bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of the epidermal growth factor receptor family in normal and malignant urothelium
Authors: Røtterud Ranveig , Nesland Jahn Marthin , Berner Aasmund , Fosså Sophie D. 
Published: May 2005

OBJECTIVETo compare the immunohistochemically assessed expression of the epidermal growth factor receptor (EGFR) family in normal and malignant bladder urothelium, and suggest new hypotheses about their function in the development and progression of transitional cell carcinoma (TCC).PATIENTS AND METHODSEGFR, ERBB2, ERBB3 and ERBB4 were evaluated immunohistochemically in normal urothelium (NU, 15), primary non‐metastasized invasive TCC (NMC, 19) and in primary invasive TCCs with corresponding metastases (MC, 51, both specimens).RESULTSAll NU samples expressed ERBB4, none expressed ERBB2 and two expressed EGFR; all staining was uniform throughout all cell layers. ERBB2 expression increased and ERBB4 decreased from normal samples to carcinomas. There was no difference between NMCs and MCs in ERBB2, ERBB3 and ERBB4, but the NMCs expressed more EGFR than both NU and MC samples. There were no associations with T category, grade or survival. All combinations of expression levels for the four receptors were detected, with no dominant profile.CONCLUSIONWe hypothesise that: (i) ERBB4 is important for differentiation in NU; (ii) ERBB2 is up‐regulated with carcinogenesis in the urinary bladder but does not discriminate between bladder cancer with or without metastases; (iii) EGFR may be a marker of indolent disease. A current hypothesis, that superficial layers of NU do not express EGFR and thus protect the basal cells from the mitogenic effect of urinary EGF, is challenged.
A novel surgical technique for implanting a new electrostimulation system for treating female overactive bladder: a preliminary report
Authors: Nissenkorn Israel , De Jong Peter R. 
Published: May 2005

There are three interesting but diverse topics in this section. Authors from Tel‐Aviv and Capetown describe a novel surgical technique for implanting a new electrostimulation system for treating overactive bladder in the female. This is followed by a classification of symptomatic nocturia from Japan, which also looks at the distribution of nocturia, with special attention to duration of time in bed. Finally, there is an interesting paper on the association between congenital adrenal hyperplasia and LUTS.OBJECTIVETo assess the results of peripheral electrostimulation of pelvic floor muscles in patients with overactive bladder (OAB) symptoms, and to describe a novel surgical technique for inserting a specially designed implantable electrostimulator which can deliver different forms of muscle stimulation through a para‐urethral electrode.PATIENTS AND METHODSThe study included seven women with OAB (mean age 59 years) who had frequency (including nocturia), urgency and urge incontinence for ≥ 1 year, and in whom conventional treatment failed. The antepubic technique was used to implant the electrostimulator and a para‐urethral electrode. The patients’ urinary symptoms and quality of life (King's College Hospital incontinence questionnaire) were compared before and after surgery, and possible complications monitored.RESULTSThe mean (range) follow‐up was 14.5 (13–17) months in six and 10 months in the seventh patient (stimulator removed because of infection). The mean (range) frequency of 15 (13–23) voids/24 h before surgery decreased to 9 voids/24 h (i.e. by 40%) afterward. All patients had leakage episodes because of urgency (4–15 times/day) before surgery, which ceased in five afterward; these patients used no further pads. In the remaining two patients urgency incontinence continued after surgery, but with significantly fewer leakage episodes, from 15 and 12 per day before to 6.7 and 4 afterward, respectively. The mean degree of urgency (graded 0–3) decreased from 2 to 1.4 after surgery, and quality of life improved significantly. Urodynamic studies showed a greater mean maximum detrusor capacity, from 135 mL before to 189 mL after implanting the stimulator.CONCLUSIONSThe good results (over a follow‐up of 1 year) in patients with OAB symptoms treated by the present electrostimulator should encourage further clinical studies in such patients. A trial to evaluate the efficacy of pelvic floor muscle electrostimulation in a broad spectrum of diseases of the lower urinary tract causing symptoms similar to OAB has been started.
In vitro viability of human cavernosal endothelial and fibroblastic cells after exposure to papaverine/phentolamine and prostaglandin E1
Authors: Pilatz Adrian , Schultheiss Dirk , Gabouev Alexander I. , Schlote Norbert , Mertsching Heike , Jonas Udo , Stief Christian G. 
Published: May 2005

OBJECTIVETo investigate the influence of commercially available vasoactive drugs on human cavernosal endothelial and fibroblastic cells in vitro, as although corporal fibrosis is a well known side‐effect of intracavernosal injection therapy for erectile dysfunction, the possible detrimental effect of these agents on the endothelium lining the cavernosal vascular spaces is uncertain.MATERIALS AND METHODSCultured primary endothelial (13) and fibroblastic cells (12), obtained from potent patients undergoing penile surgery, were exposed to different physiological dilutions of prostaglandin E1 (PGE1), papaverine/phentolamine or the respective triple‐mix of these agents for 30 min. Viable cells were counted and cell metabolic activity measured in these cultures 48 h after drug exposure.RESULTSThere was a significant dose‐dependent decrease in the viable cell count after exposure to papaverine‐containing formulations, probably because of the low pH of this substance. This cytotoxic effect was more pronounced in endothelial than in fibroblastic cells, and was not apparent in the PGE1 groups. The relative increase in cell metabolic activity in cultures affected by a moderate cytotoxic effect indicated a regenerative process.CONCLUSIONThese comparative results in endothelial and fibroblastic cell cultures suggest that the endothelium rather than the interstitium of the corpus cavernosum is more sensitive to side‐effects produced by intracavernosal injection therapy with papaverine. Thus, unfavourable consequences on the function of the endothelial layer might be as important as the risk of interstitial fibrosis. As these effects were not detected for PGE1 this drug should be preferred to papaverine in clinical practice.
Is laparoscopic unilateral sural nerve grafting during radical prostatectomy effective in retaining sexual potency?
Authors: Porpiglia Francesco , Ragni Francesca , Terrone Carlo , Renard Julien , Musso Francesca , Grande Susanna , Cracco Cecilia , Ghignone Gianpaolo , Scarpa Roberto M. 
Published: May 2005

Associate EditorMichael G. WyllieEditorial BoardIan Eardley, UKJean Fourcroy, USASidney Glina, BrazilJulia Heiman, USAChris McMahon, AustraliaBob Millar, UKAlvaro Morales, CanadaMichael Perelman, USAMarcel Waldinger, NetherlandsOBJECTIVESTo present a pilot study of laparoscopic unilateral sural nerve grafting during radical prostatectomy, with the aim of preserving sexual potency.PATIENTS AND METHODSBecause they had localized prostate cancer, 29 men had a laparoscopic radical prostatectomy with deliberate wide unilateral neurovascular bundle resection and preservation of the contralateral bundle. Fifteen men (group A) had an interposition sural nerve graft on the sectioned bundle, and 14 (group B) had laparoscopic radical prostatectomy with preservation of the unilateral bundle only. The men were also involved in a rehabilitation programme, and erectile function was evaluated after surgery, and at 3, 8, 12 and 18 months, using the five‐item version of the International Index of Erectile Function (IIEF‐5) questionnaire.RESULTSThe two groups had similar clinical characteristics (age, prostate‐specific antigen level, body mass index, prostate volume, clinical stage, Gleason score before and after surgery, postoperative stage). The follow‐up was complete for 12 men in group A and 10 in group B. Group A had significantly higher erectile function scores on the IIEF‐5 at 12 and 18 months than immediately after surgery (P < 0.01), whereas in group B the improvement was not statistically significant. Overall, by 18 months after surgery five of 12 men in group A had achieved spontaneous unassisted erection or erection assisted with sildenafil, while three of 10 in group B achieved an erection assisted with sildenafil (not significant).CONCLUSIONSThese data suggests that laparoscopic sural nerve grafting during radical prostatectomy is feasible and safe; nevertheless we cannot conclude that sural nerve grafting is more effective than preserving the neurovascular bundle alone in retaining sexual potency. More research is required to validate the effectiveness of this technique.
A phase‐1 study of sequential mitomycin C and 5–aminolaevulinic acid‐mediated photodynamic therapy in recurrent superficial bladder carcinoma
Authors: Skyrme Rob J. , French A. Jane , Datta Shibendra N. , Allman Richard , Mason Malcolm D. , Matthews Philip N. 
Published: May 2005

OBJECTIVETo report a phase‐1 study of patients with recurrent superficial bladder cancer treated with photodynamic therapy (PDT) using sequential mitomycin C and 5‐aminolaevulinic acid (ALA).PATIENTS AND METHODSTwenty‐four patients were treated, the primary endpoint being the safety and tolerability of combined therapy at increasing doses of ALA and light.RESULTSMitomycin C instillation was followed by ALA concentrations of 6%, 8% or 10%; there was no effect on toxicity. The light dose, at a wavelength of 635 nm, was increased from zero to 25 J/cm2, with the upper fluences producing transient symptoms. There were no episodes of skin photosensitivity or systemic toxicity. A total fluence of 25 J/cm2 represented the upper light dose for the tolerability of this procedure by patients. There were no persistently high urinary symptom scores or reduction in functional bladder capacity up to ≥24 months of follow‐up. In this group, cumulative tumour recurrences were none at 4, two at 8, six at 12, nine at 18 and 11 at 24 months after PDT, respectively.CONCLUSIONSequential mitomycin C and ALA‐PDT is a safe and well tolerated treatment, with potential for managing difficult‐to‐control superficial transitional cell carcinoma and carcinoma in situ of the bladder.
Is photodynamic diagnosis using hypericin better than white‐light cystoscopy for detecting superficial bladder carcinoma?
Authors: Sim Hong Gee , Lau Weber K.O. , Olivo Malini , Tan Puay Hoon , Cheng Christopher W.S. 
Published: May 2005

OBJECTIVETo review the initial clinical results of photodynamic diagnosis (PDD) using hypericin (a new photosensitizer for PDD that helps to label flat urothelial tumours to facilitate biopsy) for the early detection of superficial bladder carcinoma, as flat noninvasive tumours of the bladder may be missed during conventional white‐light cystoscopy (WLC) if there is bladder overdistension or ongoing cystitis.PATIENT AND METHODSBetween 1 January 2001 and 30 October 2004, 41 consecutive patients (mean age 66.1 years, sd 9.1, range 46–81) had transurethral resection for bladder cancer. Hypericin was introduced intravesically for 2 h before cystoscopy. Immediately after WLC, fluorescence cystoscopy (FC) was used at the same location and the same bladder site inspected using violet light. FC findings, e.g. positive or negative red fluorescence, were documented for each specific bladder site examined, and the exact location sampled for biopsy.RESULTSThe mean (sd, range) bladder capacity of the patients was 431 (86, 300–650) mL. In all, 179 biopsies were taken from the 41 patients; urothelial cancers were found in 41% (74) and 80% (33) had macroscopically visible bladder tumours; 40% (71) of the biopsies were positive under FC and 86% (61) of the 71 FC‐positive biopsies showed cancer on histology. Twenty‐five biopsies (14%) were positive on FC but not WLC. PDD testing with hypericin had a sensitivity of 82% (61/74) and specificity of 91% (95/105), vs WLC, at 62% (46/74) and 98% (103/105), respectively. The PDD test had a positive predictive value of 86% (61/71) and a negative predictive value of 88% (95/108), vs 96% (46/48) and 79% (103/131), respectively for WLC. There were no reports of significant complications after the procedure.CONCLUSIONPDD using hypericin shows promise, as it has a higher sensitivity but equivalent specificity than WLC. It can be used to detect flat lesions not seen on WLC. PDD testing is also well tolerated with minimal side‐effects.
Anatomical radical retropubic prostatectomy: ‘curtain dissection’ of the neurovascular bundle
Authors: Lunacek Andreas , Schwentner Christian , Fritsch Helga , Bartsch Georg , Strasser Hannes 
Published: May 2005

OBJECTIVETo investigate the topographical relationship of the cavernosal nerves (CNs) to seminal vesicles, prostate, rhabdosphincter and urethra during the development of the prostate, and to use the resulting morphological data to modify the surgical technique of nerve‐sparing radical prostatectomy.MATERIALS AND METHODSThe study included 29 male fetuses (gestational age 9–37 weeks) and eight adult specimens assessed anatomically and histologically. Using the plastination technique and anatomical dissection, the course of the CNs was investigated in all specimens. Based on these morphological results, the technique of dissecting the CNs during nerve‐sparing radical retropubic prostatectomy was modified.RESULTSDuring early fetal development the fibres of the CNs enclose the prostatic and membranous urethra dorsally and laterally. During the growth of the prostate, the CNs running along the prostate become displaced further anteriorly and spread, thus forming a concave shape (like a ‘curtain’) of the neurovascular bundles (NVB). Therefore, dissection of the NVB has to start anteriorly to preserve all the nerve fibres that are spread along the surface of the lateral lobes of the prostate.CONCLUSIONSFrom these anatomical findings we propose a modified ‘curtain dissection’ to improve preservation of the CNs running in the NVB, in which the incision of the periprostatic fascia and dissection of the NVB is far more anterior than previously described.
Diverse optical characteristic of the prostate and light delivery system: implications for computer modelling of prostatic photodynamic therapy
Authors: Jankun Jerzy , Keck Rick W. , Skrzypczak‐Jankun Ewa , Lilge Lothar , Selman Steven H. 
Published: May 2005

OBJECTIVETo explore the use of photodynamic therapy (PDT) as a minimally invasive form of treatment for organ‐confined prostate cancer, for although there are several therapies, ablative treatments are associated with significant morbidity.MATERIALS AND METHODSUsing the photosensitizer tin etiopurpurin, dogs were treated with interstitially placed laser fibres in an effort to validate PDT for treating prostate cancer. Earlier models assumed a uniform distribution of light output from a cylindrical fibre and a uniform attenuation coefficient throughout the prostate. Subsequent observations show that this model was too simple and that light radiance is not linear. To overcome under‐treatment, a computer program to complement real‐time fibre placement was developed.RESULTSAs light radiance from interstitially placed laser fibres varies significantly from the commonly assumed ideal cylindrical emission, a predictive mathematical model of prostate PDT needs to consider the real emission. Also, the optical properties of the prostate, e.g. absorption and scattering of light, are anisotropic. Differences in the attenuation coefficient (combining absorption and scattering of light) also varied among different animals. Incorporating all these variables into a computer program produced a virtual model of the photo‐ablated zone within ± 2 mm of that observed in animals.CONCLUSIONPDT of the prostate is not trivial and should benefit from computer‐aided methods as it is developed for clinical use.
Volume‐adjusted prostate‐specific antigen (PSA) variables in detecting impalpable prostate cancer in men with PSA levels of 2–4 ng/mL: transabdominal measurement makes a significant contribution
Authors: Kobayashi Takashi , Kawahara Takashi , Nishizawa Koji , Ogura Keiji , Mitsumori Kenji , Ide Yoshihiro 
Published: May 2005

OBJECTIVETo examine whether prostate‐specific antigen (PSA) levels adjusted according to prostate volume improve prostate cancer detection using transrected biopsies in men with PSA levels of 2–4 ng/mL, and benign findings on a digital rectal examination (DRE).PATIENTS AND METHODSMen aged ≤ 79 years and with serum PSA levels of 2–4 ng/mL and normal DRE findings were prospectively enrolled. Eligible patients were recommended for transrectal prostate biopsies after measuring prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography, and transition zone volumes with TRUS. In addition to PSA levels and the free‐to‐total PSA ratio, volume‐adjusted PSA levels, PSA densities determined by TRUS (PSADTRUS), and TAUS (PSADTAUS), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic analysis.RESULTSProstate cancer was diagnosed in 31 (22%) of the 139 men who had prostate biopsies. The area under the curve (AUC) of PSADTRUS (0.796) and PSATzD (0.792) was similar and significantly greater than that of PSA (AUC 0.588) and the free‐to‐total PSA ratio (AUC 0.658). PSADTAUS was a significantly better indicator of prostate cancer than PSA levels alone (P = 0.043).CONCLUSIONAs predictors of prostate cancer, there were no significant differences between PSADTRUS and PSATzD. Although PSADTAUS was worse than PSA variables adjusted by total and transition zone prostate volumes determined by TRUS, it was a better predictor than the PSA value alone in men with a low PSA level. These results indicate that TAUS is worthwhile where the routine use of TRUS before biopsy is difficult.
Classification and distribution of symptomatic nocturia with special attention to duration of time in bed: a patient‐based study
Authors: Yoshimura Koji , Terai Akito 
Published: May 2005

OBJECTIVETo classify the night‐time urinary frequency of patients with symptomatic nocturia by urine volume produced, nocturnal bladder capacity and time spent in bed.PATIENTS, SUBJECTS AND METHODSIn all, 110 patients whose principal complaint was nocturia were enrolled in the study; 32 age‐ and gender‐matched subjects were recruited as controls. From studies of the controls, 190 mL and 510 min were identified as the normal limits for mean nocturnal urine voided volume and time spent in bed. The 110 patients were classified into eight categories based on urine volume, nocturnal bladder capacity and time spent in bed.RESULTSThere were abnormalities of urine volume produced, bladder capacity and time spent in bed in 72%, 50% and 54% of the patients, respectively. Patients with severe nocturia (≥4 voids/night) tended to have more complex pathophysiology than those with mild nocturia (≤3 voids/night).CONCLUSIONTime spent in bed, urine volume produced and bladder capacity should be used to assess patients with symptomatic nocturia.
Does thrombin sealant allow nephron‐sparing surgery with no renal artery occlusion? A description of technique and initial results
Authors: Triaca Veronica , Zagha Ralph M. , Libertino John A. 
Published: May 2005

The first paper in this section from Burlington Massachusetts describes the authors’ experience with thrombin sealant, perhaps allowing nephron‐sparing surgery without renal artery occlusion. They describe their technique and initial results.Authors from Mannheim describe how they validate computer‐based training in ureteroscopy. This is particularly important at present, where increasingly trainees are being assessed on computer models. Obviously, all of these computer‐based methods must be carefully validated before used practically.Finally, there are two papers which describe how CT can aid in the management of urinary calculi either by PCNL or by ESWL.
Validation of computer‐based training in ureterorenoscopy
Authors: Knoll Thomas , Trojan Lutz , Haecker Axel , Alken Peter , Michel Maurice Stephan 
Published: May 2005

OBJECTIVESTo evaluate the outcome of training both urological novices and experts, using the recently developed UroMentor (Simbionix Ltd, Israel) trainer, that provides a realistic simulation of rigid and flexible ureterorenoscopy (URS).SUBJECTS AND METHODSTwenty experienced urologists (total number of previous flexible URSs 21–153) were monitored during simulated flexible URS for treating a lower calyceal stone, and the outcome was correlated with individual experience. A score was compiled based on the variables recorded, including total operation time, stone contact time, complications such as bleeding or perforation, and treatment success. A further five urological residents with no endourological experience were trained on the UroMentor in rigid URS for ureteric stone treatment. Their acquired clinical skills were subsequently compared to those of five urological residents who received no simulator training.RESULTSAll 20 experienced urologists disintegrated the stone on the simulator, and the score achieved was related to their personal experience; there was a significant difference in performance in those with < 40 and > 80 previous flexible URSs. For the five urological residents with no endourological experience, simulator training improved their skills, and comparison with urological residents who had received no simulator training showed advantages for the trained residents. After being trained on the simulator, the group performed better in the first four URSs on patients.CONCLUSIONSIndividual experience correlates with individual performance on the simulator. Simulator training was helpful in improving clinical skills. Although the distribution of computer‐based simulators is limited by high prices, virtual reality‐based training has the potential to become an important tool for clinical education.
Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three‐dimensional reformatting
Authors: Thiruchelvam Nikesh , Mostafid Hugh , Ubhayakar Gaurang 
Published: May 2005

OBJECTIVETo assess a modified technique of multidetector computed tomographic urography (CTU) which can reproducibly and accurately map the pelvicalyceal system (PCS) and complex renal calculi, as such information is essential in choosing the optimal percutaneous approach into the PCS for safe and successful percutaneous nephrolithotomy (PCNL).PATIENTS AND METHODSTen consecutive patients with renal calculi underwent a modified four‐detector multislice CTU with frusemide, abdominal compression and subsequent injection with contrast medium. After unenhanced CT of the abdomen, a high‐resolution contrast‐enhanced scan was taken through the kidneys in the pyelographic phase. Data were analysed using multiplanar reconstruction and three‐dimensional (3D) reformatting.RESULTSIn 10 CTUs there were three staghorn, two diverticular, 25 calyceal, two infundibular and two renal pelvic calculi; nine showed posterior calyces and good infundibular anatomy, and provided a good map of the PCS. Seven patients had PCNL, with the remaining three having either primary extracorporeal shock wave lithotripsy or conservative management. CTU detected stones in all patients and accurately located their relation to the PCS. With reconstructed images, subjectively the 3D imaging provided an advantage over conventional imaging in optimizing nephrostomy placement.CONCLUSIONCTU with this protocol and post‐processing techniques enables an accurate and confident, reproducible prediction of the site, number and size of stones in complex pelvicalyceal anatomy, optimal site(s) for placing the percutaneous track, and potential hazards when placing the track, with no significant increase in the patient's radiation burden. 3D CTU should become the standard imaging method for planning PCNL in selected patients.