bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproduction of functional smooth muscle tissue and partial bladder replacement
Authors: PROBST M. , DAHIYA R. , CARRIER S. , TANAGHO E.A. 
Published: November 2003

Objective To find a means of bladder augmentation that would avoid the complications encountered with the use of bowel segments, using a newly developed acellular biomaterial, the bladder acellular matrix graft (BAMG), as a homologous graft.Materials and methods Thirty‐four rats underwent a partial cystectomy (40–50%) and grafting with a BAMG of equal size. Eleven rats died within the first 72 h, probably from urinary leakage caused by obstruction of the bladder neck with stones or coagula; the surviving 23 were killed at varying intervals after cystectomy and examined.Results After providing initial bladder enlargement, the graft was progressively infiltrated by the vessels and smooth muscle cells of the host; furthermore, the mucosal lining was complete within 10 days. After 4 weeks, all bladder wall components were evident histologically in the graft. The ingrowth was complete after 8 weeks, except for neural regeneration, which was only partial. At 12 weeks, the bladder wall muscle structure in the graft was so well developed that it was difficult to delineate the junction between host bladder and BAMG. Neural regeneration continued to improve. Normal bladder capacities were maintained throughout the study.Conclusion The BAMG appears to serve, without rejection, as a framework of collagen and elastin for the ingrowth of all bladder wall components. The reason for the better acceptance of the BAMG than of other bladder augmentation grafts requires further investigation.
Multiple frequent recurrences in superficial transitional cell carcinoma of the bladder: is survival compromised by a conservative management strategy?
Authors: HROUDA D. , OGDEN C. , MORRIS S.B. , WANENDEYA N. , FISHER C. , WOODHOUSE C.R.J. 
Published: November 2003

Objective To examine whether a strategy of bladder conservation is reasonable in patients with multiple frequent superficial recurrences of transitional cell carcinoma (TCC) of the bladder.Patients and methods Fifty‐four patients with pTa/pT1, G1/G2 tumours at diagnosis, with five or more recurrences at two or more cystoscopies within 2 years of diagnosis and a minimum follow‐up of 4 years were identified. The patients were categorized according to outcome, i.e. disease settled, continuing high‐activity disease and disease progression.Results Forty‐four patients did not progress, of whom 16 continued to have high‐activity disease and 28 settled to a lower disease activity. One patient had a cystectomy for superficial disease. Nine patients progressed, six with muscle invasion in the bladder and three elsewhere in the urinary tract. Neither grade nor stage were predictive of recurrence. All but one of the patients with progression had both multicentric tumours at diagnosis and a positive cystoscopy at 3 months. Three patients died from their bladder cancer.Conclusion A policy of endoscopic resections and intra vesical chemotherapy or bacille‐Calmette‐Guèrin, with cystectomy reserved until muscle‐invasive disease develops, does not significantly compromise survival in patients with high‐activity superficial TCC. Cystectomy for superficial disease is rarely necessary.
Which patients with prostatic carcinoma require a staging bone scan
Authors: KEMP P.M. , MAGUIRE G.A. , BIRD N.J. 
Published: November 2003

Objective To determine whether the level of prostate‐specific antigen (PSA) can be used to decide which patients with newly diagnosed prostatic carcinoma require a staging bone scan.Patients and methodsOf patients referred during an 18‐month period for a staging bone scan, 98 (median age 72 years, range 52–89) had had their serum PSA level determined within 4 weeks of the bone scan and were assessed retrospectively for the presence of bony metastases.ResultsOf the 98 patients, 26 who had bone scans showing bony metastases had a PSA level >40 ng/mL. Reviewing the other published studies showed that in those newly diagnosed patients with a PSA level of <20 ng/mL, the probability of having bony metastases detected on a bone scan was <1%.ConclusionsA staging bone scan can be omitted in the vast majority of patients with newly diagnosed prostatic carcinoma and a PSA level <20 ng/mL.
The female tetraplegic: an admission of urological failure
Authors: SINGH G. , THOMAS D.G. 
Published: November 2003

Objective To present the long‐term follow‐up of female patients with tetraplegia managed in our unit, many of who require permanent indwelling catheters or urinary diversions that lead to significant complications and associated morbidity.Patients and methods Eighty‐four female tetraplegics (mean age 31 years, range 13–81) were followed for a mean of 9 years (range 2–30). Three groups of patients were identified, depending on their neurology; 27 patients had complete lesions (Frankel A), 20 had incomplete lesions with poor functional recovery (Frankel B/C) and 37 had incomplete lesions with good function (Frankel D/E).Results The patients with complete lesions (Frankel A) were difficult to manage, with 23 of the 27 (85%) treated using indwelling catheters. Three patients underwent diversion and for one patient, the carer performs clean intermittent catheterization (CIC). Of the 20 patients with Frankel B/C lesions, 14 have permanent indwelling catheters, three are able to perform CIC and three void by controlled triggering of detrusor contractions (reflex voiding). The 37 patients with Frankel D/E lesions fared better and only three (8%) require permanent catheters. Of the others, four (11%) use CIC (one following a cystoplasty) and most (30, 81%) use reflex voiding. Most of the 40 patients with permanent catheters had significant problems with bladder stones (55%), leakage and by‐passing (35%), and recurrent symptomatic infections (33%). Patients performing CIC fared better, with most needing anticholinergic therapy or subtrigonal phenol; patients who used reflex voiding also needed these two treatments at some stage. Four patients (two with ileal loops and two with indwelling catheters) developed dilated upper tracts.Conclusions The urological status of female patients following cervical cord injury depends on the level of injury and recovery. Most patients with Frankel A‐C lesions have permanent indwelling catheters and most patients with Frankel D or E lesions void with controlled triggering or use CIC. Although upper tract dilation was seen in only 5%, patients had significant morbidity related to the bladder.
Effect of sucralfate on induced chemical cystitis in rabbits
Authors: HENNINGSOHN L. , INGELMAN‐SUNDBERG H. , KINN A‐C. , TRYGG G. 
Published: November 2003

Objective To study the histological effect of locally applied sucralfate on the urinary bladder in rabbits with chemically induced cystitis.Materials and methods Sucralfate (1 g dissolved in 10 mL saline) was instilled into the bladders of six rabbits, while four controls had no instillation. The procedure was repeated 4 days later and followed immediately by 10 mL of 2% formaldehyde infused into the bladder and retained for 10 min in all 10 rabbits. After careful flushing with saline, 10 mL sucralfate solution was again instilled in the study group and 10 mL of saline only in the control group. On day 6, the sucralfate instillation was repeated in the six treated animals. All the rabbits were then killed on day 8–9, their bladders removed and examined macroscopically and histologically.Results Formaldehyde instillation was quickly followed by gross haematuria in all animals. It subsided in the group treated with sucralfate, but not in the controls. Examination revealed only slight changes in the former group, but severe inflammatory lesions in the latter.Conclusions Intravesically instilled sucralfate protected rabbit bladder urothelium against chemically induced cystitis. Clinical trials of intravesical sucralfate seem warranted in patients irradiated for pelvic cancer or with severe cystitis caused by cytotoxic drugs.
Buccal mucosal graft for secondary hypospadias repair and urethral replacement
Authors: AHMED S. , GOUGH D.C.S. 
Published: November 2003

Objective To assess the effectiveness of buccal mucosa in the treatment of complex hypospadiasPatients and methodsSeventeen patients had an onlay patch of buccal mucosa to reconstruct the urethra after failed previous surgery; five had a tubed buccal mucosal graft as an urethral replacement in the ‘primary’ repair of severe hypospadias.ResultsThere were no complications in 19 patients; two developed fistulae and one a stricture due to graft narrowing. There were no meatal complications.ConclusionBuccal mucosa taken from the inner aspect of the lip is very suitable for reconstructing a failed hypospadias repair, especially when used as an onlay graft.
Analysis of glycosaminoglycans in human prostate by high‐performance liquid chromatography
Authors: IIDA S. , SUZUKI K. , MATSUOKA K. , TAKAZONO I. , SHIMADA A. , INOUE M. , YAHARA J. , NODA S. 
Published: November 2003

Objective To investigate changes in glycosaminoglycan (GAG) profiles in human prostatic tissue.Materials and methods Seventeen human prostatic samples were examined; five were normal, six hyperplastic and six were cancerous. Prostatic proteoglycans were extracted with 4 mol/L guanidine‐HCl containing protease inhibitors. After digestion of the freeze‐dried proteoglycan extract with papain, the prostatic GAGs were purified. Total GAGs were measured by a modified dimethylmethylene blue (DMB) method. High‐performance liquid chromatography (HPLC) was used to quantify the extracted GAGs.Results Six types of GAGs, i.e. chondroitin 4‐sulphate (Ch‐4S), chondroitin 6‐sulphate (Ch‐6S), dermatan sulphate (DS), chondroitin, heparan sulphate and hyaluronic acid, were analysed qualitatively and quantitatively. The total amount of GAGs was increased in hyperplastic and cancerous prostates, with the predominant components being DS and Ch‐6S in these specimens. The Ch‐S:DS ratio in cancerous prostate was significantly higher than that in normal and BPH tissue (P<0.05). Moreover, chondroitin was increased in hyperplastic prostatic tissue (P<0.01).Conclusions These results suggest that an increase in chondroitin levels may be associated with hyperplastic change and an increase in the Ch‐S:DS ratio may be related to the development of malignancy.
Correlation of the endoscopic and radiological anatomy of congenital obstruction of the posterior urethra and the external sphincter
Authors: DEWAN P.A. , PILLAY S. , KAYE K. 
Published: November 2003

Objective To determine whether the external sphincter is distal to congenital occlusion of the posterior urethra in boys by correlating endoscopic video‐recorded information with cysto‐urethrographic observations and assessing the anatomy of the disease.Patients and methods This study reviewed the endoscopic and radiographic findings in 42 boys (mean age 42 months, range newborn to 14 years), using material from a videotape library, and correlated these with the pre‐operative cystogram. The nature of the obstructive lesion and its relationship to the verumontanum and the external sphincter was assessed.Results Of the 42 boys, 36 had the proximal extent of the external sphincter identified on the endoscopic video recording to be above the posterior urethral membrane; 22 of the membranes were obstructive. The proximal extent of the external sphincter was identified on the static cystogram images of only 31 of the 38 boys examined, but only ever above the posterior urethral membrane.Conclusion The proximal extent of the external sphincter, i.e. that portion which is most prominent endoscopically, is proximal to the membrane in congenital obstruction of the posterior urethra.
Oxybutynin in the treatment of early detrusor instability after transurethral resection of the prostate
Authors: ISELIN C.E. , SCHMIDLIN F. , BORST F. , ROHNER S. , GRABER P. 
Published: November 2003

Objective To evaluate the symptomatic and urodynamic effects of oxybutynin in the control of irritative micturitional symptoms during the first week after transurethral resection of benign prostatic hyperplasia (BPH).Patients and methods Fifty‐three patients (median age 67 years, interquartile range 62–72) were included prospectively in a double‐blind placebo‐controlled study. Pre‐operatively, uroflowmetry and cystometrography (CMG) were performed, and the post‐void residual volume (PVR) measured; symptoms were rated according to the Boyarski score. CMG was repeated on the first post‐operative day and medication was started on the third day. Before withdrawing the catheter on the fifth day, CMG was repeated. Three days later, symptoms were evaluated according to the Boyarski score and uroflowmetry and the estimate of PVR reassessed.Results In comparison with placebo, oxybutynin significantly decreased frequency, urgency and detrusor pressure at first sensation of filling. However, oxybutynin did not lower the rate of pre‐operative detrusor instability and exerted no effect on the maximal capacity of the bladder and corresponding detrusor pressure. Dryness of mouth was reported in 13% and 65% of patients receiving placebo and oxybutynin, respectively.Conclusion Oxybutynin alleviates early irritative symptoms after transurethral resection of BPH, without consistently modifying bladder urodynamics.
When is bone scintigraphy necessary in the assessment of newly diagnosed, untreated prostate cancer?
Authors: HAUKAAS S. , ROERVIK J. , HALVORSEN O.J. , FOELLING M. 
Published: November 2003

Objective To evaluate the utility of bone scintigraphy in the assessment of newly diagnosed, untreated prostate cancer.Patients and methods The probability of a positive bone scan for metastases was analysed for different threshold values of pre‐treatment concentrations of prostate specific antigen (PSA), clinical stage, tumour grade based on biopsy, and age in 128 men (mean age 69 years, range 50–90) with newly diagnosed, untreated prostate cancer. The overall survival probabilities estimated from PSA level, extent of bone metastases, tumour grade, clinical stage, and age were calculated using the product‐limit method.Results The positive predictive values of PSA level for bone metastases at thresholds of 10 and 20 ng/mL were poor (27.5 and 47.5%, respectively) whereas similar threshold levels of PSA gave negative predictive values of 100 and 94%, respectively, for a positive bone scan. In a univariate analysis, the overall survival was significantly affected by the extent of bone scan pathology (P<0.001), the pre‐treatment level of PSA (P<0.001) and tumour grade (P=0.01), whereas a multivariate analysis identified, in order of significance, tumour grade (P=0.003), bone scan findings (P=0.007) and PSA levels (P=0.03) as independent prognostic factors.Conclusions Bone scintigraphy seems to be unnecessary in the evaluation of newly diagnosed, untreated prostate cancer in patients with no clinical signs of bone pathology and serum PSA levels of ≤10 ng/mL. However, the bone scan accurately assesses bone metastases and the prognostic significance of bone scan findings is superior to that of serum PSA level.
Single‐dose versus multiple instillations of epirubicin as prophylaxis for recurrence after transurethral resection of pTa and pT1 transitional‐cell bladder tumours: a prospective, randomized controlled study
Authors: ALI‐EL‐DEIN B. , NABEEH A. , EL‐BAZ M. , SHAMAA S. , ASHAMALLAH A. 
Published: November 2003

Objective To compare single‐dose and multiple instillations of epirubicin in the chemoprophylaxis of superficial bladder tumours.Patients and methods In a prospective randomized and controlled study, 168 evaluable patients were assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline 1–2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to complete one year of treatment; group 3 (control group) received no adjuvant therapy after TURBT. The patients were assessed by cysto‐urethroscopy, urine cytology and DNA flow cytometry 8 weeks after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the next 2 years. Intravenous urography was performed annually and when otherwise indicated.Results The recurrence rate was significantly lower in the patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P<0.001). In those receiving epirubicin, the rates of recurrence were statistically comparable (P=0.9). Patients who had a large tumour burden showed slightly lower recurrence rates with single‐dose epirubicin than with delayed maintenance therapy but the difference was statistically insignificant. Patients with a history of bladder tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose (34.6 and 22.6% in groups 1 and 2, respectively); again this difference was statistically insignificant. Patients with grade 3 tumours showed a marginal difference in favour of maintenance therapy. The rates of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant differences. The overall toxicity rates were comparable in the two treated groups (22 and 25%).Conclusion With the possible exception of grade 3 tumours, single‐dose immediate epirubicin is as effective as delayed maintenance therapy, with the advantage of being more cost‐effective.
Morbidity of ultrasound‐guided transrectal core biopsy of the prostate without prophylactic antibiotic therapy. A prospective study in 415 cases
Authors: ENLUND A.‐L. , VARENHORST E. 
Published: November 2003

Objective To evaluate prospectively the incidence of complications following transrectal core biopsy of the prostate without prophylactic antibiotic therapy.Patients and methods The study comprised 426 consecutive patients who underwent transrectal core biopsies of the prostate guided by transrectal ultrasonography (TRUS). The patients were requested to return a completed questionnaire 2 weeks after the examination; 415 patients (97.4%) did so.Results The predominant complications were haematuria (49.6%) and rectal bleeding (21.7%), which did not require treatment. Twelve patients (2.9%) developed fever and 11 of these were treated successfully with antibiotics. One recovered without treatment. One patient had urinary retention.Conclusion In this study, most complications following TRUS‐guided biopsies were minor and required no treatment. Automated needle biopsy is an acceptable option for biopsy of the prostate and does not provoke the need for prophylactic antibiotic therapy. However, it is mandatory to counsel patients before biopsy and to monitor the infection rate. The ultimate need for antibiotic prophylaxis remains to be determined.
Effects of castration on adrenergic, cholinergic and nonadrenergic, noncholinergic responses of isolated corpus cavernosum from rabbit
Authors: YILDIRIM M.K. , YILDIRIM S. , UTKAN T. , SARIOGLU Y. , YALMAN Y. 
Published: November 2003

Objective To investigate the effects of castration and testosterone on the constricting effect of phenylephrine and endothelium‐dependent and ‐independent relaxing effects of different agonists in the corpus cavernosum of male rabbits.Materials and methods Twenty rabbits were castrated and 10 received testosterone replacement for 1 month after castration; 10 further rabbits underwent a sham operation and acted as controls. One month after operation the rabbits were killed and their penises excised. Strips of corpus cavernosum were used for isometric tension measurements in organ chambers; concentration‐response relationships for phenylephrine, carbachol, adenosine and sodium nitroprusside were obtained by adding the reagent cumulatively to the bath.Results The phenylephrine‐induced contractions were markedly lower, with no change in the pD2 values (i.e. the negative logarithm of the concentration for half‐maximal response), in cavernosal strips obtained from castrated rabbits than in those from controls. Endothelium‐dependent relaxation elicited by carbachol increased in the castrated group but the relaxation induced by sodium nitroprusside did not change and those elicited by adenosine were strongly depressed when compared with controls. There were no significant changes in the pD2 values of agonist‐induced relaxation responses in all groups. The relaxation elicited by electrical‐field stimulation at lower frequencies increased in strips from castrated rabbits but at higher frequencies were unchanged when compared with controls. Castration‐induced changes in the relaxation response of cavernosal strips were significantly restored by in vivo testosterone replacement but those induced by phenylephrine were not.Conclusion The lack of testosterone has an effect on the reactivity of the corpus cavernosum, indicating that testosterone has an important role in erectile function by a pre‐ or post‐synaptic action on the corpus cavernosum.
Pelvic floor exercises as a treatment for post‐micturition dribble
Authors: PATERSON J. , PINNOCK C.B. , MARSHALL V.R. 
Published: November 2003

Objective To determine the effectiveness of pelvic floor exercises and urethral milking as treatments for post‐micturition dribble.Patients and methods A method of measuring small amounts of urine loss during normal activity was developed; pads were worn for short periods (<4 h) and then stored in two sealed plastic bags which were weighed within 72 h. Forty‐nine men (age range 36–83 years) drawn from a hospital out‐patient population, who had not undergone surgery on the bladder, urethra or prostate gland, entered the study. They were randomly assigned to one of three treatment groups; pelvic muscle exercise, urethral milking or counselling. Participants in each group followed the treatment specific to their group for 12 weeks. At 5, 9 and 13 weeks, urine loss was assessed using the method described.Results The groups were comparable for age, height, weight and pelvic muscle contraction strength and compliance of the men who completed the study was excellent. The outcome measure (improvement in pad weight gain) was strongly influenced by initial pad weight gain, or degree of urine loss at the start of the study and this was treated as a covariate in an analysis of variance model. After allowing for the effects of initial pad weight gain, the counselling group showed no improvement, the urethral milking group showed an adjusted mean improvement in urine loss of 2.9 g after 13 weeks, compared with 4.7 g in the exercise group.Conclusion Both pelvic floor exercises and urethral milking are effective treatments for post‐micturition dribble compared with counselling alone. Pelvic floor exercises were more effective in reducing urine loss than urethral milking in this study.