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Biomedical subjects

P Abrams

Publications and source records attributed to P Abrams.

At least 127 records · Page 7Linked to original sources
PubMed1996

Tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist. A meta-analysis of two randomized, placebo-controlled, multicentre studies in patients with benign prostatic obstruction (symptomatic BPH). European Tamsulosin Study Group.

OBJECTIVE: This meta-analysis of two European studies evaluated the efficacy and safety of modified-release tamsulosin 0.4 mg once daily compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic obstruction (symptomatic BPH). METHODS: Patients entered a 2-week placebo run-in period, followed by randomization to treatment with tamsulosin (382 patients) or placebo (193 patients) once daily for 12 weeks. RESULTS: Maximum urinary flow rate improved to a greater extent in the tamsulosin group (1.6 ml/s, 16%) than the placebo group (0.6 ml/s, 6%) (p = 0.002). Total Boyarsky symptom score also improved to a greater extent in the tamsulosin group (3.3 points, 35.1% reduction) than the placebo group (2.4 points, 25.5% reduction) (p = 0.002). Significantly more tamsulosin patients (66%) than placebo patients (49%) had a > or = 25% decrease in total symptom score at endpoint (p < 0.001). Twelve weeks of treatment with tamsulosin also produced significant improvements in average urinary flow rate (p = 0.005) and voiding or "obstructive" (p = 0.008) and storage or "irritative' (p = 0.017) symptom scores. The incidence of drug-related adverse events was comparable for the tamsulosin and placebo groups (13 and 12% respectively, p = 0.802). The same applies to the incidence of adverse events commonly attributed to alpha 1-adrenoceptor antagonists, such as dizziness, headache, postural hypotension, syncope, asthenia, somnolence and rhinitis. There were no clinically significant changes in blood pressure or pulse rate in tamsulosin patients compared with placebo patients both in hypertensive and normotensive BPH patients. CONCLUSION: Tamsulosin 0.4 mg once daily is safe, well-tolerated and improves both the symptoms and urinary flow rate in patients with benign prostatic obstruction (symptomatic BPH).

Administration, Oral↗
PubMed1996

Frequency volume charts: an indispensable part of lower urinary tract assessment.

Frequency volume charts (FV charts) are widely used by those interested in lower urinary tract function. However, there has been little systematic work on the value and design of FV charts as they have evolved over the years as clinical tools rather than as research instruments. Although FV chart design has developed over the last 20 years, there is no standard and charts vary from simple frequency charts up to urinary diaries which record not only frequency, volume, urge episodes, pad usage and fluid intake, but also the patients' activities in relation to their lower urinary tract symptoms. Studies have shown that charts can be relatively complex and still be acceptable to patients, providing proper instruction is given, either by written advice or at face to face interviews. The correlations between the answers to simple questions concerning frequency and nocturia and the data extracted from FV charts are variably strong: nocturia, pad usage and incontinence episodes correlate well, whereas urinary frequency correlates less closely. A number of conclusions on frequency volume charts can be made. The chart is best kept for 7 days in order to cover both work and leisure periods. The daytime should be separated from the night-time, and this is particularly important in assessing older patients with possible nocturnal polyuria. Addition of voided volume measurement to the frequency chart allows the construction of a simple classification of FV charts. This classification links the characteristics seen on the FV charts with particular lower urinary tract dysfunctions. Whilst this classification gives a guide to the patient's possible diagnosis, the overlap between symptomatic groups and normal controls is large. FV charts have an important role in objectively, recording patients' symptoms, both as a base line and after therapeutic interventions. They are particularly important in everyday clinical use as a vital part of bladder training. In the research field they are important in providing objective evidence of changes in subjective symptoms in a treatment group as opposed to the placebo group. They have been particularly valuable in the evaluation of new drugs for the treatment of detrusor overactivity and benign prostatic obstruction. Most FV charts rely on pen and paper. However in the computer age the possibility of computerising the FV chart is attractive, but as yet not fully evaluated. At present it is advised that a simple frequency volume chart with the additional recording of incontinent episodes, pad usage and overall assessment of fluid intake is used for routine clinical use. In a research setting urinary diaries may add significant additional information, allowing a more complete evaluation of novel therapies.

Female↗
PubMed1995

Bladder-outlet obstruction--assessment of symptoms.

Assessment of symptoms plays a central role in the evaluation of men with suspected bladder-outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). It is on the basis of symptoms that treatment designed to relieve outflow obstruction is recommended. However, a variety of studies have suggested that a considerable proportion of men presenting with suspected outflow obstruction are not obstructed as determined by pressure-flow criteria. The relationship between many so-called "obstructive" symptoms and BOO has not yet been defined. Furthermore, all previous studies have defined BOO on the basis of urethral resistance factors, which are now regarded as outdated. Using current concepts of urethral pressure-flow relationships, we studied in detail the relationship between the "obstructive" symptoms of BPH, objective evidence of abnormal voiding and BOO. Only the symptoms of hesitancy and poor flow were found to be significantly related to BOO. The symptoms of straining to void, intermittency, terminal dribbling and feeling of incomplete bladder emptying were not specific for BOO. Objective evidence of an intermittent flow pattern and of terminal dribbling do, however, have a high specificity and positive predictive value for BOO. The assessment of men with lower-urinary-tract symptoms must include objective tests of voiding function. A better understanding of the pathophysiology of lower-urinary-tract symptoms should lead to an improved symptomatic outcome of prostatectomy.

Humans↗
PubMed1995

The Abrams-Griffiths nomogram.

The treatment of benign prostatic hyperplasia and the definition of bladder-outlet obstruction has preoccupied urologists and researchers in recent years. Bladder-outlet obstruction can be defined only by pressure-flow measurement. Various methods of analysis of pressure-flow data have been proposed. The Abrams-Griffiths nomogram is an easy method of classifying these data to distinguish between the presence or absence of obstruction. Using the values for the maximal flow and the corresponding voiding detrusor pressure a point can be plotted on the nomogram that determines whether the bladder outlet is obstructed, unobstructed, or equivocally obstructed. For those that fall in the equivocal zone, further criteria for the mean slope of the pressure-flow plot and the minimal voiding detrusor pressure are used to determine whether there is obstruction or not. The nomogram's prognostic value in predicting the outcome of prostatectomy has been studied and found to be excellent. The Abrams-Griffiths nomogram can be modified by assigning an Abrams-Griffiths number to each set of pressure-flow data. This number is easy to calculate and use and gives a continuous variable that can be used to evaluate the effects of therapy. Although the Abrams-Griffiths nomogram and number are somewhat simplistic, none of the more complex methods of pressure-flow analysis have been shown to be better predictors of treatment outcome to date.

Data Interpretation, Statistical↗
PubMed1995

The significance of abdominal straining in men with lower urinary tract symptoms.

OBJECTIVE: To determine the relationship between the symptom of straining to void, the presence of objectively demonstrated abdominal straining and bladder outflow obstruction in men with lower urinary tract symptoms (LUTS), and to assess the effect of straining on flow rate in these men. PATIENTS AND METHODS: The presence of straining to void as a symptom was determined from a symptom questionnaire in 61 men presenting with LUTS. Objective evidence of straining to void was assessed by rectal pressure measurement and the presence of bladder outflow obstruction was determined by pressure-flow studies. The effect of straining on flow rate was assessed in a separate group of 58 men with LUTS, by comparing the maximum flow rate on non-strain and strain voids of similar volume. RESULTS: There was poor agreement between the complaint of straining and the presence of straining as measured by rectal pressure recording. Twelve of the 53 patients who claimed they never or occasionally strained to void in fact showed straining on each of four voids. There was no significant difference in the proportion of men who complained of straining in the obstructed and non-obstructed groups (P = 0.86). The probability of obstruction in those men with objective evidence of straining on all voids was 80% and in those who did not strain on all voids was 51%, but this difference was not statistically significant (P = 0.53). There was no clinically significant effect of straining on maximum flow rate in men with LUTS. CONCLUSION: As a symptom, straining is an uncommon complaint in men with benign prostatic hyperplasia (BPH), and the relationship between the symptom and objective evidence of its presence is poor. Both as a symptom and as an objectively measured voiding disorder, straining lacks sufficient sensitivity and specificity for it to be of value in the diagnosis of bladder outlet obstruction (BOO). Abdominal straining does not have a marked effect on flow rate in men with BPH. This study suggests that straining is an unreliable symptom of BOO, that it does not influence voiding function in elderly men and that its inclusion in symptom scores for BPH should be reconsidered.

Aged↗
PubMed1995

Tamsulosin, a selective alpha 1c-adrenoceptor antagonist: a randomized, controlled trial in patients with benign prostatic 'obstruction' (symptomatic BPH). The European Tamsulosin Study Group.

OBJECTIVE: To evaluate the efficacy and safety of tamsulosin 0.4 mg once daily (as a modified-release formulation) compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic 'obstruction' (symptomatic benign prostatic hyperplasia [BPH]). PATIENTS AND METHODS: Of 313 patients with symptomatic BPH enrolled in a 2-week placebo run-in period, 296 were subsequently randomized to receive either placebo (98 patients) or tamsulosin 0.4 mg once daily (198 patients) for 12 weeks. The primary variables assessed to determine efficacy were maximum urinary flow rate (Qmax) from free-flow measurements and the total Boyarsky symptom score. RESULTS: Tamsulosin produced greater improvements in Qmax (1.4 mL/s, 13.1%) than did placebo (0.4 mL/s, 3.8%) (P = 0.028) and a greater decrease in total symptom score (3.4 points, 35.8% reduction) than did placebo (2.2 points, 23.7% reduction) (P = 0.002). Significantly more tamsulosin-treated patients (67%) than placebo-treated patients (44%) had a > or = 25% decrease in total symptom score after 12 weeks (P < 0.001). Treatment with tamsulosin for 12 weeks also produced significant improvements in average urinary flow rate (P = 0.040), irritative (P = 0.013) and obstructive (P = 0.014) symptom scores and symptoms of nocturia (P = 0.022) and hesitancy (P = 0.004). Tamsulosin was tolerated well by the patients. The incidence of adverse events emerging during treatment was comparable in the tamsulosin- and placebo-treated groups (34% and 24% respectively, P = 0.109), as was the incidence of cardiovascular-related adverse events (5% and 7% respectively; P = 0.596). There were no significant differences in changes in blood pressure or pulse rates between the tamsulosin- and placebo-treated groups. CONCLUSION: Tamsulosin 0.4 mg once daily is safe, well tolerated and clinically effective in improving symptoms and urinary flow rate in patients with symptomatic BPH.

Adrenergic alpha-Antagonists↗
PubMed1995

An open, in-patient incremental safety and efficacy study of desmopressin in women with multiple sclerosis and nocturia.

OBJECTIVES: To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis. PATIENTS AND METHODS: Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in-patients into an open, nonrandomized, placebo-controlled study of incremental doses of 20, 40 and 60 micrograms desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24-h periods. RESULTS: There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo, but there was no difference among the desmopressin doses. There was no significant difference in serum sodium level between the desmopressin doses. However, at the end of the 24-h period with the 60 micrograms dose, serum sodium was decreased significantly. CONCLUSIONS: Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 micrograms. A dose of 60 g was associated with a decreased serum sodium level at the end of the 24-h period but there was no biochemical hyponatraemia. Because there were no benefits and a possibility of clinical hyponatraemia with higher doses, doses of > 20 micrograms desmopressin cannot be recommended.

Adult↗
PubMed1995

Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women.

OBJECTIVE: To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre-menopausal women with recurrent idiopathic urinary infections. SUBJECTS AND METHODS: The study included 28 pre-menopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand-held probe, and the readings over 4 months compared. Monthly urine culture was compared between successive 4-month periods in which the probe was or was not used. RESULTS: The study was completed by 17 women. There was a significant shift towards urine of lower osmolality over the 4-month period using the probe (Pearson's chi 2 < 0.001). Significantly fewer urinary tract infections developed during the 4 months using the probe (McNemar's chi 2 = 0.046). CONCLUSIONS: The use of the osmolality probe encouraged the subject to maintain adequate hydration. The resulting augmentation of the natural urethral 'washout' mechanism led to lower osmolality urine and a reduction in the incidence of UTIs.

Adolescent↗
PubMed1994

Urinary symptoms in the community: how bothersome are they?

OBJECTIVES: To measure the level of reported urinary symptoms presumed to be associated with benign prostatic hyperplasia (BPH) among men aged 40 years and over in the community, and to assess how bothersome these symptoms are perceived to be. SUBJECTS AND METHODS: All ambulant men aged 40 years and over who were registered in a general practice (703) were invited to attend the health centre to complete a questionnaire containing the Maine prostatectomy scale and the International Continence Society-BPH questionnaire, and to undergo uroflowmetry. RESULTS: The prevalence of symptomatic BPH (as defined by a numerical score > or = 11 on the Maine score, a urinary peak flow of < 15 ml/s, and failure to void > or = 150 ml on three separate occasions) was 284/1000 for men aged 40 years and over. This prevalence increased from 179/1000 in men aged 40-49 to 500/1000 in men aged 70 years and over. The most commonly reported symptoms were those typically associated with BPH (terminal dribble, hesitancy, intermittency, urgency). The symptoms that caused men the greatest degree of bother were frequency, nocturia and those causing incontinence or social embarrassment. CONCLUSION: The high prevalence of urinary symptoms assumed to be related to BPH in men in the community does not necessarily suggest that these men will require treatment. Common symptoms, typically associated with BPH, were tolerated. Further research is required to investigate the natural history of urinary symptoms, the relationships between symptoms and bladder outflow obstruction secondary to BPH, and to determine the most appropriate management for men in the community, ranging from 'watchful waiting' (monitoring without treatment) to medical or surgical treatment.

Adult↗
PubMed1994

A three month double-blind study of doxazosin as treatment for benign prostatic bladder outlet obstruction.

OBJECTIVE: To evaluate the efficacy and tolerability of doxazosin in the treatment of bladder outflow obstruction resulting from benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: One-hundred and thirty-five patients with symptomatic urodynamically confirmed obstructive BPH were treated for 12 weeks with either doxazosin (67 patients) or placebo (68 patients) after an initial 2 week baseline evaluation. The main outcome measures were urodynamic and symptomatic evaluation for efficacy. Blood pressure and adverse events were monitored. RESULTS: Data were obtained in 122 patients (60 doxazosin, 62 placebo). Doxazosin produced increases in both mean and maximum urinary flow rates of 1.01 ml/s and 3.2 ml/s respectively, compared with 0.21 ml/s and 2.2 ml/s on placebo. The increase in mean flow rate was statistically significant (P = 0.04), while that for maximum flow rate approached significance (P = 0.09). The maximum subtracted voiding pressure was substantially reduced (P = 0.007) and 19 of 53 (36%) patients had an increase in maximum flow rate of 50% or more compared with 9 of 54 (17%) on placebo (P = 0.024). Twelve weeks' therapy with doxazosin resulted in significant improvements (compared with placebo) in: hesitancy (doxazosin 26 of 46, placebo 11 of 43; P = 0.003), impaired urinary stream (doxazosin 31 of 55, placebo 16 of 48; P = 0.019) nocturia (doxazosin 22 of 56, placebo 10 of 54; P = 0.017) and urgency (doxazosin 27 of 45, placebo 16 of 42; P = 0.041). Frequency improved with doxazosin therapy (doxazosin 26 of 59, placebo 15 of 55; P = 0.062). Adverse events, most frequently dizziness and headache, were usually mild and transient and led to a discontinuation of doxazosin therapy in one patient. No clinically significant changes in sexual function or blood pressure were seen. CONCLUSION: Doxazosin was well-tolerated and produced both urodynamic and symptomatic improvement in men with BPH, thereby providing a satisfactory alternative to existing drugs with the additional benefit of once daily dosage.

Aged↗
PubMed1994

Symptoms and symptom scores in BPH.

Symptoms occupy a central role in the management of bladder outflow obstruction (BOO) due to benign prostatic hyperplasia (BPH). Patients present with symptoms and are concerned with their resolution. Many urologists use symptoms as the basis for the diagnosis of bladder outflow obstruction and for assessing the effects of treatment. In this review we will discuss the relationship between the 'obstructive' symptoms of prostatism, and the objective evidence of disordered voiding and bladder outflow obstruction, and will highlight gaps in our understanding of the pathophysiology of the symptoms of prostatism.

Humans↗