bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extracorporeal Shock Wave Lithotripsy for Vesical Lithiasis: Initial Experience
Authors: BHATIA V. , BIYANI C. S. 
Published: November 2008

Summary— The classical treatment for vesical lithiasis consists of surgery or endoscopic transurethral disintegration. These procedures require anaesthesia and hospitalisation. We report our experience with the Siemens Lithostar in 18 male patients with bladder stones. Complete fragmentation was achieved after a single session in 14 patients and 4 required 2 sessions. A 3‐way Foley catheter with saline irrigation was used during treatment. Patients were treated in the prone position followed by immediate evacuation of stone fragments in 9 cases. Morbidity was minimal. Two patients developed impacted fragments and required stone retrieval.Extracorporeal shock wave lithotripsy (ESWL) for vesical lithiasis appears to be a simple, well tolerated and effective form of treatment.
Evaluation and Treatment of Incontinence after Bladder Neck Reconstruction in Exstrophy and Epispadias
Authors: HOLLOWELL JEAN G. , HILL P. D. , DUFFY P. G. , RANSLEY P. G. 
Published: November 2008

Summary— Twenty‐five children with exstrophy/epispadias who had had at least one bladder neck operation (but no augmentation) for incontinence underwent cystometrography (CMG) and urethral pressure profile (UPP) studies. The purpose of this study was to examine all components of lower urinary tract function and to determine how the properties of the bladder and the properties of the bladder neck/urethra interacted to achieve continence or to result in incontinence in the individual child.Examination of detrusor function during filling revealed involuntary contractions in 12 children and an end‐fill pressure >10cm H2O in 8. Of the 21 children in whom voiding could be evaluated only 6 could initiate a detrusor contraction. In the 18 incontinent children leak pressure could be measured and was 15 cm H2O in 12. Five of the 7 continent children also demonstrated at least one abnormality in lower tract function. The maximum pressure of the UPP did not agree with the leak pressure and may not be a valid measure of the closing pressure of the bladder neck/urethra in this patient population.Detailed urodynamic investigation is necessary in these children to guide the next step of management and to evaluate objectively each form of treatment.
Varicocele‐A Clinical Enigma
Authors: HARGREAVE T. B. 
Published: November 2008

Summary“But when the disease has spread also over the testicle and its cord the testicle sinks a little lower, and becomes smaller than its fellow, in as much as its nutrition has become defective.” Amelius Cornelius Celsus (42BC‐37 AD)“Varicocele is a compact pack of vessels quite filled with melancholic blood.” Ambroise Pare (1550)
Longitudinal Observations on Normal and Abnormal Voiding in Men Over the Age of 50 Years
Authors: JφRGENSEN J. BALSLEV , JENSEN K. M. ‐E. , MOGENSEN P. 
Published: November 2008

SummaryA cohort of 200 men over the age of 50 years was selected at random. Initially 112 men participated. After 5 years 61 were participating, and 2 years later 34 men still had no voiding problems, while 19 had had treatment for prostatism. A history was obtained and all 112 had symptom analysis and uroflow examination. The uroflow variables Qmax, Qave, Qmax‐time, Q“corrected”, volume and the ratio Qmax/Qmax‐time were recorded together with the symptom score and subjective evaluation. After 5 and 7 years all primary data were reviewed in the 61 and 34 men respectively, while a full history was obtained in the rest. The 3 sets of data were evaluated separately as 3 cross‐sectional investigations and as paired data sets by means of non‐parametrical statistical analysis. Comparing the 3 sets of data longitudinally, significant differences were found in Qmax, Qave, Qcor and Ace. A correlation analysis showed that Qmax, Qave, Q“corrected” and volume decreases significantly with advancing age in asymptomatic men, while no correlation with age was found in the 19 treated men. On the basis of the 93 men, untreated for 7 years, nomograms of Qmax, Volume and Ace were constructed using 2.5, 25, 50, 75 and 97.5% percentiles in 5‐year groups. Likewise, a nomogram on symptom score was constructed on the basis of the 82 men, asymptomatic and untreated for 7 years.In conclusion, uroflow in subjectively normal men over the age of 50 years shows increasing abnormality with advancing age. At the same time elderly men tolerate a considerable amount of symptoms of intravesical obstruction. The severity of symptoms increased with advancing age, but differently in persons likely and not likely to need operation.
Histopathological Changes in Kock Pouch
Authors: CHEN K. K. , HO D. M. , CHEN M. T. , CHANG L. S. 
Published: November 2008

SummaryTo investigate whether tumour recurrence or histological changes occur in the Kock pouch, periodic endoscopy with biopsy of the pouch was performed in 15 patients 6 to 66 months after radical cystectomy and urinary diversion for invasive bladder cancer. Endoscopy was undertaken 1 to 4 times in each patient (a total of 37 times in all patients). During endoscopy, random biopsies were taken from the pouch wall, and from the afferent and the efferent nipples. The histological changes were graded as: (1) villous atrophy (grade 0 to 3, 0: nearly normal; 1: shortening, villi/crypt of Lieberkuhn [length] between 1.5 and 4.0; 2: moderate flattening, villi/crypt < 1.5; and 3: almost complete disappearance of villi); (2) fibrosis; and (3) chronic inflammation (grade 0 to 3, based on the amount of fibrous tissue and inflammatory cell infiltration in the lamina propria, respectively). There was no dysplasia or malignant tumour in the Kock pouch in any of the 15 patients. The histology of the ileum changed in terms of villous atrophy, fibrosis and chronic inflammation in the lamina propria and thickening of the muscularis mucosa. The same grade of villous atrophy of the pouch wall, the afferent and the efferent nipples was only found in 3 patients. More fibrosis and less chronic inflammation in the lamina propria were found at the efferent nipple than at the afferent nipple or pouch wall in 8 patients and 5 patients, respectively. Thickening of the muscularis mucosa was found in 13 of 15 patients (86.7%).In conclusion, there was no dysplasia or recurrent tumour in the Kock pouch in patients who were followed for up to 66 months. Various grades of histological changes of the ileum in terms of villous atrophy, fibrosis and chronic inflammation of the lamina propria, and thickening of the muscularis mucosa were found in the pouch wall, and in the afferent and efferent nipples. More fibrosis and less chronic inflammation were commonly observed at the efferent nipple than at the afferent nipple or pouch wall. The degree of histological changes varied even among patients followed over the same period after operation. The time to progression of villous atrophy also varied. The histological changes in some patients were dissimilar even at the same site of the Kock pouch.
Superficial Bladder Cancer: Timing of Check Cystoscopies in the First Year
Authors: MORRIS S. B. , SHEARER R. J. , GORDON E. M. , WOODHOUSE C. R. J. 
Published: November 2008

SummaryWe report a prospective study of 141 patients presenting for the first time with a small, solitary, non‐invasive, moderately or well differentiated transitional cell carcinoma of the bladder. The pattern of recurrence in the first year was assessed and recurrence rates calculated; 80% of patients without recurrence at 3 months remained clear in the first year. There was a highly significant reduction in recurrence rates for those free of recurrence at 3 months. It has been suggested that this group should have the second check cystoscopy at 1 year and yearly cystoscopies thereafter. Our findings support that proposal.
Does Flexible Cystoscopy miss more Tumours than Rod‐lens Examination?
Authors: WALKER L. , LISTON T. G. , LLOYD‐DAVIES R. W. 
Published: November 2008

SummaryThe first blind, prospective, randomised comparison of flexible cystoscopy with rod‐lens cystoscopy was carried out on 53 consecutive volunteers with bladder tumours or haematuria. Three patients' recurrences were missed on flexible cystoscopy and 3 others on rod‐lens examination. It was expected that the 9% rate of missed tumours would lessen with increased experience of flexible cystoscopy, as 2 of them occurred in the first 12 examinations and all of the lesions missed were < 5 mm in diameter. Rod‐lens cystoscopy, the accuracy of which appears to have been measured for the first time, was no more sensitive.
Quantitation of Potentially Undiagnosed Incidental Carcinoma of the Prostate in Patients Treated Non‐surgically for Benign Prostatic Hyperplasia
Authors: ANDERSON G. A. , LAWSON R. K. , GOTTLIEB M. S. 
Published: November 2008

SummaryProstatectomy is the standard treatment for benign prostatic hyperplasia (BPH) and non‐surgical treatment of prostatism would reduce the detection of Stage A prostate cancer. We wished to identify the number of potentially undiagnosed cancers resulting if non‐surgical therapy were used to treat a presenting complaint of BPH. We also sought to identify the age group which would most clearly benefit from treatment of Stage A prostate cancer. Our series of transurethral prostatectomy specimens showed 92/996 patients (9.2%) positive for incidental carcinoma; 26/92 patients (28%) received further treatment and 25 of the 26 patients had Stage A2 disease. After evaluating life‐tables and survival data on untreated A2 disease, the population aged 72 years had a relative benefit of treatment ratio > 1.0, i.e. had a greater likelihood of dying from prostate cancer than from natural causes; 17/616 (2.8%) of the population aged < 72 years had their A2 disease treated and would have potentially been denied early cancer treatment if non‐surgical management of BPH had been employed. The above figures assume 100% non‐surgical treatment of BPH and no screening for prostate cancer pre‐treatment. Stage A2 patients in this study demonstrated no significant difference in cause‐specific survival rates between treated and untreated study groups (both 0%) or between treated study patients and untreated historical patients. Treated A2 patients demonstrated a significantly lower 5‐year progression rate (0 vs 32%) relative to untreated patients reported in the literature, and a trend toward a significantly lower progression rate (0 vs 25%) relative to untreated study patients.
Analysis of Biopsy Findings and Implant Quality following Ultrasonically‐guided 125l Implantation for Localised Prostatic Carcinoma
Authors: VIJVERBERG P. L. M. , BLANK L. E. C. M. , DABHOIWALA N. F. , de REIJKE Th. M. , KOEDOODER C. , HART A. A. M. , KURTH K. H. , GONZALEZ D. GONZALEZ 
Published: November 2008

SummaryTransperineal ultrasound‐guided 125I implantation was undertaken in 52 patients with localised prostate cancer. After implantation, ultrasound‐guided biopsies were taken from the previous malignant areas every 6 months in all patients. The percentage of negative biopsies increased from 22% at 6 months to 50% at 48 months. Implant quality was analysed in 37 patients. The difference between isodose levels encompassing the prostate and the aimed levels of 160 Gy was taken as a measure of implant quality. A good quality implant (< 10% underdosage) was found in 43% of patients, a moderate quality (10–25% underdosage) in 35%, and a poor quality implant (> 25% underdosage) in 22%. A statistically significant correlation was found between the quality of the implant and resulting negative biopsy at the original tumour site.Determination of prostate specific antigen (PSA) was not possible from the beginning of the study but an analysis with biopsy findings, implant quality and prostate volume reduction during follow‐up has been performed since 1989.A significant correlation was observed between implant quality and serum PSA, and also between volume reduction and serum PSA.
Deoxyribonucleic Acid Histogram of Testes in Primary Transsexualism
Authors: CHIU A. W. , CHEN M. ‐T. , CHIANG H. , WU L. ‐H. , FANG R. ‐H. , CHANG L. S. 
Published: November 2008

SummaryThe influence of oestrogen on spermatogenesis was evaluated by comparing its effect on the testes of primary male transsexuals and those who had undergone hormone therapy for prostatic carcinoma. Eight primary transsexuals were studied. They had been diagnosed on clinical and psychiatric evidence and had been on oestrogen therapy for several years since puberty. Histological sections of testicular tissue obtained at reassignment surgery from 8 phenotypic male transsexuals (aged 24–32 years) with an XY chromosome complement were studied by light microscopy. The formalin‐embedded specimens were analysed by flow cytometry for deoxyribonucleic acid (DNA) histograms. Both the histology and DNA histograms revealed a pattern of maturation arrest in 12 of 16 testes in which the diploid cell compartment occupied most of the spermatogenetic element, followed by tetraploid and monoploid cells. Two testes showed impaired spermatogenesis and 2 were normal. The DNA histograms and pathology were also evaluated in 20 testes after 3 to 8 years of hormone therapy in patients with advanced prostatic carcinoma (aged 60–78 years). No maturation arrest was found in these patients. Sixteen of them had a pattern of fibrosis and atrophy and 4 had impaired spermatogenesis. It was concluded that oestrogen influenced spermatogenesis and affected the maturation of spermatogonia mostly during puberty.
Chemical Analysis of Post‐lithotripsy Stone Fragments: a Critical Evaluation
Authors: DAS G. , HALLSON P. C. , KASIDAS G. P. , SAMUELL C. T. , VIRDI J. S. , WICKHAM J. E. A. 
Published: November 2008

SummaryA scheme for the chemical microanalysis of renal stone fragments recovered from urine voided immediately after lithotripsy has been developed and evaluated. The analytical procedure includes assay of calcium, magnesium, phosphate, oxalate and urate and has been applied to 78 such urine samples. Problems relating to co‐existing crystalluria and blood and urine contaminants have been recognised and overcome. However, significant loss of all stone components due to fragment dissolution in urine prior to recovery was found to occur and was investigated. The distribution of stone components found in these analyses was similar to that seen in previous surveys of intact stones.
Extracorporeal Shock Wave Lithotripsy in Patients with Renal Malformations
Authors: THEISS M. , WIRTH M. P. , FROHMÜLLER H. G. W. 
Published: November 2008

Summary Twenty‐four consecutive patients with malformed kidneys (21 horseshoe kidneys, 2 crossed ectopic and 1 pelvic kidney) underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis between 1984 and 1990. No serious complications occurred either during or after treatment. Urinary obstruction was accompanied by fever in 3 patients and by renal colic in 4. Auxiliary measures were required in only 2 cases. Patients with renal anomalies remained in hospital longer than patients with normal kidneys. Fifteen patients were free of stones 3 months after ESWL and 16 after 1 year. Six patients required further ESWL less than 1 year after their first treatment as a result of stone recurrence or regrowth.ESWL is a safe and successful non‐invasive procedure for the treatment of nephrolithiasis in patients with malformed kidneys. However, the higher frequency of stone recurrence and regrowth means that these patients must undergo careful monitoring.
Bacterial Factors in the Formation of Renal Scars. An Experimental Study on the Role of Escherichia coli P‐fimbriation and Hydrophobicity
Authors: ARNOLD A. J. , SUNDERLAND D. , RICKWOOD A. M. K. , HART C. A. 
Published: November 2008

Summary A model capable of comparing the effects of bacterial virulence factors on renal scarring in vivo has been developed using the female piglet. By creating, at open surgery, unilateral vesicoureteric reflux (VUR) and quantifying scarring both by uptake of an isotope bound to functioning renal parenchyma and by planimetry of the surface area scarred, the effects of 2 organisms, a P‐fimbriate Escherichia coli and an E. coli K 1 have been compared. The P‐fimbriate E. coli was shown to express P‐fimbriae in freshly voided urine, was more hydrophobic and produced smaller scars. This indicates that neither the hydrophobicity nor P‐fimbriation of the organism causing urinary tract infection (UTI) is of prime importance for the development of renal scars and is evidence against the “big bang” theory for the development of renal scars.Studies on the association of UTI with VUR showed that infection with both E. coli under study led to VUR on the side contralateral to the side undergoing surgery. It seems likely that a nonspecific effect of UTI, such as bladder oedema, is responsible for this acquired VUR.An effect of the 2 bacteria under study on the lower urinary tract was observed in that infection with the P‐fimbriate E. coli allowed the retention of an intravesical wax plug, whereas infection with E. coli K1 did not. Epidemiological data have shown that the majority of upper urinary tract infections in children are associated with UTI by P‐fimbriate organisms. Such an association may be explained in part by an effect of P‐fimbriate bacteria on lower urinary tract function rather than an effect on the upper urinary tract.
Encrusted Cystitis: Aetiology, Clinical Aspects and Management
Authors: KARAYANNIS A. , PICRAMENOS D. , SOFRAS F. , KARANASTASIS D. , STENOS I. , BECOPOULOS TH. 
Published: November 2008

Summary Encrusted cystitis is a rare condition characterised by the formation of calcified plaques adherent to or embedded in the bladder mucosa. Although chronic infection with urea‐splitting organisms is a prerequisite, other factors seem to play an important role in its development.We report our experience of 4 such cases in which encrusted cystitis presented with various symptoms, produced different pathological abnormalities and was treated by different means in each patient.
Glutathione‐S‐Transferase π Expression in Transitional Cell Carcinoma of the Bladder
Authors: THOMAS D. J. , BIRCH P. J. , VICKERS J. , ROBINSON M. , CLIFFORD S. , HALL A. , NEAL D. E. 
Published: November 2008

Summary Glutathione‐S‐transferase π (GSTπ) is a multifunctional protein that acts as an enzyme, involved in the detoxification of drugs and carcinogens. It has been implicated both in drug resistance and malignant transformation of epithelium. Using an indirect immunohistochemical technique, we have evaluated cytoplasmic and nuclear staining in normal urothelium, 23 superficial bladder tumours and 26 invasive tumours. All 26 invasive tumours had been treated with platinum‐based chemotherapy.Cytoplasmic staining was seen in normal urothelium and all bladder tumours. Nuclear staining was seen in 1 superficial tumour and in 13 invasive tumours. There was no association between nuclear staining and response to chemotherapy. Nuclear staining was seen in 1 area of dysplasia and in 2 of 3 areas of carcinoma in situ.GSTπ expression is not a predictor of response to chemotherapy. Increased intra‐nuclear expression of GSTπ may be associated with progression of transitional cell carcinoma of the bladder.
Intravesical Bacillus Calmette‐Guérin with the Danish Strain for Treatment of Carcinoma In situ of the Bladder
Authors: OVESEN H. , POULSEN A. L. , STEVEN K. 
Published: November 2008

Summary We report our experience of the treatment of carcinoma in situ (CIS) using intravesical therapy with the Danish Bacillus Calmette‐Guérin (BCG) strain 331 (SSI). Forty‐two patients received treatment, 11 had primary and 31 secondary CIS. The median follow‐up period was 26 months (range 3–68). Patients received 6 weekly instillations (1 course) and non‐responders an additional 6 instillations at 2‐week intervals (2 courses). The complete response rate was 59% for 1 ‐course patients, 33% for the 2‐course patients and 68% for the entire series. Patients were considered treatment failures if they suffered progression to invasive cancer, metastasis or died from transitional cell carcinoma. BCG treatment was more effective in primary than in secondary CIS, with a complete response rate of 80% versus 65% and with no failures versus 35%. Patients with persistent CIS after the first course of BCG had a greater risk of failure than responders: 50% versus 17%. Patients with persistent CIS after the second course had a 75% failure rate. This suggests that cystectomy should be considered for non‐responders following a 6‐week course and recommended to those not responding to 2 courses.Ten patients had CIS in the prostatic urethra. All responded to BCG treatment; 2 suffered from recurrent CIS 1 associated with invasive urethral tumour.The incidence and severity of side effects were similar to those reported with other strains of BCG. One patient with primary CIS failed to complete the treatment owing to “BCG‐itis”.
The Source of Organisms in the Post‐prostatectomy Bacteriuria of Patients with Pre‐operative Sterile Urine
Authors: IBRAHIM A. I. A. , BILAL N. E. , SHETTY S. D. , PATIL K. P. , GOMMAA H. 
Published: November 2008

Summary Ninety patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) with sterile urine pre‐operatively were prospectively studied for post‐prostatectomy bacteriuria; 26 of 90 patients (29%) developed bacteriuria (18 of 64 after transurethral resection (TUR) and 8 of 26 after open prostatectomy), of whom 15 had pre‐operative indwelling urethral catheters.The correlation of bacteriuria with several factors was studied, namely the presence of a histological inflammatory reaction within the prostatic adenoma, prostatic tissue culture, intraoperative outgoing irrigation fluid culture, intra‐operative blood culture and post‐operative external meatal swab culture. The only significant correlation was between bacteriuria and meatal cultures.It was concluded that post‐prostatectomy bacteriuria is probably caused by post‐operative ascending infection along urethral catheters. There was not enough evidence to ascribe bacteriuria to pre‐existing septic foci within the adenoma. Intra‐operative contamination and infection from distant foci were also unlikely causes.
Changes in Acid‐base Balance and Calcium Metabolism after Urinary Diversion through Ileal Segments. II. Treatment with Nicotinic Acid
Authors: MARTÍNEZ‐PIÑEIRO L. , MATEOS F. , MARTÍNEZ M. E. , MARTÍNEZ I. , MARTÍNEZ‐PIÑEIRO J. A. 
Published: November 2008

Summary Investigations in animals have shown that nicotinic acid, an intestinal cyclic‐AMP inhibitor, partially corrects the metabolic changes associated with urinary diversion through intestinal segments. Blood and serum chemistry were studied in patients before and 3 to 5 months after undergoing urinary diversion through ileal segments, both with and without nicotinic acid treatment. It was found that diverted patients had metabolic acidosis, an increased anion gap and increased levels of serum alkaline phosphatase; there were no significant changes in serum PTH and vitamin D levels, calcaemia and phosphoraemia. There was a tendency towards dehydration, hypernatraemia, hyperchloraemia and secondary hyperaldosteronism produced by ileal secretion of a hypotonic fluid. Nicotinic acid 3 g/day significantly reduced the chloraemia but did not correct the metabolic acidosis, although it reduced its severity, since blood pH decreased when treatment was suspended.Nicotinic acid cannot be recommended for routine use in the management of metabolic acidosis after urinary diversion, and patients with a marginal renal reserve should not be considered for trans‐intestinal urinary diversion.