bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of lower urinary tract symptoms and self‐reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community‐based survey of men in the UK
Authors: Trueman  , Hood  , Nayak  , Mrazek  
Published: March 2003

ObjectivesTo assess the prevalence of lower urinary tract symptoms (LUTS) in a community‐based population in the UK, to measure the impact of these symptoms on quality of life and health status in men with self‐reported ‘benign prostatic hyperplasia’ (‘BPH’), and to evaluate health‐seeking behaviour in this population.Subjects and methodsA postal survey was distributed to an age‐stratified random sample of 1500 men aged 50 years or older from throughout England, Scotland and Wales. The self‐administered survey included: demographic questions; the EuroQoL (EQ‐5D) instrument, consisting of a health‐status index questionnaire and a visual analogue scale (VAS) on which participants rated their current health status; the International Prostate Symptom Score (IPSS) questionnaire; and a questionnaire assessing the participants’ health‐seeking behaviour and awareness of BPH.ResultsResponses to the survey were received from 1115 (74%) of the 1500 men. Overall, 41% (450/ 1088) had an IPSS of ≥8, indicating moderate‐to‐severe LUTS, yet only 196 men (18%) reported that they had been diagnosed with ‘BPH’. Both quality of life (as measured by the EQ‐5D) and general health status (as measured by the VAS) decreased as urinary symptom severity increased, and the greater the severity, the more men who reported a problem with mobility, self‐care, usual activity, pain/discomfort, and anxiety/depression (the five domains of the EQ‐5D). The possibility of symptoms worsening appeared to be the key determinant in the respondents’ decisions to consult a medical professional for their LUTS. Less than 11% of the respondents were aware of the availability of specific prescription drug therapies or surgical options for the treatment of ‘BPH’. The most common first treatment strategy for those consulting for symptoms was watchful waiting (34%), followed by surgery (30%) and prescription drugs (21%).ConclusionsModerate‐to‐severe LUTS were relatively common in this UK population of men over the age of 50, yet relatively few had been diagnosed with ‘BPH’. As LUTS adversely affect quality of life, improved treatment options and increased public awareness of BPH and LUTS are needed to combat a problem facing the growing number of elderly men in the population.
The management of residual masses after chemotherapy in metastatic seminoma
Authors: Ravi  , Ong  , Oliver  , Badenoch  , Fowler  , Hendry  
Published: March 2003

ObjectiveTo review our experience in management of residual masses after chemotherapy for metastatic seminoma.Patients and methodsThe study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty‐three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response. Residual masses were classified radiologically as <3 cm or ≥3 cm and as well‐ or poorly defined. Of the patients with residual masses, 19 underwent surgery, while 24 were observed.ResultsViable cancer was present in six of 11 patients with well‐defined residual masses of ≥3 cm (positive histology in three of six undergoing surgery and site relapses in three of five observed), one of 14 patients with poorly defined masses of ≥3 cm (negative histology in nine undergoing surgery and site relapse in one of five observed), and in none of 17 patients with residual masses of <3 cm (negative histology in four undergoing surgery and no site relapses in 13 observed; one additional patient in this group died from treatment complications).ConclusionPatients with a complete response after chemotherapy, a residual mass of <3 cm and a poorly defined residual mass of ≥3 cm can be observed, reserving intervention for recurrent or progressive disease. Well‐defined residual masses of ≥3 cm should be resected because there is a 55% likelihood of persistent tumour.
Kidney‐preserving tumour resection in renal cell carcinoma with photodynamic detection by 5‐aminolaevulinic acid: preclinical and preliminary clinical results
Authors: Popken  , Wetterauer  , Schultze‐Seemann  
Published: March 2003

ObjectiveTo identify the outer border of a renal cell carcinoma (RCC) during a kidney‐preserving tumour resection by photodynamically detecting RCC after the exogenous administration of 5‐aminolaevulinic acid (ALA) in an animal model and in humans.Patients, materials and methodsHuman RCC was xenotransplanted subcutaneously and orthotopically into the kidneys of nude mice. ALA was then administered orally or intravenously (100–400 mg/kg body weight). The tumours were removed and examined macroscopically and microscopically for fluorescence, and the concentrations of protoporphyrin IX (PPIX) evaluated in the subcutaneous tumours. In a pilot study, nine patients with RCC of <4 cm diameter underwent partial nephrectomy; 20 mg ALA/kg body weight was given orally 4 h before surgery. During the operation, the macroscopic fluorescence of the tumours was evaluated and any side‐effects recorded.ResultsIn the mouse model, the RCC fluoresced in all tumours, both macro‐ and microscopically, reaching a maximum 1.5 h after intravenous and 4 h after oral administration. The tissue concentrations of PPIX in the subcutaneous tumours were also maximal 4 h after oral administration. In the patients undergoing surgery, the RCC also fluoresced clearly and was sufficiently intense to identify the outer margins of the tumours for kidney‐preserving tumour resection. There were no side‐effects of the ALA with the dosages and methods of administration used.ConclusionThe photodynamic detection of RCC with ALA facilitates the identification of tumour margins in man and in the mouse model, producing no undesirable side‐effects. It may be helpful in determining the boundaries of the resected tissue when carrying out conservative kidney‐preserving surgery.
Repeat epididymovasostomies: are they worthwhile?
Authors: Nigam  , Hendry  
Published: March 2003

ObjectiveTo establish whether it is worthwhile repeating epididymovasostomy in men with persistent obstructive azoospermia.Patients and methodsThe study included 24 men with obstructive azoospermia, persisting after previous surgery for blockage in the body or tail of the epididymes, who underwent repeat epididymovasostomy proximal to the previous anastomoses. Semen was re‐analysed after 6 and 12 months, and information about pregnancy self‐reported or determined by postal survey.ResultsThe postoperative sperm concentration was >107 /mL in 15 patients (62%) and 10 female partners became pregnant (41%). Antisperm antibodies were present in nine patients and three of their partners became pregnant after the man received steroid therapy. Unilateral revision did not produce a favourable outcome.ConclusionHaving defined a favourable group of men with obstructive azoospermia by scrotal exploration, i.e. those with caudal epididymal blocks and patent vasa deferentia, initial technical failure should not preclude surgical revision of the anastomoses in selected cases.
The dissolution of urinary catheter encrustation
Authors: Getliffe K.A. , Hughes S.C. , Le Claire M. 
Published: March 2003

Objectives To identify the optimum volume of acidic bladder washout solution to dissolve catheter encrustations and to compare the effectiveness of different bladder washout delivery devices. Materials and methods Urinary catheter encrustation was generated in vitro using a model of the catheterized bladder adapted from previous work. An acidic bladder washout solution (Suby G) was applied via the catheter in the model and retained for 15 min. The amount of encrusting material dissolved was measured by colorimetric analysis of the magnesium and calcium content of the solution returned after the washout procedure. The relative effectiveness of different volumes of washout solution and different washout delivery devices (Optiflow, Bard Ltd, Crawley; UroTainer, B/Braun Medical Ltd, Aylesbury; and a bladder syringe) in dissolving catheter encrustations was compared to the ‘standardized’ conditions commonly used in practice. Results There was no statistically significant difference between washouts with 100 mL and washouts with 50 mL for any of the delivery devices tested. Gentle agitation with 50 mL Suby G did not significantly improve the dissolution of encrustation but the total amount of material dissolved when two washouts with 50 mL Suby G were used sequentially was significantly better than a single washout with either 100 mL or 50 mL. Conclusions Under controlled laboratory conditions, smaller volumes of acidic bladder washout solution (50 mL) are as effective as the 100 mL commonly used in practice, but two sequential washouts with 50 mL are more effective than a single washout. The newly designed Optiflow delivery device is at least as effective as the other devices tested. This study provides new evidence which may contribute to decision‐making by practitioners in relation to cath‐eter care.
Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer
Authors: Tosoni I. , Wagner U. , Sauter G. , Egloff M. , Knönagel H. , Alund G. , Bannwart F. , Mihatsch M.J. , Gasser T.C. , Maurer R. 
Published: March 2003

Objective To assess the reliability of the histological diagnosis of bladder cancer by assessing the interobserver variability of staging and grading in pTa/pT1 tumours and evaluating the clinical significance of discrepancies. Materials and methods All sections from 301 superficial bladder carcinomas were reviewed by one pathologist. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined in 128 patients for whom there was long‐term follow‐up information. Results There were significant interobserver differences in both the grading and staging of tumours. From a total of 235 tumours that were initially considered pT1, the reviewer classified 35% as pTa, 56% as pT1, 6% as pT1‐ (at least pT1), and 3% as pT2–4. In 39% of all biopsies there were interobserver differences in tumour grade. The prognostic significance of grade and stage differed between the initial pathology report and the reviewer’s diagnosis. The reviewer’s staging allowed a better estimate of the risk of subsequent tumour progression than the initial staging. Progression was significantly more common in 49 tumours in which the reviewer agreed with stage pT1 than in 29 tumours that were down‐staged from pT1 to pTa (P = 0.0116). However, the initial tumour grade (P = 0.0386) but not the reviewer’s grade (P = 0.2645) was significantly linked to progression. Conclusions These results show that grading and staging by different pathologists have varying prognostic implications. If possible, biopsies from bladder tumours should be independently evaluated by two different pathologists before radical therapy is administered.
A systematic review of Cernilton for the treatment of benign prostatic hyperplasia
Authors: MacDonald R. , Ishani A. , Rutks I. , Wilt T.J. 
Published: March 2003

Objective To systematically review the evidence for the clinical effects and safety of the rye‐grass pollen extract (Cernilton) in men with symptomatic benign prostatic hyperplasia (BPH). Methods Trials were identified by searching Medline, specialized databases (EMBASE, Cochrane Library, Phytodok), bibliographies, and contacting relevant trialists and manufacturers. Randomized or controlled clinical trials were included if: men with symptomatic BPH were treated with Cernilton; a control group received either placebo or pharmacological therapy; the treatment duration was  30 days; and clinical outcomes were reported. Results In all, 444 men were enrolled in two placebo‐controlled and two comparative trials lasting 12–24 weeks. Three studies used a double‐blind method although the concealment of treatment allocation was unclear in all. Cernilton improved ‘self‐rated urinary symptoms’ (the proportion reporting satisfactory or improving symptoms) vs placebo and another plant product, Tadenan. The weighted mean (95% confidence interval) risk ratio (RR) for self‐rated improvement vs placebo was 2.40 (1.21–4.75) and the weighted RR vs Tadenan was 1.42 (1.21–4.75). Cernilton reduced nocturia compared with placebo or Paraprost (a mixture of amino acids); against placebo, the weighted RR was 2.05 (1.41–3.00), and against Paraprost the weighted mean difference for nocturia was – 0.40 times per evening (– 0.73 to 0.07). Cernilton did not improve urinary flow rates, residual volume or prostate size compared with placebo or the comparative study agents. Adverse events were rare and mild; the withdrawal rate for Cernilton was 4.8%, compared with 2.7% for placebo and 5.2% for Paraprost. Conclusions The Cernilton trials analysed were limited by their short duration, limited number of enrolees, omissions in reported outcomes, and the unknown quality of the preparations used. The comparative trials had no confirmed active control. The available evidence suggests that Cernilton is well tolerated and modestly improves overall urological symptoms, including nocturia. Additional randomized placebo and active‐controlled trials are needed to evaluate the long‐term clinical effectiveness and safety of Cernilton.
The effect of intravesical capsaicin on the suburothelial innervation in patients with detrusor hyper‐reflexia
Authors: Dasgupta P. , Chandiramani V.A. , Beckett A. , Scaravilli F. , Fowler C.J. 
Published: March 2003

Objective To determine the effect of intravesical capsaicin on the suburothelial innervation in patients with detrusor hyper‐reflexia, in whom a single dose of intravesical capsaicin (1–2 mmol/L) increases the bladder capacity for 3–6 months. Patients and methods Thirteen patients with detrusor hyper‐reflexia underwent cystometry and had flexible cystoscopic biopsies taken before and 6 weeks after receiving instillations of intravesical capsaicin (1 mmol/L). Similar biopsies were also obtained from a control group of 12 neurologically normal patients with microscopic haematuria and normal bladders. Frozen sections were stained using antibodies to S100 and PGP 9.5. Using computerized analysis, the mean nerve density scores were expressed as nerves/mm2 for S100‐positive structures and ‘red%’ and ‘red in frame’ for PGP 9.5. Results The mean (
sem) functional bladder capacity increased from 193.2 (28.17) mL before to 396.3 (41.96) mL at 6 weeks after treatment with capsaicin, in nine of the 13 patients. The mean nerve density of S100‐positive structures in the control group was 83 (3.18) nerves/mm2. In hyper‐reflexic patients who responded to capsaicin by improved bladder capacity, the mean nerve density of S100‐positive structures was reduced from 100 (12.2) before to 66 (9.4) nerves/mm2 6 weeks after treatment. In those who did not respond to capsaicin there was no significant difference in these scores. Similarly the ‘red%’ and ‘red in frame’ reduced from 3.41 (1.06) to 1.15 (0.32) and 824.7 (246.3) to 297.9 (83.5) units, respectively, before and 6 weeks after capsaicin treatment. The difference in those not responding was not significant. Conclusions Intravesical capsaicin causes a reduction in suburothelial nerve densities in the bladder of patients with detrusor hyper‐reflexia. This may explain its prolonged beneficial effect in these patients.
A maternal vegetarian diet in pregnancy is associated with hypospadias
Authors: North K. , Golding J. ,   THE ALSPAC STUDY TEAM
Published: March 2003

Objective To investigate the possible role of the maternal diet, particularly vegetarianism and consumption of phytoestrogens, in the origin of hypospadias, which is reported to be increasing in prevalence. Subjects and methods Detailed information was obtained prospectively from mothers, including previous ob‐stetric history, lifestyle and dietary practices, using structured self‐completed questionnaires during pregnancy. Previously recognized associations with en‐vironmental and parental factors were examined, focusing particularly on the hypothesized hormonal link. Multivariate logistic regression was used to identify independent associations. Results Of 7928 boys born to mothers taking part in the Avon Longitudinal Study of Pregnancy and Childhood, 51 hypospadias cases were identified. There were no significant differences in the proportion of hypospadias cases among mothers who smoked, consumed alcohol or for any aspect of their previous reproductive history (including the number of previous pregnancies, number of miscarriages, use of the contraceptive pill, time to conception and age at menarche). Significant differences were detected for some aspects of the maternal diet, i.e. vegetarianism and iron supplementation in the first half of pregnancy. Mothers who were vegetarian in pregnancy had an adjusted odds ratio (OR) of 4.99 (95% confidence interval, CI, 2.10–11.88) of giving birth to a boy with hypospadias, compared with omnivores who did not supplement their diet with iron. Omnivores who supplemented their diet with iron had an adjusted OR of 2.07 (95% CI, 1.00–4.32). The only other statistically significant association for hypospadias was with influenza in the first 3 months of pregnancy (adjusted OR 3.19, 95% CI 1.50–6.78). Conclusion As vegetarians have a greater exposure to phytoestrogens than do omnivores, these results support the possibility that phytoestrogens have a deleterious effect on the developing male reproductive system.
The role of the renal resistive index ratio in diagnosing obstruction and in the follow‐up of children with unilateral hydronephrosis
Authors: Patti G. , Menghini M.L. , Todini A.R. , Marrocco G. , Calisti A. 
Published: March 2003

Objective To assess the role of the renal resistive index ratio (RIR) in discriminating equivocal upper urinary tract dilatation in children, and thus in establishing the need for surgery, in comparison with traditional diagnostic tools. Patients and methods The study comprised 40 children with unilateral hydronephrosis unrelated to vesico‐ureteric reflux, posterior urethral valves, megaureter or a duplex system. In all patients one or more of the following ‘indices of obstruction’ were positive; an anteroposterior renal pelvic diameter of >20 mm, a half‐time diuretic ‘washout’ (T/2) of  > 20 min, a separate renal function of < 40%, and symptoms of obstruction (pain, sepsis). All these variables were measured on admission and after a mean (range) follow‐up of 9 (2–24) months. After this period, all patients who were symptomatic or with two or more of the variables above the normal range were considered as obstructed and underwent a dismembered pyeloplasty. The variables were then re‐assessed 6 months after surgery. The RIR was evaluated using duplex Doppler ultrasonography with a 3.5–5 MHz transducer, by the same operator. Differences between obstructive and unobstructive unilateral hydronephrosis were estimated from the mean values of the variables assessed and Student’s t‐test used to determine significant differences. The correlation between the T/2 and RIR before and after surgery was also evaluated. Results During follow‐up the RIR was abnormal in 27 of 30 patients with hydronephrosis who were considered to be ‘obstructed’. Twenty‐three of these patients, selected for surgery, had a positive diuretic renogram; 11 had loss of differential renal function and 16 had recurrent clinical symptoms. There were significant differences in the mean RIR and T/2 between obstructed and unobstructed patients. Six months after dismembered pyeloplasty, the RIR returned to normal in all patients except three in whom it was previously > 1.1. The diuretic renogram, if initially showing pathology, always became normal. The RIR did not change in patients with an unchanged and severe loss of differential renal function before and after surgery. Conclusions In this study the RIR was a good index of obstruction in children with unilateral hydronephrosis and it correlated well with the results of diuretic renography. The specificity of the RIR was reduced whenever there was severe renal damage.
Analysis of CD44 isoform v10 expression and its prognostic value in renal cell carcinoma
Authors: Li N. , Tsuji M. , Kanda K. , Murakami Y. , Kanayama H. , Kagawa S. 
Published: March 2003

Objective To examine the expression of CD44 isoform v10 (CD44v10) in patients with renal cell carcinoma (RCC), analyse its role in RCC and its relationship with conventional clinical‐histopathological experience.Materials and methods Sixty‐four RCC specimens and five metastatic specimens were analysed immunohistochemically using a CD44v10 specific antibody. The expression of CD44v10 was compared with the histological grade and clinical or pathological stage of the tumours.Results Of the 64 primary tumour specimens, 22 (34%) expressed CD44v10 protein; all of these positive specimens were clear‐cell and mixed‐cell RCC. Staining was also positive in four of five metastatic specimens and negative in all four cases of granular cell carcinoma. CD44v10 expression was significantly correlated with the histological grade (P < 0.0001), clinical stage (P = 0.0050) and pathological stage (P = 0.0143) of the tumours. The prognosis for patients with clear‐cell RCC who were CD44v10‐positive was worse than for patients who were CD44v10‐negative (P < 0.0001). In subgroups with different tumour stage ( pT2 or  pT3), the prognosis for patients with positive CD44v10 expression was also worse than for those with no expression (P < 0.05).Conclusion The expression of CD44v10 correlated significantly with histological grade, clinical and pathological stage, and with survival in patients with clear‐cell RCC. CD44v10 protein may play a role in the progression of clear‐cell and mixed‐cell RCC, and thus the analysis of CD44v10 expression may provide useful prognostic information.
Comparison of single and multiple sessions of percutaneous sclerotherapy for simple renal cyst
Authors: Chung B.H. , Kim J.H. , Hong C.H. , Yang S.C. , Lee M.S. 
Published: March 2003

Objective To compare the results of single and repeated percutaneous sclerotherapy in patients with simple renal cysts. Patients and methods Eighty‐two patients with simple renal cysts underwent needle aspiration andsclerotherapy under ultrasonographic guidance. Forty‐two patients (group 1) underwent one session of sclerotherapy with 99% ethanol immediately after aspiration and 40 patients (group 2) underwent sclerotherapy at least twice. The patients were followed up using ultrasonography at 3‐month intervals. The complete disappearance or a reduction of more than half in the diameter of the renal cyst was considered a successful treatment. Results The mean diameter of the renal cysts was not significantly different in group 1 (6.12 cm) and 2 (6.75 cm). There was complete or partial regression in eight (19%) and 16 (38%) in group 1, and in 29 (73%) and nine (23%) in group 2, respectively. The overall success rate was significantly better in group 2 (95%) than in group 1 (57%; P < 0.001). Conclusions These results suggest that multiple sclerotherapy is better than a single injection of sclerosant for reducing the recurrence of simple renal cysts.