Showing papers in "BJUI in 2001"

How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study.

Abstract: Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions. Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged 40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms. Results In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment. Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.

Robotically‐assisted laparoscopic radical prostatectomy

Abstract: Laparoscopic radical prostatectomy was initially described in 1992 by Schuessler et al. [1]. In the last 2 years, the laparoscopic procedure has been standardized by Guillonneau and Vallancien [2] and others [3], and by last year had replaced the open retropubic approach in some centres. However, laparoscopic radical prostatectomy remains a complex operation. Besides perfect knowledge of the topographical anatomy, it demands training in speci®c laparoscopic skills, like endoscopic suturing and intracorporeal knotting, which require considerable practice to become pro®cient. A telerobotic surgical system (the da Vinci Surgical System, InSite Vision Systems, Intuitive Surgical Inc., Mountain View, CA, USA) was developed in 1999 and used immediately by cardiac surgeons. In this ®eld, it has heralded a new era in minimally invasive surgery by enhancing endoscopic vision and anastomotic suturing [4]. The objective of the present report was to determine whether the da Vinci system could be used to facilitate laparoscopic procedures in urology. We chose laparoscopic prostatectomy mainly because this operation requires perfect endoscopic vision and meticulous suturing within a limited space below the symphysis on the pelvic ̄oor.

Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis

Abstract: Objective To determine the need to standardize the number and location of lymph nodes to be removed during radical cystectomy in patients with invasive bladder carcinoma. Patients and methods The pelvic lymph nodes from 447 patients (mean age 62.8 years) who underwent radical cystectomy between 1986 and 1997 were evaluated. The number of lymph nodes was correlated with the depth of invasion of the primary tumour (pT), occurrence of nodal metastases, clinical outcome, the operating surgeons and the pathologists dissecting the nodes. Results The clinical follow-up was available for 302 patients (mean follow-up 38.7 months). The mean (range) number of lymph nodes removed was 14.7 (1–46). The number of lymph nodes removed varied significantly among different surgeons but not among pathologists. In pT3 and pT4 tumours, a more extended lymphadenectomy ( 16 lymph nodes) correlated with a higher percentage of patients with documented nodal metastases. There was a significant correlation between the number of lymph nodes removed and the tumour-free 5-year survival in patients with pT1, pT2 or pT3 tumours, and in patients with 1–5 positive lymph nodes (P < 0.01). Conclusion Extensive lymphadenectomy significantly improves the prognosis of patients with invasive bladder cancer and represents a potentially curative procedure in patients with nodal metastases, including micrometastases that may escape detection during routine histopathological evaluation. The results indicate the need for a standardized lymph node dissection.

The pharmacological treatment of urinary incontinence

Abstract: Metabolism classified as disturbances of storage or of emptying. Excretion Failure to store urine may lead to various forms of Physiological Animal models incontinence (mainly urge and stress incontinence), and Clinical phase I failure to empty can lead to urinary retention, which Clinical Trials may result in overflow incontinence. Theoretically, a ‘practice’ disturbed storage function can be improved by agents that decrease detrusor activity, increase bladder capacity and/or increase outlet resistance. Many drugs have been Bladder contraction tried, but the results are often disappointing, partly through poor treatment eBcacy and side-eCects [3]. The Normal bladder contraction in humans is mediated development of pharmacological treatment has been mainly through stimulation of muscarinic receptors in slow, and the use of some of the currently prescribed the detrusor muscle. Atropine resistance, i.e. contraction agents is founded more on tradition than on evidence of isolated bladder muscle in response to electrical nerve based on results from controlled clinical trials [4–8]. stimulation after pretreatment with atropine, has been In the present review of drugs in current use for the shown in most animal species, but seems to be of little treatment of urinary incontinence, agents specifically importance in normal human bladder muscle [1]. used to treat urinary tract infections and interstitial However, atropine-resistant (nonadrenergic, noncholcystitis have not been included. The currently used inergic, NANC) contractions have been reported in terminology conforms with the recommendations of the normal human detrusor and may be caused by ATP ICS. Drugs have been evaluated using diCerent types of [9–11]. A significant degree of atropine resistance may evidence (Table 1). Evidence of pharmacological and/or exist in morphologically and/or functionally changed physiological eBcacy means that a drug has been shown bladders, and has been reported to occur in hypertrophic to have desired eCects in relevant preclinical experiments bladders [12,13], interstitial cystitis [14], and in neuroor in healthy volunteers (or in experimental situations genic bladders [15]. The importance of the NANC compoin patients); the present clinical drug recommendations nent to detrusor contraction in vivo, normally, and in are based on evaluations made using a modification of diCerent micturition disorders, remains to be established. the grading of evidence found in the Agency for Health Care Policy and Research (AHCPR) guidelines (Table 2). Drugs used to treat bladder hyperactivity

The prevalence of Peyronie's disease: results of a large survey.

Abstract: Objectives To determine the prevalence of Peyronie's disease, a localized connective tissue disorder of the penile tunica albuginea, the symptoms of which include palpable plaque, painful erections and curvature of the penis, in a large sample of men in Germany. Subjects and methods A standardized questionnaire was sent to 8000 male inhabitants (age range 30–80 years) of the greater Cologne area (≈ 1.5 million inhabitants). Three questions about the self-diagnosis of Peyronie's disease were previously assessed for validity on 158 healthy men and 24 patients with confirmed Peyronie's disease. To optimize the response rate, the questionnaire was mailed three times to all the men. Results The response rate after the third mailing was 55.4% (4432 men); 142 men (3.2%, mean age 57.4 years, sd 13.4) reported the new appearance of a palpable plaque which, from the previous validation, was the most sensitive question and the main symptom of the disease. In men aged 30–39 years only 1.5% reported localized penile induration, compared with 3.0% in those 40–49 and 50–59 years, 4.0% in those 60–69 years and 6.5% of those > 70 years old. Newly occurring angulation was reported by 119 of the 142 men (84%) and painful erection by 66 (46.5%). The combination of the three symptoms (plaque, deviation and painful erection) was reported by 46 of the 4432 respondents (1.04%), i.e. 32% of the 142 men with penile induration; 58 of the 142 men (41%) reported erectile dysfunction. Conclusions This is the first large cross-sectional, community-based study to examine the prevalence of Peyronie's disease. Using previously validated questions the prevalence of Peyronie's disease in the sample was 3.2%; this is much higher than indicated in previous reports. A comparably high prevalence is reported for diabetes and urolithiasis, suggesting that this ‘rare’ disease is more widespread than previously thought.

Is transurethral resection of the prostate still justified

Abstract: (WW) to holmium-laser resection (Table 1). RCTs with Introduction a follow-up of <6 months and with a substantial number of patients in urinary retention preoperatively were For decades TURP was the undisputed gold standard of therapy for patients with LUTS due to BPH; however, excluded. within the past 10 years this role has increasingly been challenged by the development of medical (5a reductase The current morbidity of TURP inhibitors, a1-receptor blockers) and less invasive interventional alternatives [1–8]. The main driving forces Mortality after TURP has decreased substantially during the past 30 years and is <0.25% in contemporary TURP behind this development were the high prevalence of the disease, an absolute indication for surgery in only 5–10% series [10–16]. Horninger et al. reported no postoperative deaths in a consecutive series of 1211 patients underof patients with symptomatic BPH, recent technical innovations and, most importantly, the apparently going TURP between 1988 and 1991 [16]. In the 29 RCTs reviewed, no patient died within the first 6 weeks unchanged high morbidity of TURP [9–16]. As a result, the number of prostatectomies decreased substantially after surgery, reflecting advances in anaesthesia achieved during the past two decades. [17,18], e.g. in the USA the number of TURPs for BPH was 253 000 within the US Medicare Program in 1987 The major intraoperative complication of TURP and fell to 145 000 in 1994, a reduction of 43% [17]. This trend is also demonstrable in Europe, although less Table 1 Pertinent characteristics of the 29 RCTs analysed pronounced in countries with very extensive public healthcare systems [18]. Enthusiastic reports on the No. of patients* in success of alternative treatment options in the lay and No. of urological press seemed to herald the end of TURP as Method studies Reference(s) TURP Control the gold standard, perhaps best reflected by Stamey’s Open 1 20 43 32 quote in 1993 that ‘TURP is now a therapy of history’ Prostatectomy [19]. TUIP 6 21–26† 285 270 The objective of this review is to determine the current TUVP 4 27–30 199 189 status of TURP with particular reference to less invasive Holmium Laser 1 31 11 23 procedures and recent developments of transurethral VLAP 7 32–38 351 416 electrosurgery. To reliably assess this issue, we reviewed ILC 2 39, 40 41 60 the recent urological literature and, specifically, all 29 TUNA 2 41, 42 107 117 TUMT 2.5 2 43, 44 61 61 randomized clinical trials (RCTs) published between IRFT 1 45 25 25 1986 and 1998 comparing less-invasive treatment TUMT 2.0 1 46 32 37 options directly with TURP (Table 1) [20–48]. These 29 BDP 2 26†, 47 45 46 RCTs contain clinical information for a total of 3032 WW 1 48 280 276 patients, 1480 being randomized to TURP, 1552 to lessTotal 29 148

Asymptomatic inflammation and/or infection in benign prostatic hyperplasia

Abstract: Objective To determine the extent, pattern and clinical significance of asymptomatic histological inflammation and latent infection (National Institute of Health Category IV prostatitis) in benign prostatic hyperplasia (BPH). Patients and methods The study included 80 patients (from a cohort of 100 consecutive potentially eligible subjects) with a diagnosis of BPH, but no history or symptoms of prostatitis. Histological sections were obtained from specimens collected prospectively at transurethral resection of the prostate (TURP), immunostained for leukocyte common antigen and scanned using a computerized image-analysis system. Foci of inflammation were categorized as glandular, periglandular, stromal or peri-urethral, and the inflammatory cell density graded from 1 to 3. Relationships and correlations were calculated between the volume, degree and type of inflammation, presence and type of bacteria (culture of deep prostatic biopsies), the use of catheters and prostate specific antigen (PSA) levels. Results Inflammation was identified in all patients but the mean tissue surface area involved was only 1.1% of the total specimen, with periglandular inflammation being the predominant pattern (0.5%). Of the prostate specimens, 44% showed bacterial growth (in 67% of the catheterized patients and 28% of those uncatheterized; 42% of patients were catheterized before TURP). There was no significant difference between any combination of inflammation pattern, volume or grade of inflammation in those catheterized or not (P=0.15) or culture-positive (pathogenic or not) and culture-negative cases (P=0.06). Neither total PSA or PSA density was significantly correlated (P>0.05) with the amount, degree or distribution of inflammation. Conclusion Prostatic inflammation is an extremely common histological finding in patients with symptoms of BPH who have no symptoms of prostatitis. There was no correlation between the degree and pattern of inflammation, catheterization, presence of bacteria, serum PSA or PSA density. The clinical significance of asymptomatic Category IV chronic prostatitis associated with BPH has yet to be determined.

Antibiotic prophylaxis for transrectal needle biopsy of the prostate: a randomized controlled study.

Abstract: Objectives To determine the effect of antibiotic prophylaxis on infective complications after transrectal needle biopsy of the prostate Patients and methods Between June 1996 and September 1998, 231 patients who satisfied the inclusion and exclusion criteria entered the study; the patients were randomized into three groups Each patient underwent transrectal needle biopsy of the prostate after a cleansing enema at 06:00 hours Patients in group 1 (75) then received a placebo tablet twice a day for 3 days; those in group 2 (79) were given a single dose of ciprofloxacin (500 mg) and tinidazole (600 mg), while those in group 3 (77) were given the same combination twice a day for 3 days Urine cultures were obtained 48 h after the biopsy and blood cultures only from patients who developed fever The complications (categorized as infective or noninfective) occurring in the three groups were compared using the chi-square test Results Noninfective complications included were lower urinary tract symptoms, rectal bleeding, haematuria and perineal pain The infective complications included urinary tract infection and fever There was no significant difference among the three groups in noninfective complications (27, 29 and 31 in groups 1–3, respectively) but the incidence of infective complications (19, six and eight, respectively) was significantly higher in group 1 (P = 0003) However, the difference was significant only for urinary tract infection (P = 001) and not for fever Conclusions In selected patients a single dose of ciprofloxacin-tinidazole is adequate prophylaxis for transrectal needle biopsy of the prostate The present urinary infection rate was higher if no antibiotics were used Continuing the antibiotic prophylaxis for 3 days offered no benefit over single-dose prophylaxis

A systematic review of intravesical bacillus Calmette-Guérin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer

Abstract: Objective To assess, in a systematic review, the effectiveness of intravesical bacillus Calmette-Guerin (BCG) in preventing tumour recurrence in patients with medium/high risk Ta and T1 bladder cancer. Patients and methods An electronic database search of Medline, Embase, DARE, the Cochrane Library, Cancerlit, Healthstar and BIDS was undertaken, plus hand searching of the Proceedings of ASCO, for randomized controlled trials, in any language, comparing transurethral resection (TUR) alone with TUR followed by intravesical BCG in patients with Ta and T1 bladder cancer. Results The search identified 26 publications comparing TUR with TUR + BCG. Six trials were considered acceptable, representing 585 eligible patients, 281 in the TUR-alone group and 304 in the TUR + BCG group. The major clinical outcome chosen was tumour recurrence. The weighted mean log hazard ratio for the first recurrence, taken across all six trials, was −0.83 (95% confidence interval −0.57 to −1.08, P < 0.001), which is equivalent to a 56% reduction in the hazard, attributable to BCG. The Peto odds ratio for patients recurring at 12 months was 0.3 (95% confidence interval of 0.21–0.43, P < 0.001), significantly favouring BCG therapy. Manageable toxicities associated with intravesical BCG were cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%). No BCG-induced deaths were reported. Conclusion TUR with intravesical BCG provides a significantly better prophylaxis of tumour recurrence in Ta and T1 bladder cancer than TUR alone. Randomized trials are still needed to address the issues of BCG strain, dose and schedule, and to better quantify the effect on progression to invasive disease.

Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy

Abstract: Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy

The long‐term results of Anderson–Hynes pyeloplasty

Abstract: Objectives To examine the durability of open pyeloplasty for pelvi-ureteric junction obstruction Patients and methods The records of 56 Anderson-Hynes pyeloplasties undertaken by two surgeons between 1981 and 1994 were examined Attempts were made to trace all patients and for them to undergo diuretic renography to examine the current status of the operated renal unit Results In all, 41 evaluable patients were identified; 24 agreed to return for reassessment The mean (range) time from surgery was 106 (6–19) years The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%) Conclusions The Anderson–Hynes pyeloplasty is an excellent procedure for treating pelvi-ureteric junction obstruction, and produces a lasting improvement in function and drainage in most patients It is the ‘gold standard’ against which newer techniques should be compared

Augmentation cystoplasty: AUGMENTATION CYSTOPLASTY

Abstract: Many patients with small-capacity, high-pressure, poorly compliant or unstable bladders will be managed successfully with pharmacological or other conservative measures. A small but signi®cant minority of these patients will require surgical intervention, the therapeutic goals of which are to provide urinary storage whilst preserving renal function, continence, resistance to infection and convenient voluntary and complete emptying.

Mortality in the elderly in relation to nocturnal micturition.

Abstract: Objective To study the relationship between nocturnal micturition and mortality in an elderly population. Subjects and methods All 10 216 members of the Swedish pensioners’ association (SPF) in two Swedish counties were asked to participate in a questionnaire survey. The questions concerned the general state of health, occurrence of somatic diseases and symptoms, number of voiding episodes per night, everyday habits and behaviour, and the use of drugs. After 6 years, data on deaths were extracted from the National Register of Deaths at the National Central Bureau of Statistics in Stockholm. Results There were 6143 evaluable questionnaires, of which 39.5% were from men. The mean (sd) ages of the men and women participating were 73.0 (6.0) and 72.6 (6.7) years, respectively. During a 54-month period after the questionnaire was completed, 444 of the men and 384 of the women died. The men with three or more nocturnal voiding episodes had a higher death rate, at 1.9 (1.4–2.6) times more than the whole group of men (3.4% vs 1.9% per 6 months; P<0.001), and the corresponding women a death rate 1.3 (0.9–2.0) times higher than all women (1.4% vs 1.1% per 6 months, not significant). In a multiple logistic regression analysis, significant independent correlates of death during the study period were: being 70–79 years vs <70 years (odds ratio, OR, 1.92, 95% CI 1.52–2.43), being ≥80 years vs <70 years (5.14, 3.96–6.68), female gender (0.44, 0.37–0.52), health (1.81, 1.46–2.25), negative health development (1.70, 1.40–2.06), spasmodic chest pain (1.38, 1.09–1.74), diabetes (1.59, 1.18–2.15), stroke (1.82, 1.12–2.93), and three or more vs two or fewer voiding episodes (1.34, 1.01–1.79). Conclusion Elderly people who need to void three or more times per night had a greater mortality rate over a 54-month observation period than those voiding less often.

Vascular risk factors and erectile dysfunction.

Abstract: Until the 1980s the aetiology of erectile dysfunction (ED) was thought to be primarily psychogenic. However, as investigative techniques have improved, organic contributions to aetiology have now been documented in up to 80% of men with ED. The penis is a specialized vascular bed and not surprisingly ED often has a vasculogenic origin. The ®rst indications of an association of ED with cardiovascular risk factors came from several studies. In 1948, Kinsey et al. [1] produced the most extensive population-based source of normative data on male sexual behaviour; 15 871 men were surveyed and the authors concluded that there is decline in sexual activity and erectile function with age. The social and medical context of that study obviously differed greatly from the current situation and somewhat limits the applicability of the ®ndings. McCulloch et al. [2], in a prospective study using questionnaires, assessed the incidence of ED in the male diabetic population; in a survey of 541 diabetic men, 190 (35%) had ED. The ®ve most signi®cant associations with ED were age, retinopathy, symptomatic peripheral neuropathy, treatment with either insulin or oral hypoglycaemic agents, and symptomatic autonomic neuropathy. The duration of diabetes, presence of ischaemic heart disease, nephropathy and poor diabetic control were also thought to be associated with diabetic ED. Virag et al. [3], in a retrospective study, assessed 440 men with ED and found diabetes mellitus (DM), hypertension, hyperlipidaemia and smoking to be independent risk factors for arterial impotence. Shabsigh et al. [4] in a prospective study of 132 men with ED, examined three vascular risk factors, i.e. smoking, DM and hypertension, and their effect on vasculogenic impotence. Vascular function was evaluated using papaverine injection and penile duplex ultrasonography; these showed a signi®cant increase in penile vascular impairment as the number of vascular risk factors increased. Wei et al. [5] assessed 3250 men with no ED who were followed for up to 4 years in a prospective study. In those who developed ED, high total cholesterol (each 1 mmol/L increase in total cholesterol was associated with a 1.32-fold greater risk of ED) and a low concentration of high-density lipoprotein (HDL, each 1 mmol/L decrease in HDL was associated with a 2.6-fold greater risk of ED) were reported as signi®cant risk factors for ED. Feldman et al. [6] and Johannes et al. [7] both reported results from the Massachusetts Male Aging study, a community-based, multidisciplinary survey of 1290 men, which provided the ®rst comprehensive new data from a healthy population since the study by Kinsey et al. [1]. Increasing age was the variable most strongly associated with the development of ED. Ischaemic heart disease, hypertension, DM, low HDL and lower education also correlated with a higher probability of ED. The authors concluded that many of these factors were modi®able, and could be improved with the right public health policy and clinical management. More recently there has been an attempt to examine ED and the presence of vascular disease outside the penile bed. Kaiser et al. [8] showed that the presence of arteriogenic ED (using penile Doppler ultrasonography) was associated with a high prevalence of clinically apparent atherosclerosis, particularly in men aged >50 years. Greenstein et al. [9], in a study of 45 men assessed using questionnaires, reported a signi®cant correlation between the number of coronary vessels occluded on angiography and the presence of ED. These studies have obvious implications for the holistic management of the patient.

Consensus development of a histopathological classification system for chronic prostatic inflammation

Abstract: Objective To develop a standardized histopathological classification system for chronic prostatitis (standardized description of prostatic inflammatory infiltrates) based on a literature review, extensive prospective evaluations in two recognized prostatitis research centres and widespread consensus of international urological centres identified as having major expertise or interest in chronic prostatitis. Methods Relevant articles for review were identified by a Medline search undertaken by the Cochrane Review Group in Prostate Diseases and Urologic Malignancies, and cross-checking bibliographies of retrieved studies, reviews, book chapters and abstracts of the American Urological Association and International Prostatitis Collaborative Network Annual Meetings. Initial drafts were based on classification systems independently developed by the Prostatitis Research Centers at Queen's University in Canada and University of Washington in the USA. A collaborative draft was distributed to 20 urological/pathological clinical centres who participated in the North American Chronic Prostatitis Collaborative Research Network and First International Prostatitis Collaborative Network. A consensus classification system was then distributed to the participating panel for acceptance. Results The literature review identified a reasonably consistent description of inflammatory infiltrate locations and patterns that were further incorporated into the draft based on the Queen's University and University of Washington proposals. Eighteen (90%) of the identified Prostatitis Centers participated in the revision of the draft and the final consensus process. The final consensus document classifies prostatic inflammation according to its extent and grade/severity in each tissue compartment (location). Conclusion The consensus of the expert panel was that this classification system can be used in the evaluation of prostatic inflammation in prostate biopsies, transurethral resected prostate chips or prostatectomy specimens. A standardized accepted framework to describe histopathological prostate inflammation will prove useful in evaluating prostate disease.

Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners.

Abstract: Objective To assess psychometrically a new questionnaire for measuring the psychosocial morbidity in patients with prostate cancer and in their partners, and to compare the morbidity of patients and their partners. Patients and methods A sequential sample of patients with any stage of prostate cancer and attending general urology outpatient clinics was identified. The questionnaire was administered to 135 patients and their partners in their homes. The Hospital Anxiety and Depression Scale (HADS) questionnaire was also administered to permit construct validation of the new measure. Test-retest reliability was calculated by re-administering the questionnaire to 60 individuals. The hypothetical general cancer distress and social subscales of the questionnaire were also tested for internal consistency. Psychosocial morbidity scores obtained by the patients and partners were compared. Results The questionnaire had good test-retest reliability and construct validity when tested against the HADS. The general cancer distress and social subscales were internally consistent. General cancer distress was highly prevalent and significantly more severe in partners than in patients. There was some degree of general cancer distress in 47% of patients and 76% of partners, whereas severe distress was detected in 11% and 30%, respectively. Social morbidity was limited and of equal severity between the groups. Treatment-related worries and concerns about pain and physical limitation were more common among partners than patients, whereas there was no difference for worries about urinary symptoms. Sexual concerns were the least prevalent and were more of a problem for patients than partners. Conclusion Psychosocial morbidity in prostate cancer is highly prevalent, not only among patients but particularly among their partners. The new questionnaire showed adequate psychometric properties for use in identifying individuals with significant psychosocial morbidity. Applying the questionnaire should permit emotional and informational support to be targeted at the most vulnerable.

A multi-institutional analysis of laparoscopic orchidopexy.

Abstract: Objective To combine and analyse the results from centres with a large experience of laparoscopy for the impalpable testis with small series, to determine the expected success rate for laparoscopic orchidopexy. Methods A questionnaire was distributed to participating paediatric urologists; each contributor retrospectively reviewed the clinical charts for their cases of therapeutic laparoscopy for an impalpable testis, detailing 36 variables for each patient. The data were collated centrally into a computerized database. For inclusion, the testis was intra-abdominal (including ‘peeping’ at the internal ring) at laparoscopic examination, was not managed through an open approach and did not undergo orchidectomy. Three surgical groups were assessed, with success defined as lack of atrophy and intrascrotal position: group 1, primary laparoscopic orchidopexy; group 2, a one-stage Fowler-Stephens (F-S) orchidopexy; and group 3, a two-stage F-S orchidopexy. Results Data were gathered from 10 centres in the USA, covering the period 1990–1999; 252 patients representing 310 testes were included and overall, 15.2% were lost to follow-up. There was no significant difference between success rates in the larger and smaller series. Atrophy occurred in 2.2% of 178 testes, 22.2% of 27 testes and 10.3% of 58 testes in groups 1–3, respectively. Testes were not in a satisfactory scrotal position in 0.6%, 7.4% and 1.7% of groups 1–3, respectively. The mean follow-up for each group was 7.7, 8.6 and 20.0 months, respectively. The overall success for all groups was 92.8% (97.2% group 1; 74.1% group 2; 87.9% group 3), with an atrophy rate of 6.1%. Conclusion Laparoscopic orchidopexy for the intra-abdominal testis, in both large and small series, can be expected to have a success rate higher than that historically ascribed to open orchidopexy. Within this series, single-stage F-S laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the two-stage repair. However, when considering both F-S approaches, the laparoscopic approach gave greater success than previously reported for the same open approaches. Despite the weaknesses inherent in a retrospective unrandomized study, we conclude that laparoscopic orchidopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testicle.

Cytoplasmic induction and over-expression of cyclooxygenase-2 in human prostate cancer: implications for prevention and treatment

Abstract: Objective To assess the level and morphological distribution of cyclooxygenase (COX)-1 and -2 in human prostates and to determine any association with the Gleason grade of prostate cancer. Materials and methods The study comprised 30 samples from patients with benign prostatic hyperplasia (BPH) and 82 with prostate cancer. Immunohistochemistry was used to assess the expression of COX-1 and -2, and 13 samples were also assessed using immunoblotting (six BPH and seven cancers). Results For both BPH and prostate cancer, COX-1 expression was primarily in the fibromuscular stroma, with variable weak cytoplasmic expression in glandular/neoplastic epithelial cells. In contrast, COX-2 expression differed markedly between BPH and cancer. In BPH there was membranous expression of COX-2 in luminal glandular cells and no stromal expression. In cancer the stromal expression of COX-2 was unaltered, but expression by tumour cells was significantly greater (P = 0.008), with a change in the staining pattern from membranous to cytoplasmic (P < 0.001). COX-2 expression was significantly higher in poorly differentiated than in well differentiated tumours (P < 0.001). These results were supported by immunoblotting, which showed similar levels of COX-1 in both BPH and cancer, but four times greater expression of COX-2 in cancer than in BPH. Conclusion This is the first study to assess the co-expression of COX-1 and COX-2 proteins in benign and malignant human prostates, and showed the induction and significantly greater expression of COX-2 in cancer, which was also associated with tumour grade. The regular use of nonsteroidal anti-inflammatory drugs is associated with a reduced incidence of cancers. The present results provide the basis for a potential role for COX-2 inhibitors in the prevention and treatment of prostate cancer.

Prevalence of lower urinary tract symptoms and self-reported diagnosed 'benign prostatic hyperplasia', and their effect on quality of life in a community-based survey of men in the UK.

Abstract: Objectives To assess the prevalence of lower urinary tract symptoms (LUTS) in a community-based population in the UK, to measure the impact of these symptoms on quality of life and health status in men with self-reported ‘benign prostatic hyperplasia’ (‘BPH’), and to evaluate health-seeking behaviour in this population. Subjects and methods A postal survey was distributed to an age-stratified random sample of 1500 men aged 50 years or older from throughout England, Scotland and Wales. The self-administered survey included: demographic questions; the EuroQoL (EQ-5D) instrument, consisting of a health-status index questionnaire and a visual analogue scale (VAS) on which participants rated their current health status; the International Prostate Symptom Score (IPSS) questionnaire; and a questionnaire assessing the participants’ health-seeking behaviour and awareness of BPH. Results Responses to the survey were received from 1115 (74%) of the 1500 men. Overall, 41% (450/ 1088) had an IPSS of ≥8, indicating moderate-to-severe LUTS, yet only 196 men (18%) reported that they had been diagnosed with ‘BPH’. Both quality of life (as measured by the EQ-5D) and general health status (as measured by the VAS) decreased as urinary symptom severity increased, and the greater the severity, the more men who reported a problem with mobility, self-care, usual activity, pain/discomfort, and anxiety/depression (the five domains of the EQ-5D). The possibility of symptoms worsening appeared to be the key determinant in the respondents’ decisions to consult a medical professional for their LUTS. Less than 11% of the respondents were aware of the availability of specific prescription drug therapies or surgical options for the treatment of ‘BPH’. The most common first treatment strategy for those consulting for symptoms was watchful waiting (34%), followed by surgery (30%) and prescription drugs (21%). Conclusions Moderate-to-severe LUTS were relatively common in this UK population of men over the age of 50, yet relatively few had been diagnosed with ‘BPH’. As LUTS adversely affect quality of life, improved treatment options and increased public awareness of BPH and LUTS are needed to combat a problem facing the growing number of elderly men in the population.

Lymphadenectomy for squamous cell carcinoma of the penis. Part 2: the role and technique of lymph node dissection.

Abstract: There is no controversy about the need for surgery in patients with nodal invasion; about half of these patients can be cured with adequate surgery (Table 1) [1±5]. However, controversy remains about the extent of surgery. Should patients with unilateral involvement undergo bilateral lymphadenectomy? Should inguinal lymphadenectomy always be followed by pelvic lymphadenectomy? The treatment strategy in this group of patients should focus on measures that decrease the morbidity associated with lymph node resection. Up to 84% of the patients have shortor long-term complications (Table 2) [1,6±26]. With the advent of effective chemotherapy there is a further need to identify patients who could bene®t from neoadjuvant or adjuvant treatment. Surgery in patients with a low metastatic load gives excellent survival probabilities (Table 1). Hence the general advice is to undertake lymphadenectomy in all patients, preferably before the advent of clinical signs (apart from patients with carcinoma in situ or small nonin®ltrating tumours). In almost 60% of the patients no single metastasis is found in the resected specimen [11,14,17±21,25,27±36]. Thus this advice leads to exposing all patients to the potential morbidity of lymphadenectomy, with bene®t to only 40% at most. For many years there has been controversy between the proponents of lymphadenectomy at an early stage, before any clinical signs, and lymphadenectomy at the ®rst sign of lymph node involvement, so-called `delayed lymphadenectomy'. The treatment strategy in this group of patients should focus on methods of timely identi®cation of metastasis, to decrease the number of unnecessary operations and to identify patients who could bene®t from lymphadenectomy. This review will focus on these controversial issues and the management strategy developed at the author's institute will be discussed. The role of lymphadenectomy

A placebo‐controlled, multicentre study comparing the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence

Abstract: Objective To assess the tolerability and efficacy of propiverine and oxybutynin in patients with urgency and urge incontinence in a randomized, double-blind placebo-controlled clinical trial. Patients and methods In all, 366 patients (149 on propiverine, 145 oxybutynin and 72 placebo, ratio 2:2:1) with urgency and urge incontinence were recruited in 32 study centres. Propiverine (group 1, 15 mg three times daily), oxybutynin (group 2, 5 mg twice daily) or placebo (group 3) were administered for 4 weeks, using the double-dummy technique. The dosages were selected specifically to compare the tolerability profile of propiverine with the commonly used therapeutic dosage of oxybutynin. Tolerability was assessed by directly questioning the patients about adverse events at four visits (V-1 before and V0 after a 1-week ‘washout’ period, V1 after 1 week and V4 after 4 weeks of treatment) during a 5-week surveillance period, and by tolerability ratings of the physicians. Efficacy was assessed using urodynamics at V0 and V4, evaluating the cystometric bladder capacity at maximal and first desire to void, and postvoid residual urine, according to the criteria of the International Continence Society. Additionally, a voiding protocol, overall assessment of clinical symptomatology and efficacy ratings by the physicians were documented. Results A remarkably high percentage of adverse events was reported in the washout period (VO: 13%, 16% and 18% in groups 1–3, respectively). At V4, the clinically most relevant symptom (dry mouth) occurred in 53% of patients in group 1, in 67% of group 2 and in 28% of group 3. Furthermore, dry mouth was less severe in group 1 than group 2. In contrast to groups 2 and 3, only patients in group 1 showed increasing tolerability during the treatment (from V1 to V4). These tolerability results were further supported by the overall tolerability assessment (‘very good’ or ‘good’ tolerability in 67% of group 1, in 59% of group 2 and in 83% of group 3). The urodynamic assessment of efficacy (comparing V0 and V4) showed a statistically significant increase in the mean (sd) maximal cystometric bladder capacity in group 1, being 222 (77) mL at V0 and 311 (125) mL at V4, an increase of 89 (108) mL, and in group 2, at 226 (75) mL and 322 (123) mL, an increase of 96 (106) mL, compared with group 3, at 211 (77) mL and 263 (93) mL, an increase of only 52 (92) mL. The cystometric bladder capacity at first desire to void also increased in group 1 (93 to 160 mL) and group 2 (89 to 160 mL), whereas in group 3 there were only minor changes (93 to 120 mL). Changes in the residual urine volume within and between the treatment groups were minimal and clinically irrelevant. The overall assessment of efficacy showed significant differences between the drugs when compared with placebo. Conclusion Propiverine is a safe and effective drug in the treatment of urgency and urge incontinence; it is as effective as oxybutynin, but the incidence of dry mouth and its severity is less with propiverine than with oxybutynin. The availability of alternative pharmacotherapeutics such as propiverine should reduce the therapeutic failure rate and improves the success rate in the treatment of patients suffering from urgency and urge incontinence.

Retroperitoneoscopic dismembered pyeloplasty for pelvi-ureteric junction obstruction in infants and children

Abstract: Objective To report our initial experience of endoscopic dismembered pyeloplasty through a retroperitoneal approach in infants and children with pelvi-ureteric junction (PUJ) obstruction. Patients and methods Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years, range 0.25–10). Nine patients presented with complications secondary to PUJ obstruction, including urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other four patients had recurrent loin pain secondary to intermittent PUJ obstruction. The patient was placed in semi-prone (for left-sided) or a semilateral position (for right-sided PUJ obstruction). The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent. Results The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. The mean (range) operative duration was 143 (103–235) min. All patients had a rapid and uneventful recovery. The drainage was satisfactory in all 12 patients on a follow-up scan. Conclusions Retroperitoneoscopic dismembered pyeloplasty is effective and safe in infants and young children giving a good early outcome, although the long-term results await further studies.

Capsaicin receptor VR1 and ATP-gated ion channel P2X3 in human urinary bladder.

Abstract: Objectives To determine the presence, distribution and molecular forms of the vanilloid receptor VR1, and confirm the presence and distribution of the ATP-gated ion channel P2X3 in the human urinary bladder. Materials and methods Normal urinary bladder tissues were obtained at postmortem from four subjects. Eight urinary bladder biopsies were also taken from patients with detrusor hyper-reflexia treated with intravesical resiniferatoxin. The specimens were studied using affinity-purified specific antibodies to VR1 and P2X3 by Western blotting and immunocytochemistry, and compared with immunostaining using antibodies to the pan-neuronal marker PGP 9.5 and Schwann cell marker S-100. Results VR1- and P2X3-immunoreactive fine nerve fibres were scattered throughout the suburothelium of the normal bladder and cystoscopic biopsies, and traversed the muscle layer. They had a similar distribution to PGP 9.5-immunoreactive fibres, but there were fewer, suggesting localization in subsets of axons. Western blot studies showed an expected 100-kDa VR1 protein and a P2X3-immunoreactive 66-kDa protein. Conclusion VR1 and P2X3 are present in the human urinary bladder and may contribute to distinct pathophysiological states of bladder overactivity, in accord with their differential expression in sensory neurones. Intravesical vanilloids act via VR1 and are effective in the treatment of detrusor hyper-reflexia. P2X3 may represent a selective therapeutic target for other causes of overactive bladder.

Male‐to‐female transsexualism: a technique, results and long‐term follow‐up in 66 patients

Abstract: Objective To report experience of a new surgical technique in male-to-female transsexual patients, the complications, and the functional and psychosocial long-term results. Patients and methods From April 1995 to July 2000, 66 male patients underwent gender-transforming surgery at our institution and were registered prospectively. The operation should result in a normal appearing introitus, a vaginoplasty allowing for sexual intercourse and a sensitive clitoris. This was achieved by preserving the neurovascular bundle. The glans was transformed into a clitoris, the phallic cylinder used as a vagina and labia were formed from the scrotal folds. Results Major complications during, immediately and some time after surgery occurred in nine of the 66 patients (14%), including severe wound infections in six, a rectal lesion in three, necrosis of the glans in three and necrosis of the distal urethra in one. Minor complications, e.g. meatal stenosis in seven patients, occurred in 24 (36%) of patients. Ten patients with insufficient penile skin had the phallic cylinder augmented with a free-skin mesh graft, but in three of these patients an ileal augmentation was finally constructed because scarring occurred at the suture line between the penile skin and the augmented graft. A long-term follow-up questionnaire about the functional and psychosocial aspects was completed by 31 patients. More than 90% of the patients were satisfied with the cosmetic result and capacity for orgasm; 58% reported having sexual intercourse. Conclusion Male-to-female surgery can achieve excellent cosmetic and functional results. Although the operative technique is partly standardized, surgery remains challenging because of several possible complications. None of the present patients claimed to regret their decision to undergo gender-transforming surgery.

An epidemiological study of enuresis in Korean children

Abstract: Objective To estimate the prevalence of enuresis in children of elementary school age, to evaluate the impact of enuresis on these children and their parents, and to identify the methods and effectiveness of managing enuresis. Subjects and methods A randomly selected cross-sectional study was conducted in one elementary school in each urban ward (nine schools) in Pusan, Korea. The parents of these 12 570 children aged 7–12 years were asked to complete questionnaires which included items about the presence and frequency of enuresis, its perceived impact and management. Enuresis was defined as an episode of wetting occurring at least once per month. Results The overall response rate to the questionnaire was 55.8% (girls 28.2%, boys 27.6%). The prevalence of nocturnal, diurnal and combined enuresis was 9.2%, 2.2% and 1.4%, respectively. The overall prevalence of enuresis declined with age from 20.4% at 7 years old to 5.6% at 12 years old; 342 (57.0%) parents and 318 (55.6%) children were concerned about enuresis. The common self-help strategies were waking the child at night to void (38.1%) and restriction of water intake (25.7%). Of the enuretic children, only 13.7% had consulted a health worker. Conclusion The prevalence rates for enuresis in Pusan are similar to those reported from European countries. Enuretic children and their parents were moderately concerned about enuresis and the parents primarily used self-management within the family.

Effect of oral administration of high‐dose nitric oxide donor l‐arginine in men with organic erectile dysfunction: results of a double‐blind, randomized, placebo‐controlled study

Abstract: Objectives To determine, in a prospective randomized, double-blind placebo-controlled study, the effect of 6 weeks of high-dose (5 g/day) orally administered nitric oxide (NO) donor l-arginine on men with organic erectile dysfunction (ED). Patients and methods The study included 50 men with confirmed organic ED who were randomized after a 2-week placebo run-in period to receive l-arginine or placebo. A detailed medical and sexual history, O’Leary's questionnaire, a specially designed sexual function questionnaire and a sexual activity diary were obtained for each patient. All participants underwent a complete physical examination including an assessment of bulbocavernosus reflex and penile haemodynamics. Plasma and urine nitrite and nitrate (designated NOx ), both stable metabolites of nitric oxide, were determined at the end of the placebo run-in period, and after 3 and 6 weeks. Results Nine of 29 (31%) patients taking l-arginine and two of 17 controls reported a significant subjective improvement in sexual function. All objective variables assessed remained unchanged. All nine patients treated with l-arginine and who had subjectively improved sexual performance had had an initially low urinary NOx , and this level had doubled at the end of the study. Conclusions Oral administration of l-arginine in high doses seems to cause significant subjective improvement in sexual function in men with organic ED only if they have decreased NOx excretion or production. The haemodynamics of the corpus cavernosum were not affected by oral l-arginine at the dosage used.

The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra.

Abstract: Objective To compare the surgical outcome using buccal mucosal free grafts in the Barbagli procedure (dorsal stricturotomy and patch technique) with the traditional ventral approach, for long bulbar urethral strictures. Patients and methods Over a period of 6 years, a total of 71 patients with bulbar urethral strictures underwent buccal mucosal graft urethroplasty. Twenty-nine patients had a traditional ventral urethroplasty and 42 were managed by the Barbagli procedure with the stricturotomy and patch on the dorsal aspect of the urethra. Results At 5 years of follow-up 5% of patients who underwent the Barbagli procedure developed recurrent strictures, compared to 14% in the traditional ventral stricturotomy group. All patients developed postmicturition dribble of urine to some degree, which was troublesome in 17% in the Barbagli group and 21% in the ventral stricturotomy group. Complications attributable to out-pouching of the graft were not seen in either group. Conclusions The dorsal stricturotomy and patch (Barbagli) procedure had a higher success rate than the traditional ventral urethroplasty. Comparing these results with our experience of skin inlay urethroplasty, buccal mucosal grafts seem to have advantages however they are used.

Quality‐of‐life aspects of the overactive bladder and the effect of treatment with tolterodine

Abstract: more to issues relevant to the patient and the clinician, Introduction and can thus be used to determine whether a desired treatment eCect has been achieved or not. Several The overactive bladder (OAB) is a multisymptomatic problem that aCects people of both sexes and all ages, instruments have been developed specifically for urinary incontinence, including the Incontinence Impact although it is more prevalent in the elderly [1–5]. The OAB is defined as urgency and frequency with or without Questionnaire (IIQ) and the Urinary Distress Inventory (UDI) [16], the York Incontinence Perception Scale urge incontinence. Urinary incontinence and urgency/ frequency have been shown to aCect a patient’s physical, (YIPS) [17], the Incontinence Quality of Life (IQoL) [18], the Incontinence Quality of Life Index (IQoLI) [19] social and emotional well-being [6–12]; the eBcacy of any treatment is generally measured as a decrease in and the King’s Health Questionnaire (KHQ) [20]. The two types of instruments are complementary and the frequency of incontinence. While such clinical eBcacy measures (often surrogate endpoints) are of great generally, they are combined in QoL research. The objective of this review is to discuss the impact value and particularly important in clinical trials, they fail to address the patients’ concept of disease burden on QoL of the OAB and analyse the improvements that can be achieved with an eCective and well-tolerated drug and the consequences of treatment from the patients’ perspective. Measuring these patient-derived values is such as tolterodine. We used the SF36 and the EuroQol to assess the impact of the OAB on patients’ well-being, therefore important, as patients are paying a larger part of treatment costs and health outcomes are increasingly and the IQoLI and the KHQ to investigate the eCect of treatment with tolterodine. The IQoLI was tested for use evaluated from the patients’ view. The benefits of specific treatments and of the healthcare delivery system in in a clinical trial setting and the KHQ, so far only validated with female patients, was also validated for general will be judged in terms of the extent to which changes in patients’ functioning or well-being meet their use in men. needs and expectations. Subjective quality of life (QoL) can be objectively Disease impact measured and several instruments have been developed, validated and used extensively. Generic instruments The SF36, a generic instrument, was used both in crosssuch as the MOS Short Form (SF) 36 [13] provide a sectional surveys and in clinical trials. The instrument profile of the patients’ QoL covering several health includes 36 questions with multiple answers that are concepts, generally grouped in physical, mental and grouped into eight subscales measuring eight health social domains. Instruments such as the EuroQol EQ-5D concepts or domains. Each subscale is scored individually [14,15] measure QoL as an index and provide a healthbetween 0 (worst) and 100 (best). It was integrated in state classification system that allows their use in costtwo large ‘willingness-to-pay’ (WTP) surveys in Sweden utility analyses. The advantage of generic measures is [21] and in the USA [22] of patients with urge and/or that they are more comprehensive and allow comparimixed incontinence. Scores were correlated with selfson across populations and diseases. However, they are reported symptoms of frequency and incontinence, and generally not sensitive enough to detect small changes to the amounts that patients were willing to pay for caused by treatment. Specific measures are targeted symptom relief, to estimate the impact of the syndrome on patients’ QoL. It was also used in a clinical study comparing tolterodine with oxybutynin and placebo over Accepted for publication 3 December 1998

Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland

Abstract: Objective To determine the occurrence of mental distress related to prostatitis in Finnish men. Subjects and methods A population-based cross-sectional survey was conducted of 2500 men aged 20–59 years living in the two northernmost provinces of Finland (Oulu and Lapland). The final response rate was 75% (1832 men). Results The fear of undetected prostate cancer was reported by 17% of the men in the population who had had prostatitis, a value significantly higher (P < 0.001) than in healthy men. Fears of having a sexually transmitted disease and suicidal thinking were also slightly more common. The men who had had prostatitis preferred to be alone in a public toilet during voiding (58% vs 44%, P < 0.001). Erectile dysfunction was reported by 43% of the men with symptomatic prostatitis and decreased libido by 24%. Self-assessment of personality, adjusted for age, showed that the men with prostatitis were more often busy and nervous than the healthy controls (P < 0.001), and that they had a more meticulous attitude to life and its problems. Marital difficulties were reported by 17% of the men who had had prostatitis at some point in their lives, and 4% were convinced that their illness had caused their divorce. Socio-economic status and social well-being had no apparent influence on the occurrence of prostatitis. Conclusions This survey showed that psychological stress is common in men with prostatitis. Urologists and general practitioners should consider that a consultation with a psychiatrist may be appropriate for selected men with prostatitis.

Phenotypic and genotypic characterization of commonly used human prostatic cell lines

Abstract: Objective To investigate and catalogue systematically the phenotypic and genotypic characteristics of the commonly used prostatic cell lines using immunocytochemistry and polymerase chain reaction (PCR) of hypervariable sequences within the genome to provide a ‘fingerprint’ characteristic of each cell line. Materials and methods Malignant (LNCaP, LNCaP-r, PC-3, DU-145) and benign immortalized prostatic cell lines (PNT-1A, PNT-1B, BPH-1) were grown on four-well slides, fixed and subjected to indirect streptavidin-biotin immunocytochemistry. Twenty-three antibodies were used in the following groups: cytoskeletal elements: cytokeratins (CK)-5, -7, -8, -14 (two), -16, -18, -19 (three), -20, vimentin and desmin; MUC1 (three); cell adhesion molecules (E-cadherin, α-β-and γ-catenin); and prostatic associated proteins: prostate specific antigen (PSA), prostatic acid phosphatase (PAP) and androgen receptor (AR). For the PCR, genomic DNA was extracted from the cell lines and from SKOV3 and MCF7 (positive controls). PCR was performed on three variable regions which were then sequenced: AR exon 1 (CAG repeat polymorphism), and two areas of microsatellite instability (MSI): AR exon 8 and hypoxanthine-guanine phosphoribosyl transferase (HPRT) exon 3. Results All cell lines were CK-8/18 positive and most also expressed CK-7 and -19. Heterogeneous CK-20 expression was detected for the first time in prostatic cell lines. All lines were positive for vimentin and negative for desmin. MUC1 was expressed in one malignant (DU-145) and all immortalized cell lines. E-cadherin expression was low or absent in three lines: PNT1A, 1B and PC-3. Only PC-3 failed to express α-catenin; β- and γ-catenin were expressed by all lines. PSA, PAP and AR were only expressed by LNCaP and LNCaP-r. On PCR, the CAG repeat lengths in exon 1 of the AR ranged from 19 to 27. Three pairs of cell lines had the same exon 1 CAG repeat length: LNCaP/PC-3 (26 repeats), BPH-1/DU-145 (19 repeats) and PNT1 A/1B (20 repeats). Exon 8 sequences were identical except for LNCaP, which showed a single base mutation, and HPRT exon 3 sequences were all identical. There was no evidence of generalized MSI in any of the cell lines examined. Conclusions The cell lines studied fell into three broad groups according to their phenotypic characteristics: (i) prostatic marker positive (LNCaP and LNCaP-r); (ii) high expression of most antigens (DU-145, PC-3 and BPH-1); and (iii) low or absent expression of most antigens (PNT1 A and 1B). Each of the cell lines derived from PC could be identified on the basis of exon 1 and 8 AR sequence variability. DU145 and BPH-1 had identical profiles of the three areas studied, but these cell lines are easily distinguished by their different phenotypic characteristics. PNT1A and 1B had identical genetic and similar phenotypic profiles, which is unsurprising given that they are subclones derived from the same parental line. Even so, these were separable on the basis of CK-19 immunostaining. Using a combination of geno- and phenotypic markers it was possible to derive a ‘fingerprint’ for each of the cell lines assessed, which will allow meaningful comparison between similar cell lines held in other laboratories.