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H L Holtgrewe

Publications and source records attributed to H L Holtgrewe.

17 recordsLinked to original sources
PubMed1995

Economic issues and the management of benign prostatic hyperplasia.

Enormous financial resources are expended worldwide on the treatment of the urologic complications and symptoms induced by benign prostatic hyperplasia (BPH). Even for its surgical management, where the best data exist, current international accounting of these expenditures remains very poorly documented. On February 8, 1994, the Department of Health and Human Services of the US government released clinical guidelines for the diagnosis and management of BPH. Imaging of the upper urinary tract as a routine diagnostic procedure is not recommended in these guidelines unless a comorbidity indicating its need exists. Diagnostic cystoscopy to assist in the decision of the need to treat is not recommended. Adherence to these two principles along with adherence to the strategies of management presented in the guidelines and discussed herein has the potential of achieving profound financial savings without impairing quality of care worldwide.

Cost Control↗
PubMed1995

Measuring disease-specific health status in men with benign prostatic hyperplasia. Measurement Committee of The American Urological Association.

In preparation for an outcomes study of benign prostatic hyperplasia (BPH), two measures of disease-specific health status were developed to supplement a symptom score and overall health status measures. The symptom problem index (SPI) captures how troublesome patients find their urinary symptoms. The BPH impact index (BII) measures how much their urinary problems affect various domains of health. A prospective revalidation of the refined instruments (N = 108 BPH patients and 50 controls) documented that both indices had good internal consistency (Cronbach's alpha = 0.88 and 0.79, respectively) and test-retest (r = 0.88 for both) reliabilities, correlated strongly with symptom scores (r = 0.86 and 0.77), and discriminated between BPH and control subjects (receiver-operating characteristic areas = 0.87 and 0.85, respectively). These indices were nearly as responsive as symptom scores in 50 men actively treated for BPH, and much more responsive than a non-disease-specific General Health Index (GHI), a Mental Health Index (MHI), and an Activity Index (AI). Finally, these measures capture most of the health status significance of BPH symptoms. In linear regression models constructed to predict scores on the GHI, MHI, and AI, symptom scores added little explanatory power to the SPI and, particularly, to the BII. These measures help clarify how BPH affects overall health status and function. Such measures have an important role to play in studies of the outcomes of treatment for BPH, and probably for other conditions that interfere with health status and function.

Adult↗
PubMed1995

Practice trends in the diagnosis and management of benign prostatic hyperplasia in the United States.

PURPOSE: The American Urological Association (AUA) first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1992. MATERIALS AND METHODS: In August 1994 a random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns for the diagnosis and management of benign prostatic hyperplasia (BPH). It asked questions regarding the practice patterns of respondents in their diagnosis and management of BPH. RESULTS: The survey revealed that 99% of the respondents were aware of and used the AUA symptom score index, and that 21% of these respondents had altered their diagnosis and management strategies because of its existence. CONCLUSIONS: Therapeutic recommendations of the respondents based upon AUA symptom score index severity parallel the recently announced federal Agency for Health Care Policy and Research BPH practice guidelines.

Adrenergic alpha-Antagonists↗
PubMed1995

Practice trends in the diagnosis and management of prostate cancer in the United States.

PURPOSE: The American Urological Association first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1991. MATERIALS AND METHODS: A random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns used in the staging and treatment of prostate cancer. The third annual survey taken during August 1994 asked questions regarding the practice of respondents in their diagnosis and management of prostatic cancer. RESULTS: The survey revealed that 95% of the respondents would recommend radical prostatectomy for men younger than 70 years with confirmed clinically localized prostate cancer. CONCLUSIONS: In this patient age group, surprisingly, the survey resulted in some interesting facts: 1) 13% regard hormonal manipulation for early stage cancer appropriate, 2) the respondents used extensive numbers of diagnostic staging studies in the new prostate cancer patient with a prostate specific antigen of less than 10 and 3) despite the obvious increased costs, the majority of patients receiving hormone manipulation were being treated with luteinizing hormone-releasing hormone agonists rather than orchiectomy.

Adult↗
PubMed1995

Transurethral prostatectomy.

In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are but marginally better. However, open prostatectomy suffers from lack of patient acceptance, increased postoperative discomfort, and prolonged hospitalization, factors which over the past six decades relegated it to a minor role in the surgical management of BPH. Given the advanced age and compromised health status of most men undergoing TURP, the procedure's current mortality, morbidity, and long-term complication rates are remarkable. The ultimate role of the emerging alternative strategies of BPH management--hormonal, pharmacologic, thermal, and device discussed elsewhere in this issue, will be dependent upon their durability and their long-term outcomes, which remain to be fully defined. In the meantime, TURP remains the standard against which all new therapies must be measured. The resectoscope is being challenged but is not yet ready for the history books.

Humans↗
PubMed1993

Relationship of symptoms of prostatism to commonly used physiological and anatomical measures of the severity of benign prostatic hyperplasia.

In previous studies the severity of symptoms of prostatism in men with benign prostatic hyperplasia have not correlated well with prostate size, degree of bladder trabeculation, uroflowmetry or post-void residual volume. As part of a prospective cohort study of benign prostatic hyperplasia treatment effectiveness in 4 university-based urology practices, we correlated symptom severity and these commonly used measures of disease severity. Symptom severity was quantified using the American Urological Association symptom index. Analyses were based on 198 outpatients completing a standardized evaluation (84 of these men have completed 6 months of followup after treatment with prostatectomy, balloon dilation, terazosin or watchful waiting). At baseline, symptom severity was not correlated with uroflowmetry, post-void residual, prostate size and degree of bladder trabeculation. However, symptom severity was much more strongly related to overall health status than the other measures. Reduction in symptoms with treatment did correlate with improvements in uroflowmetry. This poor baseline correlation with symptoms may reflect unreliability in measurement of the physiological/anatomical variables. Alternatively, these parameters may be measuring different pathophysiological phenomena.

Aged↗
PubMed1992

Indications for treatment of benign prostatic hyperplasia. The American Urological Association Study.

BACKGROUND: In 1990, a pilot study was begun that evaluated benign prostatic hyperplasia (BPH) at five clinical institutions. Data management and coordination of this study was performed at the Medical Practices Evaluation Center at Massachusetts General Hospital. Because of decreased patient enrollment, one institution was dropped. This was a randomized, prospective, clinical study that provided an initial overview of the trial and a rationale for the project. METHODS: Patients with clinically significant signs and symptoms of BPH were enrolled in this study. A symptom index consisting of seven items was used to document patient complaints of prostatic enlargement. Prostate size was determined using ultrasonography. Uroflowmetry (peak flow and mean flow) and residual urine volumes were documented. Abdominal ultrasonography was performed to rule out the presence of a dilated upper urinary tract. Cystoscopy was completed to determine the extent of prostatic and bladder neck obstruction. Trabeculations or cellules in the bladder, if present, were also documented. Conclusions. Preliminary results were obtained. The operative and nonoperative options depending on prostate size are shown in the figures of this article. The use of an interactive video disc has been beneficial in explaining the risks and benefits of each treatment option applicable to the patient in this randomized, controlled study.

Aged↗
PubMed1992

The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association.

A symptom index for benign prostatic hyperplasia (BPH) was developed and validated by a multidisciplinary measurement committee of the American Urological Association (AUA). Validation studies were conducted involving a total of 210 BPH patients and 108 control subjects. The final AUA symptom index includes 7 questions covering frequency, nocturia, weak urinary stream, hesitancy, intermittence, incomplete emptying and urgency. On revalidation, the index was internally consistent (Cronbach's alpha = 0.86) and the score generated had excellent test-retest reliability (r = 0.92). Scores were highly correlated with subjects' global ratings of the magnitude of their urinary problem (r = 0.65 to 0.72) and powerfully discriminated between BPH and control subjects (receiver operating characteristic area 0.85). Finally, the index was sensitive to change, with preoperative scores decreasing from a mean of 17.6 to 7.1 by 4 weeks after prostatectomy (p < 0.001). The AUA symptom index is clinically sensible, reliable, valid and responsive. It is practical for use in practice and for inclusion in research protocols.

Adult↗
PubMed1992

Correlation of the American Urological Association symptom index with self-administered versions of the Madsen-Iversen, Boyarsky and Maine Medical Assessment Program symptom indexes. Measurement Committee of the American Urological Association.

We correlated the American Urological Association (AUA) symptom index with other indexes that have been used to measure symptoms for benign prostatic hyperplasia (BPH) and compared their psychometric properties. A self-administered questionnaire that allowed derivation of AUA, Maine Medical Assessment Program, Madsen-Iversen and Boyarsky symptom scores was completed by 76 men with clinically defined BPH, 59 younger control subjects, and 27 men before and after prostatectomy. The scores from the 4 indexes were strongly correlated (r = 0.77 to 0.93). All 4 indexes had good internal consistency and test-retest reliabilities. All indexes were predictive of patient global ratings of the degree of bother from the urinary condition. The AUA index discriminated BPH patients from controls significantly better than the Maine Medical Assessment Program index, and equivalently to the Madsen-Iversen and Boyarsky indexes (despite having fewer items). All 4 indexes were responsive when BPH patients underwent prostatectomy, although the AUA and Madsen-Iversen indexes were significantly more sensitive.

Humans↗
PubMed1990

American Urological Association survey of transurethral prostatectomy and the impact of changing medicare reimbursement.

The American Urological Association, in a survey of all American urologists, found that TURP accounts for 38 per cent of their major surgery and also found that activities associated with the operation account for nearly 25 per cent of their total patient workload. American urologists regard TURP as complex, and they believe proficiency requires more practical case experience during residency training than is required for any other urologic operation. American urologists assign TURP a significantly higher relative value than that proposed in the pending national Medicare Fee Schedule formulated by medical economists and the Physician Payment Review Commission. The legislated reductions in allowable Medicare fees for TURP and the possible shift in management of benign prostatic hyperplasia to nonsurgical methods create a financial vulnerability for American urologists who remain economically dependent on this dominant operation. Adjustments in practice patterns and manpower policy planning may well be required.

Humans↗
PubMed1989

Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients.

The mortality rate for transurethral prostatectomy was 0.2 per cent in 3,885 patients reviewed retrospectively. The immediate postoperative morbidity rate was 18 per cent. Increased morbidity was found in patients with a resection time of more than 90 minutes, gland size of more than 45 gm., acute urinary retention and patient age greater than 80 years, and in the black population. Of the patients 77 per cent had significant pre-existing medical problems. Operative mortality, significant morbidity and hospital stay were reduced in comparison to studies done 15 and 30 years ago.

Age Factors↗
PubMed1989

Transurethral prostatectomy: practice aspects of the dominant operation in American urology.

In a national survey of all American urologists transurethral prostatectomy accounted for 38 per cent of the major surgical procedures performed by the respondents. They regarded the operation as complex and they believe achievement of proficiency requires that more be performed during residency training than any other urological operation. Furthermore, they assigned transurethral prostatectomy a significantly higher relative value than have medical economists doing research in the field of physician reimbursement. The effect of recent legislated congressional reductions in the allowable Medicare fees for transurethral prostatectomy is discussed along with the impact of these reductions on urological patient care and the American urologist. Practice patterns and geographic variations in the costs of transurethral prostatectomy also are considered.

Adult↗