ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15859.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—The rationale for selective alpha1blockade in benign prostatic hyperplasia (BPH) is based upon the observations that the prostate adenoma contains between 20% and 40% smooth muscle and the contractile properties of prostatic smooth muscle are mediated by the alpha1adrenoceptor. Terazosin is a selective alpha1adrenoceptor antagonist that is currently under clinical investigation for the treatment of clinical BPH. The United States experience with this drug is reviewed in the present report. The outcome measures used to assess the efficacy of terazosin in BPH includes Boyarsky symptom scores and uroflowmetry. The total Boyarsky symptom score decreased 55% and the peak urinary flow increased 47% following terazosin therapy in the cumulative open‐label and single‐blind studies. Three hundred and thirteen subjects with clinical BPH were randomised into a phase III double‐blind parallel‐group 3‐month placebo‐controlled study of once‐a‐day administration of terazosin. The total Boyarsky symptom score decreased 43% and 21% in the 10 mg and placebo treatment groups, respectively. The peak urinary flow increased 37% and 12% in the 10 mg and placebo‐treated groups, respectively. The adverse events associated with terazosin were relatively minor and reversible. The United States experience has unequivocally demonstrated the short‐term safety and efficacy of terazosin therapy in BPH. Studies are currently under way to determine the long‐term safety and efficacy associated with t

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15860.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—Selective renal biopsy under ultrasonic guidance has been used widely because it provides safe and accurate tissue sampling. Using this technique, we biopsied 36 renal tumours and obtained specimens in 35 cases. Histology of the biopsy coincided with that of the surgical specimen in 18/21 cases. Dissemination of tumour cells, thought to have been caused by needle biopsy and/or surgical manipulation, was observed in only 1 case of sarcoma. The method thus proved effective in determining treatment and it is suggested that it should be used in accordance with the criteria which we have devise

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15654.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—This randomised, placebo‐controlled, double‐blind study was performed to evaluate the efficacy and safety of once‐a‐day terazosin (10 mg/d) in ambulatory patients (n = 57) with benign prostatic hyperplasia (BPH). After a 4‐week placebo lead‐in and a 24‐week treatment period with terazosin (with both phases being single‐blind), 30 patients who responded to terazosin were randomly assigned to either the terazosin or placebo treatment group for 12 weeks. During the single‐blind treatment period, the peak urine flow rate increased 54% from a baseline average of 7.76 ml/s to 11.92 ml/s after terazosin administration; the mean flow rate increased 55% from a baseline of 4.90 ml/s to 7.59 ml/s; and the residual volume decreased 56% from 93. 1 ml to 40.7 ml. The mean obstructive symptom score, irritative symptom score and physician global assessment score improved by 68%, 34% and 27%, respectively. All these changes were significant when compared with baseline values.During the double‐blind period, the improvement in all the variables was sustained in the terazosin group but not in the placebo group. Peak and mean urinary flow rates, and physician assessment showed significant differences at the end of the double‐blind period. Adverse events occurred only during the single‐blind period. The most frequently experienced events were headache (n = 6), asthenia (n = 3) and hypotension (n = 3).A follow‐up study that initially included 12 patients showed no significant loss of improvement in symptoms and no change in urodynamic parameters with the 5 mg terazosin dose at 1 year. At 2 years, the 9 remaining patients showed sustained improvement an

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15861.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—Vaginal ultrasonography has been advocated as an alternative to videocystourethrography. Ultrasound avoids the potential risks of X‐rays and reduces the cost of equipment. We have investigated the effect of the vaginal probe on the physiology of the bladder and urethra. A series of 24 women underwent urethral pressure profilometry, with and without a vaginal probein situ.There was a significant increase in maximum urethral pressure, functional urethral length and area under the profile curve both at rest and during stress in the presence of the device. This was due to stretching and compression of the urethra by the probe. Transmission pressure ratios were significantly increased for the first 3 quartiles of the urethra.Twenty women underwent lateral bead chain urethrocystography with and without a vaginal probe. At rest, the probe resulted in elevation of the bladder neck and apposition to the symphysis pubis, and during a Valsalva manoeuvre the descent of the bladder neck was restricted by the presence of the probe. These results indicate that a vaginal probe alters the position and function of the lower urinary tract. We postulate that incontinence is reduced as a result of the probe. The use of vaginal ultrasonography in the assessment of women with urinary incontinence is therefore not recommen

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15655.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—The dynamic component of bladder outflow obstruction due to benign prostatic hyperplasia (BPH) has been shown to be modified by alpha, adrenergic receptors. Terazosin is an alpha, receptor‐blocking agent with a long half‐life permitting once‐daily dosing. This drug was administered in a multicentre, randomised, placebo‐controlled trial involving patients with symptomatic bladder outflow obstruction. Of 132 patients recruited for the study, 86 were randomised to receive placebo or terazosin, 81 completed the study, and 80 were considered eligible for efficacy analysis. All terazosin treatment groups showed dramatic improvement in obstructive symptoms when compared with the placebo group, but these differences were not statistically significant because of the small numbers of patients in each group. There were improvements in peak urinary flow rates, mean urinary flow rates, and residual urine volumes for the placebo and terazosin groups, but there were no statistically significant differences in the changes between the groups. Terazosin was well tolerated by patients in this study and may provide symptomatic relief in patients

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15862.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—The purpose of this multicentre, randomised, placebo‐controlled, double‐blind study was to verify the safety and efficacy of terazosin, an alpha1adrenergic blocker, in patients with benign prostatic hyperplasia (BPH). This study involved 137 patients who were randomly assigned to receive either a designed dose of terazosin (2, 5 or 10 mg) or placebo. Response to treatment was measured objectively by uroflowmetric determinations. Subjective evaluation was based on the investigator's assessment of each patient's symptoms. The safety of this agent was monitored by haematological tests and urinalysis. In addition, systolic and diastolic blood pressures and pulse rates were recorded during each visit. The treatment of BPH with terazosin produced a significant improvement in mean flow rate and peak flow rate; there were no statistically significant differences in the analysis of symptomatic responses between the groups of patients treated with terazosin or placebo. Moreover, the safety of this alpha! blocker was thoroughly tested and clinically p

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15863.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra‐prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure‐regulating balloon is implanted within the area of abdominal pressure, retroperitoneally.After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow‐up of 20 months.These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir.Although long‐term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15658.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—A meeting of the International Consultation on Benign Prostatic Hyperplasia (BPH) in June 1991 provided an update on the management of BPH. It is recognised that the development of complications in what may be regarded as a relatively well tolerated disease may necessitate surgical intervention. Current treatment is directed towards circumventing or ameliorating the complications of BPH and perhaps to find minimally invasive or non‐invasive alternatives to surgery that could eliminate this modality altogether. Anticipated changes in the management of BPH include establishment of an improved scoring system and response criteria; implementation of stenting techniques, physical modalities such as hyperthermia and laser therapy to replace transurethral resection of the prostate; development of more specific alpha blockers with fewer adverse effects; and administration of hormonal therapy, possibly as an eventual preventative of BPH.The 1991 International Consultation on Benign Prostatic Hyperplasia (BPH), which took place in Paris, France, under the joint sponsorship of the World Health Organization and the major international and national societies of urology, provided an excellent opportunity to review current knowledge on the subject of BPH and to explore future trends in its management. Most of the information included in this report is drawn from the conclusions of the consultation participa

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15864.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Summary—We describe the effect of ranitidine in reducing mucus in urine in 8 patients with enterocystoplasty and present a simple technique for measuring the concentration of mucus in urine. After a 10‐day course of ranitidine (300 mg daily in divided doses) the concentration of mucus had fallen significantly from an initial level of 1.38 ± 0.18 to 0.39 ± 0.04 mg/ml.Based on a Poster Demonstration at the 47th Annual Meeting of the British Association of Urological Surgeons in Glasgow, Jun

ISSN:0007-1331    

DOI:10.1111/j.1464-410X.1992.tb15659.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY