bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy
Authors: Makhoul B. , De La Taille A. , Vordos D. , Salomon L. , Sebe P. , Audet J.F. , Ruiz L. , Hoznek A. , Antiphon P. , Cicco A. , Yiou R. , Chopin D. , Abbou C.C. 
Published: December 2003

OBJECTIVETo evaluate the complication rate and clinical follow‐up of patients treated for T1 renal cancer by open or laparoscopic nephrectomy at the same institution, as this approach appears to be attractive for treating small renal cancers.PATIENTS AND METHODSBetween 1995 and 2002, 39 patients underwent retroperitoneal laparoscopic and 26 transperitoneal open radical nephrectomy for T1 renal cancer (TNM 1997). Variables before during and after surgery, e.g. cancer recurrence, were compared between the groups.RESULTSThere were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow‐up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P < 0.001), less need for transfusion (none vs 150 mL, P = 0.04), a lower consumption of analgesia drugs, and shorter hospitalization (5.5 vs 8.8 days, P < 0.001). With a mean follow‐up of 20.4 months there was no recurrence or tumour progression.CONCLUSIONLaparoscopic radical nephrectomy for patients with T1 renal cancer is a safe, reliable procedure that decreases hospitalization time and bleeding, and ensures the same cancer control as open nephrectomy.
A randomized crossover study to evaluate Ro 115–1240, a selective α1A/1L‐adrenoceptor partial agonist in women with stress urinary incontinence
Authors: Musselman D.M. , Ford A.P.D.W. , Gennevois D.J. , Harbison M.L. , Laurent A.L. , Mokatrin A.S. , Stoltz R.R. , Blue D.R. 
Published: December 2003

OBJECTIVESTo investigate the potential therapeutic benefits of the selective α1A/1l‐adrenoceptor partial agonist Ro 115–1240 in women with mild‐to‐moderate stress urinary incontinence (SUI).PATIENTS AND METHODSThirty‐seven women with mild‐to‐moderate SUI were enrolled in a randomized, placebo‐controlled crossover study. Patients received 1.5 mg Ro 115–1240 twice daily or matching placebo for 2 or 4 weeks. Voiding diaries were used to record the number of SUI episodes, urge incontinence episodes and pads used. Sitting blood pressures and heart rate were recorded at each visit.RESULTSRo 115–1240 was associated with a significantly lower mean weekly number of SUI episodes than placebo (8.4 vs 6.0; P= 0.0079), a 28% relative improvement over placebo. There was also a significantly lower mean number of pads used and wet pads changed/week with Ro 115–1240 than with placebo (P = 0.0055 and 0.0066, respectively). The most frequently reported treatment‐emergent adverse events were scalp tingling, headache, chills, piloerection, and pruritus. Generally these events were transient and mild to moderate. There was a slightly lower mean sitting heart rate with Ro 115–1240 than with placebo, but no difference in mean systolic or diastolic blood pressure between treatments.CONCLUSIONSThis study suggests that selective α1A/1l‐adrenoceptor partial agonists have the potential to improve the symptoms of SUI with little or no cardiovascular effect. These results are encouraging and a randomized controlled trial of Ro 115–1240 in a larger population with SUI is warranted to substantiate these findings.
Solifenacin appears effective and well tolerated in patients with symptomatic idiopathic detrusor overactivity in a placebo‐ and tolterodine‐controlled phase 2 dose‐finding study
Authors: Chapple C.R. , Araño P. , Bosch J.L.H.R. , De Ridder D. , Kramer A.E.J.L. , Ridder A.M. 
Published: December 2003

Early results using two new agents to treat urinary incontinence are published. The use of Ro 115–1240 in women with stress urinary incontinence is presented, with encouraging results. This will lead to further studies in more patients. Solifenacin was evaluated in a dose‐finding study and the results presented here; the results of the phase III study appear next month.OBJECTIVESTo evaluate the dose‐response relationship and safety/tolerability of solifenacin succinate (YM905) in the treatment of overactive bladder (OAB), and to compare its efficacy and safety/tolerability with tolterodine 2 mg twice daily.PATIENTS AND METHODSThis multicentre study included a 2‐week single‐blind placebo run‐in, a 4‐week double‐blind placebo‐controlled active treatment phase, and a 2‐week follow‐up. Men and women with an OAB and urodynamic evidence of detrusor overactivity were randomized to placebo or solifenacin 2.5, 5, 10 or 20 mg once daily, or tolterodine 2 mg twice daily.RESULTSOf 265 patients enrolled, 225 were randomized and 192 completed the study. Solifenacin 5, 10 and 20 mg produced statistically significant (P < 0.05) improvements in voids/24 h vs placebo, whereas tolterodine did not; the mean change with tolterodine was between those with solifenacin 2.5 and 5 mg. The outcome was similar for the mean change from baseline to endpoint in mean volume voided/void. For incontinence and urgency episodes/24 h the solifenacin dose groups showed numerically superior changes vs placebo; the mean effects with tolterodine were generally smaller than with solifenacin. Most of the efficacy effect of solifenacin was evident at 2 weeks. Quality‐of‐life outcomes supported the efficacy results. Solifenacin 5 and 10 mg were well tolerated; there were no serious treatment‐related adverse events. The incidence of dry mouth was 14% for solifenacin 5 and 10 mg, 2.6% for placebo and 24% for tolterodine.CONCLUSIONIn this study, the 5‐ and 10‐mg doses of solifenacin appeared to be the most clinically effective for treating OAB, considering the balance between efficacy, quality of life and tolerability. From the results of this study solifenacin 5 and 10 mg were selected for further evaluation in large‐scale phase 3 studies.
Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey
Authors: Manikandan R. , Srirangam S.J. , O'Reilly P.H. , Collins G.N. 
Published: December 2003

OBJECTIVETo analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence‐based.METHODSIn all, 410 consultant urologists practising in UK hospitals were sent a questionnaire about the management of AUR secondary to BPH. Data were collected on practice relating to initial management, trial without catheter (TWOC), the use of α‐blockers and the follow‐up. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed.RESULTSWe received 270 (66%) replies, of which six were excluded because they were from subspeciality interests (e.g. paediatric urology) or had ambiguous answers; 264 (64%) were therefore available for analysis. Urethral catheterization was the initial management of choice (98%), failing which a suprapubic catheter was inserted. Two‐thirds (65.5%) admitted the patient after catheterization. Most consultants initiated α‐blockers (70.5%), with 64% (118) of these using a TWOC 2 days after starting them. One failed TWOC was an indication for transurethral resection of the prostate for 192 (72.8%), with 136 (49.8%) re‐admitting the patient for surgery later. Routine follow‐up after a successful TWOC was advocated by 77.3%. Just over half the respondents (52.6%) felt that there was no need for uniform guidelines in the management of AUR secondary to BPH.CONCLUSIONThis survey identified a reasonable national uniformity in managing AUR secondary to BPH in the UK, but significant aspects of current practice are not evidence‐based.
Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity
Authors: Hindley R.G. , Brierly R.D. , Thomas P.J. 
Published: December 2003

OBJECTIVETo test the hypothesis, in a prospective randomized double‐blind study, that the combination of intravesical prostaglandin E2 (PGE2) and oral bethanechol chloride (BC) are additive or synergistic in improving bladder emptying, as they have been used alone for treating impaired detrusor contractility with little clinical benefit.PATIENTS AND METHODSNineteen patients with detrusor underactivity (17 men and two women) were eligible and randomized to one of two treatments. All had postvoid residual urine volumes (PVR) consistently of > 300 mL, most being reliant on clean intermittent self‐catheterization (CISC). The experimental treatment group (nine patients) received once‐weekly intravesical PGE2 (1.5 mg in 20 mL 0.9% saline) plus BC 50 mg four times daily, for a total of 6 weeks. The second group of 10 patients received a once‐weekly instillation of saline together with placebo tablets, again for 6 weeks.RESULTSBefore treatment the median (interquartile range) PVR was 426 (405–480) mL for those receiving both drugs; this decreased to 325 (290–352) mL after completing the treatment (P < 0.015). In the placebo group the respective values were 576 (539–777) and 538 (350–775) mL (P = 0.09). Four of the patients receiving the active combination reported symptomatic improvement and were able to reduce the frequency of CISC.CONCLUSIONAlthough there was evidence of a pharmacological effect, BC and PGE2 had a limited therapeutic effect compared with placebo. Whilst we would not recommend this treatment as routine, it may be considered for the occasional treatment of a patient with detrusor underactivity.
The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ
Authors: Mulhall J.P. , Jahoda A. , Aviv N. , Valenzuela R. , Parker M. 
Published: December 2003

This section includes three papers, two of which describe the use of drug treatment for erectile dysfunction in special situations. The authors from New York and Chicago write about sildenafil in patients with a penile prosthesis in situ. Authors from Zurich have used apomorphine in patients with spinal cord injury and erectile dysfunction. It is often helpful to readers with an interest in the area of erectile problems to explore the use of commonly prescribed drugs in somewhat less common situations.OBJECTIVETo assess the efficacy of sildenafil in increasing penile glans tumescence and improving patient satisfaction in men with a penile prosthesis, as this remains a major treatment for erectile dysfunction but a common complaint is the lack of glans engorgement.PATIENTS AND METHODSTo determine whether sildenafil combined with a penile prosthesis improves satisfaction, patients used an implant alone for at least 1 month, after which they completed the International Index of Erectile Function (IIEF) questionnaire. The same patients were then given sildenafil citrate and completed the IIEF questionnaire after using the sildenafil/implant combination.RESULTSPatients who responded to sildenafil with glans engorgement reported significantly greater satisfaction scores than with an implant alone.CONCLUSIONWe currently offer sildenafil citrate after implantation to all men who have a penile prosthesis placed.
Apomorphine sublingual as primary or secondary treatment for erectile dysfunction in patients with spinal cord injury
Authors: Strebel R.T. , Reitz A. , Tenti G. , Curt A. , Hauri D. , Schurch B. 
Published: December 2003

OBJECTIVESTo evaluate the effectiveness of apomorphine sublingual (SL) 3 mg, as a primary or secondary treatment for erectile dysfunction (ED) in patients with spinal cord injury (SCI), and to determine possible differences in efficacy considering clinical, urodynamic and neurophysiological findings.PATIENTS AND METHODSThe study included 22 patients with chronic SCI and neurogenic ED who were examined physically and by a video‐urodynamic evaluation. A neurophysiological evaluation included somatosensory evoked potentials of the pudendal nerve, palmar and plantar sympathetic skin responses and bulbocavernous reflex recordings. Thereafter the patients received 8 tablets of apomorphine SL 3 mg and were asked to complete the International Index of Erectile Function questionnaire before and after treatment. Side‐effects, subjective efficacy compared with other treatments and satisfaction with the SL administration were recorded.RESULTSOf the 22 men, 11 had upper motor neurone lesions (six complete, five incomplete), eight lower motor neurone lesions (seven complete, one incomplete) and three had mixed lesions. In all, 12 patients took sildenafil citrate and five alprostadil intracavernosally beforehand, and five had used nothing to treat their ED. Seven patients had some response and reported that the drug helped them to obtain an erection, but only two reported erections sufficient for intercourse and would agree to continue apomorphine SL as their standard treatment; all the others reported being disappointed. Nine patients reported side‐effects. There were no significant correlations for electrophysiological or urodynamic findings and treatment success. Of the 22 patients 20 preferred SL rather than the normal administration.CONCLUSIONSApomorphine SL, a D1/D2 dopamine agonist, facilitates erectile function in a heterogeneous group of patients with no significant relationship with any of the assessed urodynamic or electrophysiological variables. The overall low rates of response either for primary or secondary treatment suggests that apomorphine will have limited applicability in patients with SCI.
Treatment of penile curvature with Essed‐Schröder tunical plication: aspects of quality of life from the patients’ perspective
Authors: Van Der Horst C. , Martínez Portillo F.J. , Seif C. , Alken P. , Juenemann K.P. 
Published: December 2003

OBJECTIVESTo investigate retrospectively the long‐term functional results and quality of life of patients undergoing the Essed‐Schröder procedure (a simple plication of the tunica albuginea) to correct penile deviation, using a standardized questionnaire.PATIENTS AND METHODSBetween 1998 and 2001, 59 patients had surgery in our hospital to correct penile deviation (mean age 40 years at the time of surgery; mean follow‐up 30 months for this study). All 59 patients received a standardized questionnaire via mail, of which 50 could be assessed as valid.RESULTSOf the 50 patients, 22 had a congenital penile deviation and 28 Peyronie's disease. In all patients the penis was completely straightened. The proportion of patients capable of sexual intercourse was significantly higher after surgery (90%) than before (62%). The frequency of pain during intercourse was halved. Of the 50 patients, 60% would have the same operation again, 32% were undecided and 8% would not; 22% were dissatisfied with the results. None of the patients had complete erectile dysfunction after surgery; 74% reported a decrease in penile length and 78% of the patients’ partners were satisfied with the outcome.CONCLUSIONSThe tunical plication procedure is simple and minimally invasive for correcting penile deviation. In the opinion of most patients the Essed‐Schröder method provides a significant improvement in sexual function and quality of life with maximum protection of erectile function.
Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes
Authors: Johnson G.B. , Grasso M. 
Published: December 2003

The arrival of the flexible ureteroscope has been of great value to urologists, allowing access to virtually all parts of the collecting system. Authors from two centres in the New York area and Taiwan write in this section about their experience with new types of flexible ureteroscopes. Their views are sure to be of interest to readers.OBJECTIVETo increase the clinical usefulness of the actively deflectable flexible ureteroscope by making sequential changes in design and then using these prototypes clinically; and to develop a clinical series using the optimum prototype and contrast it with an extensive database of patients treated with the traditional flexible ureteroscope.METHODSA series of prototypic flexible ureteroscopes was developed and used clinically. The active deflection of the prototype ureteroscope was evaluated with and with no accessories in the working channel, and compared with a standard 7.5 F ureteroscope. Clinical data were then accrued and compared with a previously published database.RESULTSThe progression of prototypes led to a final version which incorporated > 300° primary active deflection, shaft miniaturization (8.4 F) and an increase in endoscope shaft stiffness. The prototype flexible ureteroscope had significantly greater active deflection than the standard ureteroscope, especially when working channel accessories were used. In all, 115 endoscopic procedures were carried out, the indications for which included endoscopic lithotripsy for distal calculi (51), treatment of upper tract urothelial carcinoma (27), diagnostic endoscopy (26) and retrograde endopyelotomy (three). No guidewire was required to place the flexible ureteroscope into the upper urinary tract in 27% of patients. Active intramural dilatation for access was only required in 3% of the procedures. All lower pole calyces were accessed with this instrument.CONCLUSIONSAdding exaggerated deflection is a timely advance in flexible ureteropyeloscopy. This and the other changes in design facilitated complex retrograde endoscopic procedures and increased the therapeutic potential of the instrument.
Are new‐generation flexible ureteroscopes better than their predecessors?
Authors: Chiu K.‐Y. , Cai Y. , Marcovich R. , Smith A.D. , Lee B.R. 
Published: December 2003

OBJECTIVETo compare two newly designed flexible ureteroscopes with their respective predecessors, to determine whether design advances have overcome the limitation of tip deflection, which may interfere with diagnosis and treatment of lower pole renal pathology.MATERIALS AND METHODSTwo new‐generation flexible ureteroscopes, the DUR‐8 Elite (ACMI, Southborough, MA, USA) and 11278AU (Karl Storz Endoscopy, Culver City, CA, USA) were compared with their previous models, the ACMI DUR‐8 and the Storz 11274AAU. Active tip deflection and irrigation flow rates with and without various endoscopic tools were assessed. Specifications, purchase prices and repair costs were obtained from each manufacturer. The field of view and screen image size of each ureteroscope were also compared.RESULTSThe ACMI DUR‐8 Elite and the Storz 11278AU had improvements of 79° and 144°, respectively, from their respective older models. Although the tip deflection of all ureteroscopes was compromised by inserting different endoscopic tools, these new instruments were less affected. With a 3 F basket inside the working channel, the ACMI DUR‐8 Elite and the Storz 11278AU had only 0.7% and 2.8% loss of upward tip deflection, compared with their older models, at 9.6% and 5.0%, respectively. However, the flow rates of these new instruments were decreased.CONCLUSIONThe new flexible ureteroscopes have significantly better active tip deflection than previous models, both with and without endoscopic instrumentation inserted. However, improved flexibility is at the expense of decreased flow rates and higher purchase costs.
Metabolic risk factors in patients with renal stones in KwaZulu Natal: an inter‐racial study (Asian and Whites)
Authors: Abdel Goad E.H. , Bereczky Z.B. 
Published: December 2003

OBJECTIVETo identify any differences between Whites and Indians in KwaZulu Natal province, South Africa, in the metabolic risk factors which predispose them to urinary stone formation.PATIENTS AND METHODSUrinary stone disease is often a manifestation of an underlying metabolic disorder in most patients. Intrinsic and extrinsic factors affect the susceptibility of an individual to develop urinary stones. Although South African‐born Indians and Whites in KwaZulu Natal share some of the same extrinsic factors, diet and genetic factors differ between the groups. In a study from April 1999 until April 2001, 140 patients were included who had a radiological diagnosis of renal calculi; they were evaluated metabolically using previously recommended methods.RESULTSAll the patients had at least one identifiable metabolic risk factor; the prevalence of the common metabolic risk factors was similar in the two groups. The prevalence of complete renal tubular acidosis (type 1) was significantly higher in the Indian patients. The most common metabolic abnormalities were hypomagnesuria and hypocitraturia, followed by low urinary volume. Hypercalciuria was not significant in this population. While Indians had lower urine volumes than Whites, Whites had significantly higher urinary calcium excretion than Indians.CONCLUSIONThere were a few variations in the metabolic risk factors between Indians and Whites, and the differences could be attributed to genetic or dietary habits. The high incidence of renal tubular acidosis in Indian patients could explain the higher prevalence of urinary stone disease in this group than in other racial groups.
Rhabdomyosarcoma of the bladder, prostate or vagina: the role of surgery
Authors: Filipas D. , Fisch M. , Stein R. , Gutjahr P. , Hohenfellner R. , Thüroff J.W. 
Published: December 2003

Rhabdomyosarcoma of pelvic organs is not common enough for many people to develop large series. However, the authors from Mainz retrospectively analysed 107 children with this condition, and suggest that primary chemotherapy followed by radical surgery yields excellent cure rates.OBJECTIVETo retrospectively analyse the outcome of children with rhabdomyosarcoma (RMS) of the bladder, prostate or vagina who were treated with chemotherapy, with or without radical surgery or additional radiotherapy, at our institution since 1968.PATIENTS AND METHODSFrom a total of 107 children with RMS seen between 1968 and December 2001, 22 (mean age 5.9, range 0.5–18) had RMS of bladder/prostate or vagina. Twenty of the patients received primary polychemotherapy (vincristine, actinomycin D, cyclophosphamide, adriamycin, and more recently including etoposide and ifosfamide), two had primary surgery and seven had additional radiotherapy. Fourteen patients had radical cystoprostatectomy, with continent cutaneous urinary diversion with an ileocaecal pouch in seven, in one each a transverse colonic pouch, orthotopic ileocaecal bladder substitution, a rectal reservoir and rectosigmoid pouch and a colonic conduit diversion in two patients.RESULTSAfter a mean (range) follow‐up of 8.6  (1.0–26) years, 17 patients had no evidence of disease. Five patients presenting initially with advanced tumour stages died from progressive RMS. Two patients with a continent urinary diversion required ureteric reimplantation for stenosis. In two patients severe bladder contraction after radiotherapy required bladder augmentation.CONCLUSIONPrimary chemotherapy followed by radical surgery of RMS of the prostate and/or bladder allows complete tumour resection in most cases, and yields excellent cure rates.