bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of transurethral resection on sexual dysfunction in patients with prostate cancer
Authors: Bieri S. , Miralbell R. , Rohner S. , Kurtz J. 
Published: November 2003

Objective To evaluate retrospectively the potential influence of disease‐related factors and transurethral resection of the prostate (TURP) on the sexual function of patients who had undergone curative radiotherapy for prostate cancer. Patients and methods The study comprised 104 patients (median age 69.5 years, range 49–81) who had been treated with curative radiotherapy and no first‐line hormones: 16, 52, 33 and three patients had T1, T2, T3 and T4 tumours, respectively. TURP was performed in 73 patients before RT, and needle biopsy alone in 31 patients. They were interviewed about their past and present sexual lives using a questionnaire designed to evaluate the potency of the patients at age 45 years, at 1 year before the diagnosis of the disease, before radiotherapy (after TURP or needle biopsy) and at the last follow‐up. Information concerning associated diseases, routine medication and the weight of the resected material was also collected. Results Before diagnosis, 20 patients had no erections while 84 were potent. Of the 60 potent patients undergoing a TURP, 31 (51%) indicated complete impotence immediately thereafter. There was no statistical difference between impotent and potent patients after TURP in age, associated diseases, medical treatment and the weight of the resected material. Conclusion TURP may lead to impotence in a significant proportion of patients. As TURP is an important component of ‘conservative’ treatment approaches, its potential sexual morbidity should be taken into consideration in the comparative risk‐benefit analysis of different therapeutic strategies.
Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal
Authors: Mueller E.J. , Zeidman E.J. , Desmond P.M. , Thompson I.M. , Optenberg S.A. , Wasson J. 
Published: November 2003

Objective To determine whether early removal of the indwelling Foley catheter after transurethral resection of the prostate (TURP) significantly shortens the hospital stay without causing additional morbidity and thus saves costs. Patients and methods For the year commencing 1 July 1991, 119 patients who had undergone TURP had their indwelling catheter removed on the first day after surgery. The results and morbidity of this group of patients were compared with those in 152 patients undergoing TURP during the previous year. The economic consequences of this protocol were calculated using both Medicare and CHAMPUS data. Results The demographics of the patients in both groups were similar. Post‐operative complications occurred in 5% of the study patients and in 6.6% of controls; a transfusion was required in 2.5% and 1.3%, clot retention developed in 1.7% and 3.3% and the hospital stay was reduced from 3.1 to 1.28 days in the study and control patients, respectively. Using Medicare data, the mean cost saving of early catheter removal would be $829 and $1406 for patients aged <70 and >70 years, respectively. For CHAMPUS patients, the cost saving would be $1983. Conclusion Early removal of the catheter after TURP did not increase morbidity and maintained the efficacy of the procedure. If this practice was adopted nationally, the savings resulting from the reduction in hospital stay would be considerable.
A retrospective analysis of 82 cases of cancer of the penis
Authors: Lindegaard J.C. , Nielsen O.S. , Lundbeck F.A. , Mamsen A. , Studstrup H.N. , Von Der Maase H. 
Published: November 2003

Objective To identify prognostic factors for penile cancer and to evaluate the treatment strategy for early‐stage disease, proposed recently by the European Board of Urology (EBU). Patient and methods The records of 82 patients consecutively referred to the uro‐oncological centre at Aarhus University Hospital between 1965 and 1993 were reviewed. The importance of tumour stage, differentiation, patient age, local control and regional lymph node control were assessed using univariate and multivariate analyses. Results Cox multivariate analysis identified differentiation (odds ratio [OR]=6.04), UICC‐1978 T‐stage (OR=1.88) and age (OR=1.04) as independent prognostic variables for survival. Penile amputation in tumours <4 cm in diameter improved local control but not survival. Regional control and survival were not significantly improved by prophylactic adenectomy. Conclusion Differentiation, T‐stage and age were prognostic factors for survival. The results support the EBU treatment strategy involving penis‐conserving therapy and watchful waiting for early‐stage disease.
Detrusor myopathy: an accurate predictor of bladder hypocompliance and contracture in interstitial cystitis
Authors: Christmas T.J. , Smith G.L. , Rode J. 
Published: November 2003

Objective To determine whether any histological characteristics within the detrusor in cases of early interstitial cystitis (IC) predict the subsequent development of severe symptoms due to bladder contracture. Patients and methods The detrusor muscle component of bladder biopsies from 21 patients with IC was examined in sections stained with haematoxylin and eosin. Videocystometrography was performed at least 2 months after the biopsy and the patients were then followed up clinically for at least 3 years. Results The detrusor appeared normal in 13 patients; in eight there was evidence of detrusor myopathy. Patients with biopsies confirming detrusor myopathy were significantly more likely to have hypocompliant bladders than those with normal detrusor muscle histology (P<0.02). Over the following 3 years, six of the eight patients with detrusor myopathy developed progressively severe symptoms and required subtotal cystectomy and enterocystoplasty. None of the 13 patients without detrusor myopathy required bladder substitution. Conclusion In IC, detrusor myopathy is associated with bladder hypocompliance. Patients with detrusor myopathy appear to have more severe disease and are more likely to progress to bladder contracture requiring substitution enterocystoplasty.
The effects of intranasal midazolam on urodynamic
Authors: Bozkurt P. , Kiliç N. , Kaya G. , Yeker Y. , Eliçevik M. , Söylet Y. 
Published: November 2003

Objective To determine the influence of midazolam on the function of the lower urinary tract when used to sedate the patient.Patients and methodsUrodynamic studies were performed on 20 patients (seven boys and 13 girls, mean age 4.04 years, range 1 day to 10 years) before and after the intranasal administration of 0.5 mg/kg of midazolam. The patients' heart rate, respiratory rate and oxygen saturation were monitored and the level of sedation recorded by an anaesthesiologist and a surgeon during the study.ResultsHeart rate and respiratory rate did not change and the percentage oxygen saturation remained stable throughout the study period. The childrens' behaviour began to change 3–5 min after the intranasal administration of midazolam. The sedation lasted 2 h and the full co‐operation of the patient was assured. The difference between the initial and post‐midazolam evaluation of maximal cystometric capacity, contractility, compliance, intravesical pressure, maximum flow rate, intravesical pressure at maximum flow and the amount of residual urine were statistically insignificant (P>0.05). Electromyographic characteristics showed no significant change with the use of midazolam (P>0.05).ConclusionDespite the suggestion that benzodiazepines, especially diazepam, are useful for the relaxation of pelvic floor striated musculature in voiding dysfunctions, there was no effect on urodynamic variables when midazolam was used in a single dose intranasally. The anxiolytic and sedative effects allowed children to undergo urodynamic studies in comfort.
Isothermic irrigation during transurethral resection of the prostate: effects on peri‐operative hypothermia, blood loss, resection time and patient satisfaction
Authors: Pit M.J. , Tegelaar R.J. , Venema P.L. 
Published: November 2003

Objectives To investigate the effect using irrigation fluid at body temperature (isothermic) on patients' (core) temperature during a transurethral resection of the prostate (TURP) and on the amount of peri‐operative blood loss, the resection time and the subjective assessment of comfort by the patients. Patient and methods In a randomized study, patients undergoing TURP under spinal anaesthesia were divided into those receiving either isothermic irrigation fluid (Group 1, 28 patients) or fluid at room temperature (Group 2, 31 patients). In Group 1, a fluid heater maintained the irrigation fluid at body temperature until it reached the bladder. The body temperature of the patients was recorded rectally and orally during and after TURP and the peri‐operative blood loss was also measured. The patients were interviewed on the first day after TURP to determine their assessment of comfort during the procedure. Results The decrease in body temperature was 0.74°C in Group 1 and 1.71°C in Group 2, which was significantly different (P<0.001). There was no significant difference in blood loss or resection‐time. In Group 1, only four (14%) of the patients were aware that their body was cooler, compared to 15 (50%) in Group 2 (P=0.038). Conclusion Isothermic irrigation during TURP prevents excessive cooling and reduces the level of hypothermia. The reported increased mortality after TURP is probably related to peri‐operative cardiac stress, an important factor which could be caused by the rapid decrease in body temperature which accompanies normal irrigation. Because the heating equipment presently available does not interfere with TURP, there are strong arguments for performing every TURP with irrigation fluid at body temperature.
Prognostic significance of angiogenesis in transitional cell carcinoma of the human urinary bladder
Authors: Philp E.A. , Stephenson T.J. , Reed M.W.R. 
Published: November 2003

Objectives To quantify tumour angiogenesis in bladder cancer and determine whether it correlates with tumour stage, grade and survival. Patients and methods Archival samples from a total of 113 patients newly presenting with transitional cell carcinomas of the urinary bladder were graded and staged, and analysed for angiogenic blood vessel density by a double immunohistochemical technique. The findings were correlated with the information obtained during a minimum follow‐up of 12 years. Results Univariate analysis showed that TNM stage (P=0.02) and mean vessel count (P=0.01) were significant predictors of death from bladder cancer. Blood vessel density was significantly correlated with tumour stage (P=0.01) and the presence of vascular invasion (P=0.007). Trained observers were essential for the accurate counting of blood vessels to prevent excessive inter‐observer variability. Multiple regression analysis showed that the combination of mean vessel count and stage was a significant prognostic indicator. Conclusion Angiogenesis in primary bladder cancer is a predictor of death from the disease. Further work to determine whether it predicts invasion and recurrences in superficial tumours may be valuable.
Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature‐sensitive device
Authors: Eckford S.D. , Finney R. , Jackson S.R. , Abrams P. 
Published: November 2003

Objectives To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode‐based temperature‐sensitive device in the detection of episodes of urinary incontinence in long‐term ambulatory monitoring (LTAM) studies. Subjects and methods Perineal temperature recordings were made in 46 women during various activities. A temperature‐sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects. Results A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature‐sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test. Conclusions This temperature‐sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integrated voiding channel.
Increased urinary excretion of lipids by patients with kidney stones
Authors: Khan S.R. , Glenton P.A. 
Published: November 2003

Objective To test the hypothesis that patients with calcific kidney stones (stone formers) excrete more lipids and cell membranes in their urine than do normal individuals.Patients, subjects and methods Lipids were isolated from the urine of patients with calcific stones (four women and six men, age range 28–69 years) and from normal subjects (three men and three women, age range 31–54 years). Different phospholipids, neutral lipids and glycolipids were identified using thin layer chromatography and individual lipids were characterized by several assays after scraping the spots from the plates, or by densitometry.Results Stone formers excreted more lipids and acidic phospholipids than did normal individuals; the urinary excretion of glycolipid, cholesterol and cholesterol esters was also increased.Conclusions The greater excretion of lipids may reflect the increased turnover of cells in the tubular epithelium and sloughing of cells into the urine in response to a challenge by oxalate and calcium oxalate crystals. Acidic phospholipids from cellular membranes of the sloughed epithelial cells may be involved in crystal nucleation and retention within the kidneys and thus the initial development of stone nidus and the continued growth thereafter.
Experience in renal autotransplantation:
Authors: Plas E. , Kretschmer G. , Stackl W. , Steininger R. , Mühlbacher F. , Pflüger H. 
Published: November 2003

Objective To determine the benefit of renal autotransplantation in selected patients with either renovascular lesions, renal or urothelial carcinomas or other disorders of the urinary collecting system.Patients and methods Between 1977 and 1994, 12 patients underwent renal autotransplantation, six involving renovascular hypertension, two involving tumours of the renal parenchyma, two with urothelial tumours and two with long ureteric stenoses. Pre‐operative renal function was normal in six patients and impaired in five. One patient was on haemodialysis. Five patients had a solitary kidney and four patients had functionally solitary kidneys. The follow‐up period ranged from 1 to 93 months (mean 34.9).Results Post‐operatively, six patients had normal kidney function (serum creatinine ≤12 mg/L), five patients had impaired renal function (creatinine content ≤26 mg/L) and one patient was on haemodialysis due to arterial graft thrombosis. Serum creatinine levels improved in four patients and were stable in another four. Renal function deteriorated in three patients and one patient required a graft‐nephrectomy. Immediate post‐operative complications included arterial thrombosis in one patient, perirenal haematoma in two, pulmonary oedema in one and severe intra‐operative bradycardia requiring a transient cardiac pacemaker in one.Conclusion Renal autotransplantation represents an effective alternative treatment with good long‐term results for selected patients with long ureteric lesions and renovascular disorders. It is also an effective method for patients with urological malignancies, especially those with solitary kidneys where the maintenance of renal function is of major concern.
Long‐term predictive role of urodynamics: an 8‐year follow‐up of prostatic surgery for lower urinary tract symptoms
Authors: Jensen K.M.‐E. , Jørgensen J.B. , Mogensen P. 
Published: November 2003

Objective To investigate the long‐term predictive value of urodynamics for the outcome of patients undergoing prostatic surgery for lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) and to determine the long‐term effectiveness on symptoms, maximum flow rate and the rate of re‐operation.Patients and methods Of 139 elderly men who had undergone prostatic surgery, selected without reference to urodynamic assessment but having extensive (blinded) urodynamic testing included in their evaluation, 79 were followed for 8 years using a history, symptom score analysis, uroflowmetry and review of their records.Results Comparing the results in groups of men with a pre‐operative maximum flow rate < or ≥15 mL/s, there was a similar difference in the rate of success to that noted 6 months post‐operatively. Similar results were obtained when comparing those with BOO or a normal bladder outlet function. However, although the tendency was clear it was not statistically significant because of the small sample size (type‐2 error). There was a significant reduction in all symptom scores from those assessed pre‐operatively and during the 8 years (P<0.001). The median pre‐operative maximum flow rate was 8.5 mL/s, compared with 12.5 mL/s after 8 years (P<0.001). Of the 79 patients, 14 (18%) had 28 re‐operations during the 8‐year follow‐up, 12 being repeat resections of the prostate, giving a repeat resection rate of 1.8% per year and a success rate of 71%. During the 8 years, 82% of the patients had an unchanged overall evaluation of the post‐operative outcome. In general, those having an unsatisfactory outcome were slightly younger than the whole group.Conclusion Uroflowmetry and pressure‐flow studies can predict to some degree the long‐term result after prostatic surgery. There was a durable effect on symptom scores and maximum flow rates after the operation. The annual rate of repeat resection (1.8%) was relatively low.
Long‐term follow‐up of patients with erectile dysfunction commenced on self injection with intracavernosal papaverine with or without phentolamine
Authors: Flynn R.J. , Williams G. 
Published: November 2003

Objectives To determine the usage, complications and satisfaction with intracavernosal agents in patients with erectile dysfunction commenced on self‐injection treatment at home. Patients and methods A total of 344 patients who had commenced intracavernosal treatment before December 1992 and had requested a repeat prescription were sent a questionnaire to determine the usage, complications, satisfaction and reasons for discontinuing treatment. Results Replies were received from 216 patients; of those who replied, only 126 were still using the treatment. The mean duration of treatment was 3.9 years in those continuing treatment. Whilst satisfaction ratings were high in those continuing therapy, most patients had experienced some side‐effects. Conclusion The long‐term follow‐up revealed a high attrition rate and a significant number of complications. Patients receiving auto‐injection therapy should be offered regular long‐term follow‐up.
Is the conservative management of the acute scrotum justified on clinical grounds?
Authors: Watkin N.A. , Reiger N.A. , Moisey C.U. 
Published: November 2003

Objective To determine whether there is justification for a policy of conservative management of acute scrotal emergencies, based on the ability to exclude a twisted testicle or the assumption that there is a ‘missed torsion’ when the duration of symptoms is prolonged. Patients and methods The case notes of 209 consecutive emergency scrotal explorations, carried out in one district general hospital over a 7‐year period, were reviewed. The decision to operate was based solely on a clinical diagnosis, with no information from additional radiological investigations. Results The commonest finding was testicular torsion (39.5%) with an orchidectomy rate of 22%. Only 5% of scrotal torsions occurred in patients <12 years of age, whereas 26% occurred in those >20 years of age. In five of 82 cases (6%) of confirmed testicular torsion, the surgeon did not consider this the most likely diagnosis. With a pain duration of <16 h, 89% of testes were salvaged, but with pain for >16 h this decreased to 25%. In three cases the testis was viable after pain had been present for >24 h. Conclusion In the absence of supportive radiological investigations, a small but significant number of twisted testes will be missed if conservative management is adopted.
Artificial urinary sphincter for post‐prostatectomy incontinence
Authors: Singh G. , Thomas D.G. 
Published: November 2003

Objective To assess the role of the artificial urinary sphincter in the management of patients with post‐prostatectomy incontinence. Patients and methods The study comprised 28 patients (mean age 71 years, range 45–81) with post‐prostatectomy incontinence caused by sphincter deficiency who underwent implantation of an artificial sphincter and were followed for a mean of 41 months (range 6–79). Results Twenty‐one (75%) patients had a bulbar cuff and seven (25%) had a membranous urethral cuff implanted. Problems with the bulbar urethral cuff included persistent stress leakage in six, system failure in two and infection in one patient. Nine patients with the bulbar urethral cuff and one patient with the membranous urethral cuff required revision. Of the nine re‐operations in those fitted with a bulbar urethral cuff, five required a higher pressure balloon, one a smaller cuff, two had system failures replaced and one had a membranous urethral cuff implanted because of infection. Three of these nine patients needed a third operation and in all of these a membranous urethral cuff was inserted. A total of 33 operations were performed in 21 patients with bulbar urethral cuffs (a re‐operation rate of 57%) and eight operations were carried out in seven patients with membranous urethral cuffs (a re‐operation rate of 14%). Three patients needed anticholinergic therapy and one needed a clam cystoplasty for intractable instability. Twenty‐four patients (86%) are dry and fully continent, three (11%) have occasional stress leakage and one patient had a cerebro‐vascular accident9 months after surgery and now has an indwelling catheter. Conclusions Patients who had artificial sphincters implanted to treat post‐prostatectomy incontinence achieved a social continence rate of 96%. With bulbar urethral sphincters there was a high incidence of post‐implantation incontinence and a high re‐operation rate to achieve this success.