bluuebunny/crossref_metadata_2025_split huggingface dataset:
12  Outcomes of radical prostatectomies and HDR brachytherapy in patients with intermediate and high risk prostate cancer
Authors: MACEK P. , STRICKER P. , STEVENS M. , JAGAVKAR R. , CHALASANI V. , HAYNES A.M. , MATTHEWS J. , BRENNER P. , GOLOVSKY D. , KOONER R. , O'NEILL G. 
Published: February 2006

We present a comparison of 5‐year outcomes of three groups of patients with intermediate and high risk prostate cancer treated with radical prostatectomy (RP) and high‐dose rate brachytherapy (HDRB). A retrospective analysis of patients undergoing RP during periods 1990–1994 and 1998–2000 and patients undergoing HDRB between 1998 and 2000 was performed. Inclusion criteria were: PSA > 20, or GS > 7, or clinical stage ≥T2b. We also calculated 5‐year progression free probability (PFP) based on Kattan nomograms and compared them to actual outcomes.Results:  For RP 1990–1994 group, data were available from 134 patients. Median PSA was 16, median age 65 years, median 5‐year PFP after RP 65%. 28 patients received adjuvant treatment – hormones 20, orchiectomy one, radiotherapy four, radiotherapy plus hormones three. Actual 5‐year progression free survival was 46% and mean time to recurrence 22.5 months. For RP 1998–2000 group, there were 138 patients available. Median PSA was 8, median age 63 years, median 5‐year PFP after RP 66%. 27 patients received adjuvant treatment – hormones nine, radiotherapy nine, radiotherapy plus hormones nine. Actuarial 5‐year progression free survival was 72% and mean time to recurrence 26.5 months. HDRB group consisted of 86 suitable patients. Median PSA was 13, median age 69 years, median 5‐year PFP after RP was 38% and median 5‐year PFP after external beam radiation therapy with 80 Gy was 60%. 81 patients received adjuvant hormonal treatment. Actuarial 5‐year progression free survival was 81% and mean time to recurrence 30.4 months.
14  Early experience with positron emission tomography (PET) in the management of urological malignancies
Authors: O'MALLEY P.J. , HUGHES O. , REES J. , KYNASTON H. 
Published: February 2006

Objective:  To demonstrate management alterations in patients with urological malignancies by the addition of PET.Patients and Methods:  Ten patients with primary urological malignancies were included in this initial series (eight urothelial transitional cell and two penile squamous cell). Conventional imaging of computerised tomography (CT) and / or magnetic resonance imaging (MRI) yielded equivocal staging results pertaining to definitive management. Each patient underwent PET for further staging. Management alterations with respect to PET findings are outlined.Results:  Of the 10 patients, five were downstaged and five upstaged with PET. Management changes are tabulated.Conclusion:  We demonstrated in this series the role of PET in staging urological malignancies in those patients with equivocal conventional findings. Also, more accurate physiological staging allows better oncological treatment decisions and eventual patient outcome. These points highlighted need further clarification with larger series addressing the positive predictive value of PET.  Downstaged
TABLE1: for 14

Diagnosis
CT / MRI
PET
Management

G2T3 Bladder
Pelvic LN
Negative
Surgery

G3T2 Ureter
LN at primary
Negative
Surgery

G3T2® UO
Pelvic LN
Negative
Surgery

T2 Penis
Pelvic LN
Negative
Surgery

T2 Penis
Pelvic LN
Negative
Surgery

Upstaged
TABLE2: for 14

Diagnosis
CT / MRI
PET
Management

G3T2 Ureter
Pelvic LN
Metastatic
Chemotherapy

G3T2 Bladder
Pelvic LN
Metastatic
Chemotherapy

G3T2 Bladder
Pelvic LN
Metastatic
Radiotherapy

G3T4 Bladder
N0 M0
Metastatic
Chemotherapy

G3T3 Bladder
Pelvic LN
Metastatic
Radiotherapy
17  DD3 expression in metastatic prostate cancer
Authors: NGO T. , BURGER M. , LANDERS K. , SCELLS B. , SAMARATUNGA H. , LAVIN M. , GARDINER R.A. 
Published: February 2006

Introduction:  There is currently a deficiency of predictive markers for prostate cancer (PCa). We therefore need to identify more sensitive and specific markers of this disease. Molecular markers are proving to be most useful. There are many genes whose expression patterns are altered in malignant tissues and one such gene is DD3, which is a non‐coding mRNA transcript, shown to be highly over‐expressed in localised prostate cancer. This is a pilot study to identify and quantitate the expression of the DD3 gene in metastatic prostate cancer lymph node specimens.Methods:  Quantitative real‐time PCR (RT‐PCR) was performed on 35 benign prostatic hypertrophy (BPH) specimens, 21 localised PCa specimens and 11 hormone escape metastatic PCa lymph node specimens. All statistical analyses were performed using the Statistical Package for Social Science (SPSS; version 10.00).Results:  DD3 was over‐expressed 140‐fold (P = 0.007) in the localised PCa samples compared to BPH. However, the results for the metastatic tissue samples were more variable, some samples expressed the gene in great quantities while others did not express the gene at all. The over‐expression of DD3 in metastatic PCa tissue was not statistically significant in the samples studied when compare to the localised PCa group (P = 0.19).Conclusions:  Our study shows that the over‐expression of DD3 gene does appear to increase from localised to metastatic prostate cancer. Future applications of this study are to correlate our findings with the expression of DD3 transcripts in the blood and to utilise the DD3 gene as a possible target for vaccine therapies.
4  Audit of androgen deprivation therapy (ADT) register in Auckland region
Authors: ZARGAR H. , BEAVEN T. 
Published: February 2006

Aim:  To determine the indications for therapy and disease state of men with prostate cancer on Luteinizing Hormone Releasing Hormone (LHRH) analogue treatment entered in the Auckland regional ADT register.Method:  Patients were identified from ADT register and further information was obtained using hospital electronic databases (Concerto and CRIS) and general practitioner records.Results:  Two hundred and eleven patients were registered from Jan 2000 to June 2005 on ADT register. The median age at diagnosis was 73 (45–91). 151 patients (71%) were alive at the time of audit. 118 of patients (56%)had a bone scan, 60 of which confirmed bony metastases (28% of all patients). Based on PSA score at diagnosis (>20), Gleason score (8,9,10) and stage of clinical disease (T3 or higher), high‐risk patients were identified.The most common indication for LHRH analogue therapy as first line therapy was advanced local/metastatic disease (39%). 81 (38%) of patient developed hormone refractory disease while on treatment. The patients in high‐risk group were more likely to develop hormone refractory disease (Chi Square test P = 0.009). PSA Doubling Time (PSADT) of less than 10 months was associated with significance risk of developing local/bony complications (Chi Square test P = 0.002) and mortality (Chi Square test P = 0.034). Presence of metastatic disease was associated with increased mortality (Chi Square test P = 0.012).Conclusion:  Patients in high‐risk group are more likely to develop hormone refractory disease. PSADT can be used as an indicator for identifying patients with increased risk of developing complications. Presence of metastatic disease at the time of diagnosis is associated with increased mortality.
41  Retrograde intrarenal stone surgery in ESWL resistant kidney stones
Authors: JUNG H.J. , NOERBY B.N. , OSTHER P.O. 
Published: February 2006

Introduction:  The newer flexible ureteroscopes, 150–200 micron Holmium laser fibres and superflexible Dormias have made stone treatment in all parts of the kidney possible. This evaluation concerns the outcome of Retrograde Intrarenal Stone Surgery (RIRS) in ESWL‐resistant kidney stones.Material and methods:  Thirty‐eight consecutive patients (18 males/20 females) were followed. All patients had undergone ESWL without success. Calculi ranged from 3 to 20 mm (mean 9 mm). In 32 cases stones were fragmented using Holmium laser, and in 6 cases stones were extracted with a zero tip Dormia without fragmentation. Sixteen patients had lower calyceal calculi and eight had abnormal upper tract anatomy. Follow‐up: IVP was performed 6–8 weeks posttreatment.Results:  In all cases the stones were reached and fragmented to some extend. Complete stone freedom was found in 22/38 (58%) patients after one RIRS procedure and 4 (11%) had residual fragments <4 mm which were expected to pass spontaneously. In the remaining 12 patients, who initially had larger stones (mean 11.3 mm), the residual fragments ranged from 5 to 15 mm. Three patients underwent an additional RIRS following which they were stone free. The overall success rate was 76%. There were no major complications.Conclusions:  RIRS is a safe procedure with high success rate and low complication rate. Patients with stones >1 cm, stones in the lower pole and with abnormal renal abnormality may require more than one sitting.
47  Comparison between open and laparoscopic live donor nephrectomy
Authors: KALOUCAVA S. , MARK S. , DAVIDSON P. , ROAKE J. , ARMSTRONG S. 
Published: February 2006

Introduction:  Renal replacement therapy is the best management for end stage renal failure. Laparoscopic Donor Nephrectomy (LDN), which is considered safe and effective, began in our unit in July 2003 with an average transplant rate of 12 per year. The aim of this study is to compare the donor morbidity, recovery and costs between Open Donor Nephrectomy (ODN) and LDN.Method:  A retrospective consecutive series of all Donor Nephrectomies since June 2002 were included in this study. Operative details, postoperative donor recovery, donor and recipients renal functions were reviewed. The total costs will also be calculated and compared.Results:  There were 18 LDN and 18 ODN (Total 36 cases) included in this series and equal number of male to female cases.Average operative time for ODN was 2.07 h and LDN was 3.36 h. There was no intra‐operative conversion from LDN to ODN and no peri‐operative morbidities in either group. The transplanted renal vessel lengths were also compared which showed an average artery length of 40 mm and vein length of 50 mm in the LDN group versus an average of 35 mm artery length and 30 mm vein length in the ODN group. The outcome of the recipient's renal function was not affected whether the donor had OPD or LDN. Average length of hospital stay was 6 days in ODN and 4.5 days in LDN. Costs data to follow.Conclusion:  Laparoscopic Donor Nephrectomy (LDN) is safe and effective in a smaller renal transplant unit.
49  Helical CT 3D reconstruction of renal vessels. Is it accurate? Does it aid hilar dissection in transperitoneal (non‐hand assisted) laparoscopic nephrectomy and nephro‐ureterectomy
Authors: TAN A.F. 
Published: February 2006

Introduction:  Laparoscopic Nephrectomy is increasingly accepted as the choice of treatment in patients who are undergoing nephrectomies. Current indications include renal cell carcinoma (T1 and T2), TCC of upper tract and non‐functioning kidneys. It remains a technically challenging procedure. The dissection of the hilum can be quite demanding, time consuming and stressful to the urologist. We explore the possible advantage of preoperative 3D‐CT reconstruction images of the renal vessels.Method:  The prospective study involved 46 consecutive patients who were undertaking laparoscopic nephrectomies. All the patients had preoperative 3D‐CT and data were collected regarding location, number, anomalies and spatial inter‐relationship of the renal artery and vein. These were then correlated with intra operative data. Other information included peri operative blood loss, transfusion, conversion, hilar dissection time and operative time. These were compared with 26 patients who had previously undergone nephrectomies without the 3D‐CT.Results:  The 3D‐CT was accurate in predicting the location and the anatomical relationship of the vessels in all the cases. However, it predicted the accurate number of arteries and veins in 90% and 80% respectively. With the imaging we were able to reduce the hilar dissection time (20 min), overall operative time (75 min) and blood loss. There was no conversion in the 46 patients.Conclusion:  3D‐CT is an invaluable tool preoperative for patient considered for laparoscopic nephrectomies. It aids hilar dissection by predicting the inter‐relationship of the vessels. However, the surgeon must remain vigilant, as there may be more unsuspected vessel around the corner.
57  The impact of prostate size in laparoscopic radical prostatectomy
Authors: CHANG C.M. , MOON D. , GIANDUZZO T. , EDEN C.G. 
Published: February 2006

Introduction:  Removal of a large prostate can be challenging during open or laparoscopic radical prostatectomy (LRP). Although gland size has been shown not to influence functional outcome in open radical prostatectomy (ORP) (Foley, 2003), longer operating times have been reported for transperitoneal LRP (El‐Feel, 2003; Rassweiler, 2001). The aim of this study was to investigate the influence of prostate size on LRP outcomes.Patients and Methods:  Four hundred cases of LRP were performed. 111 LRP were performed using a transperitoneal approach and 289 using an extraperitoneal approach. 319 patients had a prostate weight ≤75 g and 81 patients had a prostate weight ≥75 g on final histology.Results:  Patients’ age, weight, PSA, Gleason sum and clinical stage were all similar. Values are mean; 1independent samples test; 2Chi‐square test.Conclusion:  Larger prostates were associated with a longer operating time (15 min) but shorter hospitalisation and fewer positive surgical margins. Blood loss and complication rates were similar. Prostate size should not be a factor determining a patient's suitability for LRP. Longer follow‐up is needed to assess the effect of prostate size on functional and oncological results.

1Gland weight (g)
1Op time (min)
1Blood loss (ml)
1Hosp stay (days)
2Compl
2+ margins

Prostate <75 g
46.8
192
259
3.2
4.5%
21.5%

Prostate >75 g
97.8
207
289
2.9
10.5%
9.3%

P
<0.0001
0.03
0.25
0.04
0.07
0.03
6  Can prostatic biopsy predict insignificant disease in Western Australia (WA)
Authors: VIVIAN J.B. , COHEN R. , GARRETT K. 
Published: February 2006

Introduction:  Numerous criteria for predicting insignificant disease based on PSA density, Gleason score, number of and extent of involvement of each core with cancer have been described. Epstein et al have used this to attempt to delay or prevent surgery for low risk or insignificant disease. Epstein's criteria were applied to prostatic biopsies from the WA Uropath database.Method:  The database was searched to identify cases of Gleason score 6 or less, less than 3 cores involved with cancer, and PSA density less than 0.15. Using these criteria 37 cases were identified. All of these cases went on to have a radical prostatectomy.Results:  Nineteen had Tumour Gleason 6 or less and/or volume <=0.5cc at radical (insignificant disease). Eighteen had tumour Gleason 7 or greater and/or volume >0.5cc.Conclusion:  Epstein's criteria when applied to the WA database was inefficient at predicting insignificant disease.
63  Stapling devices: a technical advance in radical retropubic prostatectomy
Authors: HEATHCOTE P.S. 
Published: February 2006

Introduction:  This paper describes the use of a ‘thick tissue’, 3.5 ml staple, six row, articulated endoscopic linear cutting stapling gun in Radical Retropubic Prostatectomy (RRP).Patients and Methods:  One hundred and ninety four consecutive RRPs performed by a single surgeon were analysed. The first 97 were performed without the stapler and the second 97 performed using an identical surgical technique apart from using the Linear cutting stapler.Results:  Groups were of similar age, preop PSA, T stage and Gleason score. There were no staple gun failures. The dorsal venous complex was more safely secured and anastomotic sutures more easily placed especially in the presence of difficult anatomy. Limited division of the puboprostatic ligaments permitted better support of the continence mechanism. Larger pedicles were better secured without distortion of anatomy. Average operative time was reduced from 1.9 to 1.6 h (P = 0.0005). Average blood loss was reduced from 488 to 380 ml (P = 0.03). Positive surgical margins in the absence of extra capsular extension were reduced from 9% to 5% mainly due to better apical dissection. Mean time to return of urinary continence (no pads) improved from 4.6 to 4.0 months and urinary continence at twelve months improved from 88 to 92% (P = NS).Conclusion:  The stapler is reliable and easy to use. It improved surgical access and decreased blood loss and operative time improving the overall safety of the operation. It did not compromise cancer control and may improve urinary continence.
78  Use of a rabbit model to investigate the feasibility of using an innervated neosphincter transplant for the treatment of stress urinary incontinence.
Authors: SHAFTON A.D. , O'CONNELL H.E. , FURNESS J.B. 
Published: February 2006

Aim:  To examine the feasibility of using an innervated smooth muscle wrap as a neosphincter in a rabbit model of urinary incontinence.Methods:  Rabbits were rendered incontinent surgically by lesion of the proximal urethral wall to the level of the submucosa (n = 20). In twelve animals a strip of dartos smooth muscle was wrapped around the lesioned urethra to create a new urethral sphincter and stimulating electrodes were inserted into the muscle. After a recovery period of at least one‐week cystometrograms were established for control (urethra intact), lesioned and lesion plus neosphincter animals.Results:  Infusion of saline into the bladder of control animals caused a slow rise in bladder pressure until, at approximately 20–30 ml, there was an increase in pressure that rose steeply and was associated with bladder emptying. The threshold for this reflex emptying was 2–3 cm H2O, and the maximum pressure during the reflex was 6–15 cm H2O. After the bladder emptied, the pressure dropped to 0–2 cm H2O. In rabbits with lesioned sphincters, it was not possible to obtain a normal cystometrogram because there was leakage of fluid from the urethral opening before a volume and pressure sufficient to elicit a reflex was achieved. The loss of the majority of fluid often occurred without a significant pressure increase, that is, there was no true emptying reflex. Similar results were observed in animals in which the urethra had been lesioned and implanted with the smooth muscle neosphincter. Prior to electrical stimulation of the neosphincter, with constant current pulses at 2 Hz, substantial leak occurred at 11.4 ± 2.5 ml, whereas during stimulation voiding occurred at 17.8 ± 1.4 ml. At void or emptying, the peak pressure was 6.1 ± 0.1 cm H20 in control, 0.7 ± 0.2 in operated but not stimulated and 3.5 ± 0.6 in the same animals during stimulation. A satisfactory improvement of continence was observed for a period of up to 6½ months postsurgery. At the end of the study, histological examination confirmed the neosphincter to be both healthy and viable.Conclusion:  Smooth muscles of the dartos display contractile properties which make them suitable for use as transplantable sphincters. A smooth muscle neosphincter, controlled by electrical stimulation, can restore continence after urethral damage.
81  Botulinum toxin for treatment of non‐neurogenic bladders in children – a case series
Authors: RAO R. , BARKER A. 
Published: February 2006

Objective:  Several studies have shown that intradetrusor injections of botulinum neurotoxin type A may effectively treat intractable spinal neurogenic detrusor overactivity, but fewer reports exist on the use of Botulinum toxin in children with non‐neurogenic detrusor overactivity. The purpose of this study was to investigate the effect of Botulinum injections in the treatment of non‐neurogenic bladders in children.Methods:  Six children with overactive bladder symptoms were treated. Their disorder had been refractory to anticholinergics, bladder training and neuromodulation. Urodynamic studies confirmed idiopathic detrusor overactivity. Total of 300 U Botox A was injected into the dome of the bladder as 30 × 10 U injections. For follow up a bladder diary and validated urgency and incontinence charts were completed by patients at 1, 3 6 months.Results:  Bladder diaries indicated clear reduction in daytime frequency and nocturia and reduction in pad use. Maximal voiding volume increased significantly. All 6 patients were dry after 6 months. No side effects occurred specifically urinary tract infections or retention.

Time
Dry
Partial Response
Nil Response

2 weeks
1
4
1

4 weeks
3
3
0

12 weeks
6

Conclusions:  Botox A injection has positive effects in treating non‐neurogenic bladder overactivity in children.
84  One year results of a French, multicentre, prospective clinical study of act® (adjustable continence therapy) for the treatment of female of stress urinary incontinence due to intrinsic sphincter deficiency
Authors: CHARTIER KASTLER E. , HAAB P. , NORMAND L. , COSTA P. , NAOUM B. 
Published: February 2006

Introduction:  This Prospective, multicentre clinical investigation sought to assess the feasibility and efficacy of the adjustable balloons ACT® for treatment of female Stress Urinary Incontinence SUI with ISD.Materials and Methods:  The ACT® implant consists of a two‐lumen conduit of variable length with an expandable silicone balloon (0.5–8 cc) on the proximal end and a distal subcutaneous titanium port. Two balloons were placed periurethrally at the bladder neck. Continence rate (no leakage during direct visual stress test with 250 ml placed in the bladder), improvement, failures, quality of life (I‐QoL) and morbidity were assessed.Results:  Sixty‐seven patients (62 ± 9.8‐years‐old) were implanted in France during 75 procedures (8 revisions). Average follow‐up was 12 months. At baseline, urethral closure pressure was 22.5 ± 10.8 cm H2Oand 39 patients (58%) had previously undergone at least one surgery for SUI. Continence increased from 0% at baseline to 57% at1 year and I‐QoL improved from 39.4 ± 19 at baseline to 63.7 ± 23.3 at one year. Balloon adjustment was required in 64% of patients. Complications included erosion (11%), spontaneously resolved retention (2%) and infection (4%).Conclusion:  ACT® offers a viable alternative for the treatment of SUI in female with ISD. The implantation is a minimally invasive and efficient procedure and stable over time therapy for patients with severe SUI with ISD. Implantation can be done under local anaesthesia. The positioning of ACT® treatment versus artificial urinary sphincter still needs to be determined.