bluuebunny/crossref_metadata_2025 huggingface dataset:
Periurethral collagen injection: a long‐term follow‐up study
Authors: Gorton  , Stanton  , Monga  , Wiskind  , Lentz§  , Bland¶
Published: March 2003

Objective

To determine the long‐term success of the periurethral injection of collagen (Contigen® , Bard UK) in women with genuine stress incontinence.

Patients and methods

Sixty‐one women with genuine stress incontinence were enrolled in a trial of periurethral collagen injections between 1 September 1990 and 31 August 1992. They were assessed at 1, 3, 6, 12 and 24 months after the last collagen injection. In 1998, their notes were reviewed, and a standardized questionnaire was sent to 46 women who were still alive and had undergone no further anti‐incontinence surgery.

Results

Of the 53 women who were either known failures or who had follow‐up information beyond 5 years, 26% were subjectively improved. Women who had a maximum urethral closure pressure of >20 cmH2O and those who had urinary incontinence for <10 years before their first injection were more likely to have had long‐term success. There was no correlation between long‐term success and the number of previous operations, body mass index, age or preoperative pad loss. Neither the number of injection sessions, total volume of collagen injected nor perceived bulking at the time of surgery affected long‐term success rates. Of the 14 women who considered themselves subjectively improved, seven had daily incontinence and only one was completely dry. Urinary retention and urinary tract infection were the most common complications. In addition, one woman reported a flare‐up of her skin test and transient ‘flu‐like symptoms 2 weeks after the injection, and one woman developed a right upper lobe pneumonia 2 weeks after the collagen injection.

Conclusion

The long‐term results of periurethral collagen injections are disappointing. We found no evidence to support the use of periurethral collagen injections in women with intrinsic sphincter deficiency, who had a higher failure rate than those with hypermobility. Further research is essential to develop agents that are not immunogenic, produce minimal inflammatory response and yet are durable.
Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction
Authors: Orhan  , Onur  , Çayan  , Koksal  , Kadiogˇlu
Published: March 2003

Objective

To determine the effectiveness of seminal vesicle aspiration in the diagnosis and treatment of patients with ejaculatory duct obstruction.

Patients, subjects and methods

Between March 1998 and February 1999, 10 infertile men with ejaculatory duct obstruction (EDO, mean age 32.7 years, range 25–47) and 10 fertile volunteers (mean age 33.2 years, range 25–42) underwent transrectal ultrasonography (TRUS) and TRUS‐guided seminal vesicle aspiration. The volume of and presence of motile sperm in the aspirate was compared with the TRUS findings for both groups.

Results

From TRUS of the patients with EDO, the mean (sd, range) transverse diameter of the right and left seminal vesicles were 1.97 (0.54, 0.8–2.6) cm and 1.93 (0.53, 0.9–2.6) cm; the corresponding values in the control group were 1.03 (0.15, 0.8–1.3) cm and 1.0 (0.12, 0.8–1.4) cm, respectively (P<0.001). In all, 20 aspirate samples were obtained from the patients with EDO by bilateral seminal vesicle aspiration and only one (10%) had no sperm within the aspirate fluid. Of these 10 patients, two had immotile sperm and the remaining seven (14 samples) had a mean motile sperm count of 0.63 (0.45, 0.1–1.0)×106 /mL, whereas seven of eight men assessed in the control group had no motile sperm (one patient had immotile sperm within the aspirate fluid); this difference was significant (P<0.01).

Conclusions

The aspiration of significant numbers of motile sperm from the seminal vesicles suggests the presence of distal obstructions of the ejaculatory duct and enables infertile couples to be candidates for assisted reproduction. However, there is a need for further research to determine the use of this technique in the diagnosis of partial EDO.
Uneven pressure application by the artificial urinary sphincter: an explanation for tissue ischaemia?
Authors: Hajivassiliou  , Finlay
Published: March 2003

Objective

To determine, in an in vitro study, the pressure inside the AMS 800 (American Medical Systems, USA) sphincter placed around porcine intestine and to correlate this with the pressure retention for liquids, in an attempt to explain the increased sensitivity of bowel to ischaemic injury when the artificial urinary sphincter is used around bowel neo‐urethral segments.

Materials and methods

Segments of porcine intestine were placed in a specially designed mechanical jig and an AMS 800 sphincter placed around the segment. The device was inflated by injecting water and the cuff pressure measured. Water was infused into the bowel and the pressure at which leakage occurred through the sphincter recorded. At each inflation pressure, a catheter‐tipped microtransducer was used to measure the pressure inside the cuff‐fold. It was then placed in the centre of the cuff lumen, rotated by 360° and the pressure continuously recorded.

Results

The cuff occluded the lumen by creating a ‘triple‐cushion’ effect. The fluid retention pressure was ≈49% of the cuff pressure. There were directional differences in the pressure measured inside the bowel lumen. The pressure was also disproportionately higher inside the cuff folds than in the centre of the sphincter, and increased rapidly with inflation of the cuff.

Conclusion

The thin wall of the bowel may ‘crenate’ inside the high‐pressure areas in the cuff folds and this may explain the increased sensitivity of bowel to ischaemic injury in such cases.
Brefeldin A‐induced apoptosis in prostatic cancer DU‐145 cells: a possible p53‐independent death pathway
Authors: Chapman  , Tazaki  , Mallouh  , Konno
Published: March 2003

Objective

To investigate the growth inhibitory mechanism of brefeldin A (BFA), an antiviral antibiotic, in androgen‐independent prostatic cancer DU‐145 cells.

Materials and methods

The inhibitory effects of BFA (30 ng/mL) on cell growth were monitored by cell counting and viability tests after specified exposures. Flow cytometry and western immunoblot analysis were performed to examine the effects of BFA on the cell cycle and on specific growth regulators. The possible induction of apoptosis by BFA was further assessed by in situ hybridization (ISH) assay and by qualitative DNA analysis using agarose‐gel electrophoresis.

Results

Cell growth was completely inhibited with BFA (30 ng/mL), accompanied by 40–50% cell death. Cell cycle analysis revealed that this growth inhibition coincided with an 85% reduction in the S‐phase cell population. Western blots showed that the expression of cell cycle‐dependent kinases (cdk2 and cdk4), cyclin D1 and p53 was significantly reduced, while WAF1 was increased, after BFA treatment. Apoptosis was confirmed by both the ISH assay, which showed the characteristic brownish staining of BFA‐treated cells, and by DNA analysis, which revealed the internucleosomal DNA ladder.

Conclusion

BFA‐induced growth inhibition in DU‐145 cells is primarily due to the modulation of specific G1 cell‐cycle regulators, blocking the G1–S phase progression. Such a growth arrest ultimately results in apoptosis, presumably through a p53‐independent pathway.
The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy
Authors: Clobes H. , Fosså S. D. , Wæhre H. , Jocham D. , Berner A.
Published: March 2003

Objective To detect occult regional lymph node metastases in patients with T3pN0M0 prostate cancer not recognized by routine haematoxylin and eosin staining, and to evaluate the clinical relevance of this finding.

Patients and methods Formalin‐fixed and paraffin‐embedded pelvic lymph nodes (1118) from 92 patients were evaluated by immunohistochemistry using antibodies for prostate specific antigen (PSA) and pancytokeratin (AE1/AE3). Of the tumours, 14% were well, 69% moderately and 17% poorly differentiated. The extent of tumour was categorized as T3pN0M0 in all patients, who were referred for definitive radiotherapy after pelvic staging lymphadenectomy. The median (range) serum PSA value before treatment was 18.5 (0.4–342) µg/L. After radiotherapy, the patients were followed by assessing biochemical progression, pelvic recurrence and/or development of distant metastases. The median (range) observation time for all patients was 61 (16–136) months.

Results Occult lymph node metastases were detected in four (4.4%) of the 92 patients. Patients with or without occult metastases had similar serum PSA levels and histological grades. None of the four patients with occult metastases progressed, compared with 37 of the 88 (42%) with no such metastases.

Conclusion Using immunohistochemistry the detection rate of occult lymph node metastases in patients with T3pN0M0 prostate cancer is low. The occurrence of such metastases is probably unrelated to the serum PSA value before treatment. The short‐term outcome of patients subsequently treated with definitive radiotherapy does not seem to be associated with the finding of occult lymph node metastases, but long‐term follow‐up is needed. So far, the results do not justify the search for occult lymph node metastases as a routine procedure in these patients
Low‐grade left varicocele in patients over 30 years old:the effect of spermatic vein ligation on fertility
Authors: Grasso M. , Lania C. , Castelli M. , Galli L. , Franzoso F. , Rigatti P.
Published: March 2003

Objectives To evaluate the effect of spermatic vein ligation in patients over 30 years old and with low‐grade left varicocele, and thus help to establish whether such patients might benefit from surgery.

Patients and methods A randomized study was conducted on 68 infertile patients (30–38 years old) with evidence of sperm abnormalities and who had low‐grade varicocele (grade I according to Hirsch), comparing left spermatic vein ligation with no treatment. The outcome was assessed by standard sperm analysis and eventual paternity.

Results There was no improvement in sperm quality in either of the groups one year after surgery, and no significant difference in paternity.

Conclusions Left spermatic vein ligation for low‐grade varicocele in patients more than 30 years old cannot be recommended.
Homologous bladder augmentation in dog with the bladder acellular matrix graft
Authors: Probst M. , Piechota H.J. , Dahiya R. , Tanagho E.A.
Published: March 2003

Objective To determine the functional potential and antigenicity of the homologous bladder acellular matrix graft (BAMG) in a dog model.

Materials and methods Seven mongrel dogs underwent partial cystectomy (20–50%) and grafting with an equal‐sized BAMG; two control animals underwent partial cystectomy (40%) only. The dogs were killed after 30 (one), 120 (one) and 210 days (five dogs). Blood samples were obtained before and at 1, 2, 4, 7, 14, 30, 90 and 210 days after surgery. The dogs underwent cystography, intravenous pyelography and ultrasonography before and after surgery, and on the day they were killed, with cystoscopy carried out just before death. The grafted tissue was assessed using routine and immunohistochemical techniques.

Results All the dogs survived surgery; a complete blood cell count, chemical panel and white blood cell count showed no significant difference between the experimental and control animals. Cystography, cystoscopy and ultrasonography revealed no pathological changes in the upper urinary tract. After 7 months, the mean bladder capacity in the augmented dogs was significantly higher (P = 0.035) than in the controls (264 vs 172 mL). Histological evaluation showed an invasion of all bladder wall components during the first month; at 7 months, the morphological examination showed essentially complete regeneration.

Conclusion In this dog model, the potential of the BAMG as a bladder augmentation graft was confirmed, having minimal antigenicity with maximal acceptance. The reconstructed bladder matched the morphological and functional properties of the normal bladder.
Cryoablation for clinically localized prostate cancer using an argon‐based system: complication rates and biochemical recurrence
Authors: De La Taille A. , Benson M.C. , Bagiella E. , Burchardt M. , Shabsigh A. , Olsson C.A. , Katz A.E.
Published: March 2003

Objective To determine the complication rates and biochemical recurrence after cryoablation of the prostate, using an argon gas‐based system, in patients with localized prostate cancer.

Patients and methods Between October 1997 and June 1999, 35 patients underwent cryoablation of the prostate (19 after radiation therapy failure and 16 as a primary treatment for localized prostate cancer). All patients had biopsy‐confirmed prostate cancer with no seminal vesicle invasion, negative bone scans and a negative lymph node dissection. Patients received 3 months of combined hormonal therapy before cryosurgery. One surgeon performed all the procedures. Biochemical recurrence was defined by an increase in prostate specific antigen (PSA) of ≥ 0.2 ng/mL above the PSA nadir.

Results The complications were rectal pain (26%), urinary infection (3%), scrotal oedema (12%), haematuria (6%) and incontinence (6%). Complication rates were higher in those patients who failed after radiation therapy than in those who did not receive radiation (incontinence 11% vs 0%, rectal pain 37% vs 12%) but the difference was not statistically significant. Twenty‐two patients (63%) had an undetectable serum PSA nadir (< 0.1 ng/mL) after cryotherapy and 30 (84%) patients had a PSA value of < 1.0 ng/mL. After a mean follow‐up of 8.3 months (range 0.2–18), nine patients had biochemical recurrence. The biochemical recurrence‐free survival (BRFS) was 70% at 9 months. Patients who had an undetectable PSA nadir had a statistically higher BRSF at 9 months than did patients who had a detectable PSA nadir (89% vs 55%, respectively, P = 0.03). Similarly, patients with a preoperative serum PSA level of < 10 ng/mL had a statistically higher BRFS than patients who had a PSA level of > 10 ng/mL (86% vs 42% at 9 months, P < 0.001).

Conclusion A PSA level before cryotherapy of < 10 ng/mL and an undetectable PSA nadir after cryotherapy were associated with the highest BRFS. Cryoablation of the prostate, with low morbidity, seems to be a viable option in managing patients by salvage therapy after radiation therapy and for the primary treatment of clinically localized prostate cancer.
Priapism in adult Nigerians
Authors: Aghaji A.E.
Published: March 2003

Objectives To review the presentation and treatment of adult Nigerians with priapism.

Patients and methods Thirty‐five men (mean age 35 years, range 20–54) were seen over a 12‐year period. All patients underwent an immediate modified or conventional cavernospongiosus shunt and were assessed at 2, 6 and 12 weeks after discharge for erection, orgasm and fibrosis of corpora cavernosa.

Results Ten patients initially presented to traditional healers and 13 presented early to qualified medical practitioners, and were managed conservatively. As a result, 21 of the 35 patients presented to the author’s hospital 6–10 days after the onset of erection. Many did not realise that priapism was abnormal, or had no money to attend hospital. After surgical treatment detumescence was obtained in all patients and maintained. At 12 weeks, 14 patients had normal erections, 13 reduced erections and eight no erections. A local aphrodisiac was identified as the commonest predisposing factor, followed by sickle‐cell disease.

Conclusion This study shows clearly that even if a patient with priapism presents late, vigorous treatment in the form of an adequate shunt should be undertaken as soon as possible, as this is the only chance the patient has to regain potency.
Bacillus Calmette–Guérin instillation treatment for carcinoma in situ of the upper urinary tract
Authors: Nishino Y. , Yamamoto N. , Komeda H. , Takahashi Y. , Deguchi T.
Published: March 2003

Objective To analyse the efficacy and safety of bacillus Calmette–Guérin (BCG) perfusion treatment forcarcinoma in situ (CIS) of the upper urinary tract.

Patients and methods Six patients with cytologically diagnosed CIS of the upper urinary tract were treated by BCG instillation via retrograde catheterization using a 6 F ureteric catheter or an 8 F indwelling JJ ureteric stent between the ureter and bladder. BCG (Tokyo 172 strain, 80 mg in 100 mL normal saline) was instilled weekly for 4 or 8 weeks. The efficacy and safety of the treatment was assessed.

Results The mean (range) follow‐up was 22 (9–38) months; none of the patients died, and all were negative for cytology in urine collected from the upper urinary tracts. However, one patient had recurrent CIS in the prostatic urethra; the patient was treated by intravesical BCG instillation. In all patients, positive cytology became negative after one or two instillations of BCG. The ureter became stenotic in two patients. Although irritative symptoms occurred in all patients, such side‐effects disappeared in a few months and were not clinically significant.

Conclusion In these six patients retrograde BCG instillation for CIS of the upper urinary tract was effective and safe. Based on the cytology results after only two BCG treatments, the dose or number of BCG instillations could possibly be reduced, but further study is needed.
Urinary tract abnormalities in children with acute focal bacterial nephritis
Authors: Uehling D.T. , Hahnfeld L.E. , Scanlan K.A.
Published: March 2003

Objective To review the presentation, methods of diagnosis, and incidence of concomitant urological abnormalities in children with acute focal bacterial nephritis (AFBN, also known as lobar nephronia, a severe nonliquefactive infection involving one or more renal lobules).

Patients and methods Sixteen children (age range 6 months to 9 years) diagnosed with AFBN over a 5‐year period were retrospectively reviewed. Their age, gender, presenting symptoms, presence of urinary tract abnormalities, radiological imaging and treatment were assessed.

Results All 16 children received intensive intravenous and oral antibiotics. Ten required intervention for predisposing conditions including vesico‐ureteric reflux (four), bladder diverticulum (one), renal and peri‐rectal abscess (two), ureteric or bladder calculi (two), and renal mass (one). In addition, three children had reflux not requiring surgery; one had multiple renal calyceal diverticula, one had Hinman syndrome and one had leukaemia.

Conclusion Acute focal bacterial nephritis is being diagnosed with increasing frequency through increasing awareness and advances in imaging modalities. Active urological evaluation is warranted because of the high incidence of urinary tract abnormalities. In addition to antibiotics, intervention was needed in most children in this series.
Genes upregulated during castration‐induced rat prostatic apoptosis: cloning and characterization of new cDNAs
Authors: Bruyninx M. , Ammar H. , Reiter E. , Cornet A. , Closset J.
Published: March 2003

Objective To isolate new cDNAs corresponding to genes whose expression is increased during castration‐induced rat prostate apoptosis.

Materials and methods Differential display of mRNAs from 3‐day castrated and normal rat ventral prostates was used to identify differentially expressed clones. Northern blots were hybridized to confirm the positive regulation of the candidates and to follow the change in their expression in the involuting rat prostate, and in thymocytes of dexamethazone‐treated rats.

Results Five cDNAs were cloned: one encoding ribosomal protein L7, one coding for the insulin‐like growth factor binding protein‐3 (IGFBP‐3), and three whose products are unknown. After castration, all five genes had expression kinetics that closely paralleled the proportion of prostatic epithelial cells undergoing apoptosis. The gene encoding L7 and two of the unknown genes were also upregulated in glucocorticoid‐induced programmed death in thymocytes. In addition to the IGFBP‐3 gene, those coding for proteins IGFBP‐4, ‐5 and ‐6 were also overexpressed in the involuting prostate of androgen‐deprived rats.

Conclusion Five new genes were identified that are up‐regulated during castration‐induced rat prostate apoptosis, three of which are potentially involved in the common intracellular pathway leading to programmed cell death.
Early catheter removal in 100 consecutive patients undergoing radical retropubic prostatectomy
Authors: Santis W.F. , Hoffman M.A. , DeWolf W.C.
Published: March 2003

Objectives To investigate the outcome of 100 consecutive patients selected for early catheter removal after radical retropubic prostatectomy (RRP), where urethral catheter drainage is used routinely for 2–3 weeks.

Patients and methods The study included 129 consecutive patients with clinically localized prostate cancer who underwent RRP. Catheters were removed in the clinic (with no radiographic studies) 8–9 days after RRP provided there was no evidence of urine leak, pelvic haematoma, rectal injury or severe obesity. The follow‐up (mean 21 months) results were available for 118 patients, 100 of whom were candidates for early catheter withdrawal. Their records were reviewed for evidence of complications, including urinary retention, anastomotic stricture formation and urinary incontinence.

Results Urinary retention developed in two of the 100 patients, requiring simple catheter replacement. Nine patients developed bladder neck contracture requiring dilatation or incision. No patients developed anastomotic disruption, urinary tract infection or pelvic abscess. At the mean follow‐up of 21 months, 76% of patients were continent and did not require pads; 19% of patients had mild stress urinary incontinence requiring the use of  1 pad/day, 4% of patients had incontinence requiring 2–4 pads/day, and 1% of patients required > 4 pads/day.

Conclusion With appropriate patient selection as described, catheters can be removed in the clinic (with no radiographic studies) 8–9 days after RRP, with no increased incidence of complications, including anastomotic stricture, retention or incontinence.
The morphological changes in rat bladder after photodynamic therapy with 5‐aminolaevulinic acid‐induced protoporphyrin IX
Authors: Grönlund‐pakkanen S. , Pakkanen T.M. , Talja M. , Kosma V.‐M. , Ala‐opas M. , Alhava E.
Published: March 2003

Objective To assess the optimum light energy needed to induce only superficial bladder wall damage during photodynamic therapy (PDT) as a treatment for bladder cancer.

Materials and methods The urinary bladder (with normal epithelium) of 64 female rats was treated with PDT using a continuous‐wave argon‐ion laser as an energy source and aminolaevulinic acid (ALA)‐induced protoporphyrin IX photosensitizer. Four hours after the intravenous administration of ALA (300 mg/kg) the bladders were intravesically exposed to light fluences of 20–80 J/cm2. The control rats received no ALA and were exposed to 20 J/cm2 light. After 1, 3, 7 and 21 days the animals were killed and the morphological changes in bladder wall analysed both macroscopically and using light and scanning electron microscopy.

Results At the dose of ALA given, a fluence of 20–40 J/cm2 caused mainly superficial damage, whereas 80 J/cm2 produced full‐thickness injuries to the bladder wall. The maximum effect of PDT occurred after 1 and 3 days of irradiation. After 3 weeks of PDT the histology showed few full‐thickness injuries and only in those treated with 80 J/cm2 light.

Conclusion These results indicate that PDT can be used to safely induce a selective superficial removal of bladder mucosa with no fibrotic effects on detrusor musculature, when optimum photosensitizing drug and fluences are used. These findings support the use of PDT in the therapy of superficial bladder cancer.
Electrophysiological recordings from the rat prostate gland in vitro: identified single‐cell and transepithelial (lumen) potentials
Authors: Szatkowski M. , Mycielska M. , Knowles R. , Kho A.‐L. , Djamgoz M.B.A.
Published: March 2003

Objective To develop a preparation for the in vitro maintenance of the rat prostate gland and thus allow intracellular and transepithelial voltage measurements.

Materials and methods Ventral prostate glands from male rats were dissected free of connective tissue, separated into smaller lobes and maintained in vitro at 30 °C. Voltages were recorded with sharp micropipettes in identified cellular and luminal compartments, differentiated by several electrophysiological and histological parameters, including intracellular staining.

Results Intracellular epithelial membrane potentials (median −40 mV) and transepithelial or luminal potentials (mean −4.2 mV) were recorded successfully. Luminal epithelial cells were dye‐coupled. Prostate tissue could be maintained in vitro with no apparent electrophysiological or structural deterioration for up to ≈ 7 h.

Conclusion Rat prostate tissue can be successfully maintained in vitro and electrophysiological recordings made from identified cellular compartments.
A new highly specific monoclonal antibody against placental alkaline phosphatase: a potential marker for the early detection of testis tumour
Authors: Nouri A.M.E. , Torabi‐Pour N. , Dabare A.A.N.P.M.
Published: March 2003

Objective To develop specific monoclonal antibodies (mAbs) against human germ cell tumours.

Materials and methods A single‐cell suspension obtained from tumour tissue fragments (consisting of both tumour and normal compartments) from a patient with seminoma was used as an immunogen. Spleen cells from immunized mice were used to develop mAbs. Tissue specificity, biochemical characteristics and competitive studies were analysed using immunocytochemical staining, dot blots and a Western blot analysis, to identify target antigen(s).

Results The immunization protocol led to the development of 107 hybridomas, 90 of which were negative against the original tissue biopsies. The remaining 17 showed positivity against various tissue compartments. One selected mAb (ATC2) showed specific staining on germ cell tumours but not on normal tissues, and positive staining with some human tumour cell lines. The target antigen for ATC2 was confirmed to be placental alkaline phosphatase (PLAP) based on: Western blot analysis compared with commercially available PLAP; comparison of the data with another well‐known anti‐PLAP mAb (H17E2, although the two mAbs recognized different antigenic epitopes); heat resistance characteristics; high‐performance liquid chromatography of the ATC2 target antigen and purified PLAP.

Conclusion The selected mAb ATC2 has high specificity for human germ cell tumours, the target antigen for ATC2 being PLAP, although the antigenic epitope(s) differ from those recognized by H17E2. Thus ATC2 may be useful for monitoring serum levels of PLAP in patients with testis cancer and may be relevant for detecting cancer cells in the semen of individuals with suspected testis cancer, particularly in those with equivocal findings on ultrasonography.
The development of a pig model to study fetal vesico‐ureteric reflux
Authors: Dewan P.A. , Ehall H. , Edwards G.A. , Macgregor D.
Published: March 2003

Objective To develop a surgical protocol to induce vesico‐ureteric reflux (VUR) in utero by ablating the ureteric tunnel in a fetal pig model.

Materials and methods Fetal surgery was conducted on nine sows, which were divided into three groups according to changes in the surgical protocol. Sows in groups 2 and 3 received different anaesthetics and antibiotics, and the operating theatre temperature was increased. In all cases, the intramural part of the ureter was unroofed in the fetuses, which were then returned to the uterus. Upon delivery, cystograms were taken in the male piglets, and the urinary tracts removed for anatomical and histological examination.

Results All three sows in group 1 delivered healthy piglets, but the fetuses that had undergone surgery were mummified. In group 2 the animals survived the fetal intervention, as shown by ultrasonography after surgery, but the four sows aborted spontaneously within a week. In group 3, both sows delivered normally developed piglets, three of which had undergone ablation of the ureteric tunnel. VUR was present only in those renal units in which the ureteric tunnel was ablated, and this was associated with hydronephrosis, dilatation of the ureters and thinning of the renal parenchyma on gross pathological examination.

Conclusions The fetal pig model of VUR not only appears to be feasible, but with similarities in renal anatomy and physiology also seems to be ideal for investigating fetal VUR.
Annual changes in the clinical features of prostatic adenocarcinoma in Taiwan
Authors: Wu T.T. , Huang J.‐K.
Published: March 2003

Objective To determine, using a clinical and pathological database, the annual changes in the characteristics of adenocarcinoma of the prostate diagnosed in consecutive men in Taiwan.

Patients and methods All prostatic adenocarcinomas newly diagnosed between 1991 and 1999 in our institution were analysed. Using logistic regression for dichotomous variables, the annual trends were assessed for changes in the percentage of T1c disease, incidental carcinoma, clinically localized disease and Gleason grade 4/5 cancers. The annual trends for changes in the pathological features of disease in patients treated by radical prostatectomy were also analysed.

Results The study included 694 patients; the median age at diagnosis increased significantly (P = 0.004) and there was a significant increase in clinical T1c disease (relative risk, RR, 1.142, P = 0.022). There were also significant decreases in incidental carcinomas (RR 0.789, P < 0.001), patients with a serum prostatespecific antigen (PSA) level of > 20 ng/mL (RR 0.848, P < 0.001) and with Gleason grade 4/5 tumours (RR 0.919, P = 0.005). There was no significant change in the percentage of clinically localized disease. Radical prostatectomy was undertaken in 179 men; the annual incidence of lymph node metastases decreased significantly (P = 0.035) and there was a significant 19% increase in the RR of having organ‐confined disease (pT1–2N0M0) and a 19% decrease in Gleason grade 4/5 tumours.

Conclusions These results may reflect the annual trends of prostate cancer in Taiwan in the period for which the PSA assay became available. The increasing application of PSA testing was associated with a significant increase in clinical T1c disease and decrease in incidental carcinoma. There was also a significant trend towards less aggressive cancers. Despite the dramatic increase in the annual detection rate, tumours were not detected at an earlier stage. However, for patients treated with radical prostatectomy, there was a significant change to earlier stage disease and fewer de‐differentiated cancers.
The development of the external urethral sphincter in humans
Authors: Ludwikowski B. , Oesch Hayward I. , Brenner E. , Fritsch H.
Published: March 2003

Objective To assess the hypothesis that during fetal development, the external urethral sphincter changes from a concentric sphincter of undifferentiated muscle fibres to a transient ring of striated muscle which regresses caudo‐cranially in the posterior urethra during the first year of life, when the sphincter assumes its omega‐shaped configuration.

Materials and methods The anatomy and development of the external urinary sphincter was assessed in human males and females during fetal life. Plastic‐embedded sections (transverse, sagittal and frontal planes; 300–700 µm) of the pelvis of 31 females and 31 males (9 weeks of gestation to newborn) were stained with azure II/methylene blue/basic fuchsin and viewed at × 4–80. The sections of interest were taken from the bladder neck to the perineum. The sections of the membranous urethra were reconstructed three‐dimensionally using a computer program.

Results In both male and female an omega‐shaped external sphincter was apparent in all specimens at > 10 weeks of gestation. In the early fetal period (ninth week), there was undifferentiated mesenchyme; in this period the mesenchyme was more dense in the anterior part and loose in the posterior part of the urethra. In females, there was a close connection between the urethra and the anterior wall of the vagina.

Conclusion The omega‐shaped configuration of the external urethral sphincter was recognisable from 10 weeks of gestation in both sexes. There was no suggestion of a change from a cylindrical to an omega‐shaped sphincter in the fetal period to birth. Also, a transient ‘tail’ posterior to the sphincter was not apparent. The rectovesical septum was well developed in neonates. There is no reason to assume that the development of the septum leads to an apoptosis of muscle cells in the posterior part of the external sphincter in males after birth. The anatomical development of the external sphincter does not explain transient outlet obstruction during fetal life. The function of the muscle may change during development because of neuronal maturation.
Bladder functional outcome after delayed vesicostomy closure and antireflux surgery in young infants with ‘primary’ vesico‐ureteric reflux
Authors: Podesta M.L. , Ruarte A. , Herrera M. , Medel R. , Castera R.
Published: March 2003

Objective To evaluate bladder function by conventional urodynamic investigations in young infants with primary vesico‐ureteric reflux (VUR) who had undergone an initial temporary cutaneous vesicostomy followed by later antireflux surgery and vesicostomy closure.

Patients and methods From 1983 to 1990, nine boys (10–360 days old) with primary VUR were treated with an initial vesicostomy, followed by delayed closure of the vesicostomy and the simultaneous surgical correction of reflux. Severe VUR was detected bilaterally in seven and unilaterally in two infants at the time of the initial diagnosis. The mean (

sd, range) age at vesicostomy was 12.4 (8, 3–23) months and the duration of bladder defunctionalization 38.7 (25.5, 18–90) months. All patients were assessed urodynamically after closing the vesicostomy, using rapid‐fill cystometry with normal saline solution at room temperature. The mean (range) age at the time of urodynamic testing was 7.3 (5–15) years; the mean (

sd, range) follow‐up was 10.1 (4.1, 5–17) years.

Results Six boys with bilateral VUR underwent successful ureteroneocystostomy; nephroureterectomy was required in one patient. In two patients the VUR resolved with time. After re‐functionalization, the mean (

sd, range) maximum cystometric capacity, expressed as a percentage of the mean bladder capacity for age, was 1.4 (0.5, 0.6–2.2)%. In three patients the bladder capacity was higher ( 40%) than expected for age, while one had diminished (< 70%) bladder capacity. The mean (range) end‐filling detrusor pressure was 14.5 (5–42) cmH2O and the mean (

sd, range) compliance 24 (13.9, 4–44) mL/cmH2O. Two patients had a compliance of < 10 mL/cmH2O, one of whom had associated unstable detrusor contractions of 90 cmH2O. The mean (

sd, range) detrusor voiding pressure at peak flow was 47.3 (16.8, 5–76) cmH2O. One patient had a residual urine volume of 8% of bladder capacity. At the follow‐up, only one patient (aged 5 years) with detrusor instability had urinary incontinence.

Conclusion This study shows that the bladder of young infants with primary VUR treated with temporary vesicostomy regained normal function after re‐functionalization of the lower urinary tract.
Effect of different 5‐hydroxytryptamine receptor subtype antagonists on the micturition reflex in rats
Authors: Testa R. , Guarneri L. , Angelico P. , Velasco C. , Poggesi E. , Cilia A. , Leonardi A.
Published: March 2003

Objective To evaluate the effects of antagonists of different subfamilies of 5‐hydroxytryptamine (5‐HT) receptors on bladder function in anaesthetized and conscious rats.

Materials and methods The urinary bladder of female anaesthetized rats was catheterized urethrally and filled with physiological saline until spontaneous bladder contractions occurred. Infravesical pressure was measured by a pressure transducer and displayed continuously on a chart recorder. The time of bladder quiescence (to the disappearance of rhythmic contractions) after injection with different compounds tested was recorded. Conscious rats underwent cystometry with chronically (infravesical) implanted catheters to continuously record bladder capacity (evaluated as amount of saline infused between voiding cycles) and maximal voiding pressure. The affinity for the human recombinant serotoninergic 5‐HT1A subtype (inhibition of specific binding of [3H]8‐hydroxy‐2‐(di‐n‐propylamino) tetralin) and the effects on the [35S]guanosine 5′‐(γ‐thio) triphosphate (GTPγS) binding in HeLa cells was also evaluated.

Results Among the compounds tested, only 4‐(2′‐methoxy‐phenyl)‐1‐[2′‐(n‐2′′‐pyridinyl)‐p‐iodobenzamido]‐ethyl‐piperazine (p‐MPPI) and methiothepin showed nanomolar affinity for the 5‐HT1A receptors, the former being a neutral antagonist and the latter an inverse agonist in the [35S]GTPγS binding model. Intravenous injection of low doses of p‐MPPI and methiothepin induced a dose‐dependent disappearance of isovolumic bladder contractions in anaesthetized rats (> 10 min). At the highest doses, the dose‐response curves were bell‐shaped. The amplitude of bladder contractions was not markedly altered. The tested antagonists of 5‐HT2, 5‐HT3, 5‐HT4, and 5‐HT6 serotoninergic subtypes were poorly active or inactive in the model. Similarly, these compounds were inactive on cystometry in conscious rats, whereas p‐MPPI and methiothepin induced a consistent increase in bladder capacity. Methiothepin also decreased the voiding pressure, whereas p‐MPPI did not affect this variable.

Conclusions These findings confirm that only selective 5‐HT1A receptor antagonists have favourable effects on the bladder, inducing an increase in bladder capacity with no derangement of bladder contractility.
Capsaicin receptor VR1 and ATP‐gated ion channel P2X3 in human urinary bladder
Authors: Yiangou Y. , Facer P. , Ford A. , Brady C. , Wiseman O. , Fowler C.J. , Anand P.
Published: March 2003

Objectives To determine the presence, distribution and molecular forms of the vanilloid receptor VR1, and confirm the presence and distribution of the ATP‐gated ion channel P2X3 in the human urinary bladder.

Materials and methods Normal urinary bladder tissues were obtained at postmortem from four subjects. Eight urinary bladder biopsies were also taken from patients with detrusor hyper‐reflexia treated with intravesical resiniferatoxin. The specimens were studied using affinity‐purified specific antibodies to VR1 and P2X3 by Western blotting and immunocytochemistry, and compared with immunostaining using antibodies to the pan‐neuronal marker PGP 9.5 and Schwann cell marker S‐100.

Results VR1‐ and P2X3‐immunoreactive fine nerve fibres were scattered throughout the suburothelium of the normal bladder and cystoscopic biopsies, and traversed the muscle layer. They had a similar distribution to PGP 9.5‐immunoreactive fibres, but there were fewer, suggesting localization in subsets of axons. Western blot studies showed an expected 100‐kDa VR1 protein and a P2X3‐immunoreactive 66‐kDa protein.

Conclusion VR1 and P2X3 are present in the human urinary bladder and may contribute to distinct pathophysiological states of bladder overactivity, in accord with their differential expression in sensory neurones. Intravesical vanilloids act via VR1 and are effective in the treatment of detrusor hyper‐reflexia. P2X3 may represent a selective therapeutic target for other causes of overactive bladder.
The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in children
Authors: Thompson A. , Gough D.C.S.
Published: March 2003

Objective To assess the value of renal scintigraphy with 99mTc‐dimercaptosuccinic acid (DMSA) in predicting functional recovery after the surgical relief of obstructed kidneys in children.

Patients and methods Forty‐three children underwent surgery to relieve upper urinary tract obstruction; 37 had pelvi‐ureteric junction obstruction and six had vesico‐ureteric junction obstruction. The indication for surgery was a combination of an obstructed renogram with symptoms of either pain or pyelonephritis. Most children (41) had < 40% function on the affected side before surgery, with just two having hyperfunction (> 55%). In all patients intravenous urography before surgery showed hydronephrosis, and a micturating cystogram was used to exclude coexisting reflux in the presence of an associated megaureter. Diuretic renography (using 99mTc‐mercaptoacetyl triglycine or 123I‐hippuran) and DMSA scintigraphy were both carried out before surgery and the renography repeated 6 months afterward.

Results The renographic drainage curves improved from obstructed to unobstructed or ‘dilated unobstructed’ on all postoperative studies. Regression analysis showed that preoperative DMSA scan was an excellent predictor of outcome (P < 0.001) whilst the preoperative renogram was a relatively poor predictor of the functional result. In four patients where the initial renographic function was < 10%, DMSA scintigraphy predicted correctly the capacity for recovery in three and the inability to improve in the fourth.

Conclusion Before surgery, DMSA scintigraphy in children with upper urinary tract obstruction is a more useful estimate of probable long‐term renal function than value from diuresis renography. If there is doubt about the desirability of reconstructive surgery, a DMSA scan may eliminate the need for more invasive methods of estimating recovery, e.g. a period of nephrostomy drainage.
Acute urinary retention: defining the need and timing for pressure‐flow studies
Authors: Dubey D. , Kumar A. , Kapoor R. , Srivastava A. , Mandhani A.
Published: March 2003

Objective To investigate the utility of ‘late’ pressure‐flow studies in predicting the outcome of prostatectomy for acute urinary retention.

Patients and methods Fifty‐eight patients with acute urinary retention were prospectively assessed using the International Prostate Symptom Score and pressure‐flow studies at a median (range) of 24 (13–60) days after the episode of retention, and before transurethral resection of the prostate. Bladder outlet obstruction and bladder contractility were graded using a modified adaptation of Schäfer's passive urethral linear resistance relation.

Results Fifty‐six (97%) patients generated a voluntary detrusor contraction, with a mean (range) detrusor pressure at maximum flow of 72.7 (5–144) cmH2O, and 43 (75%) patients were deemed to be obstructed. Eight (16%) patients failed to void after prostatectomy and required clean intermittent catheterization. There were statistically significant differences between successful and unsuccessful patients in mean (sd) age, at 66.30 (6.9) vs 78.8 (2.6) years (P = 0.001), detrusor instability (49% vs 0%, P = 0.01), inability to void during pressure study (8% vs 75%, P = 0.001), and maximal detrusor pressure in the voiding phase, at 80 (36.0) vs 19 (11.2) cmH2O (P = 0.001).

Conclusions In patients with acute urinary retention, pressure‐flow studies undertaken after a period of adequate bladder rest (> 3 weeks) are useful in predicting the surgical outcome. Old age, absence of bladder instability, inability to void during the pressure‐flow study and a maximal detrusor pressure of < 20 cmH2O are associated with a poor outcome after prostatectomy.
The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction
Authors: Imaji R. , Dewan P.A.
Published: March 2003

Objective To assess the clinical and radiological spectrum in boys with endoscopically severe posterior urethral obstruction, as there is a broad clinical spectrum which does not always correlate with the cystoscopic findings.

Patients and methods Between December 1990 and July 2000, 39 boys (newborn to 12 years old) underwent cystoscopy to investigate a urethral anomaly and were found to have a severe obstructing posterior urethral membrane. Their voiding cystograms, video‐recorded cystoscopy and presenting signs were reviewed.

Results Of the 39 boys assessed, a voiding cystogram and presenting signs were available in 36. Of these 36 boys, three cystograms were initially reported as normal, eight showed posterior urethral dilatation as the only feature, and the remainder had more severe bladder and upper tract changes. Fourteen were diagnosed after identifying antenatal hydronephrosis, four presented with voiding dysfunction, one with haematuria and 17 were found after investigation of a urinary tract infection.

Conclusions This study shows that a congenital posterior urethral membrane that has only a small posterior defect endoscopically can have a wide clinical and radiological spectrum. The difference in outcome may be caused by variations in the response of the bladder to the obstruction, resulting in a different effect on the upper tracts.
Male‐to‐female transsexualism: a technique, results and long‐term follow‐up in 66 patients
Authors: Krege S. , Bex A. , Lümmen G. , Rübben H.
Published: March 2003

Objective To report experience of a new surgical technique in male‐to‐female transsexual patients, the complications, and the functional and psychosocial long‐term results.

Patients and methods From April 1995 to July 2000, 66 male patients underwent gender‐transforming surgery at our institution and were registered prospectively. The operation should result in a normal appearing introitus, a vaginoplasty allowing for sexual intercourse and a sensitive clitoris. This was achieved by preserving the neurovascular bundle. The glans was transformed into a clitoris, the phallic cylinder used as a vagina and labia were formed from the scrotal folds.

Results Major complications during, immediately and some time after surgery occurred in nine of the 66 patients (14%), including severe wound infections in six, a rectal lesion in three, necrosis of the glans in three and necrosis of the distal urethra in one. Minor complications, e.g. meatal stenosis in seven patients, occurred in 24 (36%) of patients. Ten patients with insufficient penile skin had the phallic cylinder augmented with a free‐skin mesh graft, but in three of these patients an ileal augmentation was finally constructed because scarring occurred at the suture line between the penile skin and the augmented graft. A long‐term follow‐up questionnaire about the functional and psychosocial aspects was completed by 31 patients. More than 90% of the patients were satisfied with the cosmetic result and capacity for orgasm; 58% reported having sexual intercourse.

Conclusion Male‐to‐female surgery can achieve excellent cosmetic and functional results. Although the operative technique is partly standardized, surgery remains challenging because of several possible complications. None of the present patients claimed to regret their decision to undergo gender‐transforming surgery.