Scandinavian Journal of Urology最新文献

{"title":"Women with isolated acute cystitis and macroscopic haematuria. Is further investigation needed?","authors":"Rula Hassan, Rasmus Ljungstedt, Elsa Ågren, Salome Olsson, Emad Sabir, Suleiman Abuhasanein","doi":"10.2340/sju.v60.44702","DOIUrl":"https://doi.org/10.2340/sju.v60.44702","url":null,"abstract":"<p><strong>Objective: </strong>To determine if women aged 50-70 years with a single episode of isolated acute haemorrhagic cystitis have a significantly lower risk of developing urological cancers, potentially indicating that further evaluation for macroscopic haematuria may be unnecessary.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on all women assessed for macroscopic haematuria at two participating centres in Sweden between 2020 and 2022. The standard evaluation included computed tomography urography and cystoscopy. Patients were divided into two groups: AHG (acute haemorrhagic cystitis group), which was defined by the presence of macroscopic haematuria and symptoms resembling acute cystitis (dysuria, frequency or urgency), and non-AHG (non-acute haemorrhagic cystitis group), consisting of women with chronic, complicated or recurrent irritative symptoms or no cystitis-like symptoms at all. The characteristics of the women and their tumours were documented.</p><p><strong>Results: </strong>A total of 1,084 women were evaluated for macroscopic haematuria. The median age was 67 years, with 652 women (60%) aged 50-70. Urological malignancies were detected in 71 women (7%). In the younger group, the AHG had a low cumulative cancer incidence (1%), whereas the non-AHG had a significantly higher rate (10%), P < 0.001. Asymptomatic haematuria showed the highest cumulative cancer incidence (11%). A multivariable Cox regression analysis (for all patients in the study) indicated that women in non-AHG have a seven-fold higher risk of developing urological cancer over time than women in AHG (hazard ratio [HR]: 7.19; 95% confidence interval [CI]: 3.64-14.21; P < 0.001).</p><p><strong>Conclusion: </strong>Women aged 50-70 years with isolated acute haemorrhagic cystitis have a significantly low risk of urological malignancies, indicating that invasive investigations, such as cystoscopy and computed tomography urography, may not always be necessary. Nonetheless, further large-scale prospective studies are needed to validate these findings.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"195-203"},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Swedish national guidelines on penile cancer.","authors":"Axel Gerdtsson, Eliya Abedi, Gediminas Baseckas, Håkan Brorson, Luiza Dorofte, Sofia Fall, Emelie Filipsson, Johan Forssell, Dominik Glombik, Diane Grelaud, Fatou Hellman, Anna-Karin Jakobsson, Kimia Kohestani, Sinja Kristiansen, Jenny Magnusson, Kajsa Nilsson, Per Nordlund, Erik Persson, Theodoros Psarias, Elisabeth Skeppner, Elin Trägårdh, Emma Ulvskog, Åsa Warnolf, Elisabeth Öfverholm, Peter Kirrander","doi":"10.2340/sju.v60.44463","DOIUrl":"10.2340/sju.v60.44463","url":null,"abstract":"<p><strong>Objective: </strong>The Swedish national guidelines on penile cancer were first published in 2013. The objective of the present study is to present the 2023 update of these guidelines and highlight the differences to the European Association of Urology (EAU) / American Association of Clinical Oncology (ASCO) guidelines on penile cancer.</p><p><strong>Material and methods: </strong>A review of the literature and a comparison to the EAU / ASCO guideline on penile cancer was performed. Differences between the EAU / ASCO guidelines and the Swedish national guidelines are highlighted.   Results: The Swedish national guidelines on penile cancer emphasized the consultation of a national multidisciplinary treatment conference for all patients diagnosed with both primary and recurrent penile cancer or penile intraepithelial neoplasia (PeIN). Clinically lymph node negative patients diagnosed with >pT1G1 are offered dynamic sentinel node biopsy (DSNB). In the EAU / ASCO guidelines the DSNB is optional for T1aG2 patients. Penile cancer surgery is centralized to two hospitals. Perioperative chemotherapy is offered to patients with ≥N2. In the EAU / ASCO guidelines the use of perioperative chemotherapy for N2 patients is optional. A structured follow-up program is advocated to find recurrences at an early stage.</p><p><strong>Conclusions: </strong>The Swedish national guidelines on penile cancer have been updated and compared to the EAU / ASCO guidelines. The national multidisciplinary treatment conference, centralization of surgery, the use of perioperative chemotherapy and a structured follow-up are the cornerstones of the Swedish national guidelines on penile cancer.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"189-194"},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival patterns after perioperative treatment escalation and cystectomy for synchronous oligometastatic bladder cancer (M1a/M1b) - a population-based series.","authors":"Fredrik Liedberg, Gediminas Baseckas, Mats Bläckberg, Ragna Fridriksdottir, Axel Gerdtsson, Oskar Hagberg, Sofia Kjellström, Petter Kollberg, Ioannis Patras, Elin Ståhl, Olof Ståhl, Anne Sörenby, Elin Trägårdh, Åsa Warnolf, Johannes Bobjer","doi":"10.2340/sju.v60.44649","DOIUrl":"10.2340/sju.v60.44649","url":null,"abstract":"<p><strong>Background: </strong>The role of cystectomy in synchronous oligometastatic bladder cancer is unclear.</p><p><strong>Objective: </strong>To describe a population-based consecutive cohort with primary oligometastatic bladder cancer (M1a or M1b) treated with curative intent.  Methods: Twenty consecutive patients with primary stage M1a or M1b bladder cancer subjected to induction chemotherapy and radical cystectomy 2013-2024 in the Southern healthcare region were identified in the Swedish National Register for Urinary Bladder Cancer. Primary staging and the evaluation of response to systemic induction chemotherapy were performed using [18F]fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET-CT). After additional chemotherapy, consolidating radical cystectomy, lymphadenectomy and in selected patients, postoperative stereotactic radiotherapy or adjuvant nivolumab were applied. Disease-free survival (DFS) and overall survival (OS) from chemotherapy start were visualised by Kaplan-Meier curves.  Results: Ten patients with retroperitoneal lymph node metastases, seven with single bone metastasis and three with inguinal metastases responding on three chemotherapy courses according to FDG PET-CT-evaluations were subjected to additional chemotherapy and subsequent radical cystectomy and lymphadenectomy with templates including lymph node metastases. Five patients with bone-oligometastatic disease received consolidating stereotactic radiotherapy, and three patients received adjuvant nivolumab. Postoperatively, one patient progressed in preoperatively known bone metastasis, and one patient displayed lack of chemotherapy response in the cystectomy specimen and was consequently subjected to second-line pembrolizumab treatment with palliative intent. At a median follow-up of 23 months, 10  patients (50%) were disease-free.</p><p><strong>Conclusions: </strong>Long-term survival was observed in some individuals after multimodal treatment for selected patients with synchronous oligometastatic bladder cancer.</p><p><strong>Patient summary: </strong>Amongst patients diagnosed with limited number of distant bladder cancer metastases, those responding on initial systemic chemotherapy can be selected for further treatment. After additional chemotherapy, radical cystectomy with lymphadenectomy and individually intensified treatment with consolidating radiation towards distant metastases and/or adjuvant systemic treatment with checkpoint inhibitors for 12 months, long-term survival was observed in some individuals despite a disease-entity with bad prognostic features.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"173-179"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding treatments for lower urinary tract symptoms, secondary to benign prostatic enlargement. A capacity and budget impact analysis in four Nordic countries.","authors":"Deirdre Blissett, Erik Sagen, Espen Kvan, Vasileios Souvleros, Dimitri Pogodin-Hannolainen, Amanda Spies, Laura Bruno","doi":"10.2340/sju.v60.44243","DOIUrl":"10.2340/sju.v60.44243","url":null,"abstract":"<p><strong>Objectives: </strong>This capacity and budget impact analysis considers implications of offering a more diversified benign prostate enlargement (BPE) surgical care offering from a healthcare payer perspective in Sweden, Denmark, Norway and Finland.</p><p><strong>Methods: </strong>A cohort simulation model compares 4-year treatment costs and capacity impact, including hospital bed-days and operating time, with Transurethral Resection of the Prostate (TURP), Holmium Laser Enucleation of the Prostate (HoLEP) using MOSES™Technology, photoselective vaporisation of the prostate (PVP) and Rezūm™ Water Vapour Therapy (WVTT). Current treatment choice is compared to a hypothetical scenario, where TURP-proportion is reduced to 50% and volumes of HoLEP, PVP and WVTT are increased. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) considered uncertainty when varying all model inputs individually and simultaneously.</p><p><strong>Results: </strong>Reducing the proportion of TURP to 50% and shifting towards a more diversified surgical offering could save 590 bed-days, 2,281 theatre hours and SEK 14,020,153 in Sweden; 343 bed-days, 1,248 theatre hours and DKK 10,493,266 in Denmark; 267 bed-days, 1,032 theatre hours and NOK 9,329,844 in Norway and 576 bed-days, 1,181 theatre hours and 1,059,528€ in Finland per year. WVTT emerged as the lowest-cost procedure in all scenarios. Both DSAs and PSAs demonstrated outcome robustness.</p><p><strong>Conclusion: </strong>The adoption of a more diversified surgical care offering for patients with BPE in the Nordics may free theatre time and hospital bed-days and create meaningful cost-savings, which off-set higher initial device cost. Economic considerations should not constitute a barrier to the adoption of a patient-centric surgical care offering for BPE patients in the Nordics.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"164-172"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy in Sclerotherapy of testicular hydro/spermatocele with 25 versus 50 mL Ethanol 99.5%; a randomised controlled phase II study.","authors":"Sarah Velander, Karl-Johan Lundström, Johan Styrke","doi":"10.2340/sju.v60.44500","DOIUrl":"10.2340/sju.v60.44500","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the dose-dependent safety and efficacy of using Ethanol 99.5% as a sclerosing agent when treating hydro- and spermatoceles.</p><p><strong>Materials and methods: </strong>This study (EUDRA-CT 2020-004630-38) was conducted as an open randomised multicentre study where symptomatic hydro- or spermatocele patients were randomised to sclerotherapy with 25- or 50-mL Ethanol 99.5%. The procedure was carried out at four Swedish outpatient clinics. An 8 F pigtail catheter was inserted after local anaesthetics of the skin, the fluid was drained and the randomised dose of Ethanol was instilled. After 30 min, the Ethanol was evacuated. Absorption was measured before and after instillation with a breathalyser and with a blood alcohol test before evacuation. Patients were followed-up by phone on days 1, 2, 3, 4, 30 and 90 after the procedure to capture any complications.</p><p><strong>Results: </strong>A total of 64 patients were included in this study. None had a significant absorption of alcohol (≥ 0.2‰). The rate of complications was 18%. The number of serious complications needing intervention was 5%. The overall success rate, defined as light or no remaining discomfort, of the treatment regardless of dose was 79%. There was no difference between the different regimens with regards to complications and the success rate, but this study is underpowered in regard to those analysis.</p><p><strong>Conclusions: </strong>No systemic absorption of Ethanol 99.5% occurred regardless of dose, when used as a sclerosing agent for hydro- and spermatoceles with a 79% cure rate. The efficacy and risks of complications are comparable to other sclerosants.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"180-185"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradigm shift in the treatment of bladder cancer? The Swedish perspective.","authors":"Per-Uno Malmström, Eugen Y H Wang","doi":"10.2340/sju.v60.44464","DOIUrl":"10.2340/sju.v60.44464","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"186-188"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcomes and complications after salvage robotic-assisted laparoscopic radical prostatectomy (sRALP).","authors":"Andreas Habberstad, Siril Stokke, Lars Magne Eri, Lien My Diep, Bjørn Brennhovd, Viktor Berge","doi":"10.2340/sju.v60.44585","DOIUrl":"https://doi.org/10.2340/sju.v60.44585","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate oncological and functional outcomes after salvage robotic-assisted laparoscopic radical prostatectomy (sRALP).</p><p><strong>Material and methods: </strong>We included 60 patients, consecutively treated with sRALP for radiorecurrent prostate cancer (PCa) at Oslo University Hospital (OUS). Data were collected from our PCa registry and electronic patient journal (EPJ). PSA persistence was defined as PSA ≥ 0.1 ng/mL 6 weeks postoperatively, and these patients were not included in the survival analysis. Logistic regression was used to find -variables associated with PSA persistence. Biochemical recurrence (BCR) was defined as PSA ≥ 0.2 ng/mL. Cox regression was used to analyse BCR-free survival. Urinary leakage was graded as minor, moderate or severe. Complications were classified according to the Clavien-Dindo classification.</p><p><strong>Results: </strong>Twenty-three patients (38%) had persistent PSA. With a median follow-up of 82 months (interquartile range [IQR] 48-101 months), 16 patients (28%) had no BCR or start of androgen deprivation therapy (ADT). Twelve patients (20%) were deceased, 10 (17%) from PCa. Preoperative PSA was statistically significantly associated with persistent PSA (p = 0.01). International Society of Urological Pathology (ISUP) Grade Group 5 showed a statistically significant association with BCR (p = 0.01). Anastomosis leakage and strictures occurred in 27 (45%) and 15 patients (33%), respectively. Twenty-nine patients (48%) suffered severe urinary leakage, whilst 11 patients (24%) had moderate urinary leakage. Eleven patients (18%) received artificial urinary sphincters, and 10 patients (17%) underwent urinary diversion. Two patients suffered a grade 4 complication (sepsis), whilst 25 patients (41%) had grade 3 complications, most of which were related to intervention in the urinary system.  Conclusion: Salvage RALP for radiorecurrent PCa has limited effect on oncological outcomes. Patients should be thoroughly informed about the high risk of urinary leakage and severe surgical complications.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"158-163"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144967235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation and psychometric validation of the Finnish version of the Expanded Prostate Cancer Index Composite-26 for patients with localised prostate cancer.","authors":"Otto Ettala, Robin Bergroth, Jarno Riikonen, Peter Boström, Juha Koskimäki, Jani Kuisma, Antti Rannikko, Markku Vaarala, Martin G Sanda, Henrikki Santti","doi":"10.2340/sju.v60.44371","DOIUrl":"https://doi.org/10.2340/sju.v60.44371","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to culturally adapt the Expanded Prostate Cancer Composite-26 (EPIC-26) questionnaire to Finnish and evaluate its usability in routine clinical practice in Finland.</p><p><strong>Material and methods: </strong>We translated the EPIC-26 questionnaire into Finnish, reviewed it, back-translated it into English, and reviewed it again. We evaluated the questionnaire in four high-volume university hospitals in Finland. The study included 220 Finnish-speaking patients with untreated, newly diagnosed non-metastatic prostate cancer. Patients completed the EPIC-26 twice before treatment and twice 6 months after treatment. We assessed internal consistency, test-retest reliability, sensitivity to change, and unanswered questions.</p><p><strong>Results: </strong>The mean age of the patients was 68 years, with 69% diagnosed with low- or intermediate-risk prostate cancer according to the D'Amico classification. The most common treatment was radical prostatectomy (36%), followed by radiation therapy (31%) and active surveillance (25%). The minimum score, i.e. the worst assessment, was observed most frequently in the sexual domain (8%), while the maximum score was in the bowel domain (47%). Irritation/obstruction and hormonal domains showed low internal consistency due to the questions regarding haematuria and breast problems. Patients who underwent radical prostatectomy or radiation therapy had statistically significant changes between pre- and post-treatment scores. Most men (72%) completed the questionnaire. Older patients were more prone to leave questions unanswered, particularly questions with multiple items (odds ratio 0.39; 95% confidence interval 0.20-0.80).</p><p><strong>Conclusions: </strong>The Finnish version of the EPIC-26 questionnaire can be used in clinical practice. Completing the questionnaire may be more difficult for older patients.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"151-157"},"PeriodicalIF":2.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organized prostate cancer screening and the declaration of Helsinki.","authors":"Takeshi Takahashi","doi":"10.2340/sju.v60.44242","DOIUrl":"https://doi.org/10.2340/sju.v60.44242","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"149-150"},"PeriodicalIF":2.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misconceptions about Swedish organised prostate cancer testing.","authors":"Ola Bratt","doi":"10.2340/sju.v60.44240","DOIUrl":"10.2340/sju.v60.44240","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"60 ","pages":"148"},"PeriodicalIF":2.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}