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J V Jepsen

Publications and source records attributed to J V Jepsen.

8 recordsLinked to original sources
PubMed1998

Economics of transurethral thermotherapy of the prostate.

Costs of BPH management is increasing dramatically and may represent as much as 1% of total National Health Service expenditure. It is important to offer the patients effective treatment and to offer the society cost-effective treatment. The ideal cost-effectiveness or cost-utility analysis includes not only evaluation of outcome but also socioeconomic and intangible costs ("quality of life" costs). Studies on economics of the newer less invasive treatment modalities for BPH such as transurethral microwave thermotherapy of the prostate (TUMT) are scarce. Parameters important in the consideration of economy in TUMT are capital and disposable costs, retreatment rate and discount percentage. More studies are needed to make precise cost estimations for TUMT, but at present, TUMT seems comparable to TURP in cost-effectiveness.

Costs and Cost Analysis↗
PubMed1998

Variability in urinary flow rate and prostate volume: an investigation using the placebo arm of a drug trial.

PURPOSE: We analyzed a large data set to study reproducibility of peak urinary flow rates and prostate volumes in benign prostatic hyperplasia patients. MATERIALS AND METHODS: Longitudinal data were analyzed from 284 placebo treated patients in a double-blind, placebo controlled benign prostatic hyperplasia drug trial. RESULTS: A statistically significant increase in mean maximum flow rate was seen in the initial 3 measurements, as well as after adjusting for voided volume and time between uroflows. The mean maximum flow rate increased from 8.61 to 9.36 ml. per second at measurement 4 (8.7%). Of the patients 43% had 2 consecutive prostate volume determinations within +/- 10%. Within patient variability accounted for 7% of total prostate volume variability. CONCLUSIONS: With subsequent voidings maximum flow rate increases in a large group of patients. At least 4 uroflows must be performed to reach a plateau for maximum flow rate. Explanations for this finding may be the increasing experience of the patient and regression to the mean. These findings may impact on comparison of large trials of treatment efficacy. Within patient variability of prostate volume is substantial and, in addition to measurement method and lack of reader blinding to time and patient identity, may be caused by other yet unknown factors.

Aged↗
PubMed1998

Long-term experience with pentosanpolysulfate in interstitial cystitis.

OBJECTIVES: An oral preparation of pentosanpolysulfate sodium (PPS) was recently approved by the Food and Drug Administration for interstitial cystitis (IC). Previously published articles have documented improvement in symptoms in 28% to 63% of patients, but no long-term studies have been published. No unique characteristics except for Hunner's ulcer have been found in patients experiencing relief from PPS. We report our experience with PPS following patients up to 116 months and analyze baseline parameters in an attempt to characterize long-term responders. METHODS: Baseline and follow-up data from 97 patients with IC and enrolled in a compassionate use study with PPS at the University of Wisconsin from 1987 to 1995 are analyzed. Previous treatments had failed, and patients had to pay for PPS. Patients continuing treatment with PPS were monitored every 3 months with questionnaires and laboratory tests. In 1996 an update on medication and a questionnaire developed by the National Institutes of Health Interstitial Cystitis Database were sent to patients who had discontinued treatment. RESULTS: By the end of the study period 11 (11.3%) of the patients were still taking PPS, with 6 (6.2%) doing so continuously for more than 18 months. Three (3%) patients who discontinued PPS were in long-term remission. An additional 15% had remission for a substantial period. Except for a weak correlation between less constant pain (P = 0.0439), no correlations were found between baseline parameters and duration of treatment with PPS. CONCLUSIONS: On a long-term basis, between 6.2% and 18.7% of patients with IC benefit from PPS. The only baseline factor predicting response to PPS was less constant pain.

Adult↗
PubMed1998

Comprehensive patient evaluation for benign prostatic hyperplasia.

It is time to consider new approaches to benign prostatic hyperplasia (BPH). Previously, obstruction, prostatism, and hyperplasia of the prostate were considered to be almost synonymous. Today, there is increasing awareness that some men have hyperplasia, some have symptoms, and others obstruction. Currently, BPH is discussed in terms of benign prostatic enlargement (BPE), bladder outlet obstruction (BOO), and lower urinary tract symptoms (LUTS). Symptom questionnaires, uroflowmetry, prostate volume determination, residual urine volume determination, and pressure-flow studies continue to be the instruments used for assessing BPH patients. Prostate enlargement, prostatic muscle tone, and bladder function all impact voiding function. A large part of BPH symptomatology may be explained by bladder dysfunction, which tends to be discounted in discussions about BPH. In the future, bladder dysfunction must receive more attention, and better measures should be developed to quantify it. Postvoid residual urine is a sign of abnormal bladder function rather than the result of BOO. However, variability limits the predictive value of residual urine volume. Uroflowmetry is also criticized for excessive variability, which is increased among men with LUTS secondary to BPH. Approximately 70% of men with uroflow < 15 mL/sec are obstructed, which means that at least 10 million men in the United States have BOO. Therefore, alleviation of obstruction would be a daunting and overwhelming task. It is still widely believed that prostatism is due to an enlarged prostate and can be cured by reducing the size of the prostate. Prostate volume can be used to select treatment, but it is not reasonable to decide whether to treat a patient with LUTS on the basis of prostate size. One of the problems with symptom-based treatment is that LUTS is not gender specific. Questions about LUTS in patients with BPH may elicit very inconsistent responses, and numeric improvement in symptom score is not proportional to how bothered the patient is. Bother, not symptom score or objective measures such as postvoid residual urine and uroflowmetry, is what drives the decision-making process in BPH management. The most recent international guidelines for BPH treatment emphasize that the degree to which the patient is bothered is more important than symptom score. More than a third of all elderly men (and women) have moderate or severe LUTS, and not all of them should receive treatment. In the future, measuring bother due to LUTS and impact on the patients' quality of life with the BPH impact should be imperative and central to treatment decisions.

Humans↗
PubMed1998

Recent developments in the surgical management of benign prostatic hyperplasia.

A new era in the surgical management of benign prostatic hyperplasia (BPH) has emerged in the past decade. A variety of less invasive treatment modalities have been introduced and well-established surgical treatments are being reassessed. Although progress has been made in the management of BPH, the substantial economic burden to the healthcare system caused by BPH emphasizes the importance of cost-effective treatment. Open prostatectomy is the most efficient BPH treatment for relieving symptoms and improving uroflow, but it is also the most invasive and morbid. Transurethral resection of the prostate (TURP) is still the "gold standard" for treatment of BPH, but open prostatectomy has been reported to have a lower perioperative mortality than TURP, and low retreatment rates reduce the long-term cost. The morbidity associated with TURP, such as impotence or urinary incontinence, has been reduced in recent years while new features, such as performing TURP under local anesthesia and bipolar electrosurgical techniques, have been introduced. Transurethral electrovaporization of the prostate (TVP) is a recent modification of TURP that has rapidly gained popularity. TVP greatly reduces TURP syndrome, provides good hemostasis, and may reduce catheterization and hospitalization times. Transurethral incision of the prostate (TUIP) is another safe and inexpensive procedure that is well-documented and comparable to TURP in long-term efficacy. TUIP is an underused procedure with which the newer, less invasive treatments should be compared. Whereas the well-established surgical treatments primarily relieve obstruction by tissue ablation, some of the newer treatment modalities may ameliorate lower urinary tract symptoms (LUTS) with minimal urodynamic change. In some of the newer nonresection treatments, no major significant postoperative reduction in prostate volume can be demonstrated. Laser treatments are based on a broad variety of techniques, generators, and fibers, of which most have initially demonstrated promising results. Well-known techniques include visually laser-assisted prostatectomy (VLAP) and interstitial laser coagulation (ILC). The laser techniques are generally not as effective as TURP, but are safe under local anesthesia on an outpatient basis with low complication rates. Transurethral microwave thermotherapy of the prostate (TUMT) and radiofrequency transurethral needle ablation (TUNA) are minimally invasive, safe new therapies. There is some evidence that the procedures create long-term, alpha-adrenoceptor-like blockade. Complications, except for transient catheterization in up to 40% of patients, may be practically nonexistent. The cost is difficult to estimate and the long-term outcome is still to be assessed. If the newer, less invasive treatment modalities provide stable long-term results and competitive costs, they will be tempting alternatives to prostate resections and may also challenge medical therapy.

Catheter Ablation↗
PubMed1998

Office evaluation of men with lower urinary tract symptoms.

In the past decade, the symptom score has been considered the essential part of the evaluation of patients with lower urinary tract symptoms (LUTS). At the University of Wisconsin, the author's have stopped routine use of symptom scores because of their limited utility in dealing with the patient's concerns. Except from men electing invasive treatment, the authors do not serve the patients better with urodynamic testing either. Bothersomeness, not symptom score or objective measures is what drives the decision making process in benign prostatic hyperplasia (BPH) management. Generally, the authors now select patients for treatment according to the degree to which they are bothered by their LUTS.

Humans↗
PubMed1998

Surgical and nonsurgical invasive treatment of benign prostatic hyperplasia.

A third era in the surgical treatment of benign prostatic hyperplasia (BPH) utilizes less invasive treatment modalities. Transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) and a wide variety of laser treatments are the most conspicuous new treatment modalities approved or awaiting approval. In general, the alternative treatments produce less improvement in symptoms and peak urinary flow rates (Q(max)) than open prostatectomy or transurethral resection of the prostate (TURP), which remains the "gold standard". However, most are promising, particularly because they are associated with low morbidity. Long-term outcome has yet to be assessed with any of the newer treatments and total costs are difficult to calculate. Most have proved safe, are feasible on an outpatient basis and which, provided a low retreatment rate, will presumably reduce the socioeconomic costs. Although differences are found in outcome, morbidity and costs, none of the newer treatments has demonstrated convincing superiority or established a well-defined niche. In the future, controlled randomized studies against well-documented treatments like TURP or transurethral incision of the prostate (TUIP), focusing on long-term outcome, quality of life and socioeconomic costs, are needed.

Journal Article↗