bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bladder Substitution with Ileocaecal (Mainz) Pouch Clinical Performance over 2 Years
Authors: NARAYAN P. , BRODERICK G. A. , TANAGHO E. A. 
Published: November 2008

Summary— A series of 11 patients underwent ileocaecal bladder substitution (Mainz pouch) with urethral anastomosis after radical cystectomy and pelvic lymphadenectomy for moderate to high grade transitional cell carcinoma of the bladder.With 12 to 27 months of follow‐up (mean 18), 6 patients are voiding and are dry day and night with timed voidings; 4 patients continue intermittent catheterisation because of inability to perform the Valsalva manoeuvre adequately, and 1 has a suprapubic tube because of stricture of the enterourethral anastomosis.Upper tract studies revealed dilatation of 4 of 22 renal units and 1 patient required endourological intervention. Serum electrolyte studies revealed slightly elevated chloride levels in 6, mild hypocarbia in 3, and reduced vitamin B12 levels in all patients, but no megaloblastic anaemia. The Mainz pouch appears to have very satisfactory short‐ and intermediate‐term results.
Prognostic Value of Raised Prostatic Acid Phosphatase and Negative Skeletal Scintigraphy in Prostatic Cancer
Authors: GOODMAN C. M. , CUMMING J. A. , RITCHIE A. W. S. , CHISHOLM G. D. 
Published: November 2008

Summary— Of 438 consecutive cases of newly diagnosed prostate cancer, 178 (41%) had skeletal metastases (TO‐4 M1) at the time of diagnosis according to skeletal scintigraphy; 139 men had serum prostatic acid phosphatase (PAP) greater than twice the upper limit of normal on 2 separate occasions at the time of diagnosis and 65% of them had metastases on bone scan. However, 49 men with normal bone scans were found to have similarly raised serum PAP. (Such patients are defined as having skeletal metastases in the current Medical Research Council immediate versus deferred orchiectomy study and stratified accordingly). The actuarial survival of this group was calculated by life table methods and was compared with that of 2 other subgroups: those patients having metastases demonstrated on bone scan, and those patients having both normal bone scans and normal serum PAP.The survival of the “metastatic by acid phosphatase” group was significantly better than that of the “metastatic by bone scan” group but did not differ from that of patients having both normal scans and PAP.For patients with no scintigraphic evidence of skeletal metastases at diagnosis, those with a raised PAP were at a significantly greater risk of scan conversion, although this was more powerfully predicted by high histological grade.
Study of the Seminal Vesicles in Acute Epididymitis
Authors: KRISHNAN R. , HEAL M. R. 
Published: November 2008

Summary— Although it has been suggested that seminal vesiculitis is present in patients with epididymitis, it has not been proven. We performed rectal ultrasound assessment of the seminal vesicles in 18 consecutive patients with epididymitis. The seminal vesicle on the same side as the epididymitis was significantly enlarged in 75% of cases; 92% of these enlarged vesicles returned to normal size in 12 weeks.A persistently enlarged seminal vesicle was associated with unresolved epididymitis, and further bacteriological studies in these cases demonstrated continued Chlamydia infection in some patients over 35 years of age.
Clam Enterocystoplasty in General Urological Practice
Authors: BERGH R. C. KOCKEL , TAN J. B. L. , BATES C. P. , BISHOP M. C. , ChM M. DUNN , LEMBERGER R. J. 
Published: November 2008

Summary A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases.Improvement occurred in 71% and those younger than 30 years had better overall results; 29% remained incontinent, with 9% requiring a urinary diversion. Many patients did not achieve maximum benefit until 9 months post‐operatively. Surgery had no statistically significant effect on any urodynamic parameter and post‐operative complications were common.The operation was performed in either the coronal (19) or the sagittal plane (26); this did not influence results. In general, surgery was found to be technically simpler in the sagittal group and it is recommended that this becomes the standard procedure. We feel that this operation involves major surgery and should only be offered with reluctance.
Hospitalisation of Prostatic Cancer Patients Undergoing Orchiectomy
Authors: JOHANSEN T. E. B. , FJAERE H. T. 
Published: November 2008

Summary We report our experience with 100 orchiectomies for advanced prostatic cancer in hospitalised patients. Approximately 60% of the patients required hospitalisation for additional treatment and investigation of complications due to their disease at the time of orchiectomy. In 51 cases the orchiectomy was combined with transurethral resection of the prostate (TURP); 37 patients had pathological levels of serum creatinine and 17 had pathological dilatation of the upper urinary tract, 6 of whom required a nephrostomy catheter. Because of anaemia on admission, 21 patients received a perioperative blood transfusion. Two patients had significant post‐operative bleeding, 2 developed a wound infection and 1 had a deep thrombophlebitis.The patients' mean age was 76.4 years and the period of hospitalisation ranged from 3 to 150 days with peaks at 3 and 8 days. The most important reason for prolonged hospitalisation was social problems.It was concluded that many patients who were hospitalised as a direct consequence of their prostatic carcinoma would have been in hospital for a similar period regardless of the method of hormonal manipulation used. Because so many patients have other reasons for hospitalisation, or require additional surgical procedures such as TURP, the true average cost of orchiectomy for advanced prostatic cancer is difficult to determine.
Results of Medical Research Council Phase II Study of Low Dose Cisplatin and Methotrexate in the Primary Treatment of Locally Advanced (T3 and T4) Transitional Cell Carcinoma of the Bladder
Authors: ROBERTS J. T. , FOSSA SOPHIE D. , RICHARDS B. , KAYE S. B. , WHITE E. F. , ROBINSON M. C. , USCINSKA B. , PARMAR M. K. B. 
Published: November 2008

Summary— A series of 49 previously untreated patients with category T3 or T4 bladder cancer underwent treatment with low dose methotrexate and cisplatin; 44 patients were eligible for assessment of response. Complete response (CR) was seen in 5 patients (11%) and partial response in 15 (34%) (overall response rate 45%). Treatment was reasonably well tolerated with no major morbidity and no treatment‐related deaths.After a median follow‐up of 3.5 years, the 1‐year and 2‐year survival rates were 70 and 30% respectively. Ten patients remain recurrence‐free without having received “definitive local therapy” (cystectomy and/or radiotherapy) at follow‐up extending from 20 to 50 months.
Sex Distribution of Adult Idiopathic Detrusor Instability in Relation to Childhood Bedwetting
Authors: MOORE KATE H. , RICHMOND D. H. , PARYS B. T. 
Published: November 2008

Summary The urodynamic case records of 1000 consecutive men and women were reviewed to study the link between idiopathic detrusor instability (Dl) and childhood nocturnal enuresis and to determine whether a sex difference in this relationship may exist.Idiopathic Dl was found in 10% of the men, 63% of whom had suffered from childhood bedwetting; 29% of the women had idiopathic instability, of whom 38% had been nocturnal enuretics. Thus the link between adult idiopathic DI and childhood bedwetting appeared to be stronger for men than for women.The sex distribution of subjects is not always reported in urodynamic studies of bedwetters and adults with an unstable bladder. We suggest that this should become routine practice as it may help to shed light on the aetiology of idiopathic detrusor instability.
Neoadjuvant Chemotherapy with Methotrexate and Cisplatln prior to Radiotherapy for Invasive Transitional Cell Carcinoma of the Bladder. Assessment of Feasibility and Toxicity
Authors: HOWARD G. C. W. , CORNBLEET M. A. , WHILLIS D. , HARGREAVE T. B. , CHISHOLM G. D. 
Published: November 2008

Summary A prospective study has been performed to assess the feasibility and toxicity of administering neoadjuvant chemotherapy with methotrexate (200 mg/m2) and cisplatin (100 mg/m2) prior to radical radiotherapy. Twenty patients with advanced transitional cell carcinoma of the bladder were assessed after each of 3 courses of chemotherapy, after radiotherapy and 6 months following treatment. Of particular concern was whether neoadjuvant chemotherapy compromised the ability to give potentially curative radical radiotherapy, delayed effective palliation of distressing urinary symptoms, or allowed local tumour progression prior to definitive treatment.It was concluded that this chemotherapy regimen was well tolerated, did not compromise the ability to give radical radiotherapy and resulted in the prompt palliation of urinary symptoms. This treatment, however, did not stop the development or progression of metastatic disease in some patients. In only 1 patient was there local progression during chemotherapy.
Initial Urethral Pressure Increase during Stress Episodes in Genuine Stress Incontinent Women
Authors: THIND P. , LOSE G. , COLSTRUP H. 
Published: November 2008

SummaryThe urethral and bladder pressure increments registered during a cough were investigated in 30 woman with genuine stress incontinence (GSI) and compared with those from 30 previously investigated healthy women. The pressures were measured by means of a double microtip transducer catheter with the bladder sensor uncovered and the urethral sensor covered with a water‐filled rubber cylinder and placed at the bladder neck, midurethrally, or distally in the urethra. In GSI women the pressure increment preceding the pressure spike produced by coughing was significantly higher in the bladder compared with the urethra, and the pressure increment seemed to be initiated in the bladder and all along the urethra simultaneously. In healthy women the pressure increment preceding a pressure spike was significantly higher in the midurethra compared with the bladder and it seemed to be initiated in the midurethra. These findings seem to reflect a defective active closure mechanism in GSI which may be a contributing factor in its pathogenesis.
Testicular Function in Patients with Hypospadias Associated with Enlarged Prostatic Utricle
Authors: SHIMA H. , YABUMOTO H. , OKAMOTO E. , ORESTANO L. , IKOMA F. 
Published: November 2008

SummaryOf 485 patients with hypospadias who underwent urethrography, enlarged prostatic utricles were found in 173 (35.7%). Utricles with a higher grade of enlargement were seen mainly in patients with a severe degree of hypospadias. Serum testosterone levels before and after 3 days' treatment with human chorionic gonadotrophin were determined by radioimmunoassay in 97 prepubertal boys with hypospadias and enlarged prostatic utricles. Lower levels of serum testosterone were found after hormonal stimulation in 22 patients with high grade utricular enlargement when compared with 5 controls and 75 patients with low grade enlargement; the difference was statistically significant. This finding supports the hypothesis that utricular enlargement may be due to androgenic insufficiency during the critical period of organogenesis.
Combined Papaverine Test and Radionuclide Penile Blood Flow in Impotence: Method and Preliminary Results
Authors: GRECH P. , DAVE S. , CUNNINGHAM D. A. , WITHEROW R. O'N. 
Published: November 2008

Summary— The investigation of vascular impotence requires a simple, reliable and non‐invasive method of estimating penile arterial supply. A method for measuring flow to the dependent portion of the penis has been developed using technetium‐labelled red blood cells (99mTc‐RBC). Its use, in conjunction with the intracavernous injection of papaverine, was investigated in 32 patients with various causes of impotence.Intracavernous papaverine was administered and a pneumatic cuff was inflated around the base of the penis both to isolate the penile circulation and to prevent dispersion of papaverine. The remaining blood pool was labelled with 99mTc‐RBC. A gamma camera was used to produce a time‐activity curve for the penis following release of the cuff. Penile blood flow was calculated from the initial gradient of the time‐activity curve.Papaverine‐stimulated penile blood flow was significantly greater in patients without evidence of arterial insufficiency. None of the subjects with arterial disease achieved flows greater than 20 ml/min/100 ml, while flow in patients without arterial disease exceeded this value. Flow estimation without the use of papaverine was not able reliably to discriminate between the 2 groups.There was no difference in papaverine‐stimulated blood flow between impotent subjects with veno‐sinusoidal leakage, in the absence of arterial disease, and a control group who achieved full erection with papaverine. It was therefore possible, by assessing the response to papaverine and measuring arterial blood flow, to distinguish between arterial insufficiency, veno‐sinusoidal leakage and non‐vascular causes of impotence.The method requires little skill and can be modified for use with inexpensive equipment.
Urological Audit: the Role for an Aggressive Approach to High Grade Superficial Bladder Tumours
Authors: MOHAMED S. R. , MISHRIKI S. F. , PERSAD R. A. , ABRAMS P. , GINGELL J. C. , FENELEY R. C. L. 
Published: November 2008

Summary— A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted.There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3).A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted.This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning “established” surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.
Urine Transparency as an Index of Absence of Infection
Authors: PHILLIPS GABRIELLE , FLEMING LAURA W. , KHAN I. , STEWART W. K. 
Published: November 2008

Summary— A visual assessment of the clarity of urine was used as an exclusion test to indicate the absence of infection; verified by dipslide culture, it was applied to 363 urine samples collected from patients attending 2 adult nephrology clinics over a period of 6 months. The crimped aluminium bowl used for collection of samples assisted the assessment of clarity. The sensitivity of the method compared with dipslide culture was 73%, with specificity and efficiency both 58%.The predictive value of a negative test (clarity) was 97% with a false negative rate of 3%, enabling this simple examination to be used as an exclusion test for further testing. In simple terms, a clear urine is unlikely to be infected. It is also an advantage to have an immediate indicator of the absence of infection available at the clinic. Analysis of only those urines assessed as cloudy could result in financial savings and, from the clinics, a 56% reduction in workload.
Screening for Bacteriuria in Urological Patients using Reagent Strips
Authors: MILLS SARAH J. , FORD M. , GOULD F. KATE , BURTON SALLY , NEAL D. E. 
Published: November 2008

Summary— A rapid and accurate ward‐based method of diagnosing urinary infection would be of value in determining the prescription of antibiotics in pre‐operative urological patients. This study describes the sensitivity and specificity of a screening technique based on commercially available reagent strips in the diagnosis of urinary infection. A total of 222 pre‐operative samples and 83 post‐operative samples was studied to compare the results of formal urine culture and reagent strips.Using a definition of a positive nitrite or a positive leucocyte esterase on the reagent strips as being suggestive of infection, it was found that the strips had a sensitivity of 91% and a specificity of 85% compared with formal culture in pre‐operative samples. The results from post‐operative samples were less satisfactory, the strips having a sensitivity of only 71% and specificity of 55%. The strips were insensitive but specific in the identification of pyuria in pre‐operative specimens.These results suggest that reagent strips can be used as a ward‐based method to identify men at risk of infection before urological procedures, and may allow selectivity in the use of peri‐operative antibiotics.
Effect of Substance P on Detrusor Muscle in Rats with Diabetic Cystopathy
Authors: DAHLSTRAND C. , DAHLSTRÖM A. , AHLMAN H. , JONSSON O. , LUNDSTAM S. , NORLÉN L. , PETTERSSON S. 
Published: November 2008

Summary—Diabetic cystopathy (DCP) is a well known complication in diabetes mellitus (DM). In the present experimental study, DM was induced in rats by streptozotocin and DCP was confirmed on cystometry.In vitrostudies on detrusor strips from diabetic rats showed an increased contractile response to substance P (SP) compared with controls, indicating denervation supersensitivity. A decreased response to capsaicin in diabetic detrusor strips indicated a decreased neuronal content of SP or a diminished number of SP‐containing sensory nerves. This suggests that DM induces alterations in nerves containing SP which may be at least partly responsible for sensory loss and the development of DCP.
Preliminary Results of Concurrent Cisplatin and Radiation Therapy in Locally Advanced Bladder Cancer
Authors: UTSUNOMIYA M. , ITOH H. , YOSHIOKA T. , MASAKI N. , ITATANI H. 
Published: November 2008

Summary— Between March 1981 and March 1990, 15 patients with locally advanced transitional cell carcinoma of the bladder were treated concurrently with cisplatin and radiotherapy. Treatment comprised a radiation dose of 40‐50 Gy in 20‐25 fractions over 4‐5 weeks and intravenous infusion of cisplatin with hydration during days 1‐5 and 22‐26. The total scheduled dose of cisplatin was 200 mg. A complete response (CR) was seen in 3 patients (2 T2 tumours and 1 T3) and the other 12 were regarded as partial responders. Two of the 12 partial responders (1 T2 tumour and 1 T4) underwent cystectomy after treatment, but 9 patients (2 T2,6 T3 and 1 T4) underwent only transurethral resection. The remaining patient (with a T4 tumour) died from systemic disease, further treatment not being possible because of unrelated heart failure. In 3 CR patients and 9 with a partial response (PR), bladder function was preserved and they have survived for a mean of 18.3 months (range 5‐47) after therapy. Although 4 patients in this group had recurrent bladder tumours and 1 died from cancer in another part of the body, 7 have survived with normal bladder function and no recurrence.It is concluded that concurrent cisplatin and radiation therapy is a safe and viable regimen and may be considered as a means of preserving the bladder in patients with locally advanced transitional cell carcinoma.
Results of the Surveillance Policy of Stage I Non‐seminomatous Germ Cell Testicular Tumours
Authors: COLLS B. M. , HARVEY V. J. , SKELTON L. , THOMPSON P. I. , DADY P. J. , FORGESON G. V. , PEREZ D.J. 
Published: November 2008

Summary— A series of 1 15 patients with clinical Stage I non‐seminomatous germ cell testicular tumours were managed with orchiectomy and close surveillance (median follow‐up 36 months, range 3‐1 19); 34 (29.5%) relapsed, 21 within 6 months, 29 within a year and the latest at 28 months. At relapse all patients were treated with platinum or analogue‐based drug combinations, supplemented in 7 by retroperitoneal node dissection; 30 patients achieved durable remissions and 2 have had further relapses successfully treated. Two died; both had malignant teratoma intermediate with primary stage T1 and vascular and/or lymphatic invasion of primary tumour. At a median follow‐up time of 36 months, the survivors (98.3%) demonstrate no evidence of disease, these results matching the outcome of other methods of management.Vascular and/or lymphatic invasion was associated with an enhanced relapse rate but specific histology, T stage of the primary and pre‐orchiectomy serum alpha‐fetoprotein status did not appear to favour relapse. The first sign of relapse was tumour marker alone in 10 patients, radiological features alone in 12, or both in 10 patients. However, in 2 cases the relapse was first detected clinically. Furthermore, pre‐orchiectomy and relapse marker status did not correlate well. These points emphasise the importance of all aspects of follow‐up, none of which can be safely omitted.
Surgical Management of Renal Carcinoma with Extensive Involvement of the Vena Cava and Right Atrium
Authors: DAVITS R.J. A. M. , BLOM J. H. M. , SCHRÖDER F. H. 
Published: November 2008

Summary Between 1988 and 1990,8 patients with a renal tumour extending into the vena cava and with supradiaphragmatic extension were treated by an operative technique involving extracorporeal circulation and deep hypothermic circulatory arrest. In 4 patients the thrombus extended into the right atrium. Six patients appeared to have a renal carcinoma. Intra‐operatively one patient's tumour proved to be a metastasis of a squamous cell carcinoma of the lung and another patient was found post‐operatively to have a leiomyosarcoma of the vena cava. Two of these 6 patients died from metastases 6 weeks and 8 months post‐operatively. Four patients are symptom‐free, although 3 of them have liver or lung metastases 10,20 and 37 months postoperatively. One has no evidence of disease 18 months post‐operatively.The use of extracorporeal circulation and deep hypothermic circulatory arrest provides optimal surgical exposure and gives the patients a considerable complaint‐free interval post‐operatively. How often cure is also achieved is as yet unclear.
Clinical Information System that Enhances the Use of Resources in Endoscopic Prostatic Procedures
Authors: EMBERTON M. , ELLIS B. W. 
Published: November 2008

Summary In this study we evaluated, by means of an automated management system, the identification of subgroups of patients within certain operative categories whose predictable length of stay was compatible with treatment on a 5‐day ward. This was achieved by using a computer directed analysis of urological workload on prospectively collected clinical data. Graphical presentation of the results was achieved by a technique known as the patient‐bed dissociation curve.Patients with bladder outflow obstruction treated by transurethral prostatic resection (701) and bladder neck incision (113) were selected from a total of 7162 hospital admissions. The main outcome measures were length of stay and complication rates for the 2 procedures.The results demonstrated that a group of patients about to undergo transurethral resection could be selected by age and source which would indicate an 18% greater probability of discharge within 5 days. These patients were easily identifiable in advance and would be suitable for treatment on a 5‐day ward.It was concluded that computer‐held clinical data were easily accessible to the surgeon. The process of detailed analysis need not take time. With properly directed studies the information retrieved could be used to effect change. The patient‐bed dissociation curve may prove a valuable tool in examining and comparing discharge patterns in any groups of patients.