Steen Walter

OUTCOME MEASURES FOR RESEARCH IN ADULT WOMEN WITH SYMPTOMS OF LOWER URINARY TRACT DYSFUNCTION

The purpose of this communication is to offer the clinical and research communities an initial attempt at incorporating outcome measurements within identifiable domains, as well as providing initial information as to the reliability of those measurements most commonly used. Scientific evaluation of the outcome of therapeutic interventions is based on assessment before and after treatment. However, the reliability of methods and measurements used in the evaluation is often poor or unclear, which makes interpretation of outcome difficult. The reliability of a test depends on the accuracy and reproducibility of the method. The diagnostic accuracy is determined by verifying test results against a reference (‘‘gold’’) standard that defines true disease status. The predictive value of a measure is considered the most important. Since it may be impossible to establish a final true diagnosis, reliability must in some cases be measured by reproducibility, which is determined by comparing results of repeated examinations of the same patient. 1 Reproducibility for tests where the result is given on a continuous scale may be expressed as bias with the 95% confidence limit [Bland and Altman, 1986], while for binary tests the kappa coefficient, which adjusts the observed agreement for expected chance agreement, is used [Gjørup, 1997]. Urinary incontinence is defined as ‘‘a condition in which involuntary urine loss is a social or hygienic problem and is objectively demonstrable.’’ It represents a multidimensional phenomenon with wide-reaching effects which may be quantified within various areas or domains. These areas or domains include:

Urinary Incontinence in Postmenopausal Women Treated with Estrogens

The effect of estrogens on urinary incontinence in postmenopausal women was studied in order to investigate whether estrogens could cure urge incontinence in patients without detrusor hyperreflexia an

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.

A Prospective Study of Antisperm Antibody Development in Acute Epididymitis

The association between acute epididymitis and development of antisperm antibodies was investigated by the gelatin agglutination technique in prospectively collected serum samples from 27 patients. Agglutinating antisperm antibodies, mainly of the IgG class, were detected in seven men (27 per cent), a significantly increased frequency compared to prevalences previously found among blood donors and men from infertile couples. The antibodies developed de novo in four patients (15 per cent). The increased incidence of positive sera and the kinetics of the antibody responses strongly indicate a causal link between acute epididymitis and autoimmunization against spermatozoa. In the majority of the patients the antibody titers were low, being of only theoretical importance in respect to later fertility.

DISTURBANCES of MICTURITION IN PARKINSON'S DISEASE

During the years 1970–1974, a total of 44 patients referred by neurologists to the Urological Laboratory were classified in the following groups: paralysis agitans (27), postencephalitic parkinsonism (5), cerebral arteriosclerosis and parkinsonism (7) and cerebral arteriosclerosis and parkinsonism, suspected (5). Bladder function was assessed on the basis of cystometry and urodynamic investigation. A high frequency of supranuclear bladder paresis (SNP) was found, although unequally distributed in the different diagnostic groups. Stereotactie operations on the thalamic nuclei seemed to be correlated with SNP. the question was raised whether SNP was part of the parkinsonian syndrome or merely signs and symptoms related to ageing.

Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction

The purpose of this communication is to offer the clinical and research communities an initial attempt at incorporating outcome measurements within identifiable domains, as well as providing initial information as to the reliability of those measurements most commonly used. Scientific evaluation of the outcome of therapeutic interventions is based on assessment before and after treatment. However, the reliability of methods and measurements used in the evaluation is often poor or unclear, which makes interpretation of outcome difficult. The reliability of a test depends on the accuracy and reproducibility of the method. The diagnostic accuracy is determined by verifying test results against a reference (‘‘gold’’) standard that defines true disease status. The predictive value of a measure is considered the most important. Since it may be impossible to establish a final true diagnosis, reliability must in some cases be measured by reproducibility, which is determined by comparing results of repeated examinations of the same patient.1 Reproducibility for tests where the result is given on a continuous scale may be expressed as bias with the 95% confidence limit [Bland and Altman, 1986], while for binary tests the kappa coefficient, which adjusts the observed agreement for expected chance agreement, is used [Gjorup, 1997]. Urinary incontinence is defined as ‘‘a condition in which involuntary urine loss is a social or hygienic problem and is objectively demonstrable.’’ It represents a multidimensional phenomenon with wide-reaching effects which may be quantified within various areas or domains. These areas or domains include:

Urethral electromyography using a new ring electrode.

AbstractA new ring electrode to study urethral sphincter electromyographic activity is described. The electrode can be attached to an 18F Foley catheter.

Repeated, rapid fill CO2-cystometry.

Summary114 consecutive patients were subjected to double, rapid fill CO2-cystometry. In 106 the two cystometries were of the same type, although several cystometric values changed statistically significantly. In eight patients the two cystometrograms were of a different type with uninhibited detrusor contraction in one but not in the other. A possible explanation for this is discussed.

Bladder Function in Urologically Normal Middle Aged Females: A Urodynamic and Radiological Investigation

The bladder function was studied in 15 urologically normal females over 40 years of age. They volunteered for this study which consisted of urodynamic studies and lateral micturition cystourethrography. The data are presented in tables. There are only small differences in the urodynamic parameters between this material and a material of women under 40 years of age. It is clearly demonstrated that a gynaecological cystocele tells little or nothing about the bladder function or bladder support. None of the cystometrograms showed uninhibited detrusor contractions. It is underlined to repeat the micturition studies several times in order to obtain a voiding event which the subject recognizes as normal.

Short and long term reproducibility of urethral closure pressure profile parameters

SummaryIn ten incontinent female patients the reproducibility of urethral closure pressure profile parameters obtained with the Brown and Wickham technique in two consecutive measurements and in measurements after a one month interval was assessed. Variances after one month were statistically signifiantly larger than the variances between consecutive measurements. The mean values obtained with one month interval did not differ significantly.