T. Dørflinger

3-Year Followup of Urinary Symptoms after Transurethral Resection of the Prostate

A total of 84 patients underwent detailed symptom analysis and urodynamic study preoperatively, and 3 and 12 months after transurethral resection of the prostate. In addition, 69 patients were contacted 3 years postoperatively for a detailed symptom analysis. These 3-year data then were compared to earlier evaluations. At 3 years 75 per cent of the patients claimed to have improvement, while 13 per cent stated that they were the same symptomatically. At the 1-year evaluation 84 per cent of the patients believed that they were improved and 10 per cent stated that they were unchanged. At 3 years 18 per cent of the patients had urge incontinence (an increase from 6 per cent at 1 year), while none complained of marked nocturia or frequency. Mean total irritative and obstructive symptoms were minimal and unchanged from the 1-year evaluation. Of the patients 33 per cent noticed decreased or absent erections and most blamed the surgery. One patient required another prostatic resection, while stricture developed in 3 and bladder neck contracture occurred in 6. We conclude that prostatic resection results in reasonable 3-year symptomatic improvement but it is hampered by other complications, including bladder neck contracture and, possibly, impotence.

Urodynamic and histological correlates of benign prostatic hyperplasia.

The tissue obtained from transurethral prostatectomies was evaluated histologically and correlated to the clinical findings in 81 patients with benign prostatic hyperplasia. A median of 9 hematoxylin and eosin-stained tissue slides per patient were examined, each containing from 1 to 15 curettings. The patients were divided into 3 groups according to the following histology: predominantly stromal hyperplasia (39 patients), predominantly glandular hyperplasia (29 patients), and equal proportions of stromal and glandular hyperplasia (mixed group, 19 patients). There was no significant difference among the groups in patient age and duration of symptoms. The weight of resected tissue was significantly lower in the stromal group (median 16 mg.), compared to the glandular group (median 20 gm.) and the mixed group (median 25 gm.). Additionally, 29 of the 81 patients had chronic inflammation characterized by multifocal infiltrates of lymphocytes. These patients had significantly larger prostates (median 25 gm.) compared to those without lymphocytic infiltration (median 15 gm.). Sixty-five patients had a 3-month followup examination. Preoperatively there was no difference among the groups in maximum flow at uroflowmetry but at 3-month followup the stromal group had a median maximum flow of 13 ml. per second compared to 16.8 ml. per second in the glandular group and 21.5 ml. per second in the mixed group. These findings document histologically what has been reported from a clinical perspective: the clinical prostatism/benign prostatic hyperplasia complex is a spectrum of histological entities, and the small prostate with predominantly stromal hyperplasia responds less favorably to transurethral resection as determined by urodynamic evaluation.

The Significance of Uninhibited Detrusor Contractions in Prostatism

In an attempt to identify preoperatively patients who will not benefit from prostatectomy, 84 patients with prostatism about to undergo transurethral resection of the prostate were evaluated prospectively with preoperative and postoperative symptom analysis and urodynamic examination, including cystometrograms. Of the patients 67 were followed at 3 months and 54 again at 12 months. Preoperatively, 65 per cent of the patients had uninhibited detrusor contractions, while 38 had persistent postoperative uninhibited detrusor contractions at 3 months. Patients in whom uninhibited detrusor contractions persisted postoperatively more often had unacceptable postoperative symptoms. Of the patients 13 per cent believed the symptoms to be the same or worse at 3 and 12 months. The incidence of uninhibited detrusor contractions in these patients was 57 and 71 per cent, respectively. While this finding suggests that persistent postoperative uninhibited detrusor contractions are associated with an unfavorable surgical outcome, we could not predict which patients would have uninhibited detrusor contractions following prostatectomy by use of preoperative cystometric findings together with detailed symptom analysis. Thus, we failed to define a role for preoperative cystometric screening of patients with prostatism.

AMS malleable penile prosthesis

The American Medical Systems (AMS) malleable penile prosthesis was implanted in 57 patients from January, 1983 to 1985. Fifty-one per cent of the procedures were performed under local anesthesia, and 28 per cent in ambulatory (day) surgery. The prosthesis was evaluated in terms of cosmetic result, patient satisfaction and function, and postoperative complications. Ninety-one per cent of patients were satisfied with their decision to select the malleable prosthesis, and 66 per cent reported no difficulty with concealment. A comparison is made with data available from the alternative Jonas malleable prosthesis.

Predictive value of low maximum flow rate in benign prostatic hyperplasia

Among 84 patients with prostatism selected for transurethral resection of the prostate, 18 had a maximum flow at spontaneous uroflowmetry less than or equal to 7 ml/sec. Preoperatively there was no significant difference between patients with maximum flow less than or equal to 7 ml/sec (Group 1) and patients with maximum flow greater than 7 ml/sec (Group 2) in age, duration of symptoms, symptom scores, bladder volume, residual urine, and detrusor pressure at maximum flow. Patients in Group 1, however, had significantly lower urethral resistance and bladder volume independent maximum flow than patients in Group 2. Postoperatively, patients with preoperative maximum flow less than or equal to 7 ml/sec improved significantly in symptom scores and urodynamic findings apart from bladder volume and detrusor pressure at maximum flow. There were no significant differences between groups in postoperative symptom scores or urodynamic findings. We conclude that preoperative maximum flow rates less than or equal to 7 ml/sec at spontaneous uroflowmetry were related to high urethral resistance and not detrusor decompensation among patients with prostatism, and that patients with maximum flow rates less than or equal to 7 ml/sec fared as well postoperatively as patients with maximum flow greater than 7 ml/sec.

The Influence of Various Body Fluids and pH on E. Coli MIC of Quinolone Derivatives

Great efforts have been made to treat chronic bacterial prostatitis but the results have been disappointing, possibly due to poor drug penetration in the prostate (9, 10).

Candicidin in Treatment of Benign Prostatic Hypertrophy

In a prospective, double-blind, placebo-controlled multicenter study, candicidin (a polyene macrolide) was investigated in the treatment of benign prostatic hypertrophy. Seventy-six patients were included in the study--34 in the candicidin group and 42 in the placebo group. Patients treated with 270 mg. of candicidin daily for 6 months had a significant decrease in residual urine, voided volume and bladder volume. No significant increases were found in flow rates. Symptoms improved significantly in both the candicidin and the placebo group, but no differences in improvement were found between the groups. The results of candicidin treatment are less satisfactory than those following surgery.