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Roger S Kirby

Publications and source records attributed to Roger S Kirby.

At least 19 recordsLinked to original sources
PubMed2006

Diabetes and the urologist: a growing problem.

The incidence of diabetes continues to increase dramatically; this incidence is predominantly of the type-2 form which clusters together with other comorbidities of hypertension and lipid abnormalities, to form the metabolic syndrome. These conditions will have an increasing impact on urological practice, with erectile dysfunction, hypogonadism, voiding difficulties and urinary tract infections all more common in these patients. These symptoms might be the initial presentation of previously undiagnosed diabetes and it is important to recognise this condition early to avoid later complications including end-stage renal failure.

Adult↗
PubMed2006

Beneficial effects of extended-release doxazosin and doxazosin standard on sexual health.

The prevalence of benign prostatic hypertrophy (BPH) and erectile dysfunction (ED) both increase with age, and increasing evidence suggests a common cause rather than independent age-related changes. Arterial hypertension often accompanies these urological disorders, suggesting the possibility that increased alpha-adrenoceptor activity may be causal in all three conditions. As evidence for this model, alpha-adrenoceptor antagonists such as doxazosin produce therapeutically beneficial effects in lowering blood pressure, reducing prostate growth and BPH symptoms, and relieving ED. At postjunctional alpha(1)-receptors in the corpus cavernosa, noradrenaline causes vascular smooth muscle cell contraction, restricting blood flow, resulting in penile detumescence. Just as alpha-adrenoceptor antagonism results in systemic vasorelaxation to lower blood pressure, the same mechanism in the penis modulates the effects of noradrenaline to favour vasodilatation, resulting in improved erectile function. Increasing clinical evidence attests to the effectiveness of doxazosin in relieving ED, even in patients refractory to ED-specific treatment, as well as in reducing BPH symptoms and elevated blood pressure.

Adrenergic alpha-Antagonists↗
PubMed2006

Management of acute urinary retention.

Acute urinary retention (AUR) is a common urological emergency, characterized by a sudden and painful inability to pass urine. There is high variability within and among countries in its management, which can be explained not only by differences in access to care but also by a lack of harmonization and consensus on the best way to proceed. Immediate treatment consists of bladder decompression, usually by a urethral catheter, although a suprapubic catheter offers several advantages not often exploited by urologists. Until recently, secondary management consisted almost exclusively of prostatic surgery within a few days (emergency surgery) or a few weeks (elective surgery) after a first AUR episode. The greater morbidity and mortality associated with emergency surgery, and the potential morbidity associated with prolonged catheterization, has led to the increasing use of a trial without catheter; this involves catheter removal after 1-3 days, allowing the patient to void in 23-40% of cases, and surgery, if needed, at a later stage. Alpha1-adrenergic blockers given before catheter removal improve the chances of success. A high prostate-specific antigen level and postvoid residual urine volume, and response to alfuzosin treatment after a first AUR episode managed conservatively, may help to identify patients at risk of an unfavourable outcome.

Adrenergic alpha-Antagonists↗
PubMed2006

Prostate-specific antigen testing in hypogonadism: implications for the safety of testosterone-replacement therapy.

Hypogonadal men have lower prostate volumes and serum prostate-specific antigen (PSA) levels than age-matched controls. When present, prostate cancer in hypogonadal men is more aggressive than in eugonadal men, and given the lack of specificity of PSA for diagnosing prostate cancer, a more accurate test would be desirable in hypogonadal men. Once testosterone-replacement therapy is started in hypogonadal men, PSA levels should be measured regularly; however, there is often an initial rise 3-6 months after starting treatment. A rise of >0.5 ng/mL within this time requires further investigation.

Aged↗
PubMed2005

Fact or fiction: what do the benign prostatic hyperplasia data tell us?

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm in men. Our understanding of this condition has improved greatly over the years and recent advances have changed our approach to management. At the end of the 19th century, prostatic enlargement was treated effectively by bilateral orchidectomy. Unsurprisingly, this treatment option never gained widespread popularity. Less than 10 years ago, surgery and watchful waiting were the only considered treatment options for BPH. We now have a number of medical therapies and minimally invasive treatment options available that can effectively manage lower urinary tract symptoms secondary to benign prostatic obstruction. However, with increased choice comes the increased need for clarity in selection and application of these various treatment options. In the current environment of evidence-based clinical practice, awareness and interpretation of data from the numerous studies is paramount. The lessons learned from these trials should be reflected clearly in our practice, with clinical management based on fact, not fiction. In this review, we critically assess the available data and understanding of the management of BPH.

Algorithms↗
PubMed2005

Efficacy of extended-release doxazosin and doxazosin standard in patients with concomitant benign prostatic hyperplasia and sexual dysfunction.

OBJECTIVE: To report a comprehensive retrospective analysis of the favourable effects of doxazosin extended-release (XL) and doxazosin standard on the sexual health of patients with comorbid benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), augmenting a previous study of 680 patients with symptomatic BPH. PATIENTS AND METHODS: Men with BPH and aged 50-80 years participated in a randomized, double- blind, double-dummy, parallel-group, multicentre trial, completing a 2-week, single-blind, placebo run-in period before receiving doxazosin XL 4 or 8 mg once daily or doxazosin standard 1-8 mg once daily for 13 weeks. Baseline sexual function and changes from baseline after treatment with doxazosin were evaluated from responses of the International Index of Erectile Function (IIEF) questionnaire (with dysfunction defined as a score of < or = 3 for any question) and the five domains for erectile function (intercourse satisfaction, orgasmic function, sexual desire and overall sexual satisfaction). RESULTS: Of 680 patients randomized into the trial, 237 (35%) had ED at baseline; in these patients there were statistically and clinically significant improvements in each of the five IIEF domains with XL and standard doxazosin (P < or = 0.0019), with the range of improvement being from 13% to 41%. There were no significant differences between treatment groups. Doxazosin XL consistently improved sexual function, as assessed by the individual questions of the IIEF questionnaire. There was no statistically significant difference between groups for any sexual function question analysed. CONCLUSION: Doxazosin XL and standard improved sexual function in men with concomitant BPH and ED at baseline. This may represent an action independent of relieving lower urinary tract symptoms, because the beneficial effect of doxazosin was reported in patients with no symptomatic BPH.

Adrenergic alpha-Antagonists↗
PubMed2005

Acute urinary retention: what is the impact on patients' quality of life?

OBJECTIVE: To evaluate the impact of admission for acute urinary retention (AUR) on patients' health-related quality of life (HRQoL) compared with that on admission for elective surgery for benign prostatic hyperplasia (BPH) and emergency admission for renal colic (RC). PATIENTS AND METHODS: Over a 2-year period, three groups of men were recruited from one institution: group 1, men aged >50 years presenting to the accident and emergency (A&E) department with AUR; group 2, for comparison, men aged >50 years admitted for elective surgery for BPH; and group 3, men aged >40 years presenting to A&E with RC. A self-completed HRQoL questionnaire was administered at five visits (72 h from admission, and 1, 2, 3 and 6 months afterward) over a 6-month follow-up. RESULTS: Group 1 reported mean pain scores on admission of 7.7, compared with 5.6 for group 2 and 8.3 for group 3. Patients in group 1 had the most investigations and recurrent attendance to A&E throughout the study, compared with almost none for the other two groups. There was a substantial economic burden for group 1; 15% had extra help at home at a mean cost of 403 UK pounds for the duration of the study. For the other domains assessed (e.g. emotions, mental state, general health) groups 1 and 2 were similar. CONCLUSIONS: An episode of AUR has a measurable impact on patients' HRQoL, which often occurs in the community and therefore may not be appreciated by the urology team providing their care. Further work is therefore required to improve the "patient journey" for those with AUR, and to prevent patients developing AUR in the future.

Absenteeism↗