Jens T. Andersen

Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia

OBJECTIVES A pooled analysis of all available randomized trials with 2-year follow-up data with finasteride and placebo was undertaken to further investigate recent observations that finasteride use may reduce the occurrence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH)-related surgical intervention. METHODS Occurrences of AUR and surgical intervention were examined by treatment group in a pooled series of 4222 men with moderately symptomatic BPH. RESULTS In total, 81 occurrences of AUR were reported, 24 (1.1%) of 2113 in the finasteride group and 57 (2.7%) of 2109 in the placebo group. The hazard ratio was consistent in all three studies, with a 57% decrease in the hazard rate for occurrence of AUR with finasteride compared with that for placebo present in the pooled data set over the 2-year study period (P < 0.001). Additionally, 227 surgical interventions were recorded over the 2-year study period, 89 (4.2%) of 2113 in the finasteride group and 138 (6.5%) of 2109 in the placebo group. The hazard ratio was consistent across the three studies, with a 34% reduction in the hazard rate for occurrence of surgery with finasteride compared with that for placebo (P < 0.002). Overall, there was 35% reduction in the two BPH-related end points (ie, AUR or surgery). CONCLUSIONS Treatment with finasteride for up to 2 years more than halves the frequency of AUR and reduces surgical intervention by over one third relative to placebo in patients with moderate BPH. This is the first demonstration that long-term medical therapy can reduce clinically significant end points such as AUR or surgery, and these data have important implications for the long-term management of patients with BPH.

Fracture risk in Danish men with prostate cancer : a nationwide register study

This section opens with a nationwide Danish study on the risk of fractures in prostate cancer, as well as assessing the impact of exposure to androgen deprivation. The authors found that there was a marked increase in the risk of fractures, especially of the hip.

Abnormalities of bladder innervation in diabetes mellitus

Electrophysiologic evaluation of the neural pathways involved in bladder and urethral function is described in 30 patients with diabetes mellitus. The study showed decreased conduction velocities in patients with the detrusor reflex as well as in detrusor areflexia. The findings indicated that diabetic vesical dysfunction is principally the result of segmental demyelination in the peripheral nerve supply to the detrusor muscle and urethra.

The Syndrome of Detrusor-Sphincter Dyssynergia

The syndrome of detrusor-sphincter dyssynergia is described in a series of patients with a variety of neurological diseases. Bladder function studies using cystometry, sphincter electromyography and electromyelography revealed that sphincter dyssynergia may be associated with detrusor hyperreflexia as well as detrusor areflexia. Impaired function of the pyramidal tracts was documented in all patients and the majority showed impaired segmental innervation of the bladder and urethra.

Cystometric, Sphincter and Electromyelographic Abnormalities in Parkinson’s Disease

Bladder function was studied in 24 patients with a diagnosis of parkinsonism using cystometry, sphincter electromyography, flowmetry and electromyelography. A high incidence of disturbances in detrusor function and sphincter control was documented and the signal tracing studies showed prolonged conduction times, giving evidence of peripheral neuropathy. The abnormalities of detrusor function were ascribed to the lesion of the basal ganglia, whereas the sphincter disturbances indicate impairment of the corticospinal tract as a result of Parkinsons disease.

Neurogenic bladder dysfunction in protruded lumbar disk and after laminectomy

Bladder and urethral innervation was studied in 18 patients with protruded lumbar disk or persistent back pain after laminectomy. A high incidence of neurogenic dysfunction of the detrusor muscle was found, whereas impaired function of the striated external urethral sphincter was rare. The lesions were encountered among the patients with protruded lumbar disk as well as among the patients with sequelae after laminectomy, suggesting that neurogenic bladder dysfunction in cauda equina injury due to protruded disk is often irreversible.

Early Detection of Diabetic Visceral Neuropathy: An Electrophysiologic Study of Bladder and Urethral Innervation

The segmental and supraspinal innervation of the detrusor muscle and periurethral striated musculature was studied in 27 patients with diabetes mellitus by gas cystometry, integrated sphincter electromyography, and spinal evoked-response latency measurements. Slowing of neural conduction velocities was a consistent finding in all the patients, even when cystometry did not show abnormalities. Thus, neuropathy in the segmental innervation of the bladder and urethra was documented.

Chlamydia Trachomatis in Acute Epididymitis

The etiology of acute epididymitis was studied in 52 patients. Infection with Chlamydia trachomatis was demonstrated by culture or serology in 13 patients. In men under the age of 25 C. trachomatis was associated with 7 out of 9 cases of epididymitis, in contrast to none of the 19 cases in men above 35. Culture from the urethra is probably sufficient in diagnosing infection with C. trachomatis in patients with acute epididymitis, since only one patient with a negative urethral culture had a chlamydia-positive aspirate from the epididymis. Half of the cases of epididymitis in men above the age of 35 years were associated with urinary tract infection. One patient was infected with N. gonorrhoeae and one had tuberculosis of the epididymis.

Cystometry: detrusor reflex activation, classification and terminology.

Changes in the concept of neural organization for micturition and the use of high flow gas cystometers have altered the performance of clinical cystometry and test interpretation. Detrusor reflex activation procedures in carbon dioxide cystometry include rapid bladder distension, change in postural states, use of bethanechol, urethral and anal distension, and sleep. Sleep cystometry requires the use of electroencephalography. These procedures have permitted specific delineation of the syndrome of detrusor reflex instability. Test interpretation is based upon detection of the presence of detrusor reflex instability or end organ denervation.

Postural Detrusor Hyperreflexia

Postural changes in bladder function have been documented previously only in female incontinent patients without evidence of neurologic or urologic disease. In our study the syndrome of postural hyperreflexia is described in patients of both sexes having a variety of neurological disorders. The investigations showed impaired function of supraspinal control of the sacral micturition center.