bluuebunny/crossref_metadata_2025 huggingface dataset:
A new technique for detrusor biopsy and its applicability in the ultrastructural study and diagnosis of voiding dysfunction
Authors: Holm N.R. , Horn T. , Elbadawi A. , Skjoldby B. , Nordling J.
Published: November 2003

Objective To determine the clinical applicability of ultrasound‐guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall.

Materials and methods The detrusor structure in 22 biopsies, 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis. In addition, several specimens from each of three bladders were evaluated, also ‘blindly’, for ultrastructural diagnosis of the detrusor in an independent current study of voiding dysfunction in geriatric patients.

Results There were no differences in intercellular distances and cell:nucleus ratios between transabdominal and transurethral biopsies in eight of the 11 patients. Furthermore, ultrasound‐guided transabdominal biopsies were as representative of the detrusor as were transurethral biopsies.

Conclusion The transabdominal approach is recommended as an easy, relatively inexpensive and efficient method of obtaining biopsies of the detrusor for study of its structure in voiding dysfunction. On the other hand, the observations and diagnoses made by ‘blind’ qualitative study of several specimens from the same bladder were identical. This, together with the similarity of detrusor structure in the transabdominal and transurethral biopsies, strongly supports the idea that such structure is relatively uniform throughout the entire bladder wall.
Comparison of three different irrigation fluids used in transurethral prostatectomy based on plasma volume expansion and metabolic effects
Authors: Akan H. , Sargin S. , Türkseven F. , Yazicioglu A. , Çetin S.
Published: November 2003

Objective

 To examine changes in the pathophysiology of the transurethral resection (TUR) syndrome with various irrigation fluids.

Patients and methods

 Three different irrigation fluids (5% mannitol in 21 patients, group A; 1.5% glycine in 18 patients, group B; and a fluid containing 2.7% sorbitol and 0.54% mannitol in 20 patients, group C) were compared during transurethral prostatectomy (TURP) by assessing plasma volume expansion, calculated using the haematocrit dilution method, and several biochemical variables.

Results

 None of the patients experienced TUR syndrome and none showed a change in plasma osmolality (P>0.05). However, serum sodium, haemoglobin, haematocrit, total protein and albumin levels declined (P<0.01). The decrease in total protein and albumin level was greater in group A than in groups B and C (P< 0.01 for both). Although the amount of fluid absorbed was the same in all of the groups (P>0.05), plasma volume expansion was greater in group A than in B or C (P<0.05 for both). Hyperammonaemia, encountered in group B, was more evident with increasing weight of the resected tissue. However, this increase was insufficient to cause encephalopathy.

Conclusion

 Although it was not important clinically, mannitol solution could cause more evident hypervolaemia than glycine and sorbitol solutions; glycine solution could cause hyperammonemia, but the solution containing mainly sorbitol had no such adverse effects.
The significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma of the urinary bladder
Authors: Chen Shiou‐Sheng , Chen Kuang‐Kuo , Lin Alex T.L. , Chang Yen‐Hwa , Wu Howard H.H. , Hsu Ted H.S. , Chang Luke S.
Published: November 2003

Objective

 To determine the significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma (TCC) of the urinary bladder.

Patients and methods

 From August 1975 to January 1991, 140 patients (121 men and 19 women, mean age 64.2 years, range 30–83) with stage Ta TCC of the urinary bladder were treated at the Veterans General Hospital‐Taipei by transurethral resection and post‐operative adjuvant intravesical chemotherapy. There were 48 patients (34%) with grade 1, 78 patients (56%) with grade 2 and 14 patients (10%) with grade 3 tumours. Disease progression and muscle invasion were assessed during a mean follow‐up of 74.3 months and related to grade, urine cytology and the number and location of tumours.

Results

 A total of 10 patients (7%) had tumour recurrence which invaded the muscle, of whom one had grade 1, six had grade 2 and three had grade 3 tumours. The patient with a grade 1 tumour developed muscle invasion within 16 months of surgery. The mean interval to the development of muscle invasion was 49.2 months in patients with grade 2 and 39.4 months with grade 3 tumour. In patients with stage Ta TCC, a grade 3 tumour was more likely to progress to muscle invasion (21%) than was a grade 1 (2.1%; P<0.05) or grade 2 (7.7%; P<0.05) tumour. One patient with a grade 2 and one patient with grade 3 tumour developed distant metastases without muscle invasion. Overall, the disease progression rate was 8.6% (12/140) in stage Ta TCC. Disease progression was more common with grade 3 (28.5%) than with grade 2 (9.0%; P<0.05) and grade 1 (2.1%; P<0.05) tumours.

Conclusion

 Tumour grade may be used to predict disease progression after resection of stage Ta urinary bladder cancer. A higher grade of tumour was associated with a higher incidence of disease progression.
Circumcision: how do urologists do it?
Authors: O' Sullivan D.C. , Heal M.R. , Powell C.S.
Published: November 2003

Objective

 To determine the range of surgical techniques, analgesic practice, post‐operative care and follow‐up procedures used in the circumcision of children by urologists in the United Kingdom, and to suggest changes which would improve patient care and medical training in the relatively simple procedure of circumcision.

Materials and methods

 In 1994, all consultant urologists in the United Kingdom were sent detailed questionnaires asking about their practices in the circumcision of children.

Results

 Of 308 urologists, 61% replied; of these, 55% use the sleeve‐resection technique and 39% the freehand method, and 57% use diathermy, half of which is bipolar. There is wide variation in the type of post‐operative analgesia; 95% use an initial dressing but few recommend any subsequent dressing, 70% perform all circumcisions as day cases and 48% review patients in the clinic. There is significant concern that circumcision is not taught adequately to junior surgeons.

Conclusion

 The sleeve technique of resection should be more widely used. Analgesic practice could be improved with greater use of regional anaesthetics. Most urologists promote no specific care after discharge. There is probably a place for increasing the use of alternative procedures to circumcision.
Assessment of quality of life after radical radiotherapy for prostate cancer
Authors: Caffo O. , Fellin G. , Graffer U. , Luciani L.
Published: November 2003

Objective To assess the quality of life (QoL) of patients with localized prostate cancer (LPC) after treatment by radical radiotherapy (RR).

Patients and methods An ‘ad hoc’ self‐administered questionnaire was developed, which comprised a series of 41 items grouped into seven subscales reflecting the main QoL domains, and the questionnaire's psychometric properties were assessed. A consecutive series of 118 patients treated with RR for LPC from 1981 to 1994 were then selected for a retrospective study and asked to complete the questionnaire.

Results Ninety patients (76%) completed the questionnaire; because 20 of them were also treated with hormonal therapy, QoL was assessed only in the remaining 70 patients, to avoid confusion. The assessment of the psychometric properties showed that the questionnaire was valid and reliable (Cronbach's &agr; coefficient >0.8 for each subscale). The main side‐effects of RR were urinary symptoms and sexual impairment, while physical, psychological and relational well‐being were good. The degree of information available about the therapy and the disease seemed to play a major role in the patients' QoL adjustment after RR.

Conclusion The study assessed a sample of patients with LPC treated with RR and showed that QoL was acceptable after RR. Prospective studies are needed to improve knowledge of the factors involved in the restoration of the QoL after therapy for LPC.
In vitro and in vivo assessment of urethral warming catheters for the transperineal cryoablation of prostatic carcinoma
Authors: Cozzi P.J. , Lynch W.J. , Robson N. , Vonthethoff L. , Lumley T. , Morris D.L.
Published: November 2003

Objective To evaluate the two most common urethral warming catheters currently available for their effectiveness in preventing urethral injury in an animal model and thus during transperineal cryosurgery for the treatment of prostate cancer.

Patients, materials and methods The warming efficiency of the variable‐diameter thin latex‐balloon catheter (Cook, Australia) and the fixed‐diameter PVC catheter (Candela, USA) were evaluated in a water‐bath. A sheep model was then used for subsequent experiments to further evaluate the better catheter. The technique used for the insertion of the Cook catheter in a series of 33 patients treated with prostate cryosurgery is also described.

Results In vitro, the Cook catheter was more effective (P<0.01) than the Candela catheter in preventing localized cooling. In vivo, results in five animals showed that the urethral epithelium was viable in all sections that had been protected by the catheter and focally denuded or necrotic in those sections not protected, with each animal used as its own control (P<0.01 Fisher's exact test). The 33 patients treated while using the Cook catheter had no subsequent complications.

Conclusion The urethral warming catheter currently in use for prostatic cryosurgery in Australia is more effective in vitro than its competitor and is effective in preventing urethral injury in vivo.
Breast and prostate cancer in the relatives of men with prostate cancer
Authors: McCahy P.J. , Harris C.A. , Neal D.E.
Published: November 2003

Objective To assess the risk of breast, ovarian and prostate cancer in the families of men with prostate cancer.

Patients and methods A case‐control study was performed by interviewing patients with prostate cancer and obtaining detailed information on family histories of cancer. Controls were hospital‐based patients, of a similar age to the cases, with bladder cancer or benign prostatic hypertrophy.

Results A total of 209 cases and 322 controls were interviewed; of the cases, 22.5% had family members with a history of one or more of breast, ovarian or prostate cancers, compared with 15.2% of controls (P<0.05). The odds ratio (OR) of having prostate cancer when there was a positive family history was 8.22 and the OR of a female relative of a patient with prostate cancer having breast cancer was 1.51. There was no apparent increased risk of ovarian or any other cancer.

Conclusions We confirm previous reports of an increased incidence of prostate cancer in the families of men with prostate cancer and report a similarly increased incidence of breast cancer in female relatives. We suggest that detailed family histories be taken routinely and intend to analyse blood samples provided from this study for genetic abnormalities.
The after‐contraction in paediatric urodynamics
Authors: Hoebeke P.B. , Van Gool J.D. , Van Laecke E. , Vande Walle J. , Plancke H.
Published: November 2003

Objective To evaluate the incidence and significance of the urodynamic registration of an after‐contraction in the bladder of children.

Patients and methods In a prospective study, 250 children with a non‐neurogenic voiding dysfunction (132 girls and 118 boys) were assessed for the occurrence of after‐contractions during their video‐urodynamic examination, and any filling‐phase dysfunction noted. Twenty children in whom an after‐contraction was recorded underwent additional voiding cystometry with three pressure transducers in the bladder (two microtip and one external transducer connected to a fluid‐filled catheter).

Results Of the 250 children, an after‐contraction was registered in 84 (63 girls and 21 boys). Eighty of thesehad a filling‐phase dysfunction; 51 had detrusor instability, 16 a hypersensitive bladder, six a low and seven a high compliance. Only four showed a normal cystometric pattern during filling. In the 20 children who underwent further study, the after‐contraction was confirmed as a detrusor contraction, as it was registered simultaneously on three transducers of two types in 10 children and on two microtip transducers in another 10 children.

Conclusion The after‐contraction is a frequent occurrence in children with voiding dysfunction, is related to bladder instability and is a genuine detrusor contraction.
Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy
Authors: Van Iersel M.P. , Thomas C.M.G. , Witjes W.P.J. , De Graaf R. , De La Rosette J.J.M.C.H. , Debruyne F.M.J.
Published: November 2003

Objective To characterize the serum kinetics of prostate specific antigen (PSA) after visual laser ablation of the prostate (VLAP).

Patients and methods The PSA values of 45 patients were measured at 24 h and at 1, 4, 12, 26 and 52 weeks after VLAP and the changes assessed in relation to symptom scores, urinary flow rates and prostate size.

Results After an initial rise immmediately after VLAP, the serum PSA level declined. At 24 h, the PSA value reached a mean level 23 times higher than the PSA level before VLAP and then took a mean of 78 days to reach a new baseline. The mean decrease of the subsequent baseline value relative to that before treatment was 1.7 ng/mL. The prostatic size and energy applied correlated positively with the rise in PSA 24 h after VLAP. The rise in maximal urinary flow after VLAP, the decrease in the symptom score and residual urine volume did not correlate with the rise in PSA level 24 h after VLAP or with the time to reach a value halfway between the level at 24 h and the new baseline value.

Conclusions The pattern of the increase in serum PSA level and decline after VLAP was not predictive of the clinical outcome of therapy.
Experience with low‐dose oestrogen in the treatment of advanced prostate cancer: a personal view
Authors: Bishop M.C.
Published: November 2003

Objective To re‐evaluate the treatment of advanced prostatic carcinoma with diethylstilboestrol (DES) in low dosage in relation to the degree of suppression of plasma testosterone.

Patients and methods The study comprised 106 patients with advanced carcinoma of the prostate (89 with T3/4 M1 and 17 with T3/4 N0/1 M0) who were treated with 1 mg/day of DES. The response was assessed clinically and by the change in plasma prostate specific antigen, prostatic acid phosphatase and alkaline phosphatase, and plasma testosterone was monitored regularly. In a few patients it was possible to reduce the dose to 0.5 mg/day DES; in others, the initial response was not sustained and they were treated with an increased dose of DES or bilateral orchidectomy.

Results Seventy patients (Group 1) showed a sustained response to 1 mg/day of DES (0.5 mg/day in three) and 50 remained in remission at a mean of 21 months of treatment. Of the 36 patients offered secondary treatment, 12 (Group 2) responded with a second remission. Only 27% of patients had mean testosterone levels in the castrate range (0–2 nmol/L) but most in Group 1 had mean levels of<10 nmol/L, whilst in 10 of the 12 patients in Group 2, the level was>10 nmol/L. Overall times to progression and death were comparable with the results of conventional monotherapy or combination treatment and complication rates were acceptable.

Conclusion Low‐dose oestrogen therapy (1 mg/day of DES) is cheap, effective and caused few side‐effects, none of which was life‐threatening. In many patients, only minimal suppression of the plasma testosterone was required and the response appeared to be qualitative, although there was considerable variation in the threshold of response. A randomized trial of oestrogen, in a minimal dose adjusted to the requirements of the individual patient, against conventional hormone treatment now seems justified.
Radioligand‐binding analysis of human prostatic alpha‐1 adrenoreceptor density following transurethral microwave therapy
Authors: Bdesha A.S. , Schachter M. , Sever P. , Witherow R.O'N.
Published: November 2003

Objective To determine the effects of single‐session transurethral microwave treatment (TUMT) on human prostatic alpha‐1 adrenoreceptor density in patients with symptomatic bladder outlet obstruction caused by benign prostatic hyperplasia.

Patients and methods Radioligand‐binding assays using 3H‐prazosin were performed on prostatic tissue obtained from 25 patients, 10 of whom had received a single TUMT whilst the remaining 15 patients had not, and acted as controls. Prostatic tissue was obtained by cold‐punch biopsy immediately before transurethral resection of the prostate from 20 patients (10 following microwave treatment and 10 controls) and from a further five patients at the time of retropubic prostatectomy; these five patients again had undergone TUMT. There were no statistically significant differences in several variables between the groups except for the weight of resected tissue, which was greater for the patients undergoing retropubic prostatectomy. Differences in the maximum receptor density (Bmax) and dissociation constant (Kd) were analysed statistically using the Mann–Whitney U‐test because the data were non‐parametric.

Results Binding was saturable and a single class of high‐affinity binding sites was identified in all cases. In the control group, the mean and 95% confidence interval (CI) alpha‐1 adrenoreceptor density (Bmax) was 96.4 (82.7–110.1) fmol/mg and the mean (95% CI) dissociation constant (Kd) was 0.56 (0.37–0.74) nmol/L. In those patients who had undergone TUMT, the mean Bmax was significantly lower at 71.3 (58.6–84.7) fmol/mg (P < 0.02) but the Kd of 0.56 (0.20–1.14) mmol/L was identical to that in the control group.

Conclusions Single‐session TUMT, using a non‐irrigated catheter, causes a significant reduction in prostatic alpha‐1 adrenoreceptor density in the region of the prostate subjected to maximum heating. This may represent one possible mechanism of action by which microwave treatment exerts its beneficial effects.
Anti‐androgenic effects of combination finasteride plus flutamide in patients with prostatic carcinoma
Authors: Fleshner N.E. , Fair W.R.
Published: November 2003

Objectives To determine the anti‐androgenic effects and safety of the combination of finasteride and flutamide in men with prostate cancer.

Patients and methods Seventeen men with various stages of prostate cancer, all of whom were candidates for androgen deprivation therapy, were treated with finasteride plus flutamide and were followed for a mean of 13.6 months using measurements of serum prostate specific anti gen (PSA), and an assessment of regression and side‐effects.

Results The initial median PSA level was 19.8 ng/mL; at 3, 6 and 12 months the median PSA had fallen to 1.2, 0.85 and 0.8 ng/mL, respectively. In four patients followed for 2 years, the anti‐neoplastic effects were sustained. Patients with initially palpable disease had regression, as assessed by a digital rectal examination. Side‐effects included gynaecomastia (five patients), mildly elevated hepatic transaminases (two) and diarrhoea (one). Most (10) men maintained their previous sexual function.

Conclusions Early results suggest that the combination of finasteride and flutamide provides significant anti‐androgenic therapy and maintains sexual function in most men. A further investigation with more patients and a longer follow‐up is warranted.
Significance of placental alkaline phosphatase (PLAP) in the monitoring of patients with seminoma
Authors: Koshida K. , Uchibayashi T. , Yamamoto H. , Hirano K.
Published: November 2003

Objective To investigate the significance of placental alkaline phosphatase (PLAP) as a tumour marker for seminoma.

Patients and methods A total of 673 serum samples from 116 patients with testicular germ cell tumours (78 seminomas and 38 non‐seminomas) were analysed for several markers including PLAP, total alkaline phosphatase (AL‐P), alpha fetoprotein (AFP), beta human chorionic gonadotrophin (HCG‐B), and lactic dehydrogenase (LDH).

Results Serum PLAP was increased initially in about 50% of patients with seminoma, and the mean magnitude of elevation was about five times the normal value. There was no significant correlation between PLAP and LDH or between PLAP and HCG‐B. Therefore, a combination of these three markers was of value, and resulted in a positive identification rate of 82% of patients with seminoma. False‐positive results for PLAP appeared in 1.6% of 673 samples investigated.

Conclusion The monitoring of serum PLAP might be of value, as fluctuations in this marker provide information about disease status and prognosis.
The role of cystoscopy before radical prostatectomy
Authors: Schwartz B.F. , Norbeck J.C. , Hansberry K.L. , Wettlaufer J.N. , Thrasher J.B.
Published: November 2003

Objective To determine the role of pre‐operative cystoscopy in men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate.

Patients and methods One hundred men undergoing radical prostatectomy for clinically localized adenocarcinoma of the prostate were evaluated for coexisting bladder pathology from a retrospective review of their charts and records.

Results Four of 100 men undergoing radical prostatectomy for clinically localized prostate cancer were found to have synchronous bladder tumours. Two of these had superficial low‐grade transitional cell carcinoma (TCC), one had a poorly differentiated invasive TCC and the last was found to have an inverted papilloma during radical retropubic prostatectomy. The patient with invasive disease died before the initiation of definitive therapy. The other three men are free of disease 2 years after diagnosis and treatment.

Conclusion Because of the low cost and minimal morbidity of pre‐operative flexible cystoscopy, we recommend that this procedure be performed on the operating table before prostatectomy. In patients with gross or microscopic haematuria, a significant history of smoking, a prior history of urothelial malignancy or symptoms of bladder outlet obstruction, cystoscopy would be best performed before surgery in an out‐patient setting.
Critical temperature for in vivo cryoablation of human prostate cancer in a xenograft model
Authors: Cozzi P.J. , Lawson J.A. , Lynch W.J. , Morris D.L.
Published: November 2003

Objectives To assess the in vivo sensitivity of human prostate cancer cells (PC3) to cryoablation and thus define the minimum temperature needed to prevent the recurrence of cancer after percutaneous transperineal radical prostatic cryoablation.

Materials and methods Twenty‐five male nu/nu mice were inoculated by a subcutaneous injection with 5×105 PC3 cells. After 3 weeks the tumours (mean area 60.4 mm2 , sem 5.7) were frozen using a 3 mm cryotherapy probe (LCS 3000 Cryotech UK) to temperatures ranging from 0° to −40°C.

Results No tumours recurred in seven mice which had tumours frozen to <−15°C. There were eight recurrences in 15 mice which had tumours frozen to between 0° and −15°C, and all were confirmed histologically.

Conclusions The minimum temperature required to prevent recurrence of tumours from human prostate cancer cells was <−15°C in this in vivo mouse model.
Estramustine‐binding protein to dihydrotestosterone ratio in human prostatic carcinoma: a new marker for predicting disease progression
Authors: Shiina H. , Igawa M. , Ishibe T.
Published: November 2003

Objective To elucidate the clinical significance of estramustine‐binding protein (EMBP) in human prostatic carcinoma (PC) as an indicator for predicting disease progression.

Patients and methods EMBP concentrations in prostate tissue samples taken from 35 patients with benign prostatic hyperplasia (BPH), 33 patients with prostatic carcinoma (PC) taken before treatment, and from nine patients with hormone‐refractory PC (hr‐PC) were measured by radioimmunoassay using an antibody raised against rat EMBP. The dihydrotestosterone (DHT), prostatic acid phosphatase (PAP), prostate‐specific antigen (PSA) and zinc levels in the tissue were also measured.

Results The EMBP concentration in well differentiated PC (W‐PC) samples was no higher than in samples of BPH tissue, whereas concentrations in moderately differentiated PC (M‐PC) and poorly differentiated PC (P‐PC) were significantly higher (P<0.01 and P<0.005, respectively); the highest levels were those in tissue from hr‐PC (P<0.001). Levels of PAP, PSA and zinc were significantly lower in tissue from PC than from BPH, while the differences in levels between W‐PC, M‐PC and P‐PC were not significant. The EMBP to DHT ratio in the tissue increased significantly from W‐PC through M‐PC to P‐PC and was greatest in hr‐PC tissue. Conversely, the PAP:DHT, PSA:DHT and zinc:DHT ratios did not correlate with the progress of histological grade. In addition, the pre‐treatment EMBP:DHT and zinc:DHT ratios in 14 patients who developed hr‐PC within 3 years after the administration of estramustine phosphate were significantly higher when compared with the remaining 19 patients (P<0.001 and P=0.0184, respectively), whereas the PAP:DHT and PSA:DHT ratios showed no significant difference between the groups. Moreover, patients with a high EMBP:DHT ratio (≥82) had a low progression‐free probability compared to those with a lower ratio.

Conclusion The androgen‐dependent property of EMBP tends to decline with the transformation of prostatic tissue into biologically more malignant disease. The tissue EMBP:DHT ratio before treatment may be a good indicator of the individual malignant potential of PCs.
Changes in sexual function after radiotherapy treatment of prostate cancer
Authors: Beckendorf MD V. , Hay MD M. , Rozan MD R. , Lagrange MD J.L. , N'Guyen MD T. , Giraud MD B.
Published: November 2003

Objective To assess sexual function before and after definitive irradiation for the treatment of cancer of the prostate.

Patients and methods The study comprised 67 patients (mean age 68 years) treated in five radiotherapy departments and assessed with repeated questionnaires about their libido, arousal, frequency and quality of intercourse, and sexual satisfaction. Interviews were obtained before radiotherapy and at the end of the first year after treatment. Sixty‐three patients were married and 50 had a sexually effective partner. Forty‐six patients presented with another pathology or medical treatment capable of inducing sexual dysfunction. Before radiotherapy, 40 patients were sexually active, with good to acceptable intercourse.

Results Between 10 and 24 months after the end of radiotherapy, no disease progression was observed and prostate‐specific antigen levels remained high in only two patients. Sexual function was preserved in 67% of patients but only 50% observed no change. The functional prognosis seemed to be related to the initial frequency and quality of intercourse; more than three times per month, the prognosis remained good, under three per month, it was poor. The patient's age was a predictive factor for the frequency of intercourse.

Conclusion Several causes of impairment of sexual function may be associated and can change over a long time. A longer survey should be conducted to analyse the organic response to radiation.
Immunohistochemical evaluation of proliferating cell nuclear antigen, prostate‐specific antigen and α1‐antichymotrypsin in human prostate cancer
Authors: Igawa M. , Urakami S. , Shiina H. , Ishibe T. , Shirane T. , Usui T. , Chodak G.W.
Published: November 2003

Objective To determine the relationship between growth fractions defined by proliferating cell nuclear antigen (PCNA), prostate‐specific antigen (PSA) and α1‐anti chymotrypsin (ACT) staining in prostate cancer.

Materials and methods A total of 96 lesions, including 71 from prostate cancers and 25 from benign prostatic hyperplasia (BPH) were evaluated in microscopic sections of the prostatic tissues from 34 patients with prostate cancer. Immunohistochemical staining was performed with an avidin‐biotin system using monoclonal anti‐PCNA antibodies, polyclonal anti‐PSA and anti‐ACT antibodies.

Results There was a significant difference in the mean PCNA labelling index between tissue from prostate cancer (4.2±7.1) and BPH (0.5±1.1) (P=0.002). The mean labelling index of PCNA tended to increase with increasing Gleason score. The proportion of cells positive for PSA was significantly higher in tissue from BPH than from prostate cancer (P=0.005). While the proportion of cells immunostaining for ACT was significantly higher in tissue from BPH compared to that from prostate cancer (P=0.02), there was no significant difference in the proportion of ACT‐positive cells among prostate cancers of differing Gleason score. The mean labelling index of PCNA decreased significantly with the increase in the proportion of PSA‐positive cells (P=0.013). There was a significant relationship between the proportion of ACT‐ and PSA‐positive cells (P=0.001).

Conclusion These results indicate a reciprocal relationship between cell growth and tumour differentiation in prostate cancer. Although the significance of ACT deserves further study, there was evidence for the complexing of PSA with ACT from the immunohistochemical studies.
A 12‐month study of the placebo effect in transurethral microwave thermotherapy
Authors: de Wildt M.J.A.M. , Hubregtse M. , Ogden C. , Carter S.St C. , Debruyne F.M.J. , de la Rosette J.J.M.C.H.
Published: November 2003

Objective To determine the placebo effect of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic enlargement (BPE).

Patients and methods A prospective, randomized sham‐controlled study in 93 patients (mean age 65, range 50–88) was conducted at two centres comparing TUMT or a sham treatment. Patients randomized to receive sham treatment underwent the same initial procedure as for TUMT, but the complete procedure was simulated on the visual display with no application of microwave energy. If the patient's condition had not improved after 3 months, a second genuine TUMT treatment was given at the patient's request.

Results After 3 months there were significant clinical and statistical differences in efficacy between the groups; 62% and 18% of patients had a >50% improvement in symptom score in the treated and sham groups, respectively (P=0.001). The corresponding changes in flow rate were 36% and 11% (P=0.002), respectively. After 1 year, 63 patients were divided into those that had TUMT initally, those that had sham initially but subsequently had TUMT and those whose sham procedure had led to sufficient clinical improvement to require no further treatment. The two treated groups had a significant improvement over the sham group.

Conclusion The benefit from TUMT cannot be due to a placebo effect alone.
Pyridinium cross‐links as urinary markers of bone metastases in patients with prostate cancer
Authors: Ikeda I. , Miura T. , Kondo I.
Published: November 2003

Objectives To determine whether the urinary excretion of urinary pyridinoline (Py) and deoxypyridinoline (dPy) serve as markers to evaluate the activity of bone metastases and the response to endocrine therapy, by determining the relationship between the excretion of these compounds and the activity of bone metastases in patients with prostate cancer.

Patients and methods Urine specimens were obtained from 15 patients with benign prostatic hypertrophy (BPH), 17 with carcinoma clinically confined to the prostate and 26 with prostate cancer and bone metastases. Among the patients with prostate cancer and bone metastases, 15 were new or reactivated cases and the 11 others were well controlled by hormonal therapy. Urinary Py and dPy were analysed using high‐pressure liquid chromatography.

Results Patient with new or reactivated prostate cancer with bone metastases had a higher urinary excretion of Py and dPy than did the patients with BPH, patients with prostate cancer and no bone metastases and patients with prostate cancer and bone metastases well controlled with hormonal therapy. Urinary levels of these compounds correlated with the extent of bone metastases in new and reactivated cases. Initial high levels of these cross‐linked compounds in patients with multiple bone metastases fell as the prostate cancer was controlled by hormonal therapy.

Conclusion Urinary excretion of Py and Dpy appears to be a useful marker for evaluating the activity of bone metastases and their response to hormonal treatment in prostate cancer.
The management of extensive penile fibrosis: a new technique of ‘minimal scar‐tissue excision’
Authors: George V.K. , Shah G.S. , Mills R. , Dhabuwala C.B.
Published: November 2003

Objective To evaluate the results of excising minimal scar tissue in patients undergoing insertion of a penile prosthesis for extensive corporal fibrosis.

Patients and methods Twelve patients (mean age 58 years, range 44–73) with extensive corporal fibrosis who underwent the insertion of a penile prosthesis were evaluated. Eleven patients had a defect of varying extent after the insertion of the penile prosthesis, and a polytetrafluoroethylene graft was used to cover the area.

Results All 12 patients tolerated the procedure well and currently have a functioning penile implant.

Conclusions Minimal excision of scar tissue provided better results and fewer complications when compared to other studies which used extensive excision.
Induction androgen deprivation therapy before radical prostatectomy for prostate cancer — initial results
Authors: Abbas F. , Kaplan M. , Soloway M.S.
Published: November 2003

Objective To determine if androgen deprivation therapy (ADT) on induction decreases the incidence of positive surgical margins and the subsequent risk of disease progression.

Patients and methods Between January 1992 and July 1994, 160 men with prostate cancer underwent radical retropubic prostatectomy (RP) and bilateral pelvic node dissection (PLND). Forty men (mean age 64.2 years) with either a higher clinical stage or a significant increase in serum prostate‐specific antigen (PSA) level (P<0.001) received induction ADT with a luteinizing hormone‐releasing hormone (LH‐RH) analogue alone (six patients), or with an anti‐androgen (34 patients), 3–20 months before undergoing RP. The remaining 120 men (mean age 64 years) underwent surgery alone and served as historical controls. Prostatectomy specimens were evaluated using step‐sections at 2–3 mm intervals and whole‐mount reconstruction. The clinical and pathological results were compared.

Results There was a clinically significant decrease in the size of the prostate in almost all patients treated with ADT. After ADT the mean PSA level declined by >95% from the levels before RP (P<0.001). Of 40 men receiving ADT and the 120 controls patients, nine (22.5%) and 49 (40.8%) had positive margins (P<0.05), nine (22.5%) and 18 (15%) had seminal‐vesicle invasion (P=0.90) and one (2.5%) and two (1.6%) had lymph‐node metastases (P=0.73), respectively. At a mean 17.6 months (range 2–29), 20 of the control patients were lost to follow‐up. PSA levels were elevated (>0.4 ng/mL) in seven (17.5%) of the men who received ADT and 14 (14%) of the control patients (P=0.60). To date, all patients are alive.

Conclusions The results of this study suggest that neoadjuvant ADT before RP is beneficial in men with a high likelihood of having a positive surgical margin. A prospective randomized trial is necessary to determine if there is a benefit in progression‐free and overall survival.
Artificial urinary sphincter in patients with neurogenic bladder dysfunction
Authors: Singh G. , Thomas D.G.
Published: November 2003

Objective To assess the role of the artificial urinary sphincter (AUS) in the management of sphincter weakness incontinence in neuropathic patients.

Patients and methods Ninety patients (75 male and 15 female, mean age 26 years, range 13–62) with neurogenic bladder dysfunction (71 with congenital and 19 with acquired cord lesions) who underwent implantation of an AUS were reviewed. All patients were followed up for a minimum of one year after the initial implantation of the sphincter (mean 4 years, range 1–10). Pre‐operative video‐urodynamics demonstrated sphincter weakness incontinence in all patients, with 24 patients having an acontractile‐type bladder. Of 66 patients with intermediate‐type bladders, 52 underwent cystoplasty.

Results Eighty‐three patients (92%) were continent both night and day, three were occasionally damp and controlled by pharmacotherapy, and four had a persistent poor result. Of the 66 patients with detrusor hyper‐reflexia, 52 (79%) required a cystoplasty to achieve continence and 14 (21%) were controlled with anti‐cholinergic therapy. The re‐operation rate was 28% (25/90) and complications included six infections, seven erosions, eight system failures, two pump failures, one sheered tube and one rectal and one bladder perforation. Seventy (78%) of the patients currently perform intermittent catheterization to treat high post‐voiding residual urine volumes.

Conclusions A rate of continence >90% was achieved in these neurogenic patients after implantation of an AUS and we recommend a simultaneous cystoplasty in patients with detrusor overactivity.
Extraperitoneal laparoscopy: anatomical dissections with experimental balloon dilators
Authors: Chan Y.K. , Pope A.J. , Webb D.R.
Published: November 2003

Objectives To develop balloon dilators in vitro and in cadavers and to evaluate the anatomy of the extraperitoneal spaces and their surroundings created by such balloons.

Materials and methods Balloons of three different materials (condoms, fingers of surgical gloves, whole surgical gloves and ‘party’ balloons) were tested in an in vitro study and compared with a prototype balloon dilator used in cadavers. The balloon dilators were used to create extraperitoneal spaces in the pelvic, the loin and the iliac regions through stab incisions. The incisions were extended after dilatation to examine the spaces created and the consequent anatomical changes.

Results In vitro, all balloons were found to have capacities of more than 10 L, except that made from the finger of a surgical glove. Early rupture after insertion and during dilatation was a problem in condom and party balloons. In cadavers, there was good exposure of anatomical structures within the extraperitoneal spaces created. Reflections of peritoneum in the loin and the iliac regions were unmoved by balloon dilatation.

Conclusions The prototype balloon dilator possessed all the characteristics desired of an ideal instrument for creating extraperitoneal spaces. Good exposure of anatomical structures by the balloon dilators allows a minimal dissection in extraperitoneal laparoscopic procedures in the aforementioned regions. That the peritoneal reflection was unmoved despite adequate expansion of the balloons also means that the exact placement of secondary laparoscopic ports is crucial in preventing peritoneal and colonic trauma.
Paraganglioma of the prostatic urethra. A report of three cases and a review of the literature
Authors: Boyle M. , Gaffney E.F. , Thurston A.
Published: November 2003

Objective To determine the incidence and clinical presentation of prostatic urethral paragangliomas and to compare these findings with paragangliomas occurring in the other sites of the lower urinary tract.

Patients and methods The clinical records of three patients with prostatic urethral paragangliomas were reviewed, as was the histology of each specimen. The tumours were stained immunocytochemically with neuron‐specific enolase, chromogranin, S100 protein, protein gene product 9.5, prostate‐specific acid phosphatase and prostate‐specific antigen.

Results The three tumours occurred in elderly men, two of whom presented with haematuria, one of whom also had a vesical transitional cell carcinoma, and the third patient had obstructive symptoms due to co‐existent prostatic hyperplasia. The histological appearances and immunocytochemical findings were consistent with paraganglioma. Treatment consisted of local excision and there were no recurrences or metastases at 5 and 6 years in two patients for whom follow‐up was available.

Conclusion Urethral paragangliomas are rare tumours arising in elderly men and are hormonally inactive. Although haematuria may be the presenting symptom, it is important to exclude additional more common and possibly more sinister lesions such as transitional cell carcinoma. Local excision appears to be curative.
Dismembered pyeloplasty in infants under the age of 12 months
Authors: Woo H.H. , Farnsworth R.H.
Published: November 2003

Objective To assess the impact of internal ureteric stenting on the surgical outcome of dismembered pyeloplasty in infants under the age of 12 months.

Patients and methods The case records of 53 of 55 infants with the diagnosis of congenital pelvi‐ureteric junction obstruction who underwent dismembered pyeloplasty over a 6‐year period were available for review. A total of 63 renal units were treated surgically. The policy for urinary drainage changed during this period from predominantly nephrostomy or no drainage to that of internal ureteric stenting.

Results The post‐operative mean (sd) length of stay for stented and non‐stented cases was 5.9 (1.8) and 12.4 (5.4) days, respectively (P<0.001). The mean length of stay for patients with bilateral and unilateral pyeloplasty was 9.7 (4.9) and 8.0 (4.7) days, respectively (P=0.19). Urinary leaks occurred in non‐stented anastomoses and not in stented anastomoses. All three cases which later required revision pyeloplasty had had significant complications associated with urinary leaks. With a minimum follow‐up of 24 months, a favourable outcome, as determined by radio‐isotope imaging, was achieved in 48 of 51 infants (94%) for whom follow‐up data were available.

Conclusion The use of internal ureteric stenting in dismembered pyeloplasty performed in infants <12 months old has, in our hands, led to a dramatic reduction in operative morbidity. The routine use of internal ureteric stents at the time of pyeloplasty is justified.
Impact of diagnostic laparoscopy in the management of the unilateral impalpable testis
Authors: Gulanikar A.C. , Anderson P.A.M. , Schwarz R. , Giacomantonio M.
Published: November 2003

Objective To evaluate the impact of laparoscopy on the management of children with a unilateral impalpable testis.

Patients and methods The study population consisted of 27 children who underwent a primary inguinal exploration for a unilateral impalpable testis.

Results Twelve of 27 (44%) children had inguinal or ‘peeping’ testes and 10 of 27 (37%) had blind‐ending vasa and vessels in the inguinal canal; four of these 10 had atrophic tubular tissue in the excised remant. Four of 27 (15%) had blind‐ending vasa and vessels proximal to the internal ring. Only one child had a testis proximal to the internal ring. Only the four children (15%) with blind‐ending vasa and vessels proximal to the internal ring would have benefited from a laparoscopy by avoiding an inguinal exploration.

Conclusions Because of the time, expense and limited usefulness of laparoscopy in altering the management of children with a unilateral unpalpable testis, we reserve laparoscopy for cases where inguinal exploration has failed.
Haemodynamic effects of irrigating fluids studied by Doppler ultrasonography in volunteers
Authors: Nilsson A. , Randmaa I. , Hahn R.G.
Published: November 2003

Objective To study whether moderate amounts of irrigating fluids induce cardiac stress when infused into healthy volunteers, giving special attention to solutions containing ethanol as a tracer of absorption.

Subjects and methods Over a period of 20 min, 15 mL/kgof glycine (1% or 1.5%) or 3% mannitol (all containing 1% ethanol) or sorbitol 2%–mannitol 1% (with no ethanol) were infused intravenously into 10 healthy male volunteers. The central haemodynamic responses were studied using Doppler ultrasonography.

Results Specific and general haemodynamic responses were observed. After infusing glycine there was a reduction of the heart rate and in cardiac output and an elevation of mean arterial pressure, indicating an increase in systemic resistance. There was no improvement when the glycine content was reduced from 1.5% to 1.0%. Furthermore, infusion of all irrigating fluids was associated with a decrease in cardiac output 30 min after the infusion. Almost identical breath‐ethanol curves were obtained with the three fluids containing ethanol and all of them caused slight hypoglycaemia. There was no evidence of ethanol‐induced tachycardia.

Conclusions Irrigating fluids containing glycine and ethanol have a specific haemodynamic effect not occurring with solutions containing mannitol or sorbitol.
A self‐expanding, self‐retaining temporary urethral stent (UrocoilTM) in the treatment of recurrent urethral strictures: preliminary results
Authors: Sikafi Z.H.
Published: November 2003

Objective To determine the efficacy of a self‐expanding, self‐retaining temporary urethral stent (UrocoilTM ) in patients with recurrent urethral strictures at different levels in the urethra.

Patients and methods Urocoil stents were placed in 18 patients (mean age 42 years, range 28–60) with recurrent urethral strictures. The stents were left for a mean of 8 months (range 6–14) and patients followed for a mean of 9 months (range 6–18) after removal of the stent, being assessed by urine culture, urethrography, flexible cystoscopy and urinary flow rate.

Results The stents were easy to insert and remove under local anaesthesia. All patients except one had a satisfactory outcome. Complications included stent migration (3), encrustation (2), hyperplasia of the mucosa (2) and the one failure, where the stent was extruded by a long fibrous stricture.

Conclusion The use of the temporary stent is an encouraging development in the treatment of this complicated problem but a longer follow‐up is necessary to exclude the possibility of late recurrence.
Treatment of female stress urinary incontinence with a new anatomically shaped vaginal device (Conveen Continence Guard®)
Authors: Hahn I. , Milsom I.
Published: November 2003

Objective To evaluate the clinical efficacy of a new vaginal device for the treatment of female stress urinary incontinence.

Patients and methods This multicentre study comprised 90 women with stress incontinence (mean age 47.5 years, range 31–65). The diagnosis of stress urinary incontinence was based on the result of a quantitative provocation test. The device was used daily for 4 weeks. Urinary leakage with and without the device was assessed using a 24 h pad‐test at home. The patient′s subjective opinion concerning their urinary leakage and the efficacy and function of the device were assessed using a questionnaire.

Results Eighty‐five women completed the study and successfully performed the pad test on both occasions. The mean (sem) urinary leakage at the end of the study period whilst using the device was 13.9 (3.2) mL, which was less than the 41.6 (7.6) mL mean leakage measured before treatment (P<0.001). Of the 85 women, 39 (46%) were completely dry during the pad test with the device in situ, 29% had a smaller leakage, 17% had the same leakage and 8% had a greater leakage. Accordingly, the overall objective improvement was 75%; 72% of the women considered the product to function satisfactorily and 60% expressed a wish to continue with the treatment. The vaginal device caused some local discomfort in 62% of the patients, but 72% of these women wished to continue with the device despite the reported discomfort.

Conclusion The new vaginal device reduced urinary leakage in stress incontinent women and 46% became continent. Even women with severe leakage had some improvement when using the device.