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Biomedical subjects

D W Soderdahl

Publications and source records attributed to D W Soderdahl.

At least 19 recordsLinked to original sources
PubMed2002

Prostate cancer screening at an equal access tertiary care center: its impact 10 years after the introduction of PSA.

INTRODUCTION AND OBJECTIVES: Dwight D. Eisenhower Army Medical Center has been involved in Prostate Cancer Awareness Week (PCAW) screening during the period 1995-2000. The purpose of this study is to review the results of screening in a self-selected population of military beneficiaries at our institution. MATERIALS AND METHODS: Screening involving a brief urologic history, digital rectal examination (DRE) and serum prostatic specific antigen (PSA) measurement was offered to our screening population. Patients with an elevated PSA (>4.0 ng/ml) and/or a suspicious DRE were considered for transrectal ultrasonography with prostate needle biopsy (TRUS/PNB). Patient health records were reviewed retrospectively and analyzed to determine patient demographic characteristics, PSA distribution, DRE results and cancer detection rates. RESULTS: A total of 455 screening visits were performed from 1995 to 2000, of which 426 visits were included for analysis. Mean age of the study population was 57.4 y (40-83). Seventy-one percent of the patients reported prior PSA screening visits. Forty-four patients met indications for biopsy. A total of 30 TRUS/PNB were performed demonstrating presence of cancer in three patients for an overall cancer detection rate of 0.7%. CONCLUSIONS: Our study shows that the overall prostate cancer detection rate at our institution is lower than detection rates previously reported in the literature. Potential reasons for this finding may include that the subjects participating in PCAW screening tended to be younger than in other series and that a majority of them had already undergone prior screening. These findings suggest the need to modify prostate cancer screening recommendations and to improve prostate cancer screening efficacy.

Adult↗
PubMed1998

Home flow rates in evaluation of lower urinary tract symptoms in men.

We wanted to determine if 5-second home flow rates can be used in the evaluation in men with lower urinary tract symptoms (LUTS). Fifty previously untreated men with LUTS were evaluated by history and physical examination, international prostate symptom score (IPSS) questionnaire, and two methods of uroflowmetry. Each participant underwent three formal uroflow measurements using the Dantec UD5500 Mk2 machine and subjective 5-second home uroflow measurements twice daily for 7 days. The reliability of each test as well as correlation coefficients between the two methods of uroflowmetry were determined. The reliability for the average of the 14 home flow rates was 0.99 and the reliability for any single home flow was 0.82. Reliability for the average of three uroflows in measuring Qmax, Qave, flow times, and volume are 0.91, 0.91, 0.86, and 0.79, respectively. If single measurements are used, the values are 0.77, 0.78, 0.68, and 0.56. Home flow average is significantly different from Qmax and Qave (p < .001). No significant correlation was found between any of the uroflowmetry measurements or home flow average and IPSS or bother score. Home flows rates and uroflowmetry are reliable tests. There is a weak correlation between average home flows and Qmax and Qave. The greatest use of home flow rates probably lies in follow-up of patients who had either medical or surgical intervention for LUTS.

Adult↗
PubMed1997

Intracavernosal drug-induced erection therapy versus external vacuum devices in the treatment of erectile dysfunction.

OBJECTIVES: To determine if there is a significant difference between intracavernosal self-injection and external vacuum devices when compared directly for satisfaction, effectiveness and side-effects. PATIENTS AND METHODS: Fifty men were randomised into two groups and received either instruction on the use of the Osbon ErecAid system or self-injection therapy. After 15 uses, each group completed a questionnaire detailing efficacy, satisfaction and side-effects, and then changed to the other modality after appropriate instruction. A questionnaire was completed by study participants and their sexual partners after using both methods. Patients were followed for 18-24 months using telephone interviews. RESULTS: Forty-four patients (mean age 62.3 years, range 38-84) completed the study. Patients and their partners reported a superior quality of erections with the injection method but the difference did not reach statistical significance. The ability to attain orgasm and the overall satisfaction of the patient and partner with the sexual experience was significantly better when using injections. Side-effects were similar between the modalities. Subgroups analysed for age, duration and aetiology of impotence showed that younger patients (< 60 years), those with a shorter duration of impotence (< 12 months) and those impotent secondary to radical prostatectomy strongly favoured injection therapy (P < 0.05). Overall, of the 44 couples, the final preferences of the patients were 25 (57%), 12 (27%), six (14%) and one (2%) for the injection, vacuum device, both or neither, respectively, and of the partners were 22 (50%), 12 (27%), six (14%) and four (9%), respectively. At 18-24 months, 80% of patients were still using either the vacuum device, injections, or both. CONCLUSION: Both the vacuum device and injections are effective treatment modalities for impotence and are associated with good long-term success. Overall, there was a trend favouring injection therapy over the vacuum device which was most significant in younger patients, those with a shorter duration of impotence, and those impotent secondary to radical prostatectomy.

Adult↗
PubMed1997

A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery.

PURPOSE: Intermittent pneumatic compression of the calf and/or thigh effectively decreases the incidence of deep venous thrombosis and other thrombotic sequelae but clinical data comparing these modalities are currently lacking. MATERIALS AND METHODS: A total of 90 patients undergoing major urological surgery was randomly assigned to receive calf length or thigh length pneumatic compression for antithrombotic prophylaxis. Duplex ultrasound of the lower extremities was performed preoperatively and twice postoperatively to evaluate for deep venous thrombosis. Health care providers in the operating room, recovery room and ward were asked to compare the compression systems, and a cost analysis was performed. RESULTS: A total of 47 patients wore the thigh length sequential pneumatic sleeves and 43 wore calf length uniform compression systems. A pulmonary embolus without evidence of deep venous thrombosis was detected in 1 patient (2%) using the thigh length system. A thrombus was detected in the common femoral vein by duplex ultrasonography in 1 patient (2%) with the calf length system. Nursing personnel found the calf length sleeves easier to apply and more comfortable by patient account but they were satisfied with both systems. There was a significant cost savings with the calf length pneumatic compression system. CONCLUSIONS: Calf and thigh length pneumatic compression systems similarly decrease the risk of deep venous thrombosis in patients undergoing urological surgery. The calf length system has the added advantage of being less expensive and easier to use.

Aged↗
PubMed1997

A novel technique to prevent Foley catheter loss following radical retropubic prostatectomy.

We describe a method to prevent Foley catheter loss following radical retropubic prostatectomy. In 84 consecutive patients undergoing radical retropubic prostatectomy, a technique of securing the indwelling Foley catheter extracorporeally using a permanent stitch and a sterile button was utilized. No instances of unintended Foley catheter dislodgment were experienced in any of the 84 cases. The extracorporeal button was well tolerated by all patients, and there was no increased incidence of catheter-related complications. This technique provided the additional benefit of balloon volume adjustment in ten patients who experienced bladder spasms. This method is a simple, safe and well-tolerated adjunct to avoid Foley catheter loss following radical retropubic prostatectomy.

Abdomen↗
PubMed1997

The use of an external vacuum device to augment a penile prosthesis.

Although penile prostheses are highly effective in the treatment of erectile dysfunction, a small percentage of patients are dissatisfied. Serendipitously, a patient in this group found that using an external vacuum device to augment his prosthetic erection provided a dramatic objective improvement in his erection and increased his overall satisfaction with intercourse. Patients who had tried the combination of external vacuum device and penile prosthesis simultaneously were identified from our penile prosthesis population as well as the Osbon Medical Systems database. Telephone interviews were conducted to determine efficacy, satisfaction, and side effects from the combination. Twelve patients completed the telephone survey. Four patients had semirigid and eight had inflatable penile prostheses. After using the vacuum device to augment the erection, all reported increased rigidity and patient/partner satisfaction, and 11 of 12 described improved length and girth. Minimal complications were noted. Concomitant use of an external vacuum device and penile prosthesis was safe in this select population. The combination may be indicated in patients with penile prostheses who are dissatisfied with size and/or rigidity, and in those who refuse or who are poor candidates for prosthesis revision.

Aged↗
PubMed1996

Erectile dysfunction following transurethral resection of the prostate.

PURPOSE: We objectively measured the incidence of erectile dysfunction following transurethral resection of the prostate. MATERIALS AND METHODS: A total of 56 men completed a questionnaire detailing perceived sexual dysfunction, and underwent nocturnal penile tumescence testing for 3 nights before transurethral resection of the prostate and again at 3 months postoperatively. RESULTS: Complete data were available for 40 men. No significant difference was found in penile tumescence, number of erectile events and duration of events before and after surgery. Preoperative and postoperative rigidity was statistically different, with a slight improvement after transurethral resection of the prostate (p < 0.05). A subjective decrease in quality of erection after transurethral resection of the prostate was reported in 27.5% of the patients. However, on further questioning, 63.6% of these patients equated retrograde ejaculation with decreased potency. CONCLUSIONS: We demonstrated no decrease in objective parameters of erectile function studies following transurethral resection of the prostate. Previous estimates of impotence after transurethral prostatectomy may have been tainted by subjective patient reports equating retrograde ejaculation with erectile dysfunction.

Aged↗
PubMed1996

Neoadjuvant hormonal therapy in the management of prostate cancer: a surgical and radiation therapy review.

Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy is an old concept that has recently been revisited. First described in the 1940s as a method to downstage inoperable prostate cancer prior to perineal prostatectomy. NHT fell out of favor for several reasons: the side effects of estrogen therapy, the finality of orchiectomy, improved staging methods, and newer treatment strategies for prostate cancer, including external beam and interstitial radiation therapy. Contemporary interest in NHT has resurfaced primarily due to the introduction of well-tolerated reversible androgen blockade. High cause-specific survival rates following radical prostatectomy for organ confined disease are possible, yet the disturbingly high incidence of positive margins in current radical prostatectomy series led to interest in offering NHT to patients prior to radical prostatectomy to impact on the positive margin rate. Initial nonrandomized studies showed that NHT provided a substantial decrease in prostate size and PSA level in addition to reducing positive margin rate by an uncertain mechanism. Subsequently, controlled randomized studies have been performed, the majority of which have confirmed decreased margin positivity. NHT has been incorporated successfully into external beam radiotherapy for locally advanced prostate cancer as well. Significantly improved disease control is possible when hormones are combined with radiation therapy. The favorable outcome of this radiation therapy approach has led to the approval of flutamide (Eulexin) for this indication when combined with a luteinizing hormone-releasing hormone analogue or orchiectomy. Whether these initial results will ultimately affect recurrence and survival data is unknown. This article provides a comprehensive review of the world literature on NHT: from an historical prospective to the current state of the art for both radical prostatectomy and external beam radiation therapy.

Antineoplastic Agents, Hormonal↗
PubMed1988

Renal cell carcinoma in cadaver donor kidney.

A cadaver kidney, reported to contain a "simple cyst," was received from another institution. Frozen section biopsy prior to transplant showed renal cell carcinoma. The contralateral kidney already had been transplanted at the other medical facility.

Cadaver↗