bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pedicled pubic phalloplasty in females with gender dysphoria
Authors: Bettocchi Carlo , Ralph David J. , Pryor John P. 
Published: December 2004

OBJECTIVETo describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria.PATIENTS AND METHODSBetween 1989 and 2000, 85 female‐to‐male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin. The complete neourethral reconstruction was in one stage in 32 patients and in two in 48; five patients did not wish to have the neourethra fashioned.RESULTSThe cosmetic appearance of the phallus was considered good in 68% of the patients. The major complications (in 60 patients) were related to the neourethra (75%) with stricture formation (64%) and/or fistulae (55%) predominating. This complication rate was significantly less (P < 0.001) when the neourethra was created in two stages. Once the neourethra was completed, patients were then offered both penile and testicular prostheses. Sexual intercourse was possible with no prosthesis in 16 patients.CONCLUSIONSThe pubic phalloplasty offers an acceptable neophallus without disfiguring the donor skin site. The main complications stem from creating the neourethra and these may be reduced by a two‐stage procedure.
Cavernosal dysfunction in a rabbit model of hyperhomocysteinaemia
Authors: Jones Robert W.A. , Jeremy Jamie Y. , Koupparis Anthony , Persad Raj , Shukla Nilima 
Published: December 2004

OBJECTIVETo investigate the effect of sustained hyperhomocysteinaemia (HHCy) on cavernosal smooth muscle function in a rabbit model of HHCy, developed using a methionine‐enriched diet in which cavernosal responses were characterized, as elevated plasma levels of homocysteine may be a risk factor for vasculogenic erectile dysfunction.MATERIALS AND METHODSSix New Zealand White rabbits were fed a diet supplemented with methionine (20 g/kg chow) for 4 weeks, while six control animals were fed a standard diet. Cavernosal strips were mounted in an organ bath and relaxation assessed when stimulated with carbachol, sodium nitroprusside (SNP), or noncholinergic, nonadrenergic (NANC)‐mediated relaxation to electrical‐field stimulation (EFS). Cavernosal tissue cGMP levels were assessed using an enzyme‐linked immunosorbent assay, and superoxide (O2·−) production assessed using an assay of the superoxide dismutase (SOD)‐inhibitable reduction of ferricytochrome c.RESULTSThe methionine‐rich diet led to an early but sustained HHCy; cavernosal strips from animals after 4 weeks of HHCy had a significantly impaired relaxation response to carbachol, an index of endothelium‐dependent nitric oxide (NO)‐mediated relaxation. This impairment was reversed by incubating with either SOD or catalase. Relaxation with either SNP, an index of endothelium‐independent NO‐mediated relaxation, or NANC‐mediated EFS‐induced relaxation, was unaffected by HHCy. There was a corresponding significant reduction in cavernosal cGMP levels (index of NO activity) in the HHCy group, with a more than five‐fold increase in cavernosal tissue O2·− production.CONCLUSIONSupplementing the diet of rabbits with methionine for 4 weeks caused an early and sustained HHCy and promoted a marked inhibitory effect on endothelium‐dependent relaxation and NO formation in isolated corpus cavernosum, an effect mediated by reactive oxygen species.
The role of unilateral nephrectomy in the treatment of nephrogenic hypertension in children
Authors: Johal Navroop S. , Kraklau David , Cuckow Peter M. 
Published: December 2004

OBJECTIVESTo define the efficacy of unilateral nephrectomy in a large series of patients presenting with renal disease and hypertension, as the latter may be a prominent finding in children with nephrourological disease (renal parenchymal disease, renovascular disease, obstruction, renal dysplasia and cancer).PATIENTS AND METHODSWe retrospectively reviewed the hospital and outpatient records of 118 children who presented for evaluation with hypertension, and who had a nephrectomy between 1968 and 2003. Patients included in the study were those who had a unilateral nephrectomy for benign renal hypertension with a normal contralateral kidney; in all, 21 had complete records and follow‐up were evaluated. The hypertension was associated with primary renal disease, obstruction and renovascular disease. Blood pressure and medication requirements were compared before and after surgery, the blood pressure values also being compared with published nomograms.RESULTSPatients were diagnosed with hypertension at a median age of 5 years and had a nephrectomy at a median of 11 months after the diagnosis. The median follow‐up after surgery was 39 months. Most patients responded well and became normotensive, or there was a reduction in the need for medication. The median time to normalization was 2, 10 and 11 days in patients with primary renal disease, obstruction and renovascular disease, respectively.CONCLUSIONNephrectomy is successful in normalizing blood pressure in children with benign renal hypertension and with a normal contralateral kidney.
Growth and stretch response of human exstrophy bladder smooth muscle cells: molecular evidence of normal intrinsic function
Authors: Orsola Anna , Estrada Carlos R. , Nguyen Hiep T. , Retik Alan B. , Freeman Michael R. , Peters Craig A. , Adam Rosalyn M. 
Published: December 2004

OBJECTIVETo establish primary cultures of smooth muscle cells (SMC) from human exstrophic bladders (E‐SMC), and determine their in vitro growth dynamics and responses to mechanical stretch.MATERIALS AND METHODSPrimary cultures of E‐SMC from three patients were established from exstrophic bladder tissue using an explant method. Growth dynamics were assessed using tetrazolium‐dye uptake. The DNA synthesis rate in response to cyclic stretch‐relaxation was determined with thymidine‐incorporation assays. Expression of the SMC mitogen heparin‐binding epidermal growth factor‐like growth factor (HB‐EGF) mRNA in response to mechanical stretch was determined using semiquantitative reverse transcription‐polymerase chain reaction.RESULTSThe approximate doubling time of the E‐SMC grown in the presence of serum was 4 days, consistent with growth rates of SMC reported previously. E‐SMC exposed to stretch had greater DNA synthesis, albeit to a lesser extent than previously seen with non‐exstrophic SMC. The expression of HB‐EGF was also increased in cells exposed to mechanical stimuli, consistent with our previous finding of stretch‐regulated HB‐EGF gene expression in bladder SMC.CONCLUSIONSE‐SMC had growth characteristics similar to those previously reported in non‐exstrophic cells. E‐SMC also had stretch‐induced expression of HB‐EGF mRNA. These observations provide evidence that despite development in an abnormal defunctionalized state, E‐SMC retain the potential for normal growth, and may modulate this response through mechanisms similar to those operating in normal bladder SMC.
The prevalence of renal cell carcinoma diagnosed at autopsy
Authors: Mindrup Steven R. , Pierre Jessica S. , Dahmoush Laila , Konety Badrinath R. 
Published: December 2004

OBJECTIVETo compare the rate of renal cell carcinoma (RCC) detected only at autopsy, from two periods, to determine if the apparent recent increase in RCC in the USA is a true increase or mainly a result of improved imaging techniques, as a true increase in the clinical incidence of RCC should not affect the number of previously undiscovered RCC found only at autopsy.PATIENTS AND METHODSWe identified all individuals who underwent autopsy in two periods, 1955–60 (3307) and 1991–2001 (2938), and who were indentified with renal tumour either before or after death. Information was obtained on age, sex, histological type and size of tumour, and whether the tumour was identified before or only after death. All cases of RCC detected at autopsy were reviewed for this analysis by one pathologist (L.D.).RESULTSBetween 1955–60 and 1991–2001 there was a 55% reduction in the mean annual number of autopsies. The proportion of malignant renal masses (RCC) did not change significantly (35.4% to 32.8%). The rate of previously unsuspected RCC detected only at autopsy did not change significantly (0.91 vs 0.72 per 100 autopsies).CONCLUSIONThe number of renal masses, both benign and malignant, discovered only at autopsy is declining, possibly because of better detection before death. However, the rate of occult kidney cancer per 100 autopsies did not change significantly between the two periods, suggesting a true increase in the frequency of clinically detected kidney cancer.
Re‐evaluation of the Tumour‐Node‐Metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a)
Authors: Murphy Alana M. , Gilbert Scott M. , Katz Aaron E. , Goluboff Erik T. , Sawczuk Ihor S. , Olsson Carl A. , Benson Mitchell C. , McKiernan James M. 
Published: December 2004

Authors from Iowa City report on the incidence of RCC; they compared the rate of these tumours at autopsy and felt that the decrease found was a result of better antemortem detection, and an increase with time in the frequency of clinically detected renal cancer.A study from New York attempted to determine whether size, or transcapsular extension irrespective of size, was more likely to produce an adverse outcome. They analysed their database of 717 such tumours between 1988 and 2002, and found that absolute tumour size was the more significant of the two findings.OBJECTIVETo determine which factor was more predictive of adverse outcome in our institutional experience with T2N0M0 and T3N0M0 renal cortical tumours (RCTs) treated surgically, as the current Tumour‐Node‐Metastasis (TNM) staging system for RCTs differentiates between tumours of >7.0 cm but confined to the renal capsule (T2) and tumours that extend through the renal capsule regardless of size (T3a).MATERIALS AND METHODSWe analysed our institutional database of surgical urological oncology for all patients with T2N0M0 and T3aN0M0 RCT treated with partial or radical nephrectomy from 1988 to 2002. All patients with preoperative metastasis, bilateral or multifocal tumours, nonsporadic disease or benign histology were excluded from analysis. A follow‐up of ≥ 6 months from the time of surgery was required for inclusion. Primary outcomes included local and distant recurrence, and death.RESULTSIn all, 717 patients had a partial or radical nephrectomy for RCT during the study period. After exclusion criteria were applied, 21 patients with T2N0M0 and 97 with T3aN0M0 tumours were eligible; the median (mean, range) age was 63 (16.6–88.3) years and follow‐up 30.5 (40.8, 6–162) months. The estimated 5‐year disease‐free survival was 68% and 85% for T2N0M0 and T3aN0M0 RCT, respectively (P = 0.002). The 5‐year disease‐specific survival was 81% and 94% for the T2N0M0 and T3aN0M0 groups, respectively (P = 0.085).CONCLUSIONPatients with T3aN0M0 tumours appear to have better disease‐free and disease‐specific survival than those with T2N0M0 disease, which suggests that tumour invasion through the renal capsule is not as significant as the absolute tumour size.
Radical prostatectomy: pathology findings in 1001 cases compared with other major series and over time
Authors: Bott Simon R.J. , Freeman A. Alex , Stenning Sally , Cohen Jonathan , Parkinson M. Constance ,   THE UROLOGISTS AND PATHOLOGISTS CONTRIBUTING TO THE DATABASE
Published: December 2004

OBJECTIVETo examine the preoperative features and pathological outcomes of clinical significance of 1001 consecutive essentially unscreened men who had a radical prostatectomy (RP) in the UK between 1988 and 2002, and their changes over time.PATIENTS AND METHODSThe details of men whose RP specimen was submitted for analysis were entered into the RP database held at the University College Hospital, London; the National Health Service and private patients of 17 surgeons were included. The age, mode of diagnosis, preoperative prostate specific antigen (PSA) level, biopsy and RP findings were compared over time.RESULTSThe mean (range) age of the men was 62 (40–76) years, the median PSA 8  (0.1–146) ng/mL and the median biopsy Gleason sum score 6; these preoperative features did not change over the study period. The diagnosis of prostate cancer was made by transurethral resection of the prostate alone in 48 men (5%). The maximum number of patients receiving neoadjuvant androgen ablation was 21 (33%) in 1996, and subsequently declined. The median (range) RP Gleason sum score was 7 (4–9). The biopsy Gleason score correlated with the prostatectomy Gleason score in 252 (47%) of 536 men, being lower in 170 (32%) and higher in 113 (21%). The median tumour volume was 2 mL (focus of invasive acini – 31 mL) and the incidence of positive intra‐ and extraprostatic margins was 52%. Both tumour volume and extraprostatic margin positivity declined with time.CONCLUSIONSThe preoperative features and pathological findings from this UK series are similar to those of other reported cohorts from unscreened populations. The incidence of positive extraprostatic surgical margins, tumour volume and stage decreased with time.
Initial incision of lateral pelvic fascia and early ligation of vascular pedicles during radical prostatectomy: potential to reduce positive margin rates
Authors: Richman Marc , McLaughlin Sean , Maygarden Susan , Pruthi Raj S. 
Published: December 2004

OBJECTIVETo report on our experience with a recently published technique to reduce positive margin (PM) rates (involving early incision of the lateral pelvic fascia, early release of the prostate and Denonvilliers’ fascia off the rectum), with the additional modification of early ligation of the lateral vascular pedicles during radical retropubic prostatectomy (RP), as reducing PM rates continues to be an important oncological goal in RP.PATIENTS AND METHODSOne hundred consecutive men (mean age 61 years, pretreatment prostate‐specific antigen level 8.9 ng/mL, and estimated blood loss 502 mL) underwent RP by one surgeon. The initial dissection involves early incision of the lateral pelvic fascia and developing the plane between the prostate and underlying rectum, before any apical dissection. This incision can be made medial to the neurovascular bundles in a nerve‐sparing procedure. After this plane is developed, the lateral vascular pedicles to the prostate are also divided. Once these same manoeuvres are used contralaterally, the prostate is lifted off of the rectum and held in place only by the apex and bladder neck. The apical/urethral dissection is then carried out conventionally, followed by dissection/transection of the seminal vesicles and the bladder neck.RESULTSThe pathological stage included T2a (11%), T2b (69%), T3a (17%), T3b (3%), and N+ (2%); 20 patients had capsular penetration, at the posterolateral (in 15) and anterior aspect (in five) of the gland. The PM rate for the 100 consecutive patients was 13%, with PMs at the apex in 10, the base in two and posterolateral gland in one. No patient had a PM at the site of capsular penetration. When patients were stratified by low‐moderate risk (pT2 and Gleason sum ≤ 7) vs high risk (pT3 or Gleason sum > 7), the PM rates were 7.9% and 29.2%, respectively.CONCLUSIONSInitial dissection of the lateral pelvic fascia, including developing a ‘perirectal pocket’, and early ligation of the lateral pedicles, resulted in a low PM rate during RP. This experience supports the previous observations that early development of the pre‐rectal fat plane may allow for more precise dissection below all layers of Denonvilliers’ fascia and with a wider margin of periprostatic tissue.
Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory
Authors: Steginga Suzanne K. , Pinnock Carole , Gardner Max , (Frank) Gardiner R.A. , Dunn Jeff 
Published: December 2004

OBJECTIVETo develop and test a measure for assessing peer support for men attending prostate cancer support groups, and to describe socio‐demographic, medical and adjustment characteristics of Australian men who attend these support groups.PATIENTS AND METHODSIn all, 1224 men (51% response) from 44 prostate‐cancer support groups across Australia were recruited by mail. Men completed self‐report measures that included the Prostate Cancer Peer Support Inventory (PCSI), the UCLA Prostate Cancer Index bother scales, psychological distress, quality of life (QoL), bother from pain and tiredness, perception of the clinician's support for group participation. Group‐level variables were also included in the analyses.RESULTSPeer support was rated positively by most men; a high satisfaction with support groups was related to better QoL, lower pain, younger age, higher perceived clinician support for group participation, use of alternative therapies, lower education, and regular attendance; dissatisfaction with support groups was related to higher psychological distress, lower QoL, and lower perceived clinician support for group participation. Group variables did not predict positive or negative support. Overall QoL was similar to community norms and psychological distress was low, with only 8% of men reporting high distress. The most common physical symptom was sexual bother, with 74% of men reporting moderate or high bother.CONCLUSIONSThe PCSI was a useful measure of peer support. Perception of the benefits of peer support was related to individual but not group differences. The clinicians’ attitudes to participation in support groups influenced the men's experience of these groups, and this finding has implications for developing support services for these men.
The economic consequences of prostate and bladder cancer in the UK
Authors: Sangar Vijay K. , Ragavan Narasimhan , Matanhelia Shyam S. , Watson Mike W. , Blades Rosie A. 
Published: December 2004

OBJECTIVETo compare the costs of managing prostate and bladder cancer and relate them to current expenditure on research, as the increasing prevalence of both necessitates the adequate direction of resources.METHODSAll new prostate and bladder cancers diagnosed in 2001–2002 were identified from British Association of Urological Surgeons Section of Oncology database (national and local). The total cost of diagnosing, treating and following patients for 5 years was estimated as the sum of direct costs (National Health Service) and indirect costs (loss of earnings). Annual research fund allocation (RFA) for each cancer were obtained from the National Cancer Research Institute UK.RESULTSThere were 15 099 and 7703 patients with newly diagnosed prostate (mean age 72.3 years) and bladder cancers (mean age 71.3 years). The total cost for prostate cancer was estimated at £92.74 million, with hormonal therapy alone costing £63.1 million. The total cost for bladder cancer was £55.39 million, of which superficial disease cost £35.25 million. The mean cost per patient was more for bladder than for prostate cancer (£8349 vs. £7294). The RFA allocation during this period was £20.56 million and £4.62 million for prostate and bladder cancer, respectively, and the respective RFA allotment per pound spent on the mean cost of disease management per patient was £2818 and £553.CONCLUSIONIndividual patient management is more costly for bladder cancer but less is invested in research than for prostate cancer. This study suggests a need to re‐evaluate future strategies.
Parenchymal imaging adds diagnostic utility in evaluating haematuria
Authors: Belani Jay S. , Farooki Aamer , Prasad Srinivasa , Yan Yan , Heiken Jay P. , Kibel Adam S. 
Published: December 2004

OBJECTIVETo compare the findings of renal ultrasonography (US) in the evaluation of patients with and with no haematuria. The increased use of cross‐sectional imaging and US has led to a dramatic improvement in the diagnosis of renal masses, such that computed tomography and/or US have been integrated into the diagnostic evaluation of haematuria, and many more incidental renal lesions are now detected. Thus it is possible that the lesions identified during evaluation for haematuria are incidental, i.e. identified serendipitously, and unrelated to the haematuria.PATIENTS AND METHODSWe retrospectively compared the US findings obtained from 301 patients referred for new‐onset haematuria to those obtained from 600 patients being evaluated for other than urological reasons. All imaging and patient charts were reviewed to verify the clinical and radiological data.RESULTSHaematuria was associated with all renal abnormalities, with an odds ratio (OR, 95% confidence interval) of 4.7 (3.6–7.3). Importantly, haematuria was associated with a renal mass, with an OR of 6.7 (2.8–16.3). Subset analysis revealed that patients with macroscopic and microscopic haematuria had significantly more renal abnormalities (OR 4.7, 2.7–8.2, and 5.3, 3.2–8.8, respectively) and renal masses (OR 7.3, 2.7–20.3, and 6.5, 2.3–18.6, respectively) than controls.CONCLUSIONSBoth macroscopic and microscopic haematuria are associated with a greater risk of identifying renal lesions. This supports the conclusion that the renal lesions identified with modern imaging techniques during the evaluation of both microscopic and macroscopic haematuria are not serendipitous.
Regional differences in responses of rabbit detrusor to electrical and adrenergic stimulation: influence of outlet obstruction
Authors: Capello Seth A. , Chieh‐Lung Chou Eric , Longhurst Penelope A. 
Published: December 2004

OBJECTIVETo examine regional responses of control and obstructed rabbit detrusor strips to electrical and adrenergic stimulation, and determine whether outlet obstruction causes regional variations in blood flow throughout the detrusor, as the detrusor smooth muscle of the bladder body has previously been considered homogeneous in its pharmacological properties.MATERIALS AND METHODSFourteen male rabbits had the bladder outlet surgically obstructed for 2 weeks and were compared with 10 unoperated control rabbits. Blood flow was measured with the bladder empty and at capacity, using fluorescent microspheres. Paired dorsal and ventral strips were harvested from the midline equatorial detrusor and electrically and adrenergically stimulated.RESULTSObstructed rabbits had significantly higher bladder capacities and bladder weights than control rabbits. Dorsal strips from both control and obstructed rabbits contracted in response to noradrenaline, whereas ventral strips relaxed. The addition of prazosin, a nonselective α1‐adrenergic‐receptor blocker, completely blocked the contraction in dorsal strips, but had no effect on responses of ventral strips. There was also a regional difference in response to electrical stimulation, with ventral strips generating significantly more tension than dorsal strips in both control and obstructed rabbits. There were no regional differences in detrusor blood flow. Obstruction resulted in significantly lower responses to all forms of stimulation, and significantly less blood flow throughout the detrusor.CONCLUSIONThere are regional differences in adrenergic receptor function and response to electrical‐field stimulation throughout control and obstructed rabbit detrusor, a region that was previously thought to be functionally homogeneous. These differences must be recognized and acknowledged to obtain accurate and reproducible data from in vitro studies of the bladder.