bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis
Authors: Kawauchi A. , Imada N. , Tanaka Y. , Minami M. , Watanabe H. , Shirakawa S. 
Published: March 2003

ObjectiveTo evaluate the mechanism of the dysfunction of arousal in patients with Type I and Type IIa enuresis.Patients and methodsThe numbers of sleep spindles and delta waves were analysed during electroencephalography in 19 patients with enuresis (17 male, two female, mean age 9.7 years, range 8–14).ResultsIn four patients with Type I enuresis, who awoke spontaneously and remained dry as a result of urinary sensation, the numbers of sleep spindles and delta waves diminished gradually and finally disappeared just before the patients awoke completely. In the remaining nine patients with Type I enuresis, there was no decrease in the number of sleep spindles and delta waves, and enuresis occurred without the subjects awakening. In the six patients with Type IIa enuresis, there was no arousal reaction or generation of sleep spindles on urination while asleep.ConclusionsAn immaturity in the function of the thalamus might be a cause of the arousal dysfunction in patients with Type I enuresis. In Type IIa enuresis, a possible abnormal or immature arousal mechanism in the pons or the lower tract may be responsible.
Transitional cell carcinoma in renal transplant recipients: the influence of compound analgesics
Authors: Swindle  , Falk  , Rigby  , Petrie  , Hawley  , Nicol  
Published: March 2003

Objectives To determine the incidence of transitional cell carcinoma (TCC) in a renal transplant population and to compare the pattern of neoplasia in patients with analgesic nephropathy (AN) with that in other patients.Patients and methodsUsing the Australia and New Zealand Dialysis and Transplant Registry, renal transplant recipients of the Princess Alexandra Hospital with TCC were identified. They were separated into two groups based on their primary disease, i.e. AN (group 1) and other causes of renal failure (group 2). The age at diagnosis of TCC, site, grade, stage of TCC and outcome were then compared between the groups.ResultsThere were 250 (15%) patients in group 1 and 1424 (85%) in group 2; seven patients in each group were found to have TCC, which thus occurred more frequently in the AN group (2.8%) than in group 2 (0.49%). In group 1, five patients died, four from metastatic disease; of these, the mean time from transplantation to diagnosis of the initial tumour was 4.4 years, with a mean time from diagnosis to death of 9 months. In contrast, there were no deaths from metastatic disease in group 2. In group 1, all patients had upper tract tumours, with five patients also having bladder involvement. The upper tract tumours tended to be of a high stage and grade (grade II–III) and were aggressive. In group 2, all the tumours were confined to the bladder and tended to be of low stage and grade (grade I–II Ta).ConclusionsPatients undergoing renal transplantation as a result of AN are at high risk of developing TCCs of the upper urinary tracts. These tumours tend to be of a high grade and stage and the patients have a poor outcome. Screening with urine analysis and voided urine cytology do not appear to be reliable for the early diagnosis of upper renal tract TCCs in the renal transplant patient. We advocate annual cystoscopy and retrograde ureteric catheterization with washings, brushings and radiological imaging to diagnose upper tract TCCs at an early stage. These patients should also be screened before transplantation using the same technique.
Structural and ultrastructural changes in ileal neobladder mucosa: a 7‐year follow‐up
Authors: Aragona  , De Caro  , Parenti  , Artibani  , Bassi  , Munari  , Pagano  
Published: March 2003

Objective To investigate the long‐term morphological changes in the intestinal segment used to create an orthotopic ileal neobladder.Materials and methods Periodic endoscopy with biopsy of the ileal mucosa was performed in 90 patients 3–84 months after radical cystectomy and urinary diversion via an orthotopic neobladder. Three cold‐cup biopsies were taken from each patient and mucosal specimens processed for light and electronic microscopy.Results Early changes (up to 1 year after surgery) comprised a marked shortening of the villi with loss of microvilli. After 4 years, the prevalent finding was of flat, avillous epithelium that tended to stratify in some areas. The avillous areas were mixed with islets of villous mucosa. There was no dysplasia or malignancy in any of the 90 patients.Conclusions Prolonged contact with urine elicited a biphasic response in the ileal mucosa, i.e. an early inflammatory phase, ascribed to the noxious action of urine, followed by a regressive phase in which the epithelium tended to assume a morphology similar to the urothelium. The atrophic changes were almost totally completed after 4 years, although areas with marked modifications alternated with others where the morphology was normal, even many years after surgery. Late changes in the ileal neobladder mucosa appear to be an expression of a functional adaptation of the mucosa to the new environment.
An animal model for the neuromodulation of neurogenic bladder dysfunction
Authors: Zvara  , Sahi  , Hassouna  
Published: March 2003

Objective To develop an animal model to examine the pathophysiology by which S3 sacral root electrostimulation alters the micturition reflex in patients with bladder hyper‐reflexia.Materials and methods Chronic sacral nerve root electrostimulation was applied to spinally transected rats; 21 animals were divided into four groups. The spinal cord was completely transected at the T10–11 level and stainless‐steel electrodes implanted into the sacral foramen in 17 animals; these animals were subsequently divided into two groups (1 and 2). Six rats in group 1 underwent sacral root electrostimulation for 2 h/day and five in group 2 for 6 h/day, for 21 days. The sham group (group 3, six rats) received no stimulation and four rats were used as healthy controls (group 4). Voiding frequency was recorded and each animal was evaluated cystometrically at the end of the stimulation period. The results were compared with the sham and control groups.Results Spinal cord transection resulted in bladder areflexia and complete urinary retention; 7–9 days after the injury, the bladder recovered its activity. Twenty‐one days after transection all animals had evidence of uninhibited bladder contractions. The mean (sd) hourly frequency of urination was 0.66 (0.18) in healthy controls, 0.83 (0.21) in group 1, 0.87 (0.34) in group 2 and 1.1 (0.31) in group 3. There was a significant decrease in the cystometric signs of bladder hyper‐reflexia in groups 1 and 2 when compared with group 3.Conclusions This work reports an initial study showing that chronic electrostimulation of sacral nerve roots can reduce the signs of bladder hyper‐reflexia in the spinally injured rat. To our knowledge, this is the first report describing the rat as an animal model to determine the effects of chronic electrostimulation on the micturition reflex.
Prolonged increase in micturition threshold volume by anogenital afferent stimulation in the rat
Authors: Jiang  , LindstrÖM  
Published: March 2003

Objective To investigate whether anogenital afferent stimulation induces a prolonged increase in the micturition threshold volume of anaesthetized rats.Materials and methods Thirteen female rats, anaesthetized by α‐chloralose and paralysed by pancuronium bromide were used for the experiments. The micturition threshold volume was determined by repeated cystometry. In two experiments, afferent activity was recorded from the exposed pudendal nerve; vaginal and anal afferents were stimulated electrically by ring electrodes. In one experiment, the dorsal clitoris nerves were exposed bilaterally and mounted for electrical stimulation. The afferents were stimulated continuously for 5 min at 10 Hz, using unipolar cathodic pulses of 0.5 ms duration with an amplitude of 10 mA (or 0.8 mA for the dorsal clitoral nerves).Results Anogenital stimulation for 5 min induced a significant and prolonged increase in the micturition threshold volume (from a median value of 0.35 mL before to 0.45 mL after stimulation; P<0.01). The increase in threshold volume was maintained for about 40 min after the end of stimulation. There was no obvious difference in effect between the stimulation sites nor with direct dorsal clitoral nerve stimulation. Neither the micturition threshold pressure nor the maximal contraction pressure were altered by stimulation. No tonic afferent after‐discharge could be detected in the pudendal nerve recordings.Conclusions Artificial electrical stimulation of anogenital afferents induced a prolonged increase in the micturition threshold volume of anaesthetized rats. The change presumably involved the modulation of the synaptic transmission in the central micturition reflex pathway. It is proposed that the observed change represents the first step in the curative ‘re‐education’ process induced in patients with urge incontinence by electrical stimulation of anovaginal afferents.
The significance of lymphadenectomy in transitional cell carcinoma of the upper urinary tract
Authors: Miyake  , Hara  , Gohji  , Arakawa  , Kamidono  
Published: March 2003

Objective To determine the efficacy of lymphadenectomy after nephroureterectomy in patients with transitional cell carcinoma (TCC) of the upper urinary tract.Patients and methods Between January 1986 and December 1995, 72 patients (mean age 67 years, range 45–82) underwent nephroureterectomy for primary TCC of the upper urinary tract. In 35 patients, a lymphadenectomy was also performed. The clinicopathological data were analysed retrospectively, focusing on the significance of lymphadenectomy.Results Lymph vessel invasion was found in 28 patients and its incidence was closely correlated with both tumour grade and pathological stage. Of the 35 patients who underwent lymphadenectomy, lymph node metastases were found in 13 patients, all of whom had lymph vessel invasion. There was no significant difference in the survival rate between patients with and without lymphadenectomy; however, among the 44 patients with no lymph vessel invasion, the survival rate of those with lymphadenectomy was significantly higher than in those without (P<0.05).Conclusion Lymphadenectomy may provide a therapeutic advantage in patients with upper urinary tract TCC and no lymph vessel invasion. However, patients with lymph vessel invasion seem to have systemic disease; therefore, aggressive systemic adjuvant therapies rather than regional lymphadenectomy should be applied in these patients.
Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy
Authors: Dalbagni  , Zhang  , Lacombe  , Herr  
Published: March 2003

Objective To evaluate our experience with primary carcinomas of the female urethra, by analysing the impact of tumour variables and treatment on overall, disease‐specific, local recurrence‐ and metastasis‐free survival.Patients and methods Between 1958 and 1994, 72 women (median age 60 years, mean 59, range 21–84) with primary urethral carcinoma were identified. They were followed for a median (range) of 85 (0–384) months. The patients were stratified by stage, nodal status, histology, treatment, type of surgery, site of disease, year of diagnosis and smoking habit.Results In a univariate analysis, stage, nodal status, type of surgery and site of the disease were important factors for survival and recurrence. In a multivariate analysis, primary stage, nodal status and site of disease were independent predictors of survival.Conclusion Current modalities of treatment are ineffective for local control and survival; new treatment strategies are needed for female urethral cancers.
The effect of transurethral alprostadil on the quality of life of men with erectile dysfunction, and their partners
Authors: Williams  , Abbou  , Amar  , Desvaux  , Flam  , Lycklama À Nijeholt  , Lynch  , Morgan  , MÜller  , Porst  , Pryor  , Ryan  , Witzsch  , Hall  , Place  , Spivack  , Todd  , Gesundheit  
Published: March 2003

Objective To evaluate the impact of treatment for erectile dysfunction on the quality of life of men and their partners. Patients and methods The study included 249 men with organic erectile dysfunction of more than 3 months’ duration who self‐administered transurethral alprostadil in an open‐label, dose‐escalating manner in an outpatient medical setting. Patients with a sufficient response (159) were randomly assigned in a double‐blind protocol to either active medication or placebo for 3 months at home. Patients and partners each completed quality‐of‐life questionnaires before and after treatment. Results In the clinic 159 of the 249 men (64%) had an erection sufficient for intercourse when using transurethral alprostadil. At home, 46 of 67 men (69%) reported intercourse at least once on transurethral alprostadil, compared with eight of 73 (11%) on placebo (P<0.001). Patients on alprostadil showed a 34% improvement in their ‘relationship with partner’, a 5% improvement in ‘personal wellness’, and a 71% improvement in ‘quality of erection’ domains, compared with a decline of 11%, 8% and 1%, respectively, in patients on placebo (P<0.005 for each comparison). Partners of patients on alprostadil showed a 35% improvement in the ‘relationship with partner’ domain, compared with a 12% improvement in the placebo group (P=0.028). There was a trend toward improvement in other partner domains. Urogenital pain was reported by 14% of patients during home treatment. Conclusion The resumption of sexual intercourse with the use of transurethral alprostadil was accompanied by an improvement in several important quality‐of‐life domains in patients and their partners.
The rectal administration of lidocaine gel and tolerance of transrectal ultrasonography‐guided biopsy of the prostate: a prospective randomized placebo‐controlled study
Authors: Desgrandchamps  , Meria  , Irani  , Desgrippes  , Teillac  , Le Duc  
Published: March 2003

ObjectiveTo evaluate the effect of the rectal administration of lidocaine gel on the tolerance of systematic sextant transrectal ultrasonography (TRUS)‐guided prostatic biopsies.Patients and methodsFrom January to September 1997, patients undergoing initial biopsy mapping of the prostate (with six systematic TRUS‐guided transrectal biopsies) were randomized using a pre‐established randomization list into two groups. In group 1, 15 mL of 2% lidocaine gel (Astra, Södertälje, Sweden) was administered intrarectally 15 min before the biopsies. In group 2 (placebo), 15 mL of trans‐sonic hydrophilic gel (Rivadis Laboratory, Thouars, France) was administered transrectally under the same conditions. Patients were randomized and the gel administered by a nurse; neither the patients nor the urologists were aware of which product was administered. At the end of the procedure, patients were asked to score the severity of discomfort of the biopsies, using a self‐administered rating scale.ResultsIn all, 109 patients were included, in either group 1 (56 patients) or group 2 (53 patients). Slight pain or no pain was experienced by the vast majority of patients in both groups. Moderate to severe pain was experienced in 12.5% of patients in group 1 and 11.3% of patients in group 2. There was no difference in patient tolerance between the groups (P=0.39). Only minor complications occurred and complication rates were not significantly different between the groups.ConclusionThe rectal administration of lidocaine has no impact on the tolerance to prostatic biopsy.
Uric acid‐binding proteins in calcium oxalate stone formers and their effect on calcium oxalate crystallization
Authors: Kalaiselvi  , Udayapriya  , Selvam  
Published: March 2003

ObjectivesTo study the effect of urinary uric acid‐binding proteins of controls and stone formers on calcium oxalate crystal nucleation and aggregation.Materials and methodsUrine samples were collected over 24 h from 20 stone formers and from 20 age‐matched normal controls. Uric acid crystallization was induced by adding equal volumes of 2.5 mmol/L uric acid. The bound proteins were separated on a cellulose column, and by sodium dodecyl sulphate‐polyacrylamide gel electrophoresis. The effect of the separated fractions on calcium oxalate crystal nucleation and aggregation was assessed.ResultsThe protein bound to unit mass of uric acid crystals was higher in hyperoxaluric urine than in control urine. On cellulose‐column separation, the uric acid‐crystal binding proteins produced three major protein peaks, i.e. fraction I (buffer), fraction II (0.05 mol/L sodium chloride in Tris‐HCl buffer) and fraction III (0.3 mol/L sodium chloride in buffer), with a minor peak obtained on elution with increasing concentrations of sodium chloride in Tris‐HCl buffer (pH 7.0). Fraction I derived from either stone formers or controls promoted calcium oxalate crystallization. Fraction II from the control samples was a strong inhibitor, whereas hyperoxaluric fraction II was less inhibitory.ConclusionUric acid‐binding proteins isolated either from the urine of stone formers or controls modulated calcium oxalate crystal growth. Proteins isolated from stone formers were less inhibitory of crystal nucleation and aggregation. These proteins may act as a bridge, leading to the epitaxial deposition of calcium oxalate over a urate core.
The free‐to‐total serum prostatic specific antigen ratio as a predictor of the pathological features of prostate cancer
Authors: Morote  , Encabo  , Lopez  , De Torres  
Published: March 2003

ObjectivesTo analyse the role of the ratio of serum free (f) to total (t) prostatic specific antigen (f/tPSA) as a predictor of the pathological features in patients with clinical stage T1c disease submitted for radical prostatectomy.Patients and methodsTotal and fPSA were determined before surgery in 76 consecutive patients with clinical stage T1cN0M0 disease and a serum tPSA level of 4–20 ng/mL. The pathological stage was defined as organ‐confined in 47 (62%), with capsular penetration in 27 (35%) and seminal vesicle infiltration in two (3%). In 18 of the specimens (24%) the surgical margins were positive. The pathology was favourable in 41 patients (55%). Total and fPSA were determined using the Tandem and Tandem‐free PSA immunoassays (Hybritech Inc, Belgium)ResultsThe mean tPSA was: 8.7 ng/mL when the tumour was organ‐confined and 8.6 ng/mL when the disease was extraprostatic (P>0.05); 8.4 ng/mL when the tumour was specimen‐confined and 9.3 ng/mL when positive margins or seminal vesicle involvement were detected (P>0.05); and 8.3 ng/mL when the pathology was favourable and 9.0 ng/mL when unfavourable (P>0.05). The f/tPSA was 11.8% when the tumour was organ‐confined and 9.1% when it was not (P<0.03), 11.9% when the tumour was specimen‐confined and 7.6% when not (P<0.002) and 12.1% when the pathology was favourable and 9.1% when unfavourable (P<0.008). A threshold of 11% f/tPSA provided an odds ratio for organ‐confined disease of 2.7, for specimen‐confined disease of 7.6 and for a favourable pathology of 3.9.ConclusionThe f/tPSA seems to provide useful information in the prediction of the pathological features of patients with clinical T1c prostate cancer and a tPSA of 4.1–20 ng/mL.
Urinary continence and erectile function after bladder neck sling suspension in male patients with spinal dysraphism
Authors: Dik  , Van Gool  , De Jong  
Published: March 2003

ObjectiveTo assess the outcome of using sling suspensions combined with clean intermittent catheterization (CIC) in patients with spina bifida, of whom a third are incontinent through pelvic floor paralysis.Patients and methodsBetween March 1992 and April 1997, 14 male patients (mean age at surgery 11.7 years, range 6.5–15.2) with spina bifida and neurogenic sphincter incontinence underwent a puboprostatic sling suspension as a primary treatment. The procedure, via an abdominoperineal approach, consists of suspending the bladder neck by placing a simple U‐shaped rectus abdominus fascial sling. The perineal approach is used to develop the plane between the rectum and Denonvillier’s fascia, and to prepare the passage of the sling alongside the prostate. Apart from the sling procedure, eight of the 14 patients underwent autoaugmentation of the bladder and two underwent ileocystoplasty during the same operation. All patients used CIC daily. Erectile function was assessed by reports from the patients and their parents, and continence by report and urodynamic studies.ResultsOf the 14 patients, 13 achieved urinary continence with no additional procedures; one required a subsequent submucosal injection at the suspension site with silicone particles in povidone (Macroplastique® ) to become continent. Two patients reported slight leakage at night. Before surgery, all but one patient reported having spontaneous or mechanically manipulated erections; none had erections on psychological stimulation. After surgery, erectile function was preserved in 13 of the 14 patients; in one there were problems establishing the right dissection plane between the rectum and prostate, but spontaneous erections returned a year after surgery.ConclusionIn males, the abdominoperineal puboprostatic sling suspension using rectus abdominis fascia appears to be a successful treatment for sphincter incontinence in patients with spina bifida, and safely maintains erectile function.
Complications of the preputial island flap‐tube urethroplasty
Authors: Elbakry  
Published: March 2003

ObjectiveTo report the long‐term results of hypospadias repair using tubularized transverse preputial island flaps.Patients and methodsSeventy‐four patients (mean age 7 years, range 2–19) underwent a transverse preputial island flap‐tube repair for hypospadias. All patients had chordee, 14 had anterior, 41 mid‐penile and 19 penoscrotal hypospadias. The mean (range) follow‐up was 43 (14–77) months and the outcome assessed by function and cosmesis.ResultsThe repair was functionally and cosmetically successful in 43 patients (58%) as a single‐stage repair. Necrosis and sloughing of the neourethra occurred in five patients (7%), urethrocutaneous fistula in 17 (23%), strictures in seven (9%), diverticula in three (4%) and insignificant urethral misalignment was detected by urethrography in three (4%); thus the overall complication rate was 42%. All of these complications were treated successfully in one or two re‐operations.ConclusionsThe transverse preputial island flap‐tube repair of hypospadias is a demanding technique. Even in experienced hands it has a relatively high complication rate. Every effort should be made to preserve the urethral plate during orthoplasty, minimizing the need to use tubularized preputial island flaps and expanding the application of onlay procedures.