bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stapled haemorrhoidopexy: a consensus position paper by an international working party – indications, contra‐indications and technique
Authors: Corman M. L. , Gravié J.‐F. , Hager T. , Loudon M. A. , Mascagni D. , Nyström P.‐O. , Seow‐Choen F. , Abcarian H. , Marcello P. , Weiss E. , Longo A. 
Published: December 2004

AbstractAn international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra‐indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers—leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.
Bladder cancer cell implantation in reconstructed bladder in vitro: a model of tumour recurrence
Authors: Nakamura K. , Fujiyama C. , Tokuda Y. , Sugihara H. , Masaki Z. 
Published: December 2004

Objective To evaluate the involvement of umbrella cells in tumour adhesion and growth, by examining whether human urinary bladder carcinoma cells (HUBCC) can grow on reconstructed urinary bladder mucosa in vitro, as the implantation of tumour cells after resection is thought to be a cause of bladder tumour recurrence. Materials and methods Normal transitional epithelial cells isolated from porcine bladder were cultured on reconstructed lamina propria using fibroblasts in type I collagen gel. The urothelium thus reconstructed was artificially injured either by a scalpel or by dilute acid, after which transitional epithelial cells began to grow in a stratified fashion within a few days of culture. A HUBCC line (HT‐1197) was seeded onto this impaired mucosa to determine whether the cells could become implanted. Cultured cells on the reconstructed mucosa were evaluated by histological observation of vertical paraffin sections. Results The inoculated transitional epithelial cells grew in a stratified fashion and closely resembled urothelium in vivo. The superficial cells that were in contact with the medium solution differentiated into umbrella cells. HUBCC were unable to adhere to reconstructed mucosa which had not been injured, but these cells could adhere to and become implanted on the reconstructed mucosa after it had been injured either by a scalpel or by dilute acid. After acid injury, only the surface‐covering cells were removed sporadically, while the lower epithelial cell layer remained intact. The bladder cancer cells adhered to and proliferated within these stripped regions. Conclusion These results suggest that the urothelium, especially umbrella cells, seems to be important in preventing the adhesion and growth of urinary bladder tumour cells.
Tubularized incised‐plate urethroplasty for proximal hypospadias
Authors: Snodgrass W.T. , Lorenzo A. 
Published: December 2004

Objective To report the experience of one surgeon using tubularized incised‐plate (TIP) urethroplasty to repair proximal hypospadias in a consecutive series of boys. Patients and methods The records of 33 consecutive patients with midshaft to scrotal hypospadias undergoing TIP repair by one surgeon were reviewed. Dorsal plication was used as necessary for penile straightening, to preserve the urethral plate. Standard TIP urethroplasty was undertaken, and the follow‐up included the selective use of neourethral calibration and urethroscopy. Results Plication was necessary in 18 (55%) patients. The incised plate had a supple appearance in all but two boys. The mean (range) follow‐up was 9 (1–48) months and included calibration in 16 (48%) and urethroscopy in 13 (39%) patients. Complications were noted in 11 (33%) boys, of whom seven (21%) developed small fistulae. The two patients in whom the incised plate appeared unhealthy had dehiscence of the repair and contracture of the neourethra with recurrent penile curvature, respectively. There was one meatal stenosis and one short neourethral stricture. Conclusions TIP urethroplasty can be used to repair proximal hypospadias in the absence of severe penile curvature, and if the incised urethral plate has a supple appearance. As with distal hypospadias repair, the procedure creates a normal‐appearing penis with a slit‐like meatus.
Improving glandular coverage during prostate biopsy using a long‐core needle: technical performance of an end‐cutting needle
Authors: Ubhayakar G.N. , Li W.Y. , Corbishley C.M. , Patel U. 
Published: December 2004

Objective To compare the technical performance of a 33‐mm core‐length biopsy needle with that of the standard 18 mm needle, as many prostate cancers are isoechoic and in large prostates the tissue coverage with the 18 mm needle is inadequate. Patients and methods A 33‐mm core length BioPince™ VSL disposable needle (Amedic, Sweden) and a standard TruCut 18 mm needle (Medical Device Technology Inc., FL, USA) were used to take prostatic biopsies in two groups of 15 patients. The following variables were assessed for each group: mean core length, core quality, capsular coverage (one or both capsules within the specimen), and side‐effects in the first week after biopsy (for the BioPince group, surveyed using a self‐completed questionnaire). The results were compared with historical data from a group of 30 patients biopsied using the standard needle. Results For the BioPince and standard groups the mean (sd) core length was 19.4 (8.9) and 14.9 (5.1) mm, respectively. Four needles in the BioPince group failed to capture a sample, requiring needle replacement. The samples were fragmented in 15 of 90 (17%) and 41 of 90 (46%) biopsies in the BioPince and standard groups, respectively (P < 0.05). Specimens had both capsules present in five of 90 (6%) and four of 90 (4%), respectively. Within 7 days minor bleeding was the most common side‐effect. Pain after biopsy was the only symptom showing a significant difference between the groups, at six of 15 and none (P = 0.001), respectively. The incidence of haematuria, haematospermia and rectal bleeding was similar in the two groups (P > 0.05), but fever more common (three vs none) in the BioPince group (P = 0.06). Conclusion When set at a 33‐mm stroke length, the BioPince needle increases the mean core length by 30%, with less fragmentation than a standard 18 mm needle. However, it has a significant failure rate for capture (27% needle replacement rate), slightly greater morbidity (pain and possibly fever) and shows no advantage in capsular coverage. Therefore, there are shortcomings with this end‐cutting needle when used at 33 mm core length.
Tubularized incised‐plate urethroplasty for hypospadias reoperation
Authors: Snodgrass W.T. , Lorenzo A. 
Published: December 2004

ObjectiveTo review our preliminary results of tubularized incised‐plate (TIP) urethroplasty for reoperative hypospadias repair.Patients and methodsThe study comprised 15 patients, of whom eight had undergone a previous repair by techniques that included incision into the midline of the urethral plate, while in the remaining seven the midline of the plate had been left undisturbed. The meatus at reoperation was subcoronal or on the distal shaft in all but one boy, who had a midshaft hypospadias. All had previously undergone one attempt at hypospadias repair, except for one patient presenting after two failed ‘meatal advancement and glanuloplasty incorporated’ procedures. The TIP repair was undertaken as described for primary surgery, except that the dorsal dartos flaps for interposition between the neourethra and skin closure were available less often.ResultsTIP resulted in a functional neourethra and a cosmetically normal meatus in 13 of the 15 patients. One boy healed with a slightly rounded meatus and the other had wound dehiscence; fistulae developed in another two boys, giving three patients with complications. The fistulae occurred in boys whose original surgery did not include urethral plate incision, while the dehiscence was in a patient with partial excision of the plate during previous tubularized preputial flap repair.ConclusionsTIP urethroplasty can potentially be used for hypospadias reoperation. Previous incision of the urethral plate was not a contraindication in these selected cases in which the plate appeared supple. However, TIP repair should be avoided in repeat hypospadias surgery if the plate has been resected or is obviously scarred.
p53 and bcl‐2 immunohistochemistry in preoperative biopsies as predictors of biochemical recurrence after radical prostatectomy
Authors: Oxley J.D. , Winkler M.H. , Parry K. , Brewster S. , Abbott C. , Gillatt D.A. 
Published: December 2004

Objective To evaluate p53 and bcl‐2 immunohistochemistry in preoperative biopsies and radical prostatectomy specimens, as predictors of biochemical recurrence. Patients and methods Preoperative biopsies from 73 men, and the radical prostatectomies from these men and from a further 47 men, were evaluated. The serum prostate specific antigen (PSA) level, Gleason score, pathological stage and margin involvement were recorded. The immunohistochemical expression of p53 and bcl‐2 was studied on a representative area of tumour with the highest Gleason grade. The median follow‐up was 53 months. Results During the follow‐up 47 of the 120 patients had a biochemical recurrence. Capsular penetration was present in 63 (53%) and the surgical margins were positive in 47 (39%). The Gleason score was < 7 in 81 (68%) patients; p53 was positive in 40 (66%) of 61 biopsies and 84 (71%) of 118 prostatectomy specimens. Bcl‐2 was positive in eight (13%) of 63 biopsies and 20 (17%) of 118 prostatectomies. On multivariate analysis the biopsy p53, Gleason score and serum PSA were significant predictors of recurrence. On multivariate analysis, capsular penetration, PSA and margin status at prostatectomy were significant predictors of recurrence. There was also a significant interaction between PSA and margin status. Although univariately significant, neither p53 nor bcl‐2 featured in the final multivariate model. Conclusion Biopsy p53 status significantly predicts recurrence after radical prostatectomy, but its low specificity and technical issues suggest that it will not be useful in the clinical setting. However, a patient with negative p53 on biopsy is likely to have a good prognosis on prolonged follow‐up.
Prognostic significance of tumour angiogenesis in schistosoma‐associated adenocarcinoma of the urinary bladder
Authors: El Sobky E. , Gomha M. , El‐Baz M. , Abol‐Enein H. , Shaaban A.A. 
Published: December 2004

ObjectiveTo report on tumour angiogenesis and its relationship with morphological variables and prognosis in adenocarcinoma of the urinary bladder associated with schistosomiasis.Patients and methodsFifty‐five vesical adenocarcinomas were evaluated from 30 men and 25 women (mean age 47.2 years,sd 8.7, range 30–65) who were followed up after radical cystectomy and urinary diversion for a mean (sd, range) of 61 (43.5, 2.7–159.5) months. Vessels were stained immunohistochemically using an antibody to the platelet endothelial cell‐adhesion molecule CD31. Microvessels were counted in active areas of angiogenesis within the tumours (at × 250) and the microvessel density (MVD) quantified using the mean of three counts. Treatment failure was defined as death from cancer or the development of local recurrence or distant metastasis. Kaplan‐Meier survival curves and Cox's proportional hazard model were used to assess survival.ResultsThe overall 5‐ and 10‐year survival rates were 57% and 51%, respectively. The presence of lymph node metastasis and high mean vascular density (> 26) were significantly associated with a poor prognosis. The 5‐year survival for patients with negative lymph nodes was 66% while no patients with positive nodes survived for 5 years (P < 0.001); the survival was 72% for patients with a low MVD and 33% for those with a high MVD (P = 0.0016). From individual results plotted against vascularity in lymph node‐negative patients, there was a significantly better outcome for those with a low MVD ( 26;P = 0.0099); this significance was maintained on multivariate analysis. However, there was no significant relationship between angiogenesis and the different clinicopathological factors apart from the grade (P = 0.03); tumour stage, grade and DNA profile had no significant effect on survival in these patients.ConclusionsThese findings suggest that assessing angiogenesis using the MVD provides an independent predictor of survival in patients with adenocarcinoma of the urinary bladder.
Prenatal diagnosis of cloacal anomalies
Authors: Warne S. , Chitty L.S. , Wilcox D.T. 
Published: December 2004

Objective To evaluate prenatal diagnosis in facilitating prenatal counselling and planning optimal perinatal care for persistent cloaca, a complex malformation with variable presentation and a difficult reconstructive challenge for the paediatric urologist and surgeon. Patients and methods The prenatal records of six patients with a suspected prenatal diagnosis of cloacal anomaly, subsequently confirmed on delivery, were reviewed. All had serial prenatal ultrasonograms. Fetal medicine and paediatric surgical specialists were present for the scans and counselled the parents jointly. Results The diagnosis was made at 19–33 weeks of gestation; all fetuses had a cystic structure arising from the pelvis and bilateral hydronephrosis, with a poorly visualized fetal bladder in most. Other prenatal features included transient fetal ascites, oligohydramnios, ambiguous genitalia and growth retardation. Female karyotype was confirmed in all cases by amniocentesis. Diagnosis was aided in two patients by fetoscopy and in another by magnetic resonance imaging. Conclusions Cloacal anomalies can be diagnosed prenatally and should be considered in any female fetus presenting with bilateral hydronephrosis, a poorly visualized bladder and a cystic lesion arising from the pelvis. Prenatal diagnosis allows time for parental counselling and planning of the delivery at a centre equipped with neonatal intensive‐care and paediatric surgical facilities.
Continent catheterizable conduits: which stoma, which conduit and which reservoir?
Authors: McAndrew H.F. , Malone P.S.J. 
Published: December 2004

Objective To assess the outcome of the various methods used in creating continent catheterizable conduits. Patients and methods The case notes were reviewed from 89 patients who underwent the formation of 112 continent catheterizable conduits. Results Sixty‐five conduits were Mitrofanoff and 47 were antegrade colonic enema (ACE); 21 patients had both. At a mean follow‐up of 34 months, 95 (85%) conduits were still in use. There was no difference in complications between the Mitrofanoff and ACE conduits; 109 (97%) conduits were continent and stomal stenosis occurred 35 (31%). There was no significant difference relating to the conduit used, the reservoir, the stoma type or the stoma site. Only 39% of patients required no revisional surgery. Conclusion Although urinary and fecal continence can be achieved in most patients there is a high burden of complications and revisional surgery. All patients should be counselled accordingly.
Inverse expression of uroplakins and inducible nitric oxide synthase in the urothelium of patients with bladder outlet obstruction
Authors: Romih R. , Korošec P. , Jezernik K. , Sedmak B. , Tršinar B. , Deng F.‐M. , Liang F.‐X. , Sun T.‐T. 
Published: December 2004

ObjectiveTo assess the expression and distribution of uroplakins, protein subunits of the asymmetric unit membrane (AUM), and inducible nitric‐oxide synthase (iNOS) in the urinary bladder urothelium of patients with bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH).Patients and methodsUrinary bladder urothelium samples from 15 men (mean age 69 years) with BOO secondary to BPH were processed for light and electron immunocytochemistry. Uroplakins and iNOS were detected, and areas of apical surface covered with AUM were compared with those of iNOS‐positive urothelial cells.ResultsAreas of superficial urothelial cells with no AUM were found in all obstructed bladder samples. The immuno‐electron microscopy showed that the uroplakin‐positive cells had the characteristic appearance of terminally differentiated umbrella cells, whereas cells from the uroplakin‐negative regions were undifferentiated, typically showing microvilli on their apical surface. iNOS was not detected in areas with continuous AUM staining, but was readily detected in the uroplakin‐negative areas. There was an inverse correlation between the intensity of uroplakin and iNOS staining.ConclusionsIn patients with BOO associated with BPH, some superficial urothelial cells lacked the AUM, suggesting focal compromise of the blood–urine permeability barrier. In such relatively undifferentiated urothelial zones there was an accompanying increase in the expression of iNOS, which marks perturbed urothelial differentiation and may modulate bladder response to the outlet obstruction.
The validity of sacral ratios to identify sacral abnormalities
Authors: Warne S.A. , Godley M.L. , Owens C.M. , Wilcox D.T. 
Published: December 2004

ObjectiveTo test the repeatability and validity of a previously described sacral ratio measurement as a method for detecting sacral abnormalities, as the association between sacral abnormalities and neuropathic bladder is well known but the diagnosis of subtle sacral anomalies is often delayed.Materials and methodsFifty sacral radiographs (from 30 patients with anorectal anomalies and 20 normal children) were viewed and reported as normal or abnormal by an expert spinal radiologist (reference standard). Sacral ratios (anteroposterior, AP, and lateral) were measured while unaware of origin by four investigators and the inter‐ and intra‐observer variability examined. Validity was assessed by comparing individual sacral ratio values with the radiological diagnosis, using Pena's criteria for a normal sacrum (normal ≥ 0.74 AP; ≥ 0.77 lateral).ResultsSacral ratio estimates were possible in 48 of the 50 selected radiographs. There was good repeatability of measurements and moderate variability among investigators (P > 0.1). For the 20 normal children the mean (sd) AP sacral ratio was 0.74 (0.156); in the 14 with anorectal conditions and a normal sacrum it was 0.87 (0.16) and in the 12 with an abnormal sacrum 0.64 (0.27). There was a difference (P < 0.02) among the three groups (analysis of variance) but there was wide variability in individual sacral ratios within each group, and considerable overlap of values between normal and abnormal sacra. When all sacra were defined as normal or abnormal using Pena's criteria, there was poor agreement using Cohen's κ (AP and lateral view) with the radiological diagnosis by all four investigators.ConclusionThe sacral ratio has good inter‐ and intra‐observer repeatability. The mean value for a normal AP ratio concurred with that described previously by Pena but the variability of values among similar patients was large, suggesting this single value is of limited value in discriminating a normal from an abnormal sacrum.
Human DNA topoisomerase‐IIα expression as a prognostic factor for transitional cell carcinoma of the urinary bladder
Authors: Koren R. , Kugel V. , Dekel Y. , Weissman Y. , Livne P.M. , Gal R. 
Published: December 2004

ObjectiveTo investigate the immunohistochemical expression of topoisomerase II‐α (TII‐α, a nuclear enzyme, the expression of which increases rapidly at the end of the S to G2/M phase and declines when mitosis ends) in bladder urothelial neoplasms (transitional cell carcinoma), and its correlation with grade, stage and survival.patients and methodsHistological sections from 57 urothelial neoplasms were stained immunohistochemically for TII‐α expression; the percentage of positive cells in the area of greatest staining was recorded as the TII‐α index.ResultsTII‐α nuclear staining was positive in all the samples except one. The mean (sd) TII‐α index was 10.7 (5.9) in urothelial neoplasms of low malignant potential (grade 1), 15.5 (5.0) in low‐grade (grade 2) and 42.1 (13.4) in high‐grade urothelial carcinoma (grade 3). The mean TII‐α index was 10.7 (5.9), 26.3 (14.8) and 44 (19) in stages pTa, pT1 and pT2, respectively. The TII‐α index was significant for predicting death from cancer, independently of the stage or grade of the disease (P = 0.019, hazard ratio 1.1).ConclusionsA higher TII‐α index indicates a greater probability of recurrence of disease and lower overall survival. Therefore TII‐α expression has prognostic value in bladder carcinoma.
A comparison of physical examination and imaging in determining the extent of primary penile carcinoma
Authors: Lont A.P. , Besnard A.P.E. , Gallee M.P.W. , Van Tinteren H. , Horenblas S. 
Published: December 2004

ObjectiveTo determine the accuracy of physical examination and imaging in assessing the extent of the primary tumour in squamous cell carcinoma of the penis.Patients and methodsA physical examination, ultrasonography and magnetic resonance imaging (MRI) were used before surgery in 33 patients with penile carcinoma. The tumour size, infiltration of the penile structures and infiltration depth were assessed. The results were compared with the histopathological examination of the resected specimen.ResultsTumour size was determined with the highest precision by the physical examination (residual sd of 8.1 mm); ultrasonography and MRI were less precise (residual sd 8.9 mm and 9.3 mm). In assessing infiltration depth, ultrasonography and MRI had comparable precision (residual sd 3.7 mm and 3.8 mm). The positive predictive value of corpus cavernosum infiltration was 6/6 for physical examination, 4/6 for ultrasonography and 6/8 for MRI; the sensitivity was 6/7, 4/7 and 6/6, respectively.ConclusionPhysical examination is a reliable method for estimating penile tumour size and predicts corpus cavernosum infiltration with a high positive predictive value. Tumours for which the infiltration of the corpora cannot be determined properly by physical palpation only should be examined by imaging.