bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopically assisted ureterocystoplasty
Authors: Cilento B.G. , Diamond D.A. , Yeung C.K. , Manzoni G. , Poppas D.P. , Hensle T.W. 
Published: December 2004

The concept of ureterocystoplasty, in this case laparoscopically assisted, is addressed by several authors from the USA. The details of their technique are described, and avoiding a large midline incision was found to be particularly beneficial to the patient. Authors from Paris and Toronto describe a further laparoscopic study. They describe a trial comparing the retroperitoneal approach to open partial nephrectomy. These authors also feel that the laparoscopic approach to surgery, in this case partial nephrectomy, is safe and feasible in children, with no increase in operative duration and a shorter hospital stay. ObjectiveTo assess the efficacy and safety of laparoscopically assisted ureterocystoplasty (LAU) in children.Patients and methodsFrom 1999 to 2001, five patients (mean age 7 years, range 3.5–13) from four centres underwent LAU with laparoscopic mobilization of the small kidney and upper ureter combined with ureterocystoplasty, with exposure of the bladder through a Pfannenstiel incision. The details and outcomes are reviewed.ResultsThe LAU was successful in all five patients; there were no complications. A large midline incision was avoided and the LAU carried out through the better tolerated and less painful Pfannenstiel incision.ConclusionLAU is an appealing technique that is safe with the added benefit of a reduced abdominal incision and acceptable operative duration. This represents the first published report of LAU.
Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation
Authors: Everaert K. , De Muynck M. , Rimbaut S. , Weyers S. 
Published: December 2004

The problem of urinary retention after hysterectomy for benign disease is extensively evaluated by authors from Ghent. Their interesting results show that it is associated with the de‐afferentiation of the bladder wall and with Fowler's syndrome. These findings help our understanding of a troublesome condition. Further work is reported into the use of the tension‐free vaginal tape procedure, particularly into its positive effect on quality of life. Another study reported here found that in patients with BOO associated with BPH, there is a focal compromise of the blood‐urine permeability barrier, with an increase in expression of inducible nitric oxide synthase. ObjectiveTo detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease.Patients and methodsFrom August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6–240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0–300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients.ResultsDe‐afferentiation (EST ≥ 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = − 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = − 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in three). A revision was needed in six patients. Uroflowmetry at the last follow‐up showed a mean (sd) maximum urinary flow rate of 22 (18) mL/s (not significantly different from during trial stimulation) with residual urine of 50–100 mL in two and 200–400 mL in three patients. Intermittent catheterization was needed in four patients.ConclusionUrinary retention after hysterectomy for benign disease is associated with de‐afferentiation of the bladder wall in some patients and is correlated inversely with the relative EST of the bladder neck. A Fowler syndrome was detected in five patients. For residual urine, about half the patients have a good and a third a partial long‐term effect; we now offer SNS as a further treatment option.
Outcome and survival with nonsurgical management of renal cell carcinoma
Authors: Baird A.D. , Woolfenden K.A. , Desmond A.D. , Fordham M.V.P. , Parsons K.F. 
Published: December 2004

OBJECTIVETo document long‐term survival in patients with renal cell carcinoma (RCC) in whom the primary tumour was left in situ and treatment limited to palliative and symptomatic measures.PATIENTS AND METHODSAll patients with a diagnosis of RCC from January 1994 to January 1999 and in whom the primary tumour was left in situ were identified from hospital records (nine women and 16 men, mean age 69 years). The tumour stage was T1–T4.RESULTSThe mean survival overall was 19.3 months; patients with locally advanced disease, i.e. stage ≥ T3a, had a mean survival of 16.9 months.CONCLUSIONSThere is renewed interest in the management of advanced RCC, with data supporting cytoreductive nephrectomy with systemic biological therapy. These results confirm that such patients with or without metastatic disease can survive for a considerable period with no aggressive surgical or systemic measures, and such intervention may offer no significant advantage in outcome and survival over supportive treatment alone.
Increased urinary 8‐hydroxy‐2′‐deoxyguanosine excretion after ileal neobladder replacement
Authors: Miyake H. , Eto H. , Takechi Y. , Kamidono S. , Hara I. 
Published: December 2004

OBJECTIVESTo examine whether orthotopic neobladder replacement using either ileum or colon segments results in increased oxidative stress, by measuring urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), one of the most commonly used markers for evaluating oxidative DNA damage.PATIENTS, SUBJECTS AND METHODSUrinary levels of 8‐OHdG and creatinine, urine analysis, nutritional status, and acid‐base and electrolyte balances, were assessed in 22 patients with an ileal neobladder, 28 with a colon neobladder, 37 with an ileal conduit and 22 healthy volunteers. The results from both types of orthotopic neobladder, the ileal conduit and in the healthy controls were compared.RESULTSThe mean (sd) ratios of urinary 8‐OHdG to urinary creatinine in patients with an ileal neobladder, colon neobladder, ileal conduit and in controls were 20.4 (7.8), 15.2 (4.3), 15.9 (5.1) and 15.2 (5.4) ng/mg, respectively. The urinary 8‐OHdG ratio in the first group was significantly higher than in the other three groups. Among patients with a neobladder, the urinary 8‐OHdG ratio was closely associated with the degree of pyuria, but not age, gender, the interval from surgery, body weight, height, serum creatinine or the degree of metabolic acidosis.CONCLUSIONSThese findings suggest that creating an ileal neobladder caused significantly greater oxidative stress than a colon neobladder, ileal conduit, or that in healthy controls. Therefore, it is recommended to conduct a careful long‐term follow‐up considering the possible development of malignant disease after urinary diversion, especially by an ileal neobladder.
Innervation of the detrusor muscle bundle in neurogenic detrusor overactivity
Authors: Drake M.J. , Gardner B.P. , Brading A.F. 
Published: December 2004

OBJECTIVETo evaluate the peripheral anatomical distribution of innervation within muscle bundles of the detrusor and the changes arising in neurogenic detrusor overactivity (DO).PATIENTS AND METHODSFull‐thickness samples from the bladder dome of three cadaveric transplant organ donors and four people with neurogenic DO caused by spinal cord injury were compared. Systematic serial cryostat sections were stained using Masson trichrome and elastin techniques, and vimentin immunohistochemistry. A coherent image stack was generated for three‐dimensional image reconstructions, which were displayed using mixed rendering (i.e. differing graphics for separate tissue components) to show peri‐ and intra‐bundle innervation against the muscle fascicle framework.RESULTSControl specimens had a dense nerve supply. Muscle bundle innervation was derived by dichotomous branching from peri‐bundle nerve trunks in the inter‐bundle connective tissue. Transverse interfascicular branches entered bundles perpendicular to the long axis at the midpoint of the bundle. They gave rise to axial interfascicular branches, which distributed to the pre‐terminal and terminal nerve fibres. All samples from patients with neurogenic DO had patchy denervation. The primary deficit was predominantly at the level of the terminal axial innervation and was cross‐sectionally consistent along the longitudinal axis of the muscle bundle.CONCLUSIONPatchy denervation may reflect a deficit at the level of the peripheral ganglia. Any contraction in the areas of denervation either occurs out of co‐ordination with the rest of the bladder, or is co‐ordinated by means of non‐neural structures. The observation of fine muscle strands running between fascicles, and connective tissue anchoring structures, represent two hypothetical mechanisms by which such co‐ordination might be effected.
Technique of laparoscopic (endoscopic) radical prostatectomy
Authors: Stolzenburg J.‐U. , Truss M.C. 
Published: December 2004

SUMMARYDuring the last decade laparoscopy has become a standard technique available to the urologist, through constant technological advances and refinements. The progress of laparoscopic/endoscopic techniques allows the indications for this surgery to include complex oncological procedures like radical prostatectomy. Since the first description of laparoscopic radical prostatectomy (LRP) in the early 1990s the technique has undergone significant technical modifications. Transperitoneal LRP is now a standard procedure and can be used successfully and reproducibly, giving results comparable with those from the open retropubic procedure. Despite many advantages, transperitoneal laparoscopy is associated with potential intraperitoneal complications. Because of the limitations inherent in the transperitoneal route, a totally extraperitoneal endoscopic radical prostatectomy (EERPE) has been developed. The totally extraperitoneal endoscopic access provides a safe and minimally invasive approach to various urological procedures, including prostatectomy. This technical improvement completely obviates intra‐abdominal complications. EERPE combines the advantages of minimally invasive laparoscopy and the open retropubic approach. We review the surgical techniques of LRP and EERPE, and highlight the indications, contraindications and outcomes.
Epidemiology and medical management of stone disease
Authors: Tiselius H.‐G. 
Published: December 2004

SUMMARYRecurrent stone formation in the urinary tract is a common and important problem that must be considered in daily urological practice. With a prevalence of> 10% and an expected recurrence rate of ≈ 50%, stone disease has an important effect on the healthcare system. It is generally agreed that patients with uric acid/urate, cystine or infection stones always should be treated pharmacologically. For calcium stone formers the treatment should be chosen according to the severity of the disease. Recurrence in patients with calcium‐stone disease can be prevented with general or specific dietary and drinking advice, and with pharmacological therapy. For idiopathic calcium stone formers the most convincing therapeutic effects have been reported with thiazide and alkaline citrate.
Prostate cancer cell growth is modulated by adipocyte‐cancer cell interaction
Authors: Tokuda Y. , Satoh Y. , Fujiyama C. , Toda S. , Sugihara H. , Masaki Z. 
Published: December 2004

OBJECTIVETo assess whether adipocytes (mesenchymal stromal cells thought to affect the proliferation and differentiation of epithelial cells) affect the behaviour of prostate cancer cells in vitro, as prostate cancer metastasizes to the bone, which is an adipocyte‐rich environment.MATERIALS AND METHODSThe human bone‐metastatic prostate carcinoma cell line PC3 was cultured with or without adipocytes in a three‐dimensional collagen gel matrix. Histological and immunohistochemical assays were used to evaluate the proliferation and differentiation of PC3 cells. The cytokine expression of this culture assembly was also examined by reverse transcription‐polymerase chain reaction (RT‐PCR).RESULTSThe proliferation and differentiation of cancer cells were clearly changed on co‐culture with adipocytes compared with the control cultures. The mean (range) bromodeoxyuridine (BrdU) indices estimated (according to uptake) to evaluate the growth of the cultured cells were 36.3 (8.55)% in the co‐culture and 26.95 (10.50) in the control (P < 0.02). PC3 cells in co‐culture formed larger clusters than in the control, at 16.0 (11.0) vs 14.0 (10.0), respectively (P < 0.01). Cancer cells also showed pleomorphism, varying from cuboidal to spindle‐shaped. The expressions of vascular endothelial and platelet‐derived growth factor were greater in co‐culture than in the control.CONCLUSIONThese findings suggest that adipocytes modulate the growth, morphology and cytokine expression of prostate cancer cells. This specific mesenchymal stromal cell type is important in the biological behaviour of prostate cancer cells.
Pelvi‐ureteric junction obstruction by crossing renal vessels: clinical and imaging features
Authors: Rigas A. , Karamanolakis D. , Bogdanos I. , Stefanidis A. , Androulakakis P.A. 
Published: December 2004

OBJECTIVETo present the characteristic clinical and imaging findings of pelvi‐ureteric junction (PUJ) obstruction caused by crossing renal vessels (CRV), as it presents particular features within the spectrum of congenital hydronephrosis.PATIENTS AND METHODSBetween April 1982 and December 2000, 384 children underwent surgery for PUJ obstruction. In 71 (18.5%; mean age 8.5  years, range 2 months to 14 years; 49 aged> 5 years), the obstruction was caused by CRV. The data collected from the medical records of these patients were analysed for their clinical presentation and imaging findings, i.e. ultrasonography (US), intravenous urography (IVU) and diuretic renography.RESULTSThe main presenting symptom was recurrent renal colic (pain, nausea, vomiting) in 59%, followed by urinary infection (UTI) in 20%, gross haematuria in 11% and an incidental diagnosis in 10%. By contrast, in the 313 children with intrinsic PUJ obstruction, renal colic was present in only 10.5%. Moreover, from 1991 to 2000, when the use of prenatal US became widespread, hydronephrosis was detected prenatally in 42 of 212 children (20%) with intrinsic PUJ obstruction, but in only two of 31 (6%) with obstruction by CRV. However, in 10 children with CRV operated on during this period, prenatal US had shown mild hydronephrosis (< 15 mm), which during the follow‐up decreased until the children became symptomatic after 5–9 years (eight renal colic, two UTI). US during acute symptoms showed significant hydronephrosis (> 25 mm), and colour Doppler US of two patients directly showed the CRV. In all 71 children with CRV obstruction diuretic IVU and renography during the acute symptoms had an obstructive pattern, and in 24 renal colic was reproduced during the examination. The differential kidney function was < 40% in 11 children who presented with UTI; two required nephrectomy and in the remaining 69 an Anderson‐Hynes pyeloplasty, after which none had an episode of renal colic or UTI during a mean (range) follow‐up of 10.2 (2–20) years.CONCLUSIONSPUJ obstruction by CRV should be suspected in older children presenting with recurrent renal colic and hydronephrosis. Good kidney function is expected in most of these children, despite their age, because the vascular obstruction is intermittent. Mild prenatal hydronephrosis that could decrease postnatally does not exclude the possibility of vascular obstruction, which may later become symptomatic. Imaging (US, diuretic IVU and renography) during an episode of pain is essential and colour Doppler US could help to establish the diagnosis in these cases. Knowing that a child has a CRV is important for choosing an open surgical approach rather than endoscopic pyelotomy, to avoid potential complications
A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours
Authors: Atsü N. , Eskiçorapçi S. , Üner A. , Ekici S. , Güngen Y. , Erkan I. , Uygur M.C. , Özen H. 
Published: December 2004

OBJECTIVESTo report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs).PATIENTS AND METHODSBetween 1978 and 2000, 132 patients (median age 28 years, range 16–52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year.RESULTSThe median (range) follow‐up was 38 (6–265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum‐based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%.CONCLUSIONThe presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.
Partin tables: past and present
Authors: Khan M.A. , Partin A.W. 
Published: December 2004

This is the start of a new section in the BJU International. The intention is to provide the reader with a series of review articles that are more focused than the traditional papers addressing wider topics. In the first of these two mini‐reviews, the development of the Partin tables is examined, which is in effect a self‐audit. Nomograms are becoming more frequently used in urological cancer and are of help to urologists to assess the likelihood of operative success and long‐term clinical outcomes. The authors review the necessary updating of the original Partin tables, given the changes which have taken place in the stage of prostate cancer at presentation over the last decade. Most patients with bladder cancer present with superficial disease, which presents its own problems. However, a very significant number present with invasive disease, which if left untreated is associated with an extremely high mortality in a relatively short period. In the second mini‐review the authors, who have long been associated with an approach which combines radical surgery with innovative reconstruction, assess their rationale for an aggressive treatment approach. It is to be hoped that both of these mini‐reviews will provide prognostic information for urologists treating prostate and bladder cancer.
Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstruction
Authors: Sandfeldt L. , Hahn R.G. 
Published: December 2004

OBJECTIVETo study whether the risk profile for cardiovascular disease correlates with prostate size in elderly men seeking medical attention for lower urinary tract symptoms (LUTS), by assessing physiological, biochemical and personality traits.PATIENTS AND METHODSFifty‐two men (mean age 68 years, range 52–85) with bladder outlet obstruction, as verified by urodynamic testing, had their prostate size measured by transrectal ultrasonography. Their blood and urine was also examined, and their personality and heart rate variability tested. The measured variables were assessed statistically in relation to whether the prostate volume was smaller (22 men) or larger (30 men) than 50 mL.RESULTSPatients with a large prostate (mean 104 mL) had a higher mean arterial pressure (105 vs 95 mmHg, P < 0.01), and serum glucose (5.3 vs 4.8 mmol/L, P < 0.01) and serum cortisol (423 vs 362 nmol/L, P = 0.06) concentrations than those with a small gland (mean 31 mL). The personality test showed that they were also less assertive than the others (P < 0.03). The components of the heart rate variability indicated that men with a large prostate had increased sympathetic activity.CONCLUSIONMen with LUTS caused by a very large prostate have more risk factors for cardiovascular disease than those with a smaller gland.
Positron emission tomography for urological tumours
Authors: Hain S.F. , Maisey M.N. 
Published: December 2004

SUMMARYFor urological tumours, positron emission tomography (PET) is currently most useful in testicular cancer. In patients with residual masses or raised marker levels after treatment, PET is both sensitive and specific for detecting recurrent disease, at suspected and unsuspected sites. Although fewer studies are available it also appears to be useful for staging at diagnosis, although this requires further investigation. Prostate cancer imaging has been more variable, with studies showing that PET cannot reliably differentiate between tumour and hypertrophy. It is not as good as a bone scan for defining bone metastases. In renal cancer, PET can be used to define the primary tumour, providing better staging of local recurrence than computed tomography (CT), and to define metastatic disease. There are few studies in bladder cancer, and despite excretion of the tracer via the bladder in early studies, it has better results than CT or magnetic resonance imaging for local staging; again it can detect metastases. Overall, the place of PET in urological tumours is developing, with the strongest areas undoubtedly being testicular and renal cancer. Tracers other than fluorodeoxyglucose are being examined and are providing further information.