Showing papers in "Scandinavian Journal of Urology and Nephrology in 1988"

The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology.

Abstract: We updated the terminology in the field of paediatric lower urinary tract function. Discussions were held of the board of the International Children’s Continence Society and an extensive reviewing process was done, involving all members of the International Children’s Continence Society as well as other experts in the field. New definitions and a standardised terminology are provided, taking into account changes in the adult sphere and new research results. Reprinted with permission of the Journal of Urology and Elsevier. First published 2006: The Journal of Urology. July 2006; 176(1): 314-324. NOTE: The article will be reproduced in two parts. Part II is to be published in the next edition of the Australian and New Zealand Continence Journal.

Urodynamics in normal infants and children.

Abstract: Urodynamic examination yields invaluable information about lower urinary tract function in infants and children in the following clinical situations: Daytime urinary incontinence, suspected infravesical obstruction, overt or suspected neurogenic bladder dysfunction, vesico-ureteral reflux with upper tract dilatation and chronic or recurrent bacteriuria. A normal development of lower urinary tract function during the first 5 years of life means that detrusor contractility will be successively more inhibited; furthermore, the child will become aware of bladder filling and will be able to postpone or initiate micturition. A disturbed or delayed development may well be the most important cause of dysfunctional states in the lower urinary tract later in life. Most urodynamic variables are age-dependent. Normal bladder capacity can be fairly well assessed by: Bladder capacity in ml = 30 + (age in years x 30). Normal maximum urinary flow during micturition (in ml/s) should approximately equal the square root of voided volume (in ml). The normal range (+/- 2SD) is given by the value thus obtained +/- 7 ml/s. Intravesical pressure is lower in girls than in boys, and lower in infants than in older children, but otherwise it does not vary with age. A tense and apprehensive child will not produce reliable urodynamic data. This is, no doubt, the most important source of error when examining children. It is strongly emphasized, therefore, that the examination has to be performed in a kind, understanding and relaxed atmosphere.

Micturition patterns in a healthy female population, studied with a frequency/volume chart.

Abstract: A 48-hour frequency/volume chart was completed by 151 women without micturition complaints. The distribution of the parameters of the chart are presented. The chart was found to be a valuable and reliable instrument for assessment of micturition patterns. The mean voided volume, which takes into account both frequency of micturition and total voided volume, showed the best reproducibility of the parameters and is suggested as the parameter of primary importance. Attention should be paid to the circumstances under which the chart is applied, as normal micturition behaviour seems to be highly dependent on social factors.

Urodynamics in prostatism. II. Prognostic value of pressure-flow study combined with stop-flow test.

Abstract: In a prospective study the prognostic value of preoperative pressure-flow studies in prostatism was examined. The indications for prostatectomy were based on non-urodynamic data only. An extensive urodynamic evaluation was performed pre- and postoperatively, including uroflowmetry, water cystometry and pressure-flow study combined with stop-flow test. In total the data from 130 patients were considered. The material was classified with respect to the "urethral resistance relation" (URR) and the "bladder output relation" (BOR). According to the first criterion 87 patients were obstructed, 36 unobstructed, while 7 were unclassifiable and finally excluded. In most urodynamic variables, the two groups differed preoperatively, but no differences were revealed postoperatively. However, the obstructed group did considerably better postoperatively as to the symptomatic outcome. The success rate was 93% as opposed to 78% in the unobstructed patients (p less than 0.02). For the BOR classification, the theoretical maximum flow rate (Qm,est) was employed forming two groups: 57 patients with decreased bladder speed (Qm,est less than 35 ml/sec) and 41 patients with normal speed (Qm,est greater than or equal to 35 ml/sec). Few differences in urodynamic variables were found both pre- and postoperatively, but no significant difference was shown in success rates. In conclusion the URR proved a significant prognostic value in prostatism and is recommended in the preoperative work-up, especially in patients with equivocal uroflow studies. No convincing prognostic role could be attributed to the BOR.

Urodynamics in prostatism. I. Prognostic value of uroflowmetry.

Abstract: A prospective study was undertaken to examine the prognostic value for the symptomatic outcome of prostatic surgery of preoperative urodynamic testing in patients with prostatism. The study design ...

Extensive Tubular Secretion and Reabsorption of Creatinine in Humans

Abstract: The validity of creatinine as a marker for the glomerular filtration rate was studied in 8 healthy volunteers in different stages of hydration and during large variations in urinary flow rates. The urine flow was 8.4 ml/min in a dehydrated state (due to furosemide infusion; 8 mg/h) and raised to 23.2 ml/min after rapid rehydration. The creatinine to inulin clearance ratio changed considerably from 1.47 in rehydrated state, indicating a substantial tubular secretion of creatinine, to 1.05 in dehydrated state, indicating a reabsorption of creatinine almost equal to secretion. Thus, substantial tubular secretion and reabsorption of creatinine, changing in relative importance in relation to the degree of hydration, make creatinine clearance an unreliable marker for the glomerular filtration rate.

Zinc in sperm chromatin and chromatin stability in fertile men and men in barren unions.

Abstract: The stability and the content of zinc of the chromatin were studied in spermatozoa from ten men with unexplained infertility, and in spermatozoa from five fertile donors. A positive relation was found between zinc in sperm nuclei (X-ray microanalysis) and the resistance of the chromatin to decondense in sodium dodecylsulfate (SDS). The infertile men had lower degree of sperm chromatin stability and lower sperm zinc content than the fertile donors. A subgroup of the infertile men, which all had minor clinical signs of prostatic inflammatory reaction, had the lowest content of zinc in the chromatin and the lowest degree of chromatin stability. A low content of nuclear zinc would impair the structural stability of the chromatin and thereby increase the vulnerability of the male genome. This mechanism may be one explanation for the reduced fertility of the men with minor inflammation of the prostate.

Ultrasonic evaluation of age-related human prostatic growth and development of benign prostatic hyperplasia.

Abstract: In 175 normal men aged 27-70 (median 40) years, the prostate was ultrasonically scanned by the transrectal route. Ultrasonic signs of adenoma were found in 26%. The earliest age at which signs of benign prostatic hyperplasia appeared was 27 years, and the incidence increased with age. Adenomatous prostates were significantly larger than nonadenomatous, with median volume 28.0 (14.5-62.1) ml versus 23.0 (11.3-39.1) ml (p less than 0.0005). The adenomatous prostates also had a larger median volume of the periurethral gland (4.1 ml vs. 3.0 ml; p less than 0.0005) and a larger peripheral zone (23.3 ml vs. 20.2 ml; p less than 0.005). The total prostatic volume increased statistically significantly with age and the growth rate was calculated to be 0.81 %/year +/- 0.25 (S.E.) corresponding to 0.2 ml/year. The growth rate of the periurethral zone was 1.5 %/year +/- 0.5 (S.E.). Volumetric correlation between periurethral gland and total prostatic volume depended on whether or not adenoma had developed. Prostatic volumes measured in vivo by ultrasound are slightly greater than values obtained at autopsy.

Irrigating fluid absorption and blood loss during transurethral resection of the prostate studied with a regular interval monitoring (RIM) method.

Abstract: A method for the study of physiological events during transurethral resection of the prostate (TUR) is described. Measurements of volumetric irrigating fluid balance, blood loss, central venous pressure (CVP) as well as blood haemoglobin and serum levels of sodium and glycine were performed at 10-min intervals. This regular interval monitoring (RIM) method offers the possibility to retrospectively correlate changes that occur during TUR at discrete time intervals. In 20 patients undergoing TUR, irrigating fluid absorption occurred throughout the procedure although the risk of having an absorption increased 30 min after surgery commenced. Increase of blood loss coincided with intravascular but not with extravascular absorptions. If there was a rapid massive intravascular absorption of about 500 ml/10 min, the CVP increased greater than 2 mmHg. The total intraoperative blood loss was not greater in patients with large absorption volumes. RIM will detect absorption greater than the urine excretion in any given period of time. If absorption occurs during a limited time of the TUR, RIM allows a partial correction for the urinary excretion in the volumetric fluid balance.

Asymptomatic bacteriuria--a long-term study.

Abstract: Four percent of the women in a population study 1969-1970 had asymptomatic bacteriuria (ABU). 15 years later a reinvestigation was carried out, in women born 1913-1948. 40 women with ABU and 40 age-matched healthy controls from the population study participated. The frequency of symptomatic urinary tract infections (UTI) had been significantly higher in the ABU group than in the control group during follow-up, but nobody had developed progressive renal disease. Three women in the ABU group and one in the control group had low urine concentrating capacity. All other osmolality values were within normal limits, although there was a significant difference between the two groups. The age-dependent decrease after 15 years was the same in both groups. The number of new hypertensives was the same in both groups. A total of 37.5% were hypertensive in the ABU group and only 12.5% in the control group, but as hypertension had been excluded in the control group at the first investigation the groups could not...

Long term reproducibility of urodynamic investigations in healthy fertile females.

Abstract: The long term reproducibility of uroflowmetry, urethral pressure profilometry, cystometry and pressure-flow studies was evaluated in 10 healthy fertile female volunteers over a two year period. All parameters were unchanged, except for an increase in the detrusor pressure. The volume at first sensation, the maximal cystometric capacity and the maximum flow rate, had a coefficience of variation (CV) of 24%, 15% and 21% respectively. The compliance and the opening time however showed a considerably higher CV. Several parameters showed a larger intra individual standard variation (SD) than the interindividual SD, indicating that these parameters should be interpreted with great care. Repetition of the investigations showed in this small material a reduction in the standard error of the mean (SEM). Repeating the investigation reduces the number of patients needed in a clinical trial to obtain a statistically significant change. The study showed that urodynamic investigation is a reliable tool in evaluation of patients over a period of years.

Urodynamic investigations and their reproducibility in healthy postmenopausal females.

Abstract: Twelve healthy postmenopausal volunteers underwent urodynamic investigation twice within two months. The two investigations were highly reproducible. The maximum urethral closure pressure and the functional profile length were on average 51.8 cm H2O, and 2.8 cm, respectively and were significantly lower than the values previously found in healthy fertile women. The maximum flow rate was 24.7 ml/sec. The flow rates, the cystometric and pressure-flow parameters were compared to previously obtained values in healthy fertile women and showed no differences except for a significantly higher premicturition detrusor and intravesical pressure in the postmenopausal group.

Urodynamic investigations in healthy fertile females during the menstrual cycle.

Abstract: Ten healthy, fertile women were investigated three times during the menstrual cycle in order to study a possible hormonal influence on the urodynamic parameters. On each occasion three urethral pressure profiles were recorded, and cystometry was carried out both in the supine and sitting position followed by pressure-flow studies. No significant changes attributive to menstrual cycle hormonal changes were observed in the profilometry data, the cystometric parameters or in the pressure-flow parameters. Both the short and long term reproducibility of the three times repeated urodynamic parameters were good. Measurements performed regardless of time in the menstrual cycle are thus representative in normal women.

Delayed tolerance to furosemide diuresis. Influence of angiotensin converting enzyme inhibition by lisinopril.

Abstract: The role of the renin-angiotensin-aldosterone system in the development of tolerance to the diuretic effect of furosemide was investigated in 12 healthy male volunteers. Furosemide in a dose of 40 mg daily for one week had a brisk acute diuretic effect, but did not lead to dehydration, hyponatremia or fall in blood pressure. The reason for this was a reduction in sodium excretion between doses (rebound effect) and a decrease in sensitivity to furosemide from day 1 to day 7. The latter phenomenon is referred to as delayed tolerance to furosemide. Inhibition of angiotensin converting enzyme with lisinopril 20 mg daily did not change the renal furosemide excretion rate, the renal sensitivity to furosemide or the tolerance development. Thus, delayed tolerance to furosemide diuresis was not related to dehydration or activation of the renin-angiotensin-aldosterone system. Other mechanisms, probably intrarenal, will have to be looked for.

DDAVP test for renal concentration capacity. Age-related reference intervals.

Abstract: The effect of different levels of fluid intake on the renal concentration test was evaluated. Maximal urinary osmolality did not significantly differ whether strict fluid restriction was kept or not. One side effect, namely headache, seemed more frequent after fluid deprivation than after a more liberal fluid intake. We suggest a practical approach to the performance of the urinary concentration test with DDAVP. The maximal urinary concentration after a single subcutaneous injection of 4 micrograms DDAVP was determined in 212 healthy adults aged 20 to 80 years. A significant decline with age was found in maximum urinary concentration, mean values ranging from 982 mOsm/kg at 20 years to 823 mOsm/kg at 80 years. References are given for different ages which render the test useful in adult patients.

Expression of ABH blood group isoantigen as a prognostic factor in transitional cell bladder carcinoma

Abstract: The expression of ABH blood group isoantigen was determined with the avidin-biotin-peroxidase complex method in a retrospective consecutive material of 230 patients with transitional cell bladder carcinoma. The follow-up period was 5 to 9 years. The five-year corrected survival for 65 patients whose primary tumours showed predominant expression of ABH antigens (‘positive’) was 80% and for 146 patients with predominant deletion (‘negative’) 60% (p<0.01). Of 107 patients with superficial tumours there were 60 negative and 47 positive. In an analysis of early progression, the negative tumours were found to progress more frequently than positive ones (p<0.03). Twenty-three per cent of the negative tumours finally progressed during the whole follow-up, compared with 15% of the positive ones; this difference was not significant. Almost all progressing tumours became negative when they reached an advanced stage.

On the Mechanism of Acute Tolerance to Furosemide Diuresis

Abstract: The renal response to continuous furosemide infusion (8 mg/h) and subsequent ECV changes was studied in 8 healthy volunteers. Furosemide increased urine flow from a basal flow of 4.3 ml/min to a ma...

Influence of drainage conditions on mucosal bladder damage by indwelling catheters. II. Histological study.

Abstract: A previous study demonstrated a strong but short-lasting suction through the catheter eyes by a hydro-dynamically generated negative pressure fluctuation terminating bladder evacuation in some frequently occurring circumstances of indwelling catheter drainage. This report regards the biological effect. Fifteen successive evacuations on such drainage conditions in each of 4 anesthetized pigs were followed by cystectomy and histological examination. All bladders presented small swollen areas, histologically showing localized mucosal elevations dominated by edema of lamina propria and submucosa, occasionally with urothelial thinning or defects. Drainage with suction prevented in 3 animals caused normal bladders. The changes were similar to those following hydro-statical suction and much like those of the "polypoid cystitis" so commonly occurring with indwelling catheters. This suggests both types of suction by ordinary drainage as a major pathogenetic factor in the latter condition. The clinical significance and the occurrence during regimes of straight drainage or intermittent clamping are discussed.

Urodynamics in prostatism. III. Prognostic value of medium-fill water cystometry.

Abstract: The influence of preoperative cystometric findings on the post-surgical outcome in prostatism was examined in a prospective study comprising 139 consecutive patients. A blinded study design was used, including an entirely non-urodynamic selection procedure for prostatic surgery. In addition an extensive urodynamic investigation was carried out including: spontaneous uroflowmetry, medium-fill water cystometry and pressure-flow study combined with stop-flow test. All patients were re-evaluated 6 months postoperatively, both symptomatologically and urodynamically. The patients were classified in three groups according to the preoperative detrusor function: normal, overactive in the standing position and overactive in the supine position. No significant urodynamic nor symptomatologic differences were shown, neither pre- nor postoperatively. Nor did the subjective outcome differ between the groups. Demonstration of postoperative (persistent) detrusor instability was associated with an unfavourable subjective outcome. While residual urine had no predictive importance, a preoperative maximum cystometric capacity less than 300 ml appeared to indicate postoperative failure. Significant association was found between urge and detrusor instability. In conclusion, cystometry is not worthwhile in the preoperative work-up in prostatism.

Transrectal prostatic ultrasonography. Equipment, normal findings, benign hyperplasia and cancer

Abstract: The principles of transrectal ultrasound scanning of the prostate and current imaging facilities are reviewed. The ultrasonic anatomy of the normal prostate is described and illustrated. Exact volumetric determination of the gland is discussed, and the ultrasonic presentation of benign hyperplasia is surveyed. Ultrasonography is useful in the diagnosis of prostatic cancer and in T-staging the tumours. Ultrasonically guided needle biopsy of the prostate is an important component in cancer diagnosis. An aim for ongoing technical developments should be detection of prostatic cancer before it becomes palpable.

Scanning Electron Microscopy of Human Urine and Purified Tamm-Horsfall's Glycoprotein

Abstract: Dialyzed and dehydrated human urine and purified Tamm-Horsfall's glycoprotein revealed similar morphology by scanning electron microscopy. Single filaments, with diameters between 15-45 nm, splitting off and merging with thicker fibers at irregular intervals made up a three-dimensional meshwork with submicrometer pores. The resulting "fishing net" is capable of trapping microorganisms and may facilitate their elimination from the urinary tract by micturition. Tamm-Horsfall's glycoprotein may accordingly be a factor protecting against urinary tract infections.

Effects of Prazosin and Carbachol in Patients with Benign Prostatic Obstruction

Abstract: To eight patients with benign prostatic obstruction (BPO), prazosin and placebo were given in a double blind cross-over manner. Prazosin decreased significantly residual urine volume and increased maximum and average flow rates. Neither when treated with prazosin nor with placebo, did the patients improve their ability to empty the bladder after injection of carbachol (0.25 mg) sc. The only significant effect of carbachol on urodynamic variables was an increase in intravesical premicturition pressure. This was observed both when the patients were treated with prazosin and with placebo. Fourteen patients with BPO were given oral carbachol in maximally tolerated doses (6 or 12 mg/day) during a 2 week period. Despite producing significant systemic side effects in all patients, carbachol did not change any of the urodynamic variables tested. It is concluded that carbachol docs not further improve bladder emptying in BPO patients given prazosin. Oral carbachol has no effects on bladder emptying in thes...

Urothelial atypia and survival rate of 500 unselected patients with primary transitional-cell tumour of the urinary bladder.

Abstract: In a consecutive series of 500 unselected patients with primary urinary bladder tumours the influence of urothelial atypia on the 5 years survival-rate was examined. All tumours were transitional-cell tumours categorized according to the T-classification. Mucosal biopsies from 7 preselected sites were taken at the initial cystoscopy in 391 patients (78%) to identify urothelial atypia. The over-all cumulative 5 years survival-rate was 48%. Submucosal and muscle invasion had major influence on survival, whereas tumour grade was less important. Patients with urothelial atypia fared significantly worse than those with normal bladder mucosa (5 years survival 42% versus 62%). This difference in survival-rate became apparent first after two years of observation. Grade II atypia in the bladder mucosa and grade III (carcinoma in situ) had equal significance assessed by the survival-rates.

Comparison between renal parenchymal sonographic volume, renal parenchymal urographic area, glomerular filtration rate and renal plasma flow in children.

Abstract: A comparison of renal size, expressed as ultrasonographic renal parenchymal volume and urographic renal parenchymal area, and renal function, measured as glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), was made in two groups of children: (1) 21 patients with normal urograms and no signs of current disease and (2) 26 children with recurrent urinary tract infections or asymptomatic bacteriuria. Renal parenchymal volume was calculated using a water delay ultrasonographic device (Octoson). Renal parenchymal area was measured urographically. GFR and ERPF were determined from the clearances of inulin and PAH, respectively. In both groups a good correlation was found between both GFR and ERPF and total renal parenchymal volume as well as renal parenchymal area. The determination of renal parenchymal volume could possibly replace the determination of GFR and ERPF in healthy children and in children with urinary tract infections with normal and abnormal urograms.

Acute renal failure following nontraumatic rhabdomyolysis.

Abstract: The etiology and clinical course of acute nontraumatic rhabdomyolysis and ensuing renal failure was surveyed in a series of 40 consecutive patients. In 28 cases the muscle damage occurred after excessive consumption of ethyl alcohol and/or other intoxications. Prolonged lying immobilized was the reason or contributing factor for rhabdomyolysis in 22 cases. The other evident etiologies were convulsions, vigorous physical exercise, arterial occlusion and hypothermia. Typical local signs of rhabdomyolysis—pain, swelling and weakness of the affected muscles—were absent in one fourth of the patients. In these cases the diagnosis was based on transient elevation of serum creatine kinase enzyme activity. Dialyses were required to manage acute renal failure in 24 subjects. All 36 survivors recovered normal renal function. Neurological defects in the extremities still persisted in 16 patients at three months' follow-up.

Relationship between blood groups and tumors of the upper urinary tract.

Abstract: Comparing the relationship between upper urinary tract tumors and blood group ABO and the rhesus system showed that patients with blood group A and blood type rhesus positive had more invasive tumors with a higher grade of dysplasia than patients with blood group O and blood type rhesus negative.

Influence of alcoholism on morbidity after transurethral prostatectomy.

Abstract: Morbidity after transurethral resection of the prostate gland was retrospectively investigated by comparing 73 alcoholics with 73 controls (daily alcohol consumption ≥60 g vs. <25 g). The compared groups derived from 1172 patients and were matched for diagnosis, age, weight, smoking habits, treatment for cardiovascular, pulmonary or endocrine diseases, anaesthesia and weight of resected tissue. The postoperative morbidity was significantly higher in the alcohol group than in the controls (62% vs. 20%). Follow-up at 1, 3 and 12 months revealed significantly more complications among the alcoholics and also more frequent requirement of supplementary procedures than in the controls.

Effects of indwelling catheters on the urethral mucosa (polypoid urethritis)

Abstract: Indwelling catheters are almost invariably associated with characteristic mucosal lesions of the urinary bladder, commonly referred to as polypoid cystitis. In the present study, 20 male patients with indwelling catheters (due to benign prostatic hyperplasia) for 1-12 months were studied. Three non-catheter bearing male patients served as controls. Biopsies were taken from the posterior urethra in all patients and from the bladder in 16 of the 20 patients with indwelling catheters. All patients with catheters had endoscopic lesions in the urethra. The lesions varied from polypoid to bullous or oedematous, with or without hemorrhagic discoloration. In 11 of 20 patients the urethral lesions were histologically almost identical to polypoid cystitis. In the remaining 9 patients the reaction was less pronounced, and oedema, with or without mucosal hemorrhage, dominated. Due to the similarity between the catheter associated bladder lesions and the urethral lesions we suggest the term polypoid urethritis for the urethral lesions. There was no correlation between type of catheter used or how long it was used and the mucosal lesions. The results suggest mechanical irritation and/or pressure exerted by the catheter on the mucosa is responsible for the development of polypoid urethritis.