bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms?
Authors: MADERSBACHER S. , KLINGLER H.C. , DJAVAN B. , STULNIG T. , SCHATZL G. , SCHMIDBAUER C.P. , MARBERGER M. 
Published: November 2003

Objective To determine whether it is possible to predict the presence of bladder outlet obstruction (BOO) by non‐invasive clinical variables in patients with lower urinary tract symptoms (LUTS) suggestive of BOO.Patients and methods Patients with LUTS suggestive of BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), prostate size, non‐invasive uroflow, post‐void residual urine volume (PVR) and a pressure flow study. Only patients with a maximum flow rate (Qmax ) of≤15 mL/s and an IPSS≥7 were included. The study comprised 253 patients; the degree of obstruction was correlated to several non‐invasive clinical variables. Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of BOO in patients with LUTS.Results Prostate volume, Qmax , PVR and voided volume correlated significantly with the degree of BOO rated according to the linear passive urethral resistance relation (linPURR). In contrast, there was no such correlation for the IPSS and the quality‐of‐life question of the IPSS. The percentage of patients with BOO defined by a linPURR of 3–6 decreased from 85% in those with a Qmax of 0–5 mL/s to 60% (Qmax 6–10 mL/s) and 44% (Qmax 11–15 mL/s). In parallel, the percentage of patients with BOO increased from 53% of those with a prostate volume of ≤50 mL, to 79% of those with prostates of 51–100 mL and 75% of those >100 mL. Based on Qmax , PVR and prostate volume, nomograms were established by multiple logistic regression analysis for the probability of BOO in patients with LUTS.Conclusion The nomograms presented herein should help the clinician to identify patients with LUTS who should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and in whom these studies can be safely spared.
The use of surgical sympathectomy in the treatment of chronic renal pain
Authors: ANDREWS B.T. , JONES N.F. , BROWSE N.L. 
Published: November 2003

Objective To assess the efficacy of renal sympathetic denervation in the treatment of chronic renal pain.Patients and methodsIn a 10‐year period, 21 patients suffering from chronic renal pain underwent 27 renal denervation operations, six of which were bilateral. The cause of pain was the loin pain haematuria syndrome in 18 patients.Results Four operations resulted in complete pain relief to date (median follow‐up 53.5 months). Pain relief after the other 23 operations in 18 patients lasted a median of 6 months. Assuming that recurrent pain was due to neuronal regeneration, nine of the 18 patients with recurrent pain underwent a total of 10 re‐explorations of the renal pedicle, stripping it of all nerve fibres and areolar tissue. Three of these re‐explorations produced complete pain relief to date (median follow‐up 40 months). The median pain‐free interval of the other seven re‐explorations in six patients was 19 months.Conclusion Renal denervation cures severe intractable pain in about 25% of patients. Recurrence of pain could be prevented in more patients if there was a way of preventing re‐innervation.
Serum pyridinoline crosslinks as markers of tumour‐induced bone resorption
Authors: NEMOTO R. , NAKAMURA I. , NISHIJIMA Y. , SHIOBARA K. , SHIMIZU M. , TAKEHARA T. , OHTA T. , KIYOKI M. 
Published: November 2003

Objective To assess serum pyridinoline (Py) and deoxypyridinoline (dPy), using a new high‐performance liquid chromatography (HPLC) method, as a serum marker to determine the incidence of metastatic bone disease in an animal model and in the monitoring of patients with or without metastatic bone disease from prostate cancer and renal cell carcinoma (RCC).Patients, materials and methods Female C3H/He mice (8–12 weeks old) received a subcutaneous injection of tumour‐cell suspensions of serially transplanted MBT tumours. The tumour cells induced osteolysis associated with osteoclast proliferation and serum samples were evaluated for Py and dPy using HPLC. The growth of the tumour macroscopically and histologically, and the extent of bone loss assessed by radiography, were compared with the serum Py and dPy level. In the clinical study, patients with or without bone metastases from RCC (24 patients) or prostate cancer (37 patients) were monitored using the same techniques and the number and extent of bone metastases compared with serum Py and dPy levels both in these patients and in 84 healthy control subjects.Results There was a significant correlation between the bone loss evaluated by radiography and the level of serum Py in the animal model. Patients with bone metastases from RCC had higher values of Py and dPy than patients without known metastatic bone disease. The serum Py level increased in two patients as metastatic bone disease progressed. Similarly, in patients with prostate cancer, the mean level of serum Py and dPy was higher in patients with bone metastasis than in the control group, and also higher than that in patients without metastases. The serum Py and dPy levels could also distinguish patients with metastatic bone disease with and without a lytic component.Conclusion Measurements of serum Py appear to provide a good index of increased bone resorption induced by experimental tumours and in patients with bone metastases from RCC and prostate cancer.
British urological surgery practice: 1. Prostate cancer
Authors: SAVAGE P. , BATES C. , ABEL P. , WAXMAN J. 
Published: November 2003

Objective To investigate the treatment of prostate cancer in the United Kingdom.Methods A postal survey was conducted of consultant urologists and general surgeons with an interest in urology to assess the current patterns of management of patients with prostate cancer in the UK and to determine patterns of clinical practice.Results Two‐hundred and seventy‐four replies were analysed. Radical radiotherapy (50%) and radical prostatectomy (29%) were the most favoured treatment options for patients <70 years old with poorly differentiated T1 disease; for those aged >70 years, active treatment was favoured by 183 (67%) consultants with radical radiotherapy (37%) and hormonal intervention (29%) the most frequent choices. In well‐differentiated T1 disease, active treatment was favoured by 226 (83%) of consultants for patients <70 years, with radical prostatectomy (44%) the most frequent choice. For patients >70 years, observational management was preferred by 190 (69%) of consultants. In poorly differentiated T1 prostate cancer, active treatment was favoured by 252 (91%) for patients <70, with radiotherapy (50%) the most frequent choice and for patients >70 years, active treatment was favoured by 67% with radical radiotherapy the most common preference being chosen, by 102 (37%). For asymptomatic locally advanced disease, 55% of consultants favoured active treatment, whilst 63% favoured the active treatment of asymptomatic metastatic disease. For patients with symptomatic metastatic disease, GnRH agonist therapy was the treatment of choice of 66% of urologists and was given as monotherapy by 44% or as part of maximal androgen blockade by 22%. In clinical practice, 82% of urologists have close links with oncology, available through joint clinics or on‐site referral. However, <5% of urologists refer patients to an oncologist before the development of hormone refractory disease. At relapse, only 53% of urologists referred their patients to oncologists or palliative‐care clinicians. A wide variety of hormonal treatments was offered at relapse; only 24% of urologists treated their patients by antiandrogen withdrawal or introduction, which is currently the most effective second‐line hormonal treatment for recurrent prostate cancer.Conclusion There is a wide variation in the clinical management of prostate cancer and we recommend the establishment of standards of practice.
Lack of correlation between blood fibrinolysis and the immediate or post‐operative blood loss in transurethral resection of the prostate
Authors: NIELSEN J.D. , GRAM J. , FABRIN K. , HOLM‐NIELSEN A. , JESPERSEN J. 
Published: November 2003

Objective To evaluate whether the activation of the extrinsic tissue‐type plasminogen activator‐related fibrinolysis is implicated in the blood loss in patients with benign prostatic hyperplasia, undergoing transurethral prostatic resection (TURP).Patients and methods TURP was performed in 24 men and the operative and post‐operative blood loss determined. The activation of the tissue‐type plasminogen activator‐related fibrinolysis was followed using new sensitive and specific assays, and the changes related to the blood loss. Measurements of the plasma concentrations of free tissue‐type plasminogen activator (t‐PA) activity, tissue‐type plasminogen activator (t‐PA) antigen, plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor 1 (PAI‐1) antigen, plasminogen (Plg) activity, plasminogen (Plg) antigen, α2‐antiplasmin (α2‐AP), d‐dimer and fibrin degradation products (FbDP) were all determined and the area under the curve (AUC) for each of these quantities correlated with the blood loss.Results TURP was followed by a marked activation of the fibrinolytic system. There was an immediate increase in systemic t‐PA activity and t‐PA antigen, coinciding with a significant drop in PAI activity. Post‐operatively, PAI activity and PAI‐1 antigen increased. The formation of plasmin was indicated by a fall in the plasma concentration of Plg activity and Plg‐antigen and α2‐AP but which increased significantly at the end of the study period. Increased systemic fibrinolytic activity was further confirmed by a marked increase in fibrin d‐dimer and FbDP. There was no correlation between the AUC in the operative period of any of the fibrinolytic variables and the measured blood loss. In the post‐operative period, t‐PA antigen (P=0.004), PAI activity (P=0.043), PAI‐1 antigen (P=0.016) and α2‐AP (P=0.047) all correlated with the post‐operative blood loss, while there was no correlation between fibrin d‐dimer or FbDP and blood loss.Conclusion The fibrinolytic system is activated during and after TURP, but the increased activity is not of pathophysiological importance for the blood loss.
Desmopressin for nocturnal enuresis: urinary osmolality and response
Authors: FOLWELL A.J. , MACDIARMID S.A. , CROWDER H.J. , LORD A. DE M. , ARNOLD E.P. 
Published: November 2003

Objective To measure the effect of intranasal desmopressin (1‐deamino 8‐d‐arginine vasopressin, DDAVP) on urine osmolality in a group of patients with persistent primary enuresis, and to determine whether changes in osmolality can the predict response to treatment.Patients and methods Thirty‐seven patients with persistent primary nocturnal enuresis were entered into a double‐blind placebo‐controlled crossover trial of 20 &mu;g intranasal DDAVP spray. Morning urinary osmolality was measured on two occasions during each phase of treatment and the clinical response recorded in a diary.Results Thirty‐one patients (22 males and nine females) were evaluable at the end of the trial period. A good clinical response, defined as enuresis on two nights or fewer each week, occurred in 12 of 31 (39%) patients, but complete continence was attained in only two. The response was better in older patients and in those with less frequent enuresis. The mean and peak urinary osmolality of the morning urine samples were higher while on treatment with DDAVP compared with placebo, but this difference was not statistically significant and the response did not predict a good clinical outcome in improving the enuresis.Conclusions Treatment with DDAVP can produce a socially acceptable level of dryness in some patients with refractory nocturnal enuresis. However, the early morning urinary osmolality, as a reflection of changes in nocturnal osmolality, was not useful in distinguishing this group or in selecting those who will respond to treatment.
Effects of Tamm‐Horsfall protein with normal and reduced sialic acid content upon the crystallization of calcium phosphate and calcium oxalate in human urine
Authors: HALLSON P.C. , CHOONG S.K.S. , KASIDAS G.P. , SAMUELL C.T. 
Published: November 2003

Objective To examine the effects of Tamm‐Horsfall protein (THP) of normal and low sialic acid content on urinary crystallization, and establish whether there are changes conducive to the formation of kidney stones.Materials and methods Purified samples of THP were recovered from the urine of non‐stone forming individuals. A portion of each THP sample was treated with the enzyme neuraminidase to yield the low sialic acid form of the protein. The two forms of THP were added separately to ultrafiltered urine and crystallization was then induced in the urine by evaporation at 37°C. Two types of experiment were then conducted with the crystals that formed; the rate at which the resulting calcium phosphate or calcium oxalate crystals sedimented in the evaporated urine was determined and the proportion of these crystals and protein which was retained when the urine was passed through a 75 &mgr;m sieve was measured.Results Calcium phosphate and calcium oxalate crystals remained in stable colloidal suspension in ultrafiltered urine when in the presence of normal THP; these suspensions passed freely through the 75 &mgr;m sieves. When crystals formed in the presence of low sialic acid THP, the sedimentation was rapid and the crystals were readily retained with protein on the sieves.Conclusions These results indicate that whilst normal THP inhibits urinary crystal aggregation, the properties of the low sialic acid form are consistent with the promotion of crystal aggregation and hence stone formation.
Topographical anatomy of the penile arteries
Authors: MARTÍNEZ‐PIÑEIRO L. , JULVE E. , MARTÍNEZ‐PIÑEIRO J.A. 
Published: November 2003

Objective To determine the relationship of the penile arteries to anatomical landmarks and thus ease their identification, so avoiding injury during surgery.Materials and methods The penile arteries in 12 formalin‐preserved adult male cadavers were dissected and the distances measured between the cavernosal arteries and both the endopelvic fascia and distal attachment of the crura to the ischial bones. The distance between the origins of both bulbar and cavernosal arteries, their length and the length of the cavernosal bodies and crural attachments were also measured.Results Several anatomical variations, e.g. accessory pudendal arteries, multiple cavernosal and bulbar arteries, irrigation of cavernosal bodies by contralateral branches, anastomosis of cavernosal arteries with accessory pudendal branches, dorsal artery or bulbar artery as main branches of accessory pudendal arteries, were observed in 13 of the 24 specimens. The mean distances between the anterior attachment of the crura to the ischial rami and the site on the tunica albuginea where the cavernosal arteries penetrated the cavernosal bodies were 1.26 cm on the right and 0.69 cm on the left. The corresponding measurements between the cavernosal arteries and the endopelvic fascia were 5.68 cm (right) and 4.85 cm (left). The mean extracavernosal lengths of the right and left cavernosal arteries were 2.47 and 2.2 cm, respectively.Conclusions Multiple anatomical variations of the arterial penile anatomy occur frequently. Surgery at the penile hilum may easily damage the cavernosal arteries, which lie medially to the dorsal nerves and arteries of the penis, have an extracavernosal length of about 2.3 cm and perforate the tunica albuginea about 1 cm distally to the anterior attachment of the crura to the ischial ramus.
Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode‐laser system with temperature feedback
Authors: De La ROSETTE J.J.M.C.H. , MUSCHTER R. , LOPEZ M.A. , GILLATT D. 
Published: November 2003

Objective To report the initial results of the treatment of patients with benign prostatic hyperplasia using interstitial laser coagulation (ILC) performed with a temperature‐sensing laser system.Patients and methods Twenty‐five patients were treated using ILC and in 12, 78 temperature‐power curves were recorded. The aim of the treatment was to maintain a temperature of 100°C during the entire treatment cycle, using the temperature‐triggered feedback system. The time to reach the maximum temperature, the maximum temperature and the energy delivered were related to the location of the punctures within the prostate. The clinical outcome at 1 and 3 months was evaluated with symptom scores and uroflowmetry variables.Results Heating at the apex seemed to require less energy to achieve and maintain higher temperatures than heating of the median lobe or base of the prostate. Patients improved markedly 1 and 3 months after treatment; the respective mean symptom scores improved from 20.6 before treatment to 9.4 and 6.9, the maximum urinary flow rates from 9.1 mL/s to 14.1 mL/s and 20.3 mL/s and the post‐void residual volume decreased significantly from 71 mL to 31 mL and 11 mL. No significant complications (incontinence, impotence or haemorrhage requiring transfusion) occurred.Conclusion The energy needed to achieve coagulation differed at sites within the prostate, depending on local circumstances. Good results were obtained using the tissue‐adaptive laser system.
Early genetic and cellular responses in the smooth
Authors: CHUANG Y.H. , CHUANG W.L. , LIU K.M. , CHEN S.S. , HUANG C.H. 
Published: November 2003

Objective To investigate the early genetic and cellular responses in the smooth muscle layer of completely obstructed ureters, and to determine whether myocytes proliferate (hyperplasia) in the ureters during the early stage of obstructive uropathy.Materials and methods The study comprised 35 female Sprague‐Dawley rats which had undergone unilateral ligation of their ureters. After ureteric ligation, five rats each were killed and examined at 0.5, 1, 2, 4, 8, 16 and 24 h after ligation. The proximal portion of the ureters was prepared for light and electron microscopy. The expression of c‐Fos, c‐Jun, c‐Myc and Ki‐67 antigen was assessed immunohistochemically.Results c‐Fos and c‐Jun were detected 2 h after ligation and the expression of these two proteins reached a maximum after 4 h, becoming undetectable 16 h after ligation. The expressions of c‐Fos and c‐Jun were strongly correlated (r=0.9854, P<0.001). The expressions were of c‐Myc and Ki‐67 antigen was not detected within 24 h after ureteric ligation. The amount of rough endoplasmic reticulum (rER) in the ligated ureters increased soon after complete ligation and the increase continued throughout the period of ureteric obstruction (r=0.9699, P<0.001). The change in rER was also significantly correlated with the expression of c‐Fos and c‐Jun within 8 h after ligation.Conclusion The expression of c‐Fos and c‐Jun, but not c‐Myc, might contribute to the hypertrophy of the ureteric smooth muscle layer during the course of complete ureteric obstruction. There is no hyperplasia in ureteric smooth muscle in the early stages of obstructive uropathy.
Conventional or Li vasectomy: a questionnaire study
Authors: SKRIVER M. , SKOVSGAARD F. , MISKOWIAK J. 
Published: November 2003

Objective To compare pain, discomfort, complications and convalescence during and after vasectomy performed conventionally or using the Li ‘no‐scalpel’ method.Patients and methods Between March 1993 and May 1995, 256 men were vasectomized at two city hospitals in Copenhagen; half of the patients underwent the conventional technique at one hospital and the remaining half the Li method at the other. The two groups were matched for the time at which they underwent surgery and therefore for the duration of follow‐up. A questionnaire was sent to all patients, in which they scored pain and discomfort using a 10 cm visual analogue scale (VAS). The reproducibility of measurements was tested on 10 patients who had answered the same questions 1.5–2 years earlier.Results Men vasectomized using the Li method experienced less pain at rest after the first week (P=0.05) and less use of analgesics (P<0.001), had fewer infections (P=0.0015) and contacts with their physician (P=0.0078) than those conventionally vasectomized. There were no significant differences between the groups for pain and discomfort during surgery and in the first week after vasectomy, frequency of bleeding, haematoma, oedema, granuloma, pain at activity, absence from work, vasectomy failure by sperm analysis, sexual activity and satisfaction with the cosmetic result (all P>0.05).Conclusion Vasectomy using the Li method reduced post‐operative pain, the use of analgesics, the frequency of infections and contacts with a physician when compared with the conventional procedure.
Diverticula of the female urethra
Authors: FORTUNATO P. , SCHETTINI M. , GALLUCCI M. 
Published: November 2003

Objective To determine the optimum procedure for the diagnosis and therapy of diverticula of the female urethra.Patients and methods The study included 18 patients with urethral diverticula treated at the Cristo Re Hospital in Rome between 1987 and 1995. Most of the patients were suffering from cystitis (eight), dysuria (seven) and recurring urinary infections (11). Less frequently, more specific symptoms were present such as post‐voiding dribbling (two) and anterior vaginal mass (three). The pre‐operative evaluation included a history, physical examination, voiding and positive pressure voiding cysto‐urethrography (VCUG) and urodynamic tests. A ‘typical’ surgical excision of the diverticula was carried out in all cases. Surgical excision was combined with cystopexis (Raz operation) in four patients with urinary stress incontinence and three with detrusor instability were treated post‐operatively with anticholinergics for 3 months. The outcome was evaluated by a physical examination and urodynamic tests at 3, 6 and 12 months post‐operatively; the mean (range) follow‐up was 34 (2–80) months.Results All the urethral diverticula were in the distal two‐thirds of the urethra, along the posterolateral wall. The VCUG was sufficient for diagnosis in eight patients while the other 10 required a positive‐pressure VCUG. Fifteen patients were evaluated; complications included a urinary tract infection for 2 months in four patients and stress incontinence for 2 months in two. There were no recurrences or urethrovaginal fistulae.Conclusions Diverticula in the female urethra are difficult to diagnose because the symptoms can be misleading; the positive‐pressure VCUG is useful in doubtful cases. However, a detailed history and physical examination are mandatory.