bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized controlled trial of tolterodine and oxybutynin on tolerability and clinical efficacy for treating Chinese women with an overactive bladder
Authors: Leung H.Y. , Yip S.K. , Cheon C. , Liu Y.S. , Lau J. , Wong H.K. , Chung K.H. 
Published: March 2003

Objective To compare the tolerability and clinical efficacy of tolterodine and oxybutynin in the treatment of Hong Kong Chinese women with an overactive bladder. Patients and methods A randomized controlled trial was conducted at two urogynaecology centres in Hong Kong. In all, 106 women with urodynamically confirmed detrusor instability were recruited. Baseline severity assessments included a visual analogue scale (VAS), urinary diary and urinary pad‐test. The women were randomized to receive either oral tolterodine 2 mg or oxybutynin 5 mg twice daily for 10 weeks. Treatment responses were assessed at 4 and 10 weeks using the VAS and urinary diary. Treatment tolerability was assessed at baseline, 4 and 10 weeks using the Xerostomia Questionnaire. A urinary pad‐test was repeated at 10 weeks. Results
The perceived change from baseline VAS was better in the tolterodine than the oxybutynin group after 10 weeks of treatment (per‐protocol analysis,
P

=
0.043). The two drugs were effective in reducing the symptoms of frequency (
P

< 0.001). Tolterodine was significantly better than oxybutynin in reducing urinary leakage (urinary pad‐test; median change − 5.00 g vs 0 g,
P

=
0.019). Both drugs caused a significant worsening of dry mouth (overall dryness,
P

< 0.005; discomfort,
P

< 0.005; sleep,
P

= 0.021; speaking,
P

=
0.045; swallowing,
P

=
0.004; and liquid consumption,
P   =  0.017). Conclusions Both oxybutynin and tolterodine were effective in ameliorating the severity of the symptoms of detrusor instability. Tolterodine was better than oxybutynin in both subjective and objective outcome measures, but both drugs caused similar worsening of dry mouth that may limit the tolerability of these medications.
The effect of urinary incontinence and overactive bladder symptoms on quality of life in young women
Authors: Van Der Vaart C.H. , De Leeuw J.R.J. , Roovers J.P.W.R. , Heintz A.P.M. 
Published: March 2003

Objective  To assess the consequences that the symptoms of urinary incontinence and an overactive bladder have on the quality of life in young, community‐dwelling women. Subjects and methods  A population‐based, cross‐sectional cohort study was conducted in women aged 20–45 years. Urogenital symptoms and quality of life were assessed using standardized questionnaires, e.g. the Urogenital Distress Inventory and Incontinence Impact Questionnaire. Results  The prevalence of symptoms of stress incontinence (39%), urge incontinence (15%) and an overactive bladder (12%) was high in this young population. Compared with urge incontinence, the symptoms of an overactive bladder similarly reduced the quality of life, but stress incontinence did not significantly affect the quality of life. Women with symptoms of an overactive bladder were especially limited in their mobility, whereas urge incontinence was especially associated with feelings of embarrassment. Although many women reported to be bothered by their symptoms, only a minority consulted their physician for them. Conclusions  The symptoms of urinary incontinence and overactive bladder are common among young adult women and have the same detrimental effect on quality of life as urge incontinence. The reduction in mobility associated with overactive bladder symptoms may be especially distressing for these young and active women.
An audit of urodynamic standardization in the West Midlands, UK
Authors: Sriram R. , Ojha H. , Farrar D.J. 
Published: March 2003

Objective  To report a follow‐up postal survey to one conducted in 1998 assessing the feasibility of standardizing urodynamic practice in the West Midlands region. Methods  From the initial survey there was interest in standardizing the practice of urodynamics and a few simple guidelines were proposed. The postal survey was repeated to identify any changes. The guidelines included zeroing the transducer to atmospheric pressure, a filling rate of 50 mL/min and using the International Continence Society (ICS) definition of detrusor instability, including numerical values and recording any contraction in the presence of urgency. A questionnaire, similar to the initial one, was circulated to all the clinicians who had participated in the initial study, distributed ≈ 8 months after agreed guidelines were issued. Specific questions included details of the filling and voiding cystometrogram, and the basis of diagnosing detrusor instability. They were also asked to comment on whether they would still like the practice to be standardized. Results  Only 17 of the 23 clinicians who participated in the initial study responded. For zeroing the transducer to atmospheric pressure, eight still zeroed to the patient. Only one unit had changed its practice by zeroing to atmospheric pressure. Varied rates of filling were still used and only eight participants used the ICS criteria to diagnose detrusor instability. Three of the 17 participants did not feel that standardization was achievable. Conclusions  Obviously there is some apathy amongst clinicians to move towards standardization. No significant changes had been made since standardization guidelines were issued. Although most preferred initially to standardize urodynamic practice, individuals do not seem to have been convinced that they need to change their method to achieve uniformity.
Can the reverse transcriptase‐polymerase chain reaction for prostate specific antigen and prostate specific membrane antigen improve staging and predict biochemical recurrence?
Authors: Adsan Ö. , Cecchini M.G. , Bisoffi M. , Wetterwald A. , Klima I. , Danuser H.‐J. , Studer U.E. , Thalmann G.N. 
Published: March 2003

Objective  To evaluate the perioperative gene‐specific primed nested reverse transcription‐polymerase chain reaction (RT‐PCR) for prostate‐specific antigen (PSA) and prostate‐specific membrane antigen (PSMA) for staging patients undergoing radical prostatectomy and predicting biochemical recurrence. Patients and methods  In 80 consecutive patients undergoing radical prostatectomy for prostate cancer, blood samples were drawn before, during and 1 and 7 days after removing the prostate. After buffy coat and mRNA extraction, gene‐specific primed nested RT‐PCR was performed for PSA, PSMA and glyceraldehyde‐3‐phosphate dehydrogenase mRNA, and Southern blot analysis of the PCR reaction. Results
The sensitivity of gene‐specific RT‐PCR to detect tumour cells was comparable with random primed RT‐PCR. In the 80 patients the stage distribution was pT1 in two (2.5%), pT2 in 30 (37.5%) and ≥ pT3 in 48 (60%); the nodal status was pN0 in 57 (71%), pN1 in 11 (14%) and pN2 in 12 (15%). The gene‐specific RT‐PCR reaction for PSA and PSMA was positive in no patients with pT1, 11 (37%) with pT2 and 23 (48%) with stage ≥ pT3 disease. The result for PSA was positive in 12 (52%) and for PSMA in 11 (48%) of those with positive nodal status. Neither gene‐specific RT‐PCR for PSA or PSMA was able to predict organ‐confined disease (
P  > 0.5). After a median (range) follow‐up of 37 (11–67) months a biochemical recurrence was predicted in 65% of patients by preoperative RT‐PCR for both PSA and PSMA, with a sensitivity, specificity, positive and negative predictive value of 58%, 80%, 87% and 47%, respectively; the assay after surgery predicted a recurrence in 73%, with respective values of 68%, 84%, 84% and 57%. Conclusions  Gene‐specific primed nested RT‐PCR for PSA and PSMA is a sensitive and simple assay; it might add substantial information for tumour staging in individual patients. RT‐PCR before surgery allows the prediction of recurrence in 65% of cases and after surgery in 73%.
The differences in health outcomes between Web‐based and paper‐based implementation of a clinical pathway for radical nephrectomy
Authors: Chang P.L. , Li Y.C. , Lee S.H. 
Published: March 2003

Objective  To evaluate the effects of a web‐based clinical pathway (WCP) for radical nephrectomy on patient care, and to compare the effects with those of a paper‐based clinical pathway (PCP). Patients and methods  Patients with renal cell carcinoma and who underwent radical nephrectomy were enrolled into the study. The results of using the WCP for radical nephrectomy from July 2000 to August 2001 were compared with those using the PCP between May 1999 and June 2000. The mean hospital stay, average admission charges, six quality indicators, and the advantages of the WCP were determined. Results
Using a WCP for radical nephrectomy reduced the hospital stay and admission charges by as much as the PCP. A similar number of patients had variances from the WCP as with the PCP (
P
= 0.407), but the number of undetected variances and the variance detection time in the WCP were significantly less (
P  = 0.0193 and 0.0162). Implementing a WCP also improved the quality of care by as much as a PCP. Conclusions  Using a WCP for radical nephrectomy can improve health outcomes by reducing the hospital stay and admission charges, and by improving the quality of care by as much as a PCP. Furthermore, the WCP was more accurate and faster than the PCP in detecting variances.
Vasopressin and hypercalciuria in enuresis: a reappraisal
Authors: Nevéus T. , Hansell P. , Stenberg A. 
Published: March 2003

Objective  To test the hypotheses that vasopressin deficiency or hypercalciuria are important in polyuric and non‐polyuric bedwetting, as nocturnal polyuria is a pathogenetic factor in enuresis responsive to antidiuretic therapy with desmopressin.Subjects and methods  Vasopressin deficiency has been implicated as a cause of nocturnal polyuria, but measurements of vasopressin in plasma have given contradictory results, because the hormone is released in pulses. Urinary levels reflect the secretion over longer periods. Hypercalciuria has also been proposed as a pathogenetic factor. Twenty‐eight enuretic children who responded to desmopressin therapy with or without added anticholinergic agents (diuresis‐dependent enuresis, DE), 15 children with therapy‐resistant enuresis (not diuresis‐dependent, NDE) and 51 continent controls were assessed. Urinary vasopressin, calcium and osmolality were measured in the morning after a 12‐h thirst provocation. Urine production was recorded for 2 days.Results  Because most data were not normally distributed, the values are expressed as the median (range). There were no differences in urine osmolality; i.e. con‐trols 919 (636–1232), DE 849 (462–1149), NDE 968 (664–1191) mOsml/kg); vasopressin, controls 34 (8–983), DE 26 (9–295), NDE 50 (9–116) pmol/L; or calcium excretion (expressed as the calcium/creatinine ratio), controls 0.16 (0.01–0.71), DE 0.14 (0.04–0.67), and NDE 0.23 (0.03–0.69). The DE group produced more urine, at 18.4 (9.2–52.5) mL/kg/day, than the other groups, i.e. control 12.7 (8.3–42.8) and NDE 12.1 (6.3–36.8) mL/kg/day (P = 0.008).Conclusion  All enuretic children with nocturnal polyuria do not have vasopressin deficiency. The urinary calcium excretion does not differ between enuretic and dry children.
Vesico‐ureteric reflux in the young infant with follow‐up direct radionuclide cystograms: the medical and surgical outcome at 5 years old
Authors: McLaren C.J. , Simpson E.T. 
Published: March 2003

Objective  To compare the 5‐year outcome of 82 infants with vesico‐ureteric reflux (VUR) against the initial (< 1 year) and follow‐up results of the direct radionuclide cystogram (DRC).Patients and methods  An initial DRC was taken at a mean age of 0.6 years and the follow‐up study at 1.7 years. VUR was graded using ‘one‐third bladder volume’ grades (BVG) of ‘low’, ‘moderate’, ‘high’ and ‘void’, with ‘low’ considered the most severe. Renal scintigraphy was used to assess renal scarring in 80 of the 82 patients. The outcome at a minimum age of 5 years was defined as resolved reflux, those with corrective surgery or those still being medically followed.Results  Those being followed comprised 29%, corrective reflux surgery 17% and resolved 54% of the patients. Children with VUR grades of ‘high’ or ‘moderate’ (as the worst grade either side) were more likely to have resolution than those with ‘low’ (by four and two times, respectively). Reflux at ‘low’ bladder volume was 2.6 times more likely to be associated with renal scarring than the other grades combined. ‘Low’ reflux was present in nine of 14 children needing surgery. There was a linear relationship between VUR grade and the scintigraphic findings.Conclusion  The severity of VUR can be assessed from the bladder‐volume graded DRC. Continuing VUR at ‘low’ BVG is associated with increased renal scarring, resistance to natural resolution and corrective reflux surgery.
Comparison of the cellular molecular stress responses after treatments used in bladder cancer
Authors: Shackley D.C. , Haylett A. , Whitehurst C. , Betts C.D. , O'Flynn K. , Clarke N.W. , Moore J.V. 
Published: March 2003

Objective  To investigate the molecular stress responses related to the quality of recovery of normal tissue after various treatments for bladder cancer, i.e. hyperthermia, ionizing radiation, mitomycin‐C and 5‐aminolaevulinic acid photodynamic therapy (ALA‐PDT).Materials and methods  The study focused particularly on intracellular fibroblast levels of heat‐shock protein‐47 (HSP47) and HSP72, which are associated with collagen metabolism and the development of tolerance to repeated treatment, respectively. Iso‐effective treatment doses (50% clonogenic cell survival) of each method were delivered to a 3T6 murine fibroblast model. Intracellular extracts were analysed at 3, 6, 9, 12 and 24 h after treatment, using Western blot analysis to compare the levels of HSP47 and HSP72. Time‐matched treatment and control groups were quantified by comparison with actin and glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH) expression using appropriate software.Results  There were various changes in levels of HSP expression with treatment method; HSP47 levels were significantly higher after hyperthermia and radiation but not with mitomycin‐C or ALA‐PDT. HSP72 levels were significantly higher with all methods except ALA‐PDT.Conclusions  Hyperthermia and ionizing radiation are associated with early increases in levels of HSP47 (a marker of collagen metabolism), in contrast to ALA‐PDT and mitomycin‐C. These findings are compatible with clinical findings where fibrosis/scarring is common with the first two but not the last two methods. In addition, all methods except ALA‐PDT are associated with an increase in HSP 72 (a protein associated with cellular tolerance) and this may help to explain, at a cellular level, why resistance to repeated ALA‐PDT treatments does not seem to occur.
Urothelial ingrowth over demucosalized gastrocystoplasty: an experimental study
Authors: Abdel Hay S. , Soliman S.M. , Debeky M.E. 
Published: March 2003

Objective  To evaluate histopathologically the ingrowth of urothelium over a demucosalized gastric flap used for augmentation, as such flaps increase the capacity of the bladder if the urothelium can cover the seromuscular patch.Materials and methods  The study included eight male dogs; the urinary bladder was widely divided at its dome anteroposteriorly to receive a seromuscular gastric flap, sutured to the edges of the urinary bladder. Before and 1 month after surgery the changes in bladder capacity and pressure were recorded, and urothelial ingrowth assessed histopathologically.Results  Two of the eight dogs died; the increase in mean bladder capacity in the remaining dogs was 20% and the decrease in mean intravesical pressure 34%. Gross pathological examination of the urinary bladder showed good ‘take’ of the gastric flap by the urinary bladder. Histopathologically, there was good healing of the flap, active ingrowth of urothelium, and no mucosal re‐growth.Conclusion  Bladder augmentation with a demucosalized gastrocystoplasty allows the creation of a large compliant urinary bladder with few complications caused by the incorporation of the enteric or gastric epithelium into the urinary bladder. The stomach has a rich blood supply, allowing the harvesting of a well‐vascularized flap, and urothelial ingrowth over this flap in the present study was significant.
Changes in sodium transport in epithelial cells in a rat ileal‐augmented bladder model
Authors: Fujisawa M. , Sakai Y. , Nakano Y. , Arakawa S. , Kamidono S. 
Published: March 2003

Objective  To investigate changes in the morphology and sodium transport ability of intestinal epithelium diverted to the urinary tract, using an in vitro sodium‐binding benzofuran isophthalate (SBFI) technique, as the effects of long‐term urine exposure on the transport of electrolytes through intestine are incompletely understood.Materials and methods  Ileal augmentation cystoplasty was conducted in female Sprague‐Dawley rats; at 3 and 12 months after surgery the serum concentration of sodium, chloride and potassium were measured. Sodium transport in the ileal epithelial cells diverted to the urinary tract was evaluated using SBFI, as the value of the 340/380 nm excitation ratio measured with fluorescence spectrophotometry. The villous height and the number of villi per ileal length were obtained from haematoxylin and eosin‐stained sections.Results  After 3 months the mean (sd) serum sodium concentrations in normal and augmented rats were 140.4 (2.5) and 140.7 (3.5) mmol/L, respectively; the chloride concentration in normal rats was 97.0 (2.9), and in augmented rats at 3 and 12 months it was 102.4 (2.9) and 99.0 (3.7) mmol/L, respectively. At 3 months, chloride concentrations were significantly higher in augmented than in normal rats (P < 0.05). The mean (sd) 340/380 nm ratio increased by 0.85 (0.09) in the normal ileum, and by 0.73 (0.15) and 0.49 (0.23) in the ileum of augmented rats at 3 and 12 months, respectively; the difference between normal and augmented ileum at 12 months was significant (P < 0.05). At 12 months the villous height in the augmented ileum, at 227.6 (16.0) µm, was significantly less than in the normal ileum, at 803.4 (66.2) µm (P < 0.05). However, the number of villi/mm ileum in normal and augmented rats at 12 months was 13.7 (1.5) and 15.0 (0.8), respectively, and not significantly different.Conclusion  Sodium transport decreased significantly after long‐term exposure to urine; the improvement in metabolic change was probably attributable to alterations of electrolyte transport and atrophic changes of the villus.
Substitution urethroplasty for anterior urethral strictures: a critical appraisal of various techniques
Authors: Dubey D. , Kumar A. , Bansal P. , Srivastava A. , Kapoor R. , Mandhani A. , Bhandari M. 
Published: March 2003

OBJECTIVETo retrospectively compare the outcome of various techniques of substitution urethroplasty.PATIENTS AND METHODSBetween 1989 and 2000, 109 patients (mean age 39.5 years) underwent substitution urethroplasty for recurrent anterior urethral strictures. Between 1989 and 1995 the procedure was by ventral placement of free grafts (bladder mucosa, buccal mucosa, penile skin) or penile skin flaps. From 1995 onwards the flaps and grafts (buccal mucosa) were applied either ventrally or dorsally. Stricture recurrence and the complications associated with each technique were compared.RESULTSVentral onlay repairs were associated with a higher incidence of complications than dorsal repairs, e.g. postvoid dribbling (39% vs 23%, P = 0.01), ejaculatory dysfunction (20% vs 5%, P = 0.03) and flap/graft pseudo‐diverticulum or out‐pouching (26% vs 2.6%, P = 0.01). Superficial penile skin necrosis was significantly more common with the use of penile skin flaps than with free grafts. There was no significant difference in stricture recurrence, erectile dysfunction and residual penile deformity among the various techniques.CONCLUSIONSDorsal free graft/flap onlay urethroplasty gives better results than ventrally placed free grafts/flaps. Dorsal onlay buccal mucosal urethroplasty is a versatile procedure and associated with fewer complications than other substitution methods.
Day‐case holmium laser enucleation of the prostate for gland volumes of < 60 mL: early experience
Authors: Larner T.R.G. , Agarwal D. , Costello A.J. 
Published: March 2003

OBJECTIVETo examine the safety and effectiveness of holmium laser enucleation of the prostate (HoLEP), as a day‐case procedure for selected patients.PATIENTS AND METHODSThirty‐eight men underwent HoLEP as a day‐case procedure; they were discharged with an indwelling catheter for 48 h with ‘Hospital In The Home’ nursing management. They were evaluated for symptomatic and flow rate improvements after 3 months. Morbidity, length of stay, the duration of catheterization and readmission rates were evaluated.RESULTSThe objective symptom score and flow‐rate improvements were equivalent to those previously published for transurethral resection of the prostate (TURP). There were five minor complications, three of which required readmission to hospital and one repeat surgery. The mean stay after surgery was 302 min.CONCLUSIONSDay‐case HoLEP is a safe and effective treatment for symptomatic benign prostatic hyperplasia. The outcomes are equivalent to those from TURP. Whilst there were three re‐admissions to hospital, two only required an overnight stay and no patient required a blood transfusion.
Intermittent androgen suppression in patients with prostate cancer
Authors: De La Taille A. , Zerbib M. , Conquy S. , Amsellem‐Ouazana D. , Thiounn N. , Flam T.A. , Debré B. 
Published: March 2003

OBJECTIVESTo evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression.PATIENTS AND METHODSFrom 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate‐specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen‐deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re‐instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others.RESULTSAfter a mean (range) follow‐up of 45.6 (12–196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5‐year metastatic disease free survival of 91.3%. The overall 5‐year biochemical recurrence‐free survival was 68%. Using multivariate analysis, a Gleason score of ≥ 8 (P = 0.021), first‐phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression.CONCLUSIONIAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of ≤ 7.