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Prostatic Obstruction (prostatic + obstruction)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Prostatic Obstruction

  • benign prostatic obstruction
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    Selected Abstracts

    Urodynamic standardization in a large-scale, multicenter clinical trial examining the effects of daily tadalafil in men with lower urinary tract symptoms with or without benign prostatic obstruction,

    NEUROUROLOGY AND URODYNAMICS, Issue 5 2010
    Stephen R. Kraus
    Abstract Aims To present the methodology, standardization techniques, and results from post hoc test,retest reproducibility analyses for a large, placebo-controlled, multicenter trial, employing urodynamic studies (UDS) to assess the impact of daily tadalafil on men with lower urinary tract symptoms (LUTS) with or without benign prostatic obstruction (BPO). Methods UDS implemented International Continence Society (ICS) Good Urodynamic Practice guidelines and standardized urodynamic and LUTS terminology. Further standardization procedures included: equipment calibration; a detailed procedure manual and centralized training; and implementation of a central reader. Measures included: monitoring of invalid studies, comparison of actual versus expected standard deviation (SD) for primary outcome (detrusor pressure at maximum urinary flow rate [pdetQmax]), and test,retest reproducibility of the placebo arm at baseline and endpoint. Results Two hundred men with moderate to severe LUTS (baseline IPSS ,13) at 20 sites were randomized to receive either tadalafil 20,mg or placebo. All men underwent non-invasive uroflow and pressure-flow studies. Numbers of invalid studies at baseline and endpoint were 9.3% and 0.6%, respectively. Variability of pdetQmax was lower than anticipated based on actual versus expected SD of 15 and 30, respectively. Correlation coefficients were very good for pressure-flow parameters including pdetQmax (r,=,.83). Conclusions Multicenter clinical trials using urodynamic outcomes require additional standardized procedures to limit inter-site variability. By implementing centralized training with a detailed procedure manual and use of a central reader, we were able to limit common difficulties arising in multicenter clinical trials, as well as demonstrate good test,retest reproducibility of pressure flow measures. Neurourol. Urodynam. 29:741,747, 2010. © 2010 Wiley-Liss, Inc. [source]

    The comparative pressure-flow plot properties of radiological bladder neck and prostatic obstruction

    BJU INTERNATIONAL, Issue 11 2009
    Sanjin Idriz
    OBJECTIVES To test the hypotheses that: (i) significant differences should exist in pressure/flow data between radiologically determined bladder neck and prostatic obstruction; (ii) these differences should inform understanding of the pathophysiology of male outflow obstruction. The biomechanics of the voiding/pressure/flow plot imply that a urodynamic assessment trace should identify outflow obstruction and characterise the urethral viscoelastic properties. Micturating cystourethrograms (MCUG) images might provide a useful diagnostic dichotomy for testing these assumptions. MATERIALS AND METHODS The pressure/flow data from 71 men who also provided video-urodynamic imaging data that a radiologist could classify unequivocally as showing bladder neck obstruction (42) or prostatic obstruction (29) were analysed. The following variables were recorded: the detrusor pressure at initiation of voiding (Pdet.open); the detrusor pressure at the end of voiding (Pdet.close); the detrusor pressure at maximum flow rate (Qmax), (Pdet.Qmax), and Qmax. The urethral resistance relation (URR) was drawn onto the pressure-flow plot and the gradient of the URR, ,Pdet/,Q, was calculated. RESULTS There were significant between group differences in Pdet.open (95% confidence interval of the difference 5.2,28.6, U = 352, P = 0.003); Pdet.close (0.2,15.0, U = 428, P = 0.034); Pdet.Qmax (0.0,18.9, U = 439, P = 0.05); Qmax and ,Pdet/,Q did not distinguish between the MCUG groups (95% confidence interval of the difference 2.3,18, U = 111; P = 0.004). The best-fit model from linear combinations of the data achieved an area under the receiver operator curve of 0.72 for discriminating between the MCUG groups. CONCLUSIONS The urodynamic assessment identified interesting and coherent biomechanical differences, and could distinguish between the obstructions with a moderate degree of accuracy. [source]

    Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effects

    BJU INTERNATIONAL, Issue 9 2004
    Roderick MacDonald
    The first paper in this section is a systematic review of the efficacy and adverse effects of doxazosin for treating LUTS compatible with benign prostatic obstruction. The criteria for inclusion were met by 13 studies involving 6033 men. The authors found evidence that doxazosin was effective and well tolerated in patients with LUTS. Combined therapy was superior to doxazosin alone in reducing the risk of clinical progression and other long-term complications of this condition. Authors from the UK reviewed the long-term results they achieved with an endourethral stent for treating BPH; quite a large proportion of patients had either died from unrelated causes or had had the stent removed. They stressed the necessity for careful case selection, but showed that it was a safe treatment for BPH in poor-risk patients. OBJECTIVE To evaluate the efficacy and adverse effects of doxazosin for treating lower urinary tract symptoms (LUTS) compatible with benign prostatic obstruction (BPO). METHODS Randomized controlled trials were included in the meta-analysis if: the study duration was ,,1 month; the study involved men with symptomatic BPO; and doxazosin was compared with placebo or active controls. Study and patient characteristics and outcome data were extracted in duplicate onto standardized forms using a prospectively developed protocol. RESULTS Thirteen studies involving 6033 men with (mean age 64 years) met the inclusion criteria; 10 were placebo-controlled, including two with combined doxazosin/finasteride therapy and finasteride monotherapy arms. Three trials were a comparison with other ,-blockers. The study duration was 1,54 months. The mean baseline symptom scores and peak urinary flow (PUF) rates were indicative of moderate BPO. Doxazosin gave significant improvements in LUTS, assessed by symptom scores, vs placebo and finasteride in the short- to long-term. Two long-term studies (1 and 4 years) reported mean changes from baseline for the International Prostate Symptom Score of ,,8.3 and ,,6.6 points (,49% and ,,39%) for doxazosin and ,,5.7 and ,,4.9 points (,33% and ,,29%) for placebo, respectively. Doxazosin significantly increased PUF rates vs placebo. In pooled results from three studies, the weighted mean difference in the mean change from baseline vs placebo was 1.6 mL/s (95% confidence interval 1.2,2.1). Efficacy was comparable with other ,1,blockers. In the long-term (>4 years) doxazosin was no better then finasteride in improving PUF. Combined doxazosin and finasteride significantly reduced the risk of overall clinical progression of BPO vs each drug separately in men followed for >4 years. Absolute risk reductions vs placebo were 11.3%, 6.9% and 6.4% for combined therapy, doxazosin and finasteride, respectively (P < 0.001). Improvements in symptom scores and PUF were also significantly greater with combined than monotherapy, and the former reduced the need for invasive treatment for BPO and the risk of long-term urinary retention, although the absolute reductions in risk vs placebo were small (<4%). Dizziness and fatigue were significantly more common with doxazosin than placebo (11% vs 7%, and 6% vs 3%, respectively). Adverse events reported for combined therapy were similar to those with each monotherapy. CONCLUSION The evidence indicates that doxazosin is effective and generally well tolerated for improving LUTS and PUF in men with symptomatic BPO. Combined therapy was better than doxazosin alone in reducing the risk of clinical progression of BPO and other long-term complications related to BPO. [source]

    An endoscopic injection device: a potential advance in the transurethral treatment of benign prostatic obstruction

    BJU INTERNATIONAL, Issue 1 2003
    J. Ditrolio
    No abstract is available for this article. [source]

    Terazosin for treating symptomatic benign prostatic obstruction: a systematic review of efficacy and adverse effects

    BJU INTERNATIONAL, Issue 3 2002
    T.J. Wilt
    Objective To systematically review and evaluate the effectiveness and adverse effects of the ,-antagonist, terazosin, for treating urinary symptoms associated with benign prostatic obstruction (BPO). Methods Studies were sought and included in the review if they were randomized trials of at least 1 month duration, involved men with symptomatic BPO and compared terazosin with placebo or active controls. The study, patient characteristics and outcome data were extracted in duplicate onto standardized forms using a prospectively developed protocol. Results Seventeen studies involving 5151 men met the inclusion criteria, i.e. placebo-controlled (10), ,-blockers (seven), finasteride alone or combined with terazosin and placebo (one), and microwave therapy (one). The study duration was 4,52 weeks; the mean age of the men was 65 years and 82% were white. Baseline urological symptom scale scores and flow rates showed that men had moderate BPO. Efficacy outcomes were rarely reported in a way that allowed for data pooling, but indicated that terazosin improved symptom scores and flow rates more than did placebo or finasteride, and similarly to other ,-antagonists. The pooled mean percentage improvement for the Boyarsky symptom score was 37% for terazosin and 15% for placebo (four studies). The mean percentage improvement for the American Urological Association symptom score was 38%, compared with 17% and 20% for placebo and finasteride, respectively (two studies). The pooled mean improvement in the International Prostate Symptom Score of 40% was similar to that with tamsulosin (43%). Peak urinary flow rates improved more with terazosin (22%) than with placebo (11%) and finasteride (15%), but did not differ significantly from the other ,-antagonists. The percentage of men discontinuing terazosin was comparable with those receiving placebo and finasteride, but greater than with other ,-antagonists. Adverse effects were greater than with placebo and included dizziness, asthenia, headache and postural hypotension. Conclusions The available evidence indicates that terazosin improves the symptoms and flow rates associated with BPO; it was more effective than placebo or finasteride and similar to other ,-antagonists. Adverse effects were generally mild but more frequent than with other ,-antagonists and associated with a two- to four-fold increase in treatment discontinuation. [source]