This is the ¢rst report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uro£owmetry, pressure recording during ¢lling cystometry, and combined pressure^£ow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and con¢guration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one speci¢c technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice. Neurourol. Urodynam.21: 261^274,2002. ß 2002 Wiley-Liss, Inc.Key words: urodynamics; standardisation; uro£owmetry; cystometry; pressure-£ow studies INTRODUCTIONA Good Urodynamic Practice comprises three main elements:A clear indication for and appropriate selection of, relevant test measurements and procedureŝ Precise measurement with data quality control and complete documentation Accurate analysis and critical reporting of resultsThe aim of clinical urodynamics is to reproduce symptoms whilst making precise measurements in order to identify the underlying causes for the symptoms, and to quantify the related pathophysiological processes. By doing so, it should be possible to establish objectively the presence of a dysfunction and understand its clinical implications. Thus, we may either con¢rm a diagnosis or give a new, speci¢cally urodynamic, diagnosis. The quantitative measurement may be supplemented by imaging (videourodynamics).Urodynamic measurements cannot yet be completely automated, except for the most simple urodynamic procedure, uro£owmetry. This is not an inherent problem of the measurement itself, but is due to the current limitations of urodynamic equipment and the lack of a consensus on the precise method of measurement, signal processing, quanti¢cation, documentation, and interpretation. With the publication of this ICS Standardisation document on good urodynamic practice, it is expected that the necessary technological developments in automation will follow.Urodynamics allows direct assessment of lower urinary tract (LUT) function by the measurement of relevant physiological parameters. The ¢rst step is to formulate the 'urodynamic question or questions' from a careful history, physical examination, and standard urological investigations. The patient's recordings of micturitions and symptoms on a frequency volume chart, and repeated free uro£owmetry with determination of post-void residual volume provide important noninvasive, objective information that helps to ...

Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial.

BACKGROUND Radical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. METHODS Between 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. RESULTS During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P = 0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical pros-tatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P = 0.04). CONCLUSIONS Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.)

Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer. Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment. (Funded by the Swedish Cancer Society and the National Institutes of Health.).