Urodynamic effects of various alpha blockers used for treatment of benign prostatic obstruction

We aimed to evaluate the effect of alpha-blockers on the urodynamic parameters of bladder outlet obstruction [BOO] and to know when to shift to more aggressive interventional procedures. Ninety patients having benign prostatic obstruction [BPO] were divided into three groups that received Doxazosin [GI], Alfuzosin [GII] and Tamsulosin [GIII]. Scores of symptoms, pressure/flow [P/F] studies and ultrasound estimated bladder weight [UEBW] were evaluated before and one year after therapy. Symptom scores and all parameters of P/F studies showed significant improvement after one year of therapy, in all groups. No significant differences were detected between treatment groups. UEBW was insignificantly decreased after therapy. 4.4% of patients were shifted to trans urethral resection of the prostate [TURP]. Alpha-blockers used for treating BPO are an effective modality of treatment not only through improving symptoms, but also through changing the P/F parameters in favour of relief of BOO. UEBW may be a promising tool for monitoring the effect of therapy

Urodynamic evaluation of surgical and endoscopic treatment of benign prostatic hyperlasia

Eighty eight patients suffering from outlet obstruction due to BPH were included in this study and divided into four groups: I open prostatectomy [TVP], II transurethral resection [TURP], III electrovaporization [TUEVP] and IV electrovaporesection [TUEVR]. All groups were age matched and had insignificant difference in means of prostatic size determined by TRUS. Patients with preoperative indwelling catheters were analyzed separately. Significant improvements were achieved in all groups in postoperative follow up of AUA symptom score in comparison with the baseline data. AUA score was significantly higher in TUEVP than in other groups during the first and third month visit. Detrusor instability was considerably reduced from 44.4%, 45.4%, 3.7% and 41.7% to 12.5%, 15.8%, 26.6% and 13.3% after relief of outflow obstruction in the four groups. However, this reduction was not statistically significant. Also, the degree of reduction in TUEVP was less than in the other groups. Other urodynamic parameters as low compliance, maximum flow rate, opening detrusor, detrusor pressure at maximum flow and volume of residual urine have significantly been improved after treatment without significant difference in the degree of improvement between the four groups

Electrovaporization of bladder ulcer, A new approach for treatment of Bilharzial bladder ulcer

The aim of this work was to study the safety and efficacy of electrovaporization as a new modality of treatment of bilharzial bladder ulcers. Sixty-six patients with bilharzial bladder ulcers have been treated by the use of vaportrode or pencil tip electrocautery electrode at high cutting current to evaporate the ulcer bearing area, till the perivesical tissue was exposed. Indwelling urethral catheters were fixed for one week. Successful vaporization of the ulcer bearing area was recorded in 59 patients. Failure to get satisfactory vaporization was reported in seven patients due to extensive calcification in the ulcer bearing area, for whom even trial of excision was failed. The operative time ranged from 7 to 18 minutes. Some postoperative complications occurred in the form of deep hematuria in four patients, peritonism in five patients and secondary hemorrhage in two patients. Symptomatic relief was recorded in 52 patients immediately after the removal of the catheter. Persistence of symptoms was encountered in five patients and proved to be due to persistence of the ulcer, as proved by cystoscopy in two patients and incomplete healing in three patients. Vaporization of chronic bilharzial bladder ulcer is an effective, easy and safe modality of treatment without considerable complications

Abrams-griffiths nomogram and the linear passive urethral resistance relation-which is more valid?

Clinical studies comparing these two nomograms are-to-our knowledge-very few. We aim at evaluating them to determine if they equally diagnose outflow obstruction. Multichannel urodynamics were done in 127 men with lower urinary storage and voiding symptoms. From December 1997 through April 1999. The data obtained from each study were plotted on both PURR, and Abrams-Griffith nomograms. Placebo treatment was given to patients with equivocal obstruction and they were followed 6 months later. On applying the data on Abrams-Griffith nomograms 71 patients [55.9 percent] were found to be obstructed, 38 patients [29.9 percent] were unobstructed, and 18 patients [14.2 percent] were plotted in the equivocal zone. On applying the data of the same three groups on the PURR nomogram, all the 71 obstructed patients were distributed through grades 3 to 6 [i.e. moderate to severe obstruction]. The 38 unobstructed patients were plotted into grade O. Among the 18 patients with equivocal obstruction 16 patients were distributed into grades 1 and 2 [mild obstruction]. Two patients were found in the initial part of grade 3. With follow up pressure/flow studies, these two patients were clearly categorized into grade 3 and the remaining 16 patients were distributed into grades 1 and 2. Both nomograms are nearly equally diagnostic for outlet obstruction. However, PURR grades the degree of obstruction. Follow up urodynamics is indicated for patients with equivocal obstruction. These patients are candidates for medical treatment

Clinical significance of prelabour rupture of the foetal membranes

The clinical aspects and complications associated with prelabour rupture of the membranes were investigated in forty patients: a control group of thirty-four full term pregnant patients were selected; cases of both groups were of similar clinical presentation except for the time of rupture of the membranes: primigravidity, toxaemia of pregnancy and cervical rigidity were more frequently encountered in the prelabour rupture group: non-engagement of the presenting foetal head was found to predispose to prelabour rupture of the membranes only in primigravidae: engagement and ripeness of the cervix shortened the latent period in the prelabour rupture group: the duration of the three stages labour was not significantly different in the two groups: prelabour rupture of the membranes was attended with a definite increase tn the incidence of operative interference, and was associated with an increased maternal and foetal risks