bluuebunny/crossref_metadata_2025_split huggingface dataset:
Varicocele in adolescence induces left and right testicular volume loss
Authors: Kass E.J. , Stork B.R. , Steinert B.W. 
Published: March 2003

Objective To determine the effect of a palpable left‐sided varicocele (which in adolescent patients can adversely affect left testicular volume) on right testicular volume with progressive Tanner development and increasing varicocele grade.Patients and methods The right and left testicular volumes were measured with a standard orchidometer in 70 control patients (mean age 14.6 years,

sd 2.2) with no palpable testicular abnormality and in 434 (mean age 14.3 years,

sd 2.3) with a palpable left‐sided varicocele. Patients with bilateral and right‐sided varicoceles were excluded from the study.Results There was no significant difference between the left and right testicular volumes in the control patients. The testicular volumes of patients with a grade I varicocele were similar to those in control patients. Patients with a grade II varicocele had a significantly smaller left testis than the controls at Tanner stages 4 and 5 (P  0.05). Patients with a grade III varicocele had a significantly smaller left testis than controls at each Tanner stage (P  0.05) and significantly smaller right testis than controls at Tanner stages 4 and 5 (P  0.05).Conclusion The presence of a grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually. Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.
The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele—avoiding postoperative hydrocele
Authors: Oswald J. , Körner I. , Riccabona M. 
Published: March 2003

Objective To assess whether identifying and preserving the lymphatic vessels, using vital dyes, avoids postoperative hydrocele in adolescents with varicocele undergoing high retroperitoneal ligation (Palomo procedure).Patients and methods The results were assessed from 28 consecutive adolescent patients undergoing varicocelectomy, treated between 1998 and 1999 by the Palomo procedure. The lymphatic vessels were identified and preserved using vital dyes, to avoid postoperative hydrocele formation.Results In 24 of the 28 patients (86%) the identification and preservation of lymphatic vessels was feasible. Over a mean (range) follow‐up of 14 (4–24) months there were no postoperative hydroceles and no clinical recurrences.Conclusion Identifying and preserving the lymphatic drainage of the testis and tunica vaginalis using vital dyes prevents the development of postoperative hydrocele in adolescents undergoing the Palomo procedure.
Urinary levels of substance P and its metabolites are not increased in interstitial cystitis
Authors: Campbell D.J. , Tenis N. , Rosamilia A. , Clements J.A. , Dwyer P.L. 
Published: March 2003

Objectives To determine whether interstitial cystitis is associated with the increased release of substance P from the bladder wall into urine, by measuring urinary excretion rates of substance P and its metabolites in women with interstitial cystitis and in a control group of women with stress incontinence and normal bladder function. Patients and methods Catheter urine was collected from 13 patients and 10 controls during a water diuresis (≈ 10 mL/min) before and after instilling the bladder with 100 mL of water. The contribution of the bladder wall to urinary substance P peptides was assessed by measuring the change in substance P peptide levels after 2 min of bladder stasis before and after instillation. Results Absolute substance P excretion rates were similar in patients with interstitial cystitis and controls; 2 min of bladder stasis reduced the substance P excretion rate (P = 0.03) and increased the excretion rate of substance P metabolites (P = 0.01). Conclusions The release of substance P from the bladder wall was not increased in patients with interstitial cystitis.
Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double‐blind placebo‐controlled trial
Authors: Thilagarajah R. , Witherow R. O'N. , Walker M.M. 
Published: March 2003

Objective To evaluate the efficacy of oral cimetidine as a treatment for painful bladder disease (PBD, variously described as a ‘symptom complex’ of suprapubic pain, frequency, dysuria and nocturia in the absence of overt urine infection) by assessing symptom relief and histological changes in the bladder wall tissue components, compared with placebo. Patients and methods The study comprised 36 patients with PBD enrolled into a double‐blind clinical study with two treatment arms, i.e. oral cimetidine or placebo, for a 3‐month trial. Patients were asked to complete a symptom questionnaire (maximum score 35), and underwent cystoscopy and bladder biopsy before treatment allocation. On completing treatment the patients were re‐evaluated by the questionnaire and biopsy. The symptom scores and bladder mucosal histology were compared before and after treatment, and the results analysed statistically to assess the efficacy of cimetidine. Results Of the 36 patients recruited, 34 (94%) completed the study. Those receiving cimetidine had a significant improvement in symptoms, with median symptom scores decreasing from 19 to 11 (P < 0.001). Suprapubic pain and nocturia decreased markedly (P = 0.009 and 0.006, respectively). However, histologically the bladder mucosa showed no qualitative change in the glycosaminoglycan layer or basement membrane, or in muscle collagen deposition, in either group. The T cell infiltrate was marginally decreased in the cimetidine group (median 203 before and 193 after) and increased in the placebo group (median 243 and 250, P > 0.3 and > 0.2, respectively). Angiogenesis remained relatively unchanged. The incidence of mast cells and B cells was sporadic in both groups. Conclusions Oral cimetidine is very effective in relieving symptoms in patients with PBD but there is no apparent histological change in the bladder mucosa after treatment; the mechanism of symptom relief remains to be elucidated.
Diversion colitis in children with colovaginoplasty
Authors: Syed H.A. , Malone P.S.J. , Hitchcock R.J. 
Published: March 2003

Objective To highlight the occurrence of diversion colitis and its effects in colovaginoplasty. Patients and methods The records of 18 children who had undergone colovaginoplasty were reviewed retrospectively. Nine patients had androgen‐insensitivity syndrome and three each had congenital adrenal hyperplasia, vaginal agenesis and Mayer–Rokitansky syndrome. Through an abdominoperineal approach a segment of sigmoid colon was isolated on its vascular pedicle and brought to the perineum in the plane between the urethra and rectum, as a blind pouch or as an interposition between the proximal vagina and the perineum. The mean (range) follow‐up was 5 (1.5–8) years. Results There were no major complications during the early follow‐up. Three patients developed severe vaginal discharge with bleeding 2–7 years after colovaginoplasty; examination showed erythema, oedema, ulceration and bleeding. Histology confirmed the classic features of diversion colitis in all three patients. One child responded to vaginal irrigation with a solution of short‐chain fatty acids, and the other two were treated with steroid enemas and mesalazine after a poor response to short‐chain fatty acids. One of these patients has required surgical reduction of an excessively long neovagina. Conclusion Symptomatic diversion colitis can occur after colovaginoplasty. The severity of the symptoms raises concerns about the use of colovaginoplasty in children and alternative techniques of vaginal replacement should be considered in the first instance.
The prevalence of loss of heterozygosity in chromosome 3, including FHIT, in bladder cancer, using the fluorescent multiplex polymerase chain reaction
Authors: Wada T. , Louhelainen J. , Hemminki K. , Adolfsson J. , Wijkström H. , Norming U. , Borgström E. , Hansson J. , Steineck G. 
Published: March 2003

Objective To determine some of the genetic alterations involved in the pathogenesis and progression of transitional cell carcinoma of the bladder. Materials and methods In a population‐based study, freshly frozen tissue was collected from all patients newly diagnosed with urinary bladder cancer in the Stockholm region during 1995–1996. The prevalence of loss of heterozygosity (LOH) was assessed at seven sites on chromosome 3, analysed in 151 patients, using a fluorescent multiplex polymerase chain reaction based on DNA from the tumour and peripheral blood. Results LOH was detected in 12.1% (at 3q25–26.2) to 22.1% (at 3p11–12) of the informative cases. Relatively frequent LOH was detected at 3p22–24.2 (21.6%), at 3p14.2 within FHIT (21.5%), and at 3p11–12 (22.1%). Of 151 tumours, 72 (47.7%) showed LOH at one or more loci on chromosome 3. LOH on chromosome 3 was weakly associated with tumour grade (P = 0.095), but not with tumour stage (P = 0.701). However, when the frequency of LOH was analysed individually at each site, the prevalence of LOH at 3p11–12 was closely correlated with higher tumour stage (P = 0.011). Replication errors were detected in only four of 151 (2.6%) tumours. Conclusion These findings suggest that the 3p11–12 locus may involve a putative candidate tumour‐suppressor gene which might be associated with bladder tumour invasiveness. The FHIT gene locus showed a relatively high frequency of LOH even in Ta tumours.
The serous‐lined tunnel principle for urinary reconstruction: a more rational method
Authors: Kato H. , Kiyokawa H. , Igawa Y. , Nishizawa O. 
Published: March 2003

Objective To examine the feasibility of using the serous‐lined‐tunnel principle for orthotopic neobladder, continent cutaneous diversion and ureteric replacement by an intestinal segment. Patients and methods We created: (i) an orthotopic ileal neobladder using the serous‐lined technique for antirefluxing ureteric implantation in 16 patients; (ii) a continent ileal pouch, adopting the principle for continent‐valve construction and for ureteric implantation, in 10 patients (another patient with a failed continent valve underwent revision using an adaptation of this principle; and (iii) by applying the same principle an ileal ureter with a proximal antirefluxing mechanism was constructed in two patients (with lower ureteric cancer), and total replacement of the ureter by a tubular segment of the colon in association with a continent transverse colon pouch in one irradiated patient. Results In all, 52 ureters implanted into ileal neobladders or continent pouches functioned well, with neither obstruction nor reflux; 11 continent valves functioned well with no incontinence. Two patients with ileal ureters showed no ileo‐ureteric reflux and had less hydronephrosis than before surgery. The tubularized ureter provided a unidirectional flow into the pouch. Conclusion Ureteric reimplantation and continent valve formation achieved by adopting the serous‐lined tunnel principle provided satisfactory results. The versatility of the principle is apparent in the present experience and the creative application of the serous‐lined tunnel principle should be possible in urinary reconstruction.
Gracilis muscle flap with a tissue‐engineered lining for experimental bladder wall reconstruction
Authors: Schoeller T. , Lille S. , Bauer T. , Piza‐Katzer H. , Wechselberger G. 
Published: March 2003

Objective To assess a pedicled gracilis muscle flap pre‐laminated with autologous, in vitro‐expanded urothelial cells to reconstruct an entire supratrigonal bladder‐wall defect in rats. Materials and methods A gracilis muscle flap was harvested from 36 male Wistar rats, transposed into the abdomen and wrapped around a silicon‐block space holder. Urothelial cells were harvested and expanded ex vivo. Cells were then suspended in fibrin glue and seeded into the gracilis muscle pocket. One week later this pre‐laminated flap was transposed into a surgically created supratrigonal bladder‐wall defect. All animals underwent such a pre‐laminated gracilis flap bladder reconstruction and were categorized into three experimental groups. All surviving animals with urothelial‐culture pre‐laminated gracilis flap bladder reconstruction were killed 12 weeks (group 1) later. Control rats had gracilis flaps with no cell seeding and treated only with fibrin glue (group 2) or a standard culture medium (group 3) before reconstruction. Results Specimens stained with haematoxylin and eosin, and a specific immunohistochemical staining (AE1 and AE3‐anti‐cytokeratin monoclonal antibody stain) showed a continuous, multilayered functioning urothelial lining along the transposed pre‐laminated gracilis flap in group 1. All animals in group 1 with an intact urothelial lining on the gracilis muscle survived, in contrast to most animals in groups 2 and 3, where eight and all 12 animals died, respectively. The surviving four animals in group 2 had no detectable urothelial lining. Conclusion Successful urinary reconstruction requires a contractile neo‐reservoir resistant to resorption over time and a stable, protective urothelial lining. A gracilis muscle flap can be seeded with autologous cultured urothelial cells suspended in fibrin glue. This pre‐laminated flap can be safely transposed on its pedicle and be successfully integrated into the remaining bladder wall, with a urothelial lining and the potential to contract. Further studies in larger animals, with a urodynamic assessment, are warranted to determine if this type of bladder‐wall replacement technique is suitable for urinary reconstruction in humans.
The role of the adult urologist in the care of children: findings of a UK survey
Authors: Thomas D.F.M. , Fraser M. 
Published: March 2003

Objective To document the current role of adult urologists in the care of children in the UK and to consider the future provision of urological services for children within the context of published national guidelines. Methods A detailed postal questionnaire was sent to all 416 consultant urologists listed as full members of the British Association of Urological Surgeons and resident in the UK. The range of information sought from each urologist included details of personal paediatric training, scope of personal practice, and information about facilities and provision of urological services for children in their base National Health Service hospital. Results The response rate was 69%; most consultant urologists (87%) in District General Hospitals (DGHs) undertake paediatric urology, mainly routine procedures of minor or intermediate complexity. Of urologists in teaching hospitals, 32% treat children but their involvement is largely collaborative. Consultants appointed within the last 10 years are less willing to undertake procedures such as ureteric reimplantation or pyeloplasty than those in post for  10 years. Currently, 18% of DGH urologists hold dedicated children's outpatient clinics and 34% have dedicated paediatric day‐case operating lists. Almost all urologists practise in National Health Service hospitals which meet existing national guidelines on the provision of inpatient surgical care for children. Conclusion Urologists practising in DGHs will retain an important role as providers of routine urological services for children. However, the tendency for recently appointed consultants to limit their practice to the more routine aspects of children's urology is likely to increase. Training and intercollegiate assessment should focus on the practical management of the conditions most commonly encountered in DGH practice. The implementation of national guidelines may require greater paediatric subspecialization at DGH level to ensure that urologists treating children have a paediatric workload of sufficient volume to maintain a high degree of surgical competence.
Undiagnosed macroscopic haematuria revisited: a follow‐up of 146 patients
Authors: Sells H. , Cox R. 
Published: March 2003

Objective To further investigate a group of patients with macroscopic haematuria who had no abnormalities on upper tract imaging and cystoscopy, to determine the appropriate follow up. Patients and methods The hospital notes of patients who presented with frank haematuria between 1990 and 1998 and had no abnormality on cystoscopy and/or upper tract imaging were reviewed, with particular note made of any further bleeding or any other further urological problems. Those with <2 years of follow‐up in the hospital notes were investigated by telephone or via their general practitioner to ensure that all patients had at least 2 years of follow‐up after the initial investigation. Results Of the 146 patients in the study, 98 were alive and had no more bleeding after the initial investigation. None of them were found to have renal or urothelial tumours during the follow‐up. Thirty‐three patients had recurrent episodes of bleeding after the initial investigation; 26 of these had repeat investigations and one was found to have a renal pelvic transitional cell carcinoma on repeat intravenous urography. One patient in this subgroup had died from a subarachnoid haemorrhage; 15 other patients had died, 13 of non‐urological causes and two of unknown causes. Conclusions Of 146 patients with undiagnosed macroscopic haematuria, only one had a missed tumour and this was detected on further investigation for recurrent bleeding. These results confirm that repeat cystoscopy and upper tract imaging is only warranted in patients who have recurrent bleeding after initial investigation.
Routine bone scans in patients with prostate cancer related to serum prostate‐specific antigen and alkaline phosphatase
Authors: Wymenga L.F.A. , Boomsma J.H.B. , Groenier K. , Piers D.A. , Mensink H.J.A. 
Published: March 2003

Objective To evaluate the need for a bone scan as a routine staging procedure in patients with newly diagnosed prostate cancer in relation to serum prostate‐specific antigen (PSA) and alkaline phosphatase (ALP) levels, and thus determine whether a reduction of the use of this staging method is possible in patients with a low probability of osseous metastasis. Patients and methods The results of bone scans were related retrospectively to levels of serum PSA and ALP in 363 patients with prostate cancer newly diagnosed between 1989 and 1997. Results Of 363 consecutive patients, 111 had a positive bone scan. In 19 of 144 (13%, ‘missed diagnosis’) patients with a PSA level of < 20 ng/mL the bone scan was positive. In 125 patients (49%, ‘false‐positives’) with a PSA level of > 20 ng/mL the bone scan was negative. A threshold level of 100 U/L for ALP gave a better balance for the number of ‘false‐positives’ and ‘missed diagnosis’. ALP values correlated better with an abnormal bone scan than did PSA levels; ALP levels of > 90 U/L indicated a 60% chance for the presence of bone metastases. Conclusion Patients with newly diagnosed and untreated prostate cancer should undergo bone scintigraphy if there is bone pain or if ALP levels are > 90 U/L. Recent reports discourage the routine use of a bone scan when the serum PSA level is <20 ng/mL. However, the present series suggests there is a greater chance of a positive bone scan in patients with low PSA levels; these findings need further confirmation.
Autoaugmentation peritoneocystoplasty in a sheep model
Authors: Close C.E. , Dewan P.A. , Ashwood P.J. , Byard R.J. , Mitchell M.E. 
Published: March 2003

Objective To report our experience with autoaugmentation peritoneocystoplasty (AAPC) in a sheep model, and to compare the results with autoaugmentation gastrocystoplasty (AAGC) in a sheep model and in paediatric patients. Materials and methods Ten 6‐month‐old male lambs underwent bladder augmentation by detrusorotomy. A flap of parietal peritoneum, dissected from the anterior abdominal wall, was used to cover the bladder mucosa. The sheep were evaluated by urodynamics 6 months after surgery. Bladder compliance (bladder volume/intravesical pressure) was calculated for the bladder capacity at leakage. The urodynamic results were compared with age‐matched control sheep and with 12 sheep that had undergone AAGC; the results were assessed using the Mann–Whitney U‐test. Results In two of the 10 sheep, bladder volumes after AAPC increased by > 100%, although for the group, the mean (range) bladder volume after augmentation, at 159 (42–261) mL, was not significantly different from that before surgery (mean 143 mL). Bladder volumes after AAPC were not significantly different from those in the control sheep (mean 205 mL) but were significantly less than in the AAGC group (mean 317 mL; P < 0.05). Bladder compliance at leak capacity in the AAPC group (mean 5.4 mL/cmH2O) was also not significantly different from the controls (mean 9.1 mL/cmH2O), but was lower than the in the AAGC animals (median 14.6 mL/cmH2O; P < 0.05). Conclusions AAPC in a sheep model does not result in a reliable increase in bladder volume or compliance. The volume and compliance are inferior to those found in bladders augmented by AAGC.
The role of imipramine therapy in bladder exstrophy after bladder neck reconstruction
Authors: Dave S. , Grover V.P. , Agarwala S. , Mitra D.K. , Bhatnagar V. 
Published: March 2003

Objective To assess the role of imipramine therapy after bladder neck reconstruction in patients with bladder exstrophy. Patients and methods Seventeen children with bladder exstrophy who achieved partial continence after bladder neck reconstruction received imipramine (1.5–2 mg/kg body weight) for a mean duration of 9.5 months. Assessment before and after therapy included an objective classification of the continence status and artificial slow‐fill cystometry. Results Eleven of the 17 patients had a good clinical response to imipramine, with an increase in the continent period to > 2 h, and in nocturnal continence. The urodynamic findings showed a significant improvement in the capacity, end‐fill pressure, uninhibited contractions and ‘20 below’ capacity. Only minor side‐effects of the drug were reported. Conclusion Imipramine has a role in patients who achieve partial continence after reconstruction, and who have a moderately small capacity bladder with poor compliance and uninhibited contractions.
A demographic profile of patients undergoing transurethral resection of the prostate for benign prostate hyperplasia and presenting in acute urinary retention
Authors: Loh S.‐Y. , Chin C.‐M. 
Published: March 2003

Objective To evaluate, in a prospective study, the demographic profile of patients with benign prostate enlargement who presented in acute urinary retention (AUR). Patients and methods The study comprised all patients admitted for transurethral resection of the prostate and categorised into two groups, i.e. those presenting in AUR or electively. The factors evaluated included the length of hospitalization, the patients' occupation, their duration of symptoms and reasons for not seeking treatment. Results There was no significant difference in the mean age and occupational status of the two groups but those in AUR had more complications and a longer hospital stay after surgery; 60% of these men had had their urinary symptoms for > 1 year. When asked why they did not seek treatment earlier, 35% reported fear of surgery, while 41% thought that their symptoms were a normal part of ageing. Conclusion There is a need to raise the level of public awareness of benign prostatic enlargement because those who present with AUR incur excess morbidity and longer hospitalization that could otherwise be avoided through earlier treatment and elective surgery.