bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rectal examination and urethral catheterization by medical students and house officers: taught but not used
Authors: Turner K.J. , Brewster S.F. 
Published: March 2003

Objective To assess the acquisition of skills in digital rectal examination (DRE) and urethral catheterization by medical students and house officers associated with a UK medical school, and to determine their confidence in these techniques. Subjects and methods Questionnaires were sent to all final‐year medical students at Oxford Medical School immediately before their final examinations. Similar questionnaires were sent to all pre‐registration house officers who had graduated from Oxford in the previous year. Results Responses were received from 71% of the students and 84% of the graduates; 88% of the students and 94% of the graduates had been taught how to perform a DRE as a medical student, but 42% of medical students had performed fewer than five DREs before qualification. Their findings were rarely checked by a doctor. Of the students, 44% had never felt a clinically malignant prostate gland and 41% were ‘not at all confident’ in their ability to give an opinion based on their findings on a DRE. House officers performed DRE regularly (53%  50 DREs) but rarely received additional instruction, and exposure to pathology remained limited. House officers' findings on DRE were rarely confirmed by a more senior doctor. Most respondents had been taught how to perform male urethral catheterization as a medical student (92% of students, 89% of house officers) but 48% of students had performed fewer than two catheterizations on qualification and 68% of house officers had received no additional instruction; however, 69% of house officers were ‘very confident’ in their ability to perform male urethral catheterization. Conclusions The DRE is a critical skill in assessing the prostate; students conduct few DREs, lack confidence and are exposed to minimal pathology. Legitimate concerns over students carrying out intimate examinations may be mitigating against the acquisition of skills. Possible solutions are explored. House officers perform DREs regularly, but with no additional instruction they may continue to lack confidence. Students lack experience in male urethral catheterization and rarely receive postgraduate instruction. House officers' confidence in their ability to perform male urethral catheterization may be misplaced.
Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners
Authors: Cliff A.M. , Macdonagh R.P. 
Published: March 2003

Objective To assess psychometrically a new questionnaire for measuring the psychosocial morbidity in patients with prostate cancer and in their partners, and to compare the morbidity of patients and their partners. Patients and methods A sequential sample of patients with any stage of prostate cancer and attending general urology outpatient clinics was identified. The questionnaire was administered to 135 patients and their partners in their homes. The Hospital Anxiety and Depression Scale (HADS) questionnaire was also administered to permit construct validation of the new measure. Test‐retest reliability was calculated by re‐administering the questionnaire to 60 individuals. The hypothetical general cancer distress and social subscales of the questionnaire were also tested for internal consistency. Psychosocial morbidity scores obtained by the patients and partners were compared. Results The questionnaire had good test‐retest reliability and construct validity when tested against the HADS. The general cancer distress and social subscales were internally consistent. General cancer distress was highly prevalent and significantly more severe in partners than in patients. There was some degree of general cancer distress in 47% of patients and 76% of partners, whereas severe distress was detected in 11% and 30%, respectively. Social morbidity was limited and of equal severity between the groups. Treatment‐related worries and concerns about pain and physical limitation were more common among partners than patients, whereas there was no difference for worries about urinary symptoms. Sexual concerns were the least prevalent and were more of a problem for patients than partners. Conclusion Psychosocial morbidity in prostate cancer is highly prevalent, not only among patients but particularly among their partners. The new questionnaire showed adequate psychometric properties for use in identifying individuals with significant psychosocial morbidity. Applying the questionnaire should permit emotional and informational support to be targeted at the most vulnerable.
High‐pressure bladder: an underlying factor mediating renal damage in the absence of reflux?
Authors: Vega‐P J.M. , Pascual L.A. 
Published: March 2003

Objective To assess urodynamic studies of children with nonrefluxing pyelonephritis, investigate the possible connection between renal damage (as ≈ 40% of children with febrile urinary tract infections and no evidence of vesico‐ureteric reflux have irreversible renal cortical scarring) and lower urinary tract dysfunction, to test the hypothesis that bladders with high storage and voiding pressures may be the cause of renal damage in these patients.Patients and methods The clinical records and urodynamic studies of 52 children (46 girls and six boys, mean age 6.6 years) with febrile urinary infections, no evidence of reflux and photopenic areas on renal scintigraphy were evaluated retrospectively. Each child was evaluated by urinary ultrasonography, a voiding cystogram, 99mTc‐dimercaptosuccinic acid (DMSA) scan and urodynamic studies. The storage phase of the urodynamic study was divided into two equal segments to consider the filling variables of each. During the emptying phase, voiding pressures and voiding pressures with reference to peak detrusor contraction were evaluated.Results Despite no child having reflux, the DMSA scans showed bilateral renal scarring in 39 (75%) and unilateral scarring in the remaining children. Forty‐eight (93%) children had abnormal urodynamic values: high filling pressures (34), high‐pressure uninhibited contractions (32), high voiding pressures (31) and discoordinated voiding (28). The cystometric bladder capacity was lower than the expected bladder capacity (– 75 mL) in 82% of the patients; in only four patients were the urodynamics considered normal.Conclusions Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of reflux.
The relationship between early renal status, and the resolution of vesico‐ureteric reflux and bladder function at 16 months
Authors: Godley M.L. , Desai D. , Yeung C.K. , Dhillon H.K. , Duffy P.G. , Ransley P.G. 
Published: March 2003

Objective To examine, in infants presenting with vesico‐ureteric reflux (VUR), the relationship between the presence of initial renal abnormalities with the outcome of VUR and bladder function at 16 months of age.Patients and methods The study group comprised 40 infants (32 boys) presenting consecutively (29 after prenatal detection) with VUR grade III or greater (bilateral in 29) on the initial micturating cystogram (median age 8 weeks). The initial presence of abnormal kidneys was determined from isotopic renography and/or ultrasonography. These data were correlated with the outcome of VUR, from direct isotope cystography, and bladder function assessed by natural filling urodynamics, examined at age 16 months (mean 16.4 months,

sd 2.1).Results Three groups were identified. Group 1 (eight boys and six girls) had normal kidneys bilaterally; initially grade III VUR was common. At 16 months bladder function was normal in 10 children and none had VUR (complete resolution). Group 2 (14 boys and two girls) had unilateral renal abnormalities; initially VUR was predominantly grade IV or grade V. At 16 months bladder function was normal in eight children and VUR resolved in eight, five of these with normal bladder function. Group 3 (10 boys) had bilateral renal abnormalities. Initially grade V VUR predominated; at 16 months the bladder function was normal in only one, and in the rest the emptying dynamics were abnormal. All 10 boys had persisting VUR (no resolution).Conclusions In infants with moderate or severe VUR, resolution at 16 months old is associated with normal kidneys in a similar proportion of boys and girls. Resolution also correlates well with normal bladder function. Presentation in infancy with bilateral abnormal kidneys, associated with severe VUR in boys, is a poor prognostic sign for the early outcome of VUR and for bladder function.
Imaging for staging bladder cancer: a clinical study of intravenous 111indium‐labelled anti‐MUC1 mucin monoclonal antibody C595
Authors: Hughes O.D.M. , Perkins A.C. , Frier M. , Wastie M.L. , Denton G. , Price M.R. , Denley H. , Bishop M.C. 
Published: March 2003

Objective To investigate the clinical application of an 111In‐labelled anti‐MUC1 mucin monoclonal antibody (mAb) imaging for staging invasive bladder cancer. Patients and methods Indirect immunohistochemistry was used to confirm the expression of the MUC1 target antigen by metastatic tumours. Twelve patients with bladder cancer (two with superficial and 10 with locally invasive/metastatic disease) underwent planar γ‐scintigraphy 48 h after an intravenous injection with 111In‐labelled anti‐MUC1 mucin mAb C595. Results No bladder uptake was detected in the two patients with superficial disease, but scintigraphy showed primary and recurrent bladder tumours and metastases in nine of the remaining 10 patients with invasive disease. In three patients additional staging information was obtained from the mAb imaging which would have altered patient management. There were no reported side‐effects. Conclusion This study confirmed the ability of the mAb technique to detect both primary and recurrent invasive bladder tumours and distant metastases. Some lesions shown by mAb imaging were not detected by other methods. The use of mAb imaging has the potential to improve clinical staging and assist in selecting those patients most likely to benefit from radical therapy.
A dose‐escalation study to assess the efficacy and safety of sildenafil citrate in men with erectile dysfunction
Authors: Meuleman E. , Cuzin B. , Opsomer R.J. , Hartmann U. , Bailey M.J. , Maytom M.C. , Smith M.D. , Osterloh I.H. 
Published: March 2003

Objective To assess the efficacy and safety of sildenafil citrate (Viagra®, Pfizer Inc., USA) in a double‐blind, placebo‐controlled, dose‐escalation study over a period of 26 weeks in men with erectile dysfunction of a broad spectrum of aetiology. Patients and methods In all, 315 patients from five countries were randomized to receive treatment with placebo (156 men) or sildenafil (159 men). Significant concomitant medical conditions were hypertension (20%), a history of pelvic surgery (19%), diabetes mellitus (15%), and ischaemic heart disease (10%). Patients randomized to treatment received a starting dose of 25 mg of sildenafil or matching placebo, which could be increased to 50 mg and then to 100 mg of sildenafil, based on efficacy and tolerability. Assessments of efficacy comprised the 15‐item International Index of Erectile Function (IIEF), including question three (ability to achieve an erection) and question four (ability to maintain an erection), a partner questionnaire, an overall efficacy question, and event‐log data. Results After 12 weeks of treatment, 26%, 32% and 42% of patients were taking 25, 50 and 100 mg of sildenafil, respectively. A similar distribution of doses was reported after 26 weeks of treatment. Treatment with sildenafil significantly improved the patients' abilities to achieve and maintain an erection compared with treatment with placebo (P < 0.001). Scores for four of the five sexual function domains of the IIEF (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) also improved significantly (P < 0.001). There was a significant improvement in the mean score for the erectile function domain, regardless of the aetiology of erectile dysfunction (P < 0.001). After 12 weeks and 26 weeks of treatment, 82% and 79% of patients receiving sildenafil reported improved erections, compared with 24% and 23% of patients receiving placebo, respectively (P < 0.001). Treatment‐related adverse events were mild to moderate and occurred in 27% of patients receiving sildenafil, compared with 8% of patients receiving placebo. Conclusion Sildenafil is an effective and well‐tolerated treatment for men with erectile dysfunction of a broad spectrum of aetiology.
Side‐effects of oral or intravesical oxybutynin chloride in children with spina bifida
Authors: Ferrara P. , D'Aleo C.M. , Tarquini E. , Salvatore S. , Salvaggio E. 
Published: March 2003

Objective To evaluate the incidence of side‐effects of oral and intravesical oxybutynin chloride in children with meningomyelocele (MMC) and a neurogenic bladder. Patients and methods The study comprised 225 children with a neurogenic bladder from MMC who were evaluated with urodynamic testing and voiding cysto‐urethrography to identify those at high risk of upper tract damage. In all, 101 children (mean age 4.2 years, range 0.25–10) had unco‐ordinated detrusor‐sphincter function and low compliance; they were treated with either oral or intravesical oxybutynin and clean intermittent catheterization. Results Of the 101 patients, 67 were treated with oral oxybutynin; in 11 the treatment was discontinued because of the side‐effects. The other 34 patients used both clean intermittent catheterization and intravesical oxybutynin. In this group there were side‐effects in six patients, including drowsiness, hallucinations and cognitive changes. Conclusions Oral and intravesical oxybutynin is effective for managing neurogenic bladder dysfunction, but intravesical administration is safer and better tolerated than oral oxybutynin in the treatment of children with MMC. However, adverse effects such as cognitive impairment can also occur in children treated with intravesical oxybutynin and these patients must be closely monitored because these effects may differ from those with oral administration.
Peyronie's disease—the Plymouth experience of extracorporeal shockwave treatment
Authors: Hamm R. , Mclarty E. , Ashdown J. , Natale S. , Dickinson A. 
Published: March 2003

ObjectiveTo describe our experience of the use of extracorporeal shockwave treatment (EST) for Peyronie's disease.Patients and methodsThe study included 28 patients (mean age 57 years, range 34–72) with stable Peyronie's disease who were treated with 3.9 (3–5) sessions of EST to the Peyronie's plaque. The patients' erectile function, pain and penile angle were assessed before and after treatment with EST.ResultsOf the 28 patients, 20 felt that their erection improved after the procedure; 11 patients were able to recommence sexual intercourse and the index of erectile function increased in all but one patient.ConclusionEST produces a significant improvement in pain and penile angle, with no serious complications.
Finasteride and tamsulosin used in benign prostatic hypertrophy: a review of the prescription‐event monitoring data
Authors: Shakir S. , Pearce G. , Mann R.D. 
Published: March 2003

Objective To review the results of non‐interventional observational cohort studies of 14 772 patients treated with finasteride and 12 484 patients treated with tamsulosin, both studies being of national proportions and undertaken in general medical practice in England. Methods Both studies were undertaken by prescription‐event monitoring (PEM), whereby the exposure data are derived from information provided in strict confidence by the Prescription Pricing Authority of the National Health Service. The outcome data are derived from ‘green form’ questionnaires completed by the prescribing general practitioners (GPs). Additional data are obtained by medical follow‐up with the attending practitioners. Adverse experience was measured in three ways; as reports of events which the doctors considered to represent adverse drug reactions; as reports of reasons for stopping the drug; and by studying the incidence density of each reported event. For these purposes a computerized dictionary containing 1430 higher level terms was used. The duration of exposure in the finasteride study was ≈ 1 year and was ≈ 6 months in the tamsulosin study. Results The outcome data on the 14 772 and 12 484 patients treated in the finasteride and tamsulosin studies were derived from the 63% and 57.4% of the green forms sent out and returned, respectively. The finasteride cohort included two women and the tamsulosin cohort 70 women. The mean (sd) age of the men in the two cohorts was, respectively, 69.0 (9.2) and 66.2 (11.7) years. Both drugs were well tolerated on long‐term therapy and 69.6% (10 274 patients) of the total finasteride and 62.0% (7739 patients) of the total tamsulosin cohort were still receiving the drug at the end of 6 months. In the finasteride study, impotence or ejaculatory failure was reported in 2.0% of the patients still receiving the drug; there were reports of decreased libido in 1.0% and gynaecomastia was reported whilst the drug was still being prescribed in 39 patients (0.3% of the cohort). With tamsulosin, uncommon cases of dizziness, headache, malaise and hypotension (89 reports in 12 484 patients, i.e. 0.7% of the cohort) were common to the findings of reported adverse reactions, reasons for stopping the drug and events of highest incidence density. None of the deaths which occurred in either of these large cohorts was attributed by either the reporting GPs or the PEM medical staff to the drugs examined. Conclusion The GPs rated the drugs effective in most patients; tolerance and adverse experience was consistent with the known pharmacology of the two drugs. No serious, unexpected adverse effects were identified.
The Yang–Monti ileovesicostomy: a problematic channel?
Authors: Narayanaswamy B. , Wilcox D.T. , Cuckow P.M. , Duffy P.G. , Ransley P.G. 
Published: March 2003

Objective To compare the differences in the quality of Mitrofanoff channels created using appendix and re‐tubularized small bowel (the Yang–Monti ileovesicostomy). Patients and methods The case‐notes were reviewed retrospectively for all patients who underwent a Mitrofanoff procedure using either appendix or small bowel, over a 5‐year period from June 1994 to July 1999. Results In all, 92 patients underwent 94 Mitrofanoff procedures; the appendix was used in 69 and small bowel in 25. The underlying diagnoses were exstrophy‐epispadias complex (38), neuropathic bladder (21), anorectal malformations and cloacal anomalies (15), posterior urethral valves (nine) and miscellaneous (nine). The mean (range) age at operation was 9.2 (1.1–18.3) years. The mean (range) follow‐up for the appendix group was 37 (6.7–65) months and for the Monti group 25 (6–66) months. Catheterization problems occurred in 18 (27%) patients from the appendix group; two needed an adjustment of technique, six dilatation and 10 revision. Stomal stenosis occurred in 10 (15%) patients, bladder level stenosis in four (6%) and conduit necrosis in two. Catheterization problems were reported in 15 (60%) patients from the Monti group; five needed revision, three dilatation and seven are being managed conservatively. The incidences of stomal stenosis (four, 16%) and bladder level stenosis (two, 8%) were comparable with the appendix group. In addition, two patients had distal channel (sub‐stomal) stenosis and two had mid‐channel stenosis. The problem unique to the Yang–Monti channel was a pouch‐like dilatation in seven patients (28%), all of whom presented with catheterization problems; five are being managed conservatively and two have needed pouch resection. Stomal prolapse occurred in five (7%) patients in the appendix group, but in none of the Monti group. Conclusions The appendix is the conduit of choice for a Mitrofanoff procedure. Re‐tubularized small bowel conduits have a considerably higher incidence of catheterization problems. Anatomical factors may contribute to the unique incidence of pouch formation.
Vaginal retropubic urethropexy with intraoperative cystometry for treating urinary stress incontinence
Authors: Clark A.D. , Salloum M.S. 
Published: March 2003

Objective To determine the effectiveness of a vaginal retropubic urethropexy with intraoperative cystometry in treating urinary stress incontinence. Patients and methods One hundred patients with genuine stress incontinence on urodynamic examination underwent the procedure and were followed up for 1 year; 96 completed the follow‐up (four were lost to follow‐up). Results At 1 year, 91 patients (95%) were cured of their stress incontinence and five (5%) failed, with recurrent stress incontinence developing. The complications were mainly of suture erosion (6%). Conclusion This method of urethropexy has produced excellent results to date, with low complication and morbidity rates, and continues to be our treatment of choice. A randomized control trial comparing it with standard established procedures would be welcomed.
The 2‐year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy vs transurethral resection of the prostate
Authors: Hindley R.G. , Mostafid A.H. , Brierly R.D. , Harrison N.W. , Thomas P.J. , Fletcher M.S. 
Published: March 2003

Objective To assess the 2‐year symptomatic and urodynamic results of a prospective randomized trial of interstitial radiofrequency therapy of the prostate (IRFT) vs transurethral resection of the prostate (TURP). Patients and methods Patients with lower urinary tract symptoms (LUTS) and urodynamic evidence of bladder outlet obstruction (BOO) were randomized to undergo IRFT or TURP and were followed up using the International Prostate Symptom Score (IPSS) and urodynamic assessment for 2 years. Results At 2 years there was a clinically relevant reduction in the IPSS in the IRFT (20 to 9) and TURP groups (22 to 4). There was also a statistically significant reduction in the detrusor pressure at maximum urinary flow in both groups, but the reduction in the IRFT group was probably not sufficient to explain the observed symptomatic improvements solely from a reduction in BOO. Conclusion IRFT can produce a sustained improvement in LUTS for at least 2 years. However, such improvements are unlikely to be entirely the result of a reduction in BOO. The effects of radiofrequency energy may, at least partly, be independent of any thermal effect and depend instead on neuromodulation of lower urinary tract nerves.