Assay discrepancy in mild haemophilia A: entire population study in a National Haemophilia Centre.

Assay discrepancy in mild haemophilia, here defined by a significantly higher factor VIII (FVIII):C response by the one-stage procoagulant assay as compared with a two-stage enzymatic method, has repeatedly been reported in literature. The purpose of this study was to determine the overall prevalence of this phenomenon amongst mild haemophilia families from a population of 2.95 million inhabitants in the Western Danish region. Information was collected retrospectively through a thorough search of archives of the National Haemophilia Centre in Aarhus. We identified 109 patients with mild haemophilia A amongst whom 92 were eligible to enter the study. These represent a total of 53 unrelated families. Our data illustrate that this assay discrepancy pattern is found quite frequently amongst our mild haemophilia A families. While the ratio of FVIII:C chromogenic/FVIII:C clot values was quite consistent amongst patients belonging to same family pattern, ratios in the entire cohort of families ranged from 0.18 to 1.00. Selecting a cut-off level for the FVIII:C chromogenic/FVIII:C clot ratios at 0.7, 0.6 and 0.5, respectively, we found that 38 (72%), 27 (51%) and 19 (36%) of families, respectively, displayed this assay discrepancy. In 10 patients, the FVIII:C chromogenic level was inside the category of moderate haemophilia at >0.01-<0.05 IU mL(-1), pointing to a class-shift in the biochemical phenotype. In conclusion, our data illustrate a substantial prevalence of the assay discrepancy phenomenon amongst mild haemophilia A patients in our geographical area.

Stone risk after bladder substitution with the ileal-urethral Kock reservoir.

OBJECTIVE: The study was carried out to compare urinary biochemical and physicochemical environments in patients who had undergone bladder substitution with the ileal-urethral Kock reservoir, and who had no actual urinary infection, with those of healthy subjects. MATERIAL AND METHODS: The participants were 23 male patients who had undergone bladder substitution with the ileal-urethral Kock reservoir and 25 healthy men. All subjects had sterile urine at the time of urine collection. Concentrations of calcium, magnesium, phosphorus, creatinine, citrate, oxalate, and ammonia in 24-h urine samples were measured. Estimates of ion activity products of calcium oxalate (CaOx), calcium phosphate (CaP), brushite (Bru), and magnesium ammonium phosphate (MAP) in urine were calculated according to Tiselius. RESULTS: There was no significant difference in 24-h urinary volume between patients with a bladder substitute and the healthy controls. For most of the other measured values the results for patients differed significantly from those for controls. The most striking findings were markedly lower urinary excretion rates of citrate (p < 0.0001) and higher urine pH (p < 0.0001) in patients compared with controls. These findings were reflected in significantly higher levels of urinary supersaturation with respect to CaOx (p < 0.0001), CaP (p <0.0001), Bru (p < 0.0001) and MAP (stuvite) (p < 0.0001) in patients with a bladder substitute compared with healthy subjects. CONCLUSIONS: Hypocitraturia seems to be the main risk factor for calcium stone formation in non-infected Kock reservoir patients, and citrate supplementation appears to be the most obvious choice for stone prophylaxis in patients with intestinal urinary diversion and recurrent renal stone formation.

The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men.

PURPOSE: We report our experience with 166 patients who underwent radical cystectomy and orthotopic bladder substitution with the ileal Kock neobladder between February 1990 and January 1999. MATERIALS AND METHODS: We classified complications as early (3 months or less postoperatively) and late. Continence was assessed by patient interview, the need to use protective devices and provocative incontinence testing. Neobladder function was evaluated by uroflowmetry, post-void residual urine volume measurement and enterocystometry, and renal function was assessed by 51creatinine ethylenediaminetetraacetic acid clearance. RESULTS: There were no perioperative deaths. However, 52 early complications developed in 39 patients (23.5%) and 73 late complications in 62 (37.4%). The rate of early and late complications associated with the urinary tract was 11.5% and 23.5% with abdominal reoperation rates of 1.8% and 2.4%, respectively, due to these complications. At 3 and 5 years the risk of stone formation on the metallic staples was 18% and 34%, and the risk of B12 deficiency was 30% and 33%, respectively. One patient (0.6%) underwent reoperation for ureteral anastomotic stricture. Anterior urethral stricture in 5 cases (3%) was caused by recurrence in 1 and urethral anastomotic stricture in 1 also resulted from recurrent disease. Daytime continence was reported by 97% and 100% of our patients at 1 and 5 years, respectively. Provocative incontinence testing confirmed this level of daytime continence. Overall 75% of patients reported nighttime continence at 1 year and 94% at 5 years. The need for a nighttime protective device decreased with time. At 1 versus 3 years 39.8% versus 45.9% of patients used no protection, 29.7% versus 39.2% used a sanitary pad and 30.5% versus 14.9% used a condom device. Enterocystometric capacity and subtracted maximum reservoir pressure remained remarkably uniform at 456 versus 411 ml. and 47 versus 50 cm. water 6 months and 5 years postoperatively, respectively. Nevertheless, median post-void residual urine volume increased from 20 ml. at 6 months to 40 ml. at 5 years with an increased prevalence of patients requiring intermittent catheterization due to post-void residual urine greater than 100 ml. from 16% at 6 months to 44% at 5 years. 51Creatinine ethylenediaminetetraacetic acid clearance remained unchanged. There was a substantial 5-year survival advantage for the subpopulation with stage pT3a or less, pN0 tumors (94% versus 51%, p <0.001). CONCLUSIONS: Radical cystectomy and orthotopic bladder substitution with the Kock ileal neobladder may be performed with an acceptable complication rate and good functional results. The probability of survival was considerably higher for patients with tumor confined to the bladder. Consequently we believe that early aggressive treatment should be considered in those with invasive disease, and reconstruction with orthotopic bladder substitution may encourage patients to accept radical surgery.

Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall.

PURPOSE: We assess the influence of the limits of pelvic lymph node dissection on survival following radical cystectomy for bladder cancer. MATERIALS AND METHODS: From January 1990 to September 1997, 194 patients underwent radical cystectomy without prior treatment. Between March 1993 and September 1997, 126 consecutive patients underwent radical cystectomy with extended pelvic lymph node dissection beginning at the bifurcation of the aorta, including the common and external iliac vessels, presacral nodes and obturator fossa. Between January 1990 and March 1993, 68 consecutive patients underwent radical cystectomy, with limited pelvic lymph node dissection beginning at the bifurcation of the common iliac vessels, including the external iliac vessels and obturator fossa. The cystectomy procedure remained unchanged throughout this period and 1 surgeon performed all procedures. RESULTS: A total of 117 patients had tumors confined to the bladder wall (stage pT3a or less) and 77 had tumors penetrating beyond the bladder into perivesical fat or adjacent structures (stage pT3b or greater). The prevalence of patients with tumors penetrating the bladder was higher in the extended dissection group (42.9 versus 33.8% limited dissection). The incidence of lymphatic involvement was 26.2% and slightly higher in the extended than the limited dissection group. There was a modest improvement in the 5-year recurrence-free survival for the extended dissection group (62 versus 56% limited dissection, p = 0.33), and a substantial improvement for the subgroups with tumors confined to the bladder wall (tumor stage pT3a or less) (85 versus 64%, p <0.02) and without lymph node metastasis (stage pT3a or less, pN0) (90 versus 71%, p <0.02). Accordingly, extended pelvic lymph node dissection reduced the 5-year probabilities for pelvic and distant metastasis (2 versus 7% limited dissection, p = 0.17 and 10 versus 21%, p = 0.15, respectively) for patients with tumors confined to the bladder wall (stage pT3a or less). Survival was similar for patients with pT3b or greater tumor. CONCLUSIONS: This retrospective analysis suggests that extending the limits of pelvic lymph node dissection from the bifurcation of the common iliac vessels to the bifurcation of the aorta improves the recurrence-free survival rate for patients undergoing radical cystectomy for bladder cancer confined to the bladder wall (stage pT3a or less).

Bone metabolism following bladder substitution with the ileal urethral Kock reservoir.

OBJECTIVES: To assess bone metabolism following bladder substitution with the ileal Kock reservoir. PATIENTS, SUBJECTS AND METHODS: The investigation comprised two separate studies, one with baseline measurements before and after surgery, and the second after surgery only, of bone mass, made using single-photon absorptiometry and dual-energy X-ray absorptiometry, biochemical variables of bone turnover, plasma analyses and measurements of renal calcium and phosphate excretion. After inclusion, both groups of patients were observed longitudinally for 2 years. The post-surgery study included 25 patients who had undergone bladder substitution (median age 67 years, range 44-75), with a median post-operative follow-up of 1.0 year (range 0.3-3.7), and 16 control subjects (either healthy or with other minor urological complaints; median age 62 years, range 34-80), and the pre-surgery study comprised seven patients who had undergone bladder substitution (median age 57 years, range 42-68). RESULTS: Total body, forearm and spinal bone mineral contents were similar in patients with an ileal bladder substitute measured 1 year after surgery and in control subjects. There were equivalent significant changes in both the patients and control subjects during the 2-year observation period, with a 2-3% decrease in total body and forearm bone mineral content. The values were similar in patients with and without a mild metabolic acidosis. Plasma calcium, phosphate, total alkaline phosphatase, intact parathyroid hormone, vitamin D and osteocalcin were normal in both patients and control subjects. Renal excretion of calcium and phosphate was also similar in patients and in control subjects. CONCLUSIONS: Ileal urethral Kock bladder substitution does not lead to accelerated bone mineral loss in elderly men, despite a mild metabolic acidosis in half of the patients.

Acid-base metabolism after bladder substitution with the ileal urethral Kock reservoir.

OBJECTIVES: To assess acid-base metabolism after bladder substitution with the ileal Kock reservoir, using capillary blood-gas analysis, measurement of the renal excretion of ammonium and titratable acid and the evaluation of renal function by plasma clearance of 51Cr-labelled ethyl-enediamine tetra-acetic acid (51Cr-EDTA). PATIENTS, SUBJECTS AND METHODS: The investigation comprised both a cross-sectional study, with initial measurements after surgery, and a longitudinal study, with pre-operative measurements, both groups of patients being followed for 2 years after inclusion. The cross-sectional study included 26 patients (median age 66 years, range 44-75), with a median post-operative follow-up of 1.2 years (range 0.3-3.7), and 16 control subjects (median age 62 years, range 34-80), and the longitudinal study comprised seven patients (median age 57 years, range 42-68). RESULTS: The median values for capillary blood pH, carbon dioxide pressure, standard bicarbonate and standard base excess were significantly lower in patients with a bladder substitute than in the control subjects. An acid-base chart showed that the values for 44% of patients and none of the controls were within the area representing mild metabolic acidosis. This difference could not be attributed to differences in renal function because the 51Cr-EDTA clearance was normal and similar in the two groups of patients and among patients and controls. Nevertheless, the median values for each of the variables measured by blood-gas analysis were within the reference interval of the normal population. Net acid excretion was similar in patients with a bladder substitute and control subjects, but urinary pH was significantly higher in the patients. Accordingly, the renal excretion of ammonium was significantly higher and the excretion of titratable acid significantly lower in patients after ileal bladder substitution. CONCLUSIONS: The results are consistent with the hypothesis that bladder substitution with the ileal Koch reservoir results in an acid load to the body, caused mainly by ammonium reabsorption in the reservoir. The acid load is compensated by an increased renal excretion of ammonium but causes a mild metabolic acidosis in about half the patients.

Research review: a computer-based diagnostic model for individual case review.

A previous study found that Iliad, a diagnostic expert system, detects diagnostic errors missed by peer review organization (PRO) review. That study used volunteer physicians from an institution as gold standard reviewers, however. The article discusses a second experiment employing Utah PRO (UPRO) review physicians as gold standards. Iliad was compared with the Unified Clinical Data Set used by the UPRO and was found to detect otherwise unsuspected diagnostic errors. The confirmation rate of Iliad flags was much higher in the earlier study, however. No agreement was found between institution and UPRO physicians, but there was agreement between a unique physician (who was both an institution and UPRO physician) and each of the two groups. Because Iliad screens for potential diagnostic errors to be confirmed or denied by gold standard physician review, the different types of physicians in the two experiments might have been the cause.

The anatomy of a prostate waiting list: a prospective study of 132 consecutive patients.

OBJECTIVE: To report the results of a standard evaluation programme performed prior to transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH). PATIENTS AND METHODS: All 132 patients with symptoms of prostatism on the waiting list for surgery were invited to attend the hospital to undergo a physical examination, symptom evaluation and routine blood sampling. Of these, 117 attended. If the suspicion of BPH was sustained a transrectal ultrasound examination of the prostate and a urodynamic evaluation, including a pressure-flow study, were performed. RESULTS: Urodynamic evaluation was carried out in 80 of the 117 patients who attended the clinic. Infravesical obstruction was present in 61 patients while in 19 (24%) there was no obstruction. An operative procedure to relieve obstruction was performed in 65 patients (49%). CONCLUSIONS: In a population of patients scheduled for TURP, 24% were found not to have an obstruction. This is in accordance with other reports. As the patients with few symptoms and those who did not have an obstruction were treated conservatively only 49% of the referred cases underwent prostatic surgery.

[The volume of the prostate in benign hyperplasia and evaluation of infravesical obstruction]. / Objem benígnej hyperplázie prostaty v hodnotení infravezikálnej obstrukcie.

In a prospective study group of 22 patients we analyzed the relationship between the volume of benign prostatic hypertrophy (BPH) and infravesical obstruction. We diagnosed obstruction with urodynamic measurement (pressure flow studies) in 16 patients (72.7%). Volume of BPH was investigated by the transrectal ultrasound. We found obstruction in 11 from 14 patients (63.6%) with BPH > or = 30 ml and in 5 from 8 patients (36.4%) with BPH < 30 ml. The diagnostic accuracy of prostatic volume measurement in the diagnosis of infravesical obstruction was only 63.6%. The volume of BPH did not correlate with the infravesical obstruction. (Tab. 3, Fig. 1, Ref. 14.)

Prostatic enlargement, symptomatology and pressure/flow evaluation: interrelations in patients with symptomatic BPH.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is the most common pathologic condition to afflict the aging male. Many patients with symptomatic BPH undergo prostatectomy without rigorous evaluation. Three concepts should be considered before any treatment of a patient with symptomatic BPH; Prostatic enlargement, symptomatology and bladder outflow obstruction. PATIENTS AND METHODS: The study comprised 188 consecutive patients with symptomatic BPH, all eligible after pressure/flow examination. One-hundred-seventy-four of the patients answered the DAN-PSS questionnaire, 140 of the patients had their prostate size measured by transrectal ultrasonography. One-hundred-fifty-three patients were able to perform a free flow measurement upon arrival. Uroflowmetry, symptomatology and prostate size were matched with the results of pressure/flow examination. RESULTS: Neither uroflowmetry, symptomatology nor prostate size correlated well with bladder outlet obstruction. The positive predictive value for infravesical obstruction was 88% if a maximum flow rate under 10 ml/s was used. Symptomatology could not be used to differentiate between patients with bladder outlet obstruction and patients without obstruction. The positive predictive value for infravesical obstruction was 76% if a prostate volume over 40 ml was chosen. DISCUSSION: The purpose of diagnostic evaluation in patients with BPH, is to identify precisely the pathophysiology underlying the patients condition, so that rational therapy can be selected. CONCLUSION: The disease entity of BPH is characterized by the interaction of prostate enlargement, the subjective symptom complex of prostatism, and urodynamic infravesical obstruction. Since it is impossible to interpolate from one to another of these conditions, a comprehensive evaluation of a patient with symptomatic BPH should include an assessment of all of these conditions.

Subjective and objective evaluation of patients with prostatism and infravesical obstruction treated with both intraprostatic spiral and transurethral prostatectomy.

In order to evaluate the effect of intraprostatic spiral and subsequent transurethral prostatectomy (TURP) on obstructive benign prostatic hyperplasia, 9 men were evaluated with symptom scores and urodynamic studies at inclusion after 4 months of spiral treatment and 4 months after TURP. Six patients in a control group were evaluated at inclusion after an observation period of 4 months and 4 months after TURP. After treatment with spiral the symptom score decreased in 7 patients, increased in 1, and was unchanged in 1. After the observation period in the control group the symptom score decreased in 4 patients, increased in 1, and was unchanged in 1. After TURP the symptom score decreased even further in all patients, but one. After spiral treatment the urethral resistance decreased in 8 of 9 patients, but according to Abrams and Griffith's [(1979): Br J Urol 51:129-134] definition, only 2 were unobstructed. Five patients in the control group were unchanged obstructed after the observation period, while one was unobstructed. After TURP, the patients in both groups were all unobstructed. Intraprostatic spirals decrease the severity of symptoms and reduce the urethral resistance, but TURP in the same patient was much more effective.

[The intraprostatic spiral. Long-term results in 150 consecutive patients]. / Den intraprostatiske spiral. Langtidsresultater hos 150 konsekutive patienter.

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported (previously published in (7)). The median follow-up time was 8.6 months (range 0 to 60 months). In 89 patients the spiral was removed after an average of four months (range 0 to 50 months); on account of dysfunction of the spiral in 58 cases, planned prostatectomy in 17 cases and unrelated to the spiral (stroke etc.) in 14 cases. A total of 34 patients died with the coil in situ. Approximately two-thirds of the patients had no or few voiding symptoms, while one fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 51 patients but was not a clinical problem. Migration occurred 65 times in 47 patients but this only led to coil removal in eight. Calcification of the coil was noted mainly after long-term treatment and we recommend replacement of the coil after two years. We conclude that the intraprostatic spiral is a useful alternative to an indwelling catheter. Life-long follow-up is, however, necessary in most patients.

Intravesical Bacillus Calmette-Guérin with the Danish strain for treatment of carcinoma in situ of the bladder.

We report our experience of the treatment of carcinoma in situ (CIS) using intravesical therapy with the Danish Bacillus Calmette-Guérin (BCG) strain 331 (SSI). Forty-two patients received treatment, 11 had primary and 31 secondary CIS. The median follow-up period was 26 months (range 3-68). Patients received 6 weekly instillations (1 course) and non-responders an additional 6 instillations at 2-week intervals (2 courses). The complete response rate was 59% for 1-course patients, 33% for the 2-course patients and 68% for the entire series. Patients were considered treatment failures if they suffered progression to invasive cancer, metastasis or died from transitional cell carcinoma. BCG treatment was more effective in primary than in secondary CIS, with a complete response rate of 80% versus 65% and with no failures versus 35%. Patients with persistent CIS after the first course of BCG had a greater risk of failure than responders: 50% versus 17%. Patients with persistent CIS after the second course had a 75% failure rate. This suggests that cystectomy should be considered for non-responders following a 6-week course and recommended to those not responding to 2 courses. Ten patients had CIS in the prostatic urethra. All responded to BCG treatment; 2 suffered from recurrent CIS 1 associated with invasive urethral tumour. The incidence and severity of side effects were similar to those reported with other strains of BCG. One patient with primary CIS failed to complete the treatment owing to "BCG-itis".

Mechanical characteristics of tubular and detubularised bowel for bladder substitution: theory, urodynamics and clinical results.

A theoretical analysis of the mechanics of tubular and detubularised bowel bladders is presented. The results are compared with clinical findings following bladder substitution with the tubular ileocaecal and the detubularised urethral Kock reservoir. The theoretical results are consistent with clinical observations showing that detubularisation increases reservoir capacity substantially, delays the onset and reduces the amplitude of the pressure rise produced by contractions. These findings account for the markedly improved nocturnal continence (80 versus 17% at 2 years), the longer voiding intervals (4 versus 2.5 h at 1 year) and the predisposition to urinary retention (25 versus 0% at 1 year) with detubularised bladder substitution. A simple equation is derived to calculate the capacities of both near-spherical and cylindrical reservoirs. The capacity of the U pouch is calculated to be less than that of the W-shaped, S-shaped and Kock reservoirs. Altering the shape of a reservoir from spherical to ellipsoid is calculated to have only a slight effect on its mechanical characteristics. Consequently the essence of detubularisation is to create a reservoir with high capacity, while shape is of secondary importance.

[The urodynamic examination in prostatism]. / Urodynamické vysetrenia pri prostatizme.

In a prospective study comprising 29 patients the authors analyzed comprehensively subjective complaints of prostatism using the score of prostatic symptoms (PSS) with the objective urodynamic finding (uroflowmetry, cystometry, pressure flow measurement) in men with benign prostatic hyperplasia. The Boyarsky and Madsen-Iversen PSS did not correlate with the infravesical obstruction assessed by the pressure flow measurements. An obstruction was detected in 23 patients (79.3%), incl. a marginal one in 6 patients (20.7%), the diagnostic sensitivity of free uroflowmetry being 90.9%. Cystometry did not reveal a significant difference between the group with and without an obstruction, instability of the detrusor was found in 12 patients (41.4%) with a significant difference of the maximal cystometric capacity, as compared with the group of patients with a stable detrusor.

Memokath: a second generation of intraprostatic spirals.

Memokath (Engineers & Doctors A/S, Hornbaek, Denmark) is a new intraprostatic spiral composed of titanium nickel alloy with shape memory effect. We describe the use of this spiral in 30 consecutive patients with prostatic outflow obstruction. Their median age was 79 years and all were either in a high risk group for surgery or had refused surgery. The spiral was inserted under sterile conditions via a delivery catheter under ultrasonic guidance. When flushed with hot water (45 degrees C or above) one section of the spiral expands in the prostatic apex and maintains the spiral in position. When cooled with cold water (10 degrees C or below) the spiral becomes supersoft, making removal easy. With a follow-up of 0.2 to 9 months (median 3) we report a success rate of 83%. Five patients discontinued treatment, 3 because of urinary retention, 1 because of progressive obstructive symptoms and 1 following persistent urinary incontinence. No migration of the spiral was observed. Encrustations have appeared and seem to be a persistent problem. Most patients were satisfied with the procedure, which provided a quick, safe and effective method of relieving infravesical prostatic obstruction. Follow-up is short and late complications have yet to be assessed.

The value of a new symptom score (DAN-PSS) in diagnosing uro-dynamic infravesical obstruction in BPH.

INTRODUCTION: A new type of questionnaire for BPH, the DAN-PSS symptom score system, was used in an attempt to predict infravesical obstruction determined by pressure-flow study. PATIENTS AND METHODS: In 50 consecutive patients a reliable questionnaire and a pressure-flow was obtained. RESULTS: Almost none of the unobstructed patients had a total obstructed index (TOI) of more than 6, whereas this was the case in half of the obstructed patients. This difference was statistically significant. DISCUSSION: This study indicates, that if the total obstructed index (TOI) is more than 6, the patient most likely have an infravesical obstruction. With this limit the DAN-PSS-score system can predict infravesical obstruction with a sensitivity of 42% and a specificity of 89%. CONCLUSION: With the new concept of combining quantity with quality in a symptom score system, a strong correlation between symptoms and objective findings has been found.

The intraprostatic spiral: clinical results in 150 consecutive patients.

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.

Intraprostatic spiral during waiting time for transurethral prostatectomy.

When benign prostatic hyperplasia results in voiding problems such as acute or chronic urinary retention, transurethral prostatectomy is often necessary. We have evaluated 24 patients, treated with an intraprostatic spiral, during waiting time for transurethral prostatectomy. The spiral treatment was a success in 21 patients. Three patients had a transurethral prostatectomy before scheduled time due to spiral failure, 2 with urinary retention, 1 with severe local discomfort. We conclude that spiral treatment of symptomatic benign prostatic hyperplasia while waiting for transurethral prostatectomy has a high success rate and is recommended as a favorable alternative to an indwelling urethral catheter.