectile dysfunction (ED).

Patients and methods Twenty‐one patients with suspected arteriogenic ED underwent DSA and CTA after providing informed consent. Prostaglandin E1 was injected into the penile cavernosal body and then non‐ionic contrast medium was rapidly infused into the antecubital vein. The DSA and CTA images were diagnosed as showing a normal or abnormal status by three reviewers independently. CTA was undertaken on an outpatient basis but DSA required hospitalization.

Results In the 42 internal pudendal arteries, DSA showed 28 normal and 14 impaired arteries; CTA showed 21 normal arteries and 21 occlusions. The CTA image correlated closely with the diagnosis of stenosis or occlusion in internal pudendal arteries, with a sensitivity of 93%, a specificity of 71% and an accuracy of 79%. In the cavernosal arteries, DSA depicted 14 normal and 28 impaired arteries; CTA showed seven normal arteries and 35 occlusions. The CTA image agreed closely with the diagnosis of stenosis or occlusion in cavernosal arteries, with a sensitivity of 96%, a specificity of 43% and an accuracy of 79%. Of the 42 inferior epigastric arteries, DSA could not depict 11 arteries but CTA showed all 42 inferior epigastric arteries.

Conclusions CTA images correlated with DSA images; at present DSA is better than CTA in visualizing stenosis in fine arteries. However, CTA is less invasive and relatively inexpensive, and in future will probably provide even greater improvements in graphic quality. CTA would be an adequate replacement for DSA in evaluating internal pudendal arterial stenosis.
A light‐ and electron‐microscopic histopathological study of human bladder mucosa after intravesical resiniferatoxin application
Authors: Silva C. , Avelino A. , Souto‐Moura C. , Cruz F.
Published: March 2003

Objective To determine the morphology of bladder mucosa and the integrity of its mucin coat in patients with detrusor hyper‐reflexia treated with intravesical resiniferatoxin.

Patients and methods Seven patients with detrusor hyper‐reflexia were treated intravesically with resiniferatoxin dissolved in 10% ethanol in saline (50 nmol/L solution in two and 100 nmol/L in five). Patients were clinically evaluated by a voiding chart and filling cystometry before and 3 months after each resiniferatoxin application. In addition, they underwent cystoscopy and bladder biopsies at 22–33 months after the first instillation and at 7–23 months after the last one. Tissue samples for light microscopy were fixed in 4% paraformaldehyde, embedded in paraffin and stained with haematoxylin‐eosin or periodic acid‐Schiff reagent (PAS). Those for electron microscopy were fixed in 5% glutaraldehyde and embedded in resin.

Results The resiniferatoxin instillation was not painful. Three months after treatment the mean voiding frequency decreased and five incontinent patients became continent. The maximum cystometric capacity increased in all patients; at cystoscopy the bladders appeared normal. On light microscopy the urothelium was of normal morphology and stained with PAS in the luminal cells and in the basement membrane. Mononuclear inflammatory cells were occasionally apparent in the lamina propria. On electron microscopy epithelial cells were visible in a thick basal lamina. Superficial cells had the usual irregular contour and contained numerous membrane‐coated vesicles. In the lamina propria, unmyelinated axonal profiles with occasional varicosities could be identified.

Conclusions Intravesical resiniferatoxin improved urinary frequency, incontinence and bladder capacity in patients with detrusor hyper‐reflexia, causing no morphological change in the bladder mucosa. The PAS reactivity of the carbohydrate moieties present in the mucin coat and the basement membrane was unchanged by resiniferatoxin.
Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms
Authors: Masood J. , Lane T. , Koye B. , Vandal M.T. , Barua J.M. , Hill J.T.
Published: March 2003

Objective To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LUTS) with those presenting symptomatically, by stage, intervention and outcome.

Patients and methods The case notes of all male patients (100) diagnosed with RCC between 1991 and 1998 were reviewed and modes of presentation recorded. The patients were divided into two groups: those who were referred with LUTS (frequency, urgency, hesitancy, poor stream, nocturia) and in whom RCC would not have been suspected and was thus detected incidentally on routine ultrasonography; and all patients in whom carcinoma might have been suspected from their symptoms but, for the purposes of this study, also included patients in whom RCC was diagnosed during ultrasonography for unrelated intra‐abdominal pathology. Details of diagnostic imaging and clinical staging were similarly recorded for both groups and where surgical intervention was undertaken, histopathological data were also noted. The clinical course and long‐term outcome of incidentally detected tumours was then compared with their symptomatically presenting counterparts.

Results The mean (range) follow‐up for all patients was 30 (1.5–96) months; for those in the incidental group it was 31 (1–86) months and in the symptomatic patients 29 (1–96) months. Organ‐confined disease was found in two‐thirds of patients with incidental tumours and in 38% of those in whom the tumour may have been suspected; the difference was statistically significant (chi‐squared test P < 0.05). The mean (sd) size of tumours discovered incidentally and in symptomatic patients was 5.9 (1.94) cm and 9.2 (3.39) cm, respectively; this difference was also statistically significant (t‐test, P < 0.001). Of the 24 patients with incidentally detected tumours, 14 (58%) were alive with no recurrence, and of the 76 presenting symptomatically, 27 (35%) were alive with no recurrence at the last follow‐up; disease survival curves showed a statistically better survival rate for those with organ‐confined tumours.

Conclusion Incidentally diagnosed RCC represents a significant proportion of those who are ultimately diagnosed with the malignancy. Opportunities which arise for appropriate screening of the upper tracts during routine urological investigations (e.g. ultrasonography of the upper tracts in patients referred for LUTS) should be endorsed, contrasting with the more traditional approach, which argues that it yields no ultimate survival advantage.