Scandinavian Journal of Urology最新文献

{"title":"A randomised study of TURP after intraprostatic injection of mepicacaine/adrenaline versus regular TURP in patients with LUTS/BPO.","authors":"Fredrik Stenmark,&nbsp;Lars Brundin,&nbsp;Olof Gunnarsson,&nbsp;Henrik Kjölhede,&nbsp;Edvard Lekås,&nbsp;Ralph Peeker,&nbsp;Marianne Månsson,&nbsp;Jonas Richthoff,&nbsp;Johan Stranne","doi":"10.2340/sju.v58.7798","DOIUrl":"https://doi.org/10.2340/sju.v58.7798","url":null,"abstract":"<p><strong>Introduction: </strong>During transurethral resection of the prostate (TURP), the most established surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), the prostate can bleed profusely, bringing about anaemia and compromised oxygen delivery to the entire body.</p><p><strong>Objective: </strong>The primary objective of this study was to assess the efficacy of mepivacaine and adrenaline (MA) injected into the prostate on bleeding. The primary endpoint was to measure blood loss per resected weight of prostate tissue.</p><p><strong>Material and methods: </strong>This randomised controlled trial evaluated 81 patients with LUTS/BPO. Patients were randomly allocated to regular TURP or TURP with intraprostatic injections of MA.</p><p><strong>Results: </strong>On univariable analyses there was a significant difference in resection weight in favour of the experimental group, not reflected by a statistically significant difference in the other studied outcome parameters. Nevertheless, in multivariable analyses, blood loss per resection weight, which was the primary outcome, showed a significant decrease in favour of the experimental group. Clavien-Dindo complication classification showed three men with a grade I complication and two men with grade II.</p><p><strong>Conclusions: </strong>The results obtained in this study showed that it is beneficial to apply intraprostatic injections of MA in immediate conjunction with TURP, in terms of blood loss per resected gram. The study is, however, small and corroboration of our results in more extensive prospective studies may therefore be warranted before embarking upon this technique.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"46-51"},"PeriodicalIF":1.5,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10056203","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":"Predictors for complication in renal cancer surgery: a national register study.","authors":"John Åkerlund,&nbsp;Pernilla Sundqvist,&nbsp;Börje Ljungberg,&nbsp;Sven Lundstam,&nbsp;Ralph Peeker,&nbsp;Marianne Månsson,&nbsp;Anna Grenabo Bergdahl","doi":"10.2340/sju.v58.12356","DOIUrl":"https://doi.org/10.2340/sju.v58.12356","url":null,"abstract":"<p><strong>Objective: </strong>Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality  following different surgical procedures and thermal ablation for renal cell carcinoma (RCC).</p><p><strong>Material and methods: </strong>All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015-2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III-V) complications, including death.</p><p><strong>Results: </strong>The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively.</p><p><strong>Conclusions: </strong>In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"38-45"},"PeriodicalIF":1.5,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10434478","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":"Abstract book for the 34th Congress of the Scandinavian Association of Urology (NUF).","authors":"","doi":"10.2340/sju.v58.18375","DOIUrl":"https://doi.org/10.2340/sju.v58.18375","url":null,"abstract":"<p><p>June 7-10th, 2023 Bergen, Norway.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"1-48"},"PeriodicalIF":1.5,"publicationDate":"2023-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9989906","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":"Fluoroquinolone-resistant Escherichia coli among the rectal flora is the predominant risk factor for severe infection after transrectal ultrasound-guided prostate biopsy: a prospective observational study.","authors":"Martin Holmbom,&nbsp;Jon Forsberg,&nbsp;Mats Fredrikson,&nbsp;Maud Nilsson,&nbsp;Lennart E Nilsson,&nbsp;Håkan Hanberger,&nbsp;Anita Hällgren","doi":"10.2340/sju.v58.11920","DOIUrl":"https://doi.org/10.2340/sju.v58.11920","url":null,"abstract":"<p><strong>Background: </strong>Infection of the prostate gland following biopsy, usually with Escherichia coli, is a common complication, despite the use of antimicrobial prophylaxis. A fluoroquinolone (FQ) is commonly prescribed as prophylaxis. Worryingly, the rate of fluoroquinolone-resistant (FQ-R) E. coli species has been shown to be increasing.</p><p><strong>Objective: </strong>This study aimed to identify risk factors associated with infection after transrectal ultrasound-guided prostate biopsy (TRUS-Bx).</p><p><strong>Methods: </strong>This was a prospective study on patients undergoing TRUS-Bx in southeast Sweden. Prebiopsy rectal and urine cultures were obtained, and antimicrobial susceptibility and risk-group stratification were determined. Multivariate analyses were performed to identify independent risk factors for post-biopsy urinary tract infection (UTI) and FQ-R E. coli in the rectal flora.</p><p><strong>Results: </strong>In all, 283 patients were included, of whom 18 (6.4%) developed post-TRUS-Bx UTIs. Of these, 10 (3.5%) had an UTI without systemic inflammatory response syndrome (SIRS) and 8 (2.8%) had a UTI with SIRS. Being in the medium- or high-risk groups of infectious complications was not an independent risk factor for UTI with SIRS after TRUS-Bx, but low-level FQ-resistance (minimum inhibitory concentration (MIC): 0.125-0.25 mg/L) or FQ-resistance (MIC > 0.5 mg/L) among E. coli in the faecal flora was. Risk for SIRS increased in parallel with increasing degrees of FQ-resistance. Significant risk factor for harbouring FQ-R E.coli was travelling outside Europe within the previous 12 months.</p><p><strong>Conclusion: </strong>The predominant risk factor for UTI with SIRS after TRUS-Bx was FQ-R E. coli among the faecal flora. The difficulty in identifying this type of risk factor demonstrates a need for studies on the development of a general approach either with rectal swab culture for targeted prophylaxis, or prior rectal preparation with a bactericidal agent such as povidone-iodine before TRUS-Bx to reduce the risk of FQ-R E. coli-related infection.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"32-37"},"PeriodicalIF":1.5,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337065","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":"Long-term patient follow-up should be routinely implemented in radiotherapy units to detect late adverse effects after cancer treatment.","authors":"Kirsti Aas,&nbsp;Amir Sherif","doi":"10.2340/sju.v58.13470","DOIUrl":"https://doi.org/10.2340/sju.v58.13470","url":null,"abstract":"<p><p>Editorial comment to Urosymphyseal fistula after pelvic radiotherapy - an entity in patients with significant comorbidity requiring multidisciplinary management Scand J Urol. 2023.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"30-31"},"PeriodicalIF":1.5,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10316299","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":"Taking the temperature: a case of urethral polyembolokoilamania.","authors":"Kristian Lyngholm Strand,&nbsp;Jan Maciej Krzak","doi":"10.2340/sju.v58.7125","DOIUrl":"https://doi.org/10.2340/sju.v58.7125","url":null,"abstract":"CONTACT Kristian Lyngholm Strand kristian.strand@rsyd.dk Fruerstuevej 21, 5700 Svendborg, Denmark. *Equally contributed. © 2023 The Author(s). Published by Medical Journals Sweden on behalf of Acta Chirurgica Scandinavica. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work. CASE REPORT","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"28-29"},"PeriodicalIF":1.5,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812227","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":"Current evidence for moderate and ultra-hypofractionated radiation therapy in prostate cancer: a summary of the results from phase 3 randomised trials.","authors":"Oscar Lilleby,&nbsp;Peter Meidahl Petersen,&nbsp;Gedske Daugaard,&nbsp;Katharina Anne Perell","doi":"10.2340/sju.v58.7719","DOIUrl":"https://doi.org/10.2340/sju.v58.7719","url":null,"abstract":"<p><strong>Problem: </strong>A low α/β ratio for prostate cancer (PCa) compared to surrounding normal tissue theoretically implies therapeutical advantages with hypofractionated treatment. Data from large randomised control trials (RCTs) comparing moderate hypofractionated (MHRT, 2.4-3.4 Gray/fraction (Gy/fx)) and ultra-hypofractionated (UHRT, >5 Gy/fx) with conventionally fractionated radiation therapy (CFRT, 1.8-2 Gy/fx) and the possible clinical implications have been reviewed.</p><p><strong>Materials and method: </strong>We searched PubMed, Cochrane and Scopus for RCT comparing MHRT/UHRT with CFRT treatment of locally and/or locally advanced (N0M0) PCa. We found six RCTs, which compared different radiation therapy regimes. Tumour control and acute and late toxicities are reported.</p><p><strong>Results: </strong>MHRT was non-inferior to CFRT for intermediate-risk PCa, non-inferior for low-risk PCa and not superior in terms of tumour control for high-risk PCa. Acute toxicity rates were increased compared to CFRT, especially an increase in acute gastrointestinal adverse effects was seen. Late toxicity related to MHRT seems to be comparable. UHRT was non-inferior in terms of tumour control in one RCT, with increased acute toxicity, but with comparable late toxicity. One trial, however, indicated increased late toxicity rates with UHRT.</p><p><strong>Discussion and conclusion: </strong>MHRT delivers similar therapeutic outcomes compared to CFRT in terms of tumour control and late toxicity for intermediate-risk PCa patients. Slightly more acute transient toxicity could be tolerated in favour of a shorter treatment course. UHRT should be regarded as an optional treatment for patients with low- and intermediate-risk disease applied at experienced centres in concordance with international and national guidelines.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"21-27"},"PeriodicalIF":1.5,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9672252","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":"Response to M. Brehmer: Register-based research. Accurate data and analysis, crucial for correct conclusions. Comment on 'Incidence, mortality, and relative survival of patients with cancer of the bladder and upper urothelial tract in the Nordic countries between 1990 and 2019'.","authors":"Eemil Karttunen,&nbsp;Jan Oldenburg,&nbsp;Steinar Thoresen,&nbsp;Anders Ullén","doi":"10.2340/sju.v58.10299","DOIUrl":"https://doi.org/10.2340/sju.v58.10299","url":null,"abstract":"","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"20"},"PeriodicalIF":1.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9631529","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":"Salvage radiotherapy after radical prostatectomy: functional outcomes in the LAPPRO trial after 8-year follow-up.","authors":"Stefan Carlsson,&nbsp;David Bock,&nbsp;Anna Lantz,&nbsp;Eva Angenete,&nbsp;Katarina Koss Modig,&nbsp;Jonas Hugosson,&nbsp;Anders Bjartell,&nbsp;Gunnar Steineck,&nbsp;Peter Wiklund,&nbsp;Eva Haglind","doi":"10.2340/sju.v58.7318","DOIUrl":"https://doi.org/10.2340/sju.v58.7318","url":null,"abstract":"<p><strong>Objective: </strong>Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy.</p><p><strong>Methods: </strong>A prospective, controlled, non-randomized trial at 14 Swedish center's including 4,003 patients scheduled for radical prostatectomy 2008-2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years.</p><p><strong>Results: </strong>Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively.</p><p><strong>Conclusion: </strong>Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients' preparedness for late side-effects.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"11-19"},"PeriodicalIF":1.5,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9463599","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":"Urosymphyseal fistula after pelvic radiotherapy in a tertial referral centre - a rare entity with significant comorbidity requiring multidisciplinary management.","authors":"Johan Brändstedt,&nbsp;Johan Abrahamsson,&nbsp;Gediminas Baseckas,&nbsp;Johannes Bobjer,&nbsp;Axel Gerdtsson,&nbsp;Adalstein Gunnlaugsson,&nbsp;Petter Kollberg,&nbsp;Marie-Louise Lydrup,&nbsp;Martin Nyberg,&nbsp;Daniel Wenger,&nbsp;Anne Sörenby,&nbsp;Johan Tham,&nbsp;Åsa Warnolf,&nbsp;Fredrik Liedberg","doi":"10.2340/sju.v58.5765","DOIUrl":"https://doi.org/10.2340/sju.v58.5765","url":null,"abstract":"<p><strong>Objective: </strong>To report population-based clinical presentation and outcomes in patients with urosymphyseal fistula (USF) after pelvic radiotherapy (RT).</p><p><strong>Patients and methods: </strong>A retrospective chart review was performed in 33 consecutive patients diagnosed with suspicion of USF in a tertial referral center from 2014-2022 to ascertain information about diagnostic delay, clinical presentation, precipitating causes, treatments received and outcomes during the median 22 months follow-up. Out of 33 consecutive patients with suspicion of USF, one female with vesicovaginal fistula, one patient developing RT-associated bladder angiosarcoma, four patients with short follow-up (<3 months), and three patients that during chart review not were considered to have a USF were excluded.</p><p><strong>Results: </strong>In all, 24 males with a median age of 77 years were diagnosed with USF. Local pain was the predominating symptom in 17/24 (71%) patients. Endourologic manipulations preceded the diagnosis of USF in 16 patients. Five patients had a diagnostic delay of more than 3 months. At diagnosis, 20/24 patients had radiological signs of osteomyelitis, and five had a concomitant rectourethral fistula. Due to comorbidity, five patients were not amenable to any other interventions than urinary catheter or suprapubic tube in conjunction with long-term antibiotics, of which three died from infections related to the USF. Out of the remaining 19 patients receiving some form of urinary diversion, five had recurrent osteomyelitis, of which four did not undergo cystectomy in conjunction with surgery for the USF.</p><p><strong>Conclusions: </strong>Urethral endourologic interventions in patients previously subjected to pelvic RT should be performed cautiously.</p>","PeriodicalId":21542,"journal":{"name":"Scandinavian Journal of Urology","volume":"58 ","pages":"4-10"},"PeriodicalIF":1.5,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9391581","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}