Nephropexy ad modum Albarran Marion: long-term follow-up.

OBJECTIVE: To report a long-term follow-up of nephropexy ad modum (a.m.) Albarran Marion. MATERIAL AND METHODS: Between 1980 and 1999, 18 women (mean age 42.6 years) underwent nephropexy a.m. Albarran Marion. The duration of symptoms varied from 7 months to 9 years. All patients were examined preoperatively using excretory urography and renography in both the supine and erect positions in order to document renal descent. Patients with decreased renal function also underwent postoperative renography. A questionnaire concerning pre- and post-treatment symptoms was sent to all patients. RESULTS: Hospitalization averaged 7.2 days (range 4-15 days). Pneumothorax occurred in 7 patients, 3 of whom required temporary drainage. One patient developed pneumonia and another a retroperitoneal haematoma; no other complications occurred. All postoperative renography findings were normal. Median follow-up time was 11.2 years (range 2-21 years). At follow-up, 87.5% of patients were satisfied with the results and were free from pain. Two patients were not satisfied with the results; retrospectively the indications for surgery in these 2 cases were not absolute. CONCLUSIONS: Operative treatment for symptomatic nephroptosis should only be performed in selected cases. We present a success rate of 87.5% for nephropexy a.m. Albarran Marion, at a mean follow-up of 11.2 years, which equals the best results obtained with other procedures. The choice of operative procedure for symptomatic nephroptosis must be based on the special interests and skills available at the institutions concerned.

[Ciprofloxacin and pivampicillin in acute epididymitis in men above the age of 40 years]. / Ciprofloxacin og pivampicillin ved epididymitis acuta hos maend over 40 år.

Ciprofloxacin 500 mg orally twice daily was compared to pivampicillin 700 mg orally twice daily for 10 days in 172 men (41-85 years) with acute epididymitis. Failure of treatment occurred in 48 patients, in 15/76 (19.7%) receiving ciprofloxacin versus in 33/82 (40.2%) receiving pivampicillin (p = 0.006). Ciprofloxacin 500 mg orally twice daily is more effective than pivampicillin 700 mg orally twice daily and has fewer adverse events.

A double-blind, randomized, controlled multicentre study to compare the efficacy of ciprofloxacin with pivampicillin as oral therapy for epididymitis in men over 40 years of age.

OBJECTIVE: To compare the efficacy and safety of ciprofloxacin 500 mg orally twice daily with pivampicillin 700 mg orally twice daily for 10 days in men with acute epididymitis and over 40 years of age. PATIENTS AND METHODS: The study comprised 172 men who entered a prospective, controlled, randomized, double-blind, trial of pivampicillin and ciprofloxacin. The median (range) age of the 158 patients eligible for the efficacy analysis was 58 (41-85) years; 41% had previously had a urinary tract infection and 27% had previously had epididymitis. Only one patient had a urethral catheter and 38% were sexually active. About half of the patients were admitted to hospital. RESULTS: No bacteria could be cultured from samples in 53% of the patients; Escherichia coli could be cultured from 35% and the remaining isolates were the expected urinary pathogens. None of the patients had Gonococci and only one in each group had Chlamydia. Mycoplasma hominis was detected in three patients only and M. genitalium was detected in three, while Ureaplasma was detected in 24 (15%). The treatment failed in 48 patients; in 15 of 76 (20%) receiving ciprofloxacin and in 33 of 82 (40%) receiving pivampicillin. This corresponds to a reduction in the risk of failure of 20.5% (95% confidence limits 6.6-40.2%, P=0. 006). The principal cause of failure was an unsatisfactory clinical response requiring changed antibiotic treatment in 27 patients; adverse events were responsible for failure in 14. The in vitro resistance of cultured bacteria was low in both groups, at approximately 4%. Adverse events, mainly gastro-intestinal, occurred in 17 of 83 (21%) patients starting on ciprofloxacin and in 33 of 89 (37%) receiving pivampicillin (P=0.04). CONCLUSION: For epididymitis in men over the age of 40 years ciprofloxacin 500 mg orally twice daily is more effective than pivampicillin 700 mg orally twice daily. Furthermore, ciprofloxacin has a lower incidence of adverse events.

A comparison of prelubricated hydrophilic and non-hydrophilic polyvinyl chloride catheters for urethral catheterization.

OBJECTIVE: To evaluate whether patients performing clean intermittent self-catheterization (CISC) for a short period preferred a prelubricated, hydrophilic, disposable polyvinyl chloride (PVC) catheter or a non-hydrophilic PVC catheter which could be used several times and that had to be lubricated by the patient. PATIENTS AND METHODS: In a prospective cross-over study, 32 patients used each type of catheter for 3 weeks. After each 3-week period, the patients completed a questionnaire to assess comfort and preference, and urine specimens were obtained for culture. RESULTS: There was no significant difference between the groups in the frequency of CISC, discomfort when used, opinion on handling the catheters, preference toward one of the catheters, or of infection. CONCLUSION: Non-hydrophilic PVC catheters may be used safely and with no discomfort to the patient. In addition it may be possible for the healthcare system to save money, as the non-hydrophilic PVC catheters are much cheaper.

The responsiveness of the ICSmale questionnaire to outcome: evidence from the ICS-'BPH' study.

OBJECTIVE: To evaluate the responsiveness of the ICSmale questionnaire to the outcome of treatments for lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Consecutive men aged >45 years attending 23 urology centres in 12 countries, with symptoms suggestive of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), were recruited to Phase I of the International Continence Society (ICS)-'BPH' study. In Phase II of the ICS-'BPH' study, 355 men in 15 centres in nine countries were followed up, having proceeded to treatment according to clinical practice. All men completed the ICS-'BPH' study questionnaire at baseline and follow-up, including the ICSmale which concerns LUTS and related problems. RESULTS: Patients included in Phase II were similar to those in Phase I according to age and levels of baseline symptoms. Patients received a range of treatments: 32% TURP, 29% drug therapies, 20% watchful waiting, 9% minimally invasive therapies and 10% 'others' (including open prostatectomy). For patients who underwent TURP, most LUTS, including voiding and filling symptoms, were highly statistically significantly better at follow-up than at baseline (P<0.0001). For drug, minimally invasive and 'other' treatments, fewer LUTS were highly statistically significantly better. For those undergoing watchful waiting, no symptoms were significantly different between baseline and follow-up. CONCLUSION: The ICSmale questionnaire, in addition to being psychometrically valid and reliable, is responsive to change in outcome.

Interstitial cystitis provoked by tiaprofenic acid.

A patient developed clinical and histological interstitial cystitis as an adverse effect of treatment with tiaprofenic acid for rheumatism. After cessation of the drug, full symptomatic recovery was obtained. Bladder biopsies 6 months later demonstrated normalization of detrusor muscle histology.

Uroflow in women: an overview and suggestions for the future.

The literature on uroflowmetry in women is presented and evaluated. Uroflowmeters are described and found generally sufficiently accurate, although the errors arising from electronic evaluation may invalidate the test. Six flow curve patterns are proposed in accordance with described pathological conditions. From the literature it is summarized that the normal Qmax is 20-36 ml/s. Qmax is linearly correlated to the voided volume, increasing by 5.6 ml/s/100 ml. Pregnancy, age and menstrual cycle do not influence Qmax. Several pathological conditions have been associated with specific flow curve patterns. These conditions are described and associations with the proposed flow definitions made.

Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-"BPH" study.

Despite the lack of evidence in the literature for close relationships between lower urinary tract symptoms and bladder outlet obstruction, the majority of urologists rely on symptomatology when selecting patients for prostatic surgery. We investigated the relationships between a wide range of lower urinary tract symptoms from the ICSmale questionnaire and the results of urodynamic pressure and flow studies. We evaluated 933 patients with lower urinary tract symptoms suggestive for bladder outlet obstruction from 12 countries who participated in the ICS-"BPH" study with the ICSmale questionnaire and urodynamic pressure and flow studies. Spearman rank correlation coefficients were obtained between symptoms and measures of bladder outlet obstruction. There was little or no correlation between a wide range of symptoms and the results of free uroflowmetry and pressure and flow studies. From symptoms alone, it is not possible to diagnose bladder outlet obstruction. Pressure and flow studies and symptom profiles measure different aspects of the clinical condition that should be viewed separately in the evaluation and treatment decision of the patient presenting with lower urinary tract symptoms.

Long-term results of the Stamey Bladder-neck suspension procedure and of the Burch colposuspension.

This retrospective study compares the long-term results of the Stamey bladder-neck suspension and the Burch colposuspension following operation for urinary incontinence in women. A total of 182 women underwent operation for urinary incontinence: 83 by Stamey bladder-neck suspension and 99 by Burch colposuspension. The case records were perused and questionnaires were sent to the 169 women who were still alive: 129 women had no previous operation for urinary incontinence. At follow-up in this group a median of 7 years after the operation, 32% were completely continent and 39% had improved after the Stamey method, as against 33% and 29%, respectively, after Burch (p > 0.05). The Stamey operation was associated with a lower complication rate (12%) and a lower rate of re-operation (16%) than the Burch operation (23% and 22%, respectively) (p > 0.05). Previous incontinence surgery and mixed type of incontinence was associated with poor outcome in the Stamey group.

Does old age contraindicate TURP.

OBJECTIVE: This investigation was performed to evaluate the prognostic role of high age as to survival after transurethral prostatic resection (TURP). MATERIAL AND METHODS: The study was retrospective, considering all men over the age of 80 years consecutively treated for lower urinary tract symptoms (LUTS). The material consisted of 249 patients who had TURP, 30 patients who were considered too ill for surgery and 18 who did not want treatment. Survival was compared to the background population. RESULTS: A significantly higher mortality was found initially if patients treated with TURP were compared to the age-matched background population. Twelve patients died within 30 days after operation. These patients suffered from severe preoperative comorbidity. Ninety-seven patients had chronic retention while only 17 had a catheter at discharge from the hospital. CONCLUSION: In conclusion, even very old men benefit significantly from a TURP provided they have been carefully selected.

Retrograde contamination and practical handling of urine-meters: a comparison of three systems for the measurement of hourly diuresis in an experimental bladder-drainage model and in clinical use.

OBJECTIVE: To compare three different urine metering systems for their ability to prevent retrograde contamination in an in vitro model of a closed urinary drainage system and for qualities important to their practical handling in a clinical setting. PATIENTS, MATERIALS AND METHODS: Using three urine-meters (the Braun Ureofix 511, the Kendall Curity 4000 and the Unoplast Unometer 500) the in vitro model was constantly flushed with a solution of Mueller-Hinton broth diluted with saline. On the first day, the urine collecting bag was inoculated with 10(8) cells of Pseudomonas aeruginosa. The system was operated for 12 days with daily sampling of the model bladder to detect any contamination. After 12 days the experiment was stopped and sampling performed at various locations, including the urine-meter and the tubing. Nine of each type of urine-meter were tested, i.e. three in three different experiments. In the clinical study, 45 patients were randomized to each of the three urine-meters and the nurses attending them were asked to complete a questionnaire on the practical handling of the urine-meters. RESULTS: When the urine-meters was omitted from the model system, the 'bladder' became contaminated with the test bacteria within 3 days. None of the nine Unometer 500 systems became contaminated, compared with four of each of the other two systems (P < 0.05). In clinical use, the Unometer 500 and Ureofix 511 were easier to suspend and empty than was the Curity 4000. The Unometer 500 was significantly easier to handle when the collecting bag was emptied. CONCLUSION: Urine-meters can prevent retrograde contamination in a closed bladder-drainage model, but the degree of prevention depends upon the type of urine-meter. In daily practice, there were differences in the ease of suspension of the systems and in the emptying of the urine-meter and collecting bag.

The effect of Buserelin versus conventional antiandrogenic treatment in patients with T2-4NXM1 prostatic cancer. A prospective, randomized multicentre phase III trial. The "Danish Buserelin Study Group".

A prospective, randomized multicentre phase III trial was undertaken to compare the effectiveness and safety of Buserelin, a gonadotropin-releasing hormone analogue (GnRHa), with conventional antiandrogenic treatment in patients with painful metastases from T2-4NXM1 prostatic cancer. Seventy-two patients received Buserelin, 22 received estrogens and 46 were subjected to orchiectomy. The trial was completed one year after allocation of the patients. No significant differences as regards suppression of testosterone or survival were found in favour of one of the three treatment modalities. The performance index improved significantly both during the first months of treatment with Buserelin and following orchiectomy. No detectable improvement of performance index was seen during treatment with estrogens. Treatment with estrogens also failed to alleviate pain or general symptoms of cancer. Tolerability, safety and compliance of Buserelin was although administered intranasally clearly evidenced as palliation of advanced symptomatic cancer and the efficacy and sideeffects were fully comparable to those following orchiectomy.

[Augmentation ileo-cystoplasty in women with disabling urge incontinence]. / Augmentationsileocystoplastik hos kvinder med invaliderende imperiøs vandladningstrang.

The results after "clam"-augmentation cystoplasty are assessed in 11 consecutively operated women aged 35-78. All were suffering from severe urgency. Eight were urge-incontinent and six of these stress-incontinent as well. Nine patients had been operated before with a total of 14 operations. Bladder distension and parasympatholytic medication had been tried in two and seven instances respectively. One patient died of a pulmonary embolism three weeks postoperatively. Follow-up ranged from 12-52 months, mean 29 months. Eight (80% (44-97)%) of the remaining 10 patients were cured with respect to urgency. One patient was improved, and one unchanged. Three (60% (15-95)%) out of five previously stress-incontinent patients were dry, one was improved and one unchanged in spite of a subsequent stamey urethrosuspension. Eight patients (80% (44-97)%) had spontaneous micturition, one used self-catheterisation once daily and one patient was retained on an indwelling catheter. It is concluded that augmentation cystoplasty is a procedure of considerable value in patients with disabling non-neurogenic urgency, where conservative therapy and previous surgery has failed.

[Antibiotic prophylaxis in diagnostic and therapeutic urological interventions]. / Antibiotikaprofylax vid diagnostiska och terapeutiska urologiska ingrepp.

An enquiry into the use of antibiotic prophylaxis in conjunction with diagnostic or therapeutic urological procedures at hospitals in four Scandinavian countries showed manifest national differences to exist for most procedures. In transurethral resection, for instance, antibiotic cover was used at 79 percent of Finnish hospitals, but at only nine percent of Danish hospitals. Not only were dosage regimens characterized by wide national variation, but also the spectrum of antibiotics used, quinolones being most frequently used in Sweden, but ampicillin and pivampicillin in Denmark. For some procedures policy was more uniform in all countries, antibiotic cover rarely being used in connection with ureterocystoscopy (5 percent of hospitals), but often in conjunction with percutaneous stone surgery (72 per cent). In certain procedures where there is strong evidence suggesting the necessity of antibiotic prophylaxis, it was not always used-e.g., in transrectal prostate biopsy where it was used at only 62 per cent of hospitals. The interpretation of published findings and clinical experience would appear to differ markedly, and local traditions would seem to be strong determinants of clinical routines. The wide variation suggests that all patients do not receive optimal treatment. To improve routines, our knowledge of antibiotic preparations needs to be expanded by well executed studies, followed by general implementation of the results at the various centres. A series of consensus conferences should be arranged and the recommendations published as a first step toward a more uniform and probably better use of antibiotic prophylaxis in conjunction with diagnostic and therapeutic urological procedures.

Flavoxate treatment of micturition disorders accompanying benign prostatic hypertrophy: a double-blind placebo-controlled multicenter investigation.

To investigate the effect of flavoxate (Urispadol) treatment on patients with symptomatic benign prostatic hypertrophy (BPH), with the main weight on the irritative symptoms, a randomized, double-blind, parallel-group, placebo-controlled and multicenter investigation was carried out. Seventy patients entered the study, 37 were allocated to flavoxate treatment on a daily dose of 1,200 mg (400 mg t.i.d.) for 12 weeks, and 33 patients were allocated to placebo treatment. In spite of a sufficient power, the study did not discriminate the two treatment groups in a statistically significant way (p > 0.05), when considering the main endpoints: the irritative symptom score and the global patient evaluation. Conservative treatment of micturition disorders accompanying BPH with flavoxate in doses of 1,200 mg/day cannot be recommended for clinical use.

Bladder neck anatomy and mobility: effect of vaginal ultrasound probe.

OBJECTIVE: To evaluate the effect of a vaginal ultrasound probe on bladder neck anatomy and mobility. PATIENTS AND METHODS: Twenty women, 15 with urinary incontinence and five with other urological complaints, were studied. Colpocysto-urethrography (CCU) during rest. Valsalva and withholding manoeuvres were compared with and without simultaneous vaginal endosonography. The CCU diagnoses and measurements of bladder neck position and mobility in relation to the symphysis pubis were compared with and without the probe inserted. A small, 7 MHz vaginal probe (Brüel and Kjaer, type 1846) was used with the scanning field 45 degrees to the long axis of the probe. RESULTS: The CCU diagnoses as well as the measurements of bladder neck position and mobility relative to the symphysis pubis were unaffected by the insertion of this probe. CONCLUSION: Vaginal ultrasonography is a minimally invasive technique; it is convenient for routine, firstline evaluation of bladder neck anatomy and mobility in incontinent women.

The value of quantitative DNA flow cytometry of testicular fine-needle aspirates in assessment of spermatogenesis: a study of 137 previously maldescended human testes.

In order to assess the suitability of DNA flow cytometry of fine-needle aspirates for quantifying spermatogenesis, the results from DNA flow cytometry were compared to histological evaluation of testicular biopsies taken concomitantly from 171 previously maldescended testes. In 137 of 171 cases, sufficient material for flow cytometric as well as histological evaluation was obtained. Histological analysis of surgical biopsy specimens revealed spermatogenesis including the spermatid stage in 117 of the 137 gonads. In six of the 117 gonads no haploid cells were found using flow cytometry. On the other hand, surgical biopsies failed to reveal spermatogenesis in five cases in which the corresponding aspirates contained haploid cells. Both methods therefore seem equally sensitive in detection of spermatogenesis. Other types of histological patterns also corresponded to distinct DNA histograms. Thus, in 11 of 12 cases with Sertoli-cell-only pattern in all tubules, at least 95% of the cells had a diploid DNA content. Furthermore, predominance of tubules with maturation arrest at the primary spermatocyte level corresponded to an increased proportion of tetraploid cells. When compared to surgical biopsy, DNA flow cytometry of testicular fine-needle aspirates is a more objective, easy and rapid method, which is more convenient for the patient. This study has indicated that DNA flow cytometry is a suitable method of quantitative assessment of spermatogenesis. One of the first target groups might be men with azoospermia. In such men, DNA flow cytometric analysis of fine-needle aspirates and surgical biopsy are apparently of equal sensitivity in detecting gonads with spermatogenesis. We conclude that DNA flow cytometry may become an alternative method for the quantification of spermatogenesis.

Twenty-four hour pad weighing test: reproducibility and dependency of activity level and fluid intake.

To evaluate the reproducibility of the 24 hour pad weighing test and the possible influence of fluid intake and level of activity to the test result, 14 women, referred for operation because of urinary incontinence, performed six 24 hour pad tests each under the following conditions: 2 tests on normal daily activity level and on normal fluid intake, 2 tests on high vs. low activity level, and 2 tests on high vs. low fluid intake. The study concludes that the results of the 24 hour pad weighing test are reproducible with moderate variation in fluid intake and activity level. Artificially low fluid intake or extreme variations in activity level could, however, significantly alter the urinary leakage. Small variations in fluid intake and activity level have no effect on the test result.