444 Urological Survey Urological Survey with serial PSA monitoring. As this report indicates, the therapy is often prompted by a “chicken switch” reaction. Until data is available, and it is unlikely that it will be in the foreseeable future, careful evaluation of prognostic variables as the authors describe, provide the therapist with at least a logical approach to triggering the switch to androgen deprivation. Pretreatment of Gleason score and PSA and post-treatment progression indicators as PSA level and doubling time currently provide the trigger for the delivery of androgen deprivation to those for whom it will benefit most and withhold it from those who are at sufficiently low risk that the morbidity consequence to the therapy equals or outweighs the benefits that androgen therapy could deliver. Clinical trials will provide the most useful and unbiased information. Some of the current Phase III trials addressing the issue of PSA recurrence are continuous vs intermittent androgen deprivation after irradiation (JPR7 – NCI, Canada); androgen deprivation and immediate vs delayed chemotherapy (RTOG, P0014), androgen deprivation ± thalidomide (NCI-00-C0080) and for patients with a rising PSA after androgen deprivation but without evidence of metastatic disease, a trial comparing second line hormone therapy (ketoconazol + hydrocortisone) to chemotherapy (docetaxel and estramustine – ECOG 1899). Other agents are being investigated to address the rising PSA; i.e. Provenge, Atrasantin (endothelin-A inhibitor), Avastin (angrogenesis inhibitor). Dr. Paul F. Schellhammer Program Director of the Virginia Prostate Center Professor of Urology, Eastern Virginia Medical School Norfolk, Virginia USA FEMALE UROLOGY _____________________________________________________________ Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data Vandoninck V, van Balken MR, Agrò EF, Petta F, Micali F, Heesakkers JPFA, Debruyne FMJ, Kiemeney LALM, Bemelmans BLH Department of Urology, University Medical Center Nijmegen, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands Neurourol Urodyn. 2004; 23: 246-51 Aim: The aim of this study was to evaluate urodynamic changes after percutaneous tibial nerve stimulation (PTNS) for the treatment of complaints related to overactive bladder syndrome and to search for urodynamic-based predictive factors. Methods: Ninety consecutive patients with symptoms related to overactive bladder syndrome were enrolled in this study. Patients underwent 12 PTNS sessions. For evaluating objective success, the primary outcome measure was a reduction in number of urinary leakage episodes of 50% or more per 24 hours. Patients’ request for continuation of therapy was considered subjective success. This study focused on urodynamic features at baseline and on changes found after 12 PTNS treatments. Results: The objective success rate was 56% (leakages/24 hours). Subjective success rate was 64%. Frequency/volume chart data and quality of life scores improved significantly (P < 0.01). Pre- and posturodynamic data were available from 46 participants. Detrusor instabilities (DI) could be abolished in a few cases only. Increments in cystometric bladder capacity and in volume at DI were significant (P = 0.043 and 0.012, respectively). Subjects without detrusor instabilities at baseline were 1.7 times more prone to respond to PTNS (odds ratio, 1.75; 95% confidence interval [CI], 0.67-4.6). The more the bladder overactivity was pronounced,