bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial urinary sphincter in patients with neurogenic bladder dysfunction
Authors: Singh G. , Thomas D.G. 
Published: November 2003

Objective To assess the role of the artificial urinary sphincter (AUS) in the management of sphincter weakness incontinence in neuropathic patients. Patients and methods Ninety patients (75 male and 15 female, mean age 26 years, range 13–62) with neurogenic bladder dysfunction (71 with congenital and 19 with acquired cord lesions) who underwent implantation of an AUS were reviewed. All patients were followed up for a minimum of one year after the initial implantation of the sphincter (mean 4 years, range 1–10). Pre‐operative video‐urodynamics demonstrated sphincter weakness incontinence in all patients, with 24 patients having an acontractile‐type bladder. Of 66 patients with intermediate‐type bladders, 52 underwent cystoplasty. Results Eighty‐three patients (92%) were continent both night and day, three were occasionally damp and controlled by pharmacotherapy, and four had a persistent poor result. Of the 66 patients with detrusor hyper‐reflexia, 52 (79%) required a cystoplasty to achieve continence and 14 (21%) were controlled with anti‐cholinergic therapy. The re‐operation rate was 28% (25/90) and complications included six infections, seven erosions, eight system failures, two pump failures, one sheered tube and one rectal and one bladder perforation. Seventy (78%) of the patients currently perform intermittent catheterization to treat high post‐voiding residual urine volumes. Conclusions A rate of continence >90% was achieved in these neurogenic patients after implantation of an AUS and we recommend a simultaneous cystoplasty in patients with detrusor overactivity.
Extraperitoneal laparoscopy: anatomical dissections with experimental balloon dilators
Authors: Chan Y.K. , Pope A.J. , Webb D.R. 
Published: November 2003

Objectives To develop balloon dilators in vitro and in cadavers and to evaluate the anatomy of the extraperitoneal spaces and their surroundings created by such balloons. Materials and methods Balloons of three different materials (condoms, fingers of surgical gloves, whole surgical gloves and ‘party’ balloons) were tested in an in vitro study and compared with a prototype balloon dilator used in cadavers. The balloon dilators were used to create extraperitoneal spaces in the pelvic, the loin and the iliac regions through stab incisions. The incisions were extended after dilatation to examine the spaces created and the consequent anatomical changes. Results In vitro, all balloons were found to have capacities of more than 10 L, except that made from the finger of a surgical glove. Early rupture after insertion and during dilatation was a problem in condom and party balloons. In cadavers, there was good exposure of anatomical structures within the extraperitoneal spaces created. Reflections of peritoneum in the loin and the iliac regions were unmoved by balloon dilatation. Conclusions The prototype balloon dilator possessed all the characteristics desired of an ideal instrument for creating extraperitoneal spaces. Good exposure of anatomical structures by the balloon dilators allows a minimal dissection in extraperitoneal laparoscopic procedures in the aforementioned regions. That the peritoneal reflection was unmoved despite adequate expansion of the balloons also means that the exact placement of secondary laparoscopic ports is crucial in preventing peritoneal and colonic trauma.
Paraganglioma of the prostatic urethra. A report of three cases and a review of the literature
Authors: Boyle M. , Gaffney E.F. , Thurston A. 
Published: November 2003

Objective To determine the incidence and clinical presentation of prostatic urethral paragangliomas and to compare these findings with paragangliomas occurring in the other sites of the lower urinary tract. Patients and methods The clinical records of three patients with prostatic urethral paragangliomas were reviewed, as was the histology of each specimen. The tumours were stained immunocytochemically with neuron‐specific enolase, chromogranin, S100 protein, protein gene product 9.5, prostate‐specific acid phosphatase and prostate‐specific antigen. Results The three tumours occurred in elderly men, two of whom presented with haematuria, one of whom also had a vesical transitional cell carcinoma, and the third patient had obstructive symptoms due to co‐existent prostatic hyperplasia. The histological appearances and immunocytochemical findings were consistent with paraganglioma. Treatment consisted of local excision and there were no recurrences or metastases at 5 and 6 years in two patients for whom follow‐up was available. Conclusion Urethral paragangliomas are rare tumours arising in elderly men and are hormonally inactive. Although haematuria may be the presenting symptom, it is important to exclude additional more common and possibly more sinister lesions such as transitional cell carcinoma. Local excision appears to be curative.
Dismembered pyeloplasty in infants under the age of 12 months
Authors: Woo H.H. , Farnsworth R.H. 
Published: November 2003

Objective To assess the impact of internal ureteric stenting on the surgical outcome of dismembered pyeloplasty in infants under the age of 12 months. Patients and methods The case records of 53 of 55 infants with the diagnosis of congenital pelvi‐ureteric junction obstruction who underwent dismembered pyeloplasty over a 6‐year period were available for review. A total of 63 renal units were treated surgically. The policy for urinary drainage changed during this period from predominantly nephrostomy or no drainage to that of internal ureteric stenting. Results The post‐operative mean (sd) length of stay for stented and non‐stented cases was 5.9 (1.8) and 12.4 (5.4) days, respectively (P<0.001). The mean length of stay for patients with bilateral and unilateral pyeloplasty was 9.7 (4.9) and 8.0 (4.7) days, respectively (P=0.19). Urinary leaks occurred in non‐stented anastomoses and not in stented anastomoses. All three cases which later required revision pyeloplasty had had significant complications associated with urinary leaks. With a minimum follow‐up of 24 months, a favourable outcome, as determined by radio‐isotope imaging, was achieved in 48 of 51 infants (94%) for whom follow‐up data were available. Conclusion The use of internal ureteric stenting in dismembered pyeloplasty performed in infants <12 months old has, in our hands, led to a dramatic reduction in operative morbidity. The routine use of internal ureteric stents at the time of pyeloplasty is justified.
Impact of diagnostic laparoscopy in the management of the unilateral impalpable testis
Authors: Gulanikar A.C. , Anderson P.A.M. , Schwarz R. , Giacomantonio M. 
Published: November 2003

Objective To evaluate the impact of laparoscopy on the management of children with a unilateral impalpable testis. Patients and methods The study population consisted of 27 children who underwent a primary inguinal exploration for a unilateral impalpable testis. Results Twelve of 27 (44%) children had inguinal or ‘peeping’ testes and 10 of 27 (37%) had blind‐ending vasa and vessels in the inguinal canal; four of these 10 had atrophic tubular tissue in the excised remant. Four of 27 (15%) had blind‐ending vasa and vessels proximal to the internal ring. Only one child had a testis proximal to the internal ring. Only the four children (15%) with blind‐ending vasa and vessels proximal to the internal ring would have benefited from a laparoscopy by avoiding an inguinal exploration. Conclusions Because of the time, expense and limited usefulness of laparoscopy in altering the management of children with a unilateral unpalpable testis, we reserve laparoscopy for cases where inguinal exploration has failed.
Haemodynamic effects of irrigating fluids studied by Doppler ultrasonography in volunteers
Authors: Nilsson A. , Randmaa I. , Hahn R.G. 
Published: November 2003

Objective To study whether moderate amounts of irrigating fluids induce cardiac stress when infused into healthy volunteers, giving special attention to solutions containing ethanol as a tracer of absorption.Subjects and methods Over a period of 20 min, 15 mL/kgof glycine (1% or 1.5%) or 3% mannitol (all containing 1% ethanol) or sorbitol 2%–mannitol 1% (with no ethanol) were infused intravenously into 10 healthy male volunteers. The central haemodynamic responses were studied using Doppler ultrasonography.Results Specific and general haemodynamic responses were observed. After infusing glycine there was a reduction of the heart rate and in cardiac output and an elevation of mean arterial pressure, indicating an increase in systemic resistance. There was no improvement when the glycine content was reduced from 1.5% to 1.0%. Furthermore, infusion of all irrigating fluids was associated with a decrease in cardiac output 30 min after the infusion. Almost identical breath‐ethanol curves were obtained with the three fluids containing ethanol and all of them caused slight hypoglycaemia. There was no evidence of ethanol‐induced tachycardia.Conclusions Irrigating fluids containing glycine and ethanol have a specific haemodynamic effect not occurring with solutions containing mannitol or sorbitol.
A self‐expanding, self‐retaining temporary urethral stent (UrocoilTM) in the treatment of recurrent urethral strictures: preliminary results
Authors: Sikafi Z.H. 
Published: November 2003

Objective To determine the efficacy of a self‐expanding, self‐retaining temporary urethral stent (UrocoilTM ) in patients with recurrent urethral strictures at different levels in the urethra. Patients and methods Urocoil stents were placed in 18 patients (mean age 42 years, range 28–60) with recurrent urethral strictures. The stents were left for a mean of 8 months (range 6–14) and patients followed for a mean of 9 months (range 6–18) after removal of the stent, being assessed by urine culture, urethrography, flexible cystoscopy and urinary flow rate. Results The stents were easy to insert and remove under local anaesthesia. All patients except one had a satisfactory outcome. Complications included stent migration (3), encrustation (2), hyperplasia of the mucosa (2) and the one failure, where the stent was extruded by a long fibrous stricture. Conclusion The use of the temporary stent is an encouraging development in the treatment of this complicated problem but a longer follow‐up is necessary to exclude the possibility of late recurrence.
Treatment of female stress urinary incontinence with a new anatomically shaped vaginal device (Conveen Continence Guard®)
Authors: Hahn I. , Milsom I. 
Published: November 2003

Objective To evaluate the clinical efficacy of a new vaginal device for the treatment of female stress urinary incontinence. Patients and methods This multicentre study comprised 90 women with stress incontinence (mean age 47.5 years, range 31–65). The diagnosis of stress urinary incontinence was based on the result of a quantitative provocation test. The device was used daily for 4 weeks. Urinary leakage with and without the device was assessed using a 24 h pad‐test at home. The patient′s subjective opinion concerning their urinary leakage and the efficacy and function of the device were assessed using a questionnaire. Results Eighty‐five women completed the study and successfully performed the pad test on both occasions. The mean (sem) urinary leakage at the end of the study period whilst using the device was 13.9 (3.2) mL, which was less than the 41.6 (7.6) mL mean leakage measured before treatment (P<0.001). Of the 85 women, 39 (46%) were completely dry during the pad test with the device in situ, 29% had a smaller leakage, 17% had the same leakage and 8% had a greater leakage. Accordingly, the overall objective improvement was 75%; 72% of the women considered the product to function satisfactorily and 60% expressed a wish to continue with the treatment. The vaginal device caused some local discomfort in 62% of the patients, but 72% of these women wished to continue with the device despite the reported discomfort. Conclusion The new vaginal device reduced urinary leakage in stress incontinent women and 46% became continent. Even women with severe leakage had some improvement when using the device.
Salvage procedures for failed Benchekroun hydraulic valves: experience in four patients
Authors: Mouriquand P.D.E. , Boddy S. 
Published: November 2003

Objective To describe the complications encountered with the Benchekroun hydraulic valve and the salvage procedures used to convert it into a successful continent diversion. Patients and methods Seven patients with spina‐bifida (two males and five females) presenting with neurogenic incontinence were treated originally with a combined urethral lengthening (Pippi‐Salle procedure), detubularized ileocystoplasty and Benchekroun hydraulic valve. Four of these patients presented with immediate (three) or subsequent (one) complications related to the devagination or the overdistension of the hydraulic valve, and stomal problems. Two techniques were used to create a catheterizable conduit with the intestinal material of the Benchekroun hydraulic valve; one used the inner tube of the valve and the other one used the appendix. These techniques are described and illustrated. Results All four patients made a satisfactory recovery and had no difficulty in catheterizing their bladder through the revised continent diversion. However, the follow‐up of these patients was short (1–8 months) and a long‐term assessment is required to evaluate these salvage procedures. Conclusions The Mitrofanoff procedure remains our first choice to create a continent diversion in children with neuropathic bladders. However, when the appendix is not available or unusable, alternative procedures such as the Benchekroun hydraulic valve might be used to create a continent catheterizable conduit. Nevertheless, complications or failure of the Benchekroun valve and its variants (e.g. Guzman's technique) are common and salvage procedures are often necessary to recreate an efficient continent conduit.
Stones in enterocystoplasties
Authors: Nurse D.E. , McInerney P.D. , Thomas P.J. , Mundy A.R. 
Published: November 2003

Objectives To assess the aetiology of stones which occur in enterocystoplasties and continent diversions, generally attributed to the presence of foreign material, e.g. staples, or to recurrent urinary infection, in patients with augmented or substituted bladders. Patients and methods The study comprised 467 patients who had undergone reconstruction of the lower urinary tract and had been followed up for at least 3 years using videourodynamics and ultrasonography. Results Stones were found in 42 patients (9%); 50% were found incidentally and the remaining patients presented with symptomatic infections (27%) or deterioration in urinary continence (23%). Stones occurred in 6% of patients with augmentation, in 7% of those with substitution cystoplasty and in 22% of patients with continent diversions. Most patients with stones (88%) used clean intermittent self‐catheterization (CISC). Stones were 5–10 times commoner in patients using CISC than in patients voiding spontaneously. Conclusion Urinary stasis was a more important cause of stone formation than was bacteriuria in patients with cystoplasty. The presence of mucus and bacteriuria are presumed to be contributory. To reduce the risk of stone formation, orthotopic cystoplasty and spontaneous voiding are to be preferred to continent diversion and CISC. Periodic bladder washouts may be an alternative solution.
Bladder replacement by detubularized ileal loop:
Authors: Alcini E. , Racioppi M. , D'Addessi A. , Menchinelli P. , Grassetti F. , Alcini A. 
Published: November 2003

Objective To evaluate the results obtained with a technique of bladder replacement using a detubularized ileal tract, developed by the authors. Patients and methods Since 1983, 34 patients have undergone an orthotopic bladder replacement using 35–40 cm of ileum, detubularized and shaped into an ‘S’ to create a neobladder with a capacity of 100–120 mL. The ureters were anastomosed directly to a 10 cm long intact afferent loop which serves as an anti‐reflux mechanism, while a 2 cm long efferent, spatulated loop was used for urethral anastomosis. The mean (sd) follow‐up was 32 (33) months. Results All the patients were continent during the day, with socially convenient intervals between voids; 3 years after the operation, 10 of 12 patients were continent during the night, with intervals of 2–4 h between voids. The mean post‐void residual urine volume was 41 mL and no patient required self‐catheterization. There were no derangements of the metabolic status of patients. Conclusion This technique was applied knowing that a detubularized intestinal loop has the remarkable ability to increase in capacity over time. Therefore, to maintain the reservoir in good condition over a long period it is important to construct it with an intra‐operative capacity of <120 mL, thus reducing the length of intestine required. This may explain the satisfactory metabolic status of these patients. Moreover, the triplication of the mesentery helps to maintain the sphericity of the neobladder and provides support for the neobladder in the lower pelvis, where it retains the same position as a normal bladder.
A comparison of various methods to burst Foley catheter balloons and the risk of free‐fragment formation
Authors: Gülmez I. , Ekmekcioglu O. , Karacagil M. 
Published: November 2003

Objective To compare the efficiencies of bursting balloons and the risks of forming free fragments after rupture using needles, the stylet of a ureteric catheter, instillation with ether or overinflation. Materials and methods Two hundred 18 F ‘silkolatex’ Foley balloon catheters were divided into four groups of 50. Each balloon was inflated with 30 mL of distilled water, the catheters immersed in urine collected from healthy volunteers and maintained at 37°C for 48 h. Attempts were made to burst the balloons with a needle (group 1), by overinflation (group 2), by ether instillation (group 3) and using the stylet of 7 F ureteric catheter through the inflation channel (group 4). Results The ratio of the burst to deflated balloons and the formation of free fragments were 100% and 0% in the group 1, 94% and 83% in the group 2, 100% and 100% in group 3 and 16% and 0% in the group 4, respectively. Conclusion Bursting the catheter balloons using a needle seems to be the most appropriate method, being efficient and having little risk of forming free fragments.
A single positive prostate biopsy in six does not predict a low‐volume prostate tumour
Authors: Ravery V. , Szabo J. , Toublanc M. , Boccon‐Gibod L.A. , Billebaud T. , Hermieu J.F. , Delmas V. , Boccon‐Gibod L. 
Published: November 2003

Objective To evaluate whether a single positive prostate biopsy in six systematic transrectal ultrasonography (TRUS)‐guided biopsies is predictive of a small tumour volume in a subsequent radical prostatectomy (RP) specimen. Patients and methods Of 158 patients submitted to RP for T1–T2 prostate cancer, 15.2% had one positive biopsy. The rate of positive margins (M+) and extracapsular involvement (C+) were assessed on the RP specimen in those with one positive biopsy (group I) and in those diagnosed by more than one positive biopsy (group II). The percentage of those with post‐operative biological progression (P+), having a prostate‐specific antigen (PSA) level>0.1 ng/mL, was evaluated in both groups. The Gleason scores in biopsies and specimens were also compared. Fifteen patients diagnosed by a single positive biopsy were management conservatively. Results The percentage of patients who were categorized C+, M+ and P+ was 29.2, 16.7 and 26% in group I and 70, 46.5 and 49.5%, respectively, in group II. All patients with <10% of the biopsy core length invaded by cancer had intracapsular (P2) disease, whereas if all the core length was invaded by tumour, all patients had extracapsular (P3) disease. The Gleason scores for biopsy cores and whole specimens were identical in 38.7% of the cases; the Gleason score was underestimated on biopsy in 48.4% of cases. In the group treated conservatively, nine of 15 patients were in biological progression, with a mean follow‐up of 22 months. Conclusion A single positive needle‐biopsy in six systematic TRUS‐guided prostate biopsies is not predictive of low‐volume prostate cancer on an individual basis and does not guarantee a favourable outcome after RP.
A 3‐year follow‐up of patients with localized prostate cancer operated on with or without pre‐treatment with the GnRH‐agonist triptorelin
Authors: Hellström M. , Häggman M. , Pedersen K. , Busch C. , Brändstedt S. 
Published: November 2003

Objective To examine the effect of pre‐operative androgen deprivation on the progression rate of malignancy in patients operated on for localized prostate cancer. Patients and methods A total of 53 patients received no hormone therapy (group 1) and a further 38 patients (group 2) received the generic releasing‐hormone agonist triptorelin during the 3 months before surgery. The patients in group 1 had T1b‐T2 tumours, whereas 12 of those in group 2 had clinical stage T3 tumours. Despite this, the surgical specimens from the patients in group 2 showed a rate of cancer invasion of the surgical margins 20% lower than those from the patients in group 1. After prostatectomy, the patients were followed for 3 years by repeated analyses of prostate‐specific antigen (PSA) in serum. Results During the follow‐up, the PSA level exceeded the upper threshold (0.6 ng/mL) in 16 % of the patients in group 1 and in 43 % of those in group 2 (P<0.05). This difference was mainly related to the pre‐treatment stage of the tumour. Some of the patients in group 1 received post‐operative radiotherapy but this was not reflected in their PSA levels. Of the patients in group 1 and 2, 4% and 14% respectively (P>0.05), developed symptoms from skeletal metastases. Conclusion There was no evidence that pre‐operative hormone therapy slowed the progression of prostate cancer.
Urinary diversion in children and young adults using the Mainz Pouch I technique
Authors: Stein R. , Fisch M. , Beetz R. , Matani Y. , Doi Y. , Hohenfellner K. , Bürger R.A. , Abol‐Enein H. , Hohenfellner R. 
Published: November 2003

Objectives To determine the late complications and consequences for renal function, vitamin and acid‐base metabolism after application of the Mainz Pouch I (MZP‐I) technique in children and young adults. Patients and methods To November 1994, the MZP‐I procedure was carried out in 463 patients at our institution, 91 of whom were children and adolescents (≤20 years old) using bladder augmentation in 21 and a continent cutaneous stoma in 70. A minimum follow‐up of 1 year was possible in 87 patients or 163 renal units (RUs) with a mean of 5.5 years (range 1–10.5). Results At the last examination, 23 of 55 (42%) pre‐operatively dilated RUs had improved, 131 of the 163 RUs (80%) were stable and nine RUs (5.5%) showed a slight clinical asymptomatic increase in the upper tract dilatation. Through an extraperitoneal flank incision, 11% of the RUs which developed stenosis at the ureterocolic anastomosis were successfully reimplanted (16% in patients with neurogenic disorders, 17% with pre‐operative irradiation and 5% in the remaining patients). Two of 32 patients with an intussuscepted and invaginated ileal nipple required re‐operation due to incontinence, but none of the patients with an appendiceal stoma were incontinent. Open revision of a stomal stenosis was performed in three and endoscopic treatment in nine patients. In 54 patients, the levels of vitamins A, B1 , B2 , B6 , E, folic and bile acid were within normal ranges. There was no significant decrease in vitamin B12 levels after operation. In none of the patients with normal pre‐operative creatinine values had the levels increased and none developed severe acidosis or bowel neoplasm. Conclusion The MZP‐I is recommended as a technique for bladder augmentation or continent urinary diversion in children and young adults, with an acceptable complication rate which offers long‐term protection of the upper urinary tract.