bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tension‐free vaginal tape for primary genuine stress incontinence: a two‐centre follow‐up study
Authors: Moran P.A. , Ward K.L. , Johnson D. , Smirni W.E. , Hilton P. , Bibby J. 
Published: March 2003

Objective To assess the safety and efficacy of the tension‐free vaginal tape procedure in the treatment of primary genuine stress incontinence. Patients and methods A two‐centre follow‐up study was conducted on 40 women with urodynamically confirmed primary genuine stress incontinence who had a tension‐free vaginal tape inserted under local anaesthesia with sedation. Operative details were recorded and all patients followed up both subjectively, and objectively with repeat urodynamic studies and pad testing. Results The mean (range) age of the women was 51.1 (33–86) years, the median parity 2 (0–4) and mean body mass index 25.1 (19–35). The mean anaesthesia and operative duration was 42 (25–65) min; 93% of the women resumed immediate spontaneous voiding with no need for catheterization. The mean inpatient stay was 2.2 (2–4) days (where 2 days is equivalent to one night in hospital). The follow‐up was conducted at a mean interval of 12.3 (6–24) months. Subjectively, 80% of women were cured and 17.5% significantly improved; objectively, genuine stress incontinence was cured in 95%. Symptomatic postoperative detrusor instability was found in 15% of women and symptoms of voiding dysfunction identified in 5% of women. There were no defects in healing or tape rejection. Conclusion The tension‐free vaginal tape procedure is a promising new technique that, in this short‐term analysis, appears to be safe and effective. Intra‐operative complications are uncommon and both hospital stay and recovery are short. Voiding complications are rare but symptomatic postoperative detrusor instability had an incidence of 15%.
The prevalence of varicocele and varicocele‐related testicular atrophy in Turkish children and adolescents
Authors: Akbay E. , Çayan S. , Doruk E. , Duce M.N. , Bozlu M. 
Published: March 2003

Objective To determine the prevalence and site of varicocele and varicocele‐related testicular atrophy in children and adolescents. Patients and methods The study included 4052 boys aged of 2–19 years, divided into four age groups; the findings of a physical examination, any testicular atrophy and testicular volume were recorded. Results Varicocele was detected in 293 (7.2%) of the 4052 boys; the prevalence was 0.79% in those aged 2–6 years, 0.96% at 7–10 years, 7.8% at 11–14 years and 14.1% at 15–19 years. The prevalence was 0.92% in 1232 children aged 2–10 years and 11.0% in 2531 adolescents aged 11–19 years (P < 0.001). The prevalence increased significantly at age 13 years (P < 0.005). The varicocele was unilateral in 263 of the 293 (89.7%) boys with varicocele; of these, one (0.38%) was on the right and the others on the left side. Varicoceles were bilateral in 30 of 279 boys (10.8%) aged 11–19 years but none were detected in those aged < 11 years. Varicocele‐related testicular atrophy was not present in those aged < 11 years, but seven boys (7.3%) aged 11–14 years and 17 (9.3%) aged 15–19 years had testicular atrophy. The difference in prevalence between the last two age groups with atrophy was not significant. Conclusion These findings support the view that varicocele is a progressive disease and that the prevalence of varicocele and testicular atrophy increases with the puberty.
A 14‐year follow‐up of conservative treatment forvesico‐ureteric reflux
Authors: Nielsen J.B. , Frøkiær J. , Rehling M. , Jørgensen T.M. , Djurhuus J.C. 
Published: March 2003

Objective To determine renal function in patients with vesico‐ureteric reflux (VUR) during 14 years of conservative treatment (no surgery). Patients and methods Sixty patients with VUR were consecutively included between 1981 and 1982. The degree of VUR was determined by conventional voiding cysto‐uretherography (VCUG) after 3 months of prophylactic antibiotics. The VUR was grade I–IV, with grades III and IV characterized as high‐grade VUR. In all patients, any urinary tract infections and bladder‐urethral dysfunction were treated. Renal function and reflux were monitored by renal and bladder scintigraphy using 123I‐hippuran and the glomerular filtration rate (GFR) was determined using the plasma clearance of 51Cr‐ethylaminediamine tetra‐acetic acid. Results Of the 60 patients who entered the study, 51 were followed for a mean of 13.7 years; nine patients were lost to follow‐up. None of the patients underwent antireflux surgery. All patients were in good health and normotensive (except two with borderline hypertension). Of the 51 patients 21 had low‐grade, 21 unilateral high‐grade and nine bilateral high‐grade reflux. In those with low‐grade reflux both the mean renal split function on the most refluxing kidney and the GFR remained stable during the whole monitoring period. Eighteen patients who had a persistent reduction in renal split function or initially had had a significantly reduced functional share to the most refluxing kidney had their GFR re‐assessed in adolescence. However, the body surface‐corrected GFR remained constant. Total GFR and single kidney GFR increased significantly. Conclusion A conservative treatment regimen in patients with VUR can ensure stable kidney function, although kidneys with a lower renal function at referral seem to have an impaired functional growth potential.
Evaluation of the 1997 tumour, nodes and metastases classification of renal cell carcinoma: experience in 172 patients
Authors: Minervini R. , Minervini A. , Fontana N. , Traversi C. , Cristofani R. 
Published: March 2003

Objective To compare the prognostic relevance of the 1987 and 1997 tumour, nodes and metastases (TNM) systems for staging renal cell carcinoma (RCC) in predicting patient outcome. Patients and methods A series of 172 consecutive patients with RCC who underwent radical nephrectomy from January 1990 to October 1997 was evaluated comparatively according to the 1987 and 1997 TNM classifications. The median (range) follow‐up of the patients was 50 (19–112) months. The probability of survival was estimated by the Kaplan–Meier method, using the log‐rank test to estimate differences among levels of the analysed variables. Results Using the 1997 TNM classification resulted in a redistribution of 99 patients from stage pT2 on the 1987 TNM classification to stage pT1. As the staging criteria for pT3 and pT4 did not change, there was no re‐classification of these patients. Kaplan–Meier survival curves showed a similar separation in 5‐year survival between stage pT1 and pT2 using both systems; 100% vs 80% for the 1987 TNM and 86% vs 69% for the 1997 TNM systems. This difference in survival rates between patients with pT1 and pT2 disease was statistically significant only for the 1997 TNM staging system. However, when the 1987 TNM staging classification was applied, the separation in 5‐year survival rates between pT2 and pT3 disease was greater. Conclusion This study confirms the prognostic relevance of the 1987 TNM system, as established in the present patients. The 1997 TNM classification resulted in a better stratification of patients with pT1–pT2 disease, but had similar prognostic value for pT2 and pT3 disease.
The clinical uroselectivity of alfuzosin is not significantly affected by the age of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia
Authors: Sánchez‐Chapado M. , Guil M. , Badiella L.I. , Fernández‐Hernando N. , Alfaro V. 
Published: March 2003

Objective To assess the effect of the age of patients with benign prostatic hyperplasia (BPH) on the clinical uroselectivity of alfuzosin during general medical practice. Patients and methods The present national, multicentre, open‐labelled, observational study involved 4018 Spanish outpatients with BPH, i.e. showing lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction. The patients received sustained release (SR) alfuzosin, 5 mg twice daily, for 2 months. The primary efficacy criteria were symptomatic improvements, as assessed by the International Prostate Symptom Score (IPSS) and quality of life (QoL) index. Safety was assessed by monitoring cardiovascular data and adverse events. Results The patients were divided into four age groups, i.e. < 56, 56–65, 66–75 and > 75 years. All groups of patients showed a mean IPSS decrease of 11–12 (55.8–65.4% from baseline) at the end of the study, while the QoL decreased by 2–3 points (55.6–63.6% from baseline). There were no relevant effects of age on the efficacy of the treatment. Moreover, alfuzosin was well tolerated independently of the age of the patient; 1.2% of the patients enrolled withdrew because of adverse events. The qualitative distribution of vasodilatory/nonvasodilatory adverse events was similar in all age groups. The incidence of asymptomatic orthostatic hypotension was low (0.58%) and not affected by the age of the patients. Conclusion This study confirms that the clinical uro‐selectivity of SR‐alfuzosin, already described in ran‐domized controlled studies, is not significantly affected in clinical practice by the age of the patients. This is considered particularly relevant to the characteristics of patients with BPH, as they are mostly elderly men.
Psychosocial morbidity in prostate cancer: I. Design of a new questionnaire
Authors: Cliff A.M. , Macdonagh R.P. 
Published: March 2003

Objective To design a questionnaire capable of measuring psychosocial morbidity in patients with prostate cancer and in their partners. Methods Issues to be covered in the questionnaire were determined by discussion among professionals, a literature review and semi‐structured interviews with a group of seven patients and their partners. The potential issues were analysed and condensed, then re‐presented to a further group of professionals, and to 10 patients and partners for comment and amendment. This process aimed to confirm the completeness and relevance of the list of issues. Questions were then constructed around the final list of issues and the questionnaire adjusted continually while testing on patients, until it was completed easily. Results The questionnaire consisted of 10 items; three items related to the general threat of cancer (concern about the diagnosis itself, fear of the future and difficulty dealing with the emotional response to the disease). Two items covered social and role functioning and there were five items to determine the severity of psychological morbidity caused by pain, urinary symptoms, treatment, physical limitation and sexual dysfunction. The questionnaire appeared to cover those areas of morbidity most consistently raised by patients and partners; it was also rapidly and easily completed by most respondents. Conclusion The questionnaire constructed may be easily applied as part of routine clinical practice; it addresses aspects of psychosocial morbidity related to prostate cancer in patients and their partners. Although it appears to have content validity, further psychometric testing is required.
Molecular markers for predicting prostate cancer stage and survival
Authors: Dunsmuir W.D. , Gillett C.E. , Meyer L.C. , Young M.P. , Corbishley C. , Eeles R.A. , Kirby R.S. 
Published: March 2003

Objective To assess several molecular markers (detected by immunohistochemistry, IHC) to determine whether they can be used to improve the prognostic value of histological grade alone in predicting the behaviour of prostate cancer. Patients and methods Tumour tissue was retrieved from 156 men in whom tumour grade, stage and survival were known. The outcome measures were: (i) local stage (T‐stage, organ‐confined vs extraprostatic); (ii) metastatic status (M‐stage, bone metastasis vs no bone metastasis); and (iii) survival. The IHC markers used were chosen to provide a broad representation of various aspects of tumour biology, i.e. the androgen receptor (AR) and oestrogen receptor (ER), adhesion molecules (E‐cadherin), proliferation markers (MIB‐1), tumour‐suppressor genes (TP53 and the retinoblastoma gene product, Rb) and other novel cancer‐related proteins (cyclin D1 and the breast cancer susceptibility gene product, BRCA2). All factors were assessed using logistic regression and Cox proportional‐hazards survival models for predictive value, after adjusting for effects. Results MIB‐1, ER, cyclin D1 and E‐cadherin all showed close statistically significant univariate associations with histological grade. Univariate analysis also identified close statistically significant associations between T‐stage and both MIB‐1 and E‐cadherin. Likewise, there were close univariate associations for both M‐stage and survival, and MIB‐1, cyclin D1 and ER. Logistic regression modelling identified MIB‐1, cyclin D1 and ER as statistically significant predictors of M‐stage and, once MIB‐1 was entered into the model, the effects of grade no longer made a significant contribution. MIB‐1 was a significant predictor for T‐stage, but the effects of grade remained significant in this model. Cox proportional‐hazards modelling identified MIB‐1, cyclin D1 and ER as being statistically significant predictors of survival, after adjusting for grade. After adjusting for both grade and MIB‐1, the effects of cyclin D1 and ER were no longer statistically significant. Excess MIB‐1, cyclin D1 or ER expression tended to be present within the most poorly differentiated and advanced‐stage lesions; this provides an inherent instability to the models described. TP53, Rb, AR and BRCA2 were of limited prognostic value. Conclusions MIB‐1, ER and cyclin D1 provide prognostic information that is clearly independent of grade. However, their true clinical value is probably limited because they are expressed mainly in the most advanced lesions. Nevertheless, MIB‐1 expression is of sufficient value to warrant inclusion in future prognostic models. Furthermore, the expression of cyclin D1 and ER may reflect aspects of tumour biology that individually are worthy of further investigation. However, none of the IHC markers used in this study can be recommended for use in routine histological preparations.
A prospective evaluation of the pathogenesis of detrusor instability in women, using electron microscopy and immunohistochemistry
Authors: Carey M.P. , De Jong S. , Friedhuber A. , Moran P.A. , Dwyer P.L. , Scurry J. 
Published: March 2003

Objective To characterize the types of detrusor smooth muscle junctions in the bladders of women with detrusor instability and in a control group without, and to assess whether there are differences in the cell junctions between these groups. Patients and methods The study included 13 women with detrusor instability (median age 57 years, range 32–86) and 11 control women (median age 50 years, range 33–62). Bladder biopsies were taken from each participant, processed for electron microscopy and immunohistochemistry (using a labelled antibody to vinculin) and analysed by investigators who were unaware of the patients' diagnoses. Results Adherens (intermediate) junctions in classic and rudimentary forms were present in all biopsies from patients and controls. Adherens junctions and dense plaques occupied almost the complete cell border in most samples. Complete immunohistochemistry was possible in seven patients and five controls. In almost every detrusor smooth muscle cell studied, there was staining of the entire cell border with labelled antibody to vinculin in all biopsies. Conclusions This study provides evidence against an ultrastructural basis for idiopathic detrusor instability based on possible differences in detrusor smooth muscle intercellular junctions. Virtually the entire cell membrane of detrusor smooth muscle fibres is occupied by adherens junctions in classic and rudimentary forms, and with dense plaques present in samples from women with an unstable bladder and from controls. There was no junction detected in those with instability that was not present in the control group. The adherens junctions in the bladder facilitate mechanical coupling between cells.
Penile lengthening
Authors: Perovic S.V. , Djordjevic M.L.J. 
Published: March 2003

Objective To describe a technique for penile lengthening and the results achieved. Patients and methods The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to insert autologous cartilage previously harvested from the rib, the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis. The increased length of the penis depends directly on the elasticity of the urethra and especially of the neurovascular bundle. From June 1995 to March 1999 the technique was applied in 19 patients aged 18–52 years, who were followed for a mean (range) of 3.3 (1–4.5) years. Results The increase in penile length was moderate, at 2–4 cm; there were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction. Fifteen patients reported painless sexual intercourse, the remaining four patients providing no data. During the follow‐up the cartilage insert remained at about the same size as that at initial implantation. Conclusion The penile disassembly technique combined with the interposition of rib cartilage in the space between the glans cap and tips of the corpora cavernosa provides a genuine increase in penile length, with satisfactory results.
Limited value of endorectal magnetic resonance imaging and transrectal ultrasonography in the staging of clinically localized prostate cancer
Authors: May F. , Treumann T. , Dettmar P. , Hartung R. , Breul J. 
Published: March 2003

Objective To examine the role of endorectal magnetic resonance imaging (eMRI) and transrectal ultrasonography (TRUS) for clinically localized prostate cancer and to assess interobserver agreement in interpreting MRI studies. Patients and methods Fifty‐four patients with biopsy‐confirmed prostate cancer underwent TRUS and eMRI before radical retropubic prostatectomy. The MR images were prospectively interpreted by two radiologists with special expertise in this field. The criteria evaluated prospectively in each patient were extracapsular extension (ECE) and seminal vesicle invasion (SVI). The results were correlated with the histopathological findings after radical prostatectomy. Results At pathology, 27 patients had stage pT2, 15 had stage pT3a and 12 had stage pT3b lesions. The overall accuracy of eMRI in defining local tumour stage was 93% by radiologist A and 56% by radiologist B; the overall accuracy by TRUS was 63%. There was a poor correlation for the MRI studies between observers. The eMRI was more sensitive than TRUS for detecting ECE and SVI in organ‐confined prostate cancer. TRUS had a relatively high specificity for ECE and SVI, and was better than eMRI in this regard. Conclusion Whereas MRI tended to over‐stage, TRUS under‐staged prostate cancer. This series shows the current limited value of TRUS and eMRI for planning treatment in patients with clinically localized prostate cancer. Treatment decisions should not be altered based on TRUS or eMRI findings alone.
Antenatal renal pelvic measurements: what do they mean?
Authors: Scott J.E.S. , Renwick M. 
Published: March 2003

Objective To analyse data on cases with urological abnormalities recorded over a 15‐year period (1984–98) by the Northern Region Congenital Abnormality Survey (NorCAS), with special reference to fetal renal pelvic measurements. Materials and methods Data on all urological cases recorded in the NorCAS database and in notification documents forwarded from hospitals in the Northern Region were extracted and incorporated in a separate unattributable database for analysis. Specific fields for filing recorded fetal renal pelvic measurements with their corresponding gestational ages were inserted; it was ensured as far as possible that these measurements were made in the anteroposterior plane. Results The total number of cases analysed was 2737; a measurement of the fetal renal pelvis was recorded in 813, and more than once in 468, giving 1301 measurement episodes with the corresponding gestational ages, pregnancy and postnatal outcome. The male/female (M/F) ratio was significantly higher in those cases which had a fetal renal pelvic measurement recorded than in those which had not. This was because there was a 12/1 M/F ratio in measured cases of vesico‐ureteric reflux (VUR). Few cases of VUR had a fetal renal pelvic measurement recorded. The difference in the fetal renal pelvic measurements between those cases which were normal postnatally and those which had a structural abnormality, an obstructive lesion or VUR became significant at 7 mm and at 18 weeks of gestational age. Over the whole period the proportion of cases in which micturating cysto‐urethrography was technically possible and might have contributed to the diagnosis was 28.5%; the highest was 44.1% in 1998. Conclusions Antenatal renal dilatation occurs infrequently in the presence of VUR and when it does, the fetus will probably be male. Antenatal ultrasonography is unlikely to contribute to detecting VUR in females, the gender in whom early diagnosis is particularly desirable. Other means of suspecting VUR antenatally, e.g. the family history or genetic coding, may be more valuable. A measurement of the fetal renal pelvis of  7 mm at a gestational age of 18 weeks should prompt subsequent careful ultrasonography during the pregnancy and early postnatal investigation of the urinary tract. The diagnosis of VUR should not be excluded because the fetal renal pelvis is only minimally dilated if the fetus is female.
Haematuria in Africa: is the pattern changing?
Authors: Dawam D. , Kalayi G.D. , Osuide J.A. , Muhammad I. , Garg S.K. 
Published: March 2003

Objective To study the aetiological factors and clinical presentation of haematuria as seen in a tertiary healthcare centre in a developing country in Africa. Patients and methods The study comprised a retrospective review of the diagnostic indices and notes of patients with macroscopic haematuria presenting at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 7‐year period from 1985 to 1991. Results Of a total of 2726 urology patients and 11 232 surgical patients, 482 had haematuria (17.7% and 4.3%, respectively, 387 males and 95 females, ratio 4.1 : 1, mean age 44.8 years, range 6–80). Many presented late with advanced malignant disease (T3, T4). Investigations useful in the diagnosis were urinary cytology, intravenous urography and cysto‐urethroscopy. Common causes of haematuria were bladder carcinoma in 142 (31%), benign prostatic hypertrophy in 64 (14%) and urinary stones in 54 (12%). Conclusion Recurrent haematuria in patients over 30 years of age in this environment should be considered or deemed to be caused by malignancy until confirmed otherwise. An educational programme is required to alert the population to the significance of haematuria as a symptom demanding a thorough investigation before treatment. This would need support by a haematuria service for accelerated diagnosis and treatment.