bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of bladder carcinoma using protoporphyrin IX fluorescence induced by 5‐aminolaevulinic acid
Authors: Koenig F. , McGovern F.J. , Larne R. , Enquist H. , Schomacker K.T. , Deutsch T.F.
Published: March 2003

Objective

To report the results of a clinical study investigating the diagnosis of malignant and dysplastic bladder lesions by protoporphyrin IX (PPIX) fluorescence and to compare them with those from earlier studies.

Patients and methods

The study included 55 patients with suspected bladder carcinoma (at initial diagnosis or at tumour follow‐up visits); 130 bladder biopsies from 49 patients were classified by pathological analysis. All patients received an intravesical instillation of 50 mL of a 3% 5‐aminolaevulinic acid (ALA) solution a mean of 135 min before cystoscopy, which was then performed under white and blue light. Malignant/dysplastic lesions showing red fluorescence under blue‐light excitation were noted and the increase in detection rate calculated.

Results

There were 63 benign and 67 malignant/dysplastic areas biopsied; 10 malignant/dysplastic lesions (four transitional cell carcinoma, two carcinoma in situ, four dysplasia) were not detected during routine white‐light cystoscopy but were identified under blue light. Fluorescence cystoscopy improved the overall diagnosis of malignant/dysplastic bladder lesions by 18% over standard white‐light cystoscopy. The improvement was greater for dysplastic lesions and carcinoma in situ (50%). However, the improvement over standard cystoscopy was less than that found by other groups.

Conclusion

The ALA‐based fluorescence detection system significantly enhanced the diagnosis of malignant/dysplastic bladder lesions. However, determining the optimum drug exposure time requires further investigation using well‐characterized instrumentation and study protocols, which would then allow comparison of the results from different groups.
An evaluation of the no‐scalpel vasectomy technique
Authors: Kumar  , Kaza  , Singh  , Singhal  , Kumaran
Published: March 2003

Objective

To evaluate the magnitude and range of complications encountered during no‐scalpel vasectomy (NSV) and to identify any limiting factor or contraindication to NSV.

Subjects and methods

A total of 4255 men visiting a family welfare clinic of a city hospital in Delhi, India, or outpatients of the surgery department, opted for NSV; 4253 procedures were performed from September 1989 to December 1997, with two not performed because of technical difficulties. The success and complication rates were recorded.

Results

The complication rates with NSV were surprisingly low; seven complications were encountered, comprising two small haematomas (0.047%), three painful nodules (0.07%), three wound infections (0.07%) and two vasal fistulae, a complication not previously described. A meticulous procedure should avoid this last complication. The mean duration of NSV was 9.5 min.

Conclusion

NSV is a refined and rapid technique of vasectomy with an extremely low complication rate. Being a minimally invasive procedure, it allays the fear of incision commonly encountered in men choosing vasectomy.
Microvessel density in prostatic hyperplasia
Authors: Foley S.J. , Bailey D.M.
Published: March 2003

Objectives To examine the prostates from patients with haematuria associated with benign prostatic hyperplasia (BPH) to determine their microvascular anatomy and thus assess histopathological differences in patients with significant haematuria.

Patients and methods Prospectively, 11 patients with BPH and haematuria (mean age 70 years) and 19 control patients with BPH alone (mean age 72 years) were identified. Neither group had received hormone manipulation or had been catheterized. The sub‐urothelial compartment of the prostatic urethra in subsequent specimens from transurethral resection was examined using factor VIII/CD‐34 immuno‐histochemistry. The microvessel density (MVD) was calculated by counting vascular cross‐sectional profiles within a 0.81‐mm2 grid. The pathologist studying the specimens was unaware of the patients’ symptoms.

Results The median (range) MVD in the haematuria group was 64 (28–137) and in the controls was 27 (14–39) (P < 0.001).

Conclusion The MVD was significantly greater in the patients with haematuria, suggesting that suburo‐thelial microvessel proliferation may play an important role in mediating haematuria associated with BPH. This is the first time that a difference has been shown at the cellular level in patients with haematuria and could form an important foundation for subsequent research.
Genetic alterations of the p16 gene in urothelial carcinoma in Taiwanese patients
Authors: Wu W.‐J. , Kakehi Y. , Chang S.‐F. , Huang C.‐H. , Chang L.‐L.
Published: March 2003

Objective To measure changes in the p16 gene (MTS1, a negative regulator of cell‐cycle progression at the G1 checkpoint, and a tumour suppressor gene) in urothelial carcinomas (including upper tract urothelial and bladder tumours), and to correlate these measurements with the clinical status of such patients in Taiwan, where renal pelvic tumours comprise 47% of all kidney tumours and are more common than the average worldwide.

Materials and methods Thirty‐five upper tract urothelial and 61 bladder tumours were examined for changes in p16. Deletion of the gene was assessed by Southern blot analysis and mutation analysed using polymerase chain reaction‐single strand conformation polymorphism, followed by direct sequencing.

Results Of the 61 bladder carcinomas, homozygous deletion of p16 was detected in 12 (20%). However, a homozygous deletion was detected in 11 of 35 (31%) upper tract urothelial carcinomas, a higher frequency than that reported for transitional cell bladder carcinomas. Deletion was detected as frequently in stage I tumours as in late‐stage tumours, suggesting that p16 deletion is a relatively early event in urothelial tumorigenesis. No point mutations were noted for p16 in any of the primary urothelial tumours. Most multiple and recurrent tumours and metastatic nodules in individual patients contained identical p16 genetic lesions, confirming that the tumours were probably monoclonal. In addition, there was a high gene dose of p16 in bladder carcinomas from patients with lymph node metastasis.

Conclusion Deletion of p16 appears to be a common event in urothelial carcinomas, especially in upper tract urothelial tumours. High levels of p16 were detected in tumours with lymph node metastasis. It seems likely that a high p16 level is associated with carcinomas of advanced stage and grade, and with poor prognosis in patients with such cancers.
Increased intra‐abdominal pressure alters the contractile properties of rabbit bladder
Authors: Bingöl‐kolog¯lu M. , Sara Y. , Ertunç M. , Onur R. , Büyükpamukçu N. , Tanyel F.C.
Published: March 2003

Objective To evaluate the effects of increased intra‐abdominal pressure (IAP) on the contractility of the rabbit bladder, as the dynamics of the bladder may be impaired in conditions associated with a high IAP, e.g. constipation and pregnancy.

Material and methods The study comprised 22 adult male New Zealand rabbits; six served as the control group, eight had an IAP of 7 cmH2O imposed for 10 days by instilling air into the abdominal cavity and this IAP was maintained for 60 days in a further eight rabbits. After treatment, the rabbits were killed, and the bladders removed and cut into 3 × 12 mm strips. The contractile activity of the muscle strips was then recorded isometrically. Electrical field stimulation (EFS) was applied using a pair of platinum ring electrodes in trains of 3 s duration every 100 s (1 ms, 100 V, 2–100 Hz). Contractile responses to carbachol and isotonic KCl were also evaluated.

Results EFS induced a frequency‐dependent increase in contractile activity in all bladder strips. Ten days of high IAP resulted in an increased responsiveness to EFS, but high IAP for 60 days reduced the EFS‐induced responses to the control levels. Carbachol (10−9–10−3 mol/L) elicited concentration‐dependent contractions in all groups. From the concentration‐response curves of carbachol, the log EC50 values (the concentration producing half the maximum effect) of the control and 60‐day treated animals were comparable, at −6.24 (0.05) and −6.25 (0.04), respectively. However, the log EC50 of the 10 day‐treated group was −4.97 (0.08) and significantly (P < 0.01) lower than that of both groups. Isotonic KCl produced contractions in all preparations; these contractions in the control and 60‐day treated animals were similar, while the 10 day‐treated group had significantly (P < 0.05) higher contraction amplitudes.

Conclusion Increased IAP alters the contractile properties of the bladder and its responsiveness to carbachol and KCl. As the intravesical pressure closely reflects the IAP, both should be increased in the present experimental design.
Evidence for the autoregulation of vesical circulation by intravesical potassium chloride and distension in the normal human bladder
Authors: Hohlbrugger G. , Frauscher F. , Strasser H. , Stenzl A. , Bartsch G.
Published: March 2003

Objectives To determine the influence of distension and intravesical KCl on vesical blood flow in the normal human bladder.

Subjects and methods Nine normal volunteers underwent comparative cystometry (NaCl vs 0.2 mol/L KCl; filling rate 50 mL/min). Peak systolic blood flow velocity (PSBFV) and end‐diastolic blood flow velocity (EDBFV) were measured in several intramural arteries at a filling volume of 50 mL and at maximum cystometric capacity (Cmax). For these measurements a colour Doppler unit fitted with an endorectal probe was used. The resistance index (RI) was defined as (PSBFV − EDBFV)/PSBFV.

Results In the presence of NaCl, the mean PSBFV increased significantly from 9 cm/s at 50 mL to 17 cm/s at Cmax (512 mL). Compared with NaCl, KCl induced a significantly higher mean PSBFV at 50 mL (15 cm/s). With increasing distension the rise in PSBFV with KCl filling (Cmax 478 mL) was nearly parallel to that obtained on NaCl filling (mean 22 cm/s); the RI did not change.

Conclusions Bladder distension and intravesical KCl significantly increased the PSBFV. The unchanged RI indicated a concomitant increase in perfusion rates. Hence, the composition of urine (high potassium concentrations and hyperosmolarity) and its storage govern the autoregulation (independent of cardiac output) of vesical circulation, probably by reflexive pathways. These findings provide further evidence for prevesical arteriovenous shunts.
Oxybutynin for detrusor instability with adjuvant salivary stimulant pastilles to improve compliance: results of a multicentre, randomized controlled trial
Authors: Tincello D.G. , Adams E.J. , Sutherst J.R. , Richmond D.H.
Published: March 2003

Objective To test the hypothesis that compliance with oxybutynin would be improved if the severity of dry mouth could be reduced, thus leading to improved urinary symptom response and improved outcome, in a randomized, controlled trial of oxybutynin with or without salivary stimulant pastilles in patients with detrusor instability.

Patients and methods Sixty‐seven women with detrusor instability were randomized to a variable dose regimen of oxybutynin with (37) or without (30) salivary stimulant pastilles for 8 weeks. Patients were asked to complete a baseline voiding diary. In weeks 1 and 2, patients were encouraged to adjust the dose of oxybutynin themselves to achieve optimum symptomatic control. A second diary was completed in the sixth week and patients were reviewed at 8 weeks. The outcome measures were the compliance rate, follow‐up attendance rate, maximum dose of medication, changes in voiding and incontinence episodes, and changes in severity of urgency and of dry mouth symptoms between the first and sixth week.

Results Of the 67 women, 32 (47%) completed the study; the proportion completing was the same in both groups. Four patients had stopped the medication and there was no difference in the distribution of maximum dosage achieved between the groups. Both groups reported a reduced severity of urgency symptoms and increased severity of dry mouth. There were no differences in reported symptom change between the groups during the study.

Conclusions The combination of oxybutynin and salivary stimulant pastilles does not improve compliance or symptom relief compared with oxybutynin alone; it does not allow a greater dose of oxybutynin to be tolerated.
Affinity of trazodone for human penile α1‐ andα2‐adrenoceptors
Authors: Krege S. , Goepel M. , Sperling H. , Michel M.C.
Published: March 2003

Objective To determine the affinities of human penile α‐adrenoceptors and cloned human α‐adrenoceptor subtypes for trazodone, an antidepressant with reported beneficial effects in erectile dysfunction.

Materials and methods Competition radioligand binding studies were performed with trazodone in human penile tissue and in cell lines stably expressing all cloned human α‐adrenoceptor subtypes.

Results Trazodone had higher affinity for human α1‐adrenoceptors (10–130 nmol/L) than for α2‐adrenoceptors (300–700 nmol/L), but did not discriminate between subtypes of human α1‐ or α2‐adrenoceptors.

Conclusion Trazodone has high and moderate affinity for human α1‐ and α2‐adrenoceptors, respectively; this might contribute to its reported beneficial effects in erectile dysfunction.
Gene transfer to urethral strictures in rabbits: a preliminary report
Authors: Meria P. , Anidjar M. , Brouland J.P. , Teillac P. , Berthon P. , Cussenot O.
Published: March 2003

Objective To assess the rationale for virus‐mediated gene transfer into the urethra in vivo and in vitro, using a rabbit model, as this is an attractive approach to prevent recurrence after the endoscopic management of urethral strictures.

Materials and methods Primary cultures of rabbit urethral stromal cells were infected with adenoviral and retroviral solutions carrying a nucleus‐targeted β‐galactosidase (β‐Gal) reporter gene (respectively 109 and 107 plaque‐forming units/mL). In addition, to mimic the human clinical situation, a model was developed of thermally induced stricture in rabbit urethra which produced fibrotic stenosis within 15 days. Using a prototype channelled balloon catheter, these strictures were endoscopically dilated and then instilled with the β‐Gal adenoviral or retroviral constructs.

Results The application of recombinant adenovirus and retrovirus harbouring a nucleus‐targeted β‐Gal reporter gene to cultured rabbit urethral stromal cells resulted in a high transduction efficiency of up to 90% and 96%, respectively. Five days after infection, histochemical and immunohistochemical staining of the strictured urethrae showed a 3% rate of transfection targeted to stromal cells within the fibrosis, confirmed by polymerase chain reaction (PCR) analysis. Adjacent and distal spread of the virus was excluded by histochemistry, immunohistochemistry and PCR.

Conclusion These results represent the first report of endoscopic adenovirus and retrovirus‐mediated gene transfer to the urethra. Although at a low rate, transduction reached stromal cells transmurally within the induced strictures and was site‐specific.
Paediatric anatrophic nephrolithotomy; stone clearance — at what price?
Authors: Gough D.C.S. , Baillie C.T.
Published: March 2003

Objective To evaluate the functional outcome of anatrophic nephrolithotomy in children.

Patients and methods All children undergoing anatrophic nephrolithotomy for complex branching and multiple renal calculi over an 11‐year period were studied prospectively. Demographic data, treatment details and outcome, as assessed by X‐ray, ultrasonography and isotope studies, were recorded. Anatrophic nephrolithotomy was carried out with surface cooling of the kidney followed by nephrostomy drainage for 5–7 days.

Results Nine children (median age 4 years, range 7 months to 9 years) underwent anatrophic nephrolithotomy. Predisposing factors included urinary tract infection (by Proteus mirabilis) in all and hyper‐calciuria in two children. The median (range) total ischaemic time at operation was 25 (15–40) min and the operative duration 150 (120–200) min. Three children required a blood transfusion. Stone clearance was incomplete in one child. There was no recurrent stone formation after a long‐term follow‐up (median 32 months, range 14–107) in the other patients. Isotope studies showed impaired split renal function (<40%) in six children before surgery; there was a significant decline (>5%) in divided function in five children (range 6–16%) after surgery.

Conclusion Anatrophic nephrolithotomy is an effective means of rendering children with branching calculi stone‐free, but this study suggests that it leads to some further parenchymal damage.
Possible biphasic changes of free radicals in ethylene glycol‐induced nephrolithiasis in rats
Authors: Huang H.S. , Chen C.F. , Chien C.T. , Chen J.
Published: March 2003

Objective To evaluate the possible role of free radicals in nephrolithiasis in rats induced by ethylene glycol, and to examine the correlation between the urinary enzymes N‐acetyl‐β‐glucosaminidase (NAG), β‐galactosidase (GAL) and neutral endopeptidase (NEP), and free radical production.

Materials and methods Hyperoxaluria was produced in male Wistar rats by adding ethylene glycol to their drinking water. After 7, 21 and 42 days of treatment, urinary oxalate, creatinine clearance and urinary enzymes (NAG, GAL and NEP) were measured. The nitroblue tetrazolium perfusion method was used to locate the sites of free‐radical production. Ultrasensitive chemiluminescence was used to directly measure the production of reactive oxygen species (ROS) in vivo. Vitamin E and potassium citrate were fed to rats, in addition to ethylene glycol, to assess their effects on free radical production.

Results Urinary oxalate increased significantly and was associated with an increase in NAG and GAL at all sample times. However, urinary NEP activity was unchanged on day 7, although there was four times as much NEP on days 21 and 42 than in the control groups. Formazan particles in the renal cortex were scored as 3+ to 4+ in rats treated for 7 days with ethylene glycol. Blood ROS levels were also higher in this group than in the controls (P < 0.01). After vitamin E and potassium citrate treatment, blood ROS levels were lower than in rats treated with ethylene glycol alone.

Conclusion Free radicals may be produced in the early stages of nephrolithiasis in rats fed with ethylene glycol. Free radicals occurred mainly in blood and might be associated with NEP inactivation.
Bacteriological safety and cost‐effectiveness of a nonrefluxing valve in the irrigation system during outpatient flexible cystoscopy
Authors: Thompson A. , Pearce I. , Robinson E. , Ladds T.J. , Payne S.R.
Published: March 2003

Objective To critically evaluate the infection rate associated with the use of a nonrefluxing irrigation system for outpatient flexible cystoscopy, by comparing it with conventional irrigation systems, and to determine the costs and benefits of this system of irrigation delivery.

Patients and methods All patients undergoing flexible cystoscopy on scheduled outpatient lists were considered for inclusion in the study; 143 patients of 220 undergoing cystoscopy fulfilled the study criteria. The study group of patients underwent cystoscopy with a new single‐use nonrefluxing valve inserted into the same irrigation delivery system that was used for the whole endoscopy session, and the control group had the complete irrigation system changed after each endoscopic examination. Midstream urine samples were taken for analysis before cystoscopy and again 3–4 days later. Infection was defined as a pure growth of  105 organisms/mL, with associated pyuria defined as  10 pus cells per high power microscopic field.

Results Complete data were available on 133 patients, with a further nine being excluded from the statistical analysis because they had a pre‐existing urinary tract infection, leaving 64 patients in the study and 69 in the control groups. The overall infection rate for flexible cystoscopy was 3.2%, with no significant difference between the study and control groups. Cost savings of > 35% can be expected using the nonrefluxing valve method of irrigation delivery.

Conclusion The nonrefluxing valve caused no detectable increase in patient morbidity from bacterial infection when compared with conventional irrigation systems for flexible cystoscopy, and can save considerable costs.
Attenuation of reperfusion injury by renal ischaemic preconditioning: the role of nitric oxide
Authors: Jefayri M.K. , Grace P.A. , Mathie R.T.
Published: March 2003

Objective To determine the effect on nitric oxide (NO) release and renal NO synthase (endothelial, eNOS and inducible, iNOS) activity of renal ischaemia‐reperfusion (I/R) in vivo in an animal model, and to examine the possible involvement of NO in ischaemic preconditioning (IP) of the kidney.

Materials and methods In a right‐nephrectomized rat model, 42 animals were randomized in four groups: controls; IP‐only (4 min of ischaemia followed by 11 min of reperfusion, total of four cycles); renal warm ischaemia (45 min) and 6 h reperfusion; ischaemia (45 min) preceded by IP pretreatment. Serum NO metabolites were assayed 2 and 6 h after ischaemia or the control equivalent. NOS expression in the kidney was detected immuno‐histochemically, and damage assessed morphologically in sections stained with haematoxylin and eosin. Kidney function was assessed by the levels of serum creatinine, urea and electrolytes.

Results Compared with before ischaemia, the concentration of serum NO metabolites at 6 h was increased in the IP‐only animals (P = 0.016) and in the IP + I/R group (P = 0.002). There was greater eNOS expression in the IP‐only group (P = 0.009) and in the IP + I/R group than in controls (P = 0.050). iNOS expression was greater in the IP‐only animals than in the control group (P = 0.050). Histological assessment showed less evidence of cellular damage in IP + I/R animals than in the I/R‐alone group (P = 0.020). Serum creatinine level was not significantly different between the IP‐only group and the control. There were no differences after 2 h of reperfusion.

Conclusion Ischaemic preconditioning has a protective effect on renal structure and function, which may be produced by increased NO release arising from increased NOS expression by 6 h after reperfusion.
Simultaneous recording of mechanical and intracellular electrical activity in human urinary bladder smooth muscle
Authors: Visser A.J. , Van Mastrigt R.
Published: March 2003

Objective To elucidate the role of the membrane potential in human detrusor smooth muscle contraction, by simultaneously recording mechanical and intracellular electrical activity in muscle strips.

Materials and methods The agonists acetylcholine and carbachol were applied to induce a contraction on muscarinic receptor stimulation; to block the response, atropine was added to the bath. The Ca2+ necessary for activating the contractile machinery can be recruited via two pathways: release from intracellular stores or influx from the extracellular matrix. High potassium was applied to induce Ca2+ influx through voltage‐sensitive Ca2+ channels.

Results There were significant changes in the force when agonist, antagonist and high potassium was administered. However, there were significant changes in membrane potential only when KCl was applied to the bath and not with muscarinic agonist or antagonist application. Activity in the form of spike potentials did not change significantly on applying any of the test substances.

Conclusion The present results indicate that the Ca2+ mobilized on M3 receptor stimulation originates primarily from intracellular stores, with no systematic changes in membrane potential. Atropine only caused a relaxation in muscle previously contracted by M3‐receptor agonist stimulation; it had no effect on relaxed muscle strips.
Tension‐free vaginal tape for primary genuine stress incontinence: a two‐centre follow‐up study
Authors: Moran P.A. , Ward K.L. , Johnson D. , Smirni W.E. , Hilton P. , Bibby J.
Published: March 2003

Objective To assess the safety and efficacy of the tension‐free vaginal tape procedure in the treatment of primary genuine stress incontinence.

Patients and methods A two‐centre follow‐up study was conducted on 40 women with urodynamically confirmed primary genuine stress incontinence who had a tension‐free vaginal tape inserted under local anaesthesia with sedation. Operative details were recorded and all patients followed up both subjectively, and objectively with repeat urodynamic studies and pad testing.

Results The mean (range) age of the women was 51.1 (33–86) years, the median parity 2 (0–4) and mean body mass index 25.1 (19–35). The mean anaesthesia and operative duration was 42 (25–65) min; 93% of the women resumed immediate spontaneous voiding with no need for catheterization. The mean inpatient stay was 2.2 (2–4) days (where 2 days is equivalent to one night in hospital). The follow‐up was conducted at a mean interval of 12.3 (6–24) months. Subjectively, 80% of women were cured and 17.5% significantly improved; objectively, genuine stress incontinence was cured in 95%. Symptomatic postoperative detrusor instability was found in 15% of women and symptoms of voiding dysfunction identified in 5% of women. There were no defects in healing or tape rejection.

Conclusion The tension‐free vaginal tape procedure is a promising new technique that, in this short‐term analysis, appears to be safe and effective. Intra‐operative complications are uncommon and both hospital stay and recovery are short. Voiding complications are rare but symptomatic postoperative detrusor instability had an incidence of 15%.
The prevalence of varicocele and varicocele‐related testicular atrophy in Turkish children and adolescents
Authors: Akbay E. , Çayan S. , Doruk E. , Duce M.N. , Bozlu M.
Published: March 2003

Objective To determine the prevalence and site of varicocele and varicocele‐related testicular atrophy in children and adolescents.

Patients and methods The study included 4052 boys aged of 2–19 years, divided into four age groups; the findings of a physical examination, any testicular atrophy and testicular volume were recorded.

Results Varicocele was detected in 293 (7.2%) of the 4052 boys; the prevalence was 0.79% in those aged 2–6 years, 0.96% at 7–10 years, 7.8% at 11–14 years and 14.1% at 15–19 years. The prevalence was 0.92% in 1232 children aged 2–10 years and 11.0% in 2531 adolescents aged 11–19 years (P < 0.001). The prevalence increased significantly at age 13 years (P < 0.005). The varicocele was unilateral in 263 of the 293 (89.7%) boys with varicocele; of these, one (0.38%) was on the right and the others on the left side. Varicoceles were bilateral in 30 of 279 boys (10.8%) aged 11–19 years but none were detected in those aged < 11 years. Varicocele‐related testicular atrophy was not present in those aged < 11 years, but seven boys (7.3%) aged 11–14 years and 17 (9.3%) aged 15–19 years had testicular atrophy. The difference in prevalence between the last two age groups with atrophy was not significant.

Conclusion These findings support the view that varicocele is a progressive disease and that the prevalence of varicocele and testicular atrophy increases with the puberty.
A 14‐year follow‐up of conservative treatment forvesico‐ureteric reflux
Authors: Nielsen J.B. , Frøkiær J. , Rehling M. , Jørgensen T.M. , Djurhuus J.C.
Published: March 2003

Objective To determine renal function in patients with vesico‐ureteric reflux (VUR) during 14 years of conservative treatment (no surgery).

Patients and methods Sixty patients with VUR were consecutively included between 1981 and 1982. The degree of VUR was determined by conventional voiding cysto‐uretherography (VCUG) after 3 months of prophylactic antibiotics. The VUR was grade I–IV, with grades III and IV characterized as high‐grade VUR. In all patients, any urinary tract infections and bladder‐urethral dysfunction were treated. Renal function and reflux were monitored by renal and bladder scintigraphy using 123I‐hippuran and the glomerular filtration rate (GFR) was determined using the plasma clearance of 51Cr‐ethylaminediamine tetra‐acetic acid.

Results Of the 60 patients who entered the study, 51 were followed for a mean of 13.7 years; nine patients were lost to follow‐up. None of the patients underwent antireflux surgery. All patients were in good health and normotensive (except two with borderline hypertension). Of the 51 patients 21 had low‐grade, 21 unilateral high‐grade and nine bilateral high‐grade reflux. In those with low‐grade reflux both the mean renal split function on the most refluxing kidney and the GFR remained stable during the whole monitoring period. Eighteen patients who had a persistent reduction in renal split function or initially had had a significantly reduced functional share to the most refluxing kidney had their GFR re‐assessed in adolescence. However, the body surface‐corrected GFR remained constant. Total GFR and single kidney GFR increased significantly.

Conclusion A conservative treatment regimen in patients with VUR can ensure stable kidney function, although kidneys with a lower renal function at referral seem to have an impaired functional growth potential.
Evaluation of the 1997 tumour, nodes and metastases classification of renal cell carcinoma: experience in 172 patients
Authors: Minervini R. , Minervini A. , Fontana N. , Traversi C. , Cristofani R.
Published: March 2003

Objective To compare the prognostic relevance of the 1987 and 1997 tumour, nodes and metastases (TNM) systems for staging renal cell carcinoma (RCC) in predicting patient outcome.

Patients and methods A series of 172 consecutive patients with RCC who underwent radical nephrectomy from January 1990 to October 1997 was evaluated comparatively according to the 1987 and 1997 TNM classifications. The median (range) follow‐up of the patients was 50 (19–112) months. The probability of survival was estimated by the Kaplan–Meier method, using the log‐rank test to estimate differences among levels of the analysed variables.

Results Using the 1997 TNM classification resulted in a redistribution of 99 patients from stage pT2 on the 1987 TNM classification to stage pT1. As the staging criteria for pT3 and pT4 did not change, there was no re‐classification of these patients. Kaplan–Meier survival curves showed a similar separation in 5‐year survival between stage pT1 and pT2 using both systems; 100% vs 80% for the 1987 TNM and 86% vs 69% for the 1997 TNM systems. This difference in survival rates between patients with pT1 and pT2 disease was statistically significant only for the 1997 TNM staging system. However, when the 1987 TNM staging classification was applied, the separation in 5‐year survival rates between pT2 and pT3 disease was greater.

Conclusion This study confirms the prognostic relevance of the 1987 TNM system, as established in the present patients. The 1997 TNM classification resulted in a better stratification of patients with pT1–pT2 disease, but had similar prognostic value for pT2 and pT3 disease.
The clinical uroselectivity of alfuzosin is not significantly affected by the age of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia
Authors: Sánchez‐Chapado M. , Guil M. , Badiella L.I. , Fernández‐Hernando N. , Alfaro V.
Published: March 2003

Objective To assess the effect of the age of patients with benign prostatic hyperplasia (BPH) on the clinical uroselectivity of alfuzosin during general medical practice.

Patients and methods The present national, multicentre, open‐labelled, observational study involved 4018 Spanish outpatients with BPH, i.e. showing lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction. The patients received sustained release (SR) alfuzosin, 5 mg twice daily, for 2 months. The primary efficacy criteria were symptomatic improvements, as assessed by the International Prostate Symptom Score (IPSS) and quality of life (QoL) index. Safety was assessed by monitoring cardiovascular data and adverse events.

Results The patients were divided into four age groups, i.e. < 56, 56–65, 66–75 and > 75 years. All groups of patients showed a mean IPSS decrease of 11–12 (55.8–65.4% from baseline) at the end of the study, while the QoL decreased by 2–3 points (55.6–63.6% from baseline). There were no relevant effects of age on the efficacy of the treatment. Moreover, alfuzosin was well tolerated independently of the age of the patient; 1.2% of the patients enrolled withdrew because of adverse events. The qualitative distribution of vasodilatory/nonvasodilatory adverse events was similar in all age groups. The incidence of asymptomatic orthostatic hypotension was low (0.58%) and not affected by the age of the patients.

Conclusion This study confirms that the clinical uro‐selectivity of SR‐alfuzosin, already described in ran‐domized controlled studies, is not significantly affected in clinical practice by the age of the patients. This is considered particularly relevant to the characteristics of patients with BPH, as they are mostly elderly men.
Psychosocial morbidity in prostate cancer: I. Design of a new questionnaire
Authors: Cliff A.M. , Macdonagh R.P.
Published: March 2003

Objective To design a questionnaire capable of measuring psychosocial morbidity in patients with prostate cancer and in their partners.

Methods Issues to be covered in the questionnaire were determined by discussion among professionals, a literature review and semi‐structured interviews with a group of seven patients and their partners. The potential issues were analysed and condensed, then re‐presented to a further group of professionals, and to 10 patients and partners for comment and amendment. This process aimed to confirm the completeness and relevance of the list of issues. Questions were then constructed around the final list of issues and the questionnaire adjusted continually while testing on patients, until it was completed easily.

Results The questionnaire consisted of 10 items; three items related to the general threat of cancer (concern about the diagnosis itself, fear of the future and difficulty dealing with the emotional response to the disease). Two items covered social and role functioning and there were five items to determine the severity of psychological morbidity caused by pain, urinary symptoms, treatment, physical limitation and sexual dysfunction. The questionnaire appeared to cover those areas of morbidity most consistently raised by patients and partners; it was also rapidly and easily completed by most respondents.

Conclusion The questionnaire constructed may be easily applied as part of routine clinical practice; it addresses aspects of psychosocial morbidity related to prostate cancer in patients and their partners. Although it appears to have content validity, further psychometric testing is required.
Molecular markers for predicting prostate cancer stage and survival
Authors: Dunsmuir W.D. , Gillett C.E. , Meyer L.C. , Young M.P. , Corbishley C. , Eeles R.A. , Kirby R.S.
Published: March 2003

Objective To assess several molecular markers (detected by immunohistochemistry, IHC) to determine whether they can be used to improve the prognostic value of histological grade alone in predicting the behaviour of prostate cancer.

Patients and methods Tumour tissue was retrieved from 156 men in whom tumour grade, stage and survival were known. The outcome measures were: (i) local stage (T‐stage, organ‐confined vs extraprostatic); (ii) metastatic status (M‐stage, bone metastasis vs no bone metastasis); and (iii) survival. The IHC markers used were chosen to provide a broad representation of various aspects of tumour biology, i.e. the androgen receptor (AR) and oestrogen receptor (ER), adhesion molecules (E‐cadherin), proliferation markers (MIB‐1), tumour‐suppressor genes (TP53 and the retinoblastoma gene product, Rb) and other novel cancer‐related proteins (cyclin D1 and the breast cancer susceptibility gene product, BRCA2). All factors were assessed using logistic regression and Cox proportional‐hazards survival models for predictive value, after adjusting for effects.

Results MIB‐1, ER, cyclin D1 and E‐cadherin all showed close statistically significant univariate associations with histological grade. Univariate analysis also identified close statistically significant associations between T‐stage and both MIB‐1 and E‐cadherin. Likewise, there were close univariate associations for both M‐stage and survival, and MIB‐1, cyclin D1 and ER. Logistic regression modelling identified MIB‐1, cyclin D1 and ER as statistically significant predictors of M‐stage and, once MIB‐1 was entered into the model, the effects of grade no longer made a significant contribution. MIB‐1 was a significant predictor for T‐stage, but the effects of grade remained significant in this model. Cox proportional‐hazards modelling identified MIB‐1, cyclin D1 and ER as being statistically significant predictors of survival, after adjusting for grade. After adjusting for both grade and MIB‐1, the effects of cyclin D1 and ER were no longer statistically significant. Excess MIB‐1, cyclin D1 or ER expression tended to be present within the most poorly differentiated and advanced‐stage lesions; this provides an inherent instability to the models described. TP53, Rb, AR and BRCA2 were of limited prognostic value.

Conclusions MIB‐1, ER and cyclin D1 provide prognostic information that is clearly independent of grade. However, their true clinical value is probably limited because they are expressed mainly in the most advanced lesions. Nevertheless, MIB‐1 expression is of sufficient value to warrant inclusion in future prognostic models. Furthermore, the expression of cyclin D1 and ER may reflect aspects of tumour biology that individually are worthy of further investigation. However, none of the IHC markers used in this study can be recommended for use in routine histological preparations.
A prospective evaluation of the pathogenesis of detrusor instability in women, using electron microscopy and immunohistochemistry
Authors: Carey M.P. , De Jong S. , Friedhuber A. , Moran P.A. , Dwyer P.L. , Scurry J.
Published: March 2003

Objective To characterize the types of detrusor smooth muscle junctions in the bladders of women with detrusor instability and in a control group without, and to assess whether there are differences in the cell junctions between these groups.

Patients and methods The study included 13 women with detrusor instability (median age 57 years, range 32–86) and 11 control women (median age 50 years, range 33–62). Bladder biopsies were taken from each participant, processed for electron microscopy and immunohistochemistry (using a labelled antibody to vinculin) and analysed by investigators who were unaware of the patients' diagnoses.

Results Adherens (intermediate) junctions in classic and rudimentary forms were present in all biopsies from patients and controls. Adherens junctions and dense plaques occupied almost the complete cell border in most samples. Complete immunohistochemistry was possible in seven patients and five controls. In almost every detrusor smooth muscle cell studied, there was staining of the entire cell border with labelled antibody to vinculin in all biopsies.

Conclusions This study provides evidence against an ultrastructural basis for idiopathic detrusor instability based on possible differences in detrusor smooth muscle intercellular junctions. Virtually the entire cell membrane of detrusor smooth muscle fibres is occupied by adherens junctions in classic and rudimentary forms, and with dense plaques present in samples from women with an unstable bladder and from controls. There was no junction detected in those with instability that was not present in the control group. The adherens junctions in the bladder facilitate mechanical coupling between cells.
Penile lengthening
Authors: Perovic S.V. , Djordjevic M.L.J.
Published: March 2003

Objective To describe a technique for penile lengthening and the results achieved.

Patients and methods The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to insert autologous cartilage previously harvested from the rib, the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis. The increased length of the penis depends directly on the elasticity of the urethra and especially of the neurovascular bundle. From June 1995 to March 1999 the technique was applied in 19 patients aged 18–52 years, who were followed for a mean (range) of 3.3 (1–4.5) years.

Results The increase in penile length was moderate, at 2–4 cm; there were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction. Fifteen patients reported painless sexual intercourse, the remaining four patients providing no data. During the follow‐up the cartilage insert remained at about the same size as that at initial implantation.

Conclusion The penile disassembly technique combined with the interposition of rib cartilage in the space between the glans cap and tips of the corpora cavernosa provides a genuine increase in penile length, with satisfactory results.
Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer
Authors: May F. , Treumann T. , Dettmar P. , Hartung R. , Breul J.
Published: March 2003

Objective To examine the role of endorectal magnetic resonance imaging (eMRI) and transrectal ultrasonography (TRUS) for clinically localized prostate cancer and to assess interobserver agreement in interpreting MRI studies.

Patients and methods Fifty‐four patients with biopsy‐confirmed prostate cancer underwent TRUS and eMRI before radical retropubic prostatectomy. The MR images were prospectively interpreted by two radiologists with special expertise in this field. The criteria evaluated prospectively in each patient were extracapsular extension (ECE) and seminal vesicle invasion (SVI). The results were correlated with the histopathological findings after radical prostatectomy.

Results At pathology, 27 patients had stage pT2, 15 had stage pT3a and 12 had stage pT3b lesions. The overall accuracy of eMRI in defining local tumour stage was 93% by radiologist A and 56% by radiologist B; the overall accuracy by TRUS was 63%. There was a poor correlation for the MRI studies between observers. The eMRI was more sensitive than TRUS for detecting ECE and SVI in organ‐confined prostate cancer. TRUS had a relatively high specificity for ECE and SVI, and was better than eMRI in this regard.

Conclusion Whereas MRI tended to over‐stage, TRUS under‐staged prostate cancer. This series shows the current limited value of TRUS and eMRI for planning treatment in patients with clinically localized prostate cancer. Treatment decisions should not be altered based on TRUS or eMRI findings alone.
Antenatal renal pelvic measurements: what do they mean?
Authors: Scott J.E.S. , Renwick M.
Published: March 2003

Objective To analyse data on cases with urological abnormalities recorded over a 15‐year period (1984–98) by the Northern Region Congenital Abnormality Survey (NorCAS), with special reference to fetal renal pelvic measurements.

Materials and methods Data on all urological cases recorded in the NorCAS database and in notification documents forwarded from hospitals in the Northern Region were extracted and incorporated in a separate unattributable database for analysis. Specific fields for filing recorded fetal renal pelvic measurements with their corresponding gestational ages were inserted; it was ensured as far as possible that these measurements were made in the anteroposterior plane.

Results The total number of cases analysed was 2737; a measurement of the fetal renal pelvis was recorded in 813, and more than once in 468, giving 1301 measurement episodes with the corresponding gestational ages, pregnancy and postnatal outcome. The male/female (M/F) ratio was significantly higher in those cases which had a fetal renal pelvic measurement recorded than in those which had not. This was because there was a 12/1 M/F ratio in measured cases of vesico‐ureteric reflux (VUR). Few cases of VUR had a fetal renal pelvic measurement recorded. The difference in the fetal renal pelvic measurements between those cases which were normal postnatally and those which had a structural abnormality, an obstructive lesion or VUR became significant at 7 mm and at 18 weeks of gestational age. Over the whole period the proportion of cases in which micturating cysto‐urethrography was technically possible and might have contributed to the diagnosis was 28.5%; the highest was 44.1% in 1998.

Conclusions Antenatal renal dilatation occurs infrequently in the presence of VUR and when it does, the fetus will probably be male. Antenatal ultrasonography is unlikely to contribute to detecting VUR in females, the gender in whom early diagnosis is particularly desirable. Other means of suspecting VUR antenatally, e.g. the family history or genetic coding, may be more valuable. A measurement of the fetal renal pelvis of  7 mm at a gestational age of 18 weeks should prompt subsequent careful ultrasonography during the pregnancy and early postnatal investigation of the urinary tract. The diagnosis of VUR should not be excluded because the fetal renal pelvis is only minimally dilated if the fetus is female.
Haematuria in Africa: is the pattern changing?
Authors: Dawam D. , Kalayi G.D. , Osuide J.A. , Muhammad I. , Garg S.K.
Published: March 2003

Objective To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa.

Patients and methods The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7‐year period from 1985 to 1991.

Results Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6–80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto‐urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%).

Conclusion Recurrent haematuria in patients over 30 years of age in this environment should be considered or deemed to be caused by malignancy until confirmed otherwise. An educational programme is required to alert the population to the significance of haematuria as a symptom demanding a thorough investigation before treatment. This would need support by a haematuria service for accelerated diagnosis and treatment.