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- Abd-el-Gawa, G, et al.
(author)
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Vitamin B12 and folate after 5-12 years of continent ileal urostomy (Kock reservoir) in children and adolescents.
- 2002
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In: European urology. - : Elsevier BV. - 0302-2838. ; 41:2, s. 199-205
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Journal article (peer-reviewed)abstract
- To assess B12 and folate deficiency after continent urinary diversion via a Kock continent urinary reservoir in children and adolescents.Ten boys and 10 girls (10.8-18 years old at surgery) were operated with a Kock reservoir and followed for 5-12 years (mean 8.5). The follow-up period was divided into early (3 months-5 years, EFU) and late (5-12 years, LFU) follow-up. Patients were investigated for haemoglobin, serum iron, total iron binding capacity (TIBC), serum Vitamin B12, serum and blood folate, methylmalonic acid (MMA), homocystine and glomerular filtration rate.Two patients developed subnormal B12 values (median 107.5 pmol/l), one at the EFU, and the other at LFW. The B12 value decreased during the LFU compared to the EFU in nine patients, but it was still within the normal range. Two patients with renal impairment had elevated MMA with normal B12 values. Five patients had high values of homocystine with folate deficiency and/or B12 deficiency and renal impairment. Plasma folate mean value was normal during the whole follow-up. Blood folate was below normal in five patients at the EFU. Two of these five patients, in addition to three patients, had low values at the LFU. Three of four patients with remaining short terminal ileum (20-45 cm) had normal B12 values at both the EFU & LFU and one had low values at the LFU. Six patients had subnormal GFR at the LFU.To a similar degree as in adults, Vitamin B12, folate and iron deficiency can occur in children and adolescents after continent urinary diversion using an ileal segment. Therefore, Vitamin B12 and folate should be monitored regularly in these patients. Serum MMA and homocystine may offer increased detection of Vitamin B12 deficiency, especially in the patients with normal renal function. Vitamin B12 deficiency is neither correlated with the time elapsed since surgery, nor with the ileum length. Patients are usually asymptomatic, so patients with true B12 deficiency should be identified and placed on life-long Vitamin B12 therapy. An adequate synthetic folic acid as supplements or fortified food is recommended for patients with folate deficiency.
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| 2. |
- Ahlberg, M., et al.
(author)
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Time without PSA recurrence after radical prostatectomy as a predictor of prostate cancer death
- 2022
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In: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 81:Suppl. 1, s. S286-S286
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Journal article (other academic/artistic)abstract
- Introduction & Objectives: Although surveillance after radical prostatectomy routinely includes repeated Prostate Specific Antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk for prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence 5 and 10 years after radical prostatectomy.Materials & Methods: Between 1989 and 1998, 14 urological centres in Scandinavia randomized patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial. Data was collected prospectively. All 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1 year from inclusion were eligible in our cohort. 4 patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6 weeks from surgery (n=3). We stratified by Gleason score (≤3+4=7 or ≥4+3=7), pathological tumour stage (pT2 or ≥pT3), and negative or positive surgical margins. We analysed the cumulative incidences and absolute differences in metastatic disease and prostate cancer death.Results: We analysed 302 patients with complete follow-up during a median of 18 years. Median preoperative PSA was 9.8 ng/ml and median age at inclusion was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score ≤3+4=7 and 57% among men with Gleason score ≥4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12% respectively. The long-term probabilities were higher for pT≥3 vs. pT2 and for positive vs. negative surgical margins.Conclusions: Following radical prostatectomy, patients with Gleason score ≤3+4=7 without biochemical recurrence 5 years after radical prostatectomy had low risk of metastases and prostate cancer death independent of pT-stage and surgical margins. The risk of clinical progression decreased drastically the first 3 years after radical prostatectomy and after 10 years without biochemical recurrence, no patient was diagnosed with metastases or died from prostate cancer. Our study indicates that men with favourable histopathology without biochemical recurrence 5 years after radical prostatectomy can stop follow-up earlier than 10 years after radical prostatectomy while men with adverse pathology should continue with at least 10 years follow-up
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| 3. |
- Aus, Gunnar, et al.
(author)
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Prognostic Factors and Survival in Node-Positive (N1) Prostate Cancer : A Prospective Study Based on Data from a Swedish Population-Based Cohort
- 2003
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In: European Urology. - 0302-2838 .- 1873-7560. ; 43:6, s. 627-631
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Journal article (peer-reviewed)abstract
- Objective: At presentation of prostate cancer, patients with proven lymph node metastasis (N1) are comparatively rare. It is difficult to give prognostic information based on the present literature. The aim of this study was to evaluate the impact of known risk factors in patients with pelvic node involvement and without distant metastasis. Methods: From the population-based, prospective prostate cancer tumour registry of the South–East Region in Sweden, we collected data on all 181 patients with N1, M0 prostate cancer diagnosed from January 1987 to October 2000 with a follow-up to December 2001. Mean follow-up was 62 months. Pre-operative risk factors as age, T-category, serum PSA, tumour grade and also primary treatment given was correlated to the outcome. Results: Median age at diagnosis was 65 years. Cancer-specific survival was highly variable with 5-year survival of 72%, a median of 8 years and the projected 13-year figure was 31%. T-category, age, PSA or treatment did not affect the outcome while poorly differentiated tumours had a tendency towards lower cancer-specific survival (p=0.0523) when compared to well and moderately differentiated tumours. Conclusions: This population-based cohort of prostate cancer patients with pelvic node involvement treated principally with non-curative intent had a median cancer-specific survival of 8 years. Preoperatively known risk factors seem to have but a modest impact on the prognosis for patients in this stage of the disease.
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| 4. |
- Glombik, D, 1988-, et al.
(author)
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Morbidity following lymphadenectomy for penile cancer in a Swedish national cohort
- 2022
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In: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 81:Suppl. 1, s. S1024-S1024
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Journal article (other academic/artistic)abstract
- Introduction & Objectives: To assess the rate of postoperative infectious and thromboembolic complications associated with inguinal (ILND) and pelvic (PLND) lymph node dissection in penile cancer and identify clinical and pathological predictors for the development of these complications.Materials & Methods: A total of 364 men subjected to ILND with or without PLND for squamous cell carcinoma of the penis between 2000 and 2012 were identified through the Swedish National Penile Cancer Register. Each patient was matched based on age and county of residence with 6 penile cancer-free men. The Swedish cancer and population registers were used to retrieve information about treatment and hospitalization for infections of the lower limbs, groins, genitalia, trunk and various septic conditions as well as thromboembolic events based on ICD-10 codes for each event. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazard models with multiple imputation to assess the effects of different variables. The net hazard rates of outcomes were estimated using a flexible parametric model.Results: The risk to suffer from infectious events remained increased up to 6 years postoperatively in penile cancer patients who underwent ILND in comparison to the matched controls. Palpable nodal disease was the only predictor of increased risk of infectious complications. The risk tends to increase with the cN stage, with a HR of 1.65 (95% CI 0.98-2.77) for cN1, 1.93 (95% CI 1.14-3.29) for cN2 and 2.62 (95% CI 1.41-4.88) for cN3 disease. Risks for the first, third and sixth postoperative year were assessed with HRs of 8.87 (95% CI 5.36-14.66), 4.20 (95% CI 2.77-6.35) and 1.83 (95% CI 0.96-3.46) respectively. The increased risk of thromboembolic events persisted up to 3 years postoperatively, HRs for the first and third postoperative year were 13.51 (95% CI 6.53-27.93) respectively 2.12 (95% CI 1.07-4.20). The results correspond well with the over-prescription of anticoagulants observed during this period. An association with bulky disease was observed, with a HR of 3.81 (95% CI 1.10-13.17) for cN3 stage. PLND did not add any excessive risks for either infectious or thromboembolic events.Conclusions: Based on data from nationwide registers of high quality and completeness, we could assess postoperative morbidity after lymphadenectomy for penile cancer with follow-up length ranging up to 12 years. Patients with palpable nodal disease are at increased risk of infectious complications up to 6 years postoperatively. The risk of thromboembolic complications was increased during first 3 postoperative years. Patients and care givers need to be aware of the increased risk of these complications and preventive measures should be considere
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| 7. |
- Henningsohn, L, et al.
(author)
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Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors
- 2003
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In: European Urology. - 0302-2838 .- 1873-7560. ; 43:6, s. 651-662
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Journal article (peer-reviewed)abstract
- Objective: The influence of specific symptoms on emotions and social activities in the individual patient vanes. Little is known about this variation in urinary bladder cancer survivors (in other words, about the relative importance of sources of symptom-induced distress). Methods: We attempted to enrol 404 surgical patients treated with cystectomy and a conduit or reservoir in four Swedish towns (Stockholm, Orebro, Jonkoping, Linkoping), 101 surgical patients treated with cystectomy and orthotopic neobladder at the Herlev Hospital in Copenhagen, Denmark, and 71 patients treated with radical radiotherapy for bladder cancer, as well as 581 men and women controls in Stockholm and Copenhagen. An anonymous postal questionnaire was used to collect the information. Results: A total of 503 out of 576 (87%) treated patients and 422 out of 581 (73%) controls participated but 59 patients were excluded. The primary source of self-assessed distress among cystectomised patients was compromised sexual function, reduced intercourse frequency caused great distress in 19% of the conduit patients, 20% of the reservoir patients and 19% of the bladder substitute patients. The primary source of self-assessed distress in patients treated with radical radiotherapy was symptoms from the bowel, 17% reported great distress due to diarrhoea, 16% due to abdominal pain, 14% due to defecation urgency and 14% due to faecal leakage. The highest proportion of subjects being distressed was 93% (substantial: 43%, moderate: 29% and little: 21%) for treated upper or lower urinary retention (indwelling catheter or nephrostomy). Conclusion: The distress caused by a specific symptom varies considerably and the prevalence of symptoms causing great distress differs between treatments in bladder cancer survivors. It is possible that patient care and clinical research can be made more effective by focusing on important sources of symptom-induced distress. (C) 2003 Elsevier Science B.V. All rights reserved.
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| 10. |
- Tiselius, H.-G., et al.
(author)
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Stone burden in an average Swedish population of stone formers requiring active stone removal : How can the stone size be estimated in the clinical routine?
- 2003
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In: European urology. - 0302-2838. ; 43:3, s. 275-281
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Conference paper (other academic/artistic)abstract
- Objective: To get information on the distribution of stone burdens in an average and representative group of Swedish stone forming patients requiring active removal of stones from the kidneys or ureters and to compare different methods for assessing the stone burden. Methods: A computerised device was used to measure the total stone surface area (Ameasured) of 599 stone situations in kidneys and ureters in a consecutive group of patients referred to active stone removal. These measurements were compared with the large and short transverse diameters of the greatest stone, the sum of the largest diameters of the stones, the arithmetically calculated surface area (Acalculated) as well as with the stone-types (A-F) previously described. Result: There were 483 stone situations with one and 116 with more than one stone. The stones were found in 407 men and 192 women. In 343 cases were the stones on the left side and in 256 on the right side. There were 34 staghorn stones. Of the examined stone situations 250 were in the kidney and 349 in the ureter. An Ameasured above 300 mm2 was recorded in 7% of all stone situations. The corresponding numbers for Ameasured above 200 mm2, 500 mm2 and 700 mm2 were 13%, 4% and 3%, respectively. When staghorn stones were excluded, good correlations were recorded for all variables but the best correlation was found between Ameasured and Acalculated. A revision of the previously published stone-type subgroups is suggested based on the following limits for the stone surface area: A = 30 mm2, B = 31-300 mm2, C = 301-700 mm2 and D > 700 mm2. Conclusion: The distribution of stone situtations with different stone burden in an average Swedish population is described. With the exception of staghorn stones and stones with extremely irregular form an acceptable estimate of the stone surface are can be arithmetically derived from the length and the width of the stone. © 2003 Elsevier Science B.V. All rights reserved.
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