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- Ivarsson, Lina Birgitta, et al.
(author)
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Treatment of Urethral Pain Syndrome (UPS) in Sweden
- 2019
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:11
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Journal article (peer-reviewed)abstract
- BACKGROUND: Urethral Pain Syndrome (UPS) in women is a recurrent urethral pain without any proven infection or other obvious pathology. There are few studies on UPS, and evidence-based treatment is lacking. The primary aim was to study what treatments are used, and to compare the treatment tradition of UPS in Sweden in 2018, with what was used in 2006.METHODS: A questionnaire on the treatment of women with UPS was sent to all public gynecology, urology, gynecologic oncology and venereology clinics, and one public general practice in each county in Sweden in 2018. Private practice clinics in gynecology responded to the survey in 2017. Comparisons were made with the same survey sent to gynecology and urology clinics in 2006.FINDINGS: Of 137 invited clinics in 2018, 99 (72.3%) responded to the survey. Seventy-seven (77.8%) of them saw women with UPS and 79.2% (61/77) of these clinics treated the patients using 19 different treatment methods. Local corticosteroids and local estrogens were the methods most used. Treatments were similar in gynecology and urology clinics in 2006 and 2018, although strong corticosteroids had increased in use in the treatment regimens of 2018. More than half of the clinics used antibiotics.INTERPRETATION: Since there is no evidence-based treatment of UPS, a wide spectrum of treatments is used, and different specialties use different treatment strategies. Despite the lack of proven infection, a large number of clinics also treated the syndrome with antibiotics. There is thus a need for well-designed randomized controlled clinical trials to find evidence-based treatments of UPS.
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| 2. |
- Lindström, B. E., et al.
(author)
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Urethral instillations of clobetasol propionate and lidocaine : a promising treatment of urethral pain syndrome
- 2016
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In: Clinical and Experimental Obstetrics & Gynecology. - : I. R. O. G. Canada, Inc.. - 0390-6663. ; 43:6, s. 803-807
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Journal article (peer-reviewed)abstract
- Purpose: To evaluate topical treatment with clobetasol propionate and lidocaine in women with urethral pain syndrome (UPS) in a retrospective pilot study.Materials and Methods: Urethral instillations of two ml clobetasol propionate cream and two ml lidocaine gel in 30 Caucasian women age 15-74 years with UPS between 1999 and 2006 were evaluated retrospectively. Instillations were given approximately once a week until the patient improved. Between one and 15 (median three) instillations were given. In substudy I a review was undertaken of the medical records to register the treatment effect at the end of the treatment (the last instillation) and any relapses six months thereafter. Substudy II was a follow-up at least five years after last instillation based on medical records and a written questionnaire.Results: Substudy I (n=30): By the end of the treatment 18 women had no symptoms and 12 were improved. Five patients had relapsed within six months. Substudy II (n=28): Twenty-eight women responded to the questionnaire. Four women remained with no symptoms, 18 remained improved, and six had the same symptoms as before treatment. Twenty women thought the treatment was very effective, five rather effective, and three women reported poor effect. Twenty-six women would ask for retreatment if a relapse occurred, two patients would not. No side effects, except transient pain, were reported.Conclusions: This retrospective study and long-term follow-up suggests that urethral instillation of clobetasol propionate and lidocaine is effective in treating women with UPS. Randomized control studies are warranted.
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| 4. |
- Hermansson, Ruth S., et al.
(author)
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HPV prevalence and HPV-related dysplasia in elderly women
- 2018
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In: PLOS ONE. - San Francisco, USA : Public Library of Science. - 1932-6203. ; 13:1
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Journal article (peer-reviewed)abstract
- INTRODUCTION: In Sweden, where screening ends at the age of 60, about 30% of the cervical cancer cases occur in women older than 60. The aim of the present study was to investigate the prevalence of HPV and cervical dysplasia in women of 60 years and above.PATIENTS AND METHODS: From September 2013 until June 2015, 1051 women aged 60-89 years (mean 68 years) were sampled for an HPV test when attending an outpatient gynecology clinic. Women with positive results had a second HPV test and liquid based cytology (LBC), after 3.5 months on average. Those with a positive second HPV test were examined by colposcopy, and biopsy and a sample for LBC was obtained.RESULTS: The prevalence of HPV was 4.1%, (95%CI 3.0-5.5, n = 43) at the first test, and at the second test 2.6% remained positive (95%CI 1.7-3.8, n = 27). The majority of women positive in both HPV tests, had dysplasia in histology, 81.5% (22/27) (4 CIN 2-0.4%, 18 CIN 1-1.7%). HPV-related dysplasia was found in 2.1%, (95%CI 1.3-3.2, n = 22) of the 1051 women. Four of the 22 women with positive HPV tests also had abnormal cytology, one ASCUS and three CIN 1. No cancer or glandular dysplasia was detected.CONCLUSION: A significant proportion of elderly women were found to have a persistent cervical HPV infection. Among them there was a high prevalence of CIN diagnosed by histology. The HPV test showed high sensitivity and specificity in detecting CIN in elderly women, while cytology showed extremely low sensitivity.
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| 5. |
- Lindström, Annika K., 1953-, et al.
(author)
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Cervical dysplasia in elderly women performing repeated self-sampling for HPV testing
- 2018
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:12
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Journal article (peer-reviewed)abstract
- BACKGROUND: About 30% of the cervical cancer cases in Sweden occur in women older than 60. The primary aim was to evaluate the acceptability of repeated self-sampling at home for HPV-testing in elderly women. The prevalence of HPV and HPV related dysplasia as well as the sensitivity of cytology was evaluated.METHODS: Repeated self-sampling at home for HPV testing was offered 375 women in each of the four age groups 60, 65, 70 and 75 years. Women with two consecutive positive HPV tests were examined with sampling for histology and cytology.FINDINGS: A self-sample was provided by 59.5% (893/1500) of the invited women. The overall prevalence of HPV was 4.4% (95% CI 3.2-6.0, n = 39) in the first test, and 2.5% were persistent positive in the second test (95% C 1.6-3.8, n = 22) collected on average 5.5 months later. Dysplasia, was found in 1.8% (16/893) (95% CI 1.1-3.0) and CIN 2+ in 1.0% (9/893) (95%CI 0.5-2.0) of the women. Of the 16 women with dysplasia in histology, 13 (81.2%) had a normal cytology.INTERPRETATION: Repeated self-sampling at home combined with HPV testing was well accepted among elderly women. A high prevalence of CIN was diagnosed by histology. Cytology showed extremely low sensitivity and should not be recommended for this age group.
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| 8. |
- Lindström, Annika K., 1953-, et al.
(author)
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Screening history of elderly women diagnosed with cervical cancer
- 2018
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In: International Journal of Gynecology & Obstetrics. - : Wiley-Blackwell Publishing Inc.. - 0020-7292 .- 1879-3479. ; 143:S3, s. 927-927
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Journal article (peer-reviewed)abstract
- Objectives: Cervical cancer in elderly women is often discovered at advanced stages and the prognosis is poor. In Sweden, where the screening program ends at the age of 60 in most counties, approximately 30% of the women diagnosed with cervical cancer are older than 60. The aim of this study was to investigate the cytological screening history in women diagnosed with cervical cancer at the age of 61 years and older.Method: This is a retrospective study including women from the counties of Örebro, Dalarna, and Gävleborg, (Sweden,) diagnosed with cervical cancer at the age of 61 years and older between 2001 and 2016. Screening history was obtained from 1967.Results: Out of the 223 women, 142 (63.7%) had participated in the screening program at least once and 95 (42.6%) had participated in the screening five times or more. Of the 142 women with at least one screening sample, 76 (53.5%) had a benign screening history. Of all women 76 (34.1%) had benign screening history, 66 (29.6%) had had dysplasia and 19 (8.5%) high-grade dysplasia. It was more common with a benign screening history among women diagnosed with adenocarcinomas compared to squamous cell carcinomas (p=0.002).Conclusions: In elderly women diagnosed with cervical cancer, more than one third had not participated in the screening program, nearly one third had a benign screening history and one-third of the women had dysplasia in their screening history. Continuing screening past the age of 60 can decrease the incidence of cervical cancer.
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