bluuebunny/crossref_metadata_2025_split huggingface dataset:
A feasibility study for the non‐invasive treatment of superficial bladder tumours with focused ultrasound
Authors: Watkin N.A. , Morris S.B. , Rivens I.H. , Woodhouse C.R.J. 
Published: November 2003

Objective To determine whether high‐intensity focused ultrasound can be used to ablate bladder wall tissue using a transabdominal approach in a large animal model, and whether it can be developed as a non‐invasive treatment for superficial bladder tumours. Materials and methods The bladder wall of 25 large white pigs was treated with a 1.7 MHz extracorporeal focused‐bowl ultrasonic transducer. Animals were killed either 2 h, 3 days or 4 weeks after treatment and the bladder wall examined macroscopically and histologically. Results Acute bladder wall damage was detected in 15 of 16 animals at 2 h and in all six animals examined after 3 days. Areas of healing were seen in 10 of 12 animals at 4 weeks. Histological analysis of the treated areas revealed that the urothelium was denuded within 2 h and was associated with an acute inflammatory response in the bladder wall. At 4 weeks, the urothelium had regenerated over a maturing scar. Conclusions Focused ultrasound can be used successfully to destroy regions of the bladder wall in a large animal model in vivo.
Partial ureteric obstruction: a study of Doppler ultrasonography and diuretic renography in different grades and durations of obstruction
Authors: Shokeir A.A. , Nijman R.J.M. , El‐Azab M. , Provoost A.P. 
Published: November 2003

Objectives To study the changes in renal resistive index (RI) and renal function with time during different grades of partial unilateral ureteric obstruction, and to determine the correlation between the ultrasonographic and renographic findings. Materials and methods Ten dogs underwent right partial ureteric obstruction; grade 1 (mild) obstruction was applied in five dogs (group A) and grade 3 (moderate and severe) obstruction in the other five (group B). All dogs were assessed using excretory urography, diuretic renography with the calculation of half‐time drainage (Tn) and bilateral renal Doppler ultrasonography before the experiment began, after one week of obstruction, and every 2 weeks during 8 weeks of obstruction. Results In both groups, after the induction of right ureteric obstruction, there was a progressive decrease of effective renal plasma flow (ERPF) and a progressive increase of the RI of the right kidney at the end of the first and second weeks of obstruction, with an almost stable value thereafter. The decrease of ERPF and the increase of RI in the right kidney were correlated with the degree of obstruction. There was also a dramatic increase of Tn of the right kidney that correlated with the degree of obstruction. Concomitantly, there was a significant compensatory increase of ERPF and a significant decrease of the RI of the left kidney in both groups. The compensatory increase in ERPF limited the loss in total ERPF in both groups. The contribution of obstructed kidney to the total ERPF was significantly reduced in both groups. At the end of the eighth week, taking all kidneys together, there was a statistically significant negative correlation between the ERPF and RI, and between ERPF and Tn, and a positive correlation between Tn and RI. Conclusions Unilateral partial ureteric obstruction increased the RI and Tn and decreased the ERPF of the corresponding kidney, together with a decrease of RI and an increase in ERPF of the contralateral kidney. The more severe the obstruction, the greater the increase in RI and Tn and the decrease in ERPF. After the obstruction stabilized, RI and T n were positively correlated.
Long‐term renal morphology and function following enterocystoplasty (refluxing or anti‐reflux anastomosis): an experimental study
Authors: Kristjansson A. , Abol‐Enein MD H. , Alm P. , Mokhtar A.A. , Ghoneim M.A. , Månsson W. 
Published: November 2003

Objective To study the morphology and function of the upper urinary tract over the long‐term in dogs with an enterocystoplasty and a refluxing or anti‐refluxing uretero‐intestinal anastomosis. Materials and methods Subtotal cystectomy and ‘cup’ ileocystoplasty were performed in 13 dogs. The right ureter was implanted into the cystoplasty with a refluxing technique in seven and with an anti‐reflux procedure in six dogs. The le ft renal unit acted as an intact control in 11 dogs, while in two the intramural part of the left ureter was incised to produce reflux. Thus, of the 26 renal units, nine had a refluxing junction (anastomosis), six were anti‐refluxing and 11 served as intact controls. Total and separate glomerular filtration rates (GFRs) were measured pre‐operatively and regularly thereafter, and cystometry, urography and ascending enterocystography were performed. At necropsy, urine was obtained for culture from the cystoplasty and renal pelves, and both kidneys were examined histologically. Results The cystometric pressure was low in 12 of the 13 dogs; urography showed no obstruction. The fall in separate GFR did not differ significantly among the groups (with and without reflux protection, and control units). Reflux was detected in three of nine renal units with refluxing anastomosis and in three of 11 control units. Bacteriuria was found in the cystoplasty in all dogs; the incidence in the upper urinary tract was seven of eight renal units with a refluxing anastomosis, one in five of those with an anti‐refluxing anastomosis and three of nine control units. Pyelonephritis was found in none of the control kidneys, in six of nine kidneys with a refluxing and in two of six with an anti‐refluxing anastomosis; it was less severe in the latter. Conclusion Refluxing ureteric implantation in a low‐pressure enterocystoplasty was commonly associated with bacteriuria in the upper urinary tract and with pyelonephritis. Thus, anti‐reflux implantation was beneficial for renal preservation in this setting.
Micrometastatic adrenal invasion by renal carcinoma in patients undergoing nephrectomy
Authors: Li G .R. , Soulie M. , Escourrou G. , Plante P. , Pontonnier F. 
Published: November 2003

Objective To examine adrenal invasion by renal cell carcinoma (RCC), particularly by adrenal micrometastasis, to determine whether adrenalectomy should be performed during radical nephrectomy. Patients and methods From 1987 to 1994, 129 patients with RCC (90 men and 39 women, mean age 61.4 years, range 22–81) underwent radical nephrectomy with associated adrenalectomy because they had risk factors for adrenal invasion (tumour size >5 cm, or tumour of the superior pole). Pathological examinations were carried out systematically and records of these examinations reviewed. The tumour size was recorded and the frequency of invasion calculated. Results There were 10 cases where the gland was invaded; one was a synchronous contralateral metastasis and nine (7%) were ipsilateral invasions of which two were tumours in the superior pole that invaded the gland by direct extension and the other seven invaded the gland by distant metastasis, six being micrometastatic (4.7%). A single micrometastasis was found in two cases (1.5%). There was no adrenal invasion by tumours of <5 cm in diameter from the superior pole. When only tumours >5 cm in diameter were considered, the ipsilateral invasion rate was 11% (9/80) and the micrometastatic rate was 7.5% (6/80). Conclusion Adrenalectomy need not be performed routinely in small tumours which are detected early, but the possibility of adrenal micrometastasis from larger tumours (>5 cm) should be considered.
Bladder replacement by ileocystoplasty: the final treatment
Authors: Christmas T.J. , Holmes S.A.V. , Hendry W.F. 
Published: November 2003

Objective To develop and improve the technique of bladder replacement with ileum in patients with interstitial cystitis. Patients and methods A consecutive series of 27 patients (23 women and four men, median age 61 years, range 40–79) with chronic severe interstitial cystitis refractory to conservative therapies underwent cystectomy and bladder replacement using an ileal pouch. The relief of pain was assessed over a median follow‐up of 30 months (range 2–48). Results Pain relief was complete in all patients and the median neo‐bladder capacity was 520 mL (range 350–700). Only four patients required intermittent self‐catheterization to drain post‐micturition residual urine. Bladder calculi formed in two patients and were removed successfully at cystoscopy. Conclusion Bladder replacement with ileum in the form of the Kock pouch is an effective surgical treatment for intractable interstitial cystitis.
Ultrasonography and colour Doppler flow in the testes of adult patients after treatment of cryptorchidism
Authors: Taskinen S. , Lehtinen A. , Hovatta O. , Wikström S. 
Published: November 2003

Objective To analyse the prevalence of post‐operative structural, parenchymal and vascular testicular abnormalities and the incidence of epididymal abnormalities in adult men treated for undescended testes in childhood.Patients and methods The testes and epididymi of 76 adult men treated for cryptorchidism in childhood were evaluated 16 to 27 years after treatment, using colour Doppler ultrasonography.Results The 61 spontaneously descended testes were significantly (P<0.01) larger (mean [sd], 22 [8] mL) than the 90 undescended testes (13 [6] mL). The echo pattern in all the spontaneously descended testes was normal, whereas in 15 cases (17%) the testicular tissue was abnormal after cryptorchidism. In 12 of these 15 cases, the echo pattern was very irregular, and two other cases had microlithiasis of the testicular parenchyma, one of them bilaterally. No normal testicular artery was detected in two cases (3%) of normally descended testes, against 18 (20%) amongst those with undescended testes. Epididymal abnormalities were found in two (3%) of the group of normally descended testes against 32 (36%) in the undescended group.Conclusions Infertility in patients with cryptorchidism may be a result not only of primary parenchymal degenerative changes of the testis directly due to the condition, but also of operative vascular trauma and epididymal anomalies. Operative trauma may be more common than has generally been believed. Ultrasonography is a suitable method to evaluate post‐operatively the prevalence of the testicular abnormalities analysed in the present study.
Farmers at risk for prostate cancer
Authors: van der Gulden J.W.J. , Vogelzang P.F.J. 
Published: November 2003

Objective To summarize the literature on the risk of prostate cancer among farmers and farm workers, to evaluate the magnitude of the risk and to determine the presence of risk factors peculiar to agricultural work.Methods Recent literature was searched and reviewed, selecting only case‐control studies in which both positive and negative odds ratios were presented for several occupations, while only cohort studies and death‐certificate studies were selected which presented risk estimates for several cancer sites, elevated as well as decreased.Results In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among farmers. It is as yet unclear whether this excess risk is caused by particular occupational exposures or by risk factors in their personal lifestyle (e.g. dietary habits). Evidence was found for a relationship between the use of pesticides and of other agricultural chemicals and the risk of prostate cancer.Conclusion Farmers probably have a slightly elevated risk of contracting prostate cancer. However, the actual risk factors are still a matter of conjecture.
Obstetric and gynaecological ureteric injuries: treatment and results
Authors: Giberti C. , Germinale F. , Lillo M. , Bottino P. , Simonato A. , Carmignani G. 
Published: November 2003

Objective To compare endourological techniques and open surgery in the treatment of ureteric injuries following obstetric and gynaecological surgery.Patients and methods From January 1982 to February 1994, 63 women (mean age 51 years, range 22–70) were treated for 72 ureteric lesions consequent upon obstetric or gynaecological surgery. In nine patients, 10 ureteric lesions were detected intra‐operatively and repaired immediately. In the remaining 54 patients, the 62 ureteric injuries were diagnosed and treated after a delay; 29 patients with 37 ureteric injuries underwent repair by open surgery while 25 patients with a unilateral ureteric lesion underwent elective primary endourological treatment.Results The results of repair were not related to the type of treatment; the cure rate was 87, 88 and 90% for delayed open surgical, endourological and immediate intra‐operative repair, respectively. The site (vesico‐ureteric junction, uterine artery or infundibulopelvic ligament) and the type (fistula or stenosis) of ureteric lesion had no influence on the results, regardless of the type of treatment. The results of ureteric repair were related to the surgery that caused the lesion; 88% of the poor results occurred in the patients who underwent radical hysterectomy alone or combined with radiotherapy and approximately half of the irradiated patients required major surgery.Conclusion When the patients are correctly selected, endourological treatment plays an equally important role in the treatment of gynaecologically‐related ureteric injuries when compared to open surgery. Special attention should be paid to the treatment of lesions caused by radical hysterectomy alone or associated with radiotherapy, as these may lead to poor results.
Adrenalectomy — still a must in radical renal surgery?
Authors: Kozak W. , Höltl W. , Pummer K. , Maier U. , Jeschke K. , Bucher A. 
Published: November 2003

Objective To investigate the incidence of adrenal involvement and survival in patients with renal cell carcinoma.Patients and methods A retrospective, multicentre trial was initiated by the Austrian Association of Urologic Oncology (AUO); between January 1980 and December 1984, 225 patients were eligible for the study. All patients had unilateral renal tumours and nephrectomies were performed either with (group A, 109 patients) or without (group B, 116 patients) adrenalectomy. The two groups were matched for sex, age, laterality and nodal status. The mean follow‐up time was 78 months.Results The location of the intrarenal tumour had no significant effect on adrenal involvement. By univariate and multivariate analysis (Cox's proportional hazards model) significant differences in outcome were found only for pT stages. The mean survival times of patients in group A were 122.9 months in those with stage pT1/2, 76.6 months with stage pT3 and 75.3 months with stage pT4. In group B, survival times were 109 months in those with stage pT1/2 (not significant) and 111 months in stage pT3 (P=0.0076). Eight patients had adrenal involvement and died from their tumours after a median of 15.3 months (range 4–63). The slightly longer survival of patients in group B with stage T1/2 tumours and the significantly better survival of patients with stage T3 disease may be attributable to statistical bias, but there was no benefit from adrenalectomy.Conclusion The effect of adrenalectomy on the prognosis was at best comparable to that of lymphadenectomy and no curative effect was demonstrated. The removal of a healthy adrenal may be detrimental and cause subsequent problems in those patients requiring hormone replacement.
Intragranular activation of bladder mast cells and their association with nerve processes in interstitial cystitis
Authors: Letourneau R. , Pang X. , Sant G.R. , Theoharides T.C. 
Published: November 2003

Objective To investigate the presence of progesterone receptors and the extent and type of degranulation exhibited by the increased numbers of mast cells (MCs) found in interstitial cystitis (IC), a painful bladder disorder which occurs almost exclusively in women, worsens perimenstrually and is characterized by increased numbers of oestradiol receptor (OR)positive MCs.Patients and methods The state of MC degranulation was analysed blindly using electron microscopy of bladder biopsies from 26 patients with IC and six control patients which included five women with incontinence, with none of the established characteristics of IC, and one man with transitional carcinoma of the bladder. Emphasis was placed on preserving the secretory granule ultrastructure. The presence of progesterone receptors (PRs) in five patients with IC and three controls was investigated using commercially available antibodies against PRs.Results Over 85% of bladder MCs expressed high affinity PRs, but the number of PR‐positive MCs in patients with IC did not differ significantly from that of controls despite the overall increase in MCs seen in IC. MCs were activated to various degrees and were often near to neuronal processes. The secretory granule content of MCs from patients with IC was in different stages of dissolution, ranging from heterogeneous loss of electron density to the appearance of crystalline substructure and target forms containing only remnants of the original material. Typical degranulation by compound exocytosis was not observed. MCs from control patients contained secretory granules with mostly intact, electron‐dense granules.Conclusion These findings indicate that the symptoms of IC may depend on an imbalance of the relative number of oestrogen receptors (ORs) to PRs on bladder MCs resulting in a ‘progesterone deficient’ state. This possibility is strengthened by demonstration that oestradiol augments the secretion of MC histamine in response to the neuropeptide substance P, which is pro‐inflammatory, nociceptive and overexpressed in bladders with IC. Intragranular activation of bladder MCs is a characteristic pathological finding in patients with IC. The lack of extensive degranulation, typically seen in anaphylaxis, may indicate a unique mode of stimulation and/or differential release of mediators.
Biological characteristics of inverted papilloma of the urinary bladder
Authors: Urakami S. , Igawa M. , Shirakawa H. , Shiina H. , Ishibe T. 
Published: November 2003

Objectives To elucidate the biological characteristics of inverted papilloma (IP) of the bladder.Materials and methods The immunoreactivity of p53, nuclear DNA content (assessed by ploidy and 2c deviation index [2cDI]) and the expression of proliferating cell nuclear antigen (PCNA) in 17 IPs were evaluated using a computer‐assisted image analyser and compared with those in 12 superficial transitional cell carcinomas (TCCs), 29 invasive TCCs and one inverted papillary TCC of the bladder.Results Positive staining for p53 and PCNA and intense staining with Feulgen were observed predominantly in the basal layer of the bladder mucosa. All IPs and most superficial TCCs were diploid, while most invasive TCCs were aneuploid. Although the 2cDI and the immunoreactivities for PCNA and p53 were significantly lower in IPs than in invasive TCCs, there was no significant difference in these three variables between IPs and superficial TCCs. However, some IPs were more immunoreactive for p53 than were the superficial TCCs.Conclusions The distribution of cells with p53 and PCNA immunoreactivity, and with intense Feulgen staining, indicated that IP of the bladder might have high proliferative activity and that those IPs with a high immunoreactivity for p53 may be susceptible to malignant transformation.
Reproducibility of prostate volume measurements from transrectal ultrasonography by an automated and a manual technique
Authors: Aarnink R.G. , De La Rosette J.J.M.C.H. , Debruyne F.M.J. , Wijkstra H. 
Published: November 2003

Objective To assess the reproducibility of estimates of prostate volume determined by planimetry from transrectal ultrasonography (TRUS) images.Materials and methods Two sequential sessions of images obtained by TRUS were obtained from 30 patients, with the ultrasound probe removed and inserted between the sessions. The stored images were outlined, both manually and by computer, and measurements of prostate volume obtained planimetrically. In addition, the ability of the urologist to accurately draw the contour was assessed by outlining predefined contours.Results The mean (sd) variability of manual outlining between sessions was 3.5 (3.4)%, within one session was 1.7 (1.3)% and of computer outlining between sessions was 4.3 (3.8)%. Comparing the results of manual and computer outlining showed a mean (sd) variability of 7.5 (5.6)%, with larger values obtained from computer outlining. The mean (sd) variation in manually outlining predefined contours was 1.4 (1.4)%.Conclusions The variability of computer outlining was slightly higher than expected theoretically. The within‐session variability was higher than the variation caused by errors in outlining predefined contours, indicating that the interpretation of TRUS images differed with time. Automated determination of prostate volume can save time during clinical investigation and the variability is within the clinically acceptable range of 5%.
Intravesical instillation of epirubicin: effect on tumour recurrence in patients with dysplastic epithelium after transurethral resection of superficial bladder tumour
Authors: Igawa M. , Urakami S. , Shirakawa H. , Shiina H. , Ishibe T. , Kadena H. , Usui T. , Kawanishi M. 
Published: November 2003

Objective To evaluate whether the intravesical instillation of epirubicin is effective in preventing the recurrence of tumour in the bladder where dysplastic mucosa remains after transurethral resection of tumour. Patients and methods Biopsy specimens were taken from apparently normal areas of the bladder mucosa in patients undergoing transurethral resection of the primary tumours. Of the 75 evaluable patients, 18 (24%) had abnormalities in at least one or more specimens. The patients were divided into two groups, 57 with normal and 18 with abnormal biopsy results. Intravesical chemotherapy with epirubicin (20 mg/40 mL saline) was randomized to patients in each group. Tumour recurrence rates were estimated and compared amongst the groups. Factors related to tumour recurrence were evaluated using univariate and multivariate analyses. Results The risks of tumour recurrence and progression were evaluated in 18 patients with concomitant mucosal abnormalities. All 10 patients with abnormal biopsy results who were treated with epirubicin had recurrence of tumour within a mean interval of 9 months, whereas six of eight controls had recurrence within a mean of 10.9 months. While there was progression in grade in four of 10 patients with abnormal biopsy results and treated with epirubicin, none of the recurrent tumours in six control patients with mucosal abnormalities progressed in grade. The overall recurrence‐free rate of the patients with mucosal abnormalities was higher in controls than in those receiving epirubicin, but the difference was not statistically significant. There were no significant differences in recurrence rate for those treated with epirubicin and controls in the 57 patients with normal biopsy results. Univariate analysis showed that the recurrence‐free rates were significantly influenced by tumour multiplicity and the mucosal biopsy results (P<0.001 and P=0.02, respectively). In a Cox proportional‐hazards model, tumour multiplicity alone had prognostic significance for tumour recurrence (P=0.002). Conclusions The prophylactic intravesical instillation of epirubicin had no effect in preventing tumour recurrence and, conversely, it may promote tumour progression in bladders with dysplastic mucosal changes.