bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: ‘the chair’
Authors: Chandi D.D. , Groenendijk P.M. , Venema P.L. 
Published: February 2004

OBJECTIVETo evaluate, in a prospective study, the efficiency and applicability of functional magnetic stimulation (FMS) of the pelvic floor for treating urinary incontinence in women.PATIENTS AND METHODSFMS was provided by a ‘magnetic chair’; 24 patients were treated twice weekly for 8 weeks (12 with urge incontinence and 12 with a mixture of urge and stress incontinence). The outcome was assessed urodynamically, by a pad test, and by patient satisfaction.RESULTSIn 58% of the patients there was an objective improvement in incontinence; three patients were completely dry and 71% reported a subjective improvement (P < 0.001).CONCLUSIONFMS is a safe, noninvasive and painless treatment for urinary incontinence; it is effective and easy to administer as an outpatient treatment.
Urethral calculi: presentation and management
Authors: Kamal B.A. , Anikwe R.M. , Darawani H. , Hashish M. , Taha S.A. 
Published: February 2004

OBJECTIVETo determine the occurrence, symptoms, treatment and outcome in patients with urethral stones.PATIENTS AND METHODSFifty‐one consecutive patients with urethral calculi were assessed prospectively; all were male and one was an infant.RESULTSAcute retention of urine occurred in 78% of patients, urethral anatomical pathology in 6% and posterior urethral calculi in 88%. The urethral stones, solitary in each patient, consisted of calcium oxalate in 86%, struvite in 6%, mixed stones in 4%, calcium phosphate in 2% and uric acid in 2%. A methodical approach to therapy was used which aimed to clearly define the circumstances in which a given procedure was used, and the resulting success rate.CONCLUSIONThe common belief that most urethral calculi in patients in developing countries originate from the bladder does not seem to be generally applicable. Urethral anatomical pathology does not seem to be a necessary condition for most of these calculi.
Quantitative assessment of a new preparatory tool for board certification in urology
Authors: MacNeily A.E. , Baverstock R.J. , Cole G. , Morales A. 
Published: February 2004

OBJECTIVETo analyse the performance of candidates in a Canadian national mock‐examination for final‐year urology residents with respect to North American speciality examinations in urology.METHODSIn 1997 the Queen's Urology Examination Skills Training Program (QUEST) was established as an annual national mock examination for final‐year Canadian urology residents. It consists of a short answer question component and an objective structured clinical examination. During the 5‐year period (1997–2001), 91 final‐year residents from all 11 Canadian urology residency‐training programmes participated in QUEST and the Royal College of Physicians and Surgeons of Canada certifying examinations (RCPSCE); 43 (47%) of candidates also attempted the American Board of Urology part 1 qualifying examinations (ABU 1). Performance on QUEST was correlated with the RCPSCE and ABU 1 in a blinded fashion after submitting QUEST scores to governing bodies. Thresholds were determined to help to predict a candidate's performance on the RCPSCE and ABU 1, based on QUEST scores.RESULTSThere was a moderately close correlation between overall QUEST and RCPSCE performance (r = 0.68, P < 0.001) and a moderate correlation between overall QUEST and ABU 1 performance (r = 0.42, P = 0.005). For the following QUEST scores, the probability of success on the RCPSCE was: <65%, 67% pass; 66–75%, 80% pass; > 75%, 100% pass (P = 0.002). For ABU 1, QUEST overall score of 80% gave a 69% probability of scoring ≥ 70% on ABU 1 (P = 0.003).CONCLUSIONSQUEST is a moderate predictor of performance on speciality examinations in urology. We consider that the time, effort and expense to maintain QUEST are justified.
Prevalence of sexual dysfunction in Chinese men with chronic prostatitis
Authors: Liang Chao‐Zhao , Zhang Xue‐Jun , Hao Zong‐Yao , Shi Hao‐Qiang , Wang Ke‐Xiao 
Published: February 2004

OBJECTIVETo investigate the prevalence and risk factors of sexual dysfunction in Chinese men with chronic prostatitis.PATIENTS AND METHODSA questionnaire survey was conducted among 2000 men diagnosed as having chronic prostatitis using the National Institutes of Health Chronic Prostatitis Index and analysis of expressed prostatic secretions. The survey was designed to elicit information about age, height, weight, occupation and history of disease and treatment. The erectile capacity of the men was assessed using the five‐question version of the International Index of Erectile Function.RESULTSOf the 2000 men with chronic prostatitis selected, 1786 completed the survey; the overall prevalence of sexual dysfunction in these patients was 49%. The prevalence of premature ejaculation and erectile dysfunction accounted for 26% and 15%, respectively; 7.7% had both premature ejaculation and erectile dysfunction. There was a negative correlation between prevalence and age, and with the duration of chronic prostatitis (both P < 0.001).CONCLUSIONSThe prevalence rate of sexual dysfunction in Chinese men with chronic prostatitis is high and related to age.
Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years
Authors: Manikandan R. , Srirangam S.J. , Pearson E. , Collins G.N. 
Published: February 2004

OBJECTIVETo evaluate the incidence and timing of the onset of chronic scrotal pain after vasectomy in two populations at 1 and 10 years after surgery.PATIENTS AND METHODSIn a retrospective questionnaire‐based study two groups of men were compared; 460 who had a vasectomy in 1991–92 (group A) and another 460 who had a vasectomy in 2000–1 (group B; 10 and 1 year after surgery, respectively). Data were collected on immediate complications, and the incidence and nature of chronic scrotal pain. Pain severity was graded using a visual analogue score (VAS). Patients were also asked if they regretted having a vasectomy because of pain.RESULTSIn all, 182 and 220 replies were received from patients in group A and B, respectively. Early complications included haematoma in five (2%) and two (0.9%) patients, respectively, and wound infection in 24 (13%) and 17 (7.7%). Eight patients who had scrotal pain even before vasectomy were excluded from the analysis (two in group A and six in group B). In group A, 25 of 180 (13.8%) had a new onset of scrotal pain of some nature, with eight (4.3%) having a VAS of > 5; one patient had an epididymectomy for this. Three of the 25 regretted having a vasectomy because of pain. In group B, 36 of 214 (16.8%) reported persistent scrotal pain, with 13 (5.9%) having a VAS of > 5. Six of the 36 regretted having a vasectomy because of the pain. The incidence of scrotal pain was not significantly different between the groups (P = 0.48, Fisher's exact test).CONCLUSIONChronic scrotal pain after vasectomy is more common than previously described, affecting almost one in seven patients. All patients undergoing vasectomy must receive appropriate preoperative counselling about this. The incidence of this complication does not appear to increase with time.
Preventing reservoir calculi after augmentation cystoplasty and continent urinary diversion: the influence of an irrigation protocol
Authors: Hensle T.W. , Bingham J. , Lam J. , Shabsigh A. 
Published: February 2004

One of the problems associated with bowel reservoirs is the development of calculi. The authors from New York describe their use of an irrigation protocol in 91 patients who had either an augmentation cystoplasty or continent urinary diversion. In addition to finding that patients with an abdominal stoma had a much higher chance of developing reservoir calculi, they found that using a definitive postoperative irrigation programme considerably reduced the incidence of calculi.OBJECTIVETo evaluate the influence of an irrigation protocol in preventing reservoir calculi forming after augmentation cystoplasty and continent urinary diversion.PATIENTS AND METHODSBetween 1985 and 1995, 91 patients had an augmentation cystoplasty and/or continent urinary diversion (group 1; 54 females and 37 males, mean age 11.1 years, range 1–31); these patients were not routinely instructed to use irrigation after surgery. The segments used included ileum (44), colon (36), stomach (eight) and ureter (three). Between 1995 and 2000, 42 patients (group 2) underwent urinary reconstruction (22 females and 20 males, mean age 14.8 years, range 4–27), the segment used being ileum (30), colon (five), ureter (five) and stomach (two) but in contrast to group 1 they then were placed on a standard prophylactic irrigation protocol. The occurrence of stones in the reservoir was then assessed.RESULTSThirty‐nine of the 91 patients (42.8%) in group 1 presented with reservoir calculi after reconstruction and 22 had several episodes. The mean time to presentation was 30 months. The incidence of stone formation by underlying diagnosis included: myelomeningocele, 32/48 (66%), exstrophy five/25 (25%), posterior urethral valves two/20 (10%) and rhabdomyosarcoma, none of three. Fifty of the 91 patients had an abdominal stoma, with stone formation in 33 (66%), while 41 used the native urethra, with stone formation in six (15%). Three (7%) of the 42 patients in group 2 developed reservoir calculi after reconstruction, two in patients with myelomeningocele and one in a trauma patient who had residual bone spicules in the bladder; the mean time to presentation was 26.5 months.CONCLUSIONSThese data suggest that the irrigation protocol used in group 2 significantly reduced the number of reservoir calculi after urinary tract reconstruction when bowel was used as part of the reconstruction (43% vs. 7%). The most calculi in both groups were in immobile patients with sensory impairment. Also, patients with an abdominal stoma had a greater risk of reservoir calculi (66%) than those using the native urethra (15%).
The urological care and outcome of pregnancy after urinary tract reconstruction
Authors: Hensle T.W. , Bingham J.B. , Reiley E.A. , Cleary‐Goldman J.E. , Malone F.D. , Robinson J.N. 
Published: February 2004

OBJECTIVETo assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus.PATIENTS AND METHODSWe retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated.RESULTSAll the patients had some difficulty with clean intermittent catheterization (CIC) during pregnancy, and four needed continuous indwelling catheters. During pregnancy 10 women had several bladder infections and all received antibiotic suppression. There were eight Caesarean sections, two vaginal deliveries and one combined delivery. Six Caesareans were elective and three were emergent. The use of CIC returned to normal in all patients after delivery.CONCLUSIONSWomen with a urinary reconstruction can have successful pregnancies. The complexity of the surgery and the concern for possible emergency Caesarean section resulted in most patients having an elective Caesarean delivery before term. Antibiotic prophylaxis is recommended and patients may require indwelling dwelling catheters while pregnant but normal CIC can be resumed after delivery.
Delayed therapy with curative intent in a contemporary prostate cancer watchful‐waiting cohort
Authors: El‐Geneidy M. , Garzotto M. , Panagiotou I. , Hsieh Y.‐C. , Mori M. , Peters L. , Klein T. , Beer T.M. 
Published: February 2004

OBJECTIVETo identify predictors of delayed therapy with curative intent, an increasingly common option in contemporary patients with prostate cancer who initially choose watchful waiting.PATIENTS AND METHODSThe characteristics of all patients at one institution and diagnosed with T1–4NXM0 prostate cancer between 1993 and 2000 were prospectively recorded. Factors recorded included: age, tumour stage, histological type, Gleason score, serum prostate specific antigen (PSA) level, prostate volume, PSA density (PSAD), percentage of positive biopsy cores, and the initial treatment selection. Outcomes, including all cancer‐directed interventions, all serum PSA values, and initial outcomes of all interventions with curative intent, were determined by review of all medical records and cancer registry data.RESULTSOf 187 patients on watchful waiting, 175 had stage T1 or T2 cancer and were analysed primarily. Thirty‐eight (22%) of these patients received delayed intervention with curative intent (15 radical prostatectomy, 17 external beam radiotherapy, six brachytherapy). Age (P < 0.001) and percentage of positive biopsy cores (P = 0.042) were significant independent predictors of intervention with curative intent. When the PSA doubling time was added to the model it became a significant predictor (P = 0.018), with percentage positive biopsy cores (P = 0.022) and age (P < 0.001).CONCLUSIONSTherapy with curative intent is common in contemporary patients with prostate cancer who initially choose watchful waiting. Age and percentage positive biopsy cores are independent predictors of such intervention, with PSA doubling time also an independent predictor.
Prediction of prostate cancer in extended‐field biopsies of the prostate
Authors: Winkler M.H. , Kulinskaya E. , Gillatt D.A. 
Published: February 2004

OBJECTIVESTo assess the prediction of prostate cancer using extended‐field prostatic biopsies (8–11 cores), as such biopsy protocols are recommended to increase the detection of prostate cancer, and as fewer cancers are missed this should improve the prediction of biopsy outcome from the patients’ history, transrectal ultrasonography (TRUS) and serum markers.PATIENTS AND METHODSIn all, 260 patients were prospectively evaluated and 206 with a total prostate‐specific antigen (PSA) level of < 20 ng/mL were included. All patients were evaluated for age, family history, lower urinary tract symptoms (LUTS), medication for LUTS, previous prostate biopsy, the presence of cysts, a digital rectal examination, calcifications or hypoechoic lesions on TRUS, total and transitional zone volume, total PSA (tPSA), PSA density (tPSAD), total PSA transition zone density (tPSATZD), complexed PSA (cPSA), cPSA density (cPSAD), cPSA transitional zone density (cPSATZD), free/total (f/t)PSA ratio and free/complexed PSA ratio (f/cPSA). Logistic regression was used to predict the outcome; 80% of the patients were used to generate the models and 20% to test the prediction.RESULTSTwo models were constructed; the most accurate contained family history, cPSA, cPSAD, cPSATZD, f/cPSA, PSAD and tPSATZD (sensitivity 91%, specificity 70%). A workable and concise model contained tPSATZD, cPSATZD and f/cPSA, and had a sensitivity of 93% and a specificity of 60%. The best single predictor was tPSATZD with a sensitivity of 92% and a specificity of 55%. Using regression models can produce considerable gains in specificity. This would allow unnecessary prostate biopsies to be avoided for a third of patients compared with tPSA alone.CONCLUSIONSThe present analysis for PSA indices appeared to be slightly more accurate than those in previously published studies. Most of this improvement in diagnostic accuracy was ascribed to the use of an extended‐field biopsy protocol. Prostate cancer in a first‐degree relative was the only variable that contributed significantly to the regression model. tPSATZD was the best volume‐adjusted PSA index. The f/tPSA appeared to be the best test with no volume adjustment, followed by f/cPSA and cPSA. Although the models are cumbersome and expensive for use in general urological practice they could be used to optimize biopsy strategies on the basis of predicted cancer probabilities in screening studies. The cost of the models may compare favourably with tPSA because of the high specificity that can be achieved.
Presumptive coding. A preliminary study of the aggregation of input diagnoses to determine their relevance to clinical governance and urological resourcing
Authors: Payne S.R. , Napier‐Hemy R.D. , Ganesan T. , Turner W.H. 
Published: February 2004

OBJECTIVETo determine the validity of a system for coding the reason for urological referral from primary care, using ICD10, and thus enable benchmarking of urological outpatient activity.PATIENTS AND METHODSFour studies were conducted: (i) A pilot study to aggregate information into a few input diagnosis codes (925 patients); (ii) Validation of the aggregated codes using input diagnoses from a second centre (928 patients); (iii) A prospective study by three urologists to determine the system's generic utility (918 patients); (iv) A study to aggregate the presumptive codes for 2771 patients to gain an insight into the case‐mix of patients referred to a general urological service via the outpatient department.RESULTSThe aggregation of input diagnoses from general practice referrals into 36 ‘presumptive codes’ was possible and could be validated. Prospective coding, for 96% of eligible patients, was possible with < 1% of referral diagnoses not being codable. Further aggregation of the data for 2771 patients showed that 31% were referred with urological malignancy whilst 69% had symptoms suggesting benign urological disease.CONCLUSIONSThis preliminary study of presumptive coding suggests that it is a feasible and valid method of recording the input diagnoses for patients presented to a urological service. The information it provides has relevance for the structuring, benchmarking, resourcing and manpower requirements of that service, essential components for clinical governance. It also has relevance to the prospective collection of patient data for research and audit.
Ileal ureteric replacement in complex reconstruction of the urinary tract
Authors: Bonfig R. , Gerharz E.W. , Riedmiller H. 
Published: February 2004

Authors from Wurzburg report their experience over a 10‐year period with the use of ileal segments in partial or total ureteric substitution. They felt it was a safe and reliable procedure, but that it should only be used as a last resort, even in difficult cases.A free graft of fat from the anterior abdominal wall was used by authors from Cairo in 26 female patients having a retropubic repair of genitourinary fistula. They found it to be an easy procedure with a high success rate, and with few postoperative complications.OBJECTIVETo report 10 years’ experience with ileal ureteric replacement as a last resort in complex reconstruction of the urinary tract.PATIENTS AND METHODSFrom March 1991 to February 2002 ileal segments were used for partial or total substitution of the ureter in 43 patients (mean age 45.6 years) with structural or functional ureteric loss secondary to irradiation, surgical complications or various other pathological conditions. Ileum was either implanted into the native urinary bladder (in 14) or an intestinal reservoir (in 29). In the latter group the technique was used at the time of primary urinary diversion in eight, in a secondary approach for treating early or late complications in nine and in undiversion or conversion procedures in 12. The ileal ureter was implanted into the urinary reservoir using a serous‐lined extramural tunnel or distal intussusception for reflux prevention (in 31). All patients were followed prospectively according to a standardized protocol.RESULTSThere were no perioperative deaths; the mean (range) follow‐up was 40.8 (1.5–109.5) months. In 41 patients with dilatation of the upper urinary tract before surgery there was a significant improvement radiographically in 34, no change in five and deterioration in two. The serum creatinine level decreased or remained stable in all. Reflux occurred in the 12 cases without and in three with an antireflux mechanism. Shortening of an elongated kinking ileal ureter became necessary because of recurrent severe metabolic acidosis and mucus obstruction in two; in one case mucus obstruction was treated endoscopically. There was pyelonephritis only in three patients with refluxing implantation into an intestinal reservoir.CONCLUSIONIleal ureteric replacement is a safe and reliable last resort even in difficult cases. Whenever feasible, antirefluxing implantation into intestinal urinary reservoirs is recommended.
A surgical model of composite cystoplasty with cultured urothelial cells: a controlled study of gross outcome and urothelial phenotype
Authors: Fraser M. , Thomas D.F.M. , Pitt E. , Harnden P. , Trejdosiewicz L.K. , Southgate J. 
Published: February 2004

OBJECTIVESTo study the outcome of composite cystoplasty using cultured urothelial cells combined with de‐epithelialized colon or uterus in a porcine surgical model, using appropriate controls, and to characterize the neo‐epithelium created by composite cystoplasty.MATERIALS AND METHODSUrothelial cells were isolated and propagated in vitro from open bladder biopsies taken from nine female minipigs. Cohesive sheets of confluent urothelial cells were transferred to polyglactin carrier meshes and sutured to de‐epithelialized autologous colon in four animals and de‐epithelialized autologous uterus in five. These composite segments were then used for augmentation cystoplasty. Conventional colocystoplasty, de‐epithelialized colocystoplasty and sham operations were carried out in six control animals. After killing the animals at ≈ 90 days the bladders were removed for examination and immunohistochemical analysis, using a panel of antibodies against cytokeratins and urothelial differentiation‐associated antigens.RESULTSMacroscopically, the bladders augmented with composite segments derived from uterine muscle had no evidence of shrinkage or contracture. Histological analysis showed that in four of five composite uterocystoplasties, the neo‐urothelium was stratified and had a transitional morphology, although in some areas coverage was incomplete. Immunohistochemical analysis showed evidence of squamous differentiation in both native and augmented segments. All composite and de‐epithelialized colonic segments showed significant contraction with poor urothelial coverage, reflecting the unsuitability of the thin‐walled porcine colon for de‐epithelialization.CONCLUSIONSThe functional and macroscopic outcome of bladder augmentation with a composite derived from cultured urothelium and de‐epithelialized smooth muscle of uterine origin endorses the feasibility of composite cystoplasty.