Other non-medical treatments: balloons and stents.
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Catheterization↗
Biomedical subjects
J Nordling
Publications and source records attributed to J Nordling.
BPH treatment: urodynamic preoperative assessment and evaluation.
Originally prostatectomy was performed for complications to infravesical obstruction. Today 70% are performed because of lower urinary tract symptoms which might be due to obstructive BPH, but also might be a consequence of detrusor weakness or other age-related functional changes in the lower urinary tract. Of patients operated for uncomplicated BPH, approximately 30% are urodynamically unobstructed. Traditional urological measures like residual urine volume, endoscopic impression of prostate and bladder, as well as prostate size and even urinary flow rate measurements, are not able to separate this group. The symptomatic outcome after surgery is statistically significantly worse in the urodynamically unobstructed group, while urodynamic improvement is only marginal. As pressure/flow studies are the only method to diagnose infravesical obstruction, this should therefore be considered before more invasive procedures intended to treat suspected infravesical obstruction are performed.
Humans↗
[The intraprostatic spiral. Long-term results in 150 consecutive patients].
The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported (previously published in (7)). The median follow-up time was 8.6 months (range 0 to 60 months). In 89 patients the spiral was removed after an average of four months (range 0 to 50 months); on account of dysfunction of the spiral in 58 cases, planned prostatectomy in 17 cases and unrelated to the spiral (stroke etc.) in 14 cases. A total of 34 patients died with the coil in situ. Approximately two-thirds of the patients had no or few voiding symptoms, while one fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 51 patients but was not a clinical problem. Migration occurred 65 times in 47 patients but this only led to coil removal in eight. Calcification of the coil was noted mainly after long-term treatment and we recommend replacement of the coil after two years. We conclude that the intraprostatic spiral is a useful alternative to an indwelling catheter. Life-long follow-up is, however, necessary in most patients.
Adult↗
Memokath: a second generation of intraprostatic spirals.
Memokath (Engineers & Doctors A/S, Hornbaek, Denmark) is a new intraprostatic spiral composed of titanium nickel alloy with shape memory effect. We describe the use of this spiral in 30 consecutive patients with prostatic outflow obstruction. Their median age was 79 years and all were either in a high risk group for surgery or had refused surgery. The spiral was inserted under sterile conditions via a delivery catheter under ultrasonic guidance. When flushed with hot water (45 degrees C or above) one section of the spiral expands in the prostatic apex and maintains the spiral in position. When cooled with cold water (10 degrees C or below) the spiral becomes supersoft, making removal easy. With a follow-up of 0.2 to 9 months (median 3) we report a success rate of 83%. Five patients discontinued treatment, 3 because of urinary retention, 1 because of progressive obstructive symptoms and 1 following persistent urinary incontinence. No migration of the spiral was observed. Encrustations have appeared and seem to be a persistent problem. Most patients were satisfied with the procedure, which provided a quick, safe and effective method of relieving infravesical prostatic obstruction. Follow-up is short and late complications have yet to be assessed.
Aged↗
The "Wallstent": a new stent for the treatment of urethral strictures.
Ten patients have been reviewed in whom urethral stents were implanted for treatment of urethral stricture. Their urethral strictures had been treated with a median of 4.2 endoscopic urethrotomies under direct vision without success. The patients were first treated with optical urethrotomy, and dilatation to 30 F--after which the stents were inserted under direct endoscopic control. A total of 12 stents were inserted. All patients had a 30 mm stent inserted first, and two patients had an additional 20 mm stent inserted because of recurrent stricture at the distal or proximal end of the first stent. One patient had a urethrotomy 12 months after insertion of the stent because of a short recurrent stricture at its distal end. The median length of follow up was 24 months. The median preoperative maximum flow rate was 6.5 ml/s, and the median postoperative maximum flow rate was 20.3 ml/s. Half the patients had postmicturition dribbling postoperatively. The stents were covered with epithelium after 6-18 months, most between 12 and 18 months.
Adult↗
The value of a new symptom score (DAN-PSS) in diagnosing uro-dynamic infravesical obstruction in BPH.
INTRODUCTION: A new type of questionnaire for BPH, the DAN-PSS symptom score system, was used in an attempt to predict infravesical obstruction determined by pressure-flow study. PATIENTS AND METHODS: In 50 consecutive patients a reliable questionnaire and a pressure-flow was obtained. RESULTS: Almost none of the unobstructed patients had a total obstructed index (TOI) of more than 6, whereas this was the case in half of the obstructed patients. This difference was statistically significant. DISCUSSION: This study indicates, that if the total obstructed index (TOI) is more than 6, the patient most likely have an infravesical obstruction. With this limit the DAN-PSS-score system can predict infravesical obstruction with a sensitivity of 42% and a specificity of 89%. CONCLUSION: With the new concept of combining quantity with quality in a symptom score system, a strong correlation between symptoms and objective findings has been found.
Aged↗
A new patient weighted symptom score system (DAN-PSS-1). Clinical assessment of indications and outcomes of transurethral prostatectomy for uncomplicated benign prostatic hyperplasia.
A patient weighted symptom score system, the Danish Prostatic Symptom Score (DAN-PSS-1), including a disease specific self administered quality of life questionnaire, is presented. The model was evaluated pre- and postoperatively in 29 patients apparently suffering from uncomplicated benign prostatic hyperplasia. The score system is based on the severity of 12 symptoms related to bladder storage and voiding function, and three questions related to sexual function (symptom score). For each of these parameters the patient must also evaluate its influence on his daily life (bother score). In the 29 patients with uncomplicated benign prostatic hyperplasia (BPH) bother scores exceeded symptom scores for the irritative symptoms but not for the obstructive symptoms, and surprisingly the symptom score was less improved than the bother score 6 months after transurethral resection of the prostate (TUR-P). Furthermore the postvoiding dribble was worsened after the operation. We find that this model, DAN-PSS-1, assists in creating a solid base for the indication for and the evaluation of treatment of uncomplicated BPH.
Aged↗
Nonsurgical, nonpharmacologic treatment of benign prostatic hyperplasia.
New treatment modalities are becoming available for benign prostatic hyperplasia. Permanent or temporary stenting of the prostatic urethra, balloon dilatation of the prostate, and hyperthermia and thermotherapy are in the forefront. None of the methods has found a definite place in the spectrum of indications. Prospective trials are needed to ascertain the safety, efficacy, and durability of results.
Aged↗
The intraprostatic spiral: clinical results in 150 consecutive patients.
The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.
Adult↗
Successful pregnancy after ileocystoplasty. Case report.
A 32-year-old woman with multiple sclerosis had an uncomplicated pregnancy and labour two years after successful "clam" ileocystoplasty for urge incontinence and frequency of micturition. She remained well after three years following.
Adult↗
A simple method for insertion of an intraprostatic coil.
A simplified method of insertion of a urethral coil for treatment of benign prostatic obstruction has been tested in 25 patients. The prostatic urethra is measured either by abdominal/transrectal ultrasound scanning or by rigid or flexible endoscopy. The coil is inserted into the prostatic urethra using simple measurements taken from a Foley catheter; 21 coils were correctly positioned at the first attempt using this new method--a success rate equivalent to that of ultrasound-guided insertion.
Aged↗
International consultation on BPH sponsored by WHO. Report of the sub-group on other non medical treatment.
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Catheterization↗
[The intraurethral plug. A new alternative in the treatment of women with stress incontinence].
The intraurethral plug has been developed for treatment of women with stress-incontinence. The plug is made of thermoplastic-elastomeric material and consists of a meatus plate, a soft stalk and one or two beads along the stalk. The individual plug is constructed on the basis of the result of the urethral pressure profile. The plug is removed manually prior to micturition and after micturition a new plug is introduced by the patient. A plug with two beads was employed in period 1 (seven days) and a plug with one bead for period 2 (seven days). Twenty-two patients completed period 1. Eight of these patients did not complete period 2, mainly on account of unchanged incontinence during period 1 or repeated loss of the plug with one bead. In periods 1 and 2, 73% and 79% of the patients, respectively, were both subjectively and objectively continent or considerably improved. This preliminary investigation demonstrates that the intraurethral plug may be an alternative form of treatment of women with stress incontinence.
Adult↗
[Ileocystoplasty in the treatment of lower urinary tract dysfunction in patients with congenital myelomeningocele].
The therapeutic results in eight patients with congenital myelomeningocele and neuromuscular dysfunction of the lower urinary tract are presented. Urodynamic assessment was performed preoperatively and post-operatively. Ileocystoplasty was performed on all of the patients. The postoperative results were good in seven out of eight patients in whom urodynamic assessment reveals a low-pressure reservoir which functions well. All of the patients employ clean intermittent self catheterization and, employing this treatment, they are continent with stable renal function.
Adolescent↗
Rate of urinary bladder blood flow evaluated by 133Xe washout and radioactive microspheres in pigs.
Urinary bladder blood flow as measured by the washout of locally injected 133Xe and by the simultaneously performed radioactive microsphere reference-sample method was studied in pigs. The washout curves were analyzed according to the initial slope, the corrected initial slope and the total curve. The corrected-initial-slope flow rates were not statistically significantly different from the microsphere whole-wall flow rates. The variability between the methods shown by the test-retest difference revealed only a minor lack of agreement. The bladder blood flow tended to decrease after the intravesical pressure had been increased to 20 cmH2O, but the difference was not statistically significant. Washout of locally injected 133Xe can be used for the evaluation of urinary bladder blood flow in humans and in longitudinal animal studies. The corrected-initial-slope method is recommended for the analysis of washout curves.
Animals↗
Cavernosometry: methodology and reproducibility with and without pharmacological agents in the evaluation of venous impotence.
Venous impotence can be evaluated by cavernosometry, although this is a controversial issue. We have evaluated various techniques for cavernosometry: with and without intracavernous papaverine, with different dosages and modalities, with different modes of induction flow and at various intracavernous pressures. A standardised technique was tested and retested in 32 impotent men. If pharmacocavernosometry is accepted as the most reliable test and a maintenance flow less than 20 ml/min indicates optimal venous occlusion, plain cavernosometry gave 6% false positive and 16% false negative results. Pharmacocavernosometry was found to be highly reproducible with regard to maintenance flow for patients thought to have optimal venous occlusion and for those with supposed leakage. The induction flow was of no diagnostic value. After injection of papaverine the maintenance flow became a reproducible parameter for quantifying venous outflow and could be measured with an intracavernous pressure equivalent to systolic blood pressure to minimise cavernous arterial inflow and increase reproducibility.
Adult↗
Intraprostatic spiral during waiting time for transurethral prostatectomy.
When benign prostatic hyperplasia results in voiding problems such as acute or chronic urinary retention, transurethral prostatectomy is often necessary. We have evaluated 24 patients, treated with an intraprostatic spiral, during waiting time for transurethral prostatectomy. The spiral treatment was a success in 21 patients. Three patients had a transurethral prostatectomy before scheduled time due to spiral failure, 2 with urinary retention, 1 with severe local discomfort. We conclude that spiral treatment of symptomatic benign prostatic hyperplasia while waiting for transurethral prostatectomy has a high success rate and is recommended as a favorable alternative to an indwelling urethral catheter.
Adult↗
Evoked potentials in urology: a method to make an exact diagnosis?
Due to the complex innervation of the lower urinary tract, many neurological diseases will lead to disturbances in the function of the lower urinary tract. The usual urodynamic procedures leave a group of patients where definitive diagnosis is impossible. Fifty-three patients were evaluated with evoked potentials of the bulbocavernosus reflex at the Urological Laboratory, Herlev Hospital. In 5 cases (2 with operative sequelae after prolapsed intervertebral discs, 1 with tethered cord syndrome and 2 with early multiple sclerosis) the examination gave a definitive diagnosis. The cases are reported.
Adult↗