bluuebunny/crossref_metadata_2025_split huggingface dataset:
The outcome of artificial urinary sphincter placement after a mean 15‐year follow‐up in a paediatric population
Authors: Kryger  , Spencer Barthold  , Fleming  , González  
Published: March 2003

ObjectiveTo evaluate the long‐term outcome in children who had an artificial urinary sphincter (AUS) placed, after a minimum of 10 years of follow‐up.Patients and methodsThe medical records of patients who had an AUS placed at the Children’s Hospital of Michigan were reviewed and a telephone questionnaire was then completed by all patients with an AUS currently in place.ResultsForty‐seven children initially had an AUS placed between October 1978 and August 1986; medical records and follow‐up were available for 32. After a mean follow‐up of 15.4 years, 13 patients had had the AUS removed and 19 currently have an intact AUS. Erosion or infection was responsible for all AUS removals. Possible risk factors for AUS removal were prior AUS erosion, prior bladder neck surgery and a balloon pressure of >70 cmH2O. Eighteen of 19 patients with an intact AUS are dry and seven void volitionally. Revision was the most common reason for additional surgery, but the revision rate has decreased with the most current AS‐800 model, to 0.03 revisions per patient‐year. Of the 13 patients with an AS‐800 model placed after 1987, nine have not required revision. Upper tract changes were mild and uncommon.ConclusionThe AUS is a durable and effective surgical option in the management of neurogenic urinary incontinence, and is the only reliable technique that can preserve volitional voiding. With technical improvements to the AUS and a longer follow‐up, the revision rate has decreased. Causes of AUS removal may be preventable with improvements in surgical technique and patient selection. AUS placement should be considered as a first choice for the surgical management of neurogenic sphincteric incompetence.
Mortality and prostate cancer risk in 19 598 men after surgery for benign prostatic hyperplasia
Authors: Holman  , Wisniewski  , Semmens  , Rouse  , Bass  
Published: March 2003

ObjectivesTo examine postoperative mortality and prostate cancer risk after the first prostatectomy for benign prostatic hypertrophy over a 17‐year period in a population‐based cohort of men in Western Australia, using improved methods to adjust for comorbidity.Patients and methodsThe relative survival from death and prostate cancer incidence was calculated against the background population rates. The outcomes of transurethral resection of the prostate (TURP) and open prostatectomy (OP) were compared adjusting for calendar year, age, admission type and comorbidity using Cox regression. Fractional polynomials were used to take account of nonlinearity in confounder effects.ResultsAt 10 years, the relative survival was 116.5% in TURP patients and 123.5% after OP. Adjusting only for confounding by age, calendar year and admission type, TURP had a higher mortality rate than OP (rate ratio, RR, 1.20; 95% confidence interval 1.08–1.34). The RR fell to 1.10 (0.99–1.23) after adjustment for comorbidity and to 1.07 (0.95–1.19) when accounting for nonlinearity. The relative survival from the incidence of prostate cancer at 10 years was 103.7% after TURP and 104.5% after OP. The RR adjusted for age and calendar year was 1.44 (0.94–2.21) for incidence and 1.37 (0.81–2.29) for prostate cancer mortality.ConclusionThere is at most a small and clinically unimportant excess mortality risk from TURP; any difference could be due to a protective effect of OP on the long‐term risk of prostate cancer and a lower rate of repeat prostatectomy.
The effect of colonoscopy on serum prostate specific antigen levels
Authors: Schwartz  , Faught  , Jezior  
Published: March 2003

ObjectiveTo evaluate, in a prospective trial, the effect of colonoscopy on serum prostate specific antigen (PSA) levels (which are known to increase after cystoscopy and prostatic needle biopsy) in men aged 50–70 years, as they commonly undergo colonoscopy and PSA screening together.Subjects and methodsTwenty‐four consecutive men (mean age 61 years, range 37–78) were enrolled in the study. All subjects had their serum PSA measured 24–72 h before undergoing colonoscopy. Further values were obtained 24 h, 7 and 30 days after the procedure. The values before and after colonoscopy were compared to evaluate the effect of colonoscopy on serum PSA levels.ResultsOf 24 patients, seven (35%) had insignificant increases at 24 h after colonoscopy; 12 (50%) patients had an insignificant increase in PSA level 30 days after the procedure. None of the 24 patients had a significant increase after colonoscopy when compared with baseline values.ConclusionFlexible colonoscopy does not adversely affect serum PSA levels. Although individuals may have a 30% daily fluctuation in serum values, this study detected no significant change in serum PSA levels after prolonged transrectal prostatic manipulation with a colonoscope.
An in vivo evaluation of the therapeutic potential of sympatholytic agents on premature ejaculation
Authors: Hsieh  , Liu  , Hsieh  , Cheng  
Published: March 2003

ObjectiveTo evaluate the therapeutic potential of sympatholytic agents on premature ejaculation in an animal model, using monitoring of rat seminal vesicle pressure change in response to electrical stimulation of the lesser splanchnic nerve.Materials and methodsMale Wistar rats (aged 12–14 weeks) were injected intra‐arterially with sympatholytic agents (phenoxybenzamine, prazosin, WB‐4101, chloroethylclomidine, yohimbine and RX 821002) at various concentrations 10 min before electrical stimulation of the lesser splanchnic nerve. The change in phasic tension (▵mmHg) of the seminal vesicle induced by electrical nerve stimulation before and after the addition of sympatholytic agents was used for statistical analysis. The maximum inhibition and the concentration required to induce 50% inhibition of the maximal contractile response (IC50 ) were obtained from the concentration‐response curves, and used to determine the potency of test agents.ResultsThe seminal vesicle contractile response to electrical nerve stimulation was suppressed in a dose‐dependent manner by all test drugs except RX 821002. The mean (sd) maximal inhibition was 78.4 (9.3)% by 0.03 mg/kg of phenoxybenzamine, 77.1 (10.1)% by 0.03 mg/kg of WB‐4101, 73.4 (6.0)% by 0.1 mg/kg of yohimbine, 67.9 (9.7)% by 0.1 mg/kg of prazosin, 75.5 (7.5)% by 3 mg/kg of chloroethylclomidine and 25.3 (4.8)% by 0.01 mg/kg of RX 821002. The potencies of WB‐4101 (IC50 3 μg/kg) and yohimbine (IC50 0.8 μg/kg) were similar to that of phenoxybenzamine (IC50 0.5 μg/kg) and much higher than that of prazosin (IC50 0.03 mg/kg) or chloroethylclomidine (IC50 0.3 mg/kg).ConclusionsPhenoxybenzamine, prazosin, WB‐4101, chloroethylclomidine and yohimbine all inhibit the contractile response of the rat seminal vesicle to electrical nerve stimulation. As phenoxybenzamine is effective in treating premature ejaculation, the comparable in vivo potencies of WB‐4101 and yohimbine strongly suggest that they have clinical therapeutic potential.
Prediction of prostatic cancer progression after radical prostatectomy using artificial neural networks: a feasibility study
Authors: Mattfeldt  , Kestler  , Hautmann  , Gottfried  
Published: March 2003

ObjectiveTo report a methodological feasibility study in a small series of patients with node‐negative organ‐confined prostatic cancer, using artificial neural networks to predict tumour progression after radical prostatectomy and thus help to identify high‐risk patients who would benefit from adjuvant treatment.Patients and methodsA group of 20 patients with pT2N0 prostatic cancer and postoperative tumour progression was compared with a control group of 20 patients with no progression, matched for age, duration of follow‐up and preoperative serum prostate‐specific antigen level. Histopathological data were obtained from the radical prostatectomy specimens, i.e. the Gleason score, World Health Organisation (WHO) grade and maximum diameter of the tumour transects. The volume and surface area of the epithelial tumour component and of the lumina of the neoplastic glands per unit tissue volume were estimated by morphometric methods. To predict recurrence, multilayer feedforward networks with backpropagation (MLFF‐BP), two implementations of learning vector quantization (LVQ), and linear discriminant analysis (LDA) were applied. The ability of these models to correctly classify new cases was tested using the ‘leave‐one‐out’ technique.ResultsProgression was predicted correctly in 85% of newly presented cases from the three routine histopathological variables alone. On the basis of the four morphometric variables alone progression was predicted correctly in 93% of cases. The use of all seven variables as input data only slightly improved the quality of prediction. The best results were obtained by the LVQ networks and LDA, followed by MLFF‐BP networks.ConclusionsIn this methodological feasibility study, the progression of pT2N0 prostatic cancer after radical prostatectomy could be predicted with good accuracy, sensitivity and specificity from routine variables or morphometric texture variables using artificial neural networks. These results suggest that this approach should be assessed in a prospective study with more cases.
A prospective randomized study comparing absorbable and nonabsorbable staples in constructing antireflux valves of urethral hemi‐Kock pouches
Authors: Arif  , Madbouly  , Mahran  , Ashamallah  , Ghoneim  
Published: March 2003

ObjectiveTo determine the long‐term complications associated with constructing an antireflux nipple valve using absorbable or nonabsorbable staples in the urethral hemi‐Kock pouch.Patients and methodsFifty patients (all men, median age 47 years, range 28–73) undergoing construction of a urethral hemi‐Kock pouch were randomized prospectively into two equal groups. In group 1, absorbable (polyglyconate) staples were used for the construction, and in group 2 nonabsorbable (metal) staples were used but omitting the staples applied at the tip of nipple valve. Assessment during the follow‐up of 6–88 months comprised urine analysis, culture and sensitivity, measurement of serum creatinine, electrolytes and blood gases, and plain abdominal radiography, intravenous urography and micturating pouchography.ResultsIn group 1, 21 patients were evaluable; a pouch stone was detected in one, extussusception of the valve in one and valve stenosis in one. In group 2, 20 patients were evaluable; pouch stones were detected in six, extussusception of the valve in three and valve stenosis in one.ConclusionCompared with nonabsorbable (metal) staples, the use of absorbable (polyglyconate) staples significantly decreased the incidence of pouch stone formation and improved valve stability in patients with a urethral hemi‐Kock pouch.
A comparative study of the effects of a colorectal valve on the oro‐anal transit time in patients with an augmented and valved rectum for urinary diversion
Authors: Mahran  , Kock  
Published: March 2003

ObjectivesTo evaluate the effect of the interposed colorectal valve on the flow of the proximal colonic contents to the rectum in patients with a valved urinary diversion to the rectum.Patients and methodsThe oro‐anal transit time (OATT) and segmental colonic transit time (SCTT) were estimated in two groups of 15 patients each (10 women and five men). In group 1, patients had a colorectal valve and in group 2 (control) they had no valve in the rectosigmoid area. The OATT and SCTT were evaluated using the 7‐day method, whereby each patient swallowed 10 ring‐shaped radio‐opaque markers daily for 6 days, and a single abdominal radiograph was taken on day 7. The OATT and SCTT were then estimated as the number of retained markers divided by the daily dose of markers.ResultsThe mean (sd) OATT was not significantly different (P=0.185), at 1.85 (1.21) days in group 1 and 2.49 (1.38) days in group 2. There were no sex differences in the values between the groups. The SCTT in the four areas of the colon again showed no significant differences within or between groups (P>0.05).ConclusionUsing a colorectal valve to functionally isolate the urinary rectal reservoir and thus reduce the high incidence of metabolic acidosis has no significant effect on intestinal transit times.
An analysis of risk factors for upper urinary tract deterioration in patients with myelodysplasia
Authors: Seki  , Akazawa  , Senoh  , Kubo  , Tsunoda  , Kimoto  , Naito  
Published: March 2003

Objective To identify the risk factors for upper urinary tract deterioration in a retrospective study of patients with myelodysplasia.Patients and methods The medical history, radiographic studies and urodynamic results from 39 children with myelodysplasia who were treated at our hospital were reviewed retrospectively to obtain more accurate data in the prognosis of such patients. The upper urinary tracts were assessed by cysto‐urethrography and excretory urography to determine the incidence of vesico‐ureteric reflux (VUR) and hydronephrosis. The relationships between the urodynamic variables, including vesical compliance, detrusor hyper‐reflexia, detrusor‐sphincter dyssynergia (DSD) and the maximum urethral closing pressure (MUCP) to such upper tract deterioration were evaluated using both univariate and multiple logistic regression analysis.Results The univariate analysis showed low vesical compliance, a high level of MUCP and the presence of DSD to be significant factors for the incidence of VUR. Low vesical compliance and a high level of MUCP also correlated with the incidence of hydronephrosis. The multivariate analysis showed a significant relationship between urodynamic values and upper urinary tract deterioration. The incidence of VUR was strongly correlated with a high MUCP and the presence of DSD. A high MUCP was also a significant factor in the incidence of hydronephrosis.Conclusion Urodynamic results associated directly with the abnormal function of urethral control are significantly correlated with the cause of upper tract deterioration in patients with myelodysplasia.
Mast cell variations in tumour tissue and with histopathological grading in specimens of prostatic adenocarcinoma
Authors: Sari  , Serel  , Çandir Ö. , Öztürk  , Kosar  
Published: March 2003

Objective To determine whether the number of mast cells (MCs) varies in and around prostatic carcinoma tissue, and with histopathological grading.Materials and methods Specimens of 27 prostatic carcinomas were stained with the toluidine blue and staged histopathologically using the Gleason grading system. The MCs were counted in five high‐power microscopy fields within and around the tissue samples, and the results analysed using the Wilcoxon signed‐rank test and Spearman’s correlation.Results The mean number of MCs was 1.7 per field within and 3.31 per field around the cancer tissue, the difference between these being significant (P<0.05). There was a close correlation between the numbers of MCs within the tumour and Gleason grade (r=0.56, P=0.002) but not between grade and counts around the tumour (r=−0.18, P=0.35).Conclusion These results suggest that some MCs aggregate at the periphery of the prostatic adenocarcinoma and that the number of MCs within the tumour tissue is related to tumour differentiation.
A 7‐year audit in a single centre of the results of the modified template retroperitoneal lymph node dissection for testicular teratoma
Authors: Bell  , Sibley  
Published: March 2003

Objective To audit the results of retroperitoneal lymph node dissection (RPLND) after chemotherapy for testicular nonseminomatous germ cell tumour (NSGCT) in a single centre over a 7‐year period, using a modified template technique via a midline transabdominal approach.Patients and methods Outcome data were collected prospectively on all patients undergoing RPLND for a residual retroperitoneal mass after chemotherapy for NSGCT between October 1990 and March 1998; 28 patients underwent 32 RPLNDs over this period.Results The clinical stage at presentation was stage I in three patients (12%), stage II in 15 (54%), stage III in one (4%) and stage IV in nine (32%). The histological classification included malignant teratoma differentiated in one patient, malignant teratoma intermediate in 12 (43%) and malignant teratoma undifferentiated in 12. Tumour markers were positive immediately before surgery in four patients. A midline transabdominal approach was used in 31 of the procedures. The size of the retroperitoneal tumour mass was <3 cm in four patients (13%), 4–8 cm in 16 (50%) and >9 cm in 12 (38%). Histology of the mass showed residual differentiated teratoma in 17 (53%), undifferentiated teratoma in six (19%), necrosis only in six (19%), adenocarcinoma in one and angiosarcomatous differentiation in two. There was no perioperative mortality. Eight patients had permanent loss of ejaculation (29%) and two had erectile dysfunction (7%). Five patients (20%) subsequently developed recurrent disease; three (12%) underwent reoperation for disease relapse (one requiring two further procedures), whilst two (8%) died from recurrent disease.Conclusion An abdominal approach via a midline incision provides satisfactory access with minimal morbidity in most patients. Results comparable with larger series can be achieved in regional centres.
Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review
Authors: Devarajan  , Jaganathan  , Harriss  , Chua  , Bishop  
Published: March 2003

Objective To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations.Patients and methodsThe study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection.ResultsThe 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney’s darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia.ConclusionsThe recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein’s mesh repair.
Treatment for human immunodeficiency virus with indinavir may cause relevant urological side‐effects, effectively treatable by rehydration
Authors: Hug  , Naef  , Bucher  , Sponagel  , Lehmann  , Battegay  
Published: March 2003

Objective To explore the occurrence of, and diagnostic and therapeutic procedures for urological side‐effects (e.g. micro‐ and macrohaematuria, and kidney stone formation) in individuals treated with indinavir for the human immunodeficiency virus (HIV).Patients and methodsThe study comprised a retrospective follow‐up of 74 individuals infected with HIV‐1 and who were treated with indinavir orally at a daily dose of 2.4 g. Data were collected at the outpatient department of our institution between March 1996 and November 1997.ResultsOf the 74 individuals treated with indinavir, 15 (20%) had indinavir‐related urological side‐effects (19 episodes), most commonly dull flank pain and dysuria. Microhaematuria occurred in 16 of the 19 episodes. Four patients showed urinary tract distension ultrasonographically as a possible indirect sign of urolithiasis and one patient passed a kidney stone. In four patients treatment had to be stopped permanently, but in the remaining 11 patients treatment was continued. Some patients required dose reduction and/or interruption of treatment; only conservative therapeutic measures were required, consisting of rehydration (fluid intake >1.5 L/day) and analgesics.ConclusionsUrological side‐effects of indinavir may be apparent in 20% of patients so treated; some (5%) may require permanent withdrawal. In addition to a history and clinical examination, urine analysis and ultrasonography were the only diagnostic procedures required. Therapy is mainly conservative, using rehydration, analgesics and a brief discontinuation of therapy, according to the severity of the symptoms.
Screening for fetal urological abnormalities: how effective?
Authors: Scott  , Renwick  
Published: March 2003

Objective To analyse urological cases registered with the Northern Congenital Abnormality Survey (NorCAS) and thus assess antenatal diagnostic sensitivity, measure regional interhospital variation and determine whether antenatal ultrasonography has contributed to the prevention of urinary tract disease in childhood.MethodsAll notification documents forwarded to NorCAS from its inception in 1984 until 31 December 1996 were inspected and those relating to urological abnormalities were abstracted. Information about postnatal progress was often missing. Twenty‐three hospitals delivering maternity services were identified and randomly allocated a code letter a–w. Data were analysed in two periods, 1984–90 and 1991–96. To quantify hospital performance an ‘expected number’ for each hospital was calculated from the overall incidence per 1000 births and the number of births in each hospital.ResultsThere was a clear improvement in antenatal diagnostic sensitivity for the major urological abnormalities in the second period, but there was considerable variation among hospitals in the number of cases notified; this applied particularly to antenatal renal dilatation. Two hospitals notified significantly more cases in this category than all the others. The difference in notification rates among hospitals was caused by diagnoses such as vesico‐ureteric reflux (VUR), pelvi‐ureteric junction obstruction and megaureter, which often produce antenatal renal dilatation. Hospitals which notified more of these cases performed more micturating cystograms and identified more children with VUR. Measurements of the fetal renal pelvis were regularly made by only seven hospitals; one of these had difficulties with postnatal follow‐up. There was evidence that moderate degrees of antenatal renal dilatation (4–10 mm) were associated with VUR; 8.5% of the children in whom VUR was diagnosed had fetal renal dilatation of this order.ConclusionAntenatal renal dilatation and its significance are either not being recognized or not appreciated in some hospitals. The high incidence of VUR in cases with moderate antenatal renal dilatation indicates that children with this condition may be escaping diagnosis.