Biomedical subjects

F M Debruyne

Publications and source records attributed to F M Debruyne.

At least 145 records · Page 8Linked to original sources

PubMed1996

A retrospective study of high mobility group protein I(Y) as progression marker for prostate cancer determined by in situ hybridization.

In a previous study using RNA in situ hybridisation (RISH), we found a significant correlation between high mobility group protein I/Y, [HMG-I(Y)] mRNA expression and tumour stage and grade in prostate cancer patients, suggesting that HMG-I(Y) might be a potential prognostic marker in prostate cancer. However, our clinical follow-up was limited because cryopreserved material was used. Assessing the potential prognostic value of this molecule is of importance because the clinical course of prostate cancer patients remains unpredictable. Here we describe our results on paraffin-embedded archival material from a group of 102 patients undergoing radical prostatectomy. These were evaluated for the presence of HMG-I(Y) using RISH, and a follow-up of 12-92 months (average 53 months) was available. In 2 of 14 prostate cancers in which the predominant histological pattern was of Gleason grade 1-2, a high HMG-I(Y) expression was observed, whereas in 19 of 23 Gleason grade 3, and 34 of 35 Gleason grade 4-5 tumours, high HMG-I(Y) mRNA levels were detected (chi-square = 38.78, P < 0.0001). Moreover, of tumours that expressed high HMG-I(Y) levels, 25% were organ confined (T1-2), in contrast to 74.5% of the invading tumours (T3, chi-square = 15.8, P < 0.001). Furthermore, 87% of recurrent tumours showed high HMG-I(Y) expression. However, a multivariate regression analysis including Gleason grade, clinical tumour stage, HMG-I(Y) expression and prostate-specific antigen (PSA) levels showed Gleason grade as the most accurate predictor of progression. High HMG-I(Y) levels measured by RISH were indicative of a worse prognosis, albeit that additional value over the more subjective grading methods was not evident.

Biomarkers, Tumor↗

PubMed1996

Improved reliability of uroflowmetry investigations: results of a portable home-based uroflowmetry study.

OBJECTIVES: To compare the results obtained using a portable home-based uroflowmeter with the results of traditional flowmetry performed in the out-patient department (OPD). PATIENTS AND METHODS: Sixty-seven patients (mean age 61 years, range 38-79) with lower urinary tract symptoms and/or benign prostatic enlargement used a home-based uroflowmeter comprising a datalogger and specially designed fluid sensors incorporated into disposable beakers. The results of these measurements were compared with those from uroflowmetry in the OPD and with other clinical variables. RESULTS: There was a good correlation between the uroflow results obtained when voiding at home and at the OPD. The highest measured maximum flow and voided volume were obtained with the home-based uroflowmeter system. However, the mean of all consecutive home-based maximum flow and voided volume measurements were lower than those obtained by single-void uroflowmetry in the OPD. CONCLUSIONS: Home-based uroflowmetry provides reliable voiding results which are comparable with those obtained in the OPD.

Adult↗

PubMed1996

Reproducibility of prostate volume measurements from transrectal ultrasonography by an automated and a manual technique.

OBJECTIVE: To assess the reproducibility of estimates of prostate volume determined by planimetry from transrectal ultrasonography (TRUS) images. MATERIALS AND METHODS: Two sequential sessions of images obtained by TRUS were obtained from 30 patients, with the ultrasound probe removed and inserted between the sessions. The stored images were outlined, both manually and by computer, and measurements of prostate volume obtained planimetrically. In addition, the ability of the urologist to accurately draw the contour was assessed by outlining predefined contours. RESULTS: The mean (SD) variability of manual outlining between sessions was 3.5 (3.4)%, within one session was 1.7 (1.3)% and of computer outlining between sessions was 4.3 (3.8%). Comparing the results of manual and computer outlining showed a mean (SD) variability of 7.5 (5.6)%, with larger values obtained from computer outlining. The mean (SD) variation in manually outlining predefined contours was 1.4 (1.4)%. CONCLUSIONS: The variability of computer outlining was slightly higher than expected theoretically. The within-session variability was higher than the variation caused by errors in outlining predefined contours, indicating that the interpretation of TRUS images differed with time. Automated determination of prostate volume can save time during clinical investigation and the variability is within the clinically acceptable range of 5%.

Aged↗

PubMed1996

Clinical implications of the rise and fall of prostate specific antigen after laser prostatectomy.

OBJECTIVE: To characterize the serum kinetics of prostate specific antigen (PSA) after visual laser ablation of the prostate (VLAP). PATIENTS AND METHODS: The PSA values of 45 patients were measured at 24 h and at 1, 4, 12, 26 and 52 weeks after VLAP and the changes assessed in relation to symptom scores, urinary flow rates and prostate size. RESULTS: After an initial rise immediately after VLAP, the serum PSA level declined. At 24 h, the PSA value reached a mean level 23 times higher than the PSA level before VLAP and then took a mean of 78 days to reach a new baseline. The mean decrease of the subsequent baseline value relative to that before treatment was 1.7 ng/mL. The prostatic size and energy applied correlated positively with the rise in PSA 24 h after VLAP. The rise in maximal urinary flow after VLAP, the decrease in the symptom score and residual urine volume did not correlate with the rise in PSA level 24 h after VLAP or with the time to reach a value halfway between the level at 24 h and the new baseline value. CONCLUSIONS: The pattern of the increase in serum PSA level and decline after VLAP was not predictive of the clinical outcome of therapy.

Humans↗

PubMed1996

Urinary tract infections following laser prostatectomy: is there a need for antibiotic prophylaxis?

OBJECTIVE: To evaluate the incidence of urinary tract infections (UTIs) after transurethral laser therapy of the prostate and the need for peri-operative antibiotics. PATIENTS AND METHODS: One-hundred and sixteen patients (mean age 65 years, range 51-85) with benign prostatic enlargement (BPE) were treated with a Nd:YAG laser, using either the TULIP device, the Urolase fibre or the Ultraline fibre. The incidence of voiding complaints, UTIs and the need for catheterization after treatment were assessed. The first 43 patients (Group I) received no antibiotics perioperatively and the next 73 patients (Group II) received co-trimoxazole for 5 days. RESULTS: The patients treated using the TULIP device had more urinary complaints after treatment than those treated using the Ultraline and Urolase fibres. In Group I, 48% of the patients developed a UTI and in Group II the incidence of UTIs decreased to 30% after treatment. The incidence of UTIs was unrelated to the procedure performed. Although not statistically significant, peri-operative antibiotics tended to reduce the incidence of UTIs. Prolonged catheterization was correlated with the incidence of UTI. In Group I, patients who were treated using the Ultraline procedure had their catheter removed after a mean of 24 days, compared with 21 days for those treated with the Urolase and 19 days with the TULIP device. In Group II, the patients needed catheterization for a mean of 17 days following Ultraline treatment and 16 days following the Urolase procedure. CONCLUSIONS: Antibiotic prophylaxis tended to decrease the incidence of post-treatment UTIs. However, there was no clear association between the presentation and duration of complaints and the presence of UTIs.

Aged↗

PubMed1996

A 12-month study of the placebo effect in transurethral microwave thermotherapy.

OBJECTIVE: To determine the placebo effect of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic enlargement (BPE). PATIENTS AND METHODS: A prospective, randomized sham-controlled study in 93 patients (mean age 65, range 50-88) was conducted at two centres comparing TUMT or a sham treatment. Patients randomized to receive sham treatment underwent the same initial procedure as for TUMT, but the complete procedure was simulated on the visual display with no application of microwave energy. If the patient's condition had not improved after 3 months, a second genuine TUMT treatment was given at the patient's request. RESULTS: After 3 months there were significant clinical and statistical differences in efficacy between the groups; 62% and 18% of patients had a > 50% improvement in symptom score in the treated and sham groups, respectively (P = 0.001). The corresponding changes in flow rate were 36% and 11% (P = 0.002), respectively. After 1 year, 63 patients were divided into those that had TUMT initially, those that had sham initially but subsequently had TUMT and those whose sham procedure had led to sufficient clinical improvement to require no further treatment. The two treated groups had a significant improvement over the sham group. CONCLUSION: The benefit from TUMT cannot be due to a placebo effect alone.

Aged↗

PubMed1996

The use of 'ultrasensitive' prostate-specific antigen assays in the detection of biochemical recurrence after radical prostatectomy.

OBJECTIVE: To determine the gain in lead time obtained when using ultrasensitive prostate-specific antigen (PSA) assays in the diagnosis of biochemical progression after radical prostatectomy. PATIENTS AND METHODS: The post-operative PSA serum concentrations of 137 patients who had undergone radical prostatectomy were evaluated retrospectively. From these patients, 12 were selected who showed biochemical recurrence, as measured by the Hybritech Tandem-E Singlepoint PSA assay. Samples of the serum frozen at the time of the initial analysis were thawed and PSA values were remeasured by the Abbott IMx PSA assay and the Tandem-E Multipoint PSA assay. Analytical thresholds (zero-dose + 3 SD) for the Tandem-E Singlepoint, IMx and Tandem-E Multipoint assay were 1.0, 0.04 and 0.04 ng/mL, respectively. The lead time to the detection of a recurrence obtained when using the IMx and the Tandem-E Multipoint PSA assay was compared with that attained using the Tandem-E Singlepoint PSA assay. As a control, PSA values were determined in 58 serum specimens of nine patients having no evidence of recurrence after radical prostatectomy. RESULTS: All 58 control specimens had PSA levels below the analytical thresholds of the three assays, except one which had a PSA serum concentration of 0.08 ng/mL, estimated by the IMx assay. When compared with the lead time obtained with the Tandem-E Singlepoint assay, the 12 patients with a biochemical recurrence had a median gain in lead time of 327 days (range 60-627) with the IMx assay and of 369 days (range 60-639) with the Tandem-E Multipoint assay. CONCLUSION: A PSA value > 0.04 ng/mL after radical prostatectomy heralds further biochemical progression. The use of the ultrasensitive IMx and the Tandem-E Multipoint assays provided more lead time, but there is no clear evidence that this gain is necessarily of benefit to the patient.

Aged↗

PubMed1996

The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints.

PURPOSE: We evaluated the urethrocystoscopic findings and results of urodynamic studies in elderly men with voiding complaints. MATERIALS AND METHODS: A total of 492 consecutive patients with voiding complaints underwent a standardized screening program, including transrectal ultrasonography of the prostate, urodynamic investigations with pressure-flow study analysis and flexible urethrocystoscopy. RESULTS: A significant correlation was found between bladder trabeculation and grade of bladder outlet obstruction. Detrusor instability correlated significantly with grade of trabeculation. Grade of obstruction showed a clear correlation with prostatic occlusion of the urethra and the presence of a middle lobe at cystoscopy. CONCLUSIONS: The findings at urethrocystoscopy correlate well with those of urodynamic investigations.

Adult↗

PubMed1996

Results of the treatment of neurogenic bladder dysfunction in spinal cord injury by sacral posterior root rhizotomy and anterior sacral root stimulation.

PURPOSE: We evaluated the results of treatment of neurogenic bladder dysfunction in spinal cord injury by sacral posterior root rhizotomy and anterior sacral root stimulation using the Finetech-Brindley stimulator. MATERIALS AND METHODS: In 52 patients with spinal cord lesions and urological problems due to hyperreflexia of the bladder complete posterior sacral root rhizotomy was performed and a Finetech-Brindley sacral anterior root stimulator was implanted. All patients were evaluated and followed with a strict protocol. A minimal 6-month followup is available in 47 cases. RESULTS: Complete continence was achieved in 43 of the 47 patients with 6 months of followup. A significant increase in bladder capacity was attained in all patients. Residual urine significantly decreased, resulting in a decreased incidence of urinary tract infections. In 2 patients upper tract dilatation resolved. In 3 patients rhizotomy was incomplete and higher sectioning of the roots was necessary. One implant had to be removed because of infection. CONCLUSIONS: The treatment of neurogenic bladder dysfunction in spinal cord injury by anterior sacral root stimulation with the Finetech-Brindley stimulator in combination with sacral posterior root rhizotomy provides excellent results with limited morbidity.

Adolescent↗

PubMed1996

Reliability of the International Prostate Symptom Score in the assessment of patients with lower urinary tract symptoms and/or benign prostatic hyperplasia.

PURPOSE: The reliability of the International Prostate Symptom Score (I-PSS) was tested in patients with lower urinary tract symptoms and/or benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 71 consecutive men with benign prostatic hyperplasia and/or lower urinary tract symptoms was asked to complete the I-PSS at baseline and 8 weeks later. At the second visit the physician also completed the I-PSS according to the complaints of the patient. Variability between both scores was evaluated by calculation of duplo errors and results were compared to the clinical data. RESULTS: A considerable variability existed between the I-PSS results obtained at baseline and 8 weeks. The duplo error was 4.3. In a regression analysis of I-PSS, including all clinical parameters, only free flow had some predictive value for I-PSS outcomes. CONCLUSIONS: It is important to consider the variability of the I-PSS score when making decisions concerning treatment.

Follow-Up Studies↗

PubMed1996

The correlation between bladder outlet obstruction and lower urinary tract symptoms as measured by the international prostate symptom score.

PURPOSE: We studied the relationship between lower urinary tract symptoms as measured by the international prostate symptom score (I-PSS) and urodynamic findings in elderly men. MATERIALS AND METHODS: We evaluated 803 consecutive patients with lower urinary tract symptoms via the I-PSS and urodynamics with pressure-flow studies. RESULTS: A statistically significant correlation was found between all I-PSS questions (except intermittency) and objective parameters of obstruction. However, the clinical significance of this finding is minimal because a large overlap of symptom scores exists among patients with different grades of bladder outlet obstruction. The filling component of the I-PSS correlated somewhat better with obstruction than did the voiding component. CONCLUSIONS: It seems impossible to diagnosis bladder outlet obstruction from symptoms alone. It does not even seem possible to define subgroups in which further urodynamic examination is indicated.

Adult↗

PubMed1996

Pressure-flow study analyses in patients treated with high energy thermotherapy.

PURPOSE: We evaluated the urodynamic changes after high energy microwave thermotherapy in patients with lower urinary tract symptoms and benign prostatic enlargement. MATERIALS AND METHODS: A total of 120 patients was available for analysis with urodynamic investigation and pressure-flow studies before and 6 months after treatment. Several obstruction parameters were used to evaluate treatment outcome. RESULTS: A significant decrease (p < 0.001) in all obstruction parameters was noted. Mean detrusor pressure at maximum flow decreased from 64.7 to 39.1 cm. water, urethral resistance factor from 41.8 to 23.5 cm. water and linear passive urethral resistance relation from 3.0 to 1.4. Analysis of subgroups showed better results in patients with greater degrees of obstruction. CONCLUSIONS: High energy thermotherapy results in a significant and substantial decrease in bladder outlet obstruction.

Aged↗

PubMed1996

Three-year followup of patients treated with lower energy microwave thermotherapy.

PURPOSE: A retrospective study was done to investigate the long-term outcome of patients treated with lower energy transurethral microwave thermotherapy. MATERIALS AND METHODS: A total of 305 patients with lower urinary tract symptoms and benign prostatic hypertrophy underwent transurethral microwave thermotherapy according to a similar protocol at 2 centers. RESULTS: After 3 years of followup 133 patients who had undergone transurethral microwave thermotherapy alone were available for study. During this observation period significant symptomatic improvement from baseline and an improved maximum flow rate of 2.6 ml. per second were noted. Of the patients 125 underwent invasive or medical treatment. CONCLUSIONS: After 3 years of followup lower energy transurethral microwave thermotherapy showed significant and durable improvements in baseline parameters in 52% of the patients.

Aged↗

PubMed1996

Formula-derived prostate volume determination.

OBJECTIVES: Despite disadvantages such as time-consuming and tedious to the user, planimetric volumetry is considered to be the most accurate method for prostate volume determination. This study investigates the possibilities of formula-derived volume determination and reveals the best alternative to planimetric volumetry. METHODS: The prostate volume is calculated using prostatic dimensions (length, height and width) in four mathematical descriptions for prostate volume calculations. As reference, the planimetric results obtained with 4 mm step size were used. RESULTS: Compared to the results of planimetric volumetry obtained with 4-mm intersection distance, the best results for volume determination with mathematical calculation were obtained with a formula describing a spheroid volume using half the mean of width, height and length as radius. CONCLUSION: Although planimetric volumetry remains the most accurate method for prostate volume determination, the spheroid formula is the best alternative method for quick volume assessment with reasonable accuracy.

Humans↗

PubMed1996

Combined androgen blockade is the treatment of choice for patients with advanced prostate cancer: the argument for.

Combined androgen blockade (CAB) is becoming standard treatment for patients with newly diagnosed advanced prostate cancer. This statement is based on the outcome and long-term evaluation of patients treated in prospective randomised trials. Particularly, patients with 'good' prognostic signs at the time of diagnosis benefit most from this approach. Patients with metastatic prostate cancer treated with CAB can be stratified on the basis of clinical prognostic parameters such as performance status, the presence or absence of pain, the levels of alkaline phosphatase, and the levels of prostate-specific antigen (PSA) during the first months of CAB: for combined androgen deprivation, if they fall in the good prognostic category (+/- 30-35% of the patients); for surgical castration and palliative treatment or (experimental) cytotoxic therapy if they belong to the poor prognostic category (+/- 20% of the patients), and, for initial CAB during the first 3-6 months of therapy, followed by an evaluation of the regression of PSA under therapy. If PSA normalises (rapidly) during this period, patients could be considered as good prognostic candidates and continue CAB. If PSA does not decrease or normalise sufficiently, patients might be classified as belonging to the poor prognostic category and should be treated with palliative measures and/or experimental cytotoxic therapy after (surgical) castration.

Alkaline Phosphatase↗

PubMed1996

Epidemiology of prostate cancer.

Prostate cancer is currently one of the most common malignancies worldwide. The incidence of prostate cancer has risen dramatically over the last decade, more so than can be explained by increasing longevity. Mortality rates have also risen, though not as dramatically. There is a wide geographic variation in the incidence of clinical prostate cancer, with higher rates in the United States than in China. One risk factor which could explain this variation is the high fat intake associated with a Western diet. It is also apparent that prostate cancer is now being detected at less advanced stages than in the past. Increased awareness of the disease and improved detection methods are thought to contribute to this earlier detection.

Diet↗

PubMed1996

Anterograde percutaneous treatment of ureterointestinal strictures following urinary diversion.

OBJECTIVE: The incidence of ureterointestinal strictures following urinary diversion ranges from 4 to 8%. Traditionally, the treatment consists of open ureteral reimplantation. During the last decade, however, percutaneous techniques have gained increased interest for treatment of these strictures. We evaluated the outcome of anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion. METHODS: Since 1985, we attempted treatment of 15 ureterointestinal strictures, either by percutaneous anterograde dilatation (n = 10) or cold-knife incision (n = 2). In 3 patients the stricture could not be passed with a guide wire, precluding percutaneous treatment. Anterograde dilatation was performed with semirigid fascial dilators in 6 patients and additionally with a Grüntzig balloon catheter in 4. Routinely, following a successful procedure, a 12-Fr multihole stent was left in place for 6 weeks. RESULTS: Restenosis was seen in 4 patients 2, 2, 19, and 36 months, respectively following the procedure. In 8 patients no stenosis developed so far (follow-up 8-96 months). Morbidity after the procedure consisted of fever after nephrostomy puncture in 1 patient and stent occlusion in another. Both were managed conservatively. CONCLUSION: Anterograde percutaneous treatment of ureterointestinal strictures after urinary diversion is a safe primary procedure with a permanent success rate in half of the patients (53%).

Adolescent↗

PubMed1996

The international terazosin trial: a multicentre study of the long-term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia. The ITT Group.

OBJECTIVE: To evaluate the long-term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia (BPH). METHODS: Thirty-three sites in 13 countries enrolled men with BPH who had an International Prostate Symptom Score (IPSS) > or = 12 [corrected]. After a 2-week, no-treatment lead-in period and a 26-week, single-blind treatment period, patients responding to terazosin were randomly assigned to receive either terazosin or placebo for a 24-week, double-blind withdrawal period. RESULTS: Of the initial 427 patients enrolled, 378 were evaluable, 273 of whom completed the single-blind period, of which 186 patients were randomized. During the single-blind treatment period, IPSS, quality-of-life score (QOL), peak flow rate (PFR), and nocturia score (NOC) improved significantly (p < or = 0.05). During the double-blind withdrawal period, IPSS, QOL, PFR, and NOC deteriorated significantly in the placebo group compared with the terazosin group. The most common adverse event resulting in premature termination from the study was dizziness. There were no clinically important mean reductions in diastolic blood pressure (DBP) for patients normotensive at baseline. Terazosin significantly reduced mean DBP in hypertensive patients during the single-blind period and maintained the reduction during the double-blind period. CONCLUSION: Treatment with terazosin has a beneficial effect on BPH, continuing for at least 12 months, and can be safely considered for medium- to long-term use in those who benefit.

Adrenergic alpha-Antagonists↗