bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angiotensin II in child urinary bladder: functional and autoradiographic studies
Authors: Lam D.S.H. , Dias L.S. , Moore K.H. , Burcher E. 
Published: March 2003

Objectives To investigate the receptors for angiotensin II (AII, reported to be a potent contractile agent in human urinary bladder), using functional and autoradiographic techniques in child and adult bladder specimens. Materials and methods Bladder specimens were obtained from 61 children (aged 4 months to 12 years) undergoing ureteric reimplantation for vesico‐ureteric reflux, and from 10 adults undergoing cystectomy. After overnight storage, the mucosa was removed and isometric contractions obtained from detrusor muscle strips in the presence of phosphoramidon (10 µmol/L). Only one concentration of AII was added to each preparation because of tachyphylaxis. The response to KCl (124 mmol/L) was 43% of that to carbachol (100 µmol/L). Sections of child bladder were radio‐labelled with the ligand [125I]Sar1,Ile8‐AII and binding sites visualized using emulsion autoradio‐ graphy. Results The potency of AII was similar in child and adult detrusor strips, with mean (
sem) pD2 values of 6.9 (1.0) (n = 25) and 6.7 (0.2) (n = 9) respectively, and the maximum responses (to 10 µmol/L AII) rather low (39% and 49%, respectively, P > 0.05), compared with carbachol (100 µmol/L). There were no age‐ or gender‐related differences. Responses to AII in strips from children under 3 years old were antagonized by the AT1 receptor antagonist losartan (1 µmol/L) but not by the AT2 receptor antagonist PD 123319 (1 µmol/L), indicating interaction with the AT1 receptor. Sections of child bladder radiolabelled with [125I]Sar1,Ile8‐AII showed moderate specific binding over detrusor muscle and arterioles, with denser specific binding over subepithelial blood vessels. Specific binding was inhibited by co‐incubation with losartan (10 µmol/L) but not with PD 123319 (10 µmol/L). Conclusion AII was a weak contractile agent of detrusor strips, with no significant differences in potency between child and adult bladder samples. These data show the presence of functional AT1 but not AT2 receptors in child detrusor smooth muscle.
Five‐year data from the Oxford Laser Prostatectomy Trial
Authors: Keoghane S.R. , Sullivan M.E. , Doll H.A. , Kourambas J. , Cranston D.W. 
Published: March 2003

Objective To evaluate the natural history of a group of patients who underwent contact laser prostatectomy or transurethral resection of the prostate (TURP). Patients and methods Patients were followed up at 5 years after enrolling in a prospective double‐blind randomized controlled trial of TURP vs contact laser prostatectomy. Results Of the initial trial patients, 11.5% had died (seven in the laser and 10 in the TURP arm) and eight (5.4%) were too incapacitated by coexistent medical disease to respond to the questionnaires. Thirty‐eight patients were not available for follow‐up, despite numerous invitations. Thirteen of the laser patients (18%) and 11 of the TURP patients (14.5%) had undergone re‐operation. Two patients from each arm had received α‐blockers for worsening symptoms. Conclusions Five years after prostatic surgery, a significant number of patients were dead or disabled by coexistent medical disease. The re‐operation rate after TURP and contact laser prostatectomy were similar.
Semen analysis after vasectomy: when and how many?
Authors: Badrakumar C. , Gogoi N.K. , SundAram S.K. 
Published: March 2003

Objective To assess patient compliance for semen analysis after vasectomy, and to determine the timing and number of semen analyses required to confirm sterility. Patients and methods The study included 1321 men who underwent vasectomy between October 1995 and June 1998. They were followed up in two groups; in group 1 (one‐test method) 961 consecutive patients were asked to provide a semen sample for analysis 4 months after vasectomy. Sterility was defined as the absence of sperm in one sample. If sperm were present in the sample, the test was repeated at monthly intervals until there were no sperm. In group 2 (two‐test method) 360 consecutive patients were advised to provide semen samples 3 and 4 months after vasectomy. The absence of sperm in two consecutive samples was defined as the criterion to declare the man azoospermic. The presence of sperm in one sample required further samples every month until two consecutive azoospermic samples were produced. Results In group 1, 810 patients provided semen samples, of which 783 (97%) had no sperm and the men were thus declared azoospermic. The remaining 27 (3%) samples contained sperm; six men withdrew from follow‐up at various times but 21 patients produced a negative sample at some time within 7 months and were declared azoospermic. At the end of the follow‐up, 804 (84%) patients had been declared azoospermic. In group 2, 294 (82%) patients provided a semen sample after 3 months but only 259 (72%) did so after 4 months. Of the patients providing the first sample, 287 (98%) were azoospermic, and after the second 252 (97%) were azoospermic. At the end of the follow‐up 255 (71%) patients were declared azoospermic. There was no reported paternity in any of the men. Conclusion These results suggest that compliance was better in group 1; when the patients in group 2 were asked to provide a second sample the compliance decreased significantly. The percentage of patients producing an azoospermic sample was similar for semen provided after 3 and 4 months. Thus, provided that the patient is adequately warned about the risk of failure of the vasectomy at any time during his life, a single semen analysis after 3 months is sufficient grounds for discontinuing other contraceptive precautions.
Testicular microlithiasis in a UK population: its incidence, associations and follow‐up
Authors: Skyrme R.J. , Fenn N.J. , Jones A.R. , Bowsher W.G. 
Published: March 2003

Objectives To determine the incidence of testicular microlithiasis in men presenting for testicular ultrasonography, to identify any associated pathology (with particular reference to testicular neoplasia) and to report the follow‐up of those patients in whom testicular microlithiasis was identified. Patients and methods In this retrospective study, the results of all testicular ultrasonography undertaken between July 1995 and March 1998 in a district general hospital were reviewed. The records of all patients diagnosed ultrasonographically to have testicular microlithiasis were retrieved and the pathology database was accessed for all testicular tumours diagnosed in the same period. Results During the study period 2215 scans were taken; 34 cases of testicular microlithiasis were identified, giving an incidence of 1.4%. Thirty‐one testicular tumours were removed during the same period. Of the 34 cases with testicular microlithiasis, five had histologically confirmed testicular tumours (15%). The incidence of testicular tumours in the scans showing no microlithiasis was 26 in 2181 (1.1%). The differential incidence of tumours in the two groups is statistically significant (P < 0.001, chi‐square analysis). Patients with testicular microlithiasis but no tumour were followed up for a median (range) of 41 (19–54) months; no interval tumours have developed to date. Conclusion This study confirms an incidence of testicular microlithiasis comparable with that in other reported series, albeit in a selected population. There was a strong association between testicular microlithiasis and testicular tumours. Whether this is a causal relationship has yet to be determined. Careful clinical and ultrasonographic follow‐up of these patients is therefore recommended until the significance of testicular microlithiasis is clear.
The influence of prostate volume on the prostate‐specific antigen (PSA) level adjusted for the transition zone volume and free‐to‐total PSA ratio: a prospective study
Authors: Moon D.G. , Yu J.W. , Lee J.G. , Kim J.J. , Koh S.K. , Cheon J. 
Published: March 2003

Objectives To evaluate the influence of prostate volume on the prostate‐specific antigen (PSA) level adjusted for the transition zone volume (PSAT) and free‐to‐total PSA ratio (f/tPSA) in detecting prostate cancer in men with intermediate PSA levels of 4.1–10.0 ng/mL. Patients and methods From March 1997 to June 1999, the f/tPSA and PSAT were measured in 105 patients who underwent ultrasound‐guided systemic biopsies and had a PSA level of 4.1–10.0 ng/mL, with an apparently normal prostate on a digital rectal examination. The PSAT and f/tPSA were evaluated in all patients and in subgroups of patients with small (< 40 mL) or large ( 40 mL) prostates, using receiver operating characteristic (ROC) curves. Results Total prostate volume was highly correlated with transition zone volume in all patients and in both subgroups (P < 0.001). In all 105 patients, PSAT had a sensitivity of 82% and its use would have avoided the largest number of unnecessary biopsies (87% specificity) at a threshold value of 0.35 ng. In men with small prostates f/tPSA and PSAT had a high sensitivity and specificity, at threshold values of 0.12 and 0.35 ng, respectively. In large prostates the PSAT was superior to f/tPSA in detecting prostate cancer. Conclusions These results suggest that both f/tPSA and PSAT are useful in detecting prostate cancer in men with small prostates, while PSAT is superior to f/tPSA in detecting prostate cancer in men with large prostates.
The role of adrenomedullin in varicocele and impotence
Authors: Ozbek E. , Yurekli M. , Soylu A. , Davarci M. , Balbay M.D. 
Published: March 2003

Objective To assess the levels of adrenomedullin (a vasodilatory peptide) in penile blood before and after injection with papaverine in impotent men, and in the internal spermatic vein in infertile patients with varicocele, comparing the results with levels in the brachial vein in the same patients. Patients and methods Intracavernosal levels of adrenomedullin were determined in 14 impotent men (with no vascular pathology, as assessed by colour Doppler ultrasonography) before and after papaverine‐induced penile erection. The effect of needle puncture alone was assessed in eight control patients. The level of adrenomedullin was also measured in the internal spermatic vein and brachial vein in 14 infertile men with varicocele. Results The mean (
sd) intracavernosal adrenomedullin levels in the 14 impotent men were significantly different between the flaccid and papaverine‐induced erectile state, at 93.5 (33.0) and 135.8 (34.9) pmol/mL, respectively, (P < 0.05). Needle puncture alone had no effect on adrenomedullin levels. In men with varicocele, the adrenomedullin level of 139.0 (34.3) pmol/mL within the internal spermatic vein was significantly higher than that in the brachial vein, at 103.9 (37.6) pmol/mL (P < 0.05). Conclusion Injection with papaverine increases adrenomedullin release into penile blood; this release may be responsible for the increase in penile blood flow and penile erection. Higher levels of adrenomedullin within the internal spermatic vein of patients with varicocele may result from the retrograde flow of venous blood from the left adrenal gland and kidney. Further studies are needed to determine the role of adrenomedullin in male infertility and impotence.
Combined bladder neck, urethral and penile reconstruction in boys with the exstrophy‐epispadias complex
Authors: Baka‐Jakubiak M. 
Published: March 2003

Objective To describe a one‐stage combined bladder neck, urethral and penile reconstruction for achieving urinary continence and creating a penis with good cosmesis and function in boys with the exstrophy‐epispadias complex. Patients and methods Seventy‐three boys underwent the combined procedure, including 36 after classic bladder exstrophy closure and 37 with epispadias. All were completely incontinent at the time of combined reconstruction. The bladder capacity just before surgery was 70–180 mL and was greater in those with epispadias. The boys were 2.5–11 years old, with those in the exstrophy group being slightly older. Results Thirty‐three boys (89%) with epispadias were completely continent during the day but 15 had episodes of nocturnal enuresis. Of boys with classic exstrophy, 27 (75%) were continent during the day but nine had occasional nocturnal enuresis. Eleven boys required intermittent catheterization, which they found easy to perform. In seven boys (10%) a urethrocutaneous fistula or urethral stricture developed. Conclusions Combined bladder neck, urethral and penile reconstruction can be carried out as a one‐stage procedure in selected patients with adequate bladder capacity. Reconstruction of the whole length of the urethra facilitates intermittent catheterization.
Insulin‐like growth factor II and androgen receptor expression in the prostate
Authors: Gnanapragasam V.J. , Mccahy P.J. , Neal D.E. , Robson C.N. 
Published: March 2003

Objective To determine the effect of insulin‐like growth factor (IGF)‐II on androgen receptor (AR) expression in prostate tissue, as IGFs may be important in re‐activating androgen‐regulated genes in advanced prostate cancer because they can trans‐activate the AR in the absence of ligand. Materials and methods Primary BPH stromal cells, LNCaP and U2OS cells were grown in full medium, medium devoid of growth factors and devoid medium supplemented with IGF‐II. The relationship between IGF‐II and AR expression was then investigated using the reverse‐transcription polymerase chain reaction, and the effects of anti‐androgens on IGF‐II expression assessed using northern blot analysis. Results IGF‐II had no effect in benign tissue, but the AR expression doubled in LNCaP and U2OS cells after culture with IGF‐II. Androgens had a minimal effect on IGF‐II mRNA levels, but anti‐androgens reduced IGF‐II mRNA levels by more than half. Conclusion These findings support the idea of a complementary paracrine (IGF) and autocrine (androgen) growth loop in prostate tissue. The study suggests that IGF‐II has a role in regulating AR expression in prostate cancer cells, and that the action of anti‐androgens is mediated partly by an ability to suppress IGF‐II expression.
A 3‐year follow‐up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy
Authors: Hammadeh M.Y. , Madaan S. , Singh M. , Philp T. 
Published: March 2003

Objective To compare the safety, efficacy and durability of transurethral electrovaporization of the prostate (TUVP) with standard transurethral resection of the prostate (TURP). Patients and methods In all, 104 patients admitted from the waiting list for surgery for BPH were randomized to either TUVP (52 patients, mean age 67.5 years) or TURP (52 patients, mean age 70.2 years); 51, 47 and 40 patients in each arm completed 1, 2 and 3 years of follow‐up, respectively. Patients were assessed at baseline and during the follow‐up using the International Prostate Symptom Score (IPSS), the associated quality‐of‐life score (QoL), postvoid residual volume (PVR) and maximum urinary flow rate (Qmax). Results Both groups had comparable mean IPSS, QoL, Qmax and PVR at baseline. The mean (
sd) values for TUVP and TURP, respectively, at 3 years showed a significant and maintained improvement in IPSS, at 4.1 (3.3) and 7.1 (6.2) (P = 0.01), in QoL, at 1.0 (0.9) and 1.6 (1.4) (P = 0.04), and in Qmax, at 22.2 (8.5) and 18 (7.1) mL/s (P = 0.02), with decreases in PVR of 30 (38) and 21.9 (26.2) mL (P = 0.27). The re‐operation rate in each group was 4% during the first year, 4% during the second year and 5% during the third year. After surgery and at 1, 2 and 3 years of follow‐up, impotence was reported in 17% of the TUVP group and 11% of the TURP group (P = 0.49), and retrograde ejaculation in 72% of the TUVP group and 89% of the TURP group (P = 0.47). Conclusion The 3‐year follow‐up results confirm that TUVP is as effective as standard TURP in the treatment of moderate‐sized BPH. The long‐term side‐effects and complications were comparable and the initial improvement was maintained over 3 years in most patients in both groups.
Preoperative simulation of partial nephrectomy with three‐dimensional computed tomography
Authors: Wunderlich H. , Reichelt O. , Schubert R. , Zermann D.‐H. , Schubert J. 
Published: March 2003

Objective To evaluate prospectively the accuracy of computer‐aided three‐dimensional (3D) volume‐rendered computed tomography (CT) in determining the appropriate anatomical limits (tumour size, tumour location, multifocality and vascular supply) and as a potential tool in the preoperative simulation of nephron‐sparing surgery (NSS) in patients with small‐volume renal cell carcinoma (RCC). Patients and methods The study included 36 patients who underwent transperitoneal radical nephrectomy for RCC of < 4 cm diameter. Helical CT was undertaken before surgery and the extent of the tumour, the course of major renal arteries and veins, and the relationship of the tumour to the collecting system were shown by 3D volume‐rendered CT. The CT findings were compared with the pathological results of all kidney specimens, obtained using 3‐mm step‐sections. Results Before nephrectomy, 39 renal tumours were identified in the 36 patients; three renal lesions of < 4 mm were not detected. All main venous branches and 42 of 43 arteries were identified by 3D volume‐rendered CT. Knowing these features, a partial nephrectomy was simulated; a surgical lesion to the pelvicalyceal or vascular system which would have been produced by the simulated surgery was displayed in colour on the simulated surface of the section. Conclusion Computer simulation provided an excellent 3D reconstruction of all kidneys, including the tumour, vasculature and renal hilum, allowing a significantly better preoperative evaluation of the renal mass. Visualizing possible resection margins and predicting the operative risks seem to be major advantages of this new method, especially when preparing for complex surgery. Reconstructed 3D CT appears to be a useful tool for defining the indications for and limitations of NSS.
Detecting circulating prostate cells in patients with clinically localized prostate cancer: clinical implications for molecular staging
Authors: Llanes L. , Páez A. , Ferruelo A. , Luján M. , Romero I. , Berenguer A. 
Published: March 2003

Objective To evaluate the clinical utility of using the reverse transcriptase‐polymerase chain reaction (RT‐PCR) to detect prostate‐specific antigen (PSA) mRNA in peripheral blood samples from patients with prostate cancer, as a predictor of extraprostatic disease, and to assess any correlations with known predictive markers of this condition. Patients and methods Immediately before radical prostatectomy, peripheral blood samples were taken from 25 men with clinically localized prostate cancer and analysed for PSA mRNA using RT‐PCR (in ‘hot‐start’ conditions and confirmed using ClaI restriction enzyme). The relationships between PSA mRNA positivity, pathological and clinical features were analysed; PSA mRNA positivity, PSA level and biopsy Gleason score were then compared as predictors of extraprostatic disease. Results There was no relationship between PSA mRNA positivity and pathological stage (pT2 or pT3), and no association between PSA mRNA positivity and serum PSA level, PSA density, the findings on a digital rectal examination or transrectal ultrasonography, and perineural invasion in the prostatic biopsy. However, there was a significant correlation between the Gleason score of the preoperative biopsy and PSA mRNA positivity. The best predictors of extraprostatic disease were the biopsy Gleason score and the PSA level. Conclusion There was no significant advantage in using the RT‐PCR assay of PSA mRNA before surgery to stage prostate cancer and to discriminate between organ‐confined and extraprostatic neoplasms.
A novel antireflux uretero‐ileal anastomosis for urinary diversion: an experimental study
Authors: Fujisawa M. , Isotani S. , Ishimura T. , Yamanaka K. , Arakawa S. , Kamidono S. 
Published: March 2003

Objectives To assess a new antireflux valve technique in a dog model of urinary diversion, and thus provide a reliable and easily constructed antireflux system for an ileal reservoir. Materials and methods In five female beagle dogs, 3 cm of ileum were intussuscepted into the reservoir formed using the adjacent 10 cm of ileum. The intussuscepted ileum was sutured to the reservoir wall after stripping the mucosa of the reservoir in a trapezoidal zone opposite the similarly stripped mucosa of the intussuscepted ileum, to avoid dessusception. After the distal 4 cm of the ureters was united and pulled through the intussuscepted segment of ileum, the combined distal ureter was sutured to the labial edge of the intussuscepted segment. Finally, the reservoir was anastomosed to the bladder as an enterocystoplasty. Dogs were evaluated by ascending cystography and intravenous pyelography at 1 and 6 months. The valve and upper urinary tract were evaluated histopathologically at 6 months. Results In all dogs the antireflux system remained intact and prevented reflux. The intussuscepted ileum was firmly attached to the reservoir wall and the submucosa of each segment was united. The upper urinary tract was normal with no ureteric stenosis. Histopathologically, the ureter was surrounded by intact ileal serosa and showed no inflammation or scarring. Conclusions The very short ileal segment required and the firm attachment of the constructed valve to the reservoir were the advantages of this practical and reliable new antireflux system.
Sacral nerve root stimulation for lower urinary tract dysfunction: overcoming the problem of lead migration
Authors: Carey M. , Fynes M. , Murray C. , Maher C. 
Published: March 2003

Objective To evaluate lead migration for two different test electrodes and the response to trial stimulation of the S3 nerve root during the selection of patients for a sacral neuromodulation implant to manage lower urinary tract dysfunction. Patients and methods Twelve women (mean age 49 years, range 23–79; seven with detrusor instability and five with sensory urgency) undergoing peripheral nerve evaluation for refractory lower urinary tract symptoms were recruited. Urodynamics and a urinary diary were completed before and during test stimulation. Two electrodes (the original 041830–002 and new 3057 models, Medtronics Inc, USA) were inserted under local anaesthesia into the S3 nerve roots bilaterally. The location was determined by the functional response to stimulation. Stimulation was applied for one week using the new lead; a positive response was defined as a subjective improvement (> 50%) in urinary symptoms. Lateral sacral X‐rays were taken after placement and before removing the lead. The distance from the lead tip to the ventral aspect of the S3 sacral foramen was measured by two assessors. Results Ten of the women had a positive response; the mean (range) migration of the new lead (on X‐ray) was 4 (2–11) mm, and of the old lead was 12 (10–45) mm (P = 0.02). Conclusion The response rate to trial stimulation was greater than in previous studies, possibly reflecting reduced migration of the new lead. The new electrode may reduce the number of test failures caused by lead migration rather than no response.