Andrea Porserud, Markus Aly, Hanna Steinertz, Elisabeth Rydwik, Maria Hagströmer
{"title":"Exercise in primary care after robot-assisted radical cystectomy for urinary bladder cancer - effects on postoperative complications: a secondary analysis of a randomised controlled trial.","authors":"Andrea Porserud, Markus Aly, Hanna Steinertz, Elisabeth Rydwik, Maria Hagströmer","doi":"10.2340/sju.v59.42589","DOIUrl":"10.2340/sju.v59.42589","url":null,"abstract":"<p><strong>Objective: </strong>An exercise programme in primary care soon after radical cystectomy for urinary bladder cancer was previously evaluated regarding its effects on physical function. A secondary aim, presented herein, was to evaluate the programme in terms of its effect on postoperative complications.</p><p><strong>Materials and methods: </strong>Patients who were planned for robot-assisted radical cystectomy for urinary bladder cancer at Karolinska University Hospital between September 2019 and October 2022 were invited to participate. At discharge from hospital, they were randomised to intervention group including aerobic and resistance exercises with physiotherapist in primary care twice a week for 12 weeks and daily walks, or to unsupervised home-based exercise including daily walks. Readmission rates between 30 and 90 days after discharge, and complications according to Clavien Dindo were collected from the medical records and analysed.</p><p><strong>Results: </strong>Ninety patients were randomised, with a mean (SD) age of 72 (9) years. Readmission rates between 30 and 90 days showed no difference between the groups. For readmitted patients, the intervention group had significantly fewer complications reported as Clavien Dindo grade 2 compared to the control group. Conclusion: An exercise programme in primary care soon after robot-assisted radical cystectomy appears to be safe for patients, as measured by hospital readmission rates. Trial registration: Clinical Trials (NCT03998579).</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"193-199"},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847593","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":"How to improve cancer care by use of guidelines and quality registers.","authors":"Pär Stattin","doi":"10.2340/sju.v59.42272","DOIUrl":"10.2340/sju.v59.42272","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"190-192"},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847595","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}
Ingunn Roth, Karin Margrethe Hjelle, Charlotte Josefine Johansen, Christian Arvei Moen, Christian Beisland, Patrick Juliebø-Jones
{"title":"Primary and revision artificial urinary sphincter for stress urinary incontinence post-radical prostatectomy: a surgery with high rewards but high risks?","authors":"Ingunn Roth, Karin Margrethe Hjelle, Charlotte Josefine Johansen, Christian Arvei Moen, Christian Beisland, Patrick Juliebø-Jones","doi":"10.2340/sju.v59.42340","DOIUrl":"https://doi.org/10.2340/sju.v59.42340","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy of artificial urinary sphincter (AUS) implantation in men with stress urinary incontinence post-radical prostatectomy and the complication burden with a focus on identifying potential risk factors for reoperation as well as determining the fate of revision surgeries.</p><p><strong>Methods: </strong>Retrospective analysis of consecutive patients undergoing primary AUS (pAUS) and revision AUS (rAUS) implantation at a tertiary centre. Logistic regression was employed to identify risk factors for reoperation associated with non-mechanical failures. Kaplan Meier method was applied to generate implant patency curves.</p><p><strong>Results: </strong>Over 11-years, 108 and 28 patients underwent pAUS and rAUS, respectively. Amongst the former group, a 30-day complication rate of 20.4% was found with a complete (zero pad) dryness rate at follow-up of 49.1%. Post-operative infection was the commonest occurring complication in 7.4%. After pAUS, 27.8% underwent reoperation with cuff erosion being the top indication in 46.7%. Diabetes was a significant predictor for reoperation with an associated 3.6-fold increased risk. The 3-year and 5-year device survival rates without reoperation for pAUS were 80% and 76%, respectively. For rAUS, complete dryness rates achieved were lower at 32.1%. The rate of reoperation was higher at 42.9% with a significantly worse survival probability compared to pAUS (p = 0.024).</p><p><strong>Conclusions: </strong>Whilst men may achieve complete dryness after pAUS, the potential complication burden and risk of reoperation are not low, and patients need to be counselled regarding this. Chances of continence success are lower when revision surgery is performed with a worse implant survival probability.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"185-189"},"PeriodicalIF":1.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802218","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}
Beth Russell, Oskar Hagberg, Christel Häggstrom, Lars Holmberg, Mieke Van Hemelrijck, Fredrik Liedberg
{"title":"The difficulty of studying the association between pathway delays and survival in cancer - an example from bladder cancer.","authors":"Beth Russell, Oskar Hagberg, Christel Häggstrom, Lars Holmberg, Mieke Van Hemelrijck, Fredrik Liedberg","doi":"10.2340/sju.v59.42176","DOIUrl":"10.2340/sju.v59.42176","url":null,"abstract":"<p><p>N/A.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"181-184"},"PeriodicalIF":1.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547161","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 Stockholm Spinal Cord Uro Study: Changing patterns of urological surgery in a regional prevalence group through 50 years - Outcomes and lessons learned.","authors":"Elisabeth Farrelly, Lena Lindbo, Åke Seiger","doi":"10.2340/sju.v59.40326","DOIUrl":"https://doi.org/10.2340/sju.v59.40326","url":null,"abstract":"<p><strong>Aims: </strong>To examine the number and types of urological surgical procedures carried out in a regional prevalence population of patients with traumatic spinal cord injury (SCI) during five decades, evaluate objective and patient-reported outcomes and to consider lessons learned for further improvement of surgical treatment in this patient group.</p><p><strong>Methods: </strong>In a cross-sectional study of 412 patients with traumatic SCI, one-third had undergone urological surgery through a period of up to 50 years. Data on types of surgery, complications, follow-up and outcomes were collected in a retrospective review of patient files. S-creatinine, S-cystatin-C, renal ultrasound and a questionnaire regarding complications during the preceding year were assembled as part of a yearly follow-up. Descriptive statistics were calculated. Logistic regression was used to determine risk profiles for the incidence of urological surgery.</p><p><strong>Results: </strong>A total of 137 patients had undergone 262 urological surgical interventions. The incidence was highest amongst persons with a cervical-thoracic neurological level of spinal cord lesion and during the first 2 years after SCI. Surgery for urinary stones constituted 29% of all procedures. One-fourth of the patients had undergone 47% of all procedures, notably urinary diversion and ensuing complications, implants and revisions, repeated stone interventions or bladder outlet procedures. After reconstructive surgery functional outcomes and patient-reported satisfaction were generally favourable, but long-term signs of renal complications were frequent.</p><p><strong>Conclusions: </strong>Urological surgery after SCI involves imperative as well as reconstructive procedures, some of which are challenging and call for centralisation to devoted teams. Prospective studies of reconstructive urology are warranted, including more extensive patient-reported outcomes.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"173-180"},"PeriodicalIF":1.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507071","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}
Albert Arch, Andreas Thamsborg, Lilli Winck-Flyvholm, Rie Seifert, Mikkel Fode
{"title":"Thermo-expandable intraprostatic nitinol stents in the treatment of bladder outlet obstruction: a consecutive case series.","authors":"Albert Arch, Andreas Thamsborg, Lilli Winck-Flyvholm, Rie Seifert, Mikkel Fode","doi":"10.2340/sju.v59.41991","DOIUrl":"https://doi.org/10.2340/sju.v59.41991","url":null,"abstract":"<p><strong>Objective: </strong>In high-risk patients, prostatic stents may alleviate obstruction at the prostate level. Since 2020 we have used thermo-expandable intraprostatic nitinol stents. Here we document outcomes through the first years with the procedure.</p><p><strong>Material and methods: </strong>We reviewed patients who had undergone stent treatment between May 2020 and October 2023. Patient and procedural data, urinary symptoms, complications and side effects were recorded. Descriptive statistics were used to summarize outcomes and we evaluated predictors of success and complications using robust multiple regression analyses.</p><p><strong>Results: </strong>We included 52 consecutive patients with a median age of 82 years (range 71-96) and a median Charlson Comorbidity Index of 6 (3-11). Forty-seven men used indwelling catheters, two used clean intermittent catheterization, and three had severe lower urinary tract symptoms. Stents were placed under general anesthesia, sedation, and local anesthesia in 39, 4, and 9 men, respectively. The median treatment time was 14 min (range 8-40). One complication, in the form of an infection requiring IV antibiotics, occurred. Subsequently, 45 men (87%) were able to void spontaneously without bothersome symptoms. After a median of 11 (2-44) months, 8 men had their stents removed due to recurring symptoms. This gives an overall success rate of 37/52 patients (71%). No predictors of success or complications were identified.</p><p><strong>Conclusions: </strong>Thermo-expandable intraprostatic nitinol stents demonstrate a high success rate with a low risk of complications and may serve as an alternative to permanent or intermittent catheterization for men who are unable or unwilling to undergo flow-improving surgery.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"169-172"},"PeriodicalIF":1.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372768","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}
Åsa Warnolf, Dominik Glombik, Fredrik Sandin, Mats Lambe, Gediminas Baseckas, Axel Gerdtsson, Kimia Kohestani, Peter Kirrander
{"title":"Evaluation of data quality in the Swedish National Penile Cancer Register.","authors":"Åsa Warnolf, Dominik Glombik, Fredrik Sandin, Mats Lambe, Gediminas Baseckas, Axel Gerdtsson, Kimia Kohestani, Peter Kirrander","doi":"10.2340/sju.v59.42029","DOIUrl":"https://doi.org/10.2340/sju.v59.42029","url":null,"abstract":"<p><strong>Objective: </strong>The National Penile Cancer Register (NPECR) in Sweden was initiated in year 2000 and currently contains more than 3,900 men diagnosed with penile cancer. The aim of this study was to evaluate data quality in the NPECR in terms of completeness, timeliness, comparability, and validity.</p><p><strong>Material and methods: </strong>Completeness was assessed by cross-linkage to the Swedish Cancer Register. Timeliness, defined as time from date of diagnosis to date of reporting in the NPECR, was calculated. Comparability was evaluated by reviewing and comparing coding routines in the NPECR with national and international guidelines. To assess validity, medical records of 375 men with a penile cancer diagnosis in the NPECR between 2017 and 2020 were reviewed and selected variables were re-abstracted and compared with previously registered data.</p><p><strong>Results: </strong>Completeness was high (93%). Timeliness was in median 4.6 (Inter Quartile Range 2.6-8.8) months. Comparability was good with coding routines and the registration forms were in compliance with current guidelines. Overall, the validity was high. The majority of variables showed an exact agreement exceeding 90%.</p><p><strong>Conclusion: </strong>Data quality in the Swedish NPECR is generally high with respect to completeness, timeliness, comparability, and validity. Hence, the NPECR represents a reliable data source for monitoring the quality of penile cancer care and research. Data quality can be further improved by revision of reporting forms and manuals, training of reporting staff, and by organizational adjustments.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"162-168"},"PeriodicalIF":1.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361968","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}
Katarina Koss Modig, Rebecka Arnsrud Godtman, Fredrik Langkilde, Marianne Månsson, Jonas Wallström, Johan Stranne
{"title":"Study design and procedures in the incontinence post robot-assisted radical prostatectomy: anatomical and functional causes (IPA) - a prospective observational clinical trial.","authors":"Katarina Koss Modig, Rebecka Arnsrud Godtman, Fredrik Langkilde, Marianne Månsson, Jonas Wallström, Johan Stranne","doi":"10.2340/sju.v59.40051","DOIUrl":"10.2340/sju.v59.40051","url":null,"abstract":"<p><strong>Objective: </strong>To describe the study design and procedures of the incontinence post robot- assisted radical prostatectomy, anatomical and functional causes (IPA) trial. This trial aims to identify and study patient and procedure specific factors leading to urinary incontinence post robot-assisted laparoscopic radical prostatectomy (RALP).</p><p><strong>Material and methods: </strong>The IPA study is a prospective, multicentre, open non-randomised surgical trial, including patients prior to RALP and registered on-line (ISRCTN67297115). IPA is administered from the Department of Urology at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients undergo an anatomical and functional evaluation using magnetic resonance imaging (MRI), urodynamics including cystometry, pressure-flow and urethral pressure profile, and dynamic transrectal ultrasound prior to and 3 months after RALP. The incontinence data are gathered using patient reported outcome measure questionnaires. The primary endpoint is incontinence at 3 months after RALP, defined as need of any pad. The secondary endpoints are incontinence 12 months post RALP defined as need of any pad, and 3- and 12-months post RALP, defined as use of more than a safety pad.</p><p><strong>Results: </strong>Until October 2023, 207 patients have been included of the stipulated 1,000, with an increasing rate of accrual. Out of these patients,187 have had a pre- and post-operative MRI and 177 have undergone pre- and post-operative urodynamics.</p><p><strong>Conclusions: </strong>The design of the IPA study, together with promising accrual and coming multicentre inclusion, will hopefully result in the identification, and deeper understanding, of the various risk-factors for post-RALP incontinence. This could improve information and decision making regarding adequate treatment for patients with prostate cancer.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"59 ","pages":"156-161"},"PeriodicalIF":1.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353113","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}
Kristina Flor Galtung,Peter Mæhre Lauritzen,Gunnar Sandbæk,Dag Bay,Eduard Baco,Erik Rud
{"title":"Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria.","authors":"Kristina Flor Galtung,Peter Mæhre Lauritzen,Gunnar Sandbæk,Dag Bay,Eduard Baco,Erik Rud","doi":"10.2340/sju.v59.40679","DOIUrl":"https://doi.org/10.2340/sju.v59.40679","url":null,"abstract":"OBJECTIVEPainless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort.MATERIAL AND METHODS\"A Prospective Trial for Examining Haematuria using Computed Tomography\" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard.RESULTSIn 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"91 1","pages":"147-155"},"PeriodicalIF":1.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269472","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}
Bassam Mazin Hashima,Abbas Chabok,Börje Ljungberg,Erland Östberg,Farhood Alamdari
{"title":"Diagnostic accuracy and safety of renal tumour biopsy in patients with small renal masses and its impact on treatment decisions.","authors":"Bassam Mazin Hashima,Abbas Chabok,Börje Ljungberg,Erland Östberg,Farhood Alamdari","doi":"10.2340/sju.v59.40844","DOIUrl":"https://doi.org/10.2340/sju.v59.40844","url":null,"abstract":"OBJECTIVETo assess the safety and diagnostic accuracy of renal tumour biopsy (RTB) in patients with small renal masses (SRM) and to assess if RTB prevents overtreatment in patients with benign SRM.MATERIAL AND METHODSIn a retrospective, single-centre study from Västmanland, Sweden, 195 adult patients (69 women and 126 men) with SRM ≤ 4 cm who had undergone RTB during 2010-2023 were included. The median age was 70 years (range 23-89). The sensitivity, specificity and predictive values of RTB were calculated using the final diagnosis as the reference standard. Treatment outcomes were recorded for a median 42-month follow-up. Complications following the biopsies were assessed according to the Clavien-Dindo system.RESULTSThe overall sensitivity of RTB was 95% (95% confidence interval [CI] 90% - 98%) and specificity was 100% (95% CI 95% - 100%). The positive predictive value was 100% and negative predictive value was 92%. The rate of agreement between RTB and the final diagnosis measured using kappa statistics was 0.92. Of the 195 patients, 62 underwent surgery and 48 were treated with ablation. The concordance rate between the RTB histology and final histology after surgery was 89%. Treatment was withheld in 67 of 195 patients with a benign or inconclusive RTB. No patients developed renal cell carcinoma or metastasis during follow-up. Complications occurred in two patients that were classified with Clavien-Dindo grades I and IV.CONCLUSIONSPercutaneous renal tumour biopsy appears to be a safe diagnostic method that provides accurate histopathological information about small renal masses and reduces overtreatment of benign SRM.","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"17 1","pages":"141-146"},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211054","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}