Transurethral versus transvesical prostatectomy. Clinical, urodynamic, renographic and economic aspects. A randomized study.
Explore the source record for details and available documents.
Clinical Trials as Topic↗
Biomedical subjects
H H Meyhoff
Publications and source records attributed to H H Meyhoff.
Long term results of transurethral and transvesical prostatectomy. A randomized study.
The long term result of transurethral (TURP) versus transvesical (TVP) prostatectomy was evaluated in a randomized study of 75 patients with clinically benign, medium sized, obstructive prostatic hyperplasia. Follow-up investigation including evaluation of symptoms and urinary flow rate was undertaken every 6 months the first 2 years as well as 5 years postoperatively. Thirteen patients died during follow-up. However, the remaining 64 patients were representative for the total series of patients. More than 90% in both groups had a satisfactory subjective result throughout follow-up. A significant and persistent relief in obstructive and irritative symptoms were seen in both groups. Nocturia was the predominant follow-up symptom being present in more than 50% of the patients 5 years postoperatively. During observation a slight decrease in sexual activity and retrograde ejaculation was reported by TVP and TURP patients. About 25% of the patients in both groups with benign histology had secondary operations during follow-up. Maximum as well as average flow rate values remained stable throughout the period of observation with small differences between the two groups. The incidence of urinary tract infections was reduced significantly by the surgical procedures. Only minor and clinically insignificant differences were observed between the results of the two operative procedures.
Follow-Up Studies↗
The effects of vaginal repair on anterior bladder suspension defects. A radiological and clinical evaluation.
In 22 patients with anterior bladder suspension defect as judged by colpocysto-urethrography (CCU) a vaginal repair was undertaken. In 14 patients urinary stress or urge and stress incontinence was the indication for operation, and in 8, genital prolapse. At follow-up more than 6 months postoperatively the CCU was repeated and a clinical evaluation undertaken. A normalization of the CCU was obtained in only 6 patients and 10 showed a less severe suspension defect. Nine of 14 patients were cured of incontinence. Only 3 of these had a normal follow-up CCU. Improvement of bladder suspension defect was not the sole responsible factor for postoperative continence. Urinary incontinence developed postoperatively in 2 of 8 patients operated on solely because of symptomatic genital prolapse. Very high cure rates for urinary incontinence have been reported following a colposuspension operation. A vaginal repair is not recommended as first-choice operation in incontinent females with anterior bladder suspension defects, if a CCU may be undertaken and the colposuspension technique is mastered.
Adult↗
Economy in transurethral prostatectomy.
The economy in transurethral (TURP) versus transvesical (TVP) prostatectomy was evaluated in a prospective randomized study. Forty-three patients were allocated to TURP and 32 to TVP. All patients had clinically benign, medium-sized prostatic hyperplasia. Median postoperative ward time was 15 1/2 days following TVP, compared with 7 days following TURP. Statistically significant differences between the two groups in favour of TURP were also seen in the duration of anaesthesia for prostatectomy, in the amount of antibiotics and i.v. infusions used, as well as in number of postoperative outpatients visits. No difference was observed in number of patients readmitted to hospital within 6 months due to sequelae of the prostatectomy. Postoperative sick-leave was 4 weeks following TVP, compared with 2 weeks for TURP patients. However, in the present study the patients' own expenses related to the operation were small and revealed minor differences in favour of TURP. It is stressed that increasing application of TURP in medium-sized prostatic hyperplasia may imply a substantial reduction in the waiting lists as well as an estimated retrenchment for the Danish community of US $3400 (34000 D.kr.) per patient or at least $4.5 million (45 million D.kr.) per year.
Aged↗
Transurethral versus transvesical prostatectomy. Physiological strain.
The present randomized study evaluated the physiological strain in transurethral (TURP) versus transvesical (TVP) prostatectomy in 75 patients with clinically benign, medium-sized prostatic enlargement. In both groups 5 patients had coincidental prostatic carcinoma. During TURP a suprapubic trocar was inserted for irrigation with 1.5% glycine. Antibiotics were given to patients with preoperative urinary tract infection and postoperatively tranexamic acid was administered to all patients. Coexisting diseases which might increase the operative risk were equally present in TURP and TVP patients. No patient died in connection with the operative procedures. Median duration of anaesthesia for TVP was 95 min and for TURP 60 min (p less than 0.001). Almost identical operative blood loss was seen in the two groups. However, more blood transfusion were given to TVP patients. Following discharge, more episodes of bleeding were registered in the TURP group, but no significant difference was observed in number of secondary operations for bleeding. In the TVP group, more patients had pulmonary complications, elevated rectal temperature as well as antibiotic treatment and 34% of these patients developed wound infection. Secondary operations before discharge were also more frequently undertaken in TVP patients. No differences between the two groups were seen pre- or postoperatively with respect to electrolyte, protein, creatinine and haemoglobin values. In the patients with incidental prostatic carcinoma a TURP was the most gentle procedure. With respect to physiological strain a TURP is clearly to be preferred over a TVP for obstructive clinically benign, medium-sized prostatic hyperplasia.
Aged↗
The effects of a new serotonin receptor antagonist (ketanserin) on lower urinary tract function in patients with prostatism.
Ten male patients with prostatism, median age 63 years (range 50 to 70 years) were given an intravenous injection of a new serotonin antagonist, ketanserin, at a dose of 10 mg., and were investigated urodynamically before and after injection. A statistically significant increase in maximum and mean flow rates and a statistically significant decrease in urethral pressure profile measurements was observed. Supine CO2 cystometry showed no significant decrease in volumes of first sensation and bladder capacity. No subjective side effects were registered, but we observed a statistically significant decrease in mean blood pressure of 6.5 mm. Hg (range 5 to 14 mm. Hg). The mechanism behind the beneficial effect of ketanserin on micturition in prostatism is not yet known, but the results could explain an alpha blocking effect of the drug.
Aged↗
[Abdominal aortic aneurysms with rupture or threatening rupture. A diagnostic pitfall?].
Explore the source record for details and available documents.
Adult↗
Urinary incontinence in the female. A long-term study of the effect of anticholinergics on overactive detrusor function.
The long-term effect of anticholinergic medication in female patients with overactive detrusor function was studied in a group of 73 patients. The definition of overactive detrusor function is in accordance with the terminology and definition of the International Continence Society. The patients were mailed a questionnaire about the medication, its effect on the continence situation, the side effects, and whether they still used the drugs. The duration of observation was more than 12 months. A satisfactory effect of the treatment was found in 43% while 50% reported no effect or severe side effect. Only 5% stopped the medication because of side effects, 18% because of lack of effect, while 42% had resigned themselves to their voiding disorders. Twenty-nine claimed to be cured or were still using the drug with beneficial effect. Nevertheless the treatment had continued for 6 months in both the group with no effect and in the group with good effect. The anticholinergic medication is of some value because it helps the patient to accept the bladder dysfunction, to alter the micturition habits and to assist in re-establishing inhibition of the micturition reflex.
Adult↗
Clinical evaluation of transurethral versus transvesical prostatectomy. A randomized study.
The present randomized study gives an evaluation of clinical results 6 months following transurethral (TURP) and transvesical (TVP) prostatectomy in 75 patients with clinical benign medium-sized obstructive prostatic hyperplasia. Following treatment of postoperative urethral stricture, urinary tract infection and residual bladder stones no statistically significant differences could be demonstrated in the effects of TURP and TVP on a calculated total symptom score nor on the individual obstructive and irritative prostatic symptoms. In both groups the obstructive symptoms were best relieved whereas rather high incidences of irritative symptoms were seen at follow-up. The median duration of incontinence following TURP was 10 weeks compared to 6 weeks following TVP but the difference, however, was insignificant. At follow-up also more patients in the TURP group had urinary incontinence although only one patient in this group with benign histology had daily urinary urge incontinence. Stress incontinence was observed in two patients with malignant histology. Persistent detrusor instability was suggested partly responsible for the follow-up irritative symptoms. In both groups and especially in the TVP group a small decrease in frequency of sexual activity was seen 6 months postoperatively. Seventy per cent of TVP patients and 57% of TURP patients reported retrograde ejaculation at follow-up. More urinary tract infections were seen in the TVP group, however, the differences were insignificant. Twenty-five per cent of TVP patients and 17% of TURP patients developed urethral strictures postoperatively and judged from flowmetry most strictures were obstructive.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Urodynamic evaluation of transurethral versus transvesical prostatectomy. A randomized study.
In a randomized study of transurethral prostatectomy (TURP) versus transvesical prostatectomy (TVP) in 75 patients a urodynamic evaluation was undertaken before and 6 months following operation. In the TURP group a resection to the surgical capsule was attempted in each case. Operative specimen weights in the two groups did not differ statistically significantly. 5 patients in each group had unexpected prostatic carcinoma. Rapid fill CO2 cystometry did not show any significant differences in bladder function between TURP and TVP patients 6 months following operation. In both groups a high incidence of detrusor instability was observed at follow-up. However, the incidence as well as the severity of the instability had decreased significantly following the two operative procedures. As judged from flowmetry and pressure flow investigation, relief of infravesical obstruction was almost complete in both groups. However, following treatment of postoperative strictures the patients with benign histology in the TVP group compared to the TURP group had higher maximum flow rate values and lower detrusor pressure values. Confidence limits for the differences between the two groups in detrusor pressure and maximum flow rate at follow-up did, however, hardly suggest clinically significantly differences. At urethral closure pressure profile measurement a statistically significantly shorter profile length was measured in TVP patients. The marginal differences in relief or infravesical obstruction might be due to differences in the amount of apical prostatic adenoma following operation.
Aged↗
Placebo--the drug of choice in female motor urge incontinence?
In a randomised double-blind cross-over trial of 19 females with motor urge incontinence but without bladder suspension defect, the effects of 14 days' treatment with emepronium bromide 200 mg qid, flavoxate chloride 200 mg qid or placebo qid were compared by means of micturition charts, the patients' drug preferences and evaluation of side effects. Placebo was the only drug giving rise to a statistically significant decrease in the frequency of voidings, incontinence and nocturia. Forty-seven per cent of the patients preferred placebo and side effects were less frequent during treatment with this medication. No differences could be demonstrated between the effects of emepronium bromide and flavoxate chloride. Perhaps detrusor instability is not always the main reason for the voiding dysfunction in these patients, in whom the effect of placebo was equal or superior to the effect of "active drugs" and superior to no treatment at all.
Adult↗
Incontinence surgery in female motor urge incontinence.
Conventional incontinence surgery was performed in 41 consecutive female patients despite the finding of motor urge incontinence. The patients were reinvestigated 6 months to more than 2 years after operation. Twenty-eight of the patients also had the symptom stress incontinence. Seventeen patients had coexisting symptomatic genital prolapse and were operated on without prior pharmacological treatment. The remaining 24 patients were all resistant to parasympatholytic treatment. The choice of operative procedure was based on vaginal examination as well as bladder suspension defect as demonstrated on voiding-colpo-cysto-urethrography. Subjective cure and improvement rate was 73%. At follow-up, 30% of the patients had normal detrusor reflex control, and a significant improvement in urge incontinence as well as frequency of micturition and nocturia was observed. Probably the primary treatment in females with motor urge incontinence should be pharmacological. However, in patients with symptomatic genital prolapse as well as in patients with ineffective medical treatment, conventional incontinence surgery seems to be well indicated in the absence of neurological disease-providing the patient has an associated bladder suspension defect.
Adult↗
Urinary incontinence in old age. A controlled clinical trial of emepronium bromide.
The effect of the anticholinergic agent, emepronium bromide (Cetiprin), was studied in a double blind crossover study of a group of elderly patients with urinary incontinence and uninhibited bladder contractions during cystometry. There was no statistically significant difference between the subjective effect of emepronium bromide and that of placebo, and no change in the cystometric parameters. The overall subjective cure or improvement rate was 79%. The effect of anticholinergic drugs in the treatment of urinary incontinence in elderly patients with uninhibited bladder contractions might to some extent be due to an improvement in the patients' understanding and acceptance of the bladder disorders.
Aged↗
The effect of prostatectomy on upper urinary tract function.
59 patients with obstructive prostatic hypertrophy (BPH) were evaluated regarding the influence of prostatectomy on upper urinary tract function by means of [51Cr]EDTA clearance and gamma camera renography measurements. 25 patients were randomly allocated to transvesical and 34 patients to transurethral prostatectomy. At the 6-month follow-up a slight decrease in glomerular filtration rate (GFR) was seen in the total patient group. Residual renal activity 20 min following injection (A20) as well as half-peak time values showed upper urinary tract obstruction in 54% of the patients preoperatively, whereas dilatation of the upper urinary tract was demonstrated at i.v. pyelography in only 15%. Patients with renographic obstruction preoperatively had low GFR values compared with patients without obstruction. In patients with upper urinary tract obstruction, prostatectomy relieved the obstruction, even in the case of normal urography. In patients with normal upper urinary tract, a clinically insignificant decrease in GFR and increase in A20 and half-peak time was observed. No differences with regard to upper urinary tract function were seen on comparing transurethral with transvesical prostatectomy.
Aged↗
Cysto-urethrographic appearance of the bladder and posterior urethra in neuromuscular disorders of the lower urinary tract.
Cysto-urethrography in the straight lateral projection with simultaneous intravesical pressure recording was performed in 57 patients with localized neurological lesions at different levels. All patients were previously extensively evaluated urodynamically. Bladder trabeculation was not related to level of neurological lesion or reflex pattern of the detrusor. Serration of the bladder wall was a reliable sign of a contracting detrusor in bladders without severe trabeculation. Open bladder neck at rest was related to lesion of the peripheral parasympathetic nervous system, while supposed insufficient bladder neck opening during voiding could be related neither to pressure-flow parameters nor to site of neurological lesion. No specific configuration of bladder or urethra could be related to lesion of the sympathetic nervous system.
Adult↗
Effect of emepronium bromide on lower oesophageal sphincter.
Explore the source record for details and available documents.
Administration, Oral↗
Different cystometric types of deficient micturition reflex control in female urinary incontinence with special reference to the effect of parasympatholytic treatment.
The effect of 4 weeks' treatment with emepronium bromide in 20 incontinent female patients with detrusor hyperreflexia was compared to the effect in 20 patients who did not have uninhibited detrusor contractions during filling cystometry but who were unable to suppress a voluntarily induced detrusor contraction. In both groups, 65% benefited from the drug and no statistically significant differences were seen in the decrease in frequency of voiding and incontinence episodes during treatment. There were no differences between the groups for age, type and degree of urinary incontinence, and radiological findings of bladder suspension defects. In these patients it is important to perform cystometry, including detrusor reflex activation procedures and the testing of their ability to suppress a voluntarily induced detrusor contraction.
Adult↗
Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?
In a double-blind placebo controlled clinical trial the preventive value of the antibacterial ointment povidone-iodine 10% (Isodine, Betadine) applied to urethral meatus was evaluated in 17 females suffering from recurrent urinary tract infections (UTI). The patients applied povidone-iodine respectively placebo ointment twice daily and before sexual intercourse in two 6-month periods in a cross-over design. No difference was observed in number of UTI during povidone-iodine and placebo prophylaxis. A decrease in the incidence of UTI was seen during application of any ointment. The antibacterial properties of povidone-iodine ointment is unimportant in the prophylaxis of reinfections as also indicated from urethral and periurethral cultures during the study revealing no change in pathogenic bacterial flora. An improved perineal hygiene in the context of application of ointment may be responsible for the reduction in UTI incidence in females with recurrent cystitis.
Administration, Topical↗