bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relative incidence of detrusor instability and bacterial cystitis detected on the urodynamic‐test day
Authors: Moore K.H. , Simons A. , Mukerjee C. , Lynch W. 
Published: March 2003

Objective To determine whether patients with detrusor instability (DI) were more likely to have bacterial cystitis or significant bacteriuria on the urodynamic‐test day than were women with a stable bladder. Patients and methods A catheter specimen of urine was cultured (overnight in air) from 862 consecutive women at the time of urodynamic testing. The upper urinary tract was imaged, with cystoscopy when indicated, to exclude upper tract lesions or malignancy. The percentage of patients with pure idiopathic DI and those with mixed DI/genuine stress incontinence (GSI), in whom the urine culture was positive, was compared with the percentage who had a stable bladder (pure GSI or urodynamically normal) and a positive urine culture, both for the entire dataset and for women aged > or <65 years. Data were also analysed to detect the converse relationship; in those women found to have bacterial cystitis, the relative risk of being found urodynamically unstable or stable was determined. Results The likelihood of bacterial cystitis occurring in patients with idiopathic DI (5.6%) was significantly greater than that in patients with GSI (1.1%; P = 0.009, Fisher’s exact test). The proportion of patients with DI and significant bacteriuria (15.4%) was significantly greater than that in patients with GSI (7.9%; P = 0.02). In patients with combined pure and mixed DI, bacterial cystitis was significantly more likely to occur (6.3%) than in GSI (P < 0.001), but bacteriuria was no more likely (12.5%, P = 0.09). Conversely, of those women found to have bacterial cystitis, the relative risk of having an unstable bladder was increased (+1.56), but for those with bacteriuria the relative risk of detrusor instability was not increased. Conclusion There was a significant association between idiopathic DI and bacterial cystitis, and we suggest that in some women with an unstable bladder, urinary infection may enhance detrusor contractility. Nevertheless, large‐scale studies are needed of the temporal relationship between the onset of bacterial cystitis and the onset of DI.
Pelvic‐floor therapy and toilet training in young children with dysfunctional voiding and obstipation
Authors: De Paepe H. , Renson C. , Van Laecke E. , Raes A. , Vande Walle J. , Hoebeke P. 
Published: March 2003

Objective To analyse experience in treating young children (4–5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive training programme. Patients and methods Between January 1996 and October 1997, 20 children (all < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic floor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic‐floor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed. Results Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation. Conclusion This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces.
The actions of metabolic inhibition on human detrusor smooth muscle contractility from stable and unstable bladders
Authors: Hockey J.S. , Wu C. , Fry C.H. 
Published: March 2003

Objectives To determine the important cellular site(s) of action of a brief exposure to NaCN (chosen to reduce mitochondrial respiration and hence mimic cellular hypoxia) on the mechanical properties and regulation of intracellular [Ca2+] in human detrusor smooth muscle. Using muscle samples obtained from patients with stable and unstable bladders, to determine whether the unstable bladder is associated with changes in the functional properties of detrusor muscle under these circumstances. Materials and methods Experiments were conducted in vitro on muscle strips or isolated cells. Isometric tension was recorded in muscle strips during electrical stimulation or exposure to agonists. Intracellular [Ca2+] and [H+] were measured by epifluorescence microscopy, and cell autofluorescence measured as an index of mitochondrial function. Results There were no differences in the responses to electrical stimulation and varying concentrations of carbachol in muscle strips from stable and unstable bladders. NaCN (2 mmol/L) reduced the contraction induced by carbachol (10 µmol/L) by a mean (
sd) of 43 (16)% and 56 (15)% in the two groups; the reduction in the unstable was significantly less than in the stable group. NaCN similarly reduced the response to 10 mmol/L caffeine, but had no effect on the KCl‐induced contraction. NaCN significantly increased the resting sarcoplasmic [Ca2+] and attenuated the calcium transients evoked by carbachol and caffeine, but again had no effect on the KCl‐induced transient. The reduction of the carbachol calcium transient was also less in cells from unstable bladders than in those from stable bladders. There was no effect of NaCN on intracellular pH, except for a brief, transient alkalosis. Conclusions NaCN reduces both the contraction and Ca‐transient to carbachol by reducing Ca2+ accumulation by intracellular stores, because the carbachol‐ and caffeine‐evoked responses were similar. Any effect on transmembrane Ca2+ flux was minimal because there was no effect on KCl‐induced responses. The greater resilience of tissue from unstable bladders to acute cellular hypoxia may reflect some adaptation acquired in vivo.
Combined sabal and urtica extract compared with finasteride in men with benign prostatic hyperplasia: analysis of prostate volume and therapeutic outcome
Authors: Sökeland J. 
Published: March 2003

Objective To test the hypothesis that in patients with benign prostatic hyperplasia (BPH), the outcome of drug therapy with finasteride may be predictable from the baseline prostate volume and that positive clinical effects might be expected only in patients with prostate volumes of > 40 mL, using a subgroup analysis of results from a previously reported clinical trial of finasteride and phytotherapy. Patients and methods A subgroup of 431 patients was analysed from a randomized, multicentre, double‐blind clinical trial involving 543 patients with the early stages of BPH. Patients received a fixed combination of extracts of saw palmetto fruit (Serenoa repens) and nettle root (Urtica dioica) (PRO 160/120) or the synthetic 5α‐reductase inhibitor finasteride. The patients assessed had valid ultrasonographic measurements and baseline prostate volumes of either  40 mL or > 40 mL. All 516 patients were included in the safety analysis. The results of the original trial showed equivalent efficacy for both treatments. Results The mean (
sd) maximum urinary flow (the main outcome variable) increased (from baseline values) after 24 weeks by 1.9 (5.6) mL/s with PRO 160/120 and by 2.4 (6.3) mL/s with finasteride. There were no statistically significant group differences (P =  0.52). The subgroups with small prostates ( 40 mL) showed similar improvements, with mean values of 1.8 (5.2) mL/s with PRO 160/120 and 2.7 (7.4) mL/s with finasteride. The mean values for the subgroups with prostates of > 40 mL were similar, at 2.3 (6.1) and 2.2 (5.3) mL/s, respectively. There were improvements in the International Prostate Symptom Score in both treatment groups, with no statistically significant differences. The subgroup analysis showed slightly better results for voiding symptoms in the patients with prostates of > 40 mL, but there were also improvements in the subgroup with smaller prostates. The safety analysis showed that more patients in the finasteride group reported adverse events and also there were more adverse events in this group than in patients treated with PRO 160/120. Conclusion The present analysis showed that the efficacy of both PRO 160/120 and finasteride was equivalent and unrelated to prostate volume. However, PRO 160/120 had better tolerability than finasteride.
The psychological effects of treatments for lower urinary tract symptoms
Authors: Quek K.F. , Low W.Y. , Razack A.H. , Loh C.S. 
Published: March 2003

Objective To assess and evaluate the level of depression, anxiety and psychiatric status in patients with lower urinary tract symptoms (LUTS) before and after treatment by surgery or drugs. Patients and methods The study included 123 patients (mean age 64.6 years,
sd 7.95) with LUTS who were treated medically (with α‐blockers, i.e. terazosin, prazosin, doxazosin and alfuzosin), and 52 patients (mean age 69.6 years,
sd 7.94) with LUTS and confirmed to have benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Both groups were assessed at baseline and 3 months after treatment using standardized questionnaires (the Beck Depression Inventory, the State‐Trait Anxiety Inventory and the General Health Questionnaire‐12). Results Patients before TURP were significantly more depressed, worried and psychiatrically morbid than were those before medical treatment. Three months after medical and surgical treatment, there was significantly less depression, anxiety and psychiatric morbidity in the TURP than in the medicationgroup. Conclusions TURP is a better treatment than medication for minimising anxiety, depression and psychiatric morbidity after treatment in patients with LUTS, but causes greater psychological stress before treatment.
The long‐term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy
Authors: Mcneill S.A. , Chrisofos M. , Tolley D.A. 
Published: March 2003

Objectives To assess the long‐term outcome of the endourological management of upper tract transitional cell carcinoma (TCC) by laparoscopic nephroureterectomy (LNU) or open nephroureterectomy (ONU). Patients and methods The records and pathology reports were reviewed retrospectively for 67 nephroureterectomy specimens (42 obtained by ONU and 25 by LNU). The grade, stage, lymph node status and site of the tumour were recorded for each patient. The primary end‐point of the follow‐up was disease‐related death. Results Overall there was a high proportion of G2 (44%) and G3 (39%) disease, with a significant correlation between increasing grade and stage of TCC (r = 0.74, P < 0.001). Of the 25 patients who underwent LNU, 22 had pelvicalyceal or upper ureteric TCC and conversion to open surgery was required in three (12%). Of the TCCs in this group half were G3 and half were invasive (pT1–3). In the ONU group there were more ureteric tumours because of selection criteria and overall 16 (39%) were G3 and half were invasive. Information on nodal status was available in one LNU and two of the ONU reports. Within a mean follow‐up of 32.9 months for LNU and 42.3 months for ONU, nine (21%) of the ONU group and four (16%) of the LNU group had died, with a mean survival of 15.1 and 17 months, respectively, after surgery (not significant). All of these deaths were associated with G3 pT1–3 disease. Conclusions In this series the case mix and outcomes were similar for those undergoing LNU and ONU. As laparoscopic renal surgery is associated with less postoperative morbidity it would seem reasonable to offer LNU to all patients with upper tract TCC, where appropriate and when there is no evidence of local invasion or metastasis. Because of the strong correlation between grade and stage, preliminary ureteroscopic assessment and biopsy may influence the surgical approach adopted.
A comparison of the histopathological findings after open and percutaneous needle testicular biopsy in adult male rats
Authors: Altay B. , Hekimgil M. , Kefi A. , Girgin C. , Çikili N. 
Published: March 2003

Objective To define the histopathological changes occurring as a result of open and percutaneous needle testicular biopsy in adult rats. Materials and methods Percutaneous needle and open testicular biopsies were taken from 35 male albino rats (120–140 days old). Nine of the rats were killed 10 days after the biopsy, eight after 30 days and the other eight 60 days after the biopsy. A control group of six rats underwent orchidectomy with no preceding testicular biopsy. Results Significant tubulitis and obstructive findings were detected 10 days after needle biopsy (P < 0.05); epididymo‐orchitis was frequent after open biopsy during this period. At 10–30 days after needle biopsy the mean seminiferous tubule diameters were significantly greater than in either the control group or after open biopsy (P < 0.05). The histopathological damage recovered 60 days after open and needle biopsy. Conclusion Although percutaneous, a needle biopsy (as an alternative to open biopsy) causes tubulitis and frequent obstructive findings in the early period; therefore, repeat testicular procedures should be planned after these changes have resolved.
Excessive sac pressures: the pathogenesis and innocence of hydroceles in children
Authors: Tanyel F.C. , Öcal T. , Büyükpamukçu N. 
Published: March 2003

Objective To determine whether paediatric hydroceles result entirely from a small‐calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms. Patients and methods Twenty‐five hydroceles were studied prospectively in 24 boys (aged 18–132 months). Consent for the intraoperative measurements was obtained before surgery. The hydrocele was repaired under general anaesthesia with endotracheal intubation, using a standard approach, taking care not to open the sac during mobilization. Intra‐abdominal pressures during surgery were measured indirectly via a nasogastric tube after gastric decompression. The pressure in the sac was measured via a 20 G intravenous cannula inserted via a purse‐string suture. The relative pressure was then calculated by subtracting the intra‐abdominal from the sac pressure. The effects of age and laterality were evaluated. Results The median (range) intra‐abdominal, sac and relative pressures were 8 (2–18), 11 (3–30) and 4 (3–30) cmH2O, respectively. The sac pressure in the sac was greater than the intra‐abdominal pressure in 17 of 25 (68%; P = 0.004) patients. Age or laterality had no significant influence on any of the pressures. Conclusions These results suggest that in a significant proportion of hydroceles in children the pressures are higher than the intra‐abdominal pressure. Therefore, they cannot be explained simply as a freely communicating, narrow‐calibre processus. In addition, the pressures may reach levels which are potentially damaging to the testis.
Proliferation and differentiation of prostatic stromal cells
Authors: Niu Y. , Xu Y. , Zhang J. , Bai J. , Yang H. , Ma T. 
Published: March 2003

Objectives To investigate the effects of androgen, transforming growth factor β1 (TGF‐β) and basic fibroblast growth factor (bFGF) on the proliferation and differentiation of prostatic stromal cells of the dog in vivo and human stromal cells in vitro. Materials and methods Twenty‐two dogs had their serum concentration of testosterone and oestradiol determined by radioimmunoassay before and after castration. Light microscopy, transmission electron microscopy and an in situ cell‐death assay were carried out successively before and after castration to evaluate prostatic histomorphology. A semi‐quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) was used to evaluate the expression of TGF‐β, bFGF and myosin in the canine prostate tissue after castration. In vitro serum‐free cell cultures from human prostatic stroma were established and exposed to dihydrotestosterone (DHT), TGF‐β and bFGF in various concentrations. The proliferation of the cell cultures was detected by the tetrazolium assay. The differentiation from fibroblasts to smooth muscle cells (SMCs) was deduced by measuring the expression of SMC‐specific proteins (myosin and smoothelin) using immunohistochemistry and RT‐PCR. Results Castration resulted in a significant decrease in circulating testosterone levels (P < 0.01), but did not affect the circulating oestradiol levels (P > 0.05). The prostatic stromal cells, including SMCs and fibroblasts, diminished and underwent a serial pathological change of atrophy and apoptosis after castration. The atrophic cells were filled with intracellular lipofuscin. The expression of SMC myosin declined after castration, coincident with the increase in TGF‐β mRNA level and decline in bFGF mRNA. In vitro, TGF‐β inhibited the growth of human prostatic stromal cells during exponential growth, while enhancing myosin staining and stimulating the expression of smoothelin in confluent cultured stromal cells. bFGF stimulated the growth of the culture and inhibited the expression of smoothelin. DHT caused a weak increase in the proliferation and expression of SMC‐specific proteins (P < 0.05). However, DHT and bFGF together stimulated the proliferation of stromal cells significantly more than either agent alone (P < 0.01). The combination of DHT and TGF‐β greatly enhanced the expression of SMC‐specific proteins (P < 0.01), more strongly than either alone (P < 0.01). Conclusions The whole prostate gland is an androgen‐sensitive organ, with both the epithelium and stroma under the control of androgen. Androgen may direct the proliferation and differentiation of prostatic stromal cells by regulating the expression of TGF‐β and bFGF. Thus DHT, TGF‐β and bFGF may have important roles in regulating stromal cell homeostasis.
Anogenital electrical stimulation as treatment of urge incontinence in children
Authors: Gladh G. , Mattsson S. , Lindström S. 
Published: March 2003

Objectives To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy‐resistant urge incontinence. Patients and method The study included 48 children (24 girls and 24 boys, 5–14 years old) with a diagnosis of bladder instability verified by cystometry in all. Anogenital afferent stimulations were applied using a battery‐powered dual constant‐current stimulator. The children were stimulated continuously at 10 Hz for 20 min once or twice daily and if required the children and/or the parents continued to apply the treatment at home. For home stimulation a single (anal) channel stimulator was used. The patients were instructed to stimulate for 20 min at maximum intensity two to three times a week until the effects were optimal. The outcome was evaluated retrospectively by comparing voiding/incontinence diaries obtained before and at the follow‐up 6–12 months after the end of treatment. Results AGAS was applied at the clinic for a median (range) of 9 (4–20) times. Thirty‐one children continued with home stimulation for another 25 (5–96) sessions. At the follow‐up, 18 children were cured and another seven improved, with a leakage score of less than half that before treatment. The treatment was well tolerated by most children. Conclusions Anogenital afferent stimulation is an effective, potentially curative treatment in children with severe urge incontinence. Home stimulation is a well accepted adjuvant to treatment at the clinic and improves the outcome.
Relaxation induced by omeprazole does not change in diabetic rabbit corpus cavernosum
Authors: Ayan S. , Sarioglu Y. , Yildirim S. , Gökce G. , Bagcivan I. 
Published: March 2003

Objective To investigate the changes in relaxation responses to omeprazole in corpus cavernosal strips from rabbits with diabetes induced by alloxan. Materials and methods Diabetes was induced in 10 New Zealand white rabbits. After 8 weeks, the reactivity to electrical‐field stimulation, carbachol and omeprazole of corporal strips from the penises of the diabetic animals and from 10 untreated controls was assessed in organ chambers. Results In the diabetic group, the relaxation responses of corpus cavernosal strips to omeprazole were comparable with those of the control group, whereas the relaxation responses to electrical field stimulation and carbachol were impaired. Conclusion The relaxant effect of omeprazole in corpus cavernosum was not affected by diabetes, in which neurogenic and endothelium‐mediated relaxations were impaired.
Pain after transrectal ultrasonography‐guided prostate biopsy: the advantages of periprostatic local anaesthesia
Authors: Seymour H. , Perry M.J.A. , Lee‐Elliot C. , Dundas D. , Patel U. 
Published: March 2003

Objective To prospectively evaluate the efficacy and safety of periprostatic local anaesthesia (LA) during prostatic biopsy guided by transrectal ultrasonography (TRUS), as 20–65% of men report moderate to severe pain, and there is anecdotal and published evidence that periprostatic anaesthesia improves patients' tolerance. Patients and methods In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant biopsies were taken in all men but some had more than six biopsies. All were asked to complete questionnaires immediately after TRUS‐guided biopsy and for the subsequent week, giving pain scores and recording any morbidity, including symptoms of infection; analgesic use was also surveyed. Results Patients given LA had significantly lower pain scores at the time of biopsy than those given no anaesthesia, with median (sd) pain scores of 1.53 (0.7) and 1.95 (0.65) (P < 0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically significant. There was no difference in the amount of haematuria, haematochezia or haematospermia, or infection rate, between the groups. The additional cost and time of the procedure was minimal (£3.00 and 3 min/per patient, respectively). Conclusion Periprostatic LA infiltration is a quick and simple procedure which significantly improves immediate pain with no added morbidity; we strongly advocate its use to improve patient tolerance of TRUS‐guided prostate biopsy.