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H J Rollema

Publications and source records attributed to H J Rollema.

14 recordsLinked to original sources
PubMed1999

Repeated pressure-flow studies in the evaluation of bladder outlet obstruction due to benign prostatic enlargement. Finasteride Urodynamics Study Group.

Test-retest reliability of repeated voids in pressure-flow studies and the influence on maximum flow rate (Q(max)pQ), detrusor pressure at maximum flow rate (p(det)Qmax), voided volume, and residual urine were studied. Also the agreement in interpretation of pressure-flow tracings between investigators and a single blinded central reader acting as a quality control center (QCC) were assessed. In addition, correlations between p(det)Qmax and patient age, International Prostate Symptom Score (IPSS), free maximum flow rate (Qmax), and prostate volume were calculated. Using suprapubic pressure recording, 216 men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) were investigated in 11 centers. In each pressure-flow study, three sequential voids were performed, and quality controlled recordings were analyzed for Q(max)pQ and p(det)Qmax by the QCC. Trans rectal ultrasound was used to measure the prostate volume. Mean Q(max)pQ did not change, but p(det)Qmax decreased significantly in the second and third sequential voids. Using the Abrams-Griffiths nomogram definition of obstruction, 125 patients (67%) were classified as obstructed from the first void, but only 111 patients (59%) from the third void. The agreement between the investigator assessment and that of a single blinded reader was good. There was no significant correlation between p(det)Qmax and patient age, IPSS, and Qmax, whereas a modest correlation was found between p(det)Qmax and prostate volume. In summary, there was no significant change in Q(max)pQ, but p(det)Qmax decreased for the three consecutive voids, which can be explained by a decrease in outlet resistance. The agreement between the investigator and QCC interpretations shows the value of a standardized technique, supporting the feasibility of multicenter urodynamic studies. There is a modest, but statistically significant, correlation between detrusor pressure and prostate size, supporting the hypothesis that prostate size is a contributing factor in symptomatic BPH.

Adult↗
PubMed1999

Continued improvement in pressure-flow parameters in men receiving finasteride for 2 years. Finasteride Urodynamics Study Group.

OBJECTIVES: To assess the long-term effects of finasteride on pressure-flow parameters in men with urodynamically documented bladder outflow obstruction (BOO). METHODS: One hundred twenty-one men with benign prostatic enlargement (BPE) and lower urinary tract symptoms (LUTS) underwent a pressure-flow study (PFS) at 1 of 11 clinical centers. The PFS technique was standardized, and all tracings were read by a single reader unaware of the treatment group. Patients who were obstructed according to a modified Abrams-Griffiths nomogram were randomized to 5 mg finasteride (n = 81) or placebo (n = 40) for 12 months; all patients continuing into an open extension received finasteride during the second 12 months of therapy. Results of the initial 12-month study demonstrated the benefit of finasteride treatment on PFS parameters. To examine the continuing effects over time, an analysis of the data from 54 patients who completed 24 months of treatment with finasteride is provided. RESULTS: Detrusor pressure at maximum flow (PdetQmax) continued to decrease during the second 12 months of therapy (decreases of 5.3 and 11.7 cm H2O at months 12 and 24, respectively). The percentage of patients obstructed by Abrams-Griffiths classification decreased from 76.2% at baseline to 66.7% at month 12 and 59.6% at month 24. An intention-to-treat analysis yielded similar results. CONCLUSIONS: Finasteride improves urodynamic measures of obstruction in men with BPE and LUTS, with continued improvement during the second 12 months of therapy.

Double-Blind Method↗
PubMed1999

Improvement of pressure flow parameters with finasteride is greater in men with large prostates. Finasteride Urodynamics Study Group.

PURPOSE: We assess the effect of finasteride, a 5alpha-reductase inhibitor, on objective voiding parameters in men with lower urinary tract symptoms and benign prostatic enlargement on digital rectal examination (known as clinical benign prostatic enlargement) in a double-blind placebo controlled multicenter study using strict standard pressure flow study techniques. MATERIALS AND METHODS: A modification of the Abrams-Griffiths nomogram was used by 1 reader to ensure that all patients met objective criteria for bladder outlet obstruction at baseline. After performing a pressure flow study patients with obstruction were randomized 2:1 to receive 5 mg. finasteride (81) or placebo (40) daily. A second pressure flow study was performed at month 12. At baseline and month 12 free urinary flow studies and transrectal ultrasound were performed, and International Prostate Symptom Score questionnaires were completed. Patients were treated between May 1994 and July 1996. RESULTS: Finasteride caused a significant decrease (-8.1 cm. water) in detrusor pressure at maximum flow (p <0.05 versus placebo p = 0.02), increase (+1.1 ml. per second) in maximum flow rate (p <0.05 versus placebo p = 0.02) and decrease (-22.8%) in prostate volume (p <0.05 versus placebo p <0.001). Men with prostates larger than 40 cc had greater improvement in detrusor pressure at maximum flow (between group difference -14.5 cm. water, 95% confidence interval -26.2 to -2.6, p = 0.02) and maximum flow rate (mean treatment effect +1.6 ml. per second, 95% confidence interval -0.2 to 3.0, p = 0.02) compared to those with prostates 40 cc or less (between group differences not significant). CONCLUSIONS: Finasteride treatment resulted in improvements in urodynamic parameters, which were greater in men with large prostates.

Aged↗
PubMed1997

[Determination of infravesical obstruction in men with benign prostatic hyperplasia using pressure-flow measurement and analysis with the Dx/CLIM software program].

BACKGROUND: Quantification of infravesical obstruction is important in the management of clinical benign prostatic hyperplasia (BPH). OBJECTIVES: The assessment of obstruction degree according to the urethral resistance parameter (URA) and bladder contractility (W) with software Dx/CLIM. METHODS: The study retrospectively analysed a group of 61 patients with BPH in order to assess the degree of obstruction and bladder contractility. Each of the patients underwent pressure/flow studies with Dx/CLIM analysis (URA < 29 cm H2O-unobstructed, Wmax > 12.8 W/m2-normal bladder contractility) and symptom score evaluation (maximum 15 points). In a dose-finding, placebo-controlled study 12 patients received 2 mg of doxazosin (alpha-1 blocker) and 11 patients received placebo during 4 weeks of treatment. RESULTS: 15 patients were unobstructed (25%) out of whom 10 had poor bladder contractility. Obstruction was present in 46 patients (75%) out of whom 18 had impaired contractility. During treatment, the symptom score decreased statistically significantly in both groups (p < 0.05). URA decreased significantly only in the 2 mg group (2 mg group: baseline URA = 53.9, final mean URA = 40.1, p < 0.05; placebo group: baseline URA = 52.9, final mean URA = 56.1). Detrusor contractility was not significantly affected. CONCLUSIONS: Pressure/flow studies with Dx/CLIM analysis are very useful in the selection of BPH patients for treatment modalities and in the assessment of efficacy. Doxazosín decreases urethral resistance effectively. (Tab. 3, Fig. 3, Ref. 12.)

Aged↗
PubMed1992

Improved indication and followup in transurethral resection of the prostate using the computer program CLIM: a prospective study.

Analysis of preoperative and postoperative detrusor pressure-flow measurements with the aid of the IBM compatible software package CLIM in 29 patients who underwent transurethral prostatic resection indicated that CLIM supplies reliable obstruction parameters that are recommended for preoperative assessment and postoperative followup, and that approximately a third of the patients who present with prostatism are nonobstructed, suggesting that the indication for transurethral resection of the prostate is over assessed.

Adult↗
PubMed1992

The prognostic value of bladder contractility in transurethral resection of the prostate.

The contractility of the bladder as quantified by a parameter of approximated power per bladder surface area based on the Hill equation (Wmax) was calculated for 29 patients before and 3 months after transurethral resection of the prostate. There was no significant change in this parameter as a result of the operation. Patients who still had a significant amount of residual urine postoperatively had decreased contractility before and after surgery so that the postoperative condition could have been predicted preoperatively. In many patients a fading contraction was observed, that is detrusor contractility decreased during voiding, which gave rise to a significantly increased volume of residual urine. In most patients this pattern was restored to normal after relief of the obstruction, indicating that it was not related to structural changes in the detrusor muscle. A preoperative fading contraction had no predictive value towards the outcome of the operation.

Humans↗
PubMed1991

Urodynamic assessment and quantification of prostatic obstruction before and after transurethral resection of the prostate: standardization with the aid of the computer program CLIM.

The clinical manifestations of benign prostatic hypertrophy (BPH) are ascribed entirely to the infravesical obstruction. Therefore relief of symptoms is pursued by surgical removal of obstruction, i.e. prostatectomy. On the other hand, it is generally accepted that the conventional clinical signs and symptoms do not correlate with obstruction as urodynamically defined. In the present study, objective obstruction and detrusor contractility parameters were calculated from detrusor pressure and flow rate measurements in 22 patients before and after transurethral resection of the prostate (TURP) using the computer program CLIM. The results indicate: (1) that CLIM supplies reliable obstruction and contractility parameters for preoperative assessment and follow-up in patients with BPH and (2) that greater than 25% of the patients, who underwent TURP, were objectively not obstructed. These findings form strong arguments for including CLIM parameters in the preoperative assessment to perform a TURP.

Diagnosis, Computer-Assisted↗
PubMed1986

[Automated uroflowmetry: new variables].

In a major uroflow study new variables are introduced to meet the needs, and to use the possibilities of automatic processing of uroflow signals. It is found that the new variables provide excellent discrimination between male and female patients with bladder outflow impairment and healthy controls. In comparison to some conventional variables they have the advantage of unambiguous determination and low sensitivity to random measurement errors.

Computers↗
PubMed1977

Flow rate versus bladder volume. An alternative way of presenting some features of the micturition of healthy males.

By transforming uroflowmetrograms from curves of flow rate versus time into curves of flow rate versus instantaneous bladder volume, additional information about the variation of the flow rate during voiding is obtained. These curves show that, within a certain volume range, the maximum flow rate is more or less independent of the voided volume. A second volume-independent parameter is the maximum contraction velocity, which can be calculated from the flow rate and the instantaneous bladder volume. This parameter is presumably a measure of the physiological maximum contraction velocity of the detrusor muscle.

Adult↗