bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urethral injury in girls with fractured pelvis following blunt abdominal trauma
Authors: Ahmed S. , Neel K.F. 
Published: November 2003

Objective To review the management of major urethral injury in three girls with fractured pelvis following blunt abdominal trauma. Patients and methods Three girls aged 5 years, 1 year and 3 years sustained major urethral injury in association with fractured pelvis following blunt abdominal trauma. Initial management was undertaken elsewhere. Two girls, with complete loss of the urethra and a closed bladder base, were managed by construction of a neourethra using a flipped anterior bladder‐wall tube. The third patient with extensive perineal soft‐tissue loss and rupture of the bladder neck and urethra had a modified Young‐Dees‐Leadbetter bladder neck reconstruction. All three had an associated vaginal injury which did not require a specific surgical procedure. Results The two girls who underwent construction of a neourethra using a flipped anterior bladder‐wall tube are continent. The first voids normally and the second is managed by clean intermittent catheterization. The patient who underwent bladder neck reconstruction is incontinent and further surgery, possibly a continent diversion, may be necessary. Conclusion Pelvic fracture following blunt abdominal trauma in girls may be associated with major urethral injury, usually with an associated vaginal injury. Surgical ingenuity is required to repair such injuries successfully. In those with complete loss of the urethra, a flipped anterior bladder‐wall tube neourethra is suitable.
The value of multiple free‐flow studies in men with lower urinary tract symptoms
Authors: Reynard J.M. , Peters T.J. , Lim C. , Abrams P. 
Published: November 2003

Objective To assess the variability of free‐flow studies in men presenting with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to determine the sensitivity, specificity and predictive values of consecutive measurements of maximum flow rate for the presence of bladder outlet obstruction (BOO) at several threshold values. Patients and methods The value of multiple free‐flow studies was assessed in 165 men presenting with LUTS suggestive of BPO. Each patient was requested to void four times into a uroflowmeter and the voided volume and post‐void residual urine volume (PVR) were also measured. The variability of the maximum flow rate (Qmax ), voided volume and PVR between consecutive voids was assessed. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various thresholds of Qmax for the presence of BOO were calculated for each consecutive void. Results The mean Qmax on void 1 was 10.2 mL/s and the mean maximum value for Qmax between voids 1 and 2 was 12.5 mL/s. For voids 1, 2 and 3, the mean maximum Qmax was 13.9 mL/s and for voids 1 to 4 it was 15.2 mL/s. There were no significant changes in PVR among any of these voids. There was a statistically significant, although small, decrease in voided volume between voids 1 to 3 and voids 1 to 4. The specificity and PPV of Qmax for BOO increased with each subsequent void, such that using a threshold value for Qmax of 10 mL/s on the fourth void, the specificity and PPV for BOO were 96% and 93%, respectively. Conclusions There was a significant increase in Qmax with each successive void when men with LUTS suggestive of BPO performed multiple free‐flow measurements and consequently, single free‐flow measurements substantially underestimated the maximum Qmax that these patients achieved. The specificity and PPV of Qmax for BOO can be improved considerably by performing multiple free‐flow studies and by carefully selecting an appropriate threshold value (although whether pressure‐flow studies are unnecessary will depend on what level of specificity and PPV is deemed acceptable in clinical practice). These findings should be considered if free‐flow studies are to be used as the basis for deciding the clinical management of men with LUTS and may be particularly useful for urologists with limited facilities for pressure‐flow studies.
The holmium:YAG laser for ureteric stones
Authors: Shroff S. , Watson G.M. , Parikh A. , Thomas R. , Soonawalla P.F. , Pope A. 
Published: November 2003

Objective To assess the efficacy of the pulsed holmium:YAG laser for the fragmentation of ureteric stones. Patients and methods One hundred patients (72 males and 28 females, age range 14 months–85 years) underwent 114 ureteroscopic procedures using either a 7.2 F semi‐rigid or 9.5 F flexible ureteroscope. A holmium:YAG laser (Sunrise Technologies, Fremont, Ca, USA) was used for laser lithotripsy at a maximum energy of 1.0 J/pulse at 5 Hz. Most of the stones (46%) were located in the upper third of the ureter. The mean size of the stones was 9×8 mm and the mean duration of the procedure was 73 min (including anaesthesia) with a mean hospital stay of 2.7 days. Results All the stones were accessed successfully using miniaturized endoscopes either retrogradely or antegradely. The holmium laser effectively fragmented all types of stones. Total clearance of all stones fragments was achieved in 87% of cases, with the best results obtained for stones in the lower third of the ureter (96%). The complications attributed directly to the laser included three strictures and three perforations of the ureteric wall. Conclusion The holmium:YAG laser was effective in fragmenting ureteric stones irrespective of their hardness. However, it has the potential to damage the ureteric wall and must be used with caution.
Open versus closed epididymal sperm retrieval in men with secondarily obstructed vasal systems—a preliminary report
Authors: Collins G.N. , Critchlow J.D. , Lau M.W.M. , Payne S.R. 
Published: November 2003

Objective To evaluate and compare sperm quality and suitability for intracytoplasmic sperm injection (ICSI) from open and percutaneous epididymal aspiration in men with obstructive azoospermia, and to determine the relevance of epididymal morphology. Patients and methods A series of 20 men undergoing vasectomy reversal were evaluated by percutaneous (PESA) and open epididymal sperm aspiration (MESA) before undergoing surgery for reversal. Two samples were taken with PESA, one with the needle in situ (PESA1) and the second while withdrawing the needle (PESA2). Epididymal morphology was graded as normal, distended and grossly distended. Five men undergoing vasectomy served as a control, non‐obstructed group for percutaneous aspiration. Analysis of the aspirates was performed immediately after operation with no knowledge of the treatment, and aspiration was considered successful if sperm suitable for ICSI were retrieved. Results In the obstructed group, 15 of 20 men had successful PESA and 13 of these also had successful MESA. PESA was successful bilaterally eight times compared with MESA on five occasions; two men with successful PESA had no success with MESA. PESA2 was five times more successful than PESA1. Only one PESA in the non‐obstructed group was suitable for ICSI. PESA was successful in 21 of 25 distended or grossly distended epididymi compared with only three of 21 non‐distended systems. Conclusion PESA is a viable alternative to MESA in patients with obstructive azoospermia, particularly when associated with clinically distended epididymi.
Quality of life in patients undergoing bacille Calmette‐Guérin therapy for superficial bladder cancer
Authors: Mack D. , Frick J. 
Published: November 2003

Objective To determine the impact of post‐operative education about bladder cancer and topical immunotherapy on the physical, psychological and social well‐being of patients with superficial bladder cancer. Patients and methods Eighty‐five patients (mean age 59 years, range 26–85, 64 men and 21 women) receiving topical immunotherapy were questioned during the initial cycle of treatment and during maintenance therapy with bacille Calmette‐Guérin (BCG). Patients completed a questionnaire on their quality of life when they commenced treatment and twice more during maintenance therapy. Results Psychological distress and physical symptoms were intense when the diagnosis of bladder cancer was revealed to the patients, despite the knowledge that this cancer is usually curable. The overall quality of life, condition of health and sexual activity were mostly only moderate, were poor during initial therapy and better during 3‐monthly maintenance therapy. Conclusion In general, the quality of life of these patients is characterized by the disruption of their lifestyle and marked by change in their circumstances. It is the responsibility of the urologist to take the necessary time to educate, comfort and motivate such patients with superficial bladder cancer.
The role of an advanced thermotherapy device in prostatic voiding dysfunction
Authors: Javlé P. , Blair M. , Palmer M. , Jenkins S.A. , Parsons K.F. 
Published: November 2003

Objectives To investigate the efficacy of an advanced transurethral thermotherapy (TUMT) device (T3, Urologix) using urodynamic analysis in addition to the standard evaluation protocol in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Fifty men with symptomatic BPH were assessed using the AUA symptom score, uroflowmetry and ultrasonography (to determine prostatic volume and residual urinary volume) before and 6 weeks, 3, 6 and 12 months after thermotherapy. TUMT was delivered using a focused microwave energy system for 1 h in each patient, treated on an out‐patient basis. Video pressure flow studies with advanced urodynamic analysis were also performed before and 3 months after treatment. Results The mean AUA symptom score decreased by 63%, the mean peak flow rate increased by 64% and the post‐void residual volume decreased by 30% 3 months after treatment; this improvement was maintained at one year after treatment. Advanced urodynamic analysis showed that 52% of the patients had a decreased severity of obstruction. Furthermore, the efficiency of detrusor contraction improved in 86% of the patients. The improvement in the symptom score, flow rate and residual urine was significantly better in patients with marginal obstruction than in patients with unequivocal obstruction. Conclusion Urodynamic analysis can predict the treatment outcome of TUMT and the results of thermotherapy are significantly better in patients with marginal prostatic bladder outflow obstruction.
The effect of heparan sulphate on the crystallization of calcium oxalate in undiluted, ultrafiltered human urine
Authors: Suzuki K. , Ryall R.L. 
Published: November 2003

Objective To determine the effect of physiological concentrations of heparan sulphate (HS) on the crystallization of CaOx in undiluted, ultrafiltered human urine. Subjects and methods Urine was collected from normal male volunteers and ultrafiltered at a nominal molecular weight threshold of 10 kDa. Calcium oxalate (CaOx) crystallization was induced by the addition of a standard load of oxalate above an experimentally determined metastable limit and the effect of added HS tested at concentrations of 0, 1, 2 and 10 μg/mL using a Coulter Counter particle analyser and scanning electron microscopy. Results The metastable limit of the urine for CaOx was unaffected by HS at any concentration, as was the total volume of crystalline material deposited. However, HS strongly inhibited the formation of crystal aggregates with a response dependent on the dose and completely prevented the formation of crystal aggregates at a final concentration of 10 μg/mL. These findings were confirmed by scanning electron microscopy. Conclusion HS is a potent inhibitor of CaOx crystallization in human urine and may protect against CaOx stone formation by reducing the degree of aggregation and thereby, the size of particles precipitated in the urinary tract.
Bladder replacement by ileocystoplasty after cystectomy for cancer: comparison of two techniques
Authors: Hendry W.F. 
Published: November 2003

Objective To compare two methods of connecting the ureters to an ileocystoplasty. Patients and methods Eighteen men with bladder cancer underwent radical cystoprostatectomy and a further two had a subtotal cystectomy, all with immediate orthotopic bladder replacement by ileocystoplasty. In 10 patients, the ureters were connected to the neobladder by a length of ileum with an inverted nipple valve, while in the other 10 the ureters were implanted directly using a serosal tunnel. Post‐operatively, the upper tracts were examined by intravenous urography and the neobladder by cystography before removel of the catheter. Results The direct implantation technique used 15 cm less ileum and took a mean of 1 h less operating time to complete. The kidneys and ureters remained normal in all patients except one, who had a subtotal cystectomy and developed severe hydronephrosis and hydroureter with acute renal failure when the inverted nipple valve became everted. Conclusions Whilst both techniques gave satisfactory results, direct implantation is more economical in the length of ileum used and in operating time.
Neuromodulation of detrusor hyper‐reflexia by functional magnetic stimulation of the sacral roots
Authors: Sheriff M.K.M. , Shah P.J.R. , Fowler C. , Mundy A.R. , Craggs M.D. 
Published: November 2003

Objective To investigate the acute effects of functional magnetic stimulation (FMS) on detrusor hyper‐reflexia using a multi‐pulse magnetic stimulator. Patients and methods Seven male patients with established and intractable detrusor hyper‐reflexia following spinal cord injury were studied. No patient was on medication and none had had previous surgery for detrusor hyper‐reflexia. After optimization of magnetic stimulation of S2–S4 sacral anterior roots by recording toe flexor electromyograms, unstable detrusor activity was provoked during cystometry by rapid infusion of fluid into the bladder. The provocation test produced consistent and predictable detrusor hyper‐reflexia. On some provocations, supramaximal FMS at 20 pulses/s for 5 s was applied at detrusor pressures which were >15 cmH20. Results Following FMS there was an obvious acute suppression of detrusor hyper‐reflexia. There was a profound reduction in detrusor contraction, as assessed by the area under the curves of detrusor pressure with time. Conclusions Functional magnetic stimulation applied over the sacrum can profoundly suppress detrusor hyper‐reflexia in man. It may provide a non‐invasive method of assessing patients for implantable electrical neuromodulation devices and as a therapeutic option in its own right.
Indapamide (Natrilix): the agent of choice in the treatment of recurrent renal calculi associated with idiopathic hypercalciuria
Authors: Martins M.C. , Meyers A.M. , Whalley N.A. , Margolius L.P. , Buys M.E. 
Published: November 2003

Objective To compare the hypocalciuric and potential side‐effects of hydrochlorothiazide (HCT) to indapamide (IND; a thiazide‐like drug) in patients with idiopathic hypercalciuria.Patients, subjects and methodsTwelve patients with recurrent renal calculi and renal hypercalciuria were studied using a randomized double‐blind cross‐over protocol. In addition, because the side‐effects of HCT are attenuated using small doses, the hypocalciuric effect of 12.5, 25 and 50 mg daily was assessed in six normal subjects.Results There was a significant reduction in urinary calcium excretion using both agents, with a mean (sd) of 6.06 (2.68) and 3.37 (2.00) mmol/24 h using IND, and 5.58 (1.98) and 3.93 (2.35) mmol/24 h using HCT, before and after treatment (P<0.05). The treatment was not sufficiently prolonged to assess adequately all the side‐effects of either agent but both produced a similar decrease in serum potassium, whilst HCT significantly increased the mean (sd) serum urate levels, from 0.34 (0.09) to 0.43 (0.08) mmol/L (P<0.01). There was also a significant decrease in mean (sd) urinary citrate excretion in those receiving HCT, from 1.41 (1.05) to 1.00 (0.71) mmol/24 h (P<0.001), but not in those receiving IND, from 1.19 (0.71) to 1.18 (0.79) mmol/24 h. Although there was a hypocalciuric effect with doses of 12.5 and 25 mg HCT, it was sub‐therapeutic when compared with the dose of 50 mg.Conclusion At a daily dose of 2.5 mg, IND is at least as effective as 50 mg HCT in controlling hypercalciuria. Because of its safety profile and lack of effects on urinary citrate excretion, this agent should be the preferred therapy for patients with idiopathic hypercalciuria and recurrent renal calculi.
Continence after bladder‐neck reconstruction in patients with bladder exstrophy and pubic diastasis
Authors: Ahmed S. , Fouda‐Neel K. , Borghol M. 
Published: November 2003

Objective To review the results of bladder‐neck reconstruction in patients with repaired bladder exstrophy and pubic diastasis. Patients and methods Nine girls (mean age 7 years, range 4–17) and four boys (mean age 9 years, range 5–15) underwent a modified Young‐Dees‐Leadbetter bladder‐neck reconstruction with augmentation cystoplasty (YDL‐C). The patients were reviewed retrospectively (follow‐up, 1–6 years) to assess continence, particularly in relation to the degree of pubic diastasis measured on an appropriate abdominal radiograph. Results Ten patients were continent; seven girls and one boy are managed by clean intermittent catheterization (CIC) and one girl and one boy void normally. One girl who would not allow CIC and one boy in whom CIC was not possible are incontinent and are scheduled for construction of a continent diversion. One incontinent boy who also would not allow CIC was lost to follow‐up. Pubic diastasis had no bearing on the surgical results, the 10 continent patients having diastasis ranging from 4 to 9 cm (mean 5.5 cm) and the incontinent patients a diastasis of 3, 4 and 6.5 cm (mean 4.5 cm). Conclusion Young‐Dees‐Leadbetter bladder‐neck reconstruction with augmentation cystoplasty is a satisfactory operation in patients with bladder exstrophy. We believe that the rate of continence reflected a competent tubularization with an adequate bladder capacity and assured bladder emptying. A closed pelvis with approximated pubic bones is not necessary to achieve this objective.
Genomic heterogeneity in bladder cancer as detected by fluorescence in situ hybridization
Authors: Yokogi H. , Wada Y. , Moriyama‐Gonda N. , Igawa M. , Ishibe T. 
Published: November 2003

Objective To investigate the relationship between genomic heterogeneity and tumour grade, stage and DNA content in 30 transitional cell carcinomas (TCCs) of the urinary bladder. Materials and methods Tissue specimens from 30 patients (25 men and five women) with newly diagnosed TCC of the urinary bladder were examined for genomic heterogeneity using fluorescence in situ hybridization (FISH) with chromosome‐specific DNA probes; the copy number of pericentromeric sequences on chromosomes 7, 9 and 17 was detected within interphase nuclei in contact preparations from the tumour specimens. Results The aneusomy of chromosomes 7, 9 and 17 was significantly higher in aneuploid than in diploid tumours (P<0.001). Tumour grade and stage were strongly associated with aneusomy for chromosome 17 (P<0.01, P<0.001, respectively). The aneusomy of chromosomes 7 and 9 were significantly correlated with increasing tumour stage (P < 0.001), but not with tumour grade. Conclusion These results suggest that the measurement of aneusomy using FISH, especially for chromosome 17, in bladder cancer may offer a new objective and quantitative assay of the biological potential of individual tumours.
Significant telomere reduction in human superficial transitional cell carcinoma
Authors: Kamata S. , Kageyama Y. , Yonese J. , Oshima H. 
Published: November 2003

Objective To investigate telomere reduction and telomerase activity in human transitional cell carcinomas (TCCs) of the bladder, using primary tissue preparations, and their relationship to the clinicopathological properties of the TCC. Materials and methods Tumour tissues were obtained from 21 patients together with apparently normal urothelia as controls. The mean telomere length of each sample was determined using southern blot analysis with an oligonucleotide probe (TTAGGG)4 and telomerase activity was semi‐quantified using a polymerase chain reaction based assay. Results The mean (se) telomere length was 6.6 (0.7) kb in tumour tissues and 11.5 (0.4) kb in apparently normal urothelia adjacent to the tumour (P<0.001). Furthermore, it was 8.9 (1.4) kb and 3.4 (0.9) kb in superficial and invasive tumours (P=0.002), respectively. Telomerase activity was detected in all 13 of the tumour tissues examined, with no relationship to telomere reduction, while it was undetectable in any of the control tissues. Conclusions In human TCCs, telomere length was reduced in tumour tissue, more so in superficial than in invasive tumours. Telomerase was detectable only in tumour tissues and its activity was unrelated to telomere reduction.
Microscopic haematuria: urological investigation using a standard protocol
Authors: Sultana S. R. , Goodman C.M. , Byrne D.J. , Baxby K. 
Published: November 2003

Objective To determine which patients with asymptomatic microscopic haematuria (AMH) should be investigated to exclude significant urological pathology. Patients and methods The study comprised a prospective audit of a standard protocol for investigating all patients referred with haematuria over one year in a haematuria clinic in the urology department serving Tayside, Scotland. Investigations included urine culture and cytology, flexible cystoscopy, and upper tract imaging which consisted of both excretory urography and renal ultrasonography in many of the patients. Results A total of 381 patients with microscopic haematuria was investigated. No malignancy was found in any <50 years of age (n=131); in patients aged >50 years the overall incidence of malignancy was 7.5% (19/250). The asymptomatic patients in this group had a lower incidence (5%, 6/126) of malignancy than the symptomatic patients (10.5%, 13/124) but this difference did not reach statistical significance. There was no statistically significant difference in the incidence of urological malignancy between men and in women with microscopic haematuria. During the same period, 233 patients were referred with frank haematuria; in these patients, those aged <50 years had a 10% incidence of malignancy (6/60), while in those aged >50 years the incidence was 34.5% (60/173). A total of 18 patients (4.7%) with microscopic haematuria had upper tract calculi, comprising 5.3% (7/131) of patients aged <50 years and 4.4% (11/250) of those >50 years with microscopic haematuria. Conclusions The investigation of older patients with microscopic haematuria (and all those with frank haematuria) is well justified, as malignancy will be found in a significant proportion even if they are asymptomatic. The benefit of a full urological investigation of younger patients with microscopic haematuria is debatable.