Postvoid Volume Research Articles

Sexual and urinary dysfunction following laparoscopic total mesorectal excision in male patients: A prospective study.

Aims:Even with the use of nerve-sparing techniques, there is a risk of bladder and sexual dysfunction after total mesorectal excision (TME). Laparoscopic TME is believed to improve this autonomic nerve dysfunction, but this is not demonstrated conclusively in the literature. In Indian patients generally, the stage at which the patients present is late and presumably the risk of autonomic nerve injury is more; however, there is no published data in this respect.Materials and Methods:This prospective study in male patients who underwent laparoscopic TME evaluated the bladder and sexual dysfunction using objective standardised scores, measuring residual urine and post-voided volume. The International Prostatic Symptom Score (IPSS) and International Index of Erectile Function score were used respectively to assess the bladder and sexual dysfunction preoperatively at 1, 3, 6 months and at 1 year.Results:Mean age of the study group was 58 years. After laparoscopic TME in male patients, the moderate to severe bladder dysfunction (IPSS <8) is observed in 20.4% of patients at 3 months, and at mean follow-up of 9.2 months, it was seen only in 2.9%. There is more bladder and sexual dysfunction in low rectal tumours compared to mid-rectal tumours. At 3 months, 75% had sexual dysfunction, 55% at median follow-up of the group at 9.2 months.Conclusion:After laparoscopic TME, bladder dysfunction is seen in one-fifth of the patients, which recovers in the next 6 months to 1 year. Sexual dysfunction is observed in 75% of patients immediately after TME which improves to 55% over 9.2 months.

Photoselective Vaporization of the Prostate: Long-Term Outcomes and Safety During 10 Years of Follow-Up.

To evaluate the long-term outcomes and safety photoselective vaporization of the prostate (PVP). From April 2005 to December 2015, a total of 1154 patients with benign prostatic hyperplasia underwent PVP. The type of Green Light laser was an 80 W potassium-titanyl-phosphate laser and later a 120 W lithium triborate laser. Before and after surgery, the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-voiding volume of residual urine (PVR), prostate-specific antigen (PSA) level, and prostate volume were assessed regularly. After surgery, events such as second PVP, transurethral incision, and permanent urethral catheterization were defined as retreatment. The mean and median periods of follow-up after PVP were 35.4 and 24.0 months, respectively. The maximum duration of follow-up was 125 months. Compared with before surgery, the IPSS, quality of life score, and PSA concentration improved significantly, even at 10 years after PVP; however, Qmax and PVR were not improved at 10 years. The retreatment-free survival rate was 93.9% at 5 years and 79.0% at 10 years. Prostate cancer was found in 27 cases after PVP, and all patients who were found to have prostate cancer remained alive. Prostate cancer-free survival after PVP was 96.7% at 5 years and 89.4% at 10 years. Our data suggest that the efficacy of PVP was maintained for 10 years; however, it may decrease after more than 10 years. PVP also did not promote the progression of or worsen the prognosis of prostate cancer.

Palliative Radiotherapy and Hormonal Deprivation for Prostate Cancer Induced Urinary Obstruction at a Sub-Saharan Tertiary Hospital

The occurrence of bladder outlet obstruction (BOO) in men with prostate cancer is common. Although relieving the obstruction may not change prognosis, it is highly valued by patients and is generally associated with improvement in general functioning and wellbeing in the short-term. The aim of this study was to assess the efficacy of high-dose external beam radiation therapy (EBRT) combined with bilateral subcapsular orchidectomy (BSO) to relieve BOO due to prostate cancer. A retrospective study design was employed and conducted at the Mulago National Referral Hospital. Records of all patients with high-risk prostate cancer who presented with urinary obstructive symptoms and treated with the BSO and EBRT were retrieved. The study variables were age, clinical stage, and pathological Gleason score. The endpoint of the study was for patients to be able to pass urine after removing the urethral catheter, analysed as follows: complete failure to pass urine; partial emptying with a post-void volume &gt;100 mL, and passing urine with complete emptying and a post-void volume &lt;100 mL. In total, 46 patients were analysed in the period of January 2011–December 2012. Mean age was 71 years (range: 63–93). Eight patients failed to pass urine, while six passed urine incompletely (partial emptying). Thirty-two passed urine with a good stream and emptied the bladder completely. The success rate was 32/46 (70%). All patients had T3 and T4 stage disease with Gleason scores &gt;8. In conclusion, orchidectomy combined with EBRT was found to be an effective and feasible option for relieving BOO due to prostate cancer.

How can we measure bladder volumes in women with advanced pelvic organ prolapse?

To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound (2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse (POP). This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System (POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient (ICC)) were estimated for each of the three formulae considered. One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance (ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume.

Urinary tract infections in women with stress urinary incontinence treated with transobturator suburethral tape and benefit gained from the sublingual polibacterial vaccine.

Stress urinary incontinence (SUI) and recurrent urinary tract infections (RUTIs) are highly prevalent diseases. Our purpose was to investigate the relationship between RUTIs and surgical correction of SUI with transobturator suburethral tape (TOT) and to describe the benefit gained from a sublingual polibacterial preparation on RUTIs developed after TOT. A retrospective study was performed on 420 women who underwent TOT surgery due to SUI between April 2003 and October 2011. Group A: patients without urinary tract infections (UTIs) before TOT (n = 294). Group B: patients with UTIs before TOT (n = 126). age, personal history, number of UTIs/month prior to and after surgery, appearance of urgent urinary incontinence (UUI) with or without UTIs, response to International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Short Form 36 (SF-36) questionnaires. Group A: 85% dry; 5% UUI; 4% de novo UTIs with good response to antibiotics over 6 days. No RUTIs during the follow-up period, 2% with sporadic UTIs. Group B: 47.61% RUTIs; 52.39% sporadic UTIs; greater incidence of diabetes mellitus (p < 0.0025) and smoking (p < 0.0031) than group A. After TOT: 79.36% dry; 10% RUTIs. After treatment with antibiotics for 6 days and bacterial preparation for 3 months, 82% of patients did not have a UTI anymore. Postoperative cystourethrogram revealed 38% of nondiagnosed cystoceles before TOT. No patient had a postvoiding volume greater than 100 cm(3) after TOT. Improvement of ICIQ-SF (p < 0.001) and SF-36 (p < 0.0004) in both groups. After eliminating bias associated with the tape, the technique and the surgeon's skills, SUI correction may decrease the number of UTIs and improve the quality of life. UTIs disappeared in 82% of patients with RUTIs after TOT.

Multicenter, prospective, comparative cohort study evaluating the efficacy and safety of alfuzosin 10 mg with regard to blood pressure in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with or without antihypertensive medications.

BackgroundThe objective of this study was to assess the efficacy and safety of alfuzosin 10 mg monotherapy or combined antihypertensive medication on blood pressure (BP) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) with or without antihypertensive medication.MethodsThis was a 3-month, multicenter, randomized, open-label study in 335 patients aged ≥45 years with a clinical diagnosis of BPH/LUTS by medical history and clinical examination, a total International Prostatic Symptom Score (IPSS) ≥8 points, a maximum flow rate >5 mL/sec and ≤15 mL/sec, and a voided volume ≥120 mL. Eligible subjects were randomized to receive alfuzosin 10 mg as monotherapy (group 1) or alfuzosin 10 mg + antihypertensive combination therapy (group 2). Based on baseline BP and hypertensive history with or without antihypertensive medications at first medical examination, group 1 was divided into two subgroups of normotensive and untreated hypertensive patients, and group 2 into two subgroups of controlled hypertensive and uncontrolled hypertensive patients. The primary study outcomes were change in IPSS, BP, and heart rate from baseline. Secondary outcomes were change in IPSS-quality of life score, maximum flow rate, average flow rate, voided volume, and post-voided volume.ResultsThe overall BP change was not significantly different between groups 1 and 2 (systolic BP, P=0.825; diastolic BP, P>0.999). In patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or combined with antihypertensive therapy significantly decreased systolic and diastolic BP. The mean difference in total IPSS and IPSS-quality of life scores from baseline between groups 1 and 2 was 0.45 (95% CI: −1.26, 2.16) and 0.12 (95% CI: −0.21, 0.45), respectively (both P>0.05). Maximum flow rate, average flow rate, voided volume, and post-voided volume at endpoint were numerically, but not significantly, changed from baseline (all P>0.05).ConclusionThis study shows that alfuzosin 10 mg is effective and well tolerated in patients with BPH/LUTS with or without antihypertensive medications. However, in patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or in combination with antihypertensive medication appears to decrease systolic and diastolic BP, and these patients should be warned about a decrease in BP on initiation of therapy.

The accuracy of three-dimensional bladder ultrasonography in determining the residual urinary volume compared with conventional catheterisation

ObjectiveTo determine the accuracy of three-dimensional bladder ultrasonography (US, using the BVI 3000, Verathon, WA, USA) for determining the residual urinary volume, compared with the conventional catheterisation method. Patients and methodsWe conducted a cross-sectional study at day-care unit of a University hospital after obtaining approval from the Ethics Review Committee of the hospital. Thirty-four patients with lower urinary tract symptoms requiring cystometrography were included. The postvoid volume was measured by bladder US, with three readings taken, and then patient was catheterised using a 12-F Nelaton catheter to measure the urinary volume. The mean of the three readings was compared with the catheterisation volume. ResultsThe mean (SD) urinary volumes by US and catheterisation were 261 (186) and 260 (175)mL, respectively, and the correlation (r2) was 0.97. There was no effect of age, gender or body mass index on the accuracy of bladder US, which was accurate even when the urinary volume was ⩽100mL. ConclusionThe bladder US estimate is as accurate as catheterisation for determining the postvoid residual urinary volume. Its accuracy was also comparable when the urinary volume is <100mL, and there was no significant effect of age, gender and body mass index. This system could replace the more invasive catheterisation, and with excellent accuracy.

OnabotulinumtoxinA Office Treatment for Neurogenic Bladder Incontinence in Parkinson's Disease

To evaluate safety and effectiveness of low-dose (100 U) onabotulinumtoxinA (onabotA) bladder injections as an office procedure with topical anesthesia only for patients with Parkinson's disease (PD) and incontinence. Qualified patients who failed oral antimuscarinic agents participated in an open-label study. They discontinued antimuscarinics, provided a King's Health Questionnaire (KHQ), voiding symptom score, and 3-day voiding diary. Free uroflowmetry with post-void ultrasounds and cystometrogram pressure/flow studies were performed. Patients underwent flexible cystoscopy and injections of onabotA 100 U (10 U/mL) dispersed into 10-20 submucosal/detrusor sitesof the bladder, including the trigone. Voiding diaries, questionnaires, and free uroflowmetry with post-void ultrasound residual urine measurements were repeated after 1, 3, and 6 months. Twelve men and 8 women were treated: mean age, 70.4 years; duration of disease, 10.6 years; median bladder contraction volume, 115 mL; maximum bladder pressure, 62 cm; and post-void volume, 9 mL. Moderate to marked symptom relief at 3 months and a 50% incontinence decrease over 6 months relative to pretreatment was reported in 59% patients (P≤.02); 5 patients failed to complete the 6-month endpoint. No urinary retention required catheterization. Office cystoscopy with low-dose onabotA injection treatment is a potential long-term management strategy for patients with PD and urinary incontinence who fail oral antimuscarinic agents. The treatment seems to be safely utilized for older men with BPH as well as women with potential hypoactive detrusor function.

Longitudinal observational cohort study about detrusor underactivity as a risk factor for bladder neck contracture after retropubic radical prostatectomy: preliminary results

To evaluate the association between preoperative detrusor underactivity (DU) and symptomatic bladder neck contracture (BNC) in patients undergoing radical retropubic prostatectomy (RRP), in order to identify a possible new risk factor in the etiopathogenic mechanisms of BNC after RRP. A total of 100 prostate cancer patients underwent RRP after preoperative complete urodynamic examination. Detrusor contractility was evaluated by bladder contractility index (BCI), power at maximum flow (WF-Qmax), and maximum velocity of detrusorial contraction (MVDC). Follow-up included uroflowmetry with bladder post-voiding volume evaluation at 3 and 6 months after surgery and repeated urodynamic examination at 12 months. Statistical evaluation was performed using the Student's t test (P < 0.01). The mean patient age was 65.6 ± 5.4 years, and pathological stage ranged from T2a to T2c. A total of 40 patients (40 %) presented normal detrusor contractility, 47 (47 %) mild DU, and 13 (13 %) severe DU. Detrusor overactivity (DO) was observed in 12 patients (12 %), small cystometric capacity in 10 (10 %), low compliance in 16 (16 %), DO plus DU (mild or severe) in 6 (6 %), and DO plus small cystometric capacity together with low compliance in 5 (5 %). Normal urodynamics were observed in 38 patients (38 %). Overall BNC incidence was 12. All patients with BNC presented preoperative DU; none presented DO or low bladder compliance. DU severity and BNC occurrence were significantly correlated (P < 0.01) for all 3 urodynamic parameters (BCI, WF-Qmax, and MVDC). We identify DU as a possible novel risk factor for BNC formation after radical prostatectomy that may contribute to its development.

Traitement de l’hyperplasie bénigne de prostate par Prostiva ® : à propos d’une série de 76 patients

To evaluate the efficacy and morbidity of BPH treatment by radiofrequency in the general population and attempt to identify factors of prognostic value for this technique. This retrospective study examined 76 consecutive patients of mean age 68.9 years with symptomatic BPH in failure of medical treatment and treated at University Hospital of Caen between April 2004 and October 2008. Urine status was assessed before and after treatment with radiofrequency by the international prostate symptom score (IPSS), the quality of life (QOL) score related to urinary symptoms, the measurement of maximum urinary flow (Qmax) and residual postvoid volume (RPV). Erectile function was assessed by the International Index of Erectile Function (IIEF-5). The primary endpoint was treatment failure by radiofrequency regarded as the reintroduction of medical treatment or the need for surgical treatment. The secondary endpoints were the improvement of IPSS and QOL score, Qmax and RPV. Morbidity per and post-operative was also evaluated. A significant improvement in voiding status was observed with an average IPSS score from 24.7 to 15.1 (P<0.0001), and a QOL score from 5.2 to 2.9 (P<0,0001) in all patients. The Qmax and the RPV were significantly improved from 8.6 to 13.1ml/s (P<0.0001) and 177 to 100ml (P=0.0002) respectively. The IIEF-5 score was improved from 9.04 to 9.97 (P=0.0164). Twenty-five percent of acute urinary retention, 7.9% of haematuria and 1.3% of prostatitis were observed postoperatively. The overall retreatment rate was 46% after 14.6 months mean follow-up. When stratified into groups, patients with the inclusion criteria to this treatment showed a treatment rates of 34.8% after 16.2 months mean follow-up against 51% after 13.8 months of monitoring patients outside the inclusion criteria. Without showing significant difference between retentionist and no retentionist concerning subjective and objective parameters, the rate of retreat was more important for retentionist (51.2% after 11.8 months of mean follow against 39.4% after 18.4 months) with a significant difference on the actuarial cumulative survival curve without reprocessing. There was no significant difference found in patients with a median lobe. The results showed an improvement in Qmax significantly greater in the group with prostates less than 60 g without being able to demonstrate significant differences in other parameters. The retreatment rates in this group was 44.4% after 14.7 months of follow-up against 53.8% after 13.8 months of follow-up in the group of patients with prostate over 60 g. Moreover, the irritative component made a better initial response to treatment with a need for retreatment delayed compared to the group of patients with obstructive symptom, without noting significant differences in terms of improvement of objective and subjective parameters. The rate of retreatment was 63.6% after 16.4 months of mean follow and 51.6% after 11.2 months in the "obstructive" group. High rates of reprocessing are observed in the treatment of BPH by radiofrequency if inclusion criteria are not respected.

Impact of preoperative haemoglobin concentrations on the efficiency of KTP-laser vaporization of the prostate

The potassium-titanyl-phoshate laser (KTP laser) device produces light (wavelength of 532 nm) that is absorbed by haemoglobin, thus releasing thermal energy. This reaction causes vaporization of the tissue. We tested whether preoperative haemoglobin concentrations (Hb) affect the efficiency of the 80 W KTP laser, thus affecting the energy applied. We assessed 164 patients undergoing KTP-laser vaporization for benign prostate hyperplasia from January 2005 to July 2006 at Heidelberg University Hospital. We prospectively collected data on patients' demographics, urodynamics, Hb, prostate volume, and energy applied. We calculated the correlation between preoperative Hb and surgery energy applied and we adjusted it for prostate volume. We further compared the postoperative urinary flow and residual volume results in non-low-Hb and in low-Hb patients. The mean age was 68.8 (+/-8.8 years), the median prostate volume 50.0 mL (interquartile range 40-80), the median preoperative urinary flow 10.1 mL/s (interquartile range 7.1-14.0), the median surgery duration 70.0 min (interquartile range 50-92.75), the median preoperative Hb 144.5 g/L (interquartile range 132-151), and the median applied energy 209.5 kJ (interquartile range 156.5-272.75). The unadjusted correlation between preoperative Hb and applied energy was -0.089 (P < 0.05). After adjustment for prostate volume this correlation was not significant (Pearson r = -0.180, P > 0.05). Functional results did not differ between low-Hb and non-low-Hb patients (P > 0.05 for urinary flow and postvoid volume). Haemoglobin concentrations, in the range of clinically encountered values, do not affect the efficiency of 80 W KTP-laser vaporization of the prostate. This laser technique is thus applicable in patients with low haemoglobin concentrations without concerns about efficiency.

Diagnóstico y seguimiento de la hipertrofía prostática benigna mediante ecografía

The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

Suprapubic bladder drainage in colorectal surgery.

Seventy-six consecutive patients were studied prospectively in order to assess the value of suprapubic bladder drainage following surgery of the rectum and sigmoid colon. An Argyle-Ingram catheter (ICI) was inserted after the laparotomy incision had been made and the bladder was drained continuously for 24 h after which the catheter was closed and opened only every 6 h for 10 min. The patients were invited to void at will after the first 24 h. The catheter was removed when the post-voided volume became less than 50 ml on each of two subsequent measurements. The longest period of drainage was necessary after rectal excision, while rectosigmoid resections demanded shorter periods. The catheter did not function in one patient and urethral catheterization became necessary after removal of the suprapubic catheter in 4 patients. The method of suprapubic bladder drainage is recommended because it permits spontaneous voiding, allows measurement of residual volume without urethral instrumentation, gives little discomfort to the patient and has few complications.

Relation between objective and subjective measures of bladder dysfunction in multiple sclerosis

The authors studied 297 patients with multiple sclerosis (MS), correlating urinary symptoms (bowel/bladder Functional System [FS] score of the Expanded Disability Status Scale [EDSS] and bladder dysfunction score of the Guy's Neurological Disability Scale [GNDS[) vs objective measurement of bladder dysfunction (postmicturition residual volume). EDSS and GNDS were of no value for predicting the presence of a clinically relevant postvoiding volume. Therefore, the authors recommend ultrasound scanning of residual volume in every patient with MS, even in the absence of subjective urinary symptoms.

Führt der Lateral Repair als Zusatzoperation zur abdominalen Urethrokolposuspension zu einer Abnahme postoperativer Miktionsprobleme?

Fragestellung: Als Standard operation bei Streßinkontinenz hat sich die abdominale Urethrokolposuspension bewährt, deren Nachteil häufige postoperative Blasenentleerungsstörungen sind. Bei einem Lateral Repair erfolgt im Gegensatz zur Urethrokolposuspension keine Blasenhalselevation in eher unveränderlicher Position, sondern eine anatomische Rekonstruktion von paravaginalen Aufhängungsdefekten am Arcus tendineus fasciae pelvis. Die Erfolgsraten zur Therapie der Streßinkontinenz sind deutlich geringer, allerdings ohne Blasenentleerungsstörungen. Ungeklärt ist, ob eine Kombination von abdominaler Urethrokolposuspension und Lateral Repair bei Streßinkontinenz und paravaginalem Aufhängungsdefekt einerseits die guten Erfolgsraten bezüglich der Streßinkontinenz-Heilung erhalten und gleichzeitig die postoperativen Blasenentleemngsstörungen vermindern könnte. Patientinnen und Methodik: Vier Kasuistiken von konsekutiven Patientinnen, die bei einem paravaginalen Aufhängungsdefekt und Streßinkontinenz eine abdominale Urethrokolposuspension und einen Lateral Repair erhielten, werden bezüglich des postoperativen Miktionsverhaltens mit vier Patientinnen verglichen, bei denen nur eine abdominale Urethrokolposuspension vom gleichen Operateur durchgeführt wurde. Ergebnisse: Die Restharnmengen nach der ersten spontanen postoperativen Miktion lagen bei drei der vier Patientinnen mit zusätzlichem Lateral Repair unter 100 ml. Die suprapubische Leitung konnte bei diesen vier Patientinnen einmal am ersten und dreimal am zweiten Tag nach Beginn des Blasentrainings entfernt werden. Blasenentleerungsstörungen wurden nicht beobachtet. Drei der Patientinnen mit Urethrokolposuspenison allein zeigten Restharn mengen über 100 ml. Der suprapubische Katheter ist hier am zweiten, dritten und fünften Tag des Blasentrainings entfernt worden. Eine Frau mußte mit der suprapubischen Leitung entlassen werden und hatte erst einen Monat post operationem eine normale Miktion ohne Restharn. Diskussion: Diese Kasuistiken scheinen die Hypothese zu unterstützen, daß der Lateral Repair als Zusatzoperation zur abdominalen Urethrokolposuspension postoperative Blasenentleerungsstörungen senkt.

Efficacy and Acceptability of Tadenan®(Pygeum africanum Extract) in the Treatment of Benign Prostatic Hyperplasia (BPH): A Multicentre Trial in Central Europe

SummaryPygeum africanum extract is available as Tadenan ® in many countries, including those in central and eastern Europe, for the treatment of mild to moderate BPH. Its efficacy and acceptability have been demonstrated in numerous open and placebo-controlled studies in large populations. The present open three-centre efficacy and safety study was conducted according to common protocol at urology clinics in the Czech and Slovak Republics and in Poland, in order to confirm the therapeutic profile o/Pygeum africanum in conditions of daily practice, using International Prostate Symptom Score (IPSS) andflowmetry assessments.Men aged 50-75 years and in compliance with the selection criteria (including IPSS ≥ 12, quality of life (QoL) score ≥ 3, and maximum urinary flow ≤ 15 mils) were first examined then recalled after two weeks during which no treatment was provided (washout and check of stability). If still compliant, they were entered at this point into a two-month period of treatment with Pygeum africanum extract 50 mg twice daily. There followed a further one-month period without treatment, the objective being to evaluate the persistence of any effects observed during the previous two months of Pygeum africanum administration.The primary efficacy parameter investigated was IPSS; the other efficacy parameters were QoL, nocturnal frequency, maximum urinary flow, average urinary flow, post-voiding residual volume and prostatic volume, after one and two months of Pygeum africanum treatment and one month after stopping treatment. A total of 85 patients were evenly distributed between the three centres and completed the entire study. At inclusion their mean IPSS was 16.17, QoL was 3.60 and nocturia was 2.6 times per night.The changes in subjective scores, IPSS and QoL after the two-month treatment period were highly statistically significant with mean improvements of 40% and 31 %, respectively. Nocturnal frequency was reduced by 32% and the mean reduction was again highly statistically significant. Mean maximum urinary flow, average urinary flow and urine volume were also statistically significantly improved, but the modest improvement in post-voiding volume did not reach statistical significance. The improvements, which exceeded those observed with placebo in earlier studies, were maintained after one month without treatment indicating an interesting persistence of clinically useful activity. Prostatic volume and quality of sexual life remained unchanged throughout. No treatment-related adverse effects were observed.In conclusion, under conditions of daily practice, Pygeum africanum extract induces significant improvement in IPSS and uroflowmetry parameters. These positive effects are accompanied by a very satisfactory safety profile with the overall result of a substantial improvement in QoL.

Valutazioni Clinico-Urodinamiche Sulla Neovescica Ileale Ortotopica Riconfigurata Sec. Rouxel-Coadou: Nostra Esperienza

Twelve patients were submitted to orthotopic ileal neobladder, performed using staplers. All patients underwent clinical and urodynamic evaluations at 3, 6 and 12 months after surgery (mean follow-up 6 months). They reported complete daytime continence and 2 pts/4 night-time continence too. At one year, post-voiding volume was absent, mean neobladder capacity was 450 cc and mean pressure at maximum capacity was 30-40 cc. These preliminary results indicate that this technique guarantees low-pressure reservoir with good capacity and compliance.

Characterization of a Dialyzable Immunosuppressive Fraction from Mastocytoma Culture Supernatants

SummaryImmunosuppression induced by mastocytoma cells is related to a soluble factor present both in the supernatants of tumor cell cultures and in tumor cell extracts and ascites fluid of tumor-bearing animals. In the present study culture supernatants of mastocytoma cells growing in serum-free medium contained an immunosuppressive material which was readily dialyzed. The concentrated dialysates from the culture supernatants were fractionated by Sephadex gel filtration. The postvoid volume fraction from Sephadex G-10 columns contained most of the immunosuppressive activity present in the dialysates. The material in the active fractions had a molecular weight in the range of 1000 to 5000. The immunosuppressive activity of the culture supernatants, the concentrated dialysates, and the post-void volume Sephadex fractions were stable to heating at 56° for 30 min but was inactivated when heated at 80°. Furthermore, the immunosuppressive activity was inhibited by treatment with trypsin in vitro but was resista...