Biomedical subjects

H C Klingler

Publications and source records attributed to H C Klingler.

24 records · Page 2Linked to original sources

PubMed1997

Is obstruction predictable by clinical evaluation in patients with lower urinary tract symptoms?

OBJECTIVE: To determine whether it is possible to predict the presence of bladder outlet obstruction (BOO) by non-invasive clinical variables in patients with lower urinary tract symptoms (LUTS) suggestive of BOO. PATIENTS AND METHODS: Patients with LUTS suggestive of BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), prostate size, non-invasive uroflow, post-void residual urine volume (PVR) and a pressure flow study. Only patients with a maximum flow rate (Qmax) of < or = 15 mL/s and an IPSS > or = 7 were included. The study comprised 253 patients; the degree of obstruction was correlated to several non-invasive clinical variables. Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of BOO in patients with LUTS. RESULTS: Prostate volume, Qmax, PVR and voided volume correlated significantly with the degree of BOO rated according to the linear passive urethral resistance relation (linPURR). In contrast, there was no such correlation for the IPSS and the quality-of-life question of the IPSS. The percentage of patients with BOO defined by a linPURR of 3-6 decreased from 85% in those with a Qmax of 0-5 mL/s to 60% (Qmax 6-10 mL/s) and 44% (Qmax 11-15 mL/s). In parallel, the percentage of patients with BOO increased from 53% of those with a prostate volume of < or = 50 mL, to 79% of those with prostates of 51-100 mL and 75% of those > 100 mL. Based on Qmax, PVR and prostate volume, nomograms were established by multiple logistic regression analysis for the probability of BOO in patients with LUTS. CONCLUSION: The nomograms presented herein should help the clinician to identify patients with LUTS who should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and in whom these studies can be safely spared.

Adolescent↗

PubMed1996

Impact of different sized catheters on pressure-flow studies in patients with benign prostatic hyperplasia.

The importance of pressure-flow studies for the diagnostic work-up of patients suffering from benign prostatic hyperplasia (BPH) has recently been recognized more widely. For these studies, several different types and sizes of catheters have been used. According to our experience, the degree of obstruction seems to be dependent on the catheter size applied. To evaluate the impact of catheter size on urodynamic results, 64 male patients underwent pressure-flow studies; 41 had the clinical diagnosis BPH; 23 were a nonobstructed control group. The 41 BPH-patients were randomized into two groups: group BPH 1 (n = 20) had a 5F catheter and group BPH 2 (n = 21) had a 10F filling catheter in addition to the 5F pressure transmission catheter in the urethra. All patients underwent three filling and pressure-flow studies. The filling catheter was removed for the third pressure-flow study. Peak flow rates (Qmax; ml/s), the corresponding detrusor pressure at maximum uroflow (PdetQmax; cm H2O) and the degree of obstruction, rated according to the linear passive urethral resistance relation (linear-PURR), were assessed. The removal of the 5F (group BPH 1) or 10F (group BPH 2) filling catheter resulted in a 21.1% and 55.7% increase of maximum uroflow rate respectively. In parallel, we observed a 9.9% and 18.8% decrease of detrusor pressure at maximum flow. The degree of obstruction classified according to linear-PURR decreased by 14.6% and 21.1% respectively. Furthermore, it became evident that five patients (21.7%) of the unobstructed control group could have been wrongly interpreted as being obstructed if measured with the filling (10F) and the pressure measurement (5F) catheter in situ. In conclusion, the degree of obstruction is dependent on the cross-sectional diameter of the used catheters. Consequently, standardization with regard to catheter size is mandatory if data from different institutions are to be compared.

Aged↗

PubMed1996

Age related urodynamic changes in patients with benign prostatic hyperplasia.

PURPOSE: We determined age related urodynamic changes in patients with untreated symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 222 patients (mean age 67.3 years, range 45 to 90) with the clinical diagnosis of symptomatic BPH was entered into a prospective protocol evaluating the international prostate symptom score (I-PSS), prostate volume, noninvasive uroflowmetry, residual volume and a pressure-flow study. To obtain a homogeneous study population only patients with a noninvasive maximum flow rate of 15 ml. per second or less and an I-PSS of 7 or more were eligible. RESULTS: There was no correlation between age and I-PSS (p > 0.05) but there was a statistically significant decrease in maximum flow rate (p = 0.045) and voided volume (p = 0.0013) with age. Prostate volume increased constantly from 31.3 to 64.4 ml. in patients 45 to 50 and older than 80 years, respectively (p < 0.0001). Pressure-flow studies revealed an age related decrease in cystometric bladder capacity (p = 0.0003) and invasive maximum flow rate (p = 0.0057) but no changes in detrusor pressure at maximum flow rate (p > 0.05), maximum detrusor pressure (p > 0.05) and linear passive urethral resistance relation (p > 0.05). The incidence of urodynamically proved bladder instability increased from 20 to 47% in men 45 to 50 and older than 80 years, respectively. CONCLUSIONS: The well established age related decrease in maximum flow rate and voided volume in patients with prostatism cannot be attributed to an increase in bladder outflow obstruction or impaired detrusor function. Because 60% of all men older than 80 years did not have urodynamic obstruction despite a decreased maximum flow rate of 10 to 15 ml. per second, all patients meeting these criteria and having symptoms bothersome enough to justify surgery should undergo pressure-flow studies before surgical intervention.

Age Factors↗

PubMed1994

Incidence of antisperm antibodies in patients with carcinoma of the testis and in subfertile men with normogonadotropic oligoasthenoteratozoospermia.

The incidence and the clinical relevance of sperm-reactive antibodies in subfertile men and in testicular cancer patients were assessed in a pilot study. The sera of 42 men with normogonadotropic oligoasthenoteratozoospermia (OAT syndrome, n = 20) or carcinoma of the testis after inguinal semicastration (n = 22) were analyzed for agglutinating antisperm antibodies using fluorescein-labeled antiglobulin. In the group with the OAT syndrome, the incidence of sperm-reactive antibodies was only 5%, which is comparable to that in normal fertile men. Although the incidence of 18% in the testicular cancer patients was markedly higher, only 2 of the patients in question had abnormal spermiograms, which in one case could, moreover, be explained by previous radiation therapy. In summary in this small group of patients, serum monitoring for sperm-reactive antibodies appeared to be of limited clinical relevance in patients with the OAT syndrome and in testicular cancer patients.

Adult↗

PubMed1993

Value of routine sonography in the diagnosis and conservative management of renal angiomyolipoma.

A prospective study was undertaken to assess the value of ultrasonography in the clinical monitoring of angiomyolipomas. 26 patients with angiomyolipomas as diagnosed by sonography and verified by computerized tomography (CT) were followed up by sonographic monitoring over a mean period of 45 months. One case was associated with tuberous sclerosis. Inclusion criteria for conservative management had been clinically asymptomatic angiomyolipomas smaller than 5 cm. Significant tumor growth and a change of the sonographic pattern during follow-up was seen in 2 patients. After renewed follow-up CT scanning failed to reveal negative density values, both patients were nephrectomized. Histologic examination showed hemorrhage in the tumor. The remaining 24 patients (92%) showed no changes in the sonographic patterns. Minor tumor growth of 0.5 cm on average was seen in 6 patients over a mean follow-up period of 52 months. Surgical intervention was refrained from in these 24 patients due to the consistent sonographic pattern and the absence of clinical symptoms. Once the angiomyolipoma is verified by CT, sonographic monitoring suffices if the sonostructure remains unchanged. Minor asymptomatic angiomyolipomas today no longer require surgical intervention as this benign tumor has a pathognomonic sonographic appearance.

Adult↗

PubMed1993

Sonographic appearance of testicular microlithiasis.

Testicular microlithiasis was sonographically diagnosed in 16 patients. Using high-frequency transducers, the typical speckled pattern with multiple small bright echoes generated by intratubular calcifications appeared in the sonograms. The finding was bilateral in all but one patient who had previously undergone semicastration for testicular cancer and subsequent irradiation. In 6 cases a testicular tumor was present and visible in the sonogram. Sonography was performed in another 6 cases because of varicocele or epididymal cysts. The spermiograms and tumor marker levels of these patients were within the normal range, and there was no evidence of an extragonadal germinal tumor. Three patients presented with oligozoospermia, 1 thereof with hypogonadism. In 7 cases the sonographic diagnosis was histologically confirmed, i.e. multiple calcifications were found within the seminiferous tubules. The etiology and clinical significance of this rare phenomenon are unclear. Testicular microlithiasis is asymptomatic and also found in otherwise normal testes. However, in contrast to normal testes, a high percentage of testicular tumors is known to be associated with microcalcifications. In the presence of a definite sonographic diagnosis, exclusion of malignancy and sonographic follow-up are therefore indicated, as in the present series 44% of cases presented with testicular tumors.

Adult↗