bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of intestinal urinary reservoirs on renal function: a 10‐year follow‐up
Authors: Fontaine E. , Leaver R. , Woodhouse C.R.J.
Published: March 2003

Objective To study the effect of the storage of urine in intestinal reservoirs on long‐term renal function and the possible causes of deterioration.

Patients and methods Eighty‐seven patients (aged 4–35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular filtration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51Cr‐ethylenediamine tetra‐acetic acid. Patients with a decline in GFR of > 5% were investigated to identify the cause.

Results Of 58 patients with a follow‐up of ≥ 10 years, 53 were evaluable, four having been lost to follow‐up and one refusing to accept the protocol. In these 53 patients, the mean (
sd) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m2 (P = 0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by ≥ 20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (five), uretero‐ileal stenosis (one), a high‐pressure reservoir (one) and uncertain causes (three).

Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, ≈ 20% of patients had some deterioration in renal function during the 10‐year follow‐up, usually from identifiable and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function. Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed.
Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma
Authors: Symbas N.P. , Townsend M.F. , El‐Galley R. , Keane T.E. , Graham S.D. , Petros J.A.
Published: March 2003

Objectives To better define the relationship between platelet count and survival using a retrospective analysis in patients with thrombocytosis and metastatic renal cell carcinoma (RCC), some of whom had a shorter life expectancy than those with a normal platelet count.

Patients and methods The records were reviewed of patients with stage IV RCC who had undergone a variety of adjuvant therapies after nephrectomy between 1972 and 1992. Entry criteria included a tissue diagnosis of RCC, at least one platelet count and a complete follow‐up until the time of death. Of 350 patients available for review, 259 met the entry criteria. Patients were divided into two groups: group 1 included 112 patients whose platelet counts remained at < 4 × 105/µL between the time of nephrectomy and the time of death; group 2 included 147 patients with at least one platelet count of > 4 × 105/µL (mean age in each group 57 years).

Results The mean (
sd) survival for group 1 was 151 (34) months, compared with 92 (18) months for those in group 2. Using the log‐rank chi‐square test the difference in survival between the groups was significant (P = 0.005). Controlling for established prognostic indicators of pathological stage, nuclear grade and cell type, using Cox's regression technique, the difference in survival between the groups remained significant (P = 0.015).

Conclusions These results suggest that patients with metastatic RCC who receive adjuvant therapy and have a persistently normal platelet count have a 64% longer life expectancy than those with thrombocytosis. The difference is highly statistically significant when controlled for nuclear grade, cell type and pathological stage.
Interstitial cystitis in Japan
Authors: Ito T. , Miki M. , Yamada T.
Published: March 2003

Objective To determine the prevalence of interstitial cystitis in Japan, and to analyse the diagnostic criteria and treatments most commonly used by Japanese urologists.

Materials and methods Questionnaires were sent to 300 urologists at major hospitals, including medical university hospitals, throughout Japan, asking about the number of patients with interstitial cystitis, its epidemiology, diagnosis and therapy.

Results The prevalence of interstitial cystitis was 1.2 per 100 000 patients and 4.5 per 100 000 female patients; the male/female ratio was 1 : 5.8. Most Japanese urologists used two or more diagnostic criteria; bladder biopsy was the most common diagnostic method. Dimethyl sulphoxide instillations and corticosteroids were the most frequently used therapies.

Conclusion The prevalence of interstitial cystitis in Japan is markedly lower than that reported in Europe and North America. The reasons for this difference were not only racial but also the lack of awareness among Japanese urologists and patients about interstitial cystitis.
Biomarker distribution after injection into the canine prostate: implications for gene therapy
Authors: Siemens D.R. , Iwasawa T. , Austin J.C. , Williams R.D. , See W.A. , Hedican S.P. , Tartaglia J. , Flynn C.M. , Cohen M.B. , Rodgers J. , Ratliff T.L.
Published: March 2003

Objective To evaluate the distribution of biomarkers after transrectal injection into the canine prostate and to report a method for enhancing the distribution of gene expression.

Materials and methods Carbon black was first used to evaluate the histopathological distribution in canine prostate of single or multiple injections via the transurethral, transperineal and transrectal routes. The distribution of canarypox virus (ALVAC) vector‐delivered gene expression was then compared using both fluid‐phase injection techniques and delivery in a solid carrier composed of a gelatine sponge matrix.

Results After transurethral administration, carbon black was detected as scattered particles in ducts and acini, mostly in the periphery of the gland. Direct transrectal injection of carbon black resulted in a localized collection at the site of injection, with only a minimal peri‐acinar distribution. Transrectal injection of the fluid‐phase (virus suspended in diluent) ALVAC vector encoding the β‐galactosidase gene resulted in a similar distribution, with limited gene expression at the site of injection and in the needle track. Delivery of the same number of virus particles in the gelatine sponge matrix resulted in qualitatively greater gene expression.

Conclusions Direct injection of the canine prostate with biomarkers, including viral vectors, in the fluid‐phase results in very localized gene expression, while the distribution was more widespread after delivery in a gelatine sponge matrix.
Efficacy of percutaneous vas occlusion compared with conventional vasectomy
Authors: Zambon J.‐V. , Barone M.A. , Pollack A.E. , Mehta M.
Published: March 2003

Objectives To determine the efficacy, evaluate the safety and assess side‐effects (swelling, haematoma and pain) of percutaneous vas occlusion compared with vasectomy in Dutch men.

Patients and methods Vas occlusion and vasectomy procedures (attempted in 58 and 50 men, respectively) were conducted at the University Hospital Maastricht. The men returned 1 week after the procedure, underwent a clinical examination and completed a questionnaire assessing subjectively any pain, swelling and haematoma. The men were asked to return for semen analysis at 6 and 12 weeks and, if necessary, for additional analyses until they were azoospermic.

Results The vas occlusion procedure was completed on both vasa in 49 of the 58 men (84%) in whom it was attempted. Significantly more (P < 0.001) men were azoospermic after vasectomy (48 of 50) than after vas occlusion (only four). Men undergoing vas occlusion reported significantly less pain (P = 0.02), swelling (P = 0.01) and haematoma (P = 0.04) after the procedure than did men undergoing vasectomy.

Conclusion Men undergoing vas occlusion would not have been able to rely on the method for contraception. From this study, vas occlusion, at least in its current form, is an unsuitable method of male contraception. Not only was the efficacy poor, but constraints in delivering the method in its current state would probably limit its utility, especially in situations where resources are limited.
The use of self‐expanding metallic urethral stents in the treatment of recurrent bulbar urethral strictures: long‐term results
Authors: Sertcelik N. , Sagnak L. , Imamoglu A. , Temel M. , Tuygun C.
Published: March 2003

Objective To evaluate the effectiveness and long‐term results of using a self‐expanding metallic urethral stent (Urolume™, American Medical Systems, Minnetonka, MI, USA) to treat recurrent bulbar urethral strictures.

Patients and methods Between 1990 and 1999, 65 stents were placed in 60 men (mean age 45.2 years, range 20–71) with a urethral stricture (mostly caused by trauma and present for a mean of 4.3 years, range 0.16–26) and who had previously undergone different unsuccessful treatments.

Results During a mean (range) follow‐up of 3.8 (1–9) years the strictures in 52 of the 60 patients (87%) were treated successfully. All patients initially had postvoid dribbling incontinence, but this resolved in most within one week; 19 patients remain incontinent.

Conclusion The Urolume is a cost‐effective alternative to other treatments for recurrent bulbar urethral strictures of whatever cause.
Urinary excretion of glycosaminoglycans in patients with isolated nocturnal enuresis or combined with diurnal incontinence
Authors: Ferrara P. , Rigante D. , Lambert‐Gardini S. , Salvaggio E. , Ricci R. , Chiozza M.L. , Antuzzi D.
Published: March 2003

Objective To determine variations in the amount of glycosaminoglycans (GAGs) excreted by patients with nocturnal enuresis and/or diurnal incontinence.

Patients, subjects and methods The study included 27 patients (aged 5–15 years) with nocturnal enuresis and/or diurnal incontinence, and 27 healthy age‐matched children. Their urinary GAG excretion was assessed over 24 h using the sodium tetraborate‐carbazole method.

Results Patients with nocturnal enuresis and/or diurnal incontinence had higher mean values of urinary GAG excretion than age‐matched controls. There were significant differences in GAG excretion between those with nocturnal enuresis and diurnal incontinence and those with nocturnal enuresis alone.

Conclusions GAG excretion in patients with nocturnal enuresis and/or diurnal incontinence was significantly higher than in normal children, suggesting that measuring urinary GAGs may be useful in evaluating physiopathological conditions of the bladder wall, and hence in monitoring potential damage in the bladder mucosa.
The management of paediatric urolithiasis
Authors: Choong S. , Whitfield H. , Duffy* P. , Kellett M. , Cuckow P. , Van't Hoff W. , Corry D.
Published: March 2003

Objective To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy.

Patients and methods In a 3‐year period (1997–1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty‐two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia.

Results Of the 23 children treated using ESWL, 21 (91%) became stone‐free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone‐free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone‐free by ESWL. Two of three children undergoing open nephrolithotomy were stone‐free after surgery and the remaining one rendered stone‐free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone‐free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones.

Conclusions Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children.
The antigenicity of fascia lata allografts
Authors: Fitzgerald M.P. , Mollenhauer J. , Brubaker L.
Published: March 2003

Objective To determine whether commercially available fascia lata allograft material contains donor antigens.

Materials and methods Human leukocyte antigens (HLA) class I and II were assessed in: (i) freeze‐dried fascia lata allografts; (ii) a Tutoplast® fascia lata graft (Mentor Urology, Santa Barbara, CA, USA); (iii) an acellular dermal graft; and (iv) a successful donor fascia sacrocolpopexy graft one year after implantation, using a polymerase chain reaction sequence‐specific primer‐based assay.

Results The donor for both the freeze‐dried fascia lata and Tutoplast fascia lata was fully HLA‐typed. At one year after implantation, antigens from the implanted sacrocolpopexy graft matched the host blood antigens. The antigenicity of the acellular dermal graft could not be ascertained because this material interfered with the assay.

Conclusion Donor fascia lata grafts prepared by freeze‐drying or by the Tutoplast technique retain donor antigens. The significance of this antigenicity is unknown. All donor antigens are replaced by host antigens after implantation.
Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery
Authors: Arda I.S. , Özyaylali I.
Published: March 2003

Objective To investigate the reliability of using bleeding from the cut surface of testicular tissue during surgery for testicular torsion to assess testicular viability, compared with the duration of symptoms and preoperative findings on testicular Doppler ultrasonography (DUS).

Patients and methods The study comprised 19 children with testicular torsion who underwent surgery; all underwent DUS before surgery. During surgery the tunica vaginalis of the affected gonad was incised and a deep incision made through the medulla after obtaining a wedge biopsy for histological examination. After waiting up to 10 min to assess any fresh arterial bleeding from the cut surface, the patients were categorized using three grades; grade I (sufficient bleeding, i.e. bleeding or oozing when the biopsy was obtained); grade II (insufficient bleeding, no bleeding immediately after the incision but starting within 10 min); and grade III (no bleeding within 10 min). The final surgical decision on whether to save the testis was made according to the grade of testicular tissue bleeding; grade I and II testes were saved and grade III testes were removed. The biopsies were histopathologically examined and classified as haemorrhagic, necrotic or indeterminate. The patients were followed up at 15 days and at 1, 3, 6 and 12 months, with the affected testis examined using DUS. At the end of the study, the sensitivity and specificity of the duration of symptoms, characteristics of blood flow on DUS and grading of testicular tissue bleeding at surgery were calculated for predicting testis viability, using the histopathological diagnosis as the reference standard.

Results The sensitivity, specificity, positive and negative predictive values were respectively 100%, 90%, 90% and 100% for a duration of symptoms of > 10 h, 78%, 80%, 78% and 80% for DUS findings, and 100%, 78%, 83% and 100% for testicular tissue bleeding in predicting gonad viability after torsion, respectively.

Conclusion Although the 10 h limit for the duration of symptoms seems a more accurate predictor of the fate of a twisted testis than were the other variables, testicular tissue bleeding may also be a good indicator of gonadal viability during surgery. The surgeon should wait up to 10 min after incising the testicular tissue deep to the medulla before deciding the type of surgery. In cases where bleeding from the cut surface is sufficient or insufficient (according to the proposed grading system), orchidopexy is the treatment of choice. The salvaged testes should be assessed during follow‐up, especially in those who had had insufficient bleeding at surgery and/or a duration of symptoms > 10 h, to assess for any delayed damage to the untwisted testis. If no bleeding is seen during surgery the best option is to remove the affected testis.
Hypospadias: a critical analysis of cosmetic outcomes using photography
Authors: Baskin L.
Published: March 2003

Objective To analyse the cosmetic outcome of hypospadias surgery using photography, rather than the classical assessment by reoperation rate secondary to fistula, diverticulum, stenosis and residual penile curvature.

Patients and methods The study included 181 consecutive patients with hypospadias who underwent surgery between 1997 and 1999. Distal hypospadias (47) was repaired using either the ‘meatal advancement and glanuloplasty’ or the glans approximation procedure. Proximal hypospadias (68) was repaired using the onlay island‐flap technique with preservation of the urethral plate. Penile curvature when present was corrected by dorsal plication (≈ 20%). Two patients with perineal hypospadias required a two‐stage repair. Complex repeat repairs (36) were defined as those patients who had undergone previous surgery 1–7 times and required a new urethroplasty by a secondary onlay island‐flap technique. The follow‐up ranged from 6 months to 3 years. Photographs of the penis were taken before, immediately and 3–12 months after surgery; these were assessed to document objectively the cosmetic outcome. The final photographs were evaluated for overall appearance, a mucosal collar, the location and configuration of the meatus. The standard was to create a penis that would pass cosmetically as a normal circumcised penis.

Results The patients who had chordee without hypospadias (15) and fistula repair (13) did not undergo glanuloplasty and therefore were not included in the final photographic analysis; this left 153 patients with follow‐up photographs. There were five cases of urethral fistula (7%) and one of meatal stenosis (1%) in the proximal group, and three of fistula (8%) and two meatal stenosis (6%) in the complex group. The distal group had one complication (haematoma) and the two‐stage group had no complications. Analysis of the photographs showed that most patients had the appearance of a normal circumcised penis. Not unexpectedly, the patients who had undergone previous surgery had the least satisfactory results (60% appearing normal) compared with the proximal and distal groups (76% and 82% appearing normal, respectively).

Conclusions Hypospadias can be repaired safely with few complications in a single stage in most patients. Classical complications such as fistula and stenosis occur in < 10% of patients, including those undergoing complex revisions. Cosmetic outcomes are generally good and photography is an objective means to document the appearance.
Association of the vitamin D receptor gene start codon Fok I polymorphism with calcium oxalate stone disease
Authors: Chen W.‐C. , Chen H.‐Y. , Lu H.‐F. , Hsu C.‐D. , Tsai F.‐J.
Published: March 2003

Objective To assess the use of Fok I polymorphism (the most frequent polymorphism, at the start codon of the vitamin D receptor gene, VDR) as a convenient genetic marker in identifying the cause of urolithiasis.

Patients, subjects and methods A normal control group of 90 healthy subjects and 146 patients with calcium oxalate stones were examined. Using polymerase chain reaction (PCR)‐based restriction analysis, the relationship between Fok I polymorphism and urolithiasis was evaluated. An unexcisable length of 265 bp was identified (allele CC) and two fragments (169 bp and 96 bp) identified as excisable lengths (allele TT).

Results There was a statistically significant difference between the groups (chi‐square test, P < 0.05) for the genotype of the VDR Fok I start codon polymorphism. The odds ratio (95% confidence interval) for the C allele in those at risk of stone disease was 1.672 (1.149–2.432).

Conclusions These results suggest that the VDR Fok I start codon polymorphism may be a good candidate for a genetic marker in calcium oxalate stone disease.
A single‐centre experience of retroperitoneoscopy using the balloon technique
Authors: Gaur D.D. , Rathi S.S. , Ravandale A.V. , Gopichand M.
Published: March 2003

Objective To report the experience in one centre of the efficacy and safety of retroperitoneal laparoscopic procedures (RLPs).

Patients and methods During 1991–2000, 351 RLPs using the balloon technique were undertaken in 340 patients (mean age 34.9 years, range 4–74); the details and outcome were reviewed. Initial access was by the mini‐open digital dissection technique in 152 and by the closed percutaneous technique in the remaining 199 procedures. Patients had not undergone previous retroperitoneal procedures, except for nine who had a percutaneous nephrostomy and eight ipsilateral abdominal surgery. There were 172 renal, seven adrenal, 97 ureteric, 50 gonadal, 13 lymphatic system, three vesical, two autonomic nervous system and seven vertebral RLPs. Nitrous oxide was used for pneumo‐insufflation in 103 procedures, instead of CO2.

Results The RLP was successful in 318 of the 351 procedures (90.6%). The operative duration was 0.5–5.5 h, depending on the difficulty of the procedure and the presence or absence of adhesions. The overall incidence of complications was 12.9%, but decreased to 9% for the last 100 procedures. There were only five major complications, e.g. avulsion of the ureter, torn renal pelvis, colonic injury and severe hypotension, but none were related to balloon dissection. The mean blood loss was 37.7 mL and the reason for transfusion in three patients was not operative blood loss but displacement of the ligature in two and severe hypotension after removing a phaeochromocytoma in one. The mean duration of analgesic use was 2.5 days, the hospital stay 3 days and return to work 14 days.

Conclusion Retroperitoneal laparoscopy using the balloon technique is a reasonably safe, efficient and reliable minimally invasive procedure. The efficiency, efficacy and safety of RLPs depend more on experience than on the type of access technique, type of balloon or medium used to inflate the balloon. Balloon rupture causes no tissue damage, and expansion to ≈ 800 mL in adults is safe if the retroperitoneal space has not previously been invaded. The use of nitrous oxide for pneumo‐insufflation in the retroperitoneal space is safe if proper precautions are taken.
An assessment of the immunological status of patients with renal cell carcinoma based on the relative abundance of T‐helper 1‐ and ‐2 cytokine‐producing CD4+ cells in peripheral blood
Authors: Onishi T. , Ohishi Y. , Goto H. , Tomita M. , Abe K.
Published: March 2003

Objective To assess the immunological status of patients with renal cell carcinoma (RCC), by analysing the proportion of cluster‐of‐differentiation 4‐positive (CD4+) cells showing intracellular cytokine production, i.e. interferon‐γ derived from T‐helper (Th) 1 and interleukin‐4 derived from Th2 cells, among peripheral blood lymphocytes from these patients

Patients, subjects and methods Peripheral blood samples (5 mL) were collected from 36 patients (mean age 61 years, range 44–78) with RCC before and after they underwent nephrectomy. The proportion of cytokine‐producing CD4+ cells was determined by flow cytometric analysis after stimulating the cells with phorbol 12‐myristate 13‐acetate, ionomycin and brefeldin A, and staining the cells with fluorescein isothiocyanate‐labelled anti‐interferon‐γ, anti‐interleukin‐4 and anti‐immunoglubulin‐2b antibodies. The results were expressed as the percentage of cytokine‐producing cells in the CD4+ population. As a control, peripheral blood obtained from 35 healthy volunteers (mean age 34 years, range 22–49) was also analysed.

Results The proportion of CD4+ cells producing interferon‐γ and interleukin‐4 was significantly higher (P < 0.04 and P < 0.001, respectively) in patients with RCC than in controls. The Th1/Th2 ratio (i.e. the ratio of CD4+ cells producing each cytokine) was significantly lower in patients with RCC (P < 0.001). There was a significant correlation in the controls between interferon‐γ and interleukin‐4 production (r = 0.489, P < 0.01) but not in patients with RCC. The proportion of CD4+ cells producing interleukin‐4 was significantly higher and the Th1/Th2 ratio significantly lower in patients with high‐stage than in those with low‐stage RCC (P < 0.05). The percentage of CD4+ cells producing interleukin‐4 was significantly less after nephrectomy in those with low‐stage RCC (P < 0.01) and the Th1/Th2 ratio significantly greater (P < 0.05) than before nephrectomy; there was no such trend in patients with high‐stage RCC.

Conclusion An evaluation of the production of interferon‐γ and interleukin‐4 in CD4+ peripheral blood lymphocytes is useful for assessing the immunological status of patients with RCC; there is a change in the predominant response from Th1 to Th2 with increasing stage of RCC.
Sheaths for urinary incontinence: a randomized crossover trial
Authors: Fader M. , Pettersson L. , Dean G. , Brooks R. , Cottenden A.M. , Malone‐Lee J.
Published: March 2003

Objective To evaluate the full range of self‐adhesive continence sheaths for men available in the UK and thus provide clinicians and consumers with a basis for product selection.

Subjects and methods Fifty‐eight volunteers (aged 30–89 years) tested each of six different self‐adhesive sheaths available in the UK in September 1998 for 1 week each. Thirty subjects applied the sheaths themselves and 28 subjects relied on a carer to do so. During each week subjects completed a diary recording sheath changes and the result of skin inspection, to note any unscheduled sheath changes (because of sheath detachment) and any skin problems. At the end of each week an 11‐item questionnaire was completed using a three‐point rating scale (‘good’, ‘acceptable’, ‘unacceptable’) to assess the key aspects of product performance.

Results A significantly higher proportion of subjects scored the ‘Aquadry Clear Advantage’ sheath as ‘good’ than four of the other sheaths (P < 0.01) and a significantly higher proportion found the ‘Incare’ sheath to be ‘unacceptable’ than all of the other sheaths (P < 0.001) for the ‘overall opinion’ question. Sheath detachments (sheath falling off or blowing off) for the ‘Incare’ were significantly more common than for four of the other products (P < 0.01). Sheath detachments for the ‘Aquadry Clear Advantage’ were significantly less common than for two of the other products (P < 0.01). A significantly higher proportion of subjects found sheaths with an applicator to be ‘unacceptable’ than sheaths with no applicator (P < 0.001) for the ‘ease of putting on’ and ‘overall opinion’ questions (when adjusted for previous product use and person applying the sheath).

Conclusions There were substantial differences between products in their general performance and ergonomics, and for the frequency of detachment as recorded in the diary. The ‘Aquadry Clear Advantage’ was particularly successful and the ‘Incare’ particularly unsuccessful when compared with the other sheaths. Sheaths with no applicators were preferred to those with applicators. Applicators are mainly designed to make sheaths easier to put on, especially for carers, but there was no evidence that carers preferred applicators. This may have implications for manufacturers.
Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction
Authors: Prieto Castro R.M. , Anglada Curado F.J. , Regueiro López J.C. , Leva Vallejo M.E. , Molina Sánchez J. , Saceda López J.L. , Requena Tapia M.J.
Published: March 2003

Objective To assess the safety and efficacy of sildenafil citrate in renal transplant patients with erectile dysfunction, as up to half of men with renal failure may be affected and only 60–75% recover potency after transplantation.

Patients and methods Fifty patients with erectile dysfunction and a functioning renal transplant were treated using sildenafil (mean age 54 years, mean time on dialysis 35 months, mean time from transplantation 20 months). The hypogastric artery was not used during transplantation in any patient. Sildenafil citrate was prescribed at doses of 25 or 50 mg depending on baseline creatinine values and on the response, and plasma levels of cyclosporin/FK506 were monitored.

Results Thirty patients (60%) had a satisfactory response, with a mean time on dialysis of 23 months. Six patients (12%) did not take the sildenafil and in 14 (28%) the drug was ineffective. The mean time on dialysis in this group was 43 months. Six patients (12%) had side‐effects that in no case led to withdrawal of treatment. Plasma levels of cyclosporin/FK506 remained within the safety and efficacy limits in all patients.

Conclusions Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction is an effective and safe option, with few side‐effects. Plasma levels of immunosuppressants are unchanged. The response was more effective in patients with a shorter time on dialysis, as penile vascular disease is less advanced.
Hypericin‐based fluorescence diagnosis of bladder carcinoma
Authors: D'Hallewin M.‐A. , Kamuhabwa A.R. , Roskams T. , De Witte P.A.M. , Baert L.
Published: March 2003

Objective To determine the use of hypericin instillation for the fluorescent detection of papillary bladder cancer and carcinoma in situ.

Patients and methods Eighty‐seven patients with papillary bladder cancer and/or carcinoma in situ received instillations with 40 mL of an 8 µmol/L hypericin solution for at least 2 h. Fluorescent excitation with blue light was effective for up to 16 h, and biopsies were examined by fluorescence microscopy.

Results There were no side‐effects reported, no photobleaching and all papillary lesions fluoresced red. The sensitivity and specificity for detecting carcinoma in situ was 94% and 95%, respectively. An interval of 4 months is recommended after BCG instillations before using this test. Fluorescence microscopy showed that hypericin was selectively localized in the epithelium.

Conclusions Hypericin‐induced fluorescence has a high sensitivity and specificity for detecting bladder cancer. After 4 months there are few false‐positive results in patients treated with BCG.
A long‐term follow‐up of autoaugmentation in myelodysplastic children
Authors: Marte A. , Di Meglio D. , Cotrufo A.M. , Di Iorio G. , De Pasquale M. , Vessella A.
Published: March 2003

Objective To evaluate the long‐term results of patients who underwent bladder autoaugmentation (BA) in whom BA was used to treat a neuropathic bladder secondary to myelomeningocele, and who presented with a high‐pressure/poorly compliant bladder.

Patients and methods Eleven patients (eight girls and three boys, mean age 12.8 years, mean follow‐up 6.6 years) were selected who had undergone BA between June 1991 and June 1994. At surgery, the patients had a poorly compliant bladder with a mean leak point volume (LPV) of 94 mL and a mean leak point pressure (LPP) of 58 cmH2O. None of the patients had vesico‐ureteric reflux (VUR) at BA; five with grade III or IV VUR had undergone endoscopic correction in a day‐surgery procedure using a suburethral collagen injection 1–3 weeks before BA. The patients were evaluated using clinical, urodynamic, radiological and endoscopic assessments. The LPV, LPP and safe bladder capacity (SBC, the cystometric volume at an intravesical pressure of 40 cmH2O) were recorded.

Results At 1 year after surgery the mean LPV was 297 mL; none of the patients had VUR. The most recent mean LPV was 198 mL and the SBC 167 mL. The mean LPP remained stable at 60 cmH2O. At the last follow‐up four patients had recurrent uni‐ or bilateral grade III–V VUR. At endoscopy the ‘augmented’ bladder portion had a smooth surface, compared with the grossly trabeculated lower half. From this finding all patients on clean intermittent catheterization were treated with oral oxybutynin. Some patients reported slightly less abdominal pain at maximum bladder volume; four needed pads to treat intermittent incontinence. On voiding cysto‐urethrography, one patient had an hourglass‐shaped bladder. Five patients recently underwent ileocystoplasty because of recurrent urinary tract infection, high‐grade VUR and incontinence.

Conclusion These results do not justify the routine use of BA in hypertonic/poorly compliant bladders secondary to myelomeningocele. The mean follow‐up of 6.6 years showed that this procedure failed in seven of 11 patients. Further studies might be able to identify subgroups in which this approach may be more appropriate.
Intracavernosal injection of vascular endothelial growth factor induces nitric oxide synthase isoforms
Authors: Lin C.‐S. , Ho H.‐C. , Chen K.‐C. , Lin G. , Nunes L. , Lue T.F.
Published: March 2003

Objective To identify genes that are affected by vascular endothelial growth factor (VEGF), as an intracavernosal injection with VEGF improved the recovery of erectile function in a rat model of arteriogenic impotence, specifically examining the three nitric oxide synthase (NOS) genes, nNOS, eNOS, and iNOS.

Materials and methods Male rats had their pudendal arteries ligated or underwent a sham operation. They were then treated by an intracavernosal injection with 4 µg of VEGF in phosphate‐buffered saline (PBS) or PBS alone. At 6 and 24 h after treatment electrostimulation was applied to the cavernosal nerve and the intracorporal pressure measured. The erectile tissue was then harvested for RNA isolation and cryo‐sectioning. The isolated RNA was used for microarray and reverse transcription‐polymerase chain reaction (RT‐PCR) analyses, and the tissue sections for immunohistochemical analysis.

Results Microarray analysis detected nNOS, eNOS and iNOS at very low expression levels in PBS‐treated rats; expression levels were higher for eNOS and iNOS in all VEGF‐treated rats. These results were further confirmed by RT‐PCR analysis. Immunohistochemical analysis identified the cavernosal endothelium and smooth muscle as the tissue types where eNOS and iNOS were up‐regulated, respectively.

Conclusions This is the first report of the induction of both eNOS and iNOS in the penis after intracavernosal VEGF. These events may help support a significant recovery of erectile function after interrupting the blood supply to the penis.
Technical characterization of an ultrasound source for noninvasive thermoablation by high‐intensity focused ultrasound
Authors: Köhrmann K.U. , Michel M.S. , Steidler A. , Marlinghaus E. , Kraut O. , Alken P.
Published: March 2003

Objective To develop a generator for high‐intensity focused ultrasound (HIFU, a method of delivering ultrasonic energy with resultant heat and tissue destruction to a tight focus at a selected depth within the body), designed for extracorporeal coupling to allow various parenchymal organs to be treated.

Material and methods The ultrasound generated by a cylindrical piezo‐ceramic element is focused at a depth of 10 cm using a parabolic reflector with a diameter of 10 cm. A diagnostic B‐mode ultrasonographic transducer is integrated into the source to allow the focus to be located in the target area. The field distribution of the sound pressure was measured in degassed water using a needle hydrophone. An ultrasound‐force balance was used to determine the acoustic power. These measurements allowed the spatially averaged sound intensity to be calculated. The morphology and extent of tissue necrosis induced by HIFU was examined on an ex‐vivo kidney model.

Results The two‐dimensional field distribution resulted in an approximately ellipsoidal focus of 32×4 mm (− 6 dB). The spatially maximum averaged sound intensity was 8591 W/cm2 at an electrical power of 400 W. The lesion caused to the ex‐vivo kidney at this maximum generator power with a pulse duration of 2 s was a clearly delineated ellipsoidal coagulation necrosis up to 8.8×2.3 mm (length×width) and with central liquefied necrosis of 7.9×1.9 mm.

Conclusion This newly developed ultrasound generator with a focal length of 10 cm can induce clear necrosis in parenchymal tissue. Because of its specific configuration and the available power range of the ultrasound generator, there is potential for therapeutic noninvasive ablation of tissue deep within a patient's body.
The treatment of pain in urology
Authors: Heid F. , Jage J.
Published: March 2003

Contemporary medicine is characterized by sophisticated specialization of the individual physician. The specialist in urological surgery may undertake one of the most important and primary medical tasks, the mitigation and therapy of pain. This review aims to provide an overview of the concepts of pain therapy in urology. Most patients benefit from basic concepts of analgesia, including measuring and documenting pain scores at the bedside by the nursing staff. Patients undergoing very painful operative procedures require more potent techniques of analgesia, e.g. intravenous patient‐controlled analgesia and epidural analgesia. These techniques need adequate supervision by an acute pain service, but their implementation improves the outcome in some situations. Pain in acute renal obstruction varies in intensity and duration; hence, analgesic therapy has to be tailored to the individual patient. Pain syndromes from cancer can be more complex than those after surgery. Neuropathic pain is probably the most difficult to manage and requires consultation with a pain‐management specialist. In the case of neuropathic pain, treatment only with opioids is of limited efficacy and combination with co‐analgesics is necessary. In addition, invasive analgesic therapies should sometimes be considered.
The rectus myofascial wrap in the management of urethral sphincter incompetence
Authors: Mingin G.C. , Youngren K. , Stock J.A. , Hanna M.K.
Published: March 2003

Objective  To review our experience with a modified rectus/pyramidalis myofascial sling, described more than a century ago for treating refractory urinary incontinence in children with neurogenic sphincteric incompetence.

Patients and methods  Thirty‐seven patients (23 females and 14 males, aged 8–21 years) presented with urinary incontinence which failed to respond to medical treatment. In 36 patients the cause of the incontinence was a neurogenic bladder; one patient had sustained a traumatic injury to the bladder neck and urethra. Patient selection was based on videocysto‐urethrographic detection of an incompetent bladder neck, and a low maximum closure pressure during urethral pressure profilometry. The bladder was augmented in 33 of the 37 patients.

Results  Of the 37 patients, 34 (92%) are dry between catheterizations; the follow‐up was 0.5–10 years. Two of the male patients continued to have persistent incontinence requiring bladder neck closure and creation of a continent stoma. One of the female patients developed stress incontinence after 4 years of being dry, with a rectus sling.

Conclusion  The rectus myofascial sling provides long‐term satisfactory dry intervals between catheterizations in patients with neurogenic sphincteric incompetence. The cinch‐wrap modification appears to enhance the occlusive effect of the sling, particularly in males.
Alfuzosin in the treatment of high leak‐point pressure in children with neurogenic bladder
Authors: Schulte‐Baukloh H. , Michael T. , Miller K. , Knispel H.H.
Published: March 2003

Objective  To decrease the detrusor leak‐point pressure (LPP) of > 40 cmH2O in children with a neurogenic bladder, using the α1‐adrenergic blocking agent alfuzosin.

Patients and methods  Videocystometry was used to measure the detrusor LPP and several other variables before and 3 weeks after the oral administration of alfuzosin (2.5–7.5 mg/day) in 17 children (mean age 6.3 years) with an upper motor neurone lesion.

Results  The mean (sd) detrusor LPP decreased from 68 (37) to 46 (31) cmH2O (P < 0.01), reflex volume (defined as the volume at the first uninhibited bladder contraction of > 15 cmH2O) increased from 78 (69) to 112 (118) mL (+ 44%), bladder compliance increased from 9.3 (6.1) to 19.6 (14.6) mL/cmH2O (+ 111%), maximal vesical pressure decreased from 84 (40) to 70 (47) cmH2O (− 17%), and the mean number of uninhibited bladder contractions decreased from 6.3 to 3.5 (− 44%). The therapy was well tolerated; side‐effects were rare and not severe. Intermittent catheterization could be avoided in six children.

Conclusion  Alfuzosin decreases the detrusor LPP in children with a neurogenic bladder caused by an upper motor neurone lesion, significantly and therapeutically, and should be considered as an alternative or addition to intermittent catheterization and anticholinergic drugs in selected patients.
Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy
Authors: Gupta R. , Kumar A. , Kapoor R. , Srivastava A. , Mandhani A.
Published: March 2003

Objective  To prospectively evaluate the safety and efficacy of the supracostal approach for percu‐taneous nephrolithotomy (PCNL), as it is usually avoided because of concerns about potential chest complications.

Patients and methods  Between August 1998 and August 2001, 465 patients underwent PCNL. Supracostal access was obtained in 62 patients (63 renal units), comprising 13% of the procedures. The indications for a supracostal approach were staghorn, upper ureteric, superior calyceal stones and high‐lying kidneys. The data were analysed for stone clearance, need for additional punctures and the complications associated with supracostal puncture.

Results  The supracostal was the only access in 63% of the PCNL procedures. Additional punctures were required mainly for staghorn stones (15 of 23). Overall, 90% of the patients were rendered stone‐free or had clinically insignificant residuals with PCNL alone. In patients with staghorn stones, they were completely cleared in 84% of renal units. Significant chest complications developed in three (5%) patients, which required insertion of a chest tube. One (2%) patient developed haemothorax secondary to injury of the intercostal artery. All the patients recovered uneventfully.

Conclusions  These results indicate that supracostal access provides high clearance rates with acceptable complications; it should not be avoided for fear of chest complications. A chest X‐ray after surgery should be routine, to detect any complication.
Ureteric reconstruction
Authors: Stief C.G. , Jonas U. , Petry K.‐U. , Sohn C. , Bektas H. , Klempnauer J. , Chavan A. , Galanski M. , Montorsi F.
Published: March 2003

Although the ureter is functionally simply a tube to transport urine, ureteric surgery requires detailed anatomical knowledge and advanced surgical skills, because the ureter has a delicate blood supply. Therefore, the urological surgeon must have distinct strategies available to bridge ureteric defects of various sites and lengths. Furthermore, handling during and after surgery should be individualized to the patient's pre‐ and intraoperative situation. In this review, the indications for reconstruction of a specific ureteric defect, the required techniques and postoperative recommendations are discussed.
The number of lymph nodes examined and staging accuracy in renal cell carcinoma
Authors: Terrone C. , Guercio S. , De Luca S. , Poggio M. , Castelli E. , Scoffone C. , Tarabuzzi R. , Scarpa R.M. , Fontana D. , Rocca Rossetti S.
Published: March 2003

OBJECTIVE

To determine the number of lymph nodes that need to be examined to accurately stage the pN variable in patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC).

PATIENTS AND METHODS

We reviewed the operative and pathology reports of 725 patients with RCC submitted for RN. All tumours were classified using the fifth edition of the Tumour‐Nodes‐Metastasis classification. For each patient the number of lymph nodes removed was recorded. The patients were divided into five different groups according to the number of nodes removed, i.e. group 1, 1–4; group 2, 5–8; group 3, 9–12; group 4, 13–16; and group 5, ≥ 17. We evaluated the factors that affected the number of lymph nodes removed with nodal dissection and the variables that influenced the incidence of nodal involvement.

RESULTS

Lymphadenectomy was performed in 608 patients (83.8%); in these patients the rate of lymph node metastases was 13.6%. The median (range) number of nodes removed was 9 (1–43); there was a statistically significant correlation between the number of nodes removed and the percentage of nodal involvement (r = 0.6; P < 0.01). The rate of pN+ was significantly higher in the patients with ≥ 13 than in those with < 13 nodes examined (20.8% vs 10.2%; P < 0.001). For organ‐confined and locally advanced tumours there was a statistically significant difference in the pN+ rate between patients with < 13 or ≥ 13 nodes examined (3.4% vs 10.5%, and 19.7% vs. 32.2%, respectively).

CONCLUSIONS

The proportion of tumours classified as pN+ increased with the number of lymph nodes examined. In RCC,> 12 lymph nodes need to be assessed for optimal staging.
Knowledge of risk of developing diabetes mellitus among siblings of Type 2 diabetic patients
Authors: Farmer A. J. , Levy J. C. , Turner R. C.
Published: March 2003

Aims We set out to investigate the extent to which siblings of diabetic subjects perceived themselves likely to develop Type 2 diabetes mellitus (DM) when offered screening tests.

Methods Nondiabetic siblings, aged 35–74 years, of Type 2 diabetic patients who were more than 35 years old at diagnosis had fasting plasma glucose measured in a study to determine heritability of diabetes. Questionnaires assessing perceived likelihood of developing, seriousness and knowledge about diabetes were completed. Logistic regression assessed factors predicting perceptions of diabetes risk.

Results Factors predicting diabetes on screening were male sex, increasing age and body mass index (BMI) ≥ 30. Eighty‐nine per cent of 540 eligible siblings completed questionnaires. Thirty‐eight per cent saw themselves at increased risk of diabetes and 34% thought diabetes a serious problem. Predictors of perceiving an increased likelihood of developing diabetes were female sex, age 35–54 years vs. 55–74 years and having a parent with diabetes. BMI did not affect perceptions of likelihood.

Conclusion A perception of reduced vulnerability to diabetes may occur due to unawareness of risk or minimization of risk. Feelings of invulnerability may affect emotional response to a subsequent result. It is not known whether providing more information about the risk of developing diabetes prior to screening would affect outcomes

Diabet. Med. 16, 233–237 (1999)