bluuebunny/crossref_metadata_2025 huggingface dataset:
Tunica Vaginalis: an Aid in Hypospadias Surgery
Authors: KIRKALI Z.
Published: November 2008

Summary— Despite the improvements that have been made in equipment and in the techniques of h?pospadias repair, some patients still present with failed repairs and urethral fistulas. In such patients the lack of prepuce leads to difficulty in obtaining adequate tissue for further reconstruction.

In 14 patients with hypospadias who had already undergone surgery, a tube was formed from proximal penile or scrotal skin and wrapped by pedicled tunica vaginalis; 4 patients with urethral fistulas were treated in the same way after primary repair of the fistulas. Excellent cosmetic and functional results were achieved in all but 1 case. The technique is simple, has few complications and is recommended in the treatment of patients with failed hypospadias repair and urethral fistulas.
Penile Prostheses in the Management of Impotence in Sickle Cell Disease
Authors: DOUGLAS L. , FLETCHER H. , SERJEANT G. R.
Published: November 2008

Summary— Priapism lasting more than 24 h in adults with homozygous sickle cell disease usually results in impotence. The dense fibrosis of the corpora cavernosa which destroys the normal vascular erectile system of the penis also complicates insertion of penile prostheses. Our experience in 5 patients is reviewed. Sharp dissection and dilatation were necessary to form a tunnel for the prosthesis, which was more easily excavated anteriorly and posteriorly through a dorsal incision than for the length of the corpora through a traditional perineal‐scrotal incision. Damage to the tunica was common and subsequent migration of the prosthesis necessitated an additional 11 procedures under general anaesthesia. Despite these technical difficulties, the procedure allowed satisfactory intercourse. The average interval between onset of impotence and implantation was 4 years. Early implantation before the dense fibrosis develops might give more satisfactory results.
Low Calcium Diet in Idiopathic Urolithiasis: A Risk Factor for Osteopenia as Great as in Primary Hyperparathyroidism
Authors: FUSS M. , PEPERSACK T. , BERGMAN P. , HURARD T. , SIMON J. , CORVILAIN J.
Published: November 2008

Summary— The bone mineral content of the radius was measured in 32 male renal stone formers, 18 of them presenting with idiopathic urolithiasis and 14 with primary hyperparathyroidism, a disease known to disturb bone metabolism. The idiopathic stone formers had been on regular treatment with a low calcium diet. The bone mineral content of the radius was reduced to a similar level in both groups of patients. The data suggest that idiopathic stone formers on a low calcium diet are at risk of osteopenia; the factors which could lead to a negative calcium balance included uncompensated renal hypercalciuria, hypophosphataemia and exaggerated serum levels of 1,25‐dihydroxyvitamin D. To treat idiopathic hypercalciuria, thiazide diuretics, which reduce the renal excretion of calcium and have been shown to be beneficial for bone, seem safer than a low calcium diet.
Renal Transplant Biopsy using Real Time Ultrasound Guidance
Authors: NICHOLSON M. L. , ATTARD A. R. , BELL ANNE , DONNELLY P. K. , VEITCH P. S. , BELL P. R. F.
Published: November 2008

Summary— We describe a safe method of percutaneous renal transplant biopsy using real time ultrasound guidance. The method provides a good histological sample, is straightforward and has a low complication rate.
Diuretic Ultrasound. A Non‐invasive Technique for the Assessment of Upper Tract Obstruction
Authors: ROSI P. , VIRGILI G. , STASI S. M. DI , GIURIOLI A. , SENSI B. , VESPASIANI G. , PORENA M.
Published: November 2008

Summary— A study was made of the diagnostic reliability of renal ultrasound with a diuretic in the evaluation of upper tract obstruction. The test comprised an initial renal ultrasound examination followed by the intravenous injection of 250 ml physiological saline with 40 mg frusemide; further ultrasound scans were carried out from 5 to 150 minutes later. A total of 67 patients was studied and the results were compared with those of diuretic intravenous urography, diuretic renography and, in some cases, the Whitaker test. Dynamic ultrasound with a diuretic showed a sensitivity of 94%, specificity of 94%, positive predictive value of 91% (obstructive), negative predictive value of 96% (non‐obstruction) and a total diagnostic capacity of 94%.
Adrenal Cysts: Diagnosis and Management
Authors: SROUJIEH A. S. , FARAH G. R. , HADDAD M. J. , ABU‐KHALAF M. M.
Published: November 2008

Summary— We present 7 patients (5 adult females and 2 neonate males) with adrenal cysts. The cysts included 1 hydatid, 1 lymphatic and 5 pseudocysts. Three cysts were diagnosed pre‐operatively and all were resected surgically. The existence of true epithelial cysts of the adrenal gland is doubted by many authors; the present series includes most types of adrenal cyst.
Treatment of Ureteric Colic. Intravenous versus Rectal Administration of Indomethacin
Authors: NISSEN I. , BIRKE H. , OLSEN J. B. , WÜRTZ E. , LORENTZEN K. , SALOMON H. , LYNGE P. , FLY P. , JØRGENSEN T. H. , SVANE S. , NIELSEN B. B.
Published: November 2008

Summary— A randomised multicentre clinical trial was undertaken to compare the effect on pain of indomethacin administered either intravenously or rectally to 116 patients with ureteric colic. Adverse reactions were also assessed.

Of the patients receiving the intravenous injection, 48/53 (91%) achieved good pain relief (i.e. no supplementary analgesia was required) 30 min after administration, compared with 46/63 (73%) receiving the enema. Significantly more side effects occurred in the group treated intravenously.

It was concluded that indomethacin administered as an enema was less effective than the intravenous form, but it should be regarded as a good alternative in the treatment of ureteric colic.
Bladder Calculus Formation as a Complication of the Stamey Procedure
Authors: EVANS J. W. H. , CHAPPLE C. R. , RALPH D. J. , MILROY E. J. G.
Published: November 2008

Summary— Three cases of bladder stone due to a migrated Stamey suture and cuff are reported. In each case peroperative cystoscopy confirmed that the sutures were extravesical. The Stamey cuff subsequently formed a nidus for intravesical stone formation. The mechanism of migration of the cuff, the radiological findings and the operative technique are discussed.
Computerisation of Urothelial Carcinoma Records: 16 Years' Experience with the TNM System
Authors: HENDRY W. F. , RAWSON N. S. B. , TURNEY L. , DUNLOP A. , WHITFIELD H. N.
Published: November 2008

Summary—Details of 554 patients with urothelial carcinomas have been recorded on computer forms between 1973 and 1988 inclusive. Essential information from initial assessment and follow‐up examinations was printed out on specially designed urothelial update sheets, copies of which were given to patients and urologists as well as being filed in the hospital notes. The survival status of all patients was established as accurately as possible in the last 2 years of the study.

Multivariate analysis of 462 bladder cancer patients with adequate follow‐up indicated that T category was the most important discriminating variable, followed by histological grade. After replacing T category by microscopic depth of invasion and bimanual examination, the latter was found to be the most important single variable. The omission of the findings on bimanual examination from the 1987 revision of the TNM classification therefore appears to be wrong.
Intraprostatic Antibody Deposition in Chronic Abacterial Prostatitis
Authors: DOBLE A. , WALKER M. M. , HARRIS J. R. W. , TAYLOR‐ROBINSON D. , WITHEROW R. O'N.
Published: November 2008

Summary— Sixty patients with chronic abacterial prostatitis and 21 men without prostatitis were studied. Transperineal prosatatic biopsies taken under transrectal ultrasound control were examined for antibody, complement (C3) and fibrinogen deposition using a direct immunofluorescence (IF) technique; 34 patients (57%) had prosatatic tissue that displayed IF staining compared with only 1 (5%) in the non‐prostatitis group. IF staining for IgM was found in 85%, for C3 in 44%, for IgA in 35% and for fibrinogen in 24%, but the IgG subclass was not detected. Antibody deposition was mainly periglandular and glandular and in the wall of vessels. Five symptoms, particularly poor urinary flow, irritative voiding and urgency, were significantly correlated with IgM and C3 deposition and, to a lesser extent, fibrinogen deposition. The aetiology of chronic abacterial prostatitis remains obscure but several possible mechanisms are discussed. The link between symptomatology and immunology could rest with functional outflow obstruction causing intraprostatic reflux of urine, this in turn inciting an immunological response, the inducing antigens being organism remnants or products, urinary constituents or autoantibodies.
Extracorporeal Shockwave Lithotripsy Monotherapy for Paediatric Urinary Tract Calculi
Authors: THORNHILL J. A. , MORAN K. , MOONEY E. E. , SHEEHAN S. , SMITH J. M. , FITZPATRICK J. M.
Published: November 2008

Summary— The role of extracorporeal Shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non‐invasive method of managing even complex stones in children of all ages, irrespective of size or position.
Treatment of Caliceal Calculi
Authors: HÜBNER W. , PORPACZY P.
Published: November 2008

Summary— We analysed the course of 80 “stone periods” (the time that elapses between making a diagnosis and passage of a stone, operation, or an out‐patient's last check‐up) in 62 patients with caliceal stones prior to the development of extracorporeal Shockwave lithotripsy (ESWL) and endourology. The observation time per patient averaged 7.4 years; 16% of the stones passed spontaneously and 40% were removed surgically. The infection rate was 68% and 45% of the stones increased in size during the observation period. Retrospective evaluation showed that of 32 patients who underwent surgery, only 11 procedures were performed at the appropriate time. In the remaining 21 cases the timing of surgery was judged to have been too late because of the ensuing complications. In 8 patients stone growth led to staghorn calculi, 8 had acute obstruction with incipient urosepsis, 3 had chronic urinary infection and 1 had loss of kidney function.

We believe that 83% of all caliceal stones require intervention (ESWL or percutaneous nephrolithotomy) within 5 years of diagnosis. Only 11% of patients with caliceal calculi remain svmDtom‐free after 10 vears.
Voiding Patterns and Prevalence of Incontinence in Women.: A Questionnaire Survey
Authors: SOMMER P. , BAUER T. , NIELSEN K. K. , KRISTENSEN E. S. , HERMANN G. G. , STEVEN K. , NORDLING J.
Published: November 2008

Summary— A detailed questionnaire on the occurrence of irritative and obstructive voiding symptoms, incontinence and the number of childbirths was sent out to 600 women aged between 20 and 79 years, randomly selected from the National Register; 432 (72%) returned the questionnaire and 414 (69%) were evaluable. The frequency of obstructive symptoms such as hesitancy, intermittency and decreased stream was low. Diurnal frequency with voiding intervals <3 h were recorded by more than 50% of the women and about 10% voided more frequently than every second hour. Nocturia increased significantly with age; 54 (13.6%) voided at least twice per night. About 40% complained of incontinence but this was troublesome in only 6%; 15.3, 13.3 and 11.5% had stress, urge and mixed incontinence respectively. More than 8% wore nappies or sanitary towels every day to protect against urinary leakage. Although the tendency to wear nappies or sanitary towels increased with age, the increase was not statistically significant. There was a positive correlation between the occurrence of stress incontinence and childbirth in the group as a whole.
Cystoplasty: Tubularisation or Detubularisation ?
Authors: WHITFIELD H. N. , CHENG C.
Published: November 2008

Summary— Previous studies on substitution or augmentation cystoplasty have highlighted the profusion of surgical techniques available, but there is disagreement as to which is the best. We established an animal model to compare various types of cystoplasties, tubularised and detubularised, using ileum and caecum. Detubularisation did not abolish intrinsic bowel contractions but delayed their onset. No differences were noted in the frequency and amplitude of such contractions after detubularisation or between large and small bowel cystoplasties. Although intravenous urography did not demonstrate any abnormality in upper tract anatomy, a significant number of animals had some functional disturbance of the kidney after cystoplasty demonstrable on isotope renography, irrespective of the surgical technique. It may be possible to prevent these contractions with their associated harmful effects by preventing the bladder volume from building up excessively.
Permanently Implanted Urethral Stent for Prostatic Obstruction in the Unfit Patient: Preliminary Report
Authors: CHAPPLE C. R. , MILROY E. J. G. , RICKARDS D.
Published: November 2008

Summary— We describe the use of a new urethral stent implanted into 12 patients with prostatic outflow obstruction. All were in a high risk group for surgery and 11 were treated successfully, with a follow‐up of 1 to 11 months (median 9). The majority of patients were satisfied with the procedure, which provided a quick, safe and effective alternative to conventional surgical treatment. The stent, woven from fine stainless steel in the form of a tubular mesh, was inserted via a delivery device using combined ultrasound and endoscopic control under local anaesthesia. The procedure was well tolerated, the stent becoming covered with epithelium by 6 to 8 months following insertion, yet allowing easy removal within the first 4 to 6 weeks should the need arise. This technique provides a useful alternative to conventional surgical treatment in the high risk patient.
99m Tc DTP A Diuretic Renography in the Evaluation of Surgery in Chronic Schistosomal and Non‐schistosomal Obstructive Uropathy
Authors: BAHAR R. H. , SABHA M. , KOURIS K. , BRITTON K. E. , ALI Y. M. , AWDEH M. , ABDEL‐DAYEM H. M. , NILSSON T.
Published: November 2008

Summary The selection of patients with chronic obstructive uropathy for surgery is difficult because of problems in identifying true obstruction in a grossly dilated urinary tract. This is especially so in schistosomal (bilharzial) obstructive uropathy.

A prospective study of 90 patients (68 with chronic schistosomal and 22 with non‐bilharzial obstructive uropathy) was carried out. All patients underwent pre‐operative and post‐operative radionuclide 99mTc DTPA diuretic renography (RDR). The aims were to assess the value of RDR in the pre‐ and post‐operative management of these patients and whether it could predict the outcome of surgery.

Distinctive renogram patterns were identified in patients who required surgical management. These were found useful in monitoring the results and in predicting the outcome of surgery.
Effect of Capsaicin on the Rabbit Urinary Bladder. What is the Function of Sensory Nerves that Contain Substance P?
Authors: HARRISON S. C. W. , FERGUSON D. R. , HANLIEY M. R.
Published: November 2008

SummaryThe sensory innervation of the rabbit urinary bladder was studied using local application of the specific sensory neurotoxin capsaicin (8‐methyl‐N‐vanillyl‐6‐nonenamide). This agent has its major effect by damaging small diameter unmyelinated sensory nerves. The drug produced a 51% reduction in the bladder content of the neuropeptide substance P. It therefore appears that a substantial proportion of the bladder's content of the peptide is to be found in capsaicin‐sensitive sensory nerves. Cystometrograms carried out before and after treatment with capsaicin were similar; this suggests that capsaicin‐sensitive sensory nerves may not be of importance in the afferent limb of the micturition reflex.In vitromuscle strip studies demonstrated a small reduction in the sensitivity of the detrusor muscle to electrical stimulation of its intramural nerves. It is possible thatin vitrointramural nerve stimulation leads to release of neurotransmitters from sensory as well as motor nerves. It is proposed that small diameter sensory nerves in the bladder wall may have a role in the transmission of the sensation of pain and in the triggering of inflammatory reactions rather than forming the afferent limb of the micturition reflex.
Tumour Markers as Prognostic Aids in Prostatic Carcinoma
Authors: LEWENHAUPT A. , EKMAIM P. , ENEROTH P. , NILSSON B.
Published: November 2008

Summary–Of 102 patients suffering from prostatic carcinoma, complete data on the serum concentration of 7 tumour markers were available from 90 patients, together with tumour grade, local stage and the presence or absence of skeletal metastases. The serum content of prostatic acid phosphatase, prostate specific antigen, neopterin, thymidine kinase, osteocalcin, C‐reactive protein and tissue polypeptide antigen was measured. By means of Cox's regression and multivariate analysis the ability of these variables to predict prognosis,i.e.death from prostatic cancer, was studied.

Neopterin appeared to be the most efficient marker, followed by tumour grade, thymidine kinase and prostate specific antigen. No other variable provided information of statistical significance. In multivariate analysis thymidine kinase performed best, followed by neopterin, tumour grade and prostate specific antigen.

Several serum tumour markers reflect the biological activity of human prostate cancers and their value should be further explored. They may become useful in the management of individual patients.
Serum Acid Phosphatase in Patients with Localised Prostatic Cancer, Benign Prostatic Hyperplasia or Normal Prostates
Authors: SALO J. O. , RANNIKKO S. , HAAPIAINEN R.
Published: November 2008

Summary –Serum acid phosphatase levels were determined in 247 men with surgically confirmed intracapsular prostatic cancer (30 patients), benign prostatic hyperplasia (BPH) (114 patients) or palpably normal prostates (103 men). Both radioimmunoassay (245 cases) and an enzymatic method (218 cases) were used. Using radioimmunoassay, the mean serum prostatic acid phosphatase (PAP) level was significantly higher in patients with BPH than in patients with intracapsular cancer or men with normal prostates. The weight of hyperplastic tissue removed during operation in the BPH group correlated closely with PAP concentrations. Age or the presence (or absence) of an indwelling catheter had no effect on PAP concentrations. Using the enzymatic method, the highest levels of acid phosphatase were also detected in patients with BPH but the difference was less marked.

It was concluded that intracapsular cancer does not elevate serum acid phosphatase levels as determined by radioimmunoassay or an enzymatic method. BPH alone leads to significant rises in PAP concentrations. The degree of BPH correlates with PAP levels.
Relationship of Primary Site of Testis to Final Testicular Size in Cryptorchid Patients
Authors: PURI P. , SPARNON A.
Published: November 2008

Summary –Testicular volume was examined in men who had undergone orchiopexy at or after 7 years of age; 159 men with 187 cryptorchid testes were available for estimation. The mean age at orchiopexy was 9.8 years (range 7–13.6) and the mean age at follow‐up was 24.3 years (range 18–41). The data showed that surgically treated cryptorchism was associated with testes that are significantly smaller than normal. The most important factor in relation to subsequent testicular size was whether or not the testes were palpable. Testes found in the superficial inguinal pouch were approximately 85% of normal testicular volume. Contralateral testicular volume in unilaterally cryptorchid patients was not significantly different from that of controls.
Study of Factors Affecting Calcium Oxalate Crystalline Aggregation
Authors: GRASES F. , COSTA‐BAUZA A.
Published: November 2008

Summary— A study was made of the effects of citrate, pentosan polysulphate (a glycosaminoglycan) and mucin (a mucoprotein) upon crystalline growth and aggregation of calcium oxalate in synthetic urine. It was found that citrate inhibited aggregation. Pentosan polysulphate had no perceptible effect on aggregation but favoured the formation of calcium oxalate dihydrate crystals. Mucin enhanced the formation of large characteristic aggregates and also led to the formation of calcium oxalate dihydrate crystals. Particles of mucin in a solution served as a substrate on which several crystals of calcium oxalate dihydrate were formed by heterogeneous nucleation; the subsequent growth of these crystals resulted in the formation of large agglomerates.
Effects of Acid‐base Changes on Human Ureteric Smooth Muscle Contractility
Authors: COLE R. S. , FRY C. H. , SHUTTLEWORTH K. E. D.
Published: November 2008

Summary— Wide fluctuations of both urinary pH and the partial pressure of CO2 (PCO2) occur in normal physiological circumstances and in a variety of pathological conditions. However, the effect of extracellular pH on the contractility of human ureteric muscle has not been clearly defined.

This study has established, using a microsuperfusion technique, that an increased superfusate PCO2 increases the magnitude of the phasic contraction to electrical field stimulation. A similar extracellular acidosis induced by alteration of the [HCO3‐], at constant [Na+] and free [Ca2+], was without significant effect. Furthermore, when both superfusate PCO2 and [HCO3‐] were simultaneously increased at constant pH the contractile response was similar to that when PC02 alone was raised.

These observations suggest that the changes of tension were mediated by intracellular pH changes, providing it is assumed that the ureteric smooth muscle cell membrane is permeable to CO2 but impermeable to H+ and HCO3‐. The occurrence of an increase of force in the presence of an acidosis is a highly significant and unusual finding, since it has been assumed that the classical association between acidosis and negative inotropy, seen in cardiac muscle, was also applicable to smooth muscle.
Pathological Classification and Follow‐up of Prostatic Lesions Initially Diagnosed as “Suspicious of Malignancy”
Authors: KEANE P. F. , ILESLEY I. C. , O'DONOGHUE E. P. N. , PARKINSON M. C.
Published: November 2008

Summary— Sections from a series of prostatic specimens (n = 44) in which the initial diagnosis implied a suspicion of malignancy were reviewed and the patients followed up (group 1).The aim was to categorise the morphological appearances according to current criteria and to determine the natural history of any pre‐malignant lesions within this group. A “control” series of patients (n = 40) in whom the primary diagnosis was benign were also reviewed and their course followed (group 2).

The heterogeneity of the abnormalities in group 1 was striking. Of the 44 cases, pre‐malignant lesions were seen in 8, microinvasive adenocarcinoma in 11 and lesions not now considered pre‐malignant in the remaining 25. None of the 8 patients with pre‐malignant lesions developed clinical evidence of carcinoma over a follow‐up period of 8 to 12 years. In contrast, 3 of the 11 diagnosed on review as having microscopic invasive adenocarcinoma developed clinically evident tumour within 5 years of surgery. Of the 25 patients whose prostatic lesions were considered benign, 2 developed carcinoma 12 and 13 years after surgery. Only 1 of the 40 patients in group 2 had a pre‐malignant lesion and he did not develop tumour within 10 years. However, adenocarcinoma was diagnosed incidentally in 1 patient 3 years after surgery.

It was concluded that there is a need to standardise interpretation and reporting of pre‐malignant lesions and microscopic foci of adenocarcinoma in the prostate. The limited results on the course of pre‐malignant lesions diagnosed incidentally in patients over 60 years of age do not indicate that follow‐up would have prompted the early diagnosis of invasive disease.

Read at the 45th Annual Meeting of the British Association of Urological Surgeons in St Helier, June 1989
Ritual Circumcision (Umkhwetha) amongst the Xhosa of the Ciskei
Authors: CROWLEY I. P. , KESNER K. M.
Published: November 2008

Summary— The Umkhwetha is an ancient custom of ritual circumcision still practised by the Xhosa people of Southern Africa. In 45 consecutive youths who required hospital admission the mortality rate was 9%. The complications seen over the years are reviewed and their management discussed.
Calcium Oxalate Crystallisation Kinetics and the Effects of Calcium and γ‐Carboxyglutamic Acid
Authors: NISHIO S. , KAVANAGH J. P. , FARAGHER E. B. , GARSIDE J. , BLACKLOCK N. J.
Published: November 2008

Summary— γ‐carboxyglutamic acid (GLA) is an amino acid with a high affinity for calcium. It is found in urine both as the free amino acid and incorporated into proteins such as osteocalcin. Free and bound GLA have been reported to be found at higher concentrations in the urine of stone formers than controls. We have investigated the effect of GLA and calcium, at physiological levels, on the crystallisation of calcium oxalate using a mixed suspension mixed product removal continuous crystalliser.

GLA caused very significant changes in the crystallisation kinetics, but the effect was dependent on the calcium concentration. At 4 mM calcium, GLA decreased the growth rate and increased the nucleation rate; at 12 mM the reverse occurred. At all concentrations of calcium tested, GLA caused a significantly increased crystal mass to be produced. Our evidence supports the hypothesis that GLA modifies calcium oxalate crystallisation and could be a promoter of stone formation in vivo, particularly at moderately elevated levels of calcium excretion.
Response to Treatment of Detrusor Instability in Relation to Psychoneurotic Status
Authors: MOORE KATE H. , SUTHERST J. R.
Published: November 2008

Summary— A total of 53 females who entered a double‐blind crossover trial of oxybutynin and placebo for idiopathic detrusor instability were questioned about life events and associated medical disorders and were given a psychometric test. Their response to treatment was studied in relation to these factors.

It was found that 11% of patients had nocturnal enuresis beyond age 8 and 25% had irritable bowel syndrome: their response to treatment was generally poor. Life events were not consistently related to treatment response. The mean psychoneurotic score of “poor responders” (43.7) was similar to that of female psychoneurotic out‐patients (47.7), although one‐third of poor responders were normal. Patients who responded well to simple anticholinergic treatment had a mean score (30.7), which was similar to that of normal urban females (33.5).

Most good responders and one‐third of poor responders showed little evidence of psychoneuroticism: a further search for neurophysiological abnormality in idiopathic detrusor instability is needed.
Urinary Infection Following Out‐patient Flexible Cystoscopy
Authors: CLARK K. R. , HIGGS M. J.
Published: November 2008

Summary— Of 161 flexible cystoscopies performed in an out‐patient endoscopy suite, the incidence of urinary tract infection was 7.5%. Infection rates were higher in patients with a history of previous urinary tract infection or where an additional procedure was also performed. No difference was noted between the infection rates in men and women.
Do Extracorporeal Shock Waves Affect Urinary Excretion of Glycosaminoglycans?
Authors: KARLSEN S. J. , SMEVIK B. , LUND K. KLINGENBERG , BERG K. J.
Published: November 2008

Summary— Urinary excretion of glycosaminoglycans (GAGs) was studied in 9 anaesthetised dogs and 10 patients with single kidneys. The animals were studied for 4 to 5 hours after administration of shock waves to 1 kidney, the contralateral organ serving as control. Urinary excretion of GAGs was measured on both sides. The patients were studied 0 to 24 and 32 to 56 h after extracorporeal shock wave lithotripsy (ESWL). In the animals an increased mean urinary excretion of GAGs was observed on both sides; this was more marked in the treated kidney. The increase reflects tissue injury in the exposed kidney induced by the extracorporeal shock waves. No increase in mean urinary excretion of GAGs was observed in the patients.
Transitional Cell Carcinoma of the Upper Urinary Tract: Prognostic Variables and Post‐operative Recurrences
Authors: KROGH J. , KVIST E. , RYE B.
Published: November 2008

Summary— In a retrospective study of 198 patients with transitional cell carcinoma of the upper urinary tract, post‐operative recurrences developed as contralateral tumours in 2.5%, in the ureteric stump after conservative resection in 19% and in the bladder in 36.4%. Upper tract recurrences resembled the primary tumours in terms of grade and stage; of the bladder tumours, 89% were similar in grade and 72% similar in stage to the primary tumours.

Age, sex, grade and stage had no effect on the number of bladder recurrences, but ureteric tumours had significantly more recurrences than renal pericaliceal tumours. Sex, bladder recurrences and site of primary tumours did not influence survival. Thus grade and stage of the primary tumour were the only predictive variables of the final outcome.
Pattern of Urological Malignancy in Zambia A Hospital‐based Histopathological Study
Authors: ELEM B. , PATIL P. S.
Published: November 2008

Summary— The pattern of urological malignancy among the indigenous population of Zambia (determined on the basis of histopathological reports from a major national hospital during an 8‐year period) is presented. A total of 6514 malignancies were observed, of which 784 (12%) were of urological origin. Bladder carcinoma, predominantly squamous type, was the commonest urological tumour (51%), followed by carcinoma of the prostate (26%), carcinoma of the penis (18%), renal tumours (4.3%) and testicular malignancy (0.7%). In nearly 32% of the bladder tumours, bilharzial ova were demonstrated histopathologically. Nephroblastoma accounted for 70% of the renal tumours and from a total of 7 cases of testicular tumours 5 were embryonal carcinoma and 2 seminoma. A brief reference is made to the pattern and aetiology of urological malignancies in some neighbouring countries.
Acquired Renal Cystic Disease: Implications for the Urologist
Authors: BRENNAN J. F. , STILMANT MAGDA M. , BABAYAN R. K. , SIROKY M. B.
Published: November 2008

Summary— Acquired cystic kidney disease has become increasingly recognised as a significant risk in patients with end‐stage renal disease, especially in those maintained on chronic haemodialysis and peritoneal dialysis. A review of the literature indicates that nearly 50% of patients on dialysis for more than 3 years develop renal cystic changes. The major complications of this condition are neoplasia and spontaneous renal haemorrhage. The risk of developing renal carcinoma has been estimated to be more than 30 times higher in dialysis patients with cystic changes than in the general population. Our experience with 5 patients is reported, including 3 with renal tumours and 1 with metastatic disease. Careful surveillance of dialysis patients using yearly ultrasonography and computed tomography is recommended. The evolving indications for radical nephrectomy in this disease are discussed.
Long‐term Follow‐up of Children with Testicular Tumours: Surgical Issues
Authors: BRUCE J. , GOUGH D. C. S.
Published: November 2008

Summary— Testicular tumours are rare in childhood. The clinical, pathological and follow‐up details of 48 children are presented. The combined approach of surgery, chemotherapy and radiotherapy is confirmed as being extremely effective. Transcrotal orchiectomy is not an appropriate surgical procedure. Testicular biopsy is detrimental to prognosis.
Comparison of alpha1 Adrenoceptors in the Prostate Capsule of Men with Symptomatic and Asymptomatic Benign Prostatic Hyperplasia
Authors: LEPOR H. , GUP D. I. , BAUMANN MARY , SHAPIRO ELLEN
Published: November 2008

Summary— The objective of this study was to compare the binding and functional properties of alpha, adrenoceptors in prostate capsules obtained from men with symptomatic and asymptomatic benign prostatic hyperplasia (BPH) undergoing simple retropubic prostatectomy and cystoprostatectomy respectively. Saturation experiments using 125l‐Heat demonstrated that the density and binding affinity of alpha, adrenoceptors in the prostate capsules obtained from men with symptomatic and asymptomatic BPH were similar. Non‐cumulative dose response experiments using phenylephrine demonstrated that the magnitude of the contractile response to phenylephrine was 4‐fold greater in the prostate capsules from men with symptomatic BPH than from those with asymptomatic BPH. The EC50 of phenylephrine in the prostate capsules of men with symptomatic and asymptomatic BPH was similar. A correlation between alpha, adrenoceptor density and phenylephrine Emax was not observed, implying that either alpha1 adrenoceptors are not localised exclusively to the prostate smooth muscle or that spare alpha, adrenoceptors exist. This study suggests that the neuropharmacological properties of the prostate capsule may play a significant role in the development of infravesical obstruction in the ageing male population.
Non‐invasive Assessment of Arteriogenic Impotence: A Comparative Study
Authors: GILBERT H. W. , DESAI K. M. , GINGELL J. C.
Published: November 2008

Summary— This study was undertaken to determine the relative accuracy of computerised Doppler waveform analysis and colour coded duplex ultrasonography in the diagnosis of arteriogenic impotence. Twenty men with ostensibly normal penile haemodynamics were compared with 50 men whose impotence was considered due to compromised penile haemodynamics. In each patient the penile arterial inflow was assessed by both methods of investigation, which were performed at an interval of 2 weeks. The results demonstrated both techniques to be sensitive in detecting penile artery insufficiency but colour coded duplex ultrasonography was significantly more accurate.
Cavernosometry: Methodology and Reproducibility with and without Pharmacological Agents in the Evaluation of Venous Impotence
Authors: KROMANN‐ANDERSEN B. , NIELSEN K. KRØYER , NORDLING J.
Published: November 2008

Summary— Venous impotence can be evaluated by cavernosometry, although this is a controversial issue.

We have evaluated various techniques for cavernosometry: with and without intracavernous papaverine, with different dosages and modalities, with different modes of induction flow and at various intracavernous pressures. A standardised technique was tested and retested in 32 impotent men. If pharmacocavernosometry is accepted as the most reliable test and a maintenance flow < 20 ml/min indicates optimal venous occulsion, plain cavernosometry gave 6% false positive and 16% false negative results.

Pharmacocavernosometry was found to be highly reproducible with regard to maintenance flow for patients thought to have optimal venous occlusion and for those with supposed leakage. The induction flow was of no diagnostic value.

After injection of papaverine the maintenance flow became a reproducible parameter for quantifying venous outflow and could be measured with an intracavernous pressure equivalent to systolic blood pressure to minimise cavernous arterial inflow and increase reproducibility.
Histological Grading of Squamous Cell Carcinoma of the Penis: A New Scoring System
Authors: MAICHE A. G. , PYRHÖNEN S. , KARKINEN M.
Published: November 2008

Summary— A system of histological grading based on retrospective analysis of 239 patients with squamous cell carcinoma of the penis is presented. A new scoring system with 4 histological grades was used. The results of this study confirm previous reports that penile cancer is usually a highly (50%) or moderately (29%) differentiated squamous cell carcinoma. Poorly differentiated carcinomas and cancers of other types are very rare. The new grading system was found to be practical and a correlation between histological grade, clinical findings and prognosis was established. Patients with grade 1 tumours had an exceptionally favourable prognosis, with more than 80% being long‐term survivors; for these patients, treatment with delayed side effects should be avoided and new forms of treatment should be explored.
The Winchester Experience with the TDS Hospital Information System
Authors: HARRISON G. S. M.
Published: November 2008

Summary— The Royal Hampshire County Hospital is a pilot site for the Resource Management Initiative. It is also the pilot site within the Wessex Region for the Hospital Information System (HIS).

We have pursued an ambitious, integrated information system strategy within the hospital. This has been planned and most of it implemented within a short timescale. Although some of the remaining difficulties are technical, the greatest challenges relate to people, their reactions to the introduction of new technology and the need to acquire new skills. The training and development of staff become critical. The importance of an effective management structure with major medical and nursing involvement has been, and will remain, crucial to our continued progress.
Ammonia Levels in Paediatric Ureterosigmoidostomy Patients: A Screen for Hyperammonaemia?
Authors: DIAMOND D. A. , BLIGHT ANNE , SAMUELL C. T. , RANSLEY P. G.
Published: November 2008

Summary— Hyperammonaemia in the urological patient is a rare and potentially grave condition. It has been reported most frequently in association with ureterosigmoidostomy, where clinical neurological symptoms have developed abruptly in association with markedly elevated plasma ammonia levels. The purpose of this study was to determine whether ureterosigmoidostomy patients might have subclinically elevated plasma ammonia levels, which would put them at risk of subsequently developing hyperammonaemic encephalopathy. Both urine and plasma ammonia levels were assayed in 10 asymptomatic paediatric urological patients with ureterosigmoidostomy. Ten paediatric colocystoplasty patients served as controls. Urine pH and urine ammonia levels were significantly higher in the ureterosigmoidostomy group. There was no significant difference in plasma ammonia levels between ureterosigmoidostomy and colocystoplasty patients. In none of the patients was the plasma ammonia level elevated, but 1 ureterosigmoidostomy patient had an exceedingly high urine ammonia level. It was concluded that an annual serum ammonia level in an asymptomatic ureterosigmoidostomy patient is probably not a valuable screen for subclinical hyperammonaemia.
Characterisation of Inflammatory Cells Associated with “Idiopathic Retroperitoneal Fibrosis”
Authors: PARUMS DINAH V. , CHOUDHURY R. P. , SHIELDS S. A. , DAVIES A. H.
Published: November 2008

Summary— During ureterolysis in a patient with “idiopathic retroperitoneal fibrosis”, fresh samples of peri‐ureteric and peri‐aortic tissue were obtained. An abdominal CT scan confirmed the peri‐aortic distribution of the inflammation associated with advanced abdominal aortic atherosclerosis. Histology confirmed the presence of fibrosis and a variable chronic inflammatory cell infiltrate. Monoclonal antibodies were used to identify the inflammatory cells. B and T lymphocytes were present with the majority of T lymphocytes of the T helper phenotype. The majority of lymphocytes and macrophages and most vascular endothelial cells were HLA‐DR positive. Ki67 and BerH2 staining was found in B cells and T helper cells, indicating that these cells were proliferating and activated. These findings compare with the characterisation of inflammatory cells associated with “inflammatory aneurysms” and with the inflammatory cells present in the spectrum of inflammation seen as a complication of advanced atherosclerosis—conditions known as “chronic peri‐aortitis”. It is suggested that our findings support the view that idiopathic retroperitoneal fibrosis represents clinical chronic peri‐aortitis seen in an undilated aorta.
Urethral Pressure and Power Generation during Coughing and Voluntary Contraction of the Pelvic Floor in Females with Genuine Stress Incontinence
Authors: LOSE G.
Published: November 2008

Summary— A probe which permits continuous measurement of the related values of pressure and cross‐sectional area in the female urethra was used for a quantitative description of the adjunctive closure forces in terms of pressure and power generation during coughing and squeezing in 30 females with genuine stress incontinence (GSI). Measurements were performed at the bladder neck, midurethrally and distally in the urethra.

A statistically significant decrease in power generation was found at the bladder neck and midurethrally during squeezing compared with the values in healthy females. During coughing the power generation was significantly decreased midurethrally and measurement of pressure generation revealed similar results. These findings indicate that the active closure mechanisms at the bladder neck and midurethra are significantly weakened in females with GSI. The results do not support the concept that impaired passive pressure transmission to the urethra is an important pathophysiological factor in GSI.
Multi‐centre Phase II Study of Low Dose Intravesical Epirubicin in the Treatment of Superficial Bladder Cancer
Authors: WHELAN P. , CUMMING J. A. , GARVIE W. H. H. , HARGREAVE T. B. , KIRK D. , NEWLING D. W. W. , ROBINSON M. R. G. , FRCS P. H. SMITH
Published: November 2008

Summary— Forty patients with multiple recurrent superficial bladder tumours received an 8‐week course of weekly instillations of 4' epirubicin 30 mg in 50 ml saline. The overall response rate was 58% and side effects were minimal.
Prostatic Specific Antigen Related to Clinical Status 1 to 14 Years after Radical Retropubic Prostatectomy
Authors: STEIN A. , DeKERNION J. B. , DOREY F.
Published: November 2008

Summary— Serum prostatic specific antigen (PSA by Tandem‐R immunoassay) was measured in 190 patients after radical prostatectomy for prostate cancer. Serial measurements were made in all patients operated on in the past 3 years; 131 had undetectable levels and 59 had levels in the detectable range. Only 10% of the patients with undetectable PSA following surgery had seminal vesical involvement or positive lymph nodes. None of the patients with undetectable PSA have had clinical recurrence within the 41 months of mean follow‐up. In 14 patients who had PSA serially measured since surgery, detectable levels were found within 6 months of operation and 7 of these patients had clinical progression within 2 years; 39 patients had detectable PSA after radical prostatectomy with no clinical evidence of recurrence. Biopsy of the anastomosis was performed in 11 patients with isolated detectable PSA after surgery and local recurrence was established in 4. PSA was detectable later in the follow‐up of 45 patients operated on before the PSA assay became available but the date when PSA actually became detectable is not known. A relatively new method of estimating that date and constructing a corresponding Kaplan Meier curve is presented. PSA is an effective marker for monitoring patients after radical prostatectomy as it often detects early persistent disease in patients with detectable measurements 6 months post‐operatively or recurrent disease in patients with later rising levels.
Urological Aspects of Behcet's Disease
Authors: KIRKALI Z. , YIGITBASI O. , SASMAZ R.
Published: November 2008

Summary— Behcet's disease, affecting mostly young males in the Mediterranean countries and Japan, is a multi‐system disease with urological manifestations. In this prospective study of 100 consecutive patients with newly diagnosed Behcet's disease, we found that 89% of the males had experienced scrotal ulceration and 6% had epididymitis. We also observed sterile urethritis in 3%. Other urological abnormalities appeared to be coincidental findings.
Xanthogranulomatous Pyelonephritis with Nephrocutaneous Fistula at the Knee
Authors: ARANGO O. , ROSALES A. , GELABERT A.
Published: November 2008

The case involves a xanthogranulomatous pyelonephritis (XGP) with a homolateral nephrocutaneous fistula at the knee. The case's interest lies in the unprecedented length of the fistula (Parson et al, 1986).
Ileocaecal Intussusception due to Metastatic Renal Carcinoma
Authors: KHAN A. B.
Published: November 2008

Intussusception is the telescoping of a segment of bowel into an adjacent area. It usually occurs in children with a peak incidence at 4 years. When intussusception occurs in adults it is predominantly associated with a lead point. In the present case, intussusception was due to metastatic renal tumour.
Morphometric Evidence for Bone Resorption and Replacement in Prostate Cancer
Authors: CLARKE N. W. , McCLURE J. , GEORGE N. J. R.
Published: November 2008

Summary A series of 78 patients with metastatic bone disease from prostate cancer underwent iliac crest biopsy, enabling histomorphometric quantification of eroded bone surface and bone volume in both tumour‐free and metastatic bone tissue. Eroded surfaces in tumour‐free specimens were high in patients with active compared to stable disease but bone volume was maintained in both groups, whilst in bone surrounding micrometastases (n = 8) eroded surfaces were further increased and bone volume reduced. Eroded surfaces within metastases were greater still but were associated with increased bone volume due to replacement of the existing trabecular tissue with abnormal woven bone, giving an overall appearance of sclerosis. These results show that the effect of prostate cancer on bone tissue is complex, involving differential disturbance of bone formation and resorption within metastases, in bone surrounding tumour invasion and in the tumour‐free skeleton.
Forced Hydration Prior to Renography in Children with Hydronephrosis. An Evaluation
Authors: NAUTA J. , POT D. J. , KOOIJ P. P. M. , NIJMAN J. M. , WOLFF E. D.
Published: November 2008

Summary We have developed a method of diuretic renography for the assessment of upper urinary tract obstruction in children. A maximal diuresis under standardised conditions is obtained by forced intravenous hydration over a 2‐h period prior to renography.

We evaluated the predictive value of this method for the clinical and functional outcome in 73 children with apparent unilateral pelviureteric junction obstruction. The predictive value of a nonobstructive pattern was 94%, while the predictive value of an obstructive pattern could not be assessed accurately because the patients concerned subsequently underwent operation. The method is safe and reliable and offers advantages over conventional diuretic renography.
Diagnostic and Surgical Aspects of Renal Carcinoma with Involvement of the Inferior Vena Cava
Authors: VALE J. A. , HENDRY W. F. , KIRBY R. S. , WHITFIELD H. N. , LUMLEY J. S. P.
Published: November 2008

Summary Over the past 10 years, 13 patients presented with operable renal carcinoma and tumour extension within the inferior vena cava. This was diagnosed accurately in all but 1 patient, using ultrasound.

Radical nephrectomy with removal of tumour within the inferior vena cava was performed in all 13 cases, 2 requiring cardiac bypass. There were no operative deaths and 6 patients remain alive and well with a mean follow‐up of 2 years. The presence and level of vena caval extension did not appear to have an adverse affect on prognosis.