bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contractile responses to α1‐adrenoceptor agonists in isolated human male and female urethra
Authors: Nishimatsu  , Moriyama  , Hamada  , Ukai  , Yamazaki  , Kameyama  , Konno  , Ishida  , Ishii  , Murayama  , Kitamura  
Published: March 2003

ObjectiveTo investigate the contractile responses mediated through α1‐adrenoceptors in human urethra and to evaluate the effectiveness of NS‐49 [(R)‐(–)‐3′‐(2‐amino‐1‐hydroxyethyl)‐4′‐fluoromethanesulphonanilide hydrochloride], a novel α1‐adrenoceptor agonist, against contraction of the human urethra.Materials and methodsThe contractile responses were assessed in 10 male prostatic urethrae and six female urethrae. Antagonism was evaluated in the urethra using phenylephrine, a nonselective α1‐adrenoceptor agonist, cumulatively applied > 20 min after applying 0.1 μmol/L prazosin or 0.1 μmol/L 5‐methylurapidil, a selective α1A‐adrenoceptor antagonist. Agonism was determined in both male and female urethrae to obtain the concentration‐response curve for the agonist.ResultsPhenylephrine caused both male and female urethrae to contract, and showed high potency and efficacy. Prazosin antagonized these contractions with low affinity (apparent pKB of 8.30 in male urethrae). 5‐Methylurapidil, also antagonized the contractions with low affinity (apparent pKB of 7.88 in male urethrae). Noradrenaline and phenylephrine caused both male and female urethrae to contract, with high potency and efficacy. A novel and selective α1A‐and α1L‐adrenoceptor agonist, NS‐49, induced contractile responses with high potency and moderate efficacy, whereas methoxamine induced contractions with low potency and moderate efficacy. Norephedrine was a very weak contractile agonist.ConclusionIn the human urethra, phenylephrine‐induced contractions were mediated through α1L‐adrenoceptors and not through α1A‐adrenoceptors. Contractions of the human urethra induced by NS‐49 were also mediated mainly through α1L‐adrenoceptors, with high potency and moderate efficacy. NS‐49 may therefore be useful for the treatment of urinary stress incontinence, with minimal side‐effects because it has subtype selectivity.
Evaluation of nuclear matrix protein 22 as a tumour marker in the detection of transitional cell carcinoma of the bladder
Authors: Sánchez‐Carbayo  , Herrero  , Megías  , Mira  , Soria  
Published: March 2003

Objectives To evaluate the sensitivity and specificity of urinary nuclear matrix protein‐22 (NMP22) in detecting bladder cancer, to compare the diagnostic performance of NMP22 alone and when corrected by urinary creatinine level, and to correlate NMP22 level with the histological and clinical characteristics of bladder cancer.Patients, subjects and methods The study included 267 patients classified into five groups: group 1 comprised 111 patients with active transitional cell carcinoma (TCC) of the bladder; group 2 included 76 patients who had had bladder TCC but were being followed and were free of disease, as confirmed by cystoscopy; group 3 comprised 25 patients with benign urological diseases; group 4 included 25 patients with other malignant pathological conditions; group 5 constituted a control group of 30 healthy subjects free of urological diseases. Urinary NMP22 was measured using an enzyme‐linked immunosorbent assay. Receiver operating characteristic (ROC) curves were constructed to obtain the thresholds which gave optimal sensitivity and specificity for combinations of NMP22 alone and when corrected by urinary creatinine level. Stage, grade, tumour size, pattern of growth, focality and the presence of recurrence were recorded and their associations with NMP22 evaluated.Results The mean levels of NMP22 were 122.8, 5.1, 3.7, 2.3 and 0.3 U/mL for groups 1–5, respectively; overall, these values were significantly different (P<0.001). The mean (95% CI) optimal combination of 78.2% (69.3–85.5) sensitivity and 95.5% (87.3–99.0) specificity was obtained from the ROC analysis with a threshold value of 13.7 U/mL NMP22. When values were corrected by urinary creatinine levels, the threshold given by the best combination of sensitivity and specificity, at 73.2% (63.2–81.7) and 97.0% (89.6–99.5), respectively, was 3.0 U/mg creatinine. NMP22 level was statistically associated with stage, grade, tumour size and focality.Conclusions Urinary NMP22 appeared to be a potential tumour marker for detecting TCC of the bladder; when corrected by urinary creatinine level, it might provide a better interpretation than when used alone. NMP22 correlated with the most relevant variables in bladder cancer. As a noninvasive adjunct, NMP22 might have a role in guiding urologists about the need for cystoscopy in such patients.
Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy
Authors: Asgari  , Safarinejad  , Hosseini  , Dadkhah  
Published: March 2003

Objective To evaluate the safety of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL) during pregnancy.Patients and methods Data from 824 women of reproductive age who were treated by ESWL were analysed and the patients surveyed using a questionnaire about pregnancies, to which 636 (76%) responded. Of these patients, six had inadvertently undergone ESWL for renal stones during the first month of pregnancy. The stones were detected and located during ESWL using ultrasonography.Results The six patients gave birth to six children who had no detectable malformations or chromosomal anomalies.Conclusion Although these results suggest that there were no adverse effects of ESWL during early pregnancy, a larger series should be assessed to confirm the safety and long‐term effects of ultrasound‐guided ESWL in the treatment of renal calculi during pregnancy. We do not advocate lithotripsy as a treatment for renal calculi in pregnancy, but inadvertent lithotripsy in a pregnant woman is not a cause for concern.
Purinergic sensory neurotransmission in the urinary bladder: an in vitro study in the rat
Authors: Namasivayam  , Eardley  , Morrison  
Published: March 2003

Objectives To determine the response of mechanosensitive pelvic nerve afferents, arising from the rat urinary bladder, to the purinergic agonist α,β‐methylene ATP and to the purinergic antagonist suramin.Materials and methods Using a newly developed in vitro bladder‐pelvic nerve afferent model, multiunit recordings were taken from mechanosensitive pelvic nerve afferents arising from the rat urinary bladder, in response to bladder distension. Control experiments were performed by distending the bladder with saline at 0.04 mL/min, and recording the total afferent nerve activity and the bladder pressure response to the distension. Bladder distensions were then repeated using a solution of the stable purinergic agonist α,β‐methylene ATP (10 μmol/L), which is known to desensitize P2X‐purinoceptors after prolonged exposure, and the total afferent activity and bladder pressure response were again measured. In a separate series of experiments the afferent nerve activity and bladder pressure response to bladder distension with saline was determined in the presence of the purinergic antagonist suramin (10 μmol/L) and repeated after washout of the drug. In both series of experiments, afferent nerve responses were compared with control using the paired t‐test, whilst the bladder pressure responses were compared using one‐way analysis of variance.Results Bladder distension with α,β‐methylene‐ATP produced a statistically significant reduction in afferent nerve activity, by up to 75% compared with the control, whilst having no significant effect on the bladder pressure response. Bladder distension with saline in the presence of suramin (10 μmol/L) produced a significant reduction in the resultant afferent nerve activity, by 50%, which returned to normal after washout of the drug.Conclusion These findings are consistent with the notion that ATP is released endogenously during bladder distension in the rat and is involved significantly in the activation of pelvic nerve afferents arising from the rat urinary bladder.
Time‐dependent up‐regulation of endothelin‐A receptors and down‐regulation of endothelin‐B receptors and nitric oxide synthase binding sites in the renal medulla of a rabbit model of partial bladder outlet obstruction: potential clinical relevance
Authors: Khan  , Dashwood  , Thompson  , Mumtaz  , Mikhailidis  , Morgan  
Published: March 2003

ObjectiveTo assess the density of endothelin (ET) receptors (ET‐1 is a potent vasoconstrictor peptide acting on two known receptors, ETA and ETB ) and nitric oxide synthase (NOS) binding sites in the kidney of a rabbit model of bladder outlet obstruction (BOO).Materials and methodsPartial BOO was created in adult New Zealand White rabbits; after 1, 3, 4 and 6 weeks of BOO, kidney sections were incubated with radioligands for ET‐1, ETA , ETB receptors and with [3H]‐NOARG (a ligand for NOS). Autoradiographs were generated and analysed densitometrically. Sections were also assessed by NADPH histochemistry. Plasma creatinine, urea and electrolyte levels were regularly monitored. The control and 6‐week BOO kidneys were also evaluated ultrastructurally by electron microscopy.ResultsThere was no significant change in plasma creatinine, urea and electrolyte levels. ETA and ETB receptor density was significantly greater in the medulla than in the cortex (P<0.001) in all animals. There was an up‐regulation of ETA receptors (P=0.03) and down‐regulation of ETB receptors (P=0.03) and NOS binding sites (P<0.001), as well as decreased NADPH staining in the medulla of 6‐week partial BOO kidneys. Electron microscopy detected glomerular disruption of the obstructed kidneys.ConclusionThe time‐dependent changes in ETA and ETB receptors, NOS binding sites and NADPH staining in the renal medulla, as well as ultrastructural changes, occur despite normal renal function. These changes appear to be an early event and may play a role in the development of renal failure. Hence, the use of ETA receptor antagonists at this early stage may prevent the development of renal failure/impairment in BOO.
Does anaesthetic technique affect the outcome after transurethral resection of the prostate?
Authors: Reeves  , Myles  
Published: March 2003

ObjectiveTo determine if the choice of anaesthetic (spinal or general) has any influence on outcomes after transurethral resection of the prostate (TURP).Patients and methodsThe records of 261 patients undergoing TURP between October 1995 and July 1998 were selected for a matched‐cohort study. There were 87 complete datasets for cases performed under general anaesthesia and each was matched to two patients (174) from those undergoing spinal anaesthesia. The cohorts were matched by age, physical status score and date of operation. The primary outcome measures were length of stay in the recovery room and satisfaction with postoperative analgesia.ResultsThere were no significant differences in major outcomes. There was a higher incidence of some minor adverse events in the group having general anaesthesia. Back pain was more common after spinal anaesthesia.ConclusionSpinal anaesthesia was not associated with an improved outcome after TURP. The choice of anaesthesia should be made by the patient, surgeon and anaesthetist on the basis of the known risks of particular adverse events.
Trends in repeat prostatectomy after surgery for benign prostate disease: application of record linkage to healthcare outcomes
Authors: Semmens  , Wisniewski  , Bass  , Holman  , Rouse  
Published: March 2003

ObjectiveTo compare the risk of repeat prostatectomy for benign prostatic hyperplasia (BPH) in a population‐based cohort of 19 598 men in Western Australia treated by transurethral resection of the prostate (TURP) or open prostatectomy over a 16‐year period.Patients and methodsThe Western Australian Health Services Research Linked Database was used to extract all hospital morbidity data, death records and prostate cancer registrations for men who had prostate surgery for BPH in 1980–95. The cumulative incidence of first repeat prostatectomy calculated using the actuarial life‐table and incidence‐rate ratios of the first repeat prostatectomy, comparing TURP and open prostatectomy, were obtained using Cox regression.ResultsThe cases comprised 18 464 TURPs and 1134 open prostatectomies, from which there were 1095 subsequent repeat prostatectomies. After adjustment for calendar time, age and admission type, the incidence rate of the first repeat prostatectomy was up to 2.30 times higher (95% confidence interval, 1.62–3.27) after initial TURP than for initial open prostatectomy. The absolute risks at 8 years for TURP was 6.6%, and was 3.3% for open prostatectomy.ConclusionThe absolute risk of a repeat prostatectomy for TURP and open prostatectomy were consistent with the best reported international experience. There was evidence that the risk in 1990–95 had declined compared with earlier periods, despite a shift towards more closed procedures. The differential risks of repeat prostatectomy should be explained to patients and considered in the development of clinical guidelines, notwithstanding the advantages of TURP over open prostatectomy in terms of surgical morbidity and cost.
Anaemia in men receiving combined finasteride and flutamide therapy for advanced prostate cancer
Authors: Ornstein D.K. , Beiser J.A. , Andriole G.L. 
Published: March 2003

ObjectiveTo determine the effect of combined finasteride and flutamide therapy on haemoglobin and haematocrit values in men with advanced prostate cancer.Patients and methodsNineteen men, previously untreated by hormone therapy, with histologically confirmed adenocarcinoma of the prostate and clinical evidence of advanced disease, were treated with combined finasteride (5 mg/day) and flutamide (750 mg/day) for at least 6 months. Complete blood counts were performed before initiation and after 6 months of therapy.ResultsAfter 6 months of finasteride and flutamide therapy both haemoglobin levels and haematocrit decreased in all men, with a mean (sd, range) decrease of 16 (10, 3–42) g/L and 4.6 (2.7, 0.8–9.9)%, respectively.ConclusionCombined finasteride and flutamide therapy significantly lowers haemoglobin and haematocrit levels in men with advanced prostate cancer, and further study of this effect is warranted.
Urinary incontinence after radical prostatectomy: a randomized controlled trial comparing pelvic muscle exercises with or without electrical stimulation
Authors: Moore K.N. , Griffiths D. , Hughton A. 
Published: March 2003

ObjectivesTo assess the effectiveness of intensive conservative treatment on and the impact of urinary incontinence after radical retropubic prostatectomy.Patients and methodsSixty‐three men with urinary incontinence ≥ 8 weeks after radical prostatectomy were randomized to one of three groups; group 1, standard treatment (control); group 2, intensive pelvic muscle exercises (PME); or group 3, PME plus electrical stimulation (PME+ES). Group 1 received verbal and written instructions about postoperative PME from their urologist and from the nurses at the pre‐admission clinic. Groups 2 and 3 were treated by a physiotherapist for 30 min twice a week for 12 weeks and carried out home exercises three times a day on the days when they were not treated. Outcome was assessed using the 24‐h pad test, two validated quality‐of‐life questionnaires and a urine symptom inventory, all obtained at baseline, 12, 16 and 24 weeks after enrolment. The final pad test was carried out ≈8 months after surgery.ResultsFifty‐eight patients completed the study, 21 in group 1, 18 in group 2 and 19 in group 3; five discontinued, three with bladder neck contractures requiring dilatation, one with rectal pain when doing the exercises and one unable to complete therapy while on vacation. The mean (median) time elapsed from surgery to entry into the study was 19 (8) weeks. At 12 weeks from baseline, the mean overall urine loss had decreased from 463 g to 115 g but there were no differences among groups, nor were there significant differences in urine loss at 16 and 24 weeks (F=0.16, P=0.69). There was a significant impact on quality of life during the early recovery. Despite preoperative instructions, many patients revealed little or no knowledge about catheter care, bladder spasms, rectal pain, incontinence and erectile dysfunction. Little of the preoperative education was retained because of the overwhelming nature of the diagnosis.ConclusionsFrom the initial assessment to the final pad‐test at ≈8 months after surgery, incontinence improved greatly in all three groups. This rapid improvement may have masked any treatment benefit. Further research should address incontinence in men whose urine loss has stabilized and who underwent surgery >8 months previously. Moreover, a telephone‐based follow‐up soon after discharge may alleviate many of the concerns expressed.
Increased expression of endothelin B receptors in the diabetic rabbit urinary bladder: functional relevance
Authors: Mumtaz F.H. , Dashwood M.R. , Thompson C.S. , Sullivan M.E. , Mikhailidis D.P. , Morgan R.J. 
Published: March 2003

ObjectivesTo determine the effect of diabetes mellitus on the density and distribution of endothelin A (ETA ) and endothelin B (ETB ) receptor subtypes in the rabbit urinary bladder, and to assess the in vitro functional properties of endothelin‐1 (ET‐1) receptors in bladder smooth muscle strips from diabetic and healthy rabbits.Materials and methodsDiabetes mellitus was induced in six male New Zealand White rabbits with alloxan and their urinary bladders excised 6 months after the induction of diabetes. On serial detrusor and bladder neck sections, low‐ and high‐resolution autoradiography was performed using radioligands for ET‐1, ETA and ETB receptors; these sections were then analysed densitometrically. The results were compared with those from six age‐matched healthy control rabbits. Functional responses were investigated using isometric tension studies.ResultsETA and ETB receptor binding sites were localized to both the urothelium and smooth muscle of the detrusor and bladder neck. There were significantly more ETB receptor binding sites in the diabetic detrusor and bladder neck sections than in controls. ET‐1 smooth muscle contractile responses were ETA receptor‐mediated. The smooth muscle contractile responses to ET‐1 were unaltered in the detrusor, but significantly impaired in the bladder neck of diabetic animals compared with controls.ConclusionAlteration in the expression of ETB receptors and in vitro contractile smooth muscle responses to ET‐1 in the diabetic rabbit urinary bladder neck may play a role in the pathophysiology of diabetic cystopathy.
A pilot study for a randomized controlled trial comparing the efficacy, safety and cost‐effectiveness of surgical treatments of the prostate
Authors: Bryan  , Byrne  , Hastie  , Anderson  , Moore  , Chapple  
Published: March 2003

ObjectiveTo assess the numbers of men in outpatients and subsequently undergoing transurethral resection of the prostate (TURP) who were referred during 1993–94 and 1996–97, thereby assessing the feasibility of a subsequent study of treatment efficacy in men with bladder outlet obstruction secondary to benign prostatic hyperplasia, prospectively randomized to the surgical treatment options, i.e. TURP, laser ablation of the prostate, transurethral needle ablation and T3 thermotherapy, to investigate treatment outcome, cost‐efficacy and cost‐benefit.Patients and methodsAll patients considered and consenting for prostate surgery were reviewed prospectively with a view to inclusion in the proposed trial. The diagnosis was based on two estimates of flow rate from voids of >150 mL and from symptoms assessed using the International Prostate Symptom Score. All patients had TURP explained by a urological surgeon and nursing staff, and subsequently had further consultation with research staff.ResultsPatients seen in clinic as new referrals increased by 11% between the periods assessed, although the numbers undergoing TURP decreased by 19%. Of the 383 patients screened, who were on the waiting list for TURP, only 13 elected to enter the trial. Of the 383 men, 267 (67%) ultimately had prostate surgery, with 39 (10%) electing to continue with watchful waiting and 34 (9%) continuing with pharmacotherapy.ConclusionAlthough more men with benign prostatic disease and lower urinary tract symptoms are being seen in clinics, the reduced proportion of patients continuing to surgical intervention will lead to increasing difficulty in carrying out randomized controlled clinical trials assessing surgical options. With ever more therapeutic options available, patients find it difficult to make decisions in both the clinical situation and when asked to enter a trial. Fully informed decisions by both the surgeon and the patient will only be possible when objective data are available from trials that investigate outcome, cost‐efficacy and cost‐benefit. This study suggests that when presented with more information and counselling, fewer men decide to undergo prostate surgery for symptomatic BPH.
An assessment of the immunological environment based on intratumoral cytokine production in renal cell carcinoma
Authors: Onishi  , Ohishi  , Imagawa  , Ohmoto  , Murata  
Published: March 2003

ObjectiveTo assess the immunological relationship between tumour and host, focusing on the production of T‐cell helper (Th) subset‐derived cytokines in patients with renal cell carcinoma (RCC).Patients and methodsThe study comprised 35 patients (19 men and 16 women, mean age 56.9 years, range 39–78) with RCC, who had undergone nephrectomy. Using enzyme‐linked immunosorbent assays, the levels of Th1‐derived cytokines were measured, including interleukin (IL)‐2 and interferon (IFN)‐γ, and Th2‐ derived cytokines, including IL‐4, IL‐5, IL‐6, IL‐10 and others.ResultsThere was no detectable IL‐2 or IFN‐γ production (below the detection limit) except in two patients; IL‐4 was produced in 18 patients (51%) and of these, 15 (43%) showed a higher level than the mean. IL‐5 was produced in 12 patients (34%), all of whom showed a higher level than the mean, and IL‐6 was produced in 32 (91%) of whom 10 (29%) showed a higher level than the mean. IL‐10 was detected in 28 patients (80%) of whom 14 (40%) showed a higher level than the mean. The production of these cytokines was closely related to the stage and grade of malignancy. Furthermore, there were significant correlations between the levels of production of IL‐4 and IL‐5 (r2=0.92), IL‐4 and IL‐10 (r2=0.91), and IL‐5 and IL‐10 (r2=0.85).ConclusionThe intratumoral immunological environment in patients with RCC shows a tendency to produce Th2‐related cytokines in accordance with the stage and grade; this suggests a role in humoral but not in cellular immunity.
The difficult orchidopexy: the value of the abdominal pre‐peritoneal approach
Authors: Adam  , Allaway  
Published: March 2003

ObjectiveTo analyse the outcome of using the abdominal pre‐peritoneal (APP) approach to orchidopexy.Patients and methodsDuring an 8‐year period, the experience of one surgeon in the management of 553 boys (median age 4.5 years, range 1–13) with undescended testes (596 testes) was assessed. The analysis emphasized those patients who had an orchidopexy performed using the APP approach detailing; the original position of the testis at exploration, whether successful placement within the scrotum was possible, and whether atrophy or ascent of the gonad occurred subsequently.ResultsIn 98 boys (110 testes) the testes were impalpable or high within the inguinal canal and they were explored using the APP approach. Of the 34 testes (31%) which were found abdominally, 12 were high intra‐abdominal and the remaining 22 just deep to the internal inguinal ring. These included seven bilateral and 20 unilateral intra‐abdominal testes. The remaining 76 undescended testes included five with bilateral high testes, 29 high unilateral testes, 13 repeat orchidopexies, 17 ‘vanishing testis syndrome’ and seven atrophic testes. The remaining 486 undescended testes were treated using a standard orchidopexy and were therefore excluded from analysis.ConclusionThe value and advantages of this operative approach and its place in the management strategy of the difficult orchidopexy are discussed.