bluuebunny/crossref_metadata_2025_split huggingface dataset:
Docetaxel and zoledronic acid in patients with metastatic hormone‐refractory prostate cancer
Authors: Vordos Dimitri , Paule Bernard , Vacherot Francis , Allory Yves , Salomon Laurent , Hoznek Andras , Yiou René , Chopin Dominique , Abbou Claude Clément , De La Taille Alexandre 
Published: August 2004

OBJECTIVETo evaluate the safety and efficacy of combined docetaxel‐zoledronic acid treatment in patients with metastatic hormone‐refractory prostate cancer (HRPC), as bisphosphonates are reported have a synergistic antitumoral effect when combined with taxanes.PATIENTS AND METHODSBetween January 2001 and June 2003, 14 patients with HRPC were treated; their mean (range) age was 71 (57–86) years and mean prostate‐specific antigen (PSA) level 202  (6–489) ng/mL. Five patients had had previous chemotherapy (cyclophosphamide in two, mitoxantrone‐prednisolone in three). The response criteria were the Karnofsky performance status, a positive response in mean daily analgesic consumption (defined as a decrease by more than half), decreased serum PSA (by more than half) at 8 weeks, blood transfusion, bone scan at 6 months, skeletal‐related events and survival.RESULTSPatients received a mean (range) of 7.3 (6–10) cycles of therapy; there was no reported drug‐related toxicity and all patients stayed at home for their treatment. Only three patients required a blood transfusion and no bone fractures were reported. At 2 months, six patients requiring analgesic drugs decreased their consumption by more than half (anti‐inflammatory, paracetamol, narcotics) and eight had a reduction in PSA by more than half; of these eight with a PSA response at 2 months, six had biochemical progression with a mean delay of 6.2 (3–11) months. At 6 months, five patients had disease progression on bone scan. Nine patients had chemo‐naïve hormone‐refractory prostate cancer; three had biochemical progression at 2 months and two of these had progression on their bone scan. Two patients died at 7 and 15 months of follow‐up; the mean follow‐up was 10.2 (6–15) months. Using Kaplan‐Meier plots, biochemical progression‐free survivals were five of 14 at 6 months and two of 14 at 12 months; overall survival was 12 of 14 at 6 and 12 months.CONCLUSIONDocetaxel‐zoledronic acid therapy is safe and decreased the serum PSA by more than half at 2 months in more than half the patients. Prospective randomized trials are needed to assess this new approach.
Histopathological and immunohistochemical study of papillary urothelial neoplasms of low malignant potential and grade associated with extensive invasive low‐grade urothelial carcinoma
Authors: Mai Kien T. , Elmontaser Ghazi , Perkins D. Garth , Yazdi Hossein M. , Stinson William A. , Thijssen Anthony 
Published: August 2004

OBJECTIVETo report five cases of papillary urothelial neoplasm of low malignant potential (UNLMP) and papillary urothelial carcinoma of low grade (UCLG) associated with extensive muscle invasion, and to investigate the clinical and histopathological presentation and their immunohistochemical properties.MATERIALS AND METHODSConsecutive cystectomy and correlating transurethral resection (TUR) of urinary bladder tumour specimens were reviewed to identify cases of UCLG having extensive invasion into the urinary bladder wall. All specimens were stained immunohistochemically, as were those from 10 control cases having reactive urothelium or superficial UNLMP. The clinical charts were reviewed.RESULTSOf a total of 95 cystectomy cases there were four of UNLMP or UCLG with extensive invasion. An additional case was added from our consultation file. All five cases had biopsies misdiagnosed as benign lesions or prostatic adenocarcinoma. The superficial invasive components consisted of UCLG conforming to the previously described entities of nested transitional cell carcinoma (TCC), microcystic or deceptively benign‐appearing TCC. Immunostaining for cytokeratin 20, MIB‐1 and p53 was similar to reactive epithelia, whereas E‐cadherin immunoreactivity was slightly different, with focal negativity compared with extensive immunoreactivity in invasive vs noninvasive UCLG. Four patients developed distant metastases; three died within a follow‐up of 3 years.CONCLUSIONSUNLMP and UCLG that widely and deeply invade the bladder accounted for 4% of urothelial carcinoma (UC) in cystectomy specimens and commonly pose diagnostic problems in superficial TUR specimens. From this study with few cases the diagnosis of this entity in superficial biopsies is aided by an awareness of it and by identifying ‘benign appearing’ nests of urothelial cells which are deeply seated in the stroma. Immunostaining is unlikely to be very useful.
Health‐related quality of life after prostate brachytherapy
Authors: Miller Nicole L. , Theodorescu Dan 
Published: August 2004

Brachytherapy for prostate cancer has become a widely used treatment. Increasingly, urologists are becoming conscious of quality‐of‐life issues relating to treatment. This mini‐review by authors from the University of Virginia looks at this important issue, reminding readers that patients are often willing to choose a treatment which will less certainly ensure a longer life‐expectancy, but which will more certainly guarantee a better quality of life.Other mini‐reviews in this section describe the technique and complications of transurethral surgery for bladder tumours, the mechanisms of vasculogenic erectile dysfunction after renal transplantation, and laparoscopic radical cystectomy and urinary diversion.
Laparoscopic radical nephrectomy in the elderly
Authors: Varkarakis Ioannis , Neururer Richard , Harabayashi Toru , Bartsch Georg , Peschel Reichard 
Published: August 2004

Authors from Innsbruck present their work in laparoscopic radical nephrectomy in elderly patients. They evaluated the outcome of this technique in patients over 75 years old and compared the results with a similar number of patients aged less than 75 years who had the same procedure. Despite more comorbid conditions in the older group the final outcome was equally as good as in the younger patients.Hormone‐refractory prostate cancer is becoming a matter of great concern, and authors from Paris describe their experience with a combination of docetaxel and zoledronic acid in this condition. In this early report, they found the use of these agents to be promising, and recommend the setting up of a prospective randomized trial.OBJECTIVETo evaluate the efficacy and outcome of laparoscopic radical nephrectomy (LRN) in patients aged >75 years, and to compare the results with those obtained from patients younger than this undergoing laparoscopic surgery for the same indication.PATIENTS AND METHODSFrom a retrospective review of 33 patients aged >75 years undergoing LRN, 28 were for tumour. A group of 28 consecutive patients aged <75 years undergoing laparoscopy for the same indication were used for comparison. The two groups were compared for American Society of Anesthesiology (ASA) physical status score, comorbidity, previous surgical history, operative duration, estimated blood loss, tumour size, complications during and after surgery, conversion rates, time to oral intake and drain removal, perioperative mortality and hospital stay.RESULTSOnly the initial ASA score was significantly higher for the older patients. All other variables before, during and after surgery were similar for both groups.CONCLUSIONSThe final outcome of laparoscopic surgery in elderly patients was as promising as in their younger counterparts. Therefore, elderly patients should not be excluded from LRN, even though they usually present with more comorbidities.
Socio‐economic deprivation and survival in bladder cancer
Authors: Begum Gulnaz , Dunn Janet A. , Bryan Richard T. , Bathers Sarah , Wallace D. Michael A. ,   the West Midlands Urological Research Group
Published: August 2004

OBJECTIVESTo investigate the relationship between deprivation, delay and survival from bladder cancer in the West Midlands, as socio‐economic deprivation is associated with worse survival in many malignancies, and it has been suggested that treatment differences and delay in seeking care are major contributing causes.PATIENTS AND METHODSData were prospectively collected on 1537 newly diagnosed cases of urothelial cancer presenting in the West Midlands between January 1991 and June 1992. Survival was censored at 31 July 2000, when 785 (51%) patients had died. The influence of deprivation on survival was explored using cause‐specific and all‐cause mortality.RESULTSPatients in less affluent groups had significantly worse survival than patients in more affluent groups when considering deaths from all causes (P = 0.02), which held true when adjusting for independent prognostic factors (age, smoking history, and tumour grade, stage, type and size). Bladder cancer‐specific mortality showed no significant difference between socio‐economic groups (P = 0.30).CONCLUSIONSocio‐economic deprivation is a significant predictor of survival when death from all causes is considered. However, this does not hold true for bladder cancer‐specific death. The perceived differences in treatment and delay between socio‐economic groups do not seem to occur for bladder cancer in the West Midlands.
How long is urinary cytology abnormal after flexible cystoscopy?
Authors: McVey Rhona J. , Persad Ranjiv V. , Brown Stephen C.W. , Robinson Elaine , Payne Stephen R. 
Published: August 2004

OBJECTIVETo examine the urinary cytological changes caused by flexible cystoscopy and provide clinical guidelines for a reliable time interval for urinary cytological examination after flexible cystoscopy.PATIENTS AND METHODSForty‐eight patients attending for flexible cystoscopy were recruited into the study. Each patient was asked to provide eight urine samples before, immediately after and at 1, 2, 7, 14 and 28 days after cystoscopy. Cytospin preparations of the urine samples were made and slides stained using the Papanicolaou stain. Cytology was analysed while unaware of sample origin, by three different cytopathologists.RESULTSThe cytological changes were characterized by a striking increase in cellularity immediately after flexible cystoscopy, mostly accounted for by urothelial cells. Consistent morphological changes included the formation of ‘columnar’ cells, papillary clusters, increased nucleo‐cytoplasmic ratio and nuclear atypia. These changes were transient, with most disappearing within a day of flexible cystoscopy.CONCLUSIONSThere are cytological changes, on voided urine cytology, after flexible cystoscopy but they were transient, and urine sent more than a day after flexible cystoscopy should be free from artefactual change caused by instrumentation. These results suggest that clinicians sending urine for cytological analysis should provide information about the nature and timing of any endoscopy so as to avoid false‐positive interpretations of urine cytology by the cytopathologist.
Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy
Authors: Copson Ellen , McKendrick Joe , Hennessey Niklas , Tung Ken , Mead Graham Z. 
Published: August 2004

OBJECTIVETo review the clinical course and outcome of patients with germ cell cancer and liver metastases treated at one centre, as the presence of hepatic metastases, although rare, is a poor prognostic feature in germ cell cancer.PATIENTS AND METHODSThe case records of all patients with germ cell cancer and liver metastases at presentation, and treated with chemotherapy at a medical oncology unit between 1984 and 2001, were reviewed. The treatment regimens, tumour responses and patient outcome were recorded.RESULTSTwenty‐seven patients with germ cell cancer metastatic to the liver were identified. Complete biochemical and radiological responses were achieved in eight patients after initial chemotherapy and surgery for non‐hepatic residual disease. Seven patients had only residual radiological hepatic abnormalities with normal tumour markers at the completion of initial treatment. There were no immediate hepatic resections and no further therapy was given. Serial computed tomography (CT) confirmed a progressive reduction in the size of hepatic lesions in six of seven patients. The persistence of residual hepatic abnormalities was not predictive of relapse, and overall survival of these patients (median survival 49 months, range 15–120) compared well with recent reports of such patients who have undergone hepatic resection.CONCLUSIONSConservative management with regular assessment by CT is an acceptable alternative to immediate hepatic resection for patients with isolated residual radiological hepatic abnormalities on completing first‐line therapy for metastatic germ cell cancer, and does not adversely affect their survival.
An epidemiological study of patients with chronic prostatitis
Authors: Liang Chao‐Zhao , Zhang Xue‐Jun , Hao Zong‐Yao , Yang Sen , Wang De‐Bing , Shi Hao‐Qiang , Liu Chen 
Published: August 2004

OBJECTIVETo assess possible causes, clinical symptoms and improvements in treatment for chronic prostatitis in China.PATIENTS AND METHODSThe study comprised 3000 patients with chronic prostatitis (aged 20–59 years), selected from urological clinics at province, city and county levels in Anhui (a province in mid‐eastern China). Anonymous questionnaires were distributed which included 29 items to ascertain patient age, height, weight, educational background, personality, career, disease course, treatment status, prostatic fluid test and score of the National Institute of Health Chronic Prostatitis Symptom Index (NIH‐CPSI).RESULTSIn all, 2498 valid questionnaires were collected (response rate 83.3%); 78.2% of the patients were aged <40 years and there were fewer patients in groups of increasing age. Discomfort and pain in the pelvis was reported by 52.3%, pain on urination by 23.0%, sexual discomfort by 21.8%, urinary frequency by 65.8%, and voiding discomfort by 74.4%; 34.9% of men were satisfied with their previous treatment.CONCLUSIONIn China there are fewer patients with chronic prostatitis as age increases. The main symptoms were voiding dysfunction, e.g. frequent urination. The prevalence of pain, e.g. on urination, was significantly less than documented in other parts of the world. Most patients had used antibiotics to treat their prostatitis; generally the effect of treating prostatitis was unsatisfactory.
The British Association of Urological Surgeons Section of Endourology audit of laparoscopic nephrectomy
Authors: Keoghane Stephen R. , Keeley Francis X. , Timoney Anthony G. , Tolley David A. , Joyce Adrian , Downey Paul ,   the members of the BAUS Section of Endourology
Published: August 2004

The Section of Endourology of the BAUS present an audit of their experience with laparoscopic nephrectomy covering a 1‐year period. In this detailed analysis of results from 25 centres in the UK they found that results were similar to those reported in other parts of the world. They also showed that there was no difference in results between larger and smaller centres performing fewer than five cases per year, but suggest that this is a result of careful case selection and the use of mentors.OBJECTIVETo report the first UK national audit of laparoscopic nephroureterectomy, radical and simple nephrectomy.METHODSAll members of the British Association of Urological Surgeons (BAUS) undertaking laparoscopic nephrectomy were invited to submit prospectively collected data from their centres to a nationally established database, using a standard proforma. The period covered by the audit was 1 July 2001 to 30 June 2002. The indications for surgery, peri‐ and postoperative data, and some demographic details were collected.RESULTSData were received from 25 centres; 13 had undertaken five or fewer cases per year; 263 procedures were reported, including 20 of hand‐assisted nephrectomy. Most cases were for nonfunctioning kidneys, or renal cell carcinoma, with transitional cell cancer and stones forming a smaller proportion. The mean (range) operative duration was 173 (89–335) min. The median postoperative stay was 4 days, with a wide range reflecting clinical and other reasons for delayed discharge. Two deaths were reported, giving a mortality of 0.7%. The mean conversion rate was 5.7% and the mean complication rate 16.8%; these rates were no higher in centres undertaking fewer than five cases per year than in the centres with a greater volume.CONCLUSIONEncouragingly, this first UK audit of laparoscopic nephrectomy shows similar results to those published worldwide. The lack of any difference in outcome between smaller and larger centres may be explained by case selection and the use of mentors, as recommended by the BAUS Section of Endourology.
Role of multiphasic helical computed tomography in planning surgical treatment for pelvi‐ureteric junction obstruction
Authors: El‐Nahas Ahmed R. , Abou‐El‐Ghar Mohamed , Shoma Ahmed M. , Eraky Ibrahim , El‐Kenawy Mahmoud R. , El‐Kappany Hamdy 
Published: August 2004

OBJECTIVETo evaluate the role of multiphasic helical computed tomography (CT) in planning surgical treatment for pelvi‐ureteric junction obstruction (PUJO).PATIENTS AND METHODSMultiphasic helical CT was used in 60 consecutive patients (mean age 32 years, sd 13.72) with primary PUJO. The different images were interpreted before surgery by a urologist and radiologist. The number, type and relation of the crossing vessels to the PUJ were detected. Pyeloplasty (open or laparoscopic) was used in patients where there was a significant crossing vessel (i.e. > 2 mm in diameter and passing at the PUJ) or with ballooning of the renal pelvis. Endopyelotomy (antegrade or retrograde) was used in the other patients. Subjective and objective success rates were determined 3–6 months after treatment and then every 6 months.RESULTSHyperdense renal stones were detected in precontrast images in 15 patients, significant crossing vessels in 33 (55%), and anterior malrotation of the renal pelvis in 23 (38%; 19 associated with significant crossing vessels, i.e. ureterovascular hydronephrosis). A large para‐pelvic cyst compressing the PUJ and upper ureter was detected in one patient. Pyeloplasty was used in 45 patients, among whom the sensitivity of multiphasic helical CT in detecting crossing vessels was 97%, the specificity 92% and accuracy 96%. Uncomplicated endopyelotomy was used in 14 patients and percutaneous aspiration of the para‐pelvic cyst in one.CONCLUSIONMultiphasic helical CT can accurately delineate the spatial anatomy of the renal and peri‐renal area; it may be important in planning surgical treatment for PUJO, especially when endopyelotomy is considered.
An assessment of the use of a continent catheterizable stoma in female tetraplegics
Authors: Walsh Kilian , Troxel Scott A. , Stone Anthony R. 
Published: August 2004

OBJECTIVESTo evaluate the success of a continent catheterizable stoma in females with cervical spinal cord injury which resulted in neurogenic bladder dysfunction, the management of which may require clean intermittent catheterization despite altered hand function.PATIENTS AND METHODSSix female tetraplegic patients with a lesion at C7 or above (age range 12–22 years) had a continent catheterizable abdominal stoma formed as part of their bladder management. As an objective measure of effectiveness, the time to complete catheterization was assessed before and after surgery. A quality‐of‐life survey at a mean (range) of 44 (6–90) months was also evaluated.RESULTSAll six patients can catheterize while in their wheelchair. The mean (range) time required for catheterization decreased from 27 (10–40) to 7.8 (1–15) min after surgery. All six reported a significant improvement in continence, body image, independence, convenience, time saving and satisfaction.CONCLUSIONConstructing a continent catheterizable stoma is a valuable option in selected tetraplegic patients.
Parastomal hernia repair using the lateral approach
Authors: Ho Kossen M.T. , Fawcett Derek P. 
Published: August 2004

OBJECTIVETo review the results of repairing a parastomal hernia after ileal conduit formation, using the lateral approach.PATIENTS AND METHODSWe retrospectively assessed 18 patients (9%) who developed a parastomal hernia, from 211 who had an ileal conduit created between 1982 and 2001; 15 had a surgical repair using a lateral incision.RESULTSAll 15 patients resumed a normal diet 1 day after surgery; the median (range) hospital stay was 4 (2–14) days. In two patients with a large hernia and difficult repair the stomas became ischaemic and required refashioning. Only one of these two patients required complete conduit replacement. The median (range) follow‐up was 15 (1–72) months. A recurrence of the hernia was recorded in one grossly overweight patient.CONCLUSIONThe lateral approach obviates the need for laparotomy and stomal relocation, and enhances a quick return of bowel function and early recovery. However, extra care is needed in managing the very large and difficult hernia, to avoid compromising the ileal conduit. The success and complication rates of the current series are within acceptable limits and this technique can be included in the options for managing parastomal hernia.
The prevalence and nature of orgasmic dysfunction after radical prostatectomy
Authors: Barnas Jennifer L. , Pierpaoli Steven , Ladd Patricia , Valenzuela Rolando , Aviv Nadid , Parker Marilyn , Waters W. Bedford , Flanigan Robert C. , Mulhall John P. 
Published: August 2004

Section EditorMichael G. WylliePanel of AdvisorsIan Eardley, UKJean Fourcroy, USASidney Glina, BrazilJulia Heiman, USAChris McMahon, AustraliaBob Millar, UKAlvaro Morales, CanadaMichael Perelman, USAOBJECTIVETo define the type of orgasmic dysfunction in men after radical prostatectomy (RP), as absence of orgasm and orgasmic pain are recognized complaints, and changes in orgasm may lead to significant sexual dissatisfaction.PATIENTS AND METHODSUsing an unvalidated questionnaire, demographic, erectile function and orgasmic function questions were answered by 239 patients who had previously undergone a retropubic RP.RESULTSOf the 239 patients, 22% had no change in orgasm intensity, 37% reported a complete absence of orgasm, 37% had decreased orgasm intensity and 4% reported a more intense orgasm after RP than before. Pain during orgasm (dysorgasmia) occurred in 14% of the patients; in these respondents the pain reportedly occurred always (with every orgasm) in 33%, frequently in 13%, occasionally in 35%, and rarely in 19%. Most patients (55%) had orgasm‐associated pain for <1 min.CONCLUSIONSThese results indicate that orgasmic functional changes are relatively common after RP and are worth considering by clinicians and researchers.