P. Mogensen

Urodynamics in prostatism. I: Prognostic value of uroflowmetry

A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design included selection of patients for prostatic surgery by means of classic non-urodynamic urologic investigations such as history, residual urine, serum creatinine, cystoscopy and possibly intravenous urography. In addition an extensive urodynamic work-up (uroflowmetry, cystometry and pressure-flow study with stop-test) was included. The results of the urodynamic studies were unknown to the surgeon selecting the patients for operation. This evaluation was repeated 6 months postoperatively. Totally 139 patients entered the study. The patients were classified according to the preoperative maximum flow rate (Qmax) and in spite of preoperative differences in uroflow, pressure-flow variables and symptom scores, no differences of clinical significance were noted postoperatively among the groups. However, the high-flow group (preoperative Qmax greater than or equal to 15 ml/sec) had a statistically significant lower success rate as judged by the patients subjective evaluation of the outcome of surgery. An analysis of diagnostic sensitivity and specificity indicated Qmax = 15 ml/sec as a relevant cut-off value regarding preoperative identification of patients at risk of a less favourable outcome of surgery. This group of patients was characterised by a higher incidence of persistent uninhibited detrusor contractions at follow-up and a lower incidence of preoperative infravesical obstruction. In conclusion we recommend uroflowmetry in the preoperative evaluation of patients with prostatism.

ESTRAMUSTINE PHOSPHATE VERSUS PLACEBO AS SECOND LINE TREATMENT AFTER ORCHIECTOMY IN PATIENTS WITH METASTATIC PROSTATE CANCER: DAPROCA STUDY 9002

PURPOSE We compared the effect of 560 mg. estramustine phosphate daily to placebo as a supplement to standard palliative therapy in patients with progressive disease after bilateral orchiectomy as first line therapy for metastatic prostate cancer. MATERIALS AND METHODS In a double-blind multicenter study 131 patients with progressing metastatic hormone refractory prostate cancer were randomized to receive 280 mg. estramustine phosphate 2 times daily versus placebo. End points were clinical progression and death. Adverse events, decrease in prostate specific antigen (PSA) and subjective response were also assessed. RESULTS Adverse events were common in both groups but breast tenderness/gynecomastia and diarrhea were more frequent among patients in the estramustine phosphate group. Subjective responses were few (9 of 50 estramustine phosphate and 4 of 57 placebo cases, p = 0.15). Median observation time for survival was 43 months and 124 patients died. Median time to subjective progression and median overall survival did not differ significantly between the 2 groups at 4.6 and 9.4 months in the estramustine phosphate group versus 5.0 and 6.1 months in the placebo group. Of 61 patients in the estramustine phosphate group 29 achieved a reduction in PSA of more than 25% at 1 month of followup compared to only 3 of 68 receiving placebo. A decrease in PSA after 1 month correlated significantly with survival. CONCLUSIONS Although this study did not prove estramustine phosphate to be superior to placebo in terms of protocol end points, it generates the hypothesis that prolonged survival may be achieved with estramustine phosphate treatment in a subgroup of patients and that this may be predicted by a decrease in PSA after 1 month of therapy.

Some Clinical Aspects of Uroflowmetry in Elderly Males: A Population Survey

A random sample of 200 males aged 50 years or more was selected from the National Register in order to investigate various aspects of spontaneous uroflowmetry and to estimate the frequency of prostatism and symptoms of lower urinary tract dysfunction. All in all the data from 112 persons were analysed. The prevalence of prostatism was found to be 17% (95% confidence limits 11-26%), while 88% (95% confidence limits 83-95%) experienced various degrees of symptoms. Only few associations between single symptoms and uroflowmetry variables were demonstrated. However, statistically significant correlations were revealed between obstructive and total symptom scores on one hand and maximum and average flow rates on the other hand. As the correlations were modest and a considerable overlap of uroflow variables in persons with and without prostatism were proved, the diagnostic specificity and sensitivity of maximum flow rate as well as other uroflow variables were low in the screening for prostatism. In conclusion uroflowmetry appears inefficient to confirm a clinical impression of prostatism.

Reproducibility of uroflowmetry variables in elderly males

SummaryIn the evaluation of prostatism urodynamics and especially uroflowmetry has received widespread attention. Review of the literature, however, revealed little information on the consistency of flow variables. Therefore eleven male volunteers above fifty years of age were asked to void five times during a short period of time. Each subject was found to reproduce his own flow curve fairly well. Statistical analysis of various flow variables, i.a. Q1s, Qmax, volume-corrected Qmax, Qmax time, Qave and volume voided, demonstrated a high degree of reproducibility. In conclusion a single flow curve is sufficient for clinical routine on the assumption that the patient declares the voiding to be typical.

Extracorporeal Shock Wave Lithotripsy of a Kidney Stone Complicated with Candida albicans Septicaemia and Endophthalmitis

Following a routine extracorporeal shock wave lithotripsy of a kidney stone, candida septicaemia and eight days later candida endophthalmitis developed.

Significance of Predominantly Irritative Symptomatology Before a Prostatic Operation

The prognostic value of an excess of preoperative irritative symptoms of prostatism was evaluated. The prospective study included 139 men treated for benign prostatic hyperplasia who were evaluated by symptom analysis, uroflowmetry, water cystometry and pressure-flow study preoperatively and 6 months postoperatively. The criterion for evaluation of postoperative success or failure was the subjective evaluation of the patient at 6 months. None of the single preoperative symptoms of prostatism predicted an eventual postoperative failure, nor did the preoperative predominance of irritative symptoms or the combination of irritative symptoms and detrusor instability attain prognostic significance.

LHRH analogue as a depot preparation (Zoladex) in the treatment of advanced carcinoma of the prostate followed by orchiectomy as a second line therapy--a phase II study.

An LHRH agonist, Zoladex, was employed as a monthly depot in 56 previously untreated patients with advanced carcinoma of the prostate. Of 53 evaluable patients, 27 achieved partial remission and 7 were stable. Median duration of response was 10 months. A favorable subjective response was attained in 68% of the patients. During treatment, serum testosterone was in the castrate range in all patients except five. Possible explanations for this escape phenomenon are discussed. No toxicity was observed and treatment was well tolerated in all patients. Thirty-two patients underwent bilateral orchiectomy following treatment failure of Zoladex. In one patient partial remission according to protocol criteria was recorded. Treatment with LHRH agonists seems safe and may serve as an alternative to conventional hormonal treatment of advanced carcinoma of the prostate.

The Significance of Digital Subtraction Angiography (Dsa) Before Operative Treatment of Hypernephroma in a Horseshoe Kidney

A case of hypernephroma in a horseshoe kidney is reported in a patient with total situs inversus organorum. The diagnostic procedures are discussed, and the significance of digital subtraction angiography for both diagnosis and treatment is emphasized, as the presentation of the arterial and venous supplies is of great value for guidance in the surgical intervention, particularly when congenital malformations are present.