bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expression of multidrug resistance‐related genes (mdrl, MRP, GST‐πand DNA topoisomerase II) in urothelial cancers
Authors: Kim W.‐J. , Kakehi Y. , Wu W.‐J. , Fukumoto M. , Yoshida O. 
Published: November 2003

Objective To characterize the multidrug resistance (MDR) phenotype in human urothelial cancers, the expression levels of four MDR‐related genes (multidrug resistance, mdrl; multidrug resistance‐associated protein, MRP; glutathione S‐transferase‐π, GST‐π; and DNA topoisomerase II, topo II) were analysed in urothelial cancers. Materials and methods Fifty‐two tumour tissue and three normal urothelial mucosa samples were obtained from 44 patients with urothelial cancers. The expression of each gene was analysed with a reverse‐transcription polymerase chain reaction (RT‐PCR) method using β2‐microglobulin (b2m) mRNA as an endogenous control. Levels of expression were expressed as the ratio of the specific products of the target gene to those specific to b2m. Results In primary urothelial cancer tissues, the mean (sd) expression of mdrl, MRP, GST‐πand topo II relative to b2m expression were 0.067 (0.061), 0.27 (0.23), 0.35 (0.31) and 0.12 (0.05), respectively. The mean expressions of MRP and GST‐πwere higher than those of mdrl and topo II. The mean ratios of mdrl/b2m, MRP/b2m, GST‐π/b2m and topo II/b2m in normal urothelial mucosa were 0.06 (0.03), 0.12 (0.09), 0.30 (0.32) and 0.14 (0.01), respectively. There was no significant association of the expression of each gene with either the grade or extent of the primary tumour. The level of MRP expression in each sample was correlated significantly with the expression of mdrl and GST‐πin the urothelial cancers (r=0.637 and 0.537, respectively). Chemotherapy did not markedly influence the induction of expression of the MDR‐related genes, except for one case in which mdrl expression was 15 times greater than before chemotherapy. The expression of GST‐πin the patients not receiving chemotherapy was significantly higher than in those that did. Conclusions These results suggest that the activation of MRP and GST‐πexpression occurs during the tumorigenesis of urothelial cancers and that it may confer de novo and acquired drug resistance on urothelial cancers. These results should provide further insight into the complex role postulated for MDR‐related genes in chemotherapy, carcinogenesis and tumour progression.
The origin of vesico‐ureteric reflux in male newborns: further evidence in favour of a transient fetal urethral obstruction
Authors: Avni E.F. , Schulman C.C. 
Published: November 2003

Objective To present further arguments supporting a transient urethral obstruction occurring during early fetal development as an explanation of the origin of vesico‐ureteric reflux (VUR) in baby boys. Patients and methods The findings of ultrasonography and voiding cysto‐urethrography (VCUG) in 25 baby boys with VUR were reviewed, studying mainly bladder and urethral anomalies on VCUG and bladder‐wall thickness on ultrasonography. Results A bladder or urethral anomaly was found in 15 patients, comprising isolated posterior urethral dilatation in five, posterior urethral dilatation with a bladder anomaly in four, tubular appearance of the urethra in two and bladder neck hypercontractility with diverticulae in four. Bladder‐wall thickness ranged from 1 to 8 mm (mean 3.7) and in eight patients, the thickness exceeded 5 mm. Conclusion The bladder and urethral anomalies found in this series of patients with neonatal VUR could be explained by a transient bladder outlet obstruction that possibly occurred in utero. These findings support the theory that a significant number of cases of VUR seen in baby boys result from a transient fetal urethral obstruction.
Improved reliability of uroflowmetry investigations: results of a portable home‐based uroflowmetry study
Authors: De La Rosette J.J.M.C.H , Witjes W.P.J. , Debruyne F.M.J. , Kersten P.L. , Wijkstra H. 
Published: November 2003

Objectives To compare the results obtained using a portable home‐based uroflowmeter with the results of traditional flowmetry performed in the out‐patient department (OPD). Patients and methods Sixty‐seven patients (mean age 61 years, range 38–79) with lower urinary tract symptoms and/or benign prostatic enlargement used a home‐based uroflowmeter comprising a datalogger and specially designed fluid sensors incorporated into disposable beakers. The results of these measurements were compared with those from uroflowmetry in the OPD and with other clinical variables. Results There was a good correlation between the uroflow results obtained when voiding at home and at the OPD. The highest measured maximum flow and voided volume were obtained with the home‐based uroflowmeter system. However, the mean of all consecutive home‐based maximum flow and voided volume measurements were lower than those obtained by single‐void uroflowmetry in the OPD. Conclusions Home‐based uroflowmetry provides reliable voiding results which are comparable with those obtained in the OPD.
The role of digital rectal examination, biopsy Gleason sum and prostate‐specific antigen in selecting patients who require pelvic lymph node dissections for prostate cancer
Authors: Rogers E. , Gürpinar T. , Dillioglugil Ö. , Kattan M.W. , Goad J.R. , Scardino P.T. , Griffith D.P. 
Published: November 2003

Objective To examine the usefulness of clinical stage, tumour differentiation and prostate‐specific antigen (PSA) level, alone and in combination, to predict regional nodal metastases in individual patients with localized prostate cancer. Patients and methods The usefulness of digital rectal examination (DRE), biopsy Gleason sum and PSA, alone and in combination, to predict nodal metastases in an individual patient was examined. The study included 689 patients who had laparoscopic or open pelvic lymph node dissection for clinical stage T1–3 prostate cancer. The Kruskal‐Wallis test, Mantel‐Haenszel test, chi‐squared test and logistic regression were used for continuous, ordinal, categorical, and multivariate analysis, respectively. Results Of the 689 patients who underwent radical prostatectomy, 52 (8%) had nodal metastases. Although clinical stage, DRE, pre‐operative PSA level and biopsy Gleason sum were significantly related in the univariate analysis, only pre‐operative PSA level and biopsy Gleason sum were significant predictors of lymph node status in a multivariate analysis. However, based on a receiver operating characteristic curve, a model with satisfactory sensitivity and specificity could not be obtained. Conclusion Current estimations of primary prostate cancer biology using pre‐operative PSA level, clinical stage and biopsy Gleason sum are not sufficiently sensitive to predict nodal metastases, and pelvic lymphadenectomy remains the definitive method of detection.
The management of superficial bladder cancer: an interactive seminar
Authors: McFarlane J.P. , Ellis B.W. , Harland S.J. 
Published: November 2003

Objectives To determine the current management of superficial bladder cancer in the United Kingdom. Methods An interactive seminar with a series of questions about management and hypothetical clinical scenarios was conducted at the 1995 conference of the British Association of Urological Surgeons. The responses of the audience were recorded electronically and analysed. Results The results showed that there is a wide variation in practice and some confusion over the place of intravesical treatment using cytotoxic drugs and bacille Calmette‐Guérin. Conclusions The management of superficial bladder cancer could be improved by a more widespread use of intravesical therapy, along with the introduction of local protocols and national guidelines.
A comparative study of laser ablation and transurethral electroresection for benign prostatic hyperplasia : results of a 6‐month follow‐up
Authors: Sengör F. , Köse O. , Yücebas E. , Beysel M. , Erdogan K. , Narter F. 
Published: November 2003

Objective To compare the efficacy of standard transurethral electroresection of the prostate (TURP) and visual laser ablation in the treatment of benign prostatic hyperplasia (BPH). Patients and methods In a randomized prospective study, the prostate glands of 60 patients with symptomatic bladder outlet obstruction caused by BPH were treated with TURP or visual ablation with the Ultraline side‐firing Nd:YAG laser; the patients were assessed using standard symptom scores, the measurement of residual urine and uroflowmetry both before and at 3 and 6 months after treatment. Results All patients in both treatment groups had a significant improvement in symptoms and objective measures of voiding. The laser treatment gave significantly better improvements in symptom score than did TURP (P=0.034), but TURP produced significantly better peak urinary flow rates (P=0.025). Conclusion These early results indicate that laser ablation of BPH may be a good alternative in the surgical treatment of this disease.
Retrograde contamination and practical handling of urine‐meters: a comparison of three systems for the measurement of hourly diuresis in an experimental bladder‐drainage model and in clinical use
Authors: Rasmussen A. , Frimodt‐Møller N. , Espersen F. , Roed M. , Frimodt‐Møller C. 
Published: November 2003

Objective To compare three different urine metering systems for their ability to prevent retrograde contamination in an in vitro model of a closed urinary drainage system and for qualities important to their practical handling in a clinical setting.Patients, materials and methods Using three urine‐meters (the Braun Ureofix 511, the Kendall Curity 4000 and the Unoplast Unometer 500) the in vitro model was constantly flushed with a solution of Mueller‐Hinton broth diluted with saline. On the first day, the urine collecting bag was inoculated with 108 cells of Pseudomonas aeruginosa. The system was operated for 12 days with daily sampling of the model bladder to detect any contamination. After 12 days the experiment was stopped and sampling performed at various locations, including the urine‐meter and the tubing. Nine of each type of urine‐meter were tested, i.e. three in three different experiments. In the clinical study, 45 patients were randomized to each of the three urine‐meters and the nurses attending them were asked to complete a questionnaire on the practical handling of the urine‐meters.Results When the urine‐meters was omitted from the model system, the ‘bladder’ became contaminated with the test bacteria within 3 days. None of the nine Unometer 500 systems became contaminated, compared with four of each of the other two systems (P<0.05). In clinical use, the Unometer 500 and Ureofix 511 were easier to suspend and empty than was the Curity 4000. The Unometer 500 was significantly easier to handle when the collecting bag was emptied.Conclusion Urine‐meters can prevent retrograde contamination in a closed bladder‐drainage model, but the degree of prevention depends upon the type of urine‐meter. In daily practice, there were differences in the ease of suspension of the systems and in the emptying of the urine‐meter and collecting bag.
A model system for the investigation of urinary stone formation
Authors: Bouropoulos N. , Bouropoulos C. , Klepetsanis P.G. , Melekos M. , Barbalias G. , Koutsoukos P.G. 
Published: November 2003

Objective To develop an in vitro model system for the investigation of calcium oxalate urinary stones under conditions of spontaneous precipitation.Materials and methods Using a calcium‐ion selective electrode and automatic titrator, a test solution was kept supersaturated with calcium oxalate and the rate of crystallization measured.Results During the spontaneous precipitation at constant supersaturation at 37°C, the induction times required for the precipitation of calcium oxalate monohydrate were inversely proportional to the supersaturation of the solution. No transient phases were identified and the interfacial energy determined from kinetic analysis was 28.4 mJ/m2 . The rates of precipitation showed a first‐order dependence on the degree of supersaturation and were in good agreement with those reported for the in vivo formation of calcium oxalate monohydrate stones.Conclusion This experimental model system allows precise measurements of the kinetics of calcium oxalate monohydrate. From the dependence of the rates of precipitation on supersaturation, a mechanism controlled by surface diffusion is suggested.
The impact of pre‐donated autologous blood and
Authors: Nash P.A. , Schrepferman C.G. , Rowland R.G. , Young J. , Foster R.S. , Birhle R. , Donohue J.P. 
Published: November 2003

Objective To assess the impact of pre‐donated autologous blood and intra‐operative isovolaemic haemodilution on the outcome of transfusions in patients undergoing radical retropubic prostatectomy. Patients and methods The charts and transfusion records of 192 consecutive patients undergoing radical retropubic prostatectomy were reviewed retrospectively. Results Of 192 patients, 14% required homologous transfusions, the rate of which varied significantly depending upon blood availability (autologous, haemodilution or homologous) (P<0.001); 66% of patients with only autologous blood available were transfused a mean of 1.96 units (range 1–6) of blood, of which 87% received autologous alone, 12% both autologous and homologous and 1% homologous blood only. Of the pre‐donated autologous units, 44% were wasted. Conclusions Both the pre‐donation of autologous blood and intra‐operative isovolaemic haemodilution lower the risk of homologous blood transfusion. It is recommended that patients pre‐donate 2 units of autologous blood and undergo intra‐operative isovolaemic haemodilution before radical prostatectomy.
Is inguinal exploration for the impalpable testis an outdated operation?
Authors: Lakhoo K. , Thomas D.F.M. , Najmaldin A.S. 
Published: November 2003

Objective To evaluate the reliability of open inguinal exploration for the investigation of the impalpable testis by reviewing laparoscopic findings after previous negative inguinal exploration. Patients and methods Laparoscopy was performed in 18 boys (with a total of 22 impalpable testes) in whom previous inguinal exploration in their referring hospitals had yielded negative or inconclusive findings. Subsequent management of the impalpable testes was based on laparoscopic findings. Results Despite previous negative surgical findings at inguinal exploration, laparoscopy revealed that 13 of the 22 impalpable testes (59%) were present, 12 within the abdomen and one in the inguinal canal. Absence of the remaining nine testes was positively confirmed by visualizing confluent blind ending vas and vessels. Conclusion Inguinal exploration is an unreliable method of investigating the impalpable testis, with an unacceptably high incidence of false‐negative or inconclusive findings. Laparoscopy should be undertaken as the initial diagnostic manoeuvre of choice.
Infection after transrectal core biopsies of the prostate
Authors: Aus G. , Ahlgren G. , Bergdahl S. , Hugosson J. 
Published: November 2003

Objective To compare the infection rate between different durations of antibiotic prophylaxis after transrectal core biopsy and to evaluate the impact of possible risk factors. Patients and methods The study comprised 491 patients who underwent transrectal core biopsies of the prostate and who were randomized to receive 400 mg of norfloxacin twice daily for one day or one week. Results Patients receiving prophylaxis for one week had a significantly lower rate of infection (4.9%) compared to patients who received only two tablets (11%; P<0.05). The most pronounced effect was seen in those patients with risk factors (e.g. an indwelling catheter, a former history of urinary tract infection, diabetes or prostatitis) in whom the infection rate was reduced from 17.9% to 3.3% (P<0.02), and febrile infections from 9.5% to 1.1% (P<0.02). Conclusions Some factors have a clear impact on the risk of developing an infection after transrectal core biopsy. Prophylaxis for one week with norfloxacin is an effective way to minimize these infections.
Bladder augmentation in the prevention of cyclophosphamide‐induced haemorrhagic cystitis in the rat model
Authors: Crocitto L.E. , Simpson J.F. , Wilson T.G. 
Published: November 2003

Objective To evaluate the effects of cyclophosphamide on the bowel mucosa of the rat and to determine whether urothelium can be protected from the effects of haemorrhagic cystitis which can occur after treatment with cyclophosphamide. Materials and methods Thirty Sprague‐Dawley rats were divided into three groups, 10 undergoing a control (sham) operation, 10 an ileal bladder augmentation and 10 a colonic bladder augmentation. Each rat underwent the appropriate surgical procedure and after a recovery period of 2 weeks, was injected with cyclophosphamide. Urine specimens were collected 24 h after the injection and analysed for gross and microscopic haematuria. The rats were killed humanely 48 h after injection and the bladders examined for haemorrhage, oedema, attenuation, inflammation and erosion. Results None of the 20 augmented rats developed gross haematuria and only four developed microscopic haematuria, compared with the control rats where six of 10 developed gross haematuria and nine developed microscopic haematuria. In addition, the control rats had moderate to severe haemorrhage, oedema and attenuation compared with only mild changes in the augmented rats. This protection was significant for both the bowel mucosa and urothelium. Conclusions It is possible that the administration of cyclophosphamide in patients with urinary diversion carries little risk of haemorrhagic cystitis. We propose that this protective mechanism is secondary to a substance secreted by the intestinal mucosa that may bind acrolein and render it inactive. Alternatively, this may be secondary to the production of mucus and its ability to coat and protect the epithelium.
The effectiveness of surgery for stress incontinence in women: a systematic review
Authors: Black N.A. , Downs S.H. 
Published: November 2003

Objective To determine the methodological quality of studies evaluating surgery for stress incontinence, the effectiveness of different procedures and the frequency of complications associated with each procedure. Materials and methods Eleven randomized controlled trials, 20 non‐randomized trials/prospective cohort studies and 45 retrospective cohort studies were reviewed systematically. Results The methodological quality of the 31 prospective studies was generally poor. The considerable variation in inclusion criteria, surgical management and assessment of outcome precluded any statistical meta‐analysis. Evidence as to the effectiveness of surgery for stress incontinence is weak; therefore, any conclusions are speculative. It appears that colposuspension may be more effective and the effect more long‐lasting than that following anterior colporrhaphy and needle suspension. There is little information on the value of sling procedures. Comparisons of different ways of performing each procedure show no significant differences in outcome but this may reflect the methodological weaknesses of the studies. Valid and reliable data on the frequency of complications following surgery are lacking so the safety of the procedures is unclear. Repeat operations to correct stress incontinence are less successful than first procedures but this finding may be subject to confounding. Conclusions There is an urgent need for some large, rigorous, prospective studies of high quality. Until such studies have been completed, recommendations as to the best clinical practice cannot be based on scientific evidence. Studies need to define cases according to widely accepted criteria, including standard measures of the severity of stress incontinence, and surgical terminology for the procedures performed needs to be standardized and outcomes need to be clearly defined, valid and reliable, not confined to short‐term assessment and include patients' views along with the surgeon's assessments.
The continent sigmoid urinary reservoir — an experimental study in pigs
Authors: Jung P. , Mersdorf A. , Wolff J. , Jahnke C. , Jakse G. 
Published: November 2003

Objective To evaluate the function of a continence mechanism in combination with a colonic urinary reservoir in a pig model. Materials and methods A colonic urinary reservoir was constructed as a bladder augmentation in six domestic pigs. The pouch was connected to a narrowed and tunnelled ileal tube as a continence mechanism. The closure pressure was measured intra‐operatively and 3 months post‐operatively. Results The mean difference between the pressure in the continence mechanism and in the reservoir was 74 cmH2O (range 50–100). Continence was complete both intra‐operatively and 3 months post‐operatively. Conclusion The modified narrowed and tunnelled ileal tube is a safe continence mechanism when combined with a colonic urinary pouch.
Childhood renal tumours with intravascular extension
Authors: Mushtaq I. , Carachi R. , Roy G. , Azmy A. 
Published: November 2003

Objective To assess whether pre‐operative chemotherapy reduces operative morbidity in children with intravascular extension of renal tumours. Patients and methods Thirty children with intravascular extension of their renal tumour, treated in 10 different centres in the UK, were reviewed retrospectively. Results Twenty‐nine patients had nephroblastoma and one child had clear cell sarcoma (favourable histology in 23, unfavourable histology in six). Patients were classified into stage II (17 patients), stage III (three patients) and stage IV (10 patients). Ultrasonography had been performed in 29 patients and had correctly diagnosed intravascular extension in 11 (40%); computed tomography (CT) was accurate in 93% of patients. A pre‐operative diagnosis was made accurately in 24 patients, with caval extension in 18 and atrial extension in six. Nine patients underwent primary surgery, whilst 21 had pre‐operative chemotherapy followed by delayed nephrectomy. In the latter group, the intravascular thrombus diminished in 16 patients. Five patients died, one from tumour rupture and four from extensive or progressive tumour disease; the overall 2‐year survival was 83%. Unfavourable histology did not adversely affect survival, and patients having pre‐operative chemotherapy appeared to have a better outcome. Conclusion CT remains the best imaging modality to assess intravascular tumour extension. Pre‐operative chemotherapy is recommended for patients with intracaval extension of tumour. Those with intra‐atrial extension or with hepatic vein obstruction (Budd‐Chiari syndrome) may require a cardiopulmonary bypass and primary surgery.
The effects of detubularization and outflow competence in substitution cystoplasty
Authors: Thomas P.J. , DeSousa N. , Mundy A.R. 
Published: November 2003

Objective To assess the effects of detubularization and outflow competence on the clinical and urodynamic results of patients undergoing substitution cystoplasty. Patients and methods The study included 142 patients undergoing orthotopic substitution cystoplasty, of whom 85 underwent a ‘straight’ and 57 a detubularized substitution cystoplasty using the ileo‐colonic segment. All were assessed clinically and by video‐urodynamic studies before and after surgery. Results In patients voiding spontaneously, detubularization produced a capacity 38% greater than that found with a ‘straight’ cystoplasty, but there was no difference in the contractility of the substitute bladder between the groups. In patients requiring clean intermittent self‐catheterization to empty, outflow competence was a more important factor in increasing capacity and reducing contractility. Conclusions Detubularization produces a modest increase in bladder capacity but far less than that predicted by mathematical models. It has no substantial effect on contractility when compared with straight substitution cystoplasty. The effects of detubularization on both capacity and contractility are less than the ‘chronic retention’ effect produced by increasing outflow competence. Detubularization is therefore only one of several factors that influence the results of substitution cystoplasty.