International Continence Society "Benign Prostatic Hyperplasia" Study: background, aims, and methodology.

The International Continence Society Benign Prostatic Hyperplasia Study (ICS-BPH) was devised in response to the perceived underutilization of urodynamics in the diagnosis of benign prostatic obstruction (BPO), together with the apparent reliance on symptoms alone when selecting patients for invasive therapies, despite evidence that lower urinary tract symptoms (LUTS) had poor diagnostic specificity for BPO. The ICS-BPH Study is an international multicenter study employing a wide-ranging patient-completed questionnaire, with questions on symptoms, bothersomeness, quality of life, and sexual function. In addition, each patient underwent multiple urine flow studies and standardized urodynamic investigations (phase I).

Urge incontinence.

This article discusses the management of patients presenting with urge incontinence as the main symptom. The etiological factors, though not understood completely, are grouped into logical subsets and discussed. The incidence and the implications of urge incontinence on the quality of life of patients is considered.

Changes in metabolism of collagen in genitourinary prolapse.

Background: Genitourinary prolapse is a common problem, the pathophysiology of which is unknown.

Methods: We analysed vaginal-epithelial tissue from premenopausal women with genitourinary prolapse and compared them with controls.

Findings: We found that genitourinary prolapse is associated with a reduction in total collagen content and a decrease in collagen solubility.

THE EFFECTS OF PREDATION ON THE AGE AND SIZE OF MATURITY OF PREY.

The effects of nonselective predation on the optimal age and size of maturity of their prey are investigated using mathematical models of a simple life history with juvenile and adult stages. Fitness is measured by the product of survival to the adult stage and expected adult reproduction, which is usually an increasing function of size at maturity. Size is determined by both age at maturity and the value of costly traits that increase mean growth rate (growth effort).

The value of multiple free-flow studies in men with lower urinary tract symptoms.

Objective: To assess the variability of free-flow studies in men presenting with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) and to determine the sensitivity, specificity and predictive values of consecutive measurements of maximum flow rate for the presence of bladder outlet obstruction (BOO) at several threshold values.

Patients And Methods: The value of multiple free-flow studies was assessed in 165 men presenting with LUTS suggestive of BPO. Each patient was requested to void four times into a uroflowmeter and the voided volume and post-void residual urine volume (PVR) were also measured.

The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing.

Objective: To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome.

Patients, Subjects And Methods: Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of 'bother' that symptoms were causing.

In new-onset insulin-dependent diabetic patients the presence of anti-thyroid peroxidase antibodies is associated with islet cell autoimmunity and the high risk haplotype HLA DQA1*0301-DQB1*0302. Belgian Diabetes Registry.

In 157 new onset IDDM (104 men, 53 women, ages 10-39 yr) anti-thyroid peroxidase anti-bodies (anti-TPO) were assayed with a specific immunological test. Values greater than 100 U ml-1 were considered positive. Seventeen per cent of the patients were positive (32% of the women versus 10% of the men, p < 0.

The significance of terminal dribbling in men with lower urinary tract symptoms.

Objective: To determine the relationship between the symptom of terminal dribbling, objective evidence of terminal dribbling on recordings of uroflow, benign prostatic enlargement (BPE) and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS).

Patients And Methods: The prevalence of the symptom of terminal dribbling was determined from a symptom questionnaire completed by 165 men presenting with LUTS. Objective evidence of terminal dribbling during voiding was assessed from uroflow recordings and prostate volume was measured by transrectal ultrasonography.

The ICS-'BPH' Study: the psychometric validity and reliability of the ICSmale questionnaire.

Objective: To assess the validity and reliability of the ICSmale questionnaire developed for the International Continence Society-'Benign Prostatic Hyperplasia' (ICS-'BPH') study.

Patients And Methods: Urology departments in 12 countries recruited 1271 consecutive men > 45 years old, with lower urinary tract symptoms and possible benign prostatic obstruction, to the ICS-'BPH' study (the clinical group); 423 ambulent men were recruited from a general practice in the UK to provide a community group. Each individual was asked to complete the wide-ranging ICSmale questionnaire, comprising questions concerned with urinary symptoms, the bother they cause, and issues of quality of life and sexual function.

The continence control pad--a new external urethral occlusion device in the management of stress incontinence.

Objective: To assess the use of an external urethral occlusion pad (the continence control pad, CCP) in the management of stress incontinence.

Patients And Methods: Nineteen women (median age 47 years, range 36-72) complaining of stress incontinence were taught to use the CCP. The patients were assessed during the week before, and again after using the CCPs for 2 weeks, by urinary diaries, pad-tests and a review of their symptoms.

Significance of intermittency in men with lower urinary tract symptoms.

Objectives: To determine the relationship between the symptom of intermittency, objective evidence of intermittency on uroflow traces, benign prostatic enlargement, and bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS).

Methods: The prevalence of the symptom of intermittency was determined from a symptom questionnaire in 165 men presenting with LUTS. Objective evidence of intermittency during voiding was assessed from uroflow traces, and prostate volume was measured by transrectal ultrasound.

The obstructive effect of a urethral catheter.

Purpose: The effect of a urethral catheter on pressure-flow relationships of the urethra has important implications for the practice to this question in the past in men with benign prostatic hyperplasia. We assessed the obstructive effect of an 8 Ch. urethral catheter in men who presented with lower urinary tract symptoms due to benign prostatic hyperplasia.

Detection of urinary incontinence during ambulatory monitoring of bladder function by a temperature-sensitive device.

Objectives: To determine whether the difference between urinary and perineal temperatures is sufficient to allow registration of incontinent episodes by detection of temperature change alone. To design and assess the use of a diode-based temperature-sensitive device in the detection of episodes of urinary incontinence in long-term ambulatory monitoring (LTAM) studies.

Subjects And Methods: Perineal temperature recordings were made in 46 women during various activities.

Frequency volume charts: an indispensable part of lower urinary tract assessment.

Frequency volume charts (FV charts) are widely used by those interested in lower urinary tract function. However, there has been little systematic work on the value and design of FV charts as they have evolved over the years as clinical tools rather than as research instruments. Although FV chart design has developed over the last 20 years, there is no standard and charts vary from simple frequency charts up to urinary diaries which record not only frequency, volume, urge episodes, pad usage and fluid intake, but also the patients' activities in relation to their lower urinary tract symptoms.

Tamsulosin, the first prostate-selective alpha 1A-adrenoceptor antagonist. A meta-analysis of two randomized, placebo-controlled, multicentre studies in patients with benign prostatic obstruction (symptomatic BPH). European Tamsulosin Study Group.

Objective: This meta-analysis of two European studies evaluated the efficacy and safety of modified-release tamsulosin 0.4 mg once daily compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic obstruction (symptomatic BPH).

Methods: Patients entered a 2-week placebo run-in period, followed by randomization to treatment with tamsulosin (382 patients) or placebo (193 patients) once daily for 12 weeks.

OPTIMALITY THEORY, GOMPERTZ' LAW, AND THE DISPOSABLE SOMA THEORY OF SENESCENCE.

The "disposable soma" theory for the evolution of senescence suggests that senescence arises from an optimal balancing of resources between reproduction and somatic repair. Dynamic programming models are constructed and analyzed to determine the optimal relationship between reproduction, diversion of resources from repair, and added senescent mortality. Of particular interest is the relationship between the repair-reproduction trade-off and the form of the mortality-rate-versus-age curve predicted.

An open, in-patient incremental safety and efficacy study of desmopressin in women with multiple sclerosis and nocturia.

Objectives: To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis.

Patients And Methods: Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in-patients into an open, nonrandomized, placebo-controlled study of incremental doses of 20, 40 and 60 micrograms desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h.

Tamsulosin, a selective alpha 1c-adrenoceptor antagonist: a randomized, controlled trial in patients with benign prostatic 'obstruction' (symptomatic BPH). The European Tamsulosin Study Group.

Objective: To evaluate the efficacy and safety of tamsulosin 0.4 mg once daily (as a modified-release formulation) compared with placebo in patients with benign prostatic enlargement, lower urinary tract symptoms and prostatic 'obstruction' (symptomatic benign prostatic hyperplasia [BPH]).

Patients And Methods: Of 313 patients with symptomatic BPH enrolled in a 2-week placebo run-in period, 296 were subsequently randomized to receive either placebo (98 patients) or tamsulosin 0.

Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women.

Objective: To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre-menopausal women with recurrent idiopathic urinary infections.

Subjects And Methods: The study included 28 pre-menopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand-held probe, and the readings over 4 months compared.

The significance of abdominal straining in men with lower urinary tract symptoms.

Objective: To determine the relationship between the symptom of straining to void, the presence of objectively demonstrated abdominal straining and bladder outflow obstruction in men with lower urinary tract symptoms (LUTS), and to assess the effect of straining on flow rate in these men.

Patients And Methods: The presence of straining to void as a symptom was determined from a symptom questionnaire in 61 men presenting with LUTS. Objective evidence of straining to void was assessed by rectal pressure measurement and the presence of bladder outflow obstruction was determined by pressure-flow studies.

Urodynamics and laser prostatectomy.

A total of 81 patients with symptomatic bladder-outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) underwent visual laser ablation of the prostate (VLAP) using a right-angled firing neodynium: YAG laser. The mean pre-operative prostatic volume was 48.5 ml.