bluuebunny/crossref_metadata_2025_split huggingface dataset:
The staged management of complex entero‐urinary fistulae
Authors: Shackley D.C. , Brew C.J. , Bryden A.A.G. , Anderson I.D. , Carlson G.L. , Scott N.A. , Clarke N.W. 
Published: March 2003

Objective To present the results of the staged management of complex entero‐urinary fistulae. Patients and methods Ten patients with complex entero‐urinary fistulae were reviewed; all patients were referred to a national intestinal failure unit after failed treatment in other centres. Each patient was treated in three stages. The acute stage involved proximal defunctioning and distal drainage of both the gastrointestinal and urinary tracts to isolate the fistula, together with the eradication of sepsis. The recovery stage involved total parenteral nutrition, organ support, radiological planning of surgical reconstruction and intensive nursing. The reconstructive stage followed when the patient was stable, nutritionally replenished and intra‐abdominal sepsis was controlled. Surgery was undertaken jointly by urological and gastrointestinal surgeons. Results The fistulae were treated successfully in all patients, with functional restoration in four, and/or diversion of the gastrointestinal and urological tracts in six. The mean (range) time to reconstruction was 5 (1–20) months. There were no postoperative deaths. Conclusion A staged multidisciplinary approach with delayed reconstruction can achieve a successful outcome in the management of complex entero‐urinary fistulae.
Neuromodulation reduces urinary frequency in rats with hydrochloric acid‐induced cystitis
Authors: Wang Y. , Zhou Y. , Mourad M.S. , Hassouna M.M. 
Published: March 2003

Objective To evaluate the effect of sacral neuromodulation on interstitial cystitis (IC) and determine the underlying mechanism of neuromodulation in the treatment of IC. Materials and methods Twenty Sprague–Dawley rats (body weight 220–250 g) were randomly divided into four equal groups; normal controls, a sham treatment (IC induced by 0.4 mol/L HCl, + saline), a second sham treatment (HCl‐induced IC + acetic acid) and a stimulated group (HCl‐induced IC + acetic acid, with electrical stimulation). In the last group bilateral electrodes were implanted into the S1 dorsal foramina and electrical stimulation applied for 8 h/day for 3 weeks. Acetic acid was instilled into the bladder to induce c‐fos expression. After 3 weeks the rats were perfused with 4% paraformaldehyde, spinal segments dissected out and an immunocytochemical method used to stain the segments for fos protein encoded byc‐fos. Results The mean (
sem) micturition frequency (voids/17 h) in the sham groups increased from 10.8 (2.7) to 23.4 (3.4) 3 weeks after the intravesical instillation of HCl. The micturition frequency in the stimulated group, at 16.2 (2.7), was significantly less than in the sham group (P = 0.04) after electrical stimulation for 3 weeks. There was no significant difference in the mean (
sem) number of fos‐positive neurones in the L6 spinal cord segment between the stimulated and the sham + acetic acid group, at 43.6 (9.4) and 35.8 (7.8) cells/section, respectively (P = 0.32). Conclusions In rats with HCl‐induced cystitis, electrical stimulation reduced the micturition frequency, but not by inhibiting afferent c‐fibre activity.
The absorption of pirarubicin instilled intravesically immediately after transurethral resection of superficial bladder cancer
Authors: Yamamoto Y. , Nasu Y. , Saika T. , Akaeda T. , Tsushima T. , Kumon H. 
Published: March 2003

Objectives To assess the validity of the prophylactic use of pirarubicin ([2′R]‐4‐O‐tetrahydropyranyl‐doxorubicin) immediately after transurethral resection of bladder tumour (TURBT), using pharmacodynamic studies. Patients and methods The study included 20 consecutive patients with superficial bladder cancer. Pirarubicin (30 mg/50 mL or 30 mg/100 mL, 10 patients each) was instilled immediately after TURBT and retained in the bladder for 1 h. Blood samples were obtained before and at 15, 30, 60 and 120 min after the instillation. After retaining the drug for 1 h all the intravesical fluid was collected and assayed for pirarubicin. Results The plasma pirarubicin concentration in those receiving either dose was below detectable levels at any time after instillation. The mean recovery rate of pirarubicin in the drained fluid was 73%. Conclusion The intravesical instillation of pirarubicin immediately after TURBT caused no detectable plasma concentration and few systemic side‐effects.
Population‐based outcomes after 28 246 in‐hospital vasectomies and 1902 vasovasostomies in Western Australia
Authors: Holman C.D.J. , Wisniewski Z.S. , Semmens J.B. , Rouse I.L. , Bass A.J. 
Published: March 2003

Objectives To examine trends in vasectomy and vasovasostomy, and the surgical complications and factors associated with reversal after vasectomy, and paternity after vasovasostomy. Patients and methods Procedure rates were estimated from 1980 to 1996 in the population of Western Australia. Linked hospital morbidity records were used in the follow‐up of men after vasectomy to estimate the risks of complications and reversals. Records of vasovasostomies were linked to the paternity field on birth registrations. Independent effects of the study factors were examined using Cox regression. Results There was little net change in vasectomy rates, whereas vasovasostomy rates increased in men aged 30–49 years. Risks of surgical complications were low and decreased for vasovasostomy. At 12–15 years after vasectomy, the risk of reversal levelled at 2.4% in the total cohort and at 11.1% in men aged 20–24 years. The risk of vasovasostomy was 69% greater after vasectomy performed in 1994–96 than in 1980–84 (P = 0.011). The factors strongly associated with reversal were age  < 30 years and being single, divorced or separated at the time of vasectomy. Paternity was achieved after an estimated 53% of vasovasostomies. Successful reversal was more likely if the man was younger at vasectomy and the time elapsed was comparatively short. Compared with vasovasostomies performed in 1980–84, the success rate of those in 1994–96 was almost four times higher. Conclusion Population rates of vasectomy are stable but the risk of seeking a reversal has increased. Outcomes after vasovasostomy have improved. Care should be taken during the counselling of men before vasectomy, and especially in those aged <30 years.
Retroperitoneoscopic dismembered pyeloplasty for pelvi‐ureteric junction obstruction in infants and children
Authors: Yeung C.K. , Tam Y.H. , Sihoe J.D.Y. , Lee K.H. , Liu K.W. 
Published: March 2003

Objective To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi‐ureteric junction (PUJ) obstruction.Patients and methods Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25–10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi‐prone (for left‐sided) or a semilateral position (for right‐sided PUJ obstruction). The retroperitoneal space was entered via a 1‐cm incision over the mid‐axillary line and further developed using a glove balloon. Video‐retroperitoneoscopy was undertaken using a 5‐mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi‐ureteric anastomosis fashioned using fine polydioxanone sutures over a double‐pigtail ureteric stent.Results The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103–235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow‐up scan.Conclusions Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long‐term results await further studies.
Postoperative mortality in patients with liver cirrhosis undergoing transurethral resection of the prostate: a Danish nationwide cohort study
Authors: Nielsen S.S. , Thulstrup A.M. , Lund L. , Vilstrup H. , Sørensen H.T. 
Published: March 2003

Objective To examine the risk of 30‐day postoperative mortality from transurethral resection of the prostate (TURP) in patients with liver cirrhosis, who are reportedly at considerably increased perioperative risk. Patients and methods For the period 1 January 1977 to 31 December 1993, a population‐based cohort was identified comprising Danish patients diagnosed with liver cirrhosis and a random sample of Danes also undergoing TURP. Logistic regression models were used to estimate the association between liver cirrhosis, age, type of admission, comorbidity and 30‐day mortality. Results In a cohort of 23 133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure. Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 (95% confidence interval 0.4–22.9) for the 30‐day postoperative mortality in patients with liver cirrhosis compared with patients without (mortality 2%). Advanced age, comorbidity and acute admission seemed to be associated with an increased postoperative mortality. Conclusion This study indicates that TURP in patients with liver cirrhosis was associated with increased mortality.
Bladder reconstruction with autotransplanted ileum in the dog: better functional results than standard enterocystoplasty
Authors: Ueno K. , Yamanaka N. , Kimura K. , Arakawa S. , Kamidono S. , Hara I. 
Published: March 2003

Objective To compare, in a dog model, the properties of a reconstructed bladder (peristalsis, histological changes and absorption) using an autotransplanted ileal segment with standard enterocystoplasty. Materials and methods Female beagle dogs were divided into two groups. In group 1 (autotransplantation, six dogs), a Heineke–Mikulicz‐type pouch was constructed using autotransplanted terminal ileum. The artery and vein of the terminal ileum were anastomosed to the iliac artery and vein, respectively. The pouch was anastomosed to the bladder remnant immediately above the vesical triangle. In group 2 (control, five dogs) the same type of bladder reconstruction using terminal ileum was undertaken but with no vessel anastomosis. Bladder function in these two groups was then compared for peristalsis (by monitoring intravesical pressure), histological changes (by microscopy) and glucose reabsorption (by measuring the amount of glucose remaining in the reconstructed bladder). The mean (range) follow‐up was 11 (7–18) months for group 1 and 9.2 (7–12) months for group 2; the recovery time before examination was 4.6 (2–7) months for group 1 and 4.0 (2–6) months for group 2. Results In group 1, there were no major complications in five dogs after the procedure and they survived for > 7 months; the autotransplant became necrotic in one dog where the arterial diameter was < 1 mm. In the control group, all five dogs survived for  7 months after surgery. Intestinal peristalsis was inhibited in group 1 but not in group 2. The bladder was oval/spherical in group 1 and elongated in group 2, with a thinner epithelium and fewer goblet cells in the latter. Glucose reabsorption was greater in group 2 than in group 1. Conclusion Bladder reconstruction using autotransplanted terminal ileum in dogs is technically feasible. For bowel peristalsis and reabsorption of glucose, autotransplanted ileum may have functional advantages over a standard enterocystoplasty.
A quantitative analysis of purinoceptor expression in the bladders of patients with symptomatic outlet obstruction
Authors: O'Reilly B.A. , Kosaka A.H. , Chang T.K. , Ford A.P.D.W. , Popert R. , McMahon S.B. 
Published: March 2003

Objective To compare the expression of the seven known P2X receptors in human bladder from male patients with detrusor instability caused by symptomatic bladder outlet obstruction with that from control bladders, using a quantitative reverse transcription‐polymerase chain reaction (RT‐PCR) method. Patients and methods Real‐time quantitative RT‐PCR provides a system for detecting and analysing RNA. Bladder biopsies were obtained from nine patients undergoing prostate surgery and control biopsies were obtained from eight age‐matched men undergoing routine bladder endoscopy studies, and who were asymptomatic. Total RNA was extracted from each sample and 10 ng of this used for individual PCR reactions. The expression levels of the seven P2X genes in the total RNA were then determined. Results In the control bladder, P2X1 was by far the predominant purinergic receptor at the RNA level, the remainder consistently present in the order P2X1≫ P2X4 > P2X2 > P2X7 > P2X5≫ P2X3= P2X6=0. Calponin, a smooth muscle‐specific protein, was used as a marker for smooth muscle content. In bladder from symptomatic patients, the P2X1/calponin ratio was greater than that in controls (P = 0.016). There appeared to be no difference in P2X2, but P2X4, P2X5, and P2X7 were all greater in the symptomatic bladder than in the controls, although these differences were not significant. Conclusion P2X1 is the predominant purinoceptor subtype in the human male bladder, consistent with pharmacological evidence. The amount of P2X1 receptor per smooth muscle cell is greater in the obstructed than in control bladder, suggesting an increase in purinergic function in the unstable bladder arising from bladder outlet obstruction.
Returning a referral for erectile dysfunction to the referrer by two different routes
Authors: Wylie K.R. , Davies‐South D. 
Published: March 2003

Objective To compare the prescribing pattern and attitude of general practitioners (GPs) in response to a clinic returning a patient referred for erectile dysfunction (ED) to the referrer by two different methods. Methods Referrals on a waiting list for an assessment of ED were reviewed and a subgroup of patients with criteria enabling them to be eligible for a prescription under the National Health Service (NHS) identified. The GP was informed either in writing or by telephone that the clinic had written to the patient, suggesting he make direct contact with his GP. A follow‐up questionnaire was sent to each GP one month after the initial letter to the patient and contact with the GP. Results Of 91 questionnaires sent to GPs, 66 (73%) were completed; an additional five GPs corresponded by letter rather than completing the questionnaire. The long waiting time for assessment had led to 35% of patients having already tried sildenafil, and by the time the questionnaire was completed, 57% of patients had tried sildenafil. Ten times as many referrers indicated that they were happy to initiate a prescription for sildenafil than not to do so, for those men eligible for an NHS prescription. More GPs who had received a letter returned the completed questionnaire (80%) than those who had received a courtesy telephone call (64%). There were no differences between the groups of GPs in their attitude to our contact with their patient and no difference in prescribing pattern. Conclusion The provision of guidelines and advice to GPs either by telephone or letter is acceptable practice in reducing long waiting‐list times for ED. Safe, simple and effective treatments are available for GPs to use under NHS guidelines.
A double‐blind, randomized, placebo‐controlled pilot study to investigate the effects of finasteride combined with a biodegradable self‐reinforced poly l‐lactic acid spiral stent in patients with urinary retention caused by bladder outlet obstruction from benign prostatic hyperplasia
Authors: Isotalo T. , Talja M. , Hellström P. , Perttilä I. , Välimaa T. , Törmälä P. , Tammela T.L.J. 
Published: March 2003

Objective To assess whether patients in acute urinary retention from benign prostatic enlargement can be treated with a combined therapy comprising finasteride and a bioabsorbable self‐reinforced poly l‐lactic acid (SR‐PLLA) urethral stent. Patients and methods Fifty‐five patients in acute urinary retention were treated as outpatients; they had a suprapubic catheter inserted and the SR‐PLLA stent placed cystoscopically. After 2 weeks the patients were randomized to receive either finasteride 5 mg daily or placebo. They were assessed at baseline and at 6, 12 and 18 months for maximum urinary flow rate, prostate volume and serum prostate‐specific antigen (PSA). Results Nineteen patients completed the study while 36 discontinued. There was a statistically significant increase in the mean maximum flow rate, and a statistically significant decrease in the prostatic volume and serum PSA in the finasteride group. The same number of patients discontinued in both groups; the major reason for discontinuation was insufficient therapeutic response. Conclusions The major problems were discontinuation of treatment because the response to therapy was insufficient, and uncontrolled breakdown of the spiral stent. To solve these problems, new configurations of bioabsorbable stents are needed.
The optimal form of urinary drainage after acute retention of urine
Authors: Patel M.I. , Watts W. , Grant A. 
Published: March 2003

Objective To assess the outcome of different forms of urinary drainage, particularly for urinary tract infection (UTI), operative findings and patient preference, in patients treated for acute urinary retention (AUR). Patients and methods A feasibility trial was conducted of men presenting with AUR; after a short period of indwelling catheterization (IDC) patients were taught how to use clean intermittent self‐catheterization (CISC). Patients who failed this were re‐catheterized and taught to manage a valve, or failing this a leg bag, and then discharged home. The patients were followed to assess the occurrence of spontaneous voiding, UTI, findings at prostatectomy and patient satisfaction. Results The CISC group (34 men) had a higher rate of spontaneous voiding than the IDC group (16 men; 56% vs 25%). The incidence of UTI was 32% in the CISC and 75% in the IDC group. At TURP, 20% in the CISC group had a UTI, compared with 69% in the IDC group. Patients using CISC preferred it and had fewer complications than the IDC group. The CISC group had a similar ability to manage and similar acceptance of their method of drainage as the IDC group. Conclusion CISC is managed and accepted well by patients who can use the technique and results in fewer UTIs. It should be considered in patients who present with AUR, and it may delay surgery.
Dorsal or ventral placement of the preputial/penile skin onlay flap for anterior urethral strictures:does it make a difference?
Authors: Bhandari M. , Dubey D. , Verma B.S. 
Published: March 2003

Objective To report our experience in managing complex anterior urethral strictures with a dorsally/dorsolaterally placed penile/preputial vascularized flap, and to discuss the advantages of this procedure over a traditional ventrally placed flap. Patients and methods Between 1995 and 1999, 40 patients (mean age 40.5 years) with recurrent strictures of the pendulous and/or bulbar urethra were treated with longitudinal penile/circumpenile flap substitution urethroplasty. Nineteen patients underwent dorsal placement of the flap as an onlay (DO), whereas 21 patients had a ventral onlay (VO). Five patients needed inferior pubectomy to facilitate high proximal placement of the flap. Results Both groups had statistically similar ages, number of previous interventions, stricture site, length and follow‐up. After a median follow‐up of 27.5 months, the stricture recurred in three (24%) of the VO and two (11%) of the DO groups (P > 0.05). One patient in the VO group required surgical closure of the urethral fistula. Flap pseudo‐diverticulum and/or sacculation with postvoid dribble occurred in six patients in the VO and none in the DO group (P = 0.01). Conclusions Dorsal placement of the pedicled flap is anatomically and functionally more appropriate than the traditional VO placement. DO preputial/penile flap urethroplasty is a versatile procedure and can be applied even for long anterior urethral strictures, including reconstruction of the meatus and high proximal bulbar strictures.
Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using colour Doppler ultrasonography and nocturnal penile tumescence monitoring
Authors: Kawanishi Y. , Lee K.S. , Kimura K. , Kojima K. , Yamamoto A. , Numata A. 
Published: March 2003

Objective To assess the effect of radical retropubic prostatectomy on erectile function, by evaluating objectively patients' erectile function before and after surgery. Patients and methods The study comprised 126 patients with clinically localized prostate cancer who were scheduled to undergo radical retropubic prostatectomy. After giving informed consent for the study, 123 patients underwent intracavernosal injection tests, colour Doppler ultrasonography and nocturnal penile tumescence monitoring before and after surgery. Results From the intracavernosal injection tests and nocturnal penile tumescence monitoring, 21 patients (17%) were evaluated as having normal erectile function before surgery. After radical retropubic prostatectomy, nine (43%) of these 21 potent men had preserved erectile function. In eight patients whose neurovascular bundles were preserved, five were potent after surgery. The cause of erectile function after surgery was a neurogenic disorder in seven and a related vascular disorder in five. Conclusion From objective tests of erectile function on patients scheduled to undergo radical prostatectomy, 17% had normal erectile function. However, even after nerve‐sparing radical retropubic prostatectomy, the proportion retaining potency was unsatisfactory. Although a neurological disorder was the main cause of erectile dysfunction after surgery, vascular disorders were also important.
Homotypic cell–cell contacts stimulate the motile activity of rat prostate cancer cells
Authors: Madeja Z. , Miȩkus K. , Sroka J. , Djamgoz M.B.A. , Korohoda W. 
Published: March 2003

Objective To characterize the effect of homotypic cell‐to‐cell collisions upon the motile activities of two rat prostatic cancer cell lines of markedly different metastatic potential. Materials and methods The movements of strongly and weakly metastatic MAT‐LyLu and AT‐2 cells, respectively, were recorded under an inverted microscope at 37 °C. The motile activities of the cells at various cell densities were characterized quantitatively by computer‐aided tracking methods and image analysis. The following variables were assessed: speed of movement, final displacement, coefficient of movement efficiency, diffusion constant and positive flow. Results MAT‐LyLu and AT‐2 cells showed only limited motile activity in sparse cultures where there was little contact amongst the cells. However, under these and all other subsequent conditions tested, the motile activity of the MAT‐LyLu cells was higher than the AT‐2 cells. As the density of the cultured cells was increased (leading to more cell‐to‐cell contacts) there was a significant increase in motility. This effect was more pronounced for the AT‐2 than for the MAT‐LyLu cells, resulting in visible acceleration of movement by direct physical contact among the colliding cells. The motile activities of the tumour cells was only slightly affected by conditioned media. Conclusion Homotypic collisions between migrating prostatic cancer cells can strongly stimulate their motility. The effect of increased contact is greater on the weakly metastatic cells, such that at high cell density, the difference in the motilities of weak and strong metastatic cells is greatly reduced.