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Home Blood Pressure Monitoring And Nocturia In Adults. J Community Health 2022; 48:238-244. [PMID: 36370256 DOI: 10.1007/s10900-022-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
Although widely viewed as a urological condition, nocturia has been increasingly recognized to accompany various non-urological conditions such as hypertension and blood pressure (BP) elevation on office determination. Home BP monitoring (HBPM) has been shown superior to office-based readings and provides an opportunity to assess potential relationships between nocturia and novel indices derived from multiple BP recordings including BP load, BP variability, and arterial stiffness, which have prognostic significance. We retrospectively studied 103 home BP logs and nocturia frequencies provided by 61 stable cardiology patients ≥ 21 years without medication change. Nocturnal voids ranged from 0 to 5 voids per night, median: 1.5. Nocturia frequency was significantly correlated with home and office systolic BPs and with BP load, but not with diastolic BPs, BP variability or arterial stiffness. On Poisson regression analysis, the estimated prevalence ratio (PR) for home and office systolic BPs were 1.025 (CI: 1.01, 1.04; p < .001) and 1.01 (CI:1.00, 1.02; p = .019), indicating 2.5% and 1% increases in the risk of nocturia per mmHg increases in BP respectively. In conclusion, higher mean home and office systolic BPs are associated with self-reported nocturia frequency with stronger associations seen for home BP measurement. Nocturia frequency appears unrelated to mean home and office diastolic BPs. Nocturia may be related to BP load, (percentage of elevated BP values), but not to BP variability or arterial stiffness. Future prospective studies using HBPM are needed to confirm these findings and to contribute to the understanding of the elevated BP-nocturia link.
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Vredeveld T, van Benten E, Beekmans REPM, Koops MP, Ket JCF, Mollema J, Ramaekers SPJ, Pool JJM, Coppieters MW, Pool-Goudzwaard AL. Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review. BMJ Open 2022; 12:e056234. [PMID: 35487713 PMCID: PMC9058800 DOI: 10.1136/bmjopen-2021-056234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). DESIGN Systematic review with best evidence synthesis. SETTING Primary care. PARTICIPANTS Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. RESULTS Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. CONCLUSION Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
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Affiliation(s)
- Tom Vredeveld
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Esther van Benten
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | | | - M Patrick Koops
- Physiotherapy Practice De Werfheegde, Haaksbergen, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Mollema
- Medical Library, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Stephan P J Ramaekers
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | - Michel W Coppieters
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - Annelies L Pool-Goudzwaard
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Bray A, Griffiths C, Drinnan M, Pickard R. Methods and value of home uroflowmetry in the assessment of men with lower urinary tract symptoms: A literature review. Neurourol Urodyn 2011; 31:7-12. [PMID: 22038511 DOI: 10.1002/nau.21197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/30/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bray
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Endeshaw Y. Correlates of self-reported nocturia among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2009; 64:142-8. [PMID: 19164272 DOI: 10.1093/gerona/gln009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Nocturia is a common and bothersome problem with multifactorial etiology. This study examines clinical factors that are associated with nocturia among community-dwelling older adults. METHODS A questionnaire-based survey was conducted among a convenience sample of community-dwelling older adults. Nocturia was defined as waking up to urinate two or more times per night for 3 or more days per week. Associations between nocturia status and sleep disturbance, daytime sleepiness, disease burden, and history of falls were determined. RESULTS Questionnaires were mailed out to 433 participants, and returned questionnaires from 247 individuals (58%) individuals were adequate for analysis. There were 144 women (57%) and 103 men (42%), with mean +/- standard deviation age of 75.1 +/- 6.9 and 76.6 +/- 5.6 years for women and men, respectively. A total of 137 participants (55%) endorsed nocturia, and 57 participants (23%) endorsed nocturia and difficulty going back to sleep. Participants who endorsed nocturia and difficulty going back to sleep were more likely to report poor sleep quality, daytime sleepiness, increased disease burden, one or more falls, and symptoms related to primary sleep disorders. CONCLUSIONS The clinical characteristics of study participants with nocturia and difficulty going back to sleep were different from those with nocturia and no difficulty going back to sleep, suggesting that these two conditions may have different etiological factors and clinical consequences. These findings would have important implications in both clinical and research-related activities aimed at the management of nocturia in older adults.
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Affiliation(s)
- Yohannes Endeshaw
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA.
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Johnson TM, Burrows PK, Kusek JW, Nyberg LM, Tenover JL, Lepor H, Roehrborn CG. The Effect of Doxazosin, Finasteride and Combination Therapy on Nocturia in Men With Benign Prostatic Hyperplasia. J Urol 2007; 178:2045-50; discussion 2050-1. [PMID: 17869295 DOI: 10.1016/j.juro.2007.07.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the effectiveness of single or combination drug therapy on nocturia in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. MATERIALS AND METHODS A total of 3,047 men with lower urinary tract symptoms/benign prostatic hyperplasia enrolled in the Medical Therapy of Prostatic Symptoms trial were randomly assigned to receive doxazosin alone, finasteride alone, combination therapy or placebo. Treatment effectiveness was assessed according to intent to treat by mean reduction in self-reported nightly nocturia at 1 and 4 years. A subgroup analysis by age (younger than 70 vs 70 years old or older) was also performed. RESULTS Of the men 2,583 reported 1 or more episodes of nocturia and finished 12 or more months of the trial. Mean nocturia was similar in all groups at baseline. Mean nocturia was reduced at 1 year by 0.35, 0.40, 0.54 and 0.58 in the placebo, finasteride, doxazosin and combination groups, respectively. Reductions with doxazosin and combination therapy were statistically greater than with placebo (p <0.05). At 4 years nocturia was also significantly reduced in patients treated with doxazosin and combination therapy (p <0.05 vs placebo). In men older than 70 years (495) all drugs significantly reduced nocturia at 1 year (finasteride 0.29, doxazosin 0.46 and combination 0.42) compared to placebo (0.11, p <0.05). CONCLUSIONS Doxazosin and combination therapy reduced nocturia more than placebo, but the net benefit of active drug compared to placebo was often modest with a net difference of less than 0.20 fewer nightly nocturia episodes at 1 and 4 years. Findings in men 70 years old or older were similar, with an even smaller effect observed for finasteride.
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Affiliation(s)
- Theodore M Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30033, USA
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Kim SH, Kim DY. Urodynamic Analysis of Taxi Drivers with Lower Urinary Tract Symptoms. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.2.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung Hoon Kim
- Department of Urology, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Duk-Yoon Kim
- Department of Urology, College of Medicine, Catholic University of Daegu, Daegu, Korea
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van Dijk L, Kooij DG, Schellevis FG, Kaptein AA, Boon TA, Wooning M. Nocturia: impact on quality of life in a Dutch adult population. BJU Int 2004; 93:1001-4. [PMID: 15142151 DOI: 10.1111/j.1464-410x.2004.04769.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the effect of nocturia on quality of life (QoL) and to assess the associated effects of sleep problems. SUBJECTS AND METHODS From a random sample of Dutch adults (>/= 18 years old) 1000 were selected after stratification to complete a written questionnaire. Respondents (819) were distributed over three groups: a target group (189, who felt bothered by >/= one void/night); a reference group 1 (120 reporting >/= two voids/night but with no bother); and reference group 2 (510, with 0-1 voids/night). Nocturia, other lower urinary tract symptoms and perceived impact on life were measured using the Bristol Lower Urinary Tract Symptoms Questionnaire (B-LUTS). Sleep problems were measured using the Sleep Wake Experience List (SWEL) and QoL using two subscales from the RAND-36, i.e. 'physical functioning' and 'mental health'. RESULTS The perceived impact on life was highest in the target group (P < 0.05), which also had more sleep problems and scored lower on the QoL scores than both reference groups (P < 0.05). Statistically significant differences in mental health and physical functioning between the target and reference groups became insignificant after correcting for sleep problems, indicating that the effect of nocturia (with bother) is mediated by sleep problems. CONCLUSIONS Nocturia may lead to sleep insufficiency and consequently to a decrease in mental and physical health. Patients who consult a doctor for nocturia should thus be treated adequately. In addition, it is worthwhile for doctors to routinely check if patients who contact them for sleep problems also have nocturia.
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Affiliation(s)
- L van Dijk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
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Abstract
AIMS The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. MATERIALS AND METHODS The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. RESULTS Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). CONCLUSIONS As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.
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Affiliation(s)
- Joshua Fiske
- Department of Urology, New York University School of Medicine, New York, NY 10016, USA
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Johnson TM, Jones K, Williford WO, Kutner MH, Issa MM, Lepor H. Changes in nocturia from medical treatment of benign prostatic hyperplasia: secondary analysis of the Department of Veterans Affairs Cooperative Study Trial. J Urol 2003; 170:145-8. [PMID: 12796667 DOI: 10.1097/01.ju.0000069827.09120.79] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We evaluate the efficacy of medical therapy on nocturia in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We performed a secondary analysis of data from the VA Cooperative Study Program Trial in which 1,229 men with BPH 45 to 80 years old were randomly assigned to receive terazosin, finasteride, combination or placebo. RESULTS The 1,078 men who completed 12 months of the trial are included in this study. Of those men 1,040 (96.5%) had at least 1 episode of nocturia at baseline and 38 (3.5%) had less than 1 episode (baseline nocturia is an average of 2 measures). Of those 1,040 men 788 (75.8%) had 2 or more nocturia episodes. Overall, nocturia decreased from a baseline mean of 2.5 to 1.8, 2.1, 2.0 and 2.1 episodes in the terazosin, finasteride, combination and placebo groups, respectively. Of men with 2 or more episodes of nocturia 50% reduction in nocturia was seen in 39%, 25%, 32% and 22% in the terazosin, finasteride, combination and placebo groups, respectively. Changes in nocturia were correlated with changes in reported bother from nocturia (Pearson correlation 0.48), BPH impact index (0.32) and overall satisfaction with urinary symptoms (0.33). CONCLUSIONS Terazosin and combination therapy reduced nocturia in men with BPH, yet the net advantage of terazosin over placebo was a net reduction of 0.3 nocturia episode. For a person to reach a 50% or greater reduction in nocturia, the advantage of terazosin over placebo was 17 percentage points. Changes in nocturia had a moderate impact on symptom specific quality of life measures.
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Affiliation(s)
- Theodore M Johnson
- Birmingham/Atlanta GRECC, Atlanta VA Medical Center, 16780 Clairmont Road, Decatur, GA 30033, USA
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Cohen DD, Steinberg JR, Rossignol M, Heaton J, Corcos J. Normal variation and influence of stress, caffeine intake, and sexual activity on uroflowmetry parameters of a middle-aged asymptomatic cohort of volunteer male urologists. Neurourol Urodyn 2003; 21:491-4. [PMID: 12232887 DOI: 10.1002/nau.10029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To assess normal variations of uroflowmetry in middle-aged asymptomatic male urologists and to analyse the influence of stress, caffeine intake, and sexual activity. METHODS Thirty-one male urologists from Quebec and Ontario were recruited for this study. All were healthy, not taking any current medications known to interfere with lower urinary tract function, and symptom-free (International Prostate Symptom Score less than 5). Each received two identical flowmeters to keep over a period of 2 weeks, one at home and one in his busiest office. Ten uroflow tracings, with a volume greater than 150 mL, were requested from each of them; five at home and five in the office. A total of 310 flows were analysed. The subjective level of stress, coffee intake, and sexual activity, in the hour before each uroflowmetrogram, was recorded, through a short self-administered questionnaire and stress visual scale. RESULTS are presented as an average per individual. The voided volume was 331.9 mL, with an SD of 94.8 mL. The voiding time was 32.7 seconds (SD=15.5). The peak flow rate was 20.5 mL/sec (SD=3.9), the mean flow rate was 14.3 mL/sec (SD=3.0), and the time to maximum flow was 7.2 sec (SD=4.0). Subjective levels of stress did not significantly change these parameters. Uroflows were obtained with and without coffee drinking. The voided volume was 337.4 mL (SD=109.2) vs. 290.8 mL (SD=77.3) (P=0.03), and peak flow rate 19.4 mL/sec (SD=4.1) vs. 18.9 mL/sec (SD=3.1) (P=0.49), respectively. CONCLUSIONS Uroflowmetry parameters and voided volume are highly variable in a normal asymptomatic population. Subjective stress level does not seem to have an influence on these parameters. Coffee intake significantly increases the voided volume but does not change the peak flow rate. These conclusions should be considered when using uroflowmetry parameters as an outcome measure.
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Affiliation(s)
- Daniel D Cohen
- Department of Urology and Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.
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Abstract
OBJECTIVE To estimate the prevalence of nocturia in the Dutch adult population, its association with sociodemographic and health characteristics, and to assess problems experienced by persons with nocturia. SUBJECTS AND METHODS In spring 2001 a telephone survey was conducted among a representative sample of 4721 Dutch respondents (response 53%). Using questions from the Bristol Lower Urinary Tract Symptoms questionnaire respondents were asked about having nocturia and the problems they experienced. In addition, questions were asked about sociodemographic and health characteristics. RESULTS The prevalence of nocturia (a mean of twice or more/night) among Dutch men and women over 18 years old was 13%, standardized for age and sex. Women had nocturia more often than men (16% vs 9%) and the prevalence was positively associated with age, poor health status and use of medication. CONCLUSION The prevalence of nocturia in Dutch men and women differs more than reported in earlier studies. The prevalence in the Netherlands seems slightly higher than in other Western countries, but Dutch persons with nocturia report fewer problems. Nocturia does not occur in isolation and is associated with sleep disturbances. It is worthwhile for general practitioners to routinely check whether patients who contact them for lower urinary tract symptoms or sleeping disorders have nocturia.
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Affiliation(s)
- L van Dijk
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Abstract
In the past decade, the symptom score has been considered the essential part of the evaluation of patients with lower urinary tract symptoms (LUTS). At the University of Wisconsin, the author's have stopped routine use of symptom scores because of their limited utility in dealing with the patient's concerns. Except from men electing invasive treatment, the authors do not serve the patients better with urodynamic testing either. Bothersomeness, not symptom score or objective measures is what drives the decision making process in benign prostatic hyperplasia (BPH) management. Generally, the authors now select patients for treatment according to the degree to which they are bothered by their LUTS.
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Affiliation(s)
- J V Jepsen
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, USA
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Elbadawi A. Voiding dysfunction in benign prostatic hyperplasia: trends, controversies and recent revelations. I. Symptoms and urodynamics. Urology 1998; 51:62-72. [PMID: 9610560 DOI: 10.1016/s0090-4295(98)00070-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A Elbadawi
- State University of New York, Health Science Center, Department of Pathology, Syracuse 13210, USA
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Riehmann M, Hansen BJ, Polishuk PV, Nordling J, Hald T. Symptom scores in benign prostatic hyperplasia. Urology 1997; 49:10-8. [PMID: 9000178 DOI: 10.1016/s0090-4295(96)00432-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Riehmann
- Department of Urology, Herlev Hospital, University of Copenhagen, Denmark
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Gerber GS. The role of urodynamic study in the evaluation and management of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Urology 1996; 48:668-75. [PMID: 8911507 DOI: 10.1016/s0090-4295(96)00249-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- G S Gerber
- Department of Surgery, University of Chicago Pritzker School of Medicine, Illinois, USA
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Madersbacher S, Klingler HC, Schatzl G, Stulnig T, Schmidbauer CP, Marberger M. Age Related Urodynamic Changes in Patients with Benign Prostatic Hyperplasia. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65478-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stephan Madersbacher
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - H. Christoph Klingler
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - Georg Schatzl
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | - Thomas Stulnig
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
| | | | - Michael Marberger
- Departments of Urology and Internal Medicine III, University of Vienna, Vienna, Austria
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