bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ileocaeco‐urethrostomy with multiple transverse taeniamyotomies for bladder replacement: an alternative to detubularized neobladders. Morphological, functional and metabolic results after 9 years' experience
Authors: Alcini E. , Racioppi M. , D'Addessi A. , Alcini A. , Menchinelli P. , Grassetti F. , Destito A. , Sasso F. , Giustacchini M. 
Published: November 2003

Objective To evaluate the results from the long‐term follow‐up of ileocaeco‐urethrostomy with multiple transverse taeniamyotomies for bladder replacement. Patients and methods Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco‐urethrostomy with multiple transverse taeniamyotomies. Avoiding detubularization, sectioning the caecal taeniae improved reservoir morphology and reduced internal pressures and wall tension, limiting the potential complications of the operation. Results All patients achieved diurnal continence with socially acceptable intervals between micturitions. Immediately after the operation, the nocturnal continence rate was good (79% of patients with a follow up <3 years), reaching 86% after >3 years. After 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 47.6 cmH2O, while the mean post‐micturition residual volume was 28 mL; no patient needs to use self‐catheterization. Given the short intestinal length used, no metabolic clinical problems have occurred. Conclusions The concept of using the caecum arose from physiological and anatomical assumptions, i.e. receptive relaxation, the presence of taeniae and ileocaecal sphincter. Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pressure and a near‐spherical shape, but, in contrast, by leaving the circular muscle intact, they allow a good basal tone to be maintained thus obtaining optimal emptying and avoiding deterioration of the reservoir.
High‐intensity focused ultrasound in the treatment of benign prostatic hyperplasia
Authors: Mulligan E.D. , Lynch T.H. , Mulvin D. , Greene D. , Smith J.M. , Fitzpatrick J.M. 
Published: November 2003

Objective To assess the role of high‐intensity focused ultrasound (HIFU) in the treatment of symptomatic benign prostatic hyperplasia (BPH).Patients and methods Thirteen patients (mean age 65 years, range 58–74) were treated with HIFU as part of a phase‐2 clinical trial and evaluated prospectively using the International Prostate Symptom Score, uroflowmetry, and transrectal and transabdominal ultrasonography to determine prostate size and post‐void residual urine volume, respectively. The results and the patients' satisfaction were assessed at regular intervals for 2 years.Results The new procedure was learned quickly and was easy to perform. Symptom scores decreased from a mean of 23 before treatment to 5 after 12 months and 7 after 2 years. There was an initial improvement in flow rates but they then declined. The size of the prostate and the post‐void residual volume were both decreased after treatment.Conclusions The treatment is safe, easy to implement and was effective in substantially reducing symptom scores in these few patients. However, we would not encourage its use as an alternative to other well established treatment modalities until it has been assessed fully in a randomized trial.
Unique synergism or antagonism of combinations of chemotherapeutic and hormonal agents in human prostate cancer cell lines
Authors: Kreis W. , Budman D.R. , Calabro A. 
Published: November 2003

Objective To evaluate combinations of anti‐tumour agents in tissue cultures using three established cell lines derived from patients with prostate cancer to obtain potential candidates for therapeutic testing in patients with prostate cancer.Materials and methods Seventeen anti‐tumour agents were tested for synergism or antagonism in combination studies in DU 145, PC 3 and LnCaP cell lines. After determining the dose required for 50% inhibition of growth in each, combinations were screened using the median‐effect plot and combination‐index isobolograms.Results Estramustine (the primary product of dephosphorylation of estramustine phosphate) showed strong synergism in all three cell lines with hydroxyflutamide, the non‐immunosuppressive cyclosporin analogue PSC 833, and Liarozole . In the hormone‐sensitive cell line LnCaP alone, synergism was also observed with vinblastine, paclitaxel, docetaxel, bicalutamide, ketoconazole and all‐trans‐retinoic acid. Other synergistic combinations of two agents were: Liarozole plus docetaxel in LnCaP, PSC 833 plus bicalutamide in DU 145 and PC 3, dexamethasone plus docetaxel in LnCaP, and finasteride plus hydroxyflutamide. Synergistic combinations of three agents were: estramustine plus PSC 833 and Liarozole and schedule‐dependent combinations of estramustine, PSC 833, and all‐trans‐retinoic acid.Conclusion Some of the synergistic combinations have shown clinical effects in patients with hormone‐refractory prostate cancer. Based on these findings, new combinations, e.g. estramustine with either PSC 833 or Liarozole, need to be clinically evaluated.
Nuclear accumulation of mutant p53 protein: a possible predictor of failure of intravesical therapy in bladder cancer
Authors: Caliskan M. , Turkeri L.N. , Mansuroglu B. , Toktas G. , Aksoy B. , Unluer E. , Akdas A. 
Published: November 2003

Objective To investigate the expression and importance of the nuclear accumulation of p53 in superficial transitional cell carcinoma (TCC) of the bladder and its role as a predictor of response to treatment. Patients and methods Tumour samples from 30 patients (two women and 28 men, mean age 60.1 years, range 44–75) with pTa/pT1 tumours were assessed immunohistochemically using the Pab1801 monoclonal antibody and standard avidin‐biotin peroxidase staining for p53 protein. Results Tumours from six patients (20%) showed nuclear accumulation of p53; five of these patients failed intravesical therapy with bacille Calmette‐Guèrin (BCG) and progressed to muscle invasive and/or metastatic disease, in contrast to six of 24 patients with no detectable nuclear oncoprotein. Conclusions The nuclear accumulation of p53 appears to be a prognostic indicator of tumour unresponsive to intravesical treatment, even with the most potent agent (BCG). Therefore, early radical treatment modalities must be seriously considered in this group of patients.
Daycase transurethral incision of the prostate using the holmium:YAG laser: initial experience
Authors: Cornford P.A. , Biyani C.S. , Brough S.J. , Powell C.S. 
Published: November 2003

Objective To ascertain whether the holmium:YAG laser can be used for transurethral incision of the prostate (TUIP), without the need for post‐operative catheterization. Patients and methods The study comprised 100 men with symptomatic bladder outlet obstruction and clinically benign glands (<30 g). The International Prostate Symptom Score (IPSS), flow rates and post‐void residual urine volume were measured before and 6 weeks after surgery. The first 22 patients were admitted overnight for observation, but the remaining 78 patients were discharged on the day of the procedure, once they had successfully voided. Results Ninety‐seven men voided successfully on the day of the procedure. The mean IPSS, flow rate and residual urine volume were all significantly improved at the time of review. Six patients developed a urinary tract infection post‐operatively and eight men reported retrograde ejaculation. Conclusion The holmium:YAG laser facilitates a bloodless TUIP thus avoiding catheterization, allowing the procedure to be carried out as a day case.
Epidermal growth factor (EGF) and EGF receptor in hypospadias
Authors: El‐Galley R.E.S. , Smith E. , Cohen C. , Petros J.A. , Woodard J. , Galloway N.T.M. 
Published: November 2003

Objective  To determine whether alterations in epidermal growth factor (EGF), which plays a major role both in the masculinization of the genitourinary tract and in wound healing, or EGF receptor (EGFR) expression are associated with hypospadias. Patients and methods  The prepuces from 22 children undergoing circumcision (median age 27 months, range 5–87) and skin biopsies from 16 children undergoing surgery for hypospadias (median age 12 months, range 3–57) were studied. Fourteen patients had distal, one had mid‐shaft and one had penoscrotal hypospadias. Immunoperoxidase staining was carried out for EGF and EGFR and the density of the staining quantified using image cytometry by an operator unaware of the diagnosis. Results
The median EGF density in foreskins obtained by circumcision was 75% (mean 73, se 2.1) compared with 54% (mean 52, se 3.9) for tissue samples from patients with hypospadias (P<0.001); the mean EGFR was similar in both materials. Conclusion  The mean EGF value was deficient in skin adjacent to hypospadias defects compared to normal phallic skin, suggesting that the inadequate expression of EGF may be related to the aetiology of hypospadias and to possible wound complications following surgery for hypospadias.
Structural alterations in the tunica albuginea of the penis: impact of Peyronie's disease, ageing and impotence
Authors: Akkus E. , Carrier S. , Baba K. , Hsu G.‐L. , Padma‐Nathan H. , Nunes L. , Lue T.F. 
Published: November 2003

Objective  To investigate whether changes in the structure of the tunica albuginea influence the development of erectile dysfunction. Patients and methods  Biopsy specimens taken from the tunica of 64 patients (both potent and impotent) with and without Peyronie's disease were evaluated. Tissue samples were stained and examined under light and electron microscopy, and the concentration of elastic fibres present in each was measured using computerized image analysis. Results
The concentration of elastic fibres was lower in impotent than in potent patients (P=0.0365) and was also significantly less in patients with Peyronie's disease. Furthermore, the concentration of elastic fibres decreased with age. Electron and light microscopy revealed the presence of distinct alterations in the tunica albuginea in impotent patients and patients with Peyronie's disease that might interfere with function. Conclusion  The decrease in elastic fibre concentration and changes in microscopic features may contribute to erectile dysfunction by impairing the veno‐occlusive function of the tunica albuginea.
A short vas deferens limiting successful laparoscopic testicular descent
Authors: Perovic S. , Janic N. 
Published: November 2003

Objective To highlight the problem of the short vas deferens in a single stage or staged laparoscopic orchidopexy. Patients and methods From October 1992 to February 1996, 23 patients (mean age 4.9 years, range 12 months to 12 years) underwent a laparoscopic staged Fowler‐Stephens orchidopexy. During the second stage (open surgery), a short vas deferens was found in three patients; two testes were located retrovesically and one was in the internal inguinal ring. Two testes could not be brought into the scrotum, but only to the inguinal region, and one testis was placed in the scrotum but under tension. Results The patients were followed for 12, 19 and 28 months; the testis under tension became fully atrophic. One of the two testes that could not be placed further than the inguinal canal developed marked hypotrophy, while the other ‘survived’. Conclusion A laparoscopic staged Fowler‐Stephens orchidopexy should not used in patients with a very short vas deferens; patients with such a short vas deferens are extremely rare.
Histological evidence of an inflammatory reaction to suture material in the dog vas deferens
Authors: Fallick M.L. , Sable D.B. , Faller G. , LaRock D. , Sant G.R. , Schlesinger R.M. , Schwaitzberg S.D. 
Published: November 2003

Objective  To evaluate changes in histology and semen variables after using an elastomeric‐hydrogel matrix plug as a reversible vasectomy device in dogs, and to determine the potential applications for improving fertility after vasectomy reversal. Materials and methods  Semen samples from six adult male dogs were obtained after left vasal ligation, placement of the plug in the right vas deferens, and subsequent removal of the plug. The vasa, epididymides and testes were evaluated histologically in four of the dogs after removal of the implant. Results  No sperm were present in the ejaculate after the plug was removed. Histological sections showed intraluminal spermatids in areas where the plug had been placed. The lumen was occluded, secondary to foreign‐body giant‐cell reaction, at the vasotomy suture site, but other areas of the vas previously containing the implant remained patent after it was removed. Conclusions  There were no sperm in the ejaculate after the plug was removed because the vasal lumen was occluded as a result of an inflammatory reaction to the suture material. In contrast, areas that had contained the implant but without a vasotomy suture were not inflamed. We suggest that further trials comparing various suture materials are carried out to determine if patency rates can be improved during vasotomy closure or vasovasostomy.
Rectus abdominis muscle flap (RAMF) technique for the management of bladder exstrophies: late clinical outcome and urodynamic findings
Authors: Celayir S. , Kiliç N. , Eliçevik M. , Büyükünal C. 
Published: November 2003

Objective To investigate the efficacy of the rectus abdominis muscle flap (RAMF) technique for the closure and augmentation of small, non‐compliant bladder extrophies.Patients and methods The RAMF technique was used in two girls and two boys (mean age at operation, 31.7 months, range 3–72) with bladder exstrophy. The clinical outcome and urodynamics were assessed during a follow‐up of 29 months to 6 years (mean 49.2 months) and included imaging, cystoscopy, biochemical and microbiological studies.Results There were no urinary tract infections, metabolic problems or electrolyte disturbances and kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMF with uroepithelium. No stone formation or mucus production were detected. Currently, three patients void using clean intermittent catheterization through the native urethra and the fourth through an appendiceal Mitrofanoff valve. However, the bladder volume was insufficient at the late follow‐up and three patients required bladder augmentation.Conclusions The RAMF technique is a good alternative for closing bladder extrophies and achieves an increase in bladder capacity; however, although there is a mild improvement in bladder capacity and compliance, RAMF should not be used as a bladder augmentation procedure. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non‐compliant bladder remnants and failed primary closures.
Long‐term effects of cigarette‐smoke exposure on plasma testosterone, luteinizing hormone and follicle‐stimulating hormone levels in male rats
Authors: Yardimci S. , Atan A. , Delibasi T. , Sunguroglu K. , Güven M.C. 
Published: November 2003

Objectives  To determine the effects of long‐term cigarette smoking on the levels of plasma testosterone, luteinizing hormone (LH) and follicle‐stimulating hormone (FSH) in male adult rats and to examine morphological and histological changes in the testes. Materials and methods  Cigarette smoke was generated by a smoking‐machine and 12 rats were exposed to cigarette smoke diluted with 90% air for 60 days (2 h/day). Twelve rats were exposed to room air only under similar conditions as controls. The concentrations of plasma testosterone, LH and FSH were measured before and after exposure using a radioimmunoassay and the testes were examined histologically. Results  In rats exposed to smoke, the mean plasma testosterone level decreased significantly but there were no significant changes in testosterone in the control rats. The mean plasma LH and FSH levels of the two groups did not change significantly after exposure. In rats exposed to smoke, histological examination of the testes showed fewer Leydig cells and degeneration of the remaining cells. Conclusion  These results indicate that the decrease in plasma testosterone levels induced by exposure to smoke was not associated with changes in plasma gonadotrophin levels. The decrease in testosterone levels may be related to the toxic effects of smoke on Leydig cells.
Physical predictors of infection in patients treated with clean intermittent catheterization: a prospective 7‐year study
Authors: Bakke A. , Digranes A. , Høisœter P.Å. 
Published: November 2003

Objective  To study urinary tract complications in patients treated using long‐term clean intermittent catheterization (CIC), and to evaluate the physical factors which might be implicated in these complications. Patients and methods  During 1995, 170 patients (84 men and 86 women, mean age 56.9 years) with a mean duration of use of CIC for 8.8 years were assessed for complications related to CIC. The same patients had participated in a thorough follow‐up study during 1988–9 and were examined again using questionnaires and the analysis of urine samples. CIC was practised by two‐thirds of the patients because they had neurogenic bladder dysfunction and for non‐neurogenic dysfunction in the remainder. Results
In this prevalence study, 111 patients (65%) had no signs of clinical urinary tract infection (UTI), while 10 patients (6%) had pronounced symptoms. The remaining 29% had only minor signs of UTI. There were three predictive factors of clinical UTI; women reported more infections than men, the patients most affected by UTI in the present study were those suffering UTI during the 1988–9 study and patients with UTI had the highest mean catheterization volume now, and the highest increase in mean catheterization volume from 1989 to 1995. Bacteriuria was found in 61% of the urine samples, with Escherichia coli the dominant species among women and Gram‐positive cocci among men. Patients who did not use anti‐infective agents had a 31% rate of sterile urine while the corresponding value among those using antibiotics was 54%. The frequency of catheterization was the only variable predictive of bacteriuria apart from the use of antibiotics. Conclusion  This study confirms previous reports showing CIC to be an excellent procedure for minimizing urinary tract complications and supports the current recommendations, e.g. restricting the use of antibiotics in patients using CIC and ensuring that they catheterize sufficiently often to ensure that the mean volume of each catheterization is kept to <400 mL in adults.
The accuracy of recording of occupational history in patients with bladder cancer
Authors: McCahy P.J. , Harris C.A. , Neal D.E. 
Published: November 2003

Objective  To determine how accurately information on the occupations of patients with transitional cell carcinoma of the bladder (TCC) was recorded. Patients and methods  Using a semi‐structured interview and a standard proforma, 108 patients with TCC of the urinary tract were studied and the results compared with records in their case notes. Results  Case notes were substantially correct in only 39% of patients. Occupations that might have been a significant factor in the aetiology of TCC were omitted in 71% of potentially exposed male patients and no occupational history was recorded in 12% of all patients. Conclusions  Important clinical information was missing from the case notes that might have been of practical use in determining whether patients might be eligible for financial redress and which might be of use in future clinical research. It is recommended that details of occupational history should be taken using a structured proforma; this could be a suitable topic for regular audit.
B‐mode and colour‐flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?
Authors: Hendrikx A.J.M. , Linh Dang C. , Vroegindeweij D. , Korte J.H. 
Published: November 2003

Objective  To determine the value of ultrasonography (US) and colour‐flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. Patients and methods  The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the ‘gold standard’ (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. Results  The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. Conclusion  For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.
The incidence of cystic fibrosis gene mutations in patients with congenital bilateral absence of the vas deferens in Scotland
Authors: Donat R. , McNeill A.S. , FitzPatrick D.R. , Hargreave T.B. 
Published: November 2003

Objective  To examine the incidence of cystic fibrosis transmembrane‐conductance regulator (CFTR) gene mutations in Scottish patients with congenital bilateral absence of the vas deferens (CBAVD). Patients and methods  Thirty patients with CBAVD presenting consecutively to the Edinburgh infertility clinic were examined for CFTR gene mutations. All patients were assessed clinically and tested for 15 gene mutations using a single‐tube polymerase chain‐reaction multiplex system. Results  All patients were in good health and without clinical evidence of cystic fibrosis. CFTR gene mutations were found in 70% of patients with CBAVD. Conclusion  CFTR gene‐testing and genetic counselling are important in all men with CBAVD.
Immersion in antibiotic solution prevents bacterial adhesion onto biodegradable prostatic stents
Authors: Cormio L. , La Forgia P. , Siitonen A. , Ruutu M. , Törmälä P. , Talja M. 
Published: November 2003

Objective  To determine whether immersion in antibiotic solution reduces or prevents bacterial adhesion onto biodegradable prostatic stents. Materials and methods Pre‐cut segments of polyglycolic acid (PGA) and polylactic acid (PLA) prostatic stents were incubated with two common uropathogenic bacterial strains (Enterococcus faecalis and Escherichia coli) with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). Results Immersion in ciprofloxacin solution prevented the adherence of both bacterial strains. Immersion in ceftriaxone solution prevented only the adherence of the E. coli strain. Immersion in tobramycin solution had no effect on either of the strains. The stent materials per se did not influence bacterial adhesion. After immersion in ciprofloxacin, the stent segments retained significant antibacterial activity even after one day's incubation in saline. Conclusion Immersion in a suitable antibiotic solution may significantly reduce and even prevent bacterial adhesion onto biodegradable prostatic stents. Preventing bacterial adhesion may reduce the risk of UTI during the use of these devices.