bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure‐flow studies before and after transurethral microwave thermotherapy of benign prostatic hyperplasia using low‐ and high‐energy protocols
Authors: Eliasson  , Damber  , TeriÖ  
Published: March 2003

Objective To compare pressure‐flow results before and 3 months after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH), performed with lower and higher energy protocols.Patients and methods Twenty‐four patients were treated using a high‐energy protocol performed with a heat‐shock strategy, i.e. a rapid increase in intraprostatic temperatures to a maximum of 55–67°C. A helical antenna was used which produced maximum heating at the base of the prostate. A further 25 patients were treated using a lower energy protocol with a slow increase in intraprostatic temperatures to a maximum of 45–53°C. A first‐generation filament antenna was used with the maximum heat produced at the prostatic apex. All treatments were performed as single‐session outpatient procedures of 60–70 min duration.Results There was a significantly greater improvement in pressure‐flow variables, i.e. maximum urinary flow rate, detrusor pressure at maximum flow and minimal urethral opening pressure, in those treated with higher energy TUMT than in those receiving the lower energy protocol. The Madsen and quality‐of‐life scores, and maximum urinary flow rate on uroflowmetry, were also significantly better in the higher energy group.Conclusion Higher energy TUMT performed using a heat‐shock strategy provides a better pressure‐flow outcome than lower energy thermotherapy. Compared with previously published results, the outcome after higher energy TUMT is at least similar to other treatment alternatives for BPH.
Topical vasoactive cream in the treatment of erectile failure: a prospective, randomized placebo‐controlled trial*
Authors: Le Roux  , Naude  
Published: March 2003

ObjectiveTo repeat a previous study on the use of a topical treatment for erectile failure using a vasoactive cream.Patients and methodsFourteen patients with erectile failure who had previously responded to intracorporeal injection therapy were enrolled in a randomized placebo‐controlled trial. They were given two topical applications, comprising either a cream containing aminophylline, isosorbide dinitrate and co‐dergocrine mesylate, or a placebo cream of similar appearance containing no pharmacologically active ingredients. Each patient received 16 applications, eight of the active cream and eight placebo. The creams were applied alternatively on successive occasions and the results recorded.ResultsThe active cream, applied on 77 occasions, resulted in three good and 13 partial erections. The placebo cream, applied on 76 occasions, yielded four good and 13 partial erections.ConclusionsWe were unable to reproduce the successful results reported by others; in the present study the active cream performed no better than placebo.
Endocrine effects, efficacy and tolerability of a 10.8‐mg depot formulation of goserelin acetate administered every 13 weeks to patients with advanced prostate cancer
Authors: Sarosdy  , Schellhammer  , Soloway  , Vogelzang  , Crawford  , Presti  , Chodak  , Mitchell  , Porter  
Published: March 2003

ObjectiveTo determine the endocrine effects, efficacy and tolerability of a 10.8‐mg depot formulation of Zoladex™(goserelin acetate, Zeneca Pharmaceuticals, Wilmington, Delaware, USA), a luteinizing hormone‐releasing hormone agonist analogue, when administration was extended from every 12 weeks to every 13 weeks in patients with advanced prostate cancer.Patients and methodsBetween July 1995 and May 1996, 59 patients with either locally advanced (T3 or T4)or metastatic prostate cancer were enrolled in an open‐label, multicentre trial. Primary efficacy endpoints were testosterone measurements, and assessments of prostate specific antigen (PSA) response, subjective and objective response. Quality of life (QoL) was a secondary efficacy endpoint.ResultsMean testosterone concentrations decreased to < 0.3 μg/L by week 4 and remained so for the duration of treatment. There were no statistically significant differences in mean testosterone levels between weeks 12 and 13, or weeks 25 and 26. Serum testosterone suppression was adequate in all 58 evaluable patients at week 13, and 51 of 52 (98%) patients at week 26. Of the 58 evaluable patients, 52 (90%) had a PSA response. A subjective response was recorded for six of 11 evaluable patients. Of 58 patients evaluable for objective response, 46 (79%) had a partial response, three (5%) had stable disease and nine (16%) had objective progression. Except for a significant (P=0.014) decrease in overall sexual interest, QoL was unchanged during therapy. The most common side‐effects, regardless of causality, were hot flushes (67%), pain (31%) and pelvic pain (22%). Mild injection‐site complaints occurred with only three of 221 (1.4%) depot injections.ConclusionsZoladex™ 10.8‐mg depot, administered every 13 weeks to patients with advanced prostatic cancer, is well tolerated, provides adequate suppression of serum testosterone and produces PSA, subjective and objective responses.
Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management
Authors: Corman  , Moody  , Aronson  
Published: March 2003

ObjectiveTo examine the outcome of 23 consecutive patients with Fournier’s gangrene.Patients and methodsPatients’ charts were reviewed retrospectively from all those treated for Fournier’s gangrene between July 1994 and July 1997 at the UCLA affiliated hospitals.ResultsTwenty‐three patients were identified (mean age 51.7 years, range 13–71). The aetiologies included perirectal abscess (43%), urethral stricture (30%), scrotal abscess (21%) and unknown (4%). Predisposing factors included diabetes mellitus (43%), steroids or chemotherapy (21%), alcohol abuse (43%), malignancy (26%) and radiation therapy (9%). All 23 patients initially received wide debridement and placement of a percutaneous suprapubic tube. At the time of the first surgery, total scrotectomy was required in all, colostomy in 17% and penectomy in 4%. An additional 35% required eventual colostomy and an additional 9% required a penectomy. Patients underwent repeat debridement a mean of 2.5 times; the overall survival was 96%.ConclusionSurvival can be improved in patients with Fournier’s gangrene by combining aggressive surgical and medical management. The keys to successful outcome included a high index of suspicion, prompt fluid resuscitation, rapid initiation of broad‐spectrum antibiotics, a multidisciplinary approach, early surgical intervention with radical debridement, haemodynamic support in an intensive care setting, and frequent repeat operative debridement.
A new approach to bladder augmentation in children: seromuscular enterocystoplasty
Authors: Dayanç  , Kilciler  , Tan Ö. , Gökalp  , Göktaş  , Peker  
Published: March 2003

ObjectiveTo report the use of seromuscular enterocystoplasty (SE) combined with detrusorectomy, in children.Patients and methodsBetween 1993 and 1998, SE was performed in 10 children (aged 10–17 years) with a spastic neurogenic bladder resulting from spinal trauma. Before surgery all children were incontinent and despite anticholinergic medication and clean intermittent catheterization, their bladder capacity was 60–100 mL and their intravesical pressure 40–60 cmH2O.ResultsBefore surgery, the mean end‐filling intravesical pressure was 47.7 cmH2O and the mean bladder capacity 82.9 mL. At 3 months after surgery the mean end‐filling intravesical pressure was decreased to 21.1 cmH2O and the mean bladder capacity increased to 319.6 mL. One patient (a 14‐year‐old girl) had urinary retention soon after surgery and has since used clean intermittent catheterization. The other children were able to void successfully using the Valsalva manoeuvre; none were incontinent. All patients were followed and there were no changes in intravesical pressure and bladder capacity.ConclusionIn providing most of the desired features of an ideal augmentation segment, SE is a good and effective method of bladder augmentation.
Laparoscopy as the investigation and treatment of choice for urinary incontinence caused by small ‘invisible’ dysplastic kidneys with infrasphincteric ureteric ectopia
Authors: Yeung  , Liu  , Ng  , Tan  , Tam  , Lee  
Published: March 2003

ObjectiveTo report our experience of using laparoscopy for the accurate location and simultaneous removal of small dysplastic kidneys with ectopic ureteric insertion causing urinary incontinence and that were not detected by conventional imaging modalities.Patients and methodsSeven girls (mean age 7.9 years, range 3.5–13) presented with urinary leakage occurring between normal voids. Imaging studies including ultrasonography, renal scintigraphy, intravenous urography, computed tomography and/or magnetic resonance imaging in six of the seven patients revealed a single normal functioning kidney, but failed to detect the contralateral nonfunctioning dysplastic kidney. All patients were examined under anaesthesia, followed by transperitoneal laparoscopy for the simultaneous localization and removal of the dysplastic kidneys under the same setting.ResultsLaparoscopy in all seven patients revealed a small dysplastic kidney that could always be easily located by first finding the draining ureter over the iliac vessels and then following it upwards. Four dysplastic kidneys were found in the renal fossa (two left, two right). One kidney was found at the left iliac fossa just above the pelvic brim, one at the left lumbar region, and the other at the right iliac fossa. Laparoscopic nephroureterectomy was successful in all seven girls and the patients were discharged 48 h after surgery. The follow‐up (mean 2.7 years, range 3 months–5.4 years) showed excellent cosmetic results and all the patients have remained completely dry.ConclusionsIn patients with a classical picture of urinary incontinence caused by infrasphincteric ureteric ectopia associated with a small nonfunctioning kidney, video‐laparoscopy, with its magnifying effect, can reliably confirm the diagnosis, locate the dysplastic kidney and allow its removal in the same setting. We propose that laparoscopy should be considered the investigation and treatment of choice in such patients, and should be undertaken without delay even if the dysplastic kidney or the ectopic ureteric orifice cannot be identified with all other conventional means.
A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones
Authors: Joshi  , Obadeyi  , Rao  
Published: March 2003

ObjectivesTo determine the optimal method of treatment for ureteric stones causing complete obstruction, treated by insertion of a JJ stent or a nephrostomy tube, followed by extracorporeal shock wave lithotripsy (ESWL) or by urgent in situ ESWL if readily available.Patients and methodsThe study comprised a retrospective analysis of 82 consecutive patients who presented with ureteric stones causing complete obstruction. Twenty‐six had a percutaneous nephrostomy (PCN, group 1) and 40 had a JJ stent (group 2) placed to relieve the obstruction, and the stones were subsequently treated by ESWL. Sixteen patients underwent urgent in situ ESWL without recourse to either a JJ stent or a PCN (group 3). The choice of the procedure was not determined by stone size, site or other factors, but mainly by the attending surgeon’s preference or the availability of urgent ESWL. The success rate was measured by the disintegration of the stone and spontaneous passage after ESWL; failure was defined as the need for additional procedure(s) for stone extraction.ResultsUrgent in situ ESWL (group 3) had a median (95% confidence interval) success rate of 81 (54–96)%, compared with 70 (53–83)% in group 2 and 54 (33–73)% in group 1.ConclusionIf facilities are available, urgent in situ ESWL appears to be the choice of treatment for obstructing ureteric stones. If such facilities are not available, a JJ stent may offer better success than a PCN. A prospective controlled trial is necessary to confirm these findings.
Resistive index in renal colic: the effect of nonsteroidal anti‐inflammatory drugs
Authors: Shokeir  , Abdulmaaboud  , Farage  , Mutabagani  
Published: March 2003

ObjectiveTo investigate the effect of nonsteroidal anti‐inflammatory drugs (NSAIDs) on the findings of Doppler ultrasonography (DU) in patients with acute unilateral renal obstruction.Patients and methodsThe study included 60 patients (120 kidneys) with unilateral loin pain suspected to be of renal origin. All patients were evaluated using renal ultrasonography (US) and intravenous urography (IVU) during the attack of loin pain and before giving any medication. Then the patients were given 75 mg diclofenac sodium and DU studies were repeated at 6 and 12 h. In 10 patients with acute renal colic, DU was possible 12–24 h after the relief of ureteric obstruction. The mean resistive index (RI) and ΔRI at baseline were compared with the mean values 6 and 12 h after giving diclofenac. The RI and ΔRI were considered positive at values ≥0.70 and ≥0.06, respectively. The sensitivity, specificity and overall accuracy of RI and ΔRI values before and after giving diclofenac were calculated using IVU as the reference standard.ResultsIVU showed that both kidneys were normal in 20 patients that 40 had unilateral obstruction. At baseline, the mean (sd) RI was 0.72 (0.06) in the 40 obstructed kidneys, significantly higher than the RI of 0.60 (0.06) for the 60 normal kidneys (P<0.001). Six hours after giving diclofenac, the mean RI of normal kidneys remained stable and that of the obstructed kidneys decreased significantly to 0.67 (0.06) (P<0.001) and was almost stable at 12 h. Nevertheless, the mean RI of the obstructed kidneys remained significantly higher than that of the normal kidneys at 6 and 12 h after diclofenac. The mean ΔRI decreased significantly from 0.11 (0.04) at baseline to 0.06 (0.04) at 6 h after diclofenac (P<0.001) and remained almost stable at 12 h. In the 10 patients undergoing DU after the relief of obstruction, the mean RI returned to normal. At baseline, RI was sensitive in 70% and specific in 98%, while ΔRI was sensitive in 88% and specific in all cases. Six hours after diclofenac, the specificity of RI and ΔRI remained stable while the sensitivity decreased significantly to 50% and 68%, respectively.ConclusionNSAIDs significantly decrease the RI of acutely obstructed kidneys, causing a significant reduction in the sensitivity of DU values identifying acute renal obstruction. To evaluate acute loin pain, DU should be carried out while the patient is in pain and before giving NSAIDs.
Sham treatment compared with 30 or 60 min of thermotherapy for benign prostatic hyperplasia: a randomized study
Authors: Brehmer  , Wiksell  , Kinn  
Published: March 2003

ObjectiveTo study the differences in subjective and objective results after 30 or 60 min of transurethral thermotherapy (TUMT) or sham treatment in men with benign prostatic hyperplasia (BPH).Patients and methodsForty‐four patients with lower urinary tract symptoms caused by BPH were randomized to undergo 30 or 60 min of TUMT or sham treatment (14, 16 and 14 patients, respectively). The patients were evaluated using symptom scores, timed micturition, free flow rates and urodynamics before and after treatment. They were followed for 1 year, at the end of which they rated the treatment results on a self‐administered visual analogue scale.ResultsForty‐two patients completed the study. The treatment failed in some patients in all groups, but the improvement in maximum and median flow rates, timed micturition and micturition frequency (day and night) was greater after TUMT than in the sham‐treated group. Symptom scores also improved more after TUMT, although not significantly. There was a good correlation between the decrease in urinary frequency, especially nocturnal, and the patients’ perception of a successful treatment, whereas the increase in maximum urinary flow rate was apparently of little importance.ConclusionsTUMT had a better effect than the placebo treatment, having a greater impact on irritative than on obstructive symptoms. More patients were satisfied after the 30‐min than after the 60‐min treatment.
The Pippi Salle urethral lengthening procedure; experience and outcome from three United Kingdom centres
Authors: Hayes  , Bulusu  , Terry  , Mouriquand  , Malone  
Published: March 2003

Objective To assess the outcome of the Pippi Salle (Kropp onlay) urethral lengthening procedure in the treatment of neuropathic urinary incontinence.Patients and methods Twenty‐eight patients (12 males and 16 females, mean age at surgery 12.6 years, range 7–32) were identified who underwent the procedure between 1993 and 1997 in the United Kingdom. Outcomes were assessed by a review of the case notes.Results Of the 28 patients, 18 (64%) were rendered continent by day, and 17 (61%) by day and night. Twelve of the 16 females were completely dry, and a further girl was dry by day, giving overall daytime continence in 13 patients; five males were rendered continent (P=0.03, chi‐square test). Four patients required revision surgery; in five patients (two females and three males) the method was abandoned and they underwent an alternative procedure, and a further four are being reassessed.Conclusion The Pippi Salle procedure should be considered as a first‐line treatment option for neuropathic incontinence in females. Its place in the management of incontinent males is less convincing.
The preventive effect of systemic treatment with interferon‐α2B for infertility from mumps orchitis
Authors: Ku  , Kim  , Jeon  , Lee  
Published: March 2003

Objective To evaluate the effect of interferon‐α2B on mumps orchitis, often caused by postpubertal mumps and which can result in permanent testicular atrophy.Patients and methods The study included 21 patients with mumps orchitis, treated between May 1990 and June 1997. Patients were randomly assigned into two groups: in group 1, 13 patients received therapy with interferon‐α2B (3×106 IU per day) and group 2 did not, acting as controls. All were evaluated by measurements of testis size, mumps virus titre, hormone level and semen analysis.Results In group 1, the patients’ symptoms resolved within 2–3 days and the volume of the testes returned to normal within 11 days; there was no testicular atrophy in any patient during the follow‐up. However, asthenospermia continued to be detected in four patients (unilateral in two, bilateral in two). In group 2, the patients’ symptoms resolved within 5–6 days and the volume of the testes returned to normal within 10 days; testes atrophied in three patients (unilateral in two, bilateral in one) during the follow‐up. Asthenospermia continued in four patients (unilateral in two, bilateral in two).Conclusion These results suggest that treatment with systemic interferon‐α2B is effective in preventing testicular atrophy when combined with standard symptomatic treatment.
The stability of free and bound prostate‐specific antigen
Authors: Cartledge  , Thompson  , Verril  , Clarkson  , Eardley  
Published: March 2003

Objective To determine if the assay for free prostate specific antigen (fPSA) and the calculated ratio of fPSA to total PSA (f/tPSA) is stable in conditions likely to be met in routine clinical practice.Materials and methods Two blood samples were obtained from 27 patients attending a routine urology clinic. Sample 1 was centrifuged immediately, assayed for fPSA and tPSA, and the f/tPSA calculated. This sample was then stored at 4°C for 24 h, 48 h and 1 week, or at −20°C for 24 h, 1 week and 1 month before the assays for fPSA and tPSA were repeated. The second sample was left at room temperature for 24 h before assay and processing, as for sample 1.Results tPSA is a highly stable analyte; if whole blood samples are processed immediately, fPSA is stable for 24 h at 4°C and 1 month at −20°C. There was a significant reduction in the calculated f/tPSA in samples stored for ≥24 h at 4°C (P<0.01); if the sample was stored at −20°C the calculated f/tPSA was stable. After 24 h storage at room temperature, fPSA decreased by 6.3% and f/tPSA by 6.4%. Subsequent storage of serum at 4°C for 1 week resulted in a 25% decrease from the baseline value. After 1 month at −20°C the fPSA value was 13% lower than the baseline value.Conclusion These results indicate that if there is to be confidence in the accuracy of the f/tPSA value, then blood samples must be handled and processed correctly. Total PSA is sufficiently stable to permit whole blood samples to remain at room temperature for 24 h before serum is separated. If fPSA is to be determined accurately then the whole blood sample must be centrifuged promptly. As the fPSA values in blood samples left at room temperature for 24 h are up to 25% lower than those on immediate assay, and the subsequent f/tPSA 29% lower, then for the optimum use of this test, these samples should also be handled appropriately.
Extra‐anatomic stents in ureteric obstruction: experience and complications
Authors: Minhas  , Irving  , Lloyd  , Eardley  , Browning  , Joyce  
Published: March 2003

Objective. To assess the role of extra‐anatomic stents (EAS) as a means of urinary diversion in patients with ureteric obstruction secondary to malignancy.Patients and methods.The technique for inserting EAS in patients with ureteric obstruction was described previously; to date, 13 patients (seven women and six men, mean age 45.3 years, range 22–78) have been treated. All patients had ultrasonographic evidence of hydronephrosis and/or significant biochemical evidence of renal impairment. Patients had advanced malignancy and one patient an abdominal aortic aneurysm.ResultsUrinary diversion was successful in all patients; two survived for more than 1 year, with stent changes at 6‐monthly intervals. In three patients the stents were replaced by percutaneous nephrostomies because of problems with leakage or infection. The remaining patients died with functioning EAS in situ.ConclusionsIn patients with ureteric obstruction secondary to malignancy or medical conditions excluding them from more invasive surgery, EAS provide a further therapeutic option instead of a permanent nephrostomy, which has associated inherent problems. This technique is not without potential problems and careful selection of patients remains vital in this difficult area.