bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing trends in prostatic cancer
Authors: Murphy  , Johnston  , Whelan  , Rider  , Lloyd  
Published: March 2003

ObjectivesTo examine the diagnosis and treatment of prostatic cancer in a population‐based study, reporting incidence trends and survival, in the decade before the introduction of prostate‐specific antigen (PSA) testing, and thus determine whether the overall incidence of prostatic cancer is increasing or not.Patients and methodsThe study included all men registered as having prostatic cancer in the Yorkshire region between 1981 and 1990. The Northern and Yorkshire Cancer Registry and Information Service has an active registration policy and after notification, the information received is validated by histopathology reports and case‐note review. Of the patients registered, 68% were over 70 years old at the time of diagnosis (mean age 74 years). Prostatic cancer was often diagnosed incidentally, after prostatectomy for presumed benign disease. Indications for treatment were not recorded, but most patients had treatment which was designed to control outlet bladder symptoms rather than with intent to cure cancer.ResultsIn all, 8118 patients with prostatic cancer were registered, of whom 6587 had histological confirmation. There was a 30% increase in the age‐standardized incidence of prostatic cancer during the study period (P<0.001). The mortality from prostatic cancer increased by 35% (P<0.001) and the percentage of patients known to have metastases at the time of presentation increased from 18% to 24%. These changes were seen in all age groups. The overall survival was 49% at 5 years and 34% at 10 years.ConclusionsThere has been a real increase in the incidence of prostatic cancer which pre‐dates the use of serum PSA testing. The percentage relative survival of patients with prostatic cancer in Yorkshire during the study period is similar to that seen in other parts of the UK, but compares badly with reported survival in other countries.
Metabolic characteristics of the elderly with recurrent calcium oxalate stones
Authors: Yagisawa  , Hayashi  , Yoshida  , Okuda  , Kobayashi  , Ishikawa  , Goya  , Toma  
Published: March 2003

ObjectiveTo determine the metabolic characteristics of elderly patients with recurrent calcium oxalate stones.Patients and methodsMetabolic abnormalities were investigated in 88 patients with recurrent calcium oxalate stones, including 70 aged <60 years and 18 aged ≥60 years. The frequency of each metabolic abnormality and the value of each urinary constituent were compared among subgroups of age and gender.ResultsHyperoxaluria was the most common abnormality, present in 56% and 67% of patients aged <60 and ≥60 years, respectively. Hyperuricosuria was significantly more common in older than in younger patients. There were no significant differences in the frequencies of hypercalciuria and hypocitraturia between the age groups. The urinary excretion of oxalate and the ratio of oxalate to creatinine were significantly greater in older than in younger men. The frequency of low urine volume was lower in older than in younger patients and the mean urinary volume was also greater in the older group.ConclusionsHyperuricosuria and hyperoxaluria seem to be essential risk factors for calcium oxalate stone formation in elderly patients. Urinary oxalate excretion is significantly greater in older than in younger stone formers and is more prominent in men.
Serum insulin‐like growth factor‐1 is not a useful marker of prostate cancer
Authors: Cutting  , Hunt  , Nisbet  , Bland  , Dalgleish  , Kirby  
Published: March 2003

ObjectiveTo determine whether the use of serum insulin‐like growth factor 1 (IGF‐1) levels is more efficient than serum prostate specific antigen (PSA) levels in predicting prostate cancer in patients undergoing prostatic biopsy.Patients and methodsThe study included 94 consecutive patients who required transrectal ultrasonography (TRUS)‐guided biopsies of their prostate and who had blood samples taken before their biopsies. These samples were then analysed for IGF‐1 and PSA concentrations. Six prostatic biopsies were taken from each patient; they were assessed and a diagnosis made of prostate cancer or no malignancy.ResultsThirty‐seven patients were found to have prostate cancer and 57 had no evidence of malignancy. There was no statistical difference in serum IGF‐1 levels between these groups. The PSA level and age of the patients differed significantly between the groups (both P<0.001). There was no correlation between IGF‐1 and PSA levels, and even when the age difference in the groups was considered, there was still no significant relationship between IGF‐1 levels and the incidence of prostate cancer. In patients with a PSA level of 4–20 μg/L there was no statistically significant difference in IGF‐1 levels between the groups.ConclusionSerum IGF‐1 as a tumour marker does not help to predict patients with prostate cancer. PSA level and even age were better predictors of the presence of prostate cancer than were serum IGF‐1 levels.
Nocturia and polyuria in men referred with lower urinary tract symptoms, assessed using a 7‐day frequency‐volume chart
Authors: Matthiesen  , Rittig  , Mortensen  , Djurhuus  
Published: March 2003

ObjectivesTo investigate if a 7‐day frequency‐volume (FV) chart could identify nocturia on a polyuric basis in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).Patients and methodsThe study included 23 patients (mean age 62.8 years, range 42–78) with LUTS who were referred for the evaluation of potential BPH and 11 men (control subjects, mean age 63.3 years, range 58–69); all completed a 7‐day FV chart investigation as outpatients.ResultsNocturia was associated with nocturnal polyuria in 10 of 23 patients with LUTS; these 10 patients had a diminished diurnal variation of urine production, whereas 13 patients had a diurnal variation in urine production comparable with that in controls with no nocturia. The degree of nocturia correlated positively with nocturnal urine production but showed no relationship with sleep duration. The nocturnal polyuria in these patients was associated with a higher 24‐h urine production and seemed at least partly to be caused by a higher fluid intake during daytime.ConclusionNocturia on a polyuric basis can be detected by using a FV chart. In these patients, a 3‐day FV chart would be sufficient to detect nocturia on a polyuric basis and seems therefore to be a valuable tool in evaluating patients with LUTS referred for potential BPH.
Biofeedback or pelvic floor muscle exercises for female genuine stress incontinence: a meta‐analysis of trials identified in a systematic review
Authors: Weatherall  
Published: March 2003

ObjectiveTo test, by meta‐analysis, the conclusion of a systematic review that biofeedback was no more effective than pelvic floor muscle exercises alone for the treatment of female genuine stress urinary incontinence.Materials and methodsData extracted from the five trials identified in the systematic review were subjected to pooled analysis of odds ratios for the outcome of ‘cure’.ResultsThe odds ratio for biofeedback combined with pelvic floor muscle exercises, compared with pelvic floor muscle exercises alone, leading to cure was 2.1 (95% confidence interval 0.99–4.4).ConclusionsBiofeedback may be an important adjunct to pelvic floor muscle exercises alone in the treatment of female genuine stress urinary incontinence. A quantitative statistical analysis of the studies identified leads to different conclusions from those in the systematic review.
Intra‐uterine testicular torsion: early diagnosis and treatment
Authors: Al‐Salem  
Published: March 2003

ObjectiveTo review the incidence and treatment of intra‐uterine torsion of the testis which although rare is being recognized with increasing frequency.Patients and methodsFrom 1988 to 1997, five newborns (mean birth weight 3.62 kg, range 3.15–4.12) with unilateral torsion of the testis were treated; all underwent emergency exploration. The right testis was affected in three and the left in two boys.ResultsIn all except one child, the affected testis was enlarged, firm to hard, tender, the overlying skin dark red and the affected testis higher than the contralateral testis. In one child the right testis was enlarged and higher, but soft to firm, and the overlying skin was oedematous and red. The exploration revealed extravaginal torsion of the testis which was gangrenous in four; in one after detorsion there was haemorrhage and haematoma of the cord and the tunica, and the testis was slightly congested but not gangrenous. This testis was preserved and bilateral orchidopexies performed; at 18 months both testes are palpable and of normal size. In the remaining four children the testes were frankly necrotic; they underwent orchidectomy and contralateral orchidopexy. Histology in all four revealed a totally infarcted testis with extensive haemorrhage and vascular congestion.ConclusionThe early diagnosis and treatment of intra‐uterine torsion of the testis is essential.
Desmopressin in the treatment of nocturnal polyuria in the male
Authors: Cannon  , Carter  , Mcconnell  , Abrams  
Published: March 2003

ObjectivesTo assess whether desmopressin (1‐desamino 8‐d‐arginine vasopressin) is safe and effective in the treatment of nocturnal polyuria in elderly men.Patients and methodsTwenty men (age 52–80 years) complaining of nocturia were found to have nocturnal polyuria, determined from frequency‐volume charts and defined as the production of >33% of the 24 h urine volume overnight, averaged over a 1‐week period. In a double‐blind study of cross‐over design, a 1‐week placebo run‐in period was followed by two 2‐week periods of placebo or 20 μg intranasal desmopressin, and ended with an open 2‐week treatment period with 40 μg desmopressin.ResultsDesmopressin caused a significant reduction in nocturnal urine volume and the percentage of urine passed at night, but the reduction in nocturnal frequency was only significant during treatment with 40 μg desmopressin. Four patients on desmopressin experienced side‐effects, three of which were thought to be due to fluid retention.ConclusionDesmopressin is an effective treatment for nocturnal polyuria in some elderly men. However, it can cause fluid retention and should not be given to patients with cardiac failure. Those undergoing treatment must be closely monitored.
Completeness and efficiency of prostate tissue removal: loop resection compared with a new operative technique of transurethral electrovaporization
Authors: Patel  , Fuchs  , Gutierrez‐Acéves  , Andrade‐Perez  
Published: March 2003

ObjectiveTo compare the completeness and efficiency of the removal of prostatic adenomatous tissue between transurethral resection (TURP) and a new operative technique of electrovaporization (TUEVAP) using a modified roller electrode.Patients and methodsIn a prospective double‐blind study, patients with moderate to severe lower urinary tract symptoms and objective evidence of obstruction, were randomized to undergo either TURP (using a standard cutting‐wire loop) or TUEVAP (performed with a new operative technique and the spiked‐bar electrode). The prostate volume measured using transrectal ultrasonography (TRUS‐PV) was used to assess the completeness of tissue clearance after treatment. Results were compared using group median values. For the TURP group, the TRUS‐PV estimate of tissue removed was divided by the dry resected weight to derive a correction factor for any discrepancy between the values. This factor was applied to the TRUS‐PV reduction in the TUEVAP group (where there was no tissue to be weighed) to estimate the actual tissue removal in this group. The efficiency of tissue removal for each treatment modality was derived by dividing the amount of tissue removed by the operative duration.ResultsThere was no difference in the reduction in TRUS‐PV at 3 months (23.9 cm3 vs 21.45 cm3, P<0.9), or in the operative duration (45 min vs 52.5 min, P<0.2), between TURP and TUEVAP, respectively. The TRUS‐PV of tissue removed exceeded the actual dry resected weight after TURP (15 g) by a factor of 1.59. After applying this factor to the TRUS‐PV reduction for the TUEVAP group, the calculated dry weight of tissue removed for this group was 13.49 g (P<0.55); the difference in tissue removal rate by TRUS criteria was 0.48 cm3/min vs 0.37 cm3/min (P<0.15).ConclusionsThese data suggest an equivalent completeness of removal of adenomatous prostate tissue between TURP and TUEVAP. The efficiency of tissue removal for TUEVAP was slightly less than that of regular loop resection, but this difference was not statistically significant. These results are specific to the combination of electrode, electrosurgical unit and operative technique used in this study, and may differ if any of these variables are altered.
The role of urine cytology in the assessment of lower urinary tract symptoms
Authors: Potter  , Quigley  , Pengelly  , Fawcett  , Malone  
Published: March 2003

ObjectiveTo evaluate the role of urine cytology in the investigation of men with lower urinary tract symptoms (LUTS) in the absence of haematuria.Patients and methodsThe study comprised 336 men attending a LUTS assessment clinic, who had neither macroscopic nor microscopic haematuria. One sample of urine was collected for cytology. Those with suspicious urine cytology were investigated with intravenous urography and cystoscopy.ResultsFive men had abnormal urine cytology results; on further investigation one of them was found to have carcinoma in situ (CIS) and one to have a transitional cell carcinoma. Three had false‐positive urine cytology results.ConclusionA bladder tumour or CIS was detected in 0.6% of the population tested. The cost per cancer diagnosed was GB £2020. Urine cytology is a simple noninvasive way of assisting accurate diagnosis of men who have LUTS in the absence of haematuria.
Mortality in the elderly in relation to nocturnal micturition
Authors: Asplund  
Published: March 2003

ObjectiveTo study the relationship between nocturnal micturition and mortality in an elderly population.Subjects and methodsAll 10 216 members of the Swedish pensioners’ association (SPF) in two Swedish counties were asked to participate in a questionnaire survey. The questions concerned the general state of health, occurrence of somatic diseases and symptoms, number of voiding episodes per night, everyday habits and behaviour, and the use of drugs. After 6 years, data on deaths were extracted from the National Register of Deaths at the National Central Bureau of Statistics in Stockholm.ResultsThere were 6143 evaluable questionnaires, of which 39.5% were from men. The mean (sd) ages of the men and women participating were 73.0 (6.0) and 72.6 (6.7) years, respectively. During a 54‐month period after the questionnaire was completed, 444 of the men and 384 of the women died. The men with three or more nocturnal voiding episodes had a higher death rate, at 1.9 (1.4–2.6) times more than the whole group of men (3.4% vs 1.9% per 6 months; P<0.001), and the corresponding women a death rate 1.3 (0.9–2.0) times higher than all women (1.4% vs 1.1% per 6 months, not significant). In a multiple logistic regression analysis, significant independent correlates of death during the study period were: being 70–79 years vs <70 years (odds ratio, OR, 1.92, 95% CI 1.52–2.43), being ≥80 years vs <70 years (5.14, 3.96–6.68), female gender (0.44, 0.37–0.52), health (1.81, 1.46–2.25), negative health development (1.70, 1.40–2.06), spasmodic chest pain (1.38, 1.09–1.74), diabetes (1.59, 1.18–2.15), stroke (1.82, 1.12–2.93), and three or more vs two or fewer voiding episodes (1.34, 1.01–1.79).ConclusionElderly people who need to void three or more times per night had a greater mortality rate over a 54‐month observation period than those voiding less often.
Endourological renal salvage in patients with calculus nephropathy and advanced uraemia
Authors: Agrawal  , Aron  , Asopa  
Published: March 2003

ObjectiveTo document our experience with percutaneous nephrolithotripsy (PCNL) for the treatment of calculus nephropathy and advanced renal failure.Patients and methodsBetween October 1989 and April 1996, 78 patients with calculus nephropathy (51 males and 27 females, mean age 42 years, range 16–67; mean serum creatinine level 663.8 μmol/L, range 282.8–1449.7) were treated in our department. Forty‐six of the patients had bilateral upper urinary calculi, while the remaining 32 had a solitary functioning kidney obstructed by stone. Thirty‐two patients had a normal urine output, 26 were oliguric and 20 presented with anuria. A preliminary percutaneous nephrostomy (PCN) was performed under local anaesthesia in 64 patients, and stone retrieved subsequently through the same nephrostomy track after improvement in their uraemic status. In the remaining 14 patients, the stones were removed at the first session. Of the 46 patients with bilateral stones, 21 underwent stone retrieval by PCNL on the contralateral side after an interval of 2–3 weeks, while 25 patients underwent simultaneous JJ stenting on the contralateral side, followed, after improvement in uraemic status, by delayed PCNL or extracorporeal shock wave lithotripsy on that side.ResultsThere were three deaths, caused by overwhelming sepsis; 64 of the remaining 75 patients recovered well from uraemia, while 11 showed no improvement, suggesting irreversible renal damage. Complications included five patients with nonfatal sepsis and five with secondary haemorrhage. At the last follow‐up 2.5–9 years after presentation, the mean serum creatinine level (271.3 μmol/L) was significantly better than the mean preoperative level. Six patients are on maintenance haemodialysis.ConclusionsIt is not uncommon in developing countries for patients with urolithiasis to present with advanced uraemia caused by long‐standing obstruction, almost invariably complicated by infection. A percutaneous endourological approach offers the best hope for these patients, and in our experience a significant percentage of these cases can be salvaged.
Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate‐specific antigen and transrectal ultrasonography
Authors: Ulleryd  , Zackrisson  , Aus  , Bergdahl  , Hugosson  , Sandberg  
Published: March 2003

ObjectiveTo determine the frequency of prostatic involvement in men with community‐acquired febrile urinary tract infection.Patients and methodsThis prospective study included 70 men (18–85 years old) who had a fever of ≥38.0 °C, symptoms or signs of urinary tract infection and a positive urine culture. Serum prostate‐specific antigen (PSA) was measured and transrectal ultrasonography of the prostate and seminal vesicles performed during the acute phase of the disease and during a 1‐year follow‐up.ResultsAlthough only six patients had a tender prostate on digital rectal examination, the initial serum PSA level was elevated in 58 (83%) patients (median 14 ng/mL, range 0.54–140). There was no correlation between PSA levels, patient age, inflammatory response to infection or presence of positive blood cultures. Despite a rapid decline in PSA level after one month, there was a protracted decrease in some patients. After 3 months the median prostate volume was reduced by 31% (range 11–54; P<0.001) in 46 of 55 patients examined, and the width of the right and left seminal vesicle was reduced by 14% and 22%, respectively. The reductions in PSA and prostate volume were significantly correlated (r=0.36, 95% confidence interval 0.09–0.58; P=0.01).ConclusionThese results show that the prostate and seminal vesicles are frequently involved in men with febrile urinary tract infection and that PSA may be a useful marker of prostatic infection. The slow decline of PSA levels in some patients after appropriate antibiotic treatment indicates a protracted healing process and should be considered when PSA is used to detect prostate cancer.
The impact of contemporary bladder management techniques on struvite calculi associated with spinal cord injury
Authors: Donnellan  , Bolton  
Published: March 2003

ObjectiveTo evaluate the incidence, risk factors and complications of upper tract struvite calculi, often associated with spinal cord injury (SCI), as such patients have a high incidence of urinary infection complicating their neurogenic voiding dysfunction, by reviewing a large population of patients with SCI in whom modern techniques of bladder management were used.Patients and methodsBetween 1982 and 1996, 1669 patients with SCI were admitted to our institution; 1359 of these patients sustained their injuries during the study period. During this time, their bladder management was based on urodynamic and imaging criteria, using techniques such as early intermittent catheterization, sphincterotomy and bladder augmentation where possible to create a catheter‐free, low‐pressure reservoir. All instances of upper tract struvite calculi in this population were documented. Risk factors for stone development, presentation and complications, management and recurrence rates were assessed.ResultsOver the 15 years, 58 patients (3.5% of the SCI population) were treated for a total of 144 episodes of struvite calculi. The incidence of stones in those injured since 1982 was 1.5%; 67% of these patients had complete spinal cord lesions, 54% had lesions of the cervical cord and 53% developed their first stone >10 years after injury. Only 22% presented within 2 years of injury. The group of patients developing stones had a significantly higher incidence of indwelling catheters (49%), bladder stones (52%) and vesico‐ureteric reflux (28%) than those who were stone‐free. The development of recurrent urinary tract infections was the most common mode of presentation. The stone‐free rate after treatment was 87%. Normal renal function was preserved in 72% of patients.ConclusionsIn a large population of patients with SCI managed using contemporary bladder techniques the incidence of upper tract calculi was 3.5%; 30% of these stones were complete or partial staghorns. Those patients with complete cord lesions, permanent indwelling catheters and vesico‐ureteric reflux were at the highest risk. Stone clearance was 87% and recurrent stones occurred in 69% of patients. Struvite renal calculi continue to be a significant problem in the spinal cord injury population.
Is the measurement of serum testosterone routinely indicated in men with erectile dysfunction?
Authors: Fahmy  , Mitra  , Blacklock  , Desai  
Published: March 2003

ObjectiveTo investigate the usefulness of serum testosterone levels as a relevant or useful indicator of sexual potency in men attending an erectile dysfunction clinic.Patients and methodsNinety consecutive men attending the erectile dysfunction clinic completed a sexual‐activity questionnaire, and underwent a focused physical examination and questioning about their medical history. The serum testosterone level was measured in all patients and the results analysed in relation to the patient’s age. Patients with low serum testosterone levels commenced replacement therapy comprising three intramuscular injections of testosterone (Sustanon™ , Organon, The Netherlands) 250 mg every third week. Potency status and serum testosterone were reassessed after 3 months’ treatment.ResultsOf the 90 men, 28 (31%) were aged < 50 years whilst 62 (69%) were ≥50 years old. Nineteen (21%) patients overall had low testosterone levels; four of these were < 50 and 15 were ≥50 years old. Five of 90 patients had a decreased libido; two of these also had low testosterone levels and all were < 50 years old. Testosterone levels returned to normal in all patients who received replacement therapy but potency returned in only two (10%); both were in the older group.ConclusionMeasuring testosterone was not helpful in assessing potency or libido and low serum levels were not related to age. Correcting low testosterone did not improve either impotence or libido.