Biomedical subjects
J T Andersen
Publications and source records attributed to J T Andersen.
[Validation of the patient-administered Danish Prostate Symptom Score Schedule].
The DAN-PSS-1 system, a self-administered quality-of-life questionnaire comprising 12 questions related to voiding problems and the perceived bother of each individual symptom, was compared to other extensively used score systems and furthermore included in different clinical situations so as to validate the system. The system was internally consistent (alpha cr = 0.73), the median test-retest reliability of answers to each question was 83.5% (range 0-99.7%). A high degree of construct validity demonstrated in the correlation with the Madsen-Iversen score system (rs = 0.51) and with the patients' answers to questions about how bothersome their symptoms were (rs = 0.71). The discriminant validity of the DAN-PSS-1 was excellent with an area under the ROC curve of 0.94. Finally, the DAN-PSS-1 was sensitive to changes following intervention, with scores decreasing 100% after transurethral prostatectomy and 65% after four months of treatment with an alpha-blocker. The DAN-PSS-1 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 during follow-up.
Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia.
OBJECTIVES: A pooled analysis of all available randomized trials with 2-year follow-up data with finasteride and placebo was undertaken to further investigate recent observations that finasteride use may reduce the occurrence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH)-related surgical intervention. METHODS: Occurrences of AUR and surgical intervention were examined by treatment group in a pooled series of 4222 men with moderately symptomatic BPH. RESULTS: In total, 81 occurrences of AUR were reported, 24 (1.1%) of 2113 in the finasteride group and 57 (2.7%) of 2109 in the placebo group. The hazard ratio was consistent in all three studies, with a 57% decrease in the hazard rate for occurrence of AUR with finasteride compared with that for placebo present in the pooled data set over the 2-year study period (P < 0.001). Additionally, 227 surgical interventions were recorded over the 2-year study period, 89 (4.2%) of 2113 in the finasteride group and 138 (6.5%) of 2109 in the placebo group. The hazard ratio was consistent across the three studies, with a 34% reduction in the hazard rate for occurrence of surgery with finasteride compared with that for placebo (P < 0.002). Overall, there was 35% reduction in the two BPH-related end points (ie, AUR or surgery). CONCLUSIONS: Treatment with finasteride for up to 2 years more than halves the frequency of AUR and reduces surgical intervention by over one third relative to placebo in patients with moderate BPH. This is the first demonstration that long-term medical therapy can reduce clinically significant end points such as AUR or surgery, and these data have important implications for the long-term management of patients with BPH.
Extracorporeal shock wave lithotripsy as first line monotherapy of solitary calyceal calculi.
Eighty-four patients with solitary calyceal stones were treated with Extracorporeal Shock Wave Lithotripsy (ESWL) as first line monotherapy. The indications for treatment were pain in 51 patients (61%), infection in 11 patients (13%), pain and infection in 18 patients (21%) and others in 4 patients (5%). Stone size (largest diameter) was median 9 mm (range 2-25 mm). Follow-up consisted of clinical control, isotope renography and a plain film after 1 month; hereafter plain films after 3 and 6 months. Auxiliary procedures due to steinstrasse were performed in 3 out of 4 patients (1 nephrostomy, 1 nephrostomy + ESWL of ureteral fragments, and 1 ureteroscopic manipulation). Retreatment of the calyceal stone was performed in 3 patients within 6 months (2 re-ESWL, 1 lower pole resection). Stone-free (without retreatment or auxiliary procedures) were 26/84 (31%) after 1 month, 34/84 (40%) after 3 months and 38/84 (45%) after 6 months. Free of pain were 43/69 (62%) after 1 month, 50/69 (72%) after 3 months and 59/69 (86%) after 6 months. Free of infection were 18/29 (62%) after 1 month, 19/29 (66%) after 3 months and 21/29 (72%) after 6 months. Complications included steinstrasse in 4 patients, sepsis in 3 patients, displacement of JJ-stent in 2 patients and atrio-ventricular dissociation in 1 patient. To conclude: ESWL as first line therapy for solitary calyceal calculi offers good results with regard to pain and clearance of infection, but leaves 55% with residual stone material.
[Treatment of benign prostatic hyperplasia with Proscar (finasteride). Results of a 10-year Scandinavian study].
707 patients with moderate prostatic hyperplasia were recruited to a two-year Scandinavian multicenter study. The study was randomized, prospective and double-blind. Half of the patients were treated with finasteride (5 mg daily) and the controls were given placebo. The patients were monitored with regard to symptoms, urinary flow rate and prostate volume. In addition, various laboratory examinations were performed. A statistically significant difference was found between the groups with regard to symptom improvement and increase in urinary flow rate in favour of finasteride. Finasteride reduced prostate volume and stopped further growth, leading to a difference of 30% in prostate volume between the two groups after two years of treatment. Thus, finasteride was able to stop the continuous growth of the prostate in the elderly male. The proportion of patients with adverse clinical experiences was similar in both treatment groups. However, the finasteride-treated group contained more patients with sexual dysfunction. We conclude that finasteride is an alternative to vigilant waiting for patients with moderate symptoms of benign prostatic hyperplasia.
[The open, interdisciplinary incontinence clinic at Hvidovre Hospital. Preliminary experiences from the first 16 months].
A "minimal care" program for examination and treatment of urinary incontinence in an open access incontinence clinic was assessed. The first 300 women and 27 men consecutively investigated in the clinic are described. A reference program based on minimal relevant work-up and non-operative treatment as first line with use of minimal resources was followed. Of 171 evaluated women, 100 received non-operative treatment besides general advice on voiding/toilet pattern and appropriate incontinence appliances. Subjectively 69% felt cured or very much improved, 25% experienced improvement while 6% did not report benefit of the treatment. Objectively, diminished leakage was demonstrated by pad-weighing test. Similar results were found in the treated men. Our preliminary results demonstrate, that an open access, interdisciplinary clinic is patient-accepted and effective for the evaluation and treatment of urinary incontinence.
[Finanseride in symtomatic benign prostatic hyeprtrophy. A 2-year placebo-controlled study].
The efficacy and safety of treatment with finasteride 5 mg daily for 24 months was assessed in this multicentre double blind placebo-controlled study including 707 patients with moderately symptomatic benign prostatic hyperplasia. Efficacy parameters were changes in voiding- and bladder storage symptoms assessed by a validated symptom score, changes in maximum urinary flow rate and changes in the prostate volume. In the finasteride patients, symptom score improved during the whole study with a significant difference between active treatment and placebo after 24 months (p < 0.01). Maximum flow rate increased in finasteride treated patients resulting in a difference between these and the placebo treated patients of 1.8 ml/s after 24 months (p < 0.01). Prostate volume was reduced by 19% in the finasteride treated patients versus an increase of 12% in the placebo treated patient group (p < 0.01). Finasteride was well tolerated. Patients receiving placebo progressed in symptoms after 16 months. Finasteride can halt the natural progression of moderately symptomatic BPH over a 24 month period.
[Lesions of the ureter in radical hysterectomy for cervical cancer].
Eight ureter lesions of the ureter occurred among 100 consecutive patients undergoing radical hysterectomy for cancer of the uterine cervix. The management of this problem is discussed, and treatment guidelines for the most commonly seen lesions are proposed. It is concluded that a more liberal use of ureteric stents or catheters should be considered so as to reduce the number of ureteric lesions occurring in connection with radical hysterectomy. Urological assistance should be sought for urological lesions recognized during or after such operations.
[Daytime urinary incontinence in children--is it treatable?].
Explore the source record for details and available documents.
Treatment of benign prostatic hyperplasia. The Scandinavian BPH Study Group.
Explore the source record for details and available documents.
Standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs.
Explore the source record for details and available documents.
Disturbances of ano-rectal function in multiple sclerosis.
Thirty patients with multiple sclerosis (MS) [18 men and 12 women, mean age 40 years (range 22-50), disease duration 12 years (range 0.5-34), Kurtzke's Expanded Disability Status Score 6.0 (range 4.0-7.5)] were interviewed about bowel symptoms and studied using ano-rectal manometry. The results were compared with findings in healthy controls. Twenty-eight had bowel symptoms: 8 constipation, 10 constipation and infrequent faecal urgency, 4 infrequent faecal incontinence and 6 frequent faecal incontinence. Anal sphincter pressure at rest was significantly reduced in MS patients 69 (SD 17) cm H2O, compared with 92 (SD 15) cm H2O in controls, and the external sphincter contraction force was also significantly reduced. Rectal sensation and rectal compliance were reduced and the ano-rectal inhibition reflex (defaecation reflex) required a higher rectal pressure to be elicited in the patients. Upon rectal filling, an early external sphincter excitation was seen. The presence of faecal incontinence correlated strongly with reduced rectal sensation. The findings suggest that faecal incontinence can at least partly be explained by low anal sphincter pressure and poor rectal sensation. The findings of early sphincter excitation and increased threshold of ano-rectal inhibition reflex may be an important pathophysiological factor for constipation in MS patients.
Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability.
A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.
The standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs. International Continence Society Committee on Standardization of Terminology. Subcommittee on Intestinal Urinary Reservoirs.
Explore the source record for details and available documents.
The standardization of terminology and assessment of functional characteristics of intestinal urinary reservoirs.
Explore the source record for details and available documents.
Finasteride in the treatment of benign prostatic hyperplasia.
Finasteride is an enzyme inhibitor which blocks the conversion of testosterone by 5 alpha-reductase to dihydrotestosterone, the active androgenic metabolite in the prostate. In a double-blind, placebo-controlled study, 707 patients with moderately symptomatic BPH were treated for 2 years. The study confirmed that treatment significantly improved symptoms, reduced prostate size and increased urine flow rate. Side effects were usually mild. The authors find that finasteride can reverse the natural progression of BPH.
Minimal care--a new concept for the management of urinary incontinence in an open access, interdisciplinary incontinence clinic. The way ahead?
A new concept for assessment and treatment of urinary incontinence in an open access, interdisciplinary clinic is evaluated prospectively. Based on the patients needs and expectations, a minimal relevant investigative programme was planned. The patients were primarily offered conservative, non-surgical treatment modalities with a limited consumption of resources. The reference programme for investigation and treatment is referred to as the "minimal care principle". We here report our results in the first 300 women and 27 men consecutively investigated and created in the clinic. Ninety percent of the patients were managed by conservative treatment modalities whereas only 10% of the patients were referred to in-hospital treatment with invasive treatment modalities, mainly surgical procedures for urinary incontinence. Subjectively, 68% felt cured or very much improved, 23% experienced improvement and 9% did not report benefit of the treatment. Objectively, significantly diminished leakage of urine could be demonstrated in 71% of the patients by the pad weighing test. Our results demonstrate that an open access, interdisciplinary clinic is well accepted by the patients and effective for the evaluation and treatment of urinary incontinence.
Can finasteride reverse the progress of benign prostatic hyperplasia? A two-year placebo-controlled study. The Scandinavian BPH Study Group.
OBJECTIVES: To study if placebo-induced improvement in men with symptomatic benign prostatic hyperplasia (BPH) is maintained over 2 years, and to study the efficacy and safety from intervention with finasteride 5 mg for 24 months. METHODS: This was a multicenter, double-blind, placebo-controlled study involving 707 patients with moderate symptoms of BPH enrolled at 59 centers in five Scandinavian countries. Following enrollment and a 4-week single-blind placebo run-in period, patients were randomized to receive finasteride 5 mg once daily or placebo for 24 months. Urinary symptoms, urinary flow rate, prostate volume, postvoiding residual urinary volume, and serum concentrations of prostate-specific antigen together with laboratory safety parameters were measured at entry and at months 12 and 24. Interim physical and laboratory examinations were performed when indicated clinically. RESULTS: In finasteride-treated patients the total symptom score improved throughout the study, with a significant difference between the two groups at 24 months (P < or = 0.01), whereas in placebo-treated patients, there was an initial improvement in the symptom score but no change from baseline at 24 months. The maximum urinary flow rate decreased in the placebo group, but improved in the finasteride group, resulting in a between-group difference of 1.8 mL/s at 24 months (P < or = 0.01). The mean change in prostate volume was +12% in the placebo group versus -19% in the finasteride-treated group (P < 0.01). Finasteride was generally well tolerated throughout the 2-year study period. CONCLUSIONS: The efficacy of therapy with finasteride 5 mg in improving both symptoms and maximum urinary flow rate and reducing prostate volume has been shown to be maintained during 24 months while patients receiving placebo experienced a return to baseline or deterioration of these parameters during the study. These results demonstrate that finasteride can reverse the natural progression of BPH.