bluuebunny/crossref_metadata_2025 huggingface dataset:
Emphysematous pyelonephritis in diabetic patients
Authors: Pontin A.R. , Barnes R.D. , Joffe J. , Kahn D.
Published: November 2008

Objective To determine the clinico‐pathological profile of patients with emphysematous pyelonephritis (EPN).

Patients and methods The records of 22 diabetic patients who presented with EPN were reviewed.

Results EPN occurred predominantly in female diabetic patients without evidence of ureteric obstruction. The ages of the patients and the duration of the diabetes were variable. EPN occurred in insulin‐dependent as well as non‐insulin‐dependent patients. The patients presented following a prodromal illness of urinary sepsis, with an acute severe illness with symptoms and signs on the affected side. Dehydration and keto‐acidosis were common. The diagnosis was made by recognizing gas in the kidney on an X‐ray or ultrasound. Eighteen patients were subjected to emergency nephrectomy.

Conclusions EPN is an uncommon, life‐threatening condition characterized by the production of intraparen‐chymal gas. We believe that vigorous resuscitation and emergency nephrectomy is the treatment of choice.
Distal penile hypospadias repair in children, with complete mobilization of pendulous urethra and triangular glandular flap
Authors: Dindar H. , Çakmak M. , Yucesan S. , Barlas M.
Published: November 2008

Objective To present a technique for repair of distal hypospadias.

Patients and methods Sixteen children (average age 6.6 years) were treated between January 1985 and January 1991. The procedure is described.

Results One child developed a mild meatal stenosis and another had a small urethral fistula; both responded to treatment. Results were excellent in the remaining 14 patients.

Conclusion This simple operative procedure was successful in the majority of patients and there were only two minor complications.
Ploidy and Tn‐antigen expression in the detection of transitional cell neoplasia in non‐tumour‐bearing patients
Authors: Pinnock C.B. , Roxby D.J. , Ross J.M. , Pozza C.H. , Marshall V.R.
Published: November 2008

Objective To study the effectiveness of combining DNA ploidy and the blood‐group related membrane antigen Tn as bladder tumour markers which have been individually associated with high tumour grade and poor prognosis. In particular to (i) determine whether use of these two markers would improve tumour detection compared with either alone, particularly of high grade disease and (ii) determine whether intermediate rates of marker expression would occur in bladder cancer patients with no current tumour compared with those with a tumour and a control group with benign prostatic hypertrophy.

Patients and methods A total of 102 patients undergoing cystoscopic monitoring for either benign prostatic hyperplasia (BPH) or for transitional cell carcinoma (TCC) at the Repatriation Hospital and Flinders Medical Centre were included in the study. The patients comprised three study groups, those with BPH (n= 37), with TCC but no tumour present (n=38) and those with TCC and a tumour present at cystoscopy (n= 27). Exfoliated cells obtained from bladder washings at cystoscopy were double‐labelled using a monoclonal antibody to the Tn antigen and a DNA stain, pro‐pidium iodide and examined by flow cytometry.

Results Rates of marker expression in 2 7 patients with tumours were 30% for Tn antigen, 30% for aneuploidy and 48% for either marker. Marker expression was strongly associated with tumour grade, with no expression at grade 1, 38% (3/8) tumours at grade 2 and 90% (9/10) at grade 3. In patients with a history of bladder tumours but no current tumour, rates were intermediate (30%) compared with patients with current transitional cell carcinoma (42%) and control patients (19%).

Conclusion The use of Tn antigen combined with DNA flow cytometry can increase tumour detection, particularly of high grade, aggressive disease. Gradation of expression of these markers across patient groups at increasing risk of a tumour, with intermediate expression in patients with no current tumour, suggests that marker expression may be detecting a pre‐neoplastic stage of the disease, which is not possible with cytology. Given two parallel disease processes for superficial papillary and for high grade disease with invasive potential, the expression of high grade tumour markers in cells from cystoscopically normal bladders may represent a pre‐clinical stage of aggressive disease. The identification of patients at risk of invasive disease using combinations of tumour markers may offer advantages in clinical management, particularly when no tumour is present and therefore no histopatholog‐ical assessment is made.
Kinetic analysis of prostatic volume in patients with stage D prostatic cancer treated with LHRH analogues in relation to prognosis
Authors: Kojima M. , Ohe H. , Watanabe H.
Published: November 2008

Objective To evaluate the clinical usefulness of the kinetic analysis of prostatic volume in the prognosis of patients with Stage D prostatic cancer treated using Iuteinizing hormone‐releasing hormone (LHRH) analogues.

Patients and methods The reduction of prostatic volume was monitored in 12 patients with Stage D prostatic cancer using transrectal ultrasonography (TRUS) after treatment with LHRH analogues. Data obtained from the kinetic analysis of prostatic volume were compared with the prognosis.

Results All the patients having a reduction time, τ (derived from the kinetic analysis of prostatic volume change with time), of less than 41 days had neither clinical progression within 15 months nor death caused by prostatic Cancer during the 5‐year followup, while the disease‐specific 5‐year survival rate in patients having a τ of greater than 42 days was as low as 17%. The difference in both the progression and disease‐specific survival between these groups was statistically significant (P<0.05) despite the limited number of patients. In contrast, conventional prognostic parameters showed no significant predictability for prognosis with the exception of prostatic acid phospha‐tase, which correlated strongly with the occurrence of progression within 15 months.

Conclusion The kinetic analysis of the change of prostatic volume using TRUS shows promise in the prognosis of the patients with Stage D prostatic cancer.
Influence of end‐stage renal disease and renal transplantation on serum prostate‐specific antigen
Authors: Morton J.J. , Howe S.F. , Lowell J.A. , Stratta R.J. , Taylor R.J.
Published: November 2008

Objective To evaluate the effect of dialysis and kidney transplantation on serum prostate‐specific antigen (PSA) levels, and to compare these results with those from normal age‐matched controls. In addition, to evaluate the efficacy of PSA and digital rectal examination (DRE) for detection of prostate cancer in patients on dialysis and following kidney transplantation.

Patients and methods Between January 1990 and July 1993 all men in the transplant programme over the age of 40 years who were undergoing pre‐transplant evaluation or post‐transplant follow‐up underwent a yearly DRE and PSA evaluation. Twelve patients were evaluated pre‐transplant and 70 patients were evaluated post‐transplant. A total of 136 PSA levels were obtained (1.7 per patient). Patients with suspicious findings underwent further evaluation with transrectal ultrasound and biopsies if indicated. Controls were patients without known prostate cancer who had been evaluated in a Prostate cancer Awareness Clinic.

Results The average PSA values in the study groups were unaffected by either dialysis or transplantation when compared with age‐matched controls. In addition, 12 patients who had been on dialysis at the time of their initial evaluation and who subsequently underwent transplantation did not show any difference in their average PSA values pre‐ or post‐transplant. Three patients (4%) were found to have prostate Cancer and two underwent radical retropubic prostatectomy. They are free of disease 24 and 36 months post‐operatively and neither has experienced any decline in renal function. Immunosuppression was not modified.

Conclusion Transplantation and dialytic therapy do not appear to affect clinical serum PSA levels. PSA and DRE appear to be equally valid for detection of prostate cancer in patients on dialysis and post‐transplant when compared with the general population. Finally, radical prostatectomy appears to be a safe and feasible treatment option in this group of patients.
Increase of serum prostatic specific antigen and clinical progression in pN + M0 prostate cancer
Authors: Josefsen D. , Waehre H. , Paus E. , Fosså S.D.
Published: November 2008

Objective To analyse the increase of serum prostatic specific antigen (PSA) as a means of early detection of progression in hormonally untreated or androgen‐deprived patients with T1‐T4, pN+ and M0 prostate cancer.

Patients and methods From 1986 to 1992 40 patients with T1‐T4 pN+ M0 prostate cancer were either deprived of androgen at diagnosis (Group 1, 19 patients) or had no immediate hormone manipulation (Group 2, 21 patients) and were followed at 3–6‐monthly intervals when determinations of PSA and routine clinical/radiological examinations were performed. A significant increase in PSA was defined as a ≥ 50% increase of the baseline PSA value which was the either the lowest PSA value within 6 months from the start of androgen deprivation (Group 1) or the initial PSA value (Group 2).

Results By June 1993 22 of the 40 patients had clinically progressed. In 12 patients the progression was pre‐ceded by a significant increase in PSA (Group 1, three of four progressing patients; Group 2, nine of 18 progressing patients). A PSA increase of ≥ 50% was observed simultaneously with clinical progression in six patients, whereas clinical progression occurred in four patients with no previous or simultaneous significant increase in PSA. In four of nine hormonally untreated patients ≥1 year elapsed between antecedent PSA increase and clinical progression.

Conclusion In routine clinical practice PSA does not significantly increase (≥50% of baseline value and > 10 μg/L) before disease progression in about one third of patients with pN + M0 prostate cancer managed with or with no hormone manipulation. Future studies should be carried out to determine whether a lower rate of increase in PSA during follow‐up has any clinical significance.
Prostate‐specific antigen and prognosis in patients with metastatic prostate cancer — a multivariable analysis of prostate cancer mortality
Authors: Reynard J.M. , Peters T.J. , Gillatt D.
Published: November 2008

ObjectiveTo analyse the prognostic significance of pre‐and post‐treatment serum prostate‐specific antigen (PSA) levels, together with a variety of other factors, in a multivariable analysis of survival in men with stage D2 prostate cancer.

Patients and methodsCox's proportional hazards model was used to compare survival in 134 men with stage D2 metastatic prostateCancerfollowed prospectively over a 4 year period, using both univariable and multivariable models. The influence of the following factors on survival was analysed: pre‐ and post‐treatment PSA (both absolute and percentage values), age, treatment, testosterone, pre‐ and post‐treatment alkaline phosphatase (absolute and percentage values), acid phosphatase, haemoglobin, symptom score and performance status and extent of disease on bone scan.

ResultsPre‐treatment PSA levels did not significantly influence survival. Similarly, a low absolute post‐treatment PSA level at 3 months after the start of treatment conferred no survival advantage relative to patients with a high PSA level at this time. A post‐treatment percentage PSA of <10% at 2, 3 and 6 months after commencement of treatment was associated with prolonged survival. Low pre‐treatment alkaline phosphatase (less than the upper limit of normal) and high pre‐treatment testosterone levels (≥10 nmol/L) were similarly associated with prolonged survival.

ConclusionsThe strong influence of post‐treatment percentage PSA on survival in patients with stage D2 prostateCancersuggests that the percentage change in bulk of metastatic deposits is more important in determining survival than the absolute volume of tumour. Pre‐treatment alkaline phosphatase seems to be a better indicator of tumour activity than pre‐treatment PSA. These findings have important implications for the design and analysis of clinical trials of new therapies in men with stage D2 prostateCancerand for the future selection of alternative treatments for patients with this stage of the disease.
Renal cell carcinoma extending into the vena cava: surgical approach, technique and results
Authors: Reissigl A. , Janetschek G. , Eberle J. , Colleselli K. , Weimann S. , Schwanninger J. , Bartsch G.
Published: November 2008

Objective To describe the technique and results of a thoraco‐abdominal approach to removing the caval thombi in patients with renal cell carcinoma extending into the vena cava.

Patients and methods Between 1970 and 1990 35 patients presenting with renal cell carcinoma extending into the vena cava were treated at the Department of Urology, Innsbruck. Twenty‐three of these patients underwent radical tumour nephrectomy including cavotomy and thrombectomy or caval resection. A transabdominal approach had been used in this department for radical tumour nephrectomy including cavotomy and thrombectomy or caval resection until 1987. Since 1988, a thoraco‐abdominal approach has been employed. In group I patients the approach was via the seventh intercostal space, whereas in group II and III patients the thoraco‐abdominal incision was made through the fifth intercostal space. In the present study the anatomy of the thoraco‐abdominal approach is described.

Results Tumour staging and grading yielded stage T3b in 15 patients (grade I, 1; grade n, 6; grade III, 8); another eight patients with stage T3b were found to have metastatic disease (N1, 6; N2, 2; M1, 3). On the basis of the extension of the caval thrombus the patients were classified as follows: group 1,16; group II, 3; group IE, 4. In T3b NO MO patients the 5‐year‐survival rate was 62.5%, while in patients with positive lymph nodes the mean survival rate was 15.5 months.

Conclusion Our Results suggest that the thoraco‐abdominal approach is the method of choice for the safe removal of renal cell carcinomas associated with caval thombi. If resection of the caval tumour is complete, prognosis is dependent on known factors, such as tumour invasion, nodal involvement and distant metastases rather than the extension of the tumour thrombus. An aggressive approach is not warranted in patients with nodal involvement and/or distant metastases, as it does not improve survival.
Health‐related quality of life after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire survey
Authors: Bjerre B.D. , Johansen C. , Steven K.
Published: November 2008

Objective To compare the health‐related quality of life after bladder substitution with that following ileal conduit diversion.

Patients and methods Sixty‐seven male patients with bladder cancer completed the questionnaire; 38 had undergone bladder substitution and 29 ileal conduit diversion; the median follow‐up was 1.0 year (range 0.5–3.0) and 4.8 years (range 1.1–15.2), respectively. Semi‐structured qualitative interviews were conducted and analysed, and the questionnaire was developed based upon these results.

Results Both day‐ and night‐time urinary leakage occurred more frequently following bladder substitution (18% against 10%, and 21% against 3%). Nevertheless, urinary leakage affected conduit patients more severely and they scored higher on a leakage distress scale. Furthermore, 58% of the ileal conduit but only 21% of the bladder substitution patients gave urinary leakage as their main concern (P=0.04). Ileal conduit patients did not retain their body image as well as those with bladder substitution. The frequency of both sexual and non‐sexual physical contacts decreased in the majority of the conduit patients but only in a minority of the bladder substitute patients. Global satisfaction was high and similar in both groups.

Conclusion These results show that the health‐related quality of life is retained to a higher degree after bladder substitution and supports the use of this procedure as the standard method of diversion after cystectomy for bladder cancer.
Paternity after cryptorchidism: lack of correlation with age at orchidopexy
Authors: Lee P.A. , O'Leary L.A. , Songer N.J. , Bellinger M.F. , Laporte R.E.
Published: November 2008

Objective To determine whether paternity is decreased among men who were formerly unilaterally or bilaterally cryptorchid and to ascertain whether paternity is related to their age at orchidopexy.

Subjects and methods Men who underwent orchidopexy between 1955 and 1969 at the Children's Hospital of Pittsburgh (363) and a group of age‐matched control men (336) were surveyed by questionnaire and their medical records reviewed.

Results Of the married men, significantly more of the unilateral cryptorchid (75%) and control (76%) groups had fathered children than had the bilateral cryptorchid group (P < 0.005). Furthermore, when the groups were compared during the period of regular intercourse with no contraception until conception of their first child, the bilateral group had relatively fewer conceptions during the first year and more after the first year. When the unilateral and bilateral groups were analysed separately, there was no relationship between either age at orchidopexy and paternity or between the age at orchidopexy and the duration of regular unprotected intercourse before conception.

Conclusions Compared with a control group, paternity was compromised after bilateral, but not unilateral, cryptorchidism. Age at orchidopexy was not correlated with paternity.
Urological day case surgery in elderly and medically unfit patients using sedoanalgesia: what are the limits?
Authors: Briggs T.P. , Anson K.M. , Jones A. , Coker B.J. , Miller R.A.
Published: November 2008

Objective To assess how elderly and medically unfit patients cope with day case surgery in a urological unit using sedoanalgesia.

Patients and methods One hundred patients (mean age 78 years, range 59‐97) either over the age of 75 years, or with an American Society of Anesthesiologists (ASA) status of 3 or 4 (58 patients) were studied before and after surgery to assess their medical condition, home circumstances and how they coped with their first day after the operation.

Results Ninety patients found the procedure good or acceptable and 86 thought having their operation and going home on the same day was a good idea.

Conclusion Elderly and medically unfit patients can be treated safely with no serious complications using sedoanalgesia in a well organized Day Unit equipped with full monitoring facilities.
Increased number of substance P positive nerve fibres in interstitial cystitis
Authors: Pang X. , Marchand J. , Sant G.R. , Kream R.M. , Theoharides T.C. , J.
Published: November 2008

Objective To explore the presence of the neuropeptide substance P (SP) in the bladders of rats and humans and to investigate its relationship to mast cells (MCs) in interstitial cystitis (IC), a bladder disorder which occurs mostly in women and is characterized by frequency of voiding, nocturia and debilitating supra‐pubic pain.

Patients, materials and methods Bladder biopsies from eight women with untreated IC (mean age 36 years, range 29‐58) and five control patients with no IC were analysed and compared with each other and with bladder tissue from 12 rats. Immuno‐histochemistry and image analysis were used to examine the density of SP‐positive nerve fibres and their relationship with MCs.

Results SP‐containing nerve fibres were present in the bladder of both rats and humans. They were increased only in the submucosa, but not in the detrusor, of IC patients and were frequently seen in juxtaposition to MCs.

Conclusion SP, a neuropeptide secreted from sensory nerve endings, has been implicated in the pathophysio‐logy of pain and has been shown to trigger MC secretion. Moreover, MC secretion by SP is augmented by oestradiol and bladder MCs have been shown to express high affinity oestrogen receptors. A functional relationship between SP and MCs may explain the pathophysiology of the neuro‐inflammatory and painful nature of IC.
Anterior bladder neck tube reconstruction at radical prostatectomy preserves functional urethral length — a comparative urodynamic study
Authors: Connolly J.A. , Presti J.C. , Carroll P.R.
Published: November 2008

Objectives To characterize the continence mechanism of anterior bladder neck tube reconstruction at the time of radical prostatectomy using urodynamic evaluation.

Patients and methods Prospective pre‐ and postoperative urodynamic profiles were performed in patients receiving conventional posterior ‘racket handle’ closures (control group — eight patients) and those receiving anterior bladder neck tube reconstruction at radical prostatectomy (study group — nine patients). Bladder neck tube reconstruction was performed by constructing 2 cm anterior bladder neck tubes over 22 F catheters.

Results A significantly longer post‐operative functional urethral length was demonstrated using urodynamic assessment in patients receiving an anterior bladder neck tube closure (4.6 vs 3.4 cm; P<0.01).

Conclusion The anterior bladder neck tube reconstruction may promote urinary continence in patients undergoing radical prostatectomy by preservation of functional urethral length.
Use of dexamethasone for ureteric obstruction in advanced prostate cancer: percutaneous nephrostomies can be avoided
Authors: Hamdy F.C. , Williams J.L.
Published: November 2008

Objective To evaluate the effectiveness of dexamethasone in relieving bilateral lower ureteric obstruction in the acute phase of renal failure secondary to locally advanced prostate cancer.

Patients and methods This study comprised 11 patients (median age 72 years, range 52‐84) presenting with advanced prostate cancer, bilateral ureteric obstruction and gross renal failure. Their response to immediate administration of intravenous followed by oral dexamethasone for 4 weeks, in conjunction with definitive treatment and final outcome, was evaluated.

Results Renal function improved in 10 patients within 72 h, avoiding the need for insertion of percutaneous nephrostomies. However, four of 10 patients whose renal failure initially improved, failed to respond to definitive therapy, and died 3 to 4 weeks after cessation of the steroids.

Conclusion When administered in the acute phase of renal failure from prostate cancer, dexamethasone may obviate the need for urinary diversion in patients with bilateral ureteric obstruction, particularly in men who will not respond favourably to available forms of therapy for advanced and aggressive disease.
Objective measurement of the effectiveness, therapeutic success and dynamic mechanisms of the vacuum device
Authors: Bosshardt R.J. , Farwerk R. , Sikora R. , Sohn M. , Jakse G.
Published: November 2008

Objectives To determine the efficacy and possible beneficial effects of the Catalyst® vacuum device (VD) in the treatment of impotence, the ischaemic state of the penis after application of a constriction ring and the origin of the blood in the corpus cavernosum after application of the VD.

Patients and methods Thirty men (mean age 62 years; range 46‐76) suffering from erectile dysfunction were selected for the trial after using the VD for 2 weeks at home. Changes in penile tumescence and rigidity before, during and after using the VD were assessed using the Rigiscan® monitor. Blood gas analysis (BGA) was performed in selected patients whilst using the VD, allowing calculation of the proportional contribution of venous and arterial blood to the increase in penile volume. The efficacy of the VD was also assessed by questionnaires completed before treatment and at the 6 month follow‐up.

Results Four patients were lost to follow‐up but the 26 impotent men who used the VD for 6 months were able to have sexual intercourse after using the VD. The average rigidity measured at the base and tip of the penis after application of the VD was > 80%. The duration and extent of nocturnal penile tumescence and rigidity at the start and the end of the study improved, although only one variable increased significantly. Patients reporting spontaneous morning erections showed significant improvements in total erection‐time, erection‐phase and plateau‐phase duration, effective rigidity and tumescence increase. BGA determined 30 min after applying a constriction ring showed ischaemia of the penile blood and the mean contribution of arterial and venous blood to penile blood volume was by 58 and 42%, respectively.

Conclusion The efficacy of the Catalyst® vacuum device was objectively determined and the quality of the nocturnal erections improved in some patients. After application of a constriction ring an ischaemia of the penis developed. In contrast to previous reports, the increased penis volume during the application of the VD is caused not only by arterial inflow but also by venous backflow.
Renal cell carcinoma metastases to the skin: a not so rare case?
Authors: Kouroupakis D. , Patsea E. , Sofras F. , Apostolikas N.
Published: November 2008

Objective To describe the clinical, histological, immunohistochemical and behavioural patterns of the metastases of renal cell carcinoma to the skin.

Patients and methods In a retrospective review of 132 cases of renal cell carcinoma submitted for examination to the Anticancer Institute ‘St Savas’ nine patients with metastatic disease to the skin were discovered. Clinical data and follow‐up information were collected and correlated to tumour behaviour and patient survival. Immunohistochemical studies with epithelial membrane antigen (EMA), vimentin, keratin and carcino‐embryonic antigen (CEA) were performed.

Results In six of the nine patients the skin metastasis was the first evidence of a tumour. Histology of the skin nodule led to identification of the primary site. Histological proof of the renal origin of the tumour was obtained using the above immunohistochemical studies. All patients died from their disease within 3 years of presenting with the skin metastases.

Conclusion Metastases to the skin from a renal cell carcinoma as first evidence of the disease may not be as rare as the literature describes. Definite proof of the origin of the tumour requires specialized immunohistochemical techniques.
Khat chewing and bladder neck dysfunction. A randomized controlled trial of α1‐adrenergic blockade
Authors: Nasher A.A. , Qirbi A.A. , Ghafoor M.A. , Catterall A. , Thompson A. , Ramsay J.W.A. , Murray‐Lyon I.M.
Published: November 2008

Objective To assess whether the effect of chewing khat leaves (Catha edulis) on the urodynamics of healthy males is altered by the selective α1‐adrenergic blocking agent indoramin in a prospective randomized double‐blind controlled trial.

Subjects and methods The urodynamics of 11 healthy males were studied before and during a khat chewing session preceded by indoramin or placebo.

Results Khat chewing produced a fall in average and maximum urine flow rate. This effect was inhibited by indoramin.

Conclusions The urinary side‐effects of khat chewing are probably mediated through stimulation of α1 adrenergic receptors. Keywords Khat, Catha edulis, α1adrenergic blocker, indoramin, urodynamics.
Psychological reactions in men screened for prostate cancer
Authors: Gustafsson O. , Theorell T. , Norming U. , Perski A. , Öhström M. , Nyman Cr.
Published: November 2008

Objective To investigate the possible negative psychological impact of screening for prostate Cancer with special focus on the impact of false positive and true positive test results.

Subjects and methods As part of an early detection study for prostate Cancer psychological and psycho‐physiological reactions to various phases of the diagnostic procedures were examined in 2400 randomly selected men divided into various groups. Their psycho‐physiological reactions were assessed by measurements of serum cortisol and their psychological reactions by questionnaires directed at determining emotional states and sleep disturbance. In a stratified sample of the population (100 men) measurements were made at the time of the screening examination and again 2 weeks later. In patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening.

Results Serum cortisol levels at the screening examination were higher than corresponding levels of a comparable sample of Swedish men during normal daily activity, indicating that an invitation to examination for prostate Cancer per se might create emotional stress. Two weeks after the screening the elevated levels had decreased to normal. The highest cortisol levels were found in men who had undergone biopsy, immediately before they were informed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The patterns of emotional state and sleep disturbance were similar except that sleep disturbance was delayed.

Conclusion In screening programmes for prostate Cancer it is important to define clearly the high‐risk groups to minimize the risk of adverse psychological reactions in those subjects with a low risk of having the disease. The results also emphasize the need to reduce the number of false positive results by choosing diagnostic tests of high specificity. The interval between a test and informing the subject of the results should be minimized to decrease the duration of the increased emotional stress
The value of prostatic specific antigen in the early diagnosis of prostatic cancer: a Greek view
Authors: Deliveliotis Ch. , Alivizatos G. , Karayiannis A. , Kontothanasis D. , Makrychoritis K. , Lysiotis P. , Dimopoulos M.A.
Published: November 2008

Objective To assess whether it is worthwhile to screen asymptomatic men for prostate Cancer using serum prostate specific antigen (PSA) and to determine how many patients could be cured of prostatic carcinoma if detected by screening.

Patients and methods Between June 1992 and January 1994 the serum PSA level of 1400 asymptomatic men over 50‐years‐old was assessed. Those men with PSA levels < 4 ng/mL were not evaluated further. Those men with PSA levels of 4–10 ng/mL underwent digital rectal examination (DRE) and transrectal ultrasonog‐raphy (TRUS) and biopsies were taken when there were significant findings on DRE and/or TRUS. If the PSA levels were > 10 ng/mL patients were submitted for DRE and TRUS and. even if both examinations were negative, random biopsies were taken. Where Cancer was detected the tumour was staged and if it was a clinically confined tumour a radical retropubic prostatectomy was performed. The pathological and clinical stages of the disease were then compared.

Results The majority of patients (95%) had PSA levels of < 4 ng/mL. Forty‐nine men had PSA levels of 4–10 ng/mL and of these 28 were biopsied, which detected 12 (24.5%) carcinomas. There were 20 men with PSA levels > 10 ng/mL and among them 11 (55%) were found to have carcinomas. Combining these figures, among the 1400 men there were 69 cases with PSA levels >4 ng/mL and, using DRE and TRUS, 23 patients (33%) were diagnosed as having prostatic adenocarcinomas. Among these, one had metastatic disease, three had lymph node micrometast‐ases during surgical exploration and 19 underwent radical prostatectomies. The pathological and clinical stages agreed in only eight patients.

Conclusion Only eight patients can be considered as cured because of the screening protocol and even this result is overoptimistic, as the future biological behaviour of these tumours is unknown. Therefore we cannot recommend screening for prostatic carcinoma among asymptomatic men in Greece.
Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence
Authors: MOTTRIE A.M. , MATANI Y. , BAERT J. , VOCES G.E. , HOHENFELLNER R.
Published: November 2008

Objective To test the efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of varicocele in teenagers.

Patients and methods The study included 38 patients (mean age 14.9 years, range 12–18) with left‐sided varicocele. Three patients had a grade 1 varicocele, 22 were grade 2 and 13 were grade 3. ASS was performed under local anaesthesia on an out‐patient basis.

Results ASS was accepted by all patients except one. There were no peri‐operative problems and only one patient developed post‐operative epididymitis. During 9 to 15 months of follow‐up (mean 11 months), only two patients developed persistence of a lower grade of varicocele.

Conclusion This study illustrates that ASS is a safe and successful out‐patient procedure for the treatment of varicocele in teenagers.
High educational level associated with reduced semen quality in men with asymptomatic varicocele testis
Authors: LUND L. , SØRENSEN H.T.
Published: November 2008

Objective To investigate the relationship between education, intelligence, varicocele testis and semen quality.

Subjects and methods Of 542 newly‐enlisted soldiers (median age 20 years, range 20–24) 47 men were found who had varicocele testis. Semen quality was assessed in 39 of the men with a varicocele and compared with a similar group with no varicocele. The educational level and intelligence of both groups was also assessed and compared.

Results There was a significantly reduced quality of semen in men with varicoceles and in men with > 10 years of school education. There was no significant relationship between intelligence level and semen quality.

Conclusions The assumption that there is a relationship between educational level and semen quality in men with asymptomatic varicocele seems well‐founded, and educational level should therefore be considered as an explanatory variable in future investigations; studies are also required to provide a biological explanation of this phenomenon.
Evaluation of patients with diseases of the prostate using prostate‐specific antigen density
Authors: WOLFF J.M. , BOECKMANN W. , EFFERT P.J. , HANDT S. , JAKSE G.
Published: November 2008

Objective To compare the efficacy of two tests, prostatic‐specific antigen (PSA) and the PSA/prostate volume ratio (PSAD), as diagnostic and staging markers to discriminate patients with benign prostatic hyperplasia (BPH) from patients with cancer of the prostate (CaP).

Patients and methods Prostate gland volumes were estimated in 60 patients with BPH and 88 patients with clinically organ‐confined CaP by performing transrectal ultrasonography (TRUS) and using the prolate ellipse formula. Serum PSA concentration was determined using an enzyme immunoassay. In patients with BPH, the prostates were removed either by transurethral resection or retropubic prostatectomy. Patients with CaP underwent laparoscopic pelvic lymph‐adenectomy followed by radical perineal prostatectomy. PSAD was calculated by relating the serum PSA level to the TRUS‐estimated prostate volume.

Results The median PSA level was 4.4 ng/mL in patients with BPH, 9.3 ng/mL in patients with CaP‐NO disease and 24 ng/mL in those with CaP‐N + disease. However, imposing a PSA limit of 4 ng/mL for the diagnosis of CaP gave a positive predictive value of only 64.8%, whereas a limit of 10 ng/mL gave a positive predictive value of 71.4%. In contrast, the median PSAD was 0.086 ng/mL/cm3 in patients with BPH, but was 0.295 ng/mL/cm3 in patients with NO‐disease and 0.775 ng/mL/cm3 in those with N+‐disease. With a limit of 0.15 ng/mL/cm3 the positive predictive value of PSAD was 81%. Furthermore, a limit of 0.6 ng/mL/cm3 revealed a positive predictive value of 81% for the diagnosis of metastatic lymph node involvement.

Conclusions There was a considerable overlap of PSA concentrations in patients with BPH and CaP, and PSA was not sufficiently accurate to distinguish between them. In contrast, PSAD enhanced the discrimination between BPH and CaP and may provide additional information about the status of the lymph nodes in patients with CaP.
Prostate‐specific antigen density: correlation with histological diagnosis of prostate cancer, benign prostatic hyperplasia and prostatitis
Authors: VAN IERSEL M.P. , WITJES W.P.J. , DE LA ROSETTE J.J.M.C.H. , OOSTERHOF G.O.N.
Published: November 2008

Objective To assess the additional value of prostate‐specific antigen density in the diagnosis of prostate cancer in patients who undergo prostate biopsies.

Patients and methods The study comprised 376 patients with symptoms of prostatism who were undergoing prostate biopsy. Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were performed and the prostate specific antigen level (PSA) and density (PSAD) were determined for each patient.

Results Both PSA and PSAD significantly differentiated (P < 0.001) between benign and malignant histology. Of the 376 patients, 91 (24%) had a PSA level in the intermediate range (4.0–10.0 ng/mL). In these patients PSAD was significantly better than PSA in differentiating between benign and malignant histology (P= 0.027 vs 0.316). With a PSAD limit of 0.15 ng/mL/cm3 in these patients, the sensitivity was 92% and the specificity was 54% for the diagnosis of prostate cancer. No patient with a positive biopsy had a PSAD < 0.11 ng/mL/cm3. No limiting value could be found for PSAD that combined both an acceptable sensitivity and specificity. Of the patients with a malignancy detected by the biopsy, 92% also had a suspect DRE.

Conclusion In patients with intermediate PSA levels, PSAD is of limited additional value when compared to DRE in correctly diagnosing prostate cancer. Acute prostatitis is also a possible cause of elevated PSA. Both PSA and PSAD had no additional value in differentiating between benign prostatic hyperplasia (BPH) and histologically proven extensive prostatitis.
Microwave hyperthermia in benign prostatic hypertrophy: a controlled clinical trial
Authors: VENN S.N. , MONTGOMERY B.S.I. , SHEPPARD S.A. , HUGHES S.W. , BEARD R.C. , BULTITIUDE M.I. , LLOYD‐DAVIES R.W. , TIPTAFT R.C.
Published: November 2008

Objective To compare the effects of microwave hyperthermia in benign prostatic hypertrophy (BPH) to sham treatment.

Patients and methods The trial included 96 patients with proven symptomatic bladder outflow obstruction (BOO) caused by BPH. Patients underwent a full subjective and objective assessment (including urodynamics) before inclusion and again 3 and 6 months later. They were randomly assigned to receive 1 h of microwave hyperthermia or a sham treatment. Of the 96 patients, 93 were assessed at 3 months and 62 at 6 months after treatment.

Results There was no statistically significant difference in the objective measures of BOO between the treated and control groups of patients. There was an improvement of approximately 40% in all the subjective measures, but there was no significant difference between the treated and control groups.

Conclusion Microwave hyperthermia, within the parameters defined in this trial, resulted in no significant difference from sham treatment in subjective or objective outcome.
The STING in the refluxing duplex system
Authors: STEINBRECHER H.A. , EDWARDS B. , MALONE P.S.J.
Published: November 2008

Objective To assess the efficacy of the subureteric Teflon injection (STING) procedure in the refluxing duplex ureter.

Patients and methods The STING procedure was performed in 23 patients (five boys and 18 girls, mean age 6.5 years, [range 1.5–14]) with six refluxing upper and 31 refluxing lower moieties. Teflon was injected separately into each moiety of the duplex. All patients were assessed by a micturating cysto‐urethrogram and ultrasonography at least 3 months after treatment and the results were analysed retrospectively for the success rate of each refluxing unit and the overall cure rate of patients.

Results No patient suffered ureteric obstruction. After the first STING the unit cure rate was 57% but only nine of 23 patients were completely cured. This improved to a unit cure rate of 68% and 11 patients cured after a second STING.

Conclusion Because the patient cure rate was poor we do not advocate using the STING to treat vesicoureteric reflux in the duplex kidney.
The density and distribution of endothelin 1 and endothelin receptor subtypes in normal and diabetic rat corpus cavernosum
Authors: BELL C.R.W. , SULLIVAN M.E. , DASHWOOD M.R. , MUDDLE J.R. , MORGAN R.J.
Published: November 2008

Objective To investigate the density and distribution of endothelin l(ET‐l) and endothelin receptor subtypes in rat cavernosal tissue, and to assess any changes brought about by the onset of diabetes mellitus (DM).

Materials and methods Hyperglycaemic non‐ketotic diabetes mellitus was induced in five rats using streptozo‐tocin (STZ). Two months later the penises were excised and stored at—70°C. Longitudinal serial sections (6 μm) were cut using a cryostat and thaw‐mounted onto gelatinized microscope slides. Low and high resolution autoradiographs were taken using radioligands for ET‐1 and endothelin A (ETA) and endothelin B (ETB) receptors and the autoradiographs analysed densitometrically. These results were compared with those from five age‐matched control rats.

Results ET‐1 and ETA receptor binding was primarily localized to the endothelium lining the cavernosal lacunar spaces; trabecular corporeal smooth muscle was much less intensely stained. No ETB receptor binding could be demonstrated, but increased binding of ET‐1 and ETA receptors was seen in the diabetic cavernosal tissue.

Conclusion ET‐1 and ETA receptor binding is increased in diabetic rat cavernosal tissue. A reduction in receptor linked nitric oxide (NO) release has previously been reported in diabetic rats. This finding may provide an explanation for the upregulation of ET‐1 and ETA receptor binding in the diabetic rat.
The limited impact of involved surface area and surgical debridement on survival in Fournier's gangrene
Authors: PALMER L.S. , WINTER H.I. , TOLIA B.M. , REID R.E. , LAOR E.
Published: November 2008

Objective To evaluate the influence of involved surface area (extent of disease) and the number and timing of surgical debridements on survival in patients with Fournier's gangrene.

Patients and methods The medical records of 30 patients with Fournier's gangrene treated over a 15‐year period were reviewed. The extent of disease was quantified and expressed as a percentage of the body surface area by applying a modified diagram used to assess burn injuries. The number of surgical debridements and their timing with respect to initial presentation and to each other were also analysed. Patients were stratified by outcome (survival or death) and the data evaluated by Student's t‐test, Fisher's exact test and regression analysis.

Results Of 30 patients treated 13 died (43%) and 17 survived (57%). The mean surface area involved by disease among survivors was 4.3% (range 1–16.5%) and 7.2% (range 5–20.5%) for non‐survivors (P = 0.10). Whilst no direct correlation between death rate and extent of disease existed, patients with <5% surface area involvement were more likely to survive (P = 0.014). Every patient underwent surgical debridement of the involved area (mean 1.72 procedures per patient). Survivors underwent from one to four debridements (mean 1.79) and non‐survivors one to three debridements (mean 1.63); the mean number of debridements did not influence outcome (P = 0.68). The performance of more than one debridement did not affect survival (P= 1.00). The initial debridement was performed within 24 h of presentation in 10 of 13 patients who died and 11 of 17 survivors and had no effect on outcome (P = 0.69). A second debridement was performed after a mean of 6.8 days (range 1–12) among the six survivors and 5.4 days (range 2–16) among the five non‐survivors; this difference was not statistically significant (P = 0.65). Four survivors required a third debridement, one required a fourth and one patient who succumbed underwent a third debridement.

Conclusion The mortality rate from Fournier's gangrene continues to be substantial (43% in our series). Although no linear correlation existed, the quantified extent of disease may affect outcome as patients with > 5% of body surface area involved were more likely to succumb to the disease. Finally, the number of surgical debridements, even if first performed within 24 h of presentation, had no impact on outcome in patients with Fournier's gangrene.
The social implications of lower urinary tract reconstruction performed during childhood
Authors: WILLIAMS E.R. , MALONE P.S.J.
Published: November 2008

Objective To compare the social effects of urinary diversion, undiversion and orthotopic bladder reconstruction performed during childhood.

Patients and methods Of 99 patients treated at the Wessex Centre for Paediatric Surgery between 1960 and 1993, 46 (16 with a urinary diversion, eight with an undiversion and 22 with bladder reconstruction) were interviewed using a standardized questionnaire. Information was collected about the types and results of surgery, the medical support received and the social effects of the different treatments.

Results By day, continence or only occasional wetting was achieved in 13 patients with diversions, all those with undiversions and 16 of those with reconstructions. At night, 13 patients with diversions, seven with undiversions and 18 with reconstructions were dry or only occasionally wet. Re‐operation rates were higher in those with reconstruction and undiversion.

Only five of the diversion group were satisfied with their management compared to all patients in the other two groups.

The social effects in terms of employment, schooling, independence, body image and social interactions were also better in those with undiversions and reconstructions.

Conclusions The social effects of undiversion and bladder reconstruction were better than those following urinary diversion despite the higher re‐operation rates and the need for a rigid regimen of post‐operative care. However, the need for continuing medical support in this group of patients cannot be over emphasized, and the vital role of the urological nurse specialist is stressed.
Some new insights into bladder function in infancy
Authors: YEUNG C.K , GODLEY M.L. , HO C.K.W. , RANSLEY P.G. , DUFFY P.G. , CHEN C.N. , LI A.K.C.
Published: November 2008

Objectives To evaluate normal bladder function and micturition patterns in infants.

Patients, subjects and methods Twenty‐one infants (16 boys, five girls; mean age 5.9 months) with no lower urinary tract pathology underwent natural filling cystometry. Micturition patterns were also observed simultaneously with polysomnography in 26 healthy neonates (16 boys, 10 girls; mean age 7.4 days).

Results In infants, cystometry showed (95% CI) a capacity of 42–53 mL, a maximum rise in detrusor pressure during voiding of 95–120 cmH2O and a voiding efficiency (voided volume/capacity) of 0.86–0.91. On micturition, urinary flow was discoor‐dinated from peak detrusor pressures in 10 infants. Detrusor instability occurred in one of 21 infants. Micturition was observed only during wakefulness or on arousal from sleep. In neonates, 17 of 61 recorded voids (28%) were during full wakefulness and 44 (72%) during arousal from sleep. Notably, none of the recorded voids occurred during quiet sleep.

Conclusions The normal infant's bladder was stable and emptied almost completely. Voiding with incomplete co‐ordination between detrusor contraction and urinary sphincter relaxation could be normal. Micturition never occurred during quiet sleep. There was cortical arousal in response to a full bladder even in new‐born infants. This contradicts the traditional concept of a totally uninhibited bladder in infancy. There are potential implications for the management of children with nocturnal enuresis.