ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08651.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To assess the criterion validity of the American Urological Association (AUA) symptom index for benign prostatic hyperplasia (BPH) in urological practice.Patients and methods The study comprised 1414 consecutive men ≥50 years of age, newly referred to a urologist in a stratified sample of 12 hospitals throughout the Netherlands, who completed the AUA symptom questionnaire at their first visit. The 39 urologists completed a questionnaire on the diagnosis. The discriminative power of the index for BPH versus other urological diagnoses was calculated by receiver operating characteristic (ROC) analysis. Subsequently, criterion sensibility was studied by assessing the effect of particular variables on the probability of the diagnosis of BPH.Results ROC areas were low for BPH versus prostate cancer (0.57, se 0.04), chronic prostatitis/prostatodynia (0.65, se 0.03), and other diseases of the lower urinary tract (0.57, se 0.04). Satisfactory to good values were found for BPH versus diseases of the upper urinary tract (0.79, se 0.03), impotence/infertility (0.79, se 0.04), penile‐scrotal diseases (0.85, se 0.02), and no abnormalities (0.84, se 0.03). The diagnosis of BPH, as made by urologists in daily practice, appeared to be a weak criterion. Irrespective of other characteristics, the chance of being diagnosed with BPH was affected by differences in definition and the type of hospital.Conclusion Although the AUA index discriminated fairly well between BPH and diseases of the upper urinary tract, as well as genital diseases, it has no potential for distinguishing BPH from other diseases of the lower urinary tract. In addition, the lack of consensus in defining clinical BPH underscores the weakness of the index as a tool in the diagnostic process of t

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08582.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives To determine the prevalence of (anatomical)benign prostatic hyperplasia/enlargement (BPH/BPE)in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH.Subjects and methods All men aged 40–79 years and living in three ex‐mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire.Results Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50–69 was>60%. Age‐specific prevalence rates for BPE (prostate size>20 g) per 1000 men were: 40–49 years, 615; 50–59 years, 776; 60–69 years, 892; and 70–79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of>20 mL/s were very unlikely to have prostates>40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate‐specific antigen (PSA) were the only independent variables associated with prostate size.Conclusion Compared to published studies, BPEwas substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08593.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To determine the variation in repeated measurements of post‐void residual urine volume (PVR), determined by transabdominal ultrasonography (TAUS), within an individual over time (test‐retest reliability).Patients and methods Forty men with symptomatic benign prostatic hyperplasia and awaiting transurethral resection of the prostate were studied over 3 months. Each underwent TAUS to determine both pre‐and post‐micturition residual volumes on six occasions within the study period.Results Although one‐third of the patients had approximately constant residual volumes (variation in range<120 mL), two‐thirds had wide intra‐individual variations over time (variation in range 150–670 mL). The values were log transformed to give a normal distribution and subjected to analysis of variance; there was a wide variation between and also within individuals. The larger the mean PVR, the larger was the overall variation in time. For those with a mean PVR of<100 mL, the variation was less marked and these patients showed a more consistent test‐retest repeatability.Conclusions Although the PVR determined by TAUS may be useful to indicate aspects of bladder dysfunction or outlet obstruction, the wide variation in repeated measurements in the same individual limits its use for any clinical purpose that requires repeated assessment, e.g. in monitoring the response to treatment. There is poor test‐retest reliability and PVRs cannot be determined reliabl

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08524.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode‐based temperature‐sensitive device in the detection of episodes of urinary incontinence in long‐term ambulatory monitoring (LTAM) studies.Subjects and methods Perineal temperature recordings were made in 46 women during various activities. A temperature‐sensitive device consisting of six IN4148 diodes, spanning 5 cm, and a nearby reference negative diode, was placed in a light perineal pad and attached to a portable amplifier/digitizer and recorder. The performance of the device was determined by comparison with increases in pad weight in 51 incontinent and 23 continent control subjects.Results A sufficient temperature differential existed between perineal and urinary temperature during all activities except being seated with crossed legs. Incontinence was reliably detected by the temperature‐sensitive device. The device had a sensitivity of 95.2% and a specificity of 90.6% compared to a pad test.Conclusions This temperature‐sensitive device offers a new method for detecting urinary incontinence during LTAM studies. It can be fitted in an unobtrusive perineal pad and has a higher sensitivity and specificity for the detection of incontinence when compared to a pad test. It may also be used as a marker of voiding in ambulatory studies not employing an integ

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08835.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To estimate differences in the absorption of ethanol‐tagged irrigant fluid in patients undergoing transurethral resection of the prostate (TURP) using measurements of ethanol concentration in the breath.Patients and methods The study comprised 100 randomly selected patients (mean age 71 years, range 38–85) undergoing TURP. At frequent intervals during TURP, the ethanol content of end‐expiratory breath samples was measured using an alcometer, venous blood samples were drawn for determination of serum sodium, ethanol and haemoglobin concentration and the absorption of irrigant fluid and blood loss were estimated. These variables were compared between patients operated on by experienced and inexperienced surgeons.Results Ethanol was detected in the expired breath of 39 patients. Patients who absorbed irrigant fluid underwent longer operations than those who did not (median 33 min and 23 min, respectively;P<0.01), had a greater weight of prostatic tissue resected (median 27.5 g and 16.5 g, respectively ;P<0.01) and lost more blood intra‐operatively (median 295 mL and 143 mL, respectively;P<0.01). Consultant urologists performed 75 of the operations, with 25 patients (33%) having detectable breath ethanol, and trainees carried out the remaining 25 operations, where 14 (56%) patients had ethanol detected in the expired breath. The difference in peak end‐expiratory ethanol values between patients in the consultant and trainee group was significant (P1 L of irrigant absorption) was one patient (1.3%) from those operated upon by a consultant and four (16%) from those treated by a trainee (P<0.05).Conclusions Irrigant absorption occurs frequently during TURP and is more likely to occur in operati

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08866.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To study whether glycine, which may contribute to the symptoms of the transurethral resection syndrome promotes death in a mouse model and whether a modification of the glycine concentration offers a better chance of survival.Materials and methods Mortality was determined in 120 mice after an intravenous infusion of increasing volumes and concentrations of glycine solution. The animals were divided into groups of 10 and given 150, 180, 200 or 220 mL/kg body weight of 1.1, 1.5 or 2.2% glycine solution. As a control, 220 mL/kg of a 5% mannitol solution was given to 12 mice.Results After receiving an isosmotic (2.2%) glycine solution 70% of the animals died, while the overall death rate for 1.5% glycine was only 20%. When 1.1% glycine was used, the mortality was 10% after infusion of 150 and 180 mL/kg and 80% after infusion of ≥200 mL/kg. Logistic regression analysis showed that the outcome for the two highest glycine concentrations was directly related to the dose of glycine and not to the water load. Of 12 mice receiving the isosmotic 5% mannitol solution, three died.Conclusions A 1.5% glycine solution offered the best chance of survival. The mortality was governed both by the glycine dose (2.2 and 1.5%) and the tendency of the solution to produce overhydration of the cells (1.1%). Glycine toxicity was most important when small volumes wer

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.07417.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To determine whether bladder distension affects venous haemodynamics during transurethral resection of the prostate (TURP) such that irrigating fluid is more easily absorbed.Patients and methods The right common femoral vein was examined using an ultrasound Doppler blood‐flow scanner in 10 patients (mean age 73 years, range 63–80) undergoing TURP. Measurements of blood flow were performed before, during and after the bladder was filled with irrigating solution. Fluid absorption was measured by the ethanol method.Results Measurements before, half‐way through and immediately after the resection all showed that the luminal diameter and the cross‐sectional area of the femoral vein increased significantly when the bladder was filled with irrigating fluid. Furthermore, a decrease in the normal variation of blood flow with breathing often occurred when the bladder was filled, indicating that proximal venous obstruction was the cause of the increase in vessel diameter. However, there was no apparent association between these changes and the absorption of irrigating fluid.Conclusions Filling the bladder with irrigating fluid with the patient in the lithotomy position during TURP was followed by signs of iliac venous obstruction but this did not correlate with the absorption of i

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08538.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To compare laser prostatectomy, using both side‐fire and contact lasers, with transurethral resection of the prostate (TURP) to identify the advantages and disadvantages of all three in the short‐and long‐term (1 year).Patients and methods Forty patients were randomized into one of four groups undergoing TURP, side‐fire laser prostatectomy alone, side‐fire with debridement and contact laser prostatectomy. Strict entry criteria ensured that no patients with malignancy were selected. The patients were reviewed after 3, 6 and 12 months.Results The duration of operation and length of hospital stay were significantly shorter in those undergoing laser side‐fire treatment than those undergoing TURP. However, the early (3‐month) symptom score was significantly worse in those treated by side‐fire laser than in those treated by side‐fire laser with debridement. After 1 year there was no significant difference in mean symptom score and mean urinary flow rate among the four groups.Conclusion Laser prostatectomy offers the prospect of a shorter theatre and hospital stay and, by debriding the thermocoagulated tissue, the early irritative symptoms were reduced, with a significant improvement in symptom score after 3 months in pati

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.08859.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective To evaluate the heating effect of microwave irradiation on the dog adrenal gland and to assess the clinical feasibility of microwave ablation of adrenal tumours.Materials and methods The thermal distribution and histology were evaluated after dog adrenal glands were irradiated at different intensities with microwaves. Irradiation at 70 W for 30 s was also performed, after laparotomy, on the adrenal tumour of a patient with primary aldosteronism.Results Microwave irradiation at 70 W for 30 s provided a sufficiently high temperature to produce coagulation within a 5mm radius of the microwave electrode. The adrenal tumour in the patient with primary aldosteronism was coagulated successfully by this dose of microwave irradiation.Conclusion Microwave ablation of the adrenal gland may be clinically applicable in the treatment of adre

ISSN:0007-1331    

DOI:10.1046/j.1464-410X.1996.86210.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY