Effect of Shifting from Combination Therapy to Monotherapy of alpha-Blockers or 5alpha-Reductase Inhibitors on Prostate Volume and Symptoms in Patients with Benign Prostatic Hyperplasia

PURPOSE: Combination therapy of alpha-blockers and 5alpha-reductase inhibitors (5-ARIs) is widely used for the treatment of benign prostatic hyperplasia (BPH). We aimed to study the effect on prostate volume and symptoms of shifting to monotherapy in patients who previously received a combination therapy. MATERIALS AND METHODS: A prospective study was conducted of 60 patients who were diagnosed with BPH. Patients were aged 45 years or older and had a prostate volume of 30 cc or more, International Prostate Symptom Score (IPSS) of 12 or above, maximal flow rate (Qmax) of 15 ml/s or less, and prostate-specific antigen (PSA) level of less than 10 ng/ml. The patients initially received a combination therapy of doxazosin 4 mg/day and finasteride 5 mg/day for 3 months and were then randomly assigned to receive monotherapy for 3 months. The factors were then compared. RESULTS: A total of 30 patients were assigned to doxazosin (group 1) and 30 to finasteride (group 2) after the combination therapy. The percentage changes in prostate volume, IPSS, and Qmax during the period from post-combination therapy to post-monotherapy were not significantly different between the two groups (p=0.052, 0.908, 0.081), whereas PSA significantly decreased in group 2 (p<0.001). IPSS was not significantly different at post-combination therapy and at post-monotherapy in both groups (p=0.858, 0.071). The prostate volume significantly increased from 40.97 cc at post-combination therapy to 44.29 cc at post-monotherapy in group 1 (p=0.001) and insignificantly increased from 38.32 cc to 38.61 cc in group 2 (p=0.696). CONCLUSIONS: Although the duration of drug administration was short in this study, 5-ARI monotherapy could maintain the alleviated symptoms and reduce the risk of acute urinary retention and surgery due to prostate regrowth in BPH patients whose symptoms improved with combination therapy.

Ureteral Obstruction Caused by Periureteral Tuberculous Granuloma after Intravesical BCG Therapy for Superficial Bladder Tumors / 대한비뇨기과학회지

Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis (M. bovis) that has been used to treat transitional cell carcinoma. Since the initial report by Morales and associates on the use of intravesical BCG for the treatment of recurrent superficial bladder tumors, intravesical therapy with BCG has proved to be more effective for prophylaxis and the treatment of superficial bladder tumors and carcinoma in situ than most of the standard chemotherapeutic agents. While the majority of patients tolerate BCG treatments well, a number of adverse reaction (e.g., fever, hematuria, dysuria, nausea and malaise) have been reported. More serious complications occur on rare occasions and they include pneumonitis/hepatitis, ureteral obstruction, renal abscess and sepsis. We report here on a case of ureteral obstruction that was caused by periureteral tuberculous granuloma after intravesical BCG therapy for superficial bladder tumors, and the condition required distal ureterectomy & ureteroneocystostomy.

Effects of Bladder Training and/or Tolterodine in Female Patients with Overactive Bladder Syndrome: A Prospective, Randomized Study

We compared the effects of bladder training and/or tolterodine as first line treatment in female patients with overactive bladder (OAB). One hundred and thirty-nine female patients with OAB were randomized to treatment with bladder training (BT), tolterodine (To, 2 mg twice daily) or both (Co) for 12 weeks. Treatment efficacy was measured by micturition diary, urgency scores and patients' subjective assessment of their bladder condition. Mean frequency and nocturia significantly decreased in all treatment groups, declining 25.9% and 56.1%, respectively, in the BT group; 30.2% and 65.4%, respectively, in the To group; and 33.5% and 66.3%, respectively in the Co group (p<0.05 for each). The decrease in frequency was significantly greater in the Co group than in the BT group (p<0.05). Mean urgency score decreased by 44.8%, 62.2% and 60.2% in the BT, To, and Co groups, respectively, and the improvement was significantly greater in the To and Co groups than in the BT group (p<0.05 for each). Although BT, To and their combination were all effective in controlling OAB symptoms, combination therapy was more effective than either method alone. Tolterodine alone may be instituted as a first-line therapy, but may be more effective when combined with bladder training.

The Comparison between Various Formulae for Calculating the Residual Volume by Ultrasonography during Volume Change, and the Influence of Gender and Age / 대한비뇨기과학회지

PURPOSE: There have been few reports concerning the accurate formula for calculating the residual urine by ultrasonography. The aim of this study was to find the most applicable formula for measuring the quantity of the residual urine by ultrasonography in terms of capacity, age and gender. MATERIALS AND METHODS: This study was carried out on 176 of 254 patients with voiding dysfunction. The mean age of the patients was 64.3+/-17.7 yrs, ranging from 4 to 88 yrs, with a M:F ration of 1.67:1. The ultrasonographic diagnostic equipment used was the HDI35000(ATL Co Ltd, United States). 13 formulae currently used in the calculation of residual urine by ultrasonography were used, and the results compared with the actual residual urine from urethral catheterization. The accuracy, percentage volume error and statistical significance of the formulae were compared in terms of the residual urines above and below 150ml from urethral catheterization, above and below the age of 50 and gender. RESULTS: The Hakenberg formula gave the best accuracy(0.95+/-0.25), whereas the McLean formula gave the best percentage error with respect to volume(17.4+/-20.9). With the formulas of Griffiths and Hakenberg, the results had statistical significance. However, none of the formulae showed statistical significance with regard to the residual urine either above or below 150ml. Therefore, a formula constant of -4.5 was added to the Griffiths formula, as this had statistical meaning in both group. There were no differences in relation to age or gender with any of the formulae. CONCLUSIONS: The Griffiths formula was relatively accurate in the volume change among the 13 formulae used. The addition of -4.5 as a constant to the formula gave statistical meaning to the residual urine, both above and below 150ml. Age and gender did not affect the correctness of the measurement.

The Comparison between Various Formulae for Calculating the Residual Volume by Ultrasonography during Volume Change, and the Influence of Gender and Age / 대한비뇨기과학회지

PURPOSE: There have been few reports concerning the accurate formula for calculating the residual urine by ultrasonography. The aim of this study was to find the most applicable formula for measuring the quantity of the residual urine by ultrasonography in terms of capacity, age and gender. MATERIALS AND METHODS: This study was carried out on 176 of 254 patients with voiding dysfunction. The mean age of the patients was 64.3+/-17.7 yrs, ranging from 4 to 88 yrs, with a M:F ration of 1.67:1. The ultrasonographic diagnostic equipment used was the HDI35000(ATL Co Ltd, United States). 13 formulae currently used in the calculation of residual urine by ultrasonography were used, and the results compared with the actual residual urine from urethral catheterization. The accuracy, percentage volume error and statistical significance of the formulae were compared in terms of the residual urines above and below 150ml from urethral catheterization, above and below the age of 50 and gender. RESULTS: The Hakenberg formula gave the best accuracy(0.95+/-0.25), whereas the McLean formula gave the best percentage error with respect to volume(17.4+/-20.9). With the formulas of Griffiths and Hakenberg, the results had statistical significance. However, none of the formulae showed statistical significance with regard to the residual urine either above or below 150ml. Therefore, a formula constant of -4.5 was added to the Griffiths formula, as this had statistical meaning in both group. There were no differences in relation to age or gender with any of the formulae. CONCLUSIONS: The Griffiths formula was relatively accurate in the volume change among the 13 formulae used. The addition of -4.5 as a constant to the formula gave statistical meaning to the residual urine, both above and below 150ml. Age and gender did not affect the correctness of the measurement.

The Effects of Bladder Training, Tolterodine and Bladder Training with Tolterodine in Female Patients with Overactive Bladder: Prospective, Randomized Study / 대한비뇨기과학회지

PURPOSE: There are few reports concerning the first-line treatment of choice for an overactive bladder. The aim of this study was to compare the effects of bladder training, tolterodine, and bladder training with tolterodine, as first-line treatments in patients with an overactive bladder. MATERIALS AND METHODS: A prospective randomized study was conducted on 99 female patients with overactive bladders. The patients were treated with bladder training, tolterodine (2mg twice daily), and bladder training with tolterodine, as first-line treatments, for 12 weeks. Of the 99 patients, 74 (bladder training: 24, tolterodine: 24, combined: 26) were followed up for 12 weeks. The treatment efficacy was measured by a micturition diary, subjective urgency scores and subjective perception of bladder condition at the end of the treatment. The safety and tolerability were assessed from adverse events and treatment withdrawals. RESULTS: After 12 weeks of treatment, the mean frequency of micturition and nocturia decreased by 27.1 and 55.8% in the bladder training group, 30.3 and 61.9% in the tolterodine group and 32.6 and 63.2% in the combined therapy group. The subjective mean urgency score decreased by 48.4, 62.5 and 63.2% in the three respective groups. The subjective perception of bladder symptom scores at the end of the treatments were 1.5, 1.42 and 1.31, with significant improvement rates of 50.0, 58.3 and 69.3% in the bladder training, tolterodine and combined therapy groups, respectively. Adverse events, and withdrawals due to adverse events, were 23.1 and 7.7% in the tolterodine and 28.6 and 7.1% in the combined therapy groups, but there were none in the bladder training group. CONCLUSIONS: Bladder training, tolterodine and combined therapy are all effective first-line treatments in female patients with overactive bladders. There are some enhanced effects with the combined therapy than with the bladder training and tolterodine monotherapies. Because of its high success rate, relatively low cost and absence of adverse events, bladder training should be included as a first-line treatment.

The Effect of a 6Fr Transurethral Catheter on the Urinary Flow in Female Pressure-Flow Studies

PURPOSE: We evaluated whether a 6Fr transurethral catheter affects urinary flow in women undergoing pressure-flow studies. MATERIALS AND METHODS: We retrospectively reviewed urodynamics database of 201 consecutive women referred for the evaluation of lower urinary tract symptoms from January 1997 to June 2000. Before the urodynamic study, all patients voided privately using a standard toilet and free uroflowmetry parameters were recorded. Then, a standard pressure-flow study was performed using 6Fr transurethral catheter. We excluded the patients with inadequate voided volume(<150ml) and volume difference more than 30% between two studies. Urinary flow parameters between the two studies were analysed by paired t-test according to voided volume, main urodynamic diagnosis and uroflowmetry pattern. RESULTS: Of 201 women, 144 were excluded and 57 were subjects of our analysis. According to voided volume, pressure-flow study parameters were significantly different from the equivalent free uroflowmetry parameters: the maximum flow rate and average flow rate were significantly lower and flow time was significantly longer in pressure-flow studies(p<0.01). According to main urodynamic diagnosis categories, the subgroups of patients with normal urodynamic study, bladder outlet obstruction, detrusor instability and others showed significantly lower maximum flow rate and average flow rate in pressure-flow studies(p<0.01). According to uroflowmetry pattern, obstructive patterns such as undulating and intermittent pattern were more common in pressure-flow studies. CONCLUSIONS: The 6Fr transurethral catheter used in pressure-flow studies significantly affects urinary flow parameters. In order to make a accurate diagnosis, we must not merely rely on the results of pressure-flow studies, but we must take into account patient's individual clinical situation and also, if available, the results of free uroflowmetry in addition to pressure flow study parameters.

The Efficacy of Allylestrenol in the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Benign Prostatic Hyperplasia is one of the most important desease with a high frequency in urology. There is no doubt that the main stream of treatment is transurethral resection. of the prostate, however, marked improvement in drug therapy has been observed in recent years. Allylestrenol is a synthetic gestagen which was known to act directly on the prostate to exhibit its effect of reducing the size of the prostate by inhibiting the selective uptake of serum testosterone, inhibition of metabolism of testosterone to 5a-DHT (dihydrotestosterone) reductase, inhibition of 5a-DHT receptor binding. Our present study was carried out on 108 patients with benign prostatic hyperplasia to evaluate the efficacy and safety of antiandrogen therapy with allylestrenol. Allylestrenol was administered in a dose of 25 mg twice a day in the morning and evening after meal for 12 weeks to the patients and its efficacy was evaluated with peak urinary flow rate, Madsen Symptom Score at 4, 12 weeks after treatment and prostate volume at 12 weeks after treatment. Of these patients 46 completed the study and only 2 patients withdrew from the study owing to side effects. However,these side effects were not serious. At baseline (mean +SD) the mean peak urinary flow rate was 11.0+/-3.7 ml/sec, mean symptom score 10.2+4.0 and mean ultrasonic assessment of prostatic volume 36.8 +/-9.6 gm. At 4 weeks after treatment(mean + SD) mean peak urinary flow rate was 12+/-3.5 ml/sec, mean symptom score 7.7+/-4.2 (p > .0.05, p 0.05).

A Case of Female Epispadias / 대한비뇨기과학회지

Female epispadias is an uncommon congenital anomaly in genitourinary tract. We experienced a case of female epispadias with total urinary incontinence which was improved with periurethral injection of Glutaraldehyde Cross-Linked Collagen(GAX-Collagen) into the area of the bladder neck. The procedure was simple to perform and without significant complications. Herein we report a case of female epispadias in 29-year old female.

A Case of Sparganosis Infesting in the Scrotum / 대한비뇨기과학회지

Sparganum mansoni is an animal parasite infesting principally in cats and dogs, but sometimes it also infests human bodies. We have experienced a case of sparganosis in scrotum. Herein we report this case with a brief review of the literatures.