bluuebunny/crossref_metadata_2025 huggingface dataset:
Trial without Catheter following Acute Retention of Urine
Authors: TAUBE M. , GAJRAJ H.
Published: November 2008

Summary— A total of 60 patients with acute urinary retention were studied to establish whether a trial without a catheter was justified and to identify subgroups of patients most likely to benefit from this practice. The patients were randomly allocated to 3 groups; the catheters were removed either immediately after the bladder was emptied, or 24 or 48 h later; 17 patients urinated satisfactorily after removal of the catheter. Re‐establishment of micturition was not associated with the length of history or severity of symptoms of prostatism, with age or the presence of urinary tract infection. The mean retained volume of urine in patients with a satisfactory result was 786 ml and 1069 ml in the failures. Of the 34 patients with retained volumes of less than 900 ml, 15 were successful in re‐establishing micturition compared with 2 of 26 of those with retained volumes greater than 900 ml. The time of catheter removal was not important. The 17 successful patients were reviewed 6 months later. None reported further urinary retention; 6 had required prostatectomy for severe symptoms, 6 had minor symptoms and 5 were symptomless. It was concluded that a trial without a catheter is worthwhile, since 11 of 60 patients had not required surgery, but it should be avoided in patients with a residual volume exceeding 900 ml.
Balanitis
Authors: ESCALA J. M. , RICKWOOD A. M. K.
Published: November 2008

Summary— The clinical features of 100 cases of balanitis are described. The condition affects no more than 4% of boys, is commonest during pre‐school years (but rare prior to toilet training) and is usually associated with a prepuce which is partly or completely non‐retractable. It does not cause phimosis and no single pathogen is involved. Most boys suffer a single episode and circumcision is indicated only for those with recurrent, troublesome attacks.
Proteinuria‐What Value is the Dipstick?
Authors: HARRISON N. A. , RAINFORD D. J. , WHITE G. A. , CULLEN S. A. , STRIKE P. W.
Published: November 2008

Summary— The value of the urinary dipstick in the assessment of proteinuria was investigated in a study correlating laboratory measurements of protein and albumin against the dipstick protein in the same samples of urine; 94 patients (100 admissions) were studied at the Royal Air Force Renal Unit, each patient collecting two 24‐h urine samples. Along with each 24‐h sample, 10‐ml aliquots of urine were obtained at 3 designated times during the day for both ward dipstick testing and laboratory assay; + or more on the dipstick correlated with abnormal proteinuria (≥ 150 mg/24 h) in 88% of cases, whilst trace values straddled the level of significant proteinuria. Further differentiation of trace was possible by repeat testing during the day. The subsequent presence of a dipstick negative during that day correlated with normality in all but 5% of cases.

In order to ensure detection of renal disease presenting as isolated orthostatic proteinuria, assay of the mid‐morning sample is recommended.
Which Urine Sample for Detection of Proteinuria?
Authors: RISDON P. , SHAW A. B.
Published: November 2008

Summary— The standard practice of screening for proteinuria in the concentrated early morning urine was examined. Protein concentration and dipstick readings were determined in early morning and daytime urines of 56 normal subjects and 110 patients with proteinuria attending a renal clinic. In normal subjects the protein concentration was similar in both urine samples and dipsticks gave the same frequency of false positive results, usually only trace positive. The protein concentration was higher in the daytime urine in 76% of patients. Dipstick readings were similar in 64.5% but higher in the daytime urine in 31% and in the early morning urine in only 4.5%. It is recommended that daytime urine should be screened for proteinuria in patients presenting in out‐patient clinics.
Development of the Invaginated Sleeve Technique for Continent Cystostomies in Dogs
Authors: GARDINER R. A. , SAMARATUNGA M. L. T. H.
Published: November 2008

Summary— Two studies were undertaken in dogs to evaluate oblique tunnels through bladder walls lined by urothelium for use in continent cystostomies. In the first study, the tracts were lined completely by urothelium by 10 weeks, but tract calibre reduced considerably after stent removal and periluminal fibrosis was a prominent feature. In the second study a tubularised partial‐thickness pedicle graft was invaginated through an oblique tunnel in the bladder wall, with the graft extending extravesically and then being wrapped in omentum. This technique provided complete urothelial covering by 2 weeks with much less periluminal fibrosis. In the 3 dogs catheterised daily up to 120 days, this technique afforded continence with generous tracts for catheterisation.
Histological Changes in the Urinary Bladder Secondary to Urethral Catheterisation
Authors: GOBLE N. M. , CLARKE T. , HAMMONDS J. C.
Published: November 2008

Summary— The macroscopic and microscopic features of the urothelial response of the human urinary bladder to urethral catheterisation are described. The catheter reaction is characterised by a predominantly eosinophilic inflammatory response producing, macroscopically, a papillary mucosal appearance termed polypoid cystitis. The severity of the epithelial inflammatory response correlates significantly with the duration of catheterisation. Urothelial dysplasia confined to the catheter reaction site was noted in 6% of cases. The possible implications of these findings are discussed.
Lack of Effect of Cholinergic Blocking and Alpha‐adrenergic Stimulation on Nocturnal Incontinence After Ileocaecal Bladder Replacement
Authors: JAKOBSEN H. , STEVEN K.
Published: November 2008

Summary— A controlled randomised trial was carried out in 9 patients to examine the possibility of achieving nocturnal continence after ileocaecal bladder replacement by reducing the amplitude of the peristaltic contractions and by increasing the maximum urethral pressure pharmacologically. The trial consisted of 4 treatment periods, each of 2 weeks' duration: a single‐blind placebo period was followed by 3 double‐blind periods with phenylpropanolamine hydrochloride 50 mg bd (Kontexin), oxybutynin chloride 5 mg tid (Ditropan), and combined treatment. Each patient completed a frequency/volume chart before the trial and for the last 7 days of each treatment period. Filling and storage urethrocystometry was performed before treatment and at the end of each treatment period.

Treatment with phenylpropanolamine and oxybutynin failed to reduce the nocturnal urine leak of about 600 ml. Treatment did not influence the maximum urethral closure pressure, which remained unchanged at about 16 cm of water with the bladder substitute at rest and filled to its maximum cystometric capacity. At storage urethrocystometry, the treatment resulted in a decrease in the amplitude of the peristaltic contractions of about 10 cm of water to approximately 45 cm of water. Accordingly, the effect of alpha‐adrenergic stimulation and anticholinergic suppression was found to be insufficient to achieve nocturnal continence in patients with ileocaecal bladder replacement.
One‐stage Repair of Hypospadias Using Split Preputial Flaps (Harris)
Authors: HARRIS D. L. , JEFFERY R. S.
Published: November 2008

Summary— An analysis is presented of the outcome in the first 100 patients treated by a new technique for the repair of hypospadias and congenital short urethra associated with chordee. Further reconstructive surgery was required in 24 patients. The effect of the position of the meatus, the length of the reconstructed urethra and the method of urinary drainage are analysed. Minor complications are described. A significantly higher complication rate was associated with a perurethral than with a suprapubic catheter; 5 of the 38 patients in whom a suprapubic catheter was used developed complications requiring reconstructive surgery. Possible causes of the complications are discussed and the results compared with those of other methods. It was concluded that this is a satisfactory method of repair for hypospadias associated with chordee.
The Effect of Glycosaminoglycans on the Crystallisation of Calcium Oxalate
Authors: KOHRI K. , GARSIDE J. , BLACKLOCK N. J.
Published: November 2008

Summary— The effect of glycosaminoglycans on urinary stone formation was evaluated using a mixed suspension, mixed product removal (MSMPR) crystallisation system together with scanning electron microscopy (SEM) to examine the resulting crystals. Chondroitin sulphate was found to decrease the nucleation rate and to promote both the growth rate and suspension density. Results obtained with hyaluronic acid, although inconclusive, are similar to those given by chondroitin sulphate. Heparin sodium salt had a powerful inhibitory effect on both the nucleation rate and the suspension density, the effect increasing in proportion to the heparin concentration. SEM examination showed that the octahedral habit of calcium oxalate dihydrate was modified by the addition of heparin sodium salt and confirmed that the average crystal size in the presence of chondroitin sulphate and hyaluronic acid was significantly greater than the control or that found in the presence of heparin sodium salt.
CA–50 as Tumour Marker in Transitional Bladder Carcinoma
Authors: TIZZANI A. , CASETTA G. , PIANA P. , PIANTINO P.
Published: November 2008

Summary— Monoclonal antibody CA–50 is a useful tumour marker in gastrointestinal carcinoma. We report an assessment of its value in bladder cancer patients. We found raised levels in 2 of 2 patients with infiltrating carcinoma and in 8 of 35 with superficial carcinoma. The recurrence rate was higher in patients with raised levels, since 6 of 8 with elevated levels and 15 of 27 with normal values had a recurrence within 6 months. T1 and T3 carcinoma had a mean CA–50 level higher than normal. G3 tumours had a mean level slightly above normal. A statistically significant difference emerged when comparing Ta with T1 + T3 carcinomas. A longer study, with serial determinations, could assess the role of CA–50 as a prognostic indicator in bladder cancer.
Voiding Pattern, Urinary Volume, Composition and Bacterial Contamination in Patients with Urinary Diversion via a Continent Ileal Reservoir
Authors: ÅKERLUND S. , BERGLUND B. , KOCK N. G. , PHILIPSON B. M.
Published: November 2008

Summary— A series of 41 patients with a continent ileal reservoir for urinary diversion (Kock pouch) was studied with regard to voiding pattern (voiding frequency), voided volume, urinary composition, bacterial contamination and mucus secretion. The mean voiding frequency in 21 patients was 5/24 h and the time required for the procedure, including the time to cover the stoma with a bandage, was 3 to 5 min; 2 patients voided once or twice at night, while 19 patients never did so. The mean volume voided during the day were significantly smaller than the volume voided in the morning. The total 24‐h urinary volume exceeded that of normal individuals but the 24‐h secretion of electrolytes was within normal limits. Bacterial contamination was found in most samples of urine. Evacuation was not impeded by the rich mucus content of the urine and mucus production did not diminish with time.
Comparison of Stamey and Pereyra‐Raz Bladder Neck Suspensions
Authors: SHAH P. J. R. , HOLDER P. D.
Published: November 2008

Summary— Endoscopic bladder neck suspension has become one of the more popular methods of surgical treatment of stress incontinence. The Pereyra technique was first described in 1959 and modified by Razin 1981. Stamey first described his technique in 1973 and this has been modified in a number of ways. The reported cure rates are 54 to 94% for the Pereyra‐Raz procedure and 61 to 92% for the Stamey procedure.

We present a comparative review of the technical results of treatment of 30 patients with a modified Stamey procedure and 17 patients with a modified Pereyra‐Raz technique. The age range of the 2 groups was comparable. A successful result, with either complete continence or only minor occasional leaks after surgery, was achieved in 80% with the Stamey techniques and 76% with the Pereyra technique. Those patients not helped by the procedure had nearly all undergone previous surgery for incontinence. The Pereyra technique was used more frequently in patients who had failed previous incontinence surgery (including the Stamey technique). Complications were minor; 5 buffer infections occurred (3 buffers were removed).

Both techniques offer a significant improvement in continence, but previous surgery is associated with a higher failure rate.
Bile Acid Malabsorption: a Complication of Conduit Surgery
Authors: DURRANS D. , WUJANTO R. , CARROLL R. N. P. , TORRANCE H. B.
Published: November 2008

Summary— We examined the possibility that use of a section of the terminal ileum for ileal conduit construction may impair bile acid absorption and cause choloretic diarrhoea. Nineteen normal subjects (mean age 41 years) and 16 patients with conduits (mean age 47 years) were investigated using the SeHCAT retention test. Conduit patients showed significant impairment of SeHCAT retention compared with normal subjects; 82% of patients had a retention below the lower limit of normal. The mean bowel frequency of patients during the test was 3 motions/day this being significantly different from their pre‐operative bowel habit. It was concluded that the use of the terminal ileum in conduit construction may impair bile acid absorption, as measured by the SeHCAT retention test, and may cause an increase in bowel frequency.
Prostate Specific Antigen—a Screening Test for Prostatic Cancer?
Authors: POWELL C. S. , FIELDING A. M. , ROSSER K. , AMES A. C. , VAUGHTON K. C.
Published: November 2008

Summary— A series of 287 patients referred by their family doctors with symptoms of bladder outflow obstruction were asked to attend the hospital for “pre‐clinic” screening for carcinoma of prostate (CaP). Blood samples were collected from 211 patients and analysed for serum prostate specific antigen (PSA) and prostatic acid phosphatase (PAP).

Thirty‐six patients had a serum PSA > 10 μg/l and 7 had PAP levels > 5 iu/l. In no instance was the PAP elevated without an associated increase in PSA concentration. Patients with raised markers underwent further investigations which included prostatic biopsy and/or resection; 17 patients were proved to have carcinoma of the prostate, 9 of whom had distant metastases. The specificity of PSA for detecting prostate cancer in this study was 90% with a sensitivity of 89.5%, in contrast to values for PAP of 100% and 36.8%.

The routine use of PAP as a marker for prostatic cancer should be abandoned. The use of PSA as a screening test in a group of patients with prostatism appears justified, but with a positive predictive value of only 47%, its use in a mass unselected screening programme is not recommended.
Sperm Density Measurement: Should this be Abandoned?
Authors: BADENOCH D. F. , EVANS S. J. W. , McCLOSKEY D. J.
Published: November 2008

Summary— Sperm density measurement by means of the Makler chamber was performed on a single semen specimen from 2 groups: 104 proven fertile men and 53 infertile men; 11.5% of the fertile population had a sperm density < 20 million/ml (median 84, mean 91.3, SD 60.5) and 33% of the infertile population had a sperm density > 20 million/ml (median 10, mean 26.9, SD 34.8). There was a statistically significant difference in median between the 2 groups, but when a discriminant analysis was applied, sperm density could predict fertile status with only 68% accuracy at optimum cut‐off. Sperm density is valueless in distinguishing fertile from infertile men and is neither useful in diagnosis nor in monitoring the progress of treatment for male infertility. It should be abandoned as a quotable measurement of male fertility.
Assessment of the Nephron Segments Involved in Post‐obstructive Diuresis in Man, Using Lithium Clearance
Authors: JONES D. A. , ATHERTON J. C. , O'REILLY P. H. , BARNARD R. J. , GEORGE N. J. R.
Published: November 2008

Summary— The phenomena of post‐obstructive diuresis and natriuresis have been studied using the lithium clearance technique in 10 patients with high pressure chronic retention. Following relief of obstruction there was a significant increase in both sodium and water excretion. There was a coincident reduction in the fractions of sodium and water reabsorbed in both proximal and distal nephron segments. This study demonstrates for the first time that following relief of chronic obstructive uropathy in man, changes in sodium and water excretion are due to altered handling in both proximal and distal nephron segments.
Does Extracorporeal Shockwave Lithotripsy Cause Hypertension?
Authors: MONTGOMERY B. S. I. , COLE R. S. , PALFREY E. L. H. , SHUTTLEWORTH K. E. D.
Published: November 2008

Summary— Several series have suggested that the incidence of hypertension following extracorporeal Shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3.

The incidence of hypertension following ESWL was 8.1%. In patients with a pre‐ESWL diastolic pressure < 90 mmHg, the incidence of those with a diastolic > 100 mm Hgpost‐operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group.

The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.
Surveillance of an At Risk Population: Assessment of Postal Urine Cytology
Authors: CUMMING J. A. , MclNTYRE MARGARET A. , MACINTYRE CECILIA C. A. , HARGREAVE T. B.
Published: November 2008

Summary— The urine postal cytology kit Urotel was assessed against our standard cytological method; 184 patients attending for routine surveillance cystourethroscopy provided free flow urine specimens. The urine cytology was reported blind. Comparison of the 2 tests showed similar specificity but significantly higher sensitivity with the Urotel kit. These kits may have a place in the surveillance of patients at high risk of recurrent tumour or those with carcinoma in situ, reducing the frequency of hospital attendance.
Effects of Simple Hysterectomy on Vesicourethral Func
Authors: PARYS B. T. , HAYLEN B. T. , HUTTON JANE L. , PARSONS K. F.
Published: November 2008

Summary— Many women who present with symptoms of bladder dysfunction relate the onset to the operation of simple hysterectomy.

A group of 42 women undergoing simple hysterectomy was studied prospectively. Urinary symptoms, urodynamic findings and sacral reflex latencies (SRLs) were assessed pre‐and postoperatively.

After hysterectomy the incidence of urinary symptoms increased from 58.3 to 75.0%. Vesicourethral dysfunction was altered in 30.6% of patients, 72.7% of whom had evidence of pelvic neuropathy as detected by SRLs.

The results show that simple hysterectomy is associated with a significant incidence of postoperative vesicourethral dysfunction and that there is an identifiable neurological abnormality incurred at operation which is pertinent to the subsequent disordered voiding.
Burch Colposuspension or Sling for Stress Incontinence? A Prospective Study using Transrectal Ultrasound
Authors: RICHMOND D. H. , SUTHERST J. R.
Published: November 2008

Summary— Twenty‐nine women with stress incontinence were treated surgically by Burch colposuspension or ox fascial sling. The operation was selected prospectively according to the transrectal ultrasound appearance of the bladder neck and urethra during stress. Two groups were defined according to the extent of bladder neck descent and posterior rotation during stress: Type I (minimal descent, i.e. < 1.5 cm) and Type II (downward posterior rotational movement). Success rates of 76% are reported and the action of each procedure discussed.
Diagnosis and Treatment of Patients with Renal Trauma
Authors: LEPPÄNIEMI A. K. , HAAPIAINEN R. K. , LEHTONEN T. A.
Published: November 2008

Summary— In this selective study, 59% of the patients had a renal injury (laceration, rupture or pedicle injury). A normal IVU excluded significant renal injury after blunt trauma. Renal angiography was more accurate than ultrasonography or computed tomography in determining the extent of the injury. A retroperitoneal haematoma found during laparotomy should be explored if significant renal trauma cannot be excluded. Renal salvage after rupture or pedicle injury should be attempted in stable patients.
Identification of the Source of Haematuria by Automated Measurement of Red Cell Volume
Authors: BANKS R. A. , REYNOLDS SALLY , HANBURY D.
Published: November 2008

Summary— The mean corpuscular volume (MCV) of urinary erythrocytes was measured by a Coulter Counter in 42 patients with asymptomatic haematuria. All patients had the source of haematuria established by a renal biopsy, cystoscopy or radiology. The mean urine MCV was significantly less in those with glomerular disease (n = 21) than in those with non‐glomerular haematuria (n = 21). In every patient with glomerulonephritis, urinary erythrocytes were smaller than those in their own venous blood. Conversely, urinary red cells larger than venous blood were confined to patients with a non‐glomerular source. Coulter analysis of urine provides a simple and objective aid to the diagnosis of haematuria.
Are Prophylactic Antibiotics Necessary during Extracorporeal Shockwave Lithotripsy?
Authors: PETTERSSON B. , TISELIUS H.‐G.
Published: November 2008

Summary—
A randomised clinical study was carried out on patients admitted for ESWL treatment in order to establish the requirement for prophylactic treatment with antibiotics during this procedure. Patients with clinical signs of urinary tract infection, evidence of infectious stones or a positive urine culture were excluded. All other patients were consecutively randomised into 3 groups which were given either trimethoprim + sulphamethoxazole or mecillinam (Group A), methenamine hippurate (Group B), or no treatment at all (Group C). Evaluation with respect to clinical signs of infection was done immediately after the treatment and 4 weeks later. In addition, a urine culture was performed 2 weeks after ESWL, i.e. 1 week after completing treatment with antibiotics and methenamine hippurate.

With respect to infectious complications there were no differences between Groups A and C, between Groups B and C or between Group A and B + C, whereas an unexplained slightly higher infectious rate was recorded for Group B compared with Group A. In all patients the occurrence of bacteriuria was low (6.7%) despite the fact that almost 30% of patients had a ureteric catheter during the ESWL procedure. Patients with ureteric catheters did not present with more infectious complications than those without. All patients had a bladder catheter during ESWL. It was concluded that prophylactic treatment with antibiotics during ESWL treatment is unnecessary in all situations where an infectious aetiology is unlikely.
Preliminary Nephrostomy and Total Ileal Replacement of both Ureters in Advanced Bilharzial Obstructive Uropathy
Authors: ELEM B.
Published: November 2008

Summary—
Total substitution of both ureters in 5 patients with advanced obstructive uropathy due to extensive ureteric bilharziasis is described. It is recommended that ureteric replacement in the presence of marked obstructive uropathy should not be undertaken without preliminary renal drainage. An open through‐and‐through nephrostomy is recommended for this purpose. It is suggested that this approach will help to minimise the incidence of nephrectomy in areas of endemic urinary bilharziasis.
Contemporary Flow Meters: an Assessment of their Accuracy and Reliability
Authors: CHRISTMAS T. J. , CHAPPLE C. R. , RICKARDS D. , MILROY E. J. G. , TURNER‐WARWICK R. T.
Published: November 2008

Summary—
The accuracy, reliability and cost effectiveness of 5 currently marketed flow meters have been assessed. The mechanics of each meter is briefly described in relation to its accuracy and robustness. The merits and faults of the meters are discussed and the important features of flow measurements that need to be taken into account when making diagnostic interpretations are emphasised.
Adjuvant Laser Treatment of Bladder Cancer: 8 Years' Experience with the Nd‐YAG Laser 1064 nm
Authors: BEER M. , JOCHAM D. , BEER ANNETTE , STAEHLER G.
Published: November 2008

Summary—
Following the development of suitable equipment for the endoscopic application of an Nd‐YAG laser in this department, the laser has been used routinely in the management of bladder cancer since 1978. To evaluate side effects and efficiency, 252 consecutive laser treatments were evaluated with a minimum follow‐up of 12 months. Side effects were few (0.3% perforation) and patients tolerated the treatment very well. The general recurrence rate of T1 tumours varied from 33% for primary carcinomas to 54% for recurrent tumours, but the incidence of local recurrence was only 7%. The long‐term results of laser treatment showed a decrease in the local recurrence rate when compared with the results of conservative electocautery resection, but there was no significant influence on the total recurrence rate.
Cisplatin‐based Chemotherapy does not Eliminate the Risk of a Second Testicular Cancer
Authors: FOSSÅ SOPHIE D. , AASS NINA
Published: November 2008

Summary—
Of 781 patients with germ cell cancer, 14 developed a second (subsequent) testicular cancer during follow‐up. The incidence was not related to the treatment of the first germ cell cancer. In particular, adequate cisplatin‐based chemotherapy did not reduce the risk of developing a second tumour. Screening programmes in patients with previous germ cell tumours should include all patients, irrespective of prior treatment.
Injury to the Prepuce
Authors: YIP A. , NG S. K. , WONG W. C. , LI M. K. , LAM K. H.
Published: November 2008

Summary—
Injury to the prepuce is uncommon. A total of 32 patients were treated within a 3‐year period. A difference in the aetiology between boys and adults was noted. Accidental injury to the prepuce occurred in 6 boys, with zipper injuries being the commonest among children. Coital and self‐inflicted injuries accounted for 85% of adult cases. In patients with coital injuries, predisposing phimosis or a short frenulum was common.
Pharmacocavernometry: a Modified Papaverine Test
Authors: DICKINSON I. K. , PRYOR J. P.
Published: November 2008

Summary—
The papaverine test has become established in the investigation of impotence. Although a full response to papaverine excludes a significant vascular lesion, failure to respond may be due to either arterial deficiency or venous leakage. Pharmacocavernometry, which combines the papaverine test and an artificial erection test, was performed in 126 patients. Intracorporeal pressure was monitored following the intracorporeal injection of 80 mg papaverine; 10 min later, saline was infused to determine the presence of a venous leak. Five different responses were observed. Patients with a Type 1 or 2 response were psychogenic or neurogenic. Patients with a Type 3 response were arteriogenic and patients with a Type 4 or 5 response had significant venous leakage. The modified papaverine test permits more information to be gained concerning the aetiology of the impotence.
Allograft Nephrectomy—a 16‐year Experience
Authors: SHARMA D. K. , PANDEY A. P. , NATHNAN V. , Gopalakrishnan G.
Published: November 2008

Summary—
A review has been made of the indications, technical problems, complications and results of 31 allograft nephrectomies in 29 patients; 12 patients died between 15 days and 1 month after graft nephrectomy, which was undertaken within 6 months of transplantation.

Gross local and general complications occurred in 7 patients who survived graft nephrectomy. The procedure is recommended when graft failure occurs within 6 months of transplatation provided it is associated with systemic signs of severe rejection or sepsis, or if it occurs in cases where continuation of immunosuppressants is life‐threatening.
Relationship between Intermittent Hydronephrosis and Megacalicosis
Authors: O'REILLY P. H.
Published: November 2008

Summary—
Intermittent hydronephrosis is notoriously difficult to diagnose but, once confirmed, requires surgery. In contrast, congenital megacalicosis is accepted as a non‐obstructive cause of upper urinary tract dilatation for which surgery is inappropriate. Experience with 2 cases and a review of the literature suggest that occasionally the clinical features and radiographic findings in the 2 conditions may overlap, leading to misdiagnosis. Attention to the combination of clinical features and radiography, together with the use of radionuclide techniques and acute pain studies, may help to distinguish between these conditions.
Painful Bladder Syndrome—a Clinical and Immunopathological Study
Authors: WITHEROW R. O'N. , GILLESPIE L. , McMULLEN L. , GOLDIN R. D. , WALKER M. M.
Published: November 2008

Summary—
Painful bladder syndrome is a clinical diagnosis in patients with symptoms of varying severity which always include frequency and suprapubic pain and occasionally include dysuria, nocturia and urgency persisting for more than 3 months with no loss of bladder capacity and no overt infection.

Immunofluorescence studies of biopsy specimens in 38 female patients were assessed and correlated with the duration and severity of symptoms, and also with routine histology (including mast cell infiltration and integrity of the glycosaminoglycans layer), in order to assess the role of immunological mechanisms in this distressing condition.

The results indicated that submucosal angiogenesis and persistence of antigen‐antibody complex in vessel walls could be responsible for this syndrome.
Percutaneous Nephrostomy in the Management of Malignant Ureteric Obstruction
Authors: TEENAN R. P. , RAMSAY A. , DEANE R. F.
Published: November 2008

Summary—
A study was made of 16 patients who developed renal failure secondary to ureteric obstruction by tumour. All were managed by percutaneous nephrostomy inserted under local anaesthesia. The results in terms of recovery of renal function, subsequent management and long‐term outcome are described.
Neo‐adjuvant Chemotherapy for Invasive Bladder Cancer. Experience with the M‐VAC Regimen
Authors: SCHER H. , HERR H. , STERNBERG CORA , FAIR W. , BOSL G. , MORSE M. , SOGANI P. , WATSON R. , DERSHAW D. , REUTER V. , CURLEY TRACY , VAUGHAN E. DARRACOTT , WHITMORE W. , YAGODA A.
Published: November 2008

Summary—
A series of 71 patients with muscle invasive bladder cancer received a median of 3 cycles (range 1–6) of methotrexate, vinblastine, Adriamycin and cisplatin (M‐VAC). Efficacy assessed by transurethral resection alone showed that 48% of patients were TO, 13% Tis and 54% had normalisation of initially positive urinary cytology after treatment. However, when considering transurethral resection of the bladder (TURB), cytology and non‐invasive procedures (CT scan and/or ultrasound), only 21% had a clinical complete remission (cCR); 48 patients (68%) had pathological evaluation and 13 (27%) were PO after treatment. Non‐responding patients had a poor prognosis: 14/30 (47%) developed metastatic disease and 13 died. In assessing the primary lesions, clinical understaging was significant. Of 15 patients who were TO cystoscopically prior to surgery, 6 (40%) had residual disease in the pathological specimen, including 4 with muscle infiltration; 23 patients (32%) remained clinically staged, only 8 of whom remain disease‐free. With a median follow‐up of 24 months (range 2–42+), 41 patients are alive and disease‐free, including 20 with a functional bladder. The large staging error raises questions concerning studies using clinical rather than pathological endpoints as the sole criteria of efficacy.
B5 Tumour Marker and Urine Cytology in Diagnosis and Follow‐up of Transitional Cell Bladder Cancer
Authors: MALPANI K. , METCALFE S. M. , HINCHLIFFE A.
Published: November 2008

Summary—
The correlation between a new tumour marker, B5, and tumour behaviour in bladder cancer was recorded and an assessment made of the value of combining the B5 test with urine cytology for predicting the presence of tumour. The study group included 57 new patients, of whom 32 were B5 positive at diagnosis and were well marked by B5 on follow‐up. There were no false positive shifts in new patients who became free of observable tumour, whilst 1 of 13 patients with persistent disease showed a false negative shift. When the findings from 199 cystoscopies were compared with the results of B5 and urine cytology, B5 was found to improve the prediction of recurrent tumour over cytology alone. Moreover, a high incidence of occult malignancy (7/19) was found in patients where cystoscopy had failed to show recurrence but whose combined marker results were both positive.
Tuberculous Epididymo‐orchitis: Clinical and Ultrasound Observations
Authors: HEATON N. D. , HOGAN B. , MICHELL M. , THOMPSON P. , YATES‐BELL A. J.
Published: November 2008

Summary—
The clinical, radiological and ultrasound features of 3 patients presenting with tuberculous epididymo‐orchitis are described and the relevant literature reviewed. Scrotal swelling, pain and sinuses are common features at presentation. The presence of a sterile pyuria is a useful sign, but intravenous urography may fail to identify active renal disease. Ultrasound examination revealed testicular involvement in 2 patients. Differentiation from tumour may not be possible, but the presence of epididymal involvement strongly suggests an infective cause. Early surgical biopsy may prove helpful if acid‐fast bacilli are not initially identified in early morning urine samples.
Xanthogranulomatous Pyelonephritis
Authors: PETRONIC V. , BUTUROVIC J. , ISVANESKI M.
Published: November 2008

Summary—
Xanthogranulomatous pyelonephritis is a rare chronic form of pyelonephritis with a clinical presentation often suggestive of a renal mass. We present 51 patients with histologically proven xanthogranulomatous pyelonephritis who were treated by nephrectomy. The results are discussed and compared with those from the literature.
Estimations of the S Phase Fraction in situ in Transitional Cell Carcinoma of the Renal Pelvis and Ureter with Bromodeoxyuridine Labelling
Authors: NEMOTO R. , HATTORI K. , SASAKI A. , MIYANAGA N. , KOISO K. , HARADA M.
Published: November 2008

Summary—
This report concerns the estimation of the S phase fraction (SPF) in situ and its value in predicting the malignant potential of transitional cell carcinoma of the renal pelvis and ureter. Eighteen patients with transitional cell carcinoma of the renal pelvis and ureter were given a 0.5 h intravenous infusion of the thymidine analogue bromodeoxyuridine (BrdU) (500 mg) at the time of surgery to label tumour cells in the DNA synthesis phase. The tumour specimens were stained by an indirect immunoperoxidase method using anti‐BrdU monoclonal antibody as the first antibody. The BrdU labelling index, S phase fraction, was determined by counting the number of bromodeoxyuridine labelled cells in the tissue sections.

All grade 1 tumours had an S phase fraction lower than 10%. The average S phase fraction for non‐invasive tumour (12 cases) and invasive tumour (6 cases) were 9.7 and 20.9%, respectively. Two patients with rapid spread of ureteric tumour showed an S phase fraction of 18.4 and 22.3%. The results obtained with the S phase fraction were comparable with histological tumour grade and invasive potential. The higher S phase fraction may indicate greater biological malignancy.

We believe that determination of the S phase fraction of transitional cell carcinoma of the renal pelvis and ureter offers a new objective and quantitative assay of the biological potential of individual tumours and might have practical value in their management.
Bladder Irrigation or Irritation?
Authors: ELLIOTT T. S. J. , REID L. , RAO G. GOPAL , RIGBY R. C. , WOODHOUSE K.
Published: November 2008

Summary—
Exfoliation rates of urothelial cells following bladder irrigation were studied in patients with long‐term indwelling catheters and chronic urinary tract infections (UTI). The irrigations were associated with an increased shedding of urothelial cells. Ultrastructural studies of these cells demonstrated increased disruption when compared with those obtained from normal subjects without catheters or chronic infection. The findings suggest that bladder irrigation further damages the already disrupted urothelium, which may in turn increase the predisposition of the bladder to the recurrent infections, commonly associated with patients who have indwelling urinary catheters. Bladder irrigation methods and the indications for their use require reassessment.
Bladder Tumours in Enugu, Nigeria
Authors: AGHAJI A. E. , MBONU O. O.
Published: November 2008

Summary—
The clinicopathological features of 103 tumours of the urinary bladder are reported; 56.3% were transitional cell and 38.8% were squamous cell carcinoma. The results support a strong association between schistosomiasis and bladder cancer.
Endoscopic Treatment of Vesicoureteric Reflux in Transplanted Kidneys
Authors: CLOIX P. , GELET A. , DESMETTRE O. , COCHAT P. , GARNIER J. L. , DUBERNARD J. M. , MARTIN X.
Published: November 2008

Summary— Twenty‐one patients underwent endoscopic subureteric injection of Polytef paste for the correction of secondary vesicoureteric reflux (VUR) in transplanted kidneys. Ureteroneocystotomy was performed in renal transplants using an extravesical technique in 19 patients and the Leadbetter‐Politano technique in 2 cases. Success was achieved in only 6 patients, including the 2 ureters reimplanted according to the Leadbetter‐Politano technique. No significant complication relating to the technique was observed. Despite the low success rate (30%), endoscopic treatment of VUR in transplanted kidneys is justified as a first attempt in view of the morbidity of VUR and the difficulties of repeated surgical reimplantation in this population.
Endoscopic Transurostomy Diathermy Anastomotomy. A Combined Approach to Uretero‐ileal Stenoses
Authors: MURRAY K. H. A. , WILKINSON M. L.
Published: November 2008

Summary— Uretero‐ileal stenosis is a recognised complication of ileal conduit urinary diversion. Two patients are described in whom a combination of fibreoptic conduitoscopy with standard endoscopic “biliary” sphincterotomy was used to treat anastomotic strictures. The technique of endoscopic transurostomy diathermy anastomotomy allowed the salvage of 3 renal units without the need for laparotomy or long‐term indwelling ureteric stents.
Frequency‐Volume Charts: Comparison of Frequency between Elderly and Adult Patients
Authors: SAITO M. , KONDO A. , KATO T. , YAMADA Y.
Published: November 2008

Summary— Urinary frequency is a common complaint in the elderly and can be due to many different causes. To clarify the aetiology of frequency, patient‐maintained frequency‐volume charts were evaluated as a diagnostic tool. We studied 215 patients who complained of frequency. They were divided into 2 groups based on age: 85 were over 65 years of age (elderly group) and 130 were less than 64 years old (adult group). Compared with the adults, elderly patients had a smaller urinary volume during waking hours and a larger volume during sleeping hours, with more frequent episodes of voiding and a smaller volume voided during the latter period. Analysis of the cause of frequency led to the patients being subdivided into 6 diagnostic categories. Among elderly patients, nocturnal polyuria (37%) and an unstable bladder (34%) were frequent causes. In adult patients an unstable bladder (28%) and polyuria due to excessive fluid intake (23%) were most common. As a result of our findings, 108 patients were advised not to be concerned about their micturition and/or restriction of fluid intake. Seventy‐six patients (35%) required anticholinergic medication. Frequency‐volume charts, together with a detailed medical history, provide useful information on the diagnosis and treatment of frequency.
Hyperthermic Intravesical Peplomycin Perfusion Treatment for Bladder Cancer
Authors: UCHIBAYASHI T. , NAKAJIMA K. , HISAZUMI H. , NISHINO A. , MIYOSHI N.
Published: November 2008

Summary— Thirty‐three patients with malignant bladder tumours were treated by hyperthermic intravesical perfusion. The study group included 25 patients with superficial T1 bladder tumours, 4 with T2 tumours and 4 with T3 tumours. Physiological saline solution containing 40 µg/ml peplomycin with/without 2% ethanol was used as a perfusate. Perfusion was carried out for 2 h 3 times per week and this regimen was repeated every other week, totalling 6 sessions in 3 weeks. Three patients achieved a complete response (CR), 5 a partial response (PR) (more than 50% tumour reduction), 8 a minimal response (MR) (25–50% tumour reduction) and the remaining 17 patients showed no response (NC). Complete, partial and minimal responses were obtained only in patients with T1 tumours. The NC patients included 4 with T2 and 4 with T3 lesions. Profuse haematuria from invasive tumour was markedly reduced after treatment. A major side effect was irritation of the bladder and urethra. Our results indicate that hyperthermic perfusion with ethanol and peplomycin is clinically safe, is accompanied by very little pain and may be useful for the management of superficial bladder tumours in elderly patients.
Wolfram's (DIDMOAD) Syndrome and its Urological Manifestation
Authors: ABOSEIF S. , GASPARINI M. , SCHMIDT R. , TANAGHO E.
Published: November 2008

Summary— We report 2 patients with DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and neural deafness), with emphasis on the urological aspects and their management. Both patients underwent thorough radiological endoscopic and urodynamic evaluation, in addition to detailed evaluation of other systems involved. Each had the characteristic hyper‐reflexive neurogenic bladder with sphincteric dyssynergia, which resulted in severe urinary tract dilation. One patient was diagnosed at this institution and managed conservatively with clean intermittent catheterisation and anticholinergic medication; the second patient was referred to us after several attempts at surgical correction. The presentation, details of the urological evaluation with special emphasis on the urodynamic findings, and the outcome of different means of management are discussed.
Morphological change in the urothelium after electrohydraulic versus pulsed dye laser lithotripsy
Authors: WU T.T. , HSU T.H. , LI A.F. , CHEN M.T. , CHANG L.S.
Published: November 2008

Objective To observe morphological changes in the urothelium after exposure to laser beam and electrohydraulic spark.

Materials and methods The pulse dye laser lithotripter (MDL‐2, Candela Corporation, Boston, USA) and the electrohydraulic lithotripter (AEH‐2, Circon ACMI Corporation Stamford, USA) were used directly on the bladder mucosa in six pigs. Immediately (after treatment, the bladder mucosa was prepared for light microscopic and scanning electron microscopic examination.

Results Both electrohydraulic spark and laser beam caused mucosal denudation, submucosal swelling and haemorrhage. There was a positive correlation between the degree of urothelial damage and the power and pulse numbers applied.

Conclusion Direct contact of the urothelium in patients treated with laser beam or electrohydraulic spark should be avoided.
Treatment of ureteric stones. Comparison of laser and pneumatic lithotripsy
Authors: NAQVI S.A.A. , KHALIQ M. , ZAFAR M.N. , RIZVI S.A.H.
Published: November 2008

Objectives To study the treatment of ureteric stones by laser lithotripsy (LL) and pneumatic lithotripsy (PL), and to evaluate the results of the two treatment modalities to assess effectiveness, complications and cost benefits.

Patients and methods Between January 1993 and February 1994 200 ureteric stones in 194 patients were fragmented intracorporeally, 48 by LL and 152 by PL. The ages of the patients ranged from 31 to 40 years with a male to female ration 2:1. All procedures were performed under general/regional anaesthetic in a day‐care set‐up. Patients were followed at weekly intervals. Re‐treatment was carried out at 4 weeks where necessary.

Results The majority of the stones treated (84%) were in the lower third of the ureter, 69% measured 7–12 mm in diameter, and 61% were composed of calcium oxalate. Ninety‐three per cent of the stones were fragmented in one treatment session. The overall stone‐free status at 4 weeks was 95% for PL and 84% for LL. The non‐fragmentation rate was 10% for LL and 1% for PL. Post‐treatment complications were encountered in 8% of the patients treated by LL and 7% by PL.

Conclusions Our experience shows that PL and LL both provide a safe and effective means of performing intracorporeal lithotripsy for smaller ureteric stones. However, PL is more effective in fragmenting larger and harder stones. Moreover, PL is more user‐friendly and highly cost‐effective compared with LL.
Correction of vesico‐ureteric reflux by subureteric fibrin injection in dogs
Authors: TANELI C. , ÖZCAN C. , ÖZDEMIR N. , GÖKDEMIR A.
Published: November 2008

Objective To study the histological and radiological potential of the biomaterial fibrin in the treatment of vesico‐ureteric reflux by a subureteric injection.

Materials and methods For histological studies the bladders of 22 non‐refluxing adult female dogs were exposed and in 20 of these two‐component fibrin glue was injected into the right subureteric intramuscular portion of the bladder and teflon was injected into the lamina propria of the left ureter; two of them acted as controls. Two dogs were killed on alternate days over the course of 21 post‐operative days and the bladders and distal portions of the ureters were examined histologically. For radiological studies micturating cystograms were obtained from 15 female puppies. In only eight puppies was vesico‐ureteric reflux naturally present. In six of these two‐component fibrin was injected into the right and teflon into the left subureteric areas, and in two puppies fibrin was injected into the subureteric areas, while the left sides acted as controls. Micturating cystograms and intravenous urograms were obtained from all puppies 3 weeks post‐operatively.

Results Histopathological studies showed persistence of increased amounts of endogenous collagen at the fibrin‐injected sites; at the Teflon‐injected sites a mass surrounded by dense granulation tissue was seen. Radiological studies revealed complete disappearance of reflux in the study group of six fibrin and Teflon‐injected puppies: in two control puppies fibrin was injected into the right subureteric area only; the left sides were left untouched to show that maturation did not play a role in abolishing the spontaneously occuring reflux. Follow‐up intravenous urography showed no evidence of vesico‐ureteric obstruction in the treated ureters.

Conclusion Fibrin has the properties of a substance inducing a controlled increase in the number of endogenous collagen fibres.