Consensus statement on bladder injuries.
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Contusions↗
Biomedical subjects
Christopher M Dixon
Publications and source records attributed to Christopher M Dixon.
The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia.
BACKGROUND: Benign prostatic hyperplasia is commonly treated with alpha-adrenergic-receptor antagonists (alpha-blockers) or 5alpha-reductase inhibitors. The long-term effect of these drugs, singly or combined, on the risk of clinical progression is unknown. METHODS: We conducted a long-term, double-blind trial (mean follow-up, 4.5 years) involving 3047 men to compare the effects of placebo, doxazosin, finasteride, and combination therapy on measures of the clinical progression of benign prostatic hyperplasia. RESULTS: The risk of overall clinical progression--defined as an increase above base line of at least 4 points in the American Urological Association symptom score, acute urinary retention, urinary incontinence, renal insufficiency, or recurrent urinary tract infection--was significantly reduced by doxazosin (39 percent risk reduction, P<0.001) and finasteride (34 percent risk reduction, P=0.002), as compared with placebo. The reduction in risk associated with combination therapy (66 percent for the comparison with placebo, P<0.001) was significantly greater than that associated with doxazosin (P<0.001) or finasteride (P<0.001) alone. The risks of acute urinary retention and the need for invasive therapy were significantly reduced by combination therapy (P<0.001) and finasteride (P<0.001) but not by doxazosin. Doxazosin (P<0.001), finasteride (P=0.001), and combination therapy (P<0.001) each resulted in significant improvement in symptom scores, with combination therapy being superior to both doxazosin (P=0.006) and finasteride (P<0.001) alone. CONCLUSIONS: Long-term combination therapy with doxazosin and finasteride was safe and reduced the risk of overall clinical progression of benign prostatic hyperplasia significantly more than did treatment with either drug alone. Combination therapy and finasteride alone reduced the long-term risk of acute urinary retention and the need for invasive therapy.
5-alpha Reductase Inhibitors↗
Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures.
PURPOSE: In a prospective manner we sought to determine the cause of lower urinary tract symptoms in young men and whether noninvasive testing and symptoms scores are useful in deciding which patients to evaluate with videourodynamics. MATERIALS AND METHODS: We evaluated 85 men 18 to 45 years old with lower urinary tract symptoms. Patients with a history of known neurological disease or urethral stricture were excluded from the study. Patients were evaluated with the American Urological Association (AUA) symptom index, noninvasive uroflowmetry post-void residual and videourodynamics, and classified by specific urodynamic diagnoses. Noninvasive uroflowmetry (normal versus abnormal), post-void residual and AUA symptom index (total, voiding and storage scores) were evaluated as predictors of urodynamic abnormalities. RESULTS: Mean patient age was 35.1 (range 18 to 45) and mean symptom duration was 53.8 months. Mean AUA scores were total 19.3, voiding 10.8 and storage 8.5. Videourodynamic diagnoses were primary bladder neck obstruction in 40 (47%) cases, dysfunctional voiding in 12 (14%), impaired contractility in 8 (9%), sensory urgency in 7 (8%), detrusor instability alone in 5 (6%), detrusor instability and impaired contractility in 1 (1%), external detrusor-sphincter dyssynergia in 1 (1%) and normal in 5 (6%). Of these patients, 9 could not void during urodynamics and in 6 (7%) no urodynamic diagnosis was made. Videourodynamics were not considered helpful in patients with a normal or nondiagnostic study or sensory urgency only (group 1) but were helpful or diagnostic in the remaining patients (group 2). Only 5 of 18 patients (28%) in group 1 had an abnormal uroflow compared to 56 of 67 (84%) in group 2 (p <0.0001). Mean post-void residual volumes were not different between the 2 groups (40.3 versus 40.0 ml.). Mean total and storage symptom scores were also not different between the 2 groups but voiding scores were significantly higher in group 2 (11.5 versus 8.3, p <0.03). CONCLUSIONS: Lower urinary tract symptoms in young men have a variety of underlying causes. Videourodynamics is an extremely helpful diagnostic test especially in men with abnormal uroflow and high voiding scores.
Adolescent↗