bluuebunny/crossref_metadata_2025_split huggingface dataset:
Terazosin in benign prostatic hyperplasia: effects on blood pressure in normotensive and hypertensive men
Authors: Kirby  
Published: March 2003

Objective To determine the effects of terazosin on blood pressure and on antihypertensive therapy when used in managing benign prostatic hyperplasia (BPH).Patients and methodsSafety data from a large, multinational study were analysed retrospectively. Normotensive and hypertensive patients received escalating dosages of terazosin for 10 weeks and were maintained on 5 or 10 mg daily doses for 16 weeks (single‐blind period). After the initial treatment period, only men having sufficient improvements in International Prostate Symptom Score (≥30%) and in peak flow rate (≥10%) were randomly assigned to continue terazosin or to receive placebo for 24 weeks (double‐blind period).ResultsIn hypertensive patients, terazosin reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) during the single‐blind period; these clinically significant reductions were maintained in patients receiving terazosin during the double‐blind period. However, in normotensive and controlled hypertensive patients terazosin produced no clinically significant mean changes in SBP or DBP during either study period. Terazosin did not adversely affect patients receiving concomitant antihypertensive medication.ConclusionTerazosin is a safe treatment for BPH in normotensive and hypertensive men, including men who are already taking additional antihypertensive drugs.
A conscious‐rabbit model for the long‐term observation of urethral and arterial pressures
Authors: Pouyet  , Briand  , Martin  
Published: March 2003

Objective To describe and evaluate a new experimental model for the simultaneous measurement of urethral (UP) and arterial (AP) pressures in the conscious rabbit, thereby avoiding the interference of anaesthesia which markedly reduces reflex activity and tone of smooth muscle.Materials and methods Female rabbits were anaesthetized and catheters inserted into the urethra, abdominal aorta, jugular vein and bladder. After recovering from surgery, rabbits were trained to remain static in a sling for a period of 2 h, during which the UP and AP were recorded. The model was validated for short‐ and long‐term stability before the effects of drugs were assessed; UP and AP were recorded for up to 60 min after drug/solvent administration to assess short‐term stability, and long‐term stability was assessed by comparing 60 min control periods between the first and fifth experimental session up to a month apart.Results Over 60 min in the control group, the UP remained steady, whereas the AP only decreased slightly. Recordings were made during five subsequent control periods, with at least 3 days of rest between successive assessments, and the UP and AP remained similar for up to 1 month. During a second phase, the effect of α1‐adrenoceptor agonists on both pressures were evaluated to characterize their functional uroselectivity. De‐glymidodrine and l‐phenylephrine (0.1 mg/kg) were administered intravenously; the UP increased by 18 cmH2O (146%) and 21 cmH2O (173%), respectively, whereas AP increased by 22 mmHg (31%) and 47 mmHg (63%), respectively. At 5 min after administering the drugs, the UP remained higher by 16 cmH2O (121%) with de‐glymidodrine, whereas it had returned to basal values with l‐phenylephrine.Conclusions This conscious‐animal model allows the simultaneous measurement of UP and AP in the absence of anaesthesia. It provides a useful means to directly evaluate the effects of a drug on the urogenital and cardiovascular systems, and thereby its functional uroselectivity.
An exploration of screening practices for prostate cancer and the associated community expenditure
Authors: Perkins  , Sanson‐Fisher  , Clarke  , Youman  
Published: March 2003

Objectives To determine: (i) the prevalence, reasons for, and demographic and psychosocial predictors of prostate cancer screening among a randomly selected sample of men; and (ii) to estimate the community expenditure involved in the screening of asymptomatic men.Subjects and methods A random sample of men aged 40–79 years was selected from the State Electoral Register of New South Wales, Australia, and asked to complete a computer‐assisted telephone interview. The questions determined their demographic characteristics, their subjective health rating compared with others of the same age (5‐point scale), the prevalence and reasons for any screening for prostate cancer (‘ever screened’ and ‘screened within the last 12 months’), whether they had undergone a digital rectal examination (DRE), a blood test for prostate‐specific antigen (PSA) or transrectal ultrasonography (TRUS), and the prevalence of urinary symptoms. Those who had been screened were then asked to nominate the single most important factor in the decision to undergo prostate cancer screening. To estimate community expenditure, the costs for prostate cancer screening were estimated by applying Medicare schedule charges to the screening and subsequent diagnostic tests performed. Two scenarios were developed to estimate costs; the first used guidelines which do not recommend the use of routine screening for all asymptomatic men, and the second was based on guidelines where the routine use of PSA or TRUS as part of a periodic health examination is not recommended, but the use of DRE in asymptomatic men aged 50–70 years is.Results Of the 551 eligible participants, 86% completed the interview; 44% of participants reported that they had ‘ever’ been screened, whilst 23% had been screened in the year before the study. Among those who had been screened, the reason reported most often for screening, apart from symptoms and family history, was the doctor’s recommendation after a medical assessment of their prostate cancer risk status. Screening status was predicted both by the age of the man and his symptom score. As a result, the community expenditure in New South Wales for screening among asymptomatic men was estimated to be A$6.4 million and A$5.2 million for the first and second scenarios, respectively.Conclusions The results of this study suggest that, despite the recommendations of primary bodies that asymptomatic men not be screened for prostate cancer, screening is occurring at a high level and with significant costs to the healthcare system.
Whole‐body potassium and bone mineral density up to 30 years after urinary diversion
Authors: Stein  , Fisch  , Andreas  , Bockisch  , Hohenfellner  , THÜroff  
Published: March 2003

Objectives To evaluate the long‐term effects of different types of urinary diversion on skeletal bone density and whole‐body potassium content in patients with an early correction of base excess (<−2.5).Patients and methods The early correction of base excess (<−2.5) is one of the principles of the treatment of patients undergoing urinary diversion at our institution. In 27 patients with urinary diversion, bone mineral density (assessed by dual‐photon absorptiometry), whole‐body potassium, electrolyte and creatinine levels were determined, and capillary blood gas analysed. The mean time since surgery was 16.8 years in 16 patients with a rectal reservoir, 20.5 years in six patients with a colonic conduit, 7.8 years in four patients with an ileocaecal pouch and 5 years in one adolescent with an ileal bladder augmentation.Results Bone mineral density was normal in 25 of the 27 patients; no exact measurement was possible in the remaining two. The whole‐body potassium content was reduced in eight of the 27 patients (three with a conduit, two with a rectal reservoir, two with an ileocaecal pouch and one with ileal augmentation). In four of these eight patients the base excess was <−2.5 (−2.7 to −5). Of the other four, two had no regular testing of their base balance and two were obese. The electrolytes were within the normal ranges. None of the patients had hyperchloraemic metabolic acidosis.Conclusion With early correction of the base excess (<−2.5), there was no decrease in bone mineral density and no hyperchloraemic acidosis. There was no significant difference between the different types of urinary diversion. There seems to be a relationship between low base excess and decreased whole‐body potassium.
Bladder tumours detected on screening: results at 7 years
Authors: Mayfield  , Whelan  
Published: March 2003

Objective To report the outcome at a minimum follow‐up of 7 years of a cohort of tumours that were asymptomatic at presentation and detected in a previous community‐based screening programme (with reduced mortality and progression at 3 years of follow‐up).Patients and methods In the original screening, 2356 men aged ≥60 years had a dipstick test for microscopic haematuria; 474 (20%) had positive results and of these, 317 agreed to further investigation. Twenty‐one were found to have bladder tumours; this was reduced to 17 after pathological review. No tumours were muscle‐invasive at diagnosis. The outcome of this cohort was evaluated at 7 years of follow‐up.Results The patients were grouped on the basis of their original histology. In group A, four patients had no tumour on histological review and none progressed in grade or stage. In group B, eight patients reported to have well differentiated superficial tumours (i.e. G1pTa) had no recorded deaths from cancer or progression to muscle‐invasive disease. In group C, of nine patients with tumours having a potentially worse prognosis (G1–2, ≥pT1, or carcinoma in situ, three died from bladder cancer, two progressed to muscle‐invasive disease (one of whom died from unrelated causes) and two further patients died from unrelated causes.Conclusion This cohort of patients represents a unique group, in that all had superficial disease at the time of diagnosis. The outcome at 3 years was excellent, but in the subsequent 4 years many patients had progression of their cancer. All patients who developed invasive disease were in group C; as their disease was identified at a superficial stage it may have been amenable to aggressive early management not usually associated with such grade and stage.
Buccal mucosal grafts in the treatment of ureteric lesions
Authors: Naude  
Published: March 2003

ObjectiveTo devise a procedure capable of curing complicated ureteric strictures and replacing segments of lost ureter, without the long‐term infective complications of bowel interposition or the surgical magnitude of autotransplantation.Patients and methodsFour patients with complicated strictures and one with segmental ureteric loss were treated by buccal mucosal patch grafts and an omental wrap. One patient with segmental ureteric loss was treated by interposition of a tubularized buccal mucosal graft.ResultsUreteric patency was established and maintained in all patients, there were no complications and urine was sterile in all patients at follow‐up.ConclusionIn a few patients, buccal mucosal patch graft repair has proved capable of maintaining patency and good urinary drainage in patients with complicated ureteric strictures. Segmental ureteric loss has been replaced in one patient by a patch graft and in another by tubularized graft interposition.
Hypospadias repair by skin flaps: a comparison of onlay preputial island flaps with either Mathieu’s meatal‐based or Duckett’s tubularized preputial flaps
Authors: Ghali  
Published: March 2003

ObjectivesTo evaluate the success of different skin flaps in the one‐stage correction of primary hypospadias, with particular emphasis on comparing onlay preputial island flaps with Mathieu’s meatal‐based and Duckett’s preputial tubularized flaps.Patients and methodsDuring a 12‐year period, 418 patients underwent single‐stage primary hypospadias repair using skin flaps, carried out by one surgeon. The surgical techniques used included Mathieu’s repair in 216 (52%), Duckett’s in 148 (35%), onlay preputial flaps in 42 (10%) and the Mustarde flap procedure in 12 (3%). The surgical results were reviewed, assessing complications and the functional and cosmetic outcome.ResultsAt a mean follow‐up of 23 months the initial overall complication rate for flap procedures was 22%; however, after a mean of 1.4 procedures, the final success rate was 95%. The complication rate was significantly (P<0.05) higher in patients with a proximal urethral meatus, with severe chordee or in repairs involving transection of the urethral plate. However, the complication rates were not significantly different when the patients underwent repair when aged <2 years or >2 years. Despite no significant difference in overall complication rates, onlay procedures tended to be used in more severe hypospadias than was Mathieu’s repair. Duckett’s repair caused a significantly higher overall complication rate as fistulae, strictures, meatal stenoses and tubular abnormalities than did onlay procedures. The use of double‐faced preputial island flaps resulted in an inferior cosmetic appearance than the use of single‐faced flaps, but the overall complication rates did not differ significantly between these techniques.ConclusionsHypospadias repair using skin flaps offered a reliable and durable outcome. However, complication rates were greater in patients with severe hypospadias and with techniques requiring transection of the urethral plate. The onlay preputial island‐flap technique was more widely applicable than was Mathieu’s repair and had a lower complication rate than Duckett’s procedure.
Papillary renal cell carcinoma: clinicopathological characteristics and evaluation of prognosis in 42 patients
Authors: Onishi  , Ohishi  , Goto  , Suzuki  , Miyazawa  
Published: March 2003

ObjectiveTo determine the clinicopathological characteristics of histologically defined papillary renal cell carcinoma (RCC) in relation to prognosis.Patients and methodsIn total, 768 patients with RCC underwent nephrectomy at our university hospital between 1957 and 1995. RCC was classified into clear‐cell carcinoma in 689 patients (89.7%, no follow‐up in 14), chromophobe cell carcinoma in 36 (4.7%, no follow‐up in two) and papillary RCC in 43 (5.6%, no follow‐up in one). In the present study, the 42 patients with papillary RCC who underwent nephrectomy and were followed up were those in whom the clinicopathological features of the papillary RCC were assessed. Factors assessed were the presence or absence of foam‐cell infiltration, occurrence of bleeding and/or necrosis, presence or absence of a pseudocapsule, mixed occurrence with clear‐cell carcinoma, presence or absence of solid variants, cytoplasmic appearance (basophilic vs eosinophilic cells), stage, nuclear grade of malignancy, and angiographic appearance in relation to prognosis. The prognosis was also compared among patients with clear‐cell, chromophobe cell and papillary RCC.ResultsThe prognosis was significantly better in patients with foam‐cell infiltration (P=0.03), with a pseudocapsule (P=0.07), with no solid variants (P=0.001) and with basophilic cells (P<0.001). There were also significant differences in survival between patients with low‐stage (1+2) and high‐stage (3+4) disease (P=0.003), and among grades 1–3 (grade 1 vs 2, P=0.05; grade 1 vs 3, P<0.001, grade 2 vs 3, P=0.006). Furthermore, the prognosis in patients with papillary RCC was worse than in those with chromophobe cell carcinoma (P=0.02), but there was no significant difference in survival between patients with papillary RCC and those with clear‐cell carcinoma.ConclusionThe clinicopathological features (e.g. the presence or absence of foam cells, of a pseudocapsule and of solid variants, cytoplasmic appearance, and the stage and nuclear grade of malignancy) are important prognostic factors for patients with papillary RCC. Furthermore, the prognosis in patients with papillary RCC is similar to those with clear‐cell carcinoma.
The urodynamic profile of prostatodynia
Authors: Theodorou CH. , Konidaris  , Moutzouris  , Becopoulos TH. 
Published: March 2003

ObjectiveTo evaluate urodynamically patients with prostatodynia, and thus define a specific urodynamic pattern that might add to the pathophysiology of the syndrome and possibly aid definitive treatment.Patients and methodsForty‐three patients (mean age 38.1 years, sd 9.25, range 24–59) with symptoms suggestive of chronic prostatitis, e.g. dysuria, frequency of micturition and a burning sensation in the perineum, were classified as having prostatodynia after excluding prostatic infection by standard bacteriological methods. Thereafter, the patients were evaluated urodynamically, including the measurement of free flow‐rate, filling (water) cystometry, a pressure/flow study of micturition, with fluoroscopy and electromyography of the external urethral sphincter.ResultsTwenty‐eight patients (65%) had a low maximum free flow rate (Qmax ), with a mean (sd) of 10.91 (1.26) mL/s. Of the 42 patients who underwent filling cystometry, 26 (62%) had a first sensation of filling, and 28 (67%) a first desire to void, at low volumes (<150 mL and <300 mL, respectively). Of the 25 patients who underwent a pressure/flow study, 16 (64%) had an obstructive pattern of micturition, as defined by a low Qmax of 10.04 (1.38) mL/s and a high intravesical pressure at Qmax of 83.3 (5.3) cmH2O. The site of obstruction was at the level of the bladder neck, as confirmed by fluoroscopy.ConclusionA significant proportion of these patients had a particular urodynamic pattern of functional infravesical obstruction at the level of the bladder neck and sensory disturbances.
The Mitrofanoff urinary diversion for complex vesicovaginal fistulae: experience from Uganda
Authors: Hodges  
Published: March 2003

ObjectiveTo evaluate the results of Mitrofanoff continent urinary diversion in a group of women with persistent severe incontinence after vesicovaginal fistula (VVF) secondary to obstructed labour.Patients and methodsSeven women with severe incontinence following a VVF were offered the Mitrofanoff procedure after all other attempts had failed to restore continence. In three patients a caecocystoplasty formed the urinary reservoir and in four the bladder was used. In all seven patients the appendix was used as the conduit for self‐catheterization. The mean (range) follow‐up was 10 (3–14) months.ResultsOne patient died postoperatively from hepatic failure, which could not be attributed to the particular procedure. One patient required re‐operation at 10 days to adjust the conduit, but of the six patients who recovered, all are fully continent and self‐catheterizing with no difficulty.ConclusionThe Mitrofanoff procedure appears to be a valuable technique to restore continence in this difficult group of patients.
Elevated urinary fibronectin levels after transurethral resection of bladder tumour: a possible role in patients failing therapy with bacillus Calmette–Guérin
Authors: Laufer  , Kaver  , Sela  , Matzkin  
Published: March 2003

ObjectiveTo investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediately and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette–Guérin (BCG), might lower the efficacy of BCG therapy over this period.Patients and methodsUrinary fibronectin was measured using an enzyme‐linked immunosorbent assay in 25 patients with superficial bladder TCC who underwent TURBT for complete resection. Eight samples were collected for each patient, one before and seven during the 4 weeks after TURBT.ResultsHigh levels of urinary fibronectin were detected in 18 patients (72%) after TURBT. In 16 patients the fibronectin level returned to normal within 2 weeks of surgery. The other two patients showed elevated levels of fibronectin for > 4 weeks.ConclusionsThese results show that urinary fibronectin concentration is significantly increased in most patients after TURBT and this should be considered in patients who receive BCG therapy. Treatment within the first 2 weeks after TURBT may be associated with a high failure rate, as urinary fibronectin levels were increased significantly in about three‐quarters of these patients during that period. Indeed, the persistent elevation of fibronectin, occurring in two of the present patients, may be responsible for some of the failures of BCG therapy when it is administered 2–5 weeks after surgery.
A new automated system for urine analysis: a simple, cost‐effective and reliable method for distinguishing between glomerular and nonglomerular sources of haematuria
Authors: Kore  , Dow  , Desai  
Published: March 2003

ObjectiveTo determine the ability, reliability and accuracy of a new automated system of urine analysis in differentiating glomerular from nonglomerular bleeding in the initial investigation of haematuria, and compare its efficacy with conventional phase‐contrast microscopy (PCM).Patients and methodsOne hundred and six urine samples from patients in whom the final diagnosis was available were analysed using electrical flow impedance to detect, enumerate and size red blood cells in a conductive fluid (the cellfacts analyser, Microbial Systems Ltd, Coventry, UK). All the samples were also tested using a dipstick method and PCM was carried out for comparison on 45 of the 106 urine specimens. The results of cellfacts analysis were correlated with the final diagnoses to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this method; the costs were also analysed.ResultsSixty‐nine urine samples tested positive for blood on dipstick urine analysis and all these were confirmed to have red blood cells on cellfacts analysis. The remaining 37 samples were negative for blood on dipstick testing and cellfacts analysis, although seven patients had been referred with previously detected microscopic haematuria, none of whom were found to have any detectable pathology in the urinary tract on clinical examination and investigations. The remaining 30 patients were diagnosed to have urological or nephrological conditions with no haematuria. In the positive group, 20 (29%) patients were from the glomerular group, with a mean (range) red blood cell size of 4.25 (4–5.1) μm, and 49 (71%) from the nonglomerular group, with red blood cells of 5.47 (4.67–5.70) μm. These ranges overlapped at 4.67–5.1 μm; at the decision threshold of 4.75 μm, the distribution of dysmorphic and eumorphic red blood cells for the glomerular group was 18 (90%) and two (10%), respectively, and for the nonglomerular group was 2 (4%) and 47 (96%), respectively. The sensitivity, specificity, PPV and NPV were 90%, 96%, 90% and 96%, respectively. Consumable and labour costs were very low.ConclusionsCellfacts analysis is a simple, rapid, objective and cost‐effective method for differentiating glomerular from nonglomerular urinary red blood cells, especially when few such cells are present.