Residual urine in 75-year-old men and women. A normative population study.

The prevalence of residual urine in elderly people in the community is poorly documented. The aim of the present study was to assess the prevalence and range of residual urine in elderly people in the community. As part of a major epidemiologic study (The Glostrup Population Study), 140 75-year-old men and women were included in this study (92 men, 48 women). All were selected at random from the Central Person Register by age and residence. All had a single sonographic measurement of residual urine with a prevoid volume of 150 ml or more. More than 10 ml of residual urine was found in 91 of the 92 men (median 90 ml; range 10-1502 ml), and in 44 of the 48 women (median 45 ml; range 0-180 ml). Our figures correspond to those previously reported in selected patient populations. It must be emphasized, however, that our findings are merely descriptive, as the clinical significance of a single residual urine determination is questionable.

Assessment of lower urinary tract symptoms in women by a self-administered questionnaire: test-retest reliability.

A self-administered questionnaire assessing female lower urinary tract symptoms and their impact on quality of life is described and validated, on 56 females in six participating departments. The patients answered two identical questionnaires on separate occasions before treatment. Test-retest reliability of the questionnaire, correlation between the symptoms and their troublesomeness, and the reproducibility of this correlation were assessed. The percentage of mistakes in answers to each of the questions varied from 1.8% to 49.1%, mainly owing to missing answers in the item groups: appliances, sexual function and social activities. Test-retest showed a repeat frequency of 50.0%-91.0% for symptoms and 44.6%-82.1% for trouble. A highly significant positive correlation was found between symptoms and trouble, which was most pronounced for questions concerning pain and incontinence. This correlation was consistent within time. The primary validation of this questionnaire is good. Its relevance as a basis for medical priority and clinical decision making remains to be investigated.

[Costs of the treatment of enuresis nocturna. Health economic consequences of alternative methods in the treatment of enuresis nocturna]. / Omkostningerne ved behandling af enuresis nocturna. Samfundsøkonomiske konsekvenser af alternative metoder til behandling af enuresis nocturna.

The health economic consequences of treating nocturnal enuresis with a buzzer alarm is compared to treatment with Desmopressin. Based on age specific prevalence estimates and reported effects of the two treatments a cost-effectiveness analysis (CEA) was performed. The analysis showed a considerable difference between the costs of the two alternative treatments. A treatment based upon the buzzer alarm could result in a net saving to society of 19.2 million DKK, while a treatment based upon Desmopressin could result in expenses for society of 44.8 million DKK. A treatment based on a combination of the two will be economically neutral to the society. Treatment with a buzzer alarm or a combined treatment is therefore from a health economic point of view preferable. The health economic consequences of the introduction of new treatments are discussed, and it is recommended that health economic analyses are performed before the introduction of new treatments.

Trends in a Danish urologic department during the years 1979 and 1984.

During recent years several international studies have shown increasing rates of prostatectomy over the past decade. In Denmark the number of prostatectomies increased by 43% in the period 1977-85. This development is still unexplained, but one of the answers is very intriguing, proposing a shift in indications for prostatectomy. Therefore we retrospectively examined the records of 207 patients in 1979 and 243 patients in 1984, admitted with a diagnosis of benign hyperplasia of the prostate (BPH). In these patients respectively 164 and 149 prostatectomies were performed in the same years, at the Department of Urology, Glostrup County hospital. We found no evidence of a change in indications towards a more liberal attitude as suspected, but in contrast, we discovered a more conservative attitude. Because the national rates since 1984 have been stable, we conclude, that the development in a specialized urologic Department can serve as a predictor for the development on a larger national scale.

Prostatectomy in Denmark. Regional variation and the diffusion of medical technology 1977-1985.

In many countries prostatectomy is one of the most common surgical operations in elderly men. We used administrative data for the entire male population of Denmark to study temporal and regional variations in the use of prostatectomy from 1977 to 1985. The total annual number of prostatectomies increased by 43% during the period, when the transurethral procedure (TURP) gradually replaced traditional open surgery. TURP accounted for 56% of all operations in 1977 but increased its share to 92% in 1985. Substantial regional variations occurred with index values for prostatectomy in 72 recruitment areas ranging from 0.56 to 1.62 (SCV x 100 = 5.3). The amount of variation decreased during the process of technology diffusion, but remained at a relatively high level (as in other countries) even after the process had been completed (SCV x 100 = 5.1).

Elevated mortality following transurethral resection of the prostate for benign hypertrophy! But why?

This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

Coping with regional variations: the case of surgery in Denmark.

This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.