bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are pelvic computed tomography, bone scan and pelvic lymphadenectomy necessary in the staging of prostatic cancer?
Authors: Levran Z. , Gonzalez J.A. , Diokno A.C. , Jafri S.Z.H. , Steinert B.W. 
Published: November 2008

Objective To investigate the effectiveness and economy of pelvic computed tomography (CT), bone scan and pelvic lymphadenectomy as staging modalities in patients undergoing radical prostatectomy. The use of prostate specific antigen (PSA) and Gleason's score as adjuncts to predict extracapsular disease were also evaluated and their economic implications examined. Patients and methods Between January 1990 and June 1993, 861 men were newly diagnosed with prostate cancer, of whom 409 underwent surgery. All patients underwent pelvic CT scans and PSA analysis. Patients undergoing surgery had pre‐operative bone scans and Gleason's scoring of their pathological tissue. Results Only 13 (1.5%) of 861 men had positive pelvic CT scans. Of the 409 patients who underwent surgery, all had negative pelvic CT and bone scans, and all underwent a modified pelvic lymphadenectomy; 192 (47%) had extracapsular disease. Only 15 (3.7%) patients who underwent surgery were found to have positive nodes. Conclusions The use of pelvic CT and bone scans for clinical staging in patients with a PSA level of ≤ 20 ng/mL should not be advocated because they have a very low yield and are not cost effective. We question the role of a modified pelvic lymphadenectomy for staging purposes, either by an open or laparoscopic procedure, because the yield of positive diagnoses is very low.
Occupational risk lor renal cell carcinoma. A case‐control study based on the New Zealand Cancer Registry
Authors: Delahunt B. , Bethwaite P.B. , Nacey J.N. 
Published: November 2008

Objective To evaluate occupational risk factors for renal cell carcinoma.Subjects and methods A case control design was employed using data reported to the New ZealandCancerRegistry from 1978 to 1986 inclusive. The occupational risk for renal cell carcinoma was derived by comparison with the occupation of cases of non‐urinary tract malignancy reported to the Registry over the same period.Results An active occupational code was derived for 86.2% of all cases and 98.9% (710) of male cases. In a series of case‐control studies for selected occupational groups, adjusting for patient age and smoking history, a significantly increased relative risk for the development of renal cell carcinoma among firefighters (RR 4.89, 95% CI 2.47–8.93) and painters (RR 1.79, 95% CI 1.31–3.44) was demonstrated.Conclusion The data suggest that both firefighters and painters may be at an increased risk of developing renal cell carcinoma, which is likely to be of significance as both occupational groups are frequently exposed to known carcinogens.
Lack of efficacy of low‐dose subcutaneous recombinant interleukin‐2 and interferon‐a in the treatment of metastatic renal cell carcinoma
Authors: Thiounn N. , Mathiot C. , Dorval T. , Flam T.A. , Tartour E. , Mosseri V. , Zerbib M. , Fridman W.H. , Debre B. 
Published: November 2008

Objective To evaluate the efficacy and toxicity of subcutaneous immunotherapy using a combination of recombinant interleukin‐2 (r‐IL2) and interferon‐α (IFN‐α) for the treatment of patients with metastatic renal cell carcinoma (RCC).Patients and methods Initially a maximum of 45 patients with advanced RCC were to be included in the study, according to a Fleming three‐stage procedure. To be included patients had to have measurable metastasis. Of a potential 45 patients with advanced RCC, 15 patients were included in the study (10 men and five women, mean age 51 years, range 25–69). From the first week of treatment r‐IL2 was given subcutaneously on day 1 to 5, at 18 times 106 units once a day and then 9 times 106 units once a day for the following 5 weeks. IFN‐α was given three times a week for the last 5 weeks. Minimum follow‐up was 6 months.Results All patients initially underwent radical nephrec‐tomy. Seven patients were found to have metastases at the time of diagnosis. All patients received ambulatory therapy, except for the first 5 days of treatment.Overall, 80% of the patients received more than 75% of the complete dose of r‐IL2. One patient suffered toxicity greater than the World Health Organization (WHO) grade 2 (neutropenia). No patient had a complete or partial response, two patients had a minor response, two patients had stable disease and 11 patients had disease progression.Conclusions Subcutaneous r‐IL2 and IFN‐α had no beneficial effect on the first 15 patients and the study was discontinued, in accordance with the Fleming rules. The dose, administration and combination of r‐IL2 and IFN‐α may explain the lack of efficacy. Other studies have shown that low doses of r‐IL2 are not effective and the superiority of the combination of r‐IL2 and IFN‐α has not been proven. Therefore, a high dose of r‐IL2, in association with other cytokines, chemotherapy and adoptive immunotherapy, may be the only way to improve the response rate of metastatic RCC.
The application of a prognostic factor analysis for Ta.T1 bladder Cancer in routine urological practice
Authors: Reading J. , Hall R.R. , Parmar M.K.B. 
Published: November 2008

Objective To assess the reproducibility of the prognostic factor findings of Parmar et al. [1], in a routine urological practice.Patients and methods The superficial tumour recurrence‐free rate has been analysed for 232 newly diagnosed consecutive patients with Ta. Tl transitional cell carcinoma of the bladder. All patients were without carcinoma in situ or muscle invasion at the time of diagnosis.Results Applying the prognostic factors recommended (number of tumours at diagnosis; tumour recurrence at first 3‐month cystoscopy) patients with Ta. Tl bladder Cancer may be divided into three distinct groups with significantly different chances of superficial bladder tumour recurrence.Conclusion Two simple clinical criteria provide a reliable guide to the likelihood of tumour recurrence in patients with Ta. Tl bladder cancer. The modification of follow‐up cystoscopy schedules on this basis requires prospective study.
The International Prostate Symptom Score in a community‐based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume
Authors: Bosch J.L.H.R. , Hop W.C.J. , Kirkels W.J. , Schröder F.H. 
Published: November 2008

Objectives To study the prevalence of symptoms of pro‐statism in the community and the correlation between these symptoms and age, prostate volume, flow rate and residual urine volume.Subjects and methods The International Prostate Symptom Score (IPSS) was administered to a community‐based population of 502 men aged between 55 and 74 years with no prostate Cancer and no history of a prostate operation. Prostate volume parameters, flow rate variables and post‐void residual urine volume were measured.Results Overall, 6 and 24% of the men were severely and moderately symptomatic, respectively. The results of a detailed questionnaire such as the IPSS (only 12% of the men scored 0) contrast with the men's global perception of their voiding function (82% claimed to have ‘no voiding complaints’). A good correlation was found between the total symptom score and the single disease‐specific quality of life question that is included in the IPSS (r= 0.74, P= 0.001). There was a weak correlation between the IPSS and total prostate volume (r= 0.19, P<0.001), and between the IPSS and physiological measures such as peak flow rate (r=— 0.18, P<0.001) and post‐void residual urine volume (r= 0.25, P<0.001). There was a very weak correlation between the IPSS and age (r=0.09, P= 0.04).Conclusions The parameters used to characterize benign prostatic hyperplasia (BPH) should be considered independently because no predictions about the value of a certain parameter can be made by knowing one of the other parameter values. Symptom scores should therefore not be used as a pre‐selection criterion in the determination of the prevalence of clinical BPH without taking other measures into account. The interpretation of the parameter values in a clinical setting should take the lack of correlation and the variability of the parameter values into account.
Changes in prostatic thickness and the location of ejaculatory ducts in autopsy prostates
Authors: Suzuki T. , Kurokawa K. , Takahashi O. , Yajima H. , Ito H. , Yamanaka H. 
Published: November 2008

Objective To measure prostatic thickness and the depth of ejaculatory ducts from the urethral surface to prevent ejaculatory duct damage during transurethral balloon laser thermotherapy.Materials and methods In 47 prostates obtained at autopsy, the prostatic thickness and the depth of ejaculatory ducts from the urethral surface were measured in eight directions from the centre of the urethra.Results The depth of ejaculatory ducts was approximately 6 mm from the urethral surface regardless of prostatic weight. Increase in prostatic weight was associated with increase in the thickness in all directions except the posterior one; the thickness ranged from 9 to 20 mm. The posterior thickness at the level of the transition zone was 10 mm regardless of prostatic weight.Conclusion When benign prostatic hypertrophy is treated transurethrally, using laser or microwave equipment, care should be taken to avoid heating the posterior region of the prostate.
The effect of age, ethnicity and geographical location on impotence and quality of life
Authors: Jonler M. , Moon T. , Brannan W. , Stone N.N. , Heisey D. , Bruskewitz R.C. 
Published: November 2008

Objective To estimate the prevalence of impotence in men over 40 years of age and correlate impotence to age, geographical location, ethnicity and quality of life.Subjects and methods While attending ‘The Prostate Cancer Awareness Week’ in Madison, WI, USA, New Orleans, LA, USA and New York, NY, USA, 1680 men were asked to complete a questionnaire regarding impotence, age, geographical location, ethnicity and quality of life.Results Impotence was found to be significantly associated with age, was less associated with geographical location but independent of ethnicity. Men living in Madison reported a lower potency score compared with men living in New Orleans and New York.However, potency score for men living in Madison did not appear to decline as rapidly with age when compared with men living in New Orleans and New York. Impotence and quality of life were also found to be associated even when the quality of life estimates were adjusted for age, geographical location, and age by geographical location.Conclusion This study indicates that impotent men have a lower quality of life than potent men and has confirmed previous findings that age is associated with impotence. Surprisingly, answers to impotence questions were also associated with geographical location.
Scarring following renal trauma in children
Authors: Surana R. , Khan A. , Fitzgerald R.J. 
Published: November 2008

Objective To assess factors relating to renal scarring following kidney injury.Patients and methods A total of 25 children who had documented renal injury between 1981 and 1988 were included in the study and 19 were followed up for 1 month to 12 years (mean 5.5 years) and the development of hypertension and renal scars assessed using ultrasonography and radionuclide scans (dimer‐capto‐succinic acid, DMSA).Results Of the 19 children 13 had renal contusions, four had renal lacerations and two sustained severe renal injury, one of whom had pelvi‐ureteric disruption. Eighteen patients presented with macroscopic or microscopic haematuria except the patient with pelvi‐ureteric junction disruption who presented 3 weeks later with abdominal distension, vomiting and hypertension. All the patients were managed without an operation except the latter patient who required neph‐rectomy. Renal scarring was demonstrated in four children at a mean follow‐up of 3.5 years, one following renal contusion (5% scarring), two after renal laceration (50% scarring) and one after rupture of the kidney (100% scarring). In one patient intravenous pyelography did not reveal a renal scar but a radionuclide scan performed 5 years later demonstrated a scar. Transient hypertension was noted in only two patients but peripheral plasma renin levels were normal.Conclusion Renal scars developed in four of 19 patients with renal trauma and more than half of the patients with severe renal injury. Long‐term follow‐up including a radionuclide scan is therefore necessary in patients with renal injury. Although no sustained hypertension was noted in any patients in this study, long‐term blood pressure assessments would seem prudent.
Bile acid dysfunction after clam enterocystoplasty
Authors: BARRINGTON J.W. , FERN‐DAVIES H. , ADAMS R.J. , EVANS W.D. , WOODCOCK J.P. , STEPHENSON T.P. 
Published: November 2008

Objective To determine if the bowel dysfunction that develops in approximately 12% of patients after a clam enterocystoplasty is due to disruption of the enterohepatic circulation of bile acids.Patients and methods Fourteen symptomatic patients (mean age 36 years, range 21–65) who had undergone clam enterocystoplasty were investigated by bowel frequency charts, hydrogen breath tests of expired air and the retention of radioactive 75Selabelled homocholic acid‐taurine (SeHCAT), a synthetic bile acid. Patients with abnormal results were commenced on anion‐exchange resins and the symptoms evaluated 6 weeks later.Results The interruption of bile acid circulation, as estimated by SeHCAT, occurred in most of the patients studied and was due to surgical resection of the terminal ileum. All hydrogen breath tests were normal, excluding bacterial overgrowth as a cause of diarrhoea. Bowel frequency correlated well with the percentage of SeHCAT retained. Anion‐exchange resins were successful in relieving the symptoms if patients complied well with the treatment.Conclusions After clam enterocystoplasty, some patients have bowel dysfunction caused by the interruption of the enterohepatic circulation of bile acids. These patients can be identified using bowel frequency charts and treated by anion‐exchange resins.
Substitution cystoplasty for intractable interstitial cystitis
Authors: HUGHES O.D.M. , KYNASTON H.G. , JENKINS B.J. , STEPHENSON T.P. , VAUGHTON K.C. 
Published: November 2008

Objective To assess the results of substitution cystoplasty for the treatment of intractable interstitial cystitis (IC).Patients and methods Thirty‐two patients (29 women and three men; mean age 58 years, range 24–74) with intractable IC resistant to conservative therapy who had undergone substitution cystoplasty between 1983 and 1992 were reviewed. Their bladder capacities were measured pre‐operatively and related to the outcome of treatment.Results All but two of the 22 women with a bladder capacity of < 250 mL under anaesthetic were improved (five) or cured (15) of their symptoms. The results in women with larger bladder capacities were much less reliable, with only two of seven being cured of their symptoms. The three men all had a good result. Those who had undergone supratrigonal cystectomy were more likely to void spontaneously, but four patients developed pyelonephritis from associated reflux. Subtotal cystectomy reduced the likelihood of reflux and, although there were too few patients for statistical significance, probably increased the chance of cure at the expense of increasing the need for intermittent self‐catheterization (ISC).Conclusions Pre‐operative bladder capacity under anaesthetic is the most reliable predictor of outcome of substitution cystoplasty for treating intractable IC in women. It is contra‐indicated if bladder capacity is >250 mL. Supratrigonal cystectomy is a quick and easy operation and is preferable in the older patient. Subtotal cystectomy with reimplantation of the ureters is preferable in the younger patient, even though it may increase the need for ISC.
Intermittent catheterization following enterocystoplasty
Authors: SINGH G. , THOMAS D.G. 
Published: November 2008

Objective To assess the segment of bowel used in enterocystoplasty and the need to perform intermittent self‐catheterization (ISC) after enterocystoplasty for the treatment of incontinence.Patients and methods Of 123 patients undergoing enterocystoplasty, 77 (mean age 29.5 years, range 13–61) had neurogenic disease (NB group) and 46 (mean age 45.7 years, range 16–74) had non‐neuropathic bladders (NNB group). The success of enterocystoplasty, with respect to the segment of bowel used and the need for ISC, was assessed during a follow‐up of 6–125 rhonths.Results Ileum was used in 84 (63.8%), ileum and caecum in 19 (15.4%) and sigmoid in 20 (16.3%) patients. In the NB group, more patients had a sigmoid cystoplasty (24.7 vs 2.2%) and less (67 vs 80 %) had an ileo‐cystoplasty than in the NNB group. A total of 87 (71%) patients required ISC; 63 (82%) of the NB group and 24 (52%) of the NNB group. The influence of the intestinal segment was conspicuous in the NB group, with 82% and 95% of patients with ileocaecal and sigmoid cystoplasty needing ISC against 77% of those patients with ileal cystoplasty. The difference was not so evident in the NNB group.Conclusions A social continence rate of 93.6% in the NB and 84.8% in the NNB patients was achieved, partly due to the patients' success with ISC, a necessary skill to be mastered by all patients before undergoing enterocystoplasty.
Are transrectal ultrasonically guided biopsies required for the accurate diagnosis of carcinoma of the prostate? Can digitally guided systematic biopsies offer an acceptable alternative?
Authors: FIGUEIREDO A.J.C. , SEENI K. , ANSON K.M. , FURTADO A.J.L. , MILLER R.A. 
Published: November 2008

Objective To compare the diagnostic yield of ultrasonically guided and digitally guided systematic biopsies of the prostate.Patients and methods Fifty two patients with suspected but unproven carcinoma of the prostate underwent simultaneous transrectal ultrasonography (TRUS)‐guided and digitally guided systematic biopsies of the prostate. A mean of 12 cores was obtained from each patient. On average more cores were obtained with TRUS guidance (mean 6.7) than with digital guidance (mean 5.3).Results Cancer was detected in 19 patients and the diagnosis was made by both techniques in 16. Two patients had tumour detected only with TRUS guidance and one only with digital guidance. No complications occurred.Conclusion This study indicates that there is no significant difference between TRUS guidance and digital guidance to direct systematic biopsies of the prostate. The use of routine TRUS in screening programmes is now in doubt.
Long‐term results with M‐VAC for advanced urothelial cancer: high relapse rate and low survival in patients with a complete response
Authors: IGAWA M. , URAKAMI S. , SHIINA H. , ISHIBE T. , KADENA H. , USUI T. 
Published: November 2008

Objective To describe the long‐term results of treating patients with advanced urothelial cancer using a combination of methotrexate, vinblastine, doxorubicin and cisplatin (M‐VAC).Patients and methods Fifty‐one patients (37 men and 14 women, median age 66 years, range 41–82) with inoperable or metastatic carcinoma of the bladder, ureter or renal pelvis were treated with M‐VAC and their responses evaluated for up to 7 years. Relative dose intensity (RDI) was calculated by dividing the actual dose intensity by the projected total dose intensity and related to outcome. Overall survival was assessed from the date of initiation of treatment with M‐VAC, using the Kaplan‐Meier method.Results Of the 51 patients, 10 (20%) had a complete and 18 (35%) had a partial response, giving an overall response rate of 55% (95% CI, 41–68%). There was no significant difference in the median values of RDIs with response to the M‐VAC regimen. The median duration of response was 11.9 months for the 10 patients with a complete response and of these, eight relapsed at a median of 10 months after treatment and died at a median of 8.5 months from the time of disease recurrence. Survival of patients with a complete response differed significantly from those with no response at 1 year after the start of treatment, but not subsequently.Conclusion Long‐term follow‐up revealed a high relapse rate and poor prognosis in patients with a complete response who received the M‐VAC as induction therapy. Therefore, new adjunctive therapies are needed for patients with locally unresectable or metastatic urothelial cancer.
Maternal serum human chorionic gonadotrophin during early pregnancy resulting in boys with hypospadias or cryptorchidism
Authors: KIELY E.A. , CHAPMAN R.S. , BAJORIA S.K. , HOLLYER J.S. , HURLEY R. 
Published: November 2008

Objective To compare maternal serum human chorionic gonadotrophin (hCG) samples before 18 weeks gestation in mothers of boys with cryptorchidism or hypospadias with that in mothers of normal boys. The effect of season on maternal hCG was also assessed.Subjects and methods Stored serum samples from mothers of singleton male fetuses born between January 1988 and December 1992 were assayed for total hCG, using a Delfia assay. There were 153 eligible samples from 96 mothers of normal boys, 31 of those with cryptorchidism, and 26 of those with hypospadias.Results The data from mothers of normal boys were used to construct a time‐specific reference range for hCG. Plotting the hCG levels of the other groups and superimposing the reference range showed no significant difference between them (P= 0.09). Maternal hCG was not significantly different between cryptorchid boys requiring orchidopexy and those experiencing early spontaneous descent. An analysis of covariance allowing for gestational age showed that maternal hCG is significantly higher during the peak summer than peak winter months (P= 0.046).Conclusion While a seasonal effect on maternal hCG was demonstrated our data does not suggest this to be the sole cause for cryptorchidism or hypospadias or to account for the observation that both have a seasonal frequency.
Cutting the cost of catheterization for acute retention—a hospital or domiciliary procedure?
Authors: WEBB V.J. , BOOTH C.M. 
Published: November 2008

Objective To report the views of General Practitioners (GPs) and patients on the most appropriate place and person to catheterize patients in acute urinary retention.Patients and methods Two separate questionnaires were sent to 50 local GPs and 100 patients who had recently been referred with acute urinary retention. The questionnaires were designed to ascertain the most appropriate place and person to catheterize these patients. They also established the number of hospital admissions due to acute retention, the use of ambulances and the uptake of the district nurse services.Results Whilst 54% of GPs advocated domiciliary catheterization, only 20% of emergency catheterizations were carried out in the home. Nearly half the patients catheterized in the Accident and Emergency Department were admitted acutely and 41% of patients had travelled to hospital by ambulance. Patients were equally divided about where they would prefer to be catheterized, but 70% of patients stated that they were happy to be catheterized by a trained nurse; no GP opposed this concept.Conclusion The cost/benefit analysis of these results strongly supports the case for establishing best‐practice guidelines to promote an emergency domiciliary service led by GPs and trained district nurses and thus hasten the emergency care of acute retention and cut costs.