bluuebunny/crossref_metadata_2025_split huggingface dataset:
The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy
Authors: Ouyang R.C. , Kenwright D.N. , Nacey J.N. , Delahunt< B. 
Published: March 2003

Objective To determine the clinical significance of nondiagnostic small acini showing cellular atypia (atypical small acinar proliferation) in prostatic biopsies of patients with clinical findings suggestive of malignancy. Patients and methods Of 331 patients who underwent thin‐core biopsy of the prostate over a 30‐month period, 21 (6.3%) had atypical histological features, and of these 17 underwent repeat biopsy. In addition, a further 20 patients with normal histology underwent repeat biopsy for persistent abnormal clinical findings. The incidence and Gleason score of carcinomas subsequently diagnosed in the two groups were compared. The predictive significance of patient age, prostate specific antigen (PSA) level and digital rectal examination (DRE) findings were compared between both patient groups, those in each group subsequently found to have carcinoma, and between patients with malignant or normal repeat biopsies who had either atypical or normal initial biopsies. Results Nine patients with atypical histology and four with normal histology on initial biopsy were found to have carcinoma on subsequent biopsy (P = 0.036). The site of carcinoma diagnosed in the repeat biopsy frequently differed from that of the initial atypical biopsy. The Gleason primary pattern was not significantly different between the groups. Neither patient age, PSA level nor DRE findings differed between patients with initial normal or atypical biopsy, or in these groups for those in whom carcinoma was subsequently diagnosed. These clinical features did not distinguish between those with carcinoma or normal findings on repeat biopsy who had an initial atypical biopsy, while only PSA level varied significantly in patients with normal or malignant repeat biopsy in the group with an initial normal biopsy. Conclusion The presence of atypia on initial biopsy is a strong predictor of malignancy in subsequent biopsy specimens.
The use of the diode laser for treating urethral strictures
Authors: Kamal B.A. 
Published: March 2003

Objective To evaluate the efficacy of the diode laser as a new tool for treating urethral strictures. Patients and methods The study comprised 22 patients with urethral strictures; a diode laser was used to circumferentially ablate the scar tissue of the strictures. Through a cystoscope, a 400–600 µm semirigid fibre was used to transmit the laser energy in the direct‐contact mode. The procedure was carried out with the patient under general or spinal anaesthesia, but the last three patients successfully tolerated local anaesthesia. A catheter was then left in place for 1–5 days. Results The patients were followed for a mean (range) of 26.7 (9–39) months; in the 14 with previously untreated strictures the procedure was successful in 11, with no recurrence during the follow‐up. However, seven of the eight patients with a recurrent stricture after previous internal cold‐knife urethrotomy had a further recurrence, but occurring at longer intervals than after the internal urethrotomy. Conclusion This experience with the diode laser for treating urethral strictures suggests that it is safe and reliable, especially as the first line of treatment.
Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation
Authors: Peters J.L. , Thompson A.C. , Mcnicholas T.A. , Hines J.E.W. , Hanbury D.C. , Boustead G.B. 
Published: March 2003

Objective To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation. Patients and methods A retrospective questionnaire was sent to 100 patients who had undergone transrectal biopsy between January and August 1998. Levels of patient acceptability and satisfaction were assessed using visual analogue scales (VAS, with a maximum score of 10 being the least satisfactory or acceptable) and direct questions about the side‐effects of the procedure. A subsequent prospective study was undertaken on 130 patients undergoing transrectal biopsy with sedation between January 1999 and January 2000. Results The mean score for patient discomfort with sedation was 1.5, compared with 3.5 with no sedation. The overall satisfaction score improved from 3.1 to 0.9 with sedation. Complication rates were comparable, although slightly higher overall in the prospective group. Conclusion Sedation can significantly reduce patient discomfort and make the transrectal biopsy a more satisfactory experience for the patient. This is particularly important in the proportion of men who need to be considered for repeat biopsies.
The use and efficacy of the American Urological Association Symptom Index in assessing the outcome of urethroplasty for post‐traumatic complete posterior urethral strictures
Authors: Aydos M.M. , Memis A. , Yakupoglu Y.K. , Ozdal O.L. , Oztekin V. 
Published: March 2003

Objective To determine if the American Urological Association (AUA) Symptom Index is an accurate and reliable instrument for use in assessing the outcome after urethroplasty. Patients and methods The AUA Symptom Index questionnaire was answered by 33 men (mean age 31.3 years) who underwent end‐to‐end urethral reconstruction after complete urethral disruption; the index was completed at a mean of 6 months after surgery. The scores were then correlated with maximum flow rates (Qmax) and presence of re‐stenosis on retrograde urethrography. Results The initial mean (sd) AUA score was 10.42 (9.6) and the Qmax 22.12 (9.37) mL/s. Of the 33 patients, six (18%) had re‐stenosis, with a mean score of 30 and Qmax of 6 mL/s. There was a significant inverse correlation between the AUA symptom score and Qmax (r = − 0.401, P < 0.05). Conclusion The AUA Symptom Index is inversely correlated with Qmax and may indicate the presence of re‐stenosis after urethroplasty. The AUA score can thus be used as a cost‐effective and easy method in the first‐line screening of the outcome of urethroplasty.
Frequency and spectrum of Malassezia yeasts in the area of the prepuce and glans penis
Authors: Mayser P. , Schütz M. , Schuppe H.‐C. , Jung A. , Schill W.‐B. 
Published: March 2003

Objective To investigate the frequency and spectrum of lipophilic Malassezia yeasts within the area of the glans penis and preputial space in healthy men, most of whom were uncircumcised. Subjects and methods As the glans penis and the prepuce are abundant in sebaceous glands, 130 clinically healthy men were examined for the presence of Malassezia spp. Two impression preparations each were made on modified Dixon (mDixon) and Leeming‐Notman agar. The media were used with no added cycloheximide to allow the identification of the full spectrum of Candida yeasts. After 10 days of incubation at 32 °C Malassezia and Candida yeasts were differentiated by micromorphological and biochemical criteria. Results
Malassezia spp. were found as part of the microflora of the glans penis in 49% of the men. The two media yielded comparable results for isolation frequency and spectrum: On mDixon agar, 47.6% of the isolates were identified as M. sympodialis, 42.8% as M. globosa, 4.8% as M. pachydermatis and 2.4% as M. furfur. Candida spp. (especially C. albicans) were found in 20.8%. There were no significant differences in the distribution of different Malassezia spp with age. Conclusions
Malassezia yeasts may belong to the resident microflora of the male genital region, which is supported by the finding that free sebaceous glands (‘Tyson's glands') normally occur at this site. They may also be involved in pathological processes of the glans penis, e.g. balanitis, seborrheic eczema or psoriasis.
Survival in patients with rare subtypes of renal cell carcinoma
Authors: Grabowski M. , Huzarski T. , Lubinski J. , Sikorski A. 
Published: March 2003

Objective To evaluate the survival of patients with rare malignant histological subtypes of renal cancer. Patients and methods The Heidelberg classification of renal cell carcinoma (RCC) divides tumours into clear cell carcinoma (CCC), papillary cancer (PC), chromophobic cancer (ChC) and collecting duct carcinoma (CDC). Sarcomatoid tumours are in a different subgroup treated as a final stage of histological progression. Between 1990 and 1997, 319 nephrectomies were undertaken because of RCC in 317 patients. In 42 patients (13%) the pathological findings showed other than CCC; in 13 PC was confirmed histologically, in nine ChC, in 11 a mixed type of CCC and sarcomatoid type, in seven a sarcomatoid tumour and in four, CDC. Results One patient of the 13 with PC and two of the nine with ChC died. The worst prognosis was in those with CDC, CCC‐sarcomatoid and sarcomatoid tumours, as all these patients died. Conclusion The histopathological differentiation of RCC into subtypes gives additional useful prognostic information.
Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy
Authors: Floratos D.L. , Sonke G.S. , Rapidou C.A. , Alivizatos G.J. , Deliveliotis C. , Constantinides C.A. , Theodorou C. 
Published: March 2003

Objective To evaluate the comparative effectiveness of electromyographic (EMG) biofeedback with verbal instructions as learning tools of pelvic muscle exercises (PMEs) in the early management of urinary incontinence after radical prostatectomy. Patients and methods Forty‐two consecutive patients (mean age 64 years, sd 4.2), with urinary incontinence after radical retropubic prostatectomy for localized prostate cancer, were randomized to receive biofeedback (group A, 28 men) or verbal feedback (group B, 14 men) as learning tools for PMEs immediately after catheter removal. Group A received 15 sessions of EMG biofeedback (three times weekly, 30 min each) and group B verbal instructions. Evaluation at baseline and 1, 2, 3 and 6 months included the 1‐h pad‐test and a questionnaire (number of pads/day and incontinence episodes). Results By the last follow‐up, 27 patients had received biofeedback and 15 verbal instructions. Data were analysed according to the intention‐to‐treat principle. Urine loss as assessed by the 1‐h pad‐test at baseline, 1, 2, 3 and 6 months was 39, 18, 7, 4 and 3 g for group A and 31, 11, 3, 1 and 0 g for group B, respectively (P > 0.05). The number of pads/day was 3.9, 3.4, 1.2, 0.8 and 0.4 for group A and 3.6, 1.8, 0.9, 0.4 and 0.2 for group B, respectively (P > 0.05). The overall continence rate at 6 months was objectively (urine loss > 1 g) 91% and subjectively (0–1 pad/day) 95%. Conclusion Intensive verbal instructions and biofeedback were both very effective behavioural methods and learning tools for PMEs in the early management of urinary incontinence after radical prostatectomy.
Stromal and acinar components of the transition zone in normal and hyperplastic human prostate
Authors: Chagas M.A. , Babinski M.A. , Costa W.S. , Sampaio F.J.B. 
Published: March 2003

Objective To analyse the histological components of the transition zone in both normal human prostate and benign prostatic hyperplasia (BPH), and to determine the volumetric density (Vv) of the different elements (connective tissue, smooth muscle cells, acini and total stroma). Materials and methods Samples of BPH tissue from the transition zone were obtained from 16 patients with clinical symptoms of bladder outlet obstruction who underwent open prostatectomy. The control samples comprised 16 transition zone samples from prostates obtained during necropsy of adults aged < 30 years (killed in accidents). The Vv of these components was determined by stereological methods. Results The mean (sd) Vv in the controls and BPH samples were, respectively: connective tissue 40.47 (5.16) and 46.71 (9.91)%; smooth muscle cells 24.86 (2.74) and 31.56 (5.49)%; acini 28.73 (6.25) and 17.78 (10.87)%; all differences were statistically significant. Conclusions These results confirm the hypothesis that in BPH there is an increase in the stromal component, both smooth muscle fibres and connective tissue.
The role of serial free/total prostate‐specific antigen ratios in a watchful observation protocol for men with localized prostate cancer
Authors: Do V. , Choo R. , De Boer G. , Klotz L. , Danjoux C. , Morton G. , Szumacher E. , Fleshner N. , Bunting P. 
Published: March 2003

Objective To examine the change in the free/total prostate specific antigen ratio (f/tPSA) with time and to assess the potential value of serial measurements of f/tPSA as a determinant of disease progression in untreated, low‐to‐intermediate grade prostate cancer (T1b‐T2b N0M0, Gleason score  7 and PSA  15 ng/mL). Patients and methods In a prospective single‐arm cohort study from November 1995, patients were conservatively managed with watchful observation alone unless they met arbitrarily defined criteria (clinical, histological and biochemical) of disease progression. Patients were followed regularly and underwent blood tests including PSA and f/tPSA. The initial and mean f/tPSA and the rate of change of f/tPSA with time were evaluated against the rate constant for the PSA doubling time (PSATd). Correlation analyses were used to evaluate any association between baseline clinical variables and either the rate of change of f/tPSA or initial f/tPSA. Results As of December 2000, 161 of a total of 206 accrued patients had three or more f/tPSA measurements and formed the basis of the study (median age 70 years; median follow‐up 2.7 years). The median initial f/tPSA was 0.16; there was a significant negative correlation between this value and the initial total PSA. The mean f/tPSA and rate of change of f/tPSA with time were significantly negatively correlated with the rate constant for PSATd. Also, the rate of change of f/tPSA correlated negatively with clinical T stage, but not with other baseline variables, including initial PSA, age and Gleason score. Conclusion The f/tPSA in men with untreated, clinically localized prostate cancer varied widely. The negative correlation between the rate of change of f/tPSA with time and rate constant for PSATd suggests that both might provide valuable information to allow clinicians to develop a strategy for optimizing the timing of therapeutic intervention for those patients choosing watchful observation alone.
Risk factors for developing renal stones in inflammatory bowel disease
Authors: McConnell N. , Campbell S. , Gillanders I. , Rolton H. , Danesh B. 
Published: March 2003

Objective To correlate renal calculi and other clinical factors with urinary biochemical analytes in patients with inflammatory bowel disease, and to investigate the relative importance of hyperoxaluria (associated with fat malabsorption) or reduced stone inhibitors in the development of calculi in these patients. Patients, subjects and methods Samples were obtained from 25 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects (controls). Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography. Urine oxalate and citrate were analysed using commercial enzymatic assays; magnesium was measured using atomic absorption and other analytes assayed using standard methods on automated analysers. Results Renal calculi were found in two patients with CD and in none with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in those with UC. Analysis of covariance showed an association between low urinary citrate/creatinine ratio and renal stones (P=0.02), and between a combined urinary citrate and magnesium deficit relative to calcium, as expressed in the CMC index ((citrate×magnesium)/calcium), and renal stones (P=0.017). Changes in urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not associated with the presence of stones. There was no independent relationship between any clinical factor and the presence of stones. Conclusion Lower urinary concentrations of magnesium and citrate (stone inhibitors), relative to calcium (stone promoter; the CMC index) may be more important in lithogenesis in inflammatory bowel disease than is hyperoxaluria. In patients with a functioning colon, a low CMC index may predict likely stone‐formers; this requires a prospective evaluation. Avoiding low urinary levels of magnesium and citrate may aid in preventing and treating renal calculi.
Penile fracture in Kermanshah, Iran: the long‐term results of surgical treatment
Authors: Zargooshi Javaad 
Published: March 2003

Objective To determine the long‐term outcome of the surgical management of penile fracture. Patients and methods In all, 170 patients (mean age 27 years, sd 13, median 24, range 13–80) with penile fracture undergoing surgery between April 1990 and December 2000 were reviewed. In addition to a history, physical examination and hospital records, long‐term potency (> 6 months after surgery) was evaluated using the patients' self‐rated assessment of erectile function and the International Index of Erectile Function (IIEF‐5) questionnaire. The results were correlated with the surgical findings. A control group of 200 men also self‐rated their erectile function and completed the IIEF‐5. For those patients who presented with their partners, the partner's satisfaction with erections was also evaluated. The mean (median, range) follow‐up after injury was 53 (61, 6–132) months. Results Satisfactory and painless erectile function with a soft straight penis was reported by 162 patients (95.2%). Complications occurred in eight patients (4.7%), of whom seven developed a mild (four) to moderate (three) penile curvature; five had penile nodules and four reported mild paresthesia over the scar line. Mild and moderate erectile dysfunction (ED) was reported by five and three patients, and four and five of controls, respectively (P > 0.05). There was no difference between the surgical findings of six patients with complications and those of the remaining 162. However, in the two remaining cases extensive injury was associated with moderate ED after surgery. Of eight patients with ED, seven responded to intracavernosal injection with papaverine/phentolamine. Erectile function returned within a mean (range) of 2 (1–5) days and coitus was possible ≈ 2 weeks after the repair. Of the patients' partners, 94.1% reported satisfaction with erections and only one reported de novo dyspareunia. Penile fracture was not associated with an increased risk of ED (odds ratio 0.95; 95% confidence interval, 0.35–2.53). In sexually active participants, the mean (sd, range) IIEF‐5 score for 162 patients was 23.2 (2.7, 13–25) and not significantly different from that for the 194 controls, at 22.8 (2.1, 11–25). However, patients had higher scores than controls for erectile firmness and maintenance ability (P < 0.05). Conclusions Surgery for a fractured penis is safe and effective, restoring erectile function to that of controls. Surgical treatment is very satisfactory for patients and partners. Considering these encouraging results, surgical intervention is strongly recommended.
Does monosymptomatic enuresis exist? A molecular genetic exploration of 32 families with enuresis/incontinence
Authors: Loeys B. , Hoebeke P. , Raes A. , Messiaen L. , De Paepe A. , Vande Walle J. 
Published: March 2003

Objectives  To confirm linkage to microsatellite markers on chromosome 8q, 12q, 13q and 22q in families with nocturnal enuresis/incontinence segregating with an autosomal dominant pattern, and to determine if there is an association between the clinical subtype and these linked loci. Patients and methods

Families with at least three members with nocturnal enuresis in two generations were included in the study. The index patient was  7 years old and had evidence of bladder dysfunction; all other family members were  5 years old. Bladder dysfunction in the index patients was documented by video‐urodynamics when indicated. A nycthemeral rhythm of diuresis was documented in all index patients. The clinical diagnosis of all family members was based on a questionnaire on voiding problems and micturition habits, uroflowmetry, measurement of functional bladder capacity and nocturnal diuresis. Linkage was analysed using an autosomal dominant model with a gene frequency equal to 0.05 and a penetrance of 0.9. Results  Thirty‐two families with nocturnal enuresis/incontinence (one with four, 25 with three and six with two generations) were included. The mean number of persons included per family was 10 and on average five members were symptomatic. Linkage of nocturnal enuresis to a region on chromosome 22q11 was found in nine families, to 13q13–14 in six and to 12q in four. There was no convincing evidence for linkage to chromosome 8q. Clinical findings in the proband and their family members with possible linkage to a given locus were heterogeneous, and hence no clear genotype/phenotype correlation could be postulated. Conclusion  These findings support the hypothesis of the genetic and phenotypic heterogeneity of nocturnal enuresis/incontinence. Putative linkage was confirmed to the same chromosomal loci as in previous studies of ‘monosymptomatic’ enuresis and different phenotypes were linked to the same loci.
Anterior prostate cancer: is it more difficult to diagnose?
Authors: Bott S.R.J. , Young M.P.A. , Kellett M.J. , Parkinson M.C. ,   Contributors to the UCL Hospitals' Trust Radical Prostatectomy Database
Published: March 2003

Objective To determine whether anterior prostatic tumours are adequately sampled using the Stamey sextant protocol, as a fifth of prostate cancers are anterior in distribution at radical prostatectomy. Materials and methods All tumours (62) with an anterior distribution (75% of the tumour anterior to the urethra) on radical prostatectomy whole‐mounts, and in which the number and results of the sextant biopsies were available, were extracted from a prostate cancer database. Sixty‐one posterior tumours (75% of the malignant tissue posterior to the urethra) and their corresponding sextant biopsies were also retrieved for comparison. The number of biopsy sessions, the number of cores involved and the summated tumour length were recorded, together with the prostate gland weight, the tumour volume and the site of 75% of tumour in the superior‐inferior axis. Results Anterior tumours required significantly more biopsy sessions to diagnose prostate cancer than posterior neoplasms (anterior, one set 47; > one set 15; posterior, one set 57; > one set, four, P=0.007). Anterior tumours had fewer cores with tumour involvement and less summated tumour length than had posterior cancers. The mean (sd) number of positive cores was; anterior 1.8 (1.01), posterior 2.50 (1.30) (P=0.001); the summated tumour length was; anterior 5.05 (4.10) mm, posterior 9.25 (7.80) mm (P<0.001). There was no significant difference in gland weight (mean anterior 43.8 g; posterior 48.3 g, P=0.3) or tumour volume (mean anterior 1.85 mL; posterior 1.49 mL, P=0.11) between the groups. There was no significant difference between the incidence of anterior and posterior neoplasms with respect to their position in the superior‐inferior axis (P=0.96). Conclusions Anterior prostate tumours account for 21% of all prostate cancers. They more often require multiple sets of sextant biopsies for diagnosis, and yield smaller areas of cancer on core biopsies than do posterior tumours in glands of similar weight and tumour volume. If prostate cancer is suspected clinically but biopsies are negative, targeting the anterior gland at subsequent prostatic biopsy should be considered.