bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tubularized‐incised urethral plate urethroplasty: is regular dilatation necessary for success?
Authors: Elbakry  
Published: March 2003

Objectives To report the results of the tubularized‐incised urethral plate repair of hypospadias.Patients and methods Twenty‐seven patients (mean age 8 years, range 6–18) had their hypospadias corrected using the tubularized‐incised urethral plate technique. Five patients had glanular, 16 had coronal, and two had recurrent hypospadias after a failed Mathieu repair, and four patients required a second‐stage repair. The urethral plate was incised in the midline and tubularized over a suitably sized stent. In patients who required second‐stage repair a Thiersch–Duplay neourethra was constructed from the hypospadiac orifice to the corona and the glanular urethra was constructed by tubularization of the incised urethral plate.Results The functional and cosmetic results were excellent. Of the first seven patients, four had a small fistula associated with meatal stenosis. By regular dilatation of the glanular urethra, all fistulae resolved spontaneously. Dilatation was instituted in all the remaining patients and no fistula or meatal stenosis occurred. Other complications included haematoma formation in one patient, urinary tract infection in another and frequent bladder spasm in two.Conclusions The tubularized‐incised urethral plate urethroplasty is a simple and versatile technique that provides an excellent cosmetic appearance of the glans. It can be applied not only for the primary repair of distal hypospadias, but also for re‐operation of recurrent hypospadias. The technique is ideal for constructing a glanular urethra when the Thiersch–Duplay operation is used to repair posterior hypospadias. Regular urethral dilatation is important in preventing adhesions between both sides of the incised plate, which can result in meatal stenosis and fistula.
Objective and subjective effects of treatment for testicular cancer on sexual function
Authors: Van Basten  , Van Driel  , Hoekstra  , Sleijfer  , Van De Wiel  , Droste  , Schraffordt Koops  , Mensink  
Published: March 2003

Objective To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction.Patients and methods Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity.Results In contrast to the surveillance group, BEP‐treated patients had higher follicle‐stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP‐treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities.Conclusions After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES‐evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.
Control of the unstable urinary bladder by graded thermoelectric cooling of the spinal cord
Authors: Callsen‐Cencic  , Mense  
Published: March 2003

ObjectiveTo evaluate local lumbosacral spinal‐cord cooling (a novel technique for neuromodulating urinary bladder reflexes) for its feasibility in possible clinical use, by determining the efficacy and the optimum temperature for suppressing reflex urinary incontinence in two rat models of neurogenic urinary bladder instability.Materials and methodsOveractivity of the detrusor muscle was induced by inflammation of the urinary bladder in a group of rats. A second group of rats was examined 6 weeks after complete midthoracic spinal cord transection, when all animals had developed neurogenic bladder hyper‐reflexia. The intravesical pressure, urethral pressure and electromyographic (EMG) activity of the external urethral sphincter (EUS) were recorded simultaneously during repetitive local cooling and re‐warming of the dorsal L6/S1 spinal cord segments, using a thermoelectric cooling device.ResultsSpinal cord cooling at L6/S1 had no influence on the recorded values at >26°C, but markedly suppressed detrusor contraction frequency at 21– 25°C. Cooling to <20°C completely and reversibly eliminated inflammation‐induced bladder contractions in rats with an intact neural axis and significantly reduced the contraction amplitudes (mean reduction 61%) and duration of contractions in spinally transected rats. Cooling simultaneously increased tonic EUS EMG activity and urethral perfusion pressure in both experimental groups, indicating closure of the urethral outlet. Cooling of adjacent spinal cord segments had no influence on bladder and urethral functions.ConclusionCooling the dorsal spinal cord at the origin of the parasympathetic innervation of the bladder can be used to reversibly suppress bladder instability with simultaneous closure of the urethral outlet. Therefore, local spinal cord cooling, e.g. as an implantable thermoelectric device, may offer a suitable method to treat detrusor overactivity and restore continence.
Angiogenic peptides in prostatic disease
Authors: Walsh  , Sherwood  , Dew  , Mulvin  
Published: March 2003

ObjectiveTo determine the value of measuring serum concentrations of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in patients with benign prostatic hyperplasia (BPH), advanced and localized prostate cancer, and thus assess the role of angiogenesis factors as markers of malignancy and the formation of metastasis.Patients and methodsSerum was obtained from 106 suitable patients who attended a routine clinic during the study period. A histological diagnosis was confirmed for each patient and a bone scan was positive in those with metastatic disease. The level of serum prostate specific antigen (PSA) was measured and the serum concentrations of VEGF and bFGF measured using a quantitative sandwich immunoassay technique.ResultsThere was a significant difference (1.6‐fold) in the serum concentration of bFGF between patients with local and advanced prostate cancer (P=0.006), but there was no significant difference for either of the growth factors between patients with BPH and metastatic prostate cancer (Mann–Whitney test).ConclusionThe serum levels of VEGF and bFGF could not be used to distinguish benign from malignant prostatic disease; the serum PSA level is of more value than either, but the serum concentration of bFGF may be of some value in differentiating patients with local and advanced malignancy.
Quantitative sensory and autonomic testing in male diabetic patients with erectile dysfunction
Authors: Wellmer A. , Sharief M.K. , Knowles C.H. , Misra V.P. , Kopelman P. , Ralph D. , Anand P. 
Published: March 2003

ObjectiveTo correlate abnormalities of nerve fibres in the lower limbs with erectile dysfunction in male diabetic patients, using a range of quantitative sensory and autonomic function tests.Patients and methodsThe study included 68 male diabetic patients with symptomatic erectile dysfunction and 11 matched diabetics without erectile dysfunction; none had clinical evidence of peripheral vascular disease or psychological disorder. Patients were evaluated with a symptom questionnaire based on the Michigan Neuropathy Screening Instrument questionnaire and examined clinically. Sural and peroneal nerve‐conduction studies, and quantitative sensory and autonomic tests (vibration, thermal, light‐touch thresholds, sensory and autonomic cutaneous axon‐reflexes) were used to detect nerve abnormalities in the lower limbs, which were correlated with erectile dysfunction.ResultsSymptoms of neuropathy were more common in the group with male erectile dysfunction (MED), but statistically significant only for neuropathic pain (53% MED, 18% nonMED, P<0.05, chi‐square test) and gastroparesis (44% MED, 0% nonMED, P<0.05). Tests of unmyelinated afferents (warming perception and capsaicin‐induced sensory axon‐reflex vasodilatation) were most often abnormal, sometimes with no other abnormalities on tests or neurological examination. However, abnormality of warm perception was not significantly different between groups (81% MED, 70% nonMED), suggesting that it is a poorer discriminant than abnormal sensory axon‐reflex vasodilatation (89% MED, 22% nonMED, P<0.001). The only other significant test difference was decreased sural nerve action potential (70% MED, 22% non‐MED, P<0.01).ConclusionsThere appeared to be preferential involvement of unmyelinated sensory fibres that mediate axon‐reflex vasodilatation in the limbs of diabetic patients with erectile dysfunction. This test appears to be a helpful indicator of neurological involvement in erectile dysfunction, and may be used to monitor the effect of new treatments.
Urinary tract infection after urodynamic studies in women: incidence and natural history
Authors: Bombieri  , Dance  , Rienhardt  , Waterfield  , Freeman  
Published: March 2003

ObjectiveTo study the incidence, natural history and symptomatic effects of bacteriuria after urodynamic studies in women.Patients and methodsIn a prospective study in the urogynaecology clinic of a large District General Hospital, 214 women (mean age 52.3 years, range 23–81) underwent urodynamic studies. Bacteriuria was detected by semiquantitative culture at 2 and 7 days after the test. Women completed a 7‐day diary of symptoms and events.ResultsThe incidence of bacteriuria after urodynamic studies was 7.9%. Bacteriuria was transient in four of 17 women but persisted in nine and developed late in four; only one of 17 infections gave rise to symptoms. Irritative bladder symptoms after the test occurred in 34% of women, but only three went to their doctors because of concern about a possible urinary tract infection. Advancing age was the only variable associated with bacteriuria after urodynamic studies (P=0.05). Menopausal status, past history of urinary tract infection, number of urethral instrumentations required, order number in a session, peak urinary flow rate and urodynamic diagnosis were not associated variables.ConclusionsIn a large series of women presenting to a urogynaecology clinic, urodynamic investigations were associated with a high incidence of transient irritative symptoms but a low incidence of bacteriuria (8%). Infection was asymptomatic in most patients, but its natural history was unpredictable. Transient, persistent and late cases of bacteriuria all occurred. In this population, urodynamic studies are associated with a low level of morbidity.
Natural‐fill urodynamics in chronically catheterized patients with spinal‐cord injury
Authors: Jamil  , Williamson  , Ahmed  , Harrison  
Published: March 2003

ObjectiveTo determine whether an indwelling catheter on free drainage provides a constantly low intravesical pressure in patients with a neuropathic bladder.Patients and methodsThirty patients with complete spinal‐cord injury (SCI) whose bladders were managed exclusively with an indwelling catheter were assessed urodynamically using natural‐fill urodynamics (ambulatory monitoring) while their catheters were left on free drainage. Their upper urinary tracts were assessed using plain X‐rays and ultrasonography.ResultsDetrusor contractions causing intravesical pressure rises of >40 cmH2O for up to 4.5 min were observed in 11 patients. Renal scarring was observed in nine patients; of these, six were in the group with contractions of >40 cmH2O, whereas only five of 21 patients with normal kidneys had such pressure rises.ConclusionAn indwelling catheter on free drainage is no guarantee of a constantly low intravesical pressure. This study provides evidence to suggest that there is an association between phasic bladder contractions which occur despite catheter drainage and upper urinary tract damage in permanently catheterized patients with SCI.
Establishment and characterization of seven human renal cell carcinoma cell lines
Authors: Shin K.‐H. , Ku J.‐L. , Kim W.‐H. , Lee S.‐E. , Lee C. , Kim S.‐W. , Park J.‐G. 
Published: March 2003

Objective To establish human renal cell carcinoma (RCC) cell lines, and to investigate the cell phenotypes and molecular characteristics of human RCC cell lines and their corresponding tumour tissues. Materials and methods Seven human RCC cell lines from pathologically proven RCCs were established. The histopathology of the primary tumours, in vitro growth characteristics and status of tumour suppressor genes, mismatch repair genes and microsatellite instability (MSI) were examined in cell lines and their corresponding tumour tissues. Five of the cell lines were derived from clear cells (SNU‐228, ‐267, ‐328, ‐349, and ‐1272), one from granular cells (SNU‐482), and one from mixed clear and granular cell types (SNU‐333). The mutational status was compared for von Hippel‐Lindau (VHL), p53, TGF‐β type II receptor (TGF‐βRII), hMSH2, and hMLH1 genes in the cell lines and their corresponding tumour tissues. The MSI status of the cell lines was determined by screening for adenine repeat sequences, e.g. BAT‐25, BAT‐26, and BAT‐40. Results All lines showed different doubling times and were confirmed by DNA fingerprinting analysis to be unique. Contamination by mycoplasma or bacteria was excluded. In two cell lines (SNU‐349 and ‐1272) and their tumour tissues, mutations in the VHL gene were found. The SNU‐267 line had a frameshift mutation in the p53 gene. A missense mutation of the TGF‐βRII gene was detected in the SNU‐1272 line and the corresponding tissue. Analysis of the repeat sequences showed one cell line (SNU‐349) to have MSI and the other six to have microsatellite stability. As MSI is a hallmark of the inactivation of mismatch repair genes, the presence of hMSH2 and hMLH1 mutations was investigated in all seven cell lines. An inactivating homozygous single base‐pair deletion of the hMLH1 gene was found only in the SNU‐349 cell line and corresponding tissue. Moreover, a frameshift mutation within an 8‐bp polyadenine repeat present in the hMSH3 coding region was found only in the MSI cell line and tumour tissue. Conclusion These newly established RCC cell lines should provide a useful in vitro model for studies related to human RCC. The SNU‐349 cell line should be especially useful for studies of MSI and mismatch repair‐defective RCCs.
Aneusomy of chromosomes 7 and 17 predicts the recurrence of transitional cell carcinoma of the urinary bladder
Authors: Watters A.D. , Ballantyne S.A. , Going J.J. , Grigor K.M. , Bartlett J.M.S. 
Published: March 2003

Objective To determine if changes in chromosome 7 and 17 copy number can be used to predict recurrence in patients with primary noninvasive (pTa) or superficially invasive (pT1) transitional cell carcinoma (TCC) of the urinary bladder. Patients and methods Tissue specimens for 129 tumours from 52 patients (38 men and 14 women) with pTa/pT1 TCC at first diagnosis were retrieved from pathology archives. All patient notes were accessed and disease outcome documented for superficial (pTa/pT1) recurrence or progression to detrusor muscle invasion ( pT2). The tumours were examined for chromosomal copy number of chromosomes 7 and 17 using fluorescence in situ hybridization (FISH) with chromosome‐specific probes. The copy number of chromosomes 7 and 17 was determined in interphase nuclei on intact 6 µm tissue sections. Results Aneusomy of chromosomes 7 and 17 was detected in the index primary tumours of 10 of 32 (31%) patients with subsequent recurrent disease. No aneusomy for these chromosomes was detected in primary tumours from 20 patients with no detect‐able recurrence (P = 0.0082). The relative risk of recurrence was 3.62 times greater (95% confi‐dence interval 1.6–8.1, Cox’s multiple regression P = 0.0019) for patients with chromosomal aneusomy in primary TCC. Neither stage nor grade of the primary tumours was associated with recurrence in these patients, nor was there a significant association with increased grade (G2/3) or stage ( pT2) at recurrence. Conclusion These results suggest that the measurement of aneusomy by FISH, using markers for chromosomes 7 and 17, predict recurrence in a subgroup of patients with pTa/pT1 tumours at presentation. This finding may offer a new objective and quantitative test for patients destined to recur.
Prostate selectivity of JTH‐601‐G1, an active metabolite of JTH‐601, in dogs
Authors: Suzuki Y. , Kanada A. , Okaya Y. , Kurahashi Y. , Kogayu M. , Kobayashi T. , Aisaka K. 
Published: March 2003

Objective To evaluate the effect of JTH‐601‐G1, an active metabolite and glucuronide conjugate of JTH‐601 (an α1‐adrenoceptor antagonist), on smooth muscle contraction in canine prostate and artery, and to examine the effect of JTH‐601‐G1 on prostatic urethral pressure and blood pressure in anaesthetized dogs.Materials and methods Male beagle dogs were used in both an in vitro and an in vivo study. In the former, the prostate and right common carotid artery were isolated, and smooth muscle strips from the prostate and open‐ring strips from the carotid artery prepared. The effects of JTH‐601‐G1 on phenylephrine‐ and noradrenaline‐induced contraction were assessed in these tissues. In the in vivo study, four dogs were anaesthetized and the change in urethral pressure, blood pressure and heart rate measured continuously. Vehicle (saline) and JTH‐601‐G1 were then infused intravenously in increasing doses (0.33–3.3 µg/kg/min for 30 min). In three other dogs, the effect of JTH‐601‐G1 infusion at a higher rate (25 µg/kg/min for 3 h) on blood pressure was evaluated, and the plasma concentration of JTH‐601‐G1 measured using high‐performance liquid chromatography‐mass spectrometry.Results Of the distinct metabolites of JTH‐601, JTH‐601‐G1 had the most potent α1‐adrenoceptor antagonistic effect in isolated canine prostate. JTH‐601‐G1 also antagonized α1‐adrenoceptor agonist‐induced contraction in common carotid artery, but the pA2 value in the artery was ≈25 times higher than that in the prostate. In anaesthetized dogs, JTH‐601‐G1 decreased urethral pressure in a dose‐dependent manner; at the highest dose, urethral pressure decreased by 24.5% and blood pressure by 7.0%. However, there was no significant change in heart rate at any dose. The plasma concentration of JTH‐601‐G1 increased with the dose of JTH‐601‐G1, but the concentration of both JTH‐601 and other metabolites was below the detection limit. The higher JTH‐601‐G1 infusion rate caused blood pressure to decrease by only 6–10% even at JTH‐601‐G1 plasma concentrations of ≈1500 ng/mL during the infusion. Although there was a negative correlation between mean blood pressure and plasma JTH‐601‐G1 concentration, the decrease in blood pressure was small compared with the reduction in urethral pressure.Conclusion JTH‐601‐G1 appears to be a major active metabolite of JTH‐601 but with a higher selectivity for canine prostate than artery. The results also indicate that in addition to the α1A‐adrenoceptor, the α1L‐adrenoceptor plays an important prostatic selective role in smooth muscle contraction via the α1‐adrenoceptor.
The changing pattern of mortality and morbidity from radical cystectomy
Authors: Rosario D.J. , Becker M. , Anderson J.B. 
Published: March 2003

Objectives To examine the morbidity and mortality of radical cystectomy as currently practised, and to compare the findings with historical data.Patients and methods The operative mortality and early and late complications were recorded in 101 consecutive patients (median age 65 years, range 38–81; 33 aged > 70 years) undergoing radical cystectomy between April 1992 and October 1997. Fifteen patients had relapsed after previous radical radiotherapy.Results The median postoperative stay was 14 days (range 8–44). There were two deaths within 60 days of surgery (of patients aged 46 and 59 years) from respiratory failure and sepsis, respectively. The mortality in the elderly was not more than in other age groups. The early morbidity included two cases of lower limb insufficiency, both in the salvage cystectomy group, where the morbidity was significantly higher than in those undergoing primary cystectomy (chi‐squared, P < 0.01). Three patients underwent early re‐exploration. There were four clinically significant episodes of deep vein thrombosis and two pulmonary emboli that were not fatal.Conclusion As currently practised, radical cystectomy is associated with a lower mortality (< 2%) and morbidity than described previously. The added morbidity of salvage cystectomy and the acceptable mortality of primary cystectomy suggests that the treatment of choice for muscle‐invasive disease is primary cystectomy, with external beam radiotherapy reserved for those patients unfit for major surgical intervention. Age alone should no longer be considered a contraindication to cystectomy.
The efficacy and parenchymal consequences of extracorporeal shock wave lithotripsy in infants
Authors: Lottmann H.B. , Archambaud F. , Traxer O. , Mercier‐pageyral B. , Helal B. 
Published: March 2003

Objectives To determine the efficacy of extracorporeal shock‐wave lithotripsy (ESWL) in young children and to evaluate, using renal scintigraphy, any possible adverse effects on renal parenchyma. Patients and methods From January 1991 to October 1998, 19 infants (aged 5–24 months) underwent ESWL for kidney urolithiasis using a Sonolith 3000 (14 kV, Technomed Corp, Lyon, France) or a Nova (14–20 kV, Direx Medical Systems, Paris, France) lithotripter. The treatment and its effects were evaluated using a physical examination, conventional imaging (plain abdominal X‐ray and ultrasonography) and renal scintigraphy 24 h before ESWL and again at least 6 months after the last session of treatment. Results Ten children were rendered stone‐free by ESWL after one session and 18 after two sessions. At the follow‐up (8 months to 8 years, mean 36 months) no hypertension was recorded and no acquired parenchymal damage was detected with conventional imaging. No scars or significant variation of differential function attributable to ESWL were identified on renal scintigraphy. Conclusion ESWL is clearly effective for treating infant urolithiasis. There were no renal parenchymal lesions associated with ESWL, even in previously damaged kidneys or after the treatment of staghorn calculi. A long‐term follow‐up (assessing blood pressure) is mandatory and renal scintigraphy before and 6 months after ESWL in infants is recommended to confirm these results in a larger series.