bluuebunny/crossref_metadata_2025_split huggingface dataset:
The tolerability of urodynamic studies and flexible cysto‐urethroscopy used in the assessment of men with lower urinary tract symptoms
Authors: Kortmann  , Sonke  , D’Ancona  , Floratos  , Debruyne  , De La Rosette  
Published: March 2003

ObjectiveTo determine the overall tolerability of urodynamic studies used in the assessment of men with lower urinary tract symptoms (LUTS), by assessing the objective and subjective morbidity experienced during and after urodynamic studies, and to assess the voiding complaints caused by the combination of urodynamic studies with flexible cysto‐urethroscopy.Patients and methodsA total of 103 men with LUTS, who underwent a urodynamic study combined with flexible cysto‐urethroscopy, completed a questionnaire designed to assess objective and subjective symptoms and degree of bother, with emphasis on the urodynamic study. In addition, a urine specimen was analysed and cultured. In all, 78 patients who underwent a second urodynamic study completed the questionnaire twice.ResultsThe results of the first questionnaire showed that more than half of the patients experienced some urge after the urodynamic study and cysto‐urethroscopy (56%); 35% of the patients experienced little and 19% experienced severe voiding discomfort after the combined investigations, compared with 24% and 5%, respectively, after a urodynamic study alone. Three patients (3%) had a symptomatic urinary tract infection. Haematuria, increased voiding frequency and increased nocturia occurred occasionally. Most of the patients found the urodynamic study less bothersome than they had expected (64%) and only 9% found it worse than expected. The overall degree of discomfort, experienced during and after the urodynamic study combined with cysto‐urethroscopy, was low, and after a second urodynamic study was even lower.ConclusionIn contrast with earlier results, this clinic‐based urodynamic investigation was associated with a low proportion of urinary tract infection, and low objective and subjective morbidity. The combination of a urodynamic study with a flexible cysto‐urethroscopy does not cause significant additional voiding complaints. Most patients find urodynamic studies tolerable and not very bothersome.
National bias in citations in urology journals: parochialism or availability?
Authors: Grange  
Published: March 2003

Objective To determine any bias by authors of different nationalities in their citation rate of selected urological journals in papers published in the British Journal of Urology and the Journal of Urology.Methods Using a simple computer program and text files of accepted reports in the BJU, or those available on CD‐ROM from J Urol, 212 recent papers in the BJU and 111 from J Urol were analysed to determine the number of citations to four major urological journals (BJU, J Urol, Eur Urol and Urology). The frequencies of citations to these journals were then compared with the national origin of the author(s), grouped as UK, Europe, North America and Other.Results In both the BJU and J Urol the citation rates of the selected journals differed significantly among authors from different regions. In BJU papers, the citation rate of the BJU was highest by UK authors and their citation rate of J Urol was amongst the lowest of the rates for J Urol. The highest citation rate for J Urol was that by European authors. American authors cited the BJU least, citing the J Urol about five times more often than they cited the BJU. Of the papers in the J Urol sample, over 60% were from American authors, with only four from UK authors; thus the UK group was not analysed separately but included in the European group. The mean citation rate of J Urol was highest in papers by American authors, at about 14 times that for citations to the BJU. The citation rates for the other two journals were not significantly different with nationality or journal, but were generally much lower in J Urol than in the BJU.Conclusion There are significant differences in citation rates both with authors’ nationality and between journals. Citation rates may be influenced by journal accessibility, perceived journal ‘prestige’ (impact factor) or national bias. Authors, editors and reviewers should be aware of this potential bias in citation habits. Authors should strive to conduct exhaustive searches using electronic methods, so that all relevant papers are assessed, regardless of their origin.
Sustained‐release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo‐controlled
Authors: Mcneill  , Daruwala  , Mitchell  , Shearer  , Hargreave  
Published: March 2003

Objective To establish whether the administration of sustained‐release (SR) alfuzosin improves the outcome of a trial without catheter (TWOC) after an episode of acute urinary retention.Patients and methods In a prospective, randomized, placebo‐controlled trial, 81 patients with acute urinary retention related to benign prostatic obstruction received either SR alfuzosin (n=40), an α1‐selective blocker, given at a dose of 5 mg twice daily, or placebo (n=41) for 48 h. The catheter was removed after 24 h of treatment. The main outcome measurement was success or failure of the TWOC. At the end of this double‐blind phase the patients were followed up on an open basis.Results After removal of the catheter, 42% of patients voided successfully, 22 of 40 (55%) with SR alfuzosin and 12 of 41 (29%) with placebo (P=0.03). The mean age of patients voiding successfully, regardless of treatment group, was 68.4 years, whilst the mean age of those who were not successful was 72.9 years (P=0.015). In an intention‐to‐treat analysis of outcome adjusted for this age difference, the benefit in favour of those receiving SR alfuzosin was not significant, but at P=0.052 there was a strong suggestion of a positive treatment effect. The observed benefit remained significant in a per‐protocol analysis adjusted for age. Taken together, these results indicate that treatment with SR alfuzosin was effective and that the observed benefit was not simply the effect of age difference between the groups. Of the 34 patients who voided successfully 23 (68%) required no further intervention within a mean follow‐up of 7 months.Conclusions Treatment with SR alfuzosin is effective in improving the success rate of a TWOC after an episode of acute urinary retention, although older patients are less likely to void successfully. By reducing the numbers of men sent home with urinary catheters, such treatment may result in a reduction in the associated perioperative morbidity in those undergoing prostatic surgery, and is clearly desirable for the patients’ comfort and convenience.
The follow‐up of patients with unfavourable early results of transurethral prostatectomy
Authors: Hakenberg  , Pinnock  , Marshall  
Published: March 2003

Objective To determine the natural course of patients with subjectively disappointing early results after transurethral prostatectomy (TURP), who experience prolonged discomfort and an initial deterioration in symptoms.Patients and methods A consecutive series of 127 patients undergoing urodynamic studies and TURP were assessed 3 months after surgery using symptom scores and measurements of urinary flow rate; 107 patients reported improved symptom and quality‐of‐life scores, but 20 did not improve, with no change or a deterioration. These 20 patients were followed for several months using symptom scores, and measurements of flow rates and residual urine volumes. Baseline variables, including preoperative urodynamic studies, were compared between those who improved and those who did not.Results Over a mean (range) follow‐up of 10.6 (6–15) months, all those initially not improving showed spontaneous improvement in all three variables with no further treatment and eventually achieved the same significant degree of improvement as those who improved soon after TURP. Preoperatively, those initially not improving had mean lower symptom scores, more bladder irritability and less obstruction than did those who improved.Conclusion A significant proportion (≈15%) of patients with obstructive symptoms will experience considerable symptomatic discomfort for a prolonged period after an uncomplicated TURP and will not gain the full symptomatic benefit from the procedure until 6–9 months afterward.
The prognostic value of different forms of prostate specific antigen and their ratios in patients with prostate cancer
Authors: Björk  , Lilja  , Christensson  
Published: March 2003

ObjectiveTo assess the prognostic value for patient survival of different forms of PSA and ratios thereof, before treatment for prostate cancer, by considering the forms and ratios both as independent markers and by comparing them with other commonly used prognostic markers, e.g. tumour grade, local stage (T‐stage) and absence or presence of skeletal metastases (M‐stage).Patients and methodsBlood samples were collected consecutively from men diagnosed with prostate cancer at our department in 1988. From this group, 66 men were followed until death, or for ≥9 years. Twenty‐five patients died from their prostate cancer and 21 from other causes during the follow‐up period. Forty‐eight patients received hormonal treatment, whereas 18 remained untreated or received no treatment for their cancer before they died from other causes. Assays measuring the serum levels of free prostate specific antigen (fPSA), PSA complexed to α1‐antichymotrypsin (PSA‐ACT), and total PSA (tPSA) were used to calculate the percentage of free to total PSA (f/tPSA) fPSA/ACT and ACT/tPSA at diagnosis. Based on the initial levels or ratios of the PSA forms, the patients were divided into three numerically comparable groups (tertiles) for survival analysis. Prognostic factors predicting patient survival were evaluated using univariate (Kaplan–Meier life‐tables with the log‐rank test) and multivariate techniques (Cox proportional hazards regression model).ResultsUnivariate analysis using the log‐rank test showed that the serum level of each molecular form of PSA, i.e. tPSA (P=0.001), PSA‐ACT (P<0.001) and fPSA (P<0.001), as well as grade (P<0.001), T‐stage (P=0.00355) and M‐stage (P<0.001), provided statistically significant prognostic information. Log‐rank tests showed that none of the ratios, i.e. f/tPSA, fPSA/ACT and ACT/tPSA, were informative of prognosis (P>0.05). However, in a multivariate analysis regression model, not only M‐stage (risk ratio 4.2; P=0.026) and grade (risk ratio 2.6; P=0.022), but also f/tPSA (risk ratio 1.8; P=0.037), provided significant prognostic information.ConclusionThe values of tPSA, fPSA and PSA‐ACT, as well as grade and T‐ and M‐stage, are all independent prognostic factors of prostate cancer survival. In a multivariate analysis, not only M‐stage and grade but also f/tPSA provided significant prognostic information.
Paradoxical expression of E‐cadherin in prostatic bone metastases
Authors: Bryden  , Freemont  , Clarke  , George  
Published: March 2003

ObjectiveTo determine whether the calcium‐dependent cell adhesion molecule E‐cadherin is expressed in metastatic deposits of prostate cancer in bone.Patients and methodsTen bone biopsies containing metastatic deposits of untreated prostatic cancer were obtained and immunohistochemically stained for E‐cadherin with the monoclonal antibody HECD‐1, using the streptavidin–biotin complex technique. Benign prostatic tissue was used as the control.ResultsOf the 10 specimens, nine showed positive expression of E‐cadherin, graded as strong in four. E‐cadherin expression was strongest in well‐differentiated metastases and decreased with increasing tumour grade. In some specimens there were mixed patterns of expression.ConclusionE‐cadherin is strongly expressed in prostatic bone metastases and the degree of expression appears to reflect local tumour grade. This suggests that loss of E‐cadherin expression may not be critically linked to metastatic potential.
Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy?
Authors: Durkan G.C. , Greene D.R. 
Published: March 2003

ObjectiveTo determine the outcome of repeated prostatic biopsies in men attending with suspected prostate cancer but an initial negative biopsy.Patients and methodsPatients who had undergone two or more transrectal ultrasonography (TRUS)‐guided prostate biopsies were identified from the Hospital Information Support System database. Indications for TRUS were a raised prostate‐specific antigen (PSA) level (>4.0 ng/mL), with or without an abnormal digital rectal examination (DRE). Sextant prostate biopsies plus biopsies of any suspicious hypoechoic area or area of DRE abnormality were obtained for histology. Forty‐eight patients underwent repeat TRUS‐guided prostatic biopsies (mean age 67.5, sd 7.25, range 53–82 years).ResultsThe mean (sd, median, range) PSA level was 16.9 (13.5, 11.6, 5.2–61.8) ng/mL. Fifteen patients (31%) had carcinoma on repeat biopsy, 11 after the second and four after a third biopsy. The positive repeat biopsy rate was 24% where the PSA level was 4.0–9.9 ng/mL, 33% if the level was 10.0–19.9 ng/mL and 39% if it was ≥20.0 ng/mL. There was no significant difference in age or initial PSA concentration between those men with positive and those with negative repeat biopsies. However, patients with cancer had significantly higher PSA levels before repeat biopsy than at first biopsy (P=0.0043) and had greater PSA velocities than had patients with no diagnosis of cancer (P=0.0067).ConclusionWhere sufficient clinical suspicion exists, despite an initial negative biopsy, repeat TRUS‐guided prostate biopsies should be carried out to exclude carcinoma of the prostate.
Predicting the extent of prostate cancer using the combination of systematic biopsy and serum prostate‐specific antigen in Japanese men
Authors: Gohji K. , Okamoto M. , Takenaka A. , Nomi M. , Fujii A. 
Published: March 2003

ObjectiveTo determine the utility of systematic biopsy alone or combined with an assay of serum prostate‐specific antigen (PSA) level to predict the extent of prostate cancer in Japanese men.Patients and methodsThirty‐two patients who were diagnosed as having clinically organ‐confined prostate cancer and who underwent prostatectomy were evaluated retrospectively for the results of systematic biopsy (percentage of positive biopsy cores and cancer location), serum PSA and the pathological stage of whole‐mount sections of the prostatectomy specimens.ResultsThe incidence of extraprostatic disease (pT3N0M0 or N+) in patients with ≥ 8 ng/mL of serum PSA and cancer in bilateral lobes was significantly higher than in those with <8 ng/mL PSA and cancer in one lobe (83% vs 30%, P=0.020). In those with more than half the biopsy cores positive, extraprostatic disease was significantly more common than in those with less than half positive (93% vs 44%, P=0.0075); moreover, in patients with more than half the cores positive and ≥ 8 ng/mL serum PSA, it was significantly more common than in those with less than half positive and <8 ng/mL of serum PSA (93% vs 27%, P=0.0021). However, the incidence of extraprostatic disease predicted by three variables (cancer location, percentage positive biopsy cores and serum PSA) was not significantly better than that predicted by two variables (percentage positive cores and serum PSA).ConclusionsThe combination of systematic biopsy and serum PSA may be useful in predicting extraprostatic cancer. Patients with ≥ 8 ng/mL serum PSA and more than half the biopsy cores positive could avoid a prostatectomy because there is a high probability that they have extraprostatic disease.
Effect of oral administration of high‐dose nitric oxide donor l‐arginine in men with organic erectile dysfunction: results of a double‐blind, randomized, placebo‐controlled study
Authors: Chen  , Wollman  , Chernichovsky  , Iaina  , Sofer  , Matzkin  
Published: March 2003

ObjectivesTo determine, in a prospective randomized, double‐blind placebo‐controlled study, the effect of 6 weeks of high‐dose (5 g/day) orally administered nitric oxide (NO) donor l‐arginine on men with organic erectile dysfunction (ED).Patients and methodsThe study included 50 men with confirmed organic ED who were randomized after a 2‐week placebo run‐in period to receive l‐arginine or placebo. A detailed medical and sexual history, O’Leary's questionnaire, a specially designed sexual function questionnaire and a sexual activity diary were obtained for each patient. All participants underwent a complete physical examination including an assessment of bulbocavernosus reflex and penile haemodynamics. Plasma and urine nitrite and nitrate (designated NOx ), both stable metabolites of nitric oxide, were determined at the end of the placebo run‐in period, and after 3 and 6 weeks.ResultsNine of 29 (31%) patients taking l‐arginine and two of 17 controls reported a significant subjective improvement in sexual function. All objective variables assessed remained unchanged. All nine patients treated with l‐arginine and who had subjectively improved sexual performance had had an initially low urinary NOx , and this level had doubled at the end of the study.ConclusionsOral administration of l‐arginine in high doses seems to cause significant subjective improvement in sexual function in men with organic ED only if they have decreased NOx excretion or production. The haemodynamics of the corpus cavernosum were not affected by oral l‐arginine at the dosage used.
Prognostic value of sarcomatoid histology and volume‐weighted mean nuclear volume in renal cell carcinoma
Authors: Kanamaru  , Sasaki  , Miwa  , Akino  , Okada  
Published: March 2003

ObjectiveTo determine the prognostic value of two histopathological factors, sarcomatoid histology and volume‐weighted mean nuclear volume (MNV) in renal cell carcinoma (RCC).Patients and methodsThe study included 106 patients (72 men and 34 women, mean age 63 years, range 32–83) with RCC, all of whom were surgically treated between 1985 and 1995. The presence of any sarcomatoid component was determined and MNV estimated using a stereological method in histological slides of tumour specimens from these patients. The prognostic significance of the two variables was evaluated by univariate and multivariate analyses in comparison with other histopathological variables (T, N and M categories, nuclear grade, tumour size, tumour type), using the cause‐specific and progression‐free survival of the patients as the endpoints.ResultsAmong the 106 RCC cases examined, a sarcomatoid component was detected in 34 (32%); the MNV was 90–627 μm3 (mean 225). By univariate and multivariate analysis, both variables were significant prognostic factors for cause‐specific survival in all patients. In addition, multivariate analysis of the 74 patients with localized RCCs (T1–3, N0 M0) showed that sarcomatoid histology was a significant prognostic factor for disease progression.ConclusionThe presence of sarcomatoid histology and the MNV, both of which can be examined with no specialized laboratory procedures, seem to be useful tumour‐related prognostic factors in RCC.
Autonomic nerve involvement and venous leakage in diabetic men with impotence
Authors: Çolakoglu  , Kutluay  , Ertekin  , Altay  , Killi  , Alkis  
Published: March 2003

ObjectiveTo determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence.Patients and methodsThirty‐four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The results were compared with those from patients with idiopathic penile venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA).ResultsOf the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations. Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage.ConclusionVenous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.
Management of renal angiomyolipoma: a report of 53 cases
Authors: De Luca  , Terrone  , Rocca Rossetti  
Published: March 2003

ObjectiveTo evaluate the clinical, therapeutic and prognostic aspects of renal angiomyolipoma (AML) in patients either monitored by clinical and radiological follow‐up or treated by surgical therapy.Patients and methodsFifty‐three patients with renal AML were divided in two groups; 33 patients in group 1 were monitored by annual clinical and ultrasonographic follow‐up and 20 in group 2 were treated with surgical therapy. Two patients had tuberous sclerosis (TS) with synchronous bilateral and multiple lesions. Apart from the patients with TS, there were 38 lesions in group 1 and 25 in group 2. The mean (range) follow‐up of group 1 was 60.2 (12–164) months.ResultsIn group 1, the diagnosis was most often incidental, after ultrasonography performed for symptoms unrelated to AML. In group 2, the suspicion of a malignant renal lesion, and spontaneous tumour rupture with bleeding and perirenal haematoma, were the main indications for surgical treatment. The mean lesion diameter was significantly greater in group 2 (5.4 cm) and in symptomatic patients (8.1 cm). In group 1, 92% of renal AMLs showed no radiographic changes, serious complications or new renal or extrarenal lesions during the follow‐up. Only three lesions grew, after 22, 85 and 164 months, respectively. Of the 20 patients in group 2, 14 underwent conservative surgery.ConclusionSmall (<4 cm) isolated AMLs, detected incidentally, showed a low risk of developing during long‐term follow‐up. Such patients may be followed conservatively by ultrasonography every 2 years. Spontaneous perinephric haemorrhage is related to the size of the lesion. When surgery is indicated (by symptoms or diagnostic doubt), a conservative procedure can be performed in most of cases.