bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproduction of functional smooth muscle tissue and partial bladder replacement
Authors: PROBST M. , DAHIYA R. , CARRIER S. , TANAGHO E.A.
Published: November 2003

Objective

 To find a means of bladder augmentation that would avoid the complications encountered with the use of bowel segments, using a newly developed acellular biomaterial, the bladder acellular matrix graft (BAMG), as a homologous graft.

Materials and methods

 Thirty‐four rats underwent a partial cystectomy (40–50%) and grafting with a BAMG of equal size. Eleven rats died within the first 72 h, probably from urinary leakage caused by obstruction of the bladder neck with stones or coagula; the surviving 23 were killed at varying intervals after cystectomy and examined.

Results

 After providing initial bladder enlargement, the graft was progressively infiltrated by the vessels and smooth muscle cells of the host; furthermore, the mucosal lining was complete within 10 days. After 4 weeks, all bladder wall components were evident histologically in the graft. The ingrowth was complete after 8 weeks, except for neural regeneration, which was only partial. At 12 weeks, the bladder wall muscle structure in the graft was so well developed that it was difficult to delineate the junction between host bladder and BAMG. Neural regeneration continued to improve. Normal bladder capacities were maintained throughout the study.

Conclusion

 The BAMG appears to serve, without rejection, as a framework of collagen and elastin for the ingrowth of all bladder wall components. The reason for the better acceptance of the BAMG than of other bladder augmentation grafts requires further investigation.
Multiple frequent recurrences in superficial transitional cell carcinoma of the bladder: is survival compromised by a conservative management strategy?
Authors: HROUDA D. , OGDEN C. , MORRIS S.B. , WANENDEYA N. , FISHER C. , WOODHOUSE C.R.J.
Published: November 2003

Objective

 To examine whether a strategy of bladder conservation is reasonable in patients with multiple frequent superficial recurrences of transitional cell carcinoma (TCC) of the bladder.

Patients and methods

 Fifty‐four patients with pTa/pT1, G1/G2 tumours at diagnosis, with five or more recurrences at two or more cystoscopies within 2 years of diagnosis and a minimum follow‐up of 4 years were identified. The patients were categorized according to outcome, i.e. disease settled, continuing high‐activity disease and disease progression.

Results

 Forty‐four patients did not progress, of whom 16 continued to have high‐activity disease and 28 settled to a lower disease activity. One patient had a cystectomy for superficial disease. Nine patients progressed, six with muscle invasion in the bladder and three elsewhere in the urinary tract. Neither grade nor stage were predictive of recurrence. All but one of the patients with progression had both multicentric tumours at diagnosis and a positive cystoscopy at 3 months. Three patients died from their bladder cancer.

Conclusion

 A policy of endoscopic resections and intra vesical chemotherapy or bacille‐Calmette‐Guèrin, with cystectomy reserved until muscle‐invasive disease develops, does not significantly compromise survival in patients with high‐activity superficial TCC. Cystectomy for superficial disease is rarely necessary.
Which patients with prostatic carcinoma require a staging bone scan
Authors: KEMP P.M. , MAGUIRE G.A. , BIRD N.J.
Published: November 2003

Objective

 To determine whether the level of prostate‐specific antigen (PSA) can be used to decide which patients with newly diagnosed prostatic carcinoma require a staging bone scan.

Patients and methods

Of patients referred during an 18‐month period for a staging bone scan, 98 (median age 72 years, range 52–89) had had their serum PSA level determined within 4 weeks of the bone scan and were assessed retrospectively for the presence of bony metastases.

Results

Of the 98 patients, 26 who had bone scans showing bony metastases had a PSA level >40 ng/mL. Reviewing the other published studies showed that in those newly diagnosed patients with a PSA level of <20 ng/mL, the probability of having bony metastases detected on a bone scan was <1%.

Conclusions

A staging bone scan can be omitted in the vast majority of patients with newly diagnosed prostatic carcinoma and a PSA level <20 ng/mL.
The female tetraplegic: an admission of urological failure
Authors: SINGH G. , THOMAS D.G.
Published: November 2003

Objective

 To present the long‐term follow‐up of female patients with tetraplegia managed in our unit, many of who require permanent indwelling catheters or urinary diversions that lead to significant complications and associated morbidity.

Patients and methods

 Eighty‐four female tetraplegics (mean age 31 years, range 13–81) were followed for a mean of 9 years (range 2–30). Three groups of patients were identified, depending on their neurology; 27 patients had complete lesions (Frankel A), 20 had incomplete lesions with poor functional recovery (Frankel B/C) and 37 had incomplete lesions with good function (Frankel D/E).

Results

 The patients with complete lesions (Frankel A) were difficult to manage, with 23 of the 27 (85%) treated using indwelling catheters. Three patients underwent diversion and for one patient, the carer performs clean intermittent catheterization (CIC). Of the 20 patients with Frankel B/C lesions, 14 have permanent indwelling catheters, three are able to perform CIC and three void by controlled triggering of detrusor contractions (reflex voiding). The 37 patients with Frankel D/E lesions fared better and only three (8%) require permanent catheters. Of the others, four (11%) use CIC (one following a cystoplasty) and most (30, 81%) use reflex voiding. Most of the 40 patients with permanent catheters had significant problems with bladder stones (55%), leakage and by‐passing (35%), and recurrent symptomatic infections (33%). Patients performing CIC fared better, with most needing anticholinergic therapy or subtrigonal phenol; patients who used reflex voiding also needed these two treatments at some stage. Four patients (two with ileal loops and two with indwelling catheters) developed dilated upper tracts.

Conclusions

 The urological status of female patients following cervical cord injury depends on the level of injury and recovery. Most patients with Frankel A‐C lesions have permanent indwelling catheters and most patients with Frankel D or E lesions void with controlled triggering or use CIC. Although upper tract dilation was seen in only 5%, patients had significant morbidity related to the bladder.
Effect of sucralfate on induced chemical cystitis in rabbits
Authors: HENNINGSOHN L. , INGELMAN‐SUNDBERG H. , KINN A‐C. , TRYGG G.
Published: November 2003

Objective

 To study the histological effect of locally applied sucralfate on the urinary bladder in rabbits with chemically induced cystitis.

Materials and methods

 Sucralfate (1 g dissolved in 10 mL saline) was instilled into the bladders of six rabbits, while four controls had no instillation. The procedure was repeated 4 days later and followed immediately by 10 mL of 2% formaldehyde infused into the bladder and retained for 10 min in all 10 rabbits. After careful flushing with saline, 10 mL sucralfate solution was again instilled in the study group and 10 mL of saline only in the control group. On day 6, the sucralfate instillation was repeated in the six treated animals. All the rabbits were then killed on day 8–9, their bladders removed and examined macroscopically and histologically.

Results

 Formaldehyde instillation was quickly followed by gross haematuria in all animals. It subsided in the group treated with sucralfate, but not in the controls. Examination revealed only slight changes in the former group, but severe inflammatory lesions in the latter.

Conclusions

 Intravesically instilled sucralfate protected rabbit bladder urothelium against chemically induced cystitis. Clinical trials of intravesical sucralfate seem warranted in patients irradiated for pelvic cancer or with severe cystitis caused by cytotoxic drugs.
Buccal mucosal graft for secondary hypospadias repair and urethral replacement
Authors: AHMED S. , GOUGH D.C.S.
Published: November 2003

Objective

 To assess the effectiveness of buccal mucosa in the treatment of complex hypospadias

Patients and methods

Seventeen patients had an onlay patch of buccal mucosa to reconstruct the urethra after failed previous surgery; five had a tubed buccal mucosal graft as an urethral replacement in the ‘primary’ repair of severe hypospadias.

Results

There were no complications in 19 patients; two developed fistulae and one a stricture due to graft narrowing. There were no meatal complications.

Conclusion

Buccal mucosa taken from the inner aspect of the lip is very suitable for reconstructing a failed hypospadias repair, especially when used as an onlay graft.
Analysis of glycosaminoglycans in human prostate by high‐performance liquid chromatography
Authors: IIDA S. , SUZUKI K. , MATSUOKA K. , TAKAZONO I. , SHIMADA A. , INOUE M. , YAHARA J. , NODA S.
Published: November 2003

Objective

 To investigate changes in glycosaminoglycan (GAG) profiles in human prostatic tissue.

Materials and methods

 Seventeen human prostatic samples were examined; five were normal, six hyperplastic and six were cancerous. Prostatic proteoglycans were extracted with 4 mol/L guanidine‐HCl containing protease inhibitors. After digestion of the freeze‐dried proteoglycan extract with papain, the prostatic GAGs were purified. Total GAGs were measured by a modified dimethylmethylene blue (DMB) method. High‐performance liquid chromatography (HPLC) was used to quantify the extracted GAGs.

Results

 Six types of GAGs, i.e. chondroitin 4‐sulphate (Ch‐4S), chondroitin 6‐sulphate (Ch‐6S), dermatan sulphate (DS), chondroitin, heparan sulphate and hyaluronic acid, were analysed qualitatively and quantitatively. The total amount of GAGs was increased in hyperplastic and cancerous prostates, with the predominant components being DS and Ch‐6S in these specimens. The Ch‐S:DS ratio in cancerous prostate was significantly higher than that in normal and BPH tissue (P<0.05). Moreover, chondroitin was increased in hyperplastic prostatic tissue (P<0.01).

Conclusions

 These results suggest that an increase in chondroitin levels may be associated with hyperplastic change and an increase in the Ch‐S:DS ratio may be related to the development of malignancy.
Correlation of the endoscopic and radiological anatomy of congenital obstruction of the posterior urethra and the external sphincter
Authors: DEWAN P.A. , PILLAY S. , KAYE K.
Published: November 2003

Objective

 To determine whether the external sphincter is distal to congenital occlusion of the posterior urethra in boys by correlating endoscopic video‐recorded information with cysto‐urethrographic observations and assessing the anatomy of the disease.

Patients and methods

 This study reviewed the endoscopic and radiographic findings in 42 boys (mean age 42 months, range newborn to 14 years), using material from a videotape library, and correlated these with the pre‐operative cystogram. The nature of the obstructive lesion and its relationship to the verumontanum and the external sphincter was assessed.

Results

 Of the 42 boys, 36 had the proximal extent of the external sphincter identified on the endoscopic video recording to be above the posterior urethral membrane; 22 of the membranes were obstructive. The proximal extent of the external sphincter was identified on the static cystogram images of only 31 of the 38 boys examined, but only ever above the posterior urethral membrane.

Conclusion

 The proximal extent of the external sphincter, i.e. that portion which is most prominent endoscopically, is proximal to the membrane in congenital obstruction of the posterior urethra.
Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate
Authors: ISELIN C.E. , SCHMIDLIN F. , BORST F. , ROHNER S. , GRABER P.
Published: November 2003

Objective

 To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH).

Patients and methods

 Fifty‐three patients (median age 67 years, interquartile range 62–72) were included prospectively in a double‐blind placebo‐controlled study. Pre‐operatively, uroflowmetry and cystometrography (CMG) were performed, and the post‐void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post‐operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day, CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed.

Results

 In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre‐operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively.

Conclusion

 Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.
When is bone scintigraphy necessary in the assessment of newly diagnosed, untreated prostate cancer?
Authors: HAUKAAS S. , ROERVIK J. , HALVORSEN O.J. , FOELLING M.
Published: November 2003

Objective

 To evaluate the utility of bone scintigraphy in the assessment of newly diagnosed, untreated prostate cancer.

Patients and methods

 The probability of a positive bone scan for metastases was analysed for different threshold values of pre‐treatment concentrations of prostate specific antigen (PSA), clinical stage, tumour grade based on biopsy, and age in 128 men (mean age 69 years, range 50–90) with newly diagnosed, untreated prostate cancer. The overall survival probabilities estimated from PSA level, extent of bone metastases, tumour grade, clinical stage, and age were calculated using the product‐limit method.

Results

 The positive predictive values of PSA level for bone metastases at thresholds of 10 and 20 ng/mL were poor (27.5 and 47.5%, respectively) whereas similar threshold levels of PSA gave negative predictive values of 100 and 94%, respectively, for a positive bone scan. In a univariate analysis, the overall survival was significantly affected by the extent of bone scan pathology (P<0.001), the pre‐treatment level of PSA (P<0.001) and tumour grade (P=0.01), whereas a multivariate analysis identified, in order of significance, tumour grade (P=0.003), bone scan findings (P=0.007) and PSA levels (P=0.03) as independent prognostic factors.

Conclusions

 Bone scintigraphy seems to be unnecessary in the evaluation of newly diagnosed, untreated prostate cancer in patients with no clinical signs of bone pathology and serum PSA levels of ≤10 ng/mL. However, the bone scan accurately assesses bone metastases and the prognostic significance of bone scan findings is superior to that of serum PSA level.
Single‐dose versus multiple instillations of epirubicin as prophylaxis for recurrence after transurethral resection of pTa and pT1 transitional‐cell bladder tumours: a prospective, randomized controlled study
Authors: ALI‐EL‐DEIN B. , NABEEH A. , EL‐BAZ M. , SHAMAA S. , ASHAMALLAH A.
Published: November 2003

Objective

 To compare single‐dose and multiple instillations of epirubicin in the chemoprophylaxis of superficial bladder tumours.

Patients and methods

 In a prospective randomized and controlled study, 168 evaluable patients were assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline 1–2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to complete one year of treatment; group 3 (control group) received no adjuvant therapy after TURBT. The patients were assessed by cysto‐urethroscopy, urine cytology and DNA flow cytometry 8 weeks after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the next 2 years. Intravenous urography was performed annually and when otherwise indicated.

Results

 The recurrence rate was significantly lower in the patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P<0.001). In those receiving epirubicin, the rates of recurrence were statistically comparable (P=0.9). Patients who had a large tumour burden showed slightly lower recurrence rates with single‐dose epirubicin than with delayed maintenance therapy but the difference was statistically insignificant. Patients with a history of bladder tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose (34.6 and 22.6% in groups 1 and 2, respectively); again this difference was statistically insignificant. Patients with grade 3 tumours showed a marginal difference in favour of maintenance therapy. The rates of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant differences. The overall toxicity rates were comparable in the two treated groups (22 and 25%).

Conclusion

 With the possible exception of grade 3 tumours, single‐dose immediate epirubicin is as effective as delayed maintenance therapy, with the advantage of being more cost‐effective.
Morbidity of ultrasound‐guided transrectal core biopsy of the prostate without prophylactic antibiotic therapy. A prospective study in 415 cases
Authors: ENLUND A.‐L. , VARENHORST E.
Published: November 2003

Objective

 To evaluate prospectively the incidence of complications following transrectal core biopsy of the prostate without prophylactic antibiotic therapy.

Patients and methods

 The study comprised 426 consecutive patients who underwent transrectal core biopsies of the prostate guided by transrectal ultrasonography (TRUS). The patients were requested to return a completed questionnaire 2 weeks after the examination; 415 patients (97.4%) did so.

Results

 The predominant complications were haematuria (49.6%) and rectal bleeding (21.7%), which did not require treatment. Twelve patients (2.9%) developed fever and 11 of these were treated successfully with antibiotics. One recovered without treatment. One patient had urinary retention.

Conclusion

 In this study, most complications following TRUS‐guided biopsies were minor and required no treatment. Automated needle biopsy is an acceptable option for biopsy of the prostate and does not provoke the need for prophylactic antibiotic therapy. However, it is mandatory to counsel patients before biopsy and to monitor the infection rate. The ultimate need for antibiotic prophylaxis remains to be determined.
Effects of castration on adrenergic, cholinergic and nonadrenergic, noncholinergic responses of isolated corpus cavernosum from rabbit
Authors: YILDIRIM M.K. , YILDIRIM S. , UTKAN T. , SARIOGLU Y. , YALMAN Y.
Published: November 2003

Objective

 To investigate the effects of castration and testosterone on the constricting effect of phenylephrine and endothelium‐dependent and ‐independent relaxing effects of different agonists in the corpus cavernosum of male rabbits.

Materials and methods

 Twenty rabbits were castrated and 10 received testosterone replacement for 1 month after castration; 10 further rabbits underwent a sham operation and acted as controls. One month after operation the rabbits were killed and their penises excised. Strips of corpus cavernosum were used for isometric tension measurements in organ chambers; concentration‐response relationships for phenylephrine, carbachol, adenosine and sodium nitroprusside were obtained by adding the reagent cumulatively to the bath.

Results

 The phenylephrine‐induced contractions were markedly lower, with no change in the pD2 values (i.e. the negative logarithm of the concentration for half‐maximal response), in cavernosal strips obtained from castrated rabbits than in those from controls. Endothelium‐dependent relaxation elicited by carbachol increased in the castrated group but the relaxation induced by sodium nitroprusside did not change and those elicited by adenosine were strongly depressed when compared with controls. There were no significant changes in the pD2 values of agonist‐induced relaxation responses in all groups. The relaxation elicited by electrical‐field stimulation at lower frequencies increased in strips from castrated rabbits but at higher frequencies were unchanged when compared with controls. Castration‐induced changes in the relaxation response of cavernosal strips were significantly restored by in vivo testosterone replacement but those induced by phenylephrine were not.

Conclusion

 The lack of testosterone has an effect on the reactivity of the corpus cavernosum, indicating that testosterone has an important role in erectile function by a pre‐ or post‐synaptic action on the corpus cavernosum.
Pelvic floor exercises as a treatment for post‐micturition dribble
Authors: PATERSON J. , PINNOCK C.B. , MARSHALL V.R.
Published: November 2003

Objective

 To determine the effectiveness of pelvic floor exercises and urethral milking as treatments for post‐micturition dribble.

Patients and methods

 A method of measuring small amounts of urine loss during normal activity was developed; pads were worn for short periods (<4 h) and then stored in two sealed plastic bags which were weighed within 72 h. Forty‐nine men (age range 36–83 years) drawn from a hospital out‐patient population, who had not undergone surgery on the bladder, urethra or prostate gland, entered the study. They were randomly assigned to one of three treatment groups; pelvic muscle exercise, urethral milking or counselling. Participants in each group followed the treatment specific to their group for 12 weeks. At 5, 9 and 13 weeks, urine loss was assessed using the method described.

Results

 The groups were comparable for age, height, weight and pelvic muscle contraction strength and compliance of the men who completed the study was excellent. The outcome measure (improvement in pad weight gain) was strongly influenced by initial pad weight gain, or degree of urine loss at the start of the study and this was treated as a covariate in an analysis of variance model. After allowing for the effects of initial pad weight gain, the counselling group showed no improvement, the urethral milking group showed an adjusted mean improvement in urine loss of 2.9 g after 13 weeks, compared with 4.7 g in the exercise group.

Conclusion

 Both pelvic floor exercises and urethral milking are effective treatments for post‐micturition dribble compared with counselling alone. Pelvic floor exercises were more effective in reducing urine loss than urethral milking in this study.
A comparison of methods of repairing the symphysis pubis in bladder exstrophy by tensile testing
Authors: SUSSMAN J.S. , SPONSELLER P.D. , GEARHART J.P. , VALDEVIT A.D.C. , KIER‐YORK J. , CHAO E.Y.S.
Published: November 2003

Objective

 To compare the efficacy of several fixation techniques in the reconstruction of diastasis of the symphysis pubis in bladder exstrophy.

Materials and methods

 The symphyses of 32 pelves removed from piglets about 1 month old were disrupted and repaired using one of eight methods. After repair, each pelvis was tested biomechanically for load‐to‐failure, stiffness and energy‐to‐failure. The various repair techniques were compared with one another and to a group of six pelves tested intact.

Results

 Four of the methods tested, including a #2 nylon suture placed through bone in a horizontal mattress arrangement, several loops of #2 nylon suture tied around the pubes, Mersilene tape tied around the pubes, and Mitek G‐II suture anchors placed into the superior pubic rami, showed the highest stiffness and load‐to‐failure. All methods were very weak compared with the intact symphysis; the best load‐to‐failure (#2 nylon horizontal mattress suture) was less than half of that for intact bone, and the best stiffness (mersilene tape) was less than one‐third that for the intact symphysis.

Conclusion

 The repairs varied greatly in the variables tested and those which are most promising merit further investigation to assess methods of improving their performance.
The role of free prostate‐specific antigen in the diagnosis of prostate cancer
Authors: AKDAS A. , CEVIK I. , TARCAN T. , TURKERI L. , DALAMAN G. , EMERK K.
Published: November 2003

Objective

 To determine whether the free/total prostate‐specific antigen (PSA) ratio can discriminate between patients with prostate cancer or benign prostatic hyperplasia (BPH).

Patients and methods

 A prospective study was conducted using free and total PSA assays in patients who underwent transrectal‐ultrasound guided biopsies indicated by a total serum PSA level of >4 ng/mL and/or a positive digital rectal examination. Sixty‐nine men (median age 68 years, range 57–86) who presented to our out‐patient department with symptoms of prostatism were included in the study. Blood samples were drawn from all patients before biopsy.

Results

 Histopathological examination detected prostate cancer in 17 of 69 (25%) patients and 13 of these 17 patients had a free/total PSA ratio of <0.15; only 12 of 52 (23%) patients with BPH had a ratio of <0.15. Receiver operating characteristic analysis indicated a threshold free/total PSA ratio of ≤0.15 was the optimum discriminatory level. In the whole study group, this threshold had sensitivity, specificity, positive‐ and negative‐predictive values of 76%, 77%, 52% and 91%, respectively. There were 40 patients with serum PSA levels of 4–10 ng/mL and 17.5% (7/40) of these were diagnosed with cancer. Using a free/total PSA ratio of 0.15 would have failed to diagnose two patients of seven with prostate cancer but 30 patients would have avoided a biopsy. In this subgroup, the threshold ratio of 0.15 had sensitivity, specificity, positive‐ and negative‐predictive values of 71%, 85%, 50% and 93%, respectively. The rates for a PSA density (PSAD) at a threshold of ≥0.15 were 71%, 76%, 38%, 93%, respectively.

Conclusion

 These results indicate that using the free/total PSA ratio gives a significant improvement over PSAD and total PSA values alone in the diagnosis of prostate cancer; its use may also enhance the diagnostic accuracy in patients with intermediate PSA levels.
Which indwelling urethral catheters resist encrustation by Proteus mirabilis biofilms?
Authors: MORRIS N.S. , STICKLER D.J. , WINTERS C.
Published: November 2003

Objective

 To test the resistance of currently available types of indwelling urethral catheters to blockage by encrustation with mineralized Proteus mirabilis biofilms.

Materials and methods

 Encrustation was studied in a simple laboratory model of the catheterized bladder. Artificial urine was supplied to the bladder chamber at 0.5 mL/min. The bladder urine was inoculated with a clinical strain of P. mirabilis that had been isolated from an encrusted catheter. The models were operated until the catheters blocked and atomic absorption spectrometry was used to assess the amounts of calcium and magnesium deposited on the catheters. Scanning electron microscopy was also used to locate and assess the degree of encrustation.

Results

 The mean times to blockage ranged from 21 h for the Bard hydrogel/silver‐coated latex catheter to 56 h for the Eschmann Folatex S all‐silicone catheter. The calcium and magnesium salts were mainly deposited on the 10 cm below the eye‐holes of the catheters, complete blockage generally occurring in the 2 cm immediately below the eye‐hole.

Conclusion

 None of the 18 types of catheter tested, including those coated with hydrogel or silver, were capable of resisting encrustation by P. mirabilis biofilm.
High‐energy transurethral microwave thermotherapy for large severely obstructing prostates and the use of biodegradable stents to avoid catheterization after treatment
Authors: DAHLSTRAND C. , GRUNDTMAN S. , PETTERSSON S.
Published: November 2003

Objective

 To assess the use of high‐energy transurethral microwave thermotherapy (TUMT) for large severely obstructing benign prostatic hyperplasia (BPH) and to compare the use of a biodegradable stent with that of a urethral Foley catheter after TUMT.

Patients and methods

 The study comprised 30 men (mean age 71 years, range 49–82) scheduled for prostatectomy for symptomatic BPH. Pre‐operative investigations included the measurement of urinary free flow rate, residual urine volume (ultrasonographically), a digital rectal examination, transrectal ultrasonography, a symptom score, cystoscopy, cystometry and pressure‐flow. The obstruction was graded according to the Schäfer nomogram. The patients were treated using the Prostatron (EDAP‐Technomed, France) TUMT system; the software used provided a maximum power of 70 W. Patients were catheterized after treatment with either a Foley catheter or a biodegradable stent. After 3 months, the measurements and obstruction grading were repeated, and the effect of the stent assessed.

Results

 In the entire group, the mean (sd) free flow increased from 7.7 (2.4) to 14.0 (3.3) mL/s, the residual urine decreased from 125 (86) to 23 (25) mL and the symptom score decreased from 16 (8) to 5 (4). The mean (sd) degree of obstruction decreased from 81.0 (16) to 62.6 (15). The biodegradable stent completely avoided post‐treatment retention.

Conclusion

 High‐energy TUMT can be used on large severely obstructing prostates with major subjective and objective improvements. The biodegradable stent is useful in relieving the problems of catheterization after treatment.
Vesico‐ureteric reflux in adult patients with spinal injury
Authors: FOLEY S.J. , MCFARLANE J.P. , SHAH P.J.R.
Published: November 2003

Objectives

 To review the incidence, aetiology, treatment and prognosis of vesico‐ureteric reflux (VUR) in patients in a regional spinal injuries centre.

Patients and methods

A retrospective review of radiological investigations revealed 34 of 447 (8%) patients with VUR on at least one study. The notes of these patients were examined to determine their management and outcome.

Results

Most patients developed VUR within 4 years of injury; the underlying intravesical pressure was high in half the patients studied. Patients were managed aggressively with a variety of medical and surgical techniques. The VUR of 15 patients resolved completely and in three patients there was some improvement. Renal function deteriorated in three patients as assessed by isotopic scanning. Two patients were transferred to our unit in end‐stage renal failure associated with VUR and died within one year.

Conclusions

VUR continues to be a problem in patients with spinal injury and remains potentially fatal through the effects of high transmitted pressure and infection. Renal failure does not always develop as a consequence of the combination of VUR and high intravesical pressure. No single aetiological factor for VUR was found. With active early treatment, the incidence of VUR can be minimized and long‐term complications avoided.
Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia)
Authors: BUZELIN J.M. , FONTEYNE E. , KONTTURI M. , WITJES W.P.J. , KHAN for the European Tamsulosin Study Group (see appendix) A.
Published: November 2003

Objective

 To compare the efficacy and tolerability of the &agr;1A‐subtype selective drug tamsulosin with the non‐subtype‐selective agent alfuzosin in the treatment of patients with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO), often termed symptomatic benign prostatic hyperplasia (BPH).

Patients and methods

 The study comprised 256 patients with benign prostatic enlargement and LUTS suggestive of BOO (symptomatic BPH) who received tamsulosin 0.4 mg once daily or alfuzosin 2.5 mg three times daily during 12 weeks of treatment. The response was assessed by measurements of maximum urinary flow rate (Qmax ), a symptom score (Boyarsky) and blood pressure at regular intervals.

Results

 Tamsulosin and alfuzosin produced comparable improvements in Qmax and total Boyarsky symptom score. Both treatments were well tolerated with respect to adverse events. Tamsulosin had no statistically significant effect on blood pressure compared with baseline but alfuzosin induced a significant reduction in both standing and supine blood pressure, compared with baseline (P<0.05).

Conclusion

 Tamsulosin is the first adrenoceptor antagonist that is selective for the &agr;1A‐subtype; this specificity may explain its lack of effect on blood pressure compared with alfuzosin, an agent that is not receptor subtype specific. Moreover, this finding may partly explain why tamsulosin, in contrast to other currently available &agr;1‐adrenoceptor antagonists, can be administered without dose titration. Another advantage compared with alfuzosin (and prazosin) is the once‐daily dosing regimen of tamsulosin.
Effects of isoniazid on the proliferation and cytokine production of bladder cancer cells in vitro induced by bacille Calmette‐Guérin
Authors: BEVERS R.F.M. , DE BOER E.C. , KURTH K‐H. , SCHAMHART D.H.J.
Published: November 2003

Objective

 To determine the effects of isoniazid (isonicotinic acid hydrazide), used to reduce the serious side‐effects of immunotherapy of superficial bladder cancer with bacille Calmette‐Guérin (BCG), on the proliferation and constitutive BCG‐induced synthesis of interleukins 6 (IL6) and 8 (IL8) in human bladder cancer cells cultured in vitro.

Materials and methods

 Three poorly differentiated human cell lines, T24, TCC‐SUP and BT‐B, were used to study the effect of isoniazid on cell proliferation. Cells were inoculated in tissue culture plates and various concentrations of isoniazid added to the medium. Cell density was then monitored for up to 6 days using a colorimetric assay. To determine the effects of isoniazid on constitutive and BCG‐induced cytokine synthesis, cells were cultured in medium containing no additions, BCG, isoniazid or BCG with isoniazid, at various concentrations. Samples of medium were collected regularly for 6 h and the cytokine content (IL6 and IL8) determined using enzyme‐linked immunosorbent assays.

Results

 Continuous incubation of proliferating T24, TCC‐SUP and BT‐B cells with isoniazid at concentrations of 0–100 μg/mL did not affect the rate of proliferation. Unlike TCC‐SUP and BT‐B cells, T24 cells released more IL6 and IL8 during incubation with BCG. At 6 h after the addition of BCG, the cumulative mean (sd) IL6 and IL8 production of T24 cells was 2.6 (0.1) and 2.3 (0.4) ng per 3×105 cells, compared with a constitutive level of 0.1 (0.0) and 1.3 (0.2) ng, respectively. There was no significant effect of isoniazid (1–100 μg/mL) on either the constitutive or BCG‐induced synthesis of IL6 and IL8 in T24 cells.

Conclusion

 Assuming an essential role of (tumour) epithelial cells in the local immune response induced by BCG, these in vitro results suggest that the administration of isoniazid does not interfere with this part of the mechanism by which BCG operates.
Carcinoma of the penis — appraisal of a modified tumour‐staging system
Authors: HEYNS C.F. , VAN VOLLENHOVEN P. , STEENKAMP J.W. , ALLEN F.J. , VAN VELDEN D.J.J.
Published: November 2003

Objective

 To evaluate variables for the prediction of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour‐staging system that combines the histological degree of differentiation and extent of local invasion of the primary tumour.

Patients and methods

 Thirty‐five patients with squamous carcinoma of the penis and histo‐ or cytological staging of the inguinal lymph nodes were reviewed. A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical extent of invasion were considered. Subsequently, the tumours were also staged according to a modified T‐system in which the histological degree of differentiation and pathological extent of tumour invasion were combined.

Results

 Penectomy was performed in 34 patients (partial amputation in 20 and radical penectomy in 17). Inguinal lymphadenectomy was performed in 31 patients and in four the presence of lymph node metastases was confirmed by aspiration cytology. Using the clinical TNM staging system, lymph node metastases were histo‐ or cytologically present in no patients with T1, in five of 19 with T2, in 10 of 13 with T3 and in both patients with T4 tumours. Lymph node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and in three of five with grade 3 tumours. Using the modified histological T‐staging system (T1=grade 1–2, invasive through dermis; T2=any grade, invasion of corpus spongiosum or cavernosum; T3=any grade, invasion of urethra; T4=grade 3, regardless of invasion) lymph node metastases were present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T4 tumours.

Conclusion

 The modified T‐staging system, which combines histological differentiation with pathological extent of invasion, provided the best predictive distinction between T1 and T2–4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but should be performed in all patients with T2–4 tumours. We recommend bilateral inguinal lymphadenectomy 6–8 weeks after penectomy in such patients.
Transition zone ratio and prostate‐specific antigen density as predictors of the response of benign prostatic hypertrophy to alpha blocker and anti‐androgen therapy
Authors: KURITA Y. , MASUDA H. , SUZUKI K. , FUJITA K. , KAWABE K.
Published: November 2003

Objective

 To determine whether transrectal ultrasonography (TRUS) can predict the clinical response of patients with benign prostatic hypertrophy (BPH) to α1‐blocker and anti‐androgen therapy.

Patients and methods

 From April 1994 to July 1995, 128 patients with BPH were randomized to treatment for 6 months with either tamsulosin (a long‐acting selective α1‐blocker) or allylestrenol (an anti‐androgen), with 64 patients receiving tamsulosin (0.2 mg/day) and 64 receiving allylestrenol (50 mg/day). The results of TRUS, uroflowmetry and the American Urologic Association (AUA) symptom score were compared before and after treatment. TRUS was used to calculate the transition zone (TZ) volume, transition zone ratio (TZ ratio=TZ volume/total prostate volume), total prostate volume and prostate‐specific antigen density (PSAD).

Results

 Both groups showed a statistically significant improvement in the AUA symptom score, quality‐of‐life (QOL) score and peak urinary flow rate (Qmax ) at 6 months (P<0.001). In the tamsulosin group, there was a significant negative correlation between the pretreatment PSAD and the percentage change in Qmax (r=−0.640, P<0.001), while there was a positive correlation between PSAD and the percentage change in the AUA symptom score (r=0.589, P<0.001). On the other hand, the allylestrenol group showed a significant positive correlation between PSAD and the percentage change in Qmax (r=0.397, P<0.01) and a negative correlation between PSAD and the AUA symptom score (r=−0.313, P<0.01).

Conclusion

 Patients with a high pretreatment PSAD responded well to anti‐androgen therapy, while those with a low PSAD responded better to α1‐blocker therapy.
Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer
Authors: KUCZYK M.A. , BOKEMEYER C. , KÖHN G. , STIEF C.G. , MACHTENS S. , TRUSS M. , HÖFNER K. , JONAS U.
Published: November 2003

Objective

 To assess the diagnosis of vena caval thrombosis (VCT) in patients with renal cell carcinoma (RCC) as an independent indicator of prognostic importance and when combined with additional tumour characteristics in a controlled multivariate analysis.

Patients and methods

 The clinical course of 53 patients (41 men and 12 women, mean age 60 years, range 35–79) with RCC and VCT was compared with that of a control group of 47 patients (37 men and 10 women, mean age 57 years, range 32–76) with RCC but no neoplastic extension into the vena cava.

Results

 With a follow‐up of 1–154 months and a mean long‐term survival of 32 and 35 months, respectively, for patients with and without VCT, neither the propagation of the tumour into the vena cava (P=0.391) nor the cranial extension of the thrombosis (P=0.158) were identified as having any prognostic value during univariate or multivariate statistical analysis. The presence of regional lymph node (P<0.001) or distant metastases (P=0.009) was an independent prognostic variable for patients with RCC, with a significant decrease in long‐term survival (13 and 14 months for patients with lymph node and distant metastases, respectively).

Conclusion

 A radical surgical approach is essential as standard therapy for the treatment of patients with RCC and neoplastic extension into the vena cava. Because they have a significantly decreased life expectancy, asymptomatic patients with lymph node or distant metastases should be treated conservatively.
Predictive value of serum immunosuppressive acidic protein for staging renal cell carcinoma: comparison with other tumour markers
Authors: MASUDA H. , KURITA Y. , SUZUKI K. , FUJITA K. , ASO Y.
Published: November 2003

Objective

 To examine the usefulness of serum immunosuppressive acidic protein (IAP) as a predictor for staging renal cell carcinoma (RCC), using receiver‐operator characteristic (ROC) analysis, and to compare IAP with other tumour markers.

Patients and methods

 From September 1983 to December 1995, serum IAP was measured in 133 untreated patients with RCC (mean age 60.1 years, sd 11.4, range 31–84). The erythrocyte sedimentation rate (ESR), the levels of fibrinogen, C‐reactive protein (CRP), and α2‐globulin were also measured. To compare these markers as predictors of local involvement of the renal capsule, lymph node and distant metastasis, the area under the corresponding ROC curve was calculated. Tumour size at the time of resection was added in this analysis for comparison with the levels of these tumour markers.

Results

 The final pathological stage was T1 or T2 in 101 patients and T3 or T4 in 32, while it was N0 in 122 patients, N1–3 in seven, M0 in 114 patients and M1 in 19. The area of the ROC curve for tumour size was greatest (0.843) for staging of the local extent (T1/T2 versus T3/T4) and that for IAP was 0.714, similar to the values for fibrinogen, ESR and CRP. For predicting lymph node metastasis, IAP and fibrinogen were the most important (0.864). However, IAP alone (0.894) was the most important predictor of distant metastasis. Using an IAP threshold of 600 μg/mL gave a high sensitivity and specificity for detecting lymph node and distant metastasis.

Conclusion

 IAP is a valuable predictor of lymph node and distant metastasis in patients with RCC, although it is inferior to tumour size in predicting local involvement of the renal capsule. The appropriate threshold value of IAP for detecting lymph node and distant metastasis is 600 μg/mL.
Further experience with the periurethral expander:
Authors: LIMA S.V.C. , ARAÚJO L.A.P. , VILAR F.O.
Published: November 2003

Objective

 To determine the long‐term effects of the periurethral expander, a new device for the treatment of urinary incontinence in children.

Patients and methods

 Twenty‐five patients (mean age 11.2 years, range 3–22) had a periurethral expander implanted around the bladder neck within the last 41 months. Twelve of these patients had neurogenic bladders as a result of myelomeningocele, 12 had undergone unsuccessful exstrophy reconstructions and one had megalourethra. Bladder augmentations were carried out in 23 of the patients. The mean follow‐up was 23 months.

Results

 Ten patients had the device removed due to erosion and/or infection; patients with exstrophy were more susceptible to complications. Patients with neurogenic bladders use clean intermittent catheterization and the remainder void spontaneously. The mean pressure in the cuff was 58.7 cmH2O.

Conclusion

 The periurethral expander seems to be a valid option in the treatment of selected cases of urinary incontinence in children and young adults. There were more complications in patients with exstrophy/epispadias and such patients must be considered unsuitable for this treatment.
The role of cigarette smoking in prostatic enlargement
Authors: KÜPELi B. , SOYGÜR T. , AYDOS K. , ÖZDiLER E. , KÜPELi S.
Published: November 2003

Objective

 To investigate the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement.

Patients and methods

The association between cigarette smoking and prostatic volume was investigated in 68 men with BPH (mean age 59 years, range 52–74) by assessing changes in serum levels of oestradiol, testosterone, dihydroepiandrosterone (DHEA) and dihydro‐epiandrosterone sulphate (DHEA‐S). Possible enzymatic mechanisms in the prostate gland that might be affected by cigarette smoking were assessed.

Results

The mean prostate volume was greater in non‐smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non‐smokers (33.8 and 26.7 pg/mL, respectively, P< 0.01). Cigarette smoking was inversely but not significantly related to testosterone level. These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA‐S levels between smokers and non‐smokers. There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates.

Conclusion

These results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.
Photodynamic therapy of bladder cancer cell lines
Authors: DATTA S.N. , ALLMAN R. , LOH C.S. , MASON M. , MATTHEWS P.N.
Published: November 2003

Objective

 To determine the effect of photodynamic therapy mediated by 5‐aminolevulinic acid (ALA) on a range of bladder cancer cell lines, including a squamous cancer cell line and a multi‐drug resistant cell line.

Materials and methods

 Experiments were performed on cells growing in culture; the cell lines studied were the transitional cell cancer lines RT112, T24 and EJ138, the squamous cancer cell line, SCaBER, and the multi‐drug resistant transitional cancer cell line, MGH‐U1(R), together with its non‐resistant parent line, MGH‐U1. The kinetics of the ALA‐mediated generation of fluorescent photosensitizer were determined using flow cytometry. Photodynamic therapy was performed by incubating cells in ALA followed by exposure to various doses of white light.

Results

 The response of the various transitional cancer cell lines to photodynamic therapy depended on dose. The squamous cell line was relatively resistant to photodynamic therapy. There was some cross‐resistance of the MGH‐U1(R) cell line to photodynamic therapy, although the mechanism of cross‐resistance appeared not to be necessarily a property of the drug‐resistant phenotype.

Conclusion

 This study suggests that ALA‐mediated photodynamic therapy may be effective in transitional cell carcinoma of the bladder. Based on these findings, this therapeutic method should be further evaluated clinically.