bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular Reflexes in the Neurological Evaluation of Impotence
Authors: NISÉN H. O. , LARSEN A. , LINDSTRÖM B. L. , RUUTU M. L. , VIRTANEN J. M. , ALFTHAN O. S.
Published: November 2008

Summary— Testing of the autonomic cardiovascular reflexes (single breath beat‐to‐beat variation and orthostatic blood pressure change) was performed in 542 patients with erectile dysfunction who were grouped according to aetiological factors and their response to visual sexual stimulation and the papaverine test. Age‐related normal values for autonomic tests were determined in the group of 124 patients with psychogenic impotence. Abnormal cardiovascular reflexes were associated with ageing and organic impotence, indicating autonomic dysfunction as a major contribution to impotence. Single breath beat‐to‐beat variation, as a simple non‐invasive test, is useful in the clinical evaluation of impotence, especially in patients with diabetes and a history of alcohol abuse.
Testicular Ultrasonography and 18G Biopty Biopsy for Clinically Undetected Cancer or Carcinoma in situ in Patients with Germ Cell Tumours
Authors: HEIKKILÄ R. , HEILO A. , STENWIG ANNA E. , FOSSÅ SOPHIE D.
Published: November 2008

Summary— The 18G Biopty biopsy has been evaluated as a tool to detect carcinoma in situ in the remaining testes of patients with extragonadal germ cell tumours or unilateral germ cell tumours. In all, 68 biopsies were performed in 57 selected patients. Five carcinomas in situ and 1 infiltrative seminoma were detected. The biopsies were performed under local anaesthesia. Pain and/or haematomas occurred after 9 of the 68 biopsies but none of the haematomas required invasive measures. This method of performing biopsies from clinically tumour‐free testes seems promising but longer follow‐up is required to evaluate the sensitivity of the method compared with open surgical biopsy.
Audit of Catheter Management Provided by District Nurses and Continence Advisors
Authors: CAPEWELL ANN E. , MORRIS S. L.
Published: November 2008

Summary— District Nurses and Continence Advisors were surveyed by post to audit their management of long‐term indwelling catheters. They were asked to outline, anonymously, their management strategies in response to common specified catheter‐related problems. The responses to each question were graded for the appropriateness of strategy from A (best) to E (worst) by previously formulated criteria. Completed questionnaires were returned from all 10 Welsh Continence Advisors and 73 of 139 (53%) District Nurses in South Glamorgan regularly involved in catheter care. A greater proportion of Continence Advisors' than District Nurses' responses were graded A or B in all problem areas specified. In patients with marked bacteriuria, 60% of Continence Advisors but only 11% of District Nurses would assess whether the patient was ill; 53% of District Nurses would treat with antibiotics without such assessment. Whereas most nurses investigating suprapubic pain would consider catheter blockage, only one‐third would consider further history taking or examination, and only 1 District Nurse considered constipation or detrusor spasm. Although two‐thirds of nurses sometimes used bladder washouts, few considered them effective and most were aware of the potential risks. Thus wide variations were found in the community nursing management of indwelling catheters and care may frequently be suboptimal. Appropriate management guidelines should be developed and disseminated.
Polypharmacy and its Effect on Urinary Incontinence in a Geriatric Population
Authors: GORMLEY E. A. , GRIFFITHS D. J. , McCRACKEN P. N. , HARRISON G. M.
Published: November 2008

Summary— The relationship between medication and incontinence was studied retrospectively in 128 elderly patients enrolled in an incontinence study. Patients were taking up to 18 non‐topical medications but most of these were unlikely to have a significant urological effect. Nevertheless, 62% of patients were receiving, for other medical problems, up to 4 drugs which could potentially affect the lower urinary tract. These were classified by their mode of action. The most common types of urologically active medication, apart from diuretics, were calcium channel blockers, used by 21% of patients, and tricyclic antidepressants, used by 12%. The urodynamic findings in patients on different types of medication were compared. Patients with urodynamically proven urge incontinence who were on calcium channel blockers had significantly less urine loss than those not on the drug. Tricyclic antidepressants have been used in the treatment of urge incontinence; in this study urine loss was less severe among those receiving tricyclics, although the differences were not significant. A few patients on beta‐blockers apparently had more severe urge incontinence. Drugs prescribed to the elderly for non‐urological medical problems can affect the lower urinary tract and may have some effect, either beneficial or adverse, on incontinence.
Economic Burden of Treated Benign Prostatic Hyperplasia in the United Kingdom
Authors: DRUMMOND M. F. , McGUIRE A. J. , BLACK N. A. , PETTICREW M. , McPHERSON C. K.
Published: November 2008

Summary— Recent epidemiological studies suggest that much urological disease is untreated. However, the overall economic burden of urological diseases has never been systematically studied. This report estimates the economic burden of treated benign prostatic hyperplasia (BPH) in the United Kingdom by considering the direct costs falling on the health service, the indirect costs in lost production, and the intangible costs in reduced quality of life. Depending on the assumptions made, the economic burden in 1990 is estimated to have been between £62 million and £91 million annually, excluding the intangible costs. The maximum cost to the National Health Service (NHS) represents approximately 0.4% of total NHS expenditure. This finding is therefore consistent with the results of recent epidemiological studies, which suggest that the main burden of BPH is borne by sufferers in terms of reduction in quality of life and is not reflected in consumption of health care resources. However, this balance may change as a result of the new General Practitioner contract and new treatment options.
Patient‐perceived Health Status before and up to 12 Months after Transurethral Resection of the Prostate for Benign Prostatic Hypertrophy
Authors: DOLL HELEN A. , BLACK N. A. , FLOOD ANN B. , McPHERSON K.
Published: November 2008

Summary— As part of a prospective cohort study of 388 men undergoing transurethral resection of the prostate (TURP) for benign prostatic hypertrophy, the perceived physical, social and emotional health before and 3,6 and 12 months after surgery was assessed using the Nottingham Health Profile. Before surgery, 88% of patients reported one or more specific health problems, most commonly concerning sleep (75%). The areas of daily life considered by the patients to be most affected by their health status were employment (by 33% of those currently in work), sex life (31%), social life (29%) and holidays (29%). Comparisons with other patient groups are described.

Three months after surgery the proportion of patients reporting at least one health problem had fallen to 66%. Significant improvements occurred in all aspects of health, particularly sleeping problems. The improvements persisted for all aspects during the year following surgery with the exception of physical mobility, which deteriorated. These improvements were reflected in a significant reduction in perceived limitations in the patients' daily lives, with a tendency for the patients to perceive fewer limitations 1 year after surgery than at the 3‐month assessment.
Prevalence of Bilateral Testicular Germ Cell Tumours and Early Detection Based on Contralateral Testicular Intra‐epithelial Neoplasia
Authors: DIECKMANN K.‐P. , LOY V. , BÜTTNER PETRA
Published: November 2008

Summary— The prevalence of bilateral tumours was found to be 4% in a retrospective analysis of 531 consecutive patients with testicular germ cell tumours. Patients with bilateral tumours were younger when their first tumour was diagnosed than those who had only 1 testicular tumour. Bilateral undescended testis was more frequent in 21 patients with bilateral tumours than in the total population of patients examined (2 of 21 versus 10 of 452, i.e., 9.5% versus 2.2%). Histology and unilateral undescended testis were not helpful in identifying patients at risk of developing a second tumour.

In a separate study, 76 consecutive patients with unilateral testicular cancer underwent contralateral testicular biopsy at the time of orchiectomy. Five patients had testicular intra‐epithelial neoplasia (TIN, so‐called carcinoma in situ) in the contralateral testis; 1 of these patients had a history of bilateral undescended testis and 4 had an increased level of serum follicle stimulating hormone post‐operatively. None of the other 71 patients had developed a second tumour after a median observation time of 30 months. Testicular biopsy and a search for TIN appear to be a safe method for the early identification of the patients at risk of developing a contralateral testicular tumour.
Collecting Duct Carcinoma of the Kidney
Authors: DIMOPOULOS M. A. , LOGOTHETIS C. J. , MARKOWITZ A. , SELLA A. , AMATO R. , RO J.
Published: November 2008

Summary— Collecting duct carcinoma (CDC) is a recently recognised histological variety of renal carcinoma (RC) considered to arise from the epithelium of the collecting ducts. Diagnosis of this entity depends on well defined gross and microscopic criteria and is supported by a characteristic immunostaining pattern. The clinical features of these patients, the natural course of the disease and its response to treatment have not been clearly established.

Between 1980 and 1990 we treated 12 patients (median age 43 years, range 16–62) with collecting duct carcinoma of the kidney. In addition to being relatively young, each patient had a strong family history of associated malignancies. Survival was short (median 22 months) and 11 patients presented with locally advanced or metastatic disease.
Pharmacological Options for the Treatment of Acute Ureteric Colic Anin vitroExperimental Study
Authors: LENNON G. M. , BOURKE J. , RYAN P. C. , FITZPATRICK J. M.
Published: November 2008

Summary—The effects of opiate and non–steroidal anti–inflammatory agents on thein vitrocanine ureter were compared using a new model for the assessment of ureteric pharmacology. A pressure measuring catheter attached to a pressure transducer and pre‐calibrated pen recorder was ligated into the lumen of 2.5 cm segments of normal canine ureter. The segments were immersed in an organ bath at physiological pH and temperature and spontaneous contractility was observed in 90% of them. Morphine had a spasmogenic effect on ureteric activity which was unaffected by naloxone. This effect was similar to that of histamine and prostaglandin F2α and was abolished by chlorpheniramine but not by cimetidine. Pethidine produced a transient stimulation followed by inhibition of ureteric activity which was unaffected by naloxone. Both indomethacin and diclofenac produced an abrupt inhibition which was reversible with prostaglandin F2α. These data suggest that pethidine or a non‐steroidal anti‐inflammatory agent may by virtue of their spasmolytic effects be a superior choice of therapy for the acutely obstructed ureter.
Interstitial Cystitis: Correlation with Nerve Fibres, Mast Cells and Histamine
Authors: LUNDEBERG T. , LIEDBERG H. , NORDLING L. , THEODORSSON E. , OWZARSKI A. , EKMAN P.
Published: November 2008

Summary—Interstitial cystitis (IC) is a painful condition in the urinary bladder of unknown aetiology and pathogenesis. To assess the contribution of the nervous system to IC a biopsy was taken from 6 patients with IC and from a control group of 6 patients with non‐ulcerative IC. Mast cells were counted and histamine measured in bladder washings from all patients. There were significantly more nerve fibres within the suburothelium and detrusor muscle in chronic IC than there were in non‐ulcerative IC. The bladder washings from all patients with IC contained mast cells and histamine, while only occasional mast cells and traces of histamine were found in washings from patients with non‐ulcerative IC. There was a good correlation between the number of nerve fibres and number of mast cells as well as between the number of nerve fibres and the amount of histamine.
Multiple Transrectal Ultrasound‐Guided Prostatic Biopsies—True Morbidity and Patient Acceptance
Authors: COLLINS G. N. , LLOYD S. N. , HEHIR M. , McKELVIE G. B.
Published: November 2008

Summary— Transrectal ultrasound (TRUS) is becoming more widely used as a method of investigating prostatic disease. This study investigated the acceptance of this technique in 89 patients undergoing evaluation for suspected malignant disease. The true morbidity associated with TRUS and TRUS‐guided biopsy was evaluated. Serious complications were rare, but minor complications were frequent. Careful counselling is recommended prior to the procedure in order to minimise the patients' anxiety and ensure that if complications do occur they are dealt with swiftly and appropriately.
Prevalence and Outcome of Renal Impairment at Prostatectomy
Authors: HILL ALISON M. , PHILPOTT N. , KAY J. D. S. , SMITH J. C. , FELLOWS G. J. , SACKS S. H.
Published: November 2008

Summary— Of 382 patients undergoing prostatectomy in Oxford in 1985 the prevalence of renal impairment (defined as plasma urea > 14 mmol/l or plasma creatinine >200 μmol/l) was 8%; prostatectomy patients had significantly higher plasma ureas than age–matched patients undergoing herniorrhaphy and cholecystectomy in the same hospitals in the same year. A review of the case records of men with renal impairment showed that case history could not predict renal impairment. Although few case notes gave follow‐up information, it was evident from the information available that recovery of renal function after prostatectomy did not occur invariably. Renal impairment in men undergoing prostatectomy represents substantial and unrecognised morbidity.
Re‐evaluation of Indications for Percutaneous Nephrostomy and Interventional Uroradiological Procedures in Pelvic Malignancy
Authors: HOE J. W. M. , TUNG K. H. , TAN E. C.
Published: November 2008

Summary— Twenty‐two patients with advanced cancer involving the pelvis were treated by percutaneous uroradiological techniques. Percutaneous nephrostomy was performed for renal failure or urosepsis or before chemotherapy. In 8 patients, ureteric stents were also placed by the antegrade route, across malignant ureteric strictures, following nephrostomy. In another 8 patients, the ureteric obstruction could not be crossed and permanent nephrostomies were required. Fifteen patients were able to achieve a useful life but in the other 7 patients there was no improvement in their quality of life and they all died 1 month after intervention. Percutaneous nephrostomy also contributed to the death of 1 patient. Not all obstructed kidneys require drainage and in patients with disseminated or advanced disease involving the pelvis, the indications for intervention need to be individually assessed. An improvement in laboratory criteria of renal function following intervention does not necessarily result in improvement in quality of life. This retrospective study highlights the difficulty in selection of patients with advanced disease for intervention and previously suggested guidelines for intervention are reviewed.
Surgical. Correction of Bilharzial Ureteric Stricture by Boari Flap Technique
Authors: RAVI G. , MOTALIB M. A.
Published: November 2008

Summary— Extensive ureteric strictures due to bilharziasis can be managed satisfactorily by reimplantation of the ureters using a Boari flap technique. A series of 150 patients with extensive ureteric strictures underwent ureteric reimplantation using this technique.

Contrary to the conventional belief that patients with bilharziasis have a contracted bladder, our patients maintained a good capacity and sufficient supple tissue was available to replace even very extensive ureteric strictures.
Treatment Preferences of Urologists in Great Britain and Ireland in the Management of Prostate Cancer
Authors: WAYMONT B. , LYNCH T. H. , DUNN J. , BATHERS S. , WALLACE D. M. A.
Published: November 2008

Summary— A questionnaire was sent to all full‐time British and Irish urologists (n=278) on the management of prostate cancer and was answered by 229 (82%). The questions included 3 specific clinical situations, namely the management of incidental disease, the timing of treatment for metastatic disease and the mode of hormonal manipulation used for advanced disease.

It was found that 79% of urologists preferred a deferred treatment policy for incidental disease in the over‐75 age group. Radical prostatectomy was advocated by 10% of those questioned for patients in the under‐60 age group. Radiotherapy was the mainstay of treatment for incidental disease in the poorer prognosis groups of incidental disease, namely younger patients with more aggressive tumours.

Most urologists treated patients with asymptomatic metastatic disease at the time of diagnosis, with 18% entering patients into the Medical Research Council trial comparing immediate with deferred therapy.

Orchiectomy was advocated by 57% of urologists as their first‐line treatment for patients where hormonal manipulation was indicated. Consequently orchiectomy should remain the “gold standard” in comparative phase III trials in advanced prostate cancer.
Dicentric Y Chromosome in Azoospermic Males
Authors: TAKIHARA H. , TSUKAHARA M. , BABA Y. , NAITO K. , KAJII T.
Published: November 2008

Summary— Two azoospermic, infertile men with a pseudodicentric Y chromosome are reported. The small isodicentric Y chromosomes were composed of duplicated short arm and proximal long arm Y, as proven by fluorescence in situ hybridisation using a Y centromere‐specific DNA probe, pDP97, and a short arm probe pY‐80. Both lacked germinal cells in the gonads. It was assumed that the azoospermia was caused by deletion or disruption of the azoospermic factor gene located at distal Yq11. Patient 2 measured 147 cm (—4.1 SD) in height and so it was assumed that he had also lost the “statural determinants” gene.
Emphysematous Pyelonephritis: Drainage or Nephrectomy?
Authors: KOH K. B. H. , LAM H. S. , LEE S. H.
Published: November 2008

Summary— Four cases of emphysematous pyelonephritis are reported and the pathogenesis, surgical implications and preferred mode of management are discussed. We have not found percutaneous drainage to be useful, but feel there is an important place for surgical drainage alone because of the potential for renal recovery and the risks of emergency nephrectomy.
Extracorporeal Shock Wave Lithotripsy Induces the Release of Prostaglandins which Increase Ureteric Peristalsis
Authors: HORGAN P. G. , HANLEY D. , BURKE J. , COUSE N. F. , FITZPATRICK J. M.
Published: November 2008

Summary—The aim of this study was to identify the changes in secretion of prostaglandins into the urinary tract as a result of treatment by extracorporeal shock wave lithotripsy (ESWL) and to determine their effects on ureteric motility.

Sixteen patients with renal or upper ureteric calculi were studied. A peripheral blood and urine sample was collected immediately before and after ESWL, with further samples taken 24 h later. The following variables were assessed by radioimmunoassay: prostaglandin E2(PGE2), prostaglandin F1α (PGF1α), and thromboxane B2(TXB2). Anin vitrocanine study was then designed to study the activity of TXB2, PGF1α and PGE2on an isolated intact canine ureter model.

Significant elevations of TXB2were found immediately after ESWL in both serum and urine, which fell almost to pre‐treatment levels by 24 h. PGF1α levels showed significant elevations at 24 h but no immediate increase as seen with TXB2. In contrast, PGE2levels were unchanged in the urine but significantly decreased in the serum.In vitrostudies showed that both TXB2and PGF1α repeatedly produced an increased frequency of ureteric contraction.

ESWL results in the release of prostaglandins from the urinary tract which are shown to cause increased ureteric peristalsis.
Characterisation of Renal Masses with Colour Flow Doppler Ultrasonography
Authors: ERDEN I. , BEDÜK Y. , KARALEZLI G. , AYTAÇ S. , ANAFARTA K. , S¸LAFAK M.
Published: November 2008

Summary— Colour flow Doppler ultrasonography (US) was used in 24 renal masses (12 benign, 12 malignant) to investigate the vascularity of the lesion and thus to characterise the mass. A colour flow Doppler US device (Toshiba 270 A) with a convex probe of 3.75 MHz was used. Colour flow and the peak‐systolic Doppler shift frequency obtained from the renal mass were used to distinguish between benign and malignant lesions. Ten of 12 malignant lesions demonstrated colour flow together with Doppler signals greater than 2.5 kHz (mean 3.5 kHz). None of the 12 benign renal masses demonstrated colour flow or tumour signals. The majority of malignant lesions give rise to neovascularisation and so high frequency Doppler‐shifted signals. Thus colour flow Doppler sonography is the most reliable means of differentiating benign from malignant renal masses.
Percutaneous Nephrostomies
Authors: KEHINDE E. O. , NEWLAND C. J. , TERRY T. R. , WATKIN E. M. , BUTT Z.
Published: November 2008

Summary— A review was made of 127 percutaneous nephrostomies (PCN) in 106 patients with benign (74 patients) and malignant (32 patients) urinary tract obstruction. Data on underlying aetiology, complications, subsequent management and long‐term management are presented. The study confirms that PCN is an effective and safe method of providing temporary or prolonged urinary diversion in obstruction. Its use in pelvic malignancy should be determined by the likelihood of obtaining worthwhile prolonged palliation in individual patients.
The Bladder Cooling Reflex in Man—Characteristics and Sensitivity to Temperature
Authors: GEIRSSON G. , LINDSTROM S. , FALL M.
Published: November 2008

Summary— The ice‐water test is a simple supplementary urodynamic test that increases the precision of the diagnosis of overactive bladder subtypes. A similar bladder cooling reflex has recently been characterised in the cat and was found to originate from specific cold receptors in the bladder wall. In the present study, the threshold temperature of the human bladder cooling reflex was determined in patients with positive ice‐water tests. Estimated threshold values were somewhat lower than those of the cat but still well above the temperatures required for cold stimulation of nociceptors. As in the cat, the strength of the cooling reflex varied inversely with the bladder temperature. These findings indicate that the human bladder cooling reflex is in principle organised in the same way as that of laboratory animals. The human bladder thus seems to be endowed with cold receptors with excitatory reflex connections to the detrusor.
Extracorporeal Shock Wave Lithotripsy for Bladder Stones
Authors: HOTIANA M. Z. , KHAN L. A. , TALATI J.
Published: November 2008

Summary— Between December 1989 and July 1991, 29 patients with bladder stones were treated on the MPL 9000 extracorporeal shock wave lithotriptor using ultrasound for localisation. The mean stone dimensions were 22.65 × 15.17 mm (<400 mm2 in 20 patients); 75% of patients required only 1 ESWL session but the largest stone (2025 mm2) required 3. Whilst larger stones tended to require more shock waves, linear regression analysis showed a poor fit and factors other than size (operator experience and stone hardness) may determine the number of shock waves required. Satisfactory fragmentation was obtained in all patients.

All were treated under intravenous analgesia without anaesthesia. Three patients also had outflow obstruction and were treated by transurethral resection of the prostate (TURP) on the day after completing ESWL. ESWL prior to TURP reduces the morbidity and operating time associated with endoscopic therapy of bladder stones. Macroscopic fragments remaining after ESWL can be washed out at TURP.
Audit and its Impact in the Management of Early Prostatic Cancer
Authors: RANA A. , CHISHOLM G. D. , CHRISTODOULOU S. , MclNTYRE MARGARET A. , ELTON R. A.
Published: November 2008

Summary— An analysis was made of a prospective database of 614 men with newly diagnosed carcinoma of the prostate who presented between January 1978 and December 1990; 3‐monthly updates were available on their clinical, haematological and biochemical parameters and 6‐monthly updates on chest X‐rays, bone scans and skeletal X‐rays. It was found that 107 men (mean age 73. 5 years) had early disease at presentation. Their management was based on regular surveillance and the treatment deferred until disease progression or development of symptoms. The audit of outcome measured various clinical events. Four patients (3. 7%) developed local failure, 11 (10. 3%) developed bone metastases, 3 (2. 8%) died of cancer with a median survival of 6. 3 years, and 34 (31. 8%) died of intercurrent disease with a median survival of 2. 6 years. The observed survival for 12 years of the whole group was similar to the expected survival for an age‐matched population in Scotland. The standardised mortality ratio was 81 (95% confidence limits 57–112).
Changes in Serum Immunosuppressive Acidic Protein following Surgery in Patients with Renal Carcinoma
Authors: UEDA T. , YASUMASU T. , UOZUMI J. , NAITO S.
Published: November 2008

Serum immunosuppressive acidic protein (IAP) was measured serially in 69 patients with renal carcinoma who were treated surgically and followed up for more than 6 months after surgery. Elevated IAP levels > 600 µg/ml were seen in 8 of 52 patients without evidence of recurrence and in 5 of 10 patients prior to clinical evidence of recurrence but in whom recurrence did eventually develop. The positive rate of IAP levels > 600 µg/ml in recurrent cases was significantly higher than in non‐recurrent ones. In 7 patients with distant metastases, IAP levels rose to > 500 µg/ml in 3 of 5 patients whose disease progressed despite therapy; levels fell to < 600 µg/ml in 2 patients who responded to therapy. The data suggest that recurrence should be suspected in patients with IAP levels > 600 µg/ml, as these changes appear to correlate with the response of metastases to therapy.
Development of a Catheterised Bladder Model to Evaluate Urinary Drainage Equipment
Authors: MULHALL ANNE , GARNHAM A. , ORAEDU A.
Published: November 2008

A catheterised bladder model was developed to examine the design features of urinary drainage bags. The drainage bag of 4 commonly used products was inoculated with either Escherichia coli or Proteus mirabilis. The speed of retrograde contamination towards the “bladder” was determined over 96 h. The effect of lifting the drainage bag above the level of the “bladder” was examined also. Within 4 days micro‐organisms were detected in the backflow valves/drip chambers of all products, but contamination had not progressed as far as the catheter. Ps. mirabilis appeared to migrate more rapidly than Esch. coli. Lifting the drainage bag had no effect on the migration of either organism. The implications of these results for clinical practice are discussed.
Uraemia with Concomitant Urothelial Cancer
Authors: JIAAN BANG‐PING , YU CHIA‐CHENG , LEE YING‐HUEI , HUANG JONG‐KHING
Published: November 2008

We report our experience with 3 uraemic patients who were found to have transitional cell carcinoma of the renal pelvis, ureter and urinary bladder after undergoing haemodialysis for an average of 18 months (range 11–28). The underlying causes of renal failure were chronic glomerulonephritis or pyelonephritis. Bloody urethral discharge was the cardinal symptom. Because of anuria, it was often discovered at a late stage. In spite of their poor general condition and advanced stage, palliative surgical intervention was still performed. After a mean follow‐up of 9 months, progression of disease was noted in 1 patient. The importance of regular follow‐up in patients with end‐stage renal disease for early detection of concomitant cancer cannot be overemphasised. Uraemic patients with urothelial cancer should be treated in the same way as non‐uraemic patients, since aggressive surgical intervention may improve their quality of life and prolong their survival.
Audit and its Impact in the Management of Advanced Prostatic Cancer
Authors: RANA A. , CHISHOLM G. D. , CHRISTODOULOU S. , MclNTYRE MARGARET , ELTON R. A.
Published: November 2008

From a prospective database of 614 consecutive men with newly diagnosed prostatic cancer an audit of outcome was studied in 169 men who presented with bone metastases and subsequently received hormonal manipulation in the form of monotherapy. The cohort was divided into 2 groups according to serum alkaline and acid phosphatase enzyme levels. Men with normal alkaline phosphatase levels (41.5%) had a better prognosis (median survival 38 months) than those with elevated levels at presentation (58.5%) (median survival 19 months). This difference was highly significant. A similar stratification on prostatic acid phosphatase levels did not yield any prognostic significance. With regard to cause‐specific survival, serum alkaline phosphatase was an even more powerful prognosticator, with a median survival of 45 and 21 months for patients with normal and elevated levels respectively. Thus monotherapy is recommended for metastatic prostate cancer patients with normal serum alkaline phosphatase, but for those with elevated alkaline phosphatase the alternative avenues of treatment must be explored.
Re‐evaluation of the Need for Pelvic Lymphadenectomy in Low Grade Prostate Cancer
Authors: FOURNIER G. R. , NARAYAN P.
Published: November 2008

In a series of 166 patients undergoing radical prostatectomy and bilateral pelvic lymph node dissection for clinical stage A and B prostate cancer we found that 83% of patients with lymph node metastases had a final tumour Gleason score 7. Gleason scoring of the pre‐operative biopsy demonstrated 3 groups of patients with biopsy scores 5, 6, and 7, and a prevalence of lymph node metastases of 2, 13 and 23% respectively. The pre‐operative serum prostate specific antigen (PSA) was of marginal value in predicting either the presence of lymph node metastases or the presence of cancer, since 15% of patients with nodal metastases had normal pre‐operative PSA levels, as did 54% of patients with tumour Gleason scores 5. It was concluded that the need for pelvic lymph node dissection in patients with low grade tumours is questionable because of the low prevalence of lymph node metastases, and that the pre‐operative biopsy can identify those patients who are at low risk for lymph node metastases.
Responses of Renal Function to Elevated Intravesical Pressure
Authors: DANGAS N. , PARASHOU E. , LYMBERI M. , KEHAYAS P.
Published: November 2008

Summary This experimental study was designed to investigate the responses of renal function to elevated intravesical pressure. Ten male New Zealand type rabbits were used. A supravesical ureterocutaneous urinary diversion was performed in all rabbits to disconnect bladder and kidneys and to ensure a free urine flow. Two parameters of renal function were measured simultaneously: urine output by simple collection and glomerular filtration rate (GFR) by total plasma clearance of 51Cr‐EDTA. Measurements were performed initially with the bladder empty and then with intravesical pressure 60 cm H2O. A significant decrease in urine output and in GFR was observed in all rabbits when the bladder was overdistended. Urine output returned to the initial levels after relief of the increased intravesical pressure. The results suggest that for these responses a vesicorenal reflex activated by the elevated intravesical pressure is responsible.
Bladder Contractility and Idiopathic Detrusor Instability in the Female
Authors: CUCCHI A.
Published: November 2008

Summary Twenty females with pure stress urinary incontinence (Group A) were studied clinically and urodynamically together with 20 stress incontinent women with idiopathic detrusor instability (Group B) and 20 controls (Group C). Forty females with the idiopathic urge syndrome, 20 with detrusor instability (motor urgency. Group D) and 20 with stable bladders (sensory urgency, Group E) were also investigated. Detrusor contractility, assessed on the basis of strength and velocity parameters derived from pressure flow data, was increased in the unstable groups. In particular, the maximum mechanical power (per unit of bladder wall surface area) generated by the contracting detrusor during voiding was higher in the unstable patients, this was also the case when estimating maximum bladder contraction velocity.

No significant difference in these parameters was found in the patients with sensory urgency when compared with the controls and with the women with stress urinary incontinence, nor was there any significant difference between patients with motor urgency and the stress incontinent patients with detrusor instability.

The enhanced contractile capability could be explained in the unstable stress incontinent group by a reduced threshold of stretch receptors in the urethral walls. If this were the case, urine running through the urethra at the beginning of voiding would be able to activate a urethrovesical reflex which may augment micturition contractions.

In the group with the idiopathic urge syndrome one could speculate that sensory and motor urgency are due to the same neurological disorder (i.e. possibly a reduction in a tonic inhibitory or modulatory device) that would affect detrusor mechanics at different levels of the nervous system, resulting in different contractile capabilities.
Is Abnormal Electrosensitivity in the Lower Urinary Tract a Sign of Neuropathy?
Authors: WYNDAELE J.J.
Published: November 2008

Summary The threshold of sensitivity to electrical stimulation was determined in several parts of the lower urinary tract in 436 consecutive patients.

In the groups with different patterns of disturbed sensation a higher incidence of neuropathy was found than in the group with a normal sensation. Further neurological investigation revealed abnormal innervation in 29% of patients who lacked electrosensitivity in one or more parts of the lower urinary tract but who had shown no previous evidence of neuropathy.
Comparison of Reagent Strip (Dipstick) and Microscopic Haematuria in Urological Out‐patients
Authors: GLEESON M. J. , CONNOLLY J. , GRAINGER R. , McDERMOTT T. E. D. , BUTLER M. R.
Published: November 2008

Summary Dipstick (reagent strip) and microscopic urine analysis for haematuria was performed prospectively on 1000 consecutive urine samples taken from urological out‐patients. Haematuria was present in 185 samples (18.5%) and absent in 687 (68.7%) using both tests; 98 samples (9.8%) had dipstick haematuria that was not confirmed by microscopy and 30 samples (3%) had microscopic haematuria that was missed on dipstick urine analysis. Dipstick urine analysis had a sensitivity of 86.1% and a specificity of 85%.

This study confirms that reagent strip testing for haematuria has both false positive and false negative results and indicates that cytoscopy should be considered in all patients with suspected haematuria.
Late Erosion. A New Complication of Artificial Urinary Sphincters
Authors: DUNCAN H. J. , MclNERNEY P. D. , MUNDY A. R.
Published: November 2008

Summary A hitherto unreported long‐term complication of artificial sphincter implantation– delayed erosion–is described.
Plasma Sialic Acid in Patients with Prostate Cancer
Authors: HÖBARTH K. , HOFBAUER J. , FANG‐KIRCHER S.
Published: November 2008

Summary Serum sialic acid (N‐acetylneuraminic acid) was evaluated as a tumour marker for prostate cancer and compared with serum prostate specific antigen (PSA). The records of 35 patients suffering from prostate cancer (9 with bone metastases) were analysed and compared with those of 21 healthy individuals. Total serum sialic acid was significantly elevated among the cancer patients. Levels in patients with distant metastases were significantly higher than in those with locally restricted disease and normal individuals, whereas no such difference was seen between the latter 2 groups. A direct association between serum sialic acid and tumour T category and grade could not be established. The difference between the cancer and the control groups was reflected more significantly by PSA. As sialic acid lacks tumour specificity, it is not helpful in screening for prostate cancer, yet might contribute towards the early detection of tumour progression and metastases during both therapy and follow‐up.
Histological and Histochemical Study of the Vesicoureteric Junction in Infancy and Childhood
Authors: GEARHART J. P. , CANNING D. A. , GILPIN SALLY A. , LAM E. E. , GOSLING J. A.
Published: November 2008

Summary The morphology of the vesicoureteric junction was compared using 19 post mortem specimens obtained from male and female Afro‐American and Caucasian children with an age range of 1 to 72 months (mean 4). All specimens were serially sectioned and the tissues processed using standard histological and histochemical techniques (acetylcholinesterase (AChE) and pseudocholinesterase (PChE)).

The results failed to reveal any differences in the structure of the vesicoureteric junction with respect to age, sex and ethnic origins. The vesicoureteric junction comprised 3 histologically and histochemically distinct smooth muscle components. Ureteric muscle formed a complete inner layer rich in PChE which continued beyond the ureteric orifices to merge distally with the superficial trigone. An intermediate layer of muscle was also demonstrated whose constituent muscle cells possessed specific histological features and which was rich in both AChE and PChE, which is distinct from that derived from the ureter and detrusor. The presence of detrusor muscle on the outer aspect of the juxtavesical segment of ureter rich in AChE was also confirmed.

While this study, using histochemical studies in infants and children, did not reveal any differences in the structure of the vesicoureteric junction with respect to age, sex or ethnic origin, an intermediate layer of muscle was identified with histochemical characteristics more like that of the male genital tract than that derived from the ureter or detrusor muscle.
Long‐term Stone Regrowth and Recurrence Rates after Extracorporeal Shock Wave Lithotripsy
Authors: YU C. C. , LEE Y. H. , HUANG J. K. , CHEN M. T. , CHEN K. K. , LIN A. T. L. , CHANG L. S.
Published: November 2008

Summary We reviewed 1055 patients with symptomatic urinary calculi treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy to determine the long‐term stone regrowth and recurrence rates as correlated with the pre‐treatment stone burden, site and multiplicity. Long‐term follow‐up (mean 75.8 months) was available in 94 patients, representing 106 renal units. The recurrence of stone was defined as reappearance of stone on follow‐up plain abdominal radiographs. The regrowth of stone was defined as stone regrowing larger than one‐third of the original residual size. A stone‐free rate of 53% was achieved. The overall stone regrowth and recurrence rates were 26 and 15% respectively. It was concluded that the stone recurrence rate after ESWL was not influenced significantly by the stone size or the multiplicity, but that the regrowth rate was. Stone recurrence and regrowth rates after ESWL were both influenced by the stone location.
Recovery of Ureteric Motility Following Complete and Partial Ureteric Obstruction
Authors: LENNON G. M. , RYAN P. C. , FITZPATRICK J. M.
Published: November 2008

Summary Complete and partial ureteric obstruction was created in 2 groups of 10 mongrel dogs by placing a ligature around, or inserting a fine bore plastic stent into, the lower end of the left ureter (Groups 1 and 2). After 4 weeks the ligature or stent was removed, a 2.5‐cm segment of ureter was harvested for in vitro analysis and the ureter reimplanted into the bladder. Pelvic and ureteric pressures and motility were recorded before, during and after the period of obstruction via a subcutaneously placed nephrostomy tube. Pre‐obstruction resting intra‐ureteric pressure was 2.1 ± 0.3 mm Hg (mean ± SEM), with regular contractions 8.9 ± 0.7/min of 36.2 ± 1.2 mm Hg amplitude. After 4 weeks of obstruction, contractility was abolished in Group 1 but increased in Group 2, 71.5 ±3.3 mm Hg, with irregular multiphasic contractions seen following diuresis. Intra‐ureteric pressure was 16.3 +1.2 mm Hg in Group 1 and 9.3 +1.2 mm Hg in Group 2. In vitro experiments confirmed the patterns of contractility seen in vivo. Eight weeks after reimplantation the ureter returned to normal rhythm and rate in Group 1, but increased contractility persisted both in vivo and in vitro in Group 2.
Quantification of Bladder Outlet Obstruction by Measurement of Urethral Opening Pressure Using an Adapted Fluid Bridge Test
Authors: PALMER M. A. , DESMOND A. D.
Published: November 2008

Summary A new technique for measuring urethral opening pressure above the distal sphincter is described, based on the fluid bridge test. This test eliminates many of the inaccuracies produced when using standard pressure flow studies. Nineteen males were studied, 15 of whom had cystometric evidence of bladder outlet obstruction, the other 4 being unobstructed. The mean urethral opening pressure in the obstructed group was 69 cm H2O (range 44–124) and in the unobstructed group 19cm H2O (range 16–22). The test is simple to perform and is not affected by muscular activity in the pelvic floor or the time lag between detrusor pressure and flow rate measurement.
The Contribution of Magnetic Resonance Imaging of the Pelvic Floor to the Understanding of Urinary Incontinence
Authors: KIRSCHNER‐HERMANNS R. , WEIN B. , NIEHAUS S. , SCHAEFER W. , JAKSE G.
Published: November 2008

Summary The anatomy of urinary incontinence and the underlying pathology is still under discussion.

We examined 24 stress incontinent patients and 6 healthy volunteers. Magnetic resonance imaging (MRI) clearly shows that the urethra is not connected to the levator ani. The urethra is not fixed to deep perineal muscle layers. In stress incontinence the sharp angulation of the levator ani of healthy volunteers is lost in 65%. MRI shows degeneration of the levator ani muscle in 45% of stress incontinent patients. The extent of damage to the levator can clearly be identified with the aid of MRI.
Intravesical Oxybutynin Chloride and Clean Intermittent Catheterisation in Patients with Neurogenic Vesical Dysfunction and Decreased Bladder Capacity
Authors: PRASAD K. V. R. , VAIDYANATHAN S.
Published: November 2008

Summary Oral administration of oxybutynin chloride is effective in increasing bladder capacity in patients with neurogenic bladder dysfunction who are practising clean intermittent catheterisation, but it is often associated with systemic side effects. The effect of intravesical instillation of oxybutynin chloride was studied in 14 patients who were practising clean intermittent catheterisation and in whom the maximum cystometric capacity was < 250 ml and/or vesical compliance <5. A 5‐mg tablet of oxybutynin chloride was crushed and suspended in 10 ml of boiled and cooled water and instilled into the bladder after emptying it completely; this was carried out thrice daily either by the patient or by his carer. During follow‐up (6–12 months) no local or systemic side effects were observed and patient compliance was excellent in 12 patients, who snowed an increase in maximum cystometric capacity and vesical compliance. One patient could not retain the drug intravesically because of reflex detrusor contraction and he was excluded from the study. One patient was lost to follow‐up.

The results suggest that the intravesical instillation of oxybutynin chloride is safe and effective in the treatment of selected patients with neurogenic bladder dysfunction whose bladder capacity is small and who are practising clean intermittent catheterisation.
Growth Fractions in Bladder Cancer Defined by Ki67: Association with Cancer Grade, Category and Recurrence Rate of Superficial Lesions
Authors: STAVROPOULOS N. E. , IOACKIM‐VELOGIANNI E. , HASTAZERIS K. , KITSIOU E. , STEFANAKI S. , AGNANTIS N.
Published: November 2008

Summary Predicting future tumour behaviour has always been a major task when treating bladder cancer. Ki67 monoclonal antibody has been reported to be a good marker of proliferative activity in a variety of tumours. We have studied the association of growth fractions defined by the monoclonal antibody with tumour grade, category and recurrence rate of superficial lesions in 34 patients with bladder cancer and 15 normal controls.

Mean Ki67 indexes (% stained cells) were 0.07 ± 0.02% in normal urothelium, 1.27 ± 1.55% in grade 1, 12.23 ± 8.32% in grade 2 and 16.42 ± 11.82% in grade 3 tumours, while the values were 5.45±5.87%, 12.66±9.81%and 17.18± 12.41%in categoriespTa, pT1 andT2‐T3 respectively. Recurrence and non‐recurrence groups of patients showed indexes of 13.29 ± 9.49% and 4.15 ± 5.0% respectively. Statistically significant differences in Ki67 values between normal urothelium and tumour, between tumours of different grades and categories as well as between recurrence and non‐recurrence groups of patients led to the conclusion that Ki67 monoclonal antibody is a good tool in defining tumour behaviour in bladder cancer.
Prostatic Surgery for Benign Prostatic Hyperplasia: Meeting the Expanding Demand
Authors: DUNCAN B. M. , GARRAWAY W. M.
Published: November 2008

Summary We describe changes in the pattern of surgery for benign prostatic hyperplasia (BPH) in Scotland between 1971 and 1989. The data are based on an analysis of routinely collected Scottish hospital in‐patient statistics for primary prostatic operations on men with a diagnosis of BPH (ICD Code 600.0).

Primary operation age‐adjusted rates for BPH increased from 8.9 to 15.8 per 10, 000 male population from 1971 to 1989. This was accompanied by a reduction in bed day use for BPH surgery from 49, 500 bed days in 1971 to 36, 000 in 1989. Case fatality for all surgery for BPH also fell steadily and can no longer be regarded as a relevant measure of prostatectomy outcome. Virtually all surgical intervention is now transurethral resection (TUR), forming 94% of surgery for BPH in 1989 compared with only 32% in 1971. The increase in surgical procedures carried out for BPH has been greater in younger age groups.

If the pattern of increasing surgical intervention in the management of BPH over the past few years continues and there is an increased demand for treatment, and if the reported demographic changes occur, there will be a need for an additional 9 new consultant urologists in Scotland by 2001. Even if present operation rates hold steady, population changes alone will produce enough work for 2 more urologists.
Complications of Ultrasound‐guided Transperineal Prostate Biopsy A Prospective Study
Authors: WEBB JUDITH A. W. , SHANMUGANATHAN K. , McLEAN ALISON
Published: November 2008

Summary A prospective study of the complications of transperineal prostate biopsy was undertaken in 171 patients; 150 (88%) returned a questionnaire 1 week after biopsy. The incidence of serious complications was low, with 1 patient requiring admission for presumed septicaemia and another developing acute retention of urine. Many patients had minor complications, with 42% having haematuria, 13% haemospermia and 31% pain. Only 18% needed analgesia following biopsy. Since transperineal prostate biopsy has such a low incidence of infective complications, we suggest that it should be considered in frail or elderly patients in whom septicaemia may be especially hazardous.