bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of exfoliative urine cytology in combination with flexible cystoscopy in the diagnosis of recurrent transitional cell carcinoma of the urinary bladder
Authors: Loh C.S. , Spedding A.V. , Ashworth M.T. , Kenyon W.E. , Desmond A.D. 
Published: November 2003

Objective To study the value of exfoliative urine cytology in predicting recurrent tumour in patients undergoing surveillance for transitional cell carcinoma (TCC) and to assess the suitability of these patients for flexible cystoscopy. Patients and methods Specimens of early‐morning and freshly voided urine were submitted 2 weeks before surveillance cystoscopy by 111 consecutive patients with known TCC. All patients then underwent cystoscopy under general anaesthesia. The urine specimens were analysed by two pathologists with no knowledge of the patients' history. Cytological findings were correlated with the findings of cystoscopy. Results Urine cytology predicted 82% of all recurrent tumours found subsequently at cystoscopy; 60% of patients with non‐neoplastic pathology had normal cystoscopy. Only 51% of patients with positive urine cytology were shown to have recurrent TCC, but 87% of patients with negative cytology had no recurrent tumours. Conclusion Urine cytology is a good adjunct to assessing the suitability of flexible cystoscopy in the follow‐up of patients with transitional cell tumours.
Determination and reversal of resistance to epirubicin intravesical chemotherapy. A confocal imaging study
Authors: Duffy P.M. , Hayes M.C. , Gatrell S.K.E. , Cooper A. , Smart C.J. 
Published: November 2003

Objective To evaluate the use of confocal microscopy in the study of resistance to epirubicin and to determine the effect of temperature, viability and a resistance‐reversing agent on the intracellular distribution of this drug in sensitive and resistant derivatives of a superficial bladder cancer cell line. Materials and methods Viable and non‐viable adherent cells were incubated in epirubicin solutions under various conditions. After incubation, the distribution of intracellular epirubicin fluorescence was visualized using confocal microscopy and a ×50 water‐immersion lens. Results There was a striking and consistent difference between resistant and sensitive cells in the intracellular distribution of the drug. In addition to having greater overall levels of epirubicin fluorescence, sensitive cells accumulated epirubicin predominantly in the nucleus. Epirubicin fluorescence in resistant cells was cytoplasmic and granular in appearance. When incubated at 0°C, both cell lines showed no nuclear uptake and thus resembled resistant cells at 37°C. However, dead cells rapidly acquired brightly fluorescent nuclei. The resistance‐reversing agent verapamil appeared to cause reversion of the resistant to the sensitive phenotype. Conclusion Confocal microscopy allows epirubicin‐sensitive and resistant cultured tumour cells to be differentiated reliably and provides information about the mechanisms of action of, and resistance to, epirubicin. Applying this technique to clinical specimens should enable patients who have the resistant phenotype to be detected and the efficacy of intravesical resistance‐reversing agents to be evaluated in such cases.
Polymorphism and smoking in bladder carcinogenesis
Authors: Chinegwundoh F.I. , Kaisary A.V. 
Published: November 2003

Objective To study the relationship between smoking, a cytochrome P‐450 gene polymorphism and the development of bladder cancer. Patients and methods The study comprised 126 patients with a diagnosis of bladder cancer from whom a full history was obtained. Genomic DNA was extracted from blood sampled from each patient and genotyping of the CYP2D6 locus, the gene responsible for debrisoquine hydroxylase activity, was performed using a polymerase chain‐reaction technique. Results Of the 126 patients, 78% had a history of smoking. There was a relationship between the number of cigarettes smoked and the grade of the presenting bladder tumour; heavy smokers developed high‐grade disease. There was a trend for those heterozygous at the CYP2D6 locus and with a history of smoking to develop more aggressive disease, but this trend did not reach statistical significance. Conclusion The link between smoking and bladder cancer was confirmed. Furthermore, the grade of the presenting tumour was related to the ‘cigarette‐years’. The CYP2D6 genotype may influence the type of bladder cancer that develops in smokers.
Computer‐controlled monitoring of bladder pressure in the prevention of ‘TUR syndrome’: a randomized study of 53 cases
Authors: Hubert J. , Cormier L. , Gerbaud P.F. , Guillemin F. , Pertek J.P. , Mangin P. 
Published: November 2003

Objective To evaluate the performance of a computer‐controlled monitor of bladder pressure in the prevention of transurethral resection (TUR) syndrome.Patients and methods The in vitro pressure loss in catheters and endoscopes of different size was measured for irrigant flow rates of 0–500 mL/min to calibrate them before surgery. The calibrations were used in a computerized monitoring system designed to control bladder pressure during TUR of the prostate (TURP). The performance of the system was assessed in a randomized study of 53 patients with a prostate adenoma or carcinoma (Group A, 27 unmonitored patients; Group B, 26 monitored patients). The primary criterion for evaluating the absorption of irrigating fluid was the level of glycine in the blood.Results When patients with capsule perforation were included in the analysis, there was no statistically significant difference in mean glycine absorption between the groups, although glycine levels were highest in Group A, particularly in those cases with perforation (four in Group A; two in Group B). When the results for patients with capsule perforation were excluded from the analysis, there was a significant difference in the incidence of irrigant absorption between the groups. The extent of absorption was not related to the duration of operation (which was shorter in Group B) nor to the weight of resection chippings.Conclusion The continuous computerized monitoring of bladder pressure during TURP effectively reduced the absorption of irrigant fluid, making the procedure safer for the patient and easier for the surgeon.
Urodynamic changes during therapeutic intravesical instillations of capsaicin
Authors: Chandiramani V.A. , Peterson T. , Duthie G.S. , Fowler C.J. 
Published: November 2003

Objective To describe the technique for and urodynamic changes during therapeutic instillations of intravesical capsaicin in patients with detrusor hyper‐reflexia. Patients and methods Ninety intravesicalinstillationsof capsaicin were performed as a therapeutic procedure in 30 patients; 21 patients had various causes of non‐traumatic spinal cord disease, five patients were very severely neurologically impaired and were bed‐bound with an indwelling catheter, and four were neurologically normal. Simultaneous cystometry was performed in 25 patients during the instillation of capsaicin; 100 mL of 1 or 2 mmol/L capsaicin in 30% ethanol/saline was instilled into the bladder for 30 min and two patients received 30% ethanol/saline only. The last 56 capsaicin treatments were preceded by the instillation of 40 mL of 2% lignocaine for 20 min. Detrusor hyper‐reflexia was decreased and urinary continence improved for 3–6 months after a single instillation; the instillation was then repeated. Two patients who received only ethanol/saline showed no clinical or urodynamic improvement. Results The treatment was not abandoned in any patient due to discomfort and there were no short‐ or medium‐term complications. All patients with spinal cord disease and phasic detrusor hyper‐reflexia had similar, frequent and repetitive detrusor contractions during the instillation of capsaicin. These acute reactive contractions did not occur in the neurologically normal patients. Similarly, the instillation of intravesical lignocaine only caused no phasic detrusor contractions. Intravesical lignocaine instillation before capsaicin markedly reduced and sometimes abolished the detrusor overactivity and lessened the discomfort for the patients. The instillation of lignocaine before capsaicin did not alter the benefit from each instillation of intravesical capsaicin. Conclusion A method has been developed for administering capsaicin intravesically which diminishes discomfort for the patient and in the short‐and medium‐term is free of complications. The study also provides functional evidence of the role of capsaicin‐sensitive afferents in phasic detrusor hyper‐reflexia due to spinal cord disease.
Long‐term effects of potassium citrate therapy on the formation of new stones in groups of recurrent stone formers with hypocitraturia
Authors: Whalley (nee Laminski) N.A. , Meyers A.M. , Martins M. , Margolius L.P. 
Published: November 2003

Objective To compare stone formation rates before (as total rates and during remote periods) and after therapy with potassium citrate in patients with hypocitraturia. Patients and methods  The study comprised 15 patients with hypocitraturia only (Group I) and 12 patients with hypocitraturia associated with other abnormalities (Group II), all of whom were recurrent stone formers. Their urine chemistry, including citrate, was measured before and after treatment. Results In both groups, the urinary citrate concentration increased significantly to within normal limits during therapy with potassium citrate (P<0.005). The rate of total stone formation in patients in Group I decreased significantly from 0.7/year before to 0.13/year after treatment (P<0.005). The corresponding remote stone formation rate before (0.88/year) was significantly greater than the rate after treatment (0.13/year; P<0.005; follow‐up 4.6±1.9 years). Patients in Group II showed a similar striking decrease in total stone formation rate, from 1.2/year to 0.08/year after treatment (P<0.005). The corresponding remote stone formation rate (1.66/year) before was significantly greater than that after treatment (0.08/year; P<0.005; follow‐up 4.1±1.6 years). There was a remission rate of 93% for stone formation over the complete follow‐up. Conclusion Potassium citrate appears to be the drug of choice in the long‐term treatment of patients with hypocitraturia as it not only decreases the rate of stone formation but also maintains normal citrate levels in the urine.
A new technique for detrusor biopsy and its applicability in the ultrastructural study and diagnosis of voiding dysfunction
Authors: Holm N.R. , Horn T. , Elbadawi A. , Skjoldby B. , Nordling J. 
Published: November 2003

Objective To determine the clinical applicability of ultrasound‐guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall. Materials and methods The detrusor structure in 22 biopsies, 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis. In addition, several specimens from each of three bladders were evaluated, also ‘blindly’, for ultrastructural diagnosis of the detrusor in an independent current study of voiding dysfunction in geriatric patients. Results There were no differences in intercellular distances and cell:nucleus ratios between transabdominal and transurethral biopsies in eight of the 11 patients. Furthermore, ultrasound‐guided transabdominal biopsies were as representative of the detrusor as were transurethral biopsies. Conclusion The transabdominal approach is recommended as an easy, relatively inexpensive and efficient method of obtaining biopsies of the detrusor for study of its structure in voiding dysfunction. On the other hand, the observations and diagnoses made by ‘blind’ qualitative study of several specimens from the same bladder were identical. This, together with the similarity of detrusor structure in the transabdominal and transurethral biopsies, strongly supports the idea that such structure is relatively uniform throughout the entire bladder wall.
Comparison of three different irrigation fluids used in transurethral prostatectomy based on plasma volume expansion and metabolic effects
Authors: Akan H. , Sargin S. , Türkseven F. , Yazicioglu A. , Çetin S. 
Published: November 2003

Objective To examine changes in the pathophysiology of the transurethral resection (TUR) syndrome with various irrigation fluids.Patients and methods Three different irrigation fluids (5% mannitol in 21 patients, group A; 1.5% glycine in 18 patients, group B; and a fluid containing 2.7% sorbitol and 0.54% mannitol in 20 patients, group C) were compared during transurethral prostatectomy (TURP) by assessing plasma volume expansion, calculated using the haematocrit dilution method, and several biochemical variables.Results None of the patients experienced TUR syndrome and none showed a change in plasma osmolality (P>0.05). However, serum sodium, haemoglobin, haematocrit, total protein and albumin levels declined (P<0.01). The decrease in total protein and albumin level was greater in group A than in groups B and C (P< 0.01 for both). Although the amount of fluid absorbed was the same in all of the groups (P>0.05), plasma volume expansion was greater in group A than in B or C (P<0.05 for both). Hyperammonaemia, encountered in group B, was more evident with increasing weight of the resected tissue. However, this increase was insufficient to cause encephalopathy.Conclusion Although it was not important clinically, mannitol solution could cause more evident hypervolaemia than glycine and sorbitol solutions; glycine solution could cause hyperammonemia, but the solution containing mainly sorbitol had no such adverse effects.
The significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma of the urinary bladder
Authors: Chen Shiou‐Sheng , Chen Kuang‐Kuo , Lin Alex T.L. , Chang Yen‐Hwa , Wu Howard H.H. , Hsu Ted H.S. , Chang Luke S. 
Published: November 2003

Objective To determine the significance of tumour grade in predicting disease progression in stage Ta transitional cell carcinoma (TCC) of the urinary bladder.Patients and methods From August 1975 to January 1991, 140 patients (121 men and 19 women, mean age 64.2 years, range 30–83) with stage Ta TCC of the urinary bladder were treated at the Veterans General Hospital‐Taipei by transurethral resection and post‐operative adjuvant intravesical chemotherapy. There were 48 patients (34%) with grade 1, 78 patients (56%) with grade 2 and 14 patients (10%) with grade 3 tumours. Disease progression and muscle invasion were assessed during a mean follow‐up of 74.3 months and related to grade, urine cytology and the number and location of tumours.Results A total of 10 patients (7%) had tumour recurrence which invaded the muscle, of whom one had grade 1, six had grade 2 and three had grade 3 tumours. The patient with a grade 1 tumour developed muscle invasion within 16 months of surgery. The mean interval to the development of muscle invasion was 49.2 months in patients with grade 2 and 39.4 months with grade 3 tumour. In patients with stage Ta TCC, a grade 3 tumour was more likely to progress to muscle invasion (21%) than was a grade 1 (2.1%; P<0.05) or grade 2 (7.7%; P<0.05) tumour. One patient with a grade 2 and one patient with grade 3 tumour developed distant metastases without muscle invasion. Overall, the disease progression rate was 8.6% (12/140) in stage Ta TCC. Disease progression was more common with grade 3 (28.5%) than with grade 2 (9.0%; P<0.05) and grade 1 (2.1%; P<0.05) tumours.Conclusion Tumour grade may be used to predict disease progression after resection of stage Ta urinary bladder cancer. A higher grade of tumour was associated with a higher incidence of disease progression.
Circumcision: how do urologists do it?
Authors: O' Sullivan D.C. , Heal M.R. , Powell C.S. 
Published: November 2003

Objective To determine the range of surgical techniques, analgesic practice, post‐operative care and follow‐up procedures used in the circumcision of children by urologists in the United Kingdom, and to suggest changes which would improve patient care and medical training in the relatively simple procedure of circumcision.Materials and methods In 1994, all consultant urologists in the United Kingdom were sent detailed questionnaires asking about their practices in the circumcision of children.Results Of 308 urologists, 61% replied; of these, 55% use the sleeve‐resection technique and 39% the freehand method, and 57% use diathermy, half of which is bipolar. There is wide variation in the type of post‐operative analgesia; 95% use an initial dressing but few recommend any subsequent dressing, 70% perform all circumcisions as day cases and 48% review patients in the clinic. There is significant concern that circumcision is not taught adequately to junior surgeons.Conclusion The sleeve technique of resection should be more widely used. Analgesic practice could be improved with greater use of regional anaesthetics. Most urologists promote no specific care after discharge. There is probably a place for increasing the use of alternative procedures to circumcision.
Assessment of quality of life after radical radiotherapy for prostate cancer
Authors: Caffo O. , Fellin G. , Graffer U. , Luciani L. 
Published: November 2003

Objective To assess the quality of life (QoL) of patients with localized prostate cancer (LPC) after treatment by radical radiotherapy (RR). Patients and methods An ‘ad hoc’ self‐administered questionnaire was developed, which comprised a series of 41 items grouped into seven subscales reflecting the main QoL domains, and the questionnaire's psychometric properties were assessed. A consecutive series of 118 patients treated with RR for LPC from 1981 to 1994 were then selected for a retrospective study and asked to complete the questionnaire. Results Ninety patients (76%) completed the questionnaire; because 20 of them were also treated with hormonal therapy, QoL was assessed only in the remaining 70 patients, to avoid confusion. The assessment of the psychometric properties showed that the questionnaire was valid and reliable (Cronbach's &agr; coefficient >0.8 for each subscale). The main side‐effects of RR were urinary symptoms and sexual impairment, while physical, psychological and relational well‐being were good. The degree of information available about the therapy and the disease seemed to play a major role in the patients' QoL adjustment after RR. Conclusion The study assessed a sample of patients with LPC treated with RR and showed that QoL was acceptable after RR. Prospective studies are needed to improve knowledge of the factors involved in the restoration of the QoL after therapy for LPC.
In vitro and in vivo assessment of urethral warming catheters for the transperineal cryoablation of prostatic carcinoma
Authors: Cozzi P.J. , Lynch W.J. , Robson N. , Vonthethoff L. , Lumley T. , Morris D.L. 
Published: November 2003

Objective To evaluate the two most common urethral warming catheters currently available for their effectiveness in preventing urethral injury in an animal model and thus during transperineal cryosurgery for the treatment of prostate cancer. Patients, materials and methods The warming efficiency of the variable‐diameter thin latex‐balloon catheter (Cook, Australia) and the fixed‐diameter PVC catheter (Candela, USA) were evaluated in a water‐bath. A sheep model was then used for subsequent experiments to further evaluate the better catheter. The technique used for the insertion of the Cook catheter in a series of 33 patients treated with prostate cryosurgery is also described. Results In vitro, the Cook catheter was more effective (P<0.01) than the Candela catheter in preventing localized cooling. In vivo, results in five animals showed that the urethral epithelium was viable in all sections that had been protected by the catheter and focally denuded or necrotic in those sections not protected, with each animal used as its own control (P<0.01 Fisher's exact test). The 33 patients treated while using the Cook catheter had no subsequent complications. Conclusion The urethral warming catheter currently in use for prostatic cryosurgery in Australia is more effective in vitro than its competitor and is effective in preventing urethral injury in vivo.
Breast and prostate cancer in the relatives of men with prostate cancer
Authors: McCahy P.J. , Harris C.A. , Neal D.E. 
Published: November 2003

Objective To assess the risk of breast, ovarian and prostate cancer in the families of men with prostate cancer. Patients and methods A case‐control study was performed by interviewing patients with prostate cancer and obtaining detailed information on family histories of cancer. Controls were hospital‐based patients, of a similar age to the cases, with bladder cancer or benign prostatic hypertrophy. Results A total of 209 cases and 322 controls were interviewed; of the cases, 22.5% had family members with a history of one or more of breast, ovarian or prostate cancers, compared with 15.2% of controls (P<0.05). The odds ratio (OR) of having prostate cancer when there was a positive family history was 8.22 and the OR of a female relative of a patient with prostate cancer having breast cancer was 1.51. There was no apparent increased risk of ovarian or any other cancer. Conclusions We confirm previous reports of an increased incidence of prostate cancer in the families of men with prostate cancer and report a similarly increased incidence of breast cancer in female relatives. We suggest that detailed family histories be taken routinely and intend to analyse blood samples provided from this study for genetic abnormalities.
The after‐contraction in paediatric urodynamics
Authors: Hoebeke P.B. , Van Gool J.D. , Van Laecke E. , Vande Walle J. , Plancke H. 
Published: November 2003

Objective To evaluate the incidence and significance of the urodynamic registration of an after‐contraction in the bladder of children. Patients and methods In a prospective study, 250 children with a non‐neurogenic voiding dysfunction (132 girls and 118 boys) were assessed for the occurrence of after‐contractions during their video‐urodynamic examination, and any filling‐phase dysfunction noted. Twenty children in whom an after‐contraction was recorded underwent additional voiding cystometry with three pressure transducers in the bladder (two microtip and one external transducer connected to a fluid‐filled catheter). Results Of the 250 children, an after‐contraction was registered in 84 (63 girls and 21 boys). Eighty of thesehad a filling‐phase dysfunction; 51 had detrusor instability, 16 a hypersensitive bladder, six a low and seven a high compliance. Only four showed a normal cystometric pattern during filling. In the 20 children who underwent further study, the after‐contraction was confirmed as a detrusor contraction, as it was registered simultaneously on three transducers of two types in 10 children and on two microtip transducers in another 10 children. Conclusion The after‐contraction is a frequent occurrence in children with voiding dysfunction, is related to bladder instability and is a genuine detrusor contraction.