H. H. Meyhoff

A New Patient Weighted Symptom Score System (DAN-PSS-1): Clinical Assessment of Indications and Outcomes of Transurethral Prostatectomy for Uncomplicated Benign Prostatic Hyperplasia

A patient weighted symptom score system, the Danish Prostatic Symptom Score (DAN-PSS-1), including a disease specific self administered quality of life questionnaire, is presented. The model was evaluated pre- and postoperatively in 29 patients apparently suffering from uncomplicated benign prostatic hyperplasia. The score system is based on the severity of 12 symptoms related to bladder storage and voiding function, and three questions related to sexual function (symptom score). For each of these parameters the patient must also evaluate its influence on his daily life (bother score). In the 29 patients with uncomplicated benign prostatic hyperplasia (BPH) bother scores exceeded symptom scores for the irritative symptoms but not for the obstructive symptoms, and surprisingly the symptom score was less improved than the bother score 6 months after transurethral resection of the prostate (TUR-P). Furthermore the postvoiding dribble was worsened after the operation. We find that this model, DAN-PSS-1, assists in creating a solid base for the indication for and the evaluation of treatment of uncomplicated BPH.

Are Doctors Able to Assess Prostatic Size

The between-observer variation was evaluated through three independent estimates of preoperative prostatic weight in each of 40 patients. Error in the estimates was of considerable magnitude irrespective of size of prostates. Experienced urologists did not attain a more reliable estimate than unexperienced doctors. Only about 2/3 of estimates were correct within a range of +/- 25 g. However, there was a statistically significant correlation between estimated and actual operative prostatic weight.

Long Term Results of Transurethral and Transvesical Prostatectomy: A Randomized Study

The long term result of transurethral (TURP) versus transvesical (TVP) prostatectomy was evaluated in a randomized study of 75 patients with clinically benign, medium sized, obstructive prostatic hyperplasia. Follow-up investigation including evaluation of symptoms and urinary flow rate was undertaken every 6 months the first 2 years as well as 5 years postoperatively. Thirteen patients died during follow-up. However, the remaining 64 patients were representative for the total series of patients. More than 90% in both groups had a satisfactory subjective result throughout follow-up. A significant and persistent relief in obstructive and irritative symptoms were seen in both groups. Nocturia was the predominant follow-up symptom being present in more than 50% of the patients 5 years postoperatively. During observation a slight decrease in sexual activity and retrograde ejaculation was reported by TVP and TURP patients. About 25% of the patients in both groups with benign histology had secondary operations during follow-up. Maximum as well as average flow rate values remained stable throughout the period of observation with small differences between the two groups. The incidence of urinary tract infections was reduced significantly by the surgical procedures. Only minor and clinically insignificant differences were observed between the results of the two operative procedures.

Urodynamic Evaluation of Transurethral Versus Transvesical Prostatectomy: A Randomized Study

In a randomized study of transurethral prostatectomy (TURP) versus transvesical prostatectomy (TVP) in 75 patients a urodynamic evaluation was undertaken before and 6 months following operation. In the TURP group a resection to the surgical capsule was attempted in each case. Operative specimen weights in the two groups did not differ statistically significantly. 5 patients in each group had unexpected prostatic carcinoma. Rapid fill CO2 cystometry did not show any significant differences in bladder function between TURP and TVP patients 6 months following operation. In both groups a high incidence of detrusor instability was observed at follow-up. However, the incidence as well as the severity of the instability had decreased significantly following the two operative procedures. As judged from flowmetry and pressure flow investigation, relief of infravesical obstruction was almost complete in both groups. However, following treatment of postoperative strictures the patients with benign histology in the TVP group compared to the TURP group had higher maximum flow rate values and lower detrusor pressure values. Confidence limits for the differences between the two groups in detrusor pressure and maximum flow rate at follow-up did, however, hardly suggest clinically significantly differences. At urethral closure pressure profile measurement a statistically significantly shorter profile length was measured in TVP patients. The marginal differences in relief or infravesical obstruction might be due to differences in the amount of apical prostatic adenoma following operation.

Accuracy in preoperative estimation of prostatic size. A comparative evaluation of rectal palpation, intravenous pyelography, urethral closure pressure profile recording and cystourethroscopy.

In a prospective study of 75 patients with prostatic hypertrophy a comparison was undertaken of the accuracy in estimates of operative prostatic weight from conventional preoperative investigations. Estimates from rectal digital palpation alone and from intravenous pyelography (prostatic impression, elevation of the bladder base as well as the configuration of distal ureters) were without significant correlation to operative weights, and were not found useful for preoperative estimation of prostatic size. Prostatic length in urethral closure pressure profile measurements as well as the distance from bladder neck to verumontanum and the weight estimated at cystourethroscopy were statistically significantly correlated to operative weights with a coefficient of correlation in the order of 0.5 and were judged useful, although not very precise in the clinical work.

Retroperitoneal Fibrosis Treated with Methylprednisolon Pulse and Disease-Modifying Antirheumatic Drugs

The conventional treatment of patients with ureteric obstruction due to retroperitoneal fibrosis (RF) is surgery in combination with long-term corticosteroids. This report describes 11 cases of RF with ureteric obstruction treated with methyl-prednisolon pulse therapy (MPPT) in combination with azathioprine or penicillamine following initial insertion of ureteral stents. The medial treatment suggested was successful in 7 patients, but only moderately effective in the last 4 patients. This principle of non-operative management of RF has not been previously reported.

Sympatholytic effect on striated urethral sphincter. A peripheral or central nervous system effect

Effects of intravenous administration of sympatholytic drugs on urethral pressure and electromyographic activity from urethral and anal sphincter, were investigated in five normal women. Clonidine (Catapresan), which easily passes the blood brain barrier, resulted in a pronounced decrease in urethral pressure and electromyographic activity from both sphincters. Phentolamine (Regitine), which does not pass the blood brain barrier, also lowered urethral pressure but had no effect on electromyographic activity from the sphincters. Neither drug depressed reflex induced increase in urethral pressure and sphincter activity during bladder filling or during voluntary contraction of the pelvic floor muscles. Phenoxybenzamine administration to one normal female had the same effect as clonidine. It is suggested that part of the clinical effect on voiding disorders seen after treatment with sympatholytic drugs passing the blood brain barrier (e.g. phenoxybenzamine) might be due to an effect on the central part of the striated urethral sphincter innervation.

Estrogen receptors in the human male bladder, prostatic urethra, and prostate. An immunohistochemical and biochemical study

The distribution and quantity of estrogen receptors (ERs) in the human male bladder, prostatic urethra and the prostate were studied in eight males with recurrent papillomas of the bladder or monosymptomatic hematuria (median age 61 years), 14 men undergoing transurethral resection due to benign prostatic hyperplasia (median age 70 years), and nine men undergoing cystectomy due to malignant tumour of the bladder (median age 70 years). In the first group of patients, biopsies for immunohistochemical examination were obtained from the bladder vault, bottom, both side-walls, the trigone area, and the mid-portion of the prostatic urethra, and in the second group from three locations of the prostatic urethra (bladder neck, mid-portion and veramontanum). In the third group, tissue specimens were taken from the vault of the bladder, prostatic urethra, and the prostate, for immunohistochemical as well as biochemical analysis. In the first group, ERs were found in three out of eight specimens of the prostatic urethra, and in one of these, ERs were confined to periurethral glands. ERs could not be demonstrated in any of the bladder-biopsies. In the second group, ERs were not found in the bladder neck, but were seen in four preparations from the veramontanum and in two from the midportion of the urethra. ERs were located in the urothelium and periurethral glands. In the third group, ERs were seen immunohistochemically in the prostatic urethra (two cases) and the prostatic stromal tissue (two cases). ERs could be demonstrated in the bladder neither by immunohistochemistry nor biochemically.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Urethral electromyography using a new ring electrode.

AbstractA new ring electrode to study urethral sphincter electromyographic activity is described. The electrode can be attached to an 18F Foley catheter.