The results indicate that polyurethane is readily encrusted and colonized by bacteria in vivo despite antibiotic prophylaxis. Newer materials must be sought if effective long-term stenting is to be achieved.
PurposeWe investigated the 3-dimensional morphological arrangement of KIT positive interstitial cells of Cajal in the human bladder and explored their structural interactions with neighboring cells.Materials and MethodsHuman bladder biopsy samples were prepared for immunohistochemistry/confocal or transmission electron microscopy.ResultsWhole mount, flat sheet preparations labeled with anti-KIT (Merck, Darmstadt, Germany) contained several immunopositive interstitial cell of Cajal populations. A network of stellate interstitial cells of Cajal in the lamina propria made structural connections with a cholinergic nerve plexus. Vimentin positive cells of several morphologies were present in the lamina propria, presumably including fibroblasts, interstitial cells of Cajal and other cells of mesenchymal origin. Microvessels were abundant in this region and branched, elongated KIT positive interstitial cells of Cajal were found discretely along the vessel axis with each perivascular interstitial cell of Cajal associated with at least 6 vascular smooth muscle cells. Detrusor interstitial cells of Cajal were spindle-shaped, branched cells tracking the smooth muscle bundles, closely associated with smooth muscle cells and vesicular acetylcholine transferase nerves. Rounded, nonbranched KIT positive cells were more numerous in the lamina propria than in the detrusor and were immunopositive for anti-mast cell tryptase. Transmission electron microscopy revealed cells with the ultrastructural characteristics of interstitial cells of Cajal throughout the human bladder wall.ConclusionsThe human bladder contains a network of KIT positive interstitial cells of Cajal in the lamina propria, which make frequent connections with a cholinergic nerve plexus. Novel perivascular interstitial cells of Cajal were discovered close to vascular smooth muscle cells, suggesting interstitial cells of Cajal-vascular coupling in the bladder. KIT positive detrusor interstitial cells of Cajal tracked smooth muscle bundles and were associated with nerves, perhaps showing a functional tri-unit controlling bladder contractility.
e u r o p e a n u r o l o g y 5 2 ( 2 0 0 7 ) 1 0 4 4 -1 0 5 1 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info AbstractObjectives: Numerous methods of calculating PSA velocity (PSAV) are used and have the potential to produce differing PSAV results from the same PSA data. We calculated PSAV using three common methods and compared differences between the methods and their predictive value for prostate cancer diagnosis. Methods: From a population-based database of PSA results, men with initial PSA < 10.0 ng/ml and a subsequent diagnosis of prostate cancer or benign histology were identified. Those with !3 PSA tests before diagnosis carried out over a minimum of 18 mo were included. PSAV was calculated by using three methods:1. Arithmetic equation of change in PSA over time (AE) 2. Linear regression (LR) 3. Rate of PSA change using first and last values only (FL)The differences between the methods and test characteristics of each method were compared. Results: Of the 2204 men included, 716 (32.5%) were diagnosed with prostate cancer and 1488 (67.5%) benign histology. PSAV differed markedly in each method of calculation. The LR and FL methods had similar predictive values, which were higher than the AE method. There was strong agreement for cancer diagnosis between LR and FL (kappa = 0.85), with weaker agreement between LR/AE and FL/AE (kappa = 0.69 and 0.66, respectively). Conclusions: Methods used to calculate PSAV using the same PSA data can produce markedly different results. Linear regression should be the method of choice for calculating PSAV. Using first and last PSA values only may be adequate for everyday clinical use, as long as measurements are separated by a sufficiently long time period.
The urethra generates sufficient tone to prevent leakage from the bladder and thus plays an important role in maintaining urinary continence. Despite this central role, relatively little is known about the mechanisms that underlie the generation and modulation of urethral tone, although it can be influenced by a number of factors including blood flow through the lamina propria . There is little doubt that a myogenic mechanism also contributes significantly to urethral tone, since it is unaffected in vitro by nerve blockade in a variety of species including pigs (Bridgewater et al. 1993), sheep (Thornbury et al. 1992, rats (McKeag et al. 2001) and humans .A number of studies have demonstrated that urethral myogenic tone is critically dependent on the influx of Ca 2+ across the cell membrane, since removal of external Ca 2+ or inhibition of L-type Ca 2+ channels reduces tone significantly in rats, humans and pigs in vitro (Bridgewater et al. 1993;Brading, 1999;Shafei et al. 2003). Shafei et al. (2003) have demonstrated that application of nifedipine or Ni 2+ significantly reduces tone in an isolated rat whole urethra preparation, suggesting that Ca 2+ influx through both T and L channels contributes to urethral tone. Recent studies by Bradley et al. (2003) have characterised the Ca 2 currents in isolated rabbit urethral myocytes and demonstrated the existence of currents with biophysical and pharmacological properties typical of L-and T-type Ca 2+ currents in arterial (Benham et al. 1987), venous (Yatani et al. 1987) and bladder myocytes (Sui et al. 2001).To date, no study has examined successfully the electrophysiology of human urethral myocytes, presumably because of the poor availability of suitable tissue and the difficulty of obtaining viable cells from small biopsy samples. In this study we provide the first electrophysiological data from freshly dispersed human myocytes obtained from adults undergoing treatment for bladder or prostate cancer. Our results suggest that human urethral myocytes possess Ca 2+ currents with electrophysiological and pharmacological properties typical of T and L channels (for reviews see Kotlikoff et al. 1999;Perez-Reyes, 2003 The purpose of the present study was to characterise Ca 2+ currents in smooth muscle cells isolated from biopsy samples taken from the proximal urethra of patients undergoing surgery for bladder or prostate cancer. Cells were studied at 37°C using the amphotericin B perforated-patch configuration of the patch-clamp technique. Currents were recorded using Cs
≥ 50 years had at least one PSA test. Men aged < 50 years accounted for 12.9% of first tests. The proportion of tests from primary care increased from 47.2% in 1993 to 67.0% in 1999. The mean age of men tested once decreased from 65.6 to 61.9 years ( P trend < 0.001) and the proportion with an elevated PSA level also declined during the period. Repeat testing increased with PSA level ( P < 0.001) but 29.4% of men with a PSA level of £ 4 ng/mL also had repeat testing. Raised PSA values were more common from hospital than primary care (32.4% vs 20.6%, P < 0.001) and in older men. Test rates varied 100-fold across general practices, a finding not explained by sociodemographic factors, but one which reflects differential adherence to national guidelines, suggesting that general practitioners are key targets for attempting to rationalise the use of the PSA test. CONCLUSIONThese findings suggest that PSA screening is taking place against evidence-based advice and has resulted in over 20 000 men being designated as having a raised PSA level, creating a need for further assessment. KEYWORDSprostate specific antigen, prostate cancer, screening, PSA OBJECTIVETo examine the pattern of use of prostatespecific antigen (PSA) testing in a UK region, where National Health Service policy does not recommend screening for prostate cancer. SUBJECTS AND METHODSData were collected on all PSA tests in Northern Ireland between 1990 and 1999. Annual rates of PSA testing were calculated by age, GP Practice and year. RESULTSIn all, 165 862 PSA tests were performed on 84 669 men, and over a third of men aged
Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39–83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6–66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required.
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