bluuebunny/crossref_metadata_2025 huggingface dataset:
Necrotising Soft Tissue Infections of the Perineum and Genitalia: Bacteriology, Treatment and Risk Assessment
Authors: BASKIN L. S. , CARROLL P. R. , CATTOLICA E. V. , McANINCH J. W.
Published: November 2008

Summary— Necrotising soft tissue infections of the perineum and genitalia are associated with a high rate of mortality and morbidity. We reviewed the records of 29 consecutive patients to investigate the possible correlation between clinical outcome and number of types of bacteria cultured, focus of infection, presence of diabetes, patient age, renal function and delay until presentation. The patients had an average of 3.9 bacterial organisms cultured intra‐operatively (range 1–9). Patients with a rectal focus of infection had a greater number of bacteria and required longer hospitalisation and more operative procedures than patients with dermal or urethral foci. Those over the age of 60 had significantly longer hospital stays and higher mortality. Diabetes and impaired renal function did not increase mortality or morbidity. Suprapubic cystostomy was required in 24 patients (83%), diverting colostomy in 9 (31%) and orchiectomy in 3 (10%). Six patients (21%) died despite broad spectrum antibiotics and aggressive and frequent surgical debridement.
Out‐patient Sclerotherapy of Idiopathic Left‐sided Varicocele in Children and Adults
Authors: BRAEDEL H. U. , STEFFENS J. , ZIEGLER M. , POLSKY M. S.
Published: November 2008

Summary— Between 1983 and 1989, 334 patients with idiopathic left‐sided varicocele were referred for transfemoral sclerotherapy; 323 were adults and 11 were children.

The standard site of injection of the sclerosing solution (Varicocid‐Natriummorrhuat 55 mg, Benzylalkohol 20 mg) was the mid‐portion of the spermatic vein. The upper third was injected only in cases where the catheter could not be negotiated further (e.g. abnormalities in the course of the spermatic vein or its drainage into the intrarenal veins). The amount of sclerosing material was predetermined fluoroscopically using contrast material. Occasionally, in cases of high catheter positioning, the Varicocid was injected fractionally. The amount injected was always between 1 and 3 ml. Of 80 patients studied 1 year later, varicoceles were still present in 3 (4%).

The best results were achieved in patients with small varicoceles (Grade 1), normal testicular volume and normal FSH levels; 29% showed an improvement in sperm count and 27% an increase in sperm motility, while sperm morphology improved in only 7%. The conception rate was 11%.
Midnight Removal: an Improved Approach to Removal of Catheters
Authors: NOBLE J. G. , MENZIES D. , COX P. J. , EDWARDS L.
Published: November 2008

Summary— There is no recognised policy regarding the timing of urethral catheter removal, although early morning removal is commonly practised. Removing the catheter at midnight allows patients to return to a normal voiding pattern more rapidly and to leave hospital earlier.
Microsurgical Vaso‐epididymostomy in 2 Layers
Authors: GARIBYAN H. , DE JONG E. A. J. M.
Published: November 2008

Summary— Eleven patients with epididymal obstruction were treated with microsurgical techniques. A 2‐layer, end‐to‐side anastomosis between the vas deferens and a single loop of the epididymal duct was created. At follow‐up, 9 patients had spermatozoa in their ejaculate and 3 of them achieved pregnancies with their partners. The technique described not only yields better results through the application of microsurgery but also gives a better understanding of epididymal function and pre‐and pet‐operative diagnosic proceedings.
Lithotripsy for Calculi in Caliceal Diverticula?
Authors: RITCHIE A. W. S. , PARR N. J. , MOUSSA S. A. , TOLLEY D. A.
Published: November 2008

Summary— There is continuing debate about the optimum management of patients with calculi in caliceal diverticula. Extracorporeal piezoelectric lithotripsy (EPL) has the advantage of being noninvasive, whereas endourological management can treat the underlying anatomical problem. A total of 20 patients with calculi in caliceal diverticula were treated with EPL. Twelve of 16 patients with symptoms (75%) were rendered symptom‐free but only 5 (25%) became stone‐free.

This information should be of value in counselling patients before selecting the appropriate treatment.
Visual Analogue Scales Distinguish between Low Urinary Flow Rates due to Impaired Detrusor Contractility and those due to Bladder Outflow Obstruction
Authors: McLOUGHLIN J. , ABEL P. D. , SHAIKH N. , WATERS J. , WILLIAMS GORDON
Published: November 2008

Summary— In patients with symptoms suggestive of bladder outflow obstruction and a free flow rate < 12 ml/s a visual analogue scale was used to measure the response to the question “Compared to 5 years ago, how thick is your stream when you pass urine?”. The visual analogue scale compared favourably with cystometry in distinguishing between low flow rates resulting from impaired detrusor contractility and low flow rates due to bladder outflow obstruction. A visual analogue scale may serve to alert the surgeon to the presence of impaired detrusor contractility and the need for a fuller urodynamic assessment in patients with a low urinary flow rate prior to consideration for prostatectomy.
Clinical Significance of the Antibody‐coated Bacteria Test in Patients with Candiduria
Authors: OHKAWA M. , TOKUNAGA S. , SHODA R. , HISAZUMI H.
Published: November 2008

Summary— The clinical significance of the antibody‐coated bacteria (ACB) test was evaluated with urine from 20 patients with candiduria. The relationship between the in vitro antibody‐coating test for Candida albicans, urinary immunoglobulin (Ig) levels and serum antibody titres was evaluated in 40 patients without candiduria, 23 of whom had bacterial urinary tract infection (UTI). Urine specimens from 19 of the 20 patients with candiduria gave a positive result regardless of clinical symptoms; 12/23 specimens of urine from patients with bacterial UTI were positive for antibody‐coated C. albicans cells, but there were no positive samples in the patients without UTI. All of the coating‐positive patients had serum antibody titres ≤ 1:160, the class of antibody being dependent on the urinary Ig levels.

The ACB test for candiduria is of little clinical value in indicating invasive Candida UTI as the Candida cells appear to adhere to antibodies in urine contaminated with circulating fluids.
Pathogenesis of Chronic Bacterial Prostatitis in an Animal Model
Authors: NICKEL J. C. , OLSON M. E. , BARABAS A. , BENEDIKTSSON H. , DASGUPTA M. K. , COSTERTON J.W.
Published: November 2008

Summary— A reproducible rat model of chronic bacterial prostatitis was developed using a defined bacterial pathogen (Escherichia coli) to study the pathogenesis and persistence of chronic bacterial prostatitis. The progression of inflammation and its consequences from acute to chronic prostatitis were documented with microbiological, histological, ultrastructural and immunological data. Chronic bacterial prostatitis in this model was associated with sparse glycocalix‐enclosed protected bacterial microcolonies within the prostatic acini and ducts which appeared to stimulate a persistent local and systemic immunological reaction resulting in chronic inflammation of the gland. This model has many striking similarities to the natural history of human chronic bacterial prostatitis.
Controlled Study of Cimetidine in the Treatment of Benign Prostatic Hypertrophy
Authors: LINDNER A. , RAMON J. , BROOKS M. E.
Published: November 2008

Summary— A series of 60 patients with benign prostatic hypertrophy (BPH) was randomly divided into 2 groups; 30 received cimetidine 1 g/day for 4 weeks and 30 received vitamin C 1 g/day for the same period. The study was double‐blind. No significant difference between the 2 groups was observed in mean urinary flow, subjective obstructive or irritative symptoms, or prostate size. There was a statistically significant difference in the peak urinary flow rate but this was a result of net deterioration in the control group. Cimetidine was found to be no more active than vitamin C in treating benign prostatic hypertrophy.
Fluid and Electrolyte Dynamics during Development of the TURP Syndrome
Authors: HAHN R.G.
Published: November 2008

Summary— Signs and symptoms, circulatory changes and the diffusion of fluid and electrolytes were examined over 10‐min periods in the course of 12 transurethral resections of the prostate (TURP) during which more than 1 litre of glycine solution was absorbed. Signs of the TURP syndrome were seen in 10 patients. During the first 20 min of absorption there was hypervolaemia, a marked diffusion of electrolytes from the interstitial space to the plasma, and elevation of central venous pressure. Patients who developed hypertension (in = 6) and chest pains (n = 3) had a smaller blood loss than those who did not. After 20 min of irrigant absorption there was an increased flow of fluid from the plasma to the interstitial space coupled with only a small diffusion of sodium. This promoted hypovolaemia and hypotension.
What on Earth are we Drinking?
Authors: MAYNE P. D. , EDWARDS L.
Published: November 2008

Summary During the past few years there has been a considerable increase in the number and variety of still and carbonated bottled drinking waters, which have an enormous variation in calcium content ranging from 0 to over 500 mg/l.

Patients with upper urinary tract stones are often advised to maintain a high fluid intake in order to achieve an increased urinary output. If they find tap water unpalatable and drink bottled water instead, they could significantly increase their daily calcium intake by as much as 1.5 g. The majority of bottled waters presently available in this country, together with tap water samples from throughout the British Isles, have been analysed and the results suggest that there are some waters which stone formers should avoid.
Asonic Imaging for Extracorporeal Shockwave Lithotripsy: Analysis of Factors in Successful Treatment
Authors: KIELY E. A. , MADIGAN D. , RYAN P. C. , BUTLER M. R.
Published: November 2008

Summary The emergence of real‐time ultrasonic imaging for extracorporeal Shockwave lithotripsy poses questions regarding the factors and techniques which facilitate stone imaging for clinicians with no previous practical experience in ultrasonography. The ability of these clinicans to assess when stone disintegration has been achieved also needs to be confirmed. A wide range of data was recorded from each of 2688 lithotripsy treatments performed over a 2‐year period using the EDAP LT.01 ultrasound‐imaged piezoelectric lithotriptor. An analysis of these data was performed using a comprehensive microcomputer‐based statistics package.

The mean time taken for stone imaging and positioning was reduced from 11.2 to 7.5 min over the 2‐year period. Obese patients and those with renal pelvic stones were best imaged in a lateral position. Overall there was no difference in percentage stone disintegration or clearance between treatments in the supine or lateral positions, but a significant reduction in the clearance of small caliceal stones resulted when the lateral position was used.

Factors associated with a significantly greater percentage of stone disintegration and clearance included pain experienced by the patient during fine adjustment of the processing head during treatment, acoustic focus attenuation and widening and acoustic shadow widening as detected by the urologist at the end of treatment.

Among the factors not associated with significant alterations in the percentage of stone disintegration or clearance were the lithotriptor operator, the side or site of the calculus, obesity and Shockwave frequency or power.

This study confirmed the ability of urologists to develop expertise in ultrasonography for renal stone imaging and to interpret successfully the subtle signs of stone disintegration.
Trans‐trigonal Phenol Failed the Test of Time
Authors: ROSENBAUM T. P. , SHAW P. J. R. , WORTH P. H. L.
Published: November 2008

Summary The results following 94 trans‐trigonal phenol injections in 60 patients over a 5‐year period are analysed. In only 1 patient was there a lasting effect. The others all required alternative treatment for bladder instability, hyper‐reflexia or hypersensitivity. Older patients with normal bladder compliance and patients with a neuropathic aetiology had slightly better results but also failed to derive lasting benefit. The complications associated with the treatment and the general anaesthetic outweigh the transient benefits of this technique.
Is the Penile Brachial Index a Reproducible and Useful Measurement?
Authors: AITCHISON M. , AITCHISON J. , CARTER R.
Published: November 2008

Summary –The intra‐ and inter‐observer variation in the measurement of the penile brachial index (PBI) was prospectively assessed in 30 patients. An appreciable error was discovered that cast doubt on the reliability of the measurements. Up to 20% of patients deemed normal by one observer would be deemed abnormal by a second. The PBI appears to be an inaccurate and poorly reproducible test of penile blood flow which can lead to a false diagnosis and subsequent management of impotent patients. There would appear no justification for the continued use of the penile brachial index in the assessment of erectile dysfunction.
Use of the Double Pigtail Stent in Stone Retrieval following Unsuccessful Ureteroscopy
Authors: JONES B. J. , RYAN P. C. , LYONS O. , GRAINGER R. , McDERMOTT T. E. D. , BUTLER M. R.
Published: November 2008

Summary— Insertion of a double pigtail stent is known to cause ureteric dilatation. We analysed the effect of an indwelling double pigtail stent on the success rate of calculus extraction by second ureteroscopy when vhe initial ureteroscopy fails. Over a 12‐month period, a first ureteroscopy failed in 42 patients; 30 were then treated by ureteroscopy combined with a ureteric stent and 12 were treated without a ureteric stent. The group with an indwelling stent had a successful second ureteroscopy or spontaneously passed the calculus in 24 cases (84%) compared with 5 unstented cases (45%). Ureterolithotomy wf>s necessary in 2 patients with a stent and 3 with no stent. It was concluded that following failed ureteroscopic manipulation of calculi, insertion of a double pigtail stent was associated with a higher subsequent success rate for removal of stone by ureteroscopy and a consequent lower rate of ureterolithotomy.
Cobb's Collar–a Forgotten Entity
Authors: CRANSTON D. , DAVIES A. H. , SMITH J. C.
Published: November 2008

Summary— Cobb's collar or Moormann's ring is a stricture of the bulbar urethra which is largely unrecognised but has considerable relevance urologically as the site of congenital or post‐instrumental strictures. The history, anatomy, embryology and surgical importance are reported.

Based on a Poster Demonstration at the 45th Annual Meeting of the British Association of Urological Surgeons inStHelier, June!989
Chronic Dehydration Stone Disease
Authors: EMBON O. M. , ROSE G. A. , ROSENBAUM T.
Published: November 2008

Summary— A study was made of 819 patients attending a metabolic stone clinic. A firm diagnosis was made in 708 (86%) and in 132 of these (19%) the diagnosis was thought to be chronic dehydration. The records were available for study for 87 males and 11 females in the chronic dehydration group. The mean age at presentation was 43 years. The causes of chronic dehydration were hot climate (62%), with hot occupation and low water intake almost equal in second place. In patients with a single cause of chronic dehydration, 57% also had a dietary risk factor for urolithiasis and this was most commonly high oxalate intake.

Following dietary advice, the mean urinary volume increased from 1720 to 2475 ml/24 h. This was accompanied by a rise in mean urinary calcium from 6.02 to 6.96 mmol/24 h, presumably due to the calcium in the additional water drunk. Urinary oxalate did not change significantly. The mean follow‐up time was 4.85 years and the stone recurrence rate was low.

It was concluded that chronic dehydration is a common cause of urolithiasis; this can be treated satisfactorily by increasing water intake plus dietary advice in certain cases.
Ureteric Substitution with Boari Bladder Flap
Authors: MOTIWALA H. G. , SHAH S. A. , PATEL S. M.
Published: November 2008

Summary— Between 1986 and 1989,12 patients underwent ureteric substitution with a Boari bladder flap at this Institute. The indications were ureteric injury following hysterectomy, difficult forceps delivery, difficult ureterolithotomy, ureteric strictures caused by a Dormia basket and previous ureteric surgery, tuberculosis, retroperitoneal fibrosis and a post‐ureteric reimplantation fistula.

There were 2 patients with a solitary kidney and 2 in acute renal failure. Double J stenting was carried out in 11 patients and the stent was removed 3 to 6 weeks post‐operatively. Good results, with no morbidity or mortality, were achieved in all but 1 patient where a simple Silastic stent had migrated to the pelvis and required open surgery to remove it. We attribute our success to the tension‐free anastomosis, a wide based posterior flap with preservation of its vascular supply, the use of a double J stent and vicryl suture material.
In vitro Evaluation of the Pollen Extract Cernitin T‐60, in the Regulation of Prostate Cell Growth
Authors: HABIB F. K. , ROSS MARGARET , BUCK A. C. , EBELING L. , LEWENSTEIN A.
Published: November 2008

Summary— Nine human‐derived cancer and non‐cancer continuous cell lines were employed to evaluate the relative in vitro activity of the pollen extract, Cernitin T‐60. Responses of the cell lines to the drug were assessed by measuring growth and cell survival as determined by cell count. The results demonstrated that of the 9 continuous cell lines tested, only those derived from the human prostate were growth inhibited by the pollen extract, whereas the non‐prostate derived cells exhibited variable degrees of resistance to the T‐60. The selectivity of the drug for the prostate cell lines was even more pronounced in the hormone‐independent models, suggesting that there might be a place for the pollen extract in the control of abnormal growth in hormone‐insensitive cells.
Increased Survival of Patients with Massive Lymphadenopathy and Prostate Cancer: Evidence of Heterogeneous Tumour Behaviour
Authors: SANDHU D. P. S. , MAYOR P. E. , SAMBROOK P. , GEORGE N. J. R.
Published: November 2008

Summary— The survival of patients with prostate cancer and radiologically detectable lymph node enlargement has been studied prospectively over an 8‐year period. Computed tomography in 108 patients presenting with symptoms, signs or biochemical results suggesting lymphatic spread revealed pelvic or abdominal node masses in 60 patients; in 29 (48%), the masses measured more than 4 cm and the maximum node diameter was 15 cm. Two‐thirds of patients had advanced (T3/T4) tumour stage.

Following treatment, actuarial survival in all 60 patients with nodal enlargement was 40% at 5 years. Within this group, survival in 22 patients with lymphadenopathy but negative bone scans at diagnosis was significantly better than that of 38 patients with both node and bone disease (70% vs 20% at 5 years). This improvement was related both to an apparent inability of certain tumours initially to progress and seed within bone and to a marked sensitivity of the node masses to subsequent hormonal manipulation. Primary tumour grade was proportionally similar in both groups. Unexpectedly, 6 of the 38 patients with combined disease obtained a complete remission after treatment.

The reason for this heterogeneous biological behaviour remains unclear; but these observations underscore the importance of vigorous treatment in all patients with advanced lymph node disease.
Persistent Carcinoma in situ of the Testis after Chemotherapy for Advanced Testicular Germ Cell Tumours
Authors: BOTTOMLEY D. , FISHER C. , HENDRY W. F. , HORWICH A.
Published: November 2008

Summary— The chemosensitivity of testicular carcinoma in situ (CIS) was analysed in 25 testes excised 10 weeks to 4.5 years following platinum‐based chemotherapy. CIS was present in 8 of the 23 evaluable cases (35%), in 5 of which the lesion coexisted with invasive germ cell tumour. It is concluded that CIS may persist or recur after chemotherapy. This has implications for occult presentation of metastatic germ cell tumours and also for the management of the contralateral testis in patients with testicular germ cell tumours.
The Importance of Prognostic Factors in the Individual Treatment of Patients with Disseminated Germ Cell Tumours
Authors: MULDERS P. F. A. , OOSTERHOF G. O. N. , BOETES C. , DE MULDER P. H. M. , THEEUWES A. G. M. , DEBRUYNE F. M. J.
Published: November 2008

Summary— Following chemotherapy for disseminated testicular cancer, 55 patients underwent surgery because of residual tumour. The histological findings were viable tumour in 12 patients, mature teratoma in 12 and fibrosis and/or necrosis in 31. Retroperitoneal abdominal masses were evaluated radiographically before and after chemotherapy. The reduction in size of these masses after chemotherapy appeared to have prognostic significance. A decrease of more than 70% was always associated with fibrosis. A residual mass over 50 mm indicated viable tumour or mature teratoma. Seminoma or embryonal carcinoma was more likely to result in fibrosis/necrosis in the resected tissue. Both the Indiana and the EORTC classification models can be used for prognosis.

Radiographic measurements before and after chemotherapy are of considerable prognostic significance. These objective indicators help in planning treatment and so diminish the side effects of therapy and maintain or even increase the high cure rate in disseminated testicular cancer.
Dilatation in the Duplex Kidney: 3 Unusual Cases
Authors: PAGE JANET E. , DOW C. JEAN
Published: November 2008

Dilatation in the upper limb of a duplex ureter is usually secondary to obstruction and may be associated with a ureterocele. By contrast, vesicoureteric reflux is the usual cause of a dilated lower moiety ureter. We report 3 cases in which unusual or complex causes of dilatation of 1 limb of a duplex ureter were demonstrated.
Oxybutynin Hydrochloride (3 mg) in the Treatment of Women with Idiopathic Detrusor Instability
Authors: MOORE KATE H. , HAY D. M. , IMRIE A. E. , WATSON A. , GOLDSTEIN M.
Published: November 2008

Summary— Oxybutynin hydrochloride (3 mg) was compared with placebo by randomised, double‐blind crossover trial in 53 females with idiopathic detrusor instability. Symptoms were cured or markedly improved in 60% of patients on oxybutynin and 2.3% on placebo. During the first treatment period, oxybutynin reduced the frequency of voiding by 35%, compared with 9% for placebo. Oxybutynin gave a significantly greater improvement than placebo in volume at the first desire to void (70 ml increase versus 7.7 ml), maximum filling‐phase detrusor pressure (17 cm H2O reduction versus no benefit) and cystometric capacity (104 ml increase versus 7.0 ml). A marked oxybutynin carry‐over effect was seen during the second treatment period. Side effects from the 3 mg dose of oxybutynin caused 7.5% of subjects to discontinue therapy.
Foley Catheter Balloon Puncture and the Risk of Free Fragment Formation
Authors: CHRISP J. M. , NACEY J. N.
Published: November 2008

Summary— The incidence of free fragment formation following balloon puncture or spontaneous bursting was examined in 294 Foley catheters immersed for 48 h in urine. The catheters were divided into 3 groups: 100 were inflated to the manufacturer's recommended volume, 100 to twice the volume and 94 to 3 times the recommended volume. The catheter balloons were punctured by pricking with a hypodermic needle.

The overall incidence of free fragment formation was 27.3%. For both types of catheter examined, increasing balloon volume was not associated with an increased risk of free fragment formation following puncture. However, increasing volume was associated with increased free fragment formation when the balloon burst spontaneously.

In view of the high risk of free fragment formation, cystoscopy should be performed in all cases of spontaneous catheter balloon rupture or after percutaneous balloon puncture.
Antibiotic Compared with Antiseptic Prophylaxis for Prostatic Surgery
Authors: PRESCOTT S. , HADI. M. A. , ELTON R. A. , RITCHIE A. W. S. , FOUBISTER G. C. , GOULD J. C. , HARGREAVE T. B.
Published: November 2008

Summary— Two different regimens of cephalosporin antibiotic prophylaxis were compared with antiseptic lubricating jelly to try to prevent infection and complications in 196 men after prostatic surgery. Pre‐operative urine was cultured and prostatic chips (170 cases) were also cultured to define the source of any infection. The use of antibiotics was associated with a reduced risk of postoperative bacteriuria. No serious complications occurred, although 1 patient in the antiseptic treated group developed rigors; 79 of 170 patients (46%) had positive prostatic chip cultures, of whom 74 had sterile pre‐operative urine. There was no association between the result of chip culture and the presence of a pre‐operative catheter. Culture positive patients had an increased risk of postoperative urine infection, although the same organism was found in the prostate and urine in only 36% of cases of post‐operative bacteriuria and in 43 (54%) the organism cultured from the prostate was Staphylococcus albus. This study provides further evidence of the benefit of true prophylactic antibiotic therapy for transurethral prostatic surgery and the prostatic chip data suggest that some of the risk is due to pre‐operative contamination of the prostate in the absence of per‐operative urinary infection or catheterisation.
Vasa Aplasia and Cystic Fibrosis
Authors: HEATON N. D. , PRYOR J. P.
Published: November 2008

Summary— Bilateral vasa aplasia is considered an invariable finding in cystic fibrosis, but such patients are rarely seen in male infertility clinics. The improved survival beyond 20 years of age is likely to change this. In a clinical study of a group of male cystics the vasa were absent in 8 of 11 boys and epididymal abnormalities were palpable in the majority. The main cause of infertility appears to be mechanical obstruction. Whether the absence is due to a primary failure of mesonephric duct development or secondary to luminal obstruction and subsequent atrophy is not known.
The Effect of Post‐pubertal Varicocele on Testicular Volume
Authors: ERKAN I. , ÖZEN H. A. , ERGEN A. , REMZI F.
Published: November 2008

Summary— Paediatric varicocele is a well known entity but its effect on adult infertility has not been adequately clarified. Since measurement of testicular volume is currently the best method of estimating the male reproductive potential, 945 boys aged between 13 and 18 years were examined with regard to testicular volume and the incidence of varicocele.

The average volumes for right and left testes were 15.087 ±0.237 and 14.514 ± 0.347 ml respectively, and the incidence of varicocele was 16.7%. The incidence increased from 14.5 to 21.7% as the ages increased from 14 to 18.

The differences in volume of the 2 testes in boys with varicocele were statistically significant when compared with the normal group, but this significance failed to become more pronounced when the slight varicocele group (grade I) was included with the normal group and compared with the severe varicocele group (grades II and III).

There may be no significant differences between the volumes of the 2 testes in boys with varicocele when careful measurement and strict statistical analyses are applied.

However, some boys in the varicocele group were found to have testicular volumes below the confidence interval (mean ‐ SE) or under 1 SD, and the 2 testicular volumes differed in certain age groups. This group requires further follow‐up.

The results of this study have added further contradictory findings to the issue of paediatric varicocele in terms of testicular atrophy, estimation of potential fertility and the indications for immediate surgery. There is a need for further prospective controlled trials.
Adjuvant Topical Chemotherapy versus Immunotherapy in Primary Superficial Transitional Cell Carcinoma of the Bladder
Authors: FLAMM J. , BUCHER A.
Published: November 2008

Summary— In a prospective randomised controlled study, the efficacy of ethoglucid was compared with that of keyhole‐limpet haemocyanin (KLH) in preventing recurrent tumours following transurethral resection of primary superficial transitional cell carcinoma of the bladder. Patients treated with ethoglucid (n = 39) received 0.565 g (1% solution) ethoglucid weekly for 6 weeks and then monthly for 1 year. Patients treated with KLH (n = 38) were immunised subcutaneously with 1 mg KLH; bladder instillations of 30 mg were then given weekly for 6 weeks and thereafter monthly for 1 year.

The recurrence rates, disease‐free intervals and tumour progression rates were evaluated. The end‐point of the study was either progression in stage or grade or more than 1 recurrence during the observation period. The minimum length of follow‐up was 1 year. The recurrence rates, mean disease‐free intervals and progression rates in the 2 groups snowed no statistically significant differences.
Short‐term Radiotherapy as Palliative Treatment in Patients with Transitional Cell Bladder Cancer
Authors: WIJKSTRÖM H. , NÄSLUND I. , EKMAN P. , KÖHLER C. , NILSSON B. , NORMING U.
Published: November 2008

Summary— We report the results and complications of treatment with palliative, short‐term radiotherapy in 162 elderly or disabled patients. Improvement in tumour‐associated symptoms was noted in 75 of these patients and 72 survived for more than a year. Those who responded to radiotherapy had a 5‐year cancer‐free survival rate of 58% compared with 4% in patients who did not respond to treatment. Survival was also affected by stage and indications for radiotherapy. In 85 patients without severe symptoms, where the tumour was judged curable but the patient was unsuitable for a full course of radiotherapy, the 5‐year cancer‐free survival rate was 21%, which is in accordance with what can be achieved with full‐course radiotherapy; 42% had various minor acute side effects. The 5‐year late complication rate was 7%.
Vasal Injuries during Childhood and their Effect on Subsequent Fertility
Authors: PARKHOUSE HELEN , HENDRY W. F.
Published: November 2008

Summary— Thirty subfertile males had testicular obstruction following inguinal or pelvic surgery in childhood. All 13 patients with bilateral obstruction were azoospermic and 6 had developed antibodies to spermatozoa. Of 17 patients with unilateral obstruction, 11 had oligozoospermia and 6 had normal sperm counts: all had high titres of antibodies to spermatozoa (a significant difference from the men with bilateral obstruction). This indicates that male infertility can result from vasal or epididymal injuries in childhood due either to the obstruction itself or its immunological consequences.

Following corrective surgery and prednisolone treatment for the antibodies, where appropriate, 5/17 patients with unilateral blocks and 1/11 with bilateral blocks successfully produced pregnancies.
Outcome of Antenatally Diagnosed Periureteric Junction Hydronephrosis
Authors: NAJMALDIN A. S. , BURGE D. M. , ATWELL J. D.
Published: November 2008

Summary— Over a 6‐year period, in a series of 107 consecutive patients with antenatally detected urological anomalies, 45 had periureteric junction (PUJ) hydronephrosis (66 units). Of these, 24 units (36%) had obstructive (group I) and 42 (64%) non‐obstructive hydronephrosis (group II). Significantly compromised renal function was found only in group I. Treatment in group I was by an early pyeloplasty; in group II the patients were kept under close review. During the 6‐year period, 2 units (5%) in group II, deteriorated, 13 (31%) improved and 27 (64%) were unchanged.

These results suggest that early in life, antenatally diagnosed PUJ hydronephrosis without obstruction may be a relatively benign condition but will require long‐term follow‐up in order to determine the natural history of the condition.
Prognostic Factors in the Conservative Treatment of Ureteric Stones
Authors: IBRAHIM A. I. A. , SHETTY S. D. , AWAD R. M. , PATEL K. P.
Published: November 2008

Summary— A prospective study was made of 125 ureteric stones in order to detect factors which would predict the successful outcome of conservative treatment. The factors studied were the duration of pain prior to presentation, pyuria, haematuria, surface regularity of the stone and the degree of obstruction as seen radiologically.

In stones ≤ 10 mm in size, conservative treatment was successful when the duration of pain was < 30 days (39/45), when there was no significant pyuria (53/82), when the stones had an irregular surface (44/65) and when obstruction was only partial (55/88). Since most of these factors were interactive, further statistical analysis showed that duration of pain was the only significant factor in predicting the outcome of conservative treatment.

In stones >10 mm in size these factors had no predictive value and only 2/23 were passed spontaneously on conservative treatment.
Interpretation of Biopsies of “Normal” Urothelium in Patients with Superficial Bladder Cancer
Authors: RICHARDS B. , PARMAR M. K. B. , ANDERSON C. K. , ANSELL I. D. , GRIGOR K. , HALL R. R. , MORLEY A. R. , MOSTOFI F. K. , RISDON R. A. , USCINSKA B. M.
Published: November 2008

Summary— In the course of a Medical Research Council trial of intravesical chemotherapy, biopsies were taken from apparently normal bladder urothelium near to newly diagnosed superficial bladder cancers in 417 patients. Differences were noted in the rates at which histological features were described in different centres. To gain more information about the reproducibility of the pathological findings, a group of 6 pathologists (5 from the UK and 1 from the USA), all having a special interest in urological pathology, were asked to examine a representative sample of 92 slides. They were then asked to re‐examine 30 of them after an interval of at least 6 months. At first examination and at reexamination the slides were assessed using a standard proforma. However, the definitions of the categories were left unspecified for the pathologists to use their own criteria. The 5 UK pathologists then met to establish a consensus view of each slide.

The results indicated that: (1) The reporting of non‐dysplastic changes varied so much between pathologists as to render it of little value to clinical practice. (2) There were wide variations between different pathologists in the reported incidence of dysplastic change. (3) On a second review the pathologists reproduced their own assessment on only 62% of occasions. (4) Even after discussion between pathologists there was no consensus on the diagnosis of mild as opposed to moderate dysplasia. Consensus was reached on all biopsies which showed either severe dysplasia or carcinoma in situ. (5) In adopting a policy of taking urothelial biopsies, urologists should be aware of the imprecision and lack of reproducibility in the interpretation of such biopsies. (6) Biopsies of cystoscopically normal urothelium may not be a useful guide in defining therapy.
Optical Urethrotomy under Local Urethral Anaesthesia
Authors: GREENLAND J. E. , LYNCH T. H. , WALLACE D. M. A.
Published: November 2008

Summary— A series of 46 patients underwent 76 optical urethrotomies under local urethral anaesthesia in the out‐patient clinic; in 70% of patients the strictures were controlled by local anaesthetic urethrotomy alone; 61% felt either no pain or mild pain during the procedure; 72% expressed a preference for local anaesthesia should the procedure have to be repeated and 82% were happy with the result of their treatment.

Optical urethrotomy under local urethral anaesthesia produces results comparable to those reported by others using general anaesthesia. If large numbers of patients are to be treated, possibly repeatedly, then out‐patient urethrotomy may result in more efficient use of resources.
Assessment of Tumour‐infiltrating Lymphocytes, Regional Lymph Node Lymphocytes and Peripheral Blood Lymphocytes and their Reaction to Interferon‐gamma in Patients with Renal Carcinoma
Authors: ONISHI T. , MACHIDA T. , MASUDA F. , HATANO T. , SHIRAKAWA H. , NATORI T. , HAMAMOTO M. , MATSUOKA Y.
Published: November 2008

Summary— The immunological distribution of tumour‐infiltrating lymphocytes (TIL), regional lymph node lymphocytes (RLNL) and peripheral blood lymphocytes (PBL) was evaluated by means of immunohistochemical staining using monoclonal antibodies of each subset of lymphocytes (stored in frozen sections) in a series of 22 patients with renal carcinoma. The immunological effect of IFN (interferon)‐gamma on these immunocompetent cells was also investigated. The effect of IFN‐gamma on TIL was an increase in CD3 (pan‐T cells), especially an increase in CD8 (cytotoxic/ suppressor‐T cells). When examining these cells according to stage and grade, a marked increase in CD3 was found in low stage and low grade patients. With regard to RLNL, there was a tendency towards a decrease in CD3 and an increase in CD20 (B‐cells) following the administration of IFN‐gamma. No specific effect on stage and grade was observed apart from a reduction in T cell subset ratios in high grade patients. With regard to PBL, no specific trend was noted except for an increase in CD 16 (NK cells) when IFN‐gamma was administered.
Abnormalities of Colonic Mucin Secretion and Metabolic Changes after Internal Urinary Diversion for Bladder Exstrophy
Authors: MARCHEGGIANO ADRIANA , IANNONI C. , LATELLA G. , FRIERI G. , DIOSI D. , DE DOMINICIS C. , LAURENTI C. , CAPRILLI R.
Published: November 2008

Summary— Ten patients with different types of internal urinary diversion for bladder exstrophy were studied prospectively in order to assess metabolic abnormalities and morphological, histochemical and lectin binding changes in the colorectal mucosa. The histochemical and/or lectin binding changes which were found in the majority of patients were identical to those observed in pre‐malignant and malignant conditions of the colon. In some cases they were detectable 3 years after the initial examination but were completely absent from the colorectal mucosa of normal subjects. Metabolic disturbances (metabolic acidosis, increased anion gap, hyperchloraemia) were observed in a substantial number of asymptomatic patients. These findings stress the need for regular endoscopic, histological and metabolic follow‐up in these patients and for life‐long treatment with bicarbonate or citrate.
Flexible Cystoscopy Compared with Ultrasound in the Detection of Recurrent Bladder Tumours
Authors: DAVIES A. H. , MASTORAKOU IRENE , DICKINSON A. J. , CRANSTON D. , O'KELLY T. J. , TURNER W. H. , FELLOWS G. J.
Published: November 2008

Summary— A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out‐patient department 1 week before flexible cystoscopy. Combination ultrasound identified 25 patients with recurrent tumours and flexible cystoscopy identified 26.

Thirty‐four patients (68%) preferred ultrasound, 10 (20%) preferred flexible cystoscopy, 3 (6%) preferred general anaesthesia and rigid cystoscopy and 3 (6%) had no preference. The main objection to ultrasound was the use of the transrectal probe.
Fractures of the Penis: Therapeutic Approach and Long‐term Results
Authors: ANSELMO G. , FANDELLA A. , FAGGIANO L. , MERLO F. , MACCATROZZO L.
Published: November 2008

Summary— Injury to the external male genitalia is considered, with attention focused on accidental fracture of the corpora cavernosa (by coitus or masturbation). Such injuries are often complicated by urethral lesions. We present 13 patients with either simple or complicated fracture of the penis, all of whom were operated on between 2 h and 8 days following injury, with excellent functional results. The need for immediate surgery is emphasised, in order to avoid erectile failure and curvature, which are typical complications of conservative treatment. Surgery consists of complete evacuation of haematoma, curettage and repair of the albuginea. If the fracture is associated with urethral disruption, the latter is also repaired.
Catheter‐less Suprapubic Cystolithotomy in Children
Authors: SABNIS R. B. , DESAI R. M. , PAUL D. P. , BAPAT S. D.
Published: November 2008

Summary— Bladder stones in children are common in developing countries and the procedure of choice for their removal is suprapubic cystolithotomy. It is standard practice to drain the bladder for a few days post‐operatively to prevent urinary leakage. We have observed that, if the bladder is closed meticulously in 2 layers, bladder drainage by means of a catheter is not required. We have analysed 86 children treated by suprapubic cystolithotomy without a catheter. Size of the stones and intra‐operative findings were noted and it was found that 85% of the patients had an excellent result; 10% had a satisfactory result and 4.7% were unsatisfactory. The advantages of the procedure and selection of the patients are discussed.
Value of the Patient's Case History in Diagnosing Urinary Incontinence in General Practice
Authors: LAGRO‐JANSSEN A. L. M. , DEBRUYNE F. M. J. , Van WEEL C.
Published: November 2008

Summary— What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history‐taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence.

Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis.

It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.
Assessment of the Long‐term Results of Subtrigonal Phenolisation
Authors: McINERNEY P. D. , VANNER T. F. , MATENHELIA S. , STEPHENSON T. P.
Published: November 2008

Summary— Long‐term follow‐up was conducted on 97 patients who had undergone subtrigonal phenolisation for detrusor instability, bladder hypersensitivity, detrusor hyper‐reflexia or interstitial cystitis. The procedure failed to alleviate lower urinary tract dysfunction in 57% of patients; it had an unsustained benefit in 24% and long‐term success was experienced by only 19%. It was most effective in the hypersensitive bladder of unknown cause. The incidence of complications (17%) suggests that the procedure should only be undertaken if more invasive measures are the only available alternative, and the possibility of these complications should be explained to the patient.
Bladder Substitution with Ileocaecal (Mainz) Pouch Clinical Performance over 2 Years
Authors: NARAYAN P. , BRODERICK G. A. , TANAGHO E. A.
Published: November 2008

Summary— A series of 11 patients underwent ileocaecal bladder substitution (Mainz pouch) with urethral anastomosis after radical cystectomy and pelvic lymphadenectomy for moderate to high grade transitional cell carcinoma of the bladder.

With 12 to 27 months of follow‐up (mean 18), 6 patients are voiding and are dry day and night with timed voidings; 4 patients continue intermittent catheterisation because of inability to perform the Valsalva manoeuvre adequately, and 1 has a suprapubic tube because of stricture of the enterourethral anastomosis.

Upper tract studies revealed dilatation of 4 of 22 renal units and 1 patient required endourological intervention. Serum electrolyte studies revealed slightly elevated chloride levels in 6, mild hypocarbia in 3, and reduced vitamin B12 levels in all patients, but no megaloblastic anaemia. The Mainz pouch appears to have very satisfactory short‐ and intermediate‐term results.
Clinical Experience with Subcutaneous Urinary Diversion: New Approach Using a Double Pigtail Stent
Authors: AHMADZADEH M.
Published: November 2008

Summary— Short‐term results in 8 patients with ureteric obstruction and hydronephrosis who underwent subcutaneous urinary diversion show this procedure to be a simple and useful method of urinary diversion for uraemic cancer patients. This method has the additional advantage of avoiding the complications and social implications of other methods of palliative treatment.
Prognostic Value of Raised Prostatic Acid Phosphatase and Negative Skeletal Scintigraphy in Prostatic Cancer
Authors: GOODMAN C. M. , CUMMING J. A. , RITCHIE A. W. S. , CHISHOLM G. D.
Published: November 2008

Summary— Of 438 consecutive cases of newly diagnosed prostate cancer, 178 (41%) had skeletal metastases (TO‐4 M1) at the time of diagnosis according to skeletal scintigraphy; 139 men had serum prostatic acid phosphatase (PAP) greater than twice the upper limit of normal on 2 separate occasions at the time of diagnosis and 65% of them had metastases on bone scan. However, 49 men with normal bone scans were found to have similarly raised serum PAP. (Such patients are defined as having skeletal metastases in the current Medical Research Council immediate versus deferred orchiectomy study and stratified accordingly). The actuarial survival of this group was calculated by life table methods and was compared with that of 2 other subgroups: those patients having metastases demonstrated on bone scan, and those patients having both normal bone scans and normal serum PAP.

The survival of the “metastatic by acid phosphatase” group was significantly better than that of the “metastatic by bone scan” group but did not differ from that of patients having both normal scans and PAP.

For patients with no scintigraphic evidence of skeletal metastases at diagnosis, those with a raised PAP were at a significantly greater risk of scan conversion, although this was more powerfully predicted by high histological grade.
Study of the Seminal Vesicles in Acute Epididymitis
Authors: KRISHNAN R. , HEAL M. R.
Published: November 2008

Summary— Although it has been suggested that seminal vesiculitis is present in patients with epididymitis, it has not been proven. We performed rectal ultrasound assessment of the seminal vesicles in 18 consecutive patients with epididymitis. The seminal vesicle on the same side as the epididymitis was significantly enlarged in 75% of cases; 92% of these enlarged vesicles returned to normal size in 12 weeks.

A persistently enlarged seminal vesicle was associated with unresolved epididymitis, and further bacteriological studies in these cases demonstrated continued Chlamydia infection in some patients over 35 years of age.
Arteriovenous Malformations of the Ureter and Bladder. A Fatal Case of Haematuria
Authors: THOMPSON A. C. , MARTIN J. E. , THORPE A. C.
Published: November 2008

Acute exanguinating haemorrhage from large bowel angiodysplasia is a well reported phenomenon, with some centres claiming it to be the causal factor in as many patients as that from diverticular disease (Ford, 1981; Howard et al., 1982). The mortality rate from lower gastrointestinal haemorrhage for all causes is 10% (Way, 1983). We report a case of fatal haematuria caused by arteriovenous malformations involving the right ureter and the bladder.