bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fertility and histological studies in a unilateral cryptorchid rat model during early and late adulthood
Authors: Zakaria  , Shono  , Imajima  , Suita  
Published: March 2003

Objective To investigate the effect of age on fertility and testicular development in rats with untreated unilateral undescended testes.Materials and methods Newborn male Wistar King‐A rats were divided into two groups. In group 1, a mechanical model of unilateral undescended testis was created by performing extra‐abdominal fixation of the gubernaculum in the neonatal period, and in group 2, sham‐operated rats were used as controls. At 90 days old (early adulthood), the fertility of both groups was assessed by mating the rats with mature virgin females for 2 weeks. Thereafter, some of the rats were killed and their testes examined histologically, while the remaining rats were allowed to develop further. At the age of 180 days (late adulthood), fertility was re‐assessed in the same way. All the rats were then killed and their testes removed for histological examination.Results There was no significant difference in pregnancy rate of females mated with males from either group in early adulthood. However, in late adulthood there was a significant reduction in pregnancy rate in females coupled with cryptorchid rats compared with that of females coupled with control rats. There was a significant degeneration of the unilateral cryptorchid testes compared with control testes in both early and late adulthood. In contrast, there were no significant changes in histological development between the contralateral scrotal testes and the controls in early adulthood, although they were significantly different from the controls in late adulthood.Conclusion These results suggest that fertility is affected by ageing in untreated unilateral cryptorchidism; this may be induced by extensive damage not only in the undescended testes, but also in the contralateral scrotal testis, in this mechanically induced model of unilateral cryptorchidism.
Clinical aspects associated with Sertoli‐cell‐only histology
Authors: Bettocchi  , Parkinson  , Ralph  , Pryor  
Published: March 2003

Objective To assess the clinical features found in infertile men in whom the histological diagnosis of Sertoli‐cell‐only (SCO) was made on testicular biopsy.Patients and methods A retrospective review was carried out of the seminal fluid analysis, testis size and follicle‐stimulating hormone (FSH) levels of 72 men who had bilateral testicular biopsies due to infertility when one (30) or both (42) of bilateral testicular biopsies showed tubules containing only Sertoli cells. In a subgroup of 15 men, the biopsies were re‐examined to correlate the morphological features with the plasma FSH level.Results When both biopsies showed bilateral SCO the patient had azoospermia (86%) or oligozoospermia (14%); the testicular size was normal in 36% and the FSH level was normal (43%), raised (21%) or grossly elevated (more than twice normal, 36%). When one biopsy showed SCO, the opposite testis showed appearances which varied from grossly impaired spermatogenesis to almost normal spermatogenesis. The clinical findings were also very variable.Conclusions The clinical features associated with the histological diagnosis of SCO are extremely variable. Biopsy evidence of bilateral SCO cannot be relied upon to indicate a total absence of spermatogenesis in the testes.
The physicochemical basis of urinary catheter encrustation
Authors: Choong  , Hallson  , Whitfield  , Fry  
Published: March 2003

ObjectivesTo determine the relationship between urinary pH and Ca2+ solubility in urine samples from patients who experienced either frequent (‘blockers’) or infrequent (‘nonblockers’) catheter blockage by crystalline deposits of divalent cation salts.Materials and methodsFresh urine samples from ‘blockers’ and ‘nonblockers’ were collected and the ionic calcium concentration ([Ca2+ ]) measured using a Ca2+‐selective electrode whilst the urinary pH was increased in 0.25 increments between 4.75 and 9.00. The pH at which crystallization occurred (nucleation) was determined and crystal composition analysed.ResultsThe mean (sd) voided urinary pH of catheter ‘blockers’ was significantly more alkaline than that from ‘nonblockers’, at 7.63 (0.64) and 5.97 (0.80), respectively (P=0.001). The nucleation pH of catheter ‘blockers’ was significantly more acid than in ‘nonblockers’, at 7.43 (0.73) and 6.45 (0.65), respectively (P=0.005). Urine from ‘blockers’ had significantly more Ca phosphate and Mg ammonium phosphate crystals. ‘Blockers’ were further divided into two subsets with and without urease‐based urinary tract infection; both showed a decrease in the nucleation pH.ConclusionIn the urine from ‘nonblockers’ there is a wide safety margin between voided and nucleation pHs; this margin was less in the urine from ‘blockers’. This reduction in the safety margin arises partly because the voided pH in those with a urinary tract infection is more alkaline. However, the decrease in the nucleation pH also suggests that a fundamental property of urine is altered, which reduces Ca2+ solubility at more neutral pH values. The long‐term goal is to increase the nucleation pH of catheter ‘blockers’ and increase the margin of safety.
Radical cystoprostatectomy combined with Mainz pouch bladder substitution to the urethra: long‐term results
Authors: Leissner  , Stein  , Hohenfellner  , Köhl  , Riedmiller  , Schröder  , Lampel  , Thüroff  
Published: March 2003

ObjectiveTo analyse, in a retrospective study, the oncological outcome, pouch‐related complications, continence and micturition after radical cystoprostatectomy combined with Mainz pouch orthotopic bladder substitution to the urethra for the treatment of bladder cancer.Patients and methodsBetween 1986 and 1996, three urological departments contributed 108 male patients to the review. The same exclusion criteria from orthotopic bladder substitution were applied by all centres, i.e. multifocal or concomitant carcinoma in situ, tumour at the bladder neck, positive biopsy from the prostatic urethra, locally advanced tumour and lymph node involvement. In all, 103 patients were evaluable for follow‐up, with a mean (range) follow‐up of 42 (3–132) months.ResultsPathological examination of the cystectomy specimen revealed 81% organ‐confined tumours. During follow‐up, 84% of patients remained free of tumour, 7% developed distant metastases, 5% local recurrences, 4% urethral recurrences, and 1% upper tract urothelial cancer; 85% of patients are capable of spontaneous voiding, with a mean pouch capacity of 720 mL. Daytime continence was achieved in 88%, including 17% wearing one safety pad; 9% had stress incontinence and 3% total incontinence; 67% could sleep through the night, with either complete continence (34%) or one safety pad (33%). Nocturnal incontinence occurred in 11%. Uretero‐intestinal stenosis occurred in 15 of 205 (7%) renal units, requiring ureteric reimplantations in 11, nephrectomy in three and antegrade dilatation in one. Reflux was not noted in any patient. About half the patients were on anti‐acidotic prophylaxis.ConclusionThe large bowel segment in the Mainz‐pouch technique of orthotopic bladder substitution provides good reservoir capacity and continence rates, with less ileum used than in all‐ileum pouches. The surgical technique is simple and reproducible, and in particular the antireflux ureteric implantation into the caecum protects the upper urinary tracts.
The incidence of hypospadias in two English cities: a case‐control comparison of possible causal factors
Authors: Chambers  , Malone  
Published: March 2003

ObjectivesTo determine the incidence and severity of hypospadias amongst children born in Southampton and Portsmouth during 1992–94, and to identify possible causal factors by comparing patients with a control group.Patients and methodsAll patients with hypospadias born in Southampton and Portsmouth during 1992–94 were identified. The Southampton cases were matched with controls; the case notes of each affected child were reviewed. The incidence determined by this study was compared with data provided by the Central Statistics Office.ResultsThere was no apparent increase in the incidence of hypospadias in Southampton and Portsmouth during 1982–94. However, there was a clear local variation in incidence, with a significantly lower incidence in Portsmouth than in Southampton and the rest of England and Wales. The severity of hypospadias was also more marked in Southampton than in Portsmouth. The only recognisable aetiological factor was a positive family history, supporting the concept of a polygenic mode of inheritance. All the environmental factors investigated were unrelated, but there was a suggestion of clustering in a single water‐quality zone.ConclusionsThis study identified no increase in the incidence of hypospadias but it did detect local variations in both the incidence and severity of the condition, and these need to be considered when planning surgical services.
Gonadal morphology in cloacal exstrophy: implications in gender assignment
Authors: Mathews  , Perlman  , Marsh  , Gearhart  
Published: March 2003

ObjectiveTo compare the histology of gonads excised from males with cloacal exstrophy (the most severe variant of the exstrophy‐epispadias complex) undergoing early gonadectomy and gender reassignment (to obviate difficulties in reconstructing male external genitalia) with those published previously.Patients and methodsTesticular tissue was obtained from males with cloacal exstrophy undergoing gender reassignment shortly after birth. Slides were stained for histological evaluation and reviewed by one author. The histology was compared with known normal features for newborn testicular tissue. The mean age at the time of gender reassignment was 6 months.ResultsThere were no significant abnormalities in the architecture of the rete testis, epididymis or vas of the study specimens. There were more germ cells in some patients with cloacal exstrophy, but this finding was not specific and is of unknown clinical significance.ConclusionsDespite the severity of the malformations in cloacal exstrophy, testicular histology is preserved. In highly selected genotypic males who have adequate phallic structures, congruent gender assignment is appropriate and early orchidopexy is recommended.
A prospective study of nonmedical prophylaxis after a first kidney stone
Authors: Kočvara  , Plasgura  , Petřík  , Louženský  , Bartoníčková  , Dvořáček  
Published: March 2003

ObjectiveTo assess, in a multicentre prospective randomized study, the effectiveness of specific nonmedical prophylaxis and nonspecific dietary prophylaxis in patients treated after experiencing their first idiopathic calcium‐containing kidney stone.Patients and methodsFrom 1991 to 1994, 242 patients with idiopathic calcium urinary stones from three urological centres were randomly assigned into two groups. In group 1 (intervention, 113 patients), a specific dietary regimen was recommended and thereafter corrected according to a comprehensive metabolic evaluation. Group 2 (control, 94 patients) underwent only minimal metabolic screening and used general dietary measures, with no regular follow‐up. An increased fluid intake was recommended in both groups. After 3 years, the effectiveness of the prophylactic and dietary regimens was evaluated in 207 patients.ResultsAt entry, the clinical characteristics were comparable in the two groups, with only extracorporeal lithotripsy being more frequent in group 2. Almost 80% of patients reported a high intake of meat and a low intake of dairy products. In group 1 and 2, a recurrent stone was encountered in seven (6%) and 18 (19%) patients, respectively; recurrent and growing stones were found in eight (8%) and 22 (23%) patients, respectively (P<0.01). There was a higher incidence of bilateral residual (or untreated) stones, and Weddellite stones (P<0.001) among patients with a recurrent or growing stone. An analysis of the dynamics of the metabolic variables indicated the significance of repeated dietary counselling.ConclusionSpecific dietary therapy, adjusted according to a metabolic evaluation, is more effective than nonspecific general dietary recommendations in preventing the formation of a second urinary stone.
Comorbidity in patients with prostate cancer and its relevance to treatment choice
Authors: Post  , Kil  , Hendrikx¶  , Janssen‐Heijnen  , Crommelin  , Coebergh  
Published: March 2003

Objective To evaluate the prevalence of comorbidity among patients with prostate cancer in relation to tumour and patient characteristics and to assess if comorbidity was a determining factor in the treatment choice for patients with localized prostate cancer.Patients and methods Serious comorbidity was recorded in the Eindhoven Cancer Registry (according to a published list of such diseases) for all patients (2941) with prostate cancer newly diagnosed between 1993 and 1996 in the southern part of The Netherlands. Logistic regression was then used to assess which factors determined the treatment choice.Results The prevalence of at least one serious comorbid condition was 38% for patients aged 60–69 years, 48% when aged 70–74 years and 53% for those aged ≥75 years, the cardiovascular and chronic obstructive lung diseases being most frequent. Patients aged 60–69 years were more likely to be treated with radical prostatectomy for moderately differentiated tumour confined to the prostate, or when younger and diagnosed in a hospital with a high case‐load. The presence of comorbidity had little influence of this choice.Conclusion Comorbidity was common in patients with prostate cancer, but the decision of urologists in the southern Netherlands to use radical prostatectomy was determined largely by the patient’s age and the urologist’s experience.
Intraurethral sphincter prosthesis to treat hyporeflexic bladders in women: does it work?
Authors: Schurch  , Suter  , Dubs  
Published: March 2003

Objective To assess the efficacy and safety of a new intraurethral sphincter prosthesis to treat hyporeflexic bladders in women.Patients and methods Between July 1997 and December 1998, 18 women (mean age 45.8 years, range 26–84) with neurogenic voiding disorders and a hyporeflexic bladder were examined prospectively. All but one patient (who used the Crédé manoeuvre) emptied their bladder using clean intermittent catheterization. The women were fitted with a prosthesis consisting of a valve and a pump inside a short self‐retaining silicone device, which was activated by a magnetic remote control unit. The evaluation before implantation comprised a medical history, a neurological evaluation, urodynamic recordings and urine cultures. The follow‐up after implantation included a monthly clinical assessment, a symptom questionnaire, urine culture, ultrasonographic examinations and replacement of the device if necessary. Urine samples were also cultured if there was any discomfort or fever.Results At 16 months of follow‐up, only six of 18 patients continued to use the implant (mean follow‐up 9.6 months) and were satisfied. In 10 patients major incontinence around the catheter, or irritation, led to removal of the device. Two patients were unable to learn how to transfer to the toilet to empty their bladder; therefore, their implant was removed and they were treated with a suprapubic catheter. Two patients died from unrelated causes. Twelve patients had positive bacteriuria while fitted with the device; six of them became symptomatic. Usually, only symptomatic lower urinary tract infections were treated. Technical problems occurred often; 14 catheters showed technical dysfunction and had to be replaced early and three external remote control units broke for no reason. Despite normal short‐term cystoscopic findings (three patients), long‐term urethral damage cannot be excluded. Indeed, the six patients who remain fitted with the device already show some widening of their urethra.Conclusion This experience with the new device was disappointing; in eight of the 18 patients incontinence appeared or worsened and led to removal of the device. Technical problems were common. The other concern is that significant long‐term urethral damage could be expected, as observed with indwelling catheters over time. Thus, although this device may function for a short period, it is unsuitable for long‐term use.
Hybrid laser treatment compared with transurethral resection of the prostate for symptomatic bladder outlet obstruction caused by a large benign prostate: a prospective, randomized trial with a 6‐month follow‐up
Authors: Tuhkanen  , Heino  , Alaopas  
Published: March 2003

Objective To compare the efficacy and safety of hybrid laser treatment, i.e. the combination of visual Nd‐YAG laser ablation of prostate and contact Nd‐YAG laser vaporization of prostate, with transurethral resection of the prostate (TURP) in the treatment of patients with symptomatic bladder outlet obstruction secondary to a benign high‐volume prostate.Patients and methods Forty‐five symptomatic patients with hyperplastic prostates of >40 mL were randomized to undergo either hybrid laser treatment (21) or TURP (24). All patients were evaluated before and after treatment with a complex urodynamic assessment, and were accepted into the study only if they had infravesical obstruction in the pressure‐flow study. In the hybrid method, Nd‐YAG laser energy was first delivered by an ‘adenoma‐dependent’ approach to all areas of the obstructing lateral lobe tissue through a side‐firing gold‐alloy tip fibre at 40 W for 90 s of ‘burn’. The prostatic urethra was then opened and the median lobe vaporized using the a contact probe at 40 W. Patients were re‐evaluated 3 and 6 months after treatment.Results Both treatments proved to be safe, and improved the subjective and objective outcome measures at 3 and 6 months compared with baseline values. After 3 months, there was a greater improvement in the TURP group in peak urinary flow rate (Qmax ; P<0.01), mean urinary flow rate (Qave ; P<0.01) and postvoid residual urine volume (P<0.05) than in the hybrid laser group. After 6 months, there was a greater improvement in the TURP group in detrusor pressure at Qmax (P<0.01), Qave (P<0.05) and prostate size (P<0.001) than in the hybrid laser group. In the pressure‐flow study at 6 months, a higher proportion of patients (seven of 19) were still obstructed in the hybrid laser group than in TURP group (two of 21; P<0.05). TURP caused more intraoperative blood loss (P<0.001) and postoperative problems associated with bleeding; 38% of hybrid laser patients were discharged with a suprapubic catheter, whereas all TURP patients could urinate at discharge (P<0.01). The duration of bladder drainage was longer after hybrid laser treatment (P<0.001).Conclusion The hybrid laser method was a safe but less effective treatment than TURP for benign prostatic enlargement in patients with prostates of >40 mL.
The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction
Authors: Pfister  , Dacher  , Gaucher  , Liard‐Zmuda  , Grise  , Mitrofanoff  
Published: March 2003

ObjectiveTo report our experience of assessing children with chronic voiding dysfunction (>6 months’ duration) using a minimal urodynamic evaluation, and the management of detrusor‐sphincter dyscoordination (DSdc) using pelvic floor biofeedback.Patients and methodsFrom 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto‐urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory.ResultsDSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico‐ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re‐education in four.ConclusionA minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.
Distribution of α1‐adrenoceptor subtype mRNAs in human renal cortex
Authors: Kurooka  , Moriyama  , Nasu  , Kameyama  , Fukasawa  , Yano  , Kawabe  
Published: March 2003

ObjectiveTo determine the quantity and distribution of α1‐adrenoceptor subtype mRNAs in human renal cortex.Materials and methodsSpecimens of renal cortex tissue were obtained at the time of radical nephrectomy or total nephroureterectomy from 46 patients (mean age 59.0 years, sd 14.7) with renal cell carcinoma, renal pelvic or ureteric tumour. Using the reverse‐transcriptase polymerase chain reaction (RT‐PCR), the RNase protection assay and in situ hybridization, the presentation, quantity and distribution of α1‐adrenoceptor subtype mRNAs were determined.ResultsExpression of the three α1‐adrenoceptor subtype mRNAs (α1a, α1b and α1d) was confirmed in the arteries of the renal cortex (arciform, interlobular, arteriole), but among the three subtypes, the α1b was less apparent by in situ hybridization. Intense α1‐mRNA staining was apparent especially in the smooth muscle of arterial walls. In both proximal and distal renal tubules, each of the α1‐mRNAs was less marked in cytoplasm than in the arteries. In the glomeruli weak staining was detected in the endothelium but there was no obvious staining in the veins. RT‐PCR showed all three subtypes of α1‐adrenoceptor. The RNase protection assay showed that the predominant α1‐adrenoceptor subtype mRNA in human renal cortex was α1a. However, the abundance of α1a‐mRNA in human kidney was much less than in the prostate.ConclusionThree α1‐adrenoceptor subtype mRNAs were recognized in human renal cortex and detected particularly in the smooth muscle of the arteries. There was more α1a‐adrenoceptor subtype in human renal cortex than the other subtypes. It is not known how each subtype operates against adrenergic stimulation; further studies are needed to examine receptor density or receptor function.