Jens Thorup Andersen

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.

Detrusor Hyperreflexia in Benign Infravesical Obstruction. A Cystometric Study

Cystometry was performed on 94 consecutive patients with benign prostatic hypertrophy or bladder neck obstruction, 45 per cent of whom had detrusor hyperreflexia. Of those cases with detrusor hyperreflexia 21 patients were re-examined 6 months postoperatively and 62 per cent of them had regained normal bladder function. The underlying pathophysiologyand the clinical aspects are discussed.

Bladder Function in Healthy Elderly Males

Bladder function was studied in 20 healthy elderly male volunteers using cystometry, uroflowmetry and voiding cystourethrography. Two persons were excluded from the study as neurological examination had shown evidence of organic neurological disease, and one person did not complete the study. 53% of the remaining 17 persons had detrusor hyperreflexia. Urinary flow rates were reduced and maximal intravesical pressures elevated in the persons studied, although they claimed to have a normal voiding pattern. No correlation was found between the reduction of urinary flow rate respectively increase in maximal intravesical pressure and the presence of detrusor hyperreflexia. The high incidence of detrusor reflex disturbances thus suggests that incipient infravesical obstruction in old age and possible subclinical impairment of the central nervous control of the micturition reflex are major etiological factors in detrusor hyperreflexia.

Symptoms and Signs Predictive of the Voiding Pattern After Acute Urinary Retention in Men

Over a 9-month period 228 men were admitted for acute urinary retention to six different casualty wards in the Copenhagen area. The patients were followed in the corresponding urological departments for one year. Twenty-seven variables were registered for each patient. The cumulative rate of recurrent retention was 56% after one week and 68% after one year. Factors predictive of preserved voiding ability were a retained volume less than 500 ml, a known event provocative of acute retention, and a maximum flow rate of more than 5 ml/s after the retention. The maximum flow rate measured within the first week after the retention was reliable within the follow-up period if the voided volume was 150 ml or more. The etiology of the acute retention was infravesical obstruction in 90% of the patients, and 85% required subsequent surgical treatment. Predictive of surgical treatment for infravesical obstruction were recurrent urinary retention within one week, a volume of retention of more than 500 ml, the absence of a provocative situation prior to the retention episode and nocturia twice or more.

Stress urinary incontinence in postmenopausal women treated with oral estrogen (estriol) and an alpha-adrenoceptor-stimulating agent (phenylpropanolamine): A randomized double-blind placebo-controlled study

Twenty-eight postmenopausal women with objectively verified stress incontinence completed a randomized double-blind placebo-controlled study. After an initial 4 weeks of placebo treatment the patients received either oral estriol (E3) (4mg daily) or oral phenylpropanolamine (PPA) (50 mg b.i.d.) alone for 4 weeks, followed by another 4 weeks of treatment with the two active drugs in combination.Subjectively, 14 of 15 patients preferred PPA to placebo (P<0.001), 9 of 12 patients preferred E3 to placebo (P=0.011), and 10 of 14 patients preferred E3 + PPA to E3 (P=0.006). Two patients became continent on PPA, 2 on E3, and 12 of 28 patients on combined treatment. PPA gave a significant decrease in urine loss when compared with placebo (P=0.023), and the combined treatment of PPA + E3 also gave a reduction in urine loss when compared with placebo (P=0.022). It is concluded that estriol 4mg daily and PPA 50 mg b.i.d. are effective in the treatment of stress urinary incontinence in postmenopausal women. The enhanced effect of combined treatment is moderate and of questionable importance.

The Intraprostatic Spiral: A New Device for Insertion with the Patient Under Local Anesthesia and with Ultrasonic Guidance with 3 Months of Followup

Acute or chronic urinary retention (median retention volume 1,000 ml.) was relieved successfully in 41 of 45 consecutive patients by insertion of an intraprostatic spiral with the patient under local anesthesia and with ultrasonic guidance. Insertion guided by ultrasound was successful in 35 patients (77 per cent). In 6 patients the spiral was inserted via the traditional endoscopic technique. During 3 months of followup the spiral remained in situ in 27 patients and in 6 it was repositioned. These 33 patients had free voiding with a median maximum flow rate of 13.6 ml. per second. Residual urine volume 1 month after insertion of the spiral was low (median 27 ml.). In 8 patients the spiral was removed during the observation period due to urinary incontinence or retention. The intraprostatic spiral is a favorable alternative to an indwelling catheter in patients awaiting an operation and in those with a high operative risk.

High flow infravesical obstruction in men: symptomatology, urodynamics and the results of surgery.

High flow infravesical obstruction in male patients with severe prostatism is defined by a maximum flow rate of more than 15 ml. per second and a vesical pressure exceeding 100 cm. water at maximum flow rate. During a 9-month period urodynamic screening of 225 patients referred to our hospital with prostatism revealed high flow infravesical obstruction in 16 (7 per cent). Transurethral surgery of the prostate or bladder neck was performed in 11 of the patients, with good results observed in symptomatology as well as in maximum flow rate. A urodynamic screening program is suggested to establish the diagnosis so that these patients can benefit from surgical treatment.

Disturbances of ano-rectal function in multiple sclerosis.

Thirty patients with multiple sclerosis (MS) [18 men and 12 women, mean age 40 years (range 22–50), disease duration 12 years (range 0.5–34), Kurtzkes Expanded Disability Status Score 6.0 (range 4.0–7.5)] were interviewed about bowel symptoms and studied using ano-rectal manometry. The results were compared with findings in healthy controls. Twenty-eight had bowel symptoms: 8 constipation, 10 constipation and infrequent faecal urgency, 4 infrequent faecal incontinence and 6 frequent faecal incontinence. Anal sphincter pressure at rest was significantly reduced in MS patients 69 (SD 17) cm H2O, compared with 92 (SD 15) cm H2O in controls, and the external sphincter contraction force was also significantly reduced. Rectal sensation and rectal compliance were reduced and the ano-rectal inhibition reflex (defaecation reflex) required a higher rectal pressure to be elicited in the patients. Upon rectal filling, an early external sphincter excitation was seen. The presence of faecal incontinence correlated strongly with reduced rectal sensation. The findings suggest that faecal incontinence can at least partly be explained by low anal sphincter pressure and poor rectal sensation. The findings of early sphincter excitation and increased threshold of ano-rectal inhibition reflex may be an important pathophysiological factor for constipation in MS patients.

Acute Urinary Retention in Women: A Prospective Study of 18 Consecutive Cases

Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.

Prophylactic antibiotics in first-trimester abortions: A clinical, controlled trial

The efficacy of prophylactic antibiotic therapy in induced first-trimester abortions was investigated in a double-blind study. Of the 493 women in the study, 254 received doses of 2 million IU of penicillin G intramuscularly one-half hour before and 3 hours after the procedure, followed by 350 mg of pivampicillin three times daily for 4 days, and 239 women received corresponding doses of placebo. The incidence of pelvic infectious complications was 5.5% in the treated group and 10.9% in the control group (p = 0.05). The difference could be attributed to a selective prophylactic effect in women who had earlier suffered from pelvic inflammatory disease (N = 105). The rate of infection in this group was 22.4% among those receiving placebo and 2.1% among those receiving antibiotics (p = 0.006). Prophylactic administration of antibiotics for first-trimester abortions should be used in women who have earlier had pelvic inflammatory disease.