bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prevalence and predictors of psychological distress in patients with early localized prostate cancer
Authors: Bisson J.I. , Chubb H.L. , Bennett S. , Mason M. , Jones D. , Kynaston H. 
Published: March 2003

Objective  To determine the level of psychopathology, traumatic distress and quality of life in men with newly diagnosed clinically localized prostate cancer, the effect on these of a consultation in a combined‐specialist early‐prostate clinic, and predictors of psychopathology. Patients and methods  Eighty‐eight patients were recruited from the combined clinic; they completed a battery of questionnaires including the Hospital Anxiety and Depression Scale (HADS), the revised Impact of Event Scale (IES) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, before their first appointment. Two weeks later they completed the HADS, IES and a patient‐satisfaction survey. Results  The overall level of psychopathology varied among the questionnaires used, from 0% on the HADS depression scale, 8% on the HADS anxiety scale and 14% on the IES. Anxiety and traumatic stress symptoms were commoner than depressive symptoms. The quality‐of‐life scores showed a relatively good level of functioning. Pre‐morbid factors and disease status did not predict psychological distress. Younger age was mildly predictive of poorer psychological functioning. Anxiety symptoms reduced slightly after a joint clinic appointment, whereas depressive symptoms showed a slight increase. Conclusion  This study suggests that men with early localized prostate cancer have low levels of psychopathology overall. However, some men experience distressing psychological symptoms and it is important that future research is conducted to help develop clear guidelines on the optimal methods of detecting and managing men with prostate cancer who have mental health difficulties.
Detrusor after‐contractions in children with normal urinary tracts
Authors: Ruarte A.C. , Podestá M.L. , Medel R. 
Published: March 2003

Objective To assess the clinical significance of after‐contractions (A‐Cs) in children with normal urinary tracts. Patients and methods Urodynamic records obtained in 315 children with urinary infection or enuresis were reviewed retrospectively; 184 were selected for analysis of A‐Cs. All patients had normal urinary tracts and none showed signs of an overt neuropathy. The urodynamic method comprised standard measurements of pressures and flowmetry (42 had video‐urodynamic studies). Results After‐contractions occurred in 151 of the 184 patients; the incidence tended to decrease with age. The mean amplitude of the A‐Cs was 77.9 cmH2O; in 36% of the records it was higher than the voiding contraction. Residual urine was found in 12 of 151 records with A‐Cs, but in only one patient was such residual urine confirmed in control voids. The patterns were assessed in 131 patients: in 36% they resembled stop‐test responses, in 31% they were preceded by brief peaks of pressure or had jagged limbs, and in 33% they were grossly irregular. In 137 records the content of the bladder was estimated at the start of A‐Cs; in 51% the bladder was empty or had evacuated >95% of its content, in 39% 95–80% and in 10% <80%. In only 7% of the patients had the A‐Cs started after the voiding contraction had completely subsided. There was no difference in the incidence of A‐Cs in girls with enuresis (84%) and girls with a history of urinary infections (85%). Detrusor instability was detected in 81% of the children with A‐Cs and in 70% of those without; there was no correlation between the amplitudes of uninhibited detrusor contractions and of A‐Cs. Characteristic images of external sphincter activity were found in only three of 14 video‐urodynamic recordings with A‐Cs. Conclusions After‐contractions are common in children with normal urinary tracts but they tend to disappear with age. In clinical urodynamics they are of limited practical use because their appearance is unpredictable and there are artefacts related to recording the final phase of micturition. The relationship with detrusor instability may be explained as a coincidence of two common but unrelated findings, and A‐Cs are unrelated to urinary infection. External sphincter activity is not the only cause of A‐Cs and when it occurs it does not alter the course of voiding, as it does in neuropathic dysfunctions. As their clinical significance is uncertain, treatment of A‐Cs is not advocated.
Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis
Authors: Yeung C.K. , Sit F.K.Y. , To L.K.C. , Chiu H.N. , Sihoe J.D.Y. , Lee E. , Wong C. 
Published: March 2003

Objective To evaluate the diurnal and nocturnal bladder reservoir function in patients with refractory primary nocturnal enuresis (PNE). Patients and methods Ninety‐five children (68 boys, 27 girls, mean age 9.3 years) with significant PNE (3 wet nights/week) that was refractory to treatment with desmopressin ± an enuretic alarm were assessed using detailed recording of voiding frequency and urinary volume both day and night, natural filling cystometry during the day and continuous cystometry with simultaneous electroencephalogram monitoring during sleep at night. Results Patients could be broadly categorized into two groups. Group A comprised those with normal daytime urodynamics and functional bladder capacity (FBC) on detailed frequency‐volume recording, but who developed marked detrusor instability associated with a significant reduction in nocturnal FBC and small‐volume voiding only after sleep at night (33 patients, 35%); and group B, those with abnormal daytime urodynamics and with reduced FBC and small‐volume voiding both day and night, but who somehow managed to mask their bladder symptoms during the day (62 patients, 65%). There was no evidence of nocturnal polyuria in either group and the ratios of day : night urinary output volumes for type A and type B patients were 1.48 and 1.99, respectively. Conclusions A reduction in nocturnal FBC, either occurring only after sleep at night in association with the appearance of detrusor instability in patients with normal daytime urodynamics and FBC, or as a manifestation of occult voiding dysfunction or bladder outlet obstruction that affects the bladder reservoir function both day and night, appears to be a common factor and probably the main cause for a mismatch between nocturnal urine output and bladder storage capacity in patients with severe bed‐wetting that was refractory to treatment.
Radical prostatectomy in Britain and Ireland at the millennium
Authors: Ravichandran S. , Dasgupta P. , Booth C.M. 
Published: March 2003

Objective  To report a national questionnaire survey of all consultant urologists, providing a ‘snapshot’ of attitudes, current practice and referral patterns for radical prostatectomy (RP) in Britain and Ireland at the millennium. Methods  During 1999/2000 a simple questionnaire about RP was sent to the 487 urologists registered as full BAUS members. From 418 (86%) returns nine were excluded, to leave a study group of 409 urologists. Results  In all, 157 (38%) consultants were undertaking RP, whilst 252 (62%) were not; 29 (18.5%) performed > 20 operations/year, 44 (28%) undertook 11–20, but 84 (53.5%) carried out ≤ 10. During the survey period, 741 (51%) RPs were conducted in teaching hospitals and 724 (49%) in district general hospitals. Of the 252 not undertaking RP, 23 (9%) stated they wished to learn the technique. Conclusions  This questionnaire suggests that the number of urologists undertaking RP in the UK and Ireland has stabilized but confirms that over half perform ≤ 10/year; outcome data are now required. Any change towards concentrating cases will have significant consequences for patient distribution and resources.
Intravesical pH: a potentially important variable affecting efficacy and the further development of anthracycline chemotherapy for superficial bladder cancer
Authors: Harris N.M. , Duffy P.M. , Crook T.J. , Anderson W.R. , Sharpe P. , Hayes M.C. , Cooper A.J. , Solomon L.Z. 
Published: March 2003

Objective  To assess, using epirubicin‐sensitive and multidrug resistant (MDR) derivatives of human bladder cancer cell lines in vitro, the probable effect of intravesical pH changes, with and without the MDR antagonist verapamil, on the uptake, intracellular distribution and cytotoxicity of epirubicin during intravesical chemotherapy.Materials and methods  Incubations for cytotoxicity testing were carried out in buffered medium containing epirubicin, at pH values of 6.0–8.5, with verapamil where appropriate. The cytotoxicity of epirubicin, with and without verapamil, was determined using the tetrazolium cytotoxicity assay. Intracellular epirubicin fluorescence was assessed using flow cytometry and confocal microscopy. Flow cytometric total intracellular epirubicin fluorescence was measured at pH 6.0, 6.4, 6.8, 7.2, and 7.6, and confocal microscopy was carried out at pH 6.0 and 8.0. The MDR‐reversing agent verapamil was added at 100 µg/mL to some incubations.Results  Epirubicin cytotoxicity in resistant cell lines appears considerably enhanced by adding verapamil and further improved, especially in MDR cells, by alkalinization of the drug solution to pH 8.0. Flow cytometry results showed striking and consistent differences in epirubicin handling with pH. Sensitive cells can be induced to absorb considerably more drug at alkaline pH, whilst resistant cells show no such behaviour. Nuclear drug fluorescence was greater in sensitive cells at alkaline pH, but cytoplasmic drug fluorescence in the resistant cells was little changed by pH. Adding verapamil to resistant cells restored the sensitive phenotype of drug handling.Conclusion  Buffering epirubicin to an alkaline pH before intravesical application should increase its intrinsic cytotoxicity. The potential for synergy at certain drug combinations will be enhanced by applying these findings. MDR reversal and fatty acid augmentation of drug uptake are discussed as examples.
Prostatitis‐like symptoms: one year later
Authors: Nickel J.C. , Downey J.A. , Nickel K.R. , Clark J.M. 
Published: March 2003

Objectives  To re‐survey (after 1 year) men identified in 1999 as having perineal and/or ejaculatory pain/discomfort severe enough to suggest a clinical diagnosis of chronic prostatitis (using the National Institutes of Health‐Chronic Prostatitis Symptom Index, NIH‐CPSI), and to compare them with an age‐matched population of men who had no prostatitis‐like symptoms in the initial survey, to determine the effect of time on specific symptoms associated with the diagnosis of chronic prostatitis.Subjects and methods  A comprehensive questionnaire incorporating the pain and voiding domains of the NIH‐CPSI, and data on demographics, medical history, socio‐economic status, health‐seeking behaviour and a quality of life assessment, was sent to 67 men who had reported prostatitis‐like symptoms in the 1999 survey, and to 202 age‐matched controls (1 : 3) who reported no prostatitis‐like symptoms in the same survey.Results  Forty men (60%) with previous prostatitis‐like symptoms, i.e. a mean (sd) 1999 NIH‐CPSI pain score of 8.8 (0.4), and 119 (59%) of the control population completed and returned the survey. There was no difference in the 1999 demographics (P = 0.82) or NIH‐CPSI pain score (P = 0.49) between patients who returned the recent questionnaire and those who could not be located or declined to complete the survey. Fifteen men (38%) identified with prostatitis in 1999 did not report similar symptoms in 2000. The initial mean NIH‐CPSI pain score (0–21) for the men who had resolution of their prostatitis‐like symptoms was 7.5 (0.6); 1 year later it was 0.73 (0.3). Their mean age was 51.1 (3.9) years and mean duration of symptoms 1.1 (0.3) years. Those with persistent symptoms had an initial NIH‐CPSI pain score of 9.6 (0.5); 1 year later it was 8.68 (0.4), at mean age of 51.4 (2.5) years and duration of symptoms 2.2 (0.3) years. Four men (3%) in the control group who had no symptoms in 1999 reported prostatitis‐like symptoms in 2000; these men had a mean age of 52.5 (5.9) and NIH‐CPSI pain score of 7.0 (0.9).Conclusion  About a third of men reporting prostatitis‐like symptoms in the general population had resolution of their symptoms (usually those with a shorter duration and less severe symptoms) 1 year later. The severity of symptoms of men with persistent chronic prostatitis remained relatively unchanged over the year.
Experimental Escherichia coli epididymitis in rats: a model to assess the outcome of antibiotic treatment
Authors: Ludwig M. , Johannes S. , Bergmann M. , Failing K. , Schiefer H.G. , Weidner W. 
Published: March 2003

Objective  To assess the effect of initial antimicrobial therapy with a new highly potent quinolone (sparfloxacin) on the outcome of infection, especially acute and chronic inflammation, in a rat model of unilateral Escherichia coli epididymitis.Materials and methods  The study included 60 Sprague‐Dawley rats, each of which received 0.1 mL of an E. coli (0:6 strain) suspension (106 colony forming units/mL) injected into the right ductus deferens. At 24 h after infection an oral antimicrobial treatment with sparfloxacin was initiated in half of the animals. The rats were killed 14 days, 3 and 6 months after infection, and both epididymes and the prostate gland cultured to re‐isolate E. coli. To evaluate the grade of inflammation in both epididymes, histological variables, including acute and chronic inflammation and scar formation, were evaluated and a total inflammatory score, representing the sum of all variables, computed.Results  Whereas antimicrobial therapy eradicated the pathogen, in untreated animals the pathogen was detectable for up to 6 months after infection in the infected epididymis and/or the prostate gland, while the contralateral epididymis was sterile. The inflammatory reaction in the infected epididymis was significantly less in treated animals (P < 0.001). Subclinical nonbacterial inflammation was present in the contralateral epididymis.Conclusions  Although adequate antimicrobial treatment eradicated the pathogen and reduced the grade of epididymal damage, inflammation was not avoided. Subclinical inflammation of the contralateral epididymis may contribute to impaired fertility. These results indicate that an inflammatory reaction initiated by bacteria might persist as a nonbacterial process despite early therapy, or by bacteria undetectable by conventional culture techniques, and may compromise male fertility.
Validation of the ethanol breath test and on‐table weighing to measure irrigating fluid absorption during transurethral prostatectomy
Authors: Shipstone D.P. , Inman R.D. , Beacock C.J.M. , Coppinger S.W.V. 
Published: March 2003

Objective  To determine the agreement between on‐table weighing and the ethanol breath test in measuring the fluid absorption of patients during transurethral prostatectomy (TURP), and to assess the practicality of on‐table weighing in the clinical setting.Patients and methods  The absorption of irrigating fluid by the patient during TURP can lead to adverse sequelae, including cardiac stress. Despite modern techniques irrigant may still be absorbed and therefore methods to detect absorption are important. Most methods are impractical or inaccurate, but the expired ethanol technique and continuous on‐table weighing are more promising. TURP was undertaken in 44 men (mean age 71 years) using continuous flow 1.5% glycine/1% ethanol as the irrigating solution. Intraoperative irrigant absorption was calculated by the ethanol breath test, using published formulae. Absorption measured by the weighing machine was calculated as (weight gain + blood loss − fluid given), and blood loss by the Hemocue method.Results  The mean (sd) resected weight was 23 (14) g at a mean resection rate of 0.74 g/min. The mean (range) absorption using the balance was 456 (− 343 to 2486) mL, and using the ethanol breath test was 435 (44–2750) mL, with the mean of the differences being − 17 mL, with a 95% confidence interval (CI) of − 81 to −40, the 95% limits of agreement being − 389 to 356 mL (95% CI − 458 to − 337 and 297 to 418 mL).Conclusions  Both methods are comparable and measure irrigating fluid absorption to levels of accuracy that are useful clinically. Either method could (and should) be used in routine practice.
Holmium laser enucleation of the prostate can be taught: the first learning experience
Authors: El‐Hakim A. , Elhilali M.M. 
Published: March 2003

Objective  To present the initial experience of a senior urology resident with holmium laser enucleation of the prostate (HoLEP) and to address the difficulties encountered while learning this technique, describing the detailed operative technique and pitfalls.Patients and methods  Between July and August 2001, 27 patients were treated using HoLEP administered by one senior urology resident (A.H.) under the supervision of an experienced urologist (M.M.E.). Patients were assessed before and 1 month after HoLEP by the International Prostate Symptom Score (IPSS), the associated quality‐of‐life (QoL) score, and measurements of maximum urinary flow rate (Qmax) and postvoid residual urine (PVR) volume. The prostate volume was measured before HoLEP using transrectal ultrasonography. The 27 patients were compared retrospectively with 118 who underwent HoLEP by the supervising urologist. Each of the 27 procedures was taped and reviewed.Results  The mean (range) prostate size was 54.8 (21–122) mL (A.H.) and 61.7 (20.5–172) mL (M.M.E.). The mean operative duration was 98 (50–175) min and the mean enucleation time 68 (29–108) min. The improvements in IPSS, QoL score, Qmax and PVR were highly significant (P < 0.001), with mean values before and after HoLEP of 16.8 and 8.2, 3.1 and 1.4, 7.7 and 20.8 mL/s, and 232 and 41.3 mL, respectively. Of the 27 patients, 23 (85%) were catheter‐free on the first day after HoLEP; the mean hospital stay was 1.8 days. All these results were comparable with the results of 118 patients treated by M.M.E. The two most difficult technical steps identified were the initial apical enucleation and the incision of the remaining antero‐apical mucosal attachment of the lateral lobes. The operator became adept with the HoLEP technique after a mean of 20 patients.Conclusion  HoLEP can be learnt but requires longer training than standard transurethral resection. Extensive experience with transurethral surgery and the supervision of an experienced urologist are prerequisites for success.
Overexpression of cyclooxygenase‐2 in high‐grade human transitional cell carcinoma of the upper urinary tract
Authors: Oku S. , Higashi M. , Imazono Y. , Sueyoshi K. , Enokida H. , Kubo H. , Yonezawa S. , Shirahama T. 
Published: March 2003

OBJECTIVETo examine cyclooxygenase (COX)‐2 expression (a key enzyme in the synthesis of prostaglandins, and involved in carcinogenesis of human epithelial tumours) in human transitional cell carcinomas (TCCs) of the renal pelvis and ureter, and to determine whether COX‐2 expression correlates with the clinicopathological characteristics of the disease.MATERIALS AND METHODSSpecimens from 144 patients with TCC of the upper urinary tract who had undergone nephroureterectomy were analysed immunohistochemically, and 23 were also analysed by immunoblotting.RESULTSImmunoblot analysis showed COX‐2 immunoreactivity in 17 (74%) of 23 tumours, but not in normal transitional epithelium. COX‐2 was localized to the cytoplasm of cancer cells and expressed in 108 (75%) of 144 tumours, as assessed by immunohistochemical analysis. COX‐2 expression correlated with tumour grade (P < 0.008), being detected in one of nine grade 1, 77 (79%) of 97 grade 2 and 30 (79%) of 38 grade 3 tumours. Other variables including tumour stage were not associated with COX‐2 expression.CONCLUSIONSWe show for the first time that COX‐2 is frequently expressed in TCC of the upper urinary tract and is associated with the degree of tumour cell differentiation, indicating that COX‐2 may be involved in TCC carcinogenesis at an early and/or late stage, and could be a useful target for chemoprevention of this type of cancer.
A prospective and randomized study of primary hormonal therapy for patients with localized or locally advanced prostate cancer unsuitable for radical prostatectomy: results of the 5‐year follow‐up
Authors: Akaza H. , Homma Y. , Okada K. , Yokoyama M. , Usami M. , Hirao Y. , Tsushima T. , Ohashi Y. , Aso Y. ,   The Prostate Cancer Study Group
Published: March 2003

OBJECTIVETo evaluate the effect of primary hormonal therapy for patients with localized and locally advanced prostate cancer.PATIENTS AND METHODSPatients with stage T1b–T3 prostate cancer who were not scheduled for radical prostatectomy were allocated into two groups: group 1 (73 men) received luteinizing hormone‐releasing hormone (LHRH) agonist monotherapy and group 2 (78 men) received LHRH agonist and chlormadinone acetate. Patients were followed using serum prostate specific antigen levels, prostate size and the detection of distant metastasis for 5 years.RESULTSThe median (range) follow‐up was 78 (63–87) months. The 5‐year progression‐free survival rate was significantly higher in group 2 (68%) than in group 1 (47%). However, the overall and cause‐specific survival rate at 5 years were similar in both groups, at 72% and 93% in group 1, and 64% and 89% in group 2, respectively.CONCLUSIONThe overall survival rates of the both groups were no different from that of the normal Japanese population of the same age group. Although this study did not include an untreated group, i.e. watchful waiting, these results might indicate the usefulness of primary hormonal therapy in controlling localized and locally advanced prostate cancer. The 5‐year observation period is still short and the study is continuing to determine the 10‐year survival.
Incidence of physician‐diagnosed interstitial cystitis in Olmsted County: a community‐based study
Authors: Roberts R.O. , Bergstralh E.J. , Bass S.E. , Lightner D.J. , Lieber M.M. , Jacobsen S.J. 
Published: March 2003

OBJECTIVETo obtain community‐based information about the incidence of interstitial cystitis, a chronic disabling condition of the bladder where knowledge is limited because there are no definitive diagnostic criteria.PATIENTS AND METHODSAll residents of Olmsted County, MN, USA who had received a physician‐assigned diagnosis of interstitial cystitis between 1976 and 1996 were identified through the resources of the Rochester Epidemiology Project. The clinical findings at diagnosis and during the follow‐up were ascertained from the community medical records for each study subject.RESULTSIn all, 16 women and four men received a diagnosis of interstitial cystitis during the study period. The overall age‐ and sex‐adjusted (95% confidence interval) incidence rate was 1.1 (0.6–1.5) per 100 000 population. The age‐adjusted incidence rates were 1.6 per 100 000 in women and 0.6 per 100 000 in men (P = 0.04). The median (range) age at initial diagnosis was 44.5 (27–76) years in women and 71.5 (23–79) years in men (P = 0.26). The median number of episodes of care‐seeking for symptoms before the diagnosis was one for women and 4.5 for men (P = 0.03). The median duration from the onset of symptoms until the first diagnosis was 0.06 and 2.2 years in women and men, respectively (P = 0.2).CONCLUSIONSThese findings suggest that the incidence of interstitial cystitis in the community is extremely low. Although the gender difference may be real, the trend toward a later diagnosis in men than in women suggests a potential for missed diagnosis in men. This might explain some of the gender difference in the incidence of interstitial cystitis in men and women.