bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of isotope penile blood flow and colour Doppler ultrasonography in the assessment of erectile dysfunction
Authors: Glass J.M. , Vale J.A. , Belcaro G. , Nicolaides A. , Witherow R.O'N. 
Published: November 2003

Objectives To determine whether the measurement of penile blood flow by colour Doppler imaging (CDI) and the subjective impressions generated from CDI correlate with the results of measuring isotope penile blood flow (IPBF), and thus determine if CDI is a useful screening investigation for vasculogenic impotence.Patients and methods The study comprised 37 men with impotence of >6 months duration. All patients underwent CDI of the penis; the maximum systolic (vmax ) and minimum diastolic velocity (vmin ) were recorded. Video recordings of the CDI were reviewed subsequently with no knowledge of the erectile response. Twenty‐seven patients then underwent measurement of IPBF.Results There was no relationship between the results obtained from IPBF and those from CDI, nor was there a significant difference between the vmax of patients identified as having arteriogenic impotence on IPBF and that of normal men or those with venous leakage on IPBF. There was no relationship between the subjective impressions from CDI and the results from IPBF, or with erectile response.Conclusions There was no correlation between the results obtained on IPBF and those obtained from CDI; the latter is not useful in differentiating between venogenic and arteriogenic impotence in men who have failed to have a full response to papaverine.
High‐dose pelvic irradiation followed by ileal neobladder urinary diversion: complications and long‐term results
Authors: Gschwend J.E. , May F. , Paiss T. , Gottfried H.W. , Hautmann R.E. 
Published: November 2003

Objective To determine the risk of post‐operative complications in patients receiving high‐dose pelvic irradiation before radical cystectomy and urinary diversion. Patients and methods Of 300 patients who underwent orthotopic bladder replacement at our institution from 1986 to 1994, 11 patients (mean age 63 years, range 53–74) did so after receiving high‐dose pelvic irradiation. The indication for cystectomy and urinary reconstruction was bladder cancer in seven men, prostate cancer in two men and a contracted bladder due to combined external pelvic irradiation and afterloading radiotherapy in two women. Results The post‐operative course, including the duration of hospital stay, peri‐operative complications and early functional results, did not differ from a control group of non‐irradiated patients, and no patients died. The mean follow‐up was 22 months (range 10–37) and revealed satisfactory results in seven of 11 patients. A neovesicoperitoneal fistula developed in one woman 10 months after surgery and was repaired by laparotomy. A neovesicovaginal fistula led to supravesical urinary diversion in the second woman. Conclusions High‐dose pelvic irradiation should not be a primary contra‐indication for orthotopic urinary diversion using segments of small intestine. For patients who undergo combined external and afterloading radiotherapy, the indication for orthotopic bladder replacement should be considered critically.
Penile Mondors' disease: an underestimated pathology
Authors: Sasso F. , Gulino G. , Basar M. , Carbone A.D. , Torricelli P. , Alcini E. 
Published: November 2003

Objective To report the aetiological, diagnostic and therapeutic aspects of penile Mondor's disease treated with non‐steroidal anti‐inflammatory drugs (NSAIDs) or surgery. Patients and methods During the last 3 years, 10 patients (mean age 35 years, range 20–57) were treated for superficial penile vein thrombophlebitis. The main aetiological factors were prolonged and excessive sexual intercourse, operations for inguinal hernia and deep vein thrombosis. All patients had noticed sudden and almost painless cord‐like induration on the penile dorsal surface. Doppler ultrasonography was useful in both diagnosis and follow‐up. Eight patients were treated with NSAIDs and platelet drugs. Results The mean interval to resolution of symptoms was 3 weeks. Two patients who did not respond to drug therapy underwent surgery (dorsal vein resection). Conclusion Medical therapy and, when indicated, vein resection are successful and effective in treating penile Mondor's disease.
Histochemical detection of intranuclear DNA fragmentation and its relation to the expression of bcl‐2 oncoprotein in human prostatic cancer
Authors: Taniguchi J. , Moriyama N. , Kurimoto S. , Kameyama S. , Kawabe K. 
Published: November 2003

Objective To assess the incidence of intranuclear DNA fragmentation and the expression of the bcl‐2 oncoprotein in prostatic carcinoma, both of which are related to programmed cell death. Patients, materials and methods Specimens of tumour obtained from 17 patients with newly diagnosed prostatic carcinoma and 16 with hormone‐treated prostatic carcinoma undergoing total prostatectomy were evaluated. DNA fragmentation was detected using the terminal‐labelling method (d‐uridine triphosphate conjugated with digoxigenin) and the expression of bcl‐2 was detected immunohistochemically. Results There was a high incidence of intranuclear DNA fragmentation in 14 of 17 untreated tumours and 15 of 16 hormone‐treated tumours. There were no differences between the positive cases in hormone‐treated tumours and untreated tumours. There was significantly greater expression of bcl‐2 in tumours treated with non‐steroidal anti‐androgen drugs (eight of nine were positive) than in those untreated (seven of 17) or treated with other drugs (one of seven) (P<0.05). There was a consistent and marked dissociation between DNA fragmentation and bcl‐2 positivity; most of the cells positive for bcl‐2 showed no DNA fragmentation. Conclusion The results indicated that cells positive for bcl‐2 might potentially be hormone resistant and that the administration of non‐steroidal anti‐androgen drugs might have a role in the induction of hormone‐resistant cells.
The frequency of posterior urethral valves in Oman
Authors: Rajab A. , Freeman N.V. , Patton M. 
Published: November 2003

Objective To ascertain the frequency of posterior urethral valves (PUV) in Oman, using hospital records. Materials and methods The resident population of Oman is 1.5 million and all complex paediatric surgical cases are referred to a single unit in the capital city of Muscat. A register of patients has been kept in that unit since 1988. Hospital case‐records were reviewed to determine associated abnormalities, date and place of birth, tribal origin and, from further interviews, the family pedigree and degree of consanguinity. Results This retrospective survey identified 56 Omani children born between 1989 and 1994 who were treated in the Paediatric Surgery Department at the Royal Hospital, Muscat for congenital PUV. The calculated incidence was 1 in 2375 newborn males, which is 2–4 times higher than that previously reported in other populations. There was no relation to the estimated month of conception and therefore environmental hyperthermia due to the extreme ambient temperature does not seems not to be a causative factor. There was consanguinity in 40 of 46 cases (87%) where a complete family history was available. Parents were first cousins in 54% of cases, compared with the background rate of 24% in over 6000 families interviewed in the antenatal clinics at six hospitals in Oman. There was also a concentration of PUV within specific tribes. About one‐third of the cases also had associated congenital abnormalities, the most frequent of which were genitourinary (17%), but gastrointestinal (9%) and spinal (7%) defects were also observed. Conclusion The frequency of PUV in newborn Omani males was 1 in 2375, which is considerably higher than any previously reported series. This was associated with an increased rate of consanguinity, but there was no clear pattern of inheritance.
Failure of pre‐natal ultrasonography to prevent urinary infection associated with underlying urological abnormalities
Authors: Lakhoo K. , Thomas D.F.M. , Fuenfer M. , D'Cruz A.J. 
Published: November 2003

Objectives To analyse the reasons underlying the failure of routine pre‐natal ultrasonography to prevent the subsequent development of urinary tract infection (UTI) in children with predisposing urological abnormalities. Patients and methods This retrospective study comprised 39 children (22 females and 17 males) who had at least one documented UTI, the presence of an anatomical anomaly of the urinary tract recognized as predisposing to UTI and had undergone ultrasonography of the urinary tract undertaken in fetal life as part of routine maternal ante‐natal ultrasonography. Four categories of patients were defined: Group A, those with normal findings on pre‐natal ultrasonography and no urological abnormality detected; Group B, those with a urological abnormality detected but where there was a subsequent failure of communication among clinicians; Group C, those with a urological abnormality but who received inappropriate or sub‐optimal post‐natal management and; Group D, those with a urological abnormality but who had a UTI despite appropriate post‐natal management. In each case, the most severe documented episode of UTI was categorized as: Grade I, asymptomatic bacteriuria; Grade II, mild/moderate symptomatic UTI and; Grade III, severe symptomatic UTI necessitating hospital admission. Results Group A comprised 22 (56%), Group B three (9%), Group C two (5%) and Group D 12 children (31%). Of the 22 children in Group A, nine experienced a UTI of sufficient severity to necessitate hospital admission. Of the 12 children in Group D only one required hospital admission. Conclusions The failure of pre‐natal ultrasonography to identify the underlying predisposing urological abnormality was the most important factor contributing to subsequent UTI in post‐natal life. Failure of communication and inappropriate post‐natal management were numerically unimportant. In some children, UTI occurred despite pre‐natal detection of their underlying anomaly and appropriate post‐natal management. However, in this group the UTI was less severe than in those children whose urological anomalies had not been detected by pre‐natal ultrasonography.
Treatment of prostate cancer using external beam radiotherapy after laparoscopic pelvic lymph node dissection
Authors: Gerber G.S. , Bales G.T. , Gornik H.L. , Haraf D.J. , Chodak G.W. , Rukstalis D.B. 
Published: November 2003

Objectives To evaluate the results of prostatic irradiation in men with clinically localized prostate cancer and no laparoscopic evidence of nodal metastases compared with a cohort of patients who received radiation therapy with no prior surgical staging. Patients and methods Thirty‐one men with clinically localized prostate cancer and no evidence of pelvic nodal metastases after laparoscopic pelvic lymph node dissection received external beam radiation therapy to the prostate (65–70 Gy). The mean and median prostate specific antigen (PSA) levels in these men before treatment were 41.6 ng/mL and 28.0 ng/mL, respectively, and the mean Gleason sum was 6.1 (range 3–7). During the same interval, a group of 42 consecutive men with clinically localized prostate cancer were treated by external beam radiation therapy with no laparoscopic staging of the pelvic nodes. Treatment failure was defined by the development of bone metastases or a rising PSA level at least 6 months after the completion of radiotherapy. Results Radiation therapy was generally well tolerated after laparoscopy and no patient required hospitalization or surgery for side‐effects related to the treatment. The median duration of follow‐up in the 31 men who underwent laparoscopy was 21.5 months. The probability of treatment failure in this group was 41.8% and 56.3% with 24 and 30 months follow‐up, respectively. When controlling for pre‐treatment PSA level, grade and stage, there was no significant difference in the treatment failure rate between the groups treated with and without laparoscopic staging. Conclusions These results suggest that there is no difference in treatment outcome with laparoscopic pelvic lymphadenectomy before external beam radiation therapy in high‐risk patients who have significant pre‐treatment elevations of PSA level.
An assessment of the usefulness of serum prostate‐specific antigen level and cancer volume in biopsy specimens to predict the extent of prostate cancer
Authors: GOHJI K. , NOMI M. , KIZAKI T. , MORISUE K. , OKAMOTO M. , TAKENAKA A. , FUJII A. 
Published: November 2003

Objective To evaluate the usefulness of the combination of serum prostate‐specific antigen (PSA) and cancer volume in biopsy specimens as markers to predict the extent of prostate cancer.Patients and methodsOf patients presenting at our hospital with urinary symptoms suggesting prostatic disease, 311 (median age 70 years, range 42–88) with either nodules in the prostate detected by digital rectal examination or with elevated serum PSA levels (>2.0 ng/mL) underwent systematic biopsy; 69 had prostate cancer. The cancer volume in the biopsy specimens was examined pathologically by measuring the percentage of the biopsy core involved with cancer, the length of cancer tissue per biopsy core and the percentage of cancer in the biopsy specimen. The relationship of serum PSA level, cancer volume in the biopsy specimen and the extent of disease was examined.ResultsThe volume of cancer in the biopsy specimens increased with increasing serum PSA concentration and the incidence of skeletal metastasis. The number of patients with extraprostatic disease or bony metastasis was significantly higher for these Japanese patients with a serum PSA of <10 ng/mL. All six patients with a positive bone scan and who had a serum PSA level of <10 ng/mL had a larger volume of cancer in their biopsy specimens. Among patients who underwent radical prostatectomy and pelvic lymphadenectomy, the incidence of extraprostatic disease increased with the value of each biopsy variable. Among patients with similar serum PSA levels, those showing higher values for the biopsy variables also showed extraprostatic disease. Among those with extraprostatic disease, seminal vesicles were involved by cancer in four of six patients with >40% positivity in the biopsy cores, >1.5 mm of cancer per biopsy core or >20% cancer in the biopsy specimens. Lymph node metastasis was found in four of five patients with serum PSA levels of >20 ng/mL and a large cancer volume in the biopsy specimen.ConclusionsThese results indicate that a combination of serum PSA level and cancer volume in the biopsy specimen could be useful markers for predicting the extent of prostate cancer.
The electrical properties and responses to nerve stimulation of the proximal urethra of the male rabbit
Authors: CREED K.E. , OIKE M. , ITO Y. 
Published: November 2003

Objective To identify the nature of neurotransmitters acting on the smooth muscle cells of the proximal urethra and the electrical activity underlying the mechanical responses to nerve stimulation.Materials and methodsThe electrical activity of longitudinal strips of proximal urethra obtained from male rabbits was recorded with microelectrode and double sucrose‐gap techniques. Intramural nerves were stimulated with 200 μs pulses. Drugs which selectively affected neurotransmission were added to the perfusing fluid.ResultsThe mean resting potential of smooth muscle cells was −39 mV and they had infrequent spontaneous action potentials. The frequency was increased by noradrenaline without depolarization; ATP produced depolarization with increased action‐potential frequency. Small (≤16 mV) spontaneous depolarizations and hyperpolarizations could be recorded from <50% of cells; large (≤40 mV) hyperpolarizations also occurred. Electrical field stimulation evoked excitatory and inhibitory junction potentials (EJPs and IJPs). Most EJPs reached a maximum within 500 ms, decayed with a time‐constant of 200–300 ms and were blocked by α,β‐methylene ATP. IJPs had a latency of >1 s and showed much variation in amplitude and duration. IJPs could still be recorded in the presence of N‐nitro‐L‐arginine methyl ester (L‐NAME). In the double sucrose‐gap, depolarization and associated contraction were reduced by α,β‐methylene ATP. Further reduction occurred with phentolamine and the remaining response was blocked by atropine. A large hyperpolarization could occur in response to a single stimulus but this decreased progressively with repeated stimulation. The hyperpolarization was partially blocked by L‐NAME.ConclusionsThe proximal urethra receives excitatory innervation involving three neurotransmitters, i.e. ATP, acetylcholine and noradrenaline, and inhibition is associated with hyperpolarization which results at least in part from action of non‐nitrergic nerves.
Urological complications in renal transplantation: impact of a change of technique
Authors: BUTTERWORTH P.C. , HORSBURGH T. , VEITCH P.S. , BELL P.R.F. , NICHOLSON M.L. 
Published: November 2003

Objective To determine whether the change from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis in renal transplantation has altered the incidence of urological complications.Patients and methods Data were retrieved from a prospective computerized database and by case‐note review on 248 consecutive renal transplants performed between January 1990 and June 1996. The characteristics of the donor, recipient and organ were noted, together with the technique used for the vesico‐ureteric anastomosis and the occurrence of major and minor urological complications.Results The Leadbetter‐Politano technique was used in 140 transplants and the stented extravesical technique in 108. There were no significant differences in the donor, recipient or organ characteristics between the groups. The stented extravesical technique was associated with a significantly lower rate of major complications (<2%) and clinically significant haematuria than with the Leadbetter‐Politano technique.Conclusion Changing from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis has been a major factor in reducing the incidence of urological complications in our transplant practice.
Patient tolerance of transrectal ultrasound‐guided biopsy of the prostate
Authors: IRANI J. , FOURNIER F. , BON D. , GREMMO E. , DORÉ B. , AUBERT J. 
Published: November 2003

Objectives To determine the acceptability by patients of ultrasound‐guided prostatic biopsy without anaesthesia.Patients and methods From January 1995 to January 1996, 81 patients in our department undergoing transrectal ultrasound‐guided prostate biopsy were asked to assess the tolerability of the procedure using an immediate post‐operative questionnaire including a 10 cm linear visual analogue scale (VAS).Results The mean VAS score was 3 (standard error 0.24) and 16% of the patients had a VAS score of ≥5. Responses to the questionnaire showed that 6% of patients judged that the procedure should have been performed under general anaesthesia, while 19% would not agree to undergo it again without some form of anaesthesia.Conclusions Even when anaesthesia‐free, transrectal ultrasound‐guided prostatic biopsy was felt to be only mildly uncomfortable by most patients, but 19% judged that it should be accompanied by some form of anaesthesia. Consequently, local anaesthetic techniques to enhance tolerance to this type of intervention without sacrificing the advantages of the current out‐patient setting should be reassessed.
Clinical uroselectivity: evidence from patients treated with slow‐release alfuzosin for symptomatic benign prostatic obstruction
Authors: BUZELIN J.M. , DELAUCHE‐CAVALLIER M.C. , ROTH S. , GEFFRIAUD‐RICOUARD C. , SANTONI J.P. 
Published: November 2003

Objective To assess the safety profile of slow‐release (SR) alfuzosin in the treatment of benign prostatic obstruction (BPO), with special attention to orthostatic blood pressure changes, postural symptoms and efficacy.Patients and methodsTwo placebo‐controlled studies involving 588 patients (292 receiving SR alfuzosin 5 mg twice daily and 296 a placebo) were pooled; 51% of the patients were ≥65 years of age and 43% had associated cardiovascular disease including hypertension and/or were receiving concomitant antihypertensive drugs.ResultsSR alfuzosin was very well tolerated with an overall incidence of adverse events similar to that of placebo (18.5% and 15.8% of patients, respectively) and an overall incidence of withdrawal from therapy for adverse events lower than that of placebo (3.4% and 5.7%, respectively). Adverse events potentially related to vasodilatation were infrequent with SR alfuzosin (the same incidence as with placebo, i.e. 2.7% of patients) and these adverse events occurred mainly during the first month of alfuzosin treatment. The effect on supine blood pressure was minimal. In the subgroups of elderly and hypertensive patients treated with SR alfuzosin, the cumulative incidence of asymptomatic orthostatic hypotension during the first month of treatment was slightly higher than with placebo with no objective consequences on the incidence of adverse events. The clinical efficacy of SR alfuzosin was confirmed by a significant improvement in urinary symptoms and a significant increase in maximum flow rates.ConclusionSR alfuzosin (10 mg/day) can be administered safely without titration in patients with BPO, even in elderly and hypertensive patients. Its favourable benefit/risk ratio allows alfuzosin to be classified as a clinically uroselective α1‐blocker. Specific analysis of orthostatic changes in blood pressure is important when assessing the safety profile of an α1‐blocker in patients with BPO.
Treatment‐seeking behaviour and stated preferences for prostatectomy in Spanish men with lower urinary tract symptoms
Authors: HUNTER D.J.W. , BERRA‐UNAMUNO A. 
Published: November 2003

Objectives To determine whether men in the community with lower urinary tract symptoms sought treatment, would choose to have a prostatectomy, and the factors that might influence their decision.Subjects and methods The study was a cross‐sectional population survey using interviewers in the autonomous community of Madrid and comprised 2002 men aged ≥50 years. The main outcome measures were self‐reported International Prostate Symptom Scores (IPSS), treatment‐seeking behaviour and the patients’ stated preference for prostatectomy.Results The response rate among eligible subjects was 68.1%; overall, 38.2% of men sought medical advice for their lower urinary tract symptoms. Whether a man sought medical advice was related to symptom severity, ‘bothersomeness’, interference in daily activities and his perception of the future; of these, bothersomeness and interference in activities were more likely to determine whether or not a man consulted his doctor. Most men in the sample (84.9%) reported that they would choose a prostatectomy, although this value depended on whether they had had a previous prostatectomy, were younger, and on the content of the information presented. Men were more likely to report that they would accept surgery if their doctor recommended it and less likely when presented with information on the outcomes of treatment.Conclusion Many Spanish men with lower urinary tract symptoms do not seek medical advice for their symptoms, although most stated that they would accept a prostatectomy on the recommendation of their doctor. Further research should examine whether reported patient preferences correspond to actual behaviour and what is the most appropriate type of information to give to potential patients.