Evolution of urinary flow rate with prostatectomy

Multicentre controlled trial of indoramin in the symptomatic relief of benign prostatic hypertrophy

A group of 139 patients with symptoms of bladder outflow obstruction due to benign prostatic hypertrophy were entered into a double-blind, parallel group, multicentre study of 2 doses of indoramin versus placebo. There were 18 withdrawals or exclusions, leaving 121 patients for analysis. After 8 weeks, mean peak flow rates increased more in patients treated with indoramin 20 mg bd than in those with placebo. The difference between indoramin 20 mg nocte and placebo was not significant. The change in mean peak flow rate for the higher dose of indoramin represented an increase of 50%. Both patients and investigators reported that the patients' symptoms had improved significantly on both indoramin 20 mg bd and 20 mg nocte; 9 patients were withdrawn because of adverse events, 5 taking placebo and 2 in each of the treatment groups. It was concluded that indoramin 20 mg bd was both effective and well tolerated in the management of symptomatic benign prostatic hypertrophy.

Association between symptomatology and uroflowmetry in benign prostatic hypertrophy

The symptoms of 128 consecutive patients (mean age 65 years) with benign prostatic hypertrophy were assessed and compared with flowmetry recordings. The 84 patients (65%) with peak flow rates greater than or equal to 2 standard deviations from the mean were considered to have abnormal flowmetry and their symptoms were compared with those of the 44 men with normal peak flows. No significant correlation between peak flow rate and age was found within this group. Symptoms of poor stream, nocturia, post-micturition dribble and nocturnal or full-bladder hesitancy were present in over two-thirds of the whole series. Poor stream, hesitancy and nocturnal or full-bladder hesitancy were found to have significant associations with abnormal flowmetry recordings but also to have a high incidence within the normal flowmetry group. Discriminant analysis was unable to define a symptom complex which would accurately predict those within our group with abnormal peak flows. It was concluded that symptomatology and flowmetry evidence of lower urinary tract obstruction are not associated and subjective and objective evidence must be considered independently in selecting candidates for prostatectomy.

Urodynamic factors in relation to outcome of prostatectomy

A pre- and postoperative five-year follow-up study on 83 patients undergoing elective prostatectomy for benign hypertrophy revealed good overall symptomatic results in 70 (84%). Hesitancy and a poor stream were improved more often than were frequency and nocturia. A high preoperative voiding pressure was significantly associated with a good result; less satisfactory results tended to be associated with a higher preoperative flow rate.

The stop-flow technique: a way to measure detrusor strength

Maximum intravesical isometric pressure, obtained by stopping the urinary flow in progress, measures detrusor strength and allows an accurate evaluation of bladder contraction. Micturition studies were performed on 7 normal subjects and 48 patients with urinary obstruction, enuresis, neurogenic vesical dysfunction or stress incontinence. In the case of obstruction maximum isometric pressure appears to relate to the degree of detrusor compensation and allows a prognosis as to the future of detrusor function after the obstruction is removed. An unexpected large proportion of patients with enuresis were found to have high maximum isometric pressure usually associated with elevated urethral resistance, suggesting that urinary obstruction may not uncommon as an etiological factor of enuresis.