Cai Frimodt-Møller

Prevalence of Carcinoma in Situ and other Histopathological Abnormalities in Testes of Men with a History of Cryptorchidism

The incidence of invasive testicular cancer is increased in men with a history of cryptorchidism. Previous studies based on relatively small series indicated that the risk of carcinoma in situ of the testis also is increased in these men. In our study 500 consecutive men 20 to 30 years old, who were previously admitted to a department of surgery with the diagnosis of testicular maldescent, were asked to participate in a screening for carcinoma in situ of the testis. Of the men 300 consented to testicular biopsy. The biopsies were evaluated by light microscopy for carcinoma in situ and other histopathological abnormalities. Carcinoma in situ was diagnosed in 5 patients (1.7%, 95% confidence limits 0.5 to 3.9%). However, the true risk of carcinoma in situ might be higher, since 2 men who had been treated for testicular cancer before they were offered biopsy were excluded from the study. Advanced spermatogenesis, including the spermatid stage in all tubules, was found in biopsy specimens from only 37% of the men. In 80% of these specimens even the number of late spermatids was decreased. Thus, our study, based on a large number of testicular biopsies from an unselected group of men with testicular maldescent, provided further evidence that these men have an increased risk for carcinoma in situ of the testis. Our data combined with the results of other Scandinavian studies indicate that the true prevalence of carcinoma in situ in men with a history of cryptorchidism is approximately 2 to 3%. Additionally, we confirmed that spermatogenic function is severely impaired in maldescended gonads. Invasive testicular cancer can be prevented if the neoplasm is detected at the stage of carcinoma in situ. In our opinion the magnitude of prevalence of carcinoma in situ found in men with a history of cryptorchidism justifies that these men should be offered testicular biopsy when they reach adulthood.

Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-"BPH" study

Despite the lack of evidence in the literature for close relationships between lower urinary tract symptoms and bladder outlet obstruction, the majority of urologists rely on symptomatology when selecting patients for prostatic surgery. We investigated the relationships between a wide range of lower urinary tract symptoms from the ICSmale questionnaire and the results of urodynamic pressure and flow studies. We evaluated 933 patients with lower urinary tract symptoms suggestive for bladder outlet obstruction from 12 countries who participated in the ICS‐“BPH” study with the ICSmale questionnaire and urodynamic pressure and flow studies. Spearman rank correlation coefficients were obtained between symptoms and measures of bladder outlet obstruction. There was little or no correlation between a wide range of symptoms and the results of free uroflowmetry and pressure and flow studies. From symptoms alone, it is not possible to diagnose bladder outlet obstruction. Pressure and flow studies and symptom profiles measure different aspects of the clinical condition that should be viewed separately in the evaluation and treatment decision of the patient presenting with lower urinary tract symptoms. Neurourol. Urodynam. 17:99–108, 1998.

The effects of a new serotonin receptor antagonist (ketanserin) on lower urinary tract function in patients with prostatism.

Ten male patients with prostatism, median age 63 years (range 50 to 70 years) were given an intravenous injection of a new serotonin antagonist, ketanserin, at a dose of 10 mg., and were investigated urodynamically before and after injection. A statistically significant increase in maximum and mean flow rates and a statistically significant decrease in urethral pressure profile measurements was observed. Supine CO2 cystometry showed no significant decrease in volumes of first sensation and bladder capacity. No subjective side effects were registered, but we observed a statistically significant decrease in mean blood pressure of 6.5 mm. Hg (range 5 to 14 mm. Hg). The mechanism behind the beneficial effect of ketanserin on micturition in prostatism is not yet known, but the results could explain an alpha blocking effect of the drug.

Changes in Symptoms and Colpo-Cystourethrography in 35 Patients before and after Total Abdominal Hysterectomy: A Prospective Study

35 women, referred for simple total hysterectomy, were evaluated pre- and postoperatively for bladder suspension and urodynamic changes. Although all patients denied urological problems, more than half of the patients had some degree of stress and/or urge incontinence. 40% had radiological signs of bladder suspension defects. At postoperative examination the symptomatology of incontinence had declined but the radiological pathologic findings had increased. On this basis it may be concluded that it is unpredictable what happens to the bladder and its suspension following simple hysterectomy.

Long-term results of the Stamey bladder-neck suspension procedure and of the Burch colposuspension

This retrospective study compares the long-term results of the Stamey bladder-neck suspension and the Burch colposuspension following operation for urinary incontinence in women. A total of 182 women underwent operation for urinary incontinence: 83 by Stamey bladder-neck suspension and 99 by Burch colposuspension. The case records were perused and questionnaires were sent to the 169 women who were still alive: 129 women had no previous operation for urinary incontinence. At follow-up in this group a median of 7 years after the operation, 32% were completely continent and 39% had improved after the Stamey method, as against 33% and 29%, respectively, after Burch (p > 0.05). The Stamey operation was associated with a lower complication rate (12%) and a lower rate of re-operation (16%) than the Burch operation (23% and 22%, respectively) (p > 0.05). Previous incontinence surgery and mixed type of incontinence was associated with poor outcome in the Stamey group.

Uroflow in women: An overview and suggestions for the future

The literature on uroflowmetry in women is presented and evaluated. Uroflowmeters are described and found generally sufficiently accurate, although the errors arising from electronic evaluation may invalidate the test. Six flow curve patterns are proposed in accordance with described pathological conditions. From the literature it is summarized that the normal Qmax is 20–36 ml/s. Qmax is linearly correlated to the voided volume, increasing by 5.6 ml/s/100 ml. Pregnancy, age and menstrual cycle do not influence Qmax. Several pathological conditions have been associated with specific flow curve patterns. These conditions are described and associations with the proposed flow definitions made.

The Effect of Buserelin Versus Conventional Antiandrogenic Treatment in Patients with T2-4NXM1 Prostatic Cancer: A Prospective, Randomized Multicentre Phase III Trial

A prospective, randomized multicentre phase III trial was undertaken to compare the effectiveness and safety of Buserelin, a gonadotropin-releasing hormone analogue (GnRHa), with conventional antiandrogenic treatment in patients with painful metastases from T2-4NXM1 prostatic cancer. Seventy-two patients received Buserelin, 22 received estrogens and 46 were subjected to orchiectomy. The trial was completed one year after allocation of the patients. No significant differences as regards suppression of testosterone or survival were found in favour of one of the three treatment modalities. The performance index improved significantly both during the first months of treatment with Buserelin and following orchiectomy. No detectable improvement of performance index was seen during treatment with estrogens. Treatment with estrogens also failed to alleviate pain or general symptoms of cancer. Tolerability, safety and compliance of Buserelin was although administered intranasally clearly evidenced as palliation of advanced symptomatic cancer and the efficacy and sideeffects were fully comparable to those following orchiectomy.

Inter- and intra-observer variation of colpo-cysto-urethrography diagnoses

To evaluate the reliability of diagnosing type of bladder suspension defect in incontinent women by means of voiding colpo‐cysto‐urethrography (CCU), 93 CCU‐series with exposures at rest, coughing, withholding and voiding were diagnosed. Three senior and one junior radiologists, a gynecologist and a urologist diagnosed the CCU‐series twice with 3‐6 months interval. The main diagnostic possibilities were anterior bladder suspension defects, posterior defects and normal, which were in accordance with general practice of choosing an abdominal suspension operation for the anterior suspension defects and a vaginal operation for the posterior defects. The intra‐observer agreement varied between 99% and 72%, i.e. 1/5 to 1/ 4 of the patients changed from one main diagnostic group to another at the two examinations. The inter‐observer agreement varied between 43% and 60%. Information of clinical patient data, given to the two clinicians, did not change their CCU‐diagnoses significantly. We concluded, that CCU should not be recommended as a routine for evaluation of type of suspension defect since the intra‐inter‐observer variation was around 25% and 50% respectively. CCU might still be useful preoperatively in selected cases, since it gives an excellent visualisation of bladder base anatomy.

Intravesical Pressure Changes during Bladder Drainage in Patients with Acute Urinary Retention

Using a transurethral approach intravesical pressure and blood pressure were recorded in 10 males with acute urinary retention during either continuous or fractionated drainage. Upon evacuation of the initial 100 cm3 urine the intravesical pressure declined to approximately 50% of the initial value in both groups relieving pain in all patients. Blood pressure was significantly lowered following the procedure, but clinical manifestations were absent. One patient demonstrated hematuria, but treatment was not necessary. The study renders no support for previous recommendations of fractionated outlet of urine in this condition.

Voiding Disturbances following Anal Surgery

Voiding disturbances following anal surgery are a well known but often ignored condition. Thirty-seven patients were investigated before and after operation for hemorrhoids by uroflowmetry and measurement of residual urine. Sixteen patients showed a decreased peak flow after operation, 13 patients had residual urine of more than 100 ml and 5 patients developed urinary retention. Five of the 13 patients complained of stranguria, incontinence, nocturia and frequency during the following months. We suggest that patients with urological problems after anal surgery should have their bladder controlled at regular intervals.