Konstantin Walmsley

Columbia University, New York, New York, United States

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Publications (7)24.3 Total impact

  • Steven A Kaplan · Konstantin Walmsley · Alexis E Te
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    ABSTRACT: In this open label, prospective study we determined the efficacy and tolerability of tolterodine extended release (ER) in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in whom previous alpha-blocker therapy had failed. A total of 43 consecutive men with BPH and LUTS in whom a mean of 5.7 months of alpha-blocker therapy had failed due to adverse events (11) or a lack of efficacy (32) received tolterodine ER (4 mg daily) for 6 months. Primary efficacy end points were American Urological Association symptom score, and mean daytime and nighttime micturition frequency. Secondary end points were the peak urinary flow rate, post-void residual volume, the incidence of urinary retention, total score on the erectile function domain of the International Index of Erectile Function and adverse events. A total of 39 men (91%) with a mean age of 61 years completed the 6-month trial. Mean 24-hour micturition frequency decreased from 9.8 to 6.3 voids and nocturia decreased from 4.1 to 2.9 episodes nightly. Significant changes in mean American Urological Association symptom scores (-6.1), the peak urinary flow rate (1.9 ml per second) and post-void residual volume (-22 ml) were also observed. Of the men 27 (63%) were potent at baseline and 29 (67%) were potent after 6 months of tolterodine ER treatment. Mean International Index of Erectile Function erectile function domain scores increased (6.9). Four men (9%) discontinued therapy because of intolerable dry mouth. There were no reports of urinary retention. Treatment with tolterodine ER in men with BPH and LUTS may be a reasonable therapeutic option as initial therapy or after failed treatment with alpha-blockers.
    No preview · Article · Jun 2008 · The Journal of urology
  • STEVEN A. KAPLAN · KONSTANTIN WALMSLEY · ALEXIS E. TE
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    ABSTRACT: Purpose: In this open label, prospective study we determined the efficacy and tolerability of tolterodine extended release (ER) in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in whom previous alpha-blocker therapy had failed. Materials and methods: A total of 43 consecutive men with BPH and LUTS in whom a mean of 5.7 months of alpha-blocker therapy had failed due to adverse events (11) or a lack of efficacy (32) received tolterodine ER (4 mg daily) for 6 months. Primary efficacy end points were American Urological Association symptom score, and mean daytime and nighttime micturition frequency. Secondary end points were the peak urinary flow rate, post-void residual volume, the incidence of urinary retention, total score on the erectile function domain of the International Index of Erectile Function and adverse events. Results: A total of 39 men (91%) with a mean age of 61 years completed the 6-month trial. Mean 24-hour micturition frequency decreased from 9.8 to 6.3 voids and nocturia decreased from 4.1 to 2.9 episodes nightly. Significant changes in mean American Urological Association symptom scores (-6.1), the peak urinary flow rate (1.9 ml per second) and post-void residual volume (-22 ml) were also observed. Of the men 27 (63%) were potent at baseline and 29 (67%) were potent after 6 months of tolterodine ER treatment. Mean International Index of Erectile Function erectile function domain scores increased (6.9). Four men (9%) discontinued therapy because of intolerable dry mouth. There were no reports of urinary retention. Conclusions: Treatment with tolterodine ER in men with BPH and LUTS may be a reasonable therapeutic option as initial therapy or after failed treatment with alpha-blockers.
    No preview · Article · Dec 2005 · The Journal of Urology
  • Jay D Raman · Konstantin Walmsley · Marc Goldstein
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    ABSTRACT: To evaluate the inheritance of varicoceles through examination of first-degree relatives of patients with known varicoceles. A total of 44 patients with a known varicocele had available first-degree relatives (n = 62) examined for the presence of a varicocele between October 1997 and November 2003. An additional cohort of 263 men presenting for vasectomy reversal without a history of subfertility or varicocele was used as the control group. Varicocele grade and the presence of bilateral varicoceles were examined as predictive factors for inheritance. Of the 62 first-degree relatives of patients with a known varicocele, 35 (56.5%) had a clinically palpable varicocele on physical examination. This was significantly greater than the 18 (6.8%) of 263 men in the control group (P < 0.0001). Of the first-degree relatives, 20 (74%) of 27 brothers, 13 (41%) of 32 fathers, and 2 (67%) of 3 sons had palpable varicoceles. Neither varicocele grade nor bilaterality was predictive of inheritance in these first-degree relatives. The increase in varicocele prevalence is significant in the first-degree relatives (particularly brothers) of patients with known varicoceles. Given the detrimental effect of varicoceles on spermatogenesis and steroidogenesis, patients should be counseled about this increased risk in male family members.
    No preview · Article · Jul 2005 · Urology
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    Carl K Gjertson · Konstantin Walmsley · Steven A Kaplan
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    ABSTRACT: Our treatment strategies for benign prostatic hyperplasia (BPH) have changed, with new insights into the pathophysiology of the disease, new clinical trials, and surgical advances. We present an update on treatment options and a diagnostic and treatment algorithm for this condition.
    Preview · Article · Dec 2004 · Cleveland Clinic Journal of Medicine
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    Konstantin Walmsley · Steven A Kaplan
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    ABSTRACT: Transurethral microwave thermotherapy (TUMT) is being used with increasing frequency by urologists as a minimally invasive therapy for benign prostatic hyperplasia (BPH). There are various modifications to this technology, with each manufacturer touting safety and efficacy. We review the rationale of TUMT, as well as the historical safety and efficacy of this approach. We reviewed the medical literature, including peer reviewed articles and abstracts. In addition, we analyzed promotional material distributed by various manufacturers with respect to scientific accuracy. TUMT results in consistent improvement in symptoms and peak urinary flow rate. Symptom improvement ranges between 9 and 11 points, compared to a 6-point improvement in sham treated patients, and peak urinary flow rate increases 3 to 5 ml per second. The degree of coagulation necrosis is different among the various TUMT devices. Although coagulation necrosis is believed to be an important proxy for clinical success, there are few data that correlate this factor with the magnitude of either symptomatic or uroflow improvement. TUMT is a safe and effective therapy for the treatment of lower urinary tract symptoms secondary to BPH. In addition, there are distinct advantages to each of the devices. However, intense marketing and hyperbole have dominated this segment of the BPH market. Ultimately, the most effective TUMT device can only be determined by direct comparison studies.
    Preview · Article · Nov 2004 · The Journal of Urology
  • Konstantin Walmsley · David R Staskin
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    ABSTRACT: This article reviews the different nonurologic causes of nocturia. It also discusses the diagnostic algorithms necessary to identify specific factors underlying a patient's symptoms.
    No preview · Article · Jan 2004 · Current Urology Reports
  • Adam J Flisser · Konstantin Walmsley · Jerry G Blaivas
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    ABSTRACT: We describe a new classification of patients with overactive bladder symptoms. The office records of 132 patients who presented for evaluation of symptoms of urinary frequency, urinary urgency and/or urge incontinence, and who underwent videourodynamics were identified. All patients completed a 24-hour voiding diary and 24-hour pad test. Data collection included age, sex, hormone status, number of voids and incontinence episodes per 24 hours, functional bladder capacity, pad weight and associated genitourinary conditions. Videourodynamics were reviewed and patients were divided into 4 clinical categories, including type 1-no evidence of involuntary detrusor contractions on videourodynamics, type 2-involuntary detrusor contractions present, and patient aware and able to abort them, type 3-contractions present, patient aware and able to contract the sphincter but not abort contractions and type 4-contractions present and patient unaware but unable to contract the sphincter or abort contractions. Average patient age +/- SD was 64 years +/- 13. There were an average of 13 +/- 5 voids and 3 +/- 5 incontinence episodes per 24 hours. Average functional bladder capacity was 306 +/- 146 cc and average pad weight was 94 +/- 165 gm. Associated diagnoses included benign prostatic hypertrophy in 28% of cases, sphincteric incontinence in 17%, idiopathic urge incontinence in 29% and uterovaginal or bladder prolapse in 17%. Another 11% of patients had bladder outlet obstruction, impaired detrusor contractility or neurogenic bladder conditions. Of the cases 72 (55%), 32 (25%), 23 (17%) and 5 (4%) were categorized as classes 1 to 4, respectively. ANOVA revealed no statistically significant differences in the number of voids or incontinence episodes, functional bladder capacity or pad test when individual categories were compared to each other. This overactive bladder classification stratifies patients according to degrees of awareness, and control of bladder and sphincter function. It may prove useful as a guide for prognosis and therapy. Patients can be stratified into clinical groups based on the presence or absence of involuntary detrusor contractions, the ability to abort contractions and the ability to contract the urinary sphincter in response to contractions. Limiting the definition of overactive bladder to apply only to patients with no proved infection or other pathological condition would have eliminated more than 75% of those in this sample with symptoms of urinary urgency, frequency and/or urge incontinence.
    No preview · Article · Mar 2003 · The Journal of Urology

Publication Stats

351 Citations
24.30 Total Impact Points

Institutions

  • 2004-2008
    • Columbia University
      • Department of Urology
      New York, New York, United States
    • New York Presbyterian Hospital
      • Department of Urology
      New York City, New York, United States
  • 2003
    • Cornell University
      Итак, New York, United States