bluuebunny/crossref_metadata_2025_split huggingface dataset:
HOSE: an objective scoring system for evaluating the results of hypospadias surgery
Authors: Holland A.J.A. , Smith G.H.H. , Ross F.I. , Cass D.T. 
Published: March 2003

Objective To determine the accuracy and utility of a scoring system designed to allow an objective appraisal of the outcome of hypospadias repair, based on evaluating meatal location, meatal shape, urinary stream, straightness of erection, and the presence and complexity of any complicating urethral fistula. Patients and methods Twenty patients (median age 23 months) were randomly selected and reviewed at a median of 8.9 months after their hypospadias repair. Two paediatric surgeons, a nurse and one of the child's parents independently assessed each patient using the ‘hypospadias objective scoring evaluation’ (HOSE) system. The results were collated and the level of interobserver variation assessed using the weighted kappa test. Results The mean weighted kappa was 0.66, indicating good agreement among observers. The level of agreement was highest between surgeon and nurse at 0.70, but remained good between surgeon and parent, at 0.65. Conclusions Interobserver variation using the HOSE system was minimal, supporting its use as an objective outcome measure after hypospadias surgery, and facilitating an impartial evaluation of operations used in correcting hypospadias.
Regional lymph node dissection in the treatment of renal cell carcinoma: is it useful in patients with no suspected adenopathy before or during surgery?
Authors: Minervini A. , Lilas L. , Morelli G. , Traversi C. , Battaglia S. , Cristofani R. , Minervini R. 
Published: March 2003

Objectives To evaluate the role of regional lymph node dissection (LND) in a series of patients with renal cell carcinoma (RCC) with no suspicion of nodal metastases before or during surgery. Patients and methods A series of 167 patients with RCC, free from distant metastases at diagnosis, and who underwent radical nephrectomy at our hospital between January 1990 and October 1997, was reviewed. The mean (median, range) follow‐up was 51 (45, 19–112) months. Of the 167 patients, 108 underwent radical nephrectomy alone and 59 had radical nephrectomy with regional LND limited to the anterior, posterior and lateral sides of the ipsilateral great vessel, from the level of the renal pedicle to the inferior mesenteric artery. Of these 59 patients, 49 had no evidence of nodal metastases before or during surgery. The probability of survival was estimated by the Kaplan–Meier method, using the log‐rank test to estimate differences among levels of the analysed variables. Results The overall 5‐year survival was 79%; the 5‐year survival rate for the 108 patients who underwent radical nephrectomy alone was 79% and for the 49 who underwent LND was 78%. Of the 49 patients with no suspicion of lymph node metastases, one (2%) was found to have histologically confirmed positive nodes. Conclusion These results suggest that there is no clinical benefit in terms of overall outcome in undertaking regional LND in the absence of enlarged nodes detected before or during surgery.
Functioning adrenocortical neoplasms in children
Authors: Patil K.K. , Ransley P.G. , McCullagh M. , Malone M. , Spitz L. 
Published: March 2003

Objective To describe the clinical features, treatment and outcome of functioning adrenocortical tumours in children, and to assess the value of tumour size as a marker for malignant potential. Patients and methods Twenty‐one children (mean age at presentation 4.9 years, range 0.6–11; 12 girls and nine boys) who presented with a functioning adrenal mass over a 29‐year period (1972–2000) were assessed. Clinicopathological features and outcome information were obtained from a structured review of the case‐notes. Before 1980 the diagnosis and staging was mainly obtained by intravenous pyelography and plain X‐ray. Since 1980, ultrasonography, computed tomography and more recently magnetic resonance imaging were the methods of choice. Results The mean (range) duration of symptoms before diagnosis was 31 (2–108) months. The symptoms and signs at presentation comprised virilization (18 children), Cushingoid features (three), precocious puberty (three) and hypertension (four). Three children had malignant neoplasms, one presented with metastasis and of the other two, one died from the disease within 6 months, despite adjuvant chemotherapy and radiotherapy. The third girl is disease‐free 11 years after complete excision of the neoplasm. Eighteen children had a benign neoplasm and all are alive and free of recurrence. In most of the children surgical extirpation was relatively simple, blood loss minimal, recovery uneventful and the hospital stay short (mean 5 days). The virilizing effects of all the neoplasms gradually resolved after surgery within a median (range) of 27 (6–108) months. Conclusions Functioning adrenocortical neoplasms in children are rare, with a peak incidence in the first decade, are predominantly unilateral and more common in girls. Most are benign, but both benign and malignant lesions can present with virilizing and Cushingoid features. The malignant neoplasms have an extremely poor prognosis, especially if excision is incomplete, despite adjuvant chemotherapy and radiotherapy. Although there is an association between tumour size and malignancy, this cannot be used as a reliable individual discriminator.
The provision of transurethral prostatectomy on a day‐case basis using bipolar plasma kinetic technology
Authors: Eaton A.C. , Francis R.N. 
Published: March 2003

Objective To evaluate, in a prospective study, the potential for providing elective transurethral prostatectomy on a day‐case basis, using new bipolar electrosurgical technology. Patients and methods Forty men with confirmed bladder outlet obstruction caused by benign prostatic enlargement underwent plasma kinetic vaporization of the prostate (PKVP) in the Day Surgery Unit; they were scheduled to be discharged on the day of surgery with an indwelling catheter, returning for a trial removal of the catheter at 48 h, and followed up at 2 and 4 months after surgery. Results Thirty‐four (85%) of the 40 patients were able to return home on the day of surgery. All patients, including the six who failed to return home as a day‐case, successfully voided at 48 h; 78% felt the procedure was acceptable on a day‐case basis. At 4 months the mean improvement in the International Prostate Symptom Score and Quality of Life score were 64% and 84%, respectively. The mean improvement in flow rate was 200–250%. Conclusion PKVP effectively relieves prostatic obstruction, at least in the short‐term (a longer term follow‐up is required). The procedure can be delivered safely on a day‐case basis and was very acceptable to the patients.
Oral propionyl‐l‐carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease
Authors: Cavallini G. , Biagiotti G. , Koverech A. , Vitali G. 
Published: March 2003

Objective To ascertain whether oral propionyl‐l‐carnitine combined with intraplaque verapamil is a useful therapy for advanced or resistant Peyronie's disease. Patients and methods The combined drugs were assessed in two studies. In the first, 60 patients with advanced Peyronie's disease, diagnosed using accepted definitions, were randomized in two subgroups treated with verapamil intraplaque infiltration (10 mg weekly for 10 weeks) plus a 3‐month administration of propionyl‐l‐carnitine (2 g/day), or verapamil infiltration plus oral tamoxifen (40 mg/day) for 3 months. In the second study, 15 patients with resistant Peyronie's disease (progression despite previous therapy) received verapamil plus propionyl‐l‐carnitine. The differences between subgroups or between the variables before and after therapy were compared using analysis of variance or the chi‐squared test. Results In the first study, the reduction in pain was the same in both subgroups. Propionyl‐l‐carnitine plus verapamil significantly reduced penile curvature, plaque size, cavernosal artery end‐diastolic velocity, the need for surgery and disease progression, and increased the International Index of Erectile Function score and resistivity index of the cavernosal arteries. Tamoxifen plus verapamil had none of these effects. No drug combination affected the peak systolic velocity. Patients receiving verapamil had no side‐effects but those taking tamoxifen did. In the second study propionyl‐l‐carnitine and verapamil modified the disease patterns as in the first and no patient had side‐effects. Conclusion The combination of propionyl‐l‐carnitine and verapamil can be considered the therapy of choice for advanced and resistant Peyronie's disease.
Time‐dependent changes of resistive index in acute renal obstruction during nonsteroidal drug administration
Authors: Kmetec A. , Peskar‐Babnik D. , Buturovic‐Ponikvar J. 
Published: March 2003

Objective To evaluate Doppler ultrasonography (DUS) and assess time‐dependent changes of the renal resistive index (RI) in acute unilateral renal obstruction during treatment with nonsteroidal analgesic for the relief of renal colic. Patients and methods In 31 patients with symptoms of renal colic, treated with ketoprofen, unilateral obstruction was confirmed by intravenous urography. The patients were divided into four groups according to the duration of their symptoms, i.e. < 23 h, 24–47 h, 48–72 h and > 72 h. In each patient, the RI was measured over the arcuate, segmental and renal arteries of both kidneys using DUS. The values obtained in the obstructed kidney were compared with those for the contralateral kidney. Results The mean (sd) RIs for all 31 patients were 0.71 (0.05) for the obstructed and 0.60 (0.05) for the contralateral kidney (P < 0.001), the mean difference (dRI) being 0.12 (0.07). In those with obstruction for < 23 h the mean RI of the obstructed kidney was 0.70 (0.05) and of the contralateral healthy one 0.62 (0.07). Values of RI were similar in the group with obstruction for 24–47 h and 48–71 h. In those with obstruction for > 72 h the mean RI of the obstructed kidney was 0.69 (0.07) and of the contralateral one 0.60 (0.04), with a dRI of 0.09 (P < 0.005). The RI was 87% sensitive and 90% specific for detecting renal obstruction. Conclusion Although the patients were given ketoprofen, their mean RI for the obstructed kidney remained above the discriminatory threshold (> 0.70) during the first 71 h of obstruction. Only in those obstructed for > 72 h was the mean RI on the obstructed side slightly below the threshold, but the difference between the kidneys was significant. The measurement of RI is a reliable diagnostic method for detecting acute renal obstruction. With a longer duration of symptoms, the difference in RI between the kidneys becomes clinically more relevant.
18F‐fluoro‐2‐deoxyglucose‐positron emission tomography in the evaluation of nonseminomatous germ cell tumours at relapse
Authors: Sanchez D. , Zudaire J.J. , Fernandez J.M. , Lopez J. , Arocena J. , Sanz G. , Gimenez M. , Rosell D. , Robles J.E. , Berian J.M. 
Published: March 2003

Objectives To compare the performance of 18F‐fluoro‐2‐deoxyglucose‐positron emission tomography (FDG‐PET) and computed tomography (CT) in the follow‐up of nonseminomatous germ cell tumours (NSGCT) in the retroperitoneum. Patients and methods FDG‐PET was used 25 times in 15 patients diagnosed with NSGCT. At the time of diagnosis five patients each were in stage I, II and III. Five patients had pure embryonal carcinoma, two had yolk sac tumours, one choriocarcinoma and seven had mixed tumours. Results Eleven patients either presented with retroperitoneal disease or this did not disappear after chemotherapy. The results of both examinations coincided in 18 cases and were contradictory in the other seven, the difference being statistically significant (P=0.042). Conclusion In these patients FDG‐PET detected the retroperitoneal relapse of NSGCT, in advanced stages treated with surgery plus chemotherapy, earlier than did CT; it also detected the presence of mature teratoma in residual retroperitoneal masses more accurately than CT. More extensive trials are needed before making conclusions about FDG‐PET imaging as a routine method for NSGCT.
Gender as a prognostic factor in patients with renal cell carcinoma
Authors: Onishi T. , Oishi Y. , Goto H. , Yanada S. , Abe K. 
Published: March 2003

Objective  To evaluate gender as a prognostic factor in patients with renal cell carcinoma (RCC), using a retrospective review of patients with RCC stratified according to gender and analysing factors affecting prognosis. Patients and methods  From January 1957 to December 1995, 768 patients with pathologically defined RCC (all of whom underwent nephrectomy) were classified as having clear cell carcinoma in 662 (follow‐up in 648), papillary RCC in 43 (follow‐up in 42), chromophobe cell carcinoma in 36 (follow‐up in 34) and cyst‐associated RCC in 27 (all followed up) according to the criteria proposed by the World Health Organization. The survival rates were compared between men and women, calculated and stratified according to the subtype of RCC. Results

There tended to be a more favourable prognosis in women than in men but the difference was not quite significant (
P

=0.061). Of those with clear cell carcinoma, women had a more favourable prognosis than men and the difference in survival was significant (
P

=0.012). No other subtype of RCC was associated with a significant difference in survival between the sexes. There was a smaller proportion of patients with stage IV and a larger proportion with stage I disease in women than in men (
P
<0.05). Of stage I patients, women had a more favourable prognosis than men (
P
<0.011). Women had better survival after recurrence than had men, the difference being significant (
P =0.007). Conclusion  The prognosis is significantly better in women than men with clear cell carcinoma. The factors that contribute to a favourable prognosis in women are the greater proportion of lower stage disease and better survival after recurrence.
The management of stress urinary incontinence after radical prostatectomy
Authors: Peyromaure M. , Ravery V. , Boccon‐Gibod L. 
Published: March 2003

SummaryUp to 30% of patients complain about urine leakage after radical prostatectomy, but persistent stress incontinence (beyond 1 year) affects <5% of them. This complication is mainly caused by sphincter dysfunction. Some preventive measures have been described to decrease the risk of incontinence after radical prostatectomy, but with conflicting results. The effectiveness of preoperative and early postoperative physiotherapy is controversial. Moreover, while meticulous apical dissection of the prostate significantly improves postoperative continence, the benefit of other surgical techniques, e.g. preserving the bladder neck and the neurovascular bundles, is under debate. The treatment of persistent stress urinary incontinence is mainly based on surgery, as this type of incontinence usually does not respond to physiotherapy and anticholinergic medication. While injection therapy is safe and well tolerated, its effect on postoperative continence is limited and decreases with time. The best results are achieved by implanting an artificial urinary sphincter, but with significant complication and revision rates.
Bladder dysfunction as a prognostic factor in patients with posterior urethral valves
Authors: Lopez Pereira P. , Martinez Urrutia M.J. , Espinosa L. , Lobato R. , Navarro M. , Jaureguizar E. 
Published: March 2003

Objective To investigate the extent to which different types of bladder dysfunction can affect long‐term renal function in boys with posterior urethral valves (PUV). Patients and methods Renal and bladder function were retrospectively assessed in 59 boys with PUV (mean age 10 years, range 5–17). All patients included in the study had at least 4 years of follow‐up and their bladder behaviour had been evaluated in at least two urodynamic studies. At the time of the study, of the 59 PUV boys, 37 had normal renal function and 22 had end‐stage renal disease (ESRD). Results Of the 59 boys with PUV evaluated by urodynamic studies, 25 had normally behaving bladders (42%) and 34 had some type of bladder dysfunction (58%). Of the 22 in ESRD, 15 had abnormally behaving bladders (68%) and only seven had bladders with normal behaviour (32%). Of the 37 boys with normal renal function, 19 had dysfunctional bladders (51%) and 18 had normal bladders (49%). Instability was found in 17 of 19 boys with bladder dysfunction and normal renal function. On the contrary among 22 boys with ESRD, poor compliance was the most frequent urodynamic pattern (eight, 53%) while instability was only found in five. Overall, eight of nine boys with poorly compliant bladders, two of three with myogenic failure and a five of 22 with instability were in ESRD, and this situation occurred at an earlier age in patients with poorly compliant bladders. Conclusions Bladder dysfunction should be considered as a prognostic factor in renal failure. Those with poor bladder compliance and myogenic failure have the worst outcome, while bladder instability was associated with the lowest incidence of renal failure.
Cadaveric fascia lata pubovaginal slings: early results on safety, efficacy and patient satisfaction
Authors: Walsh I.K. , Nambirajan T. , Donellan S.M. , Mahendra V. , Stone A.R. 
Published: March 2003

Objective  To prospectively evaluate and quantify the efficacy of cadaveric fascia lata (CFL) as an allograft material in pubovaginal sling placement to treat stress urinary incontinence (SUI). Patients and methods  Thirty‐one women with SUI (25 type II and six type III; mean age 63 years, range 40–75) had a CFL pubovaginal sling placed transvaginally. The operative time, blood loss, surgical complications and mean hospital stay were all documented. Before and at 4 months and 1 year after surgery each patient completed a 3‐day voiding diary and validated voiding questionnaires (functional inquiry into voiding habits, Urogenital Distress Inventory and Incontinence Impact Questionnaire, including visual analogue scales). Results

The mean (range) operative time was 71 (50–120) min, blood loss 78.7 (20–250) mL and hospital stay 1.2 (1–2) days; there were no surgical complications. Over the mean follow‐up of 13.5 months, complete resolution of SUI was reported by 29 (93%) patients. Overactive bladder symptoms were present in 23 (74%) patients before surgery, 21 (68%) at 4 months and two (6%) at 1 year; 80% of patients with low (< 15 cmH
2
O) voiding pressures before surgery required self‐catheterization afterward, as did 36% at 4 months, but only one (3%) at 1 year. Twenty‐four (77%) patients needed to adopt specific postures to facilitate voiding. After surgery there was a significant reduction in daytime frequency, leakage episodes and pad use (
P

< 0.05). The severity of leak and storage symptoms was also significantly less (
P  < 0.002), whilst the severity of obstructive symptoms remained unchanged. Mean subjective levels of improvement were 69% at 4 months and 85% at 1 year, with corresponding objective satisfaction levels of 61% and 69%, respectively. At 1 year, ≈ 80% of the patients said they would undergo the procedure again and/or recommend it to a friend. Conclusion  Placing a pubovaginal sling of CFL allograft is a highly effective, safe surgical approach for resolving SUI, with a short operative time and rapid recovery. Storage symptoms are significantly improved, and subjective improvement and satisfaction rates are high.
The urological complications of renal transplantation: a series of 1535 patients
Authors: Streeter E.H. , Little D.M. , Cranston D.W. , Morris P.J. 
Published: March 2003

Objective  To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors.Patients and methods  A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk‐factor analysis. An unstented Leadbetter‐Politano anastomosis was the preferred method of ureteric reimplantation.Results  There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living‐donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ‐sharing scheme vs the use of local kidneys. The management of these complications is discussed.Conclusion  The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.
Urinary catheter ‘deflation cuff’ formation: clinical audit and quantitative in vitro analysis
Authors: Parkin J. , Scanlan J. , Woolley M. , Grover D. , Evans A. , Feneley R.C.L. 
Published: March 2003

Objective  To investigate reports from district nursing staff of difficulty in removing long‐term urinary catheters (LTCs) because of the formation of a ‘cuff’ on deflating the self‐retaining balloon.Patients and methods  Problems experienced by district nurses when removing urethral and suprapubic LTCs were audited, noting the type of problem, the catheter and any action taken. Quantitative in vitro studies were conducted on the deflated self‐retaining balloons after incubating a similar range of catheters in saline at 37 °C for 6 weeks, using suprapubic profilometry to assess the resistance to withdrawal (retention force).Results  Questionnaires were returned on 154 patients with LTCs; 56% had urethral and 44% suprapubic catheters. The catheters were hydrogel‐coated (83%), all‐silicone (13%) and PTFE‐coated (3%). Twenty‐two (14%) of the sample reported problems with catheter removal in the previous year, including 15 (68%) with all‐silicone catheters and 15 (68%) with suprapubic catheters; cuff formation was noted in 60%. In the laboratory, 10 of the balloons formed a ‘cuff’ on deflation, but there was great variability in the effect this had on the retention force, with values of 0.5–3 N for different catheters.Conclusions  Most problems with catheter removal involved all‐silicone and suprapubic catheters. Suprapubic profilometry confirmed increased resistance to withdrawal by formation of a ‘cuff’ on deflation of the balloon of all‐silicone catheters. These results suggest that the first choice of catheter material for long‐term urethral and suprapubic use should be hydrogel‐coated latex.