bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resistive index in renal colic: a prospective study
Authors: Shokeir  , Abdulmaaboud  
Published: March 2003

ObjectiveTo study the role of Doppler ultrasonography (DU) in the diagnosis of acute unilateral renal obstruction.Patients and methodsIn all, 117 patients with suspected renal colic were evaluated by intravenous urography (IVU) and DU, with determination of the resistive index (RI) and the difference between the RI of ipsilateral and contralateral kidneys (ΔRI). RI and ΔRI were considered positive with values of ≥0.70 and ≥0.06, respectively. IVU results were considered the ‘gold standard’ with which renal DU findings were compared.ResultsIVU showed both kidneys to be normal in 49 patients and unilateral ureteric obstruction with a normal contralateral kidney in 68. The mean (sd) RI was 0.73 (0.05) in 68 obstructed kidneys, significantly higher than the mean RI of 0.64 (0.05) in 166 normal kidneys (P<0.001). The ΔRI in patients with unilateral obstruction was significantly higher than that in patients with both kidneys normal, at 0.09 (0.05) and −0.001 (0.02), respectively (P<0.001). For all the patients, RI was sensitive in 77% and specific in 83%, and ΔRI was sensitive in 88% and specific in 98%. Obstructed kidneys showing delayed pelvicalyceal filling with excretion of contrast medium (n=42) had significantly higher values of RI and ΔRI than obstructed kidneys without delayed filling (n=26). The RI and ΔRI were more sensitive in the former group. Among patients with obstruction, the RI did not relate to the time of delay of filling with contrast medium, the duration of renal colic or the level of ureteric obstruction.ConclusionsRenal DU is a sensitive and highly specific test that can contribute significantly to the diagnosis of acute unilateral renal obstruction. It can replace the IVU, particularly in situations where IVU is undesirable.
Total urogenital sinus mobilization: expanded applications
Authors: Ludwikowski  , Oesch Hayward  , González  
Published: March 2003

ObjectiveTo report further applications of total urogenital sinus mobilization, earlier described as an easier method to correct a cloaca.Patients and methodsSeven children (six girls and one boy, mean age 4 years, range 3 months to 10.5 years) underwent surgery and were followed for a mean of 1 year; their diagnoses included persistent cloaca and congenital adrenal hyperplasia (CAH) in two each, and a urogenital sinus (UGS), bladder exstrophy and penile agenesis in one each. The UGS is approached through a posterior sagittal incision and dissected circumferentially to the retropubic space, allowing the UGS to descend. It is then excised and separate openings of the vagina and urethra created. This technique is applicable to a UGS of ≤3 cm.ResultsIn all patients, separate openings for the urethra and vagina were created. In three patients urinary continence was preserved after surgery. The patient with bladder exstrophy remains incontinent. The remaining patients are too young to assess (not yet toilet‐trained).ConclusionThis technique simplifies the surgical correction of UGS malformation; we confirm its usefulness in cases of persistent cloaca. It is also valuable in patients with CAH, primary UGS and in selected patients with bladder exstrophy and penile agenesis. When the UGS is not associated with a cloaca, the procedure can be performed perineally. Despite circumferential mobilization of the UGS, urinary continence is preserved.
Do we do what they say we do? Coding errors in urology
Authors: Ballaro A. , Oliver S. , Emberton M. 
Published: March 2003

Objective To determine the accuracy of routine data coding in a large multispeciality urological unit.Materials and methods From the clinical records, the diagnosis and procedure codes were ascribed to 106 finished consultant episodes (FCEs) in urology, by two urological trainees. The codes were compared with those ascribed by professional hospital coders (and of which the trainees were unaware) from information written on the audit form by junior medical staff. Where there were discrepancies in codes an error was recorded and the stage in the coding process in which it occurred was determined.Results Forty‐eight coding errors were found in 38 of the 106 (36%) FCEs; 34 (71%) were caused by inaccurate coding and 14 (29%) were the result of the incorrect completion of audit forms.Conclusion The clinical codes generated from the authors’ department do not accurately reflect the clinical practice. If coding errors of this magnitude are typical of urology units in general, the concept of hospital performance tables (which will be generated using routine clinical data) is untenable unless data recording is given higher priority.
The nurse cystoscopist: a feasible option?
Authors: Gidlow A.B. , Laniado M.E. , Ellis B.W. 
Published: March 2003

Objectives To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy. Patients and methods Eighty‐three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other’s findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy. Results Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance‐corrected proportional agreement (Κ) was 0.94, indicating very close agreement. Conclusion A UNP can be trained to perform cystoscopy and detect suspicious lesions as accurately as can a consultant urologist. Legal and training issues in implementation are important.
One year’s clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic
Authors: Greenwell T.J. , Woodhams S. , Denton E.R.M. , Mackenzie A. , Rankin S.C. , Popert R. 
Published: March 2003

Objective To assess the use of unenhanced spiral computed tomography (CT) as the primary investigation of choice for suspected acute renal colic in clinical urological practice. Patients and Methods Between 1 August 1997 and 31 July 1998, all patients attending a hospital accident and emergency department with acute loin pain suggestive of renal colic underwent a physical examination, urine analysis, plain abdominal radiography (if clinically indicated) and unenhanced spiral CT. The effective radiation dose and financial cost of unenhanced spiral CT and standard three‐film emergency intravenous urography (IVU) were calculated. Results In all, 116 patients were assessed, 63 of whom had calculi and related secondary phenomena of obstruction identified on unenhanced spiral CT. There were two false‐positive and one false‐negative result. An alternative urinary tract diagnosis was made in four patients, including two with renal cell carcinoma and one ureteric transitional cell carcinoma. Causes other than in the urinary tract were diagnosed in three patients, i.e. two with ovarian cyst and one with sigmoid diverticulitis. The effective radiation dose of unenhanced spiral CT was 4.7 mSv and that for three‐film IVU was 1.5 mSv. The costs of both IVU and unenhanced spiral CT were identical. Conclusions Unenhanced spiral CT allows a rapid, contrast‐medium‐free, anatomically accurate diagnosis of urinary tract calculi and in the present series had a sensitivity of 98% and a specificity of 97%. CT provided an alternative diagnosis in 6% of patients. These advantages must be weighed against the threefold greater radiation dose of unenhanced spiral CT than with three‐film IVU, and in practice the requirement for a radiologist to interpret routine axial scans.
Benign prostatic hyperplasia and prostate carcinoma in native Africans
Authors: Dawam D. , Rafindadi A.H. , Kalayi G.D. 
Published: March 2003

Objective To study the factors associated with morbidity and mortality in benign prostatic hyperplasia (BPH) and carcinoma of the prostate in native Africans.Patients and methods A prospective study was conducted from 1993 to 1998 at the Ahmadu Bello University Teaching Hospitals, Zaria, Nigeria. During this 5‐year period 686 patients were investigated and treated for symptoms and signs of prostatism. They were followed up for a mean (range) of 19.5 (1–60) months.Results BPH was found in 588 and clinical carcinoma in 98 patients. Adequate results, including a histological diagnosis, were available for 640 patients; there were 545 patients with BPH and 95 patients with histologically diagnosed prostate cancer. Treatment consisted of open prostatectomy for BPH, and subcapsular orchidectomy and/or open bladder‐neck wedge resection for patients with prostate cancer and bladder neck obstruction. Within 6 months of surgery, four of 545 (0.7%) patients with BPH and 25 of 95 (26.3%) with prostate cancer had died. Two‐thirds of the patients with cancer presented with paraparesis or paraplegia.Conclusions BPH and prostate cancer cause significant morbidity and mortality in African men. There is a need for health education about the early recognition of symptoms. Provision of facilities for transurethral prostatectomy would minimize the complications of surgery and ensure better use of the meagre resources available for health care.
The role of reactive oxygen species in testicular dysfunction associated with varicocele
Authors: Köksal I.T. , Tefekli A. , Usta M. , Erol H. , Abbasoglu S. , Kadioglu A. 
Published: March 2003

Objective To determine the level of malondialdehyde (MDA), an indirect indicator of lipid peroxidation‐induced injury by reactive oxygen species, in testicular biopsy specimens from infertile patients with and without varicocele. Patients and methods Levels of MDA were measured in the testicular biopsy specimens from 25 infertile men (15 with varicocele, mean age 30.0 years,
sd 5.7, range 23–45, and 10 without, mean age 28.7 years,
sd 4.2, range 21–34). All patients were evaluated by a detailed history, physical examination, semen analysis (at least twice), serum follicle‐stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The level of MDA in testicular biopsy specimens was measured using the thiobarbituric acid test and the results expressed per unit tissue weight. Results As a causal factor for infertility, varicocele was identified in 15 men (60%), testicular failure in four (16%), idiopathic infertility in four (16%) and obstruction in two (8%). Of the 15 patients with varicocele, eight had bilateral varicocele and it was subclinical in three; the varicocele was grade I in four, grade II in six and grade III in two. The mean (
sd) MDA level in the men with a subclinical varicocele was 15.7 (3.1) pmol/mg tissue, while in those with grade I–III varicocele it was 32.9 (12.25), 37.1 (12.25) and 86.9 (2.89) pmol/mg tissue, respectively. The levels in patients with grade III varicocele were significantly greater than in the other groups (P < 0.05). The mean MDA level in patients with or without varicocele was 38.3 (22.92) and 33.5 (18.93) pmol/mg tissue, respectively (P > 0.05). Conclusion These results suggest that increasing levels of MDA are associated with higher grades of varicocele and support a possible rationale for controlled trials in infertile men with varicocele.
Urology and the Internet: an evaluation of Internet use by urology patients and of information available on urological topics
Authors: Hellawell G.O. , Turner K.J. , Le Monnier K.J. , Brewster S.F. 
Published: March 2003

Objective To determine the use of the Internet by urological patients for obtaining information about their disease, and to conduct an evaluation of urological websites to determine the quality of information available. Patients and methods Questionnaires about Internet use were completed by 180 patients attending a general urological outpatient clinic and by 143 patients attending a prostate cancer outpatient clinic. The Internet evaluation was conducted by reviewing 50 websites listed by the Hotbot™ search engine for two urological topics, prostate cancer and testicular cancer, and recording details such as authorship, information content, references and information scores. Results Of the patients actively seeking further information about their health, 19% of the general urological outpatient group and 24% of the prostate cancer group used the Internet to obtain this information. Most websites were either academic or biomedical (62%), provided conventional information (95%), and were not referenced (71%). The information score (range 10–100) was 44.3 for testicular cancer and 50.7 for prostate cancer; the difference in scores was not significant. Conclusion The use of the Internet by patients is increasing, with > 20% of urology patients using the Internet to obtain further information about their health. Most Internet websites for urological topics provide conventional and good quality information. Urologists should be aware of the need to familiarize themselves with urological websites. Patients can then be directed to high‐quality sites to allow them to educate themselves and to help them avoid misleading or unconventional websites.
The effects of chemical sympathectomy on testicular injury in varicocele
Authors: Öztürk H. , Tander B. , Aydin A. , Okumus Z. , Çetinkursun S. 
Published: March 2003

Objective To determine whether the sympathetic nervous system plays a role in the contralateral testicular deterioration encountered in varicocele. Materials and methods Forty male Sprague‐Dawley albino rats (28 days old) were divided equally into four treatment groups, i.e. (1) sham operation, (2) with varicocele, (3) treated by chemical sympathectomy plus varicocele, and (4) chemical sympathectomy only. Chemical sympathectomy was induced by administering intraperitoneal 6‐OH dopamine (100 µg/g for 5 days) in groups 3 and 4; groups 1 and 2 received equal volumes of physiological saline by the same route. All rats underwent laparotomy and part of the left renal vein (distal to the spermatic vein confluence) was isolated and encircled with a 4/0 silk suture. The suture was left untied in group 2, and tied around a 24 F peripheral venous cannula in groups 3 and 4. The testes were then excised when the rats were 70 days old; malondialdehyde (MDA) in the testicular tissue was assayed by the thiobarbituric acid‐reactive substances method, and superoxide dismutase (SOD) and glutathione peroxidase (GSH‐Px) levels were determined by spectrophotometric analysis. Results Varicocele resulted in a significant increase in MDA levels in both testes and chemical sympathectomy prevented this effect. SOD and GSH‐Px values were significantly decreased in both testes in group 2; chemical sympathectomy also prevented this effect. Conclusion An induced unilateral varicocele significantly increases the biochemical indicators of tissue hypoxia in both testes. As this increase was prevented by chemical sympathectomy, the sympathetic nervous system may play a role in the testicular degeneration associated with varicocele.
The role of serial transrectal ultrasonography in a ‘watchful waiting’ protocol for men with localized prostate cancer
Authors: Hruby G. , Choo R. , Klotz L. , Danjoux C. , Murphy J. , DeBoer G. , Morton G. , Rakovitch E. , Szumacher E. , Fleshner N. 
Published: March 2003

Objective To determine the value of serial 6‐monthly transrectal ultrasonography (TRUS) in a cohort of men with localized prostate cancer who consented to a programme of watchful waiting with selective delayed intervention. Patients and methods Since November 1995, 180 men were accrued into an ongoing prospective study of watchful waiting with selective delayed intervention; 174 patients enrolled before 31 December 1999 comprised the cohort for the present study. The prospectively collected clinical data, including the TRUS reports, were reviewed systematically. Twenty‐eight men met the arbitrarily predefined criteria of disease progression and required definitive treatment. The TRUS findings were scored as being consistent with the clinical scenario (i.e. clinical, biochemical or histological progression) if they reported a new or enlarging hypoechoic peripheral zone lesion, or a  30% increase in overall prostate volume at the time of progression. In 136 men who had undergone two or more serial TRUS examinations the relationships between the rate of change of prostate‐specific antigen (PSA) and changes in both gland volume and the number of hypoechoic lesions were also examined. Results The group of 28 men who progressed to require radical intervention underwent 83 TRUS examinations (median number per patient, three). Two men underwent TRUS only once at baseline because of progression within 6 months. Of these 28 men, only seven had changes on TRUS that were regarded as being consistent with progression; all seven consisted of the growth of an existing nodule or the appearance of a new nodule. In only one case was this accompanied by an increase of  30% in gland volume. In the 136 men who underwent two or more serial TRUS examinations (median three, maximum nine), there was no correlation between the rate of change of PSA and changes in either gland volume or the number of peripheral zone hypoechoic lesions. Conclusion The use of serial TRUS in men with known but untreated prostate cancer is of limited value as a determinant of disease progression.
P53, bcl‐2 and bax immunoreactivity as predictors of response and outcome after chemotherapy for metastatic germ cell testicular tumours
Authors: Baltaci S. , Orhan D. , Türkölmez K. , Yesilli C. , Bedük Y. , Tulunay O. 
Published: March 2003

Objective To evaluate the roles of p53, bcl‐2 and bax as determinants of chemosensitivity in testicular cancers and to assess whether immunohistochemical expression of these proteins in testicular germ cell tumours (GCTs) could be used to predict the outcome in patients with metastatic testicular GCTs. Patients and methods Immunoreactivity for p53, bcl‐2 and bax were examined in primary testicular tumours from 24 patients with metastatic GCTs who were treated with bleomycin, etoposide and cisplatin chemotherapy. All immunostaining results were scored for the appropriate percentage of positive tumour cells and relative immunostaining intensity (score range 0–15) and compared with the response of the patients to chemotherapy. Results Overall, 20 (83%), 13 (54%) and 24 of the 24 GCTs showed  1% immunoreactivity with p53, bcl‐2 and bax, respectively. Only the bax immunostaining intensity and score had statistically higher mean values in the nonseminoma than in seminoma GCTs (P = 0.047 and P = 0.027, respectively). Only p53 immunostaining intensity, percentage of p53 immunopositive cells and p53 staining score were sig‐nificantly different among the response groups. The median survival after chemotherapy was 30.5 months; however, taking the median values of the immunostaining scores as threshold values for the survival analysis, none of the three proteins were associated with significant differences in survival. Conclusions The incidence of p53 and bax immuno‐reactivity in testicular GCTs is higher than that of bcl‐2 immunoreactivity. However, only p53 immuno‐reactivity could be used to predict the response to chemotherapy. P53, bcl‐2 and bax scores were not significant prognostic factors for survival after chemotherapy.
The independent prognostic value of comorbidity among men aged < 75 years with localized prostate cancer: a population‐based study
Authors: Post P.N. , Hansen B.E. , Kil P.J.M. , Janssen‐Heijnen M.L.G. , Coebergh J.W.W. 
Published: March 2003

ObjectiveTo investigate which prognostic factors apply in patients with localized prostate cancer diagnosed after the introduction of prostate‐specific antigen (PSA) testing, as comorbidity has significant prognostic value for patients who were diagnosed with localized prostate cancer in the 1970s.Patients and methodsUsing the Eindhoven Cancer Registry, we assessed a population‐based cohort of patients aged < 75 years with localized (T1‐T3M0) prostate cancer diagnosed between 1993 and 1995 in a defined area with 2 million inhabitants in the southern Netherlands (n = 894). After a mean follow‐up of 2.9 years, overall survival was modelled by Cox regression analyses.ResultsComorbidity was the most important prognostic factor, especially for those aged < 70 years; at 60 years old, patients with one concomitant disease were twice as likely to die than those with no comorbidity (95% confidence interval, CI, 1.0–4.3), whereas the hazard ratio (HR) was 7.2 (3.1–16.6) for two or more diseases. This was not caused by a reduced use of curative treatment for these patients. At the age of 74 years, comorbidity was no longer a significant prognostic factor. Poor differentiation of the tumour was also an important prognostic factor at all ages; this became increasingly apparent 2 years after diagnosis (HR 3.4, CI 1.5–7.7).ConclusionComorbidity had a decisive influence on the prognosis for patients with localized prostate cancer. Because this effect was stronger in younger patients the assessment of comorbidity seems most important when evaluating the risk of early death.
Consensus development of a histopathological classification system for chronic prostatic inflammation
Authors: Nickel J.C. , True L.D. , Krieger J.N. , Berger R.E. , Boag A.H. , Young I.D. ,   participating members of the North American Chronic Prostatitis Collaborative Research Network and the International Prostatitis Collaborative Network (see )
Published: March 2003

Objective To develop a standardized histopathological classification system for chronic prostatitis (standardized description of prostatic inflammatory infiltrates) based on a literature review, extensive prospective evaluations in two recognized prostatitis research centres and widespread consensus of international urological centres identified as having major expertise or interest in chronic prostatitis. Methods Relevant articles for review were identified by a Medline search undertaken by the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, and cross‐checking bibliographies of retrieved studies, reviews, book chapters and abstracts of the American Urological Association and International Prostatitis Collaborative Network Annual Meetings. Initial drafts were based on classification systems independently developed by the Prostatitis Research Centers at Queen's University in Canada and University of Washington in the USA. A collaborative draft was distributed to 20 urological/pathological clinical centres who participated in the North American Chronic Prostatitis Collaborative Research Network and First International Prostatitis Collaborative Network. A consensus classification system was then distributed to the participating panel for acceptance. Results The literature review identified a reasonably consistent description of inflammatory infiltrate locations and patterns that were further incorporated into the draft based on the Queen's University and University of Washington proposals. Eighteen (90%) of the identified Prostatitis Centers participated in the revision of the draft and the final consensus process. The final consensus document classifies prostatic inflammation according to its extent and grade/severity in each tissue compartment (location). Conclusion The consensus of the expert panel was that this classification system can be used in the evaluation of prostatic inflammation in prostate biopsies, transurethral resected prostate chips or prostatectomy specimens. A standardized accepted framework to describe histopathological prostate inflammation will prove useful in evaluating prostate disease.