| 1. |
- Ankardal, Maud, 1957, et al.
(författare)
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A randomised trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
- 2004
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Ingår i: Bjog. - : Wiley. - 1470-0328. ; 111:9, s. 974-81
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare open Burch colposuspension using sutures with laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence. DESIGN: Multicentre, prospective randomised trial. SETTING: Departments of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Goteborg, Boras County Hospital and Orebro University Hospital, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component were included, and were randomised to either open colposuspension (n= 120) or laparoscopic colposuspension (n= 120). METHODS: Women were randomised to open colposuspension with sutures or laparoscopic colposuspension with polypropylene mesh and staples. Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. MAIN OUTCOME MEASURES: Objective and subjective cure rates from 48-hour frequency-volume chart, a 48-hour pad test and a subjective assessment of the woman's incontinence and quality of life performed one year after surgery. RESULTS: Objective and subjective cure rates were higher after open compared with laparoscopic colposuspension (P < 0.001). Quality of life was improved following surgery in both groups (P < 0.0001) and the improvement was significantly greater in the open colposuspension group (P < 0.05) with regard to physical activity. Performing an open colposuspension was less time consuming (P < 0.0001), resulted in more blood loss (P < 0.0001), longer catheterisation time (P < 0.01), greater risk of urinary retention (P < 0.01) and a longer hospital stay (P < 0.0001) compared with performing a laparoscopic colposuspension. The rate of serious complications was low in both groups. CONCLUSION: Open colposuspension had a higher objective and subjective cure rate one year after surgery but with a greater blood loss, greater risk of urinary retention and a longer hospital stay than laparoscopic colposuspension.
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| 2. |
- Ankardal, Maud, 1957, et al.
(författare)
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A three-armed randomized trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using sutures and laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence
- 2005
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. - 0001-6349. ; 84:8, s. 773-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare open Burch colposuspension using sutures (OC) with laparoscopic colposuspension using sutures (LCS) and laparoscopic colposuspension using mesh and staples (LCM) in women with stress urinary incontinence. DESIGN: Prospective randomized trial. Setting: Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component attending the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Goteborg, Sweden. METHODS: The women were assessed objectively using a 48-h frequency-volume chart, a 48-h pad test and a standardized stress test. Subjectively, the women were assessed by a questionnaire including influence on quality of life. The women were randomized to OC using sutures (n = 79), LCS (n = 53) or LCM (n = 79). Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. Main outcome measures. Objective and subjective cure rate. RESULTS: Objective cure rates 1 year after surgery were significantly higher in the OC and LCS groups compared to the LCM group analyzed by a standardized stress test. Subjective findings were in concordance with the objective results. Performing an OC was less time consuming than performing a LCS and resulted in more blood loss compared to the two laparoscopic techniques. Patients in the LCM group had a shorter duration of catheter use and hospital stay. CONCLUSION: The use of sutures, irrespective of whether the surgical approach was laparoscopic or open surgery, was superior to the laparoscopic mesh and staple technique.
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| 3. |
- Ankardal, Maud, 1957, et al.
(författare)
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Comparison of health care costs for open burch colposuspension, laparoscopic colposuspension and tension-free vaginal tape in the treatment of female urinary incontinence
- 2007
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Ingår i: Neurourol Urodyn.
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To compare direct health care costs of treatment for stress urinary incontinence in Sweden with four different procedures: (i) open Burch colposuspension (OBC); (ii) laparoscopic colposuspension with sutures (LCS); (iii) laparoscopic colposuspension with mesh and staples (LCM), and (iv) Tension-free Vaginal Tape (TVT). MATERIAL AND METHODS: A model was constructed representing a hospital with standardized surgical equipment, staff and average unit costs in 2003 Euros. The time used for anesthesia and surgery was calculated. Clinical data was collected from three different sources, a multicenter, randomized, prospective study comparing OBC with LCM with 1 year follow-up, a three-armed, prospective study where women were randomized to either OBC, LCM, or LCS with 1 year follow-up and a descriptive study reporting results of TVT with 5 year follow-up. Data collected from the studies and hospital cost data were put into the model to create the different cost elements. RESULTS: The total cost per individual, showed a lower cost for TVT compared to the other alternatives. The direct costs for a TVT, euro1,366 were only 56% of the costs for an OBC, euro2,431 (P < 0.001) and 59% of the costs for a LCS, euro2,310 (P < 0.001). CONCLUSIONS: When using a model and comparing health care costs for surgical treatment of female stress urinary incontinence in Sweden, the TVT procedure generated a lower direct cost than both open and laparoscopic colposuspension. Neurourol. Urodynam. (c) 2007 Wiley-Liss, Inc.
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| 4. |
- Braekken, I H, et al.
(författare)
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Pelvic floor function is independently associated with pelvic organ prolapse.
- 2009
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:13, s. 1706-14
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.
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| 5. |
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| 6. |
- Ellström-Engh, Marie, et al.
(författare)
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Hysterectomy and incontinence: a study from the Swedish national register for gynecological surgery.
- 2006
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:5, s. 614-8
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Tidskriftsartikel (refereegranskat)abstract
- Hysterectomy is one factor that has been suggested to be a risk factor for developing stress incontinence. In Sweden, with a population of 8.86 million, a national register was set up in 1997 in order to have data for assessing the quality of gynecological surgery for benign disorders.
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| 7. |
- Hilde, Gunvor, et al.
(författare)
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Continence and pelvic floor status in nulliparous women at midterm pregnancy.
- 2012
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: A Cochrane review recommends antenatal pelvic floor muscle training (PFMT) in urinary incontinence (UI) prevention. The aim of the study was to investigate nulliparous pregnant women's knowledge about and practising of PFMT, their pelvic floor muscle (PFM) function, and ability to contract correctly. It was hypothesized that continent women had higher PFM strength and endurance than women with UI. METHODS: Three hundred nulliparous women at gestational week 18-22 were included in a cross-sectional study. Vaginal resting pressure, maximum voluntary contraction, and PFM endurance were measured by manometer. UI was assessed by International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). Comparisons of PFM function in continent women and women with UI were analyzed using independent-samples t test. Mean differences with 95% confidence interval (CI) are presented. RESULTS: Of 300 women, 89% had heard of PFMT at mid pregnancy, and 35% performed PFMT once or more a week. After thorough instruction 4% were unable to contract correctly. Thirty-five percent reported UI, of whom 48% performed PFMT once or more a week. Continent women had significantly higher PFM strength and endurance when compared with women having UI, with mean differences of 6.6 cmH(2)O (CI 2.3-10.8, p=0.003), and 41.5 cmH(2)Osec (CI 9.8-73.1, p=0.010), respectively. No difference was found for vaginal resting pressure (p=0.054). CONCLUSIONS: Most nulliparous pregnant women knew about PFMT. Thirty-five percent performed PFMT once or more a week. Incontinent nulliparous pregnant women had weaker PFM than their continent counterparts. More emphasis on information regarding PFM function and PFMT is warranted during pregnancy.
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| 8. |
- Jansson, Markus, 1982-
(författare)
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Pelvic Floor Dysfunction and Perineal and Vaginal Tears in Primiparous Women
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pelvic floor dysfunction (PFD), including urinary incontinence, faecal incontinence (FI), and pelvic organ prolapse, is highly prevalent among parous women. There is evidence that pregnancy, vaginal delivery, and obstetric perineal tears increase the risk of pelvic floor dysfunction, but many of the studies in this field are retrospective. The overall aim of this thesis was to prospectively examine risk factors for perineal and vaginal tears and postpartum PFD in primiparous women.Study I was a validation study of a protocol for documentation of perineal tears, including 187 primiparous women in 2015–2016. The coverage of documentation was higher in the protocol compared to the obstetric record system (ObstetriX). Incidence of second degree perineal tears was 26% according to the protocol and 11% according to ObstetriX.Studies II–IV utilized a cohort of initially nulliparous women (n=1049) prospectively included in early pregnancy in 2014–2017. Women completed questionnaires on PFD in early and late pregnancy and at 8 weeks and 1 year postpartum.Study II (n=644) showed that high foetal weight and vacuum extraction were risk factors for both second degree tears and OASI, suggesting that these tears should be viewed as a continuum rather than different entities. Risk factors for high vaginal tears were large foetal head circumference, vacuum extraction, and heredity of PFD/connective tissue deficiency. Study III (n=670) found that vaginal delivery increased the risk of stress urinary incontinence (SUI) but not urgency urinary incontinence (UUI) 1 year postpartum. No single characteristic of the vaginal delivery was associated with SUI. SUI during pregnancy increased the risk of SUI postpartum, and UUI during pregnancy increased the risk of UUI postpartum.Study IV (n=898) showed that FI increased by late pregnancy, and that this increase persisted 1 year postpartum. Obstructed defecation was associated with increased FI postpartum, suggesting that post-defecatory faecal loss may be an underlying mechanism of FI. Overall conclusion: The extent to which pregnancy, vaginal delivery, and their respective characteristics contributed to the development of PFD differed between the pelvic floor disorders studied. For SUI, both the pregnancy and the vaginal delivery increased the risk, whereas for FI it was the pregnancy itself rather than the vaginal delivery that was demonstrated to increase the risk.
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| 9. |
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| 10. |
- Lindemann, K, et al.
(författare)
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Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study.
- 2008
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Ingår i: British journal of cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 98:9, s. 1582-5
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Tidskriftsartikel (refereegranskat)abstract
- We examined the relationship of body mass index (BMI), diabetes and smoking to endometrial cancer risk in a cohort of 36 761 Norwegian women during 15.7 years of follow-up. In multivariable analyses of 222 incident cases of endometrial cancer, identified by linkage to the Norwegian Cancer Registry, there was a strong increase in risk with increasing BMI (P-trend <0.001). Compared to the reference (BMI 20-24 kg m(-2)), the adjusted relative risk (RR) was 0.53 (95% confidence interval (CI): 0.19-1.47) for BMI<20 kg m(-2), 4.28 (95% CI: 2.58-7.09) for BMI of 35-39 kg m(-2) and 6.36 (95% CI: 3.08-13.16) for BMI>or=40 kg m(-2). Women with known diabetes at baseline were at three-fold higher risk (RR 3.13, 95% CI: 1.92-5.11) than those without diabetes; women who reported current smoking at baseline were at reduced risk compared to never smokers (RR 0.55, 95% CI: 0.35-0.86). The strong linear positive association of BMI with endometrial cancer risk and a strongly increased risk among women with diabetes suggest that any increase in body mass in the female population will increase endometrial cancer incidence.
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| 11. |
- Lindemann, Kristina, et al.
(författare)
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Serum lipids and endometrial cancer risk: results from the HUNT-II study.
- 2009
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Ingår i: International journal of cancer. Journal international du cancer. - : Wiley. - 1097-0215. ; 124:12, s. 2938-41
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is a major risk factor for endometrial cancer. Still, the association of obesity-related metabolic factors, such as serum lipids and lipoprotein levels, is unclear. We prospectively examined the association of serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein (non-HDL), and HDL cholesterol with endometrial cancer risk among 31,473 women. During 9 years of follow-up, 100 cases of endometrial cancer were identified by linkage to the Cancer Registry of Norway. There was a positive association of serum triglyceride levels with endometrial cancer risk. Comparing the highest to the lowest quartile of triglycerides, the age-adjusted hazard ratio was 2.34 (95% CI: 1.04-5.28), and further adjustment for body mass index attenuated the association (hazard ratio 1.79, 95% CI: 0.79-4.05). For total serum cholesterol, low-density lipoprotein cholesterol and HDL cholesterol there were no associations with endometrial cancer risk, either without or after adjustment for body mass index. Serum triglyceride levels were positively associated with the risk of endometrial cancer, and some of the association seems to be attributable to obesity. Apart from higher estrogen levels produced in adipose tissue, mechanisms more specifically related to triglycerides may also be involved in endometrial cancer. Further prospective studies on this subject are needed to better understand the association of blood lipids with endometrial cancer risk.
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| 12. |
- Lindemann, K, et al.
(författare)
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The impact of BMI on subgroups of uterine cancer.
- 2009
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Ingår i: British journal of cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 101:3, s. 534-6
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Tidskriftsartikel (refereegranskat)abstract
- Obesity increases the risk of uterine cancer, but results by histological type have differed.
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| 13. |
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| 14. |
- Marcickiewicz, Janusz, et al.
(författare)
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Vaginal sacrospinous colpopexy and laparoscopic sacral colpopexy for vaginal vault prolapse
- 2007
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Ingår i: Acta Obstet Gynecol Scand. ; 86:6, s. 733-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Vaginal sacrospinous colpopexy (VSC) and laparoscopic sacral colpopexy (LSC) both correct vault prolapse. The present study compares the perioperative course and long-term results of VSC and LSC. METHODS: This retrospective study of post-hysterectomy vault prolapse involved 111 patients operated with either VSC (n=51) or LSC (n=60). The median time for the postoperative follow-up visit was 33.6 (range: 13-60) months for the LSC group and 38.4 (range: 7-108) months for the VSC group. Prolapse grade as well as the patient's satisfaction was recorded at the follow-up visit. RESULTS: Operation time was significantly shorter in the VSC group (median: 62 min) compared to the LSC group (median: 129 min). The rate of perioperative complications was low in both groups. There were 3 laparotomies in the LSC group, due to perioperative complications. The inpatients days were similar, with 3.7 days (1-18) and 4.0 days (2-21) in the VSC and the LSC group, respectively. Surgery for the recurrence of vault prolapse at any time before the follow-up visit did not occur in the VSC group, but occurred in 7 patients in the LSC group. At the follow-up visit, there was no recurrence of vault prolapse in either group. The subjective success rate was 82% in the VSC and 78% in the LSC group. CONCLUSIONS: This study indicates that VSC and LSC are two equally effective surgical procedures to correct vaginal vault prolapse, but the LSC technique requires a longer operating time.
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| 15. |
- Werner, H M J, et al.
(författare)
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A discordant histological risk classification in preoperative and operative biopsy in endometrial cancer is reflected in metastatic risk and prognosis.
- 2013
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 0959-8049. ; 49:3, s. 625-632
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: In endometrial cancer, tissue for histological evaluation is obtained preoperatively (endometrial biopsy) and operatively (hysterectomy specimen). We investigated if a discordant risk classification based on preoperative and operative biopsy is reflected in metastatic risk and prognosis. PATIENTS AND METHODS: One thousand three hundred and seventy-four patients were prospectively included in a multicentre setting (Molecular Markers for Treatment of Endometrial Cancer (MoMaTEC) study). Preoperative and operative specimens were classified as high risk if non-endometrioid histology or endometrioid grade 3; otherwise low risk. Disease specific survival differences were calculated by means of Kaplan-Meier and Cox proportional hazard models. RESULTS: Discordant risk was found in 207 (16%) cases. Lymph node metastases were detected in 7% and 23% of patients with concordant low and high risk respectively versus 14% and 20% in the discordant groups (p<0.001). Five-year disease specific survival in the discordant groups proved intermediate (75-80%) to concordant low (94%) or high (58%) risk. Both operative and preoperative biopsy high-risk results have independent prognostic impact on disease specific survival with adjusted hazard ratios of 2.4 (95% confidence interval (95% CI) 1.5-3.9) and 2.1 (95% CI 1.3-3.2) respectively by Cox analysis. CONCLUSIONS: Discordant risk in preoperative biopsy and hysterectomy identifies an intermediate group with respect to disease spread and prognosis. Preoperative biopsy results remain important also with the hysterectomy histology available.
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