bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is follow‐up necessary after transurethral resection of the prostate?
Authors: Perkins J.M.T. , O'Brien T.S. , Hanbury D.C. , Cranston D.W. 
Published: November 2008

Objective To assess the necessity for routine out‐patient review following transurethral resection of the prostate (TURP) for benign prostatic hypertrophy.Patients and methods One‐hundred and two patients with histologically proven benign prostatic hypertrophy were prospectively reviewed as out‐patients. The views of their general practitioners were established by postal questionnaire.Results At their first out‐patient review 94 of 102 (92%) patients were discharged and only 2% (2/102) patients remained under review after 1 year. Apart from routine urine analysis, only four additional investigations were initiated at the routine clinical assessment. One patient was listed to undergo prostatic surgery again following the post‐operative out‐patient review. Over the next 16 months only three patients (3%) were re‐referred with further urological problems. Confidence in a system without routine hospital outpatient review was expressed by 90% of general practitioners and 78% of patients.Conclusion Follow‐up after TURP cannot be justified in terms of the perceived therapeutic benefit to patients. Patients should be discharged to the community and be assessed rapidly in out‐patients if and when problems arise.
Prognostic value of prostate‐specific antigen minimum after orchidectomy in patients with stage C and D prostatic carcinoma
Authors: RIEDL C.R. , HUEBNER W.A. , MOSSIG H. , OGRIS E. , PFLUEGER H. 
Published: November 2008

Objective To determine the significance of the minima of prostate‐specific antigen (PSA) levels after orchidectomy in patients with advanced carcinoma of the prostate (stage C and D disease), to thereby discriminate patients who have a statistically significant difference in prognosis and thus individualize their adjuvant treatment.Patients and methods A retrospective analysis of 50 patients (mean age 75.8 years) with extracapsular prostate cancer (58% stage C, 42% stage D disease) was performed. PSA measurement and clinical assessment were continued at 3‐monthly intervals until there was evidence of clinical progression. The minimum values of PSA were determined, the patients grouped at intervals of 1 ng/mL and the groups compared statistically on the basis of disease progression.Results Serum PSA levels decreased in all patients to a minimum after 3–6 months. There was a statistically significant difference in the probability of, and time to, disease progression for PSA minima at 1 ng/mL and 10 ng/mL. Of the 13 patients in group 1 (with PSA minima < 1 ng/mL), 11 stayed in remission during a mean follow‐up duration of 45.9 months. Of 25 patients in group 2 (with PSA minima between 1 and 10 ng/mL) 19 developed progression after a mean remission period of 16.7 months, while all 12 patients in group 3 (with PSA minima > 10 ng/mL) progressed after a mean remission period of 12.5 months.Conclusion Post‐orchidectomy PSA minima are an excellent prognostic factor with significant predictive value. While patients in group 1 tend to have a favourable prognosis after orchidectomy alone, group 2 and 3 patients need adjuvant treatment as early as possible. Group 3 patients, with their high probability of early progression, also form a uniform cohort for studies concerning new therapeutic modalities. If the PSA minimum was included in further examinations, the results of treatment should improve.
The blocking urinary catheter: the role of variation in urine flow
Authors: BURR R.G. , NUSEIBEH I. 
Published: November 2008

Objectives To relate blockage of the urinary catheter to urine chemistry.Patients and methods Of 44 patients (age range 19–72 years) with an indwelling urinary catheter, 21 were troubled by frequent blockage and 23 experienced no blockage. Variation in urinary pH and calcium concentration were determined during a 24 h period and related to the occurrence of blockage using discriminant analysis.Results The maximum pH and calcium concentrations observed, or the maximum discriminant factors calculated, correctly discriminated 91% of patients (95% CI, 78–97%).Conclusion Attention to volume and variability of fluid intake by the patient should have a major impact on the incidence of blockage of the indwelling urinary catheter.
Long‐term histological response to subcutaneously injected Polytef and Bioplastique in a rat model
Authors: DEWAN P.A. , OWEN A.J. , BYARD R.W. 
Published: November 2008

Objective To compare the long‐term carcinogenic effect of Polytef and Bioplastique in the subcutaneous space of the rat.Materials and methods One hundred Sprague Dawley rats received a subcutaneous injection of one of two particulate plastics; subsequently 48 of those injected with Polytef paste containing polytetrafluoroethylene, 48 injected with silicone containing Bioplastique, and 48 control animals were available for assessment. Animals were killed when they became unwell, developed a tumour, or were 2 years of age. The injection site and all major organs and tumours were examined histologically.Results One or more tumours were found in 30 Polytef‐injected rats, 34 Bioplastique‐injected animals and 36 of the controls. The majority of the tumours were breast and pituitary adenomas with a similar incidence in each group. No tumours were found at the injection site of the Polytef‐injected animals. Four poorly differentiated sarcomas were found on the back of Bioplastique‐injected rats; three were intimately associated with silicone particles, whereas the fourth was separate from the injection site.Conclusion This study would suggest that the carcinogenic risk from injectable plastics is low, but further work should be conducted with the larger particles, to ensure that their use in humans is safe.
Transrectal ultrasonography versus digitally guided prostate biopsies in patients with palpable lesions on digital rectal examination
Authors: TÜRKERI L. , TARCAN T. , BIREN T. , KÜLLÜ S. , AKDAS A. 
Published: November 2008

Objective To compare the efficacy of digital and ultrasonographic guidance of biopsies when there is a palpable lesion on the prostate.Patients and methods Forty patients with a palpable nodule confined to a single lobe of the prostate underwent digitally guided biopsies of this lesion or biopsies directed by transrectal ultrasonography (TRUS) and/or systematic biopsies.Results According to the histopathological examination, 21 patients were found to have prostate carcinoma (PCa) using TRUS‐guided biopsies, whereas digitally guided biopsies revealed PCa in 18 patients but did not detect three cases. In the study group, the prostate of 10 patients had a normal ultrasonographic appearance and two patients had PCa revealed by systematic biopsies.Conclusion We suggest that in the presence of a palpable lesion in the prostate, regardless of TRUS findings, systematic biopsies are mandatory. Present data indicates that digitally guided biopsies are unnecessary as they do not provide additional information over systematic or TRUS‐guided biopsies.
Micturition habits and incontinence at age 17—reinvestigation of a cohort studied at age 7
Authors: HELLSTRÖM A. , HANSON E. , HANSSON S. , HJÄLMÄS K. , JODAL U. 
Published: November 2008

Objective To study the epidemiology of micturition disturbances in teenagers.Subjects and methods A subsample of 1034 teenagers previously evaluated at age 7 years was reinvestigated 10 years later. A postal questionnaire was used and a response rate of 71% (736) obtained. Those who reported bladder symptoms were contacted by telephone for a detailed history concerning imperative urge, daytime incontinence, emptying difficulties and bedwetting.Results There was a general decrease in the frequency and intensity of symptoms from 7 to 17 years of age. At age 17 at least one symptom was reported by 5.9% of the girls and 0.9% of the boys. Overall the symptoms were regarded as mild or moderate.Conclusion At age 17 years, micturition disturbances were reported infrequently and few subjects wanted medical help.
Wilms' tumour and hypertension: incidence and outcome
Authors: STEINBRECHER H. A. , MALONE P.S.J. 
Published: November 2008

Objective To determine the incidence and outcome of hypertension associated with Wilms' tumour and to reduce peri‐operative morbidity by appropriate treatment.Patients and methods The medical and nursing case‐notes of 17 consecutive patients with Wilms' tumour treated over a 5.5 year period (1989–1994) were analysed retrospectively.Results Ten of 17 patients had hypertension, with a mean blood pressure of 150/103 mmHg (130–220 mmHg systolic and 85–145 mmHg diastolic). There was no significant difference between the hyper‐and normotensive patients in their mode of presentation. Blood pressure was stabilized pre‐ operatively in all the hypertensive patients. Perioperative monitoring in these patients was performed using arterial and central venous pressure lines. No patient had any peri‐operative hyper‐or hypotensive episodes caused by handling the tumour or after nephrectomy. Thirteen patients had a favourable histological diagnosis and all the hypertensive patients were in this group. The blood pressure of all patients returned to normal within 1 month of surgery.Conclusion Both the recognition of hypertension and appropriate peri‐operative treatment is mandatory for the safe surgical management of this condition.
Multicystic renal dysplasia diagnosed in the antenatal period: a note of caution
Authors: GOUGH D.C.S. , POSTLETHWAITE R.J. , LEWIS M.A. , BRUCE J. 
Published: November 2008

Objective To document the urological problems associated with multicystic renal dysplasia (MCRD), to assess the efficacy of radiological methods for following the natural history of MCRD and to review current experience in the light of historical data regarding this condition.Patients and methods From January 1982 to December 1992 data were obtained prospectively on 62 patients (41 boys and 21 girls, age range 1–11 years) who had a diagnosis of MCRD suspected on antenatal ultrasonography. All patients had the diagnosis confirmed with radioisotope scans and micturating cysto‐grams. Serum creatinine was measured in each patient and repeated clinically as indicated. Follow‐up was from 1 to 11 years, with a clinical review and an annual ultrasonogram. The natural history of these patients was compared with those in other published studies.Results Of the 62 patients, 12 had associated vesico‐ureteric reflux. Four patients developed impaired renal function during the course of observation and 10 patients required urological surgery for other pathologies. In the patients managed conservatively, 38% underwent no resolution on sequential ultrasonograms during the 2‐year follow‐up, and in four children, where complete resolution of the MCRD had occurred on ultrasonography, significant cellular renal masses were excised at subsequent surgery.Conclusion Patients with MCRD have significant associated urological malformations and the natural history in such patients is unpredictable. We do not regard MCRD as an entirely benign condition and feel that all patients require appropriate investigation of their urinary tract and long‐term follow‐up where conservative treatment is instituted. From the natural history of these patients, reviewed in conjuction with the literature, we recommend that decisions for management can only be taken with the full informed consent of the parents and that surgical excision is offered as part of that process.
The temporal relationship between the severity of hydroureter and the dynamic changes of obstructed ureters in a rat model
Authors: CHUANG Y.H. , CHUANG W.L. , HUANG S.P. , LIU K.M. , HUANG C.H. 
Published: November 2008

Objective To investigate dynamic changes in the obstructed rat ureter and to evaluate the usefulness of the rat model in the study of obstructive uropathy.Materials and methods Unilateral ligation of the ureter was performed in 26 rats. After ureteric ligation, four to seven rats were killed and examined after 1, 3, 7, 10, and 14 days. The severity of hydroureter and hydronephrosis was assessed by pyelography and the hydroureter‐hydronephrosis index. The middle portion of the ureter was prepared for light and electron microscopic observation. Five rats which received a sham operation were also examined as controls.Results The severity of hydroureter and hydronephrosis in the ligated ureters progressively increased during the period of obstruction (P < 0.005) and reached a maximum 10–14 days after ligation. Hypertrophy of the smooth muscle layer developed on the third day after ligation and proliferation of submucosal connective tissue occurred on the 10th day after ligation. The changes in smooth muscle and connective tissue layers also progressed consistently during ureteric obstruction (P < 0.001 and < 0.005, respectively). The number and size of granular endoplasmic reticulum and Golgi apparatus in the smooth muscle cells increased after ureteric ligation and then caveolae exocytosis developed. Deposition of collagen fibres between muscle cells became apparent later.Conclusion The rat model of hydrouropathy demonstrated a clear temporal relationship between the severity of hydroureter and the dynamic changes in the obstructed ureter and could be used as a conventional method for the study of obstructive ureter.
Derivation and application of upper limits for prostate specific antigen in men aged 50–74 years with no clinical evidence of prostatic carcinoma
Authors: DALKIN B.L. , AHMANN F.R. , KOPP J.B. , CATALONA W.J. , RATLIFF T.L. , HUDSON M.A. , RICHIE J.P. , SCARDINO P.T. , FLANIGAN R.C. , DEKERNION J.B. , WATERS W.B. , KAVOUSSI L.R. , MACFARLANE M.T. 
Published: November 2008

Objective To derive age‐specific upper limits for prostate specific antigen (PSA) level in men 50–74 years of age with no clinical evidence of prostatic carcinoma, and to test the sensitivity and specificity for cancer detection of these upper limits.Subjects and methods A total of 6166 men were recruited for a multicentre study of prostate cancer detection and underwent a serum PSA determination and digital rectal examination (DRE). Men considered to be clinically free of prostatic carcinoma were those with a normal DRE and a PSA level ≤ 4.0 ng/mL, and men with an abnormality in either parameter who underwent ultrasonography‐guided prostate biopsy that revealed no evidence of carcinoma. By these criteria, 5469 men had no evidence of prostatic carcinoma. Dividing the population into 5‐year age increments, three statistical methods were assessed to derive upper limits for serum PSA level by age; the mean +2 sd, the 99th percentile, and a 97.5% prediction interval based on linear regression.Results Newly‐derived upper limits calculated by each method in the 50–54 and the 70–74 age group were 3.9 ng/mL and 7.6 ng/mL (mean + 2 sd), 5.2 ng/mL and 14.0 ng/mL (99th percentile), and 4.7 ng/mL and 8.2 ng/mL (97.5% prediction interval). The sensitivity of the newly‐derived upper limits was tested using receiver operating characteristic curves derived from men with no suspicious findings on DRE and a serum PSA concentration > 4.0 ng/mL. Although the specificity of the test increased with increasing PSA upper limits, no upper limits derived from these three methods yielded adequate sensitivity to detect cancer; sensitivities by age range were from 53 to 94%, using mean + 2 sd, from 25 to 50% with the 99th percentile, and from 47 to 64% with the 97.5% prediction interval.Conclusion We do not recommend age‐referenced adjustments in upper limits for serum PSA concentration, but recommend that an upper limit of 4.0 ng/mL be used in all men 50–74 years of age.
Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective randomized trial of cefuroxime versus piperacillin/tazobactam
Authors: BREWSTER S.F. , MACGOWAN A.P. , GINGELL J.C. 
Published: November 2008

Objective To compare the clinical and microbiological outcome of a single‐dose administration of cefuroxime or combined piperacillin/tazobactam (PT) after transrectal prostatic core‐biopsy (TPB) in a prospective, randomized, open‐label study.Patients and methods Of 111 eligible men consecutively undergoing ultrasonographically guided TPB, 56 received 1.5 g cefuroxime and 55 received 4.5 g PT intravenously 20 min before the procedure. The anterior rectal wall was cleaned with an antiseptic swab and four biopsies were taken. Urine and blood cultures were evaluated before the procedure and again after 48 h, and oral temperature and symptoms recorded for 72 h after TPB.Results A clinically successful outcome (no symptoms to indicate urinary or systemic sepsis or pyrexia ≥37.5°C after TPB) was achieved in 100 of 108 men (92.6%), of whom 51 received cefuroxime and 49 PT. Microbiological success (no bacteriuria >105 organisms/mL, or bacteraemia, after TPB) was observed in 98 of 103 men (95%), of whom 48 received PT and 50 cefuroxime. Bacteriuria was present 48 h after TPB in 5% of the men. One man randomized to receive cefuroxime became bacteraemic (with Escherichia coli) and required hospital admission. Four of the five microbiological failures were caused by organisms sensitive to the administered antimicrobial agent. No anaerobic organisms were cultured. The most common adverse event recorded was transient diarrhoea, reported by 16 men receiving PT and two receiving cefuroxime.Conclusion With this prophylactic regimen, there was no significant difference in outcome between the groups. Most of the organisms isolated were sensitive to the administered antimicrobial agent. Thus, further reductions in sepsis after TPB may be achieved by the administration of additional oral antimicrobial prophylaxis.
The effect of extracorporeal piezoelectric lithotripsy on the contractility of the human pelvicalyceal system
Authors: HAWKYARD S. J. , PARR N.J. , SMITH G. , MOUSSA S.A. , TOLLEY D.A. 
Published: November 2008

Objective To assess the effect of extracorporeal piezoelectric lithotripsy (EPL) on the contractility of the human pelvicalyceal system.Patients and methods Contractions of the pelvicalyceal system were measured in 12 patients (mean age 55 years) before and after EPL. Pelvicalyceal pressure was measured via a Cope nephrostomy tube which had remainedin situfollowing stone debulking procedures days or weeks earlier. All patients were treated using a Wolf Piezolith 2300 lithotripter.Results The pelvicalyceal systems of two patients were acontractile before and after treatment. Immediately after treatment, contractions were completely abolished in eight of the remaining 10 systems, and reduced in frequency in the other two. All 10 systems regained contractions 24 h after treatment.Conclusion Piezoelectric lithotripsy temporarily abolishes upper urinary tract motility.
Eliminating the need for per‐operative frozen section analysis of pelvic lymph nodes during radical prostatectomy
Authors: BANGMA Chr. H. , HOP W.C.J. , SCHRÖDER F.H. 
Published: November 2008

Objective To eliminate the need for per‐operative frozen section analysis by using pre‐operative serum prostate‐specific antigen (PSA), clinical stage and Anderson biopsy grade to predict lymph node metastasis.Patients and methods Between 1988 and 1994, 214 patients underwent bilateral pelvic lymphadenectomy before an intended retropubic radical prostatectomy for clinically confined prostate carcinoma. Preoperative serum PSA, clinical stage and Anderson biopsy grade were analysed to investigate whether they were able to predict the results of per‐operative frozen sections of pelvic lymph nodes.Results Serum PSA level was the best predictor of a frozen section which was positive for lymph node metastasis, followed by biopsy grade. Clinical T‐category combined with PSA level predicted lymph node status less well than did biopsy grade and had no additional value when combined with biopsy grade and PSA. Pre‐operative serum PSA combined with biopsy grade predicted a negative frozen section result of bilateral pelvic lymphadenectomy with 95% certainty in at least 17% of patients undergoing radical prostatectomy for clinically confined prostate cancer. Frozen section analysis had a false negative rate of 4.7% when compared with histological staging. Therefore, combining those patients with an estimated 95% chance of a negative frozen section with the group of false negatives. 11 in 214 patients (5.1%) would have undergone radical prostatectomy while having micrometastases.Conclusions Selecting men for whom the per‐operative frozen section analysis could be omitted may save operating time and allow more efficient use of facilities.
Evaluation of testicular volume by three orchidometers compared with ultrasonographic measurements
Authors: SALIM A. AL , MURCHISON P.J.T. , RANA A. , ELTON R.A. , HARGREAVE T.B. 
Published: November 2008

Objective To investigate the accuracy of three commonly used orchidometers (Prader, Takihara punched‐ring and Seager) compared with ultrasonography (US) for the measurement of testicular size.Subjects and methods A prospective, randomized, blinded trial to compare three methods of measuring testicular volume was performed, involving 31 men attending the Fertility Problems Clinic for the assessment of fertility. Testicular size was measured independently by three doctors and compared with estimates obtained independently by US in the Radiology department.Results The Prader and Takihara punched‐ring orchidometers consistently overestimated testicular size compared with that estimated by US. A substantial proportion of the measurements obtained using the Prader orchidometer were more than twice the value estimated by US.Conclusions The Prader and Takihara orchidometers were useful in comparing different testicular sizes but the absolute values obtained would probably be overestimated in many clinical situations. The Seager orchidometer, although more difficult to use, agreed best with the US estimates.
Hypospadias repair: the two‐stage alternative
Authors: BRACKA A. 
Published: November 2008

SummaryOne‐stage repairs for hypospadias are attractive in concept and are currently in vogue, but many surgeons remain unhappy with their inherent limitations and drawbacks. Two‐stage repair, reconstructing the new urethra with a full‐thickness skin graft, offers a realistic alternative and the method described here can be applied to almost any degree of deformity, be it a simple primary case or salvage of a multi‐operated and skin‐deficient hypospadias ‘cripple’. From a personal series of over 600 cases the author concludes that a two‐stage operation is an acceptable price to pay for a repair that offers unique versatility, excellent reliability and a sophistication of function and aesthetics thatis hard to achieve with one‐stage methods.
Pelvic floor exercises for children: a method of treating dysfunctional voiding
Authors: WENNERGREN H. , ÖBERG B. 
Published: November 2008

Objective To evaluate the clinical effect of a pelvic floor exercise programme developed for children.Patients and methods Sixteen girls with non‐neurogenic dysfunctional voiding were treated by a physiotherapist, mostly in small groups. The exercises were designed to increase the child's awareness of their pelvic floor musculature and to teach them how to contract and relax these muscles at will. The emphasis on pelvic floor relaxation served to improve the child's voiding pattern.Results After 1 year, nine girls were cured and seven improved. Another three girls were cured at the 3–4 year follow‐up, giving a total cure rate of 12/16.Conclusion This non‐invasive method seems to be a useful alternative or complement to other treatments of children with dysfunctional voiding.