bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rectal irrigation: a useful tool in the armamentarium for functional bowel disorders
Authors: Chan D. S. Y. , Saklani A. , Shah P. R. , Lewis M. , Haray P. N. 
Published: September 2011

AbstractAim  The efficacy of rectal irrigation (RI) was assessed in patients with various functional bowel disorders.Method  A prospective analysis was carried out of patients presenting to our functional bowel clinic from 2005 to 2009. The Cleveland Clinic Constipation and Incontinence Scores were used to assess outcomes following rectal irrigation. Patients were asked if they were satisfied with RI and would recommend it to a friend.Results  Ninety‐one patients (80 female, median age 51 (17–78) years had undergone rectal irrigation for the following indications: chronic constipation (n = 32), slow transit constipation (n = 18), obstructed defaecation (n = 10), and faecal incontinence (n = 31). Of the 60 patients with constipation, 50 (83%) were available for follow up. Mean constipation scores improved from 18.72 to 11.45 following rectal irrigation (P = 0.001). Twenty‐five patients experienced failure of RI to control symptoms, 10 of whom were offered surgery. Of the patients with incontinence, 20 (67%) were available for follow up. Mean incontinence scores improved from 16.2 to 10.8 with rectal irrigation (P = 0.005). Twelve patients discontinued RI, the commonest reason being lack of improvement in symptoms. Seven of these patients were offered surgery. The only complication was in one patient with constipation who had minor rectal bleeding following irrigation, which was stopped.Conclusion  Rectal irrigation can be a useful tool in the management of functional bowel disorders and should be tried prior to the consideration of any surgery. However, further work is needed to define the precise indications and patient selection criteria.
Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours
Authors: Laydner Humberto , Autorino Riccardo , Spana Gregory , Altunrende Fatih , Yang Bo , Khanna Rakesh , White Michael A. , Isac Wahib , Hillyer Shahab , Haber Georges‐Pascal , Stein Robert J. , Kaouk Jihad H. 
Published: September 2011

Study Type – Therapy (case series)Level of Evidence 4What’s known on the subject? and What does the study add?Although laparoscopic excision of ipsllateral multifocal renal tumours is feasible, the average warm ischemia time is prolonged. Robotic partial nephrectomy in this subset of patients using blunt dissection to enucleate the tumour is feasible and safe.This study demonstrates further that robot‐assisted partial nephrectomy with a small margin of normal tissue is feasible and safe with an acceptable range of warm ischemia time in patients with sporadic ipsilateral multifocal renal tumours. This study also suggest that robotic partial nephrectomy for this particular group of patients may better preserve renal function compared to laparoscopic approach, however this needs to be confirmed with prospective comparative studies.OBJECTIVE• To report our short‐term results of robot‐assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours.METHODS• Over a 3‐year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution.• We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes.RESULTS• In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150–300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6–4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4–4.8). Mean number of tumours removed per patient was 2.4.• Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non‐hilar position), respectively.• Excluding the six off‐clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10–35). Mean estimated blood loss was 250 ± 154 mL (200; 100–500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti‐arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days.• Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II.• The mean decrease in glomerular filtration rate was 4%, with a mean follow‐up of 14 months.CONCLUSIONS• Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe.• Off‐clamp resection of multiple tumours can also be safely performed in carefully selected lesions.
Pelvic floor disorders: linking genetic risk factors to biochemical changes
Authors: Campeau Lysanne , Gorbachinsky Ilya , Badlani Gopal H. , Andersson Karl Erik 
Published: September 2011

What's known on the subject? and What does the study add?Pelvic floor disorders are associated with altered biochemical composition and structure of pelvic tissue. Epidemiological studies have postulated a genetic contribution to pelvic floor disorders.Certain biochemical changes can be explained by candidate genes and polymorphism involved in the expression of ECM‐related proteins.Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) may share a common pathophysiological process related to pelvic floor tissue laxity and loss of support. We reviewed recent literature on observed biochemical changes in women with SUI and POP, linking them to genetic predisposition. We found that studies of pelvic tissues showed differences between control subjects and women with POP and SUI in collagen and elastin structure at a molecular and fibrillar level. Studies were heterogeneous but showed a trend towards decreased collagen and elastin content. The contribution of matrix metalloproteinases to increased collagenolysis can be related to genetic polymorphisms present in higher frequency in women with PFD. Extracellular matrix (ECM) protein turnover plays a role in the development of POP and SUI, but much remains to be understood of this complex dynamic interplay of enzymes, proteins and molecules. Genotyping of candidate genes participating in ECM formation will elucidate the missing link between the manifestation of the disease and the biochemical changes observed systematically, in addition to those in the pelvic floor.
Vitamin D3 cryosensitization increases prostate cancer susceptibility to cryoablation via mitochondrial‐mediated apoptosis and necrosis
Authors: Baust John M. , Klossner Daniel P. , Robilotto Anthony , VanBuskirk Robert G. , Gage Andrew A. , Mouraviev Vladimir , Polascik Thomas J. , Baust John G. 
Published: September 2011

What's known on the subject? and What does the study add?Cryoblation is a highly effective treatment for prostate cancer yet concerns of recurrance remain due to cell survival in the periphery of the frozen volume of tissue where lethal temperatures may not be achieved. To improve efficiency research has focused on the use of low dose adjunctive agents, including vitamin D3 to senstitise cells to mild freezing thereby increasing cancer destruction.This study describes a molecular basis of Vitamin D3 cryosensitization including the response and efficacy of the combination in both androgen‐sensitive and insensitive prostate cancer. The data support a putative role for Vitamin D3 cryosensitization in enhancing prostate cancer sensitivity to mild freezing temperatures providing insight for further optimization and application of this therapeutic option.OBJECTIVES
To investigate the effect and molecular mechanisms of action of Vitamin D3 (VD3) as a neo‐adjunctive agent before cryosurgery in an effort to increase treatment efficacy for prostate cancer (CaP).
To eliminate the potential for disease recurrence that exists at the periphery of the freeze lesion, where temperatures may be insufficient to destroy both androgen‐sensitive (AS) and androgen‐insensitive (AI) CaP.
METHODS
Human CaP cells, LNCaP, were each genetically altered to express the AS and AI phenotypes and subjected to VD3 treatment and freezing in an in vitro and tissue‐engineered model.
Cell viability, caspase inhibitor and western blot studies were used to determine the basis of the different responses of AI and AS cells to VD3 cryosensitization.
RESULTS
VD3 was found to be a highly effective cryosensitizer, resulting in a >50% overall increase in cell death after −15 °C freezing.
Fluorescence microscopy, western blot analysis and caspase protease assays confirmed that the increased activation of apoptosis was modulated through a mitochondrial‐mediated pathway.
Caspase inhibition studies showed that apoptosis played an integral role in cell death, with VD3 cryosensitivation‐induced apoptotic events responsible for >30% of the overall cell death after −15 °C freezing.
CONCLUSIONS
The present study suggests that the use of VD3 as a cryosensitizer increases cryoablation efficacy through the increased activity of apoptosis as well as through necrosis.
The data show that through VD3 treatment the overall level of AI CaP cell tolerance to freezing is reduced to a level similar to that of AS CaP.
VD3 pre‐treatment in conjunction with cryoablation may increase treatment efficacy and reduce disease recurrence for CaP patients.
Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score
Authors: Fujimura Tetsuya , Kume Haruki , Nishimatsu Hiroaki , Sugihara Toru , Nomiya Akira , Tsurumaki Yuzuri , Miyazaki Hideyo , Suzuki Motofumi , Fukuhara Hiroshi , Enomoto Yutaka , Homma Yukio 
Published: September 2011

Study Type – Therapy (symptom prevalence)Level of Evidence 2aWhat's known on the subject? and What does the study add?The International Prostate Symptom Score (IPSS) has been most commonly used for the symptom assessment of men with lower urinary tract symptoms (LUTS). However, LUTS in men are so variable that they may not be fully captured by the IPSS questionnaire alone. This study has demonstrated that the Core Lower Urinary Tract Symptom Score (CLSS) questionnaire, which addresses 10 important symptoms, is an appropriate initial assessment tool for LUTS in men with various diseases/conditions.OBJECTIVE• International Prostate Symptom Score (IPSS) has been commonly used to assess lower urinary tract symptoms (LUTS). We have recently developed Core Lower Urinary Tract Symptom Score (CLSS). The aim of this study is to compare IPSS and CLSS for assessing LUTS in men.PATIENTS AND METHODS• Consecutive 515 men fulfilled IPSS and CLSS questionnaires.• IPSS QOL Index was used as the QOL surrogate.• The clinical diagnoses were BPH (n = 116), BPH with OAB wet (n = 80), prostate cancer (n = 128), prostatitis (n = 68), underactive bladder (n = 8), others (n = 72), and controls (e.g., occult blood) (n = 42).• Simple statistics and predictability of poor QOL (QOL Index 4 or greater) were examined.RESULTS• All symptom scores were significantly increased in symptomatic men compared with controls. Scores of corresponding symptoms of two questionnaires were significantly correlated (r = 0.58–0.85, all P < 0.0001).• A multivariate regression model to predict poor QOL indicated nine symptoms (daytime frequency, nocturia, urgency, urgency incontinence, slow stream, straining, incomplete emptying, bladder pain and urethral pain) as independent factors.• The hazard ratios for bladder pain (2.2) and urgency incontinence (2.0) were among the highest.• All the nine symptoms are addressed in CLSS, while three symptoms (urgency incontinence, bladder, and urethral pain) are dismissed in IPSS.CONCLUSION• CLSS questionnaire is more comprehensive than IPSS questionnaire for symptom assessment of men with various diseases/conditions, although both questionnaires can capture LUTS with possible negative impact on QOL.
Tubeless vs standard percutaneous nephrolithotomy: a meta‐analysis
Authors: Wang Jiawu , Zhao Chunlei , Zhang Chengyao , Fan Xiaodong , Lin Yanjun , Jiang Qing 
Published: September 2011

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?This study showed that tubeless PCNL could reduce hospital stay with little need for postoperative analgesia. This study discussed the clinical feasibility of tubeless PCNL, which is the tendency of PCNL. Our results are reliable by using veta‐analysis from individual studies.OBJECTIVE
To systematically review and compare tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL.
MATERIALS AND METHODS
We conducted a review of the English language literature on studies involving randomized controlled trials for PCNL. The studies chosen to be included in our review compared tubeless PCNL with standard PCNL and described the advantages of each in the outcomes.
Two reviewers independently screened the studies for eligibility, evaluated their quality and extracted the data from the eligible studies, with confirmation by cross‐checking.
Data were processed using RevMan 5.0.
RESULTS
Seven studies involving 1365 cases met the inclusion criteria, and these were included in the meta‐analysis.
The patients' baseline characteristics were comparable in all the studies. By comparing the four common characteristics, we found no difference in efficacy between the two surgical approaches in terms of mean operation duration and postoperative haematocrit change (P > 0.05).
We found that the mean analgesic requirement and number of days in hospital were lower for tubeless PCNL (P < 0.05).
CONCLUSIONS
Our results show that tubeless PCNL is a good option in non‐complicated cases, with the advantages of reduced hospital stay and little need for postoperative analgesia. There was no difference between the two approaches in operation duration, or haematocrit change after surgery.
As only few studies with small study populations were available, more high quality larger trials with longer follow‐up are recommended.
Association of prolactin‐induced protein with preputial development of hypospadias
Authors: Kurokawa Satoshi , Kojima Yoshiyuki , Mizuno Kentaro , Kamisawa Hideyuki , Tozawa Keiichi , Kohri Kenjiro , Hayashi Yutaro 
Published: September 2011

Study Type – Aetiology (individual cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Recent studies have implicated the involvement of various genes in early genital tubercle outgrowth and urethral development. However the previous studies have never focused on preputial development in hypospadias.We have developed a rat model of hypospadias, showing proximal hypospadias in 100% of offspring. We analyzed 20 500 genes of foetal penis from a rat model. We identified one gene, prolactin‐induced protein (Pip). This gene had never been reported about the correlation with penile development. We first demonstrated the association of PIP with preputial development of rat and also human.OBJECTIVE
To investigate the molecular aetiology of hypospadias during a critical developmental period by identifying differentially regulated genes in the tissues of individuals with hypospadias and comparing these genes with similar genes in the tissues of control individuals.
MATERIALS AND METHODS
Pregnant Sprague–Dawley rats were administered flutamide (7.5 mg) on gestational days 15–17 to produce hypospadiac pups. Dams were killed on gestational day 17, and the genital tubercles (GTs) of male pups were harvested.
Gene expression of RNA isolated from the GTs was analysed using an oligonucleotide microarray containing 20 500 genes. The results of microarray analysis were confirmed using quantitative real‐time PCR (qPCR). Protein expression levels were studied using Western blot analysis.
The distribution of genes associated with GT development in rats was histologically examined.
Prepuces harvested from patients with hypospadias and phimosis were immunohistochemically examined for gene distribution.
RESULTS
Of the 20 500 genes, 23 annotated genes, including prolactin‐induced protein (Pip), in the GTs of the hypospadiac rats were expressed at levels less than half of that of similar genes in the GTs of the control rats.
Findings from qPCR and Western blot analysis revealed significantly lower Pip/PIP expression in the GTs of the hypospadiac rats than in those of the control rats.
Immunohistochemical analysis revealed PIP expression in the prepuces of the GTs of the control and hypospadiac rats.
PIP was expressed in the human prepuces of the patients with hypospadias and phimosis.
CONCLUSIONS
Pip/PIP, expressed at low levels in the GTs of hypospadiac rats, may be associated with preputial development. This model can be useful to elucidate the molecular mechanisms underlying penile and urethral development as well as preputial development.
Further studies should provide detailed information regarding the molecular aetiology of hypospadias.
Partial nephrectomy in two patients with known T3a tumours involving the renal vein
Authors: Kim Eric H. , Jain Samay , Benway Brian M. , Figenshau R. Sherburne 
Published: September 2011

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Although nephron‐sparing surgery (NSS) has became accepted therapy for T1 tumours, radical nephrectony is considered the best therapy for T3a tumours involving the renal vein. NSS can be considered in T3a or greater tumours if imperative indications exist, such as bilateral disease or solitary kidney. However, there is little published data on the characteristics of these patients, the impact of surgery on their renal function, and long‐term oncologic outcomes.This study profiles single‐institution experience with nephron‐sparing surgery for known T3a tumours involving the renal vein, including patient characteristics, tumour characteristics, preoperative and follow‐up imaging, preoperative and follow‐up estimated glomerular filtration rate, length of temporary postoperative haemodialysis, and oncologic outcome. Additionally, we compare this to other published data on nephron‐sparing surgery for similar tumors.OBJECTIVE
To present two patients with T3a tumours involving the renal vein who underwent nephron‐sparing surgery (NSS) for imperative reasons.
PATIENTS AND METHODS
Retrospective chart review of patients who underwent NSS for renal cell carcinoma (RCC) with known renal vein tumour thrombus (RVTT).
Both patients underwent open partial nephrectomy and renal vein thrombectomy of a solitary kidney.
Primary outcomes of the study include radiographic evidence of recurrence, haemodialysis requirement and estimated glomerular filtration rate (eGFR) before and after surgery.
RESULTS
Patient 1 is 24 months from NSS and has no evidence of recurrence based on CT scan. His final pathology revealed a 9‐cm, T3a, clear cell, Fuhrman grade II carcinoma. He spent 42 days on haemodialysis and is now off all dialysis. His preoperative and most recent eGFR are 48 and 23 mL/min/1.73 m2 based on the Modification of Diet in Renal Disease (MDRD) equation and 69.4 and 29.8 mL/min by the Cockcroft–Gault equation.
Patient 2 is 9 months from NSS and has no evidence of recurrence based on CT scan. Her final pathology revealed a 6‐cm, T3a, clear cell, Fuhrman grade II–III carcinoma. She spent 30 days on haemodialysis and is now off all dialysis. Her preoperative and most recent eGFR are 58 and 30 mL/min/1.73 m2 based on the MDRD equation and 62.2 and 32.8 mL/min by the Cockcroft–Gault equation.
CONCLUSION
Based on our review, preservation of renal function and favourable oncological outcome can be accomplished with NSS in patients with known stage T3a RCC with RVTT and should be considered in carefully selected patients.
Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the Surveillance, Epidemiology, and End Results program
Authors: Meeks Joshua J. , Zhao Lee C. , Cashy John , Kundu Shilajit 
Published: September 2011

Study Type – Prognosis (individual cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Ductal prostate cancer is a rare histological variant of prostate cancer. The incidence, natural history and outcomes of patients with ductal have not been described. We demonstrate that ductal prostate cancers often present with advanced stage and a high percentage of men die from their disease.OBJECTIVE
To use the national Surveillance, Epidemiology, and End Results (SEER) cancer registry to describe the natural history, national incidence and treatment patterns for ductal prostate cancer (PCa) over the last 20 years, as the available literature on ductal PCa is limited to small case series because of few patient numbers.
PATIENTS AND METHODS
From the SEER registry, 693 men with ductal PCa were identified from 1970.
The demographics, clinical features and cause of death data were collected from men with ductal and acinar histological types.
RESULTS
The incidence of ductal PCa has increased over each decade, but the overall percentage of ductal relative to acinar PCa has remained stable.
Men with ductal PCa were more likely to present with advanced disease (30% T3 with ductal PCa, compared with 7% with acinar PCa).
Men with ductal PCa underwent similar rates of radical surgery, lower rates of radiotherapy but a higher frequency of outlet (transurethral resection) procedures.
Men with ductal PCa had a significantly greater rate of death from PCa (12% vs 4%) than men with acinar PCa.
Comparing PCa‐specific mortality, men with ductal PCa had similar rates of death to men with Gleason 4 + 4 grade acinar PCa.
CONCLUSIONS
Despite a stable incidence, ductal PCa remains an aggressive PCa usually presenting with advanced clinical stage and resulting in a high rate of PCa‐specific mortality similar to Gleason 4 + 4 acinar PCa.
Patients would probably benefit from combined modalities including radical surgery, radiotherapy and palliative outlet procedures.