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Journal:	Journal of Urology
Authors:	McAleer IM and Kaplan GW	Issue:	1999, 162: 1041-1044

Title:

Renal function before and after pyeloplasty: Does it improve?

Abstract:
Timing of surgical correction of presumed ureteropelvic junction (PUJ) obstruction in infancy has varied and its effect on improvement in renal function is unclear. This paper has retrospectively reviewed the data on 79 patients, from 2 weeks to 18 years old (median age 6 months), with PUJ obstruction and moderate or severe hydronephrosis who underwent pyeloplasty. The main aim of the study was to see if there is any improvement in renal function after pyeloplasty. Seventy-three percent of patients were male. Pre-natal hydronephrosis had been diagnosed in 58 (73%) patients of whom 19 (33%) were observed for a variable period before pyeloplasty was performed. In all patients diuretic renogram was performed before and after operation. Pre-operative renogram showed a drainage time of > 20 mins (in 58 cases measurable drainage time was never achieved). Pre-operative renal function ranged from 5 to 67% (mean 41%, median 45%). Following pyeloplasty, there was no statistical difference in pre-operative and post-operative renal function in all patients. There was no change in renal function in patients with an abnormal renal biopsy regardless of severity of renal scarring or when renal function was 40% or less. Drainage improved postoperatively as revealed by reduced drainage time on renograms. However, in a subgroup of patients with prenatally diagnosed hydronephrosis and who were initially followed with observation, differential renal function decreased after pyeloplasty. Although retrospective in nature, with a possibility of bias in selecting patients for observation and treatment, this study suggests that pyeloplasty should be considered when ultrasound and diuretic renography suggest obstruction because renal function does not improve significantly after pyeloplasty over preoperative values. There is a risk of deterioration in renal function that may not be recoverable and hence observational management may not be indicated in prenatally diagnosed PUJ obstruction.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Chertin B, Fridmans A, Knizhnik M, Hadas-Halperin I, Hain D and Farkas A	Issue:	1999, 162: 1037-1040

Title:

Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function?

Abstract:
There is considerable controversy over the appropriate timing of surgical intervention in congenital ureteropelvic junction obstruction. Current practice is to interfere if the patient is symptomatic or if there is any evidence of functional deterioration. The authors attempt to prove that early intervention preserves, if not improves, renal function in a retrospective study involving 113 patients over an 18-year period. Fifty patients (group 1) had prenatal hydronephrosis and sixty-three (group 2) were diagnosed to have neonatal hydronephrosis. The patients in the second group were lost to follow up after initial diagnosis and presented later with symptoms at varying intervals. The median age at surgery in each group was 11 months and 5 years and the average post-operative follow up was 4.2 and 3.2 years respectively. All patients were assessed by renal ultrasound and isotope scan pre and post-operatively. The pre-operative renal function was < 30% in 89% of patients in group 2 compared to only 12% in the first group (p<0.05). Dismembered pyeloplasty was performed on all the patients by one surgeon or under his supervision. In the first group, 60% (n=30) had improvement in renal function (> 5% on renogram) compared to 16% (n=7) in the second group (p<0.05). None of the patients in either group had functional deterioration post-operatively. Although the results do suggest that early intervention improves and prevents deterioration of renal function, further prospective studies are indicated.

Reviewer: Sunil Kumar

Journal:	European Urology
Authors:	Shafik A and Al-Sherif A	Issue:	1999, 36: 150-157

Title:

Ureteropelvic junction: A study of its anatomical structure and function. Ureteropelvic junction sphincter?

Abstract:
The authors attempt to prove their hypothesis of the existence of a sphincter at the pelviureteric junction (PUJ). They studied the morphological features of the normal PUJ in 25 cadaveric specimens. Ten were fully mature neonates and the rest were adults. Grossly, no characteristic features were identified externally although internally there was a mucosal rosette. The delineating feature microscopically was the presence of two well formed circular and longitudinal muscle layers. Physiological studies were performed after ethical approval in 13 patients who were explored for benign lower polar pathology. Manometric studies revealed a high pressure zone of 6.9 ± 1.5 mm at the PUJ. One percent xylocaine was injected into the wall of the PUJ in seven patients and the rest had saline injection. Pressure response to PUJ distension was abolished only in those patients injected with xylocaine. They conclude that their studies suggest the presence of a sphincter at the PUJ. This study does not definitely prove the presence of a sphincter anatomically and there may be many physiological variables. Further studies are indicated to corroborate these findings.

Reviewer: Sunil Kumar

Journal:	Journal of Urology
Authors:	Litwin M, Mcnaughton-Collins, Fowler Jr. MF, Nickel JC, Calhoun E, Pontari M, Alexander R, Farrar J, O'Leary M and The Chronic Prostatitis Collaborative Research Network.	Issue:	1999, 162: 369-375

Title:

The National Institutes of Health chronic prostatitis symptom index: Development and validation of a new outcome measure.

Abstract:
Chronic prostatitis is poorly understood. It has a long and ill-defined history, is often inadequately treated and is bothersome. This paper reports the development and validation of a new instrument useful in measuring symptoms and quality of life impact in patients with chronic prostatitis. Preliminary work in the development of this instrument consisted of qualitative research methods. These were a structured literature review and information obtained from key informant sources by conducting focus groups (6-8 patients) in 4 different centres. This resulted in an initial draft of 55 questions used for formal cognitive testing. Following further review, a revised draft of a 21 item questionnaire was developed and validated. The questionnaire includes a 7-item AUA symptom index, 4 demographic items and 9 items that address 3 different aspects of the chronic prostatitis experience. Pain is the primary component (4 items – location, severity and frequency). Urinary function is evaluated by 2 additional items while 3 items capture quality of life impact. The 9 items had high test/re-test reliability and internal consistency. The authors state that this index is designed to be more evaluative, however, it is found to be highly discriminative. It is not clear whether sexual problems were found to be important and if evaluation of quality of sexual life was intended. Results using this index in clinical utility and responsiveness studies will add further strength to its validity. The authors conclude that this index is likely to function best if adopted widely in the evaluation of men with chronic prostatitis and will also help in the uniform assessment of natural history of this disease and its response to various treatments.

Reviewer: Hrishi Joshi

Journal:	Journal of Urology
Authors:	Volpe MA, Pachter EM, Scalea TM, Macchia RJ and Mydlo JH	Issue:	1999, 161: 1103-1105

Title:

Is there a difference in outcome when treating traumatic intraperitoneal bladder rupture with or without a suprapubic tube?

Abstract:
The authors report a small retrospective series of 34 patients with traumatic bladder injury who required emergency operative repair, comparing short and long-term outcomes for those managed with a suprapubic catheter (18 cases) or urethral catheter (16 cases). Deaths occurred in both groups from associated injuries with no significant difference between the two groups. Both urological and non-urological complications were significantly higher in those patients with suprapubic catheters. The authors suggest that the intraoperative placement of a suprapubic catheter provides no advantage over simple urethral catheter drainage.

Reviewer: Andrew Elves

Journal:	Urology
Authors:	Al-Hijji J and Batra S	Issue:	53(3): 637-641

Title:

Downregulation by estrogen of nitric oxide synthase activity in the female rabbit lower urinary tract

Abstract:
Mature female rabbits were ovariectomised and, following recovery, were either untreated (control) or given estrogen for 8 weeks. After this time, tissue from the urinary tract was harvested to measure cytosolic and particulate nitric oxide synthase (NOS). NOS activity was also measured. Estrogen caused no alteration in NOS from the upper urinary tract. In the lower urinary tract however, estrogen caused a significant reduction in cytosolic NOS of the bladder, trigone and urethra. The authors conclude that this estrogen-dependent down regulation of NOS supports the use of estrogen in post menopausal stress incontinence, since a reduction in urethral NOS would lead to increased muscular tone. They do however add that this would be disadvantageous in the bladder in urge incontinence.

Reviewer: Jon Cartledge

Journal:	Journal of Urology
Authors:	Tanaka H, Kakizaki H, Kobayashi S, Shibata T, Ameda K and Koyanagi T	Issue:	1999, 161: 929-932

Title:

The relevance of urethral resistance in children with myelodysplasia: its impact upon upper tract deterioration and the outcome of conservative management.

Abstract:
The authors retrospectively evaluated the relevance of urethral resistance to upper tract deterioration in 32 males and 29 females with myelodysplasia, with a mean age at presentation of 3.6 years. The children were divided into those with high urethral resistance (30 children) and those with low urethral resistance (31 children). Clean intermittent self catheterisation with or without anticholinergics was instituted in all children with high urethral resistance and 18 children with low urethral resistance in whom urinary incontinence required treatment after school age. Five children with high urethral resistance required augmentation due to upper tract deterioration refractory to conservative management. The incidence of de novo upper tract deterioration was not significantly different between the two groups (10% and 7% for high and low urethral resistance respectively). The authors conclude that urethral resistance, while relevant to upper tract deterioration in untreated patients, does not preclude a conservative approach, although those with high urethral resistance may be refractory to conservative treatment.

Reviewer: Andrew Elves

Journal:	British Journal of Urology
Authors:	F Jamil, M Williamson, YS Ahmed and SCW Harrison	Issue:	1999, 83(4): 396-9

Title:

Natural-fill urodynamics in chronically catheterised patients with spinal cord injury.

Abstract:
The authors determine whether an indwelling catheter on free drainage provides a constantly low intravesical pressure in spinally injured patients with a neuropathic bladder. Thirty patients who had complete spinal cord injury managed with an indwelling catheter (with or without addition of anticholinergic agents) were assessed using natural-fill cystometry. Any anticholinergic medication was stopped 24 hours prior to the assessment. Upper tracts were evaluated for scarring with ultrasound. Detrusor contractions causing intravesical pressure rises of more than 40cm H20 were seen in 11 patients. Renal scarring was seen in 6 out of 9 patients with detrusor contractions greater than 40cm H20, while only 2 out of 21 patients with normal kidneys had such pressure rises. The authors conclude that an indwelling urinary catheter does not guarantee a low residual urine and low intravesical pressure, and they postulate the possible role of these findings in renal scarring.

Reviewer: Andrew Elves

Journal:	Urology
Authors:	Keay S, Zhang C-O, Hise MK, Hebel JR, Jacobs SC, Gordon D, Whitmore K, Bodison S, Gordon N and Warren JW.	Issue:	1998, 52(6): 974-978

Title:

A diagnostic in vitro urine assay for interstitial cystitis

Abstract:
Previously, the authors had reported that a low molecular weight factor in the urine of patients with interstitial cystitis (IC) inhibited bladder epithelial cell proliferation more than in normal patients. In this study, they compared an in vitro method for determining whether urine from IC patients inhibited epithelial cell proliferation more than urine from patients with inflammatory bladder conditions. They report that urine from 86% of patients with IC inhibited cell proliferation, compared to 12% with bacterial cystitis, 0% with vulvovaginitis and 8% of controls. For this rather specialised procedure they report a sensitivity and specificity of 91.4% and 90.6% respectively. They conclude that this may be a useful non-invasive means of diagnosing IC.

Reviewer: Jonathan Cartledge

Journal:	Urology
Authors:	Ehren I, Lundberg JON, Adolfsson J and Wiklund NP.	Issue:	1998, 52(6): 1026-1029

Title:

Effects of L-arginine treatment on symptoms and bladder nitric oxide levels in patients with interstitial cystitis

Abstract:
Nine women with interstitial cystitis (IC) were given either 3 g or 10 g per day of oral L-arginine in an open label study. Urinary nitric oxide (NO) production was measured and symptoms were measured with the IC symptom index. At baseline, patients with IC had a significantly higher NO concentration than control patients (239 ppb vs. 15 ppb). After 5 weeks of treatment there was no change in symptom score or levels of urinary NO. The authors conclude that, at a dose of up to 10 g/day, L-arginine produces no change in symptoms of IC.

Reviewer: Jonathan Cartledge

Journal:	Journal of Urology
Authors:	Bower WF, Moore KH, Adams RD and Shepherd R.	Issue:	1998, 160:2133-2136

Title:

A Urodynamic study of surface neuromodulation versus sham in detrusor instability and sensory urgency.

Abstract:
The effect of surface neuromodulation on cystometric pressure and volume parameters was assessed in women with detrusor instability or sensory urgency. An electrical current was delivered to the suprapubic region at a frequency of 150Hz, or over the third sacral foramina at a frequency of 10Hz via a transcutaneous electrical nerve stimulator with a sham neuromodulation control. Neuromodulation delivered across both the suprapubic region and the sacral skin effected a reduction in the mean maximum height of detrusor contraction, although the response in sensory urgency was limited. A current of 10 Hz, inhibiting motor activity, was not more efficacious than a current of 150Hz, inhibiting sensory perception. Sham transcutaneous electrical nerve stimulation did not alter outcome measures. The authors conclude that short term surface neuromodulation using transcutaneous nerve stimulation may have a role in the management of detrusor instability although long term studies are required to confirm these findings.

Reviewer: Andrew Elves

Journal:	Urology
Authors:	Sener F, Hasanoglu E and Soylemezoglu O.	Issue:	1998, 52(5): 878-881

Title:

Desmopressin versus indomethacin treatment in primary nocturnal enuresis and the role of prostaglandins

Abstract:
Children with nocturnal enuresis were randomised to receive either desmopressin, indomethacin or placebo for 4 weeks. Wetting diaries were recorded and serum and urine PGE2 was measured before and after treatment. The authors report that both desmopressin and indomethacin significantly increased the number of dry nights over placebo and no side effects were reported. The urine and serum PGE2 levels were significantly higher in patients with enuresis than in asymptomatic controls, but a significant reduction in serum and urine PGE2 was recorded on treatment with both agents. The authors suggest that PGE2 may have a role in the pathophysiology of nocturnal enuresis.

Reviewer: Jonathan Cartledge

Journal:	British Journal of Urology
Authors:	Assael BM, Guez S, Marra G, Secco E, Manzoni G, Bosio M, Pelegatta A, Acerbi L, Dell'Agnola CA, Selvaggio G, Vegni M, Cecchetti V and Cucchi L.	Issue:	1998, 82: 252-257

Title:

Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally.

Abstract:
Increasingly, paediatric urologists are being referred patients with prenatally diagnosed pathology, most frequently renal pelvis dilatation. Seventy-six percent of this group of patients had abnormalities defined in utero. The study identifies that even in the absence of posterior urethral valves (excluded from this study) there is a male preponderance of vesico-ureteric reflux in the first year of life, and that high grade reflux may be associated with significant early renal impairment. Although progression can be prevented with antibiotic prophylaxis, this group may remain at risk of chronic renal failure in later life.

Reviewer: Jonathan Glass

Journal:	British Journal of Urology
Authors:	Feneley MR, Feneley RCL.	Issue:	1998, 81: 193-198.

Title:

The contribution of research to urological training in the United Kingdom

Abstract:
What is expected of the British urological trainee in terms of the research he or she is expected to have carried out prior to getting a consultant post? This paper shows that writing a thesis and getting an MS or MD has not been necessary in the past (only 58% of 130 consultants who did research obtaining a higher degree). Is there any need for this to change in the future?

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Ramanathan R, Kumar A, Kapoor R, Bhandari M.	Issue:	1998, 81: 199-205.

Title:

Relief of urinary tract obstruction in tuberculosis to improve renal function. Analysis of predictive factors

Abstract:
A relatively common disease world-wide, renal TB can lead to obstructed ureters resulting in loss of the respective kidney. This retrospective review attempted to identify if there are any ways of predicting outcome from intervention to direct resources to only treating salvageable renal kidneys in countries where resources are often scarce. Cortical thickness, and GFR are, not surprisingly, among the markers of a good prognosis.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Salvatore S, Khullar V, Anders K, Cardozo LD.	Issue:	1998, 81: 211-214.

Title:

Reducing artefacts in ambulatory urodynamics

Abstract:
Does conventional urodynamics under diagnose bladder instability or does ambulatory urodynamics over diagnose it? The identification of bladder overactivity in ambulatory urodynamics was reduced by the use of a second bladder manometer line (reducing wall artefact) and interpreting the tracing with reference to a voiding diary kept by the patients whilst undergoing the investigation. Perhaps ambulatory urodynamics is not the gold standard that we were lead to believe it was.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Rentzhog L, Stanton SL, Cardozo L, Nelson E, Fall M, Abrams P.	Issue:	1998, 81: 42-48.

Title:

Efficacy and safety of tolterodine in patients with detrusor instability: a dose ranging study.

Abstract:
This double-blind, placebo controlled multi-centre study evaluates a new anti-muscarinic agent for the treatment of bladder instability. Let’s hope that it doesn’t have the cardiac side effects of terodiline that had to be withdrawn in the early nineties. There is certainly a need for new therapies in the treatment of this often frustating condition.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Donovan JL, Kay HE, Peters TJ, Abrams P, Coast J, Matos-Ferreira A, Rentzhog L, Bosch JLHR, Nordling J, Gajewski JB, Barbalias G, Schick E, Mendes Silva M, Nissenkorn I, de la Rosette JJMCH and the ICS-’BPH’ Study Group	Issue:	1997, 83 (5): 712-721.

Title:

Using the ICSQoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-‘BPH’ study.

Abstract:
Quality of life questionnaires are currently being refined in a similar manner to prostate symptom scores 7-10 years ago. The validity of the International Continence Society - Quality of Life questionnaire is subjected to further scrutiny by this study from twelve countries covering over 1600 men. A detailed and validated QoL questionnaire will be included in future BPH studies. Clinically a single question - how much do LUTS interfere with life seems adequate. (See reference below).

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	MV Hansen and A Zdanowski	Issue:	1997, 80 (5): 787-792.

Title:

The agreement among urological experts on the diagnostic management of patients with common urological problems.

Abstract:
Thirty three urologists were asked to investigate and treat 53 simulated urological conditions. The probability of the urologists using a certain test in a certain patient was recorded and the cost implications evaluated. Most consistency was seen treating stone patients, then bladder cancer, prostate cancer and lastly BPH. These were all university based consultants.

Reviewer: Mark Feneley

Journal:	Urology
Authors:	Chun TY, Martin S and Lepot H.	Issue:	1997, 50 (5): 727-732.

Title:

Pre-operative Recombinant Human Erythropoietin Injection versus Pre-operative Autologous Blood Donation in patients undergoing Radical Retropubic Prostatectomy.

Abstract:
To try and reduce the costs and risks of allogenic blood transfusion for patients undergoing RPP the authors prospectively compared the use of pre-operative autologous blood donation (PAD) with pre-operative recombinant human erythropoietin donation. Patients were randomised to receive erythropoietin 14 and 7 days pre-operatively if their haematocrit was lower than 46% (increased risk of stroke for HCT >46%) or give 1 unit of blood every 4 days pre-operatively, upto 3 units. Transfusion was only given according to an established protocol. Half the patients receiving erythropoietin did not require a second injection because their HCT reached 46% with a single dose. 80% of PAD patients received transfusion of their own blood. In both groups 9.6% of patients required allogenic transfusion. The authors conclude that pre-operative erythropoietin is a safe alternative to autologous transfusion.

Reviewer: Mark Feneley

Journal:	Urology
Authors:	Agarwal A, Ikemoto I and Loughlin K	Issue:	1997, 50 (5): 759-763.

Title:

Prevention of testicular damage by free-radical scavengers.

Abstract:
The authors studied whether ischaemic injury of testicular tissue could be prevented by free-radical scavengers. In an experimental model, using adult Sprague-Dawley rats, ischaemic testicular damage was induced by intraperitoneal injection of cadmium chloride. Free radical scavengers (heparin, oxypurinol and superoxide dismutase) were given and damage was assessed by testicular weight, LDH-X activity and histology. LDH-X in seminal plasma has leaked from spermatazoa and is an indicator of necrotic damage. Testis from control animals decreased significantly in weight, had reduced LDH-X activity, and a high degree of histological damage. Administration of oxypurinol and superoxide dismutase prevented this damage, except at high doses of CdCl2. The authors suggest further studies to determine if an anti-oxidant may be given after a diagnosis of testicular torsion is made to try and reduce testicular damage.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Martinez-Pineiro L, Julve E, and Martinez-Pineiro JA.	Issue:	1997, 80 (3): 463-467.

Title:

Topographical anatomy of the penile arteries

Abstract:
In an attempt to provide further anatomical knowledge to those performing radical pelvic surgery further anatomical detail of the penile arteries has been gleaned from 12 male cadavers. Key points seem to be the marked variation in penile blood supply, the position of the accessory pudendal arteries close to the prostate, and the potential damage of the cavernosal arteries with surgery at the penile hilum.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Hooper P, Tincello DG, and Richmond DH.	Issue:	1997, 80 (3): 414-416.

Title:

The use of salivary stimulant pastilles to improve compliance in women taking oxybutynin hydrochloride for detrusor instablity: a pilot study.

Abstract:
This is one of those short, simple papers that addresses an all too common problem that we all struggle to overcome. Oxybutinin is often effective yet patients find the side effects intolerable. Taking these pastilles may make it more bearable. This study was limited in its design and inadequate follow up yet there is a suggestion that co-prescribing oxybutynin with these pastilles (trade name Salivix) may improve compliance.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Dasgupta P, Haslam C, Goodwin R, Fowler CJ.	Issue:	1997, 80 (2): 234-237.

Title:

The ‘Queen Square bladder stimulator’: a device for assisting emptying of the neurogenic bladder.

Abstract:
A simple vibrating device placed suprapubically is described as an alternative to self-catheterisation for use in the neurogenic bladder. A randomized study comparing outcomes and patient satisfaction in two groups, one using the stimulator and one self-catheterising would have been better.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Yeung CK, Godley ML, Dhillon HK, Gordon I, Duffy PG, Ransley PG.	Issue:	1997, 80 (2): 319-327.

Title:

The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis.

Abstract:
A large review of VUR in babies with hydronephrosis detected prenatally from Great Ormond Street. VUR is commoner in males than females (3:1), and 67% of kidneys exposed to VUR remain normal. Damage when seen in the kidney is associated with severe reflux (grades IV or V) in 91% of cases. Grade V reflux is almost exclusively a male disorder. Fetal VUR is probably a benign disorder for most babies and normal kidneys can be seen following severe reflux, but the chance of a normal kidney in association with grade V reflux is low (15%).

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Gray R, Wagg A, Malone-Lee JG.	Issue:	1997, 80 (2): 222-226.

Title:

Differences in detrusor contractile function in women with neuropathic and idiopathic detrusor instability

Abstract:
A large study (1,280 patients) comparing urodynamic parameters in these two groups of women. It appears that neuropathic bladders have smaller capacities and larger residuals than bladders with idiopathic instability, and the urethral opening pressures of the detrusor and the strength of the unstable contractions were larger. Furthermore the pressures failed to return to baseline after an unstable contraction in the neuropathic bladders. The authors question whether these two conditions might have different pathophysiological pathways.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Kelly JD, Kernohan RM, Keane PF.	Issue:	1997, 32: 30-33.

Title:

Symptomatic outcome following clam ileocystoplasty.

Abstract:
This study reported the subjective outcome of patients following clam ileocystoplasty based on objectively validated symptom scores. Cystoplasties were performed on 27 patients after failed drug treatment for mostly idiopathic detrusor instability and spina bifida. Mean follow-up was 18 months. The majority (3/4) reported a subjective improvement in symptoms but some said they were worse. All patients noted voiding dysfunction of variable severity. Worst results were obtained in young women having surgery for detrusor instability.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Chandiramani VA, Palace J, Fowler CJ.	Issue:	1997, 80: 100-104.

Title:

How to recognise patients with parkinsonism who should not have urological surgery.

Abstract:
Urologists are always wary of operating on men with lower urinary tract symptoms and parkinsonism. This may however mean we are not operating on men who may benefit from a simple procedure. This paper identifies a number of clinical parameters that if present would suggest that certain men with parkinsonism should be treated medically rather than surgically. These include (i) urinary symptoms that precede or present with parkinsonism, (ii) urinary incontinence and idiopathic Parkinson's disease (iii) erectile failure preceding or presenting with parkinsonism (iv) worsening bladder function after urological surgery. At least 80% of patients in this study had two of these characteristics and these patients should be referred for a sphincter EMG before surgery.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Matthews LA, Smith EM and Spirnak JP .	Issue:	1997, 157: 2056-2058.

Title:

Nonoperative treatment of major blunt renal lacerations with urinary extravasation.

Abstract:
Management of major blunt renal lacerations associated with urinary extravasation has been an area of controversy though the trend exists toward more conservative treatment. The authors review their experience with non-operative treatment of haemodynamically-stable patients with major renal lacerations (American Association for the Surgery of Trauma grades 3-5). The aim was to determine whether urinary extravasation adversely affects outcome. All patients were assessed by CT scan. Urinary extravasation spontaneously resolved in 27 of 31 patients, but 4 remaining patients required ureteric stents for persistent extravasation. Thus urinary extravasation could be managed by conservative management which was safe and effective while endourological or percutaneous methods were required for just a small number of patients.

Reviewer: Mark Feneley

Journal:	New England Journal of Medicine
Authors:	Pryor JL, Kent First M, Muallem A, van Bergen AH, Nolten WE, Meisner L, Roberts KP.	Issue:	1997, 336: 534-539.

Title:

Microdeletions in the Y chromosome of infertile men.

Abstract:
Some infertile men with oligospermia and azospermia have small deletions in the Y chromosome. In this paper, its incidence is reported to be 7% in 200 consecutive infertile men, 23% in men with azospermia and 2% in fertile men. The size and position of the deletion correlated poorly with the severity of spermatogenic failure.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Bade JJ, Laseur M, Nieuwenburg L, Weele Th vd and Mensink HJA.	Issue:	1997, 79: 168-171.

Title:

A placebo-controlled study of intravesical pentosanpolysulphate for the treatment of interstitial cystitis.

Abstract:
Twenty women with interstitial cystitis were randomly assigned to receive either placebo or intravesical pentosanpolysulphate (PPS), which is a heparin analogue. At three months 4 of 10 patients receiving the active treatment reported subjective symptomatic improvement compared to 2 of 10 in the placebo group. The only statistically significant finding was an increase in urodynamic bladder capacity in the PPS group (265ml) compared to the placebo group (208 ml). These results are interesting but clearly the treatment requires further evaluation. In particular, a randomised trial is needed to compare intravesical administration with oral administration which is reported to result in symptomatic remission in up to 40% of patients in other studies.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Petersen T, Chandiramani V and Fowler CJ.	Issue:	1997, 79: 163-167.

Title:

The ice-water test in detrusor hyper-reflexia and bladder instability.

Abstract:
One hundred and thirty consecutive patients underwent urodynamic testing and an ice-water test. A test was positive when a phasic detrusor contraction >30cm H20 was recorded or if leakage occurred after 50-100ml of saline at 0-20°C was infused into the bladder within 15-20 seconds. Although the ice water test was positive in 65% of patients with detrusor hyper-reflexia and known neurological disease, it was also positive in 15% of patients with no neurological disease and detrusor instability. In addition the test was not sufficiently sensitive to distinguish between suprapontine and infrapontine pathology. It does not therefore add to current diagnostic techniques and remains a research tool.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Hosker GL, Kilcoyne PM, Lord JC and Smith ARB.	Issue:	1997, 79: 159-162.

Title:

Urodynamic services, personnel and training in the United Kingdom.

Abstract:
One hundred and sixty-three of 281 centres which were sent this postal questionnaire replied and were available for this study. Of these 42% were attached to urology, 23% to gynaecology and 16% to urogynaecology. Thirty-four percent of investigations were performed by a doctor, 30% by a doctor with nurse, 15% by a nurse alone and 20% by others including radiologists and technicians. The finding which most concerned the authors was that 50% of respondents felt that urodynamic training was inadequate. The paper concludes that consideration should be given to requiring a minimum standard of training for personnel performing urodynamics.

Reviewer: Mark Feneley

Journal:	New England Journal of Medicine
Authors:	Hauptmann PJ and O'Connor KJ.	Issue:	1997, 336: 422-431.

Title:

Procurement and Allocation of solid organs for transplantation.

Abstract:
This is a review article on the changing trends in the availability of cadaveric organs for transplantation including the changes in organ source, characteristics of cadaveric donors and the allocation of cadaveric kidneys.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Clarnette TD, Sugita Y and Hutson JM	Issue:	1997, 79: 99-112.

Title:

Genital anomalies in human and animal models reveal the mechanisms and hormones governing testicular descent.

Abstract:
Normal sexual differentiation and the roles of the SRY gene complex, Mullerian inhibitory substance, Leydig cells, the gubernaculum, the cranial suspensory ligament, the genito-femoral nerve nucleus and calcitonin gene-related peptide are described. The biphasic model of testicular descent is described and correlated with disorders then discussed under the heading "abnormal sexual development". These include persistent Mullerian duct syndrome, androgen disorders (androgen insensitivity / testicular feminisation and female pseudohermaphroditism e.g. CAH), true hermaphroditism and mixed gonadal dysgenesis.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Erickson DR, Ordille S, Martin A and Bhavanandan VP.	Issue:	1997, 157: 61-64.

Title:

Urinary chondroitin sulfates, heparan sulfate and total sulfated glycosaminoglycans in interstitial cystitis.

Abstract:
The aetiology of interstitial cystitis (IC) remains obscure though increasing evidence exists to implicate a deficiency in urinary glycosaminoglycans as one possible factor. This paper compares total urinary sulfated glycosaminoglycans in patients with IC and healthy controls, and examines the effect of the menstrual cycle upon total sulfated glycosaminoglycans. While the authors found patients with IC to have decreased levels of individual and total sulfated glycosaminoglycans, glycosaminoglycan-to-creatinine ratios were similar in patients with IC and controls. Furthermore no effect was seen with regard to the effect or the menstrual cycle. This paper does not support previous findings regarding glycosaminoglycan levels in patients with IC and highlights our poor understanding of this disease.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Bramble FJ and Morley R	Issue:	1997, 79: 3-7.

Title:

Drug-induced cystitis

Abstract:
This review article reminds us of the importance of taking a good drug history when a patient complains of filling symptoms and/or haematuria. The worst offenders are cyclophosphamide, tiaprofenic acid (Surgam), other NSAIDS, danazol and perhaps allopurinol.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Wessells H, McAninch JW, Meyer A and Bruce J .	Issue:	1997, 157: 24-27.

Title:

Criteria for nonoperative treatment of significant penetrating renal lacerations.

Abstract:
The authors set out to define criteria for non-operative management of penetrating renal trauma from a retrospective review of 120 patients with grade 2-4 injuries. 41 were managed conservatively and 79 underwent immediate exploration. Injuries were staged by CT or IVU in those patients managed conservatively. Those patients managed conservatively had a lower incidence of gunshot wounds, shock, associated injuries, requirement for transfusion and high grade renal injuries. While those patients with grade two lacerations could be managed safely with conservative management without complication, 23.5% of those with grade 3 or 4 experienced delayed renal bleeding. The authors conclude that patients with grade 2 renal lacerations defined by CT imaging may be managed conservatively without complications.

Reviewer: Mark Feneley

Journal:	World Journal of Urology
Authors:	Baskin LS, Hayward SW, Sutherland RA, Di Sandro MJ, et al	Issue:	1996, 14: 301-309.

Title:

Mesenchymal epithelial interactions in the bladder

Abstract:
Using a rat model, Dr Cunha's team from California define their hypothesis for the development of the normal bladder and the changes in development that occur in association with bladder-outlet obstruction. The role of growth factors (KGF, TGF a, b2 and b3) is defined.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Matthiesen TB, Rittig S, Norgaard JP, Pedersen EB and Djurhuus JC.	Issue:	1996, 156: 1292-9.

Title:

Nocturnal polyuria and naturesis in male patients with nocturia and lower urinary tract symptoms.

Abstract:
The authors investigated the circadian variation in urine output, plasma angiotensin II, aldosterone, atrial naturetic peptide, arginine vasopressin and blood pressure in 17 elderly men with nocturia and lower urinary tract symptoms and 10 age matched controls without nocturia. Loss of diurnal variation was observed in 11 of the 17 subjects with nocturia while 6 subjects had a diurnal variation in urine output comparable to controls. Loss of diurnal variation was associated with an increase in nocturnal sodium excretion. The authors conclude that nocturia in a large proportion of elderly men with lower urinary tract symptoms is due to nocturnal polyuria and naturesis.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	A) Thompson AC, Christmas TJ. B) Christmas TJ, Smith GL and Rode J.	Issue:	1996, 78: 862-865.

Title:

A) Interstitial cystitis - and update B)Detrusor myopathy: an accurate predictor of bladder hypocompliance and contracture in interstitial cystitis.

Abstract:
Two papers about interstitial cystitis. The first is a review of this uncommon heartsink condition which concludes the aetiology is unclear, diagnosis is difficult, often delayed, and treatment is palliative unless surgeon and patient are forced into curative total cystectomy with urinary diversion or orthotopic reconstruction using a Kock pouch. The second is new data suggesting a predictive role for detrusor myopathy: biopsies showing small vacuolated myocytes amid increased interstitial collagen were observed in 8/21 patients, in addition to a mast cell detrusor infiltrate which was present in all cases. These patients were more likely to demonstrate hypocompliance on videocystometrography and 6 required major surgery within 3 years. No patient without this histopathological feature required surgery.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Kaplan S A and Reis R B.	Issue:	1996, 156: 1668-1672.

Title:

Significant correlation of the American Urological Association symptom score and a novel urodynamic parameter: Detrusor contraction duration.

Abstract:
The poor correlation of the I-PSS score with urodynamic parameters has been highlighted by a number of authors. This study revisits this issue and introduces a new parameter detrusor contraction duration. Increasing symptoms as assessed by the I-PSS was associated with worsening urodynamic parameters though those with the greatest correlation were detrusor instability and duration of detrusor contraction.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Albers P, Fichtner J, Bruhl P, and Muller S C.	Issue:	1996, 156: 1611-1614.

Title:

Long-term results of internal urethrotomy

Abstract:
The authors report a retrospective analysis of long-term results of internal urethrotomy in 937 patients treated at two centres, evaluating risk factors for stricture recurrence. Mean follow-up was 4.6 years at one centre (357 patients) and 3.2 years at the second centre (580 patients). Strictures recurred in 96 of 357 (29.9%) and 260 of 580 (44.8%) patients respectively. Risk factors for recurrence were etiology, stricture longer than 1 cm, and post operative catheter drainage for greater than 3 days. Recurrence was defined by urinary flow rates and clinical symptoms. The authors conclude that urethroplasty should be considered for patients at high risk of recurrence and with more than one treatment failure after urethrotomy.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	MacFarlane JP, Foley SJ and Shah PJR	Issue:	1996, 78: 729-732.

Title:

Long-term outcome of permanent urethral stents in the treatment of detrusor-sphincter dyssynergia.

Abstract:
This paper from the spinal injuries unit at Stanmore reviews 5-year followup of 11 urethral stents. Two stents had to be removed within a year because of encrustation and pain/UTI respectively. Five others developed bladder neck obstruction which was treated by bladder neck incision. Of the remaining four patients, one died, one had haematuria and one suffered recurrent UTI. The authors conclude that urethral stenting is an effective alternative to sphincterotomy.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Robert M, Drianno N, Muir G, Delbos O, Guiter J.	Issue:	1996, 30: 335-339.

Title:

Management of major blunt renal lacerations: surgical or nonoperative approach?

Abstract:
This is a retrospective report on the results of patients treated for renal trauma following the use of a CT scan as an investigation in the work up of patients. Twenty-three patients were reviewed and most of the patients treated conservatively did well, although hospital discharge was delayed in some patients compared to those who had surgery.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Lent V.	Issue:	1996, 30: 327-334.

Title:

What classification is appropriate in renal trauma?

Abstract:
This study draws together the elements of previous classification systems for renal trauma and extracts the best to give a new system with proposed management and prognostic significance. Important points are the mechanism of injury, the site and degree of injury, and symptom severity.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Lyth DR, Folwell AJ and Iacovou JW	Issue:	1996, 78: 677-680.

Title:

The Internet for British urologists?

Abstract:
This review is the first to titillate urologists with the attractions of the internet. It covers the definition, development and use of the world wide web.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Sultana SR, Goodman CM, Byrne DJ, Baxby K.	Issue:	1996, 78: 691-698.

Title:

Microscopic haematuria: urological investigation using a standard protocol.

Abstract:
This study from Dundee prospectively investigated 381 patients with microscopic haematuria with urine culture, cytology, IVU and flexible cystoscopy. No malignancy was found amongst 131 patients aged <50 years while 7.5% of those >50 years had malignancies. Of 233 patients with frank haematuria, 6 (10%) aged <50 years and 60 (34%) patients aged >50 years had malignancies. These authors question the benefit of fully investigating younger patients with microscopic haematuria. There is an editorial comment by Dr Judith Webb on the use of IVU (plus ultrasound if the IVU and cystoscopy are negative) in the investigation of microscopic haematuria.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Sillen U, Hansson E, Hermansson G, Hjalmas K, Jacobsson B, Jodal U.	Issue:	1996, 78: 596-601.

Title:

Development of the urodynamic pattern in infants with myelomeningocele.

Abstract:
This Swedish group investigated 34 infants with myelomeningocele using videourodynamics at 1, 4 and 10 months of age. Detrusor hyper-reflexia and hypocompliance increased to 65% at 4 months. Vesico-ureteric reflux was detected in 12 patients, strongly correlated to hypocompliance, hypercontractility and outlet obstruction.

Reviewer: Mark Feneley

Journal:	Lancet
Authors:	Ruud JL and Groen J.	Issue:	1996, 348: 717-719.

Title:

Treatment of refractory urge urinary incontinence with sacral spinal nerve stimulation in multiple sclerosis patients.

Abstract:
Incontinence in multiple sclerosis (MS) patients may be caused by detrusor hyperreflexia, due to spinal pathology interrupting the spinobulbospinal pathways of the micturition reflex. Patients who do not respond to anticholinergics are difficult to manage. This Dutch group found that by electrically activating somatic afferents of the S3 spinal nerve of six MS patients, the mean number of leakage episodes reduced from 4 to 0.3 per 24 hours. The neuroprosthesis is implanted under local anaesthesia and follow-up was 2 years.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Bade JJ,Marrink J, Karrenbeld A, van der Weele L and Mensink HJA	Issue:	1996, 156: 943-946.

Title:

Increased urinary levels of Tamm-Horsfall glycoprotein suggest a systemic etiology of interstitial cystitis.

Abstract:
This paper investigates the role of Tamm-Horsfall protein (THP) in the aetiology of interstitial cystitis (IC). Twenty-four hour urinary THP excretion was analysed in IC patients and controls, and bladder biopsies stained immunohistochemically for THP. Twenty-four hour THP excretion was significantly higher for IC patients than controls, though no immunohistochemical staining was seen in bladder tissue from 10 IC patients. A possible role for THP in IC is discussed.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Pansadoro V, Emiliozzi P, Defidio L, Scarpone P, Sabatini G, et al.	Issue:	1996, 30: 24-27.

Title:

Prostate-specific antigen and prostatitis in men under fifty.

Abstract:
Patients were selected who had a low probability of BPH or prostate cancer based on age. PSA was increased in men with acute prostatitis (5/7), chronic prostatitis (2/13), and abacterial prostatitis (2/32) but none with prostatodynia (0/20). In some cases, PSA did not return to normal after antibiotics. It is difficult to say whether such PSA elevations are greater than a normal population without similar complaints but indicate that prostatitis can cause elevated PSA.

Reviewer: Mark Feneley

Journal:	European Urology
Authors:	Desgrandchamps F, Cortesse A, Rousseau T, Teillac P, Le Duc A.	Issue:	1996, 30: 18-23.

Title:

Normal voiding behaviour in women.

Abstract:
This study evaluated the I-PSS, which has recently been validated in French men, in French women. Patients were unselected from a French general practice and the patients did not have urinary complaints. Interestingly, the majority of patients complained of frequency, nocturia, and urgency. The symptom score does not evaluate incontinence and the authors suggested that a new score derived from the I-PSS would need to include this.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Benoit G, Blanchet P, Eschwege P, Alexandre L, Bensadoun H and Charpentier B.	Issue:	1996, 156: 881-884.

Title:

Insertion of a double pigtail ureteral stent for the prevention of urological complications in renal transplantation: a prospective randomised study.

Abstract:
This paper evaluates the advantages and disadvantages of ureteral stents in renal transplant recipients in the setting of a prospective randomised control study. One hundred and ninety four renal transplant patients were randomised to have stent insertion (97 patients) or no stent insertion (97 patients). In the stented group, urinary leakage was observed in 1 patient and urinary tract infection in 35 patients. In the non-stented group, 6 patients had urinary leaks, 4 had obstruction and 32 had urinary tract infections. At one year, patient and graft survival, and renal function was similar between the two groups. Stent encrustation was not observed in any of the stented group. The authors conclude use of ureteral stents decreases the incidence of urinary leakage and obstruction in renal transplantation surgery.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Taskinen S, Hovatta O and Wilstrom S	Issue:	1996, 156: 82-84.

Title:

Early treatment of cryptorchidism, semen quality and testicular endocrinology.

Abstract:
Testicular maldescent may influence male fertility even when treated, particularly in cases of bilateral cryptorchidism. This article evaluates the effect of patient age at treatment of cryptorchidism in relation to subsequent semen quality and hormone levels. Among the 39 patients with unilateral cryptorchidism there was no significant correlation between patient age at treatment and sperm concentration, motility or morphology. Poor semen quality was uncommon in the unilateral cryptorchidism group and appeared only in those patients treated after 4 years of age. Of the 12 patients treated for bilateral cryptorchidism all those treated before the age of 4 years had normal sperm concentration. Elevated FSH levels were associated with azospermia and severe oligospermia, indicating testicular damage. The authors conclude that surgery for cryptorchidism should be undertaken early and before the age of 4 years in patients with bilateral cryptorchidism if conservation of normal semen quality is to be achieved.

Reviewer: Mark Feneley

Journal:	Journal of Urology
Authors:	Morales A, Emerson L, Nickel JC and Lundie M	Issue:	1996, 156: 45-48.

Title:

Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis.

Abstract:
Interstitial cystitis (IC) is a poorly understood chronic clinical syndrome. The authors present the results of intravesical hyaluronic acid in a cohort of 25 patients with IC as defined by the National Institutes of Health Consensus Conference. All patients had failed to obtain benefit from DMSO and /or pentosanpolysulphate. Response to therapy was evaluated using a number of outcome measures covering 72 hour voiding diaries, and visual analogue scales relating to pain and urgency. Responses were graded according to the extent of symptom resolution. Follow up ranged from 24 to 68 weeks. While there was progressive improvement in all outcome scores over the study period the complete responses rate was only 25% (resolution of symptoms with a 90% reduction in outcome scores). The authors highlight the number of studies exploring new therapies for this disease which have initially demonstrated impressive results, but shown to be disappointing in the setting of a randomised control studies. The authors rightly state that effective therapy will not be available until the scientific basis of the disease is better understood.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Dinneen MD and Duffy PG	Issue:	1996, 78: 275-281.

Title:

Posterior Urethral Valves

Abstract:
A good review of the clinical presentation, treatment and long-term sequelae of posterior urethral valves. The message is that boys with valves are surviving longer which means more will eventually require renal replacement therapy and management should aim to maximise renal function in later life.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	O'Sullivan DC, Heal MR, Powell CS.	Issue:	1996, 78: 265-270.

Title:

Circumcision: how do Urologists do it?

Abstract:
This postal questionnaire to full members of BAUS in 1994 was answered by 61%. 55% of respondents use the "sleeve" technique and 39% perform circumcision freehand. The authors point out that most complaints after circumcision are due to poor cosmetic result due to the removal of too much shaft or coronal skin and that occasionally injury to the glans occurs. These complications can be avoided by performing (and teaching juniors) the "sleeve" technique.

Reviewer: Mark Feneley

Journal:	British Journal of Urology
Authors:	Mundy AR	Issue:	1996, 78: 243-247.

Title:

Urethroplasty for posterior urethral strictures.

Abstract:
Professor Mundy retrospectively compares his results of 82 transperineal bulboprostatic anastomotic urethroplasties (AU) with 59 patch (penile or scrotal skin-flap) urethroplasties (PU). The strictures for which this surgery was performed were either <2 cm in the bulbar urethra or any length in the membranous urethra as long as the remaining urethra was normal. In terms of re-stricturing at 5, 10 and 15 years, AU patients fared considerably better. Factors associated with re-stricture were age >55 years and pre-operative impotence. Mundy suggests these risk factors could have impaired urethral blood flow in common. 7% patients undergoing AU became permanently impotent post-operatively. He concluded that AU is the best repair technique for such strictures, with the exception of those due to blast injury or associated with an abnormal remaining urethra.

Reviewer: Mark Feneley