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Maximum Urinary Flow Rate (maximum + urinary_flow_rate)

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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]

A 10-year follow-up after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia; long-term results of a randomized controlled trial

BJU INTERNATIONAL, Issue 6 2010
Robert J. Hoekstra
Study Type , Therapy (RCT) Level of Evidence 1b OBJECTIVE To compare long-term results of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP) and electrovaporization of the prostate (EVAP) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between 1996 and 2001, a prospective, randomized controlled trial was conducted in 150 men with LUTS suggestive of BPH, who had a prostate volume of 20,65 mL and a Schäfer's obstruction grade of ,2. Outcome variables were the International Prostate Symptom Score (IPSS), Quality of Life (QoL) question, Symptom Problem Index (SPI), BPH Impact Index (BII), maximum urinary flow rate (Qmax), prostate volume, prostate specific antigen (PSA) level, morbidity and mortality. In 2008 we carried out a long-term follow-up in these patients. Long-term values were compared with preoperative values for each treatment group (Wilcoxon signed-rank test), differences among groups were analysed (Kruskal,Wallis test) and actuarial failure-rates of the interventions were determined (Kaplan-Meier analysis). RESULTS Although we could account for 91% of the initial participants in 2008, 66 (44%) patients (29 TURP, 20 CLP and 17 EVAP) were available for follow-up measurements after a mean (range) of 10.1(6.9,12.7) years Among the three treatment groups, there were no significant differences in IPSS, QoL, SPI, BII, Qmax, PSA level and prostate volume. The IPSS, QoL, SPI and BII were still improved (P < 0.05) from values before treatment for all treatments. Only in the TURP group were the long-term results of Qmax still improved (P < 0.05). The mortality rate was comparable among the treatments. The 10-year actuarial failure rates (95% confidence interval) were 0.11 (0.03,0.20), 0.22 (0.10,0.35) and 0.23 (0.11,0.35) for TURP, CLP and EVAP, respectively. CONCLUSIONS After a mean follow-up of 10.1 years, there were similar and durable improvements in IPSS, QoL, SPI and BII for patients with LUTS suggestive of BPH after TURP, CLP and EVAP. Between the treatment groups there were no statistically significant differences in Qmax, PSA levels and prostate volume at any time during the follow-up. However, only patients treated with TURP showed minimal durable improvements in Qmax. There was no statistically significant difference in success rate and mortality rate among the three treatments. [source]

Decrease of urinary nerve growth factor levels after antimuscarinic therapy in patients with overactive bladder

BJU INTERNATIONAL, Issue 12 2009
Hsin-Tzu Liu
OBJECTIVE To determine urinary nerve growth factor (NGF) levels in patients with overactive bladder (OAB) and after treatment with antimuscarinics. PATIENTS AND METHODS Urinary NGF levels were measured in 38 ,normal' controls and 70 patients with OAB. Patients were treated with tolterodine 4 mg once daily. Urinary NGF levels were measured by enzyme-linked immunosorbent assay method and normalized by urinary creatinine levels (NGF/Cr). The urinary NGF/Cr levels and urgency severity scale (USS) were compared at baseline, 1, 2 and 3 months after antimuscarinics, and 1 month after discontinuing treatment. RESULTS The urinary NGF/Cr level was very low in normal controls with a mean (sem) of 0.005 (0.003). Patients with OAB had significantly higher baseline urinary NGF/Cr levels than the controls. Urinary NGF/Cr levels were significantly reduced at 3 months in 50 responders (1.10 [0.26] before vs 0.41 [0.09] after, P = 0.008) but not in the 20 non-responders (1.38 [0.54] before vs 1.30 [0.46] after, P = 0.879). However, after discontinuing antimuscarinic treatment for 1 month, the urinary NGF/Cr level was elevated in 23 responders at 0.83 (0.33) and in five non-responders at 2.72 (1.41). The USS scores significantly changed with the change of urinary NGF/Cr levels in responders at different time points. The voided volume increased but maximum urinary flow rate and postvoid residual volume did not increase in responders after 3-months of antimuscarinic treatment. The limitation of this study was the lack of a control arm for comparison. CONCLUSIONS Changes in the urinary NGF levels were associated with the changes of the USS scores after antimuscarinic treatment and discontinued medication. The urinary NGF level could be a potential biomarker for evaluating therapeutic results of antimuscarinics therapy. [source]

The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis

BJU INTERNATIONAL, Issue 1 2007
Benedict T. Blake-James
Authors from the UK present a systematic review of publications on the safety and efficacy of anticholinergics in men with LUTS; they found them to be safe, but suggested that further studies are required to establish precisely their efficacy. Authors from the USA studied the correlation between risk factors for vascular disease and the AUA symptom score; there was a possible association between vascular disease and the development and severity of LUTS in men. OBJECTIVE To assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta-analysis of the reported outcomes. METHODS We searched Medline, Embase and Cochrane databases (1966,2006), and hand-searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted meta- analyses on the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings. RESULTS We identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta-analyses. Anticholinergics did not significantly alter Qmax (0.1 mL/s, 95% confidence interval, CI, 0.6,0.7). The PVR was increased by 11.6 mL (95% CI 4.5,18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12-week follow-up in 365 men in the RCTs and observational studies. CONCLUSION Anticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision. [source]

The pathophysiology of lower urinary tract symptoms after brachytherapy for prostate cancer

BJU INTERNATIONAL, Issue 6 2006
Jerry G. Blaivas
Brachytherapy for prostate cancer has many good effects, but is also associated, like every treatment, with side-effects, some of which have been previously reported in the BJU International. In this section, authors from New York assessed the pathophysiology underlying LUTS which persisted for at least 6 months after brachytherapy, and found a relatively high incidence of detrusor overactivity and other conditions affecting the lower urinary tract. OBJECTIVES To determine the spectrum of pathophysiology underlying the lower urinary tract symptoms (LUTS) persisting for ,,6 months after brachytherapy for localized prostate cancer. PATIENTS AND METHODS A database of men from two practice settings was searched for men who developed LUTS persisting for ,,6 months after completing brachytherapy for localized prostate cancer. Patients were evaluated with a structured history and physical examination, International Prostate Symptom Score (IPSS), 24-h voiding diary, noninvasive free-flow uroflowmetry, postvoid residual urine volume (PVR), cystoscopy and a video-urodynamic study. Specific data collected included symptoms, elapsed time since brachytherapy, Gleason score, IPSS, total number of voids/24 h, maximum voided volume, cystoscopic findings, and urodynamics findings (PVR, maximum urinary flow rate, Schaefer obstruction grade, Watts factor, incidence of detrusor overactivity (DO) urethral obstruction and low bladder compliance). These data were compared with those from a previous study of men with LUTS who did not have prostate cancer. RESULTS The study included 47 men (aged 54,88 years); the median (range) interval between brachytherapy and evaluation was 1.5 (0.5,13) years. Thirty-seven men complained of overactive bladder symptoms (79%), and 31 of incontinence (71%), 21 of obstructive symptoms (44%), and persistent dysuria in 12 (26%). Comparison of urodynamic findings in men with unselected causes of LUTS vs LUTS due to brachytherapy revealed the following comparisons: DO in 252 of 541 (47%) unselected vs 28 of 33 (85%) brachytherapy, (P < 0.001); and urethral obstruction in 374 of 541 (69%) unselected vs 24 of 33 (73%) brachytherapy (P = 0.85). CONCLUSION The pathophysiology and severity of persistent LUTS in men after brachytherapy differs from that of men with LUTS in the general population. Men after brachytherapy have a much higher incidence of DO, prostatic and urethral strictures and prostatic urethral stones. [source]

Chronic prostatitis during puberty

BJU INTERNATIONAL, Issue 4 2006
Yuan Li
OBJECTIVE To investigate the features of chronic prostatitis (CP) during puberty and the effects of biofeedback on young males with this disease. PATIENTS AND METHODS In all, 40 patients were divided into two groups; group 1 included 25 pubertal patients with CP (mean age 16.5 years, sd 1.1) and group 2 was a control group including 15 patients (mean age 16.2 years, sd 1.2) with a normal lower urinary tract. National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores (three parts) were assessed individually in both groups. Expressed prostatic secretions and urine samples after prostate massage from group 1 were cultured to determine whether patients were infected with bacteria, and group 1 was categorized into various NIH types. Each patients in the two groups underwent urodynamics and group 1 were treated with biofeedback. RESULTS In group 1, there were one, three and 21 patients with type II, IIIA and IIIB prostatitis. The incidence of staccato voiding and detrusor-sphincter dyssynergia (DSD), and the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), maximum detrusor pressure (Pdetmax) and maximum urethral closure pressure (MUCP) between the groups were significantly different (P < 0.05). The total NIH-CPSI scores and all the subdomains between the groups before biofeedback were significantly different (P < 0.001). In group 1 the difference in NIH-CPSI scores and Qmax before and after biofeedback was significant (P < 0.05). CONCLUSIONS The main type of CP during puberty is IIIB; the dominating symptom is a voiding disorder. The impact on life and psychological effects are substantial. Pubertal boys with CP have pelvic floor dysfunction and several abnormal urodynamic values, i.e. staccato voiding, DSD, decreasing Qmax, and increasing Pdetmax and MUCP. The effect of biofeedback strategies for treating pubertal CP is satisfactory. [source]

Are conventional pressure-flow measurements dependent upon filled volume?

BJU INTERNATIONAL, Issue 3 2005
Kanagasabai Sahadevan
OBJECTIVE To determine, in a prospective study, whether detrusor pressure (pdet.Qmax) and maximum urinary flow rate (Qmax) measurements obtained after filling to maximum cystometric capacity (MCC) differ from those obtained with filling restricted to average voided volume (Vvoid), as standard protocols for pressure flow studies (PFS) mandate bladder filling until the subject has a strong desire to void, which aids standardization but further divorces the test from real-life experience. PATIENTS AND METHODS After calculating the appropriate sample size, 84 patients attending for PFS with an adequately completed 3-day frequency-volume chart were recruited. Each underwent two consecutive PFS with filling to MCC and average Vvoid in a random order, and measurements of pdet.Qmax and Qmax were compared. For men, the agreement for a diagnosis of obstruction between the tests was also assessed. RESULTS Complete data were obtained from 76 (90%) of the patients, with a mean (range) age of 64 (20,94) years. The mean (sd) difference between MCC and average Vvoid was 134 (113) mL (P < 0.01). There were no significant differences between estimates of Qmax, at ,,0.1 (3) mL/s (P = 0.75), and of pdet.Qmax, at ,,1 (13) cmH2O (P = 0.91), obtained within each patient. For men there was 91% agreement (32 of 35) in the classification of obstruction. CONCLUSIONS Restriction of filling to the average Vvoid during PFS allows a closer approximation to normal voiding and results in no clinically relevant change to the value of standard pressure-flow measurements or alters individual classification of obstruction. [source]

Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in relation to the patient's risk profile for progression

BJU INTERNATIONAL, Issue 2005
John Trachtenberg
SUMMARY Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is a slowly progressing disease, with some patients progressing more rapidly than others. In 80% of patients who progress this is caused by the worsening of symptoms. The physician can predict the risk of progression from the patient's clinical profile; increased symptom severity, a poor maximum urinary flow rate (Qmax), and a high postvoid residual urine volume (PVR), are major risk factors for overall clinical progression of LUTS/BPH. A large baseline prostate volume and a high serum prostate-specific antigen (PSA) level are the predominant risk factors for developing acute urinary retention. After predicting risk, the most appropriate treatment should be established by balancing the benefits of treatment against the possible risks and bother resulting from adverse events. From the Medical Therapy Of Prostatic Symptoms study it can be concluded that monotherapy with an ,1 -adrenoceptor (AR) antagonist is an appropriate treatment for many patients with LUTS/BPH. However, for those at high risk of progression (those with a large prostate volume and high PSA level), it appears more appropriate to add a 5,-reductase inhibitor to the ,1 -AR antagonist to obtain maximum relief of symptoms, and ideally to halt the progression of the disease. This was confirmed by the RAND Appropriateness Method study, in which 12 urologists determined the most appropriate treatment for patients with LUTS/BPH based on their clinical profile, combination of clinical variables and/or risk factors. This study also indicates that patients at very high risk of progression, with severe obstruction (poor Qmax and high PVR), are potential candidates for immediate surgery. [source]

Comparative efficacy of two ,1 -adrenoreceptor antagonists, doxazosin and alfuzosin, in patients with lower urinary tract symptoms from benign prostatic enlargement

BJU INTERNATIONAL, Issue 6 2004
T.M. De Reijke
OBJECTIVES To compare doxazosin and alfuzosin in patients with moderate to severe lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction. PATIENTS AND METHODS In all, 210 men with LUTS were randomized to receive doxazosin 1,8 mg once daily or alfuzosin 5,10 mg divided in two or three daily doses in a 14-week, multicentre, double-blind, baseline-controlled, dose-titration study. The International Prostate Symptom Score (IPSS) and maximum urinary flow rate were used to assess the efficacy of the treatment. RESULTS At study completion, the mean dose of doxazosin was 6.1 mg/day and alfuzosin 8.8 mg/day. The least squares mean (se) change from baseline in total IPSS was ,9.23 (0.6) for doxazosin and ,7.45 (0.6) (both P < 0.001) for alfuzosin. The respective mean change from baseline in irritative symptoms was ,3.5 (0.2) and ,2.8 (0.3) (both P < 0.001). The differences between the treatment groups were statistically significant in favour of doxazosin (total IPSS, P = 0.036; irritative symptoms, P = 0.049). The improvement between groups was also significantly different for postvoid residual urine volume, at ,29.19 (8.6) and +,9.59 (8.9) mL for doxazosin and alfuzosin, respectively (P = 0.002). Improvements in mean and maximum urinary flow rates were similar for both treatments, at +,1.5 and +,1.2, and +,2.8 and +,2.5 mL/s, respectively. Doxazosin and alfuzosin were both well tolerated, with most all-cause adverse events reported as mild or moderate. CONCLUSIONS The mean doses of doxazosin and alfuzosin used in this study were not equipotent. Doxazosin 6.1 mg/day produced significantly greater improvements than alfuzosin 8.8 mg/day in total and irritative urinary symptom scores and postvoid residual urine volume in men with moderate to severe LUTS. Changes in maximum and mean flow rates were comparable. Doxazosin and alfuzosin were both well tolerated. [source]

A 3-year follow-up of a prospective randomized trial comparing transurethral electrovaporization of the prostate with standard transurethral prostatectomy

BJU INTERNATIONAL, Issue 6 2000
M.Y. Hammadeh
Objective To compare the safety, efficacy and durability of transurethral electrovaporization of the prostate (TUVP) with standard transurethral resection of the prostate (TURP). Patients and methods In all, 104 patients admitted from the waiting list for surgery for BPH were randomized to either TUVP (52 patients, mean age 67.5 years) or TURP (52 patients, mean age 70.2 years); 51, 47 and 40 patients in each arm completed 1, 2 and 3 years of follow-up, respectively. Patients were assessed at baseline and during the follow-up using the International Prostate Symptom Score (IPSS), the associated quality-of-life score (QoL), postvoid residual volume (PVR) and maximum urinary flow rate (Qmax). Results Both groups had comparable mean IPSS, QoL, Qmax and PVR at baseline. The mean ( sd) values for TUVP and TURP, respectively, at 3 years showed a significant and maintained improvement in IPSS, at 4.1 (3.3) and 7.1 (6.2) (P = 0.01), in QoL, at 1.0 (0.9) and 1.6 (1.4) (P = 0.04), and in Qmax, at 22.2 (8.5) and 18 (7.1) mL/s (P = 0.02), with decreases in PVR of 30 (38) and 21.9 (26.2) mL (P = 0.27). The re-operation rate in each group was 4% during the first year, 4% during the second year and 5% during the third year. After surgery and at 1, 2 and 3 years of follow-up, impotence was reported in 17% of the TUVP group and 11% of the TURP group (P = 0.49), and retrograde ejaculation in 72% of the TUVP group and 89% of the TURP group (P = 0.47). Conclusion The 3-year follow-up results confirm that TUVP is as effective as standard TURP in the treatment of moderate-sized BPH. The long-term side-effects and complications were comparable and the initial improvement was maintained over 3 years in most patients in both groups. [source]

Comparative efficacy of two ,1 -adrenoreceptor antagonists, doxazosin and alfuzosin, in patients with lower urinary tract symptoms from benign prostatic enlargement