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Biomedical subjects

K M Jensen

Publications and source records attributed to K M Jensen.

At least 55 records · Page 3Linked to original sources
PubMed1988

Urodynamics in prostatism. I. Prognostic value of uroflowmetry.

A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design included selection of patients for prostatic surgery by means of classic non-urodynamic urologic investigations such as history, residual urine, serum creatinine, cystoscopy and possibly intravenous urography. In addition an extensive urodynamic work-up (uroflowmetry, cystometry and pressure-flow study with stop-test) was included. The results of the urodynamic studies were unknown to the surgeon selecting the patients for operation. This evaluation was repeated 6 months postoperatively. Totally 139 patients entered the study. The patients were classified according to the preoperative maximum flow rate (Qmax) and in spite of preoperative differences in uroflow, pressure-flow variables and symptom scores, no differences of clinical significance were noted postoperatively among the groups. However, the high-flow group (preoperative Qmax greater than or equal to 15 ml/sec) had a statistically significant lower success rate as judged by the patients subjective evaluation of the outcome of surgery. An analysis of diagnostic sensitivity and specificity indicated Qmax = 15 ml/sec as a relevant cut-off value regarding preoperative identification of patients at risk of a less favourable outcome of surgery. This group of patients was characterized by a higher incidence of persistent uninhibited detrusor contractions at follow-up and a lower incidence of preoperative infravesical obstruction. In conclusion we recommend uroflowmetry in the preoperative evaluation of patients with prostatism.

Aged↗
PubMed1988

Urodynamics in prostatism. I. Prognostic value of uroflowmetry.

A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design included selection of patients for prostatic surgery by means of classic non-urodynamic urologic investigations such as history, residual urine, serum creatinine, cystoscopy and possibly intravenous urography. In addition an extensive urodynamic work-up (uroflowmetry, cystometry and pressure-flow study with stop-test) was included. The results of the urodynamic studies were unknown to the surgeon selecting the patients for operation. This evaluation was repeated 6 months postoperatively. Totally 139 patients entered the study. The patients were classified according to the preoperative maximum flow rate (Qmax) and in spite of preoperative differences in uroflow, pressure-flow variables and symptom scores, no differences of clinical significance were noted postoperatively among the groups. However, the high-flow group (preoperative Qmax greater than or equal to 15 ml/sec) had a statistically significant lower success rate as judged by the patients subjective evaluation of the outcome of surgery. An analysis of diagnostic sensitivity and specificity indicated Qmax = 15 ml/sec as a relevant cut-off value regarding preoperative identification of patients at risk of a less favourable outcome of surgery. This group of patients was characterised by a higher incidence of persistent uninhibited detrusor contractions at follow-up and a lower incidence of preoperative infravesical obstruction. In conclusion we recommend uroflowmetry in the preoperative evaluation of patients with prostatism.

Adult↗
PubMed1988

Urodynamics in prostatism. II. Prognostic value of pressure-flow study combined with stop-flow test.

In a prospective study the prognostic value of preoperative pressure-flow studies in prostatism was examined. The indications for prostatectomy were based on non-urodynamic data only. An extensive urodynamic evaluation was performed pre- and postoperatively, including uroflowmetry, water cystometry and pressure-flow study combined with stop-flow test. In total the data from 130 patients were considered. The material was classified with respect to the "urethral resistance relation" (URR) and the "bladder output relation" (BOR). According to the first criterion 87 patients were obstructed, 36 unobstructed, while 7 were unclassifiable and finally excluded. In most urodynamic variables, the two groups differed preoperatively, but no differences were revealed postoperatively. However, the obstructed group did considerably better postoperatively as to the symptomatic outcome. The success rate was 93% as opposed to 78% in the unobstructed patients (p less than 0.02). For the BOR classification, the theoretical maximum flow rate (Qm,est) was employed forming two groups: 57 patients with decreased bladder speed (Qm,est less than 35 ml/sec) and 41 patients with normal speed (Qm,est greater than or equal to 35 ml/sec). Few differences in urodynamic variables were found both pre- and postoperatively, but no significant difference was shown in success rates. In conclusion the URR proved a significant prognostic value in prostatism and is recommended in the preoperative work-up, especially in patients with equivocal uroflow studies. No convincing prognostic role could be attributed to the BOR.

Adult↗
PubMed1988

Urodynamics in prostatism. III. Prognostic value of medium-fill water cystometry.

The influence of preoperative cystometric findings on the post-surgical outcome in prostatism was examined in a prospective study comprising 139 consecutive patients. A blinded study design was used, including an entirely non-urodynamic selection procedure for prostatic surgery. In addition an extensive urodynamic investigation was carried out including: spontaneous uroflowmetry, medium-fill water cystometry and pressure-flow study combined with stop-flow test. All patients were re-evaluated 6 months postoperatively, both symptomatologically and urodynamically. The patients were classified in three groups according to the preoperative detrusor function: normal, overactive in the standing position and overactive in the supine position. No significant urodynamic nor symptomatologic differences were shown, neither pre- nor postoperatively. Nor did the subjective outcome differ between the groups. Demonstration of postoperative (persistent) detrusor instability was associated with an unfavourable subjective outcome. While residual urine had no predictive importance, a preoperative maximum cystometric capacity less than 300 ml appeared to indicate postoperative failure. Significant association was found between urge and detrusor instability. In conclusion, cystometry is not worthwhile in the preoperative work-up in prostatism.

Adult↗
PubMed1988

Urodynamics in prostatism. IV. Search for prognostic patterns as evaluated by linear discriminant analysis.

In order to examine the prognostic role of routine urodynamic testing in prostatism, a prospective study was undertaken. The patients were selected for prostatic surgery exclusively by means of non-urodynamic criteria, but in addition an extensive, blinded urodynamic work-up was performed, including uroflowmetry, pressure-flow study combined with stop-flow test and water cystometry. The study comprised 139 patients consecutively referred for prostatism. Six months postoperatively all patients were reexamined. Previously the preoperative urodynamic data from each modality were analysed separately. In an attempt to increase the prognostic information, all data were computed simultaneously using linear discriminant analysis. Several preoperative variables appeared valuable to discriminate between patients with favourable and unfavourable postoperative outcome, respectively. However, the results of classification employing even the best combinations of variables did not result in more than 88% of the patients being correctly classified. Furthermore, especially the patients with unfavourable outcome generally were misclassified. Several reasons for this lack of efficacy are briefly mentioned, including the great overlap in preoperative urodynamic data between patients with favourable and unfavourable postoperative outcome and the relatively low postoperative failure rate.

Adult↗
PubMed1987

Relationship between urinary flow curve patterns and symptomatology in elderly males.

In a random sample of elderly males prostatic type flow curves constituted slightly more than 50%, but no differences were proven comparing persons with and without prostatism. Also no clinically significant relationships between symptoms of lower urinary tract dysfunction and the various flow curve patterns were established. A hypothesis is advanced concerning the sequence of flow curve changes in elderly males, from normal bell-shaped curves to prostatic and finally irregular types, reflecting prostatic hyperplasia with gradual detrusor decompensation.

Aged↗
PubMed1986

Is there need for both intravenous urography and voiding cystography in the evaluation of children with recurrent urinary tract infections?

In a prospective study 33 children (aged 6-14 years) consecutively referred for recurrent urinary tract infections (RUTI), underwent intravenous urography (IVU) as well as voiding cystography (VC). Seven children had unilateral and two children had bilateral renal scarring, while ten children had unilateral and six children had bilateral vesico-ureteral reflux (VUR). Following normal IVU VUR was demonstrated in 22% of the ureters, but in all cases of low grade. In abnormal IVU, i.e. renal scarring or dilatation of the ureters, VC showed high grade VUR in 54% of the ureters. Based on these results and the current theories on the significance of patient age and grade of VUR, we conclude that in case of a normal IVU in children with RUTI and age of at least 6 years, there is no reason to supplement the pre-treatment evaluation with VC.

Adolescent↗
PubMed1986

Predictive value of low maximum flow rate in benign prostatic hyperplasia.

Among 84 patients with prostatism selected for transurethral resection of the prostate, 18 had a maximum flow at spontaneous uroflowmetry less than or equal to 7 ml/sec. Preoperatively there was no significant difference between patients with maximum flow less than or equal to 7 ml/sec (Group 1) and patients with maximum flow greater than 7 ml/sec (Group 2) in age, duration of symptoms, symptom scores, bladder volume, residual urine, and detrusor pressure at maximum flow. Patients in Group 1, however, had significantly lower urethral resistance and bladder volume independent maximum flow than patients in Group 2. Postoperatively, patients with preoperative maximum flow less than or equal to 7 ml/sec improved significantly in symptom scores and urodynamic findings apart from bladder volume and detrusor pressure at maximum flow. There were no significant differences between groups in postoperative symptom scores or urodynamic findings. We conclude that preoperative maximum flow rates less than or equal to 7 ml/sec at spontaneous uroflowmetry were related to high urethral resistance and not detrusor decompensation among patients with prostatism, and that patients with maximum flow rates less than or equal to 7 ml/sec fared as well postoperatively as patients with maximum flow greater than 7 ml/sec.

Aged↗
PubMed1986

Uroflowmetry in asymptomatic elderly males.

Uroflowmetry is important in the evaluation of prostatism. We have investigated 93 men, selected at random from the National Register, who had no subjective voiding problems but who fell within the appropriate age range. The sample was representative of the male metropolitan population. Uroflowmetry was carried out and the data are presented graphically in nomograms where the Q max/volume, Q average/volume and Q max time/volume relations are given. Flow variables were evaluated to delineate possible correlations to age. It was found that the median Q max decreased from 18.5 ml/s at the age of 50 years to 6.5 ml/s at 80 years. Only one-third of the group had a Q max exceeding 15 ml/s. The median voided volume was 208 ml. Half of the subjects voided less than 200 ml and one-third less than 150 ml.

Age Factors↗
PubMed1986

Detrusor instability in children with recurrent urinary tract infection and/or enuresis. I. Clinical conditions and symptomatology.

Forty-one children, aged 5-15 years, were referred because of recurrent urinary infections and/or enuresis. They were examined prospectively by means of cystometry. CO2 cystometry revealed detrusor instability in 18 children (44%), but if complete reproducibility were to be requested in repeated tests, only 7 children (17%) would have presented instability. Detrusor instability was not significantly related to definite pathological changes in the urinary tract or to irritative bladder symptoms.

Adolescent↗
PubMed1986

Detrusor instability in children with recurrent urinary tract infection and/or enuresis. II. Treatment.

Of 41 children, aged 5-15 years, referred consecutively because of recurrent urinary tract infections (UTIs) and/or enuresis, 18 (44%) showed detrusor instability (DI) in at least 2 of 6 CO2 cystometries. One child was excluded from the study because of lack of follow-up. Four children with less pronounced DI (instability during less than or equal to 50% of the cystometries performed) and frequent UTIs were given antibiotics prophylactically for 3 months. In the remaining 13 children, DI was found during more than half the cystometries performed, and 11 of these children, who also had urge incontinence, were treated with emepronium bromide, 400-600 mg daily (10-12 mg/kg) for 3 months. In 7 of the patients this treatment was supplemented by antibiotics prophylactically because of frequent UTIs. Two children with special problems received other types of treatment. All children were free from symptoms at a clinical check-up 6 months later, 95% confidence limits 0-20%.

Adolescent↗
PubMed1986

Some clinical aspects of uroflowmetry in elderly males. A population survey.

A random sample of 200 males aged 50 years or more was selected from the National Register in order to investigate various aspects of spontaneous uroflowmetry and to estimate the frequency of prostatism and symptoms of lower urinary tract dysfunction. All in all the data from 112 persons were analysed. The prevalence of prostatism was found to be 17% (95% confidence limits 11-26%), while 88% (95% confidence limits 83-95%) experienced various degrees of symptoms. Only few associations between single symptoms and uroflowmetry variables were demonstrated. However, statistically significant correlations were revealed between obstructive and total symptom scores on one hand and maximum and average flow rates on the other hand. As the correlations were modest and a considerable overlap of uroflow variables in persons with and without prostatism were proved, the diagnostic specificity and sensitivity of maximum flow rate as well as other uroflow variables were low in the screening for prostatism. In conclusion uroflowmetry appears inefficient to confirm a clinical impression of prostatism.

Aged↗
PubMed1985

Value of cystourethroscopy in the assessment of children with recurrent urinary tract infections and/or enuresis.

Forty-one children ages 6-14 years consecutively referred for recurrent urinary tract infections (RUTI) and/or enuresis constituted the study group. Cystourethroscopy (CUS) was carried out in 40 children and pathologic findings were revealed in 70% of children with RUTI in the absence of vesico-ureteral reflux (VUR). However, only in 4 patients did CUS influence treatment. Based on these data we conclude that routine CUS is not justified in the evaluation of this group of children unless anatomical infravesical lesions are suspected. VUR was proven in 44% of children with RUTI. In 86% of these ureters abnormal ureteric orifices were demonstrated. We therefore find CUS to be valuable in the assessment of children with both RUTI and VUR, because this examination is helpful in selecting patients who might need operation for severe VUR. CUS was not of therapeutic benefit to children with enuresis. Five patients with macroscopic haematuria during urinary tract infection were not managed differently following CUS.

Adolescent↗
PubMed1985

Reproducibility of uroflowmetry variables in elderly males.

In the evaluation of prostatism urodynamics and especially uroflowmetry has received widespread attention. Review of the literature, however, revealed little information on the consistency of flow variables. Therefore eleven male volunteers above fifty years of age were asked to void five times during a short period of time. Each subject was found to reproduce his own flow curve fairly well. Statistical analysis of various flow variables, i.a. Q1s, Qmax, volume-corrected Qmax, Qmax time, Qave and volume voided, demonstrated a high degree of reproducibility. In conclusion a single flow curve is sufficient for clinical routine on the assumption that the patient declares the voiding to be typical.

Aged↗
PubMed1985

The significance of uninhibited detrusor contractions in prostatism.

In an attempt to identify preoperatively patients who will not benefit from prostatectomy, 84 patients with prostatism about to undergo transurethral resection of the prostate were evaluated prospectively with preoperative and postoperative symptom analysis and urodynamic examination, including cystometrograms. Of the patients 67 were followed at 3 months and 54 again at 12 months. Preoperatively, 65 per cent of the patients had uninhibited detrusor contractions, while 38 had persistent postoperative uninhibited detrusor contractions at 3 months. Patients in whom uninhibited detrusor contractions persisted postoperatively more often had unacceptable postoperative symptoms. Of the patients 13 per cent believed the symptoms to be the same or worse at 3 and 12 months. The incidence of uninhibited detrusor contractions in these patients was 57 and 71 per cent, respectively. While this finding suggests that persistent postoperative uninhibited detrusor contractions are associated with an unfavorable surgical outcome, we could not predict which patients would have uninhibited detrusor contractions following prostatectomy by use of preoperative cystometric findings together with detailed symptom analysis. Thus, we failed to define a role for preoperative cystometric screening of patients with prostatism.

Aged↗
PubMed1985

A comparative study of various electrodes in electromyography of the striated urethral and anal sphincter in children.

The series comprised 41 children aged 6 to 14 years consecutively referred with recurrent urinary tract infection and/or enuresis. Carbon dioxide cystometry was carried out in the supine and the erect position and combined with simultaneous electromyography (EMG). The external urethral sphincter was examined with a ring electrode mounted on a urethral catheter, while recordings from the striated anal sphincter were based on an anal plug electrode and perianal electrocardiographic (ECG) skin electrodes: 211 EMG and cystometric examinations were performed and all three methods gave satisfactory results. Correlation between them was good, as was reproducibility. Perianal surface ECG electrodes are recommended for the evaluation of functional disturbances of the external sphincter. They are painless, easy to use, and are well tolerated by the patient.

Adolescent↗