ABSTRACT
PURPOSE: We evaluate whether urodynamic evaluation can determine preoperatively the clinical prognosis of patients treated with transurethral prostatic resection as measured by urinary symptom score and quality of life index. MATERIALS AND METHODS: A total of 253 patients who previously elected transurethral prostatic resection based on clinical symptoms completed the American Urological Association symptom score and quality of life index, and underwent urodynamic evaluation before and after operation. The patients were divided into 7 groups in accordance with detrusor pressure at maximum urinary flow rate. The preoperative and postoperative symptom score and quality of life index were analyzed in each group. RESULTS: Of the patients 42% were not obstructed and could not be distinguished from those who were obstructed preoperatively based on total urinary symptoms (p = 0.95) or subjective impression measured by the quality of life index (p = 0.96). The entire obstructed group demonstrated marked improvement compared to the nonobstructed group (p = 0.018). Analysis of severity also revealed a clear relationship with clinical outcome and subjective satisfaction with obstruction grade, that is the more severely obstructed cases had greater clinical benefit compared to those with little or no obstruction. Furthermore, the nonobstructed subjects did not show any clinical or subjective improvement after transurethral prostatic resection (p = 0.24). CONCLUSIONS: Urodynamic studies provide great predictive value of clinical improvement after prostatic relief but they also properly predict the poor clinical results in nonobstructed patients.
Subject(s)
Prostatic Hyperplasia/physiopathology , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate , Urodynamics , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Treatment OutcomeABSTRACT
We evaluated the course of severe aluminum-related bone disease (ARBD) after the first year of a successful renal transplantation (RTx) in 11 adult patients. Bone pain and muscle weakness, presented in all patients previously to RTx, subsided, and all were able to walk, even the ones who were confined to wheelchairs. Bone necrosis developed in 6 patients, but none required surgical repair. Serum alkaline phosphatase activity increased 2.5 times the upper normal level, up to the 5th month and then declined to normal levels up the 12th month (p < 0.05). The inverse profile was observed in both serum calcium and phosphorus levels. In bone biopsies, there was a significant decrease in all of the following histomorphometric static parameters: osteoid volume, thickness and surface and also in aluminum surface. Also, there was a significant increase in all the dynamic parameters of mineralization: mineral apposition rate, mineralization surface, bone formation rate and adjusted apposition rate. In conclusion, ARBD remarkably improves after 1 year of successful RTx.
Subject(s)
Aluminum/metabolism , Bone and Bones/metabolism , Chronic Kidney Disease-Mineral and Bone Disorder/metabolism , Kidney Transplantation , Osteomalacia/metabolism , Adult , Bone Density , Bone and Bones/pathology , Bone and Bones/physiopathology , Calcification, Physiologic , Calcium/blood , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Chronic Kidney Disease-Mineral and Bone Disorder/physiopathology , Creatinine/blood , Female , Humans , Male , Middle Aged , Osteogenesis , Osteomalacia/pathology , Osteomalacia/physiopathology , Phosphorus/blood , Postoperative Period , Prospective StudiesABSTRACT
A case of retroperitoneal fibrosis satisfactorily treated with indwelling double J catheters is presented. This method, although reserved for special cases, is an adequate alternative treatment as it allows efficient long-term drainage of kidneys without aggressive surgical dissection of ureters.