bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction predict psychosocial adjustment after cystectomy in patients with bladder cancer?
Authors: MÅnsson Å. , Christensson  , Johnson  , Colleen  
Published: March 2003

Objectives To assess if there is relationship between: (i) preoperative psychological defensive strategies, mood and type of lower urinary tract reconstruction, and (ii) psychosocial adaptation after radical cystectomy for bladder cancer.Patients and methodsFifty‐seven consecutive patients (44 men and 13 women, mean age 62 years, range 34–81) undergoing radical cystectomy (ileal conduit urinary diversion in 17, continent cutaneous diversion in 22 and orthotopic bladder replacement in 18) were assessed preoperatively using the meta‐contrast technique (MCT), a projective test to reveal individual defensive strategies. From the results the patients were classified as hypothetical ‘at risk’ or ‘no risk’ patients for postoperative psychosocial complications. An ‘at risk’ patient was designated as one who showed neurotic defensive strategies in coping with threats, i.e. primitive, immature or regressive strategies or even lack of defence in connection with pronounced anxiety. All patients completed a questionnaire and were interviewed; 10 questions dealt with mood, five reflecting anxiety and five the depressive states. The questionnaire and the interview were repeated 3 and 12 months, and 5 years after surgery.ResultsThe remembered difficulties during the first month after discharge from hospital differed between the ‘risk’ and ‘no risk’ groups after 1 and 5 years. On a visual analogue scale (VAS) the ‘risk’ patients had very low scores (less difficulty) or very high, while the ‘no risk’ patients had intermediate scores. VAS scores were also higher, although not significantly so, in patients using primitive defence strategies. The psychosocial situation did not differ between the groups in the first year, but at 5 years there were differences in self‐esteem and interpersonal contact‐seeking. High depression scores before surgery were associated with high VAS scores at 3 months when recalling the first month after discharge, but the anxiety score was not predictive. Men with orthotopic bladder replacement adapted less well throughout the 5 year follow‐up. Elderly patients with stereotypy (the commonest defensive strategy at these ages) adapted relatively well to ileal conduit diversion. About 20% of patients had difficulty in accepting the postoperative situation, regardless of urinary diversion modes.ConclusionThe combination of defensive strategies assessed using the MCT and selected on hypothetical grounds was less discriminatory than expected for those at risk of postoperative psychosocial problems. However, those with primitive strategies apparently had a long‐term risk of poor adaptation. The search for an optimal instrument for the identification of patients at risk is warranted. In this study, patients with a ‘wet’ stoma did not seem to fare less well than those with a continent reconstruction.
In vitro assessment of a collagen sponge for engineering urothelial grafts
Authors: Sabbagh  , Masters  , Duffy  , Herbage  , Brown  
Published: March 2003

Objective To investigate the deposition of urinary crystals and the growth characteristics of urothelial cells on a collagen sponge, as a preliminary step in engineering urothelial autologous grafts.Materials and methods Collagen sponges were exposed to a continuous flow of urine at pH 5.3 and 6.3 for 1 week. The sponges were examined microscopically for crystal deposition and analysed for their calcium content. Two cell lines, RT112, derived from a well‐differentiated transitional cell carcinoma, and UROtsa, an immortalized urothelial cell line, were seeded on the collagen sponges. Cells were cultured for 6, 12 and 21 days. The pattern of growth was analysed by histology and immunostaining with a pan‐cytokeratin antibody. Growth was assayed to quantify cell proliferation on the sponges.Results No crystals were evident on any of the collagen sponges. Calcium deposition was negligible at pH 5.3. Although calcium levels were measurable at pH 6.3, the levels were very low. Both cell lines attached and grew in a stratified manner on the collagen sponge, RT112 forming a layer 6–8 cells thick, and UROtsa a layer 4–6 cells thick; cell proliferation was maximal at 5–10 days. The sponge remained easy to handle after 3 weeks in culture.Conclusion These findings show that collagen sponges support the growth and stratification of urothelial cells, and indicate that the collagen sponge is a suitable substrate for developing urothelial autologous grafts.
Experimental pyeloureterectomy and calyceal neck transection with autotransplantation and bladder advancement
Authors: Teng  , Hardie  , Samaratunga  , Gardiner  
Published: March 2003

Objective To determine whether Dexon mesh, closely applied to the kidney, provides purchase for sutures to permit bladder/parenchymal apposition on autotransplantation and that, if this line of apposition were some distance from but surrounding renal papillae, urothelium would proliferate to cover exposed parenchyma to form a widely patent lumen; this should facilitate removal of the whole of an upper tract collecting system, retaining renal parenchyma alone.Materials and methods To test this possibility and explore the practicability of the concept, nine dogs underwent bilateral nephrectomy followed by unilateral autotransplantation; the other kidney was discarded. Because the canine renal pelvis is intrarenal, the ureter was stretched maximally before passing fine scissors into the renal hilum to transect the collecting system as close to the kidney as possible in six of the nine dogs. In the remaining three dogs, partial nephrectomy was performed with division of the calyceal necks under vision. Thinned bladder wall was sutured to Dexon mesh some distance from the collecting tubules; omentum was applied to the suture line.Results Three dogs were killed prematurely at <2 weeks because of perioperative complications. Four were killed at 2, 4, 5 and 8 weeks and two at 12 months. Dexon mesh proved to be an effective anchoring fabric, providing close apposition of bladder wall and parenchyma. There was no adhesion of the kidney to peritoneal contents. Urothelial proliferation to cover exposed parenchyma occurred early and by 12 months, a thin stroma was interposed between parenchyma and epithelium. The kidney was preserved in all but one removed electively, this dog having both cystitis and pyelonephritis at 12 months.Conclusions This study showed that autotransplantation of a kidney after removal of its collecting system and advancement of thinned bladder wall to renal parenchyma is practicable, with regenerated urothelium bridging the deficiency by covering exposed parenchyma, to create a widely patent lumen.
A novel in vitro bladder pelvic nerve afferent model in the rat
Authors: Namasivayam  , Eardley  , Morrison  
Published: March 2003

Objective To develop an in vitro model to allow electrophysiological recordings from pelvic nerve afferents of the urinary bladder in the rat and to ascertain the stability and reproducibility of the model with time.Materials and methods Six male Wistar rats (body weight ≈100 g) were used in the study. The bladder (complete with accessory organs of prostate and seminal vesicles), urethra and penis, together with the attached pelvic nerve and L6/S1 nerve trunk, were removed intact and placed in a specially designed recording chamber containing oxygenated Krebs solution maintained at 30 °C. The bladder was catheterized urethrally and attached to a continuous‐infusion pump and a pressure transducer. The L6/S1 nerve trunk was placed across a silicone‐gel wall into a separate chamber containing liquid paraffin, in which multiunit recordings from pelvic nerve afferents originating from the bladder were made. The afferent nerve activities in response to repeated bladder distension with saline, at 0.04 mL/min for 8 min over 3 h, were compared using the paired t‐test to assess the reproducibility of the model. Conduction velocity studies were also carried out to ascertain the proportion of C‐ and Aδ‐fibres in the multiunit recordings.Results Repeated bladder distension with saline over 3 h produced consistent and reproducible afferent nerve responses, signifying that the afferent nerves recorded in this study neither sensitize nor desensitize over time. This is an essential prerequisite when using this model to study the effects of pharmacological manipulation of the bladder on its afferent nerve response. Conduction velocity studies showed that ≈30% of the afferent fibres recorded from were C‐fibres with the remaining being Aδ‐fibres.Conclusions An in vitro bladder pelvic nerve afferent model for the rat was developed successfully; it is stable and produces reproducible results with repeated bladder distension over at least 3 h.
Neuroanatomical changes in the rat bladder after bladder outlet obstruction
Authors: Sutherland  , Baskin  , Kogan  , Cunha  
Published: March 2003

Objective To investigate the histological changes in bladder innervation in response to partial bladder outlet obstruction in a rat model.Materials and methods Forty‐eight adult female rats had their bladder outlet partially obstructed by ligating the proximal urethra over a 20 G angiocatheter; 18 sham‐operated rats served as controls. Animals were killed after 1, 2 and 4 weeks, and their bladders evaluated using computerized morphometry. Immunohistochemical staining for neuronal protein gene‐product 9.5 (PGP, a general neuronal marker) and enzyme histochemical staining of acetylcholinesterase, adrenergic fibres and nitric oxide synthase were performed.Results Bladder wall changes after obstruction consisted of a six‐ to sevenfold increase in bladder volume and weight. Smooth muscle hypertrophy was evident equally at all sample times. Cystometry showed functional alterations in bladder capacity and voided pressures; obstructed animals had markedly increased bladder capacities and higher voiding pressures (obstructed, 80–100 cmH2O; normal, 30–40 cmH2O). Neuronal changes in the obstructed bladder were most dramatic within the cholinergic and adrenergic neurotransmitter systems within and surrounding the smooth muscle bundles, where there was less staining than in control animals. PGP immunoreactivity increased slightly. The l‐arginine‐nitric oxide pathway appeared unperturbed after obstruction.Conclusions These histological findings suggest that neuropathic changes in the bladder after outlet obstruction, including detrusor instability, are mainly the result of anatomical perturbations in the cholinergic and adrenergic pathways.
Surgical management of urethral damage in neurologically impaired female patients with chronic indwelling catheters
Authors: Andrews  , Shah  
Published: March 2003

Objective To evaluate the clinical outcome of female patients with spinal cord injury who underwent a variety of surgical procedures to treat urethral injury and incontinence from prolonged indwelling urethral catheterization.Patients and methods The study included 18 female patients (mean age 53.6 years, range 17–75), most of whom had spinal cord injury, who had indwelling urethral catheterization for a mean of 3.5 years (range 6 months to 30 years); they presented with severe urethral injury and intractable incontinence despite catheterization. Several different surgical operations were used to correct the incontinence, including urethral reconstruction (urethrocleisis) and urethral closure both transvaginally and suprapubically, in association with permanent suprapubic catheterization. The patients were followed for a mean of 4.6 years.Results Four patients who underwent transabdominal urethral closure were dry. Four of eight patients who underwent urethral closure transvaginally developed urethral fistulae; these occurred within 3 months of their operation, two being corrected at subsequent operations. Two of six patients who underwent urethral reconstruction were incontinent and this was corrected via a transabdominal closure. Overall, the 18 patients underwent 22 procedures and 16 are dry, i.e. ≈90% success.Conclusion Where the urethra is irrecoverably damaged, closure via the transvaginal approach is the preferred approach because it has low morbidity and is tolerated by these severely disabled patients. Urethrocleisis and urethral preservation provide a better option only in a select group of patients.
A comparison of prelubricated hydrophilic and non‐hydrophilic polyvinyl chloride catheters for urethral catheterization
Authors: Pachler  , Frimodt‐Møller  
Published: March 2003

ObjectiveTo evaluate whether patients performing clean intermittent self‐catheterization (CISC) for a short period preferred a prelubricated, hydrophilic, disposable polyvinyl chloride (PVC) catheter or a non‐hydrophilic PVC catheter which could be used several times and that had to be lubricated by the patient.Patients and methodsIn a prospective cross‐over study, 32 patients used each type of catheter for 3 weeks. After each 3‐week period, the patients completed a questionnaire to assess comfort and preference, and urine specimens were obtained for culture.ResultsThere was no significant difference between the groups in the frequency of CISC, discomfort when used, opinion on handling the catheters, preference toward one of the catheters, or of infection.ConclusionNon‐hydrophilic PVC catheters may be used safely and with no discomfort to the patient. In addition it may be possible for the healthcare system to save money, as the non‐hydrophilic PVC catheters are much cheaper.
Renal cell carcinoma in children under 14 years old: long‐term survival
Authors: Androulakakis  , Polychronopoulou‐Androulakaki  , Michael  , Stephanidis  , Yannakis  
Published: March 2003

ObjectivesTo assess the treatment and long‐term survival of children under 14 years old operated upon for renal cell carcinoma (RCC).Patients and methodsThe records of five patients (aged 2, 4, 6, 9 and 13 years) who had been treated for RCC between 1982 and 1993 were reviewed. All had undergone nephrectomy with (two) or without (three) regional lymphadenectomy. After surgery four patients received chemotherapy (vincristine with actinomycin‐D, three, vinblastine, one), and two with advanced‐stage disease received other agents (interferon α, interleukin‐2). They were followed for 5 to 15 years.ResultsThree patients with stage I‐II RCC were well at 13, 15 and 15 years after treatment. Of the two patients with regional lymph node involvement (stage III), one was well 5 years after surgery while the other developed hepatic, lung and bone metastases, and died 2 years after presentation.ConclusionThe prognosis and long‐term survival of children under 14 years old with RCC is very good for those with low‐stage tumours. Nephrectomy with complete tumour extirpation is the main mode of treatment. For advanced‐stage tumours, the role of adjuvant chemotherapy and/or biological agents must be defined more clearly.
The expression of PAX5 in human transitional cell carcinoma of the bladder: relationship with de‐differentiation
Authors: Adshead  , Ogden  , Penny  , Stuart  , Kessling  
Published: March 2003

ObjectiveTo investigate the expression of PAX genes, a family of developmental control genes (which encode nine nuclear transcription factors essential for embryogenesis and are proto‐oncogenes in mice) in human transitional cell carcinoma (TCC) of the bladder.Materials and methods PAX gene expression was assessed in three established bladder cancer cell lines and 29 primary tumours using the reverse transcriptase‐polymerase chain reaction and Southern analysis.ResultsAll three established TCC cell lines and 79% of primary TCCs expressed PAX5 mRNA. There was a significantly higher proportion of PAX5 expression in malignant than in benign urothelium (P=0.02, Fisher’s exact test); nine of 12 pTa tumours (mucosa‐confined), seven of eight pT1 (invading lamina propria) and eight of nine pT2 (invading muscle) expressed PAX5. A higher proportion of tumours with increasing de‐differentiation expressed PAX5, which correlates well with the expression pattern of PAX5 in development. In well‐differentiated tumours (grade 1), half expressed PAX5, compared with 84% of moderately to poorly differentiated tumours (grades 2/3). The odds ratio for PAX5 expression in malignancy suggests that it increases the risk of malignancy four‐fold.ConclusionThese data support a role for the PAX family in oncogenesis, by identifying another human neoplasm in which they are inappropriately expressed. PAX5 expression in undifferentiated TCC cells may contribute to pathogenesis by supporting cellular proliferation in the de‐differentiated state. Furthermore, the high incidence of PAX5 expression suggests its potential use as a diagnostic tool and therapeutic target in TCC.
In vitro investigation of the bladder‐vascular selectivity of levcromakalim and YM934 in human tissues
Authors: Chess‐Williams  , Martin  , Korstanje  , Chapple  
Published: March 2003

ObjectiveTo examine the potencies of the potassium‐channel openers (KCOs) levcromakalim and YM934 as relaxing agents on human detrusor and human mesenteric artery smooth muscle, and to determine their bladder‐vascular selectivity in vitro.Materials and methodsStrips of human detrusor muscle and mesenteric artery (with the endothelium removed) were set up in physiological salt solution and the tension developed by the tissues recorded. Tissues were precontracted with a concentration of carbachol (detrusor) or phenylephrine (artery) which caused 80% of maximal contraction, and relaxation responses to levcromakalim and YM934 were then obtained.ResultsBoth KCOs caused relaxation of the bladder detrusor muscle and the mesenteric artery. Maximal responses, when plotted as a percentage of the precontraction, were greater for both KCOs in the bladder muscle than the artery, but the differences were small and not statistically significant. The sensitivity (drug potency) of the detrusor muscle to the KCOs was more than twice that of the artery but this selectivity was only statistically significant for YM934.ConclusionsOnly minor bladder‐vascular selectivity for levcromakalim and YM934 could be detected in vitro. This suggests that neither drug would be tolerated clinically, although the results suggest that further development of bladder‐selective KCO agents appears feasible.
Bladder augmentation: does it predispose to prosthetic infection of simultaneously placed artificial genitourinary sphincters or in situ ventriculoperitoneal shunts?
Authors: Furness  , Franzoni  , Decter  
Published: March 2003

ObjectiveTo review previous reports and our experience in assessing the risk of prosthetic infections in patients undergoing bladder augmentation simultaneously with artificial genitourinary sphincter (AGUS) implantation, and in patients with in situ ventriculoperitoneal (VP) shunts, implicated as a cause of shunt infection.Patients and methodsThe literature was searched to identify the number of prosthetic infections (AGUS or VP shunt) reported in patients who have undergone bladder augmentation. Additionally, the records of 53 myelodysplastic patients at our institution who had undergone bladder augmentation were reviewed to determine the incidence of AGUS and/or VP shunt infections. An AGUS was placed in 17 of these patients, who were then divided into three groups based upon the timing of their AGUS placement relative to bladder augmentation. Of the 53 patients, 47 had an in situ VP shunt at the time of their augmentation. All patients were followed for at least 12 months.ResultsThe reported rate of AGUS infection at the time of simultaneous bladder augmentation was not significantly different from that when these procedures were staged. In the present series, the AGUS became infected in two patients (12%); one infection occurred in each of 10 patients undergoing simultaneous procedures (10%) and one developed in each of the seven patients undergoing staged procedures (14%). Although VP shunt infections have been reported after bladder augmentation, none of the present patients had a VP shunt infection after bladder augmentation.ConclusionThese results suggest that bladder augmentation is not associated with an increased risk of prosthetic infection in patients undergoing simultaneous placement of an artificial sphincter or in those who have an in situ VP shunt.
Does maternal stress induce abnormal descent of the testis in prepubertal rats?
Authors: Shono  , Imajima  , Zakaria  , Suita  
Published: March 2003

ObjectiveTo investigate whether prenatal maternal stress, considered to alter plasma testosterone concentration and induce a lack of testosterone surge in male rat fetuses, has any effect on the growth of the processus vaginalis and testicular descent in male offspring.Materials and methodsPregnant rats were divided into two groups. In group 1, the rats were placed three times daily for 60 min each session in Plexiglas rat holders (13×6×8 cm) illuminated by two 150‐W flood lights from day 14 to day 18 of gestation during the dark phase of the animals’ light (12 h) and dark (12 h) cycle. In group 2, pregnant females were not handled and acted as controls. After birth, the anogenital distance of both the male and female rats was measured, and the length of the processus vaginalis was measured at 7 days of age in some rats. Thereafter, at 21, 24, 27 and 30 days of age, testicular descent was assessed in the remaining male rats.ResultsIn group 1, at 21, 24, 27 days of age, testicular descent was delayed in the stressed rats compared with the control rats. At 30 days of age, five of 36 stressed male offspring showed abnormal testicular descent; three testes were in the superficial inguinal position and two were above the scrotum. Both the anogenital distance and the length of the processus vaginalis were significantly less in the stressed male rats than in the controls.ConclusionsMaternal stress induced a female‐like anogenital distance in male rat fetuses, and caused delayed and abnormal descent of the testis, by inhibiting the growth of the processus vaginalis after birth. Prenatal stress may therefore be involved in the delay of testicular descent in neonatal rats by inducing a mild anti‐androgenic effect in the fetus.
Electrokinetic lithotripsy: safety, efficacy and limitations of a new form of ballistic lithotripsy
Authors: Keeley Jr  , Pillai  , Smith  , Chrisofos  , Tolley  
Published: March 2003

ObjectiveTo investigate the safety and efficacy of electrokinetic lithotripsy (EKL), a ballistic lithotripter which uses high‐energy magnetic fields to propel an impactor to fragment calculi.Patients and methodsThe records and radiographs of 121 patients who underwent ureteroscopy using the EKL for stones in the upper (26), mid (28) or lower (67) ureter were reviewed retrospectively. Ureteroscopy was performed with an 8.5 F semi‐rigid ureteroscope, through which a 3 F EKL probe was passed.ResultsA total of 148 stones (mean stone size 11.5 mm, range 6–40) in 121 patients were treated using the EKL. One patient was lost to follow‐up. Of 148 stones, 147 (99.3%) were fragmented, including five that had resisted fragmentation with either pulsed‐dye laser or electrohydraulic lithotripsy. Despite this, only 45 of 56 patients (80%) with a single stone in the lower ureter were rendered stone‐free after a single ureteroscopic procedure. Seven patients in this group (12%) required shock‐wave lithotripsy for fragments that had been propelled into the kidney, while four patients (7%) required repeat ureteroscopy for retained ureteric fragments. Complications were limited to minor ureteric perforations in two patients, both of which were treated with a stent.ConclusionEKL is an inexpensive and reliable endoscopic method which fragments nearly all urinary calculi. Its limitations include the propulsion of fragments and the need to use an offset, semi‐rigid ureteroscope. We recommend the use of a basket or graspers to remove fragments of ≥4 mm after EKL.