bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity Following Cystoscopy: Comparison of Flexible and Rigid Techniques
Authors: DENHOLM S. W. , CONN I. G. , NEWSAM J. E. , CHISHOLM G. D. 
Published: November 2008

Summary Recent reports on the value of local anaesthetic flexible cystoscopy have emphasised excellent tolerance and preference for the technique over general anaesthetic rigid cystoscopy. However, no study has yet compared the post‐operative morbidity rates of these procedures.Tolerance, preference and post‐operative symptoms in 100 patients undergoing local anaesthetic flexible cystoscopy were compared with those in 100 patients undergoing general anaesthetic rigid cystoscopy. On initial questioning, 89% of patients found flexible cystoscopy painless and 92% expressed a preference for the same procedure on a future occasion; 98 patients who underwent flexible cystoscopy and 87 who underwent rigid cystoscopy returned a questionnaire on symptoms 1 week after the procedure. The incidence of post‐operative symptoms was 33% following flexible cystoscopy and 76% following rigid cystoscopy. Patients in both groups who were undergoing check cystoscopy had a lower incidence of morbidity than those undergoing cystoscopy for other reasons.results suggest that flexible cystoscopy was well tolerated and preferred by most patients. The morbidity associated with the procedure was also significantly less than that associated with rigid cystoscopy under general anaesthesia.
Permanent External Striated Sphincter Stents in Patients with Spinal Injuries
Authors: SHAW P. J. R. , MILROY E. J. G. , TIMONEY A. G. , DIN A. EL , MITCHELL NAN 
Published: November 2008

Summary— Nine patients with complete quadriplegia underwent external striated sphincter stenting with the Wallstent in place of an external striated sphincterotomy. Although suprapubic catheters were placed to provide an outlet should problems develop with the stent, they were successfully removed within 6 weeks in all but 1 patient. Complete bladder emptying with reduced voiding pressures was achieved, together with a significant reduction in the duration of hyper‐reflexic contractions. Epithelialisation of the stent was almost complete within 3 months and intermittent catheterisation or endoscopy (and resection) is possible through the stent. Although this is a preliminary report of this new technique, it is hoped that sphincter stenting will provide a rapid, safe and effective method of treating high pressure hyper‐reflexia and detrusor sphincter dyssynergia in quadriplegic patients.Based on a Poster Demonstration at the 45th Annual Meeting of the British Association of Urological Surgeons inStHelier, June l989
Symptoms versus Flow Rates versus Urodynamics in the Selection of Patients for Prostatectomy
Authors: McLOUGHLIN J. , GILL K. P. , ABEL P. D. , WILLIAMS GORDON 
Published: November 2008

Summary— Many prostatectomies are performed on the basis of symptoms alone; 39% of patients referred by their family doctors and 23% of patients who were on waiting lists for prostatectomy of other hospitals, but who had not undergone any urodynamic investigations, were found to be unobstructed on urodynamic criteria. A screening peak urinary flow rate of 12 ml/s or less was associated with urodynamic evidence of obstruction in 95% of cases; 35% of patients with symptoms of outflow obstruction and a flow rate > 12 ml/s were also found to be obstructed.One year post‐operatively, 84% of patients who were selected for surgery on combined symptomatic and urodynamic criteria were pleased symptomatically with their result. The failure of detrusor instability to resolve following prostatectomy was associated with symptomatic failure of treatment. Residual obstruction was demonstrated in 5 patients who had undergone prostatectomy and were asymptomatic at this time.This study illustrates that objective measures are necessary in the assessment of patients prior to prostatectomy in order to select only patients who are obstructed. The importance of a screening flow rate is emphasised. All patients who underwent surgery had cystometric evidence of obstruction but the symptomatic results of surgery were no better than the results in patients who had been assessed according to non‐urodynamic selection criteria. We have thus failed to identify a need for routine cystometry in the pre‐operative assessment of these patients. Cystometry does, however, have a role in assessing patients with pre‐operative flow rates > 12 ml/s and in those who remain symptomatic following prostatectomy.
Sedoanalgesia in Urology: A Safe, Cost‐effective Alternative to General Anaesthesia
Authors: BIRCH B. R. P. , ANSON K. M. , MILLER R. A. 
Published: November 2008

Summary— Sedoanalgesia is a technique developed to provide safe and satisfactory operating conditions for a wide range of patients independent of age and overall level of fitness (although its use in children remains to be established). It is suitable for both endoscopic and open procedures, day‐cases and in‐patients. When used in day‐case surgery it significantly improves overall efficiency.It is recognised that day‐case surgery is an important and cost‐effective element in surgical care. With increasing restraints being imposed upon hospital finances, patient beds and staffing levels, any strategies designed to improve efficiency in this sphere of surgical activity are to be welcomed. That 93% of patients prefer sedoanalgesia to conventional general anaesthesia attests to its high degree of acceptability. The technique of sedoanalgesia, its applications and potential impact for urology are detailed.
Can Histological Assessment Predict the Outcome in Interstitial Cystitis?
Authors: MACDERMOTT J. P. , CHARPIED G. C. , TESLUK H. , STONE A. R. 
Published: November 2008

Summary— In a retrospective study we compared the outcome of 39 patients with interstitial cystitis to the histological findings at initial diagnostic bladder biopsy. The degree of inflammation and fibrosis and the mast cell counts were assessed on each biopsy. The prognostic relevance of the clinical features of age, duration of symptoms, frequency, nocturia, pain and bladder capacity was assessed.The study showed no statistical correlation between the severity of histological findings at diagnosis and the eventual outcome of the disease. Over 50% of patients with severe histological abnormalities responded to conservative treatment. Although the majority of patients with mild pathological changes responded to conservative treatment, some did require surgical intervention.The clinical features of pain, nocturia and bladder capacity showed significant differences between the 2 patient groups. However, the former 2 features are subject to many variables and the latter probably has too wide a range to be useful as a prognostic indicator.Only the response of patients to conservative treatment will indicate those who are not being helped and who may eventually require surgical treatment.
Is Voided Urine Suitable for Flow Cytometric DNA Analysis?
Authors: MELLON K. , SHENTON B. K. , NEAL D. E. 
Published: November 2008

Summary— Samples of bladder washings are frequently used to provide cellular material for flow cytometric DNA analysis. Since voided urine is a potential source of similar material, the aim of this study was to determine whether voided urine yields satisfactory specimens.We compared the qualitative results of flow cytometric DNA analysis of the cells in 53 specimens of voided urine and 109 samples of bladder washings; 45% (24/53) of urine specimens gave satisfactory DNA histograms compared with 93% (101/109) of bladder washings. This difference was apparent regardless of whether the bladder contained a tumour.It was concluded that bladder washings provide superior material for flow cytometric DNA analysis and that flow cytometric DNA analysis of freshly voided urine may have deficiencies which preclude its use in routine clinical practice.
Ureteroureterostomy and Pyeloureterostomy without Native Nephrectomy in Renal Transplantation
Authors: LORD ROZANNE H. H. , PEPERA T. , WILLIAMS GORDON 
Published: November 2008

Summary— A series of 23 patients, receiving full immunosuppression following renal transplantation, underwent a uretero‐ or pyelo‐ureterostomy with ligation of the native ureter and no nephrectomy. In 5 patients this was carried out at the time of transplantation because of a short donor ureter and in 18 patients, at a median of 47 days after transplantation, following ureteric complications. With a median follow‐up of 22 months, no complications have been seen in relation to the native kidney.Ureteroureterostomy was successful in all but 3 patients. A ureteroureterostomy without native nephrectomy is a safe and effective treatment for the management of ureteric complications following renal transplantation.
Lower Urinary Tract Reconstruction in Patients with Bladder Exstrophy after Failed Primary Treatment in Early Childhood
Authors: MUNDY A. R. , NURSE DIANE E. , PARRY J. R. W. 
Published: November 2008

Summary— The results of neonatal surgery for bladder exstrophy are not very satisfactory. A significant percentage of patients present in later childhood or adolescence for correction of their residual deformities.We have reconstructed 26 patients, correcting their entire urogenital and cosmetic deformity in a one‐stage procedure. The results show that one‐stage total reconstruction is possible and is preferable to serial correction of the various individual abnormalities. The principles of surgical reoperation in adolescence are the same as those now established for the primary correction in neonatal life.
Indoramin in the Treatment of Prostatic Bladder Outflow Obstruction
Authors: STOTT M. A. , ABRAMS P. 
Published: November 2008

Summary— A series of 40 patients took part in a double‐blind, placebo‐controlled trial of indoramin in prostatic bladder outflow obstruction. Patients were assessed clinically and urodynamically before and after 4 weeks' treatment. Significant improvement was seen in nocturia, volume voided, flow rates and residual urine. The drug was well tolerated, although 7 patients on treatment and 7 on placebo noted side effects.These results suggest that indoramin may be a useful agent in the symptomatic management of bladder outflow obstruction.
Neo‐adjuvant (Pre‐emptive) Cisplatin Therapy in Invasive Transitional Cell Carcinoma of the Bladder
Authors: WALLACE D. M. A. , RAGHAVAN D. , KELLY K. A. , SANDEMAN T. F. , CONN I. G. , TERIANA N. , DUNN J. , BOULAS J. , LATIEF T. 
Published: November 2008

Summary— Following 2 pilot studies which showed 57 and 61% response rates to intravenous cisplatin for transitional cell carcinoma of the bladder prior to definitive treatment, the West Midlands Urological Research Group (WMURG) and the Australian Bladder Cancer Study Group (ABCSG) independently began randomised trials to test the survival benefit of neo‐adjuvant intravenous cisplatin prior to radiotherapy in T2‐T4 M0 transitional cell carcinoma of the bladder.Both trials failed to recruit their target numbers of 250 patients in the West Midlands and 320 in Australia. Since they had similar treatment protocols and eligibility criteria, they were combined in an overview analysis, achieving a total number of 255 patients.Each treatment group was compared with its own control group and the differences were pooled to give an overall result. There was no difference in survival between treated and control patients. The odds ratio was 1.13 with the control groups faring marginally better than the chemotherapy groups. Even with 255 patients the 95% confidence interval of the odds ratio was wide (0.80–1.57). Although there is no clear evidence of a clinically worthwhile benefit from neo‐adjuvant cisplatin, this approach must be tested in a larger study using combination treatments with greater activity in metastatic disease.
Treatment of Organic Impotence
Authors: CUMMING J. , PRYOR J. P. 
Published: November 2008

Summary— A review of 86 patients referred to a urological clinic with impotence showed that in 58% the causation was predominantly psychogenic. These patients were managed with psychosexual counselling. The various treatment options were discussed with those patients with organic impotence and 14 underwent the implantation of a penile prosthesis.A review of 130 patients who received penile prostheses in the period 1983 to 1987 was carried out to compare the complications and results obtained with the various types of prosthesis. The overall satisfaction rate was 81%; dissatisfaction usually arose as a result of complications of surgery. These were highest in patients with diabetes and priapism. The complications were also related to the type of prosthesis used.
Ureteric Obstruction by Ligature Treated by Endoscopic Diathermy
Authors: GIGABHOY S. , KIELY D. 
Published: November 2008

The incidence of ureteric obstruction after hysterectomy is 2 to 3% (Symmonds, 1966). Open surgery has so far been the method of treatment of such obstruction.A cold coaxial knife has recently been used to treat ureteric strictures, with better short‐term results than those achieved following other endoscopic procedures associated with dilatation (Selikowitz, 1990).We present what we believe to be the first reported case where total occlusion of the ureter by ligature was successfully treated by endoscopic diathermy.
Anaesthesia‐free Extracorporeal Shock Wave Lithotripsy in Patients with Renal Calculi
Authors: VANDEURSEN H. , TJANDRAMAGA B. , VERBESSELT R. , SMET G. , BAERT L. 
Published: November 2008

Summary Modern extracorporeal shock wave lithotripsy can be performed with combined ECG and respiratory triggered shock wave release. Disconnecting the ECG triggering increases the risk of ventricular arrhythmias, including potentially malignant ones. The aim of this study was to assess the relationship of any sympatho‐adrenal excitation as a possible explanation for the occurrence of cardiac arrhythmia.Plasma catecholamine levels were assessed in 5 patients during and after 50 min of anaesthesia‐free extracorporeal shock wave lithotripsy for the treatment of calculi in the upper pole of the left kidney. Venous blood sampling showed no significant increase in catecholamines (epinephrine, norepinephrine and dopamine) during or after treatment. The heart rate and arterial blood pressure were measured simultaneously and showed no significant increase when shock waves were released during ECG triggering. However, when disconnecting the ECG‐triggering mode, the incidence of ventricular extrasystoles on Holter monitoring became more apparent during respiratory triggered shock wave release only, although there was no rise in plasma catecholamine levels.These data suggest that cardiac arrhythmias are related to direct and accidental mechanical stimulation of the heart rather than to any sympatho‐adrenal discharge during shock wave release.
The Effect of Cromakalim on the Normal and Hyperreflexic Human Detrusor Muscle
Authors: NURSE DIANE E. , RESTORICK J. M. , MUNDY A. R. 
Published: November 2008

Summary Cromakalim is a benzopyran derivative which relaxes smooth muscle, probably by opening membrane potassium channels.This study tested the effect of cromakalim on spontaneous, electrically induced and pharmacologically induced contractile activity of normal and hyper‐reflexic human detrusor muscle samples. All 3 types of contractile activity were reduced in the presence of cromakalim.A preliminary clinical trial of cromakalim was conducted, the results of which also suggest that this type of drug may have a significant role in the treatment of detrusor instability and hyperreflexia.
Measurement of in vivo Urological Tumour Cell Kinetics Using Multiparameter Flow Cytometry Preliminary Study
Authors: REW D. A. , THOMAS D. J. , COPTCOAT M. , WILSON G. D. 
Published: November 2008

Summary The in vivo labelling of urological tumour cells using the S phase marker bromodeoxyuridine (BRdU) for histochemical studies is reported. The use of multiparameter flow cytometry (FCM) with BRdU labelling to study tumour proliferation offers significant advantages. It provides simultaneous measurements of the DNA ploidy (Dl), the duration of the S phase (Ts), the potential doubling time (Tpot) and the total and aneuploid tumour labelling indices (LI) from a single specimen. Heterogenous tumour cell populations can be measured with high sensitivity. We report a preliminary study to evaluate the method in the measurement of the kinetics of transitional cell carcinoma of the bladder (TCCB).Nineteen patients with TCCB, 1 with leukoplakia of the bladder, 2 with renal carcinoma, 1 with prostatic carcinoma and 1 with a squamous carcinoma of the penis were studied. Of the bladder tumours, 3 were aneuploid, Dl = 1.32, 1.58 and 1.89. BRdU uptake was detected in all tumours. The median LI was 1.5% (range 0.5–10.0). In 15/19 tumours the labelling profile was satisfactory for calculation of the Ts and Tpot. The median Ts was 6.2 h and the median Tpot was 17.1 days.This study demonstrates that measurement of multiple parameters of urological tumour proliferation in vivo is possible. These parameters require further assessment as indices of biological aggressiveness and clinical prognosis.
Use of a Straw for Suprapubic Stab Puncture—an Alternative Method
Authors: TILAK A. G. 
Published: November 2008

The technique of suprapubic stab puncture has been used in 80 cases. The use of a straw to introduce a large size Foley catheter is considerably cheaper than using a sophisticated peel‐away sheath introducer.Using a straw as a third (outer) sheath over the commonly used Reuter trocar and cannula provides all of the features of a peel‐away sheath introducer and is a cost‐effective alternative method.
Renal Carcinoma with Inferior Vena Cava Malignant Thrombosis
Authors: PROCA E. 
Published: November 2008

Summary During an 11 ‐year period a total of 314 patients underwent surgery for renal carcinoma; 70 had venous extension of the tumour, 31 had extension to the main renal vein and were staged V1 and 39 had involvement of the inferior vena cava and were staged V2.Special attention was paid to the latter group, which was divided into 2 subgroups: V2a for caval extension without ingrowth and V2b for caval extension with infiltration of the caval wall. Thirty‐eight patients with caval involvement underwent surgery, with a 13% post‐operative mortality rate.Most of the patients with malignant caval ingrowth (V2b) had concomitant lymph node and distant metastases. However, some had negative lymph nodes and no metastases at the time of operation.Perifascial nephrectomy associated with caval tumour removal or lateral subhepatic caval resection for patients staged V2aN0M0 significantly increased the survival rate when compared with that of patients with no surgery on the obstructed vena cava.Total resection of the completely obstructed subhepatic vena cava for patients staged V2bN0M0 has limited indications but, in selected cases, may prolong survival.This retrospective study supports the reintroduction of indicator V in the TNM staging of renal carcinoma and suggests the splitting of stage V2 into V2a for patients with free‐floating caval extension and V2b for caval thrombus with ingrowth and caval wall infiltration.
Relationship between Clinical Stage and Histological Zone of Origin in Early Prostate Cancer: Morphometric Analysis
Authors: GREENE D. R. , WHEELER T. M. , EGAWA S. , WEAVER R. P. , SCARDINO P. T. 
Published: November 2008

Summary A detailed morphometric analysis of 96 radical prostatectomy specimens (13 clinical stage A1, 29 A2,34 B1 and 20 B2) was undertaken to examine the relationship of zone of origin to volume, grade and extraprostatic extension of cancer.In patients with stage A disease, transition zone (TZ) cancer (present in 81%) was significantly larger but of lower grade than peripheral zone (PZ) cancer (present in 90%). The total volume of cancer in stage A1 patients averaged 1.55 ml with 72% of TZ origin. In patients with stage A2 disease, tumour volume averaged 5.83 ml with only 57% of TZ origin. Specimens taken during transurethral resection of the prostate (TURP) revealed TZ cancer in 82% and PZ cancer either alone or with TZ cancer in 22%. The 9 patients with PZ cancer in the TURP specimen included 5 of the 11 with extracapsular extension and all 5 of those with seminal vesicle invasion.Every patient with stage B disease had PZ cancer which, in all except 3 cases, was of significantly larger volume and higher grade than any TZ cancer (present in 43%) in the same gland. In patients with stage B cancer, total tumour volume was 5.13 ml with 91% of PZ origin.TZ cancer tended to be well differentiated in all patients, even at large volumes, whereas PZ cancer was often moderately or poorly differentiated even at low volumes. In patients with stage B disease, TZ cancer appeared to be incidental and of no clinical importance, while in stage A patients PZ cancers were sometimes large, poorly differentiated and extended outside the prostate. Progression of a stage A cancer seems more likely to result from PZ cancer than TZ cancer, and the finding of PZ cancer in a TURP specimen should probably preclude its classification as stage A1.
Animal Models for Epididymoepididymostomy. Development of an Alternative Microsurgical Procedure for Vasoepididymostomy
Authors: McCLATCHEY M. , TEMPLE‐SMITH P. D. , SOUTHWICK G. J. 
Published: November 2008

Summary The present success rate for high level microsurgical vasoepididymostomy in patients with obstructive azoospermia is generally poor in comparison with more distal vasoepididymal bypasses, suggesting that the development of a high level bypass method which preserves the distal maturation and storage functions of the epididymis might increase the fertility success rate. To achieve this we have developed a segmental bypass of the distal caput‐proximal corpus regions of the epididymis (epididymoepididymostomy) using the rat and rabbit as animal models.In this procedure the epididymides of 11 adult male Sprague‐Dawley rats were exposed through a scrotal incision and a convolution of the duct in the proximal corpus region was attached to an opened convolution in the mid‐caput epididymides using a standard microsurgical technique. Each male was rested for at least 3 months after the microsurgical bypass operation to allow the preoperative sperm contents of the caudal storage region to be replaced by post‐bypass spermatozoa. Six of the 11 rats were proven fertile after surgery by siring litters from mating trials up to 11 months later. The patency of anastomoses was confirmed in 3 animals by laparotomy and recovery of large numbers of sperm with normal motility from the cauda epididymidis distal to the anastomosis site and also from the vas. Similar unilateral surgery in 2 adult male rabbits resulted in normal postoperative semen profiles in 1 and an in vivo fertilisation rate of 100% from 1 mating trial 8 months after surgery.The successful development of a reliable animal model for epididymoepididymostomy provides an experimental tool for studying the function of the epididymis. This technique may also have clinical application as an alternative to high level vasoepididymostomy in selected patients with obstructive azoospermia.