bluuebunny/crossref_metadata_2025 huggingface dataset:
Epididymectomy for Post‐vasectomy Pain: Histological Review
Authors: CHEN T. F. , BALL R. Y.
Published: November 2008

Summary Fifteen epididymectomies were performed on 10 patients with post‐vasectomy pain and 12 specimens were available for histopathological review. The findings were compared with those in 2 groups in which epididymectomy was performed for chronic epididymo‐orchitis and epididymal cysts. The results showed that 50% of the post‐vasectomy group were cured by simple epididymectomy. Pathological findings revealed features of long‐standing obstruction and interstitial and perineural fibrosis which may have accounted for the pain. It is important to recognise this late complication of vasectomy and, if surgery is to be performed, to include all of the distal vas and previous vasectomy site in the excision.
Bilateral Testicular Secondaries from Transitional Cell Carcinoma of the Bladder
Authors: OPPONG F. C. , RUNDLE J. H.
Published: November 2008

Testicular secondaries are uncommon but secondaries from transitional cell carcinoma (TCC) of the bladder are rare. We report the sixth case in the English literature.
New Flexible Cystoscopic Stent Retriever Forceps
Authors: IYER S. K. , ALSTON DOROTHY
Published: November 2008

Flexible cystoscopy is used more and more frequently for procedures such as removal of ureteric stents, for which various appliances are in common use and some have gained in popularity (Fig. 1). The commonly available biopsy forceps can be used, but with difficulty as the depth of the cups (or the depth of the teeth in the alligator forceps) is such that it is difficult to get a purchase on the stents, especially the larger ones (6 or 7F). The various basket retrievers also have limitations because it is necessary to pass the basket around the end of the stent before the basket can be closed to grasp the stent. This is even more difficult when using a multi‐length coiled stent, where there may be problems in locating the end of the stent. Obviously these factors increase the time taken and the discomfort to the patient.
Renal Function after Partial Nephrectomy with the Nd‐YAG Laser Experimental Study in Piglets
Authors: TAARI K. , SALO J. O. , KAIREMO K. J. A. , NORDLING S. , SCHRÖDER T. , RANNIKKO S. , KIVISAARI A.
Published: November 2008

Summary Twelve partial nephrectomies were performed in 12 piglets using either the combination (contact and non‐contact) Nd: YAG laser technique or a steel scalpel. Additional haemostasis was attempted with ligatures. The renal artery was not clamped and renal cooling was not attempted. Total nephrectomy was performed on the contralateral side. Serum creatinine and urea levels were measured, and 99mTc‐DTPA renography was performed pre‐operatively and 1 and 2 weeks postoperatively. One week post‐operatively the mean serum creatinine level was 35% higher than the pre‐operative level in the laser group and 30% higher in the steel scalpel group. Two weeks postoperatively the respective differences were 34 and 24%. The mean urea level 1 week after operation was 50% higher than the pre‐operative level in the laser group and 17% higher in the steel scalpel group. Two weeks post‐operatively the respective differences were 38% in the laser group and 20% in the steel scalpel group. The mean DTPA disappearance rate was 34% lower 1 week after operation in the laser group and 23% lower in the steel scalpel group when compared with the preoperative state. Two weeks post‐operatively the respective changes were 48 and 25%. These data indicate that there is no significant difference in renal function when the Nd: YAG combination laser technique is used in partial nephrectomy as compared with the steel scapel.
Pyonephrosis and Renal Abscess Associated with Kidney Tumours
Authors: PERIMENIS P.
Published: November 2008

Summary Whilst the diagnosis of pyonephrosis and renal abscess is fairly easy, the source of obstruction and infection is an important indicator of treatment. The association of kidney tumours with these inflammatory manifestations has not previously been emphasised. Reviewing our cases of pyonephrosis and renal abscesses, we report 4 patients with concomitant tumours of the kidney and discuss their management.
Renal Hydatid Disease
Authors: GÖǦÜŞ O. , BEDÜK Y. , TOPUKÇU Z.
Published: November 2008

Summary Hydatid disease is caused by the larval form of Taenia echinococcus (Echinococcus granulosus) in humans, the most common sites being the liver and the lungs. Involvement of the kidneys is uncommon and can be asymptomatic for long periods. Renal hydatid disease has no pathognomonic signs except for hydatiduria. Because of the risk of fatal anaphylaxis, puncture of the cyst should be avoided, and partial or total nephrectomy is still the preferred treatment. We present 10 patients with renal hydatid disease treated in the Department of Urology, Ankara University.
Relationship between Clinical Stage and Histological Zone of Origin in Early Prostate Cancer: Morphometric Analysis
Authors: GREENE D. R. , WHEELER T. M. , EGAWA S. , WEAVER R. P. , SCARDINO P. T.
Published: November 2008

Summary A detailed morphometric analysis of 96 radical prostatectomy specimens (13 clinical stage A1, 29 A2,34 B1 and 20 B2) was undertaken to examine the relationship of zone of origin to volume, grade and extraprostatic extension of cancer.

In patients with stage A disease, transition zone (TZ) cancer (present in 81%) was significantly larger but of lower grade than peripheral zone (PZ) cancer (present in 90%). The total volume of cancer in stage A1 patients averaged 1.55 ml with 72% of TZ origin. In patients with stage A2 disease, tumour volume averaged 5.83 ml with only 57% of TZ origin. Specimens taken during transurethral resection of the prostate (TURP) revealed TZ cancer in 82% and PZ cancer either alone or with TZ cancer in 22%. The 9 patients with PZ cancer in the TURP specimen included 5 of the 11 with extracapsular extension and all 5 of those with seminal vesicle invasion.

Every patient with stage B disease had PZ cancer which, in all except 3 cases, was of significantly larger volume and higher grade than any TZ cancer (present in 43%) in the same gland. In patients with stage B cancer, total tumour volume was 5.13 ml with 91% of PZ origin.

TZ cancer tended to be well differentiated in all patients, even at large volumes, whereas PZ cancer was often moderately or poorly differentiated even at low volumes. In patients with stage B disease, TZ cancer appeared to be incidental and of no clinical importance, while in stage A patients PZ cancers were sometimes large, poorly differentiated and extended outside the prostate. Progression of a stage A cancer seems more likely to result from PZ cancer than TZ cancer, and the finding of PZ cancer in a TURP specimen should probably preclude its classification as stage A1.
Surgical Technique for Inguinal Surgery and its Effect on Fertility in the Wistar Rat Model
Authors: SANDHU D. P. S. , OSBORN D. E.
Published: November 2008

Summary This study has explored the relatively neglected effects of operative manipulation of the vas deferens on fertility. Following unilateral vasectomy the contralateral vasa of 52 4‐week‐old Wistar rats were subjected to 7 different manipulations. After 7 weeks a fertility trial was conducted. All sham operated rats (n=18) were fertile. Of the remaining 34 rats, 22 (65%) were sterile. All of those with tight ring reconstruction (n = 6) were sterile, due initially to venous obstruction. Nine of 14 rats with acute clip trauma (65%) remained fertile but 11 of 14 (78%) with full mobilisation were sterile owing to extensive avascular fibrosis of the vas deferens. These results suggest that over‐zealous cord handling and operative technique in the immature animal is counterproductive and leads to vasal occlusion. This may have important repercussions in paediatric inguinal surgery, with a subsequent higher incidence of azoospermia and male subfertility.
Animal Models for Epididymoepididymostomy. Development of an Alternative Microsurgical Procedure for Vasoepididymostomy
Authors: McCLATCHEY M. , TEMPLE‐SMITH P. D. , SOUTHWICK G. J.
Published: November 2008

Summary The present success rate for high level microsurgical vasoepididymostomy in patients with obstructive azoospermia is generally poor in comparison with more distal vasoepididymal bypasses, suggesting that the development of a high level bypass method which preserves the distal maturation and storage functions of the epididymis might increase the fertility success rate. To achieve this we have developed a segmental bypass of the distal caput‐proximal corpus regions of the epididymis (epididymoepididymostomy) using the rat and rabbit as animal models.

In this procedure the epididymides of 11 adult male Sprague‐Dawley rats were exposed through a scrotal incision and a convolution of the duct in the proximal corpus region was attached to an opened convolution in the mid‐caput epididymides using a standard microsurgical technique. Each male was rested for at least 3 months after the microsurgical bypass operation to allow the preoperative sperm contents of the caudal storage region to be replaced by post‐bypass spermatozoa. Six of the 11 rats were proven fertile after surgery by siring litters from mating trials up to 11 months later. The patency of anastomoses was confirmed in 3 animals by laparotomy and recovery of large numbers of sperm with normal motility from the cauda epididymidis distal to the anastomosis site and also from the vas. Similar unilateral surgery in 2 adult male rabbits resulted in normal postoperative semen profiles in 1 and an in vivo fertilisation rate of 100% from 1 mating trial 8 months after surgery.

The successful development of a reliable animal model for epididymoepididymostomy provides an experimental tool for studying the function of the epididymis. This technique may also have clinical application as an alternative to high level vasoepididymostomy in selected patients with obstructive azoospermia.
Surgical Management of Incontinence in Bladder Exstrophy*
Authors: HOLLOWELL JEAN G. , RANSLEY P. G.
Published: November 2008

Summary Between 1978 and 1990,86 patients with previously closed classical bladder exstrophy and 10 patients seeking undiversion have presented for continence management and have undergone selective reconstruction designed for voiding and/or intermittent urethral catheterisation. The reconstruction in these 96 patients has been reviewed.

Eight of the 10 patients undergoing undiversion achieved a satisfactory state of continence but 4 required Mitrofanoff procedures to enable catheterisation.

Of the other 86 patients, 2 reached a satisfactory state of continence without further surgery; 79 underwent bladder neck surgery for continence either without augmentation (n = 32) or with augmentation (n = 47). Twenty of the 32 patients who were treated by bladder neck reconstruction alone were later found to require augmentation. Five patients had very early augmentation either to facilitate neonatal closure or on account of severe upper tract dilatation. Of these, 1 became continent without further surgery and 4 demonstrated the need for bladder neck reconstruction.

Thus 12 children achieved successful continence (n = 6) or are evolving satisfactorily with potential success (n = 6) as a result of bladder neck reconstruction.

Of the 71 patients requiring bladder neck reconstruction and augmentation, 68 have completed their surgery. The current status of these patients is: satisfactory in 57 (80%) (42 void/urethral clean intermittent catheterisation (CIC), 7 waiting to learn CIC, 5 Mitrofanoff, 3 artificial urinary sphincter (AUS)). Of the remaining 11 patients (20%), 8 are unsatisfactory to varying degrees and the status of the other 3 is unknown.
Idiopathic Kidney Stone Formation—Where and Why?
Authors: CHHABRA H. L. , MANOCHA K. K.
Published: November 2008

Summary— An attempt was made to analyse where and why stone formation in the kidney starts. For this purpose specific electrical conductivity (SEC) of the serum and urine of the same individual in 50 cases of stone formers (Group I) and 50 controls (Group II) was measured. The mean serum value of SEC at 37°C and 50 Hz in μmho/cm of Group I was 1.23 × 104, while that of Group II was 1.20 × 104. This was not statistically significant. However, urinary SEC values did differ significantly between the 2 groups. An analysis of observations reveals that in the case of stone formers there is a fault in the solute transfer system in the kidney at the membrane level (urothelium).
Management of Fracture of the Penis in Qatar
Authors: EL‐SHERIF A. E. , DAULEH M. , ALLOWNEH N. , VIJAYAN P.
Published: November 2008

Summary— We present 21 patients with fracture of the penis treated between July 1982 and July 1990. Eighteen patients were treated surgically, with good functional and morphological recovery; 3 refused surgery, 1 of whom had penile deformity and pain on erection. The literature is reviewed with respect to the necessity of different diagnostic and therapeutic options.
Pyuria: Index of Infection in Patients with Spinal Cord Injuries*
Authors: MENON E. B. , TAN E. S.
Published: November 2008

Little is known about the significance of pyuria in patients with spinal cord injuries. The progress in hospital of 55 such patients was studied. They were divided into 2 groups according to the method of bladder drainage on admission. Group A comprised 43 patients with indwelling catheters. Group B comprised 12 patients who were able to void with tapping, with/without compression and on intermittent catheterisation.

The results showed that group A had a mean pyuria level of 185 WBC/HPF on admission. The incidence of urinary tract infection was 4 per patient during hospitalisation and the mean duration of bladder training was 82 days. Group B had a mean pyuria level of 32 WBC/HPF on admission. The incidence of urinary tract infection was 1 per patient during hospitalisation and the mean duration of bladder training was 40 days. The difference between groups A and B for all 3 parameters was statistically significant.

These results suggest that patients with spinal cord injuries and indwelling catheters have a higher pyuria level and an increased risk of significant morbidity secondary to urinary tract infection, especially at the pyuria level of 100 WBC/HPF. A low pyuria level of 30 WBC/HPF was associated with a nil or low incidence of bacteriuria and urinary tract infection in our patients.
Radiation Protection in Percutaneous Renal Surgery
Authors: BOWSHER W. G. , BLOTT P. , WHITFIELD H. N.
Published: November 2008

Two British centres have published the radiation doses received during percutaneous nephrolithotomy (PCNL). Their results were disparate. This study was performed to establish the likely exposure of the eyes and fingers of an experienced urological surgeon who creates the track into the kidney and also performs the endoscopic operation. In addition, some radioprotective gloves were evaluated. Provided that specific precautions, including a judicious use of screening, are taken, the current dose limits are unlikely to be exceeded. However, a 30% reduction in the dose limits is probable. Wearing routine radiation badges under a lead apron is an inadequate method of monitoring exposure: urologists should press for more active assistance from radiation protection officers in the monitoring of procedures in theatre and the use of ultrasound should be encouraged.
Ureteric Complications of Renal Transplantation
Authors: KASHI S. H. , LODGE J. P. A. , GILES G. R. , IRVING H. C.
Published: November 2008

Summary— Of 507 consecutive recipients of renal allografts, 45 developed a urological complication. In 39 patients (7.7%) ureteric problems were implicated and these comprised 30 cases of obstruction and 9 cases of ureteric necrosis presenting as urinary leakage.

In 7 patients ureteric obstruction resolved following a period of nephrostomy decompression; 10 patients were reconstructed surgically and this was successful in 8, with 2 patients requiring further surgical procedures. Ten patients were successfully treated by percutaneous stenting after dilatation of the stricture. Stenting failed in 4 patients and in 1 patient caused rupture of a calix. All 10 stents have now been removed and there is no recurrence of stricture (follow‐up 32.0 ± 8.6 months). Of the remaining 3 grafts, 2 were removed and the other graft had percutaneous removal of a ureteric calculus.

The 1‐year survival rate of allografts in the ureteric complication group was 84.6%; in the recipients without a urological complication it was 81%.

It was concluded that an active approach to ureteric problems following renal transplantation results in the rescue of the majority of allografts.
Acute Urinary Retention. Comparison of Suprapubic and Urethral Catheterisation
Authors: HORGAN A. F. , PRASAD B. , WALDRON D. J. , O'SULLIVAN D. C.
Published: November 2008

Summary— A total of 86 consecutive patients who presented to the accident and emergency department with acute urinary retention due to prostatomegaly required catheterisation; 56 received suprapubic catheters and 30 were catheterised urethrally. Both groups were followed up for 3 years.

Of the 30 patients catheterised urethrally, 12 (40%) developed urinary tract infections compared with 10 (18%) urinary tract infections in the 56 patients catheterised suprapubically. Five patients (17%) in the urethral group developed urethral strictures with no strictures in the suprapubic group. Two patients catheterised urethrally developed epididymo‐orchitis and 1 developed septicaemia. None of the patients with suprapubic catheters developed these complications. Furthermore, 16 patients catheterised suprapubically underwent successful trial clamping of their catheter, whereas 7 patients required recatheterisation following removal of their urethral catheters.

We recommend that the use of suprapubic catheters should become the preferred initial treatment for acute urinary retention.
In vivo Detection by Microscopic Chromocystoscopy of Concurrent Urothelial Atypia in Superficial Bladder Cancer
Authors: IGUCHI A. , KINOSHITA N. , MASAKI Z.
Published: November 2008

Summary— Microendoscopic observation of methylene blue‐stained urothelial surfaces, so‐called microscopic chromocystoscopy (MCC), was undertaken in 65 patients with superficial bladder cancer (Ta and T1) and its effectiveness in detecting concurrent urothelial dysplasia or carcinoma in situ was studied. A total of 166 biopsy samples were taken from 75 stained and 91 non‐stained portions. Of 75 methylene blue‐stained areas, 21 were judged to be abnormal (MCC‐positive) by microscopic observation. Fourteen of these 21 MCC‐positive areas (67%) were proven to be abnormal histologically, while 7 of 54 MCC‐negative portions (13%) were histologically abnormal. Only 4 of 91 biopsies (4%) from non‐stained mucosa were proven to have urothelial atypia. In per patient figures, 1 or more concurrent field changes were detected in 15 of 65 cases (23%). MCC contributed to the diagnosis in 10 of these 15 patients.
Transurethral Incision versus Transurethral Resection of the Prostate. A Subjective and Objective Analysis
Authors: SOONAWALLA P. F. , PARDANANI D. S.
Published: November 2008

Summary— A prospective study was undertaken comparing transurethral incision of the prostate (TUIP) with transurethral resection (TURP) in the treatment of 220 patients with urinary obstruction caused by a small, benign prostate. Patients were managed alternately by TUIP and TURP, and their symptoms and urodynamic findings evaluated before and after surgery. Subjectively and objectively, the results were comparable in both groups. Pre‐and post‐operative complications were significantly less for the TUIPs than the TURPs. TUIP was significantly better than TU RP in terms of shorter operating time, duration of hospitalisation and reduced need for transfusion. We recommend TUIP as the operation of choice for the relief of obstruction in the presence of a small, benign prostatic enlargement.
Inter‐relation between Measurement of Serum Prostatic Specific Antigen and Transrectal Ultrasound in the Diagnosis of Benign Prostatic Hyperplasia and Prostatic Cancer
Authors: CLEMENTS R. , ETHERINGTON R. J. , GRIFFITHS G. J. , PEELING W. B. , HUGHES H. , PENNEY M. D.
Published: November 2008

Summary— Serum prostatic specific antigen (PSA) and ultrasound‐determined prostatic volume (UPV) were measured in 50 patients with histologically proven benign prostatic hyperplasia (BPH) and in 40 patients with histologically proven prostatic cancer of whom 17 had evidence of distant metastases (M1) and 23 did not (MO).

A good correlation between log PSA and UPV was demonstrated in the BPH group and rearrangement of the linear regression equation allowed calculation of a single variable—the log PSA corrected to a standard prostate volume for any given individual.

A volume‐corrected PSA correctly identified all patients with M1 disease and greatly improved but did not eliminate overlap of M0 disease with BPH. Reduction of serum PSA to a single volume‐corrected variable will allow the introduction of practical and optimum protocols for the management of patients with prostatic enlargement.
Laparoscopic Ligation of Internal Spermatic Vein
Authors: CHEN MING‐TSUN , CHIU ALLEN WEN‐HSIANG , CHANG LUKE S.
Published: November 2008

Summary— Laparoscopic procedures have long been a standard form of treatment for gynaecological disorders but have only recently shown promise in the evaluation and treatment of urogenital diseases, such as pelvic lymphadenectomy. We performed laparoscopic ligation of the bilateral internal spermatic veins in 15 male pigs. The average operative time was 20 min and operative morbidity was minimal, comprising mild subcutaneous emphysema around the trocars. Engorgement of the spermatic vein proximal to the endoclip site was noted. There was no operative mortality. Laparoscopic ligation of the internal spermatic veins seems to be a feasible method for the treatment of varicoceles, especially bilateral lesions.
Current Management of Duplex‐System Ureteroceles: Experience with 41 Patients
Authors: RICKWOOD A. M. K. , REINER I. , JONES M. , POURNARAS C.
Published: November 2008

Summary— Experience is described of 41 infants and children with duplex‐system ureteroceles, 25 presenting clinically and 16 by prenatal ultrasonography. Bladder outflow obstruction was rare but lower polar vesicoureteric reflux (VUR), usually of lesser grades, was common. Upper polar function, as assessed by 99mTc‐DMSA, was negligible in children with truly ectopic ureteroceles but well preserved in those where the lesion lay wholly intravesically. Lower polar function was good, even in the presence of secondary obstruction, except in 2 infants with major VUR.

Twenty‐three patients were treated by upper polar nephrectomy plus aspiration of the ureterocele; 2 subsequently required ureterocele excision. Histology of excised specimens indicated that a more conservative approach would not have been rewarded. Where upper polar function was good, conservation was maintained in 3 cases by pyelopyelostomy and in 5 more by excision of the ureterocele plus bipolar ureteric reimplantation. Other operative strategies were employed in 2 cases. Finally, a defined group of 8 children was managed expectantly without untoward results.

It was concluded that the variable anatomy and function associated with duplex‐system ureteroceles require a flexibile approach to treatment, including, possibly, no treatment at all.
Acquired Cystic Disease of the Kidney and Renal Carcinoma in Haemodialysis Patients: Ultrasonographic Evaluation
Authors: SASAGAWA I. , TERASAWA Y. , IMAI K. , SEKINO H. , TAKAHASHI H.
Published: November 2008

Summary— Ultrasonography was performed in 661 dialysis patients and acquired cystic disease of the kidney was found in 156 (125 men and 31 women). A higher incidence of cystic disease was found in males. There was no significant difference between the patients with and those without acquired cystic disease in terms of average age, but the duration of haemodialysis in those with acquired cystic disease was significantly longer. There was an increased incidence of cystic disease in patients with glomerulonephritis and the duration of haemodialysis in these patients was significantly longer. This suggests that the increased incidence of acquired cystic disease of the kidneys in the patients with glomerulonephritis is simply related to the longer duration of treatment. Twelve patients with renal carcinoma were found in this study. The average age at diagnosis of renal carcinoma was not significantly different between the patients with and those without acquired cystic disease, but the duration of dialysis was significantly longer in renal carcinoma patients with acquired cystic disease. The incidence of renal carcinoma in dialysis patients with acquired cystic disease was 3.85% and in those without it was 1.19%. These rates are considerably higher than those found in the general population and indicate that the risk of renal carcinoma is higher in dialysis patients both with and without acquired cystic disease
Urological Complications Following Live Donor Kidney Transplantation: Effect of Urinary Schistosomiasis
Authors: SHOKEIR A A. , BAKR M. A. , EL‐DIASTY T. A. , SOBH M. A. , MOUSTAFA F. E. , ELAGROUDI A. E. , GHONEIM M. A.
Published: November 2008

Summary— Urological complications were studied in 310 live donor kidney transplants. All recipients and donors were investigated for urinary schistosomiasis by examining tissue obtained intra‐operatively from the donor's ureter or the patient's bladder. Schistosomiasis was histologically documented in 76 cases (patient's bladder (46), donor's ureter (9), both (21)). The incidence of urological complications was 11/76 (15%) in the schistosomal group and 14/234 (6%) in the non‐schistosomal group; this was statistically significant. Among the schistosomal patients, the site of infestation had no statistically significant effect on the incidence of urological complications. No deaths or graft losses were directly attributable either to these complications or to their surgical correction.
The Actions of Extracellular Magnesium on Isolated Human Detrusor Muscle Function
Authors: MONTGOMERY B. S. I. , THOMAS P. J. , FRY C. H.
Published: November 2008

Summary— The effects of increasing the extracellular magnesium concentration ([Mg]) on the in vitro mechanical and electrophysiological properties of isolated human detrusor smooth muscle have been investigated. Raising extracellular Mg reduced the magnitude of the electrically‐induced phasic contractions as well as spontaneous contractions. A similar increase in the [Mg] reduced the magnitude of the inward Ca2+ current associated with the action potential as well as shifting the activation curve to more positive potentials. Spontaneous oscillations of intracellular Ca2+ could be observed in some isolated cells and such activity was also abolished by raising the extracellular [Mg].

It is proposed that the contractile effects of raised extracellular Mg are mediated by an action on the inward Ca2+ current and that these observations suggest a means whereby normal and abnormal detrusor contractions might be effectively regulated.
Is Urethral Pressure Profilometry Useful in the Pre‐operative Assessment of Benign Prostatic Hyperplasia?
Authors: CHAPPLE C. R. , COPPINGER S. W. , TURNER‐WARWICK R. T.
Published: November 2008

Summary— The principal aim of this study was to provide an objective assessment of the potential role of urethral pressure profilometry as a technique for assessing prostatic size by direct comparison with endoscopic assessment of prostatic length and computed tomographic measurement of prostatic volume and length. There was a poor correlation between pre‐operative prostatic length and amount resected in the operating theatre. The results obtained with urethral pressure profilometry correlated poorly with those obtained using the other techniques, and cannot therefore be relied upon in routine clinical practice. Although there was good correlation between the length of the prostate and prostatic size, assessed by pre‐operative computed tomography, this correlated poorly with the amount of tissue resected at operation. Further studies need to be conducted to compare objectively the completeness of prostatic resection with the outcome following prostatectomy.
Prostate Specific Antigen and Bone Scan Correlation in the Staging and Monitoring of Patients with Prostatic Cancer
Authors: MILLER P. D. , EARDLEY I. , KIRBY R. S.
Published: November 2008

Summary— The ability of serum prostate specific antigen (PSA) to predict bone metastases at initial presentation was determined in 146 patients, and in 66 patients during a 3‐year period; 14.7% of patients with bone metastases at presentation had a PSA value less than 20 ng/ml. All patients who subsequently developed bone metastases had a PSA greater than 20 ng/ml and the rise in PSA often antedated the detection of bone metastases. Bone scans are still necessary in the initial staging but following diagnosis and treatment can be replaced by serum PSA measurement in monitoring patients with prostatic cancer.
Treatment of Advanced Localised Prostatic Cancer by Orchiectomy, Radiotherapy, or Combined Treatment. A Medical Research Council Study
Authors: FELLOWS G. J. , CLARK P. B. , BEYNON L. L. , BOREHAM J. , KEEN C. , PARKINSON M. C. , PETO R. , WEBB J.N.
Published: November 2008

Summary— A total of 277 patients with apparently localised prostatic cancer (T2‐T4 NXMO) were allocated at random to receive radiotherapy alone (88), orchiectomy alone (90) and combined therapy (99) between 1980 and 1985. The main outcome measures were survival, time to appearance of metastases and treatment of local disease progression by further transurethral resection. Orchiectomy, whether alone or with radiotherapy, produced a significant delay in detection of metastases when compared with radiotherapy alone. There were no statistically significant differences between the 3 treatment groups in local disease control or in overall survival.
Prostate Cancer—the Impact of Irradiation on Urinary Outlet Obstruction
Authors: GREEN N. , TREIBLE D. , WALLACK H. , FREY H. S.
Published: November 2008

Summary— A series of 245 patients with prostate cancer treated by external irradiation was analysed to assess the impact of irradiation on urinary outlet obstruction. Prior to irradiation, obstruction was observed in 147/245 patients (60%). Irradiation either with or without hormonal therapy was as efficacious as Tran urethral resection of the prostate (TURP) in alleviating obstructive symptoms; 14/16 patients treated by irradiation alone responded, as did 19/19 who received hormonal therapy and irradiation and 109/112 who underwent TURP and irradiation. Following irradiation, 41/245 patients developed post‐irradiation obstruction, 26/213 had post‐irradiation strictures and 15/32 developed recurrent cancer. Surgical intervention was required less often for the management of recurrent obstruction caused by stricture as compared with recurrent cancer. TURP and urinary outlet obstruction acted as independent and additive variables to the development of post‐irradiation stricture. Thus the avoidance of TURP in patients with obstructive symptoms reduced but did not eliminate the risk of developing a stricture.
In vitro Inhibition of Struvite Crystal Growth by Acetohydroxamic Acid
Authors: DOWNEY J. A. , NICKEL J. C. , CLAPHAM L. , McLEAN R. J. C.
Published: November 2008

Summary— Struvite (MgNH4PO46H2O) crystals were produced by Proteus mirabilis growth in artificial urine, in the presence and absence of the urease inhibitor, acetohydroxamic acid (AHA). In the absence of AHA, struvite crystals assumed an “X‐shaped”or dendritic crystal habit due to rapid growth along their 100 axis. When AHA was present, crystal growth, as monitored by phase contrast light microscopy, was greatly slowed, and the crystals assumed an octahedral crystal habit. Scanning electron microscopy revealed that crystals grown in the presence of AHA were pitted on their surface. This pitting was absent in control samples. While most of this inhibition by AHA was due to lowered urease activity, some crystal growth inhibition occurred in struvite produced in the absence of urease activity through NH4OH titration of artificial urine. We conclude that while AHA is primarily a urease inhibitor, it may also disrupt struvite growth and formation directly through interference with the molecular growth processes on crystal surfaces.
Increase in Presumptive Sensory Nerves of the Urinary Bladder in Idiopathic Detrusor Instability
Authors: MOORE KATE H. , GILPIN SALLY A. , DIXON J. S. , RICHMOND D. H. , SUTHERST J. R.
Published: November 2008

Summary— The density of subepithelial, presumptive sensory nerves in the bladder wall was assessed in 21 women with idiopathic detrusor instability and compared with the density of these nerves in 21 asymptomatic women, using a point‐counting technique on sections of bladder biopsies stained for acetylcholinesterase activity. The mean value (± S.E.) for the amount of such nerves in patients with detrusor instability (91 ± 13/mm2) was significantly greater than that from the control group (61 ±7/mm2). This suggests that a relative abundance of subepithelial sensory nerves may serve to increase the appreciation of bladder filling, giving rise to the frequency and urgency of micturition which are characteristic of patients with detrusor instability.
Cold Sensation and Bladder Instability in Patients with Outflow Obstruction due to Benign Prostatic Hyperplasia
Authors: TAMMELA T. L. J. , HELLSTRÖM P. A. , KONTTURI M. J.
Published: November 2008

Summary— A series of 73 patients with bladder outflow obstruction caused by benign prostatic hyperplasia underwent urodynamic investigation, including the cold water test. The presence of detrusor instability was associated with a higher urethral opening pressure, maximum detrusor pressure and detrusor pressure at maximum flow. Instability was more common and more pronounced in patients with a lack of cold sensation, but there were some patients who, whilst lacking cold sensation, still possessed the cold reflex. This suggests partial denervation of the bladder or some form of altered modulation of sensory activity within the spinal cord or central nervous system. On the other hand, some of the patients lacked cold sensation but showed a stable detrusor and a high maximum cystometric capacity. This leads to the conclusion that there are different mechanisms by which the bladder reacts to outflow obstruction.
In vitro Investigations into the Formation and Dissolution of Infection‐induced Catheter Encrustations
Authors: HESSE A. , NOLDE A. , KLUMP B. , MARKLEIN G. , TUSCHEWITZKI G. J.
Published: November 2008

Summary— Encrustations are the most frequent complications occurring with indwelling catheters and urine drainage systems. The conditions for bacterial infections, using synthetic urine and controlled contamination by Proteus vulgaris, were standardised by using an in vitro model. Crystal deposits on catheters were analysed by infra‐red spectroscopy and scanning electron microscopy. The main components of deposits in all investigations were struvite (MgNH4PO4.6H2O) 60–70% and carbonate apatite (Ca10(PO4, CO3)6 (OH, CO3)2) 30–40%. Investigations as to the quality and quantity of encrustations confirmed the analysis. Irrigation treatment was carried out with physiological saline solution and citric acid solution (Suby G) to study and quantify the dissolution of crystal deposits. Regular irrigation with citric solution resulted in a 70% dissolution of encrustations and ensured free flow as ascertained by measuring flow rates.
Endoscopic Reappraisal of the Morphology of Congenital Obstruction of the Posterior Urethra
Authors: DEWAN P. A. , ZAPPALA S. M. , RANSLEY P. G. , DUFFY P. G.
Published: November 2008

Summary— Congenital obstruction of the posterior urethra was first systematically classified by Young in 1919. Since then, no‐one has seriously challenged the presence of both Type I and Type III “valves”, although the presence of Type II lesions has often been disputed. A review of Young's papers and more recent anatomical studies, together with endoscopic findings in our own patients, indicates that most congenital posterior urethral obstructions are anatomically similar. Consequently, Young's classification now seems redundant.
Continent Cutaneous Diversions in Children: Experience with the Mitrofanoff Procedure
Authors: BORZI P. A. , BRUCE J. , GOUGH D. C. S.
Published: November 2008

Summary Continent cutaneous diversions with a urinary reservoir emptied by clean intermittent self‐catheterisation (CISC) using a non‐refluxing conduit–the Mitrofanoff principle–were carried out in 10 children. Their age range was 3.9 to 17.1 years (average 12.2). The underlying diagnoses were ectopia vesicae (7), myelodysplasia (2) and a cervical cord injury secondary to birth trauma (1). The indications were incontinence secondary to poor bladder neck resistance in 8 children and an inaccessible urethral orifice in 2. The catheterising conduits used were the appendix in 9 and a vascularised gastric tube in 1. Eight children are bone‐dry with CISC. Another child needed a reoperation following dehiscence of her bladder neck closure. The other child has an intact bladder neck and urethra and occasionally leaks overnight.

Mitrofanoff diversions are a reliable means of continence with CISC. This means of urinary diversion can be permanent or temporary in children who cannot or will not catheterise urethrally. Elective appendicectomy in children with potential urinary incontinence or complicated urogenital anomalies is not recommended.
Use of Terazosin in the Medical Treatment of Benign Prostatic Hyperplasia: Experience in Italy
Authors: SILVERIO F. DI
Published: November 2008

Summary— The purpose of this multicentre, randomised, placebo‐controlled, double‐blind study was to verify the safety and efficacy of terazosin, an alpha1 adrenergic blocker, in patients with benign prostatic hyperplasia (BPH). This study involved 137 patients who were randomly assigned to receive either a designed dose of terazosin (2, 5 or 10 mg) or placebo. Response to treatment was measured objectively by uroflowmetric determinations. Subjective evaluation was based on the investigator's assessment of each patient's symptoms. The safety of this agent was monitored by haematological tests and urinalysis. In addition, systolic and diastolic blood pressures and pulse rates were recorded during each visit. The treatment of BPH with terazosin produced a significant improvement in mean flow rate and peak flow rate; there were no statistically significant differences in the analysis of symptomatic responses between the groups of patients treated with terazosin or placebo. Moreover, the safety of this alpha! blocker was thoroughly tested and clinically proven.
Diagnostic Challenges of Prostatic Carcinoma
Authors: JIMÉNEZ‐CRUZ J. F. , BROSETA E.
Published: November 2008

Summary— The early detection and staging of prostatic carcinoma are challenging the diagnostic acumen of urologists. Mass screening programmes of asymptomatic men are not justified, as only a small number of cases are diagnosed when the tumour is confined to the prostatic capsule. Diagnostic work‐ups of symptomatic men yield a similarly low rate of detection. The most extensively used diagnostic methods include digital rectal examination (DRE), transrectal ultrasound (TRUS) and prostate‐specific antigen (PSA) assay. Although DRE is an inexpensive technique that improves early detection, its sensitivity and specificity are low. The specificity and sensitivity of TRUS are higher, but false‐positive and false‐negative rates are significant. In a study of 566 patients, the rates were 86% and 84%, respectively. A determination of PSA may be informative in the early stages of prostatic cancer, but confirmation of the results by other methods is necessary. Thus, there is no safe method to achieve early diagnosis and precise staging of prostatic carcinoma. Only clinical trials comparing all the different methods will help to establish the definitive role of each one.
Effect of Vaginal Ultrasound Probe on Lower Urinary Tract Function
Authors: WISE B. G. , BURTON G. , CUTNER A. , CARDOZO LINDA D.
Published: November 2008

Summary— Vaginal ultrasonography has been advocated as an alternative to videocystourethrography. Ultrasound avoids the potential risks of X‐rays and reduces the cost of equipment. We have investigated the effect of the vaginal probe on the physiology of the bladder and urethra. A series of 24 women underwent urethral pressure profilometry, with and without a vaginal probe in situ. There was a significant increase in maximum urethral pressure, functional urethral length and area under the profile curve both at rest and during stress in the presence of the device. This was due to stretching and compression of the urethra by the probe. Transmission pressure ratios were significantly increased for the first 3 quartiles of the urethra.

Twenty women underwent lateral bead chain urethrocystography with and without a vaginal probe. At rest, the probe resulted in elevation of the bladder neck and apposition to the symphysis pubis, and during a Valsalva manoeuvre the descent of the bladder neck was restricted by the presence of the probe. These results indicate that a vaginal probe alters the position and function of the lower urinary tract. We postulate that incontinence is reduced as a result of the probe. The use of vaginal ultrasonography in the assessment of women with urinary incontinence is therefore not recommended.
Continent Urinary Diversion Using an Artificial Urinary Sphincter
Authors: MITROFANOFF P. , BONNET O. , ANNOOT M. P. , BAWAB F. , GRISE P.
Published: November 2008

Summary— We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra‐prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure‐regulating balloon is implanted within the area of abdominal pressure, retroperitoneally.

After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow‐up of 20 months.

These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir.

Although long‐term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.
Male and Female Sexual Function and Activity Following Ileal Conduit Urinary Diversion
Authors: NORDSTRÖM G. M. , NYMAN C. R.
Published: November 2008

Summary— A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre‐and post‐operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 41% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post‐operatively.

The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.
Cystoprostatectomy and Substitution Cystoplasty for Locally Invasive Bladder Cancer
Authors: THOMAS P. J. , NURSE DIANE E. , DELIVELIOTIS C. , MUNDY A. R.
Published: November 2008

Summary— The results and long‐term follow‐up of 48 patients undergoing cystoprostatectomy and substitution cystoplasty for T2/3, MO transitional cell carcinoma of the bladder are reported. There was no operative mortality but 1 early death from thromboembolic disease. Thirty‐six patients are alive with a mean follow‐up of 57 months (range 12–120). Eleven patients died of disseminated disease. Thirty‐one patients (64%) regained normal continence by day and night and a further 8 were dry by day but incontinent at night; 9 patients underwent further surgery for incontinence and this was successful in 8, giving an overall continence rate of 79% and a day‐time continence rate of 98%. Of the 38 patients claiming to be potent pre‐operatively, 24 (63%) were potent postoperatively. Nerve‐sparing cystoprostatectomy and substitution cystoplasty is a safe alternative to a “standard” cystectomy and ileal conduit diversion in a selected group of men undergoing radical surgery for invasive bladder cancer and it achieves its aims of preserving continence and potency in the majority of patients.
Survey of Urological Centres and Review of Current Practice in the Pre‐operative Assessment of Prostatism
Authors: WILKINSON A. G. , WILD S. R.
Published: November 2008

Summary— A survey of 24 urological centres has shown a wide variation in the routine preoperative assessment of patients being considered for prostatectomy. Imaging of the urinary tract by intravenous urography (IVU) or ultrasound (US) is performed in 21/24 centres (79%) and plain films in 16/24 (67%). Post‐micturition residual volume (PMRV) is estimated quantitatively in 10/24 centres (42%). Although there is little agreement on what constitutes a significant PMRV, a large PMRV leads to increased likelihood of operation, and earlier operation. Peak urine flow rate (Q max) is measured in 19/24 centres (79%). The significance of these findings is discussed.