bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extracorporeal shock wave lithotripsy in children: experience using two second‐generation lithotripters
Authors: Elsobky E. , Sheir K.Z. , Madbouly K. , Mokhtar A.A. 
Published: March 2003

Objectives To assess the value of extracorporeal shock wave lithotripsy (ESWL) in treating paediatric urolithiasis, and to determine factors that may affect the results. Patients and methods Using two types of lithotripters (MFL 5000, Dornier MedTech GmbH, Germany, and the Echolith, Toshiba Medical Systems, Japan), 148 children and adolescents (mean age 11.2 years,
sd 4.7, range 1–18) were treated for urinary stones. Of these, 137 patients had renal stones and 11 had ureteric stones. The respective mean (
sd) stone width and length were 10.2 (4.1) and 12.9 (5.6) mm for renal stones and 7.6 (2.7) and 9.1 (2.7) mm for ureteric stones. The patients were assessed 3 months after treatment and the results compared using the chi‐square test to detect factors that might be associated with the stone‐free rate. Results For those with renal stones, the overall stone‐free rate was 86% and the re‐treatment rate 64%. The only significant factor associated with the stone‐free rate was the transverse diameter of the stone (P = 0.012); there was no significant effect of the type of lithotripter but there was a significant difference in re‐treatment rate (P = 0.016) in favour of the MFL 5000. All those with ureteric stones were rendered stone‐free and only four required re‐treatment. Only one child among those with renal stones developed steinstrasse; this was managed by ureteroscopy and otherwise no other complications were recorded in either group. Conclusions ESWL is a safe and effective treatment for paediatric urolithiasis. The stone‐free rate is influenced significantly by stone size. The re‐treatment rate differed significantly between the electrohydraulic and piezoelectric lithotripters, but the stone‐free rate did not.
One thousand video‐urodynamic studies in children with non‐neurogenic bladder sphincter dysfunction
Authors: Hoebeke P. , Van Laecke E. , Van Camp C. , Raes A. , Van De Walle J. 
Published: March 2003

Objective To ascertain the aetiology and epidemiology of non‐neurogenic bladder sphincter dysfunction (NNBSD) by assessing the results of prospective video‐urodynamic studies (VUD) in 1000 children.Patients and methods During a 4‐year study period (January 1995 to December 1998) 1000 children prospectively underwent VUD to further define their NNBSD. After a noninvasive screening assessment consisting of a history, voiding diary, clinical examination, urine analysis, ultrasonography and uroflowmetry, those children who would benefit from further VUD were selected. The selection criteria included a history of urinary tract infection (UTI), a small bladder capacity not responding to training, dysfunctional uroflow, ultrasonographic abnormalities and resistance to therapy. During the study period 3500 children were screened for incontinence problems, including monosymptomatic nocturnal enuresis; 1000 of these were selected for VUD (524 boys and 476 girls).Results The urodynamic diagnosis was of normal bladder‐sphincter function in 62 (6.2%, male : female 44 : 56), urge syndrome in 582 (58%, 58 : 42), dysfunctional voiding in 316 (32%, 49 : 51) and ‘lazy bladder’ in 40 (4%, 20 : 80). Boys diagnosed with a ‘lazy bladder’ were younger than those with urge syndrome and dysfunctional voiding. Girls with dysfunctional voiding were younger than those with urge syndrome. The incidence of UTI was significantly higher in girls than in boys; boys with NNBSD had no greater risk for UTI and in girls the general risk was 34%. Only in girls with a lazy bladder was there a significantly higher incidence of UTI (53%). Reflux occurred equally in all groups, with an overall incidence of 15%. The incidence of obstipation was significantly higher in girls with a lazy bladder, and overall was 17%.Conclusion These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD. The age distribution provides evidence against a dysfunctional voiding sequence. The risk of developing UTI in NNBSD is greater only in girls. In children with a lazy bladder the risk is also significantly higher, indicating that residual urine is a greater risk factor than detrusor instability. Urge syndrome and dysfunctional voiding in girls carry the same risk for developing UTI, indicating that bladder instability is a higher risk factor for UTI than detrusor sphincter discoordination. All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence, UTIs, reflux and obstipation.
Laparoscopic excision of prostatic utricles in children
Authors: Yeung C.K. , Sihoe J.D.Y. , Tam Y.H. , Lee K.H. 
Published: March 2003

Objective To report our experience of laparoscopic excision of symptomatic prostatic utricles in children.Patients and methods Prostatic utricles were excised laparoscopically in four boys (mean age 6.3 years, range 1.5–17). Cysto‐urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure. Laparoscopy was conducted via a 5‐mm port inserted through a supra‐umbilical incision. Two more 5 mm working ports were inserted at the right and left mid‐abdomen. The prostatic utricle was easily identified with the guidance of cystoscopic transillumination. Dissection was further facilitated by lifting and counter‐traction of the prostatic utricle using the indwelling cystoscope. The prostatic utricle was completely mobilized and divided at its confluence with the urethra using an ultrasonic scalpel.Results Laparoscopic excision of the prostatic utricle was successful in all four patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in one. One patient also had a nonfunctioning dysplastic kidney associated with an ectopic ureter joining into the prostatic utricle, and underwent nephroureterectomy at the same setting. The mean (range) operative duration was 148 (105–225) min. All four patients recovered uneventfully with no complications.Conclusions Laparoscopic excision under cystoscopic guidance is effective for symptomatic prostatic utricles, offering a good surgical view and allowing easy dissection in a deep and narrow pelvic cavity.
The effect of superoxide dismutase on nitric oxide‐mediated and electrical field‐stimulated diabetic rabbit cavernosal smooth muscle relaxation
Authors: Khan M.A. , Thompson C.S. , Jeremy J.Y. , Mumtaz F.H. , Mikhailidis P. , Morgan R.J. 
Published: March 2003

Objective To investigate the effect of superoxide dismutase (SOD, the enzyme that accelerates the breakdown of the superoxide anion, O2– to H2O) on nitric oxide (NO)‐mediated and electrical field stimulated (EFS) relaxation in diabetic rabbit cavernosal smooth muscle. Materials and methods Diabetes was induced with alloxan (65 mg/kg) in six adult New Zealand White rabbits. After 6 months, cavernosal smooth muscle strips from age‐matched controls and diabetic animals were mounted in organ baths. After precontraction with phenylephrine (10 µmol/L) in the presence of atropine (1 µmol/L), guanethidine (5 µmol/L) and indomethacin (10 µmol/L), relaxation responses to EFS (1–20 Hz), carbachol (10−8−10−4 mol/L) and sodium nitroprusside (SNP, 10−9−10−4 mol/L) were assessed in the presence and absence of SOD (100 IU/mL). Results SNP‐ and carbachol‐mediated (endothelium‐independent and ‐dependent, respectively) relaxations were impaired in the diabetic cavernosal smooth muscle strips compared with controls (concentration required for 50% inhibition, 1.4 µmol/L for diabetic and 0.75 µmol/L for control with SNP, and 44 µmol/L for diabetic and 0.4 µmol/L for control with carbachol). SOD significantly enhanced both SNP‐ and carbachol‐mediated diabetic cavernosal smooth muscle relaxations (both P < 0.05). EFS‐mediated relaxations were also significantly (P < 0.05) impaired in the diabetic cavernosal smooth muscle strips; these relaxations were also significantly (P < 0.05) enhanced by SOD. Conclusion NO‐ and EFS‐mediated cavernosal smooth muscle relaxation is impaired in a rabbit model of diabetes but SOD significantly reversed the impaired relaxation. Therefore, in diabetes, the generation of reactive oxygen species may play an important role in the development of erectile dysfunction.
Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico‐ureteric reflux
Authors: McLaren C.J. , Simpson E.T. 
Published: March 2003

Objective To determine the sensitivity of the direct radionuclide cystogram (DRC) in detecting vesico‐ureteric reflux compared with the micturating cysto‐urethrogram (MCU) in the same initial setting, in infants younger than one year. Patients and methods The results from the dual cystograms of 62 refluxing infants < 1 year old (mean 0.58) were compared. Results from same‐day renal scintigraphy with dimercaptosuccinic acid (DMSA) in 60 of the 62 infants were also compared with the reflux grades. Results Reflux was detected in 105 units, 96 detected on the DRC and 47 on the MCU, representing a sensitivity of 91% and 45%, respectively. The DRC missed half of grade 1, 20% of grade 2 and 6% of grade 3 reflux. Reflux at low bladder filling rates (DRC) represented 40% of all reflux units, and a half (52%) of scarred renal units detected by DMSA scintigraphy. Conclusions In young infants the MCU may fail to detect significant reflux and the DRC may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information.
Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia
Authors: Tanyel F.C. , Müftüoglu S. , Dagdeviren A. , Kaymaz F.F. , Büyükpamukçu N. 
Published: March 2003

Objective To ascertain the presence of myofibroblasts in sacs associated with inguinal hernia in children, through an ultrastructural evaluation using electron microscopy Materials and methods Sacs were obtained from 10 boys and 10 girls (of similar age, ≈ 45 months) with inguinal hernia and processed for electron microscopy. Thin sections were examined specifically for the presence of myofibroblasts. Results The ultrastructural evaluation showed myofibroblasts with classical electron microscopic features within all of the sacs, regardless of the gender of origin. Conclusion The persistence of smooth muscle hinders the obliteration of the processus vaginalis; myofibroblasts are found in association with smooth muscle and thus such cells within the sac walls seem to originate from the smooth muscle, reflecting the dedifferentiation of smooth muscle. This dedifferentiated state may represent attempted apoptosis, which usually causes the disappearance of the smooth muscle and obliteration of the processus vaginalis after the descent of the testis into the scrotum.
The action of cysteinyl‐leukotrienes on intracellular calcium mobilization in human detrusor myocytes
Authors: Bouchelouche K. , Horn T. , Nordling J. , Larsen S. , Hald T. 
Published: March 2003

Objective To investigate the presence of leukotriene D4 receptors in fura‐2‐loaded human detrusor smooth muscle cells (DSMCs) by examining the ability of leukotriene D4 to raise intracellular‐free Ca2+ concentration ([Ca2+]i), to determine the origin of the leukotriene D4‐mediated rise in [Ca2+]i and to investigate whether the specific leukotriene D4 receptor antagonist montelukast inhibits the Ca2+ response induced by leukotriene D4. Materials and methods Detrusor muscle biopsies were obtained from patients with benign noninvasive bladder diseases undergoing cystoscopy. DSMCs were isolated using an explant technique and maintained in culture. Only primary cultures or cells passaged up to three times were used for experiments. DSMCs were characterized with immunohistochemical staining and their identity confirmed by transmission electron microscopy. [Ca2+]i was measured in single DSMCs using the Ca2+ probe fura‐2 and fluorescence‐ratio microscopy. Results Immunohistochemical staining showed that 80–99% of the cells were positive for smooth muscle α‐actin. The ultrastructural features of the cultured cells were those of smooth muscle cells and showed no differentiation in a fibroblastic or myofibroblastic direction. Leukotriene D4 increased the level of [Ca2+]i in a dose‐dependent manner. Calcium was mobilized almost exclusively from intracellular Ca2+ stores. There was a dose‐dependent inhibition of the increase in [Ca2+]i by montelukast. Conclusion The present study is the first to show the presence of specific leukotriene D4 receptors in human detrusor myocytes. This may have implications for a potential pathophysiological role of leukotriene D4 in patients with interstitial cystitis and other functional or inflammatory bladder disorders.
The effect of methylene blue on histological damage after spermatic cord torsion in a rat model
Authors: Greenstein A. , Schreiber L. , Matzkin H. 
Published: March 2003

Objective To investigate, in a rat model, whether methylene blue (a free‐radical scavenger) is effective in alleviating the histological testicular damage caused by reperfusion after spermatic cord torsion. Materials and methods Male Wistar rats underwent a clockwise 720° left spermatic cord torsion lasting 3 h; they were then randomly assigned to treatment and control groups. In the treated group, 2 mg/kg methylene blue was injected intraperitoneally 20 min before the cord was untwisted, and an additional 1 mg/kg injected into the penile vein 1–2 min beforehand. After 14 days, the left testicle was removed and assessed histologically. The control group was not treated. Results Thirty‐three rats in the treatment group and 35 untreated controls were suitable for evaluation. Treatment with methylene blue was not significantly predictive of histological damage; the colour of the testis before detorsion was not correlated with histological damage. Conclusion Anti‐oxidant treatment with methylene blue had no palliative effect on the histological changes after torsion and detorsion of the spermatic cord in this rat model.
Does drinking cranberry juice produce urine inhibitory to the development of crystalline, catheter‐blocking Proteus mirabilis biofilms?
Authors: Morris N.S. , Stickler D.J. 
Published: March 2003

Objective To test the recommendation that to avoid the complications of long‐term indwelling bladder catheterization (e.g. encrustation and blockage by crystalline Proteus mirabilis biofilms) patients should drink cranberry juice. Materials and methods Urine was collected from groups of volunteers who had drunk up to 2 × 500 mL of cranberry juice or water within an 8‐h period. Laboratory models of the catheterized bladder were supplied with urine from these groups and inoculated with P. mirabilis. After incubation for 24 or 48 h, the extent of catheter encrustation was determined by chemical analysis for calcium and magnesium. Encrustation was also visualized by scanning electron microscopy. Results The amounts of calcium and magnesium recovered from catheters incubated in urine pooled from individuals who had drunk 500 mL of cranberry juice was not significantly different from that on catheters incubated in pooled urine from control subjects who had drunk 500 mL of water. However, there was significantly less encrustation (P = 0.007) on catheters from models receiving urine from volunteers who had drunk 2 × 500 mL of water than on catheters incubated in models supplied with urine from volunteers who had drunk 2 × 500 mL of cranberry juice. The amounts of encrustation on these two groups of catheters were also significantly less than that on catheters incubated in models supplied with urine from volunteers who had not supplemented their normal fluid intake. (P < 0.001). Experiments in the models using artificial urine showed that increasing the low fluid intake (720 mL/24 h) characteristic of many patients undergoing long‐term catheterization by factors of three and six, significantly (P < 0.01) reduced the amounts of calcium and magnesium that formed on catheters. At a simulated fluid intake of 720 mL/24 h, catheters blocked with encrustation after a mean of 42.5 h, while those supplied with urine produced from an intake of 4320 mL/24 h, drained freely for > 10 days. Conclusion In this in vitro study, drinking cranberry juice did not produce urine that was inhibitory to the development of crystalline catheter‐blocking P. mirabilis biofilms. The important factor in preventing catheter encrustation is a high fluid intake.
The efficacy of a range of contact media as coupling agents in extracorporeal shockwave lithotripsy
Authors: Cartledge J.J. , Cross W.R. , Lloyd S.N. , Joyce A.D. 
Published: March 2003

Objective To determine if the nature of the coupling agent normally used between the lithotripter and the patient affects the stone fragmentation rate during extracorporeal shock wave lithotripsy. Materials and methods A jig designed to hold ‘phantom’ 10‐mm stones at the focal point was fixed against the shock wave delivery point of an electromagnetic lithotripter (Dornier Compact, Germany). A layer of either petroleum jelly (Vaseline™, Cheeseborough‐Ponds Ltd, London, UK) ultrasonography jelly, a eutectic mixture of local anaesthetic (EMLA) cream, Instillagel (Farco‐Pharma, Cologne, Germany) or a commercial water‐soluble lubricating jelly was placed between the jig and shockwave head, and the number of shock waves required to fragment the stones was recorded. Results Significantly more shock waves were required to fragment stones when petroleum jelly was used as the coupling agent than with all the other agents under test, whereas significantly fewer shock waves were required when using Instillagel or lubricating jelly than for all other agents. Conclusion The coupling agent used in water‐free lithotripsy can affect the stone fragmentation rate and should not be considered inert. Ultrasonography jelly is probably the optimum agent available for use as a lithotripsy coupling agent.
Assessing the vascular‐stromal coefficient in patients with benign prostatic hyperplasia or prostate cancer using transrectal ultrasonography and power Doppler analysis
Authors: Dobrowolski Z. , Jaszczynski J. , Drewniak T. , Habrat W. 
Published: March 2003

Objectives To assess a coefficient of the prostatic blood supply in patients with prostate cancer or benign prostatic hyperplasia (BPH), and thus improve the diagnostic and prognostic variables needed to evaluate patients with prostate cancer. Patients and methods The vascular‐stromal coefficient was defined as the ratio of the blood vessel surface area and the surface area of the prostate, using power Doppler functions and transrectal ultrasonography. The index was calculated for the plane of the prostatic surface from the apex to the widest points of the peripheral zone, and for the plane across the highest density of blood vessels in the transition zone. A micobubble contrast agent was used to intensify the acoustic signals from prostatic vessels. The images were reconstructed in three dimensions. In all, 61 patients with BPH and 32 with confirmed prostate cancer were examined, and compared with a control group of young men. Results In the horizontal plane crossing the apex of the prostate, the vascular‐stromal coefficient was 0.0054 for the controls, 0.0072 for BPH and 0.0067 for cancer. At the level of the highest density of blood vessels the respective values were 0.0083, 0.038 and 0.029. The respective values for the first plane after using the contrast agent were 0.025, 0.092 and 0.0365, and in the second level 0.04, 0.15 and 0.14. Conclusion The vascular‐stromal coefficient measured at both levels was higher in patients with BPH than in those with cancer or than in the controls. The prostatic vascular system can be computer‐reconstructed in three dimensions, allowing an evaluation of asymmetry and other vascular abnormalities. The contrast agent effectively increases the vascular acoustic signals from the prostate, enhancing by a factor of five the visualization of blood vessels when using the power Doppler option.
Intracavernosal injection therapy with and without sexological counselling in men with erectile dysfunction
Authors: Van Der Windt F. , Dohle G.R. , Van Der Tak J. , Slob A.K. 
Published: March 2003

Objective To compare the acceptance of and satisfaction with intracavernosal injection (ICI) therapy with and without sexological counselling in men with erectile dysfunction (ED). Patients and methods In a prospective randomized study, men were alternately assigned to ICI without sexological counselling (−SC) or with sexological counselling (+SC). In all, 70 patients were included, i.e. 35 in each group; 57 (28 −SC, 29 +SC) were interviewed by telephone after a mean follow‐up of 11.3 months to determine their use of ICI and reasons for discontinuing. Results There were no differences between the groups in discontinuation of ICI (overall 30%), in reasons for discontinuing ICI (24% did so because of the return of spontaneous erections) or in sexual functioning. Conclusion There was no positive contribution from additional sexological counselling but extensive information and support by the urologist seems to be sufficient, resulting in a high acceptance rate of ICI. The discontinuation rate (30%) is one of the lowest reported.
Detrusor myotomy: a 5‐year review in unstable and non‐compliant bladders
Authors: Potter J.M. , Duffy P.G. , Gordon E.M. , Malone P.R. 
Published: March 2003

Objective To identify urodynamic factors that might determine the clinical outcome of detrusor myotomy in incontinent children. Patients and methods Six girls and three boys (aged 5–14 years) underwent detrusor myotomy for severe urinary incontinence. Seven children had spina bifida, one had traumatic paraplegia and one had low bladder compliance. The patients were followed for a minimum of 5 years. Results Urodynamic studies before surgery showed that three patients had normal compliance with grossly unstable detrusor contractions, and six had low bladder compliance with few phasic detrusor contractions. Detrusor leak‐point pressures were > 40 cmH2O in five patients and < 40 cmH2O in four. Only two patients, both with grossly unstable detrusor contractions and leak‐point pressures of > 40 cmH2O, had a successful 5‐year outcome. The other seven patients remained incontinent; six underwent further surgery and one died from unrelated causes. Conclusion Detrusor myotomy appears to have the best outcome in those patients with marked phasic unstable detrusor contractions with a competent urethral sphincter. In this group it may have distinct advantages over more commonly used procedures.