S S Carter

Hannover Medical School, Hanover, Lower Saxony, Germany

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Publications (15)41.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We investigate the safety and efficacy of suprapubic transvesical prostatectomy, and the change in bladder wall thickness after surgery. We conducted a prospective 1 center study of 32 consecutive patients who underwent transvesical prostatectomy from December 1996 to March 1997 for benign prostatic hyperplasia with large prostate volume, who were followed for 1 year. Pressure flow study and transrectal sonography were performed at baseline and repeated at 6 months. Bladder wall thickness was measured at baseline and regular intervals postoperatively. A morbidity questionnaire was completed during the first 6 weeks after surgery. An average of 63 gm. prostate adenoma were enucleated at surgery. An indwelling catheter was required for an average plus or minus standard deviation of 5.4 +/- 2.6 days after treatment. The International Prostate Symptom Score decreased from 19.9 +/- 4.4 to 1.5 +/- 2.7 and the quality of life score decreased from 4.9 +/- 1.0 to 0.2 +/- 0.4 at year 1, respectively. Maximum flow rate improved from 9.1 +/- 5.3 to 29.0 +/- 8.9 ml. per second. Residual urine decreased from 128 +/- 113 to 8 +/- 18 ml. Before surgery 30 patients had obstruction and 2 were in the equivocal zone of the International Continence Society nomogram. At 6 months after prostatectomy 30 patients did not have obstruction, and 2 who were subsequently operated on for bladder neck sclerosis were equivocal and had obstruction, respectively. No patient had significant postoperative bleeding and no heterologous blood transfusions were required. There were 4 men who had urinary tract infection and 1 who had wound infection. A slight decrease in erectile function was observed 6 weeks postoperatively, and no change in patient libido and quality of sex life was reported. The total complication rate was 31.3%. The bladder was unstable in 7 men before and 3 after surgery. A significant decrease in bladder wall thickness was observed from 5.2 +/- 0.7 at baseline to 2.9 +/- 0.9 mm. at year 1 postoperatively. Our study confirms the excellent clinical outcome of transvesical prostatectomy, and rapid improvement of most subjective and objective parameters during the 4 weeks after surgery. Bladder hypertrophy appears to be significantly reduced after prostate surgery. The urodynamic results in patients who underwent open surgery probably represent the maximum obtainable relief of obstruction and should be considered the reference standard to which all other treatments, including transurethral resection, should aspire.
    The Journal of Urology 08/2001; 166(1):172-6. · 3.75 Impact Factor
  • S Carter, A Tubaro
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    ABSTRACT: The study was designed to explore the relation between prostatic temperature and the clinical outcome of transurethral microwave thermotherapy (TUMT). Forty-nine patients with symptomatic benign prostatic hyperplasia (BPH) were treated. Baseline evaluation included Madsen score, flowmetry, and pressure-flow study. Two fiberoptic thermosensors were placed in the prostate targeted to the region 10 and 20 mm below the bladder neck and 5 to 15 mm lateral to the prostatic urethra. The TUMT was carried out using either the low-energy (2.0) or high-energy (2.5) Prostasoft program. Follow-up was at 6, 12, and 26 weeks. A moderate correlation between intraprostatic temperatures and energy output (r = 0.409; P < or = 0.046) and prostate volume (r = 0.303; P < or = 0.0424) was observed. Outlet obstruction was associated with higher temperatures (obstructed 49.6+/-5.8 v unobstructed 46.1+/-4.2 degrees C; P < or = 0.033). A significant relation between temperature and clinical outcome was found. Patients with intraprostatic temperatures <46 degrees, 46-50 degrees, and < or = 50 degrees C had significant differences in Madsen score change (-50%, -68% and -86%) and in maximum flow rate (+26%, +32%, and +48%). Patients with temperatures >50 degrees C had a significant improvement in obstruction status (86% to 18%). A slight worsening in voiding dynamics was observed in patients with temperatures <50 degrees C. A significant relation exists between intraprostatic temperatures achieved during TUMT and the clinical outcome. Temperatures in excess of 50 degrees C seem to be associated with a greater improvement in lower urinary tract symptoms and bladder outlet obstruction. These data provide a sound rationale for monitoring intraprostatic temperatures and developing invasive thermometry feedback mechanisms for thermal treatments of BPH.
    Journal of Endourology 10/2000; 14(8):617-25. · 2.07 Impact Factor
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    ABSTRACT: The objective of the study was to investigate specificity and sensitivity of bladder wall thickness in the diagnosis of bladder outlet obstruction. The study included 174 patients referred to our prostate centers for lower urinary tract symptoms. Free uroflowmetry and pressure-flow studies were performed in duplicate as part of the diagnostic evaluation. After the 2 voiding studies were done the bladder was filled to 150 ml. and wall thickness was measured via suprapubic ultrasound. Bladder outlet obstruction was diagnosed and graded according to the Abrams-Griffiths and Schäfer nomogram as well as to the group specific urethral resistance algorithm. A significant correlation (r > 0.6, p < or = 0.007) was found between bladder wall thickness and all parameters of the pressure-flow study. A bladder wall thickness of 5 mm. appeared to be the best cutoff point to diagnose bladder outlet obstruction, since 63.3% of patients with bladder wall thickness less than 5 mm. were unobstructed while 87.5% of those with a bladder wall thickness 5 mm. or greater were obstructed. Bladder wall thickness out performed uroflowmetry in terms of specificity and sensitivity in the diagnosis of outlet obstruction as demonstrated by an area under curve value of 0.860 versus 0.688 in the receiver operator characteristics analysis. Measurement of bladder wall thickness appears to be a useful predictor of outlet obstruction with a diagnostic value exceeding free uroflowmetry although it does not represent a substitution to invasive urodynamics. These data support the hypothesis that the relationships between morphology and function are of clinical importance.
    The Journal of Urology 03/1998; 159(3):761-5. · 3.75 Impact Factor
  • R M Walker, A Patel, S St Clair Carter
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    ABSTRACT: To determine the effect of urethral instrumentation on pressure-flow study values and subsequent grading of bladder outflow obstruction (BOO) in men with lower urinary tract symptoms (LUTS) using suprapubic intravesical pressure monitoring. Seventy-two men with LUTS underwent pressure-flow study using suprapubic intravesical pressure monitoring. The urethra was then instrumented successively with a 12 F catheter and a 17 F cystoscope, and a further pressure-flow study recorded after each procedure. Standard pressure-flow variables were measured for the three recordings. The presence and degree of obstruction were determined using commonly recognized grading systems, i.e. the Abrams-Griffiths nomogram. the linear passive urethral resistance ratio (LPURR) and the urethral resistance algorithm (URA). There were statistically significant differences in the detrusor pressure at maximum flow and detrusor opening pressure between the uninstrumented and instrumented studies (12 F and 17 F) but no difference in peak flow rates between the groups or in the Abrams-Griffiths number or URA value between studies. Using the LPURR, there was a tendency to a lower obstruction class after urethral instrumentation, ranking as 17 F > 12 F > no instrumentation. The changes seen after urethral instrumentation represent no more than the biological intra-individual variation normally seen in pressure-flow studies and do not lead to a clinically significant change in obstruction class.
    British Journal of Urology 02/1998; 81(2):206-10.
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    ABSTRACT: The urodynamic profiles of 97 patients with benign prostatic hyperplasia undergoing low-energy transurethral microwave thermotherapy (TUMT) for lower urinary tract symptoms were analysed using the Abrams/Griffiths nomogram, the urethral resistance algorithm, the linPURR, Schäfer nomogram, and the CHESS classification. A significant clinical response was seen for the whole group, as shown by changes in symptom score, free flow rate, and residual urine. The best symptomatic response was identified in patients in whom obstruction was present, whatever the classification used. Only the two-dimensional CHESS classification was found to predict a group of patients with a better response in both symptoms and objective variables. Obviously, a better response from TUMT can only be predicted by a classification system that identifies the independent variables of footpoint and slope of the PURR. The CHESS classification was the only one of those studied that satisfactorily identified these two parameters and could be used as a system of case selection for this minimally invasive treatment.
    Neurourology and Urodynamics 01/1998; 17(2):109-20. · 2.67 Impact Factor
  • R M Walker, B Di Pasquale, M Hubregtse, S St Clair Carter
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    ABSTRACT: To compare suprapubic and transurethral methods of measuring intravesical pressure in a group of men undergoing investigation for lower urinary tract symptoms (LUTS), to identify which urodynamic variables are affected by the presence of an urethral catheter during the voiding phase, and consequently whether there is any change in the grading of bladder outflow obstruction (BOO) using the commonly recognised grading systems. Thirty-five men with LUTS underwent both suprapubic and transurethral pressure-flow studies during a single session. Standard pressure flow variables were measured in all patients with both methods, enabling calculation of obstruction using the commonly used grading systems, i.e. the Abrams-Griffith number, linear passive urethral resistance ratio (LPURR) and urethral resistance algorithm (URA). There were statistically significant differences between the methods in the mean values of maximum flow rate and the detrusor pressure at that maximum: 60% of men were in the same LPURR class with either method. Using the transurethral method, 26% of patients increased the LPURR class by one and 6% by two classes. Using the Abrams-Griffiths nomogram, 17% moved from a classification of equivocal to obstructed and 3% from unobstructed to equivocal. Using the criterion of a value of URA > 29, 57% were obstructed using the suprapubic and 74% using the transurethral method. According to the method used, there were differences in the classification of obstruction between the suprapubic and transurethral routes; transurethral studies tended to indicate greater obstruction. The interpretation of urodynamic studies should take into account the technique used and where the route is transurethral, the smallest catheter available should be used.
    British Journal of Urology 05/1997; 79(5):693-7.
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    ABSTRACT: We compared manual versus computer analysis of pressure-flow tracings for diagnosing bladder outlet obstruction in patients with benign prostatic hyperplasia. A total of 105 patients with a clinical diagnosis of prostate enlargement and lower urinary tract symptoms was included in the study irrespective of free flow rates. Pressure-flow studies were performed in duplicate and tracings were evaluated by 2 independent investigators blinded to patients status. Manual reading of urodynamic printouts and fully computerized analysis using CLIM software were done. All urodynamic parameters relevant to the diagnosis of outlet obstruction were compared using the Abrams-Griffiths and Schäfer nomograms. Group specific urethral resistance factors were also compared. There was good correlation between manual and computer derived values of maximum flow (r = 0.9874, p < or = 0.0001), detrusor pressure at maximum flow (r = 0.9943, p < or = 0.0001), minimum detrusor pressure during voiding (r = 0.8816, p < or = 0.0001) and group specific urethral resistance factor (r = 0.9917, p < or = 0.0001). The diagnosis of outlet obstruction according to the group specific urethral resistance factor, and the Abrams-Griffiths and Schäfer nomograms was highly consistent using the manual and computerized approaches. Manual analysis of pressure-flow tracings generated by urodynamic equipment and digital data obtained by CLIM software appeared to be highly consistent and equally reliable for diagnosing and grading outlet obstruction.
    The Journal of Urology 04/1997; 157(3):871-5. · 3.75 Impact Factor
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    ABSTRACT: A retrospective study was done to investigate the long-term outcome of patients treated with lower energy transurethral microwave thermotherapy. A total of 305 patients with lower urinary tract symptoms and benign prostatic hypertrophy underwent transurethral microwave thermotherapy according to a similar protocol at 2 centers. After 3 years of followup 133 patients who had undergone transurethral microwave thermotherapy alone were available for study. During this observation period significant symptomatic improvement from baseline and an improved maximum flow rate of 2.6 ml. per second were noted. Of the patients 125 underwent invasive or medical treatment. After 3 years of followup lower energy transurethral microwave thermotherapy showed significant and durable improvements in baseline parameters in 52% of the patients.
    The Journal of Urology 01/1997; 156(6):1959-63. · 3.75 Impact Factor
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    ABSTRACT: We evaluated the urodynamic changes after high energy microwave thermotherapy in patients with lower urinary tract symptoms and benign prostatic enlargement. A total of 120 patients was available for analysis with urodynamic investigation and pressure-flow studies before and 6 months after treatment. Several obstruction parameters were used to evaluate treatment outcome. A significant decrease (p < 0.001) in all obstruction parameters was noted. Mean detrusor pressure at maximum flow decreased from 64.7 to 39.1 cm. water, urethral resistance factor from 41.8 to 23.5 cm. water and linear passive urethral resistance relation from 3.0 to 1.4. Analysis of subgroups showed better results in patients with greater degrees of obstruction. High energy thermotherapy results in a significant and substantial decrease in bladder outlet obstruction.
    The Journal of Urology 10/1996; 156(4):1428-33. · 3.75 Impact Factor
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    ABSTRACT: We documented the results of high energy transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia. We evaluated 116 patients following transurethral microwave thermotherapy according to symptom scores, transrectal ultrasound, free voiding and pressure-flow study parameters. Significant improvement was noted in all objective and subjective parameters. Moreover, cavities in the prostatic urethra were observed in almost 40% of the patients. High energy transurethral microwave thermotherapy is an effective therapy for benign prostatic hyperplasia. Patients with larger prostates and moderate to severe bladder outlet obstruction seem to be the best candidates for this higher energy thermotherapy protocol, although morbidity is increased.
    The Journal of Urology 08/1996; 156(1):97-101; discussion 101-2. · 3.75 Impact Factor
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    ABSTRACT: To determine the placebo effect of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic enlargement (BPE). A prospective, randomized sham-controlled study in 93 patients (mean age 65, range 50-88) was conducted at two centres comparing TUMT or a sham treatment. Patients randomized to receive sham treatment underwent the same initial procedure as for TUMT, but the complete procedure was simulated on the visual display with no application of microwave energy. If the patient's condition had not improved after 3 months, a second genuine TUMT treatment was given at the patient's request. After 3 months there were significant clinical and statistical differences in efficacy between the groups; 62% and 18% of patients had a > 50% improvement in symptom score in the treated and sham groups, respectively (P = 0.001). The corresponding changes in flow rate were 36% and 11% (P = 0.002), respectively. After 1 year, 63 patients were divided into those that had TUMT initially, those that had sham initially but subsequently had TUMT and those whose sham procedure had led to sufficient clinical improvement to require no further treatment. The two treated groups had a significant improvement over the sham group. The benefit from TUMT cannot be due to a placebo effect alone.
    British Journal of Urology 03/1996; 77(2):221-7.
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    ABSTRACT: We attempted to identify any parameter that could possibly lead to a successful treatment outcome after transurethral microwave thermotherapy. Clinical parameters and treatment profiles of 292 patients were analyzed in a retrospective multicenter manner. Responder and nonresponder groups were identified according to a given definition. No statistically significant differences in baseline characteristics were found. Responders showed a 76% symptomatic improvement rate compared to 27% in nonresponders, and an 82% improvement rate in peak flow compared to a 5% decrease in nonresponders. Responders also showed a significantly greater increase in posttreatment PSA level and a significantly greater amount of energy released during treatment. No baseline clinical parameter is capable of predicting treatment outcome.
    The Journal of Urology 12/1995; 154(5):1775-8. · 3.75 Impact Factor
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    ABSTRACT: We document changes in pressure-flow study parameters in patients treated by transurethral microwave thermotherapy. Pressure-flow study tracings before and after therapy from 75 patients with benign prostatic hyperplasia were analyzed. Patients were stratified according to the predominant type of obstruction at screening (constrictive or obstructive). An improvement in Madsen score and flow rates was noted at 6 months in both groups. In contrast to compressive obstruction patients, however, those with constrictive obstruction also showed significant changes in pressure-flow study parameters, including detrusor pressure at maximum flow, maximum flow rate and urethral resistance factor. Patients with predominantly constrictive obstruction are the best candidates for microwave thermotherapy.
    The Journal of Urology 11/1995; 154(4):1382-5. · 3.75 Impact Factor
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    ABSTRACT: A total of 100 patients treated with a single session of microwave thermotherapy at 4 European centers was stratified according to 2 different types of obstruction (constrictive and compressive) and compared to clinical outcome at 6 months. Patients had a Madsen-Iversen score of 8 or more, maximum flow rate of 15 ml. per second or less and residual urine volume of 300 ml. or less at entry. The change in Madsen-Iversen score was the same in the 2 groups. Maximum flow rate increased from 8.71 +/- 2.62 to 14.73 +/- 4.04 ml. per second in the constrictive group, and from 8.54 +/- 2.26 to 10.41 +/- 4.52 in the compressive group (p < or = 0.0001). Residual urine decreased from 96.00 +/- 72.85 to 40.34 +/- 56.33 ml. in the constrictive group and from 109.86 +/- 67.09 to 84.65 +/- 81.45 ml. in the compressive group (p < or = 0.0001). Success, as defined by an increase of 50% or more in maximum flow rate and Madsen-Iversen score, was noted in 68% of the constrictive but only 15% of the compressive groups (p < or = 0.0001 chi-square test for trend). Selection by pressure-flow criteria for patients being considered for thermotherapy should improve the overall clinical results.
    The Journal of Urology 05/1995; 153(5):1526-30. · 3.75 Impact Factor
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    ABSTRACT: The findings of improved clinical results in certain patient groups in some studies suggest that the full clinical benefit of TUMT has been under-reported. The objective must be to find the thermal dose, which will maintain a clinically significant reduction in symptoms with objective evidence of improved urinary flow and reduction in obstruction, while causing minimal post-treatment morbidity and still not necessitating anaesthesia. The maximum benefit of TUMT will be obtained only by selection of individual patients for specific therapeutic protocols.
    World Journal of Urology 02/1994; 12(6):352-6. · 2.89 Impact Factor

Publication Stats

444 Citations
41.41 Total Impact Points


  • 1998
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
  • 1997
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 1994
    • Radboud University Nijmegen
      • Department of Urology
      Nijmegen, Provincie Gelderland, Netherlands