bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prevalence of Peyronie's disease: results of a large survey
Authors: Schwarzer U. , Sommer F. , Klotz T. , Braun M. , Reifenrath B. , Engelmann U. 
Published: March 2003

Objectives To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. Subjects and methods A standardized questionnaire was sent to 8000 male inhabitants (age range 30–80 years) of the greater Cologne area (≈ 1.5 million inhabitants). Three questions about the self‐diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. Results The response rate after the third mailing was 55.4% (4432 men); 142 men (3.2%, mean age 57.4 years, sd 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30–39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40–49 and 50–59 years, 4.0% in those 60–69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. Conclusions This is the first large cross‐sectional, community‐based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this ‘rare’ disease is more widespread than previously thought.
Prostatic fluid‐free insulin‐like growth factor‐1 in relation to prostate cancer
Authors: Perk H. , Serel T.A. , Delibas N. , Sütçü R. 
Published: March 2003

Objectives To establish the feasibility of measuring free insulin‐like growth factor‐1 (IGF‐1) in prostatic fluid and to determine if there is a difference in free IGF‐1 levels in the prostatic fluid of patients with prostatic adenocarcinoma and in normal men. Patients and methods Prostatic fluid samples were collected from men with histologically confirmed prostate cancer and from control subjects with no malignancy. Prostatic fluid and serum free IGF‐1 levels were measured in duplicate by radioimmunoassay, and the differences analysed using the Mann–Whitney U‐test and Pearson correlation. Results Prostatic fluid free IGF‐1 concentrations did not differ significantly (P = 0.23) and there was no difference in serum free IGF‐1 levels between the groups. While serum PSA level was significantly correlated with age (P < 0.001) the free IGF‐1 level of prostatic fluid was not. There was also no correlation between prostatic fluid free IGF‐1 and serum PSA levels. Conclusions Free IGF‐1 can be detected in prostatic fluid with acceptable sensitivity. However, the free IGF‐1 level in prostatic fluid does not help to detect patients with prostate cancer and is not a tumour marker.
Bladder autoaugmentation in the rabbit using de‐epithelialized segments of small intestine, stomach
Authors: Cranidis  , Nestoridis  , Delakas  , Lumbakis  , Kanavaros  
Published: March 2003

Objective To develop an animal model of partial detrusorectomy (autoaugmentation) and thus avoid the consequences of the direct contact of intestinal mucosa with the urinary tract in bladder augmentation.Materials and methods A diverticular urothelial bulge was created and patched with demucosalized segments of small bowel (group A), stomach (group B) and with lyophilized human dura mater (group C). The surgery was performed on 50 New Zealand rabbits which were compared with 10 control animals and killed at 2, 4 and 6 weeks after surgery. Urodynamic studies and cystography were performed before operation and at death, and the augmented bladders examined histologically.Results Six weeks after the procedure, the mean (sd) bladder compliance was 22.7 (5.7) in group A (intestinal patch, n=6), 2.3 (0.5) in group B (stomach patch, n=3), 3.1 (1.9) in group C (lyophilized human dura, n=3) and 9.4 (0.4) in the control group (n=4). Histological studies showed residual enteric and gastric mucosa but an intact urothelium under the intestinal patch.Conclusion The results of this experimental study suggest that a demucosalized segment of small bowel is the best material to increase bladder compliance in detrusorectomy (autoaugmentation) as applied in this animal model.
Relief of urinary tract obstruction in tuberculosis to improve renal function. Analysis of predictive factors
Authors: Ramanathan  , Kumar  , Kapoor  , Bhandari  
Published: March 2003

Objective To assess the effect of the relief of obstruction on the ultimate function of the affected renal unit in urinary tuberculosis, and to identify predictors of functional recoverability.Patients and methodsOf a total of 82 patients with urinary tuberculosis presenting over 7 years, 38 with evidence of upper tract obstruction were analysed. All patients were assessed with pre‐operative excretory urography, urinary mycobacterial cultures and serum chemistry. Patients with subnormally functioning kidneys were assessed with baseline renal scans. Preliminary intervention in the form of JJ stenting or percutaneous nephrostomy (PCN) was carried out in patients with reasonable renal function. Function was reassessed after 4 weeks to detect evidence of improvement and factors which could affect the outcome were determined.ResultsThirty‐eight patients had documented upper tract obstruction, of whom six had bilateral obstruction (total of 44 renal units). Ten renal units were not functioning at presentation, with a mean (sd) glomerular filtration rate (GFR) of 3.0 (5.73) mL/min, and no preliminary intervention was performed. In the remaining 34, preliminary intervention was carried out before definitive surgery (JJ stenting in 14, PCN in 15 and PCN followed by antegrade JJ stenting in five); 21 of these renal units were salvaged but 13 were lost despite overcoming the obstruction. Three of the 13 units deteriorated from having acceptable pre‐treatment GFRs to becoming non‐functional. Good renal cortical thickness, a low grade of renal involvement (Semb 1 or 2), the presence of more distal disease in the form of ureteric stricture and a GFR of >15 mL/min were good predictors of renal recovery after diversion.ConclusionsThe loss of some renal units seems inevitable in patients with urinary tuberculosis, despite advances in chemotherapy. Having pre‐operative predictors of renal recovery may ensure optimal patient selection, thereby reducing the number of procedures and economic burden on the patient who does not require intervention.
A pilot study of intermittent androgen deprivation in advanced prostate cancer
Authors: Horwich  , Huddart  , Gadd  , Boyd  , Hetherington  , Whelan  , Dearnaley  
Published: March 2003

Objective To assess the feasibility of intermittent hormone therapy for metastatic prostate cancer.Patients and methods Sixteen patients with metastatic carcinoma of the prostate were treated using a protocol of intermittent hormone therapy with the luteinizing hormone‐releasing hormone (LHRH) analogue leuprorelin at a dose of 3.75 mg every 4 weeks. The protocol required that hormone therapy be stopped when the response was stable, and was designed to assess the duration of the unmaintained response and the probability of a second response to re‐initiation of leuprorelin.Results Eleven of the 16 patients had a stable hormone response and stopped therapy 3–9 months (mean 5.5) from the start of treatment. The mean (range) duration of the unmaintained response, as judged by monitoring symptoms and serum prostate specific antigen (PSA) levels every month was 4 (2–8) months in the seven patients who had bone metastases and was 3, 3 and 6 months in the three with only loco‐regional disease (one patient temporarily discontinued follow‐up). As the immediate re‐induction of hormone therapy was not mandatory in asymptomatic patients at the time of progression, the mean (range) period off hormone therapy was 8 (3–13) months in those eight patients with bone metastases and was 3, 36 and 42+ months in the three presenting with loco‐regional disease. All 10 patients who re‐initiated hormone therapy had a second hormone response, in six of which led to a decline in PSA level to <2 ng/mL. During the period off hormone therapy no patient developed irreversible symptoms.Conclusions The temporary cessation of hormone therapy early during the response in patients with metastatic carcinoma of prostate is associated with biochemical evidence of relatively early progression in most cases, but can be associated with significant periods off therapy and with a high chance of a second hormone response. The value of this approach to the quality and duration of patients’ lives requires a prospective comparative evaluation.
Transurethral resection of the prostate vs high‐energy thermotherapy of the prostate in patients with benign prostatic hyperplasia: long‐term results
Authors: D’ancona  , Francisca  , Witjes  , Welling  , Debruyne  , De La Rosette  
Published: March 2003

Objective To evaluate the outcome and durability of high‐energy transurethral microwave thermotherapy (HE‐TUMT) in comparison with transurethral resection of the prostate (TURP).Patients and methods Fifty‐two patients with BPH and lower urinary tract symptoms were randomized and treated either by TURP (21 patients; mean prostate volume 45 mL, sd 15) or HE‐TUMT (31 patients, mean prostate volume 43 mL, sd 12). Long‐term results were obtained at a mean (sd) follow‐up of 2.4 (0.5) years.Results During the follow‐up, the mean symptomatic improvement stabilized at 56% after TUMT and 74% after TURP. The mean maximum urinary flow rate increased by 62% after TUMT and 105% after TURP. Before treatment, 78% of patients in the TURP group were obstructed according to urodynamic investigation and after treatment, 14% remained obstructed. In the TUMT group, 67% of patients were obstructed before treatment and 33% remained so afterward. Six patients (19%) underwent TURP after TUMT (four after 1 year) and two patients were also treated with medication. One patient underwent a bladder neck incision after TURP to treat bladder neck sclerosis. Three patients were not satisfied with the outcome after the additional TURP.Conclusion Both treatment modalities show good symptomatic and objective results at >2 years of follow‐up. Most re‐treatments were performed ≥1 year after treatment and were based on subjective findings.
Changes in white blood cell counts in men undergoing thrice‐weekly prostatic massage, microbial diagnosis and antimicrobial therapy for genitourinary complaints
Authors: Hennenfent  , Feliciano  
Published: March 2003

Objective To report changes in the white blood cell (WBC) counts in expressed prostatic secretions (EPS) in men with pelvic symptoms undergoing thrice‐weekly prostatic massage combined with antimicrobial therapy.Patients and methods The study comprised a retrospective analysis of the records of 35 patients (mean age 45.3 years, range 28–70, SD, 12.03) with pelvic pain, pain in the lower back, obstructive urinary symptoms, irritative urinary symptoms, or sexual dysfunction, who had undergone the same diagnosis and treatment protocol in a genitourinary clinic in Manila, Philippines, from September 1992 to September 1995.Results EPS were obtained 347 times in 35 patients (median 9 times per patient, range 6–16). In 26 of the 35 (74%) patients the WBC count in the EPS was <10 per oil‐immersion field (OIF, ×1000) at the first prostatic massage. In 34 of 35 (97%) patients the WBC count rose to ≥10 as prostatic massage continued on a thrice‐weekly schedule. The mean (range, SD) initial WBC count in the EPS was 8.4 (1–48, 8.43) and the maximum was 40.9 (6–60, 19.05); the difference between these values was 32.5 (3–57, 18.78; 95% confidence interval 26.1–40.1) and the difference was statistically significant (paired t‐test, P<0.001).Conclusions The classification of patients into those with prostatodynia or prostatitis based on one EPS examination is misleading and thrice‐weekly massage of the prostate is better than a single collection of EPS to obtain the most purulent sample for Gram staining and culture.
Free/total serum prostate‐specific antigen ratio: how helpful is it in detecting prostate cancer?
Authors: Masters  , Keegan  , Hildreth  , Greene  
Published: March 2003

Objective To determine whether the use of free/total (f/t) serum prostate specific antigen (PSA) ratio would help reduce the number of prostate biopsies performed without compromising the detection of prostate cancer, in the setting of a transrectal ultrasonography (TRUS) clinic.Patients and methods The study included 93 consecutive patients referred to the clinic for TRUS and biopsy. Serum samples were assessed for total PSA and free PSA, and the f/t PSA ratio calculated; 70 biopsies were taken. Patients over the age of 70 years with TRUS findings consistent with benign prostatic hyperplasia and with PSA levels <10 ng/mL were not biopsied.Results Tumour was detected in 23 patients; receiver operating characteristic curves showed no advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. If a f/t PSA ratio of <0.15 had been used to determine the necessity for biopsy in the group with a total PSA of 4–10 ng/mL, then two‐thirds of all tumours would have been undetected.Conclusion The f/t PSA ratio had no advantage over total PSA in improving specificity at a given sensitivity for detecting prostate cancer. Therefore, it cannot be recommended as a means of decreasing unnecessary biopsies in patients with a raised PSA level and/or an abnormal digital rectal examination. This applied particularly to the group of patients with a total PSA of 4–10 ng/mL.
The vesico‐ureteric junction in three cases of primary obstructive megaureter associated with ectopic
Authors: Dixon  , Jen  , Yeung  , Gosling  
Published: March 2003

Objective To examine the histological structure and autonomic innervation of the vesico‐ureteric junction (VUJ) in three cases of primary obstructive megaureter occurring in association with ectopic ureteric insertion.Patients and methods Specimens of VUJ were obtained from one male and two females with primary obstructive megaureter and ectopic ureteric insertions. Serial frozen sections were cut and stained with either Masson’s trichrome or immunostained for protein gene product (PGP 9.5; a general nerve marker) or dopamine beta‐hydroxylase (DβH), a marker for noradrenergic nerves.Results In each case examined the terminal ureter was encircled by a thick collar of smooth muscle on the inside of which lay normal narrow‐diameter longitudinally orientated ureteric muscle bundles. Loose connective tissue separated the surrounding detrusor muscle from this abnormal muscle collar, which was formed of distinctive smooth muscle cells arranged in a meshwork. The autonomic innervation of the ureteric and detrusor muscle bundles was similar to that previously reported for the normal VUJ while the thick muscle collar was richly innervated by DβH‐immunoreactive noradrenergic nerves.Conclusion The presence of an additional smooth muscle collar surrounding the terminal ureter may impede the normal flow of urine from ureter to bladder and be the cause of megaureter in these patients. We propose that the presence of this muscular collar arises from the developmental anomaly and suggest that these cases represent a subgroup that requires early surgical treatment.
Urological complications of bladder‐drained pancreatic allografts
Authors: Del Pizzo  , Jacobs  , Bartlett  , Sklar  
Published: March 2003

Objective To examine the spectrum of urological complications associated with bladder drainage of pancreatic allografts.Patients and method Between July 1991 and October 1996, 140 consecutive bladder–drained pancreatic allografts were performed and were reviewed retrospectively to determine the spectrum of post‐operative urological complications. Ninety‐five patients (68%) underwent simultaneous pancreas‐kidney transplantation, 35 (25%) had the pancreas transplanted after the kidney, while 10 (7%) had a pancreas transplant alone. The mean follow–up was 35 months.Results Seventy patients (50%) had urological complications necessitating intervention: 17 (12%) had retained foreign bodies, bladder tumours occurred in three, 14 had bladder calculi and 15 (11%) had cystoscopic evidence of duodenitis. One patient developed an arteriovenous fistula and one had a necrotic duodenal allograft. Reflux pancreatitis occurred in six patients. Other complications included urethral stricture (three), urethral erosion (three), epididymitis (three), acute prostatitis (one) and prostatic abscess (one). One patient developed a urethrocutaneous fistula and another developed a vesicocutaneous fistula. In the series, 30 of the 140 patients (21%) required eventual conversion to enteric drainage of their allograft as definitive therapy.Conclusions Pancreatic transplantation with bladder drainage is associated with a wide range of significant urological problems. Although appropriate treatment can resolve most of the complications, this often entails additional operative intervention, which may increase the long‐term morbidity or jeopardize graft function. As a result of the severity of these urological complications, some centres use primary enteric drainage as the method of choice for pancreatic transplantation.
Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials
Authors: Berghmans  , Hendriks  , BØ  , Hay‐Smith  , De Bie  , Van Waalwijk van Doorn  
Published: March 2003

Objective To assess the efficacy of physical therapies for first‐line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs).Materials and methods A computer‐aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, was carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research.Results Twenty‐four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels‐of‐evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high‐intensity vs a low‐intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.Conclusions More research of high methodological quality is required to further evaluate the effects of physical therapies used to treat and prevent SUI.
Adjuvant chemotherapy for high‐risk urothelial transitional cell carcinoma: the Princess Margaret Hospital experience
Authors: Michael  , Tannock  , Czaykowski  , Moore  
Published: March 2003

Objective To review the outcome of adjuvant systemic chemotherapy after surgery for patients with locally advanced urothelial transitional cell carcinoma (TCC) of the bladder and upper urinary tract who were at high risk for recurrence or metastatic spread.Patients and methodsThirty‐five patients (27 men and eight women, median age 59 years) received adjuvant chemotherapy and were followed for a median of 31 months from surgery (range 12–109). All patients had undergone surgery (cystectomy, nephrectomy, nephrouretectomy), with removal of all evident tumour from the following primary sites: bladder (29), renal pelvis (three) and ureter (three). Thirty patients had stage pT3 or greater, 22 had node‐positive disease and 16 had vascular invasion. The median interval from surgery to chemotherapy was 2 months. Patients received a median of four courses of cisplatin, methotrexate and vinblastine (n=23) or the same drugs with doxorubicin (n=12).ResultsToxicity included nine episodes of febrile neutropenia (one fatal) and six episodes of thromboembolism (one fatal). Eighteen patients (51%) remain alive and free of apparent disease with a median follow‐up of 31 months. Actuarial overall and relapse‐free survival were 64% and 57% at 2 years and 47% and 53% at 5 years, respectively. For the 22 node‐positive patients, the median relapse‐free survival and overall survival was 22 months and 33 months, respectively.ConclusionsPatients with urothelial TCC at high risk of relapse after radical surgery can have a reasonable chance of long‐term survival with systemic adjuvant chemotherapy. Treatment is associated with toxicity. The benefits of treatment should be addressed in a large randomized controlled trial.
The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder and prostate
Authors: Pantuck  , Murphy  , Amenta  , Das  , Cummings  , Weiss  
Published: March 2003

Objective To determine if the monoclonal antibody 7E12H12 , which reacts with a 40 kDa protein in normal human enterocytes and has been shown to be a marker for intestinal metaplasia and adenocarcinoma arising in the bladder, could assist in distinguishing prostatic, urachal and vesical adenocarcinoma, using a sensitive immunohistochemical assay.Materials and methods Fifteen primary prostatic adenocarcinomas and five adenocarcinomas of the urinary bladder were selected for a retrospective evaluation. The monoclonal antibody 7E12H12 (IgM isotype) was used in an immunoperoxidase assay to survey formalin‐fixed, paraffin‐embedded archival tissue specimens.Results All vesical adenocarcinomas reacted positively with the antibody, regardless of grade; none of the 15 prostatic specimens reacted positively in either the benign or malignant glandular epithelium.Conclusion The monoclonal antibody 7E12H12 can differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma arising in the prostate and may be a useful tool in diagnostic pathology.