bluuebunny/crossref_metadata_2025_split huggingface dataset:
The community‐based morbidity of flexible cystoscopy
Authors: Burke D.M. , Shackley D.C. , O'Reilly P.H. 
Published: March 2003

Objective To evaluate patients' experience after flexible cystoscopy (FC), particularly concentrating on the prevalence and degree of symptoms, the frequency of visits to their General Practitioner (GP), subsequent antibiotic rates and the actual incidence of urinary tract infection (UTI). Patients and methods Consecutive patients (420) presenting for FC were audited prospectively. A pain score for the procedure was recorded immediately afterward (linear scale 0–10) and a self‐administered questionnaire completed at 7 days, to assess the objective and subjective symptoms and their duration, and the incidence of GP visits and subsequent antibiotic provision noted. An interim analysis was conducted on the initial 274 datasets received. To estimate the incidence of FC‐induced UTI, the final 110 patients were asked not to consult their GP but to present to the urology department at 3 days after FC (or the emergency department if clinically necessary). These patients had initially provided a mid‐stream urine (MSU) sample before FC and were assessed symptomatically with a subsequent sample obtained if a urinary dipstick test 3‐days after FC was abnormal. Results In all, 384 (91%) evaluable forms were returned. The median (range) pain score for FC was 1.1 (0–8.5), with seven patients (1.8%) recording a pain score of > 5 (all men); 382 patients (99.5%) declared they would be happy to undergo an identical procedure in the future if medically indicated. Pain on voiding was reported in 190 patients (50%), urinary frequency in 142 (37%) and gross haematuria in 73 (19%). Eighteen of the initial 274 patients (6.6%) visited their GP, with 15 (5.5%) of these receiving antibiotics. The MSU data from the final 110 patients showed a FC‐mediated infection in three (2.7%). Conclusion Although FC is well tolerated, gross haematuria, urinary frequency and dysuria occur afterward much more frequently than expected. Patients should be thoroughly counselled before FC about these potential symptoms, to reduce their concern, any unnecessary GP visits and the use of antibiotics.
Laparoscopic dismembered pyeloplasty: 50 consecutive cases
Authors: Eden C.G. , Cahill D. , Allen J.D. 
Published: March 2003

Objective To test the hypothesis that laparoscopic dismembered pyeloplasty offers the same good results as open pyeloplasty, but without the disadvantages of the loin incision (which is painful, prolongs hospitalization and prevents a return to normal activities for several weeks) in the treatment of pelvi‐ureteric junction (PUJ) obstruction. Patients and methods Fifty consecutive consenting patients presenting with PUJ obstruction underwent laparoscopic dismembered pyeloplasty carried out by one surgeon using an extraperitoneal approach. Results Two (4%) procedures were converted to open surgery. The mean (range) operative duration was 164 (120–240) min. Fifteen (30%) of the patients had their ureter transposed anterior to a crossing lower‐pole vessel; 22 (44%) patients had a separate renal pelvic suture line. The mean (range) postoperative parenteral analgesic requirement was 19.1 (0–111) mg of morphine sulphate. The mean (range) hospitalization was 2.6 (2–7) days. Two (4%) patients had complications. After a mean (range) follow‐up of 18.8 (3–72) months all but one patient, who had failed endopyelotomy, had a normal renogram and were symptom‐free. Conclusion These results suggest that a loin wound is not necessary for a successful outcome after dismembered pyeloplasty, and that in expert hands laparoscopic dismembered pyeloplasty should now be considered the standard of care.
Prevalence and characteristics of cryptorchidism in a Nigerian district
Authors: Okeke A.A. , Osegbe D.N. 
Published: March 2003

Objective To determine the prevalence and characteristics of cryptorchidism among primary schoolboys in a Nigerian district. Subjects and methods The district selected had 35 primary schools with 23 342 pupils, consisting of 11 275 girls and 11 967 boys. Using a cluster‐sampling technique, five primary schools were visited; 1096 boys (aged 5–13 years) participated in the study, giving a sampling ratio of 1 : 11. The boys underwent a clinical examination of the groin, scrotum and abdomen. Results Cryptorchidism was found in nine subjects, giving a prevalence rate of 0.82%. All the undescended testes were unilateral, of which five were right‐sided. Eight of the testes were intracanalicular and one was at the external ring. There were no cases of orchidopexy. Conclusion The prevalence of cryptorchidism among primary schoolboys in this district of Nigeria was high, at eight per 1000. Delayed diagnosis and treatment remains a problem because of the prevailing socio‐economic factors. However, the incidence of cryptorchidism was similar to that reported in other parts of the world.
The natural history of urinary symptoms during adolescence
Authors: Swithinbank L.V. , Brookes S.T. , Shepherd A.M. , Abrams P. 
Published: March 2003

ObjectiveTo determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren.Subjects and methodsA prospective longitudinal study using a confidential questionnaire administered to an original cohort of 1176 local schoolchildren at 11–12 years and again at 15–16 years old.ResultsThere was a decrease in the prevalence of urinary symptoms with age. Daywetting was reported by 12.5% of children aged 11–12 years and 3.0% of children aged 15–16 years. Nocturnal enuresis was reported by 4.7% of children at 11–12 years and 1.1% at 15–16 years. Some of the children reporting daywetting and nocturnal enuresis at 15–16 years old had not reported these symptoms at 11–12 years old.ConclusionUrinary symptoms become less prevalent with age, but are reported by a significant number of healthy schoolchildren.
Pelvic‐floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding
Authors: De Paepe H. , Hoebeke P. , Renson C. , Van Laecke E. , Raes A. , Van Hoecke E. , Van Daele J. , Vande Walle J. 
Published: March 2003

ObjectiveTo analyse the treatment of girls with recurrent urinary tract infections (UTIs, at least two periods confirmed) and urodynamically confirmed dysfunctional voiding with pelvic‐floor therapy.Patients and methodsForty‐two girls with recurrent UTIs were treated prospectively during a study period of 18 months. Training consisted of an individually adapted voiding and drinking schedule, pelvic‐floor relaxation biofeedback, instructions on toilet behaviour and biofeedback uroflowmetry; residual urine was estimated by ultrasonography. All the girls received prophylactic antibiotics during treatment and those girls with urodynamically proven detrusor instability (33) received anticholinergics. Therapy was considered successful when the girls remained free of infection with no further prophylactic antibiotics for at least 6 months.ResultsFour girls younger than 6 years all suffered nocturnal and diurnal incontinence and two had reflux. Treatment was effective for recurrent UTI in all and the reflux resolved in two. All four girls became dry during the day and one became dry at night. In the 38 girls older than 6 years, the treatment was successful for recurrent UTI in 24 from the out‐patient and in all three from the clinical programme. Reflux, which was seen in six of these girls, resolved in five; one girl underwent bilateral reimplantation. Incontinence was treated in all 23 girls with incontinence problems before treatment (four of whom were initially dry). Twelve girls needed a wetting alarm to become dry during the night. In four girls the treatment was effective for recurrent UTI but the incontinence persisted; in seven the treatment was considered unsuccessful as they all had UTIs after treatment; all remained incontinent. Reflux persisted in all four girls in this group who had reflux before treatment.ConclusionThe training programme was effective in treating recurrent UTI in 35 of 42 girls (83%). The persistence of incontinence problems is a bad prognostic factor for the recurrence of UTI after the training programme. Pelvic‐floor therapy seems a reasonable and meaningful component in the treatment of recurrent UTIs in which detrusor‐sphincter dyssynergia plays a role.
Detrusor myectomy for detrusor overactivity: a minimum 1‐year follow‐up
Authors: Swami  , Feneley  , Hammonds  , Abrams  
Published: March 2003

Objective To evaluate the clinical and urodynamic outcome of partial detrusor myectomy in patients with idiopathic detrusor instability and neuropathic hyper‐reflexia.Patients and methods Seventeen patients with idiopathic detrusor instability and 10 with hyper‐reflexia and symptoms not responding to non‐surgical treatment underwent partial detrusor myectomy. The clinical and urodynamic results before and after myectomy were compared and the patient’s subjective assessment of the outcome documented.Results There was an overall improvement in 17 of 27 patients (63%) but the success rate was higher in those with idiopathic instability (12 of 17) than in those with neuropathy (five of 10). There was urodynamic evidence of reduced bladder contractility and an improvement in the storage characteristics of the bladder in most of the patients treated.Conclusions Partial detrusor myectomy is relatively simple and is associated with minimum morbidity and an acceptable success rate. The procedure alters the urodynamic behaviour of the bladder and leads to symptomatic and objective improvement, giving better results with idiopathic than with neuropathic detrusor overactivity. Detrusor myectomy may be offered to patients with detrusor overactivity unresponsive to conventional management. The option of enterocystoplasty is still open to patients with an unsuccessful outcome. However, the long‐term results and surgical variations of the technique should be evaluated further.
Down‐regulation of endothelin‐B receptor sites in cavernosal tissue of hypercholesterolaemic rabbits
Authors: Sullivan  , Dashwood  , Thompson  , Mikhailidis  , Morgan  
Published: March 2003

Objective To investigate the density and distribution of endothelin‐1 (ET‐1) and endothelin receptor subtypes in cavernosal tissue of healthy New Zealand White (NZW) rabbits (controls) and to assess any changes in a genetic model of hypercholesterolaemia (the Watanabe rabbit).Materials and methods Penises were excised from six hypercholesterolaemic (HC) rabbits 6 months after birth. Low‐and high‐resolution autoradiography was performed on cavernosal sections using radioligands for ET‐1, endothelin A (ETA ) and endothelin B (ETB ) receptors, and the autoradiographs analysed densitometrically. The results were compared with those from six age‐matched control rabbits. Immunohistochemical localization of ET‐1‐like immunoreactivity was also performed on adjacent cavernosal sections.Results ET‐1, ETA and ETB receptor binding sites were primarily localized to the smooth muscle cells of the corpus cavernosum and the endothelium lining the cavernosal spaces. There was a significant decrease in ETB receptor binding sites in cavernosal tissue from HC rabbits when compared to age‐matched healthy controls.Conclusions The findings suggest that ET‐1 may have a role in the pathophysiology of erectile dysfunction in HC. These effects may partly be due to enhanced vasoconstrictor actions and smooth muscle cell proliferation, consequent on a reduction in endothelial ETB receptors.
A novel therapy for nocturnal polyuria: a double‐blind randomized trial of frusemide against placebo
Authors: Reynard  , Cannon  , Yang  , Abrams  
Published: March 2003

Objective To report a randomized, double‐blind, placebo‐controlled trial of an afternoon dose of the diuretic frusemide, used to establish an early evening diuresis and so diminish nocturnal voiding frequency and voided volume in elderly men presenting with lower urinary tract symptoms (LUTS).Patients and methods  After a 2‐week placebo run‐in period, 49 men aged >50 years were randomized to receive 40 mg of frusemide or placebo, taken 6 h before their usual bedtime. Day and night‐time frequency and voided volume during the run‐in and treatment periods were compared between the placebo and frusemide groups.Results In the 43 men completing the study, there was a significant reduction in night‐time frequency (−0.5 and 0) and percentage night‐time voided volume (−18% and 0%) in those taking frusemide compared with placebo. Of patients on active treatment, seven of 19 had a reduction in night‐time frequency of ≥1, compared with only one of 20 on placebo, and 14 of 21 felt that frusemide had helped their nocturia, compared with only five of 22 on placebo.Conclusion Men with LUTS whose most prominent symptom is nocturia should complete a frequency‐volume chart. In those with nocturnal polyuria, 40 mg of frusemide resulted in a significant reduction in night‐time frequency and percentage voided volume.
Inter‐α‐inhibitor in urine and calcium oxalate urinary crystals
Authors: Dawson  , Grover  , Ryall  
Published: March 2003

Objective To determine which chains of inter‐α‐inhibitor (IαI) are present in urine and whether they are also found in calcium oxalate (CaOx) crystals generated in human urine.Materials and methods Fresh urine specimens were collected from five women and five men with no previous history of stone disease. An aliquot of each urine was retained for analysis, the remainder treated with a standard load of oxalate and the CaOx crystals precipitated from each specimen demineralized with ethylenediamine tetracetic acid. The resulting organic extracts from crystals and their corresponding urine samples were subjected to sodium dodecyl sulphate gel electrophoresis analysis and Western blotting using a commercial polyclonal antibody to IαI.Results Heavy chain 1 (H1) and 2 (H2) of IαI were commonly found in every urine sample, and in the CaOx crystals precipitated from those urine samples. Several protein bands were visible in urine samples from both sexes in the molecular mass range 25‐70 kDa, which may be bikunin or its fragments. As well as H1 and H2, the crystals from both sexes contained a protein band at ≈33 kDa. In many cases there appeared to be no direct relationship between the proteins detected in the crystals and the urine samples from which they were derived, which probably reflects the well known instability of IαI and the occurrence of a range of bikunin fragments in urine.Conclusion These results show for the first time that H1 and H2 are present in human urine and urinary CaOx crystals, that the bikunin chain of IαI is not the only part of the molecule capable of participating in CaOx crystallization in urine, and in theory at least, in the regulation of crystallization events in stone formation. It is also apparent that significant fragmentation of IαI occurs both in vivo and in vitro, and this must be considered in any study attempting to elucidate the influence of this protein in the formation of CaOx stones.
Long‐term results and complications of augmentation ileocystoplasty for idiopathic urge incontinence in women
Authors: Awad  , AL‐Zahrani  , Gajewski  , Bourque‐Kehoe  
Published: March 2003

Objective To assess the long‐term (3–9 years) results of augmentation ileocystoplasty for non‐neurogenic female urge incontinence in terms of continence, the need for intermittent self‐catheterization and the need for additional or auxiliary treatment, to define the long‐term complications and to assess the patients’ satisfaction with the outcome.Patients and methods The study comprised 51 women who underwent augmentation ileocystoplasty for non‐neurogenic urge incontinence between November 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an unsatisfactory outcome. All patients were interviewed about the results of the procedure, and their charts reviewed and updated with relevant information.Results Within a mean (range) follow‐up of 75.4 (36–109) months, 27 patients (53%) were completely continent, 13 (25%) had occasional leaks and nine (18%) continued to have disabling urge incontinence frequently requiring pads. Regular self‐catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or minimal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontinence and were managed with fascial sling procedures. The patch was revised in two patients and excised from four others because they had high residual volumes and uncontrollable infections. Two patients had an ileal conduit diversion for persistent incontinence. The most common complication was recurrent urinary tract infections, seen in 22 patients using intermittent self‐catheterization. Mucus retention occurred regularly in 10 patients, six had chronic diarrhoea, four had latent bowel obstruction, one developed a bladder stone, one an incisional hernia and one developed patch necrosis and perforation. Twenty‐seven patients (53%) were happy with the outcome of the procedure while 20 (39%) were not; four patients were unsure whether a change had occurred.Conclusion Augmentation ileocystoplasty is a valuable alternative for women with intractable urge incontinence. However, these patients and their physicians should be aware of its limitations, specifically the possibility that incontinence may persist and the high probability of the need for self‐catheterization, with potential subsequent urinary tract infection.
Urodynamic findings in patients with urogenital fistulae
Authors: Hilton  
Published: March 2003

Objective To assess the feasibility of carrying out a urodynamic investigation in patients with a urogenital fistula and to establish the incidence of abnormal lower urinary tract function in such patients.Patients and methods Of 38 patients referred within the last 3 years with a diagnosis of lower urinary tract genital fistula, 30 were investigated by dual‐channel subtracted cystometry before surgical treatment of their fistula; in addition, urethral pressure profilometry was carried out in 19 patients. Fourteen of the patients had fistulae into the vaginal vault; the urodynamic findings in this subgroup were compared with those of 12 patients with bladder neck and urethrovaginal fistulae. Twenty‐six of the 30 patients underwent surgical treatment and 24 (92%) were cured anatomically by their first procedure. Ten patients complained of residual lower urinary tract symptoms and were re‐investigated.Results Of the 38 patients, 47% had genuine stress incontinence, 40% showed systolic detrusor instability and 17% impaired bladder compliance. Half had evidence of voiding dysfunction; most appeared to be of a hypotonic detrusor type, although four cases showed an obstructive pattern. Fifteen patients had more than one abnormality and only five (17%) had entirely normal urodynamic findings. The overall incidence of functional abnormality was highest in the patients with urethral or bladder neck fistulae, with only one showing entirely normal urodynamic findings. Genuine stress incontinence was found more than twice as often associated with urethral or bladder neck fistulae and detrusor instability was also more common in this group. Voiding dysfunction of both hypotonic and obstructive types was found equally in the two groups. After surgical treatment, most patients became continent and free from lower urinary tract symptoms, although one complained of residual stress incontinence and nine of urgency or urge incontinence. Of the latter, six were found to have detrusor instability, one after repair of vault fistula, three after urethral or bladder neck fistulae and the other two after mid‐vaginal fistulae.Conclusion There is a high incidence of abnormal lower urinary tract function in patients with urogenital fistulae. Patients with urethral or bladder neck fistulae had a higher incidence of both detrusor instability and genuine stress incontinence than those with fistulae into the vaginal vault. Many of these abnormalities appear to resolve after successful repair of the fistula, although detrusor instability may persist and require further treatment in some women. These findings are relevant to the counselling of patients before repair and may be of medico‐legal significance.
Functional rat bladder regeneration through xenotransplantation of the bladder acellular matrix graft
Authors: Piechota  , Dahms  , Probst  , Gleason  , Nunes  , Dahiya  , Lue  , Tanagho  
Published: March 2003

Objective To determine the decreased antigenicity of the bladder acellular matrix graft (BAMG) through xenotransplantation and to assess the in vivo and in vitro functional properties of the rat urinary bladder thus regenerated.Materials and methods After partial cystectomy (>50%), BAMGs prepared from hamster, rabbit and dog urinary bladders were grafted to male and female Sprague‐Dawley rats; 10 control rats underwent partial cystectomy only. Urinary storage and voiding function were monitored in 15 animals using a specially designed ‘micturition cage’ and cystometry. After 4 months, organ‐bath studies and histological techniques were used to evaluate bladder regeneration in vitro in the grafted animals.Results Clinically relevant antigenicity was not evident; no animal died from rejection and all bladder wall components regenerated in all BAMG xenografts. However, the degree and quality of regeneration varied. Muscularization, peak pressure, and bladder capacity were higher in the hamster BAMG‐grafted animals, whereas in vitro contractility and compliance were best in the dog BAMG‐regenerated bladders. All grafted bladders had significantly better capacity and compliance than the autoregenerated bladders after partial cystectomy alone.Conclusions The present in vivo and in vitro studies show that BAMG‐augmentation cystoplasty can lead to morphological and functional regeneration of the rat bladder, preserving its low‐pressure reservoir function. Because BAMG‐regenerated bladders show functional innervation that is similar to normal bladders, they can work in coordination with the host bladder components, thus generating adequate intravesical pressure to produce sustained voiding. The decreased antigenicity makes heterologous BAMG transplants feasible without immunosuppression.
British urological surgery practice: 2. Renal, bladder
Authors: Bower  , MA  , Savage  , Abel  , Waxman  
Published: March 2003

Objective To investigate the management of urological malignancies in the United Kingdom.Methods A postal survey of consultant urologists and general surgeons with an interest in urology was conducted to examine current clinical practice in urological malignancies.Results Completed questionnaires were received from 273 consultant surgeons who saw an estimated total of 13 241 new patients with renal, bladder or testis cancer per year; 82% had access to on‐site oncology services and in general there was a consensus in the answers given. Most respondents advised active treatment of an asymptomatic primary renal cancer in the presence of metastases and a significant proportion of patients with metastases were not prescribed immunotherapy nor were offered a multidisciplinary approach for their condition. Forty‐six per cent of patients with testis cancer received no advice to store sperm before chemotherapy and there were varied opinions as to the need for surgical resection of residual masses after completion of chemotherapy.Conclusion This survey showed minor variations in the management of renal, bladder and testis tumours in the UK. Consensus management guidelines for urological malignancies and a change in the working relationships between urologists and oncologists is required, to improve the outcome of patients with urological malignancy.