| 1. |
- Andreasson, Anders, et al.
(författare)
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High revision rate following artificial urethral sphincter implantation.
- 2014
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Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 48:6, s. 544-548
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. In severe cases of stress urinary incontinence (SUI), with sphincter dysfunction, the artificial urinary sphincter AMS 800™ may be the last solution. The purpose of this study was to evaluate the outcome of surgical intervention for SUI with the AMS 800 in patients who were treated at Sahlgrenska University Hospital, Gothenburg. The primary aim of the study was to determine the complications related to the operation. Material and methods. A retrospective follow-up was done by reviewing medical records. The material comprised 97 men, who underwent their first AMS 800 implantation between May 1997 and June 2010 at Sahlgrenska University Hospital. Results. The revision rate was 28%, including an infection rate of 3% and an erosion rate of 7%. The mean follow-up for revised patients was 3 years. The median time until revision was 1 year. Seventy-five per cent of all patients were satisfied with the operation at 6 months' follow-up. Radical prostatectomy was the reason behind incontinence in 84% of patients in this series. Conclusion. The results clearly demonstrate a need for revision procedures in a considerable proportion of patients implanted with an AMS 800 device. Patient satisfaction was high, but although this operation has extremely low mortality it has its complications and the system will need to be replaced in time.
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| 2. |
- Bratt, Ola, et al.
(författare)
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The Study of Active Monitoring in Sweden (SAMS) : A randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer
- 2013
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 47:5, s. 347-355
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Forskningsöversikt (refereegranskat)abstract
- Objective. Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods. Material and methods. SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years. Results. Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres. Conclusions. It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.
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| 3. |
- Brehmer, Marianne, et al.
(författare)
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Three-dimensional computed tomography planning improves percutaneous stone surgery
- 2014
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Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 48:3, s. 316-323
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivePercutaneous nephrolithotripsy (PCNL) has become the gold standard for treatment of renal stones larger than 2 cm. To optimize the surgical procedure a method for meticulous preoperative three-dimensional computed tomography (3D-CT) planning was developed and analysed. The aim of this study was to evaluate how 3D-CT influenced the choice of access route and treatment outcome.Material and methodsPatients planned for PCNL were included in a prospective study. Decision algorithms were studied and recorded before and after 3D-CT planning in a total of 35 patients.ResultsThirty-one of the patients (88%) had a complex stone situation. The CT examinations resulted in change of access plan in 15 out of 28 patients, in addition to seven patients where access could not be planned without 3D-CT, totalling 22 out of 35 (63%). This resulted in 24 patients (69%) being stone free after a single PCNL session. Of these 24 patients, 22 (22/35 = 63%) were stone free with one dilated access track only. In 16 of the 24 patients (76%) who were stone free after one PCNL procedure, evaluation of the 3D-CT images had changed the initial preoperative planning (10 cases) or made planning possible (six cases). A few patients had thoracic complications but there were no cases with bleeding.ConclusionsPreoperative planning of complex stone situations with 3D-CT had a significant impact on operative procedure, resulting in a low number of access punctures.
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| 4. |
- Demirci, Umit, et al.
(författare)
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Urovaginal fistula formation after gynaecological and obstetric surgical procedures: Clinical experiences in a Scandinavian series.
- 2013
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Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 1651-2065 .- 2168-1805 .- 2168-1813. ; 47:2, s. 140-144
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. The aim of this retrospective study was to review what kinds of surgical procedures are most frequently complicated by urovaginal fistulae, to find out how they were diagnosed and managed, and to study the outcome after surgical reconstruction. Material and methods. Nineteen women who underwent fistula repair at Sahlgrenska University Hospital between 2003 and 2009 were retrospectively studied by reviewing the medical records. Results. For 17 of the 19 patients hysterectomy was the causative procedure. Fourteen patients developed vesicovaginal and five developed ureterovaginal fistula. Urethrocystoscopy was sufficient for the diagnosis in nearly 50% of the patients and when combined with methylene blue instillation 90% of all fistulae were found. Several patients sought medical advice due to vaginal leakage following gynaecological surgery without the doctor suspecting a fistula, and for these patients the diagnosis was delayed. Eighteen patients were operated on with an abdominal approach and one with a vaginal approach, in all cases a minimum of 3 months after primary surgery. The reconstruction technique included the interposition of vascularized tissue. None of the patients reported leakage or relapse at follow-up after fistula repair. Conclusions. Hysterectomy was the most common cause behind the formation of urovaginal fistulae. Misinterpretation of symptoms after gynaecological surgery was common even in cases where the symptoms were indicative of a urovaginal fistula. Delayed fistula repair after a minimum of 3 months, via the abdominal route and with the interposition of vascularized tissue, yielded an excellent final outcome.
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| 5. |
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| 6. |
- Elzanaty, Saad
(författare)
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Varicocele repair in non-obstructive azoospermic men: diagnostic value of testicular biopsy - A meta-analysis.
- 2014
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1813 .- 2168-1805. ; 48:6, s. 494-498
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Forskningsöversikt (refereegranskat)abstract
- Abstract Azoospermia is observed in 10-15% of infertile men and 60% of these cases are classified as having non-obstructive azoospermia (NOA). NOA results from testicular failure, and one of the causes of this is the presence of varicocele. Varicocele is found in 5-10% of men with NOA and its repair is associated with the appearance of spermatozoa in the ejaculate in 21-55% of cases. This review discusses the diagnostic value of testicular biopsy on the outcome of varicocele repair in terms of appearance of spermatozoa in the ejaculate in men with NOA and normal genetic testing. Ninety men met the inclusion criteria and were thus included in the review. The histopathological assessment of testicular biopsies revealed hypospermatogenesis in 30 out of 90 (33%), maturation arrest in 26 out of 90 (29%) and Sertoli cell only in 34 out of 90 (38%). Following varicocele repair, spermatozoa were detected in the ejaculate in 18 of 30 (60%) of men with hypospermatogenesis; 12 of 26 (46%) of those with maturation arrest; and one of 34 (3%) of those with Sertoli cell only. Regarding men with maturation arrest, varicocele repair was successful only in those men who were classified as having arrest at the spermatid stage. In conclusion, based on the best available evidence, diagnostic testicular biopsy seems to be of great value before varicocele repair in men with NOA and normal genetic testing. The best results of varicocele repair are observed in those men with hypospermatogenesis revealed by testicular biopsy or maturation arrest at the spermatid stage.
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| 8. |
- Jancke, Georg, et al.
(författare)
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Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer
- 2014
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Ingår i: SCANDINAVIAN JOURNAL OF UROLOGY. - : Informa Healthcare. - 2168-1805 .- 2168-1813. ; 48:3, s. 276-283
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To evaluate the impact of experience in transurethral resection of bladder tumor (TUR-BT) on recurrence and progression in primary Ta/T1 urinary bladder cancer.Methods: Clinical and pathological characteristics of patients with primary Ta/T1 urinary bladder cancer were recorded prospectively from 1992 to 2007 inclusive. Data on surgeons’ experience were categorized as follows: (a) experience by training status (residents or specialists); (b) number of TUR-BTs performed by each surgeon during the registration period, with cut-off levels at > 100, > 150, > 200, > median, and > third quartile of surgical volume; (c) lifetime high-volume surgeons (> 100 TUR-BTs). Hazard ratios (HRs) were estimated using Cox regression with 95% confidence intervals (CIs) in both univariate and multivariate analysis.Results: The analysis included 768 evaluable patients with a median follow-up of 60 months. Recurrence was observed in 478 patients (62%) and progression in 71 (9%). Surgery was performed by residents in 100 cases and specialists in 668, with recurrence in 75 (75%) and 403 (60%) patients, and progression in 9 (9%) and 62 (9%), respectively. Surgery performed by residents was statistically associated with recurrence (HR = 0.69, 95% CI = 0.54-0.89) but not progression (HR = 0.72, 95% CI = 0.35-1.48). Surgical volume (b and c) was not found to have a significant impact on recurrence or progression in any of the analyses at the chosen cut-offs.Conclusions: Surgical experience (specialist/resident) was a predictive factor for recurrence after TUR-BT for Ta/T1 bladder cancer. However, surgeon volume was not associated with recurrence at the chosen cut-off levels. Training programs, checklist
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| 9. |
- Jerlström, Tomas, 1969-, et al.
(författare)
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Urinary bladder cancer treated with radical cystectomy : Perioperative parameters and early complications prospectively registered in a national population-based database
- 2014
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Ingår i: Scandinavian journal of urology. - London : Informa Healthcare. - 2168-1805 .- 2168-1813. ; 48:4, s. 334-340
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.
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