bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inflatable penile prosthesis: results of 150 cases
Authors: Garber B.B. 
Published: November 2003

Objectives To evaluate the reliability of the prosthesis and the rate of complications in organically impotent men who were implanted with an inflatable penile prosthesis. Patients and methods A consecutive series of 150 men (mean age 60 years, range 25–90) were followed for a mean of 19 months (range 0–65) after implantation of the Mentor Alpha 1 penile prosthesis. Information was obtained from their medical records and by telephone interview, but the satisfaction of the patients was not assessed quantitatively. Results There were no complications in 145 of the patients and they currently have functioning prostheses. Complications occurred in five patients (3%), including two peri‐prosthetic infections (1%) and two intra‐operative and one post‐operative cylinder aneurysm. Complications requiring re‐operation occurred in three (2%) of patients; none of the implants leaked. Conclusions These results suggest that for men with organic impotence, a Mentor Alpha 1 implant is an effective treatment option with acceptable morbidity and good mechanical reliability.
Thrombelastographic evaluation of coagulation in transurethral prostatectomy
Authors: Bell C.R.W. , Cox D.J.A. , Murdock P.J. , Sullivan M.E. , Pasi K.J. , Morgan R.J. 
Published: November 2003

Objective To assess the changes in overall coagulation status and define the degree of systemic fibrinolysis occurring in patients undergoing transurethral prostatectomy (TURP). Patients and methods Thirty patients undergoing TURP, 23 for benign prostatic hyperplasia and seven for prostatic carcinoma, were studied prospectively. Serial venous blood samples were taken using the two‐syringe technique. Samples were taken before, during and at intervals up to 72 h and 10–14 days after surgery. Thrombelastography (TEG) was performed on native whole blood samples. Peri‐operative blood loss was assessed, until the catheter was removed, by photometric estimation of the haemoglobin content of the irrigant fluid and the measurement of clot volume. Results There was no evidence of fibrinolysis (TEG Percentage Clot Lysis Ly60 >15%) in any patient over the whole peri‐operative period. There was a significant change in the mean TEG variables towards hypercoagulation from 3 h until 10–14 days post‐operatively, compared with the pre‐operative values (P<0.05). There was a significant correlation between blood loss and clot volume. Conclusion These results question the role of systemic fibrinolysis in primary and secondary haemorrhage following TURP and thus the rationale of using antifibrinolytics in these patients. The persistent hypercoagulable state post‐operatively indicates a possible role of hypercoagulability in clot retention.
A prospective audit of the use of a prostate clinic
Authors: Cutinha P.E. , Potts K.L. , Rosario D.J. , Hastie K.J. , Moore K.T.H. , Chapple C.R. 
Published: November 2003

Objective To assess the efficiency of a prostate clinic and to determine the treatment outcomes and the proportion of patients who could potentially be managed by their General Practitioners (GPs). Patients and methods Referral letters from GPs were screened by the consultant urologists and appropriate patients seen in the next available prostate clinic. The initial assessment consisted of an International Prostate Symptom Score and a medical history, uroflowmetry, ultrasonographically determined post‐void urine volumes, renal function tests and measurement of prostate specific antigen, in addition to a physical examination and a digital rectal examination. Further investigations were requested as required. Results Over a period of 18 months, 403 patients were seen, 90% of them within 12 weeks from the time of referral. Uroflowmetry was performed in 96% of patients and further urodynamics in 22%. Bladder outlet obstruction was diagnosed in 246 (61%) patients and primary detrusor instability was detected in 20 (5%) patients. Fourteen per cent of patients were returned to the care of the GP following their first visit. The audit identified a potential group of patients (52%) who could be managed by their GP. Seven per cent underwent prostate surgery for the relief of bladder outlet obstruction. Conclusion The prostate clinic significantly reduced the delay for patients to be seen at the hospital and facilitated rapid assessment and investigation, much of which was carried out by a nurse practitioner during the first visit (in most cases). Several patients were identified who could be managed in the community.
A standard protocol for the evaluation of laser treatment of the prostate
Authors: Carter A.C. 
Published: November 2003

Objectives To present a standardized protocol, suitable for general use, for the evaluation of laser treatment of the prostate. Methods Many new operative treatments which are available to treat symptomatic prostatic enlargement are being accepted and offered to patients after scanty clinical evaluation, e.g. interventions using lasers. A consistent and standard protocol was developed, comprising data‐recording sheets for patients' admission details, pre‐operative assessments, operative details of laser ablation, post‐operative in‐patient progress and re‐attendance, and subsequent out‐patient follow‐up. Results The protocol was tested by the members of BLUES and fulfilled their requirement for easy use in any department of Urology. It provides a simple way of accurately recording relevant data within a structured format with the additional advantage of permitting results to be expressed uniformly. Conclusion The adoption of this protocol will allow valid comparisons of core data between studies assessing different procedures. The flexibility of the protocol enables it to be used, with minor modification, for the evaluation of any operative intervention aimed at relieving prostatic symptoms.
The aetiological significance of human papillomavirus in bladder cancer
Authors: Boucher N.R. , Scholefield J.H. , Anderson J.B. 
Published: November 2003

Objective To determine the prevalence of human papillomavirus (HPV) DNA types 6, 11 and 16 in histological sections of human bladder cancer. Materials and methods Fifty‐five formalin‐fixed, paraffin‐embedded bladder tumour specimens were analysed for the presence of HPV infection using Southern blotting DNA hybridization and radiolabelled probes for HPV DNA types 6/11 and 16. Results Despite the detection of HPV DNA type 6, 11 and 16 in positive control samples and the successful detection of HPV DNA in anogenital cancer using the same technique, no HPV DNA was found in any of the bladder tumour specimens examined. Conclusions Using a technique with proven efficacy in the detection of HPV DNA from histological specimens, no HPV DNA was present in any of the bladder tumours examined. This finding is in agreement with most recently published studies suggesting that HPV has no significant role in the development of human bladder cancer.
Financial analysis of antegrade scrotal sclerotherapy for men with varicoceles
Authors: Johnsen N. , Tauber R. 
Published: November 2003

Objective To calculate and compare the costs of the treatment of varicocele by antegrade scrotal sclerotherapy with other modalities.Patients and methods A total of 2305 operations using antegrade scrotal sclerotherapy to treat varicocele in childhood and adolescence were analysed for cost factors and compared with different surgical treatment methods for varicocele.Results Calculation of the pre‐, intra‐ and post‐operative costs showed that antegrade scrotal sclerotherapy was the most economically effective of all forms of surgical management for varicocele.Conclusions Because antegrade scrotal sclerotherapy is a cost‐effective treatment for varicocele, the indications for treatment may be widened to include more men with potential infertility, and thus avoid the need for expensive methods of artificial fertilization.
An intra‐operative seminal and prostate emission test as a control for nerve‐sparing procedures in primary and secondary retroperitoneal lymphadenectomy
Authors: Recker F. , Goepel M. , Otto T. , Krege S. , Wernli M. , Stucki P. , Tscholl R. , Rübben H. 
Published: November 2003

Objective To determine the value of an intra‐operative electrostimulatory test of post‐ganglionic nerves for the preservation of ejaculation in primary and secondary retroperitoneal lymph‐node dissection (RLND).Patients and methods Between 1991 and 1994, 21 patients with non‐seminomatous testicular cancer of clinical stage A and 15 patients with bulky or clinical stage C disease underwent primary or secondary RLND, respectively. During surgery, post‐ganglionic nerves were electrostimulated at 30 Hz and up to 20 V, for 3–10 s. Emissions were recorded simultaneously by suprapubic ultrasonography of the seminal vesicals and bladder neck (in 36 patients) and by endoscopy of the posterior urethra (in 11 patients).Results A positive intra‐operative emission test in 15 pathological stage A (with bilateral nerve‐sparing) and six pathological stage B (with contralateral nerve‐sparing) patients predicted the post‐operative preservation of antegrade ejaculation. In the group undergoing secondary RLND, the test allowed the identification and sparing of the emission‐related nerves in four of 15 patients with a residual mass consisting of necrosis/fibrosis, and preserved antegrade ejaculation after surgery.Conclusions A positive result in the seminal emission test predicted the preservation of antegrade ejaculation after surgery. The test is not necessary in patients with clinical stage A disease, but improves the chances of reducing morbidity. If the residual mass consists of necrosis or fibrosis, then electrostimulation during secondary RLND can help to identify important nerve structures when their origin is unknown initially. However, attempts to retain nerve function must not jeopardize the patient's survival. The test can be an option for clinical stage B disease with initial bilateral RLND, to identify and preserve emission‐relevant nerves while the retroperitoneal space is removed radically. The test may also give additional information about the physiology of emission.
The Oxford Laser Prostate Trial: economic issues surrounding contact laser prostatectomy
Authors: Keoghane S.R. , Lawrence K.C. , Gray A.M. , Chappel D. , Hancock A.M. , Cranston D.W. 
Published: November 2003

Objective To compare the economic implications of transurethral resection of the prostate (TURP) and contact‐laser vaporization of the prostate (with the SLT system) using data obtained from a randomized controlled trial. Methods All aspects of management before, during and after surgery on 102 patients, followed up for 3 months, were costed and analysed. Based on the data from the trial, the mean costs were calculated. A sensitivity analysis was then performed to examine the effect of changes in some of the relevant variables. The mean difference in cost between laser treatment and TURP was plotted against the cost of laser consumables, assuming a 5% re‐operation rate for both operations at 5 years and a 5% discount rate. A range of laser re‐operation rates was compared with the mean difference in costs, assuming a hospital stay of one night and two district‐nurse visits. Other assumptions on discounts and re‐operation rates, based on collected data, were also tested. Results TURP will remain more economical until the cost of laser consumables is reduced to 20% of the current list price, or a hospital stay of one night is introduced. Conclusions The costs of contact‐laser vaporization of the prostate are likely to exceed the costs of TURP unless laser treatment is accompanied by a more active approach to post‐operative management, including a hospital stay of one night and, if necessary, the removal of the patient's catheter at home by a district nurse.
Urinary concentration of human chorionic gonadotrophin and its fragments as a prognostic marker in bladder cancer
Authors: Iles R.K. , Persad R. , Trivedi M. , Sharma K.B. , Dickinson A. , Smith P. , Chard T. 
Published: November 2003

Objective To examine the prognostic significance of elevated urinary beta human chorionic gonadotrophin (beta‐hCG) in patients with bladder cancer.Patients and methods Total beta‐hCG was measured in the urine of 142 patients referred for cystoscopic examination. Patients were followed for a minimum of 17 months and grouped according to stage of disease. Because the water output by individual patients varied, urinary creatinine levels were measured as an indicator of the concentration of the urine sample. Patient outcomes were correlated with urinary total beta‐hCG levels both corrected and uncorrected for creatinine concentration. After correcting for urinary creatinine levels, 40 patients were excluded because the sample was too dilute (undetectable beta‐hCG and a creatinine level of <4 mmol/L). A further four patients were excluded as they had concurrent malignancies not in the bladder and one patient was lost to follow up.Results None of the 52 patients with benign conditions, nine of the 27 with Ta–T1, and nine of the 25 with T2–T4 bladder disease had urinary total beta‐hCG levels >3.74 IU/mmol/L creatinine. There was no significant association between urinary total beta‐hCG concentrations and the rates of recurrence or progression for Ta–T1 disease at 17 months of follow‐up. For patients with T2–T4 disease there was a significant association with widespread metastasis (P<0.01) and mortality (P<0.01) at 17 months of follow‐up. These associations persisted when urinary total beta‐hCG levels were not corrected for urinary creatinine concentration (metastasis, P<0.01; mortality, P=0.07; Kaplan–Meier survival time analysis, uncorrected for creatinine P=0.027, corrected for creatinine P<0.001). This association could not be accounted for by differences in age, histopathology or treatment.Conclusion Although sample concentration was a serious confounding factor, after correcting for dilution using the creatinine content, the elevated urinary levels of total beta‐hCG indicated those T2–T4 lesions which were likely to metastasize and those patients likely to die early. If this test is to be used clinically, concentrated samples, i.e. early‐morning urine, and a more sensitive beta‐hCG assay are required. Nevertheless, for T2–T4 bladder tumours, an elevated pre‐treatment level of urinary beta‐hCG is a marker of poor prognosis and may prove useful in deciding appropriate therapy.
The prepuce: specialized mucosa of the penis and its loss to circumcision
Authors: Taylor J.R. , Lockwood A.P. , Taylor A.J. 
Published: November 2003

Objective To assess the type and amount of tissue missing from the adult circumcised penis. Materials and methods The gross and histological features of the prepuces of 22 adults obtained at autopsy were assessed, primarily focusing on the inner or mucosal surface of the prepuce. Results Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa. Conclusion The amount of tissue loss estimated in the present study is more than most parents envisage from pre‐operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.
Electrical activity of the corpus cavernosum in patients with corporal veno‐occlusive dysfunction
Authors: Kayigil Ö. , Atahan Ö. , Metin A. 
Published: November 2003

Objective To determine whether the pattern of discoordination (an increase in electrical activity of the corpus cavernosum after an intracavernous injection with papaverine and which results in the contraction of the cavernous smooth muscles instead of relaxation) is an aetiological factor in veno‐occlusive dysfunction (VOD). Patients and methods Electromyography of the corpus cavernosum was performed before and after an intracavernous injection with 60 mg papaverine in 45 patients diagnosed as having venogenic erectile dysfunction by colour Doppler ultrasonic flowmetry and dynamic infusion cavernosometry and cavernosography. Cavernosometric values were compared in patients with and with no pattern of discoordination. Results A pattern of discoordination occurred in 14 patients (31%). There were significant differences in the cavernosometric values of patients with and with no discoordination. A poor response to papaverine and greater venous leakage were observed in the patients showing discoordination. Conclusion The pattern of discoordination diagnosed by electromyography after injection with papaverine may explain some aspects of VOD and highlights the importance of performing electromyography of the corpus cavernosum in the diagnostic evaluation of VOD.
Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non‐organic male sexual dysfunction
Authors: Aydin S. , Odabas Ö. , Ercan M. , Kara H. , Agˇargün M.Y. 
Published: November 2003

Objective To examine the effects of hypnotic suggestions or the administration of testosterone or trazodone to impotent men with no detectable organic cause for the impotence. Patients and methods The study comprised 79 men in whom clinical and laboratory examinations revealed no organic cause for their impotence; 20 men (mean age 38.7±11.47 years) received testosterone, 21 men (mean age 39.5±10.73 years) received trazodone, 20 men (mean age 34.2±11.69 years) underwent hypnosis and 18 men (mean age 39.1 ±11.46 years) served as controls. They were assessed by interview 4, 6 and 8 weeks after starting treatment; the patient's reports were verified by interviewing their partners. Results Men who received a placebo had a 39% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of testosterone and trazodone treatment and hypnotic suggestions were 60%, 67% and 80%, respectively. Conclusion Although the improvement was not statistically significant, treatment with testosterone and trazodone could be used as an adjuvant therapy in non‐organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.
Penile fracture: differential diagnosis, management and outcome
Authors: Karadeniz T. , Topsakal M. , Arýman A. , Erton H. , Basak D. 
Published: November 2003

Objective To determine the value of a diagnostic and therapeutic approach for patients presenting with acute penis and the effects of this management on the outcome. Patients and methods The study comprises 21 consecutive patients (mean age 33.3 years, range 19–53) who presented with acute penis (acute pain and swelling during and soon after intercourse). The mean interval between the accident and the treatment was 6 h (range 2–20). All patients initially underwent cavernosography, followed by surgical exploration. Results Cavernosography showed extravasation of the contrast medium, indicating a corporal tear, in 19 of 21 patients. Surgical exploration revealed rupture of the deep dorsal vein in two patients whose radiological examinations were normal. In the remaining 19 patients, corporeal tears were repaired. The mean follow‐up was 26.7 months; all patients regained penile function (potency). Penile curvature was the only adverse effect in three of the 21 patients, all of whom presented for medical treatment relatively late after the initial accident. Conclusion In the management of the acute penis, cavernosography should be performed first and the treatment policy should be determined from the radiological findings. Conservative therapy should be chosen only when the corporeal bodies are intact.
Impalpable prostate cancer: clinicopathological features
Authors: Rogers E. , Eastham J.A. , Ohori M. , Sariyuce O. , Aihara M. , Wheeler T.M. , Scardino P.T. 
Published: November 2003

Objective To determine the clinicopathological features of impalpable prostate cancer. Patients, materials and methods The numbers of T1a and T1b cancers detected in transurethral resections of the prostate (TURP) performed before and after the advent of the test for serum prostate‐specific antigen (PSA) were compared and the incidence of T1 disease in specimens from 400 consecutive radical prostatectomies examined. Results The incidence of T1b disease detected at TURP decreased significantly between the periods examined, but that of T1a was unaffected. Similarly, in radical prostatectomy specimens, T1b cancers were largely replaced by T1c and impalpable T2 cancers detected by ultrasonography. Conclusions Cancers detected incidentally at TURP tend to be small T1a tumours, possibly suitable for conservative management. T1b cancers are likely to be detected by PSA level and treated radically. T1c and impalpable T2 cancers are morphologically unlike T1b disease and justifiably belong in separate stages in the current UICC staging system.
Serum prostate specific antigen levels in non‐specific granulomatous prostatitis
Authors: Speights Jr V.O. , Brawn P.N. 
Published: November 2003

Objective To evaluate serum prostate‐specific antigen (PSA) levels in patients with granulomatous prostatitis, an inflammatory condition that can clinically mimic malignancy. Patients and methods The study comprised 10 consecutive patients (age range 53–80 years) with histologically‐documented granulomatous prostatitis and who had serum PSA levels recorded before and after diagnosis. Results PSA levels in six of the patients were normal (<4.0 ng/mL) at diagnosis. The other four had slightly elevated PSA levels, with three being between 4.0 and 6.0 ng/mL and the other 10.1 ng/mL. In six of the patients, there was a dramatic decrease (>40%) in PSA level within 6–12 months after the histological documentation of granulomatous prostatitis. At the final follow‐up, all 10 patients had normal PSA levels. Conclusion Granulomatous prostatitis may cause a relatively mild and transient increase in serum PSA level which resolves when the inflammation subsides.
Transurethral needle ablation of the prostate: clinical experience in patients in urinary acute retention
Authors: Zlotta A.R. , Peny M‐O. , Matos C. , Schulman C.C. 
Published: November 2003

Objective To evaluate the clinical outcome of patients in urinary retention due to benign prostatic enlargement (BPE) treated using transurethral needle ablation (TUNA), an outpatient procedure requiring only local intra‐urethral anaesthesia and intravenous sedoanalgesia. Patients and methods The TUNA technique was used in 38 patients in acute retention due to BPE, 34 of whom were a poor surgical risk. A special cystoscopic catheter device delivered low‐level radiofrequency (RF) energy interstitially to a localized area of the prostate, producing necrotic lesions within the prostatic parenchyma. After treatment, all men were evaluated using urinary flow rates, residual urine volume, the International Prostate Symptom Score and quality of life score at 1, 3 and 6 months. Results The mean prostate size was 43.1 g (range 18–90). Tolerance of the procedure when using topical anaesthetic and intravenous sedation was excellent. Of the 38 patients treated using TUNA, 30 (79%) resumed voiding within a mean of 8.7 days (range 2–27). After 6 months, the sustained mean peak flow rate was 10.4±3.4 mL/s and the mean residual volume was 76±45 mL. Five of the patients who did not resume voiding after TUNA underwent retropubic prostatectomy and one patient underwent TURP. The mean prostate size in these patients was 55.7 g. Failure to void was associated with the treatment of too few areas of the prostate for its volume. Conclusion This study demonstrated that TUNA is highly effective in relieving patients in urinary retention due to BPE and seems particularly suitable for treating patients who are at greater risk during surgery.