bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced glycation end‐products are responsible for the impairment of corpus cavernosal smooth muscle relaxation seen in diabetes
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B. 
Published: March 2003

Objective To determine if advanced glycation end‐products (AGEs) are responsible for the lower neuronal and endothelial‐derived nitric oxide (NO)‐mediated relaxation of corpus cavernosum in tissue in diabetic rats than in control rats. Materials and methods Diabetes was induced in male Wistar rats by an intraperitoneal injection with streptozotocin (60 mg/kg). One group of diabetic rats was given free access to water and standard diet. A second group was given standard diet and aminoguanidine with their water (50 mg/100 mL) from the initiation of diabetes. Two groups of rats that were not diabetic acted as age‐matched controls. After 8 weeks animals were killed by cervical dislocation, corpus cavernosal tissue strips harvested and mounted in an organ bath to measure isometric tension. After 90 min of equilibration at optimal resting tension and contraction with 1 µmol/L noradrenaline, the response to either acetylcholine or electrical field stimulation (EFS) after adding guanethidine (5 µmol/L) and atropine (1 µmol/L) was determined for each group. Results There was no difference between the baseline characteristics of all the experimental groups. After 8 weeks the mean body mass and glycosylated haemoglobin (HbA1c) were significantly greater in the diabetic than in control animals. Aminoguanidine had no effect on the recorded body mass or HbA1c. The in vitro relaxation response to the application of acetylcholine or EFS of tissue strips from age‐matched control animals fed a standard diet and those supplemented with aminoguanidine were the same. The administration of aminoguanidine to diabetic animals for 8 weeks reversed the expected impaired relaxation response to acetylcholine; the response to EFS was similar. Conclusion AGEs are more prevalent in erectile tissue from diabetic than in control animals. Aminoguanidine reversed the impairment in neuronal and endothelial NO‐mediated penile smooth muscle relaxation seen in diabetes. As aminoguanidine prevents AGE formation, erectile dysfunction in diabetes is probably caused partly by the generation of AGEs.
Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography
Authors: Robert M. , Segui B. , Vergnes C. , Taourel P. , Guiter J. 
Published: March 2003

Objective To assess the effects of the interposition of pelvic bones and abdominal gas in the shockwave pathway during piezoelectric extracorporeal shock wave lithotripsy (ESWL) of distal ureteric stones. Patients and methods The study included 35 patients who were evaluated with unenhanced spiral computed tomography (CT), used according to their positioning during ESWL. The shockwave pathway was simulated on the sagittal and coronal views crossing the ureteric calculi, allowing a theoretical evaluation of the effective shockwave focusing (with no bone or gas interference). Vertical and oblique approaches were statistically compared for bone and gas interposition. Results Overall, the effective shockwave focusing during in situ piezoelectric ESWL of distal ureteric stones was 71% of the theoretical area. The interposition of bone and gas was significantly lower for an oblique access than for a vertical approach in the sagittal plane (P < 0.001 and 0.03 on the sagittal and coronal views, respectively). Using stepwise logistic regression, the difference between vertical and oblique accesses in the sagittal plane was mainly affected by the bladder volume (P < 0.001). On the coronal views, the interposition of bone and gas affected 31 patients (89%). Such interference was eliminated in 73% of the patients with a contralateral inclination of the shockwave axis in the coronal plane. Conclusion The interposition of pelvic bones and abdominal gas in the shockwave pathway can affect the performance of piezoelectric ESWL of distal ureteric stones. While awaiting clinical confirmation of these theoretical data, we recommend that patients are treated with the bladder full and that the shockwave generator is inclined in both the coronal and sagittal planes.
Trends in testicular carcinoma in England and Wales, 1971–99
Authors: Power D.A. , Brown R.S.D. , Brock C.S. , Payne H.A. , Majeed A. , Babb P. 
Published: March 2003

Objectives To examine incidence, mortality and survival trends in England and Wales for testicular cancer, using the recently developed national cancer and national mortality databases. Methods The directly age‐standardized incidence rates for testicular cancer in England and Wales were calculated for the period 1971–97 and age‐standardized mortality for years 1971–99. Trends in the data were then assessed, including the influence of social deprivation on testicular cancer incidence and survival. Results The number of newly diagnosed cases of testicular carcinoma in 1971–97 in England and Wales increased from almost 650 to 1400. The age‐standardized rates were 2.9 per 100 000 cases in 1971 and 5.4 per 100 000 in 1997, an increase of 88% over 26 years. There was a large decrease in mortality since the mid‐1970s, with an age‐standardized mortality of < 0.5 per 100 000 since 1985. For men with testicular carcinoma diagnosed in 1991–93, the 1‐year relative survival was almost 98% and 5‐year relative survival almost 95%, compared with 82% and 69%, respectively, for men diagnosed during 1971–75. There is a ‘deprivation gap’ for the 5‐year survival of > 6% in favour of the most affluent socio‐economic group, with no significant change over recent years. Conclusions The incidence of testicular cancer is increasing in England and Wales, consistent with the trend documented in other developed countries. The reduction in mortality has been marked since the mid‐1970s, reflecting improved cancer management, in particular the introduction of platinum‐based chemotherapy regimens for advanced disease. Survival rates in England and Wales are as good as in other European countries. Further developments in chemotherapy are unlikely to produce such a marked improvement in survival rates again, and minimizing the effect of social status on survival rates should be an important target of future care.
Increased incidence of hypospadias in small‐for‐gestational age infants in a neonatal intensive‐care unit
Authors: Gatti J.M. , Kirsch A.J. , Troyer W.A. , Perez‐Brayfield M.R. , Smith E.A. , Scherz H.C. 
Published: March 2003

Objective To identify the incidence of hypospadias in children born prematurely and small‐for‐gestational age (SGA), and to compare this subgroup with infants of similar age and weight without hypospadias.Patients and methods Records from the neonatal intensive‐care unit (NICU) of a major metropolitan hospital active in labour and delivery were reviewed over a 3‐year period, specifically examining newborns admitted with the diagnosis of SGA, defined as a birth weight of < 10th percentile for gestational age. In all, 154 patients were identified and their charts reviewed, recording the presence and severity of hypospadias, gestational age, birth weight, placental weight, cord length, cord vessels, maternal age, parity, multiple births, drug exposure and associated comorbidity. A control group of age‐ and weight‐matched infants without hypospadias were also identified and compared.Results Of the 154 patients, 17 (11%) had hypospadias; the hypospadias was distal in nine, mid‐shaft in four and proximal in four. The severity of hypospadias did not correlate with the degree of prematurity or weight for gestational age. Placental weight, fetal weight, fetal to placental weight ratio and cord length were all lower in the hypospadias group than in the control group, but the differences were not statistically significant. The maternal age was evenly distributed (median 32 years, range 20–43). Most mothers were multiparous and births were multiple in five of 17 (30%). Cryptorchidism (three) and inguinal hernia (three) were present in four of the infants.Conclusions The incidence of hypospadias in SGA infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower placental and fetal weight in SGA infants with hypospadias than in the controls. This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.
Laparoscopic orchidopexy: a review of a large clinical series
Authors: Chang B. , Palmer L.S. , Franco I. 
Published: March 2003

Objective To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures.Patients and methods The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one‐stage and staged Fowler–Stephens (F‐S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery.Results From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra‐abdominal in 46, iliac in 14, in the internal ring in 22, ‘peeping’ in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one‐stage F‐S in 20 and a two‐stage F‐S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5–12 years); the mean (range) follow‐up was 5 (1–36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow‐up available). Four patients (4%) had testicular atrophy from failed F‐S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow‐up, was 96% (90 of 94). Of the 20 one‐stage F‐S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F‐S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy.Conclusion The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra‐abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.
The adolescent varicocele. II: the incidence of hydrocele and delayed recurrent varicocele after varicocelectomy in a long‐term follow‐up
Authors: Misseri R. , Gershbein A.B. , Horowitz M. , Glassberg K.I. 
Published: March 2003

Objective To determine, in adolescent boys after varicocelectomy, the incidence of hydroceles, when they develop and whether the development is procedure‐related.Patients and methods The records were retrospectively reviewed of 77 boys who underwent 95 varicocelectomies and had an examination at  6 months after surgery. Fifty‐six patients underwent a standard Palomo procedure (45 left and 11 bilateral) and 21 a modified Ivanissevich repair (14 left and seven bilateral). The mean (range) age of the patients at surgery was 14.1 (10–22) years and the mean follow‐up 25.5 (6–84) months.Results Of the 67 Palomo varicocelectomies 19 (24%) were complicated by hydroceles after surgery, compared with four of 28 (14%) Ivanissevich procedures (P = 0.034). Of the Ivanissevich repairs, none of the 14 unilateral repairs developed hydroceles. Three hydroceles (one bilateral and one left) developed in two of seven patients after bilateral varicocelectomy. Of the Palomo repairs, 12 of 45 unilateral repairs were complicated by hydroceles, and seven developed in five of 11 patients after bilateral varicocelectomy. Although more hydroceles developed after bilateral varicocelectomy, there was no significant difference from the unilateral group. However, patients who developed hydroceles after bilateral varicocelectomy were more likely to require hydrocelectomy (P = 0.013, Fisher's exact test), implying that hydroceles developing after bilateral repair tend to be larger. Of the hydroceles, two were detected in the first 6 months after surgery, nine at 6–12 months, three at 13–18 months, five at 19–24 months and four at > 2 years after surgery. Three patients had late varicocele recurrence, i.e. 15, 37 and 76 months after surgery; these patients had not had varicoceles on palpation after surgery at 3, 14 and 63 months, respectively.Conclusion Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic‐sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months after varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.
Systemic effects of intravesical atropine sulphate
Authors: Enskat R. , Deaney C.N. , Glickman S. 
Published: March 2003

Objective To investigate systemic antimuscarinic activity after the intravesical administration of 6 mg of atropine sulphate. Subjects and methods Ten subjects were recruited to an open study in accordance with strict inclusion and exclusion criteria. Each subject received an instillation of 6 mg atropine sulphate diluted to 20 mL with normal saline. All variables were measured at baseline (before instillation) and the instilled solution retained for at least 2 h. After instillation systemic antimuscarinic activity was monitored every 20 min for 2 h then hourly for the next 4 h. The measurements included blood pressure, sublingual temperature, pulse rate, peak expiratory flow rate, lacrimation and salivation rates; all variables were analysed statistically. Facial skin was also observed for hyperaemia. All subjects were questioned about any known symptoms produced by antimuscarinic agents. The heart rate was recorded continuously before and after instillation using a Holter monitor. Results None of the variables changed significantly after instillation and the Holter analysis showed no relevant variation in heart rate. All subjects consistently denied any antimuscarinic symptoms. One subject had mild cutaneous hyperaemia, as reportedly occurred consistently when her bladder was distended (> 500 mL). Immediate catheterization drained 600 mL and the hyperaemia resolved. Conclusion The failure to detect systemic antimuscarinic activity at a dose which has previously been shown to suppress detrusor activity suggests that intravesical atropine therapy is safe for further study by clinical trial, and might provide a treatment for detrusor hyper‐reflexia that is free from side‐effects.
The Nesbit operation for Peyronie's disease: an analysis of the failures
Authors: Andrews H.O. , Al‐Akraa M. , Pryor J.P. , Ralph D.J. 
Published: March 2003

Objective To analyse critically the reasons for a poor outcome of the Nesbit operation for Peyronie's disease in 51 patients over a 20‐year period. Patients and methods Fifty‐one patients who were classified as having a poor result from the Nesbit operation were reviewed (mean age 53 years, mean follow‐up 21 months). The factors responsible for a poor result were analysed and classified into three groups: (i) deformity > 30°; (ii) penile shortening > 2 cm; and (iii) impaired erection. Patients with a recurrent deformity were further classified according to the interval from surgery to the presentation of the recurrence. Results Thirty‐one patients had a deformity of > 30°; this occurred immediately in three patients through surgical error, soon after surgery in eight patients because of suture failure and after 11 months in the remaining 20 patients because their Peyronie's disease progressed. Penile shortening of > 2 cm was present in 19 patients but this only affected coital function in four. Erection was impaired in 10 patients but this was present before surgery in most. Conclusion The results of the Nesbit operation for Peyronie's disease can be improved by a preoperative assessment of erectile function and the use of sutures of high tensile strength. Patients should be warned that the disease may progress and that some penile shortening should be expected, although this does not affect coital function.
False‐positive pregnancy tests in patients with enterocystoplasties
Authors: Nethercliffe J. , Trewick A. , Samuell C. , Leaver R. , Woodhouse C.R.J. 
Published: March 2003

Objective To determine the incidence and causes of false‐positive pregnancy tests in patients with enterocystoplasties. Patients and methods In a pilot study, 15 consecutive patients (both sexes, with any type of urinary diversion) provided a urine sample for testing using the Clearview pregnancy test (Unipath Ltd, Bedford, England). False‐positive results occurred only in patients with continent reservoirs; patients with ileal conduits produced no false‐positive results and were excluded from the main study. The main study included 23 patients with a urinary reservoir constructed partly or solely of large bowel or ileum, who provided urine and blood samples for the assay of β human chorionic gonadotrophin and protein. Each urine sample was also analysed with the Clearview test. Results In the pilot study, three men and two women had positive pregnancy test results. In the main study, 14 patients had a positive Clearview test (nine women and five men). One women was found to be pregnant and was therefore excluded from further analysis, giving a false‐positive rate of 57%. There was no difference in the type of reservoir, urine biochemistry and urine analysis results between the positive and negative groups. Frozen/thawed samples all tested negatively. Conclusion It is possible that the mucus produced in enterocystoplasties may be interfering with the pregnancy test. Patients should be aware of this and not rely on commercial test kits. There is some potential that this test system could be adapted for measuring mucus production in urinary diversions.
Prevalence of urinary incontinence in women with cystic fibrosis
Authors: Cornacchia M. , Zenorini A. , Perobelli S. , Zanolla L. , Mastella G. , Braggion C. 
Published: March 2003

Objective To determine the prevalence of urinary incontinence (UI) in female patients (aged 15 years) attending a cystic fibrosis (CF) centre, in whom stress UI could be common, as chronic coughing and sputum production are frequent symptoms associated with progressive lung disease in these patients. Patients and methods An anonymous questionnaire was completed by 176 women with CF (mean age 24.6 years, sd 5.8) during routine assessments as outpatients. Results In all, 72 patients (41%) were classified as never incontinent; occasional UI was reported in 61 women (35%). Regular UI, occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 patients (24%). Regular UI was associated with increasing age and a lower mean (sd) forced expiratory volume/s (of that predicted) than in women with no urinary symptoms, at 26.9 (6.5) years and 53.5 (23.5)%, and 23.1 (5.4) years and 65.5 (23.2)%, respectively (P < 0.01 and P < 0.05, respectively). All incontinent women recorded stress UI; coughing, laughing and physical activity were associated with UI in 92%, 33% and 21% of the patients, respectively. Conclusion Stress UI is a common symptom in women with CF. As urine loss can be under‐reported to the healthcare providers, women should be asked about incontinence as part of their routine follow‐up. Pelvic floor muscle exercises are effective in treating stress UI and should be considered for those with CF and regular UI.
Selective urological evaluation in men with febrile urinary tract infection
Authors: Ulleryd P. , Zackrisson B. , Aus G. , Bergdahl S. , Hugosson J. , Sandberg T. 
Published: March 2003

Objective To investigate the prevalence and clinical importance of urological abnormalities in men with community‐acquired febrile urinary tract infection (UTI). Patients and methods In this prospective study, 85 men (median age 63 years, range 18–86) were followed for 1 year after an episode of febrile UTI. They were investigated by excretory urography, cysto‐urethroscopy, uroflowmetry, digital rectal examination and measurement of postvoid residual urine volume by abdominal ultrasonography. Results The radiological examination of the upper urinary tract in 83 patients revealed 22 abnormal findings in 19 men. Relevant clinical abnormalities leading to surgical intervention were found in only one patient who had renal calyceal stones. The lower urinary tract investigation disclosed 46 findings in 35 men. In all, surgically correctable disorders were found in 20 patients, of whom 15 had previously unrecognized abnormalities. All patients who required surgery were identified either by a history of voiding difficulties, acute urinary retention at the time of infection, the presence of microscopic haematuria at follow‐up after one month, or early recurrent symptomatic UTI. Conclusion Routine imaging studies of the upper urinary tract seem dispensable in men with febrile UTI. To reveal abnormalities of clinical importance, any urological evaluation should primarily be focused on the lower urinary tract.
Cimetidine in painful bladder syndrome: a histopathological study
Authors: Dasgupta P. , Sharma S.D. , Womack C. , Blackford H.N. , Dennis P. 
Published: March 2003

Objective To determine whether oral cimetidine, which reportedly improves symptoms in 60–70% of patients with painful bladder syndrome/interstitial cystitis has a similar mechanism of action on the human bladder and involving a similar peptidergic pathway as it has in human stomach, where it alters histamine‐gastrin reactions mediated via H2 receptors and a proton pump. Patients and methods Fourteen patients (13 women and one man, mean age 51 years) with refractory bladder pain and irritative urinary symptoms were treated with cimetidine. The response to cimetidine was assessed by outpatient follow‐up and an analogue pain score. Bladder biopsies from eight patients were stained with haematoxylin and eosin, and a polyclonal antibody to gastrin, with counterstaining using toluidine blue, to detect mast cell granules containing histamine. Biopsies from normal areas of the bladder from an age‐matched control group of patients with transitional cell carcinoma of the bladder were stained similarly. Human stomach and colon were used as positive controls for gastrin and toluidine blue, respectively. The clinical response to cimetidine was compared with the histology in a blinded fashion. Results Eight of the patients responded well to cimetidine; none of the biopsies showed evidence of carcinoma in situ. Although G cells in the stomach stained well for gastrin none of the bladder biopsies showed gastrin‐like immunoreactivity, apart from some nonspecific urothelial staining. Numerous mast cells with crimson granules and pale nuclei were visible in three patients and fewer in three others; their presence or absence did not correlate with the symptomatic response. Conclusions Cimetidine is a useful medical treatment for bladder pain but the presence or absence of gastrin or histamine‐like immunoreactivity does not explain its therapeutic benefit.