bluuebunny/crossref_metadata_2025_split huggingface dataset:
The penile disassembly technique in hypospadias repair
Authors: Perovic  , Vukadinovic  , Djordjevic  , Djakovic  
Published: March 2003

Objective To report experience and results with penile disassembly in hypospadias repair.Patients and methods From November 1995 to May 1997 penile disassembly was used in 92 patients aged from 9 months to 32 years. The indications for operation were hypospadias with severe penile curvature (especially with curvature in the distal third of the corpora cavernosa), chordee without hypospadias, and small penis with hypospadias. The technique involves separating the penis into its component parts, i.e. the glans cap with neurovascular bundle dorsally, together with the undivided or divided urethra and urethral plate ventrally, and the corpora cavernosa. The manoeuvre allows any curvature to be corrected, especially when in the distal third of the corporal bodies, glans tilt to be rectified, and the penis to be enlarged, particularly elongated, which is a significant gain in small penises with hypospadias.Results The patients were followed for 3–20 months (mean 14); the penis was straightened in all cases, with no recurrence of curvature. In 37 patients (40%) penile disassembly combined with extensive urethral mobilization resolved the hypospadiac meatus with no need to form a neourethra; the penis was larger after surgery. Complications were related to urethroplasty and included four urethral stenoses, two fistulae and three diverticula. There was no injury to the neurovascular bundle and urethra; sensitivity and erection were preserved in all patients.Conclusion The penile disassembly technique is most effective for hypospadias with severe curvature, especially for glans tilt and curvature located distally. Penile augmentation is possible using this technique.
A questionnaire‐based outcome analysis of the Stamey bladder neck suspension procedure for the treatment of urinary stress incontinence: the Hannover experience
Authors: Kuczyk  , Klein  , GRÜnewald  , Machtens  , Denil  , HÖfner  , Wagner  , Jonas  
Published: March 2003

Objectives To evaluate the long‐term continence rate, including subjective satisfaction and therapy‐associated morbidity, of patients undergoing Stamey bladder neck suspension.Patients and methods Eighty‐five women (median age 55 years, range 30–85) with urinary stress incontinence treated by Stamey bladder neck suspension at our institution between 1987 and 1995 were evaluated using an anonymous questionnaire over a mean (range) follow‐up of 61 (13–93) months.Results Of the 85 patients, 44 (52%) reported an improvement in clinical symptoms at the evaluation and 29 (34%) were completely continent after the Stamey procedure. However, 53 (62%) patients reported subjective satisfaction with the result, because they had a durable improvement in continence for a mean (range) of 44 (10–79) months. There was no correlation between the number of previous urogynaecological operations undergone by the patients and the success of the Stamey procedure. However, the frequency of complications other than urinary retention was significant during and after surgery, at 27%, and in accord with the complication rate reported in earlier studies.Conclusions Compared with other bladder neck suspension procedures, e.g. Burch colposuspension, the Stamey procedure appears to be associated with a higher frequency of postoperative recurrent urinary stress incontinence. Therefore, the Stamey procedure should only be used if the patient demands a minimally invasive surgical procedure for bladder neck suspension. Although 60% of patients were satisfied with the durable improvement in clinical symptoms, it is appropriate to inform patients before surgery of the high recurrence rate after Stamey bladder neck suspension.
The artificial urinary sphincter in men incontinent after radical prostatectomy: 5 year actuarial adequate function rates
Authors: Klijn  , Hop  , Mickisch  , SchrÖder  , Bosch  
Published: March 2003

Objective To determine the success (as both continence and revision rates) of the artificial urinary sphincter (AUS) in men incontinent after radical prostatectomy, and thus improve the preoperative counselling provided for these patients.Patients and methods The AUS was implanted in 27 men incontinent after radical prostatectomy (mean age 69 years, range 59–75) at a mean (range) interval of 20 (4–60) months after surgery. The Kaplan–Meier method of survival analysis was used to determine the ‘primary adequate function’ (PAF) rate and the ‘additional procedure‐assisted adequate function’ (APA‐AF) rate. Adequate function was defined as satisfactory continence (use of at most one pad per 24 h) in combination with good AUS function. PAF was defined when no revisions of the AUS were required and APA‐AF when one or more revisions of one or more parts of the AUS were required; a complete exchange or explantation of the AUS defined failure, i.e. the end of APA‐AF.Results At a mean follow‐up of 35 months, 81% of the patients had achieved satisfactory continence. However, the 5 year PAF and APA‐AF rates, based on the Kaplan–Meier curves, were 49% and 71%, respectively.Conclusions Implantation of an AUS can provide excellent continence rates in patients incontinent after radical prostatectomy, but only at the expense of a considerable re‐operation rate. The outcome is best represented by Kaplan–Meier curves of the PAF and the APA‐AF.
Modified minimal cost retroperitoneoscopic nephrectomy, nephrectomy with isthumusectomy and nephroureterectomy in children: a pilot study
Authors: Hemal  , Gupta  , Wadhwa  
Published: March 2003

ObjectiveTo assess the feasibility of retroperitoneoscopic nephrectomy, nephrectomy with isthmusectomy and nephroureterectomy in children with nonfunctioning kidneys and renal anomalies, at minimal cost using a modified technique.Patients and methodsEleven children (aged 4–16 years) underwent retroperitoneoscopic nephrectomy, nephroureterectomy, or nephrectomy with isthmusectomy for nonfunctioning kidneys. Three patients had previously undergone percutaneous nephrostomy to evaluate whether the kidney could be salvaged, but this did not alter the success of technique, although adhesions and fibrosis required careful and precise dissection.ResultsAll procedures were completed successfully with minor complications (peritoneal transgression via the port in two patients, with no consequences). The mean operative duration, blood loss and hospital stay were 109 min, 82 mL and 2.25 days, respectively.ConclusionRetroperitoneoscopic procedures can be conducted safely, successfully and at minimal cost without compromising any principles of technique. It is not essential to prepare the bowel or use ureteric catheterization and renal artery embolization. Expensive balloon dissectors, trocar‐sealing balloons, endostaplers and endobags, lap sacs or morcellators are not required. The direct approach to the kidney via retroperitoneoscopy is also quicker.
Intracavernosal versus intraurethral alprostadil: a prospective randomized study
Authors: Shokeir  , Alserafi  , Mutabagani  
Published: March 2003

ObjectiveTo compare the medicated urethral system for erection (MUSE) with standard intracavernosal prostaglandin E1 (PGE1) in the treatment of erectile dysfunction.Patients and methodsSixty consecutive men with organic erectile dysfunction were prospectively randomized to receive either 20 μg of intracavernosal PGE1 (group 1, 30 patients) or 1 mg MUSE (group 2, 30 patients). Response to the drugs was recorded in the outpatient clinic and all patients continued a home‐treatment programme for 3 months. After each home administration, patients recorded the grade of erection in diaries, whether or not sexual intercourse occurred and any adverse reactions to the drugs. Comfort and ease of administration were also recorded.ResultsThe characteristics of the patients of both groups were similar; 10 patients in group 1 and 25 in group 2 completed the 3‐month treatment programme, i.e. a withdrawal rate of 67% and 17% for groups 1 and 2, respectively (P<0.05). During outpatient dosing, 27 (90%) patients in group 1 and 18 (60%) patients in group 2 achieved a good erection (P<0.05). Intercourse during the 3 months of home treatment was reported at least once in 26 (87%) patients in group 1, compared with 16 (53%) patients in group 2 (P<0.05). After 3 months of home treatment, patients had administered a total of 242 doses of intracavernosal PGE1 and 360 doses of MUSE; intercourse was reported after 206 (85%) and 198 (55%) administrations of PGE1 and MUSE, respectively (P<0.05). The most common adverse reaction was urogenital pain, reported by 14 (47%) patients in group 1 and two (7%) patients in group 2 (P<0.05). Home treatment was assessed as easy by 12 (40%) patients in group 1 and 27 (90%) in group 2 (P<0.05).ConclusionAlthough MUSE is less effective than intracavernosal PGE1, it is more attractive and accepted well by most patients as an easy method of treatment with minimal or no discomfort.
Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre?
Authors: Jones  , Fergus  , Chapman  , Houghton  
Published: March 2003

ObjectiveTo assess the results of treatment for stage 1 germ cell tumours of the testis, outside a specialist centre.Patients and methodsFrom May 1984 until March 1996, 123 patients with stage 1 disease were treated at our institution. Sixty patients with seminoma and 31 with teratoma were treated with orchidectomy only and surveillance; 32 patients with stage 1 seminoma elected for orchidectomy and adjuvant radiotherapy. The mean ages were 40, 31 and 35 years, and the median follow‐up 52, 47 and 49 months, respectively.ResultsThere were no disease‐ or treatment‐related deaths. However, 18 (30%) patients with seminoma treated by orchidectomy only relapsed (median time 8 months, range 3–19); 14 of these responded to radiotherapy, three to radiotherapy and chemotherapy for second relapses outside the irradiated fields, and one to chemotherapy initially, for large‐volume relapse. Fifteen (48%) patients with teratoma relapsed (median time 3 months, range 1–12); all responded to 4–6 courses of bleomycin/etoposide/cisplatin chemotherapy. One patient had a second relapse and is currently disease‐free 3 years after surgical excision of a lung metastasis.ConclusionThese results show that stage 1 testis tumours can be managed successfully in a district general hospital. However, we are concerned about the high relapse rates and are now attempting to identify patients at greater risk of recurrence, to consider adjuvant therapy in this group.
The role of vitamin A in preventing renal scarring secondary to pyelonephritis
Authors: Kavukçu  , Soylu  , Türkmen  , Sarioglu  , Büyükgebiz  , Güre  
Published: March 2003

ObjectiveTo evaluate the efficiency of exogenously administered vitamin A in preventing renal scarring caused by experimental pyelonephritis in rats.Materials and methodsForty Wistar rats were injected with 0.1 mL of solution containing Escherichia coli (1010 /mL) into both renal medullae. Five equal groups were then formed: group 1 was treated only with ciprofloxacin (30 mg/kg per day, twice daily, intraperitoneally) for 5 days, starting 3 days after bacterial inoculation; in group 2, 60 kIU of vitamin A was injected intramuscularly with the bacterial inoculation; in group 3, 60 kIU of vitamin A was injected similarly, but 3 days after bacterial inoculation; in group 4, 60 kIU of vitamin A was given orally with the bacterial inoculation; and group 5 was treated with ciprofloxacin for 5 days and vitamin A intramuscularly from the third day after bacterial inoculation. All the rats were killed 6 weeks after bacterial injection; blood samples were obtained to determine serum vitamin A and β‐carotene levels, and both kidneys were examined pathologically for scarring, graded as 0 (none), 1 (mild), 2 (moderate) and 3 (severe).ResultsSerum vitamin A levels were higher in the rats given vitamin A (group 2–5) than in group 1, being highest in group 4, although only this group had significantly higher levels of vitamin A than group 1 (P<0.05). Histopathologically, the fibrosis was mildest in groups 2 and 4 (two of 16 kidneys grade 1), whereas it was most severe in group 1 (all 16 grade 2–3). Fibrosis was significantly less in groups 2–5 than in group 1 (P<0.05). There was a significant negative correlation between vitamin A levels and the sum of the fibrosis, inflammation and tubular atrophy scores of all rats (r=−0.391, P<0.02). β‐carotene levels were unrelated to renal scarring.ConclusionThe administration of vitamin A could have a role in preventing renal scar formation from pyelonephritis induced experimentally in rats.
Expression of p75LNGFR and Trk neurotrophin receptors in normal and neoplastic human prostate
Authors: Guate  , Fernández  , Lanzas  , Escaf  , Vega  
Published: March 2003

ObjectiveTo analyse the occurrence and cell distribution of p75LNGFR and Trk neurotrophin receptors in normal prostate, benign prostatic hypertrophy (BPH) and prostate carcinoma, and to determine the effect of androgen suppression on the expression of these proteins in prostate cancer samples.Materials and methodsThe study comprised formalin‐fixed and paraffin‐embedded material, obtained during surgery and from cadavers during removal of organs for transplantation. Light microscopy immunohistochemistry was carried out using polyclonal antibodies against Trks, and a monoclonal antibody against p75LNGFR . General markers for epithelial and endocrine cells were assessed in parallel.ResultsTrkA immunoreactivity (IR) was restricted to the basal epithelial cells in some acini (37%). This pattern remained unchanged or IR extended to the whole acini in BPH, and varied widely in prostate cancer. In normal tissue and BPH, TrkC IR was detected exclusively in the stroma. Nevertheless, it progressively increased in the epithelial cells of well‐differentiated to moderately differentiated prostate carcinoma, whereas in stromal cells there were no substantial changes. TrkB IR was absent in all the samples. There was weak p75LNGFR IR in normal epithelial cells, which increased in prostate cancer and to a lesser extent in BPH. Androgen suppression was ineffective in reversing TrkA modifications, whereas it caused a decrease in the expression of TrkC and p75LNGFR .ConclusionThe abnormal growth of prostatic epithelium is accompanied by increased TrkA expression and the induction of TrkC expression in epithelial cells. These results suggest that neurotrophins could be involved in the abnormal growth of the human prostate, acting through specific Trk signal‐transducing receptors whose expression is regulated by androgens.
Periurethral collagen injection: a long‐term follow‐up study
Authors: Gorton  , Stanton  , Monga  , Wiskind  , Lentz§  , Bland¶  
Published: March 2003

ObjectiveTo determine the long‐term success of the periurethral injection of collagen (Contigen® , Bard UK) in women with genuine stress incontinence.Patients and methodsSixty‐one women with genuine stress incontinence were enrolled in a trial of periurethral collagen injections between 1 September 1990 and 31 August 1992. They were assessed at 1, 3, 6, 12 and 24 months after the last collagen injection. In 1998, their notes were reviewed, and a standardized questionnaire was sent to 46 women who were still alive and had undergone no further anti‐incontinence surgery.ResultsOf the 53 women who were either known failures or who had follow‐up information beyond 5 years, 26% were subjectively improved. Women who had a maximum urethral closure pressure of >20 cmH2O and those who had urinary incontinence for <10 years before their first injection were more likely to have had long‐term success. There was no correlation between long‐term success and the number of previous operations, body mass index, age or preoperative pad loss. Neither the number of injection sessions, total volume of collagen injected nor perceived bulking at the time of surgery affected long‐term success rates. Of the 14 women who considered themselves subjectively improved, seven had daily incontinence and only one was completely dry. Urinary retention and urinary tract infection were the most common complications. In addition, one woman reported a flare‐up of her skin test and transient ‘flu‐like symptoms 2 weeks after the injection, and one woman developed a right upper lobe pneumonia 2 weeks after the collagen injection.ConclusionThe long‐term results of periurethral collagen injections are disappointing. We found no evidence to support the use of periurethral collagen injections in women with intrinsic sphincter deficiency, who had a higher failure rate than those with hypermobility. Further research is essential to develop agents that are not immunogenic, produce minimal inflammatory response and yet are durable.
Seminal vesicle sperm aspiration in the diagnosis of ejaculatory duct obstruction
Authors: Orhan  , Onur  , Çayan  , Koksal  , Kadiogˇlu  
Published: March 2003

ObjectiveTo determine the effectiveness of seminal vesicle aspiration in the diagnosis and treatment of patients with ejaculatory duct obstruction.Patients, subjects and methodsBetween March 1998 and February 1999, 10 infertile men with ejaculatory duct obstruction (EDO, mean age 32.7 years, range 25–47) and 10 fertile volunteers (mean age 33.2 years, range 25–42) underwent transrectal ultrasonography (TRUS) and TRUS‐guided seminal vesicle aspiration. The volume of and presence of motile sperm in the aspirate was compared with the TRUS findings for both groups.ResultsFrom TRUS of the patients with EDO, the mean (sd, range) transverse diameter of the right and left seminal vesicles were 1.97 (0.54, 0.8–2.6) cm and 1.93 (0.53, 0.9–2.6) cm; the corresponding values in the control group were 1.03 (0.15, 0.8–1.3) cm and 1.0 (0.12, 0.8–1.4) cm, respectively (P<0.001). In all, 20 aspirate samples were obtained from the patients with EDO by bilateral seminal vesicle aspiration and only one (10%) had no sperm within the aspirate fluid. Of these 10 patients, two had immotile sperm and the remaining seven (14 samples) had a mean motile sperm count of 0.63 (0.45, 0.1–1.0)×106 /mL, whereas seven of eight men assessed in the control group had no motile sperm (one patient had immotile sperm within the aspirate fluid); this difference was significant (P<0.01).ConclusionsThe aspiration of significant numbers of motile sperm from the seminal vesicles suggests the presence of distal obstructions of the ejaculatory duct and enables infertile couples to be candidates for assisted reproduction. However, there is a need for further research to determine the use of this technique in the diagnosis of partial EDO.
Uneven pressure application by the artificial urinary sphincter: an explanation for tissue ischaemia?
Authors: Hajivassiliou  , Finlay  
Published: March 2003

ObjectiveTo determine, in an in vitro study, the pressure inside the AMS 800 (American Medical Systems, USA) sphincter placed around porcine intestine and to correlate this with the pressure retention for liquids, in an attempt to explain the increased sensitivity of bowel to ischaemic injury when the artificial urinary sphincter is used around bowel neo‐urethral segments.Materials and methodsSegments of porcine intestine were placed in a specially designed mechanical jig and an AMS 800 sphincter placed around the segment. The device was inflated by injecting water and the cuff pressure measured. Water was infused into the bowel and the pressure at which leakage occurred through the sphincter recorded. At each inflation pressure, a catheter‐tipped microtransducer was used to measure the pressure inside the cuff‐fold. It was then placed in the centre of the cuff lumen, rotated by 360° and the pressure continuously recorded.ResultsThe cuff occluded the lumen by creating a ‘triple‐cushion’ effect. The fluid retention pressure was ≈49% of the cuff pressure. There were directional differences in the pressure measured inside the bowel lumen. The pressure was also disproportionately higher inside the cuff folds than in the centre of the sphincter, and increased rapidly with inflation of the cuff.ConclusionThe thin wall of the bowel may ‘crenate’ inside the high‐pressure areas in the cuff folds and this may explain the increased sensitivity of bowel to ischaemic injury in such cases.
Brefeldin A‐induced apoptosis in prostatic cancer DU‐145 cells: a possible p53‐independent death pathway
Authors: Chapman  , Tazaki  , Mallouh  , Konno  
Published: March 2003

ObjectiveTo investigate the growth inhibitory mechanism of brefeldin A (BFA), an antiviral antibiotic, in androgen‐independent prostatic cancer DU‐145 cells.Materials and methodsThe inhibitory effects of BFA (30 ng/mL) on cell growth were monitored by cell counting and viability tests after specified exposures. Flow cytometry and western immunoblot analysis were performed to examine the effects of BFA on the cell cycle and on specific growth regulators. The possible induction of apoptosis by BFA was further assessed by in situ hybridization (ISH) assay and by qualitative DNA analysis using agarose‐gel electrophoresis.ResultsCell growth was completely inhibited with BFA (30 ng/mL), accompanied by 40–50% cell death. Cell cycle analysis revealed that this growth inhibition coincided with an 85% reduction in the S‐phase cell population. Western blots showed that the expression of cell cycle‐dependent kinases (cdk2 and cdk4), cyclin D1 and p53 was significantly reduced, while WAF1 was increased, after BFA treatment. Apoptosis was confirmed by both the ISH assay, which showed the characteristic brownish staining of BFA‐treated cells, and by DNA analysis, which revealed the internucleosomal DNA ladder.ConclusionBFA‐induced growth inhibition in DU‐145 cells is primarily due to the modulation of specific G1 cell‐cycle regulators, blocking the G1–S phase progression. Such a growth arrest ultimately results in apoptosis, presumably through a p53‐independent pathway.
The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy
Authors: Clobes H. , Fosså S. D. , Wæhre H. , Jocham D. , Berner A. 
Published: March 2003

Objective To detect occult regional lymph node metastases in patients with T3pN0M0 prostate cancer not recognized by routine haematoxylin and eosin staining, and to evaluate the clinical relevance of this finding. Patients and methods Formalin‐fixed and paraffin‐embedded pelvic lymph nodes (1118) from 92 patients were evaluated by immunohistochemistry using antibodies for prostate specific antigen (PSA) and pancytokeratin (AE1/AE3). Of the tumours, 14% were well, 69% moderately and 17% poorly differentiated. The extent of tumour was categorized as T3pN0M0 in all patients, who were referred for definitive radiotherapy after pelvic staging lymphadenectomy. The median (range) serum PSA value before treatment was 18.5 (0.4–342) µg/L. After radiotherapy, the patients were followed by assessing biochemical progression, pelvic recurrence and/or development of distant metastases. The median (range) observation time for all patients was 61 (16–136) months. Results Occult lymph node metastases were detected in four (4.4%) of the 92 patients. Patients with or without occult metastases had similar serum PSA levels and histological grades. None of the four patients with occult metastases progressed, compared with 37 of the 88 (42%) with no such metastases. Conclusion Using immunohistochemistry the detection rate of occult lymph node metastases in patients with T3pN0M0 prostate cancer is low. The occurrence of such metastases is probably unrelated to the serum PSA value before treatment. The short‐term outcome of patients subsequently treated with definitive radiotherapy does not seem to be associated with the finding of occult lymph node metastases, but long‐term follow‐up is needed. So far, the results do not justify the search for occult lymph node metastases as a routine procedure in these patients