bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Lue procedure: an analysis of the outcome in Peyronie's disease
Authors: Adeniyi A.A. , Goorney S.R. , Pryor J.P. , Ralph D.J. 
Published: March 2003

ObjectiveTo assess the Lue procedure (plaque incision and venous grafting) for correcting the penile deformity of Peyronie's disease (which can cause penile shortening and erectile dysfunction) as an alternative to the Nesbit procedure (which can worsen the shortening).Patients and methodsFifty‐one patients (mean age 51 years, range 27–68) with Peyronie's disease had their penile deformity corrected by plaque incision and saphenous vein grafting. All patients had stable Peyronie's disease and a mean (range) penile deformity of 57 (20–90)°. The vein graft was taken from the long saphenous vein at the ankle or groin and several sites grafted in 14 patients. The mean follow‐up was 16 months.ResultsAn excellent or satisfactory result was obtained in 47 patients (92%); the penis was completely straightened in 42 (82%). Four patients (8%) developed postoperative erectile dysfunction. Eighteen men (35%) had some degree of penile shortening (> 1 cm in eight), among whom intercourse was affected to a variable extent in six (12%).ConclusionThe Lue procedure is an effective option in the surgical management of Peyronie's disease, but penile shortening after surgery remains a risk.
Thick vs thin loop transurethral resection of the prostate: a double‐blind prospective trial of early morbidity
Authors: Holmes M. , Cox J. , Stewart J. , King D. , Bary P. , Wright W. 
Published: March 2003

Objective To compare blood loss, irrigation requirements and hospital stay between standard transurethral resection of the prostate (TURP) and resection incorporating vaporization, i.e. transurethral vaporization resection (TUVRP). Patients and methods Seventy patients were prospectively randomized in a blinded fashion between TURP with a standard resection loop (thin loop) or resection with a roller cutting electrode (thick loop). The outcome was assessed as the change in haemoglobin at 30 min and 24 h after the resection finished. Secondary outcome measures were irrigation requirements, length of catheterization, hospital stay, changes in serum sodium, and complications. The nursing staff and surgical registrar managing the patients after surgery were unaware of the resection technique used. Results Data were available for 65 patients (36 thin loop and 29 thick loop resections). The mean decrease in haemoglobin after TURP was 14.8 g/L at 30 min and 11.8 g/L at 24 h; for TUVRP the corresponding values were 14.6 and 14.2 g/L (P = 0.69). In addition, there was no difference in irrigation requirements, changes in serum sodium, length of catheterization, hospital stay or bleeding complications. Conclusion The use of a thick loop at higher cutting current settings during TUVRP offers no advantage over standard thin‐loop TURP.
A randomized trial of the choice of treatment in prostate cancer: design and baseline characteristics
Authors: Auvinen A. , Vornanen T. , Tammela T.L.J. , Ala‐Opas M. , Leppilahti M. , Salminen P. , Hakama M. 
Published: March 2003

Objective To assess the effects of different approaches to decision‐making on the treatment chosen for prostate cancer and on the patients' quality of life in prostate cancer. Patients and methods A multicentre randomized trial was conducted, including all histologically confirmed cases of prostate cancer diagnosed between September 1993 and November 1994 in four Finnish hospitals. In the intervention group, the role of the patient in the choice of treatment was actively emphasized. In the control group, the treatment was chosen using standardized treatment protocols. The first intermediate endpoint was the patient's participation in decision‐making and the next will be the treatment chosen in the intervention and control groups. The main outcome will be the quality of life. Clinical data on prognostic factors including age, tumour grade, stage, functional status and serum prostate‐specific antigen (PSA) concentration was collected for comparison between the arms, and between those enrolled or not. Results In all, 210 of 251 eligible patients were randomized into the two arms. Patients were randomized before obtaining informed consent, which led to four patients already randomized refusing to participate. The 41 patients not enrolled were of similar age and grade distribution, but more frequently had extensive disease than had those enrolled in the trial. Three patients were unable to participate because of rapid deterioration in their general condition after randomization. There were no clear differences in baseline characteristics (including age, functional status, tumour grade and stage) of the patients between the arms. The distribution of PSA level differed slightly between the arms, which may require adjustment in the analyses. Patients in the intervention arm participated in decision‐making more actively than those in the control arm. Conclusion Randomized studies on ethical issues such as the patient's role in choosing treatment are feasible and likely to provide important information.
Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management
Authors: Sayed M.A.‐B. , El‐Taher A.M. , Aboul‐Ella H.A. , Shaker S.E. 
Published: March 2003

Objective To determine the causes of steinstrasse, methods of prevention and treatment strategies. Patients and methods Fifty‐two patients with steinstrasse were identified and treated; all patients were initially treated conservatively but when there was obstruction, infection or no progression of the stone fragments, further treatment was used, ranging from repeated extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrostomy (PCN), endoscopic manipulations and finally open surgery, depending on the degree of obstruction, infection, renal function and response to each kind of therapy. Results Conservative management was successful in 25 patients (48%), repeated ESWL in 12 (23%), PCN in 10 (19%), ureteroscopy in three (6%) and open surgery in two (4%). Conclusion As many patients, and particularly those with larger stones, are treated by ESWL, the risk of developing steinstrasse will increase, with associated patient discomfort, infection or impaired renal function. The optimum selection of cases (aiming to pulverize the stones rather than fragment them) and accurate stone targeting are essential to minimise the development of steinstrasse. The meticulous follow‐up of patients with steinstrasse should prevent any loss of renal function. When there is obstruction and/or infection or renal damage, active treatment is indicated, of which ESWL and PCN are the most effective, with ureteroscopy and open surgery reserved for difficult cases.
The contribution of research to urological training in the United Kingdom
Authors: Feneley  , Feneley  
Published: March 2003

Objectives To report the findings of a questionnaire survey among consultant urologists in the United Kingdom (UK) designed to examine their personal experience of research and their opinion of its contribution in urological training.Methods A questionnaire was sent to 205 consultant urologists in the UK and 154 (75%) replied. Their replies were examined to ascertain the time spent in research, the production of publications, presentations and in gaining a higher university degree. Subsequent research activity was also related to the achievement of these endpoints.Results Among the 154 consultant urologists who replied, 130 (84%) had undertaken research during their training, for a period varying from 6 months to more than 2 years. Among the 130, 99 (76%) considered this to have been well spent; 76 (58%) obtained a higher degree, 86 (66%) achieved at least three publications in peer‐reviewed journals and 90 (69%) had given at least five presentations to learned societies. Inadequate supervision in particular was cited as contributing to underachievement and motivation was also considered important to success.Conclusions The contribution of research in urological training has been assessed traditionally by the presentation of a thesis to a university for a higher degree, but alternative methods of assessment should perhaps be sought for those wishing to spend less than 18 months in research.
The release of free prostate specific antigen into the circulation during transurethral resection of the prostate: kinetics and interaction with serum protease inhibitors
Authors: Coker  , Coptcoat  , Mulvin  , Cuomo  , Scott  , Sherwood  
Published: March 2003

Objective To determine the nature and extent of the release of prostate specific antigen (PSA) and its interaction with its plasma protein‐derived inhibitors after transurethral resection of the prostate (TURP).Materials and methods Twenty‐three consecutive patients undergoing routine TURP for benign prostatic hyperplasia had blood samples taken pre‐operatively and then post‐operatively at 8‐hourly intervals for 24 h. Further samples were obtained at 48 and 72 h post‐operatively. Serum free and total PSA were determined by immunofluorometric assay. The major plasma protein inhibitors for PSA were also determined by immunoassay.Results The mean free and total PSA fractions increased significantly post‐operatively with levels greatest immediately after surgery. There was also a gradual increase in the complexed PSA fraction, reaching a peak at 48 h. The concentration of the major serum inhibitors of PSA (alpha‐1‐antichymotrypsin and alpha‐2‐macroglobulin) also declined immediately after surgery.Conclusion Increases of serum total PSA in patients after TURP are caused by increases in the free PSA fraction. The exponential decline in free PSA concentrations is consistent with the complexing of PSA with its protease inhibitors present in the plasma. The formation of this complex suggests that the free PSA released into the circulation at the time of TURP is the enzymatically active form.
Treatment of mid‐ and lower ureteric calculi: extracorporeal shock‐wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness
Authors: Bierkens  , Hendrikx  , De La Rosette  , Stultiens  , Beerlage  , Arends  , Debruyne  
Published: March 2003

Objectives To determine the efficacy and costs of extracorporeal shock‐wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid‐ and lower ureteric calculi.Patients and methods The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 men and 21 women, mean age 52 years, range 23–78, 19 mid‐ and 44 lower ureteric calculi). All patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed‐dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 μm fibre. All ureteroscopies were performed with the patient under general (n=17) or spinal (n=87) anaesthesia in a mean treatment duration of 34 min. Stones were located in the mid‐ureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone‐free rates, re‐treatment rates, time to become stone‐free, complications and costs.Results ESWL for mid‐ and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone‐free within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of <50 mm2 . The costs of URS were higher than those for ESWL.Conclusions ESWL provides a noninvasive, simple and safe option for the management of mid‐ and lower ureteric calculi, provided that the stones are <50 mm2 ; larger stones are best treated by URS.
Is there a clinically significant change in pressure‐flow study values after urethral instrumentation in patients with lower urinary tract symptoms?
Authors: Walker  , Patel  , St Clair Carter  
Published: March 2003

Objective To determine the effect of urethral instrumentation on pressure‐flow study values and subsequent grading of bladder outflow obstruction (BOO) in men with lower urinary tract symptoms (LUTS) using suprapubic intravesical pressure monitoring.Patients and methods Seventy‐two men with LUTS underwent pressure‐flow study using suprapubic intravesical pressure monitoring. The urethra was then instrumented successively with a 12 F catheter and a 17 F cystoscope, and a further pressure‐flow study recorded after each procedure. Standard pressure‐flow variables were measured for the three recordings. The presence and degree of obstruction were determined using commonly recognized grading systems, i.e. the Abrams‐Griffiths nomogram, the linear passive urethral resistance ratio (LPURR) and the urethral resistance algorithm (URA).Results There were statistically significant differences in the detrusor pressure at maximum flow and detrusor opening pressure between the uninstrumented and instrumented studies (12 F and 17 F) but no difference in peak flow rates between the groups or in the Abrams‐Griffiths number or URA value between studies. Using the LPURR, there was a tendency to a lower obstruction class after urethral instrumentation, ranking as 17 F>12 F> no instrumentation.Conclusions The changes seen after urethral instrumentation represent no more than the biological intra‐individual variation normally seen in pressure‐flow studies and do not lead to a clinically significant change in obstruction class.
Cystometry in infants and children with no apparent voiding symptoms
Authors: Wen  , Tong  
Published: March 2003

Objective To evaluate bladder function in infants and children with no apparent voiding symptoms.Subjects and methods The study included 83 infants and children (51 boys and 32 girls, aged 3 days to 12 years) with no neurological and lower urinary tract pathology but who had undergone or were about to undergo surgery for upper urinary tract or other pathology. They were evaluated using slow‐filling cystometry, with simultaneous electromyography recorded using surface electrodes on the perineum. The voiding variables were compared among groups categorized by age, sex and body weight.Results In boys and girls, respectively, the mean (sd) post‐void residual urine volume (PVR) was 6.3 (3.9) and 5.4 (4.8) mL, the maximum detrusor pressure during voiding was 66.1 (13.1) and 56.6 (14.7) cmH2O and the maximum voiding pressure was 73.9 (16.6) and 62.7 (16.2) cmH2O. There was no significant difference in these variables between the sexes or between infants and children (P>0.05). Detrusor instability (DI) was apparent in nine of 83 (10.8%) infants and children and occurred in the late filling phase. Bladder capacity increased with age and body weight (from 30 mL in neonates to 350 mL in 12‐year‐old children), and mean (sd) bladder compliance increased with age, from 3.6 (0.5) mL/cmH2O in infants to 13.3 (3.0) mL/cmH2O in older children, at a filling rate of 5–7 mL/min.Conclusions In these infants and children with no apparent voiding symptoms, most bladders were stable, DI could occur in the late filling phase of cystometry, voiding was nearly complete, the PVR being usually <10 mL, and bladder capacity increased with age and body weight.
A single‐system ectopic ureter draining an ectopic dysplastic kidney: delayed diagnosis in the young female with continuous urinary incontinence
Authors: Borer  , Bauer  , Peters  , Diamond  , Decter  , Shapiro  
Published: March 2003

Objective To document the array of diagnostic modalities, the variety of errant diagnoses and treatments, and the time from initial presentation to ultimate diagnosis in girls with an ectopic single‐system ureter draining an ectopic hypoplastic and/or dysplastic kidney.Patients and methods Between 1990 and 1997, seven females were identified who had an ectopic hypoplastic and/or dysplastic kidney with an ectopically draining ureter, and who were treated at our institutions, either initially or upon referral. The nature and number of all diagnostic evaluations, previous diagnoses and treatments, and the time from presentation to definitive diagnosis were recorded.Results All seven females had a classical history of successful toilet training, a normal voiding pattern and continuous urinary incontinence. Typically, a solitary kidney was noted on the initial diagnostic evaluation by ultrasonography and/or intravenous urography. The mean (range) age at initial presentation was 3.2 (2–6) years. Additionally, voiding cysto‐urethrography, urodynamics, radionuclide scintigraphy, computed tomography, magnetic resonance imaging and endoscopy were performed. The age at definitive diagnosis was 3–16.5 years and the mean (range) time from initial presentation to diagnosis was 5.7 (1–10) years. Nephroureterectomy was curative and all kidneys were dysplastic.Conclusion Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia. When the initial evaluation yields the diagnosis of a solitary kidney, clinicians should be aware of the possibility of a hypoplastic and/or dysplastic, often ectopic, contralateral kidney with an ectopically draining ureter. Identification of this entity should allow curative surgical treatment.
Improvements in the efficiency of care after implementing a clinical‐care pathway for transurethral prostatectomy
Authors: Chang  , Huang  , Wang  , Hsieh  , Tsui  
Published: March 2003

Objective To investigate the efficiency of care, length of hospital stay and admission charges after implementing a clinical‐care pathway for transurethral prostatectomy (TURP).Patients and methods Changes in the length of hospital stay and admission charges were identified by comparing a series of 100 patients undergoing TURP and treated after implementing a clinical‐care pathway with 100 patients treated by the same physicians before implementation.Results After implementing the care pathway, the mean length of hospital stay and admission charges were significantly lower (P<0.01). The shorter length of stay was caused by a significant reduction (P<0.05) in patient‐related psychological/social delay after implementation. The number of laboratory tests and use of pharmacological agents were also significantly lower (P<0.001) after implementation, with the decreases in these last variables significantly greater (P<0.001) among junior physicians.Conclusions The advantages of the TURP clinical‐care pathway were the shorter hospital stay, arising from reduced patient‐related psychological or social delay, and reduced admission charges consequent on the decreased use of laboratory tests and drugs, particularly for patients treated by junior physicians. These results suggest that physicians are likely to modify their management methods to improve efficiency when a clinical path is implemented.
Bowel motility after enterocystoplasty
Authors: Wood  , Heathcote  , Nicol  
Published: March 2003

Objective To determine whether the distension of bowel‐augmented bladders during filling and urine storage stimulates gastrointestinal peristalsis, resulting in diarrhoea and increased bowel frequency.Patients and methods Five patients with symptomatic diarrhoea occurring after enterocystoplasty were studied; all had undergone bladder augmentation using ileum or colon at least 6 months previously. Using bowel frequency charts and colonic transit‐time studies, their bowel function was assessed over 6 days while patients self‐catheterized 4‐hourly. This was repeated when the patient’s bladders were decompressed with an indwelling catheter, and the results before and after bladder decompression compared.Results One patient showed a significant increase in colonic transit time, from 44.4 to 57.6 h, a decrease in the percentage of liquid motions from 50% to 42.8% and a corresponding small decrease in bowel frequency with bladder decompression. One patient reported an increase in liquid stools, but there was a minor decrease in colonic transit time. The remaining three patients showed no improvement with bladder decompression. When data were combined and analysed using Student’s paired t‐test, there were no significant changes in colonic transit time, bowel frequency and diarrhoea stools with bladder decompression.Conclusions Eliminating bladder distension and hence distension of the incorporated bowel segment in reconstructed bladders has no impact on bowel motility.
Microwave thermotherapy: a long‐term follow‐up of 67 patients from a single centre
Authors: Glass  , Bdesha  , Witherow  
Published: March 2003

Objective To determine the long‐term therapeutic value of transurethral microwave thermotherapy (TUMT) in the treatment of bladder outflow obstruction secondary to benign prostatic hyperplasia (BPH).Patients and methods A total of 67 patients with BPH, assessed using symptom scores and measurements of urinary flow rate, underwent TUMT using the Leo Microthermer system (Laser Electro Optics Ltd, London, UK) between October 1990 and June 1992. Follow‐up information was obtained on 60 patients (90%). If they had undergone no further treatment for their BPH, they were re‐assessed with symptom scores and measurements of flow rate.Results The mean follow‐up was 52.4 months; eight of the 67 patients had died and seven were lost to follow‐up. Sixteen of the remaining 52 (31%) had undergone another treatment for BPH; one patient developed prostatitis and one developed localized carcinoma of the prostate. Thirty‐four patients had had no further treatment, 29 of whom attended for assessment. In these patients, a statistically significant improvement in both the symptom score and flow rate was maintained at 4 years. No patients developed retrograde ejaculation.Conclusion This is the first study to report a follow‐up of at least 4 years after TUMT with any device. Treatment with the Leo Microthermer provided at least a 50% symptomatic improvement in 16 of 50 patients treated at 4 years. However, 30% of the patients needed further treatment for their BPH. TUMT is safe and effective in patients not wanting anaesthesia and in young patients concerned about retrograde ejaculation.
Frozen‐thawed epididymal sperm is effective for intracytoplasmic sperm injection: implications
Authors: Hutchon  , Thornton  , Hall  , Bishop  
Published: March 2003

Objective To evaluate the pregnancy potential of frozen‐thawed surgically retrieved epididymal sperm when used with intracytoplasmic sperm injection (ICSI).Patients and methods From August 1994 to January 1997, 20 thawed samples of sperm from 19 patients, surgically retrieved and frozen after percutaneous or open epididymal aspiration, were used for ICSI. The results were compared with those obtained using fresh sperm obtained at the same procedure.Results Of the specimens of surgically retrieved sperm which had been frozen, stored and thawed, 15 had sufficient motile sperm for use with ICSI. The fertilization, cleavage and pregnancy rates in those cycles were similar to the same couples’ previous cycle using fresh sperm from the same collection and to the overall results in the NURTURE ICSI programme obtained with fresh epididymal sperm.Conclusion Scrotal exploration for diagnostic testicular biopsy and/or reconstructive surgery without having access to sperm‐freezing and storage facilities could represent a lost opportunity for the patient.