bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconsideration of the Roles of Urinary Infection and Vesicoureteric Reflux in the Pathogenesis of Renal Scarring
Authors: ARNOLD A. J. , SUNDERLAND D. , HART C. A. , RICKWOOD A. M. K.
Published: November 2008

Summary In an experimental study of female piglets with surgically created unilateral vesicoureteric reflux, Escherichia coli were inoculated into the bladder and, at later sacrifice, bacterial culture was undertaken of renal parenchyma from the refluxing and non‐refluxing kidneys. Positive cultures of the same E. coli were obtained from 33% of refluxing kidneys with pyelonephritic renal scars, 23% of refluxing kidneys without scars and 21% of non‐refluxing kidneys. Although other aspects of the experiments confirmed that a combination of urinary infection, vesicoureteric reflux and intra‐renal reflux is a necessary precondition for renal scarring, these findings indicate that reflux plays a role in the pathogenesis of renal scarring over and above a means whereby pathogens gain access from the lower urinary tract to the renal substance. Possible mechanisms are discussed.
Encrusted Cystitis: Aetiology, Clinical Aspects and Management
Authors: KARAYANNIS A. , PICRAMENOS D. , SOFRAS F. , KARANASTASIS D. , STENOS I. , BECOPOULOS TH.
Published: November 2008

Summary Encrusted cystitis is a rare condition characterised by the formation of calcified plaques adherent to or embedded in the bladder mucosa. Although chronic infection with urea‐splitting organisms is a prerequisite, other factors seem to play an important role in its development.

We report our experience of 4 such cases in which encrusted cystitis presented with various symptoms, produced different pathological abnormalities and was treated by different means in each patient.
Effect of Transurethral Resection of Prostate on Plasma Hormone Levels in Benign Prostatic Hyperplasia
Authors: SASAGAWA I. , NAKADA T. , SUZUKI H. , ADACHI Y. , ADACHI M.
Published: November 2008

Summary Circulating levels of pituitary and adrenal hormones were measured in patients with benign prostatic hyperplasia before and after transurethral resection of the prostate (TURP).TURP caused a significant increase in plasma LH levels 2 weeks and 3 weeks after surgery. The plasma prolactin level decreased significantly 3 weeks after prostatectomy but plasma concentrations of FSH and ACTH were unchanged. TURP did not alter circulating levels of aldosterone, Cortisol, DHEA‐S and testosterone. These data suggest that the human prostate has a role in regulating the pituitary secretion of LH and prolactin.
Combination Therapy with Flutamide and the LHRH Agonist [D‐Trp6, des‐Gly‐NH210]LHRH Ethylamide in Stage C Prostatic Carcinoma
Authors: DUPONT A. , CUSAN L. , GOMEZ J.‐L. , KOUTSILIERIS M. , SUBURU R. , EMOND J. , LABRIE F.
Published: November 2008

Summary A series of 115 previously untreated patients displaying clinical stage C prostatic carcinoma with no evidence of distant metastases received combination therapy using the antiandrogen flutamide and the LHRH agonist [D‐Trp6, des‐Gly‐NH210]LHRH ethylamide; the average follow‐up was 3.9 years. Twenty‐eight patients showed treatment failure with a probability of disease‐free survival of 91.2% at 2 years. Twenty patients died from prostate cancer and 10 from other causes, the survival probability being 93.4% at 2 years. Local control was achieved rapidly in all patients. Urinary obstruction and hydronephrosis were corrected in all cases. When compared with data obtained after single endocrine therapy (orchiectomy or oestrogens) or radiotherapy, the treatment failure rate at 2 years was more than 3.0‐fold lower after combination therapy (8.8%) than monotherapy (28.4%). The death rate 2 years after the start of combination therapy was 6.6% and was on average 22.2% (3.6‐fold higher) in the studies using monotherapy (orchiectomy or oestrogens) or radiotherapy. The present data suggest that treatment of prostate cancer with combination therapy before clinical evidence of dissemination of disease permits more efficient control of local disease and a decreased rate of progression to metastatic disease.
Management of Blunt Renal Trauma
Authors: KRISTJÁNSSON A. , PEDERSEN J.
Published: November 2008

Summary The management of major renal lacerations after blunt trauma is still a matter of controversy. In this study, conservative treatment of major renal lacerations failed in 7 of 18 patients, leading to delayed surgery. Urography after blunt trauma was abnormal in 97% of patients with severe renal injury but a normal urogram did not exclude severe renal injury. Computed tomography had a greater degree of accuracy than urography and ultrasonography in determining the extent of the injury and was more practical to perform than angiography. The results indicate that patients with significant extrarenal leakage on urography, angiography or CT should receive immediate surgical management.
Glutathione‐S‐Transferase π Expression in Transitional Cell Carcinoma of the Bladder
Authors: THOMAS D. J. , BIRCH P. J. , VICKERS J. , ROBINSON M. , CLIFFORD S. , HALL A. , NEAL D. E.
Published: November 2008

Summary Glutathione‐S‐transferase π (GSTπ) is a multifunctional protein that acts as an enzyme, involved in the detoxification of drugs and carcinogens. It has been implicated both in drug resistance and malignant transformation of epithelium. Using an indirect immunohistochemical technique, we have evaluated cytoplasmic and nuclear staining in normal urothelium, 23 superficial bladder tumours and 26 invasive tumours. All 26 invasive tumours had been treated with platinum‐based chemotherapy.

Cytoplasmic staining was seen in normal urothelium and all bladder tumours. Nuclear staining was seen in 1 superficial tumour and in 13 invasive tumours. There was no association between nuclear staining and response to chemotherapy. Nuclear staining was seen in 1 area of dysplasia and in 2 of 3 areas of carcinoma in situ.

GSTπ expression is not a predictor of response to chemotherapy. Increased intra‐nuclear expression of GSTπ may be associated with progression of transitional cell carcinoma of the bladder.
Intravesical Bacillus Calmette‐Guérin with the Danish Strain for Treatment of Carcinoma In situ of the Bladder
Authors: OVESEN H. , POULSEN A. L. , STEVEN K.
Published: November 2008

Summary We report our experience of the treatment of carcinoma in situ (CIS) using intravesical therapy with the Danish Bacillus Calmette‐Guérin (BCG) strain 331 (SSI). Forty‐two patients received treatment, 11 had primary and 31 secondary CIS. The median follow‐up period was 26 months (range 3–68). Patients received 6 weekly instillations (1 course) and non‐responders an additional 6 instillations at 2‐week intervals (2 courses). The complete response rate was 59% for 1 ‐course patients, 33% for the 2‐course patients and 68% for the entire series. Patients were considered treatment failures if they suffered progression to invasive cancer, metastasis or died from transitional cell carcinoma. BCG treatment was more effective in primary than in secondary CIS, with a complete response rate of 80% versus 65% and with no failures versus 35%. Patients with persistent CIS after the first course of BCG had a greater risk of failure than responders: 50% versus 17%. Patients with persistent CIS after the second course had a 75% failure rate. This suggests that cystectomy should be considered for non‐responders following a 6‐week course and recommended to those not responding to 2 courses.

Ten patients had CIS in the prostatic urethra. All responded to BCG treatment; 2 suffered from recurrent CIS 1 associated with invasive urethral tumour.

The incidence and severity of side effects were similar to those reported with other strains of BCG. One patient with primary CIS failed to complete the treatment owing to “BCG‐itis”.
The Source of Organisms in the Post‐prostatectomy Bacteriuria of Patients with Pre‐operative Sterile Urine
Authors: IBRAHIM A. I. A. , BILAL N. E. , SHETTY S. D. , PATIL K. P. , GOMMAA H.
Published: November 2008

Summary Ninety patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) with sterile urine pre‐operatively were prospectively studied for post‐prostatectomy bacteriuria; 26 of 90 patients (29%) developed bacteriuria (18 of 64 after transurethral resection (TUR) and 8 of 26 after open prostatectomy), of whom 15 had pre‐operative indwelling urethral catheters.

The correlation of bacteriuria with several factors was studied, namely the presence of a histological inflammatory reaction within the prostatic adenoma, prostatic tissue culture, intraoperative outgoing irrigation fluid culture, intra‐operative blood culture and post‐operative external meatal swab culture. The only significant correlation was between bacteriuria and meatal cultures.

It was concluded that post‐prostatectomy bacteriuria is probably caused by post‐operative ascending infection along urethral catheters. There was not enough evidence to ascribe bacteriuria to pre‐existing septic foci within the adenoma. Intra‐operative contamination and infection from distant foci were also unlikely causes.
Primary Obstructed Megaureter in Neonates. Treatment by Temporary Uretero‐cutaneostomy
Authors: LETTGEN B. , KRÖPFL D. , BONZEL K. E. , MEYER‐SCHWICKERATH M. , RASCHER W.
Published: November 2008

Summary During the last 10 years we have treated 24 newborn and young infants (27 ureters) in whom the diagnosis of primary obstructed megaureter was established by diuresis‐enhanced radionuclide renography and/or by antegrade pressure flow studies (Whitaker test). Temporary uretero‐cutaneostomy was performed immediately after diagnosis. After 1 year a second modified Whitaker test showed normal passage of the contrast medium into the bladder in 23 ureters. In only 4 ureters did obstruction persist and uretero‐cystoneostomy was performed. Uretero‐cystoneostomy was also performed on 8 ureters without obstruction but with persistent vesicoureteric reflux, ectopic ureter or diverticula. In 11 patients a temporary uretero‐cutaneostomy was closed without corrective surgery at the vesicoureteric junction. Temporary uretero‐cutaneostomy is a safe and effective therapy in primary obstructed megaureter in newborns. Spontaneous relief of obstruction appears to be possible in primary obstructed megaureter.
Changes in Acid‐base Balance and Calcium Metabolism after Urinary Diversion through Ileal Segments. II. Treatment with Nicotinic Acid
Authors: MARTÍNEZ‐PIÑEIRO L. , MATEOS F. , MARTÍNEZ M. E. , MARTÍNEZ I. , MARTÍNEZ‐PIÑEIRO J. A.
Published: November 2008

Summary Investigations in animals have shown that nicotinic acid, an intestinal cyclic‐AMP inhibitor, partially corrects the metabolic changes associated with urinary diversion through intestinal segments. Blood and serum chemistry were studied in patients before and 3 to 5 months after undergoing urinary diversion through ileal segments, both with and without nicotinic acid treatment. It was found that diverted patients had metabolic acidosis, an increased anion gap and increased levels of serum alkaline phosphatase; there were no significant changes in serum PTH and vitamin D levels, calcaemia and phosphoraemia. There was a tendency towards dehydration, hypernatraemia, hyperchloraemia and secondary hyperaldosteronism produced by ileal secretion of a hypotonic fluid. Nicotinic acid 3 g/day significantly reduced the chloraemia but did not correct the metabolic acidosis, although it reduced its severity, since blood pH decreased when treatment was suspended.

Nicotinic acid cannot be recommended for routine use in the management of metabolic acidosis after urinary diversion, and patients with a marginal renal reserve should not be considered for trans‐intestinal urinary diversion.
Bacillus Calmette‐Guérin Sensitises Fresh Transitional Carcinoma Cells and T24 Cell Line to Non‐MHC‐restricted Cytotoxicity in vitro
Authors: KAASINEN E. S. , KALLIOMÄKI P. H. W. , ALFTHAN O. S. , TIMONEN T. T.
Published: November 2008

Summary The activity of lymphokine (interleukin‐2) activated killer (LAK) cells from 9 patients with transitional cell carcinoma (TCC) was tested against autologous, freshly purified transitional carcinoma cells. Cytotoxicity was relatively low. Bacillus Calmette‐Guérin (BCG) substantially augmented both LAK activity and the cytolytic activity of non‐stimulated peripheral blood mononuclear cells (PBMC) against autologous TCC when tested with 6 additional TCC patients. A similar enhancing effect of BCG was noted with leucocytes obtained from normal donors when tested against an allogenic T24 cell line. Both natural killer (NK) cells and T cells appeared to be responsible for the increased cytolytic activity caused by BCG. No cytolytic activity was noted against normal transitional epithelial cells. Sensitisation of TCC cells to the immune system may explain the clinical effects of BCG.
Is beta‐Human Chorionic Gonadotrophin Production by Transitional Cell Carcinoma of the Bladder a Marker of Aggressive Disease and Resistance to Radiotherapy?
Authors: MOUTZOURIS G. , YANNOPOULOS D. , BARBATIS C. , ZAHAROF A. , THEODOROU CH.
Published: November 2008

Summary The biopsies from 75 patients with transitional cell carcinoma of the bladder (25 Ta‐T1; 45 T2‐T4, 5M) were studied immunohistochemically for the expression of beta‐human chorionic gonadotrophin (β‐HCG).

Only 5 Ta‐T1 tumours contained a small number of β‐HCG positive cells but 24 invasive tumours and all patients with metastases showed increased numbers of positive cells.

A significant correlation was found between β‐HCG immunoreactivity and tumour category.

In 30 patients with muscle‐invasive disease (T2‐T4, N0, M0) who were treated with radical radiotherapy a significant correlation was observed between response to treatment and β‐HCG expression; β‐HCG positive tumours did not respond to treatment.

A difference in survival was found between patients with tumours negative for β‐HCG compared with patients with positive tumours, all treated with radical radiotherapy. The results indicate that β‐HCG expression increases with tumour invasiveness and the use of immunohistochemistry may prove a useful means of identifying radioresistant and aggressive forms of bladder cancer.
Ureaplasma urealyticum in the Urogenital Tract of Patients with Chronic Prostatitis or Related Symptomatology
Authors: OHKAWA M. , YAMAGUCHI K. , TOKUNAGA S. , NAKASHIMA T. , FUJITA S.
Published: November 2008

Summary To elucidate the role of Ureaplasma urealyticum as a causative organism in chronic prostatitis we investigated its incidence in the urogenital tract in 131 chronic prostatitis patients and 120 prostatodynia patients; the presence of common bacteria or Chlamydia trachomatis was also recorded. According to the 4‐glass localisation test, U. urealyticum ( 103 ecu/ml) was isolated from the prostates of 16 prostatitis patients and 2 prostatodynia patients; 5 of these prostatitis patients (but neither of the prostatodynia patients) had other bacteria in specimens after prostatic massage. Thus U. urealyticum was the sole organism isolated from the prostates of 11 prostatitis and 2 prostatodynia patients, which suggests that it is an aetiological agent in some cases of chronic non‐bacterial prostatitis.
Microsurgery in the Treatment of Chyluria and Scrotal Lymphangial Fistula
Authors: JI YING‐ZHOU , ZHENG JUN‐HONG , CHEN JUN‐NENG , ZHU‐DONGWU
Published: November 2008

Summary Thirty‐nine cases of chyluria and scrotal lymphangial fistula treated by microsurgery between April 1980 and October 1989 are presented. Several different methods were used. In males a lymphatico‐venous anastomosis of the spermatic cord was performed and in females the lower inguinal lymph nodes were anastomosed to the branches of the greater saphenous vein. In patients with scrotal lymphangial fistulae, bilateral lymphatico‐venous anastomosis was carried out after excision of the fistula and scrotoplasty. Thirty‐seven patients were followed up for 1 to 9 years, 36 being cured by a single operation.
Epidermoid Cysts of the Testis: Organ‐preserving Surgery following Diagnosis by Ultrasonography
Authors: EISENMENGER M. , LANG S. , DONNER G. , KRATZIK CH. , MARBERGER M.
Published: November 2008

Summary Epidermoid cysts of the testes are rare, benign tumours that can be visualised by high frequency ultrasonographic transducers. Their echo patterns are characteristic but not pathognomonic, so that inguinal exposure of the testis is required to confirm the diagnosis. However, sonography facilitates the planning of surgery, since excision of the tumour can be performed in an organ‐preserving manner. In 6 patients with epidermoid cysts treated in this way between 1986 and 1989, no recurrence was seen during a mean follow‐up period of 37 months.
Development of Hydronephrosis in Spina Bifida Patients: Predictive Factors and Management
Authors: ANDERSON P. A. M. , TRAVERS A. H.
Published: November 2008

Summary A retrospective review of 209 children with spina bifida was performed to determine predictive factors for the development of hydronephrotic changes and to assess the outcome of management. Renal sonography demonstrated hydronephrosis in 100 cases (48%). Two risk factors were identified: level of spinal defect and age of the patient. Higher spinal levels carried the greatest risk of hydronephrosis. The high risk age periods were the first 4 months of life, affecting children with high lesions, and the teenage years, affecting those on clean intermittent catheterisation (CIC). Seventy‐nine hydronephrotic patients underwent treatment, whereas for 21 there was improvement in the sonographic appearance without intervention. CIC with or without anticholinergic pharmacotherapy was the most common treatment (58%), but often a combination of modalities was required to achieve improvement. The final result of all treatments was deemed satisfactory in 82% of cases. Renal sonography was a useful screening tool to detect upper tract changes in spina bifida patients.
Reimplantation of the Ureter in a Transtrigonal Mucosal Groove
Authors: KERAMIDAS D. C.
Published: November 2008

Summary Reimplantation of the ureter into a groove of the bladder mucosa has been used to simplify the procedure of reimplantation and overcome problems in trabeculated bladders by obviating the creation of a submucosal tunnel. Further experience is presented regarding this procedure on 40 ureters of patients with unilateral or bilateral vesicoureteric reflux, ureteric orifice(s) stenosis, bladder diverticula and posterior urethral valves submitted to simultaneous resection. Intra‐operative observations, post‐operative cystography and long‐term results led to the conclusion that the procedure is technically easy, facilitates reimplantation in trabeculated bladders, safeguards the valve mechanism by preventing vesicoureteric reflux and shortens hospitalisation time.
Antitumour effect of a synthetic analogue of fumagillin on murine renal carcinoma
Authors: MORITA T. , SHINOHARA N. , TOKUE A.
Published: November 2008

Objective To evaluate the antitumour effect of an angio‐inhibitory drug, a synthetic analogue of fumagillin (TNP‐470), on murine renal carcinoma (Renca) in vivo and in vitro.

Materials and methods The effect of TNP‐470 on the growth of Renca cells in vitro was measured by angio‐genesis assay and cell counting with dye exclusion. In the angiogenesis assay, Renca cells were injected intra‐dermally and the number of blood vessels orientated towards the tumours was counted 3 days after tumour inoculation. To examine the effect of TNP‐470 on the subcutaneous tumour growth and lung metastasis of Renca, Renca cells were injected subcutaneously or intravenously in BALB/c mice and they were treated with a subcutaneous injection every 3 days.

Results Dose‐dependent growth inhibition in vitro was observed with 50% inhibition occurring at 600 ng/ml. Angiogenesis assay revealed that administration of TNP‐470 inhibited the angiogenesis induced by Renca in a dose‐dependent manner. In the subcutaneous experiment, TNP‐470 decreased the growth rate of established subcutaneous tumours rather than reduced the size of the tumour. The administration of TNP‐470 in mice with lung metastasis inhibited the development of metastasis of Renca without weight loss or diarrhoea.

Conclusion The present study demonstrated that TNP‐470 had an inhibitory effect on tumour‐induced angiogenesis and a significant anti‐tumour effect on Renca. This suggests that TNP‐470 could be useful in the treatment of renal cell carcinoma. Further studies are needed to clarify whether TNP‐470 is more effective when combined with other drugs such as interferons.
Beta haemolytic group A streptococci causing urinary tract infection
Authors: PALOCAREN T. , MATHAI E. , BRAHMADATHAN K.N. , JOHN T.J. , BALASUBRAMANIAM N. , NATH V.
Published: November 2008

Objective To describe the clinical and laboratory findings in patients with Group A streptococci (GAS) bacteriuria.

Patients Patients with GAS bacteriuria seen in a tertiary care hospital in southern India between 1988 and 1993 were identified. Data were collected from the hospital records.

Result GAS were isolated from 15 women and 11 men. Clinical data were available for 24 of these. The condition presented as asymptomatic bacteriuria (nine patients), dysuria or frequency (12), and fever without localizing signs (three). All infections occurred in individuals with systemic or local conditions predisposing to urinary tract infection. All patients responded well to antimicrobial therapy.

Conclusion GAS bacteriuria is rare and occurs only in individuals with other predisposing conditions. Patients with this infection respond well to therapy.
Evaluation of augmentation cystoplasty in childhood with reference to vesico‐ureteric reflux and urinary infection
Authors: KRISHNA A. , GOUGH D.C.S.
Published: November 2008

Objectives To assess the non‐operative treatment of vesico‐ureteric reflux in patients with abnormal bladder compliance, to determine whether reduction in storage pressure by augmentation leads to cessation of reflux and whether symptomatic urinary tract infection worsens or renal function deteriorates if reflux continues after augmentation and clean intermittent catheterization (CIC).

Patients and methods Thirty‐nine children (17 boys, 22 girls) who underwent clam ileocystoplasty over a 5‐year‐period were evaluated. The mean age at operation was 9.7 years (range 1.5–17.5). Pre‐operative assessment included renal imaging and slow fill video‐cystometry. Vesico‐ureteric reflux, if present, was graded I‐V. The frequency and severity of symptomatic urinary tract infections were recorded. Cystometry was performed 6 months after reconstruction. Storage pressures below 20 cm saline were regarded as safe. The mean follow‐up was 3.3 years (range 10 months‐6.1 years).

Results Of the 17 renal units assessed for the outcome of reflux, 11 stopped reflux and one showed a lower grade. No patient showed worsening of upper tract dilatation or progressive renal scarring. Thirty‐seven patients (95%) had symptomatic urinary tract infection pre‐operatively. Following bladder augmentation, clean intermittent catheterization and trimethoprim prophylaxis, seven continued to have symptomatic infection.

Conclusions Augmentation cystoplasty is effective in resolving reflux in a majority of the patients. This is achieved by reducing storage pressures to below 20 cm saline and emptying the bladder regularly by CIC. There is also a reduction in the incidence and severity of symptomatic urinary tract infections. Even when reflux persists there is no evidence of deterioration of the upper tracts or progressive renal scarring.
Urodynamic and clinical follow‐up of 28 children after gastrocystoplasty
Authors: BOGAERT G.A. , MEVORACH R.A. , KOGAN B.A.
Published: November 2008

Objectives To determine the efficacy of gastrocystoplasty in creating a large and compliant urinary reservoir.

Patients and methods Twenty‐eight children (14 boys, 14 girls), with a median age of 9 years (range 4–17), were evaluated before and for a median of 2 years and 5 months after gastrocystoplasty. Evaluation included urodynamic and renal function studies and a survey of their post‐operative complications and their sense of well‐being. Renal function was assessed by ultrasound and serum creatinine, and electrolytes were measured.

Results After gastrocystoplasty bladder size increased, compliance improved, hydronephrosis decreased or was stable, and renal function remained stable. There were minimal complications and the children's subjective impression of their well‐being was markedly improved.

Conclusion Gastrocystoplasty, using our surgical technique, is a reliable method of creating a large and compliant urinary reservoir. Advantages include the absence of clinical urinary tract infections, the absence of mucus and the preservation of renal function. Complications, such as haematuria, dysuria and hypochloraemic alkalosis, might be avoided by excluding the antrum from the gastrocystoplasty, maintaining the child on a normal salt‐containing diet, employing catheterization or buffering the urine in children with normal urethral sensation.
Written consent about sexual function in men undergoing transurethral prostatectomy
Authors: THORPE A.C. , CLEARY R. , COLES J. , REYNOLDS J. , VERNON S. , NEAL D.E.
Published: November 2008

Objective To review the written recording of consent about possible sexual dysfunction after transurethral resection of the prostate (TURP), and the incidence of sexual dysfunction in sexually active men after TURP. from a large scale audit of transurethral prostatectomy held in 12 hospital sites in the Northern Region.

Patients and methods Over an 8‐month period data were collected from 12 separate hospital sites within the Northern Region by two independent nurse co‐ordinators who travelled to each of the sites. Information was gathered from medical records, operation lists and theatre books using a standard pro‐forma. The Nottingham Health Profile (NHP) was used as a quality of life instrument in a subgroup of patients who were asked about sexual function before and after operation.

Results Advice about retrograde ejaculation was recorded infrequently, with only 30% of case notes including a statement about this (inter‐site variations 0–78%). The mean age of patients in whom a written record was made was lower (70 [0.44 SEM] years) than those in whom there was no recording (72 [0.25] years; P<0.001), but marital status did not appear to be a significant factor. No significant differences in NHP were found comparing men who did or who did not have written evidence about consent regarding retrograde ejaculation. In addition, in a subset of men who had been asked pre‐operatively about sexual function, no significant differences were found in overall NHP measurements in those who did or who did not develop retrograde ejaculation. In men who were sexually active before operation, the incidence of major sexual problems, impotence and retrograde ejaculation were 12%, 11% and 24% respectively.

Conclusion The incidence of sexual dysfunction following TURP in this audit concurred with previously reported studies (4–40%), but despite this most urologists in our audit were not recording that they had advised their patients about this possible outcome.
Preliminary report – combined surgical and radiological penile vein occlusion for the management of impotence caused by venous‐sinusoidal incompetence
Authors: FOWLIS G.A. , SIDHU P.S. , JAGER H.R. , AGARWAL S. , JACKSON J.E. , ZAFAR F. , WILLIAMS G.
Published: November 2008

Objectives To combine surgical and radiological penile vein occlusion therapy in the treatment of patients with venogenic impotence, to try to improve on the results of either treatment used separately.

Patients and methods Fourteen patients, with a mean age of 46 years (range 25–71), with pure venous‐sinusoidal impotence were treated by surgical ligation of accessible veins and embolization of surgically inaccessible veins. The preliminary results over a follow‐up period of at least 8 months are reported for each patient.

Results Venous embolization was considered complete in 11 patients. Overall, 13 had improved erectile function. Post‐operatively, eight patients developed spontaneous erections and four (aged <40 years) have maintained this for 8–24 months.

Conclusion Combined surgery and radiology treats the end result of the failure of the sinusoidal smooth muscle to relax. Although some patients, the majority of whom are young (aged <40 years), will achieve short‐term benefit, all individuals need to be fully counselled with regard to the likelihood of long‐term benefit before undergoing this invasive method of treatment.
Biochemical analysis of tunica vaginalis fluid in patients with or without idiopathic hydroceles
Authors: MADLALA T.S.L. , RENCKEN R.K. , BORNMAN M.S. , REIF S. , JOUBERT H.F. , VAN DER MERWE C.A.
Published: November 2008

Objective To establish the differences, if any, between the biochemical composition of idiopathic hydrocele fluid and the fluid normally present in the tunica vaginalis.

Patients and methods Aspiration and sclerotherapy of 37 idiopathic hydroceles from patients who presented to this urology clinic were performed. The biochemical content of the fluid was compared with that of the tunica vaginalis fluid from a small group of controls (n = 8), taken from patients undergoing orchidectomy for carcinoma of the prostate.

Results Differences in several measurements were recorded; in particular, there were significantly higher concentrations of calcium, albumin, total protein and creatine‐kinase in the hydrocele group. The levels of potassium, aspartate transaminase, alanine transaminase and alkaline phosphatase were significantly lower in the hydrocele group.

Conclusion Whether these differences have a role in the causation of an idiopathic hydrocele is, at this stage, speculative. A similar study on a larger scale would probably be more conclusive.
Detection of microscopic extracapsular extension prior to radical prostatectomy for clinically localized prostate cancer
Authors: OHORI M. , EGAWA S. , SHINOHARA K. , WHEELER T.M. , SCARDINO P.T.
Published: November 2008

Objective To assess better techniques of clinical staging to identify the presence and location of extracapsular extension (ECE) and assist the surgeon in the selection of candidates for resection or preservation of neurovascular bundles during radical prostatectomy.

Patients and methods In a retrospective review of the records of 117 patients with clinically localized (31 T1 and 86 T2) prostate cancer treated with radical prostatectomy the results of digital rectal examination (DRE). real‐time transrectal ultrasound (TRUS) and a retrospective review of static films were compared to assess their accuracy in the detection of ECE. The ultrasonic criterion for ECE was bulging or irregularity of the boundary echo adjacent to a hypoechoic lesion. On DRE, the criterion for ECE was palpable bulging of a nodule beyond the normal contour of the prostate. The reference standard was the presence and location of ECE in the whole‐mount, serially sectioned radical prostatectomy specimens.

Results Microscopic ECE was present in 64 of the specimens (55%). There was no significant difference between DRE, prospective TRUS and retrospective TRUS in the overall accuracy of detection of ECE. However, when the results of DRE and TRUS were combined (if either was positive the result was considered positive), the positive predictive value (PPV) was 79% and the sensitivity (91%), with the overall accuracy increased significantly (P<0.05).

Conclusion The presence and precise location of microscopic ECE can be determined pre‐operatively with reasonable accuracy using real‐time ultrasound combined with the results of DRE.
Ultrasound in the evaluation of urethral stricture disease: a prospective study in 175 patients
Authors: HEIDENREICH A. , DERSCHUM W. , BONFIG R. , WILBERT D.M.
Published: November 2008

Objective To investigate the characteristic ultrasonic appearance of urethral stricture disease in men.

Patients and methods Between 1990 and 1992 a prospective study in 175 men with the suspicion of urethral stricture was performed using urethral ultrasound as the first diagnostic procedure, followed by retrograde urethrography, voiding cystourethrography or urethroscopy.

Results The sensitivity and specificity in detecting urethral strictures were 98% and 96% respectively. UItrasound offers a three‐dimensional study in the evaluation of the urethra without exposing the gonads to ionizing radiation. The exact length and depth of the stricture, the severity of the strictured segment as well as the anatomy of the periurethral scars were diagnosed accurately.

Conclusion Ultrasound is a simple, inexpensive and rapid investigation of the urethra which requires no exposure of the patient to ionizing radiation and should be the preferred diagnostic procedure in the evaluation of strictures in the anterior urethra in men.
Laparoscopic ureterolithotomy: the results of an initial series, and an evaluation of its role in the management of ureteric calculi*
Authors: HAREWOOD L.M. , WEBB D.R. , POPE A.J.
Published: November 2008

Objective To evaluate the place of laparoscopic ureterolithotomy in the management of ureteric calculi for which extracorporeal shockwave lithotripsy (ESWL) and endourological techniques are unsuitable.

Patients and methods Laparoscopic ureterolithotomy was attempted in nine patients (eight men, one woman) with an age range of 26–81 years (mean 55.5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 5 to 28mm (mean 13.2) and stone duration ranged from one to 24 months (mean 8.2). The transperitoneal route was used in six patients and the extraperitoneal route in three but was converted to a transperitoneal approach in two.

Results The stone was successfully removed in all nine patients. The operative time ranged from 80 to 260 minutes (mean 158). No intra‐operative complication was encountered and no patient required a blood transfusion. Post‐operative complications included urinary leak and fever. The post‐operative stay ranged from 2 to 13 days (mean 5.2).

Conclusions Laparoscopic ureterolithotomy has definite advantages over open ureterolithotomy. Furthermore, the more difficult a stone is for treatment by ESWL and endourological techniques, the more suitable it is for laparoscopic removal. For large, hard, longstanding and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferable to multiple endourological and ESWL procedures.
Bacteriuria in patients with a continent ileal reservoir for urinary diversion does not regularly require antibiotic treatment
Authors: ÅKERLUND S. , CAMPANELLO M. , KAIJSER B. , JONSSON O.
Published: November 2008

Objective To eluciadate the importance of bacteriuria in patients with a continent urinary diversion.

Patients and methods Eighteen asymptomatic patients (16 women and two men, with a meanage of 53 years [range 22–73]) with ileal reservoirs coupled to the skin for urinary diversion were studied. Consecutive urine cultures were performed over 5 months. Concomitant measurements of antibody titres against Escherichia coli and Proteus, and C‐reactive protein (CRP) values were made.

Results The results ofthe urine cultures varied considerably between samples. Increased titres of antibodies against E. coil were seen in several patients but the weak (sensitivity 33% specificity 56%). Increased titres of antibodies against Proteus were rarely seen and in no patient correlated with bacteriuria caused by Proteus. Increased levels of CRP were seen in three patients.

Conclusions The present results indicate that asymptomatic bacteriuria in patients with a continent ileal reservoir for urinary diversion is generally of no antibiotics. This conclusion is based on the observations that the bacterial strains growing in the reservoir changed spontaneously indicating colonization rather than infection. Raised titres of antibodies against E. coli correlated weakly with bacterial growth. The observed elevations in antibody titres were usually just above the normal upperlimit.
Similarity of the American Urological Association Symptom Index among men with benign prostate hyperplasia (BPH), urethral obstruction not due to BPH and detrusor hyperreflexia without outlet obstruction
Authors: CHANCELLOR M. B. , RIVAS D. A. , KEELEY F. X. , LOTFI M. A. , GOMELLA L. G.
Published: November 2008

Objective To compare the specificity of the American Urological Association (AUA) Symptom Index for benign prostatic hyperplasia (BPH) versus other urodynamically verified micturitional dysfunction in men.

Patients and methods Fifty‐seven consecutive men who had been referred for video‐urodynamic evaluation of voiding symptoms were evaluated. The patients were divided into three groups: (i) BPH group (n = 24): (ii) non‐BPH obstructed group (n = 20; nine bladder neck obstruction, 11 bulbous urethral stricture); and (iii) detrusor hyper‐reflexia group: detrusor hyperreflexia without outlet obstruction (n = 13).

Results The mean AUA symptom score for the BPH group was 18.9 (range 7–28). The mean score for the 20 non‐BPH obstructed group was 17.6 (range 4–28) and the mean score for the 13 men with detrusor hyper‐reflexia was 20.5 (range 12–27). There was no statistical difference in the AUA symptom score among the three groups.

Conclusion The AUA Symptom Index does not specifically identify BPH or bladder outlet obstruction. The index cannot differentiate the site of obstruction as noted by the similar scores among men with BPH from those with bladder neck obstruction and urethral strictures. Moreover, The AUA Symptom Index scores are similar between men with voiding symptoms secondary to bladder dysfunction and bladder outlet obstruction.
Prognostic value of c‐erbB‐2 and epidermal growth factor receptor in stage A1 (Tla) prostatic adenocarcinoma
Authors: FOX S.B. , PERSAD R.A. , COLEMAN N. , DAY C.A. , SILCOCKS P.B. , COLLINsT C.C.
Published: November 2008

Objective To determine whether the presence or absence of the oncoproteins epidermal growth factor receptor (EGFR) and c‐erbB‐2 could predict tumour behaviour.

Patients and methods Tissue from 45 stage A1 (Tla) prostatic adenocarcinomas from patients with a mean age of 65 years were immunostained for EGFR (12E) and c‐erbB‐2 (NCL‐CB11). Their expression in the tumour and surrounding benign hyperplastic epithelium was correlated with each other and with survival.

Results Forty per cent (18 of 45) and 36% (16 of 45) of patients respectively were EGFR and c‐erbB‐2 positive in the tumour. Expression of these tyrosine kinase oncogenes was not confined to the tumour and the surrounding hyperplastic prostate was also positive for EGFR in 76% (34145) of patients and for c‐erbB‐2 in 16% (11 of 45). EGFR and c‐erbB‐2 expression was weakly associated in both benign and malignant epithelium. Statistical analysis of survival showed that tumour c‐erbB‐2 expression was associated with significantly worse prognosis (exact two tailed P= 0.03 16), whereas no significant association was observed between EGFR expression and survival (P = 0.7 3 7).

Conclusion As c‐erbB‐2 expression increases the rate of dying by 4.2 times, recording its expression by thcse tumours may be useful in selecting patients who would benefit from treatment in stage A1 (Tla) disease.
The long‐term outcome of patients who relapse after chemotherapy for non‐seminomatous germ cell tumours
Authors: LEDERMANN J.A. , HOLDEN L. , NEWLANDS E.S. , BEGENT R.H.J. , RUSTIN G.J.S. , BAGSHAWE K.D. , BRAMPTON M.
Published: November 2008

Objective To examine the long‐term survival of a group of patients with non‐seminomatous germ cell tumours, who relapse after chemotherapy and are retreated with a cisplatin and etoposide‐based regimen.

Patients and methods At the Charing Cross Hospital between 1979 and 1988 38 patients in relapse were seen. The median interval after primary therapy was 8 months. They were treated with an intensive cisplatin and etoposide‐based regimen with cycles repeated at 7–10 day intervals, and with surgery in 22 patients.

Results Forty‐seven per cent of patients entered a second complete remission and 88% of these remain disease free. The overall survival was 46% with a median follow‐up of more than 4.3 years. Surgery was performed in 14 of 18 patients who entered a second complete remission. Adverse risk factors before initial chemotherapy and the time to relapse did not predict outcome but patients with unresectable radiological masses after relapse therapy had a poor outcome despite normalization of serum tumour markers. The tumours of 68% of patients initially treated with cisplatin‐based regimens and 62% of patients who also received etoposide remained responsive to conventional doses of these drugs at relapse.

Conclusions This study demonstrates that there is a group of patients with relapsed teratoma who can be cured without the need for very high dose chemotherapy and autologous bone marrow rescue.
Mild dilatation of the fetal kidney: a follow‐up study
Authors: THOMAS D.F.M. , MADDEN N.P. , IRVING H.C. , ARTHUR R.J. , SMITH S.E.W.
Published: November 2008

Objective To assess morbidity in children with mild prenatally detected pelvicalyceal dilatation and to document the natural history of this ultrasound finding in post‐natal life.

Patients and methods A retrospective (on‐going) study was carried out in 29 children (39 kidneys) with mild dilatation confined to the pelvis and/or calices confirmed on initial post‐natal ultrasound scan. Re‐evaluation was carried out at a mean age of 4.2 years (range 1.5–7.8). Clinically, each patient's history, height, weight and blood pressure were recorded. On ultrasound examination the renal length, collecting system appearances and dimensions were recorded.

Results Vesico‐ureteric reflux was demonstrated in 1 of 14 infants who underwent neonatal micturating cystourethrography. During cumulative follow‐up totalling 122 years, there were only two documented episodes of urological morbidity, i.e. one episode of unexplained haematuria and one of urinary tract infection. By a mean age of 4.2 years the ultrasound appearances had reverted to normal in 69% of kidneys. In 31% dilatation persisted and was unchanged or diminished in severity. No case of increasing dilatation was seen. Renal growth was normal in 9 7%) of kidneys.

Conclusions Mild dilatation of the fetal urinary tract is a common prenatal ultrasound finding. When confined to the renal pelvis and/or calices it is of doubtful clinical significance and is associated with a low level of morbidity in infancy and early childhood. Invasive investigation in post‐natal life is not justified.
The value of ultrasound in the child with an acute urinary tract infection
Authors: MacKENZIE J.R. , FOWLER K. , HOLLMAN A.S. , TAPPIN D. , MURPHY A.V. , BEATTIE T.J. , AZMY A. F.
Published: November 2008

Objective To assess the value of an ultrasound examination in children with a proven urinary tract infection.

Patients and methods The results of renal ultrasound and 99mTc‐dimercapto‐succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.

Results Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.

Conclusion An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.
Laparoscopic nephrectomy: Mansoura experience with 106 cases
Authors: Eraky I. , El‐Kappany H.A. , Ghoneim M.A.
Published: November 2008

Objective To describe the technique and report our experience of laparoscopic nephrectomy.

Patients and methods Between August 1992 and December 1993, 106 patients underwent laparoscopic nephrectomy at the Mansoura Urology and Nephrology Center.

Results Of the 106 patients, laparoscopic nephrectomy was performed successfully in 97 cases. Conversion to an open procedure was necessary in the remainingnine patients.

Conclusion For a selected group of patients, laparoscopicnephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and return to work is rapid.
The National Prostatectomy Audit: the clinical management of patients during hospital admission
Authors: Emberton M. , Neal D.E. , Black N. , Harrison M. , Fordham M. , Mcbrien M.P. , Williams R.E. , McPherson K. , Devlin H.B.
Published: November 2008

Objective To determine everyday practice in the hospital management of men undergoing prostatectomy and the extent of its variation.

Patients and methods A total of 5361 patients, who represented 89% of all those undergoing prostatic procedures in four health regions (Mersey, Wessex, Northern and South West Thames) and one test site (within Trent) were recruited by 103 (97%) surgeons. Clinical information was collected on a pre‐coded data collection form which was completed during the hospital stay by the principal operator. Patient identification occurred at the time of surgery.

Results Important findings included: (i) both older men and those of higher social class were more likely to undergo prostatectomy with fewer symptoms; (ii) men who waited longer for surgery had worse symptoms by the time of their operation; (iii) there were unexplained differences in routine pre‐ and post‐operative investigation and treatment. Half the men had their flow rate or residual urine measured as part of their pre‐operative assessment. About half the men received prophylactic antibiotics; (iv) when large groups were analysed, a consistent proportion of men throughout the study (12%) were undergoing the operation for a second time. The clinical course of men having a repeat operation differed in many ways from those having a first time procedure; (v) the larger proportion of men (62%) had surgery for strong indications as opposed to symptoms alone; (vi) although most operations were performed by consultants, emergency admissions, though symptomatically more severe and sicker, were more likely to be operated on by trainee surgeons; (vii) significant variation in mean pre‐operative symptom severity and bother scores were seen between surgeons.

Conclusion The clinical management of prostatectomy has been defined in a large and representative UK sample. In some circumstances consistent variations have been identified. It is not yet clear whether these variations influence outcome. These data can be used by surgeons wishing to compare their own patient management with that described here.