bluuebunny/crossref_metadata_2025 huggingface dataset:
Using multimedia for patient information — a program about nocturnal enuresis
Authors: Evans J.H.C. , Collier J. , Crook I. , Garrud P. , Harris P. , Mackinlay D.R.E. , Redsell S.A.
Published: March 2003

Objectives

To identify the information needs of children with nocturnal enuresis, and to design, produce and evaluate an interactive computer program to provide this information.

Subjects and methods

The program was developed over an 18‐month period using information provided by children, parents and professionals, and was evaluated in a hospital‐based enuresis clinic in 65 children. Usability and knowledge gained were also evaluated in 43 healthy children aged 8–10 years attending a local inner‐city primary school.

Results

An interactive program about nocturnal enuresis was developed, which runs on a personal computer and uses sound, voice, cartoon drawings and animation in a modular design. Knowledge scores increased in clinic attendees and in schoolchildren after using the program (Wilcoxon matched pairs test, P<0.001). This improvement was maintained when the program was re‐tested 6–10 months later.

Conclusion

This interactive computer program holds children’s attention and increases their understanding of enuresis. Interactive multimedia may be useful to complement the information provided by health professionals. This method of communication may be particularly useful for children with a low level of literacy.
Incidence of apoptosis and metallothionein expression in renal cell carcinoma
Authors: Zhang  , Takenaka
Published: March 2003

Objective

 To investigate the frequency of apoptosis and expression of metallothionein (MT) protein and to clarify their roles in renal cell carcinoma (RCC).

Materials and methods

 Apoptosis was detected by using the terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP‐biotin nick‐end labelling (TUNEL) technique in 70 formalin‐fixed and paraffin‐embedded RCC specimens. The expression of MT was determined immunohistochemically.

Results

 The incidence of apoptosis was significantly higher in grade 2 and 3 RCC than in grade 1. There were no significant differences amongst the other categories of RCC when grouped by tumour stage, cell type and growth pattern. The expression of MT was detected in 23 of 70 (33%) RCCs. Subcellularly, MT was localized in the cytoplasm, nucleus and cell membrane of RCC. Statistical analysis showed a close association of MT expression with the higher grades and invasive growth pattern of RCC. In addition, the incidence of apoptosis increased with increasing immunoreactivity of MT staining. There was a significant difference in the incidence of apoptosis between the diffuse staining and negative staining of MT.

Conclusions

 There were close associations of higher grade RCC with both the incidence of apoptosis and the expression of MT, as well as a close relationship between MT expression and the invasive growth pattern of RCC. This suggests that the involvement of apoptotic cell death and MT expression should be considered an important factor in the process of the renal carcinogenesis and tumour progression.
Complications relating to the urinary tract associated with bladder‐drained pancreatic transplantation
Authors: Baktavatsalam  , Little  , Connolly  , Farrell  , Hickey
Published: March 2003

Objective

 To evaluate the incidence and management of the urological complications after bladder‐drained pancreatic transplantation.

Patients and methods

 A retrospective study was carried out on 24 consecutive bladder‐drained pancreatic transplants in 24 patients with type I insulin‐dependent diabetes mellitus, 22 with simultaneous kidney transplants and two of pancreas alone, over a period of 53 months.

Results

 All 24 patients were alive within a mean follow‐up of 26.7 months; 22 patients have functioning pancreatic grafts and are insulin‐independent. The overall incidence of urological complications was 83% (20 of 24 patients) and 14 patients had more than one complication. The major non‐infective complication was haematuria (eleven), which was treated conservatively, with only two patients requiring enteric conversion. One patient developed a duodenovesical fistula and lost the functioning pancreatic graft as a consequence. Other non‐infective complications were urethritis (one) and urethral stricture (one), which were managed with catheter drainage and internal urethrotomy, respectively, and vulval ulcers (one) and reflux pancreatitis (one) treated conservatively. The main infective complications were recurrent lower urinary tract infection (nine), asymptomatic persistent bacteriuria (nine), prostatitis and epididymitis (one), and pyelonephritis (one), all managed with appropriate antibiotics. Three patients developed septicaemia from urosepsis and were treated successfully with antibiotics. Two patients developed genital warts and were treated with laser vaporization.

Conclusion

 Although bladder drainage has significantly contributed to the increasing success of pancreatic transplantation, urological complications are frequent and can be serious and life‐threatening. As more of these procedures are performed urologists need to be able to recognize and treat these problems.
Inhibition of penile erection in rats by a long‐acting somatostatin analogue, octreotide (SMS 201–995)
Authors: Kapİc·oglu  , Mollamehmetoglu  , Kutlu  , Can  , Ozgur
Published: March 2003

Objective

 To assess the effect of a new somatostatin analogue (SMS 201–995, octreotide) on erectile function in rats.

Materials and methods

 Animals were fasted and anaesthetized intraperitoneally with pentobarbital. A cannula was placed in the trachea and the femoral vein cannulated for intravenous infusion. The hypogastric and pelvic nerve, major pelvic ganglion, and the nerve fibres to the lower genitourinary tract were identified. In 20 animals, these nerves were stimulated unilaterally using bipolar silver‐wire electrodes; the stimulation was repeated every 15 min for 1 h. Twenty animals were divided into two equal groups; after measuring penile erection to obtain basal values, the animals received either saline or 50 μg SMS 201–995 over 1 h and 30 min later, the stimulation was repeated.

Results

 After administering SMS 201–995 or saline, the levels of penile erection reduced linearly in both groups, but SMS 201–995 caused a greater decrease than in the control group (P<0.05) and from baseline (P<0.01) at all times.

Conclusion

 SMS 201–995 inhibits penile erection in rats and the systems may serve as an in vivo animal model for further investigation.
The role of the plain X‐ray in the assessment of prostatic symptoms
Authors: Porter  , Stoddart  , Hinchliffe
Published: March 2003

Objective

 To assess the contribution of a plain X‐ray of the kidney, ureters and bladder (KUB) to the assessment of patients presenting with symptoms of bladder outlet obstruction.

Patients and methods

 All patients presenting to the ‘Prostate’ clinic at Weston General Hospital during the 12 months from 1 May 1993 to 30 April 1994 were assessed clinically by a history, examination and routine investigations that included a KUB examined and reported by a radiologist. Patients were followed and treatment instituted as deemed appropriate. The contribution made to the management of the patient by the KUB was assessed.

Results

 Of the 292 patients, 234 had no relevant abnormality detected; four patients had evidence of a bladder calculus, whilst in four osteosclerotic areas were noted on the pelvis and lumbar spine. Of the remainder, 14 (5%) had upper urinary tract calcification. In no patients did the KUB influence their immediate management. Those with asymptomatic upper tract stones were offered a yearly follow‐up.

Conclusions

 The routine use of the KUB as a means of investigating lower urinary tract symptoms in the male may no longer be necessary.
Evaluation of histological structure and its effect on the distribution of α1‐adrenoceptors in human benign prostatic hyperplasia
Authors: Kurimoto  , Moriyama  , Hamada  , Kawabe
Published: March 2003

Objective

 To evaluate the histological structure of benign prostatic hyperplasia (BPH) and its relationship with the density of α1‐adrenoceptors in smooth muscle.

Materials and methods

 Specimens from hyperplastic tissues obtained from 14 patients with BPH were evaluated for the density of α1‐adrenoceptors in smooth muscle using autoradiography, Mallory‐Azan staining and computer‐assisted image analyses. The binding of [3H] tamsulosin (a selective α1‐blocker) and the ratio of smooth muscle area was calculated, and the density of α1‐adrenoceptors per area of smooth muscle determined by dividing the degree of binding by the ratio of smooth muscle to total area.

Results

 There was a significant difference between the ratio of smooth muscle area in the hyperplastic acinar nodule and the surrounding stroma (P<0.01). The density of α1‐adrenoceptor per smooth muscle area was significantly higher in the hyperplastic acinar nodule than in the surrounding stroma (P<0.05). There was no correlation between prostatic weight and the ratio of smooth muscle area or the density of α1‐adrenoceptors in each region.

Conclusion

 The distribution of α1‐adrenoceptors on smooth muscle differed with histological structure; both the histological conformation and the difference in the distribution of α1‐adrenoceptors could affect urethral obstruction in BPH.
Lower moiety heminephroureterectomy in the duplex refluxing kidney: the accuracy of isotopic scintigraphy in functional assessment
Authors: Carter  , Malone  , Lewington
Published: March 2003

Objective

 To determine the accuracy of dimercaptosuccinic acid (DMSA) scintigraphy in assessing the differential function between upper and lower moieties of a refluxing duplex system.

Patients and methods

 Between 1990 and 1996, 20 patients underwent lower moiety heminephroureterectomy. All patients had their differential renal function assessed by DMSA scintigraphy before and after surgery, the results being assessed by comparing the predicted and actual loss of renal function.

Results

 The mean (SD, range) function attributed to the scarred lower moiety (predicted loss of function) was 4.3 (4.9, 0–14)%, which compared with an actual mean loss of function of 6.8 (5.1, +4 to −16)%. Thus the mean (SD, range) difference between the predicted and actual loss of renal function was −2.1 (3.2, +4 to −8)%.

Conclusion

 DMSA scintigraphy provides an accurate assessment of the differential renal function between upper and lower moieties in a duplex system. The decision to proceed to lower moiety heminephroureterectomy can be logically based on the information gained from DMSA scintigraphy.
Is the timing of post‐vasectomy seminal analysis important?
Authors: Smith  , Crooks  , Singh  , Scott  , Lloyd
Published: March 2003

Objective

 To review the practice in two hospitals with differing protocols in the timing of seminal analysis after vasectomy.

Patients and methods

 The results from 245 vasectomies carried out at Hospital A, where semen was assessed 3 months after vasectomy, were reviewed and compared with those from 100 consecutive vasectomies at Hospital B, where semen was assessed 6 months after vasectomy. The results of seminal analysis at Hospital A were also audited after changing to the 6‐month protocol. The patients’ preferences for the timing of seminal analysis were also obtained.

Results

 Of the 245 patients at Hospital A, 58 (24%) failed to provide samples, leaving 187 (76%) for evaluation; 528 samples were examined (mean 2.8 per patient, range 1–13). The first sample was positive in 36 (19.3%) and the second positive in 10 (5.3%), the first being negative. Four (2%) patients had persistent spermatozoa at 6 months, one subsequently undergoing exploration. Thirty‐one (17%) patients provided further samples despite providing two consecutive clear ones. At Hospital B, 24 (24%) patients failed to provide samples; 10 (13%) patients had persistent spermatozoa at 6 months and live spermatozoa were detected in one patient’s samples. All eventually produced clear samples, with none requiring exploration. After changing the protocol, 87 vasectomies were performed, with 18 (21%) patients failing to provide samples; seven (10%) of the samples collected showed occasional nonmotile spermatozoa at 6 months in either the first, second or both samples, with all samples clear by 8 months after vasectomy.

Conclusions

 The complete disappearance of spermatozoa after vasectomy takes longer than is generally believed and we therefore suggest that given adequate counselling, seminal analysis 6 months after vasectomy is cost‐effective and in the patient’s interest.
The percentage of free prostate specific antigen is an age‐independent tumour marker for prostate cancer: establishment of reference ranges in a large population
Authors: Lein  , Koenig  , Jung  , Mcgovern  , Skates  , Schnorr  , Loening
Published: March 2003

Objective

 To define the reference range for the ratio of free to total prostate‐specific antigen (fPSA%) in a population of healthy men with no clinically evident prostate cancer and to assess the influence of age on this tumour marker, thus determining the utility of fPSA% in enhancing the discriminatory power of PSA to differentiate healthy men and patients with benign prostatic hyperplasia from those with prostate cancer.

Subjects and methods

 In a prospective cohort study between May and August 1996, 1160 white men aged 20–89 years (957 were 40–69 years old, 82% of all subjects) from nine European and eight non‐European countries were assessed. None of the participants who had a history of prostate cancer had undergone prostatectomy. A standard clinical examination including a digital rectal examination was performed to exclude the presence of prostate cancer. Transrectal ultrasonography was not an inclusion criterion, as it was not available in every case. Total PSA (tPSA) and free PSA (fPSA) were determined in 61 laboratories using the appropriate Enzymun‐Test® for tPSA and fPSA (Boehringer Mannheim Diagnostics, Mannheim, Germany). Serum tPSA, fPSA and fPSA% were then assessed as a function of the subjects’ age.

Results

 The serum tPSA and fPSA were significantly different among age decades 2–8 (P<0.001), with increasing median values, indicating that both variables depend on age. The recommended upper reference limit (95th percentile) for tPSA is 1.78 ng/mL for men aged 30–39 years, 1.75 ng/mL for 40–49 years, 2.27 ng/mL for 50–59 years, 3.48 ng/mL for 60–69 years and 4.26 ng/mL for 70–79 years. The fPSA% was not significantly different between decades 3–8 (P=0.06). Those aged 20–29 years had a slightly higher median value (P=0.03) than the other age groups. The recommended lower reference limit (fifth percentile) for fPSA% is 12.6%.

Conclusion

 The fPSA% for clinically relevant age groups in healthy men was independent of age, which simplifies the use and interpretation of this relatively new tumour marker.
Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols
Authors: Eliasson  , Damber  , TeriÖ
Published: March 2003

Objective

 To compare pressure‐flow results before and 3 months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), performed with lower and higher energy protocols.

Patients and methods

 Twenty‐four patients were treated using a high‐energy protocol performed with a heat‐shock strategy, i.e. a rapid increase in intraprostatic temperatures to a maximum of 55–67°C. A helical antenna was used which produced maximum heating at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow increase in intraprostatic temperatures to a maximum of 45–53°C. A first‐generation filament antenna was used with the maximum heat produced at the prostatic apex. All treatments were performed as single‐session outpatient procedures of 60–70 min duration.

Results

 There was a significantly greater improvement in pressure‐flow variables, i.e. maximum urinary flow rate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher energy TUMT than in those receiving the lower energy protocol. The Madsen and quality‐of‐life scores, and maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group.

Conclusion

 Higher energy TUMT performed using a heat‐shock strategy provides a better pressure‐flow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after higher energy TUMT is at least similar to other treatment alternatives for BPH.
Topical vasoactive cream in the treatment of erectile failure: a prospective, randomized placebo‐controlled trial*
Authors: Le Roux  , Naude
Published: March 2003

Objective

To repeat a previous study on the use of a topical treatment for erectile failure using a vasoactive cream.

Patients and methods

Fourteen patients with erectile failure who had previously responded to intracorporeal injection therapy were enrolled in a randomized placebo‐controlled trial. They were given two topical applications, comprising either a cream containing aminophylline, isosorbide dinitrate and co‐dergocrine mesylate, or a placebo cream of similar appearance containing no pharmacologically active ingredients. Each patient received 16 applications, eight of the active cream and eight placebo. The creams were applied alternatively on successive occasions and the results recorded.

Results

The active cream, applied on 77 occasions, resulted in three good and 13 partial erections. The placebo cream, applied on 76 occasions, yielded four good and 13 partial erections.

Conclusions

We were unable to reproduce the successful results reported by others; in the present study the active cream performed no better than placebo.
Endocrine effects, efficacy and tolerability of a 10.8‐mg depot formulation of goserelin acetate administered every 13 weeks to patients with advanced prostate cancer
Authors: Sarosdy  , Schellhammer  , Soloway  , Vogelzang  , Crawford  , Presti  , Chodak  , Mitchell  , Porter
Published: March 2003

Objective

To determine the endocrine effects, efficacy and tolerability of a 10.8‐mg depot formulation of Zoladex™(goserelin acetate, Zeneca Pharmaceuticals, Wilmington, Delaware, USA), a luteinizing hormone‐releasing hormone agonist analogue, when administration was extended from every 12 weeks to every 13 weeks in patients with advanced prostate cancer.

Patients and methods

Between July 1995 and May 1996, 59 patients with either locally advanced (T3 or T4)or metastatic prostate cancer were enrolled in an open‐label, multicentre trial. Primary efficacy endpoints were testosterone measurements, and assessments of prostate specific antigen (PSA) response, subjective and objective response. Quality of life (QoL) was a secondary efficacy endpoint.

Results

Mean testosterone concentrations decreased to < 0.3 μg/L by week 4 and remained so for the duration of treatment. There were no statistically significant differences in mean testosterone levels between weeks 12 and 13, or weeks 25 and 26. Serum testosterone suppression was adequate in all 58 evaluable patients at week 13, and 51 of 52 (98%) patients at week 26. Of the 58 evaluable patients, 52 (90%) had a PSA response. A subjective response was recorded for six of 11 evaluable patients. Of 58 patients evaluable for objective response, 46 (79%) had a partial response, three (5%) had stable disease and nine (16%) had objective progression. Except for a significant (P=0.014) decrease in overall sexual interest, QoL was unchanged during therapy. The most common side‐effects, regardless of causality, were hot flushes (67%), pain (31%) and pelvic pain (22%). Mild injection‐site complaints occurred with only three of 221 (1.4%) depot injections.

Conclusions

Zoladex™ 10.8‐mg depot, administered every 13 weeks to patients with advanced prostatic cancer, is well tolerated, provides adequate suppression of serum testosterone and produces PSA, subjective and objective responses.
Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management
Authors: Corman  , Moody  , Aronson
Published: March 2003

Objective

To examine the outcome of 23 consecutive patients with Fournier’s gangrene.

Patients and methods

Patients’ charts were reviewed retrospectively from all those treated for Fournier’s gangrene between July 1994 and July 1997 at the UCLA affiliated hospitals.

Results

Twenty‐three patients were identified (mean age 51.7 years, range 13–71). The aetiologies included perirectal abscess (43%), urethral stricture (30%), scrotal abscess (21%) and unknown (4%). Predisposing factors included diabetes mellitus (43%), steroids or chemotherapy (21%), alcohol abuse (43%), malignancy (26%) and radiation therapy (9%). All 23 patients initially received wide debridement and placement of a percutaneous suprapubic tube. At the time of the first surgery, total scrotectomy was required in all, colostomy in 17% and penectomy in 4%. An additional 35% required eventual colostomy and an additional 9% required a penectomy. Patients underwent repeat debridement a mean of 2.5 times; the overall survival was 96%.

Conclusion

Survival can be improved in patients with Fournier’s gangrene by combining aggressive surgical and medical management. The keys to successful outcome included a high index of suspicion, prompt fluid resuscitation, rapid initiation of broad‐spectrum antibiotics, a multidisciplinary approach, early surgical intervention with radical debridement, haemodynamic support in an intensive care setting, and frequent repeat operative debridement.
A new approach to bladder augmentation in children: seromuscular enterocystoplasty
Authors: Dayanç  , Kilciler  , Tan Ö. , Gökalp  , Göktaş  , Peker
Published: March 2003

Objective

To report the use of seromuscular enterocystoplasty (SE) combined with detrusorectomy, in children.

Patients and methods

Between 1993 and 1998, SE was performed in 10 children (aged 10–17 years) with a spastic neurogenic bladder resulting from spinal trauma. Before surgery all children were incontinent and despite anticholinergic medication and clean intermittent catheterization, their bladder capacity was 60–100 mL and their intravesical pressure 40–60 cmH2O.

Results

Before surgery, the mean end‐filling intravesical pressure was 47.7 cmH2O and the mean bladder capacity 82.9 mL. At 3 months after surgery the mean end‐filling intravesical pressure was decreased to 21.1 cmH2O and the mean bladder capacity increased to 319.6 mL. One patient (a 14‐year‐old girl) had urinary retention soon after surgery and has since used clean intermittent catheterization. The other children were able to void successfully using the Valsalva manoeuvre; none were incontinent. All patients were followed and there were no changes in intravesical pressure and bladder capacity.

Conclusion

In providing most of the desired features of an ideal augmentation segment, SE is a good and effective method of bladder augmentation.
Laparoscopy as the investigation and treatment of choice for urinary incontinence caused by small ‘invisible’ dysplastic kidneys with infrasphincteric ureteric ectopia
Authors: Yeung  , Liu  , Ng  , Tan  , Tam  , Lee
Published: March 2003

Objective

To report our experience of using laparoscopy for the accurate location and simultaneous removal of small dysplastic kidneys with ectopic ureteric insertion causing urinary incontinence and that were not detected by conventional imaging modalities.

Patients and methods

Seven girls (mean age 7.9 years, range 3.5–13) presented with urinary leakage occurring between normal voids. Imaging studies including ultrasonography, renal scintigraphy, intravenous urography, computed tomography and/or magnetic resonance imaging in six of the seven patients revealed a single normal functioning kidney, but failed to detect the contralateral nonfunctioning dysplastic kidney. All patients were examined under anaesthesia, followed by transperitoneal laparoscopy for the simultaneous localization and removal of the dysplastic kidneys under the same setting.

Results

Laparoscopy in all seven patients revealed a small dysplastic kidney that could always be easily located by first finding the draining ureter over the iliac vessels and then following it upwards. Four dysplastic kidneys were found in the renal fossa (two left, two right). One kidney was found at the left iliac fossa just above the pelvic brim, one at the left lumbar region, and the other at the right iliac fossa. Laparoscopic nephroureterectomy was successful in all seven girls and the patients were discharged 48 h after surgery. The follow‐up (mean 2.7 years, range 3 months–5.4 years) showed excellent cosmetic results and all the patients have remained completely dry.

Conclusions

In patients with a classical picture of urinary incontinence caused by infrasphincteric ureteric ectopia associated with a small nonfunctioning kidney, video‐laparoscopy, with its magnifying effect, can reliably confirm the diagnosis, locate the dysplastic kidney and allow its removal in the same setting. We propose that laparoscopy should be considered the investigation and treatment of choice in such patients, and should be undertaken without delay even if the dysplastic kidney or the ectopic ureteric orifice cannot be identified with all other conventional means.
A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones
Authors: Joshi  , Obadeyi  , Rao
Published: March 2003

Objectives

To determine the optimal method of treatment for ureteric stones causing complete obstruction, treated by insertion of a JJ stent or a nephrostomy tube, followed by extracorporeal shock wave lithotripsy (ESWL) or by urgent in situ ESWL if readily available.

Patients and methods

The study comprised a retrospective analysis of 82 consecutive patients who presented with ureteric stones causing complete obstruction. Twenty‐six had a percutaneous nephrostomy (PCN, group 1) and 40 had a JJ stent (group 2) placed to relieve the obstruction, and the stones were subsequently treated by ESWL. Sixteen patients underwent urgent in situ ESWL without recourse to either a JJ stent or a PCN (group 3). The choice of the procedure was not determined by stone size, site or other factors, but mainly by the attending surgeon’s preference or the availability of urgent ESWL. The success rate was measured by the disintegration of the stone and spontaneous passage after ESWL; failure was defined as the need for additional procedure(s) for stone extraction.

Results

Urgent in situ ESWL (group 3) had a median (95% confidence interval) success rate of 81 (54–96)%, compared with 70 (53–83)% in group 2 and 54 (33–73)% in group 1.

Conclusion

If facilities are available, urgent in situ ESWL appears to be the choice of treatment for obstructing ureteric stones. If such facilities are not available, a JJ stent may offer better success than a PCN. A prospective controlled trial is necessary to confirm these findings.
Resistive index in renal colic: the effect of nonsteroidal anti‐inflammatory drugs
Authors: Shokeir  , Abdulmaaboud  , Farage  , Mutabagani
Published: March 2003

Objective

To investigate the effect of nonsteroidal anti‐inflammatory drugs (NSAIDs) on the findings of Doppler ultrasonography (DU) in patients with acute unilateral renal obstruction.

Patients and methods

The study included 60 patients (120 kidneys) with unilateral loin pain suspected to be of renal origin. All patients were evaluated using renal ultrasonography (US) and intravenous urography (IVU) during the attack of loin pain and before giving any medication. Then the patients were given 75 mg diclofenac sodium and DU studies were repeated at 6 and 12 h. In 10 patients with acute renal colic, DU was possible 12–24 h after the relief of ureteric obstruction. The mean resistive index (RI) and ΔRI at baseline were compared with the mean values 6 and 12 h after giving diclofenac. The RI and ΔRI were considered positive at values ≥0.70 and ≥0.06, respectively. The sensitivity, specificity and overall accuracy of RI and ΔRI values before and after giving diclofenac were calculated using IVU as the reference standard.

Results

IVU showed that both kidneys were normal in 20 patients that 40 had unilateral obstruction. At baseline, the mean (sd) RI was 0.72 (0.06) in the 40 obstructed kidneys, significantly higher than the RI of 0.60 (0.06) for the 60 normal kidneys (P<0.001). Six hours after giving diclofenac, the mean RI of normal kidneys remained stable and that of the obstructed kidneys decreased significantly to 0.67 (0.06) (P<0.001) and was almost stable at 12 h. Nevertheless, the mean RI of the obstructed kidneys remained significantly higher than that of the normal kidneys at 6 and 12 h after diclofenac. The mean ΔRI decreased significantly from 0.11 (0.04) at baseline to 0.06 (0.04) at 6 h after diclofenac (P<0.001) and remained almost stable at 12 h. In the 10 patients undergoing DU after the relief of obstruction, the mean RI returned to normal. At baseline, RI was sensitive in 70% and specific in 98%, while ΔRI was sensitive in 88% and specific in all cases. Six hours after diclofenac, the specificity of RI and ΔRI remained stable while the sensitivity decreased significantly to 50% and 68%, respectively.

Conclusion

NSAIDs significantly decrease the RI of acutely obstructed kidneys, causing a significant reduction in the sensitivity of DU values identifying acute renal obstruction. To evaluate acute loin pain, DU should be carried out while the patient is in pain and before giving NSAIDs.
Sham treatment compared with 30 or 60 min of thermotherapy for benign prostatic hyperplasia: a randomized study
Authors: Brehmer  , Wiksell  , Kinn
Published: March 2003

Objective

To study the differences in subjective and objective results after 30 or 60 min of transurethral thermotherapy (TUMT) or sham treatment in men with benign prostatic hyperplasia (BPH).

Patients and methods

Forty‐four patients with lower urinary tract symptoms caused by BPH were randomized to undergo 30 or 60 min of TUMT or sham treatment (14, 16 and 14 patients, respectively). The patients were evaluated using symptom scores, timed micturition, free flow rates and urodynamics before and after treatment. They were followed for 1 year, at the end of which they rated the treatment results on a self‐administered visual analogue scale.

Results

Forty‐two patients completed the study. The treatment failed in some patients in all groups, but the improvement in maximum and median flow rates, timed micturition and micturition frequency (day and night) was greater after TUMT than in the sham‐treated group. Symptom scores also improved more after TUMT, although not significantly. There was a good correlation between the decrease in urinary frequency, especially nocturnal, and the patients’ perception of a successful treatment, whereas the increase in maximum urinary flow rate was apparently of little importance.

Conclusions

TUMT had a better effect than the placebo treatment, having a greater impact on irritative than on obstructive symptoms. More patients were satisfied after the 30‐min than after the 60‐min treatment.
The Pippi Salle urethral lengthening procedure; experience and outcome from three United Kingdom centres
Authors: Hayes  , Bulusu  , Terry  , Mouriquand  , Malone
Published: March 2003

Objective

 To assess the outcome of the Pippi Salle (Kropp onlay) urethral lengthening procedure in the treatment of neuropathic urinary incontinence.

Patients and methods

 Twenty‐eight patients (12 males and 16 females, mean age at surgery 12.6 years, range 7–32) were identified who underwent the procedure between 1993 and 1997 in the United Kingdom. Outcomes were assessed by a review of the case notes.

Results

 Of the 28 patients, 18 (64%) were rendered continent by day, and 17 (61%) by day and night. Twelve of the 16 females were completely dry, and a further girl was dry by day, giving overall daytime continence in 13 patients; five males were rendered continent (P=0.03, chi‐square test). Four patients required revision surgery; in five patients (two females and three males) the method was abandoned and they underwent an alternative procedure, and a further four are being reassessed.

Conclusion

 The Pippi Salle procedure should be considered as a first‐line treatment option for neuropathic incontinence in females. Its place in the management of incontinent males is less convincing.
The preventive effect of systemic treatment with interferon‐α2B for infertility from mumps orchitis
Authors: Ku  , Kim  , Jeon  , Lee
Published: March 2003

Objective

 To evaluate the effect of interferon‐α2B on mumps orchitis, often caused by postpubertal mumps and which can result in permanent testicular atrophy.

Patients and methods

 The study included 21 patients with mumps orchitis, treated between May 1990 and June 1997. Patients were randomly assigned into two groups: in group 1, 13 patients received therapy with interferon‐α2B (3×106 IU per day) and group 2 did not, acting as controls. All were evaluated by measurements of testis size, mumps virus titre, hormone level and semen analysis.

Results

 In group 1, the patients’ symptoms resolved within 2–3 days and the volume of the testes returned to normal within 11 days; there was no testicular atrophy in any patient during the follow‐up. However, asthenospermia continued to be detected in four patients (unilateral in two, bilateral in two). In group 2, the patients’ symptoms resolved within 5–6 days and the volume of the testes returned to normal within 10 days; testes atrophied in three patients (unilateral in two, bilateral in one) during the follow‐up. Asthenospermia continued in four patients (unilateral in two, bilateral in two).

Conclusion

 These results suggest that treatment with systemic interferon‐α2B is effective in preventing testicular atrophy when combined with standard symptomatic treatment.
The stability of free and bound prostate‐specific antigen
Authors: Cartledge  , Thompson  , Verril  , Clarkson  , Eardley
Published: March 2003

Objective

 To determine if the assay for free prostate specific antigen (fPSA) and the calculated ratio of fPSA to total PSA (f/tPSA) is stable in conditions likely to be met in routine clinical practice.

Materials and methods

 Two blood samples were obtained from 27 patients attending a routine urology clinic. Sample 1 was centrifuged immediately, assayed for fPSA and tPSA, and the f/tPSA calculated. This sample was then stored at 4°C for 24 h, 48 h and 1 week, or at −20°C for 24 h, 1 week and 1 month before the assays for fPSA and tPSA were repeated. The second sample was left at room temperature for 24 h before assay and processing, as for sample 1.

Results

 tPSA is a highly stable analyte; if whole blood samples are processed immediately, fPSA is stable for 24 h at 4°C and 1 month at −20°C. There was a significant reduction in the calculated f/tPSA in samples stored for ≥24 h at 4°C (P<0.01); if the sample was stored at −20°C the calculated f/tPSA was stable. After 24 h storage at room temperature, fPSA decreased by 6.3% and f/tPSA by 6.4%. Subsequent storage of serum at 4°C for 1 week resulted in a 25% decrease from the baseline value. After 1 month at −20°C the fPSA value was 13% lower than the baseline value.

Conclusion

 These results indicate that if there is to be confidence in the accuracy of the f/tPSA value, then blood samples must be handled and processed correctly. Total PSA is sufficiently stable to permit whole blood samples to remain at room temperature for 24 h before serum is separated. If fPSA is to be determined accurately then the whole blood sample must be centrifuged promptly. As the fPSA values in blood samples left at room temperature for 24 h are up to 25% lower than those on immediate assay, and the subsequent f/tPSA 29% lower, then for the optimum use of this test, these samples should also be handled appropriately.
Extra‐anatomic stents in ureteric obstruction: experience and complications
Authors: Minhas  , Irving  , Lloyd  , Eardley  , Browning  , Joyce
Published: March 2003

Objective.

 To assess the role of extra‐anatomic stents (EAS) as a means of urinary diversion in patients with ureteric obstruction secondary to malignancy.

Patients and methods.

The technique for inserting EAS in patients with ureteric obstruction was described previously; to date, 13 patients (seven women and six men, mean age 45.3 years, range 22–78) have been treated. All patients had ultrasonographic evidence of hydronephrosis and/or significant biochemical evidence of renal impairment. Patients had advanced malignancy and one patient an abdominal aortic aneurysm.

Results

Urinary diversion was successful in all patients; two survived for more than 1 year, with stent changes at 6‐monthly intervals. In three patients the stents were replaced by percutaneous nephrostomies because of problems with leakage or infection. The remaining patients died with functioning EAS in situ.

Conclusions

In patients with ureteric obstruction secondary to malignancy or medical conditions excluding them from more invasive surgery, EAS provide a further therapeutic option instead of a permanent nephrostomy, which has associated inherent problems. This technique is not without potential problems and careful selection of patients remains vital in this difficult area.
Positron emission tomography with 18fluorine‐labelled deoxyglucose: utility in localized and advanced prostate cancer
Authors: Sanz  , Robles  , Giménez  , Arocena  , Sánchez  , Rodriguez‐Rubio  , Rosell  , Richter  , Berián
Published: March 2003

Objective

To determine the role of the positron emission tomography (PET) with 18F‐labelled deoxyglucose in the identification of prostatic cancer in the iliac and obturator lymphatic nodes before radical prostatectomy, and in the localization of relapse in patients in biochemical progression.

Patients and methods

Twenty‐one patients were divided into two groups. Group A consisted of 11 men diagnosed with organ‐confined prostate cancer, where attention was focused on the iliac and obturator lymphatic nodes, the results being compared with the pathological anatomy obtained from surgical procedures. Group B included 10 patients treated by radical prostatectomy, radiotherapy or orchidectomy and who were in biochemical progression, in whom the aim was to identify recurrence of the disease.

Results

In none of the 11 patients of group A who had undergone radical prostatectomy were deposits of radiotracer identified in the area of the iliac and obturator nodes which would indicate node metastases. However, the histopathological analysis of these nodes showed tumour in three patients. In group B the PET scans showed recurrence of prostate cancer (by deposits of radiotracer) more clearly than did computed tomography (CT) in two patients (both with recurrence in soft tissue). In one patient bone scintigraphy identified a lesion compatible with prostatic disease in the bone; this was clinically confirmed but was not identified by PET.

Conclusion

PET, using deoxyglucose labelled with 18F, cannot reliably identify prostatic adenocarcinoma in the iliac and obturator lymph nodes before surgery; other tracers may give better results. To locate relapses in patients with biochemical progression, PET seems to have better sensitivity than CT when identifying diseases in soft tissues and is possibly inferior to bone scintigraphy in detecting bony metastases.
Perivesical fat necrosis after adjuvant intravesical chemotherapy
Authors: Doherty  , Trendell‐Smith  , Stirling  , Rogers  , Bellringer
Published: March 2003

Objective

To document the presence of extensive transmural and perivesical fat necrosis in a series of radical cystectomies, and associate the surgical and pathological findings with the administration of intravesical chemotherapy.

Patients and methods

The study comprised 12 patients with pT2+ transitional cell tumours who were referred to the West Middlesex University Hospital and who proceeded to primary radical cystectomy between November 1996 and April 1998. The association between the presence of widespread transmural and extravesical necrosis and the administration of a single dose of intravesical epirubicin or mitomycin C in the 24 h after the initial transurethral resection of bladder tumour (TURBT) was analysed using the two‐tailed Fisher’s exact test.

Results

The association between the presence of transmural and extravesical fat necrosis and administration of intravesical chemotherapy was highly significant (P=0.015).

Conclusions

The depth and extent of the mural muscle necrosis and perivesical fac necrosis in patients receiving intravesical chemotherapy within 24 h of TURBT is remarkable and more florid than the usual muscle necrosis seen after TURBT. Clinically, the necrotic tissue makes the cystectomy significantly more difficult technically, and may even mimic extravesical spread of malignant disease. This was not borne out by the histology of the specimens, which showed no extravesical spread of the tumour. Surgeons should be aware of the possibility that such operative findings might be the result of intravesical chemotherapy.
Transcutaneous penile oxygen pressure during bicycling
Authors: Nayal  , Schwarzer  , Klotz  , Heidenreich  , Engelmann
Published: March 2003

Objective

To evaluate the blood supply to the penis during bicycling and thus determine whether the associated perineal compression might be responsible for some cases of impotence.

Subjects and methods

The transcutaneous penile oxygen partial pressure (pO2 ) at the glans of the penis was measured in 25 healthy athletic men; pO2 is readily measured by noninvasive techniques currently widely used in the management of premature infants, and which have been shown to give pO2 levels that correlate with arterial pO2 levels. The measurements in the healthy subjects were taken in various positions, before, during and after bicycling.

Results

The mean (sd) pO2 of the glans when standing before cycling was 61.4 (7.2) mmHg; it decreased after 3 min of cycling to 19.4 (4.7) mmHg. After 1 min of cycling in a standing position it increased significantly to 68 (7.6) mmHg; when cycling was continued in a seated position, after 3 min the pO2 fell to 18.4 (4.2) mmHg and there was a full return to normal pO2 values after a 10‐min recovery period.

Conclusion

The pO2 seems to correlate with the blood supply to the penis. The present results support the hypothesis that as the penile arteries are compressed against the pubic bone by the saddle during bicycling, the pO2 values decrease. Additionally, shifting from a seated to a standing position while cycling significantly improved the pO2 value of the penis and penile blood oxygenation was then even greater. Therefore, we suggest that cyclists change their body position frequently during cycling. Correcting the handlebars or the height of the saddle, tipping the nose of the saddle to produce a more horizontal, or even downward pointing position, and attention to the design of the saddle may be the only required precautions.
Comparison of marker protein expression in benign prostatic hyperplasia in vivo and in vitro
Authors: Fry P.M. , Hudson D.L. , O’Hare M.J. , Masters J.R.W.
Published: March 2003

Objective To use multiple immunofluorescence to compare the in vivo and in vitro expression of tissue‐specific proteins in BPH.

Materials and methods Pure populations of prostate epithelial and stromal cells were produced using standard methods. Serum‐free media for epithelial cells were compared. Co‐localization of proteins was compared in frozen‐tissue sections and cultured cells by simultaneous multiple immunofluorescence, and recorded using a high‐resolution charge‐coupled device camera.

Results In contrast to the other serum‐free media tested, epithelial cells grew without squamous differentiation or vacuolation in prostate epithelial growth medium (PrEGM, Clonetics, BioWhittaker UK Ltd., Berks, UK). These cells were predominantly of a basal phenotype, with some cells showing a luminal phenotype. Most of the stromal cells had features of myofibroblasts, but smooth muscle cells and fibroblasts also were present.

Conclusion PrEGM is a commercially available serum‐free medium in which primary cultures of prostate epithelial cells can be propagated reproducibly. This study provides a comprehensive description of tissue‐specific protein expression in BPH in vivo and in vitro. The use of simultaneous multiple immunofluorescence to study co‐localization has resulted in a more precise definition of phenotype than has previously been possible, thereby establishing the relevance of the in vitro model system BPH.
Strong effects of definition and nonresponse bias on prevalence rates of clinical benign prostatic hyperplasia: the Krimpen study of male urogenital tract problems and general health status
Authors: Blanker M.H. , Groeneveld F.P.M.J. , Prins A. , Bernsen R.M.D. , Bohnen A.M. , Bosch J.L.H.R.
Published: March 2003

Objective To estimate the prevalence of benign prostatic hyperplasia (BPH) in the community, and study the influence of BPH definition, age and response bias on prevalence rates.

Subjects and methods A community‐based longitudinal study of 3924 men aged 50–75 years was conducted in a Dutch municipality (Krimpen) near Rotterdam. Data from those responding were collected using self‐administered questionnaires, and during visits to the health centre and outpatient clinic of the urology department. The questionnaires included symptom scores on general well being (Inventory of Subjective Health, ISH) and lower urinary tract symptoms (International Prostate Symptom Score, IPSS). A short version of the questionnaire (including the IPSS and ISH) was sent to a random sample of those not responding. All subjects participating fully underwent a physical examination, uroflowmetry, transrectal ultrasonometry of the prostate and had their prostate specific antigen level measured. Age‐specific prevalence rates of BPH were estimated using different definitions, based on one or more of symptom severity, prostate volume and maximum flow rate. The influence of response bias was estimated using the questionnaires.

Results The response rate was 50% (full participants). Of those not responding, 55% completed a short version of the questionnaire (partial participants). Compared with full participants, partial participants had a lower IPSS and slightly lower ISH. The prevalence rates of clinical BPH in the study population was 9–20% (95% confidence interval, 8–11% to 22–27%) depending on the definition used. After adjusting for nonresponse bias, the age‐group specific prevalences for 5‐year age strata were 1.1–1.8 times lower for all BPH definitions used.

Conclusions The prevalence rates of clinical BPH depend largely on the definition used and increase strongly with age. The effect of age is stronger when more variables are included in the definition. Adjustment for response bias results in substantially lower prevalence rates.