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Biomedical subjects

R C Bruskewitz

Publications and source records attributed to R C Bruskewitz.

At least 19 recordsLinked to original sources
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

A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate.

BACKGROUND: Transurethral resection of the prostate is the most common surgical treatment for benign prostatic hyperplasia. We conducted a multicenter randomized trial to compare this surgery with watchful waiting in men with moderate symptoms of benign prostatic hyperplasia. METHODS: Of 800 men over the age of 54 years who were screened between July 1986 and July 1989, 556 (mean [+/- SD] age, 66 +/- 5 years) were studied (280 in the surgery group and 276 in the watchful-waiting group). Patients' symptoms and the degree to which they were bothered by urinary difficulties were measured with standardized questionnaires and medical evaluations. The primary outcome measure was treatment failure, which was defined as the occurrence of any of the following: death, repeated or intractable urinary retention, a residual urinary volume over 350 ml, the development of bladder calculus, new and persistent incontinence, a high symptom score, or a doubling of the serum creatinine concentration. Patients were followed for three years. RESULTS: Of the men randomly assigned to the surgery group, 249 underwent surgery within two weeks after the assignment. Surgery was not associated with impotence or urinary incontinence. The average follow-up period was 2.8 years. In an intention-to-treat analysis, there were 23 treatment failures in the surgery group, as compared with 47 in the watchful-waiting group (relative risk, 0.48; 95 percent confidence interval, 0.30 to 0.77). Of the men assigned to the watchful-waiting group, 65 (24 percent) underwent surgery within three years after the assignment. Surgery was associated with improvement in symptoms and in scores for urinary difficulties and interference with activities of daily living (P < 0.001 for all comparisons). The outcomes of surgery were best for the men who were most bothered by urinary symptoms at base line. CONCLUSIONS: For men with moderate symptoms of benign prostatic hyperplasia, surgery is more effective than watchful waiting in reducing the rate of treatment failure and improving genitourinary symptoms. Watchful waiting is usually a safe alternative for men who are less bothered by urinary difficulty or who wish to delay surgery.

Aged↗
PubMed1995

Cystoscopy in the evaluation of benign prostatic hyperplasia.

Cystoscopy has a limited role in the evaluation of benign prostatic hyperplasia (BPH). The examination is recommended in the evaluation of BPH patients with hematuria or a history of risk factors for urethral stricture. Available data suggest that bladder trabeculation in BPH is a predictor of the treatment outcome. Cystoscopy might be performed prior to invasive therapy to guide the urologist in choosing an operative approach.

Cystoscopy↗
PubMed1995

Transurethral resection versus incision of the prostate: a randomized, prospective study.

OBJECTIVES: To evaluate longer term effects of transurethral resection (TURP) and incision (TUIP) of the prostate in randomized patients. METHODS: In a randomized, prospective study, 120 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (estimated resectable weight less than 20 g) were assigned to TURP or TUIP. Patients were evaluated preoperatively and at intervals postoperatively as to urinary symptoms (Madsen's questionnaire), sexual function, and uroflowmetry. Overall evaluation of outcome of surgery was also assessed at follow-up visits. RESULTS: Fifty-six patients received a TURP and 61 a TUIP. Three patients refused to participate in the project after randomization, and 5 patients were lost to or excluded from follow-up. A group of 112 patients were obtainable for postoperative evaluation with a mean follow-up time of 34 months (1 to 82 months). Improvements in mean urinary peak flow rates were seen in both groups throughout the study period. The peak flow rates generally were higher (but not statistically so) in the TURP group. Postoperative irritative, obstructive, as well as total symptom scores decreased significantly at all follow-up visits after both TURP and TUIP (P < or = 0.034). Preoperatively and at all postoperative follow-up there was no statistically significant difference in irritative, obstructive, or total symptom scores between TURP and TUIP. The patients indicated an overall subjective improvement at all follow-ups in both groups, with no statistically significant difference between the treatment groups. Fifteen of 22 (68%) patients receiving TURP and 8 of 23 (35%) in the TUIP group who were sexually active before and after surgery developed postoperative retrograde ejaculation (P = 0.020). Postoperatively, 9 (16%) of the patients in the TURP and 14 (23%) in the TUIP group received further treatment for benign prostatic hyperplasia (BPH)-related infravesical obstruction. This difference was not statistically significant (P = 0.908). CONCLUSIONS: In small prostates TURP and TUIP were generally equally effective in relieving bladder outlet obstruction secondary to BPH. Most surgically treated BPH cases can be well managed by the incision technique, which is an underutilized procedure.

Adult↗
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↗
PubMed1995

Living related and unrelated donors for kidney transplantation. A 28-year experience.

OBJECTIVE: The objective of this study was to analyze a single center's 28-year experience with 1000 living donor transplants. SUMMARY BACKGROUND DATA: The number of potential renal transplant recipients far exceeds the number of cadaveric donors. For this reason, living related donors (LRDs) and, more recently, living unrelated donors (LURDs) have been used to decrease the cadaveric donor shortage. METHODS: From November 15, 1966, until August 5, 1994, 1000 living donor transplants were performed; 906 were living related and 94 were living unrelated transplants. Results were divided into precyclosporine (1966-1986, era I) and cyclosporine (1986-1994, era II) eras. Patient and graft survivals were compared between diabetic and nondiabetic recipients, between LRDs and LURDs, and according to human leukocyte antigen (HLA) matching. Donor mortality, morbidity, and postoperative renal function were also analyzed. RESULTS: The 5-, 10-, and 20-year graft survivals were 78.8%, 64.8%, and 43.4%, respectively. Patient and graft survival improved in era II (patient = 87.0% vs. 81.7%, p = 0.03; graft = 72.9% vs. 67.7%, p = 0.04). Nondiabetic patient and graft survivals were better than diabetic patient survivals in both eras. However, diabetic patient survival improved in era II (78.0% vs. 66.9%, p = 0.04). In era II, HLA-identical recipients had better graft survival than haploidentical or mismatched recipients (91.7% vs. 67.3% and 66.1%, p = 0.01). No difference between haploidentical LRDs and LURDs was seen. One donor death occurred in 1970, and 17% of donors developed postoperative complications. CONCLUSION: Living related and unrelated renal donation continues to be an important source of kidneys for patients with end-stage renal disease.

Adult↗
PubMed1995

Benign prostatic hyperplasia: pathophysiology and pharmacological treatment.

Recent studies have confirmed that alpha-blocker therapy and antihormonal therapy are effective and safe treatment modalities in patients with symptomatic benign prostatic hyperplasia. New data suggest that the clinical response to medical therapy lasts for at least 3 years without any increase in side effects during this period.

Adrenergic alpha-Antagonists↗
PubMed1995

The effect of age, ethnicity and geographical location on impotence and quality of life.

OBJECTIVE: To estimate the prevalence of impotence in men over 40 years of age and correlate impotence to age, geographical location, ethnicity and quality of life. SUBJECTS AND METHODS: While attending 'The Prostate Cancer Awareness Week' in Madison, WI, USA, New Orleans, LA, USA and New York, NY, USA, 1680 men were asked to complete a questionnaire regarding impotence, age, geographical location, ethnicity and quality of life. RESULTS: Impotence was found to be significantly associated with age, was less associated with geographical location but independent of ethnicity. Men living in Madison reported a lower potency score compared with men living in New Orleans and New York. However, potency score for men living in Madison did not appear to decline as rapidly with age when compared with men living in New Orleans and New York. Impotence and quality of life were also found to be associated even when the quality of life estimates were adjusted for age, geographical location, and age by geographical location. CONCLUSION: This study indicates that impotent men have a lower quality of life than potent men and has confirmed previous findings that age is associated with impotence. Surprisingly, answers to impotence questions were also associated with geographical location.

Adult↗
PubMed1995

Measuring disease-specific health status in men with benign prostatic hyperplasia. Measurement Committee of The American Urological Association.

In preparation for an outcomes study of benign prostatic hyperplasia (BPH), two measures of disease-specific health status were developed to supplement a symptom score and overall health status measures. The symptom problem index (SPI) captures how troublesome patients find their urinary symptoms. The BPH impact index (BII) measures how much their urinary problems affect various domains of health. A prospective revalidation of the refined instruments (N = 108 BPH patients and 50 controls) documented that both indices had good internal consistency (Cronbach's alpha = 0.88 and 0.79, respectively) and test-retest (r = 0.88 for both) reliabilities, correlated strongly with symptom scores (r = 0.86 and 0.77), and discriminated between BPH and control subjects (receiver-operating characteristic areas = 0.87 and 0.85, respectively). These indices were nearly as responsive as symptom scores in 50 men actively treated for BPH, and much more responsive than a non-disease-specific General Health Index (GHI), a Mental Health Index (MHI), and an Activity Index (AI). Finally, these measures capture most of the health status significance of BPH symptoms. In linear regression models constructed to predict scores on the GHI, MHI, and AI, symptom scores added little explanatory power to the SPI and, particularly, to the BII. These measures help clarify how BPH affects overall health status and function. Such measures have an important role to play in studies of the outcomes of treatment for BPH, and probably for other conditions that interfere with health status and function.

Adult↗
PubMed1995

Clinical manifestations of benign prostatic hyperplasia.

The clinical diagnosis of BPH is usually established after completing the initial evaluation of patients who present with symptoms of prostatism. The steps recommended in the initial evaluation include a medical history, symptom assessment using a Symptom Score Index, a digital rectal examination, a focused neurological examination, urinalysis, measurement of serum creatinine, and an optional PSA measurement. Further examinations such as uroflowmetry and cystoscopy are indicated only if the diagnosis is uncertain, or to determine the feasibility of specific invasive therapies.

Diagnosis, Differential↗
PubMed1995

Transurethral incision of the prostate.

Transurethral incision of the prostate (TUIP) is a safe and effective therapeutic modality for treating symptoms of bladder outlet obstruction in patients whose prostates have an estimated weight loss of less than 30 g. New minimal invasive techniques should be compared with TUIP instead of with transurethral resection of the prostate (TURP).

Humans↗
PubMed1995

Prostatic histology in secondary transurethral resection of the prostate.

Human benign prostatic hyperplasia consists of 3 major components, stromal and glandular tissue, and glandular lumen. To our knowledge morphometric analysis of prostatic tissue from patients who have undergone a secondary transurethral resection of the prostate has never been reported. Quantification of these histological components might aid in selecting treatment for patients with recurrent urinary symptoms following transurethral resection of the prostate. Transurethral resection specimens from 13 consecutive patients who had undergone prostatectomy twice were stained by the Masson trichrome method. Quantitative morphometric analysis was performed using computer image analyzing software. The mean total area was 15.9%, 15.4% and 68.7% for glandular lumen, and glandular and stromal areas, respectively, in the initial transurethral resection specimens and 13.3%, 14.1% and 72.6%, respectively, for secondary transurethral resection of the prostate. There was no significant difference among the 3 morphometric components in the 2 prostatectomy specimens with respect to percent area, within subject variability and skewness (all p values > or = 0.38). Our study confirms previous findings that the majority of initial transurethral resection specimens are predominantly stroma. Furthermore, our study indicates that the percent distributions between initial and secondary transurethral resection of the prostate with respect to the 3 major histological components are not different, suggesting that the stromal, glandular and glandular lumen content of an initial transurethral resection specimen is representative of the recurrent prostatic tissue.

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

Effect of age, educational status, ethnicity and geographic location on prostate symptom scores.

We evaluated the effect of patient age, educational status, ethnicity and geographic location upon the American Urological Association benign prostatic hyperplasia symptom scores. Using patients attending Prostate Cancer Awareness Week, we collected additional data on the symptom score and also on education received. A total of 2,245 records was obtained from 4 different centers. Of the population 72% were white and 13% were black. Regression analysis of patient age versus symptom score demonstrated an increase with patient age from 4.59 at age 40 years to 8.17 at age 70 years. Analysis of covariance revealed significant differences in age-adjusted scores between sites from 6.24 in New Orleans, Louisiana to 8.58 in Madison, Wisconsin. No effect was noted for education or ethnicity on symptom scores.

Adult↗
PubMed1994

Response of the isolated guinea pig bladder to exogenous and endogenous leukotrienes.

Noninfectious urinary bladder inflammation is a poorly understood phenomenon, and the participation of leukotrienes (LTs) in the pathogenesis of bladder inflammation is unclear. Leukotrienes are synthesized by the bladder, and exogenous LTs induce contraction of isolated bladder segments. LTD4 and LTC4 were more potent contractile agents than LTE4. Leukotriene-induced contractions were blocked by ICI 198,615 (10(-6) M. and 10(-7) M.) a specific LT receptor antagonist. In the presence of indomethacin (5 x 10(-6) M.), bladder contraction in response to LTD4 was increased. Endogenous LT release was studied using an experimental model of cystitis. Antigen (ovalbumin 10(-6) to 10(-2) mg./ml.) challenge of bladder segments isolated from actively sensitized animals induced release of LT, prostaglandin D2 and histamine. A-64077 (Zileuton), a 5-lipoxygenase (5-LO) inhibitor, significantly reduced contraction of sensitized bladder tissue in response to antigen challenge in a concentration-dependent manner and abolished LT release. These data indicate that the guinea pig urinary bladder produces sulfidopeptide-LTs that can be released upon specific stimulation. Furthermore, LTs activate specific receptors promoting bladder contraction. Our findings suggest that specific 5-LO inhibitors or LT-receptor antagonists might be useful in treating or preventing bladder inflammation.

Animals↗
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↗