bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the conservative management of ureteric calculi of > 4 mm safe?
Authors: Irving S.O. , Calleja R. , Lee F. , Bullock K.N. , Wraight P. , Doble A. 
Published: March 2003

Objective To determine the safety of the conservative management of ureteric calculi of > 4 mm in diameter, using mercapto‐acetyltriglycine (MAG3) radioisotope renography to monitor renal parenchymal function. Patients and methods Patients with symptomatic unilateral ureteric calculi were recruited prospectively. After confirming the position of the stone using contrast urography, a MAG3 radioisotope renogram was taken within 48 h of admission and again 1 month after the patients became stone‐free. The indications for intervention were ipsilateral loss of function ( 5% loss), infection, pain or any combination of these factors. The recovery of function was determined by follow‐up renography. Results In all, 54 patients were recruited; 18 were initially allocated to conservative treatment although four later required intervention for pain. The remainder required early intervention for pain (eight), diminished function only (15) or diminished function with infection (13). Of the 54 patients, 28% had ‘silent’ loss of renal function at presentation. No calculi of > 7 mm diameter passed without intervention. The mode of initial management was determined according to individual clinical need. The upper tracts of all patients were relieved of obstruction and all patients were rendered stone‐free. Intervention for reduced function only (at ≤ 7 days) gave a significantly better (P = 0.03) recovery of function than those undergoing later intervention. The combination of reduced function and infection were unrelated to outcome after intervention. Conclusions The conservative management of stones of 5–7 mm diameter is safe, providing that radioisotope renography is used to identify those renal units requiring intervention. This approach allows timely intervention to maximize the recovery of renal function.
Active properties of the urinary bladder: in vitro comparative studies between adult and neonatal rats
Authors: Oh S.J. , Lee K.H. , Kim S.J. , Kim K.W. , Kim K.M. , Choi H. 
Published: March 2003

Objective To determine, using in vitro comparative studies, developmental aspects associated with the active properties of the urinary bladder in neonatal and adult rats.Materials and methods Urinary bladders were removed from neonatal (1–3 days old) and adult (15 weeks old) male Sprague–Dawley rats. Anterior longitudinal muscle strips were obtained from each group and isometric tensions recorded. Nerve‐mediated contractions elicited by electrical field stimulation (0.8 ms pulse) or carbachol‐induced contractile responses in neonatal and adult bladder strips were compared. Contractile tensions were normalized using the wet weight of the bladder strip or by using the percentage contraction induced by 60 mmol/L KCl.Results Nerve‐mediated contractile responses showed that the muscarinic component predominated in the neonatal rat bladder, which contrasted with the predominant purinergic components in adult bladder. The pattern of spontaneous activity and carbachol‐induced contraction differed in the two groups. Small spontaneous contractions in the basal state occurred in adult bladder strips, while short‐lived large spontaneous contractions were present in neonatal strips. The amplitude of carbachol‐induced contractions generated in the neonatal bladder was larger than that in the adult bladder. In addition, the time to achieve peak contraction elicited by carbachol (5 µmol/L) was shorter in the neonatal bladder. Repetitive carbachol applications induced an attenuation of the contractile response (desensitization), but the neonatal bladder was more resistant to desensitization than the adult bladder.Conclusions These results show that nerve‐mediated or agonist‐induced contractile patterns, and spontaneous activity, in the neonatal bladder differ from those of the adult bladder in rats. The results suggest that in addition to neural immaturity, there are functional differences between the bladders of adult and neonatal rats.
Stilboestrol plus adrenal suppression as salvage treatment for patients failing treatment with luteinizing hormone‐releasing hormone analogues and orchidectomy
Authors: Farrugia D. , Ansell W. , Singh M. , Philp T. , Chinegwundoh F. , Oliver R.T.D. 
Published: March 2003

Objective To investigate the efficacy of low‐dose stilboestrol (SB) with hydrocortisone in patients with advanced prostate cancer refractory to androgen suppression.Patients and methods Thirty‐four consecutive patients (median age 70 years, range 51–83) with metastatic disease who progressed on hormone therapy, as shown by recurrent/worsening symptoms and an increase in prostate‐specific antigen (PSA) level, were recruited and discontinued hormonal treatment before starting SB. Patients received SB (1 mg/day) combined with hydrocortisone (40 mg/day). In an attempt to reduce the incidence of thrombo‐embolic events, aspirin (75 mg/day) was also added.Results Stilboestrol was the second‐line treatment in 19 patients and the third or fourth in 15. The median (range) duration of treatment with SB was 5 (0.5–21) months and the median follow‐up 7.5 months, with 18 patients still alive and 14 still on treatment. Of 29 symptomatic patients, 24 had symptomatic improvement and five had no clear benefit; the median duration of benefit was 6 (2–21) months. The PSA level decreased by 0–50% in six patients, by 50–90% in 13 and by > 90% in eight, while there was symptomatic improvement in these three categories in five, 11 and seven patients, respectively. The median times to PSA nadir and progression were 4 and 6 months, respectively. Some thrombo‐embolic events and fluid retention occurred but overall the treatment was well tolerated.Conclusion Low‐dose SB with hydrocortisone is effective in refractory prostate cancer, although there is some toxicity. Randomized studies against hydrocortisone or SB alone are needed to establish the cost/benefit ratio of this combination.
The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves
Authors: De Gennaro M. , Capitanucci M.L. , Mosiello G. , Caione P. , Silveri M. 
Published: March 2003

Objective To determine whether bladder dysfunction in boys with posterior urethral valves (PUV) changes from a uniform pattern of hypercontractility during infancy to the hypocontractility found in adolescence, by reviewing serial urodynamic studies.Patients and methods Thirty boys with PUV and no voiding symptoms underwent a total of 86 urodynamic tests (mean 2.8 each). The first urodynamic study was undertaken at 1–4 years of age in 15 boys and at 5–13 years in 15. They were re‐evaluated at least 3 years later; 15 patients underwent the first and last urodynamic study, respectively, at a mean age of 2.8 and 7.7 years (group A), 10 boys at 6.2 and 8.8 years (group B) and five at 9.4 and 15.2 years (group C). In 10 boys aged > 5 years the first and last pressure‐flow studies (PFS) were analysed using an advanced analysis (PFA) to better identify hypocontractility.Results Bladder dysfunction was found in 21 of 30 (70%) boys at the first evaluation and in 18 (60%) at the last. In 25 boys the urodynamic pattern changed. Of the 15 boys in group A, 10 of 12 who had hypercontractility changed to normal (seven), low compliance (one) or hypocontractility (two), and two remained stable; two of the remaining three with normal urodynamic studies changed to hypocontractility, while one was unchanged. Among the 10 boys in group B, six with hypercontractility changed to normal (three) or hypocontractility (three); two with normal urodynamic findings and one with low compliance changed to hypocontractility. Of the five boys in group C who showed severe hypocontractility after puberty, three had a normal pattern, one low compliance and one hypercontractility before puberty. The PFA showed a ‘weak’ detrusor in four of the seven boys who were considered normal on standard PFS. At the urodynamic follow‐up, the PFA pattern changed to a ‘weak’ detrusor in four boys who had a normal (two) or strong (two) detrusor at the first evaluation.Conclusions Bladder dysfunction in boys with PUV changes during childhood and through adolescence. The urodynamic pattern of hypercontractility generally found soon after valve ablation gradually changes to hypocontractility in many boys and this pattern seems to be the rule after puberty. The evidence from this series supports the hypothesis that long‐term detrusor hyperactivity in boys with PUV leads to detrusor failure, but a longitudinal 15‐year follow‐up from birth to puberty is needed to validate this concept.
Prostatic manipulation has a minimal effect on complexed prostate‐specific antigen levels
Authors: Lynn N.N.K. , Collins G.N. , O'Reilly P.H. 
Published: March 2003

Objective To assess the effect of prostatic manipulation on complexed prostate‐specific antigen (cPSA), as various forms of prostatic manipulation are known to increase the serum free and total PSA level. Patients and methods A series of 92 men (58 after prostatic biopsy, 16 after digital rectal examination and 18 after flexible cystoscopy) were assessed. Blood samples were taken from each patient before and 30 min after manipulation. Total and cPSA levels were measured using appropriate assays, respectively. Results There was no significant increase in cPSA levels after flexible cystoscopy and digital rectal examination, but prostate biopsy caused a statistically significant although minimal rise in cPSA level. There was no statistically significant increase in cPSA level after prostate biopsy in patients with prostate cancer (P = 0.35) although there was a statistically significant but minimal rise in cPSA level in patients with benign histology (P < 0.01, mean increase 2.13 ng/mL) compared with that of total PSA, which increased markedly (P < 0.01, mean increase 19.79 ng/mL). Conclusion Prostatic manipulation has minimal effects on cPSA levels.
Time‐specific effects of mono‐n‐butyl phthalate on the transabdominal descent of the testis in rat fetuses
Authors: Shono T. , Kai H. , Suita S. , Nawata H. 
Published: March 2003

Objective To determine the time‐specific effects of mono‐n‐butyl phthalate (MBP) on the transabdominal migration of the testis in fetal rats. Materials and methods Three groups of pregnant rats were administered MBP by stomach‐tube feeding when the fetus was at 7–10 days of gestation in group 1, 11–14 days in group 2, and 15–18 days in group 3; controls (group 4) were given vehicle only from 7–18 days. At 20 days of gestation the fetuses were obtained by Caesarean section, and the position of the testes, the development of the gubernaculum, cranial suspensory ligament and the epididymis were examined. Results The timed intervals of MBP administration showed that the maximum inhibition of transabdominal testicular descent was at 15–18 days of gestation. There was an elongated gubernaculum and hypertrophic cranial suspensory ligament in the MBP‐treated rat fetuses. Furthermore, the epididymis showed a few small ducti deferentia, although there were no remarkable changes in either the Sertoli and Leydig cells in these testes. The mean (sem) content of testicular testosterone was significantly less (P < 0.001) in the MBP‐treated rats, at 50.9 (3.8) pg/testis, than in the controls, at 676 (33.3) pg/testis. Conclusions These findings indicate that a brief exposure to MBP during fetal development can inhibit the transabdominal migration of the testis and reduce testosterone content in rats, although the relationship between migration and the testicular testosterone content remains unknown.
Three‐dimensional contrast‐enhanced power Doppler ultrasonography and conventional examination methods: the value of diagnostic predictors of prostate cancer
Authors: Unal D. , Sedelaar J.P.M. , Aarnink R.G. , Van Leenders G.J.L.H. , Wijkstra H. , Debruyne F.M.J. , De La Rosette J.J.M.C.H. 
Published: March 2003

Objective To investigate the value of three‐dimensional contrast‐enhanced power Doppler ultrasonography (3D‐CE‐PDU) in the diagnosis of prostate cancer and to compare 3D‐CE‐PDU with digital rectal examination (DRE), prostate‐specific antigen (PSA) levels, grey‐scale ultrasonography (GSU) and PDU. Patients and methods The study comprised 30 patients with localized prostate cancer scheduled to undergo radical prostatectomy and 29 with clinical BPH scheduled to undergo transurethral microwave thermotherapy. The 3D‐CE‐PDU examinations were carried out using 2.5 g of microbubble ultrasound contrast medium; the images were stored digitally to allow off‐line analysis. All the reconstructed 3D images of the prostate were evaluated blindly in random order by two investigators (one expert and one novice). The images were scored according to asymmetry (0–2) and vessel distribution (0–3). Marked asymmetry (2) and/or a focal increase in vascularity (> 2) were considered as suspicious for prostate malignancy. Diagnostic predictions using the DRE, PSA level, GSU, PDU, 3D‐CE‐PDU and their combinations were investigated using receiver operating characteristic (ROC) curves. Results True‐positive and true‐negative rates of the 3D‐CE‐PDU were 87% (26/30) and 79% (23/29), respectively, for the expert observer. The sensitivity of 3D‐CE‐PDU was higher than that of DRE, GSU and PDU, but not PSA level, and the specificity was lower, again except for PSA level. However, when compared with those of the other modalities in single‐test evaluations, 3D‐CE‐PDU, and a combination of 3D‐CE‐PDU and PSA level, had the largest area under the ROC curve (0.830 and 0.933, respectively). The diagnostic agreement between the examiners was 76% (Cohen kappa statistic, 0.5). Conclusion In this selected group of patients, 3D‐CE‐PDU alone was a better diagnostic tool than the DRE, PSA level, GSU or PDU alone. The most suitable diagnostic predictor for prostate cancer was a combination of 3D‐CE‐PDU and PSA level.
Optimizing the therapeutic approach of transurethral alprostadil
Authors: Ekman P. , Sjögren L. , Englund G. , Persson B.‐E. 
Published: March 2003

Objective To investigate the efficacy and safety of two different starting doses of transurethral alprostadil (250 µg and 500 µg, MUSE®, Vivus Inc., Menlo Park, CA, USA, and Astra Läkemedel AB, Södertälje, Sweden) and the need for dose titration in a general population with erectile dysfunction. Patients and methods In a 12‐week randomized and open multicentre study with parallel groups, 166 patients were randomised to a starting dose of either 250 or 500 µg of MUSE and evaluated for safety. Of these patients, 142 were included in the analysis of efficacy. MUSE marked in four doses (125, 250, 500 and 1000 µg) was supplied and during the trial the dose could be increased or decreased step‐wise until a satisfactory response was attained. The efficacy was assessed using the Erection Assessment Scale (EAS), as coitus (by diary) and the International Index of Erectile Function. Results The lowest dose of MUSE with which the patients achieved at least one EAS score of 4 or 5 was 125 µg for 1% of participants, 250 µg for 27%, 500 µg for 32%, 1000 µg for 6%, and finally 1000 µg plus a pubic band for 8%. Thirty‐five of the 142 patients (25%) did not report an EAS of 4 or 5. Most patients (> 60%) achieved an EAS of 4 or 5 on the lower doses (125, 250 and 500 µg). Almost all patients who had an EAS score of 4 or 5 also had intercourse. In all, 68% reported sexual intercourse at least once in course of the study. More patients reported penile pain while treated with 500 µg than with 250 µg (P < 0.05) during the first 4 weeks. However, the penile pain was severe in very few men and it was a minor problem. Hypotensive symptoms were reported six times, independently of dose level. The administration of MUSE was generally rated as comfortable. No patients reported urethral stricture, penile fibrosis, or priapism either in the clinic or at home. Conclusion Recommending 500 µg as a starting dose increased the percentage of patients reporting at least one EAS of 4–5, with or without sexual intercourse, from 28% to 60%. No serious dose‐related systemic effects were seen. When starting on 500 µg, patients were more likely to find directly the dose that gave sufficient response and treatment satisfaction. We suggest that the appropriate starting dose of MUSE should be 500 µg.
Oestrogen and progesterone receptor expression in the female lower urinary tract, with reference to oestrogen status
Authors: Blakeman P.J. , Hilton P. , Bulmer J.N. 
Published: March 2003

Objective To assess the incidence and distribution of both oestrogen and progesterone receptors throughout the female lower urinary tract, and to compare receptor expression in women of varying oestrogen status. Patients and methods The study included 90 women undergoing surgery for urogynaecological conditions; 33 were premenopausal, 26 postmenopausal and taking no oestrogen supplementation, and 31 postmenopausal and receiving some form of hormone‐replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, proximal urethra, distal urethra, vagina and vesicovaginal fascia in the region of the bladder neck. All biopsies were routinely fixed and processed for histopathological assessment, and were then labelled immunohistochemically with monoclonal antibodies directed against human oestrogen (NCL‐ERLH2) and progesterone (NCL‐PGR) receptors. Both oestrogen and progesterone receptor expression were assessed in the epithelial, subepithelial and muscle/deeper fascial regions of all tissue for overall tissue positivity for each receptor, and by semiquantitative analysis of receptor concentration using histochemical scoring of the tissues. Results Oestrogen receptors were consistently detected in the squamous epithelia and were consistently absent in the urothelial tissues of the lower urinary tract of all women irrespective of oestrogen status; there was no significant variation in histological score. Progesterone receptor expression was more variable, being mostly subepithelial, and significantly lower in postmenopausal women receiving no oestrogen replacement. Conclusion These findings confirm the female lower urinary tract to be a target organ for the action of oestrogen and progesterone, and shed further light on the areas of the lower urinary tract likely to respond to hormone‐replacement therapy. This may have implications for the use of oestrogen supplementation in the treatment of lower urinary tract disorders of postmenopausal women.
Changes in the toilet training of children during the last 60 years: the cause of an increase in lower urinary tract dysfunction?
Authors: Bakker E. , Wyndaele J. J. 
Published: March 2003

Objective To analyse the changes in toilet training of children in Belgium in the last three generations and to seek a possible cause for the apparent increase in lower urinary tract dysfunction over that period. Patients and methods A questionnaire (25 questions) was developed and completed by 321 people who had toilet‐trained 812 children. The population was divided into three groups according to the age of those who trained the children. Results There has been a major change in toilet training in the last 60 years; the age at which toilet training began has been significantly postponed. One reason for starting training, i.e. bladder control during the afternoon nap (which can probably be considered as an indication of sufficient bladder capacity) has become less important. Season (summer) has become a more important factor, as has starting school. Training by bladder drill, formerly widely used, was progressively abandoned and a more liberal attitude adopted by the youngest parents. Conclusion There seems to be good concordance between the programmes currently proposed for treating bladder dysfunction in children and the traditional bladder‐training methods used by parents 60 years ago. To start bladder training when the child stays dry during the afternoon nap and using bladder drill might help to avoid permanent bladder dysfunction. The lack of formal bladder training may be responsible for an increase in lower urinary tract dysfunction.
Hormone‐resistant prostate cancer with symptomatic pelvic tumours: patient survival and prognostic factors
Authors: Hernes E.H. , Linja M. , Fosså S.D. , Visakorpi T. , Berner A. , Winderen M. , Koivisto P.A. 
Published: March 2003

Objectives To determine the survival and investigate the prognostic significance of immunohistochemical variables and clinical factors in patients with hormone‐resistant prostate cancer (HRPC) and symptomatic pelvic tumours, in whom preliminary observations indicated that survival exceeded the median 8–10 months of patients with HRPC and painful bone metastases. Patients and methods Seventy‐five patients with HRPC referred for palliative pelvic radiotherapy between 1980 and 1996 were identified. For all patients at least two prostate biopsies had been obtained, one before primary hormone treatment and at least one after clinical progression despite androgen deprivation (HRPC biopsy). Bone scans at the time of referral were assessed. The medical records were reviewed for clinical variables of possible prognostic significance. Histological grade was recorded, and prostate‐specific antigen (PSA), androgen receptors (ARs), Ki‐67 and p53 determined immunohistochemically. In 18 HRPC specimens the degree of AR amplification was analysed. Results Positive staining for ARs was high in the HRPC biopsies, although there was no association with AR amplification. Ki‐67 positivity increased after the development of HRPC. The median (range) survival was 14 (1–141) months; age < 65 years was associated with increased survival. In a multivariate analysis the following variables remained independent prognostic factors for survival from the time of the HRPC biopsy: bone metastases (0–10 vs  > 10 lesions, P < 0.001), low Ki‐67 score (0 vs 1–3, P = 0.006) and low p53 positivity score (0 vs 1–3, P = 0.014) in the HRPC biopsy. Conclusions The median survival of patients with HRPC and pelvic tumours requiring palliation seems to exceed that of patients with HRPC and dominating painful bone metastases by at least 4–6 months. Simple clinical (bone metastases) and immunohistochemical variables (Ki‐67, p53) enable patients with particularly long survival times to be identified, and in whom palliative treatment needs to be improved.
Genetic identification of bilateral primary or metastatic nonpapillary renal cell carcinoma
Authors: Kume H. , Oda H. , Nakatsuru Y. , Shimizu Y. , Takahashi Y. , Matsumoto T. , Inoue T. , Kameyama S. , Kitamura T. , Ishikawa T. 
Published: March 2003

Objective To clarify the clonality of bilateral tumours by genetic analysis of bilateral renal cell carcinomas (RCCs) using the VHL gene, which is inactivated in ≈ 60% of RCCs and which plays a causal role in the development of most cases of nonpapillary RCC. Patients and methods The study included 20 patients; seven had von Hippel‐Lindau disease, three had papillary RCC and 10 had nonpapillary RCC. Paraffin‐embedded blocks of tumour tissue were obtained from two of the three patients with papillary RCC and from nine of 10 with nonpapillary disease; all three exons of VHL were examined by direct sequencing. Results As reported previously, no VHL mutations were found in papillary tumours. However, in five of the nine nonpapillary cases, VHL mutations were identified in tumours on one or both sides. Three of the tumours had the same mutation on both sides, confirming a common origin. In the remaining two patients, the mutation status differed between the sides, confirming a bilateral primary origin. The former cases were characterized by a relatively large tumour on one side and multiple tumours on the other. Conclusions In nonpapillary RCC multiplicity may suggest a metastatic origin. Such genetic information will be useful in treating and following patients with bilateral renal tumours.