bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary incontinence in Northern Ireland: a prevalence study
Authors: Dolan  , Casson  , Mcdonald  , Ashe  
Published: March 2003

ObjectiveTo determine the prevalence of urinary incontinence in a Northern Ireland community drawn from four neighbouring geographical areas and to assess factors predisposing to the development of urinary incontinence.Subjects and methodsA three‐page self‐administered postal questionnaire was sent to 1050 women (age range 35–74 years), recruited randomly from a target population of 43 829 women. The main survey was preceded by a pilot survey. Respondents and those not responding were compared.ResultsThe overall response rate was 65.6% (689/1050); there was no significant difference between respondents and those not responding. Two‐hundred and thirty‐one women (33.5%) reported incontinence ‘sometimes’ and 161 (23.4%) ‘often’. Of those who had urinary incontinence, sanitary protection was required by 21.7% (85/392). This equates to 12.3% (85) of the total study population. Age (χ2=20.34; P<0.001) and parity (Mann–Whitney U‐test, P< 0.001) were associated with urinary incontinence, with a higher proportion of women aged 45–54 years having urinary incontinence. The menopause and postnatal pelvic floor exercises were not associated with urinary incontinence. Overall 19.9% (78/392) of women with urinary incontinence had consulted their general practitioner. Of those who required sanitary protection, 40% (34/85) had consulted their doctor.ConclusionUrinary incontinence is common; it is sufficiently severe to require sanitary protection in 12% of women aged 35–74 years in a Northern Ireland community.
The changing distribution of stage in nonseminomatous testicular germ cell tumours, from 1977 to 1996
Authors: Sonneveld  , Hoekstra  , Van Der Graaf  , Sluiter  , Schraffordt Koops  , Sleijfer D.tH. 
Published: March 2003

ObjectiveTo determine the changes between 1977 and 1996 in the distribution of stages of testicular cancer (TC).Patients and methodsThe stage distribution was assessed, using various classifications, i.e. the Royal Marsden (RM), Indiana, European Organization for Research and Treatment of Cancer (EORTC), International Germ Cell Cancer Collaborative Group (IGCCCG) and the Medical Research Council (MRC), in 517 patients with nonseminomatous testicular germ cell tumours (NSTGCTs) diagnosed at a single institution between 1977 and 1996.ResultsThe number of patients in four consecutive 5‐year periods (1977–81, 1982–86, 1987–91, 1992–96) was 119, 141, 141, and 116, respectively. Frequency analyses showed a significant increase of RM stage I, in proportion to stage II–IV, in 1982–86 (55%, odds ratio, OR, 2.54), 1987–91 (53%, OR 2.33) and 1992–96 (61%, OR 3.24) compared to the period 1977–81 (33%). A separate analysis of patients with disseminated disease showed a proportionate significant decrease of RM stage II in 1992–96 (29%, OR 0.43) compared with 1977–81 (49%). There was also a relative decrease of good‐prognosis patients with disseminated disease in 1992–96 compared with 1977–81, using analyses of the Indiana (from 56% to 33%, OR 0.39) and EORTC classification (from 78% to 56%, OR 0.36). Analyses of the IGCCCG and MRC classification showed a significant decrease of good‐prognosis patients in the 1982–86 compared with the first 5‐year period (for IGCCCG, from 54% to 35%, OR 0.46, and for MRC, from 43% to 24%, OR 0.42).ConclusionThe stage distribution of NSTGCT over the past two decades has changed. The proportion of stage I patients has increased since the early 1980s, apparently resulting from a shift of low‐extent disseminated disease to stage I disease. This finding is relevant in reducing the treatment required in a higher proportion of patients and the subsequent reduction of long‐term risk from treatment.
The effects of human urine on the adhesion of calcium oxalate crystal to Madin–Darby canine kidney cells
Authors: Ebisuno  , Umehara  , Kohjimoto  , Ohkawa  
Published: March 2003

ObjectiveTo determine the effect of human urine on the adhesion of calcium oxalate monohydrate (COM) crystals to Madin–Darby canine kidney (MDCK) cells in a model system in vitro.Materials and methodsMDCK cells were exposed to COM crystals in the presence of various human urine samples. COM crystals adhering on MDCK cells were quantified by measuring the calcium concentration using atomic absorption analysis. The inhibitory activities were estimated individually for various urine samples from healthy subjects and recurrent stone formers.ResultsHuman urine inhibited the adhesion of COM crystals to MDCK cells, with some variations between individual samples. The most potent inhibition of crystal adhesion was expressed by the macromolecular fraction of the urine. Pretreatment of crystals with human urine before exposure to the cells significantly reduced crystal adhesion, suggesting that human urine altered the properties of the crystal surface but not the cell surface.ConclusionCoating of the crystals by some component(s) of human urine might be an important physiological event in preventing adhesion or retention of crystals in the renal tubules. Although the mechanisms by which crystal adhesion is prevented are unknown, a low potential for inhibiting adhesion may be a risk factor in stone formation because it permits crystal adhesion and retention in the tubules.
Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones
Authors: Menezes  , Dickinson  , Timoney  
Published: March 2003

ObjectiveTo report our experience of using flexible ureterorenoscopy for upper urinary tract stones.Patients and methodsThirty‐seven patients (13 females, 24 males, mean age 48 years, range 10–76) with upper urinary tract stones not responding to other treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragments.ResultsTwenty‐three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ureteric stones, 14 were rendered stone‐free at the end of the procedure and 14 of the 22 patients with kidney stones were treated successfully; 80% of the lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no major complications.ConclusionFlexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be reserved for such cases.
A population‐based study of clinical and pathological prognostic characteristics of men with familial and
Authors: Norrish  , Mcrae  , Cohen  , Jackson  
Published: March 2003

ObjectivesTo compare traditional prognostic characteristics of familial vs sporadic prostate cancers and to investigate potential detection biases arising from differences in the use of screening and investigative procedures.Patients and methodsFamilial and sporadic cancers were identified in a population‐based sample of incident prostate cancers (total 318) in Auckland, New Zealand. To examine the potential for detection biases in these comparisons, the sociodemographic and clinical characteristics were determined according to family history status for a sample of 959 patients newly referred to Auckland urology clinics by general practitioners for the investigation of prostate‐related conditions.ResultsCompared with sporadic prostate cancers, familial cancers were more likely to be diagnosed in patients at a younger age (P=0.05), after asymptomatic serum prostate‐specific antigen (PSA) screening (P=0.02), and to include a lower proportion with extraprostatic disease (P=0.009) and serum PSA levels before diagnosis of >20 ng/mL (P=0.04). This was consistent with the observed trend for patients referred to urology clinics with a positive family history to be of higher socio‐economic and educational status and to more frequently undergo screening and biopsy investigation.ConclusionFamilial prostate cancers appeared to be diagnosed at an earlier stage of disease progression in this study population, possibly as the result of the higher socio‐economic status and greater use of screening and investigative procedures amongst patients reporting a positive family history. These features reduce the validity of cross‐sectional comparisons of prognostic variables for familial vs sporadic prostate cancer and emphasize the need for further longitudinal prognostic studies.
The role of fine‐needle aspiration cytology of the testis in the diagnostic evaluation of infertility
Authors: Mahajan  , Imdad Ali  , Walwalkar  , Rege  , Pathak  
Published: March 2003

ObjectiveTo compare the diagnostic value of cytological smears of fine‐needle aspirate with that of histological sections obtained by testicular biopsy in the evaluation of infertility.Patients and methodsThe study included 60 patients with azoospermia or severe oligospermia (sperm counts of < 5 million/mL). A detailed history was taken and the external genitalia examined. Testicular samples were obtained by fine‐needle aspiration using a 10 mL syringe and 21 G needle; the air‐dried smears were stained using the May–Grunwald–Giemsa method. A testicular biopsy was taken after exploring the same tract and these sections were stained with haematoxylin and eosin. The cytological smears and histological sections were examined separately and the results compared.ResultsThe cytological smears were divided into three groups: normal, with all spermatogenic cells present; Sertoli‐cell only syndrome; and spermatogenic arrest (all spermatogenic cells present except spermatids and spermatozoa). There was a good correlation between the diagnosis on the cytological smears and histological sections in 58 of 60 patients (97%). In two patients there was scanty aspirate and few cells, giving an inaccurate diagnosis. Interstitial cells were not detected on cytological smears. In three patients, Sertoli‐cell only was diagnosed on cytology, and histology revealed additional features of Leydig cell hyperplasia.ConclusionFine‐needle aspiration of the testis is a simple and minimally invasive technique for diagnostic evaluation, especially in patients with obstructive azoospermia. Patients with abnormal findings on fine‐needle aspiration cytology may be evaluated histologically by further biopsy.
Lithogenic risk factors in normal black volunteers, and black and white recurrent stone formers
Authors: Whalley  , Martins  , Van Dyk  , Meyers  
Published: March 2003

ObjectiveTo compare lithogenic risk factors in normal black volunteer men (BN), male black stone formers (BSF) and male white recurrent stone formers (WSF); in addition, the differential diagnoses in the stone formers were compared to determine if the causes of renal stones differed in the two groups.Subjects and methodsThe study included 22 BN, 22 consecutive BSF and 122 consecutive WSF seen over a 10‐year period. Each subject was assessed by a thorough medical history, dietary analysis and a full serum and urinary biochemical evaluation.ResultsAlthough the WSF were significantly more overweight (P<0.001) and obese (P<0.001) than the BSF, neither group had values significantly different from those of their respective normal populations. There was no significant difference in serum levels of Ca, phosphorus, ionised Ca, calcitriol and alkaline phosphatase in BSF and WSF, but levels of parathyroid hormone tended to be (P<0.1) and calcitriol was significantly higher in BSF than WSF (P<0.03). The BSF urinary excretion levels tended to be more like that of the WSF, with the following pattern present; BN<BSF<WSF, except for citrate, where BSF< BN<WSF. No dietary or metabolic abnormality was found in 9% of BSF and 5% of WSF. Pure dietary lithogenic risk factors were present in 9% of BSF and 21% of WSF. The prevalence of metabolic risk factors was similar in the two groups but the distribution differed. Renal hypercalciuria, absorptive hypercalciuria and mild metabolic hyperoxaluria were 2.5–3 times more prevalent in the WSF.ConclusionAlthough the urine of BSF tends to be more like that of WSF, the lithogenic risk factors present differed and were less severe. The increase in urinary calcium excretion, coupled with a lower citrate excretion, may be the most important reason for stone formation in the black population. An increased protein intake may also play a role. In this small group of BSF there was no family history of urolithiasis, supporting the view that there may be a more prominent genetic influence in WSF.
Follow‐up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy
Authors: Ljungberg  , Alamdari  , Rasmuson  , Roos  
Published: March 2003

ObjectiveTo define guidelines for the follow‐up management of nonmetastatic renal cell carcinoma (RCC), by assessing tumour recurrences and the clinical course in patients who had undergone radical nephrectomy.Patients and methodsThe records of 187 patients with pT1–3, N0–X, M0 RCC who underwent radical nephrectomy between 1982 and 1997 were reviewed prospectively. Clinicopathological variables were compared with the time of first recurrence, site of metastasis and reason for diagnosis.ResultsMetastases were diagnosed in 98 sites in 56 of the 187 patients (30%). The risk for developing metastases increased with stage; 80% of the patients had their metastases diagnosed within 3 years (median 14.5 months) after nephrectomy. The time to first diagnosis was longer for patients with pT1 tumours and for those with skeletal metastases. The cause‐specific 5‐year survival rate for pT1 tumours was 95%, for pT2 87% and for pT3 tumours 37%. All patients with diploid pT1–2 RCC survived, having a survival advantage over those with aneuploid pT1–2 tumours (P=0.018). Also, pT1–2 tumours of < 5 cm were associated with better survival rates. Among 74 patients with pT3 tumours, 45 got metastases; DNA ploidy in these tumours did not influence survival. Of 30 patients with lung metastases, 28 were diagnosed during follow‐up, while 25 of 26 other metastatic sites were diagnosed because of symptoms.ConclusionsThe risk for tumour progression depends mainly on stage; these results indicate no need for follow‐up in patients with diploid pT1–2 tumours or with aneuploid pT1 tumours of < 5 cm. For patients with aneuploid pT1–2 tumours of > 5 cm and pT3 tumours, follow‐up is indicated.
Failure of allograft suburethral slings
Authors: Fitzgerald  , Mollenhauer  , Brubaker  
Published: March 2003

Objectives To report our experience of using freeze‐dried irradiated fascia lata allografts for suburethral sling procedures.Patients and methods Between December 1996 and September 1998, 35 patients (mean age 60.25 years, range 37–79) underwent suburethral sling placement with fascia allograft. These patients were reviewed, with the findings at the time of any surgical re‐exploration. Eleven (31%) had undergone prior surgery for genuine stress incontinence and 32 (91%) had a preoperative diagnosis of intrinsic sphincter deficiency.Results On re‐operation for persistent or recurrent stress incontinence, the allograft was present but grossly degenerated in two (6%) patients and completely absent in five (14%) patients. Histology of a retrieved graft fragment showed both fibroblast proliferation and degeneration within the graft.Conclusion The use of freeze‐dried, irradiated fascia lata for suburethral sling procedures was associated with a material failure rate of ≥20%. We caution against its use in this setting.
Transurethral resection or incision of the prostate and other therapies: a survey of treatments for benign prostatic obstruction in the UK
Authors: Yang  , Abrams  , Donovan  , Mulligan  , Williams  
Published: March 2003

Objective To establish the current usage of transurethral incision of the prostate (TUIP) and other forms of treatment for benign prostatic obstruction (BPO).Methods The Prostate Trial Office (PROTO) sent a survey questionnaire to all 376 consultant urologists in the UK which asked for estimates of their clinical practice in treating BPO. The survey had three principle aims: to assess the role that the determination of prostate size has in clinical practice, to determine the nature and frequency of use of a range of therapies including TUIP, and to examine the feasibility of conducting a randomized controlled trial comparing transurethral resection of the prostate (TURP) and TUIP.Results Of the 376 urologists, 349 replied (response rate 93%); most respondents used prostate size as a determinant when deciding on therapy for BPO (60%). Of their patients with BPO who were treated, 38% received surgical treatment, 33% drug therapies and 29% conservative management. Of the types of surgical treatment, the most commonly used procedure was TURP, in 79% of patients, with only 15% undergoing TUIP. When compared with TURP, TUIP tended to be used for patients with a mean prostate volume of ≤25 mL. Only 6% of surgical patients were treated using minimally invasive techniques.Conclusion This survey provides some evidence that prostate size plays an important role in determining the treatment; TUIP appeared to be under‐used and other minimally invasive techniques are rarely used in the UK.
Efficacy and limitations of delayed/salvage radiation therapy after radical prostatectomy
Authors: Egawa  , Ohori  , Iwamura  , Kuwao  , Baba  
Published: March 2003

Objective To assess the kinetics of prostate specific antigen (PSA) and the degree of PSA suppression, to better understand the efficacy and limitations of delayed/salvage radiation therapy after radical prostatectomy.Patients and methods The PSA doubling time was calculated in patients with biochemical failure after radical prostatectomy and in those who underwent delayed/salvage radiation therapy. Patients in whom PSA was undetectable by conventional assay after irradiation were followed using a hypersensitive PSA assay.Results Of 125 patients who underwent radical prostatectomy for clinically resectable prostate cancer, 47 developed biochemical failure at a mean of 11.8 months after surgery; 38 of these patients underwent radiotherapy (36 for isolated biochemical failure and two for local progression with elevated PSA levels). The mean (sd) PSA doubling time after surgery was 14.6 (16.2) months (n=44) and after radiation therapy it was 13.3 (23.9) months (n=32). Eleven of 30 evaluable patients (37%) had a sustained PSA suppression lasting at least 12 months after radiotherapy. Only the time to biochemical failure after surgery approached statistical significance for predicting a durable response to radiotherapy (P=0.08). The mean nadir value of PSA in the 11 patients with at least 12 months of sustained PSA suppression was 0.032 ng/mL at 26.9 months.Conclusions The rapidity with which PSA levels double after surgery may provide a clinically significant indication of the nature of these recurrent tumours, which deserve the best possible attempt at cure. Slow‐growing tumours with longer PSA doubling times may be better candidates for delayed/salvage radiation therapy. Larger studies involving more patients are needed to determine whether the PSA doubling time can define subgroups for which specific treatment strategies should be developed.
Evaluation of ureteric contraction: a comparison among ring, spiral‐cut and longitudinal segments
Authors: Jerde T.J. , Saban R. , Nakada S.Y. 
Published: March 2003

ObjectiveTo determine the optimal contractile response of isolated ureters to inflammatory mediators and neurotransmitters by evaluating four common methods of ureteric suspension.Materials and methodsUreters from adult domestic swine were placed immediately in Krebs buffer and cut into 4–5 mm segments. Four methods of suspension were compared: (i) an unopened ring segment suspended horizontally; (ii) a spirally cut segment (lumen cut open at a 45° and suspended end‐to‐end); (iii) an open longitudinal segment; and (iv) a closed longitudinal segment. All segments were placed in individual water‐jacketed tissue baths containing Krebs buffer, the frequency of contraction measured using a force transducer and registered on a polygraph. The sensitivity of all four segments was tested by measuring the tension and frequency in response to increasing frequencies of electric field stimulation, and by a cumulative concentration–response curve to carbachol.ResultsUreteric segments responded with an increased frequency of contraction depending on the intensity of stimulus to both electric field stimulation and carbachol. However, there were no significant differences in spontaneous levels of contraction, sensitivity or maximal response among the methods of suspension in response to electric field stimulation or carbachol.ConclusionThese results indicate that all four methods of suspending the ureteric segments produce contractile responses sensitive enough to study the action of various neurotransmitters.
A modified corporoplasty for treating congenital penile curvature and reducing the incidence of palpable indurations
Authors: Popken G. , Wetterauer U. , Schultze‐Seemann W. , Deckart A.B. , Sommerkamp H. 
Published: March 2003

ObjectiveTo reduce the incidence of postoperative palpable induration after treating congenital penile curvature, using a modified corporoplasty technique.Patients and methodsIn a retrospective unrandomized clinical trial, 105 patients with a congenital penile angulation of >30° and for whom coitus was therefore difficult or impossible, underwent surgical correction. Of the 105 patients, 55 underwent the Nesbit–Kelâmi technique, whereby a diamond‐shaped section of the tunica albuginea is excised and the defect closed with an interrupted suture. The remaining 50 patients underwent the modified corporoplasty, the edges of the tunica albuginea being brought together with a continuous, blood‐tight, intratunical suture, and the end knots buried.ResultsThe early results (<6 months) were comparable in both groups, with correction of the curvature in 94% and 95%, and postoperative complications in 14% and 15%. There were fewer postoperative haematomas in those undergoing modified corporoplasty (6% vs 18%). The late results (>6 months) also showed that these patients developed fewer palpable indurations (16% vs 44%).ConclusionThe modified corporoplasty reduced the incidence of postoperative haematoma and late complications (e.g. palpable indurations) after the surgical correction of congenital penile curvature.