bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of a multipurpose stent in children
Authors: ZAIDI Z. , MOURIQUAND P.D.E. 
Published: November 2003

Objectives To assess the use of a multipurpose stent (the ‘Blue stent’, Angiomed Urosoft Pyeloplasty Stent, Bard, UK) in children undergoing pyeloplasty and ureteric reimplantation.Patients and methods Between August 1994 and August 1996, the Blue stent was used in 50 renal units in 46 children aged 2 months to 12 years and 6 months. Twenty‐five children underwent pyeloplasty, 11 had ureteric reimplantation for vesico‐ureteric reflux (VUR), eight had ureteric reimplantation with remodelling for obstructed megaureters and in two patients it was used during the removal of stones. The mean follow‐up was 18 months (range 6–30 months).Results After pyeloplasty, 22 patients (88%) had improved renal function and drainage with a decrease in hydronephrosis; two patients had a decrease in hydronephrosis only, one had an anastomotic leak and needed a repeat pyeloplasty and four developed a urinary tract infection (UTI). After ureteric reimplantation, VUR was not detected in any patient. Two patients had no change in drainage after remodelling and reimplantation of a megaureter, one was later diagnosed as having a neuropathic bladder and one child developed a UTI after ureteric reimplantation. The hospital stay was 3 days after pyeloplasty and 5 days after reimplantation.Conclusion The design of the multipurpose Blue stent provides versatility; it can be used as a stent, and both an internal and external drain. Its use does not prolong the hospital stay. Insertion causes minimal trauma to the renal parenchyma, and removal is easy, pain‐free and requires no anaesthesia. The complication rates in the present series compare favourably with other reported series.
The effect of cryosurgical ablation of the prostate on erectile function
Authors: ABOSEIF S. , SHINOHARA K. , BORIRAKCHANYAVAT S. , DEIRMENJIAN J. , CARROLL P.R. 
Published: November 2003

Objective To investigate the incidence and identify the possible cause of erectile dysfunction after cryoablation of the prostate.Patients and methods Erectile function was examined prospectively in 15 sexually active men (aged 59–72 years) who underwent cryoablation of the prostate for clinically localized prostate cancer. Erectile function was assessed before and 6 months after treatment; after intracavernosal injection with 10 μg of prostaglandin E1 (PGE1), the degree and duration of erection, the size of the cavernosal arteries, the penile arterial blood flow velocity, and the time to achieve peak flow were evaluated using high‐resolution ultrasonography and colour pulsed‐Doppler spectral analysis.Results Post‐operatively, all patients initially reported an inability to achieve an erection sufficient for vaginal intercourse. At 6 months′ follow‐up, erectile dysfunction persisted in nine, with minimal or no response to the intracavernosal PGE1 injections, there was a significant decrease in the peak velocity of blood flow within cavernosal arteries and a significant increase in the time to achieve peak arterial flow.Conclusion Although many factors may contribute to erectile dysfunction after cryoablation of the prostate, vascular injury plays a major role.
Effect of oral administration of prostaglandin E1
Authors: SATO Y. , HORITA H. , ADACHI H. , SUZUKI N. , TANDA H. , KUMAMOTO Y. , TSUKAMOTO T. 
Published: November 2003

Objectives To investigate the effect of limaprost, an oral prostaglandin E1 (PGE1) derivative, on erectile dysfunction and to compare the effects of limaprost with a Chinese herbal drug, gosyajinki‐gan.Patients and methods The study comprised 50 consecutive patients with mild erectile dysfunction who showed a good erectile response to intracavernosal injection with 20 &mgr;g of PGE1. Limaprost was administered to the first 25 patients (30 &mgr;g three times daily) and gosyajinki‐gan (7.5 g three times daily) to the next 25 patients, for 8 consecutive weeks. Patients were evaluated by their ability to achieve vaginal penetration and by a subjective assessment of erectile function (penile rigidity and maintenance of erection) before and after the treatment, using a self‐administered questionnaire. Objective measurements (nocturnal penile tumescence, NPT, values) were also evaluated.Results Eleven of the 24 patients who received limaprost without interruption and four of the 24 taking gosyajinki‐gan succeeded in vaginal penetration; the difference in the positive response rate was significant. The mean increment of NPT was significantly higher with limaprost treatment. However, all positive responders in both groups did not experience a full erection. There were no side‐effects in any patient except one in the limaprost group who developed a facial flush. Thus the treatment was mild enough to be tolerated.Conclusion Limaprost was more effective for mild erectile dysfunction than was gosyajinki‐gan.
The treatment of benign prostatic hyperplasia with alpha blockers in men over the age of 80 years
Authors: KAPLAN S.A. , TE A.E. , IKEGUCHI E. , SANTAROSA R.P. 
Published: November 2003

Objective To determine the safety and efficacy of alpha blockade with doxazosin and terazosin in men over the age of 80 years with symptomatic benign prostatic hyperplasia (BPH).Patients and methods Thirty‐six men (mean age 83.6 years, sd 5.6, range 80‐96) received either doxazosin 4 mg (11 men) or 8 mg (10 men), or terazosin 5 mg (five men) or 10 mg (10 men), once daily at night. Twenty‐eight men (78%) were on other anti‐hypertensive medication; the type and dosage were not changed during the study. Efficacy and safety were assessed using measurements of peak urinary flow rate, symptom scores and the incidence of adverse events.Results Of the 36 men, 33 (92%) remained on study medication at 6 months; the remaining three (8%) discontinued because of asthenia. After 3 months of treatment, the peak urinary flow rate increased significantly (P<0.008) for both doxazosin (+3.7 mL/s) and terazosin (+3.2 mL/s). The American Urological Association symptom score improved significantly (P<0.01) with both alpha blockers after 3 months of treatment and efficacy was maintained at 6 months. There were small, non‐significant decreases in blood pressure in patients receiving doxazosin or terazosin, but no differences between patients who were normotensive at baseline and those whose blood pressure was controlled by other anti‐hypertensive drugs.Conclusion These results suggest that alpha blockade with either doxazosin or terazosin is well tolerated and effective in older men with symptomatic BPH. Furthermore, patients on concomitant anti‐hypertensive medication need no alteration of their therapeutic regimen before the initiation of alpha blockade for BPH.
The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy
Authors: COLOMBO T. , AUGUSTIN H. , BREINL E. , SCHIPS L. , HUBMER G. 
Published: November 2003

Objective To report the results of transurethral submucosal injection therapy of polydimethylsiloxane (PDS) to treat incontinence after radical prostatectomy (RP).Patients and methods Since 1993, about 80 retropubic RPs have been carried out at our institution each year. Severe post‐operative incontinence occurred in six patients, with a mean duration of incontinence after RP of 28 months. The pre‐operative evaluation consisted of cysto‐urethroscopy and urodynamics. Because we have no experience with artificial sphincter implantation, transurethral injection therapy was used to treat the post‐operative incontinence, using PDS (vulcanized silicone rubber particles). This material has a mean particle size of 188 μm, providing stability of the material at the injection site. The six patients with severe post‐operative incontinence were treated using injection therapy with PDS.Results After a mean follow‐up of 15.5 months, five patients, who suffered from day and night incontinence and required at least five pads per day, were dry after injection therapy. One patient improved significantly but still required two pads during the day, but was continent during the night; three patients required a second injection. A mean of 7.5 mL of PDS was used per patient and the side‐effects of therapy (dysuria and urinary retention) were minimal.Conclusion Because PDS has excellent biocompatibility, few side‐effects or complications, transurethral injection therapy using silicone particles is a justifiable procedure for treating incontinence after RP.
Differential expression of acidic and basic fibroblast growth factors in benign prostatic hyperplasia identified by immunohistochemistry
Authors: DESHMUKH N. , SCOTSON J. , DODSON A.R. , SMITH P. H. , KE Y. , FOSTER C.S. 
Published: November 2003

Objectives To detect the expression and to determine the relative cellular locations of the two peptide growth factors, acidic fibroblast growth factor (a‐FGF) and basic (b)‐FGF in tissues from human benign prostatic hyperplasia (BPH).Materials and methods A series of 50 sequential and unselected cases of human BPH tissues, obtained after transurethral prostatectomy, was examined. Adjacent sections of formalin‐fixed and paraffin wax‐embedded tissues were stained immunohistochemically for expression of a‐FGF and b‐FGF using well‐characterized and commercially available antibodies. The stained tissue sections were assessed for the cellular distribution of immunohistochemical products and analysed according to the relative intensity of staining as well as the spatial relationships of positively stained cells.Results Acidic‐FGF was weakly expressed with a pan‐cytoplasmic distribution within luminal glandular epithelial cells in regions of prostatic intra‐epithelial neoplasia (both PIN I and II) but not by non‐dysplastic normal or hyperplastic tissues. No expression of a‐FGF was detected in basal epithelial cells or in the stromal compartment of any tissue examined. In contrast, b‐FGF was strongly expressed within the cytoplasm of all basal epithelial cells, but not by luminal epithelial cells, in morphologically normal regions of all cases examined. Basal expression of b‐FGF was diminished, or absent, in regions of mild epithelial dysplasia, particularly those strongly expressing a‐FGF. Extensive nuclear and cytoplasmic expression of b‐FGF occurred predominantly in smooth muscle‐type stromal cells but not in all types of stromal cells.Conclusions This study confirmed both a differential and a reciprocal expression of a‐ and b‐FGF in non‐dysplastic prostatic hyperplasia and in mildly dysplastic regions of prostatic tissues. While only small amounts of a‐FGF were expressed in BPH, exclusively in the luminal epithelial compartment, its consistent appearance in PIN I and II suggests that it might contribute to the early stages of PIN. Conversely, b‐FGF may be an important mediator of stromal‐epithelial interaction during the pathogenesis of BPH. These results provide new information about the relative expression of these growth factors, particularly in the architectural relationships between different cell‐types within normal and non‐malignant prostatic tissues.
Early voiding difficulty after colposuspension
Authors: SMITH R.N.J. , CARDOZO L. 
Published: November 2003

Objective To determine the incidence of post‐operative voiding dysfunction (POVD) after colposuspension and to identify pre‐operative risk factors.Patients and methods A retrospective study of 100 women having colposuspension to determine the pre‐operative clinical assessment (history, physical examination, symptom‐specific questionnaire and visual analogue score assessment of urological symptoms), pre‐operative urodynamic investigations (uroflowmetry, twin‐channel subtracted cystometry and video‐cystourethrography), information on post‐operative catheter management and the presence and management of any POVD.Results Twenty‐one women experienced significant POVD attributable to their colposuspension. This resolved within 6 months in 19, but persisted beyond 6 months in two. Women experiencing POVD were significantly older and were more likely to have previously undergone a hysterectomy. The risk of POVD was 12% for those aged <50 years, 25% at age 50–64, and 50% for those over 65 years. The duration of post‐operative catheterization was related to the presence of symptoms of voiding difficulty.Conclusions The risk of POVD after colposuspension increases with age. In women over 65 years old, consideration should be given to an elective temporary discharge home with a suprapubic catheter in situ for 7–10 days before initiating a catheter‐clamping regimen.
Validation of a rapid method to quantify apoptosis in superficial bladder cancer
Authors: KELLY J.D. , HAMILTON P.W. , WILLIAMSON K.E. , WEIR H.P. , MCMANUS D.T. , KEANE P.F. , JOHNSTON S.R. 
Published: November 2003

Objectives To derive and validate a rapid method for calculating apoptotic indices in superficial transitional cell carcinoma (TCC) as a measure of chemosensitivity to mitomycin.Materials and methods Apoptotic cells, identified by light microscopy in 20 superficial TCC specimens, were expressed as an index of the total tumour cell population within defined fields. For a given field, the total cell population was estimated by: (i) an exhaustive count of the total number of cells in the field and (ii) an abbreviated method in which the number of cells in a subfield was multiplied to provide an estimate of the total field number. Field and specimen estimates were compared using agreement statistics and the intra‐ and inter‐observer reproducibility of apoptotic indices calculated.Results Cellularity and apoptotic indices obtained using method (ii) were correlated significantly with the true cell counts (P<0.001). Agreement statistics showed that only 9.4% of counts fell outside two standard deviations (sd) from the mean in field analysis, and only 10% of counts fell outside 2 sd from the mean in specimen analysis. There was a fivefold variation in tumour cell counts among individual fields.Conclusions The reported variation in cellularity among fields shows that the calculation of apoptosis must use the total cell population as the reference. The limits of agreement for the estimated and true cell counts are small enough to be confident that the shorter method to estimate cellularity can be used in place of counting all cells.
The ‘watering‐can’ perineum: presentation and management
Authors: SHARFI A.R.A. , ELARABI Y.E. 
Published: November 2003

Objectives To assess the frequency of ‘watering‐can’ perineum among patients with post‐inflammatory urethral strictures, to evaluate methods of anatomical location and to assess the efficacy of direct‐vision internal urethrotomy (DVIU) in this condition.Patients and methods From 1990 to 1996, 216 patients with post‐inflammatory urethral strictures were evaluated; all underwent ascending urethrography and urethroscopy and 44 were found to have a ‘watering‐can’ perineum. These patients were evaluated further for the presence of associated urethral pathology, e.g. calculi and diverticulae. DVIU was performed as the primary method of treatment and any associated urethral pathology treated at the same time. The follow‐up ranged from 3 to 36 months (mean 20).Results Ascending urethrography and urethroscopy located the site of the stricture in all 44 patients; 12 had associated urethral calculi. In 28 patients, the fistulae healed completely after a single DVIU, a further 11 required two urethrotomies, while the remaining five required more than two urethrotomies to treat the stricture.Conclusion DVIU can be used to treat strictures complicated by urethrocutaneous fistulae, and for detecting associated urethral pathology. It has the advantage of requiring a minimal hospital stay, provoking minimal morbidity and the procedure can be repeated as a day‐case if the stricture recurs.
Chronic systemic treatment with epidermal growth factor induces smooth muscle cell hyperplasia and hypertrophy in the urinary tract of mature Goettingen minipigs
Authors: VINTER‐JENSEN L. , JUHL C.O. , DAJANI E.Z. , NIELSEN K. , DJURHUUS J.C. 
Published: November 2003

Objective To determine the effect of systemic treatment with epidermal growth factor (EGF) on the induction of growth in the urinary tract.Materials and methodsMature Goettingen minipigs were treated daily with vehicle (Tris‐HCl; n=5) or EGF (30 μg/kg) (n=6) for 4 weeks. The total number of smooth muscle cells was counted using an optical disector in a 20 μm thick cross‐section of the ureter and the mean smooth muscle cell volume estimated. Cell proliferation was detected by immunostaining for the marker Ki67.ResultsThe ureters of the animals treated with EGF were longer and thicker than those of the controls and the median cross‐sectional area of the ureter was 3.3‐fold larger; the growth involved all wall layers. The median (range) number of smooth muscle cells in a 20 μm thick cross‐section of the ureter was 11 (9–12) × 103 in the pigs treated with placebo and 55 (19–80) × 103 in those treated with EGF, and the median (range) volume of the smooth muscle cells was 2.3 (2.2–2.4) × 103 and 4.0 (3.0–4.5) × 103 mm3 , respectively.ConclusionsThere were two likely mechanisms contributing to smooth muscle cell hyperplasia, the division of fully differentiated smooth muscle cells and division of fibroblasts in the borderline between the submucosal layer and muscular coat, with ensuing differentiation into smooth muscle cells. Treatment with EGF induces the growth of all wall layers in the urinary tract with remarkable hyperplastic and hypertrophic changes of the smooth muscle cells in the muscular coat.
Transuretero‐ureterostomy: a review of 253 cases
Authors: Noble J.G. , Lee K.T. , Mundy A.R. 
Published: November 2003

Objectives  To review our experience of transuretero‐ureterostomy (TUU), which can be a dangerous procedure if a problem arises with the anastomosis, because both upper urinary tracts are put at risk to deal with a problem that initially affected only one side. Patients and methods  TUU was performed in 253 patients following undiversion, trauma or strictures of the distal ureter, with a Mitrofanoff‐type of continent urinary diversion, or otherwise during reconstructive urological surgery, mainly in association with cystectomy and substitution cystoplasty. The patients were followed and complications or problems reviewed. Results  Five patients had problems with the distal ureter below the TUU and one had problems as a result of stone disease in the transposed ureter some distance proximal to the TUU, but there were no long‐term complications as a direct result of the TUU. Conclusions  Providing the anastomosis is stented until there is radiological evidence of healing of the TUU, then TUU is a safe and reliable procedure.
Effect of androgen deprivation on epithelial and mesenchymal tissue components in localized prostate cancer
Authors: Hellström M. , Ranefall P. , Wester K. , Brändstedt S. , Busch C. 
Published: November 2003

Objective To measure the area distribution of epithelial and mesenchymal components in the prostate of patients with localized prostate cancer after temporary androgen deprivation. Patients and methods Surgical specimens from 38 patients treated with the gonadotrophin‐releasing hormone agonist triptorelin for 3 months before radical prostatectomy were examined (group 1). Specimens from a second group of 54 patients who underwent the same surgical procedure with no prior therapy were used as controls (group 2). The specimens were serially step‐sectioned and whole‐mount tissue sections prepared. The epithelial, smooth muscle and connective tissue components were stained separately with immunohistochemical and histochemical techniques, respectively. Using colour‐based image analyses, the tissue components were classified into three categories, displayed in different colours. The percentage of tumour areas occupied by cancer epithelial cells, connective tissue and smooth muscle was determined. Results In specimens from group 1, the cancer epithelium was sparse and scattered throughout the tumour area. A mean (sd) of 21 (11)% of the area was occupied by cancer cells, compared with 40 (11)% in the corresponding material from group 2 (P<0.001). The connective tissue/smooth muscle ratio in stroma (about 1:1) was similar in both groups. Conclusions Neoadjuvant hormone treatment of patients with localized prostate cancer was associated with a marked reduction in tumour density and thus in the total amount of cancer epithelium.
Urodynamic services, personnel and training in the United Kingdom
Authors: Hosker G.L. , Kilcoyne P.M. , Lord J.C. , Smith A.R.B. 
Published: November 2003

Objective To audit the provision of urodynamic services in the UK, with particular emphasis on the personnel involved and the training they received.Methods A questionnaire was sent to 163 centres carrying out urodynamics in the UK asking for information on the department providing the service, the frequency of use, the number of patients investigated, professional training of the personnel and whether the personnel thought that the training was adequate.Results Most urodynamic facilities in the UK function on a part‐time basis. Urodynamics are carried out by a variety of healthcare professionals but most are performed by doctors and nurses. Half the respondents considered the training to be inadequate.Conclusion Consideration should be given to requiring a minimum standard of training for personnel carrying out urodynamics in the UK to ensure that a quality service is provided.
Testicular and adrenocortical function in men with prostatic cancer and in healthy age‐matched controls
Authors: Carlström K. , Stege R. 
Published: November 2003

Objective To compare the endocrine status of patients with prostate cancer with that of age‐matched healthy controls. Patients, subjects and methods Basal serum concentrations of sex steroids, sex hormone‐binding globulin (SHBG) and gonadotrophins, and the basal levels and response to adreno‐corticotropic hormone (ACTH) of adrenocortical steroids, were measured before treatment in 72 patients with prostate cancer and in 42 age‐matched healthy controls. Results Patients aged <60 years with prostate cancer had significantly elevated levels of total testosterone and unconjugated (E1) and total (tE1) oestrone while patients aged ≥60 years had significantly elevated levels of total and non‐SHBG‐bound testosterone (NST), 17α‐hydroxyprogesterone and tE1. Gonadotrophins, SHBG levels and relationships between total testosterone and SHBG were normal in both age groups of patients, as were basal levels and ACTH‐induced increments of adrenocortical steroids. The patients had normal age‐related variations in SHBG and NST and in basal levels and ACTH‐induced increments of adrenocortical steroids. There was a significant age‐related increase in serum E1 in the control subjects but not in the patients. Patients with metastatic disease had significantly lower tE1 levels than had patients without metastases. Conclusions The results suggest an increased sensitivity of the testis to gonadotrophic stimulation, as well as an increased peripheral oestrogen synthesis in patients with prostate cancer, the latter being most pronounced in younger subjects. Men developing prostate cancer may have been exposed to a combination of elevated endogenous oestrogen and androgen levels for a long time. These findings support the theory of a synergism between oestrogens and androgens as an important factor in the aetiology of prostate cancer.