bluuebunny/crossref_metadata_2025_split huggingface dataset:
A simplified grading method of transitional cell carcinoma of the urinary bladder: reproducibility, clinical significance and comparison with other prognostic parameters
Authors: SCHAPERS R.F.M. , PAUWELS R.P.E. , WIJNEN J.Th.M. , ARENDS J.W. , THUNNISSEN F.B.J.M. , COEBERGH J.W.W. , SMEETS A.W.G.B. , BOSMANH F.T. 
Published: November 2008

Objective To determine the extent to which the biological potential of transitional cell neoplasms can be predicted by histological grading of the primary tumour in a two grade system using simple histological criteria and to evaluate the additional value of grading when combined with other prognostic factors. The inter‐observer variability of the World Health Organization grading and the two grade system was tested.Patients and methods The study included 311 patients with newly diagnosed transitional cell carcinoma of the urinary bladder. Two‐hundred and fifty‐six patients (82.3%) were men and 55 (17.7%) were women. Age ranged from 17 to 92 years with a mean of 66 years. The median follow‐up was 38 months, with a maximum of 150 months (mean 46.2 months).Results A simplified grading system was developed in which only low‐grade and high‐grade tumours were distinguished. Reproducibility of this grading system was good to excellent with a group kappa value of 0.78. The survival of patients with low‐grade tumours was significantly better than that of patients with high‐grade tumours (P< 0.0001). The progressionfree interval was also significantly longer in patients with low‐grade tumours than in patients with high‐grade tumours (P= 0.0032). Combining low‐high grading, histological stage, mitotic index and age, histological stage appeared to be the most important parameter in predicting survival and progression.Conclusion A reproducible and discriminating system such as this low‐high grade system is an important prognostic factor when stage cannot be established with certainty.
Prevention of urethral stricture recurrence using clean intermittent self‐catheterization
Authors: KJÆRGAARD B. , WALTER S. , BARTHOLIN J. , ANDERSEN J.T. , NØHR S. , BECK H. , JENSEN B.N. , LOKDAM A. , GLAVIND K. 
Published: November 2008

Objective To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy.Patients and methods Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1 year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery.Results Significantly fewer (P < 0.01) patients developed recurrence of urethral stricture within the first postoperative year in the CIC group (n= 4) compared with the control group (n= 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable.Conclusion Weekly CIC is a simple method of reducing the frequency of urethral stricture recurrence after internal urethrotomy.
Loss of heterozygosity of the retinoblastoma and adenomatous polyposis susceptibility gene loci and in chromosomes 10p, 10q and 16q in human prostate cancer
Authors: PHILLIPS S. M. A. , MORTON D. G. , LEE S. J. , WALLACE D. M. A. , NEOPTOLEMOSH J. P. 
Published: November 2008

Objective To examine prostate tumours for losses of known or suspected tumour suppressor genes to determine some of the important events in the genesis of this common cancer. Materials and methods Paired tumour and blood samples were obtained from 21 patients who underwent transurethral resection of malignant prostate glands for urinary outflow obstruction. Paired tumour and normal tissue (leucocytes) DNA was extracted and examined for possible losses of several known or suspected tumour suppressor genes, using restriction fragment length polymorphism techniques to detect loss of heterozygosity. Results Deletions of the retinoblastoma susceptibility gene (RB1) locus were found in six of nine informative cases using two intragenic probes (p68RS2.0 and p123m1.8). The locus related to the familial adenomatous polyposis susceptibility (APC) gene demonstrated loss of heterozygosity in three of seven informative cases using the EF5.44 probe. Losses were also noted in loci on chromosome 10p in four of 19 informative cases (probe cTBQ7), chromosome 10q in eight out of 19 informative cases (probes EFD75 and D10S90) and in 16q in three of 17 informative cases (probe D16S7). Conclusion These finding suggest that losses of the RE31 and APC tumour suppressor genes and suspected tumour suppressor genes on lop, 1Oq and 16q may be important events in the genesis of prostatic tumours.
Reducing the loss of implants following penile prosthetic surgery*
Authors: LYNCH M. J. , SCOTT G. M. , INGLIS J. A. , PRYOR J. P. 
Published: November 2008

Objective To assess the factors associated with loss of implant following penile prosthetic surgery and to make alterations in the management of patients to prevent this from occurring. Patients and methods A retrospective analysis was carried out of the factors associated with post‐operative infection and erosion in 188 patients who underwent implantation of penile prostheses. A prospective study was then established in which 62 patients were managed by a set protocol designed to counteract the factors identified as being contributory to loss of implants in the retrospective review. Results In the retrospective study nine (4.8%) patients lost a prosthesis due to erosion. Erosion was noted to be more common with one type of implant which has since been modified. Infection was the cause of prosthesis loss in 12.2% of patients in the retrospective review. The new protocol resulted in a signi6cantly reduced infection rate in penile prostheses to 1.6% (P<0.05). Conclusion With attention to simple antiseptic prophylaxis, antibiotic penetration and continuing audit, a significant improvement in the loss of penile prostheses can be achieved along with a reduction in the amount of antibiotics prescribed.
Treatment of interstitial cystitis with intravesical heparin
Authors: PARSONS C. L. , HOUSLEY T. , SCHMIDT J. D. , LEBOW D. 
Published: November 2008

Objective To control the symptoms of interstitial cystitis with chronic self‐administered intravesical heparin and determine whether the drug's continued use can sustain remission. Patients and methods A total of 48 patients were selected to undergo intravesical heparin therapy, 10000 units in 10 ml sterile water, three times per week for 3 months. For patients who attained a good clinical remission, therapy was available for up to a further 9 months. Results At 3 months 27 of 48 patients (56%) attained good clinical remissions. All were offered continuous therapy and 23 elected for an additional 3 months. Twenty of the 23 continued in remission. Sixteen of these patients elected to have a further 6 months of therapy (12 months total) and 15 of 1ft remained in remission. Conclusion In over half of the patients studied, intravesical heparin controls the symptoms of interstitial cystitis with continued improvement even after one year of therapy.
Lymphocyte sub‐populations in the bladder wall in normal bladder, bacterial cystitis and interstitial cystitis
Authors: CHRISTMAS T. J. 
Published: November 2008

Objective To identify lymphocyte sub‐populations within the bladder wall in normal controls, in patients with bacterial cystitis (BC) or interstitial cystitis (IC). Patients and methods Bladder biopsies were taken from 21 patients with IC, four with BC and five normal controls. Immunofluorescent staining of biopsies was performed using monoclonal antibodies to the Tcell markers CD3, CD4, CD8, TCRδ1, δTCS1, βF1 and IML. Plasma cells were identified using monoclonal antibodies to IgA, IgG and IgM. The location and numbers of cells were determined. Peripheral blood lymphocyte counts were also performed in each case. Results T cells (CD4+ and CD8 +) were significantly more abundant within the bladder biopsies from patients with interstitial cystitis than in those from the normal controls, and were present within the urothelium and submucosa but not the detrusor. There was no difference between the numbers of T cells present in the biopsies from patients with interstitial cystitis and in those with bacterial cystitis. However, the presence of γδγ T cells was significantly associated with interstitial cystitis. IgA + and IgM + plasma cells were located within the urothelium and submucosa but not the detrusor in patients with IC and the numbers present in these patients were significantly greater than in those with BC or the normal controls. The peripheral blood lymphocyte counts were not altered in any of the study cases. Conclusion The increased numbers of CD4 +, CD8 + and γδ T cells as well as IgA +, IgG+ and IgM + plasma cells within the urothelium and submucosa in patients with IC suggest that these cells play an active role in the pathogenesis of the disorder. The previously described abnormal urothelial expression of HLA‐DR and hyperexpression of Class I molecules in patients with IC may enable these cells to cause destruction of the urothelium ‐ the end stage of IC.
Can regional lymph node involvement be predicted in patients with carcinoma of the penis?
Authors: AYYAPPAN K. , ANANTHAKRISHNAN N. , SANKARAN V. 
Published: November 2008

Objective To detect the incidence of metastases in regional nodes (inguinal and external iliac) in patients with carcinoma of the penis and to determine whether nodal involvement was predictable pre‐operatively by clinical and histological parameters. Patients and methods Seventy‐eight patients who in total had undergone 135 groin dissections were studied. The incidence of inguinal and iliac node metastases was correlated with factors such as the size of the nodes, the histological degree of differentiation, the extent of penile involvement by the primary tumour and the clinical palpability of the iliac nodes. Results The incidence of metastases to the inguinal and iliac nodes was 74% and 32% of patients respectively. The risk of involvement was equal on both sides irrespective of whether the nodes were palpable. Inguinal nodes larger than 2 cm in diameter and poor histological differentiation of the primary tumour were significant predictors of inguinal node involvement. The palpability of the iliac nodes, inguinal nodes larger than 2 cm and the fixity of the inguinal nodes were important indicators of metastases to iliac nodes. Extension of the primary tumour to the proximal shaft of the penis was associated with a significantly higher incidence of inguinal node but not iliac node metastases. None of the parameters studied identified all the patients with nodal metastases. Conclusions In the absence of any reliable predictor of nodal metastases, all patients with carcinoma of the penis required an intensive and continued follow‐up to detect signs of nodal involvement. In developing countries however, where patients do not come for regular follow‐up and often present with fungating inguinal secondaries, a policy of early bilateral regional node clearance despite the level of morbidity is preferable.
Sexuality in patients treated for penile cancer: patients' experience and doctors' judgement
Authors: OPJORDSMOEN S. , WAEHRE H. , AASS N. , FOSSA S.D. 
Published: November 2008

Objective To evaluate sexuality after successful treatment of penile cancer. Patients and methods Post‐therapy sexuality was evaluated in 30 men (median age 57 years; range 28–75) treated for cancer of the penis 80 months previously (median; range: 11–225 months). Treatment regimes were: local excision/laser beam treatment, 5; definitive radio‐therapy, 12; partial penectomy, 9; total penectomy, 4. Patients underwent a semi‐structured interview and completed three self‐administered questionnaires (psychosocial adjustment to severe illness [PAIS], mental symptoms [GHQ], quality of life [EORTC QLQ C‐30]). A global score of overall sexual functioning was constructed consisting of sexual interest, sexual ability, sexual satisfaction, sexual identity, partner relationship and frequency of coitus. Results In 10 of 12 patients treated by irradiation the sexual global score was not or only slightly reduced compared with two of nine patients after partial penectomy and one of five patients with local surgery/laser beam treatment. All four patients who had undergone total penectomy recorded a severely reduced sexual global score. Of the six single domains, sexual identity and partner relationship did not change with increasing age, whereas the other scores of sexual life deteriorated as the patient became older. In the patients treated by irradiation doctors evaluated the patients' post‐treatment sexuality to be more impaired than that experienced by the patients. Conclusion Within the limitations due to the small number of patients studied, radiotherapy seems to be the treatment of choice in limited cancer of the penis if preservation of sexuality is a major therapeutic aim. Physicians counselling patients with this rare malignancy need more information about treatment‐related problems of sexuality after different therapeutic modalities.
A method of demonstrating intra‐renal reflux
Authors: WHITAKER R.H. , CUCKOW P.M. 
Published: November 2008

Objective To develop a method for demonstrating intra‐renal reflux as a permanent resin cast, and subsequently to show the relationship between the shape of the papilla and the presence and extent of reflux and to determine, by histological examination of the resin casts, the extent of filling of the nephron. Subjects and methods The pericaliceal systems of fresh pig's kidneys were filled retrogradely with a dilute resin that sets within 2 h. The parenchyma was then macerated in potassium hydroxide to obtain the casts. Results The extent of the intra‐renal reflux was variable, was usually polar and appeared independent of the injection pressure. Microscopy showed branching of the collecting ducts and nephron filling to the proximal tubules. Conclusion This method could prove a useful tool in the further study of intra‐renal reflux.
Erectile function following transurethral prostatectomy
Authors: Hanbury D.C. , Sethia K.K. 
Published: November 2008

Objective To determine the true incidence and possible aetiology of impotence following transurethral prostatectomy. Patients and methods Over a 9‐month‐period 268 patients who were about to undergo transurethral prostatectomy were interviewed about their sexual function. Full details of each operation were recorded including size of prostate, operative time, grade of surgeon and the occurrence of capsular perforation. The interviews were repeated by letter or telephone 3 months after operation. Results Of the 268 men interviewed, 246 (91.8%) were suitable for inclusion in the study. Pre‐operatively, 137 (55.7%) were fully potent, 43 (17.5%) could achieve a partial erection and 66 (26.8%) were impotent. Of the fully potent patients, 20 (14.6%) became partially potent and four (2.9%) became impotent post‐operatively. Of those who were partially potent before operation, 16 (37.2%) became impotent post‐operatively. Overall, the risk of impotence was 28.1% if the prostatic capsule was breached at operation but only 10.0% if it was not (P<0.01). Conclusion In fully potent men the risk of impotence after transurethral prostatectomy is fairly low, but it is higher in men who already have a degree of erectile failure. The risk of impotence is related to the incidence of capsular perforation at the time of surgery.
Should we reconsider the indications for ileo‐obturator node dissection with localized prostate cancer?
Authors: Sullivan L.D. , Rabbani F. 
Published: November 2008

Objective To evaluate the need for ileo‐obturator node dissection in patients with localized prostate cancer who are undergoing radical retropubic prostatectomy. Patients and methods Over a 5‐year‐period, 95 patients underwent bilateral pelvic lymphadenectomy. Ninety were performed in association with planned radical prostatectomy and five were staging procedures in clinical stage T3 patients prior to radiotherapy or hormonal therapy. The patients with localized prostate cancer were stage T1a (one patient), T1b (21), T2a (30), and T2b (38). Pre‐operative biopsies in the patients with localized cancer were well differentiated in 44 patients, moderately well differentiated in 45 and poorly differentiated in one. In the patients with T3 tumours, pre‐operative biopsies were well differentiated in one, moderately well differentiated in two and poorly differentiated in two. Prostate‐specific antigen (PSA) levels ranged from 0.4 to 110.1 ng/mL (Hybritech assay). Results Two patients had positive lymph node dissections on fixed section. These two patients had well‐differentiated T1b disease with a PSA level of 72.4 ng/mL and poorly differentiated T3 disease with a PSA level of 58.5 ng/mL. There was significant upstaging (P< 0.001) and upgrading (P< 0.001) on pathological examination. None of the 71 patients with a PSA 10 ng/mL had positive lymph nodes compared with 8.3% of the 24 patients with a PSA > 10 ng/mL (P= 0.0618). Lymph node metastases were present in 1% of patients with well or moderately well‐differentiated prostate cancer on pre‐operative biopsy versus 33% with poorly differentiated disease (P= 0.0625). These P values strongly suggest an association, achieving significance only at the 10% level which might be the more appropriate level given the relative lack of power of the study due to the small number of patients with positive lymph nodes. Conclusion These Results suggest that routine ileo‐obturator node dissection in patients with well or moderately well‐differentiated, localized prostate cancer and a PSA level <10 ng/mL may be unnecessary, especially as a separate procedure.
Absolute concentration of urinary endogenous β‐glucuronidase determined by an ELISA method as a sensitive but non‐specific indicator for active renal parenchymal damage
Authors: Ho K.‐J. 
Published: November 2008

Objective To demonstrate that the absolute concentration, instead of the activity, of urinary endogenous P‐glucuronidase is a better indicator for active renal parenchymal damage. Materials and methods Urine samples were obtained from 143 adult patients comprising 60 control subjects with no evidence of urinary tract disease and 83 patients with serum creatinine >1.5 mg/dL. The absolute concentration of urinary endogenous β‐glucuronidase was determined by an enzyme‐linked immunosorbant assay (ELISA) method recently developed by us. The maximal velocity of the enzyme was determined by the enzyme kinetic method. The bacterial β‐glucuronidase and bilirubin in the urine were also detected. Results The urinary p‐glucuronidase activity was affected by certain inhibitors (d‐glucaro‐1, 4‐lactone), intrinsic substrates (conjugated bilirubin) and bacterial β‐glucuronidase present in the urine. Its concentration, determined by the ELISA method, was not interfered with by such factors. When those urine samples which were contaminated with bacteria and/or bilirubin were excluded, the β‐glucuronidase concentration (X ng/umol creatinine) was significantly correlated with its maximal velocity (Y nmol/ min/μmol creatinine): Y = 0.003 + 0.103X. Contrary to blood urea nitrogen, which increases with the increase in serum creatinine, the urinary β‐glucuronidase activity and its concentration reached a peak at a serum creatinine of 1.6 ∼ 3.0 mg/dL and declined at higher serum creatinine levels. Episodic elevation of serum creatinine due to acute insult to the kidney or flare up of disease activity was often preceded by an increase in the level of urinary β‐glucuronidase. Conclusion The absolute concentration of the urinary β‐glucuronidase was not affected by several factors in the urine which interfere with its activity, and was a sensitive indicator for renal parenchymal damage, particularly in the early stage when the disease is active.
Clam enterocystoplasty and pregnancy
Authors: Fenn N. , Barrington J.W. , Stephenson T.P. 
Published: November 2008

Objective To assess the course and outcome of pregnancy in patients who have undergone clam enterocystoplasty. Patients and methods A retrospective study was carried out of 19 pregnancies in 18 women aged from 21 to 36 years who had undergone clam enterocystoplasty. Results Urinary tract infection was common but renal function remained normal with prompt treatment with antibiotics. No other adverse antenatal factors were identified and all pregnancies had a normal fetal outcome. Vaginal delivery was a safer option for these patients, even in those who had undergone an anti‐incontinence procedure in addition to enterocystoplasty. Conclusion Careful antenatal monitoring by both an obstetrician and a urologist resulted in a successful pregnancy and vaginal delivery in these patients.
The application of continent urinary stomas to bladder augmentation or replacement in the failed exstrophy reconstruction
Authors: Gearhart J.P. , Peppas D.S. , Jeffs R.D. 
Published: November 2008

Objective To determine the application and success of continent urinary stomas in the failed bladder exstrophy reconstruction. Patients and methods A total of 3 5 patients underwent construction of a continent urinary stoma during bladder replacement or bladder augmentation between 1987 and 1993. The continent stoma was constructed with appendix (19 patients), tapered ileum (2), Benchekroun (12), Indiana (1) and Mainz type stoma (1). Results Three patients required revision of their continent stoma, one for incontinence and two for difficulty in catheterization. Overall, 95% experienced daytime continence on an intermittent catheterization regimen, while 90% were dry at night. The upper tract remained normal in 34 of 3 5 patients. Conclusions While the Benchekroun technique is reliable in producing continence, difficulty with catheterization has been a chronic problem due to stomal stenosis. Our positive experience with using the appendix as a cath‐eterizable conduit into either the bladder template or bowel segment has led us to prefer this method of continent stoma construction in the patient with a failed exstrophy. In the absence of an appendix, our preference is a tapered ileal segment. The failed exstrophy reconstruction can be salvaged with a continent stoma and substitution or augmentation cystoplasty in most patients, thus avoiding urinary diversion.
Extracorporeal piezoelectric shock wave lithotripsy as mono and multiple therapy of large renal calculi including staghorn stones in unanaesthetized patients under semi‐ambulant conditions
Authors: Bruns T. , Stein J. , Tauber R. 
Published: November 2008

Objective To examine the effectiveness and complication rate of extracorporeal piezoelectric shock wave lithotripsy (EPL) as monotherapy for the treatment of large renal calculi. Patients and methods Treatment consisted of semi‐ambulant EPL as monotherapy combined with protective ureteric stenting in 84 patients. Three groups were established according to stone volume (borderline‐stone, partial and complete staghorn). An average of 18 230 shock waves was applied in 3.76 sessions to each patient. Results No major complications were observed but there were minor complications in 33% of patients. Invasive auxiliary methods were necessary in only 12%. After a mean follow‐up of 9 months (n= 72), 54% of patients were stone‐free and in 22% the fragments passed spontaneously. Thus the success rate was 76%.Analysis of the three groups showed no difference in stone status during follow‐up. There was no relation between the outcome of treatment and stone volume. Analysis of the patients who failed to respond to treatment showed that they were treated for longer than the stone‐free group, with significantly fewer sessions per week (0.71 vs 1.28 sessions/week). It appears that higher rates of stone removal can be achieved with more frequent treatment sessions at shorter intervals. Conclusion We consider semi‐ambulant EPL monotherapy to be a minimally invasive alternative treatment in patients with large renal calculi, including staghorn stones.