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Generally, in Europe quality assurance is demanded increasingly in health care settings. European Health Act specifies new demands concerning quality assurance through documentation, monitoring of health services and follow-up considering patient flow and optimal use of resources. The aim of this study was to investigate the agreement between European guidelines and clinical practice and the association between patient satisfaction and level of documentation, recommendations and improvements of voiding function in patients with benign prostate hypertrophy (BPH). The study population encompassed men between 60 and 80 years referred to specialist treatment due to lower urinary tract symptoms. Random samples of 250 medical records were extracted from national registers. Indicators were reported as proportions. Bivariate and multivariate analyses were reported as odds ratio with a 95% confidence interval. A total of 178 patient pathways were included, and the overall documentation rate was 77%. Agreement between national recommendations and clinical practice was found in 38%. No significant associations were found regarding patient satisfaction and level of documentation, adherence to national guidelines and improvements of the voiding function. There is a need for stringency in quality assessment and reporting indicators to national databases and increased application of European evidence-based guidelines. More complete are necessary for decision-makers in the future to qualify management of BPH rehabilitation ensuring the quality of the individual patient pathways.

The aim of this study is to evaluate the accuracy of three-dimensional (3D) ultrasound in comparison with conventional bidimensional (2D) sonography in prostatic calculations. The study was performed using a Kretztechnik Voluson 530D machine with a 7.5 MHz endocavitary transducer. From March 1998 to March 2000, we examined 80 patients (63–74 years, mean 68 years). There were 59 patients with benign prostate hypertrophy (BPH) and 21 with prostate cancer awaiting a radical prostatectomy. The mean absolute error in 3D ultrasound measurement was ±0.2–3 mL. (range of error was 6.5%). Volume measurement using 2D ultrasound methods was much less accurate than 3D ultrasound methods: ±0.4–5 mL. (range of error was 35%). Both 2D and 3D measurements show that the margin of error depends on the frequent presence of a third prostatic lobe, on the morphology, and on the size of the prostatic gland. The precise estimation of prostate volumes may provide information on the real effectiveness of some therapies that act on the reduction in volume of benign alteration, such as in prostatic hypertrophy, and may eliminate the current limits of 2D sonography with a significant clinical contribution for virtually no extra cost.

A retrospective study was carried out on patients with gastrointestinal complaints, who were accidentally found to have varying degrees of hydronephrosis between October 1989 and April 1991. The criteria for hydronephrosis given by Ellenbogen et al were used for ultrasonographic diagnosis. Grade 0 and 1 were classified as mild degree and grade 2 and 3 as moderate and severe, respectively. The causes of hydronephrosis were determined by intravenous pyelography, retrograde pyelography, and/or computed tomography. Of 44 patients with hydronephrosis who had complete studies, 20 had a mild degree of hydronephrosis, 18 had a moderate degree, and 6 had a severe degree. All 24 patients with moderate and severe degrees of hydronephrosis had obstruction as the etiology, but only 50% of the cases with mild hydronephrosis were found to have pathological lesions. Urolithiasis (79.4%) was the most common cause of hydronephrosis in this study. Benign prostate hypertrophy, carcinomas, external compression, and tuberculosis followed. Hydronephrosis found accidentally by sonography in the patients with gastrointestinal complaints is significant.

Saturable binding sites for radioiodinated epidermal growth factor (EGF) have been quantified in surgical specimens of benign prostate hypertrophy (BPH), histologically normal (HN) prostate, and prostate cancer. Values for EGF binding did not differ significantly between HN prostate and prostate cancer, although dedifferentiated samples tended to higher levels. These were coincident with lower comparative levels of androgen receptors. Unfractionated BPH tissue contained lower levels of EGF binding than either HN or carcinomatous prostate, but in separated epithelial cells EGF binding fell into the same range. Saturation analyses showed two affinity classes of binding in all except dedifferentiated tissues.