bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transurethral interstitial laser coagulation for benign prostatic hyperplasia: treatment outcome and quality of life
Authors: Arai Y. , Ishitoya S. , Okubo K. , Suzuki Y. 
Published: November 2003

Objective To assess the efficacy and safety of transurethral interstitial laser coagulation (ILC) in the treatment of benign prostatic hyperplasia (BPH). Patients and methods From December 1993 to March 1995, 61 patients (mean age 69.7 years, range 55–89) with symptomatic BPH were treated with ILC. A neodymium:YAG laser was used in combination with specially designed interstitial thermotherapy light‐guides. The tip of the light guide was inserted repeatedly into each lobe of the prostate transurethrally, under direct vision. The number of fibre placements depended on the size and configuration of the gland. The prostatic urethra was preserved during the procedure. Treatment outcome was evaluated using the International Prostatic Symptom Score (IPSS), measurement of urinary flow rate and post‐void residual urine volume (PVR). The disease‐specific quality of life (QOL) was assessed using a QOL assessment score and a BPH impact index. Independently of the symptom assessment, a self‐reporting questionnaire was completed 3 months after treatment to determine the patients' satisfaction with the treatment and their sexual function. Results Among the 31 patients followed for 6 months, the mean IPSS decreased significantly, from 18.9 at baseline to 7.7 (59% improvement; P<0.001), the mean peak flow rate increased from 6.7 mL/s to 10.0 mL/s (49% improvement; n=29; P<0.001), the mean PVR decreased from 119 mL to 29 mL (76% improvement; n=28, P<0.001) and the mean prostate volume decreased significantly, from 37.1 mL to 31.6 mL (15 % reduction at 3 months; n=52, P<0.001). There was a steady and progressive improvement in both the QOL assessment and the BPH impact index scores at 3 and 6 months. More than 90% of the patients reported satisfaction with the treatment and none reported the new onset of erectile dysfunction. There were no serious side‐effects, except for two cases of loss of ejaculation. Conclusions The early clinical results suggest that the ILC procedure is a safe and effective less‐invasive treatment for BPH that appears to have favourable effects on the patients' quality of life.
Testis conservation studies in germ cell cancer justified by improved primary chemotherapy response and reduced delay, 1978–1994
Authors: Oliver R.T.D. , Ong J. , Blandy J.P. , Altman D.G. 
Published: November 2003

Objective To investigate the need for the continued encouragement of early diagnosis of germ cell cancer of the testis, in view of the prevailing cure rate of 95%. Patients and methods The study comprised a retrospective review of 453 unselected and previously untreated patients referred to one centre between 1978 and 1984, comparing the delay from first symptoms with the histological diagnosis. Results With a delay of <30 days, 20% of patients had overt metastases at presentation and if the delay was >4 months, 55% had metastases (chi‐squared trend=15.9, P<0.001); 18% of Stage‐1 patients under surveillance with a delay of <30 days relapsed, compared with 38% of those with a delay of >4 months. During the period 1978–1983, 16% of patients were seen after a delay of <60 days, during the period 1984–1988 the proportion was 22% and during 1989–1994, 31% (chi‐squared trend=8.2, P<0.004). There was a non‐significant trend for a more prolonged delay in those aged <21 years and >40 years. Thirty‐two patients had chemotherapy with the primary tumour in situ; at orchidectomy, 13 of 18 had no viable malignancy and four of five with viable malignancy also had drug‐resistant metastases. Fourteen did not undergo orchidectomy; within a median follow‐up of 9 years, one developed a second (histologically different) tumour after 12 years. The outcome of preliminary attempts to use neoadjuvant chemotherapy with or without partial orchidectomy for patients with tumours in a solitary testis is discussed. Conclusion These findings clearly justify the continued encouragement of early diagnosis, possibly best performed as part of an extended educational programme of genital health at puberty. The long‐term potential for testis conservation should be explored initially in tumours in a solitary testis.
Mucosal permeability of ileal and colonic reservoirs for urine
Authors: Davidsson T. , Åkerlund S. , White T. , Olaisson G. , Månsson W. 
Published: November 2003

Objectives To evaluate the intestinal mucosal permeability in continent reservoirs for urine. Patients and methods The mucosal permeability in continent urinary reservoirs, constructed either from an ileal or a colonic segment (six patients each), was assessed by analysing serial samples of plasma, after instilling the reservoir with 51Cr‐ethylene diaminetetra‐acetic acid (51Cr‐EDTA), and serum, after instillation with polyethylene glycol (PEG 400). Results There was no or negligible permeation of 51Cr‐EDTA and PEG 400 in either type of reservoir, as there was no significant increase of the markers in plasma and serum, respectively. Conclusion The intestinal barrier to medium‐sized hydrophilic molecules seems intact in continent urinary reservoirs. The lack of significant permeation of 51Cr‐EDTA confirms the usefulness of a single injection of 51Cr‐EDTA for the determination of glomerular filtration rate in patients with intestinal urinary diversion.
Comparison of prostatic volume and dimensions by transrectal and transurethral ultrasonography
Authors: Nathan M.S. , Mei Q. , Seenivasagam K. , Davies B. , Wickham J.E.A. , Miller R.A. 
Published: November 2003

Objective To compare the volumes and dimensions of the prostate gland as measured by transrectal and transurethral ultrasonography (TRUS and TUUS) and to study the prostatic changes that occur in the presence of an urethral instrument. Patients and methods Twenty men (mean age 71 years, range 43–85) with symptoms of prostatic enlargement underwent TRUS and the dimensions and volumes of their prostates were obtained by the dimensional method and by step planimetry. Within 24 h, all the men were examined cystoscopically under sedoanalgesia and underwent TUUS. Their prostatic volumes and dimensions were again measured by the dimensional method and by step planimetry. Step planimetry was carried out using a specially designed indexer firmly attached to the examination couch or operating table. All the static images and planimetry slices were video recorded for later computer enhancement and to study the three‐dimensional changes occurring in the prostate. The volumes and dimensions obtained by TRUS and TUUS were compared. Results Volumes obtained by transurethral step planimetry were 22% greater than those from transrectal planimetry. Although there was a good correlation (r=0.984) between transurethral planimetry and the volumes derived using the transurethral dimensions with the prolate ellipsoid formula, the latter produced values 17% and 25% lower by the transurethral and transrectal routes, respectively. These volume estimates varied widely, indicating that the simple addition of a constant to the prolate ellipsoid formula would not correct the volume. Three‐dimensional changes of the prostate occurred with TRUS and TUUS; with TUUS, the craniocaudal and anteroposterior diameters were significantly larger (by 7% and 18%, respectively) while the transverse diameter was smaller by 20%. Conclusion The estimated volumes and dimensions of the prostate differed when measured by TRUS and TUUS and three‐dimensional changes in the prostate occurred in the presence of an urethral instrument.
Reproducibility of penile arterial colour duplex ultrasonography
Authors: Mills R.D. , Sethia K.K. 
Published: November 2003

Objective To assess the reproducibility of penile arterial colour duplex ultrasonography (CDU) in patients with impotence. Patients and methods Fifty‐eight patients underwent CDU of their penile arteries on two occasions 2 weeks apart. Group A (n=34) received 60 mg of papaverine intracavernosally before CDU and group B (n=24) received a combination of papaverine, prostaglandin E1 and phentolamine. The variables measured during CDU were peak systolic velocity (PSV) and the end diastolic velocity (EDV), with the systolic rise‐time (SRT) also recorded in group B. Results In both groups of patients the reproducibility between the first and second recordings was poor for all variables. The mean variation in PSV was 31.5% and 40.2%, and in EDV was 44.9% and 50.1%, for groups A and B, respectively. For the SRT, measured only in group B, the mean variation was 25.7%. Conclusions These results show that CDU is a poorly reproducible technique for assessing vascular status in patients with impotence. Therefore, it is not reliable in the long‐term follow‐up of patients and single measurements should be interpreted with caution.
The fate of the defunctioned bladder following supravesical urinary diversion
Authors: Adeyoju A.B. , Thornhill J. , Lynch T. , Grainger R. , McDermott T. , Butler M.R. 
Published: November 2003

Objective To determine the nature, incidence and severity of bladder complications after supravesical urinary diversion without cystectomy and to identify preventative risk factors. Patients and methods A retrospective study of the last 25 years identified 35 patients who had supravesical urinary diversion without concomitant cystectomy (33 ileal loop diversions and two cutaneous ureterostomies). Urinary diversion was performed for a variety of lower urinary tract pathologies. Patients with urinary tract neoplasia were excluded. There were 15 males (mean age 41 years, range 13–72) and 20 females (mean age 49 years, range 15–81) with a mean follow‐up of 5.2 years (range 1–25). Results There were bladder complications in 10 patients (28%) including pyocystis (one mild and two severe), haemorrhage (two mild and one severe) and pain/spasm (four mild and three severe). Patients with interstitial cystitis, bladder outflow obstruction and/or a vesical fistula appeared to have a higher risk of complications. Four patients required cystectomy to treat severe symptoms while the remaining six achieved control of symptoms with no surgery. No patient developed carcinoma during the follow‐up. Conclusion We recommend that cystectomy is considered at the time of supravesical urinary diversion, particularly in patients with interstitial cystitis, bladder outflow obstruction or a chronically infected bladder and especially in those with a vesical fistula.
Artificial urinary sphincter implantation for neurogenic bladder: a multi‐institutional study in 107 children
Authors: Simeoni J. , Guys J.M. , Mollard P. , Buzelin J.M. , Moscovici J. , Bondonny J.M. , Melin Y. , Lortat‐Jacob S. , Aubert D. , Costa F. , Galifer B. , Debeugny P. 
Published: November 2003

Objectives To evaluate the outcome of implantation of the AMS 800 artificial urinary sphincter in children with neurogenic bladder.Patients and methods The records of 107 children (74 boys and 33 girls) treated for neurogenic urinary incontinence by implantation of the AMS 800 artificial sphincter between 1983 and 1993 were reviewed retrospectively. The underlying cause of incontinence in 92 patients was spina bifida, the mean age at implantation was 13.7 years and 30 patients had undergone previous bladder neck surgery. Implantation was carried out in combination with another surgical procedure in 24.3% of patients. The mean follow‐up was 61 months (minimum 12).Results The mean operational life of the sphincter was 56 months. No deaths occurred but removal of the artificial sphincter was necessary in 20 patients (19%). Surgical revision was not required in 44 patients (41%) but at least one revision was performed in 63 and more than one in 42. There were 21 mechanical failures, 40 surgical complications and 39 cases involving changes in the dynamics of bladder function. Of the 87 children (81%) in whom the device is still in place, 72 are completely continent (83%), 10 are slightly wet, and five are incontinent. The overall success rate was 77%.Conclusions The results emphasize that for successful implantation of an artificial urinary sphincter in children, the pre‐operative bladder capacity must be sufficient and previous surgery should not have been performed on the bladder neck, the site of choice for implantation in children. Sphincterotomy is not always necessary in paediatric patients. Children and parents should be informed of the high complication rate and the need for long‐term follow‐up.
Impaired production of interferon‐α in whole‐blood cultures from patients with renal cell carcinoma
Authors: Kuo J.Y. , Kita M. , Imanishi J. , Yoshida O. 
Published: November 2003

Objective To determine the immune status of patients with renal cell carcinoma (RCC) by estimating the production of interferon‐α (IFN‐α) in whole‐blood cultures from these patients and from healthy subjects.Patients, subjects and methods Peripheral blood (2 mL) was collected from 30 untreated patients (23 men and seven women, mean age 59 years, range 35–78) with RCC and 30 healthy subjects (23 men and seven women, mean age 62 years). The patients with RCC comprised 17 with low‐stage (stage I, II) and 13 patients with high‐stage (stage III, IV) RCC. Sendai virus was added to the samples and incubated at 37°C for 20 h, the supernatants collected and the activity of IFN‐α determined by a conventional cytopathic‐effect inhibition assay performed in microtitre plates with FL cells and challenged with vesicular stomatitis virus.Results The production of IFN‐α was suppressed significantly in patients with high‐stage RCC compared with that in the control subjects (P<0.05), but there was no significant difference when compared to patients with low‐stage RCC.Conclusion This study demonstrated that the immune status of patients with high‐stage RCC was impaired significantly and exogenous IFN‐α therapy might be beneficial clinically for this group.
Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy
Authors: Carringer M. , Swartz R. , Johansson J.E. 
Published: November 2003

Objective To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy.Patients and methods Four pregnant women (mean age 29.5 years, range 27–35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26–35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four).Results All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure.Conclusions Ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.
Quantitative assessment of vascular surface density in renal cell carcinomas
Authors: Köhler H.H. , Barth P.J. , Siebel A. , Gerharz E.W. , Bittinger A. 
Published: November 2003

Objective To evaluate the extent of vascularization by assessing vascular surface density in renal cell carcinomas (RCCs) of different nuclear grades, and in normal renal cortex and medulla. Materials and methods Specimens of 79 RCCs of different nuclear grades (16 of G1, 42 of G2 and 21 of G3) were immunostained with the lectin Ulex europaeus agglutinin‐I (UEA I). The vascular surface density of tumour tissue was assessed stereologically using a test grid at ×400 magnification and compared to the values obtained in normal renal tissue. Results G3 tumours had a lower vascular surface density than had G1 and G2 RCCs and normal renal tissue of the cortex and medulla (P<0.001, respectively). G1 tumours had a significantly higher vessel density than had normal medullary parenchyma and G2 carcinomas (P<0.001). Vessel density was not significantly different among G1 tumours and cortical parenchyma in controls and among normal medullary tissue and G2 tumours. Statistical analysis showed that the vascular surface density was independent of tumour stage and size and the age and sex of the patients. Conclusion The degree of vascularization in RCCs decreased with their grade of differentiation, suggesting that the extent of neovascularization in tumour tissue reflects the relationship between tumour cell proliferation and vascular growth. The values of vascular surface density in normal renal tissue of the cortex and medulla partially overlapped with those obtained in tumour tissue.
The symptom questionnaire for benign prostatic hyperplasia: an ambiguous indicator for an ambiguous disease
Authors: Stoevelaar H.J. , van de Beek C. , Nijs H.G.T. , Casparie A.F. , McDonnell J. , Janknegt R.A. 
Published: November 2003

Objective To assess the criterion validity of the American Urological Association (AUA) symptom index for benign prostatic hyperplasia (BPH) in urological practice. Patients and methods The study comprised 1414 consecutive men ≥50 years of age, newly referred to a urologist in a stratified sample of 12 hospitals throughout the Netherlands, who completed the AUA symptom questionnaire at their first visit. The 39 urologists completed a questionnaire on the diagnosis. The discriminative power of the index for BPH versus other urological diagnoses was calculated by receiver operating characteristic (ROC) analysis. Subsequently, criterion sensibility was studied by assessing the effect of particular variables on the probability of the diagnosis of BPH. Results ROC areas were low for BPH versus prostate cancer (0.57, se 0.04), chronic prostatitis/prostatodynia (0.65, se 0.03), and other diseases of the lower urinary tract (0.57, se 0.04). Satisfactory to good values were found for BPH versus diseases of the upper urinary tract (0.79, se 0.03), impotence/infertility (0.79, se 0.04), penile‐scrotal diseases (0.85, se 0.02), and no abnormalities (0.84, se 0.03). The diagnosis of BPH, as made by urologists in daily practice, appeared to be a weak criterion. Irrespective of other characteristics, the chance of being diagnosed with BPH was affected by differences in definition and the type of hospital. Conclusion Although the AUA index discriminated fairly well between BPH and diseases of the upper urinary tract, as well as genital diseases, it has no potential for distinguishing BPH from other diseases of the lower urinary tract. In addition, the lack of consensus in defining clinical BPH underscores the weakness of the index as a tool in the diagnostic process of this disease.
Sensitivity of cell lines to mitomycin C
Authors: Watts P.L. , Plumb J.A. , Courtney J.M. , Scott R. 
Published: November 2003

Objectives To determine the effect of pH on the cytotoxicity of mitomycin C on a wide range of established cell lines. Materials and methods Cultures of three human tumour cell lines, including two bladder carcinomas and one renal adenocarcinoma, and two mouse cell lines were treated with mitomycin C (concentration range 320 pm‐50 μm) at a range of pH (5.8–7.8) for 2 h. The cytotoxicity of mitomycin C over this range was determined using a tetrazolium‐dye‐based microtitration assay. Results The cytotoxicity of mitomycin C was significantly greater (confidence level≥95%) in acidic conditions (pH 5.8–6.0) than in neutral to alkaline pH (7.2–7.8) for three of the five cell lines. The same trend, although less marked, also occurred in the other two cell lines. Conclusion The cytotoxicity of mitomycin C was greater under acidic conditions for all these cell lines confirming that the activity of mitomycin C depends on pH and suggesting that the pH of the vehicle used for intravesical chemotherapy may be an important factor in the successful treatment of bladder carcinomas. The modification of pH by urine may explain some of the variation in success rates among patients treated intravesically with mitomycin C.
Determination and reversal of resistance to epirubicin intravesical chemotherapy. A flow cytometric model
Authors: Duffy P.M. , Hayes M.C. , Cooper A. , Smart C.J. 
Published: November 2003

Objective To develop a method of determining the characteristics of epirubicin resistance and to study the reversal of such resistance in the intravesical treatment of superficial bladder cancer, using sensitive and resistant derivatives of a bladder cancer cell line in vitro. Materials and methods Epirubicin fluorescence and flow cytometry were used to measure the intracellular levels of epirubicin in both sensitive and resistant live cultured bladder tumour cells, with and without different doses of the resistance‐reversing agent verapamil. Results There was a reliable, highly significant and consistent difference in intracellular epirubicin concentration between the resistant and sensitive bladder tumour cells. In addition, it was possible to substantially reverse the features of resistant cell subline with additional verapamil. Conclusion Application of this assay to clinical specimens should allow better targeting of epirubicin intravesical chemotherapy and avoid the premature termination of such treatment in patients whose tumours remain sensitive to this agent. Furthermore, the addition of verapamil to intravesical epirubicin may permit effective treatment of those patients whose tumours have inherent or acquired resistance to epirubicin.
Long‐term catheterization of the bladder:
Authors: Kohler‐Ockmore J. , Feneley R.C.L. 
Published: November 2003

Objective To estimate the prevalence and morbidity of long‐term catheterization (LTC) of the urinary bladder. Patients and methods A postal survey was conducted over two successive years from February 1989 to determine the incidence of LTC in three Bristol Health Districts with a total population of 827 595. During the first year the number of patients requiring emergency treatment for complications of LTC was also monitored over a 6‐month period. In the second year, 54 patients were selected from the first survey and each was visited by one investigator every 2 weeks for 12 weeks to obtain information on catheter management, the incidence and type of complications, the attitudes of the patients or carers about the catheter and to assess the pH and microbiology of the patient's urine. Results The initial surveys identified 457 and 467 patients with long‐term catheters during the 2 years, respectively; there were similar numbers of men and women in both years. The survey of catheter complications recorded 506 emergency referrals during the 6 months and the detailed study of 54 patients showed that 48% experienced catheter blockage, 37% reported urine by‐passing the catheter and 30% noted haematuria. Patients found the catheter uncomfortable and depended on nursing support. Catheter blockage was associated with bladder stones, a high urinary pH and the presence of Proteus spp in the urine. Conclusion The prevalence and high morbidity of LTC cause a considerable demand on the available District and Hospital nursing services; most patients with long‐term catheters are elderly, disabled or debilitated and more nurses need to be trained in the technique of catheterization and the management of the catheterized patient. Further research is required to reduce the morbidity of LTC by investigating measures to reduce catheter blockage and encrustation at the urine/biomaterial interface.