Uroflow Rate Research Articles

Ultraselective internal iliac artery chemotherapy and embolism for hormone-refractory prostate cancer

Objective To assess the application of ultraselective internal iliac artery chemotherapy and embolism for hormone-refractory prostate cancer. Methods Forty-eight patients with hormone-refractory prostate cancer were randomly divided into 2 groups: treatment group (8 cases of stage Ⅲ, 17 cases of stage Ⅳ, 10 cases with bone metastases) and control group (7 cases of stage Ⅲ, 16 cases of stage Ⅳ, 9 cases with bone metastases). Ultraselective internal iliac artery chemotherapy and embolism was performed for the treatment group with cyclophosphamidum 100 mg, pirarubicin 30mg, hydroxycamptothecin 20 mg and gel-foam as embolization material. It was carried out once per mouth for 3 times and then once every 3-6 months. Estramustine phosphate (280 mg twice per day) was administrated as well. Patients of the control group were given estramustine phosphate 280 mg twice per day alone. All the patients with bone mastatases were given 6 mg ibandronic acid per month. Results The pre-treatment prostate volume was (71.4±4.6) ml in treatment group and (72.3±3.2)ml in control group; The prostate volume was (50.2±4.1)ml and (64.2±4.5)ml, respectively, after two week treatment. The pre-treatment maximum uroflow rate (Q ) in treatment group and control group was (10.8±1.1)ml/s and (11.2±1.2) ml/s, respectively; Two weeks after treatment, the Q was (16.7±1.8)ml/s in treatment group and (13.8±1.5)ml/s in control group. The pre-treatment PSA of the patients was (64.34±5.32)ng/ml in treatment group and (65.02±6.16)ng/ml in control group; Two weeks after treatment, PSA was (23.56±4.26)ng/ml in treatment group and (56.43±4.76)ng/ml in control group. For above parameters, the difference in treatment group was significant (P 0.05) ; The difference between treat-ment group and control group was not significant before treatment (P>0.05), but was significant after treatment (P 0.05). Conclusian The ultraselective internal iliac artery chemotherapy and embolism is effective for the quality of life improvement and symptom relieving in the patients with hormone-refractory prostate cancer. Key words: Prostatic neoplasms; Carcinoma; Chemotherapy; Embolism; Estramustine phosphate

Impact of 8F intra-urethral catheter on uroflow rate in pressure-flow studies in patients with benign prostatic hyperplasia

Objective To investigate the impact of 8F intra-urethral catheter on uroflow rate in pressureflow studies in patients with benign prostatic hyperplasia.Methods one hundred and three men with lower urinary tract symptoms underwent free uroflometry and pressure-flow study respectively.With an 8F urethral catheter,we recorded the standard pressure-flow variables such as umflometry,detrusor pressure at maximum uroflow and so on.We analyze,free uroflow rate and catheter's uroflow rate with paired t-test.Results The maximum voided volume in free uroflometry and in pressure-flow study were (177.68±70.55)ml and (180.90±68.34)ml respectively.The maximum free uroflow rate and the maximum catheter's uroflow rate were (10.2±3.1)ml/s and (7.8±3.9 )ml/s in BPH with detrusor normal-activity group ( P＜0.05 ),(9.1±4.1)ml/s and (5.8±3.2)ml/s in BPH with detrusor under-activity group(P＜0.05 ).The differences of uroflometry between two voids in tow groups were (2.9±2.8)ml/s and (3.4±2.9)ml/s( P＜0.05 ).Paired t-test showed that there was significant difference between the maximum free uroflow rate and maximum catheter's uroflow rate.Conclusions 8F urethral catheter appeared to have a significant impact on maximum umflow rate in benign prostatic hyperplasia and there was more significant impact in BPH with detrusor under-activity group.It must be considered when analyzing pressure flow parameters to make a accurate diagnosis. Key words: Urodynamics; Pressure-flow study transurethral; Catheterization; Uroflometry

Correlation between Lower Urinary Tract Symptoms (LUTS) and Sexual Function in Benign Prostatic Hyperplasia: Impact of Treatment of LUTS on Sexual Function

Although many reports have shown a relationship between lower urinary tract symptoms (LUTS) and sexual function (SF), it is not known which symptom(s) among LUTS should be treated to improve SF. Thus, the aim of this study was to investigate correlations between LUTS and SF and to determine which symptom(s) should be improved to increase SF. The correlation between the severity of LUTS and erectile dysfunction (ED) was investigated, and changes in LUTS were compared and analyzed to determine which symptom(s) should be eliminated to improve SF. The correlation between LUTS and SF was investigated in 365 men (62.04 +/- 8.26) with benign prostatic hyperplasia. To measure the severity of the LUTS and ED, the International Prostate Symptom Score (IPSS), frequency of nocturia, uroflowmetry, residual urine, transrectal ultrasonography, and the International Index of Erectile Function (IIEF)-5 were performed at the first visit. After 3 months of treatment with alpha-blockers (n = 304), they were assessed again to evaluate the effectiveness of the treatment. All parameters of LUTS (IPSS, age, residual urine, uroflow rate, and nocturia) except prostate volume correlated significantly with the total and each domain of IIEF-5 (P < 0.01). After 3 months, the changed scores in the IPSS-VD domain and IPSS-quality of life (QoL) correlated significantly with the improvement in total IIEF-5 and the domains of IIEF-5 (P < 0.05). The changed rates of the mean uroflow correlated significantly with the improvement in total IIEF-5 and the EF domain (P < 0.05). Among the LUTS parameters, improvement in the IPSS-VD domain, IPSS-QoL, and mean uroflow significantly correlated with an increased score in the IIEF-5 EF domain. Thus, it is expected that the improvement of voiding symptoms and uroflow will be associated with the improvement in erectile function.

Objective outcome assessment of the modified Bretteville Technique

The paradigm for hypospadias repair is a straight, erect penis, with a vertical meatus at the tip of the glans that provides satisfactory urination and is cosmetically acceptable to the patient. We provide objective outcome data on 40 cases of hypospadias repaired using the modified Bretteville technique. The 'HOSE' questionnaire, flowmetry, wetted pad and spray pattern analysis in combination with other questionnaire data were obtained to evaluate the long-term results of the modified Bretteville technique. The average HOSE score was 15/16. Cosmesis is good, with average scores of 7.1/10 (patient) and 7.6/10 (doctor). HOSE assessment is good, with 85% of patients scoring 14 or over. Uroflow rates are very good for a hypospadiac population with 82.5% of the patients within normal limits for their age group. Wetted pad and spray pattern analysis showed 56% of patients sprayed more than 3g of urine compared to 11% in a junior football team acting as control, although there was little correlation between this objective assessment and the patients' perceived symptoms as assessed by the questionnaire. The modified Bretteville hypospadias repair provides a reliable epithelialized repair of consistent dimensions with good patient-reported cosmesis and excellent functional outcomes.

Laparoscopic versus Open Simple Prostatectomy: An Evaluation of Morbidity

To evaluate the morbidity between laparoscopic simple prostatectomy (LSP) and open simple prostatectomy (OSP) in the management of benign prostatic hyperplasia. From January 2003 through January 2008, 280 consecutive patients underwent adenomectomy either by an extraperitoneal laparoscopic transcapsular "Millin" approach (96 patients, 34.3%) or open transvesical approach (184 patients, 65.7%). Medical therapy had failed in all patients. Perioperative and outcome data were recorded and compared. There was no significant difference in patient age, prostate size, uroflow rate, mean International Prostate Symptom Score, operative blood loss, or total time of continuous bladder irrigation between the two groups. Mean operative time was significantly longer in the laparoscopy group, 95.1 +/- 32.9 minutes, v the open group at 54.7 +/- 19.7 minutes (P < 0.0001). Total catheter time was significantly shorter in the laparoscopy group (5.2 +/- 2.6 v 6.4 +/- 2.9 days; P < 0.001) as was length of hospital stay (6.3 +/- 1.9 v 7.7 +/- 2.4 days; P < 0.0001). The most common complication between the two groups was hemorrhage, occurring in 27 (28.1%) patients in the laparoscopy group and 54 patients (29.3%) in the open group. Of the 19 urinary tract infections observed between the two groups, 18 occurred in the open group as well as all 9 cases of urinary sepsis. LSP offers advantages over OSP in terms of shorter catheter time, shorter hospital length of stay, and fewer urinary tract infections.

Incidence and Risk Factors of Postoperative De Novo Voiding Dysfunction following Midurethral Sling Procedures

Purpose: To compare the incidence of postoperative de novo voiding dysfunction and to identify the risk factors affecting the development of de novo voiding dysfunction after various midurethral sling (MUS) procedures for female stress urinary incontinence (SUI). Materials and Methods: Women with SUI underwent MUS by various procedures [tension-free vaginal tape (TVTR), tension-free vaginal tape obturator (TVTOR), tension-free obturator tape (TOTR), or TVT-secureR]. Cases were reviewed retrospectively with follow-up of at least 6 months. The subjects were divided into 2 groups according to the presence of postoperative de novo voiding dysfunction. De novo voiding dysfunction was defined as a low maximal uroflow rate (Qmax 100 ml) observed at 6 months postoperatively. Clinical and urodynamic parameters were compared between the voiding dysfunction (Group I) and normal voiding (Group II) groups according to MUS procedure. Results: Of the 625 subjects, 163 (26%) patients showed evidence of de novo voiding dysfunction (Group I). Of these 163 subjects, 12 (7.3%) patients complained of voiding symptoms. There was no difference in the incidence of de novo voiding dysfunction according to MUS procedure. Multivariate analysis showed Qmax to be the only independent risk factor for de novo voiding dysfunction. Conclusions: This study confirmed the considerable incidence of postoperative de novo voiding dysfunction, which is, however, mostly asymptomatic. As preoperative Qmax decreased, the chance of postoperative de novo voiding dysfunction increased. Identification of risk factors of voiding dysfunction in women undergoing MUS may help in planning for better follow-up and early detection of possibly inherent late complications of voiding dysfunction. (Korean J Urol 2009;50:762-766) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Improvement of Lower Urinary Tract Symptoms and Sexual Function after Treatment with Alpha-Blocker

Purpose: The association of lower urinary tract symptoms (LUTS) and erectile dysfunction has not been investigated comprehensively concerning which LUTS are associated with sexual function. Therefore, we investigated the association of each domain of the International Prostate Symptom Score (IPSS), nocturia, prostate volume, and uroflowmetry with each domain of the International Index of Erectile Function (IIEF)-5. Materials and Methods: The correlation of sexual function and LUTS was investigated in 365 men with benign prostatic hyperplasia. To measure the level of LUTS, the IPSS was calculated; uroflowmetry, residual urine measurement, and transrectal ultrasonography (TRUS) were performed; and the level of erectile dysfunction was assessed by the IIEF-5. Three months after treatment with α-blocker (tamsulosin 0.2 mg/day), IPSS, uroflowmetry, residual urine, nocturia, and IIEF-5 were assessed again to evaluate the effectiveness of treatment. Results: Erectile function deteriorated more in individuals with severe LUTS (IPSS＞20) than in those with mild LUTS (IPSS＜8), and IPSS, age, and nocturia correlated significantly with all IIEF-5 domains. The maximal urine velocity and the average urine velocity on uroflowmetry correlated significantly with all IIEF domains. After the administration of α-blocker for 3 months, the changed rates of the IPSS-obst domain, average uroflow, and quality of life (QoL) correlated significantly with the improvement in the total IIEF-5. Conclusions: Changes in the IPSS-obst domain, QoL, and average uroflow rate correlated significantly with changes in the total IIEF-5. Thus, it is expected that the improvement of obstructive symptoms could effectively

The Effects of Bladder Over Distention on Voiding Function in Kindergarteners

We report the effects of bladder over distention on pediatric voiding function. We enrolled healthy kindergarten children (mean age 4.5 +/- 1.0 years) for 2 observations of uroflowmetry and post-void residual urine. Additional observations were requested if the voided volume was less than 50% of expected bladder capacity. Post-void residual was assessed within 5 minutes after voiding. A post-void residual of more than 20 ml is regarded as increased. Bladder capacity is defined as voided volume plus post-void residual and shown as percentage of expected bladder capacity. The uroflowmetry curves were categorized as bell-shaped or nonbell-shaped. Among 188 children 355 observations of uroflowmetry and post-void residual were eligible for evaluation. Nonbell-shaped uroflowmetry curves and increased post-void residual were noted in 75 (21.1%) and 78 (22%) of 355 voids, respectively. Based on the receiver operating characteristic curve for the nonbell-shaped curves and increased post-void residual, bladder capacity of 115% of expected bladder capacity or more is defined as bladder over distention. There were statistically more increased post-void residuals and more nonbell-shaped uroflowmetry curves in the voids with bladder over distention than in those without over distention (p <0.01). Of the 38 children displaying both types of curves the nonbell-shaped curves usually occurred at a higher bladder capacity than did the bell-shaped curves (133% +/- 46% expected bladder capacity vs 84% +/- 38% expected bladder capacity, p <0.01). Peak uroflow rate increased as bladder capacity increased but decreased at extreme bladder over distention. Optimal bladder capacity is important for assessing pediatric voiding function. Bladder over distention resulted in more nonbell-shaped uroflowmetry curves and more increased post-void residual. At extreme over distention peak flow rate decreased as well.

Comparative Analysis of Tubularized Incised Plate Versus Onlay Island Flap Urethroplasty for Penoscrotal Hypospadias

Despite being the dominant technique for repair of distal hypospadias, application of the tubularized incised plate approach for penoscrotal hypospadias remains controversial. We report our experience with severe hypospadias, comparing tubularized incised plate to transverse island flap onlay urethroplasty. We retrospectively reviewed consecutive patients with penoscrotal hypospadias presenting between 1998 and 2006. Based on surgeon preference 35 children underwent tubularized incised plate and 40 underwent onlay urethroplasty. Penoscrotal transposition and degree of ventral curvature, type of ventral curvature repair, complication rate, postoperative uroflowmetry pattern in toilet trained patients and number of reoperations were compared between the 2 groups. Mean patient age at surgery was 17 months (range 9 to 91) for tubularized incised plate urethroplasty and 17.8 months (10 to 58) for the onlay procedure. Urethroplasty was performed over an 8Fr catheter in all patients. With mean followups of 30 months (range 6 to 74) and 38.8 months (16 to 80) the overall complication rates were 60% and 45% for the tubularized incised plate and onlay procedures, respectively. Fistula occurred in 15 patients and repair breakdown in 3 patients (total 51.4%) treated with tubularized incised plate repair, compared to 8 and 2 patients, respectively (25%), treated with onlay repair (p = 0.01). Fistula location also differed significantly between the 2 groups, with proximal fistulas occurring in 11 of 15 tubularized incised plate repairs (73.3%) vs 2 of 8 onlay repairs (25%, p = 0.02). Recurrent ventral curvature was more frequent after onlay urethroplasty (5.7% vs 12.5%, not significant). At a mean age of 5.1 years a plateau uroflow curve (vs normal bell curve) was observed in 16 of 24 children (66.7%) who underwent tubularized incised plate repair and in 7 of 21 (33.3%) who underwent onlay repair (p <0.01). In this series the overall complication rate was similar for tubularized incised plate and onlay urethroplasty. Despite similar urethroplasty calibers, the uroflow curves and fistula positions in patients undergoing tubularized incised plate repair suggest that the neourethra distal to the fistula may be relatively narrow, creating flow resistance and leading to proximal fistula. Longer followup and close monitoring are needed before embracing one approach over the other.

Clinical effectiveness and safety study of combined therapy with an alpha-blocker and an anticholinergic for patients with LUT/BPH

The effectiveness and safety of the combined therapy of terazosin and tolterodine for LUT/BPH patients with dominant storage symptoms was evaluated. The present study included 69 patients diagnosed as LUT/BPH by IPSS, flowmetry, ultrasound for prostate volume, residual urine, serum PSA and other methods, all of them fulfilled the study's inclusive/exclusive criteria. The principal exclusive criteria were prostate volume > 50 ml, Qmax < 10 ml/s and residual urine > 50 ml. All 69 patients had bothering storage symptoms after initial treatment with terazosin 2 mg once daily for one week., they were divided randomly into two groups. Terazosin group in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group in which patients were treated with terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks. Sixty-nine patients with LUT/BPH were recruited with inclusive/exclusive criteria of our study, thirty-six patients were in terazosin group and 33 were in combination group. At baseline there were no significant differences between the groups, in mean age, body weight, prostate volume, IPSS, storage IPSS, voiding IPSS, Qmax and residual urine. The results showed that the IPSS was significantly improved in the two groups after treatment, but the reduction of IPSS in combination group was significantly greater than that in terazosin group (P < 0.001), and the decreased storage IPSS was the main contribution to the reduction of IPSS in combination group. There were no differences between the groups for Qmax and residual urine. Combined therapy with terazosin plus tolterodine for LUT/BPH patients with dominant storage symptoms can improve the IPSS, especially the storage IPSS, without any negative effects on uroflow rate and residual urine. Combining with inclusion/exclusion criteria of the study, we believe that combined therapy with alpha-blocker plus anticholinergics is an effective and safe treatment for LUT/BPH patients with relatively small prostate volume, moderate impaired Q(max) and dominant storage symptoms.

Effects of branded versus generic terazosin hydrochloride in adults with benign prostatic hyperplasia: A randomized, open-label, crossover study in taiwan

Background: Terazosin is an al-selective adrenoceptor blocking agent that has been reported in many clinical trials to be an effective choice for the treatment of benign prostatic hyperplasia (BPH). To improve cost-effectiveness, the development of an effective and well-tolerated generic formulation is needed. Objective: The aim of this study was to compare the efficacy and tolerability of branded versus generic terazosin hydrochloride in adult patients with symptomatic BPH in Taiwan. Methods: This randomized, open-label, 2-sequence, 2-period crossover study was conducted at the Urological Clinic, National Cheng Kung University Medical Center, Taman, Taiwan. Men newly diagnosed with symptomatic BPH who had not previously received treatment for BPH were recruited between August 2002 and April 2006. Patients were randomly assigned to 1 of 2 treatment sequences. Group A received generic terazosin during period 1 (6 weeks) and branded terazosin in period 2 (6 weeks); group B received the branded drug during period 1 and the generic during period 2. The 2 study periods were separated by a 1-week washout period. All treatments were given by mouth once daily (bedtime) at an initial dosage of 2 mg/d for the first 2 weeks. At the week-2 study visit in each treatment period, the dosage could be increased to 4 mg/d or decreased to 1 mg/d based on each patient's response and experience of adverse effects (AEs), based on the opinion of the investigator. Efficacy variables included the total score on the International Prostate Symptom Scale (IPSS), a 7-item instrument used to assess objective lower urinary tract symptoms, including quality of life. IPSS was measured at baseline and weeks 2 and 6 of each treatment period, and maximal and mean uroflow rates, measured at baseline and week 6. Tolerability was assessed at each time point using physical examination, including vital signs; laboratory analysis; and spontaneous reporting. Results: Fifty-three patients were randomized; 43 were included in the efficacy analysis (mean [SD] age, group A, 64.5 [7.7] years and group B, 62.9 [8.2] years; mean [SD] weight, group A, 66.4 [7.2] kg and group B, 67.1 [8.9] kg; all patients were Taiwanese). At 2 and 6 weeks, no significant between-product differences were found in mean (SD) decreases from baseline in IPSS total score (generic, 2.46 [0.84] and 2.46 [1.00], respectively; branded, 1.56 [0.60] and 2.87 [0.71]). At week 6, the between-product difference in mean increase from baseline in maximal uroflow rate was nonsignificant (generic, 2.36 [0.90] mL/s; branded, 2.03 [0.62] mL/s). A total of 86 treatment-emergent AEs were reported (45 with the generic drug; 41 with the branded drug), all of which were considered by the investigator as nonserious except for 1 case of acute epididymitis, which occurred with the generic drug. The most common AEs reported with the generic and branded formulations were dizziness (7/48 [14.6%] and 10/50 [20.0%], respectively) and peripheral edema (1/48 [2.1%] and 3/50 [6.0%]). No significant differences in the prevalences of AEs were found between the 2 treatments. Conclusion: In this group of Taiwanese patients with symptomatic BPH, the efficacy and tolerability of generic terazosin were similar to those of branded terazosin.

Low-dose X-ray radiation on pituitary gland area to treat benign prostatic hyperplasia

目的 探讨低剂量X线照射垂体区治疗老年良性前列腺增生症(BPH)的临床疗效.方法 用6 mV X射线外照射BPH患者脑垂体区,每次1.2 Gy,每周2次,总剂量4.8～6.0 Gy;测定治疗前后尿流率和残余尿量的变化.结果 近期有效率78%,1年有效率70%,照射后尿流率明显增加(P＜0.05).结论 该疗法无创伤,简便、安全,是年老多病不能手术治疗或药物治疗无效的BPH患者的首选治疗方法。

Two‐ and three‐dimensional ultrasonographic findings in urethral stenosis with bladder wall trabeculation: case report

Female bladder outlet obstruction is uncommon. We report a case of bladder outlet obstruction secondary to urethral stenosis leading to bladder wall trabeculation. The patient presented at our clinic because of lower urinary tract symptoms including nocturia, urgency, bed wetting, hesitancy, straining to void, and incomplete emptying. Urodynamic study revealed a low maximum free uroflow rate, high residual urine volume, and low compliance on filling phase cystometry. Introital ultrasonography with two- and three-dimensional (2D and 3D) scanning displayed a constriction in the echolucent part of the lower-mid urethra with hyperechogenicity and a lattice-like appearance of the bladder wall. Cystourethroscopy confirmed urethral stenosis and bladder wall trabeculation. The voiding symptoms subsided after the urethral stenosis was relieved by urethral dilatation, but, despite some improvement, the irritative symptoms persisted. Introital ultrasonography with 2D and 3D scanning may help to clarify the cause of female bladder outlet obstruction.

Sequential Holmium Laser Enucleation of the Prostate and Laparoscopic Extraperitoneal Bladder Diverticulectomy: Initial Experience and Review of Literature

Urologic applications of laparoscopy and the holmium laser have increased exponentially in the past few years. We present our experience with sequential holmium laser enucleation of the prostate (HoLEP) and extraperitoneal laparoscopic diverticulectomy for a large symptomatic bladder diverticulum and associated bladder outlet obstruction. From June 2004 to June 2005, three patients with benign prostatic hyperplasia (BPH) and a large secondary bladder diverticulum were offered sequential HoLEP and laparoscopic extraperitoneal bladder diverticulectomy. Demographic data and perioperative outcomes were recorded. A review of the literature was performed to determine the present role of laparoscopic diverticulectomy. All patients underwent the planned procedure successfully. The mean operating time was 63.33 minutes for HoLEP and 246.6 minutes for diverticulectomy. Oral intake was resumed after a mean of 8.6 hours. The mean postoperative analgesia required was 146 mg of parecoxib sodium, and the mean drop in hemoglobin was 1.13 g/dL. Patients were discharged after an average of 66.6 hours. At 1-month follow-up, the average American Urological Association Score had improved from 13 to 6, the post-void [corrected] residual urine volume had decreased from 997 mL to 164 mL, and the peak uroflow rate had improved from 4.9 mL/sec to 10.4 mL/sec. These measures showed further improvement on later follow-up. A total of 30 cases of laparoscopic diverticulectomy have been reported in literature [corrected] of which only two were done extraperitoneally. Simultaneous HoLEP and laparoscopic extraperitoneal diverticulectomy is an effective strategy for the treatment of BPH with associated large bladder diverticulum.

Combined use of androgen and sildenafil for hypogonadal patients unresponsive to sildenafil alone

To investigate the therapeutic effect of androgen on hypogonadal patients unresponsive to sildenafil alone. In total, 32 hypogonadal patients with erectile dysfunction (ED), initially had an inadequate response to sildenafil (100 mg). Oral testosterone undecanoate (Restandol, 80 mg, bid or tid) alone was supplied for 2 months, and if patients could not achieve a satisfactory erection, combined use of testosterone and sildenafil was continued thereafter. Total testosterone (TT), free testosterone (FT), and the parameters of the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and uroflow rate (UFR) were assessed. Eleven patients (34.3%) achieved satisfactory erectile function after testosterone replacement only. Another 12 (37.5%) patients experienced satisfactory intercourse after combined therapy. Serum TT and FT levels significantly increased after the use of testosterone alone (415+/-163 vs 220+/-101 ng/dl, P<0.01; 10.4+/-4.6 vs 5.1+/-1.9 ng/dl; P<0.01, respectively) and the combined use of testosterone and sildenafil (498+/-178 vs 220+/-101 ng/dl, P<0.01; 11.7+/-4.6 vs 5.1+/-1.9 ng/dl, P<0.001, respectively); as did the IIEF score (14.8+/-6.8 vs 12.6+/-7.5, P<0.01, 17.5+/-5.2 vs 12.6+/-7.5, P<0.001, respectively). However, no statistical differences were demonstrated for IPSS or UFR. In conclusions, one-third of hypogonadal patients with ED who failed to respond to sildenafil, responded to testosterone alone, another third responded to sildenafil again after normalization of testosterone. So, in hypogonadal patients with ED, androgen supplementation is first-line therapy. If patients are unresponsive to androgen alone or sildenafil alone, combined use may improve erectile function and enhance the therapeutic effect of PDE-5 inhibitors.

Treatment of Benign Prostatic Hyperplasia Using Transurethral Microwave Thermotherapy and Dilatation with Double-Balloon Catheter

To improve the outcome of transurethral microwave thermotherapy (TUMT) for the treatment of benign prostatic hyperplasia, we combined TUMT and balloon dilatation (BD) with a double-balloon catheter and investigated its effects. For a short-term trial, 40 patients were divided randomly into two groups: 20 patients received TUMT alone, and the other 20 received TUMT followed by BD. The degrees of symptoms were graded according to the International Prostate Symptom Score and Quality of Life score, and the peak urinary flow rate was measured before and 10 weeks after treatment. A historic control study of 527 patients was also performed to evaluate the long-term re-treatment rate: 98 of the patients received TUMT alone, and the other 429 patients received TUMT followed by BD. The symptom scores improved significantly in both groups. The peak uroflow rate was significantly increased in the group who received TUMT followed by BD (P < 0.01), whereas the change was not significant in the TUMT-alone group. Significant sustainability of long-term effects was more evident in patients receiving TUMT plus BD than in the TUMT-alone group, as judged by the higher proportion of BD-treated patients who required no further treatment during the 5-year study period in comparison with patients who received TUMT alone (66.3% v 28.6%, respectively; P < 0.001). Combined TUMT and BD achieves sufficient subjective and objective improvement and a sustainable long-term effect. We consider this combination technique to be useful for the treatment of prostatic hyperplasia.

Bipolar versus Monopolar Transurethral Resection of Prostate: Randomized Controlled Study

Transurethral resection of prostate (TURP) using bipolar electrocautery and physiologic saline is a new technical advancement in the field of surgical management of benign prostatic hyperplasia. The purpose of this study was to assess the efficacy and safety of this new technique and to compare the results with those of conventional monopolar TURP. This study included 60 patients who were randomized 1:1 to bipolar (group 1) or monopolar (group 2) TURP. Bipolar TURP was performed with the Vista CTR resectoscope and generator (ACMI Corp.). Preoperatively, patients were assessed by symptom score, uroflow, and transrectal sonography, and the two groups were comparable with regard to these measures and age. The preoperative and postoperative parameters studied included resection time, amount of tissue resected, irrigant amount, blood loss, fluid absorption, and change in serum sodium and hemoglobin. Postoperatively, patients were assessed for symptoms, symptom score, and uroflow rate at 1 and 3 months. There was no difference in resected tissue amount, irrigant amount, fluid absorption, duration and amount of postoperative irrigation, or fall in hemoglobin. The mean resection rate was 0.61 g/min in group 1 and 0.74 g/min in group 2. Serum Na dropped by 4.6 Eq/L in group 2, whereas it fell only 1.2 mEq/L in group 1 (P < 0.001). Improvement in symptom and QoL scores and Q(max) were similar in the two groups. Postoperative dysuria was less common with bipolar resection. Bipolar resection of the prostate is as effective as monopolar TURP. Moreover, it does not lead to any change in serum Na and causes less postoperative dysuria.

Outpatient Biofeedback Relaxation of the Pelvic Floor in Treating Pediatric Dysfunctional Voiding: A Short-Course Program Is Effective

Introduction: We report the treatment results of a short course of biofeedback relaxation of the pelvic floor (BRPF) in treating children with dysfunctional voiding. Materials and Methods: Fourteen girls and 6 boys with videourodynamically proved dysfunctional voiding were enrolled. To increase the awareness of the abnormal voiding pattern, the anatomy of the pelvis and the results of a voiding diary and videourodynamics were extensively explained to the patients/parents. Surface electromyography and uroflowmetry were used as biofeedback tools to teach the adequate relaxation of the pelvic floor during voiding. The child was asked to practice the relaxation technique at home at least twice a day. BRPF was performed once a week until the child had 2 consecutive normal bell-shaped uroflow recordings. Patients were reevaluated at 4, 8, 12 and 24 weeks after BRPF training. Results: The mean patient age was 8.3 ± 3.8 years. The mean number of BRPF training sessions was 2.2 ± 0.9. The mean follow-up period was 18.9 months. Normalization of abnormal uroflowmetry was achieved in 18 patients (90%). The mean maximal uroflow rate and voided volume increased from 13.3 ± 4.3 to 18.0 ± 3.4 ml/s (p < 0.01) and from 138 ± 56 to 193 ± 65 ml (p < 0.01), respectively. The postvoiding residual urine decreased from 54.5 ± 47.6 to 21.3 ± 10.6 ml (p < 0.01). Complete and partial resolution of voiding symptoms was achieved in 14 (70%) and 6 patients (30%), respectively. Recurrence was noted in 2 of the 10 patients who had complete resolution of symptoms and who had been followed up for more than 6 months. Conclusions: Short-course outpatient BRPF is an effective treatment of pediatric dysfunctional voiding.

Application of Transrectal Power Doppler Ultrasound in the Prediction of Corrected Maximal Uroflow Rate

Background A reliable interpretation of uroflowmetry depends on adequate voiding volume. Unfortunately, many patients may not be in a position to void enough volume to allow an effective interpretation. The main objective of this study was to determine how a valuable uroflow rate can be obtained with an inadequate or even no voiding volume. We have tried to develop a new method to predict the actual uroflow rate by adding power Doppler information during transrectal ultrasound (TRUS) in patients who do not have an interpretable voiding volume. Patients and Methods Fifty-five patients with complete uroflowmetry and TRUS with power Doppler study were enrolled. Analyses of the uroflowmetry and power Doppler parameters were performed. Correlation coefficients were calculated to reveal the relationships among these parameters. Results The correlation coefficient between the prostate intracapsular pulsatility index (PI) and corrected peak flow rate (cQ max ) was —0.79. Correlation between the PI of vessels outside the prostate and cQ max was not significant, as the intracapsular PI was. We generated a linear regression equation, cQ max = 0.8911 × PI + 14.569, to predict cQ max by intracapsular PI. This equation can be applied when adequate spontaneous voiding is not available. Conclusion TRUS is informative when power Doppler parameters are applied. Corrected peak uroflow rate can be predicted even in patients who have an inadequate or no voiding volume.

PRIMARY BLADDER NECK DYSFUNCTION IN CHILDREN AND ADOLESCENTS II: RESULTS OF TREATMENT WITH α-ADRENERGIC ANTAGONISTS

Little has been reported on the occurrence of primary bladder neck dysfunction (PBND) in the pediatric patient, particularly as it relates to the use of alpha-blocker therapy, the mainstay of medical therapy in adults. Diagnosed on videourodynamics (VUDS), PBND is characterized by the constellation of prolonged opening time, incomplete bladder neck funneling, quiet pelvic floor electromyogram (EMG) during voiding and abnormal pressure flow parameters. We report the VUDS findings in PBND and our experience with alpha-blocker therapy in the pediatric and adolescent population. A total of 34 symptomatic patients met all VUDS criteria for PBND, and alpha-blocker therapy was initiated in 26. All patients were monitored with serial noninvasive uroflow studies with pelvic floor EMG (uroflow/EMG) before and after initiation of alpha-blocker therapy. Objective clinical response was assessed by measuring average and maximum uroflow rates, post-void residual urine volumes and pelvic floor EMG lag time, a correlate of opening time. A total of 26 patients with PBND (20 males, 6 females) 5.5 to 20 years old at initiation of therapy (mean age 12.8 years) were treated with alpha-blockers. Mean average and maximum uroflow rates improved from 5.5 to 12.6 cc per second and from 10.3 to 19.7 cc per second, respectively, while mean EMG lag time decreased from 24.4 to 5.7 seconds and post-void residual urine volume from 98.9 to 8.9 cc (all p <0.001). Mean followup was 31 months, with all patients reporting significant symptomatic improvement. No patient experienced any major adverse side effects. The 8 patients with PBND who refused alpha-blocker therapy had no improvement symptomatically or urodynamically with time, and those who discontinued therapy had a return to pretreatment values. PBND is an often overlooked but significant cause of voiding dysfunction in children and adolescents. In our experience alpha-blockers are clinically effective therapy for PBND and have been reasonably well tolerated in our young patients for what may possibly be a lifelong problem.