The development of laser prostatectomy.
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Equipment Design↗
Biomedical subjects
A E Te
Publications and source records attributed to A E Te.
Transurethral vaporization of the prostate: current techniques.
Electrovaporization has quickly become a popular procedure for treating benign prostatic hyperplasia. By using standard transurethral electrosurgical technology, electrovaporization offers standard transurethral loop-like resection and transurethral prostatectomy (TURP)-like efficacy with less morbidity than that associated with TURP. Through a combination of two electrosurgical effects (vaporization and desiccation), electrovaporization ablates significant volumes of prostatic tissue with each passage of the electrode. Newly designed thicker loop electrodes have led to a modification of the original electrovaporization technique. "Vaporizing-resection" adds the advantages of transurethral resection to those of electrovaporization with the use of one electrode. Very large glands can be treated efficiently, and prostatic tissue specimens are produced. Moreover, additional vaporization of tissue occurs with minimized bleeding. This report reviews basic electrosurgical principles, electrode design, and factors that affect vaporizing efficiency. Current long-term data on electrovaporization compared with TURP are summarized, and pilot studies evaluating vaporizing- resection have shown promising results. A new technology that has entered the market--bipolar electrovaporization--is also discussed. Finally, combination therapy and Columbia's 4-year experience with vaporization techniques are discussed.
Combined Modality Therapy↗
Benign prostatic hyperplasia: challenges for the new millennium.
The understanding and therapy of benign prostatic hyperplasia (BPH) has become more complex recently. The molecular mechanisms and growth factors involved in BPH need to be elucidated in the new millennium. The current classification of disease reflects the varied pathophysiologic mechanisms causing lower urinary tract symptoms (LUTS). In addition, symptom scores have improved evaluation of men with BPH, yet 'bother' and 'health-related quality of life' should be better recognized as significant outcome parameters. Clinical evaluation with laboratory markers specific for BPH or LUTS is currently inadequate. Yet, urodynamic evaluation should remain an important aspect of evaluation to guide selection of therapy. Recently medical therapy has expanded to include uroselective alpha blockade and phytotherapy, yet more research is needed. The most significant growth in the field, however, is in minimally invasive therapies of the prostate. Long-term comparative prospective multicenter studies are needed to properly evaluate the outcomes of new technologies compared to traditional procedures that are considered standard of care.
Humans↗
Detrusor contraction duration may predict response to alpha-blocker therapy for lower urinary tract symptoms.
OBJECTIVES: Baseline pressure/flow parameters have not correlated well with response to medical therapy for lower urinary tract symptoms (LUTS). This open-label, nonrandomized retrospective study was designed to evaluate whether the urodynamic parameter duration (in seconds) of the detrusor contraction (DCD) correlates better with alpha-blocker response than previously described urodynamic parameters. METHODS: 93 men (mean age 62.6+/-8.5) with LUTS underwent urodynamic evaluation prior to initiating therapy with doxazosin titrated to 8 mg and followed for 6 months. Parameters of evaluation included the AUA symptom score (AUASx), peak urinary flow rate (Q(max)), maximal detrusor pressure (P(max)), detrusor pressure at maximal flow (P(det)) and DCD. The correlation and predictive value of therapeutic response and baseline urodynamic parameters were assessed. RESULTS: 85 patients were evaluable at 6 months. For the entire group, AUASx decreased from 15.1+/-6.9 to 9.7+/-5.1 (-36%) and Q(max) increased from 9.3+/-3.7 to 11.9+/-5.7 ml/s (+28%). Baseline P(max) was 74.8+/-19.6 cm H(2)O, P(det) was 61.6+/-18.9 cm H(2)O and DCD was 107.6+/-28.6 s. There was weak correlation between either baseline P(max) or P(det) and therapeutic response (defined as a decrease in AUASx of 40% and an increase in Q(max) of 30%). Utilizing a baseline DCD of 90 s or more, there was a significant correlation to therapeutic response (r = 0.48, p = 0.002). CONCLUSIONS: These preliminary data suggest that DCD may be a useful urodynamic parameter to predict and optimize therapy with a-blockade. The potential utility and cost-effectiveness of DCD remains to be determined.
Adrenergic alpha-Antagonists↗
Prospective analysis of 373 consecutive women with stress urinary incontinence treated with a vaginal wall sling: the Columbia-Cornell University experience.
PURPOSE: We compare the efficacy and morbidity of 373 consecutive women who underwent a vaginal wall sling for stress urinary incontinence due either to anatomical incontinence or intrinsic sphincter deficiency. To our knowledge this series is the largest prospective database on surgical management of stress urinary incontinence in the urological literature. MATERIALS AND METHODS: Preoperative evaluation included history, voiding diary, physical examination, cystoscopy, pad count and video urodynamic study. Outcome measures included postoperative presence of incontinence secondary to either stress and/or detrusor instability, number of pads used, complications, operating time, length of suprapubic catheterization, length of hospitalization and loss of work days. RESULTS: A total of 373 consecutive women 18 to 85 years old (mean age 55.7) were followed for a mean of 39.8 months. Of these patients 183 (49%) presented with anatomical incontinence and the remaining 190 (51%) had intrinsic sphincter deficiency. Preoperative detrusor instability was present in 60 (33%) patients with anatomical incontinence and 68 (36%) with intrinsic sphincter deficiency. Postoperatively, 14 patients (4%) had recurrent stress urinary incontinence. De novo detrusor instability and urge incontinence were noted in 30 women (8%), and was persistent in 22 (6%). There was no correlation between the diagnosis of anatomical incontinence or intrinsic sphincter deficiency and persistent stress urinary incontinence or detrusor instability. Daily pad use was decreased from 4.3 to 0.5 and from 4.6 to 0.4, respectively, for patients with anatomical incontinence and intrinsic sphincter deficiency. Operating time, catheter duration, length of hospital stay and days lost from work for patients with anatomical incontinence (33.3 +/- 14.3 minutes, 4.7 +/- 1.1 days, 0.9 +/- 0.7 days and 11.3 +/- 2.9 days, respectively) were similar to patients with intrinsic sphincter deficiency (38.4 +/- 17.8, 4.6 +/- 0.9, 1.1 +/- 0.7, 12.4 +/- 4.7). The most common complications were urinary tract infection (3%), wound infection (4%) and pelvic organ prolapse (7%). CONCLUSIONS: The results of this large database suggest that the vaginal wall sling is effective for the management of stress urinary incontinence. Efficacy, morbidity and reduced hospitalization time were similar for patients with either anatomical incontinence or intrinsic sphincter deficiency and independent of surgeon experience.
Adolescent↗
Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction.
OBJECTIVES: Sildenafil has been demonstrated to be safe and effective in the treatment of men with erectile dysfunction. The role of sildenafil in treating women with sexual dysfunction has heretofore not been reported. The purpose of this preliminary study was to ascertain the response of postmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months. METHODS: Thirty-three consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, nonrandomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4, 8, and 12 using a newly developed 9-item, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question ([GEQ] Did treatment improve your sexual function?). The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation. RESULTS: Of the group, 30 women (91 %) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8+/-9.8. Mean usage of sildenafil was 3.1+/-1.4 times per week for the duration of the study. The IFSF score improved to 29.5+/-7.6, 30.3+/-8.5, and 31.4+/-10.4 at 4, 8, and 12 weeks, respectively (P = 0.25). Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively, at 12 weeks. Seven women (21%) noted improvement on the GEQ. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. Clitoral discomfort and "hypersensitivity" occurred in 7 women (21%), 3 of whom withdrew from the study. Other side effects, which did not result in withdrawal from the study, included headache (n = 5), dizziness (n = 4) and dyspepsia (n = 3). CONCLUSIONS: The data suggest that sildenafil is well tolerated in postmenopausal women with sexual dysfunction. Overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenafil in treating sexual dysfunction in various cohorts of women remains to be determined.
Adult↗
Interstitial thermometry in men undergoing electrovaporization of the prostate.
BACKGROUND AND OBJECTIVES: Transurethral electrovaporization of the prostate (TVP) has been utilized increasingly in the therapeutic management of benign prostatic hyperplasia (BPH). The temperature profile within both prostatic and periprostatic tissue has been presented as a parameter of safety in various preliminary studies. This prospective study measured interstitial temperature during TVP in both the prostate and the surrounding tissue of 18 men. METHODS: These 18 men undergoing TVP had three interstitial thermocouple probes placed under ultrasound guidance. Probes were positioned in the rectal wall and at the 5 and 7 o'clock position of the prostate capsule. A fourth probe was placed within 1 mm of the area of vaporization to determine "lesion" temperature. Temperature was measured at baseline and at 15-minute intervals as TVP was performed utilizing the VaporTrode at 240 to 280 W with a Valley Lab Force 40 generator. RESULTS: The maximum temperature variability was 1.9 degrees C. The temperature within 0.5 mm of the area of vaporization was >100 degrees C. These results were independent of the temperature of the irrigating solution. CONCLUSIONS: These results provide compelling evidence that high vaporization temperatures do not affect surrounding prostatic tissue. In theory, the risk of injury to either the rectum or the neurovascular bundle during TVP should be extremely low.
Aged↗
Laser prostatectomy: checkup on the promises.
Voiding symptoms caused by benign prostatic hyperplasia are responsible for significant compromise in the quality of life of many men. As our population ages, more men are seeking medical evaluation and treatment for this condition. In addition, with the recognition that this benign condition rarely creates significant life-threatening medical problems, there has been a movement toward less invasive therapies that are associated with the least possible iatrogenic morbidity. Among the currently available, minimally invasive techniques is laser prostatectomy. Is it standing up to its rival, transurethral resection of the prostate, or lagging behind?
Journal Article↗
Transurethral resection of the prostate versus transurethral electrovaporization of the prostate: a blinded, prospective comparative study with 1-year followup.
PURPOSE: Transurethral electrovaporization of the prostate has been increasingly used as a surgical adjunct in the management of men with lower urinary tract symptoms. In this prospective study we compare the safety and efficacy of transurethral resection of the prostate and electrovaporization. MATERIALS AND METHODS: We compared 32 consecutive men (mean age 68.9 years) with lower urinary tract symptoms treated by transurethral electrovaporization of the prostate to a cohort of 32 men (mean age 72.8 years) treated by transurethral resection of the prostate. Parameters of evaluation included American Urological Association symptom score, peak urinary flow rate, adverse events, including serial changes in serum hematocrit and sodium, operative time, postoperative catheterization time, hospitalization time and days lost from work. The data were analyzed by an investigator who was blinded to which procedure was performed. RESULTS: A total of 61 patients were evaluable for followup at 1 year. None required retreatment. At 1 year symptom score decreased 12.8 (66% of patients) and 12.2 (67%) and peak urinary flow increased 9.7 ml. per second (135%) and 11.3 ml. per second (136%) for electrovaporization and resection, respectively, (p <0.001). Operative time was significantly longer with electrovaporization than with resection (47.6 +/- 17.6 versus 34.6 +/- 11.2 minutes, p <0.003). Catheterization time (67.4 +/- 13.6 versus 12.9 +/- 4.6 hours), hospitalization time (2.6 +/- 0.9 versus 1.3 +/- 0.5 days) and days lost from work (18.4 +/- 7.6 versus 6.7 +/- 2.1) were significantly greater for resection than electrovaporization, respectively. There were no major complications in the electrovaporization group while in the resection group 1 patient required transfusion (5 units) and in 1 a clinical transurethral resection syndrome developed. Potency and retrograde ejaculation were normal in 18 of 18 patients (100%) and 13 of 17 (76%) after resection and 19 of 20 (95%) and 17 of 20 (85%) after electrovaporization. CONCLUSIONS: The results indicate that transurethral resection and transurethral electrovaporization of the prostate are effective in reducing lower urinary tract symptoms with similar preservation of sexual function. Both significantly improve peak urinary flow, although resection to a greater degree. Postoperative morbidity, catheterization time, hospitalization time and days lost from work were significantly less, and operative time was significantly longer with electrovaporization. Further studies are underway to determine the long-term durability of response of transurethral electrovaporization of the prostate relative to transurethral resection.
Aged↗
Transurethral electrovaporization of the prostate.
In this report, we discuss the basic equipment, electrosurgical techniques, and achievable effects with electrovaporization of the prostate and summarize follow-up data in patients who underwent electrovaporization for treatment of prostatism. Transurethral electrovaporization of the prostate combines electrosurgical vaporization and desiccation to remove obstructive hyperplastic prostatic tissue with minimal morbidity. A special electrosurgical modification involves a grooved roller electrode with a large surface area and multiple edges of contact that allow high current density to be delivered to an extensive area of tissue to be vaporized. This device fits standard resectoscopic equipment, and its use requires no special skills other than those needed for conventional transurethral resection of the prostate. Data analysis on a personal series of 114 patients with symptomatic benign prostatic hyperplasia who were treated with electrovaporization showed a decrease in symptoms, an increase in urinary flow rates, and rapid convalescence, similar to results in other published studies. Thus, clinical experience with transurethral electrovaporization of the prostate has shown efficacy similar to that for transurethral resection of the prostate but with considerably reduced morbidity. Extended follow-up of larger numbers of patients is needed to assess the durability of this procedure.
Clinical Trials as Topic↗
Intermittent alpha-blocker therapy in the treatment of men with lower urinary tract symptoms.
OBJECTIVES: To determine the safety and efficacy of intermittent alpha-blocker therapy in men with lower urinary tract symptoms (LUTS) in a prospective study. Alpha-blockers have been demonstrated to be safe and effective in the treatment of men with LUTS. To date, the role of varying dosing regimens in responding patients has not been well studied. METHODS: Men with LUTS were entered into this prospective open label, parallel, randomized trial. In phase 1, patients were treated with alfuzosin, 2.5 mg three times daily for 3 months. In phase 2, those patients who had a significant therapeutic response were randomized into one of the following three groups: (1) maintenance of alfuzosin; (2) alfuzosin every other day; and (3) discontinuation of alfuzosin (ie, no treatment). Patients were followed up for a total of 6 months. Parameters of evaluation included the International Prostate Symptom Score (IPSS), global satisfaction, peak urinary flow rate (Qmax), and adverse events. RESULTS: At 3 months, there were 79 patients who were categorized as having obtained a therapeutic response: IPSS decreased to 7.6 +/- 3.2 and Qmax increased to 11.3 +/- 2.9 mL/s. After randomization, IPSS was 7.1 +/- 2.9 and 6.5 +/- 2.5 for group 1; 6.5 +/- 3.2 and 6.7 +/- 2.1 for group 2; and 11.4 +/- 4.8 and 12.3 +/- 4.9 for group 3 at 3 and 6 months, respectively. Qmax was 12.7 +/- 4.8 and 11.7 +/- 5.2 mL/s for group 1; 12.2 +/- 3.9 and 11.9 +/- 3.7 mL/s for group 2; and 9.7 +/- 2.5 and 9.3 +/- 2.1 mL/s for group 3 at 3 and 6 months, respectively. Global satisfaction at 6 months was the same for groups 1 and 2. There were no differences in adverse events among the three groups. CONCLUSIONS: In men with LUTS who responded to alfuzosin, changing the dosing regimen from daily to once every other day resulted in similar efficacy and safety at 3 and 6 months. By contrast, complete cessation of alfuzosin resulted in recurrence of both symptoms and impaired urinary flow. These data provide evidence that in responding patients, intermittent alpha-blocker therapy may be a reasonable therapeutic regimen. The role of intermittent alpha-blocker therapy using other agents, as well as in a large cohort of men with LUTS, remains to be determined.
Adrenergic alpha-Antagonists↗
Combination therapy using oral alpha-blockers and intracavernosal injection in men with erectile dysfunction.
OBJECTIVES: Intracavernosal injection with a combination of agents (ie, phentolamine plus papaverine or alprostadil) has been used in an effort to increase efficacy and reduce side effects compared with single agents. The purpose of this pilot study was to determine the potential role of oral alpha-blockers in combination with intracavernosal therapy in men with erectile dysfunction, for whom intracavernosal therapy alone failed. METHODS: Thirty-eight consecutive men with moderate to severe erectile dysfunction on the basis of history and examination and with minimal or no therapeutic response to intracavernosal alprostadil injection therapy were evaluated. All patients received daily doxazosin titrated to 4 mg over 3 weeks in combination with intracavernosal therapy as needed for 12 weeks. Efficacy was assessed at 4, 8, and 12 weeks after doxazosin titration using the 1 5-item, self-administered International Index of Erectile Function (IIEF) and a global efficacy question (GEQ: Did treatment improve your erections?). RESULTS: For the group, the mean baseline IIEF score before therapy was 29.7+/-9.8. After intracavernosal therapy (mean dose 34.7+/-7.3 microg), IIEF improved to 36.1+/-1 1.4 (17.7%). After addition of doxazosin, IIEF improved to 48.6+/-13.4, 46.4+/-10.9, and 51.5+/-14.3 at 4, 8, and 12 weeks, respectively (P < 0.01). The GEQ response improved from 25.7% at baseline to 81.4% at 12 weeks. Overall 22 (57.9%) of 38 patients with the combined regimen had a significant (more than 60% improvement in IIEF) therapeutic response. CONCLUSIONS: The addition of an oral alpha-blocker may have a beneficial effect in patients with erectile dysfunction for whom intracavernosal therapy alone fails. The synergistic effects of vascular dilation and blockade of sympathetic inhibition may explain this response. The potential role of alpha-blockade in synergy with other agents designed to treat erectile dysfunction remains to be determined.
Administration, Oral↗
Is the ratio of transition zone to total prostate volume higher in African-American men than in their Caucasian or Hispanic counterparts?
OBJECTIVE: To determine if the transition zone index (TZI, the ratio between transition zone volume, TZV, and total prostate volume, as estimated by transrectal ultrasonography, TRUS) differs among African-American (AA), Hispanic and Caucasian men. PATIENTS AND METHODS: The study group consisted of 104 age-matched men (36 AA, 34 Hispanic and 34 Caucasian) with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). A control group of 55 age-matched men, equally distributed among the three ethnic groups, but with no BPH (based on a digital rectal examination) were also evaluated. All men completed the International Prostate Symptom Score (IPSS) and a measurement of peak urinary flow rate (Qmax), prostate volume and TZV (by TRUS) and the TZI calculated. RESULTS: In the control group, the mean prostate volume was 20.9, 18.2 and 19.8 mL, the TZV 6.9, 4.9, and 5.4 mL and the TZI 0.33, 0.27 and 0.25 for AA, Hispanic and Caucasian men, respectively. The TZI was significantly higher in AA than in either Hispanic or Caucasian men (P < 0.03). Although there were no differences in prostate volume among the three ethnic groups with BPH, the mean (SD) TZV and TZI were significantly higher in AA men than in either their Hispanic or Caucasian counterparts, at 15.8 (7.6) mL and 0.43, 12.7 (8.1) mL and 0.37, and 13.8 (6.7) mL and 0.37, respectively. For all groups, age correlated with the IPSS (r = 0.22, P < 0.04); the mean (SD) IPSS was 14.3 (5.7), 10.2 (2.9) and 10.6 (4.9) for AA, Hispanic and Caucasian men, respectively. There was no correlation between the IPSS and either prostate volume or TZV, but there was a strong correlation with the TZI (r = 0.29, P < 0.01), regardless of race. CONCLUSIONS: These results suggest that AA men have a greater TZV and a higher TZI than their Caucasian or Hispanic counterparts, regardless of the presence of lower urinary tract symptoms. Studies are underway to determine if these differences are clinically significant and correlate with either subjective and/or objective parameters of BPH.
Aged↗
The treatment of benign prostatic hyperplasia with alpha blockers in men over the age of 80 years.
OBJECTIVE: To determine the safety and efficacy of alpha blockade with doxazosin and terazosin in men over the age of 80 years with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty-six men (mean age 83.6 years, SD 5.6, range 80-96) received either doxazosin 4 mg (11 men) or 8 mg (10 men), or terazosin 5 mg (five men) or 10 mg (10 men), once daily at night. Twenty-eight men (78%) were on other anti-hypertensive medication; the type and dosage were not changed during the study. Efficacy and safety were assessed using measurements of peak urinary flow rate, symptom scores and the incidence of adverse events. RESULTS: Of the 36 men, 33 (92%) remained on study medication at 6 months; the remaining three (8%) discontinued because of asthenia. After 3 months of treatment, the peak urinary flow rate increased significantly (P < 0.008) for both doxazosin (+3.7 mL/s) and terazosin (+3.2 mL/s). The American Urological Association symptom score improved significantly (P < 0.01) with both alpha blocker after 3 months of treatment and efficacy was maintained at 6 months. There were small, non-significant decreases in blood pressure in patients receiving doxazosin or terazosin, but no differences between patients who were normotensive at baseline and those whose blood pressure was controlled by other anti-hypertensive drugs. CONCLUSION: These results suggest that alpha blockade with either doxazosin or terazosin is well tolerated and effective in older men with symptomatic BPH. Furthermore, patients on concomitant anti-hypertensive medication need no alteration of their therapeutic regimen before the initiation of alpha blockade for BPH.
Adrenergic alpha-Antagonists↗
Electrovaporization of the prostate: electrosurgical modification of standard transurethral resection in 93 patients with benign hyperplasia.
To determine the safety and efficacy of transurethral vaporization of the prostate (TVP) in the management of men with lower urinary tract symptoms, we reviewed the records of 93 consecutive patients (mean age 65.2 +/- 5.7 years) with mild to moderate lower urinary tract symptoms who underwent TVP since August 1994. The patients were assessed at baseline for both safety and efficacy and in follow-up at 1 week (N = 93) and 1 (N = 87), 3 (N = 71), 6 (N = 59), 9 (N = 44), and 12 (N = 33) months. The mean American Urological Association Symptom Score decreased from 18.6 preoperatively to 8.9, 7.9, 8.1, and 6.3 at 1, 3, 6, and 12 months, respectively (P < 0.01). The peak uroflow rate (Qmax) increased from 7.9 mL/sec to 16.4, 14.1, 14.7, and 17.3 mL/sec at 1, 3, 6, and 12 months, respectively (P < 0.02). The mean operating time was 47.3 minutes; 96% of patients had the catheter removed within 24 hours and were discharged home the first postoperative day. There was a mean 1.1 mL/dL decrease in hematocrit and a 1.4 mEq/L decline in serum sodium. Complications included mild hematuria (46%), clot retention (5%) (all necessitating transient recatheterization), and distal bulbar urethral stricture (N = 1). There was an 8% incidence of significant postprocedure irritative symptoms. No previously potent patient reported erectile dysfunction, but there was a 92% rate of retrograde ejaculation. Transurethral vaporization is a potentially useful modification of transurethral resection. There has been significant clinical improvement maintained with minimal morbidity. This early clinical experience highlights several potential advantages of TVP, including significantly lower cost and minimal postoperative irritative symptoms. Currently, a multicenter clinical trial is under way to determine the long-term efficacy and safety of TVP.
Aged↗
Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option.
PURPOSE: Chronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. We analyzed contraction of the external urinary sphincter during voiding (pseudodyssynergia) as an etiology of voiding dysfunction in men with misdiagnosed chronic prostatitis. MATERIALS AND METHODS: The video urodynamic studies of 43 men 23 to 50 years old with chronic voiding dysfunction secondary to pseudodyssynergia performed between January 1990 and June 1996 were retrospectively analyzed. Pseudodyssynergia was diagnosed based on several criteria, including electrical activity of the external sphincter during voiding in the absence of abdominal straining, and brief and intermittent closing of the membranous urethra during voiding detected by electromyography and fluoroscopy. Patients with bacterial infection or excessive leukocytes in expressed prostatic secretions were excluded from the study. RESULTS: Of the patients 39 (91%) were firstborn men. Duration of symptoms ranged from 17 to 146 months (mean 43.6). Average number of previous antibiotic days ranged from 53 to 186 (mean 67.6). In addition, empirical trials of alpha-blockers were unsuccessful. Mean American Urological Association symptom score plus or minus standard deviation was 17.5 +/- 3.7, mean maximum flow rate was 13.3 +/- 4.2 ml. per second, mean detrusor pressure at maximum flow was 46.3 +/- 13.7 cm. water and mean detrusor contraction duration was 132.8 +/- 27.7 seconds. Behavior modification and biofeedback were successful in decreasing symptoms in 35 patients (83%) at 6 months. CONCLUSIONS: These results indicate that some men who are categorized as having and empirically treated for chronic nonbacterial prostatitis are misdiagnosed and, in fact, have functional bladder outlet obstruction. Urodynamics are helpful in diagnosing and predicting success with behavior modification and biofeedback in these patients.
Adult↗
Differential diagnosis of prostatism: A 12-year retrospective analysis of symptoms, urodynamics and satisfaction with therapy.
PURPOSE: We determined the incidence of voiding symptoms, urodynamic etiology and satisfaction with therapy in a large cohort of men with prostatism during a 12-year period. MATERIALS AND METHODS: We retrospectively analyzed the records of 2,845 consecutive men who underwent urodynamic evaluation between January 1982 and December 1994. Patients were divided into groups 1 and 2 according to the years of study (between 1982 and 1988, and between 1989 and 1994, respectively). Parameters of evaluation included prevalence and distribution of voiding symptoms, urodynamic etiology of symptoms and satisfaction with therapy (medical or surgical). RESULTS: There was 843 evaluable patients 50 to 94 years old (mean age 63.2) Group 2 patients were younger, and had a 22% higher prevalence of nocturia and a 12% higher prevalence of daytime frequency. The prevalence of all other symptoms was the same in both groups. On urodynamics 523 patients (62%) had demonstrable evidence of bladder outlet obstruction of whom 345 (66%) had concomitant detrusor instability. Of the 843 patients 647 (77%) had detrusor instability, which was the sole diagnosis in 199 (24%). We noted low pressure/low flow in 137 patients (16%) and impaired detrusor contractility in 152 (17%), including 57 (7%) in whom the latter condition was the only diagnosis. Urodynamic findings remained the same during the entire 12-year period. Global satisfaction and symptomatic improvement were better with surgical than medical therapy, although the degree of satisfaction was independent of the urodynamic etiology of symptoms. CONCLUSIONS: Symptomatic men with prostatism are presenting with a greater prevalence of significant nocturia and daytime frequency than in the past with no change in urodynamic findings. In addition, patient level of satisfaction remains greater with surgical than medical therapy regardless of the urodynamic presence of bladder outlet obstruction.
Aged↗
Etiology of voiding dysfunction in men less than 50 years of age.
OBJECTIVES: Chronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. The purpose of this study was to analyze etiology of chronic voiding dysfunction in men less than 50 years of age. METHODS: The videourodynamic studies of 137 men 50 years of age or less with chronic voiding dysfunction, performed between January 1990 and October 1995, were retrospectively analyzed. RESULTS: The distribution of urodynamic abnormalities included 74 (54%) patients with primary vesical neck obstruction, 33 (24%) with obstruction localized to membranous urethra (pseudodyssnergia), 23 (17%) with impaired bladder contractility, and the remaining 7 (5%) with an acontractile bladder. Detrusor instability was present in 67 men (49%). CONCLUSIONS: Voiding dysfunction among young men is common and is often misdiagnosed. Videourodynamic evaluation is very useful in establishing the correct diagnosis and ultimately in delivery of appropriate therapy.
Adult↗