bluuebunny/crossref_metadata_2025 huggingface dataset:
Should Urologists wear Spectacles for Transurethral Resection of the Prostate?
Authors: DAVIES J. H. , HARRISON G. S. M.
Published: December 2008

Summary— Contamination of the eyes by irrigation fluid during transurethral resection (TUR) of the prostate was assessed by measuring droplet splashes on to spectacles worn by 2 surgeons. During 30 consecutive operations, droplet splash contamination occurred during every procedure. The number of splashes increased with time.

The use of spectacles during TUR will reduce the risks of eye contamination from droplet splashes and therefore the possibility of transmission of the human immunodeficiency virus from infected patients.

Based on a Poster Demonstration at the 46th Annual Meeting of the British Association of Urological Surgeons in Scarborough, July 1990
Sperm Retrieval by Electro‐ejaculation
Authors: LUCAS M. G. , HARGREAVE T. B. , EDMOND P. , CREASEY G. H. , McPARLAND MARY , SEAGER S.W.J.
Published: December 2008

Summary— Twelve patients with spinal cord injury and 2 diabetics with secondary anejaculation underwent 26 sessions of electro‐ejaculation, using a technique which has previously been popular only in veterinary medicine. Ejaculate was obtained on 21 occasions. Semen quality was adequate for cryostorage on 9 occasions (8 patients); on 8 occasions (5 patients) it was used for immediate artificial insemination of the partner. To date, there has been 1 pregnancy resulting in a live birth.
The Growing Teratoma Syndrome
Authors: JEFFERY G. M. , THEAKER J. M. , LEE A. H. S. , BLAQUIERE R. M. , SMART C. J. , MEAD G. M.
Published: December 2008

Summary— Thirteen patients with metastatic non‐seminomatous germ cell tumours and enlarging metastases consisting of teratoma differentiated only were identified. Patients were managed with surgical resection soon after the growing lesions were documented. Surgical morbidity was minimal and 12 patients are alive (10 are disease‐free) at a median follow‐up of 28 months.
Detrusor Hyper‐reflexia as a Factor in Spontaneous Perforation of Augmentation Cystoplasty for Neuropathic Bladder
Authors: ANDERSON P. A. M. , RICKWOOD A. M. K.
Published: December 2008

Summary— In a series of 30 children undergoing cystoplasty for neuropathic bladder, 14 had a combination of a competent sphincteric mechanism and detrusor hyper‐reflexia. All 3 cases of spontaneous perforation of the augmentation occurred within this latter group and it is postulated that excessive intravesical pressure due to high pressure hyper‐reflexia was the causal factor. Strategies to reduce the risk of perforation are discussed.
Haemangioma of the Urinary Tract: Review of the Literature
Authors: JAHN H. , NISSEN H.M.
Published: December 2008

General features

Haemangiomas are benign vascular tumours. They can regress spontaneously as a result of fibrosclerosis, suggesting a conservative approach wherever possible. Asymptomatic haemangiomas do not require treatment.

Renal haemangioma. In all, 198 cases have been reported. The lesion is usually solitary and unilateral and occurs most often in the pyramid, and in the mucosa or subepithelial tissue of the pelvis. In some cases a tentative diagnosis of haemangioma has been made by means of selective renal angiography and pre‐ or per‐operative renoscopy. Partial nephrectomy is recommended in cases of minor haemangioma.

Ureteric haemangioma. Six cases have been described. When haemangioma is suspected a conservative operation is recommended.

Bladder haemangioma. A total of 106 cases have been reported. Many of the tumours had the characteristics of an iceberg, with considerable extravesical extension making endoscopic management less suitable because of the possibility of massive haemorrhage or recurrence. Consequently, many authors prefer local excision. In the case of endoscopic treatment the patient should be prepared for open surgery.

Urethral haemangioma. Twenty cases have been described. The lesions often extend further than is immediately apparent. Endoscopic management is recommended for small lesions and, in the case of more extensive lesions, open exploration is advised followed by appropriate urethral reconstruction.
Disturbance in Sodium Regulating Hormones in Chronic Obstructive Uropathy
Authors: CLARKE N. W. , JONES D. A. , TAMES F. , LAING I. , GEORGE N. J. R.
Published: December 2008

Summary— Serum atrial natriuretic peptide (ANP), plasma renin activity (PRA), angiotensin II (All) and aldosterone levels have been studied in patients with chronic bilateral ureteric obstruction resulting from high pressure chronic retention of urine (HPCR), both in the obstructed state and during the post‐obstructed period. Increased ANP levels observed during chronic obstruction fell rapidly following urinary tract decompression by urethral catheterisation. Serum ANP resurged briefly within 24 h but stabilised thereafter at a lower level. PRA was initially suppressed but rose after catheterisation, the increase lagging behind the changes seen for ANP. Rising levels of All and aldosterone followed this trend but, unlike PRA, levels were not completely suppressed in the obstructed state. The observed hormonal changes probably reflect homeostatic mechanisms directed to the maintenance of sodium and water balance during obstruction and to limitation of the diuresis following its relief.
Recurrent Kidney Stones: Causes and Diagnostic Criteria in Patients from Campania (Southern Italy)
Authors: NUNZIATA V. , GIOVANNI G. DI , GIANNATTASIO R. , LETTERA A. M. , MANCINI M.
Published: December 2008

Summary— A study was carried out on 180 recurrent kidney stone formers from the Campania region of southern Italy. The data showed that this hypercalciuric population was similar to that in previous studies; however, there was no difference in terms of parathyroid activity when compared with normal controls. The slightly depressed serum levels of vitamin D in hypercalciurics indicate that gut calcium absorption is not directly related to vitamin D levels. We found no difference in the prevalence of metabolic abnormalities associated with stone formation between the patients in this series and those in previous studies.
Stage I Seminoma of the Testis. Adjuvant Radiotherapy or Surveillance?
Authors: ALLHOFF E. P. , LIEDKE SUSANNE , DE RIESE W. , STIEF C. , SCHNEIDER B.
Published: December 2008

Summary— Lately the role of radiotherapy in stage I seminoma of the testis has been questioned by some authors who reported on a “surveillance” strategy for these patients. Since 1980, 124 patients with seminoma of the testis have been referred to this institution; 97 of 116 patients analysed presented with stage I disease and 10 of these had elevated levels of βHCG.

A total of 64 patients were given radiotherapy after orchiectomy and 33 entered a surveillance protocol. After a median follow‐up of 48 months, 3 patients in the surveillance group relapsed after 5, 13 and 49 months and 2 of the irradiated patients did so after 25 and 33 months. Elevation of βHCG was not significant because none of these patients showed progression.

A low rate of progression and excellent survival are associated with standard treatment (orchiectomy and radiotherapy) and good results have been achieved with chemotherapy in cases of relapse. A surveillance policy is not recommended in stage I seminoma because of its slower growth compared with non‐seminomatous germ cell tumours (NSGCT), the absence of a specific tumour marker, the 10% risk of occult metastases and the 3‐fold higher progression rate compared with irradiated patients. We suggest the use of a reduced dosage and radiation field.
Tuberculous Cerebral Abscess 8 Years after Renal Transplantation
Authors: PROCA E. , POPESCU A.
Published: December 2008

Most infections in renal transplant recipients are caused by common pathogens. However, the incidence of tuberculosis is more common in these immunosuppressed patients than in the general population. We report a patient who developed a tuberculous cerebral abscess 8 years after receiving a kidney from a living donor.
Incidental Renal Carcinoma Discovered during Ultrasound Localisation of Renal Calculi for Extracorporeal Piezoelectric Lithotripsy
Authors: PARR N. J. , RITCHIE A. W. S. , MOUSSA S. A. , TOLLEY D. A.
Published: December 2008

Extracorporeal shock wave lithotripsy is now widely used for the treatment of urinary calculi. Some lithotriptors, such as the Wolf 2300 Piezolith in this centre, use ultrasound imaging to localise and focus on to the stone prior to treatment. We have discovered 2 unsuspected renal carcinomas during this process, both of which were not revealed by the intravenous urogram sent with the referral. Prompt surgical intervention showed that both tumours were confined to the pathological specimen.
Cystometries, Physiological and Morphological Studies after Relief of Bladder Outflow Obstruction in the Pig
Authors: SPEAKMAN M. J. , BRADING A. F. , DIXON J. S. , GILPIN S. A. , GILPIN C. J. , GOSLING J. A.
Published: December 2008

Summary Experimental bladder outflow obstruction was relieved in 18 pigs between 2 and 15 months after the creation of partial urethral obstruction. Cystometric, physiological and morphological studies were performed 2 to 6 months after relief of the obstruction. An increase in average voiding flow rates from 2.8 ± 1.0 ml/s to 6.8 ± 1.2 ml/s was recorded in the Landrace pigs and from 2.2 ± 0.9 ml/s to 7.4 ± 1.4 ml/sin the Göttingen mini‐pigs. There was a concomitant decrease in the voiding detrusor pressures from 52 ± 11 cm H2O to 32 ± 8 cm H2O and from 78 ± 12 cm H2O to 33 ± 6 cm H2O respectively. A return towards control values of the physiological responses to exogenously applied agonists (acetylcholine and potassium) and to electrical field stimulation was observed. There was an increase in neuronal innervation in the morphological studies which was more marked in the animals with a shorter period of obstruction. The implications for patient care are discussed.
Adenocarcinoma of the Bladder: Study of 14 Cases and Review of the Literature
Authors: KAMAT M. R. , KULKARNI J. N. , TONGAONKAR H. B.
Published: December 2008

Summary Fourteen patients with adenocarcinoma of the bladder have been seen over a 14‐year period; 6 tumours were of urachal origin and the remaining 8 were primary. All tumours were muscle‐infiltrating. The 6 patients with urachal tumours were subjected to surgery; 3 underwent partial cystectomy and 3 radical total cystectomy. All patients who underwent partial cystectomy are alive and free of disease at 60 months, 12 months and 12 months respectively. The other 3 patients who underwent radical cystectomy suffered recurrence and 2 succumbed to their disease within 1 year. All patients with primary adenocarcinoma of the bladder underwent radical cystectomy, 5 of them after planned pre‐operative radiotherapy. There were 3 post‐operative deaths. One patient died of an unrelated cause 30 months after surgery and 2 died of disseminated disease 8 and 16 months after surgery. One patient developed inguinal lymph node metastases 4 months after surgery and is controlled at 12 months with radiotherapy. Only 1 of the 8 patients with primary adenocarcinoma of the bladder is alive and free of disease at 6 months.
Surgery Following Chemotherapy for Metastatic Testicular Teratoma
Authors: WHILLIS D. , COLEMAN R. E. , LESSELLS A. M. , HARGREAVE T. B. , CORNBLEET M. A. , HOWARD G. C.W.
Published: December 2008

Summary Twenty patients with metastatic testicular teratoma underwent surgery for residual disease after chemotherapy. Twelve patients in whom complete excision of all residual masses was possible are alive with no evidence of disease. Four patients have died of malignant teratoma, 2 have active malignant disease and 2 have inoperable residual cystic disease.

Patients with malignant teratoma intermediate (MTI) primary testis tumours, and those with bulky abdominal disease at presentation, are more likely to have residual masses requiring excision. Completeness of excision appears to be the most important predictor of disease‐free survival.
Low Dose Bleomycin with Etoposide and Cisplatin for Metastatic Testicular Teratoma
Authors: COLEMAN R. E. , WHILLIS D. , HOWARD G. C. W. , TAYLOR R. E. , CORNBLEET M. A.
Published: December 2008

Summary Thirty‐nine men with metastatic testicular teratoma were treated with a combination of bleomycin, etoposide and cisplatin (BEP). Unlike the usual regimen of these 3 agents, bleomycin and cisplatin were given on day 1 only of the cycle, with etoposide for 3 days. Thirty patients (77%) are alive and disease‐free after a median follow‐up of 31 months—24/25 (96%) with disease confined to lymph nodes but only 6/14 (43%) patients with lung involvement.

Modified BEP chemotherapy is a well tolerated alternative to standard BEP chemotherapy for small volume nodal disease; it minimises in‐patient time, hospital visits and the risk of bleomycin lung toxicity. However, omission of the weekly doses of bleomycin and shortening of the administration schedule of cisplatin and etoposide may be detrimental in patients with more extensive disease, for whom more intensive therapy may be necessary.
An Appliance to Direct Urine Flow following Penile Amputation
Authors: GARBUTT C. L. , GARDNER A.‐M. , DUDLEY N. E.
Published: December 2008

Penile amputation does not produce incontinence but it does lead to problems in directing the stream of urine. We describe an appliance, made from materials readily available on a general surgical ward, which reduces this problem.
Changes in Detrusor Innervation with Relief of Outflow Tract Obstruction
Authors: CUMMING J. A. , CHISHOLM G. D.
Published: December 2008

Summary— In 10 patients with urodynamically proven outflow tract obstruction, detrusor biopsies were taken prior to and following relief of obstruction. The changes in detrusor innervation were compared following the relief of obstruction within the study group and also with an age‐matched control group who were urodynamically normal. There was a significant reduction in detrusor innervation in the study group when compared with controls pre‐operatively. Within the study group there was a significant increase in detrusor innervation in 8 patients following relief of outflow tract obstruction. Persistence of symptoms after prostatectomy may be explained by failure of detrusor reinnervation.
Endoscopic Implantation of Collagen (GAX) for the Treatment of Urinary Incontinence
Authors: KIESWETTER H. , FISCHER M. , WÖBER L. , FLAMM J.
Published: December 2008

Summary— Sixteen women whose ages ranged from 42 to 73 years (mean 57) and 2 men, aged 76 and 80 years respectively, were treated for urinary stress incontinence with transurethral implantation of submucosal glutaraldehyde cross‐linked collagen (GAX); 15 females had had several continence operations previously and 1 female was totally incontinent following low anterior resection of the sigmoid colon for cancer. All but 2 patients received 8 ml GAX in a single operative session under general anaesthesia. Before implantation, patients underwent urodynamic evaluation, cystoscopy, urinary stress test and the two‐thirds capacity pad weighing test. Post‐operative evaluations were carried out after 3, 6 and 9 months and included urinary flow rate, urine analysis, residual urine determination and the two‐thirds pad weighing test. The results were encouraging.

After 3 months, 8/18 patients were cured, 7/18 had improved and 3/18 had failed to respond. Nine months post‐operatively, 7 patients were still continent, 8 had improved and 3 remained unchanged. One of the improved group had a reinjection 18 months post‐operatively and has been continent since then.

We feel that GAX collagen injection is a safe and easy method for the treatment of urinary stress incontinence; it has no observable or measurable morbidity.
Transurethral Polytef Injection for Post‐prostatectomy Urinary Incontinence
Authors: POLITANO V. A.
Published: December 2008

Summary— This report deals with 720 incontinent males injected with Polytef paste. In all cases the incontinence resulted from some form of prostatic surgery. All patients had been incontinent for at least 1 year. Approximately 88% of patients incontinent from transurethral resection (TURP) were cured or improved; 74% of patients undergoing prostatectomy were improved, and approximately 67% of patients incontinent after radical prostatectomy were cured or improved. No major complications or clinical evidence of particle migration were observed. Our 20 plus years' experience with Polytef paste has shown it to be a safe and effective method for the treatment of post‐operative male incontinence, with a high success rate.
Is Injected Polytetrafluoroethylene (Polytef) Carcinogenic?
Authors: DEWAN P. A.
Published: December 2008

Summary— Injectable polytetrafluoroethylene (Polytef) has been used in many patients for vocal cord augmentation and for the management of urinary incontinence since the early 1960s and noninjectable forms have been used for sutures, hernia repair, replacement of the stapes, hip prostheses, cardiac valves and vascular grafts.

Since 1984, many children have been treated with subureteric Polytef injection for the management of vesicoureteric reflux. Its use in young patients has heightened the concern about particle migration and carcinogenesis, particularly in view of the fact that the substance may be in the patient for decades.

The available evidence does not confirm a significant carcinogenic effect in humans; rather it suggests that, if there is a risk, it is extremely low. However, human specimens, taken decades after the implantation of Polytef, and long‐term, non‐rodent animal experiments are needed to substantiate the probable safety of Polytef in children.
Stamey‐Martius Procedure for Severe Genuine Stress Incontinence
Authors: GANABATHI K. , ABRAMS P. , MUNDY A. R. , DWYER P. L. , GLENNING P. P.
Published: December 2008

Summary— There are few options now available to treat patients with severe genuine stress incontinence caused by urethral failure. These patients usually have a low maximum urethral closure pressure (< 20 cm of water) and anterior vaginal wall scarring caused by previous surgery. In 32 such patients we used the Martius fat pad insertion procedure, in addition to the Stamey procedure, and achieved a 91% symptomatic success rate over a mean 13‐month follow‐up period. Because of its simplicity, reliability and low morbidity, we recommend this procedure in this difficult group of patients before performing a sling procedure or insertion of an artificial urinary sphincter.
DNA Analysis in Predicting Survival of Irradiated Patients with Transitional Cell Carcinoma of Bladder
Authors: WIJKSTRÖM H. , NILSSON B. , TRIBUKAIT B.
Published: December 2008

Summary— A total of 115 patients with invasive transitional cell carcinoma of the bladder underwent radical radiotherapy between 1975 and 1986 and were followed up until the end of 1990. Apart from routine clinical observations, flow cytometric DNA measurements made on fresh tumour material were available for analysis. Actuarial cancer‐free survival controlling for response to treatment was analysed with the log‐rank test, bivariate and multivariate analyses using Cox's stepwise regression model on probable prognostic factors.

The overall actuarial 5‐year cancer‐free survival rate was 30%. Survival was significantly correlated with response to treatment: 59% for patients with complete regression and 5% for those with residual tumour.

Prognostic factors that significantly correlated with death from cancer were advanced stage, large size, incomplete resection, ureteric obstruction, anaemia, carcinoma in situ grade 3 and occurrence of more than one aneuploid cell population. However, only 3 of these factors were of independent power in the multivariate analysis: stage, size and carcinoma in situ.

Of 21 patients with a history of primary or secondary carcinoma in situ, 19 died from cancer during follow‐up: 18 of the 21 patients had tumours that were aneuploid with more than one aneuploid cell population.

It is concluded that curative radiotherapy can be successful only in patients with less advanced tumours assessed according to clinical stage and size, aneuploid tumours with not more than one aneuploid cell line, no carcinoma in situ, no ureteric obstruction, and in whom a complete transurethral resection of the exophytic tumour is possible.
Eosinophilic Prostatitis and Prostatic Specific Antigen
Authors: LIU S. , MILLER P. D. , HOLMES S. A. V. , CHRISTMAS T. J. , KIRBY R. S.
Published: December 2008

Summary— Eosinophilic prostatitis is a rare form of abacterial prostatitis with uncertain aetiology. Its clinical presentation, like other types of abacterial prostatitis, commonly mimics carcinoma of the prostate. Transrectal ultrasound may be helpful in the diagnosis of prostatitis but histological confirmation is necessary. Prostatic specific antigen has been widely used in the diagnosis and follow‐up of patients with prostatic carcinoma. High levels of this antigen (> 30 μg/l) have been claimed to be highly specific for prostate cancer, although lesser elevations may also occur in patients with large benign prostate glands and in bacterial prostatitis. We report 3 patients with histologically proven eosinophilic prostatitis and high levels of prostatic specific antigen. This diagnosis may closely mimic carcinoma of the prostate and must be excluded by histological examination of biopsy material before treatment for presumed prostate carcinoma is initiated.
Non‐invasive Management of Impotence with Transcutaneous Nitroglycerin
Authors: MEYHOFF H. H. , DE P. ROSENKIL , BØDKER A.
Published: December 2008

Summary— Nitroglycerin plasters were applied to the penis in 10 impotent men and the erectile effect assessed. During laboratory testing all patients achieved an erectile response. Self‐administration of nitroglycerin patches restored potency in 4 patients and was preferred to papaverine auto‐injection by 3. Headache was a common side effect during initial administration. An attempt to treat impotence with nitroglycerin plaster seems worthwhile before starting extensive investigations or invasive treatment.
The F‐15 Diuresis Renogram in Suspected Obstruction of the Upper Urinary Tract
Authors: UPSDELL S. M. , TESTA H. J. , LAWSON R. S.
Published: December 2008

The results are presented of the first long‐term follow‐up study of patients with suspected obstruction of the upper urinary tract investigated by a modified form of diuresis renography (F‐15 renography). The incidence of equivocal results from diuresis renography is significantly reduced by the use of the F‐15 renogram.

F‐15 renography provides a reliable assessment of the upper urinary tract in patients with suspected obstruction and is recommended in the investigation of equivocal upper urinary tract dilatation.
Bladder Cancer: Inter‐relationships between Chemotherapy and Radiotherapy
Authors: WAXMAN J. , BARTON C. , BIRULS R. , JAMES N. , HARRISON M. , ROGERS H. , MEE D. , SIKORA K. , COLBECK R. , ABEL P. , WILLIAMS GORDON
Published: December 2008

There has been increasing interest in the role of chemotherapy as primary treatments for patients with urothelial cancer and because of the poor prognosis of locally advanced tumours with conventional treatment, trials have been initiated comparing radiotherapy with chemotherapy as primary therapies. In this context it is important to assess the relationship between the responses to chemotherapy and radiotherapy, and this we have examined in 64 patients treated with MVMJ (methotrexate, vinblastine, mitozantrone and carboplatin).

Either a complete or a partial response was found in 29 of the 64 patients, 15 had stable disease and 13 had progression of disease. Seven patients died within the first treatment month. The survival of the responding patients ranged from 114 to 1184 days.

Six of 15 patients who had had pelvic irradiation prior to chemotherapy responded to MVMJ, the maximum duration of response being more than 3 years.

Twenty‐two patients had radiotherapy following their chemotherapy. One of 13 patients not responding to MVMJ had a transient response to radical radiotherapy. Only 1 of 9 patients responding to chemotherapy and then relapsing responded to subsequent radical radiotherapy.

Patients with metastatic disease or with recurrent disease after radiotherapy have a worthwhile chance of responding to chemotherapy and achieve durable remissions. In contrast, radiotherapy appears relatively ineffective in patients whose disease progresses or relapses after chemotherapy given as primary treatment with curative intent.
Haemospermia
Authors: GANABATHI K. , CHADWICK D. , FENELEY R. C. L. , GINGELL J. C.
Published: December 2008

Haemospermia is a frightening symptom. Many cases are of benign aetiology but 5 to 10% will have underlying malignancy. Many younger patients require only routine clinical examination, urine analysis and reassurance, but patients aged over 40 years, those with persistent haemospermia, or those with associated haematuria require urological investigation. Imaging of the prostate and seminal vesicles with transrectal ultrasound is of particular value in the investigation of these patients.
Recurrent Infection Stones with Apparently Negative Cultures. The Case for Blind Antibacterial Treatment
Authors: ROSE G. A. , ROSENBAUM T. P.
Published: December 2008

Infection stones in the urinary tract are always associated with infection with a urease‐producing, urea‐splitting organism. The most common of these organisms are easy to culture and identify and can be treated early either with an appropriate antibiotic or with an anti‐urease agent. Ureaplasma urealyticum and Corynebacterium urealyticum are urease‐producing organisms which are difficult to grow; their presence and effects frequently go undetected and untreated. Other organisms, as yet unknown, may also be involved in the same process.

We report the first series of 8 patients with recurrent infection‐type stones likely to have been caused by a “hard to grow” organism. Five patients never had a positive culture; in 2 patients 1 of 10 urine cultures grew a coagulase‐negative Staphylococcus and in 1 patient the same organism was grown from a stone but never in the urine.

The clinical course of all of these patients was significantly improved after blind treatment with antibiotics and in one case with an anti‐urease agent.
Urinary Tract Metastasis from Renal Carcinoma
Authors: GELISTER J. S. K. , FALZON M. , CRAWFORD R. , CHAPPLE C. R. , HENDRY W. F.
Published: December 2008

Five patients with urinary tract metastases from renal carcinoma are presented. In 4, urinary tract metastasis occurred in the absence of spread elsewhere. The initial presentation in 1 patient was ureteric obstruction; 3 others re‐presented with haematuria and the fifth patient was diagnosed post mortem. Metastatic sites included ipsilateral ureter, contralateral ureter, ureteric stump, bladder and prostatic fossa.

After previous nephrectomy for renal carcinoma, urinary metastases, although rare, should be considered and investigation of unexplained haematuria should include the ureteric stump. Useful palliation and possibly cure can be achieved by resection of these lesions.
Calcium Balance, Growth and Skeletal Mineralisation in Patients with Cystoplasties
Authors: MUNDY A. R. , NURSE DIANE E.
Published: December 2008

Twelve adult female patients and 16 children who had undergone augmentation cystoplasty at least 2 years previously were studied to assess calcium balance and skeletal mineralisation.

The serum and 24‐h urinary calcium levels were measured and arterial blood gas analysis was performed in all patients. In children, skeletal mineralisation was assessed by serial study of their growth charts, comparing their growth centiles before and after cystoplasty. In adults, skeletal mineralisation was assessed by dual photon absorptiometry (DPA).

As previously reported, all patients had a metabolic acidosis, usually with respiratory compensation. Serum and 24‐h urinary calcium levels were all within the normal range. Growth charts of the 6 children with colocystoplasties showed an average of 20% reduction in growth potential in 3 of them. Growth charts in the 10 children with ileocystoplasties did not show any change in growth pattern. DPA bone scans in adults were all normal.

These results suggest that if calcium is mobilised from bone in patients with a cystoplasty as a result of the metabolic acidosis, then it is reabsorbed from the bladder by the gut segment after an ileocystoplasty; colonic segments are less efficient than ileal segments, however, so that after a colocystoplasty skeletal demineralisation or a reduction in growth potential is more likely.
Urinary Flow Rate in Benign Prostatic Hypertrophy in Relation to the Degree of Obstruction of the Vesical Outlet
Authors: CUCCHI A.
Published: December 2008

Forty men with bladder outflow obstruction from benign prostatic hypertrophy were investigated urodynamically by medium‐fill water cystometry and pressure flow study. The most obstructed patients proved to be unstable. A positive link was found between the degree of obstruction, as assessed by the opening pressure (i. e. the detrusor pressure needed to start micturition), and the maximum mechanical power generated by the contracting bladder during voiding. What seems most striking, is that neither detrusor contraction velocity nor the urine flow rate fully mirrored the degree of obstruction–i. e. the opening pressure and the maximum contraction speed did not show a negative correlation, but rather a weak (though insignificant) positive link, and the flow rate decreased only slightly (not significantly) when obstruction increased. Such a surprising observation could be explained by the fact that prostatic obstruction produces both collagen infiltration into the bladder muscle (this affecting the spread of the depolarisation wave) and, at the same time, denervation supersensitivity. The latter actually yields a decrease in electrical resistance between the detrusor smooth muscle cells (and thereby an enhanced synchronisation of the detrusor contraction), which might be only partly cancelled by the effects of collagenosis.
Squamous Metaplasia in the Penile Urethra due to Oestrogen Therapy
Authors: RUSSELL G. A. , CROWLEY T. , DALRYMPLE J. O.
Published: December 2008

Histological examination was performed on the anterior penile urethra from 21 asymptomatic trans‐sexual patients taking oestrogens prior to surgery. Squamous metaplasia was present in 15 of these patients and in 1 man taking progesterones. Immunohistochemical staining for oestrogen receptors in the urethra was negative. Severe squamous metaplasia was associated with patchy chronic inflammatory cell infiltration but this was also present in normal controls. The lack of recognised complications of squamous metaplasia at this site suggests that it is an incidental observation in men taking oestrogens.
Comparison of DMSA Scintigraphy with Intravenous Urography for the Detection of Renal Scarring and its Correlation with Vesicoureteric Reflux
Authors: ELISON B. S. , TAYLOR D. , Van der WALL H. , PEREIRA J. K. , CAHILL S. , ROSENBERG A. R. , FARNSWORTH R. H. , MURRAY I. P. C.
Published: December 2008

A series of 208 patients was prospectively assessed for reflux nephropathy by intravenous urography (IVU) and 99mTc‐dimercaptosuccinate (DMSA) scintigraphy. All patients were studied at least 3 months after their most recent urinary tract infection and micturating cystourethrography (MCU) was performed prior to the scintigraphic studies. DMSA scintigraphy detected significantly more cortical abnormalities than did IVU. There was also a correlation between cortical abnormalities in the DMSA studies and the degree of reflux on MCU.

The validity of DMSA as a cortical imaging agent is evaluated and the histological evidence for its efficacy derived from the animal model is reviewed, lending weight to its establishment as the “gold standard” for renal cortical scarring.
Extracorporeal Shock Wave Lithotripsy for Renal Calculi in Children
Authors: MISHRIKI S. F. , WILLS M. I. , MUKHERJEE A. , FRANK J. D. , FENELEY R. C. L.
Published: December 2008

Fifteen children (8 male and 7 female) with an age range of 18 months to 15 years were treated with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Two children had a history of metabolic stone disease and 1 child had previously undergone open stone surgery. Four children were treated with a ureteric stent in place and 1 nephrostomy was inserted before treatment. All children were treated under general anaesthesia and all of the stones treated were confined to the kidney and ranged in size from 5 mm to a complete staghorn.

The number of treatments ranged from 1 to 6 and generator voltage ranged from 16 to 19 kV with a maximum number of 30,000 shocks to a complete staghorn. Complications were minimal, with 3 children presenting with colic, 1 child requiring a stent and none requiring a nephrostomy after treatment. The overall stone clearance rate at 3 months was 65%.

ESWL provides an effective treatment for selected calculi in children. In the short term, complications are minimal but the long‐term effects on children need to be monitored.
Surgery for Hypospadias Fistula
Authors: EARDLEY I. , WHITAKER R. H.
Published: December 2008

The results of 12 years' experience in the surgical treatment of hypospadias fistula are presented. Overall, there was a success rate of approximately 50% for each attempt at surgical closure of a fistula. The chances of success were not significantly influenced by the number of previous surgical procedures. The best results were obtained with fistulae on the shaft of the penis which were closed with mucosal inversion and advancement of a skin flap over the fistula.
Compensatory Hypertrophy Effectively Assesses the Degree of Impaired Renal Function in Unilateral Renal Disease
Authors: O'SULLIVAN D. C. , DEWAN P. A. , GUINEY E. J.
Published: December 2008

Summary— A series of 66 children with unilateral renal disease and normal total renal function were reviewed with the aim of determining whether clinically detectable compensatory hypertrophy indicated severe contralateral renal impairment. The proportion of total renal function that was contributed by each kidney was determined using isotope renography (99mTc‐DTPA for 46 children, 99mTc‐DMSA for 20). Kidney length was measured from plain abdominal radiographs or intravenous urograms and hypertrophy was expressed as the renal size index (RSI). Of 37 kidneys with a RSI greater than 2 standard deviations from the mean, 36 had less than 15% of total function in the contralateral diseased kidney. Kidneys with less than 10 or 15% of total renal function could be selected with 97 or 80% sensitivity and 84 or 97% specificity, respectively, using the same RSI selection level.
Complications of Clam Enterocystoplasty with Particular Reference to Urinary Tract Infection
Authors: FENN N. , CONN I. G. , GERMAN K. A. , STEPHENSON T. P.
Published: December 2008

Summary— A study was carried out on 112 patients who had undergone a clam procedure. Followup extended from 15 months to 8 years. The efficacy of the operation in achieving and maintaining continence in patients with instability and hyper‐reflexia was confirmed (93% in the neuropathic group, 91% in the congenital instability group and 78% in the idiopathic group).

Complications were common and included inability to void (requiring self‐catheterisation), haematuria, mucus production and recurrent urinary tract infection. Complete bacteriological data were obtained on 80 patients; 30% were infected pre‐operatively (all but 4 in the neuropathic group) but 66% had bacteriuria at the time of assessment after surgery. Subjectively, 17 patients (24%) who “never” got infected had bacteriuria, as did 29 (63%) of those who were “occasionally” infected. Objectively, 84% of patients on intermittent self‐catheterisation (ISC) had positive cultures, but even in those voiding spontaneously bacteriuria was present in 60%.

Careful follow‐up of these patients is mandatory and a more rigorous approach to eradication of infection and subsequent prophylaxis has been instituted.
A Self‐administered Patient Questionnaire in the Assessment of Symptoms before and after Prostatectomy
Authors: BARDSLEY M. J. , VENNING PAM M. , CHAM C. W. , HASAN T. , NEAL D. E.
Published: December 2008

Summary— A self‐administered patient questionnaire was developed to assess the severity of key symptoms before and after transurethral prostatectomy (TURP). This questionnaire was validated by comparison with a standard assessment performed by the doctor. Complete data were obtained on 39 men studied before and 3 months after prostatectomy.

Close associations were found between the scores resulting from the assessments performed by the patient and those carried out by the doctor. These associations were found for individual scores and for aggregate scores for obstructive and irritative symptoms before and after operation.

Symptom scores after operation were significantly related to the patients' overall assessment of whether the operation had been a success–a low score being associated with a satisfactory outcome. It is suggested that self‐administered symptom questionnaires can give a reliable picture of the outcome of prostatectomy and might be useful in developing audit systems.
Comparison of Effects following the Intracorporeal Injection of Papaverine and Prostaglandin E1
Authors: CHEN JANG‐KWANG , HWANG THOMAS I. S. , YANG CHI‐REI
Published: December 2008

Summary— A study group of 240 impotent men receiving intracorporeal injections were divided into 2 groups: the first group received papaverine (60 mg) and the second prostaglandin E1 (PGE1 20 μg). The effect of the drugs was evaluated according to the onset of erection, rigidity and the duration of erection; 136 patients were treated with papaverine and 104 with PGE1. The onset of action in these groups was 6.42 ± 5.39 vs 10.14 ± 5.41 min; the rigidity score was 3.37 ± 0.89 vs 3.60 ± 1.10 and the duration of erection was 49.56 ± 62.56 vs 63.60 ± 44.57 min respectively. There was a significant difference in the onset of action (PGE, was slower than papaverine) and maintenance of erection (longer with PGE1, than with papaverine). Another group of 17 patients received both papaverine and PGE1. The effects of papaverine were better in 4 cases, worse in 5 and equal to PGE1 in 8. This study indicates that compared with papaverine, treatment with PGE1 produces a slower onset of action, a longer duration of erection and fewer side effects.
Skin Chordee without Hypospadias–an Under‐recognised Entity
Authors: SPEAKMAN M. J. , AZMY A. F.
Published: December 2008

Summary— Skin chordee is a congenital abnormality due to failure of development of the mesenchyme surrounding the primitive urethra. It is frequently misdiagnosed as hypospadias. We describe the presentation and surgical management of 12 patients who presented to this hospital over the past 3 years.
Personal Computers and Urological Research
Authors: CARTER P. G. , ADAMS D. , ABRAMS P.
Published: December 2008

Summary— The value of a computer in urological research depends not only upon an appropriate and informed choice of hardware, but also the purchase of software programs which will facilitate input, manipulation and transfer of relevant data. Acquaintance with the Data Protection Act is essential, as is registration as a data user in most cases.
Prognostic Value of Renal Venous Involvement in Renal Carcinoma
Authors: VIRDI J. S. , KELLY D. G.
Published: December 2008

Summary— A series of 108 renal tumour nephrectomies carried out between 1975 and 1984 was studied to determine the prognostic statistical significance of the relationship between venous involvement and various pathological features. Tumour size, spread, histological grade and lymph node involvement were compared between VO tumours (58%), V1 (32%) and V2 tumours (10%). Actuarial 5‐year survival rates revealed a poor prognosis with venous involvement (VO 66%, V1 27%, V2 33%). Tumours larger than 10 cm with perirenal spread and of higher histological grade were significantly related to venous involvement. Survival between renal vein involvement and inferior vena caval extension was statistically similar, but it was influenced by tumour size and higher grade. Perirenal spread and nodal involvement were poor indicators.
Phase II Clinical Trial of Recombinant alpha‐2 Interferon for Biopsy‐proven Metastatic or Recurrent Renal Carcinoma
Authors: ROSENTHAL M. A. , COX K. , RAGHAVAN D. , GRYGIEL J. J. , WINES R. D. , MAMEGHAN H. , ROGERS J.
Published: December 2008

Summary— Twenty patients with histologically confirmed metastatic or recurrent renal carcinoma were treated in a phase II study with alpha‐interferon (2–5 × 106 U/m2 subcutaneously, 3 times a week). Nineteen patients had multiple sites of disease and 18 had previously undergone nephrectomy; 9 had an ECOG performance status of 0·1, and 11 had a performance status of 2–3. There was one partial response, yielding an overall response rate of 5%. Treatment was well tolerated, although 7 patients developed influenza‐like symptoms, and in 2 cases this was sufficiently severe for the patients to request cessation of treatment. As a single agent at this dose schedule, alpha‐interferon has minimal activity in the treatment of renal carcinoma and cannot be recommended as standard therapy. The difference in outcome between this and some published series may reflect the stringent requirement for histological proof of the presence of metastases.
Induction of Carcinoma at Ureterosigmoid Anastomosis–with and without Faecal Stream
Authors: MIERSCH W.‐D. E. , VOGEL J.
Published: December 2008

Summary— The induction of tumours at the site of uretero‐intestinal anastomosis was investigated in Hannover: WISTAR rats. The rats were divided into 3 groups. In one group (n = 70) the ureter of the left kidney was implanted into the colon, using microsurgical techniques developed for humans. In 13% of the rats in this group benign tumours developed; in 16% malignant tumours occurred. In a second group (n = 76) the ureter was implanted into a rectal bladder; the faeces were excluded from the anastomosis by a descending colon anus praeter. In this group benign tumours developed in 17% and malignant tumours in 8%, all of them being situated at the site of the anastomosis. In a control group (n = 80) no colonic tumour could be identified.
Anti‐reflux Surgery by Injection of Teflon Paste
Authors: KONDO A. , YOSHIKAWA Y. , NAGAI T. , SAITO M.
Published: December 2008

Summary— Over a 3‐year period, 55 refluxing ureters in 36 patients were treated by the endoscopic injection of Teflon paste. Although reflux was corrected immediately in 54 ureters (98%), reflux recurred 3 to 4 months later in 18 ureters. Reinjection was carried out once in 5 ureters and twice in 1. The success rate was 71% in primary reflux and 53% in secondary reflux.

Significant side effects were encountered post‐operatively in 3 patients: vesicoureteric junction obstruction in 2 and urethral stricture in 1. We recommend that the results of surgery should not be evaluated until at least 3 to 4 months after operation. A review of the literature shows that the overall success rate was 92% in 367 ureters with primary reflux and 70% in 181 ureters with secondary reflux. Because of the uncertain outcome of surgery and the possibility of adverse side effects, one should be cautious when considering this form of treatment in young children.
J‐wire Facilitates Retrograde Manipulation of Ureteric Calculi Prior to Extracorporeal Shock Wave Lithotripsy
Authors: PARR N. J. , RITCHIE A. W. S. , SMITH G. , TOLLEY D. A.
Published: December 2008

Summary— During a 13‐month period, 55 patients underwent attempted retrograde manipulation for ureteric lying above the pelvic brim. The mean stone burden was 11 mm (range 5–21); 41 stones (75%) were primary ureteric calculi and 14 (25%) were fragments resulting from extracorporeal shock wave lithotripsy to renal calculi. The method of retrograde manipulation was recorded prospectively. Retrograde flushing through an 8F angiography catheter with a mixture of saline and lignocaine gel was successful in 27 patients (49%). The insertion of a J‐wire through the angiocath allowed for successful manipulation in a further 17 patients (31%). Retrograde manipulation was impossible in 11 patients (20%). There were 4 complications (7%), none attributable to the use of a J‐wire.
Dialysis in Patients with Upper Urinary Tract Transitional Cell Carcinoma
Authors: PERSAD R. A. , GILLATT D. A. , HARRISON P. , ABRAMS P. H.
Published: December 2008

Summary— In some patients with primary malignant disease of the kidney the only way of achieving a cure may involve radical surgery. If the tumour is bilateral or involves a solitary kidney, renal failure may be unavoidable. The role of dialysis and transplantation in these patients following “curative” cancer surgery is not clear. A review of the literature and experience with 4 patients who ultimately had bilateral nephrectomies for multiple recurrent upper tract urothelial malignancy is reported. These 4 patients remained free of tumour recurrence on dialysis at 5, 8, 12 and 72 months respectively since commencing dialysis, although 2 have died from unrelated causes. It would seem reasonable to offer dialysis followed by subsequent transplantation in this group of patients after a period of 1 to 2 years has elapsed without any evidence of malignant recurrence.
Reconstruction of the Lower Urinary Tract for Neurogenic Bladder: Lessons from the Adolescent Age Group
Authors: WOODHOUSE C. R. J.
Published: December 2008

Summary— Of 42 adolescents with neurogenic bladder who presented for lower urinary tract reconstruction, 4 patients with severe spina bifida were unfit for major surgery.

Five patients had a simple undiversion; 4 of these had a poor outcome because of unpredicted sphincter incontinence (1 patient) or instability (3).

A total of 26 patients had an enterocystoplasty. All 7 patients who had a substitution cystoplasty had a good result, as did 3 males with a clam cystoplasty. Nine of 16 females had a poor result from a clam procedure. In 3 the problem lay with self‐catheterisation difficulties. One each had persistent hyper‐reflexia and sphincter incontinence. Four had hyper‐reflexia on sexual intercourse.

Overall, 42% of females had problems from the retained bladder segment.

Seven patients had continent urinary diversions. The results were good, although 2 Kock nipples required revision.

Surgery was well tolerated. There was a 21% re‐operation rate for complications.

Pre‐operative investigation correctly predicted sphincter competence and the need for self‐catheterisation in 79 and 86% respectively.
Total Substitution of the Lower Urinary Tract. A Technique for either Reconstruction or Continent Diversion
Authors: MUNDY A. R.
Published: December 2008

Summary— A technique is described in which the right side of the colon is used for substitution cystourethroplasty, based on the flap valve principle, in order to produce a continent catheterisable outflow. The technique can equally well be used for continent diversion.
Open or Transurethral Surgery for the Large Prostate Gland
Authors: LEWIS D. C. , BURGESS N. A. , HUDD C. , MATTHEWS P. N.
Published: December 2008

Summary— A comparative study of transurethral (TUR) and open prostatectomy for the large prostate gland has been carried out. Over a 5‐year period 94 transurethral resections and 73 open procedures were performed for prostate glands weighing more than 50 g. There was a single death in each group, giving relative mortality rates of 1.1% TUR and 1.4% open. The post‐operative hospital stay was significantly shorter in the TUR group. The open group suffered significantly more complications in the first week but the TUR patients, although having fewer immediate postoperative complications, had significantly more in the first year, so that overall complication rates were similar (35% vs 36%). Patient satisfaction was equal in both groups.