bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of electropermeabilization after the administration of anticancer drugs on transitional cell carcinoma
Authors: Yanai H. , Kubota Y. , Nakada T. 
Published: March 2003

Objective To assess in vitro and in vivo the potential utility of electropermeabilization (EP) as an anticancer drug delivery system for the treatment of transitional cell carcinoma (TCC). Materials and methods To analyse the effects of EP on the internalization of adriamycin and bleomycin by cells, aliquots of a suspension of YTS‐1 carcinoma cells (derived from a human TCC line) were mixed with a solution of adriamycin or bleomycin and then exposed immediately to an electric field (1000 V/cm, 1 Hz, 100‐µs square wave, eight pulses). After a 2‐h incubation the concentration of each drug in the cells was measured by high‐performance liquid chromatography (for adriamycin) and by bioassay (for bleomycin). The concentrations of drugs in the cells were compared with untreated cells. To analyse the effects of EP on cytotoxicity, the same treatments were applied to a suspension of cells plus adriamycin or bleomycin and then the cells incubated for 6 h with tritiated thymidine ([3H]‐TdR), monitoring the incorporation of [3H]‐TdR into the cells. Cells with no electrotreatment acted as controls. To assess the effects on tumours in vivo, YTS‐1 cells were transplanted subcutaneously into nude mice; when the tumours had reached 7 mm in diameter, EP was applied (using electrical pulses as before, 10 min after the direct injection of bleomycin into the tumour). Tumours were then measured regularly and compared with sham‐treated tumours, tumours treated with electric pulses alone, and tumours treated with bleomycin alone. Survival was also compared. Results There were no significant differences in the levels of adriamycin between cells with and with no EP, whereas there was a marked difference for bleomycin. Growth inhibition by adriamycin with and with no EP was similar, while the growth‐inhibitory effects of bleomycin were almost doubled. There was a reduction in tumour size only in the group treated with bleomycin plus electric pulses and two of five tumours disappeared completely. Survival in this group was also significantly better than in the other groups. Conclusion EP after administering bleomycin might be an effective treatment for TCC.
Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience
Authors: Elbakry A. 
Published: March 2003

Objectives To report the outcome of managing urethrocutaneous fistula after hypospadias repair over 10 years. Patients and methods Forty‐seven patients (mean age 7.6 years, range 2–18) underwent repair of 57 urethrocutaneous fistulae after hypospadias surgery. The fistula was single in 37 patients and multiple in 10; 42 fistulae were small (< 4 mm) and 15 large (> 4 mm). Twenty‐one fistulae were at the corona, 15 at the anterior shaft, 16 at the mid‐shaft and five were penoscrotal. The interval between primary hypospadias repair and the first attempt at fistula repair was 6–12 months. Small fistulae were repaired using a multilayer simple closure technique, and large fistulae repaired using rotational and advancement skin flaps. Suprapubic urinary diversion was used in all patients with large fistulae or small multiple fistulae (25 patients); an overnight urethral catheter was used in the remaining patients. Results Simple closure was successful in 30 of 42 small fistulae (71%); eight were successfully closed by secondary closure, while four needed a third closure. Rotational and advancement skin flaps were successful in 13 of 15 large fistulae; one required secondary flap repair and one was closed simply. Most recurrences (78%) were of coronal fistulae; there was recurrence in four of 25 (16%) patients in whom suprapubic diversion was used, in contrast to 10 of 22 (45%) with no suprapubic diversion. Conclusions Although simple closure of a fistula is easy and not time‐consuming it is followed by a significantly higher rate of recurrence than when skin flaps are used. Rotational and advancement flaps are the optimal methods for repairing fistulae after hypospadias, particularly for large and coronal fistulae. Thus, the appropriate indication for simple closure is small fistulae at the penile shaft. Suprapubic diversion is important in those with large or multiple fistulae.
Does cystoscopy correlate with the histology of recurrent papillary tumours of the bladder?
Authors: Herr H.W. 
Published: March 2003

Objective To correlate the cystoscopic appearance of recurrent papillary bladder tumours with the histology after transurethral resection, and thus ascertain whether cystoscopy can reliably identify low‐grade, noninvasive papillary tumours suitable for outpatient fulguration. Patients and methods In all, 150 recurrent papillary tumours of the bladder identified at outpatient flexible cystoscopy were classified as either low‐grade and noninvasive (TaG1), high‐grade and noninvasive (TaG3), or invasive (T1G3) tumours, and correlated with urine cytology and histology of tumour stage and tumour grade after transurethral resection. Results Cystoscopy classified 84 of the 150 papillary tumours as TaG1 and 66 as either TaG3 or T1G3. Cystoscopy correctly predicted the histology of 78 of 84 (93%) TaG1 tumours, 71 of 72 (98%) TaG1 tumours associated with a negative urine cytology, and 92% of TaG3 or T1G3 tumours. Conclusions A skilled urologist can identify noninvasive, low‐grade recurrent papillary bladder tumours on follow‐up cystoscopy that do not require biopsy and that may be treated by outpatient fulguration alone.
Increased morbidity after circumcision from a hidden complication
Authors: Atikeler M.K. , Onur R. , Gecit I. , Senol F.A. , Cobanoglu B. 
Published: March 2003

Objective To describe a late complication of circumcision and to elucidate the role of surgical materials or any foreign body in the development of a subcutaneous mass in circumcised boys. Patients and methods From May 1998 to March 2001, 646 boys were circumcised and 523 (mean age 6.5 years, range 0–13) re‐examined for the possible development of a subcutaneous mass. Twenty‐six (5%) of the re‐examined patients had such a mass under the penile skin; it was removed in all patients under local anaesthesia and examined histopathologically. Results The mean (sd, range) delay after circumcision before developing or detecting the mass was 3.2 (0.7, 1–7) months. All patients were asymptomatic but there was purulent discharge in four. On removing the mass, histopathology showed the development of granulation tissue with foreign‐body giant cells. Conclusion There may be minor complications after circumcision which cannot be avoided even when the procedure is undertaken by surgeons. Awareness of such complications occurring long after circumcision may aid in the early detection of this asymptomatic mass and prevent a more severe outcome.
Experience with demucosalized ileum for bladder augmentation
Authors: Lima S.V.C. , Araújo L.A.P. , Vilar F.O. , Mota D. , Maciel A. 
Published: March 2003

Objective To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon. Patients and methods Eleven patients with bladder exstrophy or a neurogenic bladder had their bladders augmented with demucosalized ileum instead of the sigmoid colon, but following the same technique. The use of a Foley catheter with an inflated balloon greatly facilitated the dissection of the mucosa from the muscle. A silicone model, inserted in the bladder, was used to avoid shrinkage of the patch. An animal model was also used for total bladder replacement following the same principle. Results The mean (range) follow‐up was 15.4 (2–25) months. There was a significant increase in bladder compliance in all patients. A bladder of good shape and compliance was obtained in the animal model, with epithelial growth detected in all cases. Conclusions Demucosalized ileum can be used safely for bladder augmentation in the same way as with the sigmoid colon. The distension of the isolated patch greatly facilitates dissection between the mucosa and muscle. The animal model supported this method of bladder replacement.
Ductal carcinomas of the prostate: a clinicopathological and immunohistochemical study
Authors: Oxley  , Abbott  , Gillatt  , Maciver  
Published: March 2003

Objectives To confirm the expression of prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) in ductal carcinomas of the prostate, and to analyse p53, Ki67, oestrogen (ER) and androgen (AR) receptors in these tumours.Materials and methods Paraffin‐embedded samples from 12 patients with ductal carcinoma of the prostate were assessed for pattern, mitotic count and the presence of a microacinar carcinoma component. There were six pure ductal and six mixed microacinar and ductal carcinomas. Sections were stained immunohistochemically for the expression of PSA, PAP, Ki67, p53, AR and ER. Clinical data were obtained from case notes.Results Six of the ductal tumours had a papillary pattern whilst the others had a cribriform appearance. The mitotic rates in the ductal areas were high in the tumours from eight of the 12 patients. PSA and PAP immunohistochemistry were positive in all the cases. No ER immunoreactivity was found in any of the patients. Ten of the ductal tumours showed strong reactivity with AR, the other two were weakly positive; two of the tumours were strongly positive for p53 protein. All the ductal carcinomas expressed Ki67, three having >25% nuclear marking. One patient who was strongly positive for p53 and had a high Ki67 score survived only one year after diagnosis. Survival ranged from 1 to 13 years after diagnosis.Conclusion This study confirms the expression of PSA and PAP in ductal carcinomas of the prostate. The percentage of tumours expressing p53 was similar to that published for high‐grade microacinar carcinomas. The results for Ki67 suggest that ductal tumours have higher scores than microacinar tumours, but further studies are required to ascertain if this is significantly different. As half the patients with ductal tumours had co‐existent microacinar tumours, we advise transrectal prostatic biopsies in patients diagnosed with pure ductal carcinomas on transurethral resection specimens, to exclude high‐grade microacinar carcinomas. The presence of AR and the lack of ER in all the ductal carcinomas confirms that these tumours are prostatic in origin and should be treated with anti‐androgen therapy.
Prediction of pathological stage and clinical outcome in prostate cancer: an improved pre‐operative model incorporating biopsy‐determined intraductal carcinoma
Authors: Cohen  , Chan  , Edgar  , Robinson  , Dodd  , Hoscek  , Mundy  
Published: March 2003

Objective To relate the predictive value of serum prostate specific antigen (PSA) levels, histological grade and intraductal carcinoma (IDC‐P, a possible marker of poor prognosis) to pathological stage and subsequent clinical outcome, and thus derive an improved predictive model to aid the decision to initiate potentially curative therapy in localized prostate cancer.Materials and methods Fifty‐nine radical prostatectomy specimens were histologically graded, allocated a pathological stage and the tumour volume determined by image analysis. Pre‐operative (needle biopsy) tumour grade, the presence or absence of IDC‐P, and serum PSA levels were correlated with the pathological stage. This was used to define the sequence and values that would be incorporated into a predictive model for pathological stage and clinical outcome.Results There were close correlations between cancer volume and tumour grade (P=0.004) and between cancer volume and serum PSA level (P=0.003). However, in tumours with IDC‐P, serum PSA level did not correlate with tumour volume of IDC‐P (P>0.9). IDC‐P was an independent variable that significantly improved the prediction of pathological stage and tumour volume, and furthermore, was closely related to (r=0.53, P=0.001) and accurately predicted treatment failure.Conclusions The model which best predicted pathological stage and clinical outcome involved first identifying those cancers with IDC‐P as having the poorest outcome. Cancers without IDC‐P were then separated into low‐ and high‐risk groups on the basis of serum PSA levels below and above 10 ng/mL, and those in the high‐risk group further stratified using Gleason grading. Furthermore, the use of a sequential consideration of pre‐operative variables including IDC‐P allowed cases to be grouped which, after radical surgery, closely correlated with clinical outcome.
A study of reflux in patients with an ileal orthotopic bladder
Authors: Waidelich  , Rink  , Kriegmair  , Tatsch  , Schmeller  
Published: March 2003

Objective To determine whether there is vesico‐ureteric reflux during voiding in patients who had undergone an ileal bladder substitution after cystectomy.Patients and methodsThe study comprised 15 patients (13 men and two women) who had undergone radical cystectomy and construction of a Studer ileal neobladder. At 1–24 months (median 4) after the operation indirect radionuclide cystography (IRC) was performed after isotopic renography (using 99 m‐technetium mercapto‐acetyltriglycine) and voiding cysto‐urethrography (VCUG).ResultsNone of the patients had reflux during voiding, either on IRC or on VCUG. Renal function and morphology remained stable in all patients. Despite bacteriuria occurring in four patients, no episode of pyelonephritis was reported.ConclusionThere was no vesico‐ureteric reflux during voiding in patients with a Studer ileal bladder substitution. However, long‐term follow‐up is needed to finally determine whether an antirefluxive ureteric implantation is required to protect the upper urinary tract in patients with ileal low‐pressure bladder substitutions.
Transcutaneous electrical stimulation of thigh muscles in the treatment of detrusor overactivity
Authors: Okada  , Igawa  , Ogawa  , Nishizawa  
Published: March 2003

Objective To investigate the clinical effects on detrusor overactivity of a new method of transcutaneous reciprocal electrical stimulation of the thigh muscles.Patients and methods Nineteen patients with detrusor overactivity, comprising 14 with detrusor hyper‐reflexia (DH) and five with idiopathic detrusor instability (IDI), were studied. Electrical stimulation was applied alternately to the quadriceps and hamstring muscles of one or both legs through surface electrodes for 20 min. The treatment was given once a day for 14 days and then the patients were evaluated urodynamically.Results All 19 patients tolerated the therapy well and none reported any adverse effects. The mean maximum cystometric capacity increased significantly (P<0.05) after treatment. In 11 of the 19 patients, the maximum cystometric capacity was increased by >50% of the pretreatment value; this occurred in eight of 14 of those with DH and in three of five of those with IDI. In six of the 11 who responded in this way, there was a clinical improvement in their urinary incontinence and frequency for several weeks to 3 months after the period of therapy. A second 14‐day treatment was also effective in all four patients who underwent a repeat trial.Conclusion This method of transcutaneous electrical stimulation can inhibit DH as well as IDI with no adverse effects. The suppressive effect on detrusor overactivity may persist for several months and repeat trials appear to be effective. Thus, we believe that this new stimulation technique should be tried as an alternative to other types of electrical stimulation and augmentation cystoplasty.
Prevalence of lower urinary tract symptoms in Finnish men: a population‐based study
Authors: Koskimäki  , Hakama  , Huhtala  , Tammela  
Published: March 2003

Objective To determine the prevalence of lower urinary tract symptoms (LUTS) in Finnish men, using a population‐based cross‐sectional survey.Subjects and methods In 1994, a modified Danish prostatic symptom score system (DAN‐PSS‐1) questionnaire on the occurrence and severity of LUTS was mailed to all men (3143) born in 1924, 1934 or 1944 living in the city of Tampere or 11 rural and semi‐rural municipalities in the same county.Results After exclusions, 68% of the men were ultimately included in the study. LUTS were common and increased with age so that the prevalence of at least one symptom was 89% in the whole population (84% among 50‐year‐old, 91% among 60‐year‐old and 94% among 70‐year‐old men). Most of the symptoms were mild, with post‐micturition dribbling and nocturia the most prevalent symptoms, and stress incontinence the least prevalent.Conclusions The high incidence of LUTS may indicate a high prevalence of benign prostatic enlargement secondary to benign prostatic hyperplasia, but other causes are also involved. With the increase in the mean age of the general population, the number of individuals with LUTS is likely to increase and must be considered when resources are planned for medical care.
Urodynamic patterns in infants with normal lower urinary tracts or primary vesico‐ureteric reflux
Authors: Yeung  , Godley  , Dhillon  , Duffy  , Ransley  
Published: March 2003

Objective To compare bladder function in infants with primary vesico‐ureteric reflux (VUR) and those with normal lower urinary tracts.Patients and methods The study comprised 42 patients (36 males) with VUR (grades III to V) and 21 (16 males) without VUR (mean age in both groups, 6 months). Intravesical catheters were placed suprapubically under general anaesthesia and, after at least 24 h, natural‐filling urodynamics were monitored for three or more filling and voiding cycles.Results Various urodynamics patterns were defined: for infants without VUR these were either normal or normal‐immature (discoordinated micturition) and none showed features indicating abnormal bladder function. By comparison, 24 of 42 infants with VUR showed abnormal urodynamic patterns (57%, 95% confidence interval 41% to 72%, P<0.001). Seven (17%) were defined as unstable with small voided volumes, five (12%) had inadequate voiding dynamics, 10 (24%) showed a markedly dyssynergic pattern and two (5%) had obstructive patterns. The unstable, inadequate and obstructive patterns occurred only in boys. Detrusor activity during the filling phase occurred in 14 infants (13 boys) with VUR and in only one without VUR, when it was trivial. Post‐void residual volumes of >30% capacity were seen only in the VUR group (in 24 patients). There were 18 infants with VUR that showed the normal or immature urodynamics patterns, but for the 14 males the voiding pressures were higher than for those without VUR (mean maximum detrusor pressure, 161 and 117 cmH2O, respectively; P<0.02).Conclusions There is an association between abnormal urodynamic variables and a diagnosis of primary VUR in young infants (notably males) that may have important implications for concepts about the genesis and persistence of VUR.
Microvessel density as a prognostic marker for transitional cell carcinoma of the bladder
Authors: Hawke  , Delahunt  , Davidson  
Published: March 2003

Objective To investigate the prognostic significance of mean vascular density (MVD) in a variety of transitional cell carcinomas (TCC) obtained by biopsy and cystectomy, and thus determine the importance of vascular density as a prognostic indicator for vesical TCC.Patients and methods Tumour vasculature was visualized using factor VIII immunohistochemistry. The MVDs of tumours from 42 cystectomy specimens were correlated with patient survival over a maximum follow‐up of 156 months. The results were also compared with those obtained from initial bladder biopsy in a subset of 29 patients.Results Twenty‐five patients had died over a mean follow‐up of 32 months. The MVDs from cystectomy specimens ranged from 29 to 229 vessels per medium‐power field (0.94 mm2 ) while that for biopsies before cystectomy ranged from 51 to 155 vessels. The MVD for both cystectomy and biopsy specimens showed a significant association with survival, but this was absent in a multivariate analysis that included tumour stage and grade, and there was a poor correlation between the MVD of cystectomy‐ and biopsy‐derived tumours.Conclusion The assessment of tumour vascularity appears to be of little clinical importance for vesical TCC.
Urological consequences of incomplete cord lesions in patients with myelomeningocele
Authors: Keshtgar  , Rickwood  
Published: March 2003

Objectives To determine the urological consequences of incomplete cord lesions in patients with myelomeningocele and a neuropathic bladder.Patients and methods From a total of 407 patients with myelomeningocele and a neuropathic bladder, 31 (8%) were identified as having a combination of sacral sensory or motor sparing and positive conus reflexes. Their case‐notes were reviewed with reference to spinal neurology, patterns of micturition, including the degree of spontaneous continence, findings on imaging and urodynamic studies, and forms and outcomes of any treatment given.Results The anatomical distribution of the lesions was thoracic (two), thoracolumbar (three), lumbar (six), lumbosacral (four) and sacral (11). The mean age at presentation was 9.5 years (range 3.5–19.5) and the mean follow‐up 4.5 years (range 0.5–10.5). At presentation, 14 patients had urinary incontinent episodes both day and night, 10 by day only, seven by night only, and the upper urinary tracts were dilated in eight (26%). Nineteen were ambulant unaided and 10 with aid of crutches or calipers, whilst two were wheelchair‐bound. Only one patient had faecal incontinence. A urodynamic examination in 18 patients showed competent sphincteric mechanism and detrusor hyper‐reflexia in all, and detrusor sphincter dyssynergia in 11. The methods of treatment included oxybutynin and/or clean intermittent catheterization alone or in combination. Thirty patients are currently reliably dry by day and 26 also by night. Five patients have undergone surgical treatment for vesico‐ureteric reflux, three a Mitrofanoff procedure and two augmentation cystoplasty.Conclusion Although patients with congenital incomplete cord lesions and positive conus reflexes may gain some measure of urinary continence spontaneously, they are at serious risk of developing upper urinary tract complications. The treatment of urinary continence is simple and effective because there is a competent sphincter mechanism. These patients require life‐long supervision even if they require no treatment for urinary incontinence.
A wall‐incorporated valve for preserving continence:
Authors: Elbakry  , Gohar  , Khalaf  
Published: March 2003

Objective To describe a new continent valve incorporated as part of the wall of a urinary reservoir constructed from bowel.Materials and methods The technique was evaluated experimentally in 12 dogs; 40 cm of the distal ileum were isolated and the proximal 30 cm detubularized. The adjacent distal 7 cm of the intact ileum (valvular segment) was tailored around an 18 F catheter. The opened ileum plus the valve were doubly folded to form a pouch and the valvular segment incorporated as part of the pouch wall. The pouch was anastomosed to the trigone after subtotal cystectomy; the ureters were not manipulated. The pressure profile of the valve and ascending cystography were assessed 20 weeks after surgery and the inner layer of the valve examined histopathologically after the animals were killed.Results None of the 12 dogs showed leakage through the valve at maximum filling on ascending cystography. The urodynamic assessment verified the reliability of the valve in maintaining continence and there were no problems catheterizing the valve. The histopathological examination showed that the valve was covered by intestinal mucosa.Conclusions The new continent valve is technically easy to construct; the procedure is not time‐consuming, staples are unnecessary and the mesenteric vascular pedicle is not manipulated. A shorter ileal segment is used in constructing this valve than is required for the intussuscepted valve. The wall‐incorporated valve seems to provide a reliable and easily catheterizable continent stoma.