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Biomedical subjects

J L Bosch

Publications and source records attributed to J L Bosch.

At least 55 records · Page 3Linked to original sources
PubMed1997

Urodynamic effects of various treatment modalities for benign prostatic hyperplasia.

PURPOSE: I studied the effects of various treatments for benign prostatic hyperplasia on urethral resistance. MATERIALS AND METHODS: I reviewed the literature on urodynamic effects of treatments for benign prostatic hyperplasia. Articles that reported pretreatment and posttreatment values of relevant urodynamic parameters were analyzed. Average before and after treatment values of maximum flow rate and detrusor pressure at maximal flow rate for every study were plotted on an Abrams-Griffiths nomogram and classified as obstructed, equivocal or nonobstructed. Average values of maximum flow rate and detrusor pressure at maximal flow rate were calculated for the total number of patients treated by a certain modality. RESULTS: Based on this analysis, the rank order of urodynamic efficacy was that open prostatectomy is more effective in reducing urethral resistance than is transurethral prostatectomy. These treatments diminish obstruction better than laser treatment or transurethral incision of the prostate, which again are more effective than balloon dilation, alpha-blockers or transurethral microwave thermotherapy. Finally, androgen deprivation performs better than placebo treatment. CONCLUSIONS: The rank order of urodynamic efficacy as determined in this analysis shows a high level of agreement with reported rank order of symptomatic efficacy of various modalities. After placebo treatment there is no significant change in urethral resistance. This finding indicates that pressure-flow studies are a sensitive way to compare active to placebo treatment and that pressure-flow studies have excellent long-term reproducibility.

Electrosurgery↗
PubMed1997

Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease.

PURPOSE: To estimate and compare the results of percutaneous transluminal angioplasty (PTA) and stent placement to treat aortoiliac occlusive disease. MATERIALS AND METHODS: A meta-analysis was performed of data in six PTA studies (1,300 patients) and eight stent placement studies (816 patients) published in 1990 or later that met the inclusion criteria. Proportions were combined by means of a random-effects model. Failure-time data were pooled with and pooled without adjustment for differences in case mix. RESULTS: The immediate technical success rate in the PTA group was 91%; the rate was higher in the stent group (96%), but the difference was not statistically significant [corrected]. Complication and mortality rates were not statistically significantly different. Analyzed data included technical failures and were adjusted for lesion type and disease severity. Four-year primary patency rates were 65% for stenoses versus 54% for occlusions after PTA to treat claudication and were 53% for stenoses versus 44% for occlusions after PTA to treat critical ischemia. These rates were 77% for stenoses versus 61% for occlusions after stent placement to treat claudication and 67% for stenoses versus 53% for occlusions after stent placement to treat critical ischemia. The risk of long-term failure was reduced by 39% after stent placement compared with PTA. CONCLUSION: Stent placement and PTA yielded similar complication rates, but the technical success rate was higher after stent placement and the risk of long-term failure was reduced.

Angioplasty, Balloon↗
PubMed1997

Sacral rhizotomies and electrical bladder stimulation in spinal cord injury. Part I: Clinical and urodynamic analysis. Dutch Study Group on Sacral Anterior Root Stimulation.

OBJECTIVES: To present the clinical and urodynamic results of the treatment of neurogenic bladder dysfunction in spinal cord injury by sacral rhizotomies and electrical bladder stimulation with the Finetech-Brindley stimulator during a 3-year inclusion and study period. METHODS: 226 patients with spinal cord lesion and urological problems due to hyperreflexia of the bladder were screened for sacral rhizotomies and electrical bladder stimulation. In 52 patients complete posterior sacral root rhizotomies were performed and a Finetech-Brindley sacral anterior root stimulator implanted. All patients were screened and followed with a standard protocol. RESULTS: Complete continence during daytime was achieved in 73% of patients with 6-month follow-up and in 86% at night. Significant increase in bladder capacity and bladder compliance was achieved in all patients. Residual urine was reduced significantly, resulting in a decrease of the incidence of urinary tract infections. CONCLUSIONS: The treatment of neurogenic bladder dysfunction in spinal cord injury by anterior sacral root stimulation with the Finetech-Brindley stimulator in combination with sacral posterior root rhizotomy produces excellent results with limited morbidity.

Adolescent↗
PubMed1997

Using the ICSOoL to measure the impact of lower urinary tract symptoms on quality of life: evidence from the ICS-'BPH' Study. International Continence Society--Benign Prostatic Hyperplasia.

OBJECTIVE: To present and describe the validity and reliability of the International Continence Society-Benign Prostatic Hyperplasia study quality-of-life (ICSQoL) instrument, a new set of questions to assess the impact of lower urinary tract symptoms (LUTS) on quality of life (QoL) in middle-aged and elderly men. PATIENTS AND METHODS: The study comprised 1271 consecutive men over the age of 45 years, attending urology departments in 12 countries, with LUTS and possible benign prostatic obstruction who were recruited to the ICS-'BPH' study (the clinic group); 423 ambulant men were recruited from a general practice in the UK to provide a community group. Each individual completed the ICS-'BPH' study questionnaire which includes six items addressing general and specific aspects of QoL (the ICSQoL). Content and construct validity were assessed by interviews with patients and by testing hypotheses within the study groups, e.g. the relationships with age, individual LUTS (as measured on the ICSmale questionnaire) and generic health status, as measured by the Short Form (SF-36) and EuroQol instruments. Reliability was assessed by measures of internal consistency and a test-retest analysis. RESULTS: The ICSQoL items were easily understood by patients, were completed with low levels of missing data, and address some (but not all) concerns about the impact of LUTS on QoL. The ICSQoL items have good construct validity, showing expected differences between community and clinic samples, and expected relationships with each other and individual LUTS. Items had good test-retest reliability, but their internal consistency was poor, confirming that ICSQoL questions should not be combined into a score. General ICSQoL items were closely related with most domains of the SF-36 and the EuroQol. CONCLUSION: ICSQoL items may be used individually or as a group in research studies or in clinical practice.

Aged↗
PubMed1995

Prostate specific antigen in a community-based sample of men without prostate cancer: correlations with prostate volume, age, body mass index, and symptoms of prostatism.

The correlation between both prostate specific antigen levels (PSA) and prostate specific antigen density (PSAD) and age, prostate volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community-based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven prostate cancer, and those who had previously undergone a prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found between PSA and age (r = 0.25; P < 0.001), PSAD and age (r = 0.17; P < 0.001) and between PSA and the total prostate volume (r = 0.58; P < 0.001). PSA did not correlate independently with age after adjustment for volume (P = 0.22). The finding that PSAD correlates with age (r = 0.17; P < 0.001) is partly explained by the incomplete volume adjustment of PSAD which is proved by the positive correlation between PSAD and prostate volume (r = 0.26; P < 0.001). In the main target age-range for prostate cancer screening there is a poor basis for the use of age-specific reference values or volume adjustment for PSA levels in order to increase the clinical usefulness of this serum marker. Comparison of the results of the present study and studies conducted in others regions shows that there may be significant differences in PSA values per age stratum. Further studies are needed to clarify the reasons for these differences.

Aged↗
PubMed1995

Natural history of benign prostatic hyperplasia: appropriate case definition and estimation of its prevalence in the community.

There is no consensus about a case definition of benign prostatic hyperplasia (BPH). In the present study, BPH prevalence rates were determined using various case definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, prostate volume increase, and bladder outflow obstruction. The aim of this study--in a community-based population of 502 men (55-74 years of age) without prostate cancer--was to determine the relative impact on prevalence rates of the inclusion of these different parameters (and of different cutoff values for these parameters) in a case definition of BPH. There is agreement that age is the dominant determinant of BPH. However, of 28 different case definitions that were formulated, only eight gave a statistically significant increase in the prevalence of BPH with age. The highest overall prevalence of 19% (95% confidence interval [CI], 15-23%) occurred using the definition that combines a prostate volume > 30 cm3 and an International Prostate Symptom Score (IPSS) > 7. The lowest prevalence rate of 4.3% (95% CI, 2-6%) occurred using the definition that combines a prostate volume > 30 cm3, an IPSS > 7, a maximum flow rate < 10 mL/s, and the presence of a postvoid residual urine volume > 50 mL. Thus, prevalence rates depend very much on the parameters used in a case definition. Follow-up will establish which men will eventually request a workup and treatment for BPH and will help determine the best clinical definition of BPH.

Age Factors↗
PubMed1995

Reasons for the weak correlation between prostate volume and urethral resistance parameters in patients with prostatism.

In an attempt to increase our understanding of the clinical syndrome of benign prostatic hyperplasia (BPH) an analysis was made of the association between prostate volume as measured by transrectal ultrasound and several reported urodynamically determined urethral resistance parameters. Two types of obstruction can be recognized on the basis of urodynamic data: a compressive type characterized by a high urethral opening pressure and a prolonged isovolumetric contraction phase before urine flow can start, and a constrictive type characterized by a normal opening pressure and an increased slope of the urethral resistance relation. A combination of both types is often seen in BPH. In our study, parameters that selectively quantify compression correlate weakly to moderately with prostate volume, whereas parameters that mainly quantify constriction do not correlate at all with prostate volume. Parameters that combine a measure for compression and constriction correlate less well with prostate volume than parameters that mainly quantify compression. The variation in prostate volume was found to determine the variation in urethral resistance by 15% or less depending on the parameter used, which implies that the different pathophysiological mechanisms that can increase urethral resistance in the complex process of clinical BPH are mainly determined by factors other than the volume of the prostate. Thus, despite the lack of correlation between prostate volume and urethral resistance, pressure-flow studies and the determination of urethral resistance parameters provide a valuable contribution to the understanding of the pathophysiology of voiding dysfunction in men with symptoms of prostatism.

Adult↗
PubMed1995

Dependence of male voiding efficiency on age, bladder contractility and urethral resistance: development of a voiding efficiency nomogram.

The influence of age, urethral resistance and bladder contractility on voiding efficiency was evaluated by pressure-flow studies in 138 men of a mean age of 60 years (range 18 to 86). From these studies the urethral resistance parameter was calculated and the maximum bladder contraction strength was determined. Premature fading of the bladder contraction was quantified by a bladder contraction strength decay factor. Voiding efficiency was expressed by the parameter of post-void residual urine volume as a percentage of the initial bladder volume. Multiple regression analysis showed that voiding efficiency depended significantly in descending order of importance on urethral resistance, maximum bladder contraction strength and bladder contraction strength decay factor. Patient age was not an independent factor. Maximum bladder contraction strength and bladder contraction strength decay factor were not correlated, suggesting that maximum bladder contraction strength and its decay constitute different properties of bladder contractile function. A voiding efficiency nomogram is proposed, making use of the values for maximum bladder contraction strength and urethral resistance in individual patients. Such a nomogram may have predictive value for the occurrence of acute retention but it must be tested prospectively.

Adolescent↗
PubMed1995

Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis.

PURPOSE: We studied the effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor instability. MATERIALS AND METHODS: A permanent S3 foramen electrode was implanted in 18 patients (average age 46 years) who had shown a good response during temporary stimulation via a percutaneously placed wire electrode. Average followup was 29 months. RESULTS: The average voiding frequency and pad use per 24 hours decreased significantly. Improvement in several urodynamic parameters was noted. The correlation between symptomatic and urodynamic improvement was incomplete. CONCLUSIONS: Neuromodulation appears to be a valuable treatment option in these patients.

Adult↗
PubMed1995

The International Prostate Symptom Score in a community-based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume.

OBJECTIVES: To study the prevalence of symptoms of prostatism in the community and the correlation between these symptoms and age, prostate volume, flow rate and residual urine volume. SUBJECTS AND METHODS: The International Prostate Symptom Score (IPSS) was administered to a community-based population of 502 men aged between 55 and 74 years with no prostate cancer and no history of a prostate operation. Prostate volume parameters, flow rate variables and post-void residual urine volume were measured. RESULTS: Overall, 6 and 24% of the men were severely and moderately symptomatic, respectively. The results of a detailed questionnaire such as the IPSS (only 12% of the men scored 0) contrast with the men's global perception of their voiding function (82% claimed to have 'no voiding complaints'). A good correlation was found between the total symptom score and the single disease-specific quality of life question that is included in the IPSS (r = 0.74, P = 0.001). There was a weak correlation between the IPSS and total prostate volume (r = 0.19, P < 0.001), and between the IPSS and physiological measures such as peak flow rate (r = -0.18, P < 0.001) and post-void residual urine volume (r = 0.25, P < 0.001). There was a very weak correlation between the IPSS and age (r = 0.09, P = 0.04). CONCLUSIONS: The parameters used to characterize benign prostatic hyperplasia (BPH) should be considered independently because no predictions about the value of a certain parameter can be made by knowing one of the other parameter values. Symptom scores should therefore not be used as a pre-selection criterion in the determination of the prevalence of clinical BPH without taking other measures into account. The interpretation of the parameter values in a clinical setting should take the lack of correlation and the variability of the parameter values into account.

Aged↗
PubMed1995

Quality of life assessment in heterotopic and orthotopic neobladder reconstruction: a comparison.

Several techniques for continent urinary diversion are developed and applied in recent years. Heterotopic or orthotopic bladder replacement is an effective treatment option in selected patients. We reviewed 45 neobladder reconstructions in 25 men and 20 women. Mean age at operation was 43.7 years, mean follow-up was 34.7 months. Indications for bladder reconstruction were transitional cell carcinoma of the bladder (18), interstitial cystitis (6), neurogenic bladder (4), refractory incontinence (3) and undiversion (14). In 27 patients an orthotopic replacement (Mainz pouch in 18 and ileal neobladder in 9) was performed, in 18 patients a heterotopic replacement (Indiana pouch) was performed. Standard radiologic evaluation included ultrasonography, intravenous urography and postoperative pouchography. Preoperative urodynamic investigation and postoperative neobladder function documentation was performed routinely. Quality of life assessment was achieved by interview and use of the sickness impact profile (SIP) questionnaire. Nineteen patients (42.2%) had a completely uneventful postoperative course. Postoperative complications were acceptable as only 2 out of 20 late complications needed an open procedure for ureteric stenosis. Peri- or postoperative mortality did not occur. The mean postoperative bladder capacity was about 600 ml; 500 ml for the ideal neobladder, 560 ml for the Indiana pouch and 700 ml for the Mainz pouch. This tendency was not statistically significant. In 34 (75.5%) patients full urinary continence was achieved. One patient was consistently stress incontinent. The final overall outcome of these reconstructive procedures was excellent in the majority of cases.

Adolescent↗
PubMed1994

Parameters of prostate volume and shape in a community based population of men 55 to 74 years old.

Parameters of prostate volume and shape were determined in a community based population of 502 men 55 to 74 years old who had not undergone a previous prostate operation and did not suffer from prostatic cancer. The volumes of the total prostate and of the central relatively hypoechoic area of the prostate were determined. Of all men in this age range 95% had a total prostate volume of more than 20 cm3. Moderate correlations between age and both volume measurements were found (r = 0.26, p < 0.0001 and r = 0.34, p < 0.0001, respectively). The percentage increase per year of central hypoechoic volume (3.5%) was higher than that of total prostatic volume (2%). The average doubling time of total prostatic volume and volume of the central hypoechoic prostate was calculated to be 35 and 20 years, respectively. The roundness of the prostate as expressed by width-to-height ratio at the largest transverse section of the prostate correlated poorly with age (r = -0.13, p = 0.004). The average total prostate volumes as measured by transrectal ultrasound were 21 to 28% higher than reported average volumes measured at autopsy in men in the same age range.

Age Factors↗
PubMed1994

Treatment of benign prostatic hyperplasia by transurethral ultrasound-guided laser-induced prostatectomy (TULIP): effects on urodynamic parameters and symptoms.

OBJECTIVES: This prospective study was undertaken to evaluate the effects of transurethral ultrasound-guided laser-induced prostatectomy (TULIP) on urodynamic, symptomatic, and prostate volume parameters as well as serum prostate-specific antigen. METHODS: The TULIP procedure was performed in 33 patients with benign prostatic hyperplasia with a mean age of 66 years. Patients were evaluated by pressure-flow studies, prostate volume measurement by transrectal ultrasound, and the American Urological Association (AUA) symptom score. RESULTS: At 3-month follow-up, laser prostatectomy has resulted in an increased maximum flow rate from 6.6 +/- 0.5 to 11.2 +/- 0.6 mL/s and in an objectively proven relief of the urodynamic obstruction, as is evident by a decrease of the average value of the urethral resistance parameter URA and the detrusor pressure at maximum flow rate from 38.3 +/- 2.7 to 21.3 +/- 1.3 cm water and from 62.7 +/- 4 to 38.9 +/- 2.1 cm water, respectively. Symptomatic improvement is evident from a decrease in the AUA symptom score from 20.4 at baseline to 8.8 at 6-month follow-up. Although the total symptom score did not change significantly between 6 months and 1 year follow-up, the score of the symptom "weak stream" was significantly higher again at 12 months follow-up. CONCLUSIONS: The TULIP procedure is a urodynamically and symptomatically effective treatment. Conclusions about the durability of this treatment modality should be made with reservations.

Aged↗
PubMed1994

Peyronie's disease and congenital penile curvature: long-term results of operative treatment with the plication procedure.

OBJECTIVE: To evaluate the results of plication of the tunica albuginea in patients with a curved penis. PATIENTS AND METHODS: Twenty-two men with congenital penile curvatures and 33 men with acquired penile curvatures were treated by the plication technique. Their files were studied and all patients underwent a follow-up interview and were physically examined. The mean age of the patients with congenital penile curvatures was 25.7 (range 17-58) and that of the men with acquired penile curvatures was 54.4 (range 28-67). The mean length of follow-up was 42 months. RESULTS: The mean angle of deviation in relation to the longitudinal axis was 48.2 degrees in the congenital curvatures and 63.3 degrees in the acquired curvatures. All congenital curvatures were corrected successfully, i.e. the penis was straight and satisfactory intercourse was possible. Slight shortening of the penile shaft was noticed by eight patients, but none was concerned about this finding. Pre-operatively, 12 of 33 patients with acquired curvature were unable to have intercourse because of the combination of decreased rigidity and abnormal curvature. Of these patients, three were able to have satisfactory intercourse post-operatively. Most of the nine patients with a poor result were known pre-operatively to have adverse factors affecting erectile function. Of the 21 patients who were only able to have intercourse with difficulty preoperatively, intercourse was easier and more satisfactory in 18 and more difficult in three post-operatively. Pre-operative pain with erection improved in all patients. Complications were mild. Shortening concerned only two patients with recurrent Peyronie's disease after re-operation. CONCLUSION: Plication of the curved penis is a relatively simple, save and effective procedure.

Adolescent↗
PubMed1986

Carcinoma of the thyroglossal duct.

Based on the case histories of six patients with carcinoma of the thyroglossal duct, the literature on the origin and treatment of this disease was reviewed. As to the treatment of papillary adenocarcinoma there is some controversy, although in most cases treatment is limited to local excision as described by Sistrunk, provided that tumor growth is restricted to the cyst. The prognosis of this carcinoma seems favorable. Squamous cell carcinoma of the thyroglossal duct is rare; there is no uniform advice as to its treatment, and the prognosis is poor.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

The relationship between descriptive and valuational quality-of-life measures in patients with intermittent claudication.

The study objective was to assess the relationship between descriptive and valuational quality-of-life measures in patients with intermittent claudication. In telephone interviews, 68 patients completed a questionnaire consisting of a descriptive health status measure (RAND 36-Item Health Survey 1.0), and several valuational measures (standard gamble, time tradeoff, rating scale, and McMaster health utility index). All measures demonstrated reduced quality of life in the patients. Scores on the RAND-36 dimensions correlated moderately well with the rating scale and McMaster health utility index (R = 0.37-0.67) but less well with the standard gamble and the time tradeoff (R = 0.10-0.46). Multiple regression analysis demonstrated that 28% of the variance in the time-tradeoff values and 14% of the variance of the standard-gamble utilities could be explained by the best combination of RAND dimensions. These results suggest that answers to descriptive health-status questions cannot reliably predict standard-gamble utilities or time-tradeoff values.

Adult↗
PubMedDate not supplied

Heterogeneity in the relationship between the standard-gamble utility measure and health-status dimensions.

The authors assessed the relationship between the standard-gamble utility measure and the RAND-36 health-status dimensions, taking into account possible heterogeneity among patients in the weights they assign to different health-status dimensions. A questionnaire including both measures was completed by 68 patients with symptomatic peripheral arterial disease. Conventional multiple regression analysis, assuming a homogeneous relationship for the total population between the standard-gamble utility and the RAND-36 health-status dimensions, demonstrated that only the dimension social functioning was significant (p < 0.05), which accounted for 10% of the variation. Assuming that the population consisted of two separate classes demonstrated superior representation of the data. Latent class analysis was used to estimate the unknown parameters and class memberships. In the first class, consisting of 65% of the patients, the relationship between the standard-gamble utility and the dimension general health perception was significant. The within-R2 was 12%. The second class represented 35% of the patients and showed significant coefficients for the dimensions social functioning and role limitations due to physical problems, which accounted for 80% of the variation. The overall percentage of variation explained by latent class analysis was 49%. The results suggest that patients with symptomatic peripheral arterial disease belong to a variety of classes, all with class-specific relationships between the standard-gamble utility and the RAND-36 health-status dimensions.

Activities of Daily Living↗