No abstract

Invasive urodynamic investigation is associated with a considerable rate of complications and morbidity, particularly in men with infravesical obstruction. These facts must be considered and discussed with the patient before urodynamic testing.

Patients with acute urinary retention, age 80 years or older, with retention volume greater than 1,500 ml., no evidence of instability and maximal detrusor pressure less than 28 cm. water are at high risk of treatment failure. However, despite treatment failure the detrusor may recover in patients younger than 80. Therefore, prostatectomy should still be performed in this group (less than 80 years old) even if preoperative urodynamics suggest an unfavorable outcome.

Objective To determine whether it is possible to predict correlation for the IPSS and the quality-of-life question of the IPSS. The percentage of patients with BOO the presence of bladder outlet obstruction (BOO) by non-invasive clinical variables in patients with lower defined by a linPURR of 3-6 decreased from 85% in those with a Q max of 0-5 mL/s to 60% (Q max urinary tract symptoms (LUTS) suggestive of BOO. Patients and methods Patients with LUTS suggestive of 6-10 mL/s) and 44% (Q max 11-15 mL/s). In parallel, the percentage of patients with BOO increased from BOO were entered into a prospective protocol evaluating the International Prostate Symptom Score (IPSS), 53% of those with a prostate volume of ∏50 mL, to 79% of those with prostates of 51-100 mL and 75% prostate size, non-invasive uroflow, post-void residual urine volume (PVR) and a pressure flow study. Only of those >100 mL. Based on Q max , PVR and prostate volume, nomograms were established by multiple patients with a maximum flow rate (Q max ) of∏15 mL/s and an IPSSÁ7 were included. The study comprised logistic regression analysis for the probability of BOO in patients with LUTS. 253 patients; the degree of obstruction was correlated to several non-invasive clinical variables.Conclusion The nomograms presented herein should help the clinician to identify patients with LUTS who Subsequently nomograms were developed by multiple logistic regression analysis to obtain the probability of should undergo pressure flow studies before surgical intervention to detect the presence of obstruction and BOO in patients with LUTS.

Objective. The aim of this study was to evaluate the association between serum levels of testosterone and free testosterone to lifestyle in aging males. Methods. Men between 45 and 85 years were assessed regarding body mass index (BMI), nicotine and alcohol consumption, stress level, physical and social activity, and sleeping quality by a self-administered questionnaire. In parallel, serum levels of testosterone (T), free testosterone (fT), LH, FSH, DHEA-S, E2 and SHBG were obtained. Results. In total, 375 men with a mean age of 59.9 years (9.2 + SD) entered this study; 25.4% and 27.4% had hypogonadal testosterone or free testosterone serum levels, respectively. Nicotine consumption (smokers had higher levels of T and f T; p 5 0.01), BMI (negative correlation to T; p 5 0.01) and age (negative correlation to f T; p 5 0.001) correlated with serum levels of testosterone or free testosterone. Physical and social activity, nicotine and alcohol consumption, stress level and sleep quality did not show a significant association with serum androgen levels.Conclusion. This prospective study of 375 men aged 45 to 85 years confirms the correlation between age, BMI and smoking with serum levels of testosterone and free testosterone, whereas the investigated variety of lifestyle factors did not show a significant association to serum androgen levels.

Data on the interrelationships of bladder compliance (BC), detrusor instability (DI), and bladder outflow obstruction (BOO) in elderly men with lower urinary tract symptoms (LUTS) are scarce and were therefore assessed in this study. Principle inclusion criteria for this study were men aged ജ50 years suffering from LUTS as defined by an International Prostate Symptoms Score (IPSS) of ജ7 and a peak flow rate (Q max ) of ഛ15 ml/sec. Patients with previous surgery of the bladder, prostate, or urethra as well as a pathological neurourological status were excluded from this study. The following parameters were studied in all patients: IPSS, prostate volume calculated by transrectal ultrasonography, free uroflow study, post-void residual volume determined by transurethral catheterization, and a multichannel pressure flow study (p QS ). A group of 170 men were included in the analysis. The mean BC in the overall group was 32 ± 2 ml/cm H 2 O (mean ± standard error of the mean [SEM]; range, 4-100 ml/cm H 2 O). In 36.5% of patients, BC was significantly reduced (ഛ20 ml/cm H 2 O), and in a further 37.1%, it ranged from 20 to 40 ml/cm H 2 O. BC decreased statistically significantly (p < 0.05) in patients with advanced age, lower Q max , higher voiding pressures, and larger prostates. In men with DI (n ‫ס‬ 61), mean BC was significantly lower (22 ± 3 ml/cm H 2 O) compared to those without (37 ± 3 ml/cm H 2 O; p ‫ס‬ 0.001; n ‫ס‬ 109). Patients with severe BOO as defined by a linear passive urethral resistance relationship of ജ3 (n ‫ס‬ 109), had a significantly lower BC (23 ± 2 ml/cm H 2 O) compared to those without or minimal obstruction only (39 ± 3 ml/cm H 2 O; p ‫ס‬ 0.0002; n ‫ס‬ 61).Stepwise logistic regression analysis revealed that DI, a low bladder capacity, and a high maximum detrusor pressure were independent predictors of markedly reduced BC (<20 ml/cm H 2 O). BC is decreased in elderly men with high voiding pressures, BOO, and DI. The mechanism leading to the reduction of BC under these circumstances is largely unknown and could result from cytostructural alterations of the detrusor and changes in detrusor innervation. Neurourol. Urodynam. 18:3-15, 1999.

The molecular basis for antigenic determinants on the free beta-subunit of human chorionic gonadotrophin (hCG beta), its carboxyl-terminal peptide (hCG beta CTP) and the hCG beta-core fragment (hCG beta cf) was elucidated by means of monoclonal antibodies (MCAs). The objective of the present study was to resolve the antigenic topography of these three molecules in terms of epitope identification at different levels of structural organization as well as analysis of their spatial arrangement. An hCG beta cf preparation, a synthetic peptide corresponding to the hCG beta CTP (beta 109-145), overlapping synthetic peptides spanning the entire amino acid sequence of hCG beta, and a reduced and alkylated hCG beta preparation were assayed in a solid-phase one-site enzyme-linked immunoassay and in a soluble-phase direct-binding radioimmunoassay (RIA) or competitive RIA. The antigenic topography was mapped by incorporating the MCAs into two-site binding assays. On the surface of free hCG beta, nine different epitopes (beta 1-beta 9), arranged in three spatially distinct domains, could be distinguished. Epitopes beta 1-beta 7 were located in a single large domain on both hCG beta and the hCG beta cf whereas hCG beta CTP contained two topographically distant determinants, designated beta 8 and beta 9 respectively. All but the two epitopes located on hCG beta CTP (beta 8 and beta 9) were destroyed by reducing and alkylating hCG beta, suggesting that most antigenic determinants are predominantly non-contiguous and require an intact tertiary structure whereas the molecular structure of hCG beta CTP is linear. At a molecular level, amino acid residues spanning hCG beta 45-52, hCG beta 137-144 and hCG beta 113-116 contributed to the formation of epitopes beta 5, beta 8 and beta 9 respectively. We have also shown that the hCG beta cf represents the immunodominant part of the free beta-subunit of hCG, containing seven mainly conformationally determined epitopes, one of which has a share of the sequence beta 45-52. The hCG beta CTP does not play a critical role in the immunologically important tertiary structure of hCG beta and was itself found to be a predominantly continuous sequence also within the native hormone, expressing two spatially distant antigenic determinants located within residues beta 113-116 and beta 137-144 respectively.

Objectives To compare, in a retrospective study, pathological specimens of prostate cancer detected in additional areas of a 12‐core biopsy with tumours detected using traditional sextant biopsy. Patients and methods The study included 27 patients who had undergone radical prostatectomy (RP) for prostate cancer. Prostatectomy specimens of cancers detected using standard sextant biopsies were compared with those detected using six additional core biopsies. The RP specimens were analysed for cancer volume, Gleason score, tumour grade (Mostofi) and pathological stage. Results Of the 27 patients, six (29%) had cancer detected in the extra six biopsy cores which would have otherwise have been undetected using sextant biopsy. Only two insignificant cancers were detected. The mean Gleason score was 6.1 for cancer detected by the sextant or 12‐core method (P = 0.907); the mean grade (Mostofi) was 2.1 and 2.33, respectively (P = 0.29). The final tumour stage in the 21 patients undergoing sextant biopsy was pT2 in 13 and pT3 in eight, compared with six pT2 tumours in the six patients diagnosed using extra biopsies. The mean (median, range) tumour volume was 5.7 (3.5, 0.312–23.75) mL for cancers detected on sextant biopsy and 1.99 (1.85, 0.4–3.6) mL in the six cancers detected using extra cores (P = 0.0138). Conclusion The detection of prostate cancer was increased using extra biopsy cores. There was a significant difference in tumour volume but not in Gleason score, Mostofi grade or final pathological tumour stage between tumours diagnosed using 12 cores and those detected on sextant biopsy.