Parenteral polyoestradiol phosphate vs orchidectomy in the treatment of advanced prostatic cancer. Efficacy and cardiovascular complications: a 2-year follow-up report of a national, prospective prostatic cancer study. Finnprostate Group.

OBJECTIVE: To evaluate the clinical efficacy and cardiovascular complications of orchidectomy or polyoestradiol phosphate (PEP) in the treatment of advanced prostatic cancer. PATIENTS AND METHODS: In a prospective, randomized study 444 patients (mean age 73 years, range 45-91) with T3-4 M0 or T1-4 M1 prostatic cancer were treated either by orchidectomy (group 1, n = 217) or parenteral PEP (group 2, n = 227; 240 mg/month). The patients were examined at 3 and 6 months after start of the therapy and thereafter every 6 months; they were also assessed whenever they had symptoms indicating progression. Possible cardiovascular complications included myocardial infarction, cerebrovascular accident, pulmonary embolism and deep vein thrombosis. RESULTS: After a follow-up of 2 years there was no statistically significant difference between the groups in progression-free time; 65 of 217 (30%) patients in group 1 showed evidence of progression, including seven (3%) who died from prostate cancer. In group 2, 64 of 227 (28%) patients showed progression and eight (3.5%) died from prostatic cancer. There were 10 (5%) cardiovascular complications in patients in group 1, including five (2%) cardiovascular deaths; in group 2 there were 24 (11%) and 14 (6%), respectively. During the first year of treatment there were three (1.4%) cardiovascular complications in group 1 and 14 (6%) in group 2 (P < 0.05), and during the second year, seven (4%) and 10 (6%), respectively. CONCLUSION: Parenteral PEP (240 mg/month) seems to be as efficient as orchidectomy in inhibiting disease in patients with advanced prostatic cancer (T3-4 M0 and T1-4 M1). There were more cardiovascular complications in patients treated with PEP than after orchidectomy; the difference was statistically significant during the first year of treatment.

Duplex Doppler scanning with prostaglandin E1 in the diagnosis of cavernovenous leakage.

The aim of this study was to find out the normal response of the duplex Doppler (DD) parameter resistance index (RI) during a high dose prostaglandin E1 (40 micrograms) induced erection and to evaluate the clinical usefulness of DD scanning in the diagnosis of cavernovenous leakage (CVL). The results of DD scanning and cavernometry were compared in 10 potent control subjects and 82 impotent patients RI was > or = 1 in all control subjects later than 10 min after the intracavernous injection and RI at 20 min after the injection (RI20) was chosen as a clinical parameter. An inverse correlation (r = -0.69, p < 0.001) between RI20 and the maintenance flow (MF) at 150 mm Hg (MF150) was demonstrated. Sensitivity and specificity of RI20 (values < 1 indicating CVL) as a test of CVL (MF150 > 18 ml/min) were 89% and 86%, respectively. In conclusion, the measurement of RI20 in DD scanning after an adequate pharmaco-stimulation is a reliable, noninvasive method in the diagnosis of CVL.

Cardiovascular reflexes in the neurological evaluation of impotence.

Testing of the autonomic cardiovascular reflexes (single breath beat-to-beat variation and orthostatic blood pressure change) was performed in 542 patients with erectile dysfunction who were grouped according to aetiological factors and their response to visual sexual stimulation and the papaverine test. Age-related normal values for autonomic tests were determined in the group of 124 patients with psychogenic impotence. Abnormal cardiovascular reflexes were associated with ageing and organic impotence, indicating autonomic dysfunction as a major contribution to impotence. Single breath beat-to-beat variation, as a simple non-invasive test, is useful in the clinical evaluation of impotence, especially in patients with diabetes and a history of alcohol abuse.

Duplex Doppler scanning with high-dose prostaglandin E1 stimulation in the diagnosis of arteriogenic impotence.

The aim of this study was to find out the normal range of penile duplex Doppler parameters with pharmacostimulation of 40 micrograms prostaglandin E1 and to assess the repeatability and clinical value of the method. Maximal systolic velocity increase (SVImax) is presented as a new flow parameter. 10 potent and 82 impotent patients were investigated. Peak systolic velocity values were significantly higher when recorded at proximal than at distal penis. Repeatability of SVImax was fairly good (coefficient of variation = 0.18). SVImax ranged from 32 to 100 cm/s in 10 control subjects. The distribution of SVImax values in patients grouped according to the number of arteriosclerotic risk factors indicates that this parameter may be useful in the diagnosis of arteriogenic impotence.

Pharmacocavernometry with prostaglandin E1.

The aim of this study was to define the normal response of cavernometry parameters with high-dose pharmacostimulation, to investigate repeatability of the method and to find out the incidence of cavernovenous leakage in impotence. 82 consecutive impotent patients and 10 potent control subjects underwent pharmacocavernometry with 40 micrograms of prostaglandin E1. In control subjects, the maintenance flow at 150 mm Hg (MF150) was 3-22 ml/min with an average of 6 ml/min (SD = 6 ml/min). Cavernometry was repeated in 17 patients, but the repeatability of quantitative parameters was disappointing. Cavernovenous leakage was estimated to be present in 55-67% of all impotent patients. Cavernometry with a high-dose prostaglandin E1 pharmacostimulation is a useful method in selected patients, but the consistency of the method should be improved.

Biocompatibility of urinary catheters--present status.

Biocompatibility aspects of urinary catheters have been recognized by clinicians during the 1980's. After multiple reports of severe urethral damage caused by latex catheters, a series of investigations revealed that toxic substances added to the catheters during the manufacturing process can leak from the devices in situ and cause urethritis developing severe urethral strictures. Consequently, most manufacturers have improved their catheters, but there are still some catheters of inferior quality on the market. Quality is dependent on the biocompatibility testing methods. Cell culture tests are recommended, but there are no common standards regarding these. British Standards Institution has been the first in Europe to adopt toxicity limits for a cell culture test, but those are not acceptable. It is a task for the standardization committees working for the European Community to create adequate biocompatibility testing standards with clinically relevant toxicity limits. If this is not done, the use of latex catheters should be abandoned as potentially harmful devices.

Efficacy and side-effects of prazosin as a symptomatic treatment of benign prostatic obstruction.

This randomized double-blind crossover trial was conducted to assess the effects of prazosin, an alpha 1-adrenoceptor blocking drug, on the voiding of 35 patients with benign prostatic obstruction. Maximum and mean flow rates, residual urine, blood pressure and heart rate were measured at baseline and 2, 4, 6, and 8 weeks after starting the treatment with placebo or prazosin. At 4 weeks the treatments were switched over. The patients filled micturition charts at home and scored their voiding associated feelings. The maximum and mean flow rates increased significantly during prazosin treatment, as also did the maximum and mean voided volumes. Residual urine decreased and voiding improved subjectively but these changes were not statistically significant. Blood pressure was lowered and heart rate increased. Prazosin caused postural dizziness more often than placebo. Prazosin seems to offer an alternative to improve voiding in some patients with prostatic obstruction.

The value of basic investigations in the diagnosis of impotence.

172 patients with impotence symptoms were investigated by SBBBV-test, orthostatic blood pressure, Doppler examination of the superficial and deep penile arteries, penile-brachial index, visual sexual stimulation, papaverin test, and measurement of bulbocavernous reflex latency time. Visual sexual stimulation and papaverin test correlated well with each other, and so did papaverin test and PBI in cases of arterial insufficiency. SBBBV was simple to perform and useful in detecting autonomic neuropathy. There were characteristic differences in the pattern of erectile failure between young and old patients. The differentiation to organic or psychogenic erectile failure was easier in the young age groups, whereas the old patients more often had a combination of vascular and psychogenic aetiology.

Bladder outlet surgery in men with spinal cord injury.

The effect of bladder outlet surgery on voiding ability, changes in the upper urinary tract and urinary infections was studied in 51 men with spinal cord injury. In 24 patients reoperation was required after varying periods of time to achieve satisfactory bladder voiding. Eight of the 22 men who had undergone external sphincterotomy had constant dribbling of urine postoperatively. Dilation of the upper urinary tract was completely reversed or reduced in 13 of 18 patients following the primary operation on the bladder outlet. Vesico-ureteric reflux was found in 6 of the 8 men in whom deterioration of the upper urinary tract persisted after the initial operation or appeared during the follow-up years. Bacteriuria usually persisted, despite bladder outlet surgery, but febrile attacks of urinary tract infection ceased or became less frequent in 15 of the 22 patients who had experienced such episodes preoperatively.