bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of tolterodine in patients with detrusor instability: a dose‐ranging study
Authors: Rentzhog  , Stanton  , Cardozo  , Nelson  , Fall  , Abrams  
Published: March 2003

Objective To investigate the efficacy and safety of tolterodine, a new antimuscarinic agent, and define the optimum dosage in patients with symptoms of detrusor instability (urgency, increased frequency of micturition and/or urge incontinence).Patients and methods A double‐blind, placebo‐controlled, multicentre study was carried out; after a 1‐week run‐in period to establish baseline values, 81 patients were randomized to receive placebo or tolterodine 0.5, 1, 2 or 4 mg twice daily for 2 weeks. Micturition (diary) variables, urodynamics and subjective urinary symptoms were assessed after 2 weeks’ treatment.Results A per‐protocol analysis of efficacy in 64 patients showed dose‐related improvements in recorded micturition and urodynamic variables, e.g. at a dosage of 2 mg twice daily, the frequency of micturition, episodes of incontinence and pad use were reduced by 20%, 46% and 29%, respectively, while the volume at first contraction increased by 89 mL. The 4 mg dosage was associated with a large increase in residual urinary volume and an increased incidence of dry mouth. The incidence of adverse events (mainly mild or moderate antimuscarinic effects) was comparable with placebo at tolterodine dosages of≤2 mg. No serious adverse events were observed and tolterodine had no clinically significant impact on electrocardiographic or laboratory findings.Conclusion The results indicate that tolterodine offers an effective treatment for the symptoms of detrusor instability. The optimum dosage appears to be 1–2 mg twice daily.
Piroxicam fast‐dissolving dosage form vs diclofenac sodium
Authors: SupervÍa  , Pedro‐Botet  , NoguÉs  , Echarte  , Mínguez  , Iglesias  , Gelabert  
Published: March 2003

Objective To assess the possible therapeutic effect of 40 mg sublingual piroxicam (fast‐dissolving dosage form, FDDF) compared with intramuscular 75 mg diclofenac, as a reference drug, on acute renal colic in a randomized, double‐blind controlled clinical trial.Patients and methods Eighty patients were assigned to one of two treatment groups; one received an intramuscular injection with 0.2 mL distilled water and two sublingual tablets of 20 mg piroxicam FDDF, and the other received an intramuscular injection with 75 mg diclofenac sodium and two sublingual tablets of placebo. Pain intensity was evaluated by the patient using a visual analogue scale and by the observers. Vital signs at baseline and 30 min after the administration of the study drugs were also recorded.Results The overall efficacy of the treatment was 81%; nine patients in the piroxicam and six in the diclofenac group (no significant difference) required rescue treatment. Compared with baseline levels, the pain relief was significant (P<0.001) at 30 min in both groups. Twenty‐two patients in the piroxicam and 25 in the diclofenac group attained complete pain relief at 30 min, as evaluated by the observer (no significant difference). Both treatments were similarly effective in decreasing vital signs, mainly systolic blood pressure, heart and respiratory rates. However, when the percentage change was compared between the groups, piroxicam significantly decreased the respiratory rate (P<0.03).Conclusion Piroxicam FDDF is as effective as parenteral diclofenac in emergency renal colic treatment. Furthermore, its ease of self‐administration increases patient compliance and potential use in general practice.
Modified ureterosigmoidostomy (Mainz II) — technique and early results
Authors: Woodhouse  , Christofides  
Published: March 2003

Objective To assess the surgical method and results at 3 months of ureterosigmoidostomy modified by reconfiguration of the rectum to make a low‐pressure reservoir.Patients and methods Over the last 8 years, patients undergoing lower urinary tract reconstruction have been followed using a written protocol; the data from patients undergoing a modified ureterosigmoidostomy were retrieved for a retrospective analysis. Two groups of patients were defined: in group A, 15 patients underwent cystectomy and diversion by modified ureterosigmoidostomy and in group B, four patients already had a conventional ureterosigmoidostomy which was incontinent, and the rectum was reconfigured to improve control. The incidence of complications and causes of incontinence were assessed.Results The rectum was reconfigured by longitudinal incision and transverse closure in a ‘U’ fashion (Mainz II) in 17 patients, and augmented with ileum in two. There were no surgical complications. In group A all patients were continent at 3 months and in group B only two of four were continent; one patient in group A subsequently became incontinent. All incontinence was caused by chronic retention and overflow. There were no cases of pyelonephritis during follow‐up to 29 months and no ureteric reflux was detected.Conclusions Modified ureterosigmoidostomy is a safe method of urinary diversion after cystectomy. A longer follow‐up is needed to judge its place compared with other forms of diversion. It has a limited place in the management of incontinence in those with a long‐standing conventional ureterosigmoidostomy.
The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritis
Authors: Sakarya  , Arslan  , Erkoç  , Bozkurt  , Atilla  
Published: March 2003

Objective To assess the ability of power Doppler ultrasonography (PDU) to detect acute pyelonephritis and to compare the findings from PDU with those from enhanced computed tomography (CT).Patients and methods Eleven patients (mean age 18.5 years, range 5–37) admitted to hospital with a clinical diagnosis of pyelonephritis were assessed with PDU and enhanced CT, the latter providing the reference method.Results The imaging studies showed normal findings in three patients; a single focus of pyelonephritis was detected by CT in six, whereas a matching defect was detected on PDU in five, with PDU failing to detect an infective focus in one. Multifocal diffuse pyelonephritis was diagnosed correctly by enhanced CT and PDU in two patients.Conclusion Power Doppler ultrasonography had an overall sensitivity of 88% and complete specificity in the evaluation of patients with acute pyelonephritis.
Transurethral resection of the prostate in the
Authors: Chakravarti  , Macdermott  
Published: March 2003

Objective To assess the safety of transurethral prostatectomy (TURP) in patients on long‐term full anticoagulation.Patients and methods Twelve TURPs were performed on 11 patients with urinary retention or severe symptoms from prostatic obstruction who also required anticoagulation for a history of life‐threatening thrombo‐embolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 days before surgery; on admission a day later, full intravenous heparinization was commenced. Heparin was stopped 4 h before TURP and re‐commenced with an initial bolus in the recovery room, and warfarin re‐started that evening.Results The mean weight of prostate resected was 23 g and the mean peri‐operative decrease in haemoglobin was 1.6 g/dL. Only one patient required a transfusion of 3 units, but the activated partial thromboplastin time (APTT) had risen to >4. The mean pre‐ and post‐operative APTT were 1.7 and 2.64, respectively, and the mean total length of hospital stay 6.7 days. Three patients were re‐admitted for secondary haemorrhage at 8, 9 and 28 days after TURP, but all resolved with catheterization for 24 h only. There were no other major complications or thrombo‐embolic phenomena.Conclusion TURP can be conducted safely in this high‐risk group of patients with a regimen that allows a brief but controlled interruption to their full anticoagulation. This protects from the risks of thrombo‐embolic incidents with no major increase in haemorrhage or hospital stay.
The results of holmium laser resection of the prostate
Authors: Mackey  , Chilton  , Gilling  , Fraundorfer  , Cresswell  
Published: March 2003

Objective To assess the results of holmium–laser resection of the prostate (HOLRP) in the treatment of benign prostatic hyperplasia.Patients and methods Between 1994 and 1997, 967 patients underwent HOLRP in Tauranga, New Zealand, and in Derby, United Kingdom. The patients were followed at 1, 3 and 6 months after treatment using measurements of symptom score and urinary flow rate.Results There was a large and sustained improvement in symptom scores and urinary flow rates, with no mortality and low morbidity.Conclusion We recommend this technique as an alternative to transurethral resection in the surgical treatment of bladder outlet obstruction due to benign prostatic hypertrophy.
The value of prostate specific antigen (PSA) density and free: total PSA ratio in selecting patients with a normal digital rectal examination and intermediate total PSA levels for further investigation
Authors: Klingler  , Woo  , Rosario  , Cutinha  , Anderson  , Ward  , Chapple  
Published: March 2003

Objectives To examine the use of prostate‐specific antigen (PSA) density (PSAD) and free to total PSA ratio (f/tPSA) in enhancing the specificity of PSA in the diagnosis of prostate cancer in patients with a total PSA (tPSA) of 4–10 ng/mL and with a normal digital rectal examination (DRE).Patients and methods The study comprised 77 consecutive men in whom the fPSA and tPSA levels were obtained before DRE and transrectal ultrasonography‐guided sextant prostate biopsy. Prostate cancer was found in 39 patients and the histology was benign in 38. Receiver operator characteristic curves, obtained from all 77 patients, were used to determine the optimal thresholds for PSAD and f/tPSA in detecting cancer. A subset of 28 patients, including seven with prostate cancer, was identified who had a normal DRE and a tPSA of 4–10 ng/mL; PSAD and f/tPSA values were applied at the optimal thresholds to assess their use in identifying those patients with cancer.Results When applied to the selected group of 28 patients, the PSAD (threshold 0.15) failed to identify any with prostate cancer. The f/tPSA (threshold 0.12) yielded a sensitivity of 65% and a specificity of 38%, identifying only three of seven patients with cancer. By increasing the threshold to 0.25, six patients were correctly identified, giving a sensitivity of 86%, with a lower specificity of 14%.Conclusions These findings suggest that the neither PSAD nor f/tPSA either significantly reduce the negative biopsy rate or identify patients at greater risk of prostate cancer, particularly when the tPSA is equivocal at 4–10 ng/mL.
Urodynamic variables cannot be used to classify the severity of detrusor instability
Authors: Wagg  , Bayliss  , Ingham  , Arnold  , Malone‐Lee  
Published: March 2003

Objective To explore the relationship between subjective severity of symptoms of detrusor instability (DI) on presentation, outcome after treatment for DI and initial diagnostic urodynamic variables, with the aim of identifying a urodynamic variable which might, by predicting a favourable outcome from treatment, classify the severity of DI.Patients and methods Women with a urodynamically proven diagnosis of DI were recruited prospectively for the study. Data on disease symptoms and variables from their diagnostic cystometrogram were collected. All women were then treated and their outcome at 6 weeks after treatment compared with the initial urodynamic variables. Data on severity of symptoms were compared with initial urodynamic variables to explore any differences in these variables attributable to symptom severity.Results Of 300 women studied (mean age 54 years, sd 16), 290 were treated with oxybutynin and bladder retraining. At 6 weeks, 82 women had their treatment outcome classified as worse/no change; 218 women had improved. When good or poor outcome was compared with the urodynamic results, there was no significant difference between the groups. Likewise, the severity of symptoms did not relate to the values of urodynamic variables.Conclusions There was no statistically significant relationship between reported severity of symptoms and urodynamic variables, and no relationship between the urodynamic variables used and response to treatment. Therefore, using these values it is not possible to predict a favourable outcome from treatment or to use them to classify disease severity.
A morphometric and ultrastructural study of the changes in the lamina propria in adolescents with varicocele
Authors: Santoro  , Romeo  , Impellizzeri  , Arco  , Rizzo  , Gentile  
Published: March 2003

ObjectiveTo verify if changes in the lamina propria and its components, reported in adults with varicocele, are already present in adolescents with idiopathic varicocele, using a morphometric and ultrastructural study.Materials and methodsTwenty testicular biopsies from adolescents (mean age 15.6 years) were obtained during surgery for left idiopathic varicocele; five testicular biopsies from adolescents (mean age 16 years) undergoing surgery for hydrocele or inguinal hernia were used as controls. Biopsy specimens were processed for light and transmission electron microscopy; the sections were evaluated morphometrically using computerized image analysis.ResultsMorphometric and ultrastructural examination of the testes with varicocele showed an increased thickness in the lamina propria, caused principally by an increase in the extracellular matrix components, and deep invaginations towards the germinal epithelium.ConclusionThere is detectable damage of the lamina propria in adolescents affected by left idiopathic varicocele, although not as well developed or as severe as in adults.
β‐sitosterol for the treatment of benign prostatic hyperplasia:
Authors: Wilt  , Macdonald  , Ishani  
Published: March 2003

ObjectivesTo conduct a systematic review of the evidence for the efficacy of β‐sitosterolin men with symptomatic benign prostatic hyperplasia (BPH).MethodsStudies were identified through Medline™ (1966–98), EMBASE™ , Phytodok, the Cochrane Library, bibliographies of identified trials and review articles, and contact with study authors and pharmaceutical companies. Randomized trials were included if: men had symptomatic BPH; plant extract preparations contained β‐sitosterols; a control group received placebo or a pharmacological therapy; and treatment duration was ≥30 days. Study characteristics, demographic information, enrolment criteria and outcomes were extracted.ResultsFour trials comprising a total of 519 men met the inclusion criteria. All were double‐blind and lasted 4–26 weeks. Three studies used nonglucosidic β‐sitosterols and one used a preparation that contained only β‐sitosterol‐β‐d‐glucoside. Compared with placebo, β‐sitosterolimproved urinary symptom scores and flow measures. For the two studies reporting the International Prostate Symptom Score (IPSS), the weighted mean difference (WMD) against placebo was −4.9 IPSS points (95% confidence interval, CI,−6.3 to−3.5). The WMD for peak urinary flow rate was 3.91 mL/s (95% CI 0.91 to 6.90, four studies) and for residual volume the WMD was −28.62 mL (95% CI−41.42 to−15.83, four studies). β‐sitosteroldid not reduce prostate size. The trial using pure β‐sitosterol‐β‐d‐glucoside (WA184) showed no improvement in urinary flow measures. Withdrawal rates for men assigned to β‐sitosterol and placebo were 7.8% and 8.0% (not significant), respectively.Conclusionβ‐sitosterolimproves urological symptoms and flow measures. However, the existing studies are limited by short treatment duration and lack of standardized β‐sitosterol preparations. Their long‐term effectiveness, safety and ability to prevent the complications of BPH are unknown.
Free prostate‐specific antigen ‘in the field’: a useful adjunct to standard clinical practice
Authors: Collins  , Alexandrou  , Wynn‐Davies  , Mobley  , O’Reilly  
Published: March 2003

ObjectivesTo determine the clinical utility of the ratio of free to total prostate‐specific antigen (f/tPSA), which may improve the discrimination of PSA testing in the assessment of patients with prostatic disease, in a busy clinical practice.Patients and methodsA series of 198 men undergoing transrectal ultrasonography (TRUS)‐guided biopsy, because of a high total PSA level or an abnormal digital rectal examination or both, had blood samples taken for the assessment of both free and total PSA before any form of prostatic manipulation. The histological findings were compared with tPSA, fPSA and f/tPSA, evaluating three different thresholds of f/tPSA.ResultsPSA levels, PSA density and fPSA density differed significantly between those with benign histology and neoplasia. The f/tPSA only differed significantly in men with a PSA level of 10.1–15 ng/mL. The f/tPSA threshold of 0.25 was the most useful clinically, with a negative predictive value for prostate cancer of 91%. Using this threshold would reduce the negative biopsy rate by 30%.ConclusionThe f/tPSA is of clinical value in reducing the negative biopsy rate and in the management of patients with a high PSA level and previous negative biopsies.
Carbachol‐induced sustained tonic contraction of rat detrusor muscle
Authors: Oh  , Ahn  , Kim  , Kim  , Lee  , Kim  , Choi  
Published: March 2003

ObjectiveTo investigate the underlying contractile mechanism of the sustained tonic contraction (SuTC) induced by repetitive carbachol application in rat detrusor muscles.Materials and methodsLongitudinal muscle strips with no mucosa were obtained from the anterior wall of the urinary bladder in 12‐week‐old Sprague–Dawley rats. Carbachol (5 μmol/L) was applied repetitively to induce SuTC. The carbachol‐induced SuTC was assessed in the presence of various Ca2+‐channel blockers and drugs affecting intracellular Ca2+ concentration.ResultsThe first application of carbachol elicited a large phasic contraction followed by a tonic contraction (TC); the carbachol‐induced contraction was completely reversed by washing out the solution. However, the initial phasic contraction was not reproduced after a second or further application of carbachol. There was consistently only a SuTC with no phasic contraction. The amplitude of the SuTC was 85% of the TC induced by the first carbachol application. The application of atropine (1 μmol/L) to the bath completely blocked SuTC. The carbachol‐induced SuTC was insensitive to nicardipine (5 μmol/L) and extracellular polyvalent cations (1 mmol/L, La3+ , Co2+ , Cd2+ , Ni2+ ). Moreover, a similar SuTC was induced even after the complete elimination of extracellular Ca2+ by adding 2 mmol/L EGTA to the Ca2+‐free Tyrode solution. To exclude intracellular Ca2+ sources related to the sarcoplasmic reticulum (SR), the effects of SR Ca2+ pump inhibitors, cyclopiazonic acid (CPA, 10 μmol/L) and thapsigargin (0.5 μmol/L) were tested. The carbachol‐induced SuTC was insensitive to pretreatment with CPA and/or thapsigargin. To deplete the ryanodine‐sensitive Ca2+ pool, muscle strips were repetitively stimulated with caffeine (10 mmol/L) in the presence of 10 μmol/L ryanodine, which did not affect the carbachol‐induced SuTC.ConclusionsAlthough the characteristics of the carbachol‐induced SuTC have not been defined, these results show that a significant proportion of the carbachol‐induced contraction in rats is contributed by the SuTC, which is present even in the complete absence of external Ca2+ . The SuTC was not affected by limiting the contributions of internal Ca2+ sources. This suggests that the SuTC in rat bladders is unrelated to known Ca2+ mobilization mechanisms.
The incidence of phimosis in boys
Authors: Shankar  , Rickwood  
Published: March 2003

ObjectiveTo establish the incidence of pathological phimosis in boys.Patients and methodsA 2‐year review of circumcisions was performed for phimosis among a known population of boys, with the histological findings of the circumcision specimens assessed.ResultsSixty‐two boys (all but one aged 5–14 years) had typical pathological (cicatrizing) phimosis and among the 51 circumcision specimens examined histologically, 43 (84%) showed appearances of balanitis xerotica obliterans. During the same period, 30 boys were circumcised for developmental unretractability of the foreskin (‘physiological phimosis’).ConclusionsThe incidence of pathological phimosis in boys was 0.4 cases/1000 boys per year, or 0.6% of boys affected by their 15th birthday, a value lower than previous estimates and exceeded more than eight‐fold by the proportion of English boys currently circumcised for ‘phimosis’.
Antenatally detected pelvi‐ureteric junction obstruction: concerns about conservative management
Authors: Subramaniam  , Kouriefs  , Dickson  
Published: March 2003

ObjectiveTo review the conservative management of antenatally detected pelvi‐ureteric junction (PUJ) obstruction in children.Patients and methodsThe study included 121 children (142 kidneys) with antenatally diagnosed PUJ obstruction managed over an 8‐year period, including 21 who were affected bilaterally; the main focus of the study was on the 100 children affected unilaterally. The intent was to manage these patients conservatively, with immediate surgery (early pyeloplasty) only if renal function was initially compromised (renographic function < 40%). The indications for surgery subsequently (delayed pyeloplasty) included either a deterioration in renal function, the onset of symptoms or increasing hydronephrosis.ResultsThe anteroposterior diameter and renal function were weakly and negatively correlated. The kidneys in the delayed pyeloplasty group had a greater initial mean anteroposterior diameter than had those in the early or the conservative groups (P<0.05). The improvement in renal function was the lower in the delayed pyeloplasty group than in the early pyeloplasty group; the improvement was inversely related to the anteroposterior diameter.ConclusionsThe conservative management of some antenatally detected PUJ obstructions probably results in greater loss of function, which is not recovered after surgery.
The interaction of homocysteine and copper markedly inhibits the relaxation of rabbit corpus cavernosum: new risk factors for angiopathic erectile dysfunction?
Authors: Khan  , Thompson  , Emsley  , Mumtaz  , Mikhailidis  , Angelini  , Morgan  , Jeremy  
Published: March 2003

Objectives To explore whether homocysteine (HCy), an independent risk factor for atherosclerosis (the angiopathic effect of which occurs through the generation of superoxide anions and hydrogen peroxide, augmented by copper, the superoxide anions reacting with nitric oxide, NO, to produce peroxynitrite, a highly angiopathic free radical) and copper contribute to erectile dysfunction (ED) through similar mechanisms, by assessing their interactive effects on the relaxation of corpus cavernosum using organ‐bath techniques.Materials and methods Cavernosal smooth muscle strips were obtained from adult New Zealand White rabbits and mounted in organ baths. After precontraction with phenylephrine (100 μmol/L), relaxation responses to carbachol or sodium nitroprusside (SNP) were assessed in the presence or absence of HCy and copper. The effects of HCy and copper in the presence of superoxide dismutase or catalase were also investigated.Results HCy alone inhibited carbachol‐stimulated (NO‐dependent) but not SNP‐stimulated relaxations (NO‐independent). This effect of HCy was significantly augmented by copper, which alone had no effect. The combined effect of HCy and copper was significantly (P<0.05) reversed by superoxide dismutase or catalase.Conclusions HCy inhibited NO‐mediated cavernosal smooth muscle relaxation, an effect that was potentiated by copper and reversed by superoxide dismutase or catalase. It is therefore proposed that the effect of HCy on cavernosal smooth muscle relaxation is mediated by an interaction between NO and superoxide anions. Moreover, HCy may constitute a new risk factor for angiopathic ED.