bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome
Authors: Parnham A.P. , Low A. , Finch P. , Perlman D. , Thomas M.A.B. 
Published: November 2003

Objective To review retrospectively the Perth experience of autotransplantation for loin pain haematuria syndrome and identify possible factors associated with its failure. Patients and methods The medical records of 11 women patients (median age 42 years, range 29–48) who had 12 autotransplantations were reviewed. All patients were then interviewed and asked whether they considered the operation a success. Results All patients initally had complete relief of symptoms. Three patients who had four transplants are still symptom‐free with a follow‐up of 24–46 months. Five patients have had partial relief with marked variability in their patterns of recurrent pain. Three patient have symptoms as severe as those before operation. One kidney was lost because of acute thrombosis and another developed a urinoma. No patient had deterioration in renal function. Conclusion Renal autotransplantation is a treatment option of last resort, with acceptable morbidity in patients with intractable, functionally disabling renal pain, but three‐quarters of these patients may develop recurrent pain in the transplant site. A current or past history of depression or absence of haematuria may represent risk factors for a poor post‐operative prognosis. Treatment failure is predictable by a poor response to sympathetic neurolytic block.
Acid‐base metabolism after bladder substitution with
Authors: Poulsen A.L. , Steven K. 
Published: November 2003

Objectives To assess acid‐base metabolism after bladder substitution with the ileal Kock reservoir, using capillary blood‐gas analysis, measurement of the renal excretion of ammonium and titratable acid and the evaluation of renal function by plasma clearance of 51Cr‐labelled ethylenediamine tetra‐acetic acid (51Cr‐EDTA). Patients, subjects and methods The investigation comprised both a cross‐sectional study, with initial measurements after surgery, and a longitudinal study, with pre‐operative measurements, both groups of patients being followed for 2 years after inclusion. The cross‐sectional study included 26 patients (median age 66 years, range 44–75), with a median post‐operative follow‐up of 1.2 years (range 0.3–3.7), and 16 control subjects (median age 62 years, range 34–80), and the longitudinal study comprised seven patients (median age 57 years, range 42–68). Results The median values for capillary blood pH, carbon dioxide pressure, standard bicarbonate and standard base excess were significantly lower in patients with a bladder substitute than in the control subjects. An acid‐base chart showed that the values for 44% of patients and none of the controls were within the area representing mild metabolic acidosis. This difference could not be attributed to differences in renal function because the 51Cr‐EDTA clearance was normal and similar in the two groups of patients and among patients and controls. Nevertheless, the median values for each of the variables measured by blood‐gas analysis were within the reference interval of the normal population. Net acid excretion was similar in patients with a bladder substitute and control subjects, but urinary pH was significantly higher in the patients. Accordingly, the renal excretion of ammonium was significantly higher and the excretion of titratable acid significantly lower in patients after ileal bladder substitution. Conclusions The results are consistent with the hypothesis that bladder substitution with the ileal Koch reservoir results in an acid load to the body, caused mainly by ammonium reabsorption in the reservoir. The acid load is compensated by an increased renal excretion of ammonium but causes a mild metabolic acidosis in about half the patients.
Evaluation of asymptomatic microscopic haematuria—influence and clinical relevance of osmolality and pH on urinary erythrocyte morphology
Authors: Georgopoulos M. , Schuster F.X. , Porpaczy P. , Schramek P. 
Published: November 2003

Objective To determine whether the morphological distinction between ‘dysmorphic’ and ‘eumorphic’ erythrocytes in urinary sediment differentiates microscopic haematuria (MH) from reno‐parenchymal and post‐renal bleeding.Materials and methods The erythrocyte morphology of 2145 urinary sediments from 1391 patients with MH was evaluated by interference‐contrast microscopy and compared with the osmolality, pH and specific gravity of the urine samples.Results Compared with more concentrated urine specimens, samples of <700 mOsmol/kg showed significantly lower percentages of dysmorphic erythrocytes; there was a similar reduction in this percentage at a pH≥7. In addition, erythrocytes lysed in diluted or alkaline urine and therefore, under these conditions, no diagnosis could be made.Conclusion The assessment of erythrocytes in urinary sediment should be performed only under ‘standard conditions’, i.e. in concentrated and acidic urine, ≥700 mOsmol/kg and a pH<7. The presence of ≥90% dysmorphic erythrocytes in patients with asymptomatic MH, the absence of proteinuria, a normal blood pressure and normal radiological examination indicates ‘reno‐parenchymal MH’, requiring a long‐term follow‐up with a routine evaluation twice a year, but no immediate treatment in most cases. In contrast, the presence of ≥90% eumorphic erythrocytes or even ‘mixed’ results (10–90% eumorphic erythrocytes) indicates ‘post‐renal MH’, requiring a complete urological evaluation.
The benefits of a shared‐care prostate clinic
Authors: Booth C.M. , Chaudry A.A. , Smith K. , Griffiths K. 
Published: November 2003

Objective To establish a hospital based shared‐care clinic to investigate and manage benign prostatic hyperplasia (BPH) with general practitioners (GPs). Patients and methods During one year, 330 patients referred with suspected prostatic obstruction were investigated in an outreach clinic in a rural cottage hospital by urology department nurses according to a protocol. After this, they were referred directly back to their GPs with recommendations for their management or seen in the urologist's clinic. A questionnaire was completed by the GPs to assess their satisfaction with and attitudes to the clinic. Results One‐third of the patients were referred directly back to their GP, a third were seen routinely and a third seen urgently in the urologist's clinic, usually because a prostate‐specific antigen assay indicated the possibility of latent prostatic cancer. A survey confirmed that GP support for the clinic was unanimous whilst patients were reassured by the thoroughness and sensitivity of the clinic's nursing staff. Conclusion The clinic reduced the workload of the GPs and urologists whilst providing a speedy and comprehensive assessment of patients presenting with suspected prostatic obstruction.
Bilateral orchidectomy and flutamide versus orchidectomy alone in newly diagnosed patients with metastatic carcinoma of the prostate — an Australian multicentre trial
Authors: Zalcberg J.R. , Raghaven D. , Marshall V. , Thompson P.J. 
Published: November 2003

Objectives To investigate the hypothesis that maximal androgen blockade improves the outcome of patients with metastatic prostate cancer. Patients and methods A total of 222 previously untreated patients with metastatic prostatic cancer were entered into a randomized, double‐blind, placebo‐controlled trial of bilateral orchidectomy with or without androgen blockade (112 receiving flutamide and 110 a placebo) which commenced in 1985 in four Australian centres. The characteristics of the patients, e.g. age, performance status, the presence of bone pain, duration of disease and the use of prior radiation, were well balanced between the groups. Patients commenced the protocol therapy with flutamide or placebo within the 7 days preceding surgery and continued this medication for a minimum of 2 years, unless there was unequivocal evidence of tumour progression. Results Apart from a difference in grade 3 or 4 gastrointestinal toxicities between the flutamide and placebo arms (13% and 3%, respectively), serious or life‐threatening toxicities were uncommon and equally balanced. The assessment of response in six patients (three in each arm) was inevaluable. The objective response rates were 45% and 56% in the flutamide and placebo arms, respectively. There was no difference in survival between the treatments. Conclusions This study was not sufficiently powerful to detect small differences in outcome (although the trend in survival favoured the placebo arm) but nevertheless failed to show any benefit for maximal androgen blockade over orchidectomy in this group of patients.
A review of antegrade stenting in the management
Authors: Sharma S.D. , Persad R.A. , Haq A. , Appleton D.S. , Doyle P.T. , Bullock K.N. , Doble A. 
Published: November 2003

Objective To review experience in the management of the obstructed ureter using antegrade stenting in a variety of conditions. Patients and methods Between 1984 and 1993, 41 patients (mean age 57 years, range 9–83) had antegrade stents placed by an experienced interventional radiologist. The causes of obstruction were urological in 27, gynaecological in eight, colorectal in three and miscellaneous in three. Results The overall success rate for antegrade stent insertion was 83% and the failure rate was greatest (four of six) in cases of ureteric injury following gynaecological procedures. There were no immediate complications. Conclusion Antegrade stenting can be used as a temporary or permanent solution to ureteric obstruction. The technique is safe, acceptable to patients and avoids the need for a general anaesthetic.
Laparoscopic dismembered pyeloplasty in children: preliminary results
Authors: Tan H.L. , Roberts J.P. 
Published: November 2003

Objectives To investigate the technique of laparoscopic pyeloplasty in children with pelvi‐ureteric junction (PUJ) obstruction. Patients and methods Six children, aged between 2.5 and 15 years, were treated by laparoscopic pyeloplasty in a prospective study. The outcome was assessed by post‐operative isotopic renography. Four of the children underwent a Y/V plasty of the PUJ structure and one a Hynes‐Anderson dismembered pyeloplasty. Results One case (the first in this series) was converted to open pyeloplasty due to adhesions around the PUJ from previous surgery. One patient developed an abdominal haematoma at the trocar site, which resolved without treatment. All anastomoses were completed without complication. Five of the children had normal or significantly improved drainage times on post‐operative renography. In one patient, the drainage time deteriorated post‐operatively, although differential function of the operated kidney improved. Conclusions These early results suggest that laparoscopic pyeloplasty in children is feasible, safe and effective; a longer term follow‐up is awaited.
Evaluation of local immune response after intravesical bacille Calmette‐Guérin treatment for superficial bladder cancer
Authors: Patard J‐J. , Muscatelli‐Groux B. , Saint F. , Popov Z. , Maille P. , Abbou C. , Chopin D. 
Published: November 2003

Objective To help define the optimal protocol of Bacille Calmette‐Guérin (BCG) treatment for transitional cell carcinoma (TCC) of the bladder by examining cytokine production and antigen presentation to effector cells after instillations of BCG in patients with bladder TCC. Patients and methods Sixty‐four urine samples from 11 patients were tested for the production of interferon γ (IFN‐γ) using a modified commercial enzyme‐linked immunosorbent assay (ELISA) kit. Urine was collected before and at intervals up to 24 h after the intravesical instillation of BCG. Immunohistological studies were also carried out using a two‐step alkaline phosphatase technique to explore the expression of tumour‐associated antigens (TAAs) (E7, 19A211, T138), major histocompatibility complex (MHC) molecules and lymphocyte subset infiltrates (CD3, CD4, CD8) in bladder biopsies before and 3 weeks after the completion of treatment in seven patients. Results IFN‐γ was only detected 4, 6 and 8 h after instillation, with a maximum concentration at 6 h (2.9–34.7 IU/mL in 10 patients). During a 6‐week course of BCG, IFN‐γ was barely detectable after the first two instillations, but gradually increased from the third instillation onwards. TAA and MHC II antigens, which were absent or faintly expressed on normal urothelial cells before treatment, were expressed strongly in five patients after treatment. The local recruitment of immunocompetent cells was detected in all patients. Conclusion These results suggest that the local immune response after the intravesical instillation of BCG can be quantified using simple ELISA tests and could be useful in defining objective criteria for rationalizing treatment (dose and duration), and in determining the relation between the immune response and anti‐tumour activity. There is evidence that antigen presentation is enhanced after BCG instillations, suggesting that a T cell‐MHC restricted pathway might be involved in the anti‐tumour response. This study supports the search for tumour‐rejection antigens in bladder cancer.
Decreasing bladder cancer mortality in the Netherlands
Authors: Kiemeney L.A.L.M. , Straatman H. , Witjes J.A. 
Published: November 2003

Objective To evaluate the prediction that the observed increasing trend in male bladder cancer mortality in the Netherlands between 1955 and 1988 would change to a decreasing trend. Materials and methods Using demographic and mortality data from the Netherlands Central Bureau of Statistics, male and female bladder cancer mortality per 105 person‐years from 1955 to 1994 were calculated. Changes in the age structure of the Dutch population were adjusted using direct standardization to the European ‘standard’ population. The effects of age, calendar period and birth cohort on the temporal trend in mortality were evaluated using log‐linear modelling. Results Male mortality from bladder cancer increased from 6.2 per 105 in 1955 to 12.6 per 105 in 1990, but decreased thereafter. Female mortality from bladder cancer has remained stable throughout the study period, at 2.8 and 2.7 per 105 in 1955 and 1994, respectively. The changing trend among men is consistent with an increasing risk for successive birth cohorts until the 1910 cohort and a decreasing risk for cohorts born after 1930. This cohort effect is probably caused by changes in the smoking behaviour of the male Dutch population. There were no differences in risk for successive birth cohorts of females. Conclusion Male mortality from bladder cancer in the Netherlands will probably decrease for at least another decade. A future increase in female mortality from bladder cancer, as recorded for lung cancer, is unlikely.
Comparison of real‐time ultrasonography and magnetic resonance imaging in the assessment of urinary bladder volume
Authors: Walton J.M. , Irwin K.S. , Whitehouse G.H. 
Published: November 2003

Objective To compare estimates of bladder volume obtained by conventional real‐time ultrasonography with those obtained from magnetic resonance imaging (MRI) by the Cavalieri method of unbiased stereology. Subjects and methods The study comprised nine subjects (four men and five women, mean age 23 years, range 18–34) with no history of bladder disease. Before micturition, each volunteer underwent ultrasonography, immediately followed by MRI. The volunteers then voided, the true voided volume of urine was measured and the imaging protocols were repeated in the same order after micturition. The bladder volume was estimated from ultrasonography using the formula; volume=0.7 (L×TS×AP), (where L is the maximum supero‐inferior diameter, AP the maximum anteroposterior diameter and TS the maximum transverse diameter) and from MRI using the Cavalieri method. For each imaging modality, the volume of urine voided was estimated as the difference in the volume estimate before and after micturition. Results The mean percentage coefficient of variation for the estimates of bladder volume by ultrasonography was 2.17 before and 4.43 after micturition. There was no significant difference in the replicate estimates of each bladder diameter by ultrasonography before and after micturition (P=0.98). The MRI method consistently underestimated the voided volume; the mean discrepancy between the estimated voided volume and the true voided volume was 7.7 mL and –67.7 mL for the ultrasonographic and MRI estimates, respectively, which are significantly different (P=0.02) when assessed using a multifactor ANOVA. Further analysis using multiple‐range tests showed a significant difference between the voided volume estimated by MRI and the corresponding true voided volume. There was no difference between the voided volume estimated by ultrasonography and the corresponding true volume. Conclusion Ultrasonographic estimates of voided volume were more reliable than the those obtained using the MRI method. This is possibly due to a delay between micturition and the acquisition of MR images after micturition, which allowed the bladder to partly refill with urine. The empirical approach using measurements from ultrasonograms provides a fast and reliable technique; ultrasonography remains the recommended imaging modality for estimating bladder volume.
Sociodemographic and symptomatic characteristics of women undergoing stress incontinence surgery in the UK
Authors: Black N.A. , Griffiths J.M. , Pope C. , Stanley J. , Bowling A. , Abel P.D. 
Published: November 2003

Objectives To: (i) describe the sociodemographic characteristics of women undergoing surgery for stress incontinence in the UK and the ways in which they differ from women of a similar age in the general population; (ii) the severity and impact of their symptoms and their expectations of surgery and; (iii) their general state of health. Patients and methods A prospective cohort study was carried out on 442 women undergoing surgery for stress incontinence in 18 hospitals in the North Thames region between January 1993 and June 1994. Sociodemographic factors, stress incontinence severity, symptom impact scores, and general health status were measured. Results Women undergoing surgery for stress incontinence were similar to their peers in the general population apart from being more likely to have smoked (61.4 against 51.1%), to have subsequently given up (39.5 and 25.3%) and to be of higher parity (≥4; 19.7 and 12.0%). Most women (81.6%) reported moderate to very severe stress incontinence. The impact of symptoms was correlated positively with severity (P<0.001) after accounting for its positive correlation with mental health status (P<0.005), socioeconomic status (P<0.05) and its negative correlation with age (P<0.02). Many women also suffered from other urinary symptoms including urgency (76%) and frequency (42.3%). Apart from their urinary problems, women were in good health (77% reported no or only mild coexistent conditions). However, a very high proportion (34.2%) had previously undergone a hysterectomy. Conclusions These results suggest that women undergoing stress incontinence surgery are remarkably similar to their peers, apart from their primary condition. The effect that stress incontinence has on women's lives depends not only on the severity of the problem but also on other factors. The high rate of previous hysterectomy warrants further study.
Concrement formation and urease‐induced crystallization in urine from patients with continent ileal reservoirs
Authors: Edin‐Liljegren A. , Grenabo L. , Hedelin H. , Jonsson O. , Åkerlund O. , Pettersson S. 
Published: November 2003

Objectives To study the relationship between urinary tract infection, urine composition and concrement formation in patients with continent ileal reservoirs for urinary diversion. Patients and methods The study comprised 27 patients (seven men and 20 women, mean age 47 years, range 23–76) with continent ileal reservoirs who were followed for a mean of 67 months (range 13–146) by annual reservoiroscopy, intravenous urography and urine culture; at the final follow‐up, a sample of their morning urine was analysed for a range of compounds and the number and size of any particles present or produced in response to incubation with urease. Results The presence of urease‐producing bacteria was associated with the formation of concrement. However, a few patients in whom an infection with urease‐producing organisms was not detected also formed concrement. Urine from those patients forming stones tended to have a high calcium and a low citrate concentration. After incubation with urease, significantly more and larger particles were formed in the urine from stone formers. There was a strong correlation (r=0.8) between urinary calcium content and urinary pH when the urease‐induced precipitation commenced, and between urinary calcium and the size and volume of the crystals developed (r=0.9) after 4 h of incubation. Conclusions There are many factors which might influence the formation of concrement, e.g. outflow conditions, the presence of staples or infection in the reservoir, and the composition of the urine is also important. It thus appears appropriate to determine if measures to reduce urinary calcium and increase urinary citrate can decrease the episodes of stone formation in those patients with continent ileal reservoirs for urinary diversion who frequently form stones.
Visual laser ablation of the prostate for patients with
Authors: Farsi H.M.A. 
Published: November 2003

Objective To evaluate the efficacy of visual laser ablation of the prostate (VLAP) and bladder neck incision in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia (BPH). Patients and methods Twenty‐three patients (mean age 62 years, range 50–80) with acute urinary retention due to BPH were treated in a prospective trial of VLAP (using a neodymium : YAG laser) with bladder neck incision carried out using the KTP laser. Patients were assessed before and after treatment using the American Urological Association symptom score, prostate volume and peak urinary flow rates. Results There was a significant and durable objective improvement in measured urinary flow rates and a subjective improvement of symptoms, with minimal morbidity. Conclusion VLAP is a promising alternative treatment for patients with acute urinary retention secondary to BPH.
Prostatic adenocarcinoma labelled with a monoclonal antibody and polyclonal serum: a quantitative assessment
Authors: Gray E. , Allison L.J. , Edgar S. , Robinson E. , Cohen R.J. 
Published: November 2003

Objective To investigate the detection of tissue prostate‐specific antigen (PSA) using a monoclonal antibody or polyclonal serum in patients with localized prostate cancer. Patients and methods Fifteen samples of prostatic tissue from patients with localized prostate cancer were assessed for PSA using monoclonal antibodies and polyclonal serum. The intensity and area of chromogen precipitation in several microscopic fields was determined using image analysis. Results There were significant differences in the intensity and distribution of PSA labelling in the tumour between the methods; polyclonal serum was more sensitive in detecting PSA in tissue sections. Notably, there was a focal ‘possible clonal’ pattern of negative labelling with the monoclonal antibody, which contrasted with the positivity of the polyclonal marker. Conclusions The loss of PSA expression in some poorly differentiated cancers may represent the loss of specific epitopes rather than loss of the entire protein.