J. Nordling

Prostatism. I. The correlation between symptoms, cystometric and urodynamic findings.

One hundred and seven consecutive patients referred with symptoms of bladder outlet obstruction were studied using cystometry and combined pressure-flow-electromyographic investigation. The symptoms of infravesical obstruction were not statistically significantly correlated to the hydrodynamic documentation of increased bladder outlet resistance as judged by maximum flow rate and the calculated urethral resistance. Irritative symptoms such as frequency, nocturia, urgency and urgeincontinence were statistically significantly correlated to the presence of detrusor hyperreflexia. The functional disorder bladder neck dyssynergia was encounterd in 5% of the patients (95% confidence limits 1-10%). This diagnosis cannot be made by conventional urological investigations. It is concluded that objective demonstration of infravesical obstruction is mandatory in the selection of patients with symptoms of lower urinary tract dysfunction for surgery on the prostate or the bladder neck.

Standardized Evaluation of Erectile Dysfunction in 95 Consecutive Patients

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.

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.

The Intraprostatic Spiral: Clinical Results In 150 Consecutive Patients

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.

Prostatism: II. The Correlation between Cysto-urethroscopic, Cystometric and Urodynamic Findings

The cysto-urethroscopic findings in 93 out of 107 consecutive patients referred for symptoms of bladder outlet obstruction were assessed and graded with special reference to bladder wall trabeculation, patency of the bladder neck, prostatic occlusion of the urethra, the estimated prostatic weight and the bladder neck-verumontanum distance. The cysto-urethroscopic findings of trabeculation and prostatic enlargement were not statistically significantly correlated to the cystometric demonstration of detrusor hyperreflexia. However, urodynamic parameters of infravesical obstruction judged by the opening pressure, maximum flow rate and the calculated urethral resistance were statistically significantly correlated to the cysto-urethroscopic findings of prostatic occlusion of the urethra, increased bladder neck-verumontanum distance and an increased prostatic weight estimated at cystoscopy. It is concluded that cysto-urethroscopy gives good information of as well the site as the hydrodynamic severity of organic infravesical obstruction.

Consensus statement: the role of prostate-specific antigen in managing the patient with benign prostatic hyperplasia.

G. BARTSCH, J.M. FITZPATRICK*, J.A. SCHALKEN†, J. ISAACS‡, J. NORDLING¶ and C.G. ROEHRBORN§ Department of Urology, University of Innsbruck, Austria; *University College Dublin, Mater Hospital, Dublin, Ireland; †Department of Urology, University of Nijmegen, the Netherlands; ‡Johns Hopkins Oncology Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; ¶Department of Urology, Herlev Hospital, University of Copenhagen, Denmark; §Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA

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.

A prospective, controlled, randomized study of the effect of a slow‐release silver device on the frequency of urinary tract infection in newly catheterized patients

Objective To test the effect on urinary tract infections (UTIs) in patients needing continuous indwelling catheterization, of a newly designed urine‐collecting system containing an antibacterial device which slowly releases silver ions onto the inner surface of the system.