bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing blood loss in transurethral resection of the prostate (TURP): auditing TURP
Authors: KIROLLOS M.M. , CAMPBELL N. 
Published: November 2003

Objectives To assess the blood loss accompanying TURP and investigate its association with the resected weight of prostatic tissue, type of anaesthesia, type of presentation, histology, different surgeons and their differing techniques, and thus to reduce the morbidity associated with blood loss and transfusion.Patients and methods All prostatectomies carried out in a district general hospital were audited prospectively, recording the pre‐ and post‐operative haemoglobin concentration (Hb), blood transfusions and the variables listed above. The audit was repeated a year later.Results The peri‐operative blood loss, as assessed by various indicators, was equivalent to a decrease in Hb of 10–15 g/L (8–11%). The weight of the resected prostatic tissue was the most important measurable factor in determining blood loss. Regional anaesthesia was associated with less blood loss than general anaesthesia. The added use of a suprapubic catheter for irrigation appeared to have a marginal advantage in large resections. The type of presentation, elective or otherwise, and the histological nature of the prostate did not influence blood loss. Smaller transfusions were probably avoidable in patients having smaller resections and a normal pre‐operative Hb. On re‐auditing, the overall transfusion rate was reduced from 10.8% to 8.2% and from 4.4% to 1% in patients having resections of <30 g.Conclusion Blood transfusion can be reduced and rationalized. Patients with a normal pre‐operative Hb and undergoing resections of <30 g do not usually require transfusion. Regional anaesthesia is associated with less blood loss but its advantage is overshadowed in practice by the weight of the resected tissue. An audit of this type is repeatable and is useful in raising awareness, objectively assessing differences and advocating and assessing any changes made.
Differences in detrusor contractile function in women with neuropathic and idiopathic detrusor instability
Authors: GRAY R. , WAGG A. , MALONE‐LEE J.G. 
Published: November 2003

Objective To compare urodynamic indices of isometric and isotonic detrusor contractile function between patients with idiopathic detrusor instability and patients with multiple sclerosis (MS) and detrusor hyper‐reflexia and thus determine whether the different types of detrusor instability share a common pathophysiological pathway.Patients and methods Two groups of women were studied; 1139 neurologically normal patients with detrusor instability (mean age 55 years, sd 17) and 141 with multiple sclerosis (MS) and detrusor hyper‐reflexia (mean age 45 years, sd 11). Patients were assessed using static water cystometry, examining storage function, isometric and isotonic detrusor contractile function and voiding outflow function.Results Bladder capacities were lower in the MS group, with a median of 357 mL, 95% confidence interval (CI) 305–400 mL, compared with the neurologically normal patients (median 450 mL, 95% CI 425–450, P<0.001, Mann–Whitney U‐test). Voiding was incomplete in the MS group, with a median (95%CI) residual volume of 100 (100–125) mL, but complete in the normal group, at 10 (10–10) mL. Higher median (95% CI) detrusor pressures at urethral opening (Pdet open ) and closing (Pdet close ) were recorded in the MS group than in the neurologically normal group, at 35.5 (33.2–46.6) cmH2O and 30 (27.6–31.6) cmH2O for Pdet open , respectively (P=0.003), and 25.3 (20.9–31.6) cmH2O and 16.6 (15.0–18.1) for Pdet close , respectively, (P=0.001). In the MS group, the median (95% CI) isometric unstable contractions were less well maintained, but were more powerful, at 17.6 (15.6–18.9) N, compared to the neurologically intact group at 14.4 (14.0–14.9) N (P=0.002). In the MS group, contractions frequently did not relax back to baseline, whereas in the group with detrusor instability, full relaxation after contraction was more usual. There was no significant difference in the maximum speed of detrusor shortening (isotonic activity), measured by the velocity constant Q*, between the groups (median for both groups 20 mL/s, 95% CI 17–23).Conclusion These results show differences in storage function, isometric detrusor contractile function and voiding outflow function between detrusor instability and detrusor hyper‐reflexia, indicating that the two conditions may not share a common pathophysiological pathway.
Morphological changes in prostatic adenomas after transurethral microwave thermotherapy
Authors: BREHMER M. 
Published: November 2003

Objective To study the extension and type of tissue damage in prostatic adenomas after transurethral microwave thermotherapy (TUMT).Patients and methods Seven patients with benign prostatic hyperplasia and scheduled for open adenectomy underwent TUMT before surgery. TUMT was performed 2 h before operation in one patient, 24 h before in five and one week before in the remaining patient. The excised adenomas were examined by routine light microscopy. In addition, the terminal deoxynucleotidyl nick‐end labelling (TUNEL) technique was used to search for DNA‐strand breaks in areas with morphological alterations suggestive of apoptosis. Due to technical problems, TUMT was inadequate for one patient, i.e. the effect given was extremely low.Results In six cases, histopathological changes were found in limited areas extending from the urethra for 20–25 mm into the prostatic tissue. The predominant histopathological findings were areas of necrosis surrounded by cells with apoptotic features. The latter proved to be TUNEL‐positive, i.e. they contained nuclei with DNA fragmentation of the apoptotic type. In the case with inadequate TUMT, there was no heat‐induced tissue damage.Conclusion The area of tissue damage seen after TUMT was relatively small compared with the volume of the prostates. The main histopathological finding was massive necrosis, but cells undergoing apoptosis were also identified. Obviously, temperatures lower than those leading to necrosis induced apoptosis, which is a discrete type of cell death not associated with oedema or inflammatory reaction.
Quality‐of‐life assessment in patients after laser prostatectomy
Authors: Te SLAA E. , FRANCISCA E.A.E. , HENDRIKS J.C.M. , KIEMENEY L.A.L.M. , DEBRUYNE F.M.J. , De La ROSETTE J.J.M.C.H. 
Published: November 2003

Objective To determine the importance of the assessment of quality of life in patients who have undergone laser prostatectomy.Patients and methods Patients undergoing laser prostatectomy were evaluated using the International prostate symptom score (IPSS) questionnaire, uroflowmetry, post‐void residual volume (PVR) measurements, and quality‐of‐life (QOL) and sexual function questionnaires.Results In all, 103 patients were evaluated; there was an overall significant improvement in the mean IPSS, maximum flow, PVR and QOL score and no apparent subjective change in sexual function. There was a good correlation between the IPSS and the QOL score, but no correlation between the QOL score and the maximum flow rate, and only a weak correlation between the IPSS and the maximum flow rate.Conclusion Laser prostatectomy significantly changed the patients’ quality of life. This may be more important for the patient than the improvement in the voiding variables alone. In future (changes in) quality of life will probably contribute significantly to selecting patients with voiding complaints for particular treatments.
The urological management of men with lower urinary tract symptoms, recorded using an interactive computer program
Authors: HANSEN M.V. , ZDANOWSKI A. 
Published: November 2003

Objective To analyse the level of agreement among urologists from the industrialized world in the management of men with lower urinary tract symptoms (LUTS).MethodsThirty‐three urological departments participated in the study. A computer program was used to provide an unbiased format of 18 simulated cases of men with LUTS which individual urologists then evaluated diagnostically and made therapeutic decisions about their management. The management of the patients was assessed for the probability that a diagnostic test was used, that a therapy was offered to a particular patient, the first‐choice therapies selected, the mean cost and range for the diagnostic process per patient and the number of first‐choice therapies offered by one urologist for all the patients. Various discriminators for these therapeutic decisions were evaluated, analysing the correlations between the information provided by the diagnostic tests and the probability of a particular therapy.ResultsFor the 18 patients, the urologists, as a first choice, treated a mean (sd, range) of 8.3 (3.4, 3–16) patients with TURP, 3.9 (3.6, 0–11) with alpha‐blockers, 2.3 (1.7, 0–6) with watchful waiting and 1.7 (2.4, 0–9) with finasteride. The other therapy options were only offered as a first choice by a few of the urologists in a few of the cases. The mean (sd, range) cost per patient of the diagnostic process was US$ 594 (209, 326–1350).ConclusionThere was considerable disagreement among the urologists about the management of men with LUTS, which included both the choice of diagnostic tests and the criteria for offering therapy to patients. If such disagreement prevails generally, it may be detrimental for the outcome of patients seeking medical attention for LUTS, and the cost of the medical care of these patients will be unnecessarily high.
Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair
Authors: MILLER M.A.W. , GRANT D.B. 
Published: November 2003

Objective To obtain the long‐term follow‐up information on children born with severe perineoscrotal hypospadias associated with genital ambiguity who underwent a staged surgical correction of their hypospadias and were raised as males.Patients and methods The study comprised patients who had undergone a surgical correction of hypospadias before 1978 and were traced successfully. Postal questionnaires which were completed and returned by 19 patients and 28 general practitioners (GPs) were evaluated; in addition, nine cases were clinically reviewed.Results Of the 19 patients who completed and returned the questionnaire, four were married or living with a partner and 12 had had intercourse, with debut at a median age of 17 years. Satisfactory erection and orgasm were reported by 15 men but only seven had satisfactory ejaculation. Nine men had continued difficulties with micturition and urological function. Four men considered that their psychological well‐being and quality of life had been markedly impaired by their condition and two other men had evidence of mild depression. Nine patients did not complete the questionnaires but allowed their GPs to provide information about them; only one was reported to have marked psychological impairment and impaired general health. Two of the patients who did not participate in the study are known to have significant psychiatric problems.Conclusions Staged hypospadias repair in men with severe perineoscrotal hypospadias is associated with continued difficulty with both ejaculation and micturition, but is not usually associated with major psychiatric or psychological disturbance. The findings indicate the importance of follow‐up in adolescence and adult life with adequate counselling when necessary.
mRNA and protein expression of nitric oxide synthase and adrenoceptor alpha 1 in young and old rat penile tissues
Authors: DAHIYA R. , LIN A. , BAKIRCIOGLU M.E. , HUANG S.‐T. , LUE T.F. 
Published: November 2003

Objective To investigate alterations of neuronal structure and the mRNA expression of nitric oxide synthase (NOS) and adrenoceptor alpha 1 in young and old rat penile tissues, and assess the importance of these factors in erectile dysfunction (ED) associated with ageing.Materials and methods NOS was determined in the pelvic ganglia of 32 rats using nicotinamide adenine dinucleotide phosphate (NADPH)‐diaphorase staining. Adrenergic neurons were identified by histofluorescence staining. The gene expression for NOS and for adrenoceptor alpha 1 was investigated in corporal tissue by differential reverse transcriptase‐polymerase chain reaction (RT‐PCR) using specific oligonucleotide primers. b‐actin was used as an internal standard in each tube to quantify the baseline gene expression.Results The following changes occurred in old rats: (i) an increase of lipofuscin and a decrease in both bNOS‐containing neurons and fluorescent adrenergic neurons in the pelvic ganglia; (ii) significantly less expression of NOS mRNA than in young rat penile tissues; and (iii) no significant alteration in adrenoreceptor alpha 1 mRNA expression.Conclusions The fewer adrenergic and NOS‐containing neurons and neurotransmitters in pelvic ganglia from old rats may explain the enhanced penile smooth muscle tone previously reported in older impotent men. Furthermore, lower mRNA expression of NOS may be associated with structural and functional changes associated with ageing penile tissue.
Adrenal cortical carcinoma associated with venous tumour thrombus extension
Authors: FIGUEROA A.J. , STEIN J.P. , LIESKOVSKY G. , SKINNER D.G. 
Published: November 2003

Objective To report the diagnosis and treatment of six patients with adrenocortical adenocarcinoma and venous tumour thrombus extension.Patients and methods All six patients (four female and two male, age range 14–83 years) were approached surgically through a thoracoabdominal incision and all underwent radical ablative surgery with removal of the primary tumour, regional retroperitoneal lymphadenectomy and en bloc extraction of the venous tumour thrombus.Results Five patients with right‐sided tumours had vena caval tumour thrombus involvement and one patient with a left‐sided tumour had extension of tumour thrombus into the splenic vein. All patients had appropriate radiographic evaluation pre‐operatively and all underwent successful radical surgery with en bloc resection of the venous tumour thrombus.Conclusion For optimal management of this rare neoplasm, it is paramount that accurate diagnostic imaging be performed pre‐operatively to help dictate the ideal surgical approach and to optimize successful treatment of this disease.
Treatment of high‐risk patients with subvesical obstruction from advanced prostatic carcinoma using a thermosensitive mesh stent
Authors: GOTTFRIED H.‐W. , GNANN R. , BRÄNDLE E. , BACHOR R. , GSCHWEND J.E. , KLEINSCHMIDT K. 
Published: November 2003

Objective To evaluate the results obtained using a permanent prostatic stent system (Memotherm® , Bard/Angiomed, Karlsruhe, Germany) in high‐risk patients with advanced prostatic carcinoma and subvesical obstruction.Patients and methods The study included 35 patients (mean age 75.3 years, range 53–89) with advanced prostatic carcinoma and persistent subvesical obstruction despite androgen ablation. Because of serious concurrent diseases, 49% of these patients were classified as American Society of Anesthesiologists (ASA) grade 3 and 51% as ASA grade 4. The patients were treated using the Memotherm® stent, a thermosensitive NitinolTM mesh stent. The outcome was assessed by measuring voiding variables, a symptom score and as the incidence of complications.Results After inserting the stent, 33 (94%) of the patients were able to void spontaneously and there was a statistically significant improvement in the voiding variables. These results remained unchanged over a mean (range) follow‐up of 15.2 months (3–38). There were no serious complications arising from the insertion of the stent.Conclusion For high‐risk patients with subvesical obstruction caused by prostatic carcinoma, the insertion of a permanent metal stent system offers a useful alternative treatment to transurethral resection.
Electrovaporization of the prostate in patients with benign prostatic enlargement
Authors: MATOS‐FERREIRA A. , VARREGOSO J. 
Published: November 2003

Objective To determine the effectiveness and safety of transurethral electrovaporization in the treatment of benign prostatic enlargement (BPE).Patients and methods The study comprised 91 patients (median age 65 years) with BPE (median prostate volume 61 mL). Patients were assessed with a general and urological history, the International prostate symptom score (IPSS), urinary tract and prostatic ultrasonography, uroflowmetry and biopsy of the prostate. An electrosurgical generator (cutting at 200 W and coagulating at 70 W) with grooved electrodes was used to vaporize the prostate. The variables assessed before and after treatment were the IPSS, quality‐of‐life score, uroflowmetry, complications, and the duration of hospitalization.Results The mean operative duration was 45 min, blood loss was negligible and the mean duration of catheterization was 24 h. Recatheterization was necessary in 5.5% of patients. The median values before and after treatment were: IPSS, 19 and 5; QOL score, 4 and 2; and maximum urinary flow rate 8.3 and 22.1 mL/s (all P<0.001). In nearly all cases, the Siroky nomogram showed that patients became unobstructed.Conclusions Electrovaporization of the prostate has many advantages over other techniques used in the treatment of BPE, including transurethral resection (TURP). It is cheaper than laser‐assisted prostatectomy in particular and is also simpler to perform. Higher‐risk patients can be treated, it uses existing electrosurgical equipment with minor modifications and only the electrodes, which are inexpensive, differ from TUR loops; the TURP resectoscope can be used and there is almost no need for blood transfusion. Intra‐ and post‐operative morbidity is very low, recatheterization rare, the hospital stay brief and the results equal to or better than those obtained with TURP. Convalescence is generally uneventful and rapid because haematuria is rare and, when present, mild. Patients can return to work earlier than after TURP. Although a promising technique, only a longer follow‐up will allow firm conclusions about its suitability.
Long‐term clinical results and quality of life after insertion of a self‐expanding flexible endourethral prosthesis
Authors: ANJUM M.I. , CHARI R. , SHETTY A. , KEEN M. , PALMER J.H. 
Published: November 2003

Objective To evaluate the safety and efficacy of the Urolume self‐expanding flexible endourethral stent, based on a long‐term follow‐up, and to determine its role amongst the various modalities of treatment available for the relief of bladder outlet obstruction (BOO) arising from benign prostatic hyperplasia (BPH).Patients and methods From January 1991 to April 1992, the Urolume wallstent (American Medical Systems, USA) was placed successfully in each of 62 patients (aged 50–89 years) who had significant subjective and objective evidence of BOO. The stent was placed as a daycase procedure under general anaesthesia. Pre‐operatively, each patient was assessed fully in an out‐patient clinic by symptoms, a flow rate measurement and a rectal examination. Post‐operatively, patients were assessed using transrectal ultrasonography, cystoscopy, symptoms and flow rate measurement, and after 5 years, the International Prostate Symptom Score and satisfaction score were obtained.Results After 5 years, 27 (39%) patients survived and 10 (14%) died with their Urolume stent intact; 22 (32%) completed the follow‐up and five refused or were lost to follow‐up. Day and night‐time frequencies and flow rates improved continuously. Complete epithelialization occurred in 16 of the 22 patients assessed. Of those in whom the Urolume was removed, 20 are alive and five dead.Conclusion The effectiveness of the Urolume in improving symptoms and flow rates in patients with BPH was confirmed. However, the high failure rate arose largely from inexperience in selection and deployment. There are no absolute criteria to predict a successful outcome. This study confirms the Urolume as a safe device. Most patients whose symptoms settled in the first year maintained a good flow rate and a significant improvement in symptoms for 5 years; their quality of life at the last follow‐up was good.
A prospective randomized study comparing a catheter‐valve with a standard drainage system
Authors: WILSON C. , SANDHU S.S. , KAISARY A.V. 
Published: November 2003

Objective To determine if the use of a catheter‐valve rather than a standard drainage system decreases the morbidity associated with the use of a long‐term catheter.Patients and methods One hundred patients undergoing long‐term catheterization were recruited into a prospective randomized study to investigate the acceptability and determine any increase in infection associated with the use of a catheter‐valve, compared with the standard drainage system. Each patient participated in the study protocol for 3 months, during which the frequency of urinary tract infection was assessed, and the patients’ views obtained using a standard questionnaire and by interview.Results Ninety‐four patients completed the study; most (92%) were happy or satisfied with the valve, as opposed to only 35% of those using a standard drainage bag. There was no significant difference between the groups in the incidence of urinary tract infections.Conclusion The patients who used the standard drainage system felt their level of activity was impaired, whereas the group who were using the valve did not. In the long‐term the valve was cheaper and caused less morbidity, but because it is constructed to allow one‐way flow, this was not associated with an increase in the incidence of urinary tract infections.
Laser therapy in dogs and humans—is there a difference?
Authors: Gottfried H.W. , Brändle E. , Hefty R. , Mattfeldt T. , Badura W. , Vogel U. , Hautmann R.E. 
Published: November 2003

Objective To compare quantitatively the reduction of volume of benign prostatic hyperplasia (BPH) achieved by laser therapy in dogs and men. Patients, materials and methods Twelve mongrels, with a mean prostatic volume of 33.4 mL, underwent transurethral laser treatment using an Nd:YAG laser with an Ultraline}}rm fibre at 60 W power setting. The reduction in prostatic volume was assessed quantitatively 3 months after treatment using stereological methods. Forty patients (mean age 70.2 years, range 51–84) with symptomatic BPH (pre‐operative mean prostate volume 46.3 mL) were treated under similar operative conditions with the same laser, power and fibre system. Their urinary performance was assessed before and 6 months after treatment using urinary flow rates, residual volume and a symptom score, and their prostatic volume and necrosis assessed using transrectal ultrasonography. Results After laser treatment, the mean reduction in the dog prostate volume was 50% and in the patients was only 21%. The different impact was probably caused by anatomical differences between the human and dog prostate; the human prostate consists mainly of stromal tissue and the canine prostate of glandular epithelium. Conclusions The canine model gives only an approximate guide to the extent of tissue destruction that laser treatment can achieve in men with BPH. Furthermore, tissue differences between men may also affect the response to laser treatment.