ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.01771.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02162.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To assess the effects of detubularization and outflow competence on the clinical and urodynamic results of patients undergoing substitution cystoplasty.Patients and methods The study included 142 patients undergoing orthotopic substitution cystoplasty, of whom 85 underwent a ‘straight’ and 57 a detubularized substitution cystoplasty using the ileo‐colonic segment. All were assessed clinically and by video‐urodynamic studies before and after surgery.Results In patients voiding spontaneously, detubularization produced a capacity 38% greater than that found with a ‘straight’ cystoplasty, but there was no difference in the contractility of the substitute bladder between the groups. In patients requiring clean intermittent self‐catheterization to empty, outflow competence was a more important factor in increasing capacity and reducing contractility.Conclusions Detubularization produces a modest increase in bladder capacity but far less than that predicted by mathematical models. It has no substantial effect on contractility when compared with straight substitution cystoplasty. The effects of detubularization on both capacity and contractility are less than the ‘chronic retention’ effect produced by increasing outflow competence. Detubularization is therefore only one of several factors that influence the results

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02033.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate the prediction that the observed increasing trend in male bladder cancer mortality in the Netherlands between 1955 and 1988 would change to a decreasing trend.Materials and methods Using demographic and mortality data from the Netherlands Central Bureau of Statistics, male and female bladder cancer mortality per 105person‐years from 1955 to 1994 were calculated. Changes in the age structure of the Dutch population were adjusted using direct standardization to the European ‘standard’ population. The effects of age, calendar period and birth cohort on the temporal trend in mortality were evaluated using log‐linear modelling.Results Male mortality from bladder cancer increased from 6.2 per 105in 1955 to 12.6 per 105in 1990, but decreased thereafter. Female mortality from bladder cancer has remained stable throughout the study period, at 2.8 and 2.7 per 105in 1955 and 1994, respectively. The changing trend among men is consistent with an increasing risk for successive birth cohorts until the 1910 cohort and a decreasing risk for cohorts born after 1930. This cohort effect is probably caused by changes in the smoking behaviour of the male Dutch population. There were no differences in risk for successive birth cohorts of females.Conclusion Male mortality from bladder cancer in the Netherlands will probably decrease for at least another decade. A future increase in female mortality from bladder cancer, as recorded for lung canc

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02224.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine which patients with asymptomatic microscopic haematuria (AMH) should be investigated to exclude significant urological pathology.Patients and methods The study comprised a prospective audit of a standard protocol for investigating all patients referred with haematuria over one year in a haematuria clinic in the urology department serving Tayside, Scotland. Investigations included urine culture and cytology, flexible cystoscopy, and upper tract imaging which consisted of both excretory urography and renal ultrasonography in many of the patients.Results A total of 381 patients with microscopic haematuria was investigated. No malignancy was found in any50 years the overall incidence of malignancy was 7.5% (19/250). The asymptomatic patients in this group had a lower incidence (5%, 6/126) of malignancy than the symptomatic patients (10.5%, 13/124) but this difference did not reach statistical significance. There was no statistically significant difference in the incidence of urological malignancy between men and in women with microscopic haematuria. During the same period, 233 patients were referred with frank haematuria; in these patients, those aged50 years the incidence was 34.5% (60/173). A total of 18 patients (4.7%) with microscopic haematuria had upper tract calculi, comprising 5.3% (7/131) of patients aged50 years with microscopic haematuria.Conclusions The investigation of older patients with microscopic haematuria (and all those with frank haematuria) is well justified, as malignancy will be found in a significant proportion even if they are asymptomatic. The benefit of a full urological investigation of younger patients with microscopic haematuria is de

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.01975.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To investigate the relationship between genomic heterogeneity and tumour grade, stage and DNA content in 30 transitional cell carcinomas (TCCs) of the urinary bladder.Materials and methods Tissue specimens from 30 patients (25 men and five women) with newly diagnosed TCC of the urinary bladder were examined for genomic heterogeneity using fluorescencein situhybridization (FISH) with chromosome‐specific DNA probes; the copy number of pericentromeric sequences on chromosomes 7, 9 and 17 was detected within interphase nuclei in contact preparations from the tumour specimens.Results The aneusomy of chromosomes 7, 9 and 17 was significantly higher in aneuploid than in diploid tumours (P<0.001). Tumour grade and stage were strongly associated with aneusomy for chromosome 17 (P<0.01,P<0.001, respectively). The aneusomy of chromosomes 7 and 9 were significantly correlated with increasing tumour stage (P<0.001), but not with tumour grade.Conclusion These results suggest that the measurement of aneusomy using FISH, especially for chromosome 17, in bladder cancer may offer a new objective and quantitative assay of the biological potential of individua

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.01786.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To investigate telomere reduction and telomerase activity in human transitional cell carcinomas (TCCs) of the bladder, using primary tissue preparations, and their relationship to the clinicopathological properties of the TCC.Materials and methods Tumour tissues were obtained from 21 patients together with apparently normal urothelia as controls. The mean telomere length of each sample was determined using southern blot analysis with an oligonucleotide probe (TTAGGG)4and telomerase activity was semi‐quantified using a polymerase chain reaction based assay.Results The mean (se) telomere length was 6.6 (0.7) kb in tumour tissues and 11.5 (0.4) kb in apparently normal urothelia adjacent to the tumour (P<0.001). Furthermore, it was 8.9 (1.4) kb and 3.4 (0.9) kb in superficial and invasive tumours (P=0.002), respectively. Telomerase activity was detected in all 13 of the tumour tissues examined, with no relationship to telomere reduction, while it was undetectable in any of the control tissues.Conclusions In human TCCs, telomere length was reduced in tumour tissue, more so in superficial than in invasive tumours. Telomerase was detectable only in tumour tissues and its activity was unrelated to t

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.01957.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To help define the optimal protocol of Bacille Calmette‐Guérin (BCG) treatment for transitional cell carcinoma (TCC) of the bladder by examining cytokine production and antigen presentation to effector cells after instillations of BCG in patients with bladder TCC.Patients and methods Sixty‐four urine samples from 11 patients were tested for the production of interferon γ (IFN‐γ) using a modified commercial enzyme‐linked immunosorbent assay (ELISA) kit. Urine was collected before and at intervals up to 24 h after the intravesical instillation of BCG. Immunohistological studies were also carried out using a two‐step alkaline phosphatase technique to explore the expression of tumour‐associated antigens (TAAs) (E7, 19A211, T138), major histocompatibility complex (MHC) molecules and lymphocyte subset infiltrates (CD3, CD4, CD8) in bladder biopsies before and 3 weeks after the completion of treatment in seven patients.Results IFN‐γ was only detected 4, 6 and 8 h after instillation, with a maximum concentration at 6 h (2.9–34.7 IU/mL in 10 patients). During a 6‐week course of BCG, IFN‐γ was barely detectable after the first two instillations, but gradually increased from the third instillation onwards. TAA and MHC II antigens, which were absent or faintly expressed on normal urothelial cells before treatment, were expressed strongly in five patients after treatment. The local recruitment of immunocompetent cells was detected in all patients.Conclusion These results suggest that the local immune response after the intravesical instillation of BCG can be quantified using simple ELISA tests and could be useful in defining objective criteria for rationalizing treatment (dose and duration), and in determining the relation between the immune response and anti‐tumour activity. There is evidence that antigen presentation is enhanced after BCG instillations, suggesting that a T cell‐MHC restricted pathway might be involved in the anti‐tumour response. This study supports the search f

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.01928.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To determine whether high‐intensity focused ultrasound can be used to ablate bladder wall tissue using a transabdominal approach in a large animal model, and whether it can be developed as a non‐invasive treatment for superficial bladder tumours.Materials and methods The bladder wall of 25 large white pigs was treated with a 1.7 MHz extracorporeal focused‐bowl ultrasonic transducer. Animals were killed either 2 h, 3 days or 4 weeks after treatment and the bladder wall examined macroscopically and histologically.Results Acute bladder wall damage was detected in 15 of 16 animals at 2 h and in all six animals examined after 3 days. Areas of healing were seen in 10 of 12 animals at 4 weeks. Histological analysis of the treated areas revealed that the urothelium was denuded within 2 h and was associated with an acute inflammatory response in the bladder wall. At 4 weeks, the urothelium had regenerated over a maturing scar.Conclusions Focused ultrasound can be used successfully to destroy regions of the bladder wall in a larg

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.02189.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY

摘要:

Objective To establish the safety and efficacy of the peri‐urethral injection of silicone microimplants (Macroplastique ) for the treatment of genuine stress incontinence in women.Patients and methods Forty women (median age 50 years, range 27–74) with genuine stress incontinence confirmed on medium‐fill video‐cystometry were recruited to the study. Macroplastique (3–7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points ‘around the clock’ under cystoscopic control. Where possible, the urodynamic study was repeated after 3 months. Results were graded as excellent (dry, no protection), good (better, but not totally dry) or poor (no improvement).Results Three months after a single injection, 16 (40%) were completely dry, 13 (33%) were improved and 11 (27%) were no better. Four patients who were improved were rendered dry by a second injection. After 3 years, 16 (40%) remained completely dry, seven (18%) were improved and 17 (42%) required alternative treatment with a Stamey bladder neck suspension. Dysuria for 48 h occurred in almost all patients; two were catheterized overnight and one required a catheter for 6 weeks. A comparison of maximum voiding pressures and flow rates before and 3 months after a single injection of Macroplastique revealed no urodynamic evidence of obstructed voiding (n=25).Conclusion Injectable silicone microimplants produced a good to excellent result in 73% of patients in the short‐term and 58% of women maintained this response after 3 years. The injection is a day‐case procedure which provides a satisfactory medium‐term outcome in over half of patients with genuine stress incontinence. There are few side‐effects and those patients with no improvement may go on to be treated b

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.17510.x

出版商:Blackwell Science Ltd.    

年代:1996

数据来源: WILEY