Matti Kontturi

Postoperative Urinary Retention: I. Incidence and Predisposing Factors

198 (3.8% comprising 4.7% of the males and 2.9% of the females) out of 5220 surgical patients developed total urinary retention postoperatively. The frequency of this condition increased with age and was highest after thoracotomies and endoprosthetic surgery of the hip joints. Voiding history was abnormal in 80% of the patients affected. Subclinical obstructive bladder dysfunction, over-distension of the bladder during the operation and in the recovery room after the operation, sympathomimetic and anticholinergic medication during or after anaesthesia, and an inability to stand or sit after surgery were common causes of retention. Premedication, type of anaesthesia, nature of the liquids given and postoperative analgetics seemed not to affect the incidence of retention. Postoperative urinary retention is an underestimated and mostly avoidable complication. Every patient should be asked for a urinary history before an elective operation. Infravesical obstruction should be relieved before any other elective surgical procedures are undertaken. In cases of emergency surgery prophylactic catheterization to prevent postoperative retention is recommended for patients with obstructive symptoms.

Gene expression and prostate specificity of human prostatic acid phosphatase (PAP): evaluation by RNA blot analyses

A fragment of a complementary DNA (cDNA) clone for human prostatic acid phosphatase (PAP) (EC 3.1.3.2.) was used to study the expression of corresponding mRNA in human tissues. The specificity of its expression in benign prostatic hyperplasia (BPH) and prostatic carcinoma tissues were indicated in RNA blot analyses. The PAPcDNA probe did not recognize any specific mRNAs in RNAs extracted from human liver cancer, lung cancer, pancreatic cancer, placenta, breast cancer cells (MCF-7), mononuclear blood cells or acute promyelocytic leukemia cells (HL-60), according to Northern blot analysis. mRNA for PAP was detected in the androgen-dependent human prostatic cancer cell line LNCaP, but not in the androgen-insensitive human prostatic cancer cell line PC-3. In contrast, lysosomal acid phosphatase (LAP) mRNA was detected in both of these human prostatic cancer cell lines. Our findings indicate a high specificity for the PAP gene in prostatic tissue. The mean abundance for the PAPmRNA expression was 0.26 for prostatic carcinoma samples (n = 11) and 0.46 for BPH samples (n = 8) according to slot-blot analysis. The differences observed between the different categories of prostatic tissue in PAPmRNA abundances call for additional studies on regulation of its expression.

SERUM STEROIDS IN NORMAL MALES AND PATIENTS WITH PROSTATIC DISEASES

The subjects investigated comprised 57 normal males between 30 and 80 years of age; 40 patients between 50 and 80 years of age suffering from benign prostatic hypertrophy (BPH), and 11 untreated prostatic carcinoma (Ca) patients aged between 57 and 79 years. Serum concentrations of oestradiol, pregnenolone, progesterone, 17α‐hydroxyprogesterone, androstenedione, testosterone, 5α‐dihydrotestosterone and androsterone were determined from a single serum sample (1.6 ml). Oestradiol was determined by an automated non‐chromatographic radioimmunoassay, while other steroids were determined by radioimmunoassays, after solvent extraction and chromatographic purification on Lipidex‐5000(tm) microcolumns. When patient groups were compared with the 25 normal males between 50 and 80 years of age, several conclusions could be drawn. Serum concentrations of 5α‐dihydrotestosterone (P < 0.01) and 17α‐hydroxyprogesterone (P < 0.001) were both significantly higher in the BPH patients when compared with the normal males. This trend was also apparent in the serum concentrations of progesterone and testosterone in the older BPH patients. Although the mean concentrations of 5α‐dihydrotestosterone and 17α‐hydroxyprogesterone were slightly higher in carcinoma patients than normal males, these differences were not statistically significant. No differences were seen in the concentrations of pregnenolone, androstenedione, androsterone and oestradiol between normal subjects and patients with BPH or prostatic Ca.

Postoperative urinary retention. II. Micturition problems after the first catheterization.

198 out of 5220 surgical patients were catheterized because of unexpected postoperative urinary retention. In 39% of cases micturition succeeded after the first catheterization of the overdistended bladder, but 61% (58% of the males and 66% of the females) developed more copolicated voided problems. The volume of fluids given intravenously during anaesthesia, the volume of primary urinary retention and increasing age were predisposing factors for prolonged micturition difficulties. Hospitalization was protracted because of postoperative urinary retention in 21 patients, and for 20 males prostatic surgery was necessary to relieve persistent retention.

Late Urodynamic Findings After Surgery for Cauda Equina Syndrome Caused by a Prolapsed Lumbar Intervertebral Disk

Bladder function was evaluated urodynamically in 17 patients operated on 2 to 3 years previously for the cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. Of the patients 10 (59 per cent) reported the bladder function to be normal, while the other 7 had symptoms of obstruction or incontinence. Urodynamic findings were normal in 4 patients (24 per cent). In 3 patients (18 per cent) no detrusor contraction could be demonstrated in the pressure-flow electromyography study. Two patients (12 per cent) used the detrusor and straining during voiding. Cystometry showed an unstable detrusor in 3 patients (18 per cent). The remaining 5 patients (29 per cent) had either an increased bladder capacity or a decreased maximum flow rate. Neurological findings were normal in 2 patients (12 per cent). All of the patients with a decentralized detrusor had defective perianal sensation but detrusor contraction could be demonstrated in 3 who also had sensory impairment in the perianal region. Bladder function can be disturbed seriously in cauda equina patients without symptoms and, thus, all patients with the cauda equina syndrome should be tested urodynamically. An emergency operation seems to be capable of reducing late disturbances in bladder function. Regeneration of the autonomous nerves supplying the bladder and genitals may require an interval of several months to years.

Urodynamics in Radical Retropubic Prostatectomy

Urodynamic examinations were performed on 19 patients undergoing radical retropubic prostatectomy for localized prostatic carcinoma. Altogether 16 urodynamic parameters were analyzed preoperatively and 6 months afterwards. There was a significant decrease in bladder wall compliance and an increase in intravesical and abdominal pressure at maximum flow rate postoperatively. These findings may reflect a partial bladder decentralization caused by surgery. The amount of residual urine was reduced postoperatively. Two patients (10.5%) were totally incontinent, and in both the postoperative urethral closure pressures were low.

Urodynamic Effects of Finasteride in the Treatment of Bladder Outlet Obstruction due to Benign Prostatic Hyperplasia

Urodynamic effects of the 5-alpha-reductase inhibitor, finasteride, were studied in the treatment of patients with bladder outlet obstruction due to benign prostatic hyperplasia (BPH). A total of 36 patients was randomly assigned in a double-bind manner to receive either 5 mg. finasteride daily (19) or placebo (17) for 6 months. The possible relief of bladder outlet obstruction was monitored with uroflowmetry and repeated urodynamics. The mean flow rate, detrusor opening pressure, detrusor pressure at maximum flow and maximum detrusor pressure improved significantly in the patients treated with finasteride. There were no significant differences in the improvement of symptom score or peak flow rate, or in the reduction of residual urine between the finasteride and placebo groups. The treatment resulted in 30% average decrease in prostatic size and 46% decrease in prostate specific antigen concentration. The efficacy of finasteride in relief of bladder outlet obstruction caused by BPH seems to be of the same degree as that achieved by chemical castration therapy but without any significant side effects. There were wide variations among BPH patient response to finasteride treatment. Further studies are needed to define the responders who benefit from this treatment.

BLADDER NECK INCISION OR TRANSURETHRAL ELECTRORESECTION FOR THE TREATMENT OF URINARY OBSTRUCTION CAUSED BY A SMALL BENIGN PROSTATE? A Randomized Urodynamic Study

Transurethral electroresection of the prostate (TURP) was compared with bladder neck incision (BNI) in the treatment of 24 patients with urinary obstruction caused by a small benign prostate. An evaluation of the urodynamic findings and subjective symptoms was undertaken before the operation and 6 months afterwards. Thirteen patients underwent TURP and 11 BNI. All patients except one in the BNI group subjectively considered the result good. The urodynamic evaluation showed that the detrusor pressure at maximum flow rate decreased more in the TURP group than in the BNI group and the urethral pressure profile was shorter after the operation. The maximum flow rates after the operation were similar in both groups. Retrograde ejaculation developed in 62% of the patients after TURP but none after BNI. BNI is recommended for men under 60 years with minimal prostatic hypertrophy and with an active sexual life.

Screening for carcinoma of the prostate rectal examination, and enzymatic and radioimmunologic measurements of serum acid phosphatase compared

Veterans (n = 771, 54–76 years of age) from the Second World War, who attended a rehabilitation program arranged by the state between the years 1979 and 1983, were screened for prostatic cancer by rectal examination of the prostate and by measurement of serum prostate‐specific acid phosphatase (PAP) concentration and enzyme activity (total and tartrate‐labile). Nine cases with prostatic cancer confirmed by needle biopsy were found. Serum PAP concentrations were elevated in five of the nine cancer patients and rectal examination was positive in six of them, whereas the serum PAP concentration was elevated and rectal examination was positive simultaneously only in two patients. Serum PAP concentrations were elevated in 25 patients without prostatic cancer, and rectal palpation of the prostate resulted in 21 false‐positive findings. The enzyme activity of serum acid phosphatase was not elevated in any of the nine patients diagnosed as having prostatic cancer. The predictive value of a positive finding in serum PAP concentration (16.7%) or rectal palpation of the prostate (22.2%) in this unselected, asymptomatic population was similar and low. Both tests together gave additive information.

Treatment of Penile Incarceration by the String Method: 2 Case Reports

We report 2 cases of penile incarceration in a 10-year-old boy and a 40-year-old man. In both cases the penis was encircled by a metallic object. The string method described was successful, rapid, atraumatic and simple to use.