bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of self‐expanding metallic urethral stents in the treatment of recurrent bulbar urethral strictures: long‐term results
Authors: Sertcelik N. , Sagnak L. , Imamoglu A. , Temel M. , Tuygun C. 
Published: March 2003

Objective To evaluate the effectiveness and long‐term results of using a self‐expanding metallic urethral stent (Urolume™, American Medical Systems, Minnetonka, MI, USA) to treat recurrent bulbar urethral strictures. Patients and methods Between 1990 and 1999, 65 stents were placed in 60 men (mean age 45.2 years, range 20–71) with a urethral stricture (mostly caused by trauma and present for a mean of 4.3 years, range 0.16–26) and who had previously undergone different unsuccessful treatments. Results During a mean (range) follow‐up of 3.8 (1–9) years the strictures in 52 of the 60 patients (87%) were treated successfully. All patients initially had postvoid dribbling incontinence, but this resolved in most within one week; 19 patients remain incontinent. Conclusion The Urolume is a cost‐effective alternative to other treatments for recurrent bulbar urethral strictures of whatever cause.
Urinary excretion of glycosaminoglycans in patients with isolated nocturnal enuresis or combined with diurnal incontinence
Authors: Ferrara P. , Rigante D. , Lambert‐Gardini S. , Salvaggio E. , Ricci R. , Chiozza M.L. , Antuzzi D. 
Published: March 2003

Objective To determine variations in the amount of glycosaminoglycans (GAGs) excreted by patients with nocturnal enuresis and/or diurnal incontinence. Patients, subjects and methods The study included 27 patients (aged 5–15 years) with nocturnal enuresis and/or diurnal incontinence, and 27 healthy age‐matched children. Their urinary GAG excretion was assessed over 24 h using the sodium tetraborate‐carbazole method. Results Patients with nocturnal enuresis and/or diurnal incontinence had higher mean values of urinary GAG excretion than age‐matched controls. There were significant differences in GAG excretion between those with nocturnal enuresis and diurnal incontinence and those with nocturnal enuresis alone. Conclusions GAG excretion in patients with nocturnal enuresis and/or diurnal incontinence was significantly higher than in normal children, suggesting that measuring urinary GAGs may be useful in evaluating physiopathological conditions of the bladder wall, and hence in monitoring potential damage in the bladder mucosa.
The management of paediatric urolithiasis
Authors: Choong S. , Whitfield H. , Duffy* P. , Kellett M. , Cuckow P. , Van't Hoff W. , Corry D. 
Published: March 2003

Objective To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. Patients and methods In a 3‐year period (1997–1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty‐two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia. Results Of the 23 children treated using ESWL, 21 (91%) became stone‐free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone‐free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone‐free by ESWL. Two of three children undergoing open nephrolithotomy were stone‐free after surgery and the remaining one rendered stone‐free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone‐free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones. Conclusions Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children.
The antigenicity of fascia lata allografts
Authors: Fitzgerald M.P. , Mollenhauer J. , Brubaker L. 
Published: March 2003

Objective To determine whether commercially available fascia lata allograft material contains donor antigens. Materials and methods Human leukocyte antigens (HLA) class I and II were assessed in: (i) freeze‐dried fascia lata allografts; (ii) a Tutoplast® fascia lata graft (Mentor Urology, Santa Barbara, CA, USA); (iii) an acellular dermal graft; and (iv) a successful donor fascia sacrocolpopexy graft one year after implantation, using a polymerase chain reaction sequence‐specific primer‐based assay. Results The donor for both the freeze‐dried fascia lata and Tutoplast fascia lata was fully HLA‐typed. At one year after implantation, antigens from the implanted sacrocolpopexy graft matched the host blood antigens. The antigenicity of the acellular dermal graft could not be ascertained because this material interfered with the assay. Conclusion Donor fascia lata grafts prepared by freeze‐drying or by the Tutoplast technique retain donor antigens. The significance of this antigenicity is unknown. All donor antigens are replaced by host antigens after implantation.
Testicular tissue bleeding as an indicator of gonadal salvageability in testicular torsion surgery
Authors: Arda I.S. , Özyaylali I. 
Published: March 2003

Objective To investigate the reliability of using bleeding from the cut surface of testicular tissue during surgery for testicular torsion to assess testicular viability, compared with the duration of symptoms and preoperative findings on testicular Doppler ultrasonography (DUS). Patients and methods The study comprised 19 children with testicular torsion who underwent surgery; all underwent DUS before surgery. During surgery the tunica vaginalis of the affected gonad was incised and a deep incision made through the medulla after obtaining a wedge biopsy for histological examination. After waiting up to 10 min to assess any fresh arterial bleeding from the cut surface, the patients were categorized using three grades; grade I (sufficient bleeding, i.e. bleeding or oozing when the biopsy was obtained); grade II (insufficient bleeding, no bleeding immediately after the incision but starting within 10 min); and grade III (no bleeding within 10 min). The final surgical decision on whether to save the testis was made according to the grade of testicular tissue bleeding; grade I and II testes were saved and grade III testes were removed. The biopsies were histopathologically examined and classified as haemorrhagic, necrotic or indeterminate. The patients were followed up at 15 days and at 1, 3, 6 and 12 months, with the affected testis examined using DUS. At the end of the study, the sensitivity and specificity of the duration of symptoms, characteristics of blood flow on DUS and grading of testicular tissue bleeding at surgery were calculated for predicting testis viability, using the histopathological diagnosis as the reference standard. Results The sensitivity, specificity, positive and negative predictive values were respectively 100%, 90%, 90% and 100% for a duration of symptoms of > 10 h, 78%, 80%, 78% and 80% for DUS findings, and 100%, 78%, 83% and 100% for testicular tissue bleeding in predicting gonad viability after torsion, respectively. Conclusion Although the 10 h limit for the duration of symptoms seems a more accurate predictor of the fate of a twisted testis than were the other variables, testicular tissue bleeding may also be a good indicator of gonadal viability during surgery. The surgeon should wait up to 10 min after incising the testicular tissue deep to the medulla before deciding the type of surgery. In cases where bleeding from the cut surface is sufficient or insufficient (according to the proposed grading system), orchidopexy is the treatment of choice. The salvaged testes should be assessed during follow‐up, especially in those who had had insufficient bleeding at surgery and/or a duration of symptoms > 10 h, to assess for any delayed damage to the untwisted testis. If no bleeding is seen during surgery the best option is to remove the affected testis.
Hypospadias: a critical analysis of cosmetic outcomes using photography
Authors: Baskin L. 
Published: March 2003

Objective To analyse the cosmetic outcome of hypospadias surgery using photography, rather than the classical assessment by reoperation rate secondary to fistula, diverticulum, stenosis and residual penile curvature.Patients and methods The study included 181 consecutive patients with hypospadias who underwent surgery between 1997 and 1999. Distal hypospadias (47) was repaired using either the ‘meatal advancement and glanuloplasty’ or the glans approximation procedure. Proximal hypospadias (68) was repaired using the onlay island‐flap technique with preservation of the urethral plate. Penile curvature when present was corrected by dorsal plication (≈ 20%). Two patients with perineal hypospadias required a two‐stage repair. Complex repeat repairs (36) were defined as those patients who had undergone previous surgery 1–7 times and required a new urethroplasty by a secondary onlay island‐flap technique. The follow‐up ranged from 6 months to 3 years. Photographs of the penis were taken before, immediately and 3–12 months after surgery; these were assessed to document objectively the cosmetic outcome. The final photographs were evaluated for overall appearance, a mucosal collar, the location and configuration of the meatus. The standard was to create a penis that would pass cosmetically as a normal circumcised penis.Results The patients who had chordee without hypospadias (15) and fistula repair (13) did not undergo glanuloplasty and therefore were not included in the final photographic analysis; this left 153 patients with follow‐up photographs. There were five cases of urethral fistula (7%) and one of meatal stenosis (1%) in the proximal group, and three of fistula (8%) and two meatal stenosis (6%) in the complex group. The distal group had one complication (haematoma) and the two‐stage group had no complications. Analysis of the photographs showed that most patients had the appearance of a normal circumcised penis. Not unexpectedly, the patients who had undergone previous surgery had the least satisfactory results (60% appearing normal) compared with the proximal and distal groups (76% and 82% appearing normal, respectively).Conclusions Hypospadias can be repaired safely with few complications in a single stage in most patients. Classical complications such as fistula and stenosis occur in < 10% of patients, including those undergoing complex revisions. Cosmetic outcomes are generally good and photography is an objective means to document the appearance.
Association of the vitamin D receptor gene start codon Fok I polymorphism with calcium oxalate stone disease
Authors: Chen W.‐C. , Chen H.‐Y. , Lu H.‐F. , Hsu C.‐D. , Tsai F.‐J. 
Published: March 2003

Objective To assess the use of Fok I polymorphism (the most frequent polymorphism, at the start codon of the vitamin D receptor gene, VDR) as a convenient genetic marker in identifying the cause of urolithiasis. Patients, subjects and methods A normal control group of 90 healthy subjects and 146 patients with calcium oxalate stones were examined. Using polymerase chain reaction (PCR)‐based restriction analysis, the relationship between Fok I polymorphism and urolithiasis was evaluated. An unexcisable length of 265 bp was identified (allele CC) and two fragments (169 bp and 96 bp) identified as excisable lengths (allele TT). Results There was a statistically significant difference between the groups (chi‐square test, P < 0.05) for the genotype of the VDR Fok I start codon polymorphism. The odds ratio (95% confidence interval) for the C allele in those at risk of stone disease was 1.672 (1.149–2.432). Conclusions These results suggest that the VDR Fok I start codon polymorphism may be a good candidate for a genetic marker in calcium oxalate stone disease.
A single‐centre experience of retroperitoneoscopy using the balloon technique
Authors: Gaur D.D. , Rathi S.S. , Ravandale A.V. , Gopichand M. 
Published: March 2003

Objective To report the experience in one centre of the efficacy and safety of retroperitoneal laparoscopic procedures (RLPs). Patients and methods During 1991–2000, 351 RLPs using the balloon technique were undertaken in 340 patients (mean age 34.9 years, range 4–74); the details and outcome were reviewed. Initial access was by the mini‐open digital dissection technique in 152 and by the closed percutaneous technique in the remaining 199 procedures. Patients had not undergone previous retroperitoneal procedures, except for nine who had a percutaneous nephrostomy and eight ipsilateral abdominal surgery. There were 172 renal, seven adrenal, 97 ureteric, 50 gonadal, 13 lymphatic system, three vesical, two autonomic nervous system and seven vertebral RLPs. Nitrous oxide was used for pneumo‐insufflation in 103 procedures, instead of CO2. Results The RLP was successful in 318 of the 351 procedures (90.6%). The operative duration was 0.5–5.5 h, depending on the difficulty of the procedure and the presence or absence of adhesions. The overall incidence of complications was 12.9%, but decreased to 9% for the last 100 procedures. There were only five major complications, e.g. avulsion of the ureter, torn renal pelvis, colonic injury and severe hypotension, but none were related to balloon dissection. The mean blood loss was 37.7 mL and the reason for transfusion in three patients was not operative blood loss but displacement of the ligature in two and severe hypotension after removing a phaeochromocytoma in one. The mean duration of analgesic use was 2.5 days, the hospital stay 3 days and return to work 14 days. Conclusion Retroperitoneal laparoscopy using the balloon technique is a reasonably safe, efficient and reliable minimally invasive procedure. The efficiency, efficacy and safety of RLPs depend more on experience than on the type of access technique, type of balloon or medium used to inflate the balloon. Balloon rupture causes no tissue damage, and expansion to ≈ 800 mL in adults is safe if the retroperitoneal space has not previously been invaded. The use of nitrous oxide for pneumo‐insufflation in the retroperitoneal space is safe if proper precautions are taken.
An assessment of the immunological status of patients with renal cell carcinoma based on the relative abundance of T‐helper 1‐ and ‐2 cytokine‐producing CD4+ cells in peripheral blood
Authors: Onishi T. , Ohishi Y. , Goto H. , Tomita M. , Abe K. 
Published: March 2003

Objective To assess the immunological status of patients with renal cell carcinoma (RCC), by analysing the proportion of cluster‐of‐differentiation 4‐positive (CD4+) cells showing intracellular cytokine production, i.e. interferon‐γ derived from T‐helper (Th) 1 and interleukin‐4 derived from Th2 cells, among peripheral blood lymphocytes from these patients Patients, subjects and methods Peripheral blood samples (5 mL) were collected from 36 patients (mean age 61 years, range 44–78) with RCC before and after they underwent nephrectomy. The proportion of cytokine‐producing CD4+ cells was determined by flow cytometric analysis after stimulating the cells with phorbol 12‐myristate 13‐acetate, ionomycin and brefeldin A, and staining the cells with fluorescein isothiocyanate‐labelled anti‐interferon‐γ, anti‐interleukin‐4 and anti‐immunoglubulin‐2b antibodies. The results were expressed as the percentage of cytokine‐producing cells in the CD4+ population. As a control, peripheral blood obtained from 35 healthy volunteers (mean age 34 years, range 22–49) was also analysed. Results The proportion of CD4+ cells producing interferon‐γ and interleukin‐4 was significantly higher (P < 0.04 and P < 0.001, respectively) in patients with RCC than in controls. The Th1/Th2 ratio (i.e. the ratio of CD4+ cells producing each cytokine) was significantly lower in patients with RCC (P < 0.001). There was a significant correlation in the controls between interferon‐γ and interleukin‐4 production (r = 0.489, P < 0.01) but not in patients with RCC. The proportion of CD4+ cells producing interleukin‐4 was significantly higher and the Th1/Th2 ratio significantly lower in patients with high‐stage than in those with low‐stage RCC (P < 0.05). The percentage of CD4+ cells producing interleukin‐4 was significantly less after nephrectomy in those with low‐stage RCC (P < 0.01) and the Th1/Th2 ratio significantly greater (P < 0.05) than before nephrectomy; there was no such trend in patients with high‐stage RCC. Conclusion An evaluation of the production of interferon‐γ and interleukin‐4 in CD4+ peripheral blood lymphocytes is useful for assessing the immunological status of patients with RCC; there is a change in the predominant response from Th1 to Th2 with increasing stage of RCC.
Sheaths for urinary incontinence: a randomized crossover trial
Authors: Fader M. , Pettersson L. , Dean G. , Brooks R. , Cottenden A.M. , Malone‐Lee J. 
Published: March 2003

Objective To evaluate the full range of self‐adhesive continence sheaths for men available in the UK and thus provide clinicians and consumers with a basis for product selection. Subjects and methods Fifty‐eight volunteers (aged 30–89 years) tested each of six different self‐adhesive sheaths available in the UK in September 1998 for 1 week each. Thirty subjects applied the sheaths themselves and 28 subjects relied on a carer to do so. During each week subjects completed a diary recording sheath changes and the result of skin inspection, to note any unscheduled sheath changes (because of sheath detachment) and any skin problems. At the end of each week an 11‐item questionnaire was completed using a three‐point rating scale (‘good’, ‘acceptable’, ‘unacceptable’) to assess the key aspects of product performance. Results A significantly higher proportion of subjects scored the ‘Aquadry Clear Advantage’ sheath as ‘good’ than four of the other sheaths (P < 0.01) and a significantly higher proportion found the ‘Incare’ sheath to be ‘unacceptable’ than all of the other sheaths (P < 0.001) for the ‘overall opinion’ question. Sheath detachments (sheath falling off or blowing off) for the ‘Incare’ were significantly more common than for four of the other products (P < 0.01). Sheath detachments for the ‘Aquadry Clear Advantage’ were significantly less common than for two of the other products (P < 0.01). A significantly higher proportion of subjects found sheaths with an applicator to be ‘unacceptable’ than sheaths with no applicator (P < 0.001) for the ‘ease of putting on’ and ‘overall opinion’ questions (when adjusted for previous product use and person applying the sheath). Conclusions There were substantial differences between products in their general performance and ergonomics, and for the frequency of detachment as recorded in the diary. The ‘Aquadry Clear Advantage’ was particularly successful and the ‘Incare’ particularly unsuccessful when compared with the other sheaths. Sheaths with no applicators were preferred to those with applicators. Applicators are mainly designed to make sheaths easier to put on, especially for carers, but there was no evidence that carers preferred applicators. This may have implications for manufacturers.
Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction
Authors: Prieto Castro R.M. , Anglada Curado F.J. , Regueiro López J.C. , Leva Vallejo M.E. , Molina Sánchez J. , Saceda López J.L. , Requena Tapia M.J. 
Published: March 2003

Objective To assess the safety and efficacy of sildenafil citrate in renal transplant patients with erectile dysfunction, as up to half of men with renal failure may be affected and only 60–75% recover potency after transplantation. Patients and methods Fifty patients with erectile dysfunction and a functioning renal transplant were treated using sildenafil (mean age 54 years, mean time on dialysis 35 months, mean time from transplantation 20 months). The hypogastric artery was not used during transplantation in any patient. Sildenafil citrate was prescribed at doses of 25 or 50 mg depending on baseline creatinine values and on the response, and plasma levels of cyclosporin/FK506 were monitored. Results Thirty patients (60%) had a satisfactory response, with a mean time on dialysis of 23 months. Six patients (12%) did not take the sildenafil and in 14 (28%) the drug was ineffective. The mean time on dialysis in this group was 43 months. Six patients (12%) had side‐effects that in no case led to withdrawal of treatment. Plasma levels of cyclosporin/FK506 remained within the safety and efficacy limits in all patients. Conclusions Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction is an effective and safe option, with few side‐effects. Plasma levels of immunosuppressants are unchanged. The response was more effective in patients with a shorter time on dialysis, as penile vascular disease is less advanced.
Hypericin‐based fluorescence diagnosis of bladder carcinoma
Authors: D'Hallewin M.‐A. , Kamuhabwa A.R. , Roskams T. , De Witte P.A.M. , Baert L. 
Published: March 2003

Objective To determine the use of hypericin instillation for the fluorescent detection of papillary bladder cancer and carcinoma in situ. Patients and methods Eighty‐seven patients with papillary bladder cancer and/or carcinoma in situ received instillations with 40 mL of an 8 µmol/L hypericin solution for at least 2 h. Fluorescent excitation with blue light was effective for up to 16 h, and biopsies were examined by fluorescence microscopy. Results There were no side‐effects reported, no photobleaching and all papillary lesions fluoresced red. The sensitivity and specificity for detecting carcinoma in situ was 94% and 95%, respectively. An interval of 4 months is recommended after BCG instillations before using this test. Fluorescence microscopy showed that hypericin was selectively localized in the epithelium. Conclusions Hypericin‐induced fluorescence has a high sensitivity and specificity for detecting bladder cancer. After 4 months there are few false‐positive results in patients treated with BCG.