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- Engström, Gabriella
(författare)
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Lower Urinary Tract Symptoms in Swedish Male Population : Prevalence, Distress and Quality of Life
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim the thesis was to investigate, the prevalence of Lower Urinary Tract Symptoms (LUTS). Moreover, we examine symptom severity and different levels of distress and describe how different symptoms from the lower urinary tract affect the self-assessed health, sadness, happiness and the quality of life in men. The studies are based on two data collections. In the first data collection, all men aged 40 – 80 years (n=2571) living in the Swedish community received a postal questionnaire. Twelve months later, 504 men who had earlier reported LUTS and 504 who had not reported symptoms were asked to complete the DAN-PSS and the SF-36 questionnaires. The overall prevalence of LUTS was 24%. Post-micturition dribbling (21%) was the most frequent symptom, and stress incontinence (2%) was the least frequent symptom. Urge incontinence, stress incontinence and “other” incontinence cause a high level of distress, even if the symptoms do not occur very often. Men experiencing mild, moderate or severe urge, stress or “other incontinence” had lower mean scores for all of the eight dimensions measured by the SF-36 than men without the same symptoms. Men experiencing a moderate/severe degree of weak stream or nocturia reported a poorer quality of life in all dimensions compared to men with a mild level of the same symptoms. The total burden of moderate/severe LUTS is related to self-assessed health, sadness and happiness. For each of the 12 specific LUTS, men with mild, moderate or severe symptoms had lower scores for self-assessed health and happiness, and higher scores for self-assessed sadness, than men without the same symptoms. In conclusions, one of every four men reports LUTS. Urinary incontinence causes high level of distress even to men who experience this symptom rarely. LUTS have a negative impact on quality of life, health, sadness and happiness.
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| 2. |
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| 3. |
- Fall, Magnus, 1941, et al.
(författare)
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Bladder pain syndrome/interstitial cystitis
- 2008
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Ingår i: Baranowski, Abrams, Fall. Urogenital pain in clinical practice. ; , s. 197-210
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
- Fall, Magnus, 1941, et al.
(författare)
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Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions?
- 2008
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838. ; 54:1, s. 65-75
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Context Opinions on how to best treat bladder pain/interstitial cystitis are ambiguous. Objective To review previous and recent literature on this subject to assess the current state of evidence. Evidence acquisition With important previous papers reviewed for the 2003 European Association of Urology guidelines as background, the PubMed database was searched and articles published in 2003–2007 were reviewed and relevant ones were selected for detailed study. Evidence synthesis A large number of studies describing a variety of quite dissimilar therapeutic principles were retrieved. The various methods and level of evidence are summarised in tables. Only pentosan polysulfate sodium (oral and intravesical), amitriptyline, hydroxyzine, cyclosporin A, intravesical dimethyl sulfoxide, transurethral resection of visible Hunner lesions, and major reconstructive surgery reached a high degree of recommendation. However, a number of pitfalls hamper evaluation of the available information; a crucial one is that our understanding of basic mechanisms causing bladder pain is fragmentary. So far, we are faced with a large variety of hypotheses although it is difficult to identify the most relevant ones. In this respect, we are not much helped by the recent literature because many studies have poor descriptions of patients or are of a pilot character, with no follow-up by larger trials. Controlled studies are rather scarce. On the other hand, some good-quality studies following up positive pilot trials end up with negative results. Conclusion Perhaps the most significant problem concerns inclusion and exclusion criteria in bladder pain syndrome/interstitial cystitis studies. At this stage, it is not too easy to communicate the wide available expert knowledge to the general audience. More sophisticated standards, capable of being generally used, have to come. Take Home Message Evaluation of the rich literature on bladder pain syndrome/interstitial cystitis is difficult. The most significant problem concerns inclusion and exclusion criteria. It is not easy to communicate available expert knowledge, and more sophisticated standards, capable of being generally used, must come.
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| 6. |
- Fall, Magnus, 1941, et al.
(författare)
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What is the value of cystoscopy with hydrodistension for interstitial cystitis?
- 2006
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Ingår i: Urology. - : Elsevier BV. - 0090-4295. ; 68:1
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Tidskriftsartikel (refereegranskat)abstract
- Drs. Fall and Peeker question the prudence of dispensing with traditional cystoscopy with hydrodistension and bladder biopsy findings as diagnostic criteria for IC. We note simply that the data do not support their use. Cystoscopic findings lack specificity and correlate poorly with symptoms.1 Our study was similar to others: patients who satisfied the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases (NIDDK) criteria were no different than those who did not satisfy the NIDDK criteria, other than more intense symptoms or smaller bladder capacities.1 and 2 In essence, patients with IC are diagnosed primarily by history, physical examination findings, and negative urinalysis and urine culture results, and the select use of other tests to exclude other conditions. We wish to be unambiguous: cystoscopy is indicated to exclude bladder cancer, and biopsy of any suspicious lesion is indicated. However, the message remains: cystoscopy with hydrodistension does a lousy job at ruling in or ruling out IC. Although Fall and Peeker have reported that mast cells are increased in IC and may be a potential diagnostic criterion, mast cells are more consistently increased in Hunner’s ulcers than elsewhere in IC bladders, and increased mast cell counts are not specific to IC. Mast cell counts or urine methylhistamine levels are similar between patients meeting and not meeting the NIDDK criteria.3 IC biopsy findings show significant changes, but, again, primarily from Hunner’s ulcers and not from nonulcerated areas of IC bladders.4 Patients with nonulcerative IC show mast cell counts no different than those of controls.5 Because Hunner’s ulcers are seen in less than 10% of cases, a criterion requiring elevated mast cell counts or biopsy changes to diagnose IC would falsely exclude more than 90% of patients from the diagnosis. The danger is not “that a variety of conditions are aggregated,” but rather, that by requiring patients to satisfy restrictive criteria (of questionable relevance), we simply fail to diagnose patients other than those with long-standing and severe manifestations of IC, the “quagmire” that exists currently.6 That trend has to change. Although the European working group in 2003 believed that cystoscopy with hydrodistension and bladder biopsy remain important, it is noteworthy that in the same year, separate international expert panels convened in Japan and Bethesda, Maryland could reach no consensus to support cystoscopic or biopsy criteria for diagnosis.7 IC generates controversy, and many urologists share the traditional views and continue to diagnose by cystoscopy, despite data that question cystoscopy as a diagnostic test for IC, and despite data that question subsetting patients with IC by the cystoscopic results.1, 2 and 8 In this respect, diagnostic cystoscopy with hydrodistension and bladder biopsy findings are outdated.
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| 7. |
- Fehrling, Marianne, et al.
(författare)
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Maximal functional electrical stimulation as a single treatment: is it cost-effective?
- 2007
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Ingår i: Scand J Urol Nephrol. - : Informa UK Limited. ; 41:2, s. 132-137
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The ideal electrical parameters for maximal functional electrical stimulation (MFES) in the treatment of an overactive bladder have not yet been well established. It has been speculated that unsatisfactory results may be due to a low stimulation intensity and that the number of sessions may also be an outcome-determining factor. Herein, we present the results obtained in a group of consecutively treated patients who were given 10 sessions of MFES at the highest tolerable amplitude. Material and methods. A total of 60 patients (29 females, 31 males) with an overactive bladder were treated. All subjects underwent a urodynamic assessment and completed a 48-h micturition chart prior to treatment, immediately after the last session and 3 months after termination of treatment. The patients were thoroughly informed that the result of the treatment depended on the amplitude that they could endure; there was a gradual increase in amplitude to the maximum level that did not cause painful discomfort. Results. Immediately after termination of the stimulation, almost half of the subjects reported an improvement in their condition. However, few subjects experienced sustained symptom amelioration 3 months post-stimulation. Decreases in micturition frequency and the number of leakage episodes were noted immediately after cessation of treatment but these decreases were no longer significant 3 months post-treatment. Conclusions. In this series, although MFES was effective in the short term, the long-term treatment outcome was unsatisfactory. A critical review suggests that outcome success is proportional to the patient's ability and willingness to accept quite a high stimulation intensity or, alternatively, follow-up home treatment. Hence, the implementation of strict primary as well as secondary selection criteria can hopefully identify patients most suitable for MFES. Another lesson to be learnt is that the identification of crucial prerequisites of successful treatment is mandatory before embarking on controlled studies.
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| 9. |
- 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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| 10. |
- 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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