bluuebunny/crossref_metadata_2025 huggingface dataset:
Returning a referral for erectile dysfunction to the referrer by two different routes
Authors: Wylie K.R. , Davies‐South D.
Published: March 2003

Objective To compare the prescribing pattern and attitude of general practitioners (GPs) in response to a clinic returning a patient referred for erectile dysfunction (ED) to the referrer by two different methods.

Methods Referrals on a waiting list for an assessment of ED were reviewed and a subgroup of patients with criteria enabling them to be eligible for a prescription under the National Health Service (NHS) identified. The GP was informed either in writing or by telephone that the clinic had written to the patient, suggesting he make direct contact with his GP. A follow‐up questionnaire was sent to each GP one month after the initial letter to the patient and contact with the GP.

Results Of 91 questionnaires sent to GPs, 66 (73%) were completed; an additional five GPs corresponded by letter rather than completing the questionnaire. The long waiting time for assessment had led to 35% of patients having already tried sildenafil, and by the time the questionnaire was completed, 57% of patients had tried sildenafil. Ten times as many referrers indicated that they were happy to initiate a prescription for sildenafil than not to do so, for those men eligible for an NHS prescription. More GPs who had received a letter returned the completed questionnaire (80%) than those who had received a courtesy telephone call (64%). There were no differences between the groups of GPs in their attitude to our contact with their patient and no difference in prescribing pattern.

Conclusion The provision of guidelines and advice to GPs either by telephone or letter is acceptable practice in reducing long waiting‐list times for ED. Safe, simple and effective treatments are available for GPs to use under NHS guidelines.
A double‐blind, randomized, placebo‐controlled pilot study to investigate the effects of finasteride combined with a biodegradable self‐reinforced poly l‐lactic acid spiral stent in patients with urinary retention caused by bladder outlet obstruction from benign prostatic hyperplasia
Authors: Isotalo T. , Talja M. , Hellström P. , Perttilä I. , Välimaa T. , Törmälä P. , Tammela T.L.J.
Published: March 2003

Objective To assess whether patients in acute urinary retention from benign prostatic enlargement can be treated with a combined therapy comprising finasteride and a bioabsorbable self‐reinforced poly l‐lactic acid (SR‐PLLA) urethral stent.

Patients and methods Fifty‐five patients in acute urinary retention were treated as outpatients; they had a suprapubic catheter inserted and the SR‐PLLA stent placed cystoscopically. After 2 weeks the patients were randomized to receive either finasteride 5 mg daily or placebo. They were assessed at baseline and at 6, 12 and 18 months for maximum urinary flow rate, prostate volume and serum prostate‐specific antigen (PSA).

Results Nineteen patients completed the study while 36 discontinued. There was a statistically significant increase in the mean maximum flow rate, and a statistically significant decrease in the prostatic volume and serum PSA in the finasteride group. The same number of patients discontinued in both groups; the major reason for discontinuation was insufficient therapeutic response.

Conclusions The major problems were discontinuation of treatment because the response to therapy was insufficient, and uncontrolled breakdown of the spiral stent. To solve these problems, new configurations of bioabsorbable stents are needed.
The optimal form of urinary drainage after acute retention of urine
Authors: Patel M.I. , Watts W. , Grant A.
Published: March 2003

Objective To assess the outcome of different forms of urinary drainage, particularly for urinary tract infection (UTI), operative findings and patient preference, in patients treated for acute urinary retention (AUR).

Patients and methods A feasibility trial was conducted of men presenting with AUR; after a short period of indwelling catheterization (IDC) patients were taught how to use clean intermittent self‐catheterization (CISC). Patients who failed this were re‐catheterized and taught to manage a valve, or failing this a leg bag, and then discharged home. The patients were followed to assess the occurrence of spontaneous voiding, UTI, findings at prostatectomy and patient satisfaction.

Results The CISC group (34 men) had a higher rate of spontaneous voiding than the IDC group (16 men; 56% vs 25%). The incidence of UTI was 32% in the CISC and 75% in the IDC group. At TURP, 20% in the CISC group had a UTI, compared with 69% in the IDC group. Patients using CISC preferred it and had fewer complications than the IDC group. The CISC group had a similar ability to manage and similar acceptance of their method of drainage as the IDC group.

Conclusion CISC is managed and accepted well by patients who can use the technique and results in fewer UTIs. It should be considered in patients who present with AUR, and it may delay surgery.
Dorsal or ventral placement of the preputial/penile skin onlay flap for anterior urethral strictures:does it make a difference?
Authors: Bhandari M. , Dubey D. , Verma B.S.
Published: March 2003

Objective To report our experience in managing complex anterior urethral strictures with a dorsally/dorsolaterally placed penile/preputial vascularized flap, and to discuss the advantages of this procedure over a traditional ventrally placed flap.

Patients and methods Between 1995 and 1999, 40 patients (mean age 40.5 years) with recurrent strictures of the pendulous and/or bulbar urethra were treated with longitudinal penile/circumpenile flap substitution urethroplasty. Nineteen patients underwent dorsal placement of the flap as an onlay (DO), whereas 21 patients had a ventral onlay (VO). Five patients needed inferior pubectomy to facilitate high proximal placement of the flap.

Results Both groups had statistically similar ages, number of previous interventions, stricture site, length and follow‐up. After a median follow‐up of 27.5 months, the stricture recurred in three (24%) of the VO and two (11%) of the DO groups (P > 0.05). One patient in the VO group required surgical closure of the urethral fistula. Flap pseudo‐diverticulum and/or sacculation with postvoid dribble occurred in six patients in the VO and none in the DO group (P = 0.01).

Conclusions Dorsal placement of the pedicled flap is anatomically and functionally more appropriate than the traditional VO placement. DO preputial/penile flap urethroplasty is a versatile procedure and can be applied even for long anterior urethral strictures, including reconstruction of the meatus and high proximal bulbar strictures.
Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using colour Doppler ultrasonography and nocturnal penile tumescence monitoring
Authors: Kawanishi Y. , Lee K.S. , Kimura K. , Kojima K. , Yamamoto A. , Numata A.
Published: March 2003

Objective To assess the effect of radical retropubic prostatectomy on erectile function, by evaluating objectively patients' erectile function before and after surgery.

Patients and methods The study comprised 126 patients with clinically localized prostate cancer who were scheduled to undergo radical retropubic prostatectomy. After giving informed consent for the study, 123 patients underwent intracavernosal injection tests, colour Doppler ultrasonography and nocturnal penile tumescence monitoring before and after surgery.

Results From the intracavernosal injection tests and nocturnal penile tumescence monitoring, 21 patients (17%) were evaluated as having normal erectile function before surgery. After radical retropubic prostatectomy, nine (43%) of these 21 potent men had preserved erectile function. In eight patients whose neurovascular bundles were preserved, five were potent after surgery. The cause of erectile function after surgery was a neurogenic disorder in seven and a related vascular disorder in five.

Conclusion From objective tests of erectile function on patients scheduled to undergo radical prostatectomy, 17% had normal erectile function. However, even after nerve‐sparing radical retropubic prostatectomy, the proportion retaining potency was unsatisfactory. Although a neurological disorder was the main cause of erectile dysfunction after surgery, vascular disorders were also important.
Homotypic cell–cell contacts stimulate the motile activity of rat prostate cancer cells
Authors: Madeja Z. , Miȩkus K. , Sroka J. , Djamgoz M.B.A. , Korohoda W.
Published: March 2003

Objective To characterize the effect of homotypic cell‐to‐cell collisions upon the motile activities of two rat prostatic cancer cell lines of markedly different metastatic potential.

Materials and methods The movements of strongly and weakly metastatic MAT‐LyLu and AT‐2 cells, respectively, were recorded under an inverted microscope at 37 °C. The motile activities of the cells at various cell densities were characterized quantitatively by computer‐aided tracking methods and image analysis. The following variables were assessed: speed of movement, final displacement, coefficient of movement efficiency, diffusion constant and positive flow.

Results MAT‐LyLu and AT‐2 cells showed only limited motile activity in sparse cultures where there was little contact amongst the cells. However, under these and all other subsequent conditions tested, the motile activity of the MAT‐LyLu cells was higher than the AT‐2 cells. As the density of the cultured cells was increased (leading to more cell‐to‐cell contacts) there was a significant increase in motility. This effect was more pronounced for the AT‐2 than for the MAT‐LyLu cells, resulting in visible acceleration of movement by direct physical contact among the colliding cells. The motile activities of the tumour cells was only slightly affected by conditioned media.

Conclusion Homotypic collisions between migrating prostatic cancer cells can strongly stimulate their motility. The effect of increased contact is greater on the weakly metastatic cells, such that at high cell density, the difference in the motilities of weak and strong metastatic cells is greatly reduced.
The development and validation of a patient‐information booklet on ureteric stents
Authors: Joshi H.B. , Newns N. , Stainthorpe A. , Macdonagh R.P. , Keeley F.X. , Timoney A.G.
Published: March 2003

Objective To report a scientific approach incorporating patient preferences towards the development of a patient‐information booklet about ureteric stents.

Patients and methods Phase 1 of the study included 35 adult patients with ureteric stents who were surveyed using semi‐structured interviews (four patients) and a questionnaire (31 patients) to assess various issues relating to information given to patients about ureteric stents. In addition, published papers were assessed and clinicians' opinions sought. The results formed the basis for a comprehensive patient‐information booklet about ureteric stents that incorporated patients' views and preferences. In phase 2, the booklet was tested and formally validated by inviting 30 patients, a panel of 20 urologists and general practitioners, and five stent manufacturers to assess the booklet for adequacy, coverage and readability of the content.

Results Of the 35 patients, 30 (19 men and 11 women, mean age 49 years, range 20–78) participated in the initial survey; 80% of patients reported dissatisfaction about the information they received. Patients wanted more information about the use, adverse events and effects of stents on daily life; 85% preferred all relevant information about the stents to be in a written format with illustrative drawings. An eight‐page booklet was thus developed. The validation study revealed that the booklet matched patients' experiences (approval score of 9/10, range 8–10) and was reported as satisfactory by clinicians and manufacturers.

Conclusions A validated information booklet on ureteric stents was developed, incorporating patients' expectations and views. This booklet is expected to be an effective tool for patient communication that would help patients cope better with indwelling stents and be useful in counselling patients. A similar approach could be adopted for the development of other patient‐information packs.
Cytoreductive nephrectomy: is it a realistic option in patients with renal cancer?
Authors: Bromwich E. , Hendry D. , Aitchison M.
Published: March 2003

Objective To evaluate the role of cytoreductive nephrectomy (CRN) in improving survival in patients with renal cell cancer.

Patients and methods The case‐notes of 268 consecutive patients who presented to our specialized renal cancer clinic between 1998 and 2001 were reviewed. All patients with metastatic disease were assessed for CRN. If their primary tumour was considered operable, they were assessed further using the European Cooperative Oncology Group performance score; only patients with a performance score of 0 or 1 were considered for surgery.

Results In all, 168 patients underwent nephrectomy with curative intent for M0 disease and 11 were treated conservatively. Ninety‐four patients with M+ disease (mean age 65 years, range 38–80) were considered for CRN. Thirty‐eight patients had an inoperable primary. Of the remaining 56 patients, 20 had a performance status of 0 or 1 and were offered CRN.

Conclusion Metastatic disease at presentation occurred in 34% of all patients referred; 40% patients had an inoperable primary and 38% had a performance score of  2. With an active policy of considering all patients for CRN, only 7% of those with renal cancer were suitable for this procedure. CRN is unlikely to have a significant effect on overall survival within a population of patients with renal cancer.
Cyclic AMP and cyclic GMP activate protein kinase G in cavernosal smooth muscle cells: old age is a negative factor
Authors: Lin C.‐S. , Liu X. , Chow S. , Lue T.F.
Published: March 2003

Objective To investigate protein kinase G‐I (PKG‐I) expression and activation in cavernosal smooth muscle cells (CSMC) of young and old rats.

Materials and methods PKG‐I expression in rat penis was examined by immunohistochemical staining, reverse transcription‐polymerase chain reaction, and Western blot analysis. CSMC isolated from young (16‐week‐old) and old (28‐month‐old) rats were grown as monolayer cell cultures and treated with different dosages of cAMP or cGMP for different periods. Their proteins were then analysed for the expression of vasodilator‐stimulated phosphoprotein (VASP), phosphorylated VASP (at serine 239), PKG‐I, and protein kinase A (PKA).

Results PKG‐I expression was detected in the vascular and CSMC of the rat penis. There was little or no difference in the level of PKG‐I expression between young and old rats. Treatment of CSMC with different dosages of cAMP or cGMP did not change the expression levels of VASP throughout the entire test period (up to 24 h). In contrast, the level of VASP phosphorylation at S239, i.e. the level of PKG‐I activation, depended on the dosages of cAMP and cGMP and on the duration of treatment. Prolonged treatment (24 h) with either cAMP or cGMP resulted in down‐regulation of both PKG‐I and PKA. While cAMP and cGMP produced very similar results in nearly every aspect, there was a difference in one test, in which cGMP produced much less activated PKG‐I than cAMP in the CSMC of 28‐month‐old‐rats.

Conclusions For the first time we provide evidence for PKG‐I activation in CSMC. Both cAMP and cGMP were capable of activating PKG‐I in CSMC. Age seemed to compromise the ability of PKG‐I in response to cGMP.
Apoptosis‐related proteins in the testes of infertile men with varicocele
Authors: Tanaka Hiroyuki , Fujisawa M. , Tanaka Hirokazu , Okada H. , Kamidono S.
Published: March 2003

Objectives To assess immunohistochemically the expression of apoptosis‐related proteins in the testes of infertile men, to determine which of these proteins were related to hypospermatogenesis, as a previous report suggested that apoptosis was suppressed in infertile men with varicocele.

Materials and methods The expression of Bcl‐2, Bax, caspase‐1 (ICE) and caspase‐3 (CPP32) were examined in bilateral testicular specimens from 26 infertile men with varicocele and six normal testicular specimens, using the avidin‐biotin‐peroxidase complex method. Clinical variables were also assessed.

Results Bax, ICE, and CPP32 were expressed in germ cells, while Bcl‐2 was not. Differences in staining in left or right testes were not significant. In both testes of infertile patients with varicocele, significantly fewer germ cells stained for CPP32 than in controls (P < 0.001). For Bax and ICE, total germ cell staining was similar between these groups. Staining was less frequent in infertile patients for both CPP32 and ICE when the analysis was restricted to spermatogonia. Serum luteinizing hormone levels correlated positively with CPP32 staining (P = 0.0457).

Conclusions The reduced expression of CPP32 participates in regulating apoptosis in the testes of infertile men with varicocele.
Female urodynamics and lower urinary tract infection
Authors: Okorocha I. , Cumming G. , Gould I.
Published: March 2003

Objectives To determine the incidence of unsuspected urinary tract infection (UTI) before cystometry, to evaluate reports of a greater tendency to abnormal cystometry in the presence of asymptomatic bacteriuria, and to determine the incidence of iatrogenic significant bacteriuria after cystometry.

Patients and methods A prospective study was carried out in the gynaecology department of a district general hospital in collaboration with the medical microbiology department of a university teaching hospital. The period of investigation was 1 year and the study population was a sample of women undergoing urodynamic investigations during this period. Data were collected on age, menopausal status, parity, cystometric diagnosis and voiding dysfunction.

Results In all, 117 patients provided a urine sample before cystometry; 12 of these patients had a positive culture, giving an incidence of 10.3% for unsuspected asymptomatic bacteriuria before cystometry. There was a significant association between age and the presence of UTI before cystometry (P = 0.003) and between this UTI and sensory urgency (P = 0.01). There was no similar significant association with detrusor instability or genuine stress incontinence. Nineteen of the 97 patients who had negative bacteriology before cystometry had a positive urine culture afterward. Compared with patients who had a negative sample, there was no significant association with age, parity, menopausal status, abnormal cystometry or voiding dysfunction.

Conclusion These results do not support a policy of universal screening for bacteriuria before urodynamic investigation. Asymptomatic bacteriuria did not influence the urodynamic outcome except in patients with sensory urgency. However, we recommend that screening and treatment be considered individually in older women who are being investigated for irritative bladder symptoms. About 20% of the present patients developed UTI after the urodynamic investigation. This information should be included in the counselling before urodynamic investigation and should be incorporated into the patient information leaflet as part of good clinical practice.
The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children
Authors: Pohl H.G. , Bauer S.B. , Borer J.G. , Diamond D.A. , Kelly M.D. , Grant R. , Briscoe C.J. , Doonan G. , Retik A.B.
Published: March 2003

Objective To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal.

Patients and methods The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6–14.5, and seven males, mean age 8 years, range 5–20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow‐up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient.

Results Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow‐up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection‐free 16 months (two) and 6 years later.

Conclusion CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost‐effectively.
Non‐secretor status is associated with female acute uncomplicated pyelonephritis
Authors: Ishitoya S. , Yamamoto S. , Mitsumori K. , Ogawa O. , Terai A.
Published: March 2003

Objective To retrospectively analyse the secretor status in women with acute uncomplicated pyelonephritis, as non‐secretors of histo‐blood group antigens are reportedly at risk of recurrent urinary tract infections (UTIs).

Patients and methods The study included 245 women who had been diagnosed as having acute uncomplicated pyelonephritis in affiliated hospitals over the past 5 years. All women were sent antiseptic swabs, to collect saliva, and a questionnaire to survey their past UTI episodes and menstrual status. Responses with written informed consent were obtained from 106 women (median age 50.5 years, range 17–85). The secretor status was determined using the haemagglutination inhibition assay from the saliva on the swabs.

Results Forty‐four (41%) of the women were non‐secretors, a significantly higher frequency than in the (control) Japanese population (217 of 960, 22.6%; P< 0.001). The incidence of non‐secretors was significantly higher (P < 0.01) in premenopausal (26 of 46, 57%) than in postmenopausal women (18 of 60, 30%).

Conclusion These results suggest that non‐secretor status is associated with a genetic susceptibility to acute uncomplicated pyelonephritis, especially in premenopausal women.
Tunica albuginea acellular matrix graft for penile reconstruction in the rabbit: a model for treating Peyronie's disease
Authors: Wefer J. , Schlote N. , Sekido N. , Sievert K.‐D. , Wefer A.E. , Nunes L. , Bakircioglu M.E. , Dahiya R. , Tanagho E.A.
Published: March 2003

Objective To evaluate the use of an acellular matrix graft of the tunica albuginea for functional penile reconstruction in severe cases of Peyronie's disease.

Materials and methods In 18 rabbits, an acellular matrix graft of the tunica albuginea was used to cover a 4×8 mm tunical defect, and six animals each were killed 1, 3 and 6 months later; four unoperated animals served as histological controls. Before death an erection was induced by papaverine, with the quality classified on a scale of 0–5, and cavernosography performed. After death the penis was prepared for histological study, and the cell number, collagen and elastic fibre content evaluated in the regenerated matrix, and in control specimens and four unimplanted matrices.

Results Of 18 experimental animals, 11 had normal erections before death, four had slight penile deviation and three developed no erection. Failure was caused by severe postoperative haematoma, resulting in scar tissue. There was no graft rejection. Histologically there was no difference between natural and regenerated tunica. The collagen content and cell number were not significantly different in regenerated and control samples. There were significantly fewer elastic fibres in the unimplanted grafts and the 1‐month group, but in later samples this difference was no longer evident.

Conclusion The homologous acellular matrix graft of the tunica albuginea warrants further evaluation as an alternative treatment in Peyronie's disease, despite some postoperative failures. The advantage of this orthotopic biomaterial is its rapid integration, with no rejection.
Urodynamic findings 3 months after radiotherapy in patients treated with conformal external beam radiotherapy for prostate carcinoma
Authors: Do V. , Choo R. , Deboer G. , Herschorn S. , Danjoux C. , Chen C.H. , Barak I.
Published: March 2003

Objective  To quantify the effect of radiotherapy (RT) on urodynamic function 3 months after RT in patients with prostate cancer undergoing definitive external beam RT.

Patients and methods  Seventeen patients with clinically localized prostate cancer were accrued into a single‐arm prospective study. Sixteen of the patients completed a scheduled multichannel video‐urodynamic study at baseline and again 3 months after RT; the urodynamic variables were then compared to assess the nature and extent of urodynamic change caused by RT. Correlations were assessed between these quantitative changes and those in self‐assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL) and urinary functional enquiry.

Results  There were significant changes detected by the urodynamic study 3 months after RT in bladder volume at capacity (mean decrease 70 mL) and bladder volume at first sensation when supine (mean decrease 85 mL), and a lower postvoid residual volume (mean 50 mL). There was no significant change in the remaining urodynamic variables (including maximum flow rate and voided volume), nor in bladder compliance, bladder instability or bladder outlet obstruction. The self‐assessed qualitative urological function measured by the IPSS, QoL and median urinary frequency/24 h showed no significant change after RT.

Conclusions  This is the first quantitative study to prospectively evaluate the effect of RT on urodynamics in patients with prostate cancer. Only a few urodynamic variables changed significantly 3 months after RT, while most, including self‐assessed qualitative urinary function, did not. This finding corresponds well with the notion that most patients tolerate RT well and that acute RT‐induced urinary symptoms resolve successfully, with the return of lower urinary tract function to baseline levels by 3 months after RT.
Periprostatic nerve block gives better analgesia for prostatic biopsy
Authors: Lynn N.N.K. , Collins G.N. , Brown S.C.W. , O'Reilly P.H.
Published: March 2003

Objective  To prospectively compare two local anaesthetic techniques for prostatic biopsies, which are usually taken with no anaesthesia; because multiple biopsy techniques are becoming more common and there is an increasing need for analgesia/anaesthesia during the procedure.

Patients and methods  The study group comprised 86 consecutive men (median age 67.7 years) undergoing prostatic biopsy because of either an abnormality of prostate specific antigen level or digital rectal examination. They were randomized into four groups; men in group 1 received 10 mL of 1% lignocaine infiltrated into the periprostatic nerve plexus bilaterally; men in group 2 received 11 mL of 2% lignocaine gel rectally; men in groups 3 and 4 were recruited as controls, and given either plain gel rectally or an injection with saline into the periprostatic nerve plexus. Sextant prostate biopsies were taken in all cases using a standardized protocol. Immediately after the procedure patients were asked to indicate the degree of pain on a 10‐cm visual analogue scale.

Results

 Men in group 1 had significantly less pain than the others (
P

 < 0.001). There was no statistically significant difference in pain between men who received plain gel rectally or saline injection (
P

 
=
 0.35). The rectal instillation of 2% lignocaine gel did not reduce pain significantly (
P   =  0.186) compared with the controls.

Conclusion  A periprostatic nerve block with 1% lignocaine was associated with significantly less pain during prostatic biopsy than was rectal lignocaine gel or placebo.
Vitamin D receptor‐dependent antitumour effects of 1,25‐dihydroxyvitamin D3 and two synthetic analogues in three in vivo models of prostate cancer
Authors: Oades G.M. , Dredge K. , Kirby R.S. , Colston K.W.
Published: March 2003

Objective
 To determine the
in vitro
and
in vivo
effects of 1,25‐dihydroxyvitamin D
3 (calcitriol) and two newer less hypercalcaemic analogues, EB1089 and CB1093 (as the use of calcitriol as a therapeutic agent in humans has been limited by hypercalcaemia) in three rodent models of prostate cancer.

Materials and methods
 The highly metastatic MAT LyLu Dunning prostate model, PAIII tumours in Lobund‐Wistar rats and LNCaP xenografts in nude mice were used. Vitamin D receptor (VDR) expression and binding were assessed in all cell lines. The effects of calcitriol, EB1089 and CB1093 on tumour growth, cell cycle and angiogenesis
in vitro
, and growth and serum calcium levels
in vivo , were assessed.

Results
 The growth of prostate adenocarcinoma was inhibited by calcitriol, EB1089 and CB1093 in the Dunning prostate model. Although both analogues increased serum calcium levels, the levels were significantly less than in rats treated with calcitriol. Tumour growth was also inhibited in male athymic nu/nu mice with LNCaP tumour xenografts. PAIII cells failed to express functional VDR and were insensitive to calcitriol and its analogues, either
in vitro
or
in vivo . The analogues of calcitriol did not inhibit angiogenesis in a rat aorta assay.

Conclusion
 This is the first report comparing the actions of calcitriol and its analogues in different
in vivo
models. The results suggest that the newer less hypercalcaemic analogues of calcitriol may offer a novel therapeutic option for treating prostate cancer. VDR‐dependent growth inhibition and not the inhibition of angiogenesis is the main mechanism of action of these compounds
in vivo.
Prognostic implications of histological features in patients with chromophobe cell renal carcinoma
Authors: Onishi T. , Oishi Y. , Yanada S. , Abe K. , Hasegawa T. , Maeda S.
Published: March 2003

Objective  To assess the relationship between the histological features of renal chromophobe cell carcinoma (CCC) and clinical outcome in patients with renal cell carcinoma.

Patients and methods  From 1957 to 1996, 41 patients with CCC of the kidney (4.9% of all kidney carcinomas) were treated at our university hospitals. Of these histologically defined cases, four who died from other types of cancer and two who were lost to follow‐up were excluded, leaving 35 patients in the study; the carcinoma was classified as the typical variant in 26 and the eosinophilic variant in nine. Based on the differences of the variants, the histological features affecting prognosis were analysed.

Results  The overall survival rates at 1, 3, 5, 10, 15 and 20 years were 97%, 82%, 82%, 70%, 62% and 47%, respectively. The prognosis was more favourable in those with the eosinophilic than for the typical variant (there were no cancer‐related deaths in the former). Of those with the typical variant, five died within 2 years of surgery; of these, three with high‐stage disease had various degrees of sarcomatoid change. Conversely, two patients had a recurrence > 10 years after surgery (late recurrence). Both these patients and the others who later died from cancer had no sarcomatoid change in the tumour areas examined.

Conclusion  The eosinophilic variant of CCC has a better prognosis; on the contrary, during long‐term surveillance, early recurrence was detected especially in those with sarcomatoid change and late recurrence only in two typical variant. These prognostic implications of the histological differences are important for understanding the outcome of renal CCC.
Effect of chronic renal failure on the purinergic responses of corpus cavernosal smooth muscle in rabbits
Authors: Kilicarslan H. , Yildirim S. , Bagcivan I. , Ayan S. , Sarac B. , Sarioglu Y.
Published: March 2003

Objective  To examine purinergic relaxation responses in chronic renal failure (CRF) in an experimental rabbit model, and thus evaluate the possible involvement of the purinergic system in erectile dysfunction with CRF.

Materials and methods  The relaxant effects of ATP were measured in strips of corpus cavernosum smooth muscle taken from control and CRF rabbits. CRF was induced in New Zealand white rabbits as previously described. Penises were excised from CRF rabbits 4 weeks after inducing uraemia. In an organ bath the strips from controls and CRF rabbit corpus cavernosum were pre‐contracted with phenylephrine and increasing doses of adenosine and ATP added.

Results  In the pre‐contracted rabbit cavernosal tissue the relaxations induced by adenosine and ATP were unchanged in CRF.

Conclusion  The lack of any relaxant effect of adenosine or ATP on the relaxation of cavernosal smooth muscle in rabbits with CRF might be because the relaxant effects of these agents are endothelium‐independent and the endothelial purinergic receptor density was unchanged in CRF.
Sacral neuromodulation in functional urinary retention: an effective way to restore voiding
Authors: Aboseif S. , Tamaddon K. , Chalfin S. , Freedman S. , Mourad M.S. , Chang J.H. , Kaptein J.S.
Published: March 2003

Objective  To determine the long‐term efficacy and complications of sacral nerve stimulation as an alternative therapy for functional unobstructive urinary retention, often considered to be psychogenic and effectively treated by clean intermittent catheterization, but for which pelvic floor dysfunction has been recognized as a possible cause.

Patients and methods  Twenty patients (17 women and three men, mean age 48 years) with idiopathic, unobstructive functional urinary retention and in whom other forms of therapy had failed, had a pulse generator implanted (Medtronic, Minneapolis, MN, USA) and a sacral nerve implant. Their mean duration of symptoms was 68 months; 13 patients had chronic pelvic and perineal pain associated with their obstructive voiding symptoms. All patients were managed with clean intermittent catheterization and pharmacological therapy (α‐blockers) before the procedure. All patients had a percutaneous nerve evaluation before the permanent implant, which showed> 50% improvement in their symptoms. All patients were evaluated at 1, 6 12, 18 and 24 months, then yearly thereafter. The results were assessed both subjectively by patient's symptoms and objectively by checking the postvoid residual volume (PVR) and voided volume.

Results  Eighteen patients were able to void spontaneously with a mean increase in voided volume from 48 to 198 mL, and a significant decrease in PVR from 315 to 60 mL. Eighteen of the patients had a ≥ 50% improvement in their symptoms and said they would recommend the therapy to a friend or relative. Complications occurred in six patients.

Conclusion  Sacral nerve stimulation is an effective and durable new approach to functional urinary retention, with few associated complications. Test stimulation provides a valuable tool for selecting patients.
A ventral rotational skin flap to improve cosmesis and avoid chordee recurrence in epispadias repair
Authors: Pippi Salle J.L. , Jednak R. , Capolicchio J.P. , França I.M.P. , Labbie A. , Gosalbez R.
Published: March 2003

Objective  To describe a technical modification that facilitates dorsal skin closure, improves cosmesis and eliminates chordee recurrence secondary to contracture of the dorsal penile skin in the repair of epispadias.

Patients and methods  Eleven patients with penopubic epispadias (mean age 1.8 years) had the epispadias repaired using a modified ventral penile skin flap. Four patients had isolated epispadias and seven had had a previous primary closure of bladder exstrophy. Nine patients underwent the Cantwell‐Ransley technique, leaving the meatus in a glanular position. Two patients were repaired using the penile disassembly technique of Mitchell and Bägli, because they had a short urethral plate. A ventral island skin flap was fashioned, starting at the base of the penis. Dissection was carried ventrally into the scrotum to allow for adequate dorsal flap transposition. The flap was rotated laterally to shift the suture line from the midline and to cover the dorsal aspect of the penis with untouched penile shaft skin. Redundant ventral foreskin was discarded.

Results  All patients had an uneventful course after surgery. Dorsal penile skin was viable in every case and no patient developed recurrence of chordee or a urethrocutaneous fistula. The cosmetic result was excellent in all patients.

Conclusions  Dorsal skin closure using lateral rotation of ventral penile skin flap improves cosmesis after epispadias repair and eliminates the recurrence of chordee secondary to midline dorsal scarring.
MUC1 expression, splice variant and short form transcription (MUC1/Z, MUC1/Y) in prostate cell lines and tissue
Authors: Schut I.C. , Waterfall P.M. , Ross M. , O'Sullivan C. , Miller W.R. , Habib F.K. , Bayne C.W.
Published: March 2003

OBJECTIVE

To detect the expression and transcription pattern of MUC1 in benign and malignant disease, and in two widely studied cell lines, and to investigate the glycosylation of MUC‐1 in bone metastasis of prostate cancer, as mucins have been implicated in the progression and behaviour of several cancers.

MATERIALS AND METHODS

RNA extracted from cell lines (DU145 and PC3), five samples of BPH and five samples of prostate cancer was reverse transcribed before amplification of MUC1‐specific sequences by polymerase chain reaction. Paraffin‐embedded sections were stained for glycosylated MUC1 and MUC1 core epitopes by HMFG1 and B27.29 antibodies, respectively. Steroid‐treated cell lines werre analysed by fluorescence‐activated cell sorting, using the same antibodies.

RESULTS

MUC1, in an under‐glycosylated form, was widely expressed in the prostate and in metastatic lesions. MUC1/Z and MUC1/Y RNA were differentially expressed in BPH and prostate cancer, with no detectable expression of splice variant mRNA. This is in contrast to prostate cancer cell line cells (PC3 and DU145), which express splice variant mRNA.

CONCLUSIONS

BPH, prostate cancer and metastatic prostate cancer all express high levels of under‐glycosylated MUC1. This may explain the inability of previous studies to detect MUC1 in prostate tissue, as the antibody used was specific for a carbohydrate epitope which is not expressed on the under‐glycosylated MUC1.
In vivo evaluation of the potency and bladder‐vascular selectivity of the ATP‐sensitive potassium channel openers (–)‐cromakalim, ZD6169 and WAY‐133537 in rats
Authors: Fabiyi A.C. , Gopalakrishnan M. , Lynch J.J. , Brioni J.D. , Coghlan M.J. , Brune M.E.
Published: March 2003

OBJECTIVE

To compare in vivo the potency and bladder‐vascular selectivity of ATP‐sensitive potassium channel openers (KCOs) (–)‐cromakalim, WAY‐133537 and ZD6169 and a muscarinic antagonist, tolterodine in rats.

MATERIALS AND METHODS Bladder and arterial pressures were monitored simultaneously, before and after increasing intravenous doses of compounds, in each of two urethane‐anaesthetized rat bladder hyperactivity models: spontaneous non‐voiding myogenic contractions secondary to partial outlet obstruction and volume‐induced neurogenic contractions.

RESULTS

(–)‐Cromakalim, WAY‐133537 and ZD6169 caused a dose‐dependent suppression of spontaneous contractions in the obstructed model, with a 50% inhibition of the contraction area under the curve at doses of 0.06, 0.14 and 2.4 µmol/kg (intravenous), respectively. Corresponding decreases in mean arterial pressure at these effective doses were 24%, 15% and 15%, respectively. The KCO potency rank order was the same and their relative potency highly comparable in the neurogenic model. There was complete inhibition of spontaneous contractions in obstructed rats at doses corresponding to ≈ 50% inhibition of the neurogenic contractions. While tolterodine caused a dose‐dependent inhibition of contractions in the neurogenic model, it was ineffective at inhibiting non‐voiding contractions in obstructed rats.

CONCLUSIONS

All KCOs tested caused significant decreases in arterial pressure at doses effective on the bladder in the model of obstructive instability, suggesting a lack of bladder‐vascular selectivity. Similar KCO potency in both assays suggests no appreciable changes in KATP channel function as a result of partial outlet obstruction.
Productivity, vitality and utility in a group of healthy professionally active individuals with nocturia
Authors: Kobelt G. , Borgström F. , Mattiasson A.
Published: March 2003

OBJECTIVES

To assess the effect of nocturia on productivity, vitality and utility in a selected group of professionally active individuals with nocturia, compared with matched controls, and investigate the effect of symptom severity, to test the hypothesis that lack of sleep caused by frequent sleep interruptions could reduce an individuals' daytime energy and activity levels.

SUBJECTS AND METHODS

Subjects (203) were recruited in Sweden through advertisements, and their suitability for the study assessed in a structured interview. Controls (80) matched for age and gender were randomly selected from a market research panel and given the same interview. Both groups completed a productivity questionnaire, a generic quality‐of‐life questionnaire with a specific domain for vitality and a utility instrument.

RESULTS

The study group with nocturia had a significantly lower level of vitality and utility, and greater impairment of work and activity, than the control group. Women were more affected than men. Symptom severity correlated with all three measures.

CONCLUSIONS

In an otherwise healthy and professionally active group of individuals, waking at night to void significantly diminishes their overall well‐being, vitality and productivity, leading to a significant level of indirect and intangible costs.
Diabetes UK funded surveys of the structural provision of primary care diabetes services in the UK
Authors: Williams D. R. R. , Baxter H. S. , Airey C. M. , Ali S. , Turner B.
Published: March 2003

Aim To describe diabetes service provision in primary care in the UK.

Methods Postal questionnaires were sent to all UK primary care organizations (PCOs), and to a sample of general practices in England and all practices in Wales and Scotland. The data collection period ended on 30 April 2001.

Results Seventy‐nine per cent of the PCOs and 40% of the practices provided usable information. There is evidence that respondents were not significantly biased in relation to their interest in diabetes care. Diabetes was included as a Health Improvement Programme (or equivalent) priority by 62% of PCOs and had been identified as a clinical governance priority by 27%. Sixty‐five per cent had information about the ethnic composition of their general population, 57% had an estimate of the number of people with diabetes. Sixty‐nine per cent had a local diabetes register but this was said to cover the entire local population in only 64% of these. At least one audit of diabetes care had been carried out (in the previous 5 years) in 75% and, in 76%, clinical guidelines on diabetes care were made available to practices. In the practices, 80% had a designated lead person for diabetes. Seventy‐three per cent had at least one general practitioner with a special interest and 87% at least one nurse. Seventy‐two per cent of practices ran specific diabetes clinics and 51% had a screening policy. Eighty‐six per cent considered that they had adequate systems in place for the delivery of diabetes care. However, only 6% were able to offer a dedicated diabetes telephone help or advice line and only 9% an evening out of hours clinic. Regular practice meetings were held to discuss diabetes in 35%, whereas 39% had a formal shared care protocol. Fourteen per cent held regular joint meetings with the hospital‐based team and in 38% there was membership of Diabetes UK for at least one partner or the practice itself. A third (34%) of responding practices were unsure whether a Local Diabetes Services Advisory Group or equivalent existed in their area. Geographical differences in service provision were identified with, for example, practices in London having fewer components in place that were specifically related to the provision of diabetes care. Single‐handed practices, wherever they were situated, had in place fewer staff and facilities specifically for diabetes care.
Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 2. Workforce issues, roles and responsibilities of diabetes specialist nurses
Authors: Winocour P. H. , Ford M. , Ainsworth A. ,   the Association of British Clinical Diabetologists
Published: March 2003

Aim To examine the provision and role of diabetes specialist nurses (DSNs), and the content of patient education programmes in the UK.

Method A postal survey of secondary care providers of diabetes services in the UK in 2000.

Results Following two reminders, a 77% response rate demonstrated 2.5 (median) whole time equivalent DSNs per 250 000 population, with only 13% of centres meeting the recommended staffing level of four per 250 000 population. The vast majority carried out work both in hospital and in the community, the proportion a reflection of who employed and managed staff. There was a wide variation in the qualifications required and the nursing gradings of DSNs, and regional variation in the number of grade I nurses, with the greatest proportion based in the South‐east of England. The vast majority (96%) provided patient education, and where it existed (in 60% of responses), were the major providers of a patient help line (90%). Although key providers of patient education, there had been no specific education for this task in over 20% of responses. There was broad consistency in the topics covered at educational sessions, although advice on footwear (76%) and home urine glucose monitoring (73%) were least frequently documented. The issuing of literature and cards for patient use was also very variable. Over 25% of bids for diabetes service improvement were for additional DSNs, but only 48% of these were successful.

Conclusions There has been an improvement in staffing levels of DSNs over the last 10 years but the numbers are many fewer than recommended in national strategy documents, with evidence that despite expansion being given a high profile, such efforts are often unsuccessful. There was also evidence of considerable variation in the qualifications and gradings of DSNs throughout the UK and indeed in their day‐to‐day roles, and the content of patient education programmes. This suggests the need for a nationally co‐ordinated approach to training and recruitment.