bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low‐dose desmopressin in the treatment of nocturnal urinary incontinence in the exstrophy‐epispadias complex
Authors: Caione  , Nappo  , De Castro  , Prestipino  , Capozza  
Published: March 2003

ObjectiveTo report our experience of the use of desmopressin to improve nocturnal dryness in patients who have undergone a staged reconstruction of the exstrophy‐epispadias complex (EEC), who although continent by day, have nocturnal incontinence because their nocturnal urinary output exceeds their bladder capacity.Patients and methodsSeven children (aged 8–12 years) who had undergone a staged reconstruction for EEC (six with classical bladder exstrophy, one with incontinent epispadias) were treated with intranasal desmopressin for persistent nocturnal incontinence despite daytime dryness. Previous additional procedures for continence had been self‐augmentation in one and periurethral collagen injection in three others. The criteria for inclusion in the study were: normal renal function, no upper tract deterioration, no urinary tract infections, spontaneous voiding during the day with dry intervals between micturitions, a postvoid residual volume of <10% of bladder capacity and night‐time incontinence for 7 nights/week. Desmopressin was administered at bedtime at increasing dosages from 10 to 30 μg until effective. Body weight, arterial blood pressure, and serum electrolytes were measured, and all patients assessed using renal ultrasonography, a voiding diary and a nocturnal pad‐test.ResultsDesmopressin at doses of 10–30 μg was successful in keeping all the patients dry. The nocturnal urinary output was decreased so that it did not exceed bladder capacity. There was only one minor side‐effect (nose bleeding).ConclusionsIn selected patients with EEC, desmopressin is effective in improving nocturnal dryness, with no significant side‐effects.
Effects of a phytotherapeutic agent, PC‐SPES, on prostate cancer: a preliminary investigation on human cell lines and patients
Authors: De La Taille  , Hayek  , Buttyan  , Bagiella  , Burchardt  , Katz  
Published: March 2003

Objectives To evaluate the in vitro activity of PC‐SPES, a complex phytotherapeutic agent, against prostate cancer cell lines, and to assess its activity in suppressing serum prostate specific antigen (PSA) level in patients with prostate cancer.Patients and methods Four variant prostate cancer cell lines (LNCaP and an apoptosis‐resistant derivative, LNCaP‐bcl‐2, PC3 and DU145) were exposed to three different concentrations of PC‐SPES extract. Cell viability was measured at 3, 4 and 5 days of exposure using a colorimetric assay and was compared with control cultures receiving aliquots of the ethanolic extraction medium alone. Clinically, a prospective study was initiated in patients with prostate cancer who refused conventional therapy or who had failed previous cryosurgery, radiation therapy and/or hormonal therapy. The patients were treated with PC‐SPES (three capsules of 320 mg/day). The serum PSA responses and side‐effects were evaluated.Results All cultured prostate cancer cell lines showed a significant dose‐dependent reduction in cellular viability (compared with control cultures) by exposure to 4 and 6 μL of PC‐SPES extract/mL of culture medium (P<0.001). In contrast to the hormone‐insensitive cell lines tested (LNCaP‐bcl‐2, PC‐3 and DU‐145), only the hormone‐sensitive cell line LNCaP was affected by the lowest dose of PC‐SPES extract tested (2 μL/mL medium). In the prospective clinical trial of 33 patients, with a mean (range) follow‐up of 6.8 (2–24) months after initiating PC‐SPES therapy, serum PSA levels were lower in 87% at 2 months and in 78% at 6 months (n=18, P=0.026). The side‐effects in these patients were nipple tenderness in two (6%) and leg clots requiring heparinization in two (6%). No gynaecomastia or hot flashes were observed in this group and the treatment was well tolerated.Conclusions In this preliminary study, an extract of the phytotherapeutic agent PC‐SPES was active in suppressing the growth of cultured hormone‐sensitive and ‐insensitive prostate cancer cell lines. In the small clinical study, PC‐SPES therapy decreased serum PSA levels in most patients. However, a longer follow‐up and more patients will be required to evaluate the long‐term efficacy of this new phytotherapy.
Follow‐up of localized prostate cancer, with emphasis on previous undiagnosed incidental cancer
Authors: Berner A. , Harvei S. , Skjørten F.J. 
Published: March 2003

ObjectiveTo determine the natural course of incidental untreated transition zone prostate cancer and thus help to identify criteria to predict the prognosis and to determine treatment for individual patients.Materials and methodsA total of 1135 unselected surgical specimens of the prostate, examined during 1974 and 1975, were reviewed while unaware of case by two experienced pathologists. The patients from which the samples were obtained were followed for up to 20 years or death by The Cancer Registry of Norway and the outcome compared with the histological review.ResultsThe histology review revealed a total of 311 cancers, of which 73 had not been initially recorded; these patients had received no treatment. The kappa coefficient for interobserver reproducibility was 0.86 for carcinoma. The follow‐up showed that patient age was the strongest predictor of survival, followed by histological grade and percentage of tumour involvement. Only two of the 73 patients with untreated transition zone cancer died from prostate cancer during the follow‐up, compared with 78 of 144 patients with standard management of transition zone tumours. The 5‐ and 10‐year relative survival rates for the 144 patients with standard management of transitional zone tumours and for the 53 patients with peripheral zone tumours were 56% and 26%, and 45% and 33%, respectively. Metastasis (+ or −) was the only individual prognostic factor in the multivariate analysis.ConclusionThis study shows that patients with incidental low‐grade tumours have a low probability of dying from prostate cancer and may thus be followed expectantly. The biological distinction between atypical hyperplasia and stage T1a cancer is unclear. The survival of men with prostate cancer is significantly reduced with loss of differentiation and with increasing tumour volvement.
Staging laparoscopic pelvic lymphadenectomy in prostate cancer
Authors: Shackley  , Irving  , Brough  , O'Reilly  
Published: March 2003

ObjectiveTo assess the results of transperitoneal laparoscopic pelvic lymphadenectomy as a separate staging procedure in patients with early prostate cancer.Patients and methodsThe results were reviewed from the first 27 patients with prostate cancer admitted for laparoscopic lymphadenectomy between January 1994 and March 1998. Initially, all patients with a negative bone scan and either a negative computed tomography or negative magnetic resonance scan were admitted for laparoscopic staging. After several reports detailing ways of reducing the number of negative lymphadenectomy operations, from July 1996 only those patients with a preoperative prostate specific antigen (PSA) serum level of >10 ng/mL were admitted to the study. All procedures were performed by one experienced laparoscopic surgeon. A radical retropubic prostatectomy was performed as a separate procedure by a consultant urologist within 2 weeks. The effectiveness of the staging operation was analysed by assessing the nodal yield, and the results, including operative duration, complications and length of stay, were compared with other published series. Further analysis was provided by reviewing the PSA levels, Gleason grade sum and clinical digital staging.ResultsThe nodal yield was similar to that published in series from other institutions, with a median (range) of 6.5 (0–12). However, the operation was significantly quicker, at a median (range) of 55 (40–110) min for a bilateral dissection. There were only minor complications, with no detectable reduction in complications with experience; the median (range) postoperative stay was 1 (1–4) days. Two of the 27 patients had metastatic disease within the lymph nodes. If a PSA level of >10 ng/mL had been instituted as an entry criteria at the start of the study, six patients would have been excluded and thus the positive lymphadenectomy rate would have been two of 21 patients (10%). Of 54 patients eligible to enter the study, half did not require a lymphadenectomy.ConclusionsLaparoscopic transperitoneal lymphadenectomy can be performed expeditiously and safely. A two‐stage procedure in some patients with prostate cancer is the management of choice. Attention to carefully closing the peritoneum with sutures minimizes any retropubic adhesions and no problems associated with the staging procedure were encountered during subsequent radical retropubic prostatectomy. In efforts to reduce negative staging lymphadenectomies, the exclusion values for staging should not be set too high (PSA and Gleason grading sum). Such practice, despite a relatively safe staging procedure, would lead to unnecessary radical prostatectomy.
The nature of spontaneous cavernosal activity
Authors: Çolakoglu  , Kutluay  , Ertekin  
Published: March 2003

ObjectiveTo determine the characteristics of spontaneous cavernosal activity (SCA) and to relate this to previous descriptions of spontaneous potentials from the cavernosum (single potential analysis of cavernosal activity, SPACE).Subjects and methodsThe SCA was recorded in 31 normal men with no sexual problems; various manipulations were applied using concentric‐needle (CN), bipolar needle (BN) and surface electrodes. The electrical activity was compared with the observed slow retractile movements of the flaccid penis and with other assessments of electrical activity from skin.ResultsSCA appeared synchronously from both sides of the cavernosal bodies in all normal subjects when detected by CN electrodes. The synchronous recordings both by CN and BN electrodes, or both by CN and surface electrodes registered similar oscillatory potentials. Slow retractile movements of the penis occurred synchronously with these potentials in all subjects and both were absent during erection.ConclusionSCA is apparently related to biomechanical slow movement artefacts of the flaccid penis; it may be a consequence of the summed contractions of smooth muscle groups in the cavernosum. Observing the small retractile slow movements of the flaccid penis and recording the SCA may be a useful indirect method to characterize cavernosal neural innervation and smooth muscle activity.
The pharmacovigilance of tamsulosin: event data on 12 484 patients
Authors: Mann R.D. , Biswas P. , Freemantle S. , Pearce G. , Wilton L. 
Published: March 2003

Objective To determine drug effectiveness and adverse effects in a noninterventional observational cohort study of over 10 000 patients treated with tamsulosin in general medical practice.Methods Using prescription‐event monitoring, data were collected of all prescriptions for tamsulosin issued nationally during June 1996 to January 1998. For each patient entered into the cohort a computerized longitudinal record of exposure was constructed. The outcome data, patient information and an opinion about the effectiveness of the drug were provided by the prescriber, using a standard questionnaire sent 6 months after the initial prescription for tamsulosin. The incidence of each of almost 2000 events listed in the Drug Safety Research Unit computerized dictionary was calculated and scrutinized by medical assessors for possible adverse reactions, and any difference determined between the incidence of each event in the first month and subsequent months of exposure. All deaths were followed up to detect possibly drug‐related causes.Results Event data were obtained on 12 484 patients, from the 52.9% of questionnaires returned and that contained valid event data. Tamsulosin was reported to have been effective in 7428 (78.3%) of the 9487 patients in whom the general practitioners expressed an opinion about effectiveness. Suspected adverse drug reactions were reported in only 171 (1.4%) of the cohort. Dizziness, headache, malaise and hypotension were common to the reported adverse reactions, reasons for stopping the drug and events of greatest incidence density. None of the 282 deaths that occurred in this elderly cohort were attributed to the drug.Conclusion This study suggests that tamsulosin has a highly acceptable benefit‐to‐risk ratio. No untoward features not already mentioned in the prescribing guidance were identified.
Reflex innervation of the bulbocavernosus muscle
Authors: Yang C.C. , Bradley W.E. 
Published: March 2003

Objective To determine the somatic reflex innervation of the bulbocavernosus muscle (BCM) and to illustrate the role of the perineal nerve in BCM contraction, using electrophysiological techniques. Subjects and methods Ten healthy, potent men underwent genital electrophysiological testing. Stimuli were applied to the dorsal nerve of the penis at the base of the penis, glans and anterior urethra, and the perineal nerve branch to the BCM. The electromyographic (EMG) responses of the BCM were recorded and onset latencies measured at baseline, both after anaesthetising the perineal nerve and after recovery from the anaesthetic. Results A reflex BCM contraction was elicited from all stimulation sites. Anaesthetizing the perineal nerve resulted in alterations of the EMG response. After the anaesthetic effect wore off, the responses returned to baseline values. Conclusions Three distinct somatic bulbocavernosus reflexes were detected which are components of normal ejaculation. BCM contraction can be elicited after stimulating the dorsal penile nerve at the glans and the anterior urethra; these are the flexor responses of the bulbocavernosus reflex. BCM contraction can also be induced on stimulating the perineal nerve, which is the pathway through which the stretch and the tendon organ reflexes are carried to mediate muscle tone. The motor innervation of the BCM for all reflexes is carried through a branch of the perineal nerve. The findings may be relevant to the evaluation of ejaculatory disorders.
Impairment of corpus cavernosal smooth muscle relaxation by glycosylated human haemoglobin
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B. 
Published: March 2003

Objective To examine the effect of HbA1c, an isoform of glycosylated haemoglobin (GHb, a product of non‐enzymatic reactions between elevated blood glucose and haemoglobin), on nitric oxide‐mediated corpus cavernosal smooth muscle relaxation, and to categorize the mechanisms involved. Materials and methods Corpus cavernosal tissue from Wistar rats (300–350 g body weight) was prepared for the measurement of isometric tension. After equilibration in Krebs solution gassed with 95% O2/5% CO2 at 37 °C for 90 min, optimal resting tension was applied. Tissue was precontracted with 1 µmol/L noradrenaline (NAd) and either relaxed with incremental doses of acetylcholine (ACh) or sodium nitroprusside (SNP). After washout, strips were again precontracted with NAd and then incubated with pyrogallol (100 µmol/L), 100 µL of haemoglobin or 100 µL of GHb in the presence of either
l‐arginine (100 µmol/L), indomethacin (10 µmol/L), allopurinol (100 µmol/L), deferoxamine (100 µmol/L), catalase (600 IU/mL), or superoxide dismutase (SOD) (120 IU/mL) before ACh‐ or SNP‐induced relaxation responses were repeated. Results Haemoglobin and GHb significantly impaired the relaxation of rat corpus cavernosum to ACh in a dose‐dependent manner.
l‐arginine reversed the impairment caused by Hb, but not GHb. A donor of superoxide anions, pyrogallol, mimicked this impairment to ACh when added to control strips. Catalase, deferoxamine, indomethacin and allopurinol had no significant effect on the impaired relaxation response to ACh, whilst
l‐arginine partially reversed it. SOD completely reversed the GHb‐induced impaired relaxation; GHb did not alter the relaxation response to SNP. Conclusion GHb significantly impairs endothelial NO‐mediated corpus cavernosal relaxation in the rat, in vitro. This effect is caused partly by the generation of superoxide anions and the extracellular inactivation of NO.
The usefulness of power Doppler ultrasonography for diagnosing prostate cancer: histological correlation of each biopsy site
Authors: Franco O.E. , Arima K. , Yanagawa M. , Kawamura J. 
Published: March 2003

Objective To correlate the findings of power Doppler ultrasonography (PDUS) of the prostate with those of site‐specific transrectal ultrasonography (TRUS)‐guided biopsy.Patients and methods The study comprised 28 patients referred to our institution for TRUS‐guided prostate biopsy because of an elevated PSA level and/or abnormal digital rectal examination. PDUS findings were graded 0, 1 or 2; grades 0–1 were considered as negative and grade 2 as positive. The blood volume of each biopsy site was also determined using the mean number (MN) value that represents the average vascularity in a 5‐mm square sample. PDUS values were correlated with the histological findings of 147 biopsies with 19 focal lesions.Results Grade 2 was assigned to 19 sites, grade 1 to 52 sites, and grade 0 to 76 sites. Fourteen of the 19 PDUS findings of grade 2 sites revealed carcinoma and five were grade 1. Ten of 35 TRUS‐positive sites were carcinomas, three benign prostatic hyperplasia (BPH) and 22 normal. The MN value for prostatic carcinoma was 4.33, for BPH 11.7 and for normal tissue 4.7. The overall sensitivity of PDUS was 74%, the specificity 96% and the positive predictive value 74%.Conclusions Because TRUS alone cannot detect all cancers, PDUS should be used routinely in all patients undergoing TRUS‐guided biopsy, to improve the diagnostic yield of prostate cancer.
Gender specificity of tolterodine on micturition and the diurnal variation of urine production of the conscious rat
Authors: Yoshimura Y. , Schmidt F. , Constantinou C.E. 
Published: March 2003

Objective To evaluate the effect of the oral administration of tolterodine on the diurnal micturition characteristics of the male and female conscious rat, and to examine the relative effect of tolterodine in influencing water consumption and urine production. Materials and methods Baseline micturition volume and frequency characteristics of nine male and 10 female Sprague‐Dawley age‐matched adult rats (body weight 399 ± 15 and 249 ± 3 g, respectively) were evaluated over 24‐h. Initial hydration conditions were standardized with an oral dose (5 mL) of water. Rats were subsequently placed in a metabolic cage and had free access to water. Micturition volume/frequency characteristics were derived from the measurements of voided volume (measured using a digital balance below the metabolic cage and connected to a computer). The total volume of water consumed over the 24 h was also measured. Two separate baseline studies were conducted, followed by the administration of a single oral dose of 1 mg/mL of tolterodine dissolved in 5 mL of water. The mean frequency of micturition and mean volume voided per micturition were computed in 3‐h periods and plotted over the 24‐h period. In addition, the mean values of the number of micturitions and voided volumes during the day/dark cycle were evaluated. Results Baseline data showed that females (when corrected for body weight) consistently imbibed significantly more water (83%) than did male rats. Tolterodine did not significantly affect water consumption in the males but significantly reduced water consumption in females by 42%. Tolterodine did not significantly affect the amount of urine produced by male rats but significantly reduced the total amount of urine production in females by 26%. Tolterodine significantly increased the number of voids in male rats compared with baseline during the day but not during the night. More importantly tolterodine produce no significant effect on the volume voided per micturition in male rats either during the day or night cycle, but significantly decreased the volume voided per micturition in females. Conclusions These results suggest that the effect of tolterodine on micturition is gender‐specific, suppressing water consumption and urine production in female but not male rats, and decreasing bladder volume. There is a possibility that the reported clinical effects of tolterodine arise through the suppression of fluid consumption.
Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program
Authors: Corman J.M. , Penson D.F. , Hur K. , Khuri S.F. , Daley J. , Henderson W. , Krieger J.N. 
Published: March 2003

ObjectiveTo determine whether radical nephrectomy causes less morbidity, less mortality and is associated with a shorter hospital stay than is partial nephrectomy.Patients and methodsA total of 1885 nephrectomies (1373 radical and 512 partial) conducted between 1991 and 1998 in the Department of Veterans Affairs (VA) National Surgical Quality Improvement Program were evaluated. Using multivariate analyses, outcomes were risk‐adjusted based on 45 preoperative variables to compare mortality and morbidity rates.ResultsThe unadjusted 30‐day mortality was 2.0% for radical and 1.6% for partial nephrectomy (P = 0.58). Risk‐adjusting the two groups did not result in a statistically significant difference in mortality. The 30‐day overall morbidity rate was 15% for radical and 16.2% for partial nephrectomy (P = 0.52); risk‐adjusted morbidity rates were not statistically different. There were no statistically significant differences in the rates of postoperative progressive renal failure, acute renal failure, urinary tract infection, prolonged ileus, transfusion requirement, deep wound infection, or extended length of stay.ConclusionsPartial nephrectomy carried out in the VA program has low morbidity and mortality rates, comparable with the complication rates after radical nephrectomy.
A randomized trial comparing bladder infusion with standard catheter removal after transurethral resection of the prostate
Authors: Wilson I.D. , Bramwell S.P. , Hollins G.W. 
Published: March 2003

Objective To examine the effect of bladder infusion before catheter removal on patients' readiness for discharge and the day of discharge after transurethral resection of the prostate (TURP). Patients and methods The study comprised 75 consecutive patients undergoing TURP who were randomized to either have their catheter removed in the standard manner (38 patients), or to undergo bladder infusion before a trial of voiding (ToV) on the second day after TURP (37 patients). Results In those undergoing bladder infusion, seven (19%) patients were discharged on the same day as their ToV, compared with five (13%) in the standard group. Of the 75 patients, 15 (68%) were discharged by the third day after TURP whether or not the bladder had been filled. In the infusion group, 23 (62%) were ready for discharge on the same day as their TOV, compared with only 14 (37%) in the standard group (P < 0.05). Conclusion Bladder infusion before a ToV after TURP significantly increases the rate of readiness for discharge, allowing an early decision to discharge on the second day in a large proportion of patients.