Socioeconomic determinants of prostate-specific antigen testing and estimation of the prevalence of undiagnosed prostate cancer in an elderly Polish population based on the PolSenior study.

INTRODUCTION: Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing. MATERIAL AND METHODS: We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55-59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects. RESULTS: The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06, p < 0.001), higher personal income (OR = 1.56, p < 0.001), better education (OR = 1.49, p = 0.001), previous white-collar work (OR = 1.37, p = 0.005), alcohol abstinence (OR = 1.28, p = 0.02), married status (OR = 1.24, p = 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65, p < 0.001), and dependence in ADL (OR = 0.55, p < 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65-74-year-old and 4.5% of 55-59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55-59 and 65-74 years, respectively. CONCLUSIONS: In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men.

Depressive symptoms in patients diagnosed with benign prostatic hyperplasia.

BACKGROUND: Symptoms of depression are common in patients diagnosed with benign prostatic hyperplasia (BPH) and are usually a reaction to deterioration of health, severity of lower urinary tract symptoms, and erectile dysfunction. The aim of this observational study was to evaluate the prevalence of depressive symptoms in patients diagnosed with BPH and factors affecting their occurrence in a large Polish cohort. PATIENTS AND METHODS: Four thousand thirty-five men (4,035) diagnosed with BPH participated in the survey (age 65 ± 8 years). The occurrence of symptoms of depression was assessed using the Beck depression inventory, severity of lower urinary tract symptoms (LUTS) on the basis of the international prostate symptoms score, and erectile dysfunction using the international index of erectile function (IIEF-5). RESULTS: Depressive symptoms were found in 22.4% of patients (mild in 20.8% and moderate/severe in 1.6%). Erectile dysfunction was found in 71.9% of patients. Monotherapy for BPH was prescribed to 50.9% of patients (mostly ARA-selective α1-selective alpha-adrenolytic-47.5%), while polytherapy (ARA with a 5-alpha reductase inhibitor-5αRI) to 47.9%. Logistic regression analysis showed a bidirectional relation between the occurrence of depressive symptoms and erectile dysfunction. The occurrence of both depressive symptoms and erectile dysfunction was related to severity of LUTS, nocturia, the use of 5αRI, comorbidity, and sedentary life style. CONCLUSIONS: Prevalence of depressive symptoms in patients diagnosed with BPH is associated with severity of LUTS, erectile dysfunction, nocturia, BPH pharmacotherapy (5αRIs), sedentary life style, and comorbidities including obesity.

A case of polytrauma with splenic rupture and complete left renal artery avulsion.

This study presents a case of avulsion of the left renal artery from the aorta and splenic rupture after blunt abdominal trauma accompanied by an extensive crush syndrome. Based on contrast-enhanced abdominal ultrasound and computed tomography CT, the patient was qualified for urgent surgical intervention with removal of the injured kidney and spleen.

[Treatment of premature ejaculation]. / Leczenie wytrysku przedwczesnego.

Premature ejaculation is the most common sexual dysfunction in men. Its prevalence rate in Europe and in United States is estimated to be between 20% and 30%. The diagnosis of premature ejaculation is based on three main criteria: increased intravaginal ejaculatory latency time (IELT), lack of control over ejaculation and interpersonal psychological disturbances. Premature ejaculation is classified as lifelong (primary) or acquired (secondary) and might be facilitated by chronic prostatitis, diabetes mellitus, hyperthyroidism, obesity. The exact etiology of the disease remains unclear, although 5-HT (5-hydroxytryptamine) receptors are known to have a significant role. The use of SSRIs (selective serotonine reuptake inhibitors) is old and efficient form of therapy for premature ejaculation. Other drugs like tramadol, clomipramine, local anaesthetics and PDE-5 (phosphodiesterase 5) inhibitors also have some efficacy in the treatment of premature ejaculation. To minimize adverse effects the "on demand" therapy is preferred to the daily treatment. Simple questionnaires for patients are used to assess treatment effects.

A technique for catheter placement after transurethral resection of the prostate complicated with undermining of the trigone of the bladder.

Authors presented 17 patients in whom two techniques for catheterization of the bladder after transurethral resection of the prostate complicated with undermining of the trigone of the bladder were applied. The first maneuver, used in twelve patients, was the insertion of a rigid stylet made from a 10F pneumatic probe used for percutaneous nephrolithotripsy into the Foley catheter in order to insert the catheter into the bladder in cystoscope manner. In the remaining five patients, the second maneuver was the insertion of a Dufour catheter over the guide wire left in bladder through the resectoscope sheath. These techniques seemed to be easy and safe.

[Extended analysis of urethral profilometry in women with urinary stress incontinence--preliminary report]. / Rozszerzona analiza profilu cewkowego u kobiet z wysilkowym nietrzymaniem moczu o nowe parametry--doniesienie wstepne.

UNLABELLED: Stress urinary incontinence (SUI) is the most common kind of urinary incontinence in women. Treatment efficiency depends on the type of stress urinary incontinence. OBJECTIVES: The purpose of the following study was to compare certain urethral profilometry parameters, including additional ones, in women with stress urinary incontinence (type 0) and women categorized as a 'transitional group' who were likely to have the mechanism of the intrinsic sphincter deficiency in pathogenesis of SUI. MATERIAL AND METHODS: Examinations included 100 patients with diagnosed SUI based on medical history clinical evaluation, pad test and urodynamic evaluation. Studied population was divided into three groups depending on the presence of leakage and VLPP value in the urodynamic test. The first group consisted of 19 patients with no leakage during urodynamic test (with SUI type 0), the second group (2) comprised 30 patients with VLPP 60-89 cmH2O and the third group included 36 patients with VLPP > or =90 cmH2O. 15 patients with leakage appearing at VLPP <60 cmH2O were excluded from the study The final analysis was carried out in a group of 85 patients. The analysed urethral profilometry parameters included: (MUCP, cmH2O), (Total Profile Area, cmH2O mm), (Profile Length to Peak, mm), (Proximal Area to Peak cmH2O mm), (Distal Area after Peak, cmH2O mm) RESULTS: Most of the analyzed urethral profilometry parameters, excluding Profile Length to Peak, in the group of patients with VLPP 60-89 cmH20 have revealed significantly lower values of MUCP than in the group with no leakage. No significant differences of the analyzed parameters between group 1 and group 3 and between group 2 and group 3 have been revealed although their values were slightly elevated in the group of patients with critical VLPP. CONCLUSION: Lower values of fields under the urethral profilometry curve can suggest a greater urethral closing mechanism deficiency and the coexistence of the external sphincter insufficiency This parameter can be very useful in the group of patients with moderate leakage point.

Empyema of retained ureteral stump with gross stone 20 years after nephrectomy.

We present a rare case of empyema of the ureteral stump with a large calculus 20 years after nephrectomy for a nonfunctioning kidney secondary to chronic obstruction resulting from a small ureteral stone. The ureteral stump with stone was removed en bloc. We suggest that a ureter with stone should be excised at nephrectomy, especially in cases with a dilated ureter.

[Leaking index--a new urodynamic parameter in the diagnosis of female stress urinary incontinence]. / Wskaznik wyciekania--nowy parametr urodynamiczny w ocenie wysilkowego nietrzymania moczu u kobiet.

UNLABELLED: Stress urinary incontinence is the most prevalent kind of urinary incontinence in women. Treatment efficiency depends on the type of stress urinary incontinence. PURPOSE OF THE STUDY: The purpose of the study was to assess the differences of values of leaking indexes in women with different types of stress urinary incontinence. MATERIAL AND METHODS: 64 patients were hospitalized at Obstetrics and Gynecology Department of Silesian Medical University between 2005 and 2007. All patients included in the study were diagnosed with stress urinary incontinence (SUI) based on medical history clinical evaluation, pad test and urodynamic evaluation. The study population was divided into three groups according to VLPP and MUCP. Leaking indexes were calculated as a quotient of the area under the curve of leakage and the area under the curve of bladder pressure during the Valsalva manoeuvre. RESULTS: The values of leaking indexes and relative leaking indexes in different types of SUI were compared. Statistically significant differences between relative leaking indexes for groups of women divided according to MUCP and VLPP criterion were found. CONCLUSIONS: Judging from statistically significant differences in relative leaking indexes between groups of women with different types of SUI, relative leaking indexes might be of use in differential diagnosis of types of SUI.

A double-blind placebo-controlled study evaluating the onset of action of doxazosin gastrointestinal therapeutic system in the treatment of benign prostatic hyperplasia.

OBJECTIVE: To determine the onset of improvement in benign prostatic hyperplasia symptoms in patients after treatment with doxazosin gastrointestinal therapeutic system (DOX GITS) versus placebo. METHODS: In this prospective, randomized, double-blind, placebo-controlled trial, baseline values, including International Prostate Symptom Score (IPSS) and maximum urine flow rate (Q(max)), were determined following a 2-week placebo run-in. Patients received DOX GITS 4 mg/d (n = 108) or placebo (n = 105) for 14 days. IPSS was measured on Days 3, 7, and 14; Q(max) on Days 1, 3, 7, and 14; and the patients' perception of improvement was measured on Days 1 and 2 in the evening at home and in the office on Day 14. RESULTS: Significantly more patients treated with DOX GITS than placebo perceived improvement after Day 1 (60.6% vs. 41.9%) through Day 14 (84.3% vs. 64.1%). On Day 1, improvement in Q(max) with DOX GITS was not significantly different compared with placebo. On Day 3 of the trial (1) IPSS improvement was significantly greater with DOX GITS than with placebo; (2) proportion of patients with > or =30% improvement in IPSS was significantly greater with DOX GITS (49.5%) than placebo (28.4%) and remained so through Day 14; (3) improvement in Q(max) was significantly greater with DOX GITS (3.7 mL/s) than placebo (1.9 mL/s) and remained so through Day 14; (4) proportion of patients with > or =3 mL/s increase in Q(max) was statistically greater with DOX GITS (54.4%) versus placebo (30.8%) and remained so through Day 14. CONCLUSIONS: DOX GITS significantly improved IPSS and Q(max) by Day 3 of treatment, and these changes were maintained through Day 14. More patients receiving DOX GITS than placebo perceived improvement in symptoms as early as Day 1.

[A comparison between prostatic volume measured during suprapubic ultrasonography (TAUS) and volume of the enucleated gland after open prostatectomy]. / Porównanie objetosci stercza obliczonej za pomoca nadlonowego badania ultrasonograficznego (TAUS) z objetoscia gruczolaka stercza zmierzona metoda wypornosciowa po jego operacyjnym wyluszczeniu.

General practitioner very often uses transabdominal ultrasonograpy (TAUS) in order to measure prostatic volume. Using this method it is rather impossible to distinguish between tissue of benign prostatic hyperplasia (BPH) and prostatic tissue which forms so called surgical capsule of BPH. The aim of this study was a comparison of prostatic volume measured during suprapubic (transabdominal) ultrasonography and volume of the enucleated gland after open prostatectomy. Regarding the results authors created a nomogram based on TAUS measurement of the prostate which helps to predict the volume of BPH. They also stated that surgical capsule of the BPH makes about 1/3 of the whole volume of the prostate measured by TAUS.

Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury.

PURPOSE: We evaluated the efficacy and safety of tamsulosin in patients with neurogenic lower urinary tract dysfunction secondary to suprasacral spinal cord lesions in a 4-week randomized controlled trial (RCT) followed by a 1-year, open label, long-term study. MATERIALS AND METHODS: A total of 263 patients were randomized to 4-week double-blind therapy with placebo, or 0.4 or 0.8 mg tamsulosin once daily. Of these, 244 patients completed the RCT, 186 continued long-term tamsulosin therapy (0.4 or 0.8 mg once daily) and 134 completed 1-year treatment. The primary efficacy parameter was maximum urethral pressure (MUP). RESULTS: Although the mean decrease in MUP at 4 weeks in the RCT did not reach statistical significance over the placebo, it was more pronounced with 0.4 (-12.2 cm H2O or -10%) and 0.8 mg (-9.6 cm H2O or -9%) tamsulosin than placebo (-6.5 cm H2O or -3%). In the long-term study there was a statistically significant mean decrease in MUP (-18.0 cm H2O, p <0.001 or -15%) from baseline to end point. In the long-term study tamsulosin also decreased maximum urethral closure pressure, improved several cystometry parameters related to bladder storage and emptying, and increased to a statistically significantly degree, from baseline to end point, mean voided volume based on the micturition diary. There was statistically significant improvement for the International Prostate Symptom Score Quality of Life, as well as several questions about symptoms related to urinary leakage, and 1 question on bladder emptying and frequency, bother and severity of symptoms of autonomic dysreflexia. Finally, 71% of patients improved according to investigators (44% slightly and 27% much improved). Both doses were effective and well tolerated. CONCLUSIONS: Long-term tamsulosin treatment (0.4 and 0.8 mg once daily) seems to be effective and well tolerated in patients with neurogenic lower urinary tract dysfunction. The results suggest that it improves bladder storage and emptying, and decreases symptoms of autonomic dysreflexia.

Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy.

One hundred patients with benign prostatic hypertrophy (BPH) were randomized to transurethral incision (TUIP) or transurethral resection of the prostate (TURP). The average prostate weight before operation was not more than 30.0 g. Indications for the operations were based on the disease history, physical examination, digital rectal examination, laboratory values, and pressure-flow examination. All operations were performed with patients under spinal anesthesia. TUIP was performed with a Collins knife, and TURP was performed with a resectoscope. Follow-up was performed 24 months after the operations. After treatment there were statistically significant daytime and nocturnal reduction in voiding frequencies of 2.9 and 1.7, respectively, after TUIP, and 2.0 and 1.5 after TURP. In both groups, there occurred significantly better maximal flow rate from 7.6 mL/s to 16.9 mL/s in group I and from 6.9 mL/s to 17.6 mL/s in group II. The mean values of linearized passive urethral resistance relation in both groups significantly decreased from 3.6 +/- 0.6 to 1.0 +/- 0.5 after TUIP and from 3.9 +/- 04 to 1.4 +/- 0.5 after TURP. The TUIP procedure is effective and safe for patients with a small number of complications.