Biomedical subjects

A E Te

Publications and source records attributed to A E Te.

11 recordsLinked to original sources

PubMed1996

Differential diagnosis of prostatism: A 12-year retrospective analysis of symptoms, urodynamics and satisfaction with therapy.

PURPOSE: We determined the incidence of voiding symptoms, urodynamic etiology and satisfaction with therapy in a large cohort of men with prostatism during a 12-year period. MATERIALS AND METHODS: We retrospectively analyzed the records of 2,845 consecutive men who underwent urodynamic evaluation between January 1982 and December 1994. Patients were divided into groups 1 and 2 according to the years of study (between 1982 and 1988, and between 1989 and 1994, respectively). Parameters of evaluation included prevalence and distribution of voiding symptoms, urodynamic etiology of symptoms and satisfaction with therapy (medical or surgical). RESULTS: There was 843 evaluable patients 50 to 94 years old (mean age 63.2) Group 2 patients were younger, and had a 22% higher prevalence of nocturia and a 12% higher prevalence of daytime frequency. The prevalence of all other symptoms was the same in both groups. On urodynamics 523 patients (62%) had demonstrable evidence of bladder outlet obstruction of whom 345 (66%) had concomitant detrusor instability. Of the 843 patients 647 (77%) had detrusor instability, which was the sole diagnosis in 199 (24%). We noted low pressure/low flow in 137 patients (16%) and impaired detrusor contractility in 152 (17%), including 57 (7%) in whom the latter condition was the only diagnosis. Urodynamic findings remained the same during the entire 12-year period. Global satisfaction and symptomatic improvement were better with surgical than medical therapy, although the degree of satisfaction was independent of the urodynamic etiology of symptoms. CONCLUSIONS: Symptomatic men with prostatism are presenting with a greater prevalence of significant nocturia and daytime frequency than in the past with no change in urodynamic findings. In addition, patient level of satisfaction remains greater with surgical than medical therapy regardless of the urodynamic presence of bladder outlet obstruction.

Aged↗

PubMed1996

Etiology of voiding dysfunction in men less than 50 years of age.

OBJECTIVES: Chronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. The purpose of this study was to analyze etiology of chronic voiding dysfunction in men less than 50 years of age. METHODS: The videourodynamic studies of 137 men 50 years of age or less with chronic voiding dysfunction, performed between January 1990 and October 1995, were retrospectively analyzed. RESULTS: The distribution of urodynamic abnormalities included 74 (54%) patients with primary vesical neck obstruction, 33 (24%) with obstruction localized to membranous urethra (pseudodyssnergia), 23 (17%) with impaired bladder contractility, and the remaining 7 (5%) with an acontractile bladder. Detrusor instability was present in 67 men (49%). CONCLUSIONS: Voiding dysfunction among young men is common and is often misdiagnosed. Videourodynamic evaluation is very useful in establishing the correct diagnosis and ultimately in delivery of appropriate therapy.

Adult↗

PubMed1996

Comparison of fascial and vaginal wall slings in the management of intrinsic sphincter deficiency.

OBJECTIVES: To compare safety and efficacy of fascial versus vaginal wall slings in the management of women with intrinsic sphincter deficiency (ISD). METHODS: The hospital and office records of 79 consecutive women with ISD were retrospectively analyzed from January 1991 to September 1995. There were 43 fascial slings (group A) and 36 vaginal wall slings (group B). Parameter of evaluation included efficacy based on postoperative presence of stress or urge incontinence and number of pads used, complications, and miscellaneous factors, including length of catheterization time, length of hospitalization, quantity of analgesics used, and loss of work days. RESULTS: Baseline clinical and urodynamic data were the same for both groups. Pad use decreased from 6.9 to 0.6 for group A and from 5.7 to 0.3 for group B. Persistent stress and urge incontinence was present in 5% and 16% of group A patients and in 3% and 11% of group B patients, respectively. Group A (89%) and group B (94%) patients were either very satisfied or satisfied with their surgical outcome. The operative time, hospital days, and days lost from work for group B patients (42.3 +/- 13.4 minutes, 1.4 +/- 0.9 days, 18.4 +/- 3.2 days, respectively) were significantly lower than for group A patients (84.2 +/- 17.8 minutes, 3.7 +/- 1.9 days, 28.4 +/- 7.8 days, respectively). CONCLUSIONS: Both fascial and vaginal wall slings are effective in treating women with ISD. However, the use of vaginal wall slings resulted in significantly shorter hospital stay, decreased catheterization time, decreased use of analgesics, and decreased loss of days of work compared with fascial slings. Therefore, the vaginal wall sling should be the preferred surgical method of treating sphincter deficiency.

Aged↗

PubMed1996

The American Urological Association symptom score in the evaluation of men with lower urinary tract symptoms: at 2 years of followup, does it work?

PURPOSE: The American Urological Association (AUA) benign prostatic hyperplasia (BPH) guidelines committee established criteria for the diagnosis and treatment of patients with BPH. In a prospective study we determined the usefulness of these guidelines in 145 previously untreated patients with BPH symptoms. MATERIALS AND METHODS: Patients were evaluated initially by AUA symptom score, digital rectal examination, urinalysis, serum creatinine and prostate specific antigen. Based on symptom score, patients with mild symptoms were treated with watchful waiting, while those with moderate and severe symptoms were offered watchful waiting, finasteride alpha-blockers, or laser or transurethral prostatectomy. Minimum followup was 2 years. Patients were offered a change in therapy if they had an intolerable adverse event or no improvement. Analysis included maintenance of therapy at 1 and 2 years, number of office visits and diagnostic tests performed. In addition, all patients were queried regarding which factors influenced their therapeutic choice. RESULTS: Of 37 patients with mild symptoms 31 (81%) remained on watchful waiting at 2 years and 6 advanced to medical therapy. Among 71 patients with moderate symptoms 9 of 15 (60%) remained on watchful waiting, 27 of 36 (75%) remained on alpha-blockers and 12 of 20 (60%) remained on finasteride at 2 years. Of the 37 patients with severe symptoms 1 of 5 (20%) remained on watchful waiting, 1 of 6 (17%) remained on finasteride and 9 of 15 (60%) remained on alpha-blockers, while 3 of 5 (60%) who underwent laser prostatectomy and all 6 (100%) who underwent transurethral prostatectomy received no further treatment. At 2 years 83% of the men who selected either finasteride or alpha-blockers as either the primary or secondary therapeutic choice were still on medications. Most patients with mild (61%) or moderate (51%) symptoms cited adverse events as the predominant concern when selecting therapeutic options. In contrast, efficacy was the overriding concern (70%) in patients with more severe symptoms. CONCLUSIONS: Overall, with these guidelines and the AUA symptom score 110 men (76%) were still on original therapy at 1 year and 99 (68%) at 2 years. Additionally, 31 patients (21%) changed to an alternative, nonoperative therapy. These results suggest that the AUA BPH guidelines provide a rational and balanced approach for evaluation and management of patients with symptomatic BPH. Patients can reasonably expect to remain on the initial therapeutic option for at least 2 years.

Adrenergic alpha-Antagonists↗

PubMed1995

Transurethral electrovaporization of the prostate: a novel method for treating men with benign prostatic hyperplasia.

OBJECTIVES: To determine the preliminary safety and efficacy of transurethral vaporization of the prostate (TVP) using the VaporTrode as a therapeutic alternative in the management of men with bladder outlet obstruction. METHODS: Twenty-five men (mean age, 63.5 +/- 3.1 years) with mild to moderate symptoms of prostatism underwent TVP since August 1994. Patients were assessed at baseline for both safety and efficacy and in follow-up at 1 week and 1 and 3 months. Efficacy parameters evaluated included operative time (in minutes), change in hematocrit and serum sodium, postoperative catheterization time, American Urological Association symptom score, peak uroflow (Qmax) and postvoid residual urine. Safety parameters evaluated included incidence of side effects, changes in serum sodium and hematocrit, and evaluation of sexual function. RESULTS: Symptoms decreased from 17.8 to 5.9 and 4.2 at 1 and 3 months, respectively (P < 0.01). Qmax increased from 7.4 to 15.3 and 17.3 mL/s at 1 and 3 months, respectively (P < 0.02). Mean operative time was 40.3 minutes; mean interval to catheter removal was 14.6 hours. Changes in serum parameters included a 0.9 mL/dL decrease in hematocrit and a 1.1 mEq/L change in sodium. Complications of the procedure included mild hematuria (n = 3) and distal bulbar urethral stricture (n = 1). There were no associated significant postprocedure irritative symptoms and no patient required recatheterization. CONCLUSIONS: TVP is a new and potentially useful modification of performing transurethral resection of the prostate. In this preliminary study, there has been significant clinical improvement maintained with minimal morbidity. This early clinical experience highlights several potential advantages of TVP, including significantly lower cost and minimal postoperative irritative symptom score. Currently, a multicenter clinical trial is under way to determine the long-term efficacy and safety of TVP.

Aged↗

PubMed1995

Urodynamic findings in patients with diabetic cystopathy.

To ascertain the relationship between voiding dysfunction associated with diabetes and bladder and sphincter behavior, the video urodynamic studies of 182 patients were retrospectively analyzed. Patients were classified based on urodynamic diagnosis and the presence or absence of signs of sacral cord involvement. Urodynamic findings were classified as either detrusor hyperreflexia, impaired detrusor contractility, detrusor areflexia, indeterminate and normal. The results indicate that mean bladder capacity was 485 +/- 89.3 ml. with a mean first sensation of filling of 298 +/- 67.4 ml. Of the 182 patients 100 (55%) had detrusor hyperreflexia, 42 (23%) had impaired detrusor contractility, 20 (11%) had indeterminate findings, 19 (10%) had detrusor areflexia and 1 (1%) was normal. Bladder outlet obstruction occurred in 66 patients (36%), all men (57%). The diagnosis was isolated in 24 patients (36%) or in combination with another diagnosis in 42 (74%). However, if one considers the presence of sacral cord signs (42 patients), the most common urodynamic diagnoses were either impaired detrusor contractility in 21 (50%) or detrusor areflexia in 10 (24%). These data suggest that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and voiding dysfunction, and in fact these patients present with variable pathophysiological findings. These findings demonstrate the importance of urodynamic studies in diagnosing voiding dysfunction in diabetics before initiation of therapy.

Aged↗

PubMed1995

Uroflowmetry and urodynamics.

The ability to define and understand the relationship and significance of bladder outlet obstruction to the diagnosis and treatment of BPH continues to be a clinical problem that needs examination. Urodynamics remain the best tool to diagnose bladder outlet obstruction. However, controversies exist in its role as a diagnostic tool for therapeutic intervention. This article reviews the various issues and state of the art urodynamic modalities that pertain to the application of urodynamics to BPH. Specifically, a critical review is provided for the various urodynamic modalities such as uroflowmetry and multichannel urodynamics as it pertains to its clinical application and study of BPH.

Humans↗

PubMed1995

Transition zone index as a method of assessing benign prostatic hyperplasia: correlation with symptoms, urine flow and detrusor pressure.

PURPOSE: Prostate volume has been poorly correlated to various parameters used to assess benign prostatic hyperplasia (BPH), including symptoms, peak urine flow and detrusor pressure at peak urine flow. The purpose of this study was 2-fold: 1) to determine if transrectal ultrasound measurement of the transition zone of the prostate served as a better proxy for determining prostate size and correlated better with American Urological Association symptom score, peak urine flow and detrusor pressure, and 2) if the parameter transition zone index (the ratio between transition zone volume and prostate volume) was useful in evaluating clinical prostatism. MATERIALS AND METHODS: We prospectively evaluated 61 men with symptomatic BPH (age 64.6 +/- 9.7 years) according to symptoms, peak urine flow, pressure/flow analysis, transrectal ultrasound volume of the entire prostate and the transition zone, and calculation of the transition zone index. RESULTS: Age correlated with symptoms (r = 0.31, p = 0.01) and peak urine flow correlated negatively with symptoms and age (p = 0.002). Age also correlated with prostate volume (r = 0.54 and p = 0.03) and transition zone (r = 0.31, p = 0.05). There was a weak correlation between prostate volume and symptoms, peak urine flow and detrusor pressure at peak urine flow; a stronger correlation between transition zone and symptoms (r = 0.48, p = 0.03), and peak urine flow (r = -0.34, p = 0.05), and a significant correlation (p = 0.001) between transition zone index and symptoms (r = 0.75), peak urine flow (r = -0.71) and detrusor pressure at peak urine flow (r = 0.43). A transition zone index of greater than 0.50 was a useful cutoff point and highly significant (p = 0.002) for delineating patients with more severe abnormalities of symptoms, peak urine flow and detrusor pressure at peak urine flow. CONCLUSIONS: Transition zone index is a parameter that correlates significantly with evaluated parameters of BPH and may serve as a useful proxy for evaluating worsening obstruction. Studies are underway to determine if transition zone index can be used prospectively to predict and correlate response with therapies designed to ablate prostatic tissue medically or surgically.

Age Distribution↗

PubMed1995

A comparative study of transurethral resection of the prostate using a modified electro-vaporizing loop and transurethral laser vaporization of the prostate.

PURPOSE: We determined the relative efficacy of a modification of transurethral resection of the prostate using a vaporizing loop (VaporTrode) with transurethral laser vaporization of the prostate using the Ultraline fiber. MATERIALS AND METHODS: A comparative trial of 58 patients with symptomatic prostatism was performed. Parameters evaluated included operative time, postoperative catheterization time, American Urological Association (AUA) symptom score, peak urine flow and post-void residual urine. RESULTS: Of the 29 patients who underwent electro-vaporization AUA symptom score decreased from 15.3 to 5.3 and 4.9, and peak urine flow increased from 8.2 to 14.9 ml. per second and 15.6 ml. per second at 1 and 3 months, respectively (p = 0.01). Of the 29 patients undergoing laser vaporization of the prostate AUA symptom score decreased from 14.7 to 10.1 and 7.6, and peak urine flow increased from 9.7 to 13.7 ml. per second and 14.9 ml. per second at 1 and 3 months, respectively (p = 0.025). However, there were significant differences in mean catheterization time (electro-vaporization group 14.7 hours and laser group 79.6 hours, p < 0.001), and cases of postoperative irritative symptoms (3 electro-vaporization and 19 laser) and retention requiring repeat catheterization (6 laser). CONCLUSIONS: Our early clinical experience highlights several potential advantages of electro-vaporization, particularly the low incidence of postoperative morbidity. Currently a multicenter clinical trial is underway to determine the long-term efficacy and safety of electro-vaporization as a potential therapeutic modality in the treatment of men with symptomatic benign prostatic hyperplasia.

Electrosurgery↗

PubMed1994

Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck.

Many patients are misdiagnosed as having refractory chronic nonbacterial prostatitis, and are treated with antibiotics and/or alpha-blockers with variable success. This study was designed to ascertain the potential diagnostic role of synchronous video-pressure-flow urodynamics and the therapeutic role of transurethral incision of the bladder neck in 34 consecutive men (age 26 to 51 years) with a minimum of 2 years of misdiagnosis. Duration of symptoms ranged from 25 to 126 months (mean 38.3). The average number of previous antibiotic days ranged from 42 to 136 (mean 54.3). In addition, 24 men were given empiric trials of alpha-blockers, all unsuccessful. Patients with evidence of bacterial infection or excessive leukocytes in expressed prostatic secretions were excluded from the study. Of these 34 patients 31 had urodynamic evidence of bladder outlet obstruction localized fluoroscopically to the vesical neck, while the remaining 3 had normal studies. The mean pretreatment maximum urine flow was 9.2 ml. per second and the mean maximal detrusor pressure was 76.3 cm. water. In 31 patients the bladder neck was incised at the 5 o'clock position from the bladder neck to the verumontanum with the patient under caudal (22) or spinal (9) anesthesia. Of these 31 patients 30 had marked subjective improvement in symptoms with an increase in maximal urine flow to 16.4 and 15.7 ml. per second at 3 and 6 months, respectively. The remaining patient noticed continued symptoms despite urine flow improvement. All 31 patients reported postoperative antegrade ejaculation. These results indicate that many men who are categorized as having and empirically treated for chronic nonbacterial prostatitis are misdiagnosed and, in fact, have bladder outlet obstruction. Urodynamics are helpful in diagnosing and predicting success in these patients. Furthermore, transurethral incision of the bladder neck is an effective and safe therapeutic modality in this group.

Adult↗

PubMed1994

Neurotrophic factors in the rat penis.

An intact nerve supply is essential for normal erectile function. We have undertaken a study to examine the presence and synthesis of growth factors of the penis that support neural function. Extracts were obtained from deskinned penises of Sprague-Dawley rats, aged 3, 6 and 10 weeks, representing prepubertal, pubertal and postpubertal states. Penile extracts were subjected to Northern blot analysis to evaluate expression of nerve growth factor-beta (beta-NGF)-mRNA, PC-12 bioassay to quantitate the nerve growth promoting activity and immunoassay to detect the amount of beta-NGF protein. These initial experiments showed a disproportionately abundant level of nerve growth promoting activity as compared with the levels detected with the immunoassay. The PC-12 bioassay is sensitive to both beta-NGF and fibroblast growth factors (FGFs). To further investigate these findings, the bioassay was conducted again after heparin chromatography, with beta-NGF receptor blockade, or with the addition of anti-beta-NGF, anti-basic-FGF, or anti-acidic-FGF. These studies confirmed that the abundant nerve growth promoting activity in the rat penis is due largely to basic FGF. In conclusion, the neurotrophin NGF is expressed in the rat penis at levels consistent with its expression in other peripheral tissues. Basic-FGF, on the other hand, has been detected at levels far in excess of NGF. Since erectile function is dependent on the integrity of the vascular structure and its intact innervation and since basic FGF presents as an abundant penile growth factor with both angiogenic and neurotrophic activities, basic FGF might play a significant role in erectile physiology.

Animals↗