bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective study of the investigation and management of muscle‐invasive bladder cancer in the South West Region
Authors: Dickinson A.J. , Howe K. , Bedford C. , Sanders T. , Prentice A. , Sibley G.N.A. 
Published: November 2003

Objective To evaluate the present management of muscle‐invasive bladder cancer in the South West Region and to assess the workload resulting from the rationalization of treatment in specific centres.Methods A retrospective survey was undertaken in all the hospitals in the South West Region, to assess the management of all patients presenting with muscle‐invasive bladder cancer in the years 1989 and 1993. Data were collected from histopathology records and hospital in‐patients' notes. The optimum standard of assessment and treatment were defined by a panel of specialists in urological tumours. The management of patients was compared against these defined standards.Results A total of 186 and 199 patients in 1989 and 1993, respectively, were evaluated. When comparing their assessment against the defined standard, only 69% of patients in 1989 and 58% in 1993 had an intravenous urogram, with 7% and 4%, respectively, having no upper tract imaging (the remainder undergoing ultrasonography). Evidence from an examination under anaesthetic (EUA) was found for 80% of patients in 1989 and 84% of patients in 1993. Only 23% of patients in 1989 and 36% in 1993 were staged by either computed tomography or magnetic resonance imaging. In both 1989 and 1993, 54% of patients had definitive treatment, 31% had an endoscopic follow‐up only and 15% had no treatment; there were no differences in age or co‐morbidity among these groups. The median time elapsed between referral and diagnosis was 59 days (1989) and 52 days (1993), and the median delay to definitive treatment was 114 and 96 days, respectively.Conclusion There was insufficient upper tract imaging, poor clinical staging in the EUA and too few investigations for staging. The low rate of definitive treatment may be a consequence of the delays in management, allowing the tumour to progress, and suggesting the need for a more rapid assessment of haematuria.
The effect of prostatectomy on symptom severity and quality of life
Authors: Emberton M. , Neal D.E. , Black N. , Fordham M. , Harrison M. , McBrien M.P. , Williams R.E. , McPherson K. , Devlin H.B. 
Published: November 2003

Objective To determine the effectiveness of prostatectomy in reducing symptom severity and bother and in improving disease‐specific and general quality of life. Patients and methods A prospective, cohort study was performed in National Health Service and private hospitals in the Northern, Wessex, Mersey, and South‐West Thames Health Regions which comprised 5276 men undergoing prostatectomy recruited by 101 of the 106 (96%) surgeons (specialist and non‐specialist) performing prostatectomy during a 6‐month period. Patients were assessed using the American Urological Association (AUA) Symptom Index Score, the AUA symptom bother score, disease‐specific and generic quality‐of‐life scores, the occurrence of adverse events (urinary incontinence, erectile impotence and retrograde ejaculation) and three global (general) questions on the results of their treatment. The outcome was assessed 3 months after surgery. Results Prostatectomy was effective in reducing both symptoms (initial mean score 20.1 reduced to 7.4, P<0.001) and symptom bother (initial mean score 14.4 reduced to 4.3, P<0.001). Not all men experienced a good reduction in symptoms; 121 (3.9%) were worse, 301 (9.6%) were the same, and 721 (23%) experienced only slight improvement. The type of operation, grade of principal operator and use of pre‐operative investigations were not associated with the extent of symptomatic improvement. Changes in symptom severity were highly correlated with changes in bothersomeness and disease‐specific quality of life but not with generic quality of life. A third of men who were continent before surgery reported some incontinence 3 months later, although only 6% found it a problem. Two‐thirds of men experienced retrograde ejaculation and 31% experienced some erectile impotence following surgery. Conclusions Prostatectomy is effective in reducing symptoms in most men. Men who experience a substantial reduction in symptoms were more likely to report a favourable outcome. The study confirmed that approximately one‐third of men reported an unfavourable result 3 months after their operation.
The use of ‘ultrasensitive’ prostate‐specific antigen assays in the detection of biochemical recurrence after radical prostatectomy
Authors: van Iersel M.P. , Thomas C.M.G. , Segers M.F.G. , Witjes W.P.J. , Debruyne F.M.J. , Oosterhof G.O.N. 
Published: November 2003

Objective To determine the gain in lead time obtained when using ultrasensitive prostate‐specific antigen (PSA) assays in the diagnosis of biochemical progression after radical prostatectomy. Patients and methods The post‐operative PSA serum concentrations of 137 patients who had undergone radical prostatectomy were evaluated retrospectively. From these patients, 12 were selected who showed biochemical recurrence, as measured by the Hybritech Tandem‐E Singlepoint PSA assay. Samples of the serum frozen at the time of the initial analysis were thawed and PSA values were remeasured by the Abbott IMx PSA assay and the Tandem‐E Multipoint PSA assay. Analytical thresholds (zero‐dose + 3 sd) for the Tandem‐E Singlepoint, IMx and Tandem‐E Multipoint assay were 1.0, 0.04 and 0.04 ng/mL, respectively. The lead time to the detection of a recurrence obtained when using the IMx and the Tandem‐E Multipoint PSA assay was compared with that attained using the Tandem‐E Singlepoint PSA assay. As a control, PSA values were determined in 58 serum specimens of nine patients having no evidence of recurrence after radical prostatectomy. Results All 58 control specimens had PSA levels below the analytical thresholds of the three assays, except one which had a PSA serum concentration of 0.08 ng/mL, estimated by the IMx assay. When compared with the lead time obtained with the Tandem‐E Singlepoint assay, the 12 patients with a biochemical recurrence had a median gain in lead time of 327 days (range 60–627) with the IMx assay and of 369 days (range 60–639) with the Tandem‐E Multipoint assay. Conclusion A PSA value >0.04 ng/mL after radical prostatectomy heralds further biochemical progression. The use of the ultrasensitive IMx and the Tandem‐E Multipoint assays provided more lead time, but there is no clear evidence that this gain is necessarily of benefit to the patient.
Retrograde balloon dilatation for primary pelvi‐ureteric junction stenosis in children
Authors: Sugita Y. , Clarnette T.D. , Hutson J.M. 
Published: November 2003

Objective To evaluate the efficacy of retrograde balloon dilatation for primary pelvi‐ureteric junction (PUJ) stenosis (RBDP) in children.Patients and methods Sixteen children (12 boys, four girls; mean age 29 months) with primary PUJ stenosis initially underwent RBDP. A double‐pigtail catheter was left in the ureter for 6 weeks to provide drainage. The initial diagnosis of PUJ stenosis and the subsequent post‐operative assessment were both made by diuretic renography in almost all patients. All children were followed up for between 9 and 38 months (mean 25) after the procedure.Results RBDP was unsuccessful in nine of 17 renal units. In three of these, failure was caused by inability to pass the catheter through the PUJ or vesico‐ureteric junction (VUJ). In six cases, failure was caused by recurrent or persistent stenosis. In eight of 17 renal units, RBDP was successful in relieving the stenosis. The morbidity from the procedure was minimal.Conclusions Long‐term follow‐up revealed a significant failure rate for RBDP, caused by the inability to pass the catheter through the VUJ or PUJ, or persistent and/or recurrent stenosis. Recurrent stenosis may result from excessive dilatation which traumatizes the PUJ and causes subsequent scarring. Failure to overcome the stenosis is thought to be caused by a large redundant renal pelvis, producing ‘kinking’ of the upper ureter. In these cases, only reduction pyeloplasty may be successful in relieving the obstruction.
Mortality after transurethral and open prostatectomy in Scotland
Authors: Hargreave MS T.B. , Heynes C.F. , Kendrick S.W. , Whyte B. , Clarke J.A. 
Published: November 2003

Objective To use the linked medical and death records in Scotland to investigate the possible increased mortality that has been reported after transurethral prostatectomy (TURP) compared with open prostatectomy.Patients and methods Scotland has maintained linkable hospital, cancer and death records for more than 20 years, representing one of the largest such databases in the world. From these computerized records, data on various cohorts of men aged 55–84 years selected from 81 997 men who underwent prostatectomy in Scotland between l968 and l989 were analysed. The risk of late mortality was calculated for each type of operation, whether there was prior comorbidity and for a range of specific causes (cancer, respiratory and circulatory conditions) after prostatectomy.Results Among the largest cohort, consisting of 65 519 men who underwent prostatectomy between 1968 and June 1989, the relative risk of late mortality after TURP compared with open prostatectomy was 1.13 (95% CI, 1.10–1.16), after controlling for age and the presence of a diagnosis of cancer. A more restricted cohort of 18 732 men who underwent prostatectomy between 1974 and 1979 allowed adjustment for prior hospitalization with, or concurrent diagnosis of, circulatory and respiratory conditions. In this cohort, the relative risk of late mortality after TURP as compared with open prostatectomy was 1.15 (95% CI, 1.11–1.19) after adjusting for prior and comorbidity and age. Finally, a cohort of ‘healthy patients’ restricted to the 6932 men who underwent prostatectomy from 1974 to 1979 and with no evidence of hospitalization in the previous 5 years or any current diagnosis other than benign hypertrophy of the prostate, showed a relative risk of 1.14 (95% CI, 1.07–1.21). There was no evidence of an increased risk of dying from circulatory disease in general, ischaemic heart disease or acute myocardial infarction after TURP as opposed to open prostatectomy. However, there was an increased risk of dying from respiratory conditions and from cancer, especially of the prostate and bladder. The analysis suggested the possibility that open prostatectomy may have cured some patients with early prostatic cancer, because the late death rate from prostatic cancer was greater in patients who underwent TURP than open prostatectomy.Conclusion The present analysis confirmed the increased risk of late mortality after TURP compared with open prostatectomy, as shown in previous studies based on administrative records. However, limitations in the coding of comorbidities and the absence of coding of more subtle aspects of the condition of the patient which may influence the choice between the forms of prostatectomy mean that the differential mortality after the two procedures could still be a reflection of the pre‐operative selection of patients rather than the effects of the surgical procedure.
Minimally invasive vasectomy
Authors: Holt B.A. , Higgins A.F. 
Published: November 2003

Objective To evaluate the associated morbidity and patient comfort of the ‘minimally invasive, no scalpel’ (MINS) vasectomy.Patients and methods Eighty‐nine consecutive patients presenting for vasectomy underwent a MINS procedure. Post‐operatively, the pain experienced, recovery time and complication rate were assessed using a postal questionnaire. The questionnaire was also used to assess a group of historical controls who had undergone a vasectomy using a standard technique.Results The length of time to recovery was significantly reduced in patients who underwent the MINS vasectomy (P<0.05) and the pain, bruising, swelling and complication rate were also less than in patients who underwent a standard vasectomy.Conclusions The MINS vasectomy is preferable to a standard technique, reducing both patient morbidity and the complication rate. This is attributable to the minimal dissection and reduced tissue handling required to expose and isolate the vas.
The significance of terminal dribbling in men with lower urinary tract symptoms
Authors: Reynard J. , Lim C. , Peters T. , Abrams P. 
Published: November 2003

Objective To determine the relationship between the symptom of terminal dribbling, objective evidence of terminal dribbling on recordings of uroflow, benign prostatic enlargement (BPE) and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). Patients and methods The prevalence of the symptom of terminal dribbling was determined from a symptom questionnaire completed by 165 men presenting with LUTS. Objective evidence of terminal dribbling during voiding was assessed from uroflow recordings and prostate volume was measured by transrectal ultrasonography. Combined pressure‐flow studies were performed to determine the presence or absence of BOO. Results There was relatively poor agreement between the symptom of terminal dribbling and objective evidence of its presence; 48% of the patients who reported terminal dribbling most or all of the time showed no objective evidence of terminal dribbling on uroflowmetry. The symptom of terminal dribbling was not significantly related to the presence of BOO (P=0.74) and the group‐specific urethral resistance factor (URA) did not differ significantly (P=0.79) between those men who complained of terminal dribbling and those who did not (median URA 33 and 31 cmH2O, respectively). However, objective evidence of terminal dribbling on uroflow traces was significantly related to BOO (P<0.001) and those patients with objective evidence of terminal dribbling had higher values of URA (median 39 compared with 28 cmH2O). Objective terminal dribbling had a specificity of 92% and positive predictive value of 88% for the presence of BOO. Neither the symptom of terminal dribbling nor objective evidence of its presence were significantly related to prostatic enlargement. Conclusion While the symptom of terminal dribbling is probably not related to BOO or prostatic enlargement, objective evidence of terminal dribbling on flow curve recording is specific for BOO and as such, its presence could potentially be of value in the assessment of men with LUTS.
Ketanserin plus prostaglandin E1 (PGE‐1) as intracavernosal therapy for patients with erectile dysfunction unresponsive to PGE‐1 alone
Authors: Mirone V. , Imbimbo C. , Fabrizio F. , Longo N. , Palmieri A. 
Published: November 2003

Objective To evaluate the treatment of patients with erectile dysfunction and who were unresponsive to intracavernosal injections of prostaglandin E‐1 (PGE‐1) alone with a combination of PGE‐1 and ketanserin, a peripheral vasodilator antagonizing 5‐hydroxytryptamine receptors and with mild alpha‐blocking effects. Patients and methods The study comprised 98 men with erectile dysfunction all of whom received an intracavernosal injection of 5–40 μg of PGE‐1. The 45 patients unresponsive to the maximum dose of 40 μg were selected for further treatment using a combined dose of 40 μg PGE‐1 and 2–7 mg of ketanserin. Their erectile response was assessed both subjectively, by interviewing the patient and their partner, and objectively using the ‘Rigiscan’ monitor. Results The combined therapy was effective in producing an erection sufficient for sexual intercourse in 34 (76%) of the patients. The combined dose was tolerated well and there were no adverse effects. Conclusions The results of this preliminary study suggest that the combination of PGE‐1 and ketanserin may be a therapeutic alternative to the implantation of a prosthesis in patients unresponsive to PGE‐1.
Endoscopic rollerball electrovaporization of the prostate — the sandwich technique: evaluation of the initial efficacy and morbidity in the treatment of benign prostatic obstruction
Authors: Meade W.M. , McLoughlin M.G. 
Published: November 2003

Objectives To evaluate the safety, initial efficacy and morbidity of a new treatment for benign prostatic hyperplasia (BPH), endoscopic rollerball electrovaporization (EREV) of the prostate. Patients and methods Endoscopic rollerball electro‐vaporization with or without a modified transurethral prostatectomy (TURP) was performed in 51 patients (mean age 69 years). Before treatment, patients were evaluated by measuring maximum flow rate, post‐void residual volume (PVR) and a symptom score. After undergoing EREV and modified TURP the operative and hospital records were reviewed and the duration of the procedure, hospital stay and the incidence of complications and/or morbidity were recorded. The urodynamic variables were re‐evaluated after 3–8 months. Results Five patients were operated on for retention: of the remaining patients, the pre‐operative mean symptom score was 18 (maximum 30), the mean maximum flow rate was 11.5 mL/s, the mean PVR was 159 mL and the mean duration of the procedure was 28 min. Of the 51 patients, 30 were discharged catheter‐free on the first day after surgery. No patient required transfusion for associated blood loss, none had evidence of symptomatic bacteraemia and the transurethral resection syndrome did not occur. One patient who had a bladder carcinoma resected at the same operation was readmitted 2 weeks later with haematuria and clots. Three patients presented as emergencies within 8 weeks because of retention; one was admitted and required further EREV. On re‐evaluation, the symptom scores decreased by a mean of 11 points, the maximum flow rate increased by a mean of 6.2 mL/s and the mean PVR decreased by 102 mL. Conclusions EREV of the prostate is a safe, effective and economic alternative to a standard TURP.
The Oxford Laser Prostate Trial: a double‐blind randomized controlled trial of contact vaporization of the prostate against transurethral resection; preliminary results
Authors: Keoghane S.R. , Cranston D.W. , Lawrence K.C. , Doll H.A. , Fellows G.J. , Smith J.C. 
Published: November 2003

Objective To compare the results of contact laser vaporization and transurethral resection of the prostate (TURP) in a double‐blind randomized controlled clinical trial. Patients and methods The study comprised 148 patients with clinical benign prostatic hypertrophy (BPH) who were recruited and allocated randomly to undergo either TURP (72 patients) or laser ablation of the prostate (76 patients). The outcome was assessed using the American Urological Association (AUA −7) symptom score after 1 and 3 months as the primary measure and by urinary flow rates, haematological factors and the duration of hospital stay and length of catheterization. Results With 90% statistical power, the results at 3 months showed no clinical or statistical difference between the treatments in change in AUA symptom score. A lower blood loss, hospital stay and duration of catheterization significantly favoured the laser treatment, although the failure rate of trial without catheter and the rate of re‐operation were higher after laser treatment. Conclusions These early data are encouraging for this technique, although the outcome after one year requires evaluation before advocating the widespread uptake of this method.
A clinicopathological approach to cystitis — recommendations for simplified pathology reporting
Authors: THILAGARAJAH R. , VALE J.A. , WITHEROW R.O’N. , WALKER M.M. 
Published: November 2003

Objective To assess the accuracy of histopathology reports of bladder biopsy specimens showing chronic cystitis and to develop a standard method of reporting in the form of a template which will aid both clinician and patient in the management of this condition.Materials and methods Over a 4‐year period, the reports of 134 bladder biopsy specimens diagnosed as chronic inflammation of the bladder were examined for clinical details, cystoscopy findings, pathology details and conclusions. Within each of these groups, the common terms were assessed for their relevance to the final outcome.Results The analysis of each part of these reports revealed no clinical details in 33%, no cystoscopy details in 26% and no histopathology conclusion in 20%. The commonest terms used were: macroscopic haematuria (25%) for clinical details; red patch/inflamed (40%) for cystoscopic details; morphological site involved (65%) for pathology details; and mild chronic cystitis (37%) for the conclusions. Standardized criteria were devised and after reassessing the reports, 75% were considered to be accurate and complete.Conclusions Overall, the histopathology reports examined were more than adequate for the clinicians’ use but the spectrum of details provided did not add to the usefulness of the final report. By limiting the terms available, a more standardized report can be produced, benefiting both clinician and patient.
The in vivo and in vitro effects of hypoxia on pig urethral smooth muscle
Authors: GREENLAND J.E. , BRADING A.F. 
Published: November 2003

Objective To assess the in vitro effects of hypoxia on urethral smooth muscle and the role that these may have in the fall in urethral luminal pressure consequent upon interruption of its arterial blood supply.Materials and methods In eight anaesthetized female Large White pigs, femoral blood pressure, urethral luminal pressure and lamina propria blood flow were recorded before, during and after aortic occlusion. In three animals, changes in urethral intramural oxygen tension were also recorded. Smooth muscle strips taken from the mid‐urethra were studied in an organ bath under normal and hypoxic conditions, and in the presence of cyanide. The generation of spontaneous tone and the response to electrical‐field stimulation were also examined.Results Urethral luminal pressure declined biphasically after aortic occlusion, from a mean of 83.8 to 39.0 cmH2O. The initial rapid phase seemed to be related to a decrease in urethral lamina propria blood flow, whilst the slower phase appeared to mirror the observed decline in intramural oxygen tension. In vitro, the high spontaneous tone of the muscle strips was abolished by hypoxia or metabolic inhibition whilst the contractile response to nerve stimulation was preserved.Conclusions The decrease in urethral pressure after aortic occlusion appears to have two components, the first mediated through a decrease in vascular filling of the lamina propria and the second as a result of hypoxia‐induced smooth muscle relaxation. The in vitro effects of hypoxia upon urethral smooth muscle concur with the changes observed in vivo.
Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?
Authors: PROBST M. , PIECHOTA H.J. , HOHENFELLNER M. , GLEASON C.A. , TANAGHO E.A. 
Published: November 2003

Objective To determine by anatomical and functional studies whether stimulation of sacral rootlets might permit selective stimulation of autonomic fibres, thus avoiding the detrusor/sphincter dyssynergia characteristic of current techniques of neurostimulation for bladder evacuation.Materials and methodsIn 10 male mongrel dogs, the S2 root was isolated and its constituent rootlets followed from their origin in the spinal cord to the point of exit from the dura. The entire root and the individual rootlets were then stimulated, including intra‐ and extra‐dural stimulation and at proximal, mid and distal levels.ResultsNeuroanatomical and histological findings showed that the rootlets of ventral S2 maintain their identity throughout their intradural course; some carry predominantly autonomic fibres, some predominantly somatic and some a mixture of the two.ConclusionIt appears surgically feasible to identify, isolate and sever the predominantly somatic rootlets intradurally, sparing the predominantly autonomic rootlets for inclusion in extradural electrode placement around the entire sacral root, thus eliminating sphincteric interference with detrusor contraction for voiding at low pressure.