bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mainz Pouch II technique: 10 years’ experience
Authors: D’elia G. , Pahernik S. , Fisch M. , Hohenfellner R. , Thüroff J.W. 
Published: May 2004

In this section, the use of the Mainz Pouch II is examined in some detail, from Mainz (where it originated), and from London. Both groups of authors found the procedure to be valuable and helpful, and critically assess the results and complications.OBJECTIVETo report the long‐term results with the Mainz Pouch II procedure.PATIENTS AND METHODSBetween 1990 and 2000 a Mainz Pouch II ureterosigmoidostomy was used in 123 patients (49 females and 74 males, mean age 43.6 years, range: 1–73). The indications for urinary diversion were cystectomy for bladder cancer in 92 patients, bladder exstrophy and/or incontinent epispadias in 26, irreparable traumatic loss of the sphincteric urethra in four and cloacal malformation (sinus urogenitalis) in one. In all, 102 patients with a follow‐up of ≥ 12 months were evaluated (mean 46.2 months).RESULTSDay‐ and night‐time continence rates were 97% and 95%, respectively. The remaining patients occasionally lose some drops of urine during coughing or straining, or reported minimal soiling of undergarments during the night. The mean voiding frequency was six during the day and once at night. There were 14 ureteric implantation stenoses (7.2% of 194 evaluated reno‐ureteric units) and they were treated successfully by open repair (13) or antegrade balloon dilation (one). For metabolic disturbances, 69% of the patients had a capillary base excess of <–2.5 mmol/L and use oral alkalinizing drugs to prevent hyperchloraemic acidosis. There was no clinically evident metabolic acidosis.CONCLUSIONApplying the principles of detubularization and spherical reconfiguration to create a low‐pressure reservoir and stratifying ureteric implantation between submucosal and serous‐lined extramural tunnel techniques succeeded in giving better continence rates and long‐term preservation of the upper urinary tract than a classical ureterosigmoidostomy. The Mainz Pouch II ureterosigmoidostomy is simple and reliable as a viable alternative for continent urinary diversion in selected patients.
Experience with non‐cycled artificial urinary sphincters
Authors: Herndon C.D.A. , Rink R.C. , Shaw M.B.K. , Cain M.P. , Casale A.J. 
Published: May 2004

Papers in this section review experience with artificial urinary sphincters, hypospadias, and the exstrophy/epispadias complex. Also, in keeping with a significant theme of urological trauma in this issue of the journal, authors from Mansoura evaluate the late renal functional and morphological evaluation of high‐grade renal injuries in children after conservative treatment.OBJECTIVETo report our experience in children and adolescents with a non‐cycled artificial urinary sphincter. While some children with the AUS can void, others require clean intermittent catheterization (CIC) through the sphincter or an alternative site for catheterization; in some of the latter we have either not cycled (pumped) an activated AUS or the AUS has failed, and there is concern about ischaemia in some adults with a non‐cycled AUS.PATIENTS AND METHODSIn all, 143 patients who had an AUS placed between 1980 and 2002 were reviewed retrospectively; 15 (10 boys and five girls) no longer cycled (pumped) their AUS. The mean age at AUS insertion was 11 years and the mean (range) follow‐up after insertion was 10.4 (1.64–22.2) years. The diagnoses included myelomeningocele in 11, sacral agenesis in three and cloaca in one. Nine patients have an activated functioning AUS and in six the AUS does not function; in the first nine the sphincter has not routinely been cycled (pumped) for a mean (range) of 1.6 (0.6–2.9) years. In the other six with a nonfunctioning AUS the mean (range) observation period is 6.4 (1.5–10) years since the system has not functioned.RESULTSAll patients were completely continent, including the six with a nonfunctioning AUS. After inserting the AUS, two patients voided in combination with CIC (one each urethral and abdominal stoma) and 13 emptied by CIC (nine abdominal stoma, four urethral). There was a mechanical complication in eight patients; three had the AUS repaired and are dry, and five are dry with no repair. In one patient the AUS was never activated. To date there has been no erosion of the cuff in any of the 15 patients with a non‐cycled AUS.CONCLUSIONThe AUS remains an extremely reliable procedure to achieve continence in children and young adults. It is versatile and can be combined with other procedures that provide an alternative means for catheterization. While some have noted the need to routinely cycle the AUS to prevent erosion, this has not been our experience in these 15 patients.
THIS ARTICLE HAS BEEN RETRACTED  In vivo transfer of a neuronal nitric oxide synthase expression vector into the rat bladder by electroporation
Authors: Iwashita H. , Yoshida M. , Nishi T. , Otani M. , Ueda S. 
Published: May 2004

OBJECTIVETo investigate the possibility of in vivo gene transfer by attempting to transfer the neuronal nitric oxide synthase (nNOS) gene into rat bladder using electroporation.MATERIALS AND METHODSThe bladder was exposed through an abdominal midline incision in 8‐week‐old male rats. Plasmid DNA of the marker genes green fluorescent protein (GFP) and luciferase, and the nNOS gene, was then injected into the subserosal space of the bladder and electroporation applied. At 72 h after gene transfer, GFP and luciferase were assayed in the isolated bladder and immunohistochemical staining used to detect nNOS; NOx released from isolated bladder strips was also assessed using microdialysis and high‐performance liquid chromatography.RESULTSFrom the luciferase assay, 45 V, 1 Hz, 50 ms and eight pulses were selected as the optimum conditions for electroporation. Bladder specimens with GFP genes injected by electroporation showed bright and numerous sites of GFP expression in the smooth muscle layer. In rats with the nNOS gene injected by electroporation there was marked nNOS immunoreactivity, and NOx released from bladder strips was significantly greater than in the control groups.CONCLUSIONSThese results suggest that electroporation is a useful technique for in vivo gene transfer into rat bladder smooth muscles, and that the nNOS gene transferred by this procedure functionally expresses and contributes to NO production.
Quality of life compared during pharmacological treatments and clinical monitoring for non‐localized prostate cancer: a randomized controlled trial
Authors: Green H.J. , Pakenham K.I. , Headley B.C. , Yaxley J. , Nicol D.L. , Mactaggart P.N. , Swanson C.E. , Watson R.B. , Gardiner R.A. 
Published: May 2004

OBJECTIVESTo investigate the effects of different management strategies for non‐localized prostate cancer on men's quality of life and cognitive functioning.PATIENTS, SUBJECTS AND METHODSMen with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated‐measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1‐year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions.RESULTSSexual dysfunction increased for patients on androgen‐suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function.ConclusionsIn deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.
Guideline for the primary care management of male lower urinary tract symptoms
Authors: Speakman M.J. , Kirby R.S. , Joyce A. , Abrams P. , Pocock R. 
Published: May 2004

As my Comment in the first section of the journal suggested, the MTOPS results have offered the possibility to general practitioners of reducing the risk of side‐effects of BPH, particularly urinary retention, by giving patients dual therapy with 5α‐reductase inhibitor and alpha‐adrenergic blocker. Authors from the UK present guidelines for the primary case management of male LUTS, which significantly fills this gap in the literature.Any help in the management of chronic nonbacterial prostatitis is welcome to clinicians; many treatments have been proposed after non‐comparative trials, and so their value must be viewed cautiously. The authors from Canada and USA present the results of a randomized placebo‐controlled study into the use of finasteride in such patients.The other papers in this section all deal with LUTS, e.g. frequency and nocturia, in a variety of situations. There is still great interest in the epidemiology of these symptoms, and in the various methods of grading their severity.
Antidiuresis: a new concept in managing female daytime urinary incontinence
Authors: Robinson D. , Cardozo L. , Akeson M. , Hvistendahl G. , Riis A. , Norgaard J.P. 
Published: May 2004

OBJECTIVETo investigate the efficacy of desmopressin nasal spray on daytime urinary incontinence in women.PATIENTS AND METHODSA multicentre, multinational, randomized, double‐blind, placebo‐controlled, cross‐over exploratory study of women (aged 18–80 years) complaining of severe daytime urinary incontinence was conducted in three centres (King's College Hospital; Boras County Hospital and Skejby Hospital). Seventy‐five patients were screened of whom 64 were randomized. In all, 60 women received study medication (safety population) and 57 completed the study. The intention‐to‐treat population comprised 59 patients and there were 41 in the per protocol analysis. The primary efficacy endpoint was the number of periods with no leakage for 4 h after dosing. Women were instructed to take the drug at a time of their choosing, but ≥ 4 h before bedtime. Secondary efficacy variables included the time to first void or incontinence episode, volume leaked per incontinence episode, total volume voided and number of periods with no leakage. All measurements were made over 7 days on desmopressin and 3 days on placebo.RESULTSThere was a higher mean (sd) incidence of periods with no leakage in the first 4 h on desmopressin, at 62 (35)%, than on placebo, at 48 (40)%, and during the first 8 h, at 55 (37)% vs 40 (41)%. There was also a higher frequency of dry days on desmopressin than on placebo; 36% of patients had no leakage on virtually all treatment days (6 or 7) for 4 h after dosing. At 4–8 h the incidence of periods with no leakage on desmopressin was 68 (35)% vs 63 (41)% on placebo, and thereafter the incidence was similar. The time from dosing to first incontinence episode was longer on desmopressin, at 6.3 (2.5) h, vs 5.2 (3.3) h, whilst the volume leaked per incontinence episode was lower on desmopressin than placebo. The total volume voided was consistently lower on desmopressin, at 1180 (58) mL vs 1375 (57) mL, over the 24‐h period after administration. There were no serious or severe adverse events reported. Seven women (11%) withdrew from the study, of whom five did not attend for the final visit and two (3%) because of mild adverse events.CONCLUSIONSThe results of this exploratory study suggest that desmopressin is an effective and safe treatment in women with daytime urinary incontinence, and allows them to choose when they need treatment, thus improving motivation, which may aid compliance with therapy.
Nocturia: impact on quality of life in a Dutch adult population
Authors: Van Dijk L. , Kooij D.G. , Schellevis F.G. , Kaptein A.A. , Boon T.A. , Wooning M. 
Published: May 2004

OBJECTIVETo estimate the effect of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems.SUBJECTS AND METHODSFrom a random sample of Dutch adults (≥ 18 years old) 1000 were selected after stratification to complete a written questionnaire. Respondents (819) were distributed over three groups: a target group (189, who felt bothered by ≥ one void/night); a reference group 1 (120 reporting ≥ two voids/night but with no bother); and reference group 2 (510, with 0–1 voids/night). Nocturia, other lower urinary tract symptoms and perceived impact on life were measured using the Bristol Lower Urinary Tract Symptoms Questionnaire (B‐LUTS). Sleep problems were measured using the Sleep Wake Experience List (SWEL) and QoL using two subscales from the RAND‐36, i.e. ‘physical functioning’ and ‘mental health’.RESULTSThe perceived impact on life was highest in the target group (P < 0.05), which also had more sleep problems and scored lower on the QoL scores than both reference groups (P < 0.05). Statistically significant differences in mental health and physical functioning between the target and reference groups became insignificant after correcting for sleep problems, indicating that the effect of nocturia (with bother) is mediated by sleep problems.CONCLUSIONSNocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients who contact them for sleep problems also have nocturia.
Nocturia in patients with lower urinary tract symptoms: association with diurnal voiding patterns
Authors: Ku J.H. , Lim D.J. , Byun S.‐S. , Paick J.‐S. , Oh S.‐J. 
Published: May 2004

OBJECTIVETo determine whether diurnal voiding patterns predict nocturia in patients with lower urinary tract symptoms (LUTS), as few studies have evaluated the association between diurnal and nocturnal voiding patterns.PATIENTS AND METHODSWe prospectively analysed the frequency‐volume charts (FVCs) of consecutive patients with LUTS. At the initial visit patients had a detailed clinical evaluation and subsequently were requested to complete a 72‐h FVC. In all, 104 (41 men and 63 women, mean age 63 years, range 50–83) were included in the primary analyses. Associations between daytime variables and nocturia were described using maximum likelihood estimates of the relative risk and by 95% confidence intervals (CIs) based on logistic regression models.RESULTSWhen at least one night‐time void was used to define nocturia the multivariate logistic model showed a negative association of mean daytime voided volume with nocturia (P = 0.001). The odds ratio for nocturia decreased with this variable to 0.98 (95% CI 0.96–0.99). When ‘voiding at least twice per night’ was used to define nocturia only the number of daytime voids was positively related to nocturia (odds ratio 1.22; 95% CI 1.01–1.48; P= 0.040).CONCLUSIONNocturia may be associated with diurnal voiding patterns; these results also suggest that the causes of nocturia of one or of two or more voids may differ. This highlights the role of bladder function in more severe forms of nocturia.
Modified ureterosigmoidostomy (Mainz II): a long‐term follow‐up
Authors: Nitkunan T. , Leaver R. , Patel H.R.H. , Woodhouse C.R.J. 
Published: May 2004

OBJECTIVETo assess the long‐term results in patients treated using a modified ureterosigmoidostomy (Mainz II).PATIENTS AND METHODSBetween 1994 and 1999, 17 patients had their lower urinary tract reconstructed by a ureterosigmoidostomy, modified by reconfiguring the rectum to make a low‐pressure reservoir (Mainz II). All patients were followed on a standard protocol. Data were extracted from the database and from a review of the case‐notes. In 12 patients the procedure was with a radical cystectomy for carcinoma. Five had a failed conventional ureterosigmoidostomy for bladder exstrophy and therefore proceeded to a Mainz II. The data on continence and complications were retrieved for a retrospective analysis; the mean (range) follow‐up was 6.4 (4–8.6) years.RESULTSTen of those with bladder cancer and one in the revision group were continent. Two patients in the revision group had sufficiently severe nocturnal incontinence to require conversion to a colonic conduit. Seven of the 17 patients had hyperchloraemic acidosis, one had pyelonephritis and one had renal stones. There were no anastomotic neoplasms.CONCLUSIONThe Mainz II has a good outcome if used as the primary procedure. In patients with an existing ureterosigmoidostomy who are incontinent, detubularization of the rectosigmoid alone is unlikely to restore continence.
Late renal functional and morphological evaluation after non‐operative treatment of high‐grade renal injuries in children
Authors: El‐Sherbiny M.T. , Aboul‐Ghar M.E. , Hafez A.T. , Hammad A.A. , Bazeed M.A. 
Published: May 2004

OBJECTIVETo assess the long‐term results in children with high‐grade renal trauma who were managed without surgery, as such treatment was initially successful but little is known about the late ipsilateral renal function and morphology.PATIENTS AND METHODSThe study included 13 children (nine boys and four girls; mean age 8 years, sd 5) with high‐grade renal injury who were managed without surgery between 1997 and 2001, and followed for a mean (sd, range) of 3 (2, 0.5–7) years. The trauma was caused by a motor‐car accident in five and falling from a height in eight children, and was on the right in 10 and on the left in three. There was gross and microscopic haematuria in 10 and three patients, respectively. The trauma was graded according to the American Association for Surgery of Trauma, with grades III, IV and V renal injury in six, four and three children, respectively. All patients were treated initially by observation; one required super‐selective embolization because of continuing haemorrhage. Three children with progressive urinary extravasation were treated with a percutaneous tube drain and JJ stent for 6 weeks. Patients were discharged after a mean (sd) hospital stay of 9 (6) days. Ultrasonography then showed resolving haematoma in all patients with a mean (sd) size of 7 (2) cm2. At the last follow‐up patients were re‐evaluated by a clinical examination, renal scintigraphy and computed tomography angiography.RESULTSNone of the children was hypertensive nor had any abnormality on urine analysis; all had normal serum creatinine levels, and scintigraphy and angiography showed normal contralateral kidneys in all. Ipsilateral abnormalities were detected in 12 patients, and included a single scar in five, multiple scars in six and a cystic lesion with multiple septa in one. There was no vascular complication or hydronephrosis, and no significant functional loss, with all affected kidneys having a split function of 41–50% at the last follow‐up.CONCLUSIONAlthough there is no late functional loss there are residual morphological changes in almost all children with high‐grade renal injury. This study provides objective support for the non‐operative management of high‐grade renal injury in children, but a prolonged follow‐up is warranted to assess the risk of progression of these abnormalities.
Comprehensive analysis of tubularized incised‐plate urethroplasty in primary and re‐operative hypospadias
Authors: El‐Sherbiny M.T. , Hafez A.T. , Dawaba M.S. , Shorrab A.A. , Bazeed M.A. 
Published: May 2004

OBJECTIVETo retrospectively review our experience of the tubularized incised‐plate (TIP) urethroplasty over the last 4 years.PATIENTS AND METHODSFrom 1998 to December 2001, 133 patients (mean age 7 years, sd 4, range 1–22), had a TIP urethroplasty by one surgeon for primary (103) and re‐operative (30) hypospadias; the defects included 106 (79%) distal and mid‐shaft, and 27 (21%) posterior shaft. The neourethra was covered by a subcutaneous flap in 66 (50%) patients or by corpus spongiosa (spongioplasty) in 31 (23%), with no cover in the remaining 36 (27%). In the last 20 patients (15%) a modified meatoplasty was used; the site and size of the new meatus was predetermined on the glans around a suitable catheter before any incision. Urethral stents were not used after repair in 39 (29%) patients, and regular meatal dilation was used only in patients with voiding difficulty and obvious tendency to stenosis. The presence of complications requiring re‐operation and overall general appearance were recorded.RESULTSThe mean (sd) follow‐up was 10 (5) months; there were 24 complications in 20 patients (15%), including a small fistula in 12 (9%), complete disruption of the repair in 4 (3%), meatal stenosis in seven (5%) and neourethral stricture in one (0.8%). Complications were not significantly different between primary and re‐operative cases, and unaffected by the use of the stents. On univariate analysis complications were significantly higher with running than interrupted sutures, in repairs in the first 2 years of the study, in patients with posterior hypospadias, and in those with no neourethral coverage. However, the last two factors were the only significant independent risk factors in a multivariate analysis. Regular urethral dilatation was indicated in 43 patients (32%). Modified meatoplasty was associated with a significantly lower requirement for regular dilatation (P < 0.05) and no meatal stenosis. In the 113 complication‐free patients the operation gave an excellent cosmetic appearance with a vertical slit meatus on the tip of conical glans in 110 (97%); there was slight meatal retraction in the remaining three patients.CONCLUSIONThe TIP repair is a reliable method for treating both distal and proximal penile shaft hypospadias, is suitable for both primary and re‐operative cases, and is more versatile than other repairs. Covering the neourethra with a flap or spongioplasty significantly improves the results. Regular urethral dilatation is required in a third of patients but modified meatoplasty obviates the need for regular dilatation and eliminates the risk of meatal stenosis.