Increase In Peak Flow Rate Research Articles

Transperineal microwave thermoablation for benign prostatic hyperplasia-related lower urinary tract symptoms in an elderly patient.

Transperineal prostate microwave thermoablation (TPMT) has been established as a safe means of treating benign prostatic hyperplasia (BPH); however, its effectiveness in addressing BPH-related lower urinary tract symptoms (LUTS) remains unexplored. This case study aims to evaluate the efficacy of TPMT in LUTS attributed to BPH. An 84-year-old man with LUTS due to BPH-induced bladder outlet obstruction, unresponsive to previous medical treatments, and failed prostate artery embolization, underwent TPMT. Three coaxial needles were positioned at the midline, right, and left sides of the hypertrophic transitional zone of the prostate. Microwave energy, with parameters determined using liver data and targeted ablation area, was applied at 2,450 MHz in continuous mode. The tissue temperature was monitored using bilateral thermocouple sensors. The patient exhibited no changes in defecation rhythm, abdominal discomfort, or anorectal pain. Temporary postoperative hematuria was promptly resolved through saline irrigation within 6 hours, and hematological evaluations showed normal results. Significant clinical improvements were observed (e.g., prostate volume, prostate-specific antigen levels) accompanied by an increase in peak flow rate. Thus, TPMT appears to be a promising intervention for bladder outlet stenosis and LUTS induced by BPH.

Aerodynamic measures of patients with tracheostomy capping before and after decannulation

BackgroundGradually stepped decannulation, such as capping with fenestrated tubes or tube downsizing, is likely to prolong the decannulation process. The purpose of the study is to determine the differences in laryngeal aerodynamic measures, expiratory peak flow, and dyspnea index when breathing through the upper airway before and after decannulation. The study recruited sixteen adult patients with a tracheostomy who were fit for decannulation. Measurement of peak flow rate, aerodynamic measures, and dyspnea index has been done at two settings: first during capping and second after decannulation by 2 h using finger support to close the stoma and prevent air leak.ResultsChanges in outcome measures after decannulation revealed a significant increase in peak flow rate, vital capacity, maximum phonation, and phonatory speech pressure level; the glottal resistance significantly decreased after decannulation. The dyspnea severity index scores improved from 22.35 during capping to 13.37 after decannulation.ConclusionsThe results of our study showed that tracheostomy tube capping causes a significant reduction in peak flow and aerodynamic measures which improved after tracheostomy decannulation.

LOW IMPACT DEVELOPMENT MODELING TO MANAGE URBAN STORMWATER RUNOFF: CASE STUDY OF GORZÓW WIELKOPOLSK

Uncontrolled urbanization causes local flooding and deterioration of the water quality of receivers as a result of an increase in peak flow rate and increased washing out of contaminants from the catchment area. Currently, classic storage tanks are most often used. An alternative solution may be the use of Low Impact Development (LID), i.e. the preservation and restoration of natural landscape elements, minimizing the imperviousness of the catchment in the form of rain barrels, permeable walkways or bio-retention reservoirs. The comparison of both techniques was carried out using the Environmental Protection Agency Storm Water Management Model (EPA SWMM). The influence of several solutions on a selected urbanized catchment located in Gorzów Wielkopolski was tested.

New complexes of inhaled furosemide and cyclodextrin: assessment of the bronchodilator effect

ObjectivesThe objective of this study was to investigate the efficacy in children of nebulised furosemide administered singly or in combination with β-cyclodextrins (β-CDs) on asthma exacerbations.MethodsA single-blinded randomised controlled study...

Investigating effects of low impact development on surface runoff and TSS with a calibrated hydrodynamic model

The land development and increase in urbanization in a watershed affect water quantity and water quality. Especially, uncontrolled urbanization causes flood and poor water quality which results in an increase in peak flow rate and in Total Suspended Solid (TSS) concentration. Low Impact Development (LID) is a Best Management Practice (BMP) and land planning method which may be used to manage storm water runoff in order to reduce flooding as well as simultaneously improve water quality. In this study, the impact of LID-BMP on surface runoff and TSS is investigated by employing a calibrated hydrodynamic model for Sazlidere Watershed which is located in Istanbul, Turkey. For this purpose, a calibrated hydrodynamic model was developed by using Environmental Protection Agency Storm Water Management Model (EPA SWMM). For model calibration and validation, a rain gauge and a flow meter are set into the field and rainfall and flow rate data are obtained. And then, several LID types are selected such as retention basins, vegetative swales and permeable pavement and their influence on peak flow rate and pollutant buildup and washoff for TSS are obtained. Consequently, the possible effects of LID on surface runoff and TSS in Sazlidere Watershed are observed.

Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction.

The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following high-energy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes.

A prospective randomized study comparing alfuzosin and tamsulosin in the management of patients suffering from acute urinary retention caused by benign prostatic hyperplasia.

Objective:Prospective randomized study to compare the efficacy and safety of alfuzosin and tamsulosin in patients suffering from acute urinary retention caused by benign prostatic hyperplasia (BPH).Methods:Patients with acute urinary retention (AUR) due to BPH (total 150) were catheterized and randomized into three groups: Group A: alfuzosin 10 mg (50 patients), Group B: tamsulosin 0.4 mg (50 patients), Group C: placebo (50 patients). After three days, catheter was removed, and patients were put on trial without catheter (TWOC). Patients with successful TWOC were followed up for three months, taking into account the prostate symptom score (AUA Score), post-void residual urine volume (PVRV), and peak flow rate (PFR). ANOVA was used for statistical analysis.Results:Both group A (alfuzosin) and group B (tamsulosin) had similar results of TWOC (group A – 66%, group B – 70%), which were significantly superior than group C (placebo) – 36%. In follow up, three (9.1%) patients in group A, three (8.6%) patients in group B and eight (44.4%) patients in group C had retention of urine, requiring recatheterization. These patients were withdrawn from the study. After three months, alfuzosin- or tamsulosin-treated patients showed a significant decrease in AUA score and PVRV; and a significant increase in PFR as compared to placebo.Conclusions:TWOC was more successful in men treated with either alfuzosin or tamsulosin and the subsequent need for recatheterization was also reduced. Tamsulosin was comparable to alfuzosin in all respects, except a small but significant side effect of retrograde ejaculation.

Efficacy of nebulized furosemide in children with moderate attack of asthma

Bronchodilators are the most commonly used drugs for asthma. However, alternative treatment is necessary for those patients who experience adverse effects from bronchodilators. To investigate the efficacy of nebulized furosemide in children with moderate asthma exacerbations. A double-blind randomized, controlled trial involving three groups of children with moderate attack of asthma. Twenty children were enrolled in group A and received nebulized albuterol, 20 children in group B received nebulized furosemide and 19 children in group C received both albuterol and furosemide. Pulmonary function parameters, peak flow rates, respiratory rate, oxygen saturation and clinical scores were obtained before and after treatment. The maximum increases in FEV1 achieved were 21.1 +/- 4.6 %, 20.8 +/- 3.2 and 21.7 +/- 4.9 in groups A, B and C respectively. The differences between the groups were not significant. Maximum increase in FVC was 20.3 +/- 1.6, 22.5 +/- 5.8 % and 24.5 +/- 4.9 % in groups B and C respectively. The difference between the three groups was not statistically significant. With regards to peak expiratory flow rate (PEFR), the mean increase after treatment was 23.5 +/- 8.6% and 21.8 +/- 6.3% in groups A and B respectively. There was significant increase in PEFR in group C children (26.0 +/- 9.1%; p = 0.01). There was no statistical significant difference among the three groups regarding the improvement in respiratory rate, SaO2 and clinical scores. Combination of both furosemide and albuterol led to significant increase in peak flow rate but it did not significantly affect FEV1, FVC, FEF 25-75, respiratory rate, SaO2 or clinical scores as compared to other groups. There were no significant adverse effects from the three drugs used.

Relationship of the International Prostate Symptom score with urinary flow studies, and catheterization rates following 125I prostate brachytherapy

Purpose Prostate cancer patients undergoing 125I brachytherapy were reviewed. A relationship between pretreatment risk factors including International Prostate Symptom (IPS) score, urinary flow studies, and posttreatment urinary morbidity was assessed. Methods and materials Pretreatment IPS scores and urinary flow studies on 207 patients were reviewed. Relationship between scores and acute urinary morbidity was evaluated. Results Median age, 64 years; median baseline IPS score, 9; median prostate volume, 36 cc. Catheterization was required in 18% of patients. Baseline IPS score and peak flow rate (PFR) varied inversely, demonstrating that PFR for patients requiring a catheter was lower than that for those not requiring catheterization. Univariate regression showed that prostate volume, prior hormone therapy, and PFR were statistically predictive of postimplant urinary retention. For every one-unit increase in PFR, the odds of catheterization decreased by 6%. Multivariate analysis demonstrated that only PFR and prostate volume were predictive of postimplant urinary retention. Conclusions Pretreatment IPS questionnaire and urinary flow studies assist in predicting risk of urinary morbidity and retention post- 125I brachytherapy for prostate cancer.

203 Permanent radioiodine seed implant in clinically localized prostate cancer: Preliminary results of first 12 months of experience at Cancer Care Manitoba

look for a possible relationship between pre-treatment risk factors, including the International Prostate Symptom (IPS) score, urinary flow studies, and post-treatment urinary toxicity. Methods: Data on 215 patients undergoing brachytherapy was reviewed. All patients had pre-treatment IPS scores and urinary flow studies. The relationship between these scores and acute urinary toxicity, as indicated by post-treatment catheterization, was evaluated. Results: Mean patient age was 64 years, mean baseline IPS score was 9, and mean prostate volume was 38 cc. 12% had prior hormone therapy to downsize the prostate. 18% required insertion of a urinary catheter at any time after the brachytherapy procedure. There is an inverse relationship between the baseline IPS score and peak flow rate (PFR). PFR score for those patients requiring a catheter post-treatment was less than for those not requiring a catheter. Using a univariate logistic regression model, total IPS score was not a predictor of retention (p-value=0.85), nor was age, volume voided or post void residual; however, prostate volume (p<0.001), prior hormones (p<0.001) and PFR were predictive (p=0.011). For every 10-unit increase in PFR, the odds of catheterization decreased by 54% (e.g. 1-0.46) (95% confidence interval 0.25-0.84). In multivariate analysis, only prostate volume (p=0.005) and peak flow rate (p=0.003) were predictive. Conclusions: For patients undergoing treatment with I 125 brachytherapy for early stage prostate cancer, the pretreatment IPS questionnaire and urinary flow studies can assist in predicting who will be at increased risk of urinary toxicity and urinary retention post brachytherapy.

Flow-mediated dilation in human brachial artery after different circulatory occlusion conditions.

Different magnitudes and durations of postocclusion reactive hyperemia were achieved by occluding different volumes of tissue with and without ischemic exercise to test the hypotheses that flow-mediated dilation (FMD) of the brachial artery would depend on the increase in peak flow rate or shear stress and that the position of the occlusion cuff would affect the response. The brachial artery FMD response was observed by high-frequency ultrasound imaging with curve fitting to minimize the effects of random measurement error in eight healthy, young, nonsmoking men. Reactive hyperemia was graded by 5-min occlusion distal to the measurement site at the wrist and the forearm and proximal to the site in the upper arm. Flow was further increased by exercise during occlusion at the wrist and forearm positions. For the two wrist occlusion conditions, flow increased eightfold and FMD was only 1 to 2% (P > 0.05). After the forearm and upper arm occlusions, blood flow was almost identical but FMD after forearm occlusions was 3.4% (P < 0.05), whereas it was significantly greater (6.6%, P < 0.05) and more prolonged after proximal occlusion. Forearm occlusion plus exercise caused a greater and more prolonged increase in blood flow, yet FMD (7.0%) was qualitatively and quantitatively similar to that after proximal occlusion. Overall, the magnitude of FMD was significantly correlated with peak forearm blood flow (r = 0.59, P < 0.001), peak shear rate (r = 0.49, P < 0.002), and total 5-min reactive hyperemia (r = 0.52, P < 0.001). The prolonged FMD after upper arm occlusion suggests that the mechanism for FMD differs with occlusion cuff position.

Method for manipulating peak flow measurements producing falsely raised readings

Methods by which patients can artificially produce raised peak flow measurements have been described. We recently observed a patient manipulating the peak flow meter in a way that had not been described before. A study was therefore undertaken to determine if this technique could repeatedly produce clinically significant changes in peak flow readings. Fifteen adults, using a mini-Wright peak flow meter, made five measurements using the correct technique followed by five manipulated measurements under observation. Significant increases in peak flow measurements were observed in 14 of the 15 subjects. The mean increase in peak flow rate using the incorrect technique was 56% (range –4% to 86%). Clinicians should be aware that patients might employ this technique to manipulate measurements which could have consequences for management.

HIGH POWER POTASSIUM-TITANYL-PHOSPHATE LASER VAPORIZATION PROSTATECTOMY

We prospectively studied a cumulative cohort of men with obstructive benign prostatic hyperplasia who underwent potassium-titanyl-phosphate (KTP) laser vaporization prostatectomy to determine the safety and efficacy of this procedure. A total of 55 men with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia were treated with a 60 W. KTP laser produced by a prototype Laserscopedagger generator and delivered through a side-deflecting fiber with a 22Fr continuous flow cystoscope. Sterile water was used for irrigation. The prostatic lobes were vaporized to within capsular fibers. Mean lasing time plus or minus standard deviation was 44 +/- 19 minutes. Mean prostate volume plus or minus standard deviation was 43 +/- 14 ml. No patient had any significant blood loss or fluid absorption, or required blood transfusion. Foley catheters did not require irrigation and were removed less than 24 hours postoperatively. All patients remained satisfied with voiding outcome, which changed significantly (p <0.0001). Mean improvement in American Urological Association symptom score at 3, 6, 12 and 24-month intervals was 75%, 79%, 82% and 82%, respectively. Mean increase in peak flow rate at the same intervals was 250%, 242%, 255% and 278%, respectively. Complications included mild transient dysuria in 7%, bladder neck contracture in 2% and delayed hematuria in 4% of patients. None of the patients required re-catheterization or reoperation, or had incontinence or newly developed impotence. Of the sexually active patients 15% and 9% had retrograde ejaculation at 1 and 2 years, respectively. Our observation in a 2-year period indicates that 60 W. KTP laser vaporization prostatectomy is safe and effective for quickly relieving bladder outlet obstruction with minimal postoperative complications, a high rate of patient satisfaction and, to date, a generally good outcome.

TURP with the New Superpulsed Radiofrequency Energy:Mo re than a Gold Standard

Objective: Superpulsed radiofrequency, a new energy, has been developed and applied in transurethral resection of the prostate (TURP) using a regular cutting loop. The aim of the study was to evaluate the clinical application of superpulsed radiofrequency to reduce bleeding morbidity and to improve patient outcome. The original results of the experimental and clinical study are presented. Methods: From November 1997 to June 1998, 37 patients were submitted to a clinical, nonrandomized study. The age range was 45–81 years. All patients completed the International Prostate Symptom Score (IPSS) and were examined using digital rectal examination, prostate-specific antigen level, transrectal ultrasound, free uroflow, and urodynamic pressure flow study. Hemoglobin was tested before and after surgery. Follow-up was at 3 and 6 months. All operations were performed with a short-acting spinal anesthesia and the resected prostate weight was 18–66 g. Results: 36 patients were treated as 1-day surgery; 1 patient was hospitalized for 1 day. Intraoperative bleeding was very low (hemoglobin tested before and after surgery): the postoperative Hb was <1 g/dl in 34 patients, and Hb = 2 g/dl in 3 patients. Postoperative bleeding was minimal; late bleedings were not observed. Stress incontinence or incontinence were not observed. At 6 months, the patients were asked about any changes in their sexual lives, and no symptoms of impotence were reported. The peak flow rate (PFR) ranged from 4 to 7 ml/s at baseline, with a medium PFR of 5.5 ml/s. At 3 and 6 months the average increase in PFR was 11 and 10 ml/s, respectively, in all patients. Conclusions: As shown by this study, superpulsed radiofrequency is a safe and effective technology. It is superior to high-frequency surgical units and high-frequency coagulating intermittent cutting in terms of whole intraoperative bleeding (hemoglobin tested before and after surgery) and for the impressive impact on minimizing postoperative bleeding. In terms of improvement in urinary flow, the results of TURP with superpulsed radiofrequency at 3 and 6 months are comparable with the average PFR generally reported for TURP performed with high-frequency surgical units. Moreover, superpulsed radiofrequency TURP enhances the gold standard and makes TURP competitive with the other alternative treatments available for benign prostatic hyperplasia. Further studies could better define and extend the application of this new form of energy either in urologic or general surgery.

THE IMPACT OF MEDICAL THERAPY ON BOTHER DUE TO SYMPTOMS, QUALITY OF LIFE AND GLOBAL OUTCOME, AND FACTORS PREDICTING RESPONSE

We determine the effect of placebo, finasteride, terazosin and a combination of drugs on bother due to symptoms, quality of life and patient perception of improvement, and identify baseline clinical factors that predict clinical response to medical therapy. A total of 1,229 subjects with clinical benign prostatic hyperplasia (BPH) were randomized to 1 year of placebo, finasteride, terazosin or drug combination. The primary outcome measures were American Urological Association (AUA) symptom score and peak flow rate. Relevant secondary outcome measures were symptom problem score, BPH impact score and global rating of improvement. Group mean differences in symptom problem and BPH impact scores between the finasteride versus placebo, and terazosin versus combination groups were not statistically or clinically significant. Group mean differences in all outcome measures were highly statistically significant between the terazosin and finasteride, and combination and finasteride groups. The percentage of subjects who rated improvement as marked or moderate with placebo, finasteride, terazosin and combination was 39, 44, 61 and 65%, respectively. In the subsets of men in the placebo, finasteride, terazosin and combination groups with prostates greater than 50 cm.3 group mean decrease from baseline in AUA symptom score was -2.5, -3.6, -6 and -7, group mean increase in peak flow rate was 0.6, 2.7, 3.6 and 3.7 ml. per second, group mean decrease in symptom problem score was -2.2, - 1.9, -3.1 and -4.5, and group mean decrease in BPH impact score was -0.6, -0.3, -1.1 and -1.5, respectively. A correlational analysis failed to show a significant relationship between baseline prostate volume and treatment response to finasteride. There was a significant but weak relationship between change in AUA symptom score and peak flow rate in the finasteride and combination groups. The symptom responses with terazosin were independent of baseline peak flow rate. In men with clinical BPH finasteride and placebo are equally effective, while terazosin and combination are significantly more effective. In men with clinical BPH and large prostates the advantage of finasteride over placebo in terms of symptom reduction, impact on bother due to symptoms and quality of life is small at best, while the advantage of terazosin and combination over finasteride and placebo is highly significant. Baseline prostate volume was not a predictor of response to finasteride in the overall study population. On the basis of our results alpha1 blockers, such as terazosin, should be first line medical treatment for BPH.

THE IMPACT OF MEDICAL THERAPY ON BOTHER DUE TO SYMPTOMS, QUALITY OF LIFE AND GLOBAL OUTCOME, AND FACTORS PREDICTING RESPONSE

Purpose We determine the effect of placebo, finasteride, terazosin and a combination of drugs on bother due to symptoms, quality of life and patient perception of improvement, and identify baseline clinical factors that predict clinical response to medical therapy. Materials and Methods A total of 1,229 subjects with clinical benign prostatic hyperplasia (BPH) were randomized to 1 year of placebo, finasteride, terazosin or drug combination. The primary outcome measures were American Urological Association (AUA) symptom score and peak flow rate. Relevant secondary outcome measures were symptom problem score, BPH impact score and global rating of improvement. Results Group mean differences in symptom problem and BPH impact scores between the finasteride versus placebo, and terazosin versus combination groups were not statistically or clinically significant. Group mean differences in all outcome measures were highly statistically significant between the terazosin and finasteride, and combination and finasteride groups. The percentage of subjects who rated improvement as marked or moderate with placebo, finasteride, terazosin and combination was 39, 44, 61 and 65%, respectively. In the subsets of men in the placebo, finasteride, terazosin and combination groups with prostates greater than 50 cm. 3 group mean decrease from baseline in AUA symptom score was -2.5, -3.6, -6 and -7, group mean increase in peak flow rate was 0.6, 2.7, 3.6 and 3.7 ml. per second, group mean decrease in symptom problem score was -2.2, -1.9, -3.1 and -4.5, and group mean decrease in BPH impact score was -0.6, -0.3, -1.1 and -1.5, respectively. A correlational analysis failed to show a significant relationship between baseline prostate volume and treatment response to finasteride. There was a significant but weak relationship between change in AUA symptom score and peak flow rate in the finasteride and combination groups. The symptom responses with terazosin were independent of baseline peak flow rate. Conclusions In men with clinical BPH finasteride and placebo are equally effective, while terazosin and combination are significantly more effective. In men with clinical BPH and large prostates the advantage of finasteride over placebo in terms of symptom reduction, impact on bother due to symptoms and quality of life is small at best, while the advantage of terazosin and combination over finasteride and placebo is highly significant. Baseline prostate volume was not a predictor of response to finasteride in the overall study population. On the basis of our results alpha 1 blockers, such as terazosin, should be first line medical treatment for BPH.

Transurethral Needle Ablation of the Prostate: Report of Initial United States Clinical Trial

Purpose We studied the efficacy and safety of transurethral needle ablation of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH). Materials and Methods A total of 12 patients with symptomatic BPH underwent transurethral needle ablation of the prostate. Voiding outcomes, including American Urological Association symptom scores, bother scores, quality of life scores, peak urinary flow rates, residual urine volumes and urodynamic pressure flows, were measured with time, and immediate and short-term (6 months) complications were assessed. Results Transurethral needle ablation of the prostate was performed with local intraurethral lidocaine anesthesia in 11 patients and general anesthesia in 1. At 6 months there was a 61.7 percent improvement in American Urological Association symptom score (25.6 to 9.8, p = 0.0001), 61.1 percent improvement in bother score (18.8 to 7.3, p = 0.0002), 70.0 percent improvement in quality of life score (13.7 to 4.1, p = 0.0001), 73.0 percent increase in peak flow rate (7.8 to 13.5 cc per second, p less than 0.0001) and 54.9 percent decrease in the post-void residual (111 to 50 cc, p = 0.0457). Prostate volumes, maximum detrusor pressures and detrusor opening pressures decreased significantly. There were no intraoperative complications. Postoperatively, all 12 patients had mild dysuria for 1 to 7 days, 5 had transient urinary retention for 1 to 4 days, 3 had hematuria for 1 to 2 days and 1 had retrograde ejaculation. Conclusions This initial United States trial confirms previous experience, and shows that transurethral needle ablation of the prostate appears to be a simple, safe and efficacious procedure for treatment of symptomatic BPH. In addition, it can be performed in the majority of patients using topical urethral anesthesia.

A dose-response study of the effect of flutamide on benign prostatic hyperplasia: Results of a multicenter study

The objective of this study was to evaluate efficacy, safety, and dose-response profiles of four dosing schemes of flutamide over 24 weeks. Patients were randomized to receive one of the following five treatment regimens for a period of 24 weeks: placebo capsule, flutamide capsules 125 mg twice daily, 250 mg once daily, 250 mg twice daily, and 250 mg three times daily. Patients were then evaluated at baseline (0 weeks) and at 4, 6, 12, 18, and 24 weeks after the start of treatment, and 8 weeks after the end of treatment (32 weeks). Evaluation of efficacy was performed by noting changes in urine flow rate, residual urine volume, symptom score, prostate volume, and prostate-specific antigen level. A total of 372 patients were enrolled into the study at 32 centers (14 centers in the United States and 18 international centers). Baseline peak urinary flow rate and percent change from baseline in maximum flow rate showed a dose-related increase at 4 and 6 weeks; this increase was significant in the 250 mg three times daily group. At later time points, no significant differences between the flutamide and placebo groups were observed, largely because of the decreasing number of evaluable patients. At 4 and 6 weeks, 25% of patients in the 250 mg three times daily group had more than 3 cc/s increase in uroflow compared to about 10% of placebo patients (P < 0.05). All flutamide-treated groups had a significant decrease in prostate volume from baseline to the last treatment visit compared to placebo and this reduction was dose related (in comparison to placebo: P < 0.05 for 125 mg twice daily and P < 0.001 for all other treatment arms). Median decrease for the flutamide-treated groups ranged from 6% to 23% at 12 weeks and from 14% to 29% at 24 weeks. All treatment groups showed a subsequent increase in prostate volume after treatment was stopped. Furthermore, there was a significant reduction in residual urine volume at 24 weeks only in the 250 mg three times daily group. It increased following cessation of therapy. Urinary symptoms at 6, 12, 18, and 24 weeks did not show any significant difference between placebo and any flutamide dose group. The most common adverse events were nipple and breast tenderness (42% to 52%), diarrhea (29% to 34%), and gynecomastia (14% to 19%). Each of these adverse events had a significantly higher incidence in all flutamide dose groups compared with placebo, but none appeared to occur in a dose-related fashion. Sixteen percent of patients in the placebo group and 25% to 39% of patients in flutamide groups were discontinued due to diarrhea (12% to 17%) or nipple and breast tenderness (4% to 8%). A total of 1% to 3% of patients in various treatment arms discontinued due to deranged liver enzymes (1% for placebo); and 1% to 4% due to impotence (1% for placebo). Flutamide reduced the prostate volume in a dose-related fashion and resulted in an increase in peak flow rate at 4 weeks (3% for 250 mg three times daily, P value < 0.05), but the early positive effects did not maintain statistical significance due to an increasing number of dropouts due to adverse events. Effect on postvoid residual volume was observed only at the highest dose and at 24 weeks (median reduction, 23 mL, P < 0.05). Despite volume reduction and early improvement in peak flow rate, there were no significant differences in urinary symptoms among the placebo and flutamide groups. Higher incidences of diarrhea, breast tenderness, and gynecomastia, however, were the main limiting factors in this study and until these problems are overcome, the role of flutamide in the management of benign prostatic hyperplasia remains investigational.

Transurethral hyperthermia for benign prostatic hyperplasia: Long term results

Transurethral resection of the prostate (TURP) is the only recognized treatment in patients with benign prostatic hyperplasia (BPH). Transurethral hyperthermia (TUHT) was used as an alternative treatment in patient who refused TURP. From 1987 to 1988, 21 BPH patients with moderate to severe symptoms and signs of prostatism were treated with TUHT in a phase I trial. Mean pre-treatment subjective and objective values were: total symptom score (TSS) 13.5, obstructive symptom score (OSS) 6.5, irritative symptom score (TSS) 7.0, peak flow rate (PFR) 11.6 cc/sec, post-voiding residual volume (PRV) 187 cc, and prostate volume (PV) 93 cc. TUHT was given for a total of 177 sessions (mean 8.4), each of 60 min duration at a steady state. Temperature was recorded continuously on the urethral surface, in all treatments. It ranged from Tmin 40.3 degrees C to Tmax = 49.2 degrees C and Tmean = 44.1 degrees C. The mean minimum temperature of > or = 42 degrees C was obtained in 98% of the TUHT sessions. Treatments were given on an outpatient basis without sedation or anaesthesia. Treatment tolerance was excellent with minor acute toxicity common (71% of patients), of no clinical importance and with no late complications. Of the 21 patients treated, 17 (81%) had an objective and 15 (71%) a subjective improvement recorded at 6 months post-treatment. This statistically highly significant improvement included: 61% decrease in TSS; 66% decrease in OSS; 55% decrease in ISS; 42% increase in PFR; 55% decrease in PRV; and 21% decrease in PV. Of the 17 patients with objective improvement, nine have maintained their response to TUHT for a minimum period of over six years, two relapsed at 11 and 40 months, respectively, and six patients died of cardiovascular causes maintaining their response to death. This study has demonstrated TUHT treatment efficacy with no major or clinically important toxicity in BPH patients. A relative weakness of this report is a lack of verification of objective study parameters in the patients at seven years post-treatment. Prospective randomized trials are needed to define the role of TUHT in the management of BPH patients.

Maternal smoking and blood pressure in 7.5 to 8 year old offspring.

Reduced fetal growth in babies born preterm may be associated with reduced later blood pressure, but in children born at term, higher blood pressure. It was hypothesised, therefore, that maternal smoking in pregnancy, associated with reduced fetal growth, programmes later blood pressure differentially according to length of gestation. Six hundred and eighteen children born preterm and now aged 7.5 to 8 years were studied prospectively. Systolic blood pressure in children from smoking compared with non-smoking mothers was significantly lower in those born before 33 weeks' gestation and significantly higher in those born at 33 or more weeks. Within the range 0-40 cigarettes per day until delivery (after adjusting for potentially confounding factors, including social class and current weight) each 10 was associated with a 1.5 mm Hg fall and 2.9 mm Hg rise in pressure for children born below or above 33 weeks' gestation respectively. Similar though smaller differences were seen in diastolic pressure. These data support our hypothesis that later effects of insults impairing fetal growth are gestation dependent, and provide the first evidence that maternal smoking may have long term consequences for blood pressure in children.