bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Incontinence in Bladder Exstrophy*
Authors: HOLLOWELL JEAN G. , RANSLEY P. G. 
Published: November 2008

Summary Between 1978 and 1990,86 patients with previously closed classical bladder exstrophy and 10 patients seeking undiversion have presented for continence management and have undergone selective reconstruction designed for voiding and/or intermittent urethral catheterisation. The reconstruction in these 96 patients has been reviewed.Eight of the 10 patients undergoing undiversion achieved a satisfactory state of continence but 4 required Mitrofanoff procedures to enable catheterisation.Of the other 86 patients, 2 reached a satisfactory state of continence without further surgery; 79 underwent bladder neck surgery for continence either without augmentation (n = 32) or with augmentation (n = 47). Twenty of the 32 patients who were treated by bladder neck reconstruction alone were later found to require augmentation. Five patients had very early augmentation either to facilitate neonatal closure or on account of severe upper tract dilatation. Of these, 1 became continent without further surgery and 4 demonstrated the need for bladder neck reconstruction.Thus 12 children achieved successful continence (n = 6) or are evolving satisfactorily with potential success (n = 6) as a result of bladder neck reconstruction.Of the 71 patients requiring bladder neck reconstruction and augmentation, 68 have completed their surgery. The current status of these patients is: satisfactory in 57 (80%) (42 void/urethral clean intermittent catheterisation (CIC), 7 waiting to learn CIC, 5 Mitrofanoff, 3 artificial urinary sphincter (AUS)). Of the remaining 11 patients (20%), 8 are unsatisfactory to varying degrees and the status of the other 3 is unknown.
Pyuria: Index of Infection in Patients with Spinal Cord Injuries*
Authors: MENON E. B. , TAN E. S. 
Published: November 2008

SummaryLittle is known about the significance of pyuria in patients with spinal cord injuries. The progress in hospital of 55 such patients was studied. They were divided into 2 groups according to the method of bladder drainage on admission. Group A comprised 43 patients with indwelling catheters. Group B comprised 12 patients who were able to void with tapping, with/without compression and on intermittent catheterisation.The results showed that group A had a mean pyuria level of 185 WBC/HPF on admission. The incidence of urinary tract infection was 4 per patient during hospitalisation and the mean duration of bladder training was 82 days. Group B had a mean pyuria level of 32 WBC/HPF on admission. The incidence of urinary tract infection was 1 per patient during hospitalisation and the mean duration of bladder training was 40 days. The difference between groups A and B for all 3 parameters was statistically significant.These results suggest that patients with spinal cord injuries and indwelling catheters have a higher pyuria level and an increased risk of significant morbidity secondary to urinary tract infection, especially at the pyuria level of 100 WBC/HPF. A low pyuria level of 30 WBC/HPF was associated with a nil or low incidence of bacteriuria and urinary tract infection in our patients.
Radiation Protection in Percutaneous Renal Surgery
Authors: BOWSHER W. G. , BLOTT P. , WHITFIELD H. N. 
Published: November 2008

SummaryTwo British centres have published the radiation doses received during percutaneous nephrolithotomy (PCNL). Their results were disparate. This study was performed to establish the likely exposure of the eyes and fingers of an experienced urological surgeon who creates the track into the kidney and also performs the endoscopic operation. In addition, some radioprotective gloves were evaluated. Provided that specific precautions, including a judicious use of screening, are taken, the current dose limits are unlikely to be exceeded. However, a 30% reduction in the dose limits is probable. Wearing routine radiation badges under a lead apron is an inadequate method of monitoring exposure: urologists should press for more active assistance from radiation protection officers in the monitoring of procedures in theatre and the use of ultrasound should be encouraged.
Ureteric Complications of Renal Transplantation
Authors: KASHI S. H. , LODGE J. P. A. , GILES G. R. , IRVING H. C. 
Published: November 2008

Summary— Of 507 consecutive recipients of renal allografts, 45 developed a urological complication. In 39 patients (7.7%) ureteric problems were implicated and these comprised 30 cases of obstruction and 9 cases of ureteric necrosis presenting as urinary leakage.In 7 patients ureteric obstruction resolved following a period of nephrostomy decompression; 10 patients were reconstructed surgically and this was successful in 8, with 2 patients requiring further surgical procedures. Ten patients were successfully treated by percutaneous stenting after dilatation of the stricture. Stenting failed in 4 patients and in 1 patient caused rupture of a calix. All 10 stents have now been removed and there is no recurrence of stricture (follow‐up 32.0 ± 8.6 months). Of the remaining 3 grafts, 2 were removed and the other graft had percutaneous removal of a ureteric calculus.The 1‐year survival rate of allografts in the ureteric complication group was 84.6%; in the recipients without a urological complication it was 81%.It was concluded that an active approach to ureteric problems following renal transplantation results in the rescue of the majority of allografts.
Acute Urinary Retention. Comparison of Suprapubic and Urethral Catheterisation
Authors: HORGAN A. F. , PRASAD B. , WALDRON D. J. , O'SULLIVAN D. C. 
Published: November 2008

Summary— A total of 86 consecutive patients who presented to the accident and emergency department with acute urinary retention due to prostatomegaly required catheterisation; 56 received suprapubic catheters and 30 were catheterised urethrally. Both groups were followed up for 3 years.Of the 30 patients catheterised urethrally, 12 (40%) developed urinary tract infections compared with 10 (18%) urinary tract infections in the 56 patients catheterised suprapubically. Five patients (17%) in the urethral group developed urethral strictures with no strictures in the suprapubic group. Two patients catheterised urethrally developed epididymo‐orchitis and 1 developed septicaemia. None of the patients with suprapubic catheters developed these complications. Furthermore, 16 patients catheterised suprapubically underwent successful trial clamping of their catheter, whereas 7 patients required recatheterisation following removal of their urethral catheters.We recommend that the use of suprapubic catheters should become the preferred initial treatment for acute urinary retention.
Inter‐relation between Measurement of Serum Prostatic Specific Antigen and Transrectal Ultrasound in the Diagnosis of Benign Prostatic Hyperplasia and Prostatic Cancer
Authors: CLEMENTS R. , ETHERINGTON R. J. , GRIFFITHS G. J. , PEELING W. B. , HUGHES H. , PENNEY M. D. 
Published: November 2008

Summary— Serum prostatic specific antigen (PSA) and ultrasound‐determined prostatic volume (UPV) were measured in 50 patients with histologically proven benign prostatic hyperplasia (BPH) and in 40 patients with histologically proven prostatic cancer of whom 17 had evidence of distant metastases (M1) and 23 did not (MO).A good correlation between log PSA and UPV was demonstrated in the BPH group and rearrangement of the linear regression equation allowed calculation of a single variable—the log PSA corrected to a standard prostate volume for any given individual.A volume‐corrected PSA correctly identified all patients with M1 disease and greatly improved but did not eliminate overlap of M0 disease with BPH. Reduction of serum PSA to a single volume‐corrected variable will allow the introduction of practical and optimum protocols for the management of patients with prostatic enlargement.
Current Management of Duplex‐System Ureteroceles: Experience with 41 Patients
Authors: RICKWOOD A. M. K. , REINER I. , JONES M. , POURNARAS C. 
Published: November 2008

Summary— Experience is described of 41 infants and children with duplex‐system ureteroceles, 25 presenting clinically and 16 by prenatal ultrasonography. Bladder outflow obstruction was rare but lower polar vesicoureteric reflux (VUR), usually of lesser grades, was common. Upper polar function, as assessed by 99mTc‐DMSA, was negligible in children with truly ectopic ureteroceles but well preserved in those where the lesion lay wholly intravesically. Lower polar function was good, even in the presence of secondary obstruction, except in 2 infants with major VUR.Twenty‐three patients were treated by upper polar nephrectomy plus aspiration of the ureterocele; 2 subsequently required ureterocele excision. Histology of excised specimens indicated that a more conservative approach would not have been rewarded. Where upper polar function was good, conservation was maintained in 3 cases by pyelopyelostomy and in 5 more by excision of the ureterocele plus bipolar ureteric reimplantation. Other operative strategies were employed in 2 cases. Finally, a defined group of 8 children was managed expectantly without untoward results.It was concluded that the variable anatomy and function associated with duplex‐system ureteroceles require a flexibile approach to treatment, including, possibly, no treatment at all.
The Actions of Extracellular Magnesium on Isolated Human Detrusor Muscle Function
Authors: MONTGOMERY B. S. I. , THOMAS P. J. , FRY C. H. 
Published: November 2008

Summary— The effects of increasing the extracellular magnesium concentration ([Mg]) on the in vitro mechanical and electrophysiological properties of isolated human detrusor smooth muscle have been investigated. Raising extracellular Mg reduced the magnitude of the electrically‐induced phasic contractions as well as spontaneous contractions. A similar increase in the [Mg] reduced the magnitude of the inward Ca2+ current associated with the action potential as well as shifting the activation curve to more positive potentials. Spontaneous oscillations of intracellular Ca2+ could be observed in some isolated cells and such activity was also abolished by raising the extracellular [Mg].It is proposed that the contractile effects of raised extracellular Mg are mediated by an action on the inward Ca2+ current and that these observations suggest a means whereby normal and abnormal detrusor contractions might be effectively regulated.
Continent Cutaneous Diversions in Children: Experience with the Mitrofanoff Procedure
Authors: BORZI P. A. , BRUCE J. , GOUGH D. C. S. 
Published: November 2008

Summary Continent cutaneous diversions with a urinary reservoir emptied by clean intermittent self‐catheterisation (CISC) using a non‐refluxing conduit–the Mitrofanoff principle–were carried out in 10 children. Their age range was 3.9 to 17.1 years (average 12.2). The underlying diagnoses were ectopia vesicae (7), myelodysplasia (2) and a cervical cord injury secondary to birth trauma (1). The indications were incontinence secondary to poor bladder neck resistance in 8 children and an inaccessible urethral orifice in 2. The catheterising conduits used were the appendix in 9 and a vascularised gastric tube in 1. Eight children are bone‐dry with CISC. Another child needed a reoperation following dehiscence of her bladder neck closure. The other child has an intact bladder neck and urethra and occasionally leaks overnight.Mitrofanoff diversions are a reliable means of continence with CISC. This means of urinary diversion can be permanent or temporary in children who cannot or will not catheterise urethrally. Elective appendicectomy in children with potential urinary incontinence or complicated urogenital anomalies is not recommended.
Effect of Vaginal Ultrasound Probe on Lower Urinary Tract Function
Authors: WISE B. G. , BURTON G. , CUTNER A. , CARDOZO LINDA D. 
Published: November 2008

Summary— Vaginal ultrasonography has been advocated as an alternative to videocystourethrography. Ultrasound avoids the potential risks of X‐rays and reduces the cost of equipment. We have investigated the effect of the vaginal probe on the physiology of the bladder and urethra. A series of 24 women underwent urethral pressure profilometry, with and without a vaginal probe in situ. There was a significant increase in maximum urethral pressure, functional urethral length and area under the profile curve both at rest and during stress in the presence of the device. This was due to stretching and compression of the urethra by the probe. Transmission pressure ratios were significantly increased for the first 3 quartiles of the urethra.Twenty women underwent lateral bead chain urethrocystography with and without a vaginal probe. At rest, the probe resulted in elevation of the bladder neck and apposition to the symphysis pubis, and during a Valsalva manoeuvre the descent of the bladder neck was restricted by the presence of the probe. These results indicate that a vaginal probe alters the position and function of the lower urinary tract. We postulate that incontinence is reduced as a result of the probe. The use of vaginal ultrasonography in the assessment of women with urinary incontinence is therefore not recommended.
Continent Urinary Diversion Using an Artificial Urinary Sphincter
Authors: MITROFANOFF P. , BONNET O. , ANNOOT M. P. , BAWAB F. , GRISE P. 
Published: November 2008

Summary— We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra‐prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure‐regulating balloon is implanted within the area of abdominal pressure, retroperitoneally.After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow‐up of 20 months.These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir.Although long‐term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.
Male and Female Sexual Function and Activity Following Ileal Conduit Urinary Diversion
Authors: NORDSTRÖM G. M. , NYMAN C. R. 
Published: November 2008

Summary— A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre‐and post‐operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 41% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post‐operatively.The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.
Long‐term Results of Treatment of Urethral Injuries in Males Caused by External Trauma
Authors: JENKINS B. J. , BADENOCH D. F. , FOWLER C. G. , BLANDY J. P. 
Published: November 2008

Summary— Of 134 males with traumatic rupture of the urethra seen between 1967 and 1989, 10 have been lost to follow‐up and 124 have been followed up for 1 to 22 years (mean 8); 100 patients had a pelvic fracture (3 with associated rectal injury) and 24 had perineal injuries. Prior to referral 31 patients (25%) had undergone treatment in addition to suprapubic cystostomy. Wherever possible, strictures were managed by optical urethrotomy (33) or intermittent dilatation (4). In 2 patients only a suprapubic cystostomy was possible. Skin inlay urethroplasty in 1 or 2 stages was performed in 75 cases, an end‐to‐end anastomosis with or without resection of the symphysis pubis in 7 and a scrotal tube pull‐through in 3.The immediate and long‐term results depended on the severity of the original injury. With minimal displacement the management was simple and the long‐term prognosis good, a single urethrotomy being sufficient in 22 patients. Where there was considerable displacement the initial management was more difficult and there was a high incidence of long‐term complications: of 73 patients treated by urethroplasty or end‐to‐end anastomosis, significant post‐operative infection occurred in 11 (15%) and restenosis in 15 (20%), of whom 7 required a revision urethroplasty. Data in respect of potency were recorded in 80 patients: 28 of these were impotent, 20 of the 28 having sustained an injury with considerable displacement.
Arrhythmia during Extracorporeal Shock Wave Lithotripsy
Authors: ZENG Z. R. , LINDSTEDT E. , ROIJER A. , OLSSON S. B. 
Published: November 2008

Summary A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12‐lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right‐sided and left‐sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s.It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo‐analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oxymeter to be perfectly reliable for raising the alarm when depression of respiration and vaso‐vagal reactions occur.
Effect of Desmodium styracifolium‐triterpenoidon Calcium Oxalate Renal Stones
Authors: HIRAYAMA H. , WANG Z. , NISHI K. , OGAWA A. , ISHIMATU T. , UEDA S. , KUBO T. , NOHARA T. 
Published: November 2008

Summary— We have studied the inhibitory effects of Desmodium styracifolium‐triterpenoid (Ds‐t) (extracted from Desmodium styracifolium (Osbeck) Merr, a herbal medicine) on the formation of calcium oxalate renal stones induced experimentally by ethylene glycol (EG) and 1α(OH)D3(1αD3) in rats.The incidence of urinary stone formation was 81% in the control group, which received EG and 1αD3, and 29% in the Ds‐t group, which received EG and 1αD3 supplemented by Ds‐t. The serum calcium (Ca) concentration in the Ds‐t group was significantly elevated and urinary Ca excretion was markedly reduced. Urinary excretion of citrate (Cit), a factor that prevents stone formation, was significantly increased in the Ds‐t group. Excretion of urinary phosphorus (P), which was elevated to a significantly greater extent in the controls than in the Ds‐t group, was increased in both groups. The increase in urine volume in the Ds‐t group was significantly greater than in the control group. The 24‐h creatinine clearance rate (Ccr) was significantly lower in the controls. These findings suggest that Ds‐t inhibits the formation of Ca oxalate stones in rat kidneys by increasing the output of urine, decreasing the excretion of calcium and increasing the urinary excretion of citrate.Ds‐t may be useful in preventing the recurrence of urinary Ca oxalate stones in the clinical setting.
Extensive Condylomata Acuminata of Male Urethra: Management by Ventral Urethrotomy
Authors: KESNER K. M. 
Published: November 2008

Summary— Between 1982 and 1990,4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia. When sepsis had settled all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts. Surgical and electro‐excision were the preferred methods of removal. Of 3 patients who developed recurrences 2 were lost to follow‐up. A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed. A fourth patient was lost to follow‐up for 4 years before returning with destruction of his external genitalia by a verrucous carcinoma.The human immunodeficiency virus (HIV) did not appear to be a factor in the natural history of intraurethral warts in 2 patients who were negative for serum antibodies 2 and 8 years after presentation.
Lumbar Epidural Blockade for Management of Pain in Interstitial Cystitis
Authors: IRWIN P. P. , HAMMONDS W. D. , GALLOWAY N. T. M. 
Published: November 2008

Summary— Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18‐month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain.Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure.Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.