bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metallic stents for malignant and benign ureteric obstruction
Authors: Wakui M. , Takeuchi S. , Isioka J. , Iwabuchi K. , Morimoto S. 
Published: March 2003

Objective To report our experience of using metallic stents to treat ureteric obstruction caused by malignant or benign disease. Patients and methods Nine patients with obstruction in 11 ureters caused by malignant or benign disease (mean age 61 years, range 35–82, mean follow‐up 7 months, range 3–11) were treated using metallic stents. A balloon‐expandable metallic stent was used in one patient and self‐expandable metallic stents in the remaining eight. All stents were inserted via a percutaneous antegrade approach. Results Of the 11 ureters, nine remained patent with no further manipulation during the follow‐up of 3–11 months. An additional stent was placed in continuity with the first in two ureters of two patients at 4 and 5 weeks after the first procedure because of persistent obstruction. After the second intervention, their obstruction was improved. Transient vesico‐ureteric reflux occurred in two of three stented distal ureters, but the reflux resolved spontaneously within 2 months after stent implantation. Ureteric patency was maintained in all patients and no major complications related to stenting occurred during the follow‐up. Two patients died from cervical cancer at 3 and 5 months after stenting. Conclusion In patients with difficult ureteric obstructions a metallic stent provides a safe and effective alternative to an indwelling double‐pigtail catheter or percutaneous nephrostomy.
A prospective, controlled, randomized study of the effect of a slow‐release silver device on the frequency of urinary tract infection in newly catheterized patients
Authors: Reiche T. , Lisby G. , Jørgensen S. , Christensen A.‐B. , Nordling J. 
Published: March 2003

Objective To test the effect on urinary tract infections (UTIs) in patients needing continuous indwelling catheterization, of a newly designed urine‐collecting system containing an antibacterial device which slowly releases silver ions onto the inner surface of the system. Patients and methods The study comprised a prospective controlled randomized trial; 213 patients fulfilled the inclusion criteria. They were randomized to a urine drainage system (comprising a Unometer 400 metering system or PP 2000N closed urine‐bag system, both from Maersk Medical, Denmark) either with or without the antibacterial device. The efficacy was assessed as the number of UTIs and the time to infection in the 170 patients eligible for analysis. Results There were fewer UTIs in those using the system containing the antibacterial device (19% vs 24%), but the difference was not statistically significant (P < 0.05). Conclusion The potential importance of different infection routes were highlighted, suggesting that modifications to Foley catheters and urine‐collecting systems attempting to prevent UTIs should focus not only on the intraluminal pathway, but on the internal and external pathways of infection.
Heat‐induced apoptosis in human prostatic stromal cells
Authors: Brehmer M. , Svensson I. 
Published: March 2003

Objective To determine whether heat, used in transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia and which causes necrotic lesions within the adenoma, induces apoptosis in benign human prostatic stromal cells.Materials and methods Prostatic stromal cells were cultured from benign human prostatic tissue. The origin of the cells was identified by immunohistochemical staining and transmission electron microscopy. Cell cultures were exposed to moderate hyperthermia (47 °C) for 1 h and any apoptosis detected by light microscopy, transmission electron microscopy and the measurement of induced caspase‐3‐like activity.Results The cultures contained a mixed population of smooth muscle cells and myofibroblasts. Twenty‐four hours after heat exposure, 76% of the cells were apoptotic and the caspase activity had increased, whereas only 14% of the cells were necrotic.Conclusion Moderate hyperthermia induces apoptosis in cultured human prostatic stromal cells.
Bladder neck reconstruction in classic bladder exstrophy: the role of osteotomy in the development of continence
Authors: Mathews R. , Sponseller P.D. , Jeffs R.D. , Gearhart J.P. 
Published: March 2003

Objective To assess the role of osteotomy at the time of bladder neck reconstruction (BNR) for continence in classic bladder exstrophy, in which closure of the pelvic ring and reconstitution of the pelvic diaphragm may affect eventual continence.Patients and methods The results of using osteotomy at the time of BNR in 29 children were reviewed. The mean bladder capacity before BNR was 76 mL. The indications for osteotomy were a wide pubic diastasis and a soft intersymphyseal bar. After osteotomy, all children were maintained in external fixation and lower‐extremity traction for 6–8 weeks.Results Complications of osteotomy were limited to a partial femoral nerve palsy (one patient) and delayed union of fragments (one patient). Complications of BNR included urethral stricture (five patients) and bladder calculi (six patients). Continence results were modest, with 11 of 29 children (38%) dry during the day (dry interval > 3 h) and eight of 29 (28%) dry at night. Eight children had daytime dry intervals of ≈3 h. The mean preoperative bladder capacity in children who were dry both day and night was 101 mL.Conclusions The preoperative bladder capacity remains a key determinant for the attainment of continence after BNR in the reconstruction of classic bladder exstrophy. Osteotomy allows pelvic closure and thus improves cosmesis of the mons and stabilizes the BNR in patients with a soft intersymphyseal bar, but seems to have no effect on continence when performed at the time of bladder neck plasty.
Effect of age on the responses of rat bladder detrusor strips to adenosine triphosphate
Authors: Kageyama S. , Fujita K. , Suzuki K. , Shinbo H. , Masuda N. , Uchida W. 
Published: March 2003

Objective To assess age‐related changes in bladder function using the contractile responses to ATP of detrusor strips from rats of various ages. Materials and methods Urinary bladders were obtained from male Wistar rats aged 9 weeks (young), 24 weeks (adult) and 24 months (aged). Contractions of urinary bladder muscle strips to ATP were measured isometrically. The size of the initial phasic response and the secondary contractile response that developed after washing out ATP (postwashout contraction) were measured. The magnitudes of the ATP‐induced phasic and postwashout contraction were compared among the age groups. During the contractions, prostanoid concentrations in the organ‐bath medium were measured using an enzyme immunoassay. Results The ATP‐induced postwashout contraction did not occur after stimulation with KCl or acetylcholine, but was induced by α,β‐methylene ATP. Both the phasic and postwashout contractions were concentration‐dependent. Although the phasic contraction did not change progressively with age, the magnitude and duration of the postwashout contraction increased substantially with age. Nicardipine (a calcium antagonist) slightly inhibited both contractions. Suramin (a nonselective P2‐receptor antagonist) did not significantly inhibit the phasic contraction, but reduced the postwashout contraction. PPADS (a selective P2X receptor antagonist) did not inhibit either contraction. Indomethacin (a prostaglandin synthesis inhibitor) had no effect on the phasic contraction but almost completely blocked the postwashout contraction when added before ATP stimulation, but was less effective when added after ATP. The prostaglandin E2 concentration in the organ bath increased during the postwashout contraction. Conclusions These findings suggest that the ATP‐induced postwashout contraction is not directly mediated by P2x purinoceptors, but results from the synthesis of prostaglandins, especially E2, which is a sensory autacoid. The age‐linked increase in postwashout contraction may be involved in the changes in sensory and voiding mechanisms seen in the aged urinary bladder.
Urothelium‐preserving augmentation cystoplasty covered with a peritoneal flap
Authors: Oge O. , Tekgul S. , Ergen A. , Kendi S. 
Published: March 2003

Objectives To present the results of bladder autoaugmentation covered with a peritoneal flap in patients with bladder dysfunction. Patients and methods Thirteen patients (seven male and six female, mean age 11.9 years, range 4–25) who underwent autoaugmentation covered with a peritoneal flap were evaluated. Seven had different forms of myelodysplasia, four had spinal cord injury and two had Hinman syndrome as the cause of bladder dysfunction. Indications for augmentation included upper tract deterioration, urinary incontinence and recurrent urinary tract infection, despite anticholin‐ergic therapy. Results The mean bladder capacity increased by 18.6% after surgery and the mean compliance at capacity increased from 3.4 to 5.8 cmH2O/mL. All patients were incontinent before surgery and continence was achieved in only six afterward. Four patients showed no clinical or urodynamic improvement and required re‐augmentation using intestinal segments. Only three patients needed no anticholinergic therapy after surgery. All four patients in whom the procedure failed had capacities of < 30% of that expected for their age. There were no metabolic problems. Conclusion Autoaugmentation combined with a peritoneal flap is an easy procedure but the clinical results are poor in some patients, especially those with a small initial bladder capacity. The need for secondary augmentation with enteric segments was common. The use of a peritoneal flap does not appear to increase the capacity and compliance more than is obtained with the classical technique; it may prevent adhesion to the abdominal wall and make a secondary procedure easier. As the increase in capacity and compliance is limited with this technique, a urothelium‐preserving augmentation should be reserved for those bladders with a relatively good initial capacity.
Are dedicated bladder films necessary as part of intravenous urography for haematuria?
Authors: Corrigan N.T. , Crooks J. , Shand J. 
Published: March 2003

Objective To determine the use and assess the value of full‐bladder films during intravenous urography (IVU) which, despite the widespread availability of flexible cystoscopy, remain part of IVU in many radiology departments. Materials and methods A telephone survey of all Scottish radiology departments where IVU is regularly used showed that half routinely included a full‐bladder film in the series. The reports of all IVU over 2 years in the authors’ department were analysed retrospectively. The index urogram of all patients with bladder tumours confirmed during this period was reviewed independently by three observers, and together with the initial radiological reports was correlated with the cystoscopic and histological findings. Results From 2625 patients, 139 (5.2%) IVU reports commented on the bladder; 1423 patients presented with no haematuria. None of the patients without haematuria, where a comment was made about the bladder, had pathological evidence of a tumour. Overall 121 of 464 (26%) new bladder tumours were diagnosed on IVU before cystoscopy. Multiple tumours were always undetected and large tumours were often overlooked. Conclusions Despite its continuing popularity, IVU is a poor means of identifying bladder tumours and routine views of the full bladder should be abandoned.
Unconsummated marriage: clarification of aetiology; treatment with intracorporeal injection
Authors: Zargooshi Javaad 
Published: March 2003

Objective To clarify the aetiological factors in unconsummated marriage in Iran, and to report the results of intracorporeal injection therapy for erectile dysfunction in these circumstances. Patients and methods During a 2‐year period, 200 cases of unconsummated marriage were evaluated. A detailed history was obtained to clarify the circumstances of the problem; if simple measures failed to resolve the problem, intracorporeal injection with papaverine ± phentolamine was used. Results The main factor associated with an unconsummated marriage was the intense social pressure to accomplish hasty coitus with an unfamiliar woman (some men having had no social contact with their new bride) and in the presence of relatives waiting nearby for evidence of the bride's virginity and confirmation of coitus. The initial problem was then further compounded with resultant erectile failure caused by anxiety about sexual performance. Inability to consummate the marriage was caused by premature ejaculation in 23%, erectile dysfunction in 61%, and a combination in 16%; 70% of patients were able to consummate the union after intracorporeal injection with papaverine ± phentolamine. Conclusions In addition to psychological causes and a lack of sexual education, the social circumstances in which partners are obliged to initiate and complete coitus are important factors in the aetiology of unconsummated marriage. Intracorporeal injection is useful in treating this problem and it should be the therapy of choice for unconsummated marriage in developing countries, where the conditions do not favour psychotherapy and where alternative erectogenic agents are expensive or unavailable.
Safety and efficacy of transurethral resection of the prostate under sedoanalgesia
Authors: Chander J. , Gupta U. , Mehra R. , Ramteke V.K. 
Published: March 2003

Objective To assess the safety and efficacy of sedoanalgesia (local anaesthesia with sedation) in patients with benign prostatic hyperplasia (BPH) undergoing transurethral resection of the prostate (TURP). Patients and methods The study comprised 50 patients with BPH, two‐thirds of whom were graded III–IV using the American Society of Anesthesiologists system. All patients had a topical instillation of lignocaine jelly 2% into their urethra, combined with 1% lignocaine (100–200 mg) with 1 : 400 000 adrenaline infiltration of the prostate via the perineal route. Sedation and anxiolysis were obtained with the intramuscular pethidine (0.5 mg/kg) and promethazine (1 mg/kg). Standard TURP was then carried out, with pain monitored during surgery using a visual analogue scale (VAS, maximum 10 points) and the amount of analgesic required after TURP recorded. The amount of prostatic tissue excised, duration of surgery, blood requirement, catheter interval, complications and hospital stay were recorded. The effectiveness of TURP was assessed by comparing symptom scores, uroflowmetry and postvoid residual volume before and after surgery. Results The mean intraoperative VAS was ≤ 1 at any time during or after surgery; no patient required any postoperative analgesics. Only two patients complained of discomfort during the procedure and even they were comfortable after a supplemental dose of pethidine (12.5 mg). There were no conversions to general or regional anaesthesia. No blood transfusion was required in any patient. All patients began a normal diet 30 min after surgery and all were discharged within 48 h of surgery. There were no deaths; one patient had transient urinary incontinence and three had mild urinary tract infection. Conclusion Sedoanalgesia was an effective, safe and simple alternative to general or regional anaesthesia for TURP in patients with BPH.
The effect of intestinal urinary reservoirs on renal function: a 10‐year follow‐up
Authors: Fontaine E. , Leaver R. , Woodhouse C.R.J. 
Published: March 2003

Objective To study the effect of the storage of urine in intestinal reservoirs on long‐term renal function and the possible causes of deterioration. Patients and methods Eighty‐seven patients (aged 4–35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular filtration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51Cr‐ethylenediamine tetra‐acetic acid. Patients with a decline in GFR of > 5% were investigated to identify the cause. Results Of 58 patients with a follow‐up of ≥ 10 years, 53 were evaluable, four having been lost to follow‐up and one refusing to accept the protocol. In these 53 patients, the mean (
sd) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m2 (P = 0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by ≥ 20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (five), uretero‐ileal stenosis (one), a high‐pressure reservoir (one) and uncertain causes (three). Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, ≈ 20% of patients had some deterioration in renal function during the 10‐year follow‐up, usually from identifiable and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function. Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed.
Poor prognosis associated with thrombocytosis in patients with renal cell carcinoma
Authors: Symbas N.P. , Townsend M.F. , El‐Galley R. , Keane T.E. , Graham S.D. , Petros J.A. 
Published: March 2003

Objectives To better define the relationship between platelet count and survival using a retrospective analysis in patients with thrombocytosis and metastatic renal cell carcinoma (RCC), some of whom had a shorter life expectancy than those with a normal platelet count. Patients and methods The records were reviewed of patients with stage IV RCC who had undergone a variety of adjuvant therapies after nephrectomy between 1972 and 1992. Entry criteria included a tissue diagnosis of RCC, at least one platelet count and a complete follow‐up until the time of death. Of 350 patients available for review, 259 met the entry criteria. Patients were divided into two groups: group 1 included 112 patients whose platelet counts remained at < 4 × 105/µL between the time of nephrectomy and the time of death; group 2 included 147 patients with at least one platelet count of > 4 × 105/µL (mean age in each group 57 years). Results The mean (
sd) survival for group 1 was 151 (34) months, compared with 92 (18) months for those in group 2. Using the log‐rank chi‐square test the difference in survival between the groups was significant (P = 0.005). Controlling for established prognostic indicators of pathological stage, nuclear grade and cell type, using Cox's regression technique, the difference in survival between the groups remained significant (P = 0.015). Conclusions These results suggest that patients with metastatic RCC who receive adjuvant therapy and have a persistently normal platelet count have a 64% longer life expectancy than those with thrombocytosis. The difference is highly statistically significant when controlled for nuclear grade, cell type and pathological stage.
Interstitial cystitis in Japan
Authors: Ito T. , Miki M. , Yamada T. 
Published: March 2003

Objective To determine the prevalence of interstitial cystitis in Japan, and to analyse the diagnostic criteria and treatments most commonly used by Japanese urologists. Materials and methods Questionnaires were sent to 300 urologists at major hospitals, including medical university hospitals, throughout Japan, asking about the number of patients with interstitial cystitis, its epidemiology, diagnosis and therapy. Results The prevalence of interstitial cystitis was 1.2 per 100 000 patients and 4.5 per 100 000 female patients; the male/female ratio was 1 : 5.8. Most Japanese urologists used two or more diagnostic criteria; bladder biopsy was the most common diagnostic method. Dimethyl sulphoxide instillations and corticosteroids were the most frequently used therapies. Conclusion The prevalence of interstitial cystitis in Japan is markedly lower than that reported in Europe and North America. The reasons for this difference were not only racial but also the lack of awareness among Japanese urologists and patients about interstitial cystitis.
Biomarker distribution after injection into the canine prostate: implications for gene therapy
Authors: Siemens D.R. , Iwasawa T. , Austin J.C. , Williams R.D. , See W.A. , Hedican S.P. , Tartaglia J. , Flynn C.M. , Cohen M.B. , Rodgers J. , Ratliff T.L. 
Published: March 2003

Objective To evaluate the distribution of biomarkers after transrectal injection into the canine prostate and to report a method for enhancing the distribution of gene expression. Materials and methods Carbon black was first used to evaluate the histopathological distribution in canine prostate of single or multiple injections via the transurethral, transperineal and transrectal routes. The distribution of canarypox virus (ALVAC) vector‐delivered gene expression was then compared using both fluid‐phase injection techniques and delivery in a solid carrier composed of a gelatine sponge matrix. Results After transurethral administration, carbon black was detected as scattered particles in ducts and acini, mostly in the periphery of the gland. Direct transrectal injection of carbon black resulted in a localized collection at the site of injection, with only a minimal peri‐acinar distribution. Transrectal injection of the fluid‐phase (virus suspended in diluent) ALVAC vector encoding the β‐galactosidase gene resulted in a similar distribution, with limited gene expression at the site of injection and in the needle track. Delivery of the same number of virus particles in the gelatine sponge matrix resulted in qualitatively greater gene expression. Conclusions Direct injection of the canine prostate with biomarkers, including viral vectors, in the fluid‐phase results in very localized gene expression, while the distribution was more widespread after delivery in a gelatine sponge matrix.
Efficacy of percutaneous vas occlusion compared with conventional vasectomy
Authors: Zambon J.‐V. , Barone M.A. , Pollack A.E. , Mehta M. 
Published: March 2003

Objectives To determine the efficacy, evaluate the safety and assess side‐effects (swelling, haematoma and pain) of percutaneous vas occlusion compared with vasectomy in Dutch men. Patients and methods Vas occlusion and vasectomy procedures (attempted in 58 and 50 men, respectively) were conducted at the University Hospital Maastricht. The men returned 1 week after the procedure, underwent a clinical examination and completed a questionnaire assessing subjectively any pain, swelling and haematoma. The men were asked to return for semen analysis at 6 and 12 weeks and, if necessary, for additional analyses until they were azoospermic. Results The vas occlusion procedure was completed on both vasa in 49 of the 58 men (84%) in whom it was attempted. Significantly more (P < 0.001) men were azoospermic after vasectomy (48 of 50) than after vas occlusion (only four). Men undergoing vas occlusion reported significantly less pain (P = 0.02), swelling (P = 0.01) and haematoma (P = 0.04) after the procedure than did men undergoing vasectomy. Conclusion Men undergoing vas occlusion would not have been able to rely on the method for contraception. From this study, vas occlusion, at least in its current form, is an unsuitable method of male contraception. Not only was the efficacy poor, but constraints in delivering the method in its current state would probably limit its utility, especially in situations where resources are limited.