bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of sexual life after orchidectomy followed by radiotherapy for early‐stage seminoma of the testis
Authors: Caffo  , Amichetti  
Published: March 2003

ObjectiveTo explore the changes perceived by patients in their sexual lives after orchidectomy and radiation therapy of the pelvic and para‐aortic nodes for early‐stage testicular seminoma (ST).Patients and methodsA questionnaire mainly based on two self‐completed instruments, previously used to assess the sexual life of patients affected by testicular cancer (the UCLA/RAND sexual module and the Groningen sexual questionnaire) was mailed to a consecutive series of 143 patients treated for ST between 1961 and 1995, and who showed no signs of disease after primary treatment.ResultsNinety‐eight questionnaires (69%) were returned and were evaluable. The median age of the patients was 48 years (range 26–85) at the time they completed the questionnaire, with the median follow‐up of 123 months (range 15–496). Most of the patients (86%) had been sexually active during the month before completing the questionnaire. Of these patients, 25% reported a low libido and 14% defined their sexual capacity as poor; 14% of the patients avoided sexual contact after treatment because of the disease and/or cancer therapies. After therapy, a minority of the patients found it more difficult to achieve and maintain an erection. Similarly, a few patients reached orgasm less intensely and less frequently. During the period after treatment, 24% reported a low semen volume, 14% premature ejaculation, 2% late ejaculation and 2% an absence of ejaculation. Most of the patients considered the information and counselling given by their physician about the sexual sequelae of therapy to be insufficient. However, the amount of information about the disease and treatment was considered to be good by, respectively, 64% and 61% of the patients. The only variable predictive of sexual adjustment was age at the time of the administration of the questionnaire.ConclusionThe sexual adjustment of patients treated with orchidectomy and radiation therapy for early‐stage ST is generally good, but a few have negative experiences. Although the main predictive factor is age, communication is an important issue and better information tools could lead to better adjustment.
Early and late metabolic alterations in children and adolescents with a Kock urinary reservoir
Authors: Abd‐El‐Gawad  , Abrahamsson  , Hanson  , Norlén  , Sillén  , Sixt  , Hjälmås  
Published: March 2003

ObjectiveTo assess the early and late metabolic effects of urinary diversion in children and adolescents with a Kock urinary reservoir.Patients and methodsThirteen children (aged 10.8– 16 years) and seven adolescents (aged 16–18 years; 10 girls and 10 boys), underwent surgery for congenital urinary incontinence. They were followed for 3–10 years (mean 6.5), divided into an early (3 months to 2 years) and a late (2–10 years) period, and assessed for renal function and any metabolic effects.ResultsAt the early and late follow‐up, one of 19 and three of 16 patients, respectively, had metabolic acidosis. Hyperchloraemia was present in four of 20 patients at the early and in eight of 18 at the late follow‐up. Serum creatinine was increased in four of 20 patients at the early and eight of 18 at the late follow‐up. In patients with infrequent reservoir emptying (≤4 times/day), the serum creatinine level was increased in seven of 13 at the early and eight of 10 at the late follow‐up (P<0.05). The glomerular filtration rate was below normal in four of 20 patients preoperatively, in six of 19 at the early and in eight of 18 at the late follow‐up.ConclusionsThe continent ileal reservoir in children and adolescents produces similar changes to those previously reported in adults. However, almost all patients with metabolic disorders were younger than 16 years at operation. The pre‐existing impairment of renal function, together with associated congenital anomalies, mental and/or physical disorders, young age, recurrent urinary tract infections and infrequent reservoir emptying, leads to deterioration in renal function after the Kock operation. Even with this risk, the Kock pouch remains a viable alternative to other forms of continent urinary diversion, because it has a wide calibre stoma, allowing large‐bore catheters, and is therefore especially suitable for individuals with weak hand function, e.g. quadriplegic or meningomyelocele patients. However, as shown by these results, the child with a Kock pouch requires continuous medical attention.
Radical transurethral resection and chemotherapy in
Authors: Thomas  , Roberts  , Hall  , Reading  
Published: March 2003

ObjectiveTo evaluate the treatment of patients with muscle‐invasive bladder cancer (T2‐T4a) by radical transurethral resection (TUR) and cisplatin‐methotrexate systemic chemotherapy.Patients and methodsFifty patients with transitional cell carcinoma (TCC) of the bladder (nine T2, 36 T3 and five T4a) were treated by ‘complete’ TUR of the bladder tumour followed by 2–6 cycles of cisplatin (70 mg/m2 ) and methotrexate (40 mg/m2 ) chemotherapy. The median (range) tumour size was 3 (1–7 cm). In six patients, attempted TUR at the dome of the bladder led to intraperitoneal perforation; the tumour was excised by partial cystectomy in these patients. The latest follow‐up results from 57 patients treated by radical TUR and methotrexate alone, reported previously, are included.ResultsAt the first evaluation cystoscopy immediately after completing chemotherapy, 38 patients were tumour‐free, eight had persistent muscle‐invasive TCC and four had Ta, T1+CIS disease. With an overall median follow‐up of 47 months, 10 additional patients relapsed with muscle‐invasive carcinoma in the bladder after a median interval of 15.6 months; three patients developed Ta, T1 tumours, three Ta, T1+CIS, and six CIS only. Six of the 10 recurrent invasive tumours were at the same site, but four were at a different site in the bladder. Although during follow‐up 12 patients developed superficial recurrence that required endoscopic treatment, the bladder was preserved (free of muscle‐invasive cancer) in 37 of 50 patients. In 30 of these 37, this was achieved with no need for salvage radiotherapy or cystectomy. Six patients died from metastatic TCC with no tumour in the bladder.ConclusionIn this selected group of patients, muscle‐invasive bladder cancer was controlled by TUR and systemic chemotherapy, preserving normal bladder function in 60% of patients without apparently comprising overall survival.
Inositol hexakisphosphate in urine: the relationship between oral intake and urinary excretion
Authors: Grases F. , Simonet B.M. , March J.G. , Prieto R.M. 
Published: March 2003

Objective To study the relationship between the oral intake of inositol hexakisphosphate (InsP6, phytic acid, an inhibitor of urinary crystallization) and its urinary excretion, to establish their possible mutual influence. Materials and methods Two groups of male Wistar rats (six animals each) received either; tap water and normal rat food pellets (controls); or a liquid diet in which InsP6 was absent and which then received gradually increasing amounts of InsP6. The urinary levels of InsP6 were then assessed regularly in both groups. Results When InsP6 was absent from the diet, urinary excretion declined to undetectable levels after 22 days. The addition of increasing amounts of InsP6 to the liquid diet caused an increase in its urinary excretion after about 10 days. Adding InsP6 in amounts > 425 mg/L caused no further increases in urinary excretion. Adding inositol (with no InsP6) to the liquid diet caused only a slight increase in the urinary excretion of InsP6. Conclusion These results showed that InsP6 urinary levels were related to its oral intake; consequently, a low consumption of InsP6 would cause a urinary deficit of this crystallization inhibitor and thus an increase in the risk of developing urinary calcium stones. Although urinary excretion was dose‐dependent, there was an ingested amount (20.9 mg/kg) above which there was no increase in the amount excreted. This intake is easily obtained by consuming a normal diet (rich in InsP6) indicating that to maintain appropriate urinary levels of InsP6, the consumption of InsP6 supplements is only necessary when the diet is particularly poor in InsP6.
A clinicopathological study of bladder cancer associated with upper urinary tract cancer
Authors: Miyake H. , Hara I. , Arakawa S. , Kamidono S. 
Published: March 2003

ObjectivesTo analyse the clinicopathological features of bladder cancer associated with upper urinary tract cancer (UUTC). Patients and methods Among 106 patients with primary UUTC (mean age 65 years, range 45–82) who underwent surgical treatment, 44 also had bladder cancer. The patients were divided into three groups according to the timing of the appearance of bladder cancer. In group 1, 10 patients had UUTC preceding bladder cancer, group 2 comprised 14 patients with concurrent bladder cancer and group 3, 20 with subsequent bladder cancer; their clinicopathological data were analysed. Results Among several clinicopathological factors examined, only the number of UUT tumours was significantly correlated with the incidence of associated bladder cancer (P < 0.01). There was no significant difference between survival rates of patients with UUTC with and without associated bladder cancer. The incidence of high‐stage or high‐grade tumours in both the UUT and bladder in group 2 was higher than that in groups 1 and 3 (P < 0.05), and the survival rate in group 2 was significantly lower than in those in groups 1 and 3 (P < 0.05). Furthermore, the survival rate of patients in group 2 was significantly lower than that of all other patients (P < 0.01). Conclusions These findings suggest that bladder cancer associated with UUTC has a different biological character depending on the timing of tumour appearance, and that patients with UUTC and concurrent bladder cancer should undergo careful follow‐up and aggressive adjuvant therapy.
The detection of prostate cells by the reverse transcription‐polymerase chain reaction in the circulation of patients undergoing transurethral resection of the prostate
Authors: Heung Y.M.M. , Walsh K. , Sriprasad S. , Mulvin D. , Sherwood R.A. 
Published: March 2003

ObjectiveTo determine whether prostate cells are disseminated into the circulation of patients after transurethral resection of the prostate (TURP), as assessed by a reverse transcription‐polymerase chain reaction (RT‐PCR) assay for prostate specific antigen (PSA) mRNA. Patients and methodsFifty‐one patients, comprising 34 with benign prostatic hyperplasia (BPH) and 17 with prostate cancer who were undergoing routine TURP, had blood samples taken before and 30 min after surgery. The blood mononuclear cell layer was isolated by density‐gradient centrifugation and total RNA extracted. Complementary DNA was synthesized by RT of the RNA. The target PSA sequence was amplified by PCR with specific PSA primers and the product detected on agarose‐gel electrophoresis with ethidium bromide staining. ResultsFive patients (all with prostate cancer) were positive on PSA RT‐PCR before surgery and remained positive after TURP. Of the remaining 46 patients, five (11%; three with BPH and two with cancer) changed from a negative to a positive result after TURP. ConclusionIn a proportion of patients TURP causes the dissemination of prostate cells into the circulation which are then detectable by RT‐PCR of PSA mRNA.
A double‐blind randomized controlled trial and economic evaluation of transurethral resection vs contact laser vaporization for benign prostatic enlargement: a 3‐year follow‐up
Authors: Keoghane S.R. , Lawrence K.C. , Gray A.M. , Doll H.A. , Hancock A.M. , Turner K. , Sullivan M.E. , Dyar O. , Cranston D. 
Published: March 2003

ObjectiveTo evaluate the effect of contact laser prostate surgery in the treatment of benign prostatic hyperplasia. Patients and methodsA prospective double‐blind ran‐domized controlled trial of transurethral resection of the prostate (TURP) and contact laser prostatectomy was conducted, with an economic evaluation of both procedures. The primary outcome measure was the change in the American Urologic Association symptom score, with secondary outcome measures being the peak urinary flow rate, treatment‐related complications, re‐operation rate and health service costs. ResultsThe perioperative blood loss and transfusion requirements were statistically significantly lower for laser prostatectomy than for TURP. There was no clinically significant difference between TURP and contact laser prostatectomy in the mean change in symptom scores and flow rates. There were distinct perioperative advantages in favour of the contact laser treatment, but some disadvantages in terms of re‐catheterization and re‐operation rates. ConclusionsContact laser prostatectomy is a valid treatment for benign prostatic hypertrophy. The performance of contact laser prostatectomy as day‐case surgery would have cost advantages to the National Health Service.
The after‐contraction: a true detrusor contraction or a late dyssynergic urethral sphincter contraction?
Authors: Vereecken R.L. , Vereecken R.L. 
Published: March 2003

Objective To evaluate the mechanism and significance of the after‐contraction, recorded in bladder pressure by urodynamics, at the end of micturition. Patients and methods The urodynamic recordings showing an after‐contraction of the detrusor in 65 patients of all ages and with a variety of pathologies were re‐examined. Special attention was directed to the anal or urethral sphincter needle electromyographic activity and to the monitored urethral pressure, to determine any relationships with the patterns of detrusor pressure. Results An after‐contraction was noted in 61 patients with detrusor instability and in 11 with urethral instability. In 59 patients it was evident that the after‐contraction, i.e. a renewed increase in detrusor pressure during the declining contraction, correlated with a sphincter contraction preceding it by a fraction of a second. Similar increases in detrusor pressure were apparent in patients with detrusor‐sphincter dyssynergia throughout voiding. In six patients the relationship was less clear mainly because there were artefacts in the curves. Conclusion The after‐contraction arises by a sudden stopping of the outflow of urine, provoked by a sphincter contraction. This may occur by involuntary dyssynergia or by an early voluntary interruption of the voiding stream. The ‘milk back’ of urine from the proximal urethra to the bladder and the inhibited detrusor contraction (if the perineal contraction is prolonged) may cause some postvoid residual urine. It occurs mainly in the presence of detrusor and/or urethral instability.
A randomized trial comparing lithoclast with an electrokinetic lithotripter in the management of ureteric stones
Authors: Menezes P. , Kumar P.V.S. , Timoney A.G. 
Published: March 2003

ObjectiveTo compare two in situ ballistic lithotripters, the lithoclast and the electrokinetic lithotripter (EKL), both of which can be used through the newer small‐bore ureteroscopes, for their ease of use, robustness, fragmentation time, adequacy of fragmentation and stone‐free rate. Patients and methodsForty‐six consecutive patients with ureteric stones refractory to treatment by extracorporeal shock wave lithotripsy were randomized to undergo fragmentation using the lithoclast (23 patients) or the EKL (23 patients). One patient was excluded from analysis in the EKL group. The adequacy of fragmentation was recorded, with the degree and significance of proximal migration for each device. After treatment patients were assessed by plain X‐ray and the stone‐free rate was determined. ResultsThe mean (median) initial stone burdens in the lithoclast and EKL groups were 69 (50) mm2 and 72 (52) mm2, respectively. The respective mean (median) procedure duration and fragmentation time were 54 (50) min and 90 (49) s in the lithoclast group, and 50 (42.5) min and 87 (52.5) s in the EKL group; the differences were not statistically significant. In four (14%) patients of each group there was significant proximal migration of the stones. The stones were completely fragmented in 17 of 23 (74%) patients in the lithoclast group and 19 of 22 (86%) in the EKL group. There was no fragmentation in one patient in each group. In the lithoclast and EKL groups, 20 of 23 (87%) and 17 of 22 (77%) were rendered stone‐free, respectively (P > 0.5). The equipment failed on two occasions in each group. ConclusionIn this randomized trial there was no significant difference in the stone‐free rate, procedure duration, fragmentation time, proximal stone migration rate and equipment failure between these in situ ballistic lithotripters.
Does endoscopic laser ablation of the prostate stand the test of time? Five‐year results from a multicentre randomized controlled trial of endoscopic laser ablation against transurethral resection of the prostate
Authors: Mcallister W.J. , Absalom M.J. , Mir K. , Shivde S. , Anson K. , Kirby R.S. , Lawrence W.T. , Paterson P.J. , Watson G.M. , Fowler C.G. 
Published: March 2003

Objective To determine the long‐term objective and subjective outcome of patients with benign prostatic enlargement (BPE) treated by endoscopic laser ablation of the prostate (ELAP), as part of a multicentre randomized controlled trial of ELAP against TURP.Patients and methods Initially, 151 patients with BPE were randomized to undergo either ELAP or TURP, starting in March 1992. ELAP was performed using the Urolase™ fibre (Bard, Covington, GA, USA) in conjunction with a Nd:YAG laser source. All patients who had originally participated in the study were approached 5 years later to obtain a urological history, American Urological Association (AUA) symptom score and two measurements of urinary flow rate, with an ultrasonographic assessment of the postvoid residual urine volume (PVR).Results The mean duration of follow‐up was 61 months; 109 patients were traced, comprising 69 who were alive and well, and had undergone no further bladder outlet surgery, 26 who had required revision surgery, 12 who were dead or terminally ill and three who had dementia. Both ELAP and TURP produced sustained improvements in mean AUA score, maximum flow rate and PVR, with respective values at 5 years of 6.3, 17.8 mL/s and 76 mL, and 6.5, 20.0 mL/s and 55 mL. Eighteen of 47 ELAP patients (38%) and eight of 51 (16%) TURP patients underwent revision surgery within the follow‐up.Conclusion ELAP and TURP produced similar subjective and objective outcomes at 5 years. The re‐operation rate after ELAP was more than double that after TURP and suggests that ELAP should not be used routinely in the management of men with BPE.
Radical retropubic prostatectomy: time trends, morbidity and mortality in Japan
Authors: Arai Y. , Egawa S. , Tobisu K. , Sagiyama K. , Sumiyoshi Y. , Hashine K. , Kawakita M. , Matsuda T. , Matsumoto K. , Fujimoto H. , Okada T. , Kakehi Y. , Terachi T. , Ogawa O. 
Published: March 2003

Objectives To assess the time trends, morbidity and mortality of contemporary anatomical radical retropubic prostatectomy (RRP) in a multi‐institutional study in Japan, where RRP has become more popular in the last decade. Patients and methods Between January 1991 and August 1998, 638 patients underwent RRP at seven urological centres in Japan. Major complications (within 30 days of surgery) and the 30‐day mortality were reviewed retrospectively. Of the patients, 12.9% were < 60 years old, 56.3% were 60–69 years old and 30.9% were  70 years old (median age 67). Results The number of RRPs increased markedly, by more than sevenfold, from 1991–92 to 1996–97, mainly because there were more patients undergoing RRP in their sixth decade. The contribution of T1c disease increased in absolute and relative terms, from 13.9% in 1991–92 to 37.9% in 1997–98. Over time, the mean blood loss and the allogeneic transfusion rate decreased steadily. There was a trend toward more favourable outcomes for pathological variables (an increased percentage of organ‐confined disease, decreased margin positivity and a decreased incidence of positive lymph node metastasis). The most common complications were wound‐related (7.5%), or anastomotic leakage (4.1%). Major cardiopulmonary complications occurred in only two patients (0.31%, both pulmonary embolisms). One patient died from cerebral haemorrhage within 30 days of surgery, giving a mortality rate of 0.16%. Conclusions This study indicates a trend towards selecting patients most likely to benefit from RRP. Although the procedure is technically demanding, it can have an acceptably low rate of early complications, little mortality and need for allogeneic transfusion. The assessment of morbidity suggests a lower incidence of catastrophic thrombo‐embolic and cardiac complications in Japanese patients than in Western men. The present data may be useful in decision‐analysis models evaluating the role of therapy for Asian men with early‐stage prostate cancer.
Trends in the curative treatment of localized prostate cancer after the introduction of prostate‐specific antigen: data from the Rotterdam Cancer Registry
Authors: Spapen S.J.J.C. , Damhuis R.A.M. , Kirkels W.J. 
Published: March 2003

Objective To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing.Patients and methods Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry.Results In the period 1989–95, 4344 patients were diagnosed with prostate cancer and the age‐standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours.Conclusion While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care.
The use of isolated caecal bowel segment in complicated vaginal reconstruction
Authors: Filipas D. , Black P. , Hohenfellner R. 
Published: March 2003

Objective To report a one‐stage procedure, using a segment of caecum, both to overcome failed previous procedures and for primary vaginal replacement in patients with congenital vaginal aplasia, where primary reconstruction often results in vaginal obstruction and fistula formation. Patients and methods The vagina was reconstructed using a 15‐cm isolated caecal segment placed between the bladder and rectum and anastomosed to the introitus. Between 1985 and 1997 the technique was used in 17 patients (mean age 23 years). Indications included congenital malformations and vaginal loss through anterior exenteration or trauma. Seven of the 17 patients had undergone previous complex reconstructions; four of these had undergone previous fistula formation. Fourteen patients were followed for a mean of 3.6 (1–9) years. The surgical outcome was evaluated using a questionnaire completed by the patients. Results The postoperative course was unremarkable in all patients. Four patients developed an introital stenosis requiring surgical intervention. Two patients were minors at the time of follow‐up, while all the others had had sexual intercourse and reported that they were very satisfied with the functional and cosmetic result. Conclusion In patients in whom previous vaginal reconstruction has failed, the caecal segment should be used to create a neovagina. By considering the patient’s age, the surgeon can optimize the surgical result.