bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical sperm retrieval after previous vasectomy and failed reversal: clinical implications for in vitro fertilization
Authors: Wood S. , Vang E. , Troup S. , Kingsland C.R. , Lewis‐Jones D.I. 
Published: March 2003

Objective To investigate the effect of the interval between previous vasectomy reversal on retrieval rates of epididymal and testicular spermatozoa using percutaneous epididymal sperm aspiration (PESA), or testicular sperm extraction (TESE), and the subsequent reproductive potential of these gametes in intracytoplasmic sperm injection (ICSI) cycles. Patients and methods Sixty‐six consecutive sperm retrievals were considered in patients who were azoospermic after previous vasectomy, of whom 54 had had a previous failed reversal, the remainder deciding against a reversal. PESA and TESE retrieval rates were noted, as were the time since vasectomy and the interval between vasectomy and unsuccessful reversal. The presence of palpable epididymal cysts was noted, with their effect on sperm retrieval rates. Fertilization and pregnancy rates were analysed in subsequent ICSI cycles using freshly retrieved spermatozoa or frozen‐thawed cryopreserved spermatozoa. Results All 66 patients had sperm retrieved successfully; the success rates for PESA were not significantly affected by previous failed reversal when compared with patients who had not had a reversal, at 14 of 54 (26%) vs five of 12 (P=0.3). The interval since vasectomy did not affect PESA retrieval rates but there was a significantly poorer retrieval rate for PESA in the presence of palpable epididymal cysts, at seven of 35 (20%) vs 12 of 23 (52%) (P=0.012). Fertilization rates were significantly lower using cryopreserved spermatozoa retrieved from either the epididymis or testis (50% vs 70%, P=0.007), although subsequent implantation and pregnancy rates were not significantly different. Conclusions Surgical sperm retrieval is successful in all cases of azoospermia secondary to vasectomy, either by PESA or TESE. There are no clinical markers to indicate which patients will have successful PESA after vasectomy, although the presence of epididymal cysts is associated with significantly lower retrieval rates. The reduction in fertilising ability of cryopreserved spermatozoa does not affect clinical pregnancy rates in ICSI cycles.
Is ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative study
Authors: Chapple A. , Ziebland S. , Herxheimer A. , Mcpherson A. , Shepperd S. , Miller R. 
Published: March 2003

Objective To understand what leads men to choose ‘watchful waiting’ rather than active treatment for cancer of the prostate. Patients and methods Fifty men with confirmed prostate cancer in England, Wales and Scotland were interviewed about all aspects of their illness, for a Database of Individual Patients' Experience of illness. The sample included men at different stages of diagnosis and with experience of a wide range of treatments. We report here only what men said about their choice of treatment and the decision‐making process. Results Watchful waiting would have been clinically inappropriate for almost half of the men (those with serious urinary symptoms and those with metastatic disease). However, few of the men who might have chosen watchful‐waiting remembered this being presented as a serious option. Most in this group chose radical prostatectomy, radiotherapy, brachytherapy or cryosurgery. The few who chose watchful waiting had found doctors who supported their decision, had assessed the evidence from Internet sites, and were concerned about the side‐effects and uncertain outcome of treatment. Men who chose watchful waiting, as well as those who opted for treatment, described considerable pressure from family members, doctors or support groups, to seek active treatment. Conclusion This study helps to explain why some men will not contemplate watchful waiting, and why others may find it difficult to pursue that option. Understanding men's concerns may help clinicians to support men's treatment decisions. Treatment for prostate cancer is highly controversial because no randomized, controlled trials have shown whether or not active intervention increases survival. If trials are not completed it cannot be determined whether active treatments are the best course of action for men with prostate cancer.
Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control
Authors: Bakker E. , Van Gool J.D. , Van Sprundel M. , Van der Auwera C. , Wyndaele J.J. 
Published: March 2003

Objective To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control.Subjects and methods A questionnaire with 41 questions was distributed to 4332 parents of children completing the last 2 years of normal primary school. The questionnaire had been tested for reproducibility of the answers in a random subgroup of 80 parents. The aims of the investigation were explained in an accompanying letter and the response rate was 76.7%. The result were analysed using the chi‐square test (Yates corrected).Results Two groups of children were identified, one with no lower urinary tract symptoms (3404) and one with complaints of daytime and night‐time wetting, and urinary tract infections (928). The groups were termed the ‘control’ and ‘symptom’ groups, respectively. There were no differences in the family situation between the groups. The symptom group reported more ‘below average’ school results and less independence in homework and hygiene. The age at which toilet training started was significantly higher in the symptom group and scheduled voiding was used significantly less. The reaction of the parents when the attempt at voiding was unsuccessful was significantly different; in the control group most parents just postponed the effort and had the child try again later, whereas in the symptom group more parents asked the child to push, made special noises or opened the water tap.Conclusions These data show significant differences in toilet training between children with and with no lasting problems of bladder control. Postponing the onset of the training after 18 months of age and using certain methods to provoke voiding (asking to push, opening the water tap) probably increases the risk of later problems with bladder control.
Prosthetic replacement of the inferior vena cava and the iliofemoral vein for urologically related malignancies
Authors: Caldarelli G. , Minervini A. , Guerra M. , Bonari G. , Caldarelli C. , Minervini R. 
Published: March 2003

Objective  To evaluate the feasibility and results of prosthetic venous replacement, as inferior vena cava (IVC) and iliofemoral vein resection and replacement are sometimes necessary when they are extensively involved by a large and fixed tumour thrombus from renal cell carcinoma (RCC) or other urological malignancies. Patients and methods  Five men and two women (age range 41–75 years) were treated over a 10‐year period (1991–2001) by aggressive venous surgery to achieve complete tumour resection, with prosthetic graft replacement to re‐establish venous flow. The tumours included RCC of the right kidney (two), retroperitoneal liposarcoma (two), bladder cancer (one), retroperitoneal fibrosarcoma (one) and inguino‐pelvic lymphoma (one). Two patients had a vena caval replacement, of whom one had a circular reinforced PTFE and one a Dacron silver graft; five patients had either an iliofemoral or an ilio‐iliac circular reinforced PTFE graft. The prosthetic diameter was 18–20 mm for the IVC grafts and 8–10 mm for the iliac grafts. In all the patients, graft patency was evaluated during the follow‐up by colour flow duplex imaging, and in one it was determined by angio‐computed tomography scan and venography. Results  One patient died 30 days after surgery; of the remaining six patients one had no evidence of regional recurrence or metastatic disease at 12 months, and five died from recurrent tumour 8–30 months after surgery. The mean time to death was 23 months. At 3 months all six prosthesis were patent; at 6 months four were patent and at 12 months three of five prostheses were patent. Conclusion  Resecting and replacing the IVC allows complete tumour resection and avoids renal failure, providing durable relief from the symptoms of venous obstruction. Iliofemoral prosthetic reconstruction for urological‐related malignancies represents a viable option to avoid venous engorgement and lower extremity swelling, at least in the early postoperative period. The mean time to death for the present patients must be considered the limit for these aggressive operations.
Hand‐assisted laparoscopic nephrectomy: complications related to the hand‐port site
Authors: Okeke A.A. , Timoney A.G. , Keeley F.X. 
Published: March 2003

Objective  To evaluate the early results of hand‐assisted radical nephrectomy and nephroureterectomy in our institution. Patients and methods  The records of 13 patients with malignant disease of the kidney who underwent hand‐assisted laparoscopic radical nephrectomy and nephroureterectomy were reviewed retrospectively. Clinical outcomes were compared with a series of 16 patients who underwent similar procedures via a standard laparoscopic approach. Results  There were three major hand‐port wound complications in those who underwent hand‐assisted procedures, while one other patient required conversion because of technical failure of the device. The operative duration, length of hospital stay, estimated blood loss, transfusion rate, analgesic requirement, conversion rates, and minor complications were similar between the hand‐assisted and standard laparoscopy groups. Conclusion  There was little difference between hand‐assisted and standard laparoscopy in operative duration or recovery, but there were problems with wound complications which may be related to the hand‐assisted approach. We have consequently abandoned the technique in favour of a standard laparoscopic approach.
Sexual function after using tension‐free vaginal tape for the surgical treatment of genuine stress incontinence
Authors: Maaita M. , Bhaumik J. , Davies A.E. 
Published: March 2003

Objective  To determine whether the use of the tension‐free vaginal polypropylene tape (TVT) procedure for the treatment of genuine stress incontinence (GSI) affects sexual activity. Patients and methods  Sixty‐seven women treated by insertion of a TVT between September 1998 and March 2001 for GSI were sent questionnaires 6–36 months after surgery to determine any urinary symptoms, sexual activity, patient satisfaction and the use of hormone‐replacement therapy. Results  The questionnaire was returned by 57 patients (87%); 43 (76%) reported being sexually active and 14 (25%) were not. Of the former, 31 (72%) reported no change in sexual function after surgery and only two reported an improvement; six (14%) reported that sexual function was worse and four did not reply to the questions. The patients reporting that sexual function was worse cited loss of libido as the main reason. No patients complained of dyspareunia. Conclusions  There was no significant change in sexual function or activity after the TVT procedure and patients can thus be reassured that this operation will not affect their sex life.
An experimental study of self‐expanding ureteric metallic stents: macroscopic and microscopic changes in the canine ureter
Authors: Nishino S. , Goya N. , Ishikawa N. , Tomizawa Y. , Toma H. 
Published: March 2003

Objective  To evaluate the efficacy and safety of self‐expanding metallic stents after insertion into the canine ureter.Materials and methods  Actively expanding metallic (Nitinol) stents (diameter 8–10 mm, length 4–6 cm) were placed in eight mongrel dogs (18–34 kg). Under general anaesthesia, a midline abdominal incision was made and a stent inserted directly into the ureter through a small incision; each animal was stented on one side. The dogs were assessed after 6 or 19 days or 2, 5 (two), 6 (two) and 7 months. Ureteric specimens were evaluated both macroscopically and microscopically.Results  Macroscopically there was no leakage of urine in any of the animals. On day 6 the inserted stent was patent despite blood clots in the mesh. The lumen was smooth and shiny in three dogs examined at 5, 6 and 7 months. One of the two dogs assessed at both 5 and 6 months had hydronephrosis associated with papillary hyper‐epithelialization inside the stent, while the other animals had no dilatation of the renal pelvis. Microscopically there was loss of epithelium and bleeding of the ureteric wall at 6 days. Epithelial regeneration started after 19 days and was complete in the lumen at 2 months, with the stent incorporated into the wall of the ureter. Epithelialization was maintained up to 7 months, after which the problem of urothelial hyperplasia persisted, but an adequate lumen was maintained by epithelial regeneration. This epithelium was smooth and shiny, and composed of thin layers of cells.Conclusion  Self‐expanding metallic stents may be effective if hyperplastic epithelialization does not occur, as the stent was epithelialized within 2 months and the regenerated epithelium maintained for up to 7 months. Metallic stents may be useful for treating patients with renal failure caused by ureteric stenosis from malignant tumours.
Changes in molecular forms of prostate‐specific antigen during treatment with finasteride
Authors: España F. , Martínez M. , Royo M. , Estellés A. , Alapont J.M. , Navarro S. , Aznar J. , Jiménez‐Cruz J.F. 
Published: March 2003

Objective  To study the influence of finasteride treatment on the molecular forms of prostate‐specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH).Patients and methods  Total PSA, free PSA and PSA complexed to α1‐antichymotrypsin (PSA‐α1ACT) were measured in plasma and serum from 40 men with BPH and a total PSA of < 20 ng/mL, using in‐house and commercial immunoassays, before and during treatment with finasteride (30 men) or placebo (10 men).Results  The baseline values were not significantly different between the groups, with mean (sd) total plasma PSA levels of 3.6 (4.3) and 4.8 (5.9) ng/mL in the finasteride and placebo groups, respectively. Finasteride, but not placebo, induced a significant reduction in total PSA, free PSA and PSA‐α1ACT levels in plasma and serum (P < 0.001). However, complexed‐to‐total (c/t) and free‐to‐total (f/t) PSA ratios remained constant in both groups, both in plasma and serum, during the follow‐up.Conclusion  The decrease in total PSA after finasteride treatment results from a proportional reduction in its two major molecular forms, free PSA and PSA‐α1ACT, which explains why the c/t and f/tPSA ratios do not change significantly despite treatment. This suggests that routine analysis of molecular forms of PSA could improve the utility of the change in total PSA associated with finasteride for the early diagnosis of prostate cancer. It also suggests that any subsequent change in both ratios, particularly an increase in c/tPSA or a decrease in f/tPSA ratio, could be considered an early sign of neoplastic degeneration rather than a therapeutic consequence.
Flexible ureteroscopes: a user's guide
Authors: Parkin J. , Keeley F.X. , Timoney A.G. 
Published: March 2003

Objective  To compare, quantitatively and qualitatively, four small‐diameter flexible ureteroscopes.Materials and methods  Four flexible ureteroscopes from different manufacturers, i.e. the DUR‐8 (ACMI, Southborough, MA, USA), Olympus UPF‐3 (Keymed, Southend‐on‐Sea, UK), Storz 11274AA (Karl Storz GmbH, Tuttlingen, Germany) and the Wolf 9 F (Henke Sass Wolf GmbH, Tuttlingen, Germany), were assessed quantitatively by measuring the active tip deflection and irrigation flow rate with laser fibres (200 µm, 365 µm), an electrohydraulic lithotripter (1.9 F) and grasping forceps (3 F) in position. They were then assessed subjectively by two endourologists who scored them, using a visual analogue scale (maximum 10), for insertion, deflection mechanism, manoeuvrability, rigidity, image quality and overall satisfaction.Results  All the endoscopes are < 9 F at the tip, although the length of the smallest diameter (bevelled tip vs section of shaft) was variable. Tip deflection was 87–100% of the manufacturers’ specifications and decreased by similar percentages with instruments in the working channel. The irrigation flow rate was comparable for instruments with a 3.6 F working channel (72–88 mL/min with an empty working channel), although much greater for the Wolf, which has a 4 F channel (116 mL/min). Direction and image size were nearly identical, as was the field of view, apart from the Wolf (60° vs 90°). There was agreement in the user assessment for three instruments, with overall satisfaction scores being Storz (4), ACMI (7.5) and Olympus (8.6), but disagreement in scores for Wolf (1.9 vs 5.3).Conclusions  Whilst there were considerable similarities in the objective assessment among the instruments, the user assessment showed qualitative variability. Thus it is important to try the different instruments before selecting one. Additional variables to consider include durability, cost and service/warranty, which vary considerably among instruments.
Thymidine phosphorylase levels as a prognostic factor in renal cell carcinoma
Authors: Wada S. , Yoshimura R. , Naganuma T. , Yoshida N. , Narita K. , Ikemoto S. 
Published: March 2003

OBJECTIVETo investigate the relationship between thymidine phosphorylase (TP), a vascular growth factor, and established prognostic factors for renal cell carcinoma (RCC), e.g. histological grade or Tumour‐Node‐Metastasis (TNM) classification.PATIENTS AND METHODSTP levels were measured in RCC tissue (tumour TP) and in adjacent non‐neoplastic kidney tissue (normal tissue TP), using a sandwich‐type enzyme‐linked immunosorbent assay. The 59 patients, diagnosed with organ‐confined RCC before surgery and who had undergone radical nephrectomy, were divided into two groups according to their prognosis after surgery. Group 1 (nine patients) had a poor prognosis and group 2 (50) had no evidence of disease within a 65‐month follow‐up. The relationships among TP level, TNM classification, histological subtypes, V factor and prognosis, and of tumour TP to normal tissue TP levels were investigated. Multiple regression analysis was used to determine the importance of factors associated with increased TP levels.RESULTSNormal tissue TP levels correlated with histological grade (r = 0.31, P < 0.01); in patients with venous invasion or with a poor prognosis, the levels were significantly higher than in those without (P < 0.05 and < 0.001, respectively). The normal tissue TP levels were also significantly higher in the non‐clear cell than in the clear cell subtype. Multiple regression analysis showed that the independent factor associated with elevated normal tissue TP levels was histological grade (R2 = 0.189, P < 0.01). There was no correlation between tumour TP and other factors.CONCLUSIONNormal tissue TP levels in localized hypervascular RCC were associated with histological grade. These data suggest that normal tissue TP levels could be a prognostic factor.
RhoA is associated with invasion and lymph node metastasis in upper urinary tract cancer
Authors: Kamai T. , Kawakami S. , Koga F. , Arai G. , Takagi K. , Arai K. , Tsujii T. , Yoshida K‐I. 
Published: March 2003

OBJECTIVETo assess the roles of RhoA small GTPase (RhoA) in upper urinary tract cancer by analysing the mRNA and protein levels of RhoA.PATIENTS AND METHODSThe mRNA and protein levels of RhoA in matched sets of tumour, non‐tumour and metastatic lymph node tissues of surgical specimens were analysed in 47 consecutive patients with renal pelvic/ureteric cancer, using the polymerase chain reaction after reverse transcription and Western blotting. The relationship between mRNA and protein levels of RhoA in tumour tissues and the clinicopathological features of the patients was also assessed.RESULTSThe mRNA levels of RhoA and RhoA protein were greater in tumour and metastatic lymph node tissues than in non‐tumour tissues (all P < 0.001). The expression levels of RhoA mRNA and protein levels in primary tumours was related to poorly differentiated grade (both P < 0.05) and muscle invasion (P < 0.01 and < 0.001, respectively). Kaplan‐Meier plots of survival in patients with low or high RhoA showed that high mRNA and protein levels were associated with a shorter disease‐free (P < 0.01) and overall survival (P < 0.001). Multivariate analysis using the Cox proportional hazards model showed that a high RhoA protein level was an independent prognostic factor, second to stage, in disease‐free and overall survival (both P < 0.05).CONCLUSIONSThese findings suggest that RhoA is involved in the invasion and metastasis of upper urinary tract cancer, indicating that RhoA may be a useful prognostic factor in this disease.
Serum leptin levels in patients with premature ejaculation before and after citalopram treatment
Authors: Atmaca M. , Kuloglu M. , Tezcan E. , Ustundag B. , Semercioz A. 
Published: March 2003

OBJECTIVETo evaluate serum leptin levels (an adipocyte hormone involved in the suppression of appetite) in patients with premature ejaculation before and after treatment with citalopram, a selective serotonin reuptake inhibitor, with the hypothesis that leptin levels might become normal during this treatment.PATIENTS AND METHODSThe inhibitory effect of serotonin on libido, ejaculation and orgasm is well documented. Although there is no direct evidence of an association involving brain pathways which are related to sexual behaviour, there is an interaction between leptinergic and serotonergic systems. In a previous study serum leptin levels were high in patients with premature ejaculation. The present study comprised 30 patients with premature ejaculation according to the Diagnostic and Statistical Manual of Mental Disorders Third Revised Version. Fifteen patients (group I) were randomly assigned to 8 weeks of citalopram treatment and the remainder (15, group II) received no therapy. The patients were asked to determine the average intravaginal ejaculation latency time, and their fasting serum leptin levels were measured at baseline and after 8 weeks.RESULTSThere was no significant difference in the mean intravaginal ejaculation latency time between the groups at baseline; it increased after 8 weeks of treatment with citalopram in group I, to a mean (sd) of 209 (72.1) s, but not in group II. No difference was detected in leptin levels between the groups at baseline, but at 8 weeks they were lower in group I.CONCLUSIONAs hypothesized, leptin levels decreased in patients with premature ejaculation after treatment with citalopram, and this decrease seemed to be linked to the therapeutic effect. Further experimental studies are needed.
Screening practices for gestational diabetes mellitus in UK obstetric units
Authors: Mires G. J. , Williams F. L. R. , Harper V. 
Published: March 2003

Summary Aim To identify current screening practices for gestational diabetes mellitus (GDM) in all maternity units. Methods A questionnaire was sent to the senior obstetrician of all obstetric units known to the UK Royal College of Obstetricians and Gynaecologists. Results A response rate of 84% was achieved. 89% of units reported that they screened for GDM with a wide variation in the screening methods used, both between and within units. The most commonly employed procedure (81% of units) was screening based on the presence of maternal risk factors. The 75 g oral glucose tolerance test (OGTT) was the commonest diagnostic test (79% of units). Sixty‐six per cent of units operate a combined diabetic antenatal clinic and 58% of units have written guidelines for screening. Seventy‐six per cent of units would welcome national guidelines. Conclusion The majority of obstetric units in the UK screen for GDM but with little consensus on the appropriate screening methods. National guidelines would probably be welcomed.Diabet. Med. 16, 138–141 (1999)