Peri-operative morbidity and changes in symptom scores after transurethral prostatectomy in Switzerland: results of an independent assessment of outcome.

OBJECTIVES: To assess, in a prospective study, the contemporary outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) in Switzerland, by evaluating peri-operative morbidity and changes in lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: Between January 2000 and January 2005, 11 hospitals in Switzerland participated in the study. The hospitals were required to inform Verein Outcome (VO), an independent institution specialising in outcome measurements in the Swiss healthcare system, about patients with BPH who were scheduled for TURP. Later, the hospitals provided data on peri-operative complications in these patients. The patients' Danish Prostate Symptom Score (DAN-PSS) was obtained by VO before and 4 months after TURP (via mailed questionnaires). RESULTS: Data on peri-operative complications from 1014 patients were included in this analysis. The mean (range) age of the patients was 69 (43-91) years. The most common complication after TURP was urinary retention, in 4.5% of the patients; the overall peri-operative complication rate was 9%. In all, 468 patients returned questionnaires both before and after TURP. The mean total DAN-PSS before and 4 months after surgery was 25.2 and 6.2, respectively (P < 0.001). CONCLUSIONS: The results of this prospective multicentre study showed that the current peri-operative morbidity of TURP is lower than that reported from older large-scale trials. The independent assessment of symptom scores confirms that TURP is highly effective in alleviating bothersome LUTS due to BPH.

Urethral evoked sympathetic skin responses and viscerosensory evoked potentials as diagnostic tools to evaluate urogenital autonomic afferent innervation in spinal cord injured patients.

PURPOSE: In most spinal cord injured (SCI) patients the objective assessment of afferent neuronal pathways from the lower urinary tract and the recording of a disturbed urethral sensation and/or desire to void are still difficult. Viscerosensory evoked potentials (VSEPs) might be helpful, but they remain technically difficult to obtain and interpretation is delicate. As a new approach, sympathetic skin response (SSR) of the hand and foot were recorded after electrical stimulation of the posterior urethral mucosa. This technique should allow assessment of the integrity or deterioration of the autonomic afferent pathway. MATERIALS AND METHODS: A total of 20 males and 8 females with SCI somatosensory incomplete 15, somatosensory complete 13 and 6 healthy male volunteers were prospectively examined. During urodynamic examination electrical stimulation (single square pulses of 0.2 ms, 2 to 3-fold sensory threshold, 60 mA in complete SCI patients) of the posterior urethra/bladder neck was performed using a bipolar electrode inserted into a microtip pressure catheter. SSR recordings of the right palm and sole were simultaneously taken using surface electrodes and were analyzed by an electromyography unit. Patient reports on evoked urethral sensations at individual sensory thresholds were simultaneously noted. Additionally, well-known electrophysiological measurements such as pudendal sensory evoked potential and urethral VSEP were recorded to check clinical assessed somatosensory and viscerosensory status, and to compare SSR results with these conventional methods. RESULTS: Electrical stimulation of the posterior urethra evoked clear urethral sensation and SSRs in normal subjects. In 14 of 15 sensory incomplete SCI patients with disturbed urethral sensation SSRs could be recorded as well. Electrically evoked urethral sensations resembled the subjective desire to void at full bladder reported by controls and patients. In 13 sensory complete SCI patients with loss of any urethral sensation SSRs could not be recorded even at maximal electrical stimulation strength. All subjects with electrically induced urethral sensation had positive evoked (supralesional) SSRs of the hand. However, none of the patients with absent urethral sensation presented SSRs. Simultaneously recorded VSEPs could not be recorded clearly in 5 patients and 2 control subjects, whereas SSRs delivered clear results in all controls and patients, matching their reports. CONCLUSIONS: SSR recordings above a spinal lesion level after urethral electrostimulation might provide a useful and technically simple objective diagnostic tool to assess integrity of autonomic (visceral) afferent nerves from the lower urinary tract. Somatosensory deficits are not always paralleled by viscerosensory loss and vice versa. In this study SSRs were superior to VSEPs, the latter being more difficult to record. The subjective sensations reported by subjects during stimulation could be confirmed in an objective way in 100% of cases by positive/negative SSR findings.

A new high frequency electrostimulation device to treat chronic prostatitis.

PURPOSE: We prospectively observed a possible benefit from urethro-anal high frequency electrostimulation in patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) as a new treatment option. MATERIALS AND METHODS: A total of 88 patients with a referral diagnosis of chronic prostatitis underwent fractionated urinary cultures, including expressed prostate secretion and ejaculate analysis twice. Of this group 14 men with Cat IIIB CPPS elected electrostimulation. A urethro-anal stimulation device was applied twice weekly for 30 minutes during 5 weeks at a defined voltage of 6 V, a defined frequency of between 450 and 500 Hz, and a variable self-regulated current of between 1 and 10 mA. National Institutes of Health prostatitis symptom score and quality of life index were determined before and after the treatment. RESULTS: All patients tolerated stimulation and completed the treatment course. No urethral or anal complications occurred. Generally, the patients reported a distinct perineal feeling and the pain syndrome improved in 83%. The mean total National Institutes of Health prostatitis symptom score significantly decreased from 29 (range 20 to 37) to 14 (range 8 to 24) points (p = 0.002). Mean pain decreased from 15 (range 12 to 20) to 7 (range 4 to 13) points (p = 0.002). Micturition complaints decreased from 2.5 (range 0 to 9) to 1 (range 0 to 8) points (p = 0.007) and quality of life improved from 9.5 (range 8 to 12) to 5.5 (range 3 to 10) (p = 0.003). CONCLUSIONS: To date the new high frequency urethro-anal afferent electrostimulation device seems to have an important benefit in patients with Cat IIIB CPPS. The device is technically simple and it can be self-administered. Therefore, it may become a new ambulatory treatment option for patients with chronic pelvic pain syndrome.