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  • 1
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 5 (1998), S. 0 
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background The degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) is most accurately quantified by pressure flow studies (PFS), although these studies are more invasive and complicated than conventional tests. We examined how precisely conventional tests predicted the PFS-assessed degree of BOO. Methods The study population consisted of 232 BPH patients who had undergone routine conventional tests and PFS. Correlation of the conventional test results with the degree of BOO assessed by PFS was examined by Spearman's correlation coefficients. Regression and subgroup analyses were performed to predict the degree of BOO using the conventional test results as the explanatory variables. Results The degree of BOO correlated with prostate volume, the degree of endoscopic obstruction, and to a lesser extent, with the maximum flow rate (Qmax) and age. The predictability of conventional tests alone, or in combination, for BOO, was approximately 60% to 70%, which is not acceptable for investigational use. However, almost all patients with a prostate volume larger than 30 mL, or with severe obstruction on urethroscopic findings, had an obstructed bladder outlet. Conclusion PFS is mandatory when the precise evaluation of the degree of BOO is required, and patients are highly likely to have an outlet obstruction when they have a prostate larger than 30 mL, or severely obstructed posterior urethra on endoscopy.
    Materialart: Digitale Medien
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  • 2
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background:Transurethral prostatectomy is a standard treatment modality for intravesical obstruction with benign prostatic hyperplasia. However, some patients cannot undergo this procedure, so alternative devices or surgical procedures have recently been developed.Methods:We treated 26 patients with prostatic outflow obstruction by placement of a self-retaining intraurethral catheter (IUC). All patients had coexisting medical complications which contraindicated transurethral prostatectomy.Results:In the short-term, the treatment was successful in 96.2% of the patients, however, longer follow-up demonstrated a significant failure rate, and the 3-year success rate declined to 12.5%. The majority of late failures were associated with urinary tract infections.Conclusion:These results showed that although placement of an IUC to treat prostatic obstruction was effective in the short-term, its long-term efficacy was highly limited.
    Materialart: Digitale Medien
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  • 3
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract The place of cystoscopy and hydrodistension in the diagnosis of interstitial cystitis (IC) was discussed by an international and Japanese panel of IC researchers. Cysto and hydrodistension (HD) has been traditionally regarded as pivotal to the diagnostic process.To assess the experts’ opinions a questionnaire was circulated which revealed that 20 of the 31 responders regarded cysto and HD to remain as an important inclusion criterion in the diagnosis of IC (with 8 undecided and 3 against the inclusion). The questionnaire further demanded opinions about the specificity of the known IC changes at cysto and HD, correlation with the clinical picture, false positives, and methodology of the examination.
    Materialart: Digitale Medien
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  • 4
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Aim:  Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi-institutional experience of the procedure in Japan.Methods:  A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51–80).Results:  The median operative time was 403 minutes (range, 167–925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound-related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1–5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%).Conclusion:  Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.
    Materialart: Digitale Medien
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  • 5
    Digitale Medien
    Digitale Medien
    Melbourne, Australia : Blackwell Science Pty
    International journal of urology 9 (2002), S. 0 
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Materialart: Digitale Medien
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  • 6
    ISSN: 1433-8726
    Schlagwort(e): Key words Urodynamics ; Benign prostatic obstruction
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The prognostic value of pressure-flow study (P-FS) in the surgical treatment of bladder outlet obstruction (BOO) was retrospectively studied in patients with benign prostatic hyperplasia. In 74 patients who underwent surgical treatment for BOO, P-FS and free uroflowmetry were performed pre- and postoperatively. On P-FS, obstruction and detrusor contractility were analyzed according to the Schäfer nomogram. The patients were classified into the following 3 groups according to their preoperative P-FS: group A consisted of 39 patients with normal detrusors and obstruction (obstruction grade 3–6); group B consisted of 13 patients with weak detrusors and obstruction; and group C included 22 patients with weak or very weak detrusors combined with minimal obstruction, if any (obstruction grade 0–2). Postoperatively, the detrusor pressure at maximal flow rate and obstruction grades on P-FS improved significantly in groups A and B but not in group C. The rate of improvement was most prominent in group A, followed by groups B and C. On free uroflowmetry, however, a significant improvement occurred in all three groups with respect to maximal flow rate, average flow rate, and postvoid residue. Moreover, the rate did not differ among the three groups except for the maximal flow rate as determined between groups A and C. Although good detrusor contractility and evident obstruction on analysis of P-FS will guarantee the best surgical outcome, subjects with weak detrusors and minimal obstruction will also have a good outcome by the relief of BOO. In the weak detrusor, P-FS may be limited in diagnosing obstruction and have a low prognostic value, and such patients should not necessarily be excluded from surgical indications.
    Materialart: Digitale Medien
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  • 7
    ISSN: 1433-8726
    Schlagwort(e): Key words Urinary diversion ; Neobladder ; Bladder neoplasm ; Micturition
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We evaluated the quality of micturition in patients with orthotopic neobladder replacement. In the present study, 58 patients who had undergone orthotopic neobladder replacement following cystectomy were enrolled. The quality of micturition was evaluated by means of uroflowmetry, a self-administered questionnaire and a 24-h frequency–volume chart. The questionnaire consisted of 26 questions concerning storage (9 questions), evacuation of urine (9), patient's satisfaction with neobladder (3), limitations in daily life (3) and pain (2). In addition, 11 of the questions were followed immediately by a question concerning inconvenience to the patients. The mean follow-up period was 35 months (range 6–80). On uroflowmetry, the mean peak flow rate was 13.5 ml/s with a low average flow rate (mean: 5.7 ml/s), and the voiding time was considerably prolonged (mean: 70.2 s). According to the frequency–volume chart and questionnaire responses, although the frequency and tidal volume of micturition were normal, the majority of patients were conscious of retarded, intermittent, prolonged, and weak stream and of straining during voiding. Diurnal or nocturnal incontinence was noticed subjectively in as many as 69% of the patients. However, the degree of urine leakage was minimal. In spite of the fact that 66% of the patients replied that their micturition status was worse than before surgery and that 69% of the patients felt dissatisfied, the degree of inconvenience was low in every item and the limitations in daily life were minimal. Although micturition in patients with neobladder replacement appeared to be of lower quality than that in normal subjects and was considered by many to be unsatisfactory, most patients were able to adjust themselves to it without significant inconvenience.
    Materialart: Digitale Medien
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  • 8
    ISSN: 1433-8726
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The bladder cooling reflex was evaluated in patients with bladder outlet obstruction to study the effect of obstruction on the afferent neural function of the bladder, especially on the C-afferents. The bladder cooling test was performed by infusion of 0 °C saline into the bladder with simultaneous detrusor pressure measurement in 104 patients with bladder outlet obstruction due to benign prostatic hyperplasia. In 49 patients (47%) a positive cooling reflex was observed. This was defined as a rise in the detrusor pressure following cold saline instillation exceeding 15 cmH2O (range 15–130 cmH2O, mean 60.6 cmH2O; positive group). In the remainder of cases the pressure rise ranged from 0 to 12 cmH2O (mean 6.1 cmH2O; negative group). Bladder outlet obstruction may cause some alteration in the afferent neural function of the bladder, in particular of the C-afferent fibers.
    Materialart: Digitale Medien
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