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The article discusses the history of freedom of speech and civil liberties laws and litigation in America's Court of Appeals for the Second Circuit as of 2016, and it mentions legal developments and cases involving the First Amendment to the U.S. Constitution. English law and courts are addressed, along with several American appellate court cases which deal with topics such as potential violations of the U.S. Espionage Act, libel law, and obscenity.

Presents abstracts of articles about surgery of LUT dysfunction, to be discussed at the Annual Scientific Meeting of the British Association of Urological Surgeons from June 23-27, 2003 in Manchester, England. `Who treats urethral strictures and how?,' by A.R. Mundy et al.; `Early experience with a xenograft pubovaginal sling,' by O.J. Clyne et al.

Background: Lower urinary tract symptoms (LUTS) in men may indicate bladder outlet obstruction (BOO) or weakness, known as detrusor underactivity (DU). Severe bothersome LUTS are a common indication for surgery. The diagnostic tests may include urodynamics (UDS) to confirm whether BOO or DU is the cause, potentially reducing the number of people receiving (inappropriate) surgery., Objectives: The primary objective was to determine whether a care pathway including UDS is no worse for symptom outcome than one in which it is omitted, at 18 months after randomisation. Rates of surgery was the key secondary outcome., Design: This was a pragmatic, multicentre, two-arm (unblinded) randomised controlled trial, incorporating a health economic analysis and qualitative research., Setting: Urology departments of 26 NHS hospitals in England., Participants: Men (aged ≥ 18 years) seeking further treatment, potentially including surgery, for bothersome LUTS. Exclusion criteria were as follows: unable to pass urine without a catheter, having a relevant neurological disease, currently undergoing treatment for prostate or bladder cancer, previously had prostate surgery, not medically fit for surgery and/or unwilling to be randomised., Interventions: Men were randomised to a care pathway based on non-invasive routine tests (control) or routine care plus invasive UDS (intervention arm)., Main Outcome Measures: The primary outcome was International Prostate Symptom Score (IPSS) at 18 months after randomisation and the key secondary outcome was rates of surgery. Additional secondary outcomes included adverse events (AEs), quality of life, urinary and sexual symptoms, UDS satisfaction, maximum urinary flow rate and cost-effectiveness., Results: A total of 820 men were randomised (UDS, 427; routine care, 393). Sixty-seven men withdrew before 18 months and 11 died (unrelated to trial procedures). UDS was non-inferior to routine care for IPSS 18 months after randomisation, with a confidence interval (CI) within the margin of 1 point (-0.33, 95% CI -1.47 to 0.80). A lower surgery rate in the UDS arm was not found (38% and 36% for UDS and routine care, respectively), with overall rates lower than expected. AEs were similar between the arms at 43-44%. There were more cases of acute urinary retention in the routine care arm. Patient-reported outcomes for LUTS improved in both arms and satisfaction with UDS was high in men who received it. UDS was more expensive than routine care. From a secondary care perspective, UDS cost an additional £216 over an 18-month time horizon. Quality-adjusted life-years (QALYs) were similar, with a QALY difference of 0.006 in favour of UDS over 18 months. It was established that UDS was acceptable to patients, and valued by both patients and clinicians for its perceived additional insight into the cause and probable best treatment of LUTS., Limitations: The trial met its predefined recruitment target, but surgery rates were lower than anticipated., Conclusions: Inclusion of UDS in the diagnostic tests results in a symptom outcome that is non-inferior to a routine care pathway, but does not affect surgical rates for treating BOO. Results do not support the routine use of UDS in men undergoing investigation of LUTS., Future Work: Focus should be placed on indications for selective utilisation of UDS in individual cases and long-term outcomes of diagnosis and therapy., Trial Registration: Current Controlled Trials ISRCTN56164274., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 42. See the NIHR Journals Library website for further project information., Competing Interests: Outside this work, Paul Abrams reports grants and personal fees for being a consultant and speaker for Astellas Pharma Inc. (Tokyo, Japan), and personal fees for being a consultant for Ipsen (Paris, France) and a speaker for Pfizer Inc. (New York City, NY, USA) and Sun Pharmaceutical Industries Ltd (Mumbai, India). He also reports personal fees from Pierre Fabre S.A. (Paris, France) and Coloplast Ltd (Peterborough, UK). Christopher Chapple reports being an author for Allergan plc (Dublin, Ireland) and Astellas Pharma; being an investigator for scientific studies/trials with Astellas Pharma and Ipsen; being a patent holder with Symimetics; receiving personal fees as a consultant/advisor for Astellas Pharma, Bayer Schering Pharma GmbH (Berlin, Germany), Ferring Pharmaceuticals (Saint-Prex, Switzerland), Galvani Bioelectronics (GlaxoSmithKline; Stevenage, UK), Pierre Fabre, Symimetics, TARIS Biomedical Inc. (Lexington, MA, USA), and Urovant Sciences (Irvine, CA, USA); and receiving personal fees as a meeting participant/speaker for Astellas Pharma and Pfizer. J Athene Lane was a member of the Clinical Trials Unit funded by the National Institute for Health Research during the conduct of this trial. Marcus J Drake reports being on associated advisory boards and has received grants, personal fees and non-financial support from Allergan, Astellas Pharma and Ferring Pharmaceuticals. He has also received personal fees from Pfizer.

Objective: Dietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer., Design: Patients were recruited into a presurgical observational cohort; following radical prostatectomy, they were offered randomisation into a 2×3 factorial randomised controlled trial (RCT)., Setting: A single National Health Service trust in the South West of England, UK., Participants: Those with localised prostate cancer and listed for radical prostatectomy were invited to participate., Randomisation: Random allocation was performed by the Bristol Randomised Trial Collaboration via an online system., Interventions: Men were randomised into both a modified nutrition group (either increased vegetable and fruit, and reduced dairy milk; or lycopene supplementation; or control) and a physical activity group (brisk walking or control) for 6 months., Blinding: Only the trial statistician was blind to allocations., Primary Outcome Measures: Primary outcomes were measures of feasibility: randomisation rates and intervention adherence at 6 months. Collected at trial baseline, three and six months, with daily adherence reported throughout. Our intended adherence rate was 75% or above, the threshold for acceptable adherence was 90%., Results: 108 men entered the presurgical cohort, and 81 were randomised into the postsurgical RCT (randomisation rate: 93.1%) and 75 completed the trial. Of 25 men in the nutrition intervention, 10 (40.0%; 95% CI 23.4% to 59.3%) adhered to the fruit and vegetable recommendations and 18 (72.0%; 95% CI 52.4% to 85.7%) to reduced dairy intake. Adherence to lycopene (n=28), was 78.6% (95% CI 60.5% to 89.8%), while 21/39 adhered to the walking intervention (53.8%; 95% CI 38.6% to 68.4%). Most men were followed up at 6 months (75/81; 92.6%). Three 'possibly related' adverse events were indigestion, abdominal bloating and knee pain., Conclusions: Interventions were deemed feasible, with high randomisation rates and generally good adherence. A definitive RCT is proposed., Trial Registration Number: ISRCTN 99048944., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Aims: To develop and validate a urinary diary, using the psychometric validation protocol applied to all International Consultation on Incontinence Questionnaire (ICIQ) modules., Methods: Patient and clinician opinion was sought on diary content, format, and duration using interviews and questionnaires. Content deemed essential for inclusion were incorporated into four draft diary formats (Phase 1a). Four rounds of content validation using patient-completed diaries or patient interviews and one round of clinician opinion were undertaken, before a consensus was achieved (Phase 1b)., Results: Phase 1a: 27 patients were interviewed and 30 clinicians returned a questionnaire regarding diary content, format and duration. Content deemed essential for inclusion was identified. Patients reported no format preference but preferred a diary of ≤7 days. Clinicians preferred a 3-day diary in single sheet format. Phase 1b: 75 of 200 (37.5%) patients returned completed draft diaries. Equal preference for the two portrait format diaries was expressed. Twenty-six clinicians returned a questionnaire regarding their preference for either of these two options, with 69% (18/26) selecting the one with a printed 24-hr clock. Optimal diary duration was 4 days. Frequency, voided volume, fluid intake (amount, time and type), time of incontinence episode, and bladder sensation were supported for inclusion in the final diary., Conclusions: Diary content, format, and duration deemed essential by both patients and clinicians have been identified in this preliminary phase, allowing the formation of a draft urinary diary. Further tests of diary validity, reliability and responsiveness will be evaluated in Phase 2 of the study., (Copyright © 2012 Wiley Periodicals, Inc.)

Aims: The outcome of surgery for stress urinary incontinence (SUI) can be unpredictable. Urethral pressure measurements, including measurement of maximum urethral closure pressure (MUCP) can form part of the investigation of women prior to SUI surgery and some studies have suggested that women with higher MUCP may have a better surgical outcome. This study aims to determine whether outcome of SUI surgery is related to pre-operative MUCP., Methods: All patients undergoing colposuspension or TVT in a large European city between 1998 and 2002 were included. All women underwent pre-operative urodynamics, including measurement of urethral pressure profile; urodynamic data, including MUCP, were determined. Surgical outcome was measured using the ICIQ-FLUTS questionnaire, which was mailed to allow for a minimum follow-up period of 3 years. Surgical outcome was measured by assigning patients to one of three post-operative Stress Urinary Incontinence (SUI) groups. Group 1 (No incontinence), Group 2 (< 1 incontinence episode per day), Group 3 (> 1 incontinence episode per day). Independent statistical analysis was undertaken using STATA® software and a two-way ANOVA (Analysis of Variance) test to determine the relationship between pre-operative MUCP and post-operative SUI group., Results: A total of 463 postal questionnaires were mailed, with a response rate of 62%, allowing for those who had died or moved away. Of the 285 responders, 218 had undergone colposuspension and 66 had a TVT. Median age, length of follow up and MUCP were 54 years (range 23-81), 77 months (range 47 to 107) and 45 cmH(2) O (range 5 to 105) respectively. Difference in MUCP between the two operation groups (colposuspension and TVT) was not significant (p > 0.19). No significant difference in preoperative MUCP was demonstrated between the three SUI groups, with mean MUCP in the three SUI groups of 50, 45 and 43 cmH(2) 0 respectively, confirming that patients with higher MUCP were not more likely to be in a lower post-operative SUI group (F(2, 237) = 3.42, p < 0.04)., Conclusion: Our data demonstrate that women with higher preoperative MUCP do not have a better surgical outcome following stress incontinence surgery., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: To determine the age prevalence of nocturnal polyuria among older women in the community, and to investigate the relationship between nocturnal polyuria and nocturia., Patients and Methods: In all, 1183 women aged > or = 50 years, who were registered with a family doctor practice and who had taken part in a prevalence study, were sent brief questionnaires and a frequency/volume chart (FVC) to complete., Results: There were 227 FVCs with adequate data and 264 completed questionnaires available for analysis. The prevalence of nocturnal polyuria increased disproportionately with age. There was no clear relationship between nocturia or nocturnal polyuria and daytime frequency, nor was there a clear relationship between diuretic use and nocturnal polyuria., Conclusion: Nocturnal polyuria is common among women in the community and not obviously related to daytime frequency. Night-time symptoms are common in women as well as men, and are troublesome to them.

Purpose: We determined the prevalence of nocturnal incontinence and its association with other storage symptoms in a community population of women, Materials and Methods: We mailed the validated self-reporting Bristol female lower urinary tract symptom questionnaire to all 2,641 women 19 years old or older registered at a family physician practice in a major British city and analyzed the results. Main outcome measures were the prevalence of nocturnal incontinence and its correlation with other storage symptoms., Results: A total of 2,075 completed questionnaires (80%) were returned. The overall prevalence of nocturnal incontinence was 5.8%. However, the majority of women had nocturnal incontinence only occasionally and only 1% had it more than a third of the time. The prevalence of nocturnal incontinence increased in a linear fashion with age (chi-square test for linear trend p <0.005). Of the women with nocturnal incontinence 69% considered it troublesome. The odds of nocturnal incontinence were significantly increased when urge and stress incontinence, incontinence with no obvious cause, urgency, straining and nocturia were reported., Conclusions: Nocturnal incontinence in women is more common than generally supposed and troublesome. The rate of nocturnal incontinence increases with coexisting storage symptoms.

Background: The prevalence of urinary symptoms that impact on quality-of-life will be important in determining resource allocation in primary care groups., Aim: To determine the prevalence of urinary symptoms and their perceived impact in a community population of women., Method: A postal survey using a validated self-completed questionnaire among all women aged over 18 years and registered with one general practice in a major British city. The prevalence rates and perceived impact of a wide range of urinary symptoms and their relationship with age was determined. Data were analysed using the chi-squared test and the chi-squared test for trend. Spearman's rank correlation was used to assess the relationship between symptom severity and perceived impact., Results: The number of completed questionnaires returned was 2075, giving an 80% response rate. Of these, the number of women who reported some degree of incontinence in the previous month was 1414 (69%), although only 578 (30%) indicated that it had social or hygienic impact. Other lower urinary tract symptoms reported included nocturia (19%), poor stream (19%), urgency (61%), and dysuria (23%). The most troublesome symptoms were incontinence for no obvious reason, nocturnal incontinence, and nocturia, with 73%, 69%, and 63% of sufferers, respectively, finding these symptoms troublesome., Conclusions: Incontinence and other urinary symptoms are more common than previously thought. These symptoms are not always perceived as bothersome or as having a social or hygienic impact, and therefore many women who report urinary leakage do not require treatment. Nocturnal symptoms in women are commoner than might have been supposed and are extremely troublesome to sufferers.

Objective: To determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren., Subjects and Methods: A prospective longitudinal study using a confidential questionnaire administered to an original cohort of 1176 local schoolchildren at 11-12 years and again at 15-16 years old., Results: There was a decrease in the prevalence of urinary symptoms with age. Daywetting was reported by 12.5% of children aged 11-12 years and 3.0% of children aged 15-16 years. Nocturnal enuresis was reported by 4.7% of children at 11-12 years and 1.1% at 15-16 years. Some of the children reporting daywetting and nocturnal enuresis at 15-16 years old had not reported these symptoms at 11-12 years old., Conclusion: Urinary symptoms become less prevalent with age, but are reported by a significant number of healthy schoolchildren.

Objective: To report the use of a computer-assisted learning (CAL) program in the teaching of urology to medical students., Subjects and Methods: Four CAL tutorials were developed, covering the examination of the urological patient, prostate cancer, impotence and lower urinary tract symptoms, for an initial evaluation of the use of CAL. Twenty-six third-year medical students seconded to the department for one week of urology teaching were randomized to two equal groups. One group used the CAL programs in addition to daily formal teaching, while the other group only received daily teaching. Teaching was of a standardized format, covering all aspects of urology, including the four areas covered by the CAL tutorials. Students were assessed using standardized multiple-choice questions (MCQ) at the start and end of the week's teaching. Incorrect responses were marked negatively. The content and ease of use of the CAL programs were also evaluated by a questionnaire., Results: There was no difference between the groups in MCQ scores at the start of the week. The mean (SD) change in score over the week for those using the CAL tutorials was 6.0 (7.0), and for the control group was 0.9 (6.0), a significant difference (P < 0.005). Students reported the tutorials to be easy to use and of satisfactory content., Conclusion: The results of this study suggest that CAL programs are of benefit to students learning urology.

Objectives: To measure the level of reported urinary symptoms presumed to be associated with benign prostatic hyperplasia (BPH) among men aged 40 years and over in the community, and to assess how bothersome these symptoms are perceived to be., Subjects and Methods: All ambulant men aged 40 years and over who were registered in a general practice (703) were invited to attend the health centre to complete a questionnaire containing the Maine prostatectomy scale and the International Continence Society-BPH questionnaire, and to undergo uroflowmetry., Results: The prevalence of symptomatic BPH (as defined by a numerical score > or = 11 on the Maine score, a urinary peak flow of < 15 ml/s, and failure to void > or = 150 ml on three separate occasions) was 284/1000 for men aged 40 years and over. This prevalence increased from 179/1000 in men aged 40-49 to 500/1000 in men aged 70 years and over. The most commonly reported symptoms were those typically associated with BPH (terminal dribble, hesitancy, intermittency, urgency). The symptoms that caused men the greatest degree of bother were frequency, nocturia and those causing incontinence or social embarrassment., Conclusion: The high prevalence of urinary symptoms assumed to be related to BPH in men in the community does not necessarily suggest that these men will require treatment. Common symptoms, typically associated with BPH, were tolerated. Further research is required to investigate the natural history of urinary symptoms, the relationships between symptoms and bladder outflow obstruction secondary to BPH, and to determine the most appropriate management for men in the community, ranging from 'watchful waiting' (monitoring without treatment) to medical or surgical treatment.

A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.

Bladder outlet obstruction in women is rare. The characteristics and aetiology of the condition in 163 females are discussed and their relation to treatment evaluated.