Biomedical subjects

M J de Wildt

Publications and source records attributed to M J de Wildt.

At least 19 recordsLinked to original sources

PubMed2000

Clinical results of microwave thermotherapy for benign prostatic hyperplasia.

Transurethral microwave thermotherapy is a truly office procedure without the need for anesthesia for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. Several devices have been developed. Continuous refinement of the procedure led to higher energy protocols and high-intensity dose protocols applying the heat-shock strategy. We report on the clinical results of these protocols. Symptom scores improve around 60%, whereas maximum urinary flow rate improve from an average 9 to 10 mL/sec at baseline to 14 to 15 mL/sec during follow-up. No significant differences have been shown between the outcomes with the different devices. Long-term data show satisfactory results after 4 years. Initial clinical results with the heat-shock strategy show results comparable to those of higher-energy protocols with decreased morbidity. Treatment morbidity of higher energy protocols is moderate and consists mainly of the need for catheterization and a higher percentage of retrograde ejaculation. To improve treatment efficacy, patient selection appears to be most important. Prostate size, bladder outlet obstruction, age, and prostate composition are of predictive value for treatment outcome. Further development of the treatment protocols and refinement of the urethral applicators might enhance outcome.

Erectile Dysfunction↗

PubMed1996

Comparison of passive urethral resistance relation and urethral resistance factor in analysis of bladder outlet obstruction in patients with benign prostatic enlargement.

Analysis of the pressure/flow relation renders objective and detailed information on bladder outlet obstruction. The benefit of pressure/flow analysis for clinical and fundamental research questions, however, cannot be acknowledged without comparison of the different methods that exist. We compared one parameter analysis (URA) with two parameter (PURR) analysis in 99 consecutive patients with benign prostatic enlargement. The normal (instantaneous intrapatient) variability of both the PURR parameter Pvoidmin (minimal pressure during voiding) and the URA is approximately 10-15 cm H2O. Within these limits agreement between the two methods of analysis in the quantification of (minimal) outlet obstruction was observed in about 50% of the cases. However, when Qmax is less than 6 ml/s (in 49.5% of the patients) the URA number exceeds the value Pvoidmin in 96% of the cases. Predominantly this is caused by the fact that in the majority of these cases the type of bladder outlet obstruction is more constrictive than the URA curve, based on Pdet at Qmax indicated. In patients with a low flow rate and/or a constrictive type of obstruction, the Pvoidmin resulting from PURR analysis indicates a lower minimal pressure during voiding compared to URA.

Aged↗

PubMed1996

High-energy transurethral microwave thermotherapy: a thermoablative treatment for benign prostatic obstruction.

OBJECTIVES: High-energy transurethral microwave thermotherapy (TUMT) was developed to increase treatment efficacy over former low-energy treatment protocols as an outpatient-based, anesthesia-free procedure for patients with benign prostatic obstruction. A Phase II study was conducted to evaluate treatment outcome and to enlighten possible prognostic factors. METHODS: Eighty-five patients with lower urinary tract symptoms were included in the study. A Madsen symptom score of 8 or more, a maximum flow less than 15 mL/s, and a postvoid residual urine volume (PVR) of under 350 mL were the main requirements for entry. RESULTS: Eleven patients were lost to follow-up, making 74 patients evaluable at 1-year follow-up. Significant improvement was noticed in all indices: the Madsen symptom score improved 58% from baseline; the maximum flow rate improved from 9.4 to 14.9 mL/s, with a decrease in PVR of 80 mL to 25 mL; bladder outlet obstruction could be relieved in 78% of patients; and prostate volume decreased by 20%, with cavity formation in 42% of patients. Patients with bigger prostates (greater than 40 cm3) and patients with more severe bladder-outlet obstruction appeared to be the best responders. Post-treatment morbidity consisted of a prolonged need for transurethral catheter drainage (mean 16 days), with correlated irritative voiding complaints for an average of 2 to 3 weeks. CONCLUSIONS: Overall improvement of high-energy thermotherapy now shows comparable results to surgical resection of the prostate.

Aged↗

PubMed1996

Correlation between uroflowmetry, prostate volume, postvoid residue, and lower urinary tract symptoms as measured by the International Prostate Symptom Score.

OBJECTIVES: To evaluate the relation between lower urinary tract symptoms (LUTS) as measured by the International Prostate Symptom Score (IPSS) and noninvasive objective parameters of lower urinary tract dysfunction. METHODS: Eight hundred three consecutive patients with LUTS and/or benign prostatic hyperplasia were evaluated with IPSS, uroflowmetry, prostate volume estimation, and postvoiding residue measurement. The relations between these parameters were quantified by means of Spearman correlation coefficients. RESULTS: Statistically significant but weak correlations were found between the IPSS and results of uroflowmetry and postvoiding residual urine. There was no correlation between the IPSS and results of prostate volume measurements. CONCLUSIONS: The correlation between objective noninvasive parameters of lower urinary tract dysfunction and LUTS is weak.

Humans↗

PubMed1996

The correlation between urodynamic and cystoscopic findings in elderly men with voiding complaints.

PURPOSE: We evaluated the urethrocystoscopic findings and results of urodynamic studies in elderly men with voiding complaints. MATERIALS AND METHODS: A total of 492 consecutive patients with voiding complaints underwent a standardized screening program, including transrectal ultrasonography of the prostate, urodynamic investigations with pressure-flow study analysis and flexible urethrocystoscopy. RESULTS: A significant correlation was found between bladder trabeculation and grade of bladder outlet obstruction. Detrusor instability correlated significantly with grade of trabeculation. Grade of obstruction showed a clear correlation with prostatic occlusion of the urethra and the presence of a middle lobe at cystoscopy. CONCLUSIONS: The findings at urethrocystoscopy correlate well with those of urodynamic investigations.

Adult↗

PubMed1996

Reliability of the International Prostate Symptom Score in the assessment of patients with lower urinary tract symptoms and/or benign prostatic hyperplasia.

PURPOSE: The reliability of the International Prostate Symptom Score (I-PSS) was tested in patients with lower urinary tract symptoms and/or benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 71 consecutive men with benign prostatic hyperplasia and/or lower urinary tract symptoms was asked to complete the I-PSS at baseline and 8 weeks later. At the second visit the physician also completed the I-PSS according to the complaints of the patient. Variability between both scores was evaluated by calculation of duplo errors and results were compared to the clinical data. RESULTS: A considerable variability existed between the I-PSS results obtained at baseline and 8 weeks. The duplo error was 4.3. In a regression analysis of I-PSS, including all clinical parameters, only free flow had some predictive value for I-PSS outcomes. CONCLUSIONS: It is important to consider the variability of the I-PSS score when making decisions concerning treatment.

Follow-Up Studies↗

PubMed1996

The correlation between bladder outlet obstruction and lower urinary tract symptoms as measured by the international prostate symptom score.

PURPOSE: We studied the relationship between lower urinary tract symptoms as measured by the international prostate symptom score (I-PSS) and urodynamic findings in elderly men. MATERIALS AND METHODS: We evaluated 803 consecutive patients with lower urinary tract symptoms via the I-PSS and urodynamics with pressure-flow studies. RESULTS: A statistically significant correlation was found between all I-PSS questions (except intermittency) and objective parameters of obstruction. However, the clinical significance of this finding is minimal because a large overlap of symptom scores exists among patients with different grades of bladder outlet obstruction. The filling component of the I-PSS correlated somewhat better with obstruction than did the voiding component. CONCLUSIONS: It seems impossible to diagnosis bladder outlet obstruction from symptoms alone. It does not even seem possible to define subgroups in which further urodynamic examination is indicated.

Adult↗

PubMed1996

Pressure-flow study analyses in patients treated with high energy thermotherapy.

PURPOSE: We evaluated the urodynamic changes after high energy microwave thermotherapy in patients with lower urinary tract symptoms and benign prostatic enlargement. MATERIALS AND METHODS: A total of 120 patients was available for analysis with urodynamic investigation and pressure-flow studies before and 6 months after treatment. Several obstruction parameters were used to evaluate treatment outcome. RESULTS: A significant decrease (p < 0.001) in all obstruction parameters was noted. Mean detrusor pressure at maximum flow decreased from 64.7 to 39.1 cm. water, urethral resistance factor from 41.8 to 23.5 cm. water and linear passive urethral resistance relation from 3.0 to 1.4. Analysis of subgroups showed better results in patients with greater degrees of obstruction. CONCLUSIONS: High energy thermotherapy results in a significant and substantial decrease in bladder outlet obstruction.

Aged↗

PubMed1996

Three-year followup of patients treated with lower energy microwave thermotherapy.

PURPOSE: A retrospective study was done to investigate the long-term outcome of patients treated with lower energy transurethral microwave thermotherapy. MATERIALS AND METHODS: A total of 305 patients with lower urinary tract symptoms and benign prostatic hypertrophy underwent transurethral microwave thermotherapy according to a similar protocol at 2 centers. RESULTS: After 3 years of followup 133 patients who had undergone transurethral microwave thermotherapy alone were available for study. During this observation period significant symptomatic improvement from baseline and an improved maximum flow rate of 2.6 ml. per second were noted. Of the patients 125 underwent invasive or medical treatment. CONCLUSIONS: After 3 years of followup lower energy transurethral microwave thermotherapy showed significant and durable improvements in baseline parameters in 52% of the patients.

Aged↗

PubMed1996

The predictive value of microscopic haematuria in patients with lower urinary tract symptoms and benign prostatic hyperplasia.

OBJECTIVE: To determine the additional value of the presence of microscopic haematuria in patients with benign prostatic hyperplasia (BPH). METHODS: In 750 consecutive patients with BPH urinalysis was performed and the grade of microhaematuria was correlated with other clinical findings. RESULTS: Microscopic haematuria was found in one third of the patients. Only 3 had a bladder tumour and 49 patients had urinary calculi for which only one patient required treatment. There was no correlations between any clinical parameter and the finding of microscopic haematuria. CONCLUSION: Microscopic haematuria is a frequent finding in assessment of BPH patients and additional tests should only be performed if indicated.

Adult↗

PubMed1996

The outcome of renal ultrasound in the assessment of 556 consecutive patients with benign prostatic hyperplasia.

PURPOSE: We determined the additional value of renal ultrasonography in the assessment of patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Renal ultrasound was performed in 556 consecutive patients with benign prostatic hyperplasia and the results were correlated with other clinical parameters. RESULTS: Of the patients 14 (2.5%) had dilatation of the renal pelvis, 65 (11.7%) had renal cysts and 1 (0.18%) had renal cell carcinoma. The serum creatinine level appeared to be correlated with dilatation of the renal pelvis. To predict dilatation additional information can be obtained by including the results of the post-void residual measurements. CONCLUSIONS: Renal ultrasound is indicated only in patients with a specific serum creatinine level and/or post-void residual volume.

Carcinoma, Renal Cell↗

PubMed1996

Clinical diagnosis of bladder outlet obstruction in patients with benign prostatic enlargement and lower urinary tract symptoms: development and urodynamic validation of a clinical prostate score for the objective diagnosis of bladder outlet obstruction.

PURPOSE: We attempted to improve the method of objective clinical evaluation of patients with benign prostatic enlargement and lower urinary tract symptoms. MATERIALS AND METHODS: We compared the results of free uroflowmetry and transrectal ultrasound prostate size determination with those of pressure-flow analysis of bladder outlet obstruction in 871 consecutive elderly men. RESULTS: Maximal flow, prostate size, and post-void residual and voided volumes were correlated with bladder outlet obstruction to derive a clinical prostate score. CONCLUSIONS: Clinical prostate score shows a superior correlation with bladder outlet obstruction than isolated objective parameters or symptom scores.

Adult↗

PubMed1996

Urodynamic and clinical effects of terazosin therapy in patients with symptomatic benign prostatic hyperplasia.

PURPOSE: We evaluated the urodynamic and clinical effects of terazosin in patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 45 patients who participated in a multicenter trial was evaluated with urodynamic pressure-flow studies before and after 26 weeks of treatment. RESULTS: Maximum flow rate and symptom score improved significantly in 22 patients with and 11 without bladder outlet obstruction who completed 26 weeks of treatment. In patients with bladder outlet obstruction the condition was significantly reduced and in patients without obstruction, significant urodynamic changes could not be detected. CONCLUSIONS: Terazosin treatment results in symptomatic relief and improved urinary flow in patients with and without bladder outlet obstruction, and in significant improvement in patients with urodynamically proved obstruction.

Adrenergic alpha-Antagonists↗

PubMed1996

High energy thermotherapy in the treatment of benign prostatic hyperplasia: results of the European Benign Prostatic Hyperplasia Study Group.

PURPOSE: We documented the results of high energy transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia. MATERIALS AND METHODS: We evaluated 116 patients following transurethral microwave thermotherapy according to symptom scores, transrectal ultrasound, free voiding and pressure-flow study parameters. RESULTS: Significant improvement was noted in all objective and subjective parameters. Moreover, cavities in the prostatic urethra were observed in almost 40% of the patients. CONCLUSIONS: High energy transurethral microwave thermotherapy is an effective therapy for benign prostatic hyperplasia. Patients with larger prostates and moderate to severe bladder outlet obstruction seem to be the best candidates for this higher energy thermotherapy protocol, although morbidity is increased.

Aged↗

PubMed1996

Evaluation of detrusor activity during micturition in patients with benign prostatic enlargement with a clinical nomogram.

PURPOSE: We investigated the accuracy of analysis of detrusor contraction during micturition with a simple to use pressure-flow nomogram (linear passive urethral resistance relation). The computer derived maximum detrusor contraction parameter was used as a reference. The correlation with bladder emptying capability was used as a control. MATERIALS AND METHODS: Advanced pressure-flow analysis was performed in 224 elderly men with lower urinary tract symptoms. RESULTS: All patients with a contraction classified as normal on the nomogram had good maximum detrusor contractions. However, 50% of the patients with a weak classification on the nomogram showed good maximum detrusor contractions. CONCLUSIONS: The nomogram is useful in the selection of patients with a good detrusor contraction.

Aged↗

PubMed1996

Variability of clinical and pressure-flow study variables after 6 months of watchful waiting in patients with lower urinary tract symptoms and benign prostatic enlargement.

PURPOSE: We quantified the physiological variability of clinical and pressure-flow study variables in patients with symptomatic benign prostatic enlargement. MATERIALS AND METHODS: Symptom scores were measured, and advanced urodynamic studies with pressure-flow analysis were performed in 178 patients before and 6 months after a period a watchful waiting. RESULTS: Patients without bladder outlet obstruction experienced significant symptomatic improvement. Symptoms in patients with obvious bladder outlet obstruction did not improve significantly. The reproducibility of mean pressure-flow variables was evident. However, there was an important intra-individual variability. Patients with obvious bladder outlet obstruction showed a significant decreases in detrusor pressure at maximal flow of 14cm. water, a significant decrease in the urethral resistance factor of 7 cm. water and a significant decrease of 1 obstruction class on the linear passive urethral resistance relation nomogram, indicating less severe bladder outlet obstruction. CONCLUSIONS: Mean differences among therapy groups must be regarded critically, especially when the difference are slight and possibly within physiological variability.

Aged↗

PubMed1995

Experience with the Ultraline and Urolase laser fibers: is there any difference?

Laser treatment of benign prostatic hyperplasia has enjoyed growing popularity among urologists over the last few years. Various applicators and techniques have been reported. Because this may result in a different overall performance, we performed a prospective randomized study comparing the results of treatment using the Ultraline fiber (n = 44) with that using the Urolase fiber (n = 49). Although different types of fibers and techniques were used, the results of this study were surprisingly similar for both fibers used. The uroflow for the Ultraline group increased from an average of 7.9 ml/s at baseline to 19.3 ml/s at 3 months and 16.9 ml/s at 6 months. In the patients treated with the Urolase fiber the uroflow improved from an average of 7.8 ml/s at baseline to 19.5 and 16.3 ml/s at 3 months and 6 months, respectively. The improvement in symptoms, reflected by changes in the I-PSS symptom scores, for the Ultraline group went from 21.0 at baseline to 7.9 at 3 months and 6.0 at 6 months. The Urolase patients improved from 21.0 at baseline to 8.2 and 5.6 at 3 and 6 month, respectively. The morbidity mainly consisted of a prolonged need for posttreatment catheterization and irritative symptoms lasting for about 2-4 weeks. From this study we conclude that the results achieved by laser treatment of the prostate using the Ultraline and Urolase fibers are both equivocal and excellent; however, the morbidity of these treatments remains considerable.

Aged↗

PubMed1995

Urodynamic results of laser treatment in patients with benign prostatic hyperplasia. Can outlet obstruction be relieved?

PURPOSE: A urodynamic study was done to judge the capability of laser treatment to relieve bladder outlet obstruction. MATERIALS AND METHODS: Advanced urodynamic studies with pressure-flow analysis were performed before and 6 months after laser treatment using 3 different laser devices. RESULTS: Forty patients showed significant improvement in all obstruction parameters (detrusor pressure at maximum flow rate, urethral resistance relation, theoretical cross-sectional urethral area, minimal detrusor pressure and linear passive urethral resistance relation) together with significant subjective improvement in international prostate symptom score. After treatment 82 to 92% of the patients could no longer be considered to have obstruction. No difference in outcome among the devices used was found. CONCLUSIONS: Laser prostatectomy is indeed capable of relieving bladder outlet obstruction.

Aged↗