bluuebunny/crossref_metadata_2025 huggingface dataset:
Telomerase activity in human renal cell carcinoma
Authors: Sugimura  , Yoshida  , Hisatomi  , Nakatani  , Ikemoto
Published: March 2003

Objective

To determine if telomerase activity plays an important role in the progression of renal cell carcinoma (RCC).

Materials and methods

Telomerase activity was measured in 53 tissue samples of RCC (52 patients), 11 samples of normal renal tissue and six tissue samples from benign renal disease using a fluorescence‐based telomeric repeat amplification protocol. The activity was assessed for associations with clinical and pathological variables of RCC. To examine the influence of telomerase activity on cell immortalization in vitro, primary cultures of RCC cells were produced; the maximum passage number beyond which cell culture could not be continued was compared with the associated telomerase activity.

Results

Among the tissue samples of benign renal disease, one from a patient with a hydronephrotic nonfunctioning kidney had detectable telomerase activity, whereas none of the normal renal tissues had. In 32 of the 53 RCC tissue samples (60%), telomerase activity was detectable, varying from 1.8 to 100.0 TPG units, but was not associated with any clinical or pathological variable such as clinical stage, tumour size, grade or pathological subtype. Telomerase activity also had no association with the maximum passage number of primary cell cultures.

Conclusions

Telomerase activity may not be a prognostic marker for RCC. Alternative mechanism(s) which lengthen telomeres should be considered if maintaining telomere length is considered essential to tumour progression.
Bcl‐2 proto‐oncogene expression in low‐ and high‐grade prostatic intraepithelial neoplasia
Authors: Baltaci S. , Orhan D. , Özer G. , Tolunay Ö. , Gög?üs O.
Published: March 2003

Objective To determine the incidence of bcl‐2 protein expression in low‐ and high‐grade prostatic intra‐epithelial neoplasia (PIN) lesions, and to explore the role of bcl‐2 in prostatic tumorigenesis.

Materials and methods Immunoreactivity for bcl‐2 was examined in 10 samples of benign prostatic hyperplasia (BPH), 13 of primary prostatic adenocarcinoma, 15 of high‐grade PIN and 18 of low‐grade PIN. All immunostaining results were scored for the approximate percentage of positive tumour cells and relative immunostaining intensity (score range 0–12).

Results In all BPH samples, bcl‐2 staining was detected consistently in the basal cell layer of the ducts and acini, but no staining was ever apparent in luminal cells. The immunoreactivity for bcl‐2 was heterogeneous in the prostatic carcinomas and bcl‐2 protein expression was present in six samples. In these six bcl‐2‐positive tumours, the mean (range) staining score was 1.15 (1–6). There was detectable expression of bcl‐2 in low‐ and high‐grade PIN in all cell layers; immunoreactivity was present in 10 of 15 high‐grade PIN lesions, with a mean (range) score of 1.14 (1–4), and in 12 of 18 samples of low‐grade PIN, with a mean (range) score of 1.77 (1–6).

Conclusions The high incidence of bcl‐2 protein expression in low‐ and high‐grade PIN lesions suggests that bcl‐2 protein expression is associated with early prostate tumorigenesis.
PC‐SPES, a dietary supplement for the treatment of hormone‐refractory prostate cancer
Authors: Pfeifer B.L. , Pirani J.F. , Hamann S.R. , Klippel K.F.
Published: March 2003

Objective To assess the effectiveness of PC‐SPES, a dietary supplement containing eight herbal extracts, which is a popular alternative therapy among patients with hormone‐refractory prostate cancer; anecdotal reports claim that this agent provides relief of metastatic pain, improvements in quality of life and reduction of prostatic specific antigen (PSA) level.

Patients and methods Sixteen men treated for advanced metastatic prostate cancer (stage D3) with either orchidectomy or a luteinizing‐hormone releasing hormone agonist, with or without anti‐androgen, were enrolled into a prospective clinical trial to evaluate the possible toxic and beneficial effects of PC‐SPES. After hormone‐ablative therapy had failed, and with established disease progression, all patients received supplemental treatment with PC‐SPES (2.88 g daily) for 5 months. Hormonal therapy was continued throughout the trial to avoid the known withdrawal effect of anti‐androgen on PSA levels.

Results The supplemental intake of PC‐SPES was associated with significant (P < 0.05–0.01) improvements in quality‐of‐life measures, reductions in patient’s pain ratings (P < 0.05–0.01), and a decline in PSA levels (P < 0.01), with no major side‐effects.

Conclusions These results support the anecdotal reports of the beneficial effects of PC‐SPES as a comparable alternative to current management regimens in hormone‐refractory prostate cancer. However, no conclusions can be drawn about the long‐term effects of this new herbal therapy.
Comparison of the perimeatal‐based flap (Mathieu) and the tubularized incised‐plate urethroplasty (Snodgrass) in primary distal hypospadias
Authors: Oswald J. , Körner I. , Riccabona M.
Published: March 2003

Objectives To determine whether the perimeatal‐based flap technique or the tubularized incised‐plate repair is the more appropriate treatment for distal hypospadias in terms of fistula rate, cosmesis of the meatus and operative duration.

Patients and methods Between July 1997 and August 1998, 60 children (none of whom had previously undergone a procedure for hypospadias) underwent primary distal hypospadias repair in a prospective randomized trial. Thirty patients were allocated to undergo a Mathieu repair (mean age 24.9 months, range 9–72) and 30 a Snodgrass procedure (mean age 23.1 months, range 7–19). The mean follow‐up was 15.4 months.

Results The mean duration of surgery was significantly lower for the Snodgrass procedure than for the Mathieu repair (75 vs 115 min, P < 0.05). Three children undergoing a Mathieu repair had complications (two a urethrocutaneous fistula and one a meatal stenosis), compared with only one in the Snodgrass group (glanular dehiscence). The resultant meatus was slit‐like in all patients undergoing the Snodgrass repair whereas those with a Mathieu repair had a rounded and horizontal meatus.

Conclusion The overall complication rate was lower and the surgery significantly quicker with the Snodgrass urethroplasty, which also had a better cosmetic outcome. The Snodgrass technique is recommended as a primary treatment for distal hypospadias.
Anatomical studies of the urethral plate: why preservation of the urethral plate is important in hypospadias repair
Authors: Erol A. , Baskin L.S. , Li Y.W. , Liu W.H.
Published: March 2003

Objective To describe the detailed anatomy of the urethral plate in relation to its controversial role in hypospadias surgery.

Materials and methods A newborn penis with proximal penile hypospadias and two fetal penises with distal shaft hypospadias were included in the study; 30 normal fetal penises served as the control. Specimens were embedded in paraffin and serially sectioned (6 µm) after formalin fixation. Every 10th section was stained with haematoxylin and eosin. Immunohistochemical staining for nerves (S100), smooth muscles (α‐actin), blood vessels (factor VIII) and epithelium (cytokeratins 7, 14 and 18) were used on selected sections, with particular attention to the urethral plate. Masson’s trichrome and Sirius Red stains were used to localize collagen.

Results There were extensive blood vessels, glands and smooth muscle under the urethral plate in the hypospadias specimens. These relatively well organized tissues corresponded to an abnormally formed corpus spongiosum. The glands underneath the urethral plate and adjacent to the normal urethra showed positive staining for cytokeratins 7 and 18, respectively (markers of endodermal origin) but were negative for cytokeratin 14 (a marker of ectodermal origin). Penile skin and urethral plate epithelium stained positively for cytokeratin 14 but not for cytokeratin 7 and 18. The urethral plate has a rich nerve supply, as determined by S100 staining. Collagen intensity under the urethral plate was no different from that in normal areas. Tunica albuginea stained intensely for type I and III collagen.

Conclusion These results show that the urethral plate is well vascularized, has a rich nerve supply and an extensive muscular and connective tissue backing. These features may explain the lower complication rate with onlay flaps than with tube flaps. Therefore, from these anatomical findings, we continue to advocate preservation of the urethral plate and the onlay island flap for hypospadias reconstruction.
Acellular bladder matrix allografts in the regeneration of functional bladders: evaluation of large‐segment (> 24 cm2) substitution in a porcine model
Authors: Merguerian P.A. , Reddy P.P. , Barrieras D.J. , Wilson G.J. , Woodhouse K. , Bagli D.J. , Mclorie G.A. , Khoury A.E.
Published: March 2003

Objectives To evaluate the use of a large‐segment (> 24 cm2) bladder substitution with porcine bladder acellular matrix allograft (BAMA) in a large animal model.

Materials and methods Bladders were harvested from pigs at the time of necropsy and subjected to detergent and enzymatic extractions to render them acellular. The BAMA produced had the surgical handling and suture‐retaining properties of normal bladder tissue. Six pigs had BAMA segments implanted under general anaesthesia, through a low midline abdominal incision and after partial cystectomy. The defect was repaired with a BAMA patch (mean size 43.88 cm2, range 12–72), with no urinary diversion. Two animals each were then killed at 9, 16 and 30 days and the bladders explanted. The native bladder and BAMA patch were analysed morphometrically to evaluate cellular re‐population and matrix re‐organization.

Results All animals survived surgery; there were no urinary leaks and no stones detected in any of the bladders. At 9 days there was a diffuse infiltration with acute inflammatory cells, but no areas of necrosis. There were isolated areas of smooth muscle cell (SMC) infiltration of the BAMA. At 16 days the luminal surface was lined with a single layer of urothelium, there was stromal infiltration with disorganized SMC and angiogenesis, with mature vessels in the BAMA patch. At 30 days the urothelium was multilayered with organizing groups of SMCs and angiogenesis. The highest cell density was at the periphery of the repopulated BAMA patch, decreasing towards the centre.

Conclusions The implantation of large patches of BAMA is technically feasible and may prove to be a viable surgical alternative to bladder augmentation with intestinal segments. The advantages of BAMA include the potential for complete and functional regeneration of a bladder substitute. This model provides a tool with which to obtain a better understanding of the cellular and molecular aspects of matrix re‐population.
Reduction of radiation exposure to patients in the follow‐up of shockwave lithotripsy
Authors: Talati J. , Khan S. , Biyabani R. , Khan R.A. , Naz I. , Abbas F. , Buchholz N.‐P.
Published: March 2003

Objectives To assess, in patients undergoing extracorporeal shock wave lithotripsy (ESWL), if a policy of using unilateral X‐rays of the kidney, ureter and bladder (hemi‐KUB) whenever possible and appropriate during diagnosis and follow‐up, was successful in reducing the radiation exposure associated with ESWL.

Patients and methods Two groups of patients of statistically comparable size and demography were assessed retrospectively before and after the implementation of the policy. All had undergone ESWL for radio‐opaque upper urinary tract stones and all were finally rendered stone‐free. The number and type of all radiological procedures from initial diagnosis of the stone to documented stone‐free status were recorded and the dose calculated.

Results The appropriate use of hemi‐KUB X‐rays resulted in a significant mean reduction of radiation exposure after treatment of 2.28 mSv per patient (P < 0.05). Furthermore, as expected, the radiation dose was clearly but not closely correlated with stone size (r = 0.419).

Conclusions The appropriate use of hemi‐KUB X‐rays during the follow‐up after ESWL is a simple and effective way of significantly reducing the radiation exposure of such patients.
Melatonin administration prevents the nephrotoxicity induced by gentamicin
Authors: Özbek E. , Turkoz Y. , Sahna E. , Ozugurlu F. , Mizrak B. , Ozbek M.
Published: March 2003

Objective To investigate the effect of melatonin on the antioxidant enzyme activity and renal tubular necrosis induced by gentamicin.

Materials and methods Twenty‐four adult male Sprague‐Dawley rats were divided into three equal groups. In group 1, the rats were injected with vehicle (controls), in group 2 they were injected with gentamicin for 5 days and in group 3 injected with gentamicin plus melatonin for 5 days. At 24 h after the last injection, rats were killed and the renal cortex separated from the medulla. Most of the cortex was homogenized but a small sample was fixed in formaldehyde solution for histological examination by light microscopy. Blood samples were also taken to assess the serum levels of urea, creatinine, Na+, K+ and γ‐glutamyl transpeptidase (γ‐GT); before death, urine samples were analysed for protein content. Crude extracts of the cortex were used to determine lipoperoxides, reduced glutathione (GSH‐Px), catalase and superoxide dismutase (SOD). The results were compared using the Mann–Whitney U‐test.

Results Compared with the controls rats, gentamicin caused hyperproteinuria, an increase in the level of γ‐GT in serum, a marked increase in lipoperoxides and a significant decrease of GSH‐Px, catalase and SOD activity in the kidney. In the rats in group 3 there was a marked restoration in lipid peroxidation, GSH‐Px, catalase, SOD activity and proteinuria, and in γ‐GT in serum. In rats in group 2 there was widespread tubular necrosis (grade 2–4) but in rats in group 3 there was a marked reduction in the extent of tubular damage. There was no significant difference in serum levels of Na+, K+, blood urea nitrogen and creatinine.

Conclusion These results indicate that melatonin prevents the tubular necrosis induced by gentamicin in rats, presumably because it is a potent antioxidant and restores antioxidant enzyme activity in the rat kidney.
Deferred treatment of localized prostate cancer in the elderly: the impact of the age and stage at the time of diagnosis on the treatment decision
Authors: Neulander E.Z. , Duncan R.C. , Tiguert R. , Posey J.T. , Soloway M.S.
Published: March 2003

Objective To assess the clinical behaviour of clinically localized prostate cancer in elderly patients monitored until progression, and the impact of clinical variables, i.e. clinical stage, Gleason score, the dynamics of prostate specific antigen (PSA) and age, on the natural history of the disease.

Patients and methods Between February 1991 and January 1998, 54 patients (mean age 76.4 years, median 77 at the time of diagnosis) with clinically localized prostate cancer who elected for watchful waiting were identified. They were monitored regularly and treatment deferred until progression. Progression was defined as local stage progression (as assessed on a digital rectal examination), biochemical progression or metastasis. All patients who progressed were offered either radiation therapy or hormonal treatment. Each clinical variable was assessed by univariate and multivariate analysis to predict disease progression. The mean follow‐up was 47 months.

Results Of the 54 patients, 28 (52%) progressed; 10 had biochemical, 11 local and four biochemical and local progression, and three developed metastasis. All the patients who progressed elected to receive hormonal treatment. The mean time to progression was 35 months. Gleason score ( 6 and > 6), age ( 75 and > 75 years) and serum PSA level ( 10 and > 10 ng/mL) were statistically significant predictors of disease progression (P = 0.04, < 0.001 and 0.02, respectively). The clinical stage at the time of diagnosis had a borderline effect on disease progression (P = 0.06). On multivariate analysis, Gleason score and PSA level were statistically significant predictors of disease progression.

Conclusion These results suggest that the treatment of prostate cancer should not be deferred in patients aged > 75 years with a good performance status when the biopsy has a Gleason score  6 and the serum PSA level is  10 ng/mL.
The role of spinal and peripheral α1‐ and α2‐adrenoceptors on bladder activity induced by bladder distension in anaesthetized rat
Authors: Jeong M.S. , Lee J.G.
Published: March 2003

Objective To elucidate the effects of α1‐ and α2‐adrenoceptor antagonists on the micturition reflex induced by bladder distension in the anaesthetized rat at the peripheral and spinal level.

Materials and methods Using continuous cystometry in 80 anaesthetized female Sprague–Dawley rats, changes in basal pressure (BaP), micturition pressure (MP), bladder capacity (BC), micturition volume (MV), interval of bladder contraction (frequency) and residual volume (RV) to the selective intra‐arterial and intrathecal administration of drugs were monitored and analysed.

Results The intra‐arterial administration of phentolamine, prazosin, doxazosin and tamsulosin significantly decreased the MP; doxazosin increased MV, BC, RV and frequency. MP was inhibited more by intra‐arterial doxazosin than by prazosin or tamsulosin. Intrathecal phentolamine increased BaP, BC, RV and decreased MP and MV; tamsulosin decreased frequency and increased BC. Clonidine markedly increased BaP and frequency, whereas MV and BC were significantly lower; yohimbine increased MV, BC and decreased RV. Intra‐arterial yohimbine significantly increased MV.

Conclusions At the spinal level, the micturition reflex evoked by bladder distension was preferentially suppressed by phentolamine or yohimbine, suggesting the involvement of α2‐adrenoceptors. In the periphery, α1‐adrenoceptor blockers preferentially suppressed the reflex. We suggest that both α1‐ and α2‐adrenoceptors play a role in the distension‐evoked micturition reflex in the rat.
Expression and localization of basic fibroblast growth factor in diabetic rat prostate
Authors: Wang Z.‐J. , Ikeda K. , Wada Y. , Foster H.E. , Weiss R.M. , Latifpour J.
Published: March 2003

Objective To assess fibroblast growth factor‐2 (FGF2/bFGF), which is important in the development and maintenance of the normal prostate and in the development of human benign prostatic hyperplasia (BPH) and prostatic carcinoma, in an animal model of experimentally induced diabetes.

Materials and methods Using Western blotting and immunohistochemical analyses, the expression of FGF2 in prostates from several groups of rats was investigated. Rats had diabetes for 8 or 16 weeks (induced by intravenous injection with 65 mg/kg streptozotocin); rats were also treated with insulin (starting 8 weeks after the induction of diabetes, for 8 weeks), and two further groups acted as age‐matched control rats. Immunohistochemical markers for smooth muscle (α‐actin) and epithelium (cytokeratin) were used to distinguish different cell types in adjacent prostatic sections.

Results Diabetic rats had smaller prostates and lower serum testosterone levels than their controls; insulin treatment of diabetic rats increased prostatic size and testosterone levels. As shown by Western blotting, diabetes caused greater FGF2 expression than in controls, whereas reverse‐transcriptase polymerase chain reaction studies showed similar levels of prostatic FGF‐2 mRNA in all groups. Immuno‐histochemical studies showed that FGF‐2 was expressed in both stromal and epithelial components of the rat prostate. Furthermore, although the expression of FGF2 was higher in epithelial than stromal cells in control prostates, it was distributed uniformly in the diabetic prostate.

Conclusion The differences in the level of expression and pattern of distribution of FGF2 suggests a potential role for FGF2 in the changes observed in prostatic growth in diabetic rats.
Ejaculatory duct obstruction in infertile men
Authors: Paick J.‐S. , Kim S.H. , Kim S.W.
Published: March 2003

Objective To analyse our experience of ejaculatory duct obstruction (EDO) in infertile men, evaluating the diagnostic steps and the outcome of management according to the aetiology.

Patients and methods Over a 7‐year period, 50 infertile men were diagnosed with EDO as a contributory factor to male infertility. Diagnostic criteria included a history, physical examination, semen analyses, semen fructose measurement, hormonal study, testicular biopsy, transrectal ultrasonography (TRUS) and/or vasography. Thirty‐one patients with EDO were treated by transurethral resection (26) or forced lavage via a vasotomy (five).

Results In 45 of the 50 men, semen analyses showed the typical characteristics of complete EDO. Seminal values were variable in five cases of partial EDO; the semen fructose levels were < 1.4 g/L in all five. The main cause of EDO was a midline cyst in 16, Wolffian malformation in four, tuberculosis in 17, previous genitourinary infection in five and idiopathic in eight men. In 17 patients the seminal vesicles appeared to be atrophied on TRUS; 15 of these patients had a history of pulmonary tuberculosis and subsequent vasography in five showed multiple bilateral vasal obstruction. TRUS findings correlated well with vasography except in one case. The overall rate of improved semen values and paternity was 61% and 26%, respectively. Of 16 patients with midline cysts, 14 had improved semen variables and achieved paternity, seven after transurethral resection.

Conclusions TRUS should be the first diagnostic procedure used when infertile men are suspected of having EDO, but vasography should still be considered for a more comprehensive diagnosis. In patients with atrophic seminal vesicles on TRUS and with a history of pulmonary tuberculosis, further study is unnecessary and microscopic epididymal sperm aspiration is recommended for in vitro fertilization. The measurement of semen fructose may be helpful in diagnosing partial EDO. Patients with midline cysts who are treated by transurethral resection are expected to have the best outcome.
The relative incidence of detrusor instability and bacterial cystitis detected on the urodynamic‐test day
Authors: Moore K.H. , Simons A. , Mukerjee C. , Lynch W.
Published: March 2003

Objective To determine whether patients with detrusor instability (DI) were more likely to have bacterial cystitis or significant bacteriuria on the urodynamic‐test day than were women with a stable bladder.

Patients and methods A catheter specimen of urine was cultured (overnight in air) from 862 consecutive women at the time of urodynamic testing. The upper urinary tract was imaged, with cystoscopy when indicated, to exclude upper tract lesions or malignancy. The percentage of patients with pure idiopathic DI and those with mixed DI/genuine stress incontinence (GSI), in whom the urine culture was positive, was compared with the percentage who had a stable bladder (pure GSI or urodynamically normal) and a positive urine culture, both for the entire dataset and for women aged > or <65 years. Data were also analysed to detect the converse relationship; in those women found to have bacterial cystitis, the relative risk of being found urodynamically unstable or stable was determined.

Results The likelihood of bacterial cystitis occurring in patients with idiopathic DI (5.6%) was significantly greater than that in patients with GSI (1.1%; P = 0.009, Fisher’s exact test). The proportion of patients with DI and significant bacteriuria (15.4%) was significantly greater than that in patients with GSI (7.9%; P = 0.02). In patients with combined pure and mixed DI, bacterial cystitis was significantly more likely to occur (6.3%) than in GSI (P < 0.001), but bacteriuria was no more likely (12.5%, P = 0.09). Conversely, of those women found to have bacterial cystitis, the relative risk of having an unstable bladder was increased (+1.56), but for those with bacteriuria the relative risk of detrusor instability was not increased.

Conclusion There was a significant association between idiopathic DI and bacterial cystitis, and we suggest that in some women with an unstable bladder, urinary infection may enhance detrusor contractility. Nevertheless, large‐scale studies are needed of the temporal relationship between the onset of bacterial cystitis and the onset of DI.
Pelvic‐floor therapy and toilet training in young children with dysfunctional voiding and obstipation
Authors: De Paepe H. , Renson C. , Van Laecke E. , Raes A. , Vande Walle J. , Hoebeke P.
Published: March 2003

Objective To analyse experience in treating young children (4–5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive training programme.

Patients and methods Between January 1996 and October 1997, 20 children (all < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic floor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic‐floor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed.

Results Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation.

Conclusion This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces.
The actions of metabolic inhibition on human detrusor smooth muscle contractility from stable and unstable bladders
Authors: Hockey J.S. , Wu C. , Fry C.H.
Published: March 2003

Objectives To determine the important cellular site(s) of action of a brief exposure to NaCN (chosen to reduce mitochondrial respiration and hence mimic cellular hypoxia) on the mechanical properties and regulation of intracellular [Ca2+] in human detrusor smooth muscle. Using muscle samples obtained from patients with stable and unstable bladders, to determine whether the unstable bladder is associated with changes in the functional properties of detrusor muscle under these circumstances.

Materials and methods Experiments were conducted in vitro on muscle strips or isolated cells. Isometric tension was recorded in muscle strips during electrical stimulation or exposure to agonists. Intracellular [Ca2+] and [H+] were measured by epifluorescence microscopy, and cell autofluorescence measured as an index of mitochondrial function.

Results There were no differences in the responses to electrical stimulation and varying concentrations of carbachol in muscle strips from stable and unstable bladders. NaCN (2 mmol/L) reduced the contraction induced by carbachol (10 µmol/L) by a mean (
sd) of 43 (16)% and 56 (15)% in the two groups; the reduction in the unstable was significantly less than in the stable group. NaCN similarly reduced the response to 10 mmol/L caffeine, but had no effect on the KCl‐induced contraction. NaCN significantly increased the resting sarcoplasmic [Ca2+] and attenuated the calcium transients evoked by carbachol and caffeine, but again had no effect on the KCl‐induced transient. The reduction of the carbachol calcium transient was also less in cells from unstable bladders than in those from stable bladders. There was no effect of NaCN on intracellular pH, except for a brief, transient alkalosis.

Conclusions NaCN reduces both the contraction and Ca‐transient to carbachol by reducing Ca2+ accumulation by intracellular stores, because the carbachol‐ and caffeine‐evoked responses were similar. Any effect on transmembrane Ca2+ flux was minimal because there was no effect on KCl‐induced responses. The greater resilience of tissue from unstable bladders to acute cellular hypoxia may reflect some adaptation acquired in vivo.
Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome
Authors: Sökeland J.
Published: March 2003

Objective To test the hypothesis that in patients with benign prostatic hyperplasia (BPH), the outcome of drug therapy with finasteride may be predictable from the baseline prostate volume and that positive clinical effects might be expected only in patients with prostate volumes of > 40 mL, using a subgroup analysis of results from a previously reported clinical trial of finasteride and phytotherapy.

Patients and methods A subgroup of 431 patients was analysed from a randomized, multicentre, double‐blind clinical trial involving 543 patients with the early stages of BPH. Patients received a fixed combination of extracts of saw palmetto fruit (Serenoa repens) and nettle root (Urtica dioica) (PRO 160/120) or the synthetic 5α‐reductase inhibitor finasteride. The patients assessed had valid ultrasonographic measurements and baseline prostate volumes of either  40 mL or > 40 mL. All 516 patients were included in the safety analysis. The results of the original trial showed equivalent efficacy for both treatments.

Results The mean (
sd) maximum urinary flow (the main outcome variable) increased (from baseline values) after 24 weeks by 1.9 (5.6) mL/s with PRO 160/120 and by 2.4 (6.3) mL/s with finasteride. There were no statistically significant group differences (P =  0.52). The subgroups with small prostates ( 40 mL) showed similar improvements, with mean values of 1.8 (5.2) mL/s with PRO 160/120 and 2.7 (7.4) mL/s with finasteride. The mean values for the subgroups with prostates of > 40 mL were similar, at 2.3 (6.1) and 2.2 (5.3) mL/s, respectively. There were improvements in the International Prostate Symptom Score in both treatment groups, with no statistically significant differences. The subgroup analysis showed slightly better results for voiding symptoms in the patients with prostates of > 40 mL, but there were also improvements in the subgroup with smaller prostates. The safety analysis showed that more patients in the finasteride group reported adverse events and also there were more adverse events in this group than in patients treated with PRO 160/120.

Conclusion The present analysis showed that the efficacy of both PRO 160/120 and finasteride was equivalent and unrelated to prostate volume. However, PRO 160/120 had better tolerability than finasteride.
The psychological effects of treatments for lower urinary tract symptoms
Authors: Quek K.F. , Low W.Y. , Razack A.H. , Loh C.S.
Published: March 2003

Objective To assess and evaluate the level of depression, anxiety and psychiatric status in patients with lower urinary tract symptoms (LUTS) before and after treatment by surgery or drugs.

Patients and methods The study included 123 patients (mean age 64.6 years,
sd 7.95) with LUTS who were treated medically (with α‐blockers, i.e. terazosin, prazosin, doxazosin and alfuzosin), and 52 patients (mean age 69.6 years,
sd 7.94) with LUTS and confirmed to have benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Both groups were assessed at baseline and 3 months after treatment using standardized questionnaires (the Beck Depression Inventory, the State‐Trait Anxiety Inventory and the General Health Questionnaire‐12).

Results Patients before TURP were significantly more depressed, worried and psychiatrically morbid than were those before medical treatment. Three months after medical and surgical treatment, there was significantly less depression, anxiety and psychiatric morbidity in the TURP than in the medicationgroup.

Conclusions TURP is a better treatment than medication for minimising anxiety, depression and psychiatric morbidity after treatment in patients with LUTS, but causes greater psychological stress before treatment.
The long‐term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy
Authors: Mcneill S.A. , Chrisofos M. , Tolley D.A.
Published: March 2003

Objectives To assess the long‐term outcome of the endourological management of upper tract transitional cell carcinoma (TCC) by laparoscopic nephroureterectomy (LNU) or open nephroureterectomy (ONU).

Patients and methods The records and pathology reports were reviewed retrospectively for 67 nephroureterectomy specimens (42 obtained by ONU and 25 by LNU). The grade, stage, lymph node status and site of the tumour were recorded for each patient. The primary end‐point of the follow‐up was disease‐related death.

Results Overall there was a high proportion of G2 (44%) and G3 (39%) disease, with a significant correlation between increasing grade and stage of TCC (r = 0.74, P < 0.001). Of the 25 patients who underwent LNU, 22 had pelvicalyceal or upper ureteric TCC and conversion to open surgery was required in three (12%). Of the TCCs in this group half were G3 and half were invasive (pT1–3). In the ONU group there were more ureteric tumours because of selection criteria and overall 16 (39%) were G3 and half were invasive. Information on nodal status was available in one LNU and two of the ONU reports. Within a mean follow‐up of 32.9 months for LNU and 42.3 months for ONU, nine (21%) of the ONU group and four (16%) of the LNU group had died, with a mean survival of 15.1 and 17 months, respectively, after surgery (not significant). All of these deaths were associated with G3 pT1–3 disease.

Conclusions In this series the case mix and outcomes were similar for those undergoing LNU and ONU. As laparoscopic renal surgery is associated with less postoperative morbidity it would seem reasonable to offer LNU to all patients with upper tract TCC, where appropriate and when there is no evidence of local invasion or metastasis. Because of the strong correlation between grade and stage, preliminary ureteroscopic assessment and biopsy may influence the surgical approach adopted.
A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats
Authors: Altay B. , Hekimgil M. , Kefi A. , Girgin C. , Çikili N.
Published: March 2003

Objective To define the histopathological changes occurring as a result of open and percutaneous needle testicular biopsy in adult rats.

Materials and methods Percutaneous needle and open testicular biopsies were taken from 35 male albino rats (120–140 days old). Nine of the rats were killed 10 days after the biopsy, eight after 30 days and the other eight 60 days after the biopsy. A control group of six rats underwent orchidectomy with no preceding testicular biopsy.

Results Significant tubulitis and obstructive findings were detected 10 days after needle biopsy (P < 0.05); epididymo‐orchitis was frequent after open biopsy during this period. At 10–30 days after needle biopsy the mean seminiferous tubule diameters were significantly greater than in either the control group or after open biopsy (P < 0.05). The histopathological damage recovered 60 days after open and needle biopsy.

Conclusion Although percutaneous, a needle biopsy (as an alternative to open biopsy) causes tubulitis and frequent obstructive findings in the early period; therefore, repeat testicular procedures should be planned after these changes have resolved.
Excessive sac pressures: the pathogenesis and innocence of hydroceles in children
Authors: Tanyel F.C. , Öcal T. , Büyükpamukçu N.
Published: March 2003

Objective To determine whether paediatric hydroceles result entirely from a small‐calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms.

Patients and methods Twenty‐five hydroceles were studied prospectively in 24 boys (aged 18–132 months). Consent for the intraoperative measurements was obtained before surgery. The hydrocele was repaired under general anaesthesia with endotracheal intubation, using a standard approach, taking care not to open the sac during mobilization. Intra‐abdominal pressures during surgery were measured indirectly via a nasogastric tube after gastric decompression. The pressure in the sac was measured via a 20 G intravenous cannula inserted via a purse‐string suture. The relative pressure was then calculated by subtracting the intra‐abdominal from the sac pressure. The effects of age and laterality were evaluated.

Results The median (range) intra‐abdominal, sac and relative pressures were 8 (2–18), 11 (3–30) and 4 (3–30) cmH2O, respectively. The sac pressure in the sac was greater than the intra‐abdominal pressure in 17 of 25 (68%; P = 0.004) patients. Age or laterality had no significant influence on any of the pressures.

Conclusions These results suggest that in a significant proportion of hydroceles in children the pressures are higher than the intra‐abdominal pressure. Therefore, they cannot be explained simply as a freely communicating, narrow‐calibre processus. In addition, the pressures may reach levels which are potentially damaging to the testis.
Proliferation and differentiation of prostatic stromal cells
Authors: Niu Y. , Xu Y. , Zhang J. , Bai J. , Yang H. , Ma T.
Published: March 2003

Objectives To investigate the effects of androgen, transforming growth factor β1 (TGF‐β) and basic fibroblast growth factor (bFGF) on the proliferation and differentiation of prostatic stromal cells of the dog in vivo and human stromal cells in vitro.

Materials and methods Twenty‐two dogs had their serum concentration of testosterone and oestradiol determined by radioimmunoassay before and after castration. Light microscopy, transmission electron microscopy and an in situ cell‐death assay were carried out successively before and after castration to evaluate prostatic histomorphology. A semi‐quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) was used to evaluate the expression of TGF‐β, bFGF and myosin in the canine prostate tissue after castration. In vitro serum‐free cell cultures from human prostatic stroma were established and exposed to dihydrotestosterone (DHT), TGF‐β and bFGF in various concentrations. The proliferation of the cell cultures was detected by the tetrazolium assay. The differentiation from fibroblasts to smooth muscle cells (SMCs) was deduced by measuring the expression of SMC‐specific proteins (myosin and smoothelin) using immunohistochemistry and RT‐PCR.

Results Castration resulted in a significant decrease in circulating testosterone levels (P < 0.01), but did not affect the circulating oestradiol levels (P > 0.05). The prostatic stromal cells, including SMCs and fibroblasts, diminished and underwent a serial pathological change of atrophy and apoptosis after castration. The atrophic cells were filled with intracellular lipofuscin. The expression of SMC myosin declined after castration, coincident with the increase in TGF‐β mRNA level and decline in bFGF mRNA. In vitro, TGF‐β inhibited the growth of human prostatic stromal cells during exponential growth, while enhancing myosin staining and stimulating the expression of smoothelin in confluent cultured stromal cells. bFGF stimulated the growth of the culture and inhibited the expression of smoothelin. DHT caused a weak increase in the proliferation and expression of SMC‐specific proteins (P < 0.05). However, DHT and bFGF together stimulated the proliferation of stromal cells significantly more than either agent alone (P < 0.01). The combination of DHT and TGF‐β greatly enhanced the expression of SMC‐specific proteins (P < 0.01), more strongly than either alone (P < 0.01).

Conclusions The whole prostate gland is an androgen‐sensitive organ, with both the epithelium and stroma under the control of androgen. Androgen may direct the proliferation and differentiation of prostatic stromal cells by regulating the expression of TGF‐β and bFGF. Thus DHT, TGF‐β and bFGF may have important roles in regulating stromal cell homeostasis.
Anogenital electrical stimulation as treatment of urge incontinence in children
Authors: Gladh G. , Mattsson S. , Lindström S.
Published: March 2003

Objectives To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy‐resistant urge incontinence.

Patients and method The study included 48 children (24 girls and 24 boys, 5–14 years old) with a diagnosis of bladder instability verified by cystometry in all. Anogenital afferent stimulations were applied using a battery‐powered dual constant‐current stimulator. The children were stimulated continuously at 10 Hz for 20 min once or twice daily and if required the children and/or the parents continued to apply the treatment at home. For home stimulation a single (anal) channel stimulator was used. The patients were instructed to stimulate for 20 min at maximum intensity two to three times a week until the effects were optimal. The outcome was evaluated retrospectively by comparing voiding/incontinence diaries obtained before and at the follow‐up 6–12 months after the end of treatment.

Results AGAS was applied at the clinic for a median (range) of 9 (4–20) times. Thirty‐one children continued with home stimulation for another 25 (5–96) sessions. At the follow‐up, 18 children were cured and another seven improved, with a leakage score of less than half that before treatment. The treatment was well tolerated by most children.

Conclusions Anogenital afferent stimulation is an effective, potentially curative treatment in children with severe urge incontinence. Home stimulation is a well accepted adjuvant to treatment at the clinic and improves the outcome.
Relaxation induced by omeprazole does not change in diabetic rabbit corpus cavernosum
Authors: Ayan S. , Sarioglu Y. , Yildirim S. , Gökce G. , Bagcivan I.
Published: March 2003

Objective To investigate the changes in relaxation responses to omeprazole in corpus cavernosal strips from rabbits with diabetes induced by alloxan.

Materials and methods Diabetes was induced in 10 New Zealand white rabbits. After 8 weeks, the reactivity to electrical‐field stimulation, carbachol and omeprazole of corporal strips from the penises of the diabetic animals and from 10 untreated controls was assessed in organ chambers.

Results In the diabetic group, the relaxation responses of corpus cavernosal strips to omeprazole were comparable with those of the control group, whereas the relaxation responses to electrical field stimulation and carbachol were impaired.

Conclusion The relaxant effect of omeprazole in corpus cavernosum was not affected by diabetes, in which neurogenic and endothelium‐mediated relaxations were impaired.
Pain after transrectal ultrasonography‐guided prostate biopsy: the advantages of periprostatic local anaesthesia
Authors: Seymour H. , Perry M.J.A. , Lee‐Elliot C. , Dundas D. , Patel U.
Published: March 2003

Objective To prospectively evaluate the efficacy and safety of periprostatic local anaesthesia (LA) during prostatic biopsy guided by transrectal ultrasonography (TRUS), as 20–65% of men report moderate to severe pain, and there is anecdotal and published evidence that periprostatic anaesthesia improves patients' tolerance.

Patients and methods In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant biopsies were taken in all men but some had more than six biopsies. All were asked to complete questionnaires immediately after TRUS‐guided biopsy and for the subsequent week, giving pain scores and recording any morbidity, including symptoms of infection; analgesic use was also surveyed.

Results Patients given LA had significantly lower pain scores at the time of biopsy than those given no anaesthesia, with median (sd) pain scores of 1.53 (0.7) and 1.95 (0.65) (P < 0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically significant. There was no difference in the amount of haematuria, haematochezia or haematospermia, or infection rate, between the groups. The additional cost and time of the procedure was minimal (£3.00 and 3 min/per patient, respectively).

Conclusion Periprostatic LA infiltration is a quick and simple procedure which significantly improves immediate pain with no added morbidity; we strongly advocate its use to improve patient tolerance of TRUS‐guided prostate biopsy.
Enuresis and urinary incontinence in children and adolescents with spinal muscular atrophy
Authors: Von Gontard A. , Laufersweiler‐Plass C. , Backes M. , Zerres K. , Rudnik‐Schöneborn S.
Published: March 2003

Objective To assess the rate and type of urinary incontinence in a large sample of children and adolescents with spinal muscular atrophy (SMA), a genetic disorder characterized by loss of motor function caused by anterior horn degeneration.

Patients, subjects and methods The study included 96 severely incapacitated patients with SMA (aged 6.0–18.11 years) who were examined in detail, including a structured interview (Kinder‐DIPS), the Child Behaviour Checklist (CBCL) and a specific questionnaire for urinary incontinence. They were compared with two control groups of unaffected siblings and normal children.

Results In all, 29% of the patients were wet at night and/or during the day; mostly younger children with SMA types I and II only were affected. The results of the interview were more reliable than the CBCL. The specific questionnaire revealed a variety of possible functional and neurogenic forms of wetting, including nocturnal enuresis, voiding postponement, dysfunctional voiding, stress, symptomatic (urinary tract infections, UTIs) and neurogenic incontinence. Many patients were constipated, soiled or had UTIs. The rate of behavioural problems was twice as high (32%) as normal (15%; CBCL).

Conclusion Children with SMA have a high rate of urinary incontinence which is often overlooked, and not diagnosed and treated adequately. These problems should be addressed routinely by paediatricians in children referred to paediatric urological specialists.