bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neoplasia in adult exstrophy patients
Authors: Smeulders N. , Woodhouse C.R.J. 
Published: March 2003

Objective To document the incidence of neoplasia in a cohort of 103 patients born with classical exstrophy. Patients and methods The notes of patients born before 1964 with exstrophy were reviewed retrospectively. The patients were divided into two groups; 42 were thought to be at high risk of developing neoplasia because they had (at some time) had mixing of urine and faeces in a colorectal reservoir, whereas 61 had never been exposed to such a mixture and were thought to have a low risk of neoplasia. Results At a minimum of 35 years of follow‐up, complete data were available for 61 patients; 42 were lost to follow‐up, of whom 14 were at high risk and 28 at low risk of neoplasia. In the high‐risk group, there were three with colonic carcinoma (two of whom presented before 1980 and died), one with carcinoma in situ of the colon, 10 with benign colonic neoplasms and three with bladder cancer (two of whom died). In the low‐risk group, there was one patient with bladder cancer (who died) and one with a clear cell carcinoma of the kidney. Three of the four patients with bladder cancer had undergone cystectomy before 5 years of age. Assuming that all the lost patients are alive and free of neoplasia, the risk of neoplasia in adults born with exstrophy is 17.5%. The main risk is in those who have been exposed to mixing of urine and faeces in a colorectal reservoir (38%). Even in low‐risk patients the risk of malignant neoplasia is 3.3% at a median (range) age of 42 (40–44) years, which is 27 times higher than that of the age‐matched general population. Conclusions Annual colonoscopy of patients deemed at high risk of colorectal neoplasia appears to be an effective screen for colorectal carcinoma, by identifying a premalignant stage, as there were no deaths after this was introduced. Despite bladder closure or diversion surgery within the first few years of life, patients with exstrophy have an almost 700‐fold greater incidence of carcinoma of the bladder than the age‐matched general population. Early cystectomy is not protective.
The percentage of free prostate‐specific antigen does not predict extracapsular disease in patients with clinically localized prostate cancer before radical prostatectomy
Authors: Melchior S.W. , Noteboom J. , Gillitzer R. , Lange P.H. , Blumenstein B.A. , Vessella R.L. 
Published: March 2003

Objective To determine whether the percentage of free/total prostate‐specific antigen (f/tPSA) can predict the pathological features in patients with clinically localized prostate cancer before radical prostatectomy. Patients and methods Univariate and multivariate logistic regression was used to analyse data from 171 untreated patients who underwent radical prostatectomy. Variables included the total PSA (tPSA), fPSA, f/tPSA, biopsy Gleason score, clinical stage and patient age. Results In 115 patients with pathologically organ‐confined tumours ( pT2N0) the mean (sd) tPSA value was 6.9 (5.6) ng/mL; in 56 patients with extracapsular disease ( pT3pN0/N+) it was 10.2 (7.6) ng/mL; the respective f/tPSA values were 14.9 (8.1)% and 14.2 (12.9)%. In the univariate and multivariate analysis, tPSA and biopsy Gleason score were highly significant in predicting extracapsular disease (P < 0.001 and 0.002) but the f/tPSA was not (P = 0.18). There was no significant difference between the mean f/tPSA and final Gleason scores. Conclusion The f/tPSA does not predict extracapsular disease in patients with clinically localized prostate cancer before radical prostatectomy. Knowing the f/tPSA provides no significant additional information in predicting extracapsular disease when the biopsy Gleason score and tPSA are known.
Upper pole heminephrectomy: is complete ureterectomy necessary?
Authors: Ade‐Ajayi N. , Wilcox D.T. , Duffy P.G. , Ransley P.G. 
Published: March 2003

Objective To determine the re‐operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy. Patients and methods The case notes from one institution were reviewed retrospectively; 60 upper pole heminephrectomies with incomplete ureterectomy were undertaken in 39 girls and 16 boys (mean age at primary surgery 27 months, range 3–88). Results Thirty‐two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty‐nine of the 60 renal units (48%) had an associated ureterocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underwent initial puncture of a ureterocele. Five patients (8%), all females, required lower urinary tract re‐operation. The indications for secondary surgery were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child. Conclusions The re‐operation rate for a redundant ureteric stump in this series was 8%. The risk of injury to the good ureter may outweigh the benefits of a complete ureterectomy.
Comparative evaluation of treatments for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy
Authors: Baniel J. , Israilov S. , Segenreich E. , Livne P.M. 
Published: March 2003

Objective To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer. Patients and Methods The study included 85 patients (mean age 59.5 years, range 50–75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildenafil; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year. Results Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection sufficient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildenafil and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow‐up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildenafil, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device. Conclusion Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow‐up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.
Prevalence of undiagnosed diabetes mellitus in male erectile dysfunction
Authors: Sairam K. , Kulinskaya E. , Boustead G.B. , Hanbury D.C. , Mcnicholas T.A. 
Published: March 2003

Objective To determine the prevalence of previously undiagnosed diabetes mellitus (DM) in men presenting with erectile dysfunction (ED), using fasting blood glucose (FBG) compared with urinary dipstick testing for glycosuria. Patients and methods A prospective prevalence study was carried out in an andrology outpatient clinic of a urology department in a district general hospital serving a mixed urban and rural population. In all, 129 consecutive men presenting with ED underwent FBG and urinary dipstick testing to detect undiagnosed DM in those presenting with ED. Results The prevalence of known DM was 17% and the that of undiagnosed DM 4.7% of the 107 remaining men; an abnormal fasting glucose level was found in a further 12%. The sensitivity of urine dipstick test for diagnosing DM was 20%. Conclusions The prevalence of undiagnosed DM is higher in men with ED than in the general population. ED is a marker symptom for DM and DM should be actively sought in men presenting with ED. Urinary dipstick testing for glycosuria, if used as a screening test, will miss the diagnosis in 80% of these men. FBG testing should be undertaken to reliably diagnose DM in men presenting with ED.
Pretreatment levels of urinary deoxypyridinoline as a potential marker in patients with prostate cancer with or without bone metastasis
Authors: Wymenga L.F.A. , Groenier K. , Schuurman J. , Boomsma J.H.B. , Oude Elferink R. , Mensink H.J.A. 
Published: March 2003

Objective To assess the predictive role of the bone markers alkaline phosphatase (ALP) and urinary deoxypyridinoline (DPD), as indicators of bone turnover, at baseline in patients with prostate cancer. Patients, subjects and methods Urinary DPD, serum ALP and prostate‐specific antigen (PSA) were evaluated in 23 patients with benign prostatic hyperplasia (BPH), 115 with prostatic carcinoma, of whom 21 had bone metastasis, and in 16 age‐matched control subjects. Results Patients with newly diagnosed prostate cancer and bone metastasis had a higher urinary excretion of DPD, and a higher serum PSA and ALP than had patients with BPH and those with prostate cancer but no metastasis. Receiver operating curve analysis for PSA, ALP and DPD showed a significant discriminating ability for positive and negative bone scans (P = 0.0684). However, from logistic regression of the combinations, only serum ALP was a significant independent predictor of bone metastasis in patients with prostate cancer. Conclusion Serum ALP or urinary DPD are the best predictors of bone metastasis in patients with prostate cancer; further studies with more patients are required.
A 10‐year experience of managing ureteric calculi: changing trends towards endourological intervention—is there a role for open surgery?
Authors: Ather M.H. , Paryani J. , Memon A. , Sulaiman M.N. 
Published: March 2003

Objectives To study changing practices in the management of ureterolithiasis with the introduction of newer technologies, the efficacy and safety of endourology, extracorporeal shock wave lithotripsy (ESWL) and open surgery, and to determine if any indication remains for open ureterolithotomy in a tertiary endourology unit. Patients and methods A 12‐year retrospective review (1987–1998) was conducted of all primary ureteric stones treated by ESWL, endoscopy, intracorporeal shock wave lithotripsy (ISWL) administered via ureteroscopy, and open surgery. Results In all, 1195 patients were treated for primary ureteric stones, 44% by ESWL, 37% by ureteroscopy and ISWL, and 20% by open surgery. At the 3‐month follow‐up the stone‐free rates for ESWL monotherapy, ureteroscopy and open surgery were 95%, 85% and 97%, giving an efficiency quotient of 73%, 64% and 94%, respectively. The overall complication rate for ESWL was 13%, for ISWL 32% and for open surgery 13%, but the complications of open surgery were often serious and potentially life‐threatening. Conclusions With recent advances in endourology the indications for open surgery have decreased considerably, from 26% in 1987–95 to 8% in 1996–98. However, the remaining indications for open ureterolithotomy include failure of less invasive modalities, the presence of medical/anatomical abnormalities, a concomitant open procedure, and the presence of large impacted calculi for which patients prefer to avoid multiple procedures.
The effects of flow rate, length and external pressure upon the pressure required for fluid to flow through a ureter
Authors: Karnak I. , Büyükpamukçu N. , Tanyel F.C. 
Published: March 2003

Objective To determine in vitro the effects of increments of external pressure on the pressure required to conduct fluid through ureters of various lengths at different flow rates, as the flow of a fluid through a collapsible tube is influenced by various factors (e.g. external pressure, the pressure gradient between the ends, the length and diameter of the tube, and the viscosity of fluid). Materials and methods Two in vitro systems were designed, composed of three parts, i.e. a perfusion line, an exit line and a container of two different widths in which short or long ureteric segments, obtained from cattle, could be placed; the ureter was connected to the perfusion and exit lines. Physiological saline was added to the container until the desired external pressure was applied to the ureter. The flow pressure (height of the perfusion line) was recorded when producing flows through ureters of varying length at 1.5 and 6 mL/min, and determined under various external pressures. The intra‐ureteric pressure during flow was also monitored by a pressure transducer. The four combinations of long and short ureters with high and low flow rates were compared using analysis of variance, with the Pearson correlation coefficient used to evaluate the relationships between the various pressures. Results There were close relationships between flow pressure and external pressure (r = 0.727), intra‐ureteric and external pressure (r = 0.766), and the flow pressure and intra‐ureteric pressure (r = 0.940, all P < 0.001). Increments in external pressure resulted in greater flow and intra‐ureteric pressure (P < 0.05). Increases in flow pressure were more pronounced than increases in intra‐ureteric pressure at the same external pressure (P < 0.05) at high flow rates. A longer ureter and higher flow rates caused greater intra‐ureteric pressure (P < 0.05). Conclusion External pressure increases the pressure required to conduct fluid through a ureter and the effect is more pronounced at high flow rates. The length of the ureter also affects the flow pressure at high flow rates. Therefore, flow through the ureter follows the Poiseuille equation only at high flow rates. Thus, increases in intra‐abdominal pressure may cause greater intrapelvic pressure and induce ureteric obstruction, contributing to the pathogenesis of hydronephrosis.
Feasibility of multi‐slice computed tomography in the diagnosis of arteriogenic erectile dysfunction
Authors: Kawanishi Y. , Lee K.S. , Kimura K. , Kojima K. , Yamamoto A. , Numata A. 
Published: March 2003

Objective To compare computed tomography (CT) angiography (CTA) obtained by multi‐slice CT (a new minimally invasive method) with the current standard of arterial imaging, digital subtraction angiography (DSA), in diagnosing arteriogenic erectile dysfunction (ED). Patients and methods Twenty‐one patients with suspected arteriogenic ED underwent DSA and CTA after providing informed consent. Prostaglandin E1 was injected into the penile cavernosal body and then non‐ionic contrast medium was rapidly infused into the antecubital vein. The DSA and CTA images were diagnosed as showing a normal or abnormal status by three reviewers independently. CTA was undertaken on an outpatient basis but DSA required hospitalization. Results In the 42 internal pudendal arteries, DSA showed 28 normal and 14 impaired arteries; CTA showed 21 normal arteries and 21 occlusions. The CTA image correlated closely with the diagnosis of stenosis or occlusion in internal pudendal arteries, with a sensitivity of 93%, a specificity of 71% and an accuracy of 79%. In the cavernosal arteries, DSA depicted 14 normal and 28 impaired arteries; CTA showed seven normal arteries and 35 occlusions. The CTA image agreed closely with the diagnosis of stenosis or occlusion in cavernosal arteries, with a sensitivity of 96%, a specificity of 43% and an accuracy of 79%. Of the 42 inferior epigastric arteries, DSA could not depict 11 arteries but CTA showed all 42 inferior epigastric arteries. Conclusions CTA images correlated with DSA images; at present DSA is better than CTA in visualizing stenosis in fine arteries. However, CTA is less invasive and relatively inexpensive, and in future will probably provide even greater improvements in graphic quality. CTA would be an adequate replacement for DSA in evaluating internal pudendal arterial stenosis.
A light‐ and electron‐microscopic histopathological study of human bladder mucosa after intravesical resiniferatoxin application
Authors: Silva C. , Avelino A. , Souto‐Moura C. , Cruz F. 
Published: March 2003

Objective To determine the morphology of bladder mucosa and the integrity of its mucin coat in patients with detrusor hyper‐reflexia treated with intravesical resiniferatoxin. Patients and methods Seven patients with detrusor hyper‐reflexia were treated intravesically with resiniferatoxin dissolved in 10% ethanol in saline (50 nmol/L solution in two and 100 nmol/L in five). Patients were clinically evaluated by a voiding chart and filling cystometry before and 3 months after each resiniferatoxin application. In addition, they underwent cystoscopy and bladder biopsies at 22–33 months after the first instillation and at 7–23 months after the last one. Tissue samples for light microscopy were fixed in 4% paraformaldehyde, embedded in paraffin and stained with haematoxylin‐eosin or periodic acid‐Schiff reagent (PAS). Those for electron microscopy were fixed in 5% glutaraldehyde and embedded in resin. Results The resiniferatoxin instillation was not painful. Three months after treatment the mean voiding frequency decreased and five incontinent patients became continent. The maximum cystometric capacity increased in all patients; at cystoscopy the bladders appeared normal. On light microscopy the urothelium was of normal morphology and stained with PAS in the luminal cells and in the basement membrane. Mononuclear inflammatory cells were occasionally apparent in the lamina propria. On electron microscopy epithelial cells were visible in a thick basal lamina. Superficial cells had the usual irregular contour and contained numerous membrane‐coated vesicles. In the lamina propria, unmyelinated axonal profiles with occasional varicosities could be identified. Conclusions Intravesical resiniferatoxin improved urinary frequency, incontinence and bladder capacity in patients with detrusor hyper‐reflexia, causing no morphological change in the bladder mucosa. The PAS reactivity of the carbohydrate moieties present in the mucin coat and the basement membrane was unchanged by resiniferatoxin.
Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms
Authors: Masood J. , Lane T. , Koye B. , Vandal M.T. , Barua J.M. , Hill J.T. 
Published: March 2003

Objective To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LUTS) with those presenting symptomatically, by stage, intervention and outcome. Patients and methods The case notes of all male patients (100) diagnosed with RCC between 1991 and 1998 were reviewed and modes of presentation recorded. The patients were divided into two groups: those who were referred with LUTS (frequency, urgency, hesitancy, poor stream, nocturia) and in whom RCC would not have been suspected and was thus detected incidentally on routine ultrasonography; and all patients in whom carcinoma might have been suspected from their symptoms but, for the purposes of this study, also included patients in whom RCC was diagnosed during ultrasonography for unrelated intra‐abdominal pathology. Details of diagnostic imaging and clinical staging were similarly recorded for both groups and where surgical intervention was undertaken, histopathological data were also noted. The clinical course and long‐term outcome of incidentally detected tumours was then compared with their symptomatically presenting counterparts. Results The mean (range) follow‐up for all patients was 30 (1.5–96) months; for those in the incidental group it was 31 (1–86) months and in the symptomatic patients 29 (1–96) months. Organ‐confined disease was found in two‐thirds of patients with incidental tumours and in 38% of those in whom the tumour may have been suspected; the difference was statistically significant (chi‐squared test P < 0.05). The mean (sd) size of tumours discovered incidentally and in symptomatic patients was 5.9 (1.94) cm and 9.2 (3.39) cm, respectively; this difference was also statistically significant (t‐test, P < 0.001). Of the 24 patients with incidentally detected tumours, 14 (58%) were alive with no recurrence, and of the 76 presenting symptomatically, 27 (35%) were alive with no recurrence at the last follow‐up; disease survival curves showed a statistically better survival rate for those with organ‐confined tumours. Conclusion Incidentally diagnosed RCC represents a significant proportion of those who are ultimately diagnosed with the malignancy. Opportunities which arise for appropriate screening of the upper tracts during routine urological investigations (e.g. ultrasonography of the upper tracts in patients referred for LUTS) should be endorsed, contrasting with the more traditional approach, which argues that it yields no ultimate survival advantage.
Treatment of high‐risk superficial bladder cancer with maintenance bacille Calmette‐Guérin therapy: preliminary results
Authors: Kolodziej A. , Dembowski J. , Zdrojowy R. , Wozniak P. , Lorenz J. 
Published: March 2003

Objective To evaluate, in a prospective study, the effects and results of maintenance therapy with bacille Calmette‐Gue´rin (BCG) in treating patients with high‐risk superficial bladder cancer. Patients and methods In all, 155 patients were enrolled in a randomized study of transurethral resection alone (53) or combined with intravesical BCG (102) as a treatment for superficial bladder cancer. BCG was administered for six consecutive weeks followed by three weekly instillations in months 3, 6, 12, 18, 24, 30 and 36 after resection. Recurrence, progression, prognostic factors and side‐effects were assessed and analysed. Results After a median (range) follow‐up of 23 (6–42) months, 83 of the 102 patients treated with BCG (81%) were disease‐free, compared with 24 of the 53 treated with resection alone (45%). There was also a significant difference in tumour progression and time to progression between the trial arms. The disease progressed in eight patients (8%) treated with BCG and in 12 (23%) of those treated by resection alone. Independent risk factors for progression were DNA ploidy status and stage. Only the completion of treatment was predictive of outcome (risk of recurrence) for patients treated with BCG. Conclusion Maintenance BCG therapy was better than resection alone in reducing the incidence of recurrence and progression in patients with high‐risk superficial bladder cancer.
Usefulness of power Doppler ultrasonography in evaluating erectile dysfunction
Authors: Golubinski A.J. , Sikorski A. 
Published: March 2003

Objective To evaluate deep penile arterial flow after an intracavernosal injection with papaverine in patients with erectile dysfunction (ED). Patients and methods Twenty patients with ED were evaluated using power Doppler ultrasonography with a linear probe (8 MHz). Diagnostic tests were undertaken after an intracavernosal injection with 40 mg papaverine. The peak systolic velocity (PSV), end‐diastolic velocity (EDV) and resistive index (RI) were analysed. Results After injecting papaverine, seven patients had a normal erection and appropriate waveform patterns; their mean PSV was 30.7 cm/s, the EDV 4.42 cm/s and the RI 0.85. There was tumescence and elongation of the penis with no rigidity in eight patients; their mean PSV was 23.9 cm/s, the EDV 7.34 cm/s and the RI 0.72. There was no erection in five patients. The abnormal flow values showed insufficient arterial vessels in a quarter of the men, venous leakage in 15% and mixed ED in 20%. Conclusion The power Doppler technique allows the accurate location and evaluation of deep penile arteries. Vascular pathology may be differentiated after an intracavernosal injection with a vasomotor agent. Recognising the pathological pattern assists in choosing the best method of treatment.