bluuebunny/crossref_metadata_2025_split huggingface dataset:
The natural history of pelvi‐ureteric junction obstruction in children presenting clinically with the complaint
Authors: RICKWOOD A.M.K. , GODIWALLA S.Y. 
Published: November 2003

Objective To determine the natural history of untreated pelvi‐ureteric junction (PUJ) obstruction in children presenting clinically with the complaint.Patients and methods The study comprised 42 children with anatomical PUJ obstruction (three with bilateral lesions) who were managed expectantly in the first instance, who had no immediately troublesome symptoms and differential function in the affected kidney(s) of >40%. They were followed by serial ultrasonography and dynamic diuresis renography. Pyeloplasty was advised for those with persistent symptoms or where differential renal function fell below 40%.Results Only 15 children had presented with clearly relevant symptoms (loin pain or febrile urinary infection). Thirty‐four kidneys showed obstructive renographic curves initially and 38 had moderate or severe hydronephrosis. During the follow‐up (range 14–120 months, mean 56) patients remained asymptomatic except for four of the nine presenting with loin pain. Renographic curves were apt to change, with ‘obstruction’ increasing or decreasing with time, in the latter instance usually with lessening or resolution of hydronephrosis. Eleven patients underwent pyeloplasty, five for symptoms and six because of deteriorating renal function. Renal function did not decline in any patient with mild hydronephrosis and/or a non‐obstructive renographic curve at presentation, but did so disproportionately in those with severe hydronephrosis or a Type IV renographic curve.Conclusions Patients effectively asymptomatic at presentation are likely to remain so. Expectant management is appropriate for patients with mild hydronephrosis and/or non‐obstructive renographic curves at the outset. Conversely, pyeloplasty may be advisable for those with severe hydronephrosis or Type IV renographic curves. Otherwise, for most the natural history of the complaint remains to be determined.
Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?
Authors: SABNIS R.B. , NAIK K. , PATEL S.H. , DESAI M.R. , BAPAT S.D. 
Published: November 2003

Objective To determine the influence of pelvicalyceal angle, size of the lower calyx infundibulum and lower‐pole calyceal anatomy in predicting the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) for lower calyceal stones.Patients and methods The study comprised a retrospective analysis of 133 patients, divided into 92 who were considered to be completely clear of fragments 6 months after ESWL and 41 who had residual stones. The pelvicalyceal angle, diameter of the lower calyx infundibulum and lower‐pole calyceal pattern were determined from intravenous urograms.Results There were residual stones in 64% of the patients with a pelvicalyceal angle <90°, in 12% of those with an angle >90°, in 70% of patients with an infundibular diameter <4 mm, in 16% of those with a diameter >4 mm, in 78% with a complex calyceal pattern and 12% with a simple calyceal pattern.Conclusions These three anatomical factors play a key role in predicting the clearance of stone and they should be assessed during intravenous urography to facilitate the planning of treatment for lower calyceal stones.
Histological evidence of decreased contralateral testicular blood flow during ipsilateral testicular torsion
Authors: CIFTCI A.O. , MÜFTÜOGLU S. , ÇAKAR N. , TANYEL F.C. 
Published: November 2003

Objective To evaluate contralateral testicular blood flow by histological examination of arterioles during ipsilateral testicular torsion.Materials and methods The study comprised two groups of 20 male albino rats (weight 250–270 g). The control group underwent a sham operation, while in the second group the left testes were twisted clockwise by 720°. All rats underwent bilateral orchidectomy 24 h after the initial intervention. Three slides for each testis (n=240) were evaluated randomly while unaware of treatment to determine the total number of arterioles, the percentage of collapsed and open arterioles, the diameter of open arterioles and the presence or absence of blood cells in the lumen. Differences were assessed using t‐tests for paired and independent samples.Results Very few arterioles were collapsed in both testes of the control group and in the ipsilateral testes of the torsion group, but half the arterioles in the contralateral testes of the torsion group were collapsed. The difference between the contralateral testes of the two groups and between the ipsilateral and contralateral testes in the torsion group were significant. The diameter of uncollapsed arterioles did not differ significantly among either testes of the control and torsion groups and either testes in each group. Both testes in the torsion group had significantly more arterioles containing blood cells than those in the control group. The difference between the testes in the torsion group was also significant, but was not in the control group.Conclusion There was histological evidence of decreased blood flow in the contralateral testis during unilateral testicular torsion; contralateral testicular damage during unilateral testicular torsion may result from hypoxia caused by decreased blood flow.
Management of the long‐term urinary catheter in the asymptomatic patient in the Accident and Emergency department
Authors: WISEMAN O. 
Published: November 2003

Objective To determine the management of long‐term urinary catheters in the asymptomatic patient in the Accident and Emergency (A&E) Department.Patients and methods Using data obtained from patient records, a retrospective study was undertaken of 41 patients who presented to the A&E department of a large district general hospital, on a total of 80 occasions in a 6‐month period, with blocked or bypassing long‐term urinary catheters, but who were otherwise asymptomatic.Results In 78% of presentations, patients had one or more investigations performed on their urine, which in 15% was on urine aspirated through an old, unchanged catheter. In 23% of presentations, patients were discharged only having had their catheters flushed, and in only 41% was the catheter changed as the first line of management. Finally, in 63% of episodes, patients were discharged with antibiotics, despite having no symptoms of a urinary tract infection.Conclusions All patients with long‐term urinary catheters will have bacteriuria and performing investigations on this urine if the patient is asymptomatic is a waste of resources. Long‐term urinary catheters which become blocked usually do so by encrustation on the luminal surface of the catheter. Flushing these catheters may dislodge some of these encrustations, but ideally the catheter should be changed. The prescribing of antibiotics to asymptomatic patients with bacteriuria has no proven benefit, but on the contrary it may cause harmful side‐effects and also selects for antibiotic‐resistant bacteria. These patients should be managed in the A&E department with a simple catheter change.
Evaluation of the utility of video‐urodynamics in children with urinary tract infection and voiding dysfunction
Authors: GLAZIER D.B. , MURPHY D.P. , FLEISHER M.H. , CUMMINGS K.B. , BARONE J.G. 
Published: November 2003

Objective To assess the use of video‐urodynamic studies (VUDS) in children with urinary tract infection (UTI) and symptoms of voiding dysfunction (frequency, urgency, incontinence), to ascertain whether VUDS significantly assists in diagnosis and deciding treatment.Patients and methods Over a 16‐month period, all children seen at our centre with a UTI in conjunction with previous symptoms suggestive of voiding dysfunction underwent free and pressure‐flow VUDS. Forty‐two children underwent VUDS and 38 (mean age 9 years, range 4–16, 15 male, 23 female) had sufficient information to be included in the study.Results All children had a prior history of voiding dysfunction (mean 55 months). Only five patients were found to have reflux and three of these had associated detrusor instability. In addition, 24 of 33 patients who did not have reflux had abnormalities on urodynamic study, the most common problem being detrusor instability in 17 of 24 patients. Other abnormalities included sphincter dyssynergia (five patients), poor bladder compliance (two) and hypersensitivity on bladder filling (three).Conclusion VUDS can provide information about the aetiology of UTI and voiding dysfunction in children that cannot be obtained from any other source. The results of VUDS can be used to select specific treatments, to avoid inappropriate therapy and to identify children who may benefit from follow‐up studies despite normal findings on voiding cysto‐urethrography. From these results, we believe that VUDS should be considered for children with UTI and voiding dysfunction.
Clinical review of 100 consecutive surgically treated patients with upper urinary tract transitional tumours
Authors: RACIOPPI M. , D’ADDESSI A. , ALCINI A. , DESTITO A. , ALCINI E. 
Published: November 2003

Objective To determine the outcome of conservative or radical treatment in a retrospective study of 100 consecutive patients with upper urinary tract tumours.Patients and methods From 1965 to 1995, 100 patients (78 men and 22 women, mean age 65 years, range 27–82) with upper urinary tract tumours were treated surgically, using nephroureterectomy with excision of a cuff of bladder in 53 and organ‐sparing treatment in 47. The outcome was assessed as survival and recurrence during a follow‐up of up to 15 years.Results After radical and organ‐sparing treatment, the 15‐year cancer‐specific survival was 69% and 25%, respectively; metastases developed in 17% and 19% and global recurrence in 40% and 70%, respectively. While locoregional and bladder recurrences were similar in the two groups (9% vs 8% and 30% vs 38%, respectively), ureteric‐stump recurrence in the conservative group was 23%. There were no significant differences in survival rates between patients with single or multiple presentation, or for localization, while the grading of the lesions proved to be an accurate prognostic indicator.Conclusion This experience of urothelial neoplasia of the upper tract highlights the difficulty in diagnosing this pathology and in entrusting screening to a non‐invasive technique such as urinary cytology. The percentage recurrence observed after organ‐sparing therapy indicates that this treatment should be used cautiously.
Collagen for female genuine stress incontinence after
Authors: SWAMI S. , BATISTA J.E. , ABRAMS P. 
Published: November 2003

Objective To evaluate the medium‐term outcome of gluteraldehyde cross‐linked (GAX) collagen in the treatment of genuine stress incontinence in women.Patients and methods The study comprised 111 women (age range 33–90 years) with genuine stress incontinence who were treated with para‐urethral collagen injections between 1990 and 1995. The patients were followed prospectively and their clinical outcome documented. Pre‐ and post‐operative urodynamic data were examined to determine any prognostic indicators.Results The overall results at a minimum 2‐year follow‐up (mean 3.3) showed 25% of patients to be dry and a further 40% improved. Although there were significant changes in some urodynamic values, no predictive factors of success were identified. Previous surgery for stress incontinence did not influence the final outcome.Conclusion Para‐urethral collagen injection is a safe and relatively simple procedure with acceptable results at the medium‐term follow‐up. It could be offered as a primary or secondary procedure to women with genuine stress incontinence who are unable or unwilling to undergo surgical treatment. Objective urodynamic assessment revealed no factors of prognostic significance.
Variability in penile appearance and penile findings: a prospective study
Authors: VAN HOWE R.S. 
Published: November 2003

Objective To document prospectively variation in penile morphology and clinical findings in children.Patients and methods The study comprised a consecutive sample of 468 boys whose consultation with a physician included a genital examination in a primary‐care paediatric practice in rural northern Wisconsin.Results Circumcised boys under 3 years of age were significantly more likely to have a partially or completely covered glans, a reddened meatus, balanitis, or trapped epithelial debris, and less likely to have a fully exposed glans than were circumcised boys of 3 years or older. Among the 238 boys under 3 years, those circumcised were significantly more likely to have non‐cosmetic problems, including coronal adhesions, trapped epithelial debris, a reddened meatus, preputial stenosis (phimosis) and balanitis, than were boys with a foreskin. Findings in the circumcised group under 3 years included: fully exposed glans (n = 78, 35.6%), partially covered glans (n = 67, 30.6%), adhesions (25.6%), completely covered glans (20.1%), entrapped desquamated epithelial debris (24.7%), reddened meatus (19.1%), balanitis (15.5%), and preputial stenosis (0.9%). Only two genital examinations in boys with foreskins revealed pertinent findings. Coronal adhesions develop in circumcised boys at 2–6 months of age and usually resolve by 24 months. The degree of skin covering the glans after neonatal circumcision peaks at 6 months of age.Conclusions There are significant variations of appearance in circumcised boys; clinical findings are much more common in these boys than previously reported in retrospective studies. The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) affects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds.
Prognostic factors in squamous cell carcinoma of the penis and implications for management
Authors: ADEYOJU A.B. , THORNHILL J. , CORR J. , GRAINGER R. , McDERMOTT T.E.D. , BUTLER M. 
Published: November 2003

Objective To determine the clinical and pathological features, methods and outcome of management in squamous cell carcinoma of the penis (SCCP).Patients and methods A retrospective study was carried out of 42 patients (mean age 63 years, range 28–86) with a histological diagnosis of SCCP. The disease stage, grade, treatment of primary tumour, lymph node disease and survival were recorded; the mean follow‐up was 4 years (range 1.5–25).Results The disease stage was T1 in 24 patients (57%), T2 in 14 (33%), T3 in three (7%) and T4 in one (2%); the tumour grade was well differentiated in 20 (47%), moderately differentiated in 14 (33%) and poorly differentiated in three (7%). Eight patients had histologically confirmed inguinal node disease at presentation, six of whom underwent lymph node dissection, while two underwent radiotherapy. Five patients developed inguinal node disease during follow‐up (mean 10 months, range 4–21). Three of these patients were irradiated and two underwent lymph node dissection. Six patients (14%) had local recurrence, five of whom were managed surgically. One patient developed a local recurrence 11 years after initial surgery. Seven patients died from their disease (17%); four died within 2 years, being patients with high‐stage and/or high‐grade disease.Conclusions Modern management should include a standard staging classification and treatment protocols to maximize survival.
The role of vimentin expression in predicting the long‐term outcome of patients with localized renal cell carcinoma
Authors: SABO E. , MISELEVICH I. , BEJAR J. , SEGENREICH M. , WALD M. , MOSKOVITZ B. , NATIV O. 
Published: November 2003

Objective To evaluate the prognostic significance of vimentin intermediary filament expression by tumour cells in patients with renal cell carcinoma (RCC) localized to the kidney.Patients and methods Thirty‐nine patients with localized RCC (pT1,pT2) were assessed in a retrospective study. Tumour cells were evaluated immunohistochemically for vimentin, epithelial membrane antigen (EMA) and polyclonal cytokeratin expression. The prognosis of cases expressing positive vimentin expression in tumour cells was compared with that of cases with no expression. Additional clinical information and conventional histological grade of the tumours were also included in the survival analysis.Results Univariate analysis of patient survival and tumour recurrence showed a statistically significant association between vimentin‐positive tumours and poor patient outcome; the EMA stain showed borderline significance and histological grade was significantly associated with prognosis. The combination of tumour vimentin expression and histological grade provided a better predictor of prognosis and proved to be the best independent prognosticator of survival by multivariate analysis.Conclusions Vimentin expression by tumour cells provides important prognostic information for patients with localized RCC; the combination of vimentin expression and histological grade is a better predictor for survival than grade or vimentin expression alone.
Supravesical diversion for incontinence: a long‐term follow‐up
Authors: Singh G. , Wilkinson J.M. , Thomas D.G. 
Published: November 2003

Objectives To report the long‐term follow‐up of patients with an ileal conduit urinary diversion, constructed for intractable incontinence in patients with benign disease where the native bladder was left in situ, and to determine the fate of the bladder and the effects on the upper tracts. Patients and methods Ninety‐three patients (mean age at operation 50 years, range 8–78) were followed for a minimum of 2 (mean 5) years after undergoing an ileal conduit urinary diversion. Seventy‐one patients (76%) had neurological disease (18 traumatic and 53 non‐traumatic) and the single largest group of patients (28) suffered from disseminated sclerosis. Twenty‐two patients with no obvious neurological disease underwent the procedure for unmanageable incontinence or intractable bladder symptoms or for interstitial cystitis. The patients were assessed for problems in the bladder remnant, stomal problems and upper tract changes following surgery. Results Forty‐eight patients (52%) had recurrent vesical infections and pyocystis and of these, 23 (48%) required admission for in‐patient bladder irrigations. To control recurrent bladder problems, five patients required creation of a vesico‐vaginal fistula; this did not suffice in two and they subsequently underwent cystectomy; in total, five patients underwent cystectomy. Twenty‐nine patients (31%) had stomal problems, those with the skin being commonest. Parastomal hernia repair was required in 10 (10%) patients and three had further surgery for recurrence. Of 83 patients with normal upper tracts before diversion, post‐operative radiological assessment showed upper tract dilatation in 28 (34%) and in 10 (12%) this was bilateral. In one patient with a neuropathic bladder, the ileal diversion resulted regression of the dilated upper tracts. Conclusions Supravesical diversion is safe and well tolerated but assessing the long‐term follow‐up, the incidence of bladder problems in over half these patients and upper tract changes in over a third suggests an indefinite follow‐up is mandatory. Despite these problems, most patients are delighted with the outcome of their surgery.
Transurethral microwave thermotherapy (Prostatron version 2.5) compared with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a randomized, controlled, parallel study
Authors: Ahmed M. , Bell T. , Lawrence W.T. , Ward J.P. , Watson G.M. 
Published: November 2003

Objective To compare transurethral microwave thermotherapy (TUMT) with urethral cooling in a high‐energy protocol (Prostatron version 2.5), with transurethral resection of the prostate (TURP) for the treatment of symptomatic, uncomplicated, urodynamically obstructive benign prostatic hyperplasia (BPH).Patients and methods Patients with moderate to severe symptomatic, uncomplicated BPH, unequivocally obstructed as assessed from the Abrams‐Griffith nomogram, who were technically suitable for either form of treatment, were randomized into two groups of 30 patients each to undergo either TUMT or TURP. Five efficacy variables, i.e. the American Urological Association (AUA) symptom score, maximum flow rate (Qmax), post‐void residual urine volume (PVR), voiding pressure at maximal flow (Pdet max) and prostatic volume determined by ultrasonography (PV) were measured initially and 6 months after treatment using a defined protocol. Complications were recorded during and up to 6 months after the treatment. As the variables were independent, the data were analysed using a paired t‐test for each to assess the treatment effect for each group.Results After TURP, all the variables improved significantly; after TUMT, the symptoms improved both clinically and statistically (P<0.001), with the mean AUA symptom score decreasing from 18.4 to 5.2. However, none of the objective variables improved after TUMT. The energy delivered under software control correlated poorly with prostatic volume (r=0.322). TUMT had considerably lower morbidity than TURP, but failure of ejaculation occurred in four of 18 sexually active men after TUMT.Conclusions Despite considerable improvement in their symptoms, TUMT using the Prostatron and Prostasoft v2.5 did not alleviate obstruction in patients with BPH. Patients treated using TUMT controlled by this software should be informed of the possibility of ejaculatory dysfunction.
The influence of pH on urinary ionized [Ca+]: differences between urinary tract stone formers and normal subjects
Authors: Langley S.E.M. , Fry C.H. 
Published: November 2003

Objective
To assess the role of pH in determining the solubility of Ca2+ in urine from normal subjects and stone formers and to determine the conditions which cause the formation of crystalline products. Materials and methods
Urine, collected from normal subjects and urinary tract stone‐formers, was used in vitro. The concentration of ionized calcium, [Ca2+ ], and pH were measured with ion‐selective electrodes and the formation of crystalline products measured as the change in turbidity of the specimen. The composition of the crystalline products was analysed by infra‐red spectroscopy. Results
The [Ca2+ ] decreased with increasing pH and showed a biphasic relationship with a critical pH (pHn ) at which Ca‐containing precipitates appeared. Compared with normal subjects, the mean (sd) value of pHn was significantly lower in urine from stone‐formers, at 7.67 (0.62) and 7.21 (0.54), respectively, and nearer to their voided pH of 5.92 (0.70) and 6.26 (0.71), respectively. The lower pHn in stone‐formers could not be explained by altered concentrations or binding properties of Ca2+‐binding ligands. pHn increased after diluting the urine and the value of pHn was strongly dependent on the [Ca2+ ] at a standardized pH. Conclusions
Crystalline precipitates appear in urine at a critical pH which is closer to the voided pH in stone‐formers than in normal subjects and might explain the greater propensity of this group to form stones. The value of pHn is critically dependent on the urinary [Ca2+ ] and manoeuvres which reduced its concentration would reduce the tendency to form stones.