bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple use of fibres in the visual laser ablation of the prostate
Authors: Gilbert H.W. , O'Boyle P.J. , McLoughlin J. , Speakman M.J. 
Published: November 2003

Objective To investigate the possibility of re‐using laser fibres for the visual laser ablation of the prostate (VLAP). Patients and methods Thirty‐four patients, each with a mean maximum urinary flow rate of <14.0 mL/s and an American Urological Association symptom score of >19, were evaluated. All underwent VLAP; laser energy, generated by a Neodymium:YAG system, was delivered with a side‐firing fibre. The laser generator was fitted with a custom‐built power meter that measured the energy delivered by the fibre. Fibres were re‐used until the energy output fell below 60 W despite increases in laser generator power. Each patient was followed for at least 12 months. Results A total of seven fibres was used to treat the 34 patients; between one and nine patients were treated with each fibre. The outcome obtained with the first use of a fibre compared well with those obtained with each subsequent use. After 12 months, 25 patients (74%) expressed satisfaction with the results of their operation. Five patients (15%) had urinary tract infections. As each fibre costs about £650, multiple use saved a mean of £516 for each patient treated. Conclusion This evaluation implies that there is no justification for the single use of laser fibres on the basis of efficacy, provided that a power meter is used to monitor the efficiency of the delivery device.
Paroxetine in the treatment of premature ejaculation
Authors: Ludovico G.M. , Corvasce A. , Pagliarulo G. , Cirillo‐Marucco E. , Marano A. , Pagliarulo A. 
Published: November 2003

Objective To test the efficacy and the adverse effects of a new anti‐depressant drug (paroxetine) in the treatment of premature ejaculation. Patients and methods The study comprised 32 men (mean age 28 years) with premature ejaculation (14 of whom ejaculated before penetration) who were treated with paroxetine (20 mg orally each evening for 2 months). The study group excluded those with neurological and psychiatric disorders, urinary tract infections and drug or alcohol abuse. Results After about 14 days, the patients' symptoms improved and all patients reported a longer interval before ejaculation. The adverse effects were sleepiness in 19 patients (61%) and mild sensory confusion in 21 (68%), but only one had to withdraw from therapy. Three weeks after the end of therapy, the premature ejaculation recurred in 28 (90%) of the patients. Conclusions These results indicate that paroxetine is an effective therapy for premature ejaculation. Further studies with different dosages are necessary to decrease the adverse effects and to prolong the efficacy.
Alterations in pulmonary function after retroperitoneoscopic surgery
Authors: Chung H‐J , Chiu A.W. , Chen K‐K , Huang J.S. , Hsu Y‐S , Chang L.S. 
Published: November 2003

Objective To evaluate and compare changes in pulmonary function after retroperitoneoscopic and open surgery. Patients and methods From June 1994 to October 1995, 11 patients (five men and six women, mean age 44.7 years, range 29–69) underwent retroperitoneoscopic procedures (Group 1) and 11 patients (eight men and three women, mean age 57.5 years, range 22–73) underwent flank‐incision procedures (Group 2). The surgery comprised eight adrenalectomies and one each of nephroureterectomy, nephrectomy and pyelolithotomy in Group 1, and five adrenalectomies, four nephroureterectomies, one ureterolithotomy and one excision of a retroperitoneal tumour in Group 2. Pulmonary function tests (PFTs) were performed before and 3 days after surgery; the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), forced expiratory volume at 25% (FEV25% ), FEV1 /FVC, vital capacity (VC), total lung capacity (TLC), residual lung volume (RV) and functional residual capacity (FRC) were compared between the groups. The post‐operative changes in the PFTs were assessed using a paired t‐test and the degree of change in both groups compared using the Mann–Whitney U‐test. Other factors possibly influencing PFT were analysed using multiple regression. Results Pulmonary function was impaired in both groups on the third day after surgery. In Group 2, the FVC, FEV1 , FEV25% , VC and TLC had declined significantly (all P<0.05) from the pre‐operative value. In Group 1, only the FVC and VC decreased significantly (P<0.05). Post‐operative pulmonary complications occurred in two patients in Group 2 but in none of those in Group 1, showing that pulmonary function was generally less affected in Group 1 than in Group 2. Conclusion Although pulmonary function was impaired 3 days after surgery in both groups, retroperitoneoscopic surgery, by eliminating a large flank incision, caused less post‐operative pulmonary dysfunction than open surgery.
Varicocele testis and testicular temperature
Authors: Lund L. , Nielsen K.T. 
Published: November 2003

Objective To evaluate whether there is an association between scrotal skin temperature and impaired semen quality in patients with varicocele testis. Subjects and methods Two groups of men (all newly enlisted soldiers), 39 with an asymptomatic varicocele testis and 38 normal control subjects, were compared for semen quality and scrotal skin temperature. Results The semen quality in the men with varicocele was significantly lower than that in the control subjects; however, there was no significant difference in scrotal skin temperature between the groups. Conclusion This study confirmed previous observations showing a possible relationship between varicocele testis and impaired sperm quality, but there was no apparent difference in scrotal skin temperature in men with or without a varicocele.
Hydrolysis of cyclic guanosine monophosphate and cyclic adenosine monophosphate by the penis and aorta of the diabetic rat
Authors: Miller M.A.W. , Morgan R.J. , Thompson C.S. , Mikhailidis D.P. , Jeremy J.Y. 
Published: November 2003

Objective To investigate the hydrolysis of adenosine 3′5′‐cyclic monophosphate (cAMP) and guanosine 3′5′‐cyclic monophosphate (cGMP) by specific phosphodiesterases (PDEs) in the penis and aorta of diabetic rats.Materials and methods Non‐ketonuric diabetes mellitus was induced in 10 Sprague‐Dawley rats with streptozotocin. After 2 months, the rats were killed and their penises and aortae excised. The tissues were incubated with [3H]‐cAMP and [3H]‐cGMP and the degree of hydrolysis was assessed by separating [3H]‐cAMP and [3H]‐cGMP from [3H]‐AMP and [3H]‐GMP, respectively, in the incubation supernatants using thin layer chromatography (polyethyleneimine cellulose developed in 50 mmol/L KCl).Results The hydrolysis of cAMP and cGMP was significantly reduced in penile and aortic tissue from diabetic rats compared to that of seven age‐matched controls.Conclusions Such a reduction of PDE activity would result in increased intracellular cyclic nucleotide levels (and thus corporeal smooth muscle relaxation and erection). Consequently, the altered activity of PDE enzyme systems is not related aetiologically to the pathogenesis of diabetic erectile dysfunction. Furthermore, these data consolidate the concept that enhanced cyclic nucleotide synthesis and decreased degradation constitute an adaptive response to counteract the deleterious effects of diabetes mellitus on erectogenic mechanisms. The pathophysiology and therapeutic implications of these findings warrant further investigation.
‘Double toxicity’ of glycine solution in the mouse
Authors: Zhang W.B. , Hahn R.G. 
Published: November 2003

Objective To study whether glycine, which may contribute to the symptoms of the transurethral resection syndrome promotes death in a mouse model and whether a modification of the glycine concentration offers a better chance of survival. Materials and methods Mortality was determined in 120 mice after an intravenous infusion of increasing volumes and concentrations of glycine solution. The animals were divided into groups of 10 and given 150, 180, 200 or 220 mL/kg body weight of 1.1, 1.5 or 2.2% glycine solution. As a control, 220 mL/kg of a 5% mannitol solution was given to 12 mice. Results After receiving an isosmotic (2.2%) glycine solution 70% of the animals died, while the overall death rate for 1.5% glycine was only 20%. When 1.1% glycine was used, the mortality was 10% after infusion of 150 and 180 mL/kg and 80% after infusion of ≥200 mL/kg. Logistic regression analysis showed that the outcome for the two highest glycine concentrations was directly related to the dose of glycine and not to the water load. Of 12 mice receiving the isosmotic 5% mannitol solution, three died. Conclusions A 1.5% glycine solution offered the best chance of survival. The mortality was governed both by the glycine dose (2.2 and 1.5%) and the tendency of the solution to produce overhydration of the cells (1.1%). Glycine toxicity was most important when small volumes were infused.
Clinical significance of routine pre‐cystectomy bone scans in patients with muscle‐invasive bladder cancer
Authors: Brændengen M. , Winderen M. , Fosså S.D. 
Published: November 2003

Objective To evaluate the clinical significance of bone scans taken routinely before total cystectomy in patients with bladder cancer of clinical stage ≥T2.Patients and methods Of 227 consecutive patients with stage ≥T2 bladder cancer diagnosed between 1980 and 1990 but with no clinical suspicion of bone metastases, 91 had a pre‐cystectomy bone scan performed at the Norwegian Radium Hospital. The medical records of these patients were reviewed to examine the subsequent development of distant metastases and survival.Results Of the 91 patients, 37 (41%) developed skeletal bone metastases after cystectomy, unrelated to the clinical T category. In 35 patients, the pre‐cystectomy bone scan showed pathological uptake of isotope which was interpreted by the specialist in nuclear medicine as suspicious of (13 patients) or probably caused by (22 patients) skeletal metastases. In either circumstance, the clinician decided that total cystectomy was precluded, particularly as most of the changes could be explained radiologically as being degenerative. In the individual patient, there was no clinically useful correlation between the findings on the pre‐cystectomy bone scan and the clinical course of disease, nor if serum alkaline phosphatase (SAP) level was included as an additional predictive factor. However, although not statistically significant, the follow‐up of all patients revealed an association between the degree of change on the pre‐cystectomy bone scan and the subsequent development of skeletal metastases and cancer‐corrected survival.Conclusion Unless further investigations, particularly magnetic resonance imaging (MRI), can be performed, the findings of a routine pre‐operative bone scan are usually unable to identify patients with bladder cancer of stage ≥T2 who will not be cured by total cystectomy. An increased level of SAP did not improve the predictive accuracy of a pre‐cystectomy bone scan. However, the results indicate that future clinical research should be directed at combining the findings of bone scans and MRI in the search for micrometastases.
Benign prostatic hyperplasia in an unselected community‐based population: a survey of urinary symptoms, bothersomeness and prostatic enlargement
Authors: Simpson R.J. , Fisher W. , Lee A.J. , Russell E.B.A.W. , Garraway M. 
Published: November 2003

Objectives To determine the prevalence of (anatomical)benign prostatic hyperplasia/enlargement (BPH/BPE)in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH. Subjects and methods All men aged 40–79 years and living in three ex‐mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire. Results Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50–69 was >60%. Age‐specific prevalence rates for BPE (prostate size >20 g) per 1000 men were: 40–49 years, 615; 50–59 years, 776; 60–69 years, 892; and 70–79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of >20 mL/s were very unlikely to have prostates >40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate‐specific antigen (PSA) were the only independent variables associated with prostate size. Conclusion Compared to published studies, BPEwas substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non‐intervention/watchful waiting.
Expired breath ethanol measurement to calculate irrigating fluid absorption during transurethral resection of the prostate: experience in a district general hospital
Authors: Checketts M.R. , Duthie W.H. 
Published: November 2003

Objective To estimate differences in the absorption of ethanol‐tagged irrigant fluid in patients undergoing transurethral resection of the prostate (TURP) using measurements of ethanol concentration in the breath. Patients and methods The study comprised 100 randomly selected patients (mean age 71 years, range 38–85) undergoing TURP. At frequent intervals during TURP, the ethanol content of end‐expiratory breath samples was measured using an alcometer, venous blood samples were drawn for determination of serum sodium, ethanol and haemoglobin concentration and the absorption of irrigant fluid and blood loss were estimated. These variables were compared between patients operated on by experienced and inexperienced surgeons. Results Ethanol was detected in the expired breath of 39 patients. Patients who absorbed irrigant fluid underwent longer operations than those who did not (median 33 min and 23 min, respectively; P<0.01), had a greater weight of prostatic tissue resected (median 27.5 g and 16.5 g, respectively ; P<0.01) and lost more blood intra‐operatively (median 295 mL and 143 mL, respectively; P<0.01). Consultant urologists performed 75 of the operations, with 25 patients (33%) having detectable breath ethanol, and trainees carried out the remaining 25 operations, where 14 (56%) patients had ethanol detected in the expired breath. The difference in peak end‐expiratory ethanol values between patients in the consultant and trainee group was significant (P<0.01). Furthermore, the incidence of ‘significant’ irrigant fluid absorption, i.e. a peak breath alcohol >300 mg/L (indicating >1 L of irrigant absorption) was one patient (1.3%) from those operated upon by a consultant and four (16%) from those treated by a trainee (P<0.05). Conclusions Irrigant absorption occurs frequently during TURP and is more likely to occur in operations performed by trainee urologists.
Ureteric drainage and peristalsis after stenting studied using colour Doppler ultrasound
Authors: Patel U. , Kellett M.J. 
Published: November 2003

Objective To study peristalsis and drainage of the stented ureter under normal physiological conditions.Patients and methods Fifteen non‐obstructed patients with ureteric stents and 15 control subjects (i.e. 45 unstented ureters and 15 stented ureters) had ureteric jets and flow analysed using colour Doppler ultrasound (CDU). Cross‐sectional and longitudinal studies were performed.Results Unstented ureters had forceful ureteric jets at a frequency of 0.5–4 jets/min per ureter. Asymmetry of frequency within subjects was common (1–3 jets/min). Some patent stented ureters had no recordable flow on CDU (four cases, three within the first week of stenting). In the remainder, three types of flow pattern were recorded; weak peristaltic jets were seen in a minority (four of 15), flow around the stent (periprosthetic flow) in 11 of 15 and flow through the lumen (luminal flow) in eight of 15. Jets were only seen late after stenting(>2 months). The periprosthetic flow was mildly peristaltic in some patients and periprosthetic and jet flow increased relative to luminal flow during peak diuresis.Conclusions Passive drainage (periprosthetic and luminal flow) is the principal mode of urine transport in the stented ureter throughout the diuretic response and particularly within a week of stenting. With longer duration of stenting (>2 months) weak peristaltic activity and active ureteric transport became more evident, notably during peak diuresis. CDU is not reliable for diagnosing obstruction of the stented ureter.
The role of the nurse practitioner in a urology service
Authors: Leung H.Y. , Davis M. , Arnold D. , Hamdy F.C. , Neal D.E. 
Published: November 2003

Objective To evaluate the role of the nurse practitioner in urology and to determine the impact on the work of junior doctors.Methods Written criteria were defined before the postholder was appointed and subsequent performance was assessed against these criteria. Training was provided and the quality of work was assessed by direct observation. Senior House Officers (SHOs) were asked whether the post had increased their opportunities to attend theatre, outpatients and post‐graduate training sessions and had decreased the number of ‘inappropriate’ tasks they had to perform.Results The nurse practitioner accomplished all the tasks that were defined before the appointment. The assessment of patients in pre‐admission and haematuria clinics was satisfactory. The continuity of information, care of patients and counselling for patients receiving complex surgery were improved. Sixty‐three per cent of all patients seen in the pre‐admission clinic and all patients in a haematuria clinic were assessed initially by the nurse practitioner. Because the nurse practitioner was involved in setting up intravenous drug administration and infusions, administrative tasks and in obtaining results from the laboratory, the number of ‘inappropriate’ tasks performed by the SHOs decreased and they were able to attend more sessions of training and education.Conclusions The nurse practitioner in clinical urological practice constitutes an effective use of resources and relieves junior medical staff from other tasks, allowing them to receive a more focused training. In addition, the quality of patient care was thought to be improved in some areas. The framework of a job plan for a nurse practitioner is described.
Long‐term outcome of permanent urethral stents in the treatment of detrusor‐sphincter dyssynergia
Authors: McFarlane J.P. , Foley S.J. , Shah P.J.R. 
Published: November 2003

Objectives To evaluate the long‐term efficacy of a permanently implanted urethral stent in the treatment of spinally injured patients with detrusor‐sphincter dyssynergia. Patients and methods Twelve patients underwent external sphincter stenting in our institution between 1988 and 1990. They were reviewed at least annually and investigated with serial urodynamic and ultrasonographic studies. Results Ten patients were followed for at least 5 years. Two patients required stent removal and five patients developed bladder neck obstruction requiring surgical intervention. There were no problems with stent migration, ulceration or infection. Conclusion Stenting is an effective alternative to sphincterotomy in the long‐term, although secondary bladder neck obstruction is a frequent problem.
The epidemiology of childhood enuresis in Australia
Authors: Bower W.F. , Moore K.H. , Shepherd R.B. , Adams R.D. 
Published: November 2003

Objective To establish the prevalence of enuresis in 5–12‐year‐old Australian children, to evaluate the impact of enuresis on the children and their families and to identify common methods of managing enuresis. Subjects and methods A self‐administered questionnaire was completed voluntarily by the parents of 2292 5–12‐year‐old children during attendance at electoral polling booths in Sydney, Australia. The questionnaire inquired specifically after the child's age, gender and frequency of wetting. Results From a response rate of 74%, the overall prevalence of any reported nocturnal enuresis was 18.9% and any day wetting 5.5%. The prevalence of marked nocturnal enuresis (at least weekly) and marked day wetting was 5.1% and 1.4%, respectively. Using a 10‐point visual analogue scale to measure parental concern about their child's enuresis, the mean concern score was 3.1. There was a moderate but significant relationship between the frequency of enuretic episodes and the parental concern score. Of the enuretic children, 34% had consulted with a health worker. These children were 1.4 years older and wet more frequently than those enuretic children who had not sought help. The management of enuresis involved a mean of 3.9 strategies, primarily behavioural techniques administered by the family. The lowest cure rate was seen in the children who wet more frequently. Significantly more of the dry children woke spontaneously at night to void compared with the enuretic children. There was a trend towards greater spontaneous arousal in the children who wet less frequently. Conclusion These results suggest that prevalence rates for day and night wetting in Australia are similar to those in previous studies reported from the northern hemisphere. Australian families did not report a high level of concern about enuresis, even in the older child. The problem was managed primarily within the family.
Development of the urodynamic pattern in infants with myelomeningocele
Authors: Sillén U. , Hansson E. , Hermansson G. , Hjälmås K. , Jacobsson B. , Jodal U. 
Published: November 2003

Objective To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract. Patients methods Thirty‐four infants with MMC were investigated using cystometry, micturating cysto‐urethrography and urography at 1, 4 and 10 months of age. Results Detrusor contractility was characterized by an increase in activity, with hyper‐reflexia in 45% initially, increasing to 65% at the 4‐month investigation. During the same period, the number of infants with areflexia decreased from 25% to 12%. Between 4 and 10 months, there were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the first and fourth month. The number of patients with elevated outlet resistance increased only slightly during the first year, from 32% of all infants at the initial investigation to 40% at the 10‐month follow‐up. Vesico‐ureteric reflux was detected in 12 of the patients during the year, with five already diagnosed at the first investigation. Almost all refluxes were cured with clean intermittent catheterization, with additional pharmacological therapy in two patients; one patient required a vesicostomy. Conclusions This study indicates that detrusor activity, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in activity and occurred mostly between the first and fourth months of age. There was a strong correlation between the occurrence of reflux and poor compliance, hypercontractility and outlet obstruction.