bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ectopic human chorionic gonadotrophin (HCG) production: is the detection by serum analysis of HCG of clinical relevance in transitional cell carcinoma of the bladder?
Authors: SMITH D. J. , EVANS H. J. , NEWMAN J. , CHAPPLE C. R. 
Published: November 2008

Objective To assess the potential value of ectopic β‐human chorionic gonadotrophin (βHCG) measurement in the clinical management of transitional cell carcinoma (TCC). Patients and methods A prospective serological study of 16 3 consecutive patients undergoing cystoscopy as new or review cases was performed to assess any correlation between βHCG production and histological grading or stage. Results Ten per cent of patients with TCC had a raised βHCG level but there was no correlation with tumour differentiation, staging or prognosis. ConclusionsβHCG has no role as a tumour marker for TCC and therefore appears unlikely to play a part in the clinical management or treatment of urothelial tumours.
Pelvic floor activity patterns: comparison of nulliparous continent and parous urinary stress incontinent women. A kinesiological EMG study
Authors: DEINDL F. M. , VODUSEK D. B. , HESSE U. , SCHÜSSLER B. 
Published: November 2008

Objective To introduce neurophysiological methods to search for damage to neuromuscular structures involved in sustaining continence in women who experienced stress urinary incontinence during pregnancy andlor after delivery. Patients and methods Eight stress urinary incontinent parous women (mean of 2.75 vaginal deliveries [range 2–41 median age 45.3 years [range 31–60]) were examined using simultaneous electromyogram recordings of the left and right pubococcygeus muscle via wire electrodes. Comparisons were made with 10 nulliparous continent women (median age 2 7.2 years [range 22–32]). Results Individual muscle activation patterns in stress urinary incontinent parous women were in principle similar to those observed in the continent nulliparous women, with two significant exceptions: (i) voluntary ‘squeeze’ showed significant differences in the holding time between the parous stress urinary incontinent patients and the nulliparous Continent controls, with an empty bladder (49.0 s versus 193.9 s median value) and a full bladder (39.2 s versus 198.4 s); (ii) asymmetrical and uncoordinated levator activation patterns were demonstrated in four of eight parous stress incontinent women, i.e. inhibition of motor unit firing on coughing (n = 3) and dissociated recruitment of motor units during voluntary and reflex activation (n= 1). Conclusion Childbirth appeared to induce both quantitative and qualitative changes in the pelvic floor which jeopardized the continence mechanism. Sphincter weakness appeared to result not only from the loss of motor units but also from altered activation patterns in the remaining units: shorter activation periods, lack of response or paradoxical inhibition. Kinesiological EMG recordings revealed behavioural abnormalities which appeared relevant for planning treatment.
Immunohistological expression of p53 in primary pTl transitional cell bladder cancer in relation to tumour progression
Authors: GARDINER R.A. , WALSH M.D. , ALLEN V. , RAHMAN S. , SAMARATUNGA M.L.T.H. , SEYMOUR G.J. , LAVIN M.F. 
Published: November 2008

Objective To determine whether p53 expression is a marker of tumour progression in superficially invasive (pTl) transitional cell carcinoma of the bladder. Patients and methods The immunohistochemical status of the p53 protein in 28 pTl primary bladder cancers was determined on frozen tissue and archival paraffin block sections using three primary antibodies (CM‐1, PAB1801 and D07). The findings were compared with the patients' progress. All the patients, except for those who died during the course of the study, were followed up by check cystoscopy for a minimum of 2 years. Results Immediately adjacent frozen sections stained identically in 10 of 16 cases for CM‐1 and PAB1801. For paraffin sections, identical staining patterns were seen for PAB1801 and D07 in 21 of 26 sections. However, inter‐ and intra‐tumour staining for p5 3 was very variable, even with the same antibody. The heterogeneity of p53 positive cell distribution in the tumours indicates potential for significant sampling errors if random sections are chosen as representative of p53 status. Conclusion The p53 status of the primary tumours did not relate to patient outcome. The results obtained do not support the use of immunohistological p53 expression as a discriminating prognostic indicator in pTl transitional cell carcinoma of the bladder.
Prostate‐specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ‐confined prostatic cancer
Authors: SEMJONOW A. , HAMM M. , RATHERT P. , HERTLE L. 
Published: November 2008

Objective To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma. Patients and methods Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate‐specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal × anterior‐posterior × transverse diameter × 0.52), allows a better differentiation than the absolute PSA values. Results In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml × cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml × cm3). Conclusion The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.
Ureterocystoplasty: the ‘bladder’ augmentation of choice
Authors: HITCHCOCK R.J.I. , DUFFY P.G. , MALONE P.S. 
Published: November 2008

Objective To reduce the complications of enterocystoplasty by augmenting the bladder with a megaureter. Patients and methods Ureterocystoplasty was performed in eight children aged 20 months‐15 years. Three had impaired renal function and three were in established chronic polyuric renal failure. Results The seven older children were dry by day with clean intermittent catheterization and the youngest, at the age of 31/2 years, had a dry interval of 2 h after catheterization. The three children with polyuric renal failure required nocturnal catheterization or were wet at night. The post‐operative urodynamics showed a significant improvement in all cases with abolition of detrusor instability in seven patients and a reduction in end filling pressure. Bladder volume increased from a mean of 100 ml (range 45–215) to 311 ml (range 150–450) (P= 0.01). There was no deterioration in renal function. Conclusion The early results of ureterocystoplasty compare favourably with those of enterocystoplasty without the risks of long‐term metabolic and neoplastic complications.
Prostate‐specific antigen obtained under optimal conditions determines extracapsular adenocarcinoma of the prostate
Authors: Ehreth J.T. , Miller J.I. , McBeath R.B. , Hansen K.K. , Ahmann F.R. , Dalkin B.L. , Jr M. Schiff 
Published: November 2008

Objective To assess the relationship of prostate‐specific antigen (PSA) obtained under optimal conditions with the presence or absence of organ‐confined prostate cancer following radical prostatectomy. Patients and methods The medical records of 300 consecutive patients who underwent radical retropubic prostatectomy were retrospectively reviewed. Ninety‐three patients were excluded who had a pre‐operative PSA level potentially altered by various factors (prostate infection, manipulation or instrumentation). Results A pre‐operative PSA value < 4 ng/mL accurately predicted pathologically confined disease in 42 of 51 patients (82%) which contrasted with extracapsular disease in 74 of 84 patients (88%) who had a PSA value > 10 ng/mL. One of the 53 patients with a PSA > 15 ng/mL had organ‐confined disease at surgery. Conclusion These data demonstrate that optimal serum PSA values correlate well with pathological stage.
Magnetic resonance imaging for the diagnosis of prostate cancer metastatic to bone
Authors: Fujii Y. , Higashi Y. , Owada F. , Okuno T. , Mizuno Hitomi , Mizuno Hideaki 
Published: November 2008

Objective To examine the role of magnetic resonance imaging (MRI) in the evaluation of osseous metastasis in patients with prostate cancer. Patients and methods A series of 36 patients with known prostate cancer, who were undergoing MRI and an isotope bone scan, were studied. Results Of 19 positive bone scans, MRI was read as negative for metastasis in one. Of eight equivocal scans, two MR images were interpreted as positive and six as negative. Of nine negative scans MRI was positive in one. Further MRI demonstrated additional metastatic lesions that were not shown by bone scin‐tigraphy in six patients. MRI clearly indicated the areas of spinal cord compression in five patients with spinal metastases and associated myelopathy. Conclusion MRI is helpful in the diagnosis of metastatic prostate cancer, especially when other radiographic examinations are inconclusive or spinal cord compression is suspected.
The long‐term Results of skin inlay urethroplasty
Authors: Mundy A.R. 
Published: November 2008

Objective To report the Results of a 10‐year follow‐up of 73 patients who underwent skin‐inlay urethroplasty for the treatment of strictures that failed to respond to a trial of endoscopic surgery. Patients and methods The 10 year follow‐up of 48 patients with patch urethroplasties and 25 with tube urethroplasties of pedicled preputial, penile and scrotal skin is reported. Results The patients with patch urethroplasties tended to do well in the medium term whatever the source of skin, although there was a steady annual attrition rate after 4 years of about 5%/year requiring revision. The 2 5 patients with tube urethroplasties did less well, particularly those with scrotal skin tubes. The patients with preputial/penile tube urethroplasties did rather better but, in general, all these tube urethroplasties seem to narrow uniformly with time. Urethrotomy was never curative when a stricture recurred in relation to a urethroplasty. Conclusion If the initial result is satisfactory, then patch urethroplasties tend to do well in the medium term whatever the source of the flap. No matter how good the initial result, scrotal skin tube urethroplasties do badly; preputial/penile skin performs better but tube urethroplasties tend to narrow down nonetheless. In the long term ‐ more than 10 years ‐ all skin inlays seem to have a tendency to deteriorate.
Impotence following pelvic fracture urethral injury: incidence, aetiology and management
Authors: Mark S.D. , Keane T.E. , Vandemark R.M. , Webster G.D. 
Published: November 2008

Objective To evaluate the potency status of patients undergoing delayed perineal repair following a pelvic fracture urethral injury to determine the incidence and aetiology of impotence. Patients and methods Long‐term potency (> 6 months post‐operatively) was subjectively evaluated in 92 patients and correlated with their pre‐operative and intra‐operative findings. The management of their impotence was also reviewed. Thirty original pelvic radiographs were assessed independently to determine if the pattern of bony injury was associated with the development of impotence. Results Fifty‐seven patients (62%) remained impotent in the long term with a median follow‐up of 48 months (range 12–128) and the operation did not render any potent patient impotent. Self‐injection with vasoactive agents was successful in 24 of 27 (89%), suggesting a neurogenic aetiology in the majority. Bilateral pubic rami fracture was also associated with a high incidence of impotence. Conclusion Disruption of the cavernosal nerves lateral to the prostatomembranous urethra behind the sym‐physis pubis is the most likely cause of impotence in this injury.
The importance of accurate assessment and conservative management of the open bladder neck in patients with post‐pelvic fracture membranous urethral distraction defects
Authors: MacDiarmid S. , Rosario D. , Chapple C.R. 
Published: November 2008

Objective To review the pre‐operative assessment of bladder neck competence and assess the success of non‐operative management of the bladder neck in patients with pelvic fracture membranous urethral distraction defects. Patients and methods A series of four patients with long‐standing post‐pelvic fracture urethral distraction defects and open bladder necks demonstrated on pre‐operative investigation are presented. Results All four patients were managed by perineal urethroplasty without surgery to the bladder neck. All patients were continent post‐operatively despite the injury having ablated the distal sphincter mechanism. Conclusion We believe that the majority of patients can be managed successfully by a non‐operative approach to the bladder neck, sparing them the unnecessary operative morbidity of an abdomino‐perineal repair, which should be reserved for those with obviously scarred or distorted bladder necks.
Clinical presentation and pathophysiology of meatal stenosis following circumcision
Authors: Persad R. , Sharma S. , McTavish J. , Imber C. , Mouriquand P.D.E. 
Published: November 2008

Objective To describe the clinical presentation and pathophysiology of meatal stenosis occurring after circumcision. Patients and methods The clinical presentation and operative findings are reported in 12 children who presented with meatal stenosis over a period of 3 years. Results The cardinal symptoms of meatal stenosis were penile pain at the initiation of micturition (12 of 12), narrow, high velocity stream (8 of 12) and the need to sit or stand back from the toilet bowl to urinate (6 of 12). Following surgical correction with meatotomy there was no recurrence of stenosis after a mean follow‐up of 13 months. Traumatic meatitis of the unprotected post‐circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis. Conclusion Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.
Nocturnal enuresis
Authors: Mark S.D. , Frank J.D. 
Published: November 2008

SummaryNocturnal enuresis is common. Although its aetiology remains unclear recent evidence increasingly supports the lack of a normal nocturnal increase in ADH leading to nocturnal polyuria exceeding functional bladder capacity. Sleep patterns are probably normal although an arousal disorder might be a factor. Treatment should follow careful evaluation to determine if one is dealing with ‘uncomplicated’ or ‘complicated’ enuresis. Complicated enuresis requires further investigation. ‘Uncomplicated enuresis’ always requires reassurance and patient and parent education. Resource centres such as ERIC can provide information and advice.Active treatment should be tailored to the patients age, motivation and parental wishes. Behavioural modification techniques yield the highest long‐term cure rate but require the most commitment and are rarely successful before the age of 7–8 years. Pharmacotherapy has been revolutionized by DDAVP which gives a response rate of up to 70% relatively free from side‐effects but at the price of a high relapse rate after medication. Imipramine is less expensive than DDAVP but may be fatal in overdose. Anticholinergics should be reserved for those patients with significant diurnal symptoms or those who fail first‐line pharmacotherapy.Overall patients and parents should be reassured by the high spontaneous cure rate.
Trospium chloride versus oxybutynin: a randomized, double‐blind, multicentre trial in the treatment of detrusor hyper‐reflexia
Authors: Madersbacher H. , Stöhrer M. , Richter R. , Burgdörfer H. , Hachen H.J. , Mürtz G. 
Published: November 2008

Objective To compare trospium chloride (TCI), a quaternary ammonium derivative with atropine‐like effects and predominantly antispasmodic activity, with oxybutynin (Oxy) in terms of efficacy and adverse effects. Patients and methods In a randomized, double‐blind, multicentre trial, 95 patients with spinal cord injuries and detrusor hyper‐reflexia were studied. Treatment consisted of three doses per day over a 2 week period, with either Oxy (5 mg three times daily) or with TCl (20 mg twice daily) with an additional placebo at midday. The Results were evaluated with regard to changes in Objective (urodynamic) data and subjective symptoms as well as the incidence/severity of adverse effects. Results With both drugs there was a significant increase in maximum bladder capacity, a significant decrease in maximum voiding detrusor pressure and a significant increase in compliance and residual urine; there were no statistically significant differences between the treatment groups. The percentage of patients who reported severe dryness of the mouth was considerably lower (4%) in those receiving TCl 2times20 mg/day than in those receiving Oxy (23%) 3times5 mg/day. Withdrawal from treatment was also less frequent in those receiving TCl (6%) than in those receiving Oxy (16%). Conclusion Trospium chloride and oxybutynin, judged in terms of Objective urodynamic parameters, are of substantially equal value as parasympathetic antagonists. However, assessment of tolerance in terms of adverse drug effects showed that TCl had certain advantages.
Is there a role for in vivo methylene blue staining in the prediction of bladder tumour recurrence?
Authors: Creagh T.A. , Gleeson M. , Travis D. , Grainger R. , McDermott T.E.D. , Butler M.R. 
Published: November 2008

Objective To assess the role of in vivo staining with intravesical methylene blue in predicting tumour recurrence. Patients and methods Thirty‐nine patients (2 7 men and 12 women, age range 43–75 years) newly diagnosed with bladder tumours were prospectively studied and followed for a minimum of 2 years. Potential biopsy sites were identified by staining intravesically with a 1% methylene blue solution and compared with random biopsy sites. Results Biopsy directed by methylene blue staining detected carcinoma in situ more often than random biopsy. Rates of recurrence were similar in both stained and unstained groups. Conclusion methylene blue staining does not add significantly to the management of patients presenting with bladder tumours.
Natural filling cystometry in infants and children
Authors: Yeung C.K. , Godley M.L. , Duffy P.G. , Ransley P.G. 
Published: November 2008

Objective To evaluate natural filling cystometry in infants and young children. Patients and methods The study group comprised 57 infants and young children (mean age. 4.1 years) with various urological conditions. Suprapubic catheters were used in all patients with urethral sensation. Natural filling urodynamic (NFU) studies were performed using an ambulatory recorder and with an observer present throughout. For comparison. 17 of the 37 patients also had slow filling conventional cystometry (CMG). Results All NFU studies were successfully completed and the great majority of patients were unaffected by the investigation procedures. In comparison with conventional cystometry there were significant differences. For NFU, there was a lower bladder capacity (means. NFU 122 mL vs CMG, 188 mL. P <0.031: lower pressure rise on filling (means. NFU 5.7cmH2, O vs CMG 16.1cmH2O. P <0.001) and higher maximum detrusor pressures during micturition (means. NFU 130cmH2O) vs CMG. 78 cmH2O. P<0.0***. Voiding efficiency was also slightly greater with NFU compared with CMG. Detrusor instability was recorded in five patients only during NFU and in two other patients only during CMG. Conclusion A natural filling cystometry method which incorporates an unobtrusive recording system is likely to be superior to conventional CMG for assessing bladder function in infants and children. This is because (i) bladder function is investigated in near to natural conditions. (ii) the patients are mostly unaffected by the investigation procedures. (iii) there are significant differences between NFU and CMG in the measurements obtained, indicating that CMG may give false indices of bladder function.
Endoscopic treatment of vesico‐ureteric reflux and urinary incontinence: technical problems in the paediatric patient
Authors: Capozza N. , Caione P. , Gennaro M. De , Nappo S. , Patricolo M. 
Published: November 2008

Objective Bovine collagen has been successfully used for the endoscopic treatment of urinary incontinence (UI) and vesico‐ureteric reflux (VUR) in children for more than 8 years, although its long‐term efficacy has sometimes been questioned. Its failure is generally ascribed either to technical difficulties or to instability of collagen at the site of the implant. To assess the efficacy of the procedure we evaluated the children treated at this hospital between 1990 and 1993. Patients and methods A total of 156 children, aged 5 months to 13 years, were treated for VUR. Over the same period, 25 patients aged between 2 and 14 years (nine with neuropathic bladder and 16 with exstro‐phy‐epispadias complex who were still incontinent after bladder neck reconstruction) had periurethral or pericervical glutaraldehyde cross‐linked bovine collagen injection for UI. Five more children with exstro‐phy‐epispadias complex (aged 1–3 years) underwent periurethral collagen injection to stimulate bladder enhancement and allow subsequent bladder neck reconstruction. Results In children treated for VUR, a single injection proved successful in 72.2% of cases (127 ureters); a second collagen injection raised the success rate to 81%. Continence improved in all nine neuropathic bladders and in 10 of 16 children with exstrophy‐epispadias complex treated for UI after bladder neck reconstruction. In four of the five exstrophy‐epispadias complex patients who were treated to stimulate bladder enhancement, bladder capacity increased by 25%. Conclusions Endoscopic treatment of VUR seems to be a valid alternative to open surgery, even though concerns remain about the long‐term efficacy of collagen implantation. An important distinction should be made between early and late failure of the procedure. Early failure, which we define as persistence of reflux, is usually due to incorrect technique or technical difficulties. Late failure, or recurrence of reflux, which has previously been attributed to the biodegradability of collagen, seems to be due to the displacement of the injected collagen. Micturition itself or high bladder pressure (such as detrusor instability) could be responsible for the displacement of the injected collagen medially and distally, where it can no longer support the submucosal ureteric tunnel. In the treatment of urinary incontinence, both the implant technique and the choice of the site of injection seem to have a considerable effect on the results. In our experience, endoscopic collagen injection is effective in the treatment of both urinary incontinence and VUR in paediatric patients. Accurate selection of patients and technical adjustments and refinements are essential to obtain the best results.