bluuebunny/crossref_metadata_2025_split huggingface dataset:
The heat is on — but how? A comparison of TUMT devices
Authors: Bolmsjö M. , Wagrell L. , Hallin A. , Eliasson T. , Erlandsson B‐E. , Mattiasson A. 
Published: November 2003

Objective To compare the heat characteristics of the microwave antennae, the absorbed energy in the target volume and the cooling capacity of the catheters of three common devices for transurethral microwave thermotherapy (TUMT), i.e. the Prostcare, Prostatron and ProstaLund. Materials and methods The microwave emission from the respective catheters or antennae was measured in a tissue‐equivalent ‘phantom’ prostate. From these measurements the distribution of absorbed energy from the respective catheters and antennae was calculated from the characteristics of the phantom, the absorbed energy and the temperature difference before and after heating. The cooling capacity of the different catheters were measured by submerging each catheter in a thermally isolated water bath at a known temperature and determining the cooling of the water bath caused by the catheter. Results The design of the microwave antenna influenced the heating profile significantly. The energy absorbed by the prostate model varied among the devices, but was between 13 and 21% of the stated applied energy. The cooling capacity also varied, being least in the Prostcare and greatest in the ProstaLund catheters. Conclusions Users of TUMT should be aware of possible back‐heating along the catheter, as this limits the microwave power that can be used safely. Furthermore, the ‘treatment energy’, which is commonly used as an indicator to describe the intensity of TUMT treatments, is ambiguous and not stringent, in that the microwave energy absorbed in the prostate is only a small fraction of this value.
Peri‐urethral silicone microimplants (Macroplastique ) for the treatment of genuine stress incontinence
Authors: Harriss D.R. , Iacovou J.W. , Lemberger R.J. 
Published: November 2003

Objective To establish the safety and efficacy of the peri‐urethral injection of silicone microimplants (Macroplastique ) for the treatment of genuine stress incontinence in women. Patients and methods Forty women (median age 50 years, range 27–74) with genuine stress incontinence confirmed on medium‐fill video‐cystometry were recruited to the study. Macroplastique (3–7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points ‘around the clock’ under cystoscopic control. Where possible, the urodynamic study was repeated after 3 months. Results were graded as excellent (dry, no protection), good (better, but not totally dry) or poor (no improvement). Results Three months after a single injection, 16 (40%) were completely dry, 13 (33%) were improved and 11 (27%) were no better. Four patients who were improved were rendered dry by a second injection. After 3 years, 16 (40%) remained completely dry, seven (18%) were improved and 17 (42%) required alternative treatment with a Stamey bladder neck suspension. Dysuria for 48 h occurred in almost all patients; two were catheterized overnight and one required a catheter for 6 weeks. A comparison of maximum voiding pressures and flow rates before and 3 months after a single injection of Macroplastique revealed no urodynamic evidence of obstructed voiding (n=25). Conclusion Injectable silicone microimplants produced a good to excellent result in 73% of patients in the short‐term and 58% of women maintained this response after 3 years. The injection is a day‐case procedure which provides a satisfactory medium‐term outcome in over half of patients with genuine stress incontinence. There are few side‐effects and those patients with no improvement may go on to be treated by open surgery without complication.
The effect of radiotherapy on urethral obstruction from carcinoma of the prostate
Authors: Wells P. , Hoskin P.J. , Towler J. , Saunders M.I. , Dische S. 
Published: November 2003

Objective To assess the impact of radiotherapy on the relief of complete bladder outlet obstruction requiring catheterization secondary to prostatic carcinoma. Patients and methods From a consecutive series of 151 patients treated with radiotherapy for localized carcinoma of the prostate, 19 (12.6%; median age 72 years, range 59–83) who had an indwelling catheter in situ at the time of irradiation because of urinary retention, were analysed retrospectively and grouped according to the stage and grade of tumour and the irradiation dose delivered. Results The catheter was removed following radiotherapy in all but two patients, who both had stage 4 tumours, and normal urinary function was restored. The grade and stage of tumour did not influence the duration of catheterization. The median time from completion of radiotherapy to catheter removal was 10 weeks (range 0–46). Recatheterization was required in two patients at 3 and 64 months after radiotherapy and three patients, including these two, required transurethral prostatectomy (TURP) to relieve outlet obstruction. Conclusion Prostatic radiotherapy is effective in relieving bladder neck obstruction caused by prostate cancer. Most patients will achieve normal urinary function without requiring TURP after treatment.
Assessment of germ‐cell kinetics in the testes of patients with varicocele using image analysis of immunostained proliferating cell nuclear antigen
Authors: Tanaka H. , Fujisawa M. , Okada H. , Arakawa S. , Kamidono S. 
Published: November 2003

Objectives To examine the germ‐cell kinetics of varicocele testis using proliferating cell nuclear antigen (PCNA) immunostaining and image cytometry to evaluate the staining intensity, and to compare the proliferative index (PI) of varicocele and normal testes. Patients and methods Fifty‐six testicular biopsy specimens were taken from 28 patients with varicocele during high ligation. The specimens were fixed and embedded in paraffin, and sections immunostained using an anti‐PCNA antibody. The PI was measured using an image analyser and expressed as the percentage of the total nuclear area stained positively with PCNA monoclonal antibody, assessed from >20 seminiferous tubules. Sections stained with haematoxylin and eosin were used to determine Johnsen's score using conventional microscopy. Normal control testicular biopsies were obtained from subjects undergoing vasectomy. Results In patients with varicocele, both testes had a significantly lower PI than normal testes; the mean (sd) PI of the right and left testes was 11.3% (4.1) and 11.3% (4.8), respectively, and the PI of normal testes was 21.7% (3.1). There was no significant correlation between PI and sperm concentration or Johnsen's score. Conclusion PI is useful for assessing germ‐cell kinetics; in patients with varicocele both testes showed a deterioration in DNA synthesis, suggesting that reduced DNA synthesis is one of the causes of spermatogenic dysfunction in the varicocele testes.
Latex allergy in patients with spinal dysraphism: the role of multiple surgery
Authors: Ziylan H.O. , Ander A.H. , Alp T. , Kadioglu T.C. , Esen T. , Besisik T.A. , Cuhadaroglu C. 
Published: November 2003

Objective To investigate whether multiple surgery is responsible for the high prevalence of latex hypersensitivity in patients with spinal dysraphism by comparing the results of a skin‐prick test in three groups of patients with different surgical histories. Patients and methods An in vivo diagnostic kit was used to determine the sensitivity to latex using a skin‐prick test in three groups of patients, 23 with spinal dysraphism who had undergone surgery, 20 patients who had undergone non‐urological surgery and urological patients who had not undergone surgery (control). There was no history of latex allergy in any individual from the three groups. Results The skin‐test was positive in six patients with spinal dysraphism, in one who had undergone previous non‐urological surgery and in none of the control patients. The prevalence of latex hypersensitivity was significantly higher in patients with spinal dysraphism than in the other groups (non‐urological surgery P <0.05 and control P<0.01). This difference occurred despite the patients in each surgical group having undergone a mean of less than two operations. There was no significant difference in latex sensitivity between control patients and those undergoing non‐urological surgery. Conclusion Despite having no history of latex hypersensitivity, about a quarter of patients with spinal dysraphism were sensitive to latex. Repeated surgery alone cannot be responsible for the greater incidence of latex hypersensitivity in these patients. Despite multiple surgery being accepted as playing a major role in the development of latex hypersensitivity, relatively fewer surgical episodes than reported previously seem to be sufficient to elicit latex allergy.
The conservative treatment of phimosis in boys
Authors: Golubovic Z. , Milanovic D. , Vukadinovic V. , Rakic I. , Perovic S. 
Published: November 2003

Objective To further test the application of topical steroids in boys referred to a paediatric surgical practice with pathological, non‐retractable foreskins diagnosed as phimosis. Patients and methods This prospective study comprised two groups of 20 boys each (mean age 4.1 years, range 3–6) diagnosed as having phimosis; twice daily, a topical steroid (0.05% betamethasone cream) was applied on the narrowed preputial skin in the first group and a neutral cream (Vaseline) in the second (control) group. Patients were treated for 4 weeks and the retractability of the foreskin and any side‐effects assessed. Results Good retraction of the foreskin was achieved in 19 patients treated with betamethasone cream and the response was unsatisfactory in 16 patients from the control group; these 16 boys and one 6‐year‐old boy treated with betamethasone were circumsized. There were no side‐effects or problems after the application of either cream. Conclusion Treatment with 0.05% betamethasone cream is a simple and safe method for the treatment of phimosis in boys older than 3 years. An early operation is necessary in cases of genuine phimosis when 1 month of treatment with topical steroids has failed. We strongly support the saying, ‘The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner’.
Endoscopic laser ablation of the prostate (ELAP): changes in magnetic resonance imaging and clinical outcome at 1 year
Authors: Flynn R.J. , DeSouza N.M. , Puni R. , Williams G. , Kiely E.A. 
Published: November 2003

Objective To assess the ability of magnetic resonance imaging (MRI) to detect tissue changes immediately after laser ablation of the prostate and to correlate these changes with clinical outcome by detecting changes that may improve the outcome by allowing the laser dosimetry to be adjusted during therapy by monitoring effects on gland morphology. Patients and methods Eight men with proven bladder outlet obstruction had a standard four‐quadrant laser ablation of the prostate with a side‐firing non‐contact fibre. MRI scans were performed before, during and immediately after treatment and again after one week, 3 months and one year. Results The clinical outcome was a decrease in the American Urological Association (AUA)‐7 symptom score from a pre‐operative mean of 21.3–12.0 1 year after treatment and a corresponding increase in peak urinary flow rates from a mean of 8.9 mL/s to 12.3 mL/s. Immediately after treatment, MRI showed marked swelling of the gland (mean increase in volume 34%, range 12–75) with the loss of internal architecture. A low‐signal thin periurethral band was present in six of the eight patients after 1 week and was replaced by a wider periurethral ring at 3 months in four of the six patients. No patient had evidence of prostatic cavitation after treatment or a significant reduction in prostate volume at 1 year. Conclusion MRI can detect tissue changes after laser ablation of the prostate. The marked swelling seen on MRI immediately after laser prostatectomy may explain the delayed improvement in symptoms. The periurethral ring may indicate the depth to which laser energy has an effect on the tissue and could delineate an area of necrosis. The lack of cavitation at one year questions the durability of the effect of laser treatment delivered in this way.
The Whitaker hook in the treatment of posterior urethral valves
Authors: Chandna S. , Bruce J. , Dickson A. , Gough D. 
Published: November 2003

Objective To assess the efficacy of the Whitaker diathermy hook in the treatment of posterior urethral valves (PUV). Patients and methods Seventeen patients with PUV underwent primary treatment under general anaesthesia using a diathermy hook. The results were assessed by the clinical course of the patient, serial measurements of serum creatinine level and repeat cystography 6 weeks and 6 months after treatment. Results There were no complications in 12 patients and they required no further treatment of the valves. Three patients required a repeat procedure which resolved the urethral obstruction. Two patients continued to show incomplete disruption of the valves and required endoscopic treatment. Two patients developed ureteric obstruction after disruption of the valves, which was treated by supravesical diversion and later reversed with no further treatment of the valves. Conclusions The Whitaker diathermy hook is a safe and effective instrument which has not gained its rightful place in the treatment of patients with PUV.
Burns to the genitals and the perineum in children
Authors: Michielsen D. , Van Hee R. , Neetens C. , Lafaire C. , Peeters R. 
Published: November 2003

Objective To determine the management of perineal and genital burns in children. Patients and methods Twenty‐seven children (aged 6 months to 12 years) suffering from genital or perineal burns between 1981 and 1995 were reviewed. Most burns occurred in boys (70%), were due to scalds (85%) and caused superficial second‐degree lesions (63%). The initial treatment consisted of topical antimicrobials or grafting with allografts. Results Spontaneous healing by conservative therapy, not early excision therapy, occurred in 96% of the patients. Contractures occurred in two patients and were treated with multiple Z‐plasties and circumcision. Conclusion The management of perineal and genital burns in children should be conservative.
A one‐stage dorsal free‐graft urethroplasty for bulbar urethral strictures
Authors: Barbagli G. , Selli C. , Di Cello V. , Mottola A. 
Published: November 2003

Objective To report the use of a one‐stage dorsal free‐graft urethroplasty to reduce the incidence of urethrocele. Patients and methods From 1990 to 1994, 20 men (age range 21–86 years) underwent a one‐stage dorsal free‐graft urethroplasty of bulbar urethral strictures (iatrogenic in 12, traumatic in three, inflammatory in three and unknown in two). All patients except one had been treated previously by optical urethrotomy from one to 14 times. Results Temporary fistulae were detected on post‐operative urethrography in three patients with particularly long grafts, but they all resolved spontaneously. Within a mean follow‐up of 46 months, only one patient had a short recurrent stricture, which was treated successfully by optical urethrotomy. Two patients complained of post‐voiding dribbling, but radiographic studies never showed graft weakening and the urinary flow rate was always >14 mL/s. Conclusion Free skin grafts can be applied successfully to the dorsal aspect and by doing so the complications of urethral reconstruction can be reduced.
Cytokeratin 20 as an objective marker of urothelial dysplasia
Authors: Harnden P. , Eardley I. , Joyce A.D. , Southgate J. 
Published: November 2003

Objective To investigate the dysregulation of cytokeratin 20 (CK20) expression in urothelial dysplasia and its potential as a diagnostic aid. Patients and methods Twenty‐two patients were selected on the basis that they had undergone one or more biopsies showing dysplasia before the development of a transitional cell carcinoma (TCC); 15 of these patients also had a prior history of TCC. The dysplasia was classified as mild in 12, moderate in 14 or severe dysplasia/carcinoma in situ in 10 patients, ensuring that a spectrum of morphological appearances was represented. Control biopsies were obtained from seven children undergoing bladder reconstructions and 23 patients with recurrent urinary tract infections, haematuria or functional bladder symptoms, but no history of TCC. Results The expression of CK20 was restricted to superficial ‘umbrella’ c ells and occasional intermediate cells in the control biopsies, even in the presence of severe inflammation. In 31 of the 36 cases of dysplasia, complete loss of restriction was seen at least focally, with positive expression in all layers of the urothelium. Conclusion The abnormal expression of CK20 is a reliable, positive marker of urothelial dysplasia in the urinary bladder. Immunostaining for CK20 is therefore a useful adjunct to morphology in the diagnosis of dysplasia, of particular value in the distinction from reactive states where diagnostic difficulties are greatest.
Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia
Authors: Çetinkaya M. , Ulusoy E. , Adsan Ö. , Saglam H. , Öztürk B. , Basay S. 
Published: November 2003

Objective To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia. Patients and methods The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of <15 mL/s. Pre‐operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post‐void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre‐operatively and again 24 h after the operation. Patients were divided randomly into two groups; the first unde rwent a conventional TURP and the second TUEP using 240–300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups. Results The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform. Conclusion Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources; further studies with more patients and a longer follow‐up are required to determine the efficacy and safety of this procedure.
A follow‐up study of pre‐natally detected primary vesico‐ureteric reflux: a review of 61 patients
Authors: Bouachrine H. , Lemelle J.L. , Didier F. , Schmitt M. 
Published: November 2003

Objective To describe the pre‐ and post‐natal characteristics of primary vesico‐ureteric reflux (VUR) in a retrospective study of babies presenting with VUR suspected from pre‐natal ultrasonography. Patients and methods Between 1984 and 1994, 61 children (41 boys and 20 girls) with primary VUR were followed for 2 years after the pre‐natal detection of urinary tract anomalies. Patients with VUR secondary to infravesical obstruction and duplex systems were excluded. The mean age at ante‐natal diagnosis was 28.4 weeks of gestation; in 37 the reflux was bilateral and 98 refluxing units were reviewed. Results According to the international classification of VUR, 8% were grade 1, 32% grade 2, 38% grade 3, 16% grade 4 and 6% grade 5. Twelve patients (22 refluxing units) underwent ureteric re‐implantation. Six kidneys showed renal scars on isotope renography and two nephrectomies were carried out in patients <2 years old; in 40 patients (64 renal units) the VUR resolved spontaneously. Of the latter, eight were grade 1, 20 grade 2, 27 grade 3 and nine grade 4; seven patients (10 refluxing units) are still being followed and awaiting a decision on treatment. Conclusion This study confirms the predominance of boys in those with ante‐natally suspected VUR. The spontaneous resolution during the first 2 years of life was apparent in most cases, even in those with severe reflux (grade 3–5).
Patient acceptability of transurethral incision of the prostate under local anaesthesia
Authors: Irani J. , Bon D. , Fournier F. , Doré B. , Aubert J. 
Published: November 2003

Objective To determine the acceptance by patients of transurethral incision of the prostate (TUIP) under local anaesthesia. Patients and methods The study comprised 30 consecutive patients who elected to undergo local anaesthesia for TUIP and were treated between December 1994 and September 1995. Twenty‐two were considered a high risk for general anaesthesia and eight patients chose local anaesthesia for personal reasons. Patients were premedicated (opioid and benzodiazepine) and 1% lidocaine was infiltrated transurethrally using an endoscopic needle. The level of acceptance was determined using an immediate post‐operative questionnaire which included a linear visual analogue scale (VAS) to rate pain. Results No patient required conversion to another type of anaesthesia and there were no complications related to the local anaesthesia. The mean (se) VAS score was 3.2 (1.7) and the questionnaire results showed that 83% of the patients did not consider that general anaesthesia was necessary for the operation and that 90% would agree to undergo the procedure again under local anaesthesia. Conclusion TUIP under local anaesthesia was well tolerated in motivated patients. We recommend it as the operation of choice for the relief of obstruction in high‐risk patients with a small benign prostatic hyperplasia.
Evaluation of mucinous metaplasia of the prostate gland by mucin histochemistry
Authors: Gal R. , Koren R. , Nofech‐Mozes S. , Mukamel E. , His Y. , Zajdel L. 
Published: November 2003

Objective To evaluate the presence of mucinous metaplasia in normal and benign hyperplastic prostates, using stains for neutral and acidic mucins.Patients, materials and methods Normal prostate glands were removed during the post‐mortem examination of 11 consecutive subjects (median age 45 years, range 17–79) who had died accidentally. Specimens were also obtained from 10 patients (median age 70.2, range 61–82) undergoing suprapubic prostatectomy for prostatic hyperplasia. The specimens were examined histologically; sections were stained using the periodic acid‐Schiff (PAS) method for neutral mucins and the alcian blue (AB) method at pH 2.5 for acidic mucins. The positive sections were also immunostained for high molecular weight cytokeratin (KER), and prostate‐specific antigen (PSA) using the strept‐avidin‐biotin (SAB) method.Results Mucinous metaplasia was found in six of the normal prostates and in three of the hyperplastic glands. Usually, the cells were tall columnar, containing both AB‐ and PAS‐positive material. The cells were negative both for PSA and KER. Mucinous metaplasia affected all ages, including a 17‐year‐old, and mostly involved the inferior periurethral area.Conclusion Benign mucinous metaplasia was more frequent than previously appreciated, involved all ages, was mainly periurethral and did not correlate with the usual distribution of adenocarcinoma of the prostate.