Obstructive Micturition Research Articles

Effects of Panax ginseng on the nerve growth factor expression in testosterone induced benign prostatic hyperplasia

The prostatic hyperplasia in benign prostatic hyperplasia (BPH) leads to obstructive micturition symptoms. Previous studies showed that pontine micturition center (PMC), ventrolateral periaqueductal gray (vlPAG), and medial preopticnucleus (MPA) regions in the brain have been known to regulate the urinary bladder function. The present study shows the influences of Panax ginseng on nerve growth factor (NGF) expressions in PMC, vlPAG, and MPA regions in the brain. Wistar rats were used for the present study. The rats split into four groups; 4 groups (n = 6) in control group, BPH-induced group, BPH-induced and P. ginseng-treated group, and BPH-induced and finasteride-treated group. BPH in rats was induced by testosterone and the animals were evaluated for NGF expression in PMC, vlPAG, and MPA regions in the brain. The NGF expression was identified using immunohistochemistry (IHC). The NGF expression by IHC showed spots with dark brown color. In our results, NGF expressions in PMC, vlPAG, and MPA regions in the brainstem of the BPH-induced group showed increase than the control animal. These increased NGF expressions in three regions were decreased using treatment with P. ginseng (200 mg/kg). These results suggest that P. ginseng has therapeutic effects on the symptoms of BPH and is associated with the regulation of NGF expression in the brain. In conclusion, the administration of P. ginseng helps nerve growth factor activation.

PREFERE - Study on the rise

The PREFERE study, which compares the treatment options for prostate cancer with low and early intermediate risk, has recorded a noticeable upswing in recruitment since mid-2015. Responsible for this are the revised inclusion criteria and the wide support for this study in Germany. The inclusion criteria opened the study to the use of imaging techniques (MRI, C‑Trus / Anna) and the inclusion of all Gleason 3 + 3 = 6 cancers, regardless of tumor extent. In addition, patients can now be included who, for example due to the size of the prostate or existing obstructive micturition disorders, had a contraindication to percutaneous radiotherapy or brachytherapy - these can now be randomized between active surveillance and radical prostatectomy. With the increased recruitment numbers, it seems realistic that the required milestones in recruiting will be achieved.

Obstructive urination problems after high-dose-rate brachytherapy boost treatment for prostate cancer are avoidable.

BackgroundAiming at improving treatment individualization in patients with prostate cancer treated with combination of external beam radiotherapy and high-dose-rate brachytherapy to boost the dose to prostate (HDRB-B), the objective was to evaluate factors that have potential impact on obstructive urination problems (OUP) after HDRB-B.Patients and methodsIn the follow-up study 88 patients consecutively treated with HDRB-B at the Institute of Oncology Ljubljana in the period 2006-2011 were included. The observed outcome was deterioration of OUP (DOUP) during the follow-up period longer than 1 year. Univariate and multivariate relationship analysis between DOUP and potential risk factors (treatment factors, patients’ characteristics) was carried out by using binary logistic regression. ROC curve was constructed on predicted values and the area under the curve (AUC) calculated to assess the performance of the multivariate model.ResultsAnalysis was carried out on 71 patients who completed 3 years of follow-up. DOUP was noted in 13/71 (18.3%) of them. The results of multivariate analysis showed statistically significant relationship between DOUP and anti-coagulation treatment (OR 4.86, 95% C.I. limits: 1.21-19.61, p = 0.026). Also minimal dose received by 90% of the urethra volume was close to statistical significance (OR = 1.23; 95% C.I. limits: 0.98-1.07, p = 0.099). The value of AUC was 0.755.ConclusionsThe study emphasized the relationship between DOUP and anticoagulation treatment, and suggested the multivariate model with fair predictive performance. This model potentially enables a reduction of DOUP after HDRB-B. It supports the belief that further research should be focused on urethral sphincter as a critical structure for OUP.

Mid-term follow-up of the TVT-Secur® midurethral sling for primary stress incontinence

ObjectiveThe TVT-Secur® was introduced in 2006 as a less invasive alternative to retropubic and transobturator suburethral slings. This retrospective cohort study evaluated objective and subjective results in a series of 158 consecutive patients as well as complications and the reoperation rate after TVT-Secur procedure. Study designBetween November 2006 and June 2010 a total of 158 patients underwent a TVT-Secur procedure at a single institution. All patients underwent preoperative urodynamic testing. All patients were invited for follow-up including physical examination, urodynamic studies and subjective evaluation. ResultsA total of 96 patients (61%) were available for follow-up with a mean follow-up of 29.8 months (range 5–50, median 30). At follow-up, eight (8%) of 96 patients had reoperations for stress incontinence. There were no reoperations for bleeding/hematoma, tape erosions or obstructed micturition and there were no tape erosions or exposures. 29 patients (30%) had a negative cough stress test and 44 patients (46%) subjectively considered themselves “cured”. Nine of 43 patients (21%) without urgency symptoms preoperatively developed de novo urgency; 24 of 35 patients (69%) with preoperative urgency complaints were free of urgency symptoms. ConclusionAt 2.4 years, the TVT-Secur appears to have a low adverse events profile but inferior results compared with traditional midurethral slings.

686 Reductive cystoplasty and simultaneous prostatic adenomectomy improve symptoms score in patients with chronic obstructive urine retention and detrusor impaired contractility

686 Reductive cystoplasty and simultaneous prostatic adenomectomy improve symptoms score in patients with chronic obstructive urine retention and detrusor impaired contractility

MP27-10 FACTORS PREDICTING RECOVERABILITY OF RENAL FUNCTION AFTER RELIEF OF OBSTRUCTIVE UROPATHY SECONDARY TO BENIGN DISEASES: DOES THE METHOD OF DRAINAGE MATTER?

INTRODUCTION AND OBJECTIVES: We aim at determining factors predicting recoverability of renal function after relief of obstruction with special emphasis on the method of drainage. METHODS: We retrospectively analyzed 137 adult patients with solitary kidneys presented with obstructive oliguria or anuria because of stone and/or stricture diseases and underwent temporal drainage by either PCN or JJ stents between January 2011 and June 2013. Patients< 18 years, or with obstruction because of malignancy or those underwent definitive intervention in the emergency setting were excluded. The primary outcome is the rate of decline of serum creatinine (SCr) after drainage of obstruction. The impact of method of drainage and other potential factors on the primary outcome were determined using univariate and multivariate analyses. RESULTS: A total of 127 patients showed a median (range) decline of SCr of 0.7 (0.05-2.7) mg/dl/day while 10 patients showed no change or rise of SCr and thereby excluded from the analysis. The rate of SCr decline showed non-significant association with gender, duration of obstruction, presence of diabetes mellitus or hypertension or the method of drainage. One the other hand, the rate of SCr decline showed significant correlation with SCr at presentation (r 1⁄4 0.4; p 1⁄4 0.001), urine culture (r 1⁄4 -0.262; p 1⁄4 0.005), fever after drainage (r 1⁄4 -0.225; p 1⁄4 0.017), baseline hemoglobin level (r 1⁄4 0.226; p 1⁄4 0.016) and number of previous episodes of obstructive uropathy (r 1⁄4 -0.251; p 1⁄4 0.007). On multivariate analysis, SCr at presentation (beta 1⁄4 0.308, p 1⁄4 0.001), hemoglobin level (beta 1⁄4 0.248, p 1⁄4 0.004), episodes of previous obstructive uropathy (beta 1⁄4 -0.198, p 1⁄4 0.019) and urine culture (beta 1⁄4 -0.198, p 1⁄4 0.02) were independent predictors of the rate of SCr decline. CONCLUSIONS: The method of temporal drainage of obstructive uropathy does not matter. Higher SCr and Hemoglobin levels at presentation are associated with rapid recovery of renal function while previous episodes of obstructive uropathy and positive urine culture slow down the recovery process.

MP27-11 SLOW DELIVERY RATE VERSUS RAPID DELIVERY RATE SHOCK WAVE LITHOTRIPSY (SWL) FOR PEDIATRIC RENAL UROLITHIASIS: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTION AND OBJECTIVES: We aim at determining factors predicting recoverability of renal function after relief of obstruction with special emphasis on the method of drainage. METHODS: We retrospectively analyzed 137 adult patients with solitary kidneys presented with obstructive oliguria or anuria because of stone and/or stricture diseases and underwent temporal drainage by either PCN or JJ stents between January 2011 and June 2013. Patients< 18 years, or with obstruction because of malignancy or those underwent definitive intervention in the emergency setting were excluded. The primary outcome is the rate of decline of serum creatinine (SCr) after drainage of obstruction. The impact of method of drainage and other potential factors on the primary outcome were determined using univariate and multivariate analyses. RESULTS: A total of 127 patients showed a median (range) decline of SCr of 0.7 (0.05-2.7) mg/dl/day while 10 patients showed no change or rise of SCr and thereby excluded from the analysis. The rate of SCr decline showed non-significant association with gender, duration of obstruction, presence of diabetes mellitus or hypertension or the method of drainage. One the other hand, the rate of SCr decline showed significant correlation with SCr at presentation (r 1⁄4 0.4; p 1⁄4 0.001), urine culture (r 1⁄4 -0.262; p 1⁄4 0.005), fever after drainage (r 1⁄4 -0.225; p 1⁄4 0.017), baseline hemoglobin level (r 1⁄4 0.226; p 1⁄4 0.016) and number of previous episodes of obstructive uropathy (r 1⁄4 -0.251; p 1⁄4 0.007). On multivariate analysis, SCr at presentation (beta 1⁄4 0.308, p 1⁄4 0.001), hemoglobin level (beta 1⁄4 0.248, p 1⁄4 0.004), episodes of previous obstructive uropathy (beta 1⁄4 -0.198, p 1⁄4 0.019) and urine culture (beta 1⁄4 -0.198, p 1⁄4 0.02) were independent predictors of the rate of SCr decline. CONCLUSIONS: The method of temporal drainage of obstructive uropathy does not matter. Higher SCr and Hemoglobin levels at presentation are associated with rapid recovery of renal function while previous episodes of obstructive uropathy and positive urine culture slow down the recovery process.

Prevention of Stricture Recurrence Following Urethral Endoscopic Management: What Do We Have?

Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. This review was performed to determine the best strategy for stricture recurrence prevention following urethral endoscopic management. We reviewed the published literature in PubMed, the Cochrane Library, and Google Scholar focusing on this intractable problem regardless of language restrictions. Outcomes of interest included the study methods and the applied strategy's efficacy. The level of evidence and grade of recommendations of included studies were appraised with an Oxford Centre for Evidence-Based Medicine Scale. Currently, numerous techniques, including catheterization, repeated dilation, brachytherapy, and intraurethral use of various antifibrosis agents, have been employed to oppose the process of wound contraction or regulate the extracellular matrix. But unfortunately, none of these techniques or agents have demonstrated efficacy with enough evidence. Although lots of strategies are available, still, we do not have a suitable, single optimum solution for all the conditions. The clinical decision of stricture-recurrence-prevention techniques should be carefully tailored to every individual patient. As the studies are not sufficient, more efforts are warranted to address this interesting but challenging issue.

Spindle cell rhabdomyosarcoma of the prostate

The spindle cell rhabdomyosarcoma is a rare variant of the embryonal rhabdomyosarcoma, mostly occurring in childhood. Only a few cases are described in adults. To date, no case of the spindle cell subtype of the prostatic embryonal rhabdomyosarcoma has been published. We report on a 23-year-old man, initially presenting with obstructive micturition problems, perineal pain and night sweat. After diagnosis by transrectal biopsy of the prostate, radiochemotherapy within the CWS 2002 P study was applied: nine cycles of vincristine, doxorubicin, actinomycin D, ifosfamide, and fractionated radiotherapy of the tumor and suspect lymph nodes (final dose 50.4 Gy). The tumor initially shrank, but an early local recurrence arose. Second-line chemotherapy was applied, followed by a salvage radical cytoprostatectomy. The patient died of disseminated disease 14 months after diagnosis.

Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men

Strictures of the urethra are the most common cause of obstructed micturition in younger men and frequently recur after initial treatment.Standard treatment comprises internal widening of the strictured area by simple dilatation or by telescope-guided internal cutting (optical urethrotomy), but these interventions are associated with a high failure rate requiring repeated treatment. The alternative option of open urethroplasty whereby the urethral lumen is permanently widened by removal or grafting of the strictured segment is less likely to fail but requires greater expertise.Findings of Improved choice of graft material and shortened hospital stay suggest that urethroplasty may be under utilised.The extent and quality of evidence guiding treatment choice for this condition are uncertain. To determine which is the best surgical treatment for male urethral stricture disease taking into account relative efficacy, adverse event rates and cost-effectiveness. We searched the Cochrane Incontinence Group Specialised Register (searched 21 June 2012), CENTRAL (2012, Issue 6), MEDLINE (January 1946 to week 2 June 2012), EMBASE (January 1980 to week 25 2012), OpenSIGLE (searched 26 June 2012), clinical trials registries and reference lists of relevant articles. We included publications reporting data from randomised or quasi-randomised controlled trials comparing the effectiveness of dilatation, urethrotomy and urethroplasty in the treatment of adult men with urethral stricture disease. Two authors evaluated trials for appropriateness for inclusion and methodological quality. Data extraction was performed using predetermined criteria. Analyses were carried out using the Cochrane Review Manager software (RevMan 5). Two randomised trials were identified.One trial compared the outcomes of surgical urethral dilatation and optical urethrotomy in 210 adult men with urethral stricture disease.No significant difference was found in the proportion of men being stricture free at three years or in the median time to recurrence.The second trial compared the outcomes of urethrotomy and urethroplasty in 50 men with traumatic stricture of the posterior urethra following pelvic fracture injury. In the first six months, men were more likely to require further surgery in the urethrotomy group than in the primary urethroplasty group (RR 3.39, 95% CI 1.62 to 7.07). After two years, 16 of 25 (64%) men initially treated by urethrotomy required continued self-dilatation or further surgery for stricture recurrence compared to 6 of 25 (24%) men treated by primary urethroplasty. There were insufficient data to perform meta-analysis or to reliably determine effect size. There were insufficient data to determine which intervention is best for urethral stricture disease in terms of balancing efficacy, adverse effects and costs.Well designed, adequately powered multi-centre trials are needed to answer relevant clinical questions regarding treatment of men with urethral strictures.

Primary and minor indications to bedside renal ultrasonography

We appreciated the letter ‘‘Bedside renal ultrasonography: other utilities than hydronephrosis’’ by Chia-Ter Chao [1]. The author described the ultrasonographic (US) findings of acute pyelonephritis (APN), analysed the diagnostic accuracy of various imaging modalities in this disease, and emphasized the role of bedside US in APN. On the basis of these considerations, Chao commented on the fact that in our paper titled ‘‘Clinical applications of bedside ultrasonography in Internal and Emergency Medicine’’ [2] we considered obstructive uropathy and acute urine retention as the primary indications for bedside US in urinary tract diseases and mention, as other indications, hematuria, acute renal failure, suspected abscesses of the kidneys, and gross prostate abnormalities without including APN. We comprehend the enthusiasm of Chao for the application of US in APN that confirms the knowledge and the experience of the author in this field but completely disagree with him when he attributes the same role and similar importance of bedside US to APN versus hydronephrosis, renal stone or other obstructive uropathy. We think that between APN and the latter pathologies, there are very important differences not only for the diagnostic accuracy and the role of US, especially if performed bedside, but also for the epidemiologic occurrence in both Internal Medicine and Emergency Departments. First of all, we have to keep in mind what bedside US is. This is a rapid and simple US method for the diagnostic evaluation of emergency medical conditions in the acutely ill, critically ill or injured patient, performed bedside with small portable instruments often capable of only fundamental imaging [3]. This technique can also be executed by clinicians with a limited experience in US, equipped with only a second level of experience, according to EFSUMB learning guidelines [1]. With respect to the sonographic findings of acute pyelonephritis mentioned by Chao, we have no comment because they are well known and reported in the literature, but they do not have a high specificity, since the disease produces hypoechoic as well as hyperechoic areas. Colour and power Doppler US produces a small increase in the sensitivity of US, but mainly in the case of abscesses. Similarly angiosonography (CEUS) can be usefully employed only in the presence of renal abscesses but not in APN without complications. In fact, EFSUMB guidelines report indications for CEUS only in case of focal renal tumours, trauma, or abscesses, and not in APN [4]. Finally we have to consider that Colour and Power Doppler US, and especially CEUS, are certainly not methods used as bedside US. Moreover, a recent review on the state of the art of imaging of renal infections confirms that US is especially effective in the diagnosis of hydronephrosis or pyonephrosis, is less sensitive than computed tomography (CT) in evaluating for complications, has major limits in operator dependency and in obese patients, and remains a main stay in differentiating cystic versus solid structures [5]. The same conclusions have been reported in another important review on radiologic and pathologic aspects of pyelonephritis: diagnosis is typically based on clinical features and laboratory tests; imaging is reserved for nonresponders or patients with a typical clinical presentation. Computed tomography, over conventional radiography and US, is the preferred method for evaluating APN and emphysematous pyelonephritis. US is useful but CT A. Vincenzo C. Valeria (&) Department of Internal Medicine, Maggiore Hospital, Largo B. Nigrisoli 2, 40133 Bologna, Italy e-mail: v.camaggi@ausl.bologna.it

Protocol for the CUPIDO trials; multicenter randomized controlled trials to assess the value of combining prolapse surgery and incontinence surgery in patients with genital prolapse and evident stress incontinence (CUPIDO I) and in patients with genital prolapse and occult stress incontinence (CUPIDO II)

BackgroundAbout 40% of all patients with genital prolapse report stress-incontinence. In about half of the 60% patients that do not report stress-incontinence, occult urinary stress-incontinence can be detected. In these patients stress-incontinence is masked due to kinking or compression of the urethra by the prolapse.In case surgical correction is indicated there are two strategies to manage patients with combined prolapse and (occult) stress incontinence. This strategy is either (i) a combination of prolapse surgery and stress-incontinence surgery or (ii) to correct the prolapse first and evaluate afterwards whether additional stress-incontinence surgery is indicated. The advantage of combining prolapse and stress-incontinence surgery is that only few patients report stress-incontinence following such combination. However, this combination has been associated with an increased risk on complications, of which the development of obstructive micturition symptoms, overactive bladder symptoms and bladder retention are the most important ones. Furthermore, combining two procedures may be unnecessary as performing only prolapse surgery may cure stress-incontinenceIn the randomized CUPIDO trials both strategies are compared in patients with prolapse and evident stress incontinence (CUPIDO I trial) and in patients with prolapse and occult stress incontinence (CUPIDO II trial).Methods/DesignThe CUPIDO trials are two multicenter randomized controlled trials in which women with stress urinary incontinence (SUI) or occult stress urinary incontinence (OSUI) are randomized to prolapse surgery combined with anti incontinence surgery (concomitant surgery) or to prolapse surgery only. Patients with at least stage 2 POP are eligible, women with evident SUI are randomized in CUPIDO I. Patients without SUI are eligible for CUPIDO II and will have urodynamic evaluation or a standardized redression test. Women with OSUI are randomized, women without OSUI are followed up but not randomized.The primary outcome measure is absence of SUI twelve months after surgery. Furthermore, economic evaluations are conducted, and the effectiveness of urodynamic investigation is evaluated against a non-invasive way to determine SUI in women with POP.A total of 450 women will be included in the study.Trial RegistrationTrial registration http://www.trialregister.nl NTRR 1197 en 1070

MP-02.10: Micturating Echo Urethrography

Urethral stricture takes the second place after prostate glands that are the reasons of obstructive urination abnormality of men. Traditional X-ray diagnosing, aimed at precise localization, spread and urethral stricture patency is, currently, not enough for clinical practice determination. We studied the possibilities of micturating urethrography with the usage of modern ultrasonic technologies while estimating the character of the urethral stricture.

Hormonal Therapy in the Elderly Prostate Cancer Patient: In reply

In the context of the question raised in our article, the primary treatment cited by Egidi is one form or another of androgen deprivation. If tumor progression occurs in spite of this treatment, then, without taking recourse to laboratory tests (total PSA, possibly sarcosine concentrations in urine), local symptoms such as obstructive micturition problems or indications of systemic progression such as bone pain can be expected. All that’s left by way of therapeutic options then is palliative treatment-for example, transurethral prostatic resection, focal irradiation, or analgesic medication. Whether it is beneficial for a patient who is having hormone therapy and regular PSA tests to detect the progression before onset of symptoms is a legitimate question. In any case, PSA testing helps to detect the point at which the selected primary hormone therapy becomes ineffective and should be stopped. Such an approach does not need to be confirmed by a study, because the patient is spared at least the side effects of androgen deprivation up to the point where symptoms of progression manifest. If the patient receives an antiandrogen as primary treatment then one third of patients experience improvement when the antiandrogen is stopped. Subsequently, secondary hormone therapy should be given, which is by no means ineffective. The comprehensive range of secondary hormone treatments in PSA progression has recently been shown (1). For the future, the task is to detect castration resistant prostate cancer by regularly testing PSA values. Currently, phase III studies are investigating the option of androgen receptor manipulation.

Increased late urinary toxicity with whole pelvic radiotherapy after prostatectomy

Background. Radiotherapy aimed at prostatic bed (PBRT) can prevent recurrence or reestablish remission in prostate cancer patients primarily treated with prostatectomy. In selected patients results may be improved with the additional irradiation of pelvic nodes (WPRT). Patients and methods. The objective of the study was to evaluate late toxicity of postoperative radiotherapy in 43 patients – 21/43 treated with WPRT. Dysuria, haematuria, nocturia, continence and obstructive urination problems as well as urgency, continence, frequency, pain and bleeding of defecations were prospectively registered and converted to a modified Radiation Therapy Oncology Group (RTOG) – late effects normal tissue (LENT) scoring system. Median tumour dose (TD) for PBRT was 64.8 (59.4-70.0) Gy and for WPRT 50.4 (48.0-56.0) Gy. Results. More important than the deterioration of intestinal function (worsening for 1 grade in 54% and 2 grades in 5% of patients) was the deterioration of urinary function (worsening for 1 grade in 33% and 2 grades in 26% of patients). This appeared to be more frequent in patients with WPRT than PBRT (67% vs. 50% of patients) especially in conjunction with WPRT TD >52 Gy (deterioration in 71% of patients). Conclusions. Although several factors may influence increased urinary toxicity after WPRT, it seems reasonable to lower the urinary bladder dose as it possible with novel radiation techniques.

Defective in vitro contractility of ureteropelvic junction in children with functional and obstructive urine flow impairment

Background/Purpose Studies of children with urinary flow impairment (UFI) at the ureteropelvic junction (UPJ) have revealed prestenotic, stenotic, and poststenotic histologic changes. Muscle function, however, has not been investigated. We therefore evaluated in vitro UPJ contractility by tensiometry in children with UFI. Methods Freshly excised UPJs from 11 children with UFI (6 functional, 5 obstructive) were each divided into 3 parallel, prestenotic, stenotic, and poststenotic rings, and those from 7 children with Wilms' tumor were divided into proximal, medial, and distal segments. Each ring was studied in vitro by tensiometry in the basal state and after stimulation with 25 and 60 mmol/L KCl. Results The stenotic rings from the UFI subjects displayed a significantly lower basal contractility than the other 2 rings, and their 25 and 60 mmol/L KCl–induced contractility was absent or severely reduced, whereas the values of these parameters were similar to that observed in controls in the other 2 rings of patients with either functional or obstructive UFI. Conclusions Basal and KCl-induced contractility of the stenotic segment is severely impaired in children and infants with either functional or obstructive UFI, whereas the contractility of their pre- and poststenotic UPJ segments is similar to that recorded in controls.

The peemeter: an apparatus for measuring urinary force.

Abstract A new apparatus for measuring voiding force is described; it has been used in the assessment of normal and obstructed micturition.

Micturating urethrography in severe obstructed micturition.

Micturating urethrography in severe obstructed micturition.

Midurethral Tissue Fixation System sling – a ‘micromethod’ for cure of stress incontinence – preliminary report

To assess the effectiveness of the Tissue Fixation System (TFS) in patients with stress incontinence. The TFS uses two small plastic anchors to fix an (adjustable) midurethral polypropylene mesh sling into the soft tissues below the pubic bone. Thirty-six patients with stress incontinence, mean age 55 (35-87), mean weight 76 kg (33-117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation. The patients were preoperatively assessed with a structured questionnaire, 24-h urinary diary, cough stress test, transperineal ultrasound, and urodynamics. Using the TFS delivery system, a midurethral mesh tape was attached to the fibromuscular tissues behind the perineal membrane. The suburethral vaginal fascia was also tightened. Post-operatively. the patients were reviewed at 6 weeks, and at 3-monthly intervals with ultrasound, and cough stress tests. Primary symptomatic cure rate at mean 9 months (3-15 months) was 83.4% (n = 36). Pad test loss decreased from a mean 12.7 g to a mean of 0.2 g; mean operating time was 5 min, and mean hospital stay was 24 h (12-48 h). There were no cases of obstructed micturition, and minimal analgesia only was required postoperatively. The TFS is a promising new method. The results at this stage are similar to those achieved previously with the 'tension-free' tape operations, but with greater safety and shorter operating time. Testing by other surgeons will be required to evaluate this method further.

A reliable coding system to define screening prostate-specific antigen tests was developed in a case–control study

Objective To establish the reliability of a coding system for screening and diagnostic prostate-specific antigen (PSA) testing from patient charts. Study Design and Setting Two investigators reviewed 448 chart abstractions from a population-based case–control study of PSA screening in the Toronto area. The tests evaluated for reliability were transrectal ultrasound (TRUS), digital rectal examination (DRE), and prostate-specific antigen (PSA). Results DRE results were found in 87%, PSA results in 65%, and TRUS results in 12% of the 749 charts. Interobserver agreement was 94% for DRE texture (κ = .885), 95% for DRE asymmetry (κ = .868), 85% for DRE physician interpretation (κ = .698), 97% for final DRE result (κ = .856), and 87% for TRUS (κ = .769). Physician interpretation modified the final result in only 6.2% of DREs. Interobserver agreement for PSA coding was 91% (κ = .787). Of PSA results, pure PSA screening with no symptoms of obstructive urination was found in 19%, symptomatic PSA screening in 46%, and diagnostic PSA testing in 35%. Conclusion We have developed a practical and reliable coding system for TRUS, DRE, and PSA in the context of a case–control study of PSA screening.