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Biomedical subjects

P R Rhodes

Publications and source records attributed to P R Rhodes.

At least 19 recordsLinked to original sources
PubMed1999

Impact of drug therapy on benign prostatic hyperplasia-specific quality of life.

Quality of life (QOL) is an important issue when assessing medical treatment of benign prostatic hyperplasia (BPH). There are many QOL questionnaires available, and disease-specific questionnaires are being developed. Currently, most patients undergoing treatment for BPH receive alpha-blockers or finasteride. To determine which QOL measures are being used, we did a Medline search covering the past 10 years and found 11 studies in which BPH-QOL was investigated. The wide variety of questionnaires used made comparison between drug studies difficult. When comparing studies that used at least one similar questionnaire to that of another drug study, we found alpha-blocker treatment excelled over finasteride in improving BPH-QOL in the areas of earlier response, larger decreases in mean changes, and reduced sexual side effects. QOL assessment should be a routine part of BPH treatment, and more standardized and validated measures should be used to allow for comparative, meaningful analyses.

Adrenergic alpha-Antagonists↗
PubMed1998

Dog model for studying detrusor instability secondary to acutely induced variable bladder outlet obstruction.

BACKGROUND: Involuntary detrusor contractions often cause irritative symptoms such as urgency and incontinence. A dog model for acutely induced variable bladder outlet resistance was developed to investigate the possible role of prostatic afferent nerve fibers in the development and maintenance of detrusor instability. METHODS: Fifty-eight mongrel dogs (weight range 19.5-36.5 kg) were divided into five groups: group I (n = 11) had surgically induced bladder outlet obstruction. Group II (n = 14) had urinary obstruction and bilateral sectioning of the lowest branches of the pelvic plexus supplying the prostate. Group III (n = 10) had prostate denervation only. Groups IV (n = 10) and V (n = 13) were sham-operated and controls, respectively. In the obstructed groups (I and II), an artificial urinary sphincter (length 4.5-6.0 cm) was placed around the bladder neck and connected to a reservoir placed subcutaneously to allow postoperative adjustments of urinary resistance. All dogs were evaluated at baseline and postoperatively at 1, 3, and 6 months with uroflowmetry, postvoid residual urine volume, cystometry as well as serum creatinine, and urinalysis. RESULTS: Occurrences of detrusor instability were not associated with prostatic denervation input. The mean peak flow rates decreased significantly in the obstructed groups at all follow-ups, but did not change significantly in the nonobstructed groups. Postoperatively, the mean maximum bladder capacity was significantly decreased for groups I and II only. However, a significant correlation between maximum bladder capacity and maximum detrusor pressure could not be detected at any time point in any of the groups. Mean postvoid residual urine volume varied considerably in all groups over time. Creation of a urinary model of infravesical obstruction was associated with considerable problems. CONCLUSIONS: In our dog model of bladder outlet obstruction, prostatic sensory nerve fibers appear not to be involved in detrusor instability. Surgical induction of a constant model of bladder outlet obstruction was difficult even in a large animal. The observations from the present study raise questions about the validity of obstructive urinary animal models.

Animals↗
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

Position-related changes in voiding dynamics in men.

OBJECTIVES: To investigate by urodynamic study position-related changes in uroflowmetry and postvoid residual urine volume (PVR) in men because altered bladder function in the supine position may be a predisposing factor for urinary tract infections in the institutionalized elderly. METHODS: Two healthy men, 34 and 59 years of age and living at home, and 53 nursing home residents (mean age 71.8 years, range 46 to 92) were evaluated with uroflowmetry in the standing and recumbent positions (lying on the left or right side); corresponding PVRs were measured by transabdominal ultrasonic bladder scanning. The two healthy men were monitored longitudinally with multiple recordings in both voiding positions, and the nursing home residents were subjected to two observations: one measurement of the variable parameters in either position. Differences were considered to be significant at P < 0.05. RESULTS: The 34-year-old man performed 51 3 flows (368 standing and 145 recumbent). The mean of all the peak flow rates in the upright (28.2 +/- 4.2 mL/s) versus the recumbent (16.8 +/- 4.1 mL/s) position revealed a highly significant difference (P = 0.0001). Sixteen urinary flows and corresponding PVRs were completed by this subject in either voiding position. The difference between PVRs in the standing (13.1 +/- 14.7 mL) versus recumbent (15.3 +/- 17.5 mL) position was not statistically significant. The 59-year-old man completed 156 flows (128 standing and 28 recumbent). A highly significant difference was noted between the mean of all peak flows in the upright (18.9 +/- 4.1 mL/s) versus recumbent (12.6 +/- 2.0 mL/s) position (P = 0.0001). Thirty-seven urinary flows and corresponding PVRs were completed by this individual (10 PVRs were determined after voiding in the standing and 27 after voiding in the recumbent position). No significant difference was noted between PVRs in the standing (24.6 +/- 34.4 mL) versus recumbent (16.5 +/- 60.0 mL) position. In the nursing home residents, the difference between the mean peak flow rates in the standing (14.5 +/- 8.6 mL/s) versus recumbent (12.4 +/- 6.7 mL/s) position also reached statistical significance (P = 0.0084). The difference between PVRs in the standing (60.5 +/- 125.6 mL) versus recumbent (84.8 +/- 186.2 mL) position barely reached statistical significance (P = 0.0497). CONCLUSIONS: The urinary flow rate decreases in the recumbent position. Bedridden residents may be predisposed to urinary tract infections because of alterations in voiding dynamics in the supine position. This area needs further study.

Adult↗
PubMed1997

Pelvic pain following radical retropubic prostatectomy: a prospective study.

OBJECTIVES: To evaluate subacute and chronic pelvic pain after radical retropubic prostatectomy (RRP) performed for clinically localized prostate cancer. METHODS: Twenty-four consecutive patients undergoing RRP completed pain, quality-of-life, and incontinence questionnaires. They also wore pads for 24 hours to measure urine loss objectively before and after surgery. RESULTS: Three patients had pelvic pain preoperatively. Thirteen, 7, and 5 patients had pelvic pain at 1, 3, and 6 months, respectively, after RRP. At 6 months, none of the 5 patients with pelvic pain required analgesic medication. There was a strong relationship between pain and cancer worry, as well as between pain and incontinence. CONCLUSIONS: Many patients have subacute pelvic pain after RRP but improve over time. Severe chronic pain is unlikely after RRP.

Acute Disease↗
PubMed1997

Preservation of bladder tissue in different solutions for varying times.

OBJECTIVES: To evaluate three popular storage media and the effect of 24-hour cold storage on bladder tissue. METHODS: Guinea pig bladders were stored in three solutions: UW solution (a media used for transplant organs), Reznikoff solution [cell culture medium], and Krebs' solution with and without aeration. RESULTS: Cell potassium and sodium concentrations and total tissue water (a measurement of cell swelling) are important parameters for evaluating tissue damage. Reznikoff solution and Krebs' solution without gases maintained tissues for 24 hours with the least tissue damage; these solutions require no special equipment or attention. Twenty-four hour uniterrupted aeration of Krebs' solution caused the greatest degree of cell swelling with possible redistribution of receptors and required adjustment and regulation of the preservation apparatus. UW solution induced dehydration of cells, required the longest recovery period after cold storage, and is far more expensive than the other solutions. CONCLUSIONS: Reznikoff solution caused consistent relative changes in smooth muscle receptors and was superior to aerated Krebs' and UW solutions for 24-hour bladder tissue storage. It is unnecessary to aerate Krebs' solution during 24-hour cold storage.

Adenosine↗
PubMed1997

Dentistry in the information age.

The data available to be gathered and analyzed in this new Information Age will help dentistry fend off managed care by validating the value of dental care and reducing the cost of practice administration. Many of the tools are in place and others will be soon. It is up to dentistry, however, to take the necessary initiative.

Computer Communication Networks↗
PubMed1996

A prospective study of quantification of urinary incontinence and quality of life in patients undergoing radical retropubic prostatectomy.

OBJECTIVES: To prospectively evaluate the level of urinary incontinence and its impact on quality of life in patients undergoing radical retropubic prostatectomy. METHODS: Patients completed a 24-hour pad test together with an incontinence and quality-of-life questionnaire before and after surgery. RESULTS: Patients were followed up for an average of 7.6 months (range 4.7 to 12.5) after radical prostatectomy. The 24-hour pad test demonstrated that 87% of patients had some incontinence at 1 month and 63% at 6 months after surgery. The median volume of urine leakage was 34 mL at the last follow-up visit; 55% of patients indicated substantial bother from incontinence at the 1-month follow-up visit and 29% at the 6-month follow-up visit. For most patients, there was a substantial discrepancy between the reported and the measured level of incontinence. Patient-reported bother regarding incontinence correlated best to the actual amount of urine loss. CONCLUSIONS: Patients become incontinent after surgery but improve over time. Seventeen percent of patients still experienced leakage of more than 150 mL daily at the last follow-up visit. The questionnaire utilized in this study identifies the presence of incontinence but was not accurate in estimating the amount of urine loss. Initially, quality of life was reduced by surgery but improved over time and nearly returned to the preoperative level.

Aged↗
PubMed1995

Reproducibility of pressure-flow variables in patients with symptomatic benign prostatic hyperplasia.

OBJECTIVES: To study the reproducibility of pressure-flow studies in patients with symptomatic benign prostatic hyperplasia and to investigate if the reproducibility is influenced by the method of intravesical pressure measurement, that is, transurethral catheterization versus suprapubic puncture. METHODS: The within-patient variation of maximum urinary flow rates and detrusor pressure at maximum flow was investigated in 25 patients in whom 2 (transurethral group) or 3 (suprapubic group) sequential voidings during urodynamic investigation were analyzed. RESULTS: The within-patient variation of pressure-flow values was evaluated by the intraclass correlation coefficient, which was 0.71 for maximum urinary flow rate and 0.84 for detrusor pressure, suggesting a relatively high degree of reproducibility. However in 26% of the patients, the maximum flow rates changed by more than 3 mL/s or the detrusor pressure by more than 20 cm H2O during the repeated tests. There was no significant difference in the within-patient variation of pressure-flow values between the suprapubic group and the transurethral group. CONCLUSIONS: In larger clinical trials where the assessment of treatment effects between groups is desired, a single pressure-flow test is sufficient. In the individual patient, a single pressure-flow curve is of limited value due to a considerable within-patient variation of the test and, for these patients, multiple consecutive tests are recommended for diagnosis of intravesical obstruction and assessment of individual patient's response to treatment.

Aged↗
PubMed1994

Risk factors for bacteriuria in men.

OBJECTIVE: To identify risk factors for bacteriuria in a selected group of institutionalized men. METHODS: A total of 99 men, mean age seventy-one years, range forty-eight to one hundred four years, living in a nursing home were evaluated for diagnoses of benign prostatic hyperplasia (BPH) and diabetes mellitus (DM), symptoms of bladder outlet obstruction, and postvoid residual urine volume (PVR). At the time of evaluation urine cultures were performed for all subjects. Urinalyses had been performed in all men within the two years prior to initiation of the study. Residents unable to give informed consent, with a history of cancer of the prostate or bladder, previous urethral or prostate surgery, or inability to void in the standing position were excluded. RESULTS: Prior to or during the study 30 residents had bacteriuria, which was not correlated with age, PVR, previous diagnoses of BPH or DM, or with obstructive or irritative urinary symptoms consistent with bladder outlet obstruction. CONCLUSIONS: Competent, institutionalized residents with higher functional levels meeting the inclusion criteria were not at a high risk of bacteriuria. The concept that increased PVR per se predisposes to bacteriuria cannot be substantiated.

Age Factors↗
PubMed1994

Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis.

OBJECTIVES: To evaluate sequelae and estimate quality of life utilizing a survey instrument in 133 consecutive patients who have undergone definitive radiation therapy for localized prostate cancer. METHODS: All patients reported on have been followed for 14 to 60 months (median, 31 months) after radiation therapy and only patients with definitive prostate radiation therapy are included. Of the patients still alive at time of follow-up, 115 were mailed the questionnaire. Data regarding tumor grade and stage as well as treatment were extracted from patient files. RESULTS: Of the 91% of patients who returned the questionnaire, 11% used a pad and 13% leaked more than a few drops of urine daily. Of all the respondents, 9% stated that incontinence was a problem, and 31% found urinary leaking significantly worsened after radiation therapy compared with before their diagnosis of prostate cancer. With respect to sexual function, 77% recalled being able to have full or partial erections prior to radiation therapy. At some time after radiation therapy, 22% of previously potent respondents were able to have a full erection and 41% were able to have a partial erection. Twenty-nine percent of all patients who were able to establish an erection prior to radiation therapy reported that impotence was a problem at the time of follow-up. Forty-nine percent of patients had abdominal pain, diarrhea, or abdominal cramping during or after radiation therapy and 31% of all patients still had some intestinal symptoms at the time of follow-up. Eighteen percent of all patients were significantly bothered by one or more of these bowel problems. Overall, 31% of all patients reported a persistent degree of physical discomfort that they believed was secondary to their prostate cancer or the effect of treatment. Eighty-one percent were satisfied with radiation therapy and 97% of the patients said they would have radiation therapy again if faced with the decision. CONCLUSIONS: Utilizing a sensitive questionnaire on patients who had definitive radiation therapy for prostate cancer, we found the incidence of patients bothered by incontinence to be surprisingly frequent and higher than previously reported. The frequency of impotence is similar to previous studies. However, when our incontinence and impotence data were compared to Medicare patients who had undergone radical prostatectomy, the frequencies after radiation therapy were significantly lower. Despite the rates of sequelae, the patients were generally satisfied with the decision to undergo radiation therapy and with the medical treatment received.

Aged↗
PubMed1994

Sequelae of radical prostatectomy.

OBJECTIVE: To evaluate the sequelae of radical prostatectomy, using a survey instrument. PATIENTS AND METHODS: Ninety-three consecutively treated patients who had undergone radical prostatectomy and who had been followed-up for between 12 and 48 months (mean 22.5) were sent a questionnaire by post. Of these, 86 (92%) completed and returned the questionnaire. The mean age of the patients at time of surgery was 64 years (range 49-75) and at time of follow-up was 66 years (range 50-77). RESULTS: Of the 86 patients who responded, 47% used a pad and 59% leaked urine daily. Thirty per cent dripped more than a few drops of urine daily and 34% found their incontinence bothersome. Eighty-four per cent of patients recalled that they had erectile potency before surgery. At follow-up, 9% were able to have a full erection and 38% were able to have a partial erection. Fifty-one per cent reported a substantial problem with reduced or absent erection. Twenty per cent had undergone treatment for bladder neck contracture and more than half of these had had more than one intervention. In all, 24% of the patients reported some persisting degree of physical unpleasantness which they believed to be secondary to their prostate cancer or the effects of treatment. Despite this, 74% were satisfied with their surgery and 88% said they would undergo surgery again. CONCLUSIONS: Using this survey instrument, we found adverse sequelae of radical prostatectomy to be surprisingly high. However, patients were generally satisfied with their decision to undergo surgery.

Aged↗
PubMed1994

The computer-based oral health record: exploring a new paradigm.

The paper-based clinical chart, adequate for the days of primarily acute dental care, falls short in today's era of chronic dental care. The computer-based oral health record has the potential for active function in patient management, decision support and quality evaluation. This article discusses the use of the computer in information management, including risk management, search and query, data manipulation, automated data input and patient education; and decision support through knowledge couplers.

Decision Support Systems, Management↗
PubMed1993

Analysis of variation in prostate-specific antigen values.

This retrospective study analyzes variation in prostate-specific antigen (PSA) levels in 129 males who were not diagnosed with prostate cancer or other known malignancies. The extent to which the assay and the biologic variation contributed to the variation in PSA concentration was evaluated from analysis of slopes characterizing PSA concentration as a function of time. The mean coefficient of variation on observations was 58.0 percent. The estimated mean biologic coefficient of variation was 55.3 percent versus a mean assay coefficient of variation of 13.2 percent, indicating that the assay variation contributed negligibly to variation compared with the biologic variation. The concept that a PSA level which rises more than that attributable to assay variation indicates the need for invasive testing for prostate cancer is questionable. A decreasing PSA level was seen as often and of the same magnitude as an increasing level within a relatively narrow window of approximately one year. We are aware of no reason why this variability in PSA values would not be observed in patients with occult prostate cancer.

Aged↗