bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinical and histological features of transitional cell carcinoma of the bladder with microcysts: analysis of 12 cases
Authors: PAZ A. , RATH‐WOLFSON L. , LASK D. , KOREN R. , MANES A. , MUKAMEL E. , GAL R. 
Published: November 2003

Objective To describe the clinical course and histological features of transitional cell carcinoma (TCC) of the bladder with microcysts.Patients and methodsAmong 940 patients with bladder TCC diagnosed at our institution during a 5 year period, 12 (1.2%; eight men and four women, mean age 71.1 years, range 52–85) were diagnosed histologically as having microcystic TCC. Sections of the tumours were stained with haematoxylin and eosin, periodic acid‐Schiff and Alcian blue and clinical data obtained from the patients’ records.ResultsOf the 12 patients with bladder TCC with microcysts, three had tumours confined to the epithelium, six had tumour invasion of the lamina propria and three had muscle invasion. One patient had low‐grade TCC and 11 had high‐grade TCC; six patients had a second primary tumour; three had a colon carcinoma, one a villous adenoma of the caecum, one a locally advanced carcinoma of the prostate and the last a squamous cell carcinoma of the uterine cervix.ConclusionsMicrocystic TCC was associated with high‐stage and high‐grade bladder tumours and with other primary tumours, especially of the colon. Screening these patients for asymptomatic tumours of the colon is suggested.
Cystitis associated with tiaprofenic acid: a survey of British and Irish urologists
Authors: HENLEY M.J. , HARRISS D , BISHOP M.C. 
Published: November 2003

Objective To quantify the extent and natural history of cystitis in relation to treatment with the non‐steroidal anti‐inflammatory drug (NSAID) tiaprofenic acid.Methods Anonymous postal questionnaires were sent to all UK and Irish consultant urologists enquiring about their awareness of the association between tiaprofenic acid (Surgam™ ) and cystitis, and the number, nature and clinical details of patients with the diagnosis.Results Of the 357 urologists, 45.7% replied; 37.4% of those who responded had had cases of NSAID‐concurrent cystitis, 35.6% replied that they had no personal experience but were aware of the possibility of an adverse drug reaction and 27% were unaware of the possibility of NSAID‐related interstitial cystitis. There were 108 reported cases of cystitis; 55 (51%) were women, 12 (11%) were men and gender was not stated in 41 (38%). The median duration of treatment was 59 weeks (range 6 weeks–4 years). Symptoms abated completely on stopping the drug in 86% of patients, resolving in a median of 14 weeks (range 7 days–2 years). In seven cases (10%), resolution was incomplete; 17 patients had undergone reconstructive urological surgery.Conclusion Tiaprofenic acid has caused at least 108 cases of cystitis and several of these patients underwent extensive urological surgery based on the assumption that they were suffering from chronic interstitial cystitis. Most cases were reversible on withdrawal of tiaprofenic acid, but 10% of patients had residual symptoms. Tiaprofenic acid causes a higher incidence of cystitis than any other NSAID and its withdrawal from the market should be considered.
Biopsy Gleason score: how does it correlate with the final pathological diagnosis in prostate cancer?
Authors: FERNANDES E.T. , SUNDARAM C.P. , LONG R. , SOLTANI M. , ERCOLE C.J. 
Published: November 2003

Objective To evaluate the role of the Gleason score of needle biopsies of the prostate in predicting the final pathological staging of patients with carcinoma of the prostate treated by radical prostatectomy.Patients and methods The records of 466 patients with carcinoma of the prostate treated by radical prostatectomy were reviewed, comparing the Gleason scores of the core‐needle biopsies with the Gleason score and final pathological staging of the surgical specimens.Results The biopsy grade was the same as that of the prostatectomy specimen in 54% of the patients. The most common discordance was the upgrading of well‐differentiated tumours in 75% of the patients. When the biopsy grade was compared with the surgical pathological stage, 49% of low‐ and 82% of high‐grade lesions in the biopsy had capsular penetration by tumour or locally advanced disease (Stage C and D1).Conclusion Well‐differentiated tumours on the biopsy core are not predictive of organ‐confined disease, but a poorly differentiated lesion is a good indicator of extracapsular extension of the cancer.
Gender reversal in 46XX congenital virilizing adrenal hyperplasia
Authors: SRIPATHI V. , AHMED S. , SAKATI N. , AL‐ASHWAL A. 
Published: November 2003

Objective To review the results of gender reversal in six patients with 46XX congenital virilizing adrenal hyperplasia (CVAH).Patients and methods Fifty‐one patients with 46XX CVAH were seen in an 8 year period; 45 were managed by conventional feminizing genitoplasty, but six underwent gender reversal and were managed as males. The clinical decision for gender reversal was made after appropriate counselling and was based primarily on parental choice, this being influenced significantly by a delayed diagnosis in four patients. Surgical management consisted of gonadectomy, excision of Müllerian structures and staged hypospadias repair/chordee correction in four patients, and circumcision in two completely masculinized children.Results All six boys are well adjusted to their gender of rearing, with ages ranging from 3 years to 16.5 years (mean 8.5) at the time of review. Two children have normal penises and four have a satisfactory result after two‐stage repair of hypospadias/chordee.Conclusion Most patients with 46XX CVAH are preferably raised as females and require a feminizing genitoplasty. However, the clinical decision may be influenced by many factors, including delay in diagnosis, social bias and the premium on male rearing in certain communities. When male rearing is chosen, early gonadectomy and excision of Müllerian structures, together with staged hypospadias repair, gives satisfactory results.
Significant association between simple renal cysts and arterial blood pressure
Authors: PEDERSEN J.F. , EMAMIAN S.A. , NIELSEN M.B. 
Published: November 2003

Objective To test the hypothesis that there is an association between simple renal cysts and arterial blood pressure (BP).Patients and methodsThe study comprised a review of the case‐notes of 115 patients (mean age 67.7 years, range 31–91) in whom renal cyst(s) was an incidental ultrasonographic finding, and 115 age‐ and sex‐matched control patients. The notes were reviewed without knowledge of the origin or treatment.ResultsThe systolic and diastolic BP were significantly higher in patients with a cyst(s) than in control patients (P=0.031 and P=0.0034; mean difference 6.9 mmHg and 5.0 mmHg, respectively). In those aged 30–70 years, the presence of one or more simple renal cysts increased the risk of having a diastolic BP ≥95 mmHg from seven in 58 to 17 in 58 patients (P=0.038).ConclusionThe association between simple renal cysts and higher arterial BP probably arises from underlying renal disease causing both. Occasionally it is possible that renal ischaemia caused by cyst expansion, and therefore increased renin release, generates the elevation in BP. If so, methods to identify such cysts should be developed.
A comparison of endorectal magnetic resonance imaging and transrectal ultrasonography in the local staging of prostate cancer with histopathological correlation
Authors: BATES T.S. , GILLATT D.A. , CAVANAGH P.M. , SPEAKMAN M. 
Published: November 2003

Objective To assess the staging accuracy of endorectal magnetic resonance imaging (MRI), using a mid‐field system, in patients with clinically localized prostate cancer and to compare the results with transrectal ultrasonography (TRUS).Patients and methodsTwenty patients with clinically localized prostate cancer were prospectively staged with TRUS and endorectal MRI using a 0.5 T magnet. All patients subsequently underwent radical prostatectomy and the results of pre‐operative staging were compared with the histological findings.ResultsThe sensitivity and specificity for diagnosing capsular penetration were 38% and 100%, respectively, for endorectal MRI, and 23% and 86% for TRUS. The sensitivity and specificity for diagnosing seminal vesicle invasion were 100% and 94%, respectively, for endorectal MRI, and 33% and 100% for TRUS. The overall staging accuracy for endorectal MRI was 75% compared with 50% for TRUS.ConclusionCompared with TRUS, endorectal MRI with a 0.5 T magnet provided greater sensitivity and specificity for capsular penetration and increased sensitivity for seminal vesicle invasion.
The performance characteristics of the bladder tumour antigen test
Authors: KIROLLOS M.M. , MCDERMOTT S. , BRADBROOK R.A. 
Published: November 2003

Objective To evaluate the specificity and sensitivity of the Bard bladder tumour antigen (BTA) (Bard Inc, Covington, USA) test.Patients and methods The performance of the BTA test was assessed prospectively in 98 patients (30 women and 68 men, mean age 64 years, median 67, sd 14.8) undergoing cystoscopy for various indications. The urine of the patients was assessed using the BTA test, cytology, culture and a dipstick test for haematuria, and the results compared with those from cystoscopy as the ‘standard’.Results The overall specificity for the BTA test was 79% and the sensitivity 37%. The sensitivity was higher than for urine cytology (33%) but less than for the dipstick test (59%). The specificity was less than for cytology (100%) but higher than for the dipstick test (66%).Conclusion The BTA test is a rapid, non‐invasive qualitative test identifying degradation products of the basement membrane of the transitional cell epithelium. It represents an advance in the search for a ‘tumour marker’ for carcinoma of the bladder. The specificity is acceptable but the sensitivity relatively low, which limits its value in everyday practice. Further research and development are needed to improve sensitivity.
A prospective, randomized, double‐blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy
Authors: CHOONG S. , WHITFIELD H.N. , MEGANATHAN V. , NATHAN M.S. , RAZACK A. , GLEESON M. 
Published: November 2003

Objective To determine the optimum duration for the retention of 2% lignocaine gel intraurethrally as an anaesthetic for flexible cystoscopy in men.Patients and methods A prospective, randomized, double‐blind, placebo‐controlled trial was conducted in two parts. Initially, the importance of duration was determined, i.e. whether pain relief was significantly improved when lignocaine gel was instilled for longer than is currently practised. As pain relief was improved by retaining the lignocaine gel for longer, the optimum time was determined in a second trial. Initially, 90 patients were divided into four groups receiving 20 mL of 2% lignocaine gel or plain lubricating gel for 5 or 25 min. Subsequently, 60 men were divided into two groups receiving 20 ml of 2% lignocaine gel for 15 or 25 min. The patients’ discomfort was recorded using a 4‐point descriptive pain scale and a 100 mm non‐graphical visual analogue scale.Results In the first study, those patients receiving lignocaine gel for 25 min experienced significantly less pain than the other three groups. In the second, lignocaine gel in the urethra for 15 min provided the same level of pain relief as lignocaine for 25 min.Conclusion Pain during flexible cystoscopy can be significantly reduced when 20 mL of 2% lignocaine gel is left in the urethra for 15 min; lignocaine gel would be more effective when left for longer than is currently practised.
The ‘Queen Square bladder stimulator’: a device for assisting emptying of the neurogenic bladder
Authors: DASGUPTA P. , HASLAM C. , GOODWIN R. , FOWLER C.J. 
Published: November 2003

Objective To describe the effectiveness of a vibrating device for emptying the neurogenic bladder in patients with neurological disease.Patients and methods The study involved 36 patients, comprising 29 with multiple sclerosis (MS), four with multiple system atrophy (MSA), one with radiation myelitis and two with neurological disease of uncertain aetiology. Most patients with MS (27) were able to walk unaided or with aids. Three of the 36 patients had loss of suprapubic sensation (two MS, one with uncertain diagnosis). All patients had free flow rates and ultrasonographic post‐void residual volumes (PVRs) measured before and after voiding while using a vibrating device (frequency 60 Hz) applied to the suprapubic region. They also completed questionnaires about their urinary symptoms before and after the continued use of this device. The mean follow‐up was 11.5 months (range 8–14).Results The device improved the symptoms in 25 of 36 patients (70%) and reduced the PVR from a mean (standard deviation) of 175 (78) mL to 68 (32) mL. It was not useful in patients with PVRs of >400 mL, Kurtzke pyramidal function scores of >3, and in those with suprapubic numbness. There were no complications and most patients complied well.Conclusions Suprapubic vibration is an effective means of emptying the neurogenic bladder in patients who are not severely disabled and who have detrusor hyper‐reflexia. It probably acts through a tonic vibration reflex which is under supraspinal influence. This device may be a useful alternative to clean intermittent self‐catheterization.
Is the expression of multidrug resistance gene product a prognostic indicator for the clinical outcome of patients with renal cancer?
Authors: HOFMOCKEL G. , BASSUKAS I.D. , WITTMANN A. , DÄMMRICH J. 
Published: November 2003

Objective To determine the significance of the expression of the multidrug resistance gene product (MDR‐1) for the aggressiveness of renal cell carcinoma (RCC).Patients and methods The study comprised 31 patients with clinically locally confined RCC treated with radical nephrectomy (mean age 64.1 years, range 41–78; mean follow‐up 5.4 years, range 4.3–7.3). Their survival time and disease‐free period were evaluated retrospectively. The expression of the MDR‐1 gene product was determined immunohistochemically using the JSB‐1 antibody in formalin‐fixed paraffin‐embedded tumour samples from these patients. The significance of this variable and tumour stage and malignancy grade was assessed for predicting the survival and disease‐free period using Kaplan‐Meier plots (log‐rank test or Tarone’s test) and the Cox multiple hazard regression analysis.Results In a univariate analysis, tumour stage (P<0.002), malignancy grade (P<0.007) and MDR‐1 (P<0.03) were significant prognostic variables for both survival and disease‐free period. Lower MDR‐1 expression was correlated with poorer prognosis. On multivariate analysis, MDR‐1 and tumour stage were significant factors for predicting the disease‐free period, whereas tumour stage and malignancy grade were the most relevant factors for survival time. Calculating prognostic indices based on the results of the Cox analysis, MDR‐1 could replace malignancy grade, resulting in a better prediction of survival and disease‐free period (P<0.001 vs 0.0031, P<0.001 vs 0.021, respectively).Conclusion MDR‐1, an established predictor for chemoresistance, may also be a potent prognostic factor for outcome in patients with locally confined RCC. Moreover, MDR‐1 expression seems to correlate with the differentiation of the RCC and thus its value as an objective measure of the degree of differentiation should be further explored.
Serum free prostate‐specific antigen in the diagnosis of prostate cancer
Authors: LEUNG H.Y. , LAI L.C. , DAY J. , THOMSON J. , NEAL D.E. , HAMDY F.C. 
Published: November 2003

Objective To determine the value of the ratio of free prostate‐specific antigen (fPSA) to total PSA (tPSA) in the diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer in a cohort of patients undergoing prostatic transrectal ultrasonography (TRUS).Patients and methods The study comprised 153 patients (99 with BPH and 54 with prostate cancer) undergoing diagnostic TRUS of the prostate. Patients with a tPSA of >30 ng/mL were excluded from analysis. Free PSA was assayed using an immunoassay specific for unbound PSA (CanAg Diagnostics, Sweden). Total PSA was measured using the HybriTech Tandem‐R PSA immunoradiometric assay in routine clinical use and this estimate was validated using the CanAg tPSA assay.Results The measurements of tPSA from both assay systems correlated closely. The f/tPSA ratios in patients with prostate cancer were significantly lower than in those with BPH (median values 0.152 and 0.2, respectively, P<0.01). In patients with prostate cancer, the median f/t PSA levels apparently declined with increasing tPSA levels but in those with BPH, the levels of tPSA were not significantly associated with the f/tPSA ratio; the ratios did not vary significantly with age in either group. A f/tPSA ratio at a threshold of 0.16 had positive and negative predictive values of 44% and 74%, respectively; the corresponding values for a tPSA of >4 ng/mL were 30% and 52%.Conclusion The f/tPSA ratio differs significantly between patients with BPH and cancer but because there is a considerable overlap of f/tPSA ratios between the groups, f/tPSA values alone were not sufficiently specific to be used as a single diagnostic test.
Decreased bcl‐2 expression in segmental renal dysplasia suggests a role in its morphogenesis
Authors: GRANATA C. , WANG Y. , PURI P. , TANAKA K. , O’BRIAIN D.S. 
Published: November 2003

Objective To evaluate the potential role of bcl‐2 and apoptosis in the histogenesis of segmental renal dysplasia.Materials and methods Surgically resected specimens of dysplastic upper poles of duplex kidneys were studied from 19 patients (mean age 3.4 years, range 2 months–9 years). Bcl‐2 expression was detected immunohistochemically and apoptosis was investigated using the in situ end‐labelling technique (ISEL).Results In the histologically normal areas of the specimens, bcl‐2 expression was intense in the proximal and distal convoluted tubules, moderate in Henle’s loops and weak or absent in Bowman’s capsule. In contrast, in the dysplastic areas there was no or markedly reduced expression of bcl‐2 in mesenchyme and tubules. In the normal areas, apoptotic cells were extremely rare (0–1 per 25 high‐power fields, HPFs), whereas in the dysplastic areas, some apoptotic cells were identified both in tubules (1–2 per 25 HPF) and in mesenchyme (5–8 per 25 HPF).Conclusions As bcl‐2 expression is required for normal kidney morphogenesis, finding no or markedly decreased expression of bcl‐2 in the dysplastic areas may be related to the persistence of dysplastic fetal‐type structures. Finding apoptosis adds further support to the concept that dysplasia represents arrested development at an early stage of morphogenesis before the period when bcl‐2 assumes major importance.
Uroflowmetry in women with urinary incontinence and pelvic organ prolapse
Authors: COATES K.W. , HARRIS R.L. , CUNDIFF G.W. , BUMP R.C. 
Published: November 2003

Objective To characterize uroflowmetry parameters in women with pelvic organ prolapse (POP) and urinary incontinence (UI) and to assess the effects of clinical and urodynamic variables on these parameters.Patients and methods The study comprised 655 consecutive women who presented with UI or POP and who had interpretable uroflowmetry values. Normal uroflowmetry values were defined as a maximum flow (Qmax ) ≥15 mL/s, a mean flow (Qmean ) ≥10 mL/s, a post‐void residual volume (PVR) ≤100 mL and a continuous, single‐peak waveform. Parametric and non‐parametric analysis of variance and chi‐square analysis were used to compare differences between diagnostic groups. Multiple linear regression models were developed to evaluate factors considered to influence uroflowmetry.Results Of the 655 patients, 471 (72%) had UI of whom 16% had pure detrusor instability (DI), 69% pure genuine stress incontinence (GSI) and 15% with both, and 184 (28%) had POP, 26% of whom also had DI. Of all patients, 72% had normal uroflowmetry patterns, 13% had multiple peaks and 15% had patterns with interrupted flow; 56% had completely normal uroflowmetry. There were significant differences in uroflowmetry values between the POP and UI groups, with the former having a lower Qmax and Qmean (P<0.001), larger PVRs (P<0.001) and a lower percentage of totally normal uroflowmetry (33% and 64%, respectively, P<0.001). Of patients with POP, 30% had a PVR >100 mL. Because of the differences, the POP and UI groups were evaluated separately in the regression analysis. In both groups, the most important determinants of flow rate were the volume voided and pressure transmission ratio (PTR). However, when several factors (including age, voided volume, PTR and maximum detrusor pressure with flow and at Qmax ) were included in the model, they accounted for only 23–26% of the variability of flow in the patients with UI and 36–39% of the variability in patients with POP. The subsets of patients with pure DI in both the UI and POP groups had higher PVR volumes than the other subsets.Conclusions These results show that the positive correlation between flow rate and voided volume described in normal populations is also observed in women with UI and POP. However, most of the variability in urine flow was not attributable to factors such as age, voided volume and PTR, confirming the complexity of the micturition mechanism. Women with POP had more objective evidence of emptying‐phase dysfunction than women with UI, although most emptied their bladders efficiently. Finally, the results suggest that women with DI exhibit dysfunction of both inhibitory and facilitory detrusor control.
How to recognize patients with parkinsonism who should not have urological surgery
Authors: CHANDIRAMANI V.A. , PALACE J. , FOWLER C.J. 
Published: November 2003

Objective To examine whether there are urogenital criteria that the urologist could apply to a patient with idiopathic Parkinson’s disease (IPD) and bladder symptoms, and so avoid operating on patients with multiple system atrophy (MSA).Patients and methods The clinical features of 52 patients with probable MSA and 41 patients with IPD were studied retrospectively with particular attention to the nature of lower urinary tract symptoms and erectile dysfunction in relation to the onset of parkinsonism. Anal sphincter electromyography (EMG) was recorded in all the patients with MSA and in 12 of the patients with IPD.Results Of the patients with MSA, 60% had urinary symptoms preceding or presenting with IPD but in 94% of the patients with IPD the neurological diagnosis preceded the onset of urogenital symptoms. Most of the patients with MSA (73%) had troublesome urinary incontinence whereas the majority of those with IPD (85%) had urgency and frequency but were not incontinent; 66% of the patients with MSA and 16% of patients with IPD had a significant post‐void residual volume. Of the men with MSA, 93% had erectile dysfunction and in 48% of them this complaint preceded the diagnosis of MSA. All 11 men with MSA who had a TURP were incontinent post‐operatively.Conclusion The urogenital criteria which favour a diagnosis of MSA are: (i) urinary symptoms preceding or presenting with parkinsonism; (ii) urinary incontinence and IPD; (iii) a significant post‐void residual urine volume; (iv) erectile failure preceding or presenting with parkinsonism; and (v) worsening bladder control after urological surgery. Patients with parkinsonism and these features should be offered medical management rather than urological surgery.