Mardy D. Eckhardt

PREVALENCE AND BOTHERSOMENESS OF LOWER URINARY TRACT SYMPTOMS IN BENIGN PROSTATIC HYPERPLASIA AND THEIR IMPACT ON WELL-BEING

PURPOSE We established the prevalence and bothersomeness of symptoms and their impact on well-being in a large group of strictly selected men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Included in our study were 475 consecutive men who met the criteria of the International Consensus Committee on BPH and voided more than 150 ml. during uroflowmetry. International Prostate Symptom Scores and quality of life score were determined. We included the 7 bothersomeness questions of the Symptom Problem Index and the 4 of the BPH Impact Index of the American Urological Association Measurement Committee. These questions refer to the degree of bothersomeness caused by urinary problems and how they affect various health domains. RESULTS The symptoms with the highest prevalence based on mean scores were weak urinary stream, frequency and urgency. Urgency, nocturia and hesitancy were the most bothersome symptoms. Patients were only discouraged from performing normal daily activity when the symptom index exceeded 20. Incomplete emptying and frequency bothersomeness correlated strongly, and weak urinary stream and hesitancy bothersomeness correlated weakly with all health and quality of life domains. CONCLUSIONS Weak urinary stream, frequency and urgency were the most prevalent symptoms, while urgency, nocturia and hesitancy were the most bothersome symptoms. In contrast to weak urinary stream and hesitancy, the bothersomeness of incomplete emptying and frequency was strongly associated with well-being.

Correlations of Urodynamic Changes With Changes in Symptoms and Well-being After Transurethral Resection of the Prostate

PURPOSE To establish the predictive value of urodynamics on the outcome of transurethral prostate resection for benign prostatic enlargement we correlated urodynamic changes with symptomatic improvement, decreased bother, and increased general well-being and quality of life after transurethral prostate resection. MATERIALS AND METHODS Men with lower urinary tract symptoms were selected if they met study criteria and underwent tests recommended by the International Scientific Committee on Benign Prostatic Hyperplasia, and if post-void residual urine volume and prostate size were estimated. Patients answered quality of life, symptom index, symptom problem index and benign prostatic hyperplasia impact index questions. Patients also underwent urodynamic evaluation. Men were included in analysis when transurethral prostate resection was selected as the treatment modality. Of the 132 patients included 93 were reevaluated 6 months after transurethral prostate resection. RESULTS Improvements after transurethral prostate resection were significantly associated with decreased bladder outlet obstruction (p <0.01). However, 32 cases that were unobstructed or equivocal preoperatively also benefited moderately from resection. Effective capacity, that is cystometric capacity minus post-void residual urine volume, increased by an average of 45% postoperatively. The increase in effective capacity contributed to a significant decrease in symptoms and bother, and to improved well-being. Of the men with a urodynamically proved stable bladder 90% maintained a stable bladder after prostatectomy, while in 50% with a urodynamically proved unstable bladder it became stable postoperatively. CONCLUSIONS Performing urodynamics preoperatively helps to predict the degree of symptom relief, decreased bother and increased well-being after transurethral prostate resection.

ONE 24-HOUR FREQUENCY-VOLUME CHART IN A WOMAN WITH OBJECTIVE URINARY MOTOR URGE INCONTINENCE IS SUFFICIENT

OBJECTIVES To determine whether one 24-hour frequency-volume (FV) chart in a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits. METHODS Retrospectively, women 18 years old and older with urodynamically confirmed urinary motor urge incontinence without neurologic disease or other urologic pathologic findings, who correctly completed two or three 24-hour FV charts during normal daily life, were studied. For each patient, we compared the voiding parameters (mean voided volume, diuria, nocturia, minimum and maximum voided volumes, and total voided volume) and fluid intake calculated from the first FV chart with the same data calculated from all the FV charts. RESULTS Ninety-eight adult women were recruited. A marked dropout occurred, and 60 patients remained to be evaluated (mean age 54.5 +/- 15.5 years). The calculated voiding parameters agreed with those in published reports. Strong associations existed between all voiding parameters and fluid intake calculated from the first FV chart and those calculated from all FV charts (P <0.001 for all parameters). Compared with the well-known variability, the differences between the voiding parameters calculated from the first FV chart and those from all charts were small. These results agreed with studies in other patient groups (benign prostatic hyperplasia and interstitial cystitis) that analyzed the use of only one 24-hour FV chart. CONCLUSIONS The use of only one 24-hour FV chart completed during normal daily life by a woman with objective urinary motor urge incontinence is sufficient to gain insight into her voiding habits.

Analysis and reliability of data from 24-hour frequency-volume charts in men with lower urinary tract symptoms due to benign prostatic hyperplasia

Objectives: The aims of this study were to analyse the data from frequency–volume charts and to study the reliability of these charts in men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).Methods: Males with LUTS due to BPH were consecutively included in the study if they met the criteria of the International Consensus Committee on BPH, voided more than 150 ml during uroflowmetry, residual volume and prostate size were estimated and frequency–volume charts were completed correctly. From the frequency–volume charts, voiding habits and fluid intake were evaluated.Results: 160 patients could be included. Another 28 patients who met all other criteria did not complete the frequency–volume charts correctly. Agreement exists between reported voided volumes in the literature and those found by us. We found a significant correlation (p<0.001) between nycturia and score on symptom question 7, and between diuria and score on symptom question 2 of the AUA symptom index. The difference between results obtained from frequency–volume charts completed during 24 h and those obtained from charts completed during three or more 24–hour periods was negligible with respect to the variation of data at an individual level.Conclusion: Frequency–volume charts are reliable in the investigation of patients with LUTS due to BPH. Reporting on frequency–volume charts during just 24 h is sufficient to gain insight into their voiding habits during normal daily life.

A Randomized Controlled Trial Comparing Transurethral Resection of the Prostate, Contact Laser Prostatectomy and Electrovaporization in Men with Benign Prostatic Hyperplasia: Urodynamic Effects

PURPOSE We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Schäfer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Schäfer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Schäfer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.

Urethral resistance factor (URA) versus Schäfer's obstruction grade and abrams–griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia

Different methods of analyzing pressure/flow plots to quantify bladder outlet resistance in men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) were developed in the past. The aims of this study were to quantify the degree of agreement between the diagnosis of obstruction by the different methods, and to compare the applicability of the different methods in the evaluation of bladder outflow conditions, in a large group of these men. In consecutive men with LUTS basic initial evaluations, recommended diagnostic tests, and urodynamic investigations were performed. From pressure/flow studies, the group‐specific resistance factor (URA), Schäfers obstruction grade, and Abrams–Griffiths (AG) number were estimated. Men with 21 cm H2O≤URA≤29 cm H2O and men with Schäfers grade equal 2 were classified as equivocal. In conformity with the provisional ICS definition, men with 20≤AG number≤40 were classified as equivocal. In 78% of the 565 included men Schäfers classification agreed with URA classification. In 82% ICS classification agreed with URA classification. Most agreement (94%) existed between Schäfers classification and ICS classification. All differences were near the points of intersection of the different boundaries, and a decision whether to perform surgery on a patient is not likely to be influenced by this disagreement. Males with relatively low detrusor pressure at maximum flow and relatively low maximum flow had a high prevalence among those in whom URA and Schäfers classifications and among those in whom URA and ICS classifications differed. Neurourol. Urodynam. 20:175–185, 2001.

Data from frequency-volume charts versus symptom scores and quality of life score in men with lower urinary tract symptoms due to benign prostatic hyperplasia.

Objective: The aim is to study the relations between reported data on frequency–volume charts and the American Urological Association (AUA) symptom scores and quality of life score. Methods: Males with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH), were consecutively included in the study if they met the criteria of the International Consensus Committee on BPH, they voided >150 ml during uroflowmetry, residual volume and prostate size were estimated and frequency–volume charts were completed correctly. From the frequency–volume charts, voiding habits and fluid intake in the daytime and at night were evaluated. Results: In the included 160 men no correlation was found between total urine production at night or in the daytime and symptom index or quality of life score. Nycturia was correlated with symptom index, but surprisingly not with quality of life score. Small voided volumes at night and in daytime are attended by high symptom index and high quality of life score (= low quality of life). Diuria has a high impact on symptom index and quality of life score. Men who completed frequency–volume charts during 3 or more daytime periods (68%) had a significantly higher symptom index than those who completed only 1 or 2 daytime periods (32%). Conclusions: High diuria, and small voided volumes at night and in daytime contribute significantly to high symptoms and low quality of life. Nycturia correlated with AUA symptom index but surprisingly not with quality of life score.

Laser- and electrosurgery as a treatment modality of BPH: urodynamic evaluation of seven different techniques in 280 patients

Laser treatment of the prostate as an alternative for transurethral resection of the prostate (TURP) has evolved from a complicated troublesome procedure to a single office procedure. In this study, we compared the efficacy of different electrosurgical and laser techniques. The data of seven prospective studies in 280 patients were evaluated. The patients were treated for bladder outlet obstruction due to benign prostatic hyperplasia during the period from 1992 until 1998. Five procedures were offered using Nd:YAG laser light, including ultrasound-guided free beam, a free beam technique applying either a predetermined energy dose or a visually-guided energy does, contact laser prostatectomy and a hybrid method where free beam coagulation was followed by contact laser. Two procedures were offered using electrosurgery comprising transurethral resection and transurethral electrovaporization. The clinical outcome was assessed pre-operatively and 6 months post-operatively by free flowmetry, post-void residual, and Shaeffer obstruction grade. Results after 6 months are shown in the table below.