bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: incidence and risk factors
Authors: Sved Paul D. , Gomez Pablo , Nieder Alan M. , Manoharan Murugesan , Kim Sandy S. , Soloway Mark S. 
Published: October 2004

The considerable experience of the University of Miami in treating TCC is reviewed in the first article in this section. The authors found that the incidence of upper tract tumour after radical cystectomy for TCC is low, but that patients with prostatic urethral involvement at cystectomy have a greater risk of developing upper tract tumours.A questionnaire‐based study in the UK attempted to assess how upper tract surveillance is carried out by British urologists in patients with urinary tract TCC. They found a wide variation in practice, which presumably is similar to that also found in other parts of the world. They recommend a follow‐up strategy and suggest that this surveillance should continue for at least 15 years.There is an evaluation of the long‐term results of salvage cystectomy after interstitial radiotherapy and external beam radiotherapy for TCC reported from Amsterdam. They found that salvage cystectomy gives acceptable morbidity and for any type of urinary diversion.OBJECTIVETo review the incidence, pattern and outcome of upper tract transitional cell carcinoma (TCC) after radical cystectomy for carcinoma of the bladder, and identify risk factors for its development.PATIENTS AND METHODSThe records of 235 consecutive patients who had a radical cystectomy and urinary diversion for TCC at the authors’ institution by one surgeon between January 1992 and August 2003 were retrospectively reviewed.RESULTSFive (2%) of 235 patients developed an upper tract urothelial tumour. The mean follow‐up for all patients was 42 months, and was 52.2 months for those with an upper tract tumour. Four of the five patients presented with haematuria and one was diagnosed on routine follow‐up intravenous urography. The mean time to the diagnosis of an upper tract tumour was 39.6 months. Of the potential risk factors, only the presence of TCC of the prostatic urethra had a statistically significant association with eventual upper tract tumour (P < 0.01). At the last follow‐up, four patients died from urothelial cancer and one was disease‐free.CONCLUSIONSThe incidence of upper tract tumour after cystectomy for TCC is low; most patients present with symptoms (haematuria) and have advanced disease at diagnosis. Patients with prostatic urethral involvement at cystectomy are at greater risk of developing upper tract tumour.
The total percentage of biopsy cores with cancer improves the prediction of pathological stage after radical prostatectomy
Authors: Winkler Mathias H. , Khan Farooq A. , Kulinskaya Elena , Hoh Ivan M. , McDonald Donald , Boustead Gregory , Kaisary Amir V. 
Published: October 2004

OBJECTIVETo examine whether the simple variable ‘percentage of cancer‐positive biopsy cores’ is a significant predictor of true pathological stage after radical prostatectomy and can be used to improve pathological stage prediction by simple means.PATIENTS AND METHODSIn all, 375 patients had a radical prostatectomy for localized prostate cancer in two UK centres; 260 had complete preoperative staging information. Logistic regression was used and predicted probability graphs constructed to assess predictors of pathological stage.RESULTSIn this study, only PSA (P = 0.004) and percentage cancer‐positive biopsy cores (P < 0.001) were significant predictors of pathological stage. The final model was an acceptable classifier for pathological stage (area under the receiver operating characteristic curve 0.76, specificity 85%, sensitivity 47%). A patient with a PSA of 10 ng/mL and one of six cores positive for cancer would have a predicted probability of extraprostatic disease of 20%, whereas the same patient with all six biopsy cores positive would have a predicted probability of extraprostatic disease of 80%.CONCLUSIONSThe percentage of cancer‐positive biopsy cores significantly predicts the disease stage after radical prostatectomy. This variable is easy to obtain by the clinician and avoids the need to estimate the percentage of biopsy tissue infiltrated by cancer. This readily available information can easily be computed and may help to counsel patients about realistic expectations of organ‐confined disease in relation to surgery as a treatment option.
Comparison of doxazosin with or without tolterodine in men with symptomatic bladder outlet obstruction and an overactive bladder
Authors: Lee Ji Youl , Kim Hyun Woo , Lee Seung Ju , Koh Jun Sung , Suh Hong Jin , Chancellor Michael B. 
Published: October 2004

In a study of patients with BOO and an overactive bladder, authors from Seoul and Pittsburgh compared the use of doxazosin with or without tolterodine. The combination of the two drugs was helpful in most patients, but doxazosin alone was also effective.The impact of controlled‐release delivery of drugs on patient comfort has been considerable. The paper by authors from Germany and the USA describes the effect of the leader in this field on the pharmacokinetics of oxybutynin at different dosages. They confirm that this technology facilitates the severity‐dependent treatment of the overactive bladder with flexible‐dose adaptations to patient requirements.There are two papers on virtual cystoscopy, in one case using CT and in the other IVU. The authors report that virtual cystoscopy is valuable in investigating patients, drawing attention to its benefits and shortcomings.OBJECTIVETo assess the efficacy of combined treatment with doxazosin and tolterodine, as although α‐blockers are commonly used and generally effective in men with symptomatic bladder outlet obstruction (BOO), a subset of men with BOO and overactive bladder (OAB) symptoms often complain of persistent symptoms.PATIENTS AND METHODSIn a prospective study of 144 consecutive men with BOO at one tertiary urology centre, all had a baseline pressure‐flow urodynamic study and were then subdivided into those with BOO or BOO + OAB, based on absence or presence of involuntary detrusor contractions. The Abrams–Griffiths nomogram was used to determine obstructive BOO. After the initial evaluation, all patients were treated with doxazosin 4 mg/day for 3 months. In patients with no symptomatic improvement, tolterodine 2 mg twice daily was added for an additional 3 months.RESULTSOf the 144 patients, 76 (53%) were diagnosed as having BOO and 68 (47%) BOO + OAB. The patients with BOO + OAB were older (P < 0.05) and had a higher International Prostate Symptom Score. After 3 months of treatment with doxazosin, 60 (79%) with BOO and 24 (35%) BOO + OAB reported a symptomatic improvement. In those patients with no improvement, six of 16 with BOO and 32 of 44 (73%) with BOO + OAB improved after adding tolterodine. Acute urinary retention developed in only two of 60 men (3.3%) treated with the combined therapy.CONCLUSIONSAbout half of men with symptomatic BOO had an OAB; while about three‐quarters of men with symptomatic BOO and no OAB improved with doxazosin, only a third with BOO + OAB were helped with doxazosin alone. Combining tolterodine with doxazosin was effective in three‐quarters of men with BOO + OAB. Overall, most men with BOO with or with no OAB were helped with doxazosin alone or with the addition of tolterodine.
Effect of controlled‐release delivery on the pharmacokinetics of oxybutynin at different dosages: severity‐dependent treatment of the overactive bladder
Authors: Preik Michael , Albrecht Detlef , O'Connell Martin , Hampel Christian , Anderson Rodney 
Published: October 2004

OBJECTIVETo assess the pharmacokinetics of a controlled‐release formulation of oxybutynin (OROS®‐O, ALZA Corp., Mountain View, CA) at different dosages, compared with immediate‐release oxybutynin (IR‐O), and to determine the pharmacodynamic properties in the severity‐dependent reduction of urge urinary incontinence (UUI).PATIENTS AND METHODSIn all, 105 patients were enrolled in this multicentre, randomized, double‐blind study. Individual dose titration was used to assess the minimum effective, maximum tolerated or maximum allowed dose of either OROS‐O or IR‐O. Blood samples were collected during maintenance therapy with frequent sampling to analyse for R‐oxybutynin and R‐desethyloxybutynin concentrations. Pre‐dose plasma levels before dosing were obtained as the minimum concentrations achieved at steady state during the dosing regimen. In parallel, UUI episodes were assessed at baseline and during maintenance therapy at the final dose level.RESULTSFor both IR‐O and OROS‐O, initial R‐oxybutynin plasma concentrations increased in a dose‐dependent fashion. For comparable dosages pre‐dose plasma levels were higher for OROS‐O than IR‐O. After one dose of IR‐O plasma concentrations peaked at ≈ 27‐fold after 1 h and decreased to baseline levels within 4–8 h. In contrast, plasma concentrations of R‐oxybutynin remained constant for up to 24 h after taking OROS‐O at all doses. The overall percentage reduction in weekly UUI episodes was 84% (to 4.8 episodes) and 88% (to 3.1 episodes) for OROS‐O and IR‐O, respectively (P < 0.05). Patients who titrated to final dose levels of 10, 15 and 20 mg OROS‐O differed in their weekly UUI episodes at baseline (14.5, 30.3 and 42.0). Because of individual dose titration, UUI episodes/week were profoundly reduced at all applied doses (1.9–2.0, respectively). Fewer patients reported moderate to severe dry mouth with OROS‐O than with IR‐O (25% vs 46%, P < 0.05).CONCLUSIONThe pharmacokinetics of OROS‐O are proportional to dose, with minimal fluctuations between peak and trough concentrations, as associated with IR‐O. In clinical practice OROS‐O may thus facilitate the highly effective severity‐dependent treatment of UUI with flexible dose adaptations based on the patients’ needs.
Virtual cystoscopy from computed tomography: a pilot study
Authors: Nambirajan Thiagarajan , Aslam Sohaib Syed , Muller‐Pollard Christopher , Reznek Rodney , Chinegwundoh Frank I. 
Published: October 2004

OBJECTIVETo assess the feasibility of virtual cystoscopy reconstructed from helical computed tomography (CT) obtained using an intravenous contrast agent, and to correlate the findings with flexible (FC) and rigid cystoscopy (RC) in patients with bladder tumours.PATIENTS AND METHODSEighteen patients (16 men and two women, mean age 72 years, range 59–80) with haematuria and found to have a bladder tumour on FC were included in a pilot study. Contrast‐enhanced helical CT scans were taken and based on these datasets, virtual cystoscopy (VC) images were reconstructed by a radiologist unaware of the findings at cystoscopy. All patients had RC and a biopsy taken. The VC images were compared with the findings from FC and RC.RESULTSAt FC, VC and RC, 32, 34 and 36 lesions were identified, respectively; 33 (92%) of the abnormal lesions at RC were correctly identified at VC. At VC, all lesions of >4 mm were identified but only one of three <4 mm was seen. There were two false‐positive finding at VC; VC correctly identified 17 (94%) of 18 abnormal bladders. Only 25% of the ureteric orifices were seen. Carcinoma in situ and urethral tumours were not visualized.CONCLUSIONCT‐based VC has a high sensitivity for detecting bladder lesions and is comparable with FC; it may have a potential role as a single imaging tool for haematuria. Further larger studies are required to assess its clinical role.
The management of haemorrhagic cystitis with sodium pentosan polysulphate
Authors: Sandhu Sarbjinder S. , Goldstraw Miles , Woodhouse Christopher R.J. 
Published: October 2004

OBJECTIVETo assess the use of sodium pentosan polysulphate (SPP) for haemorrhagic cystitis (HC), a potentially life‐threatening side‐effect in patients treated with pelvic radiotherapy or cyclophosphamide, and which can be difficult to manage as patients often have significant comorbidity.PATIENTS AND METHODSBetween September 1991 and December 2000, 60 consecutive patients (24 women and 36 men) with haemorrhagic cystitis were primarily treated with SPP; 53 patients had had radical radiotherapy for pelvic malignancy and seven systemic cyclophosphamide. All patients were screened for blood dyscrasia and residual/primary urothelial malignancy with imaging, urine cytology and cystoscopy.RESULTSIn all, 51 patients were available for follow‐up; the median (range) interval between completing treatment and developing haematuria was 4.5 (0.08–39.4) years, the duration of treatment 180 (21–1745) days and patients were followed for 450 (19–4526) days from the onset of haematuria. All patients were started on SPP at an initial dose of 100 mg three times daily. In 21 patients the dose was gradually reduced to a maintenance dose of 100 mg and in 10 further patients SPP was stopped because the haematuria stopped completely. Twenty patients died while on treatment from causes not directly related to their haematuria.CONCLUSIONWe recommend the use of SPP as the primary method of managing haemorrhagic cystitis associated with pelvic radiotherapy or systemic chemotherapy.
Upper pole access for complex lower pole renal calculi
Authors: Aron Monish , Goel Rajiv , Kesarwani Pawan K. , Seth Amlesh , Gupta Narmada P. 
Published: October 2004

Authors from New Delhi assessed the efficacy of superior pole access for complex lower pole calyceal calculi; they found this to be the best way of approaching such complex stones, allowing faster and better clearance with a single puncture.The second paper in this section is from authors from the UK who set out to describe the frequency of renal symptoms and complications in patients with tuberous sclerosis complex, and to relate the history of renal haemorrhage with renal lesions identified on renal scan.OBJECTIVESTo assess the efficacy of superior pole access for complex lower pole calyceal calculi.PATIENTS AND METHODSIn all, 102 patients with complex inferior calyceal calculi were included in a prospective unrandomized study. Complex inferior calyceal calculi were defined as multiple calculi in two or more inferior calyces of the lower polar group, with each calyx draining through a separate infundibulum and at an acute angle to each other. In 33 patients (32%; group 1) an inferior calyceal puncture was made and in 69 (68%; group 2) access was obtained through a superior calyceal puncture. The stone‐free rates, decrease in haemoglobin, operative duration, requirement for additional tracts and second procedures in the two groups were compared.RESULTSStone clearance rates and blood loss values were better in group 2, although they were not significantly different. The mean operative duration, number of tracts required and the re‐look procedure rate was significantly less in group 2. Two patients (3%) in group 2 had hydrothorax related to supracostal puncture and required chest tube insertion.CONCLUSIONSSuperior calyceal puncture (supracostal or infracostal) affords optimum access to complex inferior calyceal stones, providing faster and better clearance with a single puncture, and less requirement for second‐look procedures.
Efficacy and safety of tadalafil in a Western European population of men with erectile dysfunction
Authors: Eardley Ian , Gentile Vincenzo , Austoni Edoardo , Hackett Geoff , Lembo Danilo , Wang Christine , Beardsworth Anthony 
Published: October 2004

Section EditorMichael G. WylliePanel of AdvisorsIan Eardley, UKJean Fourcroy, USASidney Glina, BrazilJulia Heiman, USAChris McMahon, AustraliaBob Millar, UKAlvaro Morales, CanadaMichael Perelman, USAOBJECTIVETo evaluate, in a randomized, double‐blind, placebo‐controlled, multicentre trial, the safety and efficacy of on‐demand tadalafil (an oral phosphodiesterase type‐5 inhibitor approved in many countries for treating erectile dysfunction, ED) in a Western European population of men with mild‐to‐severe ED.PATIENTS AND METHODSPatients were randomized according to baseline severity of ED in a ratio of 3 : 1 to receive either tadalafil 20 mg or placebo for 12 weeks. Primary efficacy endpoints were mean changes from baseline to endpoint (12 weeks) in the erectile function (EF) domain of the International Index of Erectile Function (IIEF) and percentages of ‘Yes’ responses to Sexual Encounter Profile (SEP) diary Question 2 (‘Were you able to insert your penis into your partner's vagina?’) and Question 3 (‘Did your erection last long enough for you to have successful intercourse?’). Secondary endpoints included mean changes from baseline to endpoint in IIEF Intercourse Satisfaction and Overall Satisfaction domains, selected questions of the IIEF, and the percentage of ‘Yes’ responses to Global Assessment Questions (GAQ) at the last visit. Other analyses included the percentage of patients in each treatment group at endpoint with IIEF EF domain scores in the normal range (>26), the frequency of intercourse attempts and mean per‐patient intercourse success rate at various times after dosing.RESULTSThe mean age of the patients was 53 years and 80% had a history of ED of ≥ 1 year. The mean baseline EF domain score was 13.5, with 40.5% of patients in the severe category. Tadalafil improved mean EF domain scores by 11.1, vs 0.4 for placebo (P < 0.001). In addition, 73.9% of sexual intercourse attempts were successful (SEP‐Q3) in tadalafil‐treated patients, compared with 29.9% in placebo‐treated patients during the period after baseline (P < 0.001). Tadalafil significantly improved the mean IIEF intercourse satisfaction (5.1, tadalafil; 1.1, placebo) and overall satisfaction domain scores (3.9, tadalafil; 0.5, placebo), P < 0.001. GAQs used to assess the overall effect of the treatment indicated that tadalafil was superior to placebo (P < 0.001) in improving erections (82.1%, tadalafil; 23.1%, placebo) and sexual activity (78.6% and 17.3%). The most common treatment‐emergent adverse events more frequent (>2%) with tadalafil than placebo were headache, dyspepsia, flushing, back pain, pain in limb and myalgia. These adverse events were mostly mild to moderate.CONCLUSIONSTadalafil improved erectile function and was well tolerated when taken by men from Western Europe with mild‐to‐severe ED.
Sacral ratio and fecal continence in children with anorectal malformations
Authors: Macedo Mauricio , Martins José L. , Freitas Filho Luiz G. 
Published: October 2004

OBJECTIVETo evaluate the sacral ratio (SR) in patients with an anorectal malformation (ARM) and verify whether it has predictive value for fecal continence.PATIENT AND METHODSFrom January 1990 to April 2002, 42 patients (aged 3–14 years) with an ARM and having already been operated on were reassessed and enrolled in the study. Patients with solid or paste‐like stools but no soiling were deemed continent, those with similar stool and episodes of soiling partially continent, and those with no sphincter control, incontinent. The fecal continence was always analysed by the same observer. Sacral radiographic images were reviewed and the SR calculated from anteroposterior and images in the lateral position. All images were obtained before surgery and analysed by the same observer, while a third analysed the results. Results were considered statistically significant at P < 0.001.RESULTSSeventeen patients were deemed continent, seven partially continent and 18 incontinent; there was no significant difference in SR among the three groups. When fecal continence was analysed in relation to changes in the findings on computed tomography of the lumbosacral spine, patients with sacral agenesis had a significantly higher frequency of fecal incontinence than the others, and all had a SR below ‘normal’.CONCLUSIONAlthough the SR was different in patients with sacral agenesis it was no different in continent, partially continent or incontinent patients, and thus it is of no practical value in identifying patients likely to have fecal incontinence.
Measurement of bladder compliance can be standardized by a dimensionless number: theoretical perspective
Authors: Wahl Edward F. , Lerman Steven E. , Lahdes‐Vasama Tuija T. , Churchill Bernard M. 
Published: October 2004

OBJECTIVESTo: (i) calculate traditional compliance (CTrad) for a normal bladder by ΔV/ΔPdet, where ΔV is the mean volumetric capacity and ΔPdet is the detrusor pressure rise; (ii) assess its usefulness; (iii) identify the variables that are necessary for correctly assessing bladder compliance; and (iv) using these variables, report a method that, because it includes the effect of patient age, sex and size, correctly assesses compliance for management strategies.METHODSWe obtained the mean volumetric capacity of a normal bladder (Vcap,NL) and the mean detrusor pressure rise (Pcap,NL) on filling a normal bladder to its volumetric capacity from our and other published work; (ii) calculated CTrad for a normal bladder; (ii) showed that the variables necessary for assessing compliance correctly are ΔV, ΔPdet, Vcap,NL, and Pcap,NL; and (iii) showed that the relationship among these is the dimensionless number, NWahl−1, calculated as (ΔV/Vcap,NL)/(ΔPdet/Pcap,NL). This value for individuals with a normal bladder was calculated, tabulated and graphed.RESULTSBecause a normal individual's bladder capacity increases with age while the detrusor pressure increase does not, CTrad increases with age and therefore cannot be used for assessing compliance. Published data substantiate our result that CTrad for an individual with a normal bladder varies from 6.3 at 0.5 years old to 90 mL/cmH2O at 18 years old. NWahl−1 correctly assesses bladder compliance because it is the same for all normal cases; consequently NWahl−1 is more practical for clinical use.CONCLUSIONSBladder compliance is standardized using ΔV, ΔPdet, Vcap,NL, and Pcap,NL to give NWahl−1, and bladder compliance is usefully reported using this value.
Measurement of bladder compliance can be standardized by a dimensionless number: clinical perspective
Authors: Wahl Edward F. , Lerman Steven E. , Lahdes‐Vasama Tuija T. , Churchill Bernard M. 
Published: October 2004

OBJECTIVETo devise a new, practical and more accurate method for measuring bladder compliance, and to show that traditional estimates of compliance are impractical.MATERIALS AND METHODSChildhood bladder capacity varies greatly with age while detrusor pressure in a normal bladder does not. Consequently, traditional bladder compliance (ΔV/ΔP) increases with age, i.e. maturation. Therefore we devised a standard method that includes normal values of pressures and volumes to calculate and report bladder compliance in children, and that also applies to adults. A dimensionless number (NWahl−1) was computed for standardizing bladder compliance, comparing the normalized capacity to normalized pressure by the ratio (ΔV/Vcap,NL)/(ΔP/Pcap,NL), where ΔP is the pressure at bladder capacity, ΔV the volume at bladder capacity, Vcap,NL the volume at mean expected bladder capacity and Pcap,NL the pressure at mean expected bladder capacity. Vcap,NL is obtained from nomograms of published data.RESULTSThe bladder compliance of patients undergoing urodynamic testing was calculated using NWahl−1 and the traditional equation (ΔV/ΔP). NWahl−1 provided a more accurate diagnosis and therefore was of more practical use.CONCLUSIONSBladder compliance depends on patient age, sex and size; the new estimate used to standardize bladder compliance is based on these factors and is a dimensionless number. This may help when comparing patients and assessing outcomes.