Mobile health in emerging countries: a survey of research initiatives in Brazil.

OBJECTIVE: To conduct a comprehensive survey of mobile health (mHealth) research initiatives in Brazil, discussing current challenges, gaps, opportunities and tendencies. METHODS: Systematic review of publicly available electronic documents related to mHealth, including scientific publications, technical reports and descriptions of commercial products. Specifically, 42 projects are analyzed and classified according to their goals. This analysis considers aspects such as security features provided (if any), the health condition that are focus of attention, the main providers involved in the projects development and deployment, types of devices used, target users, where the projects are tested and/or deployed, among others. RESULTS: The study shows a large number (86%) of mHealth solutions focused on the following categories: health surveys, surveillance, patient records and monitoring. Meanwhile, treatment compliance, awareness raising and decision support systems are less explored. The main providers of solutions are the universities (56%) and health units (32%), with considerable cooperation between such entities. Most applications have physicians (55%) and Community Health Agents (CHAs) (33%) as targeted users, the latter being important elements in nation-wide governmental health programs. Projects focused on health managers, however, are a minority (5%). The majority of projects do not focus on specific diseases but rather general health (57%), although solutions for hearth conditions are reasonably numerous (21%). Finally, the lack of security mechanisms in the majority of the surveyed solutions (52%) may hinder their deployment in the field due to the lack of compliance with general regulations for medical data handling. CONCLUSION: There are currently many mHealth initiatives in Brazil, but some areas have not been much explored, such as solutions for treatment compliance and awareness raising, as well as decision support systems. Another research trend worth exploring refers to creating interoperable security mechanisms, especially for widely explored mHealth categories such as health surveys, patient records and monitoring. Challenges for the expansion of mHealth solutions, both in number and coverage, include the further involvement of health managers in the deployment of such solutions and in coordinating efforts among health and research institutions interested in the mHealth trend, possibly exploring the widespread presence of CHAs around the country as users of such technology.

Benign prostatic hyperplasia and prostate cancer: an overview for primary care physicians.

Benign prostatic hyperplasia (BPH) and prostate cancer (CaP) are major sources of morbidity in older men. Management of these disorders has evolved considerably in recent years. This article provides a focused overview of BPH and CaP management aimed at primary care physicians. Current literature pertaining to BPH and CaP is reviewed and discussed. The management of BPH has been influenced by the adoption of effective medical therapies; nonetheless, surgical intervention remains a valid option for many men. This can be accomplished with well-established standards such as transurethral resection of the prostate or with minimally invasive techniques. Prostate cancer screening remains controversial despite the recent publication of two large clinical trials. Not all prostate cancers necessarily need to be treated. Robot-assisted prostatectomy is a new and increasingly utilised technique for CaP management, although open radical retropubic prostatectomy is the oncological reference standard. The ageing of the population of the developed world means that primary care physicians will see an increasing number of men with BPH and CaP. Close collaboration between primary care physicians and urologists offers the key to successful management of these disorders.

Prevalence of lower urinary tract symptoms and prostate enlargement in the primary care setting.

PURPOSE: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia often do not discuss their symptoms with their primary care physicians (PCPs). The primary objectives of this study were to estimate the prevalence of LUTS, prostate enlargement, and prostate-specific antigen (PSA) > or = 1.5 ng/ml in men visiting their PCP and to assess patients' intent to discuss LUTS with their PCP. METHODS: Men over age 50 presenting for a routine office visit at one of six PCP offices during the 8-week data collection period were invited to participate in this cross-sectional study. Men with prostate cancer, bladder cancer, indwelling urethral catheter or previous pelvic irradiation were excluded. Four hundred and forty-four men were enrolled and completed a self-administered questionnaire [including the International Prostate Symptom Score (IPSS)], provided a blood sample for PSA, and underwent a digital rectal examination (DRE), with the prostate classified as enlarged or non-enlarged by their PCP. RESULTS: Forty-two per cent of men had IPSS > 7; 48% had an enlarged prostate based on DRE and 43% had PSA > or = 1.5 ng/ml. Twenty-nine per cent (n = 129) of men had IPSS > 7 and enlarged prostate or PSA > or = 1.5 ng/ml. Of these men, 33% (n = 42) intended to discuss their symptoms with their PCP. CONCLUSIONS: Although a significant percentage of men in this older population had enlarged prostate and LUTS, only one-third of them intended to discuss their symptoms with their physician. PCPs may need to increase efforts to detect LUTS and enlarged prostate in older men.

Managing enlarged prostate in primary care.

Assessment and treatment of benign prostatic hyperplasia, or enlarged prostate, has evolved considerably in recent years; clear evidence has accumulated for the progression of disease over time, the association between disease progression and negative outcomes, and the potential for medical management of this condition. Commensurate with the long-term preventive role of primary care, efforts can and should be made to treat the underlying condition of enlarged prostate as well as to manage the symptoms short-term. This review outlines evaluation of men presenting with lower urinary tract symptoms, examines the challenges for medical treatment and suggests how treatment choice can address these challenges.

Public, patient, and professional attitudes towards the diagnosis and treatment of enlarged prostate: A landmark national US survey.

This US national survey evaluated beliefs and attitudes towards the enlarged prostate (EP) and its treatment among the men of a national sample aged > or =50 years in the US (400 with and 700 without EP), and a national sample of 100 primary care doctors and 100 urologists. The principal risk of EP was considered to be acute urinary retention among the majority of physicians, while the majority of patients believed it to be prostate cancer. In contrast to physicians' beliefs, the majority of patients with moderate-to-severe symptoms are more concerned with long-term effects of EP than acute symptoms. Furthermore, they are willing to wait up to 3 months for symptom relief if treatment of the underlying condition is achieved. Doctors and patients agree that most patients want to avoid surgery but only 18% of surgery patients were told about drugs that could reduce the risk of surgery. These findings demonstrate significant differences between the beliefs and attitudes of patients and physicians towards EP.

A cost comparison of medical management and transurethral needle ablation for treatment of benign prostatic hyperplasia during a 5-year period.

PURPOSE: We performed an analysis comparing the cost of medical management with TUNA therapy for a 5-year period. MATERIALS AND METHODS: Published costs for tamsulosin, finasteride, transurethral needle ablation (TUNA, Medtronic, Inc., Minneapolis, Minnesota) and transurethral resection of the prostate were used to construct a cost analysis model comparing medication with TUNA. The model analyzed monotherapy with an alpha-blocker (tamsulosin) and a 5alpha-reductase inhibitor (finasteride), combination therapy using both medications, and a mixed scenario using monotherapy and combination therapy. Published data were used to estimate the rate of surgical intervention in patients initially treated with medications or TUNA. RESULTS: Tamsulosin monotherapy was less expensive than TUNA for 5 years ($3,485 for tamsulosin vs $4,811 for TUNA year 5). Finasteride monotherapy reaches a break-even point with TUNA during year 5 ($4,867 for finasteride vs $4,811 for TUNA). Combination therapy reaches a break-even point with TUNA after approximately 2 years 7 months of treatment ($4,515 for combination therapy vs $4,572 for TUNA) and the mixed scenario breaks even with TUNA at approximately year 4 ($4,696 for medical management vs $4,645 for TUNA). CONCLUSIONS: The TUNA procedure compares favorably to combination medical therapy for the treatment of benign prostatic hyperplasia on a cost basis. alpha-Blocker monotherapy is less costly than TUNA while 5alpha-reductase inhibitor monotherapy is approximately equivalent to TUNA for 5 years. The TUNA procedure is less expensive than combination medical management for 5 years, with a break-even point at approximately 2 years 7 months.

Mongolian gerbils can utilize provitamin-A carotenoids in deep-fried carrot chips.

Deep-fried carrot chips, containing provitamin-A carotenes, were developed as an alternative mode of dietary intervention to combat vitamin A deficiency. The biological use of carotenoids in this product as vitamin A precursors was evaluated in Mongolian gerbils. Male 4-wk-old gerbils were fed a diet containing all essential nutrients for 1 wk. Then six gerbils were killed, and the remaining gerbils were fed the diet without vitamin A for 6 wk to produce marginal vitamin A deficiency. After depletion, six gerbils were killed and the remainder divided into four groups of 12 gerbils each and fed vitamin A-containing diet (+VA), beta-carotene-containing diet (BC), carrot chip-containing diet (CC), or diet containing no vitamin A/provitamin-A carotenes (-VA). The first three diets contained approximately 6 microg RE/g. Six gerbils from each group were killed after 2 wk of consuming these diets, and 6 after 4 wk. Final body weight and weekly food consumption did not differ among groups after 2 or 4 wk of repletion. Total liver vitamin A stores of BC and CC gerbils killed after 4 wk of repletion were not different from those of gerbils killed before depletion, but those of -VA gerbils were significantly lower (P < 0.05) and those of +VA gerbils were significantly higher (P < 0.05). Plasma retinol levels of gerbils killed after 4 wk of repletion, including the -VA group, did not differ. Total liver alpha- and beta-carotenes and 9-cis beta-carotene contents of the CC group were significantly higher (P < 0.05) than in the BC group after 4 wk of repletion. This carrot chip product effectively reversed vitamin A deficiency in gerbils.

Docetaxel followed by hormone therapy after failure of definitive treatments for clinically localized/locally advanced prostate cancer: preliminary results.

An increasingly important issue in the management of prostate cancer is the occurrence of biochemical failure (ie, increasing serum prostate-specific antigen [PSA] levels) in patients with clinically localized prostate cancer who initially underwent definitive treatments with curative intent (prostatectomy and/or radiation therapy). This pilot trial evaluated chemotherapy followed by hormone therapy for a defined period in patients with biochemical (and possibly clinical) recurrence after initial local therapies for localized/locally advanced prostate cancer. Patients who developed increasing PSA > 4 ng/mL after initial prostatectomy and/or radiation therapy received docetaxel, 70 mg/m(2) every 3 weeks for up to 6 courses, followed by 4 months of total androgen suppression (using a luteinizing hormone-releasing hormone agonist plus bicalutamide, 50 mg/d) and 8 months of peripheral androgen blockade (using finasteride, 5 mg/d, plus bicalutamide, 50 mg/d). Twenty-seven patients have enrolled to date, 23 of whom received four or six cycles of docetaxel before hormonal therapies. Seventeen (74%) of 23 patients who completed four to six cycles of chemotherapy had a > or =40% decrease in PSA, and 16 (89%) of 18 patients who completed 4 months of total androgen suppression achieved PSA values of < or =0.1. The most common hematologic toxicity was grade (3/4) neutropenia; grade 3 nonhematologic toxicities were rare, and no grade 4 nonhematologic toxicities were reported. Thus, the preliminary results suggest that docetaxel before hormonal therapy includes a PSA response in many prostate cancer patients with biochemical failure after definitive local therapies.

A quantitative analysis of the costs and benefits of prostate cancer screening.

The present study attempts to quantitate in an economically and clinically meaningful manner the cost and cost-effectiveness of prostate cancer screening and subsequent treatment, including complications from that treatment. Outcome data from large prostate cancer screening trials using prostate specific antigen (PSA) and digital rectal examination (DRE) and PSA alone were used to construct the screening model. The benefit of screening is expressed in years of life saved by screening, which is calculated by comparing the survival rate of men with prostate cancer to the survival rate of men in the general population. The cost of screening, treatment, and complications were estimated using the Medicare data base and published reports on the cost, morbidity and mortality for radical prostatectomy. The cost per year of life saved by prostate cancer screening with PSA and DRE was $2339-3005 for men aged 50-59, $3905-5070 for men aged 60-69, and $3574-4627 overall for men aged 50-69. The cost per year of life saved by prostate cancer screening with PSA alone for men aged 50-70 was $3822-4956. A sensitivity analysis demonstrates that the cost per year of life saved by prostate cancer screening will not change substantially even if the assumptions in this model have been underestimated or overestimated by 100%. This study quantifies only those parameters which can be reliably compared in concrete terms such as dollars, treatment impact on survival, published complication rates and published treatment costs. Using this type of analysis, prostate cancer screening appears to be a cost-effective intervention. However, the issue of whether prostate cancer screening is cost-effective will be decided definitively only when randomized, controlled trials are available to quantify the costs and benefits of prostate cancer screening.Prostate Cancer and Prostatic Diseases (2001) 4, 138-145.

1999 American Urological Association Gallup Survey: changes in physician practice patterns, treatment of incontinence and bladder cancer, and impact of managed care.

PURPOSE: The Health Policy Survey and Research Committee of the American Urological Association and the Gallup Organization have performed a yearly survey of American urologists since 1992 to assess practice patterns. The results of the 1999 survey are presented. MATERIALS AND METHODS: A random sample of 503 urologists was interviewed in February and March 1999. Major content areas were physician practice patterns, the impact of managed care, and the treatment of pediatric patients, prostate cancer and benign prostatic hyperplasia, female incontinence and bladder cancer. RESULTS: The average urologist is 46.8 years old, certified by the American Board of Urology, sees 78 patients and performs 3.1 major surgical procedures weekly, refers moderate and complex pediatric procedures to specialists, and receives 40.6% of practice income from managed care. CONCLUSIONS: In an era when large group practices seem to be the norm remarkably 32% of urologists remain in solo practice. There has been a shift in where urologists spend their time, that is more in the office and less in the operating room. Minor and major open surgical procedures increased from 12.4 weekly to 16.4 and 2.9 to 3.1 in 1995 and 1999, respectively. Most urologists are comfortable treating straightforward pediatric problems such as cryptorchidism but refer more complex problems to pediatric urologists. Managed care represents an ever increasing proportion of urologist practice income, while office expenses continue to increase.

The cost value of medical versus surgical hormonal therapy for metastatic prostate cancer.

PURPOSE: The cost of luteinizing hormone releasing hormone analogue and antiandrogen for prostate cancer is being scrutinized by the Health Care Finance Administration and other insurers. We compared the discounted present value cost of medical hormonal therapy to that of orchiectomy as well as the value created by these treatments from the insurer and patient perspectives. MATERIALS AND METHODS: We performed a telephone survey of 42 patients receiving hormonal therapy to estimate the value created by medical versus surgical castration from the patient perspective. The cost of medical hormonal therapy was discounted back to the present value and compared with the cost of bilateral orchiectomy. RESULTS: The total cost of bilateral orchiectomy was $2,022, while the discounted present value cost using the average wholesale price for 30 months of medical hormonal therapy was $13,620. Therefore, medical hormonal therapy costs $11,598 more than orchiectomy ($13,620 - $2,022). A discounted payment of $386 per month for 30 months is necessary to recoup the $11,598 difference. All surveyed patients on medical hormonal therapy stated that avoiding orchiectomy was worth $386 per month and it was an appropriate insurer expense. If patients paid $386 per month out-of-pocket, 22 of the 42 (52%) would pay the additional monthly expense, while 20 (48%) indicated that they could not afford the additional expense. CONCLUSIONS: These results indicate that medical hormonal therapy costs significantly more than bilateral orchiectomy but creates positive value for men with prostate cancer by enabling them to avoid orchiectomy.

A comparison of complications between ultrasound-guided prostate brachytherapy and open prostate brachytherapy.

PURPOSE: Prostate brachytherapy has reemerged during the 1990s as a treatment for clinically localized prostate cancer. The renewed popularity of prostate brachytherapy is largely due to the use of transrectal ultrasound of the prostate, which allows for more accurate isotope placement within the prostate when compared to the open approach. The present study investigates whether this improved cancer control is at the expense of increased morbidity by comparing the morbidity after transrectal ultrasound-guided prostate brachytherapy to the morbidity after prostate brachytherapy performed via an open approach. METHODS AND MATERIALS: All men in the Medicare population who underwent prostate brachytherapy in the year 1991 were identified. These men were further stratified into those men who underwent prostate brachytherapy via an open approach and the men who underwent prostate brachytherapy with ultrasound guidance. All subsequent inpatient, outpatient, and physician (Part B) Medicare claims for these men from the years 1991-1993 were then analyzed to determine outcomes. RESULTS: In the year 1991, 2124 men in the Medicare population underwent prostate brachytherapy. An open approach was used in 715 men (33.7%), and ultrasound guidance was used in 1409 men (66.3%). Mean age for both cohorts was 73.7 years with a range of 50.7-92.8 years for the ultrasound group and 60.6-92. 1 years for the open group. A surgical procedure for the relief of bladder outlet obstruction was performed in 122 men (8.6%) in the ultrasound group and in 54 men (7.6%) in the open group. An artificial urinary sphincter was placed in 2 men (0.14%) in the ultrasound group and in 2 men (0.28%) in the open group. A penile prosthesis was implanted in 10 men (0.71%) in the ultrasound group and in 4 men (0.56%) in the open group. A diagnosis code for urinary incontinence was carried by 95 men (6.7%) in the ultrasound group and by 45 men (6.3%) in the open group. A diagnosis code for erectile dysfunction was carried by 90 men (6.3%) in the ultrasound group and by 64 men (9.0%) in the open group. CONCLUSION: Prostate brachytherapy performed with ultrasound guidance does not appear to increase significantly complications resulting from the procedure. Both techniques appear to offer similar rates of procedures performed to correct urinary incontinence, bladder outlet obstruction and erectile dysfunction. The limitations of claim information in determining patient outcomes, however, must be considered when evaluating this data.

Complications after radical retropubic prostatectomy in the medicare population.

OBJECTIVES: Radical prostatectomy is the standard of care for the treatment of clinically localized prostate cancer in the appropriate patient. However, the morbidity associated with this procedure remains controversial, since complications from centers of excellence are low but nationwide surveys have reported a much higher risk of complications. This study reports the complication rates after radical retropubic prostatectomy (RRP) for men in the Medicare population. METHODS: All men in the Medicare population who underwent RRP in 1991 were identified. All inpatient, outpatient, and physician (Part B) Medicare claims for these men for 1991 to 1993 were then analyzed to determine outcomes. Procedures performed for complications resulting from RRP were recorded, as were the diagnosis codes that may have heralded a complication after RRP. RESULTS: In 1991, 25,651 men in the Medicare population underwent RRP. The mean age of these men was 70.5 years. Procedures for the relief of bladder outlet obstruction or urethral strictures after RRP occurred in 19.5% of these men. A penile prosthesis was implanted in 718 men (2.8%) after prostatectomy, and 593 men (2.3%) had an artificial urinary sphincter placed after prostatectomy. A diagnosis of urinary incontinence was reported in 5573 men (21.7%) after radical prostatectomy, but only 2025 of these men (7.9%) continued to carry this diagnosis more than 1 year after prostatectomy. A diagnosis of erectile dysfunction was reported in 5510 men (21.5%) after radical prostatectomy, but only 3276 of these men (12.8%) continued to carry this diagnosis more than 1 year after surgery. CONCLUSIONS: A review of a large, nationwide, heterogenous cohort of men revealed a morbidity rate that is slightly higher than that reported by major centers that perform large numbers of radical retropubic prostatectomies but is lower than complication rates obtained by patient surveys. The limitations of claim information in determining patient outcomes, however, must be considered when evaluating these data.

Complications after prostate brachytherapy in the Medicare population.

OBJECTIVES: Prostate brachytherapy is gaining in popularity among patients and physicians for the treatment of clinically localized prostate cancer. Although several major centers have published their results and morbidity data, nationwide data concerning complications have not been available. This study reports complications after prostate brachytherapy for men in the Medicare population. METHODS: All men in the Medicare population who underwent prostate brachytherapy in 1991 were identified. All inpatient, outpatient, and physician (Part B) Medicare claims for these men from 1991 to 1993 were then analyzed to determine outcomes. RESULTS: In 1991, 2124 men in the Medicare population underwent prostate brachytherapy. A total of 176 men (8.3%) underwent a surgical procedure for bladder outlet obstruction during the follow-up period, including transurethral resection of the prostate in 141 men. Seven men (0.3%) underwent a colostomy for complications secondary to radiation, and 4 men (0.2%) had an artificial urinary sphincter placed after prostate brachytherapy. Penile prostheses were placed in 14 men (0.6%) in the first 24 to 36 months after prostate brachytherapy. A diagnosis of urinary incontinence was carried by 140 men (6.6%) after the procedure; 179 men (8.4%) carried a diagnosis of erectile dysfunction after their procedure. A diagnosis consistent with rectal injury secondary to radiation appeared in 116 men (5.5%) after prostate brachytherapy. CONCLUSIONS: Prostate brachytherapy is being promoted as an effective treatment option for clinically localized prostate cancer that offers a low risk of complications. The low rate of urinary incontinence, bladder outlet obstruction, and erectile dysfunction was confirmed by analyzing a nationwide cohort of men. Rectal complications were also consistent with those described in published studies. The limitations of claim information in determining patient outcomes, however, must be kept in mind when evaluating these data.

Cost analysis of the treatment of vesicoureteral reflux: a computer model.

PURPOSE: Surgical intervention for vesicoureteral reflux is generally limited to children who have recurrent infection despite adequate antimicrobial prophylaxis or in whom compliance with followup cannot be ensured. In addition, surgical therapy is considered in children with persistent reflux after a reasonable period of surveillance. We used a model based on the management of a theoretical population of girls with various grades of reflux and followed the costs incurred during a 5-year management period. MATERIALS AND METHODS: The literature on vesicoureteral reflux was used to create a set of assumptions regarding epidemiology, likelihood of resolution, need for operative intervention, risk of infection and appropriate regimen for nonoperative surveillance. These parameters were evaluated in infants and children as noted in the literature. A 5-year management period was considered. Patients in whom reflux did not resolve with medical management at the end of 5 years were assumed to have undergone surgical correction. Costs were calculated based on the amounts billed, managed care reimbursement and Medicaid reimbursement in Maryland. The costs of up front surgical management were calculated and compared to those of 5 years of standard management. All costs were discounted at a rate of 10%. RESULTS: Calculated costs of standard management were lower for lower grades than those for higher grades of reflux. The costs of surgical management were lower than those of standard management for higher reflux grades using nondiscounted costs. However, when costs were discounted to present value, the costs of standard management were significantly lower than those of up-front surgery for all scenarios studied. CONCLUSIONS: The cost of vesicoureteral reflux is considerable when whole patient groups are considered. Using cost as the only parameter the standard management of reflux is less costly than up-front surgery. In the individual surgical intervention usually is predicated by patient and family factors which were not considered in this model. This computer based construct allows data from different institutions to be analyzed to project costs of the management of reflux.

1998 American Urological Association Gallup Survey: changes in physician practice patterns, treatment of ureteral stones and impact of managed care.

PURPOSE: The American Urological Association first commissioned the Gallup Organization to conduct a study to assess urologist practice patterns in 1992. We present the results of the seventh consecutive Gallup Survey performed for the Association. MATERIALS AND METHODS: A random sample of 537 American urologists who completed urological residency and practiced at least 20 hours weekly in 1997 were interviewed by telephone in March 1998. Major topic areas included general demographics, practice patterns, treatment of ureteral stones and experience with managed care. RESULTS: Demographic trends indicated a significant decrease in average urologist age from 49.4 years in 1992 to 46.8 in 1998. Of the urologists 99% reported that they treat ureteral stones. Managed care had an increasingly larger role in most practices, particularly in the western United States, where 73% of urologists reported that they contract with a Medicare health maintenance organization. CONCLUSIONS: The average age of practicing urologists significantly decreased, which may be due to an increasing number of urologists retiring at an earlier age, although this finding is not clear. Nearly all urologists treated ureteral stones with considerable consistency. Finally, managed care appeared to have a major impact on most urologists throughout the United States.

The effects of transurethral needle ablation and resection of the prostate on pressure flow urodynamic parameters: analysis of the United States randomized study.

PURPOSE: We evaluated the effects of transurethral needle ablation and prostate resection on pressure flow urodynamic parameters in men with benign prostatic hyperplasia (BPH), compared symptomatic and objective parameters of efficacy 6 months after initial treatment, and determined whether urodynamic assessment may predict symptomatic improvement. MATERIALS AND METHODS: We enrolled 121 patients with clinical BPH, American Urological Association symptom index of 13 or greater and maximum urinary flow of 12 ml. per second or less in a randomized study comparing transurethral needle ablation to prostate resection at 7 institutions in the United States. Patients underwent baseline and followup assessments at 6 months, including pressure flow studies. RESULTS: Patients who underwent each procedure had statistically and clinically significant improvement in symptom index, BPH impact index and quality of life score. After needle ablation and prostate resection maximum flow improved from 8.8 to 13.5 (p<0.0001) and 8.8 to 20.8 ml. per second (p<0.0001), detrusor pressure at maximum flow decreased from 78.7 to 64.5 (p = 0.036) and 75.8 to 54.9 cm. water (p<0.001), and the Abrams-Griffiths number decreased from 61.2 to 37.2 (p<0.001) and 58.3 to 10.9 (p<0.001), respectively. At 6 months the differences in transurethral needle ablation and prostate resection were significant in terms of maximum flow (p<0.001) and the Abrams-Griffiths number (p<0.001) but not detrusor pressure at maximum flow or symptom assessment tools. The presence or absence of urinary obstruction at baseline did not predict the degree of symptomatic improvement in either treatment group. CONCLUSIONS: Transurethral needle ablation and prostate resection induce statistically and clinically significant improvement in various quantitative symptom assessment questionnaires at 6 months. The parameters of free flow rates and invasive pressure flow studies also significantly improve after each treatment. However, transurethral prostate resection induces a significantly greater decrease in the parameters of obstruction. Baseline urodynamic parameters do not predict the degree of symptomatic improvement and they may not be helpful in patient selection for transurethral needle ablation.

Rejoining of DNA strand breaks induced by propylene oxide and epichlorohydrin in human diploid fibroblasts.

The repair kinetics of DNA single- and double-strand breaks (SSBs, DSBs) induced with two carcinogenic epoxides, propylene oxide (PO) and epichlorohydrin (ECH), was studied in human diploid fibroblasts. The methods used were: alkaline DNA unwinding (ADU), the comet assay, and pulsed field gel electrophoresis (PFGE). About 70% of SSBs, measured by ADU, were rejoined after the treatment with 5 mMh and 10 mMh of PO within 20 hr, and the half-life was estimated to be approximately 15 hr. On the other hand, effective rejoining of SSBs after ECH treatment was observed only at a dose of 1 mMh (a half-life of approximately 15 hr), whereas after 2 mMh treatment, only 26% of SSBs could be rejoined within 20 hr. Furthermore, the use of the comet assay demonstrated that DNA strand breaks were effectively rejoined after PO and ECH treatment at doses of 5-10 mMh and 0.5-1 mMh, respectively. About 76% and 83% of DSBs induced by 5 and 10 mMh of PO, respectively, were rejoined within 4 hr after the treatment (a half-life of approximately 2.5 hr), with little further repair thereafter. At lower dose of ECH (1 mMh) a half-life for DSBs rejoining was estimated to be approximately 2 hr; however, only 29% of DSBs were rejoined within 2 hr at the higher dose of 2 mMh. After 18 hr, the rejoining following treatment with a lower dose was negligible. At a higher dose, a rapid accumulation of DSBs was observed, probably as the result of cell death and DNA degradation. The results demonstrate the capability of human diploid fibroblasts to repair DNA SSBs and DSBs at low-to-moderate doses of the epoxides. A weak capacity to rejoin DNA strand breaks induced by higher doses of ECH may be a consequence of its higher DNA alkylation activity and approximately 10 times higher toxicity compared to PO.

1997 American Urological Association Gallup survey: Changes in diagnosis and management of prostate cancer and benign prostatic hyperplasia, and other practice trends from 1994 to 1997.

PURPOSE: The American Urological Association first commissioned the Gallup Organization to conduct a study to assess urologist practice patterns in 1992. We present the results of the 1997 survey, the sixth consecutive Gallup survey performed for the Association. MATERIALS AND METHODS: A random sample of 502 American urologists who had completed urological residency and practiced at least 20 hours weekly in 1996 was interviewed by telephone in February and March 1997. RESULTS: Emerging trends showed significant changes since 1994 in how urologists diagnosed and treated prostate cancer. The survey revealed a significant change in the tests routinely ordered to stage newly diagnosed prostate cancer and for diagnostic evaluation of patients with benign prostatic hyperplasia. CONCLUSIONS: Urologists are becoming more cost conscious and effective in ordering pretreatment testing. Urologists are becoming more oriented toward medical treatment for the management of benign prostatic hyperplasia, and less laser surgery is being performed.