The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part I: when statistics fail.

PURPOSE: We evaluated the International Prostate Symptom Score and correlated it with objective means of determining bladder outlet obstruction. MATERIALS AND METHODS: Beginning in May 1996, 460 men 41 to 88 years old (mean age plus or minus standard deviation 60.4 +/- 9.4) were prospectively included in this study. Symptoms were evaluated using the International Prostate Symptom Score, and digital rectal examination, outpatient cystoscopy, prostate specific antigen determination and transrectal ultrasound were done. Urodynamic evaluation included uroflowmetry, filling cystometry and pressure flow study. RESULTS: Linear regression was done to correlate scores with measurable parameters. We noted no correlation of the total, obstructive symptoms or irritative symptoms score with objective parameters, including the average and maximum flow rate, post-void residual urine, prostate size and Schäfer grade. CONCLUSIONS: Prostatic symptom scores are qualitative. Using them to quantify the degree of obstruction or evaluate therapy is questionable.

Nocturnal enuresis in men with an orthotopic ileal reservoir: urodynamic evaluation.

PURPOSE: We evaluated the urodynamic features of enuretic and continent patients with an orthotopic neobladder. MATERIALS AND METHODS: Included in our study were 100 men with an orthotopic hemi-Kock or W neobladder and a minimum followup of 1 year. Of the patients 50 were completely continent day and night, and 50 had enuresis without evidence of an underlying organic etiology, such as stones, reflux or urethral stricture. RESULTS: Univariate analysis showed significantly higher pressure and a larger volume of post-void residual urine in the men with enuresis. In addition, maximum urethral pressure, maximum flow and compliance were decreased in the enuretic group compared to the continent group. Multivariate analysis revealed that post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions are the most critical parameters affecting nocturnal continence. CONCLUSIONS: The cystometric parameters significantly associated with nocturnal enuresis in patients with an orthotopic reservoir are post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions. Urethral pressure and flow parameters did not sustain significance on multivariate analysis.

A predictive model of survival after radical cystectomy for carcinoma of the bladder.

OBJECTIVE: To evaluate the effect of patient and tumour characteristics on the disease-free survival after radical cystectomy for infiltrating bladder cancer, and to use these to help in constructing a meaningful prognostic index. METHODS: The disease-free survival was initially evaluated in 1026 patients (the reference series, 1969-1990). A multivariate analysis showed that the tumour P stage, grade and nodal involvement were the only factors which had an independent and significant association with survival. The computed regression coefficients were then used to classify patients into one of four risk categories and the results then validated by applying the model to a prospective test series (1991-1995). RESULTS: The 5-year disease-free survival of both groups was similar. When the results for the risk categories of the reference series were compared with those of the test series, there was no significant difference. CONCLUSION: This comprehensive prognostic model for the results of radical cystectomy was validated and verified in a prospective group of patients. Adjuvant therapies are indicated for patients with a high risk score.

Penile fractures: the successful outcome of immediate surgical intervention.

The data of 60 patients admitted to Mansoura Urology and Nephrology Center with penile fractures and treated by immediate surgical repair were reviewed with respect to their presentation, investigations, operative and post-operative details. Forty-nine patients were followed up regarding penile curvatures, plaques and erectile function. Patients reporting decreased erectile function were further assessed by evaluating their response to intracavernous injection of PGE1 and by penile color duplex Doppler ultrasonography. All of our patients had the classic clinical presentation of penile swelling and ecchymosis. Only five patients had accompanying urethral rupture. Penile ultrasonography was used to confirm the diagnosis in 23 patients. Immediate exploration was done using subcoronal circumferential incision in about two-thirds of the cases. All tunica albuginea ruptures were unilateral except one case which was bilateral. Interrupted absorbable sutures were used for repair in most of the patients. Urethral repair was done in five cases. Delayed complications were detected in only six cases (12.2%) in the form of mild penile curvature on erection, plaques and/or mild erectile dysfunction. Intracavernous injection (ICI) of PGE1 and penile duplex Doppler showed a normal pattern in three patients with erectile dysfunction while the fourth showed incompetent veno-occlusive mechanism. Psychosexual consultation was required for two of these patients while the third was successfully managed by self-ICI of PGE1. We conclude that the excellent outcome of our patients parallels other reports of early surgical repair regarding low morbidity, short hospital stay and rapid functional recovery. There is a low incidence and degree of erectile dysfunction among repaired patients; however, it should be thoroughly investigated and properly managed. Ultrasonography is easy and helpful; however, the more invasive cavernosography and/or magnetic resonance imaging are indicated when the case is atypical, or the diagnosis of rupture of tunica is suspicious.