bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes to the treatment of chronic anal fissure in ano after failed medical treatment
Authors: Karandikar S. , Brown G. M. , Carr N. D. , Beynon J. 
Published: November 2003

AbstractObjective  The treatment of chronic fissure may be medical or surgical. Indications for assessment, which is the better treatment and under what circumstances, are vital for the appropriate management. The aim of the study was to assess the management of this condition by an expert group of surgeons.Methods  Consultant members of the Association of Coloproctology of Great Britain and Ireland (n = 452) were approached and requested to answer a preset multiple‐choice questionnaire. The questionnaire was designed to assess their management strategy and their approach to investigation and treatment under different clinical situations.Results  The overall response was 78% (n = 356). Medical treatment was the first line treatment in 95% of the responders. Lateral anal sphincterotomy without pre‐operative endoanal ultrasound and/or anorectal physiology was performed by 57%. Anal dilatation was performed selectively by 36% but only 35% of these would perform a pre‐operative endoanal ultrasound or anorectal physiology.Conclusion  In the selected group of clinicians lateral anal sphincterotomy remains the procedure of choice in both sexes. Pre‐operative assessment using endoanal ultrasound and anorectal physiology is used selectively especially in postpartum women. Anal dilatation remains a subjective procedure and though used selectively, is performed without pre‐operative endoanal ultrasound and/or anorectal physiology in majority of cases.
Laparoscopy and its current role in the management of colorectal disease
Authors: Chung C. C. , Tsang W. W. C. , Kwok S. Y. , Li M. K. W. 
Published: November 2003

AbstractObjective  To evaluate the current place of laparoscopy in the management of colorectal disease.Method  A literature search was undertaken on Medline between the period 1991 and 2002.Results  From the literature there is good evidence that the laparoscopic approach is associated with at least some short‐term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long‐term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter‐saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions.Conclusion  The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.
Altered electrical properties of bladder smooth muscle in streptozotocin‐induced diabetic rats
Authors: Hashitani H. , Suzuki H. 
Published: November 2003

Objective To examine the alterations in the electrical properties of bladder smooth muscle in rats with diabetes mellitus (DM) induced by streptozotocin. Materials and methods The study comprised 34 control rats and 20 with DM induced experimentally by injection with streptozotocin. At 10–15 weeks after the induction of DM, control and treated rats were killed, the bladder removed and the electrical responses of membranes from the detrusor smooth muscle recorded using intracellular microelectrodes. Results The resting membrane potential of the smooth muscle remained unaltered by DM but the frequency of spontaneous spike discharges sensitive to nicardipine was decreased. Transmural nerve stimulation elicited a purinergic excitatory junction potential (EJP) in muscles from both types of rat, but the threshold intensity of stimulation required to evoke an EJP was higher in muscle from the diabetic rat. Furthermore, EJPs large enough to trigger a nicardipine‐sensitive spike potential could be elicited easily in muscles from the control rat, but not in muscles from diabetic rats. Stimulation of muscarinic receptors with exogenous acetylcholine (ACh) caused greater depolarization in muscle from diabetic rats. Stimulation of purinergic receptors with α,β‐methylene ATP caused a similar depolarization in both groups of rats. Application of potassium‐free solution or ouabain depolarized the membrane by about 9 mV or 5 mV, respectively, in muscles from both groups of rat. Removal of potassium‐free solution produced an ouabain‐sensitive transient hyperpolarization which was larger in muscle from control rats, indicating that the potency of the Na‐K pump was weakened in rats with DM. Conclusion In the detrusor smooth muscle of rats with DM, there were fewer spontaneous spike discharges, supersensitivity of post‐junctional muscarinic receptors, reduced potency of the post‐junctional Na‐K pump and a decrease in the release of neurotransmitter, possibly due to the impairment of pre‐junctional activity.
The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing
Authors: Jackson S. , Donovan J. , Brookes S. , Eckford S. , Swithinbank L. , Abrams P. 
Published: November 2003

Objective To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome. Patients, subjects and methods Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of ‘bother’ that symptoms were causing. Eighty‐five women with clinical symptoms attending for urodynamic assessment and 20 women with nonewere asked to self‐complete the questionnaire. The instrument's validity was assessed by interviewing patients and measuring levels of missing data, comparing symptom scores between clinical and non‐clinical populations and comparison with frequency/volume charts and data from pad tests. The instrument's reliability was assessed by measuring both internal consistency and stability, using a 2‐week test‐retest analysis. Results The questionnaire was completed by the patients with a mean of only 2% of items missing; most questions were easily understood. Construct validity was good, with the instrument easily differentiating clinical and non‐clinical populations. Criterion validity, as tested against frequency/volume charts and pad‐test data, was acceptable, with Kappa coefficients of 0.29–0.79 for frequency/volume data and Spearman rank correlations of 0.50–0.97 and 0.31–0.67 for frequency/volume and pad‐test data, respectively. The reliability of the instrument was good; a Cronbach's alpha of 0.78 indicated that the symptom questions had high internal consistency, while stability was excellent, with 78% of symptoms and problems answered identically on two occasions, and Spearman rank correlations of 0.86 and 0.90, respectively. Conclusion The instrument has good psychometric validity and reliability. The stability demonstrated at baseline and the ability to differentiate clearly between community and clinical populations suggest that it should be ideal for measuring changes following therapeutic intervention. The addition of life‐impact items and a ‘bother’ factor may provide the opportunity to identify those women who wish treatment for their symptoms; this dimension requires further exploration.
Incidentally detected renal cell carcinoma
Authors: Rodríguez‐Rubio F.I. , Díez‐Caballero F. , Martín‐Marquina A. , Abad J.I. , Berián J.M. 
Published: November 2003

Objectives To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC. Patients and methods In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n=55) or whether the renal tumour was suspected (n=102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses. Results There were significant differences between the groups in the number of patients with T2 (P<0.001), T3a (P<0.05), T3b (P<0.01), T4 (P<0.05) and M1 (P<0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1–2 tumours (P<0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P<0.001) in the distribution of survival in the two groups. Conclusion The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1–2), we consider that grade, size and particularly pathological stage determine the better prognosis.
Transplantation of horseshoe kidneys: a report of four cases
Authors: Botta G.C. , Capocasale E. , Mazzoni M.P. 
Published: November 2003

Objective To increase the awareness of the successful use of horseshoe kidneys in renal transplantation.Patients and methods Two donors were found to have horseshoe kidneys; these were divided at the midline and transplanted into four recipients.Results All four recipients had a delayed return of renal function; all eventually functioned with no complications related to the horseshoe kidney.Conclusion Transplantation of horseshoe kidneys has been performed infrequently but they should be considered as suitable for transplants, considering the shortage of cadaver donors and, when possible, should be divided at the isthmus and the halves transplanted into two recipients.
Staging with computed tomography, transrectal ultrasonography and transurethral resection of bladder tumour: comparison with final pathological stage in invasive bladder carcinoma
Authors: Yaman Ö. , Baltaci S. , Arikan N. , Yilmaz E. , Gögüs O. 
Published: November 2003

Objective To assess the accuracy of clinical staging methods in patients with locally advanced bladder cancer.Patients and methods Sixty‐five patients with invasive bladder cancer primarily staged using transrectal ultrasonography (TRUS), computed tomography (CT) and transurethral resection of the bladder tumour (TURBT) were compared with the final pathological stage determined after radical cystectomy.Results Accurate staging was obtained by TRUS, CT and TURBT in 40, 35 and 46% of the patients, respectively. The rank correlation between primary clinical stage and final pathological stages was significant by all three methods, but not close.Conclusions The results of this study raise doubts about the assumed benefit of TRUS and CT in the clinical staging of invasive bladder tumours. These methods did not improve the findings obtained by TURBT alone.
Conservative management of stage T2 or T3a bladder cancer with deep transurethral resection followed by four cycles of chemotherapy
Authors: Uygur M.C. , Yaman I. , Altug U. , Erol D. 
Published: November 2003

Objective To evaluate the efficacy of the conservative management of stage T2 and T3a bladder cancer with deep (radical) transurethral resection (TUR) followed by four cycles of chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin (MVEC) and its impact on bladder preservation and tumour recurrences.Patients and methodsBetween May 1990 and June 1995, 19 patients with stage T2 or T3a transitional cell carcinoma of the bladder who refused radical cystectomy entered the study. The patients were re‐evaluated 4 weeks after completion of the treatment by cystoscopy, TUR of the tumour site and multiple deep bladder biopsies. The patients were maintained on periodic local and systemic surveillance with cystoscopy and deep biopsy every 3 months, and annual intravenous urography and computed tomography.ResultsSeventeen patients completed the treatment protocol; 13 patients were tumour‐free at the first evaluation after treatment and six of these had tumour recurrences in the bladder during surveillance. Eleven patients retained their bladder in a functional state for a mean duration of 36 months (range 12–62+) and seven of them remain free of recurrence after a mean duration of 41 months (range 8–58+).Conclusion Deep TUR of the bladder tumour followed by four cycles of MVEC chemotherapy is an effective alternative in the conservative management of patients with stage T2 and T3a bladder cancer. We suggest this protocol for patients who refuse or are unsuitable for surgery.
Risk factors and mechanism of urethral injury in pelvic fractures
Authors: Koraitim M.M. , Marzouk M.E. , Atta M.A. , Orabi S.S. 
Published: November 2003

Objective To determine the risk factors and mechanism of urethral injury associated with pelvic fractures. Patients and methods A total of 203 consecutive male patients with pelvic fracture were studied prospectively, including a clinical examination, radiographic examination of the pelvis, excretory urography and retrograde urethrography. Results Thirty‐nine (19%) patients had urethral injury, five (2.5%) had bladder injury and 12 (6%) had combined urethral and bladder injuries. Urethral injury was by stretching of the intact membranous urethra in 13 patients (25.5%), partial rupture in 13 (25.5%) and complete rupture in 25 (49%). Injury involved the prostatic urethra and bladder neck in three children. Urethral injury was consistently associated with pubic arch fractures. Involvement of the posterior pelvic arch, with fractures of the anterior arch, considerably increased the risk of urethral injury. Also, the risk was greater with an increase in the number of broken rami. Conclusion The highest risk of urethral injury was found in cases with straddle fracture when combined with diastasis of the sacroiliac joint (24 times more than the rest of pelvic fractures); this was followed by straddle fracture alone (3.85 times) and Malgaigne's fracture (3.4 times). Stretching of the membranous urethra usually precedes its rupture, which classically occurs at the bulbomembranous junction.
Video‐resection does not stop corneal contamination during transurethral resection of the prostate
Authors: Muir G.H. , Davies J.H. 
Published: November 2003

Objectives To determine the efficacy of video‐resection systems in reducing the risk of corneal contamination during transurethral resection of the prostate (TURP) and thus in decreasing the possibility of transmission of blood‐borne diseases from the patient. Materials and methods After performing a TURP using a video camera system in 30 patients, the number of potential corneal droplets was measured for one operator wearing a pair of spectacles and, for a second operator, over an identically sized area of a standard disposable plastic eyeshield. Results In 20 (67%) of cases, droplets were observed on the eye protection, correlating with potential corneal contamination. Splashes were also seen on the face‐mask of the eyeshield. Conclusion Urologists should use eye and face protection when performing TURP using a video system.
Orgasm after radical prostatectomy
Authors: Koeman M. , Van Driel M.F. , Weijmar Schultz W.C.M. , Mensink H.J.A. 
Published: November 2003

Objective To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy. Patients and methods The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56–76) using a semi‐structured interview and a self‐administered questionnaire. In addition, the patients were asked to write a brief statement about their experiences and sensations during orgasm before and after the operation. Results Eighteen patients returned the questionnaire and 17 completed a statement indicating what their orgasm was like before and after radical prostatectomy. After the operation, no patient was able to maintain a completely rigid erection, but for five patients the erection was sufficient for sexual intercourse. Nine patients used a vacuum device or intracavernosal self‐injection. Half the patients reported diminished sexual desire (libido) and arousal after the operation and reported the same to occur in their partners. During their ‘dry’ orgasm post‐operatively, none of the patients experienced the exquisite sensation of inevitability, the so‐called ‘point of no return’. Seven of the 14 patients experiencing orgasm complained that their orgasmic sensation was weakened. Four patients reported normal pleasure and sensation compared to that experienced pre‐operatively. Surprisingly, nine of the 14 patients had involuntary loss of urine at orgasm; for five of them this was sufficient reason to avoid any sexual contact with their partner. Conclusion Radical prostatectomy may have serious consequences on libido and erectile function but sometimes other important factors, such as the absence of prostate and seminal vesicle contractions, the loss of ejaculation and involuntary loss of urine, may also compromise the orgasm.
Epidermoid cysts of the testis: diagnosis by ultrasonography and magnetic resonance imaging resulting in organ‐preserving surgery
Authors: Fu Y.‐T. , Wang H.‐H. , Yang T.‐H. , Chang S.‐Y. , Ma C.‐P. 
Published: November 2003

Objective To present experience in the diagnosis and management of patients with an epidermoid cyst of the testes and to confirm the role of conservative surgery. Patients and methods The records from the last 26.5 years of patients diagnosed as having a testicular tumour were reviewed retrospectively. Those patients with a confirmed epidermoid cyst were evaluated for age, clinical assessment, methods of diagnosis, treatment and follow‐up. Results Amongst a total of 131 testicular tumours, 11 patients (8.4%; mean age 25.7 years, range 21–35) were diagnosed pathologically as having an epidermoid cyst. Pre‐operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in six patients and supplemented with magnetic resonance imaging (MRI) in one. An operation sparing the testicles was performed in eight patients after the diagnosis of epidermoid cyst was confirmed from frozen sections. Three patients were treated by radical orchidectomy. There were no relapses after a median follow‐up of 47.3 months (range 2–82). Conclusion In this series, the relative incidence of epidermoid cyst was higher than that reported in the literature (1–2%). Ultrasonography and MRI of the testes may allow the diagnosis to be made pre‐operatively. The absence of relapse in these patients further supports the use of organ‐sparing surgery in these young men.
Reduction of urinary basic fibroblast growth factor using pentosan polysulphate sodium
Authors: Barrington J.W. , Fulford S. , Fraylin L. , Fish R. , Shelley M. , Stephenson T.P. 
Published: November 2003

Objective To evaluate the use of pentosan polysulphate sodium (PPS) to reduce the level of urinary basic fibroblast growth factor (bFGF). Patients and methods Forty‐one patients with a clam enterocystoplasty were randomized to receive either 200 mg three times daily of oral PPS (n=21) or placebo (n=20) for 6 weeks. Three patients acted as a cross‐over study. Urinary bFGF was measured before and after treatment and the degree of symptomatic benefit assessed using a questionnaire. Results There was no reduction in bFGF in the patients receiving placebo (P=0.235) but there was a statistically significant reduction in bFGF (P=0.0251) in the patients receiving PPS, most of whom were symptomatically improved, especially with regard to mucus production. Conclusion PPS may have a role in reducing urinary bFGF in patients with bladder tumours or following an enterocystoplasty and also in improving the quality of life of patients with a clam enterocystoplasty.
Assessment of alternative tissue approximation techniques for laparoscopy
Authors: Eden C.G. , Coptcoat M.J. 
Published: November 2003

Objective To investigate the feasibility and results of applying alternative techniques of tissue approximation for experimental urothelial re‐anastomosis in an open and laparoscopic setting.Materials and methods The study was carried out in two phases; in phase 1, an open porcine ureteric re‐anastomosis was performed using gelatin/resorcin/formaldehyde (GRF) glue, fibrin glue or potassium‐titanyl‐phosphate laser tissue‐welding with a fluorescein‐doped human albumin solder. The anastomoses were assessed both immediately, by leak pressure, and by the operating time, upper tract urodynamic studies and light and scanning electron microscopy, 6 weeks after surgery. In phase 2, the best technique from phase 1 was compared with sutured controls for porcine retroperitoneoscopic dismembered pyeloplasty, using the same assessment criteria.Results In phase 1, GRF glue produced adhesion which was insufficiently flexible to withstand rotation of the anastomosis and this technique was therefore abandoned. Fibrin‐glued anastomoses withstood leak pressures equal to those from laser‐welding (P=0.91) and gave similar changes in maximum pressure with a Whitaker test at 6 weeks (P=0.30), but were superior in requiring a shorter operating time (P=0.02) and in their electron and light microscopic appearances. In phase 2, fibrin glue gave similar changes in maximum pressure with a Whitaker test to those from polyglactin 910 sutures (P=0.51) but withstood higher leak pressures (P=0.01), had a shorter operating time (P=0.01) and had superior electron and light microscopic appearances.Conclusion Fibrin glue produced effective experimental laparoscopic pelvi‐ureteric anastomoses within less operating time than did sutured controls. Such anastomoses withstood supra‐physiological pressures, with no evidence of functional obstruction and with a more favourable histological result after 6 weeks. Laparoscopic evaluation of this modality in a clinical setting is now justified.
Penile prostheses in paraplegic men
Authors: Gross A.J. , Sauerwein D.H. , Kutzenberger J. , Ringert R.‐H. 
Published: November 2003

Objectives To determine the efficacy of penile prostheses in paraplegic men.Patients and methods Between 1980 and 1992, penile prostheses were implanted in 209 paralysed men of whom the records of 179 were evaluable. The indication for implantation was erectile dysfunction, penile retraction, or a combination of the two.Results The outcome of the implantation of semi‐rigid prostheses was worse than that of semi‐flexible or flexible prostheses. Antibiotic treatment and body disinfection reduced the infection rate to below that in a normal population. The results were satisfactory for patients with either problem and patients treated successfully for erectile dysfunction became more self‐confident.Conclusions When paraplegic patients are able to regain sexual activity after successful implantation of a penile prosthesis, their self‐confidence is increased. Prostheses might also be useful for patients who will not accept self‐injection and for those using external condom drainage. Penile prostheses clearly have a place in the treatment of paralysed men.