Simon Carter

Imperial College London, Londinium, England, United Kingdom

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Publications (16)58.29 Total impact

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    ABSTRACT: To investigate the variation in urodynamic variables during repeated filling cystometry and the impact that the variability had on the observed incidence of detrusor overactivity, to evaluate the correlation of detrusor overactivity with the symptoms of urge in men with lower urinary tract symptoms (LUTS), and to compare the variability of detrusor overactivity in men with LUTS to that in men with spinal cord injury (SCI). Sixty men with LUTS and 35 with neurogenic bladders after SCI were assessed. Investigations included the International Prostate Symptom Score (IPSS), Madsen-Iversen Symptom Score (MSS), uroflowmetry, filling cystometry and pressure-flow, in three successive studies. In men with LUTS, a significant decrease in the number and pressure of involuntary detrusor contractions (IDCs) in consecutive cystometries resulted in a reduction of observed detrusor overactivity from 72% to 63% and 48%, in the three studies. Urgency scores were significantly lower in men who became 'stable' than in those who remained 'unstable' throughout the three studies. In men with SCI, cystometric variables and detrusor overactivity remained consistent over sequential studies. Urodynamic detrusor overactivity is affected by repeated cystometry. In men with LUTS, two populations with detrusor overactivity were identified; one group adapted to repeated filling while another had persistent IDCs and greater urgency scores. The latter group had bladder behaviour similar to that of men with neurogenic bladders secondary to SCI. These findings might be important in explaining the cause of symptoms, initiating further investigation, and predicting the outcome of therapy.
    No preview · Article · Apr 2005 · BJU International
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    ABSTRACT: To determine whether prostate specific antigen (PSA) level can usefully predict or exclude bladder outlet obstruction (BOO), in men with lower urinary tract symptoms (LUTS). A cohort of men from 1996 to 1999 who had LUTS caused by BPH was evaluated by serum PSA and pressure-flow urodynamic studies, and a blinded comparison made. The settings were teaching hospitals in London, UK and L'Aquila, Italy. Men (302) were referred by primary-care practitioners with LUTS and a PSA of < 10 ng/mL. Regression analysis was used to predict the extent of BOO, and create likelihood ratios and predictive values for BOO according to the PSA value. PSA was significantly associated with BOO (P < 0.001; r2 0.07), with significant likelihood ratios altering the probability of BOO. If the PSA was > 4 ng/mL, mild or definite BOO was likely (89%), whereas if the PSA was <2 ng/mL, there was about a one-third chance each of no, mild and definite BOO. High PSA levels in patients with LUTS are significantly associated with BOO; low PSA levels mean that definite BOO is unlikely.
    No preview · Article · Jan 2005 · BJU International
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    ABSTRACT: Current androgen deprivation therapies for men with prostate cancer cause accelerated osteoporosis and a significant risk of osteoporotic fracture. We have recently shown that transdermal estradiol is an effective alternative for such patients. Here we report the impact of transdermal estradiol therapy on the bone mineral density of men with prostate cancer. A total of 20 patients with newly diagnosed locally advanced or metastatic prostate cancer were treated with transdermal estradiol patches. Bone mineral density of the lumbar spine and the proximal femur was measured with dual-energy x-ray absorptiometry, and correlated with computerized tomography and isotope bone scan findings at 6-month intervals. In all measured regions bone mineral density increased with time. By 1 year mean bone mineral density +/- SEM had increased by 3.60% +/- 1.6% in the lumbar spine (p = 0.055), 2.19% +/- 1.03% in the femoral neck (p = 0.055), 3.76% +/- 1.35% in the Ward's region (p = 0.008) and 1.90% +/- 0.85% in the total hip (p = 0.031), respectively. Of 12 osteoporotic sites 4 had improvement based on World Health Organization grading. All other sites improved toward a better classification. Transdermal estradiol protects against bone loss in men with prostate cancer and may improve bone density in those at risk for osteoporotic fracture.
    No preview · Article · Dec 2004 · The Journal of Urology
  • J L Ockrim · E-N Lalani · M E Laniado · S St C Carter · P D Abel
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    ABSTRACT: Current hormonal therapies for prostate cancer are associated with significant morbidities, including symptoms of andropause and osteoporosis. Oral estrogens prevented many of these problems but were abandoned due to cardiovascular toxicity attributed to hepatic effect. In contrast, parenteral estrogens prevent first pass hepatic metabolism and substantially reduce cardiovascular risk, and long-term transdermal estradiol therapy is believed to be cardioprotective. We report preliminary results of a pilot study using transdermal estradiol therapy to treat men with advanced prostate cancer. A total of 20 patients with advanced prostate cancer were enrolled in a before and after study that examined the impact of estradiol patches on hormones, disease, thrombophilia, vascular flow, osteoporosis and quality of life. Median followup is 15 months. Estradiol levels greater than 1,000 pmol./l. were achieved using 2 patches and higher levels were obtained by increasing the number of patches. All patients achieved castrate levels of testosterone within 3 weeks and had biochemical evidence of disease regression. One patient died of disease at 14 months and 1 cardiovascular complication occurred. Thrombophilic activation was avoided and vascular flow improved. Bone mineral density was significantly increased. Mild or moderate gynecomastia occurred in 80% of patients but no patient had hot flushes. All other functional and symptomatic quality of life domains improved. Transdermal estradiol therapy produced an effective tumor response. Cardiovascular toxicity was substantially reduced compared with that expected of oral estrogen, and other morbidity (gynecomastia) was negligible. Transdermal estradiol therapy prevented andropause symptoms, improved quality of life scores and increased bone density. Transdermal estradiol costs a tenth of current therapy cost, with the potential for considerable economic savings over conventional hormone therapies.
    No preview · Article · Jun 2003 · The Journal of Urology
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    ABSTRACT: A significant change has occurred in the management of symptomatic benign prostatic hyperplasia (BPH) since effective pharmacological treatment became available and led to a significant decrease in the number of surgical procedures in many Western countries. The hypothesis of a causative role of benign prostatic enlargement and bladder outflow obstruction (BOO) in lower urinary tract symptoms (LUTS) was based on the association between prostate growth and symptoms of prostatism in elderly men and on the dramatic reduction of LUTS upon relief of obstruction. Careful investigation into the epidemiology of LUTS and BPH failed to confirm such an association and opened new perspectives in the pathophysiology of lower urinary tract dysfunction and symptoms. The observation that LUTS were equally distributed in male and female cohorts, when matched for age, moved attention away from the prostate and towards the urinary bladder and its aging-related disorders. When BPH surgery was developed, the management of the disease was aimed at preventing death from chronic renal failure, but the picture has changed and modern medical treatment is now aimed at improving the patient’s quality of life. The increasing size of elderly populations in the Western world and the consequent financial constraints of national healthcare systems have raised the question of when pharmacological treatment of symptomatic BPH should be initiated. Retrospective and prospective analysis of various BPH populations and clinical studies has clearly defined the capacity of pharmacological treatment to reduce the incidence of complications of BPH, such as acute urinary retention and the need for surgery, but the cost/benefit ratio is unclear. Notwithstanding the limitations inherent in the experimental models, there is evidence from various animal models, investigating the pathophysiology of the urinary bladder in the presence of outflow obstruction, to indicate that a cause and effect relationship between BOO and bladder decompensation has been established and to support the hypothesis that permanent bladder damage may occur when the obstruction is not relieved early enough. Preliminary experimental evidence also suggests that α1-adrenoceptor antagonists may have a role in reducing the damaging effects of BOO on the urinary bladder. At present, there is no evidence to support the need for early pharmacological treatment of symptomatic BPH with no BOO beyond the obvious target of improving the patient’s quality of life. The evidence for early treatment of BOO and the need to preserve bladder function is clear. Further experimental and clinical research is required to identify markers of early bladder damage and decompensation which can be used to select patients for early pharmacological treatment of BPH.
    No preview · Article · Feb 2003 · Drugs & Aging
  • Simon Carter · Andrea Tubaro

    No preview · Article · Jan 2002 · European Urology Supplements
  • JEREMY L. OCKRIM · MARC E. LANIADO · ANUP PATEL · ANDREA TUBARO · SIMON ST CLAIR CARTER
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    ABSTRACT: PurposeWe explored the relationships of office assessment of lower urinary tract symptoms, transrectal ultrasound measurement and the bladder outlet obstruction index, as derived from pressure flow studies. We also developed and validated a multivariate analysis for predicting the bladder outlet obstruction index.Materials and MethodsWe evaluated 384 men with lower urinary tract symptoms using the International Prostate Symptom Score, maximum urine flow, post-void residual urine, transrectal ultrasound and urodynamic studies. Data were analyzed by multiple linear regression with continuous variables. A simple algorithm, that is the predicted bladder outlet obstruction index, was created using the best fit variables identified from a derivation set and assessed in a separate validation set. The predicted index was applied to predict the probability of actual obstruction according to office parameters.ResultsMaximum urine flow and total prostate volume predicted the bladder outlet obstruction index most completely (adjusted R2 = 0.50, F 75.9, p <0.0001), while other variables were not helpful. These variables were used to create the predicted bladder outlet obstruction index algorithm, antilog 10 (2.21 − 0.50 log maximum urine flow + 0.18 log total prostate volume) − 50. In the 42% of patients with a predicted index of greater than 40 there was a 92% risk or positive predictive value of equivocal or worse obstruction, whereas a predicted index of less than 20 in 23% indicated a 4% risk of significant obstruction.ConclusionsThe bladder outlet obstruction index can be predicted from maximum urine flow and prostate volume. Development of the predicted bladder outlet obstruction index algorithm enables the mathematical prediction of obstruction from these simple measures. Using the predicted bladder outlet obstruction index clinicians can determine the risk of obstruction in individuals. In 65% of patients we predicted equivocal or worse obstruction with greater than 90% confidence.
    No preview · Article · Dec 2001 · The Journal of Urology
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    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.
    No preview · Article · Aug 2001 · The Journal of Urology
  • Simon Carter · Andrea 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.
    No preview · Article · Oct 2000 · Journal of Endourology

  • No preview · Article · Apr 1999 · The Journal of Urology

  • No preview · Article · Apr 1999 · The Journal of Urology
  • Klaus Höfner · Andrea Tubaro · J J de la Rosette · Simon St. C. Carter
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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 independant 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. Neurourol. Urodynam. 17:109–120, 1998.
    No preview · Article · Jan 1998 · Neurourology and Urodynamics
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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.
    No preview · Article · Apr 1997 · The Journal of Urology
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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.
    Full-text · Article · May 1995 · The Journal of Urology
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    ABSTRACT: The thermometry and histological data obtained from studies of transurethral microwave thermotherapy for benign prostatic bladder outflow obstruction demonstrate that the response is thermal-dose-dependent. Over 70% of patients can be relieved of their symptoms by using conventional transurethral microwave thermotherapy. Severe bladder outflow obstruction requires high-temperature treatment with the treatment parameters of thermo-ablation to create a cavity within the prostate. Using either protocol, treatment is delivered during a single 1 h session, on an outpatient basis, without the need for general anaesthesia. (C) Lippincott-Raven Publishers.
    No preview · Article · Dec 1994 · Current Opinion in Urology
  • Marian Devonec · Chris Ogden · Simon St Clair Carter
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    ABSTRACT: The response to transurethral microwave thermotherapy (TUMT) is thermal-dose-dependent. Over 70% of patients can be relieved of their symptoms using conventional TUMT (intraprostatic temperatures between 46 and 60[degrees]C). More severe degrees of bladder outflow obstruction will require high temperature treatment (<60[degrees]C) using the same device but with the treatment parameters of thermo-ablation to create a cavity within the prostate. In either protocol, treatment is delivered during a single 1 h session, on an ambulatory basis, and without the need for neuroleptanalgesia.
    No preview · Article · Jun 1993 · Current Opinion in Urology

Publication Stats

433 Citations
58.29 Total Impact Points

Institutions

  • 2004
    • Imperial College London
      • Department of Imaging Sciences
      Londinium, England, United Kingdom
  • 2002
    • Karo Bio
      Huddinge, Stockholm, Sweden
  • 2001
    • Università degli Studi dell'Aquila
      Aquila, Abruzzo, Italy
  • 1997
    • Sapienza University of Rome
      • Department of Internal and Specialized Medicine
      Roma, Latium, Italy