| 1. |
- Jonsson, Olof, 1941, et al.
(författare)
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Afferent intussuscepted antireflux nipple valve complications in the Kock pouch for continent urinary diversion Early results with a modified technique.
- 2006
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Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 40:6, s. 472-478
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To analyse the risk of afferent nipple valve stenosis and its consequences and management in patients with a Kock pouch for continent urinary diversion and to study the early results after using an alternative antireflux technique. Material and methods. Sixty patients consecutively operated on with a conventional Kock reservoir for continent cutaneous urinary diversion between 1988 and 2001 were analysed with regard to the occurrence of afferent nipple valve stenosis and its clinical characteristics. Sixteen patients operated on for continent urinary diversion during the period 2002-04 had the antireflux valve constructed according to the serous-lined extramural ileal valve technique. Results. Eight patients with a conventional Kock pouch developed true afferent nipple valve stenosis and the risk approached 30% after 15 years. Dilatation and stenting were usually successful. Conclusions. The high risk of afferent nipple valve stenosis when using the intussuscepted nipple valve in the construction of a Kock reservoir for continent cutaneous urinary diversion calls for an alternative method for anastomosing the ureters to the reservoir. Our early results with the combined Kock/T-pouch are promising.
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| 2. |
- Pazooki, David, 1958, et al.
(författare)
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Continent cutaneous urinary diversion in patients with spinal cord injury.
- 2006
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 44:1, s. 19-23
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective study. OBJECTIVE: To examine the functional results and effect on quality of life of continent cutaneous urinary diversion in spinal cord injured patients. SETTING: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. SUBJECTS: A total of 10 patients with spinal cord injury (SCI). METHOD: The patients were operated on with an ileal reservoir (Kock reservoir or T-pouch), Cr-EDTA clearance was determined preoperatively and at follow-up. The patients answered a questionnaire concerning reservoir function, various activities and quality of life. The patient charts were reviewed. RESULTS: One patient died of pulmonary embolism 3 years after surgery. Two patients were reoperated on for reservoir perforation. All patients were satisfied/very satisfied with their reservoirs. Half of them reported improved ability to perform various activities. Eight out of nine patients reported improved quality of life. CONCLUSION: For a selected group of patients with SCI, continent cutaneous urinary diversion provides successful outcome with improved quality of life.
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| 3. |
- Pazooki, David, 1958, et al.
(författare)
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Continent cutaneous urinary diversion is still a valid alternative after cystectomy for bladder carcinoma.
- 2005
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Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 39:6, s. 468-473
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Tidskriftsartikel (refereegranskat)abstract
- Objective. We compared patient opinions concerning reservoir/bladder function as well as quality of life (QOL) after cystectomy for bladder carcinoma and continent cutaneous urinary diversion or orthotopic bladder reconstruction. Material and methods. Fifteen patients with Kock reservoirs (11 females, 4 males) and 11 men with orthotopic bladders answered the European Organization for Research and Treatment of Cancer quality-of-life questionnaire-C30 as well as specially constructed questions concerning reservoir/bladder function. The glomerular filtration rate (GFR) was determined using Cr-EDTA or iohexol clearance. Results. Functioning and global health/QOL scales did not differ between the two groups of operated patients or between diverted patients and gender- and age-matched groups from the general population. The majority of the patients were satisfied/very satisfied with their diversion but more patients were troubled by leakage in the orthotopic bladder group than in the Kock reservoir group. The GFR was similar in the two groups. Conclusion. Continent cutaneous urinary diversion is associated with fewer leakage problems than orthotopic bladder reconstruction after cystectomy for bladder carcinoma.
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| 4. |
- Edlund, Christer, 1962, et al.
(författare)
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Funktionella störningar av nedre urinvägarna.
- 2012
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Ingår i: Urologi , 2nd ed. / Jan-Erik Damber, Ralph Peeker (red.). - Lund : Studentlitteratur. - 9789144075921
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Bokkapitel (refereegranskat)
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| 5. |
- Edlund, Christer, 1962, et al.
(författare)
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Sacral nerve stimulation for refractory urge symptoms in elderly patients.
- 2004
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Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 38:2, s. 131-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The presence of an overactive detrusor (OD) is becoming more prevalent in the elderly and may severely influence the social life and activities of daily living in the senior, otherwise healthy, person. There is a marked age-dependent increase in OD above the age of 65 years, which is mainly attributed to dysfunction, with loss of voluntary control, of the micturition reflex and decreased perception of bladder fullness. MATERIAL AND METHODS: Herein, we evaluate the outcome of sacral nerve stimulation in five patients aged >65 years derived from a large, multinational, randomized, prospective study. RESULTS: The effect on symptoms was excellent in two subjects. There was a moderate improvement in another subject and a variable but eventually small effect in the remaining two patients. The results appeared to be more favourable in younger patients. CONCLUSION: Our findings suggest that the outcome of sacral nerve stimulation is more unpredictable in the elderly, a fact that should be considered when counselling the patient. However, it should be remembered that, even for the older, active person, urge incontinence may have a severe impact on quality of life and that the majority of patients treated with an implant will benefit from this treatment.
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| 6. |
- Edlund, Christer, 1962
(författare)
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Studies on the overactive bladder with special reference to diagnosis, classification and surgical treatment
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overactive bladder (OB) is a symptom of disturbed neuromuscular control of the lower urinary tract. The cause is sometimes obvious, but even a lesion that is minor and difficult to detect might be of significance. The diagnosis is set by cystometry and in order to create a uniform classification the Standardisation Committee of the International Continence Society (ICS) have suggested that OB with known neuropathy should be called "detrusor hyperreflexia" while in all other cases the term "unstable detrusor" should be used. The aim of this study was to investigate patients diagnosed as having "unstable detrusor". They were all classified according to a functional system, which includes the bladder cooling test. In this system, three subtypes are easily distinguished: phasic detrusor instability, uninhibited overactive bladder and spinal detrusor hyperreflexia.A further entity having urgency and urgency incontinence but with urodynamically stable detrusor, characterised by a steep pressure slope at the end of filling, was identified. In order to separate poor compliance from tonic bladder contraction, the bladder was treated with 150ml 2% lidocaine before a second cystometry.We also tested the hypothesis that "unstable bladder" in fact is an expression of a subtle neurological disorder. A trained neurologist performed a thorough neurological examination including analysis of cerebrospinal fluid as well as biothesiometer testing in a group of patients with OB without known neurological disease or symptoms. Two more recent surgical techniques for treatment of OB were evaluated, sacral nerve stimulation and clam ileocystoplasty.Results: Intravesical lidocaine reduced bladder pressure in three out of twenty-one patients and revealed an instability in another five. Of the forty-five patients, eighty-two per cent exhibited neurological signs when examined in detail. Nineteen per cent had immunopathy in cerebrospinal fluid. Eighteen per cent received a neurological diagnosis. A total of thirty patients were submitted to an acute test with sacral neuromodulation resulting in nine permanent implants. All patients had a positive effect of the implant at some time during the postoperative period. However, the effect varied over time and was also influenced by external factors. A remarkable spread of positions was noted regarding the temporary electrode. In thirty patients operated upon, the clam ileocystoplasty restored continence and reduced urge symptoms in ninety per cent, in accordance with their reporting of satisfaction with their voiding postoperatively.Conclusions: OB can present itself with different cystometric patterns.The current classification seams inadequate in several respects. Sacral neuromodulation is a promising treatment for OB. Patient selection, electrode position and stimulation parameters should be the subject of further studies. This technique should be reserved for specialised centres. For the treatment of severe urgency incontinence, the clam ileocystoplasty is an effective alternative for the well-motivated patient.
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| 7. |
- Wennberg, Anna Lena, 1968, et al.
(författare)
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A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women
- 2009
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Ingår i: Eur Urol. ; 55:4, s. 783-91
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. OBJECTIVE: To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged > or = 20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). METHODS: A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. RESULTS AND LIMITATIONS: In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p<0.001), and 3% (p<0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p<0.001). CONCLUSIONS: UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.
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| 8. |
- Wennberg, Anna Lena, 1968, et al.
(författare)
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Lower urinary tract symptoms: lack of change in prevalence and help-seeking behaviour in two population-based surveys of women in 1991 and 2007
- 2009
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Ingår i: BJU International. - 1464-410X. ; 104:7, s. 954-959
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES To test the hypothesis that the overt prevalence and help-seeking pattern for lower urinary tract symptoms (LUTS) might have changed over time, by comparing the prevalence of urinary incontinence (UI), overactive bladder (OAB) and other LUTS (principally storage symptoms) and help-seeking pattern in two equivalent groups of women 16 years apart. SUBJECTS AND METHODS We compared two cross-sectional studies; population-based random samples of women aged >/=20 years in the central district of Gothenburg in 1991 (2911) and 2007 (3158) were asked to complete similar self-administered postal questionnaires regarding UI and other LUTS. RESULTS The mean (sd, range) age of the two groups was 48.1 (20.4, 20-98 ) years in 1991 and 46.2 (20.0, 20-101) years in 2007, respectively. When comparing the two study populations there were no significant differences in the reported prevalence of UI, OAB or nocturia (defined as two or more voids per night) over time. Nocturia according to the International Continence Society definition was significantly more prevalent in 2007 than 1991, as was daytime voiding frequency of eight or more times a day. OAB dry (i.e. with no incontinence) was more common in 1991, while OAB wet (i.e. with incontinence) was more prevalent in 2007. Of the women in 1991 and 2007, 6% and 7%, respectively, had sought help from the healthcare system due to UI. Significantly more women in 2007 than in 1991 stated that the presence of UI limited their social life (29% vs 13%, P < 0.001). CONCLUSION LUTS are common in women and the prevalence rates of UI and OAB have not changed during the last 16 years. Many women still do not seek help from the healthcare system, and the help-seeking pattern has remained unchanged, despite effective treatment currently being offered.
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