[show abstract][hide abstract] ABSTRACT: Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.
[show abstract][hide abstract] ABSTRACT: CombAT (Combination of Avodart and Tamsulosin) was a randomised, double-blind study in men (n=4844) aged ≥ 50 years with a clinical diagnosis of BPH. Patients were randomised to daily tamsulosin 0.4 mg, dutasteride 0.5 mg or both for 4 years. The primary endpoint was time to acute urinary retention (AUR) or BPH-related surgery. Secondary endpoints included BPH clinical progression, symptoms and maximum urinary flow rate. A post hoc analysis of data from the European subgroup was conducted. A total of 2925 men were randomised to treatment in Europe as part of CombAT (tamsulosin, n=972; dutasteride, n=970; combination, n=983). Combination therapy significantly reduced the relative risk of AUR or BPH-related surgery compared with either monotherapy at 4 years, and also significantly reduced the risk of BPH clinical progression. Combination therapy also provided significantly greater symptom improvement than either monotherapy at 4 years. Safety and tolerability of dutasteride plus tamsulosin was consistent with previous experience of this combination and with the monotherapies. These data provide further evidence to support the use of long-term combination therapy (dutasteride plus tamsulosin) in men with moderate-to-severe lower urinary tract symptoms because of BPH and prostatic enlargement. The results in the European subgroup are generally consistent with those in the overall study population.
Prostate cancer and prostatic diseases 04/2011; 14(4):302-6. · 2.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this retrospective study was to evaluate in a historical series of patients whether morphological changes of the urinary tract imaged on intravenous urography (IVU) are associated with clinical or urodynamic data.
During a 1-year period, every man 45 years or older with lower urinary tract symptoms suggestive of benign prostatic hyperplasia was systematically evaluated with multi-channel computer-urodynamic investigation and IVU. Men with urinary retention, known bladder stones or diverticula, severely impaired renal function, or allergy to iodine contrast media were excluded. Structural alterations of the urinary tract were correlated with clinical and urodynamic data using logistic regression analysis.
Data on 203 consecutive patients were available for analysis. Multivariate analysis demonstrated that the "fish-hook" configuration of the distal ureter (also known as "hockey-stick", or "J-shaped" ureter) was the only sign significantly associated with benign prostatic obstruction (BPO) (odds-ratio 3.64; 95% confidence interval 1.69-7.83; P < 0.001). The sensitivity, specificity, positive and negative predictive values of the "fish-hook" ureter configuration sign to detect BPO was 53, 76, 61 and 70%, respectively. Bladder trabeculation, upper urinary tract dilatation, or bladder base elevation were not associated with BPO, detrusor overactivity, detrusor underactivity, bladder low-compliance or any clinical data.
The "fish-hook" shape of the distal ureter(s) indicates BPO and may be a result of prostate median lobe enlargement.
World Journal of Urology 11/2010; 29(2):199-204. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate the symptomatic and quality of life (QoL) response to treatment with tolterodine extended release (ER) in subgroups of male patients with Overactive Bladder Syndrome (OAB) and LUTS suggestive of non-obstructive benign prostatic hyperplasia (BPH) according to age, symptom severity, diabetes mellitus status, and concomitant treatment for LUTS.
Patients treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of > or =6 weeks duration, and presumed non-obstructive BPH (Q (max) > or = 15 ml/s) were observed for 12 weeks in a non-interventional study. Patients completed the International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-q) at baseline and after 12 weeks.
52.4% of 741 patients were aged < or =65 years; 4, 64, and 32% had mild, moderate, and severe symptoms, respectively, according to IPSS; 14% had diabetes mellitus, and in 42% tolterodine was added to alpha blockers. In the various subgroups, mean IPSS total scores improved by 2.8-11.1 points, IPSS QoL scores by 1.8-2.4 points, and all OAB-q subscores by more than 14 points. Only IPSS and OAB-q baseline scores had a relevant impact on changes during treatment, benefits were greatest in patients with more severe symptoms and bother.
In men with symptoms of OAB and LUTS suggestive of non-obstructive BPH of all IPSS severity classes, aged < or =65 years or above, with or without concomitant diabetes or alpha-blockers, symptoms and QoL improved markedly during treatment with tolterodine ER.
World Journal of Urology 12/2009; 28(3):353-7. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: The known importance of testosterone for the development of benign prostatic hyperplasia (BPH) prompted us to test the hypothesis whether polymorphisms of two genes (CYP19A1 and CYP3A4) involved in testosterone metabolism are associated with clinical BPH-parameters.
A random sample of the population-based Herne lower urinary tract symptoms cohort was analysed. All these men underwent a detailed urological work-up. Two polymorphisms in the CYP19A1 gene [rs700518 in exon 4 (A57G); rs10046 at the 3'UTR(C268T)] and one in the 3'UTR of CYP3A4 [rs2740574 (A392G)] were determined by TaqMan assay from genomic DNA of peripheral blood. These polymorphisms were correlated to clinical and laboratory BPH-parameters.
A total of 392 men (65.4 ± 7.0 years; 52-79 years) were analysed. Mean International Prostate Symptom Score (IPSS; 7.5), Q (max) (15.4 ml/s), prostate volume (31 ml) and prostate specific antigen (PSA) (1.8 ng/ml) indicated a typical elderly population. Both polymorphisms in the CYP19A1 gene were not correlated to age, IPSS, Q (max), prostate volume and post-void residual volume. Serum PSA was higher in men carrying the heterozygous rs10046 genotype (2.0 ± 0.1 ng/ml) than in those with the CC-genotype (1.7 ± 0.2 ng/ml, P = 0.012). Men carrying one a mutated allele of the CYP3A4 gene had smaller prostates (27.0 ± 2.0 vs. 32 ± 0.8 ml, P = 0.02) and lower PSA levels (1.6 ± 0.3 vs. 1.9 ± 0.1 ng/ml).
The inconsistent associations observed herein and for other gene polymorphisms warrant further studies. In general, the data regarding the association of gene polymorphism to BPH-parameters suggest that this disease is caused by multiple rather than a single genetic variant. A rigorous patient selection based on anatomo-pathological and hormonal profile may possible reduce the number of confounders for future studies thus enabling a more detailed assessment of the association between genetic factors and BPH-parameters.
World Journal of Urology 11/2009; 29(2):143-8. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), studies on combination treatment with alpha(1)-blockers and 5alpha-reductase inhibitors, alpha(1)-blockers and muscarinic receptor antagonists, and alpha(1)-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination of alpha(1)-blockers and 5alpha-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of progression. A combination therapy of alpha(1)-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising, data. Only preliminary data are available for the combination of alpha(1)-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.
Der Urologe 03/2009; 48(3):250-6. · 0.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: Auf der Suche nach Optimierung der medikamentösen Therapie des BPS werden zunehmend Kombinationen von α1-Blockern mit 5α-Reduktasehemmern (5ARI), α1-Blockern mit Muskarinrezeptorantagonisten und α1-Blockern mit Phosphodiesterase-5- (PDE-5-)Hemmern getestet. Die umfangreichsten Daten sind für die Kombination von α1-Blockern mit 5ARI publiziert worden. Eine Kombinationsbehandlung mit einem α1-Blocker und 5α-Reduktasehemmer ist zur alleinigen Symptomreduktion nicht indiziert, allerdings zur Progressionshemmung des
BPS geeignet und hierbei der Monotherapie überlegen. Die routinemäßige Kombinationstherapie aus α1-Blocker und Muskarinrezeptorantagonisten zur Behandlung der Symptome des BPS kann zurzeit aufgrund der unzureichenden Datenlage
nicht empfohlen werden, auch wenn erste viel versprechende Ergebnisse vorliegen. Für die Kombinationstherapie aus α1-Blockern und Phosphodiesterase-5-Hemmern existieren nur erste vorläufige Daten, die überzeugende Vorteile gegenüber anderen
Kombinationen bisher nicht erkennen lassen.
To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic
hyperplasia (BPH), studies on combination treatment with α1-blockers and 5α-reductase inhibitors, α1-blockers and muscarinic receptor antagonists, and α1-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination
of α1-blockers and 5α-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of
progression. A combination therapy of α1-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising,
data. Only preliminary data are available for the combination of α1-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.
Der Urologe 02/2009; 48(3):250-256. · 0.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: Detrusor overactivity is one known cause of lower urinary tract symptoms and has been linked to bladder storage symptoms (urgency, frequency, or urge incontinence).
To determine clinical and urodynamic parameters associated with detrusor overactivity in patients with suspected benign prostatic hyperplasia.
During 1993-2003, urodynamic investigations were performed in patients aged 40 yr or older and with lower urinary tract symptoms, benign prostatic enlargement, and/or suspicion of bladder outlet obstruction (maximum flow rate < 15 ml/s or postvoid residual urine > 50 ml).
Detrusor overactivity was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. The Schäfer algorithm was used to determine bladder outlet obstruction.
In total, 1418 men were investigated (median age: 63 yr) of whom 864 men (60.9%) had detrusor overactivity. In univariate analysis, men with detrusor overactivity were significantly older, more obstructed, had larger prostates, higher irritative International Prostate Symptoms Score subscores, a lower voiding volume at free uroflowmetry, and a lower bladder capacity at cystometry. The prevalence of detrusor overactivity rose continuously with increasing bladder outlet obstruction grade. Multivariate analysis showed that only age and bladder outlet obstruction grade were independently associated with detrusor overactivity. After age adjustment, the odds ratios of detrusor overactivity compared to Schäfer class 0 were 1.2 for class I, 1.4 for class II, 1.9 for class III, 2.5 for class IV, 3.4 for class V, and 4.7 for class VI.
In patients with clinical benign prostatic hyperplasia, detrusor overactivity is independently associated with age and bladder outlet obstruction. The probability of detrusor overactivity rises with increasing age and bladder outlet obstruction grade.
European Urology 09/2008; 54(2):419-26. · 10.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: The new version of the German guidelines for assessing benign prostatic hyperplasia (BPH) was written in 2006 and 2007 by experts of the BPH working group on behalf of the German Association of Urology and Federation of German Urologists. The full version is expected to be published in 2008. Recommendations for assessing BPH were modified and updated and include patient history, symptom questionnaires, physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder (including postvoid residual urine), and ultrasound examination of the upper urinary tract or creatinine measurement. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography, and urethrocystoscopy. For the first time, tests for the differential diagnosis of bladder symptoms and BPH are described. Furthermore, the latest knowledge was added on disease progression, indications for urodynamic assessment, and ultrasound measurement of detrusor wall thickness for evaluating bladder outlet obstruction. International quality standards were applied in order to increase the guidelines' value; all tests were judged using the levels of evidence and grades of recommendation of the U.S. Department of Health and Human Services classification.
Der Urologe 03/2008; 47(2):149-54. · 0.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patients with presumed non-obstructive BPH (Q (max )>or= 15 ml/s) treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of >or=6 weeks duration, were observed for 12 weeks in a non-interventional study to generate real-life efficacy and safety data. Patients completed the IPSS, the OAB-q and a 2-day micturition diary at baseline and 12 weeks. PVR was determined sonographically. Seven hundred and forty one patients were analysed. Mean PVR did not increase (25.4 +/- 26.5 vs. 29.3 +/- 30.9 ml at baseline). AUR requiring catheterization occurred in two patients, acute UTI in four patients. Median IPSS total scores decreased from 17 to 10, IPSS QoL scores from 4 to 2, OAB-q symptom bother scores from 50.0 to 22.5 and OAB-q HRQL scores increased from 59.2 to 81.6. In men with OAB symptoms and presumed non-obstructive BPH, tolterodine ER provided considerable symptomatic and QoL improvements with a low risk of AUR, acute UTI, or increased PVR.
World Journal of Urology 01/2008; 25(6):627-33. · 2.89 Impact Factor
[show abstract][hide abstract] ABSTRACT: Zusammenfassung Die neue Version der deutschen Leitlinien zur Diagnostik des benignen Prostatasyndroms (BPS) der Deutschen Urologen wurde
in den Jahren 2006 und 2007 von Experten des Arbeitskreises BPH erstellt und wird voraussichtlich im Jahr 2008 publiziert.
In der neuen Leitlinienversion wurden die Methoden zur Diagnostik des BPS neu bewertet und aktualisiert. Als obligate Untersuchungen
wurden Anamnese, Symptomfragebögen, körperliche Untersuchung, Urinstatus, PSA, Uroflowmetrie, Sonographie der Harnblase (inkl.
Restharnmessung) und die Sonographie des oberen Harntraktes bzw. Kreatininbestimmung aufgelistet. Fakultative Untersuchungen
sind Miktionsprotokoll, Druck-Fluss-Studien, sonographische Detrusordickenmessung, Urethrozystographie und Urethrozystoskopie.
Erstmals werden die Untersuchungen genannt, die zur Differenzialdiagnostik von Blasensymptomen und des BPS notwendig sind.
Weiterhin wurden neue Erkenntnisse zum Progressionsrisiko des BPS, Indikationen zur urodynamischen Untersuchung und Beurteilung
der Blasenauslassobstruktion mittels sonographischer Detrusordickenmessung aufgenommen. Alle Testverfahren wurden mit Evidenzlevel
und Empfehlungsgrad anhand der Klassifikation des U.S. Department of Health and Human Services beurteilt, sodass die Qualität
der neuen Leitlinien zur Diagnostik des BPS deutlich verbessert wurde.
Der Urologe 01/2008; 47(2):149-154. · 0.46 Impact Factor