| 1. |
- Dicuio, Mauro, et al.
(författare)
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30 minutes high energy transurethral microwave thermotherapy (30 minutes TUMT) for the treatment of chronic urinary retention in patients with ASA II-III-IV.
- 2010
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Ingår i: Archivio italiano di urologia, andrologia. - 1124-3562. ; 82:3, s. 149-154
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate if 30-Minutes-TUMT was useful and safe in the treatment of chronic urinary retention due to BOO in patients with ASA II-III-IV. MATERIAL AND METHODS: 19 patients with chronic urinary retention (mean age 73.5 years) were scheduled for TUMT treatment because of absolute or relative contraindications to surgery. According to ASA classification there were 8 patients ASA II, 9 ASA III and 2 ASA IV. Routinely parameters were studied before and after treatment. Pain and patient's discomfort before, during and after TUMT treatment were registered using the VAS score (visual analogue scale: 0 = no pain and 10 = maximal pain). Urgency, irritation, and "how they feel" were registered at 2 days, 1, 2 and 4 weeks after TUMT using VAS technique. RESULTS: Mean follow-up was 31,6 months (range 24-47), among the 9 responders patients (47.4%) who void normally without need of catheterisation, one patient died 12 months after the treatment for reasons not connected to the TUMT. Six patients (21.6%) failed the treatment and underwent TURP one or two years later (5 were ASA II and one ASA III). Among the 4 of 19 (21.0%) who had intermittent catheterisation after the treatment two died 1 and 2 years later, one has detrusor instability and one continued intermittent catheterisation. VAS during treatment was: 0 minute = 0.0; 5' = 3.1; 15' = 2.9; 25' = 2.8; 2 h after the treatment = 0.3. At 3 years follow up IPSS, QoL and Qmax were still acceptable. No major complication occurred. CONCLUSIONS: 47.4% of the patients responded positively to the new 30 minutes TUMT removing the urethral catheter, without needing surgical procedure avoiding the operation risk. 68.4% also improved their QoL. Local anaesthesia and oral/intravenous analgesia were sufficient during treatment. TUMT seems to have no anesthesiological risk. It is an option in patients with high risk of operation.
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| 2. |
- Dicuio, Mario, et al.
(författare)
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30-MINUTES-TUMT. Use of the visual analogue scale to investigate patients' pain perception, different cocktail options and tolerability during 30 minutes' treatment.
- 2004
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Ingår i: Urol Int. - : S. Karger AG. ; 73:2, s. 130-136
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Primary objective: to investigate if 30-MINUTES-TUMT can be performed under topical anesthesia and analgesics. Secondary objectives: to evaluate retrospectively analgesics and to study parameters connected with pain. Materials and Methods: Eighty-nine patients underwent TUMT. Patients were divided into four groups with different medications. Paracetamol and tolterodin-L-tartrate were administered in all groups. The first group was also given hydromorphone hydrochloride and atropine sulphate, the second group dextropropoxyphene, the third group morphine and diclofenac, and the fourth group morphine and dextropropoxyphene. Pain during TUMT was registered using the VAS scale. Results: Pain during TUMT was (VAS in mm), respectively, total-first-second-third-fourth group: at 5 min -30, 31, 12, 28, 35; at 15 min -30, 23, 16, 25, 34; at 25 min -30, 28, 18, 25, 35. All patients accepted the treatment. No significant difference between the different drug schedules was noticed. Conclusions: It is possible to treat patients with 30-MINUTES-TUMT with local anesthesia and analgesics. The pain can be accepted by all patients.
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| 3. |
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| 4. |
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| 5. |
- Hammarsten, J, et al.
(författare)
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HYPOADIPONECTINEMI – A RISK FACTOR FOR BENIGN PROSTATIC HYPERPLASIA
- 2009
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Ingår i: International Congress on Prediabetes and the Metabolic Syndrome.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- HYPOADIPONECTINEMI – A RISK FACTOR FOR BENIGN PROSTATIC HYPERPLASIA Authors: J Hammarsten1, C J Behre2, J-E Damber3, T Knutson3, R Peeker3, D Mellström 4 (1)Skaraborg Hospital, Department of Urology, Skövde, Sweden, (2) Sahlgrenska University Hospital, Institute of Internal Medicine, Göteborg, Sweden, (3) Sahlgrenska University Hospital, Department of Urology, Göteborg, Sweden, (3) Sahlgrenska University Hospital, Center for bone research at the Sahlgrenska Academy, Department of Internal Medicine, Göteborg, Sweden Hypoadiponectinemi has recently been shown to be related to the metabolic syndrome. Our group has over the last 15 years suggested that benign prostatic hyperplasia (BPH) is a component of the metabolic syndrome. In our reports we have found that 19 out of 21 conditions that are associated to the metabolic syndrome also were risk factors for BPH. The aim of the present study was to investigate the correlation between serum adiponectin levels and BPH. Given the strong correlation between BPH and the metabolic syndrome, it could be hypothesized that there is a statistical significant inverse correlation between the prostate gland volume and the circulating adiponectin levels. Material and methods: One thousand representative men, aged 72 – 76 years, living in Göteborg, Sweden involved in the Mr Os study were recruited. The Mr Os study is an international study of male osteoporosis. In 184 men, a subgroup of the total population, the prostate gland volume was determined. Serum adiponectin was determined using human adiponectin ELISA kit. Results: Men, previously diagnosed with prostate cancer or having had a prostate operation, were excluded after which 157 men remained. The mean prostate gland volume was 46 ml (13 – 139 ml). The mean adiponectin level was 11.2+5.7µg/mL(SD). Using univariate analysis, adiponectin correlated inversely with the prostate gland volume (R=-158, P=0.0481). Using multivariate analysis, adjusting for insulin, glucose and trunk fat mass, adiponectin did not come out statistically significantly. In the total material, adiponectin correlated inversely with insulin (R=-0.340, P<0.0001), glucose (R=-0.186, P<0.0001), BMI (R=-0.271, P<0.0001, trunk fat mass (R=-0.315, P<0.0001) and lean body mass (R=-0.185, P<0.0001). Conclusion: Our data show for the first time that hypoadiponectinemi is a risk factor for BPH. This is in conjunction with our suggestion that BPH is a component of the metabolic syndrome. Our data also confirm that hypoadiponectinemi is related to the metabolic syndrome.
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| 6. |
- Hammarsten, J, et al.
(författare)
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Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia.
- 2009
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Ingår i: Prostate cancer and prostatic diseases. - : Springer Science and Business Media LLC. - 1476-5608 .- 1365-7852. ; 12:2, s. 160-5
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Tidskriftsartikel (refereegranskat)abstract
- The aetiology of benign prostatic hyperplasia (BPH) remains unclear. The objective of the present study was to test the insulin, oestradiol and metabolic syndrome hypotheses as promoters of BPH. The design was a risk factor analysis of BPH in which the total prostate gland volume was related to endocrine and anthropometric factors. The participants studied were 184 representative men, aged 72-76 years, residing in Göteborg, Sweden. Using a multivariate analysis, BPH as measured by the total prostate gland volume correlated statistically significantly with fasting serum insulin (beta=0.200, P=0.028), free oestradiol (beta=0.233, P=0.008) and lean body mass (beta=0.257, P=0.034). Insulin and free oestradiol appear to be independent risk factors for BPH, confirming both the insulin and the oestradiol hypotheses. Our findings also seem to confirm the metabolic syndrome hypothesis. The metabolic syndrome and its major endocrine aberration, hyperinsulinaemia, are possible primary events in BPH.
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| 7. |
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| 8. |
- Knutson, Tomas, et al.
(författare)
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Intraurethral prostate injections with mepivacaine epinephrine: effects on patient comfort, treatment time and energy consumption during high-energy transurethral microwave thermotherapy.
- 2009
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 1651-2065 .- 0036-5599. ; 43:4, s. 300-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the effects of intraprostatic mepivacaine epinephrine injections administered by the Schelin catheter during high-energy transurethral microwave thermotherapy (TUMT) using the CoreTherm Prostalund Feedback Treatment (PLFT) system. MATERIAL AND METHODS: The study included 85 men with lower urinary tract symptoms due to benign prostatic enlargement. One group had intraprostatic injections with mepivacaine epinephrine by the new Schelin catheter, while patients in the other group were treated without intraprostatic injections. All men were treated by TUMT using the PLFT system. Before treatment, transrectal ultrasound (TRUS) volume was measured. During the procedure, treatment time, energy consumption, cell-kill parameter and maximal prostate temperature were recorded. Patients who needed perioperative intravenous analgesics and the rate of perioperative and postoperative complications were registered. RESULTS: The patients who had intraprostatic and periprostatic injections with mepivacaine epinephrine had shorter effective treatment time and reduced energy consumption. There was also a difference between the two groups in that 70% of patients without intraprostatic injections and only 11% of injected patients needed intravenous analgesics. No differences were found in TRUS volume, estimated cell-kill, maximal prostate temperature or complication rates. CONCLUSIONS: Intraprostatic injections with mepivacaine epinephrine distributed by the Schelin catheter reduce the number of patients needing intravenous analgesics during PLFT, as well as the treatment time and energy consumption during treatment. Besides improved patient comfort, intraprostatic and periprostatic injections condense the treatment time without side-effects, making PLFT less cumbersome for most patients.
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| 9. |
- Knutson, Tomas
(författare)
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On investigations of patients with lower urinary tract symptoms due to suspected bladder outlet obstruction
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lower urinary tract symptoms (LUTS) are caused by a variety of different diseases, including cancer in the urinary tract, overactive bladder (OB) and bladder outlet obstruction (BOO). In order to find the most plausible cause of the patientís LUTS, a number of different investigations have been developed. The standard investigations recommended by the WHO for a patient with LUTS include routine lab. tests like s-PSA, urinary sticks and urine culture, symptom score, a voiding diary, digital rectal examination, transrectal ultrasound, office uroflowmetry and measurement of residual urine. However, BOO can only be accurately diagnosed by the urodynamic assessment of pressure and flow studies (pQS). OB is revealed by cystometry.The first aim of the present study was to determine if home uroflowmetry can give more information than ìtraditionalî office uroflowmetry, and whether home uroflowmetry can reflect the results of pQS. BOO commonly coexists with OB in patients with LUTS. The second aim was to describe and quantify this phenomenon by a standardised investigation including cystometry and pQS and to elucidate differences between patients with ìpureî BOO and patients with BOO combined with OB.The natural history of BOO due to BPE is poorly understood. The aim of the third study was to investigate a group of patients who themselves preferred WW and to follow the development of symptoms and the frequency of failure and complications during four years.pQS has been proposed as a useful instrument for selection of graded treatment of BOO. We have also used pQS for selected treatment in three arms: TURP, TUMT and WW, and then studied the results after 1 year. In this study, the patients were treated as minimally invasively as possible.In the fifth study, we have used biodegradable PGA stents to judge the risk of post-TURP incontinence in patients with a combination of BOO and OB. With home uroflowmetry, it is possible in 50% of cases to reveal if the patient has a minor or severe BOO. pQS seems useful for selection to different treatments according to their BOO. The prevalence of OB increases with increasing BOO, suggesting that BOO can be a cause of OB. We observed that the failure rate in WW increased with increasing obstruction, but the complication rate of WW was minor.BOO combined with OB is present in 45% of the patients. In 30% of the patients there is a risk of post-TURP urgency incontinence. A PGA-stent seems very useful to judge the risk of post-TURP incontinence in patients with a combination of BOO and severe OB. None of the patients who remained continent during the stent period became incontinent after TURP
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| 10. |
- Stranne, Johan, 1970, et al.
(författare)
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One-third of the Swedish male population over 50 years of age suffers from lower urinary tract symptoms.
- 2009
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 43:3, s. 199-205
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the prevalence of and restrictions in various parts of daily life due to lower urinary tract symptoms (LUTS) in an unselected Swedish male population. MATERIAL AND METHODS: A random selection of 3345 men throughout Sweden, aged between 41 and 80, was contacted by telephone and evaluated according to International Prostate Symptom Score (IPSS). The responders were then sent two different questionnaires based on degree of LUTS, IPSS <8 or >7. RESULTS: 2106 men (66%) answered the questionnaire. Of these, 33.4% had an IPSS > 7 and the IPSS increased with age. Of the men with IPSS >7 only 41% had consulted health services for their symptoms and 23% had received treatment. Thirty-seven per cent claimed that their problems had a great negative effect on their quality of life and 77% that they had affected their relationship with their spouse negatively to a great extent. Forty per cent did not consult health services despite their symptoms. In men with an IPSS <8 as many as 33% believed that LUTS would limit them in at least some part of their daily life. CONCLUSIONS: LUTS is a common condition among Swedish men with a severe impact on quality of life and everyday life. Despite readily available medical assistance, two out of five men with LUTS still do not try to obtain a remedy. The data presented here identify a need for improved education regarding LUTS, to increase awareness of the condition and the treatment options that are available.
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| 11. |
- Vandenput, Liesbeth, 1974, et al.
(författare)
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Serum levels of specific glucuronidated androgen metabolites predict BMD and prostate volume in elderly men.
- 2007
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Ingår i: J Bone Miner Res. - : Wiley. ; 22:2, s. 220-227
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Tidskriftsartikel (refereegranskat)abstract
- Androgens are important regulators of bone and prostate health in elderly men. The role of serum levels of glucuronidated androgen metabolites as predictors of BMD and prostate volume in men is unclear. We show that specific glucuronidated androgen metabolites predict BMD and prostate volume in elderly men. Introduction: Androgens are important regulators of bone and prostate health in elderly men. Local synthesis and degradation of androgens are likely to be important parameters of biological action of androgens in androgen-responsive tissues. The aim of this study was to determine the role of serum levels of glucuronidated androgen metabolites as predictors of BMD and prostate volume in elderly men. Materials and Methods: A subsample of the population-based Swedish part of the MrOS study (n = 631, average age = 75.9 years) was investigated. Bone parameters were measured using DXA. Serum levels of total testosterone (T) and dihydrotestosterone (DHT) were measured by gas chromatography/mass spectroscopy (GC-MS); androstane-3α,17β-diol-3glucuronide (3G) and androstane-3α,17β-diol-17glucuronide (17G) were measured by liquid chromatography/mass spectroscopy. Prostate volume (n = 159) was measured by transrectal ultrasound. Results: The general pattern is that two of the glucuronidated androgen metabolites, namely 17G and 3G, are stronger positive predictors of BMD than the bioactive androgens (T and DHT). In addition, 17G is a clear positive predictor of prostate volume, explaining 4.5% of the variance in prostate volume, whereas the bioactive androgens do not display any association with prostate volume. Conclusions: Serum levels of specific glucuronidated androgen metabolites predict BMD and prostate volume in elderly men. Future studies should determine if the glucuronidated androgen metabolites also reflect other biological correlates of androgenic activity, including prostate cancer, and if low levels might be a marker of general androgen deficiency in men.
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| 12. |
- Vesely, Stepan, et al.
(författare)
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Transurethral microwave thermotherapy: clinical results after 11 years of use.
- 2005
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Ingår i: J Endourol. ; 19:6, s. 730-733
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the durability of the effect of transurethral microwave thermotherapy (TUMT) for lower urinary-tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO). Patients and Methods: A total of 841 patients with LUTS received TUMT using the Prostatron device at Sahlgrenska University Hospital, Sweden. Two treatment programs were used: low-energy Program 2.0 and high-energy Program 3.5. A questionnaire, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, and questions about general health status, was sent to all the patients. The mean followup after TUMT was 8.8 years for Program 2.0 and 2.5 years for Program 3.5. Results: At the end of follow-up, 67% of the patients treated with Program 2.0 were satisfied with the TUMT. During the follow-up period, 37% of patients experienced worsened symptoms, 18% various complications (e.g., hematuria), and 25% transient urinary-tract infection, and 16% went into retention. Secondary treatment (repeat TUMT, transurethral resection, medical therapy) was needed in 32% of patients. The mean IPSS was 13.5, and QoL score decreased to 2.1. With Program 3.5, 82% of the patients were satisfied, with another 17% having increased symptoms, 17% various complication, 25% urinary tract infection, and 26% retention. Only 7% of patients needed secondary treatment. The IPSS and QoL score went down to 11.4 and 1.6, respectively. Conclusion: These long-term data show that TUMT produces durable improvement and, with its safety and low retreatment rate, presents an attractive alternative for patients with LUTS suggestive of BOO.
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| 13. |
- Vesely, Stepan, et al.
(författare)
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Transurethral microwave thermotherapy of the prostate - Evaluation with MRI and analysis of parameters relevant to outcome.
- 2008
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 42:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To evaluate morphological changes in the hyperplastic prostate tissue following transurethral microwave thermotherapy and to investigate the dependence of the treatment outcome on structural and physiological features of the prostate. Material and methods. In this prospective study, 13 patients with chronic urinary retention due to benign prostatic hyperplasia (BPH) underwent Coretherm (ProstaLund, Lund, Sweden) microwave thermotherapy. Prior to the treatment and 1 week and 6 months after, the patients were examined with MRI using morphologic, contrast medium-enhanced perfusion and diffusion-weighted imaging. Such advanced MRI techniques permit an assessment of parameters that have a hypothetical influence on microwave thermotherapy (e.g. prostate blood perfusion, water content and prostate microstructure). Results. Morphologic and perfusion MRI showed a clear prostatic tissue defect in all 13 patients after 1 week and in all 12 patients at 6 months' follow-up. The mean size of the defect was 22.5 cm3 (27%) (range 3.7-47.3 cm3) and 4.1 cm3 (1.1-10.1 cm3) at 1 week and 6 months, respectively. The cell kill volume was estimated to be 20.5±7.4 cm3 and correlated significantly with the size assessed by MRI at 1 week (r=0.8; p=0.002) and 6 months (r=0.69; p=0.05). At 6 months, the mean decrease in prostate volume was 20.1 cm3 (p<0.0001). The microstructure of the prostate expressed as the apparent diffusion coefficient was shown to have a strong influence on the treatment process. All patients (n=12) were catheter-free at 6 months. Another patient experienced persistent obstruction and underwent transurethral resection of the prostate. Conclusions. Coretherm microwave treatment leads to significant intraprostatic necrosis, which is detectable with MRI even 6 months after the treatment. Diffusion-weighted MRI is capable of identifying structural features of the prostate that can predict the length of treatment and the amount of energy needed.
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| 14. |
- Vesely, Stepan, et al.
(författare)
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TURP and low-energy TUMT treatment in men with LUTS suggestive of bladder outlet obstruction selected by means of pressure-flow studies: 8-year follow-up.
- 2006
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Ingår i: Neurourol Urodyn. - : Wiley. ; 25:7, s. 770-775
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Tidskriftsartikel (refereegranskat)abstract
- Aims To evaluate the long-term outcome of transurethral resection of the prostate (TURP) and transurethral microwave thermotherapy (TUMT) in men with symptomatic benign prostatic hyperplasia (BPH), when allocation to the treatment-group was based on urodynamic diagnosis of bladder outlet obstruction (BOO). Methods A total of 231 elderly men with symptomatic BPH were treated either by TURP or by low-energy TUMT. A pressure-flow study was performed to detect the obstruction and to help in the selection of the two treatments. The patients were examined at baseline then checked again after 2 and 8 years. Results At 2 years of follow-up there was a significant improvement for both IPSS and QoL (P < 0.0001) in both groups of treatment. This was accompanied by a significant improvement (P < 0.0001) in the maximum flow rate from 10.0 (5.8) to 16.4 (7.6) in the TURP group and from 12.1 (5.2) to 14.9 (5.7) in the TUMT group. These findings persisted at 8 years, they were, however, more pronounced after TURP. The overall retreatment rate reached a value of 11% in the TURP group and 27% in the TUMT group, respectively. At the follow-up, 95% of the patients who underwent TURP and 70% of the patients treated by TUMT claimed to be satisfied with that choice. Conclusions With durable symptomatic improvement and lowest retreatment rate, TURP still presents a standard treatment option for patients with severe BOO. Low-energy TUMT has sufficiently relieved patients' symptoms and can be offered to less obstructed patients as an alternative. Neurourol. Urodynam. 25:770-775, 2006. © 2006 Wiley-Liss, Inc.
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