bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure‐flow studies in the diagnosis of bladder outlet obstruction: a study comparing suprapubic and transurethral techniques
Authors: WALKER R.M.H. , DI PASQUALE B. , HUBREGTSE M. , ST CLAIR CARTER S. 
Published: November 2003

Objective To compare suprapubic and transurethral methods of measuring intravesical pressure in a group of men undergoing investigation for lower urinary tract symptoms (LUTS), to identify which urodynamic variables are affected by the presence of an urethral catheter during the voiding phase, and consequently whether there is any change in the grading of bladder outflow obstruction (BOO) using the commonly recognised grading systems.Patients and methodsThirty‐five men with LUTS underwent both suprapubic and transurethral pressure‐flow studies during a single session. Standard pressure flow variables were measured in all patients with both methods, enabling calculation of obstruction using the commonly used grading systems, i.e. the Abrams‐Griffith number, linear passive urethral resistance ratio (LPURR) and urethral resistance algorithm (URA).ResultsThere were statistically significant differences between the methods in the mean values of maximum flow rate and the detrusor pressure at that maximum; 60% of men were in the same LPURR class with either method. Using the transurethral method, 26% of patients increased the LPURR class by one and 6% by two classes. Using the Abrams‐Griffiths nomogram, 17% moved from a classification of equivocal to obstructed and 3% from unobstructed to equivocal. Using the criterion of a value of URA >29, 57% were obstructed using the suprapubic and 74% using the transurethral method.ConclusionAccording to the method used, there were differences in the classification of obstruction between the suprapubic and transurethral routes; transurethral studies tended to indicate greater obstruction. The interpretation of urodynamic studies should take into account the technique used and where the route is transurethral, the smallest catheter available should be used.
The urodynamic evaluation of neuromodulation in patients with voiding dysfunction
Authors: EVERAERT K. , PLANCKE H. , LEFEVERE F. , OOSTERLINCK W. 
Published: November 2003

Objectives To determine which patients with voiding dysfunction might be suitable for treatment with neuromodulation, using urodynamics to obtain an objective measure of improvement and to illustrate the effect of neuromodulation on voiding dysfunction.Patients and methods Patients were selected for implantation of a neuroprosthesis using a urodynamic evaluation before and during subchronic stimulation; 27 such patients (four men and 23 women, mean age 33 years, sd 15) were evaluated.Results Of the 27 patients, the 17 who responded well to neuromodulation all had hypocontractile detrusors and sphincter hypertonicity; sphincter relaxation during micturition was impaired. The urodynamic evaluation showed that these patients were not obstructed. Of 10 patients with spastic pelvic floor syndrome, nine responded well to the treatment. Those not responding to neuromodulation had mainly acontractile detrusors.Conclusion The ideal candidates for neuromodulation are those patients with a spastic pelvic floor syndrome or with a hypocontractile detrusor, in combination with sphincter instability, and impaired sphincter relaxation. An increase of bladder contractility, enhancement of sphincter relaxation and decrease in bladder capacity and residual urine are the most important features of the response.
A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissues after simultaneous oral ingestion
Authors: PNG J.C.D. , TAN E. , FOO K.T. , LI M.K. , CHENG C. , REKHRAJ I.R. 
Published: November 2003

Objectives To determine the levels of two quinolones, ofloxacin and ciprofloxacin, potent broad‐spectrum antibiotics with very good oral bioavailability and low minimum inhibitory concentrations (MICs) for most pathogens, in the prostates of patients who underwent transurethral resection of the prostate (TURP) after oral ingestion for surgical prophylaxis.Patients and methods Twenty‐eight patients with BPH requiring a TURP ingested 250 mg of both drugs 2–4 h before operation. The levels of the drugs in the serum and prostate were measured using high‐performance liquid chromatography and the levels of both drugs determined at the 6 and 9 o’clock positions in the prostate to examine any local variations in drug concentration.Results Ofloxacin concentrations were significantly higher in the serum and prostatic tissues compared with ciprofloxacin for the same dose, but its penetrance into the prostate was lower. This mainly reflected its higher oral bioavailability. Both drugs were present in concentrations 50% higher at the 6 o’clock than at the 9 o’clock position but both exceeded the MICs for most Gram‐negative organisms except Pseudomonas.Conclusion Ofloxacin has the advantage against ciprofloxacin of exceeding the MICs for Staphylococcus and Chlamydia. However, ciprofloxacin has the advantage of having prostate‐to‐serum ratios of unity, but for the same dose the prostatic concentrations of ofloxacin is significantly higher.
Intracavernosal drug‐induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction
Authors: SODERDAHL D.W. , THRASHER J.B. , HANSBERRY K.L. 
Published: November 2003

Objectives To determine if there is a significant difference between intracavernosal self‐injection and external vacuum devices when compared directly for satisfaction, effectiveness and side‐effects.Patients and methodsFifty men were randomized into two groups and received either instruction on the use of the Osbon ErecAid® system or self‐injection therapy. After 15 uses, each group completed a questionnaire detailing efficacy, satisfaction and side‐effects, and then changed to the other modality after appropriate instruction. A questionnaire was completed by study participants and their sexual partners after using both methods. Patients were followed for 18–24 months using telephone interviews.ResultsForty‐four patients (mean age 62.3 years, range 38–84) completed the study. Patients and their partners reported a superior quality of erections with the injection method but the difference did not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual experience was significantly better when using injections. Side‐effects were similar between the modalities. Subgroups analysed for age, duration and aetiology of impotence showed that younger patients (<60 years), those with a shorter duration of impotence (<12 months) and those impotent secondary to radical prostatectomy strongly favoured injection therapy (P<0.05). Overall, of the 44 couples, the final preferences of the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, both or neither, respectively, and of the partners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively. At 18–24 months, 80% of patients were still using either the vacuum device, injections, or both.ConclusionBoth the vacuum device and injections are effective treatment modalities for impotence and are associated with good long‐term success. Overall, there was a trend favouring injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and those impotent secondary to radical prostatectomy.
The fate of the ‘modern’ artificial urinary sphincter with a follow‐up of more than 10 years
Authors: FULFORD S.C.V. , SUTTON C. , BALES G. , HICKLING M. , STEPHENSON T.P. 
Published: November 2003

Objective To assess the long‐term outcome of patients who had an artificial urinary sphincter (AUS) implanted between 10 and 15 years ago.Patients and methodsOf 68 patients who had an AUS implanted more than 10 years ago, 61 were followed with sufficient detail for analysis. Thirty‐four had a neuropathic bladder with sphincter dysfunction, 15 had post‐prostatectomy sphincter weakness incontinence and 12 further patients had a variety of indications.ResultsThe 61 patients experienced a total of 58 major complications and 49 have required at least one revision procedure. Currently eight (13%) patients are satisfactorily continent with their original AUS in situ and 29 others have a satisfactory revised AUS. Thus 37 of 61 (61%) are continent using an AUS at least 10 years after first implantation. Eleven patients died and of these two had a satisfactory original AUS in situ and seven had successful revisions. In two patients the AUS failed but they were considered unfit for revision. Four female patients were continent and used intermittent catheterization after the explantation of eroded AUS cuffs. In seven patients the AUS was abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary diversions fashioned. Thus, if those who died with a functioning AUS are included, 46 of 61 (75%) achieved long‐term continence with the AUS.ConclusionsDespite the high complication and revision rate, these results show that acceptable continence rates can be achieved in the long‐term, particularly in the male neuropathic bladder and in those with post‐prostatectomy sphincter weakness. Many of the complications encountered may be less common with the current re‐designed models of the AUS. However, it is essential that both surgeon and patient recognize and accept the likelihood of complications and revisions before using the AUS. The continued use of the AUS where simpler methods of obtaining continence are inappropriate remains justified.
A case‐control study to examine any association between idiopathic detrusor instability and gastrointestinal tract disorder, and between irritable bowel syndrome and urinary tract disorder
Authors: CUKIER J.M. , CORTINA‐BORJA M. , BRADING A.F. 
Published: November 2003

Objective To assess whether there are common malfunctions (e.g. of the autonomic nervous system and smooth muscle) that underlie disorders of the urinary and gastrointestinal tracts by determining whether there is an increased prevalence (i) of urinary symptoms in patients with irritable bowel syndrome (IBS) and (ii) of gastrointestinal symptoms in patients with idiopathic detrusor instability (IDI).Patients and methodsQuestionnaires were sent to patients with a diagnosis of IBS or IDI who were seen in the Departments of Gynaecology, Gastroenterology and Urology at the John Radcliffe and Churchill Hospitals, Oxford, during the 3 year period 1993– 1995. The questionnaires were also distributed to control patients who were recruited from the day‐surgery unit of the Churchill Hospital. Of 236 questionnaires sent out, 168 replies were analysed; 64 from patients with IBS, 49 from patients with detrusor instability and 55 from controls. The questionnaire included questions about micturition and defecatory behaviour (frequency, regularity, urgency, continence, pain, and ease in passing urine and stools).ResultsPatients with IBS were more likely to experience certain urinary symptoms than controls (nocturia, urgency and some forms of urinary urge incontinence) and patients with IDI were as likely as patients with IBS to experience gastrointestinal symptoms more frequently than controls. Control patients showed an unexpectedly high probability of experiencing many of the gastrointestinal and urinary symptoms.ConclusionsThe frequent occurrence of symptoms in control patients makes the significance of the results less clear, but the association between certain symptoms of urinary tract disorder and patients with IBS, and of symptoms of gastrointestinal tract disorder with patients with IDI, suggests that they may share some common underlying dysfunction.
The use of the detrusorrhaphy for vesico‐ureteric reflux: the way forward?
Authors: STEINBRECHER H.A. , RANGECROFT L. 
Published: November 2003

Objective To assess the outcome of all detrusorrhaphies carried out for simple single‐system vesico‐ureteric reflux (VUR) in children at one institution over a 4‐year period.Patients and methods Twenty‐nine patients (11 boys, 18 girls, 43 renal units; mean age at presentation 23 months; range, antenatal to 72 months) were analysed in two groups. Group 1 comprised those undergoing asynchronous bilateral procedures (two patients, four units) and unilateral procedures (15 patients, 15 units), and group 2, those undergoing synchronous bilateral procedures (12 patients, 24 units). The mean (range) follow‐up was 17 months (6–39) and 15 months (7–24), respectively.Results Three patients had antenatal hydronephrosis related to VUR post‐natally and 26 had urinary tract infections (13 recurrent, one with haematuria, seven ‘breakthrough’, one with calculi and four with enuresis). The mean age at operation was 54 months (range 14–167). The mean (range) duration of anaesthesia was 69 min (40–120) in group 1 and 80 min (65–120) in group 2. All patients were catheterized urethrally for a mean (range) duration of 3 days (2–4) in group 1 and 5 days (2–15) in group 2 and the mean hospital stay was 3 days (2–6) and 6 days (4–16), respectively. Post‐operative complications occurred in 14 patients including one bladder spasm, five urinary tract infections, two with urinary retention, three with haematuria and one each of pneumonia, epididymo‐orchitis, anuria, failure to stent and conversion to Cohen reimplantation. Operative success and clinical success were similar within groups but differed between groups, although not significantly (15 of 17 in group 1 and eight of 12 in group 2).Conclusion Unilateral but not synchronous bilateral detrusorrhaphy seems an appropriate surgical treatment for VUR.
Diagnosis and management of high‐pressure peristaltic contractions in cystoplasties
Authors: CHRISTMAS T.J. , SMITH G.L. , RICKARDS D. 
Published: November 2003

Objective To define the aetiology of and therapeutic strategy for high‐pressure peristaltic contractions within colo‐ and caecocystoplasties associated with symptoms of frequency, urgency and urge incontinence.Patients and methodsIn a series of over 150 subtotal supratrigonal colo‐ and caeco‐cystoplasties, nine patients were identified with such symptoms. These patients underwent videocystometrography (VCMG) confirming the presence of phasic peristaltic contractions of >35 cmH2O.ResultsIn three cases, there was urodynamic evidence of outlet obstruction and symptoms resolved when the obstruction was surgically relieved. In the other six cases, high‐pressure peristaltic contractions were present without bladder outlet obstruction. The symptoms did not respond to anticholinergic medication. Three of the six patients had tolerable symptoms which did not warrant further intervention. The other three cases had disabling urge incontinence and underwent ileal patch cystoplasty. The symptoms resolved in all three cases, although later recurred in one patient, probably due to incomplete division of the taenia coli during ileal patch cystoplasty.ConclusionIt appears that colonic smooth muscle can develop high‐pressure contractions in response to neobladder outlet obstruction. Relieving the obstruction ameliorates symptoms associated with these contractions and reduces the magnitude of the peristaltic waves. Symptoms related to high‐pressure peristaltic contractions without neobladder outlet obstruction do not respond to anticholinergic medication but can be successfully treated by ileal patch cystoplasty.
Glycosaminoglycans in crystal‐surface binding substances and their role in calcium oxalate crystal growth
Authors: YOSHIMURA K. , YOSHIOKA T. , MIYAKE O. , HONDA M. , YAMAGUCHI S. , KOIDE T. , OKUYAMA A. 
Published: November 2003

Objective To clarify the role of glycosaminoglycans (GAGs) in crystal‐surface binding substances (CSBS) on the growth of calcium oxalate crystals in urine.Materials and methods Urine samples (24 h) were collected from healthy men (aged 25–42 years) and CSBS were obtained from the pooled urine samples. The CSBS were digested with heparitinase or proteinase and the inhibition of crystal growth assessed before and after enzyme digestion. Anion‐exchange chromatography and high‐performance liquid chromatography (HPLC) were used to determine the types of GAGs contained in the CSBS.Results The inhibitory activity of CSBS on crystal growth decreased with concentration when digested with heparitinase or proteinase. HPLC showed that CSBS contained a small amount of dermatan sulphate and abundant heparan sulphate, both of which inhibited crystal growth.Conclusion Both heparan sulphate and dermatan sulphate may inhibit calcium oxalate crystallization, the former being the predominant GAG in CSBS.
Antioxidant deficiency following clam enterocystoplasty
Authors: BARRINGTON J.W. , JONES A. , JAMES D. , SMITH S. , STEPHENSON T.P. 
Published: November 2003

Objective To assess whether there is a reduction in serum antioxidant activity in patients who have undergone a clam enterocystoplasty procedure.Patients and methods Serum glutathione peroxidase (GPase) activity was measured in 20 patients who had undergone clam enterocystoplasty. Serum selenium concentration was also measured in 62 similar patients and compared with 56 healthy controls and 44 patients with a neuropathic bladder, mainly patients with spinal cord injuries who had not undergone surgery.Results GPase activity correlated well with serum selenium measurement. There was a significant reduction (P<0.001) in serum selenium level in young (<50 years old) non‐neuropathic bladder patients following clam enterocystoplasty. This reduction in serum selenium was similar to that found in both unoperated patients with a neuropathic bladder (who are known to have an increased risk of developing bladder cancer) and those patients with a neuropathic bladder who had undergone augmentation. This reduction was not related to urinary tract infection nor the time since surgery.Conclusion A reduction in serum selenium has been shown to increase susceptibility to bladder cancer following carcinogenic exposure to compounds such as nitrosamines. This study suggests that patients with idiopathic and congenital instability may be at an equally high risk as a result of undergoing this procedure.
The correlation between prostate volume, transition zone volume, transition zone index and clinical and urodynamic investigations in patients with lower urinary tract symptoms
Authors: WITJES W.P.J. , AARNINK R.G. , EZZ‐EL‐DIN K. , WIJKSTRA H. , DEBRUYNE F.M.J. , De La ROSETTE J.J.M.C.H. 
Published: November 2003

Objective To determine if, in patients with lower urinary tract symptoms (LUTS), measurement of the transition zone (TZ) of the prostate by transrectal ultrasonography (TRUS) and the ratio between the TZ volume and total prostate volume (TZ index) correlates better with clinical and urodynamic investigations than total prostate volume alone.Patients and methods In total, 150 consecutive patients with LUTS underwent a standardized screening programme including the International Prostate Symptom Sore (IPSS), a physical examination, TRUS of the prostate and urodynamic investigations with pressure‐flow studies. The total prostate volume and TZ volume were assessed from TRUS using the ellipsoid formula. Spearman’s rank correlation coefficients were calculated between different prostate volume measurements and specific symptomatic and urodynamic variables.Results The relationships between specific IPSS symptoms, symptom scores and the prostate volume measurements were not statistically significant except for one domain, nocturia, that appeared to be statistically significantly correlated with the TZ index (r=0.25). The correlations for free flow, pressure‐flow variables and prostate volume measurements were stronger, but only moderate at best. The highest correlations were between TZ volume and the linear passive urethral resistance obstruction category, urethral resistance factor and detrusor pressure at maximum flow (r=0.43, 0.44 and 0.40, respectively). The differences between the correlations of prostate volume and TZ index and these variables were small (r=0.39, 0.38 and 0.37, respectively for prostate volume and r=0.38, 0.40 and 0.33 respectively for TZ index).Conclusions There were very small differences between the correlations of total prostate volume, TZ volume and TZ index, and clinical and pressure‐flow variables. In the assessment of the last two, the estimation of the total prostate volume by TRUS was a reasonable way to obtain the required information about prostate size and measuring TZ volume and calculating TZ index was of limited additional value. Symptoms and bladder outlet obstruction were mainly determined by other factors than the prostate and, specifically, TZ volume. As earlier studies have indicated that including pressure‐flow data in the pre‐operative evaluation and selection of patients for interventional therapies may improve the overall clinical results, we think that prostate volume, TZ volume or symptoms alone should not be used as the main indication for deciding on the appropriate invasive treatment options.
Surgical management of the renal manifestations of von Hippel‐Lindau disease: a review of a United Kingdom case series
Authors: PERSAD R.A. , PROBERT J.L. , SHARMA S.D. , HAQ A. , DOYLE P.T. 
Published: November 2003

Objectives To review the results of nephron‐sparing surgery in a group of patients with von Hippel‐Lindau (VHL) disease, a rare familial cancer syndrome which is dominantly inherited and predisposes affected individuals to developing various tumours, including haemangioblastomas of the retina and central nervous system, and multicentric renal cell carcinoma (RCC).Patients and methods The 11 patients (seven men and four women, age range 27–62 years) assessed had been referred for surveillance to the Department of Clinical Genetics, Addenbrooke’s Hospital, often having presented with neurological or ocular manifestations of the disease. Their case notes were reviewed to assess the results of conservative surgery. Five patients had more than one parenchymal‐sparing operation (either partial nephrectomy or enucleation, i.e. removal of a malignant lesion with a 0.5 cm rim of normal tissue) while four had bilateral procedures. At the time of surgery, co‐existent cysts were aspirated to allow a more accurate definition on computed tomography during follow‐up.Results At a mean follow‐up of 60 months after surgery, eight patients were alive with good renal function. Three patients were alive with paraplegia or paraparesis from spinal cord lesions. The three patients who died (aged 50, 40 and 31 years) were diagnosed when RCC was already advanced and renal tissue‐preserving surgery was not possible.Conclusion Nephron‐sparing surgery may be justified because morbidity is reduced in patients whose quality of life may already be compromised by neurological and other problems, and because the lesions of RCC are often small, enucleation may also be justifiable in the attempt to conserve renal tissue and delay disease progression.