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Publications (3)4.47 Total impact

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    ABSTRACT: The role of pressure flow studies in the routine evaluation of patients with benign prostatic hyperplasia remains a controversial issue in urological practice. There are little data on age matched asymptomatic control groups. We evaluated pressure flow findings in such a group. A total of 24 male patients 47 to 80 years old (mean age 62.5) attending a general surgical clinic were recruited for study after ethical committee approval. The volunteers had never sought medical attention for urinary symptoms and did not perceive themselves as having a urological problem. Volunteers were assessed by International Prostate Symptom Score (I-PSS) and Madsen symptom score, clinical examination, free uroflowmetry, post-void residual ultrasound, repeat pressure flow studies and transrectal ultrasonography. Pressure flow tracings were manually analyzed for standard urodynamic values and the degree of bladder outflow obstruction according to recognized International Continence Society, Abrams-Griffith nomogram, linear passive urethral resistance relation and urethral resistance factor classifications. Median I-PSS was 2.0 (interquartile range 1.2 to 5.7). For I-PSS quality of life the median was 1.0 (interquartile range 0.75 to 2.0). On pressure flow studies 3 patients (13%) had unequivocal obstruction, 7 (29%) were in the equivocal area and 14 (58%) had no obstruction, while 15 (63%) had unstable contractions on medium fill cystometry. The data show that a surprising number of apparently normal men are obstructed by commonly used criteria. This finding confirms asymptomatic obstruction, suggesting that obstruction may be less important in the development of symptoms than previously thought. Also, until the natural history of obstruction is more clearly defined surgery in obstructed asymptomatic patients is probably unwise.
    The Journal of Urology 03/2001; 165(2):683-7. DOI:10.1097/00005392-200102000-00094 · 4.47 Impact Factor
  • R.M.H. 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. DOI:10.1046/j.1464-410X.1998.00531.x
  • R.m.h. 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. DOI:10.1046/j.1464-410X.1997.00143.x