bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of urinary nuclear matrix protein‐22 and bladder tumour antigen tests with voided urinary cytology in detecting and following bladder cancer:the prognostic value of false‐positive results
Authors: Poulakis V. , Witzsch U. , De Vries R. , Altmannsberger H.‐M. , Manyak M.J. , Becht E. 
Published: March 2003

Objectives To evaluate the diagnostic and prognostic value of the nuclear matrix protein‐22 (NMP22) and bladder tumour antigen (BTAstat) tests compared with voided urinary cytology (VUC) in detecting and following bladder cancer, assessing particularly the prognostic value of false‐positive test results in patients followed up for bladder cancer. Patients and methods From 739 patients suspected of having bladder cancer, voided urine samples for the NMP22 and BTAstat tests, and for VUC and urine analysis, were collected before cystoscopy. All patients underwent transurethral resection of bladder lesions or mapping, and were followed for a mean (range) of 27.3 (3–65) months. Results In the 406 patients with bladder cancer, the overall sensitivity was 85% for NMP22, 70% for BTAstat and 62% for VUC. For histological grades 1–3 the sensitivity in detecting transitional cell carcinoma was 82%, 89% and 94% for NMP22, 53%, 76% and 90% for BTAstat, and 38%, 68% and 90% for VUC, respectively. Although the sensitivity in detecting invasive carcinoma was > 85% for all the tests, NMP22 and BTAstat were statistically more sensitive than VUC for superficial tumours. The optimal threshold value for NMP22, calculated using the receiver operating characteristics curve, was 8.25 U/mL. The specificity was 68% for NMP22, 67% for BTAstat, and 96% for VUC. The specificity of VUC remained > 87% and was independent of benign histological findings. In contrast, in patients with no apparent genitourinary disease on histology, NMP22 and BTAstat had significantly higher specificity (94% and 92%, respectively; P = 0.003) than in the group with chronic cystitis (52% for both tests). Forty patients having no bladder cancer at biopsy had a recurrence after a mean (range) follow‐up of 7.7 (3–15) months; all had a previous history of bladder cancer. According to subsequent recurrence, the prognostic positive and negative predictive values were 18% and 91% for NMP22, 13% and 88% for BTAstat, and 79% and 91% for VUC. Both false‐positive VUC and NMP22 tests predicted recurrence (log‐rank test, P < 0.001 and P = 0.004, respectively), but the BTAstat test produced no similar correlation (P = 0.778). Conclusion The NMP22 and BTAstat tests are better than VUC for detecting superficial and low‐grade bladder cancer but they have significantly lower specificity. After excluding diseases with the potential to interfere in these tests the overall specificity of both tests is increased considerably. False‐positive results from NMP22 and VUC but not from BTAstat in patients followed up for bladder cancer correlate with future recurrences.
Magnetic resonance urography in patients with neurogenic bladder dysfunction and spinal dysraphism
Authors: Shipstone D.P. , Thomas D.G. , Darwent G. , Morcos S.K. 
Published: March 2003

Objective To investigate the reliability of magnetic resonance urography (MRU) using heavily T2‐weighted very fast spin‐echo sequences in imaging the upper urinary tract in patients with spinal dysraphism and neuropathic bladder dysfunction. Patients and methods Patients with neuropathic bladder dysfunction secondary to spinal dysraphism may have gross spinal deformity, which makes assessing the urinary tract extremely difficult by ultrasonography or intravenous urography. The study included 50 patients (median age 33 years, range 19–52) with a median (range) Cobb's angle of 60 (0–240)°. No contrast medium was given but all patients received 20 mg of intramuscular frusemide 20–30 min before MRU. Results Thirty‐five patients had previous ultrasonography, during which only 42 kidneys and no ureters were visible. Of the 94 renal tracts, MRU visualized all kidneys and 86 (89%) ureters. There was good agreement amongst observers on assessing the kidneys and pelvicalyceal systems (kappa  0.61) but only moderate agreement on evaluating the ureters (kappa  0.61). There was disagreement on normality vs renal parenchymal scarring in 14 (15%) kidneys, about no dilatation vs dilatation of the pelvicalyceal system in 14 (15%) systems and about no dilatation vs dilatation of the ureter in 20 (22%) ureters. The overall quality of the MRU images was rated highly, with a mean (range) score of 4.6 (3–5). Conclusion MRU provides a reliable noninvasive technique for imaging the upper tract in patients who were previously difficult to investigate.
The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hannover experience
Authors: Kuczyk M. , Münch T. , Machtens S. , Bokemeyer C. , Wefer A. , Hartmann J. , Kollmannsberger C. , Kondo M. , Jonas U. 
Published: March 2003

Objectives To further clarify the need for routine adrenalectomy during the surgical treatment of renal cell cancer, as in the absence of clinically overt metastatic disease, tumorous lesions within the adrenal gland are found in only 2–10% of patients, with most being over‐treated by adrenalectomy. Patients and methods The medical records of 819 patients undergoing adrenalectomy combined with nephrectomy, irrespective of the local extension of the primary tumour or the clinical stage at first diagnosis, were reviewed to determine the reliability of currently available imaging methods in predicting adrenal gland metastases. Several patient and tumour characteristics were correlated with the presence of intra‐adrenal metastases, and their possible independent prognostic value was determined by a multivariate logistic regression model. Results There was metastatic spread into the adrenal gland in 27 of 819 (3.3%) patients. In only three of eight patients in whom the adrenal was identified as the only metastatic site were preoperative abdominal computed tomography scans interpreted as false‐negative. On multivariate statistical analysis only the presence of distant metastases, vascular invasion within the primary tumour and multifocal growth of renal cell cancer within the tumour‐bearing kidney were identified as independent predictors of the presence of intra‐adrenal metastases. Conclusions None of the patient or tumour characteristics evaluated reliably predicted the likelihood of adrenal metastases in patients with no evidence of disseminated metastatic spread. However, previously published data indicate that the frequency of metachronous metastases within the contralateral kidney (1.8–3.8%) is significantly higher than the risk of a preoperatively undetected isolated intra‐adrenal metastatic lesion when currently available imaging modalities are applied. Therefore, routine adrenalectomy should not be recommended if the preoperative radiological examinations are normal.
Comparison of surgery alone with surgery and adjuvant radiotherapy for pT3N0 prostate cancer
Authors: Petrovich Z. , Lieskovsky G. , Stein J.P. , Huberman M. , Skinner D.G. 
Published: March 2003

Objective To compare the outcome between patients with pT3N0 adenocarcinoma of the prostate treated with radical prostatectomy (RP) and those receiving RP followed by a planned course of postoperative radiation therapy (RT). Patients and methods During a period of 22 years 622 patients with pT3N0 prostate cancer were treated in one medical centre by RP. Of these, 199 (32%) were treated with surgery alone while 423 (68%) received planned postoperative pelvic RT (median 48 Gy). Patients were selected for RT by having a higher incidence of adverse prognostic factors than those undergoing RP alone. These prognostic factors included pathological stage (P = 0.001) preoperative prostate specific antigen (PSA) level (P < 0.001) and Gleason score (P = 0.18). The patients' median age was 66 years; the median follow‐up was 6.1 years for all patients, 7 years for RP + RT and 5 years for the RP‐alone. Results The 5‐ and 10‐year actuarial survival was 92% and 73%, respectively, for RP + RT patients, and nearly identical for those in the RP‐alone group (P = 0.73). The 5‐ and 10‐year disease‐free survival (DFS; PSA < 0.05 ng/mL) was 69% and 51%, respectively, for the former, and 71% and 60%, respectively, for the latter group. There was no significant difference in DFS between the treatment groups by pathological stage and Gleason score (P = 0.77). Likewise, there was no significant difference in mean and median time to relapse. A preoperative PSA level of  < 10 vs 10–25 vs  > 25 ng/mL did not influence overall survival but a PSA of  > 25 ng/mL was predictive of DFS (P = 0.02). In a multivariate analysis the Gleason score was the most important predictor for overall survival and DFS (P < 0.001), while pathological stage was predictive of clinical recurrence and DFS (P < 0.001). After controlling for pathological stage and Gleason score, RP + RT patients were predicted to recur at 92% of the rate of RP‐alone patients (P = 0.65). In all, 43 (10%) patients developed a clinical recurrence in the RP + RT group, including 30 (7%) patients with distant metastases alone, 13 (3%) with local recurrence, with an additional 88 (21%) who had PSA recurrence (PSA  > 0.05 ng/mL). This compared with 13 (6.5%) patients with clinical recurrence, including seven (3.5%) with local recurrence and 23 (11.6%) with PSA  > 0.05 ng/mL in the RP‐alone group. Postoperative RT was well tolerated and did not add to the incidence of surgical complications. Conclusion We propose that postoperative RT, as described here, helped to reduce the incidence of local recurrence and improved DFS to equal that of a lower‐risk group of patients treated with RP alone. A randomized comparison is needed to define the role of adjuvant RT in patients with pT3N0 disease.
External and iatrogenic trauma of the urinary bladder: a survey in Poland
Authors: Dobrowolski Z.F. , Lipczyn˜ski W. , Drewniak T. , Jakubik P. , Kusionowicz J. 
Published: March 2003

Objective To assess incidence of urinary bladder injuries (frequently associated with pelvic trauma and often iatrogenic in Poland. Materials and methods The records and details of urinary bladder injuries treated between 1995 and 1999 were analysed for 61 urological departments in Poland. Results During the 5‐year period 512 patients had urinary bladder injuries; in 210 (41%) the injury was caused by a road traffic accident, in eight (2%) by compression (crushing injury) within the limits of the pelvic bones, in 40 (8%) by a fall from a height, in three by a gunshot wound and in the remaining 251 (49%) the injury was iatrogenic. Among the 261 bladder injuries that were not iatrogenic, 41 (16%) were associated with pelvic bone trauma. In 36 patients there was simultaneous injury of the urinary bladder and posterior urethra, constituting 14% of such injuries and 7% of all trauma cases. The iatrogenic injuries were in 98 patients (39%) in urological departments, in 130 (52%) women in gynaecological departments and in 23 (9%) on surgical wards. The injury was open in 102 patients (20%) and closed in 372 (73%); there was bladder contusion in 38 patients (7%). The injuries were intraperitoneal in 225 patients (44%) and extraperitoneal in 287 (56%). For diagnosis, abdominal ultrasonography was used in 455 (89%) patients, intravenous pyelography in 266 (52%), cystography in 388 (76%) and computed tomography in 15 (3%). The delay between trauma and diagnosis was 0.5–124 h. Surgical treatment of the injury comprised a monolayer suture of the bladder wall in 51 patients (10%), a two‐layered suture in 461 (90%), perivesical drainage in 468 (91%) and inspection of the peritoneal cavity in 232 (45%). The mean (range) interval between diagnosis and treatment was 14 (7–70) days. Seven patients died after the treatment failed. Conclusions Almost half the patients had iatrogenic injuries, of which over half occurred in gynaecological and maternity wards. Thus it is important teach the basic range of urological operations to trainee doctors. The commonest diagnostic method was not ascending cystography but ultrasonography; we recommend ascending cystography be used with at least two views after filling the urinary bladder with ≈ 300 mL of contrast medium, with an additional film after emptying the contrast medium. In patients with pelvic bone trauma it is reasonable to use spiral computed tomography with virtual analysis before surgery. A two‐layered suture of the bladder wall with perivesical drainage should be used.
Localization of peripheral dopamine D1 and D2 receptors in rat corpus cavernosum
Authors: Hyun J.‐S. , Bivalacqua T.J. , Baig M.R. , Yang D.‐Y. , Leungwattanakij S. , Abdel‐Mageed A. , Kim K.‐D. , Hellstrom W.J.G. 
Published: March 2003

Objective  To detect and locate anatomically peripheral dopamine D1 and D2 receptors in rat cavernosa, as dopamine is important in sexual drive and penile erection through receptors located in the central nervous system. Materials and methods

Corpora cavernosa were obtained from Sprague‐Dawley rats; total RNA and membrane proteins were extracted and cryostat sections prepared. The rat brain hypothalamus was used as a control for dopamine D1 and D2 receptors. The presence and expression of peripheral dopamine D1 and D2 receptor mRNAs in rat corpus cavernosa was assessed using reverse transcription and polymerase chain reaction (RT‐PCR), and Northern blot hybridization using
32
P‐UTP‐labelled RNA probes. Concurrently, corresponding proteins from D1 and D2 receptors were assayed and detected by a Western blotting technique. The anatomical location of dopamine D1 and D2 receptor mRNAs in rat penile tissues was identified by
in situ
hybridization using
35 S‐UTP‐labelled RNA probes in cryostat sections. Immunohistochemical staining was used to locate peripheral dopamine D1 and D2 receptor proteins in rat corpora cavernosa. Results

Dopamine D1 and D2 receptor gene expression was detected in rat corpora cavernosa.
In situ hybridization signals for dopamine D1 and D2 receptor mRNAs were localized to corpus cavernosal tissues and dorsal vessels in the rat penis. Western blot analyses showed peripheral dopamine D1 and D2 receptor proteins in rat corpora cavernosa. Immunohistochemically, peripheral dopamine D1 and D2 receptor proteins were detected in dorsal nerves, dorsal vessels and corpus cavernosal smooth muscle of the rat penile tissues. Conclusions  Peripheral dopamine D1 and D2 receptors are present in the corpora cavernosa of rats. The functional significance of these receptors and signal transduction pathways in modulating the vascular tone of the penis warrants further investigation.
Efficacy of desmopressin in the treatment of nocturia: a double‐blind placebo‐controlled study in men
Authors: Mattiasson A. , Abrams P. , Van Kerrebroeck P. , Walter S. , Weiss J. 
Published: March 2003

Objective To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men. Patients and methods Men aged 18 years with verified nocturia (two voids/night) and nocturnal urine production greater than their maximum functional bladder capacity were recruited. A 3‐week dose‐titration phase established the optimum desmopressin dose (0.1, 0.2 or 0.4 mg). After a 1‐week ‘washout’ period, patients who responded in the dose‐titration period were randomized to receive the optimal dose of desmopressin or placebo in a double‐blind design for 3 weeks. Results In all, 151 patients entered the double‐blind period (86 treated with desmopressin, 65 with placebo). In the desmopressin group 28 (34%) patients and in the placebo group two (3%) patients (P<0.001) had fewer than half the number of nocturnal voids relative to baseline; the mean number of nocturnal voids decreased from 3.0 to 1.7 and from 3.2 to 2.7, respectively, reflecting a mean decrease of 43% and 12% (P<0.001). The mean duration of the first sleep period increased by 59% (from 2.7 to 4.5 h) in the desmopressin group, compared with an increase of 21% (from 2.5 to 2.9 h) in the placebo group (P<0.001). The mean nocturnal diuresis decreased by 36% (from 1.5 to 0.9 mL/min) in the desmopressin group and by 6% (from 1.7 to 1.5 mL/min) in the placebo group (P<0.001). The mean ratio of night/24‐h urine volume decreased by 23% and 1% (P<0.001), and the mean ratio of night/day urine volume decreased by 27% and increased by 3% (P<0.001) for the desmopressin and placebo groups, respectively. In the double‐blind treatment period, similar numbers of patients had adverse events; 15 (17%) patients in the desmopressin and 16 (25%) patients in the placebo group. Most adverse events were mild. Serum sodium levels were <130 mmol/L in 10 (4%) patients and this occurred during dose‐titration. Conclusions Orally administered desmopressin is an effective and well‐tolerated treatment for nocturia in men.
Prognostic significance of nuclear morphometry in renal cell carcinoma
Authors: Özer E. , Yörükoğlu K. , Sagol Ö. , Mungan U. , Demirel D. , Tüzel E. , Kirkali Z. 
Published: March 2003

Objective  To assess nuclear morphometry as a predictor of prognosis in patients with renal cell carcinoma (RCC). Patients and methods  The study included 65 consecutive patients with RCC who underwent radical nephrectomy and were followed up for a median (range) of 80 (27–138) months. Nuclear morphometry was assessed using a computer‐assisted image analysis system on histological sections and characterized by five nuclear variables (area, perimeter, major and minor diameter, and form factor). From the patients' records and pathology specimens, the clinicopathological prognostic variables (histological type, Fuhrman grade and pathological stage) were recorded. The proliferative activity was assessed using immunohistochemical staining with Ki‐67 antibody. Results

Higher values of mean nuclear area, perimeter, and major and minor diameter were significantly related to higher nuclear grade, proliferative activity and advanced tumour stage. They were significant predictors of disease progression and survival, together with grade, stage, sarcomatoid histology and proliferative activity. Of all significant prognostic factors predicting progression‐free survival, only stage was independent (T4 vs T1, hazard ratio 6.55, 95% CI 1.63–26.13,
P =0.008). Conclusion  Although the significance of these preliminary results must not be overstated, nuclear morphometry might provide significant prognostic information in predicting survival and tumours at high risk of progression in RCC.
Clinical experience with a new ultrasonic and LithoClast combination for percutaneous litholapaxy
Authors: Hofmann R. , Olbert P. , Weber J. , Wille S. , Varga Z. 
Published: March 2003

Objective  To assess a new lithotripter for intracorporal lithotripsy, which combines the mechanically driven pneumatic LithoClast™ (Electro‐Medical Systems, Nyon, Switzerland) and a new ultrasonic device (Electro‐Medical Systems), for use in percutaneous nephrolitholapaxy (PNL). Patients and methods  The new lithotripter consists of a LithoClast Master with 12 Hz repetition rate and a new ultrasonic device. The 1.0 mm LithoClast probe is advanced off‐centre through the hollow 3.3 mm ultrasonic probe and protrudes about 1 mm. A new irrigation system with a pinch valve compressing the irrigation tube, a foot‐switch for activating the ultrasound, the LithoClast and both together, and a stone bucket at the outlet tube are new features. Between February 1999 and August 2001, 68 patients were treated by PNL with the new device; 35 had complete and 33 had partial staghorn calculi. PNL was administered under fluoroscopic control and with the patient prone. Results  The mean (range) duration of surgery was 61 (42–119) min. The complete stone‐free rate was 66% after the first PNL; of the 68 patients, 16 received a second PNL, giving a final stone‐free rate of 76% and 80%. The stone was composed of calcium oxalate monohydrate (COM) in 13%, COM with uric acid in 35%, apatite in 20% and cystine in 11%. Clinically the new lithotripter was very effective, producing smaller stone particles and thus fewer residual stone fragments after PNL than with the LithoClast or ultrasonic fragmentation alone. Conclusion  The new lithotripter provides easily managed and highly effective stone fragmentation of all stones, regardless of their composition.
Does smoking status influence the prognosis of bladder cancer? A systematic review
Authors: Aveyard P. , Adab P. , Cheng K.K. , Wallace D.M.A. , Hey K. , Murphy M.F.G. 
Published: March 2003

Objectives To summarize, in a systematic review, the evidence for the effect of stopping smoking on recurrence, cancer‐specific and all cause‐mortality among smokers with newly diagnosed bladder cancer. Materials and methods Two electronic databases and the reference lists of identified primary studies and reviews were searched. Studies were included if a hazard ratio and its confidence intervals could be extracted. A predefined set of study characteristics was extracted which defined whether studies were giving valid prognostic data on the effects of smoking in reasonably homogenous cohorts. The results of studies were synthesized qualitatively. Results Fifteen relevant studies were identified; former and current smokers were combined in many studies. Many studies produced information on prognosis that was confounded by the mixing of incident and prevalent cases. Only three studies examined the influence of smoking on prognosis in only incident cases, most of whom had superficial disease. Of these, only one was of high quality. These three studies and the other 12 showed suggestive evidence that continued smoking or a lifetime of smoking constitutes a moderate risk factor for recurrence and death, and that stopping smoking could favourably change this. However, the evidence base for this is weak because of the methodological shortcomings and because most studies' results were not statistically significant. A life‐table model showed that if stopping smoking altered the prognosis, the size of the benefit would be clinically worthwhile. Conclusions There is suggestive evidence that stopping smoking might favourably alter the course of bladder cancer, but this is insufficient for clinicians to inform patients that doing so will improve their prognosis, and for providing specialized services to assist in stopping smoking to patients with bladder cancer.