bluuebunny/crossref_metadata_2025_split huggingface dataset:
The urethral Kock pouch: long‐term functional and oncological results in men
Authors: Shaaban A.A. , Mosbah A. , El‐Bahnasawy M.S. , Madbouly K. , Ghoneim M.A. 
Published: August 2003

The Department of Urology in Mansoura has a well‐known experience in, among many things, urinary tract reconstruction in patients with bladder cancer. They review their results in 338 male patients who had a radical cystectomy and Kock pouch. They found good functional and oncological outcomes in properly selected patients. However, they also drew attention to several valve‐related complications.OBJECTIVETo evaluate our experience with men who underwent radical cystectomy and urethral Kock pouch construction between January 1986 and January 1996.PATIENTS AND METHODSComplications were classified as early (within the first 3 months after surgery) or late. Continence was assessed by interviewing the patient; they were considered continent if they were completely dry with no need of protection by pads, condom catheter or medication. The patients were followed oncologically and Kaplan‐Meier survival curves constructed. Urodynamic studies were used to define the possible causes of enuresis.RESULTSThree patients died after surgery from pulmonary embolism. There were 67 early complications in 63 patients. The mean (sd) follow‐up was 87.8 (49.1) months. There were 111 treatment failures from cancer; of these, four men only had an isolated local recurrence in the urethra. Late complications included 72 pouch stones in 55 patients, and 36 deteriorated renal units caused by reflux (17), uretero‐ileal stricture (11), nipple valve eversion (four) or stenosis (four). Interestingly, 65 renal units that were dilated before surgery improved significantly afterward. Ileo‐urethral strictures occurred in seven men and anterior urethral strictures in six. Nine patients were totally incontinent and two had chronic urinary retention. Daytime continence was complete in 94% of men, with nocturnal enuresis in 55; the latter had significantly more residual urine, and a higher amplitude and duration of phasic contractions.CONCLUSIONSOrthotopic bladder substitution after cystectomy for cancer is feasible, with good functional and oncological outcomes in properly selected patients. Nevertheless, the use of a hemi‐Kock pouch is associated with many valve‐related complications.
Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical technique
Authors: Moinzadeh A. , Shunaigat A.N. , Libertino J.A. 
Published: August 2003

It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject.The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results.In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre‐existing conceptions about this. They recommend early involvement of the partner to help in this very important decision‐making.The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory‐based, from a large experience in Hamburg and Mansoura.OBJECTIVETo analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plicationPATIENTS AND METHODSWe retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate‐specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third‐party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP.RESULTSThe mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%).CONCLUSIONWith our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP.
Overexpression of the cytoprotective protein clusterin decreases radiosensitivity in the human LNCaP prostate tumour model
Authors: Zellweger T. , Kiyama S. , Chi K. , Miyake H. , Adomat H. , Skov K. , Gleave M.E. 
Published: August 2003

The paper by Zellweger et al. builds on the continuing story of clusterin (TRPM‐2) in the development and progression of prostate cancer. This group have published a series of papers on this protein, showing that it correlates with progression to androgen‐independence and resistance to apoptosis. One of their recent papers has shown that ‘knocking out’ clusterin increases radiation sensitivity in prostate cancer cells. The current paper reports that increasing the expression of clusterin in LNCaP cells increases the cell's resistance to radiation‐induced apoptosis. Manipulating identified survival proteins has important implications in preventing androgen‐independent progression. Clusterin is such a survival protein and represents an important drug target in the near future.OBJECTIVETo evaluate the effect of clusterin overexpression on radiation‐induced tumour growth rates and apoptosis in human prostate LNCaP cells, as prostate cancer cells are relatively resistant to radiation‐induced apoptosis and local recurrences are common, but overexpression of the anti‐apoptotic protein clusterin can accelerate progression to androgen‐independence and to confer a chemoresistant phenotype in various prostate cancer models.MATERIALS AND METHODSWestern blot analysis and immunohistochemistry were used to compare clusterin expression levels in parental (P) and clusterin‐transfected (T) LNCaP cells in vitro and in vivo. The effects of radiation on clusterin‐expression in both parental LNCaP/P and clusterin‐transfected LNCaP/T tumours were analysed by Northern blot analysis. The cellular response to radiation was determined up to 3 weeks after irradiation using tetrazolium and re‐growth assays, and cell‐cycle analysis by flow cytometry.RESULTSClusterin mRNA expression increased from undetectable to low levels in LNCaP/P tumours after radiation and more than three‐fold in LNCaP/T tumours. Clusterin overexpression decreased the radiosensitivity in a time‐dependent manner, reducing the extent of growth arrest and apoptosis by up to 54%. Re‐growth assays showed that the improved survival rates of LNCaP/T cells after radiation did not change after 3 days, remaining constant over 3 weeks.CONCLUSIONSThese results identify clusterin as a promoter of cell survival that may help mediate resistance to radiation‐induced apoptosis. Furthermore, clusterin overexpression seems to provide an extended protection against radiation‐induced cell cycle arrest and apoptosis.
One 10‐core prostate biopsy is superior to two sets of sextant prostate biopsies
Authors: Fink K.G. , Hutarew G. , Pytel A. , Esterbauer B. , Jungwirth A. , Dietze O. , Schmeller N.T. 
Published: August 2003

OBJECTIVESTo compare the efficiency of different transrectal ultrasonography (TRUS)‐guided prostate biopsy techniques for detecting prostate cancer.MATERIALS AND METHODSIn all, 81 prostates from radical prostatectomy were used and two consecutive sets of sextant biopsies and one 10‐core biopsy taken in each specimen. The 10‐core biopsy consisted of a sextant biopsy and four cores from the far lateral areas of the prostate. To simulate a transrectal biopsy procedure, all biopsies were taken under TRUS guidance.RESULTSIn the first set of sextant biopsies 44 prostate cancers (54%) were detected and in the second set 51 (63%). Combining both sets of sextant biopsies 57 (70%) of the carcinomas were detected. One set of 10‐core biopsies detected 66 (82%) of all prostate cancers. Overall, with the 10‐core biopsies 16% more prostate tumours were diagnosed than with two consecutive sets of sextant biopsies. To find the same number of prostate cancers as with the 10‐core technique, 14% of patients undergoing sextant biopsy would require a second set and 11% at least a third set of biopsies.CONCLUSIONSThe 10‐core prostate biopsy technique is superior to the commonly used sextant technique and could spare patients unnecessary repeated biopsy. Even after including a second set of sextant biopsies, the total detection rate with these 12 biopsies was inferior to the 10‐core technique.
Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response
Authors: Malone‐Lee J. , Henshaw D.J.E. , Cummings K. 
Published: August 2003

OBJECTIVETo investigate the place of urodynamics in the evaluation of patients with symptoms of the overactive bladder by comparing the response to antimuscarinic therapy in those with and with no urodynamically verified symptoms.PATIENTS AND METHODSIn a prospective observational study, 356 female patients with urinary frequency (≥ 8 voids/24 h) and urgency, with or without urge incontinence, underwent cystometry. Patients were diagnosed with detrusor instability if there were spontaneous, uninhibited increases in detrusor pressure during bladder filling. All patients, regardless of urodynamic findings, were subsequently treated with oxybutynin 2.5 mg twice daily and bladder retraining. The outcome was evaluated as the change in urinary frequency and incontinence episodes after 6–8 weeks of treatment.RESULTSAmong 352 evaluable patients, 266 (76%) had detrusor instability on cystometry and the remainder did not. There was no significant between‐group difference in mean age, urinary frequency or the number of incontinence episodes at presentation. Both groups improved equally well during oxybutynin and bladder retraining therapy; after 6–8 weeks there was no significant between‐group difference for the mean change from baseline in urinary frequency or incontinence episodes. Tolerability profiles were comparable for the two groups.CONCLUSIONPatients with symptoms of an overactive bladder, but apparently normal urodynamic findings, respond equally well to antimuscarinic therapy as those with urodynamically verified symptoms. Such findings cast further doubt on the clinical validity of using invasive urodynamic procedures to characterize patients with irritative lower urinary tract symptoms before starting antimuscarinic therapy.
Anionic and cationic drug secretion in the isolated perfused rat kidney after neonatal surgical induction of ureteric obstruction
Authors: De Gier R.P.E. , Feitz W.F.J. , Masereeuw R. , Wouterse A.C. , Smits D. , Russel F.G.M. 
Published: August 2003

OBJECTIVETo study the pathophysiological changes of renal tubular drug transport mechanisms in congenital renal obstruction, by developing a model for perfusing the isolated kidney (IPK) after neonatal surgical induction of partial ureteric obstruction in Hanover Wistar rats.MATERIAL AND METHODSModerately severe obstruction of the right kidney of male rats was created by burying a segment of the right ureter under the psoas fascia at 5–7 days after birth. Different fluorescent substrates for renal organic anion and cation drug transport systems were added to the IPK, and the concentration of these substances with time analysed in perfusate and urine.RESULTSThe reproducibility in all groups of the glomerular filtration rate (GFR) and drug excretion was remarkably good. GFR was significantly lower in obstructed kidneys than in unobstructed kidneys. 123Rhodamine, a marker for organic cation and P‐glycoprotein transport, had a significantly lower maximum excretion rate in the obstructed than in unobstructed kidneys. Renal fractional clearance (123rhodamine clearance corrected for diminished GFR) was also significantly lower in obstructed kidneys. There was no significant difference in maximum excretion (absolute and corrected GFR) for Lucifer Yellow, a marker for sodium‐dependent organic anion transport. The maximum excretion rate of calcein, a marker for sodium‐independent organic anion transport, was significantly lower in the obstructed than in the unobstructed kidneys, but significantly higher after correcting for reduced GFR.CONCLUSIONThe IPK is a good model for studying the effect of neonatal renal obstruction on tubular drug transport. These results show that organic anion and cation transport mechanisms are affected differently by obstruction.
A description of Ca2+ channels in human detrusor smooth muscle
Authors: Sui G.P. , Wu C. , Fry C.H. 
Published: August 2003

OBJECTIVETo characterize the Ca2+ channels in human detrusor smooth muscle and to investigate their contribution to spontaneous electrical activity.MATERIALS AND METHODSIsolated human detrusor smooth muscle myocytes were used to measure ionic currents under voltage‐clamp or membrane potential under current‐clamp. Membrane potential oscillations were analysed in terms of oscillation frequency and amplitude using fast Fourier transforms.RESULTSUnder voltage‐clamp an inward current dependent on extracellular Ca2+ was recorded using Cs+‐filled patch electrodes. The current could be separated into two components on the basis of their sensitivity to Ni2+, verapamil or nicardipine, and their dependence on holding and clamp potential. A Ni2+‐sensitive component activated over a relatively negative range of potentials (−60 to −20 mV) comprised about a third of the total current and was designated a T‐type Ca2+ current. A verapamil/nicardipine‐sensitive component, activated at more positive potentials, was designated an l‐type Ca2+ current. Using K+‐based filling solutions spontaneous transient outward currents were recorded that had the characteristics of current flow through BK channels. Membrane potential oscillations, under current‐clamp increased in frequency but not amplitude as the mean membrane potential was made less negative. The voltage‐dependence of oscillation frequency was similar to that of the l‐type, but not T‐type, Ca2+ current activation curve. Furthermore oscillation frequency was slowed by verapamil but not Ni2+.CONCLUSIONThe study showed, for the first time, the presence of both T‐ and L‐type Ca2+ channels in human detrusor smooth muscle; we propose a role for these channels in spontaneous activity. The results suggest that the L‐type Ca2+ current can control membrane potential oscillation frequency. The significance of this finding for spontaneous contractions is discussed.
The management of stage T1 grade 3 transitional cell carcinoma of the bladder
Authors: Evans C.P. , Busby J.E. 
Published: August 2003

The number of Mini‐Reviews per issue is being increased to three for the foreseeable future. As mentioned before, I believe they add to the reader‐friendliness of the journal, and are enjoyable and informative.This month, the controversial topics of T1 G3 bladder cancer, surgery for penile fractures and managing patients on warfarin are dealt with. I hope that readers will feel free to write to me if they have strong feelings about these or any other subjects in the Journal.
A large prostate at radical retropubic prostatectomy does not adversely affect cancer control, continence or potency rates
Authors: Foley C.L. , Bott S.R.J. , Thomas K. , Parkinson M.C. , Kirby R.S. 
Published: August 2003

OBJECTIVESTo determine the effect of a large prostate at radical retropubic prostatectomy (RRP) on the pathological outcome, biochemical recurrence rates, potency and continence.PATIENTS AND METHODSFrom a database of 440 patients treated with RRP, retrospective information was obtained on prostate weights, patient and tumour characteristics, and follow‐up. Potency and continence after RRP was obtained using a self‐reported validated questionnaire. Patients with prostates of > 75 or ≤ 75 g were compared.RESULTSThe median (range) prostate size was 87  (76–182) and 42 (4.1–75) g in the two groups. The response rate to the questionnaire was 78% (344 men). Patients with prostates of > 75 g were older, with a median (range) age of 65 (51–74) years, than the other group, at 61 (40–76) years (P = 0.01), and had higher initial prostate‐specific antigen (PSA) levels, at 9.6 (3.4–37.8) and 7.6 (0.1–30.0) ng/mL, respectively (P = 0.001). Tumours within larger prostates were of a lower stage (P = 0.035), lower Gleason grade (median 6 and 7, P = 0.015), of smaller volume (median 1.0, 0.1–12.4; and 1.5, 0.1–21.1 mL; P = 0.04) and more often ‘clinically insignificant’ (23% and 6%, P = 0.001). There was no difference in the number or distribution of positive surgical margins. For a limited median follow‐up of 20–25 months, patients with prostates of > 75 g were less likely to have biochemical recurrence (5% vs 24%, P < 0.001). Potency and continence rates were similar between the groups.CONCLUSIONSProstate size at RRP does not affect the risk of impotence or incontinence afterward. A prostate of > 75 g is associated with a lower likelihood of PSA‐relapse, potentially as a result of lead‐time bias. While an enlarged prostate may contraindicate other potentially curative cancer treatments, the outcomes of RRP appear to be unaffected.
Transurethral resection of the prostate as catheter‐free day‐care surgery
Authors: Chander J. , Vanitha V. , Lal P. , Ramteke V.K. 
Published: August 2003

OBJECTIVETo evaluate the feasibility of transurethral resection of the prostate (TURP) as catheter‐free day‐care surgery.PATIENTS AND METHODSThe study comprised 64 patients (mean age 62.4 years) with a mean (range) American Urological Association symptom score of 21.4 (9–31) and prostate volume (by ultrasonography) of 32.8 (17–50) mL, and with no significant comorbidity. The patients were admitted on the morning of the surgery and, under brief spinal anaesthesia, underwent standard TURP. After surgery the urethral catheter was removed as soon as the effluent was clear. The patients were discharged after they could pass urine freely and with a good stream.RESULTSThe mean duration of catheterization after TURP was 7.15 h; 59 patients (92%) had their catheter removed within 10 h (mean duration 6.42 h). There were no major complications during or after TURP. After removing the catheter, no patients required its reinsertion for failure to void or for clot retention. The mean hospital stay after TURP was 10.7 h and 98% of patients were discharged within 23 h of surgery.CONCLUSIONTURP can be conducted safely in a day surgery setting in patients with mild to moderate benign prostatic enlargement and no coexisting medical illness.
An unrandomized prospective comparison of urinary continence, bowel symptoms and the need for further procedures in patients with and with no adjuvant radiation after radical prostatectomy
Authors: Hofmann T. , Gaensheimer S. , Buchner A. , Rohloff R. , Schilling A. 
Published: August 2003

OBJECTIVETo prospectively assess, using a questionnaire‐based study, the relative differences and changes in urinary continence and bowel symptoms, and the need for further surgery, within the first year after radical retropubic prostatectomy (RRP) in patients with and with no adjuvant radiotherapy (aRT).PATIENTS AND METHODSThe study included 96 men with clinically organ‐confined adenocarcinoma of the prostate who underwent RRP between March 1998 and June 1999. A subset of 36 patients was recommended aRT of the prostatic fossa (median dose 54 Gy) because of positive surgical margins and/or seminal vesicle involvement. Using a mailed questionnaire all patients were prospectively assessed at 4‐month intervals for the first year after RRP.RESULTSValid data were analysed from 83 patients (overall response rate 86%), of whom 30 (36%) had received aRT. At 4 months a significantly lower proportion used no pads and significantly more used 1 pad/day in the aRT than in the RRP group (both P < 0.05). Eight and 12 months after RRP there was no statistically significant difference between the groups in urinary incontinence. However, 53% of men in the aRT group had stool urgency and 13% reported fecal incontinence at 4 months, compared with 1.9% and none (both P < 0.01) of the RRP group. At 1 year after RRP bowel symptoms and fecal continence improved in the aRT group and there was no significant difference for these symptoms between the groups. Starting aRT early (≤ 12 weeks after RP) or late (> 12 weeks) had no significant effect on urinary continence, bowel symptoms and fecal incontinence. Apart from dilatation of urethral strictures in one patient in each group, no further procedures were reported during the follow‐up.CONCLUSIONA moderate dose of aRT after RRP had a temporary effect on subjective urinary continence at 4 months but not at 8 and 12 months. More patients receiving aRT reported significant bowel symptoms at 4 and 8 months than those with RRP only, but at 1 year most of these symptoms had resolved and there were no significant differences between the groups.
The effect of urethral instrumentation on uroflowmetry
Authors: Issa M.M. , Chun T. , Thwaites D. , Bouet R. , Hall J. , Miller L.E. , Ritenour C.W. 
Published: August 2003

OBJECTIVETo evaluate in a prospective study the effect of urethral instrumentation (flexible cystoscopy) on uroflowmetry, and in particular the peak urinary flow rate (Qmax).PATIENTS AND METHODSThirty‐two consecutive patients (median age 61.8 years, range 24–80) undergoing flexible cystoscopy were included in the analysis. Patients with active urethral stricture disease or urinary infection were excluded. The indications for cystoscopy included haematuria (44%), voiding symptoms (66%), history of bladder cancer (19%), and history of perineal trauma (3%). Patients underwent uroflowmetry immediately before instrumentation. The postvoid residual volume (PVR) was measured by bladder catheterization. After cystoscopy the bladder was completely emptied and then filled with the same volume of sterile normal saline (bladder volume = voided volume + PVR), and the patient underwent a second uroflowmetry.RESULTSPatients with voiding symptoms (21, 66%) had a median (range) American Urological Association symptom score of 17 (4–34), a Bother score of 16 (1–23), and Quality of Life score of 3 (1–6). The mean Qmax was 16.9 (4.5–36.9) and 13.3 (4.5–39.4) mL/s before and after cystoscopy, respectively (P = 0.029). The mean percentage difference in Qmax was + 27 (− 23 to 139)% higher before than after cystoscopy. After cystoscopy, up to 25% (eight) and 21% (seven) patients had a lower Qmax, from > 15 to < 15 mL/s and from > 12 to < 12 mL/s, respectively. There were no significant differences in the bladder volume and PVR (P = 0.914 and 0.984, respectively).CONCLUSIONSUrethral instrumentation by flexible cystoscopy significantly alters Qmax. A ‘false’ mean change in Qmax (favouring improvement) of +27% would result if uroflowmetry data after instrumentation were used at baseline. Therefore, study protocols for benign prostatic obstruction should exclude uroflowmetry data obtained after urethral instrumentation; failure to exclude such data will lead to disproportionately greater improvements in Qmax that are independent of the therapy delivered.