bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary stress incontinence in obese women: tension‐free vaginal tape is the answer
Authors: Mukherjee K. , Constantine G.
Published: March 2003

Objective To determine the effectiveness of the tension‐free vaginal tape (TVT) in obese women with genuine stress incontinence (GSI), in whom obesity is often considered a relative contraindication to surgical treatment by traditional approaches, e.g. Burch colposuspension and slings (which are difficult and carry increased morbidity) or injectable agents (which although simple, are unpredictable and expensive).

Patients and methods Data on 242 consecutive women with urodynamically proven GSI were collected prospectively. The women were subdivided into three groups with a body mass index (BMI) of < 25, 25–29 and  30; obesity was defined as a BMI of  30. All procedures were performed under spinal anaesthesia. The King's validated quality of life (QoL) questionnaires (version 7) were completed before and 6 months after surgery. The subjective results were defined as a cure, significant improvement or failure.

Results Almost 90% of the obese women with GSI were cured, while the remaining 10% noted a considerable improvement in their symptoms. There was no significant difference in cure rates among the three groups. There was a highly significant (P < 0.001) improvement in QoL in all groups.

Conclusion The TVT is at least as effective in obese women as in those with a lower BMI. The TVT is a simple and minimally invasive procedure, with low morbidity even in the obese group. TVT can be offered confidently to all obese women with GSI.
E‐cadherin and β‐catenin are down‐regulated in prostatic bone metastases
Authors: Bryden A.A.G. , Hoyland J.A. , Freemont A.J. , Clarke N.W. , Schembri Wismayer D. , George N.J.R.
Published: March 2003

Objective To determine the E‐cadherin and β‐catenin expression phenotype in untreated primary prostate cancer and corresponding bone metastases.

Materials and methods Paired bone metastasis and primary prostate specimens were obtained from 14 men with untreated metastatic prostate carcinoma. The tumours were histologically graded by an independent pathologist. Expression of mRNA for E‐cadherin and β‐catenin was detected within the tumour cells using in‐situ hybridization with a 35S‐labelled cDNA probe. The expression of E‐cadherin and β‐catenin were graded as uniform, heterogeneous or negative.

Results The mRNA for E‐cadherin was expressed in 13 of 14 primary carcinomas and 11 bone metastases; β‐catenin was expressed by 13 and nine, respectively. Of the primary tumours, nine expressed E‐cadherin and β‐catenin uniformly; in contrast, all metastases had down‐regulated E‐cadherin and/or β‐catenin.

Conclusions The down‐regulation of E‐cadherin and β‐catenin are a feature of the metastatic phenotype, which may be a significant factor in the genesis of bone metastases. However, this does not appear to be reflected in the expression of these molecules in the primary tumours.
Sexual function before and after various treatments for symptomatic benign prostatic hyperplasia
Authors: Leliefeld H.H.J. , Stoevelaar H.J. , McDonnell J.
Published: March 2003

Objective To determine the effect of various treatments for benign prostatic hyperplasia (BPH) on sexual function.

Patients and methods In a longitudinal multicentre study carried out in the Netherlands, 670 consecutive patients with BPH (aged 50 years) were examined at baseline and 9 months after inclusion. All patients completed a questionnaire about symptomatology, bothersomeness and sexual function before and after treatment. Other diagnostic information was retrieved from the medical records.

Results At baseline, 49–59% of the population (mean age 66 years) reported normal potency and 69% a normal libido. Outcomes at 9 months were stratified by type of treatment, i.e. surgery in 207, α‐blockers in 43, finasteride in 47 and watchful waiting in 234 men. Patients with multiple or other treatments (131) or recent surgery (eight) were excluded from the analyses. For the four sexual items included, 84% of the patients reported no changes. All treatments showed both improvement and deterioration in 3–14% and 0–16% of the patients, respectively.

Conclusion For sexual function, most patients remained stable after treatment for BPH, while positive and negative changes occurred in equal proportions for all treatments. These results question the previously reported high incidence of sexual adverse events, particularly after surgical intervention.
The community‐based morbidity of flexible cystoscopy
Authors: Burke D.M. , Shackley D.C. , O'Reilly P.H.
Published: March 2003

Objective To evaluate patients' experience after flexible cystoscopy (FC), particularly concentrating on the prevalence and degree of symptoms, the frequency of visits to their General Practitioner (GP), subsequent antibiotic rates and the actual incidence of urinary tract infection (UTI).

Patients and methods Consecutive patients (420) presenting for FC were audited prospectively. A pain score for the procedure was recorded immediately afterward (linear scale 0–10) and a self‐administered questionnaire completed at 7 days, to assess the objective and subjective symptoms and their duration, and the incidence of GP visits and subsequent antibiotic provision noted. An interim analysis was conducted on the initial 274 datasets received. To estimate the incidence of FC‐induced UTI, the final 110 patients were asked not to consult their GP but to present to the urology department at 3 days after FC (or the emergency department if clinically necessary). These patients had initially provided a mid‐stream urine (MSU) sample before FC and were assessed symptomatically with a subsequent sample obtained if a urinary dipstick test 3‐days after FC was abnormal.

Results In all, 384 (91%) evaluable forms were returned. The median (range) pain score for FC was 1.1 (0–8.5), with seven patients (1.8%) recording a pain score of > 5 (all men); 382 patients (99.5%) declared they would be happy to undergo an identical procedure in the future if medically indicated. Pain on voiding was reported in 190 patients (50%), urinary frequency in 142 (37%) and gross haematuria in 73 (19%). Eighteen of the initial 274 patients (6.6%) visited their GP, with 15 (5.5%) of these receiving antibiotics. The MSU data from the final 110 patients showed a FC‐mediated infection in three (2.7%).

Conclusion Although FC is well tolerated, gross haematuria, urinary frequency and dysuria occur afterward much more frequently than expected. Patients should be thoroughly counselled before FC about these potential symptoms, to reduce their concern, any unnecessary GP visits and the use of antibiotics.
Laparoscopic dismembered pyeloplasty: 50 consecutive cases
Authors: Eden C.G. , Cahill D. , Allen J.D.
Published: March 2003

Objective To test the hypothesis that laparoscopic dismembered pyeloplasty offers the same good results as open pyeloplasty, but without the disadvantages of the loin incision (which is painful, prolongs hospitalization and prevents a return to normal activities for several weeks) in the treatment of pelvi‐ureteric junction (PUJ) obstruction.

Patients and methods Fifty consecutive consenting patients presenting with PUJ obstruction underwent laparoscopic dismembered pyeloplasty carried out by one surgeon using an extraperitoneal approach.

Results Two (4%) procedures were converted to open surgery. The mean (range) operative duration was 164 (120–240) min. Fifteen (30%) of the patients had their ureter transposed anterior to a crossing lower‐pole vessel; 22 (44%) patients had a separate renal pelvic suture line. The mean (range) postoperative parenteral analgesic requirement was 19.1 (0–111) mg of morphine sulphate. The mean (range) hospitalization was 2.6 (2–7) days. Two (4%) patients had complications. After a mean (range) follow‐up of 18.8 (3–72) months all but one patient, who had failed endopyelotomy, had a normal renogram and were symptom‐free.

Conclusion These results suggest that a loin wound is not necessary for a successful outcome after dismembered pyeloplasty, and that in expert hands laparoscopic dismembered pyeloplasty should now be considered the standard of care.
Prevalence and characteristics of cryptorchidism in a Nigerian district
Authors: Okeke A.A. , Osegbe D.N.
Published: March 2003

Objective To determine the prevalence and characteristics of cryptorchidism among primary schoolboys in a Nigerian district.

Subjects and methods The district selected had 35 primary schools with 23 342 pupils, consisting of 11 275 girls and 11 967 boys. Using a cluster‐sampling technique, five primary schools were visited; 1096 boys (aged 5–13 years) participated in the study, giving a sampling ratio of 1 : 11. The boys underwent a clinical examination of the groin, scrotum and abdomen.

Results Cryptorchidism was found in nine subjects, giving a prevalence rate of 0.82%. All the undescended testes were unilateral, of which five were right‐sided. Eight of the testes were intracanalicular and one was at the external ring. There were no cases of orchidopexy.

Conclusion The prevalence of cryptorchidism among primary schoolboys in this district of Nigeria was high, at eight per 1000. Delayed diagnosis and treatment remains a problem because of the prevailing socio‐economic factors. However, the incidence of cryptorchidism was similar to that reported in other parts of the world.
The natural history of urinary symptoms during adolescence
Authors: Swithinbank L.V. , Brookes S.T. , Shepherd A.M. , Abrams P.
Published: March 2003

Objective

To determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren.

Subjects and methods

A prospective longitudinal study using a confidential questionnaire administered to an original cohort of 1176 local schoolchildren at 11–12 years and again at 15–16 years old.

Results

There was a decrease in the prevalence of urinary symptoms with age. Daywetting was reported by 12.5% of children aged 11–12 years and 3.0% of children aged 15–16 years. Nocturnal enuresis was reported by 4.7% of children at 11–12 years and 1.1% at 15–16 years. Some of the children reporting daywetting and nocturnal enuresis at 15–16 years old had not reported these symptoms at 11–12 years old.

Conclusion

Urinary symptoms become less prevalent with age, but are reported by a significant number of healthy schoolchildren.
Pelvic‐floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding
Authors: De Paepe H. , Hoebeke P. , Renson C. , Van Laecke E. , Raes A. , Van Hoecke E. , Van Daele J. , Vande Walle J.
Published: March 2003

Objective

To analyse the treatment of girls with recurrent urinary tract infections (UTIs, at least two periods confirmed) and urodynamically confirmed dysfunctional voiding with pelvic‐floor therapy.

Patients and methods

Forty‐two girls with recurrent UTIs were treated prospectively during a study period of 18 months. Training consisted of an individually adapted voiding and drinking schedule, pelvic‐floor relaxation biofeedback, instructions on toilet behaviour and biofeedback uroflowmetry; residual urine was estimated by ultrasonography. All the girls received prophylactic antibiotics during treatment and those girls with urodynamically proven detrusor instability (33) received anticholinergics. Therapy was considered successful when the girls remained free of infection with no further prophylactic antibiotics for at least 6 months.

Results

Four girls younger than 6 years all suffered nocturnal and diurnal incontinence and two had reflux. Treatment was effective for recurrent UTI in all and the reflux resolved in two. All four girls became dry during the day and one became dry at night. In the 38 girls older than 6 years, the treatment was successful for recurrent UTI in 24 from the out‐patient and in all three from the clinical programme. Reflux, which was seen in six of these girls, resolved in five; one girl underwent bilateral reimplantation. Incontinence was treated in all 23 girls with incontinence problems before treatment (four of whom were initially dry). Twelve girls needed a wetting alarm to become dry during the night. In four girls the treatment was effective for recurrent UTI but the incontinence persisted; in seven the treatment was considered unsuccessful as they all had UTIs after treatment; all remained incontinent. Reflux persisted in all four girls in this group who had reflux before treatment.

Conclusion

The training programme was effective in treating recurrent UTI in 35 of 42 girls (83%). The persistence of incontinence problems is a bad prognostic factor for the recurrence of UTI after the training programme. Pelvic‐floor therapy seems a reasonable and meaningful component in the treatment of recurrent UTIs in which detrusor‐sphincter dyssynergia plays a role.
Detrusor myectomy for detrusor overactivity: a minimum 1‐year follow‐up
Authors: Swami  , Feneley  , Hammonds  , Abrams
Published: March 2003

Objective

 To evaluate the clinical and urodynamic outcome of partial detrusor myectomy in patients with idiopathic detrusor instability and neuropathic hyper‐reflexia.

Patients and methods

 Seventeen patients with idiopathic detrusor instability and 10 with hyper‐reflexia and symptoms not responding to non‐surgical treatment underwent partial detrusor myectomy. The clinical and urodynamic results before and after myectomy were compared and the patient’s subjective assessment of the outcome documented.

Results

 There was an overall improvement in 17 of 27 patients (63%) but the success rate was higher in those with idiopathic instability (12 of 17) than in those with neuropathy (five of 10). There was urodynamic evidence of reduced bladder contractility and an improvement in the storage characteristics of the bladder in most of the patients treated.

Conclusions

 Partial detrusor myectomy is relatively simple and is associated with minimum morbidity and an acceptable success rate. The procedure alters the urodynamic behaviour of the bladder and leads to symptomatic and objective improvement, giving better results with idiopathic than with neuropathic detrusor overactivity. Detrusor myectomy may be offered to patients with detrusor overactivity unresponsive to conventional management. The option of enterocystoplasty is still open to patients with an unsuccessful outcome. However, the long‐term results and surgical variations of the technique should be evaluated further.
Down‐regulation of endothelin‐B receptor sites in cavernosal tissue of hypercholesterolaemic rabbits
Authors: Sullivan  , Dashwood  , Thompson  , Mikhailidis  , Morgan
Published: March 2003

Objective

 To investigate the density and distribution of endothelin‐1 (ET‐1) and endothelin receptor subtypes in cavernosal tissue of healthy New Zealand White (NZW) rabbits (controls) and to assess any changes in a genetic model of hypercholesterolaemia (the Watanabe rabbit).

Materials and methods

 Penises were excised from six hypercholesterolaemic (HC) rabbits 6 months after birth. Low‐and high‐resolution autoradiography was performed on cavernosal sections using radioligands for ET‐1, endothelin A (ETA ) and endothelin B (ETB ) receptors, and the autoradiographs analysed densitometrically. The results were compared with those from six age‐matched control rabbits. Immunohistochemical localization of ET‐1‐like immunoreactivity was also performed on adjacent cavernosal sections.

Results

 ET‐1, ETA and ETB receptor binding sites were primarily localized to the smooth muscle cells of the corpus cavernosum and the endothelium lining the cavernosal spaces. There was a significant decrease in ETB receptor binding sites in cavernosal tissue from HC rabbits when compared to age‐matched healthy controls.

Conclusions

 The findings suggest that ET‐1 may have a role in the pathophysiology of erectile dysfunction in HC. These effects may partly be due to enhanced vasoconstrictor actions and smooth muscle cell proliferation, consequent on a reduction in endothelial ETB receptors.
A novel therapy for nocturnal polyuria: a double‐blind randomized trial of frusemide against placebo
Authors: Reynard  , Cannon  , Yang  , Abrams
Published: March 2003

Objective

 To report a randomized, double‐blind, placebo‐controlled trial of an afternoon dose of the diuretic frusemide, used to establish an early evening diuresis and so diminish nocturnal voiding frequency and voided volume in elderly men presenting with lower urinary tract symptoms (LUTS).

Patients and methods

  After a 2‐week placebo run‐in period, 49 men aged >50 years were randomized to receive 40 mg of frusemide or placebo, taken 6 h before their usual bedtime. Day and night‐time frequency and voided volume during the run‐in and treatment periods were compared between the placebo and frusemide groups.

Results

 In the 43 men completing the study, there was a significant reduction in night‐time frequency (−0.5 and 0) and percentage night‐time voided volume (−18% and 0%) in those taking frusemide compared with placebo. Of patients on active treatment, seven of 19 had a reduction in night‐time frequency of ≥1, compared with only one of 20 on placebo, and 14 of 21 felt that frusemide had helped their nocturia, compared with only five of 22 on placebo.

Conclusion

 Men with LUTS whose most prominent symptom is nocturia should complete a frequency‐volume chart. In those with nocturnal polyuria, 40 mg of frusemide resulted in a significant reduction in night‐time frequency and percentage voided volume.
Inter‐α‐inhibitor in urine and calcium oxalate urinary crystals
Authors: Dawson  , Grover  , Ryall
Published: March 2003

Objective

 To determine which chains of inter‐α‐inhibitor (IαI) are present in urine and whether they are also found in calcium oxalate (CaOx) crystals generated in human urine.

Materials and methods

 Fresh urine specimens were collected from five women and five men with no previous history of stone disease. An aliquot of each urine was retained for analysis, the remainder treated with a standard load of oxalate and the CaOx crystals precipitated from each specimen demineralized with ethylenediamine tetracetic acid. The resulting organic extracts from crystals and their corresponding urine samples were subjected to sodium dodecyl sulphate gel electrophoresis analysis and Western blotting using a commercial polyclonal antibody to IαI.

Results

 Heavy chain 1 (H1) and 2 (H2) of IαI were commonly found in every urine sample, and in the CaOx crystals precipitated from those urine samples. Several protein bands were visible in urine samples from both sexes in the molecular mass range 25‐70 kDa, which may be bikunin or its fragments. As well as H1 and H2, the crystals from both sexes contained a protein band at ≈33 kDa. In many cases there appeared to be no direct relationship between the proteins detected in the crystals and the urine samples from which they were derived, which probably reflects the well known instability of IαI and the occurrence of a range of bikunin fragments in urine.

Conclusion

 These results show for the first time that H1 and H2 are present in human urine and urinary CaOx crystals, that the bikunin chain of IαI is not the only part of the molecule capable of participating in CaOx crystallization in urine, and in theory at least, in the regulation of crystallization events in stone formation. It is also apparent that significant fragmentation of IαI occurs both in vivo and in vitro, and this must be considered in any study attempting to elucidate the influence of this protein in the formation of CaOx stones.
Long‐term results and complications of augmentation ileocystoplasty for idiopathic urge incontinence in women
Authors: Awad  , AL‐Zahrani  , Gajewski  , Bourque‐Kehoe
Published: March 2003

Objective

 To assess the long‐term (3–9 years) results of augmentation ileocystoplasty for non‐neurogenic female urge incontinence in terms of continence, the need for intermittent self‐catheterization and the need for additional or auxiliary treatment, to define the long‐term complications and to assess the patients’ satisfaction with the outcome.

Patients and methods

 The study comprised 51 women who underwent augmentation ileocystoplasty for non‐neurogenic urge incontinence between November 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an unsatisfactory outcome. All patients were interviewed about the results of the procedure, and their charts reviewed and updated with relevant information.

Results

 Within a mean (range) follow‐up of 75.4 (36–109) months, 27 patients (53%) were completely continent, 13 (25%) had occasional leaks and nine (18%) continued to have disabling urge incontinence frequently requiring pads. Regular self‐catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or minimal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontinence and were managed with fascial sling procedures. The patch was revised in two patients and excised from four others because they had high residual volumes and uncontrollable infections. Two patients had an ileal conduit diversion for persistent incontinence. The most common complication was recurrent urinary tract infections, seen in 22 patients using intermittent self‐catheterization. Mucus retention occurred regularly in 10 patients, six had chronic diarrhoea, four had latent bowel obstruction, one developed a bladder stone, one an incisional hernia and one developed patch necrosis and perforation. Twenty‐seven patients (53%) were happy with the outcome of the procedure while 20 (39%) were not; four patients were unsure whether a change had occurred.

Conclusion

 Augmentation ileocystoplasty is a valuable alternative for women with intractable urge incontinence. However, these patients and their physicians should be aware of its limitations, specifically the possibility that incontinence may persist and the high probability of the need for self‐catheterization, with potential subsequent urinary tract infection.
Urodynamic findings in patients with urogenital fistulae
Authors: Hilton
Published: March 2003

Objective

 To assess the feasibility of carrying out a urodynamic investigation in patients with a urogenital fistula and to establish the incidence of abnormal lower urinary tract function in such patients.

Patients and methods

 Of 38 patients referred within the last 3 years with a diagnosis of lower urinary tract genital fistula, 30 were investigated by dual‐channel subtracted cystometry before surgical treatment of their fistula; in addition, urethral pressure profilometry was carried out in 19 patients. Fourteen of the patients had fistulae into the vaginal vault; the urodynamic findings in this subgroup were compared with those of 12 patients with bladder neck and urethrovaginal fistulae. Twenty‐six of the 30 patients underwent surgical treatment and 24 (92%) were cured anatomically by their first procedure. Ten patients complained of residual lower urinary tract symptoms and were re‐investigated.

Results

 Of the 38 patients, 47% had genuine stress incontinence, 40% showed systolic detrusor instability and 17% impaired bladder compliance. Half had evidence of voiding dysfunction; most appeared to be of a hypotonic detrusor type, although four cases showed an obstructive pattern. Fifteen patients had more than one abnormality and only five (17%) had entirely normal urodynamic findings. The overall incidence of functional abnormality was highest in the patients with urethral or bladder neck fistulae, with only one showing entirely normal urodynamic findings. Genuine stress incontinence was found more than twice as often associated with urethral or bladder neck fistulae and detrusor instability was also more common in this group. Voiding dysfunction of both hypotonic and obstructive types was found equally in the two groups. After surgical treatment, most patients became continent and free from lower urinary tract symptoms, although one complained of residual stress incontinence and nine of urgency or urge incontinence. Of the latter, six were found to have detrusor instability, one after repair of vault fistula, three after urethral or bladder neck fistulae and the other two after mid‐vaginal fistulae.

Conclusion

 There is a high incidence of abnormal lower urinary tract function in patients with urogenital fistulae. Patients with urethral or bladder neck fistulae had a higher incidence of both detrusor instability and genuine stress incontinence than those with fistulae into the vaginal vault. Many of these abnormalities appear to resolve after successful repair of the fistula, although detrusor instability may persist and require further treatment in some women. These findings are relevant to the counselling of patients before repair and may be of medico‐legal significance.
Functional rat bladder regeneration through xenotransplantation of the bladder acellular matrix graft
Authors: Piechota  , Dahms  , Probst  , Gleason  , Nunes  , Dahiya  , Lue  , Tanagho
Published: March 2003

Objective

 To determine the decreased antigenicity of the bladder acellular matrix graft (BAMG) through xenotransplantation and to assess the in vivo and in vitro functional properties of the rat urinary bladder thus regenerated.

Materials and methods

 After partial cystectomy (>50%), BAMGs prepared from hamster, rabbit and dog urinary bladders were grafted to male and female Sprague‐Dawley rats; 10 control rats underwent partial cystectomy only. Urinary storage and voiding function were monitored in 15 animals using a specially designed ‘micturition cage’ and cystometry. After 4 months, organ‐bath studies and histological techniques were used to evaluate bladder regeneration in vitro in the grafted animals.

Results

 Clinically relevant antigenicity was not evident; no animal died from rejection and all bladder wall components regenerated in all BAMG xenografts. However, the degree and quality of regeneration varied. Muscularization, peak pressure, and bladder capacity were higher in the hamster BAMG‐grafted animals, whereas in vitro contractility and compliance were best in the dog BAMG‐regenerated bladders. All grafted bladders had significantly better capacity and compliance than the autoregenerated bladders after partial cystectomy alone.

Conclusions

 The present in vivo and in vitro studies show that BAMG‐augmentation cystoplasty can lead to morphological and functional regeneration of the rat bladder, preserving its low‐pressure reservoir function. Because BAMG‐regenerated bladders show functional innervation that is similar to normal bladders, they can work in coordination with the host bladder components, thus generating adequate intravesical pressure to produce sustained voiding. The decreased antigenicity makes heterologous BAMG transplants feasible without immunosuppression.
British urological surgery practice: 2. Renal, bladder
Authors: Bower  , MA  , Savage  , Abel  , Waxman
Published: March 2003

Objective

 To investigate the management of urological malignancies in the United Kingdom.

Methods

 A postal survey of consultant urologists and general surgeons with an interest in urology was conducted to examine current clinical practice in urological malignancies.

Results

 Completed questionnaires were received from 273 consultant surgeons who saw an estimated total of 13 241 new patients with renal, bladder or testis cancer per year; 82% had access to on‐site oncology services and in general there was a consensus in the answers given. Most respondents advised active treatment of an asymptomatic primary renal cancer in the presence of metastases and a significant proportion of patients with metastases were not prescribed immunotherapy nor were offered a multidisciplinary approach for their condition. Forty‐six per cent of patients with testis cancer received no advice to store sperm before chemotherapy and there were varied opinions as to the need for surgical resection of residual masses after completion of chemotherapy.

Conclusion

 This survey showed minor variations in the management of renal, bladder and testis tumours in the UK. Consensus management guidelines for urological malignancies and a change in the working relationships between urologists and oncologists is required, to improve the outcome of patients with urological malignancy.
Does bone anchor fixation improve the outcome of percutaneous bladder neck suspension in female stress urinary incontinence?
Authors: Schultheiss  , HÖfner  , Oelke  , GRÜnewald  , Jonas
Published: March 2003

Objective

 To evaluate the outcome of a new modification of percutaneous needle suspension, using a bone anchor system for fixing the suture at the pubic bone, and to compare the results with those published previously.

Patients and methods

 From March 1996, 37 patients with stress urinary incontinence (>2 years) were treated using a bone anchor system. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ‘Z’‐stitch. A urodynamic investigation performed preoperatively in all patients confirmed stress incontinence and excluded detrusor instability. The outcome was assessed either by a clinical follow‐up investigation or using a standardized questionnaire, over a mean follow‐up of 11 months (range 6–18).

Results

 In the 37 patients, the procedure was successful in 25 (68%), with 16 (43%) of the patients completely dry and nine (24%) significantly improved. Removal of the bone anchor and suture was necessary in two patients, because of unilateral bacterial infection in one and a bilateral soft tissue granuloma in the other. One bone anchor became dislocated in a third patient. In two cases where the treatment failed, new detrusor instability was documented urodynamically. Minor complications were prolonged wound pain in 10 (26%) and transient urinary retention or residual urine in 12 patients (32%).

Conclusion

 The poor success rate in this study corresponds with the long‐term results of conventional or modified needle suspension procedures and does not reinforce the optimistic results of bone anchoring published recently. Because of the poorer long‐term results from percutaneous needle suspension than from other techniques of open retropubic bladder neck suspension, it remains questionable whether percutaneous needle suspension should be considered a first‐line procedure for the treatment of female stress urinary incontinence.
In vivo evaluation of serotonergic agents and α‐adrenergic blockers on premature ejaculation by inhibiting the seminal vesicle pressure response to electrical nerve stimulation
Authors: Hsieh  , Chang  , Law  , Hsieh  , Cheng
Published: March 2003

Objective

 To evaluate the effect of drugs on premature ejaculation using a rat animal model in which the seminal vesicle was electrically stimulated via its lesser splanchnic nerve and changes in the pressure response monitored.

Materials and methods

 Male Wistar rats (aged 12–14 weeks) were injected intravenously with prazosin and serotonergic agents (serotonin, clomipramine, fluoxetine, imipramine and indatraline) at various concentrations 10 min before electrical nerve stimulation (ENS) of the lesser splanchnic nerve; the initial increase in seminal vesicle pressure in response to ENS was then compared.

Results

 The pressure response to ENS was reduced in the presence of prazosin or serotonergic agents. The mean (SEM) maximum inhibition values were 84.1 (8.9)% by fluoxetine at 0.1 mg/kg, 67.9 (8.7)% by prazosin at 0.1 mg/kg, 60.9 (11.0)% by serotonin at 3 mg/kg, 54.9 (4.6)% by clomipramine at 3 mg/kg, 30.0 (11.0)% by imipramine at 0.1 mg/kg, and 20.9 (4.3)% by indatraline at 0.1 mg/kg. From the concentration‐response curve, the potency of prazosin was lower than that of fluoxetine, but was higher than that of serotonin or clomipramine.

Conclusions

 Like serotonin, fluoxetine and clomipramine can reduce the pressure response of the seminal vesicle to ENS. Among these inhibitory agents, including prazosin, fluoxetine was the most effective and may be valuable for the clinical treatment of ejaculatory dysfunction in man.
A histological study of Denonvilliers’ fascia and its relationship to the neurovascular bundle
Authors: Kourambas  , Angus  , Hosking  , Chou
Published: March 2003

Objective

 To evaluate the anatomical relationship between the nerves and fasciae at the site of dissection in a radical retropubic prostatectomy.

Materials and method

Eight adult male (autopsy) en bloc specimens of bladder and rectum were examined histologically after staining with either haematoxylin and eosin or S‐100 protein (as a specific nerve stain).

Results

All specimens showed Denonvilliers’ fascia to have no clearly defined layers and no definable lateral edge. No distinct neurovascular bundle was seen but nerves were scattered throughout the fasciae, including medially towards the midline.

Conclusion

In radical retropubic prostatectomy, a piece of Denonvilliers’ fascia is taken with the specimen, thus removing these nerves. The loss of these nerve fibres may explain the significant rate of erectile dysfunction after ‘nerve‐sparing’ surgery.
The role of power Doppler ultrasonography in the diagnosis of prostate cancer: a preliminary study
Authors: Sakarya  , Arslan  , Unal  , Atilla  , Aydin
Published: March 2003

Objective

 To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer.

Patients and methods

 Thirty‐six patients (mean age 66.4 years, sd 7.7, range 59–82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0–2, where grade 1–2 was considered positive and grade 0 negative.

Results

 The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%.

Conclusion

 Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy.
Holmium:YAG lasertripsy for ureteric calculi: an experience of 300 procedures
Authors: Devarajan  , Ashraf  , Beck  , Lemberger  , Taylor
Published: March 2003

Objective

 To assess the success of holmium:YAG lasertripsy in the management of ureteric calculi and to audit the complications of the procedure, with special reference to strictures in the ureter.

Patients and methods

 A total of 300 ureteroscopic laser procedures were carried out on 265 patients (204 male and 61 female, median age 51 years, range 2–95) with ureteric calculi. At ureteroscopy, the calculi were present in the upper ureter in 44%, mid‐ureter in 37% and lower ureter in 19% of patients; most calculi were >5 mm. A 7.5 F Wolf semi‐rigid ureteroscope was used and the holmium:YAG laser energy delivered using the Sharplan ML210 device at 0.8–1.0 J/pulse. The patients were followed up at ≈6 weeks with limited intravenous urography or ultrasonography to assess clearance and the incidence of strictures.

Results

 Stones were completely cleared in 90% of the patients, with the best results in the lower and mid‐ureter (97% and 96%, respectively) followed by the upper ureter (89%). Alternative procedures were required in only 17 (7%) patients; extracorporeal shock‐wave lithotripsy in 13, percutaneous nephrolithotomy in two and open pyelolithotomy in two patients. Complications with ureteric perforation in 11 patients, including laparotomy for peritonitis in one, serious sepsis in two and strictures in 10 patients. Strictures were more common in association with impacted calculi in the upper ureter early in the series.

Conclusions

 Holmium:YAG lasertripsy is a highly effective treatment for ureteric calculi, with strictures related to the treatment of difficult upper ureteric calculi.
Influence of free‐to‐total prostate specific antigen variability on the early diagnosis of prostate cancer: a comparative study of three immunoassays
Authors: de la Taille  , Houlgatte  , Houdelette  , Goluboff  , Berlizot  , Ricordel
Published: March 2003

Objective To compare three immunoassays for total prostate specific antigen (tPSA), free PSA (fPSA), free‐to‐total PSA ratio (f/tPSA), and the f/tPSA thresholds for optimal differentiation between benign prostatic hypertrophy (BPH) and prostate cancer in 141 consecutive patients referred for prostatic disease.

Patients and methods The study included 43 patients with prostate cancer and 98 with BPH, all confirmed histologically. PSA levels were assessed using the following assay kits just before histological analysis of the prostate; Hybritech (Tandem‐R PSA, normal values, NV, <4 ng/mL, and Tandem‐R free PSA), Cis Bio (PSA‐RIACT, NV <2.5 ng/mL and fPSA‐RIACT) and Immunocorp (PSA‐IRMA, NV <4 ng/mL and Free PSA‐IRMA). The results were assessed to determine the sensitivity, specificity and threshold values of the different assays to differentiate patients with BPH and cancer.

Results The mean tPSA and f/tPSA ratio were statistically different in assays with different NVs. The mean fPSA values differed significantly between the Hybritech and Cis Bio, between the Hybritech and Immunocorp but not between the Cis Bio and Immunocorp assays. With receiver operator curve analysis, there were no statistically significant differences among the three immunoassays in f/tPSA (0.72 for Hybritech, 0.73 for Cis Bio and 0.64 for Immunocorp) or between the tPSA and fPSA curves for each manufacturer. With the sensitivity fixed at 90%, different f/tPSA thresholds were defined (0.22, 0.34 and 0.25 for Hybritech, Cis Bio and Immunocorp, respectively). The specificities (i.e. the percentage of unnecessary biopsies spared) were 22%, 21% and 31%, respectively (not significantly different).

Conclusion Each immunoassay could be used to distinguish prostate cancer and BPH at different f/tPSA thresholds, with 21–30% of unnecessary biopsies spared. There was no difference in overall performance among the different assays. Further studies are needed to better define the exact use of the f/tPSA ratio in the routine diagnosis of prostate cancer.
The expression of mdr‐1‐related gp‐170 and its correlation with anthracycline resistance in renal cell carcinoma cell lines and multidrug‐resistant sublines
Authors: YU  , Chang  , MA
Published: March 2003

Objectives

 To clarify the role of the membranous glycoprotein gp‐170 in renal cell carcinoma (RCC) cell lines and their multidrug resistant (MDR) sublines, and to correlate gp‐170 with the natural and acquired drug resistance of these cell lines to anthracyclines.

Materials and methods

 The expression of gp‐170 in five cultured RCC cell lines and serial RCC8701 MDR sublines was analysed by immunofluorescent flow cytometry. The chemosensitivity of these tumour cells to the anthracycline anticancer drugs adriamycin and epirubicin was measured using the microplate tetrazolium (MTT) cytotoxicity assay, and the results correlated with gp‐170 expression.

Results

 All six natural RCC cell lines showed a variably increased expression of gp‐170, with the A704 and Caki‐1 cell lines the highest. In contrast, gp‐170 expression increased and then was suppressed in acquired MDR sublines of RCC8701 cultured in increasing concentrations of adriamycin. The A704 and Caki‐1 cells were much more resistant to adriamycin and epirubicin than the A498, ACHN and RCC8701 cell lines, in parallel with the expression of gp‐170. The resistant cell line cultured long‐term in 800 ng/mL adriamycin, RCC8701/ADR800, was 122 times more resistant to adriamycin and 238 times more resistant to epirubicin than the parent cell line; the pattern differed from that in native RCC cell lines and was unrelated to the expression of gp‐170.

Conclusion

 Membranous gp‐170 plays an important role in MDR of native RCC cell lines, while acquired MDR cells have different mechanisms of obtaining drug resistance in addition to gp‐170. This phenomenon may be applicable to the clinical treatment of patients newly diagnosed with RCC or those with disease refractory to chemotherapy.
The evaluation of sexual function in men presenting with symptomatic benign prostatic hyperplasia
Authors: Namasivayam  , Minhas  , Brooke  , Joyce  , Prescott  , Eardley
Published: March 2003

Objective

 To evaluate quantitatively and qualitatively the degree of sexual dysfunction in an unselected population of men attending a prostate‐assessment clinic using a sexual‐function inventory, and to ascertain the degree of correlation between sexual dysfunction, urinary symptoms and age.

Patients and methods

 In all, 168 men with symptomatic BPH attending a prostate assessment clinic were investigated prospectively using the International Prostate Symptom Score (IPSS), BPH Impact Index (BPHII), a measurement of urinary flow rate and residual urine volume, and a sexual function questionnaire. The results were assessed using Spearman’s rank order correlation to discern any correlations between the measured variables.

Results

 The data from 140 patients were available for analysis; of these, low scores were obtained in 59% for sexual drive, in 56% for erections (with 46% of men satisfying the National Institute of Health criterion for impotence) and in 38% for ejaculation. There was a statistically significant rank order correlation between age and the sexual symptom scores for each of the three categories (sexual drive, erection and ejaculation), but no correlation between age and the problem assessment scores for these domains, suggesting that the older patients are just as bothered by their sexual dysfunction as the younger men. Furthermore, the BPHII scores correlated weakly but significantly with all aspects of sexual function, including overall sexual satisfaction, in contrast to the poor correlation seen with the total IPSS and sexual function scores.

Conclusion

 There is a significant number of patients with symptomatic BPH who have sexual dysfunction, with the proportion increasing with advancing age and with the older men still showing a high degree of bother from their symptoms. Sexual function scores were better correlated with BPHII scores than with the total IPSS, although some of the individual IPSS questions correlated well.
Effect of calcium and calcium chelator on the response of the bladder to in vitro ischaemia
Authors: Levin  , Leggett  , Whitbeck  , Horan
Published: March 2003

Objective

 To examine the effect of different concentrations of calcium on the contractile responses of isolated strips of rabbit bladder detrusor to various forms of stimulation after 2 h incubation in the presence of substrate and oxygen depletion (in vitro ischaemia), followed by 1 h of recovery. The resultant contractile responses were correlated with the level of lipid peroxidation as determined by malonedialdehyde (MDA) concentration.

Materials and methods

 Isolated strips of rabbit bladder detrusor smooth muscle were incubated in Tyrode’s solution containing different concentrations of calcium (0–5.4 mmol/L). The effect of 2 h of incubation in oxygen‐ and substrate‐free medium (in vitro ischaemia), followed by a 1‐h incubation in the presence of oxygen and substrate, on the contractile responses to field stimulation, carbachol and KCl were determined. The effects of repetitive stimulation (15 s of stimulation at 32 Hz applied every 5 min during the 2‐h experimental period) were also assessed.

Results

 The contractile responses to all stimuli increased as the extracellular calcium concentration was increased from 0.6 to 5.4 mmol/L. A 2 h exposure to in vitro ischaemia, followed by a return to normal solution, resulted in a diminished response to all stimuli. This contractile dysfunction was least in the presence of calcium chelator (EGTA) and greatest in the presence of 5.4 mmol/L calcium. Repetitive stimulation during in vitro ischaemia also exacerbated the contractile dysfunction. Lipid peroxidation increased during in vitro ischaemia in proportion to the calcium concentration and was enhanced by repetitive stimulation during this period. Regardless of the incubation conditions, the reduction in the contractile response was significantly greater for field‐stimulated tissues than for those stimulated with carbachol or KCl.

Conclusions

 These results show that the magnitude of contractile dysfunction induced by incubation in the presence of substrate and oxygen depletion is reduced in the presence of low calcium concentrations, increased in the presence of high calcium levels and increased in the presence of repetitive stimulation. In addition, the level of lipid peroxidation after the recovery period was proportional to the magnitude of contractile dysfunction present.
Heat‐induced membrane damage combined with adriamycin on prostate carcinoma PC‐3 cells: correlation of cytotoxicity, permeability and P‐glycoprotein or metallothionein expression
Authors: Moriyama‐Gonda  , Igawa  , Shiina  , Wada
Published: March 2003

Objective

 To assess heat‐induced membrane damage in a prostate cancer cell line when combined with adriamycin treatment.

Materials and methods

 The changes in intracellular adriamycin accumulation, cell proliferation and cell‐cycle fractions were examined after human prostate carcinoma PC‐3 cells were exposed to heat and/or further treatment with adriamycin. Proliferation and the cell cycle were determined using adherent cell analysis and sorting laser cytometry (ACAS) or flow cytometry. P‐glycoprotein (PGP) and metallothionein (MT) expression, which may have a physiological role in the transport of or reduction in cytotoxicity of some anticancer drugs, were also analysed after cells were exposed to heat, using immunohistochemical or flow cytometric methods.

Results

 There was a significant increase in intracellular adriamycin accumulation, related to both influx (P<0.05) and efflux (P<0.01), in cells treated with adriamycin, especially after heating them at 44°C for 1 h. There was a significant decrease in cell proliferation of preheated cells when exposed to adriamycin, especially at 44°C (P<0.05). In the cell‐cycle analysis, cells preheated at 44°C showed partial accumulation in the debris or apoptotic fraction at 24 h, and many cells accumulated in these fractions at 48 h. There was significantly less PGP or MT expression in cells preheated at 44°C than in control cells or cells preheated at 41°C (P<0.01). This reduction in PGP or MT level by heating may inhibit drug efflux and thus increase intracellular drug level at elevated temperatures.

Conclusions

 These results suggest that hyperthermia may damage the drug‐exclusion mechanism in these cells and thus increase the effectiveness of drug action.