bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfaction
Authors: Mydlo J.H. , Volpe M.A. , Macchia R.J. 
Published: March 2003

Objective To evaluate the outcome of combined therapy (using intraurethral alprostadil and oral sildenafil) in private and clinic patients with erectile dysfunction, and thus assess predictors of satisfaction. Patients and methods In all, 360 men were treated for erectile dysfunction using single and/or combined therapy, comprising 214 private‐practice and 166 clinic patients. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Serum testosterone levels, education and socio‐economic status were also assessed. Group 1a consisted of 33 private patients and Group 1b of 24 clinic patients who tried the maximum dose of intraurethral alprostadil monotherapy initially, followed by the maximum dose of sildenafil monotherapy, and remained dissatisfied. Group 2a consisted of 32 private patients and group 2b of 31 clinic patients who tried the maximum dose of sildenafil monotherapy initially, followed by the maximum dose of alprostadil monotherapy, and were also dissatisfied. These two groups of 65 private and 55 clinic patients then underwent combined therapy. Results The mean (
sd) score for erectile function was 24.1 (2) for combined therapy (a 123% improvement), and 19.8 (1.8) (83% improvement) and 15.2 (1.6) (41% improvement) for sildenafil and alprostadil monotherapies (P < 0.05 for both patient groups). The men also reported an improvement in their satisfaction with intercourse. However, at 18 months, 60 of the 65 private patients but only 40 of the 55 clinic patients continued with combined therapy; thus, the discontinuation rate was three times greater among clinic than among private patients. Furthermore, the private patients had an overall improvement in the satisfaction score of 128%, compared with 51% for the clinic patients. Conclusion Although there were no significant differences in erectile function improvement within the two satisfied combined therapy groups, the differences in overall satisfaction and long‐term withdrawal rates suggests that other factors beside motivation must be involved for success, e.g. education, persistence, realistic expectations, and certain psychological factors. Combined therapy should be considered for those patients who have a suboptimal response to monotherapy and refuse or are not candidates for surgical options. Generally, those patients with a higher education, greater persistence and more realistic expectations were more satisfied with combined therapy.
A model to quantify encrustation on ureteric stents, urethral catheters and polymers intended for urological use
Authors: Choong S.K.S. , Wood S. , Whitfield H.N. 
Published: March 2003

Objective To validate an encrustation model and to quantify encrustation on currently used urological devices and polymers intended for urological use. Materials and methods An encrustation model was validated: (i) to measure the amount of calcium leaching from the glass model and from the polymer used; (ii) to determine whether the use of a single‐source or pooled urine produced similar results; (iii) to determine in vitro encrustation; and (iv) to compare the results of in vivo implantation of the same materials into the bladders of rodents with the in vitro results. A test polymer (a ureteric stent, a urethral catheter or a biomaterial) and a control silicone polymer were housed separately but received human urine from the same reservoir and under the same conditions (pH 6.0 and 37 °C) for 5 days. The amount of calcium encrustation on each polymer was measured using atomic absorption spectroscopy. Each experiment was repeated at least four times and the results expressed as an encrustation index, defined as the ratio of encrustation of the test and reference polymers. Results The amount of calcium leaching from the glass model and polymers tested was insignificant. The use of a single‐source or pooled urine gave the same results in the encrustation model. The in vitro results correlated with in vivo implantation of disks into the bladders of rats. Among the commonly used ureteric stents tested, the Cook C‐Flex ureteric stents encrusted least. Hydrogel‐coated ureteric stents encrusted more than uncoated stents. The Bard polytetrafluoroethylene short‐term urethral catheter encrusted more than the Bard hydrogel‐coated long‐term catheter. A plasma‐activated surface modification of a synthetic biomaterial with hyaluronic acid encrusted less than silicone, a long‐term biomaterial widely regarded as the ‘gold standard’. Conclusion This validated encrustation model is the first to quantify encrustation on currently available ureteric stents and urethral catheters. A novel coating for a biomaterial was identified using the encrustation model, and which encrusted less than silicone.
Cytoplasmic induction and over‐expression of cyclooxygenase‐2 in human prostate cancer: implications for prevention and treatment
Authors: Madaan S. , Abel P.D. , Chaudhary K.S. , Hewitt R. , Stott M.A. , Stamp G.W.H. , Lalani E.‐N. 
Published: March 2003

Objective To assess the level and morphological distribution of cyclooxygenase (COX)‐1 and ‐2 in human prostates and to determine any association with the Gleason grade of prostate cancer. Materials and methods The study comprised 30 samples from patients with benign prostatic hyperplasia (BPH) and 82 with prostate cancer. Immunohistochemistry was used to assess the expression of COX‐1 and ‐2, and 13 samples were also assessed using immunoblotting (six BPH and seven cancers). Results For both BPH and prostate cancer, COX‐1 expression was primarily in the fibromuscular stroma, with variable weak cytoplasmic expression in glandular/neoplastic epithelial cells. In contrast, COX‐2 expression differed markedly between BPH and cancer. In BPH there was membranous expression of COX‐2 in luminal glandular cells and no stromal expression. In cancer the stromal expression of COX‐2 was unaltered, but expression by tumour cells was significantly greater (P = 0.008), with a change in the staining pattern from membranous to cytoplasmic (P < 0.001). COX‐2 expression was significantly higher in poorly differentiated than in well differentiated tumours (P < 0.001). These results were supported by immunoblotting, which showed similar levels of COX‐1 in both BPH and cancer, but four times greater expression of COX‐2 in cancer than in BPH. Conclusion This is the first study to assess the co‐expression of COX‐1 and COX‐2 proteins in benign and malignant human prostates, and showed the induction and significantly greater expression of COX‐2 in cancer, which was also associated with tumour grade. The regular use of nonsteroidal anti‐inflammatory drugs is associated with a reduced incidence of cancers. The present results provide the basis for a potential role for COX‐2 inhibitors in the prevention and treatment of prostate cancer.
Percutaneous embolization of the failed renal allograft in patients with graft intolerance syndrome
Authors: González‐Satué C. , Riera L. , Franco E. , Escalante E. , Dominguez J. , Serrallach N. 
Published: March 2003

Objective To analyse the circumstances, results and complications of percutaneous embolization in failed renal grafts that are not tolerated, to avoid surgical graft removal in selected patients. Patients and methods The study included 33 patients (mean age 42 years,
sd 13.9) whose renal grafts failed between 1990 and 1999. The patients underwent percutaneous embolization of their renal transplant for graft intolerance syndrome. The allograft was left in situ after failure for a mean (
sd) of 9.9 (6.5) months. The subsequent hospital stay, the appearance of complications and the final results were assessed. Results Post‐embolization syndrome (fever for 2–5 days) appeared in 20 (61%) of the patients; the clinical intolerance resolved in 28 (85%). The embolization was unsuccessful in five of the 33 patients (15%) and they required graft removal. The mean (
sd) hospital stay was 5 (2) days; there were no major complications from graft embolization. Conclusions Graft embolization avoids kidney removal in many patients with failed and rejected transplants, with low rates of morbidity. Surgical graft nephrectomy was useful when graft intolerance syndrome persisted after embolization.
Comparison of the effects of novel antimuscarinic drugs on human detrusor smooth muscle
Authors: Yono M. , Yoshida M. , Takahashi W. , Inadome A. , Ueda S. 
Published: March 2003

Objective To evaluate the effects of tolterodine, vamicamide and temiverine, novel antimuscarinic drugs developed for the treatment of frequency and urinary incontinence, on human detrusor smooth muscle. Materials and methods Specimens of human urinary bladder were obtained from 20 patients who underwent total cystectomy for malignant bladder tumour. Using an organ‐bath technique, the effects of various drugs on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation in the detrusor strips were investigated. Results Carbachol (0.001–10000 µmol/L) caused concentration‐dependent contractions in human detrusor smooth muscles. Tolterodine (0.01–10 µmol/L), vamicamide (0.01–10 µmol/L), temiverine (0.01–1 µmol/L) and atropine (0.001–1 µmol/L) caused parallel shifts to the right of the concentration‐response curves to carbachol. All slopes for the regression line of Schild plots were close to unity, and the rank order of pA2 values was atro‐pine = tolterodine > vamicamide > temiverine. Tolterodine, vamicamide and atropine did not inhibit the maximum contractile responses to carbachol, while temiverine (10 µmol/L) significantly inhibited the maximum contractions. Tolterodine (0.001–1 µmol/L) and vamicamide (0.01–10 µmol/L) did not inhibit the KCl‐ (80 mmol/L) and CaCl2‐induced (5 mmol/L) contractions, while temiverine (0.01–10 µmol/L) significantly inhibited the contractions. Electrical field stimulation (2–60 Hz) caused frequency‐dependent contractions in human detrusor smooth muscles, which were significantly inhibited by various drugs. In the presence of 1 µmol/L atropine, tolterodine and vamicamide did not inhibit the contractions induced by electrical field stimulation at all frequencies, while temiverine (10 µmol/L) significantly inhibited the contractions. Conclusion Tolterodine and vamicamide inhibited contractions of human detrusor smooth muscles only through their antimuscarinic action, while temiverine had both antimuscarinic and calcium‐antagonist actions. Furthermore, these novel drugs have different efficacies and potencies for inhibiting human detrusor smooth muscle.
Tubularized incised plate urethroplasty for proximal hypospadias
Authors: Chen S.C. , Yang S.S.D. , Hsieh C.H. , Chen Y.T. 
Published: March 2003

Objective To review our experience of using the tubularized incised plate (TIP) urethroplasty (useful in the treatment of distal hypospadias) to treat proximal hypospadias. Materials and methods From March 1997 to March 2000 primary repairs were carried out on 40 boys (mean age 4.5 years) with proximal hypospadias. After degloving the penile skin the meatus was at the mid‐shaft in 10 boys, at the proximal penile shaft in 11, at the penoscrotal junction in 16, at the scrotum in two and at the perineum in one. The 21 patients with a mid or proximal shaft meatus were categorized as having mid‐shaft and the other 19 as having posterior hypospadias. Tunica albuginea plication (TAP) was used to correct residual ventral curvature. The method of urethroplasty was adapted from that described by Snodgrass. The key step of the TIP repair is a midline incision of the urethral plate; a subcutaneous tissue flap dissected from the inner prepuce is used to cover the neourethra. An 8 or 10 F nasogastric tube is used as a urethral stent and removed 7 or 8 days after surgery. Follow‐up endoscopy and urethral sounding were carried out in 17 of the patients aged < 6 years; the mean follow‐up was 12.5 months. Results TAP was used to correct penile curvature in nine (23%) of the patients. Excluding stenosis, the TIP repair was successful in 20 (90%) of those with mid‐shaft and in 16 of the 19 with posterior hypospadias; for all complications the respective rates were 19 of 22 and 15 of 19. The overall success rate was 88% for all 40 patients with proximal hypospadias; a urethrocutaneous fistula occurred in two of those with mid‐shaft and three of those with posterior hypospadias. Urethral meatal stenosis occurred in four (12%) of the patients (two in each group); two were associated with a fistula and the other two had only mild meatal stenosis. The overall complication rate was 17.5% (three and four in the mid and the posterior hypospadias groups, respectively). The meatal stenosis was managed by simple dilatation in three and meatoplasty in one patient. Endoscopically, the mucosa of neourethra was pink and smooth in all 17 patients assessed. The calibre of all 17 neourethra was  8 F and in 13 was  10 F. Conclusion TIP repair is a reliable method for treating both mid‐shaft and posterior hypospadias.
Nitric oxide‐mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes
Authors: Cartledge J.J. , Eardley I. , Morrison J.F.B. 
Published: March 2003

Objective To examine nitric‐oxide (NO)‐mediated relaxation in cavernosal smooth muscle in a rat model of diabetes, as previous experiments showed that HbA1c (an isoform of glycosylated haemoglobin and a marker of long‐term diabetic control) impaired NO‐mediated relaxation of normal corpus cavernosal tissue through the generation of superoxide anions. Materials and methods Eight weeks after the induction of diabetes, male Wistar rats were killed and cavernosal tissue obtained. Strips were contracted with 1 µmol/L noradrenaline before applying acetylcholine or electrical field stimulation (EFS) or sodium nitroprusside (SNP). Relaxation responses were repeated in the presence of l‐arginine (100 µmol/L), indomethacin (10 µmol/L) or superoxide dismutase (SOD, 120 IU/mL). Young and age‐matched control animals were examined in the same way. Results Eight weeks of uncontrolled diabetes caused a significant impairment in mean relaxation responses to acetylcholine (P < 0.05) and to EFS (P < 0.05), but not to SNP, compared with young and age‐matched controls, respectively. l‐arginine, indomethacin and SOD had no significant effect on this impairment. Ageing caused a lesser but significant impairment in EFS‐mediated cavernosal smooth muscle relaxation (P < 0.05). Conclusion Diabetes impairs endothelial and neuronal NO‐mediated cavernosal smooth muscle relaxation in rats in vitro. This effect is not mediated by an alteration in the intracellular action of NO, the availability of NO, superoxide anion inactivation of NO or the generation of constrictor prostanoids. It is possible that cholesterol or advanced glycation end products are responsible for the effect of diabetes on penile smooth function.
Ontogeny of bladder agenesis in rats induced by adriamycin
Authors: Liu M.I.‐P. , Hutson J.M. 
Published: March 2003

Objectives To determine the anatomical steps leading to bladder agenesis in rats prenatally exposed as fetuses on gestational days (GD) 6–9 to adriamycin.Materials and methods Timed‐pregnant Sprague–Dawley rats were injected intraperitoneally with adriamycin at 2 mg/kg (n = 28) on GD 6–9 (vaginal plug = day 0). The control group (n = 21) received saline. Fetuses were harvested on GD 10, 11, 12, 13, 14, 15 and 16. Serial paraffin sections were prepared from a minimum of 10 experimental and five control fetuses at each gestational age, and stained with either trichrome or haematoxylin and eosin, and examined by light microscopy.Results In the control group the urorectal septum first became visible and the mesonephric ducts apparently abutting the anterior cloaca on GD 12. The presumptive urinary bladder was clearly defined on GD 14. On GD 15, the common excretory ducts became incorporated into the newly formed urogenital sinus and the ureters opened into the bladder. In the treated animals, beginning on GD 11, the undivided cloaca was noticeably smaller and by GD 13–14, the vesical extension of the urogenital sinus was conspicuously absent. Instead, opposite ureters joined to drain directly into the proximal blind‐ending urethra or the persistent distal urogenital sinus.Conclusions Prenatal exposure of rat fetuses to adriamycin resulted in primary agenesis rather than secondary resorption of the bladder. The ontogeny showed that the mechanism underpinning bladder development is unique and is under the influence of factors that can be targeted by adriamycin. Further work will elucidate the unique nature of bladder organogenesis and should have important applications in future research into artificial bladders.
Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones
Authors: Keeley F.X. , Tilling K. , Elves A. , Menezes P. , Wills M. , Rao N. , Feneley R. 
Published: March 2003

Objective To report a prospective, randomized study to determine whether prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a treatment for small, asymptomatic calyceal stones. Patients and methods The study included 228 patients with small (< 15 mm total diameter) asymptomatic calyceal stones; 113 patients were randomized to undergo ESWL and 115 to the control group who were kept under observation. Outcome measurements included the stone‐free rate, requirement for additional treatment, symptoms, quality of life and renal function. Results In all, 200 patients had at least one annual follow‐up; all outcome measurements reported were those at the most recent follow‐up (mean 2.2 years, range 1–5). In the ESWL group 28 patients (28%) were stone‐free, compared with 16 (17%) in the observation group (odds ratio 1.95, 95% confidence interval, CI, 0.97–3.89, P = 0.06). Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 (21%) patients in the observation group and 15 (15%) in the ESWL group (odds ratio 0.66, 95% CI 0.32–1.37, P = 0.27). Ten patients in the observation group required invasive procedures, vs none in the ESWL group. There was no evidence of differences in the symptoms, quality of life or renal function tests between the arms of the trial at the final follow‐up. Conclusions Prophylactic ESWL for small asymptomatic renal calyceal stones does not appear to offer any advantage to patients in terms of stone‐free rate, quality of life, renal function, symptoms or hospital admissions. However, a policy of observation is associated with a greater risk of requiring more invasive procedures. A longer follow‐up is required to assess the validity of these preliminary findings.
Effect of experimental hyperoxaluria on renal calcium oxalate monohydrate binding proteins in the rat
Authors: Kalaiselvi P. , Selvam R. 
Published: March 2003

Objective To determine the functional role of calcium oxalate binding proteins in the nucleation, aggregation and retention of calcium oxalate crystals under physiological and hyperoxaluric conditions. Materials and methods Hyperoxaluria was induced in rats using 0.75% of ethylene glycol in drinking water. Calcium oxalate binding proteins were isolated and fractionated by cellulose column chromatography. Three major protein peak fractions were obtained (73 kDa in Tris‐HCl buffer, 20 kDa in 0.05 mol/L NaCl buffer and 23 kDa in 0.3 mol/L buffer). Oxalate binding and the inhibition of crystal nucleation and aggregation by these fractions were determined. Results The adsorption of calcium oxalate monohydrate (COM) was ubiquitous in rat tissues and subcellular organelles, but the percentage adsorption varied; maximum absorption occurred in kidneys and pancreas, with microsomes showing maximal adsorption in the kidney. Hyperoxaluric rat tissues showed a greater percentage adsorption. Microsomes were enriched with the 20 kDa protein, while nuclei contained the 23 kDa protein in higher concentrations. COM‐binding proteins derived from hyperoxaluric rat kidney had a greater content of 74 kDa and 23 kDa proteins with increased oxalate‐binding activities. In the crystal‐growth studies, the 74 kDa protein was a promoter, while the other protein fractions inhibited crystallization. In hyperoxaluria, the crystal‐growth promoting activity of the 74 kDa protein was further increased, while the inhibition by the 20 and 23 kDa proteins was decreased. The 74 kDa protein derived from control rats formed single COM crystals in a crystal growth system, while the hyperoxaluric rat fraction induced the aggregation of COM crystals. Conclusion COM‐binding proteins (the 74 and 23 kDa fractions) were expressed more in hyperoxaluric rats. In hyperoxaluria the 74 kDa protein tended to promote crystal nucleation and aggregation, and the 20 and 23 kDa proteins were less inhibitory, which increases the risk of stone formation.
Does the time of administration (morning or evening) affect the tolerability or efficacy of tamsulosin?
Authors: Michel M.C. , Neumann H.G. , Mehlburger L. , Schumacher H. , Goepel M. 
Published: March 2003

Objective To determine whether the time of dosing (morning or evening) affects the tolerability or efficacy of tamsulosin in the treatment of lower urinary tract symptoms. Patients and methods Data were analysed from an open‐label, observational study in which patients were treated with 0.4 mg tamsulosin once daily for 12 weeks. Treatment effects were determined using the Benign Prostatic Hyperplasia Impact Index, the quality‐of‐life question of the International Prostate Symptom Score, a similarly phrased question about sexual satisfaction, the maximum urinary flow rate, the postvoid residual urine volume, and the overall efficacy and tolerability. The results were analysed statistically for differences between dosing times, using analysis of covariance for the quantitative variables and logistic regression for the qualitative variables. Results While no specific recommendation about the dosing time was given in the trial, the retrospective analysis showed that 4420 and 2087 patients received tamsulosin in the morning and evening, respectively. Both groups had similar values for all variables before treatment. The efficacy and tolerability of tamsulosin treatment was also similar in both groups; there were small advantages for morning dosing, which were statistically significant because there were many patients. Conclusion In contrast to other α‐blockers, night‐time dosing is not necessary to improve the tolerability or efficacy of tamsulosin.