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Biomedical subjects

J Nordling

Publications and source records attributed to J Nordling.

At least 55 records · Page 3Linked to original sources
PubMed1997

Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-'BPH' Study. International Continence Society--Benign Prostatic Hyperplasia.

OBJECTIVE: To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. PATIENTS AND METHODS: The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. CONCLUSION: ICSQoL items may be used individually or as a group in research studies or in clinical practice.

Aged↗
PubMed1996

[Evaluation of symptoms in patients with benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is the most common cause of voiding dysfunction in elderly men. With the age related demographic changes in the western world, the epidemiological and economical burden of BPH is anticipated to increase. BPH is clinically diagnosed on a variety of more or less well defined symptomatic, macroscopical, and physiological criteria, whereas the histological diagnosis is straightforward. Yet, no symptom is specific for BPH and numerous other diseases have to be considered when a patient presents with symptoms of bladder outlet obstruction. A BPH questionnaire is useful when weighing the pros and cons for intervention. Furthermore, a symptom index represents a valuable indicator for the quality of care provided. Through the last decades a number of BPH questionnaires have been introduced. This article scrutinizes various BPH indices and provides an introduction to the prerequisites of clinical questionnaires.

Aged↗
PubMed1996

A new technique for detrusor biopsy and its applicability in the ultrastructural study and diagnosis of voiding dysfunction.

OBJECTIVE: To determine the clinical applicability of ultrasound-guided detrusor biopsy from the anterior bladder wall and to assess whether it is as representative and as sufficient for determining detrusor ultrastructure as the traditional transurethral biopsy from the lateral bladder wall. MATERIALS AND METHODS: The detrusor structure in 22 biopsies. 11 obtained transabdominally and 11 transurethrally from 11 patients, was evaluated without knowledge of the biopsy method by light and electron microscopy, including morphometric analysis. In addition, several specimens from each of three bladders were evaluated, also 'blindly', for ultrastructural diagnosis of the detrusor in an independent current study of voiding dysfunction in geriatric patients. RESULTS: There were no differences in intercellular distances and cell: nucleus ratios between transabdominal and transurethral biopsies in eight of the 11 patients. Furthermore, ultrasound-guided transabdominal biopsies were as representative of the detrusor as were transurethral biopsies. CONCLUSION: The transabdominal approach is recommended as an easy, relatively inexpensive and efficient method of obtaining biopsies of the detrusor for study of its structure in voiding dysfunction. On the other hand, the observations and diagnoses made by 'blind' qualitative study of several specimens from the same bladder were identical. This, together with the similarity of detrusor structure in the transabdominal and transurethral biopsies, strongly supports the idea that such structure is relatively uniform throughout the entire bladder wall.

Aged↗
PubMed1996

Placebo effects in the pharmacological treatment of uncomplicated benign prostatic hyperplasia. The ALFECH Study Group.

In order to establish accurately the exact effect of any drug therapy for symptomatic benign prostatic hyperplasia (BPH) it is important to define the effect of placebo treatment. This effect was assessed by throughly analyzing the placebo arm, which included 101 patients, from a randomized, double-blind, placebo-controlled trial of the selective alpha-blocker alfuzosin and comparing the data with those of a variety of independent studies which followed a placebo group of patients with clinical BPH. Following 16 weeks of placebo treatment a decrease of 24% (p < 0.05) in Madsen-Iversen score and an increase of 14% (p < 0.05) in peak flow rate was demonstrated. The percentages of patients who reported worsening, improvement or no change in symptoms were 9.2%, 73.6% and 17.2% respectively. The maximal effect of placebo, approximately 40% reduction in symptom scores, is likely to be achieved within the first four to six months. After this, the placebo effect stabilizes and gradually wears off but is still present following 12 months of treatment. The duration of the placebo effect and the time until it has totally worn off, if ever, remains to be studied in long-term, placebo-controlled trials, including an untreated cohort. The present study emphasizes the importance of properly designed, double-blind, placebo-controlled studies in evaluating any pharmacological intervention in clinical BPH.

Adrenergic alpha-Antagonists↗
PubMed1996

Tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist. A meta-analysis of two randomized, placebo-controlled, multicentre studies in patients with benign prostatic obstruction (symptomatic BPH). European Tamsulosin Study Group.

OBJECTIVE: This meta-analysis of two European studies evaluated the efficacy and safety of modified-release tamsulosin 0.4 mg once daily compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic obstruction (symptomatic BPH). METHODS: Patients entered a 2-week placebo run-in period, followed by randomization to treatment with tamsulosin (382 patients) or placebo (193 patients) once daily for 12 weeks. RESULTS: Maximum urinary flow rate improved to a greater extent in the tamsulosin group (1.6 ml/s, 16%) than the placebo group (0.6 ml/s, 6%) (p = 0.002). Total Boyarsky symptom score also improved to a greater extent in the tamsulosin group (3.3 points, 35.1% reduction) than the placebo group (2.4 points, 25.5% reduction) (p = 0.002). Significantly more tamsulosin patients (66%) than placebo patients (49%) had a > or = 25% decrease in total symptom score at endpoint (p < 0.001). Twelve weeks of treatment with tamsulosin also produced significant improvements in average urinary flow rate (p = 0.005) and voiding or "obstructive" (p = 0.008) and storage or "irritative' (p = 0.017) symptom scores. The incidence of drug-related adverse events was comparable for the tamsulosin and placebo groups (13 and 12% respectively, p = 0.802). The same applies to the incidence of adverse events commonly attributed to alpha 1-adrenoceptor antagonists, such as dizziness, headache, postural hypotension, syncope, asthenia, somnolence and rhinitis. There were no clinically significant changes in blood pressure or pulse rate in tamsulosin patients compared with placebo patients both in hypertensive and normotensive BPH patients. CONCLUSION: Tamsulosin 0.4 mg once daily is safe, well-tolerated and improves both the symptoms and urinary flow rate in patients with benign prostatic obstruction (symptomatic BPH).

Administration, Oral↗
PubMed1995

Morphological, stereological, and biochemical analysis of the mini-pig urinary bladder after chronic outflow obstruction and after recovery from obstruction.

Chronic partial bladder outlet obstruction was created in nine mini-pigs by implanting a 6-7 mm ring around the proximal urethra. After a median obstruction period of 63 days, the ring was removed and after a recovery period of median 60 days the animals were sacrificed. Changes in muscle and connective tissue were assessed by unbiased, modern morphometry and biochemical analysis. After obstruction the results were as follows: (1) a 6-fold increase in bladder weight, (2) a 2.5-fold increase in smooth muscle cell size, (3) a 3-fold increase in smooth muscle cell number, (4) unchanged proportions between muscle and connective tissue, (5) unchanged hydroxyproline concentrations, (6) an 8-fold increase in total collagen content, (7) an increase in the ratio of type I/III collagen, and (8) a 7-8-fold increase in total content of type I and III collagen. All changes were markedly, though incompletely, reversed after recovery, except smooth muscle cell number and the ratio of type I/III collagen.

Animals↗
PubMed1995

Length density and total length of acetylcholinesterase positive nerves related to cystometry and in vitro studies of muscle strips in mini-pig urinary bladder after chronic outflow obstruction and recovery from obstruction.

Chronic partial bladder outlet obstruction was created in mini-pigs by implanting a 6-7 mm ring around the proximal urethra. After a median obstruction period of 63 days, the ring was removed and after a median recovery period of 60 days the animals were sacrificed. At each occasion stepwise cystometry, measurement of residual urine, muscle strips studies with electrical and carbachol stimulation, and stereological estimations of length density and total length of acetylcholinesterase positive nerves were performed. The results can be summarized as follows: (1) unchanged sensitivity of muscle strips to carbachol, but markedly decreased contractility and rate of contraction to carbachol, (2) no evidence of detrusor instability, but severely decompensated bladders in two pigs, (3) a significant increase in residual volume, (4) a pronounced decrease in length density and total length of acetylcholinesterase positive nerves, and (5) at field stimulation strips from some pigs showed increased sensitivity and contractility with high atropine and TTX resistance, while strips from the other pigs revealed decreased sensitivity and markedly decreased contractility to electrical stimulation. In general, most of the changes were markedly, though incompletely, reversed after recovery. Light and electron microscopy of muscle strips showed no histological or ultrastructural changes during the experiments or after storing 1 day at 4 degrees C.

Acetylcholinesterase↗
PubMed1995

A clinical view of pressure-flow studies.

Lower-urinary-tract symptoms might be due to bladder dysfunction, infravesical obstruction, or both, and these conditions give rise to the same type of symptoms. Classification of symptomatic benign prostatic hyperplasia (BPH) patients into obstructed or unobstructed cases can be done only by pressure-flow studies. This classification has been demonstrated to be of predictive value for the outcome of surgical treatment, both symptomatically and urodynamically. Pressure-flow studies are therefore helpful in the pretreatment workup of patients in regard to both diagnosing the underlying pathophysiology and, consequently, stratifying patients for different treatments or watchful waiting. Different methods of interpreting pressure-flow investigations share the same theoretical foundation and therefore have only minor differences in classifying patients into obstructed or unobstructed cases. The more advanced methods make a more differentiated classification possible, but these are currently mostly of theoretical value in research.

Humans↗
PubMed1995

Validation of the self-administered Danish Prostatic Symptom Score (DAN-PSS-1) system for use in benign prostatic hyperplasia.

OBJECTIVE: To validate the Danish Prostatic Symptom Score (DAN-PSS-1), a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom. METHODS: Using published results from several comparisons of other symptom scoring systems with DAN-PSS-1, the test-retest reliability, internal consistency, construct and content validity, and responsiveness of the DAN-PSS-1 system were assessed. RESULTS: The system was internally consistent (Cronbach's alpha = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%) and the questionnaire was well understood by the patients. The DAN-PSS-1 system demonstrated a high degree of construct validity, correlating with the extensively used Madsen-Iversen score system (Spearman's correlation coefficient, rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The DAN-PSS-1 system discriminated clearly between patients with benign prostatic hyperplasia (BPH) and control subjects (an area under the receiver operating characteristic curve of 0.94). Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing from a median of 20 to zero 4 months after patients underwent transurethral prostatectomy and from a median of 11.5 to 7.5 (65%) after patients had received 4 months treatment with an alpha-blocker. CONCLUSIONS: The DAN-PSS-1 system is reliable, valid and responsive, and therefore can be recommended for assessing the severity of symptoms among patients presenting with lower urinary tract complaints suggestive of BPH and in the follow-up after intervention.

Adrenergic alpha-Antagonists↗
PubMed1994

Subjective and objective evaluation of patients with prostatism and infravesical obstruction treated with both intraprostatic spiral and transurethral prostatectomy.

In order to evaluate the effect of intraprostatic spiral and subsequent transurethral prostatectomy (TURP) on obstructive benign prostatic hyperplasia, 9 men were evaluated with symptom scores and urodynamic studies at inclusion after 4 months of spiral treatment and 4 months after TURP. Six patients in a control group were evaluated at inclusion after an observation period of 4 months and 4 months after TURP. After treatment with spiral the symptom score decreased in 7 patients, increased in 1, and was unchanged in 1. After the observation period in the control group the symptom score decreased in 4 patients, increased in 1, and was unchanged in 1. After TURP the symptom score decreased even further in all patients, but one. After spiral treatment the urethral resistance decreased in 8 of 9 patients, but according to Abrams and Griffith's [(1979): Br J Urol 51:129-134] definition, only 2 were unobstructed. Five patients in the control group were unchanged obstructed after the observation period, while one was unobstructed. After TURP, the patients in both groups were all unobstructed. Intraprostatic spirals decrease the severity of symptoms and reduce the urethral resistance, but TURP in the same patient was much more effective.

Follow-Up Studies↗
PubMed1994

Definition of prostatic urethral obstruction.

Prostatic urethral obstruction as defined by urodynamic criteria is only present in about 70% of patients undergoing surgical treatment for benign prostatic hyperplasia (BPH). Infravesical obstruction can only be diagnosed by simultaneous recording of detrusor pressure (intravesical pressure minus abdominal pressure) and urinary flow rate. The interpretation of these recordings should be based upon the pressure-flow relationship. The possible clinical implications of the objective diagnosis of prostatic urethral obstruction in BPH are discussed.

Humans↗
PubMed1994

The anatomy of a prostate waiting list: a prospective study of 132 consecutive patients.

OBJECTIVE: To report the results of a standard evaluation programme performed prior to transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). PATIENTS AND METHODS: All 132 patients with symptoms of prostatism on the waiting list for surgery were invited to attend the hospital to undergo a physical examination, symptom evaluation and routine blood sampling. Of these, 117 attended. If the suspicion of BPH was sustained a transrectal ultrasound examination of the prostate and a urodynamic evaluation, including a pressure-flow study, were performed. RESULTS: Urodynamic evaluation was carried out in 80 of the 117 patients who attended the clinic. Infravesical obstruction was present in 61 patients while in 19 (24%) there was no obstruction. An operative procedure to relieve obstruction was performed in 65 patients (49%). CONCLUSIONS: In a population of patients scheduled for TURP, 24% were found not to have an obstruction. This is in accordance with other reports. As the patients with few symptoms and those who did not have an obstruction were treated conservatively only 49% of the referred cases underwent prostatic surgery.

Aged↗
PubMed1994

'Clam' ileocystoplasty.

'Clam' enterocystoplasty has been performed in 23 patients in the treatment of lower urinary tract dysfunction. Twenty patients had neurogenic disorder while three were neurologically normal. Patients were evaluated urodynamically pre- and postoperatively. A significant change from a high pressure bladder to a low pressure bladder was found. Most patients had detrusor instability/hyperreflexia but 7 were operated due to poor bladder compliance. Only 2 patients had postoperative detrusor instability. Three patients later had a urinary diversion. Nineteen patients became dry giving a total success rate of 87% although 14 had to do clean intermittent self catheterization.

Adolescent↗
PubMed1994

Precision of a patient-weighted symptom score in prostatism. The DAN-PSS-1 questionnaire.

The Danish Prostatic Symptom Score (DAN-PSS-1) comprises 12 questions related to voiding problems in benign prostatic hyperplasia. The patient himself scores each symptom as regards severity (symptom score) and impact on daily life (bother score). The precision of this patient-weighted (postal) questionnaire was investigated in terms of repeat frequencies of replies from 197 randomly selected men on two sequential occasions. The questionnaire was well understood by the patients. The median frequency of repeat in answers to the questions was 83.5% (range 0-99.7%). This frequency depended on the nature of the question and the severity or bother of the symptom. Repeatability as regards bother rose markedly when the bother score was made dependent of the symptom score, suggesting a relationship between the two. As with other questionnaires, the precision of those dealing with prostatism should be established before clinical use. The observed relationship between symptom score and bother score may be of diagnostic value.

Adult↗
PubMed1994

Alfuzosin in the treatment of benign prostatic hyperplasia: effects on symptom scores, urinary flow rates and residual volume. A multicentre, double-blind, placebo-controlled trial. ALFECH Study Group.

In order to assess the efficacy and safety of alfuzosin, a selective alpha-1 receptor antagonist, 205 patients with Benign Prostatic Hyperplasia (BPH) were randomly assigned in a double-blind, placebo-controlled manner, to receive either alfuzosin 2.5 mg TID or placebo TID during 12 weeks. After 12 weeks symptom scores-assessed according to the Madsen-Iversen scale were significantly reduced in the alfuzosin group and peak flow rate significantly increased compared to the placebo group. There were no significant differences concerning adverse events or withdrawals. Alfuzosin proved to have a beneficial effect in patients with symptomatic BPH with few and minor adverse events.

Adrenergic alpha-Antagonists↗
PubMed1994

Prostatic enlargement, symptomatology and pressure/flow evaluation: interrelations in patients with symptomatic BPH.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male. Many patients with symptomatic BPH undergo prostatectomy without rigorous evaluation. Three concepts should be considered before any treatment of a patient with symptomatic BPH; Prostatic enlargement, symptomatology and bladder outflow obstruction. PATIENTS AND METHODS: The study comprised 188 consecutive patients with symptomatic BPH, all eligible after pressure/flow examination. One-hundred-seventy-four of the patients answered the DAN-PSS questionnaire, 140 of the patients had their prostate size measured by transrectal ultrasonography. One-hundred-fifty-three patients were able to perform a free flow measurement upon arrival. Uroflowmetry, symptomatology and prostate size were matched with the results of pressure/flow examination. RESULTS: Neither uroflowmetry, symptomatology nor prostate size correlated well with bladder outlet obstruction. The positive predictive value for infravesical obstruction was 88% if a maximum flow rate under 10 ml/s was used. Symptomatology could not be used to differentiate between patients with bladder outlet obstruction and patients without obstruction. The positive predictive value for infravesical obstruction was 76% if a prostate volume over 40 ml was chosen. DISCUSSION: The purpose of diagnostic evaluation in patients with BPH, is to identify precisely the pathophysiology underlying the patients condition, so that rational therapy can be selected. CONCLUSION: The disease entity of BPH is characterized by the interaction of prostate enlargement, the subjective symptom complex of prostatism, and urodynamic infravesical obstruction. Since it is impossible to interpolate from one to another of these conditions, a comprehensive evaluation of a patient with symptomatic BPH should include an assessment of all of these conditions.

Adult↗